Life-long learning is a valuable and necessary habit of physicians, but not a useful objective for medical school, because it can not be evaluated.
I am regularly asked to contribute to MedEdWorld, a wonderful resource to stimulate the thinking about medical education. Reflections like this give space to be a bit provocative, so this title is meant that way.
I can hardly think of ‘modern’ medical education programs that do not state they educate for life-long learning. It has become a fad to add that to the objectives. It is really not very surprising, and many educators start recognizing that what they teach may be outdated or deficient at the time students graduate and certainly as soon as they start practicing. Doctors need to keep up with knowledge and skills, meaning that they both maintain what they know and can, but also add what they not yet know or can. They must possess flexibility and adaptive expertise. These qualities are not easy objectives for an undergraduate medical course, both for teaching and for assessment. I have yet to see which assessment approaches can validly measure such objectives. How would we ever know at graduation that LLL will happen?
To pretend that we graduate students who will be ‘life-long-learners’ is like a promise we can’t be hold accountable to. It sounds like the objective that our graduates will be happy doctors. I have never seen a study that examines whether people have learned their life long or not, and then looked back what the medical school did to make this happen (or not). In fact, I advise a PhD candidate studying CPD in older nurses who (rightfully) states that it is difficult NOT to learn while being a practitioner, and the diversity of learning activities and approaches at work is big. And in fact, I did see studies that examine whether doctors remain happy, not whether they remain life-long learners.
Of course, some practitioners are clearly excellent learners and some should do more, but I would like to boldly state that other factors determine whether they do this or not are far more important then the education received in medical school. Willingness to do so and stimuli arising from the context are probably dominant predictors of LLL behavior. A busy clinician, with little time to dig in the literature may or may not try to learn about an unexpected finding, a new protocol, may read the New England Journal of Medicine, the JAMA, the BMJ, and three or four highly relevant specialty-specific medical journals. Or not. Why? Because of their inquisitive nature or not, because their department values discussing novelties in journal clubs or other meetings or not, or because re-registration requires them to do so. Or not. Or in the rare case, when they need to know because of research and own publications. But because of their long time ago medical school’s education?
I believe that if we really want to stimulate life-long learning (and we should want this), the structure of health care and the natural expectations at work should stimulate this and should include learning, next to doing. Re-registration requirements should be far more focused on life-long learning that they do now.
I have no problem with hoping our own graduates will learn their life long, but let’s limit the objectives for medical school to things we can truly evaluate. Learning skills would be terrific if we can measure these, but “life-long-learning” is a silly objective.
Thanks Olle, an interesting reflection, which I think I agree with, although probably not so passionately!
I agree that the concept of LL is rather nebulous for an objective but my impression is that many schools are now changing this to a hope rather than a defined objective and have introduced a learning to learning component in their curricula. Certainly if there is no structured CPD/ CME / re-accreditation processes in place, and that it certainly true of many countries in the world, then I see no impetus not motivation for life-long learning, other than through internal motivation.
Of course, many schools also pick up on others curricula and if LLL is there it sounds rather sexy to have it in your curriculum.
I live in hope that LLL develops in the individual, driven by that internal motivation to improve, to grow and to develop rather than through a curriculum that has objectives that are not attainable
Gary D. Rogers
Provocative indeed Olle! Your piece brings to mind the quote often attributed to Albert Einstein but actually coined by sociologist William Bruce Cameron in 1963, '[n]ot everything that can be counted counts, and not everything that counts can be counted'.
One of our jobs as educators is to encourage our learners into a scholarly approach to practice - an approach to life-long learning *and teaching* that it the antithesis of the clinical arrogance we so often see in experienced practitioners.
Gary D. Rogers
Other aspects of professionalism like ethical sense are also difficult to measure, but that doesn't mean we should give up on trying both to select students who have a natural facility in the area and then optimise the development of that characteristic through the culture and practices of our schools.
Olle ten Cate
Thanks Trevor and Gary.
Some objectives are hard to measure but expected to be present at graduation, such as professionalism. We must continue to search for best approaches. Life-long-learning can, at best, be an aspirational objective that we only know had happen after a life long. So maybe distinguish measurable objectives, difficult to measure objectives, and aspirational objectives that by definition cannot be measured
Nice article. Perhaps we can go some way by teaching students the basic skills needed to work independently with information from the Net.
The standard gate-keepers are not always available. To start: students need to know 1) how to filter the tons of information available; 2) how to get the information to look for them (rather than their looking for the information); 3) the strengths and weakness of different sites; 4) how to evaluate new sites and new material 5) basic management of information sources so as not to be overwhelmed.
This can be taught. This can be measured. Whether or not they implement it is up to them.
I think there are many ways medical schools could implement in the follow up and measurement of the degree of competence and performance of their medical graduates in life long learning. It´s only a matter of imagination, commitment and budget.
I completely agree with your thoughts Olle, that LLL cannot be a medical school objective because it cannot be measured. But I do believe that as educators and education designers we can instill a value for LLL or breed a culture of LLL by stimulating the intrinsic motivation of our medical students and residents through the right educational practices. The rest will be done by their own intrinsic motivation.
I don't think the philosophy of LLL needs to be measurable.