Thursday, June 30, 2011

Wii fit plus, I think, is a great metaphor for balance in all aspects

This evening I was playing with the wii fit plus. I quite liked the concept of how using the balance board as a metaphor of issues around balancing the body, and possibly many other things in life. Besides interesting take on stretching exercises and its application in balance/vestibular rehabilitation or other aspects, fostering balance and depth of focus in concentration were two things that I found really remarkable playing with the wii.

I think one of the most remarkable aspect of the wii fit plus (at least the little that I played with it) was the way it integrated the sense of balance in a very physical and psychological sense, and perhaps in a personal way, although it did not seem to enhance or recommend that aspect. For example, the evaluation of an individual on the wii fit plus system starts with the player stepping on the balance board and doing some simple balancing exercises. This in itself can have other app(imp)lications, including balancing exercises and balancing diagnostic tests for vestibular nerve disorders or vestibular diagnostics and rehabilitation exercises. Although not much work has been done on using wii fit or the balance board as such for vestibular diagnostics, there seems to be quite a bit of interesting studies on using the wii or the balance board for vestibular rehabilitation as well as using for rehabilitation of older adults which is encouraging.

I played for about half an hour with the board and the system. This could be a good accompanying or supplementary tool for the actual workout or yoga sessions, but where it struck me was the beauty of this programme in fostering the sense of balance. The focus of the programme was in ensuring an optimum balance in posture, but also if one played games such as meditation (very simple game really, where one just sits on the balance board and focuses on a flickering candle flame and there are occassional distractions, if distracted the body shifts and this is captured by the software and the score gets lower; the idea is the stiller the body is, the better the balance and the higher the score). if you discount all of the scoring and game playing, the very fact that it makes one aware of the need for maintaining balance and equipoise is a significant thing. I’d be interested to see if people have generally researched this aspect of wii in fostering a sense of balance in almost every sense of the term: physical balance, mental poise, and concentration. At least it has impacted my thinking about striking a balance not just in the physical sense of the term.

I think using this device it is quite possible to develop earthquake simulations and adjustment exercises for a range of applications. This becomes relevant in the context of the city where I live in where people’s lives have been badly affected by earthquakes.

Saturday, June 4, 2011

summative vs formative assessments in the medical education curriculum

Formative assessments involve a lot of work for the instructor or the teacher (teach, then design the assessments, carefully evaluate each submission, respond to the student, take further questions, then answer them back and the process continues for some time), and the process continues. I do not doubt that this is the best way to go, and I really wish we had regular formative assessments in our medical college when I was studying. A possible problem wiht formative assessment as the only means of capturing student performance is that it does not give you a predictive validity as to how the student may perform down the line when the role of supervision is taken off. This, I think is a big advantage of the summative assessments, and if you add to it the low workload that it imposes on the tutor, no doubt it has enjoyed such a loyal following among educationists including us medics for a long time.

As I wrote, summative assessments are easy on the teacher/tutor/instructor, and hard on the student in the sense that the onus to do well is on the student now. In other words, you shift the responsibility to the student to show that the student has successfully assimilated all that was needed to learn, plus summative assessments when done well, provide a nice overall summary of the performance of the student to all concerned (ie, regulatory bodies, such as Medical Boards), plus, perhaps it has good predictive validity (I write perhaps only because I am yet to come across a convincing study on the predictive validity of the summative assessment usually offered at the boards exams say for example).

So, while formative assessments are great while the learning is happening, and keeps the learner and the tutor on track as to each other's goals and orientations towards the teaching and learning process, it can get too highly process focused.

Perhaps a combined assessment method blending the best practices of formative and summative assessments is the way to go, I think.

"There's a crack in everything, it's how the light gets in." (Leonard Cohen)

On Sat, Jun 4, 2011 at 11:48 PM, Rakesh Biswas <> wrote:
I agree. Summative assessments ( also called 'the exams') can be a real pain for educationists who follow a constructivist approach.

Formative assessment is the way to go for them ( and i am one of them although i am yet to be able to convince the powers that be to implement it).

Formative assessment that assess a candidate's performance on 'real life' work such as real 'experiences' be it in the lab bench or the bedside. Overall these can be easily collated and assessed ( also verified) if the candidate web logs them on his own on a daily basis.

Once we involve medical students in our 'professional' work so much so that it has the power to influence the outcome of our work ( be it in our laboratory results or our patient care) our assessment of these students is bound to be very real as well as smooth.

Also everyone who does an undergraduate degree in medicine deserves to do an MD clinical residency ( a cylindrical model as in US rather than the pyramid we have).

I wonder how many faculty in this list will agree?



On Sat, Jun 4, 2011 at 5:05 PM, Kaustav Bera <> wrote:

Hmm...guess so but somebody in the decision making body should take a call and eliminate these exams.
Arent there other ways to assess...

On 4 Jun 2011 17:03, "Rakesh Biswas" <> wrote:
> :-)
> All work may eventually seem to have some use in retrospect.
> On Sat, Jun 4, 2011 at 4:51 PM, Kaustav Bera <> wrote:
>> Stupid burden of exams and writing useless files...missed so many
>> mails...damn it all.
>> Sent from my iPad
>> On Jun 4, 2011, at 4:33 PM, Rakesh Biswas <> wrote:
>> Thought i would for learning purposes (mine) share my attempts to help this
>> patient. I had earlier forwarded his details with attachments and i know
>> opening them can be a deterrent ( email below the current). I had to do some
>> reading of the AHA guidelines on permanent pacemakers and some reflection to
>> collate this response. I hope my Bengali is alright and not too funny.
>> regards, rakesh
>> From: Rakesh Biswas < <>>

>> Date: Tue, May 31, 2011 at 9:17 PM
>> Apnar Holter ECG monitoring o apnar chithite dewa history porlaam.
>> Ami anuman korchi je Holter ECG newar samay apnar kono rokom agyan bodh
>> ebong aswasti hoyni. Tahole Holter ECG te ja change dekha jacche shetar
>> jonye hoyto pace maker nao lagano jete pare.
>> Kintu jehetu apnar aer aagei ekta loss of consciousness ( agyan hoye jawa)
>> hoyechilo ebong jehetu amara janina thik oi samai holter ECG nile ki pawa
>> jeto eta hote pare je sei samai apnar ECG ebong symptoms anujai apnake pace
>> maker lagano uchit hoye uthto.
>> Aekhone eta bola sambhab noi je apni pacemaker na lagale aer paraborti kale
>> apnar abar agyan hawar sambhabano koto ta, tabe hain eta abar howar ekta
>> sambhabona aache jaar jonye apnake sabdhane thakte habe ( Jemone aaguner
>> kaache na jawa, two wheeler na chora o satar avoid kora).
>> Aei anischoiyota theke mukti pawar ekta upai holo pacemaker laagiye newa
>> jeta nischit apnar heart take nijer set kora rhythm a chalito rakhbe.
>> Apnar daktar jehetu apnar bhalo chaan oi jonye uni suggest korechen apni
>> pace maker lagiye aei anishchoyota theke mukti paan. Kintu amar mote apni
>> jodi anischoyota ke face korte paren ebong uparukt sabdhanota abalamban
>> korte paren tahole hoyto etao hote pare je apnar are kono din emnitei
>> problem habe na ( jodio etar chance kom) athoba abar ghana ghana agyan hawa
>> dekha dile apni pace maker taratari lagate badhyo haben.
>> regards,
>> rakesh
>> From: Rakesh Biswas < <>>

>> Date: Wed, May 25, 2011 at 4:12 PM
>> Subject: Medical education (user driven learning) exercise: Clinical
>> problem solving this patient with one episode of syncope
>> To: <>
>> Dear Tabula Rasians,
>> <>

>> In continuation of our attempts to integrate medical education with
>> practice through 'real problems' emailed by 'real patients' i attach (after
>> having taken informed consent) this lengthy document from a patient with
>> syncope who needs to know if he HAS TO have the permanent pacemakeradvised by his physician based on the attached investigations and patient

>> history ( which is in a scanned hand written letter in Bengali).
>> Would be great if we could take time from our busy schedule to help this
>> patient. I guess what we need to look at are the AHA guidelines on permanent
>> pacemaker insertion in the context of this patient? regards, rakesh
>> PS: Perhaps if one of the Bengali students could translate the letter in
>> Bengali for our PCMS, Bhopal students in Tabula Rasa it would be very
>> helpful. I have the patient's informed consent to share this but the
>> attachments are too voluminous to upload in the facebook page. Also we would
>> need to crop them to remove identifiers. However we could upload the useful
>> data selectively to archive at a later date?( after removing the
>> identifiers...a lot of hard work though...its time to have a salaried
>> research assistant for this activity :-)). We also have a current debate
>> going on in the Oxford EBM list serv about pharma and device manufacturers
>> influencing patients and this case represents a sample where our verdict for
>> this patient can actually have a small impact on both the patient as well
>> the device manufacturer ( pace maker manufacturing company) and imagine how
>> the effect can magnify if we start doing this activity with more and more
>> patients and students ( by students i also mean physicians who are now
>> labeled consultants). I am copying this to a few medical educationists and
>> policy makers to have their inputs on both this learning methodology as well
>> as the case ( if they can take time out from their valuable schedule).

Wednesday, June 1, 2011

Why a school put up for sale is irritating to a sociologist

This is an excellent short piece on the difference between bureaucratic, professional and business ethics. Very readable.

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How Advancements in Neuroscience Will Influence the Law

This is an excellent commentary on future speculation and the role of neuroscience on law. Recommended. Got it from the Freakonomics blog.
How Advancements in Neuroscience Will Influence the Law
Published on Freakonomics | shared via feedly

Oh, my neck! Oh, my back!

Every day, legal decisions are made based on the pain, suffering, and anxiety people say they’re feeling, even though we have no objective way to measure them. So what if we could see inside people’s minds — not just to know what they’re feeling now, but what they’ve felt in the past too?


Advancements in neuroscience are already improving our ability to do so. A new article published in the Emory Law Journal (full version here) entitled “The Experiential Future of the Law,” by Brooklyn Law School professor Adam Kolber, looks at how these advancements will continue over the next 30 years (to the point of near mind-reading), and how they’ll inevitably lead to changes in the law.

Kolber’s central claim:

My central claim is that as new technologies emerge to better reveal people’s experiences, the law ought to do more to take these experiences into account. In tort and criminal law, we often ignore or downplay the importance of subjective experience. This is no surprise. During the hundreds of years in which these bodies of law developed, we had very poor methods of making inferences about the experiences of others. As we get better at measuring experiences, however, I make the normative claim that we ought to change fundamental aspects of the law to take better account of people’s experiences.

And a few choice paragraphs:

In 2006, researchers used fMRI to help assess the mental activity of a woman believed to be in a persistent vegetative state. When the woman was scanned and asked to imagine engaging in certain actions like playing tennis or navigating rooms in her house, her brain activity looked remarkably similar to the activity in healthy control subjects who imagined engaging in the same activities. One researcher declared that the study provides “knock-down, drag-out” evidence of the patient’s conscious experiences.

Researchers are trying to develop more accurate methods of detecting deception using brain imaging.    While many in the scientific community doubt that current brain-based methods of lie detection are sufficiently accurate and reliable to use in forensic contexts, that has stopped neither companies from marketing fMRI lie detection services to the public, nor litigants from trying to introduce such evidence in court.
Even if current lie detection technology is too inaccurate to rely on in court, we already have good reason to think about future uses of such technology. Given the substantial possibility that we will develop reasonably accurate lie detectors within the next thirty years, our current secretive behaviors have already become harder to hide. A person in the year 2011 who visits a strip club, cheats on his spouse, evades taxes, or murders someone can surely be asked thirty years later about his thoughts and conduct throughout the course of his life. The “look-back” potential of accurate lie detection reduces the probability that our current thoughts and behavior will remain secret in coming decades.