Why is medical education mired in the eighteenth century? Let's discuss inquiry learning in medical education.

Concurrent Session 1

Brief Abstract

In the year 2020, it's estimated that it will only take 73 days for the volume of medical knowledge to double. Simple rote recall is clearly not feasible, so the question becomes how do medical educators prepare future providers to have both a foundation of knowledge and critical thinking skills. 



Listening, Integrating. Sharing. Teaching, Collaborating. Analyzing. Listening to stories whether, from patients, students, or anyone has been a theme of my life. Through formal education as a journalist, a master's level counselor, a physician assistant, professor, and doctoral student, I have in-depth training and experience integrating these words and stories and concerns into concise actions, whether engaging with patients, developing treatment plans, curriculum development or implementing instructional design and technology. I am an Assistant Professor at the University of Tennessee Health Science Center in the Dept. of PA studies. I've been here since the program's inception ( 4 years) and serve as the Director of Admissions, member of the curriculum committee, and provide data analytics for academic progress and identification of at-risk students. My research interests include interprofessional education, curriculum development, pediatric issues, and incorporating non-traditional methods of teaching in medical education. As an ABD student in the Doctorate Program at the University of Memphis Instructional Design and Technology program, my area of research is focused on instructional strategy and design in medical education. My expected graduation is Summer of 2018

Extended Abstract

    Why is medical education mired in the eighteenth century?
    In the year 2020, it's estimated that it will only take 73 days for the volume of medical knowledge to double. Simple rote recall is clearly not feasible, so the question becomes how do medical educators prepare future providers to have both a foundation of knowledge and critical thinking skills.
    As far back as 1899, Sir William Osler understood medical knowledge was surpassing the ability of faculty to teach students “everything” they would need to know. Osler advocated that lectures should be “abolished” and students be given more time to study while allowing faculty to observe and guide their study.  A “call to arms” known as the Flexner report was released in 1932, by the Commission on Medical Education of the Association of American Colleges, where they reported that medical schools should begin the development of “independent study and thought” allowing students to become lifelong learners. The increase in medical knowledge since Osler’s insight and the Flexner report is exponentially greater as are the expectations of medical students. (For purposes of this session medical students are defined as students seeking an MD degree (Doctor of Medicine), DO degree (Doctor of Osteopathy), or a PA (Physician Assistant).  This raises the issue of how and what to teach medical students and provides a discourse for instructional methods used in medical education.
    As the Flexner report changed medicine at the dawn of the last century, new guidelines set forth by accrediting bodies suggest that health care education needs to focus on preparing providers to be team-oriented, critical thinkers, as well as prepared learners. 
    These future medical providers are entering school with different expectations with regard to life and work balance as well as different learning styles. Why does medical education continue to be mired in eighteenth-century methods of instructional methods as opposed to more student-centered methods? Medical education appears to mostly ignore educational science and not take learning theory into serious consideration. 
    Due to changing accreditation standards, medical educators are responding by exploring non-traditional types of instructional methods which strive to create a greater learner-centered environment. Several associations including the National Health Care Standards, Pew Health Professions, Carnegie Foundation, and, the Association of American Medical Colleges, and the Commission and the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) have called for a curriculum changes focusing on information processing as opposed to information delivery. A large part of medical education continues to primarily utilize the traditional “sage on a stage” methods which have been used for over a century. Current trends in medical education research, as well as strong suggestions from program accreditation bodies,  has led to an increase in the use of non-traditional (i.e., team-based learning and problem-based learning, case studies and active learning) teaching methods, sometimes labeled inquiry-based learning. 
    Even though considerable attention is being focused in this area the existing research has mixed reviews on whether the use of non-traditional learning produces effective outcomes. The literature suggests that there are gains in knowledge retention, knowledge transfer, motivation, improved patient communication skills, and clinical competence. As with anything else, along with strengths there comes areas which need improvement, with inquiry-based learning a significant issue is identifying the “gold-standard,” which would serve as an outcome measure. Another issue that the literature discusses is the cost of implementing new curricular ideas. This cost is both financial and also measured in time consumption. Experienced faculty may be resistant to changing their approach relinquishing their “expert” status. New faculty may not be experienced enough to develop these non-traditional approaches as they likely haven’t had prior exposure to these concepts. 
    This “Conversation, Not Presentations” session will address the use of inquiry learning vs. traditional learning in medical education and will ask the following questions:
1) Is this an all or nothing proposition or is there a sweet spot balancing between both pedagogies?
2) Why don’t medical students attend class?
3) OK, this sounds interesting where and how do I begin to use this at my institution?
4) What research methods or research questions should be used to start to explore meaningful outcomes?
5) Is there one form of inquiry learning which is more effective than others?
6) What will it take to persuade medical educators to shift their focus?