Learning for Humans

Searching for the Heart of Medical Education

In a world of accelerating and disruptive change, there are few things that are likely to remain untouched within the house of medicine. The face of healthcare today will be unrecognizable to the next cohort of physicians on the near horizon. Yet there remain some persistent truths I hope will continue to sustain us and live in the hearts of physicians for generations to come. Here is the one I hold most dear:

“We are inspired to learn because what we learn has the potential to help others.”

This foundational truth of our profession is my daily pilgrimage, and my life’s journey. I see it humbly embodied year after year in my dedicated colleagues. I see it in the next generation of physicians who train side by side with me; who return day after day to the bedside in an effort to translate their new knowledge into patient care. And for those who know me, it’s an open secret that I often draw my inspiration to be a better doctor from those I work with.

Sadly, I’ve been forced to realize that our desire to learn in the service of helping others is not an immutable truth. Although resilient, it’s one that can be bruised and battered when exposed to the relentless assault of a healthcare system that makes increasing demands on our time, and implements certification requirements that have priorities other than the quality of physician learning.

If care isn’t taken, this assault can slowly transform our physician learning experience into one that devolves into simmering resentment — replacing inspiration one checkbox at a time with mandatory learning tasks designed solely for the “maintenance of certification” (MOC). When this happens, a basic truth at the heart of our profession is damaged.

I know this ugly transformation in the desire to learn can happen because I’ve experienced it — feeling the disappointment, depression and heartbreak that happens when one of the major sources of inspiration in my professional life became slowly buried under a flood of meaningless MOC requirements, and a string of disappointing educational experiences along the course of my medical training.

I also see the daily effects that competing priorities and a MOC approach to learning have on my colleagues, and even more distressingly, on many of the students and residents I teach. Like climate change, it’s a slow and insidious process, but evidence of its effects in our environment are all around us.

Loss of potential talent to other career choices, high physician burnout, high suicide rates, early retirements, and increasing job dissatisfaction amongst physicians have set off alarm bells for those charged with maintaining our healthcare system, and it has put a renewed focus on physician wellness.

Concern for a better work environment, more work/life balance, and early awareness of potential problems are frequently tossed around as solutions to the problems facing our profession, but this cannot be our only response to the situation we face. Remembering and nurturing what inspires us to be doctors is also at the heart of physician wellness and job satisfaction.

As a profession we are not simply a highly trained workforce that wants to be treated well. Neither are we snowflakes who need to be coddled, or who need special treatment in order to be fulfilled at work. In fact the opposite is true. As doctors we often relish the hard work. We are a profession inspired by a set of ideals; made up of individuals who are often willing to put aside friends, family, even our health in the service of our profession.

However when we take any of those ideals for granted (by piling on learning requirements without thought to their impact) we ignore that which lies at the heart of our profession to our own peril, and needlessly threaten to cut off the lifeblood that sustains us.

Instead of ignoring these ideals, or making the false assumption that they will always be there to sustain us, we should be devoting more energy towards designing institutional and personal spaces that nourish them; give them space to take root early and grow, in order to sustain us across the arc of our careers.

For me the simple truth that “we are inspired to learn, because what we learn has the potential to help others” is a clear imperative to listen more closely to the discouraged voices within our house that mourn the current state of learning in our profession, and it should be read by anyone who cares about the future of medical education with this emphasis:

“We MUST be inspired to learn, because what we learn has the potential to help others.”

It is inescapable that, along with patient care, the physician learning experience is at the heart of our profession, and that in an era of accelerating change how we learn takes on increasing importance. Not because we need to keep up with the latest educational fads, but because how we learn has consequences for the ideals that sustain us.

By now it should also be clear that simply adding additional time consuming and costly MOC requirements will not fix what ails us. Neither will technology and innovation alone save us from this problem. While we race ahead and seek more efficient and effective ways to improve our healthcare delivery system, we must also create a better learning delivery system — a learning system designed for humans. One that remembers who we are as doctors.

Innovation in a healthcare delivery system also requires investing in innovation in our learning delivery system.

A better learning delivery system does not require any fancy education theory, or even huge investments in technology, only a set of guiding principles, and a willingness to invest in learning structures that are designed to support that deeper understanding of why inspiration in our profession matters.

Where do we go from here? We can start by recognizing that the daily juggernaut of a healthcare system that lavishes resources on innovations in healthcare delivery, but rarely finds the extra resources for innovations in learning delivery will continually fail to reach its full potential because it fails to invest in one of our most valuable resources: the ideals that drive us to be better than we are today.

In our rush to dissect the patient experience, we have forgotten to explore the provider experience — among them, what it might feel like if physicians were provided a pathway to sustainable, even joyful, lifelong learning, and the impact this might have on the quality of healthcare.

For many, finding innovative ways to design inspiration into the learning experience will seem like a squishy and intangible goal. But for those considering how to provide a resilient workforce of physicians who can deliver high quality healthcare in the face of rapid change, we need look no further than the ideals that sit at the heart of medicine. Building a learning delivery system that sustains that heart might be a good place to start.