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: