Medical Education and eLearning Portfolio: December 2024

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Dear Phase III Surgery CG 14-25 Students,

For the Radiology session “Acute Abdomen”, this will be a one and a half hour scheduled live interactive teaching session (on Zoom) this coming Friday, 6 December at 1pm on Zoom, including time for self-study during the 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/2024/12/m3-tutorial-on-6-december-2024-1pm.html

Remarks : Please review the session outline and content before the tutorial. During the live session, I will highlight relevance of material, share ideas of how to make full use of this material, and for those students who have reviewed material beforehand, engage in interactive Q and A. Other students will have around 30 minutes or more within the allocated curricular time to do self-study of this material.

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/2024/07/m3-tutorial-on-monday-8-july-2024-1pm.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