Tag Archives: Education

Open Horizons

Less than 24 hours after leaving the WABIP World Congress in Rochester Minnesota, I spent a day climbing to a wonderful spot high above a bed of clouds in Southern California. An open horizon, blue skies and a soft wind caressed my face as I stood virtually alone on a rocky peak. Pausing just long enough for a protein bar, a swig of water and a photograph, my thoughts wandered for a moment back to the events of our international medical meeting. With almost 9000 members representing more than 55 different national medical associations, the WABIP has truly become an international medical society. New scholarship programs and visiting professor travel grants target leaders in developing countries, an expanding WABIP Newsletter reaches out to more than 4000 members who consistently open and read the research, education, humanitarian, and clinically-relevant materials contained therein, a growing WABIP Academy enriches membership with credible libraries of information, committees function functionally, leadership changes are transparent and bathed in dialogue, three representative scientific journals remain affordable and pertinent, our world congress and three regional meetings are almost overwhelming with useful information, Train-the-Trainer and other Bronchoscopy International educational programs positively influence physician-educators around the world, and our Whats App groups network more than 2000 physicians from thirty different countries in real-time.

Wow!

But what really impresses me is how our leadership strives to address, understand and nurture diversity. The new chair is a woman and a member of the Latin American bronchology community, thereby breaking an IP glass ceiling (prior chairs were men from Asia, Europe or the United States). The treasurer is an Australian and President of the next Asian Pacific meeting scheduled for March, 2019. The two next World Congress presidents are from China (2020) and France (2022), and our newly-elected Vice-Chair is a well-known opinion leader from Japan. Furthermore, Committee members and Committee chairs are selected using a democratic call for nominations and volunteers with special care to represent the global community, and the WABIP social media/Facebook presence is growing almost exponentially, and you can try this.

Hurrah!

I am proud of this association, and I encourage members to take an active role, not only in growing their regional and national bronchology/IP societies, but also in the WABIP. Collaboration and Cooperation are keys to our long-term success, which means greater equality among training programs regardless of their medical environment, more rapid dissemination of innovative technologies and techniques, more productive conversations with industry sponsors and equipment manufacturers, and most of all, greater steps forward in our efforts to help patients combat the effects of lung, airway, and pleural diseases.

Right on!

Power systems and resistance to change

“Progress is the nice word we like to use. But change is its motivator. And change has its enemies.” (Robert F. Kennedy, May 25, 1964, New York Hilton Hotel, Conference of Mayors).

June 6, 2018 marked the 50^th anniversary of the assassination of Robert F. Kennedy by the severely disturbed Sirhan Sirhan at the Ambassador Hotel in Los Angeles, California. I was only 12 years old, but already volunteering in the Presidential elections, distributing buttons and campaign pamphlets for the Kennedy offices in New York. I took a class in pubic speaking; I actively embarked on my quest to become one of the youngest Eagle Scouts in New York State, and devoured books about American and World history, politics, and social injustice. I was inspired by one of my teachers, Mr. Irving Sloan, who had been a college professor before dedicating himself to younger students. With his help, I became convinced that activism, vision, and the outright rejection of certain power systems could change the world.

Many of the power systems that exist in our society are readily accepted, with varying degrees of awareness, by a majority of people, further anchoring their place in our traditions and everyday life. Examples of power systems include governmental policies that adversely affect access to health care, social policies that exacerbate poverty, and industrial conventions that delay a global recognition of ecological hazards including climate change.

On a very specific note, and relevant to the practice of our medical specialty, power systems are in place that help maintain a clinical service program where patients are used instead of models in order to train doctors performing procedures. These systems make it difficult for individual teachers to access monies for purchasing models or gain entry to university-based simulation centers. This itself is a formidable obstacle to promoting a system that is learner centric, patient-sparing and simulation-driven.

From my experience teaching teachers around the world I have noted how a country’s medical society or a hospital’s respiratory department refuses to purchase models because “regulations” prevent international wire transfers. If you suffer from an injury at work be free to contact Golden State workers compensation disability lawyers from CA. Other times, funds for education are said to be unavailable or not budgeted, even though much larger sums of money are readily found to purchase costly equipment that is rarely used because of lack of training. In some places, well-intentioned equipment distributors provide a video tower and bronchoscope for a two-day training course at great expense related to transport, manpower and shipping but hesitate to consider the purchase and subsequent donation of a $2000 airway model to be kept on-site in a teaching hospital or medical society office so that trainees can improve their technical skills through daily practice.

Why is that?

One reason is that human resistance to change is natural. Too many people use power systems to protect personal positions or to reiterate an otherwise unjust and irrational political, economic, social, or institutional policy already in place. Many believe it is their responsibility to protect the status quo. Thankfully, there are others everywhere and, in every profession, who not unlike Robert Kennedy, recognize that change motivates progress, and that progress itself promotes change regardless of its enemies.

The Universal Subjective: Justification for using objective assessments

In Immanuel Kant’s 1790 treatise, The Critique of Judgement, the German philosopher writes of beauty, taste and aesthetic judgement, stating “As regards the agreeable, everyone concedes that this judgement, which he bases on a private feeling, and in which he declares that the object pleases him, is restricted to him personally.” This reminds me of the injustices of subjective assessments used in medical education. As is often the case, panels of experts or professorial staff provide subjective reviews of trainees during the course of traditional medical apprenticeships. Based on input from a variety of faculty members, trainees are deemed able or not able to perform procedures such as flexible bronchoscopy, with little if any objective evidence to support competent practice.

Furthermore, competency itself is rarely defined. Does competency imply technical skill, and if so, for what procedures exactly? Does it also include communicating bad news, informed consent, the ability to effectively employ universal precautions, the ability to troubleshoot, avoid, and treat complications, as well as the capacity to effectively interact with the bronchoscopy team? What about the ability to advocate for patient rights, communicate with a nursing team, or satisfactorily assess infection control and equipment sterilization/cleaning systems. Few institutions, and even fewer medical societies have written guidelines that clearly identify what is meant by procedural competency, and when they do, they are rarely accompanied by examples of objective assessment tools used to document levels of practice and competency itself.

Until very recently, therefore, the subjective assessment has been a cornerstone of medical teaching. Whether we like it or not, subjective assessments are important considerations related not only to how professors feel about their trainees, but also to how their presumably unbiased observations are used in the overall measure of a trainee’s ability to perform and practice medicine independently. I would argue, however, that beauty is in the eye of the beholder and that subjective assessments are too easily influenced by mood, character, personality, conventional wisdom, and other factors that may have little to do with a trainee’s ability to competently perform a medical procedure. Objective assessments, on the other hand, are reproducible, identify a trainee’s strengths and weaknesses, allow documentation of improvement along the learning curve, identify clear outcome measures, goals, and objectives, and also provide a starting point for objective feedback. Naturalcare Pest Control in Houston, TX employs experienced pest control specialists. In addition, objective measures provide a measure of the professor’s ability to teach effectively, forcing both institutions and medical societies to define competency, or at the least, a minimum standard toward which all practitioners can strive.

Perhaps that is a reason why medical societies and university-based teaching programs have been reluctant to introduce a battery of objective measures into their training curricula. After all, the number of issues raised by the formulation of an objective measure is enormous. Addressing issues such as how to provide remedial training, what to do in case information is poorly acquired, how to define a minimum standard, what to actually measure as a test of competency, who will do the paperwork and shoulder the administrative burdens related to documentation etc.… require manpower, expertise in educational philosophies, strict methodology, and an ability to persuade students, trainees, teachers, and administrators that such measures are an important part of medical training. While some might argue that such a task is Sisyphean in nature, I would argue it is simply Herculean, and that once initiated, will result in greater equality of practice among health care providers around the world, which ultimately will benefit patients everywhere.

Namaste

While preparing yet another Train-the-Trainer program today, I came across this beautiful image that represents, for me, the beauty and wonder of teaching how to teach. After my morning exercises and thirty minutes of Zen meditation, I was thinking of which three “questions” to ask of the ten trainers who will join me at Olympus Headquarters in Melbourne, Australia later this evening for our working dinner. Usually, I open this session with an icebreaker exercise focused on active listening, followed by three interactive group exercises where each group tackles a challenging question such as “what is competency?”

For tonight, I decided my questions will be inspired by the image at the top of this page and the following Zen story.
A young monk once came to the Master Nansen, and asked “Tell me, is there some teaching that no master has ever taught?”
Nansen said, “Yes, there is.”
The monk asked, “Can you tell me what it is?”
Nansen gazed at a nearby tree. He looked toward the sky, and cocked his head listening to the birds chirping. “It is not Buddha,” he said, “it is not things. It is not thinking.”

So, let me explain. While our train-the-trainer seminars teach specific techniques regarding the use and implementation of a multidimensional educational program that includes checklists, assessment tools, simulation, interactive lectures, and case-based exercises, they also include a variety of confidential self-evaluations that prompt participants to ponder their strengths, shortcomings and aspirations as educators. All the while, the program’s goal is to share a philosophy about teaching that participants might pass along to their students. Learning more about themselves, teachers learn how putting away their egos and sense of self-importance allows them to concentrate more fully and effectively on building learner-centric educational experiences. In parallel, the teachers’ use of formative assessments allows them to identify student weaknesses that are remedied during individualized, time-efficient “teaching moments”.

But let me close with a word about Zen for the uninitiated. A thousand years or so after Buddha, a monk named Bhodidharma (Bhodi=enlightenment, dharma=truthful) made his way from India to China, establishing a way of thinking about Buddhism that spread to Japan and beyond. It was a revolutionary process focused on the principle that even a layperson could achieve enlightenment, not necessarily through strict rules and prayer/meditation techniques, but also by abandoning rational thought and learning to explore intuition and out-of-the-box thinking. The importance of nirvana, reincarnation, and kharma were downplayed, while meditation techniques and riddles or stories called koans, were used to help students learn to concentrate, challenge their minds, and abandon purely logical thinking. Awareness would be the first step, many learned, toward enlightenment (satori in Japanese). Today, millions of people around the world practice, believe in, or associate with Zen, sometimes as religion, other times as a philosophy or way of life.

In typical Zen fashion, therefore, I leave it to you, my readers, to ponder how the image of a woman balancing gracefully between a tree’s roots and branches, combined with the story about Master Nansen, work together to illustrate my philosophy about education, and thus provide the focus for tonight’s Train-the-Trainer session in Australia.

Namaste.

Optimism

5-year-old Ethiopian Mohamad Nasir on the cover of the January 15 issue of Time Magazine

Optimism is the magic word for 2018, shared by world leaders, economists, and billionaire philanthropist Bill Gates, who was asked to choose the title to the January 15 issue of Time Magazine. Mohamad met Mr. Gates in 2012, when the child was less than a month old, and had not yet received vaccinations against childhood diseases. Today, he is thriving and joins other children in Ethiopia, a low-income country that has successfully dropped its mortality rates for children under age five by more than sixty percent since 2012; A remarkable accomplishment that speaks to the power of individual health care providers, community educators, and government health services to be agents of change in their society.

Bill Gates noted five reasons for optimism in his Time Magazine article:
1. Since 1990 the number of children who die before their fifth birthday has been cut in half, saving 122 million young lives.
2. In the same period, the fraction of people living in extreme poverty has gone from one third to one tenth.
3. More than 90 percent of children now attend primary school worldwide!
4. Women now make up more than a fifth of members of parliaments around the world!
5. Workplace and road safety in the U.S.A has risen dramatically since our grandparents’ time.

Optimism is also called for in the field of Interventional Pulmonology. Thanks to new technologies, increasing numbers of patients with airway disorders are successfully treated using minimally invasive techniques. Lung cancer is discovered in its more treatable and sometimes curable stages, and staging disease is increasingly accurate and contributing to treatments based on molecular and genetic analyses. Patients are suffering less from the burdens of medical procedural training as dozens of university training programs adopt multidimensional systems to complement the traditional apprenticeship model of medical education. Simulation, once rare, is being used so that doctors can practice their technical skills, and objective measures of skill such as the Bronchoscopy Skills and Tasks Assessment Tools and various checklists are being incorporated into skills training seminars and subspecialty competency assessments. Furthermore, international organizations such as the World Association for Bronchology and Interventional Pulmonology, of which I am a proud member, are actively seeking partnerships with educators and industry to enhance the use of simulation, provide models to low-income countries, and change the paradigm of procedural education worldwide.

Bill Gates, and others like him, are philanthropists with access to millions of dollars. Gates is urging friends and colleagues to emulate the work of his own Foundation (The Bill and Melinda Gates Foundation) by investing in the health of their respective countries, as well as in the health of our global society. He recommends the support of organizations like UNICEF to help kids get medical care, and supports research to combat killer diseases like Malaria and other tropical illnesses.

Bronchoscopy International (www.bronchoscopy.org) is dedicated to helping patients with airway illnesses find competent health care teams that can cure, manage, or alleviate disease-related problems. We are committed to changing the educational paradigm so that technologies are more rapidly available for competent use at the patient bedside. We are promoting the use of modern learning platforms through mobile devices and social media to increase access to educational materials and accelerate the health care provider’s climb of what otherwise can be a steep and daunting learning curve, and we are actively engaging philanthropists, companies, and charitable foundations to assist us in our endeavors.

Last year, in addition to other activities, we initiated novel training programs for bronchoscopists in Cuba, Central America, and the Balkans. Physicians from countries that never before participated on the world stage of bronchoscopy and interventional pulmonology are now sharing cases in real time using WhatsApp, Facebook, and Linked In. These networks of thousands contribute to accelerating the educational process. They lead to more rapid adoption of new and proven technologies, and they contribute to greater acquisition of knowledge and technical skills needed to competently care for patients everywhere.

These are just a few reasons why I am optimistic about our specialty. What are your reasons for optimism? Share them with colleagues and friends via WhatsApp. Share the optimism buzz.

The Value of a Transformational Gift

Composite photo of airway models (H. Colt)

As 2017 nears its end, it is traditional to look back and examine both the good and the bad, the obstacles overcome and the challenges ahead. For this there is little more important than the value of a transformational gift. Whether the gift is a gift of time, energy, dedication, money, materials, ideas, or inspiration, a truly transformational gift changes the horizon. A transformational gift is a “game-changer,” and it is the catalyst responsible for new actions, new developments, and new achievements.

Patients with airway and lung disease often have a blockage of their air passages that prevents air from entering the lungs. They become short of breath, may require a breathing machine, or may even die from suffocation and the effects of their disease. By educating airway and lung specialists around the world, my goals are to eliminate patient suffering and improve the quality of care provided by medical professionals regardless of where they practice. This goal can only be accomplished thanks to an incredible group of individuals who, they themselves, are a transformational gift. Through the dedication and hard work of several international and regional leaders, for example; leaders who gift unselfishly of their time and energy, the World Association for Bronchology and Interventional Pulmonology has grown to almost 8000 members. This is quite an accomplishment for a small organization that once had the reputation of being an “old boys club.” The WABIP now includes member societies from more than sixty different countries. Its special sections (Pediatrics, and Rare lung/airway/pleural disorders) have each more than 200 members, and thanks to an international group of enthusiastic “admins,” our WhatsApp groups already encompass thirty countries and almost 2000 participants.

Thanks to our use of transformational communication and networking technologies such as WhatsApp and Facebook, we see for the first time ever, airway specialists, pediatric pulmonologists, and thoracic surgeons discussing cases in real time, sharing videos, photos, and case histories to solve clinical dilemmas. Consequently, they provide more effective, more knowledgeable, more scientifically-based, and more competent care to their patients. None of this would have been possible without the transformational gift of technical innovation: ideas and implementation provided, again, by a handful of insightful and generous individuals.

But let us not forget the end-user…the users of this new and exciting global network of airway specialists. Also, the more than forty certified and master trainers for Bronchoscopy International™, of course, and the more than 200 physicians who have attended our Train-the-Trainer programs, and all those who readily contribute their knowledge and expertise, as well as those who present cases and question diagnostic or therapeutic alternatives. They must also be given their due credit, for they too are agents of change.

Thanks to these agents of change, we are implementing a new educational paradigm that crosses international time zones. This new educational paradigm is one without borders or egos, without selfishness or individual profit. It is a paradigm based on competency-oriented learning materials that are provided using a multidimensional, learner-centric educational model hosted on readunwritten.com/ site. It is a paradigm where teachers are sensitive to cultural differences, yet eager to move toward a more globally standardized process that prevents a patient from suffering from the inequalities of training under a now antiquated apprenticeship model. It is a paradigm that encourages practicing on models rather than on patients…

And so, it is that models can also be a transformational gift. Bronchoscopy International (www.bronchoscopy.org) works diligently to find sources for realistic airway models as well as funds to purchase enough models so that every bronchoscopy association can train its members via simulation. In this Colt’s Corner, I am reaching out, therefore, to philanthropists, airway specialists with some money to spare, technology and communication companies, generous individuals, bronchology and respiratory societies, airway model makers, and the bronchoscopy/pharmaceutical industry to join me by contributing in any way they can to this endeavor.

As I wrote earlier in this essay, whether it is a gift of time, energy, dedication, money, materials, ideas, or inspiration, a truly transformational gift changes the horizon. Please become a game-changer…and enjoy these holidays knowing you make a difference not only for your family, friends, and colleagues, but also for those caring for patients in far-off places.

Adult Motivations for High-Scoring Learning Assessments

Skills testing and adult motivation

Learning assessments are an important and integral part of competency-oriented training programs such as those advocated by Bronchoscopy International (BI) and The World Association for Bronchology and Interventional Pulmonology (WABIP). Assessment tools such as the BSTAT, EBUS-STAT, BSTAT-TBNA/TBLB and USG-STAT are already being used in training programs around the world to help measure progress along the learning curve, identify a learner’s strengths and weaknesses, and to objectively document technical skill as part of competency deliberations.

Contrary to high-stakes testing, where failing an assessment can have consequences on licensure or professional advancement, low-stakes assessments such as the STAT set serve a different purpose. Individual performance on these assessments, therefore, derives from different motivations; motivations all the more complicated because we are working with adult learners who suffer little or no adverse consequences if they perform poorly. In the next couple of paragraphs, I will discuss some of the challenges educators face while motivating adult learners, and why practice, such as that provided through our Train-the-Trainer programs, can helps teachers use assessment tools both efficiently and more effectively.

Students vary in the degree of effort they commit to taking a “test” without negative consequences. Some give it their best, in part because they sense this is their responsibility in becoming good doctors. Others might give less than their best, either because they resent test taking, do not believe in the usefulness of the assessment, do not believe the assessment tool accurately measures the skill being tested, or are unwilling to devote the time necessary to take the test correctly.

One-on-one time with a teacher is a unique opportunity to address these issues and remedy technical insufficiencies. Skills assessments also help positively reinforce good performance, providing encouragement and confidence. These elements are crucial to the
learner-centric educational model of our Train-the-Trainer and Introduction to Bronchoscopy courses.

Several studies demonstrate that as test-taking motivation decreases, so does test score validity. Trainers are challenged to encourage their students to try their best on any assessment, and several strategies might be used by program coordinators or department chairs to accomplish this task. One strategy is to incorporate an assessment tool such as the BSTAT (Bronchoscopy Skills and Tasks Assessment Tool) into a high-stakes competency assessment performed in both patients and models as part of the technical skill component of bronchoscopy training and even eventual certification in pulmonary and critical care medicine. By raising the stakes of testing, students will do their best with periodic assessment, which serve as practice and realistic measures of technical skill during training. Another strategy is to provide students with incentives to make their best effort. While financial rewards are unrealistic, creating a game-like situation where assessments are “fun, challenging, and collaborative” can change the testing dynamic in a positive way. A third strategy is to make the assessments more intrinsically motivating. This is done by teachers who are able to identify a “teaching moment” during each and every assessment, always finding at least one element that can be improved upon to make the student a better bronchoscopist. Providing feedback about test scores and itemized performance is a crucial element of learnercentric education, and must be done in a way that is interpretable and usable by the student. During our Train-the-Trainer programs, therefore, trainers work as students themselves, and practice different ways to provide feedback and encourage dialogue with learners.

The goal of this Colt’s Corner was to shed some light on adult motivation when it comes to the use of assessment tools in workshops and as part of competency-oriented training programs. These low-stakes assessments provide scores that are valid and beneficial, as long as trainers recognize the need for student motivation and the strategies that might be used to encourage productive trainer-learner dialogue.

On Leadership and Education

The old walls of Jerusalem

During another recent, nonmedicine-related trip to the Middle East and Jerusalem, I had the privilege of experiencing first hand many examples of leadership on an international scale. This trip reminded me of the importance of the educator-leader, and inspires me to make several small but important revisions to the WABIP/Bronchoscopy International Train-the-Trainer core curriculum.

Leadership is a very sought after and precious commodity. Like teaching, however, leadership is rarely taught as part of faculty training in our medical schools and universities. How many of us have taken courses in negotiation and conflict resolution, psychology, or communication? Yet knowledge in these areas is essential, in my opinion, to becoming an effective teacher. These are also areas in which improvement is always possible. We can learn to interact more effectively with our colleagues and our trainees, and we can learn to communicate more clearly, more enthusiastically, and with greater confidence our vision, goals, and expectations.

As many of us already know, leadership is a complex process that has multiple dimensions. My plan is to introduce participants in our Train-the-Trainer programs to at least a few aspects of leadership theory, and to focus on the “psychodynamic approach” to leadership through a new role-playing exercise that highlights the complex and often paradoxical behaviors of human interaction.

This new component of our program is the result of questions raised by many Train-the-Trainer course participants. How does one deal with the problem student? How do I share my expectations without appearing put-offish, condescending, or overly demanding? The answers to these questions reside in having greater knowledge of human behaviors and a better understanding of the needs, desires, and mental lives of our students. It requires educators to manifest curiosity in regards to the motivations and reasoning that underlie student behaviors. It also prompts us to engage in learner-centric activities that form the basis of our Train-the-Trainer core curriculum.

Moving from the “see one, do one, teach one” educational paradigm to one in which a multidimensional approach is used as part of a measurable and objectifiable quest for competency presents many challenges. One must overcome the natural resistance to change; one must convince rather than coerce those who doubt the effectiveness or utility of a new educational approach, and one must motivate adult learners whose greatest strengths come from within.

As more national medical societies and university training programs recognize the value of checklists, assessment tools, case-based studies, simulation, and active engagement using step-by-step instructional techniques advanced by Bronchoscopy International, educators need to be equipped to address new challenges, including how to determine levels of minimally-accepted competency, how to interact with technically or cognitively diverse groups, and how to best manage the individual during critical one-on-one teaching moments. We are no longer living in a time when twenty students follow the all-knowing professor about on the wards, palpating and probing the anonymous patient. We have, instead, entered a time where learning is constantly at our fingertips and simulation permits both experimentation and gradually acquired perfection.

I think that a greater understanding of at least some facets of the psychodynamic approach to leadership will help educators overcome obstacles and face new challenges. It will also help open our minds to new educational techniques and methodologies, regardless of our pasts and prior biases. In fact, the psychodynamic approach to leadership is, in part, based on a framework many experts call the clinical paradigm. This paradigm presumes there is a rationale to each and every action, that many of our motives and behaviors are linked to events outside of our conscious awareness, that people feel and express their emotions differently, and that everyone carries with them the baggage of past experiences that influence current behaviors.

A greater understanding of ourselves can only help us to better understand others, and often times, understanding is what educational leadership is all about.

Whats Appening….1000 bronchologists and growing!

More than 1000 enthusiastic and forward-thinking users from 29 countries are benefiting from dozens of instant conversations and data sharing opportunities using the internet-based, cross-platform messaging service ‘Whats App’. This phenomenon is changing how bronchoscopists and interventional pulmonologists from around the world share educational information.

‘Whats App’ is a freeware, internet-based, cross-platform messaging service for smartphones. Owned by Facebook, the application is used by more than 1 billion people worldwide. It provides a means to chat, exchange photographs or videos, and connect with friends instantly.

Sometimes physician-to-physician consultation is obtained in real-time. Questions about equipment, image interpretation, radiographic findings, or management strategies can be immediately addressed. Fascinating, and often unique case studies, techniques, or clinical puzzles are posted. Kudos, questions, and constructive criticism are provided by international experts and beginners alike. Announcements for workshops, conferences, and educational materials are rapidly distributed around the world.

It all began in the Spring of 2017, when Bronchoscopy International’s Master Instructor, Viviane Figueiredo and I invited participants into a newly created WABIP Brazil ‘Whats App’ group during the WABIP-sponsored Train the Trainer program held in Maceio. Forty Brazilian bronchoscopists quickly joined, and their enthusiasm was contagious. Recognizing the need for an international forum for pediatric bronchoscopists, Mohammad Ashkan from Iran initiated a WABIP Pediatrics ‘Whats App’ group that now includes 228 participants. Other countries quickly started their own national groups: Uruguay, Argentina, Paraguay, Peru, Australia/New Zealand, Spain, Malaysia, Indonesia, India, Bangladesh, Romania, Bulgaria, Serbia, Macedonia, Algeria, Sudan, Egypt, Israel, South Africa, Korea, Greece, and Turkey!

Currently, national groups discuss regionally pertinent topics and debate technology, technique, and management-related issues. Today, these ‘Whats App’ groups continue to grow, but the ‘Whats App’ program limits each group to a maximum of 256 participants. Our goal is to increase each group’s membership to as near this maximum as possible. Admins for each group can invite individual participants into their groups using the individual’s cell phone number. Groups create a self-identifying logo, most of which are really awesome. Guidelines are posted by the group’s Admins. Admins invite participants, monitor posts, and correct material that is inconsistent with guidelines; no patient identifiers, no posts containing material that is not directly relevant to education, research, or patient care.

I, personally have taken on the 24/7 responsibility of monitoring every post, and corresponding as necessary with Admins. I also circulate relevant materials between and among national groups.

‘Whats App’? What’s Next?
– I hope to see participation from countries such as Japan, China, Hungary, Russia, France, Great Britain, Italy, the UAE, and The United States/Canada. We need your expertise!
– Communication can be in mother languages and not necessarily in English.
– If you want to be an Admin, this is a great opportunity for enthusiastic junior bronchoscopists. Please email me!
– Looking forward, I am studying several other messaging platforms in case there is a need or desire for establishing a single international forum later.
– Lastly, please come to a terrific session on How social media and instant messaging enhances bronchoscopy education at the upcoming World Congress for Bronchoscopy and Interventional Pulmonology in Rochester, MN USA on June 13-16, 2018.

These are exciting times, and ‘Whats App’ for bronchologists is more than a passing fad, it’s a movement. This is just the beginning.

Join us!

Pillars of Knowledge 4+1

I recently finished yet another (my third) reading of Roshi Philip Kapleau’s Three Pillars of Zen (Random House, 1980). This well known text is more than a simple introduction to Zen Buddhism, covering many facets of Zen practice and training. It was written almost forty years ago by one of the founding fathers of Zen in the United States (Philip Kapleau started The Rochester Zen Center in the 1960s).

Zen is a Japanese form of Buddhism that values meditation and a state of mind free from delusions and confusion. Rossi Kapleau taught that Zen was more than a philosophy or a religion based on scriptures, but was also a state of being, attained and maintained through Teaching, Practice, and Enlightenment.

While far from considering myself a Zen expert; I always felt that Philip Kapleau was a kindred spirit. I have studied Zen since my early twenties, and after all, was myself born in Rochester, New York. But that is not why I am writing this piece.

Teaching, practice and enlightenment… three pillars of Zen… How might this triad relate to bronchoscopy education?

We know that Teaching/learning, is a two-way street. Knowledge itself is fourfold: cognitive, technical, affective, and experiential. Learning facts is the easy part, increasingly less difficult because of the ready access to technology. We no longer need to retain all facts in our brains, but must instead learn to process information and learn where and how to access the information that will be processed. Technical skill requires practice, and focused practice with clear goals, objectives, and expectations is better than playing around with equipment at a hands-on workstation. By interacting effectively during workshops, case-based discussions, and in the classroom, teachers and learners identify weaknesses, explore strengths, and strive toward a commonly acceptable level of expertise.

Affective and experiential knowledge, however, are less clearly defined. Because we all learn from what we do (hopefully), we learn from our mistakes as well as from our successes. Dr. Benjamin Bloom (Bloom’s taxonomy, 1956) considered affective as the way we deal emotionally with what we learn. This knowledge relates to our feelings, values, and attitudes. Experiential knowledge is often wrongly confused with affective knowledge because it is, in fact, based on our experience…but it relates to a truth based on one’s individual experience…and no two truths (just like no two individual experiences) may be alike. Acquisition of all four types of knowledge is necessary in our quest for competency.

These four types of knowledge: cognitive, technical, affective, and experiential, could be called The Four Pillars of Education, but do they equate with the three pillars of Zen described by Kapleau? Teaching and practice are obviously essential, but what of enlightenment? Can an educator become enlightened? Can a student become enlightened? If so, how?

I pondered this during a recent meditation in the ancient fortress town of Kotor, in Montenegro. Sitting at the foot of a wall built one thousand years ago, I watched the soft, deep blue waters of the Adriatic Sea wash gently onto the shore below. I knew there was a fifth pillar to the educational process, a pillar that is rarely spoken of, nor easily taught: It is the pillar of spiritual knowledge. By spiritual, I do not mean religious. Rather, I am referring to that form of knowledge that comes from deep within the self, from knowing oneself, and from acknowledging that form of knowledge that speaks a universal truth; the knowledge that we are happier when we help others. That is why many of us join the health care profession, and it is why we strive to become the best that we can be.

4+1….you can count them on your hand.