Ready to train or ready to practice?

thoughts?
http://www.podiatrytoday.com/blogged/ready-train-or-ready-practice-redefining-goals-and-expectations-schools-and-residency-progra

While I agree with her statement "To reach the ideal of Project 2015, our students need to receive the curriculum of the MDs and DOs and get an emphasis on the lower extremity." I'm kinda confused about some other things she talked about. It seems like she was all for NOT teaching students surgical techniques. They should learn them during residency. I don't agree with that. We should learn the anatomy and the steps involved in the procedures during school and then apply that knowledge hands-on during residency.

Perhaps I read the blog wrong though....

If that is her position, that is very interesting. Dr. Satterfield just joined the faculty at Western. Western is VERY proud that they teach us certain surgical techniques (i.e. we learnt the steps in a hammertoe correction the first semester of our first year. We are now onto surgical corrections for pes cavus and pes planus).

Again, maybe I read it wrong.

darazon said:

... we learn[ed] the steps in a hammertoe correction the first semester of our first year. We are now onto surgical corrections for pes cavus and pes planus)...

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How do you learn surgery before anatomy?

Feli said:

How do you learn surgery before anatomy?

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Exactly. You can train a monkey to "perform" a surgical technique, but if the monkey has no concept or understanding of what he/she is cutting, what's the point?

Feli said:

How do you learn surgery before anatomy?

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There are some progressive medical and podiatry schools (like the one Dr. Satterfield works at) that have virtually eliminated the traditional classroom setting. They "teach" in a group environment with case studies to exemplify the knowledge that is required to correctly identify the pathology, then they go through the medicine involved as well as the anatomic structures in the area and finally how that integrates itself into the presented case. So when discussing a diabetic foot infection, they will likely go through the anatomy of the pancreas, how and why insulin is made, what are the faulty mechanisms that lead to diabetes...etc.

They are not quite learning "surgery" per se, but are learning the surgical anatomy and how it relates to the procedure itself. If I read the post correctly, note that the poster mentions learning the steps needed to address a hammertoe, not necessarily HOW to do the surgery itself, so I imagine, based on the models I've seen, that they learn all the anatomy of the area, then the mechanics and pathomechanics leading to the development of the hammertoe, then some areas of conservative management, followed by the reasons to do a fusion vs. straight arthroplasty...etc. It may be a subtle difference, but it is still a difference.

There is currently ongoing research on how this "new" technique of learning helps to integrate knowledge versus the old school technique of cramming all the information into your head over a couple of years and then the expectation that you can regurgitate that information while developing the skill of integration at the same time.

I've read some of the research over the years, and it certainly is an intriguing way to "teach". Is it better? I have no idea, but intriguing none the less.

Kidsfeet said:

There are some progressive medical and podiatry schools (like the one Dr. Satterfield works at) that have virtually eliminated the traditional classroom setting. They "teach" in a group environment with case studies to exemplify the knowledge that is required to correctly identify the pathology, then they go through the medicine involved as well as the anatomic structures in the area and finally how that integrates itself into the presented case. So when discussing a diabetic foot infection, they will likely go through the anatomy of the pancreas, how and why insulin is made, what are the faulty mechanisms that lead to diabetes...etc.

They are not quite learning "surgery" per se, but are learning the surgical anatomy and how it relates to the procedure itself. If I read the post correctly, note that the poster mentions learning the steps needed to address a hammertoe, not necessarily HOW to do the surgery itself, so I imagine, based on the models I've seen, that they learn all the anatomy of the area, then the mechanics and pathomechanics leading to the development of the hammertoe, then some areas of conservative management, followed by the reasons to do a fusion vs. straight arthroplasty...etc. It may be a subtle difference, but it is still a difference.

There is currently ongoing research on how this "new" technique of learning helps to integrate knowledge versus the old school technique of cramming all the information into your head over a couple of years and then the expectation that you can regurgitate that information while developing the skill of integration at the same time.

I've read some of the research over the years, and it certainly is an intriguing way to "teach". Is it better? I have no idea, but intriguing none the less.

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I couldn't have said it better myself.

That's a pretty good summary of the curriculum at Western. Especially in your 2nd year. They have done away with the traditional "lecture" style and all of our learning is in small groups with cases -podiatry classes and basic science with the DO students. We work the case up from beginning to end and cover the anatomy, physiology, histology, pharmacology etc etc.

For example, we just had our PMP (Principles of Podiatric Medicine) final the other day. We have a written portion and an oral portion. For the oral we go into a room with a facilitator and a case on a powerpoint up on the TV (I actually got Dr. Satterfield for my pes planus case) We start with the initial presentation and have to provide a differential diagnosis list. We then tell what we would like to do next (imaging, physical, etc). They will ask random questions about anatomy, radiographs, angles, biomechanics, etc etc and then we have to end up with providing a suitable treatment plan -both conservative and surgical.

We do similar type of learning in our basic science classes with the DOs. We are divided into small groups where we have some cases to go through. We then meet up in the lecture hall later on in the week and go through the cases in a large group format. All of the classes are system based i.e. we are in respiratory right now, so we do a review of the anatomy and then also do the histology, physiology, pharm, clinical etc. all together, not as separate classes. No oral exams though -thanks goodness.

Like was said earlier, it is different. Some love it -others not so much. Their intention in going this direction was to help with thinking like a clinician and hopefully the info would stick better for the boards than a plain lecture.

darazon said:

I couldn't have said it better myself.

That's a pretty good summary of the curriculum at Western. Especially in your 2nd year. They have done away with the traditional "lecture" style and all of our learning is in small groups with cases -podiatry classes and basic science with the DO students. We work the case up from beginning to end and cover the anatomy, physiology, histology, pharmacology etc etc.

For example, we just had our PMP (Principles of Podiatric Medicine) final the other day. We have a written portion and an oral portion. For the oral we go into a room with a facilitator and a case on a powerpoint up on the TV (I actually got Dr. Satterfield for my pes planus case) We start with the initial presentation and have to provide a differential diagnosis list. We then tell what we would like to do next (imaging, physical, etc). They will ask random questions about anatomy, radiographs, angles, biomechanics, etc etc and then we have to end up with providing a suitable treatment plan -both conservative and surgical.

We do similar type of learning in our basic science classes with the DOs. We are divided into small groups where we have some cases to go through. We then meet up in the lecture hall later on in the week and go through the cases in a large group format. All of the classes are system based i.e. we are in respiratory right now, so we do a review of the anatomy and then also do the histology, physiology, pharm, clinical etc. all together, not as separate classes. No oral exams though -thanks goodness.

Like was said earlier, it is different. Some love it -others not so much. Their intention in going this direction was to help with thinking like a clinician and hopefully the info would stick better for the boards than a plain lecture.

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I find this interesting because it seems quite different from my experiences so far. Couple questions.
Is this what you expected? As in is this what was explained to you at your interview?
Why are students unhappy? Is it because they for some reasons had other expectations?
Has administration changed anything for the 2nd overall class (2014)?

air bud said:

I find this interesting because it seems quite different from my experiences so far. Couple questions.
Is this what you expected? As in is this what was explained to you at your interview?
Why are students unhappy? Is it because they for some reasons had other expectations?
Has administration changed anything for the 2nd overall class (2014)?

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What I've read in general about why some students find this method difficult/frustrating is because this is not the way they have been groomed earlier in their education. This is a shift in paradigm in professional schools only and some find it difficult to make the transition from "here is a bunch of information, please memorize it and then regurgitate it on this test here", to "please THINK about this case, relate it to the information you need to know, and then be able to use this process when tested on the information incorporated into the case study". People learn differently, and when you're taught to learn a certainly way all through your education so far, its not so easy for some to divert away from that.

Some people also don't work well in a group environment and find this method distracting, rather than sitting in a lecture hall and zone in only on the lecturer and then being able to review that information on their own in their study cubicle.

It certainly is an innovative way to "teach" and I really think the jury is still out on how effective the method really is.

I agree with everything you said. I just wonder how many of the students realized this is what they were getting themselves into. I personally wouldnt want to be a guinea pig. Not only is Western a new school opening (spare me the association with the rest of the programs), but it also has a "revolutionary" new type of learning. Not for me. I am NOT knocking it or the school, I just wonder how much many "willing" participants there are among the matriculants. And i dont mean for my "wonder" to insinuate bad things. Just curious.

air bud said:

Is this what you expected? As in is this what was explained to you at your interview?

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I had no idea that they we going to change to this structure for our 2nd year -at least for the basic sciences. I don't know if any of the other students did either. I knew it was a system based learning model, that was really stressed during the interview and was one of the reasons I choose the school.

We first found out about this the end of our 1st year. Apparently they had been watching the progress of a few schools who also did this model. The vets at Western have been doing this model since the beginning and apparently they kill their boards. It was a shock to us that they were changing it, but I think it was mostly a welcome shock. They explained that the new method would get rid of the more "nice to know" material and focus on the "need to know" material.

air bud said:

Why are students unhappy? Is it because they for some reasons had other expectations?

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Some students are not used to the "no lecture" idea. But I think the biggest complaint is that there seems to be a lack of direction on what to exactly study for the exam. Not only do we have the actual cases to study, but we are given readings in Harrison's, sometimes journal articles, and also most of the faculty members have a primer that goes along with the case. It's a lot of info to go through, especially if there is not direction on what to focus on. This also varies by system, as each system will have a different course director with a different style.

For example, we had a cardio exam that the director put out a study guide on what to focus on. We killed the exam -average in the high 80s. We just finished an exam in respiratory last week. Different course director, no hints as to what to focus on. The DO average was 68%! They usually nail around an 80%. I won't mention what our average was (we take the exact same exams).

Most students are used to just focusing on what was presented during the lecture. With those gone, we need something else for direction.

Things will change for the better though. It's as much as a learning curve for the faculty as it is for us. No teaching method is perfect and some students just like to complain no matter what. Personally, I like the new method as I find the stuff "sticks" more.

I think the majority of student also do like the "new" style, the biggest complaint is with the difficulty of the exams and lack of direction. It will change though, the shared curriculum faculty and the podiatry faculty are well aware of student concerns.

Will this cost us on the boards? I don't think so one bit. If anything it is over preparing us for the boards -especially for the NBPME (APMLE now). Myself and a few classmates went through the practice exam on the NBPME website and about died looking at the question style and content. Very basic style questions compared to what we see on our exams (mostly 2nd order, case based, some 3rd order).

air bud said:

Has administration changed anything for the 2nd overall class (2014)?

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PMP has changed significantly, mostly due to our feedback. But that is about it. Basic science classes will be the same for them -1st year lecture style covering micro, immune, anatomy, etc, and 2nd year case based systems. Hopefully they will have better direction on study material though. However, the DO students (class of 2014) have switched to a pass/fail system. I don't think CPM has though -I know they have flirted with the idea.

awesome reply. thanks for the insight and honesty.

darazon said:

Will this cost us on the boards? I don't think so one bit. If anything it is over preparing us for the boards -especially for the NBPME (APMLE now). Myself and a few classmates went through the practice exam on the NBPME website and about died looking at the question style and content. Very basic style questions compared to what we see on our exams (mostly 2nd order, case based, some 3rd order).

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Just so you know, everyone thinks the posted practice questions are kindergarten simple. Don't fool yourself into thinking the actual exam is that soft, or else on the big day, you might just wet your knickers. They definitely are not a good measuring stick for how well the educating system works or how well you know your stuff.