Plan for dealing with scale in medical education

by reestheskin on 13/07/2016

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If you are interested in making undergraduate medical education work, you have to be interested in scale. We have to think about scale in at least two ways.

First, within certain limits it is possible to invest more if you teach bigger numbers. If you want to produce high class online material, it will cost a lot. If you want to find out what works, larger numbers of ‘trials’ will help. If you want to produce meaningful online material, rather than just some dismal Powerpoints, it is only cost effective if class sizes are large. For many disciplines in many medical schools, there is simply not enough critical mass to produce great content. Or at least there isn’t, if teaching always plays second fiddle to research and clinical service.

The other side of the coin is simply that bedside teaching does not scale. The larger the group, the worse the teaching; and patient resource is limiting. There are of course plenty of patients, but medical schools are modelled around where the resource was fifty years ago, rather than where it is now. They are reluctant to change because the ‘start up’ costs are large, and because schools are fixated on short term rather than long term educational goals. In the old bedside model, the ready availability of suitable patients was a large (hidden) subsidy. As it disappears, people are waking up to how expensive it will be to replace. Many of these costs will be direct costs to universities, rather than hospitals, simply because the political realities in the UK mean than hospitals are simply unable to find the finance to change the way they work. Most of the money that is said to support student teaching is siphoned off to support clinical service. It is just that nobody wants to call it fraud.

From a student perspective these issues matter enormously. Student experience is often poor, and the sense of ‘place’ lacking in many, if not most, UK medical schools. The (justified) disenchantment felt by junior doctors at the hands of the NHS employers and so-called educational establishment, will spread to our undergraduates (more than it has already).

There is a quote from Clay Shirky that is germane here*.

You have to find some way to protect your own users from scale. This doesn’t mean the scale of the whole system can’t grow. But you can’t try to make the system large by taking individual conversations and blowing them up like a balloon; human interaction, many to many interaction, doesn’t blow up like a balloon. It either dissipates, or turns into broadcast, or collapses. So plan for dealing with scale in advance, because it’s going to happen anyway.

*I got this via Mike Caulfield’s blog post here