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MEDICAL SCHOOL
TRAINING

Changes in Post Graduate

Medical Education

By David P. Green, MD

ost graduate medical education has changed radically in the past
several decades. Perhaps the most obvious difference is how res-
Pidents and fellows access information. When I joined the full-
time faculty at the brand-new University of Texas Medical School at
San Antonio in 1970, medical knowledge was acquired through lec-
tures, journal articles, conferences and the relatively few textbooks that
were available then. For example, in my specialty Orthopaedics there
existed a couple of out-of-date fracture books, a single, not very good,
volume on general Orthopaedics, a difficult to read pathology text,
and a treatise on Pediatric Orthopaedics. Now, every subspeciality in
Orthopaedics has several two-or-three volume textbooks. I must con-
fess that San Antonio contributed to this deluge of written texts by
publishing “Rockwood and Green’s Fractures in Adults” in 1975 (now
in its 9th edition) and seven years later “Green’s Operative Hand Sur-
gery” (now in its 8th edition), plus additional works generated from
our department on pediatric injuries, the shoulder and orthopaedic
sports medicine. The expansion of medical journals has been even
more explosive. In 1975, there was not a single journal devoted to my
subspecialty, hand surgery, and now there are more than a half dozen.
Even more remarkable than the proliferation of books is that res-
idents and fellows rarely read the written texts in today’s modern
world. Most current textbooks and scientific journals now have online
versions on the internet, which have become the primary source of
reading for residents and fellows. Whereas my generation spent hours
wandering around library stacks looking up articles, young doctors in
training today have the entire world of medical information at their years. This exposure to seasoned veterans is perhaps nowhere more crit-
fingertips (or thumbs, as it were) on their iPhones. ical than in the student’s pursuit of surgical knowledge and techniques.
Another problematic change is the expansion of medical knowledge. The bottom line of all this is simple. No matter the source of medical
Again, to use Orthopaedics as an example, when I was a resident, we knowledge nor how easy it is to access, 90 percent of what any student
had four or five books and a single journal to study in preparation for learns comes from diligent effort and hard work. A teacher will serve as
our specialty board exams. Now, the graduating Orthopaedic resident a mentor and guide, but the goal of becoming a proficient, capable and
has a towering stack of books and journals, each of which contains compassionate physician and surgeon is achieved only by the diligence
information from which an examiner might generate questions. and dedication of the student to learn his or her craft.
It is not surprising then, that the current crop of individuals finish-
ing a residency or fellowship are equipped with far more knowledge David P. Green, MD, is a founder of The Hand and Upper
than those of my generation. What has NOT changed, however, is the Extremity Center of San Antonio, with an international
ability to apply that knowledge appropriately, and that is where men- reputation in hand surgery, and the first surgeon in San Antonio
to devote his practice entirely to hand and upper extremity
tors have a place. Every student at every level needs more experienced surgery. Dr. Green is a member of the Bexar County Medical Society,
teachers and colleagues who do their best to keep the student from and a recipient of the BCMS Golden Aesculapius Award for Lifetime of
making the same mistakes that the mentor did in his or her earlier Distinguished Service.

12 SAN ANTONIO MEDICINE • June 2024