A most dangerous idea

by reestheskin on 30/04/2014

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I used to think that medical students understood a lot about learning. They had done well to get to med school, so surely they knew how things worked? Gradually, from experience, I began to think otherwise. I have never opposed asking students questions about how they are enjoying things (Do the staff turn up? What is fun? What is bad? etc) but I have been very suspicious that they innately know what it takes to acquire the knowledge that means that you can ‘think like a doctor’ ( which is what med school should be about). Sometimes — and only sometimes — political correctness or plain lazy thinking gets in the way. Much as it does in the clinical arena when commentators misunderstand what information patients bring to a consultation: patients may have their views on wave-particle duality, but I do not attach must weight to them; other views matter more, as do sometimes the views of others.

There is of course a reasonable literature on how good (or bad, in reality) we are at assessing our own competence (for doctors, as well as students). I think some are much better than others, but as I type, I am aware I am entering the ‘All Cretans are liars’ paradox. My reading is that being aware of this issue is not sufficient to alleviate the problem. But the more educational psychology I read the more I find myself falling into a vortex of uncertainty about teaching and learning. I would like to laugh a lot of the experimental findings away. Perhaps, the findings are only true in particular experimental situations (remember these digits, recall them backwards etc); or true only for secondary or primary school levels; or fail to take enough account of motivation, and behavioural issues. Perhaps. But I suspect I and others have been living a fiction.

This most dangerous idea is that much self-assessment and reflection is bogus. That attempts to teach various types of meta skills doomed. And what matters most is knowledge: good doctors know more about patients and the way patents present with their diseases. Paraphrasing George Steiner, facts and memory, are consciousness’ ballast. Introspection doesn’t tell us too much about them, nor is it therefore a reliable guide to action.

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