Time and Medical Education

Abstract

An indispensable ingredient of good medical education is the presence of enough time to allow educational objectives to be met. The length of study needs to be sufficient for learners to acquire the necessary factual, reasoning, judgmental, and behavioral skills. For medical education to be conducted at the highest level, learners also need sufficient contact time with patients, and faculty need enough time to teach in a thoughtful, Socratic fashion. As the 21st century approaches, time is disappearing from the process of teaching and learning medicine, with disturbing implications for the quality of education. Medical educators in the future must work as hard to defend the availability of sufficient time as they do to acquire new buildings and research funds.

Clinical Reasoning: Where Do We Stand on Identifying and Remediating Difficulties?

“…The paucity of current reliable, valid, and feasible assessment tools may also contribute to clinician-educators' apparent disinclination to directly observe students' in-training performance . Moreover, feedback is hardly ever based on actual observation of student interviews with patients (Dudek, Marks, & Regehr, 2005;Hauer, Teherani, Irby, Kerr, & O'Sullivan, 2008;Howley & Wilson, 2004;Ludmerer, 2000).…”

Time to Teach: Addressing the Pressure on Faculty Time for Education

“…Ludmerer [8] noted that the early part of the twentieth century saw an exponential increase in the amount of medical knowledge and a corresponding increase in emphasis in clinical reasoning. It was in this context that Flexner advocated in 1930 for a shift to salaried faculty who would make teaching a priority and "learners became the central focus of the faculty's attention" [8] (p. 26). This manifested as a shift from curricula largely comprised of lectures to the addition of clerkships, laboratory instruction, small group conferences, and seminars.…”

“…Unfortunately, Ludmerer noted that, "educational activities have simply not been encouraged by the new rules of faculty practice that penalize any loss of 'clinical productivity'" [8] (p. 27).To counter these financial pressures, schools have provided some explicit compensation for teaching, generally to departments, and have created teaching academies to augment prestige. Yet, Barzansky and Kenagy noted that, "The current salaried full-time faculty member is highly dependent on clinical practice for his or her income" and "vulnerable to time pressures that mitigate their ability to participate in teaching" [14] (pp.…”

“…After all, the word doctor derives from the Latin docore, meaning to teach, and underscores the value attributed to transmitting knowledge to patients, students and physicians in training, and the wider society by joining the profession. At a time when the ACGME is focusing on the Clinical Learning Environment [7], it is worth noting that the least visible but perhaps most essential element of that environment is time [8]. Our goal for this editorial is to describe some of the factors, particularly financial pressures, that impose on teaching time and to place these in a historical perspective.…”

Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches

“…Specifically, arguments are proposed that challenge the status quo in the field and call for education research that holds a greater patient focus, is less classroom focused and more aligned to the clinical real world (Ludmerer 2000;Whitcomb 2002;Chen et al 2004;Cook et al 2008;Regehr 2010;Bleakley et al 2011). Ultimately this is driven by the changing expectations of the public as the role of the doctor has moved away from a traditional paternalistic approach to medicine towards one of shared decision making (Berwick and Finkelstein 2010).…”