Thursday, August 25, 2011

Let us reinvision institutional norms instead of simple reform

"In 2000, the British psychologist James Reason wrote that medical systems are stacked like slices of Swiss cheese; there are holes in each system, but they don’t usually overlap. An exhausted intern writes the wrong dose of a drug, but an alert pharmacist or nurse catches the mistake. Every now and then, however, all the holes align, leading to a patient’s death or injury. "

This quote is from The Phantom Menace of Sleep-Deprived Doctors which was published in the NYT magazine earlier this month. I finally got around to reading it today.  (dearest gf: sorry for letting it sit in my inbox so long)  I also happened to stumble across this video today, which is an awesome visualization of a powerful speech given by Sir Ken Robinson.  Read then watch, or watch then read.  Let the two sources simmer together in your brain.

When watching the video all I could think about is how relevant the issue is to medical education.  The standardized testing, the individualization, the pacified boring lectures- yep, that sums up my last 2 years.  Sure, schools now are going all out to include group sessions, simulation centers, case-based education; butt it isn't enough.  Overall though, they are still working within the old system of education, still limited by the boxed in ideology of our forefathers.  There are schools, programs, that are drastically different such as the Program for Integrated Learning (PIL) at Drexel, but they are few and far between.

Looking at the article in collaboration with the video, it illuminates the undertone that drastic change is needed.  Passing new work hour regulations may be helpful but it is not actually addressing the underlying problem and is actually causing all new problems with hand off.  So now the powers that be need to formalize hand-offs, need to expand the length of residency programs so budding doctors can see all they need to, need to come up with night-time formal curriculum so that those on extended night float don't miss out... and the list goes on.  But will filling these holes really solve the problem?  Or will it just expose other holes that already exist in the system and create new ones?

I'm enamored by medical education. This interest fueled my decision to do my clinical years at my school's satellite site.  We're learning in a new model, one that involves more kinesthetic and team based learning, one that reads more like an apprenticeship than traditional 3rd year clinical rotations.  This out-pouching of our medical school also challenges us to be non-traditional, to think outside the box, and to come up with innovative revisions to the medical community in this city. 

From being at the satellite site, from watching the video, and reading the article, I'm inspired to think outside the box.  I hope that others are too and that we can collaborate to create tangible change in the future. I want to challenge more divergent thinking for those involved in medical education, that is if they (if we) can tap into our inner-kindergartner.

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