At any given moment in this hyper-connected era, we are beckoned by our smartphones, iPods, iPads and laptops to participate in the multiple spheres in which we exist. These “spheres” — our physical surroundings, families and friends, social media, blogs, e-mail — are simultaneously concrete and confabulated, yet they equally contribute to our identity. Navigating these arenas enriches and edifies our current existence with memories of old friendships and ever-increasing networks of new contacts while also allowing us, through our “online” identity, to append alternate interpretations of our present.
As students, negotiating various information databases streamlines our learning experience. We may connect lecture topics with research or refer to notes from other classes. We can quickly email professors, clarify statements through Gchat with classmates or respond to emails for tutoring or professional workshops. These activities, as much as the lecture hall we sit in, define our educational present. Thanks to our hyper-connectivity, they can be completed swiftly and efficiently.
The physician-patient relationship is enhanced by another sort of hyper-connectivity. Just as the physician develops a coherent plan by drawing upon scientific knowledge, the medical history and clinical judgment, so too does the patient as he or she attempts to reflect past memory in his or her present experience. This exchange depends upon both parties’ ability to deconstruct their parallel existences so that they may be woven into a coherent narrative.
Yet medical care requires more than information exchange and synthesis. Health care also demands humility, listening and being present. Presence, in the clinical setting, demands reflection, focus and unwavering attention; this presence, and its accompanying interaction, underlies the continued demand for medical care delivered by a human being, when seemingly everything else is automated. If we value this meaningful exchange between individuals, then we should also strive to emphasize it in the training process.
Large lectures are frequently employed during the didactic phase of medical education; however, they are unwieldy, inefficient learning environments, with primarily passive information transfer from lecturer to student. At my undergraduate institution, they were largely eschewed in favor of tutorials — once-weekly classes with a professor and one other student — which were challenging, unexpected and exciting academic experiences. Yet certain lecturers, at their shining best, gave riveting performances full of movements, questions and concepts that I will never forget.
While video and audio recording systems make lectures less cumbersome by offering the opportunity to pause and digest difficult concepts, to speed through review material, and to link lecture topics to subjects learned elsewhere, their exclusive use precludes the possibility of meaningful and memorable human interaction. If medical schools value the ancillary benefits of in vivo lectures, they should take three steps to ensure their success. First, they should reward excellent teaching performance, selecting and promoting enthusiastic educators. Second, they should reform an evaluation system that emphasizes fact recall and pattern recognition in lieu of analysis, discussion and synthesis. Finally, they should attempt to cultivate a community that participates in small group discussions, journal clubs and other activities that promote substantive engagement with the medical profession.
Enacting these changes would uphold and reinforce the sanctity and intimacy of human interaction which in turn manifests itself in the physician-patient relationship. In doing so, it would minimize the importance of our hyper-connected alternative spheres by encouraging us to be sensible, attentive, and physically and mentally present. As future clinicians, we could receive no greater gift.