7 Student-Directed Learning—Central to a Medical Student Education – by Debra L. Klamen

Debra L. Klamen

As I began to reflect on the role of student-directed learning in a standards-based world, as Senior Associate Dean of Education and Curriculum at Southern Illinois University School of Medicine (SIUSOM), I immediately began to think about its role in medical education—surely a standards-based environment if ever there was one.

My first emotional response was, “What is its role? Essential!” “Can/Should we promote it? Absolutely!”  I hope by the end of this short article you, the reader, will agree with me.

To talk about student-directed learning, one must first define it, and to do so I will borrow its four main definition points from the Glossary of Education Reform (1). After each component of the definition, I will include why each piece must be actively included in modern medical school curricula to meet the needs of future physicians and the patients they will serve. Short examples will be included where relevant.

Definition of student-directed learning:

1. Teaching and learning is personalized, meaning that it addresses the distinct learning needs, interests, aspirations, or cultural backgrounds of individual students.

Future physicians must be self-directed, life-long learners, who are able to solve problems on their own, and in short amounts of time. Addressing specific interests and aspirations of future physicians keeps them motivated through the seemingly endless bytes of material they must learn. Further, medical students are an intelligent and talented group of individuals. Allowing students’ space to follow their own interests throughout medical school training will push even the most talented student to continue to learn and improve. Medical schools should attempt to diversify their class rosters because a varied group of physicians is needed to treat an increasingly diverse world. Acknowledging and addressing these cultural backgrounds in medical school is therefore crucial.

2. Students advance in their education when they demonstrate they have learned the knowledge and skills they are expected to learn.
   

Medical education is becoming increasingly competency-based, meaning that time to graduation might become more variable, but the basic competencies of a graduating medical student must be tracked and met, by graduation, by all students (or they should not graduate). Medical students must learn material deeply, not simply to pass a test or get a good score on the United States Licensing Examinations, but because the grade is not the end to the learning process. Physicians must use, continue to learn, and retain knowledge in order to better treat their future patients. A teacher-directed learning style may help them rotely memorize lots of data points, but the data is sure to be forgotten after the examination.

3. Students have the flexibility to learn “anytime and anywhere,” meaning that student learning can take place outside of the traditional classroom and school-based settings.

An essential need of medical education is to get students out of classrooms and into clinical experiences (both with real patients and those that are standardized). For example, these activities begin at SIUSOM in the first week of medical school. Standardized patients, computer-based simulations, and clinical experiences allow sufficient time for students to become critical thinkers and enable them to reflect on their experiences. This experience is critical for a physician’s ability to continue to learn and grow throughout his/her career. The effort (put forth by the students) and the trust (by the instructor that the students will learn in this manner) is a model (2) that will be used throughout residency training as well. Thus, it should be experienced in medical school early on as students are beginning to form their own professional identities.

4. Students are given opportunities to make choices about their own learning and contribute to the design of learning experiences.

Choices about learning are critical to future physicians because they will be making these choices for the rest of their careers. For example, SIUSOM has a variety of such opportunities, including self-designed research time in years one and four, 15 weeks of a “Personalized Educational Plan” in the third year of medical school (3), and an entire fourth year of Electives (self-designed and otherwise).  Students also need the opportunity to try out and refine their ability to be leaders. Leadership is not explicitly taught in coursework, but it is an essential skill for future team leaders. For example, a group of senior medical students at SIUSOM researched, designed, and now teach a “coachability” curriculum that is given in years one and two.

Too often in educational settings (medical school and otherwise), the need for organizational efficiency is emphasized to the detriment of efforts to enhance student learning. There are always arguments for efficient teaching (lectures to a passive audience), but there is often a failure to reflect on whether these methodologies are actually effective. Medical education needs to enable student-directed learning through a culture of creativity, innovation, and a deep and rich appreciation for the teaching and learning processes themselves (4). This culture, widely apparent at SIUSOM, is undoubtedly one of the reasons we have been asked to contribute to the commentary on this important topic, and we are honored to do so.

References

1. Student-Centered Learning Definition. The Glossary of Education Reform. https://www.edglossary.org/student-centered-learning/  Accessed October 4, 2019.
2. Adams S, Bilimoria K, Malhotra N, Rangachari PK. Effort and trust: the underpinnings of active learning. Adv Physiol Educ 41:332-337, 2017.
3. Klamen DL. Getting Real: Embracing the Conditions of the Third-Year Clerkship and Reimagining the Curriculum to Enable Deliberate Practice. Acad Med 90:1314-1317, 2015.
4. Cuneo C, Harnish D, Roy D, Vajoczki S. Lessons Learned: the McMaster Inquiry Story from Innovation to Institutionalization. New Directions for Teaching and Learning, no. 129, Spring 2012. Wiley Periodicals, Inc. Published online in Wiley Online Library (wileyonlinelibrary.com). Accessed October 4, 2019.