Challenging teaching methods in Orthopedics
In just about a year and half of teaching orthopedic residents, I became interested in finding out which of the more familiar teaching styles works best for our crop of trainees. Honestly, I'm still continually experimenting.
The unique set up with which medical-surgical training programs thrive is continually changing. With the influx of medical information everyday, a program has to adapt to the call of time and for greater efficiency in preparing this 'padawans" into full pledged surgeons.It is not simple as it seems however since in this unique set up and unlike the usual academic, lab rat experimentation, a mistake might cost someone else life.
The "Master-Apprentice" method ( probably the more popular and is what I'm familiar with) involves the "master" (attendings) showing the "apprentice" (residents) his way of doing things (skill) for a certain given situation or problem. Such teacher-student relationship is basically anchored on the assumption that the master is more experienced and adept than apprentice. This is usually an "I teach, you follow" approach to learning. One advantage of this approach is the specific skill imparted by the master to his apprentice for any given orthopedic problem. The obvious disadvantage is its limited applicability and the temptation to spoon feed a resident.
The rapid influx of modern technology and a deluge scientific evidence paved the way for a more radical, and holistic approach to learning in orthopedics. To the end of my training I was deliberately hammered by mentors to think rather than learn a specific skill, to criticize the validity of any information presented and above all, develop a logical framework for decision making process in any given orthopedic problem. Skills and techniques came in later as my mentors believe that modern technology will techniques change every 5 or so years. I am not an expert on education or teaching styles, but the latter method seems to work best for me. To my understanding, this sort of teaching style fall into the Socratic method of teaching. I'm really not interested into that. What I'm interested now is, if it'll work too for my residents?
In every opportunity I have with our residents, be it conferences and pre ops, I focus on continually challenging their minds, make them think harder, analyze a given situation, criticize an evidence, present facts properly and then develop a sound decision making process. Obviously, I'm not a fan of residents trying to impress attendings with techniques and implants when he can barely utter a word on the biomechanics involved in those implants. Often, the common excuse for residents (this is awful) is the absence of patients logistics and financial support common among government hospitals. I actually do not contest that. What we want for residents however, is to incorporate these specifics into his decision making process so he can plan ahead for his patients surgery Lastly, I wanted my residents to empathize with their patients. One common question I throw in during pre-ops is this
If you we're the patient, what would you want your surgeon do to you?Usually this type of questioning gives the residents an idea as to the best option for the patient!
All of these teaching style have one thing in come though. To pass on knowledge to the new generation of orthopedic surgeons . In short, were training them to be surgeons not residents.
Will these teaching style work for our current residents? Personally, I don't know.Not yet, but perhaps in the future.
Social networks and physician bloggers:Why some physicians blog and some others don't
In the recent years we've seen the rise of physician bloggers and physicians in social networks like Facebook, Tweeter, Multiply, online medical community like Recomed , Linked In or such online conferencing tools like Skype. While what constitute "sociable" data (those that can be shared or not shared on these networks) remains gray and debatable, this rising trend will continue for quite sometime at least in the first world countries I believe.
Still, some physicians (especially in developing countries) isn't taking advantage of these social networks and online health care tools to develop their practice and improve patient care. Obviously there are distinct advantage and disadvantages for physicians getting involve on these social networks. The recent suggestion of charging patients for online consults is gaining some discussion. While such non-conventional patient-doctor interaction evokes strong debates on ethical issues, it is putting affront alternative ways of improving health care delivery and efficiency. This is a clear indication that some physicians are opening their minds to "non-conventional" patient-physician interaction to improve health care delivery and practice. Its only a matter of time before ethical issues is resolved and guidelines set forth.
What about the other physicians who don't blog or join these social networks? What are the main reasons they don't capitalize on these social networking sites?On these online health care tools? In third world countries like the Philippines, where technology is generally 10 years behind. Ironically, this is not limited to the more senior generation of physicians. Nowadays, I am not surprised when one colleague whispers the question "what is an e-mail" or mumble "social networking are for teenagers". Surprising, but I'm not entirely surprised.
Here are some of what I gather as the reasons for this lackluster jump into blogging, online health care tools and social networking.
As I pointed earlier, in the Philippines, our technology is generally 10 years behind that of first world counterpart. Technology adaptation in medicine for developed countries is usually 3 years behind. Thus we know how developing countries delayed "jump" into these online tools. If ever we have this kind of technology, it is usually limited to private tertiary hospitals in big cities who can afford to provide their staff with a suitable online tools to improve hospital services. Even in such centers, health care technology is limited to improving health care delivery inside the institution rather than collaboration with the online health care community . What interest me though is this.Majority of physicians in this country own a PC, a laptop, top of the line cellphones phones and an internet connection, but only a few capitalize on online health care tools!
The next most common reason is that physicians are almost always busy attending to their practice and for that matter their patients. Some don't bother to read mails, journals or online medical feeds much more write something to this effect. Others, believe online networking tools isn't useful to them they'd rather spend time in their clinics and on their patients. If you noticed however, that most physicians have leisure time activities, like outings, sports, etc on a regular basis which means time can be allocated if one wants to. Which brings me to the next reason.
Social networking and online health care tools are not a priority to most physicians. There's no clear cut benefits and advantages to them and hence the "wait and see attitude". We physicians are always relying on personal experiences for technology adaptation. Look at what happened to cellphone and sms messaging. Philippines is the world's texting capital. Slowly physicians adapted to this too. Now it's common for Filipino physicians to use sms messaging to schedule patients, communicate information and what others.
Basically that will be the path of social networking to health care professionals in this country. As soon as we experience the clear advantage and use of social networking and online tools, the jump will happen. Until then, we only hope some physicians gain interest and try to advantage of these available tools. Then we will see technology adaptation just like what we saw with the sms invasion.
Townhouse blogging: Will it be for real?
When I started blogging about health care issues a year ago, I restricted my so called "online journal" to personal nuances that rarely touch anything substantial beyond my own epidermis. It was easier back then, having to simply blurt out personal experiences in order to keep the curiosity of my readers. It was this curiosity that enabled some readers a window into the often chaotic and enigmatic life of medical students, physicians, residents and the tears and glitter that came with our job. Grey's anatomy, Scrubbs and House MD entertained more viewers rather than offering realistic solutions to health care debacles. But they did succeed in bringing health care personnel into some different form of popularity.
When I stumbled on foreign medical blogs that espoused critical thinking on health care issues that affect their system, I became deeply interested and got hooked. The realization in my situation was not something of a "late bloomer syndrome" or this epic, numbnut, out of touch physician. It was rather a realization that I too failed to acknowledge (and kept it that way for so long) there's something screwed with our health care system but I walled in myself saying it wasn't my business after all. I chose to be blind and remind blind to these imperfections believing I couldn't effect some change.
That soon changed as I went by writing about whats happening "inside the system" and reading what "outsiders"(distinction mine) say about my health care system. It's simply too much to ignore. I couldn't simply box in myself to personal nuances and leave others to rot for themselves. One could not simply close thy eyes to the worsening health concerns just because we can afford to salvage our privilege arse. Thus, I slowly drifted into an opinionated blogger that criticizes anything and everything thrown on our health care system and our lives as heath care providers.
Even political ones.
I may not have the soundest and most elaborate dissertations on health care issues nor I profess to offer the sanest solution to any of these pressing problems. I hope though, that I can create awareness, encourage readers to criticize, to participate in the discussion and to offer reasonable solutions to issues affecting their health. That, is essentially what became of my erstwhile "blog for glamor" attitude-an advocacy.
So, shall we start a discussion?
The Blog Rounds Season 2 call for articles: Funny storyline
It's tempting to start season two of TBR with some "serious" topics (like health care reform or politics) but realizing we all need a breather from our busy work, I though of something "light" and funny.
Not that I'm blind to the flak of our bleeding health care system, but I've gone to lengths of babbling and rabble rousing year in and year out I think we need something "refreshingly light" now. So in line with my likeness for Scrubs rather than House MD, I've chosen"our funniest medical experience" as our season opener.
Yes, dear TBR contributors. In two hundred or so words, you will write about your funniest medical experience, encounters or debacle. If you have the gall or appetite for nauseating laughter after any grandiose display of your missteps, maybe you can write about your monumental medical debacles that brought down your sanity for laughter. Your story, not what you heard, not what you read, nor someone else's story, but your funny, real doctor or patient storyline.
Now you do have the license to kill us with laughter..
Of course, giving due respect to our beloved patients and avoiding the multitude medical malpractice that will come your clinic office, leave personal identifying information off your story. Surely you don't want lawyers and judges laughing on our stories inside a courtroom.
Deadline for submitting your articles will be 6pm this Friday August 21,2009 . For guidelines on submitting your articles to TBR please visit this site.
New Guides to Season Two of The Blog Rounds
- The Blog Rounds edition host each week shall be chosen at least 3 days prior to posting of the call of articles. Adherence to hosting schedule is very much encouraged.
- Call for articles for the upcoming TBR edition should be posted on the host blog by 6:00PM PST of Sunday
- Blog articles for carnival are due by 11:59 PM PST Friday the same week.
- The Blog Rounds round up of posts will posted on the host's blog, 12NN Saturday the same week after the call for article post.
- Send the host- blogger for that edition (schedules are listed here) an email containing the title and url link to your post.
- One entry per blogger.
- Short recent posts between 200 and 500 words are preferred
- Posts are to be written for a general audience and may be medical or non medical, depending on the category or topic chosen by the host blogger.
- The host blogger has the sole authority and responsibility of choosing the topic, announcing them, receiving the contributions, proof reading it, and posting them as he/she deemed fit for his/her topic of choice.
I may have to change our TBR logo and pictures as the latter might present us with copyright issues. Any ideas contribution or logo drawing to this effect will be great appreciated.
