Despite many recent technological advances, the convenience of lecture-based teaching has remained the norm in higher education settings, including medical education. Following this one-size-fits-all approach does not prepare medical students for real life clinical situations as they enter the healthcare arena. The explosion of medical information has made “coverage” of all foundational knowledge an impossibility. Thus, medical schools must prepare future professionals to become self-correcting learners by engaging them in a learning environment that encourages life-long learning, reasoning, divergent thinking, problem solving, and peer and continuous self-review. It is these futuristic skillsets that will enhance their decision-making when dealing with medical problems associated with the management of patients. In this chapter, the authors will discuss the utilization of the CGScholar platform, a self-and peer-review multimodal communication software program which facilitates most of these futuristic requisite learning strategies to improve medical education.
TopIntroduction: Trends And Needs In Medical, Veterinary, And Paramedical Education
The educational needs of medical education, long patterned after the Flexner Report of 1910 for medical schools, has been slowly changing (Flexner, 1910). Its author Abraham Flexner, was a high school teacher and brother of physician Simon Flexner. The ideal faculty in this educational model were physician-scientists with a heavy focus on the creation of medical information (Duffy,2011). This focus that has led to many advances in medicine, but time and research hyper-specialization has moved many medical educators further from the realities of the clinic, a conundrum first recognized by physician William Osler who bemoaned shortly after the Flexner Report that “teacher and student chased each other down the fascinating road of research, forgetful of those wider interests to which a hospital must minister” (Chesney, 1963).
From a curricular standpoint, the medical educational process was divided into “pre-clinical” or “basic science” phases and “clinical” phases with the latter initially being limited to a single final year of a curriculum, only more recently being extended in most medical schools to 2 years and most veterinary schools to 15 months or more. Lectures became the most efficient mode of “transfer” of medical knowledge to the budding medical professional, without consideration of long-term retention other than the ability to pass mid- and/or end-of-program licensure examinations. Most medical professional programs, including those for nurses, dentists, and veterinarians, were modeled after these two distinct and often non-interlacing pathways of the medical curriculum. And, in the 20th century, this mimicry made some sense as the basic science underpinning these medical and paramedical professions is quite similar.
To this day, however, despite having more information at our fingertips via the Internet, most medical curricula continue to focus on the content of instruction and less on the process of critical clinical thinking. Mukherjee (2015) describes his training as a physician: “The profusion of facts obscured a deeper and more significant problem: the reconciliation between knowledge (certain, fixed, perfect, concrete) and clinical wisdom (uncertain, fluid, imperfect, abstract)” (Mukherjee, 2015; Benner et al., 2008). In addition, science educators in general have begun to support greater amounts of instructor and peer classroom discussion time focused on application of knowledge learned (Bloom et al., 1956).
So what has changed that requires a different approach to medical and veterinary education?
Exponential Growth of Basic Medical Knowledge
No longer is it possible to “cover” with traditional lectures all foundational knowledge in a medical curriculum, no less to expect understanding and long-term retention by the learner. To give some perspective, when one of the authors (DF) graduated from veterinary school over 40 years ago, it was estimated that medical knowledge doubled approximately every 7 years. In 2020, it was estimated to double every 0.2 years, or less than once a semester! Put another way, the content of the first 3 years of a medical professional program constitutes only 6% of what is known by the time a student graduates a year later (Densen, 2011). Therefore, the medical educator’s task has changed to imbuing the medical or veterinary student with skills to function as a self-regulated continuous learner understanding the basics of evidence-based medicine (EBM). The term “self-regulated learning” (SRL) has been applied to the process. A clear continuum must exist between medical education and continuing medical education with the clinician self-identifying their own knowledge and skill deficits.