‘Medical Students these days don’t seem to know anything!’
These are the words of despair, or variations on them, that I’ve heard said by senior colleagues both at work and on social media in the last few weeks. The root of their discontent was simply that, when asked a factual question that the senior doctor believed the student should know the answer to, they couldn’t.
Now, on the face of it, particularly for those of us who were trained back in the last century, this doesn’t appear that unreasonable. We were constantly grilled by our seniors, memorising causes of erythema multiforme, antibiotic sensitivities for various infections and trigger values for the latest scoring system or guideline (not forgetting the importance of knowing the nationality of the surgeon who first performed a particular operation and the century it occurred…usually French then a toss-up between 18th and 19th century). Okay, so the latter was pretty useless but we did actually use the other knowledge once we qualified. As junior doctors, we struggled to find anyone else to ask about these things or anywhere to find that information during daylight hours, never mind at 9pm on a Sunday, so we had to be our own walking information repository. Knowledge like this, facts and figures were currency, were valuable, and if we didn’t realise this as students (and let’s be brutally honest, most of us didn’t) we soon realised it when we started work!
So, back to my discontented colleagues. Are they correct? Has something gone wrong? Are this generation of students not being taught correctly or do they just not value factual knowledge?
Well, firstly, let’s at least admit that one generation often thinks the next one is lazier, less organised, less committed than the one following. I’m sure my consultants thought that about me and their consultants about them. Maybe it’s true in some ways but given the progress we keep making as a profession I’d suggest that maybe it’s something different. I believe it just may be that it is because the next generation stops worrying about what is no longer important long before the previous generation have realised this to be the case. In doing so it frees them up to move forward and to face and conquer the next challenge we face as a profession.
So, as a medical student, or a junior doctor, why would you waste your time remembering facts when you can access that information on a computer or a handheld device like your phone? This device won’t forget, or worse still remember incorrectly when it gets tired or stressed and it can be kept up to date without the pain of having to relearn or the risk of mixing up new and old information. Why would you put a patient’s safety in the hands of an imperfect carbon based memory when you can use a perfect silicon based one? The current generation still understand and value knowledge, it is memorising most of it they’ve realised is of low value.
Following my breakdown I’ve had to embrace this ‘look it up’ school of medicine and quite frankly it is liberating. No more worrying about whether I’ve remembered the NICE criteria for a CT head correctly; no more racking my brain for the treatment for TCA overdose; and certainly no more time wasted trawling the fading memory banks for the causes of erythema multiforme, orf or any other MRCP-oma! I do still remember many facts because they are important, interesting or through familiarity but I don’t make an effort to remember most of the detail, I can look that up. Is that a bad thing? Is that a loss? I don’t think so.
Once one frees one’s mind up from remembering thousands of facts, you can start to think a bit more about why you are reaching for those facts in the first place, who you are applying those facts to, and whether they are actually relevant to your situation or not. Relieving medical staff of the burden of memory allows them to use their brains in a more useful way, in a way, dare I say, that is far better for the patient. They can spend time considering their diagnostic processes, their biases and their uncertainties. In the midst of a critical resuscitation they can think about leadership, decision making and management of their resources. At the bedside they can concentrate on listening, using skillful communication to ensure that information flows clearly between themselves and the patient. I don’t know about you but that sounds like progress to me.
Now, let me be clear, I’m definitely not saying medical students don’t need to remember any facts but we need to be really critical, really clear about what they DO need to remember. If they can look it up without it having a significant impact upon workflow, I’d question whether they need to waste cognitive effort trying to remember it.
So, have I really given up teaching medical students? No, but I have changed completely what I teach them. I no longer teach them facts, they’ll probably be out of date by the time they qualify anyway, and instead I concentrate on teaching them importance of good quality information, where to find it and what to do with it. I spend time explaining how we, as doctors, gather information and piece it together, how we relate to it, interpret it and place our own values on it. I’ve pretty much given up teaching knowledge and instead try my best to teach wisdom because in an age where knowledge is easily available, where protocols and guidelines are helping to improve and standardise care and the question of ‘Could we?’ seems to have overtaken the one ‘Should we?’, wisdom will be key.
P.S. The title picture?