Rethinking Medical Education

Author unknown

Marshall McLuhan (Canadian educator, philosopher) (1911-1981)

Background Much of what happens day to day in many medical schools is educationally suboptimal. Some of the practices are downright counterproductive, even hurtful. Our dominant activities and strategies in medical education derive from patterns that were established long before there was systematic research about human learning, and before there were journals for sharing and enriching teachers' thinking about their instructional work. Our suboptimal practices, and the instructional approaches that the evidence tells us should replace them, are the focus of many of my postings on this blog. 

There certainly are some admirable innovations in a subset of the world's medical schools. But, that subset is relatively small and in some of those innovative schools meaningful progress has been implemented in only part of the overall educational program.

As best as we can tell, too many medical teachers are insufficiently prepared, and (as I will explain more fully in future posts) some are temperamentally unsuited for the educational components of their work. They have read little about desirable teaching practices, and they are largely uninformed about the accumulated findings of decades of educational research. Many current teachers base the approaches they follow on the role models to whom they were exposed during their own education. Many of their models, in turn, were mirroring the traditional approaches to which they had been exposed during their own education. Although there are some wonderful exceptions to these generalities, only a small proportion of those who teach in medical education programs (faculty members, residents, community-based clinicians) have made serious efforts to learn and implement fresh approaches in their teaching. Overall, in too many programs, much of the process that transpires between teachers and learners has not changed significantly from generation to generation.

In addition, few medical teachers know about the recent, rapidly growing body of evidence from brain research that can now guide many of our instructional, communication and relationship strategies. Also, importantly, too few medical schools provide their exemplary teachers or educational researchers with academic rewards that come close to the rewards available for contributions to biological research or to clinical care. (Happily, this is beginning to change in some forward-looking educational programs where meaningful steps are being taken to recognize and reward deserving educators.)

Some reasons for being optimistic Despite the gloomy-sounding recitation above, some highly encouraging developments have been emerging in recent decades. For some thoughts on these encouraging developments, please see my posting, "Why are you starting this blog now?"

Missing links We need to bring the daily process of medical education into closer concordance with what we know it can and should be. Three important links seem to be missing in the chain of events that can help medical teaching be more scientifically based and consistently effective. They are: 1) Our educational institutions need to be elevating the recognition and rewards they offer for contributions to teaching more widely and consistently than they now do; 2) Teachers, educational administrators, and program regulators need deeper understandings of what is educationally possible and needed, and why educational enhancement is so necessary; and 3) Front-line teachers and educational administrators need to engage in more frequent, better informed, deeper levels of ongoing discourse about education. This blog is devoted to exploring ways to overcome the mismatch between understandings and practice.

My primary and enabling goals for this blog Against this background, my overriding goal is to help enhance and humanize the ways in which learners and patients are treated. With this blog, I'm trying to take some steps toward achieving that goal through the following four enabling goals:

I have no illusions of making a large or important difference with this small effort. I hope, however, that this blog may serve as a gentle catalytic agent for helping a growing group of thinkers join in evolving fresh ideas that can take us beyond what we now have. I hope you decide that this is a worthy quest and that you will join this ongoing conversation.

Thanks,

   Hill Jason 

First posted: 10/17/08

Revised: 11/20/08

2nd revision: 12/08/08
Minor revision: 11/3/10