iLearn (…or do I?)

In days gone by, there were few people in the world who had the wherewithal or education to actually make any educational choices in their lives. To learn medicine, for instance, would require years of sacrifice and largely self-motivated and experiential training for an acolyte. Few, therefore, could even consider our vocation.

We now have almost all of the high­­est levels of knowledge of the most brilliant of history’s brains available in print, video, and 3D within seconds of our most esoteric questions. In many cases this information has been reworked to make it even more accessible to those of us with lesser minds. We are able to appreciate the most gifted at the click of a mouse. We can solicit the opinions of almost anyone on any issue. We can independently and quietly teach ourselves nearly anything we want to learn. 

However, having all of that re­source and actually achieving something with it requires one more thing: commitment to the actual process of learning. We have to respect and appreciate how easy it has become to inform ourselves. We can’t just take it for granted or we won’t actually value making the effort to retain that information. 

Even a quarter century ago, educating yourself about a subject meant many hours in the library touching actual books and physically hauling them around to read them. You really had to want to find the answer. Part of how well things were learned or how much you were affected by your quest was in the painful process of extracting it. 

Verifying something required you to actually talk to someone or follow many hours on the heels of someone with more experience, even to hear a different take on what you found and make you re-examine things again. Seeing and assessing actual patients and writing histories and physicals that were way too de­tailed than necessary might have actually helped us learn medicine. There is intrinsic value in a process that took longer and was seemingly less efficient. 

Now, because we can get good information so very easily, we have changed the way we learn. Medical school PBL curricula actually depend upon students finding out at short notice information to teach each other. We are able to attend webinars, academic meetings, and rounds online, or participate actively or passively in chat rooms, user groups, and other online resources. There are courses in how to use search engines effectively. The process of getting the information is painless, but are we better learners?

It worries me that the more freedom and easy access to information we have, the less we may feel we have to commit to actually learning the things we pick up just from our own full participation in the process. I was at grand rounds a few months back and sat closer to the front than my usual spot. During the talk, which was not in my field, but still very interesting, I looked behind me up the rows and internally cringed at the sight of almost a third of the “participants” frowning down, watching their thumbs flagellate their version of technological device. 

There were well-meaning, very smart surgical residents who had actually set up little carrels of sorts in the back rows with their laptops open and a stack of printed PDF files they needed to get through in lieu of a rounds they were “required” to go to, but didn’t feel they needed to spend brain power listening to. 

It must have been less than gratifying to be the visiting professor who was presenting his years of work, learning, and philosophy to be facing such an apparently uninterested group. It was a very interesting talk that I would never have known anything about otherwise and would never have researched. With learning online, you choose what you are exposed to based on what you know or think you need to know. The reason we have CMEs like grand rounds is so that you will be exposed to something you don’t even realize might help your practice. In an edu­cational world that is now so self-directed, we have to remind ourselves to take every opportunity to be directed from the outside every now and then. 

It is the same when it comes to the practical part of medical education, which I believe at its core has to have the unit of interaction between a pa­tient and learner. It is hard for trainees to understand that an afternoon in the clinic actually helps them pass their exams. Many seem to believe that if there are no classifications to learn, or esoterica to bank, or it seems like they are seeing repetitive cases, that it is wasted time that could be better spent studying on their computer. In fact, the actual doing of it and retention of the whole of the educational experience is what focuses the value. Let’s not forget about fully engaging wherever possible and actually experiencing what real life—and real people—can teach us. 
—CV