Teachers' experiential learning about learning

OBJECTIVE

An experiential model of learning suggests that changing a learner's understanding will lead to the learner choosing to change behavior. A workshop was designed for medical educators to examine their understanding of learning in order to change their behavior as teachers. This article describes that workshop which was presented as part of a conference on successful techniques for education of primary care practitioners.

METHOD

Eighteen medical educators participated in the workshop. The educators were instructed to reflect on a recent personal learning experience. Group discussion led to production of a list of components of effective learning. These learning components were then applied in small groups to three hypothetical tasks related to mental health education.

RESULTS

Essential characteristics of three generic features of learning were identified: characteristics of the teacher, learner, and learning experience. When these characteristics were then applied to the hypothetical tasks, a major theme that emerged was a focus on the importance of learner motivation.

CONCLUSIONS

The essential components of learning and their application demonstrate the importance of adult learning theory in which it is more important for the learner than for the teacher to determine what, when, and how to learn. This is in contrast to traditional medical education in which the teacher decides what to learn and if it has been learned. To improve education for practicing primary care providers, a shift from a teaching paradigm to a learning paradigm is indicated.

"Reform without change": update, 1998

As a result of the Flexner Report in 1910, proprietary medical schools disappeared and science taught by researchers became a part of every medical school curriculum. Medical research produced products that improved health and brought large profits to health-related industries. Research became the currency most valued within the organizational power structure of medical schools, overshadowing the educational mission. Almost 90 years and multiple calls for the educational reform of medical education have failed to bring about true change in medical education because of researchers' conflict of interest--that is, the time spent providing effective education equals time away from the research necessary to maintain their careers. Basic scientists have kept teaching in medical schools efficient by giving discipline-related lectures that allow them to maximize their research time. Planning for meaningful learning with integration of disciplines and small-group teaching requires an investment of time that researchers are unwilling to make because it does not further their careers. Separation of scientific research from medical school teaching is necessary for reform of medical education. Medical students need to be taught by teachers who are not researchers.

Teaching portfolios: documenting teaching

In recent years, teaching portfolios have been developed as a way teachers can document teaching scholarship and demonstrate their teaching accomplishments, skills, and strategies. Most medical schools reward good teaching, often with promotion on clinician-teacher tracks, thereby acknowledging the contributions made by clinical faculty who serve the academic mission as teachers. Teaching portfolios provide a means for teachers to demonstrate their teaching achievements and display their best work. This article gives recommendations for constructing a teaching portfolio and includes examples of what can be included.

Concordance between clinician and patient assessment of physical and mental health status

The degree of concordance between clinicians' and patients' assessment of the patient's physical and mental functioning was examined in 166 consecutive eligible outpatients with rheumatoid arthritis (RA) using 4-category ordinal scales. The weighted kappa statistic was 0.39 for physical functioning and 0.30 for mental functioning, both indicating a fair degree of concordance. This disagreement differed in magnitude and direction depending on the level of disability present. We conclude that clinicians and their patients with RA often disagree in their assessment of the degree of physical and mental impairment that the patient experiences. These disagreements demonstrate the need for formal assessments of outcome and should be recognized and resolved when managing individual patients.

Antirheumatic agents: CNS toxicity and its avoidance

Altered drug metabolism, polypharmacy, multiple diseases, and errors in self-medication are all factors seen in the elderly which increase the risk for side effects from antirheumatic drug therapy. The geriatric presentation of central nervous system (CNS) toxicity, which is common yet frequently overlooked, is reviewed as it pertains to various drugs commonly used to treat rheumatic disease. Practical advice on avoiding common pitfalls in antirheumatic prescribing is offered.

Lack of correlation between the Steinbrocker staging of hand radiographs and the functional health status of individuals with rheumatoid arthritis

We evaluated the correlation between destructive changes seen on hand radiographs and disability in 54 patients with definite or classic rheumatoid arthritis. No statistically significant correlation was found between radiographic findings and patient disability as determined by patient and physician assessment or by the patient's score on the Arthritis Impact Measurement Scales questionnaire. These findings call into question the appropriateness of using hand radiographs as a determinant of disability or as a criterion for disability insurance benefits.