Recent reports have addressed weaknesses and gaps in medical education in both Canada and the United States. A list of recommendations from the reports is provided in the article along with the author's description of the changes in the curriculum.
The author states there is a drive towards guided self-assessment with "continuous formative assessment and feedback in practice." There's going to be a new outlook on the lifelong learner and exploration on the specifics of external and internal assessments. The argument towards an outcome based model, as the time based model weakens, is about "increasing efficiency, shortening training time, and reducing the overall cost of medical education." Interesting enough this past summer New York University announced that it will offer a 3 year curriculum to a small number of medical students. It reassures no loss of quality, lower cost, and efficiency in production. The YouTube talk below by Dr. Thomas Talbot on “Designing Medical Education for Today’s Brains” also calls for more effective ways of teaching the medical student with the help of simulation, technology, frequent testing, and emphasis on relevant material.
The solution?Outcome-Based Adapted to Individuals:
Swimming the Length of the Pool
The author offers his recommendation in which the outcome-based training is adapted to the needs of the learner until the outcome is achieved in which time might be more of a variable. "This form of competence, what ten Cate has called entrustable professional acts , requires evidence of performance in real settings." The emphasis is not placed on what the learner has the potential to do, but rather on actually doing.
Another important characteristic noted by the author is that currently medical education places too much emphasis on what each individual does but the actual practice of medicine takes place in a team setting. See "Collective Competence" TEDTalk below by Dr. Lorelei Lingard (H/T Dr. Cunningham for the link) in which she talks about having competent individuals creating incompetent teams when they come together. For further reading on teamwork read Dr. Body's ( @richardbody ) stemlynsblog.org post .
Ultimately, the author envisions a model that will reduce training time and cost while at the same time being flexible and individualized. It will tolerate ambiguity; handle complexity; and foster curiosity, innovation, and lifelong learning. The appropriate setting will be one in which there will be coaching , a closer teacher-student relationship, a curriculum rich in practice and feedback , continuous formative assessment , and a stepwise, developmental approach. The new hybrid model would be very time and resource intensive for the educator, because the system will go from a "see one, do one, teach one" model to a “watch until you are ready to try, then practice in simulation until you are ready to perform with real patients, then perform repeatedly under supervision until you are ready to practice independently." The author states implementing these new recommendations will be quite complex for the students, the educators, and the educational system. Fundamentally, he suggests keeping characteristics that work in the time-based model while adopting the best practices from the outcome based model.
Hodges BD. A tea-steeping or i-Doc model for medical education? Acad Med. 2010 Sep;85(9 Suppl):S34-44. Pubmed .
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