December 5, 2020

What Businesses Can Learn From Medical Education

As education everywhere continues to be disrupted by the pandemic, medical students are being particularly impacted. Students in their third and fourth years of medical school are losing valuable opportunities to apply their knowledge in hospitals and clinics.

Without a series of longer-term rotations through various specialties and patient interactions, the fear is their education will be subpar. This problem has been more than 20 years in the making, though it took the pandemic to put it in the spotlight: in-person, on-the-job experiences and skill development can be too easily disrupted.

The implications go well beyond medical schools. The massive conversion of education from largely in-person to online — too often, ineffectively — has removed crucial opportunities to practice and apply knowledge until it becomes second nature, or what we call achieving automaticity.

Medical education often has been one or two decades ahead of corporate learning — and pilot training has been even further ahead in many ways. The reason may be that the lives of pilots and their passengers are at risk, making training all the more important. The same applies in medicine when it comes to protecting patients’ lives.

Therefore, as medical schools struggle with how to provide the kinds of experiences gained in rotations, business leaders can find parallels to ensure that their workforce is prepared for the future. As McKinsey observed, “Technology and people interacting in new ways is at the heart of the new operating model for business — and of creating an effective post-pandemic organization.”

The Importance of Applying Knowledge

From medical school lectures to the typical corporate training session, the focus traditionally has been on imparting as much knowledge as possible. But cramming information into short-term memory is not real learning. (The Ebbinghaus’ forgetting curve shows that within the first 24 hours, 70 percent of newly acquired information cannot be recalled, and as much as 90 percent is lost within the first two weeks. Similar studies have been repeated throughout the decades, coming to similar conclusions.) That’s why applying knowledge to improve retention is so important.

For medical students, this cause has been taken up by the Association of American Medical Colleges (AAMC), which said in an Aug. 14 letter that, while medical students are not considered essential health care workers, they are “the essential, emerging physician workforce.” AAMC stated: “Close and ongoing collaboration between medical schools and their clinical partners is particularly critical to ensure that these national workforce needs continue to be addressed.”

With all due respect to the AAMC, the solution is not simply putting medical students into hospitals to treat Covid-19 patients and others. A long-term solution is needed to ensure that these doctors-in-training have impactful ways to apply their knowledge, and not just by having access to “patient material” (a term that should give us pause) — meaning the bodies and biological samples of real people.

Working with others does develop the 21st century skills of communications, critical thinking, collaboration, and creativity. For doctors, patient contact allows these “soft skills” to be honed and practiced, just as customer contact makes for better business outcomes. But for the development of many other kinds of skills, such as decision-making under pressure, dedicated learning environments such as simulators are crucial.

As researchers observed, “Simulation is used to train many professionals including pilots, military personnel, business managers, and health care professionals, and is an effective active-learning technique that encourages the application of knowledge and skills in real-world scenarios.”

The Importance of Simulation

Simulators immerse learners in an array of problems and crises. Learners gain decision-making experience to help them identify problems and find the right solutions — much like a doctor learns to diagnose a patient’s condition and prescribe a course of treatment.

A classic example is training of U.S. Army medics in the early 2000s before being deployed to Iraq and Afghanistan. The use of 142 life-size human patient simulators at Fort Sam Houston revolutionized medic training, involving everything from applying tourniquets and inserting IVs to dealing with gunshot wounds, loss of limbs, and chemical burns. These mannequins (which cost $37,000 each at the time) weren’t just about developing clinical skills; they also allowed the medics to practice clinical decision-making under pressure. Describing the simulation training, the New York Times called it “as close an approximation to battlefield conditions as anything this side of Kandahar.”

Admittedly, high-quality simulators are very expensive, and medical schools have largely deferred investing in them. For today’s medical students, this decision is proving to be a costly mistake. It’s not unlike some shortfalls we’re experiencing in a lack of vaccine development before the pandemic and low inventories of ventilators. Given the pressures on health care to treat more patients (often with complex medical conditions) in a system that is resource-constrained, improving medical education with the use of more simulators is an investment in public health.

Twenty years ago, when my colleagues and I were developing ways to improve medical education, we were motivated to help ensure that critical knowledge was retained. Otherwise, knowledge gaps develop, and mistaken assumptions lead to “unconscious incompetence,” which is when people believe they know something but, in fact, do not.

Unconscious incompetence among doctors and other clinicians can lead to medical errors, sometimes with tragic results. In the late 1990s, the seminal report To Err is Human found that as many as 98,000 avoidable deaths a year were due to human medical errors. This revelation led to a wave of innovations, including the importance of checklists to ensure no steps were missed and procedures were always followed, and the development of computer-based solutions to practice clinical decision-making.

Unconscious incompetence is a problem in every industry, affecting learners in as much as 30% or 40% of the material they are studying of tasks they are performing. Business leaders cannot assume that on-the-job training will suffice because such learning often happens only sporadically, and sometimes not at all. Just because the wheels keep turning every day and business is being conducted, leaders cannot assume that employees are learning. Too often, “heroic efforts” by employees who step up to do what needs to get done cover up the learning gaps of others.

If organizations are going to move forward post-pandemic, the key is having effective training that imparts knowledge and provides opportunities to apply it.

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