Introduction

This blog is about medical education in the US and around the world. My interest is in education research and the process of medical education.



The lawyers have asked that I add a disclaimer that makes it clear that these are my personal opinions and do not represent any position of any University that I am affiliated with including the University of Kansas, the KU School of Medicine, Florida International University, or the FIU School of Medicine.



Wednesday, February 2, 2011

Dr Jerry Kruse's Seussian rhyme

The following Seussian rhyme was imagined and written by Dr Jerry Kruse, Professor and Chair, Department of Family & Community Medicine, Southern Illinois University School of Medicine.
It was given during the final plenary session at the 2011 STFM Conference on Medical Student Education.



The Saga of Michael Klein


Or…..

 Ein Kleiner Schnitt

Or…..

The Triumph of Reason Over Power, Finally!
By Dr. Kreuss*

In that faraway land to the North, in Quebec,
Lived a doctor whose practice was very low tech.
A family doc, accoucher Michael Klein,
Who didn’t like forceps or women supine
Or ‘lectronic monitors, stirrups or sections
Or enemas, shaving or IV injections.

He hated electrodes and IUPC’s
And treatment of labor as if a disease.
And one of the worst – epidural blockade –
A stab in the back to start the cascade
Of catheters, tubing, Nubain and pit
And Sulfate of Mag so she won’t have a fit.
Blood pressure cuffs and punctures of veins,
Cesarean Sections and Tucker-McLains
Retained placenta, post partum metritis
I’ll bet you a buck she’ll come down with mastitis.

“I don’t like these women to all be strapped down.
Stand up and walk!”  he cried with a frown.
Michael knew in his heart, way deep down inside
That obstetrical knowledge was not well applied. 
“Technology’s great, for those who are ill,
But for those who are healthy it’s really no thrill
To be strapped down and poked, and scared stiff as a board.
This just isn’t right!”, his fervent voice roared.

One thing more than others, did gnaw at his heart,
Made his blood boil, and stung like a dart
He just couldn’t stand it, to see a long slice,
A cut, an epis - what a terrible vice,
Disruption of skin for no reason at all,
A snip with the scissors that starts very small
But rips and extends as the baby comes through
Tears into the sphincter and up the wazoo.
A third, then a fourth, oh my what a mess
“They must like to sew, is my only guess.”

So Michael jumped up, and he raised his right hand
And opened his mouth, and he took a firm stand
“I’ll study this problem,” he said with a shout
“And when I am finished there won’t be a doubt
That these cuts are no good…the whole world will see….
This idea’s a good one, they’ll have to agree.
I’ll start up a randomized, single blind study
And I’ll work with Michel who’s my very good buddy
And we’ll put ole’ McGill right here on the map.
This study of perineal trauma’s a snap.

“We’ll put in a grant, we’ll get recognition.
We send all this stuff to a good statistician.
Our alpha will be less than point zero five
And beta point two will let us derive
The number of women we’ll need.  It’s a slew.
We’ll enroll ‘bout a thousand five hundred and two.”

He worked and he toiled, he felt quite convicted—
The results were exactly the ones he predicted.
“Midline epis, when routinely done
For women in labor, is not very fun.
Our EMG’s show that sliced muscles get weak,
They heal up quite slowly and let urine leak.
And that isn’t all that comes out that should not.
She’ll find our real quick when she sits on the pot.

“The relative risk for a fourth degree rip
Is greater than twenty, with each little snip.
And all of us know, if the rectum is torn
That a permanent hole will often be born
That connects the vagina and rectal mucosa
And where it comes out then will make you nervosa.
So my warning to you, who practice OB
Is to use the epis quite conservatively.
Don’t be in a rush, and don’t interfere
Throw down the scissors, they’re not needed here.”

Now Michael was proud, and really excited
With his results he was very delighted.
He wanted to spread the good news he had found
He wanted to broadcast this stuff all around,
But a funny thing happened.  He couldn’t believe it
No one would listen, they just couldn’t perceive it.

The doctors in charge of the medical journal
The ones who are experts in issues maternal
Did not want to hear about data that’s new.
It was hard to convince that conservative crew.
“No one will believe it,” the editors cried
And they wrote down “REJECTED” with feelings of pride
And one after another they all did the same.
They suppressed this great knowledge – oh my what a shame!

But this story’s not over, he didn’t back down
He battled the towers who sport cap and gown.
Then once, then again and a third time, it’s true
His papers were granted another review.
And though eight years late and quite overdue
All three ended up in the publishing queue.

And now the world knew, both up in the North
And in states to the South, the new message went forth.
The paradigm shifted, the good word was this:
“The epis is archaic, and you’ll be remiss
To ignore this great knowledge that newly exists
And to squander this chance to cause perineal bliss!”

The r─ôsearch of Michael had ended the reign
Of procedure and practice we all thought mundane,
Of cuts and incisions most surely inane
And the scissors were thrown to the floor with disdain.

In just over a decade, the rate of epis,
Of pelvic dysfunction and fourth gaping degrees
Had tumbled to levels that went far below
The figures observed just a few years ago.
From sixty percent of all getting cleaved
To just nine in a hundred a cut to receive.

“Never give up!”  Michael’s voice still rings clear.
The moral today is to be of good cheer
To persistently fight, in the face of all the odds.
To battle ideas of conventional gods
To fight for new facts, and new evidence find
To give power to reason and sight to the blind.  (THE END).

*Dr. Kreuss                 Jerry Kruse, MD, MSPH
                                    Professor & Chair
                                    Department of Family & Community Medicine
                                    Southern Illinois University School of Medicine
                                    Springfield, Quincy, Carbondale and Decatur, Illinois

Bibliography:
1.      Klein MC, Gauthier RC, Jorgensen SH, Robbins JM, Kaczorowski J, Johnson B, et al.  Does episiotomy prevent perineal trauma and pelvic floor relaxation?  Online J Curr Clin Trials, Doc 10, July 1, 1992.
2.      KIein MC, Gauthier RJ, Robbins JM, Kaczorowski J, Jorgensen SH, Franco ED, et al.  Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation.  Am J Obstet Gynecol 1994; 171:591-8.
3.      Klein MC, Kaczorowski J, Robbins JM, Gauthier RJ, Jorgensen SH, Joshi AK.  Physician beliefs and behavior within a randomized controlled trial of episiotomy; consequences for women under their care.  Can Med Assoc J 1995; 153:769-79
4.      Huston P.  The pursuit of objectivity [editorial].  Can Med Assoc J 1995; 153:735.
5.      Schultz KF.  Unbiased research and the human spirit: the challenges of randomized controlled trials [editorial].  Can Med Assoc J 1995; 153:783-6.
6.      Klein MC.  Studying episiotomy:  When beliefs conflict with science.  J Fam Pract 1995; 41:483-8.
7.      Frankman EA, Wang L, Bunker CH, Lowder JL.  Episiotomy in the United States:  has anything changed?.  Am J Obstet Gynecol 2009; 200: 573.e1-573.e7
8.      Hyer R.  ACOG 2009:  Steep decline in episiotomy rates credited to research, peer pressure.  ACOG 57th Annual Clinical Meeting, Medscape Medical News.  http://www.medscape.com/viewarticle/702541

The rhyme contained in this blog is the intellectual property of Dr. Kruse and cannot be copied without his express consent.  Thanks. JED

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