Day 113 Course Saturation

I have a non-lethal but completely incapacitating man-URTI.  Fine, it’s just a sniffle.  But I feel drained.  I was meant to be downtown at the Canadian Bar Association, just East of King St Subway Station, at about 07:30 for a full day of what was booked as really interesting talks on breast imaging.  Screening, MRI, missed cancers… I went to bed early last night.  I even slept it, because I saw the first three talks last Tuesday at the Organ Imaging Conference.  I ate, dressed, drank a coffee and went downtown.

I was only 2 hours late for the start.  In Perth you’d expected a handful of attendees to be 2 hours late.  There’d still be plenty of seats, mostly toward the front.  Not in Toronto.  The room was packed.  I think I saw two seats free, near the front.  I couldn’t do anything but stand sheepishly at the back of the room, swearing that the keynote speaker from New York’s Memorial Sloan Centre was looking right at me all the time. I was wearing a white windbreaker and bright orange backpack.

Thankfully a tea break was announced and I saw a single empty seat at the front row, next to the two Breast Fellows from my institution.  I could get a seat and get visual confirmation of attendance.  It’s most important that everybody else sees you at a conference than actually listening to anything in the presentations.

The talks were good.  My coffees hadn’t helped.  I decided on a cold & flu tablet to suppress my minor symptoms but I think the “non-sedative” antihistamine is sedative for me.  I started to fall asleep.  The last talker was the Breast Fellowship Supervisor at my hospital, and I kept dozing off.  Time to throw in the towel, I thought.

As I walked back to the train station, on my way home, where I’ve spent the rest of the afternoon fast asleep instead of staring blankly at Powerpoints while my mind struggled to keep up with the information but it looked like I was keen, in the front row, all day.  Or I could actually learn something, come home, sleep all afternoon, then when awake read at my own pace through all the PDFs and watch the webinars.

This dilemma reminded me of Med School.  Our educational system bases a lot on passive large groups of learners sitting watching didactic presentations, text or image-based, that go on for ever, and somehow the ability to sit there all day constitutes learning.  I can’t do that.  Even if I’m interested and the talk is good and the content appropriate I will start to fidget or I’ll fall asleep.  Why do medical courses and conferences have to be in Powerpoint?  Why not do a Montessori school structure where participants get to pick out the topic they want to look at first and facilitate that?  Or why not make a tactile learning experience?  I typed out many key points of learning:

  1. Fat necrosis should be diagnostic on mammography.  Don’t try to use MRI as a trouble-shooting modality as it will mimic cancer and make things worse.
  2. MRI is useful for diagnosis of fat necrosis after TRAM flap reconstruction where the differential is palpable tumour recurrence. Is the palpable mass fat or tumour?
  3. Tomosynthesis will probably eventually be incorporated into screening mammography as well as workup and you need to get your eye into it.  You can decrease callback rates for asymmetric densities and increase perception of small masses, otherwise obscured by overlapping tissues.
  4. Patient perception of risk of radiation dose from mammography and tomosynthesis is going to be a big challenge.  How do different practices address this challenge (i.e. convincing a patient more breast radiation will do more good than harm) and in what populations is this most relevant to?

I walked home thinking that I could’ve learned these bits of information better if we’d split up into groups with butcher’s paper or large laminated cards representing patient groups or specific cases and throwing them into imaging modality workstations.  Or some digital algorithm.  They did have use of a click based MCQ answering system that often had a wide rainbow of responses.  Did this mean that there are no correct answers, as practice in Ontario varies widely?  Or were people not communicating learning points effectively?

Not feeling well I didn’t want to go and find people that I knew and say hello, or talk to anybody.  In the first break I read my book, The Rosie Project, which is a guy who has Asperger’s personality traits and behaviours and is in search of a wife but is going through personal growth instead.  I had reached course saturation and, instead of waiting in line for lunch I left.  I bought a limp pulled pork sandwich from the most laconic server ever at Quiznos, read my book on the train, came home and slept.

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