Inefficient Education

If I could sum up my criticism of my medical education thus far, as well as what I've seen from others, it would be this - our current approach to teaching medical students and residents is unacceptably inefficient.

Pre-clerkship is too heavy on wrote memorization without sufficient context or repetition, which leads to a lot of forgotten information. Much of what is retained has minimal practical value. A lot of relearning becomes necessary later on.

Clinical rotations are often fragmented, with learners switching between rotations frequently. As a result, a lot of time and mental resources are spent figuring out what to do rather than how to do those tasks well. Repetition also gets lost, with higher emphasis on seeing the presentation of multiple diseases once, rather than multiple presentations of one disease.

I've written about this before, but continuity in instruction at all levels is sorely lacking. Aside from some smaller residency programs, learners have little opportunity to form meaningful, long-term connections with their instructors. Instructor-learner relationships are constantly be formed and broken, which takes up a lot of time and energy, while preventing deep insight into a learner's (or instructor's) areas in need of improvement.

Even with the move to pass/fail evaluations, current approaches place far too much emphasis on summative assessments instead of formative assessments. Learners then have to spend the bulk of their energies trying to perform instead of trying to learn, which in turn pushes more short-term memorization.

All these approaches are shown to reduce retention in learners, some quite substantially. To compensate for inefficient instruction, medical education usually turns up the intensity. Long hours per day, long days per week, long weeks per year, then long years of training. I've written plenty about my opinions on work hours (short version - they're too long) so I won't dwell on the subject, but I do wonder how much of the current stated emphasis for long training times is a self-fulfilling prophecy. That is, medical schools and residency programs argue long hours are necessary, then without any incentive to provide more efficient instruction, design curricula that require long hours.

The further I get into my medical education, the more I'm starting to see the many individual issues in medicine as interconnected concerns. It's also why I care a lot about medical education, because a good number of problems I see in medicine itself have roots in the way we educate physicians and other healthcare professionals. Likewise, problems in medicine often filter down into training. This inter-connectivity makes addressing concerns in medical education more challenging, as ripple effects into the broader healthcare system aren't necessarily appreciated and lead to resistance to change. However, it means that when positive change does occur in medical education, a beneficial ripple effect can also occur, resulting in improvements to the broader healthcare system.

In any case, regardless of the bigger picture, I think we can do more with less in medical education, if we're willing to break with some long-held traditions.