My friend, Valerie Schwartz, and I stumbled on the importance of collaborative thinking while we spent our usual afternoon quizzing each other and discussing patient cases during our pediatrics rotation.
“At what age can babies start to use non-specific ‘mama’ and ‘dada’?” As I sifted through my knowledge bank, a third friend decided to throw me a lifeline. I thought it was 10 months, he thought it was six months. So, we decided to compromise. We landed on six months after deliberations. At our group response, Valerie responded, “Correct!” and wishfully added, “Imagine if we could take tests together just like that? Where we can figure out the answer between all of us.” And then and there, it happened. The idea hit us almost at the same time. We both agreed that idea made complete sense — we wanted to legalize cheating on medical school exams. Now don’t jump to any frivolous conclusions yet. That would be cheating, and that’s unfair. Keep reading.
In a 2010 publication titled “Collaborative Testing as a Learning Strategy in Nursing Education,” the author discusses the power of collaborative testing in developing “group process skills.” These group process skills included learning to seek and assimilate different perspectives when approaching difficult problems. Particularly interesting was the statistically significant finding of increased individual performance on each unit of testing whenever a collaborative strategy was employed compared to individual test-taking (unison answer response was not a requirement within the collaborative testing group). Important to point out is the finding that although group testing did not improve long-term retention of course material, students reported improved grasp of material as a result of debating concepts and discussions. Students also reported reduced anxiety levels and improved relationships with their peers as a result of group testing. Most importantly, group testing sets the stage for professional and respectful discourse between peers, a skill being highly sought in today’s healthcare team.
My friend Valerie shared with me her first-hand experience:
“As a first-year at the Chicago College of Osteopathic Medicine (CCOM), our biochemistry course was group-tested. Our individual work made up the vast majority of our final grade for the quarter at approximately 90 percent, but the remainder of our grade was comprised of our team scores. After every stereotypical individual exam — scary testing center environment, pages full of biochemical enzymatic pathways and multiple choice answers — our assigned team got together to take a 40 question team test on the exact same material as the individual exam. This innovative experience helped to prepare me for life on rotations where most decisions in the hospitals and clinics are discussed among a team comprised of nurses, students, PA’s, residents and attending physicians.”
Our experiences rounding on patients reinforce the importance of inter-professional as well as intra-professional discussion in developing patient plans. I can personally recount doctors seeking the nurse’s assessment, physical therapist’s assessment, the nurse practitioner’s assessment, etcetera. In this process, I’ve noticed another important skill for group dynamics — the ability to compromise or not to.
So, where in our medical education do we learn to agree and disagree? Well, many schools now have a case-based learning curriculum where students discuss scenarios and decide what to do with the patient but, from my experience, those sessions are not “high stakes.” Compare this scenario to the wards where potentially compromising the patient’s care is more often than not, very “high stakes.” So, how d0 we raise the stakes for case-based discussions? Hinge these case-based discussions on medical students’ grades? Here’s what I’ve seen: one thing medical students see as being “high stakes” is their grades (I understand that many schools are incorporating a pass-fail system to alleviate this perceived problem, but medical students still aim pretty high) and if I have to argue with you because I’m sure the answer is B as opposed to D, I’m going to do it!
Health care has moved in a direction where discussion, trust, humility and teamwork are crucial to patient care. A habit of “group-thinking” and “group-solving” early in medical training may serve multiple advantages: building self-confidence, realizing team-member’s strengths, and learning that being wrong is okay. The process of group learning teaches that the individuals who seem to have all the answers are sometimes wrong, a very important lesson as we look for new movements to battle the established hierarchy in health care. Learning this during medical school can really mold our appreciation of collaborative medicine. Let’s make discussion a habit — agree, disagree, support and collaborate!
Seeing the multiple benefits of this concept of group-testing, what next? I dare to propose that 5 to 10 percent of medical school exams should be group-taken starting from the first exam after matriculation. Out of 100 questions on an exam, five to 10 questions should be reserved for scenario-based cases that require more than just recalling facts. For example, questions such as “Should we fluid resuscitate intravenously or orally?” and “Should we give another dose of Ativan (lorazepam) or escalate to phenytoin?” are not black-and-white questions but require critical thinking. These questions give room to the influence of personality as well as improvisational thinking, providing students the opportunity to learn the art of collaborative agreement and disagreement.
So, dear readers, what do you think? Agree or disagree?