Leaders in Medical Education

Dr. Douglas Larsen, Medical Education Researcher at Washington University in St. Louis

Thasin Jaigirdar
Jul 20, 2015

Dr. Douglas Larsen, a clinical pediatric neurologist and well-known medical education researcher at Washington University in St. Louis. Dr. Larsen is one of the pioneers of applying test-enhanced learning to medical education and is very involved in the education of medical students and residents. He spoke to us about his background in medicine & education as well as his current research and what he’d like to see improved about med ed.

How did you become interested in medicine?
In many ways, I grew up with it. My father is a pediatric neurologist so I was exposed to his work from the very beginning. I always viewed medicine with interest but went through different stages of my life where I didn’t just want to do what my dad did. But during medical school I found that I had the most fun with my neurology courses, and decided that I needed to follow my heart.

As far as choosing medicine, I was always interested in biology and biomedical sciences. I realized during my college years that I wanted to have a career involving taking care of people, and meeting their needs. I had served for two years in Argentina as a missionary for my church, which was a profound experience that solidified my interest in serving people. Medicine was a good match for combining my interest in science with my desire to care for people.

In medical school I remember during my second year neurosciences course I was reading my textbook and I was hungry to keep reading and learn more. I thought that this was a pretty good sign. Then, during my third-year clerkships, I found myself getting most excited working with patients who had neurological problems. I also found I really loved working with children, so pediatric neurology seemed like a really good marriage of it all.

You’ve also established a great reputation as a medical education researcher. How did you become involved in this work?
My interest in education even predated going to medical school, and when I decided to go to med school I knew hat it would be a great way to pursue education as well. Through my neuroscience education I became fascinated with the question of “How do we learn?” I had done some reading even before applying to medical school, and then when I went through medical school I was astounded by what I felt were deficiencies in the medical education experience. My undergraduate at Brigham Young University was an excellent experience; conversely medical school seemed to be an exercise in rote memorization that was almost soul crushing at the time (though in my clinical years I regained my love for medicine, though). During the first years of medical school, I recall reflecting on the med school emphasis on lecture formats and teaching by PowerPoint, and thinking to myself, “This isn’t very effective education. What can we do to improve this?”

Then as I went through my pediatrics residency at Cincinnati Children’s Hospital, there was a masters in education program through their university. Many of the faculty were participating in the program so after I finished my residency I knew I wanted to get my masters degree in education for more formal training.

During my neurology residency I stumbled across Dr. Roediger’s work on retrieval practice and realizing that this would have obvious applications to medical education. It exposed me to the science of studying learning and memory, and led to my collaboration with Drs. Roediger and Butler, which has been very productive over the years.

When I finished residency and began looking at faculty jobs, I made it clear that I intended to pursue formal training in education as part of my job. I negotiated for WashU to pay for my masters training at the University of Cincinnati, with 50 percent protected time during my first two years.

It was during the course of the masters program that I became more familiar with experiential learning theory. As I thought about what makes someone a good doctor, I realized that all doctors identify their experiences with patients as the core of their learning. I started thinking about how we could begin to optimize and accentuate learning from experiences, since that’s where the most power is. That got me to my present work on learning goals.

Can you please elaborate on your learning goals research?
Expertise comes from extensive immersion into a specific field as well as dedicated & deliberate practice. Setting specific learning goals, often with a mentor (e.g. preceptor), and holding yourself accountable is an effective way to ensure that you’re developing expertise.  One of the things that has emerged from our work is that it’s not just the goals the students set, but being able to engage those around them and collaborate. Our work is also tied very well into the work around self-regulated learning, where self-monitoring is a critical component. We’ve realized that timeframe is very important when it comes to using learning goals to induce self-monitoring. For example, during pediatrics residencies, learners are expected to set six-month goals, which is very hard to do and be disciplined about monitoring. We’ve shrunk the timeframe for effective and manageable learning goals to one-week.

What would you change about the way we teach medical students today? Physicians?
The first thing is I would do is expand our understanding of learning and what it is. I think medical education is dominated by what’s known as an acquisition model of learning, which basically means knowledge is a commodity that can be transferred from one person to another. While that model fits well with basic facts it does not fit well with what actually makes us doctors. Learning by participation and construction is the form of learning that dominates our formation as physicians. If we begin to have an understanding of what learning is, and then we look at our educational system and what it does, then that allows us to be critical about what we’re doing and improve upon it

The very fact that summative examinations are the main metric we use to define someone’s competency as a practicing physician says that we often do not recognize how learning occurs in practice. Similarly, most continuing medical education (CME) follows a lecture-based format, which shows that we do not have the appropriate understanding of passive versus active modes of learning and their relative efficacy.