Taking notes during class?
Studying one topic at a time?
Having the same place to study each day?

As it turns out, alll are exactly the opposite of the best strategies for learning.This time last year we looked at basic learning strategies (test erly test often) and the strategy known as Mindburning – controlled unforgeting.

http://whatilearnttoday.com.au/how-to-learn-new-stuff

http://whatilearnttoday.com.au/mind-burning-how-to-learn-new-stuff-part-2

Geek Dad recently blogged about his interview with Robert Bjork, the director of the UCLA Learning and Forgetting Lab, a distinguished professor of psychology, and a “massively renowned expert on packing things in your brain in a way that keeps them from leaking out.”

http://www.wired.com/geekdad/2012/01/everything-about-learning/

“People tend to try to learn in blocks,” Bjork said. “Mastering one thing before moving on to the next.”

Instead of doing that Bjork recommends interleaving. The strategy suggest that instead of spending an hour working on your tennis serve, you mix in a range of skills like backhands, volleys, overhead smashes, and footwork.

Similarly, studying in only one location is great as long as you’ll only be required to recall the information in the same location. If you want information to be accessible outside your dorm room, or office, or nook on the second floor of the library, Bjork recommends varying your study location.

The third tip relates to the the spacing effect, which we discussed in the WILT post on mind burning.

“If you study and then you wait, tests show that the longer you wait, the more you will have forgotten,” Bjork said.”But here’s the cool part: If you study, wait, and then study again, the longer the wait, the more you’ll have learned after this second study session.

Bjork explains it this way: “When we access things from our memory, we do more than reveal it’s there. It’s not like a playback. What we retrieve becomes more retrievable in the future. Provided the retrieval succeeds, the more difficult and involved the retrieval, the more beneficial it is.”

“Bjork also recommends taking notes just after class, rather than during — forcing yourself to recall a lecture’s information is more effective than simply copying it from a blackboard. You have to work for it. The more you work, the more you learn, and the more you learn, the more awesome you can become.”

More details ar in Geek Dad’s blog on Wired.

http://www.wired.com/geekdad/2012/01/everything-about-learning/

So there you go Oliver and Harry – no excuse for forgetting anything during Year 12 this year.

Can you compress two hundred years of social and economic history into a 4 minute youtube video?

Yes, if you are Hans Rosling, The Jedi Master of Data Visualization, (and the Professor of International Health at the Karlinska Institute.)

Prof Rosling is also director of the Gapminder Foundation - ’Unveiling the Beauty of Statistics for a Fact Based World’.

Gapminder is a non-profit foundation based in Stockholm. Our goal is to replace devastating myths with a fact-based worldview. Our method is to make data easy to understand. We are dedicated to innovate and spread new methods to make global development understandable, free of charge, without advertising. We want to let teachers, journalists and everyone else continue to freely use our tools, videos and presentations.

In the video below, life expectancy is plotted against income for every country since 1810. “Instead of studying history one year at the university, you can watch this video for less than five minutes”, according to Gapminder. 

(Australia is a small red circle that leads the world during the early 1900s and thereafter always orbits like a moon around the US)

This particular segment was made as part of a BBC Documentary, the Joy of Stats. You can experience your own joy at Gapminder World. (One for you, Laura)

What is the single best thing we can do for our health?

Stop smoking? Lower our cholesterol? Take Aspirin? Lose weight? Take vitamins?

There is one treatment that has been demonstrated in multiple studies to improve life expectancy (23%), decrease cardiovascular disease, prevent progression to diabetes (58%), prevent dementia and Alzheimer’s (50%), improve the pain and disability of arthritis (47%), prevent fracture in osteoporosis (41%), reduce the incidence of anxiety (48%) and depression (47%), reduce fatigue and increase overall quality of life.

And that treatment is……….

Over to you Professor Mike Evans.

The US Agency for Healthcare Research and Quality addresses this question in a recent White Paper, “Cooordinating Care for Adults with Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions”

In this months Annals of Family Medicine, the White Paper author Eugene Rich summaries the policies and strategies developed to help typical, smaller primary care practices transform into effective medical homes that appropriately serve patients with complex needs. All the programs that they studied allow patients with complex needs to maintain existing relationships with their primary care clinicians while giving small practices the resources to overcome barriers to providing excellent care to these patients. A further ‘brief paper’ Ensuring that Patient Centered Medical Homes Effectively Serve Patients with Complex Needs also accompanies the AHRQ White Paper. The summary below draws from the Annals article and the Brief paper.

The patient-centered medical home (PCMH) is a model for strengthening primary care through the reorganization of existing practices to provide patient-centered, comprehensive, coordinated, and accessible care that is continuously improved through a systems-based approach to quality and safety. Agency for Healthcare Research and Quality (AHRQ). What is the PCMH? AHRQ’s definition of the medical home?

Recent studies have confirmed that the care provided by a patient-centred medical home reduces morbidity and costs.

The programs that were studied for the White Paper used a number of key approaches to support primary care practices.

Focusing on the most costly patients.

Placing case managers/care coordinators in primary care practices.

Case managers/care coordinators are typically nurses, social workers, or other professionals who work as a team with the primary care clinician. Case managers/care coordinators extend the reach and capacity of primary care clinicians to provide more proactive care by making home visits, providing 24-hour on-call advice, and helping patients find and secure community-based services.

Allowing flexibility in matching staff to the needs of each practice.

These staff include case managers/care coordinators, as well as specialists in geriatrics, nutrition, mental health, and assistive technology. In many programs, staff rotate among several primary care practices, but if a practice has enough patients with complex needs, support staff can be assigned to just one.

Helping primary care clinicians manage patients with complex care needs alongside their regular patients.

Most of the programs help reorganize workflow and systems; identify and proactively track complex or high-risk patients via registries; conduct in-home assessments; staff 24/7 telephone lines to complement the practice’s after-hours coverage; set up electronic health records, Web-based IT registries, and referral tracking systems;

Quality Improvement Activities and Learning Opportunities

All of the programs emphasize quality improvement, and monitor utilization and quality indicators to identify areas for improvement;
Team-based quality improvement through peer-to-peer learning and in-person meetings is another common approach

Paying additional fees to compensate primary care practices for time required to care for people with complex care needs.

Most of the innovative programs augment current payment to primary care practices with a monthly amount per patient, sometimes adjusted to reflect disease or condition complexity, which enables the practices to spend time on comprehensive assessment and care coordination.

What are the Next Steps?

Patients with complex health care needs represent the greatest challenge to transforming small primary care practices into high-functioning medical homes. These patients also present a great opportunity for medical homes to dramatically improve outcomes, such as lower costs, higher-quality care, and better care experiences for patients and clinicians. To achieve these aims, small practices will require enhanced support and resources—beyond those needed to meet current medical home standards—to deliver optimal care to patients with complex care needs. The 2 most crucial supports appear to be additional practice reimbursement for time spent coordinating care and integration of care coordinators with primary care teams.
Annals of Family Medicine

We have a tremendous opportunity in Australia to lead the world in the management of patients with complex needs by ensuring that our health system re-focuses on primary care, building on the resources, skills and relationships that exist in General Practice.

These features are comprehensiveness, patient-centeredness, and evening and weekend office hours, the University of California, Davis researchers reported in the latest Annals Of Family Medicine (Jan.Feb 2012)

cf http://www.annfammed.org/content/10/1/34.full

The evidence continues to show that what makes a difference is “longitudinal relationships over time with comprehensive care and excellent access.”

In other words, what the US considers a new innovation, the ‘Medical Home’, is standard general practice in Australia.

A recent study reports shows that North Carolina saved almost $1 billion in Medicaid costs over 4 years by enrolling patients in medical homes designed for more intense primary care.

The evidence is very very strong and getting stronger that investment in better systems for the delivery of primary care are the key to better health outcomes for our communities.

Reported in Medscape Medical News Jan 26th 2012. Hat tip to Raloh Audehm.

Brunswick Heads Medical Centre doesn’t have a “Waiting Room”.

They have a “Patient’s Lounge”.

Stealing Shamelessly, we’ve recently added a TV and a couch to ‘our lounge’. We have also consulted with the young people in our Patient Advisory Group, who have been kind enough to help us get some new toys and puzzles.

(each week the newsagent brings up the latest issues of a number of magazines – really. However, I note that they spend a considerable period of time in the staff tea room before making it to the ‘patient lounge’!)

‘Waiting Room’ or ‘Patient’s Lounge’. Is it just semantics?

I defer to Jerry Seinfeld –

Waiting room. I hate when they make you wait in the room. ‘Cause it says “Waiting room.” There’s no chance of not waiting, ’cause they call it the waiting room, they’re going to use it. They’ve got it. It’s all set up for you to wait. – Jerry Seinfeld.