What medical education can learn from homeschooling

My wife and I met in medical school. Both of us went “straight through”: going from high school to college to med school. So, like most of you, we are as educated as it gets.

But when our daughter reached “school age,” we decided to homeschool her. My son who is two years younger followed in his big sister’s footsteps, and so now, we are homeschooling both of our children.

Unlike our traditional paths of education and unlike many homeschooled children, my wife uses Unschooling (also called Whole Life Learning and Interest Led Learning) as her curriculum. In fact, there is no curriculum. None. My children choose to learn what they want to learn when they want to learn it.

You see, having come from a very traditional education background to one now that is unstructured and radically outside the realm of “normal,” I have a unique perspective on what education is and how we can better medical education.

Let me add this to the mix: right now 1/5 children in America are homeschooled and that number is growing. Our society is facing many challenges, many of which stem from our educational system and approach. The top-down method of teaching/learning/  obedience, etc. is no longer working. In fact, I believe it is the primary reason our society is stuck where we are–high unemployment rates, dissatisfied (and depressed), overweight, and at a loss for the individual spirit that defined the making of our country.

I encourage you to read Seth Godin’s latest manifesto: Stop Stealing Education for a broader overview about how our current education system is corrupting our positive movement forward as a society.

Back to medicine … where patients are now sicker, more depressed and less satisfied with their doctors (and suing them more than ever). And doctors are more stressed, unhappy and less satisfied with a career that had promised so much.

One of the reasons I attribute to the decline of our healthcare system is the method of medical education.

While there are certainly different approaches out there, I believe that medical education still consists of two years of basic sciences followed by two years of clinical work and exposure. I am sure there are plenty of medical schools that mesh and gel these separate tracks together, but for most, this traditional separation still leads the way.

We all remember the stress of anatomy lab and biochemistry and physiology and pathology — the enormous text books, the long hours in the lab, the late nights studying to pass tests, the burden on our shoulders that if we did not memorize the Krebs cycle through and through that we were not going to survive as doctors.

Those first two years of the basic sciences were grueling and stressful and for the most part pointless. Yes, pointless.

“But you need to understand the body and all of the under-workings first, if you are to understand how to take care of the body!”

I think that sums up the philosophy of the workings and order of our medical education system. If we don’t know this, then there is no way we can ever know that.

This style of teaching is based upon fear — fearful that if we don’t learn about all of the inter-workings within the body, that we will have no perspective when it comes time to heal the body.

But fear never gets us anywhere. I think most of you will agree that you truly learned medicine when you had to do it — likely sometime during your 4th year of medical school and the end of your internship. When you were forced to understand the inner-workings of physiology and biochemistry for Mrs. Thomas who was having a heart attack right now! And for Mr. Jones who has esophageal cancer right now. And for Mrs. Jackson who was diagnosed with Type 2 Diabetes right now!

The idea of learning the facts by themselves in an isolated manner makes no sense anymore. Even when you try to do this in a group with “made-up” cases. No, the very best way for us to remember how anything “works” is to learn it as it happens, in real-time, with real people.

Right now in school across the country, teachers are teaching kids about the 50 states and 50 state capitols. Facts without any sort of human connection. Maybe they are even using computers and watching videos of the 50 states. This pales in comparison to actually driving to the capitol of each state and spending some time there. Once you do that, you will always remember that the capitol of New York is Albany and the capitol of California is Sacramento. We are fooling ourselves thinking that random facts mean anything.

And the same goes in medicine. Before I took care of a patient with a mitochondrial disease, the Krebs cycle was just a bunch of jibberish to me. Now that I have a human face and story to connect with why the Krebs cycle is significant, I will always remember it.

My children teach me things everyday. Their unique perspective combined with their remarkable curiosity and interest in the world around them makes them the very best teachers.

I certainly don’t have all the answers as to how to improve medical education, but I do know from my perspective of being part of a world of Unschooling, the most amazing learning and discovery authentically comes when children engage in the real world around them. My son taught himself to read at age 4 because he wanted to. My daughter published her first book at age 9 because she wanted to.

And that want and curiosity is critical. I could care less about why the Krebs cycle matters when I was forced to regurgitate it for a test, but when I am curious and interested in how the Krebs cycle plays a role with a real patient with a mitochondrial disease, I engage it and it becomes real.

You know it was not that long ago that medical students learned directly from their attendings by following them around, house to house, engaged in real medicine from Day 1. We used to learn medicine by learning all of the facts in real time, with real patients.

But that type of apprentice learning was replaced by medical schools. And now each of us pays into this system a ton of money, time and energy so that we can emerge ready to begin the actual learning of medicine in our residencies.

Makes you wonder, doesn’t it?

We used to learn by an immersion style, one that forced new medical students to interact with real patients with real medical problems. I believe the mounting dissatisfied patients who feel disconnected and distrustful of the medical profession would decline if we embraced this immersion style of teaching and learning again. Because in that system, one learned by doing with a clear emphasis on patient interaction, not an emphasis on facts and test taking.

Public education needs to change. And from where I sit today, medical education does too.

Craig Koniver, author of Connected: The New Rules of Medicine, consults with physicians around the country at The New Rules of Medicine.

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