Had a "bonus" teaching session the other day. Well, technically it was mandatory, but it wasn't part of the official curriculum and I don't think there were any consequences for missing it, so exactly how mandatory it was is questionable.
Anyway, it was pretty clear this was an initiative started by the instructor, not the school, to cover a clear hole in our official training. It was a fairly simple lesson, but very well taught and extremely high-yield. I got to put the lesson into practice mere hours later, to great effect.
I've noticed a lot of my best learning opportunities come outside the standard curriculum. Sometimes these are initiated in conjunction with the school, sometimes not, but they're always driven primarily by the instructors themselves. Looking back, most of my more enduring learning has come through these extra-curricular sources. There are some facts that just float around in your head and some that are practically burned in there and for me, pretty much all of the latter come from these informal sessions.
The classic approach to education is to set requirements for lectures and other educational activities, then to test to ensure the information has been passed on (as well as to promote self-study on the part of learners). This works reasonably well to ensure a minimal set of knowledge is acquired, but it's rather inefficient and not all that effective. The main problem is the classic approach relies almost solely on extrinsic motivation of students - using either rewards or punishments for doing well or doing poorly along whatever evaluation metric is employed. That encourages a lot of short-term learning, cramming, or strict adherence to what is being taught. In an expansive, evolving, and applied field like medicine, that's a recipe for inefficiency. Important information may not be emphasized sufficiently in the curriculum, may not be well-tailored to a student's eventual practice, and even if a student does well on a test or other exam, that knowledge may not be well retained in the future.
Extrinsic motivation is also at play when it comes to educators. I can't say how many times I've had a lecturer say "I've been asked to talk about this subject, so here goes..." Sometimes that works out and quality instruction is given. Sometimes the instructor knows their topic well, but isn't a great teacher, or doesn't understand the broader context of our education, and their lesson is rather low-yield. Sometimes the instructor is fine as a teacher, but they aren't an expert on their subject and are just doing the best they can. Schools use the carrot and the stick on their faculty members just as much as they do on students, with much the same drawbacks.
When an instructor goes out of their way to host a session, they are always an expert on the subject, they're generally good teachers, and the information they give is generally quite applicable in practice. Likewise, when a student goes out of their way to attend a session, they are almost always interested, attentive, and receptive. It only makes sense that I would have my best learning experiences in these situations - both I and the instructor were invested in me acquiring that knowledge. These activities draw on intrinsic motivation to learn, which is rather strong in most people, but I would argue is exceptionally strong in medical students and physicians who generally spend their whole lives in search of new knowledge.
The challenge with medical education - with all education - is how to rely more heavily on intrinsic motivation to learn while maintaining standards. After all, the reason extrinsic motivation is necessary at all is that all of us have some important aspects of medicine we're not horribly interested in, yet have to learn anyway. I think a major part of medical education would be to bring some more choice into play for both students and instructors, using the more heavy-handed approaches like mandatory sessions or high-impact testing only for the sheer basics. For the vast majority of medicine though, a bit more choice and flexibility - for students and instructors - could be a very positive thing. Sure, there'll be cracks in their learning without a centralized curriculum, but frankly, centralized curriculums have plenty of cracks anyway. An intrinsically motivated student, with enough time and energy, will have no problem filling those cracks in - an extrinsically motivated student has no such incentive.
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