In this blog I would like to explore the various aspects of
learning that make up an education. The
assumption I would like to address is that learning is equal to education. In a
university set up I would like to think that students enroll in a particular
stream of courses in order to achieve education and not just gather information
about the course. During their university years students are preparing for a
career choice. To sustain a career is it enough to just know the theory behind
a particular job? Meaning if I were change my career and pursue an education
for my new career choice; I would hope to find a education system that will not
only keep me well informed of all the intricacies on my career but also the
other aspects of my career; simple skills and values that would help me succeed
in my career.
In the last class when we looked at the definition of
education as a combination of knowledge, skills, attitudes and values. In
medical education we are in the process of generating individuals who have the
knowledge to address the complications of human disease. This process in itself
can be consuming and overwhelming. At the end of the 4 years in medical school
if the learners remember every single detail gathered from all the sessions either through didactic lectures
or online modules and excelled at every exam ; does that make the individual a
medical practitioner you would like to go to when you yourself need medical
attention? Can these criteria which deem the individual as an excellent medical
expert also deem learners fit to practice? Today’s’ medical learners are going
to be treating our future generations and us who will be part of geriatric
population. In my view, the education system has a responsibility to
incorporate the appropriate value system and attitudes that could create a
better tomorrow.
'Medical experts' would be able to tackle our physical issues
medically but is healing exclusively the matter of administrating the
appropriate drugs? If so we don’t need a person to tell you what drugs to take
but would have a robot/software print a prescription based on the history you
typed in when you described your condition. When I am a patient, I am not only
looking for a treatment to my medical concern but also the attitude and values
of the doctor. On the flip side do I want to just feel warm and fuzzy but not
get a concrete treatment because the physician can’t figure out what is wrong
with me? I, for certain, as a patient would like to see a balanced professional as my medical
expert.
Medical education system has been trying for years (I will
be tracing the roots of professionalism in the coming blogs) to more from
generating physicians who are exclusively medical experts to physicians who are
medically competent. Currently in our medical school the competencies that we
are intentionally shooting for are listed in the recommendations put forward by
Royal College of Physicians and Surgeons of Canada (CanMEDS) 1 . As
in the diagram,, medical education is striving to interweave the competencies with the development of a
medical expert. That is to say that the central theme is still to create a
‘medical expert’. This medical expert
during training should have absorbed and integrated the competencies that
surround the practice of medicine; such as, professionalism, communicator,
collaborator, scholar, manager and advocate.
The Association of Faculties of Medicine of Canada (AFMC)
has a collective vision for MD education. In their report of the project on
‘The future of medical Education in Canada’ the eight recommendations were made2. The first one on the list is ‘Address
Individual and community needs’. To do so we as faculty and members of the
community have to prime the students on the diverse needs and cultures that the
community is made up. As faculty members the way we address the student
community affects the way students view the community of the class, society and
world.
How could I as a anatomy teacher try to prime the students to be aware
of these demands on their professions? I would like to address all the CanMEDS
competencies in the coming blogs and research the various teaching methods and
tools to not only include these competencies as objectives but also attempt to authentically assess these competencies.
1.
http://www.royalcollege.ca/portal/page/portal/rc/canmeds
2.
http://www.afmc.ca/fmec/pdf/collective_vision.pdf
Anna,
ReplyDeleteAs I read your blog I had several thoughts. First, I thought about my own inquiry project and the reading I have done. Much of this centres on the determining the purpose and functions of a university and a university education. Many of your comments resonated with me. I can see similarities between your discipline and mine, in that both can sometimes be viewed from the perspective of trade schools - i.e., 'just tell me where to cut' (we can use that phrase in business and in medical school!). And I believe this approach not only cheapens the discipline, but not prepares people to reach their potential as contributors to society.
This brings me to my second thought, which centred on the rise of 'Minute clinics', where modern technology is taking the place of the competent doctor. These clinics where the doctor/physician assistant/vet (yep, they use them for animals too) may be beneficial for routine or basic illness, but they are not suitable/effective for more complicated problems. In the end, you can't replicate House M.D. (or maybe you can - we just are not there yet). In your situation it is even more important that we produce professionals who are not only competent, but have the ability to be flexible in an uncertain world where new knowledge is needed.
Hi Anna,
ReplyDeleteI enjoyed the direction of your blog. I particularly like your attention to a balanced profession. It brought to mind several thoughts. First, you made a statement, “education system has a responsibility to incorporate the appropriate value system and attitudes that could create a better tomorrow”. I applaud your focus and attention on the future and wonder, who decides. Who decides what the appropriate value system is that will indeed lead to a better tomorrow? The challenge seems to be how to achieve that balance by determining what those values are and who decides. Are, for example, the values a reflection of societal values? Should the medical profession, the education profession, the nursing profession, the social work profession, the engineering profession, all adapt the values to support the agenda of the neoliberal government? Our patriarchal society? I love your statement of creating a better tomorrow – just wondering who gets to decide what that better tomorrow reflects and who’s better tomorrow?
Having said that, like you, I want to be confident that when I require medical treatment, that the person I seek out, has the knowledge to address my concerns. Two years ago, my daughter developed a rare disease involving her esophagus. Our physician initially diagnosed her with asthma. Without going into the details of how wrong this diagnosis was, we eventually were referred to 8 separate specialists locally, within a two week period. This was important because my daughter, who was very thin, could no longer eat without vomiting. She was sick and scared and hungry. Only one medical specialist took the time to understand what she had been experiencing. This one pediatrician ordered the appropriate scope that determined her disease. He had the medical knowledge but more importantly, he had the ability to listen both to my daughter and to her mother. His curious nature led to the appropriate inquiry through medical testing. His values told him it was important to hear what the patient had to say and to validate those thoughts, feelings and fears. His referral to a specialist and surgeon in London resolved this problem for Alex. He too took the time to sit with her, ask many questions and provide a sense of hope, although no certainty, as his experience and knowledge was very limited with this particular disease and especially in young people.
We are thankful that both of these medical professionals had what you refer to as a “balance” and yet the other 8 did not. Which leads me back to my original concerns, who decides what those values are?
Beth
Hi Anna,
ReplyDeleteSome very interesting considerations here. I was particularly intrigued by how you framed your focus at the beginning of the post -- that is, looking at the assumption that learning is synonymous with education. It seems like you have a particular kind of education in mind: one that prepares students for a career. Yet, you specify that it isn't education for a particular career that you have in mind, but rather something more general. Maybe education for any career? I'm not sure. It seems as though you have something akin to liberal education in mind.
The focus of the education that you talk about in that first paragraph is, though, a little more focused than liberal education, because in it students are learning the intricacies of a particular career, and all the skills, etc. associated with it. So at the end of the first paragraph I wasn't sure whether you were talking about a specific kind of career-focused education or a more general kind of liberal education that would prepare students for multiple possible careers.
The cations you raise in your second paragraph struck a chord with me (bias alert!). While the details about anatomy, physiology, etiology, etc. are certainly important parts of being a competent physician, I think you're right that there is more to it as well. Perhaps this is especially the case for physicians who deal with patients on a one-to-one and/or ongoing basis, such as GPs. Maybe surgeons and research physicians can get away without such values. But even then, I'm not sure.
There seem to be some assumptions embedded in the third paragraph that are probably worth drawing out and addressing. When you write, "'Medical experts' would be able to tackle our physical issues medically but is healing exclusively the matter of administrating the appropriate drugs?" I see some missing pieces. I'll try to summarize the problems here:
1) The first part of the sentence doesn't assert that healing is exclusively a matter of administering the appropriate drugs, so the "but" is misplaced (as it implies that the second part of the sentence is a rebuttal to the first).
2) There seems to be an implied connection between medical treatment and the administration of drugs, but it isn't made clear what that connection is.
30 There also seems to be an implication that medical experts and competent physicians should be the same people. Yet, it seems possible that one could be a medical expert without being a competent physician, and maybe even a competent physician without being a medical expert. So: why assume that those roles should be occupied by the same people?
I think that clarifying the assumptions in that sentence would help you clarify the kind of medical education you're trying to provide -- and this would clarify what you're trying to say in the preceding and following paragraphs as well.
You mention "as in the diagram", but i don't see a diagram! :)
I'm not sure how the two paragraphs at the end (about the AFMC report) fit into the rest of the post. It seems irrelevant to what you say in the other paragraphs, but perhaps there's a link that you see but just haven't made explicit yet?
At the end of the post, I was left wondering about the connections between all of the things you had said and the focus with which you began. In other words: How do these matters relate to the assumption that education and learning are synonymous? All of it is potentially relevant, I expect, but at the moment I can't see it. So I'm hoping that in the next post you make that relevance explicit for me benefit (selfish, I know!).
Lots to think about and work on here. Potentially very meaty material that could take you in some provocative directions . . .
Good blog, Anna!
ReplyDeleteThanks for reminding me that I will soon be part of the geriatric population – ha ha! It really does help to ground the discussion in the importance of education and how it is defined and evaluated. It sure makes it personal!
It is interesting that our Nurse Practitioners are often asked why they did not become physicians. People perceive the role of health practitioners as “those who defeat disease” versus those who treat people.
As a teacher I present a true case study of an elderly woman who lived alone, facing surgery for her fractured hip. She was refusing treatment until we confirmed that her cat was cared for. In order to defeat the disease, we had to treat the person.
Unless the well rounded education Ahmed discussed, the affective domain of learning and the true definition of a given career path that Jules is pursuing are defined we are pressed to determine the goals and definition of education.
I agree with you, Anna, that the goal of education should be competency. I also agree that the definition and measurement of that competency must be well defended with evidence.
It makes sense what Beth discussed, that students need a personal connection with their teachers whereby they are valued as individuals. If this is practiced by teachers, then it would hopefully translate into the behaviour being modeled in the students’ professional behaviour.