Tuesday, 25 October 2022

Small Steps to Successful Scholarship in Health Professions Education - From Micro to Meta Levels

Small Steps to Successful Scholarship in Health Professions Education - From Micro to Meta Levels

Elisabeth Schlegel and Poh-Sun Goh

IAMSE 2022 Virtual Forum, December 2022

https://julnet.swoogo.com/iamsevirtualforum22/2421254

https://iamse.site-ym.com/page/abstractsvf22



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Small Steps to Successful Scholarship in Health Professions Education - from Micro to Meta Levels 

Elisabeth Schlegel (* presenter) and Poh-Sun Goh

https://julnet.swoogo.com/iamsevirtualforum22/2818602

https://julnet.swoogo.com/iamsevirtualforum22/2421279

>> design visual - Slide 1 to 8 - with key idea from Slide 1 to Slide 7 as sequential steps on a 'staircase' along journey from bite size, just-in-time Micro-Learning, through Micro-Practice, to Micro-Scholarship


Slide 1

A new approach to Scholarship in HPE (Health Professions Education) - taking small steps from Micro- to Macro- to Meta- Levels

Our 'pitch' and key takeaway is a simple one:

That Learning, and Scholarship are similar; both taken in small iterative, cumulative steps. We learn best and engage in scholarship working together within a Community of Interest and Community of Practice. Scholarship is open, public practice, an extension of learning. We "See (one), Do (one), Teach (one) … Write (‘do’ Scholarship .. then ‘be’ a Scholar .. then) Teach (again)". We "Take Note, Make Notes, then Share Notes". - Poh-Sun Goh, 26 November 2022, Saturday, 0423am, Singapore Time

above first posted on

https://medicaleducationelearning.blogspot.com/2022/10/small-steps-to-successful-scholarship.html


Slide 2

"How can we make learning, professional practice and development, and scholarship accessible and available to all? Whether a new student, novice practitioner, or early scholar?

We offer the following 'recipe' and process:

We learn in small bites (bytes). Taking small (micro-) steps. Small (micro-) efforts. 

These add up, accumulate, compound and cumulatively, with instruction, guidance, reflection and feedback, supported by a practice environment and Community of Practice (CoP) lead to progressive mastery - knowledge, skills and attitudes (heads, hands and hearts).

Technology tools and platforms, and (social-professional) networks, institutional, organisational and loose CoP networks, support and facilitate Learning, Practice and Scholarship."

above first posted on

https://medicaleducationelearning.blogspot.com/2022/06/micro-learning-micro-practice-and-micro.html



Slide 3

"What does a single small step, of Micro-Learning, Micro-Practice and Micro-Scholarship look like?

Consider one unit, one piece of knowledge or skill. At its most granular level. For example one concept, it's definition, how to use and apply it. One illustration. One demonstration (of a skill). Add a single (or more) instructional idea or tip, a single (or more) reflection, and example(s) of application to form a unit of individual Micro-Learning, Micro-Practice and through open engagement and (digital) practice Micro-Scholarship.

We See (are exposed to, and observe), Do (explore, practice with guidance, reflection and feedback), Teach (including peer teaching and sharing, learn through recall, explanation, elaboration and recall), and engage in Scholarship (through documenting, writing, producing e.g. creating, curating, combining, integrating, applying and using - teaching and sharing; the Scholarship of Discovery, Integration, Application and Practice-Teaching [Boyer], with intentionality and informed [Glassick] and through open (digital) practice [Shulman]).

We learn, practice and engage in scholarship in small steps. Which add up. Accessible and available to all."

above first posted on

https://medicaleducationelearning.blogspot.com/2022/06/micro-learning-micro-practice-and-micro.html


Slide 4

"scholarship, like clinical or educational practice occurs in small sequential steps (ideally taken at regular, even daily intervals); each step is additive, and cumulative, as part an academic journey; each step can be documented, digitally, and visible - for open access, inspection, review; each step can be created, or curated with proper attribution, and 'value add' e.g. commentary, customisation, to enable each step to be a modular, free-standing, usable 'piece' of 'Micro-Scholarship. I audience test response to and of content by sharing selected content on Blogger (like this blogpost), Instagram - for short text, references, illustrations; and pay close attention to how the online (Communities of Practice) CoP and (Communities of Interest) CoI share and comment on this on Facebook, Twitter etc." - posted in Thread 1 section, accessible at https://medicaleducationelearning.blogspot.com/2021/04/sotl-and-rime-cenmed-nus-workshop-2021.html 

from

#BuildingBlocksOfScholarship in #MedicalEducation

https://medicaleducationelearning.blogspot.com/2021/05/buildingblocksofscholarship-in.html

to

#Categories of Scholarship in Medical Education #Scholarship in MedEd #Micro-Scholarship

https://medicaleducationelearning.blogspot.com/2021/05/categories-of-scholarship-in-medical.html


Slide 5

from

Goh P. S. (2016). Using a blog as an integrated eLearning tool and platform. Medical Teacher, 38(6), 628–629. https://doi.org/10.3109/0142159X.2015.1105947

Schlegel, E. (2021). (Not Only) for Medical Students: Get involved in Medical Education Research & Scholarship. http://elisabeth-fm-schlegel.weebly.com/elearning-bites/not-only-for-medical-students-get-involved-in-medical-education-research-scholarship

to a proposed innovation in scholarship - Micro-Scholarship

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

and

Goh, PS, Schlegel, E. Small, Sustainable, Steps to Success as a Scholar in Health Professions Education - Micro (Macro and Meta) Matters. (The Asia Pacific Scholar, submitted revision on 3 October 2022, accepted for publication 1 November 2022).


Slide 6

"Micro-Content and Micro-Scholarship, for many, 'is' the (only) content they will review, preview, sample or use.

To decide when, and if, to go deeper.

Is also likely to be what is remembered, recalled, and used.

Including the key idea, or takeaway; the key phrase or key word, to look up in the future."

above first posted on

https://telmeded.blogspot.com/2022/05/micro-content-and-micro-scholarship-as.html


Slide 7

"Expanding Extending and Elaborating the Process and Practice of Scholarship in Medical Education

- Building on the Past, Expanding Current Practice, to Embrace a digitally connected Collective Commons

Public Practice, Peer Reviewed, and on Platforms for others to Build Upon 

  • (expand, extend, and elaborate on ideas, and models of) Public Practice - including 'open digital direct to audience, directly visible global practice' - similar to open kitchens (open culinary art), open sketching and painting (in visual arts)
  • (expand, extend, and elaborate on ideas, and models of) Public Review - including an expanded and extended Audience of Professional Practitioners and 'Users', the 'silent audience' at formal academic meetings and conferences, but 'active users and professional practitioners', including addressing 'market forces', 'market acceptance', usability, design thinking, action research, and rapid prototyping
  • (expand, extend, and elaborate on ideas, and models of) Platforms for others to Build Upon - including digital and hybrid loose Communities of Interest and Practice (CoI and CoP), in addition to Professional Associations and Societies, Meetings and Journal Publications"

above first posted on

https://medicaleducationelearning.blogspot.com/2022/06/expanding-extending-and-elaborating.html


Slide 8

"(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

https://medicaleducationelearning.blogspot.com/2022/10/small-steps-to-successful-scholarship.html


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Our 'pitch' and key takeaway is a simple one:

That Learning, and Scholarship are similar; both taken in small iterative, cumulative steps. We learn best and engage in scholarship working together within a Community of Interest and Community of Practice. Scholarship is open, public practice, an extension of learning. We "See (one), Do (one), Teach (one) … Write (‘do’ Scholarship .. then ‘be’ a Scholar .. then) Teach (again)". We "Take Note, Make Notes, then Share Notes". - Poh-Sun Goh, 26 November 2022, Saturday, 0423am, Singapore Time

https://medicaleducationelearning.blogspot.com/2022/10/small-steps-to-successful-scholarship.html

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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


Schlegel, E. (2021). (Not Only) for Medical Students: Get involved in Medical Education Research & Scholarship. http://elisabeth-fm-schlegel.weebly.com/elearning-bites/not-only-for-medical-students-get-involved-in-medical-education-research-scholarship

Avital Y. O'Glasser, Vineet M. Arora, Teresa M. Chan; Capturing and Articulating Visual Media as Scholarship. J Grad Med Educ 1 April 2022; 14 (2): 233–234. doi: https://doi.org/10.4300/JGME-D-22-00112.1

Yilmaz, Y, Papanagnou, D, Fornari, A, Chan, TM. The Learning Loop: Conceptualizing Just-in-Time Faculty Development. AEM Educ Train. 2022; 6:e10722. https://doi.org/10.1002/aet2.10722

Breu, A. C., Abrams, H. R., Manning, K. D., & Cooper, A. Z. (2021). Tweetorials for Medical Educators. Journal of graduate medical education, 13(5), 723–725. https://doi.org/10.4300/JGME-D-21-00767.1

Breu, A. C., & Cooper, A. Z. (2022). Tweetorials: Digital scholarship deserving of inclusion in promotion portfolios. Medical teacher, 44(4), 450–452. https://doi.org/10.1080/0142159X.2022.2029383






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See (one), Do (one), Teach (one) … Write (‘do’ Scholarship .. then ‘be’ a Scholar .. then) Teach (again)
Poh-Sun Goh, 9 April 2022, 0446am, Singapore Time

In our journey toward deeper personal and professional growth and development, we inevitably start the process as novices, progressing from competency and proficiency toward becoming an expert with mastery as the aspirational goal and aim. Getting exposure, developing awareness and ‘trying out’ or ‘Seeing’, to ‘See’ (one) begins the process, followed by repetitive practice (with reflection and feedback), ‘Doing’ or to ‘Do’ (one). When we share and ‘Teach’ (one) what we are learning, and have learnt, we deepen our understanding and insight of the ‘technical’ aspects of what we have learnt. When we engage in Scholarship, and ‘Write’, by doing (Do), then being (Be) a Scholar we progress further along the path of expertise. Achieving Mastery, and being a Master takes place when we go deeper, and both experience, examine and then Teach (again) the fundamental principles, and ideas underpinning and forming the foundation of technical practice. Therefore See, Do, Teach, Write, then Teach (again). - https://www.instagram.com/p/CcGraM0vrW5/


'the way,' or enlightenment is attained through personal reflective-practice - (see preface from "Novice to Master: An Ongoing Lesson in the Extent of My Own Stupidity by Soko Morinaga) 




Persky, A. M., & Robinson, J. D. (2017). Moving from Novice to Expertise and Its Implications for Instruction. American journal of pharmaceutical education, 81(9), 6065. https://doi.org/10.5688/ajpe6065

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"Applied Learning Science

Micro-Scholarship practice aligns itself with what we know from learning science - specifically related to limitations in ‘working memory’ (situated before short and long term memory), our ‘attention span’, and applied motivation theory - we pay attention to, devote cognitive bandwidth to what is relevant, and useful (amongst the myriad of cognitive and environmental stimuli we are exposed to on a moment to moment, ongoing basis).

In curating, creating and cultivating micro-content, we recommend to ‘keep it brief, and to the point’ - whether text, images, illustrations audio narration, multimedia content, mixed or extended reality material - including time required to ‘get to the point’. As you assemble and stack micro-content together, you are effectively ‘building short and long term memories’ (to use an applied memory model analogy).

Hence the popularity of bite-sized, modular, on-demand, work-place learning and training content, including content for interactive discussion and applied active learning.

Catch attention - with bite-size content, for learners to ‘take note of’; to then explore and practice with this content, by ‘making notes’, and then demonstrating increasing mastery and deeper understanding of this content, including how to apply this through ‘sharing notes’, ‘open (digital) practice’ and Scholarship (both Micro-Scholarship and eventually Macro-Scholarship)."

Poh-Sun Goh, 12 November, 2022, Saturday, 0243am, Singapore Time

Cowan N. (2008). What are the differences between long-term, short-term, and working memory?. Progress in brain research, 169, 323–338. https://doi.org/10.1016/S0079-6123(07)00020-9

Camina, E., & Güell, F. (2017). The Neuroanatomical, Neurophysiological and Psychological Basis of Memory: Current Models and Their Origins. Frontiers in pharmacology, 8, 438. https://doi.org/10.3389/fphar.2017.00438


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'A (digital) Professional Portfolio is simply a record of experience and proficiency. What one's (you) know, can do, and have done (previously). A record / portfolio of Scholarship can be simply thought of as a public Professional Portfolio. Granular and modular items within this Portfolio are Micro-Competencies arising from Micro-Practice and Micro-Learning. Micro-Learning, Micro-Practice to build Micro-Competencies, which can be demonstrated as Micro-Scholarship, forming components of (a) Scholarship (professional) Portfolio (of work). - Poh-Sun Goh, 18 November 2022, 0335am, Singapore Time


the ePortfolio is both endpoint, and apex practice along spectrum of practice, i.e. "know-knows how-shows how-does" (Miller’s prism -https://www.stemlynsblog.org/better-learning/educational-theories-you-must-know-st-emlyns/educational-theories-you-must-know-millers-pyramid-st-emlyns/)

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"Micro-Scholarship is simply, and can be a logical extension of Micro-Learning and Micro-Practice i.e. that Micro-Scholarship is 'public' demonstration of outcomes of Micro-Learning and Micro-Practice (expanding on See-Do-Teach analogy).

Micro-Scholarship, and Scholarship 'is' an effective way to build a portfolio of Micro-Credentials - to show what one has done, and can do - that is portable, and not linked to a specific current role or job [I feel that this is a real value-add and reason for all to engage in Micro-Scholarship and Scholarship in general - to build one's (public) professional profile, and public portfolio of work.]"

- Poh-Sun Goh, 19 November 2022, Saturday, 0333am, 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.”
- Mahatma Gandhi




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Tuesday, 18 October 2022

Imaging of Respiratory Tract Disorders - Year 2 MBBS Lecture (NUS)

Dear Phase 2 Students

The lecture will be live face to face lecture 

A professionally produced video (e-Lecture) has been embedded on this session webpage in Entrada. Please preview and review this before the lecture.

the link to Entrada (with my pre-recorded video uploaded) below (and screenshot)

https://entrada.nusmedicine.nus.edu.sg/events?drid=309448&id=309448


with link to e-Lecture (screenshot below)


During the 'live' (lecture) session, I will have the opportunity 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

https://medicaleducationelearning.blogspot.com/2022/10/imaging-of-respiratory-tract-disorders.html

I will use these selectively for illustration during my 'live' (lecture) session

alternative review format for lecture material is available as eBook chapter

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Warmest regards,

Poh-Sun 

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(e)Lecture Outline

Section 1: Introduction 
and
Pre-lecture reflection questions / recall and review if necessary Y1 material

Section 2: Learning objectives

Section 3: Pre-test

Section 4: Lecture proper

Part 1 - review of basic principles of CXR production and tissue characterization

Part 2 - review of the CXR findings in six major diseases

Section 5: Post-test

___________________________



Section 1: Introduction 


Lets start by revising what we have covered last year.  This exercise to recall what you know follows recommendations from the educational literature on how to promote learning. By first revisiting, reviewing and recalling what has been learnt previously. The process of recalling information provides the foundation for new learning.  Learning something new is built on a foundation of prior knowledge. Repetition, review and recall promotes learning.



Please reflect on each of the following questions, pause after each question, write down your answer, and reflect upon your answer. 


1. What is the relevance of diagnostic imaging/radiology in your future clinical practice?

2. How are CXRs and CT scans of the chest produced?

3. How do different tissues appear on CXRs and CT scans? Why does bone appear white? Air black? Soft tissues varying shades of grey?

4. Can you identify normal anatomy on a CXR? CT scan of the chest?

5. Do you know where to find the lecture material on this topic presented in Year 1?

If you are unsure of the answer to any of these questions, please revisit and review the relevant sections in the Y1 lecture and interactive eLecture on the websites below.






Section 2 : Learning objectives of this (e)Lecture



Recall that radiology allows you (as future doctors), to see "living" anatomy, and "in vivo" pathology.

This ability to visualise what is going on in the patient in front of you, in both health and disease will be a useful diagnostic tool for you as doctors.

The easiest way to make sense of what you see on a radiology examination is to recall what you have been exposed to and learnt recently in gross pathology.

We will focus on the Chest Radiograph in this lecture. This is the most commonly requested radiology investigation. While this lecture won't show you every possible abnormality visible on CXRs, it is the start of a learning and skill development process. We will spend time on typical presentations of several common and important clinical conditions, and use these to illustrate the basics of CXR interpretation. As you develop experience over the next few years, you will gradually become more familiar with more subtle or gross presentations of disease, with more atypical features.

As you no doubt realise, an XR or scan is a snapshot of a point in time of a developing disease process. Early on, the manifestations of a disease on an XR or scan might be small, ill defined, or difficult to visualise. Later in the disease process, an abnormal feature might be large, and also difficult to define (for example a small, moderate size or large pleural effusion). It may be initially difficult for you to determine with a completely opaque hemithorax whether you are dealing with pneumonia, a large effusion or complete collapse of the lung.




For those of you who are focused on more immediate concerns, the assessment items on radiology that you will be faced with will evaluate your ability to recognise major examples of pathology on common radiological examinations. For example on the chest radiograph or CXR.




To review again the learning objectives of the undergraduate radiology program in the medical curriculum, you can see how radiology translates what you have learnt in Y1 anatomy, to give you the ability to see "in vivo" living anatomy in your future patients.

And visualise in vivo pathology in your patients. 


Section 3 : Pre-test



Lets do an assessment exercise now to not only show you what potential future examination assessment items might be, but also to illustrate how radiology (on the following CXRs) allows you to visualise gross pathology in your patient.



Google image search "lung gross pathology lung cancer"
Google image search "patient with lung cancer"

Google image search for "lung gross pathology pneumothorax"
Google image search "patient with pneumothorax"
Google image search "patient with tension pneumothorax"

Google image search for "lung gross pathology pneumonia"
Google image search "patient with pneumonia"

Google image search for "lung gross pathology pleural effusion"
Google image search "patient with pleural effusion"

Google image search "lung gross pathology cardiac failure pulmonary odema"
Google image search "patient with pulmonary oedema"

Google image search "lung gross pathology cardiac failure alveolar pulmonary odema"

Google image search "lung gross pathology cardiac failure interstitial pulmonary oedema"

Google image search for "gross pathology rib fractures"
Google image search for "patient with rib fractures"

Google image search for "cadaver rib fractures"



Please try and match the five diagnoses (A to E) with the CXRs provided (1 to 6). There are two examples on the CXRs provided of one of the five diagnoses.

This exercise begins the process to introducing you to the typical appearance of common and important clinical problems that your patient may present with.



Section 4: (e)Lecture proper

We will focus on two major areas. Firstly review basic principles of CXR production and interpretation. And then review the key features of six major clinical problems on CXRs.






We first very briefly review basic principles behind the production of a CXR, and why different tissues have different densities on XRs (white, shades of grey, and black).





Recall that XRs are produced by placing you patient between an XR source, and a recording medium; which may be an XR film, or digital recording plate.  The XR is therefore a record of the absorption of XRs as they pass through different organs and tissues in your patient.




By convention, on a XR, black represents areas of greatest XR absorption, and white the least absorption of XRs. On this normal CXR, you can see the radiographic densities of five categories of tissue. Air being blackest, with gradually lighter shades of grey with fat, soft tissue/blood/muscle, bone and metal. You will appreciate how fat being less dense than soft tissue will absorb less XRs, and appear a darker shade of grey than soft tissues or muscle.






This difference in XR absorption between different tissues and organs allows you to distinguish the edge or surface between different tissue layers and organs. Because XRs travel in straight lines through your patient, the interface between different tissues is highlighted and visible at tissue interfaces tangential to the path of the XR beam. This is referred to as the "silhouette sign". A simple analogy help you visualize this is to recall the what the silhouette of an object looks like when placed between a candle or light source and a background surface. The edge of the projected "shadow" is the silhouette making the edge between absorbed and transmitted light.





We use the silhouette phenomenon on a CXR to detect the edge between the normal left heart border, and adjacent aerated normal lung which contains air. We also use this to see the normal lung markings, due to difference in XR absorption between the blood within the pulmonary vessels and the adjacent normal lung. In disease, when the alveoli or air spaces in the lung are filled with fluid, blood or pus, we lose the ability of see these edges, allowing us to infer that the air spaces in the lung are not aerated or air filled.





Finally, an appreciation of the geometry of the XR beam passing through you patient allows you to understand how the heart, which you recall lies anteriorly on the front of the chest cavity is less magnified on a PA (posterior anterior) CXR, where the beam passes from back to front of the patient, compared to an AP (anterior posterior) CXR. Because patients have different chest front to back thicknesses, an AP film does not give you a good estimate of the transverse width of the heart, compared with the internal side to side chest diameter. The ratio of the widest side to side width of the heart divided by internal chest diameter (widest at that level) should be less than 50% in patients who do not have cardiomegaly; and is more reliably assessed on PA rather than AP CXRs, since we are not able to appreciate the front to back diameter of patients on CXRs; and cannot correct for this magnification factor when viewing AP CXRs.





We will now focus on the key radiological features of a few major disease categories on the CXR.

These 6 diseases are not only common, but need to be recognised quickly, accurately and confidently by you as future doctors in the EMD, wards and clinics; as you patient may require urgent treatment.

This is also why testing your ability to recognise these diseases on radiological examinations will take place not only in the radiology section of the examination, but radiology images will also be shown to you as part of the work up and assessment of your patients.





Pneumothorax (mp4)



Pleural Effusion (mp4)



Rib Fractures (mp4)



Pneumonia is described as an area of consolidation, or air space shadowing on a CXR. This appearance may be due to pus (pneumonia), fluid (pulmonary oedema), or blood (for example lung contusion or a pulmonary infarct). A definitive diagnosis is made by correlating the radiological appearance on the CXR with the clinical setting, or clinical findings.

Pneumonia (mp4)



Lung Mass (mp4)






Cardiac Failure (mp4)



In this second major section of the (e)Lecture, we will review six major diseases and their CXR findings. Please review the description of the key features of each disease, and then a typical CXR of each disease.



                         

https://www.dropbox.com/s/g7800b1qivoqqrm/Y2pneumothorax.mp4?dl=0





























Section 5 : Answers to the pre-test

We conclude this (e)Lecture by revisiting the quiz presented to you at the beginning of this lecture. The answers should be quite obvious to you after this presentation, and are given on the single slide below. Please review the content of this lecture again, focusing on any area you might be unsure about. Please post any questions you might also have on the padlet digital wall below and you classmates are invited to discuss each question with you on the digital wall before the lecture. I will address these questions both live during the lecture, as well as on the after the lecture.


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Further Reading


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Phase 1 Lecture (2022)