March 07, 2013

Specialists vs. generalists

Quote of the day by Jeremy Hill:

"Teaching by specialists is fraught with difficulties on a family medicine course: although they may be experts in their own field, many specialists may never in their careers have had exposure to family medicine. So it is difficult for them to appreciate that family doctors deal primarily with patients and their symptoms rather than with diseases. The gulf between what is taught and what needs to be learned seems difficult to bridge."

A nice entry at the BMJ blogs.

Posted by rbrent at 08:39 AM | Comments (0)

January 28, 2013

Who pays for that (Part 2: The AMA)

I'd like to boast that this blog gets results when the AMA announces $10 million in med ed grants over the next 5 years to spur educational innovation.

The profession has a stake in raising a competent and admirable next generation. Why shouldn't they help pay it? Cheers to the AMA on this one.

Posted by rbrent at 06:42 AM | Comments (0)

January 17, 2013

Gaze-Down! Medical Education Feb 2013

The February 2013 issue of Medical Education is online!

There's a pretty cool, pretty simple study showing how endoscopic training on a gaze-down display leads to superior performance than training on a gaze-up display. It is surprising how many medical devices and techniques I've encountered assume the doctor or nurse is able to manipulate something while looking at a display screen somewhere else. Even video gamers address the screen head-on. Why, when the stakes are so much higher, do we like doctors to crane their necks?

Posted by rbrent at 06:27 AM | Comments (0)

January 07, 2013

Ex-Surgeon General: Add Computer Science to Medical School

Dr. Koop (yes, that Dr. Koop) is the senior author on a paper suggesting that doctors should also be computer scientists (click to download the pdf).

From the paper:

But fundamentally, very few physicians have formal CS training. We are therefore hamstrung in implementing IT solutions. We are unqualified to participate in designing and developing transformative applications. We are poorly equipped to apply the intellectual rigor of CS in research and clinical problem solving.

The solution?

To overcome this problem, one solution is to incorporate a formal, medicine-specific [computer science] curriculum as the third pillar of medical education.

The argument?

But [computer science] and medicine revolve around the same core processes: the gathering, storage, and interpretation of data.

...and...

As a pillar of medical education, [computer science] benefits medical students and physicians in two discrete domains: critical thinking and lifelong learning. The optimal time for this training is during the preclinical years of medical school.

I can't even begin to describe how wrong I think this is. Train medical students to be doctors. They don't have to be chemists. They don't have to be physicists. They don't have to be anatomists, zoologists, or even biologists. They certainly don't have to be computer scientists any more than they have to be psychologists, sociologists, dieticians, anthropologists, or population geneticists.

Medicine is not a science: it is a discipline. Doctors are not scientists: they are doctors.

Posted by rbrent at 06:58 AM | Comments (0)

December 08, 2012

Cognitive science

What concrete improvements have cognitive psych and cognitive science folk made to medical education in the past few decades?

Posted by rbrent at 02:06 PM | Comments (0)

October 30, 2012

Happy Halloween: Med Ed style

Of course the sim center can make crazy cool costumes. They do make-believe for a living.

Posted by rbrent at 10:26 AM | Comments (0)

October 29, 2012

Cees van der Vleuten speaks!

Dr. van der Vleuten won the Karolinska Institutet Prize for Research in Medical Education this year. He was the plenary speaker at this year's University of Michigan Department of Medical Education's Medical Education Day. He is one of the most interesting voices in the world of medical education assessment.

You can hear him speak live online today Monday 29 October 2012 from 13:00-17:00 (European time) at ki.se/kiprime/live. That's in 20 minutes!

Posted by rbrent at 07:34 AM | Comments (0)

October 27, 2012

Congrats to Ruth-Marie Fincher!

Flexner award winner!

Posted by rbrent at 07:28 AM | Comments (0)

September 10, 2012

International medical education standards

One of the most interesting themes at AMEE this year was the upsides and downsides of international standardization of medical education. China is becoming a medical education powerhouse (we've hosted several Chinese med ed scholars recently and have been working with PUMC. Most of the talk I heard was about med ed life in the UK which, with its increasingly diverse patient and medical student populations, is struggling to balance the reliability of standardization with the validity of variability.

To my ear, it seems a fascinating question: How variable should medical care be? Minimum competency standards are obviously necessary, of course. But beyond that: are communication skills not one-size-fits all? How about risk management and the aggression of treatments? The amount of high-cost testing and aversion of false-positive vs. false negative diagnoses? Our quest for finding an "optimal" approach to these things and trying to line all the doctors up on the global maximum may be wrong-headed: perhaps a culturally-diverse patient population requires a medically-diverse medical culture.

UPDATE: This just came into my inbox: The Malaysian Prime Minister is worried that their medical schools are not rigorous enough.


"Malaysia requires the services of healthcare providers who are well trained and well mannered. They must be beyond reproach. They must be professionals who are ethical and put the welfare and care of their patients above everything else," he said.

Standards are good. But obviously not everything.

Plus I love the "beyond reproach" part. We can dream, can't we?

Posted by rbrent at 06:48 AM | Comments (0)

August 13, 2012

Do students' notes count?

Students have to learn to use Electronic Health Records (and I assume they are better at learning this stuff than the doctors who are training them.

I've heard other people talk about whether students should be allowed to enter notes into a patient's EHR and whether it should be flagged as a student note in the record. Certainly students' notes are not a reliable as more senior clinicians; that's demonstrable. But 1) not all students' notes are unreliable and 2) flagging students' notes casts a wide (and oddly quality-blind) net over suspicious EHR entries.

This seems like an important research topic since USMLE 2 now requires post-encounter notes; students are learning this stuff and should be assessed. Where better to assess them than in the clinic and how easier to do it than through EHRs?

Posted by rbrent at 07:49 AM | Comments (0)