Archive for the 'Medical Education' Category
March 5th, 2013
Guest poster Thomas Lemon from the School of Medicine at Cardiff University gives his review of a popular student text. Here is his review of Research Skills for Medical Students 1st Edition (Allen, AK – 2012 Sage: London ISBN 9780857256010).
Themes – Research Skills, Critical Analysis Medical Students
Thesis – Research and critical analysis are important skills as highlighted by Tomorrow’s Doctors
Allen, drawing on many years’ experience as a researcher and lecturer in the Institute of Education, at Cardiff University has bridged the gap in Research methodology literature targeted at medical students. Pushing away from comparative texts somewhat dry and unengaging tones, this book encourages student interaction, empowering the student from start to finish. Not so much a book as a helpful hand guiding the student through the pitfalls and benefits of research and critical analysis from start to finish.
Photo by bjornmeansbearPart of the Learning Matters Medical Education series, in which each book relates to an outcome of Tomorrow’s Doctors, this book is written from the a lecturers standpoint, guiding students through making sense of research, judging research quality, how to carry out research personally, writing research articles and how to get writings published. All of these are now imperative skills in what is a very competitive medical employment market.
This concise book, through its clarity, forcefulness, correct and direct use of potentially new words to the reader, Allen manages to fully develop the books objectives, using expert narrative skills.
With Allen’s interest in Global health, it is little wonder why this books exposition is clear and impartial, Allen consistently refers back to the Tomorrows doctors guidelines at the beginning of each chapter, enabling students to link the purpose of that chapter to the grander scheme. This enables Allen to argue the relevance of each chapter to the student before they have disregarded it. Openly declared as a book aimed at medical students (and Foundation trainees where appropriate) the authors style remains formal, but with parent like undertones. It is written to encapsulate and involve the student reader personally, with Allen frequently using ‘you’ as if directly speaking to the reader, and useful and appropriate activities that engage the reader in the research process, in an easy to use student friendly format.
This book is an excellent guide for all undergraduate health students, not limited to medical students, and I thank Ann K Allen for imparting her knowledge in such a useful and interactive way.
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December 12th, 2012
“It was horrible”- emerging consensus on the Situational Judgement Test sat by medical students for the UK Foundation Programme
Photo by clemsonunivlibraryIn December, the long nights and cold mornings make things tough for medical students on their way to clinical placements. Friday the 7th of December was no exception as the first round of the Situational Judgement Test (SJT) rolled out across the UK for medical students. The SJT is used to help to rank the job applications of thousands of medical students qualifying to be doctors in 2013.
So what was the verdict on the new assessment? Our own contact with students suggests two key themes: question difficulty and time pressure. This left many students struggling to cope with the time pressure, grasping for answers, and filling out the final questions without reading them in detail.
“It was horrible”
Recurring comments include long stems, long answers, and similar question responses making things difficult. As some students turned to the range of revision resources available, no single source seems to have provided all of the answers. A writer who has produced situational judgement tests for MedicalEducator gave her thoughts.
“It’s not surprising that the SJT proved a tough task for medical students. A new assessment, with one question every two minutes seems tight for what are detailed scenarios. For some students it will be relief that the SJT round is over, for the second half of UK medical students, at least they know what to expect- a difficult, time pressured assessment.”
The second round of SJTs will take place in January 2013. MedicalEducator has authored a range of situational judgement tests for the MPS, which are freely available to all members of the MPS. Just sat the SJT? Give us your verdict below!
November 22nd, 2012
Look at this skin rash. It measures 6cm in length and is occurring over the extensor aspect of the upper forearm.
Which of the following treatments is likely to result in the resolution of the rash?
a. Coal Tar
b. Mesalazine
c. Flucloxacillin
d. Topical ibuprofen
e. Topical capsaicin
Leave your answers as a comment below! Answer in a few days…
October 22nd, 2012
A medical qualification equips you with a passport to the world – it enables you to transport your skills anywhere, with opportunities to enhance them. Having appropriate indemnity is essential before you pack your bags.
Photo by the russians are hereBefore practising in a new country it is important to protect yourself: new countries may bring new risks. Having indemnity and access to 24-hour medicolegal advice is vital, and this is where MPS can help.
MPS can protect you whether you are relocating permanently, for just a year, or working on an expedition or voluntary project. The NHS indemnity scheme, which is limited to clinical negligence claims arising from NHS hospital care and claims made against the trust, does not extend to doctors working abroad.
In an article in New Doctor, the risks are discussed in more detail.
Dr Pallavi Bradshaw, MPS Medicolegal Adviser, says: “Junior doctors must be alive to the ever-increasing risks of clinical practice. Doctors travelling abroad should be alert to the current legal and ethical climate within a particular country. Being aware and managing these risks will safeguard you for the future.”
MPS protects the interests of members when concerns are raised about their practice, in any form – claim, complaint, medical council investigation. With members practising in more than 40 countries, if you are planning to work overseas MPS membership can often be arranged.
Talk to a membership adviser before travelling if you are planning to work overseas. Use the helpline number 0845 718 7187, or email international@mps.org.uk. You should provide details of your scope of practice and where you intend to work, so we can confirm the correct subscription rate for your work.
Read more about the service here, and read the New Doctor article in full here.
September 28th, 2012
Wrongly inserting a nasogastric tube can have deadly consequences. A recent Casebook article outlines how to avoid these risks
Photo by St. MurseIn 2010 75-year-old Maurice Murphy died in hospital as a result of a misplaced nasogastric tube. He was being treated for liver failure and required a nasogastric (NG) tube to be inserted. Unfortunately this ended up in his right lung instead of his stomach and feeding commenced, resulting in fatal pneumonia.
At the inquest it emerged that a junior doctor was challenged by a nurse to confirm that the tube was in the right place. The doctor in question overruled her, saying: “You don’t have a brain to remember that I told you to start the feed as the tube is in the right position.” It also emerged that there was an x-ray flagging the error. So why hadn’t anyone seen it? It would appear that a combination of factors led to the death of Mr Murphy – the misplaced confidence of the junior doctor, the fact the standardised procedure for inserting a tube was not followed, and that the x-ray was not reviewed.
This case report highlights just how careful you have to be. There are big risks associated with NG tubes, and if a misplaced tube is not spotted before feeding, patients can suffer complications like pneumonia, which can be fatal.
Avoiding the risks
Individual clinicians should consider the following before going through with the procedure:
- Is nasogastric feeding right for this patient?
- Does this need to be done now?
- Am I competent to do this?
- How can I check the right amount of tube has been inserted?
- Do I know how to test for correct placement?
- What is a safe pH level?
- When should I get an x-ray?
- What should I look for on the x-ray?
- What about repeat checks?
Did you know?
- The ‘whoosh’ test is unreliable in detecting the placement of NG tubes. The NPSA recommends pH testing using pH indicator paper as a first-line check – pH levels between 1 and 5.5 are safe.
- The NPSA was notified of 21 deaths and 79 cases of harm due to misplaced NG tubes between 2005 and 2011. The single greatest cause of harm was due to misinterpretation of x-rays. A chest x-ray is required if the first-line check fails to prove the NG tube is safe for use.
- Flushing NG tubes with water before placement can cause a pH reading of below 5.5 because of the mix of water and lubricant – this can cause practitioners to assume that NG tubes are correctly placed, when they are not.
The National Patient Safety Agency (NPSA) has issued many warnings about the dangers of nasogastric tubes over recent years. The most recent alert was in March 2012, when they issued Rapid Response Report, Harm from flushing of nasogastric tubes before confirmation of placement [1]. The NPSA is aware of two patient deaths since March 2011 where staff had flushed nasogastric tubes with water before initial placement had been confirmed. This is extremely dangerous and all medical staff should be aware that gastric placement must be confirmed before the tube is flushed.
The NPSA states that “misplaced nasogastric tubes leading to death or severe harm are ‘never events’.” Never events are very serious, largely preventable patient safety incidents that should not occur if the relevant preventative measures have been put in place.
The full Casebook article, Nasogastric tube errors, can be read here – http://www.medicalprotection.org/uk/casebook-september-2012/nasogastric-tube-errors.
