February 26th, 2021
Toward a Pedagogical Shift
“If we teach today’s students as we taught yesterday’s, we rob them of tomorrow.”
— One summation of philosopher John Dewey
The Why can’t I just Google it? Problem
Imagine seeing a patient with symptoms you suspect mighty be the result of a medication side effect. But you’ve forgotten the mechanism of action of this medication. You left your pocket pharmacology book at home, and the hospital library is 15 minutes away. There are no pharmacists on the wards for you to consult. I imagine there was a time when memorization in medicine was crucial. I am not saying it isn’t now, but I propose that it is less so. In less than 1 second, Google can tell me the mechanism of action of any medication. By conceding that the availability of lightning-fast information at our fingertips is an argument against memorization, are we doing a disservice to our learners?
Pedagogical shift, proposal 1: Let’s teach our learners how and when to appropriately utilize modern, web-based tools. More importantly, let’s teach them why it is still important to engage in some memorization instead of always reverting to “Why can’t I just Google it?” If you’ve ever run a Code Blue, you know there are times when your memory must serve you under extreme pressure. I would like to see medical education emphasize the why instead of the what. Any modern learner can Google the what (i.e., what is the mechanism of action of labetalol?). So let’s set aside testing learners’ memories and instead re-allocate time to teach them why a master clinician chooses labetalol instead of another agent.
USMLE is already moving toward making Step 1 Pass/Fail; many medical schools are shifting to a longitudinal curriculum. As someone who has come from “bench to bedside” and now is arriving back at “the bench” for ongoing enhancement of my understanding of pathophysiology, I wish I would have been taught with the above lens.
The I don’t have time Problem
Residents of today have quite a bit asked of them! Pre-round efficiently, present that data flawlessly, tend to sick patients, admit new patients, run family meetings, discharge patients (ideally before 11AM), write your notes quickly but without copy forward so the attending can co-sign, and sign-out in a timely manner so you don’t break duty-hour restrictions. All this, along with the added pressure of attending educational conferences and reading about patients. It’s hard. I worry that the residents (and the perceived “cheap labor” they provide) have been misappropriated to doing more and more. Is there a way for residents to see a similar volume of patients but re-allocate their limited duty hours back to being learners?
Pedagogical shift, proposal 2: Let’s challenge our learners to practice mental dexterity. With the ubiquity of workstations on wheels in many hospitals, is a model of “discovery rounds” better? Here, time typically spent pre-rounding can be spent at the bedside, reading about illnesses, and prepping the rest of the afternoon for success. This model may be more difficult for junior learners (medical students and interns), as it requires one to synthesize data quickly, assess the patient’s condition, and derive a plan. For senior residents, this may be the necessary way forward for critical clinical reasoning. This method might also help shift the traditional model of data transference (from the pre-rounder to the rest of the group) to one of dialogue.
The Stuck in a routine Problem
Everyone learns differently — some visually, some aurally, and some in a tactile manner. One of my favorite education philosophers is Paolo Freire. In his Pedagogy of the Oppressed, he writes, “education is suffering from narration sickness.” It is not by pretending we are empty vessels to be filled with medical knowledge that one becomes the type of provider they want to be; but rather by experiential learning through a growth mindset and empathetic dialogue will we become our best physician self. That’s a bunch of fancy words to say, as a chief, I notice a decline in enthusiasm toward attending educational opportunities and wonder why this is the case? What changes would the learners prefer?
Pedagogical shift, proposal 3: Let’s bring back the joy of teaching and learning. Celebrate being wrong in a safe space and use a dialogical and interactive model of teaching rather than narration. This has been a priority for me and my co-chiefs this year. We even created a “Stump the Chiefs” conference to get in the hot seat ourselves — which you can find on our YouTube channel. Why not try “reverse-pimping” while you’re on the wards? Here, the learners ask questions of the attending to determine how he or she catalogs a patient’s presentation and how a treatment plan is developed. It is our duty to keep our learners engaged. It’s time to get creative, pique some curiosity, and make learning fun again!
Let us no longer rob our students of tomorrow.