Empathic Education

June 3rd, 2010 by pcahn

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.

War on Drugs

June 2nd, 2010 by pcahn

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.

Safer Intersection

June 1st, 2010 by pcahn

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.

Hospitalists

May 28th, 2010 by pcahn

Yesterday's New York Times ran a story about the rise of hospitalists in health care. The physician profiled works at the Hospital of the University of Pennsylvania, where she splits her time between patient care and information technology.

In this age of accountability and quality assurance, having a specialist just for hospitalized patients will certainly help patient outcomes and increase efficiency. Another benefit of being a hospitalist that the article does not mention is the attraction of having a predictable schedule.

On the negative side, I wonder how hospitalists can advance their careers in an academic medical center. Do they have time to reflect on their work and produce scholarship? Are they documenting the teaching they do? It's still a relatively new track in departments of medicine, so it is worth watching to see how those faculty develop professionally.

Promotion

May 27th, 2010 by pcahn

The Association of American Medical Colleges released its latest Analysis in Brief. These two-page reports synthesize large data sets into legible snapshots. In this case, the picture is of promotion rates for medical school faculty.

The results are discouraging. First-time assistant professors between 1967 and 1976 took 5.2 years to get promoted. In each subsequent decade, the average time to promotion has increased until the most recent cohort, which averages 6.2 years to reach promotion.

Men are more likely to be promoted than women and white faculty are more likely to be promoted than minorities. We're still compiling statistics at Boston University's Department of Medicine to see how we stack up with these national numbers.

Still, the trend is undeniable. A smaller proportion of the faculty are getting promoted, and it's taking longer for them to do it.

Do You Know Why?

May 26th, 2010 by pcahn

One of the most consistently provocative podcasts is the stream of TED talks. The acronym stands for technology, education, and design, but the topics include just about anything. In addition to presenting innovative ideas, TED speakers model how to give conference talks. They have a single argument, avoid notes, use repetition, and sit down after about 18 minutes.

Marketing guru Simon Sinek provides an example of a successful talk. He offers a clear idea with several relevant examples. He contends that what makes companies, activists, and managers persuasive to people is that they know the why behind what they're doing. Apple, for instance, doesn't just sell computers, it sells the core belief of thinking differently.

For medical school faculty, it's also important to keep the answer to the "why" question at the forefront. Whether it's organizing a lab or managing a clinic or teaching trainees, the "what" of the day's tasks will get accomplished more effectively if everyone one knows and buys into the "why" behind the project.

Poisonous Plastics

May 25th, 2010 by pcahn

This weekend 60 Minutes broadcast a report about the dangers posed by phthalates. Phthalates are chemicals found in flexible plastic consumer items like shower curtains, vinyl raincoats, and even rubber duckies. Research by University of Rochester professor Shanna Swan has shown that exposure to phthalates interrupts the production of testosterone in young boys, leading to misshapen sexual organs.

Dr. Swan's research is a good example of the power of medical research. It has led to a federal law banning the use of phthalates in the manufacture of toys.

At the same time, the 60 Minutes piece demonstrates the dangers of scientists bringing their findings to the public. Lesley Stahl follows the media rule of showing both sides to every argument whether they are balanced or not. She interviews a businessman who must spend $8,000 to test a toy microscope for the outlawed toxin. She also talks to a scientist who says that experiments done in rats do not necessarily apply to humans.

When biomedical scientists communicate their conclusions more broadly, they have to be aware that not everyone understands what proof means in a research setting. They have to be particularly careful to specify what their findings can mean and to educate reporters about the tentative nature of scientific knowledge.

Conflicts of Interest

May 24th, 2010 by pcahn

The National Institutes of Health recently unveiled new guidelines governing conflicts of interest in biomedical research. These suggestions will be subject to public comment for sixty days.

According to InsideHigherEd.com, which published a report on the new regulations, most stakeholders seemed pleased with the move to increased transparency. Everyone from the AAMC to Iowa Senator Charles Grassley applaud the idea of holding institutions accountable for revealing financial ties between researchers and industry.

In an age of eroding public confidence in institutions, it seems crucial that biomedical research remain untainted by the appearance of impropriety. Still, I'm struck by what the additional reporting assumes about the scientific process.

If having a financial stake in the research can affect the study's outcome, what does it say about the objectivity of science? Are PIs intentionally manipulating data to produce a favorable result, or, are there less conscious ways that bias creeps in?

Revealing Resumes

May 21st, 2010 by pcahn

Student confabulist Adam Wheeler has been in the news for faking his way into Harvard. Proof of his exaggerations and prevarications came on his resume, which claims authorship of six books and mastering of Classical Persian.

While I cannot condone lying about credentials, Wheeler's resume is instructive in another way. His formatting exemplifies good resume practice. The font is clear and legible. The categories are logically labeled. The most important information comes first.

He avoids other common pitfalls of resume writing. The dates appear on the right, which effectively emphasizes the (embellished) achievements, not the years he accomplished them. Wheeler also gives explanatory text for institution-specific awards. This helps contextualize honors unfamiliar to many outside Harvard.

The resume is also notable for what it leaves out. It doesn't say "Resume" on the top. It doesn't say "Reference furnished upon request," both phrases are pointless. He doesn't include irrelevant personal information. If any good came from Wheeler's deception, it is the reminder of how to put together a resume that gets you noticed.

E-Mail Jail

May 20th, 2010 by pcahn

Chris Shanahan, one of our faculty members, gave a seminar this week on how to break out of e-mail jail. At first I thought the title referred to how tightly Outlook tethers us to our computers, but at the session I learned that some colleagues reside in a more literal jail. Their accounts are so full that they cannot receive mail. One audience member counted 3,000 messages in her inbox!

Chris's presentation borrowed from 12-step programs to approach the problem. He advised breaking the task into more manageable chunks and committing to clearing out the inbox by the end of everyday. This goal may be unrealistic, but by aiming for an ideal, you're likely to settle for something better than the status quo.

As a long-time Mac user, I tend to blame part of the problem on Microsoft's clunky design. At least in Outlook 2003, the interface makes efficiency a challenge. What's the difference between "Personal Folders," my mailbox folders, and favorite folders? For some reason, I have a "Calendar" and a separate "Calendar in Personal Folders." And these don't share a screen with my inbox.

It's like what economists have learned about motivating workers to invest in retirement plans. If you make it automatic, people will do it. But if you set up barriers to efficiency, most people will stay disorganized.