Shifting paradigms in medical education

Written by Jeff Kraakevik, M.D.

The video included with this post is eleven minutes and forty-one seconds long. It’s a little on the long side for a web-distributed video, but I think it is well worth the investment of your time.

The video was first posted in 2010, and is by Sir Kenneth Robinson. In it, he outlines how our education system as a whole has been shaped by the forces of history which were around when the modern education system was formed. He then outlines why this paradigm doesn’t work as well 100 years later.

He is using the elementary education system as an example, but I think the principles apply to medical education as well. I’d like you to watch it, and think about how what he is talking about applies to medical education. If you are pressed for time, skip to the 6:33 mark as that is where the most applicable bits start.  (A note to anyone who may have a stake in the ADHD debate: please don’t get distracted by this sub-point in his talk–that is not why I’m asking you to watch this.)



After you’ve watched it, I want you to think about how this “old” paradigm of factory-processed students being put into separate silos to learn for standard amounts of time is a really great description of most of the current medical education.

Remember that divergent thinking skills are critical for clinical problem solving. How is our current model of training either impairing or empowering those divergent thinking skills in our current curriculum?

Now, step outside that model, and dream about what could it look like as changes are made. We have the technological tools to make a competency-based education with real-time collaboration across teams and across disciplines a reality. What would the first two years of the medical school curriculum look like without set time-frames for students to complete a course on neuroscience look like? What would it look like if students moved on to the next subject or course after demonstrating they have mastered the skills necessary to move forward, and not because the 8-10 week course is done? What would a curriculum look like if there were no walls between the courses?

Now, I want to assure you this is not likely where OHSU in particular will be when the curriculum reform process is completed. I really think it is not possible to get to this level of learner-centeredness within one curriculum reiteration. But, I do put this up as a model worth considering, and it is a worthwhile discussion to debate its relative merits and risks as we do come up with our actual model of educational curriculum.

For further reading, read this recent blog post by leaders within the AAMC titled “Competency-based Medical Education: The Time is Now.”

[Special note to OHSU School of Medicine faculty, staff and students: consider attending the curriculum transformation retreat on Oct. 9. More details on the intranet (log-in required).]


Jeff Kraakevik, M.D., earned his medical degree from the University of Iowa and his fellowship in Movement Disorders from Oregon Health & Science University. He joined the OHSU movement disorders faculty in 2006 and is currently an Assistant Professor of Neurology. Dr. Kraakevik holds the unique distinction of being a former high school teacher. He has followed this trajectory of educator and currently heads up the development of medical student and resident education for the OHSU department of Neurology and VA Medical Center where he holds a joint appointment. Dr. Kraakevik’s research interests include gait and balance problems of Parkinson’s disease as well as research that explores the best teaching practices for medical education.

You can also follow him on Twitter and at his neurology education blog.

One response to “Shifting paradigms in medical education

  1. I am now going to seek more from this presenter. The concepts are clear. Thank you. It WAS worth my time to w.atch

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