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about 7 years ago
Imperial College closes its fast-track grad programme (00:49); Faisel Alam discusses sharia law-compliant student loans (3:18); Will Sapwell gives tips from the BMA's new student finance guide (6:33); University of Leicester trials virtual patient consultations (12:03); Harrison Carter talks about his experience on BBC's Eggheads (16:18).
almost 7 years ago
Imperial College closes its fast-track grad programme (00:49); Faisel Alam discusses sharia law-compliant student loans (3:18); Will Sapwell gives tips from the BMA's new student finance guide (6:33); University of Leicester trials virtual patient consultations (12:03); Harrison Carter talks about his experience on BBC's Eggheads (16:18).
over 6 years ago
WHO | WHO convenes industry leaders and key partners to discuss trials and production of Ebola vaccine
WHO convened a meeting with high-ranking government representatives from Ebola-affected countries and development partners, civil society, regulatory agencies, vaccine manufacturers and funding agencies yesterday to discuss and agree on how to fast track testing and deployment of vaccines in sufficient numbers to impact the Ebola epidemic.
over 6 years ago
Under intense pressure to react, WHO is set to fast track phase II-III evaluation of candidate Ebola virus vaccines based on adenovirus vectors in west and central Africa.1
about 6 years ago
I graduated last year and now doing my Housemanship (HO) at University Malaya medical centre, malaysia. I have done my 1st year as a real Dr. ive gone thru medical, surgical and now doing orthopaedic. the remaining year i have to go thru obs n gyne, paeds and either ED or anest posting. Ive been thinking of taking this exam (MRCP) as a fast track to become specialist. can i get any feedback for those who had gone thru this exam or anyone who have any ideas about this MRCP. Would be great to hear the positive and negative experiences, comment and etc.
almost 7 years ago
Introduction This post describe the creation of a Stroke Summary video. The aim of this project was to assess the attitudes of medical students towards the use of video animation in medical education. An educational tutorial was produced outlining the basic principles of stroke. This aimed to provide a summary of different aspects relating to stroke, outlined in the Bristol University curriculum. This intended to be a short, concise animation covering stroke presentation, definition and recognition, with an overview of the blood supply to the brain and the classification of stroke presentation used in clinical practice. This was followed by some key facts and a summary of different management stages. After the video animation was produced an assessment of student’s attitudes using an online questionnaire was undertaken. This consisted of ten short questions and an open text feedback for additional comments. The video was then edited with reference to feedback given by students and the results analysed. This report will outline relevant research and project work that lead to this assignment being undertaken. A description of the method followed to generate the video animation and to collect feedback on students will be outlined followed by analysis of results. This will then be discussed in relation to previous work and research. Background There are a number of reasons this project has been undertaken. On a personal level, I have a long-standing interest in teaching and medical education. As part of a previous project I created a series of audio tutorials in cardiovascular medicine and assessed student attitudes to audio learning. The findings of this report showed that a large number of students found these audio tutorials useful and would like more of these available to supplement their learning. One of the questions given to students at this time assessed how useful they found different types of educational material. This project showed students reporting audio tutorials more useful than previously thought, while also reporting that they were not readily available. Although a video tutorial was not provided to them at this time, feedback questions assessed attitudes to video tutorials as a learning resource. Students reported low availability and felt they would be more useful than audio tutorials. Some results from this project are shown in figure 1. Figure 1. Results from previous research by Buick (2007), showing attitudes of students towards different learning tutorials. The majority of students report audio tutorials to be ‘quite useful’ or ‘very useful’. Video tutorials are thought by students to be more useful that audio tutorials, however there is a large proportion that do not have access to these learning resources. As a number of students reported an inability to access to video tutorials, it was thought that creating a video animation tutorial followed by assessing students attitudes would be a useful follow up project. If this is found to be a useful resource, other students may generate video tutorials in the future. Therefore student feedback also assessed attitudes towards authenticity, relating to who generates the tutorial and whether they find the ability to feedback a useful tool. Medical education is widely researched globally, although it is not often a consideration for those studying medicine. Those involved in teaching and educating future doctors have looked at different methods of passing on knowledge. A high quality medical education given to future healthcare professionals is important. It is widely accepted that a better knowledge results in better care for patients and education is at the centre of any healthcare system. This is reflected in the cost of educating medical students and training doctors in the UK. In the 1997 it was reported by the Department of Health that estimates of 200 million pounds would be spent per year for an increase in 1000 medical students being trained in the UK. This suggests that the cost of training a medical student is in the region of £200,0001. Medical education in the UK is split in two halves, with undergraduate and postgraduate training. The Department of Health has recently invested millions of pounds into the development of online tutorials for postgraduate training posts in a number of different specialities. Justification for is given by reducing the cost of training through the use of standardised online tutorials. This will be a more cost effective method than the standard in hospital teaching. This approach has not been undertaken for undergraduate medical education. Universities are seen as primarily responsible for undergraduate training. Many of these institutions have used the Internet to aid teaching and have produced video tutorials. However, as reflected in the previous project (Buick, 2007), resources are often limited and students do not feel they have ready access to these educational tutorials. The benefits of different types of learning resource have been researched. These include online audio downloads (Spickard et al, 2004), practice exam questions and interactive tutorials (Hudsen, 2004). Research showing the benefit of video was shown by Balslev et al (2005) comparing video and written text while teaching a patient case. Balsley et al (2005) found those who learnt using a video presentation rather than those given written text showed a significant increase in data exploration, theory evaluation and exploration. However, there is little research looking specifically at video animation for explaining conditions. Animation software is now available on personal computers and is also possible using Microsoft PowerPointTM, which is the most widely used presentation software. It is clear that recent trends show training can benefit from this type of learning resource. Generation of high quality video tutorials can help students learn while reducing the cost of training. It is for this reason that more material is likely to become available, either from funded production supported by external organisations or by the trainers and trainees themselves who have technology able to produce material such as this on their home computer. Ethical and Legal Issues During the development of this video some ethical and legal issues arose that had to be addressed before a final video could be made. When considering what imagery would be used in the video, I wanted to include pictures of clinical signs relevant to the audio narration. However, taking images from the Internet without prior consent was not thought to be ethical and therefore clinical signs were displayed graphically through drawings and diagrams. Plagiarism and copyright were some of the legal issues surrounding the presentation of medical information. Narrated information was generated using a number of information sources, none of which were exclusively quoted. Therefore an end reference list was generated showing all supporting information sources. Images used in the animation were either self generated or taken from sources such as Wikipedia.org. This resource supplies images under a free software license such as GNU general public license2. This allows anyone to freely use and edit images while referencing the original source. Skills Needed To Develop This Video Animation To generate the video a number I had to develop a number of new skills. Unlike previous work that had been undertaken this media was generated using animation software. To use this effectively I had to research the different functions that were available. To do this I combined reading books aimed to teach beginners such as Macromedia Flash 8 for Dummies (Ellen Finkelstein and Gurdy Leete, 2006) and online sources such as www.learnflash.com . To generate voice narration, another program was used that allowed editing and splicing of audio tracks. This was then split up into a number of narrated sections and added to the animation. Method Script To produce the tutorial the first stage was to construct a script for narration. This involved outlining the areas to be covered. The main headings used were: Stroke definition This gave a clinical definition and a lay person recognition mnemonic called FAST which is used to help members of the general public recognise stroke. Pathophysiology This covered blood supply to the brain. This combined diagrams of the circle of Willis, with images of the brain. Arterial blood supply were then displayed over the brain images while relating this to the arterial vessels leaving the circle of Willis Classification Students at Bristol university are asked to understand the Oxford / Bamford classification. This was covered in detail with explanations of clinical signs that may be seen and graphical representation of these. Prevalence This section covered prevalence, national impact and cost of stroke in the UK. Management In this section management was split up it to immediate management, medical management, in hospital care and some of the procedures considered for different cases. Risk factors for stroke and research into this was also written up and narrated. However at a later stage this was not included due to time constraints and video length. Narration An audio narration was generated using software called ‘Garage Band’ which allows audio tracks to be recorded and edited. The narration was exported in 45 sections so that this could then be added to the animation at relevant points. Animation The animation was made using Adobe Flash. This software is used for making websites and animations used for Internet adverts. It has the facility to export as a ‘flash video format’, which can then be played using a media player online. This software generates animation by allowing objects to be drawn on a stage and moved around using command lines and tools. This was used as it has the ability to animate objects and add audio narration. It also is designed for exporting animations to the Internet allowing the material to be accessed by a large number of people. Feedback A short questionnaire was generated which consisted of ten questions and placed online using a survey collection website (www.surveymonkey.com). Students were directed to the feedback questionnaire and allowed to submit this anonymously. Adapting the tutorial Some feedback constructively suggested changes that could be made. The video was updated after some concern about the speed of narration and that some of the narrative sections seemed to overlap. Analysis and Report The results of the feedback were then collected and displayed in a table. This was then added to the report and discussed with reference to research and previous project work. Results Students were allowed to access to the video animation through the Internet. After uploading the video an email was sent to students studying COMP2 at Bristol University. These students are required to know about aspects of stroke covered in this tutorial to pass this section of the course. The email notified them of the options to view the tutorial and how to give feedback. In total 30 students completed the feedback questionnaire and out of these 4 students provided optional written feedback. The results to the questions given were generally very positive. The majority of students showed a strong preference to video animations as a useful tool in medical education. The results are displayed in Table 1 below. TABLE 1 shows the ten question asked of the students and to what extent they agreed with each statement. Results are given in the percentage of students who chose the relevant category. Written Feedback Four written comments were made: "Really useful presentation!! Would be much better if someone proof read the whole thing as there are some spelling mistakes; also if the pauses between facts were longer it would be more easier to take in some facts. Overall, really nicely done!!" "Some of speech went too quickly, but good overall" "Very clearly written with excellent use of images to match the text and commentary!" "The Video was excellent." Discussion Student attitudes to this video tutorial were very positive. This was in contrast to the attitudes previously shown in the audio tutorial project (Buick, 2007) where video tutorials were not thought to be a useful resource. These results support recent developments in the generation of online video training for doctors by the Department of Health and previous research by Balsley et al (2005). Question one showed that the majority of students strongly agreed that the stroke video would be a useful resource. Questions two, three and four aimed to establish what aspects of a disease were best outlined using a video animation. Results showed that students agree or strongly agreed that defining the condition, pathophysiology and management were all well explained in this format. Interestingly, a large majority of students (70%) felt pathophysiology was best represented kinaesthetically. This may be due to the visual aspect that can be associated with pathophysiology. Disease processes are often represented using diagrams in textbooks with text explaining the disease process. Using computer technology it is possible to turn the text into audio narration and allow the user to view dynamic diagrams. In this way, students can better conceptualise the disease process, facilitating a more complete understanding of disease and its clinical manifestations. Question five aimed to highlight the benefit of visual stimulation as well as audio narration as a positive learning method. All students agreed or strongly agreed that the combination of these two aspects was beneficial. Question six showed a very strong response from students wanting access to more video tutorials, with 70% of students strongly agreeing to this statement. It is often the case that students take part in generating teaching material, and some students may be concerned that this material is inaccurate. However, many students do not think that this is a significant problem. This is reflected by the spread of student’s opinion seen in question 7, where there was no clear consensus of opinion. It may be that as students learn from a number of different resources, that any inaccuracies will be revealed and perhaps stimulate a better understanding through the process of verifying correct answers and practicing evidence based medicine. Question nine and ten show that most students value resources that allow sharing of educational material and feel they could help others learn. They would also value the option to feedback on this material. The written feedback showed positive responses from students. However there was feedback on some aspects of the video that they felt could be changed. The narration was delivered quickly with few gaps between statements to keep the tutorial short and concise, however this was thought to be distracting and made it less easy to follow. Following this feedback the narration was changed and placed back on the Internet for others to review. Further research and investigation could include the generation of a larger resource of video animations. My research has suggested that using animation to cover pathophysiology may be most beneficial. The software used to make this video also allows for the incorporation of interactive elements. The video produced in this project or other videos could have online menus, allowing users to select which part of the tutorial they wish to view rather than having to watch the whole animation, or they include interactive questions. Reflections Strength and weaknesses Strengths of this project include its unique approach to medical education. There have been few animated videos produced for undergraduate medical students that use this advanced software. This software is used by professional web developers but can be used effectively by students and doctors for educational purposes to produce video animation and interactive tutorials. For these reasons, I passionately believe that this technology could be used to revolutionise the way students learn medicine. If done effectively this could provide a more cost effective and engaging learning experience. This will ultimately benefit patients and doctors alike. This material can be place online allowing remote access. This is increasingly important for medical students studying on placements who are often learning away from the university setting. Weaknesses of this project include that of the work intensity of generating animated video. It is estimated that it takes around 6 to 9 hours to produce a minute of animated video. This does not include the research and recording of narration. The total sum of time to generate material and the additional skills needed to use the software makes generation of larger numbers of videos not possible by a small community of learners such as a university. Although it was done in this case, it is difficult to edit the material after it has been created. This may mean that material will become inaccurate when new advances occur. The feedback sample collected was opportunistic and the response rate was low. These factors may bias the results as only a subsection of opinions may have been obtained. These opinions may not be representative of the population studied or generalisable to them. It was difficult obtaining a professional medical opinion about the video in the time that I was allocated. However this has been organised for a later time. Knowledge and skills gained During this project I was able to learn about stroke its presentation, classification, management and risk factors. I read texts, which summarised stroke and research into risk factors and management of stroke. The challenge of usefully condensing a subject into a short educational tutorial was a challenging one. I feel I improved my skills of summarising information effectively. I gained knowledge of some of the challenges of undertaking a project such as this. One of the largest challenges included how long it took to produce the animation. In the future I will be aware of these difficulties and allow for time to gather information and generate the material. I also learnt the benefit of gaining feedback and allowing for adaption to this. It took more time to respond to feedback but this resulted in a better product that other students can use. I also reflected on the impact of stroke itself. Stroke has a major impact on patients, health care and carers. Much can be done in the recognition classification and management. A better understanding benefits all areas and I have gained a better knowledge and the importance of helping others gain a good understanding of stroke. I learned how to generate a video animation for the use of teaching in medicine and combine this with audio presentation. I learned how long it can take to generate material like this and the skill of organising my time effectively to manage a project. I can use this skill in the future to produce more educational material to help teach during my medical career. I also gained skills in learning how to place material on the Internet for others to access and will also use this in the future. Conclusions Previously evidence has shown the use of videos in medical education to be beneficial. It has normally been used to demonstrate clinical examination and procedures this study suggest there is a place for explanation of pathophysiology and disease summaries. However, there has been little research in to its use for graphically representing condition summaries. Computer technology now allows people to generate animation on their personal computer. It is possible that over time more students and doctors will start producing innovative visual and audio teaching material. This project indicates that this would be well received by students. References Planning the Medical Workforce: Medical Workforce Standing Advisory Committee: Third Report December. 1997 Page 40. The GNU project launched in 1984. Balslev T, de Grave W S, Muijtjens A M and Scherpbier A J (2005) Comparison of text and video cases in a postgraduate problem-based learning format Medical Education; 39: 1086–1092 Buick (2007) Year 3 External SSC. Bristol University Medical School. Spickard A, Smithers J, Cordray D, Gigante J, Wofford J L. (2004) A randomised trial of an online lecture with and without audio; Medical Education 38 (7), 787–790. Hudson J. N., (2004) Computer-aided learning in the real world of medical education: does the quality of interaction with the computer affect student learning? Medical Education 38 (8), 887–895. Ellen Finkelstein and Gurdy Leete, (2006) Macromedia Flash 8 for Dummies. Wiley publishing Inc. ISBN 0764596918
Dr Alastair Buick
over 11 years ago
What is Problem Based Learning? During my time at medical school, I enjoyed (at times) a curriculum delivered through the traditional model. As the name suggests, this is an approach experienced by the majority of doctors to date. The traditional model was first implemented by the American Medical College Association and American Academy of Medicine in 1894 (Barr, 2010) and has been used by the majority of medical schools. It traditionally consists of didactic lectures in the initial years covering the basic sciences followed by clinical years, where students learn clinical medicine while attending hospital placements. Is It Better? A few years after my graduation I found myself teaching at a university which had fully adopted the use of problem based learning (PBL) in the delivery of their curriculum. PBL is a philosophy of teaching that has increasingly been used in medical education over the past 40 years. It has rapidly been replaced or supplemented in medical education as opposed to the traditional model. PBL seeks to promote a more integrated and active approach to learning right from the first year with less reliance on didactic lectures. Having been involved in these two different approaches to medical education, I was interested to explore what the evidence was for and against each. For the purposes of this blog, I have looked at four specific areas. These include student attitudes, academic achievement, the academic process of learning and clinical functioning and skills. Student Attitudes Student attitudes to PBL have been highly featured in studies and many show that there is a clear favourability towards this philosophy of teaching. Blumberg and Eckenfel (1988) found that students in a problem based preclinical curriculum rated this three times higher than those in the a traditional group in terms of what they expect to experience, what they would like, and what they actually experienced. Heale et al (1988) found physicians in the problem-solving sessions rated a Continuing Medical Education short course higher compared to others who attended traditional lectures and large-group sessions. Vernon and Black (1993) performed a Meta analysis on 12 studies that looked at attitudes and towards PBL and found PBL was favored in some way by all studies. PBL appears to be preferred by the majority of students at a range of academic levels. However, Trappler (2006) found that converting a conventional curriculum to a problem based learning model for part of a psychopathology course did not show complete favourability. Students preferred the conventional lectures given by experts, rather than PBL groups run by mentors and not experts. They did however show preference towards PBL small group sessions run by experts Academic Achievement Academic achievement is an important factor to assess. Vernon and Blake (1993) compared a number of studies and found that those, which could be compared, showed a significant trend favouring traditional teaching methods. However, it was felt this might not be reliable. When looking at the heterogeneity of the studies there was significant variation that could not be accounted for by chance alone. Interestingly, they found that there was significant geographical variation across the United States such that New Mexico showed consistently negative effects and Michigan State showed consistently positive. Other studies have shown that the traditional method may show a slightly better outcome when assessing academic achievement. Schmidt et al (1987) looked at the same progress test taken among students in six different Universities in the Netherlands and found that those taught by a traditional approach showed slightly better outcomes. Baca et al (1990) compared performances of medical students in two separate tracks, one PBL the other a traditional model. Baca et al found that PBL students scored slightly lower in the National Board of Medical Examiners (NBME) examinations. Dochy et al (2003) conducted a meta analysis comparing 43 studies and found that when considering the effect of PBL on the knowledge of students the combined effect size is slightly negative. The academic process of learning It is important in medical education to enable people to continue life long learning, to overcome problems and fill in knowledge gaps. Coles (1990) and Entwistle (1983) found that PBL students would place more emphasis on understanding and meaning compared to just rote learning, seen more in those taught by a traditional approach. Students on a PBL course also place more focus on using resources such as the library and online sources rather than those taught in a traditional approach (Rankin, 1992). Students taught by a traditional model place more emphasis on the resources supplied by the faculty itself. It has also been shown that students who learn through a process of problem solving, are more likely to use this spontaneously to solve new problems in the future compared with those taught in a traditional way (Bransford et al, 1989). Clinical functioning and skills Clinical competence is an important aspect in medical education and has been measured in studies comparing PBL and traditional methods. The traditional model focuses acquisition of clinical competence in the final years of a program with hospital placements. In a PBL course it may be more integrated early on. There are however, only a few studies that look at clinical competence gained in undergraduate PBL courses. Vernon and Blake (1993) compared some of these studies and found that students obtained better clinical functioning in a PBL setting compared to a traditional approach. This was statistically significant, however there was still significant heterogeneity amongst studies and for conclusive results to be made 110 studies would have to be compared, rather that the 16 samples they were able to use. They also found that in contrast to the NBME I giving better results in the traditional model, PBL students score slightly higher in NBME II and federation licensing examination which related more on clinical functioning than basic sciences. On reflection, this evidence has indicated to me that PBL is a very valuable approach and it has a number of benefits. The traditional model in which I was taught has provided a good level of academic education. However, it may not have supported me as well as a PBL course in other areas of medical education such as academic process, clinical functioning and satisfaction. On reflection and current recommendations are for a hybridisation of the PBL and traditional approach to be used (Albanese, 2010) and I would support this view in light of the evidence. References Baca, E., Mennin, S. P., Kaufman, A., and Moore-West, M. A Comparison between a Problem-Based, Community Orientated track and Traditional track Within One Medical school. In Innovation in Medical Education; An Evaluation of Its Present Status. New York: Springer publishing Barr D. (2010) Revolution or evolution? Putting the Flexner Report in context. Medical Education; 45: 17–22 Blumberg P, Eckenfels E. (1988) A comparison of student satisfaction with their preclinical environment in a traditional and a problem based curriculum. Research in Medical Education: Proceedings of the Twenty-Seventh Annual Conference, pp. 60- 65 Bransford, J. D., Franks, J. J., Vye, N. J., & Sherwood, R. D. (1989). New Approaches to Instruction: Because Wisdom Can't Be Told. In S. Vosiadou & A. Ortony (Eds.), Similarity and Analogical Reasoning (pp. 470 297). New York: Cambridge University Press. Coles CR. (1990) Evaluating the effects curricula have on student learning: toward a more competent theory for medical education. In: Innovation in medical education: an evaluation of its present status. New York: Springer publishing; 1990;76-93. Dochy F., Segersb M., Van den Bosscheb P., Gijbelsb D., (2003) Effects of problem-based learning: a meta-analysis. Learning and Instruction. 13:5, 533-568 Entwistle NJ, Ramsden P. Understanding student learning. London: Croom Helm; 1983 Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P. (1988) A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Research in Medical Education.;27:72-7. Trappler B., (2006) Integrated problem-based learning in the neuroscience curriculum - the SUNY Downstate experience. BMC Medical Education 6: 47. Rankin JA. Problem-based medical education: effect on library use. Bull Med Libr Assoc 1992;80:36-43. Schmidt, H G; Dauphinee, W D; Patel, V L (1987) Comparing the effects of problem-based and conventional curricula in an international sample Journal of Medical Education. 62(4): 305-15 Vernon D. T., Blake R. L., (1993) Does Problem-based learning work? A meta-analysis of evaluated research. Academic Medicine.
Dr Alastair Buick
about 8 years ago
I started medical school in 2007 wanting to 'making people better'. I stopped medical school in 2010 facing the reality of not being able to get better myself, being ill and later to be diagnosed with several long term health conditions. This post is about my transition from being a medical student, to the other side - being a patient. There are many things I wish I knew about long-term health conditions and patients when I was a medical student. I hope that through this post, current medical students can become aware of some of theses things and put them into practice as doctors themselves. I went to medical school because I wanted to help people and make them better. I admired doctors up on their pedestals for their knowledge and skills and expertise to 'fix things'. The hardest thing for me was accepting that doctors can't always make people better - they couldn't make me better. Holding doctors so highly meant it was very difficult for me to accept their limitations when it came to incurable long-term conditions and then to accept that as a patient I had capacity myself to help my conditions and situation. Having studied medicine at a very academic university, I had a very strict perception of knowledge. Knowledge was hard and fast medical facts that were taught in a formal setting. I worked all day and night learning the anatomical names for all the muscles in the eye, the cranial nerves and citric acid cycle, not to mention the pharmacology in second year. Being immersed in that academic scientific environment, I correlated expertise with PhDs and papers. It was a real challenge to realise that knowledge doesn't always have to be acquired through a formal educational but that it can be acquired through experience. Importantly, knowledge acquired through experience is equally valid! This means the knowledge my clinicians have developed through studying and working is as valid as my knowledge of my conditions, symptoms and triggers, developed through experiencing it day in day out. I used to feel cross about 'expert patients' - I have spent all these hours in a library learning the biochemistry and pharmacology and 'Joe Bloggs' walks in and knows it all! That wasn't the right attitude, and wasn't fair on patients. As an expert patient myself now, I have come to understood that we are experts through different means, and in different fields. My clinicians remain experts in the biological aspects on disease, but that's not the full picture. I am an expert in the psychological and social impact of my conditions. All aspects need to be taken into account if I am going to have holistic integrated care - the biopsychosocial model in practice - and that's where shared-decision making comes in. The other concept which is has been shattered since making the transition from medical student to patient is that of routine. In my first rotation, orthopaedics and rheumatology, I lost track within the first week of how many outpatient appointments I sat in on. I didn't really think anything of them - they are just another 15 minute slot of time filled with learning in a very busy day. As a patient, my perspective couldn't be more different. I have one appointment with my consultant a year, and spend weeks planning and preparing, then a month recovering emotionally. Earlier this year I wrote a whole post just about this - The Anatomy of an Appointment. Appointments are routine for you - they are not for us! The concept of routine applies to symptoms too. After my first relapse, I had an emergency appointment with my consultant, and presented with very blurred vision and almost total loss of movement in my hands. That very fact I had requested an urgent appointment suggest how worried I was. My consultants response in the appointment was "there is nothing alarming about your symptoms". I fully appreciate that my symptoms may not have meant I was going to drop dead there and then, and that in comparison to his patients in ICU, I was not as serious. But loosing vision and all use of ones hands at the age of 23 (or any age for that matter) is alarming in my books! I guess he was trying to reassure me, but it didn't come across like that! I have a Chiari malformation (in addition to Postural Orthostatic Tachycardia Syndrome and Elhers-Danlos Syndrome) and have been referred to a neurosurgeon to discuss the possibility of neurosurgery. It is stating the obvious to say that for a neurosurgeon, brain surgery is routine - it's their job! For me, the prospect of even being referred to a neurosurgeon was terrifying, before I even got to the stage of discussing the operation. It is not a routine experience at all! At the moment, surgery is not needed (phew!) but the initial experience of this contact with neurosurgeons illustrates the concept of routines and how much our perspectives differ. As someone with three quite rare and complex conditions, I am invariable met in A&E with comments like "you are so interesting!". I remember sitting in the hospital cafeteria at lunch as a student and literally feasting on the 'fascinating' cases we had seen on upstairs on the wards that morning. "oh you must go and see that really interesting patient with X, Y and Z!" I am so thankful that you all find medicine so interesting - you need that passion and fascination to help you with the ongoing learning and drive to be a doctor. I found it fascinating too! But I no longer find neurology that interesting - it is too close to home. Nothing is "interesting" if you live with it day in day out. No matter what funky things my autonomic nervous may be doing, there is nothing interesting or fascinating about temporary paralysis, headaches and the day to day grind of my symptoms. This post was inspired by NHS Change Day (13th March 2013) - as a patient, I wanted to share these few things with medical students, what I wish I knew when I was where you are now, to help the next generation of doctors become the very best doctors they can. I wish you all the very best for the rest of your studies, and thank you very much for reading! Anya de Iongh www.thepatientpatient2011.blogspot.co.uk @anyadei
Anya de Iongh
about 8 years ago
Imagine a world where procrastination became a productive pastime… Procrastination, as it stands, is a core feature of the ‘human condition’ and most would argue that it is here to stay. However, what if we could hijack the time we spend playing Candy Crush saga and trick ourselves into contributing towards something tangible. Today, I wish to explore this possibility with you. The phrase ‘gamification’ is not a new or made up word (I promise) although I agree it does sound jarring and I certainly wouldn’t recommend trying to use it in a game of scrabble (yet). The phrase itself refers to the process of applying game thinking and game mechanics to non-game contexts to engage users in solving problems. For our purposes and for the purposes of this blog ‘problems’ will equate to promoting healthy living for our patients and maintaining our own medical education. For one reason or another, most people show addictive behaviour towards games especially when they incorporate persistent elements of progression, achievement and competition with others. The underlying psychology won’t be discussed here; call it escapism, call it procrastination, call it whatever you will. What I want you to realise is that every day millions of people spend hours tending to virtual farms and cyber families whilst competing vigorously with ‘online’ friends. If we can take the addictive aspects of these popular games and incorporate them in to the non-game contexts I indicated to above, we could potentially trick ourselves, and even perhaps our patients, into a better way of life. The first time I heard the phrase ‘gamification’ was only last year. I was in Paris attending the Doctors 2.0 conference listening to talks on how cutting edge technologies and the Internet had been (or were going to be) incorporated into healthcare. One example that stood out to me was a gaming app that intended to engage people with diabetes to record their blood sugars more regularly and also compete with themselves to achieve better sugar control. People who have the condition of Diabetes Mellitus are continuously reminded of their diet and their blood sugar levels. I am not diabetic myself, but it is not hard to realise that diet and sugar control is going to be an absolute nightmare for people with diabetes both from a practical and psychological standpoint. Cue the mySugr Compainion, an FDA approved mobile application that was created to incorporate the achievement and progression aspects of game design to help encourage people with diabetes to achieve better sugar control. The app was a novel concept that struck a chord with me due to its potential to appeal to the part in everyone’s brain that makes them sit down and play ‘just one more level’ of their favorite game or app. There are several other apps on the market that are games designed to encourage self testing of blood sugar levels in people with diabetes. There is even a paediatric example titled; “Monster Manor,” which was launched by the popular Sanofi UK (who previously released the FDA / CE approved iBGStar iPhone blood glucose monitor). So applying aspects of game design into disease management apps has anecdotally been shown to benefit young people with Diabetes. However, disease management is just one area where game-health apps have emerged. We are taught throughout medical school and beyond that disease prevention is obviously beneficial to both our patients and the health economy. Unsurprisingly, one of the best ways to prevent disease is to maintain health (either through exercise and / or healthy eating). A prominent example of an app that helps to engage users in exercising is ‘RunKeeper,’ a mobile app that enables people to track and publish their latest jog-around-the-park. The elements of game design are a little more subtle in this example but the ability to track your own progress and compete with others via social media share buttons certainly reminds me of similar features seen in most of today’s online games. Other examples of ‘healthy living apps’ are rife amongst the respective ‘app stores,’ and there seems to be ample opportunity for the appliance of gamification in this field. An example might be to incorporate aspects of game design into a smoking cessation app or weight loss helper. Perhaps the addictive quality of a well designed game-app could overpower the urge for confectionary or that ‘last cigarette’… The last area where I think ‘gamification’ could have a huge benefit is in (medical) education. Learning and revising are particularly susceptible to the rot of procrastination, so it goes without saying that many educational vendors have already attempted to incorporate fresh ways in which they can engage their users to put down the TV remote and pick up some knowledge for the exams. Meducation itself already has an area on its website entitled ‘Exam Room,’ where you can test yourself, track your progress and provide feedback on the questions you are given. I have always found this a far more addictive way to revise than sitting down with pen and paper to revise from a book. However, I feel there could be a far greater incorporation of game design in the field of medical education. Perhaps the absolute dream for like-minded gamers out there would be a super-gritty medical simulator that exposes you to common medical emergencies from the comfort of your own computer screen. I mean, my shiny new gaming console lets me pretend to be an elite solider deep behind enemy lines so why not let me pretend and practice to be a doctor too? You could even have feedback functionality to indicate where your management might have deviated from the optimum. Perhaps more sensibly, the potential also exists to build on the existing banks of online medical questions to incorporate further aspects of social media interaction, achievement unlocks and inter-player competition (because in case you hadn’t noticed, medics are a competitive breed). I have given a couple of very basic examples on how aspects of game design have emerged in recent health-related apps. I feel this phenomenon is in its infancy. The technology exists for so much more than the above, we just need to use our imagination… and learn how to code.
Dr. Luke Farmery
about 7 years ago
In the USA the issue of indiscriminate use of expensive, sophisticated, and time consuming test in lieu of, rather than in addition to, the clinical exam is being much discussed. The cause of this problem is of course multifactorial. One of the factors is the decline of the teaching of clinical skills to our medical students and trainees. Such problems seem to have taken hold in developing countries as well. Two personal anecdotes will illustrate this. In the early nineties I worked for two years as a faculty member in the department of ob & gyn at the Aga Khan University Medical School in Karachi, Pakistan. One day, I received a call from the resident in the emergency room about a woman who had come in because of some abdominal pain and vaginal bleeding. While the resident told me these two symptoms her next sentence was: “… and the pelvic ultrasound showed…” I stopped her right in her tracks before she could tell me the result of the ultrasound scan. I told her: “First tell me more about this patient. Does she look ill? Is she bleeding heavily? Is she in a lot of pain and where is the pain? What are her blood pressure and pulse rate? How long has she been having these symptoms? When was her last menstrual period? What are your findings when you examined her ? What is the result of the pregnancy test?”. The resident could not answer most of these basic clinical questions and findings. She had proceeded straight to a test which might or might not have been necessary or even indicated and she was not using her clinical skills or judgment. In another example, the resident, also in Karachi, called me to the emergency room about a patient with a ruptured ectopic pregnancy. He told me that the patient was pale, and obviously bleeding inside her abdomen and on the verge of going into shock. The resident had accurately made the diagnosis, based on the patient’s history, examination, and a few basic laboratory tests. But when I ran down to see the patient, he was wheeling the patient into the radiology department for an ultrasound. "Why an ultrasound?" I asked. “You already have made the correct diagnosis and she needs an urgent operation not another diagnostic procedure that will take up precious time before we can stop the internal bleeding.” Instead of having the needless ultrasound, the patient was wheeled into the operating room. What I am trying to emphasize is that advances in technology are great but they need to be used judiciously and young medical students and trainees need to be taught to use their clinical skills first and then apply new technologies, if needed, to help them to come to the right diagnosis and treatment. And of course we, practicing physicians need to set the example. Or am I old fashioned and not with it? Medico legal and other issues may come to play here and I am fully aware of these. However the basic issue of clinical exam is still important. Those wanting to read more similar stories can download a free e book from Smashwords. The title is: "CROSSCULTURAL DOCTORING. ON AND OFF THE BEATEN PATH." You can access the e book here.
DR William LeMaire
almost 7 years ago
http://usmlefasttrack.com/sign-up-usmle-step-1-review-program/ For A Limited Time The Full Respiratory Chapter Review Video from First Aid for USMLE Step 1 2...
about 6 years ago
Progress towards global vaccination targets for 2015 is far off track with 1 in 5 children still missing out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases. In the lead-up to World Immunization Week 2015 (24 -30 April), the WHO is calling for renewed efforts to get progress back on course.
almost 6 years ago
People with psoriasis and their health care providers will have the opportunity to participate in research that aims to improve treatments and disease outcomes when the first independent U.S.
almost 6 years ago