Joseph O’Donnell

Teaching Equals Helping Students Learn

I had the occasion this week to reflect on teaching and it brought me back to something I remember Steve Abrahamson, Phd, ScD, one of the giants of medical education from the University of Southern California Keck School of Medicine said at one of the Asssociation of American Medical Colleges meeting years ago. He read the dictionary definition of teaching and said to the audience “now there’s the problem. ” I looked up the definition again: here it is (from the Merriam Webster Unabridged Dictionary): To teach

Cultural competency and tobacco control training in US medical schools: many but missed opportunities.

Tobacco-related morbidity and mortality disproportionately burdens America’s most vulnerable populations, and many physicians in the USA are untrained in smoking cessation skills with patients of various literacy levels and races and ethnicities. An anonymous survey was administered to 860 second year and 827 fourth year students at 12 medical schools. A faculty representative at each of the schools completed an assessment of the curriculum and rated medical students’ knowledge and skills for cultural competency. Report of experience in tobacco counseling for persons of various literacy levels and ethnicities rose from 42% (second year students) to 82% (fourth year students) and 48% (second year students) to 91% (fourth year students), respectively. However, only 37% of second year students and 40% of fourth year students reported that they had ever been taught to employ culturally competent strategies for tobacco cessation. This study found that almost two thirds of students in 12 medical schools reported no exposure to teaching about cultural competency and tobacco cessation, and approximately one third reported no practical experience with tobacco cessation counseling persons of various races and ethnicities. Effective cultural competency training for tobacco control should include teaching the social constructs of race, ethnicity, and socio-cultural concepts within a medical context. Additionally, students should receive supervised clinical opportunities to practice counseling, including opportunities to discuss and reflect on their experiences.

Conversations with a Master Cancer Educator: Joseph F. O’Donnell, M.D.

The Conversation: I am so honored to be asked by Dr. Michalek to respond to these questions in the Journal of Cancer Education’s inaugural column on BConversations with Master Educators.^ I am humbled by the request and the designation as a Bmaster educator.^ Certainly, many of those who read these words have been master educators for me. Q: Could you please tell the reader a little bit about your background and what attracted you to the field of cancer education? A: Teaching has always been in my genes; my mother was an elementary school teacher. But even more, it was a part of my environment that so captivated and inspired me. My wife was an elementary school teacher and I learned so much from her about Bhelping students learn.^ I was also so blessed to have many great teachers, and I have not ever properly thanked them. This reminds me of something I have always meant to do; Dr. Ernie Boyer, as head of the Carnegie Foundation for the Advancement of Teaching, often told the story of the President of Fredonia State College in New York who began orientation for the incoming freshman with the task that they write a thank you note to the teachers who had helped them get to where they were that day. I can only imagine those second grade, middle school, or high school teachers receiving these notes of thanks in what is too often a thankless job and how it must have lit up their lives to see how they had touched their former students. My own thank you list is enormous and I need to get going on these notes! I have also become captivated with the work of Parker Palmer and his book called The Courage to Teach [1] is one of my all-time favorites. Teaching does take mounds of courage as you put yourself on the line to try to influence the minds and behaviors of others. Palmer talks about the state of being Bdivided no more,^ a state in which your inner values and outer actions are in concert. This is a very pleasurable state, and achieving this state helps one to thrive in what he/she does. Palmer says this state is the work of the whole self, the head, the hand, the heart, and the soul. Good teachers (or practitioners or researchers) may put parts of themselves into their work or lives, but great ones put their whole selves in. That is what I tried to do in my teaching. I came to oncology soon after President she Nixon passed the National Cancer Act, and an unprecedented amount of energy, resources, and hope was applied to the problem of cancer. I was swept up in this as a medical student, and I had the joy of working with inspiring mentors who lived in a way that they were Bdivided no more.^ I was attracted to the hope and the incredible science, but won over completely when I realized that cancer was a disease that involved the whole person, a bio, psychosocial, emotional, and spiritual quest. I was drawn to the practice of oncology and whole patient care and further drawn to educating others about this, because I wanted cancer patients and their loved ones to get the best possible care. I realized I had more of a chance to do this as a teacher, showing by example, than as a practitioner or a clinical trialist. Q: What do you feel has been your greatest contribution to the field of cancer education? A: I think my greatest contribution to cancer education has been to intentionally bring in what may be called the softer sides of the discipline. I am very interested in compassionate care and have tried to focus on the disciplined education of the * Joseph F. O’Donnell Joseph.odonnell@dartmouth.edu

Health Literacy in Canada; a Primer for Students: Laurie Hoffman-Goetz, Lorie Donelle, and Rukhsana Ahmed

My first and most important message is to get this book and devour it. It was a joy for me to read, and I only hope my review captures all that I learned from it! It is highly readable with very helpful tables and charts, useful thought questions to make sure the reader is understanding, and an outstanding structure. I began my reading by thinking I know a bit about this subject and its importance, but with each chapter, I became more and more convinced that health literacy is a key to approaching issues of health inequity, the social determinants of illness, compliance, shared decision making, cross cultural issues, and other difficult to change topics in health and healthcare. Approaching health literacy may give a manageable and effective way in to these topics. Two things from the title deserve comment. The BIn Canada^ part is important because Canada has the most well-reasoned, systematic, and long-standing strategies and data in this arena. We all can and should learn from Canada! The second misnomer I feel is the designation BA Primer.^ This text is the most comprehensive, readable, and useful writing on this topic that I have ever seen. The Bprimer^ educated me enormously. I love the organization. The forward is an elegantly constructed road map for the book by Dr Irving Rootman. His own passion for the subject, contributions, and pride in the authors work comes through Bloud and clear.^ Each chapter begins with a memorable quote, specifically articulated learning objects and opening paragraph framing the chapter and a closing synopsis. In between, the objectives are clearly discussed and illustrated in the sequence they were laid out at the beginning. There are stopping points with highlighted reflective questions to make sure the reader understands. Each chapter ends with a few key references with a more complete bibliography included at the end of the book. Chapters include the following: Why a Book on Health Literacy from a Canadian Perspective?; A Definition of Health Literacy; Population Measures of Literacy and Health Literacy; Health literacy and Social Determinants of Health; Culture and Health Literacy; Information Technology and Health Literacy: Mass Media and Health Literacy; Risk Communication and Health Literacy; Health Literacy in the Clinical Context; and Health Literacy Interventions in Canada. The chapters are full of clear definitions, useful measurement tools, logical discussions of health literacy, and the impact of addressing it as a social determinant or across culture or in the clinic. The most exciting chapters were on the new world of eLiteracy and all the implications this will have for great care. Here are some sobering statistics: ninety million people in the US find it difficult to understand and correctly utilize health information! Sixty percent of adults in Canada do not possess a level of health literacy adequate to manage their own health and healthcare needs! The implications of this data are sobering! More attention to this topic which is only superficially taught in most health professions schools or significantly underappreciated at most frontline healthcare venues could yield huge benefits in reaching the Institute for Healthcare Improvement’s Triple Aim of improving heath, improving healthcare, and lowering costs. As I read and learned from the book, I had an idea for the AACE, EACE, and CPEN organizations. Each year, the town I live in selects one book for everybody to read. They then discuss it in groups, learn from each other, and appreciate the book even more than reading it solo. I propose that the publishers distribute this book at a manageable cost to interested * Joseph O’Donnell Joseph.F.ODonnell@Dartmouth.edu

An Incredible Mentor: a Tribute to Dick Bakemeier.

Our esteemed editor, Art Michalek, has written a beautiful piece above on the life, career, legacy, and impact of Dr Dick Bakemeier. My own reflections are much more personal about Dick and his impact on me. I have poured my heart out writing about Dick in the past...Bon the shoulders of a giant^ and Bto be beloved^...and I had a hard time sitting down to write the finality that this last piecemeant about Dick. I found that even though I have pouredmy heart out in the past that as I went back in there, my heart was still incredibly full, of both love and gratitude. I entitled my last piece in the Journal’s 25th anniversary tribute to Dick using a favorite a Raymond Carver poem I love named BAfterglow^ [1]. I repeat the poem...it is worth your reading again!

A Life with Boundless Energy: a Tribute to Former AACE President, John L. Currie (1942–2015)

The Reader’s Digest magazine used to have a regular piece in each issue about Bthe most unforgettable character I’ve ever met^. Dr. John A. Currie is one of the most unforgettable characters I have ever met. Tragically, the world lost his talents and energy at the age of 73 on April 22, 2015. He died surrounded by his five children and their families in his beloved Asheville, North Carolina. He always was a proud Btarheel.^ Hewas a past leader for our AACE, a visionary doctor, and a person with infectious energy that he spread to those around him. He was one of a small group of visionary leaders who turned the course of the great ship of AACE from a place of instability to a place with a solid foundation to build upon. John took over the finance and treasurer’s role and with several others at a time of crisis, his self-described Bfrugality^ helped save the organization and helped establish a resource base on which to grow. John assumed the presidency in 1995 and set in motion some of the strategies and procedures that exist today. I remember well his conversation with me about Bgetting more good papers^ for this journal. John established the R. Davilene Carter Presidential Paper awards that had as a requirement that a completed, reviewed manuscript about something presented at this annual meeting was required for consideration, and through this stroke of genius, the floodgates opened for great manuscripts. John was unique and unforgettable. I want to tell four stories about him.

Connecting Hearts and Minds to Transform Lives

The title for this editorial comes from our website at the Geisel School of Medicine (our school “Dartmouth” was renamed for Dr Theodor Suess Geisel and his wife Audrey) and this phrase represents our “committment”....what we stand for. Dr Suess intended that his last book “Oh the Places You’ll Go” [1] would be a message to all that “we can and must do better” [2] and indeed, we can and we must. And connecting hearts and minds to transform lives is a good way to do it. It might be the credo of the great cancer educator! In these pages, I have often cited the work of one of my great gurus, Dr Parker Palmer, and his thoughts about how we can and must do better in education [3, 4]. Palmer has taught me and as I wind down as editor, I want this to be one of the most enduring messages you hear from me, that as cancer educators, in order to to be most effective, we must pay as disciplined attention to the education of the heart and soul as we do to that of the head and the hand. This may sound easy, but is both a tough message to hear and an even tougher one to live, since we often view the heart as a source of bias, or darkness, or as too soft and mushy...and therefore not to be believed or heeded. Palmer says that the “heart (which) comes from the Latin word ,cor, and points not merely to our emotions, but to that core of self, that center place where all our ways of knowing converge-intellectual, emotional, sensory, intuitive, imaginative, experiential, relational, bodily among others. The heart is where we integrate what we know in our minds aith what we know in our bones. Cor is the Latin root word from which we get the word courage. When all that we understand of the self and the world comes together in the center place called the heart, we are more likely to find the courage to act humanely on what we know”[5]. He also gives great emphasis for the pivotal role of the soul, which is also at the center of our being, the place where we make meaning and perhaps where our values reside. Our souls are even more difficult to engage in the educational process. Souls are timid, and they are prone to run away and hide at any sign of judgement or controversy. They flee any place not perceived as safe and welcoming (which by the way often includes our medical centers, schools, and classrooms). Another of my great gurus, Dr Rachel Naomi Remen, who has led a movement to bring the soul back into medicine through a course for students called “The Healer’s Art” and one for later along professionals called “Finding Meaning in Medicine” [6], has said that if a shaman were asked to diagnose the very common and prevalent malady that afflicts today’s medicine, he/she would recognize it as “soul loss.” She says we have come as a profession to forget who we are, what we stand for, what matters and the lineage of healers we come from. The solution is regaining the soul. So, how are we to capture or re-capture, honor and utilize, or invite in and make it safe for our hearts and souls to be connected to our minds in the educational process? It’s a good question and a big question. If we can make this connection happen, almost surely, we will become better teachers and help our students become better learners. As the take home for this editorial, here’s some advice:

What a Difference One Person Can Make: A Tribute to Mary P. Lovato

Mary P. Lovato is an example of how one courageous and dedicated person can make a huge difference to the American Indian communities and the science of cancer education. Ms Lovato, a member of the Santo Domingo Pueblo Tribe, was diagnosed with cancer in 1987. At that time, there were no culturally relevant cancer education or support services available to her on her reservation or elsewhere in Indian Country. After 7 years of tireless efforts, her tribal Nation agreed to allow her to begin cancer education and support within the community. Her training was developed from her own experiences, curricula from the “People Living Through Cancer” (PLTC) organization, and staff from the Indian Health Service (IHS) Cancer Program. She created a weeklong education program called

Finding Information About Active Learning

I wanted to write a brief editorial to make all our readers aware of some “neat stuff” that I happen to tumble across every once in awhile. I’ve never met her, but I’m such a huge fan of Dr Deidre Bonnycastle, Clinical Teaching Development Coordinator at the University of Saskatchchewan in Saskatoon,Saskatchewan, Canada. She puts together the most useful tool sets for educators that I’ve ever seen. If you look up the definition of teaching in a dictionary, most of the definitions are along the lines of “imparting one’s knowledge,” but we all know that teaching is really “helping people learn.” And we also know that being active with the material and making it meaningful is probably the best way to help people learn. I was trying to get the students in my problem-based learning group to help their peers learn and came across this very valuable site from the Saskatchewan websitehttp:// medicaleducation.wetpaint.com/page/Active+Engagement. I shared it with the students and they are doing all kinds of active engagement techniques...and we’re having fun learning. I’d suggest you visit this site—it will enlarge your repetoire as a teacher and is filled with well tested “low-hanging fruit” that will help teachers get rave reviews and most importantly, help students learn. That’s tip one. Tip two is to go to the DR-ED website where, in one of the many informative chats taking place, I came across the Bonnycastle site, but DR-ED is filled with gems. To reply or post messages to this list, direct your messages to: dr-ed@list.msu.edu.To manage your subscription go to:http://omerad.msu.edu/dr-ed/instructions.php. To explore the DR-ED archives (filled with many pearls), go to http://list.msu.edu/archives/dr-ed.html. If you need help, send an e-mail to: dr-ed-request@list.msu.edu. These are two tips worth your attention!

“We Are the World”…Applied to Cancer

As I thought about this issue and this editorial, and about the work we are doing together, the powerful song by multiple artists—including Michael Jackson, Lionel Richie, Tina Turner and a host of others—called “We Are the World” kept playing in my head. I’d suggest that each of you reading this go to the website [1], get yourself charged up by watching the video, and think about the solidarity that the “We Are the World” performance showcased, which was centered around the plight of Africa and the devastating consequences that famine was having there. Now let’s apply this solidarity to cancer as we work together to eradicate the ravages of this disease. Remember that this journal is “An Interdisciplinary Journal that Aims to Reduce the Burden of Cancer in the World Through Effective Education.” We have some heroes and extraordinary partners as we reach for these goals. The first person I want to pay tribute to is Darren Starmer, an extraordinary associate editor doing yeoman’s work to get articles from outside North America reviewed, critiqued and improved for this journal. If you look at any issue, there are articles from all over the world from good people doing good things, but in this issue alone, there are contributions from Crete, Italy, Nicaragua, China, Turkey, and Egypt. All of these provide cultural insights into the quest to eliminate disparities among our diverse populations in the US and Canada. A second editor who deserves special tribute is Amr Soliman, who along with his colleagues in Michigan, is helping to train a contingent of international cancer control experts. His work is detailed in an article in this issue. Amr introduced me to the exceptional work that Joe Hartford’s Office of International Affairs is doing at the NCI. I was deeply influenced by his recent paper, published in Lancet Oncology [2], that addresses strategies for dealing with breast cancer in low-resource settings. There is a fair amount of “pressure” on policy makers to institute organized breast cancer screening via mammography. Much less attention is being paid to the women with symptoms, including those that are diagnosed very late in the disease process. One point of the article is that it might be better to direct resources toward women who have breast cancer, rather than screening the whole population, the overwhelming majority of whom do not have breast cancer. One place where resources are scarce is in palliative care services. Joe’s wise message concerning this paper was: “I hope the paper will be of help to you since all of us are striving to do what we can with what we have.” Another voice of incredible wisdom from our editorial board is that of Frank Ferris, Director of International Programs, The Institute for Palliative Medicine at San Diego Hospice (check out their programs!) who is trying to bring palliative care to the world. Please have a look at a video Frank is involved with called “Cancer Pain” [3]. Here are some highlights from this latest “Treat the Pain/Life before Death” video: