The study assessed the impact of lateral thinking pedagogy in undergraduate ophthalmology education from the perspective of students. The lateral thinking teaching method has been implemented and studied in more analytical courses like engineering [24, 25]. Frequently, educators encouraged their students to think “laterally” without labeling it, but further instrumentation of this pedagogy has not been explored in undergraduate medical education. Lateral thinking is seen as a tool to reform thought patterns, to nurture new ideas, focuses on process and less on end results when order and sequence don’t matter [21]. It is complementary to the vertical thinking method, a hierarchical process that establishes that each step must be correct before proceeding to the next step. [26].
Overall, the LTM group found that the method improved their confidence in ophthalmic clinical knowledge, managing common eye conditions, and recognizing signs of visual or life-threatening eye diseases. We have found that the LTM stimulates student interest because direct instruction or questioning of the provider during the course engages and challenges student thinking; to encourage them to think of new ideas on the given topic. By not emphasizing the order of thought, students may work out their thought process laterally or even upside down. Moreover, by not sticking to a routine or rigid structure of knowledge processing or input, students could expand the breadth (and depth) of their knowledge and make associations of any “invisible” element with the information given. This form of active learning could improve students’ long-term memory compared to the normal classroom, which may be affected by the short attention span of medical students. [27]. Moreover, the method also encouraged higher-order learning processes in the learning domains, as shown in Table 1.
The advantage of this method over the flipped classroom, which had gained popularity in undergraduate ophthalmology education [17, 18, 28, 29] and postgraduate [30] level is that students did not have to commit to specific pre-readings or recorded lectures prior to instruction. The goal of the LTM is for students to make meaningful associations between current learning material and their previously acquired knowledge that was not necessarily limited to the field of ophthalmology. As the ophthalmology curriculum has become increasingly remote and peripheral to other clinical specialties, students may find it difficult and complex to make these connections. An educational tool like LTM can fill these gaps in undergraduate ophthalmology education.
Additionally, the questionnaire data revealed that students had a neutral response with no preference for teaching methods aimed at alleviating their anxiety or the negative preconception that the undergraduate ophthalmology curriculum was difficult. This finding is not surprising given the limited time students have to explore ophthalmology with limited exposure to the clinical setting. [20, 31].
We identified that the study lacked longitudinal follow-up because we assessed student responses once after class. A crossover design would be ideal for comparing the strengths and drawbacks of each teaching method, but the limited time allocated to the ophthalmology externship of the entire clinical phase of the medical program makes such an implementation less practical. Pedagogy can be deepened on the impact of long-term memory and student retention via reassessment after a period of time without prior review. While the flipped classroom promotes online teaching and the digitization of education with pre-recorded lessons, lateral thinking pedagogy relies heavily on teachers’ ability to actively provide effective instructional materials to enable active engagement and learning. safe place to generate mistakes and learn from them. Therefore, provider training can be practical and effective, especially if they know about creative or lateral thinking methods that can be cost-effective and resource-saving in delivering undergraduate ophthalmology education, as evidenced by the scores of students.
Reassessment and reformulation of questionnaires to address other areas of students’ perspectives could be mandated in future studies, including their enthusiasm for pursuing ophthalmology and their confidence in solving unfamiliar problems. Additionally, the study was limited to some key topics associated with clinical ophthalmic anatomy, which relies primarily on memorizing older information rather than reforming new ideas and solutions that can encourage creativity. The overly structured and less abstract topic may not be suitable for lateral thinking pedagogy, although it places a relative emphasis on long-term memory formation and restructures knowledge into focused clinical application.
Additionally, the study was culturally challenging, as students who have been exposed to vertical and analytical thinking for a long time may find it difficult to publicly express their creative thinking skills. Since lateral thinking requires finding solutions regardless of orders and sequences, students may find that voicing “wrong” answers can be humiliating in front of their peers. They were used to being rewarded for giving correct and valid answers rather than original and unusual ideas and building resilience and celebrating creative learners can be difficult. Techniques for teaching lateral thinking may vary across student cohorts, as the more the provider taught, the better they were in the pedagogy offered and thus benefited new groups more than old ones.
As the undergraduate medical curriculum becomes more complex and arduous, the time devoted to training in ophthalmology has decreased, with more resources directed to other specialties and the diminished role of primary care physicians in the community eye care [32]. Therefore, the LTM approach emphasizing patient safety, systematic lateral analytical thinking, and practical application of knowledge can be an impactful approach for teaching undergraduate ophthalmology. Moreover, such an approach can be applied to other areas of medicine, making the learning and practice of medicine more meaningful for both practitioners and patients. By making lateral thinking a regular teaching practice through structured training and instruction, students can reshape their minds to enable better application of knowledge and versatile ways of thinking within limited time and resources.
