Content isn’t important, relative to thinking

I just had a brief conversation with a colleague on the nature of the teaching method we’re using in my department. Earlier this year we shifted from a methodology premised on lectures, to the use of case-based learning. I’ve been saying for a while that content is not important, but I’ve realised that I haven’t been adding the most important part, which is that content is not important, relative to thinking.

Of course content is important, but we often forget why it’s important. Content doesn’t help students to manage patients (not much anyway). The example I often use is that a student can know many facts about TB, including, for example, its pathology. But, that won’t necessarily help them to manage a patient who has decreased air entry because of the TB.

What will help the student is the ability to link data obtained from the medical folder, patient interview and physical exam, with the patients signs and symptoms. By establishing relationships between those variables, the student develops an understanding of how to proceed with the patient management process, which includes treatment. There is very little content that the student needs in order to establish those relationships. In those situations, what the content does focus on is a recipe list of commonly used assessment and treatment interventions, which the student can memorise and apply to a patient who presents in a certain way. This is NOT what we want though. This approach doesn’t help students’ adapt and respond to changing conditions.

Knowing the pathology of TB may tell the student WHY there is decreased air entry to the basal aspect of the lungs, but not WHAT TO DO about it (unless you want students to follow recipes). Clinical reasoning is the important part, not content. This is what I’ve been missing when I tell people that content isn’t important. It’s not, but only relative to thinking.