Education and training in internal medicine in Europe.

Sir William Osler was the Regius Professor of Medicine in Oxford at the end of World War I. In those days there was a great demand for postgraduate medical education. This was the motive for the foundation of the Fellowship of Postgraduate Medicine, under the presidency of William Osler. Osler himself had received his postgraduate education in Europe, from 1872 to 1874, during a two year sabbatical leave in teaching clinics in Germany. It was during this period that internal medicine was introduced as a specialty in the schools of medicine in Berlin, Gottingen, and Vienna. [1] Postgraduate education in these clinics was directed at the practice of clinical medicine and was based on the latest advances in physiology, bacteriology, and pathology. The switch from mere observation to understanding had been made.

William Osler was one of the first medical teachers who realised that this paradigm shift towards pathophysiology, from knowing to knowing how, had significant implications for medical education. He wrote about this on several occasions, and his main message was: do not try to teach the student too much, but give him good methods, and a proper point of view, and all other things will be added, as his experience grows. [2] Self directed, problem based learning "avant la lettre".

With this quotation by the most cited author on medical education, I thought that I could easily accept the invitation to present the Fellowship of Postgraduate Education lecture on the subject of postgraduate education in internal medicine in Europe. After all, internal medicine was invented in Europe, William Osler, respected in the Old and in the New world, had prescribed the teaching method already, and all I had just to do was describe the good methods and the proper point of view.

I completely agree with Osler's point of view on medical education that it is not the burden of factual knowledge that is important, because knowledge is fleeting. What is important is to learn the methods for obtaining and applying knowledge, and to acquire a viewpoint on how to become the best possible internist for your patients and your public: that is the core of medical education in internal medicine.

I will, therefore, try to develop a point of view for the European internist, a blueprint of internal medicine founded on the philosophy of internal medicine, the present legislation, the practice of internal medicine in Europe, and on images of Europe. I will also discuss the method of good educational practice on the basis of the present training programmes and of concepts of learning.

A point of view on internal medicine in Europe

The main goal of postgraduate education in internal medicine is the making of good internists. For that purpose it is necessary to define what a good internist is, since a viewpoint on the principles and practice of an internist in the 21st century in Europe will obviously form the framework for present final requirements of postgraduate training.

The philosophy of internal medicine

As a consequence of the Cartesian philosophy, that man functions as a machine and that defects in this machinery cause illness, the science of internal medicine started in the middle of the 17th century with observation at the bedside with the description of diseases, known as nosography. Thomas Sydenham, who practised in London in 1655, gave clinical observation its place as a scientific method. [3] In philosophical terms observational medicine is an inductive science, from observation of single patients or phenomena to general rules. Boerhaave, who taught at Leiden University at the beginning of the 18th century, was greatly influenced by Sydenham's work on clinical observation. In Boerhaave's textbook, A Method of studying Physics, sold in London in 1729 for the price of five shillings, an early mention of medicina interna can be found. At that time, Boerhaave's influence as a clinical …