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Why I’m loving learning about medicine and the arts

Medicine and the Arts: The University of Cape Town [Six Weeks] (3 hours pw) 68% completed

A couple of weeks to go. I’ve been on track and usually with fellow participants on this exciting, invigorating, inventive and important course. I would hold this up as the standard to copy: a team of contributors, the most senior and influence academics, and many other vibrant educators, health staff, performers and creatives. Most if not all the FutureLearn learning tools are used, so activities include short videos, all professionally shot and modest in length, micro-assignments of 350 that are peer reviewed, well-thought through multiple-choice quizzes, additional reading and of course rich, insightful discussions with fellow participants. The icing on the cake are the glorious mosaic graphics: photographs of a huge mural on the University of Cape Town campus.

Medicine and the arts: children’s experiences of medical institutionalisation

Age 12 Stacey Pidden was diagnosed with Pulmonary Hypertension (PH) and given a couple of years to live unless she went on a new trial drug which, with her parents behind her, she did. A decade later and she was given two years to live and put on the waiting list for a double lung and heart transplant – that was three years ago. She blogged her story to fellow students of the Open University from 2010, then a couple of years later started her public blog.  One friend with PH stopped taking drugs and died. She shares everything openly and honestly. From age 4 she underwent heart surgery and had a couple of operations every year or so. What is immediately apparent in blog is her skill as a writer and her view that “life is worth fighting for.” She is a feisty and determined and would be far weaker had she not found her voice and even a purpose in life: she is the voice of a new NHS donor card campaign.

Based on Marc Hendricks concerns of children’s voices being marginalised I see value in blogging as a creative outlet: it combines so much that the University of Cape Town team address: giving young patients a voice – their voice, in a way that suits them. Tracey, for example, is in close contact with the 17 other in the UK waiting for a double lung and heart transplant like her: this empowers her and reassures her – there are other people in her situation and she has a voice that requires no filters. Susan Levine talks of a person’s life world.’ Tracey shares her ‘life world’ with us; whilst we may think of our community as neighbours and friends, hers includes her transplant team and regular consultants. A blog is text, voice, photos, artwork and even song; whatever the author wants in fact. It’s certain than visual metaphors as Kate Abney found are an important way to express meaning too. While hospital radio is another way to enable storytelling as Nina Callaghan has found.

Creatively Stacie is a erudite, witty and frank voice representing those waiting for a transplant. Where permitted, children, not just young adults, should be given such freedoms to communicate and share beyond the confines of their ward and so give them confidence to speak their minds, improving their lives, their motivation to live and the quality of communication with hospital staff.

A personal story, in sharp contrast to TB in southern Africa, is a skiing accident in the French alps. This is a world away from the many children around the world who spend long, life threatening spells institutionalised in hospital, and in the UK is historically a century from TB (my great uncle died of TB when he was 27 in the 1920s). A skiing accident is like a traffic accidents these days, nonetheless resulting in children being hospitalised. Age 13 I smashed my leg. It took a traumatic 36 hours to get me into hospital near home 1000 miles away during which time I was trusted with a bottle of pain relief pills. Despite this responsibility once in hospital all power rested with the consultant to whom all communicated, deferred to and waited to hear from, my mother included. If I was in pain – it had to wait.

I found myself isolated in a private room courtesy of family insurance with nothing for pain relief other than a panic button to call a nurse. As I reflect on it I would say the isolation and not getting a response when I called for pain relief was the most difficult. I had no one to talk to. Not even a radio or TV to distract me.

Only when my mother was present did I feel I had an interpreter between the medical staff and me: I was not consulted, I was told. Just as I was told six weeks later moments before I went under that my leg would be re-broken, reset and put in a new plaster which in turn would mean my missing an term of school. The consultant knew everything. I knew nothing, and the way they were treated the nurses knew less.

Decades on, and age 10, I am with my daughter who has potentially suffered a fracture of some kind too. We are in France. Although their English wasn’t fluent and I was present more effort was made, even to my exclusion, to talk directly to her: after all, it was her suffering the pain or discomfort, not me. In this instance there was no broken limb, but I can see that efforts we made to communicate directly with my daughter, not to hear an interpretation of her possible ailments through a parent with a tendency to exaggerate.

Hearing from the patient is not only better for the patient, it is also sound medical practice – increasingly so as we can take some responsibility for understanding what is wrong with us by making informed searches on the Internet.

 

Time to write

Fig.1 H809 EMA Mindmap (for fellow H809 / MA ODErs I’ve added a PDF version in the TMA Forum) Created using Simpleminds.

  • H809 – Practice-based research in e-learning
  • MA ODE – Masters in Open and Distance Education
  • TMA – Tutor Marked Assignment
  • PDF – PDF

Yonks ago I realised for me the best time to study was v.early in the morning. 4.00 am to breakfast isn’t unusual, 5.00 am is more typical. All it costs is an early night. This is easy too – no television. Its move from the shed to the dump is imminent.

A week ahead of schedule I find I have an EMA to complete – this’ll give me a three hour, exam like run of it. Even the dog knows not to bother me.

For those on the same path the mindmap of my H809 EMA is above.

Ask if you’re interested in a legible PDF version.

This gorse bush off density has patterns within it that I can decipher. The net result ought to come out somewhere around the 4,000 word mark too. This approach could not be more different to my earliest TMAs and EMAs three years ago – they were too often the product of what I call ‘jazz writing’ (this kind of thing), just tapping away to see where it takes you. This process used to start on scrolls of backing wallpaper taped to my bedroom wall. Now it goes onto a whiteboard first.

As always this blog is an e-portfolio: most notes, moments in student forums and references are in here.

I recommend using a blog platform in this way. You can default to ‘private’, or share with the OU community … or ‘anyone in the world’. One simple addition to this would be a ‘share with your module cohort’.

By now I have clicked through some 165 posts taggeed H809 and can refer to H809ema for those picked out for it.

One split occured – I very much wanted to explore the use of augmented reality in museum visits, but found instead a combination of necessity and logic taking me back to the H809 TMA 01 and a substantial reversioning of it. Quite coincidentally this proposed research on adherence to preventer drugs amongst moderate to severe asthmatics had me taking a very close interest on a rare visit to a hospital outpatient’s. Nasal endoscopy must look like a circus trick to the casual observer as the consultant carefully ‘lances’ my skull through the nose with a slender and flexible rod on which there is a tiny camera and light. ‘Yes, I can see the damage from surgery’ he declares (this was 33 years ago), ‘but no signs of cancer’.

There’s a relief.

An unexplained nose bleed lasting the best part of 10 weeks was put down to my good-boy adherence to a steroid nasal spray that had damaged the soft tissue. And the medical profession wonder why drug adherence can be so low? 20% to 60% 33 years on and courtesy of the OU Library I found a wholly convincing diagnosis – allergic rhinitis. The ‘paper’ runs to over 80 pages excluding references and has some 20 contributors (Bousquet, 2008). I’ll so miss access to the online library as most papers appear to cost around the £9 to download. This desire to remain attached by a digital umbilical chord to such a resource is one reason I wish to pursue yet more postgraduate studying and potentially even an academic career. I get extraordinary satisfaction browsing ‘stuff’ to feed my curiosity.

When I stop diddling around here I’ll pick off this mindmap in a strick clockwise direction from around 1 O’Clock.

Simpleminds is great as a free App. It’s taken me a couple of years to get round to paying £6 for a version that can be exported into a word file though I rather enjoy the slower, more considered ‘cut and paste’ which adds another opportunity to reflect, expand or ditch an idea.

REFERENCE

Bousquet, J, Khaltaev, N, Cruz, A, Denburg, J, Fokkens, W, Togias, A, Zuberbier, T, Baena-Cagnani, C, Canonica, G, Van Weel, C, Agache, I, Aït-Khaled, N, Bachert, C, Blaiss, M, Bonini, S, Boulet, L, Bousquet, P, Camargos, P, Carlsen, K, & Chen, Y (2008) ‘Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN’, Allergy, 63, pp. 8-160, Academic Search Complete, EBSCOhost, viewed 19 June 2013.

What will the impact be of the Web on education? How is knowledge sharing and learning changing?

Fig. 1. Father and daughter

From four or five months after conception with the formation of the brain, to the moment of brain death we have the capacity to learn, subconsciously as well as consciously.

Whether through interlopers before birth, in infancy and early childhood, or through family and carers in our last moment, days, weeks, months or years. At both ends of life the Web through a myriad of ways can advise, suggest and inform, and so educate, like never before. While for all the time in between as sponges, participants and students we can access, interact, interpose and interject in an environment where everything that is known and has been understood is presented to us. The interface between person and this Web of knowledge is a fascinating one that deserves close study for its potentially profound impact on what we as humans can do as people and collectively:  Individually through, by, with and surfing the established and privileged formal and formal conveyor belt of education through nursery, primary, secondary and tertiary centres of learning. Individually, also through expanding opportunities globally to learn unfettered by such formal education where such established opportunities don’t exist unless hindered through poverty and politics or a lack of communications infrastructure (a robust broadband connection to the Web). And individually and collectively alongside or beyond whatever formal education is provided or exploited by finger tapping into close and expanded networks of people, materials, ideas and activities

Open learning comes of age.

By seeking to peg answers to the role the Web is starting to play, at one end to the very first opportunity, at the micro-biological level to form a thought and at the other end to those micro-seconds at the end of life once the brain ceases to function – and everything else in between, requires an understandings neuroscience and an answer to the question ‘what is going on in there?’ How do we learn?

From an anthropological perspective why and how do we learn?

Where can we identify the origins of knowledge sharing and its role in the survival and domination of homo sapiens? And from our migration from the savannas of Eastern Africa to every nook and cranny of Earth, on land and sea, what recognised societal behaviours are playing out online? And are these behaviours mimicked or to a lesser extent transmogrified, warped or elevated by the scope, scale and speed of being connected to so much in such variety?

A history of learning is required.

From our innate conscious and subconscious capacity to learn from our immediate family and community how has formal education formed right the way through adding reading, writing and numeracy as a foundation to subject choices and specialisms, so momentarily expanded in secondary education into the single subjects studied at undergraduate level and the niche within a niche at Masters and doctoral levels. And what role has and will formal and informal learning continue to have, at work and play if increasing numbers of people globally have a school or university in their pockets, courtesy of a smartphone or tablet and a connection to the Web?

The global village Marshall McLuhan described is now, for the person connected to the Web, the global digital fireplace.

It has that ability to gather people around. Where though are its limits? With how many people can we develop and maintain a relationship? Once again, how can an understanding of social networks on the ground inform us about those that form on the Web? Multiplicity reins for some, flitting between a variety of groups while others have their niche interests indulged, celebrated and reinforced. Is there an identifiable geography of such hubs small and large and if visualised what does this tell us? Are the ways we can now learn new or old?

In relation to one aspect of education – medicine – how are we informed and how do we respond as patients and clinicians?

The journey starts at conception with the mixing of DNA and ends once the last electrochemical spark has fired. How, in relation to medicine does the quality (or lack of), scale and variety of information available on the Web inform and impact upon our ideas and actions the length of this lifetime’s journey At one end, parents making decisions regarding having children, then knowledge of pregnancy and foetal development. While at the other end, a child takes part in the decision-making process with clinicians and potentially the patient – to ‘call it a day’. Both the patient or person, as participant and the clinicians as interlocutors have, potentially, the same level of information at their fingertips courtesy of the Web.

How is this relationship and the outcomes altered where the patient will know more about their own health and a good deal about a clinician’s specialism?

The relationship between the doctor and patient, like others, courtesy of the connectivity and capacity of the Web, has changed – transmogrified, melted and flipped all at the same time. It is no longer them and us, though it can be – rather, as in education and other fields, it can be highly personalized and close.

Can clinicians be many things to many people?

Can any or only some of us cope with such multiplicity? A psychologist may say some will and some won’t, some have the nature for it, others not. Ditto in education. Trained to lead a classroom in a domain of their own, can a teacher take on multiple roles aimed at responding to the unique as well as the common traits of each of their students? While in tertiary education should and can academics continue to be, or expected to be undertake research as well as teach? Where teaching might be more akin to broadcasting, and the classroom or tutorial takes place asynchronously and online as well as live and face-to-face.

Disaggregation equals change.

In relation to one aspect of education in medicine and one kind of problem, what role might the Web play to support patients so that they can make an informed decision regarding the taking of potentially life saving, if not simply life improving, medications? Having understood the complexity of reasons why having been prescribed a preventer medication, for example, to reduce or even eliminate the risk of a serious asthma attack, what is going on where a patient elects, sometimes belligerently, not to take the medication. Others are forgetful, some misinformed, for others it is the cost, or the palaver of ordering, collecting and paying for repeat prescriptions. Information alone isn’t enough, but given the capacity of the web to brief a person on an individual basis, where they are online, what can be done to improve adherence, save lives and enhance the quality of life?

My hypothesis is that a patient can be assisted by an artificial companion of some kind, that is responsive to the person’s vicissitudes while metaphorically sitting on that person’s shoulder i.e. in the ‘Cloud’ and on their smartphone, tablet, headset, laptop or whatever other assistive interface will exist between us and the Web.

 

Fig. 2. Where it ends … more or less

At a parent’s side when they die is a profound experience. The breathing stopped and a trillion memories drained away. To what degree will this no longer be the case when a life logged digitally becomes a life in part preserved?

 

How to improve asthma patient outcomes using spaced education

Cover of "Living with Asthma"

Cover of Living with Asthma

There had been no plans to make this content public, but I thought I’d share it because of my interesting realisation that the Zemanta search tool may be  a reasonably valid way to winkle out papers relevant to a topic of interest. Out of habit it now I offer link to further content that on first appearances seems to  offer similar or contrasting views. Before I look at the selection that was offered to me, and the 7 from the 16 or so I was offered I am going to go through conventional route using the Open University Online Library and see what I may find that to any large extent differs.

I am not a physician or Medical Docotor, though I am asthmatic and have been in, on and off a variety of inhalers and sometimes oral steroids for some thirty years.

Preventer – Inhaled Steroid – two puffs twice a day. Used with a spacer to reduce chances of thrush.

Reliever – as needed, which is generally never, with rare need if I develop a chest infection, in which case I may end up on antibiotics anyway.

Oral Steroids – Very rarely, usually related to a chest infection. Once every five years?

Nebulizer – Never. Unlike my late father and one (or two) relations who take the view that they only need the preventer when they are wheezy … and end up hospitalised when they have an asthma attack and in the case of my father on steroids for so long that he became diabetic.

Preventative measures – know your triggers, avoid them, keep fit and attend an annual Asthma Clinic. I have to be cautious with house dust allergy and its partner in crime – damp. The odd list of triggers includes, at times, bleach, cumin seeds, one of the Lucozade sports drinks (odd that, coming from GSK who also produce asthma drugs). Possibly white flour. Yeast causes other problems too. We have a dog, but I’m not comfortable for long in a house with soft furnishings where there are cats. Get the bedroom windows open as often as possible. Use a specialist vacuum cleaner on the mattress, pillows and duvet. No carpets. No curtain. Leather sofa preferred.

Fig. 1. Twenty years ago I found myself producing, directing and writing a two information videos for a major pharmaceutical company – ‘Living with Asthma’ and ‘the Cost of Asthma’.

These had a shelf life of some ten to fifteen years, eventually to be replaced by DVD and online interactive equivalents. We did a combination of narrative drama reconstruction – a thread from a TV soap  in which a protagonist has an asthma attack, interviews with patients and experts (doctors and pharma) and narration with 3D animations and charts.

The purpose of this exercise is to:

  • Justify and explain the question for a piece of empirical research.
  • Offer FIVE pieces that  support then set you research on its way.
Though an academic exercise I’m going to treat this as something that could find funding, and that I could carry out.
What is the proposed research about? Asthma patient ignorance of best practice in relation to taking their prescribe drugs – why they are taking the drugs, how they work, when they should take them, how and how often …
What is it trying to find out or achieve? Improve patient care i.e. compliance (UK) – so taking their medicine correctly. This is important where the condition is chronic and the symptoms aren’t continuous. People tend to lapse taking the preventative drugs … it takes several days on onset of symptoms for these to kick in.
How will it go about doing that? A randomised controlled trial in which all asthmatics are invited to sign up to receive information over a period of x months, reminders about asthma and their drug taking regime.
What will we learn from it and why was it worth learning? That a significant percentage of asthmatics who have been prescribed an inhaled steroid (preventer medicine) to take twice daily are failing to do so, simply because they don’t see the need to do so unless they are feeling wheezy (a misconception, it should be taken regardless) or they allow their inhalers to run on empty for some time before being aware of this.That a significant percentage of asthmatics, probably largely the same group as above, misuse their reliever inhaler a) taking it too often b) not correctly inhaling so that drug ends up lining their mouth rather than entering their lungs.Taking the right dosage of inhaled steroid, as prescribed, in the correct manner, is likely to reduce need for the reliever inhaler to nil and will result in less long term damage being done to the lining of the lungs.It will improve patient outcomes, reduce the use of inhibitors and reduce hospital visits or overnights where a person has suffered an avoidable asthma attack.

 

Learning in extremis

Fig.1. Three years later

“Emergency Home Birth!” my wife exclaimed pointing at a book on pregnancy and childbirth.

My wife went into labour at 2.30am, we’d planned a home birth (this is her second) however our hospital was some 37 miles away and our allocated Midwife was another 20 miles beyond that.

I got her on the phone and she spoke to my wife between contractions – she wouldn’t make it.

‘Call an ambulance and I’ll be over in due course’, she said.

Chapter Six, ‘Emergency Home Birth’ looked like it needed half an hour to read and at least as long  again to digest; there wasn’t time.

Thankfully om the facing page of Chapter Six the editor had laid out the essentials in clear bullet points – towels, scissors and string are the ones I remember, probably because I required all three, these and the warning that the umbilical cord can get caught around the baby’s throat. I needed that too.

Just in time learning, delivered just in time.

And so it was, at around 3.20am, my wife on floor holding onto the  the end of the bed, towels in place that our son was born.

First his head, the umbilical cord wrapped tightly around his throat. I eased this over his chin and around his head, surprised at how thick and tough it was – then one,the both shoulders and he fell into my arms like a muddy rugby ball out of a scrum. My wife rolled around and sitting at the end of the bed she took him into her arms.

A few minutes later the midwife arrived, thought everything was going well and went to run a bath. In due course she showed me how to cut the umbilical cord then took my wife to the bathroom.

Learning in extremis?

In my day job I was supporting the teaching of such techniques at the logistics and distribution group UGC in Oxford.

I didn’t need a book, or a training video and given this was 1996 I wasn’t going to have Google, Quora or YouTube offer some advice.

I’ve had no further need for these particular parenting skills, though it’s been an adventure following two infants through childhood into their early teens.

Learning works best when it is pushed, when there is a challenge of time and circumstances, where it can be applied and seen to work.

How do we apply this to formal education, to studying for exams through secondary and tertiary education?

What is the difference with learning in the workforce, between physical actions on a factory floor, in a mine, power station or warehouse, out on a civil engineering building site or in an office or boardroom?

There need to be exams – from mocks to annual exams and finals.
Essays and regualr assignments are part of this best practice.
And how about tests, even the surprise test, not so much for the result, but for the pressure that ought to help fix some learning in our plastic, fickle minds?

In advertising we often spoke of ‘testing  to destruction’ that nothing beats a clear demonstration of the products power, staying power or effectiveness in memorably extreme conditions.

I like the idea of working Against the clock, of competition too, even learning taken place, as I have heard, as someone cycles around Europe, or drives a Russian Jeep from Kazakstan back to Britain.

I believe in the view that ‘it’ll be alright on the night’ – that you can galvanise a group to rally round when needed and those new to this game will pick up a great deal in the process; personally I loved the ‘all-nighters’ we did in our teens breaking one set then building another in the Newcastle Playhouse, some sense of which I repeated professionally on late night and all night shoots, often in ‘extreme’ places.

 

The Educational Impact of Weekly E-Mailed Fast Facts and Concepts

In this study, the authors assessed the educational impact of weekly Fast Facts and Concepts (FFAC) e-mails on residents’ knowledge of palliative care topics, self-reported preparedness in palliative care skills, and satisfaction with palliative care education.

The more papers I read, like learning a foreign language, the thinner the blur between mystery and comprehension in terms of judging a paper and its contents. My goal is to be able to conduct such research and write such papers. I understandably feel that a first degree in medicine and a second masters degree in education is required at this level. At best I might be able to take on psychology or neuroscience. My preference and hope would be to become part of a team of experts.

Purpose: Educational interventions such as electives, didactics, and Web-based teaching have been shown to improve residents’ knowledge, attitudes, and skills. However, integrating curricular innovations into residency training is difficult due to limited time, faculty, and cost.

What – A clear problem:

Integrating palliative care into residency training can be limited by the number of trained faculty, financial constraints, and the difficulty of adding educational content with limited resident duty hours. (Claxton et al. p. 475 2011)

Who – Participants

Beginning internal medicine interns

Why – Time- and cost-efficient strategies for creating knowledge transfer are increasingly important. Academic detailing, an educational practice based on behavioral theory, uses concise materials to highlight and repeat essential messages. Soumerai  (1990)

How – We designed this study to assess the educational impact of weekly e-mailed FFAC on
internal medicine interns in three domains: knowledge of palliative care topics, satisfaction with palliative care education, and self-reported preparedness in palliative care skills.

Methods

This randomized, controlled study of an educational intervention included components of informed consent, pretest, intervention, and posttest.

Fast Facts and Concepts

FFAC are 1-page, practical, peer-reviewed, evidence-based summaries of key palliative care topics first developed by Eric Warm, M.D., at the University of Cincinnati Internal Medicine Residency Program in 2000.6

Intervention

One e-mail containing two FFAC was delivered weekly for 32 weeks to interns in the intervention group.

Pre-test

All participants completed a pretest that assessed knowledge of palliative care topics, self-rated preparedness to perform palliative care skills, and satisfaction with palliative care education.

Method: Internal medicine interns at the University of Pittsburgh and Medical College of Wisconsin were randomized to control and intervention groups in July 2009. Pretests and post-tests assessed medical knowledge through 24 multiple choice questions, preparedness on 14 skills via a 4-point Likert scale and satisfaction based on ranking of education quality.

The intervention group received 32 weekly e-mails.

Control Group
No e-mails were sent to the control group.

Post-test
Respondents completed a post-test 1 to 8 weeks after the
intervention

Educational equipoise
All study participants were informed of the content and the online availability of FFAC during recruitment. At the conclusion of the study, both control and intervention groups were given a booklet that contained all the e-mailed FFAC.

Statistical analysis

Descriptive statistics and t tests were used to compare the demographic data between the control and intervention groups. Medical knowledge, preparedness, and satisfaction were compared pretest and post-test within groups by Wilcoxon tests and between groups via Mann-Whitney U tests. The data did not meet assumptions for multivariate analysis due to the small sample size. Only univariate analysis was performed.

Although traditional academic detailing techniques include educational outreach visits and distribution of printed graphic materials, e-learning techniques such as e-mail delivery of educational content, listservs and Web-based tutorials can also be considered rooted in this behavioral theory given their focus on repeated, concise content.

Pain assessment and management, breaking bad news, communicating about care goals, and providing appropriate medical care for a dying patient are necessary skills for surgery, family medicine, pediatric, obstetrics and gynaecology, physical medicine and rehabilitation, emergency medicine, neurology, radiation oncology, anesthesiologist, and psychiatry residents.

Studies that focus on e-mail education interventions have shown that weekly e-mails change the behavior of e-mail recipients, improve learner retention of educational content and that retention improvements increase with the duration over which e-mails were received. (Kerfoot et al. 2007 ) (Matzie et al. 2009)

Results: The study group included 82 interns with a pretest response rate of 100% and post-test response rate of 70%. The intervention group showed greater improvement in knowledge than the control (18% increase compared to 8% in the control group, p = 0.005).

Preparedness in symptom management skills (converting between opioids, differentiating types of pain, treating nausea) improved in the intervention group more than the control group ( p = 0.04, 0.01, and 0.02, respectively).

There were no differences in preparedness in communication skills or satisfaction between the control and intervention groups.

Conclusions: E-mailed FFAC are an educational intervention that increases intern medical knowledge and self-reported preparedness in symptom management skills but not preparedness in communication skills or satisfaction with palliative care education.

REFERENCE

Claxton, R, Marks, S, Buranosky, R, Rosielle, D, & Arnold, R 2011, ‘The Educational Impact of Weekly E-Mailed Fast Facts and Concepts’, Journal Of Palliative Medicine, 14, 4, pp. 475-481, Academic Search Complete, EBSCOhost, viewed 25 February 2013.

Matzie KA, Price Kerfoot B, Hafler JP, Breen EM: (2009) Spaced education improved the feedback that surgical residents given to medical students: A randomized trial. Am J Surg 2009;197:252–257.

Price Kerfoot B, DeWolf WC, Masser BA, Church PA, Federman DD: (2007) Spaced educational improves the retention of clinical knowledge by medical students: A randomized controlled trial. Med Educ 2007;41:23–31.

Soumerai SB, Avorn J: (1990) Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA 1990;263:549–556.

 

Creative Problem Solving Techniques Library : Working with Dreams & Keeping a Dream Diary

There is a health warning with these activities as they could bring up deeply personal memories, emotions, feelings and responses.

I offer a different kind of health warning having persevered with this over the last few weeks: be prepared to wake up several times a night wondering ‘what on earth was that all about?’

Having got my head to alert me to dreams and bring me into a state of semi-consciousness I am now able to remember anything (so far) between one and three dreams every night. I haven’t the time, energy or circumstances to deal with any of them. To do one justice I would give each two hours, this is a combination of getting the detail down then working through a set of 27 questions to analyse what it means directly to you, your circumstances, the problem or problems, feelings, anxieties and so on.

I’m still recalling a dream from two nights ago! Vivid not for where I was , what I was doing or who I was with, but how it in the way you get from watching a movie I came away feeling x, y & z from the protagonist.

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