These are the words medical educators should think about

Readers are slowly learning about my admiration for the Farnam Street Blog.  The about page describes the blog in this way:

My goal is to help you go to bed each night smarter than when you woke up. I’ll do this by giving you tools, ideas, and frameworks for thinking.

I’m not smart enough to figure all of this out myself. I try to master the best of what other people have already figured out. Sounds simple, doesn’t it?

The best way to do this is to read a lot. And so I make friends with the eminent dead.

Along the way, I write about what I’m learning. I’d encourage you to look around and decide for yourself if this is something that interests you.

Last week he reviewed The Laws of Simplicity by John Maeda.  I read the book, and loved the approach to knowledge.  As an educator, he has evolved to a BRAINy approach:

BASICS are the beginning.
REPEAT yourself often.
AVOID creating desperation.
INSPIRE with examples.
NEVER forget to repeat yourself.

I love this conceptualization.  These lines seem counterintuitive to newly minted educators, but over time, many evolve to understanding the wisdom in these lines.

As I work with medical students, interns and residents, these words accurately describe my evolution as an educator.  We should never assume that our learners really understand the basics.  Unfortunately (in my opinion) the first two years of medical school that should emphasize the basics, quickly get too complicated.  We have not defined the basic, must know physiology, biochemistry, anatomy, pharmacology, histology and microbiology.  Rather we try to teach the basics as well as the more advanced concepts all in one package.  This style of teaching makes it more difficult for our learners to separate the important signals from the noise.  The national testing (Step 1) drives how we teach because of the way they test.

So too often our clinical learners do not really understand the basics.  We who teach in the clinical years, therefore, must always start with the basics, and not assume that our learners “own” those basics.

Too many educators assume that when they brilliantly explain something that the learners will absorb that teaching.  Unfortunately, cognitive psychology teaches us that learning often does not occur at the first exposure to a concept or fact.  Try teaching something and asking questions about that teaching a week later.  Neuroscience research teaches that we will help our learners actually learn the material when we repeat our teaching.  As educators, we then must teach the same concepts repeatedly.  I have had third-year residents who rounded with me as third-year students, fourth year, interns and second-year residents.  When I give the same short talk at morning report about a subject, they tell me afterwards that they have learned new things.  Repetition actually works.

As medical educators we must acknowledge the difficulty of learning our field.  Internal medicine is difficult.  When we acknowledge that and encourage our learners that the road towards excellence is a long road, we decrease their anxiety and, therefore, increase their ability to concentrate and learn.

Examples in medicine are patient stories.  Our teaching always improves when we focus on patient stories.  When a point needs emphasis, tell a patient story about success or failure.

Finally, never fear repetition.  It may seem that you are boring the learners, but believe me, you are not.  The learners appreciate your efforts to make certain that they are learning.  Separate the concept of teaching from learning.  Our job is not to teach but rather to induce learning.  Teaching is meaningless if it does not result in learning.

And when in doubt repeat yourself.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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