Archive for June, 2010

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Flexible Education

Tuesday, June 8th, 2010

A new report by professors at UCSF encourages a rethinking of traditional medical education. One area for reform is the time necessary to receive the M.D. degree. Why four years for everyone? If students learn at different paces and have different interests, why not a more flexible schedule?

The proposal would make medical school more like doctoral programs, whose curricula are much less rigid. At the same time, recent critics of ten-year-long Ph.D. programs have called for graduate study in the arts and sciences to be more like medical school.

I’m inclined to favor more rigid timelines for medical school but more loose guidelines for residency. Sharing a common experience of courses over four years provides benefits that outweigh accommodating individual learning styles.

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Why We Work

Friday, June 4th, 2010

Dan Ariely is a psychologist and author. His first book, Predictably Irrational, described real-life examples of how people make economic decisions. Instead of using mathematical models, he set up experiments (many with MIT students) to show that people often act in irrational ways.

He spoke on NPR recently about his new book, The Upside of Irrationality.  One of the axioms he tested was whether receiving more money stimulates people to work more effectively. He found, counterintuitively, that when offered big bonuses to do small tasks, people flubbed more often than when offered small bonuses.

Another experiment showed that even when people were paid for a task like building structures from Lego, they lost motivation if they saw the work undone. His findings do not argue for eliminating paychecks, but rather encourage us to treat the relationship between salary and performance as indirect. Satisfaction at work comes from more than just money.

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Empathic Education

Thursday, June 3rd, 2010

When I was a college student, I took some memorable lecture classes. Though they could not address individual student concerns, the professors gave compelling lectures illustrated (in those days) with relevant slides and memorable anecdotes.

Lectures are an efficient way to communicate content. It's a brain dump from the expert to the novice. But there is no way to ensure that the recipient of the material understands the core concepts or can implement them in novel ways. Increasingly, pedagogical theory has turned to more dynamic, learner-centered teaching.

The Chronicle of Higher Education published a piece by Jeremy Rifkin that made me reflect on good teaching practices. He points out that the traditional system stifles collaboration--it's considered cheating to work with others. Yet, studies have shown that when medical students work together, they diagnose patients more quickly and accurately.

If the goal of medical education is to train empathetic physicians, we should consider replacing lectures with small group projects that prepare students for the kind of work they will be doing as practicing doctors.

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War on Drugs

Wednesday, June 2nd, 2010

For last week's grand rounds, Ethan Nadelmann of the Drug Policy Alliance spoke about the public health implications of the war on drugs in the United States. He argued that drug use should be treated in the medical system, not the criminal justice system.

He makes a compelling case that punitive drug laws lack any rational basis and serve only to incarcerate minorities for minor offenses. Using the metaphor of the automobile, he believes that drug use will not go away soon, but we have an obligation to minimize the negative impacts through enlightened public policy and medical intervention.

I am sympathetic to his claim that marijuana and heroin should be legally available like alcohol and tobacco. What I'm not too sure about is what limits to place on legal drugs. Is there a minimum age at which citizens can use cocaine? Should a person be allowed to possess hundreds of pounds of marijuana? Just as there is no scientific basis for banning drugs, nor is there sound evidence for the consequences of deregulation.

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Safer Intersection

Tuesday, June 1st, 2010

When I first applied for a position at BU, I had to visit the Human Resources office. HR at the medical campus is located in the Crosstown Building at the corner of Mass Ave. and Albany St. It's a busy, dizzying intersection with cars coming off the interstate, others turning to the hospital, and buses ferrying passengers to the subway.

In the lobby of the Crosstown Building is a photograph of the intersection mounted on poster board. A sign asks viewers to mark with a push pin the most dangerous part of the intersection for pedestrians to cross. The board is riddled with pins.

So, it's good news that BUMC faculty and students successfully negotiated with city officials to protect pedestrian crossings at the lights. It took persistence, pique, and creativity (at one point the advocates wrapped their heads in bubble wrap), but it shows how effective a small group with an important cause can be.

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