Medical Education 2012: 46 : 153–162 Context  Aphorisms are succinct sayings that offer advice. They have permanently coloured medical culture and inhabit it in the same way as uncertainty; they are acknowledged, but rarely explored. Little has been written analytically or critically about the meanings and purposes of aphorisms in contemporary medical education, especially as a processional activity that maintains tradition, but both adds to and reframes it. Discussion  We note multiple purposes for medical aphorisms, including roles as heuristics (rules of thumb) for practice, and in the identity construction of the clinician within a community beset by professional uncertainty and accountability. We suggest that aphorisms should be cared for not simply as historical curiosities, but as renewable ways of creating an ‘art of memory’ in medical education, stimulating recognition and recall as aesthetic rhetorical devices. In this spirit, we encourage the development of aphorisms appropriate for 21st century medicine in a process that should include the involvement of patients in building a proxy public literacy to inform collaboration in clinical encounters. Conclusions  We propose a novel framework for aphorisms, emphasising strategies to enhance or maximise clinical judgement and professional behaviour, affirm identities, and educate the public via the media.

A curriculum innovation for a new UK medical school – Peninsula, launched in 2002 – was grounded in a period of radical pedagogical innovation in medical education in the UK during the 1990s. Part of this thinking was to include the medical humanities as a medium for re-thinking medical practice, especially how medical students might better learn to communicate with patients and colleagues, and how they might become agents of change in progressing medicine through innovations. In designing the curriculum, Cultural-historical Activity Theory (CHAT) was used as a model to ‘think’, or reconceptualise, the purposes of a curriculum. The first question asked was: ‘what do patients want?’ Emphasis was placed on resisting a ‘will-to-stability’ in adopting safe curriculum process, in favour of adopting a ‘possibility knowledge’ framework that celebrated dialogue. This operated through three ‘spearheads’, or radical aims: democratic habits, towards the feminine, and tender-mindedness.

Progress in teaching and learning clinical reasoning depends upon more sophisticated modelling of the reasoning process itself. Current accounts of clinical reasoning, grounded in experimental psyc...

The journal Advances in Health Sciences Education: Theory and Practice has, under Geoff Norman’s leadership, promoted a collaborative approach to investigating educationally-savvy and innovative health care practices, where academic medical educators can work closely with healthcare practitioners to improve patient care and safety. But in medical practice in particular this networked approach is often compromised by a lingering, historically conditioned pattern of heroic individualism (under the banner ‘self help’). In an era promising patient-centredness and inter-professional practices, we must ask: ‘when will medicine, and its informing agent medical education, embrace democratic habits and collectivism?’ The symptom of lingering heroic individualism is particularly prominent in North American medical education. This is echoed in widespread resistance to a government-controlled public health, where the USA remains the only advanced economy that fails to provide universal health care. I track a resistance to collectivist medical-educational reform historically from a mid-nineteenth century nexus of influential thinkers who came, some unwittingly, to shape North American medical education within a Protestant-Capitalist individualist tradition. This tradition still lingers, where some doctors recall a fictional ‘golden age’ of medical practice and education, actually long since eclipsed by fluid inter-professional health care team practices. I cast this tension between conservative traditions of individualism and progressive collectivism as a political issue.