PTSD

Took a well-deserved break from studying by watching a movie with some old friends. I don't want to spoil the plot of the movie, but essentially a soldier (who was thought to be dead) unexpectedly returns from his service in Afghanistan suffering from post-traumatic stress disorder (PTSD). While a captive in Afghanistan, he was forced to kill his comrade or risk being killed himself.

When the solider returned to his family, he had difficulty trusting his loved ones. He presented with unusual behaviours, such as compulsively organizing dishes in the kitchen according to shape, size, and height. His affect changed from before - it became incongruent. Finally, he lost his ability to show emotion.

It's hard to say whether the movie made me more or less interested in psychiatry. I've always found psychiatry fascinating for the reason that patients often present with complex and multi-layered problems. Piecing together a patient's situation is no easy task, but the exercise itself allows room for interpretation and analysis. Psychiatry may not be one of the more evidence-based branches of medicine, but it does finely capture the art of it. However, treatment is usually long and arduous (even if you suggest pill-popping), some patients may deny having any mental health disorders, and improvements are hard to measure. With limited techniques and strategies, how do you know you are helping your patients?

WC

Reflections on My 22nd Birthday

Loosing energy and easily fatigued from 9-5 classes. Falling behind in my lectures even though I'm studious. Not leaving enough time for my friends and family. Getting moody, doubting my abilities, and questioning career choices. Unhappy with my learning progress and intimidated by my peers. Cannot express my thoughts clearly to others. Finding emptiness in other people's advice and suggestions. Looking for a confidence boost.

Dx: burnout?

Rx:

Long-term care: re-sparking the debate

Staff at Joseph Brant Hospital in Burlington are asking their elderly patients to go home in order to free up hospital beds for those needing acute/emergency care. Critics of this action suggest that the hospital is really removing, rather than freeing up, these beds in order to reduce their $5.5-million deficit. What strikes me as surprising is that staff are wearing "Home First" buttons to promote this initiative. What impression does this give to patients who absolutely need hospital care? Unfortunately, in order to balance the reality of taking on more patients, especially those with acute care needs, others are left to draw the short end of the stick. This time its seniors, re-sparking debate about the need for extended home care coverage and investment in long-term care facilities. 

A few issues are at play.

There are both advantages and disadvantages to receiving care at home. At home, patients are most comfortable in a familiar setting, can move around more to improve rehabilitation, and are away from any threat posed by superbugs at hospitals. However, the sicker the patient, the more supervision they need. Supervision by health care professionals costs money and currently the province only covers 1-hour worth of services - the rest of the costs have to be shouldered by the patient and their family. Admittedly, the hospital is trying to get churches and community organizations to help out, but the absence of any suitable long-term care facilities makes alternatives difficult to consider. 

One hopes that the hospital is only releasing elderly patients when they are deemed fit to leave. This cannot be guaranteed in constrained circumstances where new patient arrivals dictate the frequency of freeing up hospital beds. Acute care needs trump chronic care needs, but a chronic care patient left unsupervised in their home can easily wind up with an acute care problem. Are they ways in which adequate home care services can prevent this from happening?

My housemate Gabe believes that technology offers a solution. Specialized monitoring systems could be set up at home to provide 24/7 visual access on the patient's whereabouts. In addition, gadgets could be attached to their bodies to provide feedback on vitals and any unusual physical movements. All this information could then be fed into a data processor where people would work around the clock to monitor the health and safety conditions of hundreds, if not thousands, of patients living at home. Could this work as a short-term solution? 

WC 

Teaching Evaluation

Period 1 Ratings   4 3 2 1 Total  Overall Evaluation of Orgo Instructor?  2  8  2  0  3.00   Was the instructor prepared for class?  3  7  2  0  3.08   Did the instructor make the class interesting?  3  7  2  0  3.08   Was the instructor on time?  11  1  0  0  3.92   Did the instructor move the class at the right pace?  5  6  1  0  3.33   Student 28, Evaluators: 13 Average 3.28   4 = Excellent; 3 = Good; 2 = Satisfactory; 1 = Poor; 0 = Unacceptable

Not bad. Wish there was qualitative feedback. 

WC

Crying Babies

Imagine this. You've been asked to supervise a male infant in one of the pediatric wards. Upon entering his room, you are relieved by the fact that he is sleeping peacefully. It's almost the end of your shift and you welcome some tranquility at last. 

As you take a seat at a nearby chair, you can't help but notice the rhythmic rising and falling of the infant's chest. You remind yourself to look out for any abnormal patterns of breathing. The boy is resting on his stomach and you wonder why he hasn't fallen asleep on his back. You remember from your developmental psychology class that it is generally safer for infants to sleep on their backs with their face to the ceiling. He seems comfortable in his resting position so you don't bother to move him. At least his head is tilted sideways so that you can watch his face while he sleeps. 

After the fascination of scrutinizing the baby subsides, your mind starts to wander. You start to think about your plans for the afternoon, for the rest of the week, and ultimately for the rest of the summer. A TV is right beside you, but you know better than to turn it on. If a parent walked in, you wouldn't want to be caught doing anything other than supervising their precious child.   

Suddenly, the infant blinks. Is he waking up or just teasing you in his sleep? He blinks again and his eyes widen. He's awake! You haven't played with an infant in a while, but you are ready to at a moment's notice. 

He starts crying. Not surprising. He probably misses his mom or dad and feels threatened by this random stranger in the room. Predictable attachment response for an infant at this age. You try to use soothing words to calm the baby, but to no avail. 

Next, you try rolling him over on his back to facilitate more open communication. Your maneuvers are clumsy and sloppy. His crying gets worse. 

You try to give him a soother. It works temporarily, but he wants none of it after a few seconds. He redoubles his crying efforts.

Out of desperation, you try to distract him with some toys. He hardly pays attention to them. By now, his wailing hurts your ears and you are emotionally crushed by the tears rolling down his cheeks. Must be a pain response to something medical in nature. 

You attempt the last trick in your books - a cuddle. You haven't done one of these in a while so you're naturally hesitant to take him out of his bed. You note several cords and lines attached to his body, which complicates getting a firm hold on his limbs and torso. Forgetting to swathe him in blankets, lowering the guard on the bed, and giving him enough neck support are only a few mistakes you make while performing this intricate move. He cries more intensely to signify your failure to attend to his needs. Frustrated, you put him back down on the bed. 

Despite years working with children and being a regular volunteer on the pediatric ward, you feel a strong uneasiness about what to do next. Besides being unable to calm the baby, you are not even certain about why he is crying. 

Feeling helpless, you're about to give up when a nurse suddenly arrives. Remarkably calm, she provides words of encouragement, explains why the baby is crying, and thanks you for supervising the child. It's her turn to take over now. You feel undeserving of her appreciation. 

As you exit the room with a hanging sense of defeat, you wonder what you would do if the nurse didn't show up.

Am I ready to respond to an emergency?

Last weekend, I did a course on Standard First Aid and CPR. If there is one thing I took away from the experience, it would be the following: saving a person's life in any emergency situation is of utmost importance. Those with adequate training have a responsibility to intervene in dire situations that call for their expertise. 

All of this seems noble and Good-Samaritan like, but I'm still left with an unsettling feeling. After a weekend of training, I hardly consider myself qualified to handle an emergency situation on my own. If I make a mistake in any step of the life-saving protocol, am I not guilty of doing more harm than good on the patient even though I act out of good faith? Despite sufficient training, making a mistake is a real possibility in the heat of the moment as you race against time to save a life. 

For example, using an automated external defibrillator (AED) can help bring a patient back to life from cardiac arrest by delivering an electrical shock. Although the AED is a reliable, user-friendly, and generally worry-free device, things can still go wrong if metallic objects are not removed from the patient's body before administering the shock. These details are all too easy to miss in the spur of the moment. If death results from this negligence, you may not be held liable due to Good Samaritan laws, but can you truly escape the blame put on yourself? Can you erase the thought that, had you not intervened, the patient would probably still be alive? In this case, fear of adverse consequences and doubt about one's competency are legitimate excuses for inaction. Wouldn't it be better if someone else assumed responsibility? 

I'm at the cusp of understanding not when and how, but if, I can provide care. 

Methadone not good enough?

One of two Calgary methadone treatment centres that services about 500 patients is scheduled to close at the end of this month. The reasons include not meeting city standards for zoning and not adequately consulting with community associations before it opened in late 2008. 

How it managed to open despite these claims is anyone's guess, but is it justifiable that the community associations are legitimately worried? On one hand, they can be blamed for adopting a "not in my backyard" policy and fueling the stigma of those living with substance addictions. But if you put yourself in the shoes of a community resident, having addicts freely and frequently roam your streets may be a good enough reason to complain. 

Let's take a step back and look at the big picture for a second. Closing the treatment centre will leave a few hundred of people without the appropriate care and support needed to wean off their drug addictions. This will be particularly devastating to those who are already committed to their regimens, but that need convenience and habituation to carry themselves through. The risk of relapse will be high, potentially undoing years of hard work on the part of both patients and health care workers. 

Although immediate closure seems like a worst-case scenario, relocation is not that much better. As mentioned, treatment for substance abuse can be long and arduous. If people with addictions rely on routines to maintain compliance, any disruption in this pattern can be detrimental. How big of an impact will moving a clinic cause? I guess it depends on how far away it will be from the greatest locus of clients, how many health care personnel will continue to work in it, and if the services will be delivered at the same level of efficiency. It doesn't help that a 3-month wait time exists at the other methadone clinic, which cannot realistically take on more patients. 

What bothers me is this. Even though science (and perhaps some heart-warming testimonies) can show compelling evidence of the effectiveness of methadone treatment, the needs of substance abusers often come second to none. Are they less deserving of treatment because of who they are or what they do? You would be surprised if I told you that those with drug addictions come from all walks of life. 

Even then, a doctor would say no to this question because dealing with health and health care issues is what unifies all human beings. As Perri Klass puts it nicely, "doctors are engaged with individual humans at the level that makes everyone human." 

On the other hand, a policy-maker (as this is a career path I'm still considering) has to weigh several other opinions, ranging from those of city counsellors to community members to anyone else with a public interest on this matter. Policy-makers sorting through this dilemma would be hard-pressed to take sides between those that are healthy versus those that are unhealthy. Doctors, as advocates for their patients, have a clear position. 

How can someone reconcile being both a doctor and a policy-maker?

WC

Big'ups

Big'ups to the movie Up!

I finally had the chance to see it, and after much anticipation, it still managed to exceed my expectations. Just based on the preview alone, one would think that the lead character, Carl, is just a grumpy old man with nothing better to do than concoct wild ideas of flying a house. Who would have thought that he lived a life that many people only wish they had, of growing old with the person you love the most?

There was an obvious climax to the movie. This was when Carl finally reached Paradise Falls and looked over his sentimental "Adventure Book" for the last time. Up until then, Carl had been living on a unfulfilled promise to his late wife, Ellie. When he flipped through the book, little did he realize that Ellie's adventure began when they got married. It was a heartfelt reminder of cherishing the past and moving on. 

Sometimes we need a wake-up call to remind us of appreciating, rather than, regretting life's journey. Sometimes it takes the most unlikely of characters, such as a chubby Wilderness Explorer, a talking dog, and even an overgrown pelican, to change our frame of mind. Sometimes, embarking on a new adventure happens when we least expect it.

WC

Dental Discoveries #2

My tooth aches. It's the same tooth that had a cavity and then a filling. I'm seeing the dentist this Wednesday to get it checked up. I suspect that either the filling came loose or the cavity wasn't completely removed. Either way, the dentist should fix it up without charging extra on top of a regular appointment. I will be quite surprised if I have to pay additional costs for what very well may have been her mistake. 

During my last appointment, the dentist recommended a wisdom teeth extraction. She stressed the importance of preventative action: taking out your wisdom teeth at a younger age will lower your risk of getting infections in the future. In her opinion, removing the teeth before their roots fully mature would be a less invasive and less painful procedure (no bone drilling required!). Although she presented these reasons convincingly, I was suspicious about her vested interest in doing the extraction. I asked her about the fee for removing one wisdom tooth - a whopping $300! For three teeth, my dental insurance would not only max out, but over 2/3s of the funds would have to come from my pocket. Tooth be told, I needed to talk to other people and do my own research before making a final decision. 

So far, I have shared my concerns with three of my colleagues at UofT dentistry. They have all provided me with some sound advice, despite the controversy surrounding wisdom teeth removal. One friend encouraged me to consider whether my teeth will induce pain and discomfort by putting pressure on adjacent ones. When I reviewed my X-ray images with the dentist, she pointed out that one of my teeth was growing in sideways. I admit that I was worried about this at the time and almost bought in to the procedure right away. 

My other friend told me, in more detail, about how impacted wisdom teeth can cause many problems down the road. There are several ways. If they grow sideways, they can crowd the rest of your teeth and mess up your beautiful row of pearly whites. Although this may be true, tooth alignment does depend to some degree on the size of your jaw. 

He also discussed the possibility of having the wisdom teeth erupt into the oral cavity, allowing bacteria to accumulate and cause decay on adjacent teeth. Although infrequent, these infections can spread to the head and neck regions, potentially damaging surrounding nerves. In a worst case scenario, the brain and heart can be infected through fascial spaces. 

On the other hand, he mentioned about the cons of going forward with wisdom teeth extraction. With any medical procedure, risk is involved and mouth surgery is no different. For example, the lingual nerve, which is fairly close to the third molars, can be damaged if the surgeon is not careful. I wonder how often this happens as I have yet to look at studies that investigate dental errors. 

My last friend talked about the risk of having caries on partially erupted and fully impacted wisdom teeth. This can potentially lead to damage to the surrounding bone structure if decay progresses toward the root of the tooth. When he mentioned this, I couldn't help but wonder whether good oral hygiene would save any of this from happening. He did say that brushing wisdom teeth is more difficult than brushing regular teeth. In addition, there is no accessibility to those that are impacted.

He did leave me with some positive considerations for keeping the "wise" ones. First, they can be used to treat damaged teeth - I guess in a similar way as grafting skin for burned areas on the body. Apparently, they can also prevent bone resorption of the jaw during old age. As to how this happens, I have no clue. I'm sure the dental literature holds the answer. All these considerations come with keeping immaculate oral hygiene. 

At the moment, I am leaning towards having my wisdom teeth removed, but only when my dental insurance coverage gets renewed in the fall. I have three impacted wisdom teeth with one growing sideways into an adjacent tooth. Although none of them bother me at the moment, they are in a prime position for extraction because their roots are not fully grown. This means that the surgery will be less intense and post-operative recovery will be smoother if I do not delay.

I'm anxious to see what the literature has to say about my colleagues' advice. 

WC

Losing Momentum...

Teaching is something I used to enjoy. Now, it feels like a chore that I just don't want to do. 

When I'm giving a lecture, I often wonder what my students are thinking about me. Are they confused about my explanations? Do they think my jokes are too corny? Am I a boring lecturer? I can sometimes read their minds through their facial expressions and body movements. Not everyone is going to be wide awake and interested about what I have to say, yet I am quick to assume fault for this. Irrational, no? 

Today, I got the sense that my students were getting fed up with my teaching style. I covered a particularly unexciting section of organic chemistry, which involved writing out reaction upon reaction on the board. I admit that I wasn't fully prepared for this class - my boardwork was sloppy, my explanations unclear, and I made mistakes. As the class carried on, I felt that I was losing the confidence of my students, leading to doubts about my ability to teach. I was quickly reminded of my struggles during the training session for this job. 

Why am I having these reservations? Maybe there are things that I don't like about this teaching position. Firstly, organic chemistry is not my passion. I don't get excited about electrons moving around, but I'm sure that there are some people who do. Secondly, teaching that requires intense board work for 2.5 hours is physically laborious. I feel like I have to bring a change of clothes, a towel, and a water bottle even though I'm not headed to the gym. Finally, my learning philosophy is fundamentally different from what the Princeton Review practices. Being in the shoes of a student, I know that there is limited value to lecture-based learning. It takes a lot of skill and practice to be an excellent lecturer, but if I could have it any other way, I wouldn't be teaching the material in this style. 

Teaching does have its perks. It's always nice to interact with the students and help them reach the "Aha!" moment when they finally understand a concept. Questions that are asked during class encourage me to be quick on my feet. Finally, teaching is an opportunity to develop communication skills - you have to be clear and concise when conveying your knowledge to other people. 

I suppose that I just had a bad day and things will pick up in the next class. I wish there was an opportunity to get more consistent feedback from my students so I could see where to make improvements. I'm not satisfied with being just an average teacher...I want to be a good one. 

WC

What a patient can teach a doctor?

Dressed in a gown and wearing only shorts, I felt cold in the doctor's room. This was going to be a long night, I reminded myself, and popped a piece of cinnamon-flavoured gum in my mouth to freshen my breath. I quickly reviewed my clinical case so that I knew all the facts of my "fake" condition. The OSCE examination was supposed to commence 15 minutes ago, and I had no idea why things were starting so late. Oh well, I thought to myself, time for me to sneak in a power nap. Afterall, I needed all the rest I could get before blitzing for 6 hours straight.

As I was just about to close my eyes, the clinical evaluator for my station came in. She looked a bit flustered, and I gathered that she too was unhappy about the lack of punctuality. We had a quick introduction before she started shuffling through her papers and getting organized. When she was finished preparing, we discussed about possible reasons why the examination was running behind schedule - could it be that some preceptors or standardized patients didn't show up, was there a mix-up in the organization, did some first-year medical students loose their way? We did not know, but clearly she was becoming more impatient with each passing moment. 

Alas, we heard shuffling noises behind the door - the students were lining up and reading the triggers! A gentle knock on the door soon followed. The first medical student was ready to enter the room and perform their required duties. I was nervous for them. 

A young man in his late twenties walked in. Upon entering the room, he washed his hands right away, introduced himself, asked me how I should be addressed, and asked permission to examine me - all standard procedures of a short clinical exchange. Did he forget the confidentiality spiel? I made a mental note of it. I could tell that he was anxious - it showed in his trembling hands and stuttering voice. He asked me to describe my symptoms and I gingerly recalled the information relevant to my clinical case. For some responses, I deliberately spoke in vague terms so as to prompt him to follow up with more focussed questions. There was nothing interesting or outstanding about my clinical presentation, but I noticed that the medical student was trying hard to study every response I made. Simultaneously, he was trying to work through a standard set of history-taking questions - past medical history, family history, taking any medications, drinking/smoking/recreational drug use, diet, etc. There were moments where he paused to recall a series of questions. This impacted the flow of the conversation. Who would have thought that communication could be so challenging in a clinical setting? 

After the history-taking, he performed an abdominal examination on me. I had to lie across the bed in the room with my gown rolled up to my chest and drapes across my lower extremities. I felt vulnerable, self-conscious, and not surprisingly afraid. This random stranger was about to put his hands on my stomach and perform tests that would induce discomfort and pain. I could tell his hands were cold and I cringed at the prospect of having sweaty hands kneading at my skin. I was not prepared for this kind of up-front and physical interaction with a person entrusted to care for me. I had a rare glimpse of what it feels like to be a patient.

During this one-night stint, what did I learn about being a doctor? Sure, it is important to know how to take a proper history and physical examination. As you build a differential diagnosis about what the patient has, you have to be quick on your feet to process new information. It is important to ask the right questions that will guide your clinical judgment but not restrict the flow of the conversation. For example, when you ask a patient if they have experienced "fevers, chills, or nightsweats", you might get a response along the lines of "no." Does that mean that the patient is experiencing none of these symptoms or just a few of them? It doesn't hurt to clarify, summarize, or paraphrase in these circumstances. But these competencies alone do not separate average doctors from good ones. 

Of all the medical students that I met that evening, who did I prefer to be my doctor? Those that showed empathy immediately caught my attention. One of my rehearsed opening statements consisted of telling the students that I was worried about my condition. Only a handful of students picked up on the opportunity to say, "I could imagine that going through this must be hard for you." A seemingly insignificant statement made a significant difference in my mood. Realistically, it's difficult to remember to be empathetic when your mind is juggling what you're trying to say, what you are seeing and hearing, and how everything fits together to paint a clinical picture. But showing empathy is crucial because it demonstrates that you genuinely care about the patient's plight and take interest in understanding their situation more deeply. 

Of course, there are other things that a physician can do to show concern for the patient. For example, asking permission to perform certain procedures, explaining in lay terms what they are doing during an examination, warming their hands before touching the patient, and reassuring them that they made the right decision of coming in. These are all small actions that demonstrate respect and professionalism, the sum of which can have a huge impact on the patient's disposition. If we know that these displays of politeness and dignity are effective in building patient rapport, why do I still suspect that they are not emphasized enough in real life situations? No doubt there are competing objectives. In a brief 10 minute appointment, how do you know that you are showing enough empathy while balancing your duties of taking a thorough history and physical examination? Ten minutes is arguably not enough time to perform all these tasks, yet there is a point to be made about being efficient in the way you communicate. Of greater concern, how do you show that you are genuinely empathetic about your patient's plight when you have nothing in your past experiences to relate to what they're going through? For example, if a young pregnant female comes to see me about aborting her fetus, am I really in a position to understand what she is enduring? And finally, when does being genuine cross the emotional threshold in a way that biases your clinical judgment and renders your thought process irrational? 

In that brief encounter between the physician and the patient, I almost find the weight of the physician's responsibilities overbearing. 

WC

New Hairstyle...

Let me begin by saying that I think my head is awkwardly shaped. It is round yet asymmetrical, with the misfortune of having hair grow longer at the sides than on the top. In addition, my hair is dry and coarse in texture - two qualities that would make you cry if you were my personal stylist. Did I also mention that in bright, reflective light you might mistake my black hair for being gray? 

When I was young, I used to hate going to the barbershop because I almost always expected to be disappointed. My barber would ask me what I want, to which I would reply, "go crazy." I was never impressed by a single design. 

Recently, I've grown accustomed to my current hairstyle - the quasi fo-hawk. Its a clean cut, a bit funky, and has encouraged me to care more about personal grooming. However, maintaining this bad boy requires me to drop a bill almost every two weeks. Frankly, its time for a change. 

I know that my new hairstyle will be longer than the current one, with proportionally more length than width. I might push for a messy or a clean look, the former requiring less styling product and the latter requiring more. I'll also give the hair stylists a second chance. When I grow my hair, at least they'll have more confidence working with something long enough to hide their mistakes...

Here are some photos of old hairstyles. Should I return to them or try something new?  

The Paper Tear...4 Years Later

The dean of my program is known for his "paper tear" talk. I've heard him give the speech several times over the past four years, but I only decided recently to give it critical thought.

Here is what the "paper tear" is about: every audience member starts with a blank sheet of paper. Del, the dean of my program, delivers a simple set of instructions that requires folding the sheet of paper several times over and ripping it at specific corners. The catch to this straightforward exercise is that no one can talk and everyone has to keep their eyes shut at all times.

Although everyone followed the same set of instructions to complete the relatively easy task, each individual's final product was inevitably different.

What can be gathered from this demonstration?

Del believes that too often than not we aim for conformity and fail to acknowledge individual differences. For example, in a formal education environment, lecture-based teaching promotes a one-size fits all model for learning. Everyone gets the same dose of information, but it is obvious that the interpretations of such information will differ. Yet, when it comes time to evaluate our learning progress, we are expected to share similar interpretations in order to arrive at the same answers. The "paper tear" reminds us that while learning in this idealistic way is necessary for cognitive development, it has its limitations in the real world where complexity can shatter our overly naive thinking.

This brings me back to my program. BHSc. is rooted in the philosophy that a more personalized approach to learning allows its students to acquire knowledge at their own pace, using various mediums, and with the support of facilitators and peers. The "paper tear" exercise demonstrated that everyone arrived at a different final product because they weren't able to communicate with each other. It's no surprise then that collaboration is at the heart of the program. Were we able to work together, I have no doubt that our paper products would look similar if not the same.

In addition, we should understand how we arrived at the final product rather than if we had the same design. Focusing on process promotes the identification of strengths and weaknesses that is necessary for growth in learning. Exclusive orientation to outcome, on the other hand, can be maladaptive should it detract from understanding one's learning process. Unfortunately, most systems, especially those pertaining to education, are rested on measuring and standardizing outcomes. For example, good marks and grades are necessary for getting into professional school even though they are debatable indicators of your competency to learn.

It bothers me that I can't seem to remember my interpretation of the "paper tear" demonstration back in first year. Being young and reckless at the time, I suspect that I didn't have enough experiences to appreciate and internalize the value of the underlying message. Moving to a new school next year with a somewhat different pedagogical paradigm, I wonder how my interpretation of the "paper tear" will change. Will I still be a strong believer of problem-based learning? Only time, in the length of 4 years, will tell...

WC

Biking for a Cause?

Before this summer, I kept telling myself that my post-graduation vacation trip would consist of a luxurious and lengthy stay in a posh European city. I had other options laid out too: a trip to the motherland, an Indiana Jones' like escapade to Machu Picchu, and...a bike trip across Ontario.

So it seems that reality has set in and I just don't have enough dough to travel by air. I tell myself that I would rather travel by bike because I can get regular physical activity, leave less of a carbon footprint, and have the luxury of creating my own adventure. Economical considerations aside, it seems that a bike trip is growing more and more enticing.

Having the willingness to go on a bike trip assumes that one enjoys biking. I do enjoy biking, although I wouldn't say that I'm a hardcore marathon cyclist or an adrenaline-seeking mountain biker. Ever since I started the Duke of Edinburgh Awards program back in Grade 9, my first real exposure to the outdoors was with a biking troupe. On my very first excursion (from Toronto's Harbourfront to Mississauga's Indian Line campgrounds), I learned how to be safe while sharing the road with other vehicles, how to refrain from eating all of the other cyclists' food (anyone who knows my appetite can speak to this), and how not to roll over people in a communal tent. It was the beginning of my appreciation of the Canadian outdoors, although I would hardly consider a trip from Toronto to Mississauga "roughing it out".

The biking trips that followed were more physically strenuous, longer in duration, and wrought with challenges that required the problem-solving efforts of an entire team. On one trip, for example, my fellow cyclists and I could not find our campsite because it was late at night and we were caught in a torrential downpour. At one point, we found ourselves in the middle of nowhere...even our map was of no help. A few members of the group became frustrated at the realization of being lost. After everyone was reassured that we were not in an emergency situation, we calmly retraced our steps and found our original path. No sooner than later, we were at the campsite and everyone was relieved to have a good night's rest. As much as this experience was a mental whirlwind for me, I miss it because it was exhilirating. Being lost can be an excuse for finding adventure - something I look forward to on my next, highly anticipated bike journey.

More about this next big trip. It will likely happen in August. I finish work on the 14th and start school on the 24th - a perfect window of opportunity. I'm hoping to have some of my close friends come along if they're up for the challenge: Dave, Tom, Mike, Justin, Reena, Gabe, and Katrina. I also think there needs to be a greater purpose attached to this trip beyond self gratification. I've recently been inspired about the Ride for World Health project, which is a 2-month, cross-country biking tour that aims to address global health disparities by focusing on education, advocacy, and fundraising. The education stream is quite interesting. Participants deliver lecture series at community centres and schools along the way with the goal of facilitating discussion on global health problems and empowering audiences to become informed and active global citizens. Unfortunately, this project is only based in the United States. Fortunately, there may be a chance of starting something like this in Canada, perhaps with slight differences in design (as suggested by my friend Dave).

Rather than focussing on global health issues, why not pick health/health care issues that directly affect Canadian communities, such as rural medicine, Aboriginal health, ecological health, sexual health, healthy living & exercise, etc. Of course, doing adequate research on these topics and being culturally sensitive to our audiences would be requirements before delivering any kind of presentation. I think high school students would be most receptive to our message, as biking long distances is a feat worthy of inspiring this population. Gauging the interest of fellow cyclists with a passion for biking as well as health(care) issues would be a good start of getting together a group of like-minded individuals. Who knows where the planning process might take us...

For my upcoming one week bike trip, I'm anxious to see if I can not only overcome the physical and mental duress of an outdoor adventure, but also the inertia of developing an idea and not seeing it come to fruition. On that note, what are ways to sustain one's motivation for a fleeting thought? Perhaps committment of the thought to a written form...

WC

Dental Discoveries #1

Dental insurance companies love me. I've only used the McMaster student dental plan twice in the last four years. Both times involved a regular checkup and two sets of X-rays. During my second time, which was last week, I saw a new dentist on campus. The cleaning and X-ray imaging was performed by an assistant, while the dentist did a thorough assessment and inspection of my teeth, palate, jaw, and other parts of the mouth. She also interpreted the X-ray findings and found three impacted wisdom teeth and a cavity between a molar and pre-molar (egad!). I was impressed by the efficiency of this system and it reminded me of the setup of the primary care clinic in the McMaster Student Centre. At this clinic, a nurse records a patient's history on a computer software program, which is then thoroughly examined and followed through by a doctor. Having a system like this in place provides a few benefits: nurses and doctors learn to work cooperatively together, the doctor can determine the complexity of a case before actually meeting the patient, and a proper division of responsibility ensures that services are carried out at the least possible cost.

However, there are also potential pitfalls to this system. With any history-taking procedure, the type of questions asked directs what the patient will reveal. Information that the nurses gather will be filtered according to their interview style. Therefore, the doctor who follows up with the patient will only be able to build on the nurse's foundation - a bad thing if it turns out that he/she missed something important. This is the price that is paid for efficiency. Of course, one can make the counter-argument that improper diagnoses do not happen frequently, that a more efficient system allows for more patients to be seen per hour.

Bringing it back to my dental experience, a dental assistant's responsibilities are uniquely different from a nurse's. The assistant does not do any history-taking (at least mine didn't) and they are highly specialized in performing certain tasks, such as cleaning teeth and taking X-rays. With practice, an assistant can become more efficient in doing their selected responsibilities than a dentist. On the surface, this type of system does not seem to come with the same bag of problems that may be present in a primary care setting where nurses and doctors have to work together. In fact, as a client, I prefer this system because I will pay less if an assistant performs most of the mundane tasks. With this in mind, can the argument for more highly specialized roles be extended to a primary care setting? This seems to contradict the very nature of this field, which is purposely wide in scope to ensure a first point of consultation for patients.

WC

Boy Should Be Taken Down - Part II

This post is a response to a dilemma that my friend found herself in last Saturday. As she mentions in her blog, she witnessed a larger and older male bully a young girl after a ride for no apparent reason. I was also present when this incident happened and in the company of a few other friends. We all witnessed this event unfold before our eyes, but due to the influence of each other and those around us we did not react. My friend concludes her post by saying that she will remember to intervene when a similar situation presents itself in the future.

I beg to differ on this last statement.

Diffusion of responsibility is a social phenomenon that definitely played a role in our lack of action. Each of us may have believed that we were not qualified to handle the situation; thus, diffusing the responsibility of taking action onto someone else. Personally, I am guilty of this because I assumed that amusement park staff, who were operating the ride, would take action. In my mind, I thought they were trained to handle conflict situations.

However, before looking at who should have taken action in this situation its important to take a step back. In the first place, did we understand that the situation demanded some type of emergency action? In retrospect, it is easy to say yes to this question after ample time for reflection, but at the heat of the moment I don't think we had the answer.

Our ability to evaluate whether a situation is an emergency or not is, like the diffusion of responsibility, based on the social behaviours of those around us - a concept known as collective ignorance. If no one responds to an incident, then we determine that it is not an emergency and therefore not deserving of some type of intervention. Making an emergency assessment is necessary for mobilizing action, even if we know exactly what and how to intervene on a victim's behalf. This speaks to the power of other's influences - their behaviour can override all of our individual convictions, no matter how compelling they are.

If the situation was different, I am sure we would have acted. For example, if we saw another person take initiative in calling out the bully, this would break our collective ignorance. If we were closer to where the incident took place and not restricted by a barrier, we would feel more responsibility to intervene because of proximity. Finally, if the young girl had reacted more openly to the offense, we would have likely determined that the situation was an emergency that required attention.

All of this has got me thinking - when are we to blame for inaction?

WC

"1987"

When I was young, I tried to be different. Setting up an e-mail account was the popular thing to do in elementary school and while some people opted for flashy names such as pixiegirl_xoxo and sticky_fingerz_blingbling, I was less creative. Where I lacked in creativity, I prided myself for thinking prospectively. I knew that my boring yet neutral e-mail address would one day save me from embarassment. In retrospect, this was wishful thinking for a naive boy.

williamc1987@hotmail.com

What's wrong with this e-mail address? Nothing seems obviously out of the norm. It has my first name and the initial of my last name (for identity purposes of course), seems simple to remember, and is associated with a popular e-mail account. However, there's one thing that bugs me about it - "1987" is not my favourite number!

My complaint is straightforward. Showing people how old you are through your e-mail address grows more embarassing with age. You might be asking why I don't change it. Here's the problem...

1) My current e-mail account is impeccably organized. I spent too many hours reforming it and I would hate to see all my effort go to waste.

2) There are too many William Chan's in this world and all the variations of my name for a new e-mail address have been taken. "william.k.chan", "chan.k.william", "willy_k_chan", "billiam_chan", etc. are all being used. It makes me wish I had a wacky and crazy first/last name.

Unfortunately, I'm stuck with this e-mail address and must learn to live with it. That, or I could reembrace my lost youth by making a new address that begins with "sillywilly..." - an apt name to characterize the writer of this most random of posts.

I dedicate this to others who share my pain.

WC

Can I justify playing video games?

Whenever I hear the words "video game", I shudder. It brings back dreadful memories of me staring in front of a bright computer screen for countless hours battling make-believe villains in a fantasy world. Some people have addictions to gambling, drugs, maybe even sex - my addiction was to video games.

The word "addiction" has a strong connotation to it, especially when used in a clinical setting. According to wikipedia.org, the ideal video game addict displays the following list of symptoms:

• play many hours a day
  
• gain/lose significant weight due to playing
• disrupt sleep patterns to play
• play at work/school
• avoid phone calls from friends
  
• lie about play time
• strained relationships with family and friends
• performance suffers at work/school

I am guilty of symptoms #1, #3, #6, and #7 - so perhaps I might have a mild form of videogame-itis. But to be quite serious for a moment, addictions of any sort are no small matter. People have died from video game binges in countries such as China, South Korea, and Vietnam. One has to question whether this problem is bigger than it seems and worthy of some form of intervention.

I started playing video games when I was in elementary school. My mother was a computer software programmer at the time and, needless to say, had containers full of games on retro 3.5 inch floppy disks. I played them fervently. My brother was often the local video game competitor, but even he was and still is no match for my skills. Beating him gave me a chance to get back at him for his occasional displays of physical dominance. I showed no mercy...

Come high school, I started meddling with online multiplayer action. My brother grew out of videogaming and so I buddied up with a hardcore Korean gamer named Lloyd. He was a natural marksman at Counterstrike and introduced me to some of the sketchiest web cafes in downtown Toronto. Oddly enough, these places got me exhilarated about being a rebellious young adolescent. I know...I was such a badass!

Gaming became a problem when I was able to play by myself for hours on end after school, lied to my parents about where I was, and became infatuated with winning. The problem only got worse when my parents set up high-speed Internet at home and could see the monster in its full hideous form. I regret those nights where I locked myself in my room without making a single exchange with the P-unit.

When I moved into my new off-campus house in second year, my interest in video games began to wane. My housemates didn't game at all so it was easy to get distracted with other things. Suddenly, I felt that I could assert control over my obsession as long as I was exposed to the right environment. Obviously, action was needed on my part too. I actively deleted all games on my laptop and even bought a MacBook to limit future purchases.

I would lie to you if I said that I don't still suffer from occasional video game relapse. After a stressful night, I often unwind by wasting time on miniclip.net. Last week, in order to cope with the anxiety of waiting for medical school acceptances, I installed my long-last War III Frozen Throne on my computer. It seems that I still have the superior gaming skills intact, but other than giving me a sense of gratification, I often find myself struggling to answer the following question: what have I accomplished with this fruitless squandering of precious time?

Getting into medicine might give me an excuse to play video games...that is, only if I decide on becoming a surgeon! According to simulation and training research done in Arizona, playing game consoles can hone the scalpel skills of surgeons-in-training. Apparently, the Wii can improve eye-hand coordination more so than any other gaming console, which comes as no surprise because it demands more complicated physical maneuvers. Admittedly, playing more Counterstrike or Warcraft III will perhaps improve my manual dexterity, but it will not prepare me for performing simulated surgical procedures such as laparoscopy. Adapting to such a procedure would be like learning a new computer game, and the skills gained in one game are not always transferable to another.

For all its worth, spending time on video games means forgoing doing more productive and intellectually stimulating things such as reading, blogging, exercising, cooking, and socializing. The truth of the matter is that these activities are sometimes mentally, emotionally, or even physically draining while videogaming as well as YouTubing, Facebooking, sitcoming, and MSNing seem to provide me with an outlet for mindless time wasting. My opinion is bound to differ from others.

In any event, my recovery from video game addiction is almost complete.

WC

Health Professionals

New legislation in Ontario is set to be introduced soon, allowing health professionals to have a wider scope of practice. Some of the proposed changes include the following:

• NPs prescribing ultrasounds, set casts, and prescribe certain drugs
• PTs ordering X-rays
• Midwives taking blood samples
• Pharmacists renewing prescriptions

I suppose these changes are a good thing. They may help to offload the burden of work from doctors who will then be able to spend more time on complicated tasks. Having physicians perform routine services like immunization and check-ups that other health professionals can do with the same level of quality is an inefficient use of resources if doctors get paid more for doing that service. The same can be said for ordering diagnostic tests, prescribing certain drugs, and renewing prescriptions.

However, given the wide scope of a doctor's responsibilities, do we risk making the physician's role more specialized, rendering the role of the General Practitioner obsolete? Can we trust that physician's financial incentives are aligned with treating complicated cases?

As soon as we grant more autonomy to other health-care professionals, we have to be aware of competing interests for performing overlapping services, which may deter rather than foster cooperative interdisciplinary team-building. The difference in roles needs to be clearly delineated by regulatory bodies so that there are guidelines that balance efficiency goals of the system and hierarchical structures between professions. Also, the public needs to be aware of these changing powers by generating discussion from the ground up.

Given the state of today's health care system, government action of this sort is needed. There are more pressing concerns than the rivalry it might create among different health-care professionals who are all fighting for their piece of the cake. Currently, we see evidence of this between RNs and PAs. As a health professional, it is important to remember that your foremost duty and service is to the public even if it means making concessions to your colleagues. Perspective, something that healthcare professionals understand well about their patients, gets lost in settings where professional interests clash.

WC

A Tribute to my Housemates!

Call this a cheesy post if you will, but I feel it's time to acknowledge the good men that I have lived with for the past 3 years. As this chapter in my life closes, I can only imagine what kind of success Michael, Dave, and Gabe will achieve in the years to come. Despite the fact that this was our last year living together as a Kingsmount unit, I know we will continue to keep in touch in the future (although I might have some difficulty reaching Gabe - inside joke).

Michael "Kills" Kilian


I am so glad you decided to grow your hair after high school. Keep the current length...it is better than it was in 2nd year (see picture).

Um...where should I begin. I've known you since Gr. 8 of high school. Although we've endured tough times together (i.e. family medical situations), we have somehow managed to stay tight all these years. I think it's because we share the same kind of humour. We can crack each other up in an instant by doing silly things like dancing randomly to the beat of Beyonce's "Single Ladies".

You are the number one go-to man for girl advice and could probably write your own book on relationships if you ever decided to become a writer. It would be a hot sell. At the same time, I can still talk to you about all the emotional and sensitive stuff that I keep bottled up. You have a way of listening well, being empathetic, and offering appropriate advice. Don't worry...you had these skills before taking Carl's Communication class!

Michael mannerisms:

1) "A-buff" (simulating a small explosion of some sort with minor whiplash in the head, arms, and torso).


Davide "Gwai-Lo" Cina

If only I was half the Asian you are...I would be able to speak Cantonese more fluently. You are my long last childhood friend. We have our serious moments (when we discuss about current events), but also our fair share of goofyness (when we make fun of other people in a light-hearted way). I can depend on you for Raman noodles, Pho dinners, and Timmy's coffee. You are also the inside man to get information about the latest buzz in the Asian community. I'm becoming more and more like you by the day - my wardrobe is evidence of this even though I have yet to sport the skinny tie look.

Dave idiosyncracies:

1) "Ehhhhhh"
2) "Look at that"
3) Wushu in the kitchen and the living room. As Sipreeya would say, "I hate you air!"

Although I eat more than you, I am still puzzled by the fact that you eat so quickly.

Our trip to Ottawa for our medical school interview was a blast. I was secretly jealous about your attire because it was better fitted than mine. You cracked me up when you tried using a French accent during a cab ride.

This summer, we shall have many more opportunities to play frisbee, toss the baseball around, and drink strawberry milkshakes at Saigon. We are also becoming CBC radio fanatics. Long live Anna-Maria Tremonti and Jian Ghomeshi.


Gabe "Granovsky" Grant


Last, but not least, is Mr. Gabe. You are one in a million. I could have a conversation with you about anything and everything into the waking hours of the morning. Your dance moves and facial contortions put me to shame. It puzzles me that you remain so social even after spending a full week locked up in your dungeon downstairs. I hope you keep your munchkin minions well fed!

You are a small man with big ideas. Before meeting you, I never thought that eating vegetarian dishes could be so good. You're given me advice on a range of things and I credit you for making me a critical thinker. I don't win a lot of arguments against you, but then again we discuss more than we argue.

I have yet to get you mad...but I will by the end of this summer. You are a family person and this was evident last summer when we spent a few days at Tom's cottage. You have varied skills and varied interests and quite possibly could do anything that you set your mind to. Whatever avenue you wish to pursue in the future, please make sure that it involves interaction with people on some level!

Gabe actions:

1) "____ is necessary but not sufficient"
2) Arm flailing motion after overexaggerating a response.


More cheesiness to follow. Kingsmount housemates, I will never forget those nights where we had dinner parties at Boston Pizza, dancing marathons at Absinthe, and cooking fiascoes at our house. By getting to know each of you so well, I've learned the meaning of trust and the importance of having a close social support group. You guys have always been at the front lines of helping to deal with my problems and are the first to know about good or bad news on my end. I can't believe you still tolerate my random bouts of singing and hip-gyrating movements. I guess you get a kick out of it (at least Reena does). All in all, I shall remember our Kingsmount castle as a community rich with good company, good food, and good conversations. Although there were moments where we jousted, we were more than just knights battling fire-breathing dragons and saving damsels in distress...we lived like kings.

WC

A week before May 15th...

It's an understatement to say that May 15th is a big day. All med school hopefuls know what I mean. On May 15th, I find out if I get accepted, rejected, or put onto the waitlist of the med schools that I interviewed at. It just hit me about an hour ago that it's just under a week before I find out about the fate of my next 3-4 years. It's not only the realization of moving on that shocks me, but also the fact that I've come so far over the past 4 years.

This was me in first year.


I was tanned from a whole summer of working at a day camp as a counselor. My hair was longer and untamed (I had an aversion to hair products at the time). My rez card was around my neck, a hallmark of the stereotypical frosh. The jeans on me were way too baggy, and I thought I was cool because I enjoyed making funny faces in front of the camera.

According to this photo, some things haven't changed. I still love eating (copious amounts of food!), although its clear that my friend Michael on the left could put me to the test. I'm still a goofy person and enjoy making other people laugh when I get the chance. Maybe the weird face does show some personality after all.

My other friend Ari, on the right, is currently at Queen's Medical School finishing up his 1st year of studies. I went to high school with both Michael and Ari. I'm still supertight with Michael as we lived in the same house for the past 3 years. He's my Polish Polar Bear and I'm his Asian Sensation.

Fast forward in time and here is a current picture of me.


This is me in my parent's optical store the day after my graduate school interview at UofT. Ha, no goofy face (I screwed up a bunch of earlier photos and, frankly, my mom was getting fed up with my antics). My hair is shorter and I am dressed more formally. The dress shirt, tie, and vest combo is a new style that I tried this year. I am quite comfortable with the combination and know that it will pass as being professional.

When I look at myself in comparison to 4 years ago, I can't help but think that whatever the outcome on May 15th - I will continue to be proud about who I am, the difference I have made in some people's lives, and the experiences that have shaped the core of my values and beliefs. I've learned to overcome obstacles, such as the worry about losing a close family member to the shock of not getting a desired MCAT score. Struggle and even failure has motivated me to expend all of my resources to make the mark, but even doing my best is limited by the constraints of factors beyond my control. Attitude, as I've learned, is everything.

So seeing how far I've come, I'm anxious to understand how well prepared I am for the next stage of my life, be it grad school or med school. Do I have the knowledge and skills to be a competent researcher? Will I be able to handle the stressors of being a medical student? Is the pursuit of academia or medicine going to make me happy? How will my obligations to my family, friends, colleagues, or more broadly society change? These are all big questions that I am wrestling with and I'm sure a few readers can relate to my situation. I am intimidated about what the future has in store for me, but excited about the prospects of setting and reaching higher benchmarks.

All of this reminds me of the importance of ongoing self-reflection. Life is busy and personal reflection may seem like a nuisance for some people. When I was younger, I didn't see the value of it. Reflecting felt like a chore with no compensation, and there were better things to waste my time on. I realize that reflecting (as I'm doing now) forces me to extract meaning from major and minor experiences in my live so that I am better able to draw inductive inferences when similar situations present themselves in the future. This thought is probably no surprise to anyone, but I'm sure that most of you can agree that there is always more room in your lives for introspection.

I finish with a quote by Thomas Paine: "The real man smiles in trouble, gathers strength from distress, and grows brave by reflection."

WC

Things to look forward to in academia...

April 30th - attending a discussion at McMaster about how hospital cutback decisions are made? I'm interested in understanding more about how the Local Health Integration's Network (LHIN) came to the decision of making the emergency ward at McMaster Hospital peds-only in the face of public protest. Many people question whether this decision was made democratically with adequate public consultation (as far as I'm aware, students attending the university were not included in any talks), raising concerns about the LHIN's role at the local level. An ombuds investigation is currently underway to determine the legitimacy of these concerns.

I expect a raucous debate to ensue between the four different speakers (LHIN director, prez of HHS, MPP, and a rep. from the Ontario Health Coalition).

May 6th - attending Research Day for the Health Policy, Management, and Evaluation (HPME) Department at UofT. Looking forward to hearing guest speakers, networking with future colleagues, and looking at research posters. If med school doesn't work out for me this year, I will be doing graduate studies at the Master's level in Health Services Research.

The keynote speaker of the day is Kathleen Sutcliffe and she will be talking about "Organizing for Resilience." Seems interesting that her talk will bring a business flavour to the management of medical errors, a topic that I've only learned about from a bioethics perspective. Resilience is a word that also carries a lot of meaning in the psychology world, especially in the field of child development studies.

According to the day's schedule, a panel discussion will focus on accessing and integrating Mental Health Care. On April 15th, I attended Research Day for the Department of Psychology, Behaviour, and Neurosciences at McMaster University. The theme, which was on Psychiatric Disorder, Epidemiology and the Life Course, helped me conceptualize mental health disorders as developmental processes that are expressed in different ways over the lifespan. Given this paradigm shift, it is a daunting task for health policy-makers to ensure that mental health services are provided to those who need it. As a society, we may be better at identifying and framing mental health problems, but it remains to be determined whether we will have success in managing them on a system-wide level.

May 7th - participating in the second annual Hamilton Economic Summit. I was drawn to this community event because of the prospect of learning more about commercializing the downtown sector of Hamilton in order to create opportunities for economic development. I think the university can play an important role in this operation, and evidence of this is already emerging with the expansion of health services and education. Perhaps this may be a solution to the poverty issue in Hamilton.

Exciting days lined up for the next two weeks. I am clearly not ready to move on to the real world...

WC

Teaching to Learn, Learning to Teach

Two weekends ago, I went for training to become a certified Princeton Review teacher for the MCAT. Princeton Review is a for-profit company that helps students prepare for standardized tests. Friday night of that week, I learned a bit about company policy and how my role as a teacher is important for furthering the business prospects of the organization. It was drilled in my head that the training weekend was to be taken seriously, and I got a good taste of what it means to be a professional.

Being a professional means living up to the standards of a company. With the Princeton Review, I had to demonstrate knowledge of the teaching material and show my ability to convey information in a simple, logical, and structured way. Although this may seem like an easy task for some people, it wasn't for me. I struggled with conforming to the didactic teaching style of the company because, as a student on the receiving end, I know my own personal limits of this model. Lectures can be helpful for giving a brief overview of new material, but they hardly foster learning and retention at a deeper level. The problem with lecture-based classes is that they prohibit students from taking initiative in their learning because the lecturer decides what the students should know. Postman and Weingartner argue that it is more important to "actively investigate structures and relationships in one's learning process, rather than being passively receptive to someone else's (the teacher's) story" (1). Interestingly, problem-based learning aims to provide students with more control over their curriculum, so that an element of personal preference is factored in. At the same time, how do we know that our specific learning style (which we've grown quite accustomed to) is the one that best maximizes our productivity as learners? Comfort can be misconstrued as resistance to change. While I was thinking about this, I couldn't help but realize that conforming to a proscribed way of teaching challenged my integrity as a learner. My roles as a teacher and a student were at once in conflict.

There is a way to resolve this intrapersonal conflict. It starts with admitting that didactic learning has its advantages. For one, it's practical. At the undergraduate level, juggling a full course load plus any other extracurriculars is hard enough as is, so it helps make life easier if learning material is "fed" to us in a structured and sequential fashion. The same can be said about an MCAT prep course, where time constraints are imposed by juggling meaty subjects such as verbal reasoning, general chemistry, biology, physics, and organic chemistry. In addition, learning through a lecture format is helpful for acquiring a condensed version of a specific subset of knowledge. This can open the door to deeper levels of analysis that serve to compliment, rather than substitute, other learning styles. For this reason, it's no surprise that the Princeton Review stresses the importance of doing several hours of indepedent homework after class. I suspect that these reasons, and several others, challenge the effectiveness of using anything other than lectures to teach MCAT material.

So how does lecture-based learning prepare someone to score well on a standardized test (which is the main outcome of interest for test prep companies)? A standardized test almost always contains multiple-choice questions with one answer that is more right than the others. In a similar way, didactic learning promotes the acceptance of reaching a one-answer state because those things that have no answers (or even multiple ones) are not fun to teach and rather time-consuming.

Perhaps there is room for problem-based approach learning in the standardized test prep business. I don't know if there is a market for something like this at the moment, but I would suspect that there is little data to show how effective it is in this setting. As long as standardized tests play a role in establishing didactic practices as the dominant paradigm of educational learning, they will continue to stifle the growth of more open-ended, active, and motivational ways of learning.

WC

(1) "The Inquiry Method"
Postman, N. & Weingartner, C.
Teaching as a Subversive Activity

4 am...

Another night of dancing, drinks, and socializing. Another night of pizza and junk food. Another night with new company. And yet I am sitting in front of my computer at 4:14 am with a feeling of uneasiness and a lack of fulfillment. Did I have a good time?

As a sense of fatigue envelops me, I can't help but wonder if I'm growing old of this type of "having fun." I'm going to wake up sometime after noon tomorrow, and I'll look back at the night to see what I've accomplished. Does something need to be accomplished if the sole purpose of doing it is just to have fun? Maybe. I get the feeling that I'm always looking for more.

But look at me 5 hours ago and you would have seen a completely different person. I was dying to leave the house and celebrate the end of exams and, frankly, the end of my undergrad. I was led to believe that this monumental occasion would translate to a most memorable night.

I think I'm coming to understand what I value in my social life. Drinking, dancing, and music are not always needed, although they certainly help to lighten the mood. Close friends help make the night more personal. Last but not least, humour and food are always a good combination in moderation. In conclusion, what does it take to make social outings "fun" on a regular basis?

Oddly enough, the only way to find out is by going out more...

WC

First Blog!

Hello all,

I've decided to start blogging because I feel to need to put my thoughts down on paper and reflect on personal experiences. I was never a big fan of writing, but I think there is some value in documenting your thinking in a systematic and analytical way. I am primarily interested in blogging about health care related issues, but occasionally I feel the need to ponder on personal aspects of my life. As an aspiring doctor, I know that blogging will encourage introspection in an environment where difficult decisions are made on a daily basis.

So...a little bit about myself. I am 21-years old and just finished a 4-year undergrad at McMaster University. I applied to med school this year and hope to receive good news on May 15th. If that doesn't work out, then I will be doing graduate studies in health policy at UofT. I currently live in a house off-campus with my best friends of 3 years: Michael, Davide, and Gabriel. They say that some of your best relationships are established in your university years - I can certainly attest to that.

My family lives in Toronto and I see them often. My mom and dad own a family business (an optical store), while my brother practices as a chiropodist (or foot care specialist) in his new clinic. Family is a central aspect of my life. I can tell my parents anything over a half-chicken dinner at Swiss Chalet or a BBQ pork & rice dish with bak choy at Congee Queen. During stressful moments in my undergrad, I have relied on my parents for social support (and a lot of other things too, such as $). It goes without saying that they go out of their way to offer me advice and are always willing to listen to my concerns (however small and insignificant they are). I've learned that conflicts between family members are a necessary aspect of developing strong relationships. When arguments erupt, they can be healthy for building relationships if the family member at fault learns to be apologetic. I've had my fair share of arguments with my mom, dad, and brother. We know which buttons to press to make each of us mad, but at the end there is always reconciliation.

The past 4 years at McMaster University in the Bachelor of Health Sciences program has been extremely rewarding. I intend to blog more about the uniqueness of this program and how it serves as a model for teaching and learning at the post-secondary level. Looking back at my undergrad career, I really think that I found my niche at McMaster, socially and academically. It's a small enough institution that you can recognize familiar people on campus, but large enough to keep you excited about exploring different dimensions of university life. I have no regrets for making the decision of coming here (the other contender was UofT) and I am proud of the opportunities it created for me. If I attend another university next year, I wonder what the transition will be like...something to blog about in the near future.

Anyways, that's all for now. More to come. Thanks for reading.

WC