Medical Education Reform

To the Editor.—  We read with interest the article by Cantor et al¹ and accompanying editorial by Tosteson² regarding the need for reform in medical education and the obstacles (deemed organizational by both) facing instructional innovation. In our view, one salient reason not mentioned for the difficulty in producing meaningful change is that a key paradigm underlying medical learning and practice—medical ignorance—has neither been clearly articulated nor even respected within the confines of our medical knowledge factories.In this era of the information explosion, medical deans, faculty, and students continue to be preoccupied with new ways to package and transmit burgeoning knowledge. Perhaps it would be more productive to admit the transitory nature of much accepted knowledge and concentrate on nurturing the ability not only to learn with enthusiasm, but also to forget needless, mind-boggling information. In 1985, based on the whimsical suggestion of physician-essayist Lewis Thomas that