Educational psychology in medical learning: a randomised controlled trial of two aide memoires for the recall of causes of electromechanical dissociation

Improvement in medical students' knowledge on chronic pain assessment through integrative learning approaches: a randomized controlled trial

Introduction

This study aimed to compare the knowledge and skills of medical students in chronic pain assessment after being trained using the PQRST (P, provoke and palliate; Q, quality; R, region and radiation; S, severity; T, time) and ACT-UP (A, activity; C, coping; T, think; U, upset; P, people) mnemonics with those using only the PQRST mnemonic.

Methods

A double-blind, randomized controlled trial was conducted at the Faculty of Medicine, Universitas Indonesia, including forty students who participated in a simulation-based chronic pain assessment workshop. Pre- and post-test scores were used to assess participants' knowledge. Two independent raters assessed the students' skills.

Results

No significant differences in knowledge or skills were observed between the groups; however, a significant improvement in the post-test scores (85.71 [71.43-95.24]) compared to the pre-test scores (61.90 [25.87-90.48]) was observed. The students reported high satisfaction with the workshop.

Conclusions

Training with the PQRST and ACT-UP mnemonics is not better than training with the PQRST mnemonic alone in improving students' knowledge and skills in chronic pain assessment. Nevertheless, this pain education workshop was beneficial for student learning. Learning of patient-oriented chronic pain assessment should be provided in a repetitive and integrative fashion using different approaches, such as lectures, demonstrations, simulations, and interactions with patients experiencing chronic pain. To conclude, mnemonics are helpful but not a primary learning tool.

The Twelve Cranial Nerves of Christmas: Mnemonics, Rhyme, and Anatomy - Seeing the Lighter Side

Anatomy, has in history, been linked to helpful ways to remember structures, branches of nerves, structures passing through foramina, etc. Scalp is even a mnemonic in itself (Skin, Connective tissue, Aponeurosis, Loose areolar tissue, Pericranium). There has been concern by some educators that using mnemonics or rhymes promotes a surface approach to learning and is unhelpful in establishing long-term and meaningful deep learning. This article argues that mnemonics and rhyme can be used, in the appropriate way, at the right time, by students as an important learning strategy. That strategy can help lay a foundation of knowledge to be developed and later built upon, or simply recall information more easily. Mnemonics, like all information that is to be recalled, is consolidated by rehearsal. In examining the neuroanatomy of learning theories, it is therefore possible to suggest that when students begin to learn an area of anatomy, such as the cranial nerves, using a mnemonic or rhyme, it can help students remember the names and facilitate the engagement of the working memory processes assisting the student to build a construct for subsequent deeper layers of knowledge. Modern approaches to anatomy education involve a myriad of learning opportunities, but educators must assess the value of each one before recommending them to students. It appears that using mnemonics and rhyme is as valid today as it has been for centuries.

Early Clinical Exposure to Geriatric Psychiatry and Medical Students' Interest in Caring for Older Adults: A Randomized Controlled Trial

OBJECTIVE

In the next 25 years, the population aged 65 and older will nearly double in many countries, with few new doctors wishing to care for older adults. The authors hypothesize that early clinical exposure to elderly patient care could increase student interest in caring for older adults during their future career.

METHODS

The authors conducted a pragmatic medical education randomized controlled trial (RCT) at the Jewish General Hospital and the Douglas Mental Health Institute, McGill University, in Montreal, Canada. Third-year medical students undergoing their mandatory 16-week half-time clerkship rotation in psychiatry were randomly assigned to the equivalent of 2-4 weeks of full-time exposure to clinical geriatric psychiatry (n = 84).

RESULTS

Being randomly assigned to geriatric psychiatry exposure (n = 44 of 84) was associated with increased "comfort in working with geriatric patients and their families" at 16-week follow-up (59.1% versus 37.5%, χ² (1) = 3.9; p = 0.05). However, there was no significant association found between geriatric psychiatry exposure and change "in interest in caring for older adults," or change in "interest in becoming a geriatric psychiatrist."

CONCLUSION

The results of this pragmatic education RCT suggest that exposing third-year medical students to 2-4 weeks of geriatric psychiatry did not increase their interest to care for older adults or become a geriatric psychiatrist. However, it did increase their comfort level in working with older adults and their families. However, more research is necessary to identify potential interventions that could inspire and increase medical student interest in caring for older adults as part of their future careers.

Factors influencing student performance on the carpal bone test as a preliminary evaluation of anatomical knowledge retention

It has been demonstrated that a positive correlation exists between clinical knowledge and retained concepts in basic sciences. Studies have demonstrated a modest attrition of anatomy knowledge over time, which may be influenced by students' perceived importance of the basic sciences and the learning styles adopted. The aims of this study were to: (1) conduct a cross-sectional evaluation of the retention of anatomical knowledge in preclinical (second-year) and clinical (fifth-year) chiropractic students at Murdoch University; and (2) examine students' perceptions of factors that may influence their anatomy knowledge retention. Second- and fifth-year chiropractic students at Murdoch University were invited to participate in the study. Ninety-one students voluntarily participated. The Carpal Bone Test, previously utilized to determine the retention of anatomical knowledge, was utilized to determine the extent to which participants retained gross anatomy knowledge. Participants also completed a questionnaire specifically designed to identify the factors that may have influenced their retention of gross anatomy knowledge. A two-sided Pearson chi-square test of association was used to ascertain statistically significant differences in carpal bone retention and students' responses between the two cohorts. Seventy percent of the fifth-year (clinical) chiropractic students correctly identified all eight carpal bones compared to only six percent of second-year chiropractic students. The majority of participants in both cohorts believed that gross anatomy knowledge is of clinical importance. The use of mnemonics and the clinical application of anatomy knowledge were identified as factors that significantly influenced participants' gross anatomy knowledge retention within this study.

Using a context-sensitive ranking method to organize reversible causes of cardiac arrest in a digital cognitive aid

Medical doctors typically identify reversible causes associated with cardiac arrest by recalling them from memory, using a mnemonic. External techniques, such as cognitive aids (e.g., iPad-based applications), have been shown to produce an increase in performance in medical diagnosis. We studied two alternative approaches to the traditional method of using mnemonics to identify reversible causes of cardiac arrest. One approach displayed the causes in alphabetical order (alphabetical scheme) while the other approach displayed causes ordered by their relevance to the patient-context (context-sensitive scheme). We recorded performance and usability measures for these two approaches in two simulated cardiac arrest scenarios for each group. It took significantly longer for the participants to identify the causes using the context- sensitive scheme. However, the context-sensitive scheme resulted in significantly fewer unnecessary keystrokes. The two schemes did not differ significantly in terms of their usability ratings.

Validating the 5Fs mnemonic for cholelithiasis: time to include family history

BACKGROUND

The time-honoured mnemonic of '5Fs' is a reminder to students that patients with upper abdominal pain and who conform to a profile of 'fair, fat, female, fertile and forty' are likely to have cholelithiasis. We feel, however, that a most important 'F'-that for 'family history'-is overlooked and should be introduced to enhance the value of a useful aide memoire.

METHODS

To assess the usefulness of each of the existing factors of a popular mnemonic, 398 patients admitted with upper abdominal pain between March 2009 and April 2010 were studied. The clinical features expressed in the cholelithiasis mnemonic in patients with sonographic evidence of cholelithiasis were compared with those of patients without.

FINDINGS

In the cholelithiasis group, significantly more patients were women (150/198 (75.8%) vs 111/200 (55.5%), p<0.001), fair (144/198 (62.9%) vs 54/200 (32.1%), (p<0.001)), fertile (135/198 (68.2%) vs 50/200 (25%) (p<0.001)) and had a body mass index >30 (56/198 (28.3%) vs 19/200 (9.5%) (p<0.001)) compared with controls; but age over 40 years did not predict cholelithiasis (82/198 (41.4%) vs 79/200 (39.5%) (p=0.697)). In the cholelithiasis group, 78/198 (39.4%) had a family history in at least one first-degree relative, compared with 27/200 (13.5%) of controls, (p<0.001). Where the phenotypic elements of the history existed in combination, that patient was found to be at an increased risk of cholelithiasis.

INTERPRETATION

Our study found that the validated 'students' 5Fs' mnemonic retains a role in clinical diagnosis of patients suspected of cholelithiasis but the factor 'familial' should be substituted for 'forty' in recognition of the role of inheritance and the changing demographics of gallstone incidence.

I-AIM: a novel model for teaching and performing focused sonography

This project was designed to use existing evidence in education and clinical quality improvement to design an educational and clinical model specific for physician-performed focused sonography. The I-AIM model (indication, acquisition, interpretation, and medical decision making) was created to serve as both a mnemonic and checklist. The model follows a stepwise logic for performing focused sonographic examinations and contains detailed subcomponent listings that cover specific areas to improve use and performance. Although validation and reliability studies will be required before implementation, the I-AIM model represents the first effort to standardize and improve clinical and educational focused-sonography.

A randomised control trial to determine if use of the iResus© application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency

This study sought to determine whether using the Resuscitation Council UK's iResus© application on a smart phone improves the performance of doctors trained in advanced life support in a simulated emergency. Thirty-one doctors (advanced life support-trained within the previous 48 months) were recruited. All received identical training using the smart phone and the iResus application. The participants were randomly assigned to a control group (no smart phone) and a test group (access to iResus on smart phone). Both groups were tested using a validated extended cardiac arrest simulation test (CASTest) scoring system. The primary outcome measure was the overall cardiac arrest simulation test score; these were significantly higher in the smart phone group (median (IQR [range]) 84.5 (75.5-92.5 [64-96])) compared with the control group (72 (62-87 [52-95]); p=0.02). Use of the iResus application significantly improves the performance of an advanced life support-certified doctor during a simulated medical emergency. Further studies are needed to determine if iResus can improve care in the clinical setting.