At first, the students dont see themselves as Doctors but through the blogging process they become more reflective and get used to using the vernacular. From the article:

“When students from ethnic minority communities and disadvantaged economic backgrounds dream of becoming doctors, they sometimes struggle to envision themselves within that world. The contrasts between hometown, university, medical school, and hospital rounds can be overwhelming.”

“Weekly blogging is an integral part of my students’ pre-medicine internship. Through this creative, reflective process, they gradually see themselves as doctors and nurses, redefining their identities.”
Source: Arizona Daily Star

Its an interesting approach and yet another example of new technologies being used in learning and medical education. Have you got help from blogging your personal learning experiences? We’d love to hear from you.

To recap, here is our 36-year old’s patient history and findings:

“I’ve been getting hot for the last 6 weeks, on and off and have been off my dinner, pretty much all the time. I’ve been generally not right, tired and that. I’ve started to get a bit breathless too, not coughing and the like, but still having problems when I’m out. Bad like. Gets worse when I have a fever. Like I’ve had a friend who had the same thing about 3 years ago and he had really bad lung fibrosis, because of infections during his childhood. Not like me and that I’ve always been well. I have still got problems injecting the drugs and that, but like my key worker, she says that me methodone will help me deal with that kind of problem, so from that side I’m pretty happy.”

• Hands Normal.
• Pulse 80.
• No Signs in the face.
• BP 182/92 Pan systolic murmur left sternal edge.
• Otherwise NAD.

Tip 6. Group your thoughts logically every time

a) By the most likely causes
“The differential includes the following:…”

b) By the problem that’s causing the issue:
“Based on the limited information from the history the differential would include infections (viral: T cell disorder seroconversion illness) Bacterial (bacterial endocarditis, bronchopneumonia, abscess etc), fungal (less likely but consider underlying immunosupression), malignancy…”

Tip 7. Let the examiners know you are finished every time

Once you’ve finished or exhausted all the possible causes, let your examiner know! “Causes of a pan systolic murmur include… they are the main causes that I know.” This is vital and stops you looking stupid standing around.

Tip 8. Acknowledge what you don’t know

If you’re asked a question you don’t know the answer to, be prepared to tell the examiner in a clear way i.e. “I cant recall that at this time, I don’t know the answer to that question”. This saves valuable time, and is refreshing for examiners to get clear, honest responses, which is what they require from junior doctors.

Tip 9. Have a set way of presenting examination findings every time

Practice this, it is the same every time. For the above case here would be our example:

“No stigmata of cardiovascular disease in the hands, pulse 80 and regular in terms of rate and volume, hypertensive with a blood pressure of 182/92. No stigmata of CVSD disease in the face. Apex beat palpable 5th intercostal space, mid clavicular line, normal character. The first heart sound is normal. The second heart sound is normal. There is a pan systolic murmur, best heard with the diaphragm, at the left sternal edge that is non-radiating. JVP not elevated, no peripheral oedema.”

If you do this the same every time it will stop you making mistakes.

Tip 10. Thank and ‘look after’ your exam patient (and the examiners).

This is vital. Your duty is first to the patient. When you have finished examining, show the patient the dignity and respect they deserve, cover up exposed areas, and express thanks. The patient has volunteered most likely to do the exam! Thanking both is important, and professional.

We hope this has helped, remember there are over a thousand questions, dozens of videos and downloads to help you with your exams in the student login area.

This is based on common errors in exam/ OSCE techniques that crop up in medical examinations from our experience.

Here are the first 5 tips for preparing for your verbal examinations, the next follow soon.

Let’s consider the following features and clinical examination…

A 36 year old male gives the following history:

“I’ve been getting hot for the last 6 weeks, on and off and have been off my dinner, pretty much all the time. I’ve been generally not right, tired and that. I’ve started to get a bit breathless too, not coughing and the like, but still having problems when I’m out. Bad like. Gets worse when I have a fever. Like I’ve had a friend who had the same thing about 3 years ago and he had really bad lung fibrosis, because of infections during his childhood. Not like me and that I’ve always been well. I have still got problems injecting the drugs and that, but like my key worker, she says that me methodone will help me deal with that kind of problem, so form that side I’m pretty happy.

Your Examination Findings are:

• Hands Normal.
• Pulse 80.
• No Signs in the face.
• BP 182/92 Pan systolic murmur left sternal edge.
• Otherwise NAD.

Tip 1. Look professional

Dress smartly and conservatively, in accordance with the accepted policy for dress and infection control. We think this means, white shirts (ironed!), smart black shoes, trousers or dress.

Tip 2. Organise your presenting posture to minimise nerves

This is it. Hands behind your back. Head up. Speak clearly and decisively. By organising your posture fidgeting with your hands (common in stressful situations) will not be possible. Standing with an open posture (feet apart, slightly out turned) is a common technique used in business, and will help you present in an organised fashion.

Tip 3. Structure your presentation of medical terminology

This needs to be structured in the same was that you elicited the history. PC, HPC PMHx, for example:

Mr X is a 36 year old male with a background of intravenous substance use, who presents with a 6 week history of malaise, retired office worker presents with a three week history malaise, night sweats, dyspnoea and anorexia…

Note the use of medical terminology to describe symptoms. This is not the same as describing clinical signs in the history, which you should not do!

Tip 4. Interpret as you go

Don’t be afraid to explain your interpretations as you assess the situation. For example with history: “The history importantly raises concerns: substance misuse (introducing a blood borne infection, other viral infections and T cell Disorders transmitted by IV drug use), symptoms that suggest a systemic illness/ infection (fevers, malaise, anorexia) that would have a wide differential based on this information that would include….”

Tip 5. Learn to summarise in one sentence

Floundering, being vague, or summarising in a small essay just won’t do. Be clear and to the point – for example “36 year old male, current problem of intravenous substance misuse with 6 weeks of symptoms that include anorexia night sweats and general malaise.”

We hope this helps some of you student doctors in preparing for your OSCEs…. view the final 5 tips here!

In the waiting room, the patient’s family members circled a Blackberry. About every 15 minutes, Dr. Carlos Wolf of Miami Plastic Surgery gave them a few keystrokes of information about how the patient was doing.

“M is asleep,” one of Wolf’s nurses typed at 9:13 a.m. on June 3. “We will start surgery soon.”

Less than an hour later, the nose job was complete.

“Beautiful,” the nurse typed. “She’s going to love it.”

From the Miami Herald

Although this may seem absurd, the use of social networking tools is now commonplace in personal circles and businesses are starting to take note. Over the last 6 months we have seen an explosion in professional networking and knowledge share sites, meaning it is quicker and easier to get in touch and share information.

The example in the article later goes on to describe how surgeons used Twitter to report the account of an operation to remove a kidney tumour, and how anyone with web access could tune in to a webcast to watch a knee ligament being repaired live.

These are all great advances and examples of people using the technology well to further professional learning. Here at Medical Educator it’s what we are good at, our niche is medical students.

Has anyone else got any good examples of how web 2.0 has helped their professional lives? We’d love to hear your comments.

A valuable source of information for doctors and students

MPS is not just a sponsor for Medical Educator, but a valuable source of ethical and practical information for doctors. They publish a series of educational publications including Casebook, New Doctor magazine and GP Registrar.

MPS is a mutual membership organisation which provides comprehensive professional advice to doctors, dentists and other health professionals in more than 40 countries around the world. As a not-for-profit organisation, MPS supports its members with medicolegal advice and education relevant to their professional practice.

Joining is free for all medical students

Remember joining the Medical Protection Society is free for all medical students. Why not check out their pages here to see what they can offer you.

One of the contributors to the site describes his experiences of being a member of MPS:

“I’ve been a member with the MPS since I was a medical student, and now I am 7 years post qualification, and on the speciality register. The MPS were helpful not only in my postgraduate studies, but were able to give me advice on my elective project and what needed to be done in this instance. As I was conducting this abroad, it was a very useful service. MPS has also been a useful port of call when faced with challenging ethical and medicolegal problems that are unavoidable to practicing physicians”.

Professional support and advice

One of the founders of Medical Educator has this to say about the MPS:

“I really have valued the support of MPS in my professional career to date, and I am pleased that they are helping to develop the Medical Educator site. Medical Indemnity support is critical to both practising doctors and medical undergraduates. Professional support and expert advice is simply a phone call away. Casebook is helpful. As a doctor practising internal medicine it has some useful pointers on common medico-legal pitfalls. For example in the September 09 issue, two Orthopaedic surgeons cover the subject of Cauda Eauina syndrome.”

The article is available in full through the website but lets look at an excerpt focussing on the diagnosis of CES:

Excerpt from Casebook: Cauda equina syndrome

CES is usually characterised by the following so-called “red flag” symptoms:

• Severe low back pain (LBP)
• Sciatica – often bilateral but sometimes absent – especially at L5/S1 with an inferior sequestration
• Saddle and genital sensory deficit
• Bladder, bowel and sexual dysfunction.

Three types of cauda equina syndrome have been identified:

• Rapid onset without a previous history of back problems.
• Acute bladder dysfunction with a history of low back pain and sciatica.
• Chronic backache and sciatica with gradually progressing CES.

Within these groups, CES may be complete or incomplete and its onset may be either acute within hours or gradual over weeks or months.

Providing you with content

We hope to provide some bespoke content on some medico-legal cases from the experts at the MPS as well as updating our own members in the monthly newsletter that’s sent out with some more relevant content. Expect to find updates and other relevant info from them. If you’re not already a member we would recommend choosing MPS to provide your professional indemnity.

Listening to BBC reports of the introduction will lead to “serious accusations” being made by junior doctors that they were essentially instructed to falsify monitoring data. True? It remains an indisputable fact that hospital trusts continue to practice inappropriate monitoring practices which fall short of the accepted published standards. A quick poll of junior doctors shows that 0 of our sample of 10 understood the monitoring basics (how hospitals should practice the process of monitoring), however 9 out of 10 knew it was a contractual obligation! We suspect that is because of the keenness of monitoring bodies to point this out to us. One junior doctor recounts his own experiences of monitoring to us:

The trust essentially conducted the monitoring without due warning. The results were not disseminated in the required way. The management was reluctant to allow the process of monitoring to be transparent. Junior Doctors who should not have been monitored as working the full shift rota actively colluded to distort the monitoring figures. Annual leave and holidays were not properly accounted for. Legal action via the BMA was threatened.

Another told us the following

Only until an employment tribunal was threatened by the junior doctor representatives did the trust acknowledge that the rota was not compliant. It was not an argument over break times, rest, sleep patterns or any other caveats. It was simply that the number of hours was outside of the banding which we were being paid (and not by a small amount). The trust went to the extent of claiming typographical errors on the published rota.

On balance the hospitals have a very difficult job in managing rotas: no one doubts that the overall interest remains patient care despite all the potential wrangling. That said, the new cohort of junior doctors starting work in the UK and the European Union will not just be struggling with acute pulmonary oedema in the early hours, they will be grappling with complicated employment and payment issues that has dogged the training of juniors over the past decade.

We call for a no nonsense guide to the hours that doctors can work in the EU, and that all rotas distributed to juniors should include average hours worked per week, and a clear breakdown of how the rota has been applied to the British banding system. We’d be interested to hear the views of students and qualified doctors here about how their new jobs shape up over the coming weeks, and months. We’re particularly interested to hear how interns from the US, Canada and Australia cope with working patterns, and doctors from India and Pakistan on how they contrast their own working conditions with those described here.

Please do not name organisations or individuals, for legal reasons we will not publish such comments.

Links to National organisations representing junior doctors and students below.

UK:Remedy UK, and the BMA, US: The American Medical Student Association, Australia: The Australian Medical Student Association, Canada: Canadian Federation of Medical Students

The organisatoin EVIP has been created to bring together a bank of virtual patients for medical students. This will hopefully be open access for all to learn from. An exciting proposition!

In this interview, Dr David Davies from the University of Warwick, UK, talks to Dr James Bateman about the role of virtual patients, and the challenges of incorporating them into the medical curriculum.

You can learn more about EVIP at www.virtualpatients.eu, at Twitter (Virtualpatients) and Facebook.

The answer is….. b. Warfarin

Based on NICE Guidance 36 (AF) and the CHADS 2 scoring system.

The CHADS2 score is an excellent aide memoir to anticoagulation in AF. It is based on:

SCORE

• 2 or over=Warfarin
• 1= Warfarin or aspirin
• 0=aspirin

This means our chap here will score:

• 1 for being >75
• 1 for being hypertensive

This means he should be treated with warfarin (assuming he has no contraindications)

A link to the original publication citation in circulation is available here. (link will open in a new window)

Get more questions like this in our free trial. ]]> http://medicaleducator.co.uk/answer-to-question-of-the-day-atrial-fibrillation.html/feed 1 http://medicaleducator.co.uk/question-of-the-day-atrial-fibrillation.html http://medicaleducator.co.uk/question-of-the-day-atrial-fibrillation.html#comments Fri, 26 Jun 2009 08:05:10 +0000 admin http://medicaleducator.co.uk/?p=427 A 76 year old man presents with atrial fibrillation which is permanent. He is lucid and has specifically made an appointment with you to discuss the best way of stopping him “dying ” as a result of the AF.

PMHx:
Hypertension (treated), Mild COPD. Nil else of note.

DHx
Verapamil (as treatment for AF)
Amlodipine
Simvastatin
PRN inhalers

SHx
Lives alone. Independent. Can carry out all ADL’s (activities of daily living)

What is the anticoagulation schedule you would recommend to prevent stroke?

a. Clopidrogel
b. Warfarin
c. Aspirin
d. No anticoagulation
e. Warfarin and Aspirin

At Medical Educator we are always looking to push the boundaries of what we can do on the web to further medical student e-learning in preparation for medical student finals.

We’re pretty excited about the potential our new technology (in collaboration with the kind folks at iSpring) has to offer medical students an even richer learning experience.

Have a go at our free interactive MCQ picture quiz above to get a feel of the kind of things we will be producing in future – that’s ontop of our established base of over 1000 MCQs for medical students, practical video guides for medical finals, podcasts, and one-minute revision downloads!