Teaching medicine as if we were scientists

This article is a continuation of the articles about Cognitive Error and Teaching Problem Solving
At a recent presentation Carl Wieman, a Nobel Laureate physicist talked about how the K-12 and undergraduate education systems had failed to meet the needs of science because these systems were not teaching students to think like scientists. Instead, science was often taught as a series of formulas and facts to be memorized; as something frozen like a mammoth in time.
Dr. Wieman went on to say that if we taught science in the way we do science, we would:
 Practice based on good data
 Utilize research on how people learn
 Disseminate results in a scholarly manner & copy what works
 Utilize modern technology.
So let’s take a minute to examine what he says in terms of how we teach medicine.
Practice based on good data
We have made a lot of progress in developing students who are able to discriminate between good and bad data through our emphasis on evidence-based medicine. With 10,000 new books and online articles published every month, how can we improve our students’ life long need to search out new information?
Utilize research on how people learn
For 50 years, we have ignored the educational research that says the lecture method is ineffective. I sometimes think that we are like baby ducklings that are imprinted to follow our professors. We find it almost impossible to give up our place at the front of the stage.
For 30 years, cognitive scientist have told us about how much the brain can retain in short term memory, yet we continue to stuff medical students with the richness of our knowledge and are surprised at their starvation of knowing.
For 30 years, medical education research has told us that active learning increases retention, yet medical students passively continue to sit waiting for question period at the end of sessions.
Does your department have a subscription to a medical education journal?
Disseminate results in a scholarly manner & copy what works
Does your department encourage research into the best way to teach your medical specialty? Does your department actively seek grants and inter-university initiatives in educational scholarship? Who in your department last published an article in one of the numerous medical education journals? Did you read it?
Utilize modern technology
Physicians are great users of medical technology and advocate for the purchase of new equipment when it becomes available. In terms of educational technology, many of us are like the immigrant who refuses to learn English and depend on our children to negotiate our way.
Who in your department is using innovative technology to teach? How many of the following do you use?
 Educational games
 Clickers
 Simulations
 Blogs
 Wikis
 Social Networks
 Elluminate
 Tagging software
 Videocasts
 Podcasts
 Image banks
 Personal website
 Class website

How video cases should be used as authentic stimuli in problem-based medical education

The following article is written by the Maastricht School of Health Professions Education about the study Bas de Leng, Diana Dolmans, Margje van de Wiel, Arno Muijtjens.
Medical Education 2007; 41; 181-188.

The more authentic the case, the better it triggers learning, at least that is one of the popular mantras in medical education today. But how to apply this wisdom and achieve authenticity in preclinical education where real patients are at a premium? Video cases have been suggested as a potential solution. But are they?
Studies have said about video cases:
– they can present a holistic picture of patients;
– they allow students to make observations unfiltered through a professional’s perspective;
– they convey emotion and non-verbal cues;
– they are more congenial to the MTV generation student, who is typically hooked on visual images.
But what if we apply the real litmus test to video cases? Do students really learn from them, better than from less authentic, paper cases? Does all the hard work put into producing and delivering them pay off? This is what Bas de Leng and his colleagues set out to investigate. They conducted a focus group study to pinpoint the additional value, if any, of video cases as experienced by second-year undergraduate medical students and they picked the students’ brains on what promotes the productive use of video cases. The students had been exposed to text-based cases and some fifteen video cases (3 to 20 minutes), including a patient in pain making a strong emotional appeal to the doctor, advanced trauma life support, 3 patients with chest pain and differing pathophysiology. The key messages from the students on the additional value of video cases and their productive use are listed below with illustrative quotations.
Additional value ofVideo cases:
are more authentic: “A physician uses his eyes first … He sees signs and symptoms and detects certain clinical pictures. We read about them in books and sometimes have little idea of how to visualise them ….”
present a comprehensive picture: “In a video on shock. We had to compare 3 patients … What was good was that we started to pay attention to details. What is pale skin, what is red skin? In a text you just read red skin, it is a given.”
are motivating and challenging: “A video on behavioural disorders showed a child just sitting there crying … and you did not know what was going on. You want to know what is wrong with that child. The image is challenging of itself; it really moves you.”
are better retained in memory: “Yes, the image, like that epileptic patient, I can still picture it in my mind.”
Productive use
The contents should not be too complete or directive: “… things were explained and the video did not engage your curiosity, it raised no questions”
The degree of difficulty should be appropriate: “Seeing an endoscopy … after having learned about the anatomy of the bowel and then being asked what do you see here … now that would be really interesting ….”
Cases should be watched in a structured fashion: “… we had to compare and describe 3 patients with similar symptoms. Next we had to figure out who had had an infarction. That was a different way of watching a video … Your are motivated and made to think.”
The cases should be brief and unique: “With the arthrosis cases, the second video was structured in exactly the same way, only with the questions about the hip instead of the knee. That video we just did not watch at all.”
The students’ messages appear to confirm advantages described in the literature, i.e. a holistic picture and emotion, visualisation of disorders to help students connect mental representations to the real world and thereby make them stick in memory. The importance of directions and structure supports that it is mistaken to assume that video cases require little effort. Because visual information is ambiguous, directions are needed to preclude too little attention for important elements or too much attention for extraneous elements. Cases should be tailored to students’ current knowledge, match curricular objectives and offer cues, but not too many, because the aim is to stimulate elaboration not stifle it.
Finally, the authors propose observational studies and studies of specific attributes of video as a medium. For now, the conclusion seems to be that, provided certain conditions are met, video can actually increase authenticity and help students learn and remember.

Web 2.0

You may have heard people referring to Web 2.0, the interactive sites that allows people to interact with the web in new ways. Facebook, Blogs, Google Maps, UTube, Flicker, Podcasts and Wikis are all Web 2.0 tools that allow people to post content, see other people’s creations and comment on what others are doing. Friends and families share photos and videos. Students share projects with classmates and students in other parts of the world. If MySpace were a country, its population would be greater than Canada’s.
How might you and your students use Web 2.0? What are you using now?
The video below explains this concept in more depth. Click twice to activate.

New Technology

This is a very funny video about using new technology. I find it particularly funny because I am quite passionate about history and know there has always been “new technology”. That’s what makes us human.
Click twice to play