Thursday, August 30, 2012

Ladies and Gentlemen, Please Silence your Cameras!

We should have expected this, it was just bound to happen.  But when it came, it still took many aback.

I am talking about the use of smartphone cameras to capture speaker slides during presentations.  I recently attended the AMEE 2012 meeting and noticed a large segment of the audience taking endless photos during presentations.  They took multiple photos of one slide either because the shot was not focused or the speaker was building the sliding via animation and they missed some bullet points.

Personally I have no problem with this practice.  I have been doing this myself in a limited manner using my Motorola Xoom tablet and Evernote.  The problem is that people are forgetting to mute their cameras and can be irritating and distracting to the people around them.  When many people start taking multiple photos, the issue can be quite serious.

At one session one of the audience members got so upset that she got up and asked everyone to silence their cameras.  I expect that presenters will soon be adding something on their first slide to ask the audience to silence their cameras.

Saturday, August 18, 2012

Hidden Curriculum in Medical Schools - Are we teaching what we want students to learn?

We all know that

  • The amount of information is increasing rapidly
  • The 1/2 life of knowledge is shrinking - what we knew few years back does not hold true anymore.
As Alvin Toffler said, 
“The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn. ” 
Once our students leave the formal education settings of medical school, they will have to learn how to keep up with literature and new advances on their own.  Thus medical educators want to teach students how to become self-motivated self-directed lifelong learners.  

The hidden curriculum is the unintended lesson/s, usually about norms, values, beliefs or behaviors, learned during a learning experience.  Thus in medical schools students are taught a particular way to communicate with patients.  When students see health care practitioners interact with their patients differently, they get a different message.

One of the biggest hidden curricula is the way students are expected to learn in medical schools.  Traditionally, they are expected to attend lectures and seminar, show up in clinical rotations and have information delivered to them, drilled into their heads.  [A number of medical schools are trying to break out of this mold]. These students get the unintended message that someone else is taking the responsibility for their learning.   This hidden message is more powerful than the intended message for their need to be self-directed learners.  

To truly help students become the independent, self-directed learners we want them to be, schools need to reform the way they educate.  Instead of large lecture halls, early in the training the students need to learn how to look up and find information to solve problems.  Students can learn individually or in small groups (e.g. Problem based learning and Team based learning).Passive learning should be avoided.  This  will create a hidden curriculum that will help our students learn the only useful lesson we can teach! 

Friday, August 17, 2012

What medical educators can learn from the car industry

Formative and Summative Feedback

Formative feedback - that is the ongoing, near real time, specific, non judgmental feedbak - is critical to learning and helping change behavior [Ref].  Unfortunately medical educators have for too long used only summative feedback for assessing medical students - you know the end of rotation grades, the USMLE scores etc.

Part of the problem is that faculty and preceptors are the ones who need to provide this feedback as they work with students on a daily basis.  But they are unaware of the need for such feedback or are not trained to provide it or unable to provide it for logistic reasons.  Clerkship directors meet with the students only infrequently and do not have such feedback to review and share with the students.  They often have comments like "Excellent" or "Great presentation" or "needs to work on presentation skills" which is not specific or helpful.

How can we train our faculty in giving useful formative feedback? Since most faculty members went through traditional medical school programs and did not receive much formative feedback, they may not be aware of what it is and the importance of giving this.  A metaphor we can use is something we see almost daily and comes from the car industry.  [For some interesting reading on this see the National Renewable Energy Laboratory Report (pdf) by Gonder et al]

Learning Objective: Learn to drive in a way that improves fuel efficiency.

Cars now give immediate and constant feedback to the driver regarding the rate of fuel consumption as miles per gallon.  This is visible on a visual scale next to the odometer.  It also shows a color indication in a ring around the speedometer (e.g. green if driving at optimal speed and acceleration).   This is an excellent example of formative feedback and can lead to correction in behavior.

Cars also provide an average fuel consumption for a particular duration, and can be reset by the user.  In most cases it is reset on refilling the fuel tank.  Looking at this at the time of refueling gives the driver summative feedback on their performance for that duration.  If the number is low, it should not come as a surprise to the driver who has been getting constant feedback and has failed to change behavior.  The driver has control over how she/he chooses to drive.

While drivers can choose to ignore the feedback, in case of students, they come to a medical school to become good physicians.  They want to get such feedback and to constantly improve.  Using this metaphor hopefully we can train our faculty to provide more useful, timely, non judgmental feedback.  One hopes this will lead to them spending more time in helping all our students become better physicians and less time comparing and ranking them.

If the car industry can understand this, why not medical educators?

Monday, August 6, 2012

My Gold Medal Goes to....

Achievements in Olympics reflect huge sacrifices, long years of training and planning and performing under high pressure in front of a global audience.  The feats of these athletes serve as inspiration for us common mortals and help to hopefully unite the world.

While the London Olympics are underway, something even more difficult than any individual or team performance and more awe inspiring just took place - the landing of a huge rover on Mars using a maneuver never used before after 7 minutes of terror.  Here is a video explaining the difficult procedure.

Very early this morning (EST) Curiosity landed successfully on the surface of Mars and sent back its first images.  The world cheered but the video of the NASA team watching with bated breath and then their emotions when they got the good news brought tears to my eyes.

Without belittling the performance of the athletes, if I had to give a gold medal it would easily go to the NASA team for their amazing work in the face of budget cuts and political uncertainties.  Congratulations NASA!  

This post was prompted by an online conversation on Google+ with @Brad Gill one of the many brilliant students to come out of our medical school. 

Saturday, August 4, 2012

The Olympics: Hunger Games or Human Games?

Following the Olympics has been a emotional roller-coaster of a journey and has led to a lot of soul searching.
There have been some amazing moments - with Michel Phelps getting probably the most press - coming fourth in one event, missing gold by .05 seconds in another, winning the most ever Olympic medals along the way..
Watching the US athletes on the podium listening to the "Star Spangled Banner" invariably brought tears to the eyes.  Serena unleashing a powerful performance in the finals to win 6-0, 6-1 was jaw dropping.  The US flag was not there - blown away by a gust of wind at Wimbledon - bringing much needed humor at a solemn moment.
Image linked from

Along the journey something kept bothering me.  Seeing young teens competing in individual events carrying the hopes and expectations of their family, friends, schoolmates, their country on their young shoulders.  Watching a 15 year old Katie Ledecky blowing away a super strong field in the 800 meter freestyle and 17 year old Missy winning multiple events in swimming was a celebration of youth.  The tears of 17 year old Victoria Komova on losing the gold in the individual all around (she won the silver) showed the incredible pressure on these young shoulders.  The 16 year old Chinese sensation Ye Shiwen forced to defend herself against allegations of using performance-enhancing drugs because she has improved dramatically over the last year.  Then the image of a Canadian trampoliner going from shock to breaking out in smile when her Chinese competitor fell at the end of her routine realizing she had won the gold with that spill.  The latter reportedly declined to wear her bronze medal.  These young athletes are damned if they win and damned if they nearly win and damned if they don't win.  All this under the microscope of social media and 360 degree 24-7 fast news coverage.  These scenes reminded me eerily of the Hunger Games.  As we celebrate the champions, do we hear the stories of all the people who did not make it, who were proud to just compete, to try, to give it their all, their sacrifices, their heart breaks?  Are they learning the right lessons, is the Olympic movement working, is the Olympics spirit alive and well?

And then I reflect on the following images and my faith is restored:

  • Jordyn Weiber crying her heart out on missing out competing in the individual all-around event and then coming back to cheer her team mates on in the event she missed.
  • Margot Shumway in the women's double sculls learning a new sport so she could get to the Olympics and coming from behind to make it to the A Finals with her mother in the audience - fighting lung cancer - making it to London to watch her daughter between 2 rounds of chemo
  • Oscar Pistorius a double amputee who had an epic struggle to get accepted to the Olympics because folks thought the "blades" gave him an "unfair" advantage.  He was just happy to be able to compete.  His mother wrote in a letter for him to read as an adult, ""The real loser is never the person who crosses the finishing line last,'' she wrote. "The real loser is the person who sits on the side, the person who does not even try to compete.''
They don't need medals, they don't need their photos on cereal boxes.  But we need their stories to be told just as loudly and frequently and proudly as those of the medal winners.  Once we do that, the Olympics will truly be the Human Games instead of being the Hunger Games!