What Are the Advantages of Differentiated Instruction?
When educators don’t proactively implement instructional strategies that align with their students’
The world’s eyes have never been so fixed on health. Even before COVID-19 ravaged the globe, the healthcare field was marked by dramatic change. Healthcare communities have had to grapple with a number of challenges that include a global shortage of healthcare professionals and a drastically shifting policy landscape within the United States.
Innovators have met these problems with new perspectives and techniques in both practice and pedagogy, attempting to combine new trends in education and information with modern technology to address today’s challenges in health science education.
According to Luke Bonney, CEO at Redox, change is just beginning.
“In the next decade, the industry will see the rise of the first set of healthcare leaders who are digital natives. This will have a profound impact on healthcare organizations.”
The next generation of healthcare leaders will bring a different set of assumptions to work—different ideas about what is and what should be possible.
Health science education must evolve accordingly. Here are five of the most impactful health science education trends.
The barriers between nations have become more porous. Just as health concerns travel across borders, so do health professionals and students.
More and more medical students pursue at least a portion of their education abroad, and young professionals often serve on international rotations. As individuals leave to navigate different locales, the need for common standards has become clear.
A standardized curriculum befitting a globalized field will include:
Emerging health education institutions—particularly those in resource-poor countries—often model themselves on established institutions, but this is to their detriment. Administrators and educators in resource-rich locations can presume certain availabilities as well as cultural values, systems, and safeguards. Their models frequently fail to suit the needs of many parts of the world.
Standardization and a focus on demonstrable ability instead of assessment helps move health science education away from specific, often irrelevant academic cultures and toward real-world practice. Institutions are increasingly adopting a standardized set of competencies and evaluating their students in context, according to measurable demonstrations of skill.
Perfectly uniform care may be impossible, but institutions can demand a more consistent set of competencies and a unified vernacular that applies across the globe. Universities and continuing education programs are in the process of reevaluating their health science education standards and developing a universal vocabulary. Many schools are attempting to reinvent traditional programs, break free of curricular inertia, which all too often stifles improvement, and create programs that measure competency via practice, not assessment.
Once demonstrated competencies have been certified or otherwise verified, students can collect their work and certifications in a learning portfolio, tracking their education and performance and making necessary changes or additions. Unlike milestone exams or degrees, a fluid portfolio can extend into continuing education, ensuring all working professionals keep their skills current.
Competency-focused portfolios also enable flexible education. Programs can be tailored to local health needs, allowing institutions and students to prioritize certain skills over others. Instead of demanding expertise that may not be relevant to a community, institutions can let students develop a responsive portfolio of care. At the same time, resource-rich and resource-poor places can both benefit from the enhanced communication and consistency of a clear, competency-based metric.
Standardization will also help to address the global shortage of healthcare workers through greater task-shifting. One 2016 study indicated that the global demand for healthcare professionals would reach 80 million by 2030, while the supply would reach only 65 million. Students and professionals with demonstrable specializations or skills can relieve much of the burden on overworked doctors. They are also relatively cheaper, as their education requires less time and funding.
Ironically, uniform expectations will open the doors for greater individuation within student education. To better gauge student skill, knowledge, and professionalism, schools are looking to curriculums that can be tailored and adjusted to the individual.
Each individual learns at a different pace. Traditional instructor-paced curriculums run with strict timelines and do not afford great flexibility. Modern curriculums will be more learner and learning-focused to encourage greater active self-direction and allow students to learn at their own speed.
The proposed shift to learning portfolios is also a huge step in the right direction. By centering around demonstrated competencies in context, learning portfolios help to break down old academic fetishes such as traditional exams in favor of more relevant demonstrations of skill.
Collecting different types of assessments into a portfolio allows both students and instructors to judge content-mastery instead of assessment-mastery. It’s well-established that high test scores do not always mean an individual is effectively prepared for professional practice—often, tests simply gauge test-taking ability.
A shift towards content-mastery also prevents individuals from compensating for a “failure” in one area of course material with “success” in another. Most grades judge success by averaging assessments of the same type, such as multiple-choice exams or lab work. This means that a student can offset poor performance in one area with outstanding performance in another, with the unfortunate consequence that the individual is deemed competent in both.
Learning portfolios play a key role in programmatic assessment, the routine and ongoing collection of information about the learner’s progress, developmental processes, and attained levels of competence. Schuwirth et al. (2017) compare programmatic assessment with medical diagnosis to emphasize the need for comprehensive assessment in health science education:
“Much like there is no single instrument that will diagnose any illness in its full scope, there is no single instrument that will assess ‘competence’ in its entirety. Diagnosing in healthcare involves the careful collection and collation of information from various sources such as the history, physical examination, lab tests, pathology or radiographic studies. Likewise, programmatic assessment is the careful collection and collation of information from various sources not only to diagnose the examinee’s competence but also to promote and improve their competence.”
Schuwirth et al. urge institutions to provide better mentorship, relationships in which this kind of holistic diagnosis becomes possible. They suggest the use of official mentors, separate from assessors, that can facilitate dialogue and provide helpful feedback.
Learner and learning-focused pedagogy must constantly adapt to changes in information technology and student needs to keep students engaged. In Jeffrey Gold’s 2014 inaugural address, the chancellor of the University of Nebraska’s Medical Center declared,
“[I]t is no longer a question of whether an individual can retain or access facts, but how they use them, evaluate them and apply them to the day-to-day challenges of the healthcare of individuals and of their communities.”
In line with these changes, universities must move away from many traditional teaching methods—particularly methods aimed at memorization and test-taking—and toward newer methods that encourage critical thinking and strengthen problem-solving abilities.
To evaluate student engagement along these lines, Michelene T. H. Chi and Ruth Wylie developed the ICAP framework. The framework classifies student interaction with course materials according to four different modes:
For example, students might engage with a text in the following ways:
Using this framework, Chi and Wylie discovered that student learning increased as engagement moved from passive to more interactive.
Several studies have applied the ICAP model to health science education and discovered similar results. One study found that interactive activities were most productive when preceded by constructive ones. Students were best able to take advantage of discussion when they had already engaged in constructive cognitive engagement through question-formation and self-explanation.
The model of the physician as the autocratic decision maker and sole care provider is now, in many cases, a vestige of the past. Moving forward, collaborative healthcare will take center stage.
According to the World Health Organization, collaborative practice in healthcare “occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, careers, and communities to deliver the highest quality of care across settings.”
The movement towards interprofessional collaborative practice (IPCP) has been happening for decades, but the last fifteen years have seen a surge due to several factors:
Physicians will increasingly work in concert with nurses, physician’s assistants, therapists, nutritionists, social workers, and pharmacists to provide consultative team-based care.
Health science education will develop accordingly. Universities have already begun to create curriculums with team-based, interdisciplinary, and interprofessional elements. Interdisciplinary educational initiatives will be particularly important to bridge the various healthcare professions.
Interdisciplinary studies help:
The current health crisis underscores the need for communication and teamwork. In addition to nurses and technicians, future health science professionals will work with students from schools of public health and take courses in business and management.
Technology pervades every aspect of modern life, including how we learn and teach. Instructors now take advantage of the latest machines and tools, such as smartphones and computer-assisted virtual environments.
Educators have seized on tools such as interactive 3D anatomy, which allows students to learn firsthand in a controlled, repeatable environment. In his inaugural address, Gold championed the ability of simulated environments to “enhance the safety of healthcare [and] create an ongoing basis for team participation.” New “learning environments…are far less challenging than the ‘see one, do one, teach one’ methodology that has been around for decades.”
Interactive content such as digital 3D anatomy bolsters student understanding of complex health science topics. It is an effective supplement to traditional textbooks and allows for highly engaging activities that would otherwise be impossible without virtual technologies.
Virtual reality (VR) training will continue to grow as a viable tool for health science education. VR can help address many challenges in health science education and brings with it many logistical benefits:
Virtual reality simulations have already started to permeate into domains of health science education such as surgical training. In the future, VR will play an even larger role in clinical training.
These new technological tools push student engagement towards interaction—the I of the ICAP framework. In an article for Building Design and Construction, Pat Bosch elaborates.
“Learning is not listening; learning is doing. The means and methods of education that have been in place since the Industrial Revolution are now being called deeply into question—and in many cases supplemented or replaced entirely with active learning and simulation methodologies.”
These, in turn, provide for “competency-based measurement” and “more individualized learning models,” trends we have covered above in this article.
Virtual immersive reality and simulation technologies are powerful tools, but they are not the only ways in which technological advancements will transform healthcare. Today we can gather and share unfathomably vast amounts of information. This mountain of data makes it more feasible to judge healthcare based on actual patient outcomes.
Qualitative measurements of care are important to evaluating effectiveness across all healthcare professions and specialties. For instance, in an interview, Trip Hofer, the CEO of AbleTo, claims that the discourse surrounding mental health care must change.
“It’s not enough to only discuss access to mental health care. We need to be more specific about quality care. Providers need clinical criteria that are evidence-based and allow them to measure outcomes in a standard way, ensuring the care they deliver is actually working. Providers have improved the existing access to care, but often miss this crucial follow-up—What did the care do? What was accomplished? The emphasis on standards of quality and measurable outcomes will become a focal point.”
Data is more readily available in all areas of medicine. Healthcare experts can track statistics such as hospital readmissions and hospital-acquired infections with relative ease. Professionals can also be evaluated based on their appropriate and judicious use of limited resources, encouraging less waste and greater efficiency within healthcare institutions.
Practitioners aren’t the only ones who will be judged based on outcomes, however. The institutions that trained them will also be evaluated through the lens of outcome-based performance.
Mark E. Rosenberg, the Vice Dean for Education at the University of Minnesota Medical School, asks universities to focus on outcomes instead of process, assessing medical education by the quality of care graduates deliver—not by test scores. He hopes this change will lead to undergraduate medical education that produces “a medical student capable on day 1 of performing the work required of residency.”
Several studies have also attempted to evaluate residency programs with respect to actual patient outcomes. For instance, in the article, “How Do You Deliver a Good Obstetrician?” David Asch et al. argue:
“Judging residency programs by actual patient outcomes is not only more patient-centered, it better supports innovation. When training is judged by process, the process becomes fixed. But when training is judged by outcomes, multiple pathways toward those outcomes may emerge, some of which might yield better outcomes.”
In short, outcome-based evaluation will better equip institutions to respond to current trends and adapt to future ones.
The modern medical landscape calls for dramatic changes in health science education. New technologies, global labor shortages, and changes in pedagogy and practice will all inform how health science evolves in the future:
We live in strange, perhaps even frightening times. But we also live in an era in which innovation is commonplace. These health science education trends reflect that spirit. Many critical medical experts do not posit problems without offering solutions, and most simply demand that we discard outdated pedagogies and old totems to make room for better learning trends. Universities and other training programs are working hard to address the challenges faced by today’s healthcare professionals. Caduceus is here to help. Contact us to discover how we can help you embrace the latest trends and technology in health science education.
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