With a Little Help From Your Friends

My latest article for Medscape's The Differential includes some tips about how to make the most of the teaching you'll encounter on your clinical rotations. If you listen closely, you'll encounter help from people all around you. Even from the gruffest nurses and most militaristic scrub techs. Check it out.

One Book, PRN

In medical abbreviations, PRN stands for "pro re nata" or "when necessary." In my article for The Differential this week, I review the practice of giving one book to each kid at every well-child check between the ages of 6 months to 5 years. I learned about this strategy to increase literacy and the love of literature at Seattle's own Odessa Brown Children's Clinic when I rotated there last October for my pediatrics clerkship. Go on over to my article to read more.


Then come back here and pick out your own title from the book pharmacy.

The one about Ceasar Chavez is good. So is Goodnight Moon.

High School Science Bloggers

I recently stumbled upon the efforts of a high school biology teacher to increase her students' fluency in online learning and discussion. I think it is smart to introduce them to the science blogging community, and what could be the future of science communication. Elissa Hoffman at Appleton East High School is moderating a blog called Endless Forms Most Beautiful, and she is looking for guest bloggers. Here is my unauthorized want ad placed on Hope for Pandora on her behalf:

Seeking scientists who can capture the attention and imagination of AP Biology students in east-central Wisconsin. Duties include posting one or more 500-1000 word entries to a weblog and participating in the online comments section. Candidates need not be local. Compensation in the form of warm fuzzies.

Sound interesting? Read this informational page. Cruise around the other entries and responses, too. But avoid this post.

Graduate Ethics Education

This weekend, I'll be heading to Lexington, Kentucky to represent the University of Washington at the National Conference on Graduate Student Leadership. I'm giving a talk about how ethics education should and can be better incorporated into graduate school. I have 8 minutes... Naturally, I'll be speaking a bit about the Forum on Science Ethics and Policy, but I'll also lay out a case for why providing formal and informal training in ethical reasoning makes for better graduate students.

I had hoped to take my new EEE PC, but it seems as though UPS got confused and shipped it to Ontario, California instead of Seattle. I've already weaned myself down to checking email once a day. I think I can cut the cord for a whole weekend...

Ethics of Medical Training Vol. 1

You're a patient at your local university hospital. Chances are good whatever is wrong with you is complex enough that you have traveled further than most people do when they go to the doctor. But then again, maybe you live just down the street! In any case, you come to the UXMC for the reputation, for the expertise, and to get an answer for what is wrong. It's your first visit. You've filled in the forms, the nurse has taken your vitals, and you're sitting in the cold, fluorescent bulb-lit exam room waiting to be seen, and who is the first to walk in? A twenty-something wearing a poorly-fit white coat grasping a clipboard like a security blanket. "Who is this?" you wonder, and "why does he look so nervous?"

Congratulations. You have just experienced a critical component of the graduate medical education complex. Shifting uncomfortably in front of you is the first rung of the ladder known as the medical hierarchy. Immediately you think, "How is this spring chicken going to heal me when all of the other docs were puzzled?" The answer is a little complex.

Hopefully the medical student in front of you is a little more comfortable than the way I've described him. Unless it's the month of July (when all of the residents and medical students are new), the student has already interacted with hundreds of patients, so he shouldn't have problems conducting an interview. At the foundation of your observation is a critical tension at the base of medical education and professional ethics: How are we to balance what is in the best interest of the patient with what is in the best interest of society? A byline of this tension is the medical student's concern about evaluation. While we students should be focusing on doing the right thing for the patient, many of us also want to do the right thing for our grades. That usually means thinking inside the box and being conservative with answers. Such thinking is not, however what doctors usually order at tertiary medical centers, and it's not what you need to solve your problem.

Fortunately, the medical hierarchy comes to the rescue. The residents, fellows and attending physicians who are actually liable for patient care benefit from the constant discussion, questioning and brainstorming (all lumped into that unfortunate term, 'pimping') that a teaching environment affords. You benefit from the system that brings you the medical student.

On a lighter note, keep in mind that medical students usually only take care of 2-3 patients at a time in the hospital. This means that they have more time to sit in your room and ask questions, catch overlooked relevant physical exam findings and pore over books (paper or electronic) to learn about your condition. And if you are a kid, maybe the student will take you over to the playroom to use the finger paints!

In many ways, you are the best teacher for medical students (especially those tired of sitting in class). Thanks for working with the medical student. Society thanks you, too.

Open Access Tissue Engineering

Are you curious about the field of tissue engineering? This fall, you have the opportunity to take a course on the subject from your own home. This opportunity is not affiliated with Sally Struthers or the International Correspondence School. The course is offered online by a joint program of Harvard and MIT.

HST 535: The Principles and Practice of Tissue Engineering will be available starting in September, and will be viewable by webcast for half a year. That means you get curriculum and video of the course. The website even says that,

during the lectures, questions can be e-mailed to the Course Coordinator.

MIT has opened its curriculum to the public for the past several years. Using a platform called OpenCourseWare, anyone from around the world can take MIT courses. Well, not exactly. As a resource to "educators, students and self-learners around the world," anyone with an internet connection can dial up the MIT site for course materials from subjects ranging from planetary studies to urban planning and literature to biological engineering.

From the OCW site, MIT OCW:

• Is a publication of MIT course materials
• Does not require any registration
• Is not a degree-granting or certificate-granting activity
• Does not provide access to MIT faculty

I can see motivated undergraduates, interested (and maybe retired) citizens, faculty working on new curriculum, science outreach workers, students at smaller colleges, and anyone needing broad information about a specific topics and even busy graduate students finding this resource useful. Perhaps those with the most to benefit from this program are students in developing countries. In fact, MIT OCW's stated goals are to:

• Provide free, searchable access to MIT's course materials for educators, students, and self-learners around the world.
• Extend the reach and impact of MIT OCW and the "opencourseware" concept.

This second objective is a noble one. Long regarded as the premier science and engineering university in the world, it is an important statement that MIT is making curriculum resources open to all. Because of its reputation, MIT is probably the only entity that could pull off an attempt to change the way information is available to the interested public. At first, there were some complaints about this policy. What are MIT students paying for if all of the course material is free anyway? The answers are in the caveats above: OCW users have no access to faculty and no record of enrollment.

Can secondary (and tertiary) education really be boiled down to networking and credentialing? I'll wager that the majority of OCW users either passively watch the material or look for specific answers or resources before moving on. Without cramming for exams and office hours to make sure sure you 'get it,' this material is by no means a complete course of study - it is merely another resource. Albeit a free resource from a prestigious institution.

This tissue engineering course however seems to contradict one of OCW's central points. That Professor Myron Spector is available for questions could be his own choice. Maybe this is his way of connecting with the public about science. I like the sound of that.

Open access as a route to citizen scientist.

There's an idea. Can open access (courseware, journals, software, etc.) effectively distribute the building blocks of the ivory tower to the masses and in so doing increase the role of science in society? We shall see.

Scientists: Meet Your Clergy

The Clergy Letter Project has accumulated statements of support for evolution from clergy and also promotes Evolution Sunday (the Sunday closest to Charles Darwin’s February 12 birthday). I am not so sure that we need to devote a sermon every year to evolution, the project's current effort at promoting scientist-clergy dialogue sounds worthwhile. As The Clergy Letter Project matures, they aim to provide more and better resources to clergy members who understand the importance of science and who do not find science to be a threat to their faith. (Wouldn't it also be nice if more scientists did not find faith a threat to their science?)

Here's where all you scientists come in to the picture. The project is beginning to create an on-line database of scientists who are willing to answer questions posed by clergy members. Consider if you are excited about the possibility of interacting with clergy members and their parishioners in an attempt to explain the beauty and power of science. If you are willing to provide technical advice to clergy members in need of such support, please sign up.

To enroll in this project, email Michael Zimmerman (mz at butler dot edu) with the following information:

Name:
Title:
Address:
Areas of Expertise:
Email Address:

This is a concrete way that you could help to build the relationship between science and religion.

Bioengineering ELSI

This report is a summary of one I presented to the committee tasked with identifying the future of bioengineering and by extension the UW BioE department. It has been revised for consideration by the Bioengineering Department's chair search committee. My opinions are based in large part on my experiences leading a group on campus called the Forum on Science Ethics and Policy.

I think it is important for the bioengineering department – and by extension the chair – to seek innovative ways to bridge science and engineering with medicine, ethics and social impact. From my perspective, the extent that this is even considered as an important task by the bioengineering department is small. In the current environment of ultra-competitive funding (Science, Vol 316, 20 April 2007, p. 356-361), increased occurrences of scientific misconduct (Nature, Vol 435, 9 June 2005, p.737-8), and ever-prevalent social concerns about science, I believe it important for the chair to have ideas about how to prepare students for the complexities of biomedical research and enable faculty to engage each other in meaningful conversations.

Several research strengths at the UW exist in the midst of important public discussions about science and society. Three of these are global health, stem cell research, and nanotechnology. Not only are there prominent researchers in each of these fields within or affiliated with the bioengineering department, but there are centers here focused on each of these topics. As the bridge between basic biomedical research and practical implementation, bioengineers are uniquely positioned to think critically about the needs and expenses of the technology they are building. I believe that the best bioengineers will be able to integrate needs and opinions from society into the healthcare setting. They should be, at the minimum, competent communicators about issues in science, engineering and society.

I believe strongly that a deliberate effort to incorporate issues of social responsibility and public policy into science and technology would provide the foundations to develop individuals that will lead their fields in academia, the corporate sector and the public sphere. How would this be accomplished? I have some ideas, but there are several more out there. Candidates for chair should provide innovative insights into how meaningful conversations about ethical, legal and social implications of research could be facilitated in the UW Bioengineering department. It will not be easy to incorporate concepts often relegated to liberal arts departments into a technical education, but creativity and dedication could result in significant gain. Bioengineers familiar with the global, social and political context of their work will be better prepared to tackle the current challenges in health care and lead us through the next century.

bioMEDICALengineering

This entry is modified from text I prepared for submission to the search committee for the new bioengineering department chair. For the record, I also submitted a revised form of a previously prepared recommendation concerning the role of ethical, legal and social impacts on engineering education. I am interested in hearing what anybody out there thinks of this perspective.

My comments today focus on the need for the new chair of bioengineering to lead efforts in interdisciplinary collaboration, interdepartmental partnerships and translational clinical research.

The new chair must have a vision for more and better collaborations with clinicians. Such a perspective (and the skill to form and implement a plan) will ensure that translational research is not merely entrepreneurial, or “bench to bedside,” but is “bedside to bench to bedside.” Too often, it seems that clinicians, scientists and engineers are not on the same page. This is a problem in the increasingly competitive environment for funding, where there will be good science that does not make the cut. In the context of bioengineering, the proposals that will succeed will contain good science that is problem driven. It is easy to label this as lofty talk, but I believe it is possible to fulfill these ideals if the department chair possesses some particular skills and is willing to facilitate certain kinds of interactions. Some of my ideas are listed here:

1. The chair should hold regular meetings with leaders from other departments and centers, and should make an effort to foster relationships all over campus. A familiarity with other centers’ research programs is important.
2. The chair should freely offer statements to departmental faculty that start with the phrase, “Have you spoken with...?” The chair should be in the best position to synthesize new collaborations because she or he has relationships with other campus administrators.
3. The chair could hold periodic department-wide meetings (with food) to offer a “State of the Department” address or to host feedback sessions.
4. The chair could sponsor quarterly seminars that appeal (either in one talk or in rotating talks) to clinicians, applied and basic scientists. It might be necessary to hold such seminars at a location that enables clinicians to attend. Any event that mixes clinicians and faculty would improve our current state.
5. The department should reiterate support for extending teaching and exam privileges to clinicians. Such clinicians could teach classes, serve on committees or co-advise students. More deliberate infusions of clinical experience would benefit students and faculty alike.

The bioengineering department at the UW is excellent. It is ranked highly in reputation and in revenue. This status is well-earned. I am surprised that there is not more interaction with the clinicians just down the street, particularly at the student level. Third-world diagnostics design might be more pertinent if trainees had some experience in the laboratory medicine department. Bone, heart or esophageal tissue engineers could learn a lot by interacting with orthopedic, heart or gut surgeons. I believe that a chair who has experience working in translational medicine and can communicate with engineers, basic scientists and clinicians will enable the UW to develop into the best bioengineering department in the nation.

A Case for Faculty Unions

Janet Stemwedel (nom de blog Dr. Free-Ride, of Adventures in Ethics and Science) has just posted an excellent entry about unionized faculty in the Cal State University system. My 4 readers may recall my own perspectives about academic unions - most notably my objection to the graduate student variety. This long post presents history, motivations and reflections about faculty unionization, and how that relates to the labor of love called higher education.

Project Steve

On April 24th, Project Steve logged its 800th signature. According to the National Center for Science Education, this represents 80,000 individuals that object to the replacement of science education with pseudoscientific instruction in Creationist science. Although I do not appreciate the way that NCSE and their loyal followers tend to use sarcasm and mockery to retort Creationism, I do think more scientists need to speak up for the proper instruction of science.

A couple of questions:

• Why are there not any more Steves signed on to this?
• The NSCE description says 1% of American names start with Steve. But wait a minute - Stephen Hawking was signatory #300. He's not American! Who are the statisticians on this job?

Are you a Steve, Stephanie, Stefan, or Esteban? Do you want to be part of Project Steve? See if you are qualified to join the club...

By the way, if you have been wanting to stick up for evolution, I recently reviewed an evolutionist's apologetic for a journal called Perspectives on Science and Christian Faith. Titled, The Top 10 Myths About Evolution, this short book reads a bit like a print version of the Mythbusters TV show. I gave it three stars in my 'Recent Reads' panel because it mostly covered arguments I was familiar with. It does present the history and science of evolution quite well, and is a good start if you are not familiar with the details.

This Just in From Kansas...

Did you think that the new school board elected last year in Kansas would solve the political dilemmas in that state about evolution and creation? If so, you should reconsider your ideas about the appropriateness of elected officers defining education standards. The political pendulum will always swing, but the recent pass has opened a new can of worms. This time, defenders of evolution must deal with topics that has plagued this debate for a century: the problems of eugenics and social Darwinism.

First, a brief timeline from Kansas:

August '99: Kansas state school board de-emphasizes evolution in science standards.
August '00: Two conservative board members booted.
February '01: Evolution teaching restored.
August '02: Board split 5-5 on evolution.
August '04: Conservative resurgence led by Kathy Martin: Creationism 6, Evolution 4
February '05: Announcement that evolution will be reconsidered.
November '05: Science standards criticizing evolution approved.
August '06: Pro-evolution members regain majority.
February '07: Standards including evolution adopted.

So what's the fuss about?

Well, it turns out that not only is the new school board removing the creationist and intelligent design (ID) material from the science standards, they are removing references to the two most egregious examples of scientific misconduct from the twentieth century. It happens that in November 2005, the standards that inserted ID in the science curriculum, also for the first time included accounts of the Tuskegee syphilis study and Nazi human experimentation. My guess is that these were thrown in as tools to discount everyday science as immoral. In fact, it is the pseudoscience of eugenics that should be criticized! Now ID proponents, including Seattle's Discovery Institute, are using this example of 'censorship' to point out that science education is being improperly sanitized.

So I guess we need to talk about what students actually learn about science in school... Every science student is introduced to the scientific method, but most scientists (and every philosopher of science) who read a high school textbook will agree that the accounts of the history of science are sanitized. It's not really until upper level college courses that budding young experimentalists learn that science is not exactly tidy. Experiments rarely work the way you think they will, and the discoveries that are so succinctly accounted in the textbooks were preceded by years of failure. That does not even touch on the fact that ethics and the responsible conduct of science are hardly ever taught on through the graduate levels. So is it a step in the right direction to include these crimes of human experimentation at the high school level?

I have to agree with these ID proponents that introducing students to horrors conducted in the name of science is acceptable. The examples of Nazi science and Tuskegee belong in science education within the context of learning about the practice of science. A condition of including these accounts should be a proper discussion of the Nuremberg Code and the Belmont Report as efforts to reach consensus on the limits of scientific experimentation.

As a final side note, I have yet to see an account accessible to the public that distinguishes evolutionary biology from social Darwinism and eugenics. Does anyone know of one?

Bioengineering in Society

This is the short version of a vision I have for the UW bioengineering department's strategic plan. I've posted the longer version in a comment.

Bioengineering is a term that includes many particular topics, but it is always associated with advances in medicine or biotechnology. Since its inception, the field has been synthetic. In the 1960’s, physicians and materials scientists collaborated to generate a solution enabling long-term kidney dialysis. The Teflon Scribner shunt led to Seattle’s prominence as renal failure treatment center and is but one example of ground-breaking interdisciplinary engineering work at the UW. Bioengineers may forget that it also set the stage for a situation in which a “God Committee” made decisions about which patients could receive the expensive dialysis procedure in a resource limited environment. In the end, federal health care policy was changed so that no renal failure patient would be refused treatment. The area of bioengineering that I believe should be tackled in the next 5-25 years is not a specific research program; it is the way that bioengineers think about their position in society.

As the bridge between basic biomedical research and practical implementation, bioengineers are uniquely positioned to think critically about the needs and expenses of the technology they are building. I believe that the best bioengineers will be able to integrate needs and opinions from society into the healthcare setting. They will be at the minimum competent communicators about issues in science, engineering and society.

My proposal is for the bioengineering department to deliberately invest in the dialogue among bioengineers about the social implications of the work they do. Several research strengths at the UW exist in the midst of important public discussions about science and society. Three of these are global health, stem cell research, and nanotechnology. Not only are there prominent researchers in each of these fields within or affiliated with the bioengineering department, but there are centers here focused on each of these topics. It is clear that faculty and students are committed to contributing to society in meaningful ways. The Grand Challenges in Global Health Care grant is an example that bioengineers at the UW are committed to the complex challenge of moving healthcare out of the resource intensive Western hospital environment into the home and beyond to developing countries.

I believe strongly that a deliberate effort to incorporate issues of social responsibility and public policy into science and technology would provide the foundations to develop individuals that will lead their fields in academia, the corporate sector and the public sphere. How would this be accomplished? I can imagine three techniques. The first is a prominent seminar series on campus focused on issues in engineering and society. Speakers must be qualified to discuss the social and political aspects of fields that they work with, not merely offer armchair analyses of public policy. Such a series could rotate between bioengineering related fields of global health nanotechnology, or stem cell science. Another technique – perhaps more effective but less prominent – at increasing knowledge and ideas about science and society is an ongoing discussion group that includes faculty and all levels of trainee. This could incorporate idealism, practicality and a breadth of ideas in a collegial environment that could engage student and teacher alike. The third, and perhaps most difficult implement would be a course focused on issues of engineering and society. Challenges here include finding the teaching resources, adding to an already heavy course load, and the artificiality of classroom discussion on social, ethical and political issues. Perhaps this would be best as a joint effort between departments. It will not be easy to incorporate concepts often relegated to liberal arts departments into a technical education, but creativity and dedication could result in significant gain. Bioengineers familiar with the global, social and political context of their work will be better prepared to tackle the current challenges in health care and lead us through the next century.

Here are some web resources for UW groups interested in science and society:

International Health Group:
http://depts.washington.edu/ihg/index.htm
Nanotechnology and Nanoscience Student Association:
http://students.washington.edu/nansa/index.html
Forum on Science Ethics and Policy:
http://www.fosep.org/