I was a medical student between 1986 and 1991. It took me six long years to qualify as a doctor. During those years, I was forced to study many subjects—anatomy, physiology, biochemistry, pharmacology, pathology, microbiology, forensic medicine, ENT, ophthalmology, public health medicine, internal medicine, neurology, paediatrics, dentistry, anaesthetics, psychiatry, general surgery, orthopaedics, urology, dermatology and venereology, obstetrics and gynaecology ... the list goes on.

We were expected to know about each specialty in some detail. We read elaborate textbooks about the common (and uncommon) diseases in each, their clinical presentations, and their treatments and prognoses. It didnt seem so strange at the time, probably because everyone was doing it. There was an air of inevitability about it. Yet we forgot most of the intricate details a few days after the exams.

Now, more than a decade down the line and having chosen psychiatry as my career, it seems like a waste of my precious time. The more I think about it, the more puzzled I am. What was the point in burning litres of midnight oil, becoming myopic because of too much near work (or have I forgotten my ophthalmology?), and cramming so much unnecessary detail about every disease known to humanity into my aching brain? Is it to answer some obscure multiple choice questions, impress the examiners by faring well in the viva voce exams perhaps? My reasoning fails me. Even within each chosen specialty, there is enough redundant factual information that you need to know in order to pass exams.

Today in my work as a psychiatrist, I dont use my dwindling knowledge of surgery or obstetrics. I have no reason to. I dont need the anatomical fact that the popliteal artery divides into anterior and posterior tibial arteries. Or the knowledge that, based on limited evidence, isoflurane represents the anaesthetic agent of choice for patients with coronary heart disease. There are people who should know these things. They are called surgeons and anaesthetists. I can safely leave it to them.

In todays world of choices, medical students should be able to decide at an early stage what they want to do later in life. There should be proper career guidance in medical schools to facilitate this decision making for each individual. We need to develop a system where students can make an informed choice, with all information about each specialty being available to them. They can then go on to study their chosen subject along with its allied basic sciences. That would make their lives easier. Their training and careers would become more enjoyable. It would also reduce their sense of disorientation and confusion when they are placed in a specialty they are not particularly keen on.

We need to change the medical student assessments in line with the new system. We should no longer quiz them on arcane points of factual knowledge in exams. A more focused and practical approach to assessment would benefit both students and trainers.

There may well be a few students who change their minds midway through the process. We need to build some flexibility into the system to allow this to happen. But most students who have chosen their career path will be spared the ordeal of reading and later forgetting unnecessary information. The curriculum should focus more on important but neglected aspects of medical education such as communication skills, developing appropriate attitudes, and learning how to handle patients perceived as difficult.

I am arguing for specialisation to begin at an earlier stage, which has its advantages. It may reduce the number of dropouts from medical schools. It is likely to make students more motivated and committed to medicine if they are allowed to do what they want from the beginning. If some students want to train as generalists they can do so from the start. But we need not force all the others to toe the same line.

Medicine has become more and more specialised recently. Gone are the days when a doctor could treat all types of illnesses. All doctors need to know is when to refer a patient and to which specialist.

Given this trend, it seems unfair that for career advancement young doctors to be are forced to do things they neither need nor like. If the same time were spent in developing their skills in their chosen specialty, the training period might be substantially shortened. More vacant specialist jobs could be filled in the health service.