Rethinking Medical Education

The ThinkerQuestions, observations, and recommendations toward reform of the process and content

Why are you starting this blog now? - Part 1
My short answer: Several professional and personal factors coalesce to make this an appealing time for me to be creating and maintaining this blog. The main recent developments are:
  • The improving quality and expanding range of educational research.
  • New neuroscience research techniques are providing fresh insights into how our brains learn.
  • The arrival of "Web 2.0" (see below).
  • Some medical education programs are taking steps toward recognizing and rewarding deserving educators.
  • Colleagues and friends have encouraged me to have a regular outlet for sharing my reflections and ideas.
  • My current career stage provides me with some of the considerable time needed for this project.
My fuller answer, in 2 parts:

There are encouraging developments 
A glimpse at the list of journals and other sources of information about medical education, many of which are available in the links in two sidebar widgets on the left of this screen (Related Journals/Info and Related Organizations), confirms that many encouraging developments are underway. There are growing numbers of people doing educational research in the health professions, and there is an impressive number of organizations focused partly or largely on efforts to enhance educational quality in our medical schools. Also, there are growing numbers of meetings and conferences focused on education in medicine and the other health professions.
But, we have a paradox of progress with limited meaningful change

Looked at organizationally and operationally, medical education has undergone many encouraging changes during recent decades. Among the welcome educational transformations are the following:
  • From only one prominent professional journal dedicated to medical education when I was in medical school, we now have many, and the list keeps growing.
  • Distinguished journals that previously served exclusively as outlets for clinical or biological research now include educationally-relevant articles (at least some of the time). 
  • There is diminished reliance on conventional, large-group lectures in many schools. 
  • High quality simulations are used in "skills labs" and in a growing number of other contexts, including the assessment of learner performance. 
  • Proportionally more time is spent in small groups and other participatory learning activities.
  • Problem-based and case-based learning in various forms is widely used (although with widely varying approaches and facilitator competence).
  • Increased proportions of learners' time is devoted to experiences outside the hospital setting, in the community, in ambulatory clinics, and in clinicians' offices (in contexts that match their future career settings better than do teaching hospitals for most learners).
Yet, despite these and other encouraging signs of progress, some serious questions must be asked and worries voiced. 
Might some of the changes in medical education be more organizational than substantive? Could our curricular and scheduling modifications be alterations in the administrative arrangements without sufficient enhancements of the essential elements of our direct teachinglearning encounters? (For example: How much small group time is spent with teachers actually lecturing rather than facilitating constructive explorations?) Might we be building better homes without giving sufficient attention to the family dynamics happening inside?
Some reasons for concern The following are some of the current conditions I propose should give us pause:
  • Being a genuinely effective educator demands a great deal. I'm persuaded that the array of skills, understandings, and personal characteristics needed for optimal effectiveness in teaching meet or surpass in difficulty those needed for optimal effectiveness as a clinician or researcher.
  • Clinicians and researchers serving as faculty members in medical schools have typically spent many years of concentrated effort preparing for that set of responsibilities but little or no serious effort preparing for their responsibilities as teachers.
  • Very few of those who do day-to-day teaching in medical schools give the literature in medical education (or in general education or psychology) a level of attention that is even close to what they give to the literature in their clinical or research specialty areas.
  • Most of those who teach (faculty members, community clinicians, residents) attend regular meetings and conferences related to their clinical or research work. Remaining current in their field is assumed to be vital to being a professional. Yet, most of those same people almost never attend events that are focused on their work as professional educators.
  • Although we have a deep clinical tradition of respecting the diversity among patients, leading us to provide individualized care, we have an equally deep tradition of ignoring the differences among learners. Many of our instructional practices are retained from a much earlier era in which there was no educational or brain research to guide the design of those practices. Much of our instruction continues to be offered automatically, shaped more by the calendar and by the teacher's habits than by any information about the learners' characteristics or needs. Typically, all members of a class or group are treated nearly identically, despite solid and growing science indicating that every learner is unique and is deserving of at least as much individual assessment (diagnostic workup) and targeted instructional offerings as are our approaches to patient care.
Put another way, although our available understandings of the teachinglearning process have been growing dramatically, we have little to suggest that our teachers' levels of time or effort devoted to becoming and remaining current as educators has kept pace.
Of even greater concern is the fact that keeping up with emerging educational and brain research findings, while desirable, is not a sufficient goal in itself. Being current in these areas is only a starting place. Converting those understandings into constructive actions demands far more than awareness. Teaching is a performing art, requiring high levels of relationship, communication, perceptual and explanatory skills that are in need of continuous refinement. Acquiring and enhancing the skills needed for optimal effectiveness as a teacher can and should be keeping us engaged, challenged and humble throughout our professional lives.
If the day-to-day, direct transactions between teachers and learners on the frontlines of medical education programs are not significantly changed, then the most important part of constructive educational reform remains neglected. 
So, part 1 of my reply to the question at the top of this page is: Our educational practices have not kept up with our understandings of what is needed, and I want to do what I can to help clarify what is needed.


      Hill Jason 
    Hilliard Jason, MD, EdD

    First posted: 10/15/08
    Last revised: 12/02/08
    2nd revision: 12/14/08
    3rd revision: 11/8/10


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