How
does my identity as a teacher align with the underlying value system that is expected
of a medical graduate and how and where are these values being taught?
In the last blog I tried to define a few values that I
thought were important for a practicing physician such as intellectual
curiosity, mindfulness and professionalism. The comments after the post got me
thinking of whether I agree with these definition or not and how I fit into the
picture an if these values can be taught and if so where.
I think Intellectual
curiosity is not different from critical thinking. Both ignite the same inquiry
process that leads to purposeful unknotting of the threads of a messy yet
structured ball of unsolved problems.
The first step of critical thinking for a medical students would
be identifying red flags in a given clinical cases. Where can we teach this and
how do I fit in? In the anatomy lab, before
an incision is made I ask the students to jot down any surgical scaring that they
notice. After which, I encourage the
group to contemplate what surgical procedure the patient may have gone through.
The only information they have about the “patient” is the cause of death. They
hold on to this information and then confirm their findings upon complete
dissection of that particular region.
In addition, more
often than not we see pathology, variations from the normal and even congenital
anomalies once we begin out dissections.
The resources they have are the books in the lab, internet and faculty
members. Using these resources they infer
the best plausible explanation for the condition. The group of students’, who
have observed this pathology/variation /congenital anomaly, are encouraged to
discuss their findings with the whole class. This guides the students on why it
is important to be observant and to confirm their observations with questions
or tests. As clinicians it is beneficial for the physician and to be observant
of every detail from the time a patient walks in present their case. The sooner the physician can connect the
various observations with the history the more efficiently a diagnosis can be
made. The lab allows the advantage of
taking a direct look into how complications of one organ can very often affect
structures and organs around them.
As my teaching philosophy inventory demonstrates I have a strong
apprenticeship and developmental perspectives. As a facilitator, I see myself trying
to channel the students to dissection by showing them the relevant of what they
are learning and the clinical significance of the same. As the result, learners are able to demonstrate and explain their
understanding; learning has indeed taken place1. Each dissection session has a clinical case
attached to it. These cases are discussed from history taking -to chalking down
differentials- to lab tests - to treatment and the case ends with the prognosis.
The cases reinstate a real world scenario to the findings in the lab; this I believe
makes the learning process authentic and deep.
Mindfulness is a
value that keeps our feet to the ground, our eyes fixed on the person in front
and our empathy is equal stride with the story presented. Mindfulness is being
aware and sensitive to our own challenges and the variations that exist in the society
via culture, gender, economical status and physical differences. We need to be comfortable
with were we come from and how we interact with others on a one to one basis.
In the lab, students are initially given time and space to feel and talk about
death, the concept of learning from a donor and this learning is accepted with responsibility,
respect and gratitude.
Probably the toughest part of being a medical practitioner
is death and dying. As young zealous and industrious first year medical
students are exposed to the anatomy lab; very often the feelings that overwhelm
them linger through their lives. In order
to address these feeling; on day one in lab we participate in a memorial
service. Students’ reflections from the previous year are part of this service.
As a nurturer, I pay attention to and take care of the students who are unable
to cope with their feelings. The most dominant teaching philosophy that emerged
when I did the TPI tests was apprenticeship.
I try my best to be mindful of the students’ state of mind and in the
lab make it very clear that the attitude of respect and gratitude is the least that
is expected of them. Thus learning in
the lab is all about the process and product of education; which in accordance to
the apprenticeship perspective is a definition of learning 2.
Professionalism as defined by ‘The Canadian stakeholders
Coalition on Medical Professionalism’ is in my previous blog. (The
Canadian Stakeholders Coalition on Medical Professionalism states:
"Medical professionalism describes the skills, attitudes and behaviours
common to those undertaking the practice of medicine. It includes concepts such
as the maintenance of competence for a unique body of knowledge and skill set,
personal integrity, altruism, adherence to ethical codes of conduct,
accountability, a dedication to self-regulation, and the exercise of
discretionary judgment. Professionalism is also the moral understanding among
medical practitioners that gives reality to the social contract between
medicine and society. This contract in return grants the medical profession a
monopoly over the use of its knowledge base, the right to considerable autonomy
in practice and the privilege of self-regulation.")
Do I agree that all of the qualities need to me procured
during the education years of a medical learner? Yes I do, but the other
question is, are all these qualities teachable in the anatomy lab? How can I
create the opportunity for the students to practice these values?
In the anatomy lab, the climate is that of deep learning and
respect. Students are shown respect and facilitators respect all human tissue
in the lab. This respect and responsibility is infused in to the culture within
the lab. Here students works as a group and learn to collaborate for a mutual beneficial
learning3. They present their findings and assessments as a group. I
try to bring in inter-professional interactions by calling in Physiotherapist
and clinician to assist in the lab. In the process, the students get to
interact with other professional and understand the different roles played by
the various professionals.
The teaching philosophies that emerge in the lab are that of
apprenticeship, developmental and nurturing.
1.
Ric Arseneau and Dirk Rodenburg; The
Developmental Perspective ,Cultivating Ways of Thinking; Teaching Perspectives Inventory,
Chapter 6 .
2.
Janice Johnson and Daniel D. Pratt, Modelling
ways of being; Teaching Perspectives Inventory, Chapter 5 .
3.
William J. Swartz; Using gross anatomy to teach
and assess professionalism in the first year of medical school. Article first published online: 8 MAY 2006; DOI: 10.1002/ca.20331
I think the first thing that stuck out for me was your statement that "Intellectual curiosity is not different from critical thinking". If intellectual curiosity is just a synonym for critical thinking, why not just use 'critical thinking'?
ReplyDeleteThe reason I bring this up is that as I read I felt that you were modeling behaviour to your students and encouraging them to be critical thinkers. If your students were already intellectually curious wouldn't they have asked the questions you posed themselves? I guess that the way I am conceptualizing intellectual curiosity is that it develops from engaging in critical thinking.
I really liked your post on mindfulness. It made me think that you are encouraging your students be engage in reflective practice and looking at their development as more than just technical knowledge and practical skills. This was rather inspiring to read. Thanks!
Nurturing is listed as one of your goals for lab and that seems to be a value you have also identified for your posed question.
ReplyDeleteCritical thinking and mindfulness I agree, are necessary attributes for graduating physicians. The critical thinking method of learning incorporates a willingness to experiment. The crux of the purpose in using critical thinking is that it teaches students how to think versus what to think. Van Gyn & Ford (2006, p. 11) state that the users take content knowledge and learn to make judgements "based on criteria, providing justifications for the conclusion, as applied to meaning, relation, empirical or value claims". That is exactly what physcians require in order to develop an accurate diagnosis and choices for diagnostic tests and treatments. Spot on, Anna!
Very nice. I, too, am struck by the equivocation of critical thinking and intellectual curiosity. And, like Jules, IC may develop out of CT, I have to wonder, too, whether the other way around makes sense. Are CT skills improved if, first, there is IC? Or, does IC improve our students' abilities to apply CT skills?
ReplyDeleteI wonder, too, which teaching perspectives are conducive to promoting CT skills, intellectual curiosity, and mindfullness -- and how if at all these can be promoted?
Very intriguing post, Anna!
ReplyDeleteIt may be possible to define intellectual curiosity and critical thinking ways that make them seem synonymous, but such definitions would probably be quite stipulative and prescriptive, and may be so far from their reportive definitions that they would be difficult to defend. For instance, it's easy to imagine someone who is intellectually curious but lacks critical thinking ability or aptitude. Small children come to mind -- they're often quite curious, but utterly lacking in critical thinking ability. If intellectual curiosity and critical thinking were the same thing, this would be impossible. Also, it's easy to imagine people who are critical thinkers but not especially curious. I've known many people who were quite sharp, skilled critical thinkers who didn't seem very interested in learning new things. Wouldn't that mean they weren't intellectually curious?
On the other hand, I think you're right when you say that curiosity and critical thinking can both ignite inquiry processes. While I agree that this is probably true, note that it doesn't mean they are the same thing, because one process can be the effect of any number of causes. Think about this in terms of etiology: we would never conclude that two people had the same disease merely because they exhibited one common symptom (how many things can cause a fever?). :)
The step-by-step account you give of your approach to clinical cases is quite interesting. To draw definitions out of it, generalize the characteristics of that practice that characterize critical thinking. What is it about what students do in this situation that makes it reasonable to call it an instance or process of critical thinking?
Your definition of mindfulness is interesting as well. It's quite broad. I would have liked some details regarding its defensibility -- such as how you determined whether it met the necessity criterion, sufficiency criterion, etc. I still need time to think about it, but knowing your process would be helpful!
It isn't so important in our context whether or not you accept the CSCMP's definition of professionalism. What really matters is whether it's defensible, reasonable -- in other words, why you accept it, and why it sought to be accepted. This is one place where claims and definitions need to be evaluated.
Lots of food for thought here, Anna. Thank you!
That should have been "one effect can have many causes". I need to proofread!
ReplyDeleteHi Anna,
ReplyDeleteI enjoyed your post.
You spoke my language in the area of mindfulness. I was particularly interested in your comments about the students feeling overwhelmed in the lab first day and your role as nurturer for those 'unable to cope'. I was intrigued by the memorial service. I wondered about the whole environment and the students feelings. Death and loss can evoke such strong feelings within people and I was wondering about the dualist position that may put some of the students in. Here they are, medical students, with a strength in science. I am making an assumption here that many may fall within a positivist paradigm, the expert, one truth, discovered by scientific objectivity. Yet, I am being influenced, potentially by my feelings and feelings are not objective. How the students navigate those potentially different or opposing positions would be interesting to know.
Beth