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Creativity and Innovation in Medical Education: It's Time to Let the Trees Grow Freely

November 2013
Annals of the Academy of Medicine Singapore 42(11):557-8

DOI:10.47102/annals-acadmedsg.V42N11p557

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PubMed

Authors:

Darren Koh

Singapore General Hospital

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November 2013, Vol. 42 No. 11

557

Creativity and Innovation in Medical Education: It’s Time to Let the Trees Grow

Freely

Darren LK Koh, 1MBBS, MMed (Anaesthesia), FAMS

1Department of Anaesthesiology, Singapore General Hospital, Singapore

Address for Correspondence: A/Prof Darren Koh, Department of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore 169608.

Email: darren.koh.l.k@sgh.com.sg

Albert Einstein once said: “All religions, arts, and sciences

are branches of the same tree. All these aspirations are

directed toward ennobling man’s life, lifting it from the

sphere of mere physical existence, and leading the individual

towards freedom”. The essence of this tree is our creativity.

But in the world of medical education, is this tree of

creativity really necessary? After all, since medicine sits on

solid bedrock of basic science, isn’t creativity something

we use just to make our academic lives more fun, a bonus

or a luxury?

A decade ago, Irby1 described 5 environmental trends in

medical education. Increased clinical productivity resulted

in diminished learning environment and necessitating

new organisational structures to support teaching.

Multidisciplinary approaches to science and education

stimulated the growth of multidisciplinary curricular design

and oversight along with integrated curricular structures.

The science of learning advocates necessitated new active

learning methods, learning communities and instructional

technology. Shifting views of health and disease encouraged

the addition and weaving of new content in the medical

curriculum. The calls for accountability led to new forms of

performance assessment using objective examinations and

comprehensive assessment programmes. These situations

are even more pronounced 10 years later. Furthermore, the

continual increase of medical student intakes both in our

undergraduate and postgraduate medical schools creates

tremendous stress to our faculty and resources. In times

like this, creativity is an essential fuel for solutions and

pivotal in the fruition of innovations.

Creativity is the use of imagination to produce something

into existence and innovation being creativity with a purpose.

Creativity is the ability to transcend traditional ideas,

patterns, rules or relationships and to produce meaningful

new concepts, forms, methods and interpretations. It has the

hallmarks of originality, progressiveness and imagination. In

our society, creativity cannot be recognised until its product

is judged to be of value. As a default, creativity is often met

with scepticism. People are sceptical when an initial new

idea is introduced. It is rarely accepted at the beginning. In

fact, the journey of creativity is one that is often tortuous;

as getting an organisation to recognise, support, accept

and commit often meets with roadblocks. But deep in the

hearts of many, they know that the fundamental ingredient

necessary for the future of science and medicine is creativity.

Humans generally have an innate ability to be creative.

This desire to innovate stemmed from needing to overcome

problems to everyday living and to make our lives better.

Every human has this innate tree of creativity from the

moment a baby is born. But the modern society plays

the role of systemically poisoning this tree. The modern

society wants every individual to conform so that he can

be a machine of productivity. In fact, it’s been said that

creativity is the greatest rebellion in existence. Essentially,

we get “educated” out of creativity.

So how do we cultivate this tree of creativity in each

individual and hopefully see a beautiful forest of creativity

trees in our midst? Our current climate of algorithmic

and process-driven type of medical system needs to be

adjusted to provide the right environment and conditions.

The availability of protected time and ﬁ nancial support

are crucial ingredients together with organisational and

collegial support. As it is, the issues of faculty fatigue and

burnout is becoming more prominent.2 Can doctors have

time and space just to chat, exchange ideas, ponder or even

dream? Can doctors and students have protected time and

opportunity to do creative activities during working hours?

We must also consider the fact that time for fruition and even

failure is also necessary for this creativity tree to ultimately

sprout and ﬂ ourish. Institutions have recognised this need

and its processes, leading to the formulation of expert

instructional courses3 to enhance creativity and innovation.

But importantly, creativity is not just notions of individuals

but it encompasses all around and should inﬁ ltrate into

Creativity and Innovation in Medical Education—Darren LK Koh

Editorial

558

Annals Academy of Medicine

the culture of an organisation. Some organisations have

already embarked on this and have set up funding to foster

creativity.4 It takes extreme commitment and foresight to

allow this heavy investment, so that a forest of creativity

will one day ﬂ ourish.

The world has too much unpredictability. We do not know

for sure what will happen in the future, not even in the next

5 years. In the medical ﬁ eld, one thing for sure is that there

will be changes. In this modern age, things happen fast and

the pace of change will continually increase. The future for

medical education is certainly set for signiﬁ cant challenges.

To survive and continue to leap forward, creativity and

innovation must be fostered. The message is stark, be

creative and innovate or be left behind.

REFERENCES

1. Irby DM, Wilkerson L. Educational innovations in academic medicine

and environmental trends. J Gen Intern Med 2003;18:370-6.

2. Brian M. Wong, Kevin Imrie. Why resident duty hours regulations must

address attending physicians’ workload. Acad Med 2013;88:1209-11.

3. Ness RB. Teaching creativity and innovative thinking in medicine and

the health sciences. Acad Med 2011;86:1201-3.

4. Andolsek KM, Murphy G, Nagler A, Moore PR, Schlueter J, Weinerth JL, et

al. Fostering creativity: how the Duke Graduate Medical Education Quasi-

Endowment encourages innovation in GME. Acad Med 2013;88:185-91.

Creativity and Innovation in Medical Education—Darren LK Koh

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Why Resident Duty Hours Regulations Must Address Attending Physicians' Workload

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For much of the past decade, the duty hours debate has focused primarily on the intended and unintended effects of resident duty hours restrictions on resident well-being and fatigue, patient safety, discontinuity and handoffs, and opportunities for teaching. On the other hand, attending physicians' needs and perspectives generally have been ignored. The authors of this commentary discuss the report by Roshetsky and colleagues in this issue of Academic Medicine, which found that attending physicians reported a greater clinical workload since the implementation of the 2003 Accreditation Council for Graduate Medical Education resident duty hours regulations, and that this increase in attending physicians' workload appears to correlate with decreased time for teaching. However, attending physicians not having time to teach may be but the tip of the iceberg. Other potential implications include faculty members' decreased availability for direct supervision of residents, their reduced emphasis on resident assessment, and their burnout and dissatisfaction, which ultimately also negatively affect patient care. Therefore, deliberate efforts to address attending physicians' workload must receive greater attention if the duty hours movement is to achieve its ultimate goal of improving patient outcomes. In this commentary, the authors advocate that duty hours regulations require programs to seek creative solutions to address these issues, just as the 2011 regulations require programs to address patient handoff training.

Fostering Creativity: How the Duke Graduate Medical Education Quasi-Endowment Encourages Innovation in GME

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The Duke Medicine Graduate Medical Education Quasi-Endowment, established in 2006, provides infrastructure support and encourages educational innovation. The authors describe Duke's experience with the "grassroots innovation" part of the fund, the Duke Innovation Fund, and discuss the Innovation Fund's processes for application, review, and implementation, and also outcomes, impact, and intended and unintended consequences.In the five years of the Innovation Fund described (2007-2011), 105 projects have been submitted, and 78 have been funded. Thirty-seven projects have been completed. Approved funding ranged from

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Roberta B Ness

The National Academies of Science recently criticized the state of scientific innovation and competitiveness in the United States. Evaluations of already-established creativity training programs--examining a broad array of students, from school age to adult and with a wide range of abilities--have shown that such courses improve thinking skills, attitudes, and performance. Although academic medicine provides informal training in creativity and innovation, it has yet to incorporate formal instruction on these topics into medical education. A number of existing, thoughtfully constructed and evaluated creativity programs in other fields provide a pedagogical basis for developing creativity training programs for the health sciences. The content of creativity training programs typically includes instruction and application in (1) divergent thinking, (2) problem solving, and (3) creative production. Instructional formats that have been shown to elicit the best outcomes are an admixture of lectures, discussion, and guided practice. A pilot program to teach innovative thinking to health science students at the University of Texas includes instruction in recognizing and finding alternatives to frames or habitual cognitive patterns, in addition to the constructs already mentioned. As innovation is the engine of scientific progress, the author, founder of Innovative Thinking, the creativity training pilot program at the University of Texas, argues in this commentary that academic health centers should implement and evaluate new methods for enhancing science students' innovative thinking to keep the United States as a worldwide leader in scientific discovery.

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Fifteen educational innovations in academic medicine are described in relation to 5 environmental trends. The first trend, demands for increased clinical productivity, has diminished the learning environment, necessitating new organizational structures to support teaching, such as academies of medical educators, mission-based management, and faculty development. The second trend is multidisciplinary approaches to science and education. This is stimulating the growth of multidisciplinary curricular design and oversight along with integrated curricular structures. Third, the science of learning advocates the use of case-based, active learning methods; learning communities such as societies and colleges; and instructional technology. Fourth, shifting views of health and disease are encouraging the addition of new content in the curriculum. In response, theme committees are weaving content across the curriculum, new courses are being inserted into curricula, and community-based education is providing learning experiences outside of academic medical centers. Fifth, calls for accountability are leading to new forms of performance assessment using objective structured clinical exams, clinical examination exercises, simulators, and comprehensive assessment programs. These innovations are transforming medical education.

Teaching creativity and innovative thinking in medicine and the health sciences