Happy Holidays

This is the time of the year we look back and reflect on what we achieved – and what not. Trying to do so in an honest way can be painful. What tangible results remain, if we leave all the fluff off? Just the facts, no wishful interpretations, no stories, no fake news.

I personally believe there are few things that will always stand the test of the fact checker. One of them is having made a patient or family feel better by letting them experience our empathy and being with them not only as factual content expert, but as a trustworthy human being and guide in a difficult situation. We all try this every day. Sometimes we succeed. Sometimes we don’t, despite trying hard. Not infrequently this is emotionally draining; some of us may have contemplated at times to stop trying or have been tempted to retract to acting purely as technicians. While understandable, I strongly believe that only by trying to do our job as both, human beings and expert professionals, do we serve our patients to the best of our abilities. And that’s why we went into Medical School, isn’t it?

The uncertainties coming with the current changes in our health care system do not help coping with these challenges inherent to our profession either. Manage to Budget, Consolidation, building up Shared Health on the health care side, a new budget model and budget cuts at the university side: all disrupt how we are used to doing business as academic physicians. I know that these ongoing changes are perceived by many as negative, stressful and, at times, demotivating, to say the least. I am not denying that it can be overwhelming, but let me remind you that change is absolutely necessary to bring our business, whether health care delivery or academia, back on track to sustainability.

And let me remind you that changes of the extent we experience currently also create opportunities. Our task is to recognize those opportunities, partner with others and take advantage of them in order to keep our Department afloat. I know that all of you do your best to do so. The Department is you, the Department’s successes is your success. I’d like to express my sincere gratitude and thank you for all you continue to do, every single one of you in his/her place and role, to master these turbulences and propel the Department to the next level of academic and service excellence.

I wish you Happy Holidays, hope you can recuperate for a few days with your family and friends, and tank new energy. I look optimistically forward to tackle together with you the challenges 2020 will undoubtedly bring.

On Learning Environment

Eberhard Renner, MD
Head – Department of Internal  Medicine

“Learning Environment” must be amongst the strongest candidates for the (academic) buzz word of the year. It has all the ingredients for becoming the winner: short, easy to remember – and ill defined. No wonder it is part of everybody’s vocabulary at appropriate and less appropriate occasions.

Don’t get me wrong, I do not believe that we shouldn’t pay attention to the circumstances in which our trainees are held accountable for improving their knowledge and skills, nor do I believe they shouldn’t be asked about their perception of these circumstances. That said, I find it interesting that trainees seem today to be the only ones that are asked for their opinion, and their perception is often taken as the most important, if not sole source of truth when it comes to so important things as program accreditation.

Also, have you ever heard somebody talk about the teaching environment? Have you ever been asked as a teacher how you perceive the circumstances you have to teach in? Has anybody ever attempted to put the two sides of the coin – learning and teaching environment – together into a more holistic view before jumping to conclusions? Who is making efforts to develop solid, evidence based instruments and metrics to gauge the circumstances in which learning and teaching can proceed in the most effective way?

Along the same line, how do we measure teaching quality? It cannot be that we simply rely on immediate trainee feedback which inherently risks reflecting simply a teacher’s popularity. I would respectfully submit that a teacher’s popularity is not necessarily congruent with the quality of his/her teaching. In particular not if the trainee is contemporaneously asked. If we look back, most of us will judge the value of certain learning experiences differently in retrospect than at the time we were in the midst of them. It is also highly unlikely that the number of words a teacher uses in a written feedback on a trainee’s performance multiplied by some fudge factor has anything to do with teaching quality, regardless of whether the resulting score is given with two decimal points suggesting an objectivity and accuracy that can hardly be there.

In academic research, peer review processes are well established and used since a long time to judge quality. When I was in high school the school principal used to sit from time to time as an unscheduled observer in our class to assess the teacher’s quality. This was admittedly a long time ago, and I am not sure whether it still happens today. But why are no such (or other) peer-review processes involved in measuring the quality of academic teaching activities?

Even more importantly perhaps, does anybody track whether and to what extent our trainees grow mid and long-term into the academic and/or community roles and positions they were meant to be trained for, and whether doing so they successfully serve the societal needs, i.e. whether our training programs produce down the road the desired end-products?

Granted, this is all more complex than simply asking for contemporaneous feedback by trainees and for their subjective perception of the “learning environment” (whatever that means). But it would likely yield a more meaningful measure of the quality of our teachers and training programs, i.e. would give us a more solid basis for actions aimed to improve the current state, a goal we should always aspire to!