med school standardization and continuity - Open Courseware and medical school

[incubate6times]

If allopathic med schools basically teach the same thing during pre-clinical years and have everyone take the same standardized test, why is it that schools don't make their materials openly available (a la MIT's open courseware)? Better yet, why don't schools work together to make a centralized online resource of the best figures, tables, lectures, vid casts, practice questions/exams etc explaining all major topics covered in the first two years.

With technology where it is why doesn't medical education take advantage of the possibilities instead of haphazardly using it (eg. using blackboard to post ppt slides)?

I suppose there isn't really much of an incentive for schools to do such a thing, but I was just wondering if anyone else has any ideas/dreams about how medical education could improve.

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[hb2998]

... and put US News & World Report out of business? I'm down.

Lets be realistic though. Faculty in the same department at the same medical school have trouble coordinating course work.

The only way I could see it happening is through a company that puts together all you need to know and for students to just purchase this information and learn the material. A few names come to mind:

Lippincott Williams & Wilkins, Elsevier Saunders, McGraw-Hill Medical, etc.

 

[hb2998]

This is exactly what medschool.com wanted to accomplish (CEO/Co-Founder = Vikas Bhushan, same awesome dude that wrote FirstAid). It was supposed to be an online education site with all medical school contributing to it, with very high quality videos, etc, but no medical school wanted to sign up. So the idea was sold to the pharmaceutical industry. Check out the site, the graphics are very impressive. To bad we're stuck with a black and white syllabus with references to the professor's highly specialized field research here and there.

I guess my point is, you need someone to organize all of it, and once you do that, you are setting up a system with leaders and followers. Try convincing the top 10 medschools to admit that they teach the same thing as the bottom 10 medschools -- which they do, today, i think...

 

[PeepshowJohnny]

Before we do something like this, I'd lke to see more "evidence based" medical school education.

Yes, I know stuff gets published all the time about how problem based learning or early patient interaction helped students at X school, but usually it's like comparing Step 1 scores for a few few classes worth of students compared to a control a few years ago. I've never really been that impressed with the rigorousness.

I'd like to see some big time stuff that looks at what works and what doesn't in medical education. The difficulty with this is obvious for several erasons.

What do we use as our endpoints? Step 1 is not a "clinically relevent endpoint" to how good of doctors we become, but defining what makes a "good doctor" is a whole other can of worms.

Also, it's going to be hard to quantify our variables. Let's say we study Problem based learning. School's range from zero PBL to lectures supplemented with some amount of PBL to basically an all PBL format and every variation and iteration in between. It's going to be very hard to draw any meaning from measuring something which can vary so much depending on school.

 

[incubate6times]

You're right hb2998, someone definitely has to lead the way. Maybe if a top school decided to follow MIT's example and start posting their course materials it would be a start, and this could happen through the Hewlett Foundation who funds opencourseware projects at a number of universities.
Edit: After searching, Harvard posts some OCW courses but at a quick glance the quality of materials is underwhelming.

Streamlining the first two years would save so much time and money. Why isn't this made a priority to lower tuition? I feel like schools are in an arms race of adding extraneous courses in order to 'keep up with the Jones''. I didn't think the first year of med school was horrible in the way it was done, but there were enough times that I was thinking about how the way they were teaching, or the way everyone was studying was such a backwards and inefficient way of doing things, that there needs to be change.

It would be fascinating to study medical education rigorously, but you're right Johnny, there are so many variables that are difficult to control for. It would be interesting to do educational experiments; create several different delivery methods of material and change different variables (lecture vs reading vs pbl vs distance learning etc), test the delivery variations on similar groups of students and give them a standardized test to gauge their progress.

 

[OncoCaP]

How are schools going to show that they are better than the other guys if they use openly the same free material that anyone on the street could google? Imagine going into a patient encounter and the patient shows you want you are doing wrong on his wireless tablet .... It's never going to float for many reasons. We will just use the similar material behind the scenes. Even though the content is similar, each school has their own take one various aspects of the education in terms of what book or syllabus they rely on.

Funny thing is, however, as wikipedia continues to improve, it may become a significant part (10%? 20%? More?) of the educational content in med school and elsewhere. We shall see. Wikipedia really angers many physician educators (including the ones I respect the most) for a variety of irrational reasons, none of which can be backed by any sort of systematic evaluation these same individuals insist that everyone else do. I can find just ans many, if not more, errors in a syllabus than I can in a typical wiki article. One of our pedi surgeons (an awesome, competent, nice one, by the way) was dismayed that after pimping one of the residents with a question that this resident couldn't answer this surgeon found that the resident had looked up the answer on wikipedia (and left the screen up on a monitor at the hospital terminal). Although the resident got the answer 100% correct from wiki, the surgeon was deeply offended that the resident had used wikipedia to look up the information because the question involved patient care (even though the resident got it right).

Although there is a special kind of wiki-hate out there, I think this is related to the problem you will have with any sort of open courseware. Profs at various schools will find errors and be unhappy with the material, especially if they forced to use it. People ascribe value to something based on how much the respect the "brand," which involves how respected the sources are, how exclusive its availability is, how well it is marketed, and how accurate it is. It's going to be hard to build a respected "brand" for free information that any prof out there (good or bad) can create and compete with commercial interests that devote significant resources to marketing their information. If you start to put this information together by committee, you run into all kinds of efficiency problems.

We will see more free courseware (various schools putting up web sites for various things). You can already see tons out there and much of it is exceptional (look at some of the radiology and anatomy sites, for example). It's just not organized around courses. Profs pick and choose information from a variety of resources, including free ones, especially as schools get strict about getting official authorization / permission for all copyrighted images used in course. I expect that each school will have their own courseware for many years into the future but that more will be available online as supplemental or not so supplemental material.

 

[njbmd]

Most lecture and educational materials are the property of the authors. There are serious copyright laws that govern the reposting and use of materials that are not your property. I can tell you that when I put 40 hours into the preparation of one of my lectures on atherosclerosis (or another disease process), I am not interested in having those materials broadcast on the open internet. There are limits to what we may place on password in house websites such as Blackboard. I generally furnish no more than a syllabus and a handout. I have seen many of my colleagues lectures, photos and syllabi end up overseas as lesson plans for people who are not capable of producing their own materials.

The problem with Wikipedia is that it isn't a peer-reviewed journal or primary source. While much of the information is correct, it's not a reliable source for making patient care decisions. It may be quick but you have no reliable means of knowing how the material has been collected and produced. I do not allow Wikipedia as a primary source for any Evidence based decision-making on my rounds and service. If you bring me an answer, you have to have a peer-reviewed journal or source that you consulted for your answers.

 

[Monica Lewinsky]

Funny thing is, however, as wikipedia continues to improve, it may become a significant part (10%? 20%? More?) of the educational content in med school and elsewhere. We shall see. Wikipedia really angers many physician educators (including the ones I respect the most) for a variety of irrational reasons, none of which can be backed by any sort of systematic evaluation these same individuals insist that everyone else do. I can find just ans many, if not more, errors in a syllabus than I can in a typical wiki article. One of our pedi surgeons (an awesome, competent, nice one, by the way) was dismayed that after pimping one of the residents with a question that this resident couldn't answer this surgeon found that the resident had looked up the answer on wikipedia (and left the screen up on a monitor at the hospital terminal). Although the resident got the answer 100% correct from wiki, the surgeon was deeply offended that the resident had used wikipedia to look up the information because the question involved patient care (even though the resident got it right).

It offends them since wiki is so easy to use, along with saving so much time. Some of the more esoteric facts in a wiki article can only be found in primary literature. 30 mins of searching articles or 10 seconds on wiki?

What is offensive is that they are too arrogant to ever look at wiki and realize that most legitimate medically related articles have appropriate citations.

 

[GoodEats]

Most lecture and educational materials are the property of the authors. There are serious copyright laws that govern the reposting and use of materials that are not your property. I can tell you that when I put 40 hours into the preparation of one of my lectures on atherosclerosis (or another disease process), I am not interested in having those materials broadcast on the open internet. There are limits to what we may place on password in house websites such as Blackboard. I generally furnish no more than a syllabus and a handout. I have seen many of my colleagues lectures, photos and syllabi end up overseas as lesson plans for people who are not capable of producing their own materials.

The problem with Wikipedia is that it isn't a peer-reviewed journal or primary source. While much of the information is correct, it's not a reliable source for making patient care decisions. It may be quick but you have no reliable means of knowing how the material has been collected and produced. I do not allow Wikipedia as a primary source for any Evidence based decision-making on my rounds and service. If you bring me an answer, you have to have a peer-reviewed journal or source that you consulted for your answers.

I've thought off an on about this topic, and have a couple things to throw into the ring.

First, responding to njbmd, I know it is frustrating putting in a lot of time into something that others then snatch and use without a second thought. I've heard it happen many times over. At the same time, I think the rising generation of students has grown up with the internet (and has the additional liberal bump of youth). We are seeing inefficiencies in the system and are saying, "there must be a better way to do this!" We have some outstanding lecturers and some fantastic notes, but also some not so stellar performers. It would be ideal to somehow pool the educational material and let the cream rise to the top.

A major obstacle is the disparity in curricular structure from one school to another. Another is the pride of the lecturers that find their material is lacking. On the flip side it may spur them on to improve their materials or to collaborate with others who are doing superior work. One barrier I didn't think of initially is that a lot of lecturers do have material cropped from other sources. If this was published on an open website, the school would have legal issues with copyrights.

Ideally, there will be more schools opening their doors to those who wish to utilize their material. This would come with the common clause that the material is to be clearly credited and, of course, used purely for non-commercial purposes. A second layer would be built on top, with a portal for organizing and accessing these resources. In this portal, students would be able to rate the resources, give both positive and constructive feedback to the creators of the material, and leave comments about the usefulness for future users to see.

Student-generated material (e.g. review sheets, powerpoints, diagrams, etc) is already being disseminated in a similar fashion (www.ustacks.com), and I think it will take off in coming years.

In the most extreme version of this scenario, multiple schools align their curricula and make available videotaped lectures. These lectures could be given by the best lecturers, and updated periodically. Students are expected to watch lectures/read material/etc on their own or in groups. And then each institution's faculty's time would be better spent on higher level synthesis of material, leading small groups, problem-solving, clinical cases, etc. I know there are those who learn better from listening in lecture, so I don't expect this to ever happen.

A nearer fantasy is for course syllabi to become wiki-ized, allowing students to fix typos, add clarifications, and suggest deletions. As in the wiki world, all changes are tracked and recorded (including who made the change), and prior versions are easily reverted to. Lecturers and course masters would have final say over any disputes. Parallel versions would be created -- a base outline format and a paragraph-style text. Then heading into each course, students could opt in/out for what they wanted printed (full text, outline, or not at all).

Which brings me to Wikipedia. I also don't think it should ever be cited as a primary source. Rather, it is useful as a quick summary and portal to other resources. In this way it is very similar to UpToDate, but with a broader scope and fewer details about specific clinical trials and recommendations. Wikipedia is extremely quick and easy to use, has proven invaluable for boards studying, and is quickly becoming a more reliable resource as more people contribute. I think it's enough for a lightning-fast question you need answered, but I agree that the primary papers are the foundation you need to rely on. I'd be interested to know what you all think of emedicine, as I feel it's an appropriate hybrid.

Enough procrastination -- back to the learning.

 

[EBI831]

to the people who say that it will save a ton of money and get rid of the pointless class time etc in the 1st year: here's a somewhat off question. why don't more people do online colleges like university of phoenix? it teaches the same material and in the end you have to take the same SAT to get in, MCAT/GMAT/LSAT to get into professional school ie standardized tests. why? because there is a stigma associated with these things.

 

[incubate6times]

to the people who say that it will save a ton of money and get rid of the pointless class time etc in the 1st year: here's a somewhat off question. why don't more people do online colleges like university of phoenix? it teaches the same material and in the end you have to take the same SAT to get in, MCAT/GMAT/LSAT to get into professional school ie standardized tests. why? because there is a stigma associated with these things.

There is definitely a stigma with phoenix online and such, but I think it would be easier for med schools to beat the stigma because they are already established as reputable programs. Many reputable universities have online classes (Harvard, MIT, UNC, BYU, Penn State, Minnesota...).

 

[ACSurgeon]

If allopathic med schools basically teach the same thing during pre-clinical years and have everyone take the same standardized test, why is it that schools don't make their materials openly available (a la MIT's open courseware)? Better yet, why don't schools work together to make a centralized online resource of the best figures, tables, lectures, vid casts, practice questions/exams etc explaining all major topics covered in the first two years.

With technology where it is why doesn't medical education take advantage of the possibilities instead of haphazardly using it (eg. using blackboard to post ppt slides)?

I suppose there isn't really much of an incentive for schools to do such a thing, but I was just wondering if anyone else has any ideas/dreams about how medical education could improve.

1- Copyright. Most schools get their figures from other authors, and wouldn't be allowed to publish it publically.

2- there is no way around the egos... everybody thinks they are doing it better.

 

[yohimbine1]

OP you have my support. I applaud your ideas and dreams.

 

[incubate6times]

Funny thing is, however, as wikipedia continues to improve, it may become a significant part (10%? 20%? More?) of the educational content in med school and elsewhere. We shall see. Wikipedia really angers many physician educators (including the ones I respect the most) for a variety of irrational reasons, none of which can be backed by any sort of systematic evaluation these same individuals insist that everyone else do. I can find just ans many, if not more, errors in a syllabus than I can in a typical wiki article. One of our pedi surgeons (an awesome, competent, nice one, by the way) was dismayed that after pimping one of the residents with a question that this resident couldn't answer this surgeon found that the resident had looked up the answer on wikipedia (and left the screen up on a monitor at the hospital terminal). Although the resident got the answer 100% correct from wiki, the surgeon was deeply offended that the resident had used wikipedia to look up the information because the question involved patient care (even though the resident got it right).

Although there is a special kind of wiki-hate out there, I think this is related to the problem you will have with any sort of open courseware. Profs at various schools will find errors and be unhappy with the material, especially if they forced to use it. People ascribe value to something based on how much the respect the "brand," which involves how respected the sources are, how exclusive its availability is, how well it is marketed, and how accurate it is. It's going to be hard to build a respected "brand" for free information that any prof out there (good or bad) can create and compete with commercial interests that devote significant resources to marketing their information. If you start to put this information together by committee, you run into all kinds of efficiency problems.

We will see more free courseware (various schools putting up web sites for various things). You can already see tons out there and much of it is exceptional (look at some of the radiology and anatomy sites, for example). It's just not organized around courses. Profs pick and choose information from a variety of resources, including free ones, especially as schools get strict about getting official authorization / permission for all copyrighted images used in course. I expect that each school will have their own courseware for many years into the future but that more will be available online as supplemental or not so supplemental material.

Why not take the good parts of wikipedia and make a modified wikipedia med-wiki? Instead of having the editing feature open to everyone, profs, students etc. log in with a valid .edu med school email, and the changes will be tracked back to that person. From that account they can bookmark/watch certain pages in the med-wiki and receive questions or comments about their changes. It could be integrated with a web portal for the med-wiki and study tools.

The copyright problem is a big one. The way wikipedia tackles this is by having its members create their own original figures and graphs. They might not be as polished as figures published in textbooks, but these again benefit from having a community watching and editing the figures.

Getting schools, students and profs to use and embrace such a model would be very difficult, and I suspect that it would take the doing of a publisher to get something like this to work, like hb2998 said. Even then, the publishers don't have much incentive to do such a thing because this system would largely replace textbooks.

 

[yohimbine1]

It's "web 2.0". Also you may consider posting topics like this in the Med Business forum. And don't be discouraged--in the history of innovation it has always been hard getting people to embrace new models. It was only yesterday that professors used physical slides and projectors. And posted grades on bulletin boards.

 

[Law2Doc]

1- Copyright. Most schools get their figures from other authors, and wouldn't be allowed to publish it publically.

2- there is no way around the egos... everybody thinks they are doing it better.

3- Antitrust laws. There's a limit to how much you can collaborate and still be the only accredited game(s) in town.


I think the key phrase in OP's question is "basically teach the same thing". In fact all schools have their own tweaks, focuses, approaches. Professors are like snowflakes, no two are going to be identical, some will reach the students better than others. Some schools like PBL. Some add more clinical experience earlier. Some emphasize journal reading, some emphasize presentations. Sure, at some level all schools are going to cover the same basic science material because the students all take the same boards. But at another level each has its; own independent product. And while the boards are the test everybody takes, as mentioned above, they are not considered particularly valuable in determining who will be the best "doctor" -- the test simply doesn't address that. So schools need to focus on trying to create good doctors (be it clinicians, researchers, empaths, or whatever the school feels is important) on top of generating folks who will do decently on the boards. So yeah, there is value to letting schools go their own way. There isn't an accepted "better" as of yet, once their is it quickly gets adopted by the rest. But there are differences, beyond just copyright issues. This isn't a trade school where you just go to learn to pass the test and get your certification. This is a profession, basically an apprenticeship, where your brain gets packed full of basic science as foundation and then you are groomed clinically to actually work in the profession.

The Steps are sort of a side thing, not meant to be the focus, although it's kind of hard to ignore them due to their impact on specialty selection. The real improvements in medicine will not come through standardization of resources. Probably the opposite. The NBME will at some point merge Step 1 into Step 2 at a later point to deemphasize it (they are talking about it, but not likely to happen anytime really soon). Then the other "professional grooming" components of med school will loom larger, and perhaps more differences amongst schools will be more apparent, as they focus on training doctors rather than testtakers. As such, the OP's idea of standardization is probably not a step forward.

 

[MONKEYBOY]

Every lecturing prof is writing their own text. We can usually consider these 'unedited'. Students in lecture edit them, only by making the mistake of correcting the lecturer.

What an enormous waste of work hours by so many professors!

An obvious phenomenon is that professors that those working at schools aren't there to increase efficiency, they are trying more and more to increase what they get paid. Usually this coincides with less productivity (Read: sleeping in a broom closet).

All of these suggestions point directly to build the BEST curriculum. This is something that good students want. Do profs want to do new or different things, regardless of the positive outcome? The novelty that profs show answers this question. We are essentially doing the same things as was done in the 1940's in education.

Educational research is very abundant, and clearly points away from having a Ph.d. read us slideshows for 2 years to make us doctors. This falls on deaf ears.

Maybe in 20 years or so, when creative minds like those expressing opinions like in this great thread are closer to the steering wheel something will happen.

Until then ... we sit, try to stay awake, and wait for summer so we can read a First-Aid & Wiki and finally learn this -- teach it to ourselves.

We are paying our $180,000+ for the paper degree. The education we get is essentially free (wiki, answers.com, etc.).

It's a silly old world we live in.

 

[Law2Doc]

Until then ... we sit, try to stay awake, and wait for summer so we can read a First-Aid & Wiki and finally learn this -- teach it to ourselves.

We are paying our $180,000+ for the paper degree. The education we get is essentially free (wiki, answers.com, etc.).

If your school is adding no value whatsoever over First Aid or wiki, you are indeed getting ripped off. Most of us are getting some value for our buck. This is particularly so in the later years of med school where we learn directly from practitioners while doing stuff, on top of reading. (As an aside your profile indicates you are a dental student -- perhaps that is where the differences lie?)

 

[jsydc]

If allopathic med schools basically teach the same thing during pre-clinical years and have everyone take the same standardized test, why is it that schools don't make their materials openly available (a la MIT's open courseware)? Better yet, why don't schools work together to make a centralized online resource of the best figures, tables, lectures, vid casts, practice questions/exams etc explaining all major topics covered in the first two years.

With technology where it is why doesn't medical education take advantage of the possibilities instead of haphazardly using it (eg. using blackboard to post ppt slides)?

I suppose there isn't really much of an incentive for schools to do such a thing, but I was just wondering if anyone else has any ideas/dreams about how medical education could improve.

Speaking as someone who has taught from a standardized curriculum, the more flexibility you take away from the teacher/lecturer, the more difficult it is to deliver the material effectively, and the worse the student's experience. That being said I think tools like open courseware are great for opening up access to additional resources for both lecturers and students. There should be (and are in most places) viable standards in place, but not standardized lecture material at every school.

More useful is more open access to reference texts, with projects like opentextbook (http://www.opentextbook.org), although it doesn't have much of use in terms of medicine in it's repositories yet.

 

[MONKEYBOY]

Law2Doc: Speaking from the courses we take with medical students.

Dental-only courses are mostly focused on very practical aspects of a given topic.

 

[osli]

Our pathology professor has he entire noteset online for the world to view, and encourages it to do so.

As for wikipedia not being peer-reviewed, that isn't really accurate. It is peer reviewed, often by a hell of a lot more peers than a journal article or textbook. The problem is that you don't know how many peers, or who, has been reading and editing. You might have a log of the few edits made, but no count of the countless many that simply read and agreed. And no controls really over who actually gets to edit and what their credentials are.