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Two Videos Showing Fluoroscopy and Animation of the TAVI Procedure

Fluoroscopy with Videography Showing Deployment of the Valve: The valve is deployed during rapid right ventricular pacing. The crimped valve and support frame are expanded with underlying balloon inflation. Also seen are the transesophageal echocardiography probe and the temporary right ventricular pacing lead. Animation of the Complete Transfemoral Transcatheter Aortic-Valve Implantation (TAVI) Procedure: The procedure for transfemoral TAVI involves insertion of the sheath through the femoral artery, retrograde balloon aortic valvuloplasty, advancement of the TAVI system across the aortic valve, and subsequent deployment of the valve and support frame.  
Nicole Chalmers
almost 8 years ago
Foo20151013 2023 eztttu?1444774181
3
138

Dealing with Personal Illness in Med School

Hey guys! I’m Nicole and I’m a second year medical student at Glasgow University. I’ve decided to start this blog to write about my experiences as a med student and the difficulties I encounter along the way, hopefully giving you something you can relate to. Since June of last year I have been suffering with a personal illness, with symptoms of persistent nausea, gastric pain and lethargy. At first I thought it was just a bug that would pass on fairly quickly, but as the summer months went on it was clear that this illness wasn’t going to disappear overnight. I spent my summer going through a copious amount of medications in hope that I’d feel better for term starting. I visited my GP several times and had bloods taken regularly. After 2 months, I finally got given a diagnosis; I had a helicobacter pylori infection. I started eradication therapy for a week and although it made my symptoms worse, I was positive would make me better and I’d be well again within the week. The week passed with no improvements in my condition. Frustrated, I went back to my GP who referred me for an endoscopy. Term started back the next week and despite feeling miserable I managed to drag myself out to every lecture, tutorial and lab. Within a few weeks I began to fall behind in my work, doing the bare minimum required to get through. Getting up each morning was a struggle and forcing myself to sit in lectures despite the severe nausea I was experiencing was becoming a bigger challenge each day. In October I went for my endoscopy which, for those of you that don't know, is a horribly uncomfortable procedure. My family and friends assured me that this would be the final stage and I’d be better very very soon. The results came back and my GP gave me a different PPI in hope that it would fix everything. I waited a few weeks and struggled through uni constantly hoping that everything would magically get better. I gave up almost all my extra-circular activities which for me, the extrovert I am, was possibly the hardest part of it all. I wanted to stay in bed all the time and I become more miserable every day. I was stressing about falling behind in uni and tensions began to build up in my personal life. It got to the point where I couldn’t eat a meal without it coming back up causing me to lose a substantial amount of weight. I got so stressed that I had to leave an exam to throw up. I was truly miserable. I seen a consultant just before Christmas who scheduled me in for some scans, but it wasn’t until January. I was frustrated at how long this was going on for and I thought it was about time I told the medical school about my situation. They were very understanding and I was slightly surprised at just how supportive they were. I contacted my head of year who arranged a visit with me for January. During the Christmas break I had a chance to relax and forget about everything that was stressing me. I got put on a stronger anti-sickness medication which, surprisingly, seemed to work. The tensions in my life that had built up in the last few months seemed to resolve themselves and I began to feel a lot more positive! I met with my head of year just last week who was encouraged by my newly found positive behaviour. We’ve agreed to see how things progress over the next few months, but things are looking a lot brighter than before. I’ve taken on a new attitude and I’m determined to work my hardest to get through this year. I’m currently undertaking an SSC so I have lots of free time to catch up on work I missed during the last term. My head of year has assured me that situations like the one I’m in happen all the time and I’m definitely not alone. I feel better knowing that the medical school are behind me and are willing to help and support me through this time. The most important thing I have taken from this experience is the fact that you’ll never know the full extent of what a patient is going through. Illness effects different people in different ways and it may not just be a persons health thats affected, it can affect all aspects of their life. This experience has definitely opened my eyes up and hopefully I’ll be able to understand patients’ situations a little better.  
Nicole Mooney
almost 8 years ago
Foo20151013 2023 2iw10f?1444774140
9
664

Medical students face new NHS entry exam

The Health Service Journal have announced this week that medical students could be given a license to practice medicine in the NHS as soon as they graduate. What do we know? The proposal comes from Health Education England. Students would qualify by taking an additional exam when applying for the Foundation Programme. The aim is to improve the standard of medics joining the NHS. Another driving force is to reduce the rising number of med students applying for the two-year Foundation Programme (currently the only way for junior doctors to achieve a full license to practice). Last year there were 297 more applicants than places. If approved the plan would require changes to the Medical Act. Statement from the BMA Dr Andrew Collier, Co-Chair of the BMA’s Junior Doctor Committee said: “We do not feel the case has yet been made for a wholesale change in foundation programme selection process, especially as the system was significantly overhauled and implemented only one year ago. There is little evidence that another new national exam over and above current medical school assessment methods will add any benefit either for graduating students or the NHS as a whole. It is also unlikely to solve the ongoing oversubscription to the foundation programme which will only be addressed by well thought out workforce planning.” Will it work? This proposal has certainly come as a surprise to me so soon after recent changes to the Foundation Programme selection process. I would love to know what you think about it. Do you agree with Dr Collier’s statement? If the plan goes ahead do you think it will be effective in achieving the desired outcomes? Please post your comments and thoughts. Nicole Read more: http://www.hsj.co.uk/news/exclusive-medical-students-face-new-nhs-entry-exam/5066640.article#.UrbyS2RdVaE  
Nicole Chalmers
about 8 years ago
Foo20151013 2023 1hbf5w2?1444774116
2
278

Creating the Pre-Hospital Emergency Medicine Service in the West Midlands –The Inaugural lecture of the Birmingham Students Medical Leadership Society

Many thanks to everyone who attended the Birmingham Students Medical Leadership Society’s first ever lecture on November 7th 2013. The committee was extraordinarily pleased with the turn out and hope to see you all at our next lectures. We must also say a big thank you to Dr Nicholas Crombie for being our Inaugural speaker, he gave a fantastic lecture and we have received a number of rave reviews and requests for a follow up lecture next year! Dr Crombie’s talk focussed on three main areas: 1) A short personal history focussing on why and how Dr Crombie became head of one of the UK’s best Pre-Hospital Emergency Medicine (PHEM) services and the first post-graduate dean in charge of PHEM trainees. 2) The majority of the lecture was a case history on the behind the scenes activity that was required to create the West Midlands Pre-Hospital Network and training program. In summary, over a decade ago it was realised that the UK was lagging behind other developed nations in our Emergency Medicine and Trauma service provisions. There were a number of disjointed and only partially trained services in place for major incidents. The British government and a number of leading health think-tanks put forward proposals for creating a modern effective service. Dr Crombie was a senior doctor in the West Midlands air ambulance charity, the BASICS program and had worked with the West Midlands Ambulance service. Dr Crombie was able to collect a team of senior doctors, nurses, paramedics and managers from all of the emergency medicine services and charities within the West Midlands together. This collaboration of ambulance service, charities, BASIC teams, CARE team and NHS Trusts was novel to the UK. The collaboration was able to tender for central government and was the first such scheme in the UK to be approved. Since the scheme’s approval 5 major trauma units have been established within the West Midlands and a new trauma desk was created at the Ambulance service HQ which can call on the help of a number of experienced teams that can be deployed within minutes to a major incident almost anywhere in the West Midlands. This major reformation of a health service was truly inspirational, especially when it was achieved by a number of clinicians with relatively little accredited management training and without them giving up their clinical time, a true clinical leadership success story. 3) The last component of the evening was Dr Crombie’s thoughts on why this project had been successful and how simple basic principles could be applied to almost any other project. Dr Crombie’s 3 big principles were: Collaborate – leave your ego’s at the door and try to put together a team that can work together. If you have to, invite everyone involved to a free dinner at your expense – even doctors don’t turn down free food! Governance – establish a set of rules/guidelines that dictate how your project will be run. Try to get everyone involved singing off the same hymn sheet. A very good example of this from Dr Crombie’s case history was that all of the services involved in the scheme agreed to use the same emergency medicine kit and all follow the same Standard Operating Procedures (SOP), so that when the teams work together they almost work as one single effective team rather than distinct groups that cannot interact. Resilience – the service you reform/create must withstand the test of time. If a project is solely driven by one person then it will collapse as soon as that person moves on. This is a well-known problem with the NHS as a whole, new managers always have “great new ideas” and as soon as that manager changes job all of their hard work goes to waste. To ensure that a project has resilience, the “project manager” must create a sense of purpose and ownership of the project within their teams. Members of the team must “buy in” to the goals of the project and one of the best ways of doing that is to ask the team members for their advice on how the project should proceed. If people feel a project was their idea then they are far more likely to work for it. This requires the manager to keep their ego on a short leash and to let their team take credit. The take home message from this talk was that the days of doctors being purely clinical is over! If you want to be a consultant in any speciality in the future, you will need a basic underlying knowledge of management and leadership. Upcoming events from the Birmingham Students Medical Leadership Society: Wednesday 27th November LT3 Medical School, 6pm ‘Learning to Lead- Preparing the next generation of junior doctors for management’ By Mr Tim Smart, CEO Kings Hospital NHS Trust Thursday 5th December LT3 Medical School, 6pm ‘Why should doctors get involved in management’ By Dr Mark Newbold, CEO of BHH NHS Trust If you would like to get in touch with the society or attend any of our events please do contact us by email or via our Facebook group. We look forward to hearing from you. https://www.facebook.com/groups/676838225676202/ med.leadership.soc.uob@gmail.com  
jacob matthews
about 8 years ago
Foo20151013 2023 5jd630?1444774107
4
80

Do hacks really work?

Well I think they do. In 2012 I attended the #digidoc2012 conference in London. This was a conference aimed at bringing clinicians and technology enthusiasts together to learn how better to use technology to help in a clinical setting. Part of the day included tutorials and lectures, but my favourite part was the ‘hack’ session. In groups, we pitched ideas about potential apps which could be created to help different groups i.e. clinicians, patients, providers etc. From this session the initial concept of PhotoConsent was formed. The problem: Medical photography in a hospital setting can be relatively straight forward. A clinician can call up the medical photography department, get them to sort out the forms and details, patient consented, picture taken...done. The main issue with this is the time taken to access the medical photography department. Medical photography in a moderately acute setting or primary care is considerably less straight forward. Issues on how you document the consent, what methods used (verbal or written) and how this is stored need to be considered. There exists some guidance on the matter (see Good Medical Practice: Making and using visual and audio recordings of patients), however actual practice is variable. The added issue of social media and the ease of which images can now be shared can add to the confusion. The solution - PhotoConsent: I am involved in several on-line forums and governance groups. With seeing interactions about patient images in social media and various online clinical groups, I felt a more complete solution was needed which gave better protection and governance for both patients and clinicians. Following the #digidoc12 conference (https://thedigitaldoc.co.uk/), I met some innovative colleagues including Ed Wallit (@podmedicsed). We took this brainstormed idea further and now we have a finished product- PhotoConsent app. PhotoConsent is a new application designed to help you as a clinician to safely and easily take photos of a patient and then obtain the relevant consent for that photo quickly and efficiently. It is currently available on iOS. How does it work? Upon opening the app you can take a photo from the home screen. Once you have confirmed you have the best possible image, you and the patient are shown the consent options. Using PhotoConsent you can choose to obtain consent to use the photo for assessment, second opinion or referral, educational use or publication. In real time with the patient you can then select each consent option to explore in more detail to allow informed consent. This consent can then be digitally signed and emailed to the patient instantly. The image and consent can then be used by the clinician in accordance with GMC guidance. This can be via the app, email or via the online portal: PhotoConsent.co.uk. What makes PhotoConsent unique is that the consent is digitally secure in the metadata of the image. So proof of consent is always with the image. Why should I use PhotoConsent? It is important if taking a medical image of a patient, that consent is obtained and recorded. Written consent is considered the best option. PhotoConsent allows you to take consent with the patient in real-time, forward the patient a copy of the consent so they can stay informed, and be safe in the knowledge that consent is secure within the image metadata. All this is possible through your own iOS device making it convenient and effective for all involved. What is next for PhotoConsent? The first release of PhotoConsent is out, but there can always be progression. In the future I hope to bring the app to the Android platform to make it more accessible to a wider audience. We are also working on expanding the app to include consent for non-medical use. We have a few other ideas but time will tell if these are possible. About the owner: Dr Hussain Gandhi (@drgandalf52) is a GP and GP trainer working in the Nottingham area. He is a RCGP First5 lead, Treasurer of RCGP Vale of Trent faculty, co-author of The New GPs Handbook, owner of PhotoConsent and egplearning.co.uk – an e-learning portal; and a member of Tiko’s GP group on Facebook (@TheVoiceofTGG). All Images taken via PhotoConsent.  
Hussain Gandhi
over 8 years ago
Foo20151013 2023 1nuvntv?1444774080
2
891

Obesity Part 1 – Fat Kid in a Fat Society

Introduction to Obesity One of my favourite past-times is to sit in a bar, restaurant, café or coffee shop and people watch. I am sure many of you reading this also enjoying doing this too. People are fascinating and it is intriguing to observe: what they do; how they act; what they wear and what they look like. My family and I have always observed those around us and discussed interesting points about others that we have noticed. When I first came up to visit Birmingham University my family all sat in a coffee shop in the centre of Birmingham and noticed that on average the people walking past us looked much slimmer than what we were used to seeing back in south Wales. Now, when I go home it is more painfully obvious than ever that the people in my home region are much, much heavier than they should be and are noticeably bigger than they used to be even a short number of years ago. This change in the population around me is what first made me seriously think about obesity, as a major problem affecting the world today. Nowadays obesity is all around us! It is noticeable, it is spreading and it should worry us all. Not just for our own individual health but also for the health of our society. Obesity affects everything from the social dynamic of families, to relationships at school or work, to how much the NHS costs to run. Obesity is a massive problem and if we as a society don’t start getting to grips with it, then it will have huge implications for all of us! I am currently in my 5th year at medical school. While I have been here I have taken a keen interest in obesity. The physiology, the psychology, the anatomy, the statistics and the wider affects on society of obesity have all been covered in curriculum lectures and extra curriculum lectures. I have taken part in additional modules on these subjects and sort out many experts in this field while on hospital placements. Obesity is fascinating for some many reasons and I thought that it would be a great topic to write some blogs about and hopefully start some discussions. Warning For my first blog on the topic of obesity I quickly want to write a bit about myself and my battle with weight. Everyone’s favourite topic is themselves, but I like to think that’s not why I have written this and I hope it doesn’t come across as a narcissistic ramble. I don’t intend to try and make myself come off well or suggest that I have all the answers (because I know very well that I don’t) and I hope it doesn’t come across like that. I want to write a bit of an autobiography because I wish to demonstrate how easy it is to go from a chunky kid to a technically obese teenager to a relatively fat adult without really realising what was happening. Chunky Child to Fat adult While planning this blog I realised that my Meducation profile picture was taken when I was at my all time fattest. At the graduation ceremony at the end of my 3rd year at university after completing my intercalation I was over 19 stones. At 6 foot 2” this gave me a BMI of >33 which is clinically obese. I had a neck circumference of >18”, a chest circumference of 48”, a waist of >40”, a seat of >52” and a thigh circumference of >28” per leg. Why do I know all of these rather obscure measurements? Partly because I am quite obsessive but mainly because I had to go to buy a tailor made suit because I could no longer buy a suit from a shop that I could fit into and still be able to move in. The only options left to me where massive black tent-suits or to go to a tailors. After the graduation I sat down at my computer (whilst eating a block of cheese) and compared my face from the graduation photos to pictures I had taken at the start of university and the difference in shape and size was amazingly obvious. I had got fat! I realised that if I had a patient who was my age and looked like me with my measurements then I would tell him to lose weight for the good of his health. So, I decided that finally enough was enough and I that I should do something about it. Before I describe how I got on with the weight management I will quickly tell the back story of how I came to be this size. I have always been a big guy. I come from a big family. I have big bones. I had “puppy fat”. I was surrounded by people who ate too much, ate rubbish and were over weight themselves, so I didn’t always feel that there was anything wrong with carrying a bit of tub around the middle. When I went to comprehensive school at age 12 I had a 36” waist. I thought I carried the weight quite well because I was always tall and had big ribs I could sort of hide the soft belly. Soon after arriving at the new school I had put on more weight and for the first time in my life I started to get bullied for being fat! And I didn’t like it. It made me really self-aware and knocked my confidence. Luckily, we started being taught rugby in PE lessons and I soon found that being bigger, heavier and stronger than everyone else was a massive advantage. I soon got my own back on the bullies… there is nowhere to hide on a rugby field! This helped me gain my confidence and I realised that the only way to stop the bullying was to confront the bullies and to remake myself in such a way as that they would be unable to bully me. I decided to take up rugby and to start getting fit. I joined a local club, starting playing regularly, joined a gym and was soon looking less tubby. Reflecting (good medical jargon, check) on my life now I can see that my PE teachers saved me. By getting me hooked on rugby they helped get me into many other sports and physical activity in general and without their initial support I think my life would have gone very differently. Rugby was my saviour and also later on a bit of a curse. As I grew up I got bigger and bigger but also sportier. I started putting muscle on my shoulders, chest and legs which I was convinced hid how fat I actually was. I developed a body shape that was large but solid. I was convinced that although I was still carrying lots of excess weight I no longer looked tubby-fat. When I was 14 my PE teachers introduced me to athletics. They soon realised that I was built for shot putt and discuss throwing and after some initial success at small school competitions I joined a club and took it up seriously. At this age I had a waist of about 38” but was doing about 3-4 hours of exercise almost everyday, what with rugby, running, gym, swimming and athletics – in and out of school. My weight had by now increased to roughly 15 stones and my BMI was over 30. I was physically fit and succeeding at sport but still carrying quite a lot of fat. I no longer thought of myself as fat but I knew that other people did. Between the ages of 14 and 18 I started to be picked for regional teams in rugby and for international athletic competitions for Wales. My sporting career was going very well but the downside of this was that I was doing sports that benefited from me being heavier. So the better I got the heavier I wanted to become. I got to the stage where I was eating almost every hour and doing my best to put on weight. At the time I thought that I was putting on muscle and being a huge, toned sports machine. It took me a while to realise that actually my muscles weren't getting any bigger but my waist was! By the time I had completed my A-levels I was for the first time over 18 stones and had a waste of nearly 40”. So, at this point I was doing everything that I had been told that would make me more adapted for my sport and I was succeeding but without noticing it I was actually putting on lots of useless excess weight that in the long term was not good for me! During my first year of university I gave up athletics and decided that I no longer needed to be as heavy for my sports. This decision combined with living away from home, cooking for myself and walking over an hour a day to and from Uni soon began to bear fruit. By the summer of my first year at Uni, aged 19, I had for the first time in my life managed to control my weight. When I came to Uni I was 18 stone. After that first year I was down to 14 stone – a weight I had not been since I was 14 years old! I had played rugby for the Medical school during my first year but as a 2nd row/back row substitute. These positions needed me to be fit and not necessarily all that heavy and this helped me lose the weight. During my second year I began to start as a 2nd row and was soon asked to help out in the front row. I enjoyed playing these positions and again realised that I was pretty good at it and that extra weight would make me even better. So between 2nd year and the end of 3rd year I had put on nearly 5 stone in weight and this put me back to where I started at my graduation at the end of 3rd year. The ironic and sad thing is about all this that the fatter, less “good looking” and unhealthier I became, the better I was adapted for the sports I had chosen. It had never occurred to me that being good at competitive sports might actually be bad for my health. The Change and life lessons learnt At the beginning of my 4th year I had realised that I was fatter than I should be and had started to pick up a number of niggly injuries from playing these tough, body destroying positions in rugby. I decided that I would start to take the rugby less seriously and aim to stay fit and healthy rather than be good at a competitive sport. With this new attitude to life I resolved to lose weight. Over the course of the year there were a number of ups and downs. I firstly went back to all the men’s health magazines that I had stock piled over the years and started to work out where I was going wrong with my health. After a little investigation it became apparent that going running and working out in the gym was not enough to become healthy. If you want to be slim and healthy then your diet is far more important than what physical activity you do. My diet used to be almost entirely based on red meat and carbs: steak, mince, bacon, rice and pasta. Over the year I changed my diet to involve far more vegetables, more fibre, more fruit, more salad and way less meat! The result was that by Christmas 2012 I was finally back below 18 stones. The diet had started to have benefits. Then came exams! By the end of exams in April 2013 I had gone back up 19 stones and a waist of >40”. I was still spending nearly 2 hours a day doing weights in the gym and running or cycling 3 times a week. Even with all this exercise and a new self- awareness of my size, a terrible diet over the 3 week exam period had meant that I gained a lot of fat. After exams I went travelling in China for 3 weeks. While I was there I ate only local food and lots of coffee. Did not each lunch and was walking around exploring for over 6 hours a day. When I got back I was 17.5 stone, about 106kg. My waist had shrunk back down to 36” and I could fit into clothes I had not worn in years. This sudden weight loss was not explained by traveller’s diarrhoea or any increased activity above normal. What made me lose weight was eating a fairly healthy diet and eating far less calories than I normally would. I know this sounds like common sense but I had always read and believed that if you exercised enough then you could lose weight without having to decrease your calorie intake too much. I have always hated the sensation of being hungry and have always eaten regular to avoid this awful gnawing sensation. I had almost become hunger-phobic, always eating when given the opportunity just in case I might feel hungry later and not because I actually needed to eat. The time in China made me realise that actually I don’t NEED to eat that regularly and I don’t NEED to eat that much. I can survive perfectly ably without regular sustenance and have more than enough fat stores to live my life fully without needing to each too much. My eating had just become a habit, a WANT and completely unnecessary. After being home for a month I have had some ups and downs trying to put my new plans into action. Not eating works really easily in a foreign country, where it’s hot, you are busy and you don’t have a house full of food or relatives that want to feed you. I have managed to maintain my weight around 17.5 stones and kept my waist within 36” trousers. I am counting that as a success so far. The plan from now on is to get my weight down to under 16.5 stones because I believe that as this weight I will not be carrying too much excess weight and my BMI will be as close to “not obese” as it is likely to get without going on a starvation diet. I intend to achieve this goal by maintain my level of physical activity – at least 6 hours of gym work a week, 2 cardio sessions, tennis, squash, cycling, swimming and golf as the whim takes me. BUT MORE IMPORTANTLY, I intend to survive off far fewer calories with a diet based on bran flakes, salad, fruit, nuts, chicken and milk. I am hoping that this very simple plan will work! Conclusion Writing this short(-ish) autobiography was quite cathartic and I would really recommend it for other people who are trying to remake themselves. Its helped me put my thoughts in order. Over the years I wanted to lose weight because I wanted to look better. This desire has now matured into a drive to be not just slimmer but healthier; I no longer want to be slimmer just for the looks but also to reduce the pressure on my joints, to reduce the pressure on my cardiovascular system, to reduce my risks of being fat when I am older, to hopefully reduce the risk of dying prematurely and to some extent to make life cheaper – eating loads of meat to prevent hunger is expensive! I hope this blog has been mildly interesting, but also informative of just how easy it is for even a health conscious, sporty individual to become fat in our society. I also wanted to document how difficult it is to lose weight and maintain that new lower weight for any prolonged length of time. At some point I would like to do a blog on the best methods for weight loss but that may have to wait until I have found what works for me and if I do actually manage to achieve my goals. Would be a bit hypercritical to write such a blog while still having a BMI yo-yoing around 32 I feel! Thought for the day 1 - Gaining wait is easy, becoming fat is easy, losing fat is also technically easy! The hard part is developing AND then maintaining a healthy mental attitude towards your weight. The human body has evolved to survive starvation. We are almost perfectly made to build up high density fat stores just in case next year’s crops fail and we have to go a few months on broth. I will say it again – We are designed to survive hard conditions! The problem with the modern world and with modern society is that we no longer have to fight to survive. For the first time in human history food is no longer scarce… it is in fact incredibly abundant and cheap (http://www.youtube.com/watch?v=-Z74og9HbTM). It is no surprise that when a human body is allowed to eat want and how much it craves and then do as little activity as possible, that it puts on fat very quickly. This has to be one of the major ironies of our age – When the human race has evolved society enough that we no longer need to have fat stores in case of disaster, that we are now the fattest humans have ever been! 2 – The best bit of advice I was ever given is this: “Diets ALWAYS fail! No matter what the diet or how determined you are, if you diet then within 2 years you will be the same weight or heavier than you are now. The only way to a healthy body is through a healthy LIFESTYLE CHANGE! You have to make changes that you are prepared to keep for a long time.”  
jacob matthews
over 8 years ago
Foo20151013 2023 10deu9q?1444773933
10
1030

Problem based learning - Friend or Foe?

What is Problem Based Learning? During my time at medical school, I enjoyed (at times) a curriculum delivered through the traditional model. As the name suggests, this is an approach experienced by the majority of doctors to date. The traditional model was first implemented by the American Medical College Association and American Academy of Medicine in 1894 (Barr, 2010) and has been used by the majority of medical schools. It traditionally consists of didactic lectures in the initial years covering the basic sciences followed by clinical years, where students learn clinical medicine while attending hospital placements. Is It Better? A few years after my graduation I found myself teaching at a university which had fully adopted the use of problem based learning (PBL) in the delivery of their curriculum. PBL is a philosophy of teaching that has increasingly been used in medical education over the past 40 years. It has rapidly been replaced or supplemented in medical education as opposed to the traditional model. PBL seeks to promote a more integrated and active approach to learning right from the first year with less reliance on didactic lectures. Having been involved in these two different approaches to medical education, I was interested to explore what the evidence was for and against each. For the purposes of this blog, I have looked at four specific areas. These include student attitudes, academic achievement, the academic process of learning and clinical functioning and skills. Student Attitudes Student attitudes to PBL have been highly featured in studies and many show that there is a clear favourability towards this philosophy of teaching. Blumberg and Eckenfel (1988) found that students in a problem based preclinical curriculum rated this three times higher than those in the a traditional group in terms of what they expect to experience, what they would like, and what they actually experienced. Heale et al (1988) found physicians in the problem-solving sessions rated a Continuing Medical Education short course higher compared to others who attended traditional lectures and large-group sessions. Vernon and Black (1993) performed a Meta analysis on 12 studies that looked at attitudes and towards PBL and found PBL was favored in some way by all studies. PBL appears to be preferred by the majority of students at a range of academic levels. However, Trappler (2006) found that converting a conventional curriculum to a problem based learning model for part of a psychopathology course did not show complete favourability. Students preferred the conventional lectures given by experts, rather than PBL groups run by mentors and not experts. They did however show preference towards PBL small group sessions run by experts Academic Achievement Academic achievement is an important factor to assess. Vernon and Blake (1993) compared a number of studies and found that those, which could be compared, showed a significant trend favouring traditional teaching methods. However, it was felt this might not be reliable. When looking at the heterogeneity of the studies there was significant variation that could not be accounted for by chance alone. Interestingly, they found that there was significant geographical variation across the United States such that New Mexico showed consistently negative effects and Michigan State showed consistently positive. Other studies have shown that the traditional method may show a slightly better outcome when assessing academic achievement. Schmidt et al (1987) looked at the same progress test taken among students in six different Universities in the Netherlands and found that those taught by a traditional approach showed slightly better outcomes. Baca et al (1990) compared performances of medical students in two separate tracks, one PBL the other a traditional model. Baca et al found that PBL students scored slightly lower in the National Board of Medical Examiners (NBME) examinations. Dochy et al (2003) conducted a meta analysis comparing 43 studies and found that when considering the effect of PBL on the knowledge of students the combined effect size is slightly negative. The academic process of learning It is important in medical education to enable people to continue life long learning, to overcome problems and fill in knowledge gaps. Coles (1990) and Entwistle (1983) found that PBL students would place more emphasis on understanding and meaning compared to just rote learning, seen more in those taught by a traditional approach. Students on a PBL course also place more focus on using resources such as the library and online sources rather than those taught in a traditional approach (Rankin, 1992). Students taught by a traditional model place more emphasis on the resources supplied by the faculty itself. It has also been shown that students who learn through a process of problem solving, are more likely to use this spontaneously to solve new problems in the future compared with those taught in a traditional way (Bransford et al, 1989). Clinical functioning and skills Clinical competence is an important aspect in medical education and has been measured in studies comparing PBL and traditional methods. The traditional model focuses acquisition of clinical competence in the final years of a program with hospital placements. In a PBL course it may be more integrated early on. There are however, only a few studies that look at clinical competence gained in undergraduate PBL courses. Vernon and Blake (1993) compared some of these studies and found that students obtained better clinical functioning in a PBL setting compared to a traditional approach. This was statistically significant, however there was still significant heterogeneity amongst studies and for conclusive results to be made 110 studies would have to be compared, rather that the 16 samples they were able to use. They also found that in contrast to the NBME I giving better results in the traditional model, PBL students score slightly higher in NBME II and federation licensing examination which related more on clinical functioning than basic sciences. On reflection, this evidence has indicated to me that PBL is a very valuable approach and it has a number of benefits. The traditional model in which I was taught has provided a good level of academic education. However, it may not have supported me as well as a PBL course in other areas of medical education such as academic process, clinical functioning and satisfaction. On reflection and current recommendations are for a hybridisation of the PBL and traditional approach to be used (Albanese, 2010) and I would support this view in light of the evidence. References Baca, E., Mennin, S. P., Kaufman, A., and Moore-West, M. A Comparison between a Problem-Based, Community Orientated track and Traditional track Within One Medical school. In Innovation in Medical Education; An Evaluation of Its Present Status. New York: Springer publishing Barr D. (2010) Revolution or evolution? Putting the Flexner Report in context. Medical Education; 45: 17–22 Blumberg P, Eckenfels E. (1988) A comparison of student satisfaction with their preclinical environment in a traditional and a problem based curriculum. Research in Medical Education: Proceedings of the Twenty-Seventh Annual Conference, pp. 60- 65 Bransford, J. D., Franks, J. J., Vye, N. J., & Sherwood, R. D. (1989). New Approaches to Instruction: Because Wisdom Can't Be Told. In S. Vosiadou & A. Ortony (Eds.), Similarity and Analogical Reasoning (pp. 470 297). New York: Cambridge University Press. Coles CR. (1990) Evaluating the effects curricula have on student learning: toward a more competent theory for medical education. In: Innovation in medical education: an evaluation of its present status. New York: Springer publishing; 1990;76-93. Dochy F., Segersb M., Van den Bosscheb P., Gijbelsb D., (2003) Effects of problem-based learning: a meta-analysis. Learning and Instruction. 13:5, 533-568 Entwistle NJ, Ramsden P. Understanding student learning. London: Croom Helm; 1983 Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P. (1988) A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Research in Medical Education.;27:72-7. Trappler B., (2006) Integrated problem-based learning in the neuroscience curriculum - the SUNY Downstate experience. BMC Medical Education 6: 47. Rankin JA. Problem-based medical education: effect on library use. Bull Med Libr Assoc 1992;80:36-43. Schmidt, H G; Dauphinee, W D; Patel, V L (1987) Comparing the effects of problem-based and conventional curricula in an international sample Journal of Medical Education. 62(4): 305-15 Vernon D. T., Blake R. L., (1993) Does Problem-based learning work? A meta-analysis of evaluated research. Academic Medicine.  
Dr Alastair Buick
almost 9 years ago
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1 Billion users - Well done! But there are still bigger fish to fry.

I would like to say "well done, Mark Zuckerberg" as Facebook tops 1 billion active users! But all this is while 1 billion people in the world never see a health worker in their entire lives. The internet is the most powerful tool of our generation and there is no doubt that its influence will increase further in the future. I think we can all recognise the success of an enterprise such as Facebook and it is certainly a commendable feat to bring 1 billion people closer together on a regular basis. Well done Mark Zuckerberg! But does this not highlight some bigger questions? When will we see the internet making a real difference? I don't mean to belittle any enterprise such as Facebook which excites and energises a huge community, but when will we see a movement that has such an impact to save and improve billions of lives every month? The WHO Global Health Workforce Alliance estimates that there are a billion people alive today who will never see a health worker in their lives... Ever! We are not short of the tools to change this. So, how will this movement come about? Will it be a political push? Will it be an established company that walks in the 'right' direction? Or could it come from the grassroots? I believe this is one of the greatest challenges of our generation, and the most exciting challenge I can think of. As a doctor and co-founder of Meducation, we have started a movement in the right direction. Meducation aims to unite the medical community - yes all of it, but we know our limits. You can not make such an impact in one step. Most of the charitable solutions and philanthropic activity takes us huge leaps in the right direction and these are of significant importance, but will we ever see the sort of impact possible if we can't maintain the ability to push forwards with the attrition needed to effectively get this right. I would assume that most of those who have set up an innovative and successful solution to a problem would say that they could not achieve this with an element of freedom to experiment, try different methods and approaches before finding the formula that works. Is it not the same with this problem? The solution is going to grow from the grassroots and for us at Meducation, although we are starting with health workers in the UK, we certainly see the hopeful future where the health workers in the developing countries can gain access to the educational material and support they need from the rest of the community. With the global medical community working closely together, we will be better placed to help the 1 billion people who would have never see a health worker in their lives. So well done Mark.... but there are still bigger fish to fry.  
Dr Alastair Buick
almost 9 years ago
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What are some possible surgical procedures for bronchiectasis?

For a female 45yrs with lower lobes in left lung.  
Donna Thompson
almost 9 years ago
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Is it routinely necessary for patients with suspected appendicitis to undergo an appendicectomy?

I do understand that surgeons are particularly worried of an abscess forming around the appendix and want to remove if needed.But I was wondering whether it is necessary for the patient to undergo the procedure...  
Debkumar Chowdhury
almost 9 years ago
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Arthritis and Arthrocentesis

A talk I developed for Emergency Medicine residents. Includes links to YouTube videos demonstrating some of the procedures described on the slides.  
Joe Lex
about 9 years ago
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Designer Babies - Physiology and Ethics

An essay I wrote for my course, with which I received an Honours grade (75%). I have an interest in Medical Ethics, and this essay discusses the possible physiology and ethics surrounding the controversial topic. **Introduction** (taken from the essay): My topic is designer babies. A designer baby is defined by the Oxford Dictionary of English as, “a baby whose genetic make-up has been selected in order to eradicate a particular defect, or to ensure that a particular gene is present” (1). In this essay, I shall be exploring the arguments and ideas surrounding the selection of a baby’s genes, which in modern times has become a highly controversial subject. This essay will start by describing the methods by which designer babies may be produced, namely pre-implantation genetic diagnosis (PGD) and pro-nuclear transfer, also coined the ‘three-parent baby’ by some (2). Once these procedures have been presented, ethical considerations forming both sides of the debate will be discussed. Whilst the typical argument used is ‘autonomy vs. playing god’, other ideas include whether such procedures will have a drastic effect on the future, and change the world as we know it, as suggested in the science-fiction film Gattaca (3). The ‘nature vs. nurture’ debate is also described: whether we are defined by our genes as shown in Gattaca, or if the environmental influence we are subjected to can cause our genotype to be negligible, i.e. our genes have no impact on our traits; personality, looks etc. The expectations placed upon our offspring; the definition of disease and disability; the fear of the rate of medical development – will all be discussed in this essay. The conclusion will summarise the arguments of both sides, and will attempt to answer the following question: should we be allowed to design our babies?  
Jonathan Chernick
about 9 years ago
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Which bacteria could cause urinary tract infections but would not show up on a normal urine culture?

Some bacteria species (such as Mycoplasma) are difficult to culture using standard methods. Could these bacteria cause a urinary tract infection in the absence of a positive urine culture? If so, how can these infections be diagnosed in a patient with only general symptoms of cystitis? What other hard-to-culture species besides Mycoplasma can cause urinary tract infections?  
Joshua Lotz
about 9 years ago
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Acute back pain Presentation

An overview of clinical back pain, looking at common aetiology and methods of avoiding reinjury.  
Thomas Lemon
over 9 years ago
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Femoral Nerve Block – A Guide for Medial Students and Junior Doctors.

I completed this article in collaboration with a senor registrar whilst studying as an undergraduate medical student in Dundee. This article outlines the proposed introduction of a technique that employs ultrasound to visualise the femoral nerve whilst performing a femoral nerve block. This procedure is performed on patients in both the emergency dept and surgical theatres. Traditionally this procedure has been performed using a 'blind technique' which has an increased association with side effects including inadvertent damage to local structures and systemic toxicity related to local anaesthetic. In the article we give a brief outline of both the the traditional and ultrasound guided techniques and allow readers to understand the benefits of using the proposed technique. We believe that this article will be of great interest to senior medical student and junior doctors who are interested in careers in emergency medicine and anaesthesia. This  
michael jamison
over 9 years ago
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Immune Evasion of Cancer

This diagram was created to summarise my dissertation. It shows numerous methods of immune evasion methods of a cancer cell. I did a lot of research around this subject and never found a diagram that brought this number of methods together, so created one.  
Deleted User
over 9 years ago
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Mneumonics/Acronyms for Population Health and Evidence-Based Practice

Some easy methods to remember: - the definition of 'Epidemiology' and 'Public Health'. - what are Primary, Secondary, and Tertiary disease prevention. - the Bradford-Hill criteria for disease causation.  
David Jones
about 10 years ago
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Detailed first and second year OSCE stations

Explanations of procedures and signs associated with various OSCE style stations relevant to first and second year MBBS, including pictures of relevant pathology and illustrative diagrams. Includes - resuscitatio - peripheral pulse - blood pressur - cardiovascular exam (including relevant aspects of the general examination - ECG lead placemen - Respiratory exam (including relevant aspects of the general examination - peak flo - vitalograp - abdominal examination (including relevant aspects of the general examination - PNS (motor function - Reflexes alon - cranial nerve exa - Thyroid exa - cervical and lymph node (diagrams only - Shoulder joint exa - Hip joint exam  
Gemma McIntosh
over 10 years ago