Continuing Medical Education

September 14th, 2010 by pcahn

Physicians must earn continuing medical education credits each year to maintain their licenses. These credits come in the form of courses with updates on the latest peer-reviewed findings in medical care. For instance, one doctor I spoke to who works with many Iraq War veterans has set up a workshop to help other physicians identify the signs of PTSD in patients.

Increasingly, pharmaceutical companies and device manufacturers have sponsored CME courses. The accrediting agency for CME found that industry contributed $1.2 billion –nearly half of all funding for CME–in 2007. While that number has dropped as medical schools begin to cut down on conflicts of interest, many companies still pay for doctors to attend CME courses in luxurious locations.

A Harvard Medical School neurologist is part of a team that is developing a new CME curriculum free of industry influence. As the Boston Globe revealed in their story, even the founders of this company have ties to another firm that accepted industry money. And their own plan is to sell courses directly to hospitals. Just as with campaign finance, it seems that it’s impossible to avoid any conflict of interest when it comes to the medical field. Maybe the solution is to require more disclosure of funding sources.

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Learning On-Line

September 13th, 2010 by pcahn

Doing educational research is tricky. Unlike in clinical trials, investigators can't limit all variables or deny some students knowledge. The slipperiness of qualitative research has left many questions about the effectiveness of on-line learning unanswered.

A report this summer for the National Bureau of Economic Research adds another finding to the ongoing debate. The authors, academic economists, attempted to create a controlled experiment by dividing students taking a microeconomics course into a "live" learning group and a virtual group. They found that low-achieving, male, and Hispanic students performed significantly better with the in-person format.

All the usual limitations on educational research apply to this study, but it does suggest that synchronous learning still has its benefits. Just like e-readers are not replacing traditional books, all these teaching methods can exist simultaneously. The internet is not a panacea for higher education, but it offers powerful tools for learning.

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IRB

September 10th, 2010 by pcahn

To conduct research on the effectiveness of the mentoring program we're rolling out on the Boston University Medical Campus, I have been revising an application to the Institutional Review Board. The IRB oversees all research with human subjects to make sure investigators comply with federal regulations.

The motivation for such an oversight body is admirable. Especially with biomedical research, the potential for harm to research subjects is too great to go unchecked. But when it comes to more psycho-social research like the evaluation project I am proposing, the board's requirements can be cumbersome.

A New York Times article from 2007 points out the mission creep of IRBs, which originally applied just to research sponsored by federal grants. As universities require social scientists to go through the process, some of the protections for subjects end up sounding absurd. What's more, the regulations may interfere with a scholar's first amendment right to study and publish freely. I think of the New York Times itself, which does not have to seek any external approval before it writes potentially harmful pieces about subjects in the news.

In the end, though, the process of crafting an IRB application has been helpful for clarifying the safeguards my study has in place to protect research subjects. If it takes a cumbersome on-line form to get researchers to consider the ethical implications of their studies, then it's a worthwhile cost.

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Conduct Unbecoming

September 9th, 2010 by pcahn

Charges that Harvard psychology professor Marc Hauser falsified data have been widely reported. Hauser suffered professional embarrassment and the retraction of published papers, but his employer does not seem ready to impose any lasting sanctions. He will take a year off from teaching and advising and then, presumably, return to research.

The Harvard Crimson notes that when other prominent faculty have committed scientific misconduct, the punishment has been similarly lax. The head of psychiatry at Harvard Medical School resigned in 1988 after admitting plagiarism, but was then hired back as chief emeritus. According to sources at Harvard, the university has never revoked tenure for research lapses.

No doubt the exposure has been devastating for Hauser and will cloud any of his future accomplishments. Still, it is not clear that he incurred any institutional penalty for his actions. Falsifying data erodes the core of a university's academic mission. There should be some commensurate punishment for violating those values. Firing Hauser is not the solution either because he could return to research chastened and invigorated. As befitting an educational setting, Hauser's experience should become a teachable moment for the rest of the community, not an excuse to banish him for a year.

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How Much Is a Professor Worth?

September 8th, 2010 by pcahn

Accountability has long been the watchword in elementary and secondary education. The Los Angeles Times stirred controversy when it published rankings of school teachers based on their students' progress in test scores. Now, the Texas A & M system plans to bring quantitative measures of effectiveness to higher education.

As reported in The Eagle, The Texas A&M University System Academic and Financial Analysis would tally up all the research funds that a professor draws along with tuition revenue from classes taught. By subtracting the faculty member's salary from the total, university leaders would arrive at a ranking of cost effectiveness.

The plan is still in a draft phase, but it has already sparked objections. So much of the education-related activities of faculty occur outside a traditional classroom setting, but advising, mentoring, and grading are not taken into account. Moreover, the simple formula takes a crude measure of worth. A Dante scholar might not generate sponsored research or large class sizes, but her contributions to the intellectual life of the university may be great. It's one thing to look for waste in higher education, but applying economic principles to learning impoverishes students and teachers alike.

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Gender and Commercial Science

September 7th, 2010 by pcahn

Higher education has long recognized the need to hire and promote a diverse faculty. To increase gender representation among the teaching staff, Boston University hosts a Women's Guild and the Women in Science and Engineering network. Still, women represent only 36% of full-time BU faculty.

A new report from researchers at UC Berkeley, Harvard, and MIT highlights how much further women have to go to reach equality in commercial science. The authors reviewed the composition of scientific advisory boards at 500 biotech companies. They found that women make up less than 7% of paid advisors in commercial science.

Their data do not suggest a single explanation for the poor representation of women on scientific advisory boards. Perhaps it reflects the more conservative nature of corporate culture. No matter what the cause, the discrepancy points to a larger pay gap than previously acknowledged. Because board membership comes with increased prestige and compensation, the low number of women scientists indicates more work to be done before reaching parity.

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Adding Administrators

September 3rd, 2010 by pcahn

Boston University employs 9.5 administrators for every 7.9 students enrolled but only 33.7 instructors and researchers for every 100 students. Doesn't this sound like bloated bureaucracy steering the institution away from its core mission?

The Goldwater Institute thinks so. The Arizona-based libertarian organization released a report called Administrative Bloat at American Universities. It points out that between 1993 and 2007 the number of full-time administrators at U.S. universities rose by 39% but the number of educators and investigators rose by only 18%. And BU did relatively well in their survey. Vanderbilt University has over 60 administrators per 100 students!

As someone invested in higher education, I share the Institute's concern with the growing ranks of administrators. But as someone who recently shifted to an administrative role, I can see the value in having competent support staff. When I talk to faculty, they rarely mention they'd like more colleagues to teach classes. What they say is they want more help with writing grants or creating syllabi and more protected time to think creatively. To achieve all these goals, more administrators are needed to lessen the burden on faculty.

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Nominating Letters

September 1st, 2010 by pcahn

One of my happier tasks is to solicit letters of support for faculty members nominated for awards in the Department of Medicine. Usually, everyone I contacted was pleased to write about their colleague or mentor. Unfortunately, that enthusiasm did not always translate into a compelling recommendation.

The AAMC has an instructive example on their website of how to improve nominating letters. They focus in particular on the often unconscious use of gendered language. Female candidates are described as nurturing or hard-working while male candidates produce results. In addition to watching for biased wording, I suggest other ways to strengthen letters:

  • Describe specific outcomes: You can assume that all the nominees are devoted to mentoring or research or whatever the prize recognizes. But not all nominees volunteered to judge a junior high science fair or stayed late on a Friday night editing a grant before the deadline. Give concrete examples.
  • Organize the paragraphs: Chronological order is always a logical way to structure a letter. Or you could devote a section to teaching, a section to research, and another to service. Just make sure you group similar comments into a coherent paragraph.
  • Go onto the second page: Fair or not, awards committee members often judge the quality of the recommendation by its length. Short letters look like you don't really have much to say or you're writing out of obligation. If you need to pad a letter, you can talk about how the nominee compares to other mentors/students you've had in the past.

I used to think that awards went to the people who deserve them. Now I know that awards go to those who put together the best nomination packet.

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Backing Up

August 31st, 2010 by pcahn

It's a researcher's nightmare: you are close to completing a large project, and your computer crashes, taking the data or the analysis with it.

Graduate student John Boldt thought he could avoid the problem by storing his nearly finished thesis on a laptop and a backup on an external hard drive. He left them in his car when he went for a run. When he came back, both copies were stolen.

Sometimes when I lose a piece of writing I'm working on, it's a blessing in disguise. I'm forced to go back and recreate my thoughts. The second time is usually more succinct. Still, I don't like that feeling of seeing all my efforts get deleted.

I back up on a shared drive, but usually only once a week. I've also tried thumb drives to ferry files back and forth between my work and home computer. There's an on-line service called Dropbox that gives users 2GB free storage on the cloud. I'm not sure there's a single best way to back up as long as it becomes a consistent habit.

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Attracting PCPs

August 30th, 2010 by pcahn

The number of primary care physicians in the United States is already too low to meet the demand. With the implementation of  reforms to bring health care access to millions more, the shortage of PCPs will become even more acute.

Time Magazine reported on this looming problem last week. Experts estimate that we will be short 30,000 primary care doctors by 2015. With fewer than 7% of current medical students interested in practicing general internal medicine or family medicine, the problem will only escalate.

Like other media that report on the problem, Time blames the rise in debt that medical students accrue. Even though the average primary care physician can expect to make almost $200,000 a year, that is less than half what a cardiologist can earn and a small part of the $500,000 in loans that a student might have to repay.

Money is no doubt a consideration for medical students choosing a specialty.  I doubt many applicants for dermatology residency slots chose to pursue medical studies because of a passion to treat skin diseases. Rather, dermatology offers a higher pay with more control over schedules. For younger generations, practicing medicine should not be incompatible with building a life.

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