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Reflecting on what is missing in medical education – A letter to a mentor.

Below is an excerpt from a letter I recently sent to a friend and mentor.

I hope by sharing it it may inspire others to think through these issues, and hopefully to share their ideas with the community.


Dear (Mentor):

We began our conversation with the definition of learning: “Learning is the extraction of insights from experience…and this extraction comes through reflection.”

I am in complete agreement and support of this statement.

(Interestingly today’s ‘rapid learning models’ try to automate the extraction and the reflection processes through algorithms and computational analysis…but it is still the human adult learner that needs to then react to this computation…presumably the reaction will be grounded in trust, relevance, and context; but this is fodder for another conversation.)

We discussed in brief the learning moment ‘when eyes dilate’ and insight has been initially identified. Perhaps we could also say that the learning moment includes the moment of cognitive dissonance, but that might cloud the term – clearly there are moments of dissonance when insight does not immediately follow. And clearly there are learning moments that are not actually moments, but actually prolonged periods of intermittent reflection that might not rise to solution and insight. This temporal element of learning plays a large role in where my head is at currently.

If learning is indeed a ‘process’ then there is surely a temporal element which may be on the scale of 30 mins or 30 days. As educators, is it not our obligation to build the support systems around and beneath our learners such that the time for re-exposure to an idea, the time for reflection, and the time for extraction of insight is as simple, efficient, and effective as possible?

It might help to think outside of the classroom and to think outside of the mentor/facilatator role: How can educators craft a better architecture that supports the prolonged process of learning? (I think this is my most basic question…and the question I that I have been working on answering for several months now.)

We then discussed the 4 questions of learning (forgive my paraphrasing) that a learner must answer before making the investment to learn:

  1. Is it relevant?
  2. Is it possible?
  3. What would it take?
  4. What is the benefit of learning it to me?

As I see it, these questions are neither binary or consistent. There would be shading in my answers and at different times I might answer each question differently…again, this leads me to ponder the temporal nature of reflection and extraction…and to therefore also question the temporal nature of a requisite learning architecture.

I do love considering the idea that so many adult learners have engineered their own structure in support of their learning process (I have written about this before at length) and this confounds the problem. The medical education community, especially the CME community has hardly considered the relevance of the learning architecture – in fact many have told me that they have faith that clinicians are smart people and therefore they know ‘how to learn.’ The reality is that extraction of insight is rarely a linear process…in fact it is quite often a laborious process. And if we rely on learners knowing how to learn, if we rely on the tens of thousands of unique and jerry-rigged learning architectures that learners have built for themselves, then is it any wonder we find it so difficult to make a connection between educational content, learning, and behavior change. There is little question, we are failing in this regard.

We may each be able to share examples of how we learn and we might each be able to share examples of how learning takes place within our educational programs, but I would argue that upon greater reflection, we would realize that we are barely making a dent in what is needed. My argument is that by moving beyond content development and by exploring new models for content architecture, we may very quickly come to learn that we can indeed transform medical education in meaningful ways.

This reminds me…I probably have some notes from our last call that I never got a chance to reflect on…

In pursuit of learning,



I hope there are some greater lessons to be learned from this letter and perhaps some novel ideas are generated.  I don’t claim to have all the answers, but having conversations such as the one that lead to this letter make me realize how lucky I am to have the career I have, to have the social graph I have, and, from time-to-time to have access to some of the great conversations I have.

All the best,


Written by

Brian is a research scientist and educational technologist. He helped transform Pfizer’s Medical Education Group and previously served in educational leadership roles at HealthAnswers, Inc.; Acumentis, LLC.; Cephalon; and Wyeth. He taught graduate medical education programs at Arcadia University for 10 years. Dr. McGowan recently authored the book "#socialQI: Simple Solutions for Improving Your Healthcare" and has been invited to speak internationally on the subject of information flow, technology, and learning in healthcare.

One Response to “Reflecting on what is missing in medical education – A letter to a mentor.”

By Greselda - 8 February 2013

Dr. McGowan,
A few things came to mind while reading this:
1. My ongoing interest in why learners are motivated to seek information and subsequently “learn”, then apply in practice is a few questions too short.
2. Beyond that I should have been inquiring as to the motivation of the HCP learner to consistently apply the best practices they were motivated to learn, what are the skill sets and tools that support consistent best practice behaviors, and does the education reinforce and support application of best practices.
3. Clearly, it is not the education alone that will move close the quality chasm, it is also the infrastructure that supports the learner.


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