Pedagogy of the Proxy: How We Teach ‘Data-First’ Medicine

There was a time when a student could theoretically learn “everything.” As medical knowledge grew to incomprehensible proportions, we hit a wall—and we responded by doubling down on the wrong thing.

Pedagogy of the Proxy: How We Teach ‘Data-First’ Medicine

There was a time when a student could theoretically learn “everything.”

But as medical knowledge grew to incomprehensible proportions, we hit a wall. The human mind simply cannot hold that much data. Unfortunately, instead of evolving to focus on the capacity to think and the ability to feel, medical education doubled down on the memorization of facts and expanded to the management of data. And with the EHR, data is plentiful.

We continue to teach students to treat a lab value, a radiology test, a dashboard, and (my personal favorite) the RVU potential of a patient long before they ever touch a human being. We aren’t teaching them to read the person; we’re teaching them to read data points.

In behavioral science, this is Shaping. We incrementally reward students for over-valuing structured data while ignoring subjective observation.

• The Reward: Identify a “normal” lab on a slide, and you get praise.
• The Penalty: Ask about the complex, unmeasurable psychosocial factors behind that lab, and you’re told it’s “non-essential.”

By the time a student reaches residency, we have successfully shaped a “Data-First” reflex. We’ve built the foundation for the Representative Heuristic and trained them to believe the data is the patient.

By the time a student reaches residency, we have successfully shaped a “Data-First” reflex. We’ve built the foundation for the Representative Heuristic and trained them to believe the data is the patient.

It’s no wonder some physicians worry that AI will take their profession. We are training them to do something that AI can do better.