Friday, December 2 2022

When I went to medical school over 40 years ago, virtually every school taught in a very traditional way: by lecturing on topics and subjects that included individual tuition. We have been trained in anatomy, biochemistry, pathology, pharmacology and many other courses common to biomedical sciences.

Traditional lecture-based learning was the norm until the turn of the century, when there was a gradual transition to teaching medical students by a case-based method. The students began to learn the diseases according to the systems. The discussion of clinical vignettes has become a central part of the curriculum. Students were expected to learn aspects of basic science courses that related to solving clinical problems and answering case-relevant questions. The case-based learning method evolved from problem-based learning and has been touted for its deep learning.

Case-based learning also has other advantages. It introduces clinical material early in the program, links theory to practice through application of knowledge to cases, and involves learning in small groups with common goals and objectives. Case-based learning mimics the practice of medicine in the real world – especially teamwork – and case-based learning has proven to be in force to a wide variety of fields in health care as well as non-medical professions.

Indeed, case-based teaching was the predominant learning method when I attended business school in the mid-1990s, nearly 15 years after graduating from medical school. It was more popular (and appealing) than the lecture format because the analysis of problems faced by real companies allowed students to generate their own ideas and develop their critical thinking and communication skills. Today, most MBA programs are case-based – using case files from Harvard Business School – and require advanced reading and preparation as well as quality class participation, contrary to my experience in medical school, which promoted post-hoc learning and simple identification of memorized responses from lectures.

The means by which medical students learn—attending lectures or studying cases in peer groups—strongly resembles learning the piano. Whether the piano is classified as a percussion or string instrument makes little difference in terms of the quality of the instrument’s playing. The beauty of the instrument depends on the skill and skill of the pianist, which depend, in part, on the quality of individual education.

I was taught to play the piano the same way I learned in medical school: the traditional way. I learned through notation (reading and playing notes), the equivalent of taking classes and using them as educational building blocks. Practicing and rehearsing musical compositions was like memorizing medical facts and minutiae; it was a repetitive process that lacked soul. I was stuffed with classical music the same way I was mandated to take courses in physiology, histology, and microbiology. I would have preferred to play the Beatles rather than Bach and Beethoven.

Studying medicine through case-based learning is like how children learn to play the piano (and other instruments) through the Suzuki method — learning organically by ear rather than notation, and nurtured by their parents and other “team” members. For Shinichi Suzukiit was about creating the right learning environment, and that placed auditory learning at the heart of his method.

Listening skills are also essential when it comes to patient care. Like William Osler, MD, says famous, “Just listen to your patient, he tells you the diagnosis.” I wonder if I would have been a better pianist – or doctor – if I had taken lessons according to the Suzuki method. I spent a “Hard Day’s Night” going through Bach and Beethoven sonatas. My preference for rock music, which could often be played by ear, was never taken into account by my music teachers.

Whether taught through the case-based method or through traditional lectures, medical students must master a great deal of information in the first 2 years of medical school. Students must acquire a certain level of knowledge so that when they undertake their clinical rotations, they are well equipped to apply their knowledge in a medical setting.

I find it interesting that the results The US Licensing Medical Examination (USMLE) Stage 1 and Stage 2 exams for students enrolled in a problem-based program versus a traditional lecture-based program are roughly the same – both methods prepare appropriately for students in the later phases of their medical training. However, students clearly prefer to learn from clinical cases and simulations rather than lectures. Osler recognized this over 100 years ago when he stated“I wanted to be remembered for leading the students out of the lecture hall and into the halls.”

There are pros and cons to traditional learning approaches versus case studies in medicine, just as there are pros and cons to different methods of learning music. I believe the best way to teach medical students is to choose from a variety of learning methods to ensure there is an adequate balance between theory and practice, instilling an appreciation for the history of medicine and the changing nature of diagnosis and treatment over time.

Although the piano has characteristics for both percussion and string instruments, and has been classified in both categories, it is generally considered to be a combination of the two and is quite unique in this respect. Shouldn’t it be the same for the training of future doctors? Shouldn’t the learning preferences of medical students matter, and shouldn’t they be taught to integrate the art and science of medicine to be “in tune” with contemporary practice? Roll on Beethoven, tell the news to Tchaikovsky.

Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board, Doximity Luminary Fellow 2021-2022 and assistant professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.

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