Friday, November 11, 2011

The value of teaching and testing medical trivia in 2011

I'm a first year course director for the basic neuroscience course for second year medical students.  With my co-course director, we're gearing up for the course to start in a few months, and are in the process of tweaking the schedule, and looking over who will cover what as the course proceeds.  As we are going over the details of each session, we stop every once in a while to ask what are our main goals with this course.  It's a bit daunting to think about a major course like neuroscience and come up with over-riding goals, but I think it is a useful exercise.

I'm trying to do things better than they were done when I went through medical school.  It seemed to me going through courses like my neuroanatomy course that the goal of the course was recall of very minor details of neurological anatomy, physiology, and pathology.  This was due to the fact that the majority of our assessment was through a multiple-choice test which primarily asked questions about what minutiae. Thus, we all envied our classmates who had the ability to look through notes once and be able to recall all the little details without any trouble.  Those people were always then rewarded with high test grades.  Tests seemed more like a medical "Jeopardy" competition than a review of facts that will actually be useful in caring for patients.  However, life has changed since that time.

The advent of search engines and a whole library of research articles being available where ever you are has made it harder to argue for drilling in facts to the level we used to do.  I was always told that the reason for doing this is that you will likely not remember everything you've learned, so if you oversqueeze information into your head, the important stuff will likely stick.  And, it is true, that every physician I've ever met has moments where they will be presented with a case, and dredge up some unmined factoid from medical school that will help them with a case they are seeing right now.  So, I don't think we can get entirely rid of the feeling that medical training is much like trying to drink from a fire hose of information.  But, I think we can be more targeted in which factoids are required to be known, and I'm not the only one with this opinion.  It's not really important to know what chromosome the defect for Huntington's disease is on, or even the name of the protein affected.  What is important is to know the basic clinical presentation of Huntington's disease, and it's variants.  This is far more useful.  It's also important to know those rare medication side effects so you can monitor if needed for them, and be aware of what medications can do.

I'm not sure I know all the answers to how much is too much detail for a medical school lecture.  But, hopefully in the course I'm directing, the weird stuff the students will be memorizing will all be stuff that one day may percolate up when their seeing a patient.  And, hopefully when that thought percolates up, they'll stop and say out loud, "Thanks, Dr. Kraakevik."

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