A recent survey indicates that teaching physicians and new doctors have different ideas about which procedures medical students need to learn before graduating—particularly when it comes to minimally invasive activities. 

 

Michael T. Fitch, MD, PhD, and colleagues at Wake Forest School of Medicine in Winston-Salem, N.C., asked doctors to rate throat culture, spinal tap, and 29 other basic clinical procedures in terms of how important they are to know in the first year after medical school. Participants included the school's residency and fellowship directors, resident physicians who had completed their internship at Wake Forest University Baptist Medical Center, and graduates of the medical school who completed training elsewhere.

 

Of the 14 procedures faculty physicians rated as “must know,” only six garnered the same rating from the newest members of the profession. The new doctors countered with an additional five procedures that they considered essential but faculty did not.

 

The procedures identified as most important by the new doctors were more invasive than those named by the faculty. For example, the new physicians championed spinal taps, incisions and drainage, intubation, and central-line insertion. The greatest divergence of opinion usually involved minimally invasive procedures. For example, the new physicians disagreed that knowing how to draw blood is important. Dr. Fitch and colleagues say this could be due to the fact that this task is often performed by nonphysician staff, making it nonessential knowledge for interns.

 

“Like a lot of clinical education in most medical schools, the third and fourth years are learning-by-doing—taking care of real patients,” pointed out Dr. Fitch in a statement describing the study results. “So, the procedures the patients need end up being the ones students learn.”

 

Wake Forest University's medical school has changed its curriculum to include all 19 procedures named as “must knows” by the two groups of survey respondents, and students are required to track electronically any time they observe, participate in, or perform these acts.

 

Full survey results appear in the April issue of the peer-reviewed publication Medical Teacher (abstract only; subscription required).