Book Review: One World School House: Education Reimagined by Salman Khan

Salman Khan, former hedge fund manager, is a darling of the TED talks circuit and a bit of an education reform celebrity.  His story begins with his younger cousin, who was struggling with math in spite of overall strong academic performance.  What started as a long-distance internet based family tutoring session, has grown into a cottage industry of YouTube based lessons—technologically simple, relatively short and digestible—which can be viewed, reviewed and mastered at the learner’s own pace (Incidentally, if interested you can brush up on your immunology or cardiac electrophysiology).  His book, One World School House: Education Reimagined, is part history lesson, part pedagogical treatise.  Although it has nothing directly to do with medical education, it is useful to read this entertaining and accessible work through the lens of a medical educator.

Khan’s fundamental contention is that the current educational system is based on the 18^th century Prussian model of public education—innovative in its day.  The system was developed to meet the labor needs of an increasingly industrial society, and “to create loyal and tractable citizens”.  The system was not intended to foster independent thinking, learning or creativity.   The theme of the book, and his work overall, can probably be summarized in his words:

The old classroom model simply does not fit our changing needs.  It’s a fundamentally passive way of learning, while the world requires more active processing of information.

Basic tenets of Khan’s world view include:

• Basic concepts must be fully understood and mastered before moving on to other more advanced concepts (think competency based, rather than time based education).

• Teachers can convey information, assist and inspire learners. However, we ultimately educate ourselves.

• Associative learning is critical. Per Khan, it makes no sense to put courses into discreet boxes—to divide learning into periods and courses with discreet beginnings and endings. As humans, we truly learn by associating information systematically with knowledge that is already deeply rooted in our memory. “…no subject is ever finished. No concept is sealed off from other concepts. Knowledge is continuous; ideas flow.”

• There is incredible inertia in existing educational systems. It is difficult to escape customs established for decades or centuries, even when it is clear the customs do not serve us well.

• The knowledge explosion and subsequent rapid pace of change requires a change in pedagogy. We can no longer approach education as a process of filling heads with knowledge, so learners can coast off that knowledge for thirty or forty years. If you have children in school today, more likely than not the job they will be doing has not been invented yet. It is critical that we teach people how to teach themselves, rather than perseverating on what they learn.

• There is value to mixed aged classrooms. When there are learners at various degrees of progress it promotes an atmosphere where everyone can learn at their own pace. In addition, it provides opportunity for learners to to be leaders—the more advanced can help those still trying to master concepts.

• Testing has a limited (but important) role. Tests can measure quantity of information learned, at least when the test was taken. Tests are less able to measure “quality of minds [or]…character”.

• The current day university plays an important credentialing role—because you have completed this degree, you therefore have these skills. If competency and proficiency could be reliably measured, the credentialing role of education could be decoupled from the educational role.

This work is a rapid read, and worth the time.  It is not an academic treatise, and does not purport to be.  At times Khan’s enthusiasm for his subject, and his apparent success, leaves the reader feeling like his approach is an educational panacea (which he takes great pains to deny).  But his concepts resonate at an intuitive level.  He raises important fundamental questions about the nature of education in the information age.  His encouragement to move forward without waiting twenty years for a randomized trial is an important message in an era of reform.

With regard to medical education, although the work does not explicitly discuss the training of physicians or healthcare providers, it does align with some of today’s pressing concerns.  How do we provide high quality education at an affordable cost to our citizens, and to the world?  In an environment where information is increasing perishable, how do we turn a commitment to “life-long learning” from hollow platitude to a fundamental educational principle?  As medical knowledge is increasingly integrated, how do we evolve from a silo approach to knowledge acquisition, to one in which our new bit of genomics learning is associated with what we have already learned in cardiology, immunology and population health?  If you think these questions are important, Mr. Khan’s book is worth an investment in your time.