{"id":3123,"date":"2021-02-26T10:47:58","date_gmt":"2021-02-26T15:47:58","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=3123"},"modified":"2021-03-02T08:26:18","modified_gmt":"2021-03-02T13:26:18","slug":"toward-a-pedagogical-shift","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2021\/02\/toward-a-pedagogical-shift\/","title":{"rendered":"Toward a Pedagogical Shift"},"content":{"rendered":"
\"Sneha<\/a>

Dr. Shah is a Chief Resident in Internal Medicine at the University of Colorado.<\/p><\/div>\n

\u201cIf we teach today\u2019s students as we taught yesterday\u2019s, we rob them of tomorrow.\u201d<\/strong><\/p>\n

\u2014 One summation of philosopher John Dewey\u00a0<\/strong><\/p><\/blockquote>\n

The Why can\u2019t I just Google it?<\/em> Problem<\/h4>\n

Imagine seeing a patient with symptoms you suspect mighty be the result of a medication side effect. But you\u2019ve forgotten the mechanism of action of this medication. You left your pocket pharmacology book at home, and the hospital library is 15 minutes away. There are no pharmacists on the wards for you to consult. I imagine there was a time when memorization in medicine was crucial. I am not saying it isn\u2019t now, but I propose that it is less so. In less than 1 second, Google can tell me the mechanism of action of any medication. By conceding that the availability of lightning-fast information at our fingertips is an argument against memorization, are we doing a disservice to our learners?<\/p>\n

\"Sherlock's<\/a>Pedagogical shift, proposal 1:<\/strong> Let\u2019s teach our learners how and when to appropriately utilize modern, web-based tools. More importantly, let\u2019s teach them why<\/em> it is still important to engage in some memorization instead of always reverting to \u201cWhy can’t I just Google it?\u201d If you\u2019ve ever run a Code Blue, you know there are times when your memory must serve you under extreme pressure. I would like to see medical education emphasize the why<\/em> instead of the\u00a0what.<\/em>\u00a0Any modern learner can Google the what\u00a0<\/em>(i.e., what is the mechanism of action of labetalol?). So let’s set aside testing learners\u2019 memories and instead re-allocate time to teach them why<\/em> a master clinician chooses labetalol instead of another agent.<\/p>\n

USMLE is already moving toward making Step 1 Pass\/Fail; many medical schools are shifting to a longitudinal curriculum. As someone who has come from \u201cbench to bedside\u201d and now is arriving back at \u201cthe bench\u201d for ongoing enhancement of my understanding of pathophysiology, I wish I would have been taught with the above lens.<\/p>\n

The I d<\/em>on’t have time<\/a><\/em>\u00a0Problem<\/h4>\n

Residents of today have quite a bit asked of them! Pre-round efficiently, present that data flawlessly, tend to sick patients, admit new patients, run family meetings, discharge patients (ideally before 11AM), write your notes quickly but without copy forward so the attending can co-sign, and sign-out in a timely manner so you don’t break duty-hour restrictions. All this, along with the added pressure of attending educational conferences and reading about patients. It\u2019s hard. I worry that the residents (and the perceived \u201ccheap labor\u201d they provide) have been misappropriated to doing more and more. Is there a way for residents to see a similar volume of patients but re-allocate their limited duty hours back to being learners?<\/p>\n

\"medical<\/a>

Courtesy of CU IMRP<\/p><\/div>\n

Pedagogical shift, proposal 2:<\/strong> Let’s challenge our learners to practice mental dexterity. With the ubiquity of workstations on wheels in many hospitals, is a model of \u201cdiscovery rounds\u201d better? Here, time typically spent pre-rounding can be spent at the bedside, reading about illnesses, and prepping the rest of the afternoon for success. This model may be more difficult for junior learners (medical students and interns), as it requires one to synthesize data quickly, assess the patient\u2019s condition, and derive a plan. For senior residents, this may be the necessary way forward for critical clinical reasoning. This method might also help shift the traditional model of data transference (from the pre-rounder to the rest of the group) to one of dialogue.<\/p>\n

The\u00a0Stuck in a routine<\/i>\u00a0Problem<\/h4>\n

Everyone learns differently \u2014 some visually, some aurally, and some in a tactile manner. One of my favorite education philosophers is Paolo Freire. In his Pedagogy of the Oppressed,\u00a0<\/em>he writes, \u201ceducation is suffering from narration sickness.\u201d It is not by pretending we are empty vessels to be filled with medical knowledge that one becomes the type of provider they want to be; but rather by experiential learning through a growth mindset and empathetic dialogue will we become our best physician self. That\u2019s a bunch of fancy words to say, as a chief, I notice a decline in enthusiasm toward attending educational opportunities and wonder why this is the case? What changes would the learners prefer?<\/p>\n\n\t\t