I have recently enjoyed reading two of Derek Bok’s books on higher education. I think both of these books contain information important to the field of continuing medical education. The first book (Universities in the Marketplace: The Commercialization of Higher Education) discusses the impact of commercialization on higher education and the second book (Our Underachieving Universities) discusses his perspective on how universities can improve.
The connection in the former may seem self evident given the intensity of today’s concerns related to funding in CME. This book points out indirectly that the forces toward commercialization exist throughout universities and are not isolated to the field of CME. Furthermore and more importantly he makes the case that university faculty rarely, in any systematic fashion study their own teaching and thus the effectiveness. Importantly, faculty are under numerous conflicting pressures to achieve. This is even truer in the field of medicine where on top of all normal faculty duties; the physician also has patient care responsibilities. Thus the time to teach or evaluate one’s teaching as been negatively impacted. I especially like the quote from James Watson, “To encourage real creativity, you need a good deal of slack.”
This book also discusses online education and the potential connection between continuing education and extension education. In particular points out that if extension schools are treated as profit centers, they are potential compromised from the get go, a situation I have discussed related to CME several times over the last few years.
The second book discusses what universities do well and where they might improve. It again draws attention to the need to study how we teach and the outcomes associated with such. It elaborates on the tension between educators who see the role of higher education to be scholarly activity compared to those who see a more trade-based approach as important. The former, scholarly work for scholarly sake, making it hard to perform outcomes assessments and the latter being potentially devoid of new knowledge generation. The connection to some of the same tensions in CME is obvious. It also helps clarify why physician educators have not advanced much further than our general university brethren with regards to these tensions.
Importantly this book stresses the need to advance interactive education and the importance for generating understanding as compared to knowledge. The quote from Charles Eliot’s inauguration as President of Harvard over 150 years ago seems quite apropos, “The lecturer pumps laboriously into sieves. The water may be wholesome but it runs through. A mind must work to grow. This book also references some of the studies by Eric Mazur. I decided to look him up on the web and found some very interesting videos available on Youtube. He stresses in these that he has learned to “teach by questioning rather than telling” and that “you can forget facts, but you don’t forget understanding”.