Medical Educator – Medical students, revise for your OSCE medical student exam with our free MCQs, EMQs, videos, podcasts, downloads.

Podcast: a history of chest pain

Today we are focussing on chest pain and listening to a patient describe their problems. Chest pain is is one of the most common reasons to be seen and assessed on an emergency department in the UK. Listen to the patient and try to diagnose – then see what our diagnosis is for the chest pain.

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Medical Educator interviews Professor Alan Mortiboys: Perspectives on Emotional Intelligence, and its importance to medical training.

Alan Mortiboys is Professor of Educational Development at Birmingham City University, United Kingdom. He talks to James Bateman from the Medical Educator team about learning theories.

Professor Alan Mortiboys, Tutor for Educational Development at Birmingham City University

Professor Mortiboys lectures at BCU on educational development and also on formal “medical education” programmes to doctors and health professionals including the Masters in Medical Education at the University of Warwick.  His publications include Teaching with Emotional Intelligence (Routledge 2005) and The Emotionally Intelligent Trainer’s Toolkit. (Fenman 2004). He is also a Fellow of the Royal Society of Arts.

Thanks for talking to us Alan. You came to the attention of Medical Educator after we heard you speak on learning styles. We write a little about this on the site: From your perspective on teaching, where do you see the typical doctor falling into in terms of the ‘pragmatists’, ‘theorists’ ‘reflectors’ and activists? Have any patterns emerged from your own experiences?

Many doctors I have met have the characteristics of the ‘pragmatist’ – asking ‘What’s the implications of this?’ or ‘How do I prepare to put this into practice?’ I guess this reflects the work that you do, normally called upon to make decisions, plan and act, often under pressure. If you want to behave a like, say, a reflector, you need plenty of time to step back and think things through thoroughly, with no compulsion to act, only to arrive at conclusions. I have not met many doctors whose working situation allows or encourages that. Here’s a question for you – do pragmatists set out to become doctors or does being a doctor make you a pragmatist?

Do you think people teaching should always have consciously have these concepts in their minds?

The case has been made that although the idea of these four learning styles has aroused a great deal of interest, there is no solid evidence to back up the theory. Nonetheless, teachers have found the idea very useful. Awareness of these different styles can usefully inform your planning for any episode of teaching. You can say to yourself, ‘If these learning styles do exist, what will there be in this session that I am planning which will engage each of the activist/ reflector/theorist/ pragmatist, given that they each look for something different as a learner?’

Others have suggested that you should help your learners become aware of their learning style and assist them in developing their less favoured styles. That means to help the activist, for example, to know how to respond productively when they are in a situation in which there is no opportunity to learn by doing, by trial and error.

The question for you as a teacher is, do you set out to acknowledge and accommodate people’s learning styles, or to develop and shape them?

I was intrigued when I first heard your comments on multiple intelligences. Most medical students won’t know what this means: tell us a little about it.

Howard Gardner‘s idea of multiple intelligences challenged the notion that there is one form of intelligence which incidentally can be measured by an IQ test. He suggested back in the 1980′s that we have seven intelligences, each of which is developed to a greater of lesser extent in every one of us. We each have our own intelligence profile. The question is not, ‘How intelligent are you?’ but ‘How are you intelligent?’

The seven are: linguistic, logical mathematical, spatial, musical, bodily kinaesthetic, interpersonal and intrapersonal.

Like learning styles, the evidence for the existence for these intelligences has been questioned. Like learning styles, the idea has proved very popular in some sectors of education.

How do you see multiple intelligences applying to student and junior doctors as they go through their training?

As with learning styles, the first step is to become aware of your own preferred/dominant intelligences and then decide – are you going to play to your strengths or are you going to improve your less developed intelligences? It can be liberating to recognise that you are never going to learn well by reading about things (linguistic) but that by manipulating objects and experimenting with them, you will always learn rapidly(bodily kinaesthetic).

You also write on emotional intelligence. Is this an important characteristic for medical students?

My chief interest in emotional intelligence is in how it applies to teaching. I am convinced that the effective teacher has to use emotional intelligence, that is, put energy into:

• Encouraging an emotional state in your learners that is conducive to learning

• Recognising and responding to the feelings of both yourself and your learners in the classroom, in order to make you both more effective in your respective roles

Daniel Goleman’s definition of emotional intelligence, which is not specific to any occupation, is:

Professor Alan Mortiboys: Teaching with Emotional Intelligence

“The capacity for recognising our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and in our  relationships’. You cannot avoid the emotional dimension in your work, whether in dealing with patients or with colleagues, and a developed emotional intelligence will help you to function more effectively, giving you more energy to tackle problems and more resilience when under pressure.”

Medical Educator Would like to thank Professor Alan Mortiboys for his contribution.

Politicisation of Healthcare:Medical student training may become the 8th point?

Nice to read what’s going on at the Whitehouse after President Barack Obama was sworn in earlier today: they have some sensible thoughts about helthcare in the US the complete transcript of which you can read here.

The 7 key reforms listed on the site are as follows:

• “Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.”
• “Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.”
• “Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.”
• “Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.”
• “Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees’ health care.”
• “Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.”
• “Ensure everyone who needs it will receive a tax credit for their premiums.”

Some of these concepts will be unfamiliar to our British and European students. How much will this cost the US taxpayer? $65 billion is just the start. It will be interesting to see if the medical training comes under closer scrutiny under the new regime.

The Rise of the EMQ (Extended Matching Question!)

EMQ’s

EMQ’s are being increasingly used in research and papers have recently been published on their success in the USMLE. Its likely that many medical schools will adopt this N from many approach. An EMQ is simple: its a series of typically 6-10 answers, used a number of times with different question stems.They first cropped up in 1993 after work by Case and Swanson. Read more about EMQ’s and their development here.

Distracters

Distracters are being used to throw students off the scent, and in some ways discriminate from good and bad students. An example would be describing a history of a rash affecting the flexor surfaces and giving on e of the answers as psoriasis. Seeing the two together can lead to the assumption this is the correct answer. This is an example of a good discriminator, but EMQs can easily be written in such a way that the more capable student gets it wrong!

Take an example EMQ from our new section dedicated to them on the login site.

“A 64 year old homeless man presents after being found exposed under a bush shelter by paramedics. He is ‘tided over the night’ by the emergency department staff with an IVI of 5% dextrose. The next morning he is confused, and ataxic. On examination he has nystagmus. Which of the following is treatment is most likely to be effective?”

Students classically then have to pick from a range of answers:

• Aciclovir
• Ciprofloxacin
• Buscopan
• Omeprazole
• Gluten free diet
• Peg Interferon alpha
• Mesalazine
• Vitamin B Complex

Here’s the Answer from the main site:

“Nystagmus, and ataxia are features of cerebellar disease, with the addition of confusion this triad is suggestive of Wernickes Encephalopathy (vitamin B1 deficiency- thiamine). Risk factors: poor nutrition (+/- alcohol).

Thiamine is important in carbohydrate metabolism and the Krebs cycle: it’s vital to remember that dextrose presents a carbohydrate load, the excess of which cannot be effectively metabolised , leading to cell death.

Hence the treatment: Vitamin B complex: initially this is given as Intravenous Pabrinex © for 48-72 hours.”

The EMQ here does a number of things: You could use your knowledge of drugs alone to answer the question: An antiviral (acivlovir), quinalone antibiotic (ciprofloxacin), an antispasmodic (buscopan), a Proton pump inhibitor (omeprazole) a gluten free diet (!), etc.

Aciclovir would initially seem attractive for a possible encephalitis- there are some things that fit: confusion, other CNS signs? This is a form of a distracter-look at the history, and the role of the glucose drip.Here the answer has been worked through by correctly recognise the triad of opthalmoplegia, confusion and ataxia that isin keeping with the diagnosis of Wernickes.

So, we can see that EMQs look initially pretty intuative, but more are being written, and expect them to be coming to an exam near you soon.

You can work through some examples of EMQ’s to prepare for your medical finals with different question structures on the subscription section of our site.

How are you doing?

We’ve published our latest averages on our subscription site topic by topic. This helps our users compare things with other people subscribing. Remember, people revise for their exams in many different ways so it doesn’t allow you to make a direct comparison, but it will give you some idea of how people are doing in comparison to your own marks. Remember we have subscribers from different countries, currently predominantly in the European Union. We here at medical educator aim to set questions at a medical finals level, but these questions could just as easily crop up in any clinical year (years 3-5, phase 2 students) or in problem based learning (Years 1-2, phase 1 students).