Rethinking Medical Education

Thanks for stopping by. I'm glad you're here.

This blog is a non-commercial, voluntary effort. Although I serve as "provocateur-in-chief," I try offering observations that encourage others to join the exchange. I try to keep my entries fairly brief and easily digestible. When a topic needs fuller development I refer to other entries in this blog, or to writing that others or I have done. Throughout this site you will find links that can take you to other parts of this site or to other web sites. Some links take you to a document you can read on-line or download for reading later.

The "posts" (entries) in this blog are meant to stimulate reflection and the exchange of ideas. I consider all my posts to be "works in progress." Although most of them are based on a good deal of thought and, when available, research by myself or others, I regard all my ideas as being in evolution, never as "final." I consider our "conclusions" in medical education, as in all of science, to be tentative, forever subject to the influence of new findings, and new insights. ("A conclusion is simply the place where you got tired of thinking." Author unknown)
I encourage your comments and look forward to ongoing, productive exchanges with you and others. For guidance on adding comments to this blog, please see this posting. (You can also reach that post via the FAQs, available in the ever-present menu bar, above.)

Thanks,

  Hill Jason 

Hilliard Jason, MD, EdD

First posted: 9/17/08

Revised: 11/16/08
2nd revision: 12/11/08
3rd revision: 12/16/08
4th revision: 1/3/09
5th revision: 11/2/10

The following, in alphabetical order, is an incomplete list of people who have had a memorable impact on my thinking about teaching and learning during the past 50+ years, some through personal contact, some through their presentations and writings, many through both. (I've saved a lot of space here by not including many others who accelerated my thinking about medical education through their bad  examples.) I will add the names of other positive influences as they come to mind, and as additional people exert a memorable influence in the future. I'm deeply grateful to all of the people below and to the many other deserving people who I've inadvertently overlooked in this first pass. My apologies to those in the latter group.

Stephen Abrahamson, Louise Arnold, David Aspy, DeWitt Baldwin, Michele Baldwin, Gwyn Barley, Howard Barrows, Carole Bland, Walter Blass, John Bligh, Charles Boelen, David Bor, Georges Bordage, Rick Botelho, Nathaniel Cantor, Ken Cox, Dale Dauphinee, Arthur Elstein, Ronald Epstein, James Erdmann, Roy Fairfield, Richard Frankel, John Frey, Tamas Fulop, Michael Gordon, Janet Grant, Larry Green, Larrie Greenberg, Jean-Jacques Guilbert, Frederic Hafferty, John Hamilton, Ronald Harden, David Irby, Jon Kabat-Zinn, Jerome Kassirer, Arthur Kaufman, Christine McGuire, Ian McWhinney, Stewart Mennin, George Miller, Victor Neufeld, David Newble, John Norcini, Geoff Norman, Hannes Pauli, Christina Puchalski, Carl Rogers, Everett Rogers, Henk Schmid, Lee Shulman, Kelley Skeff, Parker Small, Barbara Starfield, Orienne Strode, Richard Tiberius, Caes van der Vleuten, Lawrence Weed, Jane Westberg, Kerr White, Luann Wilkerson, John Williamson

Additional acknowledgements: Although she is recognized, as she should be, in the paragraph above, I single out Jane Westberg for special extra thanks here. As my wife and as my closest professional collaborator for more than three decades, Jane has been a consistent and continuous guide toward much of whatever might be worthy in any contributions I make, here and elsewhere. 

And thanks to David Rosenberg for his technical help and guidance in setting up this blog.

First posted on 9/19/08

Revised 12/9/08

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