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#2
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2
73

Extolling the benefits of learning plans

“You’re a boring whore! Fix it.” The barked criticism came like a slap in the face. The director of Les Miserables was right, though. I was a boring whore. Actors need to immerse themselves in their roles, shed inhibitions and squelch embarrassment. I was not managing to do this while rehearsing the Lovely Ladies prostitute scene. My performance was overly self-conscious and restrained. Three days later I found myself at a medical education conference, attending a session discussing learning plans. A popular tool in adult education generally, and a training requirement for all GP registrars, learning plans are actively disliked by many. Done purposely and thoughtfully, they can be of great benefit; completed hastily or reluctantly because they are compulsory, they are next to useless. I have to confess that, as a registrar, my own learning plans were dashed off with little thought, submitted and then promptly forgotten. I’d never thought this technique would work for me. At the conference, the attending educators were instructed to each write a learning plan that addressed an aspect of their non-medical lives. We were asked to choose something that we genuinely wanted to improve. I instantly knew what I’d write about, and completed the task with seriousness and sincerity. The facilitator randomly picked a few participants to read out their learning plans. The topics were predictable: “I want to exercise each morning”, “I want to get at least seven hours of sleep a night” and the like. Yes, you can see where this is leading ... I should have anticipated being called upon, but when the “We have time for one more, how about you?” came, along with direct eye contact and a kindly smile, I momentarily panicked. Surveying the room of mostly middle-aged, male faces, many of whom I didn’t know, I considered making something up on the spot. Instead, I stood up, took a deep breath and read out: “I want to be a more exciting whore.” I then outlined my proposed methods for achieving this objective and how I intended to measure my progress. Without explanation, I then sat down. Silence. Not a sound. Most eyes were glued to me, the others looking anywhere but. The atmosphere was thick with shock, amusement, confusion, suspense and fascination. I didn’t leave them hanging for too long. After my disclosure as to why I chose the topic and the context in which I was “whoring”, there were audible sighs of relief and a sprinkling of laughter throughout the room. It was memorable for those present. Four years later, I still get the occasional question about my “whoring” when I run into certain educators at conferences. I am pleased to report that my learning plan well and truly achieved its aim. I enacted my plan exactly as written and practised diligently. I knew I had been successful when the director instructed me to “Tone it down a bit. This is a family show, you know!” I now feel a lot more comfortable extolling the benefits of learning plans to unconvinced registrars. I tell them: “I used to think that I wasn’t a learning plan-type person either but I’ve discovered that if you choose a relevant and important objective and spend time and effort working out how to achieve it, the technique can really work.” I tend to leave out: “It didn’t do much for my medicine, but it turned me into a fabulous whore.” This blog post has been adapted from a column first published in Australian Doctor. Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/  
Dr Genevieve Yates
almost 5 years ago
#3
Foo20151013 2023 e9tc1t?1444774226
5
119

Grand Round: Dos and Don’ts

“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” The words of Sir William Osler, the acclaimed father of modern medicine, are still no less profound. They hark from an age when medicine still retained a sense of ceremony: an amphitheatre filled to the rafters, the clinicians poised in their white coats and ties, all eyes convergent on their quarry or rather the patient seated before them. Any memory of such scenes live out a vestigial existence in black&white photos or histrionic depictions recalling the rise of modern medicine. To think this is how the tradition of grand rounds proceeded in the not so distant past. Today grand rounds have a more tuitional flavour to them. The Socratic dialogue which reportedly took place has been superseded by the much less appetising PowerPoint presentation. It’s a weekly event marked in the calendar. For the ever-busy junior doctor it at least offers the prospect of a free lunch. I gest, they serve a social as well as an educational function. On the other hand medical student grand rounds are purely a learning exercise. They are most importantly not a race to find and present the most ‘interesting’ case in the trust because this is usually interpretted as a vanishingly rare condition, which even your ejudicating consultant has never encountered in a lifetime of experience. It falls short of the primary aim: to learn about the patients who you will be seeing as a junior doctor and as the addage goes - common things are common. What will make your grand round interesting, is not the patient you choose but how you choose to present that patient. Unfortunately, as fair a point Sir Osler makes, the old practice of patient participation in grand rounds has long since faded. You will have to call upon your thespian talents to retell the story to your fellow students. Of course not everyone’s a natural showman, however fortune favours the prepared and in my experience there are only a handful of things to worry about. Structure. This is the back bone of your presentation. Obviously a solid introductory line about the patient with all the salient points goes without saying, it’s no different to presenting to the consultant on ward rounds or in the clinic. Always set the scene. If you clerked your patient on a hectic night oncall down in majors, then say so. It makes the case less one dimensional. The history is your chance to show off - to consider the presenting complaint expressed in the patient’s own words and to form a working differential, which you can encourage your colleagues to reel off at the outset. The quality of the history should guide your audience to the right diagnosis. Equip them with all the information they need, so not just the positive findings. Showing that you have ruled out important red flag symptoms or signs will illustrate good detective work on your part. However you wish to order the relevant past medical/family history, medications, social impact etc is up to you. It’s a subjective thing, you just have to play the game and cater to the consultant’s likes. You can only gage these after a few cases so do the honourable thing and let your colleagues present first. Performance. Never read your slides in front of an audience. Their attention will rapidly wane (especially if they’re postprandial). The slides are an aide-memoire and to treat them as a script is to admit your presence adds nothing more to your presentation. Communicating with the audience requires you to present uncluttered slides, expanding on short headings and obliging your colleagues to listen for the little nuggets of clinical knowledge you have so generously lain in store. Insight. When the consultant asks you the significance of an investigation, always know on what grounds it was ordered and the limitations of the results. The astute student will be aware of its diagnostic or prognostic potential.The same may be said of imaging. Perusing the radiologists report and using it to guide the audience through (anoynmised) CXRs, CTs, US etc is a feather in your cap. Literature reviews of your choosing constitute a mandatory part of the presentation. They are demonstrative of not only your wider reading but your initiative to find the relevant evidence base e.g. the research underlying the management plan of a condition or perhaps its future treatments. Timing. Waffling is only detrimental to the performance. Rehearsing the presentation with a firm mate is a sure way to keep to time constraints. Memorability, for the right reasons, relies on a concise and interactive presentation. A splash of imagination will not go unnoticed. The consultant marking you has seen it all before; surprising titbits of knowledge or amusing quirks in your presentation will hopefully appeal to their curious and humorous side. If anything it might break the tedium grand rounds are renown for. Oratory is a universal skill and is responsible for so much (undue) anxiety. The more timid can take comfort grand rounds aren’t quite the grand occasions they used to be. Illustrator Edward Wong This blog post is a reproduction of an article published in the Medical Student Newspaper, December 2013 issue.  
James Wong
almost 5 years ago
#4
Foo20151013 2023 fkplre?1444774007
3
1085

Pathological Priorities

Previously I blogged about the 'stigma' and discrimination often faced by those confronting mental illness - even by colleagues. It was incredibly apt, therefore, that just a week later, the Royal College of Psychiatrists (RCPsych) published their "Parity" report. The report entitled Whole Person Care: from rhetoric to reality calls for an equality in physical vs mental health. As with many of my colleagues, I saw the word "Whole Person Care" and was instantly guilty of a pre-formed stereotype. I don't like the term whole person care nor holistic medicine. I hear these terms and my thoughts instantly switch to bright colours, 60s attire and I start humming "this is the dawning of the age of Aquarius". More so, this topic becomes riddled with questionable pseuodoscience and tentative nods to evidence-less forms of complimentary medicine. I think such terms are perhaps self destructive and instantly mark out mental health as odd. Ambiguous terms such as this make the whole topic even more off putting. Holistic rants aside, this report is an exceptionally important read (or at least glance) for all future doctors. There is an unquestionable inequality in mental and physical health in this country. It seems that if we can't 'see' something, it's not quantifiable and therefore loses a position of importance. It leads us to have 'pathological priorities', putting the physical before the mental. Despite this, both influence one another and deserve equal importance. Some of the key points of the report are: A call for equal funding of Mental and Physical Health Services A call to reduce discrimination and stigmas associated with Mental Health A call for equal care and treatment of Mental health/Physical Health A call for management and leaders (such as commissioning boards)to acknowledge the equality of mental/physical health Perhaps the most important for myself as I read through this was a call for equal access to Mental Health treatments under NICE clinical guidelines. Currently, patients have the right to receive only mental health treatments which have undergone NICE technology appraisals - not those offered by clinical guidelines. For example, NICE Clinical Guidelines state talk therapies are more effective than instant antidepressants for treatment of mild depression. The report is a huge step toward equality in mental and physical health. Perhaps we should all just take a moment to address the importance of both. You can read the full report and a summary on the RCPsych website here: http://www.rcpsych.ac.uk/usefulresources/publications/collegereports/op/op88.aspx  
Lucas Brammar
almost 6 years ago
#5
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Immunology - MHC I Processing

https://www.facebook.com/ArmandoHasudungan Support me: http://www.patreon.com/armando Instagram: http://instagram.com/armandohasudungan Twitter: https://twit...  
YouTube
over 4 years ago
#6
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2317

Microbiology - bacteria, fungi, yeasts and viruses

I made this Powerpoint presentation a while ago to help me learn/revise this topic.  
Sarah Watson
about 7 years ago
#7
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Pediatrics - Endocrinology part 1

The online lecture series for medical students. On demand streaming video lectures. www.mdcrack.tv Owner: MD CRACK  
YouTube
over 4 years ago
#8
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2
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Retroverted Uterus

The normal position of the uterus is anteverted. In this position, the uterus is concave on the side of the bladder, and bends round to sit just above and behind the bladder.   In a retroverted uterus, the uterus instead bends ‘backwards’ so that the concave side is posterior. About 20-30% of women have a retroverted uterus.   Clinical features  
almostadoctor.com - free medical student revision notes
almost 5 years ago
#9
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19
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Psychiatry Presentation

This is a powerpoint presentation I created on Psychiatry recently. All information is taken from NICE guidelines and MIMs guides. If any information is incorrect let me know! Pictures are from google. This was a bit of a slog to make truth be told and it is a LONG presentation, but I feel most of the information that is relevant to sitting final written exams is in there. I hope it helps!  
Conrad Hayes
over 5 years ago
#10
30087
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Calcium - Physiology and pathology

Video tutorial on calcium homeostasis, calcium pathology including hypocalcaemia and hypercalcaemia.  
Podmedics
over 7 years ago
#11
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Brachial Plexus Made Insanely Easy

This is the best way to learn anatomy! Sick of long and boring videos? This lecture is concise, engaging, and effective!  
YouTube
almost 5 years ago
#12
Fd4421b361d4ac8368f0fa8de280c0abd83ca11a21883323795002918
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Chronic Obstructive Pulmonary Disease (COPD) - Ahmados Notes

Through out my 6 years studying, I made huge number of medical notes simplified from medical textbooks to one A3 paper in a well-organized manner that will let students to study easily and effortlessly ,, You can imagine this by looking at my "COPD" in the attachment. My COPD explanation video in "Ahmados Academy youtube channel" : https://youtu.be/b1Yzi-KxsFk My facebook page : https://www.facebook.com/Dr.Ahmados.Summaries  
Ahmados Academy
over 3 years ago
#13
Foo20151013 2023 e2a8vo?1444774258
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217

Monkey See, Monkey Do.

So you're sitting in a bus when you see a baby smile sunnily and gurgle at his mother. Your automatic response? You smile too. You're jogging in the park, when you see a guy trip over his shoelaces and fall while running. Your knee jerk reaction? You wince. Even though you're completely fine and unscathed yourself. Or, to give a more dramatic example; you're watching Titanic for the umpteenth time and as you witness Jack and Rose's final moments together, you automatically reach for a tissue and wipe your tears in whole hearted sympathy ( and maybe blow your nose loudly, if you're an unattractive crier like yours truly). And here the question arises- why? Why do we experience the above mentioned responses to situations that have nothing to do with us directly? As mere passive observers, what makes us respond at gut level to someone else's happiness or pain, delight or excitement, disgust or fear? In other words, where is this instinctive response to other people's feelings and actions that we call empathy coming from? Science believes it may have discovered the answer- mirror neurons. In the early 1990s, a group of scientists (I won't bore you with the details of who, when and where) were performing experiments on a bunch of macaque monkeys, using electrodes attached to their brains. Quite by accident, it was discovered that when the monkey saw a scientist holding up a peanut, it fired off the same motor neurons in its brain that would fire when the monkey held up a peanut itself. And that wasn't all. Interestingly, they also found that these motor neurons were very specific in their actions. A mirror neuron that fired when the monkey grasped a peanut would also fire only when the experimenter grasped a peanut, while a neuron that fired when the monkey put a peanut in its mouth would also fire only when the experimenter put a peanut in his own mouth. These motor neurons came to be dubbed as 'mirror neurons'. It was a small leap from monkeys to humans. And with the discovery of a similar, if not identical mirror neuron system in humans, the studies, hypotheses and theories continue to build. The strange thing is that mirror neurons seem specially designed to respond to actions with clear goals- whether these actions reach us through sight, sound, smell etc, it doesn't matter. A quick example- the same mirror neurons will fire when we hop on one leg, see someone hopping, hear someone hopping or hear or read the word 'hop'. But they will NOT respond to meaningless gestures, random or pointless sounds etc. Instead they may well be understanding the intentions behind the related action. This has led to a very important hypothesis- the 'action understanding' ability of mirror neurons. Before the discovery of mirror neurons, scientists believed our ability to understand each other, to interpret and respond to another's feeling or actions was the result of a logical thought process and deduction. However, if this 'action understanding' hypothesis is proved right, then it would mean that we respond to each other by feeling, instead of thinking. For instance, if someone smiles at you, it automatically fires up your mirror neurons for smiling. They 'understand the action' and induce the same sensation within you that is associated with smiling. You don't have to think about what the other person intends by this gesture. Your smile flows thoughtlessly and effortlessly in return. Which brings us to yet another important curve- if mirror neurons are helping us to decode facial expressions and actions, then it stands to reason that those gifted people who are better at such complex social interpretations must be having a more active mirror neuron system.(Imagine your mom's strained smile coupled with the glint in her eye after you've just thrown a temper tantrum in front of a roomful of people...it promises dire retribution my friends. Trust me.) Then does this mean that people suffering from disorders such as autism (where social interactions are difficult) have a dysfunctional or less than perfect mirror neuron system in some way? Some scientists believe it to be so. They call it the 'broken mirror hypothesis', where they claim that malfunctioning mirror neurons may be responsible for an autistic individual's inability to understand the intention behind other people's gestures or expressions. Such people may be able to correctly identify an emotion on someone's face, but they wouldn't understand it's significance. From observing other people, they don't know what it feels like to be sad, angry, surprised or scared. However, the jury is still out on this one folks. The broken mirror hypothesis has been questioned by others who are still skeptical about the very existence of these wonder neurons, or just how it is that these neurons alone suffered such a developmental hit when the rest of the autistic brain is working just dandy? Other scientists argue that while mirror neurons may help your brain to understand a concept, they may not necessarily ENCODE that concept. For instance, babies understand the meaning behind many actions without having the motor ability to perform them. If this is true, then an autistic person's mirror neurons are perfectly fine...they were just never responsible for his lack of empathy in the first place. Slightly confused? Curious to find out more about these wunderkinds of the human brain? Join the club. Whether you're an passionate believer in these little fellas with their seemingly magical properties or still skeptical, let me add to your growing interest with one parting shot- since imitation appears to be the primary function of mirror neurons, they might well be partly responsible for our cultural evolution! How, you ask? Well, since culture is passed down from one generation to another through sharing, observation followed by imitation, these neurons are at the forefront of our lifelong learning from those around us. Research has found that mirror neurons kick in at birth, with infants just a few minutes old sticking their tongues out at adults doing the same thing. So do these mirror neurons embody our humanity? Are they responsible for our ability to put ourselves in another person's shoes, to empathize and communicate our fellow human beings? That has yet to be determined. But after decades of research, one thing is for sure-these strange cells haven't yet ceased to amaze and we definitely haven't seen the last of them. To quote Alice in Wonderland, the tale keeps getting "curiouser and curiouser"!  
Huda Qadir
almost 5 years ago
#14
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Endometriosis

 
almostadoctor.com - free medical student revision notes
almost 5 years ago
#15
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1
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Medical Mnemonics .com: World's Database of Medical Mnemonics

A free online searchable database of medical mnemonics to help students of health-related professions remember the important details.  
medicalmnemonics.com
over 3 years ago