Category Archives: Education

Roundup: On Accessible & Inclusive Conferences & Meetings

Accessible? Twist handle, then pull

I just returned from the annual meeting for the Medical Library Association, where multiple discussions arose around what would it look like to expand what is done to make the conference both accessible and inclusive. [Yes, the image at the head of this post is an actual photo from the actual meeting.] Just a couple weeks before that I was privileged to attend “Cripping” the Comic Con 2019 which was, by FAR, a truly exemplary model for how to create an inclusive event. (I’m hoping to write a second post about what blew my mind so much about CripCon!) Pretty much the same topic also arose in one of my Facebook groups, Teaching Disability Studies, where several of the resources mentioned here where shared.

Since my organization (UofM) has done some work in creating resources around this, and since I was on the original committee that created our resource, I volunteered to share that resource with MLA and put together a collection of selected resources related to this topic. The resources collected here are organized alphabetically within section (resources, readings) by either the author or providing organization. Organizations represented in the post include:
– ABA (American Bar Association)
– ACM SIGACCESS
– ADA National Network
– ASAN (Autism Self Advocacy Network)
– New York State
– Ohio State University
– Syracuse University
– University of Arizona
– University of British Columbia
– University of Michigan
– Vera Institute of Justice

RESOURCES

ABA Section of Civil Rights and Social Justice. Planning Accessible Meetings and Events, a Toolkit https://www.americanbar.org/content/dam/aba/administrative/mental_physical_disability/Accessible_Meetings_Toolkit.authcheckdam.pdf

You want to know what the lawyers think about what you should do? Well, start here. This 22 page PDF provides a number of thoughtful strategies to promote accessibility and inclusion in events, from working with attendees and presenters in an interactive way to plan the best possible event to post-event surveys designed to elicit information on accessibility improvements needed for future events. I’ve been working in disability spaces and communities most of my life, and they had suggestions that were new to me. I have some more work to do. This one is a must read.

ACM SIGACCESS. Accessible Conference Guide. https://www.sigaccess.org/welcome-to-sigaccess/resources/accessible-conference-guide/

It’s a bit amazing to me how each of these guides has something wonderful and necessary that I missed seeing or which wasn’t included in the other guides. This one includes discussions around making events safe for people with migraines, having drinking straws available, and where can a service dog relieve themselves with causing problems for the event. They point out that simply asking for a sign language translator doesn’t tell you which version of sign language the viewer needs, since there are regional and country variations which can be quite significant. They include example draft language for eliciting accommodation requests from attendees, registration, formatting your promotion material PDFs accessibly, and having a triage plan in case problems arise. This document is updated regularly, and this newest version was just updated a few weeks ago (April 2019). Note that they also have an Accessible Writing Guide and an Accessible Presentation Guide. Must read.

ADA National Network. A Planning Guide for Making Temporary Events Accessible to People With Disabilities. https://adata.org/publication/temporary-events-guide

Okay, this thing has chapters. I mean, CHAPTERS. That tells you something. In some ways, it’s almost too detailed. However, it also focuses almost exclusively on physical factors (venue, parking, toilets) and has very little on the interaction or experience. While this is highly detailed, the intended audience seems to be focused on government or community event planners, and not for professional events or conferences. This is more of a basic introduction to what is involved, and is intended for broad audiences. Also available as a 61 page PDF and a 119 page large print PDF.

ASAN: Planning Accessible and Inclusive Organizing Trainings: Strategies for Decreasing Barriers to Participation for People with I/DD https://autisticadvocacy.org/resources/accessibility/ PDF: https://autisticadvocacy.org/wp-content/uploads/2017/11/White-Paper-Planning-Accessible-and-Inclusive-Organizing-Trainings.pdf

While several of the other resources listed here focus primarily on physical barriers to inclusion, this document is absolutely essential for those with sensory integration concerns or learning disabilities. It explains and describes the impacts of such factors as loud or unpredictable noise, motion, and other stimuli; unpredictable events; abstract or overly-complex language; speaking spontaneously (or putting people in situations where they are expected to improvise their reactions); body language; touch; and much more. It includes information on scheduling that describes the need for breaks, use of plain language content, color communication badges, and the risks to the audience of some popular presentation engagement strategies. This is the only of the resources listed here to richly describe the role of support persons in events. I doubt it would be possible to plan an inclusive event sensitive to any of these issues without, at a minimum, reading a document like this one, or being close to someone who shares these issues and concerns. A must read.

New York State, Department of Health: People First: How To Plan Events Everyone Can Attend https://www.health.ny.gov/publications/0956/

This is a lovely document which includes both high level thinking around accessible events as well as fairly detailed specifics. This is one of few of these types of resources that spends time on the importance of developing a formal policy with specifications for events, and has suggestions for approaching the development of a policy if your organization lacks one. It includes nitty-gritty suggestions, such as “Plan for 30% more meeting space when 10% or more of the participants will use mobility aids,” having ramps to the stages, and how to look for tripping hazards. Absolutely a must read. Also available as a 13-page PDF.

Ohio State University: Composing Access, An invitation to creating accessible events https://u.osu.edu/composingaccess/

Includes information on making accessible presentations, including live-streaming and handouts (when, why, and how), as well as the expected accessibility thoughts and practices for conference organizers. Includes resources; ways to encourage attendees to act as advocates for accessibility and inclusion; descriptions and videos for creative practices like interaction badges, quiet rooms, “crip time,” and more.

Syracuse University: A Guide to Planning Inclusive Events, Seminars, and Activities at Syracuse University http://sudcc.syr.edu/resources/event-guide.html

Available only as a 27 page accessible PDF. This exceptionally detailed resource is far too rich a resource to do justice to in a brief description. Syracuse is the home of Cripping the Comic Con, and it is clear that they have really put considerable time and thought into not only conceptualizing accessible events, but putting this into practice, seeking feedback, and learning from experience. It has four appendices, of which the most essential, to my mind, is Diane Wiener’s example introduction in Appendix B. In addition to the usual content (planning, venue, promotion, and presentation) this guide includes prudent practices for inclusive use of language, use of images and media, the role of environment (fragrance, sound/noise, lights, color), and much more. This is my own preferred go-to guide for starting with this. I guess that means I should mark it a must read, too.

University of Arizona: A Guide to Planning Accessible and Inclusive Events https://drc.arizona.edu/planning-events/guide-planning-accessible-and-inclusive-events

A short example of how to write a resource like this for a campus community. Includes a brief but helpful section on how to train event support staff.

University of British Columbia: Checklist for Accessible Event Planning https://equity.ok.ubc.ca/resources/checklist-for-accessible-event-planning/

Exactly what it says — a collection of terse reminders of what should be remembered. Includes roughly 60 entries in 7 categories (planning, marketing, transportation, space, programming, catering, final). Available as a 9 page PDF download.

University of Michigan: Ten Tips for Inclusive Meetings https://hr.umich.edu/working-u-m/workplace-improvement/office-institutional-equity/americans-disabilities-act-information/ten-tips-inclusive-meetings

This information in this resource is presented in a layered fashion for ease of access, action, and remembering, similar to the UBC checklist. The ten tips are very short, focusing on major areas to consider, but include links to richer information for those willing to explore more deeply. The design stresses retention and adoption of the concepts by making them easy to access and simple to remember. Main areas included are scheduling, accessible presentations, promotion, restrooms, food and drink, personal assistance, offsite participation, representation, transportation and navigation, and options for help for event planning and management.

Vera Institute for Justice: Designing Accessible Events for People with Disabilities and Deaf Individuals https://www.vera.org/publications/designing-accessible-events-for-people-with-disabilities-and-deaf-individuals

This isn’t a guide or a checklist. This is a toolkit, and boy, does it have a lot of different tools. They have several different tip sheets focusing on special aspects of meetings and events, from registration to budgeting, and including venues and how the meeting itself is handled. They even have a tip sheet for working with Sign Language Interpreters, and how to develop successful contracts with hotel management (which sounds worth its weight in gold). These aren’t one page tip sheets, though. The tip sheet for designing accessible registration is 7 page long. That’s a lot of tips. These are so well done that countless other disability organizations host copies on their own websites and recommend them for their own audiences and clients. These are another must read.

Additional resources & examples

ACS-ALA, Accessibility and Libraries, October 4, 2017. Rough edited CART copy (Webinar transcript). https://docs.google.com/document/d/1JIVc5-QcvBb74AitQXrnFfHReYk6nnKez3gR33llHvU/edit

ALA Annual: Accessibility https://2019.alaannual.org/general-information/accessibility

Inclusion BC: How-to Make Your Event More Inclusive https://inclusionbc.org/our-resources/how-to-make-your-event-more-inclusive-2/ PDF: https://inclusionbc.org/wp-content/uploads/2019/02/Makeyoureventinclusive.pdf

NCCSD Clearinghouse and Resource Library: Inclusive Event Planning https://www.nccsdclearinghouse.org/inclusive-event-planning.html

WorldCon 76: https://www.worldcon76.org/member-services/accessibility

TO READ

This is a twitter thread from a few weeks back that “won Twitter,” as in it went viral, with 144 replies, 294 Retweets, and 1,562 Likes. It began with Alex Haagaard’s mention of their own accommodation requests at conferences, and resulted in a highly educational thread of accommodations people need or wish they could request at conferences. I recommend reading this thread for any conference planners or organizers.

MORE

“If part of what we train our students to do is enter into scholarly conversations, how we go about that conversation in our own professional settings matters.”
Accessibility at ASECS and Beyond: A Guest Post by Dr. Jason Farr and Dr. Travis Chi Wing Lau https://asecsgradcaucus.wordpress.com/2019/02/21/accessibility-at-asecs-and-beyond-a-guest-post-by-dr-jason-farr-and-dr-travis-chi-wing-lau/
Includes: “Toward a More Accessible Conference Presentation” https://drive.google.com/file/d/1xzGyfVlMRUwZMjuZ6mef87OXCIfN3uiW/view

“Use the microphone: this gets repeated dozens of times on Twitter every conference for at least the last five years. I guess I’ll just say: yes, abled people, using a microphone indicates that you are considerate of D/deaf and hard-of-hearing folks, and suggesting that others do is beneficial to the audience.”
S. Bryce Kozla. Accessibility and Conference Presentations https://brycekozlablog.blogspot.com/2018/01/accessibility-and-conference.html

“But I believe that losing my hearing was one of the greatest gifts I’ve ever received. You see, I get to experience the world in a unique way. And I believe that these unique experiences that people with disabilities have is what’s going to help us make and design a better world for everyone — both for people with and without disabilities. … I stumbled upon a solution that I believe may be an even more powerful tool to solve some of the world’s greatest problems, disability or not. And that tool is called design thinking.”
When we design for disability, we all benefit | Elise Roy https://www.ted.com/talks/elise_roy_when_we_design_for_disability_we_all_benefit?language=en

Coding and tech comics & coloring books

First posted at https://michigan.it.umich.edu/news/2017/12/19/comics-coloring-books/


We are coming up quickly on the winter break, with families gathered and children out of school. With that in mind, it might be fun to have some some (slightly eccentric?) options for family activities and young folk distractions. Even better if these are options that promote learning, or just understanding more about what the old folks do with their days, eh? Here are a few highlights from my collections of (mostly free) comics, coloring books, and games around the world of geekery, coding, and tech. Who knows? Maybe you’ll find something that tickles your own funny bone!

A FORTRAN Coloring Book

Coloring Books

The first coding coloring book I could find dates from 1978 — Roger Kaufman’s FORTRAN Coloring Book, actually published by MIT Press and used as a textbook, back in the day. I was tickled pink when I found it, in part because I remember by Dad coding in FORTRAN when I was a young thing. (Yes, I have a copy on paper in my office. Honest!) It is robustly humorous for actual coders, and probably not as much fun for kids today. It is, however, available in the fabulous Internet Archive (but you might have to wait your turn to get access, since it is still under copyright).

Another rather amusing tongue-in-cheek (optionally NSFW) geek coloring book comes from the infamous Oatmeal. Check out 404 Not Found (and 404 Not Found NSFW). Not free.

With coloring books about coding going back so many decades, I thought there must be more, and oh my, there are.

ABC++ [PDF] (free)

The Coder’s Coloring Book [PDF] (free)

Kevin’s Python Coding Coloring Book (usually around $7)

Lady Ada’s E is For Electronics Coloring Book [PDF] (free as PDF, or you can buy a copy for $9.95)
(You might want to see also Lady Ada’s R is for Robots, which is not free.)

Programmer’s coloring book (About) [PDF] (free)

The SELinux Coloring Book (Github) [PDF] (free)

Soldering is Easy (free, but no PDF, only individual page downloads)

The Imitation Game, by Jim Ottaviani

Comics, Graphic Novels, Zines, Etc.

– About Coding & Tech-

These include comix for kids and comix for pros, but even those for kids are so well done I get a giggle out of them.

BubbleSort Zines. (Includes zines like “Hip Hip Array!” as well as t-shirts and jewelry such as “BYTE ME!”) (not free)

Code Cartoons (such as A Cartoon Guide to Flux and more) (free)

Google Chrome comic by Scott McCloud (free)

Grokking Algorithms: An illustrated guide for programmers and other curious people (~$17 onAmazon)

Hello, Ruby (for ages 5 and up) (not free, but free stuff available for downloading at the site)

How DNS Works (start here) (free)

Linux comics, a small zine. Others from the same author include “Let’s Learn tcpdump,” “Spying on your programs with trace,” and “Networking! ACK!” (free)

What Makes a Clock Tick (free)

Why’s Poignant Guide to Ruby (free)

– About Geekery Other Than Coding –

We are very lucky here to have Jim Ottaviani on campus as a hard core science geek who loves and loves to make comics. I could hardly talk about comics and coding without mentioning his collaboration with Leland Purvis, The Imitation Game: Alan Turing Decoded! But there are more comics and graphic novels about coders, geeks, and the work and culture they love. This is just a few selected titles, not at all comprehensive (try searching cyberpunk graphic novels to see what I mean). [NOTE: These are mostly NOT free, but for sale at bookstores both analog and virtual.]

Alice in Quantumland: An Allegory of Quantum Physics

William Gibson’s Neuromancer

The Thrilling Adventures of Lovelace and Babbage: The (Mostly) True Story of the First Computer (Pantheon Graphic Novels)

Tom Clohosy Cole’s Space Race

(And if this isn’t enough to keep people busy, you can always make your own, one way or another.)

Keeping Busy, the June Edition

I’ve been a tad overwhelmed for months now — major events, presentations, travel, etc. Lots of stuff to share, but as a quick overview, here are just a few of the Storify collections from recent events I livetweeted or attended or collected online. (I will be doing more blogposts on specific LARGE events for which I did several Storify, like the MLA Annual Meeting, or the Comics & Medicine Conference, or … and then also others from earlier this year). WordPress doesn’t like people to embed Storify links directly into the blogpost, so for each entry, I’ve embedded a tweet that has an embedded link to the Storify. This means, the easiest way to get to the good stuff is to click through.

June 7, 2017

The “Strategies to Empower Women” Symposium aims to close the historic gap that leaves females consistently behind their male counterparts in salaries, grant awards and opportunities for advancement. It was a really powerful event, and I was sad to miss the beginning of it. Making a Storify helped me find and read some of the early comments, even if I didn’t actually get to see the presenters.

“Strategies to Empower Women to Achieve Academic Success”

June 21, 2017

You need to look backwards to look forwards. You need that context of what happened and what worked and what failed to help inspire you to do something truly innovative. I was really delighted to hear Barbara MacAdam describe some of the evolution of library innovation on our campus through the lens of her own personal experiences.

“Barbara MacAdam on Library & Intellectual History at #UofM #UMich200”

June 24, 2017

Great Twitter conversation sponsored by the Journal of the American College of Radiologists on the topic of what is burnout among physicians and other healthcare workers, what does it look like, what do you do?

“Physician Burnout – #JACR June 2017 Chat”

June 26, 2017, AM

The Emergent Research series rarely has presenters from within the library, and rarely presenters who are not actually presenting research or data. In this case, the time slot was used to present really mission critical skills for researchers, faculty, and staff who work with data or concepts that should maybe not be completely public all the time to the whole world. They cast the conceptual net broadly, because, well, frankly speaking, these skills apply to everyone at the University, sooner or later.

“Digital Self-Defense (#MLibRes)”

June 26, 2017, PM

“The Evolving Bargain Between Research Universities and Society”

On D-Day, Exploring the Context of “As We May Think”

As We May Think (Cover)

During National Poetry Month (April), I thought it would be interesting to quote one of the poems published in the same issue of The Atlantic Monthly as the incredible essay, “As We May Think,” by Vannevar Bush.

“As We May Think” was required reading when I was in grad school, and it still it. This is a work that was truly seminal in shaping the origins of the Internet, hypertext, the Web, more. Provocative, inspirational, decades before its time. It’s online, easy to find, and it’s even open and free to the world. When I went looking for poems from the issue, though, that was not easy to find, much less free. I ended up having to request the print copy. Print. Really? You must be kidding me, but no, it’s true. It took me a month to believe I wasn’t going to find it online, and another few weeks for me to place the request for the print and find time to actually look at it.

You know what happens with print? You go looking for one thing, and find something else. You turn a page, and a picture catches your eye. You start to skim one article, but a beautiful word or phrase on the facing page distracts you. Before you know it, you are turning pages whether or not they have anything to do with your original question.

Let me tell you something about the issue of The Atlantic for July 1945. It was published less than a year after D-Day. It was published only a few months after the official end to the war. It was published when people first began to see, to believe, that World War II really was going to end, and stay done. It was the beginning of moving through the shock and trauma of the war, beginning to tell stories that couldn’t be born, that no one wants to remember.

When I first read “As We May Think” it seemed all shiny and glossy, this vision of what might someday become computers, personal assistants, ready flexible access to information. The dream that was so much bigger than people realized at the time, bigger than I realized when I read it in grad school. I had no idea that this was one essay of a larger series that The Atlantic was publishing on science and the war, no real idea of the world in which it was written. Sure, we studied WWII in school, read about the concentration camps, the war bonds, the atom bomb, the refugees, the destruction of historical treasures across Europe, the bombing of London, the evacuations, the debates in America about whether or not to enter the war, the American resistors who joined the war efforts in Europe early and were shunned as unpatriotic for the rest of their lives.

It never really came alive for me, though, in the way that it did when my computers broke this week and I went through the journal issue that contained Vannevar Bush’s essay. Some of what I found there:
– “paper bombs” as tools to influence thought
– Ad: advertisements on new technologies created for the war that had drastic impacts on food and home lives of civilians (from ice cream to oranges to vitamins)
– serious examinations of media reporters, “their reliability, their prejudices, and their mistakes”
– the role of propaganda on both sides of the conflict as obvious and visible even at the time
– first person reports of Buchenwald, shocking ghastly stories neglected from modern reports of the camps
– bitter heart-wrenching poems of soldiers from the fronts
– sweet stories of life back home, still edged with fatigue and loss and an undertone of the global anxieties, and stories of life with what we now call PTSD or depression or anxiety or others
– “Should Jews Return to Germany?”
– Ad: the misunderstood science that led to putting iodine in gasoline
– “Prithee, Little Book, Who Made Thee?”
– Ad: “Coal? Yes, indeed, it’s a big item in the drugstore!”
– Ad: “For the first time in history, a world without poverty and without war is technically possible. Whether we achieve it depends on how well we understand the ‘Economies Of Peace’.”
– book reviews of and advertisements for works by Henry James, Upton Sinclair, Thomas Mann, John Crowe Ransom, W. H. Auden, and other familiar names.

Somehow, “As We May Think” takes on a different flavor in the context of essays, and poems like this snippet from Sasserath, which resonate so very differently now than when they were written, that echo with limits and struggles that repeat now in some places and yet have become fictions in others.

“We who must live on substitutes for life,
The powdered egg, the dehydrated spud, …
Or learn the art of love with plastic limbs …”
“On Anodynes, by Simpson Sasserath, RT2/c

Reading and seeing “As We May Think” in the context of the series of which it was a part, similarly lends a depth that makes it seem even more extraordinary. The series was called, “A Scientist Looks at Tomorrow,” beginning in 1945 ad stretching to at least 1947. It included titles such as these:

– The Social Animal / Caryl P. Haskins
– Stars, Proteins, and Nations / Philippe Le Corbeiller
– A Design for Fighting / Harlow Shapley
– Penicillin, Plasma Fractionation, and the Physician / Dr. John F. Fulton
– A Physicist Returns from the War / I. I. Rabi
– Psychiatry and the Way / Big. Gen. William G. Menninger
– DDT and the Balance of Nature / V. B. Wigglesworth

I’m now curious to find them all, as a fascinating window into what was considered the cutting edge of emerging technologies in the mid-1940s. But the few sentences that resonated with me most closely came from a few months after the Bush essay, towards the end of the year, in an essay called, “The Return to Love,” by Rollo Walter Brown.

We can take our choice. If we do not believe that the awakening, the generosity, the loyalty, the warmth, expressed in love can transform the world into something more livable than what we now have, then we can take the alternative and believe that husbands and wives who cannot endure each other, neighbors who cannot endure each other, races who cannot endure each other, people who scoff at anyone who would make an improvement, can somehow, added together, constitute one world living in amity. We can wait among our raucous hatreds until somebody somewhere decides to enforce his special hatred with some super-super atomic bomb. That is something definite and “realistic.” But might we not have a more interesting world if we tried love?

Visual Abstracts — Thoughts from a Medical Librarian

Visual Abstracts (Screenshot)

You might be interested in this initiative arising out of surgery, and primarily developed by Andrew M. Ibrahim MD, MSc of the University of Michigan. Dr. Ibrahim is a Clinical Lecturer in Surgery here and a Robert Wood Johnson Clinical Scholar at the Institute for Healthcare Policy & Innovation. His idea of a visual abstract is kind of a blend of visual literacies, infographics, posters, and science abstracts.

In surgery, this is being adopted as a new strategy for creating journal article abstracts. It is being mentioned by the Annals of Surgery, Cochrane Collaboration, Journal of the American College of Surgeons (JACS), and the World Journal of Surgery, among others.

It lends itself to plain language explanations of concepts, clarity for funding agencies and policy makers, and as a tool for public outreach and education. The visual abstract may be more accessible to folk with cognitive or learning disabilities, while being less accessible to those with visual disabilities. There are powerful benefits, especially in this era of publicly contested science findings, as well as some significant drawbacks if we were to depend on the visual abstract to replace written abstracts. Another challenge is that it isn’t actually searchable in databases, and the issue of how to include and discover visual abstracts in MEDLINE remains to be addressed by the National Library of Medicine. Personally, I’m not sure that it replaces the full functionality of the traditional abstract, but rather supplements it, which I suspect is the intent. Offering both strongly empowers science communicators and educators, especially if the images are licensed to promote use and dissemination. It would be ideal if the standard of practice for visual abstracts would be to make them Creative Commons licensed.

Medical librarians must be aware of this, and should develop the competencies and skills necessary to make them so that they can help support their institutions as well as creating these for their own articles and research. One of the most common questions about this is how to locate or create icons to use. Just a few quick suggestions. If you have a significant budget, hire a graphic designer. If you have a smaller budget, consider licensing icons from the Noun Project. If you have more time than money, consider using Open Clip Art, where the images are free, but it may take more digging or editing for images you can use.

Cool Toys Pic of the day - Noun Project

So, how do you make these? Dr. Ibrahim has examples, videos, and guidelines available at his site.

Here is the direct link to the primer, including guidelines and best practices for the creation of visual abstracts, but I have not been able to get the direct link to work consistently.

https://static1.squarespace.com/static/5854aaa044024321a353bb0d/t/58b8f5b437c5816223531822/1488516555585/VisualAbstract_Primerv2.pdf

Increasing numbers of journals are requesting visual abstracts as part of article submissions or are creating them as part of promotional content for highlighted articles. You can find many examples on the website, and more in the Twitter stream for the hashtag #VisualAbstract. Here are some examples from the past couple weeks.

The “July Effect” and Tips for New Doctors

THE “JULY EFFECT”

It’s that time of year again. Maybe you’ve already heard of the “July Effect”? Here’s a post making the rounds again today illustrating the depths of sarcasm and irony with which this meme is sometimes considered in healthcare.

Ask a July 1st Medicine Intern http://gomerblog.com/2015/07/medicine-intern/

But this is an idea that goes back for years. The gist of the idea is that it’s dangerous to go to the doctor in July because the new interns start then.

Here are a few pieces presenting that perspective.

Kirchheimer, Sid. Avoid the Hospital in July. Why? New doctors and nurses report to work for the first time. AARP June 2013. http://www.aarp.org/health/doctors-hospitals/info-06-2010/why_you_should_avoid_the_hospital_in_july.html

Headed to the Hospital? Beware the ‘July Effect’ — July means a fresh crop of medical residents. Should that scare you away? http://health.usnews.com/health-news/patient-advice/articles/2014/07/21/headed-to-the-hospital-beware-the-july-effect

This idea has been around for decades, at least since the 1980s.

Dedra Buchwald, MD; Anthony L. Komaroff, MD; E. Francis Cook, ScD; Arnold M. Epstein, MD, MA. Indirect Costs for Medical Education: Is There a July Phenomenon? Arch Intern Med. 1989;149(4):765-768. doi:10.1001/archinte.1989.00390040007001. http://www.ncbi.nlm.nih.gov/pubmed/2495778

Of course, it’s not as simple as the popular press would like to make it sound, and there is far more research presenting the opposing (but less well known) view, or that it is a small effect and one which impacts only certain patients in specific circumstances. Basically, the idea is that The “July effect” is mostly not true, and has been well debunked.

“For the subset of patients with internal medicine diagnoses, the expected “July Phenomenon” was observed, with significant relative declines in diagnostic and pharmaceutical charges in teaching hospitals over the academic year. In contrast, surgery patients showed an increase in length of stay and various charges over the academic year in teaching hospitals. There were no meaningful effects of housestaff experience on mortality, operative complications, or nursing home discharge. These results indicate that housestaff training is significantly related to the use of hospital resources for inpatients, but that the degree and direction of the effects differ by specialty.” (Rich et al, 1993)

“Although this study finds no support for a “July Phenomenon” in terms of quality of clinical care, house officers were found to be more likely to have poor documentation practices earlier in the academic year.” (Shulkin, 1995)

“There was no evidence of an increase in negative outcomes early in the academic year compared with the end of the academic year. We believe that a systematic approach to the diagnosis, resuscitation, and treatment of trauma prevented a July phenomenon.” (Claridge et al, 2001)

“Although small differences in outcome exist with respect to the academic time of the year, the timing of these differences indicates that there is not a “July phenomenon” in obstetrics at our institution.” (Myles, 2003)

“We find that the annual house-staff turnover results in increased resource utilization (i.e., higher risk-adjusted length of hospital stay) for both minor and major teaching hospitals and decreased quality (i.e., higher risk-adjusted mortality rates) for major teaching hospitals. Further, these effects with respect to mortality are not monotonically increasing in a hospital’s reliance on residents for the provision of care. In fact, the most-intensive teaching hospitals manage to avoid significant effects on mortality following this turnover.” (Huckman & Barro, 2005)

“The data suggest a “July effect” on some outcomes related to shunt surgery, but the effect was small. Nonetheless, the potential morbidity of shunt failure, infection, and the cost of treatment indicate that continued vigilance and appropriate supervision of new staff by attending surgeons is warranted.” (Kestle et al, 2006)

“Conclusions: High-risk acute myocardial infarction patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low-risk patients experience no such July effect in teaching-intensive hospitals.” (Jena et al, 2013)

“Particularly in major teaching hospitals, we find evidence of a gradual trend of decreasing performance that begins several months before the actual cohort turnover and may result from a transition of responsibilities at major teaching hospitals in anticipation of the cohort turnover.” (Huckman et al, 2014)

“Data from a single institution study did not show a “July Phenomenon” in the number of operating minutes, overutilized minutes, or the number of ORs working late in July.” (Sanford et al, 2016)

“These data, in combination with the findings of Shah et al,1 suggest that the July phenomenon can largely be debunked in the modern era of surgical education.” (Thiels et al, 2016)

… and much more (Pubmed, Wikipedia)

The basic fundamental idea is, unless you are a high-risk patient, it is PERFECTLY SAFE TO SEE THE DOCTOR IN JULY.

TIPS FOR NEW DOCS

Why is it safe? Because the new docs are well trained, and have experience in a variety of situations. This all made me very interested in the annual event on Twitter in which experienced docs share tips with new docs just starting out. The biggest and best hashtag is #TipsForNewDocs, but others included #DearIntern, #DearResident, and #DearPatient.

I’ve collected a bunch of these awesome tips for all those new docs that started today, and you can find them here.

Teach Feast: Engaged Learning Through Internships, Badges, e-Portfolios, & Storytelling


Teach Feast 2015: integrative tools for engagement at Michigan http://www.slideshare.net/umhealthscienceslibraries/teach-feast-2015-integrative-tools-for-engagement-at-michigan

I was invited as a last minute fill-in to be part of a panel at the annual Teach Feast festival of learning technologies at the University of Michigan. It was a great learning experience for me, and I hope also for the participants. I learned more about how engaged learning can be a continuum, incorporating relatively small or subtle changes to traditional instruction or going whole hog and literally uprooting a student from their culture and context and positioning them in a new space for a different type of learning experience. Engagement can originate with either student or teacher (or both); it can be collaborative and/or competitive and/or creative. The one part that seemed foundational to all the strategies was reflection, turning your gaze both inward and outward.

My part was on digital storytelling. I’m a big fan of digital storytelling, in case you didn’t know. I like to test new online storytelling tools, and see how they work to support different kinds of stories. My current fascination with comics is based out of my larger enthusiasm for storytelling. I argue that storytelling is part of every academic discipline. It’s obvious that the humanities dissolve if you remove stories. What is history without story? But when it comes to the sciences, people are more likely to have trouble seeing the story as part of the academic process. Of course, case studies in health care, sure, those are stories. And psychology and psychiatry, they don’t work without stories. Social work, yeah, of course. But physics? And engineering? Maybe if you aren’t in the field you have trouble seeing the story, but if you really think about every research paper, every structured abstract is a frame for a story. Every piece of science has a backstory, a motivation, a reason someone wanted to know THIS. Even mathematics. Even when camouflaged, the stories of science are implied. What changes isn’t the presence of the story, but how we tell them, and the tools we use to carry them.

The advantages of digital storytelling are similar to those of printed stories: portable, inclusive, persistent, and reaching a broader audience. One of the great lessons from education is that communication is never one-size-fits-all. The more ways you present important content, the more people will be able to understand it and engage with it. The greater the variety of media you use to tell a story, the more people will hear it. I’m happy to help people find and tell stories, especially science stories. There are a lot of different types of tools and resources in the slides. If I have time, I’ll spend a little more time on specific ones here some other time. If there is something in particular from the slides that you’d like me to talk about, say so in the comments, and I’ll make it a priority.