What led you to study medical education and advocacy?
"My personal opinion is that physicians are natural advocates and natural educators. But to be an effective advocate, you have to be a good educator—I think that there’s a lot that can be improved with both the medical education for students and the education physicians do with our patients. They are very transferrable skills.
"I think that physicians often lack the desire or knowledge to effectively advocate for their field or for their patients. I think we saw that in the health care reform law. Nobody’s quite happy with it. There are a lot of great pieces and also a lot of weaknesses, and I think part of the reason for that is that the key stakeholders, the physicians, didn’t stand up and have a unified voice on what they thought would really help the American health care system.
"For me the intersection of education and advocacy comes in the scholarly publications and literatures that physicians follow, hence our letters to the editors. Finding ways to get your voice heard in these sorts of publications allows you to get people thinking and really start a dialogue at both a local and national level about what needs to be changed."
What would you say is the biggest problem in medical education?
"Many would argue that medical education is behind the times because we’re not putting into practice what educators field have known for many years. I would argue that medical education, knowledge-wise, isn’t behind—it’s just the implementation that is behind.
"The way medical education is still done, students begin by receiving two years of preclinical science in the classroom. Even with team-based learning and problem-based modalities, students are still trained in a very pedagogical manner, a very top-down approach.
"They start at the dysfunctioning physiology and work their way back to how that manifests in the person. Then they get to third year and are expected to suddenly turn that on their head and start thinking and practicing in a radically different way. Patients do not come in complaining of misfiring neurons, they arrive with a headache and eye twitching. Those are just at odds with one another. We really have to train our students from Day One to be thinking in the way we need them to be thinking on the wards.
"We say that we need to be a competency driven field, to have flexible and asynchronous learning, yet we never actually see that implemented. So it’s excellent that the New England Journal is publishing pieces on making education more "sticky,” but until folks actually implement any of the things that they say, it really is meaningless. These things have been written for years; it’s a question of seeing something change."
What’s the biggest obstacle to creating that change?
"To me, it’s a question of resources. Academic health centers need to put resources toward education.
"It’s a costly endeavor to educate the next generation of physicians, but you have to put money toward faculty, faculty development and the educational experience. Otherwise it’s not ever going to be what we think and know it can be in terms of the quality of the education.
"One of the things that our NEJM letter talked about was that essentially anyone who graduates medical school is thought to be a teacher. That’s not necessarily true; there’s nowhere in medical school where people get formal training on how to be an effective teacher."
Until that change happens, how can individual physicians be better educators and advocates?
"One of the things that I think people lose track of sometimes is that, to be a good educator, you don’t have to have a specific set of skills and you don’t have to have training in education. To be a great educator, sure, you need to have that understanding of how adults learn, but to be a good educator—you just have to have passion.
"The people who are most enthusiastic about their teaching, they don’t necessarily get every lesson across or use competency-based education, they’re just excited about it. Often medical students are such high-level learners that if they see someone enthusiastic about something, they will take that enthusiasm and run with it and learn.
"The big deal is that teaching is not learning; understanding that difference is important for educators. If you think of yourself as an educator, you have to recognize that you can teach as much as you want but that does not translate to the learners getting anything out of it. Being mindful of that, and really facilitating learning rather than teaching, is the best thing that you can do."