Discover and read the best of Twitter Threads about #MedEd

Most recents (24)

HELP! I have a family member in Orange County, CA on a vent in critical condition for #COVID19. We are urgently seeking a person who has recovered from #coronavirus infxn w/ no symptoms in past 14d & able to donate plasma asap. Irvine/Tustin or LA area. DM me w/ leads. Pls RT.
Tweet #2: Thank you SO MUCH for your kindness! I'm getting many Qs, so answering them here for efficiency. People are asking what criteria they need to meet to donate plasma & which patients with #COVID19 can get plasma & how. See here: bit.ly/2WK2NT9.
Tweet #3: Others are asking if the donor has to be where the recipient is. The answer is no unless there is time urgency to get the product to the pt. Blood products are routinely collected at blood drives & shipped where the need is, but that does introduce a delay. #COVID19
Read 9 tweets
Short image tweetorial on thoracic ultrasound findings in pneumonia. #POCUS #IMPOCUS #FOAMed #FOAMus #Medtwitter #Meded #COVID19 @medpedshosp @cianmcdermott @msiuba @siddharth_dugar @grepmeded @NephroP @emresidents
Normal lung ultrasound. A-profile with thin pleural line with lung sliding. Linear transducer used.
Irregular pleural line with patchy B-lines. Seen in viral (including COVID19) and bacterial pneumonia. This patient had mycoplasma pneumonia. Linear probe used.
Read 11 tweets
Hello guys! Isn't it fascinating that one virus infected the whole world - 176 countries, 6 continents & almost 300 thousand confirmed cases now - through possibly just ONE initial patient?

A thread on Patient Zero.

#COVID19 #Coronaviruspandemic #Epidemiology
Patient zero is a term used to describe the first documented human infected by a viral or bacterial disease in an outbreak. 

#COVID19 #MedEd #Epidemiology
Advances in genetic analysis now make it possible to trace back the lineage of a virus through those it has infected.Combined with epidemiological studies, scientists can pinpoint individuals who may have been the first people to start spreading the disease #MolecularEpidemiology
Read 11 tweets
1/
La pandemia por #COVID19 está en boca de todos en estos días y todos deberíamos estar familiarizados con las medidas que se deben tomar
Cambiaré el enfoque de la cuenta por esta ocasión para desmenuzar una de las medidas más importantes

El lavado de manos 🧼🤲

Abro hilo:
2/
Se tocarán los siguientes puntos básicos que nos ayudarán a entender el tema:
- Virus vs bacterias
- Bases del coronavirus
- Jabón vs Gel "Antibacterial"
- El lavado de manos en si mismo

¿Cuál de los dos piensas que es mejor?
3/
Usualmente los hilos de esta cuenta están orientados para estudiantes/profesionales de la medicina, pero en esta ocasión, dada la situación actual, pretendo que la información sea accesible para la población general.

Ahora si, iniciamos!
Read 30 tweets
With med, nursing, & PA schools around the world switching to online learning, profs are scrambling to figure out the tech and create content.

But guess what?

There are a number of great YouTube channels that have been producing UME level content for years!

A quick list:

1/
Of course, I'll start with my channel, Strong Medicine.

IMHO, my particularly good videos include ECGs, CXRs, PFTs, EBM, shock, AKI, hematology, antiarrythmics, cardiac auscultation, H&P, and a series on how to approach specific symptoms.

youtube.com/channel/UCFq5v…

2/
A great resource for teaching the physical exam is produced by my awesome colleagues @StanfordMed25:

youtube.com/user/eozdalga

3/
Read 11 tweets
Increase use Telehealth as an during #COVID19pandemic Decided to share my 5 year experience as a TelePCP internist
Lessons learned from #telemedicine

✅Do not assume any demographic will love/hate it. Ask all patients/caregivers. You will be surprise. #ageisjustanumber
2/
✅Rapport via video takes less time compared to telephone. Look for visual cues of engagement.

✅How and where we present ourselves matter. If we are teleworking be mindful of your surrounding background should appear professional.
3/
✅Be on time. Depending on the service you use the link to the appointment might expire. Is up to you to keep track.

✅You might need to ask the pt/caregiver to reposition the camera or smartphone. Do not be afraid to ask.
Read 10 tweets
Hello guys!

Here's an important thread on the possible implications of a #COVID19 outbreak in Sri Lanka! Please read carefully and responsibly! 

#CoronaVirusOutbreak #FlattenTheCurve #lka
1) If you've been to a govt hospital, you'd know that most of our government hospitals are already running over capacity under NORMAL conditions. We have 2 patients per bed in wards & 100% occupancy in ICUs 365 days. 

#COVID19 #SriLanka
2) 20% of COVID19 patients will need hospitalization, 5% of patients will need ICU care and respiratory support, about 2.5% will need very intensive care to survive. 

#COVID19 #CornonavirusOutbreak
Read 15 tweets
A Friday #tweetorial #medthread about patient privacy on
#medtwitter #SoMe

There are many facets of patient privacy & professionalism concerns in this communal space—I’m going to focus on this through the
lens of case-based teaching

🧵
1/N
We know that #medtwitter & #SoMe enhance learning based on tenants of adult learning theory—this includes the microsimulation, mini-challenges, & active discussion of case-based learning.

However, how can we make this effective safe for our patients AND ourselves?

2/N
I want to introduce this concept—the term came to me a couple of weeks ago:

“POST THE PEARL, NOT THE PATIENT”

3/N
Read 25 tweets
Thanks #medtwitter #meded #nephpearls for answering this question! As suggested by the wisdom of the crowd, the correct answer is cyanide poisoning due to "vitamin B17." (Shout-out to @J_Corky who guessed early on). See tweetorial for discussion!
@J_Corky Wait, they didn't cover that in training? Vitamin B17 is not a vitamin - it's marketed as one, though, and used as alternative therapy for cancer and "general health." Some alternative rx is innocuous - vitamin B17 is not.
@J_Corky Let's call vitamin B17 what it is - amygdalin. Amygdalin is a compound found in Prunus species seeds - peach pits, apricot seeds, bitter almonds. See that -CN (cyano) moiety at the bottom of the structure? That's right - it is hydrolyzed by gastric acid to cyanide. 2/
Read 20 tweets
1//
Does knowing type of diabetes matter to clinicians and trainees

Yes, will try to explain why in this #tweetorial #medtwitter #MedEd #diabetes

Still hear residents/fellows start with 49 yo f with diabetes or insulin dependent diabetes or non insulin dependent diabetes...
2/
Type 1 diabetes: automimmune, usee to be called juvenile-onset or insulin dependent

Clearly need insulin at diagnosis

Typically lean, onset peaks during teenage years but can occur at later age..

Can check c-peptide with simultaneous glucose, GAD 65 Ab, IA2 Ab.
3/

LADA, latent autoimmune diabetes in adulthood

Often misclassified as type 2, think in non-obese with onset in 30s, 40s

Often started on oral glucose lowering medications, not controlled for very long... end up needing insulin

May have antibodies found in type 1
Read 9 tweets
#hapc call today, 6 new consults:
Avg pt age= 84
Avg # serious dx= 4
Most common dx: ES CHF, no tx option; ES Ca, no tx option; ES COPD, no tx option
Reason for consult: "Need you to talk about goals and EOL"

Me: So, have you started the convo?
Avg response: "Umm, not really"
1/
#medtwitter It's not easy to discuss late stage dx & end of life issues, but it's crucial. Patients & families deserve clear, honest, empathic info. We all need to know how to *at least* start the conversation. #PalliativeCare teams can help coach, or look for other resources
2/
And certainly at a tertiary care or teaching hospital, this should be hard-wired into the training. Make basic communication a required skill, like diagnosing PNA, placing a line, or running a code. #MedEd- we can, and must do better for our learners & our patients.
3/
Read 6 tweets
1/
#medtwitter is fairly comfortable managing “normal” DKA right? But how about in the anuric dialysis patient? The cookbook protocol can be deadly.

Read this #tweetorial to learn about how their DKA pathophysiology is fascinatingly different.

#meded #nephpearls #endotwitter
2/
Quick recap of normal DKA pathophysiology;

🔑 insulin requirement > insulin supply

✅ “stress hormones” rise
✅ blood glucose rises & because glucose is an osmotic diuretic, there is a huge, inappropriate urine output
✅ body makes ketones as alternative fuel, so pH falls
3/
Recap of normal DKA;

✅ patient symptomatic,extracellularly dry, 6 litres down & counting
✅ whole body K low due to osmotic diuresis, but often ⬆️K at first due to hypertonicity/ low insulin/ acidosis
- serum K then rapidly falls as INsulin drives K & glucose INtracellularly
Read 18 tweets
1/
I’ve been working on my #medtwitter elevator pitch. Mostly because lately I seem to have lots of fleeting conversations about it.

And I know I’m not alone.

Here's what I find:

Some are sold but nervous.
Some are intrigued but don’t get it.

And a lot are precontemplative.
2/
I think it’s because it can seem like all #medtwitter users look the same.

Them: “I would get on Twitter but I’m not a social media person.”
Me: “Twitter is different! Even if you don’t do social media!”
Them: 😐“Nah. Can’t see it.”

*ping*

Them: ✌️🏾

Elevator ride over.
3/
But I’ve been thinking about the many different #medtwitter identities there are. Most can find a fit nestled somewhere in 1 or a few of them.

What works for each person depends on a few things:

Who you are
What you hope to get from it
What’s going on in your life

Yup.
Read 22 tweets
DOI: doi.org/10.1016/j.ijca…

Drs @SukhNijjer, @jerd10 and @RicardoPetraco. What are your views on @DavidLBrownMD fallacies of FFR?

As a budding interventional cardiologist, I like to hear all opinions and sides to the story :)
“In conclusion, FFR in isolation is of no proven clinical value in the evaluation of patients with suspected ischemia. The ESC guidelines continue to promote an outdated paradigm for the evaluation of suspected ischemia that focuses on the focal epicardial stenosis.”
The 4 fallacies

1/4 - The first fallacy is the foundational premise of FFR that ischemia caused by a focal obstructive epicardial coronary stenosis is on the direct pathway to death or MI and therefore should be a target of revascularization
Read 7 tweets
1/12

A few years ago I became an attending and was struck by how hard it was to teach endoscopy. So I did a little #meded research with @GIMedEd and @BrighamGI to identify best practices.

Here’s what we found bit.ly/2SRtYYk

@AGA_CGH @AmerGastroAssn @BrighamBEI
@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 2/

We first developed 18 endoscopy teaching competencies that spanned the endoscopy teaching encounter. We further refined this list after interviews with experts in the field.
@GIMedEd @BrighamGI @AGA_CGH @AmerGastroAssn @BrighamBEI 3/

We then invited GI fellowship PDs and endoscopy education experts to participate in a Delphi process, which involves a series of survey rounds to help reach consensus amongst a group of experts.
Read 13 tweets
This week, the @NBMEnow announced that the USMLE Step 1 would be moving to P/F as early as 2022. Folks far smarter than I am like @jbcarmody and @BenMazer have had a lot to say about this seismic change in US #MedEd, but I wanted to offer some other thoughts on this. 1/
For those of you unfamiliar with medical education, Step 1 is a basic sciences exam often taken after the 2nd year of med school. It’s original (and really still, primary) purpose is to serve as one of 4 licensing exams to practice medicine in the US. 2/ en.wikipedia.org/wiki/USMLE_Ste…
The issues surrounding this exam are very well documented on @jbcarmody’s blog, thesheriffofsodium.com, and aren’t worth repeating at length here. 3/
Read 23 tweets
1/ Do you mentor or are you: a learner wanting to improve exam scores? Dx the reason for low test scores in today’s #MedEdMethodsMonday!

Inspired by @thecurbsiders ep193 featuring @Missydoc0128

#MedEd #MedThread #MedEdPearl #MedTweetorial #FacDev #Medtwitter #medstudenttwitter
2/ Self-Regulated Learning Microanalytic Assessment and Training (SRL-MAT) - a tool that can identify 6 test-taking problems, described by Dr. Andrews @williamkellymd @GenesseyFlint & Dr. Dezee from @USUhealthsci in @AcadMedJournal

tiny.cc/SRLtool
3/ The tool is used between a mentor & learner in a 60-min session.

The learner 1st reads & thinks aloud while going through a vignette appropriate for their level, with the actual question and answers covered.

They then talk through a Question Review Form:
Read 9 tweets
Thread: I am getting tons of msgs from fellows since a few recent talks at @hopkinskimmel, @SocTransOnc Fellows Forum, etc, + Twitter. I am happy to hear from all of you, esp the many people interested in #regulatory science. But many similar Qs, so here goes w/ resources!
@hopkinskimmel @SocTransOnc The #FDA_ASCOFellowsDay is a 1d workshop for #hematology & #oncology fellows in last yr (+ lim # of next to last yr) of training. It happens 2x/yr (fall & spring) on FDA campus in MD & 1x/yr at @ASCO Annual Mtg (1/2 day on Fri am). Applications for #ASCO20 one will open soon. 2/X
@hopkinskimmel @SocTransOnc @ASCO Our next one at the FDA campus is coming up on 3/10/20 (already full). This is a screenshot w/ high-level overview of it, and here's the link where you'll find application instructions for the next one once it opens in a few wks: asco.org/training-educa… 3/X
Read 9 tweets
1/ Thread

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome #MECFS

Is it really that bad?

Trigger warnings: The studies below paint a very bleak picture

#MyalgicE #SickNotWeak #pwME #MyalgicEncephalomyelitis #ChronicIllness #MedEd #MedTwitter #SickNotWeak
2/ Full recovery from #MECFS is rare

The median recovery rate from multiple published studies is 3-7%

(just 1 paper linked below)
#MyalgicE #SickNotWeak #pwME #MyalgicEncephalomyelitis #ChronicIllness #MedEd #MedTwitter
academic.oup.com/occmed/article…
3/ ~25% of #MECFS patients are housebound or bedbound.....

....sometimes for decades!

That means no work, no vacations, no social life, lost time, lost goals, lost relationships.....

journals.sagepub.com/doi/abs/10.117…
Read 11 tweets
1/ Time Management is today's #MedEdMethodsMonday #MedThread

As junior faculty & a #GIM fellow working on a #MedEd Masters, life is often a precarious juggling act. How do you stay on track in #academics?

#Medtwitter #MedEdPearl #FOAMed
2/ Components of Time Management
Gordon & Borkan’s lit review highlights 4 principles of time management tiny.cc/MedEdTime:

1. Set goals
2. Prioritize competing responsibilities
3. Plan & organize activities
4. Minimize wasted time
3/ Set Goals
- Set short- (1-3yr) & long-term (5-10yr) goals for your career
(see tiny.cc/MedEdGoals)
- Break long-term ends goals into bite-sized means goals
- Monitor past & current activities for goal compatibility
Read 11 tweets
1/ Let's differentiate pyogenic from amebic liver abscess in a #Tweetorial today. We will examine DDx, risk factors, microbiology, clinical features, diagnostics, and treatment. This came from my most recent morning report. #IDTwitter #LiverTwitter #MedEd
2/ Differential diagnosis for liver abscess:
Infectious etiologies predominate. Most are pyogenic (bacterial). Amebic (Entamoeba histolytica) and hydatid cyst (Echinococcus) important. Differentiate these from HCC or liver mets. @CPSolvers what am I missing?!
3/ Pathogenesis of pyogenic liver abscess (PLA):
- Biliary obstruction (GB, cancer) most commonly
- Surgical complication, trauma
- Portal vein pyemia from intra-abdominal infection (e.g. appendicitis)
- Hematogenous seeding (endocarditis)
- Cancer tx complication (RFA, TACE)
Read 27 tweets
Two days ago, someone called my son the ‘N’word. He was on the school bus. My son called me while I was leading a meeting for the residency program to tell me. He is 10 yo. The other boy is also 10. (This is a thread...)
I excused myself from the meeting to talk him through it. He was in tears. He was confused. The boy asked him, “what are you going to do if I call you the ‘N’ word, then proceeded to blurt it out.
After consoling my son I helped him create a plan of action with which he was comfortable. I hung up the phone and my eyes welled with tears.
Read 15 tweets
#meded #Thread @nelkassabany starts #AnesGR with his take home points:

➡️ Always think about adding value
➡️ Measure outcomes that matter to patients
➡️ Involve all stakeholders
➡️ Bust silos

#medthread #regionalanesthesia
#regionalanesthesia takes commitment!

@nelkassabany quotes @aboezaart1: "A block is not a one night stand..."
Developing a comprehensive enhanced recovery protocol means considering all phases of patient care. Patient education and engagement are key!

See free materials from @ASRA_Society here: asra.com/page/40/patien…
Read 10 tweets
1/
Hyperkalaemia treatment

KDIGO have just published their conference conclusions on managing acute #hyperkalaemia so I run through some learning points, some criticisms and the bits I’m not sure about as a renal reg.

#medtwitter #nephpearls #meded
2/
Before we start - why do we care?

Because hyperkalaemia associates with a large increase in risk of death in the next 24 hours.

☠️ mortality not necessarily caused by the hyperkalaemia itself, but can indicate that something bad is happening

ncbi.nlm.nih.gov/m/pubmed/19546…
3/
So, the KDIGO conference paper.

Firstly, no one can even agree on the definition of hyperK. What’s up with the Swiss? 4.5mmol/l as the upper limit of normal? Compare this with some values used in research papers.....!
Read 14 tweets

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