Saturday, February 25, 2012

Kingdom Learning

He told them another parable: “The kingdom of heaven is like a mustard seed, which a man took and planted in his field. Though it is the smallest of all seeds, yet when it grows, it is the largest of garden plants and becomes a tree, so that the birds come and perch in its branches.”  Matthew 10:31-32 (The Message)
One day children were brought to Jesus in the hope that he would lay hands on them and pray over them. The disciples shooed them off. But Jesus intervened: "Let the children alone, don't prevent them from coming to me. God's kingdom is made up of people like these." After laying hands on them, he left. 
Matthew 19:13-15 (The Message)

We visited Disney World this last year and were again impressed with the pilgrimage from around the world.  We had fun seeing the excitement in the eyes of our grandchildren as well as the memories of this place.   What was a favorite in the Magic Kingdom was the “It’s a Small World” ride that celebrates children and their cultures. 
The learning issues that confront us are similar to what we experienced in the Magic Kingdom.  We have been challenged by the expansion of information and information technology and we are like children learning how to explore this big world of ideas and information.   The question is how to approach this “big” problem?  Will we approach it from the “bottom” or the “top”.  The answer in the past has generally been, top/down with assigned educational goals and objectives.  
Microlearning starts at the bottom with small learning groups confronted with a care challenge.  Beside the learners there is a guide who asks  the questions and facilitates getting the answers and applying them.  It is much like the “mustard seed” approach.  It starts small and then grows!  The other similarity is, it is how we learn when we are children.  Small, simple steps that can have a “kingdom” impact on the lives around us.
from Tenwek Hospital, Kenya

Wednesday, February 8, 2012

Conscience Check

The recent announcement by Katherine Sibelius of HHS created a dilemma for faith-based organizations and providers.   The context of the dilemma is the provision of contraceptive services to women as a part preventive services without additional charges or co-pay.  This final rule provides for a grace period of one year to “allow these organizations more time and flexibility to adapt to this new rule.”  This rule is a response to the Institute of Medicine’s report,  Clinical Preventive Services for Women: Closing the Gaps.

There is no question that the administration is aware of tension between religious liberty and the scientific basis of the recommendation.  The last sentence of the release is particularly revealing...”And this final rule will have no impact on the protections that existing conscience laws and regulations give to health care providers.”
There are a multitude of state rules/regulations as well as a long history of federal rules that support the idea of not forcing health care providers to participate in any procedure or service that they find morally objectionable.  The concern is that these protections are  “slipping away” given the demands of “access” and “control of health care costs”.
This issue is an opportunity to revisit prior “posts” addressing the purpose and nature of why and what we do.(1)   What seems likely to happen is that this will be seen in political terms particularly at this time in our history and ultimately as a legal question.  So what should be our conscientious response?
We can say that there is “a significant minority” of physicians who object to participation in procedures or recommendations that are morally objectionable.(2)  The other data is the impact of oaths and professional codes.  One example has been the refusal of physicians to participate in capital punishment.(3)  The anesthesiology board prohibits participation and sights a “Hippocratic” reason and support of the AMA.   Their policy is informative in that it does not argue the laws but addresses their professional response. It is a clear response that physicians are not agents of the state.
In summary, rules and regulations are important to consider in our actions as individuals and organizations but are not the definition of our mission either as a profession or as a vocation.  We have been confused in the past and should try and avoid this error as we are confronted with changes in the framework or context of our practice.


(1) 12/24/2010 - The "Telos" for Christian Healing Agents
07/23/2011 - Power, Politics and Healing
01/6/2012 - Burdens and Benefits

(2) Lawrence RECurlin FA. Physicians' beliefs about conscience in medicine: a national survey.  Acad Med. 2009 Sep;84(9):1276-82.


(4)  Genuis SJ. (2006). Dismembering the ethical physician.  Postgraduate Medical Journal, 82(966), 233-8

Wednesday, February 1, 2012

Techniques and Transformation

These are the things you are to do: Speak the truth to each other, and render true and sound judgment in your courts;  Zechariah 8:16 (NIV)
“Blessed are the peacemakers” or “Blessed are those who struggle for justice.” Greater precision in translation would say, “You’re in the right place if … you are single-hearted or work for peace.”
Boyle, Gregory (2010-02-14). Tattoos on the Heart (p. 75). Simon & Schuster, Inc.. Kindle Edition. 
For healthcare education, the most difficult task has not been the cognitive or the procedural tasks; it has been the transformative educational task.  In a CNN report on medical certification exams getting the right answers apparently took precedence over doing the right thing.  

In his memoir, Tattoos on the Heart, by Father Greg Boyle we get some insight into the sociology of education of very difficult students.   What we see is a passion for the more difficult educational task of transformation.    He is not a teacher in an identified school.  His life, loves and actions are all predicated on a deep worth of his “students” that to him become “kin”.   He is one of them and at the same time a trusted mentor and critic who suffers and celebrates.
One tactical educational response has been the use of blogs as a tool for self-reflection in undergraduate medical education*.   There are concerns**but one obvious advantage is that these tools are not limited to a specific place***.   What we must keep in mind that with these new tools, we need faculty like the example of Father Boyle who was in the “right place” and committed to those he saw as “kin”.

*Chretien K.  Goldman E.  Faselis C.  The reflective writing class blog: using technology to promote reflection and professional development.  Journal of General Internal Medicine.  23(12):2066-70, 2008 Dec.
Gewin V. Social media: self-reflection, online.  Nature.  471(7340):667-9, 2011 Mar 31.
**Shore R.  Halsey J.  Shah K.  Crigger BJ.  Douglas SP.  AMA Council on Ethical and Judicial Affairs (CEJA).  Report of the AMA Council on Ethical and Judicial Affairs: professionalism in the use of social media.  Journal of Clinical Ethics.  22(2):165-72, 2011.
***Ali FR.  Finlayson AE.  Tweet to collaborate with poorer nations.  Nature.  475(7357):455, 2011 Jul 28.