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Inferior heel pain
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Dishan Singh, Shelain Patel, Karan Malhotra
This chapter aims to provide an overview on the various causes of inferior heel pain, the relevant anatomy, history and investigations, and the treatment options available. The structure of the chapter serves as a guide for the reader to develop their surgical sieve and apply this knowledge in their everyday orthopaedic practice.
Diagnostic strategy
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
Chai et al. developed a ‘compass medicine’, which is a diagnostic aid that uses a surgical sieve approach to help generate a differential diagnosis list. It helps the user structure their diagnostic thinking. Chai et al.’s recent study attempted to determine the effect of using such an aid on the diagnostic ability of medical students and showed positive results.10 However, this is an emerging field of research and there is much scope for further development of diagnostic aids and for research into their usefulness, especially in terms of their impact on reducing diagnostic error.
Otolaryngology
Published in Shelly Griffiths, Surgical Interviews: The Survival Guide, 2019
This can be very varied, from ENT emergencies to clinic scenarios. You will need to make sure your clinical knowledge is up to standard. As with all the questions, you need to develop a structured manner to answering. This is vitally important for the emergency scenarios. The assessors want to know you will be a safe registrar. A recommended approach is as per Advanced Life Support, Advanced Trauma and Life Support or Care of the Critically Ill Surgical Patient protocols, but this should just be a starting point. You have to address all the management and clinical issues that are required and, most important, make sure you ask for senior help early and as appropriate. Learning the classifications of relevant conditions and medications required, for example, is essential. For clinic scenarios again a similar methodical approach is required; using the surgical sieve will cover most bases.
Twelve tips for teaching neuroanatomy, from the medical students’ perspective
Published in Medical Teacher, 2023
Sanskrithi Sravanam, Chloë Jacklin, Eoghan McNelis, Kwan Wai Fung, Lucy Xu
We would recommend that when you teach from clinical cases, you initiate the discussion by asking the students: “Is it neurological? Where is the lesion? What is the lesion?”. These questions are arguably ordered from most to least challenging. In fact, the first question is almost certainly beyond the undergraduate level. Despite this, encouraging students to consider the possibility of a non-neurological aetiology will help to engage their minds. The third question is reasonably straight-forward, and students should be able to come up with differentials using the surgical sieve approach. Asking “Where is the lesion?” is of most interest and requires the student to draw together their knowledge of systems, decussations and how aspects of the anatomy are geographically related. Approaching the case from first principles may also aid them to think more intelligently when performing a focused neurological examination.
Developing expertise for uncertainty; do we rely on a baptism of fire, the mills of experience or could clinicians be trained?
Published in Education for Primary Care, 2018
Debrief [4] Doctors may struggle to distinguish between formal knowledge (‘this case showed how little I know about the diagnosis of skin disease’) from skills; in the latter example even if there are some knowledge gaps, a skin rash can be mapped to the ANALYSING quadrant and explored using the formal thinking skills belonging to that quadrant. For example, a ‘surgical sieve approach’ will narrow down the possibilities. Other formal clinical reasoning skills can be introduced in the Analysing quadrant. In reflecting on which skill is needed, we introduce the concept of metacognition; at times we need to think about how we are thinking about a problem, as well as thinking about the problem itself. For example, the skills needed to differentiate between ‘ruling in’ and ‘ruling out’ are different to the skills needed to explain a management plan to a patient. Changing to a better way of thinking can reduce the paralysis that uncertainty may bring.