What's wrong with Osteopathic Medicine....

[MODEERF NIATPAC]

My opinion of what is wrong with osteopathic medicine is

[This message has been edited by Derek (edited 04-29-2000).]

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[ADRIANSHOE]

Originally posted by RollTide:
I agree with much of what mj said, but I think the larger problem would arise in attempting to get attendings to monitor themselves and those whom they work with. I think that this could cause problems for everyone. That is why there is an administration at both the hospital and the school. You can not expect an attending to provide oversight on those whom he/she works with. Too many conflicts would arise from a situation like this. I think that students should evaluate the rotations(already being done right?) and the administration should pass these evaluations onto the attendings who should use this information to improve what they are doing. If the administration feels that the attendings are not attempting to improve the conditions at a particular rotation, then you could have the sanctions passed down to the attendings. But the faculty would have to be paid for the sanctions to work I would think.

josh, i dont think i intentionally ignored your last post, i think i skipped over it to read MJs post and never got back to reading it, because i certainly would have answered it if i had read it, you and i are in complete agreement on this, the problem is a lot of attendings aren't getting that necessary oversight and thus arent modifying their instruction, You have identified precisely the problems that exist right now. As you said, The school has the students write evaluations, the school then reads the evaluations and gives feedback to the attendings...then it has been up to the DME and the attendings to modify their style, but there isnt' any meat to entice the attending to change nor is there measures to enforce the change, some attendings dont teach because they like having students, they teach for their own sense of self esteem without putting effort into it and also to have students do all their psychiatric h/ps while they go to their office all afternoon and see medical patients. And as you stated much better than i could, this doesnt work well. That is precisely why i argue for looking at ways to fund attendings. nice post.

 

[mj]

Originally posted by ADRIANSHOE:
some attendings dont teach because they like having students, they teach for their own sense of self esteem without putting effort into it and also to have students do all their psychiatric h/ps while they go to their office all afternoon and see medical patients. And as you stated much better than i could, this doesnt work well. That is precisely why i argue for looking at ways to fund attendings. nice post.

Wow, Adrianshoe, you humbled on me while I was gone. I don't quite know how to take that. Maybe all the complements have just finally gone to your head

If I wasn't the new kinder gentler mj, I might point out that Josh's original point was that whether you pay someone or not, if they are the type of person you described above, they will not perform their duties with any conscientiousness. If they are the type of person who will perform well, they don't need to be paid to do it. I might even have gone so far to say that it is well proven in corporate America that the best performance enhancing plans revolve around two major axis: The first is the position must have perceived value. No one will do a job well if they do not perceive that job to have any importance. It is the organizations responsibility to instill that value within not only the employee, but those around the employee -- to create a culture that inspires the excellence you seek. Secondly, any performance enhancing plan must be system oriented. In other words, there must be a plan for failure, a way for the system to right itself if it breaks down at any point. People will come and go. The organization maintains inspite of that by creating systems that ensure its survival. The plan you propose, respected attendings...overseeing educator...relies on the "goodness" of the people involved and in the long run will fail as "less good" people take over those postions. And they eventually will for the reasons you listed above.

But as I am now embracing happiness, I will merely say that I am so glad you Josh have found common ground

peace and happiness

mj

 

[ADRIANSHOE]

i dont disagree that those people would still exist, only that with paid incentives they would be easier to REPLACE... a lot of instructors would be more than happy to teach and be good at it if they were paid...i could name some names, they simply refuse to not be compensated for their effort...and i applaud that...why should they go unrewarded? this idea that you SHOULD volunteer as an instructor is untenable, in fact, i don't think anyone even raised it. To quote the bible:
a laborer is worth his hire. LOL!
i would love some suggestions for oversight and evaluation of attendings...anyone got a model they want to share for critique?

 

[Nanook]

I've been watching this debate with great interest, and I have to say that Shoe has the "common sense" point (i.e, paid attendings). As much as we'd like to think otherwise, money is a motivator, a validator, and a respect-granter.

The above point made by Josh and mj is like saying that Major League Baseball teams would be just as good even if all the players were volunteer, simply b/c all the players who love the game would still play their hearts out and those that don't would still be lazy.

By the way, Shoe, I think you have successfully talked me out of applying to Nova.

 

[mj]

Oh Nanook, your critical reading skills that Shoey is always harping on were not working very well.

I've never said that attendings shouldn't be paid. What I have continually said is that our dear Shoey hasn't adequately defended his argument as to WHY they should be paid. Until his last post he has been arguing the "good and evil" point. He finally talked himself into a LOGICAL reason attendings should be paid: They are easier to both RECRUIT and REPLACE should they stray, which I absolutely agree with. Of course that is only true if his "perfect system" is constructed properly. In most hospitals and academic settings I've been associated with it almost takes and act of God to get someone fired.

But at least now there is a basis for that construct. An organizational system based on that is rather easy to come up with.

Consider:

A crash course in organizational design: http://www.wfu.edu/users/valentpc/bus211/course-materials/chapter%2013%20presentation/sld001.htm

Additional organizational motivation theories: http://www.cba.uri.edu/Scholl/Notes/Sources_Motivation.htm

Further readings: http://www2.jun.alaska.edu/~jfdja/BA301/bk_strct.html

I have a ton more for any interested parties. I?m a big Katz and Kahn fan. I believe organizational structure should be derived from a systems approach.

However, it is na?ve to believe that simply paying attendings will bring the change Shoey desires. Corporate America is full of failed organizations where people are paid an enormous amount of money.

As I eluded to in an earlier post, one of the key indicators of organizational success is organizational and management culture. Nova struggles to perceive attending positions as important enough to even pay. What kind of culture does that tell of? IMHO Shoey is putting the cart before the horse.

Katz and Kahn (1978) "The essential difference between a democratic and an authoritarian system is not whether executive officers order or consult with those below them but whether the power to legislate on policy is vested in the membership or in the top echelons"

Peace and happines

mj