1. Medical Protection: The Medical Protection Society

The MPS has a range of online resources and clinical information to help guide medical students and healthcare professionals through their medical training. One thing we like is their magazine for newly qualified junior doctors which are handy for a quick read through relevant junior doctor experiences of life at work. New Doctor magazine can be found here, and Medical Student pages (UK) here.

2. Mnemonics: Medical Mnemonics

We love Mnemonics. Take this one for joint pain.

SOFTER TISSUE:
Sepsis
Osteoarthritis
Fractures
Tendon/muscle
Epiphyseal
Referred
Tumor
Ischaemia
Seropositive arthritides
Seronegative arthritides
Urate
Extra-articular rheumatism (such as polymylagia)

They missed trauma out but hey, nobody’s perfect.

3. Anatomy Guides: Cross sectional Anatomy from anatomy atlases .

We think this picture is of a brain. It’s definitely not the glenohumeral joint.

4. Radiology Help: IMIAIOS

We like this sitter from IMAIOS, who provide detailed pictures like the one you can see here of the famous Scottie dog. We thought it looked like a lumbar spine. How wrong we were.

By the way, you won’t see many more lumbar spine radiographs because your local radiologist will probably have a heart attack if you try to request one! This is because they are notoriously useless at picking anything important up, other than fractures.

5. Stats Advice: BMJ Stats Pages

The BMJ weigh in with a great free resource which requires no subscription. The BMJ really are helping doctors make better decisions (we’re aiming to help you as a medical student make the best decision).

6. iPhone App: IResus

We love this app from the developers at Imobilemedic.com.  You might get a few funny looks from doctors over45 at the next cardiac arrest if you whip this out, and remember not to spill your coffee on your iPhone.

7. Apps for all Smartphones: Med Calc

Thought the Anion Gap was a tourist attraction north of Watford? We’ve got new for you….

If you need to work out a BMI, GCS or Disease Activity score quick? Check out Med Calc… It works on most smart phones. As one contributor said: “I use this most days at work”*

We are fairly certain this is just to show off, but we love this app.

8. General Information: GP Notebook

Most of the GPs that we deal with from medical educator would be doing well to be dealing with most of the complex stuff listed on here. Need to know the classification system for bone tumours? Look no further.

9. Quick information: Wikipedia

Wikipedia is still top of our list for those obscure things you need to know about. As students you always need to be sure to check your sources, however there comes a time when you need fast reliable information, or when you need to read round a topic.  The Journal Nature found that Wikipedia was as good as the Encyclopaedia Britannica across a range of scientific areas. That’s good enough for us, this represents web2.0 in action!

10. Free MCQs & video: Medical Educator

You didnt think we would leave ourselves out did you? If you don’t know already, signing up is completely free and gives you access to loads of our sample multi-questions, videos and podcasts.

Got any other top free resources that you know, use and love? Leave a comment and share the joy!

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!

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!

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/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!

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.

UMAP, one organisation currently working to standardise medical student exam question content across medical schools

It’s essentially the organisation which is writing/ collecting a bank of medical student exam questions for use in ‘high stakes’ examinations, such as medical finals.

UMAP’s description of their activities can be found on their website: On the site they describe themselves as follows:

UMAP’s aim is to improve quality in high stakes written assessments across UK medical schools. UMAP runs best practice item writing sessions where clinical and academic staff come together to learn about item writing techniques and to represent their subject area in the developing question bank.

UMAP QA process

Once written, questions move on to be quality assured at UMAP question review meetings which are convened at our partner schools. Staff members with experience in assessment and who are familiar with UMAP style and technique check each question and amend as necessary to ensure the highest accuracy and conformity to question writing principles. Questions are then ready for use and are listed as part of selection documentation available to our partner medical schools.

Schools are invited to select the items they wish to use and then confirm their selections to us. Schools later return results data in an electronic format which is then analysed and uploaded into the UMAP bank. A summary of this data is displayed within question selection documentation to enable schools to make informed, evidence based, item choices.  [Accessed 4.03.09 from http://www.umap.org.uk/about/]

From their site they cover about 14 medical schools and they run an active recruitment of Specialist Registrars to write questions for their bank, most recently to our knowledge in Birmingham at a West Midlands General Internal Medicine training day.

UMAP currently publish on their site that as of October 2008 they have over 2500 questions for use in the these high stakes examinations. They acknowledge that they seem to be lacking in a few key areas, however they are currently working to address this.

What do you need to know about UMAP as a medical student? Well probably not that much. In fact all UMAP really are trying to do is generate sensible MCQ questions that are fair, and are well written. They have a reasonably complicated list of rules that a number of ME’s contributors have been talked through at a number of different times: overall though its not rocket science.

• you shouldn’t be able to answer a question just by using the investigation result or the stem on its own (e.g. a big intro and then showing an ECG with complete heart block etc.)
• The questions are aimed at core FY1 knowledge
• You should be able to guess the likely options for the answer (again straight forward)

In principle, when UMAP look at the answers for any given question, they check that these same answers seem reasonable. They also like the same level of detail for both (for example the answers should all be of similar length).

What about the stem’s themselves: again UMAP make some sensible judgements including avoidance of medical jargon, avoiding using the same words in the questions and the answers etc. They should be readable and comprehensible.

So is there any technique involved? Well yes! Look carefully at results an investigations. Its clear that UMAPs strategy will be not to spoon feed the reader. For example if an important feature is tachycardia the question may read as follows

Ther pulse rate was 124 – Rather than mentioning the tachycardia directly, or showing a picture of an ECG

The same goes for investigation reults: e.g. K+ 3.0 mmol/l (NR 3.5-5.5 mmol/l) rather than ‘hypokalaemia’

All this means is that you have to look carefully at the investigation answers, and then draw conclusions. The rest is guesswork? Not really. Simple mathematics state that you should rule out the maximum number of wrong answers, and maximise your chance of success.

Medical Educator or its wuestion writers have not contributed any questions to the UMAP quesiton bank and have no formal or informal association with the organisation. We’d be interested to hear students comments and opinions about the work done by UMAP.

Remedy UK, A British organisation representing doctors.This problem has been mirrored to some extent in the US.

A UK pressure group, set up and run by doctors called Remedy UK has been representing doctors  in the UK for the last few years. Many will remember the junior doctors Marchig through London on the 17th of March 2007. A medical educator writer was present on the march and recalled the following:

For the first time in a long time an organisation captured the mood of a whole group of junior doctors. After the initial progress, they have a difficult struggle against what are very powerful organisations.

Some may question the part that Remedy play representing the junior doctors in Britain. Medical Educator is inviting a member of the organisation to speak about why what they stand for is relevant to medical student in the UK and internationally. We hope to publish their views soon.

Doctors Marching on the 17th March 2007 through London.

Remedy are now attempting to mount a landmark legal challenge to the whole application process. We hope to bring you a report on this ’straight from the horses mouth’.