Author: Christopher

I'm a qualified clinical physiologist with a keen interest in free open access meducation (FOAMed), pacing and electrophysiology.

Synap: Beta Test Update

Synap is an upcoming revision tool that is driven by students. The platform enables students to create their own multiple choice questions and upload them, then download those created by others. It’s possible to “follow” other users, as you would someone on Twitter or, incidentally, this site (you can do that in the sidebar of this page…), and take any quiz that they have created. Image upload and basic editing is supported, so quizzes for physiology, such as ECG arrhythmia or echocardiography quizzes are more than possible, and are one of the reasons I decided to get involved with the whole thing. In addition, the app tracks your progress and structures your revision for you, based on your course and modules.

I’ve spent the last week or so beta testing the Synap web platform or, more specifically, I’ve been taking tests and creating basic ECG quizzes to help bug test and check functionality.

The platform, as I’ve mentioned, is currently in closed beta and only present on the web, so without having an app and a larger number of users I cannot comment on it fully, but as it stands, the processes involved in creating a profile and quiz are incredibly simple; adding and annotating images is a cinch, and a complete question only requires the user to add a correct answer and a few wrong ones. Whilst I encountered a few bugs initially, the feedback I provided was swiftly taken on board and the problems were remedied overnight. Taking quizzes is incredibly simple, and all you need to do is click “take quiz” (shockingly), then select your answers and have them marked. You can take these as many times as you like, too, and if the creator has provided any, feedback will be available for each individual question.

My only concern is the reliance on the quiz-maker supplying the correct information. I’ve taken a quiz wherein the correct answer was the only one that was possible to be correct (think “What has tusks and a trunk? 1) Elephant 2)Belephant 3)Your hamster”) yet I was still told my answer was wrong. This is a closed beta, though and that’s what these processes are for. I know it hasn’t escaped the attention of the developers, so we shall see how it is dealt with.

To break all of this down and show you what I know for sure so far, have a look at this (incomplete) features list:

  • MCQs:
    • Image/annotation upload
    • Correct answer & up to 5 incorrect
    • Optional feedback for test-taker
    • Optional link to external learning resource
    • Test result calculation
    • Obtainable achievements
    • Personalised revision quizzes sent to you
  • Community links based on:
    • Course/Discipline
    • Cohort
    • Institution

I’ll add to this list the more familiar I become with the platform.

Omair and James, its creators, and the rest of the Synap team hope that this app will enable students nationwide to help each other and revise together, and it’s a pleasure for me to be involved, even if it’s only in a small way, currently. I’ll continue to post updates as things progress.

For more info, visit @Synap on twitter.

Thanks

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Being A Patient: Part II

As with part one, the procedure itself will not be detailed, as it is not under discussion, currently. My experience as a patient will be the focus, so I will relate my experience back to those who you will be performing these tests on throughout your careers.

After part I, my legs- nay- my whole body ached, so I was looking forward to my echocardiography patient experience, as it would not only give me an idea as to my heart’s structural health, but also give me a bit of lie down…

Unlike those patients who have never undergone an echo procedure, I knew what to expect, as I had observed more than a few and have had a go at one before, but I was still apprehensive, given the required level of undress and the fact that I had never had one before. I had an idea that my heart was in fairly good condition, but you never know for sure until you have results so as you can imagine,  for a patient with a suspected pathology the time spent waiting for the test is a nerve-wracking experience.

Hearing people talk about what they can see on images of your heart that, due to the angle you are often required to lie and that of the monitor, you can’t see, isn’t wholly pleasant, so it was easy for me to further empathise with patients having the procedure themselves. In addition to this, the feeling of exposure is made worse by the positions one is required to remain in; my hips, shoulders and legs were uncomfortable to the point that they hurt after 20 or so minutes. Guidelines recommend that an echo procedure takes 45 minutes, and whilst a patient is supine for some of it, an elderly patient, or one with previous limb surgeries will likely find the scan more painful than I did, especially when required to roll onto their side.

There is an odd feeling of one’s personal space being invaded, as the practitioner has to reach across the patient’s trunk in order to reach the designated areas for scanning, which further adds to the discomfort.

These things combined, meant that my longed-for lie down, was not as relaxing as it could have been. Throw the anxiety that comes with a) being in a clinical setting, and b) awaiting a verdict on your heart health/ a pathology, and I can only imagine how much more uncomfortable an experience it is for patients.

My echo and stress test experiences have shown me that, even when procedures are at opposite ends of the patient participation scale*, patients have to endure a great deal of discomfort. Even though echo is physically non-invasive, it comes with a heap of emotional distress, so when you’re out on placement, just think about what your patients are going through.

If you’re having a bad day, remember that, even if their visit is routine, due to simply having to be there, your patient’s is probably worse.

*not an officially recognised scale

Thanks

Christopher

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Being A Patient: Part I

(or “what I learned when the tests I have done to others, were done to me”)

The tests presented in this post are intentionally not explained thoroughly here. I have focussed, currently, on patient experience. If you wish to learn more about the things presented here, and the interpretation of the possible results, wait for them to be explained in your lectures, or, perform a quick Google search.

Before the new semester began proper, I was asked to assist with some physiology practicals on my campus. I agreed because I felt (much in the same way a chef will sample his/her food before selling it to the masses) that it would be good for my overall learning to experience the same anxieties and physical exertions -if applicable- that a patient may endure when they undergo physiological testing. When one repeatedly performs tests day in, day out, it’s easy to forget that the patient likely does not have anywhere near the same levels of familiarity with the procedure and proficiency with them as that of you, the practitioner, so to gain an insight into the emotional and physical aspects from the other side would, I felt, be good practice.

Day one was one of a cardio nature, in that I performed lots of exercise tests at a physiologist’s disposal. (Some of these tests are reserved for respiratory physiologists, but if you’re studying and are not yet at the point of choosing which PTP pathway to follow, you’ll experience these, too).

I discovered upon entry, that I would be performing the following:

  • YMCA step test
  • Bleep test
  • Treadmill test: ramp protocol (similar to the Bruce Protocol)

The wait to enter the lab was, (obviously not the same in terms of anxiety levels, but regardless) akin to a patient’s wait to enter a clinic testing room; knowing that I was going to have to perform tests, but not knowing exactly what they were was rather nerve-jangling (especially considering my then-unknown weight gain after the obligatory food-filled, sedentary lifestyle commonly experienced over the festive break).

The real difficulties stemmed from trying to comprehend the techniques required for each test. Explaining, or writing about them is one thing, but actually doing them is another thing entirely.

The YMCA step test itself wasn’t particularly challenging, given that it only involved 3 minutes of steady box steps. The difficulty came in not influencing heart rate on recovery. Knowing that my HR was being documented every minute meant I kept looking at the oximeter, and as has been documented (a quick google search will give you confirmation of this), it is relatively easy to change your HR on command.

For a patient, this last point may not be of particular issue, given that they might not be particularly aware of the potential influence they can have on their HR, but I can easily see how repeatedly stepping onto and off of a box could be difficult task for a patient of advanced age.

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Bonus Clinical Perspective: In this test the Heart Rate Recovery and VO2 max doesn’t appear to be particularly accurate, when using normal values, especially when compared with the VO2 max displayed through the other tests, either. The values are based on age, as oppose to individual physiological characteristics, so assume a physical ideal that doesn’t necessarily transcend to real life.  

The bleep test wasn’t like ones I have previously attempted in the gym, or what have you; rather, it was more about timing, ensuring there were no stops. This involved slowing down so as to reach the end of the designated track in time with the beep, then speeding up to repeat, meaning that pacing yourself was a must. The resulting strain on my legs caused them to become incredibly painful, incredibly quickly..! (I’m aware that bleep test procedure differs between fitness centres, so forgive my whinging if you use this format regularly).

Encouraging a patient to exhaust themselves doing this test would take a great deal of commitment from both parties; I’m not particularly unfit, but I had nothing tangible to aim for, with regards to an end point, so with no time to “beat”, I didn’t have anything to work towards and as a result, I gave up after 10 or so minutes, despite the fact I could have carried on for a while longer.  For the average patient that would frequent clinics to perform this test, achieving maximal exertion may not be something that can be coaxed out of them, especially if they had already endured other tests in the same day.

Already I was beginning to understand the plight of the patient, when it comes to tests that require their full participation, and I still had the hardest one to come… I was not looking forward to the post-lunchbreak activities.

It turns out, the Ramp Protocol test was actually the most enjoyable of the day. Perhaps this was simply because I was growing used to being fatigued/dehydrated, or perhaps it was the setup of the test itself, but I could have happily continued running on the treadmill for a great deal longer than I did, time allowing.

The ramp protocol treadmill test involves the face mask setup presented in the pictures, and a steady speed and incline increase on the treadmill for as long as it takes for the patient to reach their VO2 max, but it is up to the patient when they stop. Unlike the bleep test, which involved travelling at an uncomfortably slow rate at times, the ramp protocol was a fairly rapid journey to a pace similar to that of a distance runner. It was far from comfortable, so would still require a great deal of coaxing and encouragement in order to get the patient to work hard to complete the test, but it was certainly more comfortable than the test that had preceded it.

The whole day not only reminded me of tests and theory that I had almost forgotten, but it really helped me to understand what a patient has to go through when they visit a hospital. The feelings and tests that I personally experienced were, on the whole, not pleasant, but I wanted to be there. For a patient, this will most likely not be the case. When your clinic list is seemingly never-ending and you don’t have time for restarts, it’s easy for the fact that patients don’t know the requirements and procedures as well as you might, to slip your mind, but thanks to this experience, it’s something that I’ll never forget, and I feel it solidifies a vital skill that students require to be able to operate efficiently and fairly: empathy.

Tomorrow brings a different kind of discomfort, in that I will be having my first echocardiogram. I’ll add that experience to part II

The ramp protocol will also get the full write up treatment, as it was by far the most complex and in addition, I have a detailed set of results.

Thanks for reading.

Christopher.

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Holiday-Only Arrhythmias

During the festive season, its easy to indulge in excess; too many sprouts, an increase in afternoon napping, festive drinks… You know the score. It isn’t all smiles and sunshine, though, as we shall see.

One particular result of all the festive excess relevant to cardiac professionals, has been reported across the globe, but particularly in Entirely Fictitious Primary Care Centres (EFPCCs); Bacardi Branch Blocks, or BacBBs

BacBBs are thought to affect the heart as a whole, but it can be seen that they have a particularly odd effect on the ventricles, and cause an odd, never-seen-in-real-life depolarisation wave on the ECG, that actually defies physics and medical science by going back in time!

Symptom sheets compared with the compiled ambulatory data have shown unanimously that BacBBs are present sporadically within sinus rhythms, but coincide with that one-drink-too-many during a family game of Monopoly (Mr Moneybags isn’t thought to be an underlying cause, so the activity isn’t seen as a risk factor).

Atrial activity stops altogether, presumably because the SA node just forgets what it’s doing, as it’s seen enough crepe paper hats and screwdriver sets fly from crackers to last it a lifetime.

After an episode of BacBB, sinus rhythm resumes, and the patient will return to whatever their festive-norm may be until the next instance.

This phenomenon seems to disappear entirely during the first couple of weeks of January, when normal working hours begin again, hence, I feel that it is triggered by the holidays themselves.

None of this is being researched, or is even disputed, because it is both totally false, and invented entirely by me.

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Bacardi Branch Block

  • Common holiday rhythm abnormality only found during the festive season, and even then, only in fictitious settings
  • HR between 80-120bpm
    • Depends entirely on board game leader-board position
  • No P waves
  • Abnormal ventricular action
    • Resembles upturned cocktail glass
  • Is thought to only contribute to familial tolerance levels during prolonged exposure to each other

 

HAPPY HOLIDAYS FROM EVERYONE AT THE STUDENT PHYSIOLOGIST!!

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The Art of Anatomy

Remember those  anatomy and physiology lectures that tortured you? Remember all that terminology that was relentlessly thrown at you for  hours every week? Remember the pop-quizzes? Remember wishing there was an easier way to store all the information you were given?

Of course you do.

A few institutions have employed a rather novel way of encouraging learning by doing, by combining art and anatomical learning. Cathal Breen of Analyse fame kindly sent me a copy of the University of Ulster’s journal outlining a study he was a part of, that brought the two disciplines together.

The study focuses on exactly what I outlined in the first paragraph: the difficulty in learning anatomical names and information via textbooks and lectures alone. Students from radiology and cardiac physiology formed groups and learned by painting anatomical structures on each other, using textbooks, presentations and spoken word.

By encouraging students and staff to engage in the teaching and learning process in this creative manner yielded incredibly positive results: student feedback referred to the sessions as “enjoyable”, “helpful” and “interesting”, citing the experience as one that makes things clearer, too. The study humorously points out that the first three statements are not things that have been used to describe A&P before (thanks to my own experience, I imagine this to be an indisputable fact).

Obviously, there may be issues with inhibition when it comes to each individual, so to get around this, painting onto clothing; t shirts, gloves etc, is an option. Lecturer participation is a must, so the whole thing seems to lend itself to full participation from everyone and bonding in a shared learning experience.

Students pointed out that this style of learning made them aware of discrepancies between actual anatomy and the pictures contained within the textbooks they used, and that gave them a better understanding of the internal geography present in the body. In recent years, the practice has been adopted by numerous institutions, and the twitter page @artandanatomy showcases some of the wonderful body-painted works of art that have cropped up across the globe.

So, what do you think? Would this be something you feel would make the learning process easier for you? Sound off in the comments below and let us know.

Ref:

Breen, C., Conway, S., Fleming, K.,. (2010) The Art of Teaching Anatomy – A Case Study. Perspectives on Pedagogy and Practice 1 (1), pp. 17-30.

Images courtesy of @artandanatomy 

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ECG Difficulties

I never considered just how difficult trace analysis could be. Don’t get me wrong; I knew it would be hard, I just didn’t fully appreciate quite how hard.

During lectures on specific arrhythmias, when ECGs are displayed, they generally contain the abnormalities that make up the subject matter so it doesn’t take long to come to the correct answer, but looking at a trace without any history or prompting as to the condition, is still overwhelming to me. So overwhelming, in fact, that I often feel like I’m falling short of the mark with regards to my learning as a whole. The TSP ECG section is as much for my benefit as it is for you guys, in that I’ve found analysing the ones selected for posting incredibly difficult.
No matter what answer I come to, there’s always the lingering worry that I’ve missed something.

How much is too much, with regards to analysing?

What’s a result of over-analyzing, and what’s accurate?

Textbook traces, whether clinical, or stylised, have been selected as the best possible example of the rhythms under scrutiny, so it stands to reason that they won’t exactly mimic those that will be encounered in the field. In my limited experience, clinical traces contain a great deal of variation and have thus far, rarely resembled anything you’d find in a book.

They have been difficult, yes, but they have also been possible. This will all become easier, with practice (I assume/hope), so I hope you all find the analysis quiz good practice, as it’s certainly proving to be that for me.

 

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Postgraduate Preceptorship

One of the SCST Annual Update sections most relevant to PTP students was based around postgraduate preceptorship. Delivered by Sophie Blackman, of Boston Scientific and the SCST, the talk went through the updates regarding the assessment and accreditation that a newly qualified physiologist can obtain, in conjunction with the council. Sophie stated that she has been quite heavily involved in the production of this framework, and proceeded to outline its intricacies.

The preceptorship programme is relevant to PTP students, because it is aimed specifically at us once we are “let loose”, as it were, into clinical practice. The SCST has received a great deal of feedback from around the country, pertaining to the varying levels at which new healthcare scientists are emerging from their academic study and also feedback from students themselves, on what they feel they need by way of support from the governing body. I for one, can appreciate this; I’m terrified of graduating. I’m confident in my own skills, thus far, and whilst I don’t think that fear will ever go away, I think it’s beneficial for newly qualified HCS to have someone outside of their department that can help them make that transition from student to professional. This nationwide initiative will help to provide this support for the individual, but will also ensure there is an equitable workforce in practice.

The programme itself is based around the individual, and is likely to take anywhere from six months, to two years, based on proficiency. Much like in your current degrees (if you’re a student), the programme features competencies and case based discussions, but in this case, they are undertaken as you perform a job at which you are already doing. Upon “qualification” (this may seem like an odd word to use, given the fact that the practitioner is already qualified, but bear with me…), the student will receive a certificate displaying their confidence in a particular discipline, and that can not only demonstrate a willingness on the practitioner’s part to be the best that they can be, but it will further cement that person’s knowledge and skills base to aid them in their position, thereby helping them, to a point, to leave the student role behind them.

The implication was that if you, as a new HSP, want to make that leap to the STP programme, or follow a different career framework, then this accreditation will assist in identifying your individual fortes, and allow you to perhaps see what pathway you would be best suited to.

The full texts relevant to students are given below:

Preceptorship Framework

Preceptorship guidance for HSPs

For more information, visit the SCST preceptorship page:

new_scst_logo

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