half-baked idea: weekly conversations with patients

Adam Grant

This half-baked idea is inspired by this great NYT article, "Is Giving the Secret to Getting Ahead?" It's about Adam Grant, a Wharton (Penn business school) professor that is the youngest tenured professor at Wharton, but is better-known for being helpful and giving. His students love him for the career advice he doles out and the connections he's glad to set up. 

One of Dr. Grant's major research interests is the idea of motivating humans. He developed this interest at the University of Michigan where he was an undergrad, and he worked at a university fund-raising call-center. The job is known for being taxing and boring, but Grant desperately wanted to figure out how to increase production. His solution was to bring in students that had benefitted from the call-center's funds. Every week, a different student came in to share stories of being first-generation college students that saw the scholarships as a once-in-a-lifetime opportunity to attend college, stores of being elated to pursue a humanistic post-college path like Teach for America because they weren't drowning in student loans. As Grant predicted, productivity almost doubled.  

That constant motivation is the same underlying idea that drives the incredible success of institutions like Alcoholics Anonymous. The secret behing AA is not that they have an incredible message, it's that they keep you coming back every week, and they keep giving you just enough motivation to keep at it for another week or another day or however often you attend meeting. AA constantly replenishes your motivation to achieve the goal of staying sober. sidenote - In my opinion, this is one of the top reasons for organized religion, but that sounds like a topic for another day. 

So how does this come back to med school? 

One of the frequent complaints I hear from med students is, "I'm just not motivated anymore." The first week or two of a block aren't bad. Most of us had a weekend or a vacation to spend some time away from school, doing whatever we do out of school, and coming back refreshed. But that motivation juice doesn't last long, soon we're falling behind, and we're growing increasingly sick and tired of studying. sidenote - one of my philosophies with physician burnout is that you have to minimize the time you study while you're absolutely sick and tired of it. Sometimes when you study, you feel productive, and it's going great. This is a good time to study. Then, there are other times when it's an absolute struggle, you can't focus, and you find yourself hating yourself more and more after every slide. The more time you spend studying in this second "hating-your-life" zone is when you're creeping towards physician burnout. 

Med school is no different than the university fund-raising call-center. We need constant motivation. So here's my half-baked idea: Why not have patient/ex-patient volunteers from the hospital speak to students every month? 

They could give a glowing talk about what great care they received in the hospital, and how amazing their doctors were. Actually seeing the patients in real life, talking to them, and remembering why we got into this whole mess in the first place would be a great way to stay motivated and prevent physician burnout. 

I can just imagine it. Do you guys remember the first lecture of the year, when Dr. McEvoy showed a picture of her daughter Ansley that had leukemia? What if he took it a step further and brought her in to chat with the class about how much she loved her doctors?

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

half-baked idea: mentored day off per week

I threw out a half-baked idea last week about taking a mandatory gap year between undergrad and med school. Part of the motivation for the gap year would be to help med students develop passions. Here's a second half-baked idea to go along with it. 

Half-baked idea: Mentored day off per week. 

I'm sure I don't need to sell med students on a day off every week, but hear me out. 

the hub

Stanford, probably the best at innovative med education is already on this train. They give their students every Wednesday completely off from med school obligations. sidenote - Palo Alto would be one of my top career destinations if not for the cost of living. Absolutely insane. One of my friends did an away rotation there, and he told me his attending rented a house there because he couldn't afford to buy. I can't remember what specialty he was in, but the average doctor makes six figures easily. Probably looking at $200,000+ per year. And he couldn't buy a house... Durham or St. Louis it is.

Anyways, back to Stanford. When I unsuccessfully interviewed there, I met a student working on an Immunology PhD, another that tutored undergrads in anatomy lab, and I heard of others that took literature courses at Stanford undergrad. sidenote - Abraham Verghese (Cutting for Stone, Tennis Partner, My Own Country) teaches undergrad writing courses at Stanford. Would love to take those classes.

can I just hang out with you?

I love this idea of giving students free time, but let's face it. Do I have time for this? No. I have to figure out what the hell a uterus is. I have IP assignments to do. 

Med students are busy. If I had one day off from class I'd definitely just study more. So here's the added caveat for the day off -  meeting with a mentor. sidenote - Atul Gawande wrote this great article about the need for coaches in medicine. 

At MUSC there are 280 faculty members in the dept of general medicine, 100 in the dept of surgery, 160 in the dept of peds, 240 in neuro/psych, and 30 in ob/gyn. Between those 800 diverse faculty members, we could assign each med student to a faculty mentor. Every incoming student would choose one of these specialties, undecided students will get thrown into general med, because statistically the most students will end up there. 

We could even add niches like doctors interested in working with minorities, teaching on the wards, writing and interweaving humanities, using social media to reach the uninsured, being pregnant while in med school, you can use your imagination. 

So every Wednesday during the school year, the student and faculty mentor would meet for 30 minutes to chat over coffee and break down life. They'd mainly focus on what they're doing with their Wednesdays. It would double as career mentoring and therapy. The faculty mentor would decide if the student was doing a satisfactory job of meeting the 'Wednesday' requirement, which would be a given. 

rosie

And what would students do on these Wednesdays? Well, here's one half-baked idea within a half-baked idea. Rosie Taam, from my small group, took a gap year and became a yoga instructor. Wouldn't it be a cool way to develop as a doctor to teach something 'alternative' as yoga? I always wondered how she could work this into her life as a physician, and on Wednesdays she could keep teaching yoga one day a week and develop a vision to weave yoga into her practice. What if she ran a private practice where she taught a yoga class to her patients? I guarantee there would be a patient population and investors interested in backing that practice. Why shouldn't med schools be helping students come up with ideas like this? 

If nothing else, it just seems like a good idea because a lot of us young med students are confused. I bounce between interests in specialties every five minutes. I also want to have a family, and would love some advice from older doctors. Doesn't it just make sense for us young confused people to have contact with established slightly less confused older people?

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

half-baked idea - mandatory year off between undergrad/med school

Back in 2005, the NBA agreed to scale back the influx of high school players by setting a mandatory age limit at 19 and requiring that players be one year removed from high school to enter the NBA. Players don't have to attend college if they don't want to, some players go for the D league, others like Brandon Jennings go ball for a year in Europe. 

This rule makes total sense. What 18 year old is prepared for a biweekly paycheck in the tens of thousands? 

Stan Van Gundy rocking a Dwight Howard Loyalty shirt, priceless

You can't tell me that Andrew Bynum wouldn't have benefited from a year or two in college. Not everyone is LeBron James and physically/mentally prepared for life as a professional basketball player. I know I wasn't anything close to a functioning adult at age 17. 

So here's my half-baked idea: Let's put two requirements on med school education - applicants must be age 22 or over, and have a bachelor's degree before submitting the AMCAS. This would force undergrads to take at least a year off before beginning med school. 

I have a hypothesis - students who came straight through college have a higher average MCAT, higher undergrad GPA, and better CV's than students who took time off after college. They're better med school applicants, and I would assume if you compared grades you'd find that they are better med student. Except, here's the problem: they've never had time to think about their life and evaluate what they want from it. They've spent their whole life running down the track of academia - getting good SAT scores in high school, entering college knowing they were smart enough to declare pre-med as their major of choice, knocking out biology and chemistry classes, and before they knew it they had an MCAT score that was good enough for med school. But do they know what med school entails? Aren't there handfuls of students that ended up in medicine that don't want to be there?

The short answer is yes. At least half the times I've told doctors about how I want to be a doctor - they ask me to reconsider. It's not what you think. It's not like what House or Grey's Anatomy. It's a lot of paper work. My patients are all old and hate me. You don't know what you're getting into. 

Why are docs giving me this advice? Well, one possibility is that they wish someone had told them that twenty years ago, when they were at the crossroads I'm at. Maybe they've just been at gogogo speed on the academia-biology-premed-medschool track for years without half a second to re-evaluate their values in life. 

hey guys, I know I've only been here for
a few months but, just give me the damn ball

NBA sidenote - let's take the Rookie of the Year conversation - the leading candidate is Damian Lillard. DL is the starting point guard for a surprise .500+ team. He leads rookies in points, assists, and minutes. He went to four years of college, and carries himself with swag. He's the only rookie to hit a game winning shot all year. 

Lillard talks a lot about his time in college in this great interview. He faced his first serious injury - a broken foot - nine games into his junior year. It forced him to take some time to re-evaluate his game. He religiously studied film of elite guards like CP3 and Westbrook. He came back from his injury stronger than ever. He had a career year that launched him into a lottery pick. His coaches kept pushing him to be better and better, and Lillard thrived under the attention as the leader of his team. 

What 18 year old basketball star ever regrets going to college? You're the big man on campus, go to tons of parties, dominate every basketball game, and have a ton of time to develop your skills while hanging out with a bunch of other guys that love playing basketball? 

Now, here's 3 reasons why this would be great for med students.

1) Maybe this would give them a chance to slow down, if only for a year, and figure out if this is really what they want. I've had friends that went down a Teach for America path and decide that all they wanted from life was to reach young people through teaching, and it wasn't worth it to them to spend hundreds of thousand of dollars in loan money, not to mention the better part of a decade in training. I've also had friends that spent some time on a Teach for America path, and realize what they really wanted to do was medicine. They came back more passionate than ever, prepared for whatever medical education put in their way.

2) How many people do you meet in med school that are boring? All they do is numbly go through the day-to-day - study, work out, get blitzed on the weekends. One of my theories is that the world would be a better place with more passionate, interesting people. The year off would be HUGE for that. Future doctors could spend it discovering passions that correspond with a career in medicine. Or maybe they could just add a hobby like fishing that could keep them sane. Or they could get married. 

3) It's common knowledge that physician burnout is a huge problem. Think a year of rest would help? Yes. The answer is definitely yes. 

I dare you to tell me why we shouldn't do this. 

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Math > Mayans: a Nate Silver Book Review

The Mayans came out with the bold prediction that the world would end two days ago.  For better or for worse, the Mayans were full of it, and we're all still here. But according to the hottest thing since sliced bread - Nate Silver - we shouldn't be surprised.  

If you've never heard of Silver - he hit it big for using math to predict the election.  Before that he developed one of the top major league baseball forecasting systems - PECOTA.  And before that he was a professional online poker hustler.  Silver's recent book The Signal and the Noise: Why Most Predictions Fail - But Some Don't is all about his specialty - predicting.  The thesis: predicting is hard, but some things are easier to predict.  For instance, Silver analyzes earthquake predictions and weather forecasts - while the computing industry has allowed weather forecasters to take leaps, earthquake hunters still have miles to go  

While Nate Silver is definitely a bonafied genius.. he's not quite an original, more like the remix. He's the same genius as Bill James and the Moneyball crew that first applied mathematical analysis to baseball.  He's the same genius as the guys who decided to infuse bioinformatic analysis to biomedical research.  Silver was simply the latest to add a splash of math to a field in desperate need of it.  

So my question is: how can we apply the same genius to medicine?

to be fair, it's not like airplanes
have advanced much either

Here's one of the main reasons I think med school education is outdated.  We need a clearer definition of a good doctor.  Since our current definition is utterly vague, med students are left with the same training program that educated doctors in the era of kitty hawk.  

In track - you have the goal of running as fast as possible.  In order to do this, you don't just run around in circles randomly.  You run according to a rigorous schedule, each day with a set purpose.  One day might be optimizing VO2 max, another increasing lactic acid tolerance, and yet others to train neuromuscular junctions to fire optimally.  It's a real science.  

We need to get med school education to that same point.  Once we have a scientific defintion of "a good doctor" it'll become a lot easier to figure out how to educate "a good doctor."

I bet you thought we were just
running around in circles

So this is where it gets hard - quantitatively defining a good doctor.  What sort of stats should we be keeping on doctors?  I don't have any good ideas, so instead here's a list of half-baked ideas Kevin Wildes-style.

1- (%age) times washed hands per opportunity

2- # of times yelled at a nurse per shift 

3- total amount of shit other doctors talk about you (respect of co-workers)

4- triathalon time (endurance is important)

5- miles walked per shift (shows commitment and effort..?)

Anyways, please send your half baked ideas my way.  I need to incubate some more ideas.  

See you on the other side,

from ken

now taking requests for future blog posts. please comment or email.

Insane in the Sarcolemma: test week #2

So we just started test week #2 - musculoskeletal aka f-load of anatomy.  For non-MUSC readers, before every test we get a week off from classes and small group discussions to focus on studying.   I thought the last study week was crazy.  [link to test week #1]  Turns out that was only the beginning.  

don't waste your time

The last test went well - the class average was an 88.  That block was mostly a review of undergrad, but this musculoskeletal block has been completely different.  The material is almost all new, and there's a TON of it - one of my friends estimated 650+ powerpoint slides of anatomy - slide after slide of muscle, nerve, bone, ligament, artery, repeat.  It's hard to describe how hard it is, but I consider myself a fairly intelligent guy, and I've had to wake up at 5 AM just to cram in enough time to study.  And I just scored a 40% on the metabolism self-assessment.  

In a sense, this was the block med school got real and lived up to the hype.  It definitely got hard.  

exactly how I feel

But.. how real is it?  Anatomy seems pretty useless, although you could maybe sell me on it - I guess we should understand the structure of the body.  On the other hand, I'm about 200% sure glycolysis has nothing to do with being a doctor.  Personally, I want to be a cancer scientist - and glycolysis/TCA cycle/oxidative phosphorylation is even meaningless to me.  Sidenote - I'm pretty sure the Warburg effect is controversial, which isn't surprising considering Otto Warburg came up with it 50 YEARS AGO.  I would not be happy to see it on an exam of modern science.  Anyways, It might help to have a general understanding of metabolic principles - but to know the exact name of each enzyme?  Absolutely useless - just wiki that shit.

So why do we learn this?

Maybe we're trying to develop a crop of doctors that's planning to dominate bar trivia - I swear my classmates would be the top 160 trivia masters in Charleston.  We are REALLY good at memorizing facts.  But if any of you have complaints about your doctors not spending enough time with you, or not having a human side - don't hate the player, hate the game.  I'm surprised any doctors come out of this training system with a lick of humanity left in them.  

But anyways, here's my simple answer to why we're trained in this outdated style - because the class of 2015 learned it, and the class of 2014 learned it, and the cl...  It's the status quo.  But is producing trivia robts really what med school should try to accomplish?  Do patients want robot doctors?  Should students be investing $200,000+ in loan money for this?  Don't we deserve to get training that will actually help us be better doctors?  

See you on the other side,

from ken