April 23, 2028
Dear Dave Harris of 2018,
It has been a long time my friend, in fact 10 years. I have plenty of good news to share with you, which may be shocking or expected!
First, I am happy to inform you that the past decade has been extremely good for your Philadelphia Eagles! After winning Super Bowl LII in 2018, they have gone on to win 3 more with Carson Wentz running new “Philly Specials” year after year! Tom Brady finally retired after he dropped another wide-open pass in Super Bowl LV. However, the biggest surprise for you may be that the Cleveland Browns won Super Bowl LV!
I am also happy to tell you that the educators survived the Great Medical Education Transformation of the 2020s! I knew that you saw this coming around 2015, but the speed at which the Transformation occurred was mind-blowing for many faculty! We lost a few good “soldiers” in the process when they failed to adapt their educational views and styles, but as of now, medical education has never been better and there have been substantial improvements in patient safety and outcomes! I am sharing some of the changes with you to prepare the faculty of the future!
One of the first recognizable changes was the manner in which students approached medical school curricula. Even during your time, schools saw drastic reductions in class attendance and student engagement with the formal curriculum. The millennial students were used to obtaining information how they wanted and immediately when they wanted. Recording of lectures led to students remaining at home so that they could double speed your voice to sound (you have no idea how they describe you!), allowed them to view these lectures at midnight in their pajamas, and gave them the ability to stop and take notes. Many faculty mistook this as student disengagement and tried to “force” them into class by making mandatory sessions or increasing the frequency of assessments. However, students responded by stating that some sessions were a “waste of time” and “took time away from studying for Step 1”. They continued to vote with their feet and migrate away from the classroom!
However, what caught most faculty of your time off guard was the use of external resources outside of your own curricular items. The emergence of the “hidden curriculum”! Students were presented with alternative options such as Anki, Sketchy Medical, Osmosis, First Aid, Khan Academy and Pathoma to name a few! At first faculty were unaware and put up a staunch resistance. It was even postulated by some that the core curriculum of basic science could be delivered as a shared Medical Curricular Ecosystem (Le and Prober) that would help reduce redundancy in medical schools. This caused an imbalance in the galaxy and many of the upset faculty tried to prevent this from coming. However, many astute faculty quickly realized that it was already there!! At that point the faculty rebel forces decided to become proactive instead of reactive!
Town hall meetings, focus groups, and interviewing revealed many weaknesses in the medical school schema to date. Faculty struggled to realize that the millennial students grew up with the internet and basically a cell phone attached to their hand. Finding content was not an issue for them and what faculty discovered was that much of the content delivered in lectures was identical to what could be viewed in a video in 8 minutes. They also discovered that students grew up in a world where everyone was connected through social media and available almost 24 hours a day! They expected responses from their friends on a chat within seconds! After all, how many people sleep with their cell phone next to them? Faculty also discovered in these town halls that the generation valued work/life balance and anything that was deemed inefficient cut into this time that they could be doing something else. Through these important meetings, faculty also discovered that students were excellent at recalling facts and regurgitating knowledge. However, when asked to apply that knowledge to a problem, the students went back to recalling the facts. Students had mistaken memorizing for learning! And many faculty had mistaken learning for telling! Some faculty reflected back and actually admitted that we may have enabled the behaviors with our constant barrage of standardized tests of knowledge!
At least, the good news is that this led to some drastic changes in medical education! Gross anatomy has been severely trimmed down in an effort to focus on clinically relevant anatomy for undifferentiated medical students. Gross anatomy dissection is reserved for students interested in a surgical career as an elective. Much of that experience of cutting through muscle layers and isolating each artery, nerve and vein, and picking through layers of fat to get there has been replaced by complex computer programs that help students visualize the anatomy in 3D! Since ultrasound is currently available to any physician through their phone, more emphasis of anatomy related to ultrasound aspects has been a focus of instruction. For many of the pathological or anatomical variations, 3D printing has allowed for much cheaper and better alternatives for learning. Everything is currently related to clinical medicine and focuses on key concepts that are necessary to master as opposed to “knowing” everything! However, the changes did not stop there!
Much of the basic physiology content knowledge is now presented to the students in alternative ways using directed, short videos or providing references. The class time has been reserved for higher level threshold concepts where students are placed in situations in which misconceptions and dangerous reasoning can be identified and corrected. Simulations and standardized patients (robots) have become common place where students have to integrate what they were learning in Doctoring courses with real life physiology. Students enjoy the safe environment and as faculty discovered the role of affect in cognition, they quickly realized that this was a time efficient pedagogy. Faculty have discovered that 1 hour of intense, clinically oriented, and high yield threshold concept learning is much more beneficial and time efficient than 4 hours of didactic lecture. And faculty discovered it was fun!
Another aspect under appreciated by faculty of your time is that students enjoy being able to learn in their own environment as opposed to in the classroom. In your day coffee shops were filled with students studying away, but technology has allowed for large communities of learners to “get together” from their own homes. Time spent traveling from various hospital sites during the clerkships was saved by developing online communities for learning and using technology to facilitate discussion. Students felt more at ease critiquing another’s differential with this new design and appreciated the time saved from travel.
As I said my friend, medical education has been transformed in exciting and very positive ways! Successful faculty have worked with the students to enhance the learning experience as opposed to trying to teach the way we were taught! Faculty focused more on the learning process as opposed to trying to relay knowledge to the students. It was discovered that technology could not substitute for poor teaching. Faculty learned to develop activities to get students out of their comfort zones so that true learning could occur. And lastly, faculty realized that their roles were not eliminated. Rather the role of faculty had to change from the expert sage on the stage to the facilitator of student learning!
Well, I can’t wait to see what the next ten years will bring! You will be happy to know that your two daughters have grown up to be beautiful, caring people!
See you in 10 years and Fly Eagles Fly!!
Dave Harris of 2028
I realize that this letter may be viewed as provocative, crazy, and aspiring! However, I hope that the conversations in medical education can begin to REALLY improve patient safety and outcomes in the future. What changes do you think will occur in medical education in the next 10 years?
Reference: Le TT, Prober CG. A Proposal for a Shared Medical School Curricular Ecosystem. Acad Med, March 6, 2018