My undergraduate education was enlivened by a number of professors who were fond of taking rather unconventional points of view, many of which would be considered “politically incorrect” in today’s parlance. They were even fonder of defending those perspectives with spirited and colourful debate. Perhaps the leading proponent of this approach was Dr. Tony Travill, professor of Anatomy, who would spend more of his curricular time discussing points of professional practice and social foibles than the assigned topics of embryology or anatomy. On the rare occasion that one of us mustered the temerity to point this out, he would make the rather emphatic point that “universities aren’t centres of teaching, they’re centres of learning”. The message was clear – it wasn’t his business to teach so much as it was our responsibility to learn. Our goal should be to learn for the benefit of our future patients, not simply to satisfy curricular goals. I recognize in retrospect that his not-to-subtle shift of emphasis helped us to transition from being passive consumers of information to what today’s educational theorists would term “active learners”, although we had no idea this was happening at the time.
Turing our attention to the present, one of our 2015 students, Eve Purdy, spoke eloquently at the recent Celebration of Teaching Day of how she addressed her interest in the process of clinical decision-making. She searched the internet and came upon a free web-based seminar series from the University of California (San Francisco) that she accessed over several weeks and found quite useful. She shared the information with others, both students and faculty who also made use of this resource. As teaching faculty, we should take considerable comfort in the fact that our students are, on their own, seeking opportunities to advance their learning, often going beyond the baseline requirements of our curriculum.
In fact, our students make use of a wide variety of unstructured learning opportunities in addition to standard curricular offerings such as Courses, Integrated Learning Streams, various types of Small Group Learning, clinical rotations and assigned projects.
Last academic year, about 20 Student Interest Groups were active, each developing a series of at least 8 learning sessions outside standard curricular time that were devoted to a particular discipline or theme. Although supported by faculty on a voluntary basis, students developed the themes and content of these sessions. The following is a list of some of the groups that were active this past academic year:
In addition, our students informally access the world of information available to them through the internet and social media. A world of information is literally at their fingertips, and they make use of this almost continuously, both to search information and to dialogue with each other, with faculty (sometime during lectures), and people farther afield. The challenge is not access, but rather discernment of relative value.
Perhaps the most powerful non-curricular learning experience our students engage is what’s been termed the Hidden Curriculum. This term refers to all of the unintentional but incredibly powerful messaging that occurs in the context of their environment and clinical experiences. Observing a respectful and effective interaction between an attending physician and nursing staff provides a much more effective and durable lesson than hours of formal teaching on the topic of professionalism.
The challenge for teaching faculty in the midst of all this is to keep pace what’s happening around us, and to shift our focus from delivering content to guiding the learning process. To borrow an old adage – we can’t control the wind, we can only set our sails. In this environment, it becomes more important to set the objectives and provide direction than to attempt to rigidly control the process.
And so, as the song says “Everything old is new again” when it comes to student directed learning in medical education, although technical advances and connectivity expand the potential (and our challenge) tremendously. I like to think Dr. Travill would be amused.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education