Donate

Teaching of medicine: ivory tower, or horse and buggy?

Teaching of medicine: ivory tower, or horse and buggy?

  • April 9, 1954
  • Dickinson W. Richards
  • Article

In his 1954 essay “Teaching of Medicine: Ivory Tower or Horse and Buggy?”, Dickinson W. Richards critiques the evolution of medical education from its early 20th-century shift toward laboratory-based science to a more recent resurgence of experiential, community-based learning. He highlights the historical push led by reformers like William Welch and the Flexners to ground medicine in science, which led to significant advances but also distanced students from the humanistic, patient-centered aspects of care. Richards notes a new educational movement emphasizing field-based experiences and learning alongside general practitioners in rural settings. While acknowledging the value of reconnecting students with real-world medicine, he raises concerns about students being sent into communities without proper training or guidance. Drawing on philosophical reflections, especially from Plato, Richards urges educators to focus not only on the content taught but on nurturing the whole student—“the soul of our young men.” He stresses the importance of observation, systematic learning, and memory in medical education, and concludes that true clinical teaching requires not a specific setting but the right combination of teacher, student, and patient, emphasizing that how we teach students to learn is just as critical as what we teach them.

  • Source: Transactions of the American Clinical and Climatological Association

Related Resources

Coleen De Villa

Administrator
Coleen De Villa worked with the Development Academy of the Philippines, WHO, and the Department of Health, excelling in project coordination, research management, and training facilitation.

Dr. Sarah Larkins

MBBS, BMedSci, MPH&TM, PhD, FRACGP, FARGP, GAICD Dean, College of Medicine and Dentistry and Professor, Health Systems Strengthening James Cook University
Dr Sarah Larkins is an experienced research leader, general practitioner and Dean, College of Medicine and Dentistry, James Cook University, comprising disciplines of Medicine, Dentistry, Pharmacy, Public Health and Tropical Medicine and Biomedicine and Molecular Cell Biology.  As a clinician researcher, Sarah has particular skills and experience in health systems and workforce research and Aboriginal and Torres Strait Islander health research and is a recognised expert in social accountability in health professional education. Sarah is also Co-Director of the Anton Breinl Research Centre for Health Systems Strengthening. Sarah has over 180 published peer-reviewed journal articles and several book chapters, with an h-index of 37, more than 4500 citations and well over $98m in grant funding.  She currently supervises 10 HDR students with 20 PhD completions.
Sarah’s particular focus is on collaborating to improve equity in health care services for underserved populations, particularly rural, remote, Indigenous and tropical populations, and on training a health workforce with appropriate knowledge, attitudes and skills for this purpose.  She currently serves as the Convenor, Clinical Leadership Group for the NHMRC-recognised Tropical Australian Academic Health Centre and a member of the National Health and Medical Research Council Research Committee for this triennium. Sarah has three young adult sons and loves travel, hiking and other outdoor activities.

Dr. Charlie Labarda

Board Member

Charlie Labarda, MD, PhD, is a Professor of Medicine and Dean of the School of Health Sciences at the University of the Philippines Manila (UPM-SHS), where he has taught for more than a decade. He is a regular member of the National research Council of the Philippines, belonging to the Medical Sciences Division (Division III). Before joining the medical faculty at UPM-SHS he trained in at the Department of Family and Community Medicine at the Philippine General Hospital. He finished his PhD in the Department of Psychology at The University of Hong Kong, his Master in Development Management from the Asian Institute of Management (high honors), Doctor of Medicine (cum laude) at the Our Lady of Fatima University-College of Medicine, and his undergraduate Social Sciences studies (cum laude) at UP Tacloban College. He was a topnotcher in the Physician Licensure Examination (8th place).

He served as the Unit Faculty Representative to the All UP Academic Employees Union-Manila Chapter. He is also part of the UPM-SHS core faculty for the Leadership and Development Program (LDP) capacitating local chief executives (governors and mayors) in strengthening their health systems to achieve the goals of universal health care and sustainable development goals (SDGs) of the Philippine government. He also volunteers as civil society partner of DSWD in its 4Ps Program as Vice-Chairperson for the National Independent Monitoring Committee (NIMC). He also helps in various DOH and WHO projects in line with his advocacies around medical education, health equity, disaster public health, resilient and healthy communities, and mental health especially in low resource settings. Recently he became part of the Data Science for Public Policy Working Group based at the UP Center for Integrative and Development Studies (UP-CIDS), promoting the use of data science for public policy.

Dr. Shafik Dharamsi

Board Member
Dr. Dharamsi is Professor and Dean of the School of Public Health at the University of North Texas Health Science Center (UNTHSC) in Forth Worth, Texas. He received his Ph.D. in 2003 from the University of British Columbia in Vancouver, Canada. After completing his doctoral education, he worked with the Aga Khan Development Network as the Regional Director of an innovative, community-engaged early childhood development initiative in East Africa (Kenya, Tanzania & Uganda). He then returned to Canada to join the University of British Columbia. His research focuses on social accountability and health professions education, global health, and social determinants of health.
He led the creation of an extensive, university-wide project that resulted in an innovative flagship initiative called the Ethics of International Engagement and Service Learning, which received the prestigious UBC Graduating Class Award for campus-wide initiatives that are “creative, support social justice, support sustainability, and support volunteer programs on campus.” Prior to joining UNTHSC, Dr. Dharamsi served in various academic leadership positions including as Senior Advisor the Provost at New Mexico State University, Dean of the College of Health Sciences at the University of Texas at El Paso, and Founding Associate Dean for the new School of Osteopathic Medicine at the University of the Incarnate Word in San Antonio. His work has been published widely and funded through prominent foundations and research agencies. He has extensive education, research and community development experience in Asia and Africa, as well as in Canada and the U.S.

Dr. Dharamsi currently serves as the Dean of the College of Public Health at the University of North Texas Health Science Center. With 25 years of experience, he brings an interdisciplinary background and extensive international and community development experience as an educator, scholar, and administrator.

Dr. Dharamsi’s academic journey began in Canada, where he earned an interdisciplinary PhD from the University of British Columbia (UBC) and achieved tenure in the Department of Family Medicine. He also co-directed the UBC Center for International Health.

 

His work is at the intersection of public health, medical humanities, global health, ethics, and the social determinants of health.

 

Born in Tanzania, Dr. Dharamsi is a first-generation high school and college graduate. He is deeply committed to student success. He began his career as an inner-city schoolteacher.

 

His career includes leadership roles as regional director for early childhood development and poverty alleviation in East Africa with the Aga Khan Development Network, founding associate dean of the School of Osteopathic Medicine at the University of the Incarnate Word in San Antonio, dean of the College of Health Sciences at the University of Texas at El Paso, and senior advisor to the provost at New Mexico State University.

 

Dedicated to advancing public health, Dr. Dharamsi actively serves on the boards of several national and international organizations, including the ASPPH Global Engagement and Partnerships Advisory Committee.

Bjorg Pálsdóttir, MPA

Chief Executive Officer and Co-Founder of THEnet
Before co-founding THEnet in 2008, Björg served as a consultant to organizations, governments and institutions such as the National Academy of Sciences, the World Bank and the Bill and Melinda Gates Foundation.
She is a member of the Institute of Medicine´s Global Forum on Innovation in Health Professional Education, chairing an Innovation Collaborative on on Learning through Community Engagement. Earlier she co-founded the Center for Global Health at New York University School of Medicine, and worked for the International Rescue Committee, an emergency relief and development organization as a Regional Coordinator for East and Central Africa.