Flipping social determinants on its head: Medical student perspectives on the flipped classroom and simulated patients to teach social determinants of health.

BACKGROUND: Inequalities in healthcare are increasing. Engaging medical students to tackle this urgent challenge alongside clinical sciences can be demanding. This study examines medical student perceptions of a flipped approach to health inequalities co-designed by faculty and sixth-year students. INNOVATION: A flipped learning session was piloted for year 4 medical students combining an online lesson followed by a tutorial with a simulated patient. METHODS: A mixed-methods approach collected questionnaire data using 4-point Likert scales and free text answers. A semi-structured group interview was conducted with six voluntary participants. RESULTS: Two hundred and eighty-nine students completed questionnaires. 85% (n = 246) completed the online lesson. Students agreed the session helped their understanding of key concepts (mean 3.2), was improved by having an actor (mean = 3.6), and was enjoyable (mean = 3.2). Thematic analysis of qualitative questionnaire and interview data revealed three themes: engagement; structure; and attitudes towards social determinants of health. The simulation increased clinical relevance and students gained understanding of the impact of health inequalities upon individuals. CONCLUSIONS: This paper indicates flipped learning can increase clinical relevance and engagement in population health and person-centered care. Further work could assess changes in practice and attitudes of future doctors in tackling such global health challenges.

Bedside ultrasound--experience in a palliative care unit.

Little has been published on the use of imaging in palliative care. This paper discusses the use of 'in-house' ultrasound at the bedside in a specialist palliative care unit. The aim of this paper is to evaluate the potential uses of bedside ultrasound in the hospice population with consideration of length of stay and cost. A single operator scanned inpatients using ultrasound in the specialist palliative care unit. The majority of these scans were done to evaluate and mark complex ascites prior to paracentesis. Other indications included marking pleural fluid prior to chest drain insertion, evaluating renal appearances and imaging bladders. Scans were done in 40 patients over a 17-month period enabling subsequent successful paracentesis in 25. The reasons for other scans included renal failure, urinary obstruction and confirmation of clinical diagnosis of liver metastases. All scans were done on the day of admission. This paper provides an anecdotal experience in improving clinical care and convenience to patients and offers a potential tool for future evaluation as a bedside aid to clinical management. The results indicate a potential for a reduction in length of inpatient stay.

Differences in conicity in young adults of European and south Asian descent.

A survey of 320 (175 male, 155 female) 19 year-old medical students showed that male students of South Asian origin in the top tertile for body weight or body mass index had a significantly greater conicity index than European males in these top tertiles. This difference in conicity was not significant in the group as a whole, or when ethnic pairs were matched for body weight or body mass index. However, females of South Asian descent had a significantly higher conicity index than females of European descent irrespective of how the groups were compared. The trend towards higher conicity (i.e. abdominal obesity) in young Asians may help explain the higher incidence of diabetes and cardiovascular disease seen in elderly Asians living in the United Kingdom.