Eight Harms of Medical Education (and what we might do about them)

Eric J. Warm M.D., F.A.C.P.

Richard W. & Sue P. Vilter Professor of Medicine
Program Director, Internal Medicine
University of Cincinnati Academic Health Center

Overview: Do our education systems harm our learners? Multiple studies show that medical training often erodes the core values that bring people to medicine, and these "lessons" can last a career.

Hope, and the process of educational quality improvement, begin with recognition and identification of the problem. To spark conversation and offer paths forward, let's begin as medical educators to consider 8 ways we appear to be harming learners across the nation. Do we (1) provide perverse incentives (grades over growth); (2) continue less effective pedagogy; (3) lack cohesive assessment and coaching strategies; (4) fail to connect learning to outcomes; (5) undervalue inter-professional co-production of care; (6) create discontinuity among patients, providers, and teams; (7) stress only personal resiliency in the face of system-level dysfunction, and (8) teach learners to solve only the problems that they can see?

If these 8 harms seem plausible, so, too are the consequences connected to these harms. Are our learners learning to (1) adopt fixed mindsets; (2) waste time with ineffective learning strategies; (3) be unaware of their weaknesses; (4) believe they are not responsible for care outcomes; (5) not know what they don't know about team members and teamwork; (6) accept fragmentation and passive roles in the clinical environment; (7) burn out and blame themselves, and (8) not recognize the problems of the future. In this presentation we will explore each of these harms, analyze learning environments for danger, and discuss mitigation strategies to reduce harm. As educators, we will do as we do in practice--identify risk and address it with inspiration, forethought, and prevention.

Learning Objectives: Upon completion of this session, participants will be able to

1. Identify 8 ways medical education may be harming our learners;
2. Consider consequences that arise from harming our learners;