Fear as an Educational Technique

In a recent discussion with medical residents, someone asked the question “What’s wrong with fear as an educational technique?” Several people then told about how fear had worked to increase their preparation for class or exams.
I was mildly shocked that someone would even suggest that this was a legitimate teaching technique, but then I sat down and did some more thinking about the theories of teaching and learning.
Spare the rod and spoil the child is a concept that has been around for a very long time. It is part of an authoritarian system that required an authority (church, father, king, husband or teacher) to know what is best for others. The others must be guided to follow the authority figure without question because they don’t have the ability to make decisions. If they don’t obey, then punishment must be used to bring the rebel, unbeliever or lazy student back into the fold for their own good. Those who respond positively to the authority figure are rewarded with praise, promotion and belonging. In educational theory, this is called Behaviorism. If you want passive, unquestioning students, behaviorism works. Non-conforming students are removed from the system through failure or opting out. Industrial economies require an authoritarian educational system.
Constructivism is another educational theory that has become increasingly popular in the last thirty years as we move into the information economy. Constructivism is based on the idea that all knowledge is a construction of the human mind. Knowledge is shared from person to person, but acquisition is always the result of individual learning. This result will differ from person to person based on ability, culture, exposure and motivation. Teachers facilitate the opportunities for student acquisition of knowledge, skills and attitudes, but they don’t control it. The student is expected to bring their personal motivation to learn to the table. They are expected to be or to become self-directed, lifelong learners. Punishment is considered to be disrespectful and counter-productive of that student’s right to learn.
Between these two very different approaches to education is the question we are continually asking, “What is the best way to educate future physicians?”

Preparing Students to Work with Addiction Issues

Several medical Blogs have been commenting on alcoholics and drug addicts tricking doctors into giving them drugs. Many of these Blogs suggest that heightened vigilance is the answer to this problem even if this means not giving pain medication to patients who need it.
As physicians preparing students for medical practice, this important issue needs to be more closely examined and prepared for in medical school. Here are some suggestions:
1. Increase awareness of addiction treatment including how the desire to take responsibility for stopping the addiction results in physicians playing futile control games with addicts. Identifying what is and is not in the physician’s control is essential here.
2. Teach students to handle stressful situations in ways that avoid becoming involved in power struggles with patients. Acceptance of things the student cannot change is essential to this process.
3. Increase awareness of how and when pain medication is needed even when facing addiction issues including the information from the National Cancer Institute below.
People who take cancer pain medicines rarely become addicted to them. Addiction is a common fear of people taking pain medicine. Such fear may prevent people from taking the medicine. Or it may cause family members to encourage you to “hold off” as long as possible between doses. Addiction is defined by many medical societies as uncontrollable drug craving, seeking, and use. When opioids (also known as narcotics) — the strongest pain relievers available — are taken for pain, they rarely cause addiction as defined here. When you are ready to stop taking opioids, the doctor gradually lowers the amount of medicine you are taking. By the time you stop using them completely, the body has had time to adjust. Talk to your doctor, nurse, or pharmacist about how to use pain medicines safely and about any concerns you have about addiction.