I had a crazy thought the other day, why don't we do more research in medical schools. I know you're saying that there is a ton of research going on in the modern medical school. But I bet if you are reading this you don't care that much about most of the research that is going on. Sure, there is plenty of basic science research. For instance, my good friend and co-conspirator/ co- director of our first medical school module is the famous Joe Fontes. He is in the Department of Biochemistry and he has two RO1s from the NIH. Pretty impressive! We also do some clinical research. One of my partners has an RO1 from the NIH to study colon cancer screening in minority populations.
But I am talking about research on and about the educational process. How much of what we do on a daily basis is evidence based? I don't mean the knowledge content that is being delivered but the way that the information is delivered. Is a lecture better than a small group? Is an experienced lecturer better than one who is young and inexperienced? Is a preceptor visit a better way to learn about professional behavior than lecturers. Are preceptorship visits better for teaching clinical skills or faculty physicians or trained patients?
These are all important questions. Why don't we know the answers to them?
You might say that we know the answer to some of those questions. I would say that we probably know part of the answer to some but we don't know the whole answer to any of them. But does that matter? I think it does. We talk all the time about how we think evidence-based medicine is important but do we apply the same standard to the education of our students? I don't think so. I am not even sure that we could all agree on the definition of "better".
But don't you think we should have an evidence-based standard for educational practice just like we have for clinical practice? This is what I propose. We need a medical school that is totally based on the best available educational research. Wait a minute, that won't work, will it? We already know that there is not enough evidence for most of what we do. So, if we can't do it now maybe we could in the future. But how can we get there? Here is the radical part. We need to experiment on our students. (a big gasp was heard!)
The funny part is that I think we already do this. But right now we are not getting their permission. Every time that we use an unproven educational method in our teaching, we are experimenting on them. We just don't get their consent. I propose that we start asking for consent and randomize them to the standard educational method or to a well thought out intervention that is based on sound educational theory. This will require us to have a good grounding in educational theory which most physicians don't. And it will require an acknowlegement by us that our methods may not be right. We might need to change.
If I was a med student, I would be excited by this. Our students in Salina (see my blog about Salina) were told at the beginning that they would be the innovators, not guinea pigs. It was and is exciting to them. They were excited to be the first to prove that a medical school could be run in a small town in rural Kansas. I think that the same would be true on other campuses with other methods. Let's be innovators.
What do you think?
