Archive for the 'Learning' category

My New Baby

Oct 09 2014 Published by under Learning

What do you call 100 babies in a single litter?

What do you call 100 babies in a single litter?

Hard copies arrived! My new book, The Promotion Game, arrived in a big box.

I never realized how proud I would feel to see my work in print and hold it in my hands.

It's almost like giving birth to something, except without the blood.

If you are interested in succeeding in academic medicine, this book may be for you. You can get more information here.

Ebooks are expected to be available soon on Amazon and the other usual venues.

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High Stakes Games

Oct 08 2014 Published by under Learning

Too many new faculty in academic medicine get lost.

They sign on with academic medical centers with the best intentions. They want to inspire the next generation of providers. They want to solve healthcare problems. They hope to make the world a better place.

Unfortunately, academic medicine provides many distractions.

Unlike our PhD colleagues*, we MDs often fail to teach our trainees anything about academic life. I came from an academic family. I knew about ranks and tenure and other issues, but I still didn't really know how to succeed in The Ivory Tower. Someone gave me the Faculty Handbook, including promotion and tenure (P&T) guidelines, when I showed up at my first job.

Yes, I wrote it all down!

Yes, I wrote it all down!

Have you ever read a faculty handbook? Have you ever tried to read a faculty handbook? These documents tend to be written with stilted dry language. The handbook for an entire campus also keeps things vague enough that it applies to all departments and sections; this provides little guidance for a new assistant professor. You have to find contacts who can give you the real dirt. How many papers are considered "a significant number?" What sort of funding counts toward the tally? Will case reports be held against you? How do you document your educational efforts?

Mentorship helps (those contacts described above). P&T workshops with department-specific information can help. Unfortunately, none of these can be used as a lasting reference. Clinician faculty, in particular, often lose sight of their goal. Patient care responsibilities and other tasks can distract them from achieving and documenting the things that matter for academia. They get a few years into their first appointment and discover that they are behind the eight ball. Many leave academic medicine at this point.

That's why I have written down wisdom collected from multiple institutions and many colleagues. I have tried to keep this brief guide chatty and useful, rather than an academic tome. Yes, it is vague in that it gives no specifics for any institution; however, it does help faculty members know what to ask their colleagues and mentors.

When you get down to it, P&T is really a game. You have rules, you reach milestones, you keep score, and eventually you can win.

Yes, this is my Big Surprise. The book is debuting soon, both in print and as an ebook. Learn more at the website,

*Instead, our PhD colleagues prepare everyone for an academic career, even though we know there are not enough positions for every trainee and many will have to pursue careers outside of The Ivory Tower.

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Good for the Soul: Claude Bernard Lectureship #EB2013

Apr 22 2013 Published by under Learning, Uncategorized

keep-calm-and-talk-science.pngP stands for many things in my life. It's my first initial. As a nephrologist, it's liquid gold. It can stand for physician or physiologist, either of which I will admit to.

It rarely stands for Physics in my world.

Yet Sunday, a packed room experienced Confessions of a Reformed Lecturer, a performance by Eric Mazur, Professor of Physics at Harvard. He brought his peer instruction technique into the convention center, convincing a large group of physiologists about their validity (and teaching a spot of basic physics along the way).

Last fall I taught my 6 hours of renal pathophysiology using the flipped lecture technique with peer instruction. I converted my talks to video, asked the students to watch these and read the handouts ahead of class, and then be prepared to use the material in class. During the assigned "lecture" time I would post a case-based problem and then ask the students to discuss among themselves what was going on and commit to an answer. We would then discuss the right and wrong answers and the logic behind them. Those who attended and worked in small groups seemed to "get it." Some students sat isolated in the back and did not participate in discussions. Many did not show up at all. If they can learn the material without being in class, I am OK with that.

Several months later the evaluations for my coursework came in. They were the worst of my career, even worse than my initial efforts with plain old lectures.

Damn! What happened? Flipped lectures were the answer to it all, the "mom and apple pie" of education.

Turns out a lot of educators, including Eric Mazur, get students who do not appreciate this method. For their tuition dollars, they expect us to use the time we have together "in a more responsible way." *

So back to the Bernard presentation or performance (you can view his slides here). He asked each of us to think of something at which we excel. Then he asked us how we got so good at it. Overwhelmingly, the audience said practice. Mazur gives this talk over and over, in countries around the world, and the answer is always the same. Lectures and reading may transmit knowledge, but they do not make us good at using it.

ElectrodermalActivity.jpgPart of this is because we do not engage our brains in lecture. Wearable sensors for electrodermal activity (a strong correlate of sympathetic activity reflecting emotion, cognition, and attention) show that students flatline during lectures. Their tracings during lectures look like those while watching TV. Students appear to be more engaged while asleep than in class! Labs, homework, and studying all appear to invoke more physiological engagement! (For the original study and a peek at a tracing click here.)

By the end of the hour he had us all convinced that plain old lectures would not do. However, he had not addressed my question: how do you get student buy-in? How do you convince them that they have to learn to use the material themselves?

I swam upstream through the crowd, and Mazur was kind enough to point me to his website, Peer Instruction. All it takes to register is a valid email address and an ability to fill out a captcha. Soon I had access to the blog, Turn to your Neighbor, a source of amazing treasure for educators. If you teach anything, anywhere, you need to have access to this information! Many posts deal with the issue of student buy-in. I have only begun to scratch the surface of the treasure buried there.

I am already plotting how I can keep my interactive format with peer-instruction next fall but without so may bad evaluations! This was by far one of the most practical sessions I have attended on teaching (and I saw Khan speak last November).

Congratulations, Dr. Mazur, for a well-deserved award, even if your discipline is "the wrong P," at least in my humble opinion.

And I will never forget what happens when you heat a metal plate with a hole in the middle.

*Seriously, from one of my evaluations

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Reversing Courses

Dec 19 2012 Published by under [Education&Careers], Learning

Back in November I had the pleasure of hearing Sal Khan, founder of, address the Association of American Medical Colleges Annual Meeting. He described how a stint of long-distance tutoring of his niece led to a revolutionary platform of free online education. He is one of those speakers who immediately connects with his audience, making  you feel like everyone can learn from him. The talk can be viewed on the AAMC website, although it does require registration through an AAMC member school.

Click to Amazon

Now almost finished with his book, I know even more about Khan's amazing journey from hedge fund manager to educator. The One World School House: Education Reimagined begins with the journey of his talk, but pulls in adult learning theory and other educational science that supports his methods. He knew none of this when he developed his videos and software; he just instinctively moved in this direction.

A visit to the Academy videos shows very basic media. While the narrator describes a process, the lesson gets illustrated in several basic colors on a blackboard-like screen. No lighting, no faces, and no fancy animations (see below).

Very Simple

Very Simple

"Flipping lectures" has received a lot of attention in higher education in the past 5 years. Khan's methods essentially fit this model; information gets delivered by video or text book and class time is used for problem-solving and other active learning with teachers. Students like this approach, and studies to date suggest that all students do better. Students predicted to score low do well, and those predicted to do well do even better.

Last fall, when I taught fluid, electrolyte, and acid-base pathophysiology to second year medical students, I took this approach. I had text-and-figure handouts in PDF format already. I then took my PowerPoint slides and narrated them, turning them into video files the students could view whenever. Class time involved case-based questions that the students could discuss among themselves and then answer. We then went over the answers and rationale.

Yes, this took a lot of work on my part ahead of the class. It was a lot more fun for me than lecturing to a group of droopy-eyed students.

One barrier I see to flipping lectures involves video production. Faculty often complain that they do not have the software or equipment to set up the videos. They do not want to put effort into that sort of production.

Of course, nothing is necessary besides their computer with a microphone and their lecture slides. PowerPoint now has a "Save As Video File" option on both the Windows and Mac platforms. As we can see from the Khan videos, nothing fancy is required for learning. Clear presentation and illustration is most important.

I have made a video about making PowerPoint videos. I hope you enjoy it and find it useful.

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Merely Delivering Information?

Jul 08 2011 Published by under Learning

Click for source

The summer issue of Harvard Business Review includes an interesting piece synthesizing several books about higher education. Justin Fox argues that academia is overdue for change in Disrupting Higher Ed. He opens with the following:

Last summer my family moved from Manhattan to Cambridge, Massachusetts. Thanks to a lucky break in the rental market, we ended up with part of a house in a lovely, leafy neighborhood near the Harvard campus. Many of our neighbors are Harvard professors. They’re lovely (not leafy) folks. Smart, friendly, funny. Did I mention smart?

They’re also among the most privileged people I’ve ever met. Privileged not because they inherited large sums of money or lounge around eating bonbons. Privileged because they work in rewarding, stimulating jobs—with lots of opportunity for variety and personal initiative—and seemingly don’t ever have to worry about losing them.

A few paragraphs later, after discussing the last decade's disruption in the media, the fallacy sets in:

Higher education, like the media, is in the business of delivering information.

Uh, no. Even in BA/BS level courses, the idea is not to merely read and remember stuff; most faculty want undergrads to integrate the facts into understanding. The information delivered should be used, ultimately, to generate new knowledge: new interpretations of history, new pieces of art, new search engines, and new science break-throughs. The purpose of higher education is knowledge, including its communication, generation, and preservation. As students mover higher up the system, through the masters and doctoral levels, the emphasis on communication of knowledge lessens. Especially for the PhD student, the emphasis becomes research, taking what is known and integrating it in new ways, perhaps with new facts.

Higher education is like making the information, then delivering and editorializing on it, ultimately hoping that someone will make more new information with it all.

As a medical school faculty member, I have to communicate certain facts to the students; if they do not learn how to calculate the anion gap, they cannot use it at the bedside. However, what they really need to know is what the anion gap means,what it tells them about the patient's pathophysiology. I want them to understand the systems of the body, to appreciate the interactions of all of these systems, and to juggle this level of complexity when they see the patient. These latter skills do not happen in the lecture hall; they occur at the bedside. While some of this complex consideration of everything can be simulated (in really expensive, high-tech teaching halls), nothing compares to actually using new information in the care of a patient.

Students learn by grappling with knowledge, fighting with the facts and figures for mastery. Some students learn visually, others by reading, and others by hearing. Often, providing ways to manipulate and understand new knowledge in multiple ways can help students grasp stuff faster. The online world makes this easier, by letting those of us who do teach post videos, songs, and other non-traditional materials that students can use. However, I do not see anyway a student could get a meaningful degree just by learning facts online.

I have participated in some online learning myself through webinars with interactive discussions, both in real-time and via asynchronous message boards. For short courses it works pretty well, and interactivity can be generated. I was forced to use the facts I read between sessions and to support my actions with my teacher and my peers. Learning can be done via new technologies. I don't know that I would have wanted to do an entire degree program via that format; it took far more effort on everyone's part than gathering a bunch of students in a classroom. As an extrovert, I also gain energy with people. I like the social aspects of education, even the camaraderie of a class learning with a bad teacher!

I agree that we in academia are privileged. I make less than my counterparts in private practice, but I have a stimulating, rewarding job. I can justify a lot of wide-ranging interests as part of my profession, including readings on adult learning, social media, and even creative non-fiction writing. I would not give up that aspect of my career! Of course, my job security comes not from that part of my job, but from my clinical skills. In the current era of funding cuts, having MD behind my name provides far more salary guarantee than tenure, even in the Ivory Tower!

Fox presents recent books demonstrating the "disruption" that is occurring outside the Ivy League. One book, The Innovative University: Changing the DNA of Higher Education from the Inside Out, he describes as an "entertaining, informative history of higher education as seen through the joint lens of Harvard and BYU-Idaho." It sounds like a great read, but it won't be available until July 26 (and not yet in an eReader format for pre-order; hello, disruptive technology?).

How do you see higher education in this online media age? Disrupted or supplemented? Do you think we professors and instructors are merely in the business of delivering information?


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Exploring the VARK

Nov 24 2010 Published by under Learning

Yesterday's email queue brought the table of contents for Advances in Physiology Education. One article caught my eye- A comparison between learning style preferences and sex, status, and course performance- by John L. Dobson of the University of Florida. The abstract follows:

A comparison between learning style preferences and
sex, status, and course performance. Adv Physiol Educ 34: 197–204,
2010; doi:10.1152/advan.00078.2010.—Students have learning style
preferences that are often classified according to their visual (V), aural
(A), read-write (R), and/or kinesthetic (K) sensory modality preferences
(SMP). The purposes of this investigation were to compare
student perceived and assessed SMPs and examine the associations
between those SMPs and status (i.e., undergraduates vs. graduates),
sex, and course performance. Students from the fall 2009 APK 3110
and APK 6116 Exercise Physiology courses were asked to indicate
their perceived SMPs and complete the standard VARK SMP assessment.
There were 64 student respondents: 50 undergraduates and 14
graduates (40 women and 24 men). According to the perceived SMP
results, the largest number of respondents chose V (36%), followed by
R (28%), K (19%), and A (17%). In terms of assessed SMPs, the
largest number of respondents were classified as VARK (37%),
followed by R (14%), AK (11%), K (8%), VK (6%), ARK (6%), A
(5%), VAK (3%), RK (3%), V (2%), AR (2%), and VRK (2%).
Nearly two-thirds of the respondents correctly matched their perceived
and dominant assessed SMP. There was no statistical association
between SMP and status. There was a very nearly significant
relationship between sex and both perceived (2  7.18, P  0.06)
and assessed (2  17.36, P  0.09) SMP. Finally, there was a
significant relationship between perceived SMP and course scores
(P  0.01 by ANOVA). Post hoc tests revealed that the K group
scored significantly lower than the other three modality groups.

Sex differences pulled me into the article; other questions kept me digging. The VARK site gives a bit more detail about the instrument used to classify learning preferences. As noted in the abstract and article, there are four preferences: V (visual), A (aural), R (read-write), and K (kinesthetic). While many of us know that one of these is our most important learning style, most of us have multimodal preferences; we like to learn through more than one modality. The online VARK instrument has been statistically validated, but longitudinal studies have not been performed to see if VARK remains stable over time (like MBTI or Strengthsfinder). Younger participants generally show more K preference than older people, so VARK may change as we grow up, perhaps in response to an educational system dominated by R. Alternatively, there may be generational differences in VARK. Could it be that GenXers and Millennials, raised with television and multimedia, are permanently skewed toward K? Only time will tell. There is even a book about using VARK preferences to improve performance via athletic coaching!

Courtesy of PhotoXpress

The Dobson study presented few real differences in its small sample of physiology students; most impressively it demonstrated an association between K preference and worse academic performance. This association is not surprising; higher education clearly rewards those who learn and express their learning by reading, writing, and listening.  Would any of us in academia be successful if we didn't have tolerable R levels? I seriously doubt it.

What I wanted to know is whether VARK predicts vocational choices. I know bright kids who opted out of college; I wonder how many of these children have strong K preferences that our higher learning systems do not reward? I remember a couple of young adults who started college and performed adequately, but dropped out because they could not stand the idea of ending up in an office all day. Sounds like an ongoing K preference to me!

I am not in a position to perform this study; anyone out there who is can have the idea (just let me know the results when you publish)!

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