Mother and child. Fountain on the roundabout, Kigali Convention Centre, Rwanda (personal collection)

Missed opportunities (1): making a dent requires rethinking how we construct medical education

Reda Sadki#DigitalScholar

“We are training 30 people to become doctors. My focus is on developing content for open educational resources (OER) that we can use to transmit foundational knowledge.”

Training 30 people at a time is not going to make a dent. Cost and scale are related. Quality does not need to diminish against lower cost or higher scale.

OER are obviously about producing knowledge, but seldom question agency in epistemology. How do we know what know? Who knows how we know? Is the democratization of learning about producing new resources by conventional means, albeit in an African context in partnership with a U.S. university?

I realize then that we understand the content trap in very different ways. For me, it is avoided by embracing pedagogical transformation from transmission to knowledge co-construction. The trap is to remain mired in transmissive modes in a world of content abundance. For various reasons, some people cannot see this distinction or its significance.

“Imagine if you could convene 1,000 doctors,” I say, “to take this foundational knowledge and develop localized guides, grounded in their indigenous expertise. In four weeks, they would produce hundreds of high-quality, peer-reviewed guides with the synthesis of their collective, practical experience of how to challenge health inequity in practice, in situ…”

They know what others do not know. Imagine connecting medical students to such a global network of practitioners who find it immoral that they can only treat those who can pay – and who are already doing something about it. The standard of care may be the same everywhere, but how you drive change to achieve it is so dependent on context. Surely, he will grasp how transformative this could be?

“You may want to speak to our colleagues who do in-service training. They do a lot of that. They may have a real interest in what you are doing here.”

We have already done this with topics completely disparate from each other: pre-hospital emergency care, safer access for humanitarian teams, immunization… But this confuses those who still think in silos of subject matter expertise. There is no topic specificity to what I am proposing. Yes, my proposal breaks with the conventions of medical education. You do not connect students to global action networks. You confine them in a controlled environment to train them, tell them what they must do and how they must do it in order to avoid killing people who are sick, and ensure that they can recall (or look up) the information they need to do this without you.

Is that really all that we can do? Is that really all that must be done?

He ends by boasting how the new campus will have fiber optic. By this point, I can only smile wrily. Fiber enables two-way knowledge flows. Ideological or epistemological limitations confine us to using only half of this potential.

Changing medical education is more than changing locale, revising enrollment criteria, producing “free” resources (subsidized by university endowments), or considering political economy as part of medicine. It requires a change in education as a philosophy.

Image: Mother and child. Fountain on the roundabout, Kigali Convention Centre, Rwanda (personal collection)