Knowledge without understanding has no value
When I was at medical school, I almost failed my pathology exam. I was poorly prepared, but that was not my undoing, I had a system that accommodated student distractions but still allowed me to pass my exams. Until this exam.
As I type, panic and fear spread over me as I relive that terrible moment of realization: I did not have enough time. There were too many facts to memorize and no way to compensate for their absence with insights, deeper understanding, or clear communication. I needed the naked, unadorned facts. And I did not know them.
Knowing without understanding
Should we prize fact memorization so highly? Education is about learning and understanding. Exams should be about testing what we have learned and understood, but testing fact recall often rewards knowing without learning, answering without understanding.
The bones of the hand offer an example. There are 27 bones, including eight metacarpals. We used a pleasing mnemonic — Some Lovers Try Positions That They Cannot Handle—to remember the metacarpal names and order: Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate. That I still remember this is a tribute to the devices we use to memorize. But what do I really know?
I know the names some humans use for some objects, the names humans give to hand bones in English, not in Polish or Indonesian. This knowledge does not teach me why there are eight or why they are in this formation. I understand nothing of their individual or collective functions, strengths, and vulnerabilities. But I can ace the multiple-choice questions.
Facts in the internet age
I started my medical career pre-internet when facts were both simpler and harder to come by. Simpler because fewer sources were available, harder because those sources were more than a click away. Memorizing facts was a valuable timesaving step in connecting symptoms to causes.
Today, the value of this memorization is hard to see. We still need to connect symptoms, causes, and treatments, and this has become deeply complex. We now have ready access to many more inputs, from patients, from peers, from science, from medical research.
We have the desire and duty to integrate this copious information to improve the care we provide. Standalone facts lend themselves to exam questions but rarely help us make connections. Spending hours memorizing facts that anyone with a smartphone can lookup feels pointless, and healthcare does not have the luxury of such self-indulgence.
Curation is king
Information is cheap and easy, we are drowning in data. Curating facts, connecting, judging, weighing, revising, integrating information is the new goal. And it is a bottleneck in healthcare. The training doesn’t teach us how to do it and doesn’t test how well we do it.
Changing education is difficult and slow; there are few incentives and many deterrents. But we must take a fresh look at what healthcare professionals need to learn and understand and how best we can deliver this.
Too much of current medical training is outdated, serving question-setters at the expense of students and the people they need to serve.