- Joined
- Sep 12, 2017
- Messages
- 93
- Reaction score
- 8
…especially given that all Internists, are facing, or were recently, or are perhaps even now faced with, board-examinations every 2 years (although, thankfully, open book, right?).
Let me preface the following by 1) stating that I am unsure as to where to place this topic, and the associated content, forum-wise, so, if this is not the right place for it, please, move it, accordingly, PRN. Thank you, in advance. 2) most of, if not all, I have written below is not based on statistical evidence.
Sirs and Madams, Colleagues and, perhaps, Future Colleagues,
I have had the fortune to "explore," both first-hand and through personal study, the education of medical students (future bearers of the M. D. – unfortunately, I cannot comment on that of those who will come to bear the D. O., and continue to maintain what integrity I have) in England, the Continent, and the States.
It is with great sadness and alarm that I, after a long period of time and personal rumination, have come to conclude, in general, that excepting of institutions such as Stanford, Yale, Hopkins, Harvard, Duke, etc. – although this may very well be the case at those, as well, and, indeed, may not be the case in others – the education of medical students Stateside in the "Basic Sciences" appears to be in shambles.
*I have chosen to focus on this aspect of medical student education Stateside as the States are near and dear to my heart. I certainly have critiques and issues with that portion of medical student education in England, as well as the Continent. So, please, do not think that I am simply “bashing” that in the States while willfully ignoring that in England and the Continent.
Now, I am not necessarily speaking of the "school-made" examinations the students must pass to move forward in their education nor am I speaking of any "independent" studies that they undertake to learn the "Basic Sciences." In fact, I laud “independent” study of the “Basic Sciences” and consider it a necessity to, among other things, become a good “clinical student” and make the most of that clinical portion of medical student education.
I am speaking of 1) how and 2) what they are being taught by their "instructors" in lecture, "Socratic discussion sessions," laboratories, etc., (esp. those “instructors” relative newly-minted with their Doctorates).
I will speak to the 1) how, first.
To begin, I have no issue with lecture, "Socratic discussion sessions, " laboratories, etc. These are all forms of teaching that have well-established, time-tested, etc. evidence as to their effectiveness, and, in my opinion, remain the foundations of sound pedagogy. *This is not to say “new” methods of teaching are of no merit.
However, I do have issues with how, for instance, lectures are presented.
I. First is the issue of the use of PowerPoint, and, other, similar, visual aids. They can be fantastic. But, oftentimes I find them to be woefully lacking in professionalism in construction.
An instructor’s presentation need not be the ceiling of the Sistine Chapel (although, admittedly this may be a poor example as I find that the eyes’ focus moves frequently, and does not hold, when viewing it in totality), but it should not, and cannot, equate to the scribblings of a child with neither talent nor gift for painting. Nor does the presentation need to be Oxford’s Guide to English Grammar, but it should not, and cannot, equate to a primary schooler’s writings as they are learning proper grammar.
Too often do I see presentations consisting of slide after slide of illogical smattering of image and text, which are quite difficult to follow – especially when the presenter does not physically guide one’s viewing of the slides while speaking, which also is much too common!
A phenomenon which occurs much too frequently, as well, and I think is correlated to the aforementioned, is that there is complete lack of commentary on upwards of 50% of what is displayed on a slide. Not a single word! Why then, may I ask, include that content in the slide deck used in the presentation? It only serves to distract.
There are also slide decks with a complete absence of a theme of formatting/design, multiple slides with different font styles used on the same! slide, where it makes absolutely no sense to do so, font colors poorly contrasted with the background, font sizes which are much too small for even the middle row of the audience to make out clearly, blurry images, images missing portions of significant information, such as axes labels for those of graphs, etc.
Perhaps the most shameful element of the decks is unprofessional, or even total lack of, citation of text and images. This is not only, again, unprofessional, but wastes students’ time in finding where a piece or pieces of information originated from, if they need to, or are interested in referring to the origin, PRN.
To close, I would say that out of every 10 of the presenters I witness over multiple of their presentations on different topics and relying “heavily” on the use of this visual aid, 1 would usually be given, if being graded at the Graduate level, an “A,” 1 would be given a “B,” ” 1 or 2 would be given a “C,” and the remainder “D/E/F (failing/remediation req.),” with one probably being laughed out of the program with a presentations not fitting of a passing mark at even the Undergraduate, Sophomore level.
II. A second issue is with laboratories. A simple example, of this is the anatomy laboratory.
For the sake of brevity, I ask you the following: with how, in the vast majority of the States, 1) a “GP” practices, 2) how almost any imaging specialist is trained and practices, 3) almost any surgeon is now trained and practices, what use, especially for the vast majority of students, is especially, “first year,” mandatory and/or comprehensive, cadaveric dissection? – NOT PROSECTION! dissection – , for learning what they need to learn for their clinical years, and later, for their internships, and beyond, especially considering the current time constraints for the completion of the “Basic Science” portion of their education, and everything else they must learn? This is perhaps the most galling issue for me, and, while it seems to be, ever so slowly, dying, its resilience is simply astounding!
Amusingly, quite literally every single physician and surgeon I have spoken to holds this view – both younger and older gentlemen, and varying from intern to “up there,” and about 2, perhaps 3, out of every 10 of those individuals (not including students) involved in teaching these dissection-based courses do so as well. These latter deserve merit as I am sure their paychecks would take a bit of a downsizing if this course structure was removed from curricula.
III. A third issue is with the “Socratic discussions,” of which instruction in performance of the physical examination I consider a part, and is one on which I would like to focus. This will be very short. 1) Are most students even learning proper and/or meaningful physical examination, especially with regards to how it should be performed given now widely available technologies? 2) Why would a non-clinician (someone with absolutely no medical training as a physician received from anywhere on this planet) ever be tasked, or involved with the teaching of this examination? 3) Why would a clinican who 1) does not perform this aspect of the physical exam regularly, and truly does a good and thorough job at doing so, and/or 2) does not even specialize in the area of medicine/surgery in which this exam is regularly performed? be involved in the teaching of it? *Teaching, as I used the term here, does not include serving as an “actor/dummy.”
Finally, I will speak to the 2) what, but…, really, I will keep this brief, as in writing this, I suppose I simply needed to “vent.” What happened to undergraduate medical pedadogy in the first half of the 20th century, happened, what’s done is done, and, frankly, it is not my problem, and “mine own’s” problem to solve. That is another generations problem, now. But, I am a big believer in equilibrium, and I believe the pendelum is swinging back in the right direction, although slower than I would like.
As to the aforementioned 2) what: 1) How many lecturers know the "big picture" and how and/or why what they are teaching is painted into it? 2) How many teach completely irrelevant things? 3) How many newly minted clinical students, even those rotating in Internal Medicine, are lacking the “big picture” and clinically important concepts but seem to know far too many of the completely irrelevant details?
...Is it not amusing that independent entities have been able to “contribute” so much (and have developed/expanded their influence so much in “Basic Sciences” education) to the passing of, and even now commonly what was/is considered quite admirable performance on, not only “school-made” examinations, but Step 1? As I predicted a long time ago, though, why listen to the average person at the podium when you can watch a recording of, for instance, one who was or is a brilliant lecturer at another medical school that is many kilometers away from yours… Although doing so becomes quite an annoyance if one’s lecture attendance is mandatory...
Let me preface the following by 1) stating that I am unsure as to where to place this topic, and the associated content, forum-wise, so, if this is not the right place for it, please, move it, accordingly, PRN. Thank you, in advance. 2) most of, if not all, I have written below is not based on statistical evidence.
Sirs and Madams, Colleagues and, perhaps, Future Colleagues,
I have had the fortune to "explore," both first-hand and through personal study, the education of medical students (future bearers of the M. D. – unfortunately, I cannot comment on that of those who will come to bear the D. O., and continue to maintain what integrity I have) in England, the Continent, and the States.
It is with great sadness and alarm that I, after a long period of time and personal rumination, have come to conclude, in general, that excepting of institutions such as Stanford, Yale, Hopkins, Harvard, Duke, etc. – although this may very well be the case at those, as well, and, indeed, may not be the case in others – the education of medical students Stateside in the "Basic Sciences" appears to be in shambles.
*I have chosen to focus on this aspect of medical student education Stateside as the States are near and dear to my heart. I certainly have critiques and issues with that portion of medical student education in England, as well as the Continent. So, please, do not think that I am simply “bashing” that in the States while willfully ignoring that in England and the Continent.
Now, I am not necessarily speaking of the "school-made" examinations the students must pass to move forward in their education nor am I speaking of any "independent" studies that they undertake to learn the "Basic Sciences." In fact, I laud “independent” study of the “Basic Sciences” and consider it a necessity to, among other things, become a good “clinical student” and make the most of that clinical portion of medical student education.
I am speaking of 1) how and 2) what they are being taught by their "instructors" in lecture, "Socratic discussion sessions," laboratories, etc., (esp. those “instructors” relative newly-minted with their Doctorates).
I will speak to the 1) how, first.
To begin, I have no issue with lecture, "Socratic discussion sessions, " laboratories, etc. These are all forms of teaching that have well-established, time-tested, etc. evidence as to their effectiveness, and, in my opinion, remain the foundations of sound pedagogy. *This is not to say “new” methods of teaching are of no merit.
However, I do have issues with how, for instance, lectures are presented.
I. First is the issue of the use of PowerPoint, and, other, similar, visual aids. They can be fantastic. But, oftentimes I find them to be woefully lacking in professionalism in construction.
An instructor’s presentation need not be the ceiling of the Sistine Chapel (although, admittedly this may be a poor example as I find that the eyes’ focus moves frequently, and does not hold, when viewing it in totality), but it should not, and cannot, equate to the scribblings of a child with neither talent nor gift for painting. Nor does the presentation need to be Oxford’s Guide to English Grammar, but it should not, and cannot, equate to a primary schooler’s writings as they are learning proper grammar.
Too often do I see presentations consisting of slide after slide of illogical smattering of image and text, which are quite difficult to follow – especially when the presenter does not physically guide one’s viewing of the slides while speaking, which also is much too common!
A phenomenon which occurs much too frequently, as well, and I think is correlated to the aforementioned, is that there is complete lack of commentary on upwards of 50% of what is displayed on a slide. Not a single word! Why then, may I ask, include that content in the slide deck used in the presentation? It only serves to distract.
There are also slide decks with a complete absence of a theme of formatting/design, multiple slides with different font styles used on the same! slide, where it makes absolutely no sense to do so, font colors poorly contrasted with the background, font sizes which are much too small for even the middle row of the audience to make out clearly, blurry images, images missing portions of significant information, such as axes labels for those of graphs, etc.
Perhaps the most shameful element of the decks is unprofessional, or even total lack of, citation of text and images. This is not only, again, unprofessional, but wastes students’ time in finding where a piece or pieces of information originated from, if they need to, or are interested in referring to the origin, PRN.
To close, I would say that out of every 10 of the presenters I witness over multiple of their presentations on different topics and relying “heavily” on the use of this visual aid, 1 would usually be given, if being graded at the Graduate level, an “A,” 1 would be given a “B,” ” 1 or 2 would be given a “C,” and the remainder “D/E/F (failing/remediation req.),” with one probably being laughed out of the program with a presentations not fitting of a passing mark at even the Undergraduate, Sophomore level.
II. A second issue is with laboratories. A simple example, of this is the anatomy laboratory.
For the sake of brevity, I ask you the following: with how, in the vast majority of the States, 1) a “GP” practices, 2) how almost any imaging specialist is trained and practices, 3) almost any surgeon is now trained and practices, what use, especially for the vast majority of students, is especially, “first year,” mandatory and/or comprehensive, cadaveric dissection? – NOT PROSECTION! dissection – , for learning what they need to learn for their clinical years, and later, for their internships, and beyond, especially considering the current time constraints for the completion of the “Basic Science” portion of their education, and everything else they must learn? This is perhaps the most galling issue for me, and, while it seems to be, ever so slowly, dying, its resilience is simply astounding!
Amusingly, quite literally every single physician and surgeon I have spoken to holds this view – both younger and older gentlemen, and varying from intern to “up there,” and about 2, perhaps 3, out of every 10 of those individuals (not including students) involved in teaching these dissection-based courses do so as well. These latter deserve merit as I am sure their paychecks would take a bit of a downsizing if this course structure was removed from curricula.
III. A third issue is with the “Socratic discussions,” of which instruction in performance of the physical examination I consider a part, and is one on which I would like to focus. This will be very short. 1) Are most students even learning proper and/or meaningful physical examination, especially with regards to how it should be performed given now widely available technologies? 2) Why would a non-clinician (someone with absolutely no medical training as a physician received from anywhere on this planet) ever be tasked, or involved with the teaching of this examination? 3) Why would a clinican who 1) does not perform this aspect of the physical exam regularly, and truly does a good and thorough job at doing so, and/or 2) does not even specialize in the area of medicine/surgery in which this exam is regularly performed? be involved in the teaching of it? *Teaching, as I used the term here, does not include serving as an “actor/dummy.”
Finally, I will speak to the 2) what, but…, really, I will keep this brief, as in writing this, I suppose I simply needed to “vent.” What happened to undergraduate medical pedadogy in the first half of the 20th century, happened, what’s done is done, and, frankly, it is not my problem, and “mine own’s” problem to solve. That is another generations problem, now. But, I am a big believer in equilibrium, and I believe the pendelum is swinging back in the right direction, although slower than I would like.
As to the aforementioned 2) what: 1) How many lecturers know the "big picture" and how and/or why what they are teaching is painted into it? 2) How many teach completely irrelevant things? 3) How many newly minted clinical students, even those rotating in Internal Medicine, are lacking the “big picture” and clinically important concepts but seem to know far too many of the completely irrelevant details?
...Is it not amusing that independent entities have been able to “contribute” so much (and have developed/expanded their influence so much in “Basic Sciences” education) to the passing of, and even now commonly what was/is considered quite admirable performance on, not only “school-made” examinations, but Step 1? As I predicted a long time ago, though, why listen to the average person at the podium when you can watch a recording of, for instance, one who was or is a brilliant lecturer at another medical school that is many kilometers away from yours… Although doing so becomes quite an annoyance if one’s lecture attendance is mandatory...
