Medicine, as a secular technique, has always posed the problem of teaching and learning. The Hippocratic Oath largely concerned the pedagogical relationship between teacher and student and the constraints to be respected in the transmission, and then also in the use, of medical art, when doctors were organized into brotherhoods or sects. At least since the seventeenth century, successive pedagogical and didactic innovations have taken place in different times and for different reasons. Medical science is changing and health challenges are changing faster and faster, as a pandemic with unpredictable characteristics has shown.
The epistemological status of medicine, as it takes shape after the experimental turn of the mid-nineteenth century, or the fact that it is a “set of applied sciences, evolving”For this reason, medical activity must mediate between the search for general knowledge, that is scientific knowledge, and the original purpose for which medicine exists, that is, to take care of the individual patient, is reflected in the philosophical dimensions of medical pedagogy. A look at teaching and learning the ways to cure in the last century shows that the two fundamental innovations, namely the Flexner Reform and the spread of Problem based learning (PBL), were inspired by two well-defined philosophies. Upstream of the Flexner Reform was the idea that scientific medicine was the one that applied experimental method and laboratory research to the definition and solution of clinical problems. The emergence of the PBL was inspired, in addition to the difficulties of the Flexner method after World War II and the new constructivist pedagogy, especially the ideas of clinical epidemiology and then evidence based medicine (Ebm), which equated medical practice with the ability to use the results of randomised and controlled clinical research aimed at empirically establishing the relative effectiveness of different treatments or risk factors.
In recent decades, universities and medical schools around the world have experimented with different thematic alchemy and pedagogical strategies to address the needs of professional differentiation and continuing education, as well as to improve the scientific, cultural and psychological characterization (improperly called “human”) of the doctor. No curricular or didactic solutions have been found to concentrate or better structure the constantly growing and diversified load of information needed to train a good doctor. How to ensure that the doctor who emerges from the training course is properly prepared on a clinical level, as well as motivated, flexible and open to address and manage the ethical, social, economic and organizational challenges of health, and at the same time to seize the opportunities for rapid innovation.
It makes no sense to wait for a new genius and visionary of medical pedagogy like Abraham Flexner or a new group of clinical epidemiologists and inspired pedagogues like the one that at McMaster University introduced the PBL as the basis of medical pedagogy. However, beyond the didactic strategies and curricular integrations so far privileged, something less bureaucratic and more visionary would serve to restore enthusiasm and impetus to those who today undertake the study of medicine, with the attitude of those who face a tiring and not always rational obstacle course. While it could live the training experience as a unique and exciting journey in the most extraordinary scientific knowledge and with equally unique and rewarding opportunities to improve people’s lives.

Gilberto Corbellini
Scientific Director, Festival della Scienza Medica