Neurology Pedagogy, Androgogy, and Continuous Revision

How should teaching and learning be done, especially in the field of neurology? And how do you take a classic textbook on neurology and keep updating it to make it relevant to the times?

Two of the authors of Adam and Victor’s Principles of Neurology — Allan Ropper, M.D., Professor of Neurology at Harvard Medical School, executive vice chair of Neurology at Brigham and Women’s Hospital; and Martin Samuels, M.D., Miriam Sydney Joseph Professor of Neurology at Harvard Medical School and chair, Department of Neurology, Brigham and Women’s Hospital — sat down with McGraw-Hill Education to share some insights.

According to Dr. Ropper, “there are two streams of medical pedagogy” — one in which students pick up information in traditional ways, via lectures and textbooks such as Adams and Victor’s, and then in experiential ways, by seeing knowledge in use on the job by clinicians.

To Dr. Samuels, it’s about pedagogy versus what he called “androgogy, the teaching of adults.”

Dr. Samuels pointed to Malcolm Shepherd Knowles, a former Boston University education expert who was a champion of androgogy, self-directed learning, and adult education. Infed.org, in writing about Knowles, says his work shifted the focus of adult education from “educating people” to “helping them learn.”

“[Knowles] made the argument that adults learn in a different way, that they have to have a reason for learning, that they have to get immediate feedback, whereas in a child’s case, you can tell a child what to learn and expect them to just do it, because you’re the teacher,” Dr. Samuels says.

But in medical education, for students to learn successfully, there has to be a combination of pedagogy and androgogy, Dr. Ropper and Dr. Samuels say.

“It’s that magical marriage of the two that makes it work,” Dr. Ropper says “Either one alone doesn’t allow people to advance very much.”

Because of the continued need for textbook-supported pedagogy in neurology, Dr. Ropper and Dr. Samuels, along with authors Joshua P. Klein, M.D., Ph.D., and Sashank Prasad, M.D., work on keeping Adam and Victor’s textbook updated for the times.

To do that takes continuous editorial review, Dr. Ropper says.

Every Monday, “The four of us sit down and do what might be called a Talmudic discussion of each section” of the book, he says. They debate what should be updated and why it should be updated, or whether it should be kept exactly as it is.

“It’s one of the best journal clubs that you could imagine going to,” Dr. Samuels says. “We sit there together and read every word of it.”

And the process of revisions never ends. “When we get to the end of the current one, the word edition has no meaning anymore,” Dr. Samuels says. “We’ll just start over from the beginning, and there we are again. It goes on forever, and our successors I hope will do the same. That’s why we recruited these two young people [Klein and Prasad] who are very talented and committed to a similar view that this is a very important piece of the medical literature.”

Dr. Ropper says, like Adams and Victor, he and his co-authors continue to review the medical literature on each subject in the book. “And there of course is an endless supply of material, because if you look at the brain tumor chapter that we’re working on now, there are thousands, maybe tens of thousands of papers that have been written in the last five years, particularly with the explosion of genetics,” he says. “We try to cull them down to the essentials.”

Dr. Ropper hopes Adams and Victor’s, as a result of this continuous revision and review process, “has a traction that transcends us or the times.”

For an excerpt from Adams and Victor’s Principles of Neurology, 10th Edition, please download Approach to the Patient with Neurologic Disease. Adams and Victor’s can also be found in AccessMedicine’s Neurology Collection.

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