PHM Session: Medical Education Dogmas: Things Educators Do for No Reason
Presenters: Eric Zwemer, MD, UNC Children’s Hospital, Chapel Hill, N.C., Jimmy Beck, MD, MEd, Seattle Children’s Hospital, Wash., Whitney Browning, MD, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tenn., and Benjamin Kinnear, MD, MEd, Cincinnati Children’s Hospital, Ohio
The presenters discussed the limitations of medical education research including lack of funding, retrospective and uncontrolled data, suboptimal statistical methods, and limited outcome measures. The audience was led through four medical education dogmas and provided with proven educational alternatives.
Dogma: Okay, boomer: Debunking the myth of the millennial learner
Dr. Browning analyzed the assumption that millennial learners have different characteristics, values, and skills than their predecessors: notably poor work ethic, lack of organizational loyalty, and tech-savviness. Sweeping changes made to accommodate millennial learners are not supported by the literature. Generational stereotypes are often overstated, causing a divide. Educators should encourage generational humility and look at the evidence before making curricular changes.
Dogma: Anchors away! The misguided obsession with cognitive biases
Dr. Beck questioned whether teaching cognitive debiasing strategies improves clinical reasoning or reduces medical errors. Heuristics are often blamed, yet there is poor agreement among experts on biases present in case reviews. Educators should embrace diagnostic uncertainty and review both good and bad clinical outcomes.
Dogma: All VARK and no bite: The learning styles matching hypothesis
Dr. Zwemer discussed VARK (visual, auditory, reading/writing, and kinesthetic) learning styles and the belief that matched teaching results in improved learning outcomes. Students don’t choose study strategies matching their VARK style or have better grades when matched. Instead, instruction should be determined by the subject matter.
Dogma: Humans are not bread: Getting beyond time-based training
Dr. Kinnear re-examined time-based resident training. Individuals have variable learning curves, rates of competence attainment, and rates of entrustment over time. Competence attainment and time are related but not in a fixed manner.
- Rigorous scientific evidence on generational differences is lacking.
- There is a paucity of evidence to support the overhaul of the educational curriculum for the millennial learner, as this has not been associated with improved learning.
- Help learners navigate and become comfortable with diagnostic uncertainty.
- Be thoughtful about the best modality for teaching a given subject matter instead of attempting to teach differently to multiple learning styles.
- We should consider a shift to fixed outcomes and variable time for resident training.
Dr. Woomer is an assistant professor and the pediatric hospital medicine fellowship program director for the University of Louisville, Ky. Her interests include medical education, quality improvement, hyperbilirubinemia, asthma, and unconscious bias.
I’ve read much about the significance of cognitive biases in diagnosis and misdiagnosis, and every day we see the role cognitive biases play when taking care of hospitalized patients. If there are experts who do not agree or do not believe that cognitive biases play a role, I would love to get more information from these sources as this information can impact what we’re teaching our residents.