Recently I was visited by a very good friend who had just returned from a long walk in the woods, and I asked her what she had observed. 'Nothing in particular,' she replied. I might have been incredulous had I not been accustomed to such responses, for long ago I became convinced that the seeing see little.

How was it possible, I asked myself, to walk for an hour through the woods and see nothing worthy of note? I who cannot see find hundreds of things to interest me through mere touch. I feel the delicate symmetry of a leaf. I pass my hands lovingly about the smooth skin of a silver birch, or the rough, shaggy bark of a pine. In spring I touch the branches of trees hopefully in search of a bud, the first sign of awakening Nature after her winter's sleep. I feel the delightful, velvety texture of a flower, and discover its remarkable convolutions; and something of the miracle of Nature is revealed to me.

-Helen Keller, Three Days to See (1933)
NB: Helen Keller was deaf-blind.

Wednesday, November 24, 2010

epidurals

whether or not you recommend an epidural, remember what really counts:
http://www.ncbi.nlm.nih.gov/pubmed/12011880

Saturday, November 20, 2010

Multiple Choice Question Strategies: Getting Them Right Even When You Don't Deserve To

It’s often said that those who get good grades in medical school (and in other disciplines) are not necessarily the ones who will make the best doctors. In fact, some go as far as to say that many who get below average grades are those who will excel in practise. I believe there is much truth to this.
Keywords: multiple choice test strategies, mcq, improve, grades
Unfortunately, though, nobody enjoys having grades floating around the 60s. So, in solidarity with all those who don’t think their grades reflect their knowledge, I’m writing this post to address one of the root causes of this: multiple choice testing. This is a compilation of a few multiple choice strategies that allow people who know them to do well despite mediocre understanding. Moreover, since profs subconsciously expect students to know and apply these, those who haven’t picked them up over the years can do more poorly than is reflective of their understanding. Hope you find them helpful!


Before you start

Remember that you are looking for the best answer, NOT one which must be entirely true all of the time, in all cases, and without exception.


When reading the question/stem

Look for grammatical clues. If the stem ends with the indefinite article "an," for example, then the correct response probably begins with a vowel.

Try to anticipate the correct response before you are distracted by seeing the options provided. Then uncover the responses and select the option that most closely matches your answer. Do NOT confuse this with the myth that your first answer is usually correct! Change your first answer when you are fairly sure of the correction, or when other cues in the test prompt you to change it.

Know if you are allowed to select more than one response per question/stem (e.g. Clinical Decision Making Questions). If so, select the maximum number of responses.


When considering the options

Question responses that are totally unfamiliar to you. Profs have no problem including terms/concepts that have never been discussed as long as they are part of INCORRECT responses.

You can often rule out responses that contain absolute terms like "always" or "never." Responses that contains generalizations like "usually" or "mostly" are more likely to be correct.

Look alike options: If they have different meanings (e.g. back pain, chest pain, abdominal pain), one is probably correct; if they have practically the same meaning (e.g. chest pain, torso pain), neither one can be correct.

When faced with double negatives consider the equivalent positive statement.

If two options are opposite (e.g. increases heart rate, decreases heart rate) one of them is probably correct.

Favour options that contain qualifiers (e.g. ...often presents with intense chest pain which radiates to the left arm or neck). The prof usually puts more effort (and words) into composing the correct answer.

If two alternatives seem correct, compare them for subtle differences and then refer back to the stem to find your best answer.

"All of the above" is often a correct response. If you suspect that more than one of the other responses is probably correct, then choose "All of the above."

"None of the above" is usually an incorrect response (used when the instructor has run out of ideas), but this is less reliable than the "All of the above" rule. Be very careful not to be fooled by double negative options when “None of the above” is also an option (e.g. ... rarely decrease blood pressure – this is probably the correct response but would have been taught as “usually increases blood pressure”).

Look for verbal associations. A response that repeats key words that are in the stem is likely to be correct.

If all else fails, choose b) or c). Many profs subconsciously feel that the correct answer is more "hidden" if it’s surrounded by distracters. Apparently, response a) is usually least likely to be the correct one.

Don't worry about the pattern of the answers. If you answer b) to four questions in a row, you might be right (especially when you consider the previous point).


A particular case:
Which are classic symptoms of lupus?
a) photosensitivity and acromegaly
b) angiomas and oral ulcers
c) oral ulcers and photosensitivity
d) photosensitivity and claudication

Profs like their answer to be ambiguous. In this sort of question with multiple elements in each response, profs achieve ambiguity by having one correct element and one incorrect element in each incorrect response. Since the correct elements also usually appear in the correct answer, elements that appear most often are most likely to be correct. In this case “photosensitivity” appears three times and “oral ulcers” appears twice, so the correct answer is probably “c”.


Applying the same logic to the following question:
Which of the following statements is most true with regards to Crohn’s?
a) it is an inflammatory disease that is worsened smoking.
b) it is worsened by smoking and has an increased incidence in Hispanics
c) it is an inflammatory disease that affects the ileum exclusively
d) it is a genetic disease that accounts for 60% of the global prevalence of constipation

“a” is most likely.


Finally:
Which is the proper sequence of events in mitosis?
a) 3-4-2-1
b) 3-2-4-1
c) 1-2-3-4
d) 2-3-4-1

Consider the most common position of each element (more correct positions means more ambiguity):
1 in 4th
2 in 2nd
3 in 1st
4 in 3rd
There’s your answer (b)! You didn’t even need to know that
3=prophase 2=metaphase 4=anaphase 1=telophase.

Another very special case:


The following are extra-articular disorders associated with rheumatoid arthritis, EXCEPT:
  1. glaucoma
  2. Felty's syndrome
  3. Caplan's syndrome
  4. Edward's syndrome
In this question, I believe the author is actually trying to test the student's pediatric/genetic knowledge. The student is expected to recognize that Edward's syndrome is trisomy 18 which is certainly not an extra-articular disorder, and is thus the correct answer. The student is not even expected to recognize all of the remaining options.



Wednesday, November 17, 2010

what's so special about Yaz (drospirenone)?

"CONCLUSIONS: Currently available oral contraceptives still have a major impact on thrombosis occurrence and many women do not use the safest brands with regard to risk of venous thrombosis."

Monday, November 8, 2010

tantalizing tropical trout

i wanted to make ceviche, but wasn't ready to "cook" fish in lime juice without any heat... this is what happened.

Place 2 trout/pink fish fillets onto enough aluminum foil to fold over.
Top with:
Dijon mustard
5 cloves of garlic, corsely chopped
1 fist of broccoli (cut stalk into thin slices and florets into chestnut-size pieces)
1 onion sliced into thin rounds
Fold over aluminum and cook on BBQ - careful not to OVERCOOK the fish.

Chop:
2 ripe tomatoes
1 cup of cilantro

Combine and add:
1/4 cup lemon juice
1/8 cup balsamic vinegar

Lots of ground pepper

Serve together on brown rice. With steamed kale?

Friday, November 5, 2010

55 words

The moment the dame walked in the door I knew she was trouble. Blood-red lips, smoldering eyes, legs from here to Cleveland.

I thought of telling her to scram, but she was my first customer all day. "Ma'am?"

"Coffee, hash browns," she said, settling into a booth. "And two eggs."


"Hard-boiled?" I asked hopefully.


"Scrambled."