Lifelong Learning “Not Excessively Rare”

As I get ready to go back on service at the hospital as a psychiatric consultant, I’m trying to get my head back into the game by reading papers like Psychiatric News. The March 15, 2019 issue (volume 54, number 6) has an interesting article about how medical students are learning these days, entitled “Wright State Adopts Curriculum Without Lectures,” written by Mark Moran. You can easily access this article on the web for free by just searching with the term “Psychiatric News.”

The article mentions the pathology textbook, Robbins’ Pathologic Basis of Disease. My class used the nearly 7 pound red 3rd edition containing 1,467 pages. This book is hailed as an outstanding foundational text, which it is. Dr Stanley Robbins has been eulogized as an exacting editor who championed writing of the type espoused by Will Strunk in The Elements of Style.

Not to be picky, but the book contained the phrase “not excessively rare” in reference to some process or disease which I can’t recall. I do recall that a majority of our class howled about this verbiage, which seemed the antithesis of what Strunk tried to teach.

Robbins book is described as “dense” in the article. It’s probably still pretty tough to wade through. I admire any medical student who can teach peers about its contents using only a study guide. I saw a used copy for sale a few years ago in a bookstore in Madison, Wisconsin.

Wright State University is using Team-Based Learning (TBL) which allows medical students to teach each other in small groups. They prepare by reading on their own about topics and come prepared to teach their peers who participate in discussions. This is thought to promote a better way to promote lifelong learning and to be more effective than the lecture style—which is how I learned.

Another point in the article is that the lecture-based approach is pretty inefficient, which is true in my opinion. I remember it often resulted in poor lecture attendance and cramming before exams. It spawned the sometimes-controversial Note Service (which I think a lot of medical schools had and may still have), in which class members take turns taking notes in lectures, which are then cleaned up and distributed to the rest of the members of the class who sign up for the Note Service.

Wright University also has a problem-based learning exercise in which small groups discuss a clinical case with a faculty facilitator. Students come up with learning objectives, search the medical literature, and then present to each other about evidence-based approaches to real-world clinical challenges which physicians encounter in practice.

It turns out this problem-based learning method is not really new and not excessively rare. It happens to have been the approach used by one of my teachers during my residency rotation through the consultation-liaison psychiatry service. It was eventually called Clinical Problems in Consultation Psychiatry (CPCP). I continue to use this model, although general hospital psychiatry has gotten very busy over the years, making it difficult to do regularly. Medical students and residents have given many outstanding CPCP presentations, often using PowerPoint slides and generating stimulating discussions. The video below is an example to give you the idea of one component.

And this post reminds me that the phased retirement process involves periodically flipping between my work identity and my retiree identity. I suspect this experience is not excessively rare.

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.

            Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.

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