Meaningful Learning is Transformative AND Initially Uncomfortable

     "Fundamentally, transformative learning is a process whereby individuals engage in critical reflection to develop new perspectives, skills, and behaviors.

     Specifically, the process of transformative learning begins with experiencing a disorienting dilemma**, which is a life event that causes the learner to pause and question underlying beliefs and assumptions. The next and perhaps the most important phase is critically reflecting on the disorienting dilemma to expose the learner’s limitations and areas for improvement. The learner then addresses these limitations by acquiring new knowledge, skills, or attitudes. Ultimately, these newly developed skills will transform the learner by providing him or her with fresh perspectives and powerful means for enacting improvement." 

       Wittich CM et al. "Transformative Learning: A Framework Using Critical Reflection to Link the Improvement Competencies in Graduate Medical Education." Academic Medicine 2010; 85(11): 1790-3.

     ** a minor "shipwreck": http://healthyhealers.blogspot.ca/2012/05/self-concept-worldview.html

Citadel Hill, Halifax, NS

Are we Taught to be Smart BUT Unwise?

     The degree to which we see ourselves as fixers of broken (diseased) patients, we are detached from humanity. Sadly, "professional detachment" is actively promoted in medical curricula as a requirement for practice. This may be considered "smart" but it's clearly unwise. See: http://healthyhealers.blogspot.ca/2014/07/were-experts-and-dumbasses-smart-but.html
     This flawed mindset keeps us isolated AND suffering! It's off base on many levels: 

     "Loneliness, a socially painful state of perceived social isolation, may be a common risk factor for pain, depression, & fatigue. For example, people who felt socially disconnected were able to tolerate less physical pain than those who felt more socially connected, suggesting that feeling unconnected to those around you may increase pain sensitivity. In addition, lonelier people became more depressed and fatigued over time than people who felt more socially connected." 
       Jaremka, L.M., et al., Loneliness predicts pain, depression, and fatigue: Understanding the role of immune dysregulation. Psychoneuroendocrinology (2012), http://dx.doi.org/10.1016/j.psyneuen.2012.11.016

     "Being socially connected has health benefits. For example, married people had lower premature all-cause mortality rates, higher 5-year cancer survival rates, and fewer chronic health conditions than their non-married counterparts. In addition, people with more diverse social ties had lower premature all-cause mortality rates and a better prognosis following a myocardial infarction or stroke than people who were less socially integrated. On the other hand, distressing interpersonal relationships enhance risk for a variety of health problems such as coronary heart disease, delayed wound healing, metabolic syndrome, and premature all-cause mortality. Importantly, the links between close relationships and health remain after controlling for important sociodemographic and health-relevant risk factors.
     Growing evidence suggests that immune function may be one potential pathway linking close relationships and health; proper immune function is essential to health. Indeed,
inflammation and other forms of immune dysregulation increase risk for premature all-cause mortality and a variety of diseases including cardiovascular disease, cancer, and metabolic syndrome."
       Jaremka, L. M., Derry, H., & Kiecolt-Glaser, J. K. (in press). Psychoneuroimmunology of interpersonal relationships: Both the presence/absence of social ties and relationship quality matter. In D. I. Mostofsky (Ed.), Handbook of Behavioral Medicine (Vol. 2). Hoboken, NJ: Wiley-Blackwell.           http://pni.osumc.edu/publications.html

Don't we feel like this at times?

"Not Good Enough" Runs our Lives

     I'll never forget an instructor in first year dentistry - Dr. S. Each time I'd show him something I had just finished working on, he'd look at it for 30 seconds or so with a disgusted look on his face, then inevitably say "Ehhhh, do it over again." What he meant of course was "not good enough!"
     Like Dr. S, our parents likely meant well by repeatedly urging us to improve on various activities - HOWEVER - after a steady diet of this, doesn't a distinct impression form that WE are not good enough? And what do we do about this deep sense of insufficiency? WE STRIVE for ACCEPTANCE, which deep down we know we can't ever achieve, because ... we're simply "not good enough." 
     So we sense that we're perpetually running after (praise, acceptance) some elusive "must have" thing - like the fake rabbit that's always just out of the reach of the hounds on race tracks. Is this at least partly why some of us will "never retire"? At the same time, we're running from criticism, rejection.
     Maybe "not good enough" not just runs, but ruins lives. Is there any wonder why self-acceptance is a critical part of various psychotherapies?

Simulated Town, Palestine - Adam Broomberg & Oliver Chanarin

Social / Emotional Intelligence

     Though highly intelligent and technically skilled, "physicians often lack skill levels in the social/emotional intelligence domain. In the context of this study, it was discovered that medical students tend to lack self-awareness and an empathic connection with others, but these emotional skills can be taught. ... people who possess a high level of emotional intelligence are liked more by others, rise to leadership positions, and when coupled with high technical skills are often on the high end of the income pay scale."

       Walcher ME. A look in the mirror: Self-development and transformational learning in medical students. Dissertation Abstracts International Section A: Humanities and Social Sciences 2013; 73: 8-A.

How I Feel Affects My Decisions & Patient Care

     "Historically, the prevailing view in medicine is that clinical decisions should be objective and free from contextual affective issues: one could not be objective and rational if emotion entered the reasoning process. Indeed, many of us would consider it a professional virtue to be able to rise above the emotional pull of clinical situations, to deliver cool, clear, analytical judgments. However, despite what we might believe, our feelings (affect) intrude into almost every decision that we make. Our daily interactions with others are influenced by conscious or unconscious social transference phenomena which are affectively polarised in ways that range from subtle to substantial. Similarly, specific clinical situations provoke lesser or greater degrees of affective valence. In fact, our first response to anything is an affective one that governs the future direction of our relations — we tend to trust our first impressions and stick with them. To then understand the role that affective state has in clinical decision making seems important. 

     The best evidence might be degraded when it is unconsciously passed through an affective filter."
       Croskerry P, Abbass AA, Wu AW. How doctors feel: affective issues in patients' safety. Lancet 2008; 372(9645): 1205-6. 


     "Within mindfulness, the busy physician may find a practical place to begin. Through the cultivation of mindfulness, the busy physician can find clues to the self and to the other, as well as to the aspects of inter-being that not only set the intention of the medical encounter but also provide boundless information and the basis for right action."
       Physician, Know Thyself, Michael Krasner, Shambhala Sun, September 2007.

 

snellius   www.dpreview.com

Educators & Administrators: A Threatened Self-Concept Diminishes Learning!

     Though we learn to avoid SOME of our teachers' unskilful habits, we inevitably retain & embody some of them. When as pathology residents (in the early 1980's) we presented cases, we knew that we'd be mercilessly, public humiliated if we didn't present all of our facts correctly. 

     When trained through intimidation - AND MOST OF US WERE - student-centered learning is a completely foreign concept. So most of us over the age of ~35 have NO IDEA how fragile our current students' egos are compared to our own crusty, heavily-armoured egos.
  
     "Educational research has shown that emotions and cognition are interactive. Excessive anxiety decreases our ability to process information. As a result, a negative learning environment, however it is created, limits a student’s ability to process, synthesize, and retain information. Learning requires a receptive mind; negative emotions interfere with our cognitive functioning. Therefore, a threatened self-concept diminishes learning. In terms of medical education, this means that high expectations should be accompanied by a positive learning environment and support until residents have gained a measure of mastery over the new material. Positive assessments should never be seen as the result of favoritism or of effort alone in the absence of actual achievement. The corollary is that negative assessments should not be seen as unfounded or lacking in constructive advice. Residents may forget what we said, but they will never forget how we made them feel."
       Pinney SJ et al. Orthopaedic surgeons as educators. Applying the principles of adult education to teaching orthopaedic residents. J Bone Joint Surg Am 2007; 89(6): 1385-92.

     Shame severs Relationships - see: http://www.johnlovas.com/2013/06/from-shame-to-wholeheartedness.html

My former Chief of Pathology - on a benign day.

FerruginousHawk   www.dpreview.com

First International Congress on Whole Person Care - Oct 17-20, 2013 – McGill University, Montréal, Canada

The First International Congress on Whole Person Care
October 17-20, 2013 – McGill University, Montréal, Canada

Dear Colleague,

This is a gentle reminder that the deadline for submitting abstracts for poster presentation at The First International Congress on Whole Person Care is May 31, 2013.  Submissions are welcome from all disciplines within the health care professions on the topic of whole person care, which is healthcare that relates to the recipient of care as a whole person (as opposed to a relationship limited to a disease, an organ system or even a whole body).

*A full list of subject categories as well as submission instructions and descriptions of each type of presentation can be found on the Congress website (www.wpc2013.ca).

Presented by McGill Programs in Whole Person Care, McGill University, the first university center specifically focused on whole person care, this Congress will bring together acknowledged experts from around the world, and will put you at the cutting edge of what it means to practice whole person care.

Designed for physicians, nurses and other healthcare professionals, the programme will include plenaries and interactive workshops by leaders in the field, as well as opportunities to share the latest research findings through oral and poster presentations – all this, in an environment that is nurturing and conducive to deep interaction and reflection.

PROGRAMME UPDATE
The updated Agenda including the oral presentations from accepted abstracts is now available on our website: http://www.wpc2013.ca/en/agenda.htm

For more information, please visit www.wpc2013.ca or call +1 450-292-3456 ext. 227.

We look forward to welcoming you this Fall.

Sincerely,

April O’Donoughue
Congress Coordinator

The First International Congress on Whole Person Care
2013 Congress Secretariat
c/o O’Donoughue & Associates Event Management
75 chemin Mountain
Mansonville, Québec, Canada J0E 1X0

Tel: +1 450-292-3456, ext. 228
Fax: +1 450-292-3453
E-mail: info@wpc2013.ca
Web: www.wpc2013.ca

Montreal at night    www.tripadvisor.ca

Annual Mindfulness Course for Health-Care & Other Professionals in Halifax NS

MINDFULNESS
for Health-Care & Other Professionals:

An 8-week Immersion in Self-care

Dr. John Lovas
Thursday Evenings, 5:30 – 8:00 pm, early October – November Each Year

Faculty of Dentistry, Dalhousie University

Halifax, NS, Canada

Course Synopsis
          Working in health care, other professions, and life in general, is very stressful at times. Yet to truly enjoy life, and best serve our patients, clients, coworkers, families and society, we ourselves need to be healthy. Effective, regular self-care is not only sensible, but also a professional responsibility. Mindfulness – a universal, but underdeveloped way of relating both realistically and kindly to ourselves and the world – is becoming a well-recognized foundation of self-care. 

          This continuing education course is designed for health-care & other professionals who spend an unhealthy portion of their time & energy caring for everyone but themselves. The course provides a unique opportunity to learn about and experience a profoundly beneficial program of self-care practices. 

          Not simply a technique, mindfulness is a state of being “that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.” (Kabat-Zinn) Mindfulness training “increases awareness of thoughts, emotions, and maladaptive ways of responding to stress, thereby helping participants learn to cope with stress in healthier, more effective ways.” (Bishop et al)

Course Objectives
          Participants will learn and practice sitting meditation, walking meditation, qi gong breathing, standing meditation, and partake (voluntary) in discussions about integrating mindfulness into our professional and private lives.
          Intended audience: Dental, medical, mental health, social work, legal & other professionals. You and your entire office are invited to engage in a profoundly positive transformative learning experience. Attendance is limited to 20. Participants are encouraged to engage in daily practice. We derive from this practice precisely what we put into it.
         

John G.L. Lovas BSc, DDS, MSc, FRCD(C)  

          Dr. Lovas obtained science and dental degrees from the University of Toronto, and specialty training in oral pathology at the University of Western Ontario. He’s served as chief examiner in oral pathology for the Royal College of Dentists of Canada and as president of the Canadian Academy of Oral Pathology. Dr. Lovas was full-time faculty at the Faculty of Dentistry, Dalhousie University, teaching oral pathology & oral medicine for 31 years, and served as Assistant Dean for Student Affairs until his retirement in 2014. He obtained teacher-training in Mindfulness-based Stress Reduction (MBSR) at UMass Medical Center, the Omega Institute in New York, and the Rochester Medical School. For over ten years Dr. Lovas has been leading Mindfulness workshops for dental, dental hygiene, medical, law and other students, practitioners and staff.

Course Schedule
5:30 – 6:00 pm Registration and light dinner
6:00 – 8:00 pm Thursday evenings

Please note that we will postpone any sessions that the majority cannot attend or for inclement weather. 

Participants are expected to attend at least 7 of the 8 sessions. Positive group dynamics depend on consistent attendance and participation.

For fees, registration, please contact:

CDE Office          Phone: (902) 494-1674        Email: dentcde@dal.ca

See also:              http://jglovas.wix.com/awarenessnow#!courses/cfvg

CREDITS  16 hours of lecture

****** Register early to avoid disappointment ******

Promoting Mindfulness in Health-care

     Evidence has repeatedly shown that normal psychosocial development / maturation tends to be at least temporarily arrested during dental and medical training. Cynicism tends to replace idealism, and "clever nihilism" festers.

         Cohen MJ et al.  Identity transformation in medical students. Am J Psychoanal 2009; 69(1): 43-52.
         Meserve C et al. Clever nihilism: Cynicism in evidence based medicine learners. Medical Education Online 2005; 10: 1-9.

     "To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments.”
       Teunissen PW, Westerman M. Opportunity or threat: the ambiguity of the consequences of transitions in medical education. Med Educ 2011; 45(1): 51-9.

     See also: http://mindfulnessforeveryone.blogspot.ca/2013/11/432-i-try-and-i-try-but-i-cant-get-no.html

     Mindfulness practice promotes normal psychosocial maturation - towards greater empathic connection with others & environment (counteracting the above-mentioned disruption). Mindfulness is increasingly being taught at the post-secondary level, in medicine, dentistry, dental hygiene, nursing, chiropractic, veterinary medicine, design / architecture, music, business, law, liberal arts, etc.

         Lovas JG, Lovas DA, Lovas PM. Mindfulness and professionalism in dentistry. J Dent Educ 2008; 72(9): 998-1009.

Photo: CollBaxter   www.dpreview.com

Self-concept Maturation

     "There are three aspects to the development of self-concept, which refer to the extent to which a person identifies him or herself as 
     • an autonomous individual, 
     • an integral part of humanity or society, or 
     • an integral part of the unity of all things as one independent whole, such as the universe. 

     Each aspect of self-concept corresponds to one of three character dimensions: 
     • self-directedness, 
     • co-operativeness and 
     • self-transcendence, respectively. 

     ... the well-balanced maturation of (these) character traits appears to be essential for the development of intrinsic academic motivation in medical students."

     Tanaka M. et al. Personality traits associated with intrinsic academic motivation in medical students. Med Ed 2009; 43(4): 384-7.

Andre Gallant   http://www.andregallant.com/

Control and Liminality

     “The term ‘humanities’ has been defined as ‘the contemplation of truths which cannot be verified, and the understanding of values which cannot be measured.’ Both concepts are alien to the biomedical model of education. Yet many educators consider medical humanities as a vital part of the education of health science practitioners."

        Balis SA, Rule JT. Humanities in dental education: a focus on understanding the child. J Dent Educ 1999; 63(9): 709-15.

     For 'liminality' see: http://healthyhealers.blogspot.ca/2012/03/to-burnout-or-engage.html 

     It's unfortunate then that the medical humanities "receive more than their fair share of students' critiques in terms of both quantity and virulence."
       Shapiro J et al. Medical humanities and their discontents: definitions, critiques, and implications. Acad Med 2009; 84(2):192-8.

     Health care is where our illusions of control regularly collide with existential reality. Palliative care docs are constantly on the front lines of this meeting place, hence the wisdom of giants in the field like Balfour Mount:

Part 1 of 3: Making Healing Connections - Palliative Care

Part 2 of 3: Living as if Everything is a Miracle - Palliative Care

Part 3 of 3: Death Anxiety and Finding a Healing Path - Palliative Care