I have some opinions.

Traditional Teaching of OB-GYN

At many institutions, OB-GYN is taught today much like it was when I was in medical school 50 years ago. For that matter, it is still much the same as it was when my Grandfather Cartmell was a medical student at Northwestern University in 1900.

There are some recurring problems with this traditional structure.

No one can predict which patients might be in the hospital at any one time, nor what their clinical issues might be. There could be several patients with the same disease, but no patients with other important diseases. Consequently, the breadth of student clinical exposure is limited.

Didactic Lectures. Some are good, some not so good. Some are missed by lecturers or by students. Lectures and Lecturers are sometimes selected more on the basis of tradition, availability, and academic hierarchy than the needs of the students. Even good lectures are often an inefficient use of student time…an hour lecture could be covered by a scripted and recorded lecture in 1/3 the time, and if played back at 2x speed, could be covered in 1/6th the time. Without any loss in comprehension or retention.

The style and most of the content of this traditional training continue to be based on medical care and medical education paradigms that are more than 100 years old (Following the Flexner Report). But during the last 100 years, massive changes in healthcare have occurred. Among these are:

• • Shift from hospital based care to ambulatory care
  • Shift from solo providers to institutional and group practice
  • Improved management, rendering older methods obsolete
  • Internet / digital resources for patients and providers
  • Electronic medical record keeping
  • Changes in finance  (Insurance, Government)
  • Explosive growth in research funding
  • Specialization and sub-specialization
  • Growth of full-time faculty (research funded)
  • Changing role of voluntary (teaching) faculty
  • A global pandemic necessitating social distancing

Despite these major changes, it strikes me that medical students are still being taught mostly the same material, in mostly the same way, as when I was in medical school.

The high cost to the student of medical education. When I graduated from medical school in 1974, annual tuition for me was $2500 ($12,775 in 2016 dollars). If I were attending the same school in 2016, my annual tuition would be $49,318, a four-fold increase in real dollars. It’s not clear whether the medical students of today are getting a four-fold increase in the quality or quantity of their medical education compared to mine. I think not.

So I have worked hard to address these shortcomings through electronic learning. I don’t claim that someone who goes through all of these videos will be qualified to pass through to the next stage of training. There still must be hands-on experience and close interaction with supervising physicians through accredited institutions. But I do believe that remote learning will provide great support to the students who use it, enhancing their knowledge in ways that are certainly different, and may be superior in some respects to what they are otherwise experiencing.

Online Learning. I’m persuaded that online  education and medical simulation is the future of medical education. I’m confident that this small venture into online medical education soon will be joined by others, and probably replaced by even better simulations and better training.

More than half the visitors to my other websites arrive using mobile devices (tablets and smart phones).  I’ve tried to make this material as usable on a mobile platform as it is on a desktop or laptop computer.

I’ve also tried to make use of all of the science of how students best learn off screens. This is more complicated than it would seem, and there is a learning curve to addressing these needs. My later efforts are much better than my earlier efforts. I intend to continually improve in this area.

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