Wow, what a wordy title. Anyhow, I’m sitting here doing an assignment for missing a day of Clinicals, and I’m starting to wonder if I should pick a different article.
For some reason, my teacher is sorta rabidly insane about beta blockers and COPD. Conventional wisdom (which she’s latched onto like a pitbull and Keeps. On. Repeating. It.) is that you shouldn’t use beta blockers in someone who has COPD, because it might make their bronchoconstriction worse, leading to an exacerbation of COPD. This article I’ve found, however, claims that the actual rationale behind that is theoretical in nature, and that, in actual patients, giving people with COPD beta blockers not only reduces mortality from cardiac events, it *reduces *exacerbations of COPD, not increases them.
In other words, to take the medical stuff out, there’s evidence that what she’s teaching us is wrong. I have it, should I use it?
This isn’t just *her *assertion, mind. This possible error is the conventional wisdom, at least as currently taught and tested in nursing school. Do I go there? Do I choose this article as one of the three I have to summarize in penance for missing a day of class? Or should I do the cowardly thing and chose another article?
I’d throw it in there, sure. I wouldn’t make it the focus of the assignment in a ‘you’re wrong style’, though.
A big difference (maybe the biggest) between the Masters (your teacher) and the Apprentices (you) is understanding what is important in the field. So it is quite possible that the article you link to (not working for me, requires psswd) is not important at all and it would be a serious error to interpret it as such (I see this frequently in undergrad lit assignments I mark, fwiw). OTOH, it could have merit and you’ll show your ability by taking the measure of it. Throwing it down as some sort of devastating rebuttal is not recommended, though. How can you be confident in your ability to assess the literature if you’re still in school?
I think it is overwhelmingly likely that your instructor will never in fact read what you are working on, so you’re probably ok.
In my own classroom, I like it when students present contrary views, and I work very hard to make my students feel comfortable about challenging me. That said, I get annoyed with smart-asses who seem to feel like coming up with a minor exception to a general rule is somehow scoring points off of me. That said, I’ve had about two kids over the years who really did that.
Well, the assignment is to find 3 articles and summarize them in a page and a half each. So there’s no way to slide this into a larger assignment, it is the assignment, unless I pick a different article on a different topic.
Absolutely! In fact, I finished the summary with, “While, for the sake of my exams and patient contact, I will continue to consider beta blockers contraindicated for use in patients with COPD, I will also pay attention to further research and recommendations on this topic.”
Now I just have to decide whether or not to turn it in…
Thanks. Chronic Obstructive Pulmonary Disease (that is, emphysema or chronic bronchitis. But hang me if I know why the two entirely unrelated diseases are lumped under one term!)
snicker Ya know, you’re probably right. But she’s that kind of teacher who, after weeks of turning back papers with nothing but “Good” on them, will one day hand you back a paper that looks like the bleeding Rosetta Stone, all marked in red with exclamation points scattered on it like buckshot. Some days, she actually does read them!
ETA: Thanks for the teacher perspective. Seems like, as long as it’s done respectfully, evidence based and not a neener-neener kind of thing, it’s probably okay not to agree with the teacher at all times.
I’d say it’s a crapshoot. Some teachers will welcome signs that their students are thinking for themselves. But some will hate it - and they’ll justify their disapproval by pretending it’s not personal. They tell themselves they didn’t fail you because you disagreed with them - they’ll tell themselves they failed you because you didn’t understand the material (as demonstrated by the fact that you disagreed with them).
I would make sure that you understand the research methodology and can defend it. There are peer-reviewed papers to support a lot of claims that defy conventional wisdom. I can’t see access the paper (it seems to require medscape professional) but it couldn’t hurt to take a quick look at the journal, sample size, what kind of study it was, etc. Also, make sure that the paper isn’t drawing conclusions about a certain subset of COPD pts (like pink puffers or blue bloaters or whatever) but about COPD as a whole. And also, make sure you agree with their hypothesis as to why this is the case.
Okay, I signed up for medscape and could access the article. I only read the abstract, but, they admit that they didn’t control for the fact that the increased longevity of the pts on B-blockers could be because of the cardiac vasodilatory effects of these drugs, right? I’m not sure, but I think there is a high co-morbidity between COPD and cardiac disease. So, maybe these are things to think about or mention in your paper.
I didn’t access the article, just didn’t want to sign in. My take is to do four summaries. Turn in the three unquestioned ones as your assignment. Then the last, more controversial one, asking her if she had seen said article.
Do this ONLY if the article is from a well recognized publication. New England Journal, Lancet, yes; JAMA, maybe not.
You’re a med student, yes? At the level I teach (graduate school) - hell, at all levels really, I’d welcome well-reasoned, thoughtful, evidence-backed dissent. When I lecture on a topic and present it as the prevailing conventional wisdom, supported by many research studies, etc., I don’t appreciate someone saying, “Well, y’know, I think it’s really not what they say it is” without bringing some thoughtful analysis to the table.
But I like learning from my students, and they in turn can be the best teachers to their peers, so I say bring it if you have the evidence.
My undergraduate degree is in Electronic Engineering, and I corrected my Graduate School adviser in a lecture when he said a transistor circuit was dependent upon temperature because of the beta factor of the transistor. I piped up, “That circuit is beta independent”. He was pissed, but admitted the next day that I was correct.
G-d, I love engineering classes, and hate liberal arts!
I have no problem with people disagreeing with me- it actually helps a lot, especially if they’re right. The only concern I have is when it becomes something that derails an entire class. If I mess up a name or a date, by all means say something. If you disagree with my conclusion and can present a logical argument against it, that’s great! But when it’s something that isn’t relevant to everyone else in the room, I would just as soon do it in office hours or right after class- my courses are usually crammed pretty tightly with content, and there are a lot of times when a 30-45 minute debate in class would mean that there’s a whole topic we would have to either skip or rush through.
IME, some doctors/nurses/teachers have had a dramatic experience in which a pt died, or almost died, or made a miraculous recovery and have a subsequent faith in a treatment that far exceeds the evidence. It’s a dirtly little secret in our profession how many gaps there are in the evidence based choice of treatments. If she’s a believer in beta blocker harm to COPD you may decide that this is not a hill you want to die on, but if there’s openess to new research in your program it may be good.
I’d suggest saying sonmething like, ‘I came across this article that has a new perspective and I wondered if you think this source is credible and reliable or are they known for shoddy reporting?’ And gauge her response.
I wouldn’t argue with your boss. I’m a medical student and I’ve heard numerous stories about how contradicting an attending or any other superior can at best leave you where you were before, and at worse make you a powerful enemy or tarnish your reputation.
Also, non selective beta blockers do exacerbate COPD. I’ve seen it happen before in the setting of a patient with CHF and comorbid COPD. The guy’s previous GP had him on propanolol and he was having a difficult time catching his breath. The doc who I was working with at the time switched him over to ER metoprolol and lo and behold, his symptoms improved tremendously.
Had my Evaluation with her today, and I passed! (Yay!) I asked her what she thought of the article, and she said it was very interesting, but I was absolutely right to keep thinking of beta blockers as contraindicated for COPD for exams and in practice. She also, quite rightly, told me to go look up the original study and not place too much faith in one person’s interpretation of it.
So, all in all, just the best response I could have hoped for. Guess she’s not such an ogre after all.
In the day, most teachers who were capable would turn this into a learning opportunity.
Woe be to he who raised a question in the classroom! It would be an opportunity to involve the skeptic in a research project and perhaps to even include the entire class.
(I once overheard my children discussing asking a question of their grandmother, a retired teacher. My son said, “Don’t do it! She’ll make us look it up in the dictionary.”)
Said skeptic would be warned in the dorm to keep his mouth shut. Cuz nobody really goes to school to work. Heh.
I think today people are more apt to display ego in their public disclosure and in their work. I don’t know why, but I suspect that we are losing our sense of individual importance. So if your teacher is the insecure type and hasn’t learned to soothe his ego at work he may take offense
Maybe things have changed, but I’ve heard and read a lot of stories of teachers in the good old days punishing anyone who bruised their over-inflated ego. And since the teacher probably wouldn’t get away with whipping the students now, maybe things are better, in fact.
As a math teacher, no one could actually refute anything I said, but a student once (and on an exam too!) gave a substantially easier argument than the standard one I had taught (that a regular pentagon is constructable) and I was thrilled! Not to mention astonished. I made a point of describing it when I went over the exam in class. I was disappointed only when she used the incident as a reason to ask me to write a recommendation for her to go to law school. What a waste. Well, maybe she will make it to the Canadian Supreme Court.
It is an awfully poor excuse for a teacher who would take such a thing personally.
Chronic Obstructive Pulmonary Disease (that is, emphysema or chronic bronchitis. But hang me if I know why the two entirely unrelated diseases are lumped under one term!)