Teaching How to Learn

HMS faculty prepares for curriculum reform

Faculty members learn about how to teach lifelong learning at Medical Education Day 2013 in anticipation of pending curriculum reform. Image: Steve Lipofsky

Medicine is a constantly changing field. With each passing year, new diseases and treatments continue to be discovered, and some of what has been "known" in medicine is proven wrong.

Doctors must keep their knowledge and skills up to date after completing medical school and clinical training, educators say, but many often lack access to the training necessary to identify learning needs or craft plans to fill knowledge gaps on their own.

"We want students to develop skills and habits of mind that encourage lifelong, self-directed learning, but we don't do a lot to prepare them for that," said Richard Schwartzstein, director of the Academy at Harvard Medical School and Ellen and Melvin Gordon Professor of Medical Education at Beth Israel Deaconess Medical Center.

Citing a growing body of evidence, education leaders at Harvard Medical School said at Medical Education Day 2013 that the issue will be addressed by shifting the focus of HMS's standard medical education curriculum from simply transferring factual knowledge to students to fostering more independent learning and problem solving.

That, in turn, means faculty members must develop new skills to help transform medical students into lifelong learners.

"Transforming the Learning Culture at HMS," held on Oct. 22, featured a combination of lectures and hands-on workshops designed to help faculty better understand the six steps of self-directed learning as they prepare to introduce them to a new generation of physicians.

Some studies indicate that students exhibit less initiative after their first year of medical school than when they arrived, Schwartzstein said, suggesting that current teaching methods impair rather than encourage the skills needed for self-directed learning throughout their careers.

"The goal is to help students learn to take initiative. How do we learn to get out of their way?" asked Randall King, HMS Harry C. McKenzie Professor of Cell Biology. "It entails a shift in focus from teaching to learning, and a shift in responsibility from faculty to student."

"There is a lot more to learn than we have time to teach," said Alberto Puig, associate professor of medicine at Massachusetts General Hospital, who planned the day's courses with King.

If the old adage in medicine is true that "everything we teach you today will be obsolete tomorrow," Puig said, then above all "we need to teach people how to learn to think for themselves."

Edward Hundert, director of the Center for Teaching and Learning in the HMS Academy, gave the keynote speech. He discussed managerial strategies for culture change and led attendees in an interactive exercise in which they constructed a "future history" of a revamped HMS curriculum, uncovering potential challenges and solutions along the way.

Participants then divided into workshops focused on topics such as different teaching approaches to self-directed learning, serving as a "learning coach" and constructing mock classroom sessions.

"One of our goals is to have people leave our workshops with a new skill they can try out in their own teaching," said Schwartzstein.

Salman Khan, founder and executive director of the Khan Academy, then joined by video link from California to lead a conversation about issues related to changing curricula and encouraging innovation.

Throughout the day, speakers acknowledged that at any large institution with many departments and a long history, change can take time.

"Faculty in general tend to be conservative about how they teach. We tend to get into a comfort zone. When something very new is introduced, it provokes anxiety," Schwartzstein said before the seminar. "When the standard lecture or session you used to do for students or residents is no longer appropriate, it requires you to rethink how you're teaching.

"What we're trying to do with this kind of program is help faculty understand why this is a valuable and important thing to do, and also help them get past some of that anxiety. We want to encourage our faculty to be curious and look at the underlying science of learning," he said.

The ultimate objective, Schwartzstein emphasized, is to produce better doctors.

Or, as Puig put it: "The goal is to have a fourth-year student come back to you and say, 'I am now a much better learner than you will ever be a teacher.'"