Unit 12 - The Role Model of Physicians as Medical Humanists. The Case of Gr. T. Popa

University of Medicine and Pharmacy “Grigore T. Popa”, Iași, Romania

This work is licensed under a Creative Commons Attribution - Non-commercial 4.0 International Grigore T. Popa, world famous Romanian physician and writer, in images

1. Grigore T. Popa’s general considerations on pre- and post-WWII medicine in Romania. Available from: 2. Letter from George E. Palade, M.D. to Prof. C.D. Zeletin on the initiatives to honour the memory of Grigore T. Popa. Available from: 3. Grigore T. Popa’s certificate of membership to Sigma Xi honor society in Chicago. Available from:

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• Two-fold approach (The relevance of world famous Romanian physicians and writers for the medical profession - the case of Grigore T. Popa).

• Learning objects strategy, i.e., reading & case scenario (PhD thesis abstract, research articles, videos, interviews) to help learners develop an understanding of medical research and thought, and also create the abilities needed to compare famous role models in medicine.

1. Reading, divided into three sub-topics: Grigore T. Popa – the man and his literary work, medical research, and bioethical concerns. 2. Case study - a physician’s own account of his professional/medical development. 3. Videos - testimonials of Grigore T. Popa as a role model for a disciple and a family member, and a review of his diary during the American experience.

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• Description: Grigore T. Popa’s life philosophy: his belief that everyone’s life has something to offer to others and that one’s work and life are inseparable should serve as inspiration to all students for their personal development;

• This leads to a discussion about the international importance of physician-writers as symbols of the doctor-scholar as well as the anticipatory nature of Grigore T. Popa’s activity for the field of Medical Humanities.

• Popa’s human, literary and medical qualities were acknowledged by important Romanian critics, peers, and by international specialists; he opposed the oppressive communist regime in Romania, whose consequences were felt in clinical practice, bioethics, social medical sciences, restricted communication between doctor and patient, doctor and official bodies;

• Popa’s medical research is rendered differently in the reading from the case scenario; the former highlights the Romanian physician’s contributions to medicine from an academic viewpoint, often supported by colleagues from the country or abroad; the case scenario provides Popa’s own account as recorded in his memoirs.

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• From a didactic perspective, this should help learners become familiar with salient aspects of communication between medical researchers and their advisors, particularly in their early career, and also get hands-on medical knowledge.

• Comparison between Grigore T. Popa’s findings (e.g., the vascular link between the hypothalamus and the pituitary gland) and the research conducted by George Emil Palade in cell biology (1974 Nobel Prize winner in Physiology and Medicine for the discovery of the ribosomes of the endoplasmic reticulum) to encourage learners to analyze the situation in their own countries and worldwide with respect to medical role models.

• Popa’s bioethical contributions as outlined in the reading (a holistic vision of the world and man, an anthropocentric vitalism in opposition to materialism) to help students cope with current problems of humanity and design scenarios to manage them.

This work is licensed under a Creative Commons Attribution - Non-commercial 4.0 International Information for lecturers (3) • Video 1 - the review of Jurnalul unui savant român în America (2014) by Romanian literary critic Dan C. Mihăilescu; Grigore T. Popa’s diary covering his research stay at the Rockefeller Foundation in New York and Chicago between 1925-1926, which is discussed in five minutes during the cultural programme Cartea de la ora 5 (The 5 o’clock book), gives learners the possibility to contrast the situation of medical development in America to that of their home countries and other geographical spaces from such multiple viewpoints as the cult of competition and performance, meritocracy, democracy, efficiency, freedom as self-fulfillment, civic spirit, public libraries, the social function of wealth etc. (http://www.carteadelaora5.ro/ep-232-grigore-t-popa-jurnalul-unui-savant-roman-america-editura-filos/ )

• Video 2 - Grigore T. Popa’s great granddaughter, Maya Catherine Popa, teacher and writer in New York City, is seen reciting her poem, A Technique for Operating on the Past, inspired by her great grandfather. This literary piece is an opportunity for learners to reflect on a family role model that inspired them and also enrich their medical communication skills by sharing their thoughts. (https://www.youtube.com/watch?v=qsRCe1rlpu0)

• Video 3 - an interview with Prof. Mircea Rusu, Grigore T. Popa’s student and disciple, founder of the discipline of orthodontics and periodontology at the University of Medicine and Pharmacy Iasi and a pioneer of pediatric dentistry in Romania. Speaking about the magazine Însemnări ieșene, which he had co-founded together with Popa, Prof. Rusu pays homage to his former professor, which is a good opportunity for learners to assess the impact of an inspiring mentor in academia and in medical institutions, and also hypothesize on the necessary qualities of such a personality. • (https://www.youtube.com/watch?v=JlObbEAQL9o&t=32s)

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 Describing what the learner will be able to do upon completion of this educational activity

 Outline the learners’ knowledge, skills and/or attitudes

 Specify the measurable way in which performance and change can be assessed based on Bloom’s taxinomy: cognitive (knowing), psychomotor (doing: skill) and affective (attitude) domains – The cognitive domain: 6 levels-recall or recognition of facts (knowledge), increasingly to more complex and abstract mental levels, to the highest order (evaluation). – Five elements: who, will do, how much or how well, of what, by when are included – Examples of action verbs that represent each of the six cognitive levels, from lowest to highest

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• Knowledge: define, list, name, order, recognize, recall, label

• Comprehension: classify, describe, discuss, explain, identify, locate, report, review

• Application: apply, choose, demonstrate, illustrate, practice, solve, use

• Analysis: analyse, appraise, calculate, compare/contrast, differentiate, diagram

• Synthesis: arrange, assemble, construct, design, formulate, prepare, write

• Evaluation: assess, argue, judge, predict, rate, evaluate, score, choose

• Example of a SMART objective for this unit: “Upon completion of this unit, participants should be able to assess the importance of reputed Romanian physicians such as Grigore T. Popa for the development of medicine worldwide.”

This work is licensed under a Creative Commons Attribution - Non-commercial 4.0 International Learning objectives (2) The participants will be able to:

a) Recognize and list a minimum of five challenges mentioned in the case study, the reading and the filmed testimonial;

b) Describe and report solutions to the challenges based on both the available resources and on personal medical practice / personal research;

c) Analyse own work context and choose one main challenge and propose a solution to it;

d) Appraise the current status of Grigore T. Popa’s scientific discoveries in various medical sub-fields as seen in their own medical institution and formulate a short critical diagram of the difficulties identified, if any;

e) Predict the likely solutions to potential problems over the next 5 years in relation to the issues in point d).

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Other generic learning objectives, as detailed in the literature (Kirkpatrick,1998; Barr et al.,2000):

• Encourage learners’ participation and motivation for learning;

• Contribute to changing participants’ attitudes or any bias towards the medical progress generated by reputed Romanian physicians (see the YouTube links for a learning object focusing on both testimonials of relatives or disciples whom Popa inspired, and on reviews of his literary work which dwell on the life philosophy that helps doctors in their career);

• Contribute to changing learners’ behaviour so as to ensure ready transfer of what they have acquired to the (medical) workplace;

• Stimulate participants’ proactive attitude with a view to formulating practical solutions to the needs highlighted in the reading/case scenario/YouTube links, or identified by participants in their own life or in medical institutions;

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• Differentiate among new concepts according to which medicine has evolved in time due to the contribution (including procedures and principles) of Romanian physicians;

• Exercise and practise social skills, cognitive thinking and problem-solving skills as assets for a medical doctor via the reading/case scenario/YouTube testimonials;

• Stimulate a positive attitude to change in organizational practice for healthcare institutions and highlight mistakes to be avoided (with a focus on equal opportunity policies to avoid discrimination of outstanding professionals based on employers’ ideology or perpetuated by a totalitarian state, as was the case of the Romanian communist regime);

• Identify positive role models and good medical practices of the predecessors that are beneficial to patients and their well-being (mobilities abroad, continuing professional development etc.)

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• Strategy used: learning objects strategy • Characteristics: reusability, granularity and ability to form new learning - resource conglomerates depending on the learning objective of the unit • Suitable for preclinical and clinical training as part of a blended learning strategy • Learning objects strategy: units of learning are smaller in size (2-15 minutes)

Added value • Medical education becomes more efficient • The approach encourages accountability, outcomes, and competence-based learning • Unlimited number of learners in various locations since it can be accessed on demand

This work is licensed under a Creative Commons Attribution - Non-commercial 4.0 International Teaching methodology (principles, methods and strategies) The main learning principles: • Students’ prior knowledge is activated • Learning objects aim at creating new medical knowledge and modify older concepts  conceptual change via expert role models • The authenticity part is highlighted; • Includes collaborative teaching and learning by supporting teacher-learner(s) and learner-learner collaboration, and co- creation of knowledge; • Stimulates critical thinking, problem solving, and analogical reasoning • Meets the needs of all types of learners

Teaching strategies include visualization • Learning objects can be used creatively by each lecturer • They encourage inquiry-based instruction and reflection • Formative and summative evaluation questionnaires invite reflection and problem solving, and also applying the information in new contexts

This work is licensed under a Creative Commons Attribution - Non-commercial 4.0 International Information for students (1) By the end of the unit, students will have knowledge of and be able to discuss:

• A range of aspects related to the activity of reputed Romanian physicians-writers, such as Grigore T.Popa, which will give students a better understanding of the evolution of the concepts of clinical practice, medical ethics, medical social sciences and doctor-patient communication; • Major developments in medical sub-fields (e.g. neuroanatomy, bioethics) and cultural thought generated by Romanian physicians-writers; • Issues that have a direct bearing on medical researchers (working in the laboratory), communication barriers included; • The important role that physician-writers played in outlining a holistic approach to medical science; • Factors that contribute to the training of (Romanian) physicians, both internal (willingness to succeed, taking risks and making sacrifices) and external (research stays abroad).

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By means of the learning objects in the unit and upon completion of the stated learning objectives, students will be able to:

• Come up with solutions to existing problems that have a bearing on Romanian medical researchers in our days;

• Put their medical and cultural learning to good use in their clinical practice by following the example of famous predecessors trained abroad (e.g. Romanian physician and writer Grigore T.Popa) and avoiding the perils of a flawed ideology. i.e., one that encourages discrimination and racism;

• Show proper behaviour as part of medical ethics and treat peers, superiors and patients with respect and consideration;

• Appraise the impact of medical social sciences on their career and give proof of quality doctor-patient communication.

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5 open-ended questions related to the unit to test students’ acquired knowledge at the end of the lecturing phase.

What are the factors that contributed to the developments in medicine reputed Romanian Question 1 physicians and writers are credited with? What impact did Grigore T.Popa’s neuroanatomical discoveries have on the progress of medicine Question 2 worldwide? How can the bioethical issues Grigore T.Popa addressed help us to cope with some of the current Question 3 problems of humanity? How can a physician’s preoccupations as a fiction writer, journalist and translator contribute to Question 4 his/her professional and personal development? What solutions could be adopted to further improve medical research in Romania and avoid Question 5 ideology-based discrimination?

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Question n. 1 Name two great Romanian physicians, excepting Grigore T.Popa, who contributed to the progress of medicine worldwide. They are mentioned in the reading and also present in the photos. C.D. Zeletin Yes/ True George E. Palade Yes/ True Eugen Târcoveanu No/ False Question n. 2 Explain why Grigore T.Popa’s bioethical concept of ……………… is essential for major issues we face nowadays, viz. dealing with technology beyond our control and man gradually turning into a cyborg: anthropotechnics Yes/ True vitalism No/ False Question n. 3 Illustrate how Grigore T.Popa’s activity as a physician-writer is relevant to the field of Medical Humanities as well as being a reflection of... Renaissance humanism Yes/ True European ideals No/ False a good doctor No/ False Question n. 4

Identify Grigore T.Popa’s main contributions to the field of neuroanatomy. The endoplasmic reticulum (ER) No/ False Cerebro-stimuline Yes/ True A system of vessels between the hypothalamus and the pituitary Yes/ True gland (with Una Fielding) Question n. 5 Choose the other fields in which Grigore T.Popa distinguished himself: journalism Yes/ True translation This workYes/ True is licensed under a Creative Commons film AttributionNo/ False - Non-commercial 4.0 International Summative Evaluation Questionnaire

Question n. 6 Drawing on Dan C. Mihăilescu’s review (included in the learning object as a YouTube link), formulate a hypothesis as to how any medical professional could realize their full potential, just as Popa did during his stay in the US, by means of: Corruption and dolce far niente No/ False “Help me to help you” approach Yes/ True

People being encouraged to make the best of every opportunity Yes/ True

Question n. 7 Predict other obstacles that are likely to prevent medical scientists from conducting research, in addition to those encountered by Romanian physician and writer Grigore T.Popa, as mentioned in the case scenario: A beginner’s insufficient knowledge Yes/ True Poor funding No/ False Imperfect techniques Yes/ True Question n. 8

Design a scenario meant to solve the problems of population overgrowth on our planet without resorting to racist solutions such as …………. mentioned in the reading.

Human extermination Yes/ True Practices against life Yes/ True Celibacy No/ False Question n. 9

Based on Prof. Mircea Rusu’s testimonial about Grigore T.Popa (YouTube link), evaluate the impact of an academic role model on medical students by considering the following factors:

Knowing how to make anatomy attractive Yes/ True Being patronizing and acting as if you knew everything No/ False Showing care and respect for students Yes/ True Question n. 10

Based on Maya Catherine Popa’s poem (YouTube link), write a 4-line poem to appraise Romanian physician and writer Grigore T.Popa’s great achievements, including ………. :

His great ability for brain study Yes/ True His personality as a close reader and musician ThisYes/ workTrue is licensed under a Creative Commons His great love for country AttributionNo/ False - Non-commercial 4.0 International References • Barr, H., Freeth, D., Hammick, M., Koppel, I. & Reeves, S. (2000) Evaluations of Interprofessional Education: A United Kingdom Review of Health and Social Care (London, CAIPE/BERA) • Chiappe, Andres.; Segovia, Yasbley; Rincon, Yadira (2007), Educational Technology Research and Development, Boston: Springer, pp. 671-681, (http://andreschiappe.blogspot.com.au/2007/09/que-es-un-objeto-de-aprendizaje-what-is.html) • Constantinescu R., Despre contribuțiile lui Grigore T. Popa în neuroanatomie (fragmente), pp. 1-16. • Constantinescu R., Gr. T. Popa – Doctor Writer and Journalist, PhD thesis abstract, scientific advisor prof. Carmen Elena Cotrutz, PhD, University of Medicine and Pharmacy “Gr. T. Popa”, Iași, 2011. • Constantinescu R., Inception of Bioethics in the Late Works of Grigore T. Popa. Editorial. Romanian Journal of Bioethics, Vol. 8, No. 4, October – December 2010. • Constantinescu R., Despre contribuțiile lui Grigore T. Popa în neuroanatomie (fragmente), pp. 1-16. • Cushing, H., Posterior Pituitary Activity from an Anatomical Standpoint, Am J Pathol. 1933 Sep; 9(5): 539-548.19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2063420/ • Gregor T. Popa and Florica Popa, The Influence of the Sympathetic on the Pigeon’s Wing. Journal of Anatomy, Vol. LXV, Part 4, pp. 407-410.

This work is licensed under a Creative Commons Attribution - Non-commercial 4.0 International References

• Gregor T. Popa and Eug. Lucinescu, The Mechanostructure of the Pericardium, J Anat. 1932 Oct; 67(Pt 1): 78–107. Avaiable from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1248960/ • Kirkpatrick, D. (1998) Evaluating Training Programs, 2nd ed. (San Francisco, Berrett-Koehler Publishers) • Learning Technology Standards Committee (2002), Draft Standard for Learning Object Metadata. IEEE Standard 1484.12.1, New York: Institute of Electrical and Electronics Engineers. • Liisa Ilomäki (ed.), Tomi Jaakkola, Minna Lakkala, Lassi Nirhamo, Sami Nurmi, Sami Paavola, Marjaana Rahikainen & Erno Lehtinen (2003) Principles, models and examples for designing learning objects (LOs), A working paper for EU-funded CELEBRATE-project. Available from: www.helsinki.fi/science/networkedlearning/texts/principlesforlos.pdf • Mihăilescu, Dan C., review of Gr. T. Popa’s Jurnalul unui savant român în America http://www.carteadelaora5.ro/ep-232- grigore-t-popa-jurnalul-unui-savant-roman-america-editura-filos/ • Popa, Maya Catherine, Operating on a Technique from the Past, https://www.youtube.com/watch?v=qsRCe1rlpu0 • Rehak, Daniel R.; Mason, Robin (2003), "Engaging with the Learning Object Economy", in Littlejohn, Allison, Reusing Online Resources: A Sustainable Approach to E-Learning, London: Kogan Page, pp. 22-30. • Wiley, David A. (2000), "Connecting Learning Objects to Instructional Design Theory: A Definition, A Metaphor, and A Taxonomy", in Wiley, David A. (DOC), The Instructional Use of Learning Objects: Online Version. • Rusu, Mircea , interview on Gr. T. Popa and the literary magazine Însemnări ieșene, https://www.youtube.com/watch?v=JlObbEAQL9o&t=32s

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