We were a interested in a report from the The Independent (a leading British newspaper) highlighted the case of one British Medical Student. It relates to students from University College London, specifically the transfer of student information to the United States Central Intelligence Agency (CIA). The case in question is that of Umar Farouk Allmutallab, arrested in the US over terrorism charges from Northwest Airlines Flight 253 on Christmas Day.  To refresh your memory on this, read reports on this here from The Times and here from the BBC. He was, of course the former student and president of the University College London (UCL) Islamic Society. There now seem to be repercussions for other Muslim students studying at UCL.

One British medical student has apparently had personal information passed to US authorities as a result of being a member of the UCL Islamic Society. He was quoted by the Independent on the 1st April as saying the following.

I feel frustrated and outraged. To pass on 900 student details because they were members of UCL Islamic Society is ridiculous. The reason I joined the society was for socio-cultural reasons. I’ve never seen the guy [he's referring to Abdulmutallab]. I wasn’t here when he was at university.

Is does seem a little extreme. One of our main contributors (who happens to be British Muslim) had the following to say.

It seems a little curious that the apparently all the members of what was apparently a fairly mainstream society have been put on a US watch list. Its difficult enough getting through US border control at the best of times, never mind having your name potentially put on a list of potential terror suspects! I guess things need to be kept in perspective, but it does seem a little odd.

UCL were reported to say that no details other than the student names and their email addresses had been passed on. Their student Union said the following.

The police asked the student union to provide details of members of the UCL Islamic Society and the Royal Free and UCL Medical Islamic Society between 2005 and 2008. The union provided the names and email addresses of student members only.

Another contributor to medical educator had the following thoughts…

We certainly won’t be spamming any of our customers with junk or sending out any other sort of unsolicited mail. I can’t help but wonder what sort of spam you might get from the CIA. Could be quite fun really. They are now off our list of potential sponsors for the coming year…

Read to read the whole article here from the Independent, and commented on elsewhere in British Newspapers.We’d be interested in any comments from medical students in the UK or abroad about this.

Medical Educator promises not to pass on your email addresses to other companies/ organisations or third parties, there’s no special box to tick, we just wont do it. This includes the CIA, unless they make us!

Its interesting to find many of the images and descriptions are still relevant today, although some of the descriptions are a little ‘brutal’. To the right you can see handwritten notes by a student along with an image describing the excision of a portion of a rib.

We have concluded 3 things.

1. Medical students revision notes were as illegible 00 years ago as they are today. We can’t decipher much of the revision notes shown here (answers on a postcard). There was one bit that we could read that started with Oh-Oh Oh To Touch And… We haven’t printed the rest out of common decency.
2. Writing in flowing fountain pen certainly adds to the drama of revision notes.
3. Although the 1910 book is of exceptional quality and detail, we reccomend using some of the more up to date texts available. Some of our colleagues have even suggested searching the internet, but we’re not too sure about this and prefer to stick to books!

Thanks to Ms K for the donation of the text, we hope to publish some other relevant diagrams in coming months. William Wheeler died in 1943. A telling comment from his obituary in the BMJ from the same year follows:

He was not only a brilliant operating surgeon, a clinician of much wisdom, and an authoritative writer on surgery, but
a man with a great capacity for friendship.

They look so fashionable they must be great for the modern day medical student. Right?

We here at medicaleducator.co.uk are currently checking out he use of predominantly free iPhone apps on for medical students. So what we would like are three things. Why not email us at iphone@medicaleducator.co.uk if you have a point of view on any of our points below. We’re keen to supply our users with a free iphone guide once we know what’s worth checking out. So we have a few questions….

1. Have you been refused access to any iPhone health resource because you are ‘only a student’ ? (something we’ve heard is getting more common- and is perhaps a little frustrating [we know you need the information most!]
2. Any apps that are really worth their weight in gold to budding students out there?
3. Anything you think is not worth the free download time?
4. Any recommended top apps?
5. Overall as medical students do you think an iPhone is worth the money in terms of the benefit it gives you?

We;’ll be covering a feature on a few of some of the apps that we like, and are currently using in our day to day practice. We’ll leave you with this…

I was using my iPhone to check a patients disease activity score (DAS) to check their eligibility for anti-TNF therapy- a biologic agent that is a powerful treatment for rheumatoid arthritis.  I think the patient thought I  was checking my text messages! It took a careful explanation to avoid an embarrassing incident.

A free subscription to the user who sends us in the most detailed answer to any/ all of the above. And if you can make us laugh heartily you might get one too. Check out our user guide coming soon too!

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.

She examines a 19 year old female patient admitted with asthma on the medical assessment ward for revision purposes.

The patient has a past medical history she has the occasional migraine, and eczema.
The observations are as follows.

BP 128/70

Pulse  98 regular

Fingerprick blood glucose 8.3

Oxygen Sats 97% on Air

She performs a cardiovascular and opthalmological examination.

Cardiovascular examination: Split S2 (second heart sound) on deep inspiration.

Ophthalmology examination: Normal Eye movements. Pupils 6mm and reactive to light. Eye movements normal. Visual fields normal. No scotoma. Fundoscopy examination of one eye is shown below…

Do you get this good a view when performing fundoscopy? Of course not, this is a digital retinal photograph-remember when you are using a hand held opthalmoscope you only get to view a bit of this at a time, which is why its important you should know which eye this is!

Why not have a go at the questions below? We’ll put up the answers in a couple of days…

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/free-interactive-mcq-picture-quiz-for-medical-students.html http://medicaleducator.co.uk/free-interactive-mcq-picture-quiz-for-medical-students.html#comments Tue, 16 Jun 2009 21:18:11 +0000 admin http://medicaleducator.co.uk/?p=413

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!

The overall average score of medical students on MedicalEducator.

The following weeks will represent the culmination of years of hard work by medical students over the past 1-5 years. Revision patterns have been changing and increasingly medical students are approaching final examinations preparing for them using web based MCQ, OSCE and video guides. For the first time, resources like podcasts and the like have taken a firm footing in the medical students preparation for final examinations.

One technique of sitting mock written papers has long been popular. Short answer questions, EMQ and MCQ format questions help people to prepare.

To quote one of our contributors:

I always felt more comfortable preparing for any exam, and I mean any, by running through exactly what I should know, first from a theoretical perspective, then from a practical perspective. If that meant filling in multiple choice questions, I got a book on multiple choice questions. It was what it was.

Maybe you’d like the opportunity to measure yourself against other medical students across the UK or

The average mark in one of our mock final examinations, which was added to the site in April 09.

across the world. A good example of this is our *(tough) mock medical finals paper. This is designed for students sitting year 1, year 2, year 3 year 4 or final examinations, which have a clinical component.

The average for this exam is 49.6%. Tough. But will it help you learn? A comment from a subscriber:

You keep doing questions where a principle that you didn’t understand is explained in the answer. Thats the value of them.

Overall this is a stressful time for medical students, on behalf of the Medical Educator team, good luck in those examinations.

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!

No problem.  My pleasure to answer them!

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

1. Evidence based medical knowledge is transferable across continents in terms of pathophysiology, clinical assessment investigation, and treatment approaches
2. 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.
3. 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
4. A wide variety of delivery formats will help to provide students with the capacity to learn from multiple different domains
5. 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.