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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  • http://profile.yahoo.com/LYJDGD6ZRZHCUZ263DOCGDFPBM ahmad

    I remember the hours of useless but mandatory didactic lectures that “needed to be documented” for the ACGME. It was a colossal waste of time that have been better spent with the patients, in clinic or in the OR. If children can intuitively learn as you have told us, why can’t adults? 

    • Anonymous

      Because most of the adults were schooled by the state and taught to “learn” what they could spew back out onto tests.  I was brought up not wanting to learn, but I wanted the grades.  I learned what I needed to get straight A’s.  Education was never important to me until after college really.  The focus had always been grades and success and NOT education or true knowledge.  My daughter (on 4th year being homeschooled) is more curious and truly interested in learning and being educated than I ever was.  I have multiple graduate degrees and never really knew the value of learning for fun or learning to be educated…seemed I was taught to chase the grades and class rank standing.  It is only now that I am truly feeling educated!!!

      • Craig Koniver, MD

        Awesome–very well said…thanks for sharing that!

    • Craig Koniver, MD

      Great point, Ahmad! Yes, we have been “duped” into thinking that the only way we can learn anything is for someone else to teach it to us. This goes against the very powerful, natural ability of humans to learn and be curious…intuitively!

  • Anonymous

    I have no doubt that children can learn in a home with two loving adults, but what about a home with no loving adults?  We then have 12 year old pregnant females and 12 year old male drug dealers.  For many parents school has become a place to warehouse their children for 8 hours a day and provide one or two free meals.

    • Anonymous

      It is sad that for many children school is a better place for them than their homes.  That is TRAGIC to consider, but a fact.  However, in homes where there are 2 parents committed to a quality education the options are limitless.

  • http://www.facebook.com/profile.php?id=777147421 Chris Porter

    Please provide a link to stats confirming that 20% of American children are homeschooled. The figure is wildly higher than anything I could find.

  • http://rk.md Rishi

    You’ve made some excellent points, Dr. Koniver, but I still feel that a foundation in the basic sciences often times drives our curiosity. There are so many interconnected things in medicine that it’s often difficult to generate good questions without understanding how things are “in most healthy people.” It’s true that regurgitating detailed pathways initially has very little utility short of scoring well on exams; however, knowing that (in your example), there’s an aerobic pathway in mitochondria which drives energy production helps us realize how it plays into disease states we encounter on the wards… even if we don’t remember all the details.

    Thanks for the great post!

    • Craig Koniver, MD

      Great points, Rishi! Thanks for chiming in with your perspective!!! We need more people like yourself who is open to this type of discussion!

  • Anonymous

    It’s I could not care less. Next time, try to write an article about your superior educational ideas without any grammatical errors. I’m sure that the children of two doctors are smart enough to do well as little kids, but a large part of school is learning skills like critical thinking and emotional intelligence. When these kids are in high school and have spent all their lives with the world revolving around them, with parents who obviously have a rare set of resources that allow geography class to include fifty cross-country trips, they will be in for a rude awakening. Please tell me, how are they supposed to become productive workers if they don’t have the skills that employers are looking for? It’s the crumbling of our schools, the loss of funding, and the class divide (smart kids and wealthy parents flocking to private schools, creating a massive brain drain and again, lack of funding) that are producing workers without the right skills. Unschooling just produces more useless people.

    • phdmom

      Actually if you look around at the research, many colleges and universities have separate admissions counselors and are looking to attract homeschoolers.  Rice University admissions counselors love homeschoolers and find they are much more prepared, even for Rice which has some of the brightest kids around enrolled, than the average non-homeschooled students.  I homeschool and have been pleasantly surprised by the reception of colleges to homeschoolers.  As far as employers, homeschoolers tend to me more self-motivated and are accustomed to working independently. Your response was so negative and nasty.  If you don’t like homeschooling, don’t do it.  But for many kids it is providing a great education with endless opportunities.

      http://voices.yahoo.com/homeschoolers-preferred-colleges-universities-6318238.html

    • Anonymous

      Sorry, the evidence does not support your claims.  Homeschooling isn’t for everyone, but don’t knock it for people it works for.  My kids have all been home schooled for their entire lives, and they are doing very well, thank you.

    • http://twitter.com/InnovativeEdu Lisa Nielsen

      ==Please tell me, how are they supposed to become productive workers if they don’t have the skills that employers are looking for?==
      This is a question that is of far greater concern for those who receive the drill and kill, sit n git, memorize and regurgitate, test prep factory-style experience in our public schools today. Students are graduating high school and college prepared to sit, git and be told what to do and how to think. In short they are successfully prepared to be great on a factory line.

      Many parents are choose home/unschooling because it better prepares their children for the world outside of school since that is where they learn everyday.  Furthermore, colleges are hungry for home educated students and home educated young people grow well-prepared for a variety of careers. The difference is they often don’t pick professions where they are forced to sit around and do what other people tell them to do all day. Those are often the careers they are not well-prepared or suited for and this is just the way many parents who choose this path want it to be.

      For more concrete advice read these articles:

      Concerned about Your Child’s College and Career Success? Leave School.

      15 Key Facts about Homeschool Kids in College

      • Craig Koniver, MD

        Very well said, Lisa!

      • http://twitter.com/IVLINE Aaron Sparshott

        Well said. I have found that education in western society globally has trended towards teaching students how to do well on one-off exams, as opposed to how to learn. I’ve seen a greater number of children these days who have no scope outside of A + B = C and struggle to apply the information in different contexts.

  • Anonymous

    This only works with educated parents- I have patients who are doing this with their kids for other reasons, who are this side of illiterate.
    One of the great and not so great part of school is the kids we meet.And this is what the real world is like- for good or evil.
    We will have bullying attendings,and wonderful ones.We have horrible bosses and wonderful mentors- but those experiences are important.
    For my own kid- I remember a couple of great teachers-and some horrible ones- and we did supplemental education at home.But it is helpful to make contact with people of other religions and races and beliefs.
    This was made clear  to me ( again) when I moved from the liberal Northeast to the Southwest, in the last few years.
    One of the most enlightening bits of history I learned was in Virginia,with in 5 years of desegregation- the textbook said that masters were kind to their slaves, and it wasn’t so bad. The next year we moved North, and I learned the other( true)  version.I learned very early to look at the source of information.I would  not have learned this at home.
    I was not the star pupil in the traditional system; I had to got back and do pre-med later; but this was due more to my home environment- my ADD mother could never have provided the structure.
    I admire the discipline of home schooling parents- but the above is key. And soccer teams and baseball are not the answer.

    • Craig Koniver, MD

      Thanks for your comments. I think any homeschooling family can conform that real-world does not mean living life with bullies and being teased in a school setting–we only accept that as real world now. But in actuality, real world is just that, in the real world, engaging and exploring life. 

      All homeschoolers have a vibrant community around them of kids of all ages and all personalities–plenty there to experience real-life. 

      I agree with you that homeschooling is not for everyone, but I do think it has to be a part of the education discussion moving forward. To me, I was using homeschooling as a background to talk about medical education, but I think many people could not get past the homeschooling issue!

  • http://twitter.com/IVLINE Aaron Sparshott

    The best way to teach in my opinion is not what to learn, but how to learn and let the pupil guide their studies.

    I would agree with you that most medical schools place too much emphasis on the basic sciences, however as others have said it does drive our curiosity. More importantly as we come into our clinical placements, we can frame what is happening around us, within these foundations that we have built up.

    The other issue that I felt has been neglected, is who is going to teach these medical students. I’m not aware of the situation in US, but if you started loading all the students into the wards, you would be placing a greater teaching burden on the hospital staff. At the end of the day they can often be great teachers, yet their primary responsibility is still the health of the patient. One at times has to give way to the other.

    • Craig Koniver, MD

      Thanks for your comments and perspective here….I agree with you that we certainly cannot just flip the switch and go back to the olden days of apprentice learning, but I do think this approach makes more sense. The more we discuss these ideas over and over and over and are open to better and more innovative ways of teaching and learning, I think the better. Unfortunately, the masses want all of us to stick to the mantra that top down learning is the only way….

      • http://twitter.com/IVLINE Aaron Sparshott

        Thanks for your reply. I think Osler summed it up best;

        He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

        We as students, should be the masters of our own voyages, with only the sail-masters hand to guide us when we go astray.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    In order to have home schooling, you would have to have one parent not gainfully employed, or the financial ability to hire a full time private tutor, similar to how the aristocracy used to educate their children until very recently.
    Public schools were created to allow all children a shot at an educated life, including those whose parents lacked the means and ability to educate their children themselves.
    Public education is what it is because it serves as the canary in the mine when it comes to reflecting the ills of society. For each one of the happily home-schooled children, there is one child living in extreme poverty (less than $2 per day) http://npc.umich.edu/publications/policy_briefs/brief28/policybrief28.pdf

    Our society is declining because a few selfish and greedy barons are allowed to extract an inordinate amount of resources from the American people, and our health care system is deteriorating for the same reason, particularly as health care gets industrialized into a much better profit-extracting machine.
    Returning to a medieval education system where rich kids are taught at home, while others clean toilets (per Mr. Gingrich), and lucrative professions are learned through apprenticeships with the guild, is neither globally competitive nor an acceptable substitute to a fair equal-opportunity system.

    • http://twitter.com/InnovativeEdu Lisa Nielsen

      ==In order to have home schooling, you would have to have one parent not
      gainfully employed, or the financial ability to hire a full time private
      tutor, similar to how the aristocracy used to educate their children
      until very recently.==

      This is a myth. All sorts of working families are home educating their children either as single parents or ones where both work. If you want more information about that you can read Working Home Educator’s Guide to Success. The introduction happens to be written by a single, working mother. The families featured in the guide are not rich and did not hire full-time private tutors, they just were able to think of non-traditional ways to make home education work. You can read about one such family where both parents work here Mom’s Story: When School Left My Child Behind…He Was Finally Able to Learn.

    • Craig Koniver, MD

      I agree with Lisa Nielsen on this….there are so many families who are creatively choosing to homeschool that the idea that it has to be done under certain settings is a big myth. 

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Just to enrich the conversation a bit, here is one public school system that is working just fine
        http://www.theatlantic.com/national/archive/2011/12/what-americans-keep-ignoring-about-finlands-school-success/250564/

        I am not disputing the wisdom of home schooling for special situations, but as a rule, this is not and it cannot be, the solution for an entire nation. Instead of pulling our kids out of the system, we should make an effort to improve it for all kids, because at some point even the home schooled children will have to enter the larger society and live within it.

        I don’t think it is important to visit the 50 state capitals as part of a well rounded education and I don’t think that memorizing capitals or multiplication tables is a useless exercise even in this YouTube era. I actually think that it is best to keep kids away from computerized learning aids for as long as possible. 

        I may be old fashioned, but I also don’t think one should forgo organic chemistry or differential equations when pursuing a career in medicine. You may not recall what Navier–Stokes equations are or what the differences are between a sigma and a pi bond, but this is completely irrelevant because you learned how to learn, and just like you cannot learn to treat patients without treating patients, you cannot learn how to learn without learning something. 

  • Lumi St. Claire

    While I appreciate your perspective, I have to agree wholeheartedly with Margalit’s post.  I also think it’s important to mention that the divide between the preclinical and clinical years is not nearly as wide as you describe, and I would encourage you to do a little research regarding programs that have made specific efforts to include early clinical experiences into their curricula.  

    The Interdisciplinary Generalist Curriculum Project established very specific recommendations over ten years ago regarding the top-priorty need to incorporate early clinical encounters into the medical school experience (https://cbase.som.sunysb.edu/som/fac_retreat_uploads/42.pdf).  Additionally, the Robert Wood Johnson Generalist Physician Initiative has funded initiatives to foster early clinical encounters at many medical school programs since the early nineties.  While I agree with your general opinion regarding the need for real life examples to bring meaning to learning, so does the US Medical Education system as a whole.  

    ~Lumi St. Claire
      http://mywhitecoatisonfire.com 

    • Craig Koniver, MD

      Thanks for your comments. I certainly do not pretend to be the expert on medical education. I was merely trying to point out that homeschooling my children has provided me a unique perspective on what education is. And from where I sit, I think we can do so much better with medical education to incorporate real-life learning from the very beginning of medical training. Why do we even have to go to college and get a college degree before going to medical school? I know it is standardized now and that is the norm, but it wasn’t always this way. I think it makes more sense to just go and learn and engage then to spend 4 years of college “preparing” for medical school. I know there are many good arguments against this, but that is my perspective.

  • http://twitter.com/InnovativeEdu Lisa Nielsen

    I’m surprised this article pointed to Seth Godin’s “Stop Stealing Dreams” which has an anti-homeschooling message that offended many proponents of home education.

    • Craig Koniver, MD

      I included it here because while I do think it has an anti-homeschooling message, I think it is a well-written manifesto about how our current education system is not working. I think that the majority of readers of this blog probably are anti-homeschool and pro-school and so I thought that this manifesto does provide a good overview. 

      I emailed him directly about his homeschool comments and he wrote back and that helped explain his position. I think any discussion about the future of education needs to place a strong emphasis on homeschooling. 

      I included the homeschool info to set the stage for my comments about medical education, but I think I hit a nerve with the anti-homeschooling crowd…

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    Most medical schools I have worked with are integrating the basic sciences with exposure to medical issues and patient care from day one.  The students learning is self motivated and accelerated with group learning. 
    Public education worked well in the 1950′s, 1960′s and early 1970′s when classrooms were arranged by a childs ability and achievement. Even if a teacher had a large class ( 35 or more students) there were usually no more than 2-3 math levels and reading levels that needed to be addressed. Very advanced students were sent to older classes to get instruction in those areas where they were especially gifted. In the mid 1970′s during the Civil Rights movement these classes were judged to be segregated in many cases. Public schools moved to have ” heterogeneous ” classes resulting in 10 or more reading and math levels in big classes. You had non readers in with college level readers so no one learned well.
    Home schooling done correctly can meet your childs educational needs but fails to provide the cultural and socioeconomic mixers and exposure that helped make America great. If you rarely or never see how the other half lives it is easy to become polarized and insulated. If you are not placed in a competitive environment daily where you can be successful with hard work and achievement how do you come out into the real world and know how to compete.?  

    • Craig Koniver, MD

      “but fails to provide the cultural and socioeconomic mixers and exposure that helped make America great. If you rarely or never see how the other half lives it is easy to become polarized and insulated. If you are not placed in a competitive environment daily where you can be successful with hard work and achievement how do you come out into the real world and know how to compete.?”
      While I do appreciate your comments, I disagree with these statements. If you just look at the direction we are headed in all sectors of society, we are rewarding innovation and creativity and independence–none of these are fostered in a competitive environment that seeks to inform from the top down.

      I was not trying to make the case that homeschooling is for everyone–it definitely is not. I was using my example to point out that we can indeed start to think about medical education differently. 

  • http://pulse.yahoo.com/_JYZSGDUXTNSTJUV5WJB3ZIY23M terminator

    how do these homeschoolers share their education with other peers???do they someday say my parents were smarter than yours? where is there universal structured teaching?
    our kids today are weak in the social realm. they are not facing changing situations. their homestyle becomes stagnant.
    i went to europe to study medicine, but i learned other languages, saw tons of artworks,exchanged cultural differences and equalities. i can go on and on. i made my bones!!!!
    today—-i am a flight surgeon for 3rd world. i started as a dr. without borders. my parents were from europe and worked hard so that i may get my butt out there and be someboy—-not under their tutelage, but, under principles that i was raised under that made me the doctor i am today….

  • http://twitter.com/brainbeautie Willa

    In the Joint Medical Program at Berkeley, there are NO LECTURES at all. It’s ALL problem-based learning. The students teach each other through case studies. And it works. So I think that proves the validity of some of our statements. http://jmp.berkeley.edu/curriculum/case-based-curriculum

  • http://twitter.com/FreeRangeEd TheresaLode

    Great article…great discussion!  Dr. Koniver….I have thought of the very things you write about but as it applies to nursing education.  I went to a 12-month vocational nursing program and at the time, the pass rate for the boards was 100%.(That is, if you graduated from the rigorous program.) And nurses graduated with a good chunk of their learning having had taken place on the floor.  Today, it has morphed into a two year program (read: Bloated and agenda driven) and the board pass rate is no longer 100%.  More filler classes does not make a better nurse. 
    For RN’s, I think it is a great loss to nursing that hospital-based programs are a rarity.  Those three year programs pumped out grads who knew their stuff. When I contrast this to four-year RN’s who got good grades have little horse sense and poor clinical skills ..I think we all lose.  BTW- I am an unschooling mom to my teens.  

  • David Cutter

    I’m curious where you got the statistic that 1/5 of children in the U.S. are homeschooled. The US Dept of Education says, “the estimated percentage of the school-age population that was
    homeschooled increased from 2.2 percent in 2003 to 2.9 percent in 2007.” (http://www2.ed.gov/about/offices/list/oii/nonpublic/statistics.html)

  • http://GreenMommyBlog.com/ Kristen Suzanne

    Excellent and thoughtful. Thank you. My husband and I always said we’ll teach our children evolution in the Galapagos and democracy on the Acropolis.