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Vestibular system

The vestibular system. This image shows the central part of the vestibular system( the system responsible for providing information concerning gravity, rotation and acceleration) showing: 1. occulomotor nucleus 2. trochlear nucleus 3. abducent nucleus 4. vestibular nuclei 5. vestibular  
edoctoronline.com
over 4 years ago
7
0
59

What is the advantage of 'block and replace' regime in managing grave's disease patient?

I am now doing a thyroid surgery rotation. This morning we had a tutorial regarding management of patient with grave's disease (hyperthyroid). We were asked about what are the options that available for them. One of the participants highlighted the so called "block and replace regime" in which we are giving patient with carbimazole (block) and thyroxine (replace). The problem is, despite giving carbimazole alone, why do we need to add on thyroxine in managing hyperthyroid patient since this thyroxine might worsen the condition. Any ideas?  
malek ahmad
about 7 years ago
1
0
15

How could it be possible to get angina from normal coronary arteries in cardiac x syndrome?

Now I'm doing a rotation in cardiology. I've come across about Cardiac X syndrome, but I don't really get what it is. A book said "it is a form of microvascular angina but occurs in normal coronary arteries". Unfortunately, no-where in the book is it explained in depth. So I have a few questions: Is there any proper definition and how to diagnose it? What is the pathophysiology than can explain this syndrome? Does it something related to metabolic x syndrome? Any takers?  
malek ahmad
about 7 years ago
12
0
25

Do final year medical students enjoy their ICU placements?

I often see that final year students do not enjoy their rotations through the ICU. Maybe the whole environment is daunting and all the machines just confuse things? Do you find it a great place to apply core physiology? Would be great to hear the positive and negative experiences.  
Dr Sunil Patel
almost 6 years ago
Foo20151013 2023 1ecatpw?1444774000
9
17920

My transition from medical student to patient

I started medical school in 2007 wanting to 'making people better'. I stopped medical school in 2010 facing the reality of not being able to get better myself, being ill and later to be diagnosed with several long term health conditions. This post is about my transition from being a medical student, to the other side - being a patient. There are many things I wish I knew about long-term health conditions and patients when I was a medical student. I hope that through this post, current medical students can become aware of some of theses things and put them into practice as doctors themselves. I went to medical school because I wanted to help people and make them better. I admired doctors up on their pedestals for their knowledge and skills and expertise to 'fix things'. The hardest thing for me was accepting that doctors can't always make people better - they couldn't make me better. Holding doctors so highly meant it was very difficult for me to accept their limitations when it came to incurable long-term conditions and then to accept that as a patient I had capacity myself to help my conditions and situation. Having studied medicine at a very academic university, I had a very strict perception of knowledge. Knowledge was hard and fast medical facts that were taught in a formal setting. I worked all day and night learning the anatomical names for all the muscles in the eye, the cranial nerves and citric acid cycle, not to mention the pharmacology in second year. Being immersed in that academic scientific environment, I correlated expertise with PhDs and papers. It was a real challenge to realise that knowledge doesn't always have to be acquired through a formal educational but that it can be acquired through experience. Importantly, knowledge acquired through experience is equally valid! This means the knowledge my clinicians have developed through studying and working is as valid as my knowledge of my conditions, symptoms and triggers, developed through experiencing it day in day out. I used to feel cross about 'expert patients' - I have spent all these hours in a library learning the biochemistry and pharmacology and 'Joe Bloggs' walks in and knows it all! That wasn't the right attitude, and wasn't fair on patients. As an expert patient myself now, I have come to understood that we are experts through different means, and in different fields. My clinicians remain experts in the biological aspects on disease, but that's not the full picture. I am an expert in the psychological and social impact of my conditions. All aspects need to be taken into account if I am going to have holistic integrated care - the biopsychosocial model in practice - and that's where shared-decision making comes in. The other concept which is has been shattered since making the transition from medical student to patient is that of routine. In my first rotation, orthopaedics and rheumatology, I lost track within the first week of how many outpatient appointments I sat in on. I didn't really think anything of them - they are just another 15 minute slot of time filled with learning in a very busy day. As a patient, my perspective couldn't be more different. I have one appointment with my consultant a year, and spend weeks planning and preparing, then a month recovering emotionally. Earlier this year I wrote a whole post just about this - The Anatomy of an Appointment. Appointments are routine for you - they are not for us! The concept of routine applies to symptoms too. After my first relapse, I had an emergency appointment with my consultant, and presented with very blurred vision and almost total loss of movement in my hands. That very fact I had requested an urgent appointment suggest how worried I was. My consultants response in the appointment was "there is nothing alarming about your symptoms". I fully appreciate that my symptoms may not have meant I was going to drop dead there and then, and that in comparison to his patients in ICU, I was not as serious. But loosing vision and all use of ones hands at the age of 23 (or any age for that matter) is alarming in my books! I guess he was trying to reassure me, but it didn't come across like that! I have a Chiari malformation (in addition to Postural Orthostatic Tachycardia Syndrome and Elhers-Danlos Syndrome) and have been referred to a neurosurgeon to discuss the possibility of neurosurgery. It is stating the obvious to say that for a neurosurgeon, brain surgery is routine - it's their job! For me, the prospect of even being referred to a neurosurgeon was terrifying, before I even got to the stage of discussing the operation. It is not a routine experience at all! At the moment, surgery is not needed (phew!) but the initial experience of this contact with neurosurgeons illustrates the concept of routines and how much our perspectives differ. As someone with three quite rare and complex conditions, I am invariable met in A&E with comments like "you are so interesting!". I remember sitting in the hospital cafeteria at lunch as a student and literally feasting on the 'fascinating' cases we had seen on upstairs on the wards that morning. "oh you must go and see that really interesting patient with X, Y and Z!" I am so thankful that you all find medicine so interesting - you need that passion and fascination to help you with the ongoing learning and drive to be a doctor. I found it fascinating too! But I no longer find neurology that interesting - it is too close to home. Nothing is "interesting" if you live with it day in day out. No matter what funky things my autonomic nervous may be doing, there is nothing interesting or fascinating about temporary paralysis, headaches and the day to day grind of my symptoms. This post was inspired by NHS Change Day (13th March 2013) - as a patient, I wanted to share these few things with medical students, what I wish I knew when I was where you are now, to help the next generation of doctors become the very best doctors they can. I wish you all the very best for the rest of your studies, and thank you very much for reading! Anya de Iongh www.thepatientpatient2011.blogspot.co.uk @anyadei  
Anya de Iongh
over 6 years ago
Foo20151013 2023 8occ4b?1444774213
4
136

A taste of someone else's medicine

Choosing a career path is one of the hardest (non-clinical) decisions many doctors will face in their professional lives. With almost 100 specialties and sub-specialties available, settling on any one career can seem pretty daunting, particularly as in the majority of cases the choice will set a path you’re likely to be on for the next 30+ years. But, with only a very small range of these specialties and almost none of the sub-specialties available to undertake as rotations during any one foundation programme, finding out what actually working in different specialties is like can be difficult. It’s likely you’ll have at least identified an area you’re kind of/maybe interested in before starting the foundation programme but, to use a total cliché, you wouldn't buy a car without taking it for a test drive, right? There is good evidence to show that any experience, even if only brief, can be very influential on career choice and this is why all deaneries offer new doctors to undertake a ‘taster week’ at some point during the Foundation Programme. This is usually from 2-5 days, taken as study leave, in a specialty of the doctor’s choosing which they haven’t and won’t work during their foundation programme. Most hospitals will allow doctors to do this at an external hospital or organisation if the desired specialty isn't available locally. Tasters are often organised by the trainee but deaneries are encouraged to provide a list or register of structured taster programmes to its trainees. A timetable split into half-day activities, including time for 1:1 discussion with both consultants and trainees, should be provided or agreed with a supervisor, which gives the doctor as broad an experience of the roles, responsibilities, highlights, challenges and lifestyle of the specialty as possible. This should then give the doctor plenty of food for thought and provide an opportunity for (you guessed it) reflection to confirm or exclude that specialty as a career choice and identify (if the former) what steps they need to take to get there. At the end of the experience the doctor should fill in a feedback form and formally reflect in their portfolio. Taster weeks aren't limited to particular specialties and sub-specialties either; there are plenty of more over-arching opportunities such as experiencing leadership and management roles or getting involved in academia, research or medical education. As long as you can identify and describe what you’ll aim to learn or understand from the experience, almost any taster is possible. So, how do you go about it? Each deanery should have a policy relating to taster weeks, or have an responsible administrator who can provide advice. Talking to your educational supervisor can also be really useful. Considering early on in FY1 which area or specialty you want to explore is important; time runs out scarily quickly and taking time out of rotations needs careful planning and co-ordination to make sure there is enough cover for your day job. You may already know or have identified an appropriate supervisor who will facilitate the experience but if not, your supervisor or administrator will almost certainly be able to point you in the right direction. You’ll never get to experience every possible career path before starting out on one; the specialty or sub-specialty you eventually work in may not even exist yet. But getting an idea of what you’ll definitely consider, or definitely won’t, will give you a better chance of identifying something that will suit you personally and professionally, and, particularly in the more competitive and run-though specialties will give you another example of commitment to specialty. Don’t be afraid to think outside the box or look at something really niche – it may give you a taste for something unexpected that you’ll love for life. References: http://www.foundationprogramme.nhs.uk/download.asp?file=Tasters_guidance_2011_final-2.pdf  
Dr Lydia Spurr
almost 6 years ago
Foo20151013 2023 gvoh9v?1444774222
2
311

Socks, Kiwis and Surgical Removal

I’m a klutz. Always have been. Probably always will be. I blame my clumsiness on the fact that I didn’t crawl. Apparently I was sitting around one day and toddling on two feet the next. Whatever the cause, it’s a well-tested fact that I’m not good on icy footpaths. Various parts of my anatomy have gotten up close and personal with frozen ground on many an occasion. Not usually an issue for a born-and-bred Australian, except when said Australian goes to visit her Canadian family during the northern winter. During one such visit, I found myself unceremoniously plopped onto slick ice while my two-year-old niece frolicked around me with sure-footed abandon. I thought, “There has to be an easier way.” As freezing water seeped through my jeans, providing a useful cold pack for my screaming coccyx, my memory was jogged. I recalled that a lateral-thinking group of New Zealand researchers had won the Ignoble Prize for Physics for demonstrating that wearing socks on the outsides of shoes reduces the incidence of falls on icy footpaths. To the amusement of my niece, I tried out the theory for myself on the walk home. I don’t know if I had a more secure foothold or not, but I did manage to get blisters from wearing sneakers without socks. I love socks. They cover my large, ungainly clod-hoppers and keep my toes toasty warm almost all year round. You know the song ‘You can leave your hat on.’? Well for me, it is more a case of ‘You can leave your socks on, especially in winter. There’s nothing unromantic about that… is there? I’m not, however, as attached to my socks as a patient I once treated. As an intern doing a psychiatry rotation, one of my tasks was to do physical examinations on all admissions. Being a dot-the-i’s kinda girl, when an old homeless man declined to remove his socks so that I could examine his feet, I didn’t let it slide. “I haven’t taken off my socks for thirty years,” he pronounced. “It can’t be that long. Your socks aren’t thirty years old. In fact, they look quite new,” I countered. “When the old ones wear out, I just slip a new pair over the top.” I didn’t believe him. From his odour, I would have believed that he hadn’t showered in thirty years, but the sock story didn’t add up. He eventually agreed to let me take them off. The top two sock layers weren’t a problem but then I ran into trouble. Black remains of what used to be socks clung firmly to his feet, and my gentle attempts at their removal resulted in screams of agony. I tried soaking his feet. Still no luck. His skin had grown up into the fibres, and it was impossible to extract the old sock remnants without ripping off skin. In retrospect I probably should have left the old man alone, but instead got the psych registrar to have a peek, who then involved the emergency registrar, who called the surgeon and soon enough the patient and his socks were off to theatre. The ‘surgical removal of socks’ was not a commonly performed procedure, and it provided much staff amusement. It wasn’t so funny for Mr. Sock Man, who required several skin grafts! From my perspective here in Canada, while I thoroughly commend the Kiwis for their ground-breaking sock research, I think I’ll stick to the more traditional socks-in-shoes approach, change my socks regularly and work a bit on my coordination skills. References: PHYSICS PRIZE: Lianne Parkin, Sheila Williams, and Patricia Priest of the University of Otago, New Zealand, for demonstrating that, on icy footpaths in wintertime, people slip and fall less often if they wear socks on the outside of their shoes. "Preventing Winter Falls: A Randomised Controlled Trial of a Novel Intervention," Lianne Parkin, Sheila Williams, and Patricia Priest, New Zealand Medical Journal. vol. 122, no, 1298, July 3, 2009, pp. 31-8. (This blog post has been adapted from a column first published in Australian Doctor http://www.australiandoctor.com.au/articles/58/0c06f058.asp) Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/  
Dr Genevieve Yates
over 5 years ago
Foo20151013 2023 1u6up6r?1444774235
4
132

Keep on Truckin’

Shattered. Third consecutive day of on-calls at the birth centre. I’m afraid I have little to show for it. The logbook hangs limply at my side, the pages where my name is printed await signatures; surrogate markers of new found skills. Half asleep I slump against the wall and cast my mind back to the peripheral attachment from which I have not long returned. The old-school consultant’s mutterings are still fresh: “Medical education was different back then you see....you are dealt a tough hand nowadays.” I quite agree, it is Saturday. Might it be said the clinical apprenticeship we know today is a shadow of its former self? Medical school was more a way of life, students lived in the hospital, they even had their laundry done for them. Incredulous, I could scarcely restrain a chuckle at the consultant’s stories of delivering babies while merely a student and how the dishing out of “character building” grillings by their seniors was de rigeur. Seldom am I plied with any such questions. Teaching is a rare commodity at times. Hours on a busy ward can bear little return. Frequently do I hear students barely a rotation into their clinical years, bemoan a woeful lack of attention. All recollection of the starry-eyed second year, romanced by anything remotely clinical, has evaporated like the morning dew. “Make way, make way!...” cries a thin voice from the far reaches of the centre. A squeal of bed wheels. The newly crowned obs & gynae reg drives past the midwife station executing an impressive Tokyo drift into the corridor where I stand. Through the theatre doors opposite me he vanishes. I follow. Major postpartum haemorrhage. A bevy of scrubs flit across the room in a live performance of the RCOG guidelines for obstetric haemorrhage. They resuscitate the women on the table, her clammy body flat across the carmine blotched sheets. ABC, intravenous access and a rapid two litres of Hartmann’s later, the bleeding can not be arrested by rubbing up contraction. Pharmacological measures: syntocinon and ergometrine preparations do not staunch the flow. Blood pressure still falling, I watch the consciousness slowly ebb from the woman’s eyes. Then in a tone of voice, seemingly beyond his years, the reversely gowned anaesthetist clocks my badge and says, “Fetch me the carboprost.” I could feel an exercise in futility sprout as I gave an empty but ingratiating nod. “It’s hemabate....in the fridge” he continues. In the anaesthetic room I find the fridge and rummage blindly through. Thirty seconds later having discovered nothing but my general inadequacy, I crawl back into theatre. I was as good as useless though to my surprise the anaesthetist disappeared and returned with a vial. Handing me both it and a prepped syringe, he instructs me to inject intramuscularly into the woman’s thigh. The most common cause of postpartum haemorrhage is uterine atony. Prostaglandin analogues like carboprost promote coordinated contractions of the body of the pregnant uterus. Constriction of the vessels by myometrial fibres within the uterine walls achieves postpartum haemostasis. This textbook definition does not quite echo my thoughts as I gingerly approach the operating table. Alarmingly I am unaware that aside from the usual side effects of the drug in my syringe; the nausea and vomiting, should the needle stray into a nearby vessel and its contents escape into the circulation, cardiovascular collapse might be the unfortunate result. Suddenly the anaesthetist’s dour expression as I inject now assumes some meaning. What a relief to see the woman’s vitals begin to stabilise. As we wheel her into the recovery bay, the anaesthetist unleashes an onslaught of questions. Keen to redeem some lost pride, I can to varying degrees, resurrect long buried preclinical knowledge: basic pharmacology, transfusion-related complications, the importance of fresh frozen plasma. Although, the final threat of drawing the clotting cascade from memory is a challenge too far. Before long I am already being demonstrated the techniques of regional analgesia, why you should always aspirate before injecting lidocaine and thrust headlong into managing the most common adverse effects of epidurals. To have thought I had been ready to retire home early on this Saturday morning had serendipity not played its part. A little persistence would have been just as effective. It’s the quality so easily overlooked in these apparently austere times of medical education. And not a single logbook signature gained. Oh the shame! This blog post is a reproduction of an article published in the Medical Student Newspaper, February 2014 issue.  
James Wong
over 5 years ago
Foo20151013 2023 vvr5q9?1444774253
5
184

Clinics - Making the most of it

Commencing the first clinical year is a milestone. Things will now be different as your student career steers straight into the unchartered waters of clinical medicine. New challenges and responsibilities lie ahead and not just in an academic sense. After all this is the awaited moment, the start of the apprenticeship you have so desired and laboured for. It won’t be long before these clinical years like the preclinical years before them, will seem just as distant and insular, so why not make the most of it? The first days hold so much excitation and promise and for many they deliver, however, it would be wise not to be too optimistic. I am afraid your firm head standing abreast the doors in a prophetic splaying of arms is an unlikely sight. In this new clinical environment, it is natural to be a little flummoxed. The quizzical looks of doctors and nurses as you first walk in, a sure sign of your unexpected arrival, is a recurring theme. If the wards are going to be your new hunting ground, proper introductions with the medical team are in order. This might seem like a task of Herculean proportions, particularly in large teaching hospitals. Everyone is busy. Junior doctors scuttling around the ward desks job lists in hand, the registrar probably won’t have noticed you and as luck would have it your consultant firm head is away at a conference. Perseverance during these periods of frustration is a rewarding quality. Winning over the junior doctors with some keenness will help you no end. What I mean to say is that their role in our learning as students extends further than the security of sign-off signatures a week before the end of the rotation. They will give you opportunities. Take them! Although it never feels like it at the time, being a medical student does afford some privileges. The student badge clipped to your new clinic clothes is a license to learn: to embark on undying streaks of false answers, to fail as many skills and clerkings as is required and to do so unabashed. Unfortunately, the junior doctors are not there purely for your benefit, they cannot always spare the time to directly observe a history taking or an examination, instead you must report back. With practice this becomes more of a tick box exercise: gleaning as much information and then reconfiguring it into a structured presentation. However, the performance goes unseen and unheard. I do not need to iterate the inherent dangers of this practice. Possible solutions? Well receiving immediate feedback is more obtainable on GP visits or at outpatient clinics. They provide many opportunities to test your questioning style and bedside manner. Performing under scrutiny recreates OSCE conditions. Due to time pressure and no doubt the diagnostic cogs running overtime, it is fatefully easy to miss emotional cues or derail a conversation in a way which would be deemed insensitive. Often it occurs subconsciously so take full advantage of a GP or a fellow firm mate’s presence when taking a history. Self-directed learning will take on new meaning. The expanse of clinical knowledge has a vertiginous effect. No longer is there a structured timetable of lectures as a guide; for the most part you are alone. Teaching will become a valued commodity, so no matter how sincere the promises, do not rest until the calendars are out and a mutually agreed time is settled. I would not encourage ambuscaded attacks on staff but taking the initiative to arrange dedicated tutorial time with your superiors is best started early. Consigning oneself to the library and ploughing through books might appear the obvious remedy, it has proven effective for the last 2-3 years after all. But unfortunately it can not all be learnt with bookwork. Whether it is taking a psychiatric history, venipuncture or reading a chest X-ray, these are perishable skills and only repeated and refined practice will make them become second nature. Balancing studying with time on the wards is a challenge. Unsurprisingly, after a day spent on your feet, there is wavering incentive to merely open a book. Keeping it varied will prevent staleness taking hold. Attending a different clinic, brushing up on some pathology at a post-mortem or group study sessions adds flavour to the daily routine. During the heated weeks before OSCEs, group study becomes very attractive. While it does cement clinical skills, do not be fooled. Your colleagues tend not to share the same examination findings you would encounter on an oncology ward nor the measured responses of professional patient actors. So ward time is important but little exposure to all this clinical information will be gained by assuming a watchful presence. Attending every ward round, while a laudable achievement, will not secure the knowledge. Senior members of the team operate on another plane. It is a dazzling display of speed whenever a monster list of patients comes gushing out the printer. Before you have even registered each patient’s problem(s), the management plan has been dictated and written down. There is little else to do but feed off scraps of information drawn from the junior doctors on the journey to the next bed. Of course there will be lulls, when the pace falls off and there is ample time to digest a history. Although it is comforting to have the medical notes to check your findings once the round is over, it does diminish any element of mystery. The moment a patient enters the hospital is the best time to cross paths. At this point all the work is before the medical team, your initial guesses might be as good as anyone else’s. Visiting A&E of your own accord or as part of your medical team’s on call rota is well worth the effort. Being handed the initial A&E clerking and gingerly drawing back the curtain incur a chilling sense of responsibility. Embrace it, it will solidify not only clerking skills but also put into practice the explaining of investigations or results as well as treatment options. If you are feeling keen you could present to the consultant on post-take. Experiences like this become etched in your memory because of their proactive approach. You begin to remember conditions associated with patient cases you have seen before rather than their corresponding pages in the Oxford handbook. And there is something about the small thank you by the F1 or perhaps finding your name alongside theirs on the new patient list the following morning, which rekindles your enthusiasm. To be considered part of the medical team is the ideal position and a comforting thought. Good luck. This blog post is a reproduction of an article published in the Medical Student Newspaper, Freshers 2013 issue.  
James Wong
over 5 years ago
Foo20151013 2023 1vzj1mi?1444774262
5
201

Wikipedia - help or hindrance?

It’s quick, it’s easy and we’ve all done it. Don’t blush, whether it’s at our leisure or behind the consultant’s back we can confess to having used the world’s sixth most popular website. You might have seen it, sitting pride of place on the podium of practically any Google result page. Of course, it’s the tell tale sign of one of Web 2.0’s speediest and most successful offspring, Wikipedia. Now for fear of patronizing a generation who have sucked on the teat of this resource since its fledgling years, the formalities will remain delightfully short. Wikipedia is the free, multilingual, online encyclopedia, which harnesses the collective intelligence of the world’s internet users to produce a collaboratively written and openly modifiable body of knowledge. The technology it runs on is a highly flexible web application called wiki. It is open-source software; hence the explosion of wiki sites all united under the banner of combined authorship. Anyone with internet access can edit the content and do so with relative anonymity. It would be unthinkable that a source, which does not prioritize the fidelity of its content, could possibly play a role in medical education. How ironic it seems that medical students can waste hours pondering which textbook to swear their allegiance for the forthcoming rotation, yet not spare a second thought typing their next medical query into Wikipedia. Evidently it has carved itself a niche and not just among medical students, but healthcare professionals as well. According to a small qualitative study published in the International Journal of Medical Informatics, 70% of their sample, which comprised of graduates from London medical schools currently at FY2 and ST1 level, used Wikipedia in a given week for ‘clinical purposes’. These ranged from general background reading to double checking a differential and looking up medications. We are so ensnared by the allure of instantaneous enlightenment; it’s somewhat comparable to relieving an itch. "Just Google it..." is common parlance. We need that quick fix. When the consultant asks about his or her favourite eponymous syndrome or you’re a little short on ammunition before a tutorial, the breadth and ease-of-use offered by a service accessible from our phones is a clandestine escape. The concept of Wikipedia, the idea that its articles are in a way living bodies because of the continual editing process, is its strength. Conversely textbooks are to a degree outmoded by the time they reach their publication date. While I commend the contributors of Wikipedia for at least trying to bolster their pages with references to high impact journals, it does not soften the fact that the authorship is unverifiable. Visitors, lay people, registered members under some less than flattering pseudonyms such as Epicgenius and Mean as custard, don’t impart the sense of credibility students (or for that matter patients)expect from an encyclopedia. Since the prestige of direct authorship if off the cards, it does beg the question of what is their motivation and I’m afraid ‘the pursuit of knowledge and improving humanity’s lot' is the quaint response. There is a distinct lack of transparency. It has become a playground where a contributor can impress his/her particular theory regarding a controversial subject unchallenged. Considering there is no direct ownership of the article, who then has the authority to curate the multiple theories on offer and portray a balanced view? Does an edit war ensue? It is not unheard of for drug representatives to tailor articles detailing their product and erase the less pleasant side-effects. Obviously Wikipedia is not unguarded, defences are in place and there is such a thing as quality control. Recent changes will come under the scrutiny of more established editors, pages that are particularly prone to vandalism are vetted and there are a special breed of editors called administrators, who uphold a custodial post, blocking and banishing rebellious editors. A study featured in the First Monday journal put Wikipedia to the test by deliberately slipping minor errors into the entries of past philosophers. Within 48 hours half of these errors had been addressed. Evidently, the service has the potential to improve over time; provided there is a pool of committed and qualified editors. Wikiproject Medicine is such a group of trusted editors composed primarily of doctors, medical students, nurses, clinical scientists and patients. Since 2004, its two hundred or so participants have graded an excess of 25,000 health-related articles according to quality parameters not dissimilar to peer review. However, the vast majority of articles are in a state of intermediate quality, somewhere between a stub and featured article. Having some degree of professional input towards a service as far reaching as Wikipedia will no doubt have an impact on global health, particularly in developing countries where internet access is considered a luxury. March this year saw the medical pages of the English Wikipedia reach a lofty 249,386,264 hits. Its ubiquity is enviable; it maintains a commanding lead over competing medical websites. The accessibility of this information has catapulted Wikipedia far beyond its scope as a humble encyclopedia and into a medical resource. Patients arrive to clinics armed with the printouts. As future doctors we will have to be just that one step ahead, to recognise the limitations of a source that does not put a premium on provenance but is nevertheless the current public health tool of choice. Illustrator Edward Wong This blog post is a reproduction of an article published in the Medical Student Newspaper, November 2013 issue.  
James Wong
over 5 years ago
Foo20151013 2023 thqdyy?1444774274
1
184

Why we need to work to maintain a social life - A Darwinian Medical Training Programme

Book of the week (BotW) = The Darwin Economy by Prof Frank Being a medical student and wanna-be-surgeon, I am naturally very competitive. I know exactly where I want to end up in life. I want to be a surgeon at a major unit doing research, teaching and management, as well as many other things. To reach this goal in a rational way I, and many others like me, need to look at what is required and make sure that we tick the boxes. We must also out-compete every other budding surgeon with a similar interest. Medicine is also a dog-eat-dog world when it comes to getting the job you want. Luckily you can head off into almost any field you find interesting, as long as you have the points on your CV to get access to the training. In recent years, the number of med students has increased, but so has the competition for places. The number of FY1 jobs has increased but so has the competition for good rotations. The number of consultant posts has increased, but so has the competition for the jobs. To even be considered for an interview for a consultant surgeon post these days a candidate (hopefully my future self) will have to demonstrate an excellent knowledge of anatomy, physiology, pathology and demography. They will need to have competent surgical skills and have completed all of the hours and numbers of procedures. To further demonstrate this they will need to have gone on extra-curricular courses and fellowships. They will also need to show that they can teach and have been doing so regularly. They must now also have an understanding of medical leadership and have a portfolio of projects. Finally, they will have had to tick the research box, with posters, publications, oral presentations and research degrees. That’s a long list of tick boxes and guess what? It has been getting longer! I regularly attend a surgical research collaborative meeting in Birmingham. Many of those surgeons didn’t even get taught about research at medical school or publish anything until they were registrars. Now even to get onto a good Core Training post you need to have at the very least some posters in your chosen field and probably a minimum of a publication. That’s a pretty big jump in standards in just 15 years. In two generations the competition has increased exponentially. Why is that? Prof Frank explains economic competition in Darwinian terms. His insights apply equally well to the medical training programme. It’s all about your relative performance compared to your peers and the continual arms race for the best resources (training posts). However, the catch is, if everyone ups their performance by the same amount then you all work harder for no more advantage for anyone, except for the first few people who made the upgrade. The majority do not benefit but are in fact harmed by this continual arms race. I believe that this competition will only get worse as each new year of med students tries to keep up and surpass the previous cohort. This competition will inevitably lead to a greater time commitment from the students with no potential gain. Everything we do is relative to everyone else. If we up our game, we will outperform the competition, until they catch up with us and then relatively we are no better off but are working harder. Why is this relevant? I know everyone will want to select “the best” candidate, but in medicine the “best” candidate doesn’t really exist because we are all almost equally capable of doing the role, once we have had the training. So there is no point us all working ourselves into the ground for a future job, if all our hard work won’t pay off for most of us anyway. But we can’t make these choices as individuals because if one of us says that “I am not going to play the game. I am going to enjoy my free time with my friends and family”, that person won’t get the competitive job because everyone else will out-perform them. We have to tackle this issue as a cohort. How do we ensure that we don’t work ourselves into the ground for nothing? Collectively as medical students and trainees we should ask the BMA and Royal Collages to set out a strict application process that means once candidates have met the minimum requirements, there is no more points for additional effort. For instance, the application form for a surgical consultant post should only have space to include 5 peer-reviewed publications. That way it wouldn’t necessarily matter if you had 5 or 50 publications. This limit may seem counter-intuitive and will possibly work against the highly competitive high achievers, but it will have a positive effect on everyone else’s life. Imagine if you only had to write 5 papers in your career to guarantee a chance at a job, instead of having to write 25. All that extra time you would have had to invest in extra-curricular research can now be used more productively by you to achieve other life goals, like more time with your family or more patient contact or even more time in theatre perfecting your skills. If you were selecting candidates for senior clinicians, would you rather pick an all round doctor who has met all of the requirements and has a balanced work-life balance or a neurotic competitor who hasn’t slept in 8 years and is close to a breakdown? Being a doctor is more than a profession, it is a life-style choice but we should try to prevent it becoming our entire lives.  
jacob matthews
over 5 years ago
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Confidence Building During Medical Training

My fellow medical students, interns, residents and attendings: I am not a medical student but an emeritus professor of Obstetrics and Gynecology at the University of Miami Miller School of Medicine, and also a voluntary faculty member at the Florida International University Herbert Wertheim College of Medicine. I have a great deal of contact with medical students and residents. During training (as student or resident), gaining confidence in one's own abilities is a very important part of becoming a practitioner. This aspect of training does not always receive the necessary attention and emphasis. Below I describe one of the events of confidence building that has had an important and lasting influence on my career as an academic physician. I graduated from medical school in Belgium many years ago. I came to the US to do my internship in a small hospital in up state NY. I was as green as any intern could be, as medical school in Belgium at that time had very little hands on practice, as opposed to the US medical graduates. I had a lot of "book knowledge" but very little practical confidence in myself. The US graduates were way ahead of me. My fellow interns, residents and attendings were really understanding and did their best to build my confidence and never made me feel inferior. One such confidence-building episodes I remember vividly. Sometime in the middle part of the one-year internship, I was on call in the emergency room and was called to see a woman who was obviously in active labor. She was in her thirties and had already delivered several babies before. The problem was that she had had no prenatal care at all and there was no record of her in the hospital. I began by asking her some standard questions, like when her last menstrual period had been and when she thought her due date was. I did not get far with my questioning as she had one contraction after another and she was not interested in answering. Soon the bag of waters broke and she said that she had to push. The only obvious action for me at that point was to get ready for a delivery in the emergency room. There was no time to transport the woman to the labor and delivery room. There was an emergency delivery “pack” in the ER, which the nurses opened for me while I quickly washed my hands and put on gloves. Soon after, a healthy, screaming, but rather small baby was delivered and handed to the pediatric resident who had been called. At that point it became obvious that there was one more baby inside the uterus. Realizing that I was dealing with a twin pregnancy, I panicked, as in my limited experience during my obstetrical rotation some months earlier I had never performed or even seen a twin delivery. I asked the nurses to summon the chief resident, who promptly arrived to my great relief. I immediately started peeling off my gloves to make room for the resident to take my place and deliver this twin baby. However, after verifying that this baby was also a "vertex" without any obvious problem, he calmly stood by, and over my objections, bluntly told me “you can do it”, even though I kept telling him that this was a first for me. I delivered this healthy, screaming twin baby in front of a large number of nurses and doctors crowding the room, only to realize that this was not the end of it and that indeed there was a third baby. Now I was really ready to step aside and let the chief resident take over. However he remained calm and again, stood by and assured me that I could handle this situation. I am not even sure how many triplets he had delivered himself as they are not too common. Baby number three appeared quickly and also was healthy and vigorous. What a boost to my self-confidence that was! I only delivered one other set of triplets later in my career and that was by C-Section. All three babies came head first. If one of them had been a breech the situation might have been quite different. What I will never forget is the implied lesson in confidence building the chief resident gave me. I have always remembered that. In fact I have put this approach in practice numerous times when the roles were reversed later in my career as teacher. Often in a somewhat difficult situation at the bedside or in the operating room, a student or more junior doctor would refer to me to take over and finish a procedure he or she did not feel qualified to do. Many times I would reassure and encourage that person to continue while I talked him or her through it. Many of these junior doctors have told me afterwards how they appreciated this confidence building. Of course one has to be careful to balance this approach with patient safety and I have never delegated responsibility in critical situations and have often taken over when a junior doctor was having trouble. Those interested, can read more about my experiences in the US and a number of other countries, in a free e book, entitled "Crosscultural Doctoring. On and Off the Beaten Path" can be downloaded at this link. Enjoy!  
DR William LeMaire
over 5 years ago
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Beating the Bully

I read an article recently that 90% of surgical trainees have experienced bullying of one form or other in their practice. That’s 90%. That’s shocking. Worryingly it is highly likely that this statistic is not purely isolated to surgery. This is evidence of a major problem that needs to be addressed. We don’t accept bullying in schools and in the workplace policies are in place to stop bullying and harassment– so why have 90% of trainees experienced bullying? I can relate to this from personal experience, as I am sure most of us can. Prior to intercalating I had always had the typical med student ambition of joining the big league and taking on surgery. I had a keen interest in anatomy, I had decided to intercalate in anatomy, I did an SSC on surgical robotics, presented at an undergraduate surgical conference and had a small exposure to surgery in my first couple of years that gave me enough drive to take on a competitive career path. I took it upon myself to try and arrange a brief summer attachment where I would learn as a clinical medical student what it is like to scrub in and be in theatre. At the beginning I was so excited. At the end every time someone mentioned surgery I felt sick. It became apparent very quickly that I was an inconvenience. I think medical students all get this feeling – ‘being in the way’ - but this was different. This was being made to feel deliberately uncomfortable. I asked if I could have some guidance on scrubbing in and this was met with a complete huff and annoyance because I didn’t know how to do it properly (thank goodness for a lovely team of theatre nurses!). I even got assigned a pet name for the week – the ‘limpet’ (notable for their clinging on to rocks) that was frequently used as a humiliation tactic in front of colleagues. By the end of the week I dreaded walking into the hospital and felt physically sick every morning. Now some people might say ‘man up’ and get on with it. Fair enough, but I’m a fairly resilient character and it takes a lot to make me feel like I did that week. This experience completely eradicated any ambition I had at the time to go into surgery. Since then I’ve focused elsewhere and generally dreaded surgical rotations until very recently where I managed to meet a wonderful orthopaedic team who were incredibly encouraging. Bullying can be subjective. Just because a consultant asks you a difficult question doesn’t mean they’re bullying you. By and large clinicians want to stretch you and trigger buttons that make you go and look things up. If it drives you to work and develops you as a professional then it’s not bullying, but if it makes you feel rubbish, sick or less about yourself then you should perhaps think twice about the way you’re being treated. Of course bullying doesn’t stop at professionals. Psychological bullying is rife in medical schools. We’ve all been ‘psyched out’ by our peers – how much do you know? How did you know that when I didn’t? Intimidating behaviour can be just as aggressive. Americans dub these people ‘Gunners’ although we’ve been rather nice and adopted the word ‘keen’ instead. Luckily most medical schools have a port of call for this sort of behaviour. But a word of advice – don’t let anyone shrug it off. If it’s a problem, if it’s affecting you – tell someone. Bullying individuals that are trying to learn and develop as professionals is entirely unacceptable. If you would like to share similar experiences, drop them in the comments box below.  
Lucas Brammar
over 5 years ago
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Internal Medicine: Third year rotations

Hi, I’m student doctor Thompson, I'm a third year medical student. In this video I’m going to give you a heads up on some things to expect on your internal m...  
youtube.com
over 4 years ago
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24

Psychiatry: Third year rotations

Hey guys, I’m student Doctor Thompson and in this video I will be talking about my rotation in Psychiatry, 5 things I loved, some things I didn't like, and g...  
youtube.com
over 4 years ago
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Psychiatry: Third year rotations - YouTube

Hey guys, I’m student Doctor Thompson and in this video I will be talking about my rotation in Psychiatry, 5 things I loved, some things I didn't like, and g...  
youtube.com
over 4 years ago
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Pause for Thought . . . Let’s ditch the numbers and focus on the comments when assessing learners

By Lynfa Stroud  “Expectation is the root of all heartache.” – William Shakespeare               In my role as an attending on the general medicine wards, I complete In-Training Evaluation Reports (ITERs) for the residents who I work with. I am sure that most people reading this also either complete ITERs, (or end-of-rotation reports) or have…  
icenetblog.royalcollege.ca
over 4 years ago
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9

How to develop targeted simulation learning objectives – Part 1: The Theory

Simulation has filled a void that was once present in medical education. Written and oral examinations continue to be used to assess Miller’s “knows” and “knows how” levels of performance while clinical rotation evaluations rest at the top of the triangle: “Does”. Simulation completes Miller’s triangle by allowing learners to “show how” their knowledge and…  
emsimcases.com
over 4 years ago
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Geriatric Survival Handbook by Brian Christopher Misiaszek, MD

http://fhs.mcmaster.ca/medicine/geriatric/docs/Geriatric_Handbook08.pdf : This link leads to the Geriatric Survival Handbook by Brian Christopher Misiaszek, MD, FRCPS (C) Assistant Professor of Medicine Michael G. DeGroote School of Medicine at McMaster University. It's a handy overview for anyone starting/reviewing a Geriatric rotation.  
fhs.mcmaster.ca
over 4 years ago
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Gastro-oesophageal reflux disease

This is a short presentation I prepared as part of my surgical rotation.  
David Rassam
over 4 years ago