Chapter 10. The Evolution of Medical Education

10.1 Instructional Context

Shayna Watson – Queen’s University

In this chapter, I review innovations in medical education over the last century through the perspective of ICE, a learning framework characterized by “opportunities to engage in critical thinking, and creative problem solving as ways to enhance learning” (Fostaty Young, 2005). I propose that there has been a move from a focus on Ideas to one trying to educate through connection, connection of content to context, and when educating for Connections across context we can see the beginning of intention to educate medical students with Extensions in mind.

In medical education we are not testing students for ICE – we are infusing their education with opportunity to take their learning in that direction, a direction that is not linear, but like a double helix, deepening over time and stabilized by connections and cross-linkages. The ideal educational experience affords time for learning, is based in patient care, and richly interconnects with students’ previous experiences. It is an education that is experiential and helps students to satisfy requirements and attain competencies but is not limited by them.  It is an education in which students are active and legitimate members of communities of practice, with ongoing learning relationships with patients, preceptors, and places. Students who learn certainty, seek certainty and students who learn in complex ways and environments are comfortable in the complex messiness of the real world. If we educate students to see Connections between their various experiences and domains of learning, articulate relationships, and connect skills in novel ways then they will bring these skills to their practice, it will encourage them to extrapolate to novel situations with confidence in their ability to anticipate and plan for varied outcomes.