Discussion 1 Discussion: How have the liberal arts changed?Read the Overview and Introduction to the Bellevue text.Read Chapter 1: BeginningsRead Chapter 2: Hosack?s VisionCreate a post with a minimum

Discussion 1 Discussion: How have the liberal arts changed?Read the Overview and Introduction to the Bellevue text.Read Chapter 1: BeginningsRead Chapter 2: Hosack?s VisionCreate a post with a minimum
Cultural History,?escriptive Article,?ost-Classical History (600 CE-1492 CE),?orld History November 4, 2018 The Seven Liberal Arts ? The Foundations of Modern Day Education A Medieval Depiction of the Seven Liberal Arts by the artist Herrad of Landsberg circa 1180. | Courtesy of Wikimedia Commons MARTINA RODRIGUEZ The Seven Liberal Arts. While the phrase ?Liberal Arts? is nothing new to any student?s ears, the specific term ?Seven?iberal Arts? might not have the same sense of familiarity. The term ?liberal arts? comes from the Latin word ?liber,? which means ?to free?; thus it was believed that the Seven Liberal Arts would ?free? one through the knowledge gained in each of various disciplines.1?he term ?Seven Liberal Arts? or?rtes liberales?efers to the specific ?branches of knowledge? that were taught in medieval schools. These seven branches were divided into two categories: the?rivium?nd the?uadrivium. The?rivium?efered to the branches of knowledge focused on language, specifically grammar, rhetoric, and logic. The second division, the?uadrivium, focused on mathematics and its application: arithmetic, astronomy, geometry, and music.2?reek philosophers believed the Liberal Arts were the studies that would develop both moral excellence and greater intellect for man.?owever, it was not from the Greeks, but rather from the Romans that we see the first official pattern or grouping of the Seven Liberal Arts. The beginnings of this pattern came from the Roman teachers Varro and Capella.?Varro (116 BCE-27 BCE), a Roman scholar, is credited with writing the first articulation about the Seven Liberal Arts.3?owever, Capella (360 AD-428 AD) in his?arriage of Philology and Mercury,?et the number and content of the Seven. Branching off of Capella?s work, three more Roman teachers?Boethius, Cassiodorus, and Isadore?were the ones who made the distinctions between the?rivium?nd?uadrivium.4?hrough the writings and research of these men, the foundation for the Seven Liberal Arts was set and ready to be taught officially in the Medieval schools across Europe. ?The Seven Liberal Arts? by the painter Giovanni di Ser Giovanni Guidi circa 1460 | Currently housed in the National Art Museum of Catalonia | Courtesy of Wikimedia Commons The first division of the liberal arts was called the?rivium?hich means ?the place where three ways or roads meet.? The?rivium?as the assembly of the three language subjects or ?artes sermoincales?: grammar, dialectic, and rhetoric.5?t was expected that all educated people become proficient in the Latin language. After so many years of school with Latin being the spoken language, the student would be deemed proficient in the language and he would begin studying the higher-level curriculum.6?ompletion of the?rivium?as equivalent to a student?s modern day bachelor degree.7 The grammar aspect of the?rivium?imed to have students critically analyze and memorize texts as well as produce their own writings. One of the most famous grammatical texts studied by students was the?octrinale?f Alexander of Villedieu, which was a work of verse written in 1199. Naturally, the classics, such as Virgil, were studied as well as some Christian texts.8?n the stronger monasteries, other pagan authors besides Virgil were also studied.9?ot only was Virgil studied, but Donatus and Priscian wrote two very popular textbooks for the study of grammar. Donatus? work was seen as an elementary work because he focused on the eight parts of speech. Priscian?s work, on the other hand, dealt with more advanced grammatical topics, and he cited some of the Roman forefathers of the Seven, such as Capella, Augustine, and Boethius.10 The student interest level in?ialectic?ad been immense since the early days of the Greek schools, since they focused on the arts of reasoning and logic. For some, such as Rhabanus Maurus, dialectic was considered ?the science of sciences.??he commonly studied dialectic textbooks were translations of the famous Greek teacher Boethius??ategories?nd?e interpretatione?f Aristotle. By the twelfth century, the study of dialectic, or logic, came to be seen as the major subject of the trivium.11 The final academic aspect of the Trivium was?hetoric, which focused on expression as well as some aspects of history and law. Again, Boethius had some famous works that were studied in this discipline, but the common textbook was the?rtis?hetoricae?y Fortunatianus.?rammar and rhetoric were encouraged to a greater extent in the first half of the Middle Ages because knowing Latin was essential.12?he Carolingian period saw the expansion of the discipline of?hetoric?row to include prose composition. This discipline set the groundwork for the studies of canon and civil law in medieval schools.13? ?A Young Man Being Introduced to the Seven Liberal Arts? a painting by Sandro Botticelli. Circa 1483-1485 | Currently housed in the Louvre Museum | Courtesy of the Wikimedia Common The?uadrivium, whose Latin translation is ?the place where the four roads meet,? was the assembly of the four mathematical subjects or?rtes reales: arithmetic, music, geometry, and astronomy.14?hese four areas of study were more advanced than those of the?rivium. Because of this, completion of the?uadrivium?ould result in the student being awarded a Masters of the Arts degree.15?or Medieval education, all the liberal arts subjects were seen as complementary to ones theology lessons, all of which every educated student would received. The Church encouraged the completion of liberal arts education so strongly that one could not even be ordained a priest if they weren?t deemed proficient in what the?uadrivium?emanded.16? The first discipline of the?uadrivium, arithmetic, focused on the qualities of numbers and their operations. When the Arabic notation gained popularity, its methodology was implemented into study, thus increasing the content and understanding of arithmetic.17?he Church had very specific requirements for a man to be deemed?roficient?n arithmetic. For example, unless a man was able to compute the date of Easter using the writings of the Venerable Bede, he would not be allowed to be ordained into the priesthood.18?The second aspect of the?uadrivium?as music. At first, the extensive music courses aspired to produce worship music. Not only did these courses include composition of music, but also performance aspects. The invention and early use of the organ in the medieval churches caused the interest in music to increase.19?Geometry was a new academic aspect for the Medieval world. Up until the tenth century, medieval knowledge of geometry was extremely limited. The discipline focused on geographical and geometrical components. More specifically, the focus was towards the practical applications of surveying, map making, and architecture. The works of Ptolemy were the basis for instruction for geometry. From the work of Ptolemy came further understandings of botany, mineralogy, and zoology.20?The final aspect of the?uadrivium?as the teachings of astronomy. However, is was more than understanding how to read the stars. At first, Astronomy was used for arranging the feast days and fast days for the church.17?t also included more complex mathematics and physics. The purpose here was to be able to create and predict the calendar for the church as well as the most advantageous times for harvesting and planting crops. For this discipline, the works of Ptolemy and Aristotle were studied.22? ?A Young Man Being Introduced to the Seven Liberal Arts? a painting by Sandro Botticelli. Circa 1483-1485 | Currently housed in the Louvre Museum | Courtesy of the Wikimedia Common The Seven Liberal Arts. A previously forgotten, but important foundation to our modern-day educational system. The specific disciplines were great, not only from an academic stand point, but in the contributions they held for society. A lot has changed for academia since the medieval period, but if not for the work of our medieval forefathers, how academia changed towards our experiences in the modern day could have been very different (Rodriguez, 2018). Bibliography Rodriguez, M. (2018, November 4). St. Mary’s University. Retrieved from STMU History Media: https://stmuhistorymedia.org/the-seven-liberal-arts-the-foundations-of-modern-day-education/ ALSO: https://www.memoriapress.com/articles/what-are-the-liberal-arts/
Discussion 1 Discussion: How have the liberal arts changed?Read the Overview and Introduction to the Bellevue text.Read Chapter 1: BeginningsRead Chapter 2: Hosack?s VisionCreate a post with a minimum
Why We Need the Liberal Arts Now More Than Ever BY CLAYTON ROSE AUGUST 30, 2017 1:05 PM EDT Rose is the 15th president of Bowdoin College As I prepared to welcome Bowdoin College?s students back to campus this week, I couldn?t help pondering where we are today in the worlds of politics, of government and of the media ? imperfect but essential institutions for a healthy democracy. We have evolved to a most distressing place ? to a place in our society and world where intellectual engagement is too often mocked. Facts are willfully ignored or conveniently dismissed. Data is curated or manipulated for short-term gain rather than to test or illuminate aspects of the truth. Hypocrisy runs rampant and character appears to no longer be a requirement for leadership. Instant gratification and personal aggrandizement are celebrated as virtues over the work of tackling hard problems that ultimately serve the public interest and common good. Too often, respectful and thoughtful discourse about the tough issues and efforts to find common language for a conversation ? let alone common ground for solving problems ? are among the rarest of commodities. This is decidedly a nonpartisan problem. We have evolved to this place over a long period, and there is more than enough blame to go around to all sides. Whatever one?s political and world views, we should all be alarmed. A system where skill, expertise, data, judgement, discourse, respect and character are in short supply is a system in trouble. A liberal arts education can play an important role in correcting this problem. At Bowdoin, we work hard to create an environment where students can be intellectually fearless, where they can consider ideas and material that challenge their points of view, may run counter to deeply held beliefs, unsettles them or may make them uncomfortable. We do this to prepare our graduates to effectively tackle climate change, economic inequality, race relations and so many other issues that polarize us today. In a liberal arts setting, intellectual fearlessness is achieved through the development and enhancement of competence, community and character. Competence comes through a rigorous education ? one that builds and sharpens the skills of critical thinking and analysis; the ability to understand the political, social, natural, ethical, cultural and economic aspects of the world we inhabit; the ability to continue to learn; and the disposition to be intellectually nimble, to exercise judgment and to communicate effectively. We don?t tell students what to think. We strive to teach them how to think, to give them the knowledge and skills to develop the courage to think for themselves and shape their own principles, perspectives, beliefs and solutions to problems. We also provide students with seemingly endless ways to serve the common good ? the notion that we have an obligation to something bigger than ourselves. This serves to strengthen our community and to make our students part of other communities, helping them better understand what binds each of us together. We want our students to understand and celebrate their wonderfully diverse identities, experiences and backgrounds, while also enjoying and appreciating the deep bonds of being a part of our college community. Being part of a strong and diverse community requires an ability to talk honestly with one another about the real issues. That?s why we push our students to develop skills and an ability to engage in thoughtful and respectful ways with those who have varying perspectives, and with whom they may disagree ? sometimes profoundly. We also seek to promote character ? principled lives, work and play that have integrity, an acknowledgment of the gifts we have been given and respect for others and ourselves. Liberal arts colleges are steeped in opportunities to engage intellectually and to reflect deeply across all disciplines about what character means, why it matters and how one might live it. And there are many chances over four years for students to actually engage in challenges that test and develop their character. At this challenging moment in our society and world, it would be easy to despair. But I do not. I am optimistic because I know the power of competence, community and character. The liberal arts matter now more than ever.
Discussion 1 Discussion: How have the liberal arts changed?Read the Overview and Introduction to the Bellevue text.Read Chapter 1: BeginningsRead Chapter 2: Hosack?s VisionCreate a post with a minimum
SWSC 2019 Presidential address?Putting Patients First? I think it is often tradition, appropriately, to open such Presiden- tial addresses by acknowledging and thanking your mentors. I truly believe, though, that we have many, many mentors in life; and many different mentors in different stages in life and different needs for different mentors. So I won’t mention all my mentors today, but I want to honor two mentors important in my career and my membership in Southwestern Surgical. There is a reason I asked Dr. Edward Nelson to introduce me today, and that is because he is a great mentor to me. I met Dr. Nelson as an intern at the University of Utah in 1995. And since that meeting he has been my teacher, my senior partner, my Divi- sion Chief, my Chairman, my friend, and now my neighbor. And every one of those relationships has been a privilege to me. And through all of those relationships, he has been a mentor to me. When I met Dr. Nelson, I immediately recognized that he is the surgeon that I was going to be. He takes better care of patients than most. He is technically one of the most skilled surgeons I’ve ever trained with. He is an extremely diplomatic leader. He is kind, and he is supportive. My?rst presentation as a trainee at SWSC, was with Dr. Nelson, as my senior author. He has shared this lectern as President of SWSC, so he is a mentor in Southwestern surgical to me as well. I hope I have and will continue to try to emulate Dr. Nel- son’s career in surgery. I wanted to mention my other mentor in Southwestern Surgical, and that is Ronnie Stewart. I don’t know why Dr. Stewart chose me to be the Recorder, following his term, but it’s been such an honor to try to follow his footsteps as a Recorder. He was so committed to that position, and remains so committed to Southwestern surgical. I tried to?ll only half those shoes. He is the face (and camera) of this organization. I think that one of the reasons that he chose me, is that he wanted to change the phenotype of this organization. He wanted a younger and a female person on the Executive Council to help make forward changes in the organization. He asked me to represent that. Instead of me making changes, Ronnie, your advocacy for the diversity of this organization, by being a promoter and a supporter of diversity, has been far more powerful in imple- menting change in Southwest surgical then I have been. You have in?uenced and preserved the future of this organization. Thank you. So, it is not surprising, with those two as my Mentors, that my topic today is?Putting Patients First?. You start to think about this talk two years earlier, and you go to every meeting’s Presidential Address, and it all just makes you nervous. You then go back through the previous Presidential Addresses here, and that makes you even more nervous. I wanted my topic to be something that was true to me, but interesting to the broader SWSC audience. So, I started to think about what projects I’ve done at the University of Utah since I’ve been on faculty there, excluding oncology, HPBsurgery and pancreas cancer research; which this general audience of SWSC is not so interested in. And in this re?ection, I realized that a lot of my career has really been trying to put patients?rst, and make our work serve the patients and meet the needs of the patients. When you?Google?putting patients?rst, there are a lot of def- initions. This de?nition is the one that was truest to me:?Putting patients?rst focuses on the patient’s personal needs, wants, de- sires, and goals so that the individual becomes central to care.? (http://lippincottsolutions.lww.com/blog.entry.html/2018/02/06/ putting_patients?r-6cUL.html). My goal for today, with this talk is to address: 1) did we get away from putting patients?rst? 2) I think we have, so how did that happen? And 3) was it us or the patients or both? 4) Do we need to change our approach, meaning, should we be putting patients ?rst; are there bene?ts to doing so? And then,?nally, 5) I want to mention brie ?y?ve projects that I’ve been working on the past several years at the University of Utah, trying to improve a patient centric approach. To start this topic, we must understand our origins. Why we do what we do, and how our profession started. In a simpli?ed gener- alization, most of us went into medicine to be a healer. A healer is a person who claims to be able to cure a disease or injury using spe- cial powers, a person or thing that amends or repairs something, and speci?cally someone who alleviates a person’s distress or anguish (Oxford dictionary). That is what we wanted to be, one who relieves someone’s distress. An individual who wanted to serve as a healer has been documented in nearly every culture since the beginnings of mankind. From as early as 7000 B.C. there are archeologic?ndings consistent with shamans and apothecaries in the role of healers, taking care of their own. There is evidence of Shashtrakarma, the Indian art of surgery as early as 3000 B.C. (Wiki- pedia, History of Medicine; and Ancient Greek medicine). In the United States, the?rst nation cultures had their own healers and shamans caring for their tribe. It wasn’t until the 1600s that physicians were immigrating to the United States, from northern Europe, mostly trained in England and Scotland. Still, this early organized and trained group of healers, or the early modern physician, would travel to the patient, make house calls, to care for the ill. Medical care revolved around the patient. The?rst organized hospitals opened in the United States in the 1750’s. Interestingly, New York, New Orleans and Philadelphia all opened hospitals at about the same time. And this is when medical care started to change to revolving around the institutions and the providers and not around the patients, or serving patients in their own homes. With increases in technology, improved transporta- tion, speci?cally, the invention of an ambulance; it became easier to transport the patient to the hospital, with immediate access to Contents lists available atScienceDirect The American Journal of Surgery journal homepage:www.americanjournalofsurgery.com The American Journal of Surgery 218 (2019) 1035e1039 https://doi.org/10.1016/j.amjsurg.2019.10.021 0002-9610/?019 Elsevier Inc. All rights reserved. all?modern?technology tools, pharmacy, and supplies; than to transport the doctor to the patient’s remote under supplied home. This allowed the hospitals to become more physician centered; meeting the needs of these highly trained and hard- working individuals to provide critical health care to patients in need. This exaggerated doctor-centric approach is emphasized by us, the surgeons, speci?cally. We are a major part of this hospital and doctor based problem, and one of the leaders in the transition of emphasis from the patient, to the providers; because we need to be in a specialized?operating room?. Patients must come to us, to our healthcare facility, for safe specialty surgical care. This, patients much come to the doctor-centric approach, has led to a sort of arro- gant attitude of the physician. In modern medicine, physicians have become very specialized, are highly skilled and each with extremely unique knowledge and skill set. This advanced training and high stress, high demand work load has led further to an arrogance of physicians. And then, let’s be honest, medicine and surgery is particular, is?nan- cially rewarding. Physicians are privileged. And there’s always been a demand for more physicians and speci?cally more surgeons. Through all of this, we have become very paternalistic to pa- tients. Patients must come to a surgeon in their?theater?to be cared for, while they are asleep, and have little ability to weigh-in on the?game-day?decisions made in their best interests, in the operating room. And surgeons become valuable to the healthcare institutions, so the hospital systems are often designed around the highly skilled surgeon’s needs, for example:?Doctor’s prefer- ence cards?, describing how a surgeon likes their surgical?eld set-up and which instruments they will require. Not what does this patient need, but rather what does this surgeon like? A CEO of a hospital system in Ohio once described patients as hostages of the healthcare system, as they sit in the waiting room in our pa- tient of?ces and wait for the privilege of being seen (attributed to the CEO of Riverdale Methodist Hospital, Ohio). That is not a Patients First approach. Our electronic health record history is a marker for how we have gotten away from the patient This is a really fascinating paper that I, that is worth a read, on the history of health records (From Papyrus to the Electronic Tablet: A Brief History of the Clinical Medical Record with Lessons for the Digital Age;The American Journal of Medicine 126, 10, October 2013, 853e857). Originally, health records were just notes for the physicians themselves, to serve as their own teaching notes, or to learn from their own patients. Nearing the 1800s, notes became more about teaching others, residents and students. Some feel that modern hospital records come from the Mayo Clinic (PBS T.V. special;History of the Mayo Clinic). The Mayo brothers hired an internist, Dr. Harry Plummer, to join them to serve as an early hospitalist. And Dr. Plummer recognized the disorganization and discontinuity in the hospital as each pro- vider had their own notes about a patient, but no one had access to the other provider’s notes. Dr. Plummer recognized a need to assign the patient a?medical record number?and a record in the number could follow the patient. Every provider could add their own notes, but the record would be centered around the patient rather than the providers. Shortly after, in 1910, the Flexner Report was published, on the training of medicine in the United States, and the streamlining and standardizations of medical training in some ways, led to the continuity of a?medical record?for hospital pa- tients across the country. The weakness of these hospital records was that they did not span across patient clinic and outpatient medical encounters. So, jump forward a hundred years, when CMS demands and American Recovery and Reinvestment Act enforce the need for an electronic health record, we now have elec- tronic health records. The goal of an electronic health record would be to follow the patient, to record every medical visit, inpatienthospital stay, and any study, test or procedure. It would capture every medical event that the patient had. How patient centered is that? It is brilliant. But we failed. The evolution of electronic health records systems has led to systems which do not capture the story of the patient, the communication from provider to provider. Most modern successful health records systems are billings based. With this, unfortunately, what has happened, concluded in theBrief History of the Clinical Medical Record with Lessons for the Digital Age; is that? in light of projected bene?ts, the actual performance of leading commercial electronic health records has been the subject of much criticism in the literature by practitioners, in failing to record the medical events which occur for the patient. For the sake of this talk, I found a few examples of billing based notes of recent acute care or emergency room visits of patients that I have seen in clinic. The electronically recorded event is a serial of automatically inserted imaging and labs results, a drop-down menu catch phrase physical exam which does not describe the speci?c pa- tient at all, and a series of diagnosis codes for the assessment and plan. I have no idea what the provider saw, thought, or concluded. These records are NOT patient centric at all. It’s not helping us look at the patient more carefully, and it’s not helping us take care of the patient together. It is billing based. So, this paper concludes that ?physicians must not allow technology to devalue the doctor- patient relationship and the continuity of care in which the patient as a person maintains a place in the memory of the clinician and not just the computer.?This change in our medical re?ects the changes in our healthcare systems, becoming system and provider based, not Patients First. So, what about the patients? Maybe they have contributed to this turn in modern healthcare as well? Maybe it’s not just the fault of physician and speci?cally surgeons. Maybe it’s not just the health records’ weaknesses. Maybe they have left us as well: As I was putting this talk together, and one of the chief residents at the University of Utah, now a Thoracic and Critical care surgery fellow, Dr. Megan Bowen, gave a fantastic grand rounds in 2018 titled,?Postmodernism and its Effect on Medicine?(medicine.utah. edu/surgery/general_surgery/grandrounds/video.php?video?_ hdcylscf). I highly recommend you follow this link and watch this video to understand our modern patient. Dr. Bowen’s interest was looking at the prevalence and in?uence of complementary and alternative medicine. In the introduction of her talk, she addresses exactly what I was interested in the regarding the evolutions of the doctor patient relationships. Fortu- nately for me, she just did all my research for me, in one hour! She explains that Modernism the period from the late 1800s up to World War II. The era was generally associated with a social emphasis on rational logic and a search for knowledge; knowledge obtained through scienti?c inquiry in a rational manner. The post- modernism era is after World War II. This era the generalized social feeling is that people (patients) have become disillusioned with data and pessimistic toward knowledge. They have abandoned the search for truth. They feel that the universal truth or the search for universal truth is impossible. Generalized philosophies of the post-modernistic person is anti-intellectualism, anti-science, and a belief in public knowledge. This post-modernistic patient is more likely to believe in a blog-post, then a medical journal publi- cation. These patients believe in cosmetic lotions and essential oils, non-regulatory dietary supplements, gluten-free diets and anti- vaccines; but are not willing to believe in the anti-hypertensive you have prescribed. This modern patient has learned to believe in social lore about untested supplements far more than they believe in you, the practicing?Western-medicine?medical provider. C. Scaife / The American Journal of Surgery 218 (2019) 1035e1039 1036 Drs. Martin and Finlayson, from the University of Utah, pub- lished a study on patient pre-surgery education materials (World J Surg. 2017 Jun; 41(6):1447e1453). They evaluated and provided patients different education resources: electronic e-mail and tablet based resources and printed materials. They then surveyed patients for?What information did you use and did you?nd most valuable before your surgery??Overwhelmingly, the patients reported that the information they got from their family, friends, or neighbor who may have been through or associated with someone who had been through a similar situation, was the most valuable infor- mation that they got for their pre-surgery education. Despite best efforts to try to educate these patients. They don’t believe us, and listen to the social?gossip?about health care. This is the post- modernism patient. Many studies have shown that the post- modernism patient would prefer to be seen by a chiropractor than a doctor; presumably because they put their hands on the pa- tient more, listen, spend more face-to-face time, and maybe most importantly, they let the patient do some of their own self-care and participate in their deci

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