Together or Apart, Is There a Better Way to Teach?

I subsribe to the DR-ED Listserve out of Michigan State University. This is a really good listserve of mainly medical educators, although others chime in every once in awhile to liven things up a bit. Over the past two weeks there has been a lively thread concerning the best way to teach. The choices given were 1) interactive facilitation or independant reading with lectures. Each side provided literature to back up their beliefs. The usual arguements were posed. "You may learn more stuff by attending a lecture, but the depth of understanding will be superficial" and "Knowing facts (stuff) is important, you can't problem solve without knowing the underlying facts." I think maybe I've been in this education business too long, as I have seen these arguements surface time and again. Since I have access to this BLOG, I'm going to share my thinking on this.



From all my years of study and practice, I have distilled all of the equivical literature about how best to teach down to three commandments>

1. Thou shalt engage the learner - If students (at any level) are not engaged, they will not learn. What engages learners depends on the content, the learner and the context. Learners can be fully engaged by interacting with an interesting essay, a well designed textbook, a computer learning module, short excellent lectures and small group activities.
2. When teaching about complex concepts, thou shalt offer opportunities for learners to "elaborate" on new concepts - When topics are complex or controversial learners usually benefit from hearing others point of view and having the opportunity to articulate their understanding and receive feedback from experts and peers. Although the norm is face-to-face during discussion groups, on-line electronic discussions work well for certain content and learners. The disadvantage of "solitary study" is that the learner is stuck with only 2 perspectives (the teacher and him or herself)
3. Thou shalt design and share goals for any instructional activity - Purposeless chats about anything that crosses our minds may be therapeutically beneficial, but are not a good basis for learning. Carefully crafted cases can provide the goal as can experienced facilitators.

Perhaps overly simplistic, but I've found these three commandments to be very serviceable.

Simulation in Medical Education

We had an interesting talk about the use of simulation in medical education this morning and it made me think about how far we have come from the "apprenticeship model' of the late 19th and early 20th century. The concept of practicing medical procedures on inanimate objects rather than on patients (especially me) seems a "no brainer", yet medicine has been slow to take full advantage of simulations. Perhaps the allure of the "cadaver lab" was lost on previous generations of medical students and residents, even though these labs provided the only opportunity to "do no harm" while developing skills. Today's high-tech simulation labs provide the opportunity for students and residents to practice everything from interviewing skills with standardized patients to intubation and team ACLS with high-tech mannequins.

We are designing a multi-purpose, multi-site simulation system here at the Clinic that appears to take full advantage of modern technology, all the while honoring the tradition of low-tech human-human interaction. I was impressed with the fore-thought and planning that went into the design. ...My generation marvels at robotic surgery, social media and high tech simulators, imagine the simulations that could be conceived by future generations who interact with avatars in pre-school. Will it be better medicine?? I don't know.

ACGME and vocabulary

I just returned from the ACGME Annual Education meeting in Nashville on Saturday. It was a really good meeting with great plenary speakers, and the opportunity for me to network with others who are interested in developing Program Director Training Programs at there institutions.

I want to start out positive, because I will quickly reverse direction and explode with frustration. As a faculty development professional, I have spent many years "translating" the educational concepts central to the "Outcomes Project" to our PD's and faculty. Competencies, competency-based learning objectives, and benchmarks were all new concepts to many of the PD's. All are smart people, many of whom sincerely wanted to understand how this new approach to education would benefit their residents. Ultimately we have made great progress.

Now,... new leadership, new vocabulary! The "Milestone Project" has recently been established. I went to one meeting at which a whole new set of terms were identified. Entrustable Professional Activities (EPA's), Landmarks and Milestones were introduced. The presenters had good slides and spent time educating us about the use of these new concepts in planning program development and evaluation. All the concepts seemed educationally sound.

That said, where do we start? Are milestones, that are determined by each specific discipline (Internal medicine has identified 142) like objectives or are they different? What is the difference between "landmarks" and "benchmarks". If after 25 years in education, I'm confused... imagine our PD's who have a few other things on their minds.

Things change... I get it! However, it sure would be great if these changes came with a logical "bridge" between old and new language and rationales for change.