This is an excellent post by Ilana Yurkiewicz who is a first year medical student at Harvard Medical School which was originally posted on her blog Unofficial Prognosis which is a blog with The Scientific American website. Posted in full here with her permission.

How (not) to think like a doctor

By Ilana Yurkiewicz

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On our first day of physiology, our professor showed us a picture of an elephant. He let us look at it for several seconds and then asked: what is this? On the next slide, he put up a chest X-ray. We stared for a few more seconds and were then asked: what’s the diagnosis?

He was demonstrating what was done in a recent experiment that examined the way doctors think. In the study, similar images were shown for similarly brief amounts of time, but to physicians rather than first-year medical students. It took doctors the same amount of time to recognize an animal as to make a diagnosis – under 1.5 seconds. Moreover, brain scans revealed that the same parts of the brain were being used to do both tasks.

This was not the first time in medical school I was made acutely aware of how I think.

What are the ways a person could identify an elephant? One method is working from the top-down. You could observe: this is large, grey, and has four legs and a trunk. Then you would come up with possible objects that possess those qualities, exclude ones that do not make sense, and continue to collect and reason through data until you arrive at the correct diagnosis.

Or, you could reflexively recognize the pattern and make the identification.

For something like an elephant, which approach we take is obvious. We call upon pattern recognition all the time, without even consciously noticing that we’re solving a problem. It can be extremely beneficial.

Imagine if you had to derive an elephant from the top-down every time you saw one. Moreover, imagine you saw twenty elephants a day. You wouldn’t have the time to reason through your assortment of observations in each case. The ability to perceive patterns and instinctively classify them based on things we’ve seen before supplies us with the tools to derive those things we have not.

As a result, it makes sense that medicine would rely on this mode of thinking. Medicine is huge in scope. It is cumulative. Many doctors are taught the top-down approach – meaning take a few facts, and formulate a diagnosis. Receive a few pieces of the puzzle, and extrapolate the whole picture.

Entering medicine means learning a new language, and you won’t be able to solve complex problems if you are looking up every other word and puzzling through every concept in the question. There are undoubtedly disease patterns you should know, cold.

But there are downsides. Jump to conclusions based on only a few facts, and your ideas are prone to biases. There is the bias associated with arbitrary prior experience; you might be more likely to make a diagnosis of one illness, for instance, simply because you happened to see it before. You might try to massage your observations into preconceived models in which they do not belong. Or, you might discard stubborn data completely, assuming them flawed.

Maybe most of the time, your prediction based on pattern recognition will be correct. But you will be wrong about the complicated cases. And being wrong in medicine can have serious consequences.

Our professor’s point in showing us the elephant experiment was not to encourage us to think like the doctors in the study. Rather, the point was to show what we might be prone to do – and thereby to encourage us to resist those impulses. Do not guess, we were advised. Do not just memorize patterns. Work through each problem, and fill in each step.

Following these recommendations will be an uphill battle. Problem-solving takes time – something that is relentlessly lacking from medicine. Medicine is fast-paced. People talk fast and make decisions fast. The doctors in the study diagnosed chest X-ray lesions in a mere 1.33 seconds.

As I continue to learn more and find myself in increasingly fast-paced environments, I realize I may have the urge to memorize patterns. I can look at lab values and remember that the last time A and B went down, C and D went up, and feel tempted to speculate that the same disease process underlies a new case. I will likely have colleagues and superiors that endorse rather than temper this kind of thinking.
But medicine is more complicated than that.

I hope I can develop the ability to recognize the elephants of medicine when I need to, but to remember to pause and think: what else could be large, grey, with four legs and a trunk? What other information would I need to distinguish the possibilities?

Thinking like this will be more work. But it just might lead to discovering what’s really going on.

Image: From Wikimedia Commons

 

About the Author: Ilana Yurkiewicz is a first-year student at Harvard Medical School who graduated from Yale University with a B.S. in biology. She was a science reporter for The News & Observer in Raleigh, North Carolina via the AAAS Mass Media Fellowship and then went on to write for Science Progress in Washington, DC. She has an academic interest in bioethics, currently conducting ethics research at Harvard after previously working at the Presidential Commission for the Study of Bioethical Issues. Follow on Twitter @ilanayurkiewicz.

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Mindfulness and Cognitive Behavioral Therapy

Mindfulness is a discipline that trains a person to be aware of the present moment and his or her place in that moment. It has a focus on the awareness which processes the mental and emotional responses of that person's consciousness. Mindfulness is often associated with Buddhist meditation.

Cognitive Behavioural Therapy (CBT) is a form of psychotherapy that undertakes to change behaviour by understanding and modifying the thinking behind that particular behaviour.

What happens when Mindfulness is combined with Cognitive Behavioural Therapy (CBT) to form a new form of psychotherapy called Mindfulness-Based Cognitive Behavioral Therapy (MB-CBT)?

Actually I was not surprised at this merger because Buddhism recently has become very closely involved with neuroscience.

I find this article interesting

The ‘third wave’ of Cognitive Behavioural Therapy (CBT) – Can it be integrated into a Christian context?
By Sarah Plum and Paul Hebblethwaite

The aim of the article is to look at the possibility using Mindfulness Based Cognitive Therapy as a tool for treating depression and some forms of anxiety and how this may be compatible with Biblical teaching. We appreciate that some individuals may find this technique not compatible with their Christian faith, but we are not asking or expecting individuals to change their fundamental Christian beliefs or to participate in any practice that would contradict their faith but rather to look at how this tool can be used for the benefit of their clients. This article should be useful even to those that could not embrace this technique as it will at least give some useful insight.

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Review on Piper's Think

John Piper, (2010), Think: The Life of the Mind and the Love of God (Wheaton, IL: Crossway)

This book by pastor-theologian John Piper reminds me of books on similar theme such as Mark Noll's Scandal of the Evangelical Mind, Os Guinness' Fit Bodies, Fat Minds, J.P. Moreland's Love Your God with All Your Mind and Gene Veith's Loving God with All Your Mind. These scholars and thinkers have written these excellent books (all of which are worth reading) based on their exposure to different worldviews and their effort to create or instill biblical worldviews.

Piper's approach is different in that he draws solely from the Bible and in that he limits himself mainly to Proverbs 2:3-5 and 1 Timothy 2:7. He writes that his approach is that of a Bible expositor and in that he has succeeded because the book read like a series of sermons. Thinking is a serious aspect of discipleship, Piper suggests and that such thinking "is wholly engaged to do all it can to awaken and express the heartfelt fullness of treasuring God above all thing."

This book seems to be seeking a balance between the "anti-intellectualism" of some churches and "over-intellectualism" of the academia, However unlike his other books, I find it difficult to decipher what Piper is really trying to say in this book. While I agree with his emphasis on reading and understanding the Bible (which he equate to thinking) and his asserting that thinking is loving God, I find it difficult to apply his conclusion to the rest of the world who are mostly illiterate, do not have access to the Bible, and to the category of people who are intellectually impaired. And also in most of Africa, Asia and South America, most pastors and Bible teachers are not theologically trained. I refuse to accept that because of these handicaps, the Christians in these regions are defective in their thinking and hence not able to love God with their minds. I believe the power of the Holy Spirit transcend the inability of believers to read and write and that these inabilities do not handicap their relationship with the Triune God.

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Book Review on The Element

This is an excellent 2009 book by Sir Ken Robinson on creativity, multiple intelligences and finding your passion which he defines as "the element". The element or our human potential is "where the things you love to do and the things you are good at come together (p.8). Based on numerous interviews conducted by Robinson and his co-author Lou Aronica, this book is both a collection of success stories of people who dropped out of the education system and made good, and a subtle critique of the inflexibility and ineffectiveness of the education system. However, the authors did not specific which education system as they drew examples from both side of the Pacific. They seem to be aiming at a generic education system. (see Sir Robinson's lecture in TEDS).

Similar in essence to Outliers: The Story of Success (2008) by Malcolm Gladwell, the authors however argue that a passion for success is a combination of being in the element; doing what you like to do in the area you are talented in. While this true in the people they have selected for interviews (usually those who were miserable in school and those who dropped out), there are however two other groups of people which was ignored in the book. The first other group is school dropouts who did not succeed as spectacularly as those mentioned. The implication is that they did not succeed because they did not find their elements. The second group is that those people who stuck through school, graduate, get a higher education and are now pillars of society (clerks, lawyers, doctors, teachers, etc). The implication is that these people have not found their elements and are now unhappy in their lives.

While I agree some of the principles of many of the things the authors espoused, I believed their arguments are too generalised and giving it a label (the Element) does not make it better. Like Gladwell did in Outliers, these specially chosen interview subjects are chosen specially to provide their theories. However, what was obvious from the people interviewed in both books are their determination and perseverance to achieve their dreams no matter the cost. The lesson I draw from them is the indomitable power of the human spirit.

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Os Guiness on the Thinking Man's Quest for Meaning

Os Guiness gave a great talk at the Veritas Forum. The Journey: A Thinking Person's Quest for Meaning
Os Guinness
University of California, Los Angeles
7 April 2010

Rethinking the Wesleyan Quadrilateral

Guest T wrote an interesting post about the Wesleyan Quadrilateral and asked some important questions on Scot McKnight's The Jesus Creed blog.

How exactly do we come to think what we do about God? How do we think about each of Scripture, Tradition, Reason, and Experience separately in relation to good theology? How do we think they inter-relate in our actual practice and how should they inter-relate?

Hopefully a post on each of the four "quads" will be helpful for all of us to think about those questions and refine our own approach. Before we look at each of the four individually, though, a little background is in order. First, Wesley saw scripture as clearly primary among the four. In fact, he saw the other three as the unavoidable lens through which we viewed everything, including scripture and even God himself. We should note that the Quadrilateral is offered as both prescriptive (for how we ought to build our theology) and descriptive (of how we all inevitably assemble our knowledge of God). Of course, the emphasis we put on each "quad" may make for a wide margin between the prescriptive and the descriptive uses, as well as the ideas about God that we end up with. (And two quick points for the record: 1. I'm not Methodist, so folks from that background may want to give correction or depth to my summaries, and 2. although the quadrilateral is faithful to Wesley's theology, the term "quadrilateral" was coined by a much later admirer of Wesley's approach.)

I agree with Wesley that scripture should be primary among the four; I also agree that it should not be, perhaps more importantly, cannot be the only player in forming our knowledge of God. Scripture often supports contrasting claims about God. It presents opposite truths in tension. It leaves a sea of questions unanswered. Some explicit statements we don't take explicitly. And we place enormous weight on some Reasonable inferences (like the Trinity, for instance), especially those that have the support of Tradition. Not only do Tradition, Experience and Reason form the lens for our view of Scripture, they address, with Scripture, they explore and fill in many gaps in our understanding of God, some of which Scripture itself creates. Perhaps most importantly, they make the faith into our faith.

Please note that the highlight in bold is mine and not in the post.

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Seth Godin's Insubordinate

From Seth Godin

I’ve written a personal addendum to Linchpin. Here it is, it's a free PDF. Insubordinate is a 40 page ebook, feel free to share. I couldn’t possibly include all the linchpins I’ve worked with over the years, but I think you’ll find that many of the examples in the ebook resonate.

Other free eBooks by Seth Godin

knockknock
who's there
brainwashed
permission marketing
unleashing the ideavirus
the bootstrapper's bible
what matters now (editor)

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Ken Robinson on Schools kill Creativity

TEDTalk

Speakers Ken Robinson: Author/educator

Creativity expert Sir Ken Robinson challenges the way we're educating our children. He champions a radical rethink of our school systems, to cultivate creativity and acknowledge multiple types of intelligence.

Why don't we get the best out of people? Sir Ken Robinson argues that it's because we've been educated to become good workers, rather than creative thinkers. Students with restless minds and bodies -- far from being cultivated for their energy and curiosity -- are ignored or even stigmatized, with terrible consequences. "We are educating people out of their creativity," Robinson says. It's a message with deep resonance. Robinson's TEDTalk has been distributed widely around the Web since its release in June 2006. The most popular words framing blog posts on his talk? "Everyone should watch this."

A visionary cultural leader, Sir Ken led the British government's 1998 advisory committee on creative and cultural education, a massive inquiry into the significance of creativity in the educational system and the economy, and was knighted in 2003 for his achievements. His latest book, The Element: How Finding Your Passion Changes Everything, a deep look at human creativity and education, was published in January 2009.

TEDS: Amy Tan on Creativity

Amy Tan on Creativity

Amy Tan is the author of such beloved books as The Joy Luck Club, The Kitchen God's Wife and The Hundred Secret Senses.

Born in the US to immigrant parents from China, Amy Tan rejected her mother's expectations that she become a doctor and concert pianist. She chose to write fiction instead. Her much-loved, best-selling novels have been translated into 35 languages. She's writing a new novel and creating the libretto for The Bonesetter's Daughter, which will have its world premiere in September 2008 with the San Francisco Opera.

Tan was the creative consultant for Sagwa, the Emmy-nominated PBS series for children, and she has appeared as herself on The Simpsons. She's the lead rhythm dominatrix, backup singer and second tambourine with the Rock Bottom Remainders, a literary garage band that has raised more than a million dollars for literacy programs.

Random Musings on Teaching In Higher Education (2)

Teaching Values in Higher Education

Recently I received an email about medicine with this equation

E² - evidence + experience = good medicine

I beg to differ from my learned colleague whom I respect very much. While the practice of medicine has improved with the introduction of evidence-based medicine, it is important to realize that evidence based-medicine is not the holy grail of medical standards. Even the highest level of meta-analysis has its limitation. It is just a statistical program which analyses data fed into it. It is important not to forget the old axiom: GIGO (garbage in, garbage out). Also not everything that is done in the practice of medicine is available in the evidence-based medicine databases.

Experience is a good teacher but repetition is not a proof of expertise or even of competence. A doctor may be repeating the same mistake repeatedly. However, not repeating mistakes and increased competence may be achieved by combining evidence with experience. I believe that there is still another component to the equation. This component is good character. Thus I will suggest that the equation should be

E²GC- evidence + experience + good character = good medicine

I believed that good medicine can only be practiced by a doctor with good character. I have seen surgeons who have excellent surgical skills who could not bother with whom they operated upon. “The operation was successful but the patient died” was their creed. I have seen doctors who treat their patients as objects- some problems to be solved and then move on. True care, concern and compassion can only come out of good character. Good characters are formed by good beliefs.

It is a fallacy in many institutions of higher learning that knowing will automatically lead to believing. For example, if we teach our students to be compassionate to their patients, they will automatically be compassionate because of their knowledge. Unfortunately this is not true.

Educator Emeritus Professor Brian Hill of Murdock University identifies in How Learners Respond to the Teaching of Beliefs and Values the three dimensions in how students respond to the teaching of values. These dimensions are the psychological dimensions of the cognitive, the emotional, and the volitional. While writing about teaching in schools, I believe his findings have implications in centers of higher learning. The possible response of a student to the teaching of a value X may be:

Cognitive

(1) I don’t get it. What do you mean by X?

2) Ah, I understand what you mean by X.

(3) I understand what you mean by X, but I don’t believe X is true.

(4) I accept your claim that X is true.

Emotional

1) Knowing X makes no difference to me.

(2) I have a bad feeling about X.

(3) I don’t feel I can leave up to X

(4) I have a good feel about X.

Volitional

(1) I’m not willing to attach value to X in my life-priorities.

(2) I’m willing, so far as I can, to attach value to X in my life-priorities.

(3) I’m prepared to prioritise X in my own life, but I don’t regard it as something everyone else should necessarily prioritise.

4) I’m prepared to prioritise X in my own life and, whenever appropriate, will commend its priority to others.

According to Hill, the cognitive plays a small role in the learning of values. The emotional dimension is more important and it is that dimension that influences the volitional in prioritizing its values. In the teaching of values, I agree with Hill that teachers have a tendency to use conditioning, coercion, indoctrination and persuasion as possible pedagogies.

Instead he suggests the following:

(1) I will model X in my own behaviour before students.

2) I will, where necessary for the common good, require students to behave in the classroom in a manner consistent with X.

(3) I will encourage maturing students to engage in critical examination of the grounds for and against prioritizing X in their lives.

4) I will represent to students that X, in my opinion, points to a defensible value by which to live, but I will respect and not penalize dissent.

Hill highlights that in the teaching of values, we need to be aware of the cognitive, emotional and volitional dimensions of learning. Our pedagogy must be based on these dimensions and should involve modeling, reflection and respect.

Reference:

Hill, Brian V., How Learners Respond to the Teaching of Beliefs and Values, Journal of Education and Christian Beliefs, 12:2 (2008) 101-113

Outliers: Malcolm Gladwell

Malcolm Gladwell (2008), Outliers: The Story of Success (New York: Harchette Book Group).

One of my observation is that most medical students who scored well in their assessment examinations during their long medical courses do not do well and become successful medical practitioners after they graduate. Of course, there are rare exceptions. Usually those who are average and sometimes borderline passes do well in their lives after graduation. I have often wondered about this.

Malcolm Gladwell, the author of Blink: the power of thinking with thinking and The Tipping Point: how little things can make a big difference offers some insights into this. Gladwell is an insightful author, looking behind the obvious to gives us a more obvious answer.

Outlier (noun) means:
(1) something that is situated from or classified from a main or related body, and
(2) a statistical observation that is markedly different in value from the others of the sample.
In an average mean chart, an outlier will be a person who is either in the top or bottom 10% of the mean.

Gladwell tried to analyse the lives of successful men and women, those whom he calls 'outliers' to discover the secret of their successes. As in the previous books, he balanced his arguments with facts and anecdotes. His theses are both fascinating and obvious.

There is a limitation to what genetics can offer a person. For example, IQ. The higher the IQ a person has does not automatically translate to a more successful life. In fact, there is no advantage to being a success beyond a 120 IQ points.

Galdwell's theses has a lot to do with nurture. Given a person with average intelligence, these are the factors that will help make a person a success:

(1) Nurture
both in families and communities that produce an higher EQ. It is the high EQ that is a determining factor. The nurture of EQ seems to be better in higher income families and in families who are concerned to help their children grow.

(2) Opportunities
one example quoted is Bill Gates who in high school was given the opportunity to learn from the very best computer code writers and be allowed a job to write computer codes himself while as a high school student.

(3) Cultural legacies
such as the Asian culture of hard work ( Asian students tend to score well in Maths) which produce successful people and the hierarchical system in Asia which inhibits individual initiative and thus inhibits success (example the high rate of airplane crashes in Korean Air in the past).

It will be useful if Gladwell defines what he meant by success instead of mentioning men and women who "did things out of the ordinary" and launched into various biographies and autobiographies. My gleaming of what he meant by success is something very achievement-orientated, secular and individualistic. There is no spiritual or moral element in his definition of success. It will be useful to include these two elements into his group of 'outliers' and see how many still remains after this two criteria are added.

Another problem I have with this book is the way data from some researches are used. I find it hard to understanding how the hard work related to rice farming in China is linked to Asian children doing better in Maths. While it it true that rice farming demands hard work, it is a leap of faith to declare that the Chinese cultural legacies of hard work is related to the rice field and also to Asian children doing well in Maths. Another explanation offered in why Asia children do better in Maths is that numbers in English is longer that the same numbers in Mandarin. For example the pronunciation of the numbers: 7 in English is double syllable se-ven, while in Mandarin is monosyllable. Also English has more number names than Mandarin; English-eleven ,twelve, thirteen... while in Mandarin, Korean and Japanese, it is more logical- ten-one, ten-two, ten-three...

My impression is that Galdwell has formulated his theses first and then find studies to support them, i.e. he is working backwards. Thus he was very selective in his choice of literature. On the whole this is an interesting book to read. I am amazed at the varieties of studies Galdwell has dug up.

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Eight Thought Experiments

from WIRED MAGAZINE: ISSUE 15.06

The Best Thought Experiments: Schrödinger's Cat, Borel's Monkeys
Greta Lorge 05.22.07

1. Galileo's balls
Contrary to what your teachers told you, Galileo Galilei likely did not drop balls from the Tower of Pisa; he conducted the gravity experiment in the laboratory of his mind. His 16th-century peers believed heavier objects fell faster than light ones. So Galileo imagined a heavy ball attached by a string to a light ball. Would the light ball create drag and slow the heavy one down? Nope, he concluded, they would hit the ground simultaneously.

2. Schrödinger's cat
A cat is trapped in a box with radioactive material, a Geiger counter, and a mechanism rigged to release poison if particle decay is detected. According to Erwin Schrödinger, the cat exists in two probable states. But that doesn't track with reality (cats are not both alive and dead). Proposed in 1935, the postulate illustrates that some quantum concepts just don't work at nonquantum scales. Also that Schrödinger was a dog person.

3. Searle's room
A man sits alone in a room. Someone slips paper with Chinese writing on it under the door. The man doesn't read Chinese, but with a set of instructions he's able to manipulate the symbols and respond. To an observer, the man appears to understand the language. Philosopher John Searle devised the scenario in 1980 to make a point about computers. CPUs, like his man, lack comprehension and thus can't have humanlike intelligence.

4. Hawking's turtles
The 1988 book A Brief History of Time begins with the story of a scientist giving a lecture on astronomy. At the conclusion of his talk, a woman insists he's wrong: Earth is a flat plate carried on the back of a giant turtle. The scientist asks what the turtle is standing on, and the woman says, "It's turtles all the way down!" Stephen Hawking used the story to caution fellow cosmologists against piling one unproven theory upon another.

5. Einstein's light beam
When he was 16, Albert Einstein daydreamed about chasing after a beam of light until he caught up to it. At that point, young Einstein reasoned, the light wave would appear frozen. The problem: This was impossible according to the thinking back in 1895. Somehow, this little glitch led Einstein right to the theory of special relativity. Lost? Don't worry. Physicists still debate exactly how this mental exercise got him there.

6. Borel's monkeys
Variations go back to Aristotle, but the modern version of the infinite-monkey theorem was introduced in 1913 by French mathematician Émile Borel. You know the deal: An infinite number of monkeys pecking at typewriters for an infinite length of time will "almost surely" produce the complete works of Shakespeare. Seems unlikely, because our minds have a hard time grasping the infinite. Mathematically, it's true.

7. Maxwell's demon
In 1867, James Clerk Maxwell pictured two chambers, A and B, each filled with gas at the same temperature and with a door between them. Theorists later had a demon open the door (without doing any work) to let the fastest-moving molecules pass from A into B, and the slowest from B to A. Over time, the speed of the atoms (and therefore the temperature) increases in B — a violation of the second law of thermodynamics.

8. Parfit's teleporter
Philosopher Derek Parfit is famous for basing thought experiments on sci-fi. In 1984, he envisioned a teleporter malfunction, like the one that made two James T. Kirks in an episode of Star Trek. Teleporters annihilate every particle in you, then rebuild them from scratch. What happens if the original isn't destroyed? Which is the real you? Parfit says both. Evil Kirk would disagree.

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Illustration by Mark Matcho