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Discussions and news

Thursday 13 March 2014

The first and second year med students were just off on spring break, but the fourth years were well represented by our speakers Stephen Wills and Taisa Priester, who were accompanied by their mentor, Mark Deutchman MD of the rural medicine track, and an enormous poster which they were forbidden to read but allowed to scoth tape to the wall. They talked about whether our school, which prides itself on producing primary care doctors, was actually as productive as claimed. They found out by contacting several years-worth of graduates who had entered primary care residencies, and asking whether they had, or were planning, to exit them as primary care doctors. No, said the majority: they had subspecialized as their training progressed. Stephen and Taisa referred to the "Dean's Lie," which made me gasp, seeing as there were several varieties of current and former deans there, but Mark told me that's from the title of a 2013 report in Medical Economics: "How medical schools consistently cover up their primary care failures: The "dean's lie." There was a lively discussion of the disincentives to following a career in rural primary care, the most obvious one being, how do you earn enough to pay off your loans? but another, nasty one, was the comment they occasionally hear that primary care is what you do if you aren't smart enough to specialize. Which I think is nuts; I think you may well have to be smarter. Though some of the tone was grim, several people told me how gratified they were, as I was, to see that a significant number of our students nevertheless are planning primary medicine careers.

Thursday 18 April 2013

A snowy week reminded us that Denverites tend to stay home if there's even a hint of snow—probably sensible considering that half the drivers are below average. But a feisty group showed up at the Fulginiti Pavilion to hear Katherine Brandao, a postdoc at NJH, wonder whether Gen Y students (Millennials) lack the ability to listen critically in classes or anywhere else. This led to riffs on whether listening was all that important in medicine, and whether if so, machines could listen better, anyway. We also wondered whether not knowing how to listen critically is the standard condition of beginners (Katherine teaches freshmen) and since the only thing you, the teacher, can really change in the classroom is yourself, we need to recognize that beginners aren't experts and change our teaching. The flipped classroom got some props in this context. Then Jon Bowser, who's Director of the Physician Assistant program, talked about their planned curriculum revision, and wondered about calibration: how well do I know how I'm performing (skills or knowledge) or will perform? Studies show we're really bad at this (unless we know we're flunking). So how do you design a curriculum to help students be realistic about learning? Are humans just naturally optimistic (and is optimism inherently unrealistic?) Are millennials actually different, or does every older generation regard younger ones as, well, inferior? Jon told of surveys indicating our students are more diverse, more progressive, less religious, and more likely to trust institutions, than are, or were, their predecessors Gen X and the Baby Boomers. How do we deal with that? Finally, we know also that we and our patients both "confuse confidence with competence." Maybe the world is just too complicated now for us to take it seriously.

Thursday 14 February2013

Psychiatrist Brian Rothberg kicked off our new season in the excellent Gossard Forum in the equally excellent Fulginiti Pavilion. He posed two questions: In a small group learning session, who's in charge? And more broadly, what rle do you play in the classroom? The discussion revealed that even in a small group, individual students may have very different ideas of who is in charge; it isn't always the teacher/facilitator, and sometimes it's the whole group, not an individual. The social-psychological properties of groups, it turnes out, is a profound subject. There were questions about group learning: does it mirror problem-solving in real professional practice? Does that matter?

Then Nichole Zehnder from Internal Medice took over, to talk about the relationship between rugby and team-based learning. She revealed that she was a Hooker, which startled many in the group but not an old Number Eight like me. If you are still startled, glance at this. She described team-based learning; in a large hall, several groups of 4-6 students get together to solve a problem; there is a faculty or chief resident facilitator whose role is purposely kept minor. She told us about students who left town during the course to do rural rotations, but kept in touch by Google Hangouts to continue working with their group. The feeling here is that students are really in charge. With the increasingly internet-based world, it seems likely that graduates in practice will soon have access to groups for support, discussion, continuing education and cameraderie.

Thursday 5 April 2012

April's session featured, quite by accident, the founders of the Café Ped, Helen Macfarlane and JJ Cohen. Helen was postponed from March after she donated her time to the lively discussion of the medical students' presentations. She began by reminding us what an LMS is: a Learning Management System, of which the ones we use, Blackboard and eCollege, are examples.She thinks that they are in some ways an inappropriate tool for what we do: they are huge programs and thus not easily modified for our special medical campus needs; and they are teacher- and management-centric in an age where student-centric is what we are looking for. There was much agreement from the approximately 50 attendees. Our LMS needs to be more interactive, more accessible, less restricted to course registrants, less of a data dump and more of a learning environment. On a practical level, we need a better calendar (customizable by each student), better searching, and earlier posting of course materials by facult so students can prepare in advance for class. And we thought it would be good if it were portable so students could take it with them when the class is over. This led to JJ's discussion of LLL, or life-long learning. It has many definitions, the main distinction being: Is it a program (e.g., a continuing education course) or is it an attitude (i.e., the desire to learn, the right habits for learning)? Because if it's an attitude, there is a question whether that can be taught, or is formed in childhood. One theme that kept coming up: Should CU, for example, assume a responsibility for helping all physicians (and other health care professionals) in Colorado, and possible all alumni, stay up to date and informed about the changes in their fields? Not in CE courses, but by some far more distributed mechanism, always available to anyone. Then med school could truly be considered not the end of one's learning, but the beginning, with a clear connection and integration between undergraduate, graduate, and continuing medical education.

Thursday 8 December 2011

This Café marked the reappearance of the Vast Jar of Jelly Bellys. The first speaker was Andy Fine, MD, an internist in private practice who is very involved in teaching at the Medical School. He talked about how engaging (not to say addictive) massively multiplayer online role-playing games (MMORPG) can be, and then asked whether we thought a game could be written in which health-care people (students, professionals, all fields) manage patients while trying every expedient to save the system (taxpayers, insurance premium payers) the greatest amount of money. Say you recommended medical treatment rather than a coronary artery bypass; you save thousands, but would you lose charisma points, or gain malpractice points, or be attacked in a dark room by a troll-with-an-axe (Andy Bradford's fear)? This kicked off some pretty interesting and funny conversations and suggestions. Could we pit teams of lawyers agains teams of doctors? Could we assemble interdisciplinary teams (with real-life PA's playing online PA's, for example)? Would CME credit be available? Who would write the code? Would it take place in a virtual hospital, or a single country, or the whole world? It seems likely that if there's an angel out there with about $5 million in start-up funds, we're ready to go.

Next, Tess Jones, PhD, Director of Arts and Humanities in Health Care, asked: What do we mean when we ask students to reflect? This interested some of the students there, since it seems they are always being assigned the writing of reflective pieces, and were not always thrilled with that. We talked about what happens next: Is the writing of the reflective piece the end of the process, or must it be read by a teacher? Why? Would here be a difference in the content? Yes, it was thought, and many might write what the teacher "wanted to read" rather than true reflections of their feelings. Rob Feinstein told us about the book The Doctor, His Patient and The Illness by Michael Balint, which Rob considers essential reading. He described "Balint Groups" in psychiatry, where trainees and faculty gather to reflectively discuss patient interactions and other events in a safe and supportive environment. We thought that maybe the Café Ped was such a place!

Thursday 3 November 2011

Another excellent Café, though attendance was a bit down due to the beginning of the AAMC Annual Meeting downtown in Denver; quality once again was demonstrated to trump quantity, though more people would be would be good, too. First off was Anand Reddi talked about teaching patient advocacy—whether that was acceptable, and how it should be done. It was argued forcefully by several people that all medical practice is essentially political; one makes a statement with every patient one sees, or doesn't see. We tried to define an "honest broker" in this setting. None of this seems easy, and Anand, a 3rd year med student who's taken a year for research, led the discussion expertly, with good input from other med students. Then Jennifer Gong, PhD, from the School of Medicine education group, talked about curiosity: do we allow, encourage, or discourage it in professional schools? How creative can a student be, who has a million facts to memorize to get through USMLE or other licensing exams? Not very, some felt, gloomily. Do exams kill curiosity? There was some support for that unpleasant thought. About required creative work, like the Mentored Scholarly Activity, reviews were mixed.

Monday 10 October 2011

This was one of the best Cafés yet. We started with rheumatologist Sterling West, MD, Professor of Medicine, who raised the topic of professionalism by telling us a real-life dilemma: a patient with a life-threatening illness for which there is an effective but expensive drug for which Medicare won't pay. They will pay for it for a different diagnosis. Dilemma: Should a doctor change the diagnosis in order to save the patient? But to do so would be to commit Medicare fraud. We went round and round on this, and could not solve his problem. If you had been there, could you?

Then we had a guest from University of Calgary's medical school, Janet Tworek, who is their specialist in e-learning. She asked: Do our students know what they are getting into? As a former schoolmarm, Janet had us all wriggle about and go woo-woo, which woke up some of the elderly attendees, and then we were given kazoos. Not quite sure why, but it was pleasant for those of us who never had advanced past this elegant instrument. We discussed "tech-envy" and whether there needed to be evidence-based justification for adding technology to traditional teaching. Nothing, we though, was inherently good or bad in teaching; instead, as Kingsley Amis once wrote, there is no end to the ways in which nice things are nicer than nasty ones.

Summer 2011

We took the summer off at AMC, but we weren't idle!

This summer there was a special Café Ped after the CU Online Spring Symposium; it was supposed to be at BJ's Brewhouse, 14442 East Cedar Ave in Aurora, after the symposium on Thursday 19 May (on the nearby Anschutz Campus) ends. But, Update: Well, of course, in the event it was pouring down with rain and freezing, so we hastily confected a mini-Café on campus, sans frothy refreshing yeast-based beverages, but nevertheless it was a good time. JJ Cohen offered "Anschutz Medical Campus freshmen have better brains than Downtown Denver Campus freshmen, and there's nothing you can do about it." This turned out to be about maturation of the prefrontal cortex, so a brawl was avoided. Joni Dunlap and Patrick Lowenthal presented "More Cow Bell: It's the little things that matter most in learning," a title which distinguished those who are too old (or smart?) to stay up late enough to watch SNL, from all the rest.

Also this summer, we had the 4th annual Café Ped as part of the COLTT Learning and Teaching with Technology Conference in Boulder, the evening of Wednesday 3 August.

Thursday 5 May 2011

A strange spring ended for a bit and it was warm and pleasant, which was nice for us and the confused goose sitting on a clutch of eggs on top of the big transformer north of Building 500. Stephen MacLeod, MD, DDS, started off with some life story (Scotsman raised in New York) and segued into the proposition that too many competencies and guidelines were becoming detrimental to the training of house staff (and he pointed out that they are called that because until recently they really lived in the "house," that is, the hospital.) The EU has imposed strict limits on hours worked; not the controversial (many think it too few) 80 hours/week that now exists in the US, but a soon-to-be standard 37 hours! There is not a lot of evidence that these rules greatly increase patient safety, physician satisfaction, or much else. Stephen made a strong case for keeping doctors in training until they are "fully cooked" rather than sending them out when the obligatory 3 or 4 years are up, adequately trained or not.

Robin Michaels, PhD, started by telling us the story of her childhood, especially her unprepossessing grades in science. Somehow she survived, thanks to a quiet but insistent mentor who eventually convinced her that science, not medicine, was what she loved. She talked about teaching 3rd grade kids, and how their curiosity and enthusiasm was unlimited. What happens, she wondered, between then and when they come to our campus? Lots of folks had opinions about that. It seems that knowing too much is not always a good thing. We also discussed the Hollywood stereotype of the scientist, and whether this turned away interested kids.

Oh, and Rob Feinstein told us that he had arranged a Café Ped at a recent Colorado psychiatric meeting, cajoling two of his chums to take opposite sides in a discussion of the merits or otherwise of medical marijuana. It was well received, underscoring our notion that this format is easy as pie to arrange and always fun.

Thursday 3 February 2011

A snowfall that wasn't supposed to happen weeded out some of our more Southern regulars, but we still had a great showing, especially of students (CHA/PA, medical; others?). Rob Winn, MD, Associate Dean for Admissions in the School of Medicine and a pulmonologist, started things off. He said that there was a growing trend in medical schools to particularly value applicants who were older or "non-traditional," with the belief that they are more settled, centered, mature, focused, your adjective. But, he said, there seemed to be precious little evidence for that, in terms either of behavior in school, or longer-term outcomes. Not that they are worse; they just aren't better, either. The discussion eventually came around to some consensus: that age isn't the most important thing, personality is. Jerks, it was pointed out, can be any age. But there was some sympathy for older, experienced people who may find themselves in the position of getting orders from someone younger. Since all of us will eventually be in that position, it was thought, we might as well get used to it.

Then James Rose, 4th year medical student, took the floor to say that he had found 3rd year challenging because he started off not knowing what was expected of him, and who he should be. Early on, by being as conscientious as possible, answering all questions and asking lots of his own, he found himself (he thought) out of step with what was expected. Eventually he adapted, to be less of a gunner and more of a good ol' boy, and that seemed to work. This raised a lot of emotion: how should you behave, for example, on a rotation whose speciality you hate? Who gets the best letters—the brown-nosers, the caring doctors, the know-it-alls? Several of the faculty there thought this is an area that could use some real fact-finding. So, again, a Café conversation ended up with some real food for thought.