To the Editor:
In a recent commentary, Prober and Khan1 suggest that delivering a core curriculum during the didactic phase of medical education through a series of 10-minute video presentations coupled with discussion and optional “deep dives” would be an effective and novel approach to medical education. Though well intentioned, their ideas may weaken our system of medical education.
Medical education is a wonderfully complex combination of facts, ideas, and the art of effectively presenting challenging information. An important component of student learning is building the knowledge necessary to distill and then correctly apply this information in an often chaotic and unstructured environment. I am aware of no evidence that critically important learning skills can be developed by presenting students with a curated set of “lecturettes” that are available in a “just-in-time” learning environment. Though the authors highlight the importance of discussion and other forms of interactive learning, reducing the opportunity for students to establish a framework, integrate course content, and then apply this content to problem solving may be counter to effective education.
Prober and Khan suggest that a medical student would benefit from the same “flipped classroom” educational methods being used in grade school. Research has shown, however, that adult learners are more self-directed in their learning,2 they have established a problem-centered rather than subject-centered orientation to learning,3 and they have an increased ability to integrate large amounts of information into their existing knowledge base when compared with young children. It is likely that the optimum methods and assumptions for teaching elementary school students are quite different from those for instructing medical students.
Prober and Khan acknowledge that “the current system of medical education has resulted in the training of a superb workforce of physicians,” yet they argue that the system needs to be revamped. Any major changes in methods of instruction, however, should be evidence based. The authors’ statements that
- “the net effect of [innovations in teaching strategies] on the way we educate physicians has been limited,”
- “the introduction to a life of medical education often is not … compelling,”
- “much of what [medical students] will be taught … will prove to be wrong,” and
- the current system of medical education is “inflexible and not sensitive to the skills and aspirations of individual learners”
are broad generalizations that are not supported by evidence.
It is admirable to challenge the status quo of medical education, but it is essential that any change will enhance value. The mere existence of technology or free content without evidence that these add value should not be the catalyst for reimagining education.
Harry Goldberg, PhD
Assistant dean, Johns Hopkins School of Medicine,
director, Academic Computing, and faculty,
Biomedical Engineering, Johns Hopkins University,
Baltimore, Maryland; firstname.lastname@example.org.
1. Prober CG, Khan S. Medical education reimagined: A call to action. Acad Med. 2013;88:1407–1410
2. Knowles MS The Modern Practice of Adult Education. 1980 New York, NY Adult Education Company
3. Davenport J, Davenport JA. A chronology and analysis of the andragogy debate. Adult Educ Q. 1985;35:152–159