“Are your simulations that good?” my wife joked as we stepped out of Star Tours (a pretty fantastic space flight simulator at EuroDisney). I pause… “They’re a close second of course. Well, maybe a distant second, close third? It’s different, right?” As the day went on, more questions kept popping up in my mind. Just how good are our simulation sessions? Star Tours was hugely entertaining (hard not to like flying a spaceship) but surely simulation in medical education is about more than entertainment, isn’t it? And what about in other arenas of teaching, like the lecture theatre? Does a presentation on stroke need be entertaining? In the end, when it comes to medical education, just how important is the entertainment part?
It isn’t just simulation and lectures on my mind. This question about entertainment has firmly affixed itself to most forms of teaching known to me: lectures, small group sessions, simulation, web based learning and blogging. This question about entertainment in education applies to the whole spectrum and also includes a relatively newer concept known as serious games. It turns out there is a great deal happening in the area of education and entertainment, and it has been happening right under my nose for some time.
A fusion of education and entertainment, edutainment is defined by its entertainment value/focus. David Suzuki’s “The Nature of Things” on the CBC and the classic children’s game “Where in the World is Carmen Sandiego?” are great examples. In this context, it is a type of entertainment that may appear limited to just that: games, shows and films. In medical education it is often used in the form of games such as “Medical Jeopardy” where content learning isn’t as important as the typically much needed diversion and engagement. We also see variations of this concept in the use of pictures and videos in lectures and cases to help illustrate points or make them somewhat humorous. While the above examples seem to fit the above definition, innovations in serious games (such as simulation and virtual patient programs) are already challenging this still-fresh education & entertainment fusion/characterization.
Serious Games and Medical Edutainment
The Serious Games Institute (SGI) addresses the balance between education and entertainment in teaching by explicitly placing entertainment as secondary to some other primary objective.
With this in mind, simulation can be classified as a serious game as it is not intended to be primarily entertainment, but rather an experience whose primary objective is to enhance medical trainee performance in a safe and effective way. That doesn’t mean that these experiences aren’t entertaining. A recent email sent to the U of S CLRC (simulation centre) from a participant following a high fidelity simulation session demonstrates this:
The afternoon was the most exciting learning experience I have ever participated in during my 25 year career as a Registered Nurse! Being able to go through the scenarios as participant and as observer, along with communicating and troubleshooting with my colleagues afterwards, was an amazing learning experience!! My husband picked me up when it was done and asked why I was so happy?? I didn’t realize the smile on my face!! I told him it was one of the BEST afternoons I have had LEARNING in a very long time!!
Beyond shamelessly promoting the U of S, the quote nicely illustrates the point: despite being primarily of an educational nature, HFS is greatly valued and dare I say, entertaining. And the best part about it: the entertainment part takes care of itself! It is there, amongst many other key items, by the very nature of the simulation experience.
Balancing Entertainment and Education
This brings us back to the questions about entertainment and education: how much of each and where can we find balance? While I think there is a great deal to be learnt from the field of edutainment, I believe it represents only one of the many approaches to effective teaching and learning. Knowing when to use the right approach is perhaps the bigger challenge.
Proponents of edutainment highlight the importance of engagement and active learning in adult learning. But is entertainment always the best way to access these key components of effective learning? The answer depends on the situation: the type of learner, the learning/instructional medium to be employed, the instructor/teacher and the content. So when is entertainment most needed and effective?
To answer this, let’s take a good look at the time-honored tradition of the medical lecture. Lectures in medical school are the most common and least effective of all teaching methods. By their very nature (didactic, impersonal) they pose even the most keen of teachers a major challenge in terms of engagement and active learning. Studies suggest dismal retention (less than 20% at 1 week) and yet they continue to be used, largely out of a sense of necessity/economy. While we can (and should) reduce our reliance on them, they are nonetheless here to stay in one form or another. That being the case, I propose that it is in the lecture theatre, more than anywhere else in education, where we really need to entertain.
When I say entertain I don’t necessarily mean “make laugh” or “be funny”. With the goal being learner engagement, a heart wrenching patient encounter, well told, could be the vital part of a lecture on substance abuse or liver failure. After all, with the evidence on lectures being what is it, the primary goal of a lecture isn’t content mastery, it is engagement!
This brings us to some of the innovative ideas coming to large group teaching arenas. The idea of the flipped classroom (discussed here in FOAM and here in the NEJM) is consistent with the tenets of serious games and edutainment. Such approaches represent a big change for not just teachers but their students as well. Both groups must now engage an unprecedented level of preparation. A change that will no doubt require some time to take hold.
A colleague and mentor once told me “A good lecture is like theater.” It needs to be well prepared, timed and rehearsed. Its delivery should be informed by education research (awareness of the components of a good presentation, effective use of audiovisual aids, awareness of audience fatigue times, opportunities for active learning, and so on) and it should be free of technological hiccups (for a good read on the topic of effective lectures, check out Andrew Long and Bridget Lock’s chapter Lectures and Large Groups in Tim Swanwick’s Understanding Medical Education). Lastly, but perhaps most importantly, the topic should be presented as though it matters.
Such lectures require a lot of effort on the part of the teacher, but as I alluded to, this is the one arena that is in greatest need of that effort (check out TED talks for a good example of what I mean by lectures as theater).
Entertainment has always been a part of effective teaching and it will continue to be just that: a part of it. I would suggest its importance varies from arena to arena, as does its form. Whereas some learning arenas, like simulation or blogging, benefit from a higher baseline level of engagement, others like the lecture theatre start at zero (or maybe even in a deficit?). The evidence suggests that is where the extra effort will pay off.
Paul Olszynski, MD, CCFP EM
A big thanks to Brent Thoma for his thoughtful input and helpful peer review!
PS: In keeping with the evidence on simulation, the next day my kids and I went back to Star Tours for a second mission… you know what they say: (deliberate) practice makes perfect.”