Bronchology and the 20th anniversary of The Matrix

Photo from WikiMedia Creative Commons

Twenty years ago this week the science fiction film The Matrix was released in the United States. This film directed by the Wachowskis brothers stars Keanu Reeves and Laurence Fishburne. The film grossed more than 460 million dollars worldwide. 

The Matrix describes a dystopian future in which the hero is a computer programmer named Thomas who actually lives a double life as a hacker named Neo. Neo feels trapped within an inauthentic life. He goes in search of a man called Morpheus to ask him the truth about the world. Morpheus offers Neo a choice between swallowing a “red pill” which will allow Neo to live a life of constant awareness and truth or a “blue pill” after which Neo will continue living his current life in blissful ignorance and security.  

When Neo swallows the red pill, he is immediately awakened to a new reality. He learns that The Matrix in which he lives is actually an illusory 20th-century world that is sustained in order to prevent people from knowing they are being exploited…and the adventure begins.

The red pill-blue pill meme described in The Matrix has become part of our culture. In this piece, however, my goal is not to discuss red pill-blue pill life philosophies, but to briefly reflect on how using educational tools offered in the Bronchoscopy Education Project provide red pill opportunities.

For example, if trainers successfully use assessment tools to identify a learner’s place on the learning curve and ascertain the effectiveness of their own teaching techniques (akin to swallowing the red pill), it follows that they will want to incorporate assessment tools into competency determinations. This new reality morally obliges the trainer to identify competency measures and to change educational practices accordingly.

As a second example, if trainers experience that checklist-type assessment tools are helpful for teaching bronchoscopic inspection (example BSTAT), or EBUS-guided TBNA (example (EBUS-STAT), it follows that a similarly designed assessment tool for intubation over the bronchoscope would also be helpful. Aware of this new reality, trainers would design such a tool and incorporate it into competency determinations.

In Australia, for example, colleagues designed and validated new assessments for ultrasound-guided thoracentesis and chest tube insertion (available on www.bronchoscopy.org) with excellent results. These tools are increasingly used around the world and form an important element of competency-based training for lung doctors in Australia and New Zealand.

A third example of red pill philosophy relates to experiential evidence for using a four-box approach to procedural consultation. This structured approach to case-based learning identifies cognitive pathways and allows trainers to explore the multiple facets of a particular clinical scenario in a stepwise fashion (akin to swallowing the red pill). The harshness of this new reality is that trainers now discover their need for additional education in order to learn how to maximize case-based instruction, which is very different from giving didactic lectures. This red pill-related truth has a global impact because it means that bronchology societies around the world should take steps toward offering more focused training of bronchoscopy educators. Programs might include information about how to organize learning units, how to provide and receive feedback, and how to facilitate case discussions. Learning the intricacies of two-way communication as an educational product requires practice and repeated simulation with guidance. An ideal program will also help trainers gain knowledge of psychology, group dynamics, and negotiation. 

My fourth example and the inspiration for today’s topic relates to an exciting red pill moment occurring in Australia this week. The 8th Asian Pacific Congress for Bronchology and Interventional Pulmonology Meeting is on the beautiful Gold Coast near Brisbane, Australia. Under the leadership of APAB President Kiyoshi Shibuya and APCB President/WABIP Treasurer David Fielding and his team, the conference’s scientific program is built around case studies and facilitator-led discussions using the Four Box Practical Approach as a basis for structured learning. Hands-on workshops are led by BI-certified and master instructors using many Bronchoscopy Education Project inspired teaching techniques that promote a learner-centric philosophy.  Models, simulation, checklists, and individualized instruction/feedback form the basis of both cognitive and hands-on technical skill instruction. 

Thanks to this conference, many physicians are likely to abandon antiquated blue pill methodologies represented by didactic lectures and overpopulated hands-on workshops in favor of a red pill approach. This new awareness, I am sure, will not only inspire a new generation of bronchoscopists in the Asia Pacific region but may forever change the educational dynamics of bronchology and Interventional Pulmonology conferences in the future.

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