I actually wrote this last semester; some of the references are to events long past. The gist remains relevant:
Today I left pharm class a bit early to make the drive to Clinton, Indiana, where I was scheduled to give a short presentation to a group of senior citizens at the Clinton Senior Center.
My presentation was part of a series titled “Dine with Doc” which I think I mentioned at some point in the spring or winter blog entries last year. Created by a local individual, it provides access to doctors in an informal setting for educational presentations followed by q & a. Our campus of IUSM had agreed to work with the organizer to provide volunteer speakers from among the medical students, and MSII Tyler Fromm has been the student contact. I had originally discussed with Tyler the possibility of speaking this past June, but a miscommunication lead to my presenting today.
I thought a good topic would be the positive effects of exercise and activity as people age, with the meat of my information based on articles I had recently read;
These two articles had inspired the topic, so I was looking forward to meeting the group and sharing some information that might give them an approach to the usual loss of muscle and cognitive function we associate with aging.
The drive up takes about 25 minutes through almost immediately rural Indiana, and the day itself was bright and sunny. A hint of the coming fall color was playing around the edges of the tree canopies, so I thoroughly enjoyed the journey. The Senior Center is a compact structure with ample parking in an almost park-like setting, and finding it was simple enough. I was greeted warmly as soon as I entered, and after a brief introduction that certainly flattered my ego, I launched into the material. I had not had time-I thought-to commit to memory my speaking points, so I apologized for reading directly off the page. Of course, I hate to just read things, so almost immediately I began ad libbing the material, referring to the written word only now and again, just enough to catch my breath and get a chuckle from the group as they saw me realize I had covered the topic.
My familiarity with the material stemmed primarily, I realized only after (when I was debriefing with my wife), from the fact that I had been ‘preaching’ it to my parents for the last few years, and the recent articles only reinforced my beliefs. Not very science, but it’ll work in a pinch.
The gist of my presentation, was that exercise CAN build lean muscle mass in the elderly, and improve general health conditions both physical and mental, and actively challenging your brain stimulates measurable neurogenesis in the brain structures associated with spacial relationships as well as emotion and reward and memory. I feel strongly this message is not communicated enough to the senior members of our society in a way that they can use practicably. So part of my spiel was to encourage creative problem solving and teamwork. So that if you can’t afford a gym membership, then get together with friends and do something that is physically challenging and maybe even fun, and try working out in pairs so that you can help each other. Look for ways to get the resistance training that seems so important. I recalled the antique irons my grandma Brack had on the floor in her kitchen-they only weighed about 5 to 10 lbs each, but they would certainly serve in the stead of a dumbbell for someone on a budget. One basic concept I explained was that if you only did your normal routine everyday, you would effectively see a slow progressive loss of strength and energy as you went on aging. It is imperative that some time is devoted to activity that goes beyond normal routine, to challenge the body and mind.
My presentation was followed by a number of questions and several of the audience members spoke up about their own experiences which seemed to reinforce my basic message. I especially enjoyed the story from the woman who trained herself to put on full-length hose without using her hands. What a trooper.
We had our annual visit from the Indy Deans yesterday, and made good use of the opportunity to discuss various programs. I think everyone would agree that education in general, and medical education in particular, is in a state of flux as we all wrestle with new technologies, new budgetary realities, new philosophies about what should be taught, etc. As Dr. King explained last year in Biochem, for example; when he began 20 some years ago, they were focused on teaching the chemistry “mechanisms” which have little if anything to do with clinical medicine. For him it was an unnecessary waste of time when there are so many other more relevant aspects of biochem to learn. Of course, even back then you could probably ask a practicing physician how much they used those mechanisms, and they would have laughed and said they couldn’t even recall what they looked like; but that is just what you had to go through to become a doctor.
We would all like to think that the days of teaching things because they had always been taught, rather than because they were relevant are long behind us. Most professors will acknowledge that 1/2 of what we are learning today will likely be disproved in 10 years (perhaps hyperbole). Medicine is a moving target, and even when you are given an answer, your first responsibility as a student is to understand why it is right or wrong based on the best information available. Our tests in fact are for the most part based on the concept of “what, of the following possible answers, is more correct”. Our ICM II class faced this recently when we completed a 50q take-home exam on the gastro-intestinal system (GI).
Using a variety of sources it quickly became evident that in medicine today ‘more correct’ is relative to the source of info. What we usually settled on as we completed our work in various groups, was that the best answer was the one someone argued most reasonably, or conversely,with the most energy, when the lack of a definitive answer was apparent.
But when it comes time to be scored, the best answer is the one provided by the source, and though it has not been an issue on this particular exam, at times any attempt to discuss the logic or correctness of a question isn’t met with resounding encouragement, but rather is perceived as an attempt to ‘claw back’ points.
Perhaps my perspective is off because I am so “old”, but in my mind, I am in a partnership with the faculty. One where the right answer isn’t always the one provided as standard issue. We have a responsibility to challenge the faculty to teach us, especially when the process is in a state of flux, where ‘right’ answers aren’t so obvious, and at times changes to curriculum need to be suggested or encouraged.
In a recent online test we took, we were told up front in the test explanation that even expert clinicians will only agree on diagnosis or treatment 80% of the time. But our testing methods emphasize without fail “most correct”. Of course you have to have some metric for assessing progress with material, so ‘settled’ answers have become the norm. I think one thing that is forgotten at times, though, is that even on the USMLE tests, some of the questions are experimental, supplied to see how students interpret them, to see if a majority will consistently arrive at the same conclusion, given the same features of a situation. In other words, is it a good question? In the average classroom, this also occurs, and professors are at liberty to ‘give back’ points if they see a particular new question stem is not working. But not everyone uses this evaluation process, and given that most medical school professors don’t have degrees specifically in “education”, it is inevitable that occasionally bad questions creep into the tests. Which brings me back to the point, that as partners in this educational process, we have an obligation to bring up such issues, so that those who follow behind us will benefit from our experience as guinea pigs. But this only works if both sides recognize the role each has to play. And I think that is why the Deans visited with us yesterday, to survey our opinions about the state of medical education on our IUSM campus and place our responses in the context of the statewide system. From the sound of things, much work is being done to ensure that IUSM remains one of the top programs in the world. I like the sound of that, even if the reality is a little bit messier.
