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Medical students aren’t showing up to lectures, so how do med schools teach them : Shots

by | Jun 1, 2023 | Health Blog | 0 comments


Many medical college students don’t attend lectures within the first two years, as a substitute opting to observe recorded lessons on their very own time.

Tom Fowlks/Getty Photographs


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Tom Fowlks/Getty Photographs

Many medical college students don’t attend lectures within the first two years, as a substitute opting to observe recorded lessons on their very own time.

Tom Fowlks/Getty Photographs

Throughout my first two years as a medical pupil, I nearly by no means went to lectures. Neither did my friends. The truth is, I estimate that not even 1 / 4 of medical college students in my class constantly attended lessons in particular person. Certainly one of my professors, Dr. Philip Gruppuso, says in his 40 years of instructing, in-person lecture attendance is the bottom he is seen. Even earlier than the COVID-19 pandemic, first- and second-year medical college students recurrently skipped lectures. As a substitute, they opted to observe the recordings at residence on their very own time. The pandemic accelerated the shift. This absence from the classroom has lots of people within the medical schooling system questioning how this can have an effect on future docs, and has precipitated vast dialogue amongst medical establishments. Medical schooling is altering quickly, and the change is being pushed by college students — so how do faculties incorporate the truth of digital studying whereas coaching them adequately for the massive accountability of affected person care?

“Flip” the classroom for the primary two years

The primary half of medical schooling (traditionally the primary one to 2 years, that are additionally generally referred to as the preclerkship years) prepares college students to succeed throughout the second half of medical college, clerkships, the place college students work straight with affected person care groups. Preclerkship medical schooling is the place college students be taught the technical components of being a physician earlier than seeing sufferers. It consists of lectures in medical science — anatomy, embryology, physiology, pathology, and pharmacology — and well being system science – ethics, professionalism and public well being. And it goes past lectures. It consists of dissecting a human physique in anatomy lab, working towards the way to interview a affected person and conduct a bodily examination (usually utilizing affected person actors) and quite a few small group dialogue periods related to particular lectures.

Digital studying throughout these essential first two years for me had some important downsides. I used to be unable to ask questions of a prerecorded lecturer. Scholar-teacher relationships, one of many elements of medical schooling I used to be most wanting ahead to, grew to become a lot more durable to domesticate. It was isolating at instances.

Dr. Gruppuso and I began speaking and now we have a couple of ideas on the way to change the medical schooling system to mitigate these downsides whereas supporting college students in a call they’ve already made to be taught on their very own time.

Our proposal is that this: make use of the “flipped classroom” mannequin extensively for preclerkship medical college lectures. On this mannequin, the in-person lecture all however disappears, and college students be taught a lot of the classroom-type materials on their very own earlier than in-person time — therefore the flip. We advise beginning with a collection of digital modules to arrange for case-based small group periods held in particular person. Actions similar to anatomy lab, affected person interviewing and bodily examination follow and particular visitor lectures would stay in-person. This, in essence, embraces the digital lecture trajectory however requires precise attendance for small group hands-on studying.

A medical pupil’s perspective — Alexander Philips

Let me begin by saying, I did take pleasure in benefits of digital lectures. Pausing, rewinding, re-watching, and dashing up the talks was an effective way to give attention to my weak areas and save time, and time was my most beneficial useful resource as a medical pupil, given the sheer quantity of knowledge to be realized. Digital studying made it a lot simpler for me to include non-lecture assets into my examine plan, too, similar to flash playing cards, internet tutorials or lectures by third events.

Within the flipped classroom situation, my typical day may contain a morning of watching quick, focused medical science modules, with pauses in between so I might draw diagrams, examine on-line flash playing cards, and skim and watch different assets. Then, I’d have an hour or two of required in-person case-based small group dialogue with my professors and classmates the place we give attention to the scientific functions of that medical science by discussing hypothetical affected person instances. Different days can be dedicated to anatomy lab, scientific expertise follow with standardized sufferers (affected person actors) underneath the direct supervision of school, shadowing within the hospital, and non-structured time for different actions like analysis, advocacy and group service.

Along with permitting for discussions and attending to know professors and fellow college students, it will give some regularity to my schedule. Within the present system, with the comfort of recorded lectures, I used to be alone to maintain on monitor with the fabric and it was simpler to fall behind.

A professor’s perspective — Dr. Philip Gruppuso

I’ve taught medical college students for practically 40 years in lots of contexts – on hospital rounds, throughout affected person appointments, working small group discussions, and instructing massive lessons. I’ve lectured on subjects that vary from biochemical pathways to life-style ailments (these related to issues like bodily inactivity) to vitamin science and the biology of getting older.

Essentially the most gratifying a part of instructing is passing alongside the much less tangible points of being a doctor — the way to present respect for all sufferers and be a real caregiver. I do that by telling tales about my scientific expertise throughout lectures and the payoff for me is engagement with college students. The pandemic and its attendant shift in how college students realized modified all of that.

Totally digital studying for the primary two years of faculty might have been obligatory throughout the pandemic, however persevering with to do that would ailing put together younger adults to be physicians.

The intrinsically private nature of drugs taught in scientific expertise curricula or human physique dissection can’t be captured in a studying format that’s intrinsically impersonal. There’s additionally extra to preclerkship schooling; different facilitators of holistic doctor coaching like analysis, specialty exploration, and volunteer work, are almost impossible with digital studying.

Lastly, there’s a very actual risk to the medical schooling enterprise in altering the function of the doctor school member. Medical doctors are uncommon amongst professions within the expectation that they may educate no matter the place and what specialty they follow. Take away the gratification that comes with face-to-face instructing and we danger dropping the dedication of school, a lot of which is commonly completed on a completely voluntary foundation.

Medical schooling at an inflection level — our joint take

Within the dialogue of what post-pandemic medical schooling may seem like, some have referred to as for the preclerkship years to be totally digital. Development to clerkships can be decided by competency (ie. have you mastered the coursework) rather than time. However we favor a much less excessive incorporation of digital studying that depends on this flipped classroom.

The Warren Alpert Medical Faculty of Brown College, amongst different faculties, is more and more implementing this method. The worth of interplay with friends, asking questions, and constructing relationships with academics is best and most time-efficient when college students have a radical understanding of the basic frameworks and key ideas of the underlying science. That framework can usually be constructed extra effectively in a tailor-made digital setting the place college students can really work on their weaknesses, permitting college school to give attention to serving to college students apply that information to caring for sufferers. Lecturers may complement these discussions by sharing experiences about how they identified and handled particular sufferers working in organizations and communities during which medical college students will serve throughout their clerkships. Taking out the bigger in-person medical science lectures and specializing in creating or sourcing high-quality digital content material attracts on the strengths of digital studying; diverting saved time and assets in direction of optimizing common in-person case-based small group periods with school and different college students mitigates the drawbacks of digital studying.

Medical schooling is at an inflection level. A conventional vs. flipped preclerkship medical science classroom is only one of a number of selections we face when enthusiastic about the way to practice the following technology of physicians. For instance, the next questions are intimately intertwined with the function of digital studying in medical schooling, and are concurrently being debated in faculties throughout the nation.

  1. What’s the function of medical science coursework in medical schooling? The USMLE Step 1 Exam is the primary licensing examination to changing into a doctor and primarily exams medical science ideas. The transfer in direction of a shortened preclerkship schooling time period will solely be accelerated by a latest shift of the examination to move/fail. Encouraging college students to start viewing medication from a scientific lens earlier of their coaching is an efficient, however much less time spent constructing a deep understanding of mechanisms of illness and therapy can undermine the muse for scientific schooling.
  2. To what extent can or ought to preclerkship medical science schooling combine exterior assets to effectively educate content material? Medical college students have already been embracing a shift in direction of exterior assets for years through a self-directed curriculum to both complement or substitute medical college lectures. This has been taking place largely unbiased of enter from school or administration.
  3. If the price of offering lectures decreases in mild of reusable or simply updatable digital content material, presumably standardized throughout faculties, the ensuing efficiencies might conceivably decrease the price of schooling. If that may be completed, ought to medical tuition lower to replicate this? If that’s the case, this will imply broader entry to medical schooling, much less pupil mortgage burden, and fewer boundaries to pursuing careers in lower-paying specialties, together with major care. Conversely, the time and college intensive nature of extra small group periods might improve value burden to colleges.
  4. Will the advantages of those instructional reforms be obtainable to all? For college students who enter medical college from much less advantaged instructional backgrounds, together with college students with neurodivergence or these from teams underrepresented in medication (URiM), on-line coursework might end in poorer instructional outcomes. Conversely, neurodivergent learners might profit from customized studying modules; URiM college students and people who historically have much less entry to school might have extra face-to-face studying time. As schooling shifts to a digital format, it’s essential that its results throughout the whole pupil inhabitants be evaluated.

These questions are a lot more durable to reply than a query of whether or not flipped lecture rooms deserve an elevated function in preclerkship medical schooling. However these decisions will not be all or nothing. Change needs to be made with an understanding of the tradeoffs, and with the foresight to mitigate the unfavourable penalties of these adjustments.

Medical faculties must get preclerkship medical schooling proper. The robust basis from my (Alexander Philips’) first two years of medical college was what helped me diagnose, admit, deal with, and discharge my first affected person only a few weeks in the past as a 3rd 12 months medical pupil on my first clerkship. We imagine the rapid subsequent step for preclerkship medical science medical schooling is evident. A flipped classroom, and thus an elevated function for digital studying within the preclerkship years of medical college, is a promising mannequin. Can we protect the broad targets of preclerkship medical schooling whereas supporting medical college students in a call they’ve already made to be taught on their very own time? We imagine the reply is sure.

Alexander P. Philips is a third-year medical pupil at Brown College and Tweets @AlexPPhilips. Dr. Philip Gruppuso is the previous Affiliate Dean for Medical Schooling and at the moment teaches at Brown. This piece solely represents the angle of the 2 authors, who want to thank Dr. B. Star Hampton and Dr. Sarita Warrier with Brown College, for his or her enter.



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