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We’re really excited about our new slide technology and the potential it has for creating dynamic, interactive slides with audio and video.
The technology is from the kind folks at iSpring who have collaborated with us to enable us to start producing some great interactive slides for student medical education.
Take a look at our first foray below – it’s a guide to assessing and evaluating back pain.
We have big plans for the future for this – OSCE stations anyone? We feel its an excellent string to our already strong bow of MCQs, video, podcasts and guides. And of course all new content we produce will be available, at no extra cost, to our members.
We would love to hear what you think of it and are open to all of your ideas for developing educational content for medical students. Let us know what you want to see!
Thanks for talking to us Joel. We came across you via the social networking site Twitter. As a UK based doctor, its always nice to chat to students from across the pond. Tell us a bit about yourself and your medical training.
Joel Adler, Studying at the University of Wisconsin School of Medicine, USA, Founded in 1848 (which is significantly before www.medicaleducator.co.uk!
First of all, thanks for asking me to do this. Born and raised in Wisconsin, I earned my undergraduate degree in Spanish from the University of Wisconsin-Madison. I’m presently a third-year medical student at the University of Wisconsin School of Medicine and Public Health. I spent a year between second and third year on a research fellowship from the Howard Hughes Medical Institute. I studied novel therapeutics for neuroendocrine tumors and clinical outcomes of surgical management of endocrine disease. After I graduate next May, I plan to pursue residency training in general surgery with fellowship training in either surgical oncology or transplant surgery.
As you know we’re a British website, run by British doctors but we feel our information is relevant to medical students from across the world. Do you know of any specific differences between medical training in the US and the UK?
As I understand it, the main difference is in the way we split our training. In the US, we do a separate degree (often at a different institution) before enrolling in medical school. The undergraduate degree can be of any course of study, as long as specific pre-medical requirements (biology, chemistry, physics, etc.) are fulfilled. As I mentioned earlier, mine was Spanish. Medical school is four years in length, with optional extensions for other degrees (MPH, PhD) or experiences. But as far as the overall training of medical school, I’m not aware of any large differences.
Medical students in England have very limited professional responsibility and remain heavily supervised at all times (for example, they do not see patients unless they have been first reviewed by an attending doctor. Is this the same in the US?
We’re supervised all the way through. Most medical schools follow a traditional format: the first two years are classroom instruction with sporadic clinical experience, and the final two years are clinically based with less formal classroom instruction. In the final two years, most supervision is performed by resident physicians. Responsibility increases with time, but we are certainly supervised at all times. There’s usually no requirement for signoff before seeing patients, but we are typically observed in our interactions and signed off at that time.
Do you get many opportunities to do practical procedures? If so, what sort of things do medical students in general have the opportunity to do?
Procedures are certainly possible, and are dependent upon the clinical clerkship. Most students have a fair deal of experience in delivering babies, suturing, starting IVs, intubating, and drawing blood. Other more advanced procedures typically come in the fourth year once we have chosen our specialties and spend time working in those specific areas.
In the UK we focus heavily on observed clinical history taking and examination for many of the assessments. Is that something you identify with? And are you familiar with the term OSCE?
Absolutely. The emphasis on this varies between schools, but the majority of school will do some OSCE testing in the first two years in order to prepare for the third year. During the third year, grading is a mix of clinical performance, a written exam, and OSCE-style testing. The emphasis is typically much more heavy on observed clinical day-to-day work, and the OSCE serves as a final exam to ensure that you are competent in areas that weren’t observed. For example, I’m currently rotating on an inpatient medicine service that is very heavy on GI and hepatic disease. During the OSCE, I suspect I’ll have some stations involving either pulmonary or cardiac disease. They seem to be good ways to assess skills, but they tend to be rather artificial situations.
Many UK based medical students wont have heard of the USMLE. What are your views on it as a standard across the US? (in the UK each medical school sets its own exam standards).
As far as a standardized exam, I feel it’s fine. Nobody looks forward to taking them, but many schools provide adequate support and guidance to prepare for the test. The scores are typically used by residency programs when considering applicants, and all parts of the USMLE must be passed before a full medical license is granted. It’s nice to have standard exams to make sure that we’re all covering similar material.
The USMLE comes in three “steps”. Step 1 focuses on pre-clinical knowledge (basic science, pathophysiology, basic treatment and diagnosis) and is usually taken between the second and third years of school. Step 2 is actually two parts: clinical skills (a day-long OSCE-style examination) and clinical knowledge (a day-long written examination on clinical decision making). That is usually taken during the fourth year. And finally, before a medical license is granted, Step 3 is taken during early residency. It focuses on advanced clinical skills and decision-making.
Joel, we’d like to say a big thanks for taking part in our interview. Its great to hear things first hand from an American student. Finally is there anything that you like to use as a US student that we might not be so familiar with over here in the UK?
I’ll share some of the things I use often for studying and caring for patients. I use my iPhone constantly, usually for Epocrates and the Johns Hopkins Antibiotic Guide. I also like MedCalc. On the computer, I love using Evernote to keep track of things to study – I can just open up the program on my phone and studying during downtime. I use Papers (Mac only) to keep my PDFs of articles organized.
Thanks again for your time Joel, and good luck in the forthcoming OSCEs, exams and that USMLE!
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.
Want to know how the exam revision is going? Not sure how many medical questions you’ve got right? Just how good is everyone else at clinical pharmacology?
Medical Eudactor subscribers can track their performance against other users. All data is anonymous.
In our subscription section we have now added the latest data which allows you to compare how you’re doing with our other medical educator subscribers. If you are a subscriber why not have a look for yourself?
And whilst we’re on the topic, our new exam paper has been published with 150 new questions all written at SPR or consultant level. Want to try them out? Why not subscribe!
Currently we have a limited 6 months for the price of 3 offer. They are written and edited with your medical finals in mind.
This is the latest in a series of improvements to the site, following on from our improved video download speed as a result of technical improvements.
To quote one of our users:
.hmmessage P { margin:0px; padding:0px } body.hmmessage { font-size: 10pt; font-family:Verdana } I’m loving the website, its a much friendlier layout compared to the xxxxxxx site
(we’ve edited out the other leading medical student exam revision site!)
The most important thing is the quality of our content, not the volume, and the intention to provoke thought and debate.
There are numerous standards which local hospitals in the United Kingdom have to adhere to, for example to perform well in the “Annual Health Check”, run by the Healthcare Commission. This sets the standards for the hospital practice across a number of domains. What about the trainees in these hospitals? Whilst Medical Educator has little formal experience of funding practices in the US, and other parts of Europe, here in Britain 2 things are clear.
Firstly hospitals are recieving large amounts of funding fro the training and education of medical students, including assessment, evaluation and preperation for their medical exams, OSCEs and revision papers.
Secondly hospitals are under increasing pressure to achieve relevant targets such as the “4 hour wait”.
So far so good. Information about how good local services are being put to good use. Check out the influential BBC’s health website, touting the following postcode search for local services. Surely no bad thing?
The BBC's link to the Care Quality Commission website which will allow you to search local services by postcode
What isn’t clear is the priority that issues such as continuing medical education, medical student training and the quality of these activities will have under these increasingly pressured environments. More importantly is this data actually reliable? Is it validated by independent inspectors, patients, doctors, nurses, physiotherapists, managers and secretaries who work in these institutions? Is there pressure to perform well under the spotlight of the media, as recent accusations of certain English hospitals have recently suggested?
What about the medical press. Are they immune to this new phenomenon of the information age. What is an impact factor anyway? It could be considered that in this regard, being under the media spotlight isn’t so much of a problem is you’re a medical journal as the Lancet found out this month, accusing the religious leader of ‘distorting condom science’. The Lancet’s editorial has cited that Pope Benedict the XVI has made an
…outrageous and wildly inaccurate statement about HIV/AIDS
The Lancer 373 Issue 9669
The Lancet editorial certainly does seem to have a point, so what do these 2 seemingly unlinked topics have in common?
The increasing pressure of organisations to be accountable for their profiles in their own communities, be it local Health Authorities or the Medical Literature is plain to see. A quick Google search of Lancet pope reveals >270,000 results. Is there an ulterior motive to some of this reporting? Or simply action taken in the public interest. Has the Lancet reported on any other religious leaders / other religions and their attitudes to certain practices? The counter argument is that this is a vital public health issue, and one that seemingly should be above an individual / organisations own goals or ideals.
Certainly the information age is one of the main driving forces behind the actions taken by individuals, authorities, journals, and other healthcare organisations. Just as long as we all know where we’re going, and that the informaiton itself isn’t up for manipulation…The verdict from the action of the Lancet is that we largely applaud their stance, are they casting sufficient scrutiny on other religious practices? WIth regards the Healthcare Commission, time will tell.
