Rethinking Medical Education

The ThinkerQuestions, observations, and recommendations toward reform of the process and content
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Why are you starting this new blog now? - Part 1  

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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:


PART 1
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








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Why are you starting this new blog now? - Part 2  

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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.

PART 2
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? 



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Why have you chosen to write a blog, not a book?  

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Why have you chosen to write a blog, not a book?
To my surprise, this has been a frequent question asked by friends and close colleagues.
I'm not a stranger to book writing. Together with Jane Westberg, we've written seven academic books  (and I've been involved with several other books). Truth be told, however, without Jane's persistence, discipline, and skills, I doubt if any of our joint books would have been done. 
I don't enjoy the process of working on books, but I'm exulting in the process of working on this blog! If you are interested in this topic, here's why I feel that way.
Books impose closure on writers Books bring a sense of finality. That end-point characteristic of writing that is to be published in books or professional journals is vital for those of us who would never stop writing or re-editing without an external deadline. But, for me, it is also a turn-off. For me, writing about teaching and learning involves dealing with thoughts and ideas, not immutable facts. Paper-based publishing can serve an important purpose, providing recorded snapshots of stages in the evolution of understanding, but I've found the process constraining and uncomfortable. Thoughts and ideas, by their nature, continually evolve, or should, not just year to year, or research study to research study, but moment to moment.
The arrival of blogging and "Web 2.0" The relatively recent availability of the Internet and the newer collaborative approaches it now supports have been a dream come true for me. I'm now dealing with a medium in which there is no closure on my writing, unless I choose to impose it (or I'm forced to by health problems or other personal issues). I spend almost as much time massaging what I've already posted on this blog as writing new material, and I expect that ongoing tweaking of my own ideas and writing to continue, especially if they generate comments from you and others. 
Brevity is important Inevitably, academia is afflicted with the same high-pressure, brief-attention-span mindset that has been gripping much of the comtemporary world. Blogging, for me, seems to fit well with that sensibility. I've decided to limit each of my essays to roughly 1500 words, with most of them being under 1000 words. Brevity doesn't need to imply superficiality. In a blog, I can add links among my essays as they evolve, even returning to previously published postings to add and update links. Overall, this process really fits for me, while no prior writing process has come close. I'm now able to fulfill my decades-old fantasy of how idea-writing might one day be done.  
One additional time-related factor There's another big issue for me associated with book writing and time, which may also be relevant for you: book-writing demands that you have a gargantuan capacity for delayed gratification. From the day you conceive a book idea until you complete all the processes involved in conducting research, writing, re-writing and editing, finding a publisher, and stepping through all the stages of publication, several years have usually passed. This time-scale fits well for some people, but not for me.
Blogging is certainly not for everyone Devoting oneself to creating and sustaining an academic blog, especially one that is as consuming as this one, requires some rather specialized circumstances and personal characteristics. Most prominent, at least for now, is the requirement that one has arrived at a place or stage in life where you feel free to devote yourself to an endeavor that holds little or no promise of contributing to your career, and no hope of financial income (at least as I'm choosing to do it and as most academic blogs turn out). In addition, it is best if you don't have, or are past the stage of having had, serious responsibilities to regular work or for raising young children, or for maintaining a household.
It works for me I'm delighting in having found an outlet for my accumulated and evolving notes, ideas and positions without the constraints of a schedule, someone else's idea of acceptability, or any arbitrary rules (a/k/a the circumstances of conventional journal and book publishing). I'm at an age where I'm assuming that this will be my culminating writing project and contribution. Although I'm hoping that a fair number of people will find helpful ideas and information in my ongoing musings, and in the comments from others that might be generated, I'm delighted to be liberated from feeling dependent on the judgment of others. I'm undertaking this project more for me than for anyone else, except maybe a hope that it will someday have meaning for one or more of my five grandchildren, or perhaps even my new great-grandson. 
My apologies if all this seems excessively narcissistic, which it probably is. I don't mean it to be. While some self-interest is part of this equation, I'm sustained by the hope that all of this work may actually make a small contribution to the future of health professions education and health care (and may even provide some personal guidance to a few young people who are embarking — or considering embarking — on careers in health professions education). Whether or not that happens is the one area in which I'm fully dependent on — and welcome — the judgment of others. If you have a point of view on the potential or actual value (or lack of value) of this blog to you and others, I'm eager to hear from you. Everything about this blog is open to reactions. Please leave a public comment right here (how do I do that?) or click here to send me a private note.
Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD









First posted: 11/17/08

How do I add my comments to this blog?  

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How do I add my comments in response to what I read on this blog?
I'm delighted that you are considering adding comments and encourage you to do so. Please share your reactions to any posting or to any comment you read on this blog. Just click on the "Add comments" link in the upper right corner of the posting you are reading, or click on the "Post a Comment" link at the bottom-left corner of posting. An entry box will be added at the bottom of that posting, where you can write your comments and ask your questions. 
Please offer comments on any of the following: 
  • Your thoughts about and your reactions to what you read. Do you agree or disagree? Why? Do you find it relevant to your situation? If not, in what ways?
  • Your suggestions for changes or additions that are needed. Please suggest topics that you think are missing that deserve to be included.
  • Are there any topics included here that you feel don't belong? Why?
  • Your questions and suggestions about anything that is insufficiently clear.
  • Your recommendations for improving the layout, esthetics and operation.
  • Please suggest specific web sites that should be added as links from this blog, and please also suggest sites that we should ask to provide a link to this blog.
  • Do you consider the posting of potential value as advance reading for people who will be participating in a meeting/seminar/workshop about a related aspect of health professions education? If not, please suggest changes that might make it more appropriate for such a use.
  • Please provide any other contributions or concerns you care to share.
Guidelines regarding comments:
  • When you can, please support your arguments and recommendations with literature references and relevant web links.
  • Please be constructive. This isn't the place for personal rants or diatribes.
  • Please remain within the overall topical focus of this blog.
  • Please don't add nasty, hurtful, or other non-constructive, judgmental comments.
  • When you click to submit your comment, you will be asked to enter a little information about yourself. Please do so. We want you to stand behind you comments and to get credit for your contributions. We won't publish anonymous comments.
  • Before you can submit your comment you will be asked to type a word you will be shown that is in the form of a graphic. Such graphics help us avoid the intrusion of automated systems. We're sorry to bother you with this added step, and hope you support this effort to keep robots from cluttering this blog with advertising or other unwelcome messages.
  • Please don't submit any advertising or promotions.
  • Finally, I have to add that I reserve the right to refuse publication of comments that are not germane to the goals and focus of this blog.
Many thanks,
  Hill Jason 
Hilliard Jason, MD, EdD

First posted: 9/17/08
Revised:12/2/08 

Don't existing journals and web sites already do what you are doing?  

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Don't existing journals and web sites already do what you are doing with this blog?
There are many worthy, MEDLINE-indexed journals for reporting research in medical education and for presenting thoughtful opinions. There are also interesting, helpful online discussions of a wide range of issues related to the teaching and learning of medicine and the other health professions. I'm trying to ensure that this site provides a supplement to, not a replacement for, any of these valuable resources. In the sidebar, in the widget, "Related Journals/Information," you will find links to many of those resources and I invite your recommendations of others you think should be added to that list.
I hope you find that this blog offers something not readily available elsewhere. Journals offer a somewhat unpredictable array of topics, being dependent in large part on the initiative of those who submit papers, and on the vagaries of the peer review process. Online discussions tend to be even less predictable. The quality of the contributed writing, thinking and information in online forums can be highly variable, which can demand a lot of reading to find nuggets of personal interest and value.
In this blog I try to offer a consistent writing style, a demarcated array of topics, a fairly robust organizational and searching mechanism, and a focus on the big-picture implications of accumulated research and thinking, not the original reports themselves. Also, for better or worse, you get the coordinating influence of one person's vision and sensibility. Here, you also have hot-links that make it easy to jump among related topics, enabling you to pursue a fairly complex path of your own design. (The possibilities will become richer over time as posts and comments accumulate.) In addition, you have the opportunity to react at any time, and the possible joy of observing the impact of many people's collaboration in the evolution of some ideas that may come closer to the leading edge (and, possibly, the future) than tends to characterize the intellectual evolution observable in other sources. Your contributions to the ongoing discussions can help these goals be reached.
I hope you understand and support this rationale. I invite your thoughts about the appeal and viability of this proposition.
Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD

First posted on 9/17/08

Is this a money-making plan? If not, why are you offering this blog?  

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Will this blog be a money-maker? If not, why are you developing and providing this blog?
Actually, this site is not only not a money-maker, it is a non-trivial personal expense. It is not now, and won't be, a source of revenue for me or anyone else. To avoid the risk of being constrained by any sponsor's policies or sensibilities, I've decided not to accept any advertising or to seek any institutional or grant support, To avoid any risk that something I include in this blog could be a source of awkwardness for our university, I'm paying an outside site for hosting, rather than ask for hosting at my university. I know that some of what I plan to say in this blog will be regarded as controversial in some quarters. I want my only constraints to be the available evidence and the best available thinking on the issues that I regard as needing to be considered.
I’m at the stage of my life and career where the possibility of making a worthy contribution is far more important to me than generating income. I care deeply about the ways in which learners and patients are treated. I've spent more than a half century trying to enhance and humanize those processes and hope that this site will add a step toward fulfilling those goals.
Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD
First posted on 9/17/08

Are the entries on this blog copyrighted?  

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Are the entries on this blog copyrighted? 
May I copy them?
All of the posts in this blog, and documents I've authored that you access from links in this blog, are considered subject to copyright protection, but as part of the "Creative Commons." That is, you are free to copy, keep and redistribute my contributions, provided that you don't change the documents and that you retain all indications of authorship. You can learn more about the Creative Commons process in the link that is available at the bottom of all pages in this web site.


Any other documents you reach from links on this site are subject to their own copyright rules, which you will need to determine from the copyright holders.

Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD

First posted: 9/17/08
Revised: 1/25/12

May I submit questions for advice on my teaching?  

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May I submit questions for advice on my teaching?
Yes, questions about your teaching, or about teaching in general, are most welcome. Please post any questions you have in the spaces provided for comments, in whatever context (topic area) seems most appropriate. Or, if you would rather keep your question private, send it to me, by email. Although I promise to read and give serious consideration to all publicly and privately conveyed questions, I cannot promise to provide individual replies. I do promise that all such questions will be taken into consideration in postings that I offer in the future.
   For all publicly conveyed questions, I encourage other visitors to reply, and even generate an ongoing conversation about the topic introduced by the question. 
(You may recognize that I'm trying to simulate the functions of a web-based Forum. Unfortunately, at this time, the resources available to us don't support our offering an actual Forum. If that capability becomes available, we will add it to this site.)

Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD


First posted on 9/17/08

Is there peer review of your postings?  

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Are your posts subjected to peer review before being published here?
Unlike conventional journal publishing, which follows the important validation process that comes from both editorial and peer review, blogs typically relinquish some of that pre-screening in favor of speed and collaborative exploration. (I say "some" in the prior sentence as I generally subject my postings to the informal review and critique of one or more trusted colleagues prior to their publication here.) Unlike journal articles, which are typically the culmination of an author's substantial work and writing over an extended period of time, blog postings tend to be more tentative presentations and in earlier stages of their evolution. The main peer-review begins after the blog is posted.
Postings here, as on many blogs, are meant to be provokers of reaction and deliberation. They are not meant to serve as definitive or final declarations. Unlike readers of professional journal articles, visitors to blogs don't have the assurance offered by formal pre-screening. But readers of blogs have much more of an opportunity to offer their judgments about, and reactions to, what they read.
The interactive character of blogs is an expression of a profound change now underway in the evolution of human understanding and expertise. It is the character and promise of "Web 2.0." The potential of this blog, like most others, will only be realized if enough people find my postings worthy of their reflection and commentary. Please consider this an invitation to linger on this site, to return to it often, and to offer all of us the benefit of your comments, as explained in the FAQ on how to offer comments.
Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD

First posted on 9/17/08

How should I cite a posting from this blog  

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How should I cite a posting from this blog in something I write?
With the importance of the Internet growing as a component of academic discourse, standards are evolving for citing references that are based in this non-traditional resource. As with all citations of sources of material you quote or reference in your writing, you should include the name of the author, the title of the item you are citing, the publication (or web site name) where the cited writing appeared, and, for a web source, the specific URL of the page to which you are referring, plus the date on which you read or copied the material in question. For example, if you were to cite something I had written in one of my postings in this blog, your citation could be:
You can learn more about the citation process in two Wikepedia pages: Citing Sources and Citation Templates. 
  Hill Jason 
Hilliard Jason, MD, EdD
First posted:9/17/08
Revised: 11/29/08
Revised: 1/25/12

Why is this blog focused mainly on "medical" education?  

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Why is this blog named for, and focused primarily on, "medical" education?
Physicians in health care Unquestionably, many health professionals in addition to physicians are vital in preventing and managing illness. Physicians, however, have long had, and in most places continue to have, considerable influence on decisions that affect people's health, as well as on the organization and costs of the healthcare system. In many settings, physicians are still the "rate-limiting" factor in healthcare, shaping the pace and direction of change. That is, physicians, for better or worse, still have considerable monetary and political power, within their own practices and, usually, within the larger healthcare system. If constructive changes are to be made in the healthcare system, physicians need to be active partners in the process. In addition to influencing physicians' direct care of patients, the ways physicians are educated will likely remain potent factors shaping the character and direction of whatever changes in healthcare are sought and achieved.
The potential of educational reform If the education of physicians were substantially better than it usually is, the health of the public could benefit greatly. We already know enough about the main reforms that are needed to overcome many of our deficiencies in physician preparation and, ultimately, in healthcare. Much of this blog is being devoted to clarifying those deficiencies and the alternative approaches we should be considering. I'm persuaded that many of those who are in a position to make a constructive difference in the medical education process have insufficient understandings of the key issues that require their attention, or what to do about them. Perhaps these essays, enhanced by the exchanges and insights that I hope will evolve from the contributions of visitors to this site, may help enhance our general levels of understanding and, thereby, increase the possibility that our educational programs will pursue needed, worthy reforms. I encourage you to be one of the contributors to this process.

Many thanks,
  Hill Jason 
Hilliard Jason, MD, EdD
First posted on 9/17/08

How do I navigate and search?  

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How do I navigate around and search for information on this blog?
There are multiple strategies you can use to make your visits to this blog efficient and effective. These approaches to navigating and searching in this blog are sufficiently elaborate that they are explained in a full, separate posting, named, "Navigating this Blog." 
You can visit that post now by clicking here, or by selecting the link with that name in the Header Bar, which you can do at any time while visiting any page on this web site.

Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD

First posted on 9/17/08

What is a "Blog"?  

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What do you mean by calling this web site a "Blog"?
A blog (a contraction of the phrase "web log") is a specialized type of web site, usually maintained by an individual, with regular entries of commentaries, descriptions of events, or other material. Entries (usually called "posts") are typically displayed in reverse-chronological order, as is done here. "Blog" can also be used as a verb, meaning to maintain or to add content to a blog. ("Thanks for your good suggestion. I'll blog it.")

Some blogs are diaries or journals. Others, such as this one, present the evolution of ideas linked to a theme or set of issues. Often, a blog will offer background information on the main subjects of the blog, and it may offer links to other web sites that provide additional, related information and resources, as is available here in two of the widgets in the left column of each page (Related Journals/Info Sources; Related Organizations). 


Usually, as I've also done here, visitors are encouraged to offer comments on the posts and on comments that have been made by others. Again, as here, many blogs provide a searchable archive, giving visitors access to the full collection of past posts and comments. For guidance on searching this blog, please see the post called, Navigating this blog, which is available in the "header bar" at the top of each page. (For more about blogs and blogging, please visit Wikipedia.)

Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD

First posted: 9/17/08
Revised: 1/25/12

Who are you? Why should I care what you say?  

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Who are you? Why should I care what you say?
Appropriate questions. I can easily tell you who I am, and I will do so shortly. As to your second question, that's not as easy. I have long worried that we academics tend to pay more attention to the source than to the force of arguments.* We are inclined toward checking people's titles before deciding if we should bother listening to what they say. I invite you to consider doing the reverse here (and elsewhere). I encourage you to take a little time to scan the titles of my essays. If any titles kindle your curiosity, I hope my writing will succeed in speaking to you, generating your own reflections, questions, even refinements of your own thinking. I hope that the questions and ideas I've assembled on this site will stand on their own. If you are still curious about my "right" to be offering the observations I present here (or if you are interested in knowing more about me for any reason), please jump to this brief biography. or, if you have the stomach for it, please request a copy of my full, conventional, academic curriculum vitae by sending me an email message .
If you want to read an interview of me done for Education for Health: Change in Learning and Practice, please click here.
If you want to read an interview of me done for Advances in Health Sciences Education, please click here.

* A variation on this thought: "People will accept your ideas much more rapidly if you tell them Benjamin Franklin said it first."  (David Comins)
Thanks,
   Hill Jason
First posted on 9/15/08

Will others be contributing essays to this site?  

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Will others be contributing essays to this site?
Contributions of posts by others aren't planned at this time, but I've included links to other web sites that I think offer helpful information and resources related to our central themes: enhancing the quality and humanizing the process of education in medicine (and the other health professions). I'm certainly not ruling out the possibility of inviting others to contribute essays to this site in the future.
Also, many other people have contributed to the ideas offered on this site, through their research, writing and personal influence. I try to link to the related work of others and I'll continue to add relevant links as I learn about them. You and everyone with an interest in these topics are encouraged to contribute comments on my postings and on other people's comments. 
Finally, I encourage you to please:
  • share with us links to relevant documents you or others have written that you consider relevant to the themes and sub-themes here
  • offer any advice you can about any aspect of this blog that will help enhance its value.
Many thanks,
  Hill Jason 
Hilliard Jason, MD, EdD
First posted on 9/10/08

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