Graham Easton

How medical teachers use narratives in lectures: a qualitative study

BackgroundThere are strong theoretical arguments for using narratives in teaching and learning within medicine, but little is known about how they are used in medical lectures. This study explores the types of narratives lecturers use, the attitudes of lecturers and students to the use of narratives in teaching, and the aspects of learning that narratives may facilitate.MethodsObservation of three medical lectures was followed by one-to-one interviews with the respective lecturers, and separate focus group interviews with medical students who attended each of the three lectures.ResultsLecturers used a variety of narratives on a range of themes, from clinical cases to patient experience narratives or narratives about their professional careers. Students and lecturers highlighted key aspects of narrative learning: for example providing a relevant context, as a “hook” to engage the audience, and as a memory aid.ConclusionThe findings support existing literature which suggests that narratives may be a useful tool for learning in medicine. This study suggests that narratives tap into several key learning processes including providing a relevant context for understanding, engaging learners, and promoting memory. For medical students in lectures, narratives may be particularly relevant in promoting humanistic aspects of medicine, including professional identity and empathy.

Human and veterinary medicine

Theme issue will look at ways in which doctors and vets can work together Traditionally, human medicine and veterinary medicine tend to be viewed separately. Doctors treat people, and vets look after animals. Of course differences exist between the two types of patients and options for treatment. Euthanasia, for example, tends not to be looked on favourably in humans, whereas in veterinary medicine it might be the best approach. Similarly, culling infected individuals or those suspected of being infected is not an option for controlling an outbreak of infectious disease in humans but may well be so in animals. Doctors usually have the advantage over …

Advances in pancreas transplantation

The potential to reverse diabetes has to be balanced against the morbidity of long-term immunosuppression associated with transplantation. For a patient with renal failure, the treatment of choice is often a simultaneous transplant of the pancreas and kidney or pancreas after kidney. For a patient with glycaemic instability, choices between a solid organ or islet transplant have to be weighed against benefits and risks of remaining on insulin. Results of simultaneous transplant of the pancreas and kidney transplantation are comparable to other solid-organ transplants, and there is evidence of improved quality of life and life expectancy. There is some evidence of benefit with respect to the progression of secondary diabetic complications in patients with functioning transplants for several years.

Diagnosing chronic obstructive pulmonary disease

#### What you need to know A 55 year old man attends surgery with a productive cough for nine months, which he has put down to his smoking. He had “chest infections” the previous winter and takes ramipril for hypertension. His breathing is now preventing him from climbing stairs.

Antibiotic prescribing for upper respiratory tract infections in children: how can we improve?

Upper respiratory tract infection (URTI) in children is one of the most common problems that general practitioners (GPs) see. Although complications from URTIs are rare, and antibiotics offer little or no benefit in uncomplicated cases, antibiotic prescribing has increased in recent years following a decline in the late 1990s. This article explores possible reasons for the increase, weighs the evidence on withholding antibiotics and asks how GPs will interpret recent National Institute for Health and Clinical Excellent (NICE) guidelines when dealing with URTI in children. We review some of the latest approaches to help implement antibiotic prescribing guidelines and suggest some practical solutions to help busy GPs.

Time to revive the GP-focused clinical examination

As GPs we are rightly proud of our focused history-taking and consultation skills, but how many of us would say the same for our focused examination skills? It is time to claim the focused clinical examination as a specialist GP skill we can be proud of, for us and for our patients. GPs will benefit as we start to understand what is really worth doing and what isn’t, in the GP setting. We will begin to feel more confident in what we do (and what we don’t do) in practice; perhaps we can even start teaching and assessing the focused exam properly, something too often glossed over in GP training. Patients will win because appropriate examinations can cut errors and avoid diagnostic delays,1 reduce unnecessary and potentially harmful tests,2 and provide a reassuring connection with their doctor.3 A well-targeted physical examination …

How would a decision to leave the European Union affect medical research and health in the United Kingdom

Azeem Majeed, Anna Hansell, Sonia Saxena, Christopher Millett, Helen Ward, Matthew Harris, Benedict Hayhoe, Josip Car, Graham Easton, Christl A Donnelly, Robert Perneczky, Marjo-Riitta Jarvelin, Majid Ezzati, Salman Rawaf, Paolo Vineis, Neil Ferguson and Elio Riboli School of Public Health, Imperial College London, London W6 8RP, UK Corresponding author: Azeem Majeed. Email: a.majeed@imperial.ac.uk

Promoting physical activity: the general practice agenda.

There is a continued national public health strategic focus on increasing physical activity at a population level1 and primary care is being called on to play a central role in this drive,2 with the Royal College of General Practitioners (RCGP) set to appoint the first clinical champion for physical activity. Nationally Public Health England (PHE)3 and globally the World Health Organization4 have highlighted the importance of increasing physical activity and reducing sedentary time. Guidelines and recommendations from the Department of Health5 and the National Institute for Health and Care Excellence6 also emphasise the importance of physical activity promotion in primary care. GPs’ workloads are already ballooning; but with the right knowledge, skills, and support, prioritising physical activity could potentially have a positive impact on our patients health.7 Physical activity is as important as healthy lifestyle choices such as diet, smoking cessation, and sensible alcohol intake. It is estimated that physical inactivity is directly responsible for up to 10% of noncommunicable diseases and another 9% of premature mortalities.8 Daily physical activity totalling 150 minutes of moderate intensity or 75 minutes of vigorous intensity per week9 can help prevent many noncommunicable diseases: a 20–35% reduction in cardiovascular disease and premature mortality risk with a reduction in the risk of other diseases including type 2 diabetes (35–50%) and breast and colon cancer (20–50%) …

Feedback – what’s new?

Giving feedback is one of the most important things that a teacher can do for learners, but it is also one of the most challenging. For example, teachers often avoid providing corrective feedback for learners in the presence of patients or peers. Similarly, teachers dodge giving feedback in situations where they fear they might reduce learners’ sense of competence and self-efficacy. Yet without feedback poor practice continues unabated and patients may suffer.1

Biting off more than we can chew: is BMI the correct standard for bariatric surgery eligibility?

In the UK, the proportion of adults with obesity has been increasing significantly, with no signs of any reversal;1 this is despite the UK government ambitiously announcing in 2007 that England was to be the first country to reverse the trend in rising rates of obesity and the introduction of public health programmes such as Healthy Lives, Healthy People , and Change4Life . One reason why obesity has proved difficult to control is due to the limited impact of pharmacological interventions. Adverse effects such as valve disease and pulmonary hypertension (as a result of fenfluramine and dexfenfluramine treatment), psychiatric disorders (associated with rimonabant) and increased risk of myocardial infarcts or stroke (due to sibutramine) forced withdrawal of drugs by regulators or resulted in voluntary withdrawal by manufacturers. Of those drugs for obesity that remain, many are short-term and only give modest results (<4 kg weight loss) while only one (orlistat) is licensed for long-term management; all are associated with common and unpleasant side-effects.2 Bariatric surgery, whatever method is used, is superior to non-surgical techniques for the management of obesity.3 There are several types of bariatric surgery; restrictive procedures (such as sleeve gastrectomy and gastric banding) aim to produce satiety earlier, whereas bypass procedures (Roux-en-Y or biliopancreatic diversion with duodenal switch [BPDDS]) have both an element of restriction and malabsorption. In one systematic review comparing outcomes between procedures, the mean percentage excess weight loss (%EWL) was greatest for …