Sunday, October 13, 2013

Response to Friday's post from Rebekah Brown

Veterinary and medical elearning developer and blogger Rebekah Brown responded to Friday's post with a comment that is itself worthy of a post. 

If you want to read more, click here to visit Rebekah's blog.

This was a fantastic post and a topic most worthy of discussion. I’d love to have time to construct a logical piece but I know it will never be finished, given my current workload, so here at least are a few ideas and thoughts, varying considerably in quality and relevance. An (admittedly extremely brief) glance at the veterinary literature did not reveal any recent published work in this area – perhaps it’s time to revisit the issue more formally.

Teaching metacognition (understanding of the process of learning) to students could have significant value.

In Stephen May’s recent article on clinical reasoning1, he mentions a study which demonstrated that individuals who could solve novel problems in unfamiliar domains more expertly than most had greater understanding of their own thought processes2. Another related point is that, from purely a learning viewpoint, there is a preclinical-clinical divide ‘at which students stop being taught backward, from textbook lists of diagnoses and start being taught how to work forward from problems toward answers’1. As a learner who only fully grasped this concept about half way through final year, I think having it explained to me earlier may have been extremely useful. I also remember chatting to two particular students, one in the year above and one in my year, during preclinical years and realising that they were learning in a much more applied way than I, still grasping as I was to the rote system rather than how I would need to apply the knowledge in the real world. Both those students were dux in their respective year levels, which I think was strongly related to the way they thought about how to study.

Introduction of streaming into veterinary education

This has been raised many times and is the current model at UC Davis, albeit in a limited form i.e. graduates choose a stream but still must find a way to cover other species in order to get a licence. I actually emailed Davis earlier this year to seek clarification of the system and got this reply from Jan Ilkiw, Professor and Associate Dean-Academic Programs:

‘While there has been talk of limited licensure in the US for 20 odd years it is unlikely to eventuate. It came up in the NAMEC discussions when State boards and National Board of Veterinary Medical Examiners were all in the room together. There was talk that perhaps the licensing exam might consist of a number of sections and that students would have to pass say 4 out of 6 sections which would allow for some species selection - not heard anything more about this.

All students have to pass a broad all species national exam in order to practice in the US so they are therefore are licensed to practice on all species. For curricula like ours and we have had tracking for 20 years it does mean that the students are then responsible for getting the extra species material to pass the licensing exam.

The general feeling was that veterinarians are professionals and take an oath and therefore they should regulate what species they practice on - i.e. only practice on species they are competent to practice on. If they don't then they could be reported to state licensing boards if they end up doing things that are not considered standard of practice.’

Curation of information is key

In the past, information was relatively scarce. Teachers told students facts and suggested texts and journals to use for further information and clients came to veterinarians seeking ideas about possible diagnoses. Now anyone can find virtually any information online and I have certainly had clients arrive with printouts on the condition they believe their pet may be suffering from. The vet and vet educator’s roles seem now to be as much curators of information and information sources as providers. This throws the problem of overload back on the educator to some extent rather than solving the problem.

Forms of assessment

With pedagogy now (rightly) a much more central focus, considerably more thought is being put into teaching strategies than will engage students and best assist their learning. I have noticed at least in some cases that design of assessments have not kept pace and are still often in an older style which encourages rote learning. As so many students study for the test rather than the real world, this may be a significant barrier in changing student attitudes towards when they have learned something. Designing assessments to be as authentic as possible to real world tasks (easier in some areas than others) would be of benefit.

Aims of veterinary education

Nigh on 20 years ago Bushby3 stated that the Mississippi State College University of Veterinary Medicine had redefined the goals of the professional curriculum to include the following:

  • The graduate must be able to learn on his or her own.
  • The graduate must be able to access and use information in an interdisciplinary manner to solve problems.

Perhaps we need to renew the focus on these goals. They will not of course reduce the load but may better equip students to manage it.

1.   May SA (2013) Clinical reasoning and case-based decision making: the fundamental challenge to veterinary educators. Journal of Veterinary Medical Education 40(3):200-209
2.   Brown AL et al (1983) Learning, remembering and understanding. In Mussen PH, editor Cognitive development Vol 3, Handbook of Child Psychology. Oxford, Wiley

3.   Bushby P (1994) Tackling the knowledge explosion without overloading the student. Australian Veterinary Journal71:372-374.