Isabella Laws: Innovative teaching—why hasn’t it come further?

isabellaMedical education has long seen the need for reform. The aged style of listening to a lecturer impart hours worth of highly technical scientific information at a rate which sees you frantically scrawling everything down on a page continues to cling on, despite the fact that it is outdated.

For one, lecture notes are available online on university portals. And secondly, lecturers and professors are no longer the sole sources of knowledge. The internet, e-books, and the rise of easily accessible information has removed the obligation to attend lectures (unless you are unfortunate enough to attend a university which records attendance). Instead, you choose to go, hopefully because they will be able to engage you in the topic.

It can be argued that medicine has more of a need for innovative teaching than other subjects. Uniquely it is a study of a profession, rather than a subject. We are required to learn skills that enable us not only to problem solve and work out differential diagnoses, but also to communicate effectively with our colleagues and patients. So why haven’t we come further in how we teach?

Recently I interviewed Maria Troco-Troconis, who pioneered an online virtual teaching environment at Imperial College, London in 2008. Her project was based on the platform Second Life and offered students a chance to diagnose and treat five patients on a respiratory ward. Discussing its limitations, she mentioned the concept of flow theory, where the challenge must match the level of the student’s capabilities. This can be hard to achieve in a virtual environment where there is no immediate feedback from an audience.

She says “the students were engaged in treating the first patient, and maybe the second one. But after that, they were bored. So there is one of the key gaming theories, in motivation for playing games is called the flow theory…. It is basically saying that your challenge should be in line with your skill. So if your skill is very low and your challenge is very high you become anxious, you can’t really do it. If your skill is very high, and the challenge is very low, then you’re bored and you give up. And that’s what happened in the students in this game based experience. Once they reached the level where they manage the flow of the patient in the virtual world, they became bored and they didn’t want to carry on.”

Maintaining student’s engagement in a learning activity is difficult in any setting, but Troco-Troconis thought that the interface was mainly to blame. Though innovative teaching is well geared to a generation that has been raised on word processing and Wikipedia, they were not all comfortable with gaming. “The students that are coming in now that are used to social media and using the internet and you are probably one of them [to me]. For you, it’s natural. But gaming and playing games is something different. You are used to the digital world but we didn’t find that in our study, there were not really high gamers. So, that’s something that we need to think about…So I think, what’s the limitation at the moment is really the interface.”

Online learning can be limited by distractions such as Facebook or Twitter, but a solution might be the use of the “flip classroom” model. This sees traditional learning activities being done at home, and the discussion of practice questions during class time, and is an increasingly popular method.

Additionally, innovative teaching will never be able to completely replace more traditional methods. Some teaching, such as clinical and communication skills require face to face contact. “We need to think about the bigger picture, and the blended learning experience. So whatever you put online should be something that’s factual, targeting the low end of the cognitive domain, leaving out discussions and more critical skills that you need to learn to be learnt in the classroom, because that’s not really the right environment” says Troco-Troconis.

We shouldn’t lose faith in the merits of alternative learning though. She also pointed out that online environments will be able to offer medical teaching an aspect hard found elsewhere: the chance to make a mistake. “I think in medicine, stimulation and games are key. Because you can’t stimulate some things in real life, it’s very difficult to simulate something where you can kill the patient…but you need to get the platform right, you need to get the environment right, and you need to keep in mind the flow theory. So you need to make sure that the students are kind of engaged.”

Troco-Troconis seemed confident that the way we are learning and teaching is changing, but that change will take time, “but imagine, that means changing so many things, [even] the spaces where you learn because why [learn in] lecture theatres anymore, if you know you need to be working in groups, thinking about problems, solving problems, answering questions, talking to your peers and making you actively involved in the learning process? But that’s difficult, [because] that means we need to change a lot of things in the whole education system.”

So for now, we wait.

I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

 Isabella Laws is a Clegg Scholar and a second year medical student at St George’s, University of London.