Innovation rarely happens from within…

I was thrilled to recently hear from colleague and friend Neil Mehta, MBBS, MS from Cleveland Clinic Lerner College of Medicine that he was about to publish a “Perspective” piece in the journal Academic Medicine.

I have known Neil for some time and have had the pleasure of collaborating with him as a faculty member and as a learner (we engage quite frequently through Twitter chats: @Neil_Mehta), so it came as no surprise to me that he sees the world in much the same way I do. Neil was kind enough to send me his article – the abstract can be found here – for review.

Before I offer my comments on his work, first let me share the key elements of his perspective:

To advance solutions, the authors review innovations that are disrupting higher education and describe a vision for using these to create a new model for competency-based, learner-centered medical education that can better meet the needs of the health care system while adhering to the spirit of the above proposals. These innovations include:

1. collaboration amongst medical schools to develop massive open online courses for didactic content;
2. faculty working in small groups to leverage this online content in a “flipped-classroom” model; and
3. digital badges for credentialing entrustable professional activities over the continuum of learning.

In many ways the ideas that Neil presents are perfectly aligned with those I describe in #socialQI: Simple Solutions for Improving Your Healthcare (see Chapter 9) and those I have written about in my Medical Meetings article from 2011, “Re-engineering the Data Stream from Meetings to Medical Practices” – though Neil does provide a bit more detail.

Neil begins by articulating the problem, and he pulls no punches:

A stark inventory of the shortcomings of the current model of medical education includes inefficiency, inflexibility, and lack of learner-centeredness. Current teaching models often depend on arcane assessment methods (e.g., multiplechoice examinations), and learning often focuses on test performance rather than developing professional competencies. Students’ grades in basic science courses and on clinical rotations, though a key factor in their selection for residency training, may not be based on direct observation or assessment of knowledge application and problem-solving ability. Thus, these grades likely do not reflect true skills, behaviors, and attributes needed to be an effective physician…basic science faculty face increasing pressure to obtain research funding in a highly competitive environment with declining funding resources. Productivity pressures limit clinical faculty members’ teaching time. Providing small-group instruction in either area is challenged by financial constraints on faculty growth.

And, Neil introduces this community to any number of models to learn from and adopt.

…the Khan Academy started in 2006 as a series of short YouTube videos created by an individual with a laptop and an Internet connection. Since then, the Khan Academy has grown into a series of over 3,300 video lessons that cover K–12 topics. Over 180 million lessons have been delivered to date. The site offers practice tests for skill building and resources for teachers to monitor their students’ progress and intervene if students get stuck.

 

…the concept of massive open online courses (MOOCs) was popularized by a group of learning researchers when a course on “Connectivism and Connected Knowledge” in 2008 attracted over 2,300 worldwide participants. The model of this MOOC was based on learners generating content by working collaboratively in social networks.

 

…previous generations of learning management systems faltered because they focused more on tracking and managing instruction and content, these new systems are student-centered …They aim to promote active, retrieval-based learning; customized feedback based on analysis of vast amounts of data created by students’ performance; real-time collaboration; and peer learning while also creating an experience mimicking one-on-one tutoring.

 

Badges encode metadata containing information such as the badge recipient’s name, the institution (or individual) awarding the badge, information about the endorser (i.e., the organization that certifies or approves the badge or the badge provider), information about what the recipient had to do to get the badge, and evidence that the recipient met the criteria to earn the badge. Thus, digital badges can provide concrete evidence of skills, achievements, and qualities in a more granular manner than traditional grades and degrees.

How can these movements help solve the resource problems facing medical education today? We could develop a central online collaborative learning environment for didactics, peer learning, and assessment of knowledge, instead of multiple medical schools teaching the same content at multiple sites. We could ensure multidisciplinary collaboration by building communities of learning. The vast numbers of students in these MOOCs would ensure that they would always have other students online at the same time helping to build a virtual, and most likely multidisciplinary, collaborative environment…Such a virtual  learning environment would help build an interprofessional community of practice that could lead to improved communication and collaboration in a team-based practice model of the future.

And perhaps the solution I like the most:

Students would be provided a list of knowledge, skills, attitudes, and behaviors that are required to demonstrate knowledge and mastery of skills at different levels through medical school and for graduation. Students could choose their badge providers and schedule their advancement through the curriculum guided by the parameters set by the medical school and ultimately by the accreditation bodies. Students could create custom paths for progressing through and augmenting their training…In this process, badges can be used to capture learning across the continuum of medical education and potentially enable tracking for the purpose of maintenance of licensure….No longer will a limited number of medical schools or faculty constrain our ability to educate medical students. Learning communities will form naturally, and students will need to take ownership of their education.

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To be clear, having spent years arguing the strengths and weaknesses of Khan Academy or ‘flipped’ classroom or MOOCs…I believe wholeheartedly that the current renditions for these models will NOT be the silver bullet we need in medical education – they are, more often than not, pedagologically unsound and, in ways, short-sighted in their innovation. But the innovations are fundamentally better than what we have today…and this is the point that Neil makes. Neil glances out at the what is happening in other realms of education and seems to see the opportunity that far too few see, flaws and all.

What is most impressive is that this vision of what may be comes from inside the house of medicine, and rarely do the problem and the solution arise from the same source. While Neil may not be your average clinician, and he is certainly not your average educator, he is by all accounts an ‘insider’ and a ‘champion of innovation.’ With this in mind, as I read his work I was left with one slightly derivative but all-too-critical question: ‘how do we ensure that more clinician educators think the way Neil thinks?’ Because it is unlikely that we will ever overcome the challenges that plague medical education (or healthcare more broadly) without ensuring that more clinician educators teach the way Neil wants us all to teach…

Let me know what you think?

Brian