The Self-Directed Medical Student Curriculum – A Medical Student’s Response

By Zack Merhavy

https://jamanetwork.com/journals/jama/article-abstract/2785917

The 3 authors from Warren Alpert Medical School provide information and insight as to how medical students study for their exams in their pre-clinical years. The authors use supporting data to express that the percentage of students that use school-created resources and lectures is declining whereas the percentage of students using outside resources are increasing.

Before dissecting the article, as medical students, I think most of us would likely agree that when it comes to being successful, the nature of the resource often isn’t what matters, but rather how well that resource is going to prepare us to pass exams and truly learn the material. I know a lot of people, both at Ross and other medical schools, who do not watch lectures and solely focus on outside material, and vice versa.

The authors posit that because students are using more outside resources than in-house lectures to prepare for exams, it means that the lectures are no longer necessary. The authors are under the assumption that if what they are providing isn’t working for students, they just shouldn’t provide it at all. I think we as medical students can agree that, for most of us, the lectures and slides are crucial in our understanding of the material; however, outside resources provide another perspective and more exposure to the material.

Regardless, it seems the authors are leveraging this idea with the LCME’s Accreditation Standard 6.3 to offer the perspective that medical students should essentially be left to their own devices when studying for exams. They are implying that medical curricula would be more efficient if students aren’t given lectures or in-house resources since they utilize outside resources anyway. LCME’s Element 6.3 states that the faculty of a medical school should ensure that the curriculum includes self-directed learning experiences and time for independent study to allow students to develop lifelong learning skills. Although the vague nature is expected, I can’t imagine the LCME was implying that all medical curricula should be entirely independent.

Later in the article, the authors discuss the ever-expanding nature of the available resources for medical students, implying that there is less and less need for the school to provide resources. They do at one point cede to the perspective that maybe schools can integrate some of these outside resources into current practices such as recommending specific sets of flash cards that may be of benefit for students. This would have been a refreshing balance if it was not immediately followed up with the implication that these flashcards could potentially replace slides, handouts, or even lectures altogether.

Logically, if medical students spend 2 years taking exams, studying completely independently, with only outside resources, it begs the question, “why go to medical school?” If a system is put in place where students pay hundreds of thousands of dollars just to sit at home and learn solely through Boards and Beyond, Rx, Anki, etc., what becomes the point? Would that system essentially be admitting that there might not be a need for formal basic science education altogether? Would it assume that students could theoretically study for Step 1 on their own and on their own time, pass, and begin clinicals?


Image found at https://en.wikipedia.org/wiki/Anki_(software)

Many medical schools across the world have seen an increase in self-directed learning modules, especially as a direct result from the ongoing pandemic. Just about every student I know at other medical schools who share these experiences have consistently expressed their struggles and frustration with being constantly told to essentially “figure it out”. Speaking personally, when given modules like this, I find it incredibly difficult to determine what’s important, what will I likely be tested on, how to approach the topic, how the information connects with previously learned material, and/or where I should even start.

Though I applaud the authorial team for taking the time to analyze these learning methods of medical students, the recommendations and ideas drawn from the data are unfortunately unfounded. There are countless other factors that come into play in medical education, and for them to make such a polarizing suggestion exemplifies a heavily misguided and myopic view of medical education reform.


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Ross Academic Research Society is a student organization at the Ross University School of Medicine that promotes research and evidence-based medicine.

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