Persistent

The real problem of focusing on knowledge and skill that has persistent value is not that quality could not be quantified, but, what makes up a persistent value.

For example, although we agree a fellowship or PhD degree does not worth much as more and more people bear the title, does it mean a certain collection of clinical skill (or, using the jargon of our educationalist, core competence) is timeless and should be mastered by all medical students?

On the face of it, yes. Otherwise it would be silly to conduct a clinical examination.

However, when you think of it again, no single technique is critical and indispensable, not to say the importance of which would not change with time. For example, it is not that necessary for a final year student to be able to pick up a heart murmur if he decides to become a surgeon or psychiatrist. Well, it really isn’t important if the student misses a murmur even if he intends to be a cardiologist – because he would certainly learn echocardiogram in the future. In fact, with the advance in technology, stethoscope with an amplifier is now widely available, and it is not difficult to detect a murmur even if he is almost deaf. (The real problem often is, of course, as Sherlock Holmes said, you hear, but you do not listen.)

You may argue the ability to take a full history and performing a competent physical examination remains the core competence if a medical graduate determines to be a clinician, because he may be working in a place that has not advanced technology. Well, that argument only proves that the ability of performing echocardiogram or reading a CT scan has no eternal value – because you may be practicing in a place without these facilities. However, it does not prove that being able to detect a murmur or performing a complete neurological examination has a timeless value – because you may also be working in an institute where you always need to objectively prove a physical sign by technology.