Pears from the elm: pulmonology training in the third decade of the 21st century

Abstract

The training of Mexican pulmonologists in the third decade of the 21st century has undergone profound changes. Twenty-two years of experience training residents allow me to observe the progressive loss of three pillars that, in my experience, define the good specialist: integrative clinical thinking, intellectual discipline, and mentorship. Pulmonary auscultation, the integrative exercise par excellence, is being replaced by imaging and laboratory studies without prior clinical reasoning. Journal clubs, the central space for the development of critical thinking, are increasingly delegated to artificial intelligence applications that generate summaries and slides within minutes, eliminating the cognitive exercise that this activity is meant to produce. The mentor figure —the physician who accompanies the resident over years, knows them, challenges them, and eventually decides they are ready to practice— has been replaced by an impersonal network of teachers with administrative functions. This scenario is compounded by the historical origin of the problem: the AH1N1 influenza and COVID-19 pandemics made the shortage of pulmonologists evident, and the system’s response was to increase the number of training sites with direct entry, without prior internal medicine training, frequently in sites with one or two faculty members and without basic diagnostic equipment. In this critical essay I argue that these changes are not inevitable and propose three operational actions: institutionalizing the mentor figure with protected time, redistributing residents toward sites with critical formative mass, and recovering journal clubs as the resident’s personal cognitive exercise. Artificial intelligence and digital tools are valuable allies when they complement thinking; they become destructive when they replace it. Recovering modern tutorial training does not require major structural reforms; it requires the deliberate will of teachers and institutions to refuse to accept as destiny what is merely inertia.