I have been thinking about how we help students become aware of the thinking processes (pattern making, creative analysis) that we use everyday to solve problems. These processes have become habits that we rarely think about but students who see us travel from A-H see something magical or worse think we are taking shortcuts because we don't show them the underlying knowledge we use. The picture below comes from the article Role Modelling by Cruess and Steinert. I think its a great way to think about helping our students become aware of the implicit.
Before the student arrives
1. Pick two or three things you do very well and break these procedures/techniques down into steps that the student needs to know in order to replicate what you do.
2. Create two or three illness scripts for the most common issues students will see in your clinic.
3. List 5-10 attitudes that you think exemplify great physicians and think about how you are going to role model those attitudes while students are in your clinic. Pick some that relate to patients, some that relate to staff, some to other areas of you life.
While the student is in your care
1. Encourage the student to ask questions about why you made the decisions you made.
2. Pick one or two difficult cases a week and walk the student through how you made the diagnostic decisions; even if it seems obvious to you that A=F, it may not be as obvious to the student. Avoid asking students to read your mind.
3. Share your illness scripts with students before asking them to create their own.
4. Guard the appropriateness of your behaviour to patients and staff even when the day is trying.
5. Talk to students about working with patients whose values, behaviours, and illnesses can create issues for the physician. Try and reflect the guidelines of the profession even if they aren't your own (save those discussions for colleagues).
6. Demonstrate and encourage Deliberate Practice by giving students multiple opportunities to apply what you are teaching them with patients.
References
Role modelling—making the most of a powerful teaching strategy
WHEN IT COMES TO H1N1 BEING OLD LOOKS LIKE A GOOD THING RECOMMENDATIONS FOR SWINE FLU INFLUENZA A VACCINATION
Winston Churchill , when asked how it feels to be old was said to remark that considering the alternative it's not bad. Generally though, it seems that when it comes to disease and health the elderly take a disproportionate hit but perhaps not in the case of the swine influenza A flu H1N1. I was surprised when I read the CDC recommendations about the priority of who should be vaccinated for swine flu H1N1.
"The committee does not expect that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others:
pregnant women,
people who live with or care for children younger than 6 months of age,
health care and emergency medical services personnel with direct patient contact,
children 6 months through 4 years of age, and
children 5 through 18 years of age who have chronic medical conditions.
The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these prioritized groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65".
How the Flu Virus Can Change: "Drift" and "Shift"
Influenza viruses can change in two different ways.
One is called "antigenic drift." These are small changes in the virus that happen continually over time. Antigenic drift produces new virus strains that may not be recognized by the body's immune system. This process works as follows: a person infected with a particular flu virus strain develops antibody against that virus. As newer virus strains appear, the antibodies against the older strains no longer recognize the "newer" virus, and reinfection can occur. This is one of the main reasons why people can get the flu more than one time. In most years, one or two of the three virus strains in the influenza vaccine are updated to keep up with the changes in the circulating flu viruses. So, people who want to be protected from flu need to get a flu shot every year.
The other type of change is called "antigenic shift." Antigenic shift is an abrupt, major change in the influenza A viruses, resulting in new hemagglutinin and/or new hemagglutinin and neuraminidase proteins in influenza viruses that infect humans. Shift results in a new influenza A subtype. When shift happens, most people have little or no protection against the new virus. While influenza viruses are changing by antigenic drift all the time, antigenic shift happens only occasionally. Type A viruses undergo both kinds of changes; influenza type B viruses change only by the more gradual process of antigenic drift.
Do your eyelids need a lift? Michigan's Allure Medical Spa has launched a new online resource for those interested in eyelid enhancement. You can find it at www.EyeliftCenter.com
Dr. Kotlus is an eyelid specialist and a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery. He developed the site to answer common questions about cosmetic eyelid procedures.
The image above shows one of Dr. Kotlus' patients who underwent eyelid ptosis repair- a correction for droopy eyelids caused by stretching of the tendon that lifts the eyelids.
Do your eyelids need a lift? Michigan's Allure Medical Spa has launched a new online resource for those interested in eyelid enhancement. You can find it at www.EyeliftCenter.com
Dr. Kotlus is an eyelid specialist and a member of the American Society of Ophthalmic Plastic and Reconstructive Surgery. He developed the site to answer common questions about cosmetic eyelid procedures.
The image above shows one of Dr. Kotlus' patients who underwent eyelid ptosis repair- a correction for droopy eyelids caused by stretching of the tendon that lifts the eyelids.
MAKING LEMONS INTO LEMONADE A COMPUTER GLITCH GIVES BIG TIME SCIENTIST IDEA THAT HIGH BLOOD PRESSURE DRUGS MIGHT TREAT MULTIPLE SCLEROSIS
What does using a blood pressure drug to treat multiple sclerosis have to do with Louis Pasteur? Pasteur's assistant was about to throw into the garbage samples of bacteria they were using in an experiment. The bacteria usually killed chickens but these didn't harm a feather. Pasteur derailed the garbage plan realizing he was on to something, which turned out to be vaccine. This kind of stuff happens in biology, science and medicine a lot more than you might think. I thought of that when I read the amazing story of how a researcher at Stanford got the idea that blood pressure drugs might have some connection with multiple sclerosis.
PNAS (Proceedings National Academy of Science) is carrying a paper about the possibility that a blood pressure drug might have the power to treat multiple sclerosis symptoms. The paper showed an effect in mice with MS like disease. "Researchers at the Stanford University School of Medicine have found a link, in mice and in human brain tissue, between high blood pressure and multiple sclerosis. Their findings suggest that a safe,(when used properly) inexpensive drug already in wide use for high blood pressure may have therapeutic value in multiple sclerosis, as well".
Lisinopril and the class it belongs to, ACE inhibitors, is one of the favorite heart and blood pressure drugs of cardiologists and family practioners. Angiotension Converting enzyme (see why they call them ACE?) inhibitors seem to have added beneficial side effects like heart remodeling.
"The genesis for the paper can be traced to about seven years ago, when Steinman learned he had high blood pressure. His doctor put him on lisinopril, which is used by millions of people all over the world and has an excellent safety profile. Chagrined, Steinman went home and, researcher that he is, immediately did a Google search on the drug. (Steinman is a renowned multiple sclerosis investigator whose earlier work on the inflammatory features of the disease spurred development of a blockbuster class of anti-inflammatory multiple-sclerosis therapeutics. The drug natalizumab, marketed under the trade name Tysabri, is one).
"Long ago, a glitch crept into Steinman’s home computer: No matter what keywords he types into the search field, the computer automatically inserts the additional term, “multiple sclerosis.” Thus, to his surprise, a list of medical literature popped up offering tantalizing, if vague, hints of a possible connection between multiple sclerosis and a fast-acting hormone, angiotensin, whose receptors abound on blood-vessel walls throughout the body."
Drug and Pharma, Health IT and EMR, Medical Articles, Medical News, Patient Care, Primary Care | DukeMedical.net, 27 Aug 09 | 
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