Has medical education killed "silence"?

There is an ignorance of "silence" observed from student selection methods to teaching and learning approaches. While selecting the candidates with suitable values to medical schools is crucial, most methods are unable to address fairness issue toward students from some disadvantaged background or certain personality specifically introversion. Similarly, teaching and learning approaches have shifted away from didactic to a more discursive methods such as brainstorming, team-based learning and case-based learning. These methods emphasize active participation and communication with team members, but having more discussion does not indicate that deep learning has taken place. Majority of these approaches require students to complete a task within an allocated time frame. Therefore, most of the time is utilized to complete a task instead of learning how to acquire a skill or learning how to learn. Important "silent" skills such as observation, reasoning process, and listening skills, are given less time or almost none due to time constraint within these discursive approaches, although these skills are extremely important as a doctor. Hence, it is time to think about on how best to balance the use of silence and externalize thought processes in medical education.