1) True learning is not about reading a lot of books, checking out many Tweetorials or listening to a lot of podcasts.

If that was so, everybody would have been 'successful' and not creating content about 'success'.
2) True learning is based on something I called the retention percentage --> the percentage of your knowledge that you can actually use in your day to day life.
3) I have applied this retention ratio to medicine since the day I started --> 10 years back in 2022.

Whatever you learn, until and unless you are comfortable with it --> that you can use it in day to day clinical practice --> you have not really learnt it.
4) For example --> let's talk about familial colorectal Ca syndromes like Lynch syndrome/FAP/Cowden/PJ etc etc.

Its okay to read about it.

Its more important to think about it when you see a patient with Ca colon!
5) If you think about it, you will read about it again maybe using POC guides like UpToDate --> this consolidates your knowledge!

This is real learning --> knowledge that goes beyond your hippocampus and into the neocortex.
6) The next time you see another patient with Ca colon --> these encoded memory pathways are strengthened again and maybe you get to diagnose a syndrome!

Your peers laud your skills --> but its just a different way of thinking!
7) Remember, that our cognition is like a searchlight!

If you don't think about something, you will always miss it!

So don't overload your brain with information, learn to what you already have!

Learn to focus the searchlight of cognition!
*learn to do with what you already have.

• • •

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More from @AdiG1993

Jul 17
1) The TB issue is huge in India because

1. TB can invade every organ system with a bewildering array of manifestations --> requires great diagnostic skills.

2. Dx methods like microscopy and even PCR often fail in case of paucibacillary disease.

3. Serology = useless
2)

4. The interaction between the TB bacillus and the immune system is complex.

Why some people can contain it within granuloma and why it spreads hematogenously in others --> this is not well known.

Research is less focused here since TB is not a First World problem.
3)
5. ATD is hepatotoxic (among others) and relies on the same 1st line drugs since the 1950s --> HIV appeared in 1981 but we already have more drugs than we can handle. PLHIV are now dying of ASCVD, like the gen popn!

Why?

Because HIV was a 1st world problem.
Read 6 tweets
Jul 16
1) Somebody just asked me about the management of scorpion bite --> something I have never dealt with before.

Apparently, they are divided by species and by presentation --> autonomic storm/neuromuscular toxicity or DIC!

India --> Mesobuthus spp --> autonomic storm!
2) How did I learn all this within 5 minutes?

UpTodate.

The single most important resource for internists everywhere.

I love textbooks, but this is the digital age.
3) Textbooks will help you with the deep diving but for POC medicine where time is of the essence and you need high fidelity, organized information --> you will need UpToDate.

Unpopular opinion and @stethospeaks may skewer may for this --> but this is what I stand by!
Read 4 tweets
Jul 11
1) Unpopular opinion here --> but something you should check out.

If you are planning on doing MD gen med residency, it might be worthwhile to do it somewhere with a relatively smaller subspecialty/gen med ratio.
2) A large and very well equipped subspecialty dept will usually directly admit all the unusual/teaching cases. Gen med can't do much here.

A smaller dept usually does not have enough staff to cover 24×7 on call and is less enthusiastic about situations like this.
3) So you get all the input that you need while managing to take care of patients directly.

This is very important --> you can't fire a rifle after placing it on someone else's shoulder.
Read 4 tweets
Jul 10
1) This is Kaiser Wilhelm II of Germany (1859-1941).

He strengthened the German Empire but his erratic personality and tactless behaviour antagonized the international community.

It is believed that his unstable foreign policy was one of the major reasons behind World War I.
2) He was born on the midnight of 26th Jan, 1859 and had an extremely traumatic birth.

You can read an extensive account through this link.

roadstothegreatwar-ww1.blogspot.com/2017/09/the-tr…
3) Long story short, his attending doctors were forced to operate within the confines of royal etiquette --> while dealing with a breech delivery --> with the patient under chloroform --> a relatively unknown substance.
Read 14 tweets
Jul 9
1) I was reading a bit of neurology today, for exams and general knowledge.

I have always maintained a lively interest in medical history and the development of this great profession of ours.
2) I was also influenced by the fact that we have a patient admitted at present, with generalized chorea under evaluation.

Common differentials have been ruled out but we haven't made the elusive diagnosis yet.

So a bit of reading was in order.
3) Neurogenetics is one such topic which has grown by leaps and bounds within the last few decades.

Clinical diagnoses of yesteryears can now be confirmed by genetic tests --> thanks to the work of certain stalwarts like Prof. Anita Harding.
Read 10 tweets
Jul 8
Since there are lots of MBBS students are asking me how to approach Harrison in UG,

Here is my approach -->

DON'T.

#MedTwitter
#Cardiotwitter
#NephTwitter
#NeuroTwitter
Etc etc
The latest Harrison is a giant encyclopedia of molecular data. Clinical medicine has been reduced to a bare minimum. I am talking about the 20th ed.
In fact, the Oxford Textbook of Med 6th ed is relatively better clinically but it comes in 4 giant volumes.
Read 4 tweets

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