["Reversing" the teaching of medicine, yesterday and today]

Recently the radical critique has been revived of medicine teaching developed some fifty years ago by G.A. Maccacaro with special focus on Italy. He maintained that a dominating biological perspective obscured all social dimensions of health and disease, educating doctors poorly equipped to grasp the practical relevance of social determinants of diseases and to correctly perceive their own role in society. In fifty years, many aspects of the practice of medicine have however changed: how such changes relate to the current teaching of medicine? Three key developments have taken place. First, separate specialties and subspecialties have multiplied at fast pace, and teaching has usually favoured this increasing fragmentation. Second, in actual practice doctors need to overcome disciplinary segmentation and collaborate, often to a substantial extent: little trace of how best to implement this is present in academic teaching. Third evidence-based medicine and guidelines for preventive, diagnostic and therapeutic interventions have become common currency in medicine: teaching of these topics is, notably in Italy, in general weak, leaving future doctors unprepared to a critical understanding and use of evidence-based medicine and guidelines in the daily practice. Substantial changes in medical teaching appear needed today no less than fifty years ago, but they can only start from a recognition of medicine as it stands today rather than fifty years ago.