As clinicians, a significant but underrecognized portion of our role is related to education. We are constantly educating patients, nurses, surgeons, and other anesthesia personnel. For those who spend time around learners in a structured teaching program (medical school, residency/fellowship, or CRNA training program), the effort devoted to education can be significant. Our learners are embedded in an increasingly complex ecosystem of multimedia tools, structured assessments, and learning management systems: these tools add to the assumption that we’re “doing more” for our learners. We have shifted a significant amount of responsibility and trust onto our learners to set their own agenda. Do they really know best? (Educ Psychol 2013;48:169-83).

Certain concepts, falsehoods, and urban myths have established strong footholds in medical education (BMJ 2007;335:1288-9). These supposed sacrosanct edicts have changed the face of education. While not all medical education myths require “busting,” many traditional teaching techniques are no longer considered en vogue (Med Educ 2020;54:15-21). In this article, we’ll discuss several urban legends in medical education, dispelling some myths and offering their contemporary replacements. These include the belief in individual learning styles, an emphasis on the “millennial learner,” the utility of self-assessment, and the challenges of the board certification process.

The concept of individual learning styles is an intuitive one, and one in which our learners have come to believe. These beliefs may be based off their own observations or performance on a “learning test” taken online. Nearly 100 learning styles have been described in a recent review (asamonitor.pub/3xdAHUU).

There is ample evidence that teaching to designated learning styles does not lead to better educational outcomes (Med Educ 2012;46:634-5). Small studies that show improved outcomes using learning style-based instruction have significant methodological flaws and are far outweighed by the negative studies suggesting no difference (J Educ Psychol 2020;112:221-35). Providing individualized educational experiences based on learning style is a very labor-intensive process, and the payoff is minimal (Psychol Sci Public Interest 2008;9:105-19). This is not to say that some techniques, such as multimodal instruction, are not better suited to certain topics. Our point is that these do not need to be individualized.

Many within the educational sphere coined the phrase “millennial learner” in the early 2000s. Because millennial learners gear up with game consoles, social media, texting, and watching multiple screens at once, they are theorized to be better at multitasking and prefer online resources.

Little data suggest that millennials learn differently than their previous generations of learners (Med Educ 2020;54:60-5). While the technology for instruction may be different, fundamental learning styles have not changed significantly. Ample evidence suggests that these learners do not need to be multitasked, shown videos in lieu of traditional media, or educated differently simply by virtue of their decade of birth – and that digital learners may not be any stronger than others at multitasking or learning from media (Educ Psychol 2013;48:169-83).

An often-discussed topic is the performance of self-directed learning by adult learners (Int Rev Educ 2019;65:633-53). The myth is that adult learners can make a self-assessment of their own strengths and weaknesses and that these adult learners can direct their own learning. This has been en vogue since the 1970s and has been adapted into mainstream adult education to a large degree (Self-directed Learning: A Guide for Learners and Teachers. 1975).

As more recent literature has shown, adults are often quite poor at gauging their own strengths and weaknesses (Int Rev Educ 2019;65:633-53). Drivers consistently rank themselves as above-average, despite a lack of correlation between their self-assessment, adverse driving events, and driving performance (Accid Anal Prev 1998;30:331-6). In order to set their learning agenda, adult learners must possess metacognition of their learning edges, which many adult learners struggle to do accurately (J Pers Soc Psychol 1999;77:1121-34; Thinking, Fast and Slow. 2011).

Critically important in setting a learning agenda is the recognition of cognitive load and the need for feedback to help consolidate knowledge. Learners might not be aware of their own cognitive load, so it’s important as educators to know not just what to teach but when to teach and how to cement that newly acquired knowledge through feedback and repetition (Learning and Instruction 2002;12:1-10).

With the increasing cost of board certification examinations, there is a renewed emphasis on the value of multiple-choice testing. The traditional teaching is that multiple-choice testing is helpful for assessing knowledge but that these examinations are not effective at assessment of skills or attitudes. There is increasing skepticism of the value of expensive board certification exams based solely on multiple-choice tests (Med Sci Educ 2021;31:889-91).

There is ample evidence that high exam performance is associated with better patient outcomes as well as protection against medical license actions (Med Educ 2002;36:853-9; JAMA 2007;298:993-01; Anesthesiology 2017;126:1171-9). Additionally, the ABA has recognized the limitations of multiple-choice testing and has incorporated both standardized oral examinations and objective structured clinical examination testing as part of the board certification process. The initial board certification process is designed to assess for competence, while the maintenance of certification process is designed to ensure lifelong learning and deliberate practice throughout one’s career. The evidence behind this is limited, and it may also be a myth.

The intent of competency based medical education is to ensure that all learners achieve competence in key skills. There are many threats to fairness that lurk in each training program (Perspect Med Educ 2017;6:347-55). Efforts to address both equity and equality are hampered by lack of understanding of learners, maldistribution of opportunities, lack of faculty development, and poor cultures of feedback. Additionally, assessments themselves may disadvantage some learners more than others. Lucey et al. characterize equity in assessment as a “‘wicked problem’ with inherent conflicts, uncertainty, dynamic tensions, and susceptibility to contextual influences” (Acad Med 2020;95:S98-108). Challenges of equity in education are abundant and deserve significant attention and funding to result in fairness for each learner.

As physicians and practitioners of evidence-based medicine, we should strive to incorporate the evidence basis behind all we do professionally. The evidence basis behind many educational dogmas is often sorely lacking. We could be doing more for our learners, helping them to achieve their goals by avoiding firmly held but poorly supported doctrine.