Archive for the 'New Research' Category
September 21st, 2011
Modern society is becoming increasingly frantic. If we are not rushing to get somewhere, we are reading headline news or replying to text messages, in between preparing our next tweet and Facebook post, while planning how we can afford an iPad, get fit, feed ourselves, pass our exams and see our friends; I could go on.
Photo by chris@APLStress has become an acceptable cliché, ignored by most and discarded as normal by most medical students and junior doctors alike.
In the United Kingdom, studies have determined that the proportion of medical professionals demonstrating above-threshold levels of stress is around 28%, compared to around 18% in the general working population. The British Medical Association (BMA) has estimated that one doctor in 15 could develop a dependency on alcohol or drugs at some point in their career.
So what’s the moral of this research? Identify when you are being affected by stress and tackle it early. Sara Williams and Gareth Gillespie have written an article in MPS’s signature journal Casebook exploring the indicators of stress and how to tackle it in the medical world – you can read it here.
MPS has also launched a worldwide counselling service for members, to provide support in times of work-related stress. It is available to members who have experienced an adverse incident or medicolegal issue and are experiencing emotional or psychological difficulties. For further information contact MPS at 0845 605 4000 or querydoc [at] mps.org.uk.
January 9th, 2011
Google body: getting a good look at the vasculature and internal organs in 3D
Google Body is here. And boy, although it hasn’t yet it made an impact as far as we can see in the medical community, we like it, and we like it a lot.
Over the years as educationalists contributing to medical education, things come and go. Innovations are frequent, and new developments are normally hamstrung by copyright issues, usability issues, problems with institutional subscriptions, and restricted access to resources.
What is google body? One of our contributors explains…
Google Body lets you do several things, but basically its your own detailed 3d medical body, which you can zoom rotate, and add and remove anatomical layers with ease. Its so simple. I didn’t need any instructions, and I’m pretty sure todays crop of web savvy medical students won’t either. Google don’t specifically say who this is being marketed towards, but superficially it seems perfect for the medical students. I love it. I think you will love it too
Lets consider whats possible. Take a view of the shoulder. The nervous innovation, vascular supply, bursa, tendons and glenoid fossa are all clearly on view. Rotation is simple. Zooming in and out is simple and straightforward. Moving through the different soft tissue plains and adding and removing nervous tissue, bony anatomy, vascular system in what is a very user friendly navigation system.
As a group of educationalists, the potential for medical student and patient education is really fantastic, and whilst the items remain free, we’re all for it.
It really is the next best thing to a three dimensional model. We have been commenting on Google body through our Twitter account, under the hash tag #googlebody. We would be interested to hear medical students opinions on this, and a simple rating scale is below if you want to register your opinion on it, or post a comment below on whether you think it can be used as a good resource for medical students.
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September 20th, 2010
A recent paper in JAMA, the journal of the American Medical Association has found that over third of students with ‘burnout’ had 1 or more ‘self reported’ features of unprofessional behaviour, significantly more than their colleagues not exhibiting these features. Examples included copying other students work, misrepresenting examination findings, and essentially cheating in closed book medical examinations.
As responsibilities of student in the US could be argued to fall above those in the UK (whose work is almost always supervised and duplicated by qualified personnel) these findings are concerning, but perhaps we need to be worrying more about the students than the patients at this stage. The paper handles this issue well, and rather than focusing on sticking the scalpel into students who are clearly struggling the authors make some very sensible conclusions. The following excerpt fits in with the overall tone of the report.
Researches used composite self reported measures including depression scores and quality of life indices.
The fact that students frequently engage in dishonest behaviours despite knowing they are inappropriate may imply that some elements of the learning climate foster dishonesty. This could lead to a situation in which students are more willing to falsely report physical examination findings than admit they performed an incomplete examination. In addition to students’ fear of poor evaluations and a desire to fit in with the team,9 this study suggests that burnout may be another important variable contributing to unprofessional behaviour
The first conclusions we draw reading the report is credit to the authors to allow students to actually report these items: admission of guilt by cheating in a closed book exam is professional misconduct that could end the career of a medical student in Europe or the US, and all the student’s we have spoken to today were surprised students would report these attitudes, even anonymously. The method of determining burnout although robust, is not the point here, the message from the paper speaks clearly: students that are struggling are more likely to fall on the wrong side of professional expectations.
Interestingly the behaviour also related to patient care: such as essentially lying about a test that may not have been requested, or documenting an examination as ‘normal’ which had not in fact been done.
Although students recognize cheating and dishonest clinical behaviours as unprofessional,5-7 feel guilty about engaging in these behaviours, and believe that the behaviours may make them a less trustworthy physician, a relatively high prevalence of unprofessional conduct related to patient care was reported by students in this study.
These things in their own right are small comments, and perhaps not quite the crime they initially seem. If a doctor is filling in a proforma where they ‘have’ to document a certain finding (paper or online) then it is inevitable that at times it is necessary to cut certain corners to deliver the care to the patients. There is a very fine line between poor professionalism and living with the reality of ‘real’ clinical care. What of the student being asked of the Professor of Hepatology if they have counted and charted the location of splinter haemorrhages on the patients fingers. Yes? Or the request for an obscure immunology request (‘I’ve done it’), or the “you do know how this new biologic drug works don’t you?” (no I haven’t a clue but I’m clearly not going to tell you that now Prof).
As such this study perhaps represents a wake up call to those physicians and trainers both teaching and looking after/out for medical students on a day to day basis, and from our own experiences as educators we will conclude with a few lines of verse.
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he’s dead
It must have been too cold for him his heart gave way,
They said.
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.
Stevie Smith, “Not Waving but Drowning”, 1957
April 15th, 2009
Is it possible to have an international site for medical revision? There is a diverse range of assessment methods in place in today’s medical marketplace, ranging from the familiar MCQ exam, to the OSCE format that may not be so familiar to some medical students in the US or in other parts of Western Europe and Asia.
Trying to cater for the 140 countries that use the site and our growing list of >1000 registered users can at times be difficult. We asked one of our contributing registrars to comment on the forms of assessment:
Its a very interesting question if a single site can provide enough different content to suit the needs of different medical students. I think the best approach is to remain diverse in your tutorial and assessment methods on the site, which is something that medicaleducator manages to do. Obviously there’s a number of domains which could be improved, and that’s the big challenge.
When asking a newly qualified doctor about their own experiences we got a slightly different answer:
I dont think it makes any difference what you do, as long as you have some practice in the assessment method- I mean if you’re doing an MCQ, then that’s fine, you should have had some MCQ practice, same goes for an OSCE, but the knowledge you get from sites like these about key important things, that you might not understand, really helps you to get an overall grasp of whats going on.
One of the qeaknesses of assessment methods is the opportunity to use exam technique to help students perform well in OSCEs. James Bateman, one of the key contributors to the site has his own view:
I do see exam technique as an important issue, but for a different reason to many doctors.
An example of the format of the answers used in the site.
I’ve helped a large number of doctors (>20) sit complicated clinical examinations in tutorials of up to 3 doctors (for entry to specialist training). Its actually problems in techniques in fielding and answering questions that leads to the main problem, i.e. the doctors are being penalised for problems in the way that they answer questions.
Its a shame to see people not maximise their potential because of nerves. I do think that assessment methods used are robust (the evidence from the literature supports this), I do think that web based learning on the site will help people learn (as the meta-analysis by Cook DA et al in JAMA suggests).
So our reasons are as follows
- Evidence based medical knowledge is transferable across continents in terms of pathophysiology, clinical assessment investigation, and treatment approaches
- Almost all assessment by medical schools involve MCQ based assessments, a strong component of our approach. This can be useful practice, and any essay format or long answer question will still revolve around key medical facts.
- Clinical examination skills as taught by a video format can help in both clinical and written examinations. Our questions also highlight clinical connundrums based on different clinical findings
- A wide variety of delivery formats will help to provide students with the capacity to learn from multiple different domains
- Detailed clinical answers to MCQ and EMQ question format will help in medical written assessments and other viva situations by providing the students with key clinical facts.
Medical Educator hopes to publish some interviews with UK based and US based medical students in the coming weeks, to see how their needs differ. We already have some US contributors. If you’re a student, and you’re like to get invovled in this, or are interested why not email interviews@medicaleducator.co.uk for further details.
Further Reading:
Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Internet-based learning in the health professions: a meta-analysis. JAMA. 2008;300(10):1181-1196 Full text here.
November 9th, 2008
Nice to see the people at the NEJM continue to provide us with clinically relevant topics across all specialities: none more so than the complication of DVT in pregnant women.The review article (link here) highlights management and thromboprophylaxis in the NEJM. What is more interesting to my eyes is the actual planned investigation of suspected PE in patients who do not have a clinically proven DVT.
An interesting viewpoint for our British Readers can be found at the BTS guidelines in the management of pulmonary embolism here. Note how the issue of imaging in pregnancy is not exactly clear cut!
Nevertheless despite the use of a Well’s score, and ultrasound dopplers of the lower limbs, the jury is still out on the imaging modality of choice for pregnant women with suspected pulmonary embolism (i.e. CT Pulmonary Angiography (CTPA) , Limited CTPA, Limited Nuclear Medicine Scanning, MRI). The risks from nuclear medicine imaging seem likely to be higher than CT given the added problems of a reduced sensitivity and specificity, whereas the use of MRI is limited in the UK by the relative paucity of units offering this as a service/ lack of scanning facilities in some smaller hospitals.
Even though a lead apron will protect the foetus there are still concerns from CT about maternal breast tissue in this situation.
In the absence of hard and fast rules, this is an area of medicine that continues to challenge clinicans on a dya to day basis.
