Education, Instruction, PBL: Thinking about Trauma, Brains and Textbooks

This post is about participating in problem-based learning. As a non-clinician, sometimes I’m at a loss informationally in PBL. There are eight medical students and one experienced physician in the room with me and – frankly speaking – a certain amount of the clinical material is over my head.

Much of what is covered in problem-based learning focuses on recognizing classic or emergency symptoms in a hypothetical patient, parsing etiology, past medical or family history, looking at evidence presented through physical exam, lab data, radiological images, occasional photographs. Each case unfolds over a two-week period; students are given several pages of the case and time to discuss the “patient’s chief complaint“, list data, formulate questions. During the following days, they do research using clinical sources, then create a narrative, concept map or bulleted problem-list to bring to the class the next week.

One standard schematic used to manage patient data is to organize it in the following way: What is the Nature of… , What is the Meaning of… , What is the Significance of… , What is the Relationship of… (or WIN-WIM-WIS-WIR)? A different script, created by a student several years ago is: Etiology, Findings, Pathogenesis, Treatments, Psychosocial considerations.

The utility of this information sorting/schema matters to graduate students in their first two years of medicine, when they are learning basic medical science, organ systems, human health over the lifespan in addition to spending one day per week assisting at the office of a community physician. Time spent in PBL is for learning to think like a clinician in a low-risk setting, and to create a foundation for recognizing illness patterns. (Thanks to Diedre B who created this page found on Medical Education Wiki).

This week I picked up a new textbook from the New Book Shelf, titled Trauma Anesthesia, edited by Charles E. Smith (Cambridge University Press, 2008 ) and began reading through the chapters. This 606-page text is a gold-mine of technical information, evidence-based flowcharts, tables, dozens of photos and patient radiographs, and the strong point of the book is discussing typical presentations in trauma. I wasn’t aware that unintentional injury is the leading cause of death in U.S. for those under the age 45, that in 2002, 162,000 deaths were recorded due to traumatic injuries and the cost of medical treatments for treating these injuries total $200,000,000,000 each year (Source: MMWR, 2004:53:1-4). Trauma can be sustained in many ways… mechanical, chemical, thermal, radioactive or biological insults to the human body.

But a comatose patient can’t answer the question: “What brought you in today? Maybe that is one of the attractions about choosing emergency medicine: the adrenaline of in-coming, when the physician has to make the call in limited time and with information that is only partially forthcoming. This textbook, and books like it, provide the technical framework for making that call.

For example, the chapter on Head Trauma refers to the Brain Trauma Foundation where the following statistics about traumatic brain injuries were found:

Photo Image/Credit: www.braintrauma.org

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I recommend this textbook. Below is a brief list of related Trauma websites which may be useful for medical students or others interested in critical care teaching/learning links:

• Trauma.org – A truly multipurpose site, there are a variety of tutorials and quizzes on Trauma & Critical Care Medicine. Try out their list of Moulage (“practice scenarios”). If you mess up the clinical decision-making and the virtual patient dies, you’ll get critical, sarcastic comments from the virtual preceptor.
• Primary Trauma Care (UK) provides a 32-page PDF manual on Primary Trauma Care (2000)
• SafetyLit.org – Injury Prevention Resources and Sources of Statistics
• ACLS.net - Advanced Cardiac Life Support site has several algorithms and interactive quizzes
• For radiological images, visit RadRounds and Learning Radiology
  
• Society of Critical Care Medicine
• CDC – Dept of Emergency Preparedness and CDC Clinician Outreach & Communication Activity
• American College of Emergency Physicians where I found links to EMS & Disaster Preparedness teaching materials (in English and Spanish languages).
  
• National Guidelines Clearinghouse – Index by Topic
• Pre-Hospital Trauma Guidelines (2001) a free 36 page PDF document from State of Alaska-Department of Community Health & EMS
  
• For Health Center students and personnel, UCHC Library subscribes to CardioSource and AccessMedicine and an e-textbook, Atlas of Emergency Medicine and other subscription databases and journals about Trauma and Critical Care.
  

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Okay, so I will never be able to concept-map the Krebs cycle…

Image credit: http://wikipedia.org

… but I can show you several ways to search Medline effectively. I’m great at that.