Tuesday, 29 July 2008

An International Flavour

Dear Bloggers

Yesterday saw a group of international medical students visit this institution. Although their visit was only 2 hours, it was still possible in that time to do a short problem based learning [PBL] case and some bedside examination.

It was very impressive to see medical students of all different years of training trying to contribute to the PBL case in order to work out potential problems. One thing I found interesting was the fact that people from other countries do not mind making mistakes in the classroom. By making mistakes and learning where they might have gone wrong allows the whole group to understand. There is no embarrassment in making mistakes and nobody really minds.

As part of my training of doctors in Japan, I make it clear that I want to hear the opinions and answers from the junior doctors, whether they are right or wrong-- that is an important point. It is better to make the mistakes in the classroom setting and learn the best / correct / EBM way to then avoid potentially making a mistake on a real patient. At my institution, I have been able to propogate an environment whereby doctors can speak openly and freely in my teaching sessions and moreover, they are requested to answer questions rather than passively absorbing a lecture. The beauty of Problem Based Learning is that it requires interaction not only from the teacher to the audience but vice versa.

From the 18 members who joined this session, the vast majority have been taught the Review of Systems questioning methodology which is used as a screening tool to define new or existing symptoms or conditions.
Such medical students came from Indonesia, Australia, Hong Kong, Malaysia, Taiwan, Thailand, the Ukraine, South Korea and the UK. The Review of Systems teaching is an integral part of history taking and allows the physician the better understand all the problems that the patient has. By asking all the questions and getting 'no' replies is better than just saying that 'the patient did not say'. The latter relies on the patient having a good memory and thinking that they understand what is medically relevant. That situation would be in a perfect world and diagnoses could be made very quickly. Sadly, it is not the case and hence, screening questions from the ROS must be utilised. Of course, positive replies to questions can lead to the uncovering of a new disease that had been otherwise previously missed or not appreciated.

Finally, at the bedside I was immensely impressed with a young lady student from Malaysia who in her 3rd year of medical school could identify that the patient being examined, had heart failure just by inspection alone, and when she listened to the heart, she defined a 2/6 Levine systolic mitral regurgitant murmur and a gallop rhythm. I say again, she was a 3rd year medical student-- not yet a doctor.
The junior doctors at this institution also receive such high level training in physical examination allowing them to make daily assessments, for example, of patients with heart failure without the need to keep taking chest Xrays. The physical examination is a learned skill that can be taken anywhere and diagnoses at the bedside can be made in the absence of lab data and radiology. It is quick, very cheap (free) and highly effective.

Although such training was just a short snap-shot of what can be taught at this institution, the students seemed very pleased and impressed.

Always remember that every problem that is identified needs an Assessment and every Assessment needs a Plan. There can be no Plan [i.e. radiology / labs / therapeutics] without an adequate Assessment [as taught by Professor Stein, Florida, USA]. It is akin to driving in the dark without headlights.

Finally, I would like to thank Professor Masami Matsumura of Kanazawa University for attending this institution to join my teaching rounds yesterday in addition to the above international medical student teaching session.

Professor Matsumura's comments and opinions were precise and very helpful.

Also, thanks to all the other doctors at my institution who took their time to help out during the day to make it the success that it was.