Goodbye, Pat

It is a sad day for the Camp Parsons community as one of our family has passed away.

I had the pleasure of working with Pat Lundemo on Camp Parsons staff for my first three summers.  Pat was one of the few whose genuine enthusiasm for scouting and summer camp didn't waver for the length of the summer.  I can't think of a time when Pat was ever in a bad mood or anything but positive.  You may not always think of a camp ranger as a big part of program, but Pat was always there to joke around with staff, chat up adults, and get to know the scouts.  (When I joined the staff in 2008, Pat was the one person who knew who I was from when I was a scout.)  Every week, he cheered scoutmasters on in their makeshift golf game and hardly a day went by when you didn't see Pat sitting at the tool room door singing and drumming along.  His heart was always in the right place, always going out of his way to meet the needs of the scouts as well as being a friend to the rest of the staff.  I especially enjoyed visiting with him (and his cat Rusty) and hearing his stories and also catching a ride on the backhoe across camp after a meal. Plus "Where's Joe Boo!?", "Two single file lines, one behind the other please.", "If you break something, just tell me, I'll fix it."

I want to elaborate a little more on Pat's relationship with the staff.  When there was someone who had a rough start on staff that caused them not to be one of the more popular staff members, Pat had a knack for seeing past that to the good person they had the potential to grow into.  Rather than casting them aside as dumb kid or a screw up, Pat would do what he could to help them along, making a big impact on their time at camp and on their life.  There was one instance I remember when a few CITs drew on a table outside the dining hall on their first day.  Your first thought may be to send them home, but Pat sat them down and explained the importance of camp to him and how drawing on a table is more than just graffiti, but is a disrespect to the staff and to camp and its history.  After their talk (which didn't involve any yelling or punishment - apart from sanding the table), there wasn't a dry eye among them.  He cared enough about them as people not to cast them aside right away, but use the opportunity to teach them and it worked for most of them, who stayed on as CITs and did a great job.

Most of my greatest memories in life come from Camp Parsons, with Pat playing a big role in my first years on staff.  He cared deeply about all of us on staff (when I visited him last month, all we could talk about was what everyone is up to now).  I am incredibly grateful to have had the opportunity to work with Pat at camp, as well as to have him as my friend.  He made such a positive impact on the lives of so many of us and I'm really going to miss him.

What are you protesting now?

I walked onto campus today to the sight of graffiti on multiple walls proclaiming that there is a walk-out on May 1st. This is a great example of the stupidity of many college students. Sure, it may have started out as a good cause, but the way they go about showing their opinion is all wrong. Advocating for a wide-spread student strike, from what I've seen, involves almost no information about what the strike is for. The problem with this is that many undergraduates will go along with it and skip class, yet have absolutely no idea what they're protesting. News media has interviewed students in similar situations here and at other schools. Most don't even know what their "cause" is. On the off chance they do, they only have a shallow understanding of the general purpose but don't understand any details or big-picture repercussions of what they're protesting for.

So, as a result of this lack of understanding and blind following by students, walls are vandalized, traffic may be disrupted, campus operations are impeded, and other students are affected. I'm not arguing one way or the other about the merits of protesting, I'm simply saying that if you do, it should be an issue that you really care about (to do something as extreme as a strike) and you should definitely know what it is you're protesting for or against. And if you care enough about fighting for your quality education, you should care enough to go to class then dedicate your free time to your cause. I doubt the majority would be protesting if it wasn't an excuse to get out of class.

My favorite example of these blind followers who jump on the walk-out bandwagon is a few years ago when a major walkout was staged for some education issue. There was a picture in the paper of a student holding up a sign that said "Who's school? Our school!" I doubt many of the people in that picture knew what they were protesting, but even if they did, their time would've been better spent in class, brushing up on their grammar.

Here comes summer!

Summer is just around the corner.  Yes, I've been excited for summer since the last one ended, but the anticipation has recently started ramping up.  Part of that was because of last weekend.  There were a few districts of penninsula scouts at camp for their camporee last weekend.  Having a semi-full camp combined with near-summer weather really sparks that eagerness for the summer season to begin.  Camp has a different feel in the off-season (still great, just different) and that feeling is starting to shift as the weather gets nicer, projects near completion, more people start using camp, and as we start preparing program areas and campsites.

Even things that aren't as pleasant make me anticipate summer even more.  After so many scouts use camp, there are inevitably some plumbing issues that need to be fixed.  Usually they can be remedied with a few pushes of a plunger, but one we encountered on Sunday wasn't quite so easy.  In the end, it turned out that someone tried to flush an apple, but it took removing the toilet from the floor and flipping it over to figure that out.  I also got a pretty good-sized blister on the palm of my hand from so much plunging, which is still painful when I extend my fingers or get my hand wet.  That said, though, even the 1-2 hours of dealing with garbage and bathrooms made me even more excited for summer.  Could be because of my love of camp or hatred for school; probably a little (or a lot) of both.

The staff work party is coming up in a couple weeks, when we will be getting some campsites ready as well as reuniting with old staff members and meeting new ones.  It's always an enjoyable weekend and is sort of the pre-kick-off to summer, which I look forward to every year. 

Also coming up, my family is holding a work party of sorts to do some maintenance and renovation on our property in South Colby.  I'm glad we have a chance to get the whole family together like that for a weekend since I don't get to see as much of them during the summer as I did before I joined camp staff.  Our big project is to work on the foundation of the house my grandpa grew up in, which will involve a lot of digging in small spaces, some of which the local otters have recently grown accustomed to living in.  It's hard to believe this year has gone by so quickly (only 26 more days of school and 6 weeks until NCS), summer will be here before we know it.  And I couldn't be done with school soon enough!

Light Fixtures for Days

This past weekend's Adult Work Party was a productive one!  The weather wasn't great, but luckily most of the work was inside.   The inside of the trading post was painted Thursday and Friday morning so we could start putting up light fixtures and installing switches and receptacles.  It took the better part of two days to put in all the fixtures, mostly due to the fact that we had to improvise a lot.  The lights we have are very nice; 6 bulbs facing down and 3 facing up.  They're hung with cables that come out of the top.  The only problem is that the cable mounts in the center of the top and the bulb sits in the center of the top.  See a problem there?  Luckily we have a metal fab expert (and his new apprentice) who spent most of the day making custom brackets to hang the fixtures.  They look so good that some people thought they came with the fixtures originally.  In addition to that, the end caps were all sized differently (which required some drilling and filing to correct).  Once we got them all installed, which took until 9 pm Saturday plus all of Sunday morning, we turned them on only to find that the quick-connect plugs were miswired at the factory and the top of some light up with the bottom of others.  So this week, I'll be taking them all apart and rewiring them.  Oh, and we didn't check bulb colors when we were putting them up, so we'll have to play musical bulbs until everything matches.  But since they were donated, it's worth a little extra work for the great cost savings.  Plus it was a good excuse for Ralph to show Chris some welding tricks.  It was a long haul, but we got everything installed after 9 hours of work Friday, 12.5 on Saturday, and 8 on Sunday.  I don't think I've ever slept that long after a work party!

Another ongoing project is the remodeling of MBC.  Greg Hammond spent yesterday crawling around under the deck, finding lots of "how-did-that-stay-up-for-so-long" construction flaws.  When the deck was added, it was nailed into the building without joist hangers and without a post supporting it.  Then, the outside wall was built on top of that.  So the deck was slowly sinking and in turn the wall and roof were on their way down.  But now, an extra beam and some pier blocks mean that we can finish up the framing and start work on plumbing and electrical.  

Alan and his crew are working on plans to remodel the basement of the museum.  With so much history and more and more pictures being added every month, we've finally run out of wall space upstairs.  This weekend, we got the downstairs completely empty so we can spruce up the floor and add some partial walls like we did upstairs a couple years ago.  I'm glad we have people who are so dedicated to constantly improving and adding to the museum so future scouts can see the history of camp.

From various posts on Facebook, it sounds like some areas got a dusting of snow last night.  It's nice and sunny here at camp, though, so I guess that means it's a perfect day for some trench-digging and grading around the building.  The air conditioning people are coming today to finish their part, then after some sanding of beams and minor light fixture modifications we'll be ready to start scrubbing the floor to get it ready to finish.  

Whatever...

As this quarter comes to a close, I find it harder and harder to care about school.  On a couple of exams recently, I've used the word "whatever" when deciding between 2 multiple choice options.  Just pick one and move on so I can get out of there.  It's like I've just stopped caring.  I don't think I'm alone in this thinking, either.  Many classmates that I've talked to feel the same way.  It's really too bad that it has come down to this mentality.  Because of the lack of consideration from professors, unfair and unrealistic expectations, disorganization, condescension, and sometimes utter nonsense that has come to pass the last couple terms, many people (myself included) have lost all motivation to do anything more than just pass classes.  We think "why study this when we know all the questions are going to trick us?" and are just burned-out in general when it comes to school because of the reasons above and what I've said in previous blogs.  It's true that for some sections on recent exams, no matter how hard you study or focus on what is correct and widely accepted, you'll still miss a lot of points because the questions are written to trick you or are based on one lecturer's personal opinion and not the norm (whether this is a conscious decision on the question writers' part(s) remains a mystery).  So what a lot of people think is "if I'm going to get it wrong anyway, why agonize over studying it?"  I do agree with this mentality and I plan not to study certain things for the final as hard in favor of studying the material that I know will be fairly tested on, hoping that that is enough to offset the lack of points in the "trick" sections.  It's really too bad that mediocrity has become the status quo, because what is suffering is our knowledge.

This is not how school should be.  We are paying tuition and attending grueling 3-hour classes so we can learn, not so we can be tricked and set up to fail.  Professors should be in the business of educating students and caring about them and their knowledge gain, not sending out ambiguously-worded rubber-stamp email responses to any questions that are asked or casting people aside like yesterday's garbage when they perform poorly on an unfair exam (along with 20 of their colleagues).

I hope that this is an isolated feeling we're all having right now and that after this quarter of hell (as well as parts of last quarter) things will shape up a little bit.  It's not going to do us much good to go into clerkships with a honey badger mentality that is residual from such a poorly-executed education.

I could go on for days (fer dayz) on this subject.  As I've said before, I'm not happy with my education but it's a means to an end.  After next year, I'll finally have a degree and I can be the pharmacist I pictured when I was accepted and have nothing to do with the school thereafter.  A classmate put it well: "My advice to the young: Don't do drugs. Be true to yourself. Don't go to pharmacy school. It's terrible."  It's funny, but sadly kind of true at this point.  I sincerely hope that the curriculum changes in the future so that other students aren't put through this wringer.  The combination of long, drawn-out classes, unfair exams, waste-of-time labs that cover unrealistic objectives, and many other factors contribute to the lack of caring that I, as well as some of my classmates, am experiencing and future students will continue to experience if they don't make some drastic changes.  From what some of the good professors have said, though, this change isn't going to come easily or any time soon.

Five more days and this quarter will be over!  Just gotta pass 4 more finals…  

The Right Thing

When you're talking about morals and ethics, there are a few different types of people.  There are those who know what's right and have an internal drive to do that.  There are also those who know what is right and what is wrong, but don't have that drive and may choose to do the wrong thing, without much guilt, if it suits them better.  And finally, there are those who either have a skewed view of right and wrong or simply can't make the distinction.  Of course, this is a spectrum; people may fit more than one of those descriptions depending on the circumstances.  A person's ethics are constructed at an early age and molded throughout childhood.  When they reach a certain age, these things can't be changed and become part of who they are.  (I don't have any references or citations supporting this; just an observation).  Side Note: It makes me wonder why they have classes at some schools called "moral decisions."  I can't really judge since I've never taken one but hopefully they're not trying to teach the difference between right and wrong to high-schoolers.  It's probably a little late at that point.

The reason that this topic came to mind is that a young friend of mine was faced with an ethical/moral decision recently.  It basically came down to making the choice to go somewhere he was told he couldn't.  Very soon after he snuck away, he was given the choice to turn back or face consequences.  He made the right decision to abandon his plan and turn around.  His reason for making that choice wasn't because of the consequences, but because of something less concrete to him; that he "just couldn't do it."  What that meant to me is that he thought about the guilt and the breakdown of trust that would likely follow doing the wrong thing and, as much as he was looking forward to his ultimate plan, couldn't go through with it. 

These qualities are one of the most important factors for me when I'm choosing who I want to associate with and who I can consider good friends.  We've all been around people who try to get us to do something with phrases like "no one will find out" or "it's not that big of a deal" but when it's not the right thing to do, that should be reason enough not to do it.  The people I want to be around are those who have that inherent ethical decision-making ability and are honest.  Doing the right thing should take precedence over a borderline or definite unethical decision that's more convenient or is only made to serve your own interests.  Everyone makes stupid mistakes from time to time, but what matters at the end of the day is what you learn from them and that you ultimately make the right decisions regardless of the missteps in the process.  Many things about a person (as we all have our faults) can be overlooked when certain character strengths are present.  There are a number of people that I can still consider good friends in spite of various shortcomings because they are enjoyable to be around and, more importantly, have "strong moral fiber."  There seems to be an association between these qualities and many people on camp staff.  After all, all of my best friends are "camp people."  Hmm…coincidence?

I want to be a druggist, not a doctor!

When I was deciding what I wanted to do for a living, one of the things that made me want to be a pharmacist is the way that independent community pharmacies run.  We (pharmacies/pharmacists) are an important part of the health care system, bridging the gap between people and their doctors.  We serve as a resource for people who don’t understand their disease states or their drug therapies.  We also serve as somewhat of a triage for people who don’t know if a minor problem warrants a trip to the doctor or just some over-the-counter option.  We are there to help people with deciding which OTC to choose as well as which medical device to choose and how to properly fit it (knee braces, compression stockings, etc.)  We are also a resource for the rest of the healthcare community when it comes to drugs.  However, those things are not what I am learning in school.  I have become more and more disappointed with my education at UW as the last few years have unfolded because we spend way too much time on clinical diagnoses and “doctor stuff” instead of the things we will encounter most often working in an outpatient pharmacy.  If I wanted to be a doctor, I would have gone to medical school instead.

I understand that some of each graduating class will go into residencies and later move into positions in hospitals as clinical pharmacists, who actually do rounds with physicians, but something like 80% of us will end up in the community.  It’s important to get a basic knowledge of clinical issues for wherever we end up, but it’s asinine that we spend probably less than 10% of our time on the things that 80% of us will be doing on a daily basis.  Clinical knowledge of disease pathophysiology and diagnosis is important to an extent (when explaining things to our patients and when evaluating their drugs) but our classes go way too far in-depth. 

Some of the things we have just glossed over are the most common things that community pharmacists do.  We spent a very small of time on patient counseling in first year, before we had learned anything about the drugs (so it was difficult to apply the little bit they taught us).  Only one class discussed OTC choices, and as a once-a-week class, I didn’t learn a whole lot.  Mostly because he used “team-based learning” … refer to a previous blog for my feelings of hatred towards that approach.  The only class that discussed medical devices was a once-a-week elective that involved student presentations instead of lectures.  So the little we learned was basically whatever that particular group of students presented.  Apart from that class, we haven’t learned anything about orthopedic devices, compression stockings, wheelchairs/walkers/canes/crutches, incontinence supplies,… the list goes on. 

I think I know the reason that so little time is spent on these things.  It’s because of the huge amount of time we spend on “doctor stuff.”  In labs, we have spent hours on full heart and lung exams.  It’s good that we learned what findings of those exams may mean, but I think it’s just stupid how much time we spent learning how to actually perform them.  And it wasn’t even from someone who does that; it was from a person only 2-3 years ahead of us in their education.  We also spent a lot of time learning how to read ECGs.  I’m glad to know what a ST-segment elevation means (as it affects drug therapy decisions), but when is a pharmacist ever going to be the one to look at an ECG and determine that that is what is going on?  Never.  That’s going to be the job of a cardiologist, an ER doc, or maybe even a general physician, but never a pharmacist.  Why not devote some of the time spent on these things to things that will be more relevant in the majority of students’ careers?  If you’re going to specialize in clinical cardiology-pharmacy, you’re going to do a residency in that, which is where these specific things would be better suited to teach.

I am inexpressibly thankful for working at a drugstore while I’m going to school for two reasons.  First off, it’s where I learn all of these things that I am not being taught in school.  It’s great that I know the structure of a drug and the decision-making that goes into picking that drug, but that barely helps me explain to a patient the big picture of their disease and how to take their drugs and what to expect from them.  I’m glad I have such knowledgeable pharmacists at work that I can learn all the useful stuff from.  A cycle I have kind of developed this year is after I learn about something at school I go to work and ask what that means practically and what is important for patients to know when we counsel them.  The other reason I enjoy work so much is that it is a constant reminder of why I’m putting myself through this program in which I am not learning what I set out to learn.  Sometimes I wonder why I’m sitting through 4x/week three-hour lectures and excruciating lab sessions to learn a lot of things I’ll never actually do and only a little that I will.  But working regularly reminds me of what attracted me to pharmacy in the first place: the juxtaposition of healthcare with quality customer service, two things that both interest and excite me.  Regular dealings with real people and helping them improve their health in ways they can understand is what I truly enjoy. 

So school has basically become a means to an end.  I go through all my classes with two objectives: learn everything I need to know to pass the exams, but more importantly, learn everything I can about the pharmacist things in such a way that I can retain them and apply them in the future.  If some of the doctor stuff gets forgotten a couple weeks later, that’s fine, as long as I remember the things that I’ll need and the things that matter to a pharmacist who isn’t also trying to be a doctor (which is kind of what they’re trying to push).  Then I can augment that with the practical things I learn at work as well as the practical things I’ll learn from preceptors in my 4^th year rotations.  Who knows what the future of pharmacy schools will bring.  Maybe there should be a movement towards separating the education between future clinical pharmacists and future community pharmacists.  Since both roles are changing so quickly, it makes sense to cater education to what someone's ultimate destination is.

Using Time Wisely

One of the biggest conundrums I face sometimes is deciding whether or not to go to class.  I am not one to skip class just for the heck of it, but if my time is going to be wasted, it’s not worth going.  I am a huge fan of traditional education.  If someone experienced in their field (not someone whose career is solely education) and is going to give us an actual lecture (not reading PowerPoint slides they’ve already posted), I will attend 100% of the time.  However, when it’s going to be an interactive, group-discussion, pull-teeth-to-get-a-volunteer presentation, it’s more a waste of time than anything else.  Sometimes I think that these types of presentations are an excuse for the instructor to be lazy.  They don’t have to present their own information; they rely on students to do that.  So what is the point?  I’m not paying $6500 a quarter to hear fellow students regurgitate something we’ve all already learned, I want to hear from people that can actually teach me something. 

It’s not only the waste of time in the classroom itself, it’s the time surrounding it.  If I go to school for just one hour-long class, from the time I leave home until the time I return is about 2-1/2 hours because of how long the bus takes and how long I have to wait.  So, if I’m not going to learn a whole lot, it’s well worth the time to stay home and study the material on my own.  I can be much more efficient at home, even if I take frequent breaks.  I would rather not waste time with useless classes because that translates more time studying after class and therefore fewer and fewer hours of sleep (especially with 7 classes this quarter…)

Given all that stuff I just said about how much time school takes, I still spend the majority of my weekends at Camp Parsons, paying absolutely no attention to school.  My argument for that is that if I actually did spend all of my time studying (which I could easily do, considering how much there is to do) I would go insane.  Volunteering at camp is the one thing I do that gets my mind completely off of school.  Spending last weekend with most of my best friends, getting a LOT accomplished on various projects, and enjoying the company of many generations of camp staff is what makes it so I can tolerate the agony and torture of school.  Matthew Broderick said it well: “Life is packed with things you have to do, but sometimes you’ve got to live a little.”  During the week, I might spend extra time studying to make up for being gone on weekends, but as long as I learn everything I can that will be useful once I graduate and pass all of my classes and have some time left over for camp and friends, I’m content.  (All the stuff we’re supposed to learn that is impractical is a subject for a future blog…)  So in conclusion, I think I made a good decision to go to the library and get caught up on some studying than sit through a class where I wouldn’t learn much.  I guess I did just waste a little time writing this, but now I can start studying…

2 Great Customer Service Experiences in One Day?

If you've read some of my previous blogs, you know I'm someone who appreciates customer service a LOT.  Today, I had two marvelous experiences.  The first was at Whistle Workwear in Shoreline.  Chris and I have been talking about getting overalls for a while since we want to be as cool as Ralph and Greg(s) so we went out in search for some today.  I have also been looking for work boots for a number of years as well as a new buckle belt so I can wear my CP belt buckle without needing to tape down the lengthening tail of my old belt.  Well, lo and behold, this store had all three things!  Something I've had trouble with all my life is finding a store that sells clothes that have a larger vertical dimension but a regular horizontal dimension.  Also, I haven't been in a shoe store in 5+ years since most of them don't carry larger than a 13 and I wear a 16 shoe (15 boot).  The employee at this store today was very helpful in getting a boot that fit me well and spent at least half an hour customizing the insole setup so that I was as comfortable as possible.  In the end, I walked out with a pair of overalls, a pair of work boots, and a quality leather belt.  She even threw in a free pair of socks and was far more than friendly and courteous the whole time. 

The second experience, immediately following, was at Famous Dave's BBQ in Everett.  I hadn't been there before, but had heard of their excellent food in the past so we made the journey up I-5.  Their wait staff attended to all the small details that, individually, aren't all that significant, but when added together, make a superb experience.  They open the door for you, seat you promptly and make sure you understand the menu (in a non-robotic manner), and most importantly, make sure your drink is full.  I was just setting down my coke after taking the last sip and the waiter was standing there with a full one.  The manager even came by to make sure we were enjoying our food, which was amazing.  It's a little pricey and far north, but the combination of great food and fabulous service make it well worth-while.

It's getting more rare that you see such great customer service, but these two establishments are still going strong.  Whenever I need barbeque or work wear, these two places will top my list.  After all that, I stopped by my parents' house to do some laundry and it just happened to be filet mignon night!  It didn't take much convincing to get me to stay for dinner and we enjoyed a meal of a quality that I never buy and cook for myself (both for lack of a steady income and a barbeque.)  Tomorrow I guess I will need to start studying, as I've put it off for long enough during this unexpected ten-day vacation.  Since the stuff we missed on the snow days will be on Friday's exam, I better take a first look at the stuff we've covered so far this quarter... 

Flowery Language

When people talk, listen to the words they choose.  People are judged on the way they speak every day.  Whether or not they say "like" a lot, if they use proper grammar, and the "caliber" of words they choose are all things that form ideas about their intelligence in other people's minds.  Something I have noticed a lot, especially in school, is the use of lots of fancy words when simpler words will suffice.  Sometimes people try to use words of which they don't know the meaning, but I'm not talking about them.  I'm talking about the people that try to make themselves seem smarter or superior by using as many twenty-dollar words as they can. 

When I'm sitting in school, I don't get to hear patient cases, I get to hear patient-care case vignettes.  We no longer go to work, we go to our "work sites" which will become our "practice sites" after we graduate.  People don't talk about things they've seen at work, they talk about experiences they have encountered in their practice.  We no longer have externships, we have "introductory and advanced pharmacy practice experiences."  As pharmacists, one of our jobs is to encourage patients to be "concordant" with their therapy.  Who even knows what that means? It's the new term for "adherence" which was coined when "compliance" was deemed not to be politically correct.  When we write "patient care notes" we have to say things like "her past medical history is significant for hypertension" not that she has high blood pressure.  They mean the same thing and one is much simpler and easier to understand.  One professor actually said, instead of "you should ask a nurse," that we should "utilize our multidisciplinary friends."  Now that's going a little too far. 

I had to stay after class once because I was "using my positive influence over the class to squash people's self-efficacy."  I had no idea what she meant by that, but didn't take the time to ask what her fancy (and I think some made-up) terms actually meant.  I think the problem she had was that I said differentiating between concordance, adherence, and compliance was stupid.  My other point during that day's discussion was that people don't care if you refer to them as "customers" or "patients" when they come into a drug store (sorry… a pharmacy practice site).  It confuses some people, because they think of themselves as "patients" when they're in the hospital, and even if we are providing healthcare, they are also paying for a product and service from a business, so they are customers.  When we call doctors about things, we refer to the people as "patients."  It all depends on context and who you're talking to, but in a lot of cases, it just doesn't matter.

Now I understand the need, in medicine especially, to speak and write in such a way that your intent is clear and the points you make are specific, but when you add all that flowery language, it just makes for more to sort through and takes extra time.  Shouldn't we be using as few words as possible to fully get a point across since we're so busy as healthcare workers?

My main point is that when you speak, choose the correct words ("because these words have meaning") but don't go over the top trying to impress people with extravagant language that is time-consuming and over-the-top-unnecessary for the situation.  

Tried and true methods are best left alone

There is this new method of learning that I have been dragged through a couple times in the last few years.  I'm not sure if it's a widespread trend or just someone's "brilliant" idea at this school, but I don't like it one bit.  It's called "Team-Based Learning," abbreviated TBL.  The concept is that the students learn the material on their own and in teams, then it is reviewed as a class.  It is an ineffective teaching method (if you can call it teaching) for two big reasons: it puts the traditional lecture---learn/discuss---exam method in a really odd order and it wastes a lot of time, both before and during class.

This is how the process goes:

1. There is a pre-class multiple-choice quiz (online) over the subject for the following day's class.  The student works on his own, using whatever resources he wants (not having had any instruction on that topic yet).  This is called a "readiness assessment test (RAT)."

2. There is another quiz at the beginning of class (the same questions and answers) but this time it is taken as a group.  So there is a lot of time given for groups to argue between their answers, still not having had any instruction on the topic.  All the discussion stems from whichever resources each student found and the impressions they have based on their very limited experience.

3. The class discusses each of the questions and the answers their group chose.  This is the first time in the whole process that the instructor may insert her own experience and make sense of all the resources that provide conflicting information or guidelines for treatment.

So, in effect, most of the process is a struggle for each student to find information on his own, and that information is usually limited to the specific circumstances surrounding each question, not how to treat the disease state in general.  I understand that students learn better when they can come up with some of the knowledge on their own, but providing absolutely no basic knowledge or information in advance of two quizzes is not the right way to make that process happen.  Answering the quiz questions usually comes down to trying to justify little pieces of each option that are not ideal and arguing between two answers that are probably both semi-correct.  I don't know about the "ideal modern student," but I learn best in the traditional manner: give some preparation work before class (reading, etc.), lecture on the material (supplementing the text with personal knowledge or experience), allow time to study the material on one's own, then give an exam.  It's frustrating to take a quiz and have to come up with all of the answers from scratch rather than drawing from a professional's knowledge (since that knowledge was never provided in the first place).

Secondly, it's a huge waste of time.  If we had at least a basic background of the topic beforehand, quiz time could be spent looking up exceptions or juggling two good options, rather than that in addition to learning all the general knowledge of the disease state.  Then, in class, more time is wasted when the groups are given time to discuss.  Many times, the whole group agrees, and when they don't it is on something that only clinical experience could decide (something which the professor has not commented on yet).  So inevitably, there is a 10-30 minute period when your group is done with the quiz that you do absolutely nothing.  All this does is take away from the time at the end when the instructor may or may not add to the discussion with the experiences he's had, which is the only thing worth the huge amount of tuition that goes towards these classes.

The class I'm taking now uses parts of this method, so at least it's not as bad as last year's class that used every bit of it, including scratch-ticket-like answer sheets (another great use of tuition…).  But I still feel like the teaching process is turned backward and a lot of my time is being wasted.

So that was the second half of my day…  The first half of my day was about the same level of frustrating and waste of time, learning things I'll never use as a pharmacist.  But that's a different blog for a different day.  Off to camp for a long weekend and work party tomorrow!

Computers in class?

Brace yourself for another old-man-esque rant about technology…

If you sit down in the middle of a pharmacy lecture and tune out the professor (something I may occasionally be guilty of) you hear one sound: the incessant pitter-patter of keyboards.  Now I understand the appeal of using a computer to take notes, but I think sometimes, it's a little unnecessary and can sometimes be detrimental, both to yourself and those around you.

There are a lot of arguments for bringing a computer to class.  I do agree with some of them, but I think that the reasons not to bring it outweigh the positives.  The biggest argument you'll probably hear is that it's easier to take notes on a computer.  Ok, for some that may be true.  However, I think that pen(cil) and paper offers much more.  Learning to take notes in a shorthand form is important so that you can write more quickly and not miss as much of the lecture.  Part of that shorthand is using symbols (arrows, abbrevs that require non-letter/number characters, etc.) and making those symbols, drawing arrows to different parts of the notes, and making quick diagrams takes much longer on a computer.  Some people say they can type faster than they can write, which I believe, but for a lot of the people who use their computers in class, that isn't true.  The slowdown of typing and trying to make crude diagrams on the pdf of the notes causes them to lose time.  They miss points made and have to either ask their neighbor or interrupt class to ask the professor to repeat himself.

Another advantage of pen/paper notes is that when you go to study, you have the wonderful opportunity to copy those notes, organize them, and make them legible.  Seeing (and especially writing) something more frequently means that you learn it better.  If you want computerized notes, just add it into the pdf at home when you are reviewing the lecture.

You may disagree with the points I've made so far.  Fine.  Everyone learns differently and has different talents with typing, writing, and drawing.  But the aforementioned reasons are not the only reasons that computers don't usually belong in the classroom.  Computers are a distraction both for the user and those around him.  Computers open you up to any resource you could dream of, which could enhance your learning (if you need to, just look it up after class, I say…), but they also open you up to distractions like shopping, facebook, chat, email, and lots of other things that you don't need to be doing during class.  If you are just going to come to class day after day and not pay attention because the internet is so enticing, why even come to lecture?  I know how hard it is to resist temptation.  I'm often guilty of checking my phone during a dull point in class, but what bothers me are the people I sit behind who, without fail, are doing five or six things during every single class.  It's not uncommon for someone to have open facebook, google chat, their email, the Coach shopping site, many other random things, and somewhere in the background, their notes.   Not only are you distracting yourself, you're distracting the people around you who can't help but see your shopping or chat windows flashing different colors as you talk to classmates.  I will say, though, that there are a rare few who I have sat behind and do nothing but pay attention and take notes.  I commend them on their ability to resist the powerful pull of the world wide web.

One other thing… computers are pretty heavy.  Even with lighter computers, once you factor in the protective case and power adapter, that adds up to much more than a small stack of looseleaf paper and a pencil or two.  You're not doing your back any favors by lugging that thing around every day.

I may be old-fashioned with my learning styles (see my post on why powerpoint is an asinine alternative to overhead projectors), but I do think that more often than not, computers are used for non-academic purposes when they are being used during class.  There are definitely times when computers can be of great benefit during a class, but most of the time, they're unnecessary.  I don't really care all that much when so many people have their computers; when an interesting person is lecturing, it's not hard to focus solely on him or her and take my notes on my sheet of paper.  The people distracted by their computers are the ones who have the potential to lose out on a good lecture or miss good points made that weren't in the furnished notes.

Just be patient...

The impatience of some people amazes me. So many times, someone's desire to get somewhere or make something happen a few seconds quicker clouds their common courtesy.

A pretty common example of this, one that I encounter almost daily at school, is when a class runs a couple minutes late and the next class floods in before the class before them even begins to leave. All I can think of is that they must just be excessively eager to learn. Today, our once-weekly class ran a little (4 minutes) past the scheduled ending time. The professor for the following class came in and shouted "are you almost done?" in a pretty impatient tone. We had literally just finished wrapping up and many people were packing their bags. Our teacher said "yes, we are done now" to which Mr. Crabby-pants replied "good, because there's a seminar in here in TWO minutes." Apparently he missed the day in professor school when you learn that when the minute hand is on the five, there are not 2, but 5 minutes until half-past the hour. Then, as soon as we stood up, the seminar attendees rushed in like the flood gates had been opened. I stood at the door watching every person come in while 10-15 of them squeezed past me trying to get in. I wanted to see how many people would go by before someone realized that letting us out first would make it easier for them to enter and find seats. But that moment didn't come, so I ended up just pushing my way through.

Some people just need to chill out a little and realize that maybe getting somewhere fifteen seconds later or waiting briefly before doing something is worth sacrificing in exchange for showing a little consideration for someone else.  I won't even get into impatience on the road, as that is a whole other topic altogether, but in most aspects of life, people would be a lot happier and tolerant of each other if they just slow down and show a little courtesy to one another.

The Cost of Healthcare

Today was the first day of class.  The only class I had was one I thought might be boring, but it turned out to be pretty interesting and I think I will get a lot out of it.  It's about healthcare, our current and future system, other systems in the world, economics, and related topics.  The instructor made the assumption that we've all had at least a basic economics course (which I haven't), so hopefully that won't hinder me.  I guess if I don't understand something, I'll have to find a friend who knows something about Econ.  I think I have one of those…

An interesting point was brought up in class today that related to an experience I had recently at work.  We discussed the relationship between the patient, the provider, and the payer in our current healthcare system.  The patient doesn't pay nor choose services; the provider doesn't pay nor use services; the payer doesn't choose nor use services.  The analogy was made to buying a cup of coffee.  If you had "insurance" that would cover a cup of coffee, you'd probably be more likely to buy more often and more extravagant (expensive) drinks, especially if the copayment was similar or the same for differently-priced options.  After all, you're not the one paying for it…  I think this is one problem that contributes to our high cost of healthcare.  When people aren't asked to pay for things more than a minimal copayment, they're way more likely to choose more expensive treatments that may only work slightly better or sometimes not at all. 

One man that is a regular customer was picking up his wife's prescription for a drug that had been recently switched from a shorter acting form (taken twice daily) to a long-acting form (taken once daily).  His copayment was the same for the two products, but he noticed on his receipt where it lists the "usual and customary" amount, which relates to the cost of the drug to his insurance company, the long-acting drug was considerably more expensive (somewhere around 10-fold).  Even though his cost would be the same, he asked us to switch back to the short-acting form.  Having taken both in the past, his wife didn't notice any difference therapeutically and he said he'd rather not get something that is going to cost his insurance company ten times as much if it only means having to take it twice a day. 

That was a shocking interaction, as that line of thinking is so rare.  Most people don't care what their drugs cost to their insurance company, as long as their copay doesn't increase.  Maybe if more people thought like this particular man, insurance premiums and healthcare costs wouldn't be as astronomical as they are.  It's amazing how many complaints we got with DSHS started charging a $1.10 copay for drugs that were previously free to patients (drugs which may cost hundreds of dollars) or how much people complain about a ten dollar increase in copay when the drug they switched to costs way more than the alternative.  An example is minocycline (used commonly for acne in teenagers) vs. its extended-release form, Solodyn.  From what I've heard (I haven't read studies), there isn't much of a difference in efficacy.  The big difference is that you don't have to take Solodyn as often.  But get ready for this… the average wholesale price for Solodyn is more than $28/pill where we get generic minocycline for less than $0.20/pill.  And patients complain when their copay is $10 more for a month's supply of Solodyn.  So what if it doesn't work quite as well.  Is that $25+ difference in the price of each pill really worth the convenience of less-frequent dosing?

Another example is when doctors start patients on a nasal steroid for allergies.  Two common choices are Nasonex (not generic with a ~$105 wholesale price) and Flonase (generic wholesale price ~$20).  Nasonex might work a little better for some people, and many doctors will try to start people on that, but why not start on Flonase and see if that works well enough for that patient.  If the insurance company actually does pay for it (many don't), it costs much less for all parties involved to try the cheaper one first, and it will likely work just fine for most people.

When you think more broadly, past the amount you're paying and more about the true costs of things and who is actually paying for it, you begin to realize why our healthcare costs so much.  It also makes you lean more towards the insurance companies in some situations when they say they're not going to pay for some incredibly expensive treatment that isn't much better than the standard.  Sure, if people want to pay the difference to get the state-of-the-art treatment, that's fine, but they shouldn't expect their insurance (especially government-subsidized or -sponsored plans) to do so.

Without economics in my background and not having much in-depth knowledge about the healthcare system, I think this class will bring up a lot more topics that will help me relate to, work in, and understand the healthcare system as well as the current healthcare reform.  I hardly get involved when politics come up, but this is one topic that I actually do care about as it relates to my future career and the well-being of myself, friends, and family.