THE REVOLUTION IN
MEDICAL EDUCATION
Medical schools
have been among the most tradition-bound of all education
institutions. Mere suggestions by forward thinking professors
that there might have been better alternatives to having
students sit for hours in crowded lecture halls learning
anatomy and the history of disease followed by carving up
a lifeless cadaver were normally met with near-treasonous
accusations by senior faculty members.
Fortunately
for medical students – and their future patients –
the beginning of the revolution in medical education initiated
by McMaster University in Hamilton, Canada over 30 years
ago, has now finally begun to gain momentum.
Medical schools as diverse as
Harvard University (USA), University of Sydney (Australia)
and International University of the Health Sciences (St.
Kitts) are among the 200 or so worldwide who have adopted
versions of the Problem Based Learning (PBL) approach first
put forth by McMaster University.
Instead of the mind-numbing memorization of a rapidly expanding
data base of medical facts, PBL puts the emphasis on clinical
reasoning, integrative thinking, problem-solving, communication,
teamwork and self-directed learning – all desirable
generic skills previously neither taught nor assessed by
medical schools. As one might expect, the approach to PBL
taken by medical schools can differ widely – but in
its purest form, students, working in small groups, are
presented with increasingly complex sets of symptoms and
case histories. PBL medical students become better prepared
to deal with the real world as they learn to solve these
problems using methods which promote lifelong, independent
learning and integration across basic, social, population
and clinical sciences.
Hand-in-hand
with solving cases in the classroom, many PBL medical schools
recognize the importance of having its students interact
with real patients as soon as possible. At the University
of Toronto, Canada’s largest medical school, first-year
students are required to tour the city’s many alternative
clinics to research in detail the health issues they find
there. Students at the International University of the Health
Sciences (IUHS) on the Caribbean island of St Kitts, accompany
the school’s clinical professors on their hospital
rounds twice weekly. Prospective students are now asking
medical schools how quickly will it be before they will
be seeing real patients and not just actors playing sick
people.
When given a choice to participate
in the solving of medical problems of living and breathing
human beings versus spending months dissecting a cadaver,
most medical students apparently choose the living example
over the dead one. It is therefore not surprising to hear
that medical schools have already been moving away from
the use of cadavers in their basic medical education for
several years now.
A by-product of Problem Based
Learning is the shift in the nature of capital expenditures
by medical schools. “Bricks and mortar” are
giving way to “Bandwidth and computer access”.
The planned expansion of McMaster’s medical library
has been put on hold so that those budgeted dollars can
electronically link its medical students into a virtual
campus. Harvard’s medical school is investing heavily
in virtual instruction in order to do more training outside
its North East US location. One also finds that relatively
new medical schools, who do not have the heavy fixed investment
in buildings, can develop unique electronic programs aimed
at specialized medical personnel. As a prime example, IUHS
offers allied health care professionals (such as Physician
Assistants, Nurse Practitioners, and certain PhD’s)
the opportunity to enroll in the school’s electronic
learning program for the first 80 weeks, thereby allowing
them to “study down the hall at home” instead
of being separated from loved ones while living in St. Kitts.
Another
winner in the change in medical education has been the smaller
communities. In 2001, top medical school administrators
met at Harvard in an exercise in how to train 21st Century
practitioners. Their top suggestion was to get students
out of the big-city hospitals and “into places where
real medicine is practiced”. These smaller communities
have welcomed PBL students and graduates as Problem Based
Learning is, by its very nature, patient centered and holistic.
As prospective students learn
more about the advantages of the Problem Based Learning
approach to medical education, they will no longer have
to judge a medical school by the height and width of its
ivy covered walls, the cavernous lecture auditoriums, and
the size of its “paper-based” library. PBL students
of the 21st Century are able to electronically access every
medical journal, study guide and lecture note with a few
personal computer keystrokes any hour, day or night. A PBL
student’s study partner may just as well be 5,000
miles away or 5 feet across the table. And new graduate
doctors from PBL schools will be better suited to help solve
their patients’ problems with the essential humanity
and caring intrinsic to this vocation.
Author:
Randall John Simms,
Managing Director, IAG, Inc.
(rjsimms@iagconsult.com)
