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2013 QUARTERLY ISSUE 2

The Rossi MED ICAL ED UCA TI ON NEW S, RESEAR CH RE VIEW S, TEAC HIN G TIP S ,

CON VER SA TI ON S W ITH ED UCA TIO N LEA DER S

Interview with Dr. Basil Hanss A Teacher of Teachers and Distinguished Scientist Alexa Mieses

Basil Hanss, PhD is an Associate

Professor in the Department of Nephrology

and an Associate Dean in the Division of

Biomedical Sciences. He also oversees the

Humanities in Medicine (HuMed)

program, and is the Associate Course Di-

rector for the first year Physiology course.

In addition to mentoring graduate and

medical students, Dr. Hanss also provides

support and mentorship to faculty.

Despite Dr. Hanss’ very busy schedule,

The Rossi editor, Alexa Mieses, had an

opportunity to sit with him to discuss his

career and medical education.

What set you on your path to becoming

involved in medical education?

I started getting involved while I was in graduate school. I was a PhD stu-dent in physiology and they needed tutors

to help the medical students who were struggling in physiology.

What is your philosophy on curriculum

design and teaching? The basic philosophy I have is that teaching is all about a logical sequence of events and that logical progression of thought is what you need to provide students with, so they can anchor the information as much as possible. That is the foundation of it—building a concept from not understanding at all, not being exposed to it, all the way to understanding the concept and the surrounding details we need in medical school. In terms of the bigger picture of curriculum, you take the information provided in lecture and reinforce it with as many teaching modalities as you can. If a major concept is presented in lecture, it

� MEDICAL EDUCATION RESEARCH CORNER: CRITICAL ASSESSMENT OF RECENT LITERATURE ... 8

� INTERVIEW WITH DR. BASIL HANSS (CON’T)

............................... 2

� FIRST GENERATION SCHOLARS: A STUDENT- RUN PROGRAM ........... 5

THE ROSSI GOES LIVE ONLINE The Rossi articles are featured on blog.mountsinai.org Read articles online and join in on the conversation today.

Icahn School of Medicine at Mount Sinai

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should be reinforced as much as possible in other ways like clinical presentation or in problem solving sessions or in laboratory exercises. That way, you have the student look at the same con-cept from as many different angles as possible, and all of those different angles should provide the student with a firmer grasp of the concept.

Over the years, what has been influential to

your philosophy?

I think just being aware of what hinders students, being conscious of what they are strug-gling with, and trying to come up with as many different ways to explain a concept and from multiple angles. That correlates to explaining it with these different modalities. I think part of my philosophy stems from courses where I struggled in school. If I struggled with a specific class, it’s because I couldn’t see it in my mind’s eye – I couldn’t see the concept. And if I had a teacher that was just going at the same concept over and over again from the same perspective, it didn’t help me at all. So it’s important to present the material in a multitude of ways.

Was there something throughout your own

education and training that worked especially

well for you, that stuck with you over the

years?

I learned eventually that I was a visual learner. So what I had to do was take a concept and either make a figure or make a flow chart out of it. If I could reduce concepts to that, a single figure, then I would understand it. That’s what I learned helped me a lot.

Do you have any advice for students who want

to become more involved in academia or

medical education? For medical education specifically, I think you need to teach as early on in your train-ing as you can. Get involved early in teaching so that you’re developing your teaching skills while you’re not necessarily facile with the material yourself. You can use your own uncertainty about the material to develop your own teaching approaches. It’s hard to start teaching when you

have such a great grasp of the material. You don’t necessarily see where students are going to struggle with the material, so starting to teach very early on is important. I think another important point is to be observant of your students. If you take the time, even during a lec-ture which is sometimes hard to do, to look at the students and see what their posture is, see what the expression on their faces is, you can see whether they are confused with the material and you can make adjustments on the fly to fix that. Just being conscious of your students and the language they’re giving to you, spoken and unspoken, about how they are perceiving the material, makes a big difference.

What are some of the changes you hope to see

instituted in medical education at Sinai and

beyond? What are some of the ways you think

we can improve the way we teach medicine? It’s hard because I think the struggle right now is the sheer increase in volume of material, and how do you incorporate all these new disciplines while maintaining the core

knowledge. There can be a real struggle between using the time to teach in the classic traditional disciplines and the new disciplines.

Do classic disciplines refer to prototypical

medical school classes that provide the

foundation for the rest of a student’s career,

and new disciplines to cutting edge

information that may be applicable in the

future?

That is exactly right. It is a little bit easier when you’re thinking about techniques and technology concepts. I think that there are clearly certain courses that some teachers think need to be streamlined or maybe even cut out. There is also a big discussion about what can or should be shifted to the undergraduate level. Are there things we are teaching that are occupying curriculum time that should be moved into a pre-requisite? For instance, everyone has had the Krebs cycle since high school, maybe even grade school. How much do we need to, and I’m not

“Get involved early in teaching so that you’re

developing your teaching skills while you’re not

necessarily facile with the material yourself. You

can use your own uncertainty about the material

to develop your own teaching approaches.”

THE ROSSI STAFF

EDITOR –IN-CHIEF K. H. VINCENT LAU ASSOCIATE EDITOR LENARD BABUS EDITOR-AT-LARGE DR. ERICA FRIEDMAN EDITORS ALEXA MIESES ALISON THALER ANN WANG WEB EDITOR MIGUEL YAPORT WRITERS DEMETRI BLANAS GRACE CHARLES DANI DUMITRIU H. CINDY KO LOHEETHA RAGUPATHI JOHN ROZEHNAL DIPAL SAVLA SUSAN YIN

Observe, record, tabulate, communi-cate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert. - Sir William Osler

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saying specifically at Sinai but medical education in general, go through the Krebs cycle and spend an hour, two hours, or a day going through it? Should we just assume the student has that information, and not cover it at all, and go straight into a system we would not otherwise have time for? And I think that there is a transition going on about those concepts now that has been going on for a while.

Yes. Also, Sinai has changed its

entrance requirements for the new Flex-

Med students, as an expansion of the

HuMed program. I understand the

philosophy behind that but if there are

things that should be shifted to the

undergraduate level, do you think Flex-

Med students would miss that boat?

I think that is one of the challenges of early assurance/acceptance programs. If we as an institution were to make those changes, what would we have to do to those prerequisites for the early accepted students? As we currently teach, I think there is a long history that shows it is not a problem for the HuMed students. Their performance in medical school is fine. They perform well and by most met-rics are not distinctly different from pre-med cohorts. But I do think you’re right. As medicine evolves, we always have to be willing to respond and make changes to medical education. But I think that our programs are constantly evaluating the needs of our students, so we will respond appropriately. There is a lot of discussion around the changes to the MCAT exam and how that is going to change under-graduate education and medical education as well. We’ll have to be nimble in order to adjust to those things.

Definitely. Shifting gears a bit, what is a

normal workweek like for you? How do

you spend your time? My time is divided into four different areas: my leadership of the HuMed program, my laboratory work, the graduate school work and my medical education work – teaching within Physiol-ogy and being the Associate Course Direc-tor. It depends seasonally where we are, but typically I spend not enough time in the laboratory. However, I have a really talented graduate student who is independ-

ent and works well. We meet almost daily but it still is not enough. Right now, I’m working on preparing lectures for the week as you well know. I have all these lectures this week so I’m spending time preparing. Unfortunately, I spend a lot of time answering emails. That is bit of a time sink. In the graduate school I direct one of

the Masters programs and oversee several others. With one program in particular, the Masters of Biomedical Sciences, we’re doing curriculum development and expansion and developing new tracks. We’ll be accepting students specifically into those tracks this year.

That’s exciting. What are some of the

tracks?

Basically, of the students that are in that program, most of the students are looking to go into either medical school or graduate school. A small minority are interested in preparing for industry jobs. As of now we have two informal pathways that focus on medical school and graduate school preparation. This year we will be formalizing these two tracks and adding a third for students who want to go into

industry or biotechnology – the Biotech-nology/Entrepreneurship track. It’s going to go hand-in-hand with a PhD program that is currently under development and will be a component of that. So that will give students an opportunity to take courses that will support not just the scientific elements but also business ele-

ments. It will support internships, science and research components in translational labs or industry labs so there will be exposure to that type of research as well. It will be a formal classroom curriculum and research experience curriculum.

With all that is changing in healthcare,

do you think there needs to be a strong-

er emphasis on the business side of

medicine and the policy/economics

aspect of it, among medical schools? I think policy is important. We’re going through a big change in healthcare policy right now. The more informed the physician is, the better he or she will be able to respond to those changes. I think that physicians are not only caring for patients but they’re running a small business, and I don’t think that they’re

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”

“As medicine evolves, we always have to be willing to

respond and make changes to medical education.”

Dr. Hanss on vacation with his family

- Sir William Osler

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adequately trained for being small-business owners. So I do think there is a need for that. And even within the academic paradigm, academic institutions are being forced to run more and more like businesses which is great. Twenty years ago or more, they had this this idea that we’re going to sit around and care for patients and we’re going to do research and we don’t really care for revenue streams because we’re doing it for the good of the people. And medicine is still all about that, but the financial pressures are making it more and more centered on “how are we going to stay solvent?” which is perfectly appropriate and necessary.

Jumping back to your career—how do

you balance your work life and personal

life? It seems like you juggle a lot of

activities. What advice do you have for

students in terms of balancing their

lives? I think that my hobby is my kids. So at the end of the day, I go home to spend time with my family and I don’t go do a variety of things that people do as hobbies. Until they’re into college and not living at home, they are my top priority.

I’m lucky because my schedule is pretty flexible in the day, and my kids’ school is close by. So if they have a school perfor-mance, I go to the school performance and I schedule my day around being able to do that. It takes me 15 minutes to get there by cab so I can easily go up and do those sorts of things. I think that it is a lot about tak-ing the small moments that present them-selves, and taking advantage of them and

just prioritizing. If you have 15 minutes and you don’t have to sit on the couch answering emails which is a big time sink for me, you put the computer down and spend 15 minutes talking to your child and that’s important to me. It is hard. From a practical point of view, I tend to come in very early in the morning. I usually am up by 5:30 and arrive at work by 6:30, and I

will work until maybe 6:00 or 6:30. And I’ll do some work at home too. Right now it’s crunch time with the physiology course, and I’ll definitely do quite a bit of work at home, but I’ll sit in my daughter’s bedroom while she’s studying and I’ll work on my computer. And throughout an hour of homework time we’ll have snippets of a conversation.

So it sounds like a matter of learning to

be efficient with your time. It’s hard, but I think it’s just about prioritizing the best you can.

Thank you so much for the interview,

Dr. Hanss.

“I think that it is a lot about taking the small

moments that present themselves, and taking

advantage of them and just prioritizing.”

FlexMed: A Revolutionary Approach to Medical Education Dipal Savla

In the early 1900s, schoolteacher Abraham Flexner was tasked with critical-ly evaluating the state of medical education in the United States. His find-ings, as published in the Flexner Report, spearheaded a concentrated effort to intro-duce standardization in medical school admissions criteria and curricula. Flexner’s goal was simple: to redesign training pro-grams so they could produce the highest quality physicians.

This fall, approximately 100 years after the publication of the Flexner Report, the Icahn School of Medicine at Mount Sinai will launch a program based on the radical philosophy that enabling aspiring physicians to step away from the traditional premedical trajectory can enhance medical education. Named in honor of Abraham Flexner, the FlexMed Program will allow prospective medical students to gain guaranteed admission during their sophomore year of undergrad-uate studies.

Unlike the HuMed or SciMed early assurance programs that Icahn School of Medicine offers, students from all majors will be able to apply to Flex-

Med. Applicants may select the Computa-tional Science and Engineering, Humani-ties and Social Science, or Biomedical Science tracks, depending on what they wish to focus on during undergrad. In lieu of preparing for and taking the MCAT, accepted students will be encouraged to direct their efforts towards pursuing an in depth exploration of their academic and extracurricular interests. Students will be required to engage in experiences through which they gain exposure to human illness, take a diverse array of courses ranging from statistics to health policy, and produce a senior thesis in their major. FlexMed students will be welcome to de-fer matriculation and spend one to two years studying or working in a field they are passionate about.

But how will such requirements impact medical education? Dr. Muller, Dean for Medical Education at Icahn School of Medicine, postulates that the process of independently seeking clinical experiences, reaching out to mentors, and trouble-shooting the issues that arise in writing a thesis will equip FlexMed students with a unique skillset that they

will carry to medical school. They will also bring with them a fervor for effecting change. Students at Icahn School of Medicine have been involved in ground-breaking research and advocacy projects and have created some of the school’s most successful organizations including the East Harlem Health Outreach Program, the Global Health Program, and the Human Rights and Social Justice Scholars Program. The introduction of FlexMed will help in creating a school-wide culture that promotes such initiatives and encourages students to challenge norms.

While the FlexMed program is designed in a way that can be replicated at other medical schools across the nation, it is not meant to be seen as the only solution for improving medical education. Instead, as Dr. Muller explains, it is “a call to arms” and “an indication of what is possible.” FlexMed challenges medical schools to reevaluate their curriculum and admissions requirements in the spirit of Flexner, and implement the innovative solutions needed to produce physicians capable of driving the field of medicine forward.

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In 2008, a first-year medical stu-dent named Jennifer Ling developed a pro-gram called the First Generation College Application Essay Writing and Scholarship Program, under the sponsorship of Students for Equal Opportunity in Medicine (SEOM). There were six students in the program, all of whom enrolled seeking help with their college application essays. Three years later, Jennifer’s program merged with the Mount Sinai Scholars Program, a tutor-ing program originally sponsored by Mount Sinai’s Department of Health Education. The combined program was renamed the First Generation Scholars Program, and continues as an SEOM-sponsored program. Since then, the program has grown to in-clude more than sixty students and mentors. First Generation Scholars operates for 10 weeks between October and Decem-ber. High school students are recruited from East Harlem, and meet once a week with an Icahn School of Medicine at Mount Sinai medical student to learn about and begin the daunting process of applying to college. This past year, the program was led by three second-year medical students—Lenard Babus, Gabrielle Phillip, and Evan Pulvers.

All three initially became involved in the program as first-year medical students. Phillip had wanted to participate from the moment she’d first heard about the program. As a college student, Phillip had been involved with a similar program that recruited girls from underserved areas and provided weekly workshops focused on women’s education and empowerment.

In their few short months as leaders, Phillip, Babus and Pulvers were able to add a tremendous amount to the program. In the past, First Generation Scholars functioned primarily as a college essay mentoring program that culminated in an essay scholarship contest. Mount Sinai mentors would grant the two students with

the best essays $500 awards. Although the results were often encouraging (the majori-ty of the students completed their essays by the end of the program), it was clear to this year’s leaders that the students needed more support. “These kids would graduate our program with fantastic essays,” Phillip told me, “and then never apply to college.” With no other resources to help them through the

application process - to teach them how to ask for and submit recommendations, for instance, or to decide when to take the SATs - many of the students never completed their applications. To address these issues, Phillip, Babus and Pulvers decided to expand the program. At each student/mentor meeting, Mount Sinai mentors were instructed to help their scholars create weekly to-do lists in order to better organize the application process. Phillip, Babus and Pulvers also added a number of information sessions regarding the common application and the SATs. Additionally, they told the students to bring copies of their high school tran-scripts to their first mentoring sessions. Provided with the transcripts, the Mount Sinai mentors were better able to guide the students and help them create realistic col-lege lists. “Most often,” Phillip told me with a smile, “it isn’t that the students are reaching too high. They have no idea how amazing they are. They aren’t reaching high enough.” The three leaders also altered the scholarship component of the program, distributing smaller prizes to more students rather than bigger prizes to only two, in the hopes of providing more motivation. Final-ly, they coordinated two special events over the course of the ten weeks: first, a trip to Columbia University, complete with a guided tour by two current Icahn School of Medicine students/Columbia alumni; Gabrielle Phillips working on a college application essay with a First Generation Scholar

First Generation Scholars: An Interview With

Lenard Babus, Gabrielle Phillip and Evan Pulvers

Alison Thaler

“Most often,” Phillip [says], “it isn’t that the

students are reaching too high. They have

no idea how amazing they are. They aren’t

reaching high enough.”

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second, a panel discussion with a number of first- and second-year medical students, focused on their experiences in college, the obstacles they faced when applying to col-lege, and other aspects of their paths to-ward medical school.

The success of these many changes is yet to be determined (college acceptances don’t come out for a few more weeks), but Phillip, Babus, and Pulvers have great confidence in their program and in their scholars. In December, once essays were completed and applications were well on their way to submission, First Genera-tions Scholars hosted a large banquet dinner for the scholars and their parents.

Phillip, Babus and Pulvers handed out awards and graduation certificates, and brought in speakers to talk about different career options, financial aid, and research opportunities. “It’s the best part of the pro-gram,” Babus says, “when you see the

smiles on the students’ faces after they are recognized for all their hard work.” This year, the program had approximately thirty students. Twenty-five of them graduated with completed essays – one of the best results the program has ever seen. This year’s leaders have recruited five new leaders for next year in order to tackle what has become a huge amount of work: fundraising, establishing connections with

local community groups and high schools, and recruiting mentors to help with college applications and essays. However, First Generation Schol-ars still has a long way to go. “There are still a lot of gaps that we haven’t been able to address,” Babus told me, referring most specifically to SAT preparation. “By the time the students enter the program, there’s only so much SAT work we can do. It can be really challenging.” Ultimate-ly, the goal is to catch these kids earlier. The Sinai Umbrella Mentorship Organiza-tion, founded just a few weeks ago, aims to increase coordination among the various student mentor groups at Sinai, many of which are targeted to kids in elementary school or junior high. The idea is to create a cohort of students who are guided and mentored by Mount Sinai students from a relatively young age. The hope is that by the time these students enter the First Generations Scholars program, they will be better prepared. In the meantime, the First Generation Scholars program has been working with the Union Settlement

Former CBS News anchor Dan Rather (right), with moderators Dr. David Reich (left), Chair

of Anesthesiology, and Jamie Zimmerman (center), currently a fourth year medical student.

“It’s the best part of the program,” Babus says,

“when you see the smiles on the students’ faces

after they are recognized for all their hard work.”

Mentor leads First Generation Scholars to a tour of Columbia University campus

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Association (a community center in East Harlem) in the hopes that they will be able to help supplement the First Generation Scholars program with additional tutoring resources and SAT preparation classes.

It was clear by the end of my conversation with the leaders of First Generation Scholars that the program means a lot to them. “Sinai has such a strong focus on improving the physical health of the residents of East Harlem,” Babus told me, “but isn’t it just as im-portant to support the education and devel-

opment of the members of this communi-ty?” The First Generation Scholars pro-gram focuses on essay writing and college applications, but at its heart, it’s about the time spent one-on-one with the high

school students. “We’re guaranteed to talk about other things,” Babus says – things, he clarifies, that have nothing to do with college essays and teacher recommenda-tions. “Over the course of 10 weeks, strong relationships develop, and we can have a really big impact on these kids’ lives.” Phillip interjects — “also, there’s the idea

that, of the thirty kids, a few may be in-spired by our interests in science and med-icine, that a few may be touched by that. Then these kids may one day become doc-tors and be able to act as their own advo-cates for their own community.” Not surprisingly, these students also seem to make a pretty big impact on their mentors. “Interacting with our stu-dents and hearing their stories – it’s one thing to be aware of the health statistics of East Harlem,” Babus says, “but actually working with students gives us a real ap-preciation of what it means to be an East Harlem resident.” As any Icahn School of Medicine student understands, it can be very easy to hole up in Aron Hall and the Levy Library and largely ignore what’s happening just a few blocks away. Partici-pating in First Generations Scholars makes that impossible. “It not only makes us pay attention to what’s happening a few blocks north of us,” Babus told me, “it makes us part of it.”

Sinai mentors working with First Generation Scholars

“It not only makes us pay attention to

what’s happening a few blocks north of

us… it makes us part of it.”

Northeastern Group on Educational Affairs (NEGEA) Annual Meeting

April 12-13, 2013 in New York, NY https://www.aamc.org/members/gea/regions/negea/meetings/

52nd Annual Conference on Research in Medical Education (RIME) in conjunction with the 124th Annual Meeting of the

Association of American Medical Colleges (AAMC) November 1-6, 2013 in Philadelphia, PA

https://www.aamc.org/members/gea/gea_sections/322066/2013researchinmedicaleducationrimeconfer

ence.html

UPCOMING MEDICAL EDUCATION MEETINGS

8

Critique of Study #1

Ann Wang

Academic physicians have a pro-

found impact in teaching, research, and role-modeling for medical students. Today, many medical education programs are concerned about the relatively small num-ber of medical students that choose to stay in academic medicine. One possible reason for this shortage is the barriers that medical students perceive as standing between them and a successful career in academic medicine. The biggest barrier may be that medical school graduates feel inadequately trained in the diverse knowledge base and broad skillsets that academic medicine requires.

The above article describes a summer program spearheaded by the American Medical Student Association (AMSA) and George Washington Univer-sity School of Medicine and Health Sciences (GWU). The goal of the week-long program is “providing knowledge, skills, and attitudes related to teaching and curricular reform” to medical students across the country, and attracting them to careers in academic medicine. AMSA’s “Training Tomorrow’s Teachers Today” (T4) summer program began in 2004, and was in fact sponsored by Icahn School of Medicine at Mount Sinai for three years. In 2009, AMSA partnered with GWU, which has a strong background in undergraduate medical education, to overhaul the curriculum. The newly designed T4 Medical Education

Leadership Institute exposes medical students to academic medicine, and gives them the tools to succeed in such a career through “teaching, leadership, educational scholarship, and academic career-planning.”

The 41-hour week-long program accepted applicants from rising first to fourth years, M.D. and osteopathic schools, and dual degree programs. A total of 11 students attended the 2009 session.

The program was largely student-led, and a significant part of the curriculum involved the participants designing a long-term project relevant for academic medicine to be completed at their home universities.

To evaluate the success of the program, the leaders used both short-term and long-term evaluations. The short term evaluation was students providing feed-back on each session. They also rated their own teaching skills before and after the week-long course. The average score rose from 3.0 (using a 1-5 scale, with 5 being the highest) before the conference, to 4.1 after the conference. Similarly, the

students’ commitment to pursuing academ-ic medicine rose from 3.6 to 4.5. The students also completed an OSTE (Observed Structured Teaching Exercise) with standardized patients before and after the conference. Their average scores rose from 63% to 79%.

The authors also pursued long-term follow-up with the students 8 and 18 months later, asking the students about the status of the long-term projects they were

pursuing at their home institutions. They found that 7 out of the 11 students had completed their projects.

Social cognitive career theory (SCCT) explains how one chooses a career and succeeds in it. The researchers used this theory, to evaluate the effectiveness of the course. The SCCT is based on “self-efficacy, outcomes expectations, personal characteristics, and continuity.” They stat-ed that self-efficacy and outcomes expecta-tions were well fulfilled by the course’s use of role models, close relationships be-tween faculty and students, the OSTE, and the completion of long term projects. How-

AMSA’s “Training Tomorrow’s Teachers

Today” (T4) summer program began in 2004,

and was in fact sponsored by Icahn School of

Medicine at Mount Sinai for three years.

ABSTRACT FOR STUDY #1:

Preparing students to be academicians: a national student-led

summer program in teaching, leadership, scholarship and

academic career-building.

Coleman MM; Blatt B; Greenberg L. Acad Med 2012;87:1734-1741.

Medical schools have the responsibility of producing future leaders

in academic medicine, yet few students choose academic medicine

as a career. In 2009, the American Medical Student Association

(AMSA) and the George Washington University School of Medicine

and Health Sciences joined forces to provide students with a

comprehensive introduction to careers in academic medicine

through the redesign of an existing annual summer program for

medical students. Since 2004, AMSA had hosted the Medical

Education Leadership Institute, a weeklong program that attracted

medical students from across the country who were interested in

gaining teaching skills. In the redesigned sixth annual program, the

authors expanded the curriculum to include principles of leadership,

of medical education scholarship (or project development), and of

academic medicine career-building. The purpose of this article is to

describe the features of this comprehensive program and to share

the lessons learned from its development and implementation. The

authors also describe the multifaceted approach they used to

evaluate the program, which featured a rubric they derived from

social cognitive career theory.

MedEd Research Corner Critical Assessment of Recent Literature Ann Wang and Loheetha Ragupathi

9

ever, less attention was given to the latter two components of the SCCT.

Assessing the Study

The authors noted several study limitations: the Institute was an isolated, week-long course, the study only looked at one group of 11 students who completed the course during one summer, there was no longitudinal continuity with the students who attended, and the course directors did not partner with the students’ home universities to ensure continuity. The authors suggested that a longitudinal course that is more integrated with each student’s medical education curriculum may be more effective in drawing students to a career in academic medicine. Since the first time the redesigned curriculum was used was in 2009, it is too early to deter-mine whether students who completed the course are more likely to go into academic

medicine or not. Finally, the authors did not suggest how the material in the course might be integrated into a standard medical education.

Assessing the Application Despite the limited data, the study

highlights an important lack in medical

education, and suggests one method for addressing it. The authors very thoughtfully analyzed the results from the study, using many different methods and perspectives. Their results are certainly a good starting point for adding more exposure to and training for academic medicine careers in medical schools.

Critique of Study #2 Loheetha Ragupathi

The Socratic Method of teaching in medicine is the conventional system in which questioning the learner allows for knowledge transfer. In this paper by Cho et al based in South Korea, the authors posit-ed that questioning is "the most common and effective teaching method.” They measured and evaluated the caliber of questioning employed by a group of facul-ty. Most notably, they were assessed in the time that faculty allotted students to ponder a question before revealing the answer.

The authors compared the actual duration of time to the duration of the time as per-ceived by the teacher. The authors approached 40 facul-ty members who lectured to second year medical students in the fall of 2008. It is unclear whether these 40 faculty members represented the total number of faculty members who had planned to lecture to these students, or whether there was any other selection mechanism in place. Of those 40 faculty, 33 consented to partici-pate in the study. The authors first surveyed the participants using a question-naire concerning demographic characteris-tics and perceived use of the Socratic

Method; the wait time; whether or not faculty planned their questions in advance;

at what point during the lecture did faculty choose to pose their questions; and whether faculty intended to direct the questions towards the whole group of students or an individual. The authors then compared the questionnaire responses to actual questioning behaviors elucidated from 99 class lectures given by the 33 faculty participants.

On average, faculty believed that they waited 10 seconds to allow students to answer questions. The actual measured wait time was only 2.5 seconds. This result is portrayed in a bar graph in the paper

ABSTRACT FOR STUDY #2:

Analysis of questioning technique during classes in medical

education.

Cho YH, Lee SY, Jeong DW, Im SJ, Choi EJ, Lee SH, Baek SY,

Kim YJ, Lee JG, Yi YH, Bae MJ, Yune SJ. BMC Med Educ. 2012

Jun 12;12:39. doi: 10.1186/1472-6920-12-39.

Background: Questioning is one of the essential techniques used by

lecturers to make lectures more interactive and effective. This study

surveyed the perception of questioning techniques by medical

school faculty members and analyzed how the questioning tech-

nique is used in actual classes.

Methods: Data on the perceptions of the questioning skills used

during lectures was collected using a self‒questionnaire for faculty

members (N = 33) during the second semester of 2008. The

questionnaire consisted of 18 items covering the awareness and

characteristics of questioning skills. Recorded video tapes were

used to observe the faculty members’ questioning skills.

Results: Most faculty members regarded the questioning technique

during classes as being important and expected positive outcomes

in terms of the students’ participation in class, concentration in class

and understanding of the class contents. In the 99 classes ana-

lyzed, the median number of questions per class was 1 (0–29).

Among them, 40 classes (40.4 %) did not use questioning tech-

niques. The frequency of questioning per lecture was similar re-

gardless of the faculty members’ perception. On the other hand, the

faculty members perceived that their usual wait time after question

was approximately 10 seconds compared to only 2.5 seconds

measured from video analysis. More lecture‒experienced faculty

members tended to ask more questions in class.

Conclusions: There were some discrepancies regarding the ques-

tioning technique between the faculty members’ perceptions and

reality, even though they had positive opinions of the technique.

The questioning skills during a lecture need to be emphasized to

faculty members.

The authors suggested that a longitudinal

course that is more integrated with each

student’s medical education curriculum may be

more effective in drawing students to a career

in academic medicine.

10

without other descriptive statistics. The authors subsequently concluded that “faculty members place a high value on the questioning technique in medical classes, but their actual question applications were insufficient to show an effect on improving learning." The reader should be reminded that the authors did not attempt to show an effect on learning in the first place. Inter-estingly, they did find through their review of recorded lectures that 40% of lectures did not employ any questioning at all. Furthermore, the number of questions asked by faculty increased with their rank, presumably reflecting that more experienced teachers asked more questions. The authors identified several limitations of their study, the most important of which was that they did not assess the various types of questions posed by the faculty member; in medical school,

questions can range from those stimulatory of critical thinking to simple yes/no questions. Finally, the authors also emphasized that faculty members needed to be mindful of their questioning technique to enhance learning. Assessing the study

This paper attempts to alert medical educators to the purpose of and manner in which questioning is used in education. Due to flaws in diction and study methodology, the paper has little relevance in terms of application.

Regarding the duration of time

between the question and revealing the answer, the authors cite a study reporting that wait times of 3-5 seconds have a positive effect on students' achievement. This seems close to the 2.5 second average wait time achieved by the participants in the study. Therefore, it is unclear why the authors suggest that faculty wait 10-15 seconds by either counting or performing slow breathing three times after posing a question. In the discussion section of the paper, the authors introduced that they had also distributed a questionnaire to 100 students in addition to their 33 faculty members, which was not described in the

Methods section. These students had, on average, requested 5 questions per class with a wait time of 12.5 seconds. Given the bias demonstrated by the difference in perceived and actual wait times by faculty, there is very likely bias on the part of the students as well.

The data obtained from the questionnaires and the observation of lectures is also not presented in a format that lends itself to comparison. For example, descriptive statistics should have been used to compare actual data and data

about perceived wait times. Assessing the application

The best use of this paper would be for medical educators to reflect on their own personal teaching styles, and to consider their method of teaching includ-ing questioning. Medical educators may consider increasing their use of the Socrat-ic Method in lectures, increasing wait times, and planning questions ahead of time. While this paper provides little con-vincing evidence that any of the above changes would be helpful in learning, it does show that educators are frequently not

using these techniques in the manner in which they perceive they are doing so. This paper may encourage educators to become aware of the educational techniques they are employing in order to identify areas of improvement. The Socrat-ic Method is by no means unique to medical education. Further investigation into this teaching method should review the use of this method in other disciplines to better inform its application in medical education.

“It is much simpler to buy books than to read them and easier to read them than to absorb their contents.”

- Sir William Osler

Kamini Doobay

Creative Writing and Reflection in Medical Education

The rapid advance of science and technology has transformed the under-standing and management of human disease and produced new tools to help narrow our gaps in medical knowledge. The Icahn School of Medicine at Mount Sinai is at the forefront of such develop-ments, and is revolutionizing medical edu-cation by incorporating many of these state-of-the-art instruments into both the class-room and the clinic. Just one example: currently, first-year medical students are learning how to use brand-new handheld

ultrasound machines in their Arts and Sci-ence of Medicine course.

However, Icahn School of Medi-cine recognizes that quality patient care goes far beyond scientific and technologi-cal advances. Good physicians not only diagnose and prescribe, but become part of their patients’ stories. In order to foster the development of physicians who understand this – namely, that illness is only one small part of their patients’ lives and identities — the School encourages its students to approach illness holistically, within the

context of their patients’ entire lives, rather than as simple, scientific problems that need to be solved. Icahn School of Medi-cine provides students with structured op-portunities for reflective writing, self-expression and focused listening in order to help students understand and process the impact of health and illness on themselves and their patients. Ultimately, the aim is for students to build stronger relationships with their future patients.

In 2002, Dr. Suzanne Garfinkle was a first-year humanities and medicine

Medical educators may consider increasing their

use of the Socratic Method in lectures, increasing

wait times, and planning questions ahead of time.

11

student at Icahn School of Medicine. She had been an English major at Amherst College, where she’d been inspired by Anne Faidman, an acclaimed author and one of Dr. Garfinkle’s writing professors. As a first-year medical student, Dr. Garfinkle was struck by medical educa-tion’s lack of means to facilitate thinking about her patients as people in a compas-

sionate, reflective and, as she describes, “writerly” way. In her own words: “In the literary world, ambiguity is tolerated and gratified, and good things can happen even when illness is not treated with 100 per-cent efficacy.” She and her fellow class-mates were bursting with boundless scien-tific information and clinical skills; how-

ever, she saw the need to engage in exer-cises that were more emotionally resonant, that fostered a deeper understanding of and empathy for her patients and that this was just as – if not more –important to being a physician caring for your patients. As a Sinai student, Dr. Garfinkle developed a course that she called Writing About Medicine, under the guidance and direction of Dr. David Muller, current Dean of Medical Education. The class focused on reflective writing exercises and close-reading of relevant, illness-related literature. Students were encouraged to take emotional risks and share personal thoughts and ideas. Quickly and powerful-ly, a close-knit community was formed.

After graduation, Dr. Garfinkle started her Psychiatry residency at Colum-bia. During her time there, she noticed the many ways in which physicians struggled to remain open-minded and compassion-

ate, and saw how the existing medical model promoted reductionism. Stress and long work days made patient-centered, humanistic care nearly impossible. Hoping to help bridge the divide between doctors and their patients, Dr. Garfinkle became involved in Columbia’s Narrative Medicine Program, now a well-respected and flourishing component of the

Columbia Physicians & Surgeons Medical College curriculum.

Dr. Garfinkle has since returned to Icahn School of Medicine with a mis-sion to spearhead creative writing initia-tives in her role as the Director of the Academy for Medicine and Humanities.

Along with a large community of students, trainees and faculty members,

she is facilitating multiple medical student focused courses/experiences. Students have approached her to partner in develop-ing elective courses that promote reflection, critical thinking and communi-cation skills. For example, a current second-year student Emily Sorg worked

with Dr. Garfinkle to develop Words to Live By, a creative writing workshop that aims to help develop the creative voices of future physicians and give participants the tools they will need to reflect, communicate and write thoughtfully throughout their careers. There are also a number of literature and critical thinking courses offered this spring, including Growing and Aging, a course that will be taught by author and award-winning for-mer Yale professor, Dr. Priscilla Gilman. These nexus electives fill up quickly;

course directors have been pleased by the consistently large numbers of interested students.

Apart from these courses, all Icahn School of Medicine students are invited to submit pieces to the Mount Sinai Mosaic, a student literary publication re-leased biannually. This long-standing magazine, led this year by second year students Selwyn-Llyod McPherson, Ryan Wang, and Michael Vishnevetsky, is gen-erously supported by the Mount Sinai Alumni Association. The publication fea-tures photography, poetry, reflective es-says and other literary pieces by Icahn School of Medicine students.

And finally, just this year, the Academy for Medicine and the Humanities has made it possible for first-year students to be funded by the Summer Research Scholars’ Program to pursue creative projects in the humanities over the

summer. Such meaningful projects foster personal reflection and self-growth and, as Dr. David Muller told the Rossi in a recent interview, encourage the development of interesting, warm and compassionate future physicians.

The class focused on reflective writing exercises

and close-reading of relevant, illness-related

literature. Students were encouraged to take

emotional risks and share personal thoughts and

ideas. Quickly and powerfully, a close-knit

community was formed.

Just this year, the Academy for Medicine and the

Humanities has made it possible for first-year

students to be funded by the Summer Research

Scholars’ Program to pursue creative projects in

the humanities over the summer.

There are, in truth, no specialties in medicine, since to know fully many of the most important diseases a man

must be familiar with their manifestations in many organs. - Sir William Osler

12

Writing an Effective Abstract Grace Charles

While scientific research takes significant effort and months to years to complete, abstracts require the sum of that work to be condensed into a few select words, often 300 or less. The abstract is a succinct description of your project that enables a reader to understand the purpose and method of the work and to judge its quality. There are four categories that need to be addressed in the body of the abstract: the Introduction (alternatively Background or Purpose), Methods, Results, and Conclusion (or Discussion). Writing an effective abstract is an important skill; below are some guiding principles: Title: Keep the title around 10-12 words. Aim to include the scope of the investigation, the study design, and the ultimate objective(s). If possible, reference the study’s take-home message. It is preferable in the title to describe what was investigated rather than to state the results or conclusions. Authors and Affiliations: The order of the author list is based upon the relative contributions of each author, with the exception of the senior author, who is typically listed last. The first author is the research-er who developed the study and/or did most of the research and writing and is usually the one who presents the results. Introduction: It should include a concise hypothesis, i.e., a statement of the problem or the reason the study was needed, describe the study objective(s), and indicate the potential outcome. Remember to be careful with your wording and to maintain objectivity: your aim is to find out whether something is true, not to prove that it is true. Methods: This section is most often identified as deficient by reviewers and editors, and shortcomings here are the most common reason for rejection of submitted work. Your goal is to give the reader a clear idea of what you actually did. For studies involving human subjects, include the study design (retrospective, prospective, or observational), setting and duration, subject recruitment and selection process, subject inclusion/exclusion criteria, and the use of randomization, if applicable. Where appropriate, also include a description of the intervention, assessment procedure, and method of data collection. Clearly state the outcomes measured and method of data analysis employed. Results: The number of participants, response rate, and demographics should be included. Report results pertaining to your hypothesis and the primary endpoints described in the methods, even if no statistically significant differences were identified. Describe conclusion-supporting data in as much detail as space permits. Stick to true statistical significance in your reporting; discussion of trends and “almost-significant differences” is unnecessary. A table or figure is often helpful, but bear in mind that it will be reduced in size for publication and that the labels and data points must remain legible if the image is to be effective. Data should be presented as the mean ± standard deviations unless otherwise noted. Narrative results should summarize but not duplicate the table data. Conclusions: This should be an interpretation of the most relevant results and should include a brief statement of the importance and significance of your findings. State only those conclusions that can be reasonably backed up by your results. You should also include reflection with next steps and limitations to your research methodology and results. Reference: David J Pierson. How to Write an Abstract That Will Be Accepted for Presentation at a National Meeting. Respir Care, October 1, 2004 49:10 1206-1212.