Tomorrow’s Medical History: A Discussion Of The Teaching Of Medical History To “Generation Me” Students
assessment, history of medicine, medical education, student selected component ssc
N Metcalfe. Tomorrow’s Medical History: A Discussion Of The Teaching Of Medical History To “Generation Me” Students. The Internet Journal of Medical Education. 2012 Volume 2 Number 2.
Recent research has attempted to characterise students born after 1980 as “Generation me”. This paper uses that research to make general recommendations to educators involved in the planning, delivery, or assessment to such students. It also uses the specific example of medical history teaching in Britain to highlight these recommendations.
Hippocrates suggested “The physician should know what the physician before him has known if he does not want to deprive himself and others”. 1Since the mid-nineteenth century there has been a debate regarding the merits of medical history in the medical undergraduate curriculum. 1-20Ultimately, it was the General Medical Council (GMC) publication
“Generation Me” students have been taught to “aim for the stars”. 24Studies have shown they are highly optimistic, self-confident, and ambitious. 24This has been advantageous in balancing gender applications to higher education as well as by increasing numbers of students from lower socio-economic hat aim for professional careers. 24Moreover, this has been disadvantageous for some. 24 Stress and anxiety have long been high in medical students but a described perfectionism has seen mental health problems rise in this current generation of students. 24-25 Twenge mentions that the students are either “crispies”, burned out from too much work and perfectionism, or “teacups”, perfect on the outside but easily broken if rattled. 24
A study led by this author recently revealed that summative essays and presentations were the most common method of assessment in history of medicine SSCs in the UK (see Table 1). 26 These develop research and presentation skills but can be time-consuming and place too much emphasis on student progression. No formative assessments are used. 26As “assessment drives the curriculum”, 27medical history providers are encouraged to develop strengths as formative assessors (see Appendices 1-2) and to use them (see Table 2). 28Formative assessments have helped reduce demotivation in students who had been high achievers at didactic teaching environments at secondary school but who then struggled at tertiary level. 28This is likely to be primarily from feedback which allows students to feel more confident to discuss their difficulties. It can also aid teachers to identify students in difficulty. 28Furthermore, some of these assessment tools could be used within a possible student’s “portfolio”. Importantly, portfolios can assess what a student “does”. This is the highest level of Miller’s pyramid (see Figure 1) for the assessment of clinical competence and preferred by medical educationalists. 29-30
Delivery of course
“Generation Me” students prefer experiential learning. 24They like to do rather than sit and listen to a lecture. This can include using several media technologies at once, both in timetabled and non-timetabled learning environments. Many “Generation Me” students have utilised computers since their early childhood and some of the pre-clinical undergraduates today may not be able to remember a world pre-internet. Fewer read books than in previous generations, which Twenge suggests has reduced the skill of reading long passages of text. 24
The method of delivering the teaching needs attention. Medical history is an ideal subject for experiential learning. This is because it could be done at an archive, historical society, museum, relevant archaeological or historical site. At these potential learning centres, if careful handling, showing, and discussing relevant historical artefacts and documents were to be permitted then the student can visually and physically encounter their chosen subject. This would be preferable to allow such learning when compared with the age-old standard lecture hall at the university campus. In addition, interactive sessions using people who have experienced past treatments, notable historical figures, National Health Service (NHS) and indeed pre-NHS, could be used. Why not learn from such people at their home, General Practice surgery, community centre, hospital ward, or pharmacy? This is all because research has shown that knowledge is gained most effectively when it is learnt in the context in which is to be applied. 31
Information technology also aids interactive learning. If lectures are being used, the maximum attention span of students is, on average, between 10 and 15 minutes, after which learning drops off significantly. 32-34Consequently, to interact with students and help the retention of information from short-term into long-term memory, 35lectures can be broken up using video, audio, and internet material. E-learning and e-teaching are described elsewhere 36 but it is important that future SSC providers consider using such technology and resources that are favoured by students. For some, and that includes myself, learning such methods of teaching could form part of a professional development need and be piloted and evaluated.
Narcissism is higher in “Generation me” students than in previous cohorts. 24 One of the facets of this is that more students feel entitled to higher marks for “trying” or “working hard”. 24 Such marks and not necessarily for actual performance. 24This was supported by a study that found a third of undergraduates believed they deserved a ‘B’ merely for attendance.37 This entitlement has caused more students to argue over their marks. 24This has been postulated to be due to students obtaining higher marks in secondary education for proportionally less work than their predecessors. 24In the UK, this may also be due to this generation now having to pay tuition fees compared with their predecessors who did not.
So how should medical history deal with narcissism and entitlement? In reality, it should do the same as other parts of the undergraduate course by ensuring that academic standards do not drop. Standards for marks in the subject should parallel other components of the undergraduate programme. Constructive alignment, when the curriculum is designed so that the learning activities and assessment tasks are aligned with the learning outcomes that are intended in the course, should be attempted. 34In turn, this allows the educational system to be consistent. 34 Written information, available via intranet, WebPages, or course booklets, should document grade criteria. These strategies would allow linked feedback to students and help counter the aforementioned possible difficulties.
“Generation Me” students have been described to be over-confident, entitled, mentally fragile, and enjoy experiential learning. 24This is a generalisation but there are differences in students of different generations. Furthermore, “Generation Me” students have been described using samples from the USA so how translatable is such research to other countries? The trend probably applies to other Western countries due to similarity of educational methods and cultural experiences, though this cannot be certain. However, if providers ensure that high standards are maintained, consider incorporating formative assessment and portfolios, embrace some teaching strategies outlined above, and incorporate evaluation that involves students, then “Generation me” students will enjoy and benefit from learning medical history. Perhaps Hippocrates’s words can be used for medical educators as well as physicians: only through awareness of differences between the generations can medical educators of the present and future help students to learn efficiently.
Appendix 1. Characteristics of highly competent teachers that affect the quality of formative assessment
Knowledge - Greater knowledge base and understanding of the subject matter than students
Attitude to teaching- Empathy with students, ability to communicate educational goals, desire to help students improve, concern for the integrity of their own judgements
Skill in constructing assessments- Use of varied assessment tools to develop different skills in students
Knowledge of assessment criteria - Awareness of standards and appropriate expectations
And appropriate standards- of students’ performance at a certain level within the curriculum based on learning outcomes and previous experience of student achievement
Evaluative skills- Ability to make qualitative judgements informed by experience as assessors
Expertise in giving feedback- Identification of strengths and weaknesses, evaluative comments in relation to criteria, suggestions for alternative learning methods, examples of different ways to achieve the goals
Appendix 2. Characteristics of formative assessment
Ongoing and frequent
Part of the overall teaching and teaching process
Promotes self-directed learning
Engages students in the learning process
Encourages deep learning and understanding
Offers help with specific remediation
Promotes self-directed learning by the students
Fosters interactive teaching and learning methods
Encourages varied and challenging teaching methods
Identifies students in difficulty early in the curriculum
Develops teaching skills
Evaluation feeds into curriculum development