Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Re: The diagnostic skills of fourteen-year olds Elizabeth Yates, Jonathan F. Finks & Gurjit Sandhu To cite this article: Elizabeth Yates, Jonathan F. Finks & Gurjit Sandhu (2015) Re: The diagnostic skills of fourteen-year olds, Medical Teacher, 37:8, 791-792, DOI: 10.3109/0142159X.2015.1042440 To link to this article: http://dx.doi.org/10.3109/0142159X.2015.1042440
Published online: 13 May 2015.
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Date: 05 November 2015, At: 21:09
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Letter to the Editor
we knew the surgical department, had worked in a sterile environment and was familiar with surgical attire (points 2, 3 and 6). Having met the patient prior to surgery and read up on the procedure (points 1 and 2) the surgeon was impressed with our anatomical knowledge and understating of the patient’s reasons in opting for the surgery (point 8). During the operation our scrub hat touched the sterile covering on the theatre light. Despite feeling embarrassed we spoke up before patient safety was jeopardised (point 9). The surgeon was understanding and grateful for our honesty. He explained that previous students had only admitted to similar incidents after being overcome by guilt in the hours following the operation, putting the patient at risk and potentially damaging the surgeon’s reputation. We believe this reflection underlines the importance of point 9 by Weinberg et al. ‘‘be aware of the professional, ethical, and legal issues in surgery’’. It also raises an additional point which, despite falling within the bounds of ethics and professionalism, must be reiterated as evidenced by the surgeon’s previous experience: always be honest about your mistakes. This is an essential message for all the medical students as we move through education into a healthcare system in which we strive for transparency. Simon Davies & James O’Donovan, Medical Student Office, Newcastle University, Newcastle upon Tyne, UK. E-mail: [email protected]
I feel that my learning has benefitted greatly from the use of my iPad. The advantages to the students at MMS range from the ability to utilise any dead time travelling to and from placements to the ability to access textbooks all the time, without having to carry them around the wards. However, whilst spending time with other students it has been interesting to see how each student utilises their iPads differently in the hospital. Some students use it all the time and in every situation, whilst other students use their iPads solely for administrative tasks whilst in hospital. By providing iPads to all students MMS has addressed the problems that Doherty et al. (2015) raise in their article regarding the equity of using tablet computing as a core part of the curriculum and of students owning different devices. However, it has highlighted new problems, such as how to ensure that all students utilise their iPads to their full capacity to ensure they are not wasted. William Melton, Manchester Medical School, University of Manchester, Manchester, UK. E-mail: william.melton@ hotmail.co.uk
Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.
References Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Reference Weinberg D, Saleh M, Sinha Y. 2015. Twelve tips for medical students to maximise learning in theatre. Med Teach 37(1):34–40.
Student use of iPads at medical school
Doherty I, Sharma N, Harbutt D. 2015. Contemporary and future eLearning trends in medical education. Med Teach 37(1):1–3. Mooney J, Byrne-Davis L, Cappelli T, Dexter H, Taylor M, Moffatt L, Lumsden C. 2014. Implementing mobile learning with iPads in higher education: A large scale case study. UCISA (2014) Good Practice Guide. Mobile Learning: How Mobile Technologies Can Enhance the Learning Experience, 18–23.
Re: The diagnostic skills of fourteen-year olds
Dear Sir Dear Sir As a student at Manchester Medical School (MMS) I was interested to read the article by Doherty et al. (2015) which considered three future trends in Medical Education. I was particularly interested to read their views on the use of tablet computing at the current time and where this might lead in the future. At MMS we are provided with iPads in the third year of study, the beginning of our clinical education at no cost to ourselves (the students). The iPads are distributed in order to standardise the teaching of the core curriculum at the numerous hospital locations, to enable students to continue with their learning regardless of location and to provide an innovative learning experience (Mooney et al. 2014).
We read Dr. Hibbs’ Letter to the Editor in Medical Teacher (Hibbs 2015) describing a clinical diagnosis activity he ran with a group of 14–15 year old students from underfunded schools in the United Kingdom. The approach Dr. Hibbs took resonated with medical students and faculty leading the Doctors of Tomorrow program at the University of Michigan (UM), USA. In the summer of 2013, Michigan’s state capital (Detroit) became the first USA city in history to file for bankruptcy. The subsequent budget cuts had a devastating impact on Detroit Public Schools, resulting in approximately 30 school closures. Reduced opportunities for the students in Detroit will only exacerbate socioeconomic and racial disparities in medical schools in Michigan and across the USA.
791
Downloaded by [Deakin University Library] at 21:09 05 November 2015
Letter to the Editor
In response to this educational upheaval, the UM Doctors of Tomorrow (DoT) program was developed as a ‘‘pipeline’’ for Detroit students interested in the medical field. DoT students in their first year of high school (approximately 30 students per year) gain exposure to the medical field through monthly hands-on field trips to UM, longitudinal academic mentoring from medical students, and career development opportunities including volunteer experiences, physician shadowing and summer health internships. With Dr. Hibbs’ support, we were able to recreate his clinical diagnosis activity across ‘‘the pond’’ with a group of 20 DoT students (ages 13–16). Students were grouped into teams and tasked with diagnosing a theoretical unresponsive ER patient. They received an EKG, chest X-ray, blood/sputum culture and arterial blood gas measurement as evidence, along with basic guides on how to interpret these studies. DoT students critically worked through medical knowledge, collaborated and problem-solved as teams, and were enthusiastically engaged. The success of this activity enabled expansion of the curriculum into a three-part mini-course on developing clinical diagnostic skills for senior high school students. This cross-national experiment in implementing clinical reasoning education in low-resource high schools as a means of fostering students’ interest in medical professions bodes well for continued adoption across diverse cultures and communities. Elizabeth Yates, Jonathan F. Finks & Gurjit Sandhu, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA. E-mail: [email protected].
Declaration of interest: The authors report no declarations of interest.
Reference Hibbs SP. 2015. The diagnostic skills of fourteen-year olds. Med Teach 37(3):301–302.
Gut feeling: Can it be taught?
encouraged in clinicians, as it potentially forms the foundation to future evidence-based medicine. Furthermore, Biswas suggests that as individual experiences contribute to the development of intuitive clinical judgement; early exposure to such experiences should encourage its use and strengthen its reliability. This could be provided through: (i) As part of the final year of undergraduate teaching, medical students could be provided with cases that stimulate the use of intuition. Such cases should be drawn from actual experiences of teaching clinicians, where they themselves relied on their gut feeling. By completing these scenarios, students would not only have an opportunity to discover what their own personal response would be, but would also learn from the outcome of the real-life situation. (ii) Students could also receive intuitive teaching within the hospital setting, whereby clinicians would provide ‘‘bedside’’ teaching to encourage instinctive clinical judgment in patient management and diagnosis. If appropriate suggestions were made by the student, this exercise should make them more confident of their own gut feeling. Alternatively, feedback would be given in order to mature their intuitive skills, well in advance of when they may be required to use them. In addition, supporting this teaching with a reflective learning portfolio would maximise learning from these experiences. We ourselves would like to receive this teaching within the medical school curriculum to enhance our intuitive ability as future doctors. Manon Jenkins & Lauren O’Donnell, School of Medicine, Cardiff University, Cardiff, UK. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Reference Biswas A. 2015. Gut feeling: Does it have a place in the modern physician’s toolkit? Med Teach 37(4):309–311.
Dear Sir We read with interest ‘‘Gut feeling: Does it have a place in the modern physician’s toolkit?’’ by Biswas (2015) who evaluates the importance of a clinician’s ‘‘gut-feeling’’ in clinical practice and suggests that strategies should be incorporated into medical teaching to develop this intuition. As undergraduates on placement, we are often impressed by a consultant’s natural intuition in the clinical setting and have wondered how these skills are acquired: is this intuition developed through growing knowledge or is it part of the individual’s innate ability. Biswas highlights the relationship between the practice of evidence-based medicine and intuitive medicine and therefore one could argue that as one is taught, the other should be nurtured simultaneously. Intuitive medicine should be 792
Evaluating assessment programmes using programme evaluation models
Dear Sir We read with great interest the insightful article entitled ‘‘Twelve Tips for programmatic assessment’’ by van der Vleuten et al. (2015). The authors have addressed the important issue of ‘‘programmatic assessment’’ and have eloquently provided concrete tips for its implementation. Development of a comprehensive competency assessment
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Re: The diagnostic skills of fourteen-year olds Elizabeth Yates, Jonathan F. Finks & Gurjit Sandhu To cite this article: Elizabeth Yates, Jonathan F. Finks & Gurjit Sandhu (2015) Re: The diagnostic skills of fourteen-year olds, Medical Teacher, 37:8, 791-792, DOI: 10.3109/0142159X.2015.1042440 To link to this article: http://dx.doi.org/10.3109/0142159X.2015.1042440
Published online: 13 May 2015.
Submit your article to this journal
Article views: 94
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=imte20 Download by: [Deakin University Library]
Date: 05 November 2015, At: 21:09
Downloaded by [Deakin University Library] at 21:09 05 November 2015
Letter to the Editor
we knew the surgical department, had worked in a sterile environment and was familiar with surgical attire (points 2, 3 and 6). Having met the patient prior to surgery and read up on the procedure (points 1 and 2) the surgeon was impressed with our anatomical knowledge and understating of the patient’s reasons in opting for the surgery (point 8). During the operation our scrub hat touched the sterile covering on the theatre light. Despite feeling embarrassed we spoke up before patient safety was jeopardised (point 9). The surgeon was understanding and grateful for our honesty. He explained that previous students had only admitted to similar incidents after being overcome by guilt in the hours following the operation, putting the patient at risk and potentially damaging the surgeon’s reputation. We believe this reflection underlines the importance of point 9 by Weinberg et al. ‘‘be aware of the professional, ethical, and legal issues in surgery’’. It also raises an additional point which, despite falling within the bounds of ethics and professionalism, must be reiterated as evidenced by the surgeon’s previous experience: always be honest about your mistakes. This is an essential message for all the medical students as we move through education into a healthcare system in which we strive for transparency. Simon Davies & James O’Donovan, Medical Student Office, Newcastle University, Newcastle upon Tyne, UK. E-mail: [email protected]
I feel that my learning has benefitted greatly from the use of my iPad. The advantages to the students at MMS range from the ability to utilise any dead time travelling to and from placements to the ability to access textbooks all the time, without having to carry them around the wards. However, whilst spending time with other students it has been interesting to see how each student utilises their iPads differently in the hospital. Some students use it all the time and in every situation, whilst other students use their iPads solely for administrative tasks whilst in hospital. By providing iPads to all students MMS has addressed the problems that Doherty et al. (2015) raise in their article regarding the equity of using tablet computing as a core part of the curriculum and of students owning different devices. However, it has highlighted new problems, such as how to ensure that all students utilise their iPads to their full capacity to ensure they are not wasted. William Melton, Manchester Medical School, University of Manchester, Manchester, UK. E-mail: william.melton@ hotmail.co.uk
Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.
References Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Reference Weinberg D, Saleh M, Sinha Y. 2015. Twelve tips for medical students to maximise learning in theatre. Med Teach 37(1):34–40.
Student use of iPads at medical school
Doherty I, Sharma N, Harbutt D. 2015. Contemporary and future eLearning trends in medical education. Med Teach 37(1):1–3. Mooney J, Byrne-Davis L, Cappelli T, Dexter H, Taylor M, Moffatt L, Lumsden C. 2014. Implementing mobile learning with iPads in higher education: A large scale case study. UCISA (2014) Good Practice Guide. Mobile Learning: How Mobile Technologies Can Enhance the Learning Experience, 18–23.
Re: The diagnostic skills of fourteen-year olds
Dear Sir Dear Sir As a student at Manchester Medical School (MMS) I was interested to read the article by Doherty et al. (2015) which considered three future trends in Medical Education. I was particularly interested to read their views on the use of tablet computing at the current time and where this might lead in the future. At MMS we are provided with iPads in the third year of study, the beginning of our clinical education at no cost to ourselves (the students). The iPads are distributed in order to standardise the teaching of the core curriculum at the numerous hospital locations, to enable students to continue with their learning regardless of location and to provide an innovative learning experience (Mooney et al. 2014).
We read Dr. Hibbs’ Letter to the Editor in Medical Teacher (Hibbs 2015) describing a clinical diagnosis activity he ran with a group of 14–15 year old students from underfunded schools in the United Kingdom. The approach Dr. Hibbs took resonated with medical students and faculty leading the Doctors of Tomorrow program at the University of Michigan (UM), USA. In the summer of 2013, Michigan’s state capital (Detroit) became the first USA city in history to file for bankruptcy. The subsequent budget cuts had a devastating impact on Detroit Public Schools, resulting in approximately 30 school closures. Reduced opportunities for the students in Detroit will only exacerbate socioeconomic and racial disparities in medical schools in Michigan and across the USA.
791
Downloaded by [Deakin University Library] at 21:09 05 November 2015
Letter to the Editor
In response to this educational upheaval, the UM Doctors of Tomorrow (DoT) program was developed as a ‘‘pipeline’’ for Detroit students interested in the medical field. DoT students in their first year of high school (approximately 30 students per year) gain exposure to the medical field through monthly hands-on field trips to UM, longitudinal academic mentoring from medical students, and career development opportunities including volunteer experiences, physician shadowing and summer health internships. With Dr. Hibbs’ support, we were able to recreate his clinical diagnosis activity across ‘‘the pond’’ with a group of 20 DoT students (ages 13–16). Students were grouped into teams and tasked with diagnosing a theoretical unresponsive ER patient. They received an EKG, chest X-ray, blood/sputum culture and arterial blood gas measurement as evidence, along with basic guides on how to interpret these studies. DoT students critically worked through medical knowledge, collaborated and problem-solved as teams, and were enthusiastically engaged. The success of this activity enabled expansion of the curriculum into a three-part mini-course on developing clinical diagnostic skills for senior high school students. This cross-national experiment in implementing clinical reasoning education in low-resource high schools as a means of fostering students’ interest in medical professions bodes well for continued adoption across diverse cultures and communities. Elizabeth Yates, Jonathan F. Finks & Gurjit Sandhu, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA. E-mail: [email protected].
Declaration of interest: The authors report no declarations of interest.
Reference Hibbs SP. 2015. The diagnostic skills of fourteen-year olds. Med Teach 37(3):301–302.
Gut feeling: Can it be taught?
encouraged in clinicians, as it potentially forms the foundation to future evidence-based medicine. Furthermore, Biswas suggests that as individual experiences contribute to the development of intuitive clinical judgement; early exposure to such experiences should encourage its use and strengthen its reliability. This could be provided through: (i) As part of the final year of undergraduate teaching, medical students could be provided with cases that stimulate the use of intuition. Such cases should be drawn from actual experiences of teaching clinicians, where they themselves relied on their gut feeling. By completing these scenarios, students would not only have an opportunity to discover what their own personal response would be, but would also learn from the outcome of the real-life situation. (ii) Students could also receive intuitive teaching within the hospital setting, whereby clinicians would provide ‘‘bedside’’ teaching to encourage instinctive clinical judgment in patient management and diagnosis. If appropriate suggestions were made by the student, this exercise should make them more confident of their own gut feeling. Alternatively, feedback would be given in order to mature their intuitive skills, well in advance of when they may be required to use them. In addition, supporting this teaching with a reflective learning portfolio would maximise learning from these experiences. We ourselves would like to receive this teaching within the medical school curriculum to enhance our intuitive ability as future doctors. Manon Jenkins & Lauren O’Donnell, School of Medicine, Cardiff University, Cardiff, UK. E-mail: [email protected]
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
Reference Biswas A. 2015. Gut feeling: Does it have a place in the modern physician’s toolkit? Med Teach 37(4):309–311.
Dear Sir We read with interest ‘‘Gut feeling: Does it have a place in the modern physician’s toolkit?’’ by Biswas (2015) who evaluates the importance of a clinician’s ‘‘gut-feeling’’ in clinical practice and suggests that strategies should be incorporated into medical teaching to develop this intuition. As undergraduates on placement, we are often impressed by a consultant’s natural intuition in the clinical setting and have wondered how these skills are acquired: is this intuition developed through growing knowledge or is it part of the individual’s innate ability. Biswas highlights the relationship between the practice of evidence-based medicine and intuitive medicine and therefore one could argue that as one is taught, the other should be nurtured simultaneously. Intuitive medicine should be 792
Evaluating assessment programmes using programme evaluation models
Dear Sir We read with great interest the insightful article entitled ‘‘Twelve Tips for programmatic assessment’’ by van der Vleuten et al. (2015). The authors have addressed the important issue of ‘‘programmatic assessment’’ and have eloquently provided concrete tips for its implementation. Development of a comprehensive competency assessment
