Kieran Walsh: The case against medical education

Bryan Caplan is an American economist and author of a popular new book—The Case against Education. He thinks that much of our education system is a waste of time and money. He says that students spend thousands of hours learning things that will be of little use to them or to society at large. And they end up massively in debt at the end.

Some people disagree with Caplan and say that employers are interested in well-educated graduates and that they pay them more—so all the education and debt will be worth it in the end. But Caplan says that this has little to do with education and more with a phenomenon called signaling. Signaling means that employers aren’t interested in what students actually learned at university, but are interested in the signal that a good degree sends them. The signal is that the graduate is conscientious, diligent, and intelligent, and will stick at something until they achieve it. This is probably true, but Caplan thinks that spending years at university is not the most efficient way of showing this.

Could the same be true of medical education? You could argue that there are parallels. Medical students still spend time learning things that will be of little value when they qualify. They also end up in considerable debt by the time that they get their degree. A degree is essential to practice medicine, but at the same time a better degree or a higher degree will make graduates more attractive to employers. It is a moot point as to whether they will help the graduate become a better doctor.

The cost of the degree has other unwanted effects. Medical students become investors in their own education and at the end of their course they will want to see a return on their investment. This can only come through higher wages. The purpose of medical education should be to produce healthcare professionals that can provide care that the population needs. But the high cost of medical education means that some graduates will pursue a career in a high paying specialty so that they can repay their debt. This is why some countries have lots of highly paid interventional tertiary care specialists but few family doctors.

We could make medical education free but everyone says that we can’t afford it. I am not sure about this. I went to university in the Republic of Ireland in the 1980’s and got a free university education. The country was in a bad recession at the time—so bad that some people wanted the country to default on the national debt. But university education was still free. I don’t think that finances today are as bad as they were then.

Another way of thinking about this issue is to develop lower cost forms of medical education. Using new technologies to deliver medical education might be one way of saving costs. But it is unlikely that technology enhanced learning in isolation will work—technology will need to be blended with other delivery mechanisms. As one example it has always been heartening to hear tutors saying that they used BMJ Learning modules to prepare their students before their next tutorial—so that they could use the flipped classroom approach in the tutorial.

In the meantime, we should “cast a cold eye” on everything that we do in medical education and ask ourselves: is it as efficient as it could be?  

Kieran Walsh is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor—specialising in care of the elderly medicine and neurology.

Competing interests: Kieran Walsh works for BMJ Learning which provides e-learning resources. He has also written a book on cost and value in medical education.