This week, I have heard two different stories about limitations being placed upon interactions with medical students by institutions. To be completely honest, they both strike me as horror stories with a Draconian response to managing power dynamics. First, I was told that at a major medical school that very strict limits were placed on what residents and faculty are allowed to ask medical students to do. This was followed in short order by learning that at another medical school the resident or faculty member has to explicitly ASK the medical student if they can ask them questions to assess their learning.
I had recently been flabbergasted, reading about the climate in higher education at many institutions and concerns expressed by students about having their fundamental understanding of the world disrupted. And now, this piece in The Atlantic talking about the damage being done long-term to learners who are being overly-protected in their university environments since their professors can no longer teach them how to think.
For anyone who has been wondering why their interns aren’t always well-prepared to be a doctor on Day 1, I may have hit upon the “why.” I understand that questioning can occur in ways that are not conducive to learning and that can even be disrespectful to the learner in some way; I’ve seen it done. This is the exception, however, and often occurs in conjunction with other marginally professional behaviors. It seems that some medical schools have, in the interest of preventing “student mistreatment”, created an environment where their teachers are denied any of the tools available to assess clinical reasoning. If I may ask a question, how am I supposed to assess a trainee’s clinical acumen if I can’t ask them to walk me through their thought process?
I spend a tremendous amount of time discussing that we are behind the curve in medical education, where we still focus on single right answers and MCQs to assess knowledge that is largely based upon retention of facts. We test this way in a day and age when we all have easy access to facts, and in a time when the rate of knowledge acquisition cannot be matched by the human brain. If we are going to move beyond testing for facts- knowing that factual knowledge does not necessarily a good doctor make- how do we prepare learners for a new world order focused on clinical knowledge application if we cannot ask them to solve clinical problems?
More importantly, how do we turn back the tide? I’m not saying that we should yell questions at our students and residents, or that we should ostracize and humiliate them when they don’t know answers. But as educators, if we are going to responsibly create the next generation of physicians, we must be able to engage in questioning in a way that is both meaningful and constructive. Draconian solutions in which we’re simply not allowed to ask learners questions will have huge- and negative- impacts on the care we are all able to receive in time.