Virtual Mentor February 2010

Some goodies from this issue. What is informed consent for experimental procedures? Do patients really understand the risk? How will surgical procedures progress if there are no patients? What about the harm during the learning curve?

(For best results, view as HTML or request text version from virtualmentor@ama-assn.org)

Virtual Mentor. February 2010, Volume 12, Number 2: 67-142. Full Issue PDF

February 2010 Contents

Ethics and Innovation in Surgery

From the Editor

Responsible Progress in Surgical Innovation: A Balancing Act
Catherine Frenkel
Full Text | PDF
Virtual Mentor. 2010; 12:69-72.

Educating for Professionalism

Clinical Cases

New Devices and Truly Informed Consent
Commentary by Charles Rosen
Full Text | PDF
Virtual Mentor. 2010; 12:73-76.

Prophylactic Bariatric Surgery
Commentary by Robert E. Brolin, Bruce Schirmer, and Angelique M. Reitsma
Full Text | PDF
Virtual Mentor. 2010; 12:77-86.

Technical Skill and Informed Consent
Commentary by Robert M. Sade
Full Text | PDF
Virtual Mentor. 2010; 12:87-90.

Counterfeit Medications

Counterfeit drugs is one of my greatest concern when I started practising medicine. How can I be sure that the drugs I prescribed is the real stuff and not sugar water?


This is an interesting article from The Scientist that shares my concern.
The article is written by

Brendan Borrell

---

The Counterfeiter

The story of how one of pharma’s biggest enemies was nabbed in Houston, Texas

Stone / Getty Images

On May 25, 2007, Kevin Xu logged into his Gmail account and found a startling message from a man who could have been his biggest client.

From an office suite on the 28th floor of the Plaza Royale in Beijing, the baby-faced businessman had gone from selling shark cartilage and penicillin to Chinese hospitals and clinics to cashing in on the high-profit margins of the European and—he hoped—US pharmaceutical markets. Xu kept a list of 29 brand-name drugs he could deliver at cut-rate prices, from the baldness remedy Propecia to lifesavers like the antileukemia drug Gleevec. If it wasn’t on the list, Xu boasted that he could find a way to get it.

read more

The Child with Fits

Doctors in Detention

Doctors in detention and the Hippocratic Oath

Meera Selvakone, MD

Family physician
Richmond Hill, Ont.

Every year, many newly qualified doctors recite the Hippocratic Oath upon graduating. But how many of us would actually put those words to the test if our own lives were in jeopardy? Half a world away, three physicians faced this dilemma.

During the first five months of 2009, an intense war played out in the densely populated coastline of northeastern Sri Lanka. More than 300 000 civilians were trapped between battle lines. A government-imposed media blackout meant the world was largely unaware of what the United Nations called a "bloodbath."

I solemnly pledge to consecrate my life to the service of humanity. I will practice my profession with conscience and dignity.¹

Doctors Thangamuthu Sathiyamoorthy, Thurairajah Varatharajah and Veerakaththi Shanmugarajah were employed by the government to work in the conflict zone. Dr. Shanmugarajah might easily have been working in a peaceful nation; several years ago, he emigrated to Canada only to return to Sri Lanka to serve the developing nation.

read more

CMAJ • November 10, 2009; 181 (10). First published October 19, 2009; doi:10.1503/cmaj.091527
© 2009 Canadian Medical Association

Image courtesy of Fred Sebastian

Humanizing Physician Learning

The November issue of Virtual Mentor from the American Medical Association Journal of Ethics is on Humanizing Physician Learning

Educating for Professionalism

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated that residents could work no more than 24 consecutive hours and limited resident hours to an average of 80 per week over the course of 1 month. The creation of this policy was prompted by the 1984 death of Libby Zion, an 18-year-old who was admitted to New York Hospital for a high fever and died while under the care of overworked and fatigued interns. The incident led to a critical reevaluation of resident work hours. The possible harm patients could experience under the traditional training system was serious enough to provide the impetus for a large-scale reform of residency education.

Clinical Cases

The Ethical Dilemma of Duty-Hour Reporting
Commentary by Mary E. Klingensmith and Katrina S. Firlik
Full Text | PDF
Virtual Mentor. 2009; 11:835-841.

Can a Pass/Fail Grading System Adequately Reflect Student Progress?
Commentary by Bonnie M. Miller, Adina Kalet, Ryan C. VanWoerkom, Nicholas Zorko, and Julia Halsey
Full Text | PDF
Virtual Mentor. 2009; 11:842-851.

Should Applicants’ Ethnicity Be Considered in Medical School Admissions?
Commentary by Will Ross
Full Text | PDF
Virtual Mentor. 2009; 11:852-858.

Medical Education

The Winnowing Fork of Premedical Education: Are We Really Separating the Wheat from the Chaff?
Raymond G. De Vries and Jeffrey Gross
Full Text | PDF
Virtual Mentor. 2009; 11:859-863.

The Longitudinal Integrated Clerkship
Ann N. Poncelet, Karen E. Hauer, and Bridget O’Brien
Full Text | PDF
Virtual Mentor. 2009; 11:864-869.

Helping Those Who Need It Most: Medical Education Focused on Poor and Disenfranchised Communities
Charles Vega
Full Text | PDF
Virtual Mentor. 2009; 11:870-873.

Virtual Mentor. November 2009, Volume 11, Number 11: 829-926. Full Issue PDF

Will My Future Clinic Look Like This?

The Office of the Future features a variety of products to help pediatricians transition to the patient-centered medical home concept.

read more

Medicine-Reigniting our Passion

Tuesday, August 18, 2009

Medicine—Reigniting our Passion…

This is an interesting reflection on the medical profession especially when the country in the throbs of the Influenza A (H1N1) pandemic. Makes me wonder why I did not choose a safer profession like being a pastor!

David Quek is a Consultant Cardiologist and President of the Malaysia Medical Association (2009-2010). He writes,

Being a medical doctor is certainly one profession, which can become an all-consuming life and living itself—one learns to eat, drink, and breathe medicine.

Our thoughts and thought processes are submerged within the lingering echoes and ethos of a Hippocratic ancien[t] regime: one of highly-structured codified dos and don’ts and exhortations of an intricately-crafted analytical process. Many are now lamenting the relevance of these methods and constraints, the seemingly outmoded sweeping codes, so enshrined within its antiquarian Aesculapian confines...

It is against this backdrop, that we should address the issue of where our medical profession is heading. With the onslaught of rising commercialism, market-driven personal consumerism, and greater patient autonomy, it is becoming increasingly hard for the medical professional to practice as a doctor.

A thought provoking article and worth the reading here

.

The Swine Flu Hysteria

My blog post Much Ado about Nothing: Influenza A H1N1, elicited some positive and negative responses in the blog, Facebook, email and indirect references in other blogs. Patrick Di Justo writes in Apocalypse Not: Behind the Swine Flu Hysteria, Wired magazine 17.07

At the height of the swine flu pandemic this spring, when the US Centers for Disease Control and Prevention was recommending that schools with cases of H1N1 be closed for 14 days and Mexico was still on lockdown, the epidemiology community already suspected the world wasn't ending. Why? The numbers came in: case fatality rate (how many infected people are dying) and replication rate (how many others an infected person will transmit the illness to — "R-zero," in disease-speak). H1N1 had an RØ of about 1.3, high enough to spread the virus but low enough that a strong isolation program could break its back. Its case fatality rate was a wussy 1.9 percent in Mexico and 0.1 percent worldwide. By comparison, the 1918 Spanish flu had an RØ of 2.7 and a case fatality rate of up to 5 percent, making it far more deadly. A real apocalypse, like the killer flu in The Stand — Stephen King's opus of epidemiologic eschatology — would be off the chart, with an RØ of 5 to 6 and a case fatality rate of 99 percent. So, don't panic ... unless H1N1 surges this fall. Where did we leave that hand sanitizer, again?

read more for the wonderful and informative graphs.

One good thing that come out of this pandemic is that it reveals the effectiveness of our governments and health authorities in their ability to respond to a pandemic. This report from Trust for America's Health (TAfT) give 10 early lessons learned from the H1N1 outbreak makes for interesting reading. While the pandemic is not over yet and we are watching for the infection rates in the southern hemisphere, it may be time for us to take stock of our preparedness and appropriateness of our responses to pandemics.

Why are essential drugs so expensive in poor countries?

One of the issue I face as a doctor in private practice is the high price of drugs or medications. While I recognize that the pharmaceutical companies need to recoup their R & D costs, yet somehow I feel that it has become a convenient excuse to price their medications high. Why are propriety medications so expensive in poor countries? In this interesting article by Brook Baker in the magazine Virtual Mentor (American Medical Association Journal of Ehics), July 2009 offers some perspectives on the issue Medicines in Developing Countries

Of the 12 million people living with HIV/AIDS in developing countries who will die within 3 years without immediate access to affordable antiretroviral medicines, only 4 million were receiving treatment at the end of 2008. Access to a much broader list of essential medicines (those defined as essential for health by national governments or the World Health Organization, or WHO) is equally dismal. Recent WHO studies found that public pharmacies in developing countries had only one-third of essential medicines available onsite, and the private pharmacies had only two-thirds of medicines available. End prices were 2.5 and 6.5 times international reference prices at public and private pharmacies, respectively

he continues,

Many factors contribute to a lack of access to existing medicines in developing countries: tattered health systems, insufficient numbers of health workers, weak regulatory regimes, and poor procurement and distribution systems. Other conditions—import duties and taxes, mark-ups throughout the distribution chain, and even corruption and product diversion—coalesce to produce high drug prices. Weak research and development (R&D) capacity and limited investment in R&D combine to restrict research on neglected diseases in developing countries. But clearly one of the factors most implicated in unavailability (and unaffordability) of medicines in developing countries is the current intellectual property regime—a regime that allows proprietary drug companies with intellectual property monopolies to charge high prices and maximize profit by the sale of medicines that only rich and well-insured people can afford while simultaneously deprioritizing R&D into products that poor people need.

read more

Is there anything we who live the the poorer countries can do? Any help from those living in developed countries?

picture source

Much ado about nothing? Influenza A (H1N1)

PANDEMIC! PLAGUES AND PESTILENCES! END OF THE WORLD!

These are scary words and since April 2009 the world has been truly and thoroughly scared. The Centers of Disease Control and Prevention (CDC) in the United States noted

On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway.

More than 70 countries are now reporting cases of human infection with novel H1N1 flu. This number has been increasing over the past few weeks, but many of the cases reportedly had links to travel or were localized outbreaks without community spread. The WHO designation of a pandemic alert Phase 6 reflects the fact that there are now ongoing community level outbreaks in multiple parts of world.

WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus.

The World Health Organisation (WHO) latest update June 24 states that there are 55,867 cases and 238 deaths. The first death in Asia occurred last week.

MANILA, June 23 (Reuters) - The Philippines closed down the lower house of Congress for five days on Tuesday and sent about 3,000 workers home after cases of influenza A (H1N1) were reported in the offices, officials said.

A 49-year-old woman who died last week from symptoms exacerbated by the flu was a staff member on a congressional committee, said Ramon, a doctor and deputy secretary-general of the House of Representatives.

The mode of transmission is by coughing and sneezing and contact of articles touched by infected people.

So Malaysia, as is the rest of the world is closing down schools and starting to quarantine travelers.

I want to raise two questions here:

(1) For a pandemic, aside from being a good traveler, it does not seem to be extra virulent or particularly dangerous. Most people infected by the virus recovered. If we take the number of confirmed cases and the number of deaths, we have a mortality rate of 0.4%. That is not exactly a killer like SARS.

(2) The spread is by contact, sneezing and coughing which is extremely difficult to control. Often many others would have been exposed long before the infected are traced by health officers and quarantined.

To the first question, should we panic? Or is there a need to panic? Apparently the panic is driven more by the media hype and the health authorities than what the plain facts warrant.

The second question addresses our present health measures. Trying to contain this infection is like trying to catch the wind. It is obvious that quarantines and closing of schools, factories or congress will do nothing to stop the spread. So why are so many countries and health authorities, not to mention a certain health minister and a deputy prime minister spending so much money and effort to catch the wind? Wearing face masks and giving influenza vaccine is known to be not effective prevention against influenza A (H1N1).

I will suggest that instead of instilling panic in our populations and wasting valuable resources in isolation and quarantine, we should

(1) allow the infection to spread. People over time will develop immunity to it. We call this herd immunity.

(2) focus our resources on treating those who became really sick due to this virus. There are anti-viral agents which are effective against the virus.

(3) educate the population about personal hygiene, especially hand-washing.

Following the news about the pandemic of Influenza A (H1N1), I wonder if the response is more political, emotional and knee-jerk rather than evidence-based medicine. It did take our mind off the world wide financial crisis.

.

What is Paediatrics?

Paediatrics is not the list of signs and symptoms that is listed in the textbooks or in an online database. It is a young child that suffers from what was described on that list. This child is dependent on adults; such as parents, grand-parents or others who love them, see to their needs and provide comfort for them. These adults in turn, reside in the context of relatives, communities, cultural and religious beliefs. A bigger circle will be the country they reside in, the standard of medical care and the availability of such care. Each of these factors affect the little chap who manifest these signs and symptoms that you have memorised. This little child has a name which is not a hospital bed number nor is it the name of a disease. He or she looks to you, with your evident-based medical knowledge, experienced clinical practices, and refined clinical acumen for help. They want to have relief from their sufferings so that they can get on with their business of growing up. Paediatrics is not about treating diseases. Paediatrics is about relationships.

What is Paediatrics?

Paediatrics is not the list of signs and symptoms that is listed in the textbooks or in an online database. It is a young child that suffers from what was described on that list. This child is dependent on adults; such as parents, grand-parents or others who love them, see to their needs and provide comfort for them. These adults in turn, reside in the context of relatives, communities, cultural and religious beliefs. A bigger circle will be the country they reside in, the standard of medical care and the availability of such care. Each of these factors affect the little chap who manifest these signs and symptoms that you have memorised. This little child has a name which is not a hospital bed number nor is it the name of a disease. He or she looks to you, with your evident-based medical knowledge, experienced clinical practices, and refined clinical acumen for help. They want to have relief from their sufferings so that they can get on with their business of growing up. Paediatrics is not about treating diseases. Paediatrics is about relationships.

Money, Medicine and Business

In this issue of Virtual Mentor from the American Medical Association Journal of Ethics, the issue of money and business is explored. This include the choice of specialty by medical students, the impact of money and business on medical practice, the rise of 'spa doctors' and 'concierge doctors' and whether the issue of making money is a problem for medical students.

Virtual Mentor. May 2009, Volume 11, Number 5: 349-422. Full Issue PDF

May 2009 Contents

Specialty Choice and Business Decisions in Medicine

Listen to the VM's May podcast on Medical Students and Specialty Choice.

Clicking the "Ethics Talk" link will take you to VM's podcast.index page, where you can download any of VM's podcasts, including May's interview with two medical students who discuss how and why they selected the residency programs they wish to enter.

From the Editor

The Growing Importance of Business to Medical Students
Nathaniel J. Brown and Jeffrey M. Dueker
Full Text | PDF
Virtual Mentor. 2009; 11:351-354.

Educating for Professionalism

Clinical Cases

Decision Making at the Crossroads of Practice Choice
Commentary by John G. Halvorsen
Full Text | PDF
Virtual Mentor. 2009; 11:355-360.

Mainstream Medicine Meets the Medi-Spa
Commentary by Lionel Bercovitch
Full Text | PDF
Virtual Mentor. 2009; 11:361-367.

Competitiveness Can Undermine Team Goals
Commentary by Jeffrey Reagan and Laurel C. Blakemore
Full Text | PDF
Virtual Mentor. 2009; 11:368-372.

Medical Education

Medical Business Ethics Education: Guarding the Patient-Centered Focus of Medicine
James M. DuBois
Full Text | PDF
Virtual Mentor. 2009; 11:373-377.

Journal Discussion

O Doctor, Where Art Thou? Why Fewer Students Pursue Internal Medicine
David Y. Chen
Full Text | PDF
Virtual Mentor. 2009; 11:378-382.

Clinical Pearl

What Is the Consensus about Managing Health Risks Associated with Type-A Personality?
Sundeep Jayaprabhu
Full Text | PDF
Virtual Mentor. 2009; 11:383-386.

Law, Policy, and Society

Health Law

Splitting Fees or Splitting Hairs?
Cheryl Miller
Full Text | PDF
Virtual Mentor. 2009; 11:387-389.

Policy Forum

Closing the Gap: Finding and Encouraging Physicians Who Will Care for the Underserved
Keisa Bennett, Julie Phillips, and Bridget Teevan
Full Text | PDF
Virtual Mentor. 2009; 11:390-398.

Medicine and Society

The Business of Healing, Then and Now
Daniel N. Robinson
Full Text | PDF
Virtual Mentor. 2009; 11:399-401.

History, Art, and Narrative

Medical Narrative

On Money in Medicine and the Angst It Creates for Medical Students
Allison Carmichael
Full Text | PDF
Virtual Mentor. 2009; 11:402-405.

Op-Ed and Correspondence

Op-Ed

Higher Pay
E. Ray Dorsey, John A. Dorsey, and E. Richard Dorsey
Full Text | PDF
Virtual Mentor. 2009; 11:406-409.

Money, Medicine and Business

In this issue of Virtual Mentor from the American Medical Association Journal of Ethics, the issue of money and business is explored. This include the choice of specialty by medical students, the impact of money and business on medical practice, the rise of 'spa doctors' and 'concierge doctors' and whether the issue of making money is a problem for medical students.

Virtual Mentor. May 2009, Volume 11, Number 5: 349-422. Full Issue PDF

May 2009 Contents

Specialty Choice and Business Decisions in Medicine

Listen to the VM's May podcast on Medical Students and Specialty Choice.

Clicking the "Ethics Talk" link will take you to VM's podcast.index page, where you can download any of VM's podcasts, including May's interview with two medical students who discuss how and why they selected the residency programs they wish to enter.

From the Editor

The Growing Importance of Business to Medical Students
Nathaniel J. Brown and Jeffrey M. Dueker
Full Text | PDF
Virtual Mentor. 2009; 11:351-354.

Educating for Professionalism

Clinical Cases

Decision Making at the Crossroads of Practice Choice
Commentary by John G. Halvorsen
Full Text | PDF
Virtual Mentor. 2009; 11:355-360.

Mainstream Medicine Meets the Medi-Spa
Commentary by Lionel Bercovitch
Full Text | PDF
Virtual Mentor. 2009; 11:361-367.

Competitiveness Can Undermine Team Goals
Commentary by Jeffrey Reagan and Laurel C. Blakemore
Full Text | PDF
Virtual Mentor. 2009; 11:368-372.

Medical Education

Medical Business Ethics Education: Guarding the Patient-Centered Focus of Medicine
James M. DuBois
Full Text | PDF
Virtual Mentor. 2009; 11:373-377.

Journal Discussion

O Doctor, Where Art Thou? Why Fewer Students Pursue Internal Medicine
David Y. Chen
Full Text | PDF
Virtual Mentor. 2009; 11:378-382.

Clinical Pearl

What Is the Consensus about Managing Health Risks Associated with Type-A Personality?
Sundeep Jayaprabhu
Full Text | PDF
Virtual Mentor. 2009; 11:383-386.

Law, Policy, and Society

Health Law

Splitting Fees or Splitting Hairs?
Cheryl Miller
Full Text | PDF
Virtual Mentor. 2009; 11:387-389.

Policy Forum

Closing the Gap: Finding and Encouraging Physicians Who Will Care for the Underserved
Keisa Bennett, Julie Phillips, and Bridget Teevan
Full Text | PDF
Virtual Mentor. 2009; 11:390-398.

Medicine and Society

The Business of Healing, Then and Now
Daniel N. Robinson
Full Text | PDF
Virtual Mentor. 2009; 11:399-401.

History, Art, and Narrative

Medical Narrative

On Money in Medicine and the Angst It Creates for Medical Students
Allison Carmichael
Full Text | PDF
Virtual Mentor. 2009; 11:402-405.

Op-Ed and Correspondence

Op-Ed

Higher Pay
E. Ray Dorsey, John A. Dorsey, and E. Richard Dorsey
Full Text | PDF
Virtual Mentor. 2009; 11:406-409.

Random Musings on Teaching in Higher Education (3)

Team-Based Learning

A concept I picked up recently is Team-Based Learning (TBL). Though the facilitator mentioned it only once, I was so intrigued by the word that I ‘googled’ it. The results opened up a new dimension of the learning process to me. Team-based learning is different from small group learning, Problem-based learning (or its modified Patient-based learning), cooperative learning, and collaborative learning. Mooted by an idea by Larry Michaelsen, team-based learning has been picked up by many medical schools all over the world which includes the newly formed NUS-Duke Graduate Medical School in Singapore.

This is from the website, Team-Based Learning Collaborative

Team learning or team-based learning (TBL) is a well-defined instructional strategy developed by Dr. Larry K. Michaelsen that is now being used successfully in medical education.

The TBL method allows a single instructor to teach through conducting multiple small groups simultaneously in the same classroom.

Learners must actively participate in and out of class through preparation and group discussion. Class time is shifted away from learning facts and toward application and integration of information. The instructor retains control of content, and acts as both facilitator and content expert. The team learning method affords the opportunity for assessment of both individual and team performance.

As an instructional method, team learning consists of repeating sequences of 3 phases:

• In Phase 1, learners study independently outside of class to master identified objectives.
• In Phase 2, individual learners complete a multiple-choice exam to assure their readiness to apply Phase 1 knowledge. Groups of 6-7 learners then re-take this exam and turn in their consensus answers for immediate scoring and posting.
• In Phase 3, which may last several class periods, groups complete in-class assignments that promote collaboration, use of Phase 1 and 2 knowledge, and identification of learning deficiencies. At designated times, all groups simultaneously share their groups' answers with the entire class for easy comparison and immediate feedback. This stimulates an energetic total-class discussion with groups defending their answers and the teacher helping to consolidate learning.

TBL stresses the importance of a priori, out-of-class learning based on clear learning objectives. It emphasizes the importance of holding learners accountable for attending class prepared to participate, and provides guidelines for designing group learning tasks to maximize participation.

TBL emphasizes three keys to effective active learning:

1. Individual and group accountability
2. Need and opportunity for group interaction
3. Motivation to engage in give-and-take discussion. In medical education, team learning has been successfully used in preclinical, clinical, residency, fellowship, and CME venues and in interdisciplinary settings.
   

Resources About Team Learning

• Three Keys to Using Learning Groups Effectively
• Team Learning: Putting sTEAM into Learning Groups

• University of Oklahoma Team-Based Learning Website (link)
  This is the original site developed by Dr. Larry K. Michaelsen who developed team learning. The site is intended for educators in any grade level or settings. It includes a e-discussion board with many useful pointers submitted by faculty from their experiences with team learning.

This is another pedagogical tool for effective learning. I wonder whether it can be used for theological education?

Random Musings on Teaching in Higher Education (3)

Team-Based Learning

A concept I picked up recently is Team-Based Learning (TBL). Though the facilitator mentioned it only once, I was so intrigued by the word that I ‘googled’ it. The results opened up a new dimension of the learning process to me. Team-based learning is different from small group learning, Problem-based learning (or its modified Patient-based learning), cooperative learning, and collaborative learning. Mooted by an idea by Larry Michaelsen, team-based learning has been picked up by many medical schools all over the world which includes the newly formed NUS-Duke Graduate Medical School in Singapore.

This is from the website, Team-Based Learning Collaborative

Team learning or team-based learning (TBL) is a well-defined instructional strategy developed by Dr. Larry K. Michaelsen that is now being used successfully in medical education.

The TBL method allows a single instructor to teach through conducting multiple small groups simultaneously in the same classroom.

Learners must actively participate in and out of class through preparation and group discussion. Class time is shifted away from learning facts and toward application and integration of information. The instructor retains control of content, and acts as both facilitator and content expert. The team learning method affords the opportunity for assessment of both individual and team performance.

As an instructional method, team learning consists of repeating sequences of 3 phases:

• In Phase 1, learners study independently outside of class to master identified objectives.
• In Phase 2, individual learners complete a multiple-choice exam to assure their readiness to apply Phase 1 knowledge. Groups of 6-7 learners then re-take this exam and turn in their consensus answers for immediate scoring and posting.
• In Phase 3, which may last several class periods, groups complete in-class assignments that promote collaboration, use of Phase 1 and 2 knowledge, and identification of learning deficiencies. At designated times, all groups simultaneously share their groups' answers with the entire class for easy comparison and immediate feedback. This stimulates an energetic total-class discussion with groups defending their answers and the teacher helping to consolidate learning.

TBL stresses the importance of a priori, out-of-class learning based on clear learning objectives. It emphasizes the importance of holding learners accountable for attending class prepared to participate, and provides guidelines for designing group learning tasks to maximize participation.

TBL emphasizes three keys to effective active learning:

1. Individual and group accountability
2. Need and opportunity for group interaction
3. Motivation to engage in give-and-take discussion. In medical education, team learning has been successfully used in preclinical, clinical, residency, fellowship, and CME venues and in interdisciplinary settings.
   

Resources About Team Learning

• Three Keys to Using Learning Groups Effectively
• Team Learning: Putting sTEAM into Learning Groups

• University of Oklahoma Team-Based Learning Website (link)
  This is the original site developed by Dr. Larry K. Michaelsen who developed team learning. The site is intended for educators in any grade level or settings. It includes a e-discussion board with many useful pointers submitted by faculty from their experiences with team learning.

This is another pedagogical tool for effective learning. I wonder whether it can be used for theological education?

Random Musings on Teaching In Higher Education (2)

Teaching Values in Higher Education

Recently I received an email about medicine with this equation

E² - evidence + experience = good medicine

I beg to differ from my learned colleague whom I respect very much. While the practice of medicine has improved with the introduction of evidence-based medicine, it is important to realize that evidence based-medicine is not the holy grail of medical standards. Even the highest level of meta-analysis has its limitation. It is just a statistical program which analyses data fed into it. It is important not to forget the old axiom: GIGO (garbage in, garbage out). Also not everything that is done in the practice of medicine is available in the evidence-based medicine databases.

Experience is a good teacher but repetition is not a proof of expertise or even of competence. A doctor may be repeating the same mistake repeatedly. However, not repeating mistakes and increased competence may be achieved by combining evidence with experience. I believe that there is still another component to the equation. This component is good character. Thus I will suggest that the equation should be

E²GC- evidence + experience + good character = good medicine

I believed that good medicine can only be practiced by a doctor with good character. I have seen surgeons who have excellent surgical skills who could not bother with whom they operated upon. “The operation was successful but the patient died” was their creed. I have seen doctors who treat their patients as objects- some problems to be solved and then move on. True care, concern and compassion can only come out of good character. Good characters are formed by good beliefs.

It is a fallacy in many institutions of higher learning that knowing will automatically lead to believing. For example, if we teach our students to be compassionate to their patients, they will automatically be compassionate because of their knowledge. Unfortunately this is not true.

Educator Emeritus Professor Brian Hill of Murdock University identifies in How Learners Respond to the Teaching of Beliefs and Values the three dimensions in how students respond to the teaching of values. These dimensions are the psychological dimensions of the cognitive, the emotional, and the volitional. While writing about teaching in schools, I believe his findings have implications in centers of higher learning. The possible response of a student to the teaching of a value X may be:

Cognitive

(1) I don’t get it. What do you mean by X?

2) Ah, I understand what you mean by X.

(3) I understand what you mean by X, but I don’t believe X is true.

(4) I accept your claim that X is true.

Emotional

1) Knowing X makes no difference to me.

(2) I have a bad feeling about X.

(3) I don’t feel I can leave up to X

(4) I have a good feel about X.

Volitional

(1) I’m not willing to attach value to X in my life-priorities.

(2) I’m willing, so far as I can, to attach value to X in my life-priorities.

(3) I’m prepared to prioritise X in my own life, but I don’t regard it as something everyone else should necessarily prioritise.

4) I’m prepared to prioritise X in my own life and, whenever appropriate, will commend its priority to others.

According to Hill, the cognitive plays a small role in the learning of values. The emotional dimension is more important and it is that dimension that influences the volitional in prioritizing its values. In the teaching of values, I agree with Hill that teachers have a tendency to use conditioning, coercion, indoctrination and persuasion as possible pedagogies.

Instead he suggests the following:

(1) I will model X in my own behaviour before students.

2) I will, where necessary for the common good, require students to behave in the classroom in a manner consistent with X.

(3) I will encourage maturing students to engage in critical examination of the grounds for and against prioritizing X in their lives.

4) I will represent to students that X, in my opinion, points to a defensible value by which to live, but I will respect and not penalize dissent.

Hill highlights that in the teaching of values, we need to be aware of the cognitive, emotional and volitional dimensions of learning. Our pedagogy must be based on these dimensions and should involve modeling, reflection and respect.

Reference:

Hill, Brian V., How Learners Respond to the Teaching of Beliefs and Values, Journal of Education and Christian Beliefs, 12:2 (2008) 101-113

Random Musings on Teaching In Higher Education (2)

Teaching Values in Higher Education

Recently I received an email about medicine with this equation

E² - evidence + experience = good medicine

I beg to differ from my learned colleague whom I respect very much. While the practice of medicine has improved with the introduction of evidence-based medicine, it is important to realize that evidence based-medicine is not the holy grail of medical standards. Even the highest level of meta-analysis has its limitation. It is just a statistical program which analyses data fed into it. It is important not to forget the old axiom: GIGO (garbage in, garbage out). Also not everything that is done in the practice of medicine is available in the evidence-based medicine databases.

Experience is a good teacher but repetition is not a proof of expertise or even of competence. A doctor may be repeating the same mistake repeatedly. However, not repeating mistakes and increased competence may be achieved by combining evidence with experience. I believe that there is still another component to the equation. This component is good character. Thus I will suggest that the equation should be

E²GC- evidence + experience + good character = good medicine

I believed that good medicine can only be practiced by a doctor with good character. I have seen surgeons who have excellent surgical skills who could not bother with whom they operated upon. “The operation was successful but the patient died” was their creed. I have seen doctors who treat their patients as objects- some problems to be solved and then move on. True care, concern and compassion can only come out of good character. Good characters are formed by good beliefs.

It is a fallacy in many institutions of higher learning that knowing will automatically lead to believing. For example, if we teach our students to be compassionate to their patients, they will automatically be compassionate because of their knowledge. Unfortunately this is not true.

Educator Emeritus Professor Brian Hill of Murdock University identifies in How Learners Respond to the Teaching of Beliefs and Values the three dimensions in how students respond to the teaching of values. These dimensions are the psychological dimensions of the cognitive, the emotional, and the volitional. While writing about teaching in schools, I believe his findings have implications in centers of higher learning. The possible response of a student to the teaching of a value X may be:

Cognitive

(1) I don’t get it. What do you mean by X?

2) Ah, I understand what you mean by X.

(3) I understand what you mean by X, but I don’t believe X is true.

(4) I accept your claim that X is true.

Emotional

1) Knowing X makes no difference to me.

(2) I have a bad feeling about X.

(3) I don’t feel I can leave up to X

(4) I have a good feel about X.

Volitional

(1) I’m not willing to attach value to X in my life-priorities.

(2) I’m willing, so far as I can, to attach value to X in my life-priorities.

(3) I’m prepared to prioritise X in my own life, but I don’t regard it as something everyone else should necessarily prioritise.

4) I’m prepared to prioritise X in my own life and, whenever appropriate, will commend its priority to others.

According to Hill, the cognitive plays a small role in the learning of values. The emotional dimension is more important and it is that dimension that influences the volitional in prioritizing its values. In the teaching of values, I agree with Hill that teachers have a tendency to use conditioning, coercion, indoctrination and persuasion as possible pedagogies.

Instead he suggests the following:

(1) I will model X in my own behaviour before students.

2) I will, where necessary for the common good, require students to behave in the classroom in a manner consistent with X.

(3) I will encourage maturing students to engage in critical examination of the grounds for and against prioritizing X in their lives.

4) I will represent to students that X, in my opinion, points to a defensible value by which to live, but I will respect and not penalize dissent.

Hill highlights that in the teaching of values, we need to be aware of the cognitive, emotional and volitional dimensions of learning. Our pedagogy must be based on these dimensions and should involve modeling, reflection and respect.

Reference:

Hill, Brian V., How Learners Respond to the Teaching of Beliefs and Values, Journal of Education and Christian Beliefs, 12:2 (2008) 101-113

The Buddhist Hippocratic Oath

"One who cares for the sick is fit to do so if he has 5 qualities.

What 5?

He can prepare medicine,he knows what is healing and administers it BUT never administer what is harmful,he cares for the patient out of love NOT out of desire for gain, he is unmoved by excrement, urine, vomit and spittle, and from time to time he can instruct, uplift, gladden and encourage the patient with talk on the Truth."

The Buddha in Anguttara Nikaya

HT: Punna

The Buddhist Hippocratic Oath

"One who cares for the sick is fit to do so if he has 5 qualities.

What 5?

He can prepare medicine,he knows what is healing and administers it BUT never administer what is harmful,he cares for the patient out of love NOT out of desire for gain, he is unmoved by excrement, urine, vomit and spittle, and from time to time he can instruct, uplift, gladden and encourage the patient with talk on the Truth."

The Buddha in Anguttara Nikaya

HT: Punna