Educating medical students in laboratory medicine.

Conferring a professional degree on a person implies that the person awarded that degree, through his or her education as a student, has attained certain levels of understanding and competency in defined areas of knowledge. A professional degree also implies that the person is qualified to seek a higher level of education, be that a residency training program in medicine, dentistry, or veterinary medicine; a clerkship in law; or graduate education in a related field. To educate effectively, organizations providing that education must be able to assume that graduates of professional programs have the knowledge and competency to be successful in their programs. Attaining this common body of knowledge is what curricula are designed to provide and tiered examinations are designed to assess. It is also assumed that these curricula, examinations, and degrees are in some way designed in an integrated and cohesive manner to ensure that students receive an education that will prepare them for the current state of training and, eventually, practice. Thus, it is (or should be) expected that this common body of knowledge includes all of the pertinent areas of medicine. To a great extent, this indeed happens: curricula at different medical schools are far more similar than they are dissimilar. Yet there are gaps in this education that defy common sense and reason, one of which is the lack of a requirement for formal education in laboratory medicine at all medical schools. This phenomenon is difficult to understand: the number, type, and complexity of laboratory tests has increased markedly during the past 50 years, and health care providers increasingly rely on laboratory tests to make diagnoses, assess the efficacy of therapy (or even to predict the outcome of therapy), and follow the natural progression of diseases. The pressures to see ever higher numbers of patients in many settings limits the time that providers can collect data from interviewing and examining patients, a state that forces providers to rely more and more on the results of laboratory tests, imaging studies, and other types of information generated by health care professionals outside of direct patient care. Why, then, is so little attention paid to teaching medical students about laboratory medicine during medical school? Why is such education not mandated by accrediting agencies? Is informal education about laboratory medicine gained through clinical rotations sufficient to eliminate the need for formal coursework? Would implementing the proposed curriculum described in this issue of the Journal meet the needs of medical students?1 Or are there better alternatives to a standardized curriculum? What would it take to make laboratory medicine a core part of medical school curricula? What should be the next steps to integrate such a curriculum into overall medical school curricula?