Learn it-memorize it! Better yet--open your smartphone and use the information!

1309 June 2014 W ILLIAM Osler, M.D. (1849–1919; Physicianin-Chief, Johns Hopkins Hospital and Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland), the Canadian physician often called the “Father of Modern Medicine,” has been credited with the creation of 20th century medical education. What may have arguably been Osler’s most radical and important contribution to medical education was his belief that lecture halls were necessary but not sufficient to form great physicians. Applying adult education theory, that is, making learning relevant, Osler created the medical clerkship and sleep-in residency systems, bringing undergraduate and graduate medical students out of the lecture hall very early in their training. He recognized that applied learning was far superior to memorizing facts heard in the lecture hall. Curiously, medical students, residents, and fellows still spend countless hours in the lecture hall and similar passive didactic sessions. Continuing Medical Education programs, although more interactive than ever before, still have a long way to go in this regard. One only needs to view the American Society of Anesthesiologists’ Annual Meeting syllabus to appreciate how many passive lecture hours are included in the program. In anesthesiology residency and fellowship programs, as with other specialties, there is an expectation that educational time should be “protected” from clinical duties, allowing trainees to attend didactic sessions instead. For those of us working tirelessly to ensure the education of the next generation of physicians, we are left thinking, “Is there no better way to do this?” In this vein, we were excited to read the study by Hand et al.1 in this month’s AnEStHESIOLOgy: “Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients.” The authors designed an electronic smartphone “app” decision support tool for anesthesiologists. They demonstrated that interacting with the decision support tool in an “open book” method for learning resulted in applied learning that both improved adherence to recommended patient care guidelines and decreased healthcare costs. The effect of the new tool on the management of patients in the simulated scenarios decreased with subsequent practice; that is, practicing caring for patients appropriately using the “open book” tool resulted in improved and long-lasting care of subsequent patients. Hand et al. demonstrated what Osler chided us to recognize long ago: physicians learn best by doing. This effect is particularly important given the additional information that all study participants were offered a didactic lecture about the American College of Cardiology/American Heart Association guidelines 2 weeks before testing. Furthermore, additional years of training, that is, previous practice making similar clinical decisions, did not have any effect on how efficiently the anesthesiologists learned the clinical knowledge or were able to effectively apply it in patient care. The conclusions of the study by Hand et al. add to a growing body of evidence that our historically based medical education models need revision. Bloom’s (Benjamin Samuel Bloom, Ph.D., 1913–1999; Educational Psychologist and Professor of Education, University of Chicago, Chicago, Illinois) classic taxonomy of learning teaches us that factual knowledge is the lowest level of cognition.2 In anesthesiology perhaps more than in many other medical specialties, knowing/remembering/memorizing the right thing to do for a test does not necessarily correlate with doing/applying the right thing in real-time patient care. Case-based written assessments and newer forms of paper or computer-based knowledge examinations attempt to test comprehension and synthesis of facts rather than Learn It–Memorize It! Better Yet–Open Your Smartphone and Use the Information!