End of Rotation Thoughts

Tina Zhu

On Thursday, we presented our session on Residents as Teachers to our fellow 4th year clerks.  We presented a few models of how we can make ambulatory teaching and learning more efficient for both the teachers and the learners.  As a resident, we will have to straddle both of these roles, to both teach our junior colleagues and learn from the senior faculty. I hope the session illustrated some of the tools that are available in the literature for our fellow classmates, they have certainly been enlightening for me.  

As this will be my last blog, I would like to thank Dr. HPK and Dr. C for their time and efforts in creating this selective.  It has certainly been an eye-opening experience.  I have certainly learned many skills from this rotation that I will carry with me in my future residency and career in Internal Medicine.  

Case Conferences

Throughout my time with CEEP over the past three weeks, there have been various opportunities where we have conducted a variety of case conferences regarding our patients.  Some have in included the think tank with the chief residents and multiple CEEP staff, conferences with the dermatologists and multiple wednesday afternoon sessions with the radiologists.  These have varied from formal consults to "hallway consults", all of them resulting in better care for the patients.  All of these case conferences occurred while I have had the privilege and pleasure of working with Dr. HPK, recognized to be one of the best diagnosticians in the city.  A great lesson I think I have learned from him, simply said, is that two heads is always better than one.  He takes great care to involve other physicians and experts in the care of his patients.  He gets corroborating opinions and works closely with his colleagues, caring a great deal about their input and going out of his way to get it.
We have spent a lot of time in our medical training learning about interprofessional care and education.  It was the new buzz word in workshops and education sessions for the past 4 years.  I think what they have forgotten to touch upon though, is intraprofessional care.  Working well with your referring and referral colleagues directly impacts the care your patient recieves and it takes skill and thoughtfulness.  This is something I hope to keep in mind going forward.

Ashlay 

Consolidation

This ambulatory practice has reinforced a concept that I think medical school has been trying to instill in me since the beginning of clerkship.  That is the importance of consolidation.  It has often been recommended that you read around your cases to help and consolidate your knowledge.  I have always thought it was a great game plan but sometimes when things get busy it's hard to do that on a nightly basis.  Life gets in the way and often when clinic is busy, and especially with the paperwork associated with graduating medical school! However, in the past three weeks I have been making an effort to do just that and read around the cases that we have seen.
In particular there have been a large number of thyroid cases that we have seen.  There was also a lunch rounds on the topic of evaluating the thyroid nodule and I spent time reading through and reminding myself of management in the evenings.  I have realized in seeing subsequent patients with thyroid nodules that I really have improved my knowledge, confidence and clinical astuteness when it has come to the thyroid exam.  I feel very comfortable evaluating patients with thyroid problems now and know that this will be a high yield topic for MCCQE as well as future practice because of how common it is.  I hope that I will carry this lesson forward into residency and make an even bigger effort to spend the time learning around my cases.

HPK Photo Sessions (#6)

Tina Zhu

"Come here, let me show you something." 

And with this, each day Dr. HPK would invite us into his office during the free moments between patients or after clinic and, with a mysterious twinkle in his eyes, he would pull out pictures of curious physical exam findings and ask us for our diagnosis.  The photos portrayed the patients' chief complaints and sometimes also contained clues for associated findings, although we might have to look closely to find them.  Each photo series would then segway into a short discussion of the patient's presentation, diagnosis and management plans.  So far I have seen presentations of pretibial myxedema due to Grave's disease, bilateral ear erythema and edema from recurrent bilateral chondritis, skin findings of cutaneous T-cell lymphoma and many many more.  Although these sessions can sometimes get intense when we can't figure out the diagnosis, they have always led to great learning.  It is certainly true what they say, "A picture is worth a thousand words."  I really appreciated being able to see the findings that I have read about in texts, so much so that I believe I will start my own picture collection for my own reference and maybe future teaching sessions.  

History of Medical Education

The history of medicine is an important topic to many practitioners that tends to come up time and again in lectures and pimping sessions alike.  Regardless of what specialty you're planning to go into, it is generally a good idea to have a few school and specialty specific tidbits up your sleeve.  For Toronto, important ones tend to be Sir Willam Osler and Banting and Best.  There are also the numerous eponyms that medicine (especially internal) is famous for.  I was pleasantly surprised and comforted when I heard a few of the chief medical residents say they usually ignore them, which is my preferred method of dealing with them as well.
The reason for the above pretext is that this week we were assigned to read some articles written by various forward thinkers in the field of medical education in preparation for this week's discussion.  I expected to be reminded that I was very unfamiliar with this field of research but I was surprised see I was mistaken.  The articles focussed on the development of PBL and OSCEs. These things were a big part of my medical education and will continue to be an anxiety provoking experience far into my residency.  It was enlightening to learn about the theory behind the development of PBL, contrasting how it would be used in an ideal world and how different local schools use it as a teaching tool.  It was interesting to learn that a single department in Scotland is responsible for testing OSCEs as a means of examination and disseminating that information throughout the world.  Although I'm not particularly fond of either one of these teaching/examination techniques I can now approach them with a better understanding of their goals and how they came to be incorporated in medical education.  For myself and many others in my field, I think understanding where things come from provides me with a greater respect for the thing itself.

Ashlay

Preparing for the MCCQE (#5)

Tina Zhu

As the end of medical school approaches at alarming speed, we are faced with the challenge of preparing for our board licensing exam.  Yesterday, I consulted my calendar and realized that my exam date is a mere 24 days away and I have not yet started reviewing.  Since the exam will touch on facets from all 4 years of our learning, I am having trouble organizing my study schedule.  My usual approach to written exams had always been to read the material 2-3 times through, accompanied with lots of highlighting.  Unfortunately, this would not be feasible this time around due to the shear amount of information to be reviewed.  A few alternatives options are: 1) Attend the much touted Bruce Tovee lectures for the entire 2 weeks that it is offered and do targeted readings around the topics covered; 2) Skip the lectures and read Toronto Notes and other review materials on my own; 3) Buy question banks from online and do question-based learning.

The Tovee lectures are well-known for its quality of presentations and has been highly attended in the past. The topics being reviewed are likely high yield since they are designed by those who has experience with standardized tests.  However, the issue with lectures is that the yield is often variable, this is partly due to variability in quality of the speakers are often variable, and partly the format of delivery.  Lectures, especially ones delivered via Powerpoint slides to a 200+ audience, are usually passive form of learning.  And for me at least, my long-term recall rate from listening to lectures have been extremely poor.  I think case-based teaching and audience participation would be needed to maximize the efficiency of learning from these lectures.

If I were to compare the yield of listening to 1 hour of ill-delivered lecture to 1 hour of self-study, the latter would win.  However, the downside of boycotting lectures altogether is that I don't have a good idea of which topics to focus on.  Since it is impossible to review everything in detail, targeted studying would be necessary.  So maybe that is where the question banks would come into use.  Furthermore, I recall reading a study that showed students demonstrated higher level of recall when the completed a multiple-choice exam right after a teaching session.

So after much reflection, I believe that I can maximize my learning efficiency by attending Tovee lectures for broad topics such as Surgery and Internal Medicine to get a better idea of where to focus my time, and read on my own for topics such as Paediatrics, Psychiatry, and Obstetrics/Gynecology using mainly Toronto Notes.  In addition I will test my knowledge on a daily basis with question banks purchased on-line.  Hopefully, that will be enough.