Cast & Curious

Tag: medical education

  • Teaching the “right” attitude and values to would be doctors

    There are several methods of curriculum development in medical education. I’m familiar with Kern’s Six Step Approach to Curriculum Development which I discussed  briefly in this post. This approach is far from perfect but components of medical education ( knowledge, skills, attitudes and values) may be effectively taught using this approach.

    Kern's 6 Step Approach
    Kern’s 6 Step Approach to Curriculum Development

    On top of of this Six Step Approach is a well conducted general needs assessment of the community where health professionals are to be deployed. This needs assessment also determines the context that wrap health issues in that specific community. Implementing a health education program without prior contextual needs assessment is like running a car without a definite destination. Resources are spread thin across multiple objectives, draining resources and produce graduates who are “misfits”- physicians who just don’t fit the target community’s context of health issues. A misfit health professional so to speak.

    For years I believe, our goals for educating health professionals didn’t change much and remained true to the ideals of health profession. We still want to train ethical and moral health professionals serving our country in the most excellent and conscientious way. Our instruments in achieving these goals however have changed dramatically in todays digital age. Access to information greatly improved but processing these information lags behind. We have access to western health research but such data just don’t fit especially in the countryside where the context of health issues is radically different. We train our would be physicians that western medical knowledge and skills is the way to go in medicine but what is in the books and journals are vastly different from what we have here on the ground. The stark difference is even more palpable in the attitude and values being taught at healthcare academe. We have forgotten the socio cultural context of our health issues. We train highly skilled and knowledgeable physicians yet they don’t seem to fit the community they’re placed in. Most of them just gravitate towards the urban tertiary centers where western medicine, the context of how we train them, resides.

    Teaching medical knowledge and skills has evolved so much in recent decades.  Attitudes and values however remains the hardest, most elusive component teach and assess. Thus we hear of health professionals who’s attitudes and values are way off what’s expected of a health professional. Whispers of “lazy, easily discouraged, whiner, scum” health professionals  can sometimes be heard on performance evaluations.  The lack of a clear context and need assessments predisposes a program to produce such health professionals.  The lack of validated instruments to impart and assess our methods of teaching attitudes and values in our health education programs remains challenge to the medical academe. We’ve tried teaching methods like “fellowships” or paired didactic/clinical exposures, increasing patient exposures, community immersions  and other but we yet to figure out exactly how to teach and assess desirable attitudes and values to our health professionals.  We knew teaching methods are customised  on the context of the community and cannot be standardized across regional difference. Perhaps a basic framework to work on and modified regionally according to context would be a good way to start.

    So far, a standard method of evaluating attitudes of health professionals needs to be implemented and validated widely.  The closest we can get after going through the rigodon of trying to each time, is the multi peer assessment. This is an assessment method wherein everyone in the health professionals working environment gives an assessment as to the attitude of that health professional.   The assessment is quite comprehensive and is reflective  the working atmosphere of that health professionals. It is however tedious. Categorising components of this assessment tool and making sure everyone in the working environment uniformly understand its content requires training.

    In summary, our goals in teaching the “right” attitude for health professionals, hasn’t changed much in the past decades. The lack of clear context and needs assessment plus the scarcity of teaching and assessing ” attitudes and values ” among our health professionals is contributing much to “misfits” in the health community. A multi peer assessment is the closest tool we can use but is tedious and time consuming. A basic framework for training should be created on a national level but modified regionally according to the specific context of health issues present in that region.

  • Addressing generational medical learning stereotypes

    Does generational learning stereotypes affect  graduate medical education?

    Consider these medical educator- medical student thoughts:

    Medical Educator: Some of this generation’s medical students lack interest and commitment to their medical training. With all the health information inside their laptops and tablets, they find it hard to answer my questions confidently.

    Gen X student: I hate professor A! He expects us to read chapters in our textbook, do research on the side, while simultaneously go on clinical duty 48 hours a week!
    First observation is common among medical educators, although local documented research on this is lacking. Observation number two is a common complaint among medical students, often perceived as lack of interest by many health educators.

    Meyer and Weiner in 2002 Journal of American Medical Education pointed this out:

    Empirical evidence shows that college students are becoming less interested in attending medical school. The number of applicants to medical schools in the United States has dropped approximately 20% during the last 10 years.

    In short, unless new research would point to otherwise, generational stereotypes do (negatively?) affect learning in graduate medical education.

    There are many ways to develop and improve a medical curriculum. I am only familiar with Kern’s Six Step approach(in picture below) to curriculum development for medical education. (Here’s a link to the book at Amazon. See disclosure).

    Kern's 6 Step Approach
    Kern’s 6 Step Approach to Curriculum Development

    A health educations study applying Kern’s six step is discussed in this article. Here is a more detailed presentation of Kern’s Six Step to developing med ed curriculum by Joanne Lynn, MD, MPH Department of Neurology, Associate Dean of Student Life Ohio State University Wexner Medical Center. Suffice to say, there are hundred of ways to address the generational learning stereotypes in medical education. It’s never easy, but it can be done says. Dr. Lynn.

    Natalie May of St. Emelyn’s Emergency Medicine #FOAMed sums up beautifully in post, the generational stereotypes ( she called “challenges in medical curriculum”) and the corresponding learning environment adjustments we can make to address these challenges.

    Yes, of course it’s exhausting and hard work to rethink our education strategies – it’s much easier to stick up a two hundred slide lecture and read it from the screen but we owe the next generation of doctors more than this. And if we stick to teaching the way that worked for us, we are forcing them to do the hard work of trying to fit into our schema – and isn’t that against the very essence of education?

    In one tweetchat episode (Residency Training in a Millenial World) hosted by Dr. Helen Madamba, a medical educator herself, we also tackled generational learner stereotypes among residents of a training program. In this Saturday’s edition of #HealthXPh chat, we dig deeper into the medical curriculum and discuss possible solutions to this challenge. Our guiding questions are:

    • T1.  As a healthcare student or healthcare professional, do you believe generational stereotypes affect learning in medical education? Why?
    • T2. Does your institution’s medical curriculum acknowledge these generational stereotypes exist and have done steps to address it? How?
    • T3. Which of Kern’s Six Step approach do you think is the best step to intervene and address this challenge? Least? Why?

    Please give your final thoughts after discussing these Qs.

    Join us this Saturday July 8, 2017 9PM Manila time as #HealthXPh discuss generational learner stereotypes on #healthXPh twitter chat!

    #meded #healthed #healthprofed #medicaleducation

    ( Disclosure: The author used an Amazon affiliate link for one of the book cited in this post.)

    References:

    1. Meyer AA, Weiner TM. The Generation GapPerspectives of a Program Director. Arch Surg. 2002;137(3):268-270. doi:10.1001/archsurg.137.3.268
    2. Kern DE, Thomas PA, Hughes MT. Curriculum Development for Medical Education: A Six‑Step Approach. 2nd ed. Baltimore, MD: The John’s Hopkins University Press; 2009.
    3. Sweet LR, Palazzi DL. Application of Kern’s Six-step approach to curriculum development by global health residents. Educ Health 2015;28:138-41.
    4. Natalie May.”Generation Why – Challenges in Medical Education at #NSWMET”. August 10, 2016. Blog : St.Emlyn’s Emergency Medicine #FOAMed

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  • Addressing the diaspora: Return of Service Contract for healthcare workers

    There is 1 physician per 1, 153 Filipinos according to WHO’s Global Health Observatory  physician density data. In remote areas of the Philippines however,  the ratio is lower at one physician per 33,000 Filipinos. WHO recommends a 1 is to 1,000 (or less) physician to population density. This is just one of the many healthcare concerns we should address if we are to achieve this country’s millenium development goals.

    The Philippine health system devolved most (at least in paper) of its health care implementation to the local and regional government units. Except for a few retained and autonomous healthcare institutions, the Department of Health only oversees and “augments” health needs of this country. The rest of health planning, policies, and implementation are up to the various local government units.
    mededph
    The lack of medical practitioners in the rural areas is attributed to several factors:

    The diaspora of physicians from the Philippines to practice abroad is one of these factors. Majority of those who stayed in the Philippines opt to practice in  urbanized cities, where their medical education and training suits the work environment. Practice of profession is also more profitable in urban centers. A lot of Filipino physicians also choose to work as a private practitioner for a more sustainable income rather than work in a government healthcare institution.

    The lack of infrastructure and suitable working environment also discourages many doctors to practice in rural areas..  Most LGUs are unable to hire the necessary healthcare professionals in their locality. This, despite the law mandating LGUs to spend 30-35 percent of their internal revenue allotment to health needs of their locality. For decades, Department of Health’s response to doctors shortage is the Doctors to the Barrios program, started by then DOH secretary and Senator Juan Flavier. The program which has been lauded and popular at that time, had its successes limited to areas they are implemented.

    One of proposed solution is the return of service contracting for graduates of government subsidized medical schools. Graduates of government subsidized medical schools are required to render service in the country for a specified number of years.

    Join us this Saturday at #HealthXPh as we nitpick return service contracting as a solution to the lack of physicians in the country

    • T1. Do you agree that healthcare workers in government subsidized schools render return of service after graduation? Why or why not?
      T2. How can we keep our doctors from leaving the country after return of service?
      T3. How do we keep our medical education attune with the health goals of the country?

    Don’t forget 9:00PM Manila Time October 1, 2016, #HealthXPh tweetchat live. Join the discussion!

  • Social media in healthcare education, inclusion or just distraction?

    Social media is pervasive, even in healthcare. As an early adopter, I witnessed how social media went mainstream as it integrates into our lives. I’ve also been a witness to the many challenges and opportunities social media presents as it slowly encroaches into the silos of our daily lives.

    My struggle though is not always about social media integration or the technical skills needed to do so. I have have always been preoccupied on how social media could or should enhance my learning- to reflective thinking rather than just information, knowledge more than opinion and in healthcare, clinical and patient skills rather than textbook regurgitations.

    In #HealthXPh, we’ve previously discussed why social media is of value to healthcare. We’ve tackled how social media is used as a tool to enhance education and build interactivity to our traditional learning styles. Social media has shown promise in areas  collaborative learning using user generated materials while creating meaningful engagements in the healthcare sector.

    There are stinging questions to the value social media in educating healthcare or would be healthcare professionals. Would incorporating social media in healthcare education really improve the knowledge, attitudes, values and skills, of future healthcare professionals?

    There were studies that tries to understand the challenges and opportunities of  incorporating healthcare social media in their medical curriculum. But the “infancy” of social media and the lack of rigorous controlled studies eludes a clear answer at this moment. The answer to these questions ( if ever it could be answered) may be found in the next generation of healthcare professionals.

    In spite these issues, healthcare institutions abroad began incorporating healthcare social media in their learning curriculum. In the Philippines, social media healthcare is not in any medical or healthcare curriculum. Why? Why are current healthcare students taking social media seriously?

    When asked, most nursing and medical students would answer, “I have no time for such”.  If it’s not included in the curriculum we’re not going to spend time learning it. Surely if our medical educators didn’t include it in our curriculum, they probably didn’t find any value for it in our education” .

    I’m not an expert in healthcare education, but I do understand the problems besetting an institution in training future healthcare professionals. Identifying what’s important to the KAVS learning of healthcare students is difficult enough, incorporating a complex, learning resource such as social media doesn’t make it easier, at least to most healthcare educators that I know. It would take a generation of physicians to find that out.

    I have a balance of views regarding inclusion of social media in the healthcare curriculum. But, if we don’t bring the discussion now, we may never find out in the next generation of healthcare professionals.

    Join us this Saturday August 8, 2015 9PM as we discuss the value of healthcare social media in medical education. Is it a distinction or just a distraction?

    • T1: Should healthcare social media be included in medical/healthcare curriculum? Why or why not?
    • T2: What are the challenges and opportunities in incorporating social media in our healthcare curriculum?
    • T3. How do you measure the impact of incorporating social media into the healthcare professional’s education?

    As a closing thought (CT) please give an area in the education of future healthcare professionals, where social media has the most / least impact.

    Resources:

    McGowan BS, Wasko M, Vartabedian BS, Miller RS, Freiherr DD, Abdolrasulnia M
    Understanding the Factors That Influence the Adoption and Meaningful Use of Social Media by Physicians to Share Medical Information
    J Med Internet Res 2012;14(5):e117
    URL: http://www.jmir.org/2012/5/e117
    DOI: 10.2196/jmir.2138
    PMID: 23006336
    PMCID: PMC3510763
    http://www.eventscribe.com/2015/ACEHPAnnual/assets/pdf/142420.pdf

    Kind T, Genrich G, Sodhi A, Chretien KC. Social media policies at US medical schools. Medical Education Online. 2010;15:10.3402/meo.v15i0.5324. doi:10.3402/meo.v15i0.5324.

  • 10 Financial Tips for Medical Students

    Pursuing a career in medicine is one topic I’m often asked during career talks and speaking engagements. Most questions under this topic fall into distinct but interdependent subgroup of questions  known as the “what”, “when”, “where” and “how”.  A few dared ask the “why”. Surprisingly, majority of the few  who asked the “why”  we’re already doctors !

    Here’s one question posted in the comment section of a post in this blog. 

    Hi, I’m Ian Patrick from Pampanga, I really would like to become a doctor since the day I graduated nursing in 2008. My father decided to loan our 1.7 hectare land for me to pursue the degree. I would like to ask for any suggestion where or what type of bank can we go to, or is there other option other than going to banks here in the Philippines. I really would like to go to med school and I think this is the only way for me and my family to generate money. Thank you.

    As far a I know, you can sell a parcel of land to most banks and use the money to finance your medical education. The process of selling land varies from one bank to another. You can directly ask banks of these processes but make sure you have the necessary documents for your parcel of land. Selling properties to a bank is tedious, would take some time ( valuation-market assessment-actual sale) and may not yield the highest amount you expect from the sell of your land. Taxes and fees for this transaction should also be considered.

    Selling the land to third parties without legal business identities is also risky. I’m not aware of any bank that accept a parcel of land as collateral to subsidize a medical education. I would not advise you to use your land as a collateral for a personal loan because the interest rates are usually sky high. My family tried this and was only able to fully pay the debt 20 years after. The interest we paid is five times the initial loaned amount!

    I hope this answers your question Patrick.

    To help out Patrick and (potential) medical students who are roughly in the same circumstances as he is, here are financial tips that will save you some expense during med school.

    1. Choose a quality medical school with the least tuition fees. Many state colleges and universities in the Philippines have medical schools that are at par or even better than some private medical schools.
    2. Choose a medical school located within or near your place or potential place of practice. Saves you the lodging and transportation expenses.
    3. Choose a medical school located in an area where the cost of living is relatively cheaper. Regional state colleges and universities have medical schools too.
    4. Get a scholarship, if you can. Or if the scholarship is some sort of study now pay later scheme, choose the one that offers a “pay out” maximum of 1:2 ratio (e.g. 1 year of study equivalent to two years of service). A ratio larger than that is typically costly when you look at the expense -payment ratio. (±300%)!
    5. Never sell or loan every asset your family have  and hope you’d be able to pay this right after you graduate medicine. Yes, you will have a job right after med school but I doubt it that would be even enough to even buy you your own car.
    6. Borrow books if you can. Avoid buying books that will probably have another edition in 3-5 years. Maximize your library card! This will push you to efficiently study and maximize reading time.
    7. I do not recommend marrying during med school, unless of course you’re marrying a millionaire who would subsidize your medical education. A wedding will cost you at least a semester of medical education expense! What’s five years of waiting anyway when you’re too busy hurdling exams and duty schedules?
    8. Get a job during summer breaks and add that income to your medical education’s fund!  Just don’t do part time jobs during med school proper or it will wreak havoc on your grades. Take that from me :).
    9. Join a like minded group of medical students that offer possibilities of sharing resources in med school like books and instruments . Cut off the partying expense however. Admit it, you’re in med school to study medicine. You may party all you want when you pass the boards.
    10. Finally, never pursue a career in medicine with the monetary income as your primary goal after med school.  You’d be frustrated. Yes, you will have a job and you will not go hungry as a doctor. But if you aim to get into Forbes’ Top 100 Richest People via medicine alone, good luck.

    You have to finish “doctor of medicine” degree from a recognised medical school and pass the Professional Regulations Commission’s licensure exam to practice medicine in the Philippines.  Then you have to decide on what path will you take in the vast field of medicine. Are you going to be a general practitioner? A community physician? A public health physician? or take further training for specialization? This will definitely entail additional trainings depending on the field or niche you decide to practice. Still other fields require specialty board exams to fully practice that field. I’m outlining these, because these are the first few tangible short term goals you should have if you are eyeing a career in medicine. All financial considerations must be tailored efficiently towards achieving these goals. Any expense that is not contributing to achieving these goals should be stripped off your “budget” and realigned to your medical education fund!

    If you have reactions or additional tips to offer, please don’t hesitate to leave a comment in this post.