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March 2018 Archives

By Richard Claflin

A Doctor's very first patient: The most important teacher you've probably never thought about.

Many years ago I found myself sitting in a doctor's waiting room with a sore throat. Perhaps influenced by a parenting magazine on the coffee table, suddenly an odd thought occurred to me: How do gynecologists and urologists learn to do invasive exams? Who do they practice on? Manikins? Is that even helpful? I thought, how do you practice a prostate exam? Does some unlucky patient wind up being the first attempt for a new doctor just out of school?

And...wouldn't it be awful to be that first patient?

To make a long, circuitous story very, very short, I find myself now training instructors to address that challenge. As I discovered, the problem of how to practice these sensitive exams creates a lot of anxiety for medical students, and hadn't been given much attention. I've spent the last several years committed to changing this.

Historically, it has been next to impossible to get anyone to volunteer to act as a "guinea pig" for untrained hands learning how to do the invasive, stigmatized, and emotionally complicated gynecological, urogenital, and prostate exams.

No surprise there.

Professors, understandably, won't allow their own bodies to be examined by students who need to practice. Likewise, students should not be required to practice on each other. Plastic manikins simply don't work: Their hard components don't accurately feel like the delicate structures, and manikins don't provide any immediate feedback. This is a huge drawback for a student who wants to learn how to perform these exams without hurting a patient in the process.

Some students have been made to practice on anesthetized patients. Some students still are. (Note: Always read the small print when you sign consent forms before going under general anesthesia.) To their credit, students and professors have strong moral objections to this practice...and, just like manikins, there is no feedback from an anesthetized patient.

But even if there was a willing volunteer, would that really work? There is so much emotional discomfort and social baggage involved when it comes to the private areas of the body, so much anxiety for the students, such a great possibility for injury to the volunteer, so little direction about what to say to a patient to make them comfortable, so much inconsistency in the methodology...and, aside from all that, no guarantee that an untrained volunteer will provide constructive feedback to the student. From the standpoint of a school, such a volunteer creates more problems than they solve.

The result is that many students get no hands-on training when learning to perform "bathing suit-area" exams. The thinking too often is that this whole area of instruction is too complicated, too embarrassing, too stigmatized, and too traumatizing. And therefore nothing is offered and nothing is done.

So, yes...you very well could be that first patient for a new doctor with inexperienced hands.

But there is a solution. What schools need are highly trained specialists who can instruct students as well as use their own bodies to allow students to practice the techniques. These specialists are called Gynecological Teaching Associates (GTAs) and Male Urogenital Teaching Associates (MUTAs). They are substitute professors, if you will, who teach the necessary exam skills and then also act as "patients" to guide the students as they practice those exam skills on that same instructor. Equally important, GTAs and MUTAs teach the students essential communication skills that help make the patient feel comfortable during the exam.

I didn't invent this idea; here and there schools have trained GTAs and MUTAs "in-house." But most schools don't have the wherewithal or the kinds of resources to recruit and train such high-level instructors. Most schools need an outside group to come to them with excellent GTA and MUTA instructors to provide standardized training for their students. Such outside groups have been rare or non-existent, until now. After many years of experience as a GTA, one of my current colleagues formed a company about a year ago to address this need. I quickly joined her to help develop a MUTA program and act as Managing Director and Lead Trainer for the company.

Finding instructors willing to do this was -- and is -- a challenge. Being a GTA or MUTA is hard work, physically and emotionally. In addition, there was virtually no information on how to train instructors. As we expanded our reach over the past year, I wound up having to write the only available curriculum to train MUTAs. My colleague, Isle Polonko, developed the curriculum to train GTAs. Our company, Clinical Practice Resources (ClinicalPracticeResources.com), now provides instructors to dozens of teaching hospitals, schools, and institutions throughout the country. We now have over 20 highly trained male and female instructors doing this important work, and we are the largest independent company in the world providing this kind of educational instruction. And yet, we barely feel we have scratched the surface.

The response from students and teaching institutions has been overwhelmingly positive, and we are continually getting referrals, requests to expand our program, develop new programs, and start programs in other areas of the country. There is a huge need for this kind of instruction. Over the last several years I have been invited to give presentations at international conferences by the Association of Standardized Patient Educators (ASPE), and have been invited again to give a number of presentations about my work at ASPE's annual conference this June. What started out as a random musing in my doctor's office one afternoon has certainly led me on a fascinating journey.

The most rewarding aspect of this work, though, was something I hadn't expected at all. Most of the students we teach are in the middle of medical school, and have spent their entire education up until that point immersed in books or interacting only with plastic manikins. When I teach a class, I am often the first real human "patient" they have yet to come in contact with. Students start the class filled with anxiety, terrified. By the end of my class, they are filled with confidence. This is, after all, what everything has been about for them: working with people. Because I've provided them with an anxiety-free way to conquer the scariest challenge so far in their medical training, they emerge fearless about the challenges that lay ahead for them...and excited to meet their future patients with care and empathy. It's a momentous transformation, and I am continually grateful to be a part of that accomplishment.

So, as it happens, I was wrong. For me, being that first patient for a young doctor turns out to be a wonderful experience.

For more information about his work, Richard Claflin can be reached at richardcprte@gmail.com. Or, through the website at ClinicalPracticeResources.com

By Peter A. Eden, Ph.D.

Landmark College was built on the belief that neurodiversity is a strength. The kind of neurodiversity commonly seen in our students (whether on our Vermont campus or elsewhere in the U.S. through our summer short-term programs or growing online programs) include LDs such as dyslexia, ADHD, executive function challenges, and ASD.  No longer seen as a deficit, neurodiversity is justifiably gaining long-overdue recognition across industries. Corporations are actively recruiting neurodiverse individuals, recognizing that they often have an approach to learning and problem-solving that can lead to innovation.

Landmark College has, therefore, always functioned as a "center for neurodiversity" - and today we have established a Center for Neurodiversity (CND). The CND allows us to better promulgate the research- and evidence-based practices in teaching and learning for those with an LD, and facilitates efforts to develop and apply new methodologies, technologies, and modalities for success in learning, living, and career readiness.

Among the CND's primary goals:

Thought Leadership and Social Justice: The CND will operate as a think tank, and will generate white papers and opinion pieces that shape the global conversation about neurodiversity, with input from neurodiverse individuals. To that end, author and advocate John Elder Robison - who refers to himself as "a proud Aspergian" - serves as visiting lecturer and advisor to the CND.

Innovative Programming: The CND will support research, development, implementation, evaluation, and dissemination of models that support neurodiverse learners in living, learning, and workplace environments.

Resource Development: The CND will build online resources to support neurodiverse individuals, parents, educators, and employers related to neurodiversity issues.

Partnership Building: The CND will facilitate dialogue and partnerships, both internally and outside campus, to create synergistic opportunities. One example is our work to soon establish Landmark College as the first Neurodiversity Hub in the United States, through partnership with DXC Technology and the Dandelion Program.

Community-Building: The CND is creating activities and events, including guest speakers on campus, to allow opportunities for neurodiverse individuals (and anyone with an interest in neurodiversity) to share perspectives and participate in action plans.

Closely related to the establishment of the CND are Landmark College's growing relationships with forward-thinking corporations such as SAP, Hasbro, and JP Morgan Chase, to name just a few, which have created new opportunities for neurodiverse individuals to bring their unique talents to the workplace. Also in line with these efforts is the College's establishment of the Landmark Entrepreneurial Accelerator Program (LEAP), which, through the support of the Morgan Le Fay Dreams Foundation, awards up to $10,000 per year to Landmark College student entrepreneurs who create and then pitch business plans for novel ventures including a social justice-inspired clothing line and virtual reality software.

As neurodiversity is increasingly recognized as a strength by business leaders, Landmark College, the preeminent college for neurodiverse individuals, aims to help large companies understand the minds of people with LD, and change the way the public thinks about truly innovative educational models. In years to come, when people think of neurodiversity, they will no longer think of stigma or a deficit, but instead simply a different way of thinking and operating. Landmark College is proud to lead the way.#

Peter A. Eden, Ph.D., is president of Landmark College in Putney, Vermont.

A free 50-minute program, During the Field Trip, student reporters Maceo Carney and Mizani Ball will take viewers on a cross-country journey through documentary-style interviews with WWII survivors, giving middle and high school students the opportunity to listen to firsthand accounts from WWII Home Front worker Betty Reid Soskin, the oldest living National Park Service Ranger, and Tuskegee Airman George Hardy. Students will also have a chance to look inside two historic WWII sites - the Port Chicago Naval Magazine National Memorial and the Rosie the Riveter/WWII Home Front National Historical Park.

"Our mission at The National WWII Museum is to tell the story of the American experience in the war that changed the world," said Chrissy Gregg, the Museum's Distance Learning Manager. "In order to fulfill this mission, we're taking education beyond our physical campus and into classrooms - a space where students may not get the opportunity to hear firsthand accounts about pivotal times in history. We are proud to host this Electronic Field Trip, especially as we look at how African Americans heroically fought to preserve freedoms abroad at a time when they did not have those freedoms here at home."

Central to the Field Trip's discussion is an examination of how throughout World War II, African Americans pursued a double victory - one over the Axis abroad and the other over discrimination at home. Major cultural, social and economic shifts amid a global conflict were changing American lives. Although President Franklin Delano Roosevelt banned discrimination against African Americans in the defense industry in 1941, segregation in the armed forces remained. Nevertheless, more than 2.5 million African Americans registered for the draft during World War II, and over 1 million served.

Broadcasting during Black History Month, the Electronic Field Trip is influenced by The National WWII Museum's signature special traveling exhibit Fighting for the Right to Fight: African American Experiences in World War II, which is currently on view at the Dallas Holocaust Museum through January 26, 2018. In addition to student reporters and WWII survivors, the Field Trip will feature Rob Citino, PhD, the Museum's Samuel Zemurray Stone Senior Historian, and Damon Singleton, WDSU-TV Meteorologist and retired US Naval Commander. Both will lead a live Q&A and polling with students around the country as they discuss the vital roles African Americans played in securing our nation's freedom, and the postwar fight for equality during the Civil Rights Movement.

The Fighting for the Right to Fight: African American Experiences in World War II Electronic Field Trip is produced in partnership with the National Park Service and with generous support from Paul and DiDi Reilly in honor of Paul J Reilly, US Marine Sergeant, WWII; The Dale E. and Janice Davis Johnston Family Foundation in honor of Dr. Earle R. Davis and his service aboard the USS Tranquillity; the Albert and Ethel Herzstein Charitable Foundation; Alan and Diane Franco; and the C. Jay Moorhead Foundation.

Additional support provided by Fabenco Founding Fathers Foundation and Anonymous.

Learn more about how your classroom can participate in the Fighting for the Right to Fight: African American Experiences in World War II Electronic Field Trip or visit www.nationalww2museum.org/electronic-field-trips. Send questions in advance to distancelearning@nationalww2museum.org.

The National WWII Museum tells the story of the American experience in the war that changed the world - why it was fought, how it was won, and what it means today - so that future generations will know the price of freedom and be inspired by what they learn. Dedicated in 2000 as The National D-Day Museum and now designated by Congress as America's National WWII Museum, it celebrates the American spirit, the teamwork, optimism, courage and sacrifices of the men and women who fought on the battlefront and served on the Home Front. The 2017 TripAdvisor Travelers' Choice® awards ranks the Museum No. 2 in the world and No. 2 in the nation. For more information, call 877-813-3329 or 504-528-1944 or visit nationalww2museum.org.



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