In considering the challenges medical educators face in addressing the needs of today's health-care system, it is instructive to review the challenges Abraham Flexner (1910) was called upon to address at the turn of the last century. As Flexner surveyed the state of U.S. medical schools 100 years ago, he found a legacy system of medical education that was failing to prepare 20th-century physicians to meet the evolving needs and expectations of patients. That legacy system was based (...) largely on an outmoded apprenticeship model of education, was failing to incorporate the rapidly developing natural sciences, and to make matters worse, was devoid of external scrutiny and uniform standards by which medical schools .. (shrink)

Thinking in medicine is still dominated by the cartesian view of science of the past centuries, dividing individuals into the reasoning mind (res cogitans) and an objective body as part of all non-subjective things of the world (res extensa). This classical scientific paradigm does not take into account the influence the observer exerts on the observed phenomena. Applying this paradigm to medical research and education has consequences regarding the relationship between physicians and patients as well as between medical (...) teachers and their students. An improvement of medical education towards a broader understanding of complex illnesses with their psycho-social implications must be based on philosophical and epistemological issues. The requirements of modern medicine cannot just be met by adding more psycho-social content to somatic medical education or by changing the didactic approach without reflection on the underlying concepts and the relation of the human being to his world. (shrink)

The biomedicalist conceptualization of disablement as a personal medical tragedy has been criticized by disability studies scholars for discounting the difference between disability and impairment and the ways disability is produced by socio-environmental factors. This paper discusses prospects for partnerships between disability studies teaching/research and medical education; addresses some of the themes around the necessity of critical disability studies training for medical students; and examines a selection of issues and themes that have arisen from disability education courses (...) within medical schools globally. The paper concludes that providing there is a commitment from senior management, universities are well positioned to apply both vertical and horizontal approaches to teaching disability studies to medical students. (shrink)

In October 2012, the Loyola University Chicago Stritch School of Medicine amended its eligibility requirements for admission. In addition to U.S. citizens and permanent residents, persons who qualify for the Deferred Action for Childhood Arrivals program of the United States Citizenship and Immigration Service are now eligible for admission. Simply put, we extended the educational opportunity of medical school to people who are in a particular category of undocumented immigrants. We became the first medical school in the United (...) States to have an intentional, transparent policy of eligibility for persons eligible for the DACA program. This expanded admissions policy has gained some attention in the popular press and brought us many expressions of support. It has also dismayed a few members of our school's circle of faculty and alumni.We wish to walk you through the history of our policy's development. We believe that viewing it as it developed will make clear three pertinent ideas: this policy flows directly from the mission of medical schools, it suits a positive notion of social justice and is also compelled by a duty not to discriminate on arbitrary grounds, and educators who steward educational institutions must have the moral courage to place considerations of institutional mission and social justice above the political views and negative responses of some alumni and donors. (shrink)

Contemporary medical education must train skilled and compassionate health care professionals who are rigorous in their approach to patient care and their pursuit of knowledge and solutions. Problem-based learning has been widely introduced, but there is no evidence that it leads to better outcomes than more traditional programs, and fundamental gaps in conceptual knowledge may result. Recently, emphasis has been placed on a solid grounding in underlying concepts combined with a systems-based approach, and ability to transfer information and solve (...) problems. Integrating traditional scientific and clinical disciplines with progressive and continuous assessment, may be a better means of achieving the combined aims of clinically relevant curriculum design, vertical integration of medical knowledge, and facilitation of the continuum of training. Being adaptable and flexible, cognisant of costs, and driven by evidence are key features of delivering medical education and contemporary medical practice. Educational research should lead to continuous improvement, but innovation without evaluation and attention to costs may create as many, or more, problems as are solved. (shrink)

To determine the attitude of general practitioners towards continuing medical education and reasons motivating or hindering them from attending CME procedures, we conducted a cross-sectional survey from November 2013 to April 2014 in Karachi. Three hundred general practitioners who possessed a medical license for practice in Pakistan filled a pre-designed questionnaire consisting of questions pertaining to attitudes towards CME. Data was entered and analyzed using SPSS v16.0. 70.3% of the participants were males. Mean age was 47.75 ± 9.47 (...) years. Only 67.33% knew about CME and only 52% had attended a CME session. Reasons for attending CME procedures reported were: need for updating knowledge, skills and competencies, opportunity to meet colleagues and presenting scientific papers. Mean Likert score was 1.67 for those who thought CME is worthwhile and 1.44 for those who consider their clinical duties as the major hurdle in attending CME procedures. Most common cause for not attending CME was lack of knowledge followed by time constraint. Most physicians were not sufficiently informed about the potential benefits of CME and had never attended a CME session. Most common reason for attending CME procedures reported was need for updating knowledge, skills and competencies while reasons hindering physicians from attending CME were lack of knowledge and time constraint. (shrink)

BackgroundAnatomy Act provides legal ambit to medical educationists for the acquisition of cadavers. The changing medical education scenario, socio-demographic change, and ethical concerns have necessitated an urgent review of its legal and ethical framework. Suitable amendments addressing the current disparities and deficiencies are long overdue.MethodsAnatomy Act in India is a state Act, which ensures the provision of human bodies for medical education and research.The methodology included three components namely: Comparison of various Anatomy Acts clause by clause,Feedback from (...) anatomists, andFormulation of comprehensive model Anatomy Act.ResultsVarious Acts studied showed discrepancies in the purpose of the Act, roles and duties of stakeholders, regulation for body donation, the procedure to handle unclaimed bodies, disposal of dissected bodies, etc. No Act defines a donor and neither addresses the issue of transport of anatomical material. Only ten states have a clause for body donation. Acts of only six states have been amended over the last 50 years. Three states denied having an Act. The whole exercise of review of Acts, extensive feedback received from end-users, and taking into account global good practices, culminated in drafting a comprehensive model Anatomy Act founded on ethical principles.ConclusionIndia, with the largest number of medical colleges, is not only at the forefront but also a hub of medical education in the Southeast Asia region. Legal reform can be a torchbearer to promote ethical and transparent practices for obtaining cadavers for other countries of the region with similar socio-demography and shall also motivate anatomic fraternity across the globe for critical analysis of their respective Anatomy Acts. (shrink)

Over the last 80 years, a major goal of medical educators has been to improve the quality of applicants to medical school and, hence, the resulting doctors. To do this, academic standards have been progressively strengthened. The Medical College Admission Test (MCAT) in the United States and the undergraduate science grade point average (GPA) have long been correlated with success in medical school, and graduation rates have been close to 100 percent for many years. Recent studies (...) have noted that some doctors having difficulties in practice were found to have had similar problems while in school. In this essay, we present a brief historical account of attitudes and approaches to admissions requirements, then discuss basic broad areas of accomplishment in clinical practice: academic mastery, clinical acumen, and professionalism. We then review data that suggest that lack of competency can often be detected very early in a student’s career and may or may not be immune to remediation efforts. We end with a recommendation for a course of action that upholds and fulfills the profession’s social responsibility. This will be a moral argument, defending an aggressive but equitable approach to maintaining both public accountability and trust. (shrink)

Book reviewed in this article: Learning to Heal: The Development of American Medical Education. By Kenneth M. Ludmerer Getting Rid of Patients: Contradictions in the Socialization of Physicians. By Terry Mizrahi.

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.

For decades, debates over medical curriculum reform have centred on the role of science in medical education, but the meaning of ‘science’ in this domain is vague and the persistence of the debate has not been explained. Following Bourdieu, this paper examines struggles over legitimate knowledge and the forms of capital associated with science in contemporary UK medical education. Data are presented from a study of two UK medical schools, one with a traditional, science-oriented curriculum, another (...) with an integrated curriculum. Constructions of legitimate knowledge were explored at both schools through six months participant observation, interviews with faculty members (n=15) and students (n=37) and documentary analysis. Findings show that medical schools compete for both scientific and clinical capital, but ultimately science has greater legitimacy. ‘Science’ is defined in accordance with the structure of the traditional curriculum and has become a symbolic resource – a mark of distinction for both medical schools and medical students – which is equated with clinical competence. The significance of science is circumscribed by the medical education field, yet the struggles for scientific capital there have ramifications beyond medical education itself. It is argued that Bourdieu’s concepts are particularly useful tools for studying the meanings that science takes on outside of the scientific field. (shrink)

In her 2018 book, What the Eyes Don’t See, Dr. Mona Hanna-Attisha wrote that it is the duty of doctors to speak out against injustice. In fact, no other physician or institution in Flint had done the research and spoken out, as a whistleblower, against the poisoning of Flint’s children by Michigan government. Why had Dr. Hannah-Attisha? Unfortunately, in the absence of a medical education system that teaches community-oriented primary health care in the tradition of the 1978 Alma Ata (...) Declaration, there is little reward in doing so. This article focuses on three movements that are challenging medical education orthodoxy: 1) primary health care 2) the medical humanities and 3) “Study Up your Town” medicine. How can we create a radical health pedagogy – one that draws the links between several pandemics raging across the planet: capitalist collapse, climate disruption, Covid-19, racism, and an emergent neoliberal fascism – to enable doctors, health professionals and citizens to see them as all of one piece? Medical educators must employ critical pedagogy to create legions of “constructive troublemakers” who challenge the social-structural obstacles that are driving millions to premature death. We have reached the “end times.” A new “planet medicine” is finally emerging. (shrink)

The author discusses the contribution of humanities teaching in medical education. Five "qualities of mind" specifically engendered by the humanistic disciplines are isolated, delineated, and illustrated: critical abilities, flexibility of perspective, nondogmatism, discernment of values, and empathy and self-knowledge. Keywords: humanities, humanities and medicine, medical education CiteULike Connotea Del.icio.us What's this?

One hundred years ago, Flexner emphasized the role of science in medical education. With a 21st-century perspective, the question may be posed anew: is science relevant to medical education and practice? If so, then which areas of science are fundamental to learning and making ongoing decisions in medicine? The answers to these questions should determine what is needed in the preparation of an undergraduate student for medical school.Educators and students alike question the relevance of current premedical requirements, (...) and there is concern that these in fact diminish student interest in medical or biomedical research careers. For example, premedical science courses are viewed by many students (including those who .. (shrink)

This article explores the disconnection between what pre-professional students expect from college and what their undergraduate education might foster, between the focus on “getting into medical school” and the development of humanistic physicians. It reviews the longstanding challenge inherent in helping pre-meds acquire not only sufficient scientific background but also well-developed interpersonal skills to help them understand patients’ experience of illness and their own interactions with other members of the health care team. Clinical experiences from the NEH Institute are (...) interpreted from the perspective of a pre-med advisor who also teaches literature; they are also incorporated into an undergraduate course on literature about illness. (shrink)

Although the teaching of medical ethics and law in medical education is an old story that has been told many times in medical literature, recent studies show that medical students and physicians lack confidence when faced with ethical dilemmas and medico-legal issues. The adverse events rates and medical lawsuits are on the rise whereas many medical errors are mostly due to negligence or malpractices which are preventable. While it is true that many medical (...) schools teach their students medical law and ethics, there are wide variations in what is being taught because there is no universally agreed syllabus. Yet the knowledge of medical law and ethics is closely relevant to the medical profession and that failure in abiding the law may result in serious civil or even criminal consequences. While this paper does not propose to lay detailed analysis of the relevant areas of law or ethics, it proposes to cover some legal areas so as to highlight and bring to attention the need for a medical law and ethics course. This article also considers the problems faced and recommendation as to future directions to be taken with respect to teaching medical law and ethics. It concludes with a suggested course outline for the teaching of medical law and ethics. (shrink)

Berger and Miller raise important considerations regarding the ongoing relevance and use of cultural competency in medical education. In particular, the authors critique the United States’ L...

Medical student learning is dependent on an unwritten agreement between patients and the medical profession, in which students “practise” upon real patients in order that, when they are doctors, those same patients will benefit from the doctors’ skills. Given the increasing propensity for patients to refuse to take part in such learning, there is a danger that doctors will qualify without being truly competent. As patients, we must all ask ourselves, when asked to take part in medical (...) teaching: if this student/trainee doesn’t learn now, on me and under supervision, how will the person be truly competent next time, when this is for real, and the patient might be me or my loved one?We argue that a new and more explicit agreement is needed, in which the default should be that all patients are willing to help in the education of medical students, while we ensure that all such students are already competent in simulation before first practising upon real patients. (shrink)

Although social justice is an integral component of medical professionalism, there is little discussion in medical education about how to teach it to future physicians. Using adult learning theory and the work of Brazilian educator Paulo Freire, medical educators can teach a socially-conscious professionalism through educational content and teaching strategies. Such teaching can model non-hierarchical relationships to learners, which can translate to their clinical interactions with patients. Freirian teaching can additionally foster professionalism in both teachers and learners (...) by ensuring that they are involved citizens in their local, national and international communities. (shrink)

Spirituality in medical education is an abstract multifaceted concept, related to the healthcare system. As a significant dimension of health, the importance and promotion of this concept has received considerable attention all over the world. However, it is still an abstract concept and its use in different contexts leads to different perceptions, thereby causing challenges. In this regard, the study aimed to clarify the existing ambiguities of the concept of spirituality in medical education. Walker and Avant concept analysis (...) eight-step approach was used. After an extensive review of online national and international databases from 2000 to 2015, 180 articles and 3 books in English and Persian were retrieved for the purposes of the study. Analysis revealed that the defining attributes of spirituality in medical education are: teaching with all heart and soul, Life inspiring, ontological multidimensional connectedness, religious-secular spectrum, and socio-cultural intricacies. Moreover, innate wisdom, skillful treatment, transcendent education, and environmental requirements were antecedents to this concept, with the health of body and soul, intrapersonal development and elevation, and responsive treatment and education being its consequences. The defining attributes provided in this study can assist physicians, instructors, and professors to develop and implement evidence-based, health based and comprehensive education plans according to the guidelines of professional ethics and qualification of using spirituality in practice. The clarification of the noted concept facilitates further development of medical knowledge, research, and research instruments. (shrink)

Resistance by physicians, medical researchers, medical educators, and medical students to pharmaceutical industry influence in medicine is often based on the notion that physicians and the industry are in conflict. This criticism has taken the form of a professional movement opposing conflict of interest in medicine and medical education and has resulted in policies and guidelines that frame COI as the problem and outline measures to address this problem. In this paper, I offer a critique of (...) this focus on COI that is grounded in a broader critique of neo-liberalism, arguing it individualizes the relationship between physicians and industry, too neatly delineates between the two entities, and reduces the network of social, economic, and political relations to this one dilemma. (shrink)

There has been increasing emphasis on professionalism in medical education over the past several decades, initially focusing on bioethical principles, communication skills, and behaviors of medical students and practitioners. Authors have begun to discuss professional identity formation (PIF), distinguishing it as the foundational process one experiences during the transformation from lay person to physician. This integrative developmental process involves the establishment of core values, moral principles, and self-awareness. The literature has approached PIF from various paradigms—professionalism, psychological ego development, (...) social interactions, and various learning theories. Similarities have been identified between the formation process of clergy and that of physicians. PIF reflects a very complex process, or series of processes, best understood by applying aspects of overlapping domains: professionalism, psychosocial identity development, and formation. In this study, the authors review essential elements of these three domains, identify features relevant to medical PIF, and describe strategies reported in the medical education literature that may influence PIF. (shrink)

In calling for the transformation of military medical education and training, the 2005 Base Realignment and Closure Commission recommended relocating basic and specialty enlisted medical training to a single site to take advantage of economies of scale and the opportunity for joint training. As a result, a joint medical education and training campus (METC) has been established at Fort Sam Houston, Texas. Two of METC's primary long-term goals are to become a high-performing learning organization and to seek (...) accreditation as a community college. Such goals require a clear model of organizational improvement with well-defined metrics for measuring its performance and using research and evaluation to assess and improve that performance. Lessons learned from a review of practices at institutions with similar missions -- such as community colleges, corporate universities, the UK's Defence Medical Education and Training Agency, and other federal agencies, such as the Veterans Health Administration -- establish a clear need for an office of institutional research to help METC attain its organizational goals. They also provide useful recommendations regarding the METC office's structure, scope, and governance. (shrink)

We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across (...) institutions. (shrink)

The article traces the forty-year history of the establishment of the Bioethics training course at the Volgograd State Medical University, which turns 85 this year. It is told about those who played a major role in the development of bioethics as a training course, what difficulties and successes were along this path. The logic of the institutionalization of bioethics through the creation of ethical examination procedures is traced. Actual problems of bioethics, as well as ongoing bioethical activities are not (...) covered and are not called, since the materials of the anniversary issue of the journal are devoted to them. (shrink)

Patients increasingly see physicians not as humane caregivers but as unfeeling technicians. The study of philosophy in medical school has been proposed to foster critical thinking about one's assumptions, perspectives and biases, encourage greater tolerance toward the ideas of others, and cultivate empathy. I suggest that the study of ethics and philosophy by medical students has failed to produce the humane physicians we seek because of the way the subject matter is quarantined in American medical education. First, (...) the liberal arts are seen as the province of undergraduate education, and not medical school. Second, philosophy, when taught in medical school, is seen by students as just one subject to be mastered along with many other more important ones, and not as a way to foster critical thinking and empathy. What is needed is a new pedagogy that combines both cognitive and affective elements to implant and nourish the liberal arts in students. Removing the quarantine of philosophy from other facets of medical education is an important first step. (shrink)

Pain is one of the most frequent presenting symptoms for patients who come to a physician's office. Despite the frequency of this presentation, little consistent, systematic information is provided to medical students or physicians about the treatment of pain. In addition, relatively little information is given about the recognition and prevention of drug abuse and about how to prescribe analgesics rationally to minimize the chances for abuse. This lack of educational preparation for both pain and addiction contributes to significant (...) fear and inability on the part of health professionals to diagnose and treat both conditions. It creates a barrier of fear to prescribe adequate doses of pain medications for patients who present with both acute and chronic pain problems. Inadequate medicating can be caused by the physician's overriding worry about creating addiction in a patient. Morgan has called this problem “opiophobia.”. (shrink)

A century after his landmark report Medical Education in the United States and Canada (1910), Abraham Flexner remains an icon in the history of American medical education. Working for the Carnegie Foundation for the Advancement of Teaching, he visited each of the 155 medical schools then in existence in the United States and Canada, after which he published a blistering, muckraking report. This report helped bring about the destruction of the proprietary medical school, put forth the (...) Johns Hopkins School of Medicine as the ideal of what a medical school should look like, and established Flexner as the unchallenged arbiter of educational reform in American medicine. Two years after the report, he became assistant .. (shrink)

The modern science of judgment and decision making began to emerge in the 1950s, and was thus unknown when Abraham Flexner wrote Medical Education in the United States and Canada (1910). This did not stop Flexner from highlighting the unique challenges facing the physician as a decision maker, as part of his effort to press for requiring some college education as a prerequisite for medical school:The engineer deals mainly with measurable factors. His factor of uncertainty is within fairly (...) narrow limits. The reasoning of the medical student is much more complicated. He handles at one and the same time elements belonging to vastly different categories: physical, biological, psychological elements are involved in .. (shrink)

Scientism in medical education distracts educators from focusing on the content of learning; it focuses attention instead on individual achievement and validity in its measurement. I analyze the specific form that scientism takes in medicine and in medical education. The competencies movement attempts to challenge old “scientistic” views of the role of physicians, but in the end it has invited medical educators to focus on validity in the measurement of individual performance for attitudes and skills that medicine (...) resists conceptualizing as objective. Academic medicine should focus its efforts instead on quality and relevance of care. The social accountability movement proposes to shift the focus of academic medicine to the goal of high quality and relevant care in the context of community service and partnership with the institutions that together with medicine create and cope with health and with health deficits. I make the case for this agenda through a discussion of the linked histories of the opioid prescribing crisis and the professionalism movement. (shrink)

In this article, the author explores a model of alternative medical education being pioneered at Loyola University Chicago Stritch School of Medicine. The five-year Global Health Fieldwork Fellowship track allows two students per year to complete an extra year of medical education while living and working in a free rural clinic in the jungle lowlands of Bolivia. This alternative curricular track is unique among other existing models in that it is longitudinally immersive for at least one full additional (...) year of medical education, grounded in clinical and service learning, and heavily focused upon global health and the social components of medicine. Studies have shown that both longitudinal alternative medical curricular tracks and short-term global health electives have long-term benefits upon the professional development of participants, suggesting that the GHFF is likely to do the same. The author also argues that the GHFF is an advantageous model of global health education compared to standard offerings and provides a unique curricular model by which to foster the development of social values—such as professionalism, advocacy, and social justice—that are widely considered lacking in today’s medical education. (shrink)

Public policy tries to promote appropriate drug use by allowing firms to market drugs in interstate commerce only for uses that the Food and Drug Administration has found to be safe and effective. Because of their medical knowledge, physicians are authorized to prescribe drugs even for uses unapproved by the FDA. Nevertheless, physicians have relied on drug firms for information on appropriate prescribing despite the inherent tension between drug firm dissemination of information to promote sales and rational prescribing. In (...) the past, physicians often relied particularly on drug firm advertising for information on drug use. Today, physicians rely on drug firms to finance continuing medical education. A historical review reveals connections between these two different ways commercial interests have influenced the information that physicians receive and points the way to needed reforms. (shrink)

The Dobbs decision will directly affect patients and reproductive rights; it will also impact patients indirectly in many ways, one of which will be changes in the physician workforce through its impact on graduate medical education. Current residency accreditation standards require training in all forms of contraception in addition to training in the provision of abortion. State bans on abortions may diminish access to training as approximately half of obstetrics and gynecology residency programs are in states with significant abortion (...) restrictions. The Dobbs decision creates numerous hurdles for trainees and their programs. Trainees in restrictive states will have to travel to learn in a different program in a protective state. As training opportunities diminish, potentially leading to a decline in clinical skills, knowledge, and experience in the provision of abortion, the rate of complications and maternal mortality are likely to rise. This will likely have a disproportionately negative effect on preexisting disparities in reproductive health fueled by a longstanding history of systemic racism and inequities. This work aims to both define the looming problem in abortion training created by Dobbs and propose solutions to ensure that an adequate workforce is available in the future to serve patient needs. (shrink)

Reflection has been proclaimed as a means to help physicians deal with medicine’s inherent complexity and remedy many of the shortcomings of medical education. Yet, there is little agreement on the nature of reflection nor on how it should be taught and practiced. Emerging neuroscientific concepts suggest that human thought processes are largely nonconscious, in part inaccessible to introspection. Our knowledge of the world is fraught with uncertainty, ignorance and indeterminacy, and influenced by emotion, biases and illusions, including the (...) illusion of not having illusions. Neuroscience also documents that lifelong learning processes may hone nonconscious cognition to high levels of sophistication, allowing rapid and precise perceptions, judgments and actions in complex situations. We argue that knowledge of mechanisms underlying human thought may be useful in designing educational programs to foster desired attributes such as curiosity, critical self-awareness and intuitive acumen in medical professionals. The juxtaposition of neuroscientific insights with ideas from Kant on reflective judgement, van Manen on tact, and Aristotle on phronésis, supports a concept of reflection that manifests as wise practice. We suggest that reflection in medical education should be an imperative for educators seeking to guide learners to manage the complexity and “messiness” of medical practice, and a role-modelling mode of medical practice characterized by self-correcting behaviors that culminate in good and right professional actions. An example illustrates reflective practice in the teaching and learning of physicianship. (shrink)

How medical education and practice can move beyond a narrow focus on biological intervention to recognize the lived experiences of illness, suffering, and death. In Afflicted, Nicole Piemonte examines the preoccupation in medicine with cure over care, arguing that the traditional focus on biological intervention keeps medicine from addressing the complex realities of patient suffering. Although many have pointed to the lack of compassion and empathy in medical practice, few have considered the deeper philosophical, psychological, and ontological reasons (...) for it. Piemonte fills that gap, examining why it is that clinicians and medical trainees largely evade issues of vulnerability and mortality and, doing so, offer patients compromised care. She argues that contemporary medical pedagogy and epistemology are not only shaped by the human tendency to flee from the reality of death and suffering but also perpetuate it. The root of the problem, she writes, is the educational and institutional culture that promotes reductionist understandings of care, illness, and suffering but avoids any authentic confrontation with human suffering and the fear and self-doubt that can come with that confrontation. Through a philosophical analysis of the patient-practitioner encounter, Piemonte argues that the doctor, in escaping from authentic engagement with a patient who is suffering, in fact “escapes from herself.” Piemonte explores the epistemology and pedagogy of medicine, examines its focus on calculative or technical thinking, and considers how “clinical detachment” diminishes physicians. She suggests ways that educators might cultivate the capacity for authentic patient care and proposes specific curricular changes to help students expand their moral imaginations. (shrink)