Ophthalmology: Excellence in Medical EducAation

A great deal of research is done on how to educate medical students. Our government, and the medical schools themselves, have a lot of money invested in the process. The Canadian public depends on that investment having a productive return in the form of competent, quality doctors.

The challenges of medical education are many. Each medical student arrives from a unique background; how can we draw on students’ previous skills and knowledge while bringing them all to the same place of medical competence? Similarly, each medical student is preparing for a different career. The  teaching required to prepare a student for General Practice might be quite different than that needed by a Specialist. How can a single curriculum sufficiently address both? The universe of medical knowledge is simply too vast to be given justice in four years – choosing which information is most important can be a real challenge.

There is currently a paradigm shift occurring in the research of medical education. New studies are showing that the century-old approach of didactic lectures is ineffective. Someone once said that a lecture is: “the process by which the notes of the lecturer become the notes of the student without passing through the mind of either“. There’s some truth to that.

As an alternative to having a lecture, educators are suggesting a team-structured, problem-solving session. Ever since McMaster started the trend, all medical schools have incorporated this approach to some degree in the form of “Problem-Based Learning”. Although the Mac kids seem to love it, the rest of us are a little more hesitant. We prefer our lectures! So do the instructors. Nonetheless, Queen’s and other schools are doing their best to apply the new conclusions in education research, without sacrificing the best aspects of the strong curriculum we have right now!

This past week we studied Ophthalmology. The challenges of conveying a broad overview to Ophthalmology in a single week are a small-scale representation of the challenges in overall medical education. Having now completed the week, I can say appreciatively that the Queen’s Ophthalmology Department delivered the most excellent teaching I’ve encountered. It was incredibly well done. Here’s how they did it:

• Acquisition: Through a series of online videos, and a recommended textbook, students were required to prepare for each session by obtaining the relevant background knowledge independently.
• Application: Each morning we met in teams to discuss clinical cases. We would decide on our approach to each patient, and ask for necessary investigations. As decisions were made, the facilitator would reveal new information that eventually led us to a diagnosis and constructing a management plan.
• Clinical Skills: We finished off the week with a session to learn the necessary skills to examine the eye. The Opthalmology Clinic in Kingston closed their doors to patients for the afternoon, and instead invited us into their department, where in groups of twos and threes we learned from the Ophthalmologists directly the techniques we need to know to examine the eye.

From my perspective, the Ophthalmologists’ approach was highly successful, and  I feel it serves a good model for how medical education should be done in general.