In our noon rounds session today, Dr. Cavalcanti made a simple, passing comment that stayed with me. In the middle of his presentation, he paused to open the discussion and said, "Well, you learn more when you talk than when I talk."

This statement resonated with me because of my recent reflection on the medical education process at the University of Toronto. In our first two years, our training was predominantly didactic. Lecturers would give us hours and hours of high-quality but non-interactive teaching; for me, as a Mississauga student, it took place through a videoconference system. To ask a question, we would have to press a button and have our face broadcast on a huge screen to the 200 other medical students at the downtown campus. Needless to say, we did not press the button often.

Some measures were taken to help learn by 'us talking', such as problem-based learning sessions. However, these were a small percentage of the week, and often a few students would dominate the discussion. Instead, we would find our own ways to bring our own voices into the learning, whether that meant reading our notes aloud to ourselves in our bedrooms, debating with our peers about the best way to approach a disease, or simply trying to tutor a friend. I can say with confidence that those experiences were far more beneficial to my learning than hearing a video on my computer.

In clerkship, the teaching modalities changed. Now, we were asked to bring the answer to a question the next day, and teach the group. We stood in front of whiteboards and drew diagrams, teaching our preceptors in order to demonstrate our knowledge. We spoke aloud every case presentation, integrating our clinical and didactic learning into unified approaches. The richness of learning in our clinical clerkship was unparalleled by any stage of education I've experienced before in high school, undergrad, or early medical school. We were exposed to more new environments, team dynamics, problems, procedures and situations than ever before, while expected to work long hours, maintain consistent professional standards, and never get in anyone's way. It was certainly not was, but I learned a LOT more by participating.

Having reflected on my own education and on Dr. Cavalcanti's EBM talk, I became curious about the implications of physician's familiarity with new medical research. In a recent ProPublica article that has been circulating around social media today, Dr. David Epstein explores why doctors do not always follow best practices in the article 'When Evidence Says No, but Doctors Say Yes'. It is a fascinating article that discusses cognitive biases, the notion of 'bio-plausible' but unproven medications and why it is so hard for physicians to stop using them, and finally, the idea that physicians cannot often even conceptualize the effects of medications because of the way they are presented in research. Statistics such as the number needed to treat (NNT) are not easily visualized in terms of an individual patient, which contradicts the patient-centred care principles that are emphasized in current education. When doctors are not able to say, in their own words, what the implications are of using one intervention versus another or none at all, the best medical evidence is meaningless.

- Shara