HEALTH : What Students Do Not Know Is What Counts in This Course
Marlys Witte is the founder of a unique program in medical education that summons future doctors to embrace what they fear most--ignorance.
She wants medical students to understand that what is unknown about diseases far exceeds what is known, that doctors and medical textbooks are often wrong and that the inability of many in the profession to admit these things creates an environment in which discovery is stifled.
“We’re trying to break down the finality and arrogance that exist in medicine in part from a fear of admitting ignorance,” says Witte, professor of surgery at the University of Arizona Medical School here. “What we don’t know is an important part of medical education.”
Witte’s exploration of ignorance began in 1984. She and philosopher Ann Kerwin developed what they call the Curriculum of Medical Ignorance, a series of courses, lectures, clinics and research projects that combine a dose of whimsy with serious probing into the gaps in medical knowledge.
*
Questions form the core of the curriculum. Students are judged not on finding answers, but on the quality of their questions, which they studiously jot down in what are called ignorance logs.
After meetings with patients, students must develop more questions, then return to ask patients if they have any questions. Groups of future doctors also gather once a month for sessions called Pondering Rounds.
Among the questions raised at a recent session: Can we ever cure one thing without having side effects? Since skin keeps germs out of the body, shouldn’t it be considered part of the immune system?
Visiting speakers are brought in to lecture about what they don’t know in their field of expertise. They’re called distinguished ignoramuses.
The atmosphere is intellectual but loose. Witte and Kerwin sprinkle their conversation with references to great poets, philosophers and mathematicians, from Socrates to Pascal.
Yet the two professors wear silver pendants and earrings in the form of question marks. “We even accessorize ignorance,” Kerwin says.
“Ignorance is a paradigm for the 21st Century,” Witte says. “The 20th Century has been the information and knowledge century. But as our sphere of knowledge enlarges, so does our contact with the unknown.”
Kerwin says that questions are more important than answers because knowledge is transitory. “Even the dean of the Harvard Medical School tells entering freshmen that in 10 years, 50% of what they learn will be proven false,” Kerwin says. “The problem is we don’t know which 50%.”
Realizing that there are no pat answers, the professors say, can lead to hard questions--and breakthroughs. “If we don’t know the basic problem in AIDS, then maybe AZT isn’t the best treatment,” Witte says. “If we can ask that question, the research and the answers we get will be very different than if we can’t.”
*
Smart students in a competitive environment are sometimes reluctant to delve into what they don’t understand. But they come around, often with a sigh of relief, upon realizing that the process of learning is always rife with mistakes and stumbles.
Most students say they find the course a welcome respite from the relentless memorization and regurgitation of facts, which Witte call academic bulimia.
Michael Joyner, one of Witte’s former students who now teaches anesthesiology at the Mayo Clinic in Minnesota, said the program made medical school “more than an intellectual death march,” consisting of soaking up facts and passing tests. “She liberated us from that,” Joyner says.
Witte’s formula is that 5% of every medical school class should be devoted to questioning what is known and confronting what is unknown, just enough time to head off over-confidence and arrogance.
What’s one sign of those dread afflictions? Witte grins and says: “When you don’t know what’s wrong with a patient, give it a Latin name.”
Witte believes the word ignorance scares some in the medical Establishment. “But if you can’t face the word, you can’t face the concept,” she says.
