DundeeChest 3.0

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It’s web 2.0, then? What happened to web 1.1.4, and web 1.3.8? What about web “Snow Cheetah”? Well, it’s web 2.0 until we get to web 4.0, I’m told. So about time we got with the program, and brought the Dundee Medical Course into the “teen-ies” (after the nought-ies….). The Dundee Blogging Network aims to do just that, and spearheading the attack is DundeePRN. I don’t know of any other medical school who is running the same thing: a student led; student written; student delivered; student edited, moderated and administrated web based resource of the same scope as DundeePRN.

A couple of the students have put in literally hundreds of hours over the past 4 months putting this together, and the fruits of their labours are starting to be evident now.

We launched the site during lectures today (DundeeChest braving the outside world despite his precarious post operative condition), and already we have over 60 users registered with the site. We start the analytics from today, to see how the site is utilised – we hope to get the other years involved in this as soon as possible.

The site is available to everyone and anyone – some pages are only visible to registered users, but there’s nothing stopping anyone registering.

Exciting times…

Head over to the cases section to see the latest case of the week on DundeeChest 3.0 This young man has a persistent productive cough – can you work out the unifying diagnosis?

Exams. Medicine is all about taking exams. End of year in medical school, finals, membership, fellowship, exit exams, revalidation. It never seems to stop, does it? It’s easy to get despondent – there’s so much out there to learn, and it all seems a very daunting. I’m irrepressibly glass half full, about pretty much everything, so revising for exams fills me with as much excitement as it does tripidation. How so?

The revision sites, the question books, the guides, the textbooks – they all give tests to let you know how you’re going. Getting the answers wrong could get you down – but the way I see it, every question you get wrong leads to learning something new, the correct answer hopefully. Each wrong answer is the first step to a new learning journey. Isn’t that exciting?

The same is true for all the ward teaching, the out patient teaching, the practical sessions, the tutorials. In my experience, the students I teach sit or stand like rabbits in the headlights whilst I ask questions – we’re not trying to catch them out, we just want to know what they know, so we don’t go over new material, and get an idea of knowledge base. The opportunity is there for you students – just ask.

Think about how much time you have spent saying nothing when asked a question over the time you’ve been a student. The time sat looking awkward, glancing side to side, gazing alternately at the navel or the ceiling hoping for inspiration. All that cumulative time that could have been spent learning something. Those of you who know me will readily accept that I’d rather be talking that listening to silence.

So next time you’re in a learning situation, and someone asks you a question you don’t know the answer to, rather than clamming up in silence, why not use that time more effectively?

“I don’t know” is my cue to tell you the answer; and you learn something. And I do like teaching you lot things. In person, or on-line.

Don’t forget Ask Dundee Chest, where you can ask us questions about respiratory medicine, or you can e-mail me by clicking here. About anything. I’ll reply. Honest.

The opportunities to attend post mortems are not what they were – when I was at medical school back in Addenbrookes in the mid 90’s, we went to PM every day, apart from Grand Round day, to see the specimens from the morning. We were grilled, but we saw so much, and learnt so much.

I doubt many current medical students ever go to PM. So here’s a great Flikr stream of pathological specimens taken from patients who succumbed to lung cancer. The photos are remarkable, and cover a wide spectrum of disease. Well worth a look.

Donald MacGregor, consultant paediatrician in Perth, told me about 18 months ago that he had noticed a dramatic increase in empyema cases in children over the preceding year. The reasons for this rise were not clear to him, or me, at the time.

Today, Paediatrics reports the same increase in empyema, and notes that this comes in spite of increased pneumococcal vaccination rates in recent years.

There’s a latin (or Greek) name for everything in medicine. Have you heard the Amateur Transplants song about latin names, Dorsal Horn Concerto?

You must say things like defacate, micturate, copulate. You can’t say things, like……

If you’ve not heard the song, you can go to their online shop, buy the first album, and the proceeds go to Macmillan Cancer.

I digress.

What name do you give to ‘stuff the patient coughs up? If it’s blood it’s haemoptysis, if it’s anything else it’s…. Sputum? Gob? Spit? Loogie? What if it’s something a bit solid.

This week’s BMJ has a short article about a man who coughed up a big blob of tissue, which turned out to be a bit of tumour. They suggest Histoptysis as a Greek name for coughing up bits of tissue. Or Oncoptysis for coughing up bits of tumour specifically.

Will it catch on?

X-Posted from DundeeMedEd

The ITA staff, and the medical computing staff, have arranged a trial of a SMART-board – an interactive whiteboard. What is an interactive whiteboard? The idea is this:

A normal, standard projector, projects an image against a specialised board with a “sensor array” behind it. Specific “pens” can be used to draw on the screen, or move anything projected onto the screen; basically think Minority Report, but in 2D. It’s more like the screens they use in CSI, or Silent Witness.

So why should we be excited about an interactive whiteboard? The obvious advantage is to be able to combine high fidelity images and slides, with hand drawn annotation, or doodling; a combination of a flip chart/blackboard with powerpoint/keynote. More interaction with the presenting material.

So how did it go? I have to admit to being fairly thoroughly underwhelmed. Problems:

The projector/board set up has to be set up and calibrated every time it’s moved. This might not be a big problem if the system is set up permanently in one place, but one of the main attractions of the system is that it is portable, moveable between sites, and around the room. The more expensive versions have built in projectors above the screen, but they still need recalibrating every time they’re moved.
The projector, no matter whether it is in front, or above the screen, casts a shadow. We’ve all been in lectures where the lecturer decides to forgo the mouse pointer, or the laser pointer, and use a finger at the end of an arm to point to something on the screen. A bloody great shadow appears over the screen, obliterating what we’re trying to see. This is inherent in the system of projection, and I think might be a big stumbling block
The calibration is not perfect. Today the finger needed to be a good 3 cm below where one wanted to “click”. I found myself using the trackpad on the MacBookPro, as it’s accurate.
The software is complex. Very complex. I’m told that the presentation given by the rep was a magical tour de force of Minority Report standards: grabbing youtube videos, clipping flash objects, pushing and pulling objects around, exporting as a PDF, recording a video of the presentation. But today, sans rep, we couldn’t import a PowerPoint presentation, struggled with the tools, and I left feeling as though we’d spent 40 minutes faffing around.
That all seems a bit negative, but it is my first impression of the technology. There are potentials for improvement: I’m told that there is an overlay to put on a large screen TV which allows the finger to be used on the screen, in the aforementioned interactive manner. This is a much more attractive proposition to me – no shadow on the screen, permanent calibration (once the overlay is laid), and it can be moved about, so long as the screen is on a stand with wheels, of course. But the presenter still has to stand in the way of the screen to write on it.

So, what alternatives would I propose? Powerpoint already has an overlay solution – a click of the semi-transparent pen button allows the presenter to doodle on the screen, albeit with a mouse, rather than a pen. The doodler stands at the computer screen, not the big screen all the learners are trying to see. So it’s hard to write with a mouse, but it is built in, on the PC version of PP, at least.

What about “just” Powerpoint/Keynote? I put a lot of effort into my Keynote presentations – I know what I’m going to do during the lecture, so I make the appropriate animations, focuses, and builds to make the presentation interesting, or I like to think so.

So why do I need an interactive whiteboard? I don’t think I do, to be honest. I do my version of Just In Time Teaching with a flip chart and a connection to the internet – it fits the way I teach, so why complicate things?

This is my wish-list, for a presenting tool :

It needs to be better than what I have now; better, that is, than Keynote, Powerpoint, a flip chart, a connection to the internet, and me.

I want to be able to write on the presentation: using a mouse or trackpad is cumbersome, and my handwriting is bad enough already. I am a doctor, after all.

I want to be able to do the writing/moving/annotating/doodling without obliterating the presentation. Ideally I want to doodle on a separate screen, ideally hand held, and the image appear on the TV or projected up on the wall.

I think this is already in (near) existence. I know I’m an Apple maniac, but surely the iPad has a massive potential in this regard. We heard from Uncle Steve last week that the iPad will connect to a projector (I already have the connector, to connect my iPhone to the big TV in our seminar room), and we saw the Keynote app. demonstrated ably on the iPad, and the big screen. Was I the only person who, on seeing the drawing app. immediately thought of overlying the drawing app onto Keynote? Immediately we have the ultimate interactive presentation tool – I can move my Keynote presentations to the iPad, connect to a projector, wander with the iPad in hand, and use my stubby index finger to point, draw, animate, and navigate my presentation. Over 100,000 apps on the app store – someone with an SDK *must* be working on “my” app, mustn’t they?

The trial of the SMART board continues, and we will try to climb the steep learning curve. I think there is a will to get this kit for the medical school. If we do get them, there will need to be a significant investment in staff development to get anything like the most out them.

And me? I’ve put in a note of interest for an iPad, of course.

When patients come to clinic and tell me that they gave up smoking 4 weeks ago, my doom-ometer starts swinging wildly. When patients stop smoking “Out of the blue”, we know there’s a high chance that they have lung cancer. Whether patients consciously decide to stop, because they know they have something seriously wrong, or there’s an unconscious push to stop, it’s a recurring theme. But is stopping smoking at the point of lung cancer diagnosis worth it?

One of my more cynical colleagues says “Why stop now? The outlook is terrible, it’s their only pleasure in life, the damage is done”. Our oncological colleagues are adamant that chemotherapy is more effective if the patient stops smoking, and “reduces the risk of second primary”.

So what should we be telling our patients? What this needs is a bit of evidence base, I suspect.

This week’s BMJ has an editorial, and a meta-analysis on smoking cessation in early lung cancer. They conclude that it’s never too late to stop, even in early lung cancer.

The difficulty putting this data into clinical practice in Dundee, though, is that we don’t see very much limited stage lung cancer. Well over 80 % of our presenting lung cancer is Stage IIIb or above (In the old system – it’ll be a higher with the new system, I’m sure). What do we tell someone with stage IV NSCLC, with a life expectancy of 2 months?

I think the message here, kids, is: don’t smoke in the first place.

Cigarettes on display in a Canadian duty free store

The Scottish Government voted 108 vs 15 to ban the open display of cigarettes in Scottish stores, the BBC News website reports

The Tobacco and Primary Medical Services Bill will also ban cigarette vending machines and introduce a registration scheme for retailers.
BBC News Website

Large stores have until 2011, smaller stores until 2013, to remove all displays of cigarettes and vending machines.

Opposition leader John Drummond of the Scottish Grocers’ Federation is quoted as saying:

The evidence that this will actually stop young people smoking just isn’t there
John Drummond, Scottish Grocers’ Federation

Good grief, man. When did we start to need evidence about such obvious measures? Out of sight, out of mind, anyone? I think it’s a fantastic piece of legislation, but I hope just the start. In some parts of America, where smoking has been banned in public places for some time, smokers are looked on with disdain, and perhaps a bit of pity; in the UK we’re still making jokes about smokers standing out in the rain…

Dropping smoking rates might put me out of a job, but it’ll take 20 years, so my pension is safe. I jest – I would be overjoyed if every smoker in the country stopped today, and lung cancer all but disappeared from routine medical practice. I’m sure the cardiologists feel the same about ischaemic heart disease.

Scotland certainly leads the rest of the UK in this, I’m not sure about the rest of Europe…..

The second case of the week is up in the cases pages. This case centres around severe breathlessness in a 48 year old lady – do you know why she’s so breathless?