Tag Archives: Education

Feelings are important

Oscar Wilde wrote that “experience is the name that everyone gives to their mistakes” (Lady Windemere’s Fan, Act III, 1892). Just as we are not expected to become champion tennis players without hours of physical training, coaching, and careful attention to our head game, doctors should not be expected to become competent bronchoscopists simply by taking the scope in hand at the patient’s bedside. As in sports, learning requires the acquisition of skills and facts, but also an understanding of how we feel about what we are doing. Professional athletes have recourse to a team psychologist. Doctors are presumed to converse with colleagues or other health care professionals.

When I ask bronchoscopists from around the world whether they practice their response to procedure-related complications such as massive bleeding, seizures, cardiopulmonary arrest, or pneumothorax, in a simulated setting, the answer is almost always no. Nor do they discuss how they feel after the occurrence of such complications. I think this is because doctors have learned by doing for too long, and only recently is there a move toward coaching using models, simulation, and debriefing sessions.

Organized efforts are still necessary, however, before new generations of physicians adopt this as the norm. The same can be said about addressing a doctor’s emotional responses to complications. Most surgery departments have morbidity and mortality conferences to discuss problem cases, but such practices are not routine within the interventional pulmonary community. Even when discussions occur, there is little support for physicians struggling with their feelings.

While it is relatively straightforward to convince an enthusiastic trainee that practicing on a model will accelerate growth along the learning curve, it is less obvious to persuade doctors that talking about their feelings (which addresses their affective and experiential knowledge) can help prevent complications and improve patient care, as well as reinforce positive attitudes toward medical practice.

An educational program that includes simulation-based instruction and open discussions about feelings, therefore, requires a paradigmatic shift where leaders think outside the box monopolized by “see one, do one, teach one” behaviors in order to embrace practices guided instead by a “First, do no harm” philosophy.

Master Instructor Viviana F. implements simulation-based bronchoscopy training in Brazil

 

 

 

 

Virtual Reality and the future of bronchoscopy education

The strength of clinical medicine resides in the practitioner’s ability to diagnose, treat, and understand the impact of disease on a patient’s condition. Such practical wisdom, or what Aristotle called phronesis is gained and nurtured at the bedside.

It is the scientific understanding of disease and health, Aristotle’s episteme, however, that leads to medicine’s greatest advances. From a technology, education, and practice perspective, interventional pulmonologists are the descendants of giants such as the American Chevalier Jackson, the German Gustav Killian, the Japanese Shigeto Ikeda, and the Frenchmen Jean-Francois Dumon and Christian Boutin.  These men armed themselves with technologically innovative equipment created as a result of discoveries in the optical sciences, improved the initially engineered product, and applied their creative skill and imagination to serve their fellow man.

Technology today provides interventional pulmonologists increasing means to diagnose and treat disease. It is no surprise therefore, to see a global focus on education in order to provide practitioners with a uniform foundation of knowledge and technical skill regardless of where they reside. The future of our educational process includes structured multidimensional learning programs, masterful use of simulation and models, and now, development of virtual reality-based instruction. Equipped with headsets from Oculus, for example, learners can already navigate the virtual airway to master anatomy in minutes. Using an iPad and programs such as BronchPilot Anatomy or BronchPilot EBUS, learners can master bronchoscopic movements, factual knowledge and inspection strategies well before touching a real patient.

Creating these virtual worlds is a current challenge for medical educators. It is a challenge the faculty of Bronchoscopy International and leaders of the World Association for Bronchology and Interventional Pulmonology gladly accept. Exciting times are surely ahead!