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WEEK 10: June 8

Sorry for the delay on this post - I was confused about the number we had left to complete.  I guess THIS post was the one in which I was intended to give some advice to incoming BHI-ers.  Since I did that last time, I'll have to come up with something different to discuss.  I think I'll go back to the original format of reflecting on the learning that has happened this past week.

I've been in San Francisco at a conference called the Clinical Genome.  I haven't actually had much time to attend most of the lectures because I've been frantically trying to wrap up my thesis and a few remaining projects for the quarter.  I don't have all that much to report about the actual conference, except that I saw a great example of what NOT to do in presentations:  The new Chief Medical Officer for 23&Me (the direct-to-consumer genetic testing company that was stopped by the FDA this past winter from providing disease risk test interpretations) was a young, fiery pathologist who reminded me of a sun-tanned surf board sales rep that I know from a past life.  She was definitely hired for looks as well as brains.  But, she went up to the podium ready to swing fists, and it was really uncomfortable for everyone.  23&Me has always gotten flack from physicians because it's a pain in the butt when a patients walk in to the clinic with their own DNA test results, wanting to know what it means that they have a 58% chance of having prostate cancer.  There were also major issues with the way the company combined statistics and dealt with Genome Wide Association Studies.  So, admittedly, this lady was kind of coming in as an underdog -- a wounded one at that.  But she literally stated four times during her presentation, "If you want to fight about this, I'm happy to debate."  In fact, her conclusion was, "So, that's it.  Now we can fight or you can ask me questions."  If it was a strategy to keep critics at bay, it certainly worked, because no one in the Q&A challenged her to any hard ball questions.  But, all in all, it probably didn't help her out that much because I think most people walked out of the room feeling like they had been accosted for absolutely no reason.  She had probably spoken to audiences of uppity physicians in the past in which this confrontational attitude helped (maybe?).  But this audience of industry reps, tech geeks, and a few lone geneticists, had no bone to pick with her.

It makes me think about tactics and techniques for presenting.  Last week I gave five presentations of varying lengths about a couple different topics.  My goal was to try and use a bit of humor at the beginning of each one to calm myself as well as the audience.  I was able to do it with varying degrees of success and ultimately felt like it was something I could "figure out" and use in the future.  But, then I started thinking about Tompkins and this whole idea of being natural, genuine and really interested in figuring out what it is that the audience (or the students) need to learn.  My use of humor was a technique, and definitely one that I would try to hide behind, rather than exposing any vulnerability to a group of people.  Sometimes it matches up with what the audience needs -- but other times, like with 23&Me's CMO, the technique completely misses the target and ends up exposing the gap between what the speaker thinks the audiences needs, and what they actually need.

Humor seems like a safer technique, but it's still a technique.  I'll be on the lookout for presenters who do it genuinely, not as a tactic, but as a way to expose themselves and show that all they want is to know thy audience.

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WEEK 9: June 1

So for this journal post, I believe we are supposed to consider what we would tell incoming BHI students about how to take advantage of their learning opportunities during this first year.  Coming up with some overarching advice seems pretty tough because I’d want to know a bit about the people to whom I’m giving advice.  At the graduate level, the experience and background of all the various incoming students is so different that, the things they need to know to take advantage of the BHI program are pretty different.  For example, I came in with more than average knowledge of medicine and biology, but was 100% ignorant of stats and research methodologies.  I felt that I was able to get much more out of my BHI coursework because I took biostats and epidemiology courses concurrently with them, giving me a really important perspective on how to generate, analyze and interpret data for the various informatics fields we discussed.  Yet, I realize others in our cohort were incredibly well versed in research methods, so it wouldn’t make sense to recommend they take these courses.  Similarly, some of us already have been through graduate school programs, while others were right out of undergrad, or even coming from industry.  So, we each had various work/study habits and skills.  I guess, if forced to provide a concrete piece of advice, it would be to reflect on what your skills are going into the program and use those to explore the topics that are introduced in class.  

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WEEK 8: May 25

The Weekly Reflections have been a good learning activity for me.  First, I think they were useful in that they require me to stop moving forward for a few minutes and try to remember what has happened earlier in the week.  Usually, I'm constantly keeping so busy that whatever happened two days ago might as well have happened in a past life.  Not only is it probably healthy to halt the drive to move forward occasionally, but I believe it takes advantage of the idea of spaced repetition -- revisiting an idea that I was thinking pretty intensely about two days ago, but have since stopped thinking about, really helps to solidify it as a concept that I can apply to new situations/conversations.  Spaced repetition has become a pretty hot topic in medical schools, because it seems to be an effective approach to all the memorization that students have to perform.  However, there's no reason it needs to be restricted to discrete datum, like lists of parasites or anticholinergics.  It seems like the weekly reflections take the idea of spaced repetition and apply it to broader concepts and 'qualitative' elements.

I'm imagining what it would take to try and keep up a weekly reflective journal during clinical rotations.  Seems like, on top of everything else (formal write-ups, readings, studying, complete exhaustion, etc.) that it would take a lot of extra effort to do these reflections.  Still, I'd like to try it, but considering the extra effort makes me want to be very clear with myself about what I'd want to get out of doing them.  Should I use it to remember patients?  To help solidify medical knowledge?  To decompress?

I'm nervous about using it as a personal journal because it seems like it could easily become amorphous like some crappy blog.  If I didn't have a good idea of what I was doing it for, I'm sure I'd lose interest pretty fast.

One thought that comes to mind is to use it to become a better writer.  Learning to write seems like a big task take on while learning to do doctor-ish things, but there seems to be a growing niche for physicians writing from the 'battlefront'.  I'm not too fond of the medical memoirs that have been popular of late, but I do have lots of respect for medical journalism like Gawande or Groopman.  I'm a long way off from writing at that level, but it'd be nice to have that style/format as a goal.

No conclusions yet, but it's something I'll be pondering over the next month as I transition into clinical work.

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WEEK 7: May 18

 These last few weeks of the spring are turning out to be a whirlwind of presentations that are providing lots of 'real-world' opportunities to implement the ideas we've been working on this quarter.  This past Saturday and Sunday, the high-school carpentry education non-profit that I run had two different fundraisers.  On Saturday, we were hosting twenty of some new, potentially big funders at a fancy dinner.  The next day, we had a larger community fundraiser that was less formal.  At each, I gave a presentation with a few other members of the leadership team.  The presentations were very different but each provided a chance to practice some good 'speech etiquette' and get some great feedback/insight.

On the first night, we created a 20-minute presentation that was similar in content to a TED-talk.  The goal was to inform people about our program, get them jazzed up about it, then ask them to support it.  We used a mix of personal stories, stories about our students, and some discussion about our educational model/theory (lots of "Transfer").  We had a great slideshow to go with it -- a friend of ours who develops slideshows professionally fine-tuned it for us, but he says the prototype we gave him was great to work with because there were almost no words and absolutely no bullet points (thanks Dave!).  At the end, we tied all the ideas together and made an "Ask" for a bunch of money.  There were three of us speaking and we each put a lot of effort into it with a number of group rehearsals and critique from another buddy who writes speeches for microsoft big wigs.  Certainly a nerve-wracking experience, but I'm told that we pulled it off pretty darn well.

The one piece of feedback that we got that was somewhat negative was that one listener felt it was "too scripted" and maybe "too rational".  We memorized a lot of the speech and weren't reading from anything - and we also practiced not sounding too machine-like.  But, I think that what our listener was getting at was that we had a very logical argument to the presentation -- very much along the lines of an argument that you'd expect in a scientific presentation or a TED-talk, just supplemented with some ooie, gooey feel-good stories.  I recall putting a lot of time into making sure the logic flowed properly and that our ideas all added up properly.  It only now strikes me that, for this type of event, maybe people don't want to learn a new idea or follow a rational argument, but really just want to jump from fun story to fun story.

That idea was partially verified at the next presentation.  The second one was way less formal, way less practiced and had no slides.  We kind of "winged it" by getting up and each saying a few main points to get people excited.  I spoke very vaguely (for my tastes) about a micro-housing project that will be doing for the homeless encampment, Nickelsville, and the crowd was really jazzed.  There was nothing scientific or rigorous about how I spoke, but we had nothing but interested people asking questions and buzzing with excitement afterwards.

Sorry this is so long, I guess the whole point that I'm getting at is going back to the idea we discussed about the role of presentations in the learning environment.  I just keep getting more and more personal evidence that presentations are best used to inspire, rather than teach or inform.  In our first presentation, we weren't really "teaching", but we were tryign to communicate the logic behind our methods, and I think we would have been better off just sharing the emotion of what we do.

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WEEK 6: May 11

I was out sick on Tuesday, so my comments here only apply to the speakers we saw on Thursday.  I thought both did a terrific job and that there were many interesting comments brought up about both.  The content of both was very compelling, which interesting reminder that part of presenting is not just in how you saying something, but also in what you say.  Makes me think of presenting the same way I think about writing:  You take care of all the little tics and quirks (or, in writing, dot your Is and cross your Ts) so that you don't distract your audience from the ideas.  Even though presenting feels more exposed, it still seems like a good job to get "out of the way" of the content so it can be addressed and critiqued on its own validity.

That said, there was still some good stuff to be learned about the practice of presenting from these lecturers.  We say that one needs to be passionate about the lecture she is giving, but the nuances of that are tough.  It's a fine line between being monosyllabic and dull to being overbearing and disingenuous.  I thought both speakers today managed to convey their enthusiasm for their topics very well, without seeming fake or staged.  I guess a lot comes down to tone of voice, which is maybe something that can be practiced.  I recognize that there will be times when I'm not particularly interested in what I need to present or to whom I need to present, but this largely seems to be a state of mind.  How can we continually find a way to be excited about what it is we need to communicate to the rest of the world -- even if the topic isn't earth-shattering or thrilling?  

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WEEK 5: May 4

Giving an actual presentation this week was a nice transition from pontificating to practice.  As expected, it was harder to do than say, and incorporating the many good ideas that have been circulating was a challenge.  Yet, all of the feedback given during the presentations was very poignant and helpful.  

I thought one that Dave made was kind of interesting:  that you fix one nervous tic just to reveal a new one.  I felt that keenly as, after the first round of presenting, I was very focused on not swaying and not saying "turns out".  While my attention was focused on those, I started doing weird gestures with my hands.  It reminds me of old cartoon clips in which someone is trying to stop water leaking from a fire hydrant, only to have the water spout out of somewhere else.  It seems like you could go on ad infinitum stopping up holes and creating new ones, but really the only way to stop the whole situation is by preventing the water -- or anxiety -- from building up.  I suppose that just comes from doing lots of presenting and feeling comfortable enough to keep the nerves down to a dull roar.

All the presenters this week were very impressive.  Seems like we all had different, small things that we could improve, but that overall the presentations were pretty solid.  Even though we were in critique mode, I noticed many positive things that others were doing that I wanted to try and incorporate in my own presenting.  The adage of 'if you want to improve, surround yourself by good people," applies pretty well to public speaking.

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WEEK 4: April 27

The focus on presentations this week was inspiring, as it made me think of them as something of a "lost art" in education.  I've sat through so many long boring lectures that I was overly committed to the idea of the flipped classroom, in which lectures are limited to online formats prior to an interactive class time.  However, in focusing on the ideas of this week, it made me recall the really amazing lecturers that I've been lucky to watch.  It furthermore made me question exactly what the place of lecture is in the ideal learning environment.

I'm still interested in the question I brought up on class of how to present on a topic that requires facts, details and memorization such that it doesn't lend itself to 3 big ideas.  I liked Dave's idea that lectures can serve to motivate someone, such that they go home afterwards and are willing to dig into the books and hunker down with the nitty gritty.  It reminded me of one of the few really progressive courses in the first two years of medical school, gastroenterology, in which lecture time was pretty much cut down to 30 minutes a day (most courses have 2-4 hours of lecture in a day).  That time involved the course directors in the lecture hall, in front of all the students, interviewing a patient with a crazy medical story or telling stories of their own.  The last ten minutes were an incredibly brief overview of the days major points, then the rest of the time was spent in small group sessions working through clinical scenarios.

Most of the other courses in the medical school curriculum that claim to be 'flipped' or progressive generally don't live up to much.  It usually means they assign a mountain of reading before class then have traditional didactic (and boring) lectures with a few quiz questions along the way.  Courses that utilize vodcasts prior to small group sessions are a little better, but seem lacking in the inspiration department.  

I'm mulling over this idea that the purpose of a lecture in an academic setting is to inspire and that its place is indispensable.  It doesn't mean we need to keep 50 minute lectures, but it means we shouldn't record them all as vodcasts and do away with the live ones.  I'm not coming to any conclusions yet, but I like how the preliminary idea changes my idea of an ideal learning environment.

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WEEK 3: April 20

This week was a combination of setting up a learning session and leading discussions.  These two topics are clearly tightly intertwined, as discussions are a very common technique used in contemporary learning sessions.  Indeed, the concept of the horizontal classroom has become so prevalent that courses without adequate discussion are deemed "flawed".  I've always found this to be somewhat difficult to deal with because discussions seem to have a very particular use in a learning environment, but we so often find them in situations where they don't make sense.

I'm imagining my biostatistics course that I took last quarter, which was structured in a very traditional didactic format.  There were slideshow-based lectures and then a "discussion" section once a week, but the discussion section was basically an opportunity for the students to ask the professor for clarification.  And quite honestly, the course was incredibly well taught and effective.  I wouldn't have wanted a horizontal classroom for learning how to interpret Poisson regressions.  There are certain topics and subjects that are fact-based and not really up for opinionated debates.

The problem for me comes when I start thinking that there must then be topics and subjects that aren't fact-based or theory-based that are well-suited for discussions.  When I ponder that idea, I don't really believe it's true.  I honestly can't think of a topic that doesn't have a foundation of knowledge or concepts that people could learn and know, rather than just intuit or feel.  There are certain skills that you develop in a discussion based classroom - such as listening to others, elucidating your ideas clearly, and tracking a conversation - but those could just as easily be learned at a bar with a pint of beer.  Why do we believe that those skills need to be practiced in the context of education?  My biggest fear about the rise of horizontal classrooms and the high prevalence of discussion-based learning is that educators are forced to do it because we have a culture of learners who think they need to be heard.

My volunteer life entails teaching inner-city high school kids carpentry skills.  When we first started the program, we wanted to highlight the artistic side of carpentry and let kids give input on structures and designs.  But, we quickly learned that when we opened those things up for discussion, kids were mostly quiet.  They needed skills, experience and familiarity with the basics before they could engage in any type of meaningful conversation about how something is built.  In a sense, I think we found that you just need to buckle down and build a dozen walls, and demolish a couple more before you really know what a wall.  Only at that point can you start to meaningfully "discuss" modifications, designs, and structural theories.

I'm all for students being verbal and engaging in grounded debate of a concept for clarification's sake, but I think those things can happen in ad hoc, Q/A-based, and short on-the-fly conversations.  I recognize that extended discussion has a place in education, but I'm not quite convinced that I really know what it is yet.  

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WEEK 2: April 13

The topic of this week's class was a mix of life-long learning, expertise and meta-cognition.  The discussion of expertise, in relation to the "How People Learn" text, was particularly interesting to me.  I recognized some of the language and ideas in that book from Jerome Groopman's "How Doctor's Think", which was clearly heavily influenced by Bransford's ideas.  What is really identified with from both books is this concept of pattern recognition that develops in experts.  I think about it in slightly broader terms, in which experts not only recognize patterns better then novices, but also details.

I spent a couple years after college working as an apprentice carpenter.  It was the first time I had done any significant work with my hands and I found it incredibly challenging in numerous ways.  However, one of the hardest things was trying to identify what was "good work".  I would work for hours on a cabinet, piece of furniture, or stair case and desperately want my work to be quality.  Inevitably, when I felt like I had finished, my boss would come along and point out all the imperfections I had left.  It was so bizarre, because I swear those things were invisible until he showed up and pointed them out to me.  To him, they were glaring errors, and when he finally brought them to my attention, I saw that they were glaring, too.  But, during the process, without the experience and the knowledge of what "perfect" would entail, I just couldn't see the details.

The lead contractor had been building for twenty some years.  When he walked into a room he could immediately point out shoddy work a subcontractor had left behind.  He could also rapidly identify how to fix or correct the shoddy work, making it blend in with the rest of the room.  I kind of felt like that was a type of pattern recognition - having seen ways in which things can go wrong so many times and haven't had to correct them just as frequently.

Carpentry was a particularly great way to expose the challenge of being able to see details or patterns as a novice, because it's such a physical, visual trade.  However, I can see how similar principles apply in writing, in medicine, in research -- really, in any field.  While I am sure there are practices of meta-cognition that one could carry from field to field to more quickly tune into these patterns, I still have a hunch that there is an element of time, practice and exposure that can't be translated.  There's a physical adaptation of the body that needs to occur -- possibly in the formation of certain neural networks -- in order to see, hear, or taste things with an expert appreciation for detail. If this is true, then carpenters, musicians and chefs can't skip the boringness of repetition and exposure (see below) that result in pattern and detail recognition.

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WEEK 1: April 6

This week in class we've been considering what it requires to be a lifelong learner.  We brought up some interesting issues of definitions and semantics, but I am going to temporarily forgo working with those because I want to start focusing on the practical steps towards continuous learning.  Whether we are talking about "learning" as digestion of content and information, honing of a physical skill, or awareness of one's existential situation, I suspect there are techniques and methodologies that can help us constantly explore, discover and associate.

In the "Seven Characteristics of Good Learners" article in Faculty Focus, I found the third statement particularly interesting.  The author suggests that lifelong learners aren't put off by the mundane and laborious nature of learning.  I appreciated this perspective because I feel that one of my challenges in learning a topic is staying focused.  Focus doesn't just entail a conscious selection of important vs irrelevant information/ideas/experiences, but also the ability to persevere on a task when it becomes boring.  Indeed, I would argue that ennui is one of American culture's strongest and most subversive values.

My upbringing was filled with forms of media that gradually trained my brain to pay attention to an idea for 30 minutes (with at least two commercial breaks).  Modern cinema feeds into the waning attention span of our culture by breaking shots every few seconds; long drawn scenes, which were traditionally the norm in film and theater, are now used for dramatic effect because they make the average viewer feel anxious.  Even our the teaching tools of late are adapting to the short attention span of learners -- TED talk speakers are given stringent training to ensure their pacing and slide progression is fast enough to keep an educated audience interested.

Despite this well-documented observation that our culture's collective attention span is dwindling, personal experience tells me that an important part of learning is sticking with a topic long enough to let it's nuances manifest.  Only when I'm completely fed-up with boring scales while practicing my banjo, and willing to stay with it just a little bit longer, do I discover a new element of subtlety: the slightest alteration in finger positioning changes the tone; a microsecond delay in the timing of a note makes the entire scale fit together; or raising my fretboard hand slightly higher reduces tiny squeals of the strings.  I've experienced this as well with more content-based materials, such as memorizing pathways of cranial nerves or antibiotic regimens.  It's so easy and fast for me to feel as though I've gotten an "adequate" understanding of the topic, but when I put in the time and put up with the monotony, I am able to connect with the material in a different way.

So, my reflection this week is this:  Is it important to face "drudgery" in lifelong learning.  And if so, why?