This video covers common fractures in children, what to look out for and the possibility of complications.
over 7 years ago
This short video goes into the changes that occur to a newly-fertilized zygote as it develops through the bilaminar and trilaminar phases.
over 6 years ago
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
about 7 years ago
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.
about 7 years ago
Clinical Skills Resuscitation station Assess danger of situation. Approach. “Rouse”. Assessment of consciousness. Gently shake shoulders. Use pain e.g sque…
about 10 years ago
This tutorial explores the function of the nephron, in particular: Filtration, Reabsorption, Secretion and Excretion. It explains explains the solutes involved and how they are processed by the nephron. It is recommended that you view the Renal Anatomy series before watching this tutorial.
Handwritten Tutorial Videos
over 7 years ago