slightlymoving

in medicine, there’s an incredibly embedded hierarchy and tradition that often means teaching methods are slow to change and knowledge acquisition is, in some ways, made a goal in and of itself. part of this system involves memorising long lists… of conditions, side effects, drugs, outcomes, risks, limitations, benefits, statistics, anatomical features… to name a few. some of these lists are useful and are worth having at immediate recall - but many of them are almost pointless to remember because of the detail, the lack of use, and the utility of them.

recently, at a grand rounds presentation, a young fresh-out-of-medical-school intern condescended half the audience by stating he was dropping the topic down to medical student level and briefly discussed the mechanism of action of steroids. he then proceeded to ask each student present to name one side effect of steroid. i think i was about 6th in line and when it came to me i couldn’t think of anything, so i said so. it caused a little uproar in the room, which was fascinating in a number of different ways.

firstly, there were a few encouragers, suggesting that i did know more side effects and could think of one. there was a call for nudging my neighbour to get a whispered answer - accompanied by some whispered answers. there was a scornful call of that’s just not good enough. and finally a plaintive voice saying it was important to know as it will be on the exams and you’ll get asked a lot as an intern.

amazing really, to get such a varied and active response.

for me though, it highlighted some of the things that concern me about medical education and the lack of thought behind such methods for consolidating knowledge. the assumption here is that the intern was attempting to help us learn and not simply assert a knowledge hierarchy - and i’d like to give him the benefit of doubt.

the main concern for me is about equating immediate recall with knowledge. if you can answer a question with a list then you show you know something - when of course, that’s not necessarily the case at all. i often see some students reeling off a list in answer to a question but most of the list having absolutely nothing to do with the situation at hand. i suppose it comes down to ways of thinking and working. a computer might be good at processing through lists to determine appropriate choices according to set criteria - but most humans are not. the best clinicians i see are attentive to their patients so that when they give them steroids, for example, they don’t reel off a long list of possible side effects (mind the buffalo hump won’t you) but engage with the patient about observing changes and symptoms.

a list will always be written down in a book. or on your iphone. or on wiki.

there’s more to this post but i’m a bit tired after that effort…