Thursday, November 01, 2007


I'm willing to bet that many medical students in their third year think that they should be provided with classroom-style teaching as part of their clerkship education process. Medical $chool is, after all, really expensive. One might think that an education that keeps you in debt for many years should have a good amount of structured teaching. Many still think it is important to pull you away from hospital learning to sit in a class with four to fifteen other students to view some Powerpoint slides about the differential diagnosis of pediatric cough or the role of sleep apnea in pulmonary medicine. (My clerkship director thinks this, for example.) Five years ago, I may have agreed with the need for structured lectures.

These days, I much prefer learning in small groups in the care provider room, in patients' rooms, in the halls of the clinic, or even over dinner when on call. The thing about the medical training system, is that MOST people are in the process of learning and teaching. There is an adage in medicine called, "See one, Do one, Teach one," and while this may not be appropriate for some complex procedures, everyone should be in this mode. The residents teach each other and the medical students; students absorb experience from nurses and other providers; everyone learns from attending physicians. That's how teaching hospitals work. And don't just rely on others to teach you! If you are light on heart malformations, ask for some teaching from a cardiology fellow or the sub-intern on the cardiology team! Look up a paper, and present the tetrology of Fallot to your team. Chances are good that several others could use a brush up on that.

I know that the medical school wants to standardize its education so that everyone sees the same thing, or that some people just learn better in the classroom. I am pretty sure that the practice of medicine does not have didactics very often. If you cannot learn on your own or on the fly with and from your colleagues, good luck keeping up. I wish I didn't have to waste a good chunk of my days commuting to the lectures and figuring out ways to keep interested in them.

I mean no disrespect to the lecturers at my medical school, and specifically in my clerkship. It is clear that the administrators pay close attention to students' feedback - the lecturers are hardly ever boring, speakers generally use A/V aides appropriately and they often engage the students - I just think that time is better spent in clinic. We sat in the same chairs for almost 2 years absorbing info in classrooms. I wonder if these 5-10 hours of classroom learning are just a way to wean medical students from the structure of a classroom.

I'd rather go cold turkey.


Drugmonkey said...

and yet you barely touch on why you feel this way.

Something to do with your science training, perhaps?

thomas said...

Yeah - sorry for the post 'lite.' Sometimes I want to get my thoughts and ideas down 'on paper' when they are clear & I have the time.

I have the sense that this resistance to classroom teaching has less to do with my training as a scientist and more to do with my preference for active learning. You might say that such a different learning style is what inclined me to science in the first place.

It's funny though - I loved classroom learning as an undergrad. Granted, these were philosophy and engineering classes where problem solving were strongly emphasized...

SO there could be something underneath it all, but what pops out at me the most while thinking about it on a lazy Saturday morning is that I am tired. Tired of sitting in classes.

Maybe that's why I nod off in some of them...