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September 7, 2011

The Education and Training of Future PhysiciansWhy Coaches Can't Be Judges

Author Affiliations

Author Affiliations: Department of Medicine, University of Toronto; Department of Medicine, University Health Network; and Department of Medicine, Mount Sinai Hospital (Drs Cavalcanti and Detsky); Dr Herbert HoPingKong Centre for Excellence in Education and Practice, University Health Network (Dr Cavalcanti); and Department of Health Policy, Management, and Evaluation, University of Toronto (Dr Detsky), Toronto, Ontario, Canada.

JAMA. 2011;306(9):993-994. doi:10.1001/jama.2011.1232

A physician must be able to diagnose and treat patients. The clinical skills required to be successful include gathering data, differentiating important from unimportant facts, making decisions about further investigations and treatments, implementing therapy, and providing follow-up, education, and counseling. These skills cannot be learned through reading or in classrooms alone; practical experience is required. The present method of exposing physicians-in-training to practical experience involves a hierarchical team approach with graded levels of responsibility whereby the decisions of the most junior members of the team are reviewed by physicians with more experience and seniority. These practical experiences impart content knowledge and also allow trainees to become comfortable with decision making and to learn the consequences of these decisions. Although there may be better ways to train future physicians, this apprenticeship method seems to work, as evidenced by the relatively low failure rate in medical schools and training programs.

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