Freedom in Nature

The paper starts with the proposal that the cause of the apparent insolubility of the free-will problem are several popular but strongly metaphysical notions and hypotheses. To reduce the metaphysics, some ideas are borrowed from physics. A concept of event causality is discussed. The importance of Hume's Principle of Causality is stressed and his Principle of Causation is weakened. The key concept of the paper, the so-called relative freedom, is also suggested by physics. It is a kind of freedom that can be observed everywhere in nature. Turning to biology, incomplete knowledge is defined for all organisms. They cope with the problem by Popper's trial and error processes. One source of their success is the relative freedom of choice from the basic option ranges: mutations, motions and neural connections. Finally, the conjecture is adopted that communicability can be used as a criterion of consciousness and free will is defined as a conscious version of relative freedom. The resulting notion is logically self-consistent and it describes an observable phenomenon that agrees with our experience.Comment: Changes: Improved formulation, three references added; 22 pages, no figure. Comments are welcom

Analysis of ultrasound in teaching gross anatomy to medical students

Background: Ultrasound is used as a supplement in undergraduate anatomy teaching. Summary of work: Ultrasound was incorporated into practical session of upper/ lower limb natomy. Questionnaires were distributed to 30 first year graduate entry (A101) & 211 second year (A100) medical students and feedback analysed using chi-square test. Summary of results: The response rate was 60.2% (145/241). 78% of A101 and 63% of A100 students found the teaching useful/ essential. The graduate entry group had statistically significant positive responses for identifying bone (91.67% vs. 70%, p=0.02), vessels (91.67% vs. 54.4%, p=0.001) & nerves (45.83% vs. 12.60%, p=0.001), finding line diagram useful/essential (95% vs. 55.10%, p<0.001) and being able to translate most/ all of the structures on line diagram (61.90% vs. 36.61%, p=0.03) when compared with non-graduate group. Similar trend though not significant was obtained for identifying muscle (62.5% vs. 51.67%, p=0.33) & tendons (45.83% vs. 31.67%, p=0.18). Conclusions: Majority of students found ultrasound as a useful tool in anatomy teaching. The A101 group had better results probably because they are mature learners or had the advantage of having cross-sectional anatomy images with line diagrams. Take home message: Ultrasound could act as a useful adjunct in teaching anatomy to medical students

Anatomy teaching with portable ultrasound to medical students

Background: Medical students as future clinicians will apply their anatomy knowledge in medical imaging. There are various radiological resources available for the medical students to learn anatomy and contextualise it to the clinical setting. Ultrasound is a safe and non- invasive imaging procedure commonly used in clinical practice. This study aimed to use portable ultrasound and evaluate its impact as an adjunct to cadaveric anatomy teaching together with cross sectional anatomy images and line diagrams. Methods: Ultrasound teaching was incorporated into upper limb and lower limb anatomy practical dissecting room sessions. The number of medical students who participated was 121 students from the year 2008 - 2009 and 94 students from the year 2009- 2010. The students were divided into groups of 15-20. Initially ultrasound demonstration was carried out on a volunteer and then the students were given the opportunity to use the ultrasound and identify normal anatomical structures visualized on images. For the students in the year 2009- 2010, ultrasound teaching was supplemented with cross sectional anatomy images and line diagrams. Questionnaires were distributed with seven questions rated using four point Likert scale and free text. Qualitative data was analysed using 2- proportion Z test and Fischer's exact test. Results: The number of students in the 2009-2010 year group who were confident in interpreting ultrasound images increased significantly when compared to the 2008-2009 year group of students. The majority of students were able to identify structures like bone, muscles and blood vessels on ultrasound images. There was a significant increase in the number of students who found the ultrasound teaching useful and also those who regarded ultrasound to have improved understanding of anatomy considerably. Conclusions: Ultrasound acts as a useful adjunct to teach anatomy in a clinical context to medical students. The use of cross sectional anatomy images and line diagrams together can aid ultrasound image orientation of structures during these sessions. Early exposure to this imaging technology may prime students for later encounters with ultrasound during clinical practice

Role of ultrasound in teaching Anatomy to first/ second year medical students

Ultrasound demonstration of living anatomy has been used as asupplement in undergraduate cadaveric anatomy teaching toreinforce their anatomy knowledge and its importance in clinicalpractice. Ultrasound was incorporated into dissecting roomsession of upper/lower limb anatomy. Twenty-four first yeargraduate entry (A101) medical students and 121 second year(A100) medical students were included. A100 group weredemonstrated with/without line diagrams whereas A101 grouphad the benefit of cross-sectional anatomy images along with linediagrams. Questionnaires were distributed and qualitative datawas analysed using 2 proportion Z test and Fischer’s exact test.78% of A101 and 63% of A100 students found the teachinguseful/essential. A101 group had statistically significant positiveresponses for identifying bone (91.67% versus 70%, P = 0.02),vessels (91.67% versus 54.4%, P = 0.001) & nerves (45.83% versus12.60%, P = 0.001), finding line diagram useful/essential (95%versus 55.10%, P = 0.001) and being able to translate most/all ofthe structures on line diagram (61.90% versus 36.61%, P = 0.03)when compared with A100 group. Similar trend though notsignificant was obtained for identifying muscle (62.5% versus51.67%, P = 0.33) & tendons (45.83% versus 31.67%, P = 0.18).Majority of students found ultrasound as a useful tool inanatomy teaching. A101 group had better results probablybecause they had the advantage of having cross-sectional anat-omy images with line diagrams. Ultrasound could act as a usefuladjunct in teaching anatomy and its relevance to medicalstudents. It also enables them to develop skills in interpretingnormal ultrasound images/machine which they will encounter inclinical medicine

Role of Sim-Man in teaching clinical skills to preclinical medical students

Introduction: After a GMC report on Tomorrow’s Doctors (2003) was published, there has been more emphasis on clinical skills training in undergraduate medical education1. It is challenging for pre-clinical medical students to learn and develop clinical skills systematically, which are appropriate to working in a clinical environment. At Newcastle University Laerdal Sim-Man 3G, a high fidelity simulator, was used 1) To ascertain if Sim-man could be used as an adjunct to facilitate student’s ability to acquire clinical skills in their pre-clinical years by determining the effect of Sim-Man on the confidence levels and knowledge of pre-clinical medical students during clinical skills sessions. 2) To bridge the gap between the pre-clinical and clinical setting with an opportunity to experience differentiating between normal and abnormal signs. Methodology: 24 first year graduate entry (preclinical) medical students had previously been taught the generic clinical skill of chest examination on each other. They were divided into 2 groups (AC and BD). A pre-test was conducted where the students of both groups completed a questionnaire on knowledge and confidence (rated using a Likert scale from 1-5). Later half the students (AC group) performed chest examination on each other while the other half (BD group) used Sim-Man. Sim-Man was programmed to display abnormal signs in 4 clinical conditions based on their PBL case series. A mid-test was conducted. They then crossed over with students in AC group performing chest examination on Sim-Man while students in BD group examined each other. A post- test was carried out. Data was analyzed using Mann-Whitney test. Results: There was no difference in the test scores on knowledge questions between the two groups for pre-test and post test whereas the test scores increased significantly between the two groups for mid-test (p=0.002). A significant increase in the test scores was seen between pre-test and midtest for the BD group (p=0.01). There was a similar trend, which was not statistically significant between mid-test and post-test for the AC group (p=0.16) The mean confidence increased from pre to mid-test and then further in post-test for both groups. Their confidence increased significantly in differentiating between normal and abnormal signs [BD group, between pre-test and mid-test (2.3 to 3, p= 0.01) and AC group, between mid-test and post-test (2.8 to 3.6, p=0.01)]. Conclusion: This pilot study suggests that Sim-Man can be used as a valuable adjunct to increase knowledge and student self-confidence when acquiring clinical skills in the pre-clinical years. References: 1. Paskins Z, Kirkcaldy J, Allen M, Macdougall C, Fraser I, Peile D : Design, validation and dissemination of an undergraduate assessment tool using SimMan in simulated medical emergencies. Medical Teacher 2010, Jan 32(1): e12-e17

Self-enhancement: food for thought

Self-enhancement denotes a class of psychological phenomena that involve taking a tendentiously positive view of oneself. We distinguish between four levels of self-enhancement—an observed effect, an ongoing process, a personality trait, and an underlying motive—and then use these distinctions to organize the wealth of relevant research. Furthermore, to render these distinctions intuitive, we draw an extended analogy between self-enhancement and the phenomenon of eating. Among the topics we address are (a) manifestations of self-enhancement, both obvious and subtle, and rival interpretations; (b) experimentally documented dynamics of affirming and threatening the ego; and (c) primacy of self-enhancement, considered alongside other intrapsychic phenomena, and across different cultures. Self-enhancement, like eating, is a fundamental part of human nature