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edical 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.

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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.

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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.

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  • The “learning styles” myth has been refuted several years ago. A comprehensive systematic review of the literature found zero evidence that learning styles exists. So, each time I see an article written about something that the larger education and psychology research communities has already buried I roll my eyes. The actual literature says people have a preference for how they receive information, but there is no evidence whatsoever that people actually perform better when they are taught according to their preference. Note to everyone: Stop reading blogs and opinion-pieces and instead seek out the peer-reviewed literature by experts. Too much damage occurs when people fail to investigate things for themselves and refuse to let go of an idea based on opinion when there is no evidence to support it.

    • Yes “Ed” (really?), the relevant peer reviewed lit should be read in the original. The simplified roll up summaries attributed vaguely to ” the larger education and psychology research communities” do not encourage intellectual growth.

      Style is very much an open question. Too easy to dismiss lack of performance difference to no style difference. Most learners learn the plasticity to cope, especially if the learning demands are not onerous and occur in well-understood environments. What happens when learners are exhausted, over-extended, out of their depth and in unfamiliar high stakes situations? Like most professional site placements on the graveyard shift or nearing presentation deadlines. What about the learners without the plasticity to learn in radically different environments?

      As professional educators we usually punt, that is, we ignore all this disfunctionality and retreat to our comfortable ‘average student; average content, average demand”. Think about damage that allows to continue.

  • People differ. Perception differs. Learning differs. Care differs. Every time we ignore this to favor of institutional revenues, management or professorial efficiency we lose, that is the learners lose as does the society served. At the very least we convey the message that the individual matters less than the in-place structure. Wrong and wrong.
    The various critiques of learning/ cognitive/individual style center around the problem of experimental design. I know, I have written them. Doing RTCs with high stakes professional education is not on and the more inventive design approaches require a scale of involvement and control I have not seen supported anywhere in professional schools. Funding research in education is considered peripheral by all funding agencies leaving professional education research to be funded by individual professions, if at all. Even well funded professions like medicine have a hard time coalescing around a research agenda in education.
    There has been enough good quality evidence around for years now (see below) to merit better organized, bigger scale, longer time-frame investigations and series of intervention trials (achieving style plasticity is important to efficient functioning in different settings with different structures and demands).
    Maybe now that we are talking about individualizing patient care we could transfer that same respect to our students for the same reasons: better outcomes. Every decade style seems to cycle in and out of the ambit of professional educators. Here’s hoping we are into another up-swing. Any takers?
    For some background on what we do know and some sense of what we could do, please see:
    1. Individual differences in cognitive style, learning styles and instructional preferences in medical education. Chapter 8 (pages 263-276) in International Handbook for Research in Medical Education Part One. (Eds) Norman, G., van der Vleuten, C. and Newble, D. 2002. Amsterdam: Kluwer Academic Publishers. ISBN 1-4020-0466-4
    2. Review of Learning Style, Studying Approach and Instructional Preference Research in Medical Education. Chapter 9 (pages 239 – 276) in International Perspectives on Individual Differences (Eds) Riding, R and Rayner S. 2000. Stamford, Connecticut: Ablex Publishing Corporation
    3. Cognitive and Learning Styles in Medical Education. Academic Medicine, 1999, Vol. 74, No. 4, 409-413
    4. Patterns of learning style across selected medical specialties. Educational Psychology, 1991, Vol. 11, No. 3/4, 247-277
    5. Critique of the Research on Learning Styles. Educational Leadership, 1990, Vol. 48, No. 2, 50-56. Reprinted in Educational Psychology, Annual Editions, 1992 and 1993. Dushkin Publishing Group, Inc. Guilford, CT
    6. Integrating Concepts of Cognitive or Learning Style: A review with attention to psychometric standards. (The Curry Report) The Learning Styles Network, Center for the Study of Learning and Teaching Styles. 1987. Jamaica, New York: St. John’s University.
    7. Learning Style in Continuing Medical Education. 1983. Ottawa, ON: Canadian Medical Association.

    • Hi Laura,
      I can’t access the full text of this article without purchasing it but it’s main points seem to be that learning styles categorizes students unnecessarily and that there is no proof that teaching to these differences improves student performance. I was not suggesting categorizing students or advocating learning styles but rather, suggesting students be allowed to choose how they learn and study based on personal feedback. At the medical school level, this assumes motivation and intelligence from participants but I’d expect anyone in med school is capable of that. “Learning styles” in this sense is more colloquial.

    • Laura, it’s waaaay premature to declare the concept of learning styles dead and buried. I’ll concede, at lease for the moment, that the author’s assertion in the article you cite is valid – that the scientific basis for the concept is currently thin. Currently. But it’s hard to argue that al our brains are wired the same, when daily experience suggests otherwise. Neural diversity is, in fact, “a thing.” So rather than crush this conversation out of some undefined fear of “categorizing” people, how about we engage constructively in conversations that welcome the many ways people perceive and process the world around them?

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