Last week in my personal blog I reflected on humility as defined by James Ryle:
God given self-assurance that eliminates the need to prove to others the worth of who you are and the rightness of what you do.
Ryle suggests, from 1 Peter 5:5-7, that central to humbling ourselves is throwing our cares on to God. Every concern, care and fear being hurled on to God who is faithful and powerful enough to handle them. When we know that we are loved by Him no matter what and that He is in control no matter what, then we remove the need to prove ourselves or protect ourselves. We become humble – secure enough to allow God to be in control and to serve others. Once our eyes are lifted from ourselves we are able to see others to love and serve them.
Just before writing the last post I was reading an article about the report by Robert Francis QC on the appalling treatment of patients at Stafford Hospital. One of the recurring comments made by many different people is that the pressure of targets and incentives increasingly displaces focus on compassion and patient care. When doctors, nurses and managers alike are bombarded with ever increasing and regularly changes hoops to jump through and targets to meet, no wonder their attention and efforts are dragged from patient care.
I’ve seen something of the effects of this in a family member who for many years worked as a Health Visitor. In their decades of service they saw an ever increasing and ever changing string of targets and goals alongside cost cutting moves that stripped resources and personnel. Their desire to be compassionate and offer the best care possible became more and more stressful until it finally proved too much. She recently changed jobs.
Now I’m not trying to attack the NHS and I am well aware that so many people receive great care. But this is not a new concern that is being bandied around with fresh vigour in the light of Stafford Hospital. What struck me is that it demonstrates on an institutional level what also seems true at a personal level. Namely, that when we are forced to operate from a place of insecurity we begin to miss the most important things. NHS services have to meet targets to receive funding to simply keep operating – there will be no patient care if there is no hospital. Oftentimes, especially as a leader, we can live with a sense that, unless we meet expectations or make people like us or recognise our worth, then we’ll have no influence to do any of the things we know we are called to do.
The secret of personal humility is to recognise that we are already loved by our Father before we even move our finger; to recognise that He is control and we can throw every care on Him. A person who can live from that place of security finds, free from the need to prove themselves or their actions, can begin to simply do what they are made and called to do. They are no longer pulled in different directions by a multiplicity of cares. What about an institution?
It strikes me that a similar solution is needed for the NHS. Is there a way to give security for doctors, nurses and caring professionals so that they are able to do what they are called to do without constantly watching their back? Obviously there is a need for accountability for the safety of patients and to ensure a good standard of care, but the constant need to prove worth and achievement cannot be helpful for those who are called to compassionate care.
I’m not a healthcare professional. I don’t know exactly what this would look like. But I recognise in the diagnosis of struggles in the NHS, God’s diagnosis of struggles in many people’s lives. The way He designed us to live with Him is often a good basis to begin to imagine a new way for every level of society to function.
So, my question is this: what would a humble NHS look like? To whom could a National Health Service throw it’s concerns and cares?
It’s quick, it’s easy and we’ve all done it. Don’t blush, whether it’s at our leisure or behind the consultant’s back we can confess to having used the world’s sixth most popular website. You might have seen it, sitting pride of place on the podium of practically any Google result page. Of course, it’s the tell tale sign of one of Web 2.0’s speediest and most successful offspring, Wikipedia.
Now for fear of patronizing a generation who have sucked on the teat of this resource since its fledgling years, the formalities will remain delightfully short. Wikipedia is the free, multilingual, online encyclopedia, which harnesses the collective intelligence of the world’s internet users to produce a collaboratively written and openly modifiable body of knowledge. The technology it runs on is a highly flexible web application called wiki. It is open-source software; hence the explosion of wiki sites all united under the banner of combined authorship. Anyone with internet access can edit the content and do so with relative anonymity. It would be unthinkable that a source, which does not prioritize the fidelity of its content, could possibly play a role in medical education. How ironic it seems that medical students can waste hours pondering which textbook to swear their allegiance for the forthcoming rotation, yet not spare a second thought typing their next medical query into Wikipedia. Evidently it has carved itself a niche and not just among medical students, but healthcare professionals as well. According to a small qualitative study published in the International Journal of Medical Informatics, 70% of their sample, which comprised of graduates from London medical schools currently at FY2 and ST1 level, used Wikipedia in a given week for ‘clinical purposes’. These ranged from general background reading to double checking a differential and looking up medications.
We are so ensnared by the allure of instantaneous enlightenment; it’s somewhat comparable to relieving an itch. "Just Google it..." is common parlance. We need that quick fix. When the consultant asks about his or her favourite eponymous syndrome or you’re a little short on ammunition before a tutorial, the breadth and ease-of-use offered by a service accessible from our phones is a clandestine escape.
The concept of Wikipedia, the idea that its articles are in a way living bodies because of the continual editing process, is its strength. Conversely textbooks are to a degree outmoded by the time they reach their publication date. While I commend the contributors of Wikipedia for at least trying to bolster their pages with references to high impact journals, it does not soften the fact that the authorship is unverifiable. Visitors, lay people, registered members under some less than flattering pseudonyms such as Epicgenius and Mean as custard, don’t impart the sense of credibility students (or for that matter patients)expect from an encyclopedia. Since the prestige of direct authorship if off the cards, it does beg the question of what is their motivation and I’m afraid ‘the pursuit of knowledge and improving humanity’s lot' is the quaint response. There is a distinct lack of transparency. It has become a playground where a contributor can impress his/her particular theory regarding a controversial subject unchallenged. Considering there is no direct ownership of the article, who then has the authority to curate the multiple theories on offer and portray a balanced view? Does an edit war ensue? It is not unheard of for drug representatives to tailor articles detailing their product and erase the less pleasant side-effects. Obviously Wikipedia is not unguarded, defences are in place and there is such a thing as quality control. Recent changes will come under the scrutiny of more established editors, pages that are particularly prone to vandalism are vetted and there are a special breed of editors called administrators, who uphold a custodial post, blocking and banishing rebellious editors. A study featured in the First Monday journal put Wikipedia to the test by deliberately slipping minor errors into the entries of past philosophers. Within 48 hours half of these errors had been addressed. Evidently, the service has the potential to improve over time; provided there is a pool of committed and qualified editors.
Wikiproject Medicine is such a group of trusted editors composed primarily of doctors, medical students, nurses, clinical scientists and patients. Since 2004, its two hundred or so participants have graded an excess of 25,000 health-related articles according to quality parameters not dissimilar to peer review. However, the vast majority of articles are in a state of intermediate quality, somewhere between a stub and featured article. Having some degree of professional input towards a service as far reaching as Wikipedia will no doubt have an impact on global health, particularly in developing countries where internet access is considered a luxury.
March this year saw the medical pages of the English Wikipedia reach a lofty 249,386,264 hits. Its ubiquity is enviable; it maintains a commanding lead over competing medical websites. The accessibility of this information has catapulted Wikipedia far beyond its scope as a humble encyclopedia and into a medical resource. Patients arrive to clinics armed with the printouts. As future doctors we will have to be just that one step ahead, to recognise the limitations of a source that does not put a premium on provenance but is nevertheless the current public health tool of choice.
Illustrator Edward Wong
This blog post is a reproduction of an article published in the Medical Student Newspaper, November 2013 issue.
1. Sleep (I realize I’m posting this at 12:30 am…)
I know there’s a popular perception of sleep deprivation going hand in hand with working hard or succeeding academically. However, that is only true if you’re working very last minute, and don’t care about retaining the information–you basically just want to get through your upcoming test/assignment. I would like to clarify that, although learning about 10 months of material in 2 weeks is overwhelming, it is NOT last minute because whatever you’re working on right now, you’ll have to remember in 2 weeks for your exam. Besides the exam, if you’re studying medicine, you need to remember most of these things for the rest of your life.
In order to retain that information, you need to stay alert, well rested and motivated. Prolonged sleep deprivation can make you feel very ‘CBA’ very fast.
2. Stay Energized
Sleep is only one factor in staying motivated and alert; another is staying energized¬–in a healthy way. Simply put: if you feel well, you’ll work well.
difficult, I know, when you’ve got so little time to spare; but as much as you can, try to eat more whole foods (aka things that don’t come in wrappers or have their own commercial) and keep a balanced diet (too much of anything is usually not good). Everyone snacks while they’re doing exams, but try to find a vice that won’t put you in a sugar coma (some good examples include berries and other fruits, nuts, carrots with hummus to dip in, granola bars, etc).
Note: drinking tea is also an excellent way to stay energized!
Again, I know something like this is difficult to keep up in normal everyday life, let alone during exam stress. Even if it is just for 15-20 minutes, some cardio (note: the more strenuous the workout in a short period of time, the more benefit you’ll get) is a fantastic ‘eye-opener’ (I learned that phrase while learning how to take an alcohol history and now I really like it)! No one wants to go for a run in the morning, but after you get past the first 2-3 minutes of wanting to collapse, your body starts to feel really grateful. This is the BEST way to stimulate your senses and wake yourself up. I promise it’s better than any energy drink or cup of coffee you could have.
Take small breaks: SMALL breaks!!! About 10 minutes. Every once in a while, you need to get up and walk around to give yourself a break, have some fresh air, grab a snack, but try not to get carried away; try to avoid having a short attention span.
3. Make Lists
I cannot stress enough how counterproductive it is to overwhelm yourself with the amount of work you have. Whether you think about it or not, that pile is not going anywhere. Thinking about it won’t wish it away. Stop psyching yourself out and just get on with it– step by step.
Making a list of objectives you need to accomplish that day or week is a great way to start; then, cross them out as you go along (such a satisfying feeling). Being able to visualize your progress will be a great motivator.
Remember: it is important to be systematic with your studying approach; if you jump around between modules because they’re boring you’re just going to confuse yourself and make it hard to remember things when that exam comes
Note: I have a white board in my room where I write my objectives for the week. Some days it motivates, some days it I want to throw it out the window (but I can't reach the latch)…
4. Practice Questions
Practice questions are excellent for monitoring your progress; they’re also excellent at scaring you. Do not fear! This is a good thing, because now you know what you’re missing, go back and read up on what you forgot to take a look at, and come back and do the questions later. Then give yourself a sticker for getting it right ? Practice questions are also great for last minute studying too because they can help you do what I call “backwards studying”–which is what I just described: figuring out what you need to learn based on what the questions look like.
5. Be realistic
Set realistic goals for yourself; most importantly, set realistic daily goals for yourself so that when you get all or most or even some of them done you can go to sleep with a level of satisfaction. Also, you need to pick your battles. Example: if you suck at neuro, then one module’s loss is another’s gain. Don’t spend too much time trying to get through one thing, just keep moving forward, and come back to it later
6. ‘Do not disturb’
Facebook, twitter, instagram, youtube, whatsapp, texting, pinterest, meme websites, so many fantastic ways to kill your time… Do yourself a favor, save them for your breaks. If someone is dying or on fire, they will most likely call you, not text you or write on your wall; you do not need to check your phone that often unless you're expecting something time sensitive.
Everyone studying in your program is going to be stressed about things; do NOT let it rub off on you. You know those moments when you hear a peer or a prof/tutor describing something you have never even heard of, then you start panicking? Yeah, don’t do that. It happens to everyone. Instead of worrying so much, just go read about it! Simple solution right? What else are you going to do? Plus, a lot of the time other students seem to know more than they need to about certain things (which I can tell you right now, doesn’t always mean they’re doing better than you; knowing random, very specific factoids doesn’t mean they can bring it in clinic. Everyone can pull a Hermione and know a book inside out, but this is not necessarily the hallmark of a good doctor), what’s it to you? Worry about yourself, be confident in your abilities, and don’t trouble yourself with comparing to other people
8.Practice for Practicals
Everyone is afraid of practical exams, like the OSCE (at any rest station you're likely to find me with my head in my hands trying to stabilize my breathing pattern and trying not to cry). The best way to be ready is to practice and practice and practice and practice. It’s like learning to drive a car. At first you’re too aware of your foot on the gas, the position of your hand on the wheel, etc; but, after driving for a little while, these things become subconscious. In the same way, when you walk into a station, you could be so worried about how you’ll do your introduction and gain consent, and remembering to wash your hands, and getting equipment and and and and and; the anxiety affects your confidence and your competence. If you practice enough, then no matter what they throw at you, you will get most of the points because the process will be second nature to you.
Practice on your roommates, friends, family members, patients with a doctor's help...when appropriate... Even your stuffed animals if you're really desperate.
DO NOT leave practicing for these practicals to the last minute; and if you do, make sure you go through every thing over and over again until you’re explaining examinations in your sleep.
NOTE: When I'm practicing for OSCE alone, I record myself over and over again and play it back to myself and criticize it, and then practice againn.
You don’t necessarily have to study in the same place every day; however, it is always good to have some level of routine. Some examples include: waking up/sleeping at the same time everyday, going for a run at the same time every day, having the same study routine, etc. Repetition is a good way to keep your brain focused on new activities because, like I said before, the more you repeat things, the more they become second nature to you.
Hope these tips are of some use to you; if not, feel free to sound off in the comments some alternate ways to get through exams. Remember that while exams are stressful, this is the time where you build your character and find out what you’re truly capable of. When you drop your pen after that final exam, you want to feel satisfied and relieved, not regretful.
Happy Studying ?
So you're sitting in a bus when you see a baby smile sunnily and gurgle at his mother. Your automatic response? You smile too. You're jogging in the park, when you see a guy trip over his shoelaces and fall while running. Your knee jerk reaction? You wince. Even though you're completely fine and unscathed yourself. Or, to give a more dramatic example; you're watching Titanic for the umpteenth time and as you witness Jack and Rose's final moments together, you automatically reach for a tissue and wipe your tears in whole hearted sympathy ( and maybe blow your nose loudly, if you're an unattractive crier like yours truly).
And here the question arises- why? Why do we experience the above mentioned responses to situations that have nothing to do with us directly? As mere passive observers, what makes us respond at gut level to someone else's happiness or pain, delight or excitement, disgust or fear? In other words, where is this instinctive response to other people's feelings and actions that we call empathy coming from?
Science believes it may have discovered the answer- mirror neurons.
In the early 1990s, a group of scientists (I won't bore you with the details of who, when and where) were performing experiments on a bunch of macaque monkeys, using electrodes attached to their brains. Quite by accident, it was discovered that when the monkey saw a scientist holding up a peanut, it fired off the same motor neurons in its brain that would fire when the monkey held up a peanut itself. And that wasn't all. Interestingly, they also found that these motor neurons were very specific in their actions. A mirror neuron that fired when the monkey grasped a peanut would also fire only when the experimenter grasped a peanut, while a neuron that fired when the monkey put a peanut in its mouth would also fire only when the experimenter put a peanut in his own mouth. These motor neurons came to be dubbed as 'mirror neurons'.
It was a small leap from monkeys to humans. And with the discovery of a similar, if not identical mirror neuron system in humans, the studies, hypotheses and theories continue to build. The strange thing is that mirror neurons seem specially designed to respond to actions with clear goals- whether these actions reach us through sight, sound, smell etc, it doesn't matter. A quick example- the same mirror neurons will fire when we hop on one leg, see someone hopping, hear someone hopping or hear or read the word 'hop'. But they will NOT respond to meaningless gestures, random or pointless sounds etc. Instead they may well be understanding the intentions behind the related action. This has led to a very important hypothesis- the 'action understanding' ability of mirror neurons.
Before the discovery of mirror neurons, scientists believed our ability to understand each other, to interpret and respond to another's feeling or actions was the result of a logical thought process and deduction. However, if this 'action understanding' hypothesis is proved right, then it would mean that we respond to each other by feeling, instead of thinking. For instance, if someone smiles at you, it automatically fires up your mirror neurons for smiling. They 'understand the action' and induce the same sensation within you that is associated with smiling. You don't have to think about what the other person intends by this gesture. Your smile flows thoughtlessly and effortlessly in return.
Which brings us to yet another important curve- if mirror neurons are helping us to decode facial expressions and actions, then it stands to reason that those gifted people who are better at such complex social interpretations must be having a more active mirror neuron system.(Imagine your mom's strained smile coupled with the glint in her eye after you've just thrown a temper tantrum in front of a roomful of people...it promises dire retribution my friends. Trust me.)
Then does this mean that people suffering from disorders such as autism (where social interactions are difficult) have a dysfunctional or less than perfect mirror neuron system in some way?
Some scientists believe it to be so. They call it the 'broken mirror hypothesis', where they claim that malfunctioning mirror neurons may be responsible for an autistic individual's inability to understand the intention behind other people's gestures or expressions. Such people may be able to correctly identify an emotion on someone's face, but they wouldn't understand it's significance. From observing other people, they don't know what it feels like to be sad, angry, surprised or scared.
However, the jury is still out on this one folks. The broken mirror hypothesis has been questioned by others who are still skeptical about the very existence of these wonder neurons, or just how it is that these neurons alone suffered such a developmental hit when the rest of the autistic brain is working just dandy? Other scientists argue that while mirror neurons may help your brain to understand a concept, they may not necessarily ENCODE that concept. For instance, babies understand the meaning behind many actions without having the motor ability to perform them. If this is true, then an autistic person's mirror neurons are perfectly fine...they were just never responsible for his lack of empathy in the first place.
Slightly confused? Curious to find out more about these wunderkinds of the human brain? Join the club. Whether you're an passionate believer in these little fellas with their seemingly magical properties or still skeptical, let me add to your growing interest with one parting shot- since imitation appears to be the primary function of mirror neurons, they might well be partly responsible for our cultural evolution! How, you ask? Well, since culture is passed down from one generation to another through sharing, observation followed by imitation, these neurons are at the forefront of our lifelong learning from those around us. Research has found that mirror neurons kick in at birth, with infants just a few minutes old sticking their tongues out at adults doing the same thing.
So do these mirror neurons embody our humanity? Are they responsible for our ability to put ourselves in another person's shoes, to empathize and communicate our fellow human beings? That has yet to be determined. But after decades of research, one thing is for sure-these strange cells haven't yet ceased to amaze and we definitely haven't seen the last of them. To quote Alice in Wonderland, the tale keeps getting "curiouser and curiouser"!