Rethinking Medical Education

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

Why are you starting this blog now? - Part 2

Have you seen Part 1 of my answer to this question? If not, you can go to it here.

Partly, I'm starting this blog out of my impatience with the slowness of the progress I've witnessed

Resistance to change 
Throughout the 55+ years in which I've been a close observer of medical education I've seen the availability of information on ways to improve medical education move forward at a far faster rate than changes in the educational process itself. Although educational research has become increasingly sophisticated and more widely undertaken, resistance to revising established practices in medical education remains strong in many quarters. Those who try to initiate constructive changes are too often ignored and marginalized. Resistance to constructive change has many sources and takes many forms. Much is passive, not active, deriving more from indifference and ignorance than from overt rejection. Many teachers choose, or are forced by lack of awareness of alternatives, to rely on patterns similar to those they experienced as learners. As I've tried to point out elsewhere, we are doing far better with our "macro" decision-making (our organizational planning) than with our "micro" decision-making (decisions that are needed during moment-to-moment, teacher-to-learner transactions). Our overall planning strategies have evolved fairly steadily, but our day-to-day encounters between teachers and students remain largely in the hands of people who are not sufficiently prepared for the demands of the tasks we depend on them to pursue. Too much front-line teaching has not changed significantly from a half-century ago. 

Why does change come so slowly? 

Partly, we medical teachers are like most people. We tend to be slow to change, even when our current approaches are demonstrably suboptimal. Psychotherapy and preventive health care would be so much quicker and easier if resistance to change were not a characteristic of our species. Partly, those who resist change in medical education feel empowered by the presumed validity attached to practices that have a long history. "But, we've always done it this way." "If it isn't broken, don't fix it." "If it was good enough for me, its good enough for my students." Are any of these observations familiar to you? I've heard such observations (rationalizations) in one form or another throughout my career. Educational decisions in many institutions are still made more on the basis of historical precedent and the institutional political power of individuals than on the basis of scientific findings or informed reasoning. (Among the striking exception to this generalization is the "BEME" initiative. But, like most efforts to bring research to bear on educational decision-making in medicine, the BEME resources are unknown to, and therefore unused by, most medical teachers.)
What makes this time different? 
The past decade has brought two sets of technologies and accompanying sensibilities that make possible two important changes in our overall situation, raising the prospects for meaningfully enhanced practices.
First, investigations of human brain functioning that were not previously possible are becoming commonplace. These studies are producing findings that couldn't be dependably provided by conventional educational research. Until recently, most educational research was limited to narrow, not widely representative populations, with minimal control of the interventions being studied. Experimental and double-blind research, which we revere as the "gold standard" of clinical research has been difficult and often impossible in education. Partly, the array of possible independent variables in education is enormous, and many of the relevant variables are often unknown. Partly, in hugely complex domains, such as human learning, generating dependably generalizable findings from action research requires huge research projects. Such projects require levels of funding support that have only rarely been available. Overall, the fiscal support of educational research has been minuscule compared to that available for clinical and biological research. Moving some of our investigations to the level of the molecular structure of our species' brain overcomes these problems for an important component of educational research: understanding how information and procedures are perceived, absorbed, retained, recalled and applied. These developments can overcome centuries of uncertainty and help modify whole encyclopedias of repeatedly transmitted assumptions and beliefs that were largely without solid foundations. (There is an enormous amount we still need to know about learning at the live, experiential level that current brain research can't answer, but that's another story.) For a video of a presentation I gave at McGill University in April, 2010, summarizing some of the implications of brain research for educational planning and implementation, please visit this site.
Second, the arrival of "Web 2.0" makes possible a substantially enhanced approach to the process of developing and sharing thoughts and ideas, enhancing the prospects for accelerated insights into human learning. For the first time, conditions exist for exchanging ideas widely, spontaneously and informally, permitting rapid interaction and the collaborative development of insights among many people. Ideas and insights can now evolve far more quickly than individuals can achieve alone or that conventional publishing systems can support. I invite you to join this process by reading the postings and comments in this blog, and by contributing your own comments.
To learn a little more about Web 2.0 I encourage you to spend 5 minutes viewing this cleverly done video. For additional information about Web 2.0, visit this Wikipedia page.
Our tendency to revere the practices of the past need to be rethought. For the first time we are moving toward reliable understandings of the biological basis of learning. We are beginning to have solid evidence of how the human brain learns. We have an increasingly dependable basis for knowing what we should continue doing and what we should be modifying or discontinuing. While building on decades of increasingly searching explorations of the teachinglearning process in medicine and elsewhere, I'm devoting this blog, in part, to exploring the spectacular information that is tumbling out of neuroscience research. I will do my best to capture and present some of the guidance we can now derive about desirable and undesirable practices. 
I hope you enjoy the exhilaration of this unprecedented journey toward a fuller and richer understanding of the teachinglearning process and that you join this exploration.
Some questions for your further reflection and your possible comments:
  • To what extent do you stay current with emerging understandings of the teachinglearning process?
  • How well do you understand which of your current instructional approaches are consistent with our knowledge of how our brains learn?
  • Can you (and do you) advise your students on how best to learn? 
  • Do you consider the task of helping our learners become and remain effective learners to be part of our overall instructional obligation?

  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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