Viewpoint: refocus medical training

Are undergraduates being made to study too much?

Location: UK
Published: Tuesday 26 September 2023
Radhamanohar Macherla

Do you remember the steps of the Krebs cycle? How about the course of the lateral femoral cutaneous nerve? And a third question – if you don’t remember those things, does it really matter?

During the last few decades, there have been exponential developments in the medical field, such as new variants in infectious diseases, pandemics, immunotherapies, new cancer treatments, and invasive interventions in stroke and cardiovascular diseases. So much so that ‘disease specialties’ such as stroke medicine, hepatology, and immunology have emerged from ‘organ specialties’.

Accommodating these ever-increasing advances in medicine needs adequate time for training. There is also a risk of information overload and stress to undergraduates unless we review and remodel medical training. I would suggest it means that two aspects of medical training need scrutiny – the volume of what is studied in pre-clinical, and the model of clinical training that follows it.

The pre-clinical subjects could be whittled down to the essentials needed by discarding inconsequential and unhelpful content. This is a good starting point. How helpful is the detailed anatomy of the whole body, except that of the brain, for future psychiatrists, or biochemistry or pharmacology for future radiologists? How relevant is the course of that nerve I mentioned to a would-be gastroenterologist or cardiologist? It is though, to a rheumatologist.

This doesn’t mean we strip whole basic sciences in medicine to the bare minimum of a chart or two of human anatomy, a couple of biochemistry charts and histopathology slides. This must be carefully thought through and be balanced against acquiring adequate knowledge in pre-clinical to understand a disease’s underlying pathogenesis and pathophysiology, and that medical standards are not compromised.

When graduates choose their specialty, they could learn these pre-clinical subjects relevant to their specialty in detail – such as anatomy for surgeons, and the histopathology of the alimentary tract for gastroenterologists. This would offload the subject’s excess volume and retain the students’ interest. 

Clinical training itself could be streamlined. How much does the training in identifying cardiac arrhythmias or different obstetric conditions help a psychiatrist, radiologist, or otolaryngologist? 

This model may work with some specialties, such as radiology and psychiatry, but may not fit well with some other branches of medicine, as the content of different medical branches intertwines a great deal. But we could take some ideas from it. Undergraduates could receive a shortened but broad-based clinical training covering all branches followed by early entry into their selected specialties. 

This ‘specialist undergraduate’ model is not without its disadvantages – limited student exposure to specialties and risk of fragmented medicine. A gastroenterologist or a neurologist may be uncomfortable or even unable to treat a simple cough and fever and may seek a pulmonologist’s advice. But, to some extent, this trend already exists with the current specialties. 

Striking a balance isn’t easy, far from it; no doubt, such remodelling of intricate medical education and training beseeches medical educationalists’ expertise. 

We all admit there is a limit to what we can possibly know. We need to be just as open about there being a limit to what we actually need to know.


Radhamanohar Macherla, now retired, was for more than 20 years a consultant physician with Barts Health NHS Trust