I was back on the wards today. It was pretty busy in the hospital over the weekend as usual. Mondays are almost always days when psychiatry consultations are pretty heavy, and Fridays are about the same. I got 2.3 miles and 17 floors on the step counter today.
I’m trying out adjusting my exercise and mindfulness practice—mindfulness in the morning and exercise in the evening. Since I get up pretty early anyway, I tried the yoga this morning and after the day was done, I did my exercise routine. It might be hard to stay awake through sitting meditation tomorrow morning. We’ll just have to see how it goes.
In my off-service time, I’ve been trying to work on cooking—sort
of. I’m fair at best even with frozen pizzas. That’s a shame for someone who
used to make pizza.
Home-made pizza I made–not that long ago.
I’m just OK with microwave popcorn. On the other hand, I managed not to ruin Jiffy Pop popcorn. Remember that?
As I get ready to go back on service at the hospital as a
psychiatric consultant, I’m trying to get my head back into the game by reading
papers like Psychiatric News. The March 15, 2019 issue (volume 54, number 6) has
an interesting article about how medical students are learning these days,
entitled “Wright State Adopts Curriculum Without Lectures,” written by Mark
Moran. You can easily access this article on the web for free by just searching
with the term “Psychiatric News.”
The article mentions the pathology textbook, Robbins’ Pathologic Basis of Disease. My
class used the nearly 7 pound red 3rd edition containing 1,467 pages.
This book is hailed as an outstanding foundational text, which it is. Dr Stanley
Robbins has been eulogized as an exacting editor who championed writing of the
type espoused by Will Strunk in The
Elements of Style.
Not to be picky, but the book contained the phrase “not
excessively rare” in reference to some process or disease which I can’t recall.
I do recall that a majority of our class howled about this verbiage, which
seemed the antithesis of what Strunk tried to teach.
Robbins book is described as “dense” in the article. It’s
probably still pretty tough to wade through. I admire any medical student who
can teach peers about its contents using only a study guide. I saw a used copy
for sale a few years ago in a bookstore in Madison, Wisconsin.
Wright State University is using Team-Based Learning (TBL)
which allows medical students to teach each other in small groups. They prepare
by reading on their own about topics and come prepared to teach their peers who
participate in discussions. This is thought to promote a better way to promote lifelong
learning and to be more effective than the lecture style—which is how I
learned.
Another point in the article is that the lecture-based
approach is pretty inefficient, which is true in my opinion. I remember it
often resulted in poor lecture attendance and cramming before exams. It spawned
the sometimes-controversial Note Service (which I think a lot of medical
schools had and may still have), in which class members take turns taking notes
in lectures, which are then cleaned up and distributed to the rest of the
members of the class who sign up for the Note Service.
Wright University also has a problem-based learning exercise
in which small groups discuss a clinical case with a faculty facilitator.
Students come up with learning objectives, search the medical literature, and
then present to each other about evidence-based approaches to real-world
clinical challenges which physicians encounter in practice.
It turns out this problem-based learning method is not really
new and not excessively rare. It happens to have been the approach used by one
of my teachers during my residency rotation through the consultation-liaison psychiatry
service. It was eventually called Clinical Problems in Consultation Psychiatry
(CPCP). I continue to use this model, although general hospital psychiatry has
gotten very busy over the years, making it difficult to do regularly. Medical students
and residents have given many outstanding CPCP presentations, often using
PowerPoint slides and generating stimulating discussions. The video below is an
example to give you the idea of one component.
And this post reminds me that the phased retirement process involves periodically flipping between my work identity and my retiree identity. I suspect this experience is not excessively rare.
Yates, W. R. and T. T.
Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen
Hosp Psychiatry 18(3): 139-144.
Problem-based learning (PBL) is a method of instruction
gaining increased attention and implementation in medical education. In PBL
there is increased emphasis on the development of problem-solving skills, small
group dynamics, and self-directed methods of education. A weekly PBL conference
was started by a university consultation psychiatry team. One active
consultation service problem was identified each week for study. Multiple
computerized and library resources provided access to additional information
for problem solving. After 1 year of the PBL conference, an evaluation was
performed to determine the effectiveness of this approach. We reviewed the
content of problems identified, and conducted a survey of conference
participants. The most common types of problem categories identified for the
conference were pharmacology of psychiatric and medical drugs (28%), mental
status effects of medical illnesses (28%), consultation psychiatry process
issues (20%), and diagnostic issues (13%). Computerized literature searches
provided significant assistance for some problems and less for other problems.
The PBL conference was ranked the highest of all the psychiatry resident
educational formats. PBL appears to be a successful method for assisting in
patient management and in resident and medical student psychiatry education.
Go Retire Psychiatrist 