A surgical education: Joseph Queally on what surgical training can learning from music

It’s been a while since I posted anything on this blog, a longer while since I posted anything that wasn’t just a link to something else here, and an even while since I posted anything all that medical education related.

So here is Addrenbrookes orthopaedic surgeon Joseph Queally with an excellent piece on the BMJ site on what surgical training can learn from music. :

Anyone who has learnt a musical instrument knows that countless hours of practice are needed to achieve success. As a musician who has performed as an individual and as part of a group, I have spent many hours practicing before competitions and performances. It becomes apparent that how one practices is a skill in itself and the type or quality of practice is often more important than the quantity of practice. Ericsson formally described this phenomenon as deliberate practice after studying violinists in a music academy in Berlin. Rather than monotonous repetition of a skill or task, deliberate practice involves breaking the task up into chunks, identifying which ones need improvement, and performing focused practice on this chunk or task until a goal is achieved.

As a surgical educator, I can also see a role for deliberate practice in surgical training. As in music, complex tasks (e.g. percutaneous screw placement in fracture surgery) can be broken up into basic steps or “chunks,” such as image intensifier positioning, appropriate screw entry point identification, and trajectory planning. Trainees can then practice the steps they are deficient in under supervision. Here trainers provide critical feedback by identifying the troublesome parts of a technique that an individual trainee is struggling with. Simulation in particular can provide a safe environment for deliberate practice where trainees can practice tasks repeatedly without risk to patients.

Read the whole thing, as they say.

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Artificial hip as hood ornament

From Paula and Andrew’s Travels – a visit to Burghley House which is full of entertaining detail , especially this:

“Transgenerational Trauma – the Armenian Genocide Considered”

I have posted at times speculating as to the long term impact of collective traumas I may have a personal motivation for this. On my other blog I have often re-posted from the excellent blog of Adam deVille, Eastern Christian Books. On this blog deVille considers recent books relevant to the broad theme of Eastern Christianity – along with his own always perceptive and thought-provoking reflections.

He has a post on a recent book on transgenerational trauma and the Armenian Genocide:

To my mind one of the most important and far-reaching insights Freud first helped us to understand, and many analysts–as well as other psychologists, sociologists, historians, and churchmen–have deepened in the years after Freud (and in particular after the Holocaust) is the long-lasting nature of major trauma, and the very real ways in which something of those traumatic memories will shape later generations who did not experience the trauma directly.

In this instance, Eastern Christians have first-hand experience, starting in 1915 (though, of course, actually much earlier, given a centuries-long trail of blood and tears among Armenian Christians, subject to periodic mass slaughters under the Ottomans) with the Armenian, Assyrian, and Greek genocides. The first of these was the largest, and has attracted a good deal of attention in the last two decades. Now that a century and more has passed, and all survivors are dead, the memories and effects of the genocide are not, as a new book reminds us: Anthonie Holslag, The Transgenerational Consequences of the Armenian Genocide: Near the Foot of Mount Ararat (Palgrave Macmillan, 2018), 291pp.

About this book the publisher tells us:
This book brings together the Armenian Genocide process and its transgenerational outcome, which are often juxtaposed in existing scholarship, to ask how the Armenian Genocide is conceptualized and placed within diasporic communities. Taking a dual approach to answer this question, Anthonie Holslag studies the cultural expression of violence during the genocidal process itself, and in the aftermath for the victims. By using this approach, this book allows us to see comparatively how genocide in diasporic communities in the Netherlands, London and the US is encapsulated in an historic narrative. It paints a picture of the complexity of genocidal violence itself, but also in its transgenerational and non-spatial consequences, raising new questions of how violence can be perpetuated or interlocked with the discourse and narratives of the victims, and how the violence can be relived.

Vierordt’s Law and experimenting with time

Karl von Vierordt has a relatively short Wikipedia bio (compared, for instance, to this) for someone who pioneered the measurement of blood pressure, the measurement of lung function and – the activity that would link his name with a “law” for posterity, the experimental study of the time sense. Indeed, he seems to have been one of the first experimental psychologists.

vierordtk

This excellent set of slides gives an overview of Vierordt’s career and a very detailed discussion of the time experiments, their methodology, context, and implications. So what is Vierordt’s Law? As stated by Wearden in the talk:

the proposition that short intervals
of time are judged as longer than they are,
whereas long intervals are judged as
shorter, with an indifference point, where
intervals are judged correctly, somewhere
between the two

In 1868, Vierordt published Der Zeitsinn nach Versuchen
– “The Time Sense According to Experiments.” This was not the first study of time perception, but by had by far the most data. Wearden describes Vierordt’s experimental methodology:

The data collected in Der Zeitsinn come from
experimental studies in which Vierordt himself,
or sometimes his pupil Höring, was the sole
experimental participant
• Höring [Vierordt’s student] not only carried out time perception
studies to qualify for a medical degree, but his
thesis work has the oddity that Höring was the
participant and not the experimenter (who was
Vierordt)
• The data were derived from very extensive
experimentation, often involving hundreds of
experimental trials carried out over many days

Two taps (on a glass plate) define a target
time interval and the participant must
make a response so that the time between
the second tap and the response is equal
to the time between the two taps

A very full account of the Vierordt effect (perhaps a better term than “law”) is given in Wearden’s paper linked to above. Wearden has an intriguing conclusion:

A potential conclusion is that the Vierordt effects
shown in different tasks don’t actually have any
common cause, and that different processes are
responsible in the different cases

• Here, unusually, theoretical analysis seems to
suggest that things that look the same aren’t
really the same at all, a kind of theoretical
“disintegration” rather than the usual theoretical
“integration” of different phenomena within the
same theoretical framework


He ends with two points that should give pause to those who see the science of today as inherently superior to the science of the past:

You can see that this 19th. Century work, in spite
of some peculiarities, not only produced reliable
data, but also has posed some problems which
are unsolved (and, it seems, quite difficult to
solve) even today in the light of many recent
advances in our understanding of time
perception
• More generally, Vierordt seems to be a pioneer
of experimental Psychology who is unjustly
neglected….until now

Circadian Rhythms video from Oxford Nuffield Sleep & Circadian Neuroscience Institute

From here

“Sober Minds” Documentary Trailer

Sober Minds [2017] Short Documentary Trailer from Zimmerhands Films on Vimeo.

Sober Minds is an uplifting autobiographical documentary that showcases the beauty of urban wildlife through breathtaking photography and powerful anecdotes.

OFFICIAL SELECTIONS 2017

Flickers Rhode Island International Film Festival US (World Premiere)
Fingal Film & Arts Festival IRE (Irish Premiere)
DocUtah International Documentary Film Festival US.

Website: CharloJohnson.com/SoberMinds
Facebook: facebook.com/SoberMindsFilm

This trailer looks really interesting – even the trailer powerfully depicts the power of nature connection and suggests that nature can be a source of connection that more mainstream education (for instance) misses out on

Language recognition in the womb – Fetal rhythm-based language discrimination – study from NeuroReport

I have blogged before about on the tendency to grandiosity of neuroscience, or rather (very often) how the science media portray neuroscience. This phobia of neurohype is not the same as a suspicion of neuroscience. The ingenuity of the methodology of studies like this is staggering. I don’t have access via my usual library sources to recent issues of NeuroReport so I’m afraid that I can’t assess the study directly (in so far as as I am at a certain stage of clinical practice, and the consequent distance from what personal study of relevance I have done)

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Fetal rhythm-based language discrimination: a biomagnetometry study
Minai, Utakoa; Gustafson, Kathleenb; Fiorentino, Roberta; Jongman, Allarda; Sereno, Joana

Neuroreport: 5 July 2017 – Volume 28 – Issue 10 – p 561–564
Abstract

Using fetal biomagnetometry, this study measured changes in fetal heart rate to assess discrimination of two rhythmically different languages (English and Japanese). Two-minute passages in English and Japanese were read by the same female bilingual speaker. Twenty-four mother–fetus pairs (mean gestational age=35.5 weeks) participated. Fetal magnetocardiography was recorded while the participants were presented first with passage 1, a passage in English, and then, following an 18 min interval, with passage 2, either a different passage in English (English–English condition: N=12) or in Japanese (English–Japanese condition: N=12). The fetal magnetocardiogram was reconstructed following independent components analysis decomposition. The mean interbeat intervals were calculated for a 30 s baseline interval directly preceding each passage and for the first 30 s of each passage. We then subtracted the mean interbeat interval of the 30 s baseline interval from that of the first 30 s interval, yielding an interbeat interval change value for each passage. A significant interaction between condition and passage indicated that the English–Japanese condition elicited a more robust interbeat interval change for passage 2 (novelty phase) than for passage 1 (familiarity phase), reflecting a faster heart rate during passage 2, whereas the English–English condition did not. This effect indicates

that fetuses are sensitive to the change in language from English to Japanese. These findings provide the first evidence for fetal language discrimination as assessed by fetal biomagnetometry and support the hypothesis that rhythm constitutes a prenatally available building block in language acquisition.