In The Role and Importance of Research and Scholarship in Dental Education and Practice (Journal Dent Educ 66 (8):918-924), Dr. Charles N. Bertolami argues that the goal of health professions education is not to make every student a scientist -- a producer of research -- but rather to make every student a man or woman of science. What is a man or women of science? Dr. Bertolami defines such people as sophisticated consumers of research. He goes on to emphasize sheer intellectual curiosity and an appreciation for complexity, for problems, and for problem solving, as essential elements in the making of health professions students who are men and women of science. In keeping with these concepts, we would like to offer the following reflections on the role of discovery in shaping the thinking, beliefs, and behavior of men and women of science.
Teachers as Facilitators of Discovery
The word discovery is often used to refer to the production of knowledge that did not exist before. But even the most original, revolutionary discoveries do not constitute the creation of knowledge ex nihilo. Scientific discoveries make sense to us because we are able to interpret them within a context, a larger structure of knowledge. Few men and women of science are likely to make paradigm-shifting discoveries, just as most career scientists rarely contribute profound, theory-altering breakthroughs. Nevertheless, the concept of scientific discovery is pivotal to understanding the process by which men and women of science develop.
The late educator and philosopher Mortimer Adler distinguished between learning by instruction and learning by discovery. In terms of the knowledge that teachers pass on to their students, someone first must have discovered the entity, idea, theory, or practice. Learning by discovery is therefore primary, while learning by instruction is secondary. It follows that in an absolute sense, teachers are dispensable. However, this does not mean that teachers are unimportant; on the contrary, they are necessary for most of us. Socrates analogized his role as a teacher to that of a midwife. In this way of thinking, effective teachers are facilitators who assist learners in giving birth to new knowledge through discovery. Like the Socratic midwife, they assist learners in discovering knowledge for themselves. But unless the teacher is a man or woman of science -- one who is skilled at learning by discovery -- he or she cannot assist students in becoming men and women of science.
Discovery is involved in all learning, and learning by instruction can be defined as learning by aided discovery. In the classroom and clinic, faculty have the capacity to develop men and women of science whenever they stimulate excitement and inquisitiveness among their students about the process of learning, and create the desire among their student protégés to make discoveries for themselves -- about techniques, materials, concepts, theories, and applications. Faculty also aid discovery when they encourage students to ask questions, challenge assumptions, and learn not only in the classroom or clinic, but, more important, on their own, in the outside world. Such faculty meet the core challenge of teaching. By their ability to make the subject matter appealing and fascinating to students, they facilitate students’ ability to discover knowledge for themselves. As Adler observes, the excellent teacher is one whose aim is to make his or her instruction totally dispensable by transforming those taught into independent learners.
Closely related to discovery is the ability to think critically. While critical thinking is not a sufficient condition for scientific activity, one could not be considered a scientist if he or she failed to exhibit critical thinking skills. By the same token, we would expect men and women of science, as sophisticated consumers of the outcomes of scholarly inquiry, to be able to think critically.
Critical Thinking: The Basis for a Scientific, Evidence-based Approach to Clinical Practice
Critical thinking means the ability to apply logic and accepted intellectual standards to reasoning; access and evaluate evidence; demonstrate a disposition towards inquiry that includes openness, self-assessment, curiosity, skepticism, and dialogue; and, for healthcare professionals, the ability to apply knowledge in clinical reasoning. Critical thinking enables the healthcare provider to recognize pertinent information in a patient’s presentation; make accurate diagnostic and therapeutic decisions based on a deliberate and open-minded review of the available options; evaluate outcomes of therapeutic decisions; and assess his or her own performance.
Role Modeling an Evidence-based Approach to Clinical Practice
Faculty members can help students become evidence-based practitioners by modeling behavior that distinguishes among conjecture, conviction, and certainty in relation to scientific claims.
Conjecture represents contentions that are speculative in nature, based on hopes and assumptions, but without scientific underpinnings; conviction represents assertions based on belief, hopes and desires or argumentation; and certainty represents theories and heuristics supported by the accumulation of evidence.
Men and women of science do not posit knowledge and subsequent applications simply because it works well for me, but rather because the matter works well for others in a variety of circumstances over time. In doing so, they show themselves to be sophisticated consumers and appraisers of research, able to assess the patient objectively with the goal of providing care based on the best evidence.
Beware the Baedeker
Educating health professions students to become men and women of science is essential to the creation of competent healthcare practitioners. The assumptions, methodology, and values of science need to become a way of seeing the world, a way of interpreting it, and a general attitude toward theory and practice. However, there is one caveat that is especially important for men and women of science as they enter the caring professions. The Viennese thinker Ludwig Wittgenstein submits this caution:
People who are constantly asking ‘why’ are like tourists who stand in front of a building reading Baedeker [the guidebook] and are so busy reading the history of its construction, etc., that they are prevented from seeing the building. (Wittgenstein, Ludwig. Culture and Value. Trans. Peter Winch. Chicago: University of Chicago Press, 1980.)
In the extreme, science becomes scientism, the adherence to the assumption that the scientific method is the only reliable way of knowing anything. Scientism runs the danger of a reductionist approach to life: every object and event, including all human ones, are reduced to a description of mechanical processes. Are we in danger of developing men and women of scientism? Probably not. Scientism is an impractical philosophy by which to conduct one’s life because of the inability to act consistently with its basic assumptions. Nevertheless, if the scientific view becomes the only interpretation and the only way of interacting with patients, men and women of science run the risk of practicing health care with the head only and not also the heart. The potential exists to minimize the importance of human emotions, ethics, morality, aesthetics, spirituality, and other areas where empirical verifiability is difficult or, as far as we know, impossible.
Accordingly, men and women of science must learn to balance science’s rigorous analytical approach with emotional intelligence. One does not need to postulate about metaphysical entities to note that aspects of our humanity emerge from the conglomeration of atoms from which we are formed. The reduction of the patient’s fear and anxiety to neural firings is of little comfort to the patient. But a healthcare provider who thinks like a man or woman of science and empathizes with the patient is of great value to society.
Ultimately, to call a person a man or woman of science is to say that he or she expresses an attitude toward the world -- has a way of seeing the world -- through the lens of science. Plato wrote that all philosophy, which included science at the time, begins with a sense of wonder. In general, men and women of science are people who express this sense of wonder. They have a desire -- in its exemplary form, a compelling desire -- to know. This desire to know shows itself in a variety of behaviors, but in particular those behaviors that we as educators associate with the joy of learning by discovery.
* The Academy for Academic Leadership (AAL) is a collaborative of scholars, educational specialists, and consultants serving individuals and organizations in professional education. The AAL’s mission is to cultivate personal and professional leadership by engaging individuals and organizations in the discovery of ideas, the application of knowledge, and the adventure of lifelong learning.