Download - 400 degrees, 20 minutes
400 Degrees, 20 Minutes
About the only things I cook in the kitchen are steaks and
fish. I cook everything at 400 degrees for 20 minutes, and things have always seemed to me to turn out quite well.
The fish is moist and tender, and the steaks are cooked enough so that they no longer move under their own
power and are never burnt. It seems like a good formula
to me. Once in awhile I get fancy and add, as a flourish,
1 minute of broiling at the end, but that's just showing
off. That came to mind the other day when I was looking
at some marvelous three-dimensional images of the upper
thorax that showed the subclavian artery trapped between
the clavicle and the first rib. The image could be turned
any which way, and on one view I could even see down
the vertebral canal. Spectacular stuff. All it takes is a spi- ral computed tomographic scanner, a properly planned
image acquisition protocol, and adequate reconstruction
time.
Our physicist tells me that the day will come when all
of our diagnostic studies will be portrayed on a television
monitor rather than on film, and I believe him. He also
tells me that the day will come when everything we see will be in three dimensions and be utterly manipulable.
Two-dimensional images will be passr, and plain radio-
gral~hs will be historical curiosities. Since most of the ex-
aminations now performed in our department are these soon-to-be historical curiosities, the prospect of the New
Order gives me pause. Now that our radiology course has become a required
clerkship, I get to go to the monthly meetings of the
clerkship directors. There we discuss problems and de-
sign solutions, and we spend quite a lot of our time talk-
ing about the creation of a new curriculum. The old one
is to be discarded in favor of a curriculum characterized
by small class groups, few lectures, lots of interaction, and problem-based learning, from year 1 on. The design-
ers of the new plan assure us that the day is long gone
when faculty time can be conserved by lecturing to large
groups, and the sciences basic to medicine will be learned
at the same time as patient care. The anatomy course I re-
member (from 1951) lasted many hours a day for a full
academic year. It is now but a faint shadow of its former
self--an 8-week course that necessarily leaves out a lot. No one has figured out a way to accurately measure
the quality of the product we produce in medical school,
so we are unlikely to be able to show much in the way of
difference between the physicians we produced under the
old curriculum and those we manufacture under the new
one. But modern times require modern approaches, and if
all that results is happier students, perhaps we should be
satisfied. The fact that the new curriculum will require
immeasurably more faculty time for no real promise of
improved results is largely ignored.
Progress is a good thing, but it is not synonymous with
change. In the case of radiologic imaging, progress may
be defined as steps in the direction of improving diagnos- tic accuracy such that patient care is improved. We can
count as progress of a lesser degree those steps that do
not change things for the patient but make them cheaper.
In the case of curricular reform, progress should be de-
fined as those changes that improve the outcome, that is,
produce a better physician. Failing that, we can count as
lesser progress those changes that do not cause deteriora-
tion of the product and at the same time make everyone
happier. We can cook steaks on the outdoor grill, microwave
them, or even bury them in the earth wrapped in banana
tree leaves and surrounded by hot coals. And fish can be
eaten raw, marinated and never cooked, or cooked in a
variety of ways. If the result is better looking, better tast-
ing, or better for you and costs no more in time, trouble,
and money than 400 degrees at 20 minutes, we should
surely do it. Some of the time we do it just for the sake of variety, and I think that is a potent element of our interest
in new imaging methods and curricula. But if we cannot
demonstrate that we have gotten something demonstrably worthwhile for our extra effort and expense, we might
want to hang on to tried-and-true methods a little bit
longer. Melvyn H. Schreiber, MD
University of Texas Medical Branch Galveston, Tex
659