Throughout my pre-clerkship phase in medical school, I wasn't sure I was learning properly. Yes, I was told that studying during the first two years of medical school would be like drinking from a firehose. But I didn’t think this phase of learning would feel so much like an extension of undergraduate classes. We sat through hours of lectures with limited interaction and time for Q&A. The professor had to keep moving because we would fall behind if we weren't kept at such a breakneck pace.
As COVID-19 lingered and lecture attendance became optional, my learning experience worsened. We had the option to attend lectures; however, most of us opted to study at home and watch the recorded lectures. I was glad we had such access, but I knew very few in the class of 136 watched these lectures, and if any of us did, we sped the videos up to twice the speed to shorten the watch time.
Many students realized that watching school lectures took simply too long and preferred to study using materials from Boards & Beyond, Sketchy, Pathoma, and other exam-preparation companies. Our class didn’t have many in-house exams, so students could still do well with third-party exam prep resources.
What bothered me during this time was what the school was doing when students preferred to study mostly with materials not provided by the school. Students could still do well on the exams without attending lectures. Yet there were professors who stood up and gave lectures for hours each day. The disconnect between my expectations for learning in medical school and the reality of how we studied became more evident over time. Increasingly, I wondered what value medical school offered if medical students were going to supply their own learning materials and engineer their learning experience.
I knew that most faculty members lacked formal training in teaching and often delivered lectures as part of their job descriptions in academia. I later interviewed several faculty members who told me that protected time for preparing lectures is almost nonexistent, and hours for clinical duties needed to be maintained or increased. On the business side, teaching did not generate enough revenue, and they had to spend more time seeing patients despite how much they would love to invest time in preparing for education. These professors were demoralized by the low level of participation in class, even though they spent hours preparing their presentations.Unable to find a clear solution, I constantly wondered how we would tackle this ongoing systems issue that only seemed to spiral downward. Knowledge delivery was becoming much easier as companies dedicated to creating exam prep resources hired star lecturers who would outperform most faculty members at delivering efficient, succinct lectures for Board prep. Faculty members had almost no chance of outdoing these companies because they were not trained to do so. Thus, there was no competition to begin with if medical schools with limited funding had to face off against companies whose single goal was to be compensated for great teaching and exam results.
If the students only needed to spend a few thousand dollars for all the yearly subscriptions they needed to tackle the preclerkship phase, I was not sure how medical school teaching was calculated to justify the tens of thousands of dollars paid for tuition, especially for the first two years in school. Obviously, there are large institutional costs associated with the latter two years in medical school, in which clinical rotations take place. Still, it feels hard to justify such costs for two years of hands-on training, when medical students face increasing tuition over the years, even though a substantial number of students had not been relying on what the medical school offered.
My proposal may sound radical to some readers, but I believe that time for interaction and sharing wisdom should be prioritized from now on. Perhaps we should let third-party resources deliver knowledge, as they are great at that, and let faculty members do what they are great at: teaching how to master the art of medicine.
The earlier phase of medical education for me was a pure bombardment of material, with not enough time to connect with the clinical environment and the faculty whom I should have gotten to know better. We should have spent more time solving problems by questioning, discussing, and working together instead of studying in isolation. Who would be the ones to connect us in one setting? It’s the faculty who can do that.
The more I studied, distant from those I aspired to care for, the more tired I felt, especially knowing they were not too far away. Perhaps faculty members could be the bridge that connects us back to patients and teaches us how things could have been different as they recount their painful mistakes. Learning from personal stories delivers a powerful impact beyond book knowledge, and these lasting impressions and lessons guide students and trainees as we encounter similar situations. Perhaps we might hear about rare cases that are not even reported in journals or before they are in print. Perhaps experiential learning could take place, allowing us to learn how to apply knowledge in settings beyond our classroom and NBMEs.
I challenge educators to stop preparing hundreds of slides when they are asked to give lectures. We can already find them online, and no students or trainees will closely examine them in this age of AI. I ask that we consider how we will engage our learners through storytelling and by highlighting what will make a difference as we enter clinical practice. I am sure there is a thing or two everyone will learn when learning becomes more personal.
Sharing your successes and failures will be much more valuable than spending a full hour reading from PowerPoint slides that people will prefer not to review. Making slides is easy, and reusing someone else's slides is easy, but is that actually helping the learners actively? Adding on content to extend the slides is not the point of interaction between faculty and learners. Subtracting materials down to only the essence is much harder to do, but perhaps it has been due for too long.
I know some medical schools have implemented case-based learning and/or project-based learning to change the class dynamic and encourage participation. From what I have gathered from peers, some favor it, whereas others absolutely abhor it. I deem the implementation of these newer pedagogical methods a positive change, since students will have to synthesize answers rather than rely on recall. Yet I sincerely hope schools and faculty at least acknowledge their limitations in knowledge delivery and focus on honing their strengths, whatever they may be.
How do you think medical school education could be be improved? Share in the comments!
