Skills we want our students to have

wood_carver-573x341This post was inspired in part by this article on the 10 skills that every student should learn. These are some of the skills that we’re intentionally trying to help our students develop, as a way of integrating them into the culture of professional clinical practice.

  1. Reading carefully. If you can read you can learn anything, it is the gateway to all knowledge.
  2. Touch type. Not being able to type is the modern equivalent of not being able to write.
  3. Write persuasively by developing and supporting arguments with evidence. Our students must develop the skill of communicating in the language of the profession. Writing also means being able to structure their work, because there is meaning in structure. It helps to develop logical thinking, beginning with an introduction, developing the argument, and concluding it. Drafting is an important means of refining their understanding, and discarding ideas that don’t fit. Simplify the sentence so that it conveys only what is necessary. Being concise and clear in presenting their thoughts.
  4. Conduct research. Identify missing knowledge or information. Question everything. For everything that they do or say, they need to have a reason. Why do a grade 3 and not a grade 4 mobilisation? Why at L3 and not at L5? Why stretch the soleus and not the gastrocnemius? A healthy skepticism should inform their learning. Think like scientists. Be comfortable saying: “I don’t understand, can you explain that again?”. Developing their own questions as a way of finding answers to fill in gaps in their own knowledge. Challenge authority. Question the way that the world is (or the way it is presented to you) with the intention of figuring out ways to make it better.
  5. Use technology as part of their learning environment. Developing skills in managing information. Searching, filtering, aggregating, summarising, synthesising, and sharing information. Identifying credibility in a source. Know when to stop looking.
  6. Collaborate. Working together to solve complex problems.
  7. Accountability. Make a statement of belief, backing it up with evidence. Stand by your statement. Commit to it.
  8. Care. Care about what you’re learning. Care about doing your best.

I’m sure that I could carry on with this list, seeing that there are clearly many other skills that we aim to develop. But for now, I think that this is a useful point at which to pause and reflect.

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.