Achieving the aims of education: curricular decisions in critical care

The mind is never passive; it is a perpetual activity, delicate, receptive, responsive to stimulus. You cannot postpone its life until you have sharpened it.Whatever interest attaches to your subject-matter must be evoked here and now; whatever powers you are strengthening in the pupil, must be exercised here and now; whatever possibilities of mental life your teaching should impart, must be exhibited here and now. That is the golden rule of education, and a very difficult rule to follow.(Alfred North Whitehead, Presidential Address to the Mathematical Association, January 1916)Peets and colleagues report on a strategy for selecting content for inclusion in a critical care curriculum for residents [1]. The authors constructed a three-domain classification of common clinical problems and asked resident trainees and attendings to score each problem according to the threat to life, to frequency and to reversibility. The scales were organized to give greatest weight to greater life-threat, higher frequency and ease of reversibility. The authors report strong concurrence between the product of domain scores of resident trainees and of their supervising attending physicians. In their conclusion, the authors assert that their process is widely applicable and 'can facilitate creation of a reliable and valid curriculum' [1].It is unsurprising that residents and their teaching staff should have similar assessments of the three objective features listed. For example, brain death – which appears at the bottom of the priority list – is irreversible by definition. If any resident or attending scored brain death as anything other than not reversible, it would be at once surprising and problematic. Similarly, the frequency of the condition of brain death in the intensive care unit (ICU) studied and the degree to which brain death threatens life are not matters for debate.What is of greater concern, however, is that the methodology advanced by the authors results in brain death bein