The Troublesome Ethics of Entrepreneurship in Medical School Admissions

Medical school applications are becoming big business, and a rather troubling expression of supply and demand economics.

The “demand” side consists of the many thousands of young people in North America engaged in the highly competitive process of applying to the limited number of seats available at publicly subsidized Canadian and American schools. Rebecca Jozsa, our intrepid Admissions Officer and I recently explored the “supply” side by carrying out a simple Google search of options available to the assist the aspiring medical school applicant.

For MCAT preparation, we found no fewer than 22 available courses (probably an underestimate). The “MCAT Ultimate LiveOnline 123-hour” experience is offered multiple times per year for $2,199US. For those who prefer more intense and more personal preparations, the “MCAT Summer Immersion” experience can be had for $9,499US, not counting, of course transportation and accommodation. The “Most Comprehensive Prep Course in Canada” runs over 10 weeks, costs $2,195, comes with testimonials from satisfied customers and features both instruction by successful students and “unlimited free repeat policy”. There are many other choices, a veritable smorgasbord of choices.

One can also opt for more comprehensive guidance through the entire application process. One group provides the following offering: “With our flagship service, we offer unparalleled quality that will make your application to medical school stand out”. In addition to “MCAT prep”, clients can opt for any or all of “Online Diagnostic”, “Comprehensive Application Planning”, “Application Review”, “CASPer prep”, “Interview Crash Course”, “Interview Preparation”, and “MMI prep”. Costs, understandably, vary based on individual preference and perceived need, but appear to range from a few hundred dollars for individual components to more comprehensive packages such as the Platinum bundle which goes for $3500US. It’s hard to get all the details as to what’s available without engaging one of the friendly “consultants” for a “personalized needs analysis” (which we declined) but the sky appears to be the limit in terms of costs. Some arrangements even come with money-back guarantees!

It’s clear from the advertising that many of these programs employ, or are even operated by, medical students or recent grads. Who, after all, would be in a better position to provide the “inside information” so essential to success?

So, is all this a problem?

On the one hand, all this is perfectly legal free enterprise. It’s addressing a perceived need, clients are fully informed and fully competent, no one is forced to engage these processes unwillingly. It could be argued that these programs allow very worthy and genuinely motivated young people to pursue their dreams and overcome many of the unintentional barriers that we all would acknowledge are inherent in the admissions system. One could argue that medical schools themselves have given rise to these business opportunities by making the MCAT such an integral component of the admission process, while at the same time dropping basic science prerequisites.

On the other hand, one must also acknowledge a number of potential concerns:

  • The widespread availability of these services may force students to participate to simply not be disadvantaged relative to other applicants. It’s no understatement to say that candidates feel desperate for any advantage in the process. That desperation, it could be argued, is being exploited.
  • This intensive preparation and rehearsing for the various application processes may result in candidates portraying themselves in an unrealistic fashion, thus subverting a process fundamentally intended to ensure applicants are appropriately suited to a career in medicine. Such “mismatches” can be disservice to all, including the applicant themselves.
  • These services are obviously expensive, adding a further socioeconomic barrier to medical education, a problem widely acknowledged in both Canada and the United States.
  • The involvement of medical students, as paid consultants or instructors is troubling. Their recent experience with the details of application processes, including the structured interviews (for which most schools require them to sign a non-disclosure agreement) makes them attractive for this role, but also sets up an ethical dilemma: Can they undertake to help applicants navigate their interviews without sharing information or insights they have acquired as a result of their own experience? Even if specifics are not explicitly divulged, it’s hard to imagine that their recent intimate involvement in the process won’t find its way into their “counseling”.

All this provides lessons and demands reflection on a number of levels.

For the aspiring applicant, perhaps a word of caution. The principle of “caveat emptor” (let the buyer beware) very much applies. There is no accreditation or credentialing process for these offerings. Applicants may not be getting valid advice. I’ve heard anecdotally from students who have been advised to avoid expressing any personal opinions and instead memorize and regurgitate the prepared responses to anticipated questions. Admission committees and interviewers, searching for sincerity and deep commitment to a career in medicine, are astute assessors and have become very attuned to the “coached” candidate. They will become even more vigilant. The sincerity and true commitment they’re looking for tends to stand out, and is very difficult to artificially manufacture.

This entrepreneurial phenomenon should also cause medical admissions committees to reflect on their processes. One has to question the validity of the MCAT as an assessment of scientific aptitude if an “immersion experience” is truly effective in influencing test results. Do we believe a background or interest in basic science is an important applicant characteristic? If so, do we feel successfully undertaking an MCAT prep course meets that criterion?

For medical students, entering a profession that is self-regulatory and rightfully expects high levels of personal integrity and accountability, opportunities to become involved in these programs pose perhaps their first personal ethical dilemma. Clearly, what makes them attractive to these agencies is not their personal counseling or teaching skills, but rather their status as successful medical school applicants, which brings considerable cachet and intimate knowledge which is of high value. They will find (as they will as practicing physicians) that their professional identity can’t be easily separated from their personal lives, and therefore puts them in an ethically ambiguous position.

In our society, it seems supply will always be found when demand exists and sufficient resources are made available. That this has extended to the medical school admission process should come as no surprise. However, it does raise some unintended, but nonetheless concerning consequences. As always, your views on this issue are most welcome.

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

 

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Socrates, questioning and you

Socrates, Questioning and You: Revisiting the question of questioning

Happy 2016 all! Are you thinking about some educational resolutions? How about reflecting on how you question medical students, especially in a clinical setting?

When we last spoke in December, the topic was Socrates, “pimping” and teaching in medical education (http://meds.queensu.ca/blog/undergraduate/?p=2575).

I ended by saying I’d be back to talk about Socrates and questioning.  Well, I’m back…

We often use the term “Socratic questioning” but what does it mean? Socrates used questions as a way to teach, in that he questioned his students so that they would uncover truths for themselves.

socrates-statue

Six Types of Socratic Questions: Here below, are R. W. Paul’s six types of Socratic questions as a modern day interpretation. (There are now 8 types! I’ve combined a few. ) These are from several sources listed below.

What I love is that they are grouped by purpose. You’ll note that none of the less desirable purposes (humiliation, venting, anger, etc.) are present. I’ve put a star beside some of my particular favourites—perhaps you could do the same? Because, as you’ll see next, planning your questions (and that starts with types and purpose) is part of being a Socratic questioner.  Can you see how you could use these in your questioning?

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1. Questions for clarification:
  • What do you mean by?
  • How does this relate to x?
  • What is your main point?
  • Can you give me an example?*****!
  • What is the source of that idea or information?
  • Can you summarize what we discussed?
  • Jane, could you summarize what Wei just said? Wei, is that what you meant?*
  • Would you say more about___
2. Questions that probe purpose and assumptions:
  • What is the purpose of _______?
  • What are you assuming?*
  • How would you support your assumptions?
  • What could we assume instead?
  • How can you verify or disapprove that assumption?
3. Questions that probe reasons and evidence:
  • What did you observe?
  • What would be an example? ****
  • What evidence supports your hypothesis? What is it analogous to?
  • Is this good (or enough) evidence to believe this?
  • What is the cause?
  • How did you come to that conclusion?*
  • What do you think causes to happen…? Why?
  • Have you seen this pattern before?
4. Questions about Viewpoints and Perspectives:
  • What would be an alternative? *
  • How could you answer the objection that another group might make?*
  • What is another way to look at it? *
  • Would you explain why it is necessary or beneficial, and who benefits?
  • Why is the best?
  • What are the strengths and weaknesses of…?
  • How are…and …similar?
  • What is a counterargument for…?
5. Questions that probe implications and consequences, inferences and interpretations
  • What effect would that have?”
  • What generalizations can you make?
  • What are the consequences of that assumption? *
  • What does this remind you of?
  • What patterns have you seen?*
  • How are you interpreting her behaviour? Is there a more logical inference?
  • What have you left out?*
  • How did you reach that conclusion?
  • How does…affect…?
  • How does…tie in with what we learned before?
  • What do you predict will happen next?
6. Questions about the question: (especially if the students are struggling…)
  • How can we find out?
  • Is this the same issue as ___?
  • Can we break this question down?*
  • What was the point of this question?
  • Why do you think I asked this question?*
  • What does…mean? Was the question clear?
  • How does…apply to everyday life?
  • What does this question assume?
  • Why is this question important? *

TIP 1: Try to pose questions that are more meaningful than those a Weekly-Tips-Imagenovice of a given topic might develop on his or her own.

TIP 2: Start with key answers you hope students will give–in other words the key teaching points of the session.

TIP 3: Phrase 3 key questions.

TIP 4:  Use some of the above questions to fill out your Socratic roster.

Are you a “Socratic Teacher?” The teacher who uses the Socratic method is looking for “systematicity”, “depth”, and has a keen interest in assessing the truth or plausibility of things.Close-up-of-Socrates

Strategies:

  1. Model critical thinking
  2. Respects students’ viewpoints,
  3. Probe their understanding,
  4. Show genuine interest in their thinking.
  5. Helps students feel challenged, yet comfortable in answering questions honestly and fully in front of their peers.

Implementing Socratic Questioning in your clinical (or classroom or seminar) setting. Try some of these strategies to build a positive questioning climate bedside rounds

  1. Distinguish upfront between Socratic Questioning and “Hounding”. Ask students to bear with you while you ask keep asking questions as soon as they have answered and tell them why. Let them know this is your educational approach and that there are no ulterior purposes such as humiliation. In other words, set the climate for this kind of questioning by being explicit with students right from the start.
  2. Not all questions have a single “right” answer. Prepare students for the difficult position of having to determine which is most right…sorting through the grey areas, and being wrong, at least first time around.
  3. Set some ground rules: If a case coming up for rounds is an important case (and it’s helpful if you can identify important cases, as medical students may not be able to), it’s fair game, and students are expected to “read around” that case.
  4. You DO ask questions of individual students (but you don’t center out students): Let students know that you will be asking individual students questions as well as asking for volunteers. However, like Socrates did, it’s helpful to have the group help. It’s all in the way you phrase it: “I can see you’re stuck—you’ve done well to get us to this point. Is there someone who can take us to the next question?”
  5. Mature student responses for when they’re stuck: To create the “safe climate for questioning,” students should have mature answers for not knowing an answer that you are willing to accept:
  • Student A. “That’s as far as I can go from my reading, Dr. Z___.”
  • Student B. “In my reading, the ____was the most likely diagnosis. Can you help me with this?” (Don’t be fooled into giving an answer—Socrates would just keep asking questions to get at a deeper concept.)
  • Student C: “I think I do need to call a friend.”
  • Student D:“I didn’t do the reading, Dr. B___I apologize and I’ll pick up tonight.” (However, if this latter student keeps giving this answer, then it’s moved to scholar and professional competencies and you have to switch from Socrates to assessment, and they need to explain what’s going on.)

OR…explain to students what answers you will accept.

It’s important to teach students to acknowledge shortcomings and to motivate them to correct these. It’s also important to give them the language to respond to questions and to accept it.

6. If there is a problem: If the questioner is disturbed by a learner’s diff feedbackpreparation, attitude, or any other issue, humiliation in front of a peer group, or a near peer group is not recommended in any circumstance.  Rather, discussion, with feedback, follow-up and tracking with that student should be conducted separately, apart from the rest of the group. (I know…it’s time-consuming.  But it’s better for the learner and for the teacher.)

7. Forge a relationship on mutual respect, and allow the learner to question the questioner, and to ask for clarification and where to go to learn more.

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Do you agree with these strategies? What do you like about the 6 types of questions? Will I ever stop asking questions? 🙂question upside down

Feel free to write back with your questions or answers about questions.

Sources

How to Use Socratic Questions: http://serc.carleton.edu/introgeo/socratic/fourth.html

Kost, A & Chen,F.M. (2015). Socrates Was Not a Pimp: Changing the Paradigm of Questioning in Medical Education. Acad Med. 2015; 90:20–24.

The role of Socratic Questioning in Thinking, Teaching and Learning
Socratic Questions: http://changingminds.org/techniques/questioning/socratic_questions.htm

The Six Types of Socratic Questions http://www.umich.edu/~elements/5e/probsolv/strategy/cthinking.htm

Schumacher DJ, Bria C, Frohna JG. The quest oward unsupervised practice: Promoting autonomy, not independence. JAMA. 2013; 310: 2613–2614.

Tredway, L. (1995). “Socratic Seminars: Engaging Students in Intellectual Discourse.” Educational Leadership. 53 (1).

 

 

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The Art and Science of Medicine – a critical but troubled marriage

“I always feel better after talking to the doctor.”

The first time I recall hearing this statement, it was many years ago, spoken by an elderly lady emerging from the inner office of our family physician. I also recall it leaving me me a little confused, and a little intrigued.

Dr. Mitchell practiced in Collingwood for many years and looked after any malady that might befall members of my family. I was waiting to get my biweekly “allergy shot” (another story). With Dr. Mitchell, you didn’t really have an appointment; you just showed up and read magazines until called. No one ever complained. There seemed to be acceptance that the order was based on some greater principle than “first come, first served”. As I was leafing through a New Yorker searching for the cartoons, I overheard the lady make that statement to her waiting husband as they got ready to leave. I wasn’t really eavesdropping; she seemed to intend the comment for everyone in the room. She’d been in there only a few minutes. She entered clearly worried and upset. She emerged looking considerably relieved and energized.

What, I wondered, had happened in there? Clearly, there had been no time for any treatment to have been administered, let alone take effect. All he could have done was talk to her. And yet, she was better. She was relieved. She was grateful. Whatever happened was effective and made a difference to her. Some talking! I was intrigued, and whatever process eventually led to my decision to consider a career in Medicine probably started, or was at least advanced, that day.

I’ve since heard variations of that statement many times. During medical school and residency I heard it applied by patients to many of the excellent physicians I had opportunity to train with over the years. I heard it applied to many of the highly skilled colleagues I’ve worked with. I consider it to be one of the simplest but also purest ways patients can acknowledge the effectiveness of their encounters with their physician. Simply put, they feel better afterward than they did before.

This ability is not the exclusive domain of physicians. People emerge everyday from their encounters with nurses, therapists, pharmacists with similar feelings of well being and renewed energy.

What’s going on?

To the skeptical, this could be dismissed as some sort of placebo effect, a psychological delusion or defense mechanism that those desperate for help construct for themselves in order to deal with their malady. After all, no concrete intervention has occurred. No pathophysiologic process has been medically or surgically influenced. It doesn’t really make logical sense.

On the other hand, it doesn’t always work, and we’re all aware that making the correct diagnoses and applying appropriate therapy can often be inexplicably ineffective. Patients tell us repeatedly how frustrated and abandoned they feel after encounters where they’re told “everything’s fine”, or “take this medication and you’ll be fine” but are unconvinced, and feel no better afterward. Moreover, sound recommendations may be completely ignored by patients, leaving their doctors baffled, or perhaps never even knowing and therefore content in the false knowledge of a job well done.

All this relates, of course, to the fundamental and critical duality of the physician role – what we’ve come to regard as the “art” and the “science” of Medicine. It’s been appreciated since ancient times that, in order to be effective, physicians must combine their knowledge of medical science with personal qualities and skills that provide and promote a human relationship, a personal link with their patients, and it’s in the context of that relationship (and only in that context) that scientific therapies are effectively applied.

The importance of these humanistic “healing arts” has been well described.

Hippocrates is credited with the aphorism “it is more important to know what sort of person has a disease than to know what sort of disease a person has.”

William Osler is famously quoted as proclaiming, “the good physician treats the disease, the great physician treats the patient who has the disease”.

Abraham Flexner, the non-physician educator who so profoundly transformed medical schools in the early 20th century is famous for championing the inclusion of fundamental science in medical education. He’s less well known for his views on what were termed the “empiric” aspects. The following is taken from his 1910 report:

“The practitioner deals with facts of two categories. Chemistry, physics, biology, enable him to apprehend one set; he needs a different…appreciative apparatus to deal with the other, more subtle elements. Specific preparation in this direction is more difficult; one must rely for the requisite insight and sympathy on a varied and enlarging cultural experience. Such enlargement of the physician’s horizon is otherwise important, for scientific process has greatly modified his ethical responsibility.”1

It’s interesting that 15 years later he tried to correct what he perceived to be an over-emphasis on his recommendations regarding science and technology. The following is taken from Medical Education: A Comparative Study (1925):

“In respect to the position I have thus far taken, a curious misapprehension not uncommonly arises. The careful scrutiny, reflection, and decision (which is the essence of the scientific method), the employment of every weapon by means of which the causation of disease may be ferreted out and health restored (which is the essence of the scientific procedure) – these are sometimes regarded as in conflict with the humanity which should characterize the physician in the presence of suffering. Assuredly, humanity and empiricism are not identical; with equal assurance, one may assert that humanity and science are not contradictory…It is equally important and equally possible for physicians of all types to be humane, and at the same time to employ the severest intellectual effort that they are severally capable of putting forth…The art of noble behaviour is thus not inconsistent with the practice of scientific method”2

The late Bernadine Healy, prominent American physician, academic leader and former head of the NIH, spoke eloquently on this subject and is perhaps more pragmatic: “the art of medicine transcends all else when an anxious individual confronting death or disability looks to the physician and asks, ‘What’s right for me?’” In an excellent article on the subject, she goes on to describe four key components: Mastery, Individuality, Humanity and Morality. Her description of Mastery seems particularly apt: “expertise, not just experience; wisdom more than knowledge; and a creative way of thinking, ever alert to the reality that sickness is not as obvious as it seems.”3

It would seem that the importance of maintaining the “art” as we engage the ever expanding “science” of medicine is critical and fundamental to effective practice. It is what elevates the profession beyond the simple application of remedies or technical interventions. It is, to be more pragmatic, what the public expects, and what it feels it is paying for. It is also what makes the teaching and learning of medicine so very challenging. Knowledge, these days, is easily within our grasp. Technical skill comes to the appropriately skilled with dedication and practice. The ability to understand patients as individuals, establish relationships of trust, and apply treatments with sage wisdom are all much more difficult to identify in applicants, to teach and to assess.

At this point in our history, it seems we’re at a critical juncture. Our dual roles appear to be heading in opposite trajectories. Medical science is in unprecedented ascendency. In virtually every discipline, new and highly effective therapies are available. Conditions previously untreatable are being cured or at least improved. People are living longer and better. All this is wonderful. At the same time, we have many indications that the “art”, the humanistic components of medicine, are under threat and in decline.

The threats are both multidimensional and unintentional.

Time pressure. I know no physician who doesn’t feel under over-extended and under pressure to do more in less time. The provision of “timely”, “efficient” and “cost effective” care has become the paramount objective. Although this may seem necessary and even noble, the result is that our clinics, emergency departments, hospital wards, procedural units, are all under intense pressure to deal with high volumes expeditiously. We fall back on corporate, business- based approaches to deal with these practical issues. It becomes easy to forget that those “high volumes” are individual people experiencing what they perceive to be a time of great personal crisis. They often do not feel the centre of care, but rather something more akin to components on an assembly line. It’s not all bad – necessary care is provided, conditions are treated and usually resolved. But patients too often emerge wondering what happened, and even who was treating them.

The harsh reality is that the medical/technical aspects of care are more easily and more efficiently applied devoid of the need for interpersonal interaction. In our multidisciplinary and team based approach, compassion can come to be regarded as a delegated act.

The primacy of therapeutics over diagnostics. The practice of medicine has gradually and unceremoniously shifted over the past several decades from a largely diagnostic to therapeutic endeavor. This is a function of the greatly expanding therapeutic options, medical, interventional and surgical, now available for many conditions previously not treatable. In addition, many diagnostic tests and procedures are now available that can establish a diagnosis with a minimum of historical information. This is all obviously good, to the benefit of our patients and society at large. However, a consequence of this change is that the communication skills, personal contact and relationships required ferreting out a useful history and differential diagnosis is a less prominent, less essential physician skill, particularly in procedurally heavy specialties. Conditions previously diagnosed by historical and physical examination features alone are now established (even defined) on the basis of laboratory or imaging studies. This may have advantages in terms of time required and objectivity, but the “art” of establishing a diagnosis through insightful questioning and insight (still essential in all but completely straightforward situations) is gradually being eroded and, with it, the necessary human interaction.

Specialization. The dramatic expansion of knowledge and therapeutic options has required physicians to specialize in specific applications of medical service. Medical school graduates in Canada currently select between about 30 entry disciplines, many of which branch further resulting in well over a hundred very different practice options. This, again, is a function of our success and provides advanced, effective service to patients. However, a consequence of this specialization is that, for many physicians, their engagement of patients is exclusively in the context of a very specific, often predetermined, service. The need to establish that interpersonal connection may not be seen as necessary or welcome and, amazingly, may even be seen to be inappropriate to the encounter. This has important consequences. Patients are at risk of being deprived of individual consideration during these encounters. Perhaps more profoundly, the practice of medicine is finding a home for individuals who are unable, or unwilling, to engage the humanistic aspects. In essence, what was previously requisite is becoming optional.

Our award system. In terms of both prestige and monetary compensation, we clearly value situational, specialized technical or procedural expertise over primary patient contact and continuing care. We may value the art and science equally from a theoretical perspective, but our practical choice is very clear. Our learners and young physicians, both astute and aware, are faced with unbalanced choices.

Medical school admissions and curricula. Despite decisions and efforts to make medical education more broadly available to individuals with backgrounds and interests in the broader human experience, it remains largely the domain of those with scientific backgrounds. In fact, pre-medical courses in the humanities are seen as disadvantageous to potential admission since they generally provide much lower marks than science or math courses. Medical school curricula themselves are very much, and understandably, directed to knowledge and skill acquisition, and increasingly to career exploration. The “arts” are simply being squeezed.

These issues, although rather daunting, are nonetheless individually approachable and our profession lacks neither the imagination nor capacity to approach them. However, this brings us to the most significant issue of all. Do we see this as a problem? Is the gradual erosion of humanism within the practice of medicine a threat we must marshal our efforts to reverse, or do we see it as a natural evolutionary change, a natural consequence of how medicine and health care in general must adapt to a vastly expanding base of interest and the resource constraints we’re all only too familiar with? Are those who raise these concerns simply pining nostalgically for a bygone era?

In posing this question, I recognize that my contemporaries and I are not the ones who must provide the answer and necessary commitment to change. It is, in fact, our students and young colleagues who will face this choice and determine the direction of our profession. They will need to consider what’s left without the humanistic “art” of medicine, how it will be regarded by their patients, and how it will be valued by society. The choice is perhaps best summarized by Thomas Lewis, a former medical school Dean and frequent essayist and writer, who wrote:

“The uniquely subtle, personal relationship has roots that go back into the beginnings of medicine’s history and need preserving. To do it right has never been easy; it takes the best of doctors, the best of friends. Once lost, even for as short a time as one generation, it may be too difficult a task to bring it back again. If I were a medical student or intern, just getting ready to begin, I would be more worried about this aspect of my future than anything else. I would be apprehensive that my real job, caring for sick people, might soon be taken away, leaving me with the quite different occupation of looking after machines. I would be figuring out ways to keep this from happening.”4

So, does your patient feel better after seeing you?

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

  1. Medical Education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching. Abraham Flexner. Arno Press &The New York Times. New York. 1910. Page 26.
  2. Medical Education: A Comparative Study. Abraham Flexner. The MacMillan Company. New York. 1925. Page9-10:
  3. http://www.cbsnews.com/news/medicine-the-art/
  4. The Youngest Science: Notes of a Medicine Watcher. Thomas Lewis. Alfred P. Sloan Foundation Series.1983.

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Year in Review? Why wait until then?

When I worked as a journalist (about a million years ago), an annual task was writing “Year in Review” articles. These were summary or “round up” stories with the highlights of the previous year.

The stated intent was historical record, reminders and reminiscing; marking highs and lows, significant events and momentous occasions. On a more practical level, these stories could be compiled fairly easily, mostly in advance, and take up copious column inches in our weekly paper in the week between Christmas and New Year’s when nobody was reading anyway and the editorial staff wanted to take extra time off from covering newer news. Closely tied to these were “Resolutions You Should Make Now!” advice columns.

With this cultural backdrop assigning retrospection to the turn of the year, it’s easy to become cynical about such things—and reduce thoughtful review to top-ten lists and cliché-ridden commentary. For educators, however, the importance of review should not be treated so lightly. Review and reflection are important. We expect our learners to do it. Educators should give it just as much attention.

Review and reflection are integral to effective teaching practice. January is a great time for this, but so is June, or September, or some other month. Right now, for some, a semester has recently ended, for others, it’s just beginning. There are benefits to both retroactive and proactive review – and in doing it more frequently than an annual check-mark on a to-do list.

So, instead of a ‘year in review’ summary, or even a list of new year’s resolutions for medical education, here’s a sample framework for incorporating review into your teaching practice. (Use it annually, or more often, as needed).

Theresa’s Five Step Review and Revise Process

Step 1: Review & Reflect

Whether you’re considering a whole course, a few teaching sessions, or a single seminar or other learning event the process is the same. Consider:

  • What happened? What worked? What didn’t? (If you’re forecasting: What could be some pitfalls? What am I worried about?)
  • For anything that didn’t go well, or didn’t accomplish what I planned: How can I fix it? (Forecasting: Do I have a back-up plan? Do I need one?)
  • What’s a manageable change? Do I have the knowledge, skills and ability to do this? Where can I get support and/or resources? (Forecasting: Do I have the resources I need? What kind of feedback could be helpful to me on my teaching sessions?)

 Step 2: Reconsider7916463

Once you’ve reflected on what’s happened, or what you have planned, consider:

  • Did I meet my objectives (or will my plan meet my objectives)?
  • Are there things I did (or I’m planning) that are just out of habit?
  • What should I change to make my course/session/seminar more engaging/relevant/appropriate?

 Step 3: Find Resources

When you revise your teaching plans, you may also need additional resources. This could be in the form of your own skills, materials, input from colleagues. Consider:

  • What support do I need to get to where I’d like to be?
  • Do I have the abilities to do what I plan? If not, how could I acquire the necessary skills?
  • Are there existing materials that could help me? Do I need to develop new materials? Who could help with that?
  • Who could I call on for support or assistance?
  • What sort of time frame do I have?

 Step 4: Refine your plan

Evauluation ChecklistSometimes, what we’d like to do just isn’t in the cards this year—there can be a lot of constraints on our teaching in time, materials, scheduling. It’s important to refine revisions into things that are manageable and realistic. Sometimes you are in a position to make large-scale changes to how you deliver your learning events, other times, not. Avoid the “all-or-nothing” plan: Incremental changes are better than no changes. It’s better to be good, than to be perfect. Consider:

  • How realistic is my plan?
  • Are there things I consider “must haves” and things that are “nice to haves”?
  • If I could only make one change in my teaching right now, what would it be?

 Step 5: Reflect & Review

At the end (or the beginning) – take another look. Good teaching really is an iterative process with the cycle of review, revision, redeliver.

Sometimes the best way to review and reflect (and plan) is to talk it out with a colleague. Bouncing around ideas can bring new perspectives and inspire you and others to add to your teaching toolbox. If you’d like to chat about your teaching any time, get in touch with the Education Team.

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