Tag: teaching

#MSCOVID19 & education: changing the way we manage MS one young brain at a time

Barts-MS rose-tinted-odometer: ★★★★★

At Barts-MS we spend a lot of time teaching people about MS. It is not only important to generate new information (ideas, testable hypotheses and research), but also to disseminate knowledge (teaching). However, with the COVID-19 pandemic and the resultant social distancing, almost all teaching has gone online and that does not make for very engaging and interesting. Most of us are webinar-ed or Zoomed-out. I wrote a piece on Medium that I titled Zoomed-Out addressing this exact point. 

Can we make teaching the next generation of potential MSologists more interesting? I think we can. The following is an example of case-based teaching we are trying out at our first MS Academy Basecamp in a few week’s time. Let’s hope it works and it encourages more junior doctors, nurses, therapists and other allied HCPs to plan a career in multiple sclerosis. 

Scenario 1: You are called to see a case with double-vision due to an internuclear ophthalmoplegia (INO) in casualty and an abnormal MRI suggestive of MS.

  1. How are you going to confirm the location of the lesion?
  2. How do you diagnose MS?
  3. What MS mimics do you need to exclude?
  4. How do you profile the patient’s prognosis at baseline?
  5. Is the patient eligible for DMTs?
  6. How do you de-risk the DMTs?

Scenario 2:  Your consultant asks you to see a young woman of 26 with her partner. She is coming for a scheduled follow-up appointment after a diagnostic work-up for MS. The consultant tells you she has MS.

  1. How are you going to confirm the diagnosis of MS before seeing her?
  2. How are you going to tell her the diagnosis?
  3. How are you going to counsel her about her future disease course?
  4. She asks if she can have a family. What are you going to tell her?
  5. What is active MS, highly active MS and rapidly evolving severe MS?
  6. What is the difference between maintenance-escalation and immune reconstitution therapies? How are you to explain the difference to them between these two treatment options? 

Scenario 3:  You are asked to do an MS follow-up clinic for your consultant neurologist? 

  1. How are you going to prepare for the clinic?
  2. What information are you going to record in the medical notes?
  3. How are you going to investigate and manage an MS-bladder?
  4. How do you manage MS-related fatigue?
  5. Should you routinely screen for and manage MS-related cognitive impairment?

Scenario 4: You attend your departments, MS Research Day, for patients with MS and are asked to prepare a teaching session for the attendees.

  1. How do you explain the cause of MS to the attendees?
  2. What are the latest treatments available for progressive MS?
  3. A woman attendee asks you about the risks of her children getting MS. What do you tell her?
  4. An attendee asks about stem cell therapy; how are you going to counsel her? 

What would you want us to teach the next generation of MSologists and how? 

CoI: multiple

Twitter: @gavinGiovannoni  Medium: @gavin_24211

The next generation

Training the next generation of MSologists is one of my priorities.

I helped arrange and teach on the Pan-London Calman Specialist Registrar (SpR) teaching day yesterday. It was great to see so many young trainee neurologists attending; thank you. And to the speakers for giving up their time to teach and inspire the next generation of neurologists to become MSologists; thank you.

I hope you all enjoyed the day the following is the programme.

Neuro-Calman-MS-programme-16th-Jan-2019-gg3

I was impressed by the level of engagement of the audience. I was particularly happy with an insight from one of the trainees who suggested we should be managing MS they way rheumatologists manage RA; i.e. early and aggressively. This was music to my ears. I have been pushing the treat-2-target RA paradigm for MS for several years now. The only difference is that our treatment targets have gradually become more ambitious as we have moved from NEDA-1 (relapses) to NEDA-3 (MRI activity) to preventing end-organ damage as measured with MRI (normalising the rate of brain volume loss or NEDA-4) and normalising CSF and blood neurofilament levels (NEDA-5) and beyond. What I mean by beyond is that our ultimate aim is to cure people of having MS and to allow them to get to old age with as much brain as possible. Is this too ambitious?

The following is my presentation from yesterday that can be downloaded from my slideshare site.

At the end of my session, we got into a lively debate about whether or not everyone with MS needs to be treated. Obviously not, based on my presentation only people with active MS are eligible for treatment. Those who have inactive MS cannot be treated under current NHS England guidelines and if they remain inactive they will hopefully end-up having benign MS. Surely the aim of our treatments is to convert everyone with MS into having inactive MS that will hopefully turn out to be benign MS after 25-30 years of follow-up. What we did not cover in this mini-debate is what is active MS? Should it include smouldering MS?

If any of the trainees are reading this post can I please recommend that you read the following posts I have recently done and to bookmark my MS-Selfie site that is still under development.

Posts of potential interest:

  1. Why do MSers get worse despite being NEDA?
  2. Can we cure MS?
  3. Sequential therapies
  4. MS-relatedd fatigue
  5. Food Coma
  6. What the eye doesn’t see?
  7. MMR: to test or not to test?
  8. Radiologically isolated syndrome
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