Dana J. Herrigel, M.D. Assistant Professor of Medicine, Mayo Clinic Alix School of Medicine
How do we create conditions for success as lifelong learners in a turbulent world?
I was recently teaching a group of medical students, and we encountered a particularly difficult clinical scenario. A patient with terminal brain cancer presented with psychosis and requested to leave the hospital against medical advice to die peacefully at home. This unique problem challenged the students’ medical knowledge and ethical discernment, and required careful examination, deliberation, and shared decision making. A human life was in the balance, with no “textbook” answer.
In the midst of our insightful discussion, one of my exceptional students could not contain themselves any longer and exclaimed, “But Dr. Herrigel, what is the right answer on the test?” And for a moment, I was speechless.
How could this bright and empathetic student have been so utterly focused on “the test”? My thoughts shifted back to the time when dedicated learning patterns begin: high school. The students sitting in classrooms now are in training to become lifelong learners. Classroom learning involves a bolus of information and a subsequent assessment of understanding and retention, typically in the form of a test. The bolus-assessment paradigm can be considered laminar flow, where orderly information is moving linearly in one direction. Teachers provide clear objectives, and learners are given concrete solutions. At the periphery, there may be eddies and vortices when a student encounters difficulties or asks questions outside of the standard curriculum. The laminar flow of learning is hardly disrupted, with content constraints and the pressure head of time pushing ever forwards.
I can recall making the transition from AP courses in high school to chemical engineering exams in college: these were NOT “multiple choice.” The expectation was to solve problems never before seen in the textbook or in class. These exams were challenging, yet problems were pre-formed and well-defined, and remained within the bolus-assessment paradigm.
Learning material in order to achieve a high score on a test conditions students to seek one “right” answer. Standardized multiple-choice style tests reinforce this concept by giving discrete options as solutions to a problem. Placing value on the approach to problem solving is arguably far more important than the outcome of any single test.
The transition from laminar flow to turbulent flow occurs during the transition from classroom to “real-world” learning. Real-world learning, whether it’s in the form of an advanced degree, initial on-the-job learning, or the kind of learning that happens as you mature in your career, is much more stochastic (i.e., chaotic). The questions are not known, they must be sought after. The answers are not always clear. Knowledge once solidified becomes liquid again – it is challenged by new information and new paradigms. This turbulence can be such an abrupt change, learners who once thrived in the classroom may find themselves feeling overwhelmed. In the turbulent flow of learning, thoughtful consideration, seeing multiple sides of an argument, and critical appraisal of evidence are crucial in framing and solving problems and moving forward to new insights.
How can teachers better prepare students to thrive in the turbulent flow of lifelong learning? Consider the following principles:
When presenting new information, encourage students to pursue evidence. What is the basis for these “facts”? Truths are not simply won; data is amassed with much effort over time.
Model how to organize information systematically when it is received from multiple sources and in a variety of contexts.
Promote teamwork to optimize creative solutions.
Value curiosity; praise the questions over the answers.
My medical students have succeeded in the laminar flow, rewarded for academic excellence and test-taking skills. When our intense discussion was interrupted by the question, I paused. What is more tangible to these students - the answer on “the test” or the outcome of the patient? Making decisions that will influence a human life is not a multiple-choice test, but a complex dilemma that requires drawing from many areas of knowledge, experience, and teamwork to come to a unique patient-centered solution.
I smiled and responded, “This is real life - there is no test! Thank you for asking… and what other questions do you have?”