I was a little surprised to find so many of my friends supporting an open book examination for our medical students.
You know what, after that blog, I actually gave some thought and considered how that could actually work out. Should we limit the number of book to be brought by each student, or limit the total weight of the books ? Do we accept books enriched with sticky notes and handwriting ? How about lecture notes ? Again, do we limit the number of pages or the weight ? If we go for further, who is going to count, and do we count those tiny sticky note papers ?
(I would go mad once I begin to think of allowing computers.)
Of course it is all because of my paranoid personality. One can always follow examples (say, examination of law students) and, to begin with, allow one book - which could include a reasonable number of sticky notes and handwritten material.
As a believer of the game theory, my next question is: How would that affect the behaviour of our students ?
I give you a day to imagine.
Sunday, February 7, 2010
Saturday, February 6, 2010
Moleskine
There is a recent recrudescence of interest in using the traditional Moleskine notebook. Chua Lam (蔡瀾) mentioned it in his daily column, and a little friend of us actually posted a video clip that compares iPhone and Moleskine in his Facebook wall.
I was so impressed that I almost rushed to order a new Moleskine on line.
I gave up at the last minute, when I remembered there is already a hard-cover notebook in my pocket. Although I still carry with it everywhere I go, my need of referring to it has dropped to almost zero: I have so many appointments (and they keep changing) that I am forced to organize my activity in the Google calender (which synchronizes with my iPhone). A similar problem - and resolution - happened to my contacts. I used to write down some ad hoc ideas and things to do on the notebook, but now I prefer typing them electronically (because of my deteriorating handwriting).
Alas, now the only thing that I refer to my notebook is to check on the equation for the calculation of glomerular filtration rate - which I use so often but could never remember.
PS. After my urge to buy a Moleskine, I actually bought a little notepad software for my iPhone - paid by my remuneration for my chapters in the department textbook.
I was so impressed that I almost rushed to order a new Moleskine on line.
I gave up at the last minute, when I remembered there is already a hard-cover notebook in my pocket. Although I still carry with it everywhere I go, my need of referring to it has dropped to almost zero: I have so many appointments (and they keep changing) that I am forced to organize my activity in the Google calender (which synchronizes with my iPhone). A similar problem - and resolution - happened to my contacts. I used to write down some ad hoc ideas and things to do on the notebook, but now I prefer typing them electronically (because of my deteriorating handwriting).
Alas, now the only thing that I refer to my notebook is to check on the equation for the calculation of glomerular filtration rate - which I use so often but could never remember.
PS. After my urge to buy a Moleskine, I actually bought a little notepad software for my iPhone - paid by my remuneration for my chapters in the department textbook.
Friday, February 5, 2010
Kokuhaku
My recent bedtime reading is Kokuhaku (告白) by Kanae Minato (湊佳苗) - I borrow it from AL.
The story is not at all exciting but well told. To me, it is the written mimic of some cubism painting by Palbo Picasso: A single event was outlined by five persons, each with their own view and contributes to the overall picture.
In a sense, this way of telling a story is a slight twist of The Long Murder (長い長い殺人) by Miyuki Miyabe (宮部美幸), who is more imaginative by using ten purses from the first-hand perspective. Nonetheless, the real pioneer of this trick was Ryunosuke Akutagawa (芥川龍之介). In his masterpiece In a Grove (藪の中), all seven witnesses gave an entirely different story, so much so that one could never tell what did actually happen - or whether there exists a reality at all. (Yes, that's the movie Rashomon [羅生門] of Akira Kurosawa [黒澤明].)
PS. The final chapter of Kokuhaku is a kind of self confession, which turns out to be an anti-climax. I'm quite disappointed. Alas, after the confession of Justice Wargrave in And Then There Were None, who could do a better job ?
The story is not at all exciting but well told. To me, it is the written mimic of some cubism painting by Palbo Picasso: A single event was outlined by five persons, each with their own view and contributes to the overall picture.
In a sense, this way of telling a story is a slight twist of The Long Murder (長い長い殺人) by Miyuki Miyabe (宮部美幸), who is more imaginative by using ten purses from the first-hand perspective. Nonetheless, the real pioneer of this trick was Ryunosuke Akutagawa (芥川龍之介). In his masterpiece In a Grove (藪の中), all seven witnesses gave an entirely different story, so much so that one could never tell what did actually happen - or whether there exists a reality at all. (Yes, that's the movie Rashomon [羅生門] of Akira Kurosawa [黒澤明].)
PS. The final chapter of Kokuhaku is a kind of self confession, which turns out to be an anti-climax. I'm quite disappointed. Alas, after the confession of Justice Wargrave in And Then There Were None, who could do a better job ?
Thursday, February 4, 2010
Pathologist
(continue)
I started my work on one of the specimens that afternoon. It was a woman's pelvis, cut into half from the middle. My original plan was to show the blood vessels and nerves that supply the uterus and bladder.
But I met difficulty very soon. In the next morning, I showed the specimen to Ching and said, "Em ... this pelvis seems a bit weird. The organs are sticking together."
"This woman was a street-sleeper who was found dead. Nobody claims for the body, and therefore it ends up here. I noticed the point you mentioned as soon as I received it. You see, the peritoneum is all thick and spongy. It means inflammation - or what they called peritonitis. I have checked and the appendix appeared normal, but there was a hole on the duodenum. Obviously she died of perforated peptic ulcer ..." he explained.
My eyes were wide open. That was literally the first lecture of human pathology for me.
The new friend of mine was obviously in the best of his mood. He went on and point to the other pelvis that he gave me yesterday, "You see. This men was said to have prostate cancer and multiple metastasis. But, look, the prostate is small and contracted. The pelvic bone also appeared OK. I don't think he had the disease at all !"
"Then why did he die ?" I asked.
He laughed, "Oh, don't be silly. His lungs were hell - that's why I threw them away."
***************************
Later in my clinical years, many teachers said that one could learn a lot simply by staying in the ward. I was always skeptical with this suggestion because, if it works, all hospital amah should become consultant physicians.
Nonetheless, there remain some highly gifted and motivated few who, despite having no formal teaching, could acquired an incredible amount knowledge and insight simply by staying in the field for long enough.
Do rest in peace.
PS. I turned the two pelvis into specimens showing the nerves and muscles of the pelvic floor and perineaum - which (I was happy to know) were still in use until very recently.
I started my work on one of the specimens that afternoon. It was a woman's pelvis, cut into half from the middle. My original plan was to show the blood vessels and nerves that supply the uterus and bladder.
But I met difficulty very soon. In the next morning, I showed the specimen to Ching and said, "Em ... this pelvis seems a bit weird. The organs are sticking together."
"This woman was a street-sleeper who was found dead. Nobody claims for the body, and therefore it ends up here. I noticed the point you mentioned as soon as I received it. You see, the peritoneum is all thick and spongy. It means inflammation - or what they called peritonitis. I have checked and the appendix appeared normal, but there was a hole on the duodenum. Obviously she died of perforated peptic ulcer ..." he explained.
My eyes were wide open. That was literally the first lecture of human pathology for me.
The new friend of mine was obviously in the best of his mood. He went on and point to the other pelvis that he gave me yesterday, "You see. This men was said to have prostate cancer and multiple metastasis. But, look, the prostate is small and contracted. The pelvic bone also appeared OK. I don't think he had the disease at all !"
"Then why did he die ?" I asked.
He laughed, "Oh, don't be silly. His lungs were hell - that's why I threw them away."
***************************
Later in my clinical years, many teachers said that one could learn a lot simply by staying in the ward. I was always skeptical with this suggestion because, if it works, all hospital amah should become consultant physicians.
Nonetheless, there remain some highly gifted and motivated few who, despite having no formal teaching, could acquired an incredible amount knowledge and insight simply by staying in the field for long enough.
Do rest in peace.
PS. I turned the two pelvis into specimens showing the nerves and muscles of the pelvic floor and perineaum - which (I was happy to know) were still in use until very recently.
Wednesday, February 3, 2010
Prosector
It was the summer of 1987. Shortly before I took the final examination of medical year one, PT - a senior lecturer of anatomy and the tutor of my group - indicated me to stay after the afternoon anatomy class.
He asked if I was interested to do a part-time prosector job during the holiday (not too rare an invitation in those days, when the department was expanding its collection of dissected specimens for teaching and examination).
I was more than eager to agree. To begin with, I have much interest in anatomy; it would be an excellent chance to consolidate my knowledge. Moreover, I was desperately in need of money for the textbooks next year.
A few weeks later, I finished with the examination and (after a brief break) returned to the smelly basement of the Basic Medical Science Building. PT introduced me to Ching, the embalmer at that time, and asked him to take care of me.
Of course I knew Ching for nearly a year - who doesn't after studying his first year of medicine in this university ? He loved to chat with our class when we did the dissection, and he did show us a few mnemonics of anatomy that he brought with him from another medical school. Nonetheless, to many of us, he was a friendly technical staff but nothing more.
To my surprise, Ching was immensely efficient at work. In no time he gave me two newly obtained pelvis and asked me to think what I could do with them.
(To be continued.)
PS. After that summer, PT disappeared in my story. He actually quited his job in Hong Kong a few months later and returned to Britain, where he soon became an eminent professor of anatomy.
He asked if I was interested to do a part-time prosector job during the holiday (not too rare an invitation in those days, when the department was expanding its collection of dissected specimens for teaching and examination).
I was more than eager to agree. To begin with, I have much interest in anatomy; it would be an excellent chance to consolidate my knowledge. Moreover, I was desperately in need of money for the textbooks next year.
A few weeks later, I finished with the examination and (after a brief break) returned to the smelly basement of the Basic Medical Science Building. PT introduced me to Ching, the embalmer at that time, and asked him to take care of me.
Of course I knew Ching for nearly a year - who doesn't after studying his first year of medicine in this university ? He loved to chat with our class when we did the dissection, and he did show us a few mnemonics of anatomy that he brought with him from another medical school. Nonetheless, to many of us, he was a friendly technical staff but nothing more.
To my surprise, Ching was immensely efficient at work. In no time he gave me two newly obtained pelvis and asked me to think what I could do with them.
(To be continued.)
PS. After that summer, PT disappeared in my story. He actually quited his job in Hong Kong a few months later and returned to Britain, where he soon became an eminent professor of anatomy.
Tuesday, February 2, 2010
Visit
Met K - a young consultant of another specialty in a peripheral hospital - in an informal incident. I did not see him for quite some time.
"Hi ! How're you getting on ?" I asked lightheartedly.
"Just back from an overseas visit. You know, our boss is very keen on quality improvement and introduction of successful experience from overseas centres. This time, we - a handful of newly promoted consultants - have the chance and visit several hospitals and private clinics in that friendly city ..." My friend appeared enthusiastic.
"Well, was that useful ?"
"Quite a bit, quite a bit." He sounded more apologetic than proud, "For example, we learn some useful ways to streamline drug dispensing after a clinic visit, and how to shorten the queue waiting outside the consultation room."
"That sounds great." I tried to be encouraging, "Are you people going to put them in use ?"
"Oh, not yet ..." my friend sighed, "We are not in the position of making any administrative decision. All we could do is to report to our headquarters people and arrange further meetings to present our proposal - if there is any ..."
(You may ask why don't those administrating specialists do the overseas visit themselves. They do - for example, to some Japanese motor corporations. The problem is: The first clinic that they should pay a visit and learn is our own ones.)
PS. As to shortening the queue, DC - another friend of mine who works in yet another specialty - told me that the way they learned was to stop people from waiting outside the consultation room; patients were asked to stay outside the building and wait there.
The only difference is: The administrators agreed to adopt that policy !
"Hi ! How're you getting on ?" I asked lightheartedly.
"Just back from an overseas visit. You know, our boss is very keen on quality improvement and introduction of successful experience from overseas centres. This time, we - a handful of newly promoted consultants - have the chance and visit several hospitals and private clinics in that friendly city ..." My friend appeared enthusiastic.
"Well, was that useful ?"
"Quite a bit, quite a bit." He sounded more apologetic than proud, "For example, we learn some useful ways to streamline drug dispensing after a clinic visit, and how to shorten the queue waiting outside the consultation room."
"That sounds great." I tried to be encouraging, "Are you people going to put them in use ?"
"Oh, not yet ..." my friend sighed, "We are not in the position of making any administrative decision. All we could do is to report to our headquarters people and arrange further meetings to present our proposal - if there is any ..."
(You may ask why don't those administrating specialists do the overseas visit themselves. They do - for example, to some Japanese motor corporations. The problem is: The first clinic that they should pay a visit and learn is our own ones.)
PS. As to shortening the queue, DC - another friend of mine who works in yet another specialty - told me that the way they learned was to stop people from waiting outside the consultation room; patients were asked to stay outside the building and wait there.
The only difference is: The administrators agreed to adopt that policy !
Monday, February 1, 2010
Force
Although it sounds idea to have government policy nothing to do with religion, it is nevertheless an ingenuous expectation that politics should be independent from our spiritual belief. We know from history that the two are magnetic and electric forces of physics - they are all but one.
For that reason, when religious force moves fast enough, it generates a political one.
To go one step further, it is often to the advantage of a government to have highly religious citizens. Although a country always needs a well structured legal system to keep everything in order, one could not resolve every problem in the court. Although religion could not keep everything in order, it does help to keep most things in harmony.
That's a cut higher than in order.
Alas, that's not my invention. The Han emperors started to use Confucianism and Taoism for China, and I don't think I need to elaborate on the relation between Vatican and other European countries over the last 2000 years.
PS. The most recent example on the interaction between politics and religion is probably the heavy governmental support to the movie Confucius.
You may argue that strictly speaking, Confucianism is not a religion. That actually brings us to a deeper water of the concept (or domains) of god, which I hope I could elaborate later.
For that reason, when religious force moves fast enough, it generates a political one.
To go one step further, it is often to the advantage of a government to have highly religious citizens. Although a country always needs a well structured legal system to keep everything in order, one could not resolve every problem in the court. Although religion could not keep everything in order, it does help to keep most things in harmony.
That's a cut higher than in order.
Alas, that's not my invention. The Han emperors started to use Confucianism and Taoism for China, and I don't think I need to elaborate on the relation between Vatican and other European countries over the last 2000 years.
PS. The most recent example on the interaction between politics and religion is probably the heavy governmental support to the movie Confucius.
You may argue that strictly speaking, Confucianism is not a religion. That actually brings us to a deeper water of the concept (or domains) of god, which I hope I could elaborate later.
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