I don't remember the exact age of my son when started to focus more on reading. Ever since he was born I have tried to read to him, and as he became more of a little person and less of an animal (around 3-4 months?) the reading became more regular I think.
We are fortunate that we live within walking distance of a library, even though the hours aren't always convenient. I've made it a habit of having 5-10 books from the library at our house to supplement the usual books that he has had. I think that spending an hour a day of reading (not all at once) is the cornerstone of teaching to read. I pick out books about things I know he likes (any book about space, the moon). Sometimes he picks out books randomly but most of the time while we are there he is more interested in the blocks and puzzles they have.
I think teaching him the alphabet just happened by reading a lot of alphabet books and quizzing him on what the letters were. Around a year and a half I found that he liked it when I would open a word processor, crank up the font size to 80 or so and then let him press the buttons to make the letters appear on the screen. I could also sneak in a little learning by asking to press specific letters. Learning the sounds of the letters sort of just piggy backed on this with me asking him what sound each letter makes (either as we read an abc book or played the word processing game). I haven't really used any online programs or computer programs.
This week I got around to trying out the "Flesch Cards" (ie flash cards based on Larry Sanger's essay on reading, where he makes a pun out of a method endorsed by the author of Why Johnny Can't Read). My son hated it immediately, I was able to get through maybe 3-4 cards. Perhaps if I had introduced it earlier he would tolerate it more but I think it is just so much different than our current style of how we interact that it isn't going to work for us. Let's give it a couple more tries and see, otherwise I think I'll just stick to lots of reading with him and encouraging him to sound out the words.
Tuesday, December 29, 2015
Wednesday, December 9, 2015
Introduction to Case Reports
If you've never experienced a case report in person this will give you an overview of how they work.
A case report is a meeting, usually with a small to medium sized group that discusses a particular patient. These patient's are usually chosen because they either have an unusual disease, have an unusual presentation of a common disease, present a therapeutic challenge, or an ethical dilemma. The presentation is divided into several parts (based on how information about a patient is usually temporally collected and organized) to allow group discussion and further questioning. The following describes my experience during my residency which is probably similar to other places.
To begin with, the presenter will give a brief one-three sentence introduction to the patient, something like "This is a 51 year old gentleman who is coming into the hospital with two days of abdominal pain" or "This is a 30 year old woman transferred to our hospital after seven days of worsening rash". This will usually be followed by an overview of general questions you would ask every patient such as how long it has been going on for, where the symptom is located, etc... Sometimes, in the interest of developing the participants' history taking skills, all of the history and review of systems (ROS) will need to be teased out through questioning. For this to be particularly effective the presenter should also be asking the participants why they are asking certain questions, which will allow others to understand the reasoning behind certain lines of inquiry and how it can alter your differential diagnosis.
After the above back and forth to flesh out the HPI, the presenter will ask for initial differential diagnosis and why each one should be included. So now we have an embryonic differential floating out there and the fun will be in seeing how more information will change/narrow our thoughts.
Next, the presenter will fill in all (unless there is some obvious juicy tidbit vital to the case) of the past medical history, meds, family history. The social history should be fleshed out by the participants, as it is often a very useful source of information in complicated patients. Sometimes there will be another pause to go back to the differential diagnosis or it will wait until after the next section.
After this will come the physical exam, and usually all the basic exam is given away. If there are certain crucial exam findings that are beyond basic (basic usually defined as vital signs, general appearance, heart and lung sounds, abdomen, basic neuro exam, any obvious skin findings) these are withheld unless asked for by a participant. Again, a jump back to the differential will occur at this point.
Finally, basic labwork will be given (CBC w diff, BMP, LFTs) and participants can ask for more labwork (if available) as well as the imaging studies, biopsy results, etc... that may or may not have been done (and of course the presenter should be asking "why" to every request so that others can understand why certain things are done).
It should be mentioned that at any point people can go back and ask a question pertaining to a previous part (for example, you might want to ask about travel history after seeing the eosinophils on the CBC).
Finally, we get together for one last discussion of the differential and the diagnosis is revealed. There is usually some prepared learning from the presenter on the true diagnosis to cap it off (usually brief). Sometimes, lingering questions that would best be served with a literature search are collected and an email is sent out with the results.
That is the basic overview. The key to a good case presentation is participation and mutual respect. Nobody should be felt like they are being pimped or ridiculed for asking a question since the point of this is to bring everybody up to a higher level. Case reports are great because they teach the method of diagnosing and deductive reasoning (something not easily conveyed in books) as well as information on particular disease. If nobody feels comfortable asking a question that might make them look ignorant than everybody suffers.
In Summary:
Brief Intro --> HPI/ROS (fleshed out by questions) --> Initial differential diagnosis --> Past medical history, family history, meds, etc... (Social Hx fleshed out) --> Differential revisited --> physical exam --> differential revisited--> labs/images/ecgs/pathology (fleshed out by questions) --> differential revisited --> Diagnosis revealed --> Discussion
A case report is a meeting, usually with a small to medium sized group that discusses a particular patient. These patient's are usually chosen because they either have an unusual disease, have an unusual presentation of a common disease, present a therapeutic challenge, or an ethical dilemma. The presentation is divided into several parts (based on how information about a patient is usually temporally collected and organized) to allow group discussion and further questioning. The following describes my experience during my residency which is probably similar to other places.
To begin with, the presenter will give a brief one-three sentence introduction to the patient, something like "This is a 51 year old gentleman who is coming into the hospital with two days of abdominal pain" or "This is a 30 year old woman transferred to our hospital after seven days of worsening rash". This will usually be followed by an overview of general questions you would ask every patient such as how long it has been going on for, where the symptom is located, etc... Sometimes, in the interest of developing the participants' history taking skills, all of the history and review of systems (ROS) will need to be teased out through questioning. For this to be particularly effective the presenter should also be asking the participants why they are asking certain questions, which will allow others to understand the reasoning behind certain lines of inquiry and how it can alter your differential diagnosis.
After the above back and forth to flesh out the HPI, the presenter will ask for initial differential diagnosis and why each one should be included. So now we have an embryonic differential floating out there and the fun will be in seeing how more information will change/narrow our thoughts.
Next, the presenter will fill in all (unless there is some obvious juicy tidbit vital to the case) of the past medical history, meds, family history. The social history should be fleshed out by the participants, as it is often a very useful source of information in complicated patients. Sometimes there will be another pause to go back to the differential diagnosis or it will wait until after the next section.
After this will come the physical exam, and usually all the basic exam is given away. If there are certain crucial exam findings that are beyond basic (basic usually defined as vital signs, general appearance, heart and lung sounds, abdomen, basic neuro exam, any obvious skin findings) these are withheld unless asked for by a participant. Again, a jump back to the differential will occur at this point.
Finally, basic labwork will be given (CBC w diff, BMP, LFTs) and participants can ask for more labwork (if available) as well as the imaging studies, biopsy results, etc... that may or may not have been done (and of course the presenter should be asking "why" to every request so that others can understand why certain things are done).
It should be mentioned that at any point people can go back and ask a question pertaining to a previous part (for example, you might want to ask about travel history after seeing the eosinophils on the CBC).
Finally, we get together for one last discussion of the differential and the diagnosis is revealed. There is usually some prepared learning from the presenter on the true diagnosis to cap it off (usually brief). Sometimes, lingering questions that would best be served with a literature search are collected and an email is sent out with the results.
That is the basic overview. The key to a good case presentation is participation and mutual respect. Nobody should be felt like they are being pimped or ridiculed for asking a question since the point of this is to bring everybody up to a higher level. Case reports are great because they teach the method of diagnosing and deductive reasoning (something not easily conveyed in books) as well as information on particular disease. If nobody feels comfortable asking a question that might make them look ignorant than everybody suffers.
In Summary:
Brief Intro --> HPI/ROS (fleshed out by questions) --> Initial differential diagnosis --> Past medical history, family history, meds, etc... (Social Hx fleshed out) --> Differential revisited --> physical exam --> differential revisited--> labs/images/ecgs/pathology (fleshed out by questions) --> differential revisited --> Diagnosis revealed --> Discussion
On Teaching Reading
Because of the shift work of my job, I get to spend a lot of time as a stay at home dad. One of my goals has been to see how young I can teach my son to read. To achieve this, I have done a bit of researching on how to teach children to read, and it's interesting how difficult it is to find good information that has been vetted by experts without pernicious influence. If you just try to search "teach my child to read" you will have to wade through scores of companies trying to sell you something.
I did find the Department of Educations evidence based report, called the National Reading Panel which was request by Congress in 1997 to guide how one should go about teaching a child how to read (full report is 448 pages, which can be found here or there is am more reasonable summary here). There are probably other state and local level resources as well (and perhaps teacher union or groups) which I am not aware of. It's actually pretty sad how hard it is to find an entity that's acting (presumably) in the interest education rather than a commercial enterprise to make money. There were a lot of broken links on the government's websites. I haven't read the entire report, so although I am aware of the general overview, I'm not sure if there are a lot of details in how to teach reading in the most effective manner.
Personally, I just try to read to my son multiple times a day. Learning the alphabet was actually pretty easy (at one point we stopped because he couldn't say the three syllable letter "w", although he knew all the capitol letters, and most of the lower case ones). Next came teaching him the basic sounds of each letter, which wasn't that much harder (we haven't tried "sh", "th", etc... yet). Now I am at the point where I am trying to have him sound out words, but it is hard because he "memorizes" (often incorrectly), his books and just wants to say what he thinks the picture says rather than what the words actually say. I will post some of my own methods of teaching him in case it might help others.
I did find the Department of Educations evidence based report, called the National Reading Panel which was request by Congress in 1997 to guide how one should go about teaching a child how to read (full report is 448 pages, which can be found here or there is am more reasonable summary here). There are probably other state and local level resources as well (and perhaps teacher union or groups) which I am not aware of. It's actually pretty sad how hard it is to find an entity that's acting (presumably) in the interest education rather than a commercial enterprise to make money. There were a lot of broken links on the government's websites. I haven't read the entire report, so although I am aware of the general overview, I'm not sure if there are a lot of details in how to teach reading in the most effective manner.
Personally, I just try to read to my son multiple times a day. Learning the alphabet was actually pretty easy (at one point we stopped because he couldn't say the three syllable letter "w", although he knew all the capitol letters, and most of the lower case ones). Next came teaching him the basic sounds of each letter, which wasn't that much harder (we haven't tried "sh", "th", etc... yet). Now I am at the point where I am trying to have him sound out words, but it is hard because he "memorizes" (often incorrectly), his books and just wants to say what he thinks the picture says rather than what the words actually say. I will post some of my own methods of teaching him in case it might help others.
Friday, December 4, 2015
Online Participative Case Presentations
During my current time off, I have been working on a system to participate in case presentations online. Case presentations are a common way of sharing medical knowledge and are especially good for teaching the skill of making a differential diagnosis based on history taking and to lesser extant exam skills. They are also great in teaching how to efficiently rule in or out important differentials.
Currently, case reports are usually done in live situations at individual institutions. This can include "Grand Rounds", "Morbidity and Mortality" (AKA M&M), and "Morning Reports". More distributive methods include the NEJM's classic case report series and several other journals. To my knowledge there is no standard open source case report repository or system and that is what I'd like to work on.
In my experience, embryonic attempts at open case reports have been done with some success on reddit.com/r/medicine. However, several limitations exist. These include a need for outside links to show graphical information (such as radiology, ECGs), the lack of an efficient or elegant way for the presenter to update the entire group, and to a lesser extant the lack of real-time interaction.
I've been stewing on several ideas about how to best implement something. Creating my own website that would have all of the features i want (including a reddit-like meritocracy point system) was one plan, but it would require me to invest a lot of time into network programming. I have been looking to see if there are already platforms that might be co-opted for this and I think I may have found an answer with twitch.tv
Twitch.tv is a website that my brother introduced me to that was designed for people who enjoy watching other people play video games. I'm thinking that I could stream my desktop with a word processor for the case presentation (and images) and use the chatroom interface for the discussion. The downsides are the high bandwidth required which would limit participation from those who are practising in areas where high speed internet isn't available.
The other downside is the need for more buy in from participants (ie they need to be available for a specific time rather than with reddit they can post and leave). This is probably going to be the biggest hurdle and I think I will start by posting more case reports on r/medicine and see if I can drum up a group of like-minded practitioners who might be more willing to try this.
Currently, case reports are usually done in live situations at individual institutions. This can include "Grand Rounds", "Morbidity and Mortality" (AKA M&M), and "Morning Reports". More distributive methods include the NEJM's classic case report series and several other journals. To my knowledge there is no standard open source case report repository or system and that is what I'd like to work on.
In my experience, embryonic attempts at open case reports have been done with some success on reddit.com/r/medicine. However, several limitations exist. These include a need for outside links to show graphical information (such as radiology, ECGs), the lack of an efficient or elegant way for the presenter to update the entire group, and to a lesser extant the lack of real-time interaction.
I've been stewing on several ideas about how to best implement something. Creating my own website that would have all of the features i want (including a reddit-like meritocracy point system) was one plan, but it would require me to invest a lot of time into network programming. I have been looking to see if there are already platforms that might be co-opted for this and I think I may have found an answer with twitch.tv
Twitch.tv is a website that my brother introduced me to that was designed for people who enjoy watching other people play video games. I'm thinking that I could stream my desktop with a word processor for the case presentation (and images) and use the chatroom interface for the discussion. The downsides are the high bandwidth required which would limit participation from those who are practising in areas where high speed internet isn't available.
The other downside is the need for more buy in from participants (ie they need to be available for a specific time rather than with reddit they can post and leave). This is probably going to be the biggest hurdle and I think I will start by posting more case reports on r/medicine and see if I can drum up a group of like-minded practitioners who might be more willing to try this.
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