EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

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: http://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:

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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.

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2 responses to “Education, Instruction, PBL: Thinking about Trauma, Brains and Textbooks

  1. creaky15 September 9, 2008 at 3:39 PM

    Here is a parallel post from the blog “Not My Second Opinion”, written by a medical student, who describes events from Trauma call using a Sim-patient (Aug 22 2008 ) :
    http://notmysecondopinion.blogspot.com/2008/08/trauma-call.html

    Creaky

  2. Pingback: Clinical Tutorials, Teaching & Learning in Medicine: Krebs Cycle, with Singing | EBM and Clinical Support Librarians@UCHC

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