Doctors and publishing results

As doctors we can improve outcomes if we publish results and outcomes.

How do you think we can do this in General practice? Wouldn't it be great. I am sure we can share and learn something from other doctors for the good of our patients.

Educational Psychology

This may help you remember more stuff. You can skip to the last 2 minutes where he talks about this.

Process information immediately, link it to past memories, and use visualisation.

Memory and its pitfalls

For example, have you ever had a memory in childhood that you were sure happened to you, but actually happened to your brother/sister?

I like the application of this talk towards the end, where it may be possible to lie about a memory and make it real.

How do you make memories seem real? As with previous talks, this is another piece of evidence that adds to my suspicion that there is no difference in our memories of a real memory compared to a vividly imagined memory. How do you vividly imagine a memory? How do we perceive the world? Through our senses?

I will post a talk soon of what NLP calls 'submodalities' - the senses that we perceive the world with, sight, sound, touch, taste, smell...

Personality profiling

 Currently, there is a free trial on a new validate Personality Profiling Tool, the

ECCOS (Eysenck, Cripps, Cook Occupational Scales) is a brand new adaptation of the Eysenck Personality Scales (EPQ) updated for the occupational psychology and human resource sector of commerce, industry, teaching and research.

We hope you find this enjoyable and useful. Click here or on the paragraph above to access the site to get your free password and access to the site. This is available free as a test pilot for a short period of time.

There are  7 dimensions.

The seven dimensions are: 

• Extraversion-Introversion

• Cairng vs Tough-Mindedness

• Anxiety

• Impulsiveness

• Venturesome

• Empathy

• Social Desirability

So perhaps in general practice, you’d like someone who is not anxious or impulsive, but is caring and has empathy, yet can tolerate risk (is more venturesome ).

Do you think a good surgeon may be more predictable, and take fewer risks.

Overall personality profiling for a doctor may be someone who empathises, is not too impulsive and is more caring and not at all anxious…

Male Doctors get more Complaints than Female Doctors

There is an experiment that might explain this...

Men appear to get greater satisfaction than women when witnessing retribution, a brain imaging study funded by the Wellcome Trust biomedical research charity has revealed.

This evidence of male schadenfreude, or pleasure at seeing revenge exacted, was highlighted during an experiment, published online by Nature today(Jan 18th), undertaken to compare empathy in the brains of people watching someone they either liked, or disliked, suffering pain.

A series of tests was undertaken involving 32 male and female volunteers plus four ‘confederates’ who were actually actors, but this was kept secret from the rest of the group.

In the first part of the experiment volunteers played a monetary investment game giving cash to one of the actors who had to then decide how much to give back. During each “transaction” the amount was tripled, so it was beneficial for both volunteer and actor to send as much as possible.

The study was designed to allow one actor to behave fairly, by returning a similar amount, while the other, unfair actor, tended to send back very little, if anything at all.

In the second part of the experiment at the Wellcome Department of Imaging Neuroscience in London, at UCL (University College London)**, the volunteer was placed in a magnetic resonance imaging brain scanner, to allow researchers to measure empathic responses as he or she watched the actors receiving a mild electric shock. When the “fair” players received this stimulation –the equivalent of a short bee sting- both female and male volunteers showed empathy activation in pain related areas of the brain – the fronto-insular and anterior cingulate cortices.

When the unfair actor received a shock the women taking part in the experiment showed empathy with them. However brain images of the male volunteers showed no increased activity in the empathy-related pain areas, but did reveal a surge in the nucleus accumbens, the “reward” region of the brain.

This reward- related activity was not seen in the majority of female participants, who appeared to have empathy for both the fair and unfair actors suffering pain.

Dr Tania Singer, who led the study, said: “During breaks in the tests you could tell from the body language that both the male and female volunteers did not like the actors who had cheated them. They tried to stay away from them as much as possible.

“These emotional responses were later confirmed in questionnaires completed by the volunteers who were asked to judge the actors. They consistently rated the fair player as being more agreeable, more likeable and even more attractive than the unfair actor.

“These results suggest that fairness in social situations shapes the nature of the emotional link we have to other people. We empathize with others if they cooperate and act fairly. But, in contrast, selfish and unfair behaviour compromises this empathic link. So, when the unfair player received a painful shock there was, at most, very little sign of anything registering in the empathy-related region of the men as opposed to the reward-related area where there was activity. They expressed more desire for revenge and seemed to feel satisfaction when unfair people were given what they perceived as deserved physical punishment.

“This type of behaviour has probably been crucial in the evolution of society as the majority of people in a group are motivated to punish those who cheat on the rest. This altruistic behaviour means that people tend to protect each other against being exploited by society’s free-loaders, and evolution has probably seeded this sense of justice and moral duty into our brains.

“We will need to confirm these gender differences in larger studies because it is possible the experimental design favoured men as there was a physical rather then psychological or financial threat involved. However this investigation would seem to indicate there is a predominant role for men in maintaining justice and issuing punishment.”

Ends

Notes to Editors:

* “Empathic Neural Responses are Modulated by the Perceived Fairness of Others.”

Authors: Tania Singer. Ben Seymour. John P O’Doherty. Klaas E Stephan. Raymond J. Dolan. Chris Frith.

**Wellcome Department of Imaging Neuroscience and UCL Institute of Cognitive Neuroscience, University College London.

The Wellcome Trust is an independent research-funding charity established in 1936 under the will of tropical medicine pioneer Sir Henry Wellcome.The Trust’s mission is to promote research with the aim of improving human and animal health and it currently spends more than £400m p.a.

How to develop Willpower - imagine using this in terms of exercise and weight loss

What we'll try this time is after watching the video, if you could post your ideas in the comments on how we could use this practically, that would be useful.

I found this entertaining, especially the videos of children with marshmellows. However, getting to the point of it, was rather difficult.

I think he is saying that if you can kick start a habit by tricking your mind with a reward, that eventually you will develop the habit and adopt it unconsciously.

Perhaps with Eating Healthy or Keeping Fit, one could start this with a reward and then as time goes by, this will remain a habit and the person will maintain the new habit and forget the reward, even if it is a high calorie food. I wonder if it is worth a try in practice.

Enjoy

Social Science of Persuasion used in Medical Consultations

Another Another animated video on reminding us all that what we are doing is selling health - we ask patients to give up something they value for something that we are trying to convince them will make their life better. Doctors often forget this fact. I believe we have a lot to learn from the research already done in marketing and social science.

Enjoy this video.

On Sherlock Holmes and mindfulness, curiosity and enjoyment

What a great way to introduce these concepts that are so important - mindfulness - and the importance of quiet, thinking time! Also, the importance of curiosity, and 'the Game is on'...

An excellent doctor once told me what he enjoyed in medicine - it was the part of being the detective - Sherlock Holmes. I hope this reminds you of this enjoyment and the importance of it!

Posture Correction for Plantar Fasciitis, Tennis Elbow, Back Pain, etc

A long video, but quite good exercises

Motivation cartoon

A funny illustrated talk on management / motivation which will see some of your needs for developing this aspect of your curriculum.

Shave excision skin surgery

Shave excision demonstration. You can inject fewer times to achieve anaesthesia.

Why Things Hurt

It is a myth that people should be 'pain free'. Drugs are NOT the answer.

Video on Understanding Pain - What to do about it in less than five minutes?

An Australian Government Funded body produces this Video.

I wonder how we can make this more available for patients.

Cure Hiccups / Hiccoughs

Very occasionally patients come in with this strange one. All the patients I have seen in General Practice share one common item in their history - they never learnt a good way to stop hiccups.

From the reading it involves some sort of resetting of the diaphragm that's going beserk.

Click on this website for an interesting read on how you can easily teach someone to cure hiccups and try it at home.

 http://www.hiccupcurenow.com/

Wedge resection of toenail

This will be a revision video for our resection later today. We tend to use a twisting motion to dislodge the nail's lateral edge and you will be surprised by how much nail is embedded. This procedure is so important to result in final resolution of effectively a foreign body. Enjoy.

Another Achievable Diet / Weight loss plan

I do believe the more ways that you can introduce to patients, the better the chance they will find something that suits them.

He does have some good pointers to keeping a habit. Learning by humiliation seems familiar.... What an interesting talk!

How to Inject Steroids for Trigger Finger TUTORIAL

One for my trainees in General Practice

Easy to do, 

Use an orange needle. Always use local anaesthetic. 

In my opinion, target the nodule and you can feel the nodule disperse very often. get the to bend it while the needle is in to ensure you have just the right point.

Often once the nodule disperses, results can be immediate.

I would only do it twice at most and refer on to Hand surgeons.

Could we teach our patients to make themselves happy?

Talking Therapies

Having attended some Medical NLP training with the Society of Medical NLP, it made me look deeper into Hypnosis - in particular the almost mythical Milton H Erickson who its worth following the link to read about.

It seems a lot of everything we do in medicine is getting that 'link' with them and honing our communication skills to that.

Also, there is the use of 'metaphor' for learning, and how this bypasses unconscious defenses against learning new skills.

With regards to CBT or Cognitive Behavioural Therapy which seems to be a fancy term for - self help involves homework and you should know that everything is connected - how you feel and how you act.

Useful resources are the Five Areas approach

or the Living Life to the Full website

There is also something strange called mindfulness CBT or MCBT. This is actually all about Meditation and the results are overwhelming! Who would have thought all the Eastern approaches that have been going on for so many years actually worked! I wonder how they have survived so many thousands of years? Yes, I am being sarcastic!

A resource here with the MP3s by Prof Williams at http://franticworld.com/ are worth listening to as to why it works.

You can also download podcasts from here on MCBT


I hope you find it all helpful. This is a brief introduction to Talking therapies.

Speed reading for learning

Again, the concept of peripheral vision and training how to use this comes up in this post by Tim Ferriss, a very interesting man... Follow this link
http://www.fourhourworkweek.com/blog/2009/07/30/speed-reading-and-accelerated-learning/

CSA - MRCGP exam - second part

CSA - MRCGP examination

A nice video of someone who has done the exam and some good tips in summary

What a great use of time

Examination Help Hypnosis Video for Free

Excision of Sebaceous Cyst - instructional video

We often teach our trainees minor surgery. There are numerous videos out there. Some better, some not so good. This is quite a good one.

The infiltration of anaesthetic is good, and notice that he talks about cutting in the direction of surgical lines.

Reflective Repetitive Learning - Clinical Learning

So, hopefully, by this time we should all know that the mind is malleable (Neuroplasticity), and that we can alter our thinking and how our mind works.

Also, we know that our mind cannot differentiate vivid imagination from reality! The stories of almost equivalent biceps strength and size from lifting imaginary weights... How children when interviewed in a certain leading way can believe an event actually took place that never did.

We know we've got so far by Rote learning, or Repetitive learning. This is how we learn language as children. Try , try , and try again....

So, how can we apply all this to reflective learning?


That's the Kolb cycle.

Used for a clinical case, this is how I would see it used.

You reflect on the case and experience, learn about it. Think about how you'd like to do it in future. Wonder what would have happened if something was said differently but in the same consultation. Its all great if someone exactly the same presented and talked in exactly the same manner but that will never happen. So, how do you change and reflect upon changes? You imagine how it would have happened if something was different, and your mind goes ahead and applies the changes from your learning, and you try another scenario and you do it again. Then you've tried many scenarios such that a new patient comes along presenting with something similar, but hey, you feel like you've seen this and dealt with it before because your mind tells you its happened before.

Of course, the more cases you see, the more scenarios you can design in your head. However, reflecting in this way will give you more experience with fewer patients - useful if say you're just starting out in a new specialty or for medical students.

Hope you've enjoyed this post.

Learning in the Clinical Environment - review

As I mark some essays on learning in clinical learning by undergraduates, it seems the focus tends too much on medicine and what we have taught ourselves as doctors. I think this is wrong. I think doctors have a lot to learn from exeryone else about medicine, leadership, and learning.

As in the previous posts, I am sure you can tell I am a fan of TED and various people suggesting how to do various things.

I like the talk on procrastion: that teaches you to chunk your learning. For example, before a big exam, I remember how many of us would have a timetable of 2 weeks, say Monday, Tuesday for CVS, Wednesday for RS,GI,  Thursday - GI, Urology,  Friday - Haematology, Rheumatology, Oncology.... etc...

And this would lead up to the exam. Although the timetables were not that strict, it made studying the whole of medicine in 2 weeks achievable.

I think reflective learning, which is what we keep talking about is important. But what does this mean? I will post this next and how I would propose Reflective Repetitive Learning. We are all children after all, and repetition or rote learning is how we learn. Because we are higher monkeys/apes (sorry creationists), we have minds that allow variation to develop in our thinking and we can vary each scenario slightly differently, so that we 'experience' a whole new encounter.

Medical MCQs and the USMLE

I received a question on one of my earlier blog posts from a Medical Student in the UK on whether the USMLE questions are useful.

What if I told you the background to the many Medical MCQs out there.

There are question banks. This is not a secret. To construct your own MCQ questions means a lot of fine tuning and getting it wrong - it is easier to ensure that the questions are validated and in general, MCQ banks are. All the following information is deduced from Google.

There is a very large question bank in Hong Kong that supply many medical schools around the globe. It seems to have great references to Toronto and the LMCC MCQ exams. Of course, the Canadian exams derive their questions from the USMLEs (Step 2 - the clinical Step).

Why USMLEs? I believe this is the most validated Medical Examination in the world with ALL medical students sitting the same exam. Personally, I think this should be where all medical exams should be and how I think the UK exams should aim to be. You might have heard questions being cancelled as too many people get it wrong - these are usually locally produced questions going through the phase of validation. These will be fewer than the standard bank questions, in general.

So, the answer is YES, doing USMLE Step 2 questions will in general help your skills in the following UK exams, Undergraduate MCQ, AMK, MRCGP AKT, DRCOG, DCH, and many others.

A good review book is one that has good explanations about why the other answers are incorrect... rather than just A to E as a correct answer. In my day, I have done thousands and thousands of medical MCQs and do not find them a challenge. Personally, it is pattern recognition - with some variation - like practising clinical medicine.

I have added a bit more to this post as it seems to be the most popular post.

MCQ books are not all the same. What you want is a book that will talk you through the answers as once you understand why the answers to the question are such, you will find out 2 things

1. How the questions are set - an essential part of MCQ technique

2. How to answer a similar question put in a different way to indicate a different answer

I suggest if you are in the UK - this book has a good section on telling you why the answers are the right ones



In the US this is the equivalent book with a link to Amazon there: