Medical

The Changing Culture of Medical Education

Transitioning to medical school is a significant change for most students; this naturally makes it a source of excitement, anxiety, stress, and even fear. Being a successful college student will not necessarily translate to success in graduate/professional school, although many of the same or similar strategies will help. Ultimately, adjusting to medical school is going to depend on the individual student and their school; each curriculum will present unique challenges and each student will handle them in a unique way. Although curricula vary among schools, some concepts are similar across the board. Perhaps the most uniform component of twenty-first century medical school curricula is the fact that they are constantly seeking to improve; thus the adage that “change is life’s only constant” seems to be true, at least of medical schools.

Learning How to Learn
One aspect of medical education that will challenge most students is the process of learning itself, especially at a faster pace. Many students indicate that medical school is not significantly more difficult than college coursework in the same subject areas, but it is achieved at a much faster pace. For example, an upper-level undergraduate course in physiology will often cover information at sufficient depth for a medical professional; however, what the undergraduate student learns in a full semester might be accomplished in four to six weeks (or less) in medical school. The rate of change also increases in most programs – second year is often faster paced than first year, which allows students to adjust to the change in pace. As with college, the material often does not get more difficult from one year to the next, but the information builds on previous knowledge and the pace at which it is covered tends to increase. (For this reason, it is often difficult to say which class or even year of school is the hardest. The first year of medical school might be more challenging for a student that is slower to adjust, even if the material being covered is not as technically difficult. Like their opinions on the transition to medical school, students’ opinions on what courses are difficult and easy are going to vary significantly from person to person, so take these words of advice or warnings in the context of the individual.)
Decentralizing Education
In addition to the rate of learning, a significant change from college to medical school is the way in which the material is presented. Thirty years ago, there may not have been an appreciable difference between the curriculum of an undergraduate pre-med program and medical school, besides the pace – both were typically structured with lectures, prepared slides and course note packs, with guided laboratory exercises included where applicable. Although this model remains the norm for college courses, most medical schools are moving away from this model or have completely departed from it already. In general, medical school curricula are less structured – formal lectures are limited and/or delivered online, to be watched in advance or as a supplement, and prepared notes and lecture outlines are being provided less and less. Instead, students are given learning objectives and encouraged to study the authoritative textbooks, and even the primary literature, themselves. Lectures have been largely replaced with active learning experiences – “Team Based Learning”, “Problem Based Learning,” etc.
Student Centered and Focused
These changes represent a significant cultural shift for most medical students. These students have usually not had experience with this type of learning prior to medical school, which can make this aspect of the transition difficult. Although troublesome, this cultural shift is guided, at least in part, by research demonstrating improved outcomes. Accrediting bodies such as the AAMC require more active learning hours and limit the hours that are permitted to be lectures. These accreditation requirements are what drive some of the change, although reciprocally the guidelines are often shaped by the novel ideas that each school tries and finds to be successful. The “active learning” sessions are designed to facilitate group learning, discourse and discussion, and peer to peer instruction. The collective intelligence of groups enables everyone involved to gain more than they might be able to on their own, and students can take advantage of the strengths of their colleagues in areas that might be weak for them. In addition to improved learning, these types of activities promote scientific inquiry, professional communication, and collaboration in ways that were previously not part of most medical curricula.
In addition to the academic benefits, there are personal benefits of the new style of curriculum as well. Students are able to structure their own schedules for efficient learning, based on their own needs, without the constraints of required lectures and class time. Each individual can spend more time on subjects they find challenging without burdening their classmates, and similarly can spend less time on subjects with which they are already comfortable. One of the reasons that I personally enjoy this model is the flexibility it affords me. We often have less days scheduled with required class attendance, which allows several benefits: I can travel more easily, work according to my own schedule, and study in a variety of locations (such as at home, local libraries, and coffee shops). These benefits are all possible because of the transition to a student-centric model of self-guided learning.
Challenges and Outcomes
There are, no doubt, challenges to these new and changing systems. Motivation is a key factor; decreasing structure puts more of the responsibility on the students’ shoulders. Since medical students are usually chosen for being driven and eager to learn, this is not usually a significant issue, but may influence the criteria medical schools use to select incoming students. The transition is particularly difficult as new aspects of curricula are rolled out for students to try, only to learn that they are not as effective as expected. Although this can be frustrating for students and educators, it is ultimately part of the learning experience – trial and error, and learning from mistakes and successes. Students, faculty, and administration are all seeking to improve learning outcomes for students – and it seems likely that with continued improvements, each new generation of doctors will be even better prepared for the changing world of medicine.

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Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshoft School of Medicine. His professional interests include medical humanities, mental health, and medical education. Brent Schnipke, MD is a writer based in Dayton, OH. He graduated medical school in 2018 and is psychiatry resident at Wright State University Boonshof...