Radiology Resident Tutorial - Applied Learning Science, Learning Efficiently and Effectively, illustrated through Applied Head and Neck Anatomy and Pathology using Imaging, Monday, 17 October 2022, 0745am to 0830am
"Participants can 'prepare' by going through curated resources on following blogpost 'before' the tutorial- all open access online content - just review images and captions and how this applies to day to day Radiology practice." - pre-session preparation message, in email to residents on Friday, 14 October 2022, through Residency Program (e)mailing list, by Residency Co-ordinator
As you review the following material, which is curated for this topic and theme, from open access online material, please reflect upon, practice with, and experience for yourself the usefulness and applicability of 1) exposing yourself to as wide a spectrum of clinical/radiological practice, 2) in an efficient manner - using a wide variety of curated focused on topic/theme high quality open source material, 3) and the effectiveness of applied learning science - specifically block and interleaved practice - comparing multiple similar, and compare and contrast differential 'visual examples' - combined with short format captions, and then, and only then, 4) do deep dive into underlying anatomy, and pathology, illustrated by the images you have now become familiar with. With the ultimate aim to 5) recognise what you 'see' in clinical radiological practice with speed, accuracy and confidence - and be able to name what you see, and justify your 'radiological diagnosis', including visualising and discussing potential differential diagnoses, and explain why you have not chosen these. Poh-Sun Goh, 15 October 2022, Saturday, 0543am, Singapore Time
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CT of the Neck: Image Analysis and Reporting in the Emergency Setting. Alain Cunqueiro, William A. Gomes, Peter Lee, R. Joshua Dym, and Meir H. Scheinfeld. RadioGraphics 2019 39:6, 1760-1781 https://pubs.rsna.org/doi/full/10.1148/rg.2019190012
Tshering Vogel, D.W., Thoeny, H.C. Cross-sectional imaging in cancers of the head and neck: how we review and report. Cancer Imaging 16, 20 (2016). https://doi.org/10.1186/s40644-016-0075-3
Lee JH, Cheng KL, Choi YJ, Baek JH. High-resolution Imaging of Neural Anatomy and Pathology of the Neck. Korean J Radiol. 2017 Jan-Feb;18(1):180-193. https://doi.org/10.3348/kjr.2017.18.1.180
Wippold F. J., 2nd (2007). Head and neck imaging: the role of CT and MRI. Journal of magnetic resonance imaging : JMRI, 25(3), 453–465. https://doi.org/10.1002/jmri.20838
Magnetic resonance neurography of the head and neck: state of the art, anatomy, pathology and future perspectives. Fréderic Van der Cruyssen, Tomas-Marijn Croonenborghs, Tara Renton, Robert Hermans, Constantinus Politis, Reinhilde Jacobs, and Jan Casselman. The British Journal of Radiology 2021 94:1119. https://www.birpublications.org/doi/full/10.1259/bjr.20200798
Hussey, D., Shaw, A. V., Brian, P. L., & Lazarus, M. D. (2022). Learning Head and Neck Anatomy Through a Radiological Imaging Platform. MedEdPORTAL : the journal of teaching and learning resources, 18, 11230. https://doi.org/10.15766/mep_2374-8265.11230
Reflect on the well know aphorism "You see what you look for, you look for what you know"
"Understanding basic theory using a few illustrative examples. Mastering a topic by exposure to and experience with many examples
Typical examples or real-life scenarios can be used to illustrate theory, and help students understand fundamental principles. Mastering a topic usually requires exposure to and experience with many examples, both typical and atypical, common to uncommon including subtle manifestations of a phenomenon. The traditional method of doing this is via a long apprenticeship, or many years of practice with feedback and experience. A digital collection of educational scenarios and cases can support and potentially shorten this educational and training process. Particularly if a systematic attempt is made to collect and curate a comprehensive collection of all possible educational scenarios and case-based examples, across the whole spectrum of professional practice. Online access to key elements, parts of and whole sections of these learning cases; used by students with guidance by instructors under a deliberate practice and mastery training framework, can potentially accelerate the educational process, and deepen learning."
above from
Goh, P.S. A series of reflections on eLearning, traditional and blended learning. MedEdPublish. 2016 Oct; 5(3), Paper No:19. Epub 2016 Oct 14. http://dx.doi.org/10.15694/mep.2016.000105
"By reviewing research on medical performance and education, the author describes evidence for these representations and their development within the expert- performance framework. He uses the research to generate suggestions for improved training of medical students and professionals. Two strategies— designing learning environments with libraries of cases and creating opportunities for individualized teacher-guided training—should enable motivated individuals to acquire a full set of refined mental representations. Providing the right resources to support the expert- performance approach will allow such individuals to become self-regulated learners—that is, members of the medical community who have the tools to improve their own and their team members’ performances throughout their entire professional careers.'
from abstract of
Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med. 2015 Nov;90(11):1471-86. doi:10.1097/ACM.0000000000000939. PubMed PMID: 26375267.
What is the message from the "yellow curve" below?
"How could one use this material to dramatically reduce case review time?
Reduce study time?
Reduce residency duration?
Use training time in other ways?"
"How would you use this material to develop confidence and familiarity with less common conditions?
Given that time is limited."
"How do you stay sharp, not rusty, get better (sharper)."
[Practice. With feedback. With reflection. With increasing difficulty. Systematically. Regularly. With material that is at hand. At your finger tips.]
-Poh Sun (posted on 7 February 2018 @ 0358am)
This article investigates the relation between mind wandering and the spacing effect in inductive learning. Participants studied works of art by different artists grouped in blocks, where works by a particular artist were either presented all together successively (the massed condition), or interleaved with the works of other artists (the spaced condition). The works of 24 artists were shown, with 12, 15, or 18 works by each artist being provided as exemplars. Later, different works by the same artists were presented for a test of the artists' identity. During the course of studying these works, participants were probed for mind wandering. It was found that people mind wandered more when the exemplars were presented in a massed rather than in a spaced manner, especially as the task progressed. There was little mind wandering and little difference between massed and spaced conditions toward the beginning of study. People were better able to correctly attribute the new works to the appropriate artist (inductive learning) when (a) they were in the spaced condition and (b) they had not been mind wandering. This research suggests that inductive learning may be influenced by mind wandering and that the impairment in learning with massed practice (compared to spaced practice) may be attributable, at least in part, to attentional factors-people are "on task" less fully when the stimuli are massed rather than spaced. above abstract from
Inductive learning -- that is, learning a new concept or category by observing exemplars -- happens constantly, for example, when a baby learns a new word or a doctor classifies x-rays. What influence does the spacing of exemplars have on induction? Compared with massing, spacing enhances long-term recall, but we expected spacing to hamper induction by making the commonalities that define a concept or category less apparent. We asked participants to study multiple paintings by different artists, with a given artist's paintings presented consecutively (massed) or interleaved with other artists' paintings (spaced). We then tested induction by asking participants to indicate which studied artist (Experiments 1a and 1b) or whether any studied artist (Experiment 2) painted each of a series of new paintings. Surprisingly, induction profited from spacing, even though massing apparently created a sense of fluent learning: Participants rated massing as more effective than spacing, even after their own test performance had demonstrated the opposite.
When students encounter a set of concepts (or terms or principles) that are similar in some way, they often confuse one with another. For instance, they might mistake one word for another word with a similar spelling (e.g., allusion instead of illusion) or choose the wrong strategy for a mathematics problem because it resembles a different kind of problem. By one proposition explored in this review, these kinds of errors occur more frequently when all exposures to one of the concepts are grouped together. For instance, in most middle school science texts, the questions in each assignment are devoted to the same concept, and this blocking of exposures ensures that students need not learn to distinguish between two similar concepts. In an alternative approach described in this review, exposures to each concept are interleaved with exposures to other concepts, so that a question on one concept is followed by a question on a different concept. In a number of experiments that have compared interleaving and blocking, interleaving produced better scores on final tests of learning. The evidence is limited, though, and ecologically valid studies are needed. Still, a prudent reading of the data suggests that at least a portion of the exposures should be interleaved.
"When the student is ready the teacher will appear."
- Laozi
"You cannot make people learn. You can only provide the right conditions for learning to happen."
- Vince Gowmon
“I do not teach anyone I only provide the environment in which they can learn”
- Albert Einstein
I hear and I forget. I see and I remember. I do and I understand.
- Confucius
“A man who asks is a fool for five minutes. A man who never asks is a fool for life.”
- Chinese Proverb
"Shall I tell you a secret of a true scholar? It is this: Every man I meet is my master at some point, and in that, I learn from him."
- Ralph Waldo Emerson
"Like this cup, you are full of your own opinions and speculations. How can I show you wisdom unless you first empty your cup?"
- Nyogen Senzaki
"If you are willing to learn, no one can help you. If you are determined to learn, no one can stop you. "
- Anonymous
"One hour per day of study in your chosen field is all it takes. One hour per day of study will put you at the top of your field within three years. Within five years you'll be a national authority. In seven years, you can be one of the best people in the world at what you do."
- Earl Nightingale
“Live as if you were to die tomorrow. Learn as if you were to live forever.”
Goh, P.S., Roberts-Lieb, S., & Sandars, J. (2022). Micro-Scholarship: An innovative approach for the first steps for Scholarship in Health Professions Education. Medical Teacher, 1–6. Advance online publication. https://doi.org/10.1080/0142159X.2022.2133689
"(Open) Micro-Scholarship is an extension of (open) Micro-Practice and Micro-Learning; from Taking note, to Making notes, to Sharing notes." - Poh-Sun Goh, 22 October 2022, Saturday, 22 October 2022, 0731am, Singapore Time
Goh, PS. (2021). 'The vision of transformation in medical education after the COVID-19 pandemic'. Korean J Med Educ. 33 (3): 171-174. Publication Date (Web): 2021 August 27
at the scheduled live 'lecture' session, I will selectively highlight important material, take opportunity to go deeper (on request from live audience), and / or do more interactive Q and A
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alternative modular self-study pathways, curated online content, and links to my individual slides are accessible on following link, from last year's session
Email message to M3 students on Monday 26 September 2022
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Dear Phase III Surgery CG 26-38 Students,
For the Radiology session “Acute Abdomen”, this will be a one hour scheduled live interactive teaching session (on Zoom) this Tuesday 27th September 2022 at 1pm, 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/2022/09/m3-tutorial-on-tuesday-27th-september.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 Tuesday. 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/2021/12/m3-tutorial-on-wednesday-8-december.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.
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"
Bite size Just-in-Time (JiT) Learning in the classroom, workplace and as a Lifelong Activity - Technology, Practices and Pedagogy
by Poh-Sun Goh
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Brief Synopsis:
Bite size JiT learning and practice is a doable, sustainable classroom, workplace and lifelong learning activity. We all do this. And are familiar with this. My short presentation, and much longer anticipated and planned interactive discussion with participants will focus on this activity as a core and key meta-skill to succeed and thrive in your professional and personal life.
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25 October 2022, Tuesday, 1pm-2pm
Lunch time sharing session is a part of faculty development programmes and the attendees are academic staff from SHSS, NYP - nursing, oral health therapy, social work, medical sciences, paramedicine, and behavioural science.
Essential Skills for a Medical Teacher: An Introduction to Teaching and Learning in Medicine (2020 edition). Chapter 7: The ‘Authentic Curriculum’, page 57. by Ronald M Harden, Jennifer M Laidlaw
Three questions. Three (regular, daily) activities
Why learn? Read, get Exposure and Experience (on regular basis, daily). To take note. Develop and build knowledge and skills. Expertise.
Why practice? (What does this involve?). To make notes. (Write, Draw, Illustrate, Create, Build, Combine, Apply, Transfer to Professional Practice). Develop and build knowledge and skills. Expertise.
Why engage in 'scholarship'? Share notes. (Write on regular basis, daily. Share this. Make 'public' and get published. Publish. Demonstrate and Share). Knowledge and Skills. Expertise. (Know How, Show How, 'Feel'). To 'enter', (gain entrance), and participate. In an area (areas) of Professional Practice. Communities of Practice. Communities of Interest. Get licensed (to practice). Establish Credentials. Professional Standing.
- Poh-Sun Goh, 18 September 2022, 0205am, Singapore Time
As part of a 'self-directed' learning process, self-directed learning, I would throw into the mix the role of 1) regular habits, e.g. of reading, viewing and exposure to material, ideas, and individuals/teams working in areas of interest and relevant to practice; and 2) linking 'learning' with performance roles, settings and events; and 3) combining 1) and 2) with a relentless commitment 'to get better', 'improve'. And a discussion of a 'growth mindset'.
- Poh-Sun Goh, 21 September 2022, 0235am, Singapore Time
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"When the student is ready the teacher will appear."
- Laozi
"You cannot make people learn. You can only provide the right conditions for learning to happen."
- Vince Gowmon
“I do not teach anyone I only provide the environment in which they can learn”
- Albert Einstein
I hear and I forget. I see and I remember. I do and I understand.
- Confucius
“A man who asks is a fool for five minutes. A man who never asks is a fool for life.”
- Chinese Proverb
"Shall I tell you a secret of a true scholar? It is this: Every man I meet is my master at some point, and in that, I learn from him."
- Ralph Waldo Emerson
"Like this cup, you are full of your own opinions and speculations. How can I show you wisdom unless you first empty your cup?"
- Nyogen Senzaki
"If you are willing to learn, no one can help you. If you are determined to learn, no one can stop you. "
- Anonymous
"One hour per day of study in your chosen field is all it takes. One hour per day of study will put you at the top of your field within three years. Within five years you'll be a national authority. In seven years, you can be one of the best people in the world at what you do."
- Earl Nightingale
“Live as if you were to die tomorrow. Learn as if you were to live forever.”
Goh, P.S., Roberts-Lieb, S., & Sandars, J. (2022). Micro-Scholarship: An innovative approach for the first steps for Scholarship in Health Professions Education. Medical Teacher, 1–6. Advance online publication. https://doi.org/10.1080/0142159X.2022.2133689
"(Open) Micro-Scholarship is an extension of (open) Micro-Practice and Micro-Learning; from Taking note, to Making notes, to Sharing notes." - Poh-Sun Goh, 22 October 2022, Saturday, 22 October 2022, 0731am, Singapore Time
Goh, PS. (2021). 'The vision of transformation in medical education after the COVID-19 pandemic'. Korean J Med Educ. 33 (3): 171-174. Publication Date (Web): 2021 August 27
What does 'success' and (making) progress look and feel like?
participation and engagement metrics - completed writing tasks (daily micro-scholarship), and in order to write daily, it is required at minimum to engage in 'the process' (review, reflect, read, engage in conversations, give and receive feedback - synchronously and asynchronously) - basically 'take note, make notes and share notes'; and then progressively and systematically create (in public, and for public professional audiences) presentations and publications
participation in regular, scheduled and opportunistic 'events' - including meetings, conferences
qualitative and performance level metrics include acceptance, feedback and engagement 'with' audiences and peers (who, where, and at what level); or, to use a sporting analogy (moving from local, to regional, then international level / higher levels of performance[s] - which may include broader range, more depth, and both increasingly complex and simpler - meaningful and useful - outputs)
- Poh-Sun Goh, 16 September 2022, Friday, 0635am, 16 September 2022, Singapore Time
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Three questions. Three (regular, daily) activities
Why learn? Read, get Exposure and Experience (on regular basis, daily). To take note. Develop and build knowledge and skills. Expertise.
Why practice? (What does this involve?). To make notes. (Write, Draw, Illustrate, Create, Build, Combine, Apply, Transfer to Professional Practice). Develop and build knowledge and skills. Expertise.
Why engage in 'scholarship'? Share notes. (Write on regular basis, daily. Share this. Make 'public' and get published. Publish. Demonstrate and Share). Knowledge and Skills. Expertise. (Know How, Show How, 'Feel'). To 'enter', (gain entrance), and participate. In an area (areas) of Professional Practice. Communities of Practice. Communities of Interest. Get licensed (to practice). Establish Credentials. Professional Standing.
- Poh-Sun Goh, 18 September 2022, 0205am, Singapore Time
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Three workshop activities. In three sessions.
Who do you want to be? What role(s)? What setting(s)? For example - clinician, educator, scholar. Local, National, International. What do you need to do? Role of 'Presentations' and 'Publications'. In what settings? At what level? Local, National, International. Training (getting trained). Experience. Documentation. Logs (log books). Credentials. License(s) [to practice]. Admission [selection, to participate]. Portfolio(s).
Specific examples and exercises. Topic review. Case study. Case series. Generalisable ideas. Transfer to practice. Relevance. Usefulness. Analyse presentations and publications. What are their component parts? How are they put together and assembled? The process and 'recipe'. Reflect on what you are currently doing with your 'projects' and 'assignments'. Build on this. Increasingly do this 'publicly' in professional settings. Collect and document what you do on a regular stepwise basis. Not only finished work, but work(s) in progress. Including key component parts.
Pick one of the following (below), and work on this individually/in groups throughout the workshop, and present back - between session 1 and session 2, between session 2 and session 3; and in final 'report' on WhatsApp at end of workshop (before end of workshop - last 15 to 30 minutes of session 3 planned to give you all time to do this. Topic 1 - 'empowering patients' (how will you do this?). Topic 2 - 'keeping up to date' (how will you engage in 'lifelong professional education and training'). Topic 3 - 'organising and organisations, formal institutions and informal networks' (what is the future of professional organisations and networks?)
- Poh-Sun Goh, 20 September 2022, 0610am, Singapore Time
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