The end of the world as we know it

I made an interesting choice this year for our surgery clerkship; I say interesting because it’s either going to prove to be absolute genius or complete catastrophe.  Time will tell.

Didactics have been one of the biggest challenges for the last several years with the clerkship.  Faculty attendance has not always been ideal, it’s been challenging to communicate that in advance to the students, and some of the sessions I initially thought would be helpful for broadening the base for shelf prep instead turned out to be consistently low-rated by the students.  I also recognize that even though I asked faculty three years ago to make their class sessions case-based and interactive that this was not consistently happening- faculty often default to the lecture format simply to get their material covered.  And, of course, there are little facts about how much material is retained from a one-hour lecture (which is, of course, the format we have inherited from the system).  For those who haven’t seen any of that data, the short answer is…not much.

If you examine our goals for medical student learners, particularly once they come into their clinical years, we don’t just want them to have facts.  The whole point of the clinical years is for students to learn how to apply all of those facts and knowledge that we have crammed into their brains during the non-clinical years of medical school; in other words, we’re striving for long-term transferability of information.  We are also imbued with the responsibility of helping students become life-long learners, and the truth is that spoon-feeding them in lectures does little to achieve that end as well.  What we should be doing in the learning environment, be it clinical or classroom, is facilitating student-led work and coaching by giving feedback and advice.

Have you guessed yet what my crazy move was?

Maybe the fact that we’re down to about 6 hours of faculty-led classroom didactics that all happen in the first two days of the clerkship?

Indeed.  Almost no more “class,” per se.

I know, it’s not completely novel.  2012 and 2013 were essentially the years of the eulogy for the lecture in higher education as best I can tell.  But there have been plenty of misgivings in medical circles about the death of the lecture, maybe because lecture done right can be amazing.  But how often is it done THAT well?  As I think back through medical school, rarely to never was my own experience.

I did maintain one set of didactic sessions that I am now trying to fine-tune; each student prepares a 20 minute case-based discussion on a topic they are assigned.  These mini-clinical pathology correlation sessions are designed to be interactive, with the lead student facilitating and the rest of them working as a group to “solve” an unknown (but common) general surgery case.  I’m there, both because it’s a graded activity and to provide real-time advice on issues that come up in discussion.  These sessions have been terrifically successful for the last 3 years, and are honestly fun to moderate.  It’s simply with the absence of other classroom sessions I feel even more strongly about coaching so that the critical material is covered during this contact time.  The students have consistently excelled in these presentations, and I’m always impressed at how closely they are willing to listen to one another during these sessions.  Levels of engagement are HIGH.

So, yes, student-led work is our new paradigm for didactics in the surgery clerkship at Utah.  I promise some follow-up on how it goes.  And since I mentioned feedback and advice as being central to where we are trying to get our learners, I promise more on that next week.