If you’ve ever taken exams at school, you probably remember studying for a test, taking the test and then promptly forgetting everything you studied. And how much of your high school or college classes do you remember? Often the answer is, “not much.”
But if you’re a neurosurgeon (or any medical professional) you have to do better than that. Much better. Neurosurgery education spans many years and covers an immense amount of information.
On top of that, neurosurgeons cannot simply study for a test, take the test and then “brain dump” the information. Their patients’ well-being depends on their ability to not just learn the information, but master it.
Dr. Christopher Winfree, Director of the Columbia Neurosurgical Pain and Peripheral Nerve Centers, is challenging the traditional way neurosurgery is taught to residents and interns so they master the content and remember it better long-term.
In the mid-2000s, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) realized there were some gaps in neurosurgery education, likely due to the reduced work-hour regulations. Residents were simply not getting enough instruction in some areas. To combat this they organized a series of “boot camps,” or short, intensive courses that allow residents to get focused training on specific areas of neurosurgery.
Dr. Winfree joined the faculty and planning committee for these boot camps in 2010, and it soon became clear that a module on pain management was needed.
He recently talked to AMA Wire about writing the pain curriculum: “I thought it would be an excellent opportunity to teach pain management at a boot camp level so the interns and junior residents are getting not only comprehensive neurosurgical training but also a focus—at least in one module—on pain,” he told the publication.
But he was also concerned about making sure the learning stuck. Although he was pleased with the curriculum, residents were still not performing as well as hoped on the pain management sections of their board exams.
At the same time, the newly passed Affordable Care Act was calling for a push for more comprehensive pain management education. As Chairman of the AANS/CNS Joint Section on Pain, Dr. Winfree found himself at the forefront of a national effort to improve pain management education.
Dr. Winfree’s solution was to replace the passive learning (traditional lecture and test) with a more active learning approach, in which students directly engage with and use information in different ways. He worked with his colleagues to develop a self-assessment exam, one that followed every point of the pain management curriculum.
It works like this: Students take the exam and discover how much they already know—or don’t know. Then they attend the pain classes and work with faculty members to learn the material. At the end of the coursework they take the test again and see how much they improved.
Dr. Winfree explained to AMA Wire, “When you have somebody study ahead of time and test her on the material, then show it to her in person, while she can sit one-on-one with faculty members in these sessions, and then you test her again, she has this stuff for life.”
Now Dr. Winfree is using this style of more active learning to make even bigger changes in how he teaches the regular Columbia neurosurgical curriculum, apart from the boot camps. Instead of presenting an hour-long lecture, for example, he has residents evaluate a series of 15-minute case studies. For each case, Dr. Winfree gives a brief presentation, and then the residents address it as a group.
This system has several benefits, he told AMA Wire. The first is that the sessions are short. “Studies have shown that an educated person’s attention span for a talk is 18 minutes,” he said. “This is why, for example, TED talks are typically only 18 minutes in length, and not longer”
Another benefit is that the sessions are case-based, with all the information connected to a patient scenario. “It’s not a lot of PowerPoint and bullet presentations. Instead, it captivates them. It’s active learning.”
The results have been encouraging. Residents say they like the changes and are learning better, Dr. Winfree remains hopeful that their subsequent test scores increase, thus demonstrating that the new system is working.
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