I was in the middle of reviewing the First Aid chapter on Respiratory diseases when I had a thought about the battle we face at University Medical School for the attention of the medical students.
Class attendance at UMS, as it is in many schools, has hit an all-time low. This causes some consternation among folks who keep score based on lecture attendance, or lack thereof. My initial reaction to this concern is, initially, incredulity – how many times have I heard my friends in Teach for America wish that they had more students to teach?
Okay, so maybe the folks in primary education measure their success differently. Maybe that’s because they consider their roles differently. Indeed, I recently sat next to the Dean of UMS at a meeting which discussed this issue, where the Dean rhetorically asked “what could be more efficient than one lecturer instructing 120 students?”
To me the question is rhetorical, but perhaps not in the way the Dean intended. The view of lectures as “efficient” is the root of the very problem in the way that many folks conceptualize medical education. The goal of lectures used to be to solve an information distribution problem: good textbooks were outdated, few and far between. Textbooks and reference materials could never keep up with the advances in medicine, nor could they explain complicated concepts to students, in the ways that even average lecturers could.
Today, the tables have turned. There are great textbooks, great websites, hundreds of videos from schools and instructors around the world, in short: a glut of information. The absolute last thing students need is another source of information. We need a guide. We need someone who can uniquely illuminate the path and inspire us. We do not need a data dump. We do not need more Powerpoint (a dreadful hobby which killed the dinosaurs and downed the space shuttle and will probably cause World War IV).
Lest I sound insensitive (which, in truth, I am), I should note that taking an hour or two out of a very busy clinical or research day to lecture to students is not an easy thing to do. Particularly when you are offered little or no salary support for teaching: it actually costs most of our lecturers more to lecture to us than it costs us to attend their lectures. This is particularly true of surgeons and other procedural-based specialties (although, I suppose, these days that’s just code for “doctors who actually make money”). And, having been educated through the data dump system, it is understandable that lecturers may calculate that if they do not “teach” enough students (read: enough students have their butts in seats), then their time would have been better spent doing another catheterization, rhinoplasty or seeing another kid with a runny nose.
We’re in the midst of a fundamental revolution in medical education. For the first time in thousands of years of training physicians, the best road to a basic science education does not necessarily run through the lecture hall. But it could – oh yes, it could.
Lectures aren’t the best way to disseminate information, or even the way to disseminate the best information. But there can be something irreplaceable, even life altering, about being in the presence of a great mind. Witness the popularity of TED talks, and the TED conferences. I hope that everyone who has gone through the educational system has, at some point, had an instructor who has inspired them. I know that I’ve been fortunate to have several, and even more fortunate to count among them some of my current mentors. That relationship, and great lecturers ALWAYS create a relationship between themselves and their learners, is unique to the human-human bond created by engaging in a dialog with another person.
In short, the loss of the emphasis on creating faculty – learner relationships is what’s missing from medical education. Modern medical education is not about information transmission, and in truth it probably never was. It is as much a moral education as it is a technical education. That education can only be given person-to-person, face-to-face. I call upon all current medical educators to redefine their mission from providing knowledge to providing inspiration, guidance and true education. When you stop trying to be “efficient” and start trying to be mentors (one of the least “efficient” activities imaginable), we’ll start coming to class again. I know that there are places in the country where this has already happened. University Medical School is not yet one of them. Until then, the internet will provide us with more than enough information to pass your tests and licensing exams, but we’ll always be missing your light and passion. I sincerely hope the faculty recaptures its ability to provide that passion before we forget that it should even exist.