Now I would like you to ask her about something even more miraculous: immunization. As Priscilla trains in pediatrics, she will learn about disorders that used to kill and cripple children. She will see first-hand what some of these diseases can do when parents opt out of the shots. These diseases wreak havoc; that's why we developed those pesky jabs!

Please consider promoting immunizations on Facebook. The internet contains so much bad information about childhood shots, most of it untrue. Perhaps the social network can help make the world a safer place.

By the way, I would love to tell your spouse about the joys of a career in Pediatric Nephrology. If the joy of transplantation thrills her, she should certainly consider devoting her life to kidneys, just like me!

Sincerely,

Pascale

I did manage to add a new widget to the right-hand column so that you can donate to Scientopia via PayPal.

You will also notice some ads around here in the near future.

So feel free to donate, click, or otherwise generate income to keep Scientopia running.

And I will try to get my act together and provide some real content.

In short, not the most "online" group in the world.

The earlier post included a Storify summary of a presentation by Kevin Knebl, a networking guru. He walked the group through LinkedIn, and the participants ate it up. He coached them through their fear.

Aside from the nuts-and-bolts of the networking site, he had one major message: don't focus on the tool (social media); work on the outcome (networking).

LinkedIn, Twitter, Facebook and others are just new ways to connect to other human beings, something people have done since the dawn of time. Yes, it makes us more visible to others, but it also widens our networks. These networks are merely new tools, not a mysterious new process or world. My own husband sees them wasting time, but I see them as a valuable extension of what I need to do anyway.

Since that message seems to escape a lot of folks in my demographic (not just the one I married), I figured it could use repeating here.

And if you have a techno-phobic group you want to embrace social media, then Kevin may be the guy to help you do this task. He certainly worked for WESH.

If you want to learn how to get started with LinkedIn, click here for my introduction to the service.

Pediatric kidney disease, 1978

Arnold sometimes seemed wise beyond his years. Of course, he was being played by 10-year-old Gary Coleman who looked far younger than his chronological age. Thanks to focal segmental glomerulosclerosis (FSGS), a particularly nasty form of childhood nephrotic syndrome, and attempts to treat it, Gary's growth was stunted. His adult height measured 4 feet 7 inches, so he could play much younger characters...up to a point. He received two kidney transplants, both of which failed due to recurrent kidney disease.

The entire child cast of the show subsequently led troubled lives. Gary Coleman died in 2010 of a brain hemorrhage.

This week the face of pediatric kidney failure changed when Sarah Hyland, the older sister on Modern Family, revealed that she has lived with chronic kidney disease her entire 20 years of life. She recently received a kidney transplant from her father during the show's summer filming hiatus. 

Pediatric kidney disease, 2012

Lucky for Sarah, she had a much different condition called dysplasia. During development, her kidneys failed to form enough normal tissue to support her throughout her life. Doctors diagnosed her slowly-progressive condition at 9 years of age. She never received the high-dose steroids that gave Gary Coleman his round face. She benefited from decades of research that dramatically improved the ways we manage the growth failure and bone disorders that can accompany all kidney diseases. She will likely have excellent function from her father's kidney for many years without the appearance-altering side effects of earlier anti-rejection drugs.

We have made a lot of progress, but we need to make more. FSGS has some new treatments, but many patients still fail to respond and develop permanent kidney failure. FSGS still recurs in the transplant, killing the new kidney as it did the native ones. Dysplasia does not develop in the transplant, but other conditions may shorten the life of the replacement kidney. The side effects of anti-rejection drugs may be less visible, but their risks of infection, diabetes, and cancer still raise problems. We still have a lot of research to do.

But in my lifetime, look at the progress we have made!

Click to Amazon

I will buy anything Christopher Moore writes; I love his over-the-top world that much. I also like art, particularly the impressionists and others of La Belle Epoque. Sacre Bleu delighted me for these reasons. The novel begins with the death of Vincent Van Gogh, thought to be a suicide but in reality a murder by a mysterious, misshapen man. Lucien Lessard and Henri Toulouse-Lautrec become detectives, eventually tracking down the murderer and his beautiful female friend. Along the way the reader gets to review the wonderful art and colorful artists of this period, as well as some others throughout time. I loved my college art history class, but I wish it could have been this much fun.

The other book is a first novel from Chad Harbach, The Art of Fielding. Two factors went into this download. First, it made Maureen Corrigan's best of 2011 list. Of course, I live in a baseball family, providing my second motivation for the download.  My son got his Fisher-Price tee ball set for his second birthday, and he then insisted that I pitch to him ("No. Throw ball!"). I gently lobbed the plastic whiffleball, he swung his bat, and the ball hit me in the face. He and his father love the sport, and I have grown to appreciate it along the way (despite the injuries I have suffered).

Click to Amazon

This novel follows a nearly perfect shortstop, Henry, as he joins the team at Westish, a tiny liberal arts college along the shores of Lake Michigan. The plots revolve around Henry, the player who discovers him, Henry's roommate, the college president, and the president's daughter; everyone except Henry's roommate take turns narrating the action.

Through 60% of the novel I was enthralled with its mix of baseball, academia, and the fate of our dreams. The last 40% requires some major suspension of disbelief. I kept reading, trying to figure out how these plots would resolve. Some events are improbable, to say the least. I hoped to tell you that this is a great novel, but the ending action drops it down to merely good. If you like baseball, especially at the college level, you will enjoy this read. Like Sacre Bleu, you will never believe these events actually happened.

I have another trip later this week, and I have downloaded Christopher Buckley's newest work, They Eat Puppies, Don't They? I will let you know how I like that one next week.

Are you reading something you love? Let me know; I am always looking for good stuff!

Why should they want to move up the chain of command?

I am looking for answers to this question.

Click to enlarge

Preparing for this event gave me a great excuse to play with Easel.ly, a new site for the creation of infographics. Click over to their beta site; it's cool.

The most obvious reasons to pursue leadership positions are for yourself. Moving up brings you accolades and opportunities. Leaders control resources and help shape their institutions. They are "The Deciders" and this role can be fun and rewarding.

Of course, other people may motivate someone to leadership. Those resources and decisions can make life better for patients, students, and employees. Many women shy away from personal ambition; by focusing on these altruistic goals, they can achieve without guilt.

Why else should faculty pursue leadership roles? Can we frame our encouragement another way?

I'm waiting for you answers...

Except now.

I keep reading interesting stuff, both good and bad, and filing it away for blogging. I just cannot seem to get in the mood today.

So forgive my lame post. I think I will head for the gym early and celebrate my eldest child getting a real, not-an-internship job.

Empowering today's leaders to guide tomorrow's healthcare enterprise

I spent another weekend (OK, a long, Thursday through Sunday weekend) on the road in Philadelphia. This time I attended the first meeting of a group now called Women Executives in Science & Healthcare (WESH).  This group consists of men and women who have middle- and upper-level management positions in academic medicine and dentistry and public health. As part of our recent rebranding, we developed the following definition:

Integrated network of executive leaders in healthcare & science across the academic health enterprise

We want to bridge the walls between disciplines both within and outside of academia. We hope to attract C-suite women in healthcare: Chief Legal Officers, Chief Medical Officers, and others in healthcare management who do not necessarily have a healthcare or science degree. Managers in biotech and pharma will also be interested in the networking opportunities provided by this group.

The educational portion of the Spring Summit, dedicated to Renewal and Redirection, can be found here. While not the largest gathering of twitterati on the planet, a handful of folks provided enough thoughts to produce this Storify:

Want to know more about WESH or think you might want to join? Click the links and learn more at our brand-spanking-new web site!

Medical students and residents generally have great fact-learning skills. To get this far in life they have learned volumes of information and successfully regurgitated it on multiple-choice exams. During the clinical years of medical school and residency, we really try to hone analytic and critical thinking skills. Many of my colleagues feel we do an inadequate job in this arena. When I received an invitation to view a video on teaching critical thinking today, I jumped at the chance!

First, what is critical thinking? We all know it when we see it, but what skills make it happen? We can all agree that analysis, evaluation, and problem-solving are part of the picture. Self-reflection often goes along with the process. The hot skill in education circles is metacognition, or thinking about thinking. This boils down to making the learner address what they know and do not know, as well as the quality of their information, assumptions, and reasoning. Critical thinking can best be triggered via collaborative settings with high levels of learner engagement. Early feedback also helps drive this skill set.

Click for source

Writing assignments are ideal for critical thinking because writing open-ended answers forces engagement with a topic. Interaction and early feedback further drive interaction and reflection, either via peer or supervisor review. One speaker in the video session discusses successful use of a model in which students prepare a draft of an assignment, they undergo peer review, and then they turn in a final product. The quality of these assignments increased dramatically with this model when compared to making an assignment without the peer-review step.

The most writing in clinical courses involves structured clinical documentation, often in the inpatient setting. The nature of these notes has changed a lot since my days as a resident. Back then (1985-88), our notes followed the SOAP format- Subjective, Objective, Assessment, and Plan. We organized the assessment section by problems, either as an established diagnosis (Meningitis) or symptom (Acute Febrile Illness).  Plans for each problem could be organized as diagnostic, therapeutic, or educational (discussing exacerbating factors or importance of immunization with parents). In our assessment, we had to discuss the diagnostic possibilities for a symptom complex or other issues for an established diagnosis (for acute asthma exacerbations, we had to identify possible factors that provoked the episode). If we saw something new or unusual, we had to read something about the condition to provide an adequate discussion or we got it at rounds.

Sometime in the past decade, inpatient notes switched to a systems-based format for the assessment, listing the status of the cardiovascular, respiratory, and all other systems. I first saw this in intensive care settings; now all residents seem to use this format in all settings. I can see why intensivists love this method. It provides a very clear snapshot of how all body systems are supported and the progress they are making. The goal of ICU care is to get the patient out of the ICU alive, not necessarily to solve the overall issues. When no systems require intensive care, the patient can go to the floor whether or not the overall problem has been diagnosed.

This form of note does not force or promote the sort of critical thinking of the original SOAP format. Can we do the same thing verbally on rounds? Possible, but as the video points out, writing is still the best way to engage trainees.

I wonder if other academic physicians feel the same way about "systems-based assessments?" Has anyone tried a hybrid format with an assessment section like the old days followed by systems-based assessments and plans?

My other question is how this shift happened? I have been unable to find publications to support the superiority of the systems-based approach. Does it exist?

Click for source

Here's a a thought: Let's harness technology to make our government more efficient. All MOGs do all day is talk; to each other, to their constituents, to lobbyists, and to advocates. Surely they can do that via email or Skype. Constituents and advocates try to persuade MOGs by educating them about their issues; education no longer requires face-to-face interaction, right? And lobbyists? Just add a Paypal button and the bucks can still flow in.

Think of how much we could save on buildings and government employees. Seems like those "smaller government" MOGs should jump at the chance to cut their staffs and costs. They would no longer have to pay for those DC residences and clubs since they could stay in their home districts.

What's that,  you say? You need that personal connection? There is value in meeting face-to-face? Government requires that human interaction?