DOES TECHNOLOGY HAVE A PRICE?

Every innovation has both an intended effect and other effects that are unintended. Technology is no different. ScienceDaly recently published an article titled "Is Technology Producing a Decline In Critical Thinking and Analysis?" that summarized a study that recently appeared in "Science". In this article, Dr. Patricia Greenwood from UCLA reviewed over 50 studies. One conclusion from this review was that while visual intelligence had gone up, "skills in critical thinking and analysis have declined."

Another interesting finding, particularly relevant to schools that provide and promote the use of laptops, was that "students who were given access to the internet during class did not process what the speaker said as well as student who did not have access". Although many of the studies reviewed were completed with children, the results are no less important for those of us who teach students and residents in the health professions.

Click on the link http://www.sciencedaily.com/releases/2009/01/090128092341.htm and check out the summary and find the citation for the full "Science" article.

What are your thoughts about these findings? Does this disturb you? Is it just a predictable evolution of man? Do we need to change our expectations? Should we offer more opportunities for discussion and problem solving? Should we reduce the number of computer simulations? Is it too late by the time students come to us to make a difference? It would be great to hear from readers who grew up in the technology age and also from those of us who grew up with "books". Respond to any of these questions or just react to the findings of this study.

JANUARY/FEBRUARY SUMMARY

Our January “Education Item from the News” from The New York Times, titled “At MIT, Large Lectures Are Going The Way Of The Blackboard” really seemed to spark some interesting conversation. The vast majority of the 18 posts seemed interested in rethinking Grand Rounds to make it more engaging, while a few others thought that Grand Rounds was OK, and described it as a unique educational venue in which experts presented interesting findings on topics of interest. The perhaps missed point was that “Grand Rounds” was just an example of a teaching venue that might benefit from “rehab”. Individuals do not learn unless they are engaged and teaching formats that rely on “listening” alone as the means of engagement disadvantage many learners.

One of our readers suggested the use of the Audience Response System (ARS) as a means of promoting engagement in large groups. ARS has been found to increase attention on the part of participants and may be a great way to encourage engagement. A few other ideas from our BLOGGERS were to:

• “Allow invitees to large lectures to submit questions to the speaker a few days PRIOR to the session to allow them to customize their presentations.”
• “Archive the presentations in a way that can be accessed later by non-attendees and attendees who would like to review.”
• "Grand Rounds"-- when given by residents and fellows and arranged properly so that feedback can be given-- can serve the very important function of allowing trainees to hone their public speaking skills. It is important for doctors... as teachers... to possess such communication skills.”
• “Teaching to smaller groups provides an opportunity to engage all participants in a discussion that presumably, enhances an active learning; the lecturer, acting as a moderator, can gauge the level of understanding and effectively ensure the learning of the information”

WHAT'S SO GRAND ABOUT GRAND ROUNDS?

A recent article in The New York Times Education Section
http://www.nytimes.com/2009/01/13/us/13physics.html?partner=permalink&exprod=permalink described an enormous change in the way the introductory science courses are taught at MIT; yes, Massachusetts Institute of Technology! Rather than the traditional crowded lecture hall, small groups of students explore the problems of science by interacting with peers and using faculty as resources and facilitators. The “50 minute expert lecture” is dead; instead, professors engage students in small group work while clarifying key concepts as they roam from table to table.

How’s it working out?

“Last fall, after years of experimentation and debate and resistance from students, who initially petitioned against it, the department made the change permanent. Already, attendance is up and the failure rate has dropped by more than 50 percent.”

What does this have to do with Medical Education and Grand Rounds?

Everything!! For years, many of the Basic Science and Clinical teachers in medical schools and residency programs across the country have been “bucking” the “case-based and/or collaborative teaching” trends by saying that there is simply too much to “cover” to use these more interactive concept-based teaching approaches. It is true that you can cover more ground with a lecture, but if no one is awake, much less learning, what is the point?

Will medical and residency education be “brave enough” to follow the example of MIT? Can we resurrect interaction, clinical reasoning discussions and vigorous debate at some of our education meetings?

Can we change “Grand Rounds” into something really GRAND? Click on the link above and read the whole article. It is fascinating. We want to hear what your think?

CAN CLINICAL TEACHING BE BOTH HIGH QUALITY AND EFFICIENT?

I don't think Cleveland Clinic is alone in attempting to balance high standards for clinical teaching quality and the need for greater clinical productivity. The same way that experienced clinicians seem able to efficiently care for patients without a drop in patient satisfaction or quality of care, so then, experienced clinical teachers seem to be able to "teach" both efficiently and well.

The other day I was observing a clinical teacher with a group of residents and students during rounds. It was quite a sight. I wish I would have had a video camera, because this was a clear example of teaching expertise in action. The attending interacted with everyone on the team, the flow was quick and there did not seem to be a minute wasted as the team moved from room to room. The questions she asked were insightful. She provided quick feedback and was at the same time respectful to the "senior", asking him to "teach" at one point.

So... What is your secret? How do you make time to observe, give feedback, provide focused teaching? If each person that receives this BLOG could share one idea, we would really have something worth saving!