Weed or Flower?

Aug 07 2013 Published by under Life of a Physician

Lots of students aspire to medical careers. Being a physician seems like a noble calling, you can always find a job, and it will make your parents proud. Over the years, interest in obtaining the coveted MD often exceeded the openings in medical colleges. Pre-med courses often served not only to provide essential knowledge for a medical career, but also to "weed-out" marginal students.

Earlier this week, I saw something that suggested organic chemistry was one of these weed-out classes. What could future doctors learn from the dreaded O-chem? Persistence and fortitude?

How about organic chemistry itself?

I am a graduate of a 6-year BA/MD program. Yes, I entered college and medical school simultaneously from high school. I never took the MCATs. I never took calculus or college physics either. I have managed to succeed as both a clinician and a scientist despite these "gaps" in my education.

I cannot imagine skipping organic chemistry.

All life on  this planet is based on carbon compounds, and those building blocks are the focus of organic chemistry. From understanding the interactions of these molecules, we can then move on to biochemistry and pharmacology and physiology and other more medically-focused disciplines.  Do I use the "raw data" from O-chem on a daily basis? No, but without that background I do not think I could be a good physician.

Over the years, we all learn a lot of stuff that we will never use again. Sometimes this material provides the base to understand the next rung on the ladder of knowledge; other times, this stuff is just crap someone assigned.

O-chem is not crap (although crap is made of organic materials).


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Another Way To Help Oklahoma

May 22 2013 Published by under [Education&Careers], Donors Choose

Click for original site

Whether you watched the massive tornado decimate Moore, OK, from 20 or 2000 miles away, you probably want to reach out and hug those survivors. And most of us want to help.

In case you're not close enough to volunteer your chainsaw skills, or your time in a cemetery wearing clothes you can throw away, there are other venues for official relief funds.

With two elementary schools completely destroyed and others damaged, I was delighted to receive an email from DonorsChoose this morning, asking for donations to a relief fund for teachers in Moore. Right now these teachers are dealing with the same adverse conditions as everyone else, so there are no specific projects to choose. If you like, the organization can show you similar projects funded through donation programs for Joplin in 2011 and Hurricane Sandy in 2012.

You can donate by clicking this link now. If you want to act later, don't worry; they made me a widget for my sidebar! Give early and often.

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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 www.khanacademy.org, 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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Welcome to My Weekend

Empowering today's leaders to guide tomorrow's healthcare enterprise

I spent another weekend (OK, a long, Thursday through Sunday weekend) on the road in Philadelphia. This time I attended the first meeting of a group now called Women Executives in Science & Healthcare (WESH).  This group consists of men and women who have middle- and upper-level management positions in academic medicine and dentistry and public health. As part of our recent rebranding, we developed the following definition:

Integrated network of executive leaders in healthcare & science across the academic health enterprise

We want to bridge the walls between disciplines both within and outside of academia. We hope to attract C-suite women in healthcare: Chief Legal Officers, Chief Medical Officers, and others in healthcare management who do not necessarily have a healthcare or science degree. Managers in biotech and pharma will also be interested in the networking opportunities provided by this group.

The educational portion of the Spring Summit, dedicated to Renewal and Redirection, can be found here. While not the largest gathering of twitterati on the planet, a handful of folks provided enough thoughts to produce this Storify:

[<a href="http://storify.com/PHLane/wesh-spring-summit-2012" target="_blank">View the story "WESH Spring Summit 2012" on Storify</a>]<br /> <h1>WESH Spring Summit 2012</h1> <h2>Women Executives in Science &amp; Healthcare is an integrated network of executive leaders in healthcare &amp; science across the academic health enterprise. We held our Spring Summit May 4-6 in Philadelphia, dedicated to our theme, Renew &amp; Redirect. </h2> <p>Storified by Pascale Lane &middot; Mon, May 07 2012 13:23:18</p> <div><a target="_blank" href="http://weshleadership.org/upcoming-meetings.htm">Meeting Program</a></div> <div> <h2>Friday, May 4: Opening Reception</h2> </div> <div>Shopping for our cause. #WESH12 http://pic.twitter.com/kHUfkphGPascale Lane</div> <div>With a nice spread of finger food and wine, we chatted and shopped for our renamed group.</div> <div> <h2>Saturday, May 5</h2> </div> <div>Summit beginning with Janet Bickel addressing Resilience. #WESH12WESH</div> <div>At this stage our careers less like juggling, more like gardening an unruly plot, trying to make it grow. #WESH12Pascale Lane</div> <div>Success and failure are not necessarily opposites. May be self-defined. #WESH12Pascale Lane</div> <div>Janet Bickel addressing our full conference room. #WESH12 http://pic.twitter.com/9uL1PfE9Pascale Lane</div> <div>&quot;No matter how cynical you become, it's never enough to keep up with events.&quot; Janet Bickel #WESH12WESH</div> <div>Success = (Purpose x Talent)^Culture - Janet Bickel #WESH12WESH</div> <div>Looking for logic in all the wrong places = major mojo killer. M Goldsmith #WESH12Pascale Lane</div> <div>Next up: Ann Bonham, first female Chief Science Officer at the Association of American Medical Colleges</div> <div>Know that you are always being evaluated. Ann Bonham #WESH12WESH</div> <div>RT @WomenESH: What do you want to be known for? Ann Bonham #WESH12Pascale Lane</div> <div>Power networking at #WESH12 Follow @WomenESH for more info. http://pic.twitter.com/1m8edp8ZPascale Lane</div> <div>After the break, it's time for our presidential address.</div> <div>President Elisabeth Kunkel addresses #WESH12WESH</div> <div>After lunch, we are back to the program</div> <div>Robert Taylor and Karen Novielli discuss hiring, firing and moving people on. #WESH12WESH</div> <div>Great case discussions on hiring and firing issues. #WESH12Pascale Lane</div> <div>Business meeting, open to all registered participants</div> <div>Business meeting now, then dinner. Middle eastern food tonight! #WESH12WESH</div> <div>New president is Elizabeth Travis of MD Anderson. #WESH12WESH</div> <div> <h2>Sunday, May 6</h2> </div> <div>Gen X and beyond by @JenLLane today. #WESH12WESH</div> <div>Great Job today by @JenLLane speaking at the Women Executives in Leadership &amp; Healthcare Conference! #WESH12Philly PR Girl</div> <div>@kevinknebl speaking about linkedIn at #WESH12Jennifer Lane</div> <div>Working on a Sunday is sometimes worth it! Listening to @kevinknebl speak about #SocialMedia at the #WESH12 meeting.Philly PR Girl</div> <div>It doesn't matter what u do, ure long-term success is based on relationships #WESH12Jennifer Lane</div> <div>Social media platforms are communication tools, nothing more. #WESH12WESH</div> <div>Great advice from Kevin Knebl about social networking. #WESH12Pascale Lane</div> <div>LinkedIn is the largest business database in the world. Ur profile is ur business card. #WESH12Jennifer Lane</div> <div>Change ur public profile url to ur name and place under email signature #WESH12Jennifer Lane</div> <div>Add a video showing who u are on linkedIn profile to show experience and who u are #WESH12Jennifer Lane</div> <div>LinkedIn has its own seo build in #WESH12Jennifer Lane</div>Want to know more about WESH or think you might want to join? Click the links and learn more at our brand-spanking-new web site!

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Critique on Critical Thinking

May 03 2012 Published by under [Education&Careers]

As a physician-educator, I prepare the next generation of healthcare professionals. Talk about a big responsibility; one of these kids may be my doctor someday!

Medical students and residents generally have great fact-learning skills. To get this far in life they have learned volumes of information and successfully regurgitated it on multiple-choice exams. During the clinical years of medical school and residency, we really try to hone analytic and critical thinking skills. Many of my colleagues feel we do an inadequate job in this arena. When I received an invitation to view a video on teaching critical thinking today, I jumped at the chance!

First, what is critical thinking? We all know it when we see it, but what skills make it happen? We can all agree that analysis, evaluation, and problem-solving are part of the picture. Self-reflection often goes along with the process. The hot skill in education circles is metacognition, or thinking about thinking. This boils down to making the learner address what they know and do not know, as well as the quality of their information, assumptions, and reasoning. Critical thinking can best be triggered via collaborative settings with high levels of learner engagement. Early feedback also helps drive this skill set.

Click for source

Writing assignments are ideal for critical thinking because writing open-ended answers forces engagement with a topic. Interaction and early feedback further drive interaction and reflection, either via peer or supervisor review. One speaker in the video session discusses successful use of a model in which students prepare a draft of an assignment, they undergo peer review, and then they turn in a final product. The quality of these assignments increased dramatically with this model when compared to making an assignment without the peer-review step.

The most writing in clinical courses involves structured clinical documentation, often in the inpatient setting. The nature of these notes has changed a lot since my days as a resident. Back then (1985-88), our notes followed the SOAP format- Subjective, Objective, Assessment, and Plan. We organized the assessment section by problems, either as an established diagnosis (Meningitis) or symptom (Acute Febrile Illness).  Plans for each problem could be organized as diagnostic, therapeutic, or educational (discussing exacerbating factors or importance of immunization with parents). In our assessment, we had to discuss the diagnostic possibilities for a symptom complex or other issues for an established diagnosis (for acute asthma exacerbations, we had to identify possible factors that provoked the episode). If we saw something new or unusual, we had to read something about the condition to provide an adequate discussion or we got it at rounds.

Sometime in the past decade, inpatient notes switched to a systems-based format for the assessment, listing the status of the cardiovascular, respiratory, and all other systems. I first saw this in intensive care settings; now all residents seem to use this format in all settings. I can see why intensivists love this method. It provides a very clear snapshot of how all body systems are supported and the progress they are making. The goal of ICU care is to get the patient out of the ICU alive, not necessarily to solve the overall issues. When no systems require intensive care, the patient can go to the floor whether or not the overall problem has been diagnosed.

This form of note does not force or promote the sort of critical thinking of the original SOAP format. Can we do the same thing verbally on rounds? Possible, but as the video points out, writing is still the best way to engage trainees.

I wonder if other academic physicians feel the same way about "systems-based assessments?" Has anyone tried a hybrid format with an assessment section like the old days followed by systems-based assessments and plans?

My other question is how this shift happened? I have been unable to find publications to support the superiority of the systems-based approach. Does it exist?

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#EB2012: Competent or Not?

Apr 23 2012 Published by under [Education&Careers]

Bernard: Look at those chops

As we slipped into the lecture hall, a particularly fierce image glared at us from the screen. Claude Bernard's portrait greeted us to the lecture in his honor. The speaker, William Galey, took the podium, and proved that this visage was not necessary for teaching excellence.

Dr. Galey spent most of his career at the University of New Mexico and gave a wonderful history of its move to a case- or problem-based curriculum over the years. He also spoke of ongoing efforts to develop competencies for medical students and to drive our curricula in that direction. In his current position at Howard Hughes Medical Institute, he helped develop (with the Association of American Medical Colleges) a listing of competencies for students entering and graduation from medical school (available here).

My favorite part of his musings involved the central nature of physiology and medicine. Really, we need to start embroidering samplers with this quote:

Physiology is to medicine as physics is to engineering.

Later in the day, at What Do Competencies Have To Do With My Teaching? the audience got a more thorough look at the concept of competencies and their relationship to standards, objectives, goals, and assessment. Competencies first came about in graduate medical education, but now have extended into the pre-medical and medical curricula. Every objective and every assignment should be linked to achieving a particular necessary competency. Curriculum maps will make your head spin, but they can be quite valuable to identify gaps and other issues.

Competencies may soon be more as some groups work toward defining these skills for faculty. Particularly in academic medicine, new faculty often have minimal, if any, pedagogical training. Other skill gaps may present as well. As a person who works in faculty development, I appreciate these efforts so I can figure out what our faculty members may need.

Like it or not, we are educators. Even though our primary job may be research or patient care, at some point we will have to help train someone else. If we cannot say what they need to know, we cannot know if we succeed.

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#EB2012 #apsComm: Using New Communication Tools

Apr 22 2012 Published by under [Information&Communication], EB2012 Meeting

Yesterday, April 21, I had the pleasure of serving on a panel at Experimental Biology discussing the use of blogs and other social media to do public outreach. Yes, I got to be the old lady on the stage with Dr. Isis, Danielle Lee, and Jason Goldman at the session moderated by James Hicks. A good time was had by all (although Isis got a bit sweaty in her headdress replete with golden cobra) as we pontificated on our own uses of the brave new world of the internet. By unanimous request of the audience (OK, more like there were no objections) we have each agreed to share our slides on a number of platforms. I am also placing mine here.

Thus far many other sessions have addressed the use of these relatively new tools for communication. At their heart, Facebook, Twitter, and Blogs merely provide the latest pigment to spread on cave walls. Since the dawn of time humans have desired to tell their stories; these new media let us do it more widely and permanently than ever before.

The Animal Care and Experimentation Committee provided a Toolkit for Public Outreach (#apsACE) that addressed the need for transparency and engagement, rather than the bunker mentality that has prevailed at most institutions. Even this morning in accepting the Claude Bernard award, William Galey mentioned all the education resources available online. For today's students, access to information is not a problem. However, we must make sure that they learn to evaluate the reliability of information and sources before they use them in critical applications like patient care.

I ended my slides with a still from the movie Meet Me in Saint Louis. In its early scenes, a suitor calls the eldest sister, Rose, on that new-fangled invention, the telephone. A prolonged discussion ensues over whether or not a respectable girl should accept a proposal via an "invention". Similar attitudes toward the phone can be seen in the first season of Downton Abbey. All of the technology we use today was once considered radical, experimental, and unnecessary (I can remember when email elicited similar reactions to those about the phone). Social media will soon be just how we communicate, and we will move onto sessions on other cutting-edge topics, like flying cars or Star Trek transporter physiology.

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#EB2012: Physiology Education

Apr 22 2012 Published by under EB2012 Meeting

Dr. William (Bill) Galey will deliver The Claude Bernard Distinguished Lectureship of the APS Teaching of Physiology Section on Sunday, April 22, at 10:30 am in Room 27 of the San Diego Convention Center. If you tweet about the lecture, please use #Galey as your hashtag.

Bernard and the Lectureship

The Claude Bernard Distinguished Lectureship is awarded to an established investigator with a history of excellence in education who is making outstanding contributions to teaching and learning. This award is not restricted to APS members. The award is named for a 19th century French physiologist who pushed science and science education from “product” to “process” by incorporating experimentation, demonstration, and other activities.

Bill Galey

Dr. Galey

Born in Boise, Idaho, Bill Galey grew up on a small farm and was fascinated by the birth, growth, and death of the animals about him. He always wanted to know "how and why" things, such as plants and animals, and even machines, work the way they do. He decided to study science because of his interest in understanding how things work.

He was the first member of his family to attend college. He ultimately obtained a PhD from the University of Oregon.  After fellowship at Harvard and a brief period in the pharmaceutical industry, he joined the University Of New Mexico School Of Medicine where he conducted research and taught medical and graduate students. Bill was active in the development and implementation of problem based learning as well as numerous other educational innovations while a faculty member at New Mexico and was a founding member of IAMSE. Subsequently Dr Galey held various administrative positions including Associate Dean for Graduate Studies and Interim Dean for Research at UNMSOM before joining HHMI in 2002.

Dr. Galey is currently Director of Graduate and Medical Education Programs at Howard Hughes Medical Institute, running HHMI's programs to enhance biomedical science graduate education and scientific training of medical students. Among the programs under his directorship are HHMI's Medical Research Fellows Program and the HHMI-NIH Medical Research Scholars Program, which provide opportunities for medical students to engage in an intensive year of research. Dr. Galey was instrumental in developing and conducting the HHMI partnership with the Association of American Medical Colleges known as Scientific Foundations for Future Physicians (SFFP), which sets out the scientific competencies needed by physicians to practice medicine in the 21st century. Graduate education efforts under Galey's direction include the very successful Med into Grad Program, which supports efforts of graduate programs to graduate PhDs with a strong understanding of medicine. Dr. Galey's group also administers HHMI's Gilliam Fellowship Program, which provides predoctoral support to individuals committed to creating a more diverse professoriate. A new program known as the HHMI International Student Dissertation Research Fellowship Program is being initiated to support international graduate students during their dissertation research. Dr. Galey and his group also developed and conducted a highly successful partnership with the NIH to integrate graduate training in the physical and computational sciences with the biomedical sciences in a program known as Interfaces.

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That Time of Year Again: "Equal" Pay Day

Apr 17 2012 Published by under [Education&Careers]

April 17, 2012, is the date when women will earn what men took home in 2011. Yes, it will take the average women almost four extra months to earn what men get in twelve.

When I grew up in the 1970's I spent no time worrying about this problem. After all, I was a woman going to medical school, then a male-dominated profession. If more women chose the MD instead of the RN we would catch up with those pesky d00ds. The answer lay in education, getting me and my "sisters" to pursue higher-paying fields.

Now women make up nearly half of new doctors, yet even we suffer a pay gap. Even in academia we make less, even in pediatrics, a specialty with lots of women physicians. I wrote in detail about a study that came out in January in Academic Medicine in which the Department of Pediatrics at University of Colorado performed a gender equity study. They found many gaps in the treatment of their female faculty, but the salary differences were impressive (figure below right).

Click to enlarge; data from Acad Med 87:98, 2012

All salaries were standardized to 1.0 FTE and compared to national means for rank, years in rank, and subspecialty. The average male faculty member received 105% of the median, while the average female received only 98%. Looked at another way, 51% of men had salaries at or above the median (black line in red bar in right column of figure), about what one would expect with a "normal" salary distribution. Only 28% of women earned in this range (black line in left column of figure). Remember, these data have been adjusted for part-time work, rank, years in rank, and subspecialty. The authors concluded that the department did not treat women and men equally, and salary corrections were implemented immediately.

These women got a break. First, this salary gap averaged $12,000, a gap they would "make up" with only 1-2 more months of work. They also worked in a department that did the study and made corrections. Women in lower-paying fields may take much longer to catch up to their male counterparts, and many of them have no idea how underpaid they are. If they cannot document the gap, then they cannot use the law to address it.

Pay equity is unfair. Pay equity is wrong. Find out where the candidates stand on fair pay laws. Then use your vote. Together, we can change the country.

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Powerful Support Groups

Oct 03 2011 Published by under Donors Choose

A few years back, I actually lost weight during the weeks between Thanksgiving and New Year's Day. A bunch of us at work created a support group to hold us accountable to a goal each week. Some of us set exercise goals. Others swore off the drive-through window. We gathered once each week and self-reported our progress. Anyone failing to make goal put $5 in the pot, an amount high enough we all found it annoying to lose, but low enough that we could kiss it goodbye when life intervened.

Pot of Gold

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As one woman put it, one night her children's activities got rescheduled so it was fast food or nothing. She knew the drive-through cost her an additional $5, but it may have been the best money she spent all week. That was also the only time they ate fast food all month.

At the end of the challenge we had a pot of just over $100. We thought about buying lottery tickets, but eventually settled on a coat. One of our housekeeping staff was a recent immigrant who did not have outwear up to Nebraska winter. We got him a heavy-duty parka.

Group support for goals has been around for a long time. Why am I telling you this story? Because you, the WhizBangers, are now my support group. I only made it to the gym once last week. I want to make it at least three times this week. Next week will be a lesser goal because I am traveling, but the week after that I will do 3 work-outs again. What will I do if I fail to make these goals? $25 to my DonorsChoose page.

Want to participate? Feel free to leave your goal and "failure payment" in the comments. Next Monday we will gather here again to compare progress and make payment.

Even if we make our goals, we can still give to DonorsChoose. Supporting education is a great thing to do. Of course, if it gets me to the gym, even better!

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