Two professors from Stanford say that it is time to change the way doctors are taught, according to an article published in the May 3 issue of the New England Journal of Medicine.”Since the hours available in a day have not increased to accommodate the expanded medical canon, we have only one realistic alternative: make better use of our students’ time,” the authors wrote. “We believe that medical education can be improved without increasing the time it takes to earn a medical degree, if we make lessons “stickier” (more comprehensible and memorable) and embrace a learning strategy that is self-paced and mastery-based and boosts engagement.”
The professors make a radical suggestion to move traditional lectures outside of the classroom and use class time for more “active” learning. They believe that in an era with a perfect video-delivery platform students would be wasting their class time sitting through a lecture. Instead, they say that the classroom model should be flipped to where students absorb an instructor’s lecture in a digital format as homework, which would free up class time for a focus on applications, including emotion-provoking simulation exercises. “Students would welcome more opportunities for case-based, problem-based, and team-based exercises – strategies that activate prior knowledge,” they wrote. “Teachers would be able to actually teach, rather than merely make speeches.The professors use the example of the Khan Academy to make the case that a ‘lecture-less” model would indeed be effective. The Khan Academy, a non-profit organization that offers online video lessons and exercises on elementary and high school topics, allows students to gain proficiency in core academic concepts at their own pace. The professors say that if such a model like one that the Khan Academy uses were applied to medical school, class time would be freed up for what they call “higher-order” and more interactive lessons.
One school already trying out this model is Stanford Medical school where the core biochemistry course did away with the standard lecture-based format and adopted one similar to the Khan Academy. Under this structure, class time was used for interactive discussions of clinical vignettes highlighting the biochemical bases of various diseases. According to the authors, the results were significant. Not only did the proportion of student course reviews that were positive increases substantially from the previous year, the percentage of students who attended class shot up from about 30% to 80% – even though class attendance was optional.
In their article the professors present a scenario: Imagine first-year medical students learning critical biochemical pathways by watching short videos as many times as necessary in the comfort of their personal learning space. Knowledge acquisition is verified by repeated low-stakes quizzes. Then, in class, the students participate in a discussion that includes a child with a metabolic disease, his or her parents, the treating clinicians, and the biochemistry professor. The relevant biochemistry – so dry on the page of a textbook – comes to life. The lesson sticks. “That’s the vision we want to chase: education that wrings more value out of the unyielding asset of time,” the authors concluded.