Which doctor for the near future? Here’s what to change in the formation of our universities

by Silvio Garattini

09 JUNE – Dear Director,

our country is in shortage of doctors because few are admitted to medical schools and because many seek foreign shores to exercise their professionalism. The new resources made available by the European project for health and education should make it possible to improve the situation in the future, but it is important to ask ourselves whether the current teaching of medicine is appropriate to the times and in particular to the development of knowledge that flows into the care of the sick. . Even knowing that I am unpopular, I would say that if we want to train good doctors, many things must change.

First of all, is it possible that medical schools are governed by the Ministry of Education or according to political moods by the Ministry of University when doctors have to serve the needs of the National Health Service (SSN)? It should be the SSN that determines the number of people admitted to the Schools and the programs.

The sustainability of the NHS depends on avoiding disease, but prevention in current programs is a “Cinderella” because it is not part of a culture that considers disease a failure of medicine. Good lifestyles with all their implications are not taught primarily as a source of good example and then as a methodology to be used in all activities, from the community to the hospital. A major cultural change is needed, which is difficult to achieve because it tends to limit the medicine market.

Current teaching programs do not take into account the fact that Italy has one of the largest elderly populations, because we have a long life span indirectly supported by a low birth rate. However, if we consider the “healthy” lifespan, we move down the rankings.

Pathology is therefore concentrated in old age, but teaching today does not take it into account. Furthermore, we are witnessing more and more the presence of polypathologies, but teaching deals with individual diseases. Instead, it would be necessary that at least once a week courses were held that bring together several specialists from the various areas. For example, that histologist, physiologist, biologist, pathologist and pharmacologist carried out collective teaching.

As well, later on, there should be more specialists who, under the guidance of a geriatrician, deal with the various pathologies also to simplify the pharmacological treatments that are increasingly numerous, but without scientific evidence of effectiveness.

We need to make sure that students are not just passive listening to lectures. They should be doing some lessons themselves following the instructions and advice of the Professors. Students should be trained in debates by assigning diagnostic or therapeutic themes. Today the teaching is very theoretical, while it is important that future doctors have spent some time in the laboratories and in the wards also to know not only the equipment that they will have to use, but also the sick with their problems and related bad debts.

Discussions of bioethics, psychology, pedagogy should also be important to give the doctor the ability to interact with the patient using dialogue and knowledge sharing. Medicine must be understood as a mission that requires time and sacrifices. It is also important that doctors leaving school have the conviction that studying must be a fundamental part of their daily activity, but for this to happen they need to know the sources to draw from. They must be sources that ensure independence of judgment, while today they are subjected only to biased information, for example, that of the drug market.

Finally, the doctor having to operate within the NHS must know the organization and above all he must remember that incorrect relationships with his patients have repercussions on the effectiveness and sustainability of the NHS. So be careful. Increasing the facilities of current medical schools without changing the context in which they operate would be a grave mistake.

Silvio Garattini
President of the Mario Negri Institute for Pharmacological Research IRCCS

09 June 2021
© All rights reserved

Other articles in Letters to the editor