Epidemiology As A Liberal Art
David W. Fraser
The New England Journal of Medicine
Abstract
Epidemiology has features that resemble those of the traditional liberal arts. This makes it fit both for inclusion in an undergraduate curriculum and as an example in medical school of the continuing value of a liberal education. As a "low-technology" science, epidemiology is readily accessible to nonspecialists. Because it is useful for taking a first look at a new problem, it is applicable to a broad range of interesting phenomena. Furthermore, it emphasizes method rather than arcane knowledge and illustrates the approaches to problems and the kinds of thinking that a liberal education should cultivate: the scientific method, analogic thinking, deductive reasoning, problem solving within constraints, and concern for aesthetic values. (N Engl J Med 1987; 316:309-14).
Text:
The sharp distinction between undergraduate and medical education has been a peculiar and useful characteristic of the educational system in the United States. Because physicians-to-be are expected to finish four years of college before medical school, they are encouraged to acquire a broad understanding of the liberal arts. Recently, the importance of this breadth has been emphasized, especially in the humanities (Ref. 1). The distinction, however, may have obscured the fact that a medical discipline need not be confiningly narrow and may in fact contain many of the elements of the liberal arts that make them suitable for an undergraduate curriculum.
In judging the suitability of a discipline for undergraduate study, one should look for the essential characteristics of the liberal arts, which I take to be the fields that help free students from the limitations of prior beliefs and experiences and that teach important modes of thinking so as to prepare them to ask and answer new questions. Five approaches to problems or modes of thinking stand out as particularly important, and although not all may be used in a particular discipline, students should seek to become competent in each during the course of liberal arts study. The five, in no particular order, are the scientific method, analogic thinking, deductive reasoning, problem solving within constraints, and concern for aesthetic values.
In this paper, I propose epidemiology as an example of a discipline that, although rarely included in undergraduate liberal arts education, (Ref. 2,3) might well be. This essay is not intended particularly as a brief for epidemiology or to explain why an epidemiologist (myself) might head a liberal arts college (Swarthmore). It is meant more as an exploration, using a concrete example, of the characteristics of a discipline that fit it for inclusion in a liberal arts curriculum and a demonstration that, at least for some disciplines, an emphasis on teaching rather than content distinguishes liberal from purely professional learning.
Although it is often assumed to be limited to the investigation of epidemics, epidemiology is more properly considered either the study of patterns of disease occurrence in human populations or, even more broadly, the comparison of rates of occurrence of phenomena in various populations so as to increase understanding of the human situation. Epidemiology is commonly considered one of the subdisciplines of medicine, which -- like other professional disciplines -- is often seen as antithetical to the liberal arts. In some ways that characterization of the professions is fair. Certainly, the arcane nature of the professions, with their heavy emphasis on detailed information, the repetitive application of knowledge to solve common problems, and the narrowness of the scope of inquiry suggest that professional studies are inappropriate for an undergraduate liberal arts education. But epidemiology as a professional discipline is anomalous. The heavy emphasis on the method of inquiry, rather than specialized information, is distinctive. Its usefulness as a technique for taking a first pass at a new problem makes it applicable to a wide range of interesting phenomena. And the fact that it is a "low-technology" science makes it accessible to many who are more interested in clear thinking than in complicated laboratory experimentation.
A series of examples may illustrate best the ways epidemiology draws on various modes of thinking.
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