This is like telling someone "we need to figure out how to use technology to prevent people from spending years of rote memorization before they can speak <X_foreign_language>!"
Edit:
Also, this is what happens in practice anyway! Doctors don't remember a lot and constantly have to look things up ( as is understandable and expected ). You must be a master of the "grammar of medicine" though. Otherwise you won't be able to construct well formed sentences... aka medical thoughts.
You need some memorization to give some concrete instances of the grammar, of course; however, going overboard on the "vocabulary" is not constructive and shifts the focus onto knowing a lot of words, not knowing how to construct great sentences. It's like a writer that knows a lot of uncommon words, but ends up having nothing meaningful to say... because the power of writing is not in the vocabulary alone, but in the craft of composition.
They don't bootstrap this search every time. Enough of the basics have been instilled that they will know what they should look up.
For example if you named the bones in the fingers as left, thumb, two then it’s little effort to recall. Instead people need to recal the stuff like distal phalanges. Math is arguably worse with redundant notations for the same thing. So, I see the benifit of avoiding creating multiple systems.
PS: I would include tendons, joints, and muscles etc not just 206 bones in that example. Also, that was rather off the cuff as left/right could confuse things so maybe you want port vs starboard or something.
What's your point? It seems to be that medical terminology (or the expert body of knowledge that distinguishes someone with anatomical or medical knowledge from the layperson) is an artificial construct which imposes undue restrictions on the easy transfer of this knowledge - guild behaviour.
Every realm of knowledge has its own language which must be learned in order to be proficient. In briefly reading your other replies in this thread, it seems like you feel that computing and programming don't have these restrictions - that is absolutely not true, just ask anyone who has been trying to learn programming themselves but is stuck on the difference between a method and a function (only to find out they are the same thing).
It is not possible to be an expert without gathering the knowledge, the language, and the real understanding necessary to partake in the field. Anything else is simple arrogance, to assume that any specialised field that people spend decades learning, is actually just arcane crud and cruft that disguises the simplicity hidden within
Math however is trying to be as clear as possible and more elegant notation generally though not always wins over time. Mathematics don’t still use Roman Numerals even though they worked.
PS: Languages change over time, programmers dropped the term subroutine. This can look messy, but it’s benifical over time.
I understand your last comment about languages changing over time (technical languages) - medicine is no different. See for instance the Dukes grading of bowel cancer, now largely superceeded by TNM Grading which carries specific histological and pathological meanings (as dukes does) but is applicable to all cancers.
Ah, yes, the best way to learn all the intricacies of a human: osmosis.
Good luck attaining knowledge that takes 8+ years of focused study in medical training today through osmosis over 30 years of "on the job" training, being paid $0 because you are still "learning" and can't contribute to anyone's actual medical care during that time unlike a resident physician.
“Distal phalanges” are the far away phalanges, which are the bones that are in an array like a phalanx in the extremities.
The problem is that language changed after that, and the expectation for those words to make intuitive sense changed in the broader culture doctors were pulled from.
They’re then faced with having to rename everything, breaking with the established record and creating confusion or having to explicitly teach the names.
I’m also curious what you think is redundant in math notation.
Taking classes that use different notation for the same thing is annoying.
That said, I started with: ‘Math is arguably worse with redundant notations for the same thing.’
He asked “I’m also curious what you think is redundant in math notation.”
1,2: memorize 3,4, residency: poorly compensated labor
Residency is after medical school, and that's the first time you start earning a meager paycheck. In medical school, even when you're "working" with patients, you still pay tuition.
Med students are probably the most numerous users of spaced repetition tools like Anki. The rest of us are doing it the inefficient way.
I would greatly prefer my doctors to not skip up-front memorization.
I would have thought that name "spaced repetition" explains why.
(Before somebody complains of layman mob rule, remember checking a proof vs inventing a proof does and should require far less expertise.)
What technology do you anticipate using? Johnny Mnemonic neural implantation?
Medical school today would be like learning programming by memorizing the x86 ISA spec.
Which is a pre-med subject.
There is a minimum amount of material in any subject that needs to be available for rapid recall in order to be an expert in that subject.
A wide variety of different areas have been studied to relate performance to level of learned information. Linguistic fluency requires easy recall of vocabulary. High rankings in chess depend on the recognition of thousands of distinct patterns. Musical improvisation requires thousands of hours of tedious repetition and practice. Effective programming requires a body of knowledge encompassing a variety of topics, a lot of which will be memorised as a side-effect of repeated exposure.
But if you think you can be a better doctor than a doctor by scanning the indices of medical textbooks -- realising a little late that you are unfamiliar with a lot of the terms and also unsure in what order the concepts need to be assimilated before you can apply them -- then at least make sure your will is up to date.
I'm all for a liberal arts approach of understanding other layers of abstraction for more context, but empirically this is not how the vast majority of premeds experience the orgo requirement. And if liberal arts was really the goal, then corresponding amounts of public health classes would also be required (layers of abstraction above and below at equal distance). But that's not the case. Clearly then it's not about a broader perspective but instead about weeding people out arbitrarily for sake of some combination of wages and egos.
I'm not a doctor or on that track. But I am a musician and programmer, at say 1000+ hours for the former, and 10,000s of hours for the latter. Not once have I engaged in flash-card-style rote memorization for either, especially not for any written test. I am certainly full of random facts by now, but the knowledge I hold most valuable is not that which I could also get from API docs or stack overflow.
No doctor, med student, or premed I have ever met studdied their field remotely like the ways I've studdied mine. Is being a doctor inherently that different? I can't see why not, and if I look at economics and public health research the arguments I give leap out at me.
(I also studdied Chinese for a few years when I was younger and definitely did not do enough flash cards. Now that is a field (language learning) where rote memorization is inherent to the problem at hand.)
My wife is in med school. It has nothing to do with technology.
It comes down to an insane risk aversion present throughout all of medicine. If you can't prove an alternative method is empirically better, it won't even get tried. If it's not tried, you can't get the numbers.
Even when things are obvious improvements or carry limited down-sides, the whole medical field is hesitant to pursue them.
There IS technology that does help with memorization. Many, many students use Anki for spaced repetition. Most subscription study sources offer some kind of spaced rep (USMLERx Flash Facts, Firecracker, etc). There is also Sketchy and Picmonics for pictorial memorization of microbes and drugs.
Most doctors aren't researchers. You don't need that much education to practice medicine and fit the role of what people need when they seek a doctor. It has to change, because the current state of affairs is out of control. People are losing all that they have to the raping of the medical industry.
You can't practice medicine without knowledge. You can't learn how to practice medicine without knowledge.
What knowledge is required?
Physics,
inorganic chemistry,
organic chemistry,
mathematics,
microbiology,
cellular biology,
biochemical biology,
molecular biology,
developmental biology,
physiology,
pathophysiology,
human anatomy,
pharmacology,
histology,
gross pathology,
statistical analysis,
internal medicine,
paediatric medicine,
general surgery,
orthopedic surgery,
neurologic surgery,
urologic surgery,
gynecology,
obstetrics,
outpatient medicine,
cardiology,
pulmonology,
nephrology,
hepatology,
radiology,
neurology,
psychiatry,
critical care,
healthcare economics,
medical ethics, et cetera.
If you don't have a knowledge base, you simply can not practice medicine because you don't understand how things actually work...
Critical thinking without knowledge isn't critical thinking, it's ignorance.
Nonsense. Why does a heart surgeon need to know anything about psychiatry? What does a radiologist need to know about cellular biology?
The equivalent for programming would be forcing someone to understand how transistors work at the atomic level, CPU architecture, and OS structure before letting them write a webapp. It's definitely one of the problems in medicine. There's way too much useless knowledge required leading to a limited supply of people being able and willing to master it. Plus, it makes it much more expensive and time consuming to train all of those people.
They seem to follow a pretty similar career arc. If you take a typical CS grad they're going to go through a couple years as a junior dev, couple more as a more senior one, and then five years or more in they are ready to be in charge of their own project. That's pretty similar to the intern -> resident -> attending pattern that doctors follow.
Honestly, the biggest difference between having a career in programming and being a doctor is the gate keeping. In programming, you can drop out of high school and 20 years later be an expert in the field. There's a path for talented people to go from junior -> dev -> senior -> lead -> principle -> whatever. There's no path like that in medicine. Sure, as a nurse you can go from LPN -> RN -> NP but that's where it ends. Your only option at that point is to spend 4 years and hundreds of thousands of dollars. And there's really no reason for that.
Heart surgeons have patients with psychiatric problems. And patients are typically on psychiatric medications, which have cardiac side effects.
More broadly, heart surgeons are also general surgeons, and some psychiatry base knowledge is necessary to understand their patients.
Heart surgeons don't have to be psychiatrists, but they need some knowledge in it, which is why it's a 4 week rotation in medical school.
Which they don't treat. That's why we have psychiatrists.
>And patients are typically on psychiatric medications, which have cardiac side effects.
Which is something a cardiologist should know. Knowing which mental illness they treat and how it does that isn't relevant.
Medications that are prone to abuse, ones that may be more complex to take, ones that can be dangerous if someone takes too many... all are things the cardiologist should be aware of which takes some basic psychiatric knowledge.
There are few in cardiology, but many physical health meds can definitely create psychiatric side effects. How do you differentiate those from an existing psychiatric illness?
There's a large body of literature that recognizes the links between cardiac care and mental health, resulting in poorer outcomes, increased system utilization and costs, etc. Saying "this is my area, that's yours" exacerbates this problem.
> Which they don't treat. That's why we have psychiatrists.
People with mental illness also have heart problems that need heart surgery. It'd be nice if heart surgeons had a bit of understanding of psychiatry so they can avoid diagnostic overshadowing. This is a significant problem that contributes to the shorted lifespan of people with severe mental illness.
It's difficult to unhorse a debating partner who refuses to allow any evidence but their own imagination.
Oh nonsense. There's plenty of evidence that lower trained providers are just as effective as doctors.
Midwives are equal or better than doctors:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
No difference between Nurse Practioners and Drs:
https://www.ncbi.nlm.nih.gov/books/NBK384613/
Of course we don't have studies comparing what the equivalent radiologist not because it's strictly impossible for it to happen. But because it's strictly illegal.
There's also evidence that the way doctors are trained isn't the only possible way.
Humanities and social science majors who omitted organic chemistry, physics, and calculus, and did not take the MCAT do just as well as traditional students:
https://journals.lww.com/academicmedicine/Fulltext/2010/0800...
Performance in medical school does not correlate with performance in residency:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951767/
>Just let it go. You are making an apex fool of yourself in the eyes of each and every health professional reading this
Put up or shut up. Where is your evidence based argument that cardiologists who have a psych rotation have measurably better patient out comes than those that don't. Or that a radiologist with more biochem knowledge is a better one?
Or does your self-righteousness exclude that 3 professionals telling you you misunderstand could maybe have a point? I certainly earn less than you do and have no MCAT, does that make me more truthful? CRNAs also have to learn a lot about cell biology, is that also useless cruft? Something that is taught in med school is to critically review one's own reasoning!
Forget your petty certitudes and slow down. If there was an easy way to do much better, even the AMA could do nothing to stop it. I certainly don't expect to persuade you and therefore will not take the time to "put up" and brandish more useless Cochrane reviews, but you might consider the remote possibility that you are wrong. And extremely arrogant.
Go hide under a rock!
Medicine doesn't resemble neatly modulular systems with crisp APIs. A nodding familiarity with distant specialities is required because very frequently a patient cannot be well-treated by a single specialist.
I have a psychiatrist, an endocrinologist and an orthopaedic surgeon. They all take an intense interest in what the others have investigated, diagnosed or treated. More to the point, they have enough overlapping knowledge to profit from their interest.
> The equivalent for programming would be forcing someone to understand how transistors work at the atomic level, CPU architecture, and OS structure before letting them write a webapp.
Webapps don't often come down to distinguishing between conditions which are benign through uncomfortable, disruptive, disabling up to fatal, and besides, our hardware cousins have striven mightily to hide the messiness of reality from us. Medicine doesn't have improvable subject matter to protect it in the same way.
You can’t just delete the baseline foundational knowledge.
A given radiologist shouldn't be predicting the imaging manifestation of cellular disease. They should be using their knowledge of how known diseases or conditions appear on scans to diagnose the issue. The people that need to understand things on a deeper level are the ones trying to devise new tests or scans to expand front line radiologists diagnostic abilities.
Radiology is a particularly egregious case. If it weren't for legal protection the profession would be dramatically different. It's obviously stupid to spend a bunch of time training them to interpret and diagnosis a bunch of different scans. Basic efficiency would be to train Person A to interpret chest X-Rays, person B to do CT scans, Person C for leg X-rays and have them spend all day doing that one thing. Instead, radiologists spend a decade learning how to interpret a hundred different things and spend 1/100 of their time on each of them.
In other words, let's say that a patient has a fever. Chest X-ray was done.
High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid?
What about when the ordering physician wants to discuss the findings with the "radiologist"? Will that "radiologist" actually understand anything that the physician is talking about?
There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist.
Because you're looking to identify patterns and match them to known ones. To use an analogy, I can teach you to identify statues of Hindu Gods without teaching you anything about Hinduism. For example, to identify Ganesh you need to know that he has an elephant head. Knowing that he has an elephant head because Shiva cut his human head off doesn't really help you.
>In other words, let's say that a patient has a fever. Chest X-ray was done.
>High-school educated "radiologist" sees the image. Does he understand the anatomy? The variations of anatomy? Pathological manifestations of potential causes of fever? How to exclude image artifact versus include potential sign of pathology? What about findings that are not related to fever but need to be identified, further characterised and further imaging required for follow-up? What about signs of infectious fluid versus non-infectious fluid like blood or extravasated fluid?
All of the things you mentioned are things that a radiologist interpreting a chest X-ray needs to know. What you need to explain is why someone interpreting a chest X-ray needs to understand Organic Chemistry. And the vein structure of the leg. And the typical development pattern of a child. And the various mental illnesses a person might have. And interpret a knee MRI.
>There is a role for AI assisting in rapid analysis of radiological studies, however radiologists can never be replaced because AI will never perform to the level of or have the same functions as a physician radiologist.
No, but I could easily take 10 people, train them each 1/10th of what a radiologist studies, and have them perform just as well as 10 radiologists by routing the right stuff to the right person.
While specialization is coming to all of Medicine, we tend to cluster by body region/disease state, rather than by modality. This is because all of the modalities provide complementary information and you must be able to cross reference across the various manifestations of disease.
All of medical knowledge is iterative. Unlike programming, you can’t just abstract the low-level programming. The premedical curriculum provides the baseline knowledge to understand pharmacology, which is essential when trying to understand our interventions in physiology and pathophysiology. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
We have to know how referring clinicians will treat disease, and know the major complications to look out for on imaging. We discuss their treatment plans during tumor boards and need to speak the language of the treating teams so we can tailor our interpretations to be useful.
There are no easy shortcuts here. NPs and PAs are a living experiment at a shortcut, but what I see day in and day out is that the people they consult (radiology and pathology) need to know even more clinical medicine to help the inexperienced NP or PA in knowing what to do when something happens that deviates from the protocol. Many many many times I will call with a semi-urgent unexpected finding, and just get silence on the other end of the phone. They don’t know what to do, whereas on weekends or nights when I get residents or attendings, I don’t hear this complete absence of understanding.
>While specialization is coming to all of Medicine, we tend to cluster by body region/disease state, rather than by modality.
These are contradictory statements. If Doctors typically go:
No Training -> Trained in everything -> Specialized in body region/disease state
You can easily go:
No Training -> Trained in body region/disease state -> Specialized in body region/disease state
So even if we assume it's not possible to specialize radiologists any further than they already are we can still cut the training time and difficulty.
>We have to know how referring clinicians will treat disease, and know the major complications to look out for on imaging. We discuss their treatment plans during tumor boards and need to speak the language of the treating teams so we can tailor our interpretations to be useful. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
No one is denying that there are things in medicine that are complicated and require very skilled people. What you describe is the end state of a fully educated and experienced doctor. Medicine is more or less the only field that makes you become that before you start working. Can you take a reasonably smart person off the street and have him designing plans to treat tumors in a year? No. Can you take that person and train them to identify normal appearing lungs vs cancerous ones in that time? Probably. And can that person learn on the job and develop the ability to design a treatment plan over the course of 10 years working? For sure. And they wouldn't learn everything taught in Med school. They would pick up only the things relevant to the job they are trying to perform.
>All of medical knowledge is iterative. Unlike programming, you can’t just abstract the low-level programming. The premedical curriculum provides the baseline knowledge to understand pharmacology, which is essential when trying to understand our interventions in physiology and pathophysiology. We need to know both physiology and pathophys when interpreting imaging to know how disease manifests and what is abnormal versus post therapy related change.
Going back to the comment that kicked this all off. If I handed you a cellular biology final from Med school do you think you'd be able to pass it? What about the USMLE?
>There are no easy shortcuts here. NPs and PAs are a living experiment at a shortcut, but what I see day in and day out is that the people they consult (radiology and pathology) need to know even more clinical medicine to help the inexperienced NP or PA in knowing what to do when something happens that deviates from the protocol. Many many many times I will call with a semi-urgent unexpected finding, and just get silence on the other end of the phone. They don’t know what to do, whereas on weekends or nights when I get residents or attendings, I don’t hear this complete absence of understanding.
Every other field has the ability to take inexperienced people and make them experienced. There's no reason medicine can't do the same. Your clueless NP and PA should have more experienced people to go to for help when they experience something new. The next time they get that call they wouldn't be as clueless.
As far as your targeted questions, yes, I do think I would pass a cellular biology test from medical school. I wouldn't get 95%+ but I would expect myself to get at least 80% correct.
I'd estimate the overwhelming majority of practicing physicians would pass the USMLE if they took it cold. They probably wouldn't do as well as they did after many weeks of dedicated study, but they would be above the minimum threshold.
It's not because you can't start on the path without going to medical school. And you don't need medical school to start learning radiology. I messed up my elbow in high school. They showed me the x-ray and said this is a fracture, this is a chip, etc. It wasn't difficult to understand and with enough time and practice I'd be able to see them in other x-rays. I don't see where something like Organic Chemistry comes into play.
>As far as your targeted questions, yes, I do think I would pass a cellular biology test from medical school. I wouldn't get 95%+ but I would expect myself to get at least 80% correct.
So ~20% of what you learned in cellular biology isn't needed as a radiologist assuming you only remember what you've actually needed.
From what I can tell in this exchange is that you have an innate distrust of credentialing, because you think because there is some excess therefore the entire system is wasteful. I’d argue that this is the DunningKruger effect in action.
And claiming that 20% of cellular bio is unnecessary is a silly metric when in the US 70% is passing... I don’t think that logical conclusion applies.
Yes we have more tools to look up information that we have forgotten, but as another poster here says “we aren’t bootstrapping the search each time”. If there’s something we’ve forgotten, it’s much more effective knowing where to start the search.
I agree there’s a lot wrong with our current training paradigm; the cost of medical school education is #1 with several terrible downstream effects.
However, there are no shortcuts. You have to put in the time to master the material, else you are doing your patients a disservice.
>And claiming that 20% of cellular bio is unnecessary is a silly metric when in the US 70% is passing... I don’t think that logical conclusion applies.
You're saying that you don't know 20% of cellular biology that they teach in med school. You are a practicing radiologist. Therefore, 20% of the cellular biology they teach is not necessary to be a radiologist.
I have certifications in my field. Developer, Senior Developer, and Lead Developer. If I were to retake the tests, I'd get a 100% on the Developer and Senior one without studying for a minute. Those are good tests. They reflect what you need to know to be effective. The Lead one isn't. I'd probably not pass if I took it today even though I've worked several years as a lead developer since I passed it. So despite actually working in the field and becoming a better developer I'd do worse on the test. That means it is a bad test.
So when you say that the overwhelming majority "wouldn't do as well as they did after many weeks of dedicated study" that makes it a bad test. It means that a good chunk of it is meaningless hoop jumping irrelevant to practicing physicians. A competent practicing physician should breeze through a well designed certification exam.
>I agree there’s a lot wrong with our current training paradigm; the cost of medical school education is #1 with several terrible downstream effects.
>However, there are no shortcuts. You have to put in the time to master the material, else you are doing your patients a disservice.
If someone who wants to be a geriatric doctor skips pediatrics I don't see the disservice. Or take someone like a registered Nurse Midwife. Someone with 20 years experience delivering babies. The only way for them to become competent to prescribe pitocin, antibiotics, or use forceps is 4 years and $200k worth of school? It doesn't pass the smell test.
That's not a meaningful test of correctness.
Many medical practices are organised as you describe (for example, surgeries specialising in nothing but hernias), but medical cases often transcend simple boundaries and a broad amount of understanding is required to detect that boundary violation (such as realising it's not a hernia, or that an organ near the hernia seems to be diseased, or that the patient is going into anaphylactic shock because of a surprise reaction to anaesthetics, or ... or ... or ... or ... ).
And if I go into anaphylactic shock during my hernia surgery should I be grateful that my surgeon did a Pediatric, OBGYN, Neurology, Psychology, and Oncology rotation? Or that they can draw the Krebs cycle?
Okay, that was sarcastic. But in my view no doctor knows all of those subjects in depth. Pre-med students take the basic STEM courses in order to pass their MCAT's, and then forget most of what they learned, and those courses were all just superficial intro courses anyway.
To be fair, the same can be said of most engineers.
Many med students (wisely) major in a STEM subject, so they may get into more depth than someone who majored in some kind of "studies." But what they know is a function of what they actually studied, learned, and kept up with after college, which does not make me super optimistic.
Do you remember every detail of your first grade education? Probably not, but it has served as a foundation for everything else you learned in life. How do you learn calculus if you don't learn numbers and letters?
Different people have different strengths and collaboration is all about enabling others to use their strengths. You do not need to learn most of the things on your list before you can make a positive contribution to medicine. Your list would exclude most physicians from contributing.
The problem is doctors (and lawyers) are the best unionized workers in the country. I'm all for unions, but when a certain group of laborers is much better protected than everyone else, and their work legally distinguished creating extra monopoly power, the asymmetries erase the benefits to society.
1. All the memorization acts as gatekeeping to tighten supply. This is in addition to other explicit quotas.
2. Young post trainees (residents, young associates) do the boring drudgery (and in medicine are under-compensated relative to later). This internally is a hazing ritual, pure and simple. Externally, this is again terrible for productivity. Reducing the drudgery at the top of the food chain removes the psychological yearning for improvement from those with more power. And in the resident case exacerbates the lack of competition which would force change.
The long hours of residents + stigma talked about here also exposes the rank hypocrisy.
And yes the institutions that most want to pay doctors left are totally untrustworthy with that money. So I am not advocating letting them do that.
I guess I'd like:
1. Government health care. Nobody can rationalize the value of their life on their death bed; markets make no sense for health.
2. After that (which fixes the deepest problems), switch to an apprentice style program where everyone starts as a nurse, and then some go back to school to learn more.
The way society valorizes doctors above all (including, implicitly, nurses) (this "last line of defense stuff", etc, etc) strikes me as ungrounded and, frankly, classist or sexist in many instances. There are other well-meaning individuals, and focusing on the individual level, whether patient or care-giver, is not the right approach to systemic problems.
1. Do the job that is traditionally yours.
2. Handle all the impromptu alone because no one else will do it.
The second part is the problem, and is largely due to ressource constraints.
What's clear is that the system is already in pretty bad shape, so I'm just saying that the frontline workers are not a suitable target for pressure. BTW your view regarding the nurse to doctor transition would have been ok 50 years ago. Nowadays, nurses are hyperspecialized in their own niches. If you meant to say "you should know how to make a bed before doing heart surgery", I heartily agree that it would do great good to everyone if docs were to experience what life is lower down the care ladder.
I was aware that nurses are far more trained today. But is their training that orthogonal to the doctors? I was thinking doctors starting with nurses in tandem with nurses allowed to operate more machines, do more radiology, etc.
You may also be surprised by the fact that specialist nurses are well paid and would often never want to "upgrade" to being a doc, precisely be cause of the additional constraints. Finally, the ego of specialist nurses rivals that of docs, and they are even stronger unionized. I don't think it's really possible to keep the same quality of care for cheaper by changing education because armies of residents and fellows are effectively doing slave labor and you'd have trouble finding cheaper and more efficient than a highly-trained slave. In my opinion, well applied technology is the only long term solution.
Great job enjoying such circumstances, but the evidence would point to it being a sub-par way to have residents perform at their best. Surely we could have regular-length shifts (with fixed start times so as to work with a reversed circadian rhythm) and more overlap to solve the patient hand-off problem.
At a bad medical school, maybe.
Pretty much anything can be taught as blank facts, versus a method that stimulates critical thinking.
Programming, for instance. ;)