The Jeremiah Metzger lecture: Osler - web - rendezvous: impact of the information explosion on medical education.

Bert Dupont has been a mentor, colleague, and friend for over 35 years and I am honored to have been invited by him to give the 44th Jeremiah Metzger lecture. In reviewing Dr. Metzger's life, his contributions, and his role in this association, I was pleased to see that he spent most of his medical career here in Tucson. As the new Dean of Medical Education at Baylor College of Medicine, I have focused in the past year on assessing the continuum of medical education, UME → GME → CME and the effects of the information explosion on the practice of medicine. Because of my interest in and admiration for William Osler's achievements, I thought about how he would view our current and future educational issues. Have things in medical education really changed? Are we witnessing a true revolution or the natural evolution of issues debated by academic educators for the past 100 years? After teaching at both McGill University and the University of Pennsylvania Schools of Medicine, William Osler arrived at the new Johns Hopkins Hospital (1889) and medical school (1893) as the first Chair of Medicine and Chief of the Medicine Service (1). For sixteen years in Baltimore (1889 - 1905) and fourteen years in Oxford, England (1905 - 1919), Osler implemented and published many of his ideas on medical education (2–6). Through his published essays, he outlined a philosophy of life and delineated the critical issues facing his generation (Figure 1). He was concerned about multiple educational issues: the influence of teacher on student, the access to medical information through libraries and professional societies, and the centrality of the physician - patient relationship. Fig. 1 William Osler's central medical education issues. Osler was recognized during his lifetime as the consummate clinician - educator. He wanted to be remembered for bringing bedside teaching to the 3rd and 4th year medical students. He instituted the beginnings of a medicine residency program which has many similarities to how we structure ours to this day. He was a staunch benefactor of state and local medical societies and believed they were vital resources for the practicing physicians' continuing education (7). Unlike Abraham Flexner, who focused predominately on the undergraduate medical school curriculum, Osler was concerned equally about the continuum of medical education from undergraduate to post-graduate training and about the need for lifelong learning for the practicing physician. Osler's textbook, The Principles and Practice of Medicine, was first published in 1892 and became an instant best-seller (8). It went through multiple editions and was translated into many languages. For over 30 years, it was considered the single best source for practitioners who wanted to be “up to date.” During his career, there was a dramatic increase in published journals and pamphlets (9). Most of the published journals in the late 19th and early 20th centuries were not well reviewed or edited (10). Randomized controlled trials (RCTs) would not be published until the 1940's. Even with the growth of medical journal publications, many physicians could not access the published literature unless they lived in large cities with medical societies and/or libraries (11). Throughout his writings, Osler voiced his concerns about the increase in the volume of medical literature, about the need for improved accessibility and quality, as well as, how the information would affect medical education across the continuum.