A Modern Day Fairy Tale for Medical Education

28 12 2011

Recently, I was asked to speak about innovations in inpatient medical education for leaders in general internal medicine.  Knowing that I would be last in a distinguished lineup of speakers and that my charge was to discuss novel ways to teach in the inpatient setting, I thought it would be important to review how its been done for a long time — so long that it is embodied in one of my favorite fairy tales…

You see, Cinderella dreamed of one day becoming the best clinical educator in the academic kingdom.  Unfortunately, her evil stepmom “Mrs. Dean” scoffed at Cinderella and said “teaching does not pay…look at your hard working and loyal stepbrothers….“Bill” has been our primary breadwinner due to his high volume of Patient Care and “Grant” –yes, while its feast or famine with him, just got a big payout for his Clinical Research.  Teaching? That’s no way to make a living.  Go work work for them until you figure you what you want to do.” 

So Cinderella toiled away…until one day, she met the Godmother of a grateful patient “Mrs. Fairy” who donated a small sum money to improve inpatient teaching…and with this Cinderella was able to transform herself into one of the leading teachers of the new curriculum (she was also able to get a raise to update her wardrobe!).  She quickly became a hit among all the medical students and residents who were truly “charmed”.  Then one day, at the stroke of midnight, Cinderella’s protected time ran out…and all of her work went up in smoke as she was forced back to her life of hardship seeing patients and doing research.  The students and residents were distraught at the thought of losing their most prized teacher and searched the academic complex for her –they were so moved they wanted to award her the precious “Glass Slipper” teaching award, which not only is bestowed with honor, but also a promotion to become a tenured educator in the academic kingdom.   And she lived happily ever after…

While you may think that this is the stuff of fairy tales (especially happily ever after), we all have Cinderellas at our institutions.  And those Cinderellas want to teach, but they struggle not only with funding, but also the realities of today’s inpatient environment.  So, what are these Cinderellas to do? Well, there are few of the ways to ensure that clinical teaching is rewarded – and possible resolutions for the New Year for medical educators.

  • Focus on a gap that needs to be filled:  Protected time is most likely be awarded to someone who is filling a need – think new curriculum that is mandated by LCME/ACGME or other alphabet soup organizational body.  What is the specific need that you can fill with teaching?  Often this may require thinking about a topic that may not exactly match your initial interest, but it is more likely to lead to funding for your teaching.
  • Learn new teaching methods:  Teaching methods for today’s wards are not well developed in the land of an organized chaos.  By incorporating a new platform for teaching (think case blogs, video reflection, standardized patients, or a host of other ideas), you can breathe new life into an old topic.  For example, using simulation to teach end of life discussion, or using blogs to teach about professionalism, can result in a novel curricular program that not only engage next generation learners, but also gains attention of leaders in medical education.
  • Document the effectiveness of the teaching – it is only through methodological evaluation that one can document that teaching translates into practice.  By showing that teaching can be linked to improvements in knowledge, attitudes, or practice, it is more likely that someone (maybe a fairy) will finance this teaching as critical to the mission of the hospital.  Think about procedural training that shows reduction in central lines.
  • Work with a mentor – Just like ‘big research’, mentorship is still important although not always emphasized. To be honest, mentors can serve to mobilize resources or promote your work with senior leaders.

However, regardless of these strategies, funding for teaching requires institutional leadership to recognize that the academic mission of teaching hospitals is still ‘to teach’.   Of course, this mission is sometimes lost in the chaos of teaching hospitals surviving budget crisis in an increasingly competitive environment.  So during this holiday season as everyone is reminded of the time of giving, now is a great time to remind the fiscally minded Mr. Scrooge in your C-suite that the greatest gift they can give is enabling a teacher to teach the future doctors of our nation.

–Vineet Arora MD


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Becoming a Medical School Memory Champion via Cartooning

11 06 2011

Congratulations to all of our MS2 who recently took the dreaded USMLE 1 Exam!  Unfortunately, much of medical school is about memorization – and believe it or not, there is a science to memorization.  I learned this from one of our students—who describes her experience meeting a ‘memory champion’ and picked his brain for some memory tricks for Step 1 including cartoon images.   As I’ll be speaking at the upcoming Comics in Medicine conference here in Chicago this weekend, it seemed fitting to describe her journey.

Right around the time I was beginning an epic five-week studying stint to prepare for STEP 1 of the Boards, Joshua Foer happened to be a guest on The Colbert Report (my go-to 20 minute study break).  Joshua Foer is this ridiculously young and talented journalist who won the US Memory Championships (yes this exists).  If his name sounds familiar you may be thinking of Jonathan Foer, his equally talented older brother who is also a writer.

Anyway, Joshua Foer was promoting his recently released book “Moonwalking with Einstein:  The Art and Science of Remembering Everything.” The book is about memory and his adventures in the world of memory competitions. Apparently there is a small group of people who get together each year and have memory competitions which consist of several memory “events” including faces of strangers, poetry, random words, numbers, binary digits, stacks of cards, etc.  Participants wear noise cancelling headphones and blinders (think sunglasses with two little holes drilled out) to reduce distractors as much as possible.  After attending the US competition as a journalist he wound up being tutored by and English memory master and winning the completion the next year (the US memory scene is not very developed, the Germans are much more serious).

Foer stressed that memory champions are not born with extraordinary powers of memory. They training themselves to use some established memory techniques and are constantly developing new ways on remembering things. This intrigued me since I wondered if I could use some of these techniques to master the overwhelming volume of facts needed for the Boards.  I started reading his book and loved it. It’s very pop-science quick read.   When chatting with one of my best friends who was studying for the Bar, she says, “Oh Josh Foer is giving a talk at this spot in Echo Park this weekend, let’s go pick his brain for ideas.”  (I studied in LA).

So we went… and I managed to get up the nerve to ask him for any advice.  In the most bizarre coincidence, he tells me that his wife is a also second year medical student studying for the boards (bet she’ll do just fine!).   Since visual mnemonics are big in the memory world, he explained that when making a visual aid, the funnier, scarier, raunchier, and stranger it is, the easier it is to remember. He recommended trying to enrich the image with as much detail as possible. He also explained that, though these images help you remember, thinking up good ones takes a lot of creative energy and can be exhausting. That’s one of the things you work on developing when training for a memory championship – the capacity to conjure up rich, creative images really quickly.  He signed my First Aid for the Boards, and I went home and started using that idea by making cartoons (a la Micro Made Ridiculously Simple).

He was right…creative effort is draining.  Sometimes, it took forever to think of something that would stick – but the stuff I made cartoons for is in the vault! Here is an example of a visual aid I made myself for a mucopolysccharidosis, Hurlers. In this image there is a gargoyle (Hurler’s causes gargoylism) hurling a ball (Hurler’s).  He has a dark spleen and liver (spleno- and hepatomegaly) and rain clouds for eyes (clouded corneas). He is also panting and gasping because of airway obstruction.  What I love about this picture is that if I can remember one part of the image (one thing about Hurler’s) the rest of the image (the rest of the facts) come back to me. The other nice thing I noticed is that on a lot of Boards questions you narrow it down to two answers, but it’s been a while since you looked at that material and you are 70% sure you picked the right answer. If I made a picture like this I was sure, clouded cornea’s goes with Hurler’s, not the related Hunter’s disease.  I used some other techniques from the book: the “memory palace” for biochemical pathways; the “major system” to remember lab values.   While memory tricks don’t lend itself to everything, it was really helpful for stuff that is difficult to reason through (lysosomal storage diseases, embryology).

–Gabrielle Schaefer, MS2

Thanks to Gabrielle for describing her experience!  And who said doodling in class never got you anywhere?


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Twitter to Tenure: 7 ways social media advances my career

2 05 2011

As part of our SGIM Social Media Workshop “From Twitter to Tenure” our workshop lineup of ’twitterati’ will be posting each day this week about how social media affected their career.   So yesterday was @AlexSmithMD on GeriPal.   Here is the schedule for the week:  Monday – me (@FutureDocs) here on Futuredocs; Tuesday – Bob Centor (@medrants) on DB’s Medical Rants; Wednesday – Kathy Chretien (@MotherinMed) on Mother’s in Medicine; Thursday – Eric Widera (@ewidera) on GeriPal (and hope to see you in Phoenix for our workshop!)

For the Twitter to Tenure workshop at this year’s Society of General Internal Medicine Meeting, I was asked to think about how social media enhanced my career.  This may sound ridiculous at first- after all, social media is a big waste of time right? Wrong as some of you have discovered.  Social media has opened doors for me by connecting me to a variety of people I would not have met.  Here is just a brief list of the ways social media has impacted my academic career.

  • Media interviews – I was interviewed by Dr Pauline Chen through the New York Times who located me through – you guessed it Twitter!  She actually approached me for the interview by direct messaging me through Twitter.  She was following me and noticed my interests in handoffs on my Google profile which is linked to my Twitter account.  She was also very encouraging when I started the blog which was exciting!
  • Workshop presentations- I presented a workshop on social media in medical education (#SMIME as we like to call it), at 2 major medical meetings with 3 others (including @MotherInMed who encouraged me to start a blog and also is my copresenter at SGIM).  The idea was borne on Twitter…and the first time I actually met one of the workshop presenters (who I knew on Twitter) was at the workshop.
  • Acquired new skills  – My workshop co-presenter who I only knew through Twitter ended up being Carrie Saarinen, an instructional technologist (a very cool job and every school needs one!).  She is an amazing resource and taught me how to do a wiki.  After my period of ‘lurking’, I started my own ‘course’ wiki  dedicated to helping students do research and scholarly work which we are launching in a week.
  • Lecture invitations – Several of my lecture invitations come through social media.  Most notably, I was invited to speak for an AMSA webinar on handoffs and also speak to the Committee of Interns and Residents on teaching trainees about cost conscious medicine.  Both invitations started with a reference to finding me through Twitter or the blog.
  • Committee invitations – I am now on the SGIM communications task force as a result of my interest in social media.  Our most recent effort was a piece about ‘tweeting the meeting’ with @medrants and an older piece focused on the top Twitter Myths and Tips.
  • Grant opportunities – I recently submitted a grant with an organization that I learned of on Twitter – Initially, I had contacted Neel Shah from Costs of Care asking him if they had a curriculum on healthcare costs.  They did not, but were interested in writing a grant to develop a curriculum so they brought my team on board and we submitted together (fingers crossed).
  • Dissemination - One of the defining features of scholarship (the currency of promotion in academic medical centers) is that it has to be shared.   Well, social media is one of the most powerful ways to share information.   In a recent example, we entered a social media contest media video contest on the media sharing site Slideshare.  Using social media, we were able to obtain the most number of ‘shares’ on Facebook on Twitter which led to the most number of views and ultimately won ‘Best Professional Video.’  To date, this video, has received over 13,000 views, which I was able to highlight as a form of ‘dissemination’ in a recent meeting with our Chairman about medical education scholarship.    While digital scholarship is still under investigation with vocal critics and enthusiastic proponents debating the value of digital scholarship in academia, digital scholarship does appear to have a place for spreading nontraditional media that cannot be shared via peer review.

Part of being a good citizen on social media is giving back.  I try to give back when I can through helping anyone who contacts me for something specific – so I have read personal statements, reviewed websites, and offered input to others who are interested in my perspective on their work.  I can’t always keep up since I have a day job and alas, this is an extracurricular activity.  The good news is a tweet is only 140 characters  – so like the blue bird, I can keep it short but sweet.

–Vineet Arora, MD


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