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"See one, Do one, Teach one"
You must read the
satire on the "Glorious Tradition" of the description of medical
education as "See one, Do one, Teach one" in the October 1 2012 issueof the "Daily MedicalExaminer" where a doctor K.R. Thuxston. III, MD writes an essay about
the topic, presumably "tongue in cheek" but then who knows. This concept of a medical student or intern
learning a procedure but in reality
actually learning it upon a patient and often the patient unaware of the
learning going on was a practice considered acceptable back in the old days of
medical professional paternalism. Ah!
But then came the last generation of medical practice and education with an
ethical switch from medical professional paternalism to patient autonomy. "See one and Do one" has become a
"no-no" ..well, at least not on a living patient or at least not to
"do one" with minimal, if any, supervision unless it is only drawing
blood from a vein. Simulators are all
the rage now in medical education.
Simulators characterized by "standardized patient" (actors
playing patients) are used for honing up
on interview techniques and general physical examination techniques but
particularly female breast and genital exam of both genders. For surgical practice, the simulators can be
divided into organic, a very old technique in education in which animals and fresh
human cadavers are utilized and inorganic, the current and future educational
tools which comprise virtual reality simulators and synthetic bench
models and who knows what other "gadgets" in the future. These tools bearing major medical educational
investment are said to be of significant educational value but there are still
studies going on regarding the validity of that conclusion. For example even the use of standardized
patients to instill the skill for students to later convey satisfactory
"end-of-life" communication to real patients is still under
investigation (JAMA. 2013;310(21):2257-2258}.
On the other hand, what is wrong with "See one, Do
one..."? Shouldn't patients take an
altruistic view of donating their living body to medical education? And as Dr. Thuxston concluded " Post-op, patients should look
down at the ragged, poorly sutured scar on their abdomen and forget about the
fact that they can’t wear a swimsuit at the beach anymore. Instead, they
should beam with pride, because the misshapen scar will remind them that their
body was once used to teach a budding doctor how to operate." And you, how about you? A bit of altruism? ..Maurice.
Graphic: Ancient Greek Medicine. Wikipedia via Google Images