Inam Haq

Mobile Medical Education (MoMEd) - how mobile information resources contribute to learning for undergraduate clinical students - a mixed methods study

BackgroundMobile technology is increasingly being used by clinicians to access up-to-date information for patient care. These offer learning opportunities in the clinical setting for medical students but the underlying pedagogic theories are not clear. A conceptual framework is needed to understand these further. Our initial questions were how the medical students used the technology, how it enabled them to learn and what theoretical underpinning supported the learning.Methods387 medical students were provided with a personal digital assistant (PDA) loaded with medical resources for the duration of their clinical studies. Outcomes were assessed by a mixed-methods triangulation approach using qualitative and quantitative analysis of surveys, focus groups and usage tracking data.ResultsLearning occurred in context with timely access to key facts and through consolidation of knowledge via repetition. The PDA was an important addition to the learning ecology rather than a replacement. Contextual factors impacted on use both positively and negatively. Barriers included concerns of interrupting the clinical interaction and of negative responses from teachers and patients. Students preferred a future involving smartphone platforms.ConclusionsThis is the first study to describe the learning ecology and pedagogic basis behind the use of mobile learning technologies in a large cohort of undergraduate medical students in the clinical environment. We have developed a model for mobile learning in the clinical setting that shows how different theories contribute to its use taking into account positive and negative contextual factors.The lessons from this study are transferable internationally, to other health care professions and to the development of similar initiatives with newer technology such as smartphones or tablet computers.

Effect of ethnicity and gender on performance in undergraduate medical examinations

Objective  To assess the effect of ethnicity and gender on medical student examination performance.

Dynamic measurement of lumbar curvature using fibre-optic sensors

Dynamic continuous measurement of the curvature of the lumbar spine is technically difficult but could provide important information about the functions of the spine. A new measurement system using a ribbon of specifically modified fibre-optic sensors was attached to the back and used to dynamically measure lumbar surface curvature during flexion and lifting. Reliability of the collected data and comparison to a video-based system were investigated in thirteen participants for curvature of both the lower and whole lumbar spine. The coefficients of multiple correlation of repeated measurements of curvature-time curves were found to be high, 0.97-0.98, and all measurements were as reliable as data obtained by the video method (0.93-0.97). Root mean square error values were below 2.5° for the fibre-optic system. Reattachment reliability was found to be excellent (0.91-0.97) as were comparisons to a video-based method (0.84-0.95). It is concluded that the fibre-optic motion analysis system is capable of reliably measuring sagittal lumbar curvature across time and offers the ability to provide information regarding sequencing and relative motion between specific regions of the lumbar spine.

A novel approach to the clinical evaluation of differential kinematics of the lumbar spine

Clinical measurement of lumbar motion has traditionally been limited to range of motion (ROM). Despite this, deficits in angular velocities and accelerations are more pronounced compared to ROM in low back pain (LBP) sufferers. There is increasing interest in movement quality among manual therapists and therefore the ability to measure angular velocities and accelerations within the clinical environment is becoming increasingly important. The aims of this study were to (1) investigate the reliability of a clinic based inertial sensor system to measure ROM along with angular velocities and accelerations in low back pain sufferers; (2) introduce the feasibility and reliability of using the relationship between ROM and velocity to investigate movement trajectory and irregularity. Forty LBP sufferers completed three trials of spinal movements and lifting. The ROM curve was differentiated and double differentiated to yield angular velocities and accelerations. Repeated measures reliabilities were determined by comparisons of kinematic curves as well as peak values. ROM and angular velocity relationships were investigated for their use in describing the movement trajectory and irregularity. Results show excellent similarities of ROM and angular velocity curves and moderate-to-good similarities for angular acceleration curves. Peak value similarities were excellent with small error measurements for all variables. The quantification of ROM-angular velocity plots was reliable with small mean absolute differences in motion irregularity scores. Such a method was able to demonstrate differences in movement irregularity. This method provides clinicians with the ability to yield important additional movement related information including angular velocity, acceleration and movement irregularity.

Qualitative study of the impact of an authentic electronic portfolio in undergraduate medical education.

BackgroundPortfolios are increasingly used in undergraduate and postgraduate medical education. Four medical schools have collaborated with an established NHS electronic portfolio provider to develop and implement an authentic professional electronic portfolio for undergraduate students. We hypothesized that using an authentic portfolio would have significant advantages for students, particularly in familiarizing them with the tool many will continue to use for years after graduation. This paper describes the early evaluation of this undergraduate portfolio at two participating medical schools.MethodsTo gather data, a questionnaire survey with extensive free text comments was used at School 1, and three focus groups were held at School 2. This paper reports thematic analysis of students’ opinions expressed in the free text comments and focus groups.ResultsFive main themes, common across both schools were identified. These concerned the purpose, use and acceptability of the portfolio, advantages of and barriers to the use of the portfolio, and the impacts on both learning and professional identity.ConclusionsAn authentic portfolio mitigated some of the negative aspects of using a portfolio, and had a positive effect on students’ perception of themselves as becoming past of the profession. However, significant barriers to portfolio use remained, including a lack of understanding of the purpose of a portfolio and a perceived damaging effect on feedback.

Measuring the Response of Extrahepatic Symptoms and Quality of Life to Antiviral Treatment in Patients with Hepatitis C

Background. HCV infection is associated with musculoskeletal manifestations such as chronic widespread pain, sicca syndrome, polyarthritis, and a reduced HRQOL. Little data is available on the effect of treatment on these manifestations. This study measured changes in extrahepatic symptoms and HRQOL before and after antiviral treatment in a large UK patient cohort. Methods. 118 patients completed HQLQ and rheumatological questionnaires before and after treatment with pegylated interferon-α and ribavirin, with specific regard to chronic widespread pain, sicca syndrome, and sustained virological response. Results. There was significant improvement in HQLQ domains of physical functioning, physical disability, social functioning, limitations and health distress due to hepatitis, and general health. There was significant deterioration in domains of positive well-being, health distress, and mental health. There was a significant decline prevalence of CWP (26.3% versus 15.3%, P = 0.015). Sicca syndrome prevalence fell insignificantly (12.7% versus 11%). SVR was associated positively with all HRQOL changes and significantly with CWP remission. Conclusions. HCV antivirals significantly improve poor HRQOL scores and CWP. Before treatment, both were common, coassociated, and unaccounted for through mixed cryoglobulinemia alone. Although a role of the hepatitis C virus in CWP cannot be deduced by these results, symptomatic improvement via antiviral treatment exists for this subset of patients.

An exploratory study of the potential learning benefits for medical students in collaborative drawing: creativity, reflection and ‘critical looking’

BackgroundBuilding on a series of higher educational arts/medicine initiatives, an interdisciplinary drawing module themed on the human body was developed for both year 3 Craft students and year 3 Medicine degree students. This became the subject of a research project exploring how the collaborative approach to drawing adopted on this module impacted on the students’ learning. In this article, emphasis is given to issues thought to have most potential relevance to medical education.MethodsUsing an ethnographic research design, the methods adopted were: direct observation of all aspects of the module sessions, audio and video recordings and photographs of the sessions, the incorporation of a semi-structured discussion at the end of each session, and anonymous student questionnaires.ResultsA number of key themes emerged. The complex, phased and multi-sensory nature of the ‘critical looking’ skills developed through the drawing exercises was seen as of potential value in medical education, being proposed as analogous to processes involved in clinical examination and diagnosis. The experience of interdisciplinary collaborative drawing was significant to the students as a creative, participatory and responsive form of learning. The emphasis on the physical experience of drawing and the thematic use of the human body as drawing subject led to reflective discussions about bodily knowledge and understanding. There were indications that students had a meta-cognitive awareness of the learning shifts that had occurred and the sessions provoked constructive self-reflective explorations of pre-professional identity.ConclusionsThis preliminary study suggests, through the themes identified, that there may be potential learning outcomes for medical students in this model of interdisciplinary collaborative drawing of the human body. Further research is needed to explore their applicability and value to medical education. There is a need to explore in more depth the beliefs, motivations and learning styles of medical students opting for the module, the significance and weighting of different learning and teaching elements in the module and the impact of the learning on medical students in the immediate post-module phase.

An Investigation Into the Onset, Pattern, and Effects of Pain Relief on Lumbar Extensor Electromyography in People With Acute and Chronic Low Back Pain

OBJECTIVE The aim of this study was to use an experimental pain relief model to determine the effect of pain relief on lumbar muscle function in people with low back pain. METHODS A test-retest design was used with all data collection being completed within a therapy setting. Twenty people with acute and 20 with chronic low back pain were recruited from general practitioner and therapist referrals. Participants completed spinal movements and lifting. Electromyography (EMG) was used to measure the pattern of muscle activity, onset of muscle activation, and peak activation of bilateral lumbar multifidus and iliocostalis. Movements were investigated before and after pain relief, through the self-administration of oral analgesia. RESULTS Electromyography profiles and peak values were reliable across 3 trials, and EMG profiles correlated well with kinematic profiles. Specific EMG profiles were commonly associated with specific kinematic values, and on the whole, the EMG profiles were unaffected by pain relief. Muscle onset times and peak muscle amplitudes were not affected by pain relief in either acute or chronic low back pain. CONCLUSION This study showed that the EMG activities from the lumbar region, including lumbar multifidus and iliocostalis, are reliable, and specific EMG profiles are identifiable. Pain relief as achieved in this study did not affect the pattern of EMG activity, onset of muscle activation, or peak activation values.

Dynamic Lumbar Curvature Measurement in Acute and Chronic Low Back Pain Sufferers

OBJECTIVES (1) To determine the reliability of a novel fiber-optic method to dynamically measure lumbar curvature in low back pain (LBP) sufferers, and (2) to investigate the dynamic lumbar curvature in acute and chronic LBP sufferers. DESIGN Cross-sectional study. SETTING Physiotherapy clinic. PARTICIPANTS Acute (n=20) and chronic (n=20) LBP sufferers recruited from general practitioner and therapist referrals. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A fiber-optic device was used to measure curvature through time during flexion, lifting, and extension movements. Repeated-measures reliability for curvature-time curves was tested using coefficients of multiple correlation (CMCs) and root mean square error, and for peak curvature values intraclass correlation coefficients (ICCs) and mean absolute errors were used. Acute and chronic LBP groups were compared using peak curvatures and sequencing of curvature change. RESULTS The fiber-optic method was shown to be highly reliable in measuring both whole lumbar and lower lumbar curvature with CMC values >.81 and ICC values >.99. Chronic LBP sufferers displayed greater peak curvatures during flexion and lifting for the whole lumbar spine and lifting for the lower lumbar spine. The sequencing behavior demonstrated that the quartile of movement associated with the greatest curvature change was the second for flexion and lifting and first and second for extension across both groups. No significant differences in sequencing were demonstrated between the 2 groups. CONCLUSIONS This method is reliable for dynamic lumbar curvature measurement in back pain sufferers and is a viable option for clinicians. Acute LBP sufferers display less kyphosis during flexion and lifting. Sequencing of curvature change is similar across the 2 groups.

Pre-treatment waking cortisol response and vulnerability to interferon α induced depression

Depressive disorder is a common consequence of interferon α treatment. An understanding of the aetiological processes involved is evolving. HPA axis abnormalities are clearly described in community depressive disorder and represent vulnerability to depression development. We explored whether pre-treatment HPA axis abnormalities influence depression emergence during interferon α treatment. We examined waking HPA axis response via salivary cortisol sampling in 44 non-depressed, chronic hepatitis C infected patients due to commence standard interferon α treatment. Hamilton depression scales and the structured clinical interview for DSM-IV major depressive disorder status were administered monthly during treatment. Major depressive disorder developed in 26 of 44 subjects during interferon-α treatment. The pre-treatment waking cortisol response over 1h was significantly greater in the subsequent switch to depression group (F=4.23, p=0.046). The waking cortisol response pre-treatment with interferon α appears greater in those subsequently switching to depressive disorder during treatment. This waking response may join other vulnerability factors for depression emergence in this group. This model could prove a valuable tool in understanding non-iatrogenic depressive disorder in the general population and notably the role of cytokines.