How different minds approach the same challenge

We take a deep dive into the way learners and educators make connections between clinical concepts to better understand the clinical reasoning process.

Welcome! Tell us a bit about yourself.

My name is Mohamed Elashwal, I am a senior medical student at Alfaisal University in Riyadh Saudi Arabia. I was born in Egypt before I moved with my family to Saudi. I am interested in adult neurology; my neurophilia started in one morning report during my neuroscience rotation when I could feel my heart racing and his brain twisting thinking about the cases. I plan to apply to neurology residency next year. In my free time, I enjoy baking, and cooking; I also like playing the piano (level: very amateur).

These are the connections you made from our recent game.

Carcinoid syndrome can lead to B3 deficiency (aka pellagra) due to the use up of tryptophan. Pellagra classically has the description of a triad of dermatitis, diarrhea and dementia. Carcinoid syndrome are most commonly found in the GI tract but can also be found in the lungs.

If they do occur in the lungs specifically at the apex they can damage the sympathetic chain and result in the triad of Horner’s syndrome (ptosis, miosis and anhydrosis).

Lastly, vitamin B3 requires vitamin B6 for synthesis and a deficiency of vit. b6 can lead to sideroblastic anemia.

 See Mohamed’s Twitter post for more details.

When you first saw these cards, what was your approach to creating your teaching points?

When I first saw the cards I tried to think of a triad that could link all the cards together, but I couldn’t come up with just one triad so I put two. I wanted all the cards that are touching to be connected together via one theme. My connections were instantaneous. I went back to my FA (as suggested ;)) to confirm the info that I was posting. 

How did you make your subsequent connections?

I tried to think of a common link between the two different syndromes that I thought of and that common link was the lung. Since it’s a common location for carcinoid and where pancoast tumors occur. The remaining connections flowed in a similar way – from left to right, then down to miosis then up again to the anemia. I was thinking of adding the anemia before the miosis but felt that it flowed better that way. 

When you were making these teaching points, who did you imagine would benefit from reading them?

Medical students mainly, maybe residents as well. It’s a good refresher and a reminder that everything is connected.

How long did it take you to come up with the connections?

I think about 20 minutes, and I made them all in one sitting.

How does Table Rounds contribute to your learning and what would you like to see more of?

I think you guys are doing a pretty great job. One of the things I’m really interested in is how different minds approach the same problem and Table Rounds demonstrates this beautifully every time. So I would suggest keep doing what you’re doing and keep adding more cards and engaging with the medical community. 

Interview by Paulius Mui, MD

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