#easier than solving systematic problems in your life that are difficult or even impossible to change

[alterboyx]

Surely this purchase will fill the void

[dawnfelagund]

Am I crazy for wanting to become a teacher? I'm taking classes for teaching certification right now, but I saw the post about ADHD and the anger there really shook me. Any words of wisdom for a young aspiring educator?

The short answer is, no, I don’t think you’re crazy. :) I adore my job and there is nothing else I’d rather do. I have so much fun with my students; laughter and joy are part of my everyday work. I’m on summer break now, and the other day, I found myself scrolling through pictures on my phone that I’d taken throughout the school year and reminiscing about the last school year and laughing anew at the things we got up to and missing my kiddos badly.

But–you probably knew there was going to be a but :)–I would be lying if I didn’t say my job is extremely hard. Teachers are notoriously bad at work-life balance. (One of my professional goals for next year is to improve on work-life balance because the year I had last year is not sustainable long-term.) I think new teachers should go into their work with eyes open to the challenges we face in our profession right now; they are not insurmountable challenges, but they are significant and tend (in my experience) to be glossed over by teacher-prep programs and school districts desperate to solve teacher shortages by harping on the “Make a Difference!!” message at the expense of acknowledging what the day-to-day reality of new teachers will actually look like.

As I said in my original post, expectations and working conditions vary widely by district in the U.S. Contrary to conservative myth, the federal government does not control or mandate curriculum (Common Core is standards, not curriculum, and also not adopted by every state)–and ironically, the biggest federal education mandate, the unfunded No Child Left Behind law, was a Republican policy–and this is controlled at the state or local level, so my experiences in the two states where I’ve taught (Maryland and Vermont) may not reflect what your experiences would be where you live.

In general, though, teachers are on the front lines of a society where people are increasingly finding it difficult to meet their basic needs and where the social safety net has been systematically dismantled. Unless you end up in a very privileged school–which is near-impossible for a new teacher–this absolutely impacts the kids you will see in your classroom every day. It most often manifests in behavior problems, either because kids in families stretched thin by poverty haven’t been taught behavioral expectations for school or because kids are acting out due to trauma and other psychoemotional problems that they are unprepared to cope with. In my experience, teacher-prep programs have done little to nothing to prepare new teachers for how to manage a classroom where kids are daily trying to cope with such challenges. (For the record, the first five years of my career were spent in a special-ed school in Baltimore for boys with emotional disabilities, so I know what extreme behavior looks like … and my teacher-prep program spent one week in one class addressing classroom management, never addressing significant behavior issues that you most likely will encounter in the classroom. While my first school had major shortcomings, I am extremely grateful that it did offer me the training I needed to be effective with the most challenged and challenging kids. I hope your program serves you better than mine did but if not, I’m happy to share resources.)

Again, the impact this would have on your as a professional depends on your district. I am lucky to work in a district that prioritizes education, so even though my school had the highest eligibility for free and reduced meals in the state last year, you would not know it from looking at my school, which does a commendable job of extending the same opportunities to our students as would a school serving a middle-class community. Most of the enrichment and social services we provide is funded through our school budget or grant money. Sadly, this is not the case for most schools in the U.S. that serve low-income populations, which is why you often hear of teachers coming out of their pockets not only for their classroom supplies but for food and clothing for their students who would otherwise go without.

Part of my anger is because of this: because how have we failed as a nation if we cannot protect the basic needs and safety of children? Yet I have had children in my care for every moment of my career who have faced hardships that would have been the end of me.

And some of the anger you sensed is because one of the other realities of our profession that no one talks about in your teacher-prep classes is how despised our profession has become–and routinely and casually so–due to right-wing slander against educators. And for whatever reason, this rhetoric has been picked up by people across the political spectrum. This is Tumblr, so I’d be willing to wager that most of the people in the original thread I was responding to would identify with the left politically, yet are fully comfortable making claims that public educators medicate kids because they’re too lazy to deal with developmentally normal behaviors. Likewise, I have had progressive friends make disparaging comments about educators directly to me, thinking nothing of it because it’s become so commonplace to assume that teachers are stupid, incompetent, and lazy that they don’t even stop to think about what they’re saying long enough to consider their audience. (To wit, the saying “If you can’t do, teach,” which an online friend–again, an outspoken progressive–actually wrote to me when congratulating me for completing my certification, apparently never stopping to consider that I might find that sentiment insulting.) But, as I noted in my post last night, we are one of the only professions remaining with strong union membership, and this makes us a threat to big-money interests that would like to skim out of our pockets in the same way they have the U.S. people as a whole and are fighting with every ounce of their being to privatize and profit from the public right to a free and appropriate education for every child in the U.S. In addition, as I noted in the tags, we are the ones teaching kids inconvenient facts about their legal rights and democratic ideals and some of the less-rosy chapters of our nation’s history, which makes us a threat to certain groups who would far prefer an ignorant, frightened populace.

Anyway, as I noted at the beginning, I would not choose to do any other work, despite the frustrations and challenges. At the core of what I believe is the potential of all human beings to influence our world for the better, no matter the color of their skin or their gender identity or the amount of money in their parents’ bank accounts when they’re born, and so I feel compelled to do this work, to put my talents and energy to offering a leg up to kids who might otherwise slip through the cracks.

If I could offer advice to a teacher-in-training, it would be this: First of all, be aware and evaluative of the amount of training your are receiving in classroom management. I can’t speak for every teacher-prep program, but the ones I’m familiar with spend very little time on this even though classroom management is the top concern of new teachers and, in my experience, the biggest reason why new teachers leave the field. Although I know that adding one more thing is probably like adding gasoline to a wildfire at this point in your career, it really is worth pursuing information on this on your own, if your program is not meeting your needs. It will make your first job so much easier (and make you so much more confident to be able to handle the challenges I described–and projecting confidence is itself a good classroom management strategy, especially if you work with older kids). As I said, I’m happy to share resources. If you have a mentor, they can help here as well.

If at all possible, student-teach in a school that is similar to the schools where you think you’ll eventually work. Another shortcoming I find with the teacher-prep programs I’m familiar with is that they stick their student teachers into the cushiest, easiest middle-class schools before casting them into a job market where they will likely start in a low-income, high-need school with significant challenges.

Talk to teachers in districts and schools where you’re considering working and find out what the strengths and challenges are. What support do they offer new teachers? (Ideally, you’ll get a mentor for at least your first year.) How much support do they offer their teachers in general? Does the administration have your back, or are they going to abandon you the moment the going gets tough? How much control will you retain over what and how you teach? Classroom management? You should be able to make adjustments to meet your students’ needs and interests; this is best practice, and if a district or school is doing otherwise, run. Does the school/district favor a positive or punitive approach to classroom management? What does the district/school see as their priorities? (Growing the whole child or raising test scores? Relationships or rigor?) How much pressure is put on teachers around test scores? How will you be evaluated and what is the philosophy around evaluation? (Assuming everyone can always grow and improve or using evaluations to punish shortcomings and mistakes?) How supportive is the administration in terms of maintaining a healthy work-life balance? What resources will you be given? Will you have a budget for supplies? How much? Are the books, resources, and technology up to date? (Is there even technology? What is the ratio of students to devices actually available to use?) What opportunities are available in the school day for the arts? Do students have access to unstructured play and social time during the day? What resources does the school offer for kids and families in need of additional social services? Are there meals available for food-insecure kids? Counseling and mental health services? After-school programs? Or will you be buying breakfast every day for your homeroom rather than imagining them struggling through their morning on empty stomachs? Asking teachers and not administrators will help get some honest answers to these questions.

And please feel free to reach out to me at any time (and this goes for anyone thinking about or starting a teaching career!). I’m a mentor in my district and so trained to coach new teachers, and if I can offer any tips or resources then I’m happy to do so.

[jasoningram]

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[type2diabetestreatments-blog]

Josh Makower, Stanford Biodesign, on Medical Innovation and What's Wrong with the FDA

New Post has been published on http://type2diabetestreatment.net/diabetes-mellitus/josh-makower-stanford-biodesign-on-medical-innovation-and-whats-wrong-with-the-fda/

Josh Makower, Stanford Biodesign, on Medical Innovation and What's Wrong with the FDA

Dr. Josh Makower is Co-founder of Stanford's Biodesign Innovation Program, and a Consulting Associate Professor of Medicine at the Stanford University Medical School. He's also Founder and Chief Executive Officer of ExploraMed, a medical device incubator. And he's a Venture Partner with New Enterprise Associates, where he supports the investing activity in new medical devices.

In short, Dr. Makower is a world authority on med-tech innovation. I bumped into him while beginning preparations for the 2011 DiabetesMine Design Challenge. He was kind enough to share his insights on some of the hottest issues in this arena today: FDA's apparent quashing of medical innovation, the American healthcare mess, and how patients are really and truly being integrated into the design process, at last:

On policy...

DBMine) Dr. Makower, the recent editorial Chicago Tribune editorial ("Is FDA sucking the life out of life-saving innovation?") cited your work, noting that "the current regulatory environment is putting our nation's fragile medical innovation infrastructure at risk." Can you tell us in laymen's terms what's going on?

JM) The overwhelming majority of medical technology innovation is found in small and mid-sized companies. Their lifeblood is the angel and VC communities that help fund their work, as they have no revenue while they are in the development stages. When an environment exists where it takes longer and longer to gain market approval by regulators, more and more investors are walking away from this innovative field. In essence, the oxygen is being sucked out of the room for many of the innovators and entrepreneurs we are relying on for tomorrow's devices and technologies. It truly is a very precarious time, but it is not too late to address these challenges.

The editorial also said "FDA and industry must work together towards a reasonable and balanced regulatory process for new innovations." How would you define a "reasonable and balanced process" here?

In order for innovation and patient care to thrive, there needs to be reasonable, and perhaps most importantly, predictable expectations. Much of this can be addressed up front. When manufacturers and regulators begin discussions on what a 510(k) submission's endpoints are, it is important that these milestones are well thought out, and then, adhered to. When the goal posts are moving and there isn't certainty as to whether or not the benchmarks will be constant, this can wreak havoc on the ability of innovators to meet metrics. When this happens, everyone loses.

You've stated, "panels that advise the FDA are full of scientists with all sorts of conflicts of interests." But you've also said, "Money is not the biggest driver of behavior." So what do you think is driving behavior at the health policy level?

I think often we tend to address short term concerns without fully realizing the long term consequences. The practice of medicine -- as well as the development of the products used in it -- is constantly changing and improving. While we always strive for perfection, we simultaneously learn how deliver better care, and safer products. My concern is that an environment where there is less tolerance for risk and a greater demand for clinical data — which often provides little if any more value -- is reacting to isolated stories and misconceptions in the med-tech field. We need to change some of the mindset for both innovators and regulators, and it is crucial that we work together and communicate so we can achieve our common goals: improved patient care and innovation.

Regarding the national healthcare mess - You've put the spotlight on WellPoint as being the quintessential health payor Bad Guy because they have "too powerful grip on what gets paid for." Why them? And how can one organization wield so much power?

I used that company as an example, but of course they are not the only ones. The issue today is that several large organizations like them control much of which procedures and technologies are deemed to be worthy of coverage and payment. Many of these organizations have created exceptionally difficult pathways for new technologies and procedures, often only yielding when the outcry from doctors and patients reaches a crescendo. Many also have established policies making it impossible for medical technology innovators to appeal decisions or meet with key officials. Since they often have a captive set of lives they cover, it is very difficult for patients to change plans or go to other carriers that offer certain new procedures and technologies; thus, they do not truly need to be very responsive. I think this illustrates the challenges we have in this area.

How will the proposed medical device tax impact patients like us? (i.e. people living active but expensive lives with manageable chronic illnesses?)

My greatest concern is that patients miss out on advancements that would continue to improve their quality of life, and in the long run reduce health costs. Over the years, life expectancy has greatly increased, and the average hospital stays continue to drop. This is a win-win scenario for patients, and in no small part due to medical technology. The device tax, as it is currently structured, will tax any and all revenue, regardless of whether or not a business is profitable. The fact is that almost all start-ups and novel businesses are not profitable for years, so this tax could force them to shut their doors. We have time to work on this issue as it is not imposed until 2013, and it is my hope that we can at a minimum recognize that small and mid-sized companies -- where the overwhelming majority of innovation takes place -- can be exempted from this provision.

On His Work...

What exactly are you and your colleagues doing to lobby the FDA to change their approach to medical innovation?

The truth is that the medical technology field is a very complex profession, and elected officials and policy makers often don't realize the myriad of steps it takes to get a product into the marketplace. There are reimbursement challenges, patent disputes, and many other issues that confront our industry. We are working to help educate the FDA and others about the real-world ramifications their decisions have on innovation and patient care. We've met with them in person as they visit regions throughout the country with a strong med-tech presence. it's one thing to discuss issues in Washington, but it certainly helps to put a face on these challenges, and show them just how complicated it has become. In the end, we all want safe and innovative products in the marketplace, the question is how we can work better together to recognize our respective challenges.

At the Stanford BioDesign Innovation Program, which you co-founded, what would you say are the key principles students learn about medical innovation?

The fundamental principle behind the biodesign innovation program is that innovation is a process which can be reproducible and can be learned and taught. Given the high stakes of medical technology innovation, it's exceptionally important to try to master the process, and perhaps avoid many of the common pitfalls.

What are some of the typical pitfalls in medical device design?

A few common pitfalls are: 1) to be so excited about solving a big problem that one leaps at the first good solution that presents itself, rather than systematically continuing to generate ideas and choosing the one that fits the need criteria the best, or 2) to not consider all the possible downstream challenges with respect to clinical or reimbursement path and if only some minor changes were made, an easier path forward might have been possible.

How are real-world patient needs being integrated into the design process?

The process starts and ends with patients — not technologies. We teach the students that one must focus on the patient and their needs first and foremost to truly understand what is required to help them before thinking about any technologies or solutions. To us, the patients teach us, not the other way around — they are everything.

Here's what we do: With all the appropriate HIPPA training for all involved and with the consent from the patient, we go into the operating room, into the clinic, into the office, and sometimes even into patients' homes to try to understand their problems better. I'm not much of a fan of focus groups or online surveys to get into patient's needs, but I will do it on rare occasion when reaching the patient directly is too difficult or I am looking for confirmation of an issue more broadly.

At your innovation incubator company ExploraMed, the stated mission is "to significantly improve the quality of life for patients through fresh paradigms which create value for our customers and shareholders." If someone comes forward with a new medtech idea, how do you determine if it constitutes a "fresh paradigm"?

I often find that too much dogma is integrated into the way we think as physicians. We accept too many things as 'the way things are done' or the 'way we were trained.' I really enjoy opportunities to take this mind-set apart and offer solutions that are unexpected and have the potential to deliver patient outcomes that were never anticipated. When this happens, it usually represents a new paradigm... a new base for thinking about how we approach treating an important disease or condition.

Specific to diabetes, what do you see as the Next Big Thing?

If we can fix the problems we're having bringing new therapies to market, I have a feeling we will have a chance to see a complete change in the way we treat diabetes in our lifetime. I believe some of these new device solutions that target unexpected metabolic pathways are the beginning of some of this change, and every success there will bring new insights and urge innovators forward.

Finally: I'm hoping you've seen our innovation competition called the DiabetesMine Design Challenge. Any thoughts on this effort to encourage fresh thinking in medical innovation?

I think it's great! Keep up the good work. Every little bit helps.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

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