Category Archives: teaching

Medical Leadership Course

medical leadership seriesflyer copy

This post is half professional, half confessional. But it concerns the critical limits of professionalism, so let’s call the style apposite.

Over the past year, I’ve been helping to run the medical humanities minor at Rice, out of the HRC. I was also diagnosed with Langerhans histiocytosis, and had a skull tumor removed. It’s commonly observed that academic research is always autobiographical, but in this case it was my life that started to imitate a research agenda!

As a result of this biographical/biological turn, my teaching in this area took on a more practical edge. And when I was asked to teach a course on medical leadership (HURC 306, Spring ’17), I realized that this was an important opportunity to explore how these institutions got to be the way they are (mostly, big and technologically-intensive), and what that has meant for American medicine.

The HRC and the Doerr Institute for New Leaders generously contributed funds to bring in a series of speakers (including Steven Schroeder, the former CEO of the Robert Wood Johnson Foundation, and Ann Robison, the head of the Montrose Center), and to fund undergraduate summer research this year.

In two weeks, my students from 306 will be presenting their final research projects; and so at this transition between phases of our medical leadership project, I’m going to share some remarks I made back in February on the question, at a welcome reception to grant winners hosted by the Doerr Center. Comments/feedback appreciated, as always.

What is “Medical Leadership,” and Why do We Want It

The Urban Institute projects that the congressional bill currently proposed for passage through the budget reconciliation process will eliminate the individual insurance market and gut Medicare and Medicaid, leaving 30 million more people uninsured by 2019, with 82% of these people being in working households (coverage rates will be lower than before the ACA). This is a dangerous situation for the professional identity of all healthcare workers, and those of us who depend on a functioning healthcare system. If medicine comes to be seen a luxury good available only to the relatively well-off or the desperately poor, then doctors cannot assume the survival of their cultural authority, and the relative professional autonomy that comes with it – and at that point, patients won’t really be able to depend on the honest impartiality of their doctors.

It’s at times like these, when we have lost our compass completely, that we end up calling for leaders. That’s the argument with which John Gardner, former Secretary of the Department of Health, Education, and Welfare under Lyndon Johnson, begins his 1990 monograph On Leadership. Of course, he makes his argument in stereotypically liberal fashion, by attacking his central theme. When people cry out for leadership, he says, that’s not exactly what they want:

Why do we not have better leadership? The question is asked over and over. We complain, express our disappointment, often our outrage; but no answer emerges.

When we ask a question countless times and arrive at no answer, it is possible that we are asking the wrong question–or that we have misconceived the terms of the query. Another possibility is that it is not a question at all but simply convenient shorthand to express deep and complex anxieties. It would strike most of our contemporaries as old-fashioned to cry out, “What shall we do to be saved?” And it would be time-consuming to express fully our concerns about the social disintegration, the moral disorientation, and the spinning compass needle of our time. So we cry out for leadership.

Seriously. Those are the first two paragraphs of his book on leadership. Gardner is telling us that when we ask for leaders, it’s usually not because we’ve lost our sense of how to do some important task, but rather that we’ve lost our bearings completely, and have no idea what is important and what is not.

That is essentially what happened in the field of medicine in the 1980’s, when doctors came to realize that the for-profit medical industry that they had helped to build was posing a direct challenge to their professional autonomy. Lots of us experience anomie and directionlessness in late capitalistic society, as Gardner was pointing out; but as the authors of a 1988 paper for the Journal of the American Medical Association point out,

… the physician-organization conflict is different than generic personal-organizational conflict when considering professional autonomy. Organizational intensity threatens physicians’ ability to remain independent.

In other words, institutional life threatens the core of doctors’ professional identities, by forcing them to bring their primary value, the maximization of the patient’s quality of care, into direct contact with a directly contrary value: efficiency. Asking doctors to care less is like asking teachers to teach less; and asking them to do so for the benefit of a corporation’s profits was, at the time, professional anathema.

Our 1988 authors ended their essay by imploring physicians to actively engage with the changing environment:

Medical practice in the future will demand more management-related responsibilities…. [P]hysicians need to adopt a prudent perspective about representation in organizational governance and management issues. This is an immensely important issue for all physicians to resolve personally.

In other words, if you don’t shape corporate medicine to reflect your professional values, your profession will be shaped to reflect the valuation of for-profit corporations.

The topic of leadership therefore ends up being a fascinating pivot on which turn the conflicts of medical professionalism in a hyper-industrialized society. Medicine, like teaching, still retains an aura of a higher calling in a secular society — we can at least say that it allows space to articulate value sets not immediately reducible to profit. And so medicine is not just a useful case study in what happens to professional values in the institutionalization process, but an opening for talking about how we articulate and come to share values at all, in a society made up of large and powerful institutions.

That process, of articulating, debating, and democratically committing to a shared value set, is both possible and necessary for corporate medicine (and nearly all medicine is corporate today). Peter Drucker, the grandfather of management theory, in 1946 articulated corporations as mission-driven (rather than profit-driven) institutions. In quoting this, I am borrowing from Deak Nabers at Brown University.

Any social and political analysis of an institution has to proceed on three levels.

It has to look at the institution as autonomous … capable to be judged in terms of its own purpose.

Every institution has to be analyzed in terms of the beliefs and promises of the society which it serves. …

It has to analyze the institution in its relationship to the functional requirements of the soiety of which the institution is a part….

Values are what hold institutions together. And without a clear value set and a commitment to these values, a profession or even an industry can quickly lose the public’s good favor and be delegitimized.

Dr. Melissa Bailar and I applied for a grant from the Doerr Institute in order to promote student research in this critical area, in part as a supplement to the 300-level Medical Leadership course I am teaching this semester through the new medical humanities minor. In its first stage, the grant allows us to bring medical leaders with a variety of different perspectives to campus, to speak to and run workshops with our medical humanities and broader premed community. These speakers will share their diverse experiences in leadership roles and in studying leaders in the medical field to give students and the community a rich historical context for understanding how individuals and groups have stepped up to shape the medical profession in times of crisis before; how they have found their calling, how they have gathered groups around shared values, and how they have mobilized for change.

Our speaker list includes scholars, executives, and a manager, all of them advocates and leaders for what healthcare is supposed to be and how we can get there, and all of them students, as well, in how we came to be in this situation:

“On Leadership” (talk + workshops): Tacey Rosolowski Ph.D., Oral History Project, MD Anderson Cancer Center.

“Professionalizing Medicine: Oslerianism and Medical Education Reform”: Bryant Boutwell, Dr. P. H., Special Advisor to the President, John P. McGovern Professor of Oslerian Medicine, Distinguished Teaching Professor, UT System.

“Advocate Leaders”: Ann J. Robison, MPH, Ph.D., Executive Director of the Montrose Center.

“Institutional Reformers”: Steven Schroeder, MD, Professor, Department of Medicine; and Director, Smoking Cessation Leadership Center, UCSF; former President and CEO of the Robert Wood Johnson Foundation.

“Patient Advocacy”: Renata Domatti, LMSW, CCM, Lead Case Manager at Cornerstone Hospital of Austin.

In the project’s second stage, we will competitively fund 3 undergraduate students to work over the summer on their own research projects, learning about medical leadership in present-day Houston institutions and making recommendations for these institutions on the basis of their months-long work.

Our goal, at this critical moment for healthcare (which has been decades in the making), is to empower students and Houston communities to imagine a more just and effective healthcare system that reflects shared values — and this involves opening up the space in which people can have the necessary debates over these values. It is our hope that this course, lecture series, and independent research opportunities will become a fixture in Rice’s medical humanities programming, and in Rice’s connections with local healthcare institutions.

Singing Shelley

Paula Feldman has recently pushed discussions about the musicality of Romantic poetry into a consideration of the movement’s actual music. As I understand it, her project, Romantic-Era Lyrics, attempts to bring contemporary sheet music renderings of the period’s poetry to life, by making these accessible as a database and providing some actual recorded performances.

One of my students this semester, Molly Mohr, was very interested in the musicality of the poetry we had been reading. She was also a member of a talented group in Rice’s vibrant a capella scene. Molly used her final project to bring her artistic skills to bear on the material we had been working with. Choosing two poems by Percy Shelley and their 1903 arrangement by Colin McAlpin, she arranged these as a capella numbers and performed each twice: once solo, and once as a duet.

The performances are beautiful, but in my opinion the most important part of Molly’s project was her critical reflection on how the arrangement and singing of these poems productively interfered with her readings of them. Molly has been kind enough to share these recordings; I’ll present them below with her readings of each.

In another post, I said that experimental practical work is complementary to critical work when students feel empowered in relation to the cultural artifacts they’re working with. I think Molly’s work is a great example of this.

Everything below is from Molly’s artist statement! There is a link below each song to the pdf of the scored music.

1. “Widow Bird”

McAlpin’s composition really highlights the stressed and unstressed syllables of Shelley’s poem. In 4/4 music, the emphasis usually falls on the first and third beats of each measure, and the stressed syllables in Shelley’s poem mostly match up with these stressed musical beats. For example, in measures 1-2, the lyrics say “A widow bird sat” (the bold syllables are the ones stressed in Shelley’s poem). Accordingly, “wi” and “bird” fall on the first and third beats of the measure, which emphasizes those syllables just as Shelley does in his poem. McAlpin repeats this method throughout a lot of the song – for another example, look at measure 18: “flow’r upon the.” Similarly, McAlpin uses dotted quarter notes and eighth notes to further emphasize Shelley’s stressed syllables. For instance, in measure twelve, the notes in “stream below” emphasize “stream” because the word falls on a dotted quarter note, which is held longer than the quickly following eighth note. The eighth note with the first syllable of “below” has the effect of an unstressed syllable because of how quick it passes. McAlpin also utilizes pickup notes to imitate unstressed syllables from the poem, such as in measures 5-6. The fourth beat of measure 5 is the syllable “up,” which leads into – or gives weight to – the first beat of measure 6, which is both a stressed note and a stressed syllable (the “on” of “upon”). McAlpin’s various uses of musical rhythms and beats to emphasize Shelley’s stressed and unstressed syllables allowed me to understand exactly what Shelley wanted the readers to hear through the stresses of his poem.

I perceived Shelley’s poem to be dreary and serious. He writes of a widowed bird that is alone and mourning for her love, and he uses various cold adjectives, like wintry, freezing, and frozen, to metaphorically express the depressed mood of the poem. So, I composed the duet (alto) line to emphasize the sad, “mourning” tone of the song. First, while the first soloist (soprano) sings a lot of quarter notes, like in measure two, I wrote the duet line to hold long notes ranging from two to four beats underneath the soprano’s movement. For example, in measures 1-5, the alto line holds low notes to give the impression of a death march of sorts to accompany the mood of mourning. Then, in measures 8-10, the alto line sings half notes held to give the feeling of “creeping,” just as the lyrics state. I also wanted to emphasize the adjectives Shelley uses to add to the mood of the song. So, I turned “wintry” in measure six into two eighth notes so that the syllables are sung quickly. Through the quickness, the consonants of the word are brought out; for example, the “tr” of the word is more violent. The consonants in turn really make the word stand out to help establish the cold mood of the song. I also wanted to exacerbate Shelley’s depiction of frozen wind “above” and freezing stream “below,” so I had the soprano hold “above” for one beat longer than the alto because she sings the high note (measures 10-11), while I had the alto hold “below” for an extra beat since she sings the low note (measures 12-13). These small additions make Shelley’s scenery stand out to add to the wintery atmosphere.

I added depth to the songs through the two places I chose to remain solo-voiced: measures 17-19 and 25-29. In measures 17-19, the narrator seems to be reflecting on a thought because of the sudden quietness of the dynamic marketing (p means piano, or quiet) and the performance marking of “ad lib,” meaning to sing at your own pace and rhythm. To accentuate the narrator’s reflection, I excluded a duet voice because it seems as if the narrator is in her own head, alone. Then, in measures 25-29, I chose to not write a duet line because I wanted the ending of the song to have a “haunting” mood. While McAlpin repeats “A widow bird of mourning” at the end of his song, Shelley doesn’t repeat this line at the end of his poem. This addition makes me think that McAlpin wants to emphasize the dreary nature of the poem by repeating “widow” and “mourning.” I left the measures solo to create a haunting, eery effect, which is accentuated even more so because of the pp, or double-soft, dynamic marking McAlpin used. I also wanted to highlight the fact that the bird is alone, hence the solo voice.

PDF: Widow-Bird (Solo)

PDF: Widow-Bird (Duet)

2. “Music, When Soft Voices Die”

McAlpin’s version of Shelley’s poem definitely altered my perception of the song. When I first read Shelley’s “Music,” I simply thought the narrator of the poem was saying that love lives on even after death – a romantic thought. However, the very beginning of McAlpin’s song threw me for a loop because of the suggested performance marking of “Grave.” This means that the composer wants the mood of the song to be just that – grave. Confused, I re-examined the poem and found it to have underlying moments of dreariness, such as when Shelley writes “die,” “sicken,” and “dead,” which are not exactly cheery and supportive words. I then reviewed the song with a mindset of a mix of happiness and sadness.

Just as he did in “Widow Bird,” McAlpin uses beat stresses in his music to emphasize stressed and unstressed syllables in the poem. For example, in measure 1, the first and third beats of the measure emphasize the stressed syllables of the line: “Music, when soft.” Another example is in measure 11 with the stressed word “rose” falling on a dotted quarter note and its next word, “is,” quickly going by in an eighth note. My favorite example, however, is in measure 12 when McAlpin really emphasizes the three unstressed syllables in a row by using a triplet set of eighth notes: “Are heap’d for the beloved’s.”

When writing the duet, I wanted to highlight the feeling of “yes, this is supposed to be romantic, but something just doesn’t feel right.” I therefore wrote the alto line to mostly sound great with the soprano, but to have a few small clashes that throw things slightly off. This dissonance between notes occurs on “die” in measure 1, the last syllable of “sicken” in measure 7, the first syllable of “dead” in measure 11, and the first syllable of “slumber” in measure 18. In what is not a coincidence, these small note clashes occur on the words that stick out and give an ugly picture among an otherwise romantic poem. McAlpin adds to this feeling of uneasiness with his random sharps and naturals in measures 4, 6, and 13, so I took his lead and created even more uneasiness by adding in oddly sounding notes to the alto line in measures 4 and 13.

I chose to leave out the alto line in measure 16 because, like in “Widow Bird,” the extra “art gone” is not part of Shelley’s poem. This fact, coupled with the sudden growth and decline in volume and the performance marking of rit, or to slow down, creates a feeling of reflection. To highlight the narrator’s pondering within her own head, I removed the second voice.

Overall, McAlpin treats the two songs similarly by aligning his stressed beats with Shelley’s stressed syllables and by adding in random but meaningful moments of extra lyrics. I simply expanded on McAlpin’s work by trying to make “Widow Bird” even more mournful and “Music” more uneasy by adding in a duet line.

PDF: Soft Voices (Solo)

PDF: Soft Voices (Duet)

2014 Wordsworthian Student Projects

2014 was busy: teaching at URI, moving to Houston, writing like mad, and teaching at Rice — Romanticism and Shakespeare, so thanks both to the Romanticists back at Brown and to the Shakespeareans James Kuzner and Jean Feerick, without whom I wouldn’t be able to teach a spider to weave a web.

flower copy

The point being that I only blog about my students these days, and my Romanticism students this past semester did some very interesting work that lends itself to the blog format. Conveniently, they both worked with the same subject material, namely the working relationship of Dorothy and William Wordsworth. That relationship has become something of a pedagogical touchstone for me (displacing even Blake!), after two years of on-and-off dissertation engagement with the subject.

And so in my Fall 2014 Rice seminar, I gave students a crash course in Wordsworthianism, walking them through Homans, Levin, Mellor, Woof (and Woof), Fay, and Newlyn — though I should say I only teach the journals. I’ve adopted, as a means of fixing the canonicity problem, the resolution never to teach William without Dorothy. I’m more in Fay’s camp than anywhere else, and try to do justice to the complexity of their working relationship, but as one student (I can’t remember who) assessed my terrible poker face rather fairly during office hours, “You weren’t going to let William get away with it.”

And I love what they did. Dorothy, in their renderings, isn’t an appendix, or a pretext, or an index. Their representations make us think of the writer’s relationship in terms of intertextuality, with interesting and productive differences between their readings.


1. Jessica, Chas, and Daniel made a video reflecting on William and Dorothy’s biographical and literary relationship. In a reading (Daniel) of an excerpted “Tintern Abbey”, they allow William only to go so far in his approach to the poem’s closing address to his sister (see Fay’s “address-to-maiden”). At a certain point, Dorothy insinuates herself into this poem as though she were refusing to merely be imagined by her brother, and retroactively changes the video we’ve just watched.


2. Alitha (Computer Science major) and Sharon (English major) combined their skills to create a hypertext version of the “Daffodils”. In one column, we have William’s poem (the 1815 version); in the second, Dorothy’s journal entry; and in the third, a changing block of commentary. When you mouseover portions of either column that have been categorized in a particular way, corresponding blocks of text in both columns are highlighted. When you click on such a highlighted text, commentary pops up in the third column. It’s a lot like RapGenius, but I like this interface much better: there is no original text here with an index, but two interrelated texts and a changing third that attempts to mediate. As you’ll see, the page takes a determined interpretive stance on the nature of the relation between the texts; and while such authoritativeness is often a subject of criticism against hypertextual presentations, I think the site’s interactivity and critical approach present a real challenge by Digital Humanities to the traditional anthology form.

syau-site-conceptConcept sketch. Click to view interactive site.
(best viewed in full-screen mode)

Kudos to both groups for doing great critical work in nontraditional formats, and for giving me some incredible teaching aids for this semester’s Romanticism class!

2013 Summer Science Fiction Course Feedback

Regular visitors to my blog know that I taught a science fiction course last year at Brown, through the Continuing Education department. In that course, we explored a number of different authors’ and filmmakers’ attempts to understand the limits of personal and social human existence, from Mary Shelley’s Frankenstein to Star Trek to Neal Stephenson’s imagination of a Turing tests with paranoid computers.

Some of my students, a year out, have written testimonials for me to share about how the course has helped them as writers and critical readers of literature, and I’d like to share them! It was an immensely gratifying experience to teach an often-overlooked genre to such gifted students, and I’m so pleased to hear the same from them.

Student 1:

“Future Perfect was a fantastic course, not only because of the nature of the material, which was in and of itself fascinating, but because of the new way that the class forced me to look at literature, at society, and at the world- expanding my horizons, opening my eyes to a new layer of textual analysis. Exploring the crossroads of science and literature in a way I never would have imagined, gave us all a chance to think about things in new ways and to try to understand the innate human desire to wonder about what the future will bring, what our technological advancements mean, and ultimately what makes us human and what makes humanity superior or different to nature or to technology. I find myself thinking about literature in new ways still, of course as much as this is an accolade for the class, it is even more so an accolade for John, who expanded my world view, while simultaneously helping me focus on the close analysis of science fiction in every medium and most surprisingly helped me to unearth aspects of my own writing that I otherwise never would have realized fully.”

Student 2:

As someone who adores science fiction, Future Perfect was basically an irresistible opportunity to talk about the books and films I love. Sci-fi is a field that gets tragically overlooked by just about every curriculum, so to be able to learn more about it and discuss its themes in a classroom environment was a unique (and awesome) experience. The class definitely helped me as a writer; the assignments gave us a lot of room for creativity, and the feedback we received was conducive to improvement.

Student 3:

I signed up for Future Perfect planning to indulge a guilty pleasure of mine (science fiction of course!), but after the two weeks were over I had such a deep respect for the genre and its ideas that I now consider sci-fi a true art form and a (entirely guiltless) passion. The class touched on everything from philosophy to history to real scientific discoveries, all of which are the inspiration for science fiction along with the powerful question, what if? Science fiction is not only a film and literary genre, it is a lens through which many people have looked at the world and imagined it differently, which of course, is the first step to changing it. As a student of the Future Perfect class, I was expected to complete college-level reading and writing assignments, and the fact that I was reading Frankenstein and writing short stories about reanimated corpse “service beings” and meteorites that bent the laws of probability had no impact on the fact that now, as I face college in a mere few months, I feel ready for it. Future Perfect was an unforgettable experience, and as close to perfect as things come outside of fiction.

I’m teaching a new version of this course in July. If you know a pre-college student who loves science fiction and wants to learn how to read it and write it (either in short story form or as an academic essay), please send them my way!

Student: Honorable Mention in Science Fiction Competition

I’m catching up on news from my summer students. Phoebe Shalloway, a student in my course Future Perfect: The Politics of Science Fiction, has received honorable mention in the 2013 Writers of the Future competition. Judges for the award include Orson Scott Card and other SF big-shots.

Congrats to Phoebe, whose short story “The Skyfill” was her final project for the course, imaginatively reworked some of the motivating questions behind M. John Harrison‘s novel Light. It was a real pleasure to read, and Phoebe has been kind enough to let me share the work with you, below.
(Download the pdf here)

I will be teaching this course again in July! I’m reworking the syllabus now. Among the changes: Neal Stephenson is out. Eileen Gunn is in.

Student wins film award

Brown CE Digital Storytelling Student Wins Film Award
Brown CE Digital Storytelling Student Wins Film Award

Jihyun Lee, a student in my 2013 Digital Storytelling course, has notified me that one of her film projects won 2nd place in the Asian International Children’s Film and Video Festival. There were some excellent projects produced in the course, and I’m thrilled to see Jihyun receiving recognition for her work.

Jihyun’s film:

Portfolio of various students’ projects:

I am very much looking forward to teaching the course again this summer, and seeing what the new batch of storytellers produces!