When Charles Dickens penned the words, “It was the best of times, it was the worst of times” for his novel, A Tale of Two Cities, he could not have imagined how appropriate they would be in characterizing the current tensions which exist in graduate medical education today.
In their article, “Computer-Assisted Instruction in Clinical Education: a Roadmap to Increasing CAI Implementation”, Berman, Fall, Maloney and Levine (2008) offer this description of the graduate medical education environment.
“The traditional model of residency education, which relies heavily on direct faculty teaching at the bedside and in protected didactic session, is being eroded by the modern pressures of clinical productivity (Shea et al., 1996) and restricted resident duty hours (Gelfand et al., 2004). At the same time, graduate medical education faces additional new challenges with requirements to “provide educational experiences as needed in order for their residents to demonstrate the competencies” in six core areas of medical practice. At least 2 of these new areas, practice-based learning and improvement and systems-based care, require significant new curriculum development (Carraccio, Englander, Wolfsthal, Martin & Ferentz, 2004).”
There is need not only for medical expertise and knowledge, but the practice of teaching excellence and the incorporation of technological advances which can provide learning opportunities for residents which did not exist even 10 years ago. Many programs are struggling to manage the difficult task of bringing medicine, education and technology together in ways that are both effective and sustainable. The times are marked with great innovation and ingenuity, as well as great frustration and complexity. In order for graduate medical education to succeed, it seems that the achievement of true collaboration, integration and synthesis of medical knowledge, educational excellence and technological expertise must emerge.
Perhaps some of the concepts expressed in the theory of connectivism have relevance, especially if we move beyond the idea of individual learning and make an application to learning as it involves individual disciplines.
“Realizing that complete knowledge cannot exist in the mind of one person requires a different approach to creating an overview of the situation. Diverse teams of varying viewpoints are a critical structure for completely exploring ideas. Innovation is also an additional challenge. Most of the revolutionary ideas of today at one time existed as a fringe element. An organization’s ability to foster, nurture and synthesize the impacts of varying views of information is critical to knowledge economy survival. Speed of “idea to implementation” is also improved in a systems view of learning.” (Siemens, 2004)
Great challenges face current leadership in the design and delivery of graduate medical education today. However, great rewards may come as collaboration, integration and synthesis in the areas of medicine, education and technology are fully realized.