The AMSA conference in DC ended on Sunday 1 March. Wednesday 4 March in San Antonio the conference for the Association of Professors of Gynecology and Obstetrics was being held. Celeste Royce, the doctor in Boston with whom I had presented a workshop last summer, had taken initiative in inviting me to present Wikipedia to her colleagues there in a scheduled session and I was interested in joining because I had made women’s health a focus of my outreach work and was interested in meeting other instructors in this specialty.
As is becoming routine, the session was well received. Lots of people attended. They were kind to ask questions. We got some editing in during the session, which was more than we usually manage but this was a group of fast learners. I have a list of contacts and look forward to following up with them. It was nice to talk more with Celeste, and I hope to join her and her class again in April as she said.
Celeste invited me to dinner with her department. At dinner I talked with one colleague in particular named Kip. He is a gynecology instructor also, and he told me several interesting stories. Both here and at the AMSA conference, I watched demonstrations with medical manikins. These were models of plastic and other bits and which could have health maladies inserted into them with expansion kits, like some kind of action figure that becomes more functional when the person playing applies theme sets to them. Many of them plug into simulated health data feeds, so that they give heartbeats and blood pressure and whatever else. Some can cough, or talk through a computer, or have medical histories that can be read to give limitless practice experience in diagnosing or addressing problems. At AMSA the students were testing them and they were mostly horrible looking, but I suppose that I was just a little disturbed because I was not accustomed to the idea of weird whining robots which exist to be fake sick repeatedly. At this conference the manikins were really horrible. They were either manikins with vaginas or just vaginas sitting on tables next to a lot of awful looking tools. The people were sticking things in the robo-vaginas which had cameras inside them, then looking on a screen to see what was happening. The screen had a simulated bloody view and could fake bleed if the doctor touched the walls of the chamber inappropriately. I was thinking how like a video game it looked, and it occurred to me that any gamer could master these games without further medical training just by spending time with these models. It made me wonder what part of medical practice is human critical thinking, and what part is following a rubric and the rules of the simulated game.
Anyway, Kip was saying that the games are lame, and I wanted to hear more of this dinner conversation because the manikins had been striking to me. As an instructor, he wanted to give his students the best experience, and said that there are some conditions which must be understood but are relatively rare, so practical experience was difficult to offer yet doctors needed it. Cadavers, he told me, can be had for $3-4000, which I was interested to hear and a price that I expected, and he told me this was prohibitively expensive. He did not like the manikins because even though they helped practice the order of operations, they did not build into the hands any memory of how hard to press, how the flesh cuts, what resistance is, or the sensation of cauterizing meat. His idea was to hang out in slaughterhouses and build models from animal parts, then use those in student training.
I asked him more about this idea, intrigued at why a person like him would spend his time in a mess of bloody guts. My first thought was that he was hoping to replicate the experience at scale, and after making enough models from various animals, he would either find some way to do what he did with better synthetic simulation, or that he would teach a slaughterhouse laborer to make the models, or that somehow there would be same way to produce standard real tissue specimens so that many medical students could benefit from his idea.
He told me that someday there would be cellular 3D printing of medical models, but not soon, as right now live cell tissues printing is exorbitantly expensive and experimental. He said that slaughterhouse workers could not make models that were suitable for students as each animal has different parts, and that it takes an experienced surgeon to examine the look and feel of these parts to match parts from different individual animals of different species to build something which is close enough to seem human for the purposes of practice surgery. He said that if these models were made in greater numbers, then it would have to be as trained labor in cottage industry with partnership to particular medical instructors, and that at this time, he had no plans to partner with anyone to make these models nor did he know of anyone else who was passionate about making models of this sort as he was.
At the conference, I was surprised that there were several video sessions in which instructors had made educational videos to explain some routine things that students ought to learn. Kip was telling me that he produced a podcast for his field of practice, and that the intent behind these was that they could be maintained and updated as needed but that they would strive to be broadly useful for all students in the field and giving general information so that they could be used at scale. I appreciated that Kip and the video makers were thinking of how to provide more educational resources to more people. I thought it was interesting that Kip would spend time both to create a digital resource for the world and a resource which was so scarce that it could only be used when he spent his time as a craftsman making an artisanal product.
Talking more of education with him, he told me of a job he had in his past as a procurer for a wealthy private high school in Massachusetts. The problem which he was tasked to solve was the difficulty of insensitivity of rich youth in rich communities. The story was that in Massachusetts, rich people lived in neighborhoods with other rich people, and the region was so wealthy that entire communities had entire school districts in which all the students attending were rich, white, of a certain culture, and with certain factors insulating them from outside cultures. Part of the civic design of their communities was in place to provide the inhabitants with luxuries and convenience, which suited the parents who had some idea of what it meant to work, even among those in the area with old money. As time went on, the children became more and more bratty and obnoxious as they never had developmental experiences with people who were not raised in privilege, to the extent that their neighborhood, school, town, county, and region presented no opportunity for them to have peers with any less privilege. At some point in adulthood the lack of sensitivity of such people would harm their ability to interact with the world. It was resolved that the way to product better children would be to introduce diversity in schools. The diversity should be by race, culture, socioeconomic status, and whatever other factors can be introduced while still promoting excellent education.
Kip’s job was to travel around the United States, including to rural areas, and find young people who had a history of excellence in their educational performance but who were as culturally unlike the local people of the region of the high school which employed him. When he found these children, he offered them 4-year scholarships to move to Massachusetts and live at the boarding school as they studied in high school, which would be approximately age 14-18. One of the cities he mentioned drawing students from was Corpus Christi, Texas, which was not so far from my place of birth and which I knew to produce people of a culture unlike that of the one in Massachusetts.
I asked him about outcomes of his work. He said that it was not studied to the extent that he would have liked, but that he encountered some problems consistently which no one anticipated. One problem was the disruptive nature of the cultural change which the students would experience by moving to Massachusetts. The primary goal of the program was to give the rich kids more exposure to diverse culture, but the kids brought in to experience diverse culture also were changed in that they adopted Massachusetts culture. Kip told me that this was a positive influence on the students, as they got excellent education and beneficial exposure to social skills and guidance which can lead anyone to a successful career and good company with elite in society. However, this also changed the student to make them critical of their origins, and in many cases it led them to de-identify with their cultural upbringing even while they were unable to wholly integrate with the Massachusetts culture they learned. Furthermore, the students would commonly develop traits which made them alien in their own communities, and led to them being ostracized by people who formerly accepted them. Kip told me in one case, an exceptional student had come from a rough neighborhood and a background of gang activity. In Massachusetts he proved to be an ideal find in that he excelled at his studies and was well liked. Somehow, though, after graduation and when visiting home, his new habits caused him to stand out as different and he attracted the attention of ruffians whom most people, natives of Massachusetts for example, would avoid or never encounter but with whom he should have been able to mingle effortlessly at least to pass in the street. His instinct did not tell him to avoid the danger, and there was no cultural precedent in his community for knowing the stress of what it means to study in another culture then come home with a new education. The young man was shot and killed for no particular reason, or perhaps for the reason that he was a good student, and somehow because of his education and skills had become an alien in his culture and especially offensive for being different.
I asked Kip if he knew of cases when someone from a poor community got the scholarship, benefited, then went back home with the skills they learned and the money they made to uplift their communities of origin. Kip believed, and I was not surprised, that students who completed their high school education at a nice private school were especially likely to succeed in their careers. They should get high paying jobs, and live in wealthy and successful social circles, and overall be exposed to opportunities which would not exist in poor communities. He told me that it could be taken for granted that the students he recruited benefited from an increase in career opportunities as a result of the intervention of them being given scholarships. He said that he had no information about whether after these students left high school and did their careers for 30 years whether they ever felt a cultural debt to what they left behind, and returned with the fruits of what they have gained to similarly try to grant extra opportunities to others from their geographical origin.
I was interested in the question of how to increase opportunities at a community level because of my own thoughts about my poor home town in Texas, and because of my time spent living and working in India, and because of the talk I had with Jim Guest in which he asked me to solve the problem of how Consumer Reports can bring benefit to the poor rural people it is not currently touching in the United States. It is commonly imagined that if some social intervention can be done in a place to “train the trainers” then people will train each other, and an entire community might benefit by sharing knowledge. Coincidentally, the latest episode of This American Life called “Three Miles” discussed this issue also. I have been reflecting on how to uplift people who have a basic lack of resources, because providing access to resources will not necessarily improve anyone’s quality of life.