The pyramid of medical knowledge grows continuously. Its base broadens, sides expand and apex rises as knowledge accumulates. Relatively little is shed as obsolete as compared with that which is added as new. This growing structure is impressive when viewed in the light of the actual knowledge represented: likewise it appears colossal when considered from the standpoint of the young physician who attempts to learn all of its contents.A physician's efforts to absorb this pyramid of knowledge may follow various patterns. Starting in its base he may work horizontally, gaining a little insight into many fields, or vertically, becoming more and more proficient in a relatively narrow field. The horizontal method is that of the physician who becomes a general practitioner. After accumulating limited insight into many different fields of medicine he may advance toward the apex in certain fields of interest, the number and height depending
COLWELL AR. PRINCIPLES OF GRADUATE MEDICAL INSTRUCTION: WITH A SPECIFIC PLAN OF APPLICATION IN A MEDICAL SCHOOL. JAMA. 1945;127(13):741–746. doi:10.1001/jama.1945.02860130001001
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