Answers for “Gaps” …. Within our grasp?

Moving Towards Modern Medical Education — Part 10


Part 9 of this series presents the argument that there are real problems and real viable solutions (in medical education).

Problems: There exists a diverse, multi-generational talent pool in medicine from whom is expected greater ability and competency than is realistic (from any radiologist or doctor). Perhaps in part because of this, weak and unreliable training and assessment methods are applied to our medical professionals, undermining overall capabilities and reputation as a profession.

Solutions: The structural foundations exist to encourage increased depth and specialization of knowledge, better access to expertise, and the improvement of decision-making processes. Available digital capabilities can transform the education system so as to support better-trained and better-performing physicians.

How then do we, as physician educators and our educational teams/support sturcture, present useful tools for the initial, as well as ongoing, dissemination of knowledge and training to modern learners with such different backgrounds?

Moreover, how do we close knowledge gaps that already exist and continue to emerge as our imaging acquisition tools become more sophisticated? How do we teach trainees and those who must keep up with the fast pace of our technological advances to use these powerful tools in the most optimal manner and interpret their output accurately, coherently and in context?

First, there must be a comprehensive curriculum that allows people to practice at a proficient or expert level. The scope must define the knowledge base and behavioral objectives in each subspecialty area (eg: of radiology).

  • The defined curriculum must be based on some reasonable aggregate of the experience likely to be encountered in the various scenarios that are the building blocks of these subspecialty areas.
  • In delivering the curriculum we must incorporate techniques that are actually used in practice.
  • There must be an endpoint at which the physician-learner can reasonably assume competence in each scenario and be prepared to demonstrate proficiency in an actual clinical situation and/or simulation of such.

Second, we must finally incorporate modern educational theory and practice in our educational tools.

  • Adult learning generally includes a desire to learn independently and asynchronously, at a time and place that can be reconciled with other adult responsibilities.(1)
  • We need a suite of tools that will adapt to individual learning bias be it visual, auditory or tactile or some mix of these styles of learning. Adult learners wish the tasks assigned to replicate what they actually do in practice (see and interpret imaging studies and report/ consult about their meaning) and in this desire there is an inherent acceptance of experiential learning principles as a preferred method of curriculum design.(2)
  • The suite of tools must include a short burst of specific, core, goal-oriented material to be mastered, presented in a reasonably illustrated format (for the purposes of medical decision-making).(1–6)
  • As they study, adult learners wish to apply their knowledge gained to assure progress is being made; this suggests built in self-assessment tools that assure progress in a critical thinking and reasoning model.(1–6)

The mature modern adult learner inherently wishes to have an experience that parallels the educational theory of the Bloom Taxonomy of Learning (6,7,8). While no model is perfect this one should be a cornerstone of planning a curriculum as a guide to modern educational theory.

Third, we must provide expert artificial intelligence (AI) — like tools as virtual consultants, when the closure of knowledge and reasoning gaps through continuing education efforts cannot accomplish the entire task.

Finally, the modern adult learner, admitted or not, comes to understand that acquisition of knowledge is only the first step and that not all the knowledge necessary for making good decisions can be assimilated and retained. They also come to understand that the educational system must train reasonable critical thinking and reasoning that can be targeted to specific problem solving scenarios.

In consultative medicine this must be aligned with the ethics of specific levels of consultation and communication required in the decision path. With patients now reading our imaging consultation/reports it is necessary for documents to be constructed in a manner that is factual, understandable and will not create unnecessary anxiety.

The technology is here. We must do more than marginally mobilize the extraordinary IT tools now available to educators.

As a beginning, our education must be delivered to any site in the world and provide the adult learner with an asynchronous experience that mimics the best of our current educational techniques in diagnostic radiology; namely, the instructor at the workstation with the trainee working through a particular clinical scenario. This basic experience should include an expert presence that can be accessed in a variety of learning styles through visual, auditory and tactile operations that can be blended as the modern learner prefers. Recognizing that not all gaps can be closed and new ones constantly emerge, this same system should be offered as a virtual consultant.

This would, in diagnostic imaging, incorporate Dr. Weed’s idea of IT leveraged knowledge couplers that will focus the evidence-supported knowledge base with patient centeredness and wisdom to tell the story of each patient: an Idea conceived by Dr. Weed in the 1960’s (9–13) before any of the current generations of diagnostic radiologists were practicing!

Coming Next: Part 11 — A Medical Curriculum for the Modern Adult Learner


I am on a mission to modernize post graduate medical education. With my team at the University of Florida, we have spent the last eight years developing a competency based curriculum and evaluation for radiology, based on modern learning theory. In this essay series, Moving Towards Modern Medical Education and Training, I examine in detail the pathway to modern learning and educational theory, and the outcome of the application of modern learning principles in this sphere of medical education.

Part 1: Medical Education: How Did we Arrive at the Current State

Part 2: “See one do one teach one”

Part 3: Teaching to the Test

Part 4: Competency or Passing the Boards? Every patient wants an expert.

Part 5: Errors and “Experts”

Part 6: Real Experts and Tolerable Error

Part 7: An Invitation to Harm?

Part 8: Three Ways Medical Education Could Better serve the Modern Learner

Part 9: Bridging Knowledge, Learning Styles, and Generational Gaps


References

1-Knowles, M. (1984). The Adult Learner: A Neglected Species (3rd Ed.). Houston, TX: Gulf Publishing.

2-Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Englewood Cliffs, NJ: Prentice-Hall.

3-Ericsson, K. A. (2006). The Influence of experience and deliberate practice on the development of superior expert performance. In K. A. Ericsson, N. Charness, P. J. Feltovich, & R. R. Hoffman (Eds.), The Cambridge handbook of expertise and expert performance (pp. 683–704). New York, NY: Cambridge University Press.

4-Ericsson, K. A., Krampe, R. T., & Tesch-Ro¨mer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363–406.

5 — Understanding by Design® book (Wiggins & McTighe, 1998)

6 — The Five-Stage Model of Adult Skill Acquisition Stuart E. Dreyfus

Bulletin of Science Technology & Society 2004 24: 177 (The online version of this article can be found at http://bst.sagepub.com/content/24/3/177 )

7- Bloom, B., Englehart, M. Furst, E., Hill, W., & Krathwohl, D. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive domain. New York, Toronto: Longmans, Green.

8-Krathwohl, D. R. Methods of Educational & Social Science Research: An Integrated Approach. 1st Ed. 1993, 2nd Ed. 1998, New York: Longman, also Long Grove, IL: Waveland Press; 3rd Ed 2009, Waveland Press

9-Weed, L. L. (1964–06–01). “MEDICAL RECORDS, PATIENT CARE, AND MEDICAL EDUCATION”. Irish Journal of Medical Science. 462: 271–282. doi:10.1007/BF02945791. ISSN 1863–4362. PMID 14160426.

10-Weed, L. L. (1968–03–14). “Medical records that guide and teach”. The New England Journal of Medicine. 278 (11): 593–600. doi:10.1056/NEJM196803142781105. ISSN 0028–4793. PMID 5637758.

11-Weed, L. L. (1968–03–21). “Medical records that guide and teach”. The New England Journal of Medicine. 278 (12): 652–657 concl. doi:10.1056/NEJM196803212781204. ISSN 0028–4793. PMID 5637250.

12-Weed LL. Medical records, medical education, and patient care: the Problem-Oriented Medical Record as a basic tool. 1970. Cleveland (OH): Press of Case Western Reserve University.

13-Jacobs L. Interview with Lawrence Weed, MD — the father of the problem-oriented medical record looks ahead [editorial]. Perm J 2009 Summer;13(3):84–9.

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