In the early 1990s, a revolution began in the American higher educational system. The time had come to change the focus of education from teaching to learning.1 Instead of focusing on what was covered in a didactic session, such as grand rounds, a call emerged to shift the focus instead to the extent that learners actually learned. In theory, this shift would have been readily accepted by educators as a logical direction to pursue. In practice, however, moving educational practices in this direction has been an exceedingly difficult challenge. Changing practice is never easy. To move from teaching to learning, educators must think about teaching in a different way. This shift means moving from traditional lectures of content-laden material to instructional methods designed to draw learners directly into their own learning, and difficulty has been increased by the ubiquity of PowerPoint software. Succinctly stated by King in 1993, it involves moving “from sage on the stage to guide on the side.”2
In the early 1990s, this new approach to focus on learner engagement was named “active learning.” The credit for launching the term is most often attributed to Bonwell and Eison.3 In their groundbreaking book, they defined active learning as “anything that involves the students in doing things and thinking about the things they are doing.” Note the inclusion of two aspects of active learning: students “doing things” (eg, preparing for the learning session, participating in discussion with other learners, taking notes) and “thinking about things they are doing” (eg, reflection, classroom assessments). It is important to note that active learning pertains to all forms of learning: precepting, small group teaching, and large-group didactics. An educational experience is active based on what happens with the learner, not the number of learners present.
Although the active learning movement began 30 years ago, many family medicine residencies have not fully embraced this instructional approach. One reason may well be that our language runs counter to the concept of active learning. For example, in medical education, the word “didactic” is often synonymous with all formal teaching. The Oxford Advanced Learner’s Dictionary defines “didactic” as “telling people things rather than letting them find out for themselves.” A system of education whereby learners are “told” is efficient when it works. Unfortunately, studies over the past 25 years have consistently shown that extended lectures are not an effective instructional strategy.4-6 Although efforts to improve education in family medicine have often included statements like “family medicine should devise effective methods to teach community medicine…”7 there is often a lack of information about the process by which that should happen.
Making a major shift in the way we teach is no small feat. At this time, however, an ever-increasing body of work clearly and consistently documents active learning effectiveness over traditional lecture through the use of an increasing number of supporting teaching strategies and educational technology solutions.8 Within family medicine, recent studies have similarly highlighted the effectiveness and use of active learning in both undergraduate9,10 and graduate medical education settings.11
In preparation for the family medicine residency summit, the American Board of Family Medicine conducted a national survey of both residency faculty and residents about how residency conferences are taught.12 The results paint a mixed picture. Didactic sessions represent a substantial commitment of time; over 86% of residency faculty and residents report over 4 hours of formal conferences per week, with 72% of residency faculty reporting that, during the pandemic, the didactic curriculum was unchanged and an extra 22% reporting only a slight decrease in time. Attendance is variable, however, with 21% of residents reporting attending less than half of the conferences and only about 50% of residents reporting attending more than 75% of the conferences.
Over 80% of residents report having required prereading or material to review in advance in less than 25% of conferences. Fifty-two percent of residents report that over half of the sessions used interactive techniques such as case discussion, polling, or other techniques. Faculty and resident estimates of the need for preparation and the use of interactive learning was similar: there is clearly substantial room for improvement in making learning more likely to be effective. Residents also report significant amounts of personal teaching, with 63% of the national sample having taught at least one session in the 3 months prior to the survey, but only 29% report formal training in teaching. The culture of “see one, do one, teach one” is alive and well: without being taught evidence-based strategies for effective teaching, many residents will likely anchor their teaching strategies in how they were taught, which often does not include active learning strategies. These results need to be considered in the context of the methodology that is described on the website. Of faculty interested in contributing to the project of reenvisioning the future of residency education, 543 faculty (65.1% response rate), and 301 residents (50.4% response rate) responded. In addition, the survey took place in the fall of 2020, when there was ongoing impact of the COVID-19 pandemic on resident clinical care and schedules.