Monday, February 20, 2012

Who is Henry Mandin? And Why do You Care?

Dr. Henry Mandin had a novel idea: he wanted to teach medical students how to think like doctors.  
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Henry saw that medical schools had begun to use problem based learning (PBL) created by MacMaster University in 1968.  Many of you used this model in your medical training.  PBL is when a small group of students is proposed a problem, and the students figure out how to solve it.  They collect the facts they will need to solve the problem, generate ideas on how to solve the problem, and even figure out what they should learn in the process. 
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This was a marked improvement over sitting in a lecture hall and learning a bunch of scientific facts and then being thrown to the wolves (wards) and asked to make sense of what you had learned on your own.  But Mandin knew something about how people learn and how doctors solve problems.  And so he proposed we use schematic based learning.
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What you do is this: you are presented with a chief complaint.  Then in a classroom, you are taught how an expert clinician would solve the problem.  Along the way, you learn the science that the clinician uses to make his or her decisions. 
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In 1988, Mandin led the University of Calgary to change its entire curriculum to follow schematic based learning.  Now, in the preclinical years, the students are learning the science behind clinical medical decision making, rather than simply learning science.
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In an email conversation with Mandin, he said this: "the one group of physicians that have always supported my curricular approach have been ER physicians. The first reason is that they do tend to approach patients by identifying their chief complaint or clinical presentation, and secondly because almost all ER physicians do use algorithms"
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What if we taught our EM medical students and residents this way?  If you are having a formal lesson about stroke, why not start with a schematic on how to approach the patient with dysarthria.  This is not a case discussion of a patient with a stroke.  This is a discussion about the schema that experts use to approach the patient with dysarthria.  Then, you can talk about the science and management of stroke.  
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For more information on how this curriculum formed, see this paper:
http://www.ncbi.nlm.nih.gov/pubmed/7873005

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