Medical Education and eLearning Portfolio: September 2021

Wednesday 29 September 2021

M3 Tutorial on Friday 1st October 2021 @ 1pm

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Email message to M3 students on Friday, 1st October 2021

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Dear M3 SUR CG 26-38 students (79 students, 13 Clinical Groups),

For the Radiology session “Acute Abdomen”, this will be a one hour scheduled live interactive teaching session (on Zoom) this Friday 25 1st October 2021, followed by self-study session of the presented and reference-further reading online content (see below). Please refer to Entrada and visit the blog for the open access online content curated by A/Prof Goh Poh Sun at this URL https://medicaleducationelearning.blogspot.com/2021/09/m3-tutorial-on-friday-1st-october-2021.html.

Remarks : One hour live interactive presentation by instructor, with live Q and A. Post session optional self study of content from presentation blog. For those students who are interested, please feel free to review the session outline and content before the tutorial.

We will be covering 7 major clinical conditions (below)

Radiology Bowel Perforation

Radiology Bowel Obstruction

Radiology Acute Appendicitis

Radiology Acute Cholecystitis

Radiology Acute Diverticulitis

Radiology Acute Pancreatitis

Radiology Colon Cancer

Best regards

Poh Sun

(This tutorial process has been iteratively refined over the last year, during the COVID-19 pandemic.

Learning takes place essentially as a process of self study, in each of you individually. Following by active discussion and use of this material in clinical practice. For this session, we will review and discuss your understanding during the live session this Friday. My role is to present compact, usable content, that you can both review and use, and come back to, as and when you require in the future. For those of you who are interested in how this tutorial process has been refined with previous tutorial groups please click to tap on this link - https://medicaleducationelearning.blogspot.com/2021/06/m3-tutorial-on-friday-25-june-2021-1pm.html)

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Start here with background info and learning tips

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Some tips to increase your learning and training effectiveness and efficiency:

Poh-Sun Goh

1. Reflect on the purpose of your medical education and expected outcomes of your undergraduate education and clinical training process.

2. Your current clinical exposure to case based learning in the emergency department, wards, and clinics-outpatient settings builds on a foundation of pre-clinical basic sciences in year 1 and 2 of the medical program (with anatomy and pathology particularly applicable to the interpretation of radiology / imaging studies of your patients).

3. For the abdomen, think about what anatomical structures lie within the area of interest/clinical presentation, or may present with the clinical symptoms and signs exhibited by your patients. Ask yourself what radiological investigation you might request or review in order to make a diagnosis - to rule in, or rule out potential clinical diagnosis. Radiology helps you to "see living anatomy and pathology" in your patients. Thus confirm or exclude diagnosis. Keep in mind that early disease may have very subtle of "negative" imaging during the early stages of clinically symptomatic disease.

4. Review the Radiology studies for your patients. Ask yourself why certain investigations were performed. And in what order.

5. Correlate imaging findings with your clinical observations. Do they make sense, correlate with clinical findings, or do you have to entertain alternative diagnostic possibilities?

6. Use textbooks and a wide variety of online resources to improve your diagnostic and interpretative skills. Practice, practice, practice with reflection and feedback, using a range of resources, to increase your exposure to the variety and spectrum of clinical and imaging findings, both normal and abnormal, from typical, to less common and atypical (as you progress to increase your experience and mastery of clinical practice, and improve your knowledge and skills from undergraduate, through postgraduate to continuing professional development and lifelong learning settings).

7. Compare and contrast is one of the simplest and most effective methods to learn to recognise and differentiate between normal and abnormal XRs and scans. Review a series of normal XRs and scans, and then do side by side comparison between examples of normal, normal and abnormal, and examples of abnormal XRs and scans.

https://effectiviology.com/interleaving/ (mixed practice or interleaving superior to blocked practice)

and

https://www.learningscientists.org/interleaving

https://www.learningscientists.org/downloadable-materials

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Below section is guided learning path (Option 1)

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Session guide (one learning path) - start with 'Tips' section above, then explore material section below, all on open access websites. One path is to start with 'a curriculum', then explore an approach to the AXR, both normal, and abnormal. Followed by review of common pathology presenting as an acute abdomen on CT scans. Start with bowel perforation on erect CXR, and AXR, unknown cases, for example here, focusing on appearance of free air, and 'Rigler's sign' on AXR. Then move on to examples of acute appendicitis, acute cholecystitis, acute diverticulitis (focusing on the similarities between these three pathologies, and taking note of differences between normal and abnormal structures, paying attention to the wall of the structure, and the adjacent fat in particular). Then review bowel obstruction, on the AXR, and CT scan, paying attention to the strengths and weaknesses of the AXR, and added value of a CT scan - pay attention to visibility of bowel segment which is dilated proximal to obstructing point, and cause of obstruction shown on CT).

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Below section is alternative exploratory path (Option 2)

Starting with background information, and "curriculum"

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Below section for Google images search for thematic cases (for practice review, and click through for additional information for selected cases)

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Radiology Bowel Perforation

Radiology Bowel Obstruction

Radiology Acute Appendicitis

Radiology Acute Cholecystitis

Radiology Acute Diverticulitis

Radiology Acute Pancreatitis

Radiology Colon Cancer

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Section below for self-directed learning

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https://radiopaedia.org/articles/abdominal-radiology-for-students-curriculum

and

https://www.radiologymasterclass.co.uk/tutorials/abdo/abdomen_x-ray/anatomy_introduction

https://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal

Further reading/Radiology Masterclass

and

https://www.learnabdominal.com/
and
(see interactive CT cases without and with annotation on this online resource
https://www.learnabdominal.com/cases/abdominal-ct-101)

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Google and Entrada analytics for current tutorial

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Wednesday 22 September 2021

Imaging of the Chest and Lungs - Online resources to support lecture for year 1 MBBS (NUS)

above from

NUSMed Entrada link for Sep 29, 2021 M1 lecture scheduled for 12 noon.

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Good morning, Class of 2026, YLLSOM

The decision you will have to make this morning, regarding (attending) this lecture (live) is this:

Why attend? And if you do, why engage (fully)? Be (fully) present. Is the material relevant? Examinable? Will attending, and engaging make you a better doctor?

Let me give you a couple of reasons to do so (attend, engage fully, and be fully present):

This lecture has been scheduled within your curriculum, at this time and place (within the curriculum) intentionally (by the curriculum/Phase 1 or Year 1 team). To bring a clinical perspective, into the classroom. Show you, but more importantly make you feel 'why' clinical imaging or Radiology is relevant and will be used (extensively, and on a regular, daily basis) by you, when you care for your patients. Attending and fully engaging with a 'live' lecture experience is a gift you make to yourself to form links between what you are studying in the classroom, and it's 'real world' application. Shared with you from the perspective, and voice of an active clinician and practitioner in the field. Through this experience I hope you 'feel' the value add of Radiology to not only your future clinical practice, but its immediate relevance to what you are studying in Year 1. Know the 'Why', will encourage and motivate you to work on the class material in Year 1, the 'What' and 'How' - #Why first, before #What and #How.

Yours sincerely,

Poh Sun

29 September 2021 at 0655am, Singapore Time

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Hello Year 1 YLLSOM students, the Class of 2026,

The content in this lecture, and skills you will progressively pick up, to 'read' CXRs (Chest Radiographs or XRs) and familiarity with other imaging (Radiology) of the Chest will help you to see into your patient's. Making you better and more confident doctors, by being able to visualise that is going on in the patient in front of you. Both normal structures, and function (Anatomy and Physiology), and abnormalities, (Pathology and Pathophysiology), which we will revisit next year, Year 2 of your program in 2022.

I hope the content you review here, and which we will cover, gives you an insight, visually, and in your 'mind's eye', of the anatomy, and physiology you are currently studying in lectures, small group sessions, the Anatomy museum and your experience with cadaveric anatomy in your prosection demonstrations.

Yours sincerely,

Poh Sun

27 September 2021

Preparation for session, and Content to be reviewed (below section)

The aim of the session is to link the anatomy which you have learnt in the chest, to what is visible on the two most commonly used imaging tests you will use as doctors in day to day clinical practice - the CXR, and CT scan of the Chest. Radiology allows you to see 'living anatomy' and pathology, of your patients in vivo. The CXR allows you to look inside your patient in 2D, while the CT scan gives you multi-planar sectional details, and a '3D-like' appreciation of both anatomy and pathology. You should aim to develop the ability to orientate yourself to the visible structures when viewing both the CXR, and CT scans; and be able to identify normal anatomy. This will form the foundation for the study of pathology, and the appreciation of visible pathology in your patients using CXRs and CT scans in year 2, and subsequent clinical years.

There are two learning paths (illustrated on the blog below) - a Guided learning path, and an Exploratory learning path. Please choose one path based on your learning preference, and review the material before the 'live' lecture. We will review this content during the 'live' lecture on Microsoft Teams.

Guided learning path: For those of you who like a very prescriptive guided learning path - start with CXR video 1, then CXR video 2, then CXR anatomy website (see chest section) (using illustrations as drill and quiz examples, by viewing CXR first without annotations, then mousing over each image, then read text); then view CT chest video 1, then CT chest video 2, then attempt to identify CT anatomy here. (Viewing these videos within or embedded in the blog below is one method to reduce ads which appear before the video).

Exploratory learning path: For those of you who prefer a more exploratory learning path, starting with interactive illustrations and text, you are encouraged to review the open access CXR anatomy website (see chest section) below, as well as information about how to approach the CXR (including normal anatomy), and CT scan with scrollable images links below. For those students who prefer learning from illustrated online videos, please review the two videos below before the lecture - Chest X-Ray Interpretation Explained Clearly - How to read a CXR and LEARN to Read a Chest Xray in 5 minutes!. Also review the two videos below reviewing visible anatomy on CT of the chest - Anatomy of a Transverse CT of the Thorax and Introduction to Computed Tomographic imaging of the Chest. (Viewing these videos within or embedded in the blog below is one method to reduce ads which appear before the video).

The following are links to my individual 'lecture' slides. You can preview these in sequence.

Value add of radiology

Radiology as 'AR' app

PA vs AP CXR

5 radiographic densities

5 radiographic densities illustrated

Silhouette sign

Collage CXR, axial and coronal CT chest

CXR anatomy quiz

CXR anatomy answers

Axial CT chest quiz

Axial CT chest answers