Category Archives: Colt’s Corner

Seven Learning Styles and Artificial Intelligence

It is common sense that everyone learns differently, and that teachers should do their best to use a variety of methods to transfer knowledge from themselves to their students. Of course, we also want learners to do more than solve problems they have seen before. This means that we want them to be able to apply whatever they have learned to solving new problems in novel settings. This also means we want them to acquire what psychologist William James referred to as “an inventive mind.”

Artificial Intelligence (AI) is favorably impacting this environment because it empowers learners. It offers them a variety of tools so they may embark on “learning paths” that best suit their individual natural preferences and particular customizable circumstances. Whether it be from the elaboration of interactive diagrams, engaging with chatbots, receiving instant feedback, or listening to individually-tailored audio lessons, for example, AI promotes learning according to Visual, Auditory, and Verbal styles. By interacting in a digital space or AI-driven simulation, using algorithm-based tutors that evolve as individuals progress, and collaborating with others through smart platforms, people who benefit most from physical, logical, and social styles can also expand their means for learning. And let’s not forget that AI promotes independent study by offering learners an opportunity to formulate a series of increasingly complex or deep-rooted queries simply by repeated interactions with programs such as ChatGPT, Claude, or Gemini (and others).

So, what does this mean for bronchoscopists and interventional pulmonologists? It means we must rethink the way we organize educational programs, on-site or remotely-delivered lectures, conferences, and even hands-on workshops. It probably means increased emphasis on a learning by doing methodology, or what the philosopher John Dewey referred to as “activity methods,” at the bedside, in the classroom and procedure suite, as well as in the conference hall. The transition will come naturally for a new generation of learners and teachers but may pose a significant challenge for old-schoolers and those inclined to be resistant to change.

Five Key Components of Training

As numbers of interventional pulmonology procedures increase in both scope and applicability, teachers are challenged with finding the best means by which to train their students. Let’s not forget, therefore, that everyone learns differently. The four major ways people receive, and process information are VISUAL, using images, slides, charts and spatial understanding; AUDITORY, by listening to lectures, discussions or audio recordings; READING/WRITING using notes, summaries and textbooks or manuscripts; and KINESTHETIC, through hands-on experiences, physical activity, simulation scenarios, and real-world applications.

Although modern research suggests that learning is most effective when multiple modalities are used, teachers should try to ascertain their students’ preferences, and tailor their training programs accordingly. They should also revise their programs according to the particularities of a region’s customs, traditions, local politics, personalities, and available resources. Of course, regardless of the teaching modalities used, programs should be designed to address five essential components of training. These are cognitive knowledge, simulation-based technical skills, the integration of procedures into practice in a particular medical environment, the acquisition of non-technical skills, and the objective identification of strengths and weaknesses using competency-based assessments.

Let’s Implement Assessment Tools

Doctors have a privileged position because we wear white coats and surgical scrubs, but this does not necessarily make us good teachers. To believe it does is both arrogant and egocentric, vestiges of a tradition where knowledge was dispensed solely from within the ivory towers of academia. I strongly believe in well-structured Train-the-Trainer or Faculty Development Programs, whose value in democratizing knowledge is now well documented. These programs help participants become better teachers, enhance their communication skills, practice using elements such as checklists or 4-box approach exercises in various settings, and become more familiar with educational philosophies and methodologies.

Participants also learn to use validated modern assessment tools such as BSTAT, EBUS-STAT, BRadStat, RIGID-TASC, and for the pleura, tools such as ICC-STAT. The implementation of these tools into regional and national training programs helps teachers who don’t want to presume their students are merely capable of doing procedures based on subjective assessments of their students’ experience and exposure. Instead, by using competency-based assessment tools, modern teachers objectively measure their students’ technical skills for a specific set of procedures. They can identify weaknesses that require remedial training, as well as reinforce or improve upon skills already acquired. This works for airline pilots and surgeons, so it is only natural for it to be equally valuable for interventional pulmonologists….imo.

Real-time Procedure Numbers are Important

Interventional pulmonology entails procedural expertise in a number of conventional and evolving medical procedures. The number of procedural modalities are increasing, however, as is their complexity. In addition to their traditional apprenticeship training, IP specialists use simulators and attend on-site multi-day training courses. These are invaluable for acquiring training for specific procedures, emergencies, and technical skills, but procedural numbers, actually learning by doing in the clinical setting, help develop the judgment, resilience, and nuance that only real-world experience can provide.

Real-time procedural numbers are critical because they represent real-world complexity and unpredictability crucial to learning good decision-making and crisis management. They are important to becoming an “interventional pulmonologist” because situational awareness and experiential knowledge grow over time. They teach stress management and enhance an operator’s confidence. They also abide with legal and regulatory standards, even if these are not yet evidence-based. Finally real-time procedural numbers are crucial to learning communication, leadership, and team-building skills that are applicable in an ever-changing real-world medical environment.

Considering the growing number of IP specialists seeking training, however, institutions are increasingly challenged with finding enough patients to fill the “procedural demand,” and it is uncertain whether all training institutions can honor procedural numbers criteria listed in the specialty’s various guidelines. Finding a satisfactory and ethical solution to this problem is a task the specialty’s leaders must address…soon.

A Glimpse Towards the Future

The history of Interventional Pulmonology (IP) is marked by technological advances, progress in imaging and surgical techniques, the vision of a few key personalities, and the establishment of dozens of IP associations around the world. Important milestones were reached by resolving conflicts with various national and international pulmonary and thoracic surgery societies, and by reexamining the specialty’s self-defined goals and identity.

Despite occasional differences of opinion and instances of competitive rather than collaborative professional interactions, the interventional pulmonology field remains unified by a shared commitment to improving the diagnosis, prevention, and treatment of patients with emerging, potentially life-threatening, or advanced lung, airway, and pleural disorders.

For over a century, generations of clinicians, researchers, industrial engineers, basic scientists, physicists, equipment manufacturers, and computer scientists have contributed to innovations aimed at meeting the growing demands for minimally invasive interventions and the challenges of a changing medical landscape. The ongoing pursuit for effective, targeted, and personalized quality patient care ensures that interventional pulmonology will continue to thrive as a dynamic, integrative, and transformative medico-surgical specialty.

However, the approach, scope, timing, and purpose of interventional pulmonology must respond to the needs of a growing population, shifting social and medical demographics, and the advancement of evolving technologies. It must also address challenges posed by an increasing diversity of care environment and a world struggling to overcome significant disparities in medical access, philosophies of care, economics, education, and collaboration.

I believe the future of interventional pulmonology hinges on five key elements, all equally important and inherently interconnected, much like the links in a bicycle chain. These are (1) Greater collaboration across borders for training and education; (2) A strategic shift from reactive to proactive patient care interventions; (3) Building environments that nurture courageous, unselfish, and visionary leadership; (4) Developing a global strategy to address issues of cost and accessibility; and (5) Supporting dreamers, pragmatists, teachers, and students in their quests for professional security in a world increasingly governed by artificial intelligence. IP societies should draft and publish papers addressing each of these elements in a concerted effort to build a foundational blueprint for the years ahead.

HIV/AIDS Awareness

December was HIV/AIDS Awareness Month. It is great to celebrate our many victories over this infectious disease, but we must also remember the extent to which HIV/AIDS continues to affect our global community.

In the United States, about 1.2 million people over 13 were living with HIV in 2018. At least 14% (1 in 7 people) do not know they are infected. Black/African Americans and Hispanic/Latinx continue to be disproportionately affected, accounting for more than 50% of infections¹.

In the WHO/European Union and European economic area (53 countries in the 2018 report), the number of people diagnosed with HIV increased by 22% in the last decade. The number of people living with undiagnosed infection has also increased. Many are diagnosed late in the course of their disease, particularly in the Eastern region. While sex between men remains the prevalent mode of transmission (52%), heterosexual spread accounts for 42% of cases where diagnosis and mode of transmission are known².

In Eastern and Southern Africa, the number of people living with HIV/AIDS is increasing, but so is access to antiretroviral treatment. More than 20 million people in the region live with HIV/AIDS (6.7% adult HIV prevalence). Excellent progress is being made regarding raising awareness, diagnosis, treatment, and viral suppression³.

In the West and Central African regions, prevalence is relatively low (1.4% adult HIV prevalence), but in 2018, only 68% of individuals were aware of their status. The epidemic is driven by heterosexual sex, with adolescent girls and women (age 15-24) being almost twice as likely to acquire HIV than their male counterparts⁴.

In Latin America, cases have declined in many countries, but the region has seen an increase of 7% overall since 2010, with several countries; Brazil, Costa Rica, Bolivia, and Chile noting increases between 21%-34%. Throughout the region, gay men and men who have sex with men remain disproportionately affected⁵.

The Asia-Pacific region has wide variations in prevalence, with China, India, and Indonesia being most touched by the epidemic. Overall, almost 6 million people are infected. Many countries note decreases, but the increases in The Philippines, Bangladesh, Afghanistan, Pakistan, and Papua New Guinea are worrisome. Significant progress has been made reducing transmission from sex workers (although prevalence remains around 5% in Indonesia, Laos, Myanmar, and Papua New Guinea) because of successful 100% condom-use programs⁶.

With more than 33 million people living with HIV worldwide, the disease has substantial social and economic consequences, particularly in countries with limited infrastructure or an abundance of low-income communities. Having parents with HIV puts children at risk of becoming orphans. Infected and ill individuals are less able to work, which diminishes their ability to provide adequate food and shelter and promotes poverty.

Thankfully, many NGOs and governmental agencies are actively fighting the pandemic. Improved quality of care, reduced mortality, and decreased transmission through education and prevention is possible and ongoing.

While a cure for HIV/AIDS still eludes us, significant improvements in antiretroviral drug safety and efficacy profiles are encouraging. Collaborative efforts between researchers, academia, governmental and nongovernmental organizations, and the pharmaceutical industry promise further progress.

At the local level, health care professionals must continue to raise awareness and promote understanding to help reduce the stigma and discriminative practices that might persist in their communities.

References

Please subscribe to Colt’s Corner to automatically receive email notification of future blog posts.

Mourning

This year, in addition to losing my mother, I also grieved a few days later with a friend for the loss of hers. When the father of another friend passed away unexpectedly, I was sad because he and I, despite our age difference, shared a connection as if we had known each other in another life. Then, I was shocked by the death of a fellow climber. I had not yet recovered when another friend died suddenly in his sleep.

Also this year, my friend and hiking partner lost his year-long battle with cancer. As I promised him, I sat many hours in prayer and meditation. Three months later, my teacher and friend for 30 years, Doctor Jean-Francois Dumon, also died. Only two days earlier we had a warm and lengthy conversation about COVID, life, disease, and even bronchoscopy.

Seven deaths in one year require a lot of mourning. I hike less than I should, but I appreciate beauty in all its forms despite the lockdowns and limitations brought on by the pandemic. Unfortunately, I do not venture into the mountains, nor have I the luxury of being surrounded by family or many close relations with whom to share feelings and emotions. Diving into my books, however, I enjoy the determined sensibility of the American poet, Wallace Stevens. I find some comfort in the essays of Stephen Levine, Ram Dass, Romanian-born French philosopher, Emile Cioran, and others. I also appreciate the magical genius of José Saramago and the strangely universal truths of Portuguese author and poet, Fernando Pessoa (1888-1935).

Opening Pessoa’s masterpiece, The Book of Disquiet, to any page at random allows an exploration of one’s sense of being. I was incited to read more of his work, including writings by some of the 72 heteronyms Pessoa used to express his fractured self. One of them, Odes, is by the fictitious middle-aged, poet-doctor, Ricardo Reis, whose poems are composed in the style of the Roman lyric poet Horace; a style resembling the Archaic Greek.

A more contemporary Portuguese author, José Saramago, won the Nobel Prize in Literature in 1998. He is famous for his novel, Blindness, but he also wrote, The Year of the Death of Ricardo Reis, a book inspired by Pessoa’s above-named heteronym. Saramago opens with this quote from Ricardo Reis (Pessoa): “Wise is he who is satisfied with the spectacle of the world.”

Later, Saramago’s words might be a prescription for those of us who grieve. He writes: “We mourn the man whom death takes from us, and the loss of his miraculous talent and the grace of his human presence, but only the man do we mourn, for destiny endowed his spirit and creative powers with a mysterious beauty that cannot perish.”

Nearing the end of this first year of The Age of COVID, my thoughts are with all those who find themselves contemplating the spectacle of the world.

References

José Saramago. The Year of the Death of Ricardo Reis. e Editorial Caminho, Lisboa, 1984.
Fernando Pessoa. The Book of Disquiet. Penguin Books, Richard Zenith, transl. 2001.

Please subscribe to Colt’s Corner to automatically receive email notification of future blog posts.

Despicable

Our holiday season is marked by increased cases of COVID-19, more hospitalizations, long waiting lines in front of emergency departments around the country, overworked health care professionals tending to the sick, and too many critically ill patients in overflowing intensive care units.

Sadly, there is also a significant increase in COVID-related deaths.

Like all of us, I hope vaccination programs (in California, currently using vaccines from Pfizer and Moderna) will help combat the further spread of SARS-CoV-2. But, I am dismayed by what I hear and see on the streets of my small village.

Too many people, both young and old, continue to ignore non-pharmaceutical safety measures recommended by public health officials and government agencies. Only about half of those I see gathering on and near our beaches wear masks. Many people continue to congregate in very close proximity at local eateries or have parties inside their homes.

Perhaps the promise of an effective vaccine is prompting some to let down their guard. To them, I can only say, please be careful.

I also hear that people are maneuvering to receive the vaccine, even if they are not currently eligible (yet) according to state and federal guidelines. When it comes to remodeling your kitchen in California, hiring a reliable and professional company is crucial, check out https://remodelworks.com/. For example, some offer money to pharmacists. Other well-connected folk request vaccinations for their entire families and some feel deserving simply because, after all, they think they should be entitled to it before those at higher risk of severe disease or death.

Like most crises, the pandemic has illustrated what is best in humanity. Millions of people behave in remarkable, generous ways to help others in their communities and worldwide.

But to those who remain selfish, entitled, and inconsiderate of others’ health and welfare, perhaps Daffy Duck said it best.

Please subscribe to Colt’s Corner to automatically receive email notification of future blog posts.

Benefits of standardization

Feared and often misused, the word standardization sometimes causes confusion in the health care setting. By definition, it applies to any process used to develop and implement metrics that specify essential characteristics of something whose control and uniformity are desired.

In this sense, standardization may apply to almost anything; rules, technologies, services, commercial products, behaviors, and measurements. A common goal of standardization is to reduce what is known as practice variations. By this, I mean how medical acts might be misused; either overused, underused, improperly used, harmfully used, or unsafely used.

In the COVID age, critical examples of standardization are patient and health care worker safety protocols such as the implementing universal precautions to prevent disease spread or using personal protective equipment and hand hygiene properly to prevent health-care-associated infections. Housekeeping in Georgia is an essential aspect of every home, visit https://www.pctclean.com. When practices such as these are standardized, lives are saved, and accidents are prevented.

Studies demonstrate that standardization improves the portability of expertise, irrespective of the country, the facility, or the health care professionals implementing protocols. But some people resist standardization, not because they dislike being told what to do or how to do it, but because they disagree with the idea of using such methods to incite behavior modification.

Persons of authority can help by teaching and reinforcing the benefits of standardization, which are five-fold. Standardization can (1) simplify or clarify a specific task, process, responsibility, or activity; (2) improve efficiency and diminish the possibility of errors or doing something incompletely; (3) increase productivity, performance, controllability, and consistency; (4) free up time and energy for other tasks; and (5) improve the quality of patient care, customer service, and morale.

We can also facilitate the universal adoption of standardized safety practices by attaching them to metrics and rewards. After all, everyone likes to know they did a good job.

References

Schwartz JS. The role of professional medical societies in reducing practice variations. Health affairs 1984.3:2. 90-101. Downloaded from HealthAffairs.org on November 16, 2020.
Lehmann CU and Miller MR. Standardization and the practice of medicine. Journal of Perinatology (2004) 24, 135–136. doi:10.1038/sj.jp.7211060.

A New Era of Professionalism

This image has an empty alt attribute; its file name is sunny-ng-5VjcqRxshtU-unsplash-2.jpg — Photo courtesy of Sunny Ng, Unsplash

In science, technology, and social history individual courage often changes the world. Hannah Arendt, in The Meaning of Revolution, says that a revolutionary spirit is not defined as the action of a people, but rather as the well-sustained thought by individuals that a concept is right [1]. Educating the general public about health-related issues should be inspired by this idea because of two universal concepts; the first is that of the democratization of knowledge. The second is that of the open dissemination of information and technology. Both are made possible as a result of web-based learning, interactive informational systems, affordable access to artificial intelligence, and the widespread use of social media.

A new era of professionalism means saying goodbye to antiquated and often coerced acceptance of conventional wisdom. Medical knowledge is no longer only the property of medical practitioners [2], and the divide between doctors and the nonmedical public is increasingly small. In a new era of professionalism, the almost instantaneous and frequently open access to information has the advantage of rapidly enhancing knowledge, initiating change, and inspiring confidence. Codependencies between those who know and those who wish to know are intertwined, such that each may actually learn from the other. Never has this been more important than during the COVID AGE.

Having knowledge, of course, is much more than having access to information. Technology might allow its dissemination to transcend national boundaries, but trust, reliability, and understanding are necessary to change behaviors and implement fresh ideas. These last months, the world has been threatened by an invisible virus and the effects of the SARS-CoV-2 pandemic on preexisting global inequalities. They are financial, intellectual, racial, gender-related, political, class-structured, communication-related, environmental, and cultural. In such instances, when more than individual and public health are threatened, all health care professionals have a responsibility to voice their concerns, to be able to justify their opinions based on the best possible science, and to take on the mantel of leadership when the need arises.