And just in case you like Iceland, Sigur Rós and drones, here is a video from Philip Bloom. Sit back.
A short video on epidermal biology with an emphasis on barrier function and irritant dermatitis.
A short video on urticaria and the biology of the mast cells
Here is number 3. My favourite bit of skin biology.
Here is video number 2 in the ‘clinical’ skin biology series.
I have been busy producing and updating some videos. Here is the first in a series on skin biology.
This story is not just about physical infrastructure but also about expertise and the relation between expertise and ‘practice’. It is tempting to imagine that certification is about a moment in time, but this is not how medicine or many other areas of high level skill work. The example of surgery is perhaps the easiest, but the same holds for specialties such as imaging, dermatology or histopathology, where perceptual skills are important. How may moles or melanomas you report a week is not the only determinant of competence, but it is a key variable once you pass the novice stage. You know more than you can say, but you only know what you know if you keep doing it every day. The concert pianist still practises his scales every day. BTW, at last, in terms of safe health care, people are beginning to focus once again on diagnostic ability — or lack of it. You cannot control costs or think seriously about medical errors without an obsession about diagnosis and the system wide factors that undermine it (The National Academy of Sciences report is here).
A new welcome video for our Edinburgh Medical School dermatology module. Judging by the gesticulation, I must have some Italian blood in me (or so somebody tells me).
Several weeks ago, I visited our Vet School, based in Roslin, a few miles outside Edinburgh. It was a beautiful blue sky day, and I was in awe of the beauty of the building and the environment for their students my colleagues had created. Earlier this week, I was talking to a colleague from another College (as in, Faculty) about student learning and how to square ‘experience’ with ‘learning’ (actually, when I typed this first, I omitted the ‘l’ from learning…). This absolutely inspiring video says something about both, and the failure of constraint, compliance, control, and contract. (If this week’s THE is to be believed, automated staff surveillance will be thrown into the mix, too. See “Peak indifference”: Cory Doctorow on surveillance in education. Who knows, next you will see popups all over your browser when you attempt to access your VLE because you haven’t given your course feedback responses…)
Oliver Sacks has died. I haven’t read any of his books for a long time, but I loved ‘Awakenings’, and ‘The man who mistook his wife for a hat’. I have never known what many brain people thought of him, but he was a link with the great age of medical description in my own subject in the 19th century. Others have said something similar before: you can learn more about the brain from n of 1 studies than from mega studies that are devoid of meaningful insight. To recognise the world, you have to imagine it first.
I wrote in an earlier post after reading some of his memoirs something about medical education:
When we choose students, so obsessed are we with the avoidance of risk, that we have forgotten that the best defence against whatever adversity the future might throw against us, is diversity.
I doubt if Sacks would have survived much of what we subject our students and you doctors to.
Much of what makes humans special is our visual system (as he says), but he had the wonderful voice to go with his approach, sounds that makes the telling of his stories all the more special.
This is up on my Vimeo page , as well. How to approach and think about pigmented lesions. #fOAmed.
This is another useful talk from HILT. One problem that bugs me with both undergraduate teaching and learning, and clinical expertise when you are qualified, is the dynamic between measures of competence at a defined time point, and the influence of exposure on the pattern of competence over time. People often assert that because you have some skill at timepoint X, that somehow ‘clinical exposure’ will maintain that skill over time ( I am not talking about revalidation here, simply because most accept as currently construed revalidation is not credible). However, keeping knowledge accessible is not just a function of formal learning, but a function of how often you encounter particular clinical problems. The dynamics are worth thinking about. To maintain competence for rare disorders, you must encounter them at a certain rate. However, it seems to me possible that ‘routine clinical practice’ may not allow enough encounters to allow this competence to be maintained at the rate that is required. [So, the rate required to maintain competence, is greater than the rate at which you might routinely encounter the problem]. This is of course why we might use simulation, or attend clinical meetings, or spend much of our life talking about ‘cases’. If you want high level competence, you have to control the ratio of mundane to advanced case-mix. This is one of the reasons you need a hierarchy, and why a consultant delivered service, is not compatible with high level clinical competence (yes, I am skipping over a formal proof, here!). Some of this is at least tangentially related to this video by Robert Bjork — he of desirable difficulty). It is not exactly the rugby training mantra of no gain without pain, but something cognate; and that our tacit yesteryear views of competence are being destroyed.
This is a talk by Richard Mayer, one of the doyens of multimedia learning, at a HILT meeting. I find much of his work thought provoking and, at the very least, he makes me question much of what I do. But I have lots of questions: issues about transference and generalisability of the data; the applicability of the principles to advanced or at least non-novice learners (as he admits); and how this all interacts with Bjork’s desirable difficulty and motivation. A good intro to the topic is the book edited by him, The Cambridge Handbook of Multimedia Learning, although he has written stuff specifically for a medical audience too . My most insightful moment has been to realise that much as our students complain about lack of feedback, it is the lack of systematic student -> teacher feedback that limits what I do. The ‘curse of knowledge’ looms large, but I am deeply antagonistic to the idea that you cannot substantially improve teaching at both the macro and the micro levels. And without being ‘trendy’.
BTW: German and most European hospitals tend to look cleaner than UK ones. And they wear white coats.
BB King has died. What a life.
“I was a regular hand when I was seven. I picked cotton. I drove tractors. Children grew up not thinking that this is what they must do. We thought this was the thing to do to help your family,” he said.
When the weather was bad and he couldn’t work in the cotton fields, he walked 10 miles to a one-room school before dropping out in the 10th grade.
I saw him just once, on a double bill with Miles Davis in Vienna, sometime in 86/87. Just listen: one note fills.
I like this because it shows how discovery should and can work, and how it all relies on a generosity of spirit (just as a reader must give an author some slack). Also because several years after, I was first shown a browser when I was visiting NIH, and I just didn’t ‘get it’. (music is a bit loud, but persist…)
Chantelle Winnie via the Guardian
Worth a view if you want to know a little bit more about where the UK may be going.
I really like this from Rhett Allain. Of course I don’t know whether it improves learning, but it screams at me as an example of how the dissemination of low cost technology can improve learning— when it is coupled with insight and domain expertise. More physics envy on my part, perhaps.