Discover and read the best of Twitter Threads about #tweetorial

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This week’s #MedEd #Tweetorial will focus on #LearningStyles. Courtesy of my @uicdme coursework with @mededdoc

What are learning styles?
Is there evidence to support them?
Should we tailor our teaching (or learning) to them?

Let’s get started.
@uicdme @mededdoc 2/

What are learning styles?

This article by Pashler et al (…) defines learning styles as

“the view that different people learn information in different ways”
@uicdme @mededdoc 3/

To most of us, the concept of learning styles makes intuitive sense.

One popular model (by Dunn and Dunn) includes the concept of “modality preferences” where individuals prefer that information appeals to one of the senses: auditory, visual, tactile, or kinaesthetic.
Read 16 tweets
Have I ever told y’all how much I loooove to give #feedback?

Here’s why:
1. It adds meaning to my work in #MedEd.
2. It honors the learners and the patients.
3. It informs my final evaluations.
4. It improves the learning climate.
5. It's necessary.

*Shout out to #2.
I know lots of experts have written and presented great stuff on this. But if #medtwitter has taught me nothing else, it's that we can always add new ways to look at stuff.


So with that, here’s my practical approach to feedback on the wards and in clinic. Ready?
Okay, so 1st, let’s quickly revisit how feedback was defined in Ende’s classic paper:

“an informed, nonevaluative, objective appraisal of performance intended to improve clinical skills”  

(Ende J. Feedback in clinical medical education. JAMA. 1983;250:777–781)

Cool? Cool.
Read 22 tweets
This was a *CRAZY* busy week. I must have done 900 thoracenteses this week, so I had some questions about pleural effusions and their effect on dyspnea based on things I observed. Here are my take aways. #MedTwitter #MedEd #PulmCrit #FellowLife
1/ I felt like a hero - swooped in, did a thoracentesis, drained 1.5L... and her breathing didn't get better. I was like... 😕wtf. It turns out size of pleural effusion correlates poorly with dyspnea. This holds true for reduction in symptoms after thoracentesis.
2/ Did another thora, and his SpO2 was WORSE after. 😖I'm like... WHAT'S WRONG WITH ME? Things can actually worsen immediately after thoracentesis (even without mucking it up) for a few hours. Also, gas exchange issues DON'T correlate with the symptom of dyspnea!
Read 8 tweets
What is #cirrhosis?

This is for patients & anyone who has ever asked:

❓ What is it
❓ Where did it come from?
❓Why do I feel this way?
❓ Am I dying?

A #livertwitter #tweetorial
First, what is the liver, anyway?

1⃣It's Huge (but hides under your ribs on the right side)
2⃣It's a filter (processes everything u eat or drink)
3⃣It's a factory (makes a ton of stuff u need to live)
4⃣It's a warehouse (stores a ton of stuff…that u need 2 live)
What is liver disease?

Basically, it's liver inflammation (🔥)

👉 2 main parts of the liver can be🔥(Pic 1)
👉 Lots can🔥the liver (Pic 2)

The problem:
🔥+ time = ⬆️chance of #cirrhosis
Read 13 tweets
Have you ever wondered why patients in shock are refractory to vasopressor support if also severely acidotic?

I always assumed it was b/c cellular stuff just doesn't work well at low pH.

It turns out the answer is slightly more complicated...

#medtwitter #tweetorial
First we need to establish if acidosis actually leads to vasopressor resistance.

This was first described in 1927 in an experiment involving pithed cats:
- The researchers increased/decreased their respiratory rate to change serum pH
- Responses to vasopressors were measured
Lo and behold, the cats with a lower serum pH had diminished blood pressure responses to vasopressor injection (they used epinephrine).
Read 15 tweets
The #ICUROXtrial has been published today in @NEJM. The 1st author (and our #ICUROXtrial project manager extraordinaire) is @dianemackle…
This #tweetorial is to highlight what we did, what we found, what I think is means, & what next.
We enrolled 1000 mechanically ventilated adults who were anticipated to require ventilation in ICU beyond the calendar day after randomisation.
Read 27 tweets
Acute allergic-like reactions to intravascular iodinated contrast: Who's at risk and how do you reduce the risk?

A #TWEETORIAL for #radres and referring clinicians alike

Inspired by a recent paper in @Radiology_RSNA by Cha MJ, Kang DY, et al.… 1/40ish
@radiology_rsna First some background:

Which of the following is most likely to represent an allergic-like contrast reaction?
@radiology_rsna Not all acute adverse reactions to contrast are allergic-like. Allergic-like reactions include hives, pruritus, nasal congestion, wheezing, anaphylaxis. Reactions are subcategorized by severity.
Mild: self-limited
Moderate: commonly requiring treatment
Severe: life-threatening
Read 48 tweets

Hello everyone! I’ve been inspired by #MedEd colleague @JenniferSpicer4 to make my foray into #IDTwitter. I’m jumping right in with a #Tweetorial that combines my curiosity for the language of medicine and passion for powerful visuals and teaching about antibiotics!

I’ve always been intrigued by how we describe abx decisions – ‘narrow’, ‘broaden’, ‘expand’, ‘[de]escalate’, etc. For my UME micro course, I made a figure that captures this terminology and lets learners compare/contrast spectra of activity visually.

Let’s build it together.

Let’s start with a horizontal bar that represents the spectrum of clinically important bacteria. We will represent antibiotics above that spectrum with another horizontal bar.
Read 13 tweets
How do you enhance recovery before surgery? Let's talk about preoperative #optimization initiatives with goal of #prehabilitation! #EB4S 1/

#MedThread #Tweetorial
@aoglasser @TomVargheseJr @KurtPfeifer @afedwardMD @Docbasia @dremilym @tony_breu @ruthi_landau
1st, goal is optimization for everyone, but that may not be possible in your place. You want to risk stratify your patients. We use the NSQIP Surgical Risk Calculator, Gupta MICA Calculator, and the Duke Activity Status Index DASI. 2/
You can learn about risk stratification here:
Remember: it's not always just about the heart. Kidney, Lungs, Brain, etc. are at risk. 3/

Read 23 tweets
(1/12) #JACC #Tweetorial: #cvCAD in Young Adults: A Hard Lesson, but a Good Teacher
✔️#AFIJI Cohort 20 year-follow-up: @ActionCoeur
✔️ Editorial: by @ErinMichos and @AChoiHeart
@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC (2/12) #JACC #Tweetorial: The consequences of premature #cvCAD are devastating. Declines in ASCVD events have not extended to younger adults and rates have increased particularly among women 35-54 yrs old.

Arora, et al @CircAHA:
@ActionCoeur @ErinMichos @AChoiHeart @MichelZedBay @mathieukerneis @docjohanne @DrHulot_PARCC @CircAHA (3/12) #JACC #Tweetorial: In this issue Collet, JP, et al (@ActionCoeur) describe a cohort of 880 adults who experienced symptomatic #cvCAD at a young age (<45 years) presenting as obstructive CAD followed for up to 20 years.
Read 12 tweets
Today I'm going to do a #Tweetorial on non-resolving pneumonia (NRP)! These are a series of pearls on a prior #MorningReport case that I gave earlier this year. We are going to cover definitions, differential diagnosis/schema & workup of NRP #IDTwitter #PulmTwitter
So first off, what is non-resolving pneumonia (NRP)?

It is a bit vague, but it's a lack of resolution of symptoms or radiographic findings over an expected time period despite appropriate antibiotic treatment.
Let's separate this term from "recurrent PNA", which consists of multiple episodes with symptom free intervals & radiologic clearance (e.g. aspiration PNA).

We will avoid the topic of "what is a pneumonia anyway?"
Read 14 tweets
A #periopmedicine #tweetorial/#medthread

It’s that time of year again!
Sunday football?
ERAS applications?
Girl Scout cookies?
Well, yes…but for the purposes our discussion, it’s “COLD & FLU SEASON”

What do you do if a patient scheduled for surgery has a URI?

what is the theoretical concern?
That presenting for surgery, and the anesthetic management including intubation required to facilitate it, will lead to #perioperative complications if the patient has (or has recently had) an upper respiratory tract infection.

these concerns include the risk of periop pulmonary complications:
🔘respiratory failure
🔘airway hyperreactivity (during induction or emergence) ➡️laryngo/bronchospasm
🔘deeper infection like pneumonia

does this “biologic plausibility” translate into real-world events?

Read 23 tweets
After 12 yrs of waiting, and 5 years of development, the @atscommunity @IDSAInfo community-acquired pneumonia guidelines have come out…. I have been asked repeatedly for my take and it has taken a while to fully dig my teeth into everything w/ a #tweetorial
Minimize microbiology (no sputum/BC unless severe of MDRO Rx)
Don't base initial Rx on PCT
Don't use steroids
Macrolides for outpts ONLY if low resistance
Stop using "HCAP"
Severe CAP: BL+macrolide OR FQ
No routine F/U CXR
prepared by an ad hoc committee (15)
COI wasn't an exclusion; 2 members recused themselves because of ++ COI
M:F 10:5 (@geetamehta0)
Cauc 13, Hisp 2, Other 0 (@DrJRMarcelin)
ER 0, GIM 4, ID 3, Resp 7, Pharm 0 (@EMCases @Kerry_LaPlante)
0 patients (@SolidFooting)
Read 22 tweets

For this week’s #MedEd #tweetorial, I’m going to share one evidence-based learning principle we can use to improve our teaching (and learning) by helping our students (and us) retain information (and do well on those pesky board exams).

Let’s get started.

Typical classroom instruction involves listening to a lecture, studying content at home, & taking a test to show knowledge.

The problem: The “testing” part actually results in the best learning, yet students often don’t get the opportunity to review/discuss their answers.

Tests force us to retrieve information from our brain. This process of retrieval builds connections making it easier to access the info again.

Think of it as pulling a file out of a file cabinet; the more you do it, the more easily you remember the info & where to find it.
Read 21 tweets
Syphilis! RMSF! Hand-foot mouth!

Slow down there, Tiger! Let's dive deeper into:

ACRAL RASHES - a #tweetorial/#medthread
(aka rashes on the "palms and soles" - kind of 😉).

#MedEd #FOAMEd #medtwitter #dermtwitter #dermatology #dermatologia pc:@dermnetnz
No where else on the body does a rash evoke more of a knee-jerk differential. That's not wrong per se, as we all learn this in med school, but it's more complicated then starting doxycycline and checking an RPR!

Let's start with a definition - what does "acral" actually mean?
Technically, "acral" just means our distal body parts. So while we often think of palms and soles, it's actually inclusive of the whole hand, the whole foot, ears, and some include even the nose!

I actually didn't learn this until #derm residency, which was shocking to me.
Read 20 tweets
1/ Alright #medtwitter and #askrenal, in honor of our CJASN publication "Associations of Opioid Prescriptions with Death and Hospitalization across the Spectrum of Estimated GFR," I'm attempting my first #tweetorial. Here's what you need to know about opioids in CKD.
2/ First of all, pain is common for people with kidney disease because of vascular disease, diabetic neuropathy, and pain syndromes unique to kidney patients like osteodystrophy and calciphylaxis. In fact, an estimated 58% of people with advanced CKD experience pain.
3/ People with kidney disease have limited options for pain control. NSAIDs can lead to Na/K/H20 retention, AKI and CKD. Tylenol is okay, but never seems to work. As a result almost half of patients with advanced CKD are prescribed opioids.
Read 19 tweets
What are the Epidemiologic Signatures in Cancer? A new special report out in NEJM by Gil Welch, Barnett Kramer, and William Black is so good I had to do a #tweetorial.…
TL;DR -- The MAJOR takeaway doctors and trainees should get from this article is this:
Cancer incidence is an UNRELIABLE measure of cancer burden.
Using data from SEER, which essentially serves as the cancer registry of the United States, authors show trends in cancer mortality, incidence, and metastatic incidence between 1975 and 2015.
Read 29 tweets
Let's go back to the basics today, and talk about some #morphology in the #dermatology exam.

Today's #tweetorial/#medthread will be about evaluating....


#MedEd #FOAMEd #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
Before we get too far into it, how do we think about #scale? Meaning, which one of the following is it?
When we say "primary lesion," we mean the most basic element of a lesion/rash (papule, macule, patch, plaque etc).

SECONDARY CHANGE (which scale is) means the extra exam element that occurs on top of the primary lesion!

Tertiary/Quaternary isn't a thing. I'm just a jerk.
Read 15 tweets
A lines, B lines, Consolidation… the ABCs of Lung Ultrasound

But what do they really mean?

Here we attempt a #tweetorial presenting a way of thinking about common patterns seen on lung ultrasound.

See table here for a summary, and thread below for details


We will start with a hypothetical case for illustration
65 y/o f w HFpEF, COPD admitted 4 days ago with acute pancreatitis (now resolved). You are prepping her for discharge but she is now short of breath/hypoxic requiring 4 L O2.

Reportedly coughed a lot after dinner yesterday. Has not gotten any inhalers or antiHTN meds this hosp stay.
Net positive 4L. HR 88 SpO2 90% 4L BP 165/90 RR 22 T 99.8. WBC 22 (from 12 a day ago).
JVP not seen RRR, +S1/S2, 2/6 SEM
Bibasilar crackles, No LE edema. BNP 150.

Read 19 tweets
Good morning, #epitwitter!
I’m a co-author on @JessGeraldYoung’s new paper out now in Trials & I want to tell you all about it!

Do you use longitudinal data? Are your measurements often enough? Do you know what “often enough” is?

Time for a #tweetorial!…
If exposure happens once, then we only need to worry about confounders once too.

But if exposure can happen over time, so can confounding! & if exposure happens every day, so can confounding😰

But we usually don’t have data everyday. Is that bad? Classic epi answer: it depends!
How often do we need to measure our exposure and confounders to be able to adequately adjust for confounding?

We did a simulation study to find out!
Read 13 tweets
It’s #ClimateWeek2019 so I thought I’d create a #MedThread/#Tweetorial of Explore The Space podcast episodes focusing on #ClimateChange.
Please scroll through!
Episode 152 w/ @MichaelEMann
A smashing layout of the current state of #ClimateChange & our response w/tons of resources for us to communicate more effectively. Also a premium @BillNye name drop!
Episode 132 w/ @Jamie_Margolin @ThisIsZeroHour
“The Teenager” (h/t @maryheglar) is tenacious, motivated, and inspiring.
She’s also just getting started!
Read 9 tweets
1/#Tweetorial! The @Aaimonline Collab on Learning & Working Environment Optimization released a conceptual model to guide LWE improvement.

But how do you actually USE the model?

We suggest 3 simple applications for #meded at the front lines:…
2/One quick question before explaining our three proposed approaches. In your opinion, is there a difference between a “Definition” of a thing, and a “Model”? Poll below and feel free to explain your answer:
3/Merriam Webster defines “Definition” as “A statement of the meaning of a word” or “A statement expressing the essential nature of something.”

A definition is, by definition (ha), reductionist. The goal of a definition is clarity, sharp lines, exactitude, immutability.
Read 16 tweets
Our inaugural #tweetorial on #DangerousAnastomoses is READY for the #NeuroEndovascularFellows. We will discuss the HIGH YIELD POINTS.We hope this serves as a springboard for collaborative learning amongst NIR fellows. Please tweet interesting/classic cases. We hope you enjoy.
@AmeerEHassan @DanTonettiMD @DrJeremyStoneMD @svinsociety @SNISinfo @BrianHoward_MD @youngneuros @eytanraz @AshuPJadhav @shazamhussain (1/15)As a fellow, it’s crucial to understand the collateral circulation between the intracranial(IC)and extracranial(EC) territories, especially when we are embolizing for the first time to avoid complications such as embolic stroke or even cranial nerve palsies.
@AmeerEHassan @DanTonettiMD @DrJeremyStoneMD @svinsociety @SNISinfo @BrianHoward_MD @youngneuros @eytanraz @AshuPJadhav @shazamhussain (2/15)Always remember 3 main regions of potential anastomotic routes between the EC/IC arteries when you embolize or “CROP”:
1. (C)ervical (R)egion 2. (O)rbital 3.(P)etrocavernous.
Read 16 tweets
For my 1st #MedEd #Tweetorial, I’m going to discuss cognitive load theory and its implications for our teaching in the classroom & clinical setting.

Here’s a great reference for anyone interested in learning more from @AMEE_Online & @MedTeachJournal:…
@AMEE_Online @MedTeachJournal 1st, a definition:

Cognitive load = the amount of mental energy that it takes to learn new information or perform a task.

Cognitive load theory proposes that we have a limited amount of mental energy available, and optimizing it makes it easier for us to function.
@AMEE_Online @MedTeachJournal Cognitive load theory identifies 3 components of cognitive load:

1. Intrinsic load
2. Extraneous load
3. Germane load

These components can be altered to make a task easier or harder to perform.
Read 17 tweets

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