Medical education is constantly evolving to keep pace with the rapidly advancing world of modern medical practice. The teaching model that has dominated for the last few decades — four years divided between lecture, study, and clinical rotations — is giving way to programs that include more creative approaches to learning. Yet these reforms may not be enough to produce the innovative, dynamic thinkers required by medicine’s expanding frontiers.
The curriculum overhaul at the University of Vermont’s Larner College of Medicine plans to completely replace lectures with so-called active learning approaches that let students learn material in a more hands-on way, as in simulation labs and group case studies. At the new Hofstra North Shore-LIJ School of Medicine, students are required to train and practice in the field as certified emergency medical technicians rather than sit through lectures during their first eight weeks.
Other programs give students more time for hands-on electives in later years by concentrating academic courses in early semesters. Still others supplement the traditional four-year system with classes targeting newer technologies and databases.
These changes are all aimed in the right direction. But they still force students at the same school to learn the material the same way. Why keep things uniform when we want original approaches to problem-solving and patient care?
Every medical student has a style of learning that works best for him or her, and each one is most likely to succeed in mastering new concepts and material when using that style.
I’ve discovered that I learn best with a combination of visualization, listening, and verbalization. Before a lecture, I need to make mental maps of new concepts on my own so I can better engage with them. This means picturing a biological pathway in my head, or making an outline or diagram to illustrate a system’s function. Then, when the subject comes up in a class or lecture, I can apply what the lecturer is saying to the visual groundwork in my head. To reinforce the idea, I’ll talk out what I’m picturing with a classmate after lecture or verbally walk myself through it again.
Ideally, I would have time before, during, and after lectures, labs, assessments, and extracurricular activities to form this understanding of underlying concepts my own way and consider follow-up questions about other parts that interest me. In reality, I’m sometimes forced to resort to memorization, which limits original insights and personal perspectives.
When the system is inflexible, it can stand in its own way — if I can’t learn in the way I learn best, I’m left with facts and figures I have memorized not concepts and ideas I understand.
The more flexible medical school curricula encourage this unique learning and ownership of education in the second half of their programs by letting students pursue chosen electives. But few let students customize their approaches when it comes to the basics.
Perhaps medical schools should take a lesson from the increasingly popular student-centered learning model being embraced at the K-12 level.
In student-centered classrooms, teachers empower students to determine for themselves what they’re interested in, how they want to learn it, and how they’ll measure progress. To make sure students cover all the required academic checkpoints, teachers encourage them to make interdisciplinary connections between areas that interest them and other necessary topics they may have otherwise skipped. This approach helps students gradually develop consciousness of their academic strengths and weaknesses and the learning strategies that work — and don’t work — for them.
With these tools, students can set goals, create plans for achieving them, and revise their strategies personal feedback. The ultimate goal is to foster independent thinking over rote learning or memorization and to nurture individuals with uniquely developed approaches to solving problems sculpted by their strengths and personalities.
Medical education has the same goal.
Increased student-centered learning in medical school curricula can be accomplished with a similar model. Instead of eliminating lectures or introducing other required classes, programs could make available a variety of optional resources, such as lectures, small-group sessions, and hands-on exercises. From the start of their med school careers, students could decide how to meet established academic objectives based on their preferred learning methods.
Lectures don’t have to be required — or even physically attended. Instructors could record talks on each subject and virtually present clinical case studies so students could choose to come in person with questions or listen whenever and wherever works best for how they learn. Active-learning exercises, like small-group simulations of patient cases or group problem-solving, could be offered too, encouraging students to meet and interact with material. If, like me, they need to prepare on their own ahead of time to get the most out of interaction, students would have the resources and choices to do so.
Widely used visual technologies could support this flexibility by making it possible for students to virtually go deeper into cases or anatomical structures they don’t immediately understand. Regularly spaced pass-fail exams would make sure they covered all of the material necessary for successful medical practice, provide feedback about the success of their chosen learning methods, and give them a heads-up that they need to adapt those methods before falling behind. With no curricular requirement dictating attendance or sequence, students could decide how to distribute their time based on what they need to do to learn best.
If budget constraints or resources are a barrier to large-scale reform, simply modifying attendance requirements or removing formal grades from courses could encourage freedom and independent thinking in existing programs. This would let students choose which of the offered sessions to attend based on their individual needs and learning styles. As long as they replaced skipped sessions with other methods for learning essential material, they could optimize their education within the existing structure.
In a curriculum like this, I would spend a lot of time with visual resources like 3-D simulations and diagrams, redrawing them and taking notes on big ideas before listening to recorded lectures and case studies. The ability to replay sections and pause during sections where I need to investigate a bit more would give me the opportunity to sit for a few seconds and imagine processes or structures as they’re being described. For subjects in which I’ll likely have questions or need help making connections, I might attend the actual lectures or arrange to meet with the professor one-on-one. I would do all of this before participating in active learning exercises, which I would use to cement my understanding once I felt thoroughly prepared. Each of my classmates would undoubtedly take other approaches.
By encouraging medical students to pursue the avenues of learning that work best for them, medical schools would let students intuitively shape their education, just as they will someday be expected to shape treatment plans to meet unique patient needs. Not only will these students be as academically prepared as their traditionally educated peers, they will enter medical practice with different approaches to problem-solving, which will be a boon to the teamwork often needed to tackle tough diagnoses and treatments.
By giving medical students the freedom to learn in the ways that fit them best, medical schools will be better suited to turn out doctors with the critical and creative thinking skills necessary to provide unparalleled patient care and to find innovative approaches to the increasingly complex problems facing modern medicine.
Kendall Sarson is a second-year student in Columbia University’s Postbaccalaureate Premedical Program.