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TSR Med Students' Society Part III

I have to teach another 15 minute presentation but this time on a medical topic.

We were advised to try something we weren't very good at so we can combine a bit of revision with teaching. I was thinking of doing the different heart murmurs and what they correspond to. Plan looks something like this:

Introduction while teaching the normal heart cycle from the perspective of the location of blood. So, during diastole the atria are contracting moving blood into the ventricles and the AV are open, SL are closed. Then during systole the ventricles are contracting moving blood into the great arteries and the AV are closed, SL are open. Most of this will hopefully come from the students prior knowledge. I'd also use the introduction to give relevence (heart sounds are a major part of medicine). I'm also thinking about using a clinical scenario to give context and anchoring which we could then refer to in the end.

Then I was going to move onto how to briefly time heart murmurs (auscultate while timing the pulse on the right carotid). Finally I would teach what you'll hear when. Aortic/Pulmonary stenosis (systole) and regurge(diastole), mitral/tricuspid stenosis (diastole) and regurge/prolapse (systole). A little part on continuous murmurs but more like a mentioning as opposed to explaining the theory behind.

I'm thinking for continuous assessment I'm going to distribute two EMQs, one for after the first part (contraction, normal heart sounds) and then the second for the latter main part (corresponding each murmur to a condition). Wrap up would be offering questions etc. Possibly using students "new" knowledge to explain what the murmur in the clinical scenario could possibly be.

Thoughts? Any input on teaching would be great and I also want to double check my core knowledge is correct as I don't want to look like a dumb ass. the explaination of each murmur will also highlight early/mid/end-systole/diastole murmur etc.

Reply 8821

Isometrix

11

Original post by GodspeedGehenna

Yea. Nobody seems to care :dontknow:

I hate having loads of crap in my pockets.

Ohmdays I'd love to see that. Reminds of that dude from Inbetweeners that got called "briefcase ******" in school! But what do you even need to carry when going around on the ward? If I'm getting teaching all I take is a small notepad and pen. I normally rely on someone else to lend me their steth, otherwise its swung round my neck. I'm sure your ward has a staff room where you can leave all your things? i even leave my iphone and wallet there as its a pretty safe place.

Reply 8822

Supermassive_muse_fan

10

Original post by RollerBall

I have to teach another 15 minute presentation but this time on a medical topic.

Spoiler

Sounds like you've got it pretty much covered! Are you going to embed sounds in your presentation e.g. murmurs? Also you get a free heart sounds CD with the Littmann Steth, so you could play bits of that (I'm assuming it has heart sounds lol, its been on my bookshelf for about 2 years and I've never actually used it.)? Will make it easier for people to remember as you're targeting more of their senses.

(edited 12 years ago)

Reply 8823

RollerBall

20

Original post by Supermassive_muse_fan

Sounds like you've got it pretty much covered! Are you going to embed sounds in your presentation e.g. murmurs? Also you get a free heart sounds CD with the Littmann Steth, so you could play bits of that (I'm assuming it has heart sounds lol, its been on my bookshelf for about 2 years and I've never actually used it.)? Will make it easier for people to remember as you're targeting more of their senses.

Yeah, if I can find them. I'm going to dig out my notes on it when I get home on Monday. Planning it at the moment at my girlfriends as she takes way longer than me to get ready to go out so I've got some spare time. Pretty sure I've still got that CD knocking around somewhere.

Targeting of more senses sounds like a good plan. I was going to describe what they sound like either way which should *hopefully* help. The other thing I'm wondering about is what I can suggest for further learning. I was possibly going to suggest other heart sounds since I'm only going to be covering the common ones, not stuff like LAD stenosis etc.

The other thing I'm struggling with is trying to give credentials as to why they should listen to me. As I'm going to be peer teaching it's going to be difficult to get them to give weight to what I'm saying.

Reply 8824

GodspeedGehenna

3

Original post by Isometrix

Ohmdays I'd love to see that. Reminds of that dude from Inbetweeners that got called "briefcase ******" in school! But what do you even need to carry when going around on the ward? If I'm getting teaching all I take is a small notepad and pen. I normally rely on someone else to lend me their steth, otherwise its swung round my neck. I'm sure your ward has a staff room where you can leave all your things? i even leave my iphone and wallet there as its a pretty safe place.

Usually carrying notes, lecture material, a handbook, steth, lunch, wallet, phone, keys etc. Nowhere to dump this **** on the wards so I (along with the other medics) carry it all around with them.

I don't see the big deal tbh.

(edited 12 years ago)

Reply 8825

Supermassive_muse_fan

10

Original post by RollerBall

Spoiler

Do you get taught of 'lup-whoosh-dup' and 'lup-dup-whoosh' on murmurs, we got that in our lecture and haven't forgotten it since (I think I'm an auditory learner, which is why I seem to study better with music on.)

As you know: Lup = closure of a/v valves. Dup = closure of semilunar valves.

So mitral regurge would be lup-whoosh-dup. You could get the students to do that right at the end, like say a murmur and they do the lup-whoosh-dup thing (our lecturer did this with us and that's how I think when listening to locating murmurs :redface:

)Making presentations interactive make them easier to remember.

I wouldnt worry too much about the credential stuff, murmurs are important and always good to go back over (and much more fun to learn about than immunology for example but I'm biased!). Also just get on with it really, I expect other people are going to be giving presentations too? Had to present to half of year (everyone had to) and mine was causes of exophthalmos (we couldn't choose) but everyone pays attention as it's not easy standing up and talking for 15 minutes. Ooh and mnemonics are good.

And do summary slide at front and end of lecture. Just to make sure you keep it focused.

Reply 8826

Tech

12

Does anyone actually carry the BNF around with them on the wards? Seems like it'd be a pain to juggle that with OHCM/notepad and pen too.

Reply 8827

Supermassive_muse_fan

10

Original post by Tech

Does anyone actually carry the BNF around with them on the wards? Seems like it'd be a pain to juggle that with OHCM/notepad and pen too.

There's always an available BNF to use on the wards.

Reply 8828

Tech

12

Original post by Supermassive_muse_fan

There's always an available BNF to use on the wards.

Ah good to know - thanks :smile:

Reply 8829

Supermassive_muse_fan

10

Original post by Tech

Ah good to know - thanks :smile:

Also if you do want something to refer to, download the Micromedex app on smartphone, it's free and there's a drug interaction checker. :smile:

(Off topic, but is the quote in your sig from Futurama?)

Reply 8830

Medicine Man

16

Quick question - one of our assignments for this module is to pretend we are the head of a medical school and design an assessment tool to assess final year medics. I just wondered what you guys think of this idea.

So far, I have come up with:

1.

A 2.5 hour 150 item EMQ paper (these apparently are the most reliable examination formats) testing clinical and basic science knowledge. Would SBAs be better?

2.

A long case examination - basically each student is taken in to see a patient and given one hour to collect and record a history and full examination under the eye of an examiner. After one hour, the examiner asks students to present the case as if they were on a ward round and then ask a few questions usually about treatment/management choices. The problem with this is it would be near on impossible to standardise the patients students get on each exam. That and it would take forever to go assess each student. Still quite useful I would imagine.

3.

A standard OSCE exam - just like the usual OSCE exam except it would test more practical skills (inserting cannulae, taking blood etc.) than clinical skills

4.

A prescription exam. Not to sure how this would work just yet, but this is something Barts do (I think) and I reckon it's a good idea.

5.

One pathology exam like is done at some unis. Again, not too sure of the format for this just yet.

And for borderline students, the chance for them to redeem themselves (if they failed either one of 1,4 or 5) with a viva with a panel of assessors. Everyone would have to pass the long case exam and OSCE exam.

Its all hypothetical but I just wondered what your thoughts are on this? Am I missing something? Is this flawed? Am I being too mean with all these exams?

Reply 8831

DexterM

11

I thought it was a major faux pas for students to wear steths around their necks. Is this just bollllocks?

Reply 8832

Supermassive_muse_fan

10

Original post by DexterM

I thought it was a major faux pas for students to wear steths around their necks. Is this just bollllocks?

It is a faux pas, but I'm a sheep.

Reply 8833

Phryx

Original post by DexterM

I thought it was a major faux pas for students to wear steths around their necks. Is this just bollllocks?

Only time I've worn it around my neck was while I was on a cardiology firm. The consultant was pretty keen on his students listening to as many hearts as possible.

Reply 8834

magichearts

7

Original post by DexterM

I thought it was a major faux pas for students to wear steths around their necks. Is this just bollllocks?

Yeah it's still a major faux pas but I don't think anyone says anything if you do walk around with a steth around your neck. Even when I do put my steth around my neck during examinations, it doesn't feel right.

Still hate carrying everything around. I really don't enjoy carrying a bag around so I hold everything in my hands as my pockets aren't deep enough. I carry a small notebook, log book, and my steth. My pen would be placed on my lanyard. But whenever I get the chance to, I will put my stuff down on a desk and hopefully I won't forget it. I don't take my phone on the wards though. I would feel the urge to check my phone from time to time so I just leave it in my bag. I mean the doctors room is on the ward so if I need to look up something I would write it down in my notebook and look it up later during a break.

Reply 8835

RollerBall

20

Original post by Medicine Man

Quick question - one of our assignments for this module is to pretend we are the head of a medical school and design an assessment tool to assess final year medics. I just wondered what you guys think of this idea.

So far, I have come up with:

1.

A 2.5 hour 150 item EMQ paper (these apparently are the most reliable examination formats) testing clinical and basic science knowledge. Would SBAs be better?

2.

A long case examination - basically each student is taken in to see a patient and given one hour to collect and record a history and full examination under the eye of an examiner. After one hour, the examiner asks students to present the case as if they were on a ward round and then ask a few questions usually about treatment/management choices. The problem with this is it would be near on impossible to standardise the patients students get on each exam. That and it would take forever to go assess each student. Still quite useful I would imagine.

3.

A standard OSCE exam - just like the usual OSCE exam except it would test more practical skills (inserting cannulae, taking blood etc.) than clinical skills

4.

A prescription exam. Not to sure how this would work just yet, but this is something Barts do (I think) and I reckon it's a good idea.

5.

One pathology exam like is done at some unis. Again, not too sure of the format for this just yet.

And for borderline students, the chance for them to redeem themselves (if they failed either one of 1,4 or 5) with a viva with a panel of assessors. Everyone would have to pass the long case exam and OSCE exam.

Its all hypothetical but I just wondered what your thoughts are on this? Am I missing something? Is this flawed? Am I being too mean with all these exams?

Would the long case examination consist of an actor or a legitimate patient? If it's a legitimate patient then I agree it's going to be very difficult to standardise and as such I'd be a bit against it.

For example, I'm personally against "master chef" style judging for something worth a life time such as medicine examinations.

I'd also question the validity of a pathology exam along side the EMQ exam and a prescription exam. Isn't there going to be too much overlap and reduce the efficacy of the total examination time vs usefulness?

This is from a students side though, I have no idea about the theory behind examination apart from a 30 minute off topic debate.

Reply 8836

Tech

12

Original post by Supermassive_muse_fan

Also if you do want something to refer to, download the Micromedex app on smartphone, it's free and there's a drug interaction checker. :smile:

(Off topic, but is the quote in your sig from Futurama?)

I'm regretting being stuck in a two year contract with a rubbish phone! Although after it's up I'll definitely get an iphone. Cheers for the heads up!

Yeah it's Futurama :wink:

New series this year, hope it lives up to the rest...

Reply 8837

Medicine Man

16

Original post by RollerBall

Would the long case examination consist of an actor or a legitimate patient? If it's a legitimate patient then I agree it's going to be very difficult to standardise and as such I'd be a bit against it.

For example, I'm personally against "master chef" style judging for something worth a life time such as medicine examinations.

I'd also question the validity of a pathology exam along side the EMQ exam and a prescription exam. Isn't there going to be too much overlap and reduce the efficacy of the total examination time vs usefulness?

This is from a students side though, I have no idea about the theory behind examination apart from a 30 minute off topic debate.

It would be with a legitimate patient. Granted it won't be standardised as an OSCE but it does give examiners a chance to see how soon to be doctors would treat patients holistically. Maybe I could alter the way the long cases are done and use actors as opposed to real patients, although then you could be undermining the authenticity of the assessment. Then again OSCEs which are like the gold standard use actors sometimes so maybe thats not such a bad idea...

True point about the overlap. Hadn't thought about it - maybe an OSCE station on prescribing (which I imagine already happens at most medical schools anyway?). Apparently most errors with junior doctors seems to be down to prescribing and this was my rather feeble attempt at trying to solve that! :p:

The only reason I wanted an extra pathology exam was because it is really underrepresented in the current medical school exam system. I think Imperial had (still have?) that extra pathology exam students sit in the 5th year - so it'll test stuff like microbiology, immunology etc.

Reply 8838

RollerBall

20

Original post by Medicine Man

It would be with a legitimate patient. Granted it won't be standardised as an OSCE but it does give examiners a chance to see how soon to be doctors would treat patients holistically. Maybe I could alter the way the long cases are done and use actors as opposed to real patients, although then you could be undermining the authenticity of the assessment. Then again OSCEs which are like the gold standard use actors sometimes so maybe thats not such a bad idea...

True point about the overlap. Hadn't thought about it - maybe an OSCE station on prescribing (which I imagine already happens at most medical schools anyway?). Apparently most errors with junior doctors seems to be down to prescribing and this was my rather feeble attempt at trying to solve that! :p:

The only reason I wanted an extra pathology exam was because it is really underrepresented in the current medical school exam system. I think Imperial had (still have?) that extra pathology exam students sit in the 5th year - so it'll test stuff like microbiology, immunology etc.

The only issue I'd have with real patients is that patient X could have a really discrete murmur where as patient Y's murmur could be really obvious. If you were only assessing how they treated patients as opposed to what they're treating then it would work. For example, would it be okay in the exam for a student to say "I couldn't hear a murmur" as long as they checked for one? Realistically they would call for a consultant to double check if they thought they would have one but that's not available in an exam situation.

So, if you're assessing something like attitude as opposed to knowledge then the full patient examination would be fine. Otherwise I'd question the validity of it. Actors would eliminate that and for examinations you could present them with scenarios. So, you could have a patient who you take a history and examine. Then you could be presented with information from the examiner like "imagine when you examined that patient they had a mid systolic low rumbling murmur".

While pathology is under-represented couldn't you just adjust the EMQ exam? If it's covering basic science and knowledge just slightly reduce the amount of basic science and add in more pathology? This is only suggestions though. Could you justify why you'd want to test more microbiology/immunology as opposed clinical knowledge? Could you justify why an FY1 doctor would need to understand underlying pathology vs clinical scenarios?

I think one of the major **** ups of junior doctors isn't due to the prescribing but due to interactions as well. Feel free to correct me as I can't source it at the moment. You could pitch scenarios such as this is patient X with A/B/C conditions what would you prescribe them? I think this would be a very useful examination but it would be done in a sort of SAQ style which is less efficient to the EMQ style of examination. I think it would be difficult to incorporate prescribing interactions into an EMQ style exam but maybe that's something you can work on.

Reply 8839

digitalis

17

Original post by DexterM

I thought it was a major faux pas for students to wear steths around their necks. Is this just bollllocks?

Load of *******s. Not a faux pas at all. Where else are you supposed to keep the damn thing? :s-smilie:

Plus it makes you look a bit more like a doctor than a schoolboy on work experience.

Original post by magichearts

Yeah it's still a major faux pas but I don't think anyone says anything if you do walk around with a steth around your neck. Even when I do put my steth around my neck during examinations, it doesn't feel right.

Get some more self confidence man.

(edited 12 years ago)

TSR Med Students' Society Part III

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