Becoming a Medical Doctor Without Going to College?

Can you imagine a future where a person is endorsed as fully qualified to serve as a medical doctor without ever going to college or medical school? If we look back far enough in history, we know that this was commonplace, even the standard. Today, such an idea seems reckless or absurd to most people. How could someone possibly gain all the knowledge, skill, and experiences necessary to do that job at the standard that we expect in healthcare today? How could someone reach that level of competence without going through a formal curriculum, studying from several hundred dollar textbooks, attending countless seminars and lectures, doing the carefully crafted hands on learning, being carefully assessed and vetted, and going through the entire sequences of learning experiences created for future doctors as they progress through college and medical school? Would you want a brain surgeon to work on you who never went to medical school? It is hard to even imagine a modern world work someone could reach that level of expertise, be recognized as such, be highly qualified, and receive a job as a doctor.

Yet, as a thought experiment, imagine that you had to propose and then create two or three alternative models for people becoming doctors. Suppose that you had to create a system for equipping tens of thousands of highly qualified and competent future medical doctors, but you had to do it without college or medical school. Where would you start?

Many instructional designers would probably begin by conducting a careful analysis of exactly what knowledge, skills, dispositions, and mindsets are necessary to do the work of a general practitioner today. You might interview people, do a careful and in-depth study of doctors in the workplace, examine the problems and procedures commonplace in that line of work, and whatever else it takes to create this initial list. Then, given the importance that people attribute to this particular work, you would probably establish ways to further vet, verify, and refine that list.

Once you know what is needed, then what? Again, the traditional instruction designer might jump to the end. What is the best possible evidence that someone embodies all of the competencies and/or proficiency that you identified? Given the importance attributed to this line of work, you would work hard to make sure that whatever plan you devised would provide a high level of confidence that people were truly competent.

After that, you might delve into research on the best way to help someone move from novice to expert in terms of the competencies and/or proficiencies listed. Perhaps you would examine a blend of teaching and learning strategies, maybe even looking at how to design adaptive learning software that constantly monitors performance and adjust to optimize learning.

Not doing this in the context of formal college and/or medical school, you don’t have any of the limitations established by these structures. Time, place, pace, and the learning pathway are completely flexible. One person might demonstrate competency in a short time, while another might work on it over a decade or two. There are no rules about who is allowed to study or not. There are no rules about how much it would cost. There are not requirements about who is in charge of the learning. The only requirement is that there is a clearly defined set of competencies and proficiencies, and that there are valid and reliable measures of learning that have an incredibly high level of predictive power with regard to future performance as a medical doctor. You can also be free to design multiple learning pathways, even ones that are constantly adapting and learning how monitor and maximize the learning of each person.

We talk about the unbundling of higher education today, and there are ample examples of it. Most are with competencies related to less regulated jobs and professions. However, thinking about a highly regulated and largely unquestioned learning pathway like medical school might be a helpful thought experiment. It is an exercise in imagining alternatives to the current system, the potential affordances of such alternatives, as well as the limitations.

As it stands, much policy and practice is based upon an unquestioning acceptance of the current system. As I’ve mentioned before and drawing from a Henry Ford quote, our attempts at educational innovation are most often the faster horse sort of solution. We assume that the system that we have is the one that we should have or will always have. Or, we are too worried about the potential losses to consider something that might completely disrupt the current system. Yet, there is benefit in sometimes stepping away from the current structures and allowing ourselves to truly imagine the breadth of possibilities. Perhaps we will discover truly promising options that were largely hidden from us before.

One Reply to “Becoming a Medical Doctor Without Going to College?”

  1. Robert Columbia

    Dr. Bull,

    Excellent points, and ones that I’ve believed for some time.

    Isn’t it about time to actually *do* something about this? I’ve been following Competency-Based Education (CBE) trends for years now, and it seems that it has mostly gotten stuck in “Analysis Paralysis” – lots of articles come out every year about how the future of direct assessment is going to be so awesome, more awesome than sliced bread, the awesome power of the “always on” educational technology on the Internet will allow ambitious children to receive the equivalent of three PhD’s by age 12 by watching videos, reading e-books, and doing experiments in Virtual Reality (VR), and that in a few years the workplace’s “Skills Gap” is going to be gone because everyone will be able to learn any skill they want at home for less than a Jr. Double McMegaBurger. I see far more of this talk, and a lot less of the associated walk.

    What do you think we will be able to *accomplish* in the coming, say, five or ten years? I’m guessing that direct entry exam-only medical doctor licensure for persons without a college education is too ambitious (and it seems you are acknowledging that by phrasing your article as a thought experiment), but *what level of progress do you think is reasonable and achievable*? Should we expect direct entry, no college licensure as a Licensed Practical Nurse (LPN) to be introduced? In my state, you do not need any college to be licensed as an LPN, but you have to at least attend an accredited LPN trade school – no self-taught, MOOC-taught, or otherwise not-traditionally educated mavericks allowed! Would non-healthcare professions be a better next step? Most professions seem to be moving in the *opposite* direction – adding more prerequisites, requiring more advanced degrees, and overall making the process more burdensome, not the other way around! Should we bring back the old exam-only public school teacher licensure routes? Should we bring back their *idea*, but roll out the latest in higher-order, adaptive assessment ands make the new exams very closely aligned with the true competency requirements of the field?

    To be clear, CBE programs such as those offered by WGU are great – but it seems that those have been around for a long time and that progress has stagnated. There are more schools getting on the CBE bandwagon and offering their own programs, true, but I don’t see very many truly new CBE *pathways*. I’m also a bit dismayed at how CBE programs *must* link back to the standard university degree system (bachelor’s, master’s, etc.), which date back to the Middle Ages at least, rather than set up a new system that more closely matches today’s ways of life. At one point, academic degrees were about *academia*, and anything not in academia (e.g. professional practice, trades, business, etc.) was outside of the standard degree system. Nowadays, we have degrees in accounting, auto mechanics, paralegal studies, even police work. Do we really need that?

    I do know that a lot of this stuff is mired in politics, but isn’t that’s a problem to solve, not a reason to give up? What can be done? And, more importantly, what can ambitious independent learners such as myself do other than hang out in the library, learning and waiting for our dream program to land in our laps?

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