In the late 19th century, medical education in the United States was similar to learning a trade like carpentry or masonry. Johns Hopkins, modeled after European graduate medical training, was the first scholarly medical center in America to base its education on scientific research and clinical observations at patients’ bedsides.
While other U.S. medical training institutions required no previous college education for their students, the founders of the Johns Hopkins University School of Medicine directed that all applicants have a four-year baccalaureate degree, then undergo a rigorous four-year academic curriculum, marking a first for U.S. medical education.
Today, 125 years later, the institution continues to forge new paths in training physicians and scientists. This history of innovations will be celebrated throughout the year as the school of medicine commemorates its anniversary milestone with special events, lectures and other celebrations.
“The 125-year celebration prompts us to reflect on the history of our great institution and on the legacy we have inherited,” says Roy Ziegelstein, cardiologist and vice dean for education at the school of medicine.
He points to the landmark 1910 report by Abraham Flexner that set standards that still exist. Flexner cited Johns Hopkins as “the model for medical education.”
But Ziegelstein says the anniversary also offers a chance to “recognize our responsibility to continue as leaders in medical and graduate biomedical education in the future.”
An example of that leadership is an instructional theory that uses technology and data to customize learning for students. “Precision education” replaces one-size-fits-all lectures with a range of mix-and-match educational materials suited to trainees’ backgrounds and learning styles.
Much as precision medicine allows physicians to improve patient care by personalizing treatment for patients with the same diagnosis, precision education seeks to tailor course material—and the form in which it is delivered—to individual students’ knowledge and skill base.
Harry Goldberg, biomedical engineer and assistant dean of the Johns Hopkins University School of Medicine, says that the precision education approach enables a far more fluid and student-centric approach.
Goldberg and his team are designing a system where medical students can explore facets of particular subjects that interest them before, during and after traditional classroom lectures. An online network of articles, videos, discussions and even notes from other students opens up new options for class preparation and engagement. He adds that not only can students assume greater control over their own learning, but that this approach allows courses to grow into dynamic collections of materials shared by faculty as well as students.
“The idea is that we are creating a community of learners, that we’re all in this together,” says Goldberg. “It’s often more difficult for the expert to explain something to the person who is not the expert than it is for a colleague to explain it to that non-expert.”
The approach encourages students to learn important lessons about collaboration, Goldberg says.
“Sometimes as instructors, we have a hard time explaining,” he says, “whereas students can communicate with one another in a much different way.”
Goldberg says precision education could prod medical students to explore areas they might not otherwise pursue.
“This has the potential to help students learn more about themselves,” he says. “If a student takes an interest in a particular area, such as biomedical ethics, that may be something he or she could make a career of.”
Khalil Ghanem is applying the precision education approach for the first time to his course this semester on Infectious Diseases and Microbiology. When the internal medicine and infectious diseases professor heard about precision education from Goldberg, he says he was immediately drawn to the concept.
He says that no matter how prepared and well-educated a first-year Johns Hopkins University medical student is when he or she first encounters the material, that student faces a steep uphill climb to make the complex connections between microbes, the infections they cause and the epidemiology of disease.
Ghanem has established an online collection of information, compiled by instructors and students alike, that enables students to better make those connections. It is designed to grow from semester to semester.
Precision education also addresses the disparate experiences and interests that exist among students who come to medicine from different academic backgrounds.
“Currently, every student receives the same information regardless of their academic needs. Such standardization compromises our ability to enhance creativity, wonder and academic diversity of thought,” Harry Goldberg says.
Precision education, he says, “is more than just a syllabus at the beginning of a semester. This is a scaffold where knowledge will be built.”