0 Guide to VAPs March 2012 · Camtasia converts each slide into small mpeg4 video files. When viewing (streaming), this feature reduces delays commonly encountered when watching videos

A GUIDE TO VAPS (VOICE ANNOTATED PRESENTATIONS)

March 2012

VAP Guide March 2012 2

A GUIDE TO VAPS (VOICE ANNOTATED PRESENTATIONS) TABLE OF CONTENTS

TOPIC PAGE

A. The “Why” of VAPs: Vision And Perks 3 B. The “What”: Techie Talk 3‐4 C. The “How”: General Guidelines 5

a. Creating a Very Appealing (not Appalling) Presentation b. Slide Size, Style, & Structure

1. Size matters: Less is More 2. Style & Structural Do’s and Don’ts

c. Using Images, Figures and Copyrighted Material d. Supplemental/Supporting Material e. Authorship and Intellectual Property f. Using Patient Data

D. The “What Now”: Projects in Particular 9 a. First‐year Basic Science Project b. L.I.T. (learning in ten) Reviews c. Clinical Science Library d. Clinical Clerkships E. The “What The? $@&%#”: FAQs 10 F. The “Who”: Contact Information 12

APPENDIX 13‐29

Appendix A Instructions on voice‐annotated recording with: I. PowerPoint 2010 II. PowerPoint 2007 Appendix B Recommended Resources for Persuasive Presentations

Appendix C A Brief Guide to USMLE Step 2 CK Examination, List of topics, and Sample questions


A. THE “WHY” OF VAPS: VISION AND PERKS

Duke‐NUS Graduate Medical School is partnering with Duke University Medical School to implement the VAP – Voice Annotated Presentations – project. Voice annotation has been around for some time, but technology tailored at Duke‐NUS converts such presentations into small, portable files for downloading and/or streaming. Our goal is to amass a repository of engaging VAPs openly accessible to learners within any medical school community. Those creating VAP material are expected to adhere to strict academic principles and practices, while open access will render this a practical and productive pedagogical resource. There are several promising perks to use of VAPs. While videos capture the essence of a lecture, effectiveness is predicated on an assumption that lecture delivery rate matches that of the audience’s learning. For those with a mismatch, VAPs allow paced viewing of presentations to fit one’s needs and preferences. As shown in Figure 1, presentations are indexed by slide titles and text content, so users may preview a presentation not only in its entirety, but also as individually timed slides, each of which has its unique online identifier (URL). One can search the library of VAPs for specific key words and identify individual slides containing them. Given a fragmented technological design, presenters can edit/revise one slide at a time, and tailor presentations to different audiences (perhaps some day in different languages). For example, on the topic of hemoglobinopathy, students at Duke University School of Medicine can focus primarily on sickle cell disease, while Singapore‐based Duke‐NUS students can view a presentation with thalassemia as its main example instead. Educators from campuses worldwide can more easily communicate content and revisions, e.g. “drugs for asthma control have been changed on slide #25 to reflect new guidelines”. Further, discussions underlying such changes or controversies can be brought to light via “under the hood” discussion links attached to each slide. In the sprit of open access, presentations can be rated by users.

B. THE “WHAT”: TECHIE TALK The general flow of creating a VAP is as depicted in this diagram:

At present, software entitled Camtasia is used to create VAPs by converting large video and audio files into bite‐size pieces. The VAP team receives a variety of files from presenters including audio (.wav, .mp3, .aiff), video (.mov, .mpg, .mpeg4) and audio incorporated Microsoft PowerPoint (.ppt, .pptx). Camtasia converts each slide into small mpeg4 video files. When viewing (streaming), this feature reduces delays commonly encountered when watching videos online. A separately created html file allows seamless viewing. A table of contents displays each slide title for easy navigation between slides. VAPs can be viewed either online through streaming via Internet browsers, or offline by downloading VAP package files onto a playback device (e.g. laptop, personal computer, etc). The mpeg4 video format (as opposed to flash videos) will allow playback on iPad and various Smartphones. VAPs are available in HTML4 &/or HTML5 formats. Browsers that support HTML5 (Google Chrome, Safari) allow features such as changing presentation speed (Figure 1), viewing elapsed time, and emailing. HTML4 (Internet Explorer, Firefox) does not support many advanced viewer features. At present, we recommend Google Chrome for best VAP viewing results.


Figure 1. Example of a VAP slide. The slide is on the top right. The left‐hand column shows each individual slide with exact timing and whether a slide has been viewed (as seen by a change in color from blue to orange). Authors should identify their appropriate audience level and specify learning objectives. The online locator or URL for each individual slide can be obtained as shown (bottom panel) to ease communication amongst viewers.


C. THE “HOW”: GENERAL GUIDELINES a. Creating a Very Appealing (not Appalling) Presentation Our goal is to amass attention‐grabbing, academically sound presentations. Presentations will eventually be open to user‐ratings and discussion links. Users will not be able to change the content of presentations. To create a new VAP, see instructions in Appendix A. We strongly recommend use of a recording studio (available on both Duke‐NUS and Duke campuses) for best audio results. If working with previously prepared lecture material you wish converted, or if you do not wish to use your voice for narration, please contact the Duke‐NUS VAP team for technical support. b. Slide Size, Style, and Structure 1. Size matters: Less is More This is highly context‐dependent. For most clinical applications, we recommend 10 slides in 10 minutes. Delivering succinct yet meaningful information underlies VAP philosophy. The intent is not to clone comprehensive textbook chapters but to know one’s audience training level/needs, appropriately distill the essentials, and guide learners on how to approach a topic.

Longer VAPs are acceptable, but keep in mind short audience attention spans. If a VAP is too long, consider 1) dividing it into separate VAPs, and/or 2) including more extensive text/lecture notes as a pdf file under “supporting material” (see below for details.)

“Making the simple complicated is commonplace; making the complicated

simple, awesomely simple, that's creativity.”

Charles Mingus

“We don’t pay attention to boring things.”

John J Medina


2. Style & Structural Do’s & Don’ts

Do Use the template provided by the VAP team and fill in all the blanks. This is necessary for legal

reasons, IT coordination, indexing, searching, etc. Try to follow the “rule of 10’s”: 10 slides in 10 minutes. Start off with specific learning objectives. When composing slides, think about the take‐home

message. This tells viewers if their learning needs are addressed and keeps the presentation focused. Learning objectives are also displayed in a summary screen that enables viewers with their search within the VAP library.

Minimize number of words on each slide. Use no smaller than 22‐point font, and no more than 6 bullet points and 5 words per bullet. If easier to relate, think Twitter.

Stay focused on the topic of each slide. Cite all images and figures. For details, see “Using images, figures and copyrighted material”. Use examples/illustrations/graphs/images whenever possible. Provide examples/stories, and when relevant, talk about a patient (de‐identified) whose care

may highlight your points. Include de‐identified patient data (images, etc.) Use appropriate, descriptive titles on every slide. Each title will be displayed on a left‐hand

column (Figure 1) for identification/navigation between slides (see FAQs for more details). Include a well‐written transcript of your talk. Part of the presentation package, this will be

made available to viewers as a pdf. Include all authors as indicated in the appropriate slide.

Don’t × do the opposite of above “Do”s. × pick a very generic title for the talk such as “Diabetes”, which is generalized and vague. × lose sight of your audience level. E.g. don’t create the same VAP for a medical student new to

clinical wards as you would for a 3rd year resident. × read your slides word‐for‐word. Respectfully, your voice only serves as a distraction, as viewers

can read slides faster. People learn best when visuals are narrated, not dictated. × use nonspecific slide titles (e.g. “Patient 1” or “Consent”), as these are used on a left‐hand menu

bar for viewer identification of relevant information. × use information that can be traced back to a patient.

c. Using Images, Figures and Copyrighted Material Images, figures, and copyrighted material are core components of presentations. You may use these, but it is imperative to cite all sources. Accessibility does not automatically translate into usability. All presentations go through a “scrubbing” process. The VAP

team will look into each image/figure to ensure compliance with copyright rules. To facilitate, please provide the team proper referencing for external material to include Author, (Year), Title of Article, Title of Journal, Volume Number, Issue and Page Number. If a copyrighted image is found (and the owner does not grant permission for use), the VAP team considers three options: 1) Replace; 2) Redraw; or 3) Remove. The VAP team can help you identify replacement images, redraw the information in an original manner, or remove the image and provide a link.

©


To quote something under “Fair Use”, the Copyright Act accepts use of short quotes for the purpose of criticism, commentary or news reporting. However, the quote used should involve only a small portion of the work without replicating the “heart” of the material. When creating a new presentation, use images and figures from either public domain or royalty‐free websites. Otherwise, consider drawing your own figures when appropriate. The VAP team can also help with some software illustrations. Additionally, there are several websites from which you can buy images and programs that help support illustrations. If you have special requests for image or figure creation, please contact the VAP team. Public domain carries works that are free for use without any copyright restrictions. Below is a list of websites that have images compliant with our VAP licensing agreement.

1. Flickr photos http://www.flickr.com/creativecommons/by‐nc‐nd‐2.0/

Contains either public domain images or compatible Creative Commons License images – please check with VAP team to ensure images are appropriate for use.

2. Commons Wikimedia http://commons.wikimedia.org

Consists of either public domain images or compatible Creative Commons License images – please check with VAP team to ensure images are appropriate for use.

3. ClipArt ETC http://etc.usf.edu/clipart/sitemap/anatomy.php

If resources from this site are incorporated, 1) credit FCIT (Florida Center for Instructional Technology); and 2) include a link to http://etc.usf.edu/clipart on your VAP.

4. Custom Medical Stock Photo Inc

https://www.cmsp.com/

5. PdClipArt http://www.pdclipart.org/

6. Open Clip Art Library http://openclipart.org/tags/public%20domain

Don’t × assume you can copy material if there is no copyright message or source indicated. The

Copyright Act states that it is no longer necessary to indicate a copyright notice for works done. As such, whether expressed with a copyright notice or not, every published work (either on paper or digital media) is automatically granted copyright protection.

× assume that if a copyright statement is removed, the material is free to use. The material is the property of the Author, and use without proper acknowledgment constitutes copyright infringement.

× copy material even if you can’t find a copyright holder. The fact that a copyright holder cannot be identified does not imply that the material can be freely copied.

d. Supplemental/Supporting Material Supplemental/supporting materials include documents or files such as publications, web links, or educational resources you wish to add to your VAP. This is in addition to the PowerPoint file and written transcript of the presentation, which are considered standard downloaded material. To include supporting material, submit either the reference or the actual material to the VAP team. This will be made available under the “downloads” section in the VAP viewer. We also provide the full VAP folder for download and offline viewing.


What if you want to post a journal publication as supporting material? If the publication is open‐access, the VAP team will provide the full text of the article in pdf format. If the journal requires a subscription, the abstract will be provided along with links to the article for subscribers.

e. Authorship and Intellectual Property Creating a VAP has similar authorship rights as if you were writing a book chapter. You will retain the copyright to all the materials you provide for VAPs and can continue to use them for any purpose in the future. However, please note that Duke‐NUS may modify your materials without your explicit consent. Authorship for VAPs should follow general scientific publication guidelines. In the VAP context, the first and (more, if applicable) author(s) should be so listed on the first slide of the VAP. Anyone else who has made a valuable contribution should be named in an “Acknowledgement” slide. f. Using Patient Data All patient data should be de‐identified such that no description can be traced back to a patient. When using patient images, for example, permanently block out any patient name and other identifiers. Images of body parts are typically considered non‐identifiable. If it is not possible to de‐identify patient data, you may seek consent from a patient using the form “Consent for People Appearing in VAPs”. It is not necessary to obtain consent from those who cannot be identified.


D. THE “WHAT NOW”: PROJECTS IN PARTICULAR Following are snapshots of VAP projects‐in‐progress. For more information, feel free to contact the VAP management team. a. First‐year Basic Science Project The aim is to make available the majority of year‐one basic science lecture material at Duke and Duke‐NUS in VAP format. At present, this is not available as open access. b. L.I.T. (learning in ten) Reviews The goal of this project is to create a comprehensive repository of 10‐minute clinical reviews in VAP format targeting an audience preparing for USMLE Step 2 CK in an open‐access format, be it for study at home or on‐the‐go. Although exam preparation per say is not the goal of this project, USMLE Step 2 CK provides a frame of reference for the content depth and breadth. For more details on USMLE content, topics, & questions, please see Appendix B. We also hope to gradually develop a collection of “real” clinical cases that tap into the VAP review library as reference material, linking multiple topics so as to coalesce the knowledge content with practical examples. c. Clinical Science Library The Duke‐NUS Office of Clinical Sciences has identified a series of topics relevant to clinical research, having made available nearly 100 open‐access VAPs on such topics. A committee is helping create “modules” that VAP viewers can use to become conversant in clinical research. These modules will include self‐assessment quizzes and may offer a Certificate of Recognition. d. Clinical Clerkships This project involves recording of lectures/tutorials that recur on clinical clerkships. Faculty have the option of recording lectures in VAP format, to allow student viewing outside clinical windows, and freeing that time for other learning activities such as practical application/reinforcement of concepts relayed through VAPs. Maybe even make time for old‐fashioned bedside rounds featuring patients?


E. THE “WHAT THE ?$@&%#”: FAQs o What sort of credit will I get for contributing to a VAP? The Duke‐NUS Appointments, Promotions and Tenure Committee is committed to recognizing VAP authorship and contributions as an academic teaching activity. Authors can include VAPs on their CV, and faculty may consider including VAP authorship and contributions on annual performance reviews. o Is it acceptable to work with a medical student or resident to help create a VAP? Absolutely. We encourage you to involve your trainees, as this provides a scholarly activity that also credits the contributors. Please recognize authorship contributions accordingly. o What if a VAP needs to be updated? Duke‐NUS will decide if part or all of a VAP needs to be updated. Duke‐NUS will contact you if changes are to be made to your presentation. If the VAP team modifies your presentation, you will still be credited as an author, although additional authors may be added if appropriate. o Will Duke‐NUS make any money off this project? Will I receive any royalties? The purpose of this project is to provide freely available VAPs to the medical community, and it is unlikely that Duke‐NUS will profit from VAPs alone. Duke‐NUS may explore the possibility of revenue generation in the future by packaging certain VAPs as CME material. Any potential royalties gained in this manner will go to Duke‐NUS and/or Duke educational efforts, and not to individual authors/editors. o How is a VAP different from viewing information on a web page? VAPs are narrated presentations that allow the viewer to listen to the presenter at his/her own speed with ability to toggle amongst individual slides. o Do I have to be connected to the Internet to view VAPs? The current website does not support downloading of presentations for offline viewing. Technological development for offline viewing is underway. VAPs can be streamed online via an Internet browser. o Can I view a VAP offline? Currently, VAPs on the website can only be viewed online. However, the VAP team can provide you the entire file for offline viewing. o Can I view a VAP using my iPhone or iPad? VAPs can be viewed online but not downloaded onto an iPad or iphone. The latter’s small screen size may prohibit ideal viewing of certain VAPs. Technological developments for downloads (and offline viewing) are underway. o Why do I have to give citation information on figures/images for which I am an author? When you use a figure in a publication or book, the publisher may have imposed guidelines on its future use. By providing a citation, the VAP team will ensure you comply with copyright rules. o What if my data and/or figure are not yet published? If you provide an unpublished figure for which you want to ensure appropriate citations by others in the future, please include a citation. The citation information should include the author, publication status, relevant manuscript information (title, journal name if submitted) name of journal if appropriate) and date. See http://linguistics.byu.edu/faculty/henrichsenl/apa/APA14.html for more information. Please contact the VAP team if you need help citing your unpublished work. o What if I don’t know the source of an image? Please provide all information you can to the VAP team to help find the source. Otherwise, the image will either be replaced or published as “source unknown”.


o Am I required to have a title on each slide? Yes. Our search mechanism looks for the text associated with each slide. Slide titles are also displayed in a format similar to a table of contents to help users with their search within a presentation. As VAPs are indexed and searched by slide titles, it is important to make these relevant. The library will eventually allow search using free text (such as Google), or by title, author, and other advanced search terms. When users conduct a search and click on the selected link, they will be guided to the exact slide where the search term is found. Also see below. o What if I don’t want the title to appear on a particular slide? You can hide the title by changing the font/fill of the title box to match the slide background.


F. THE “WHO”: CONTACT INFORMATION

VAP projects are works in progress. Be it queries, criticisms, or comments, we want to hear from you.

Queries & Comments Email Tel (+65) General Inquiries vap.team@duke‐nus.edu.sg 6516 5438 Studio Recording Support shruti.shah@duke‐nus.edu.sg 6516 5438 Studio & Live Lecture Recording Support eugene.seah@duke‐nus.edu.sg 6601 1994 Project Specific Support silke.vogel@duke‐nus.edu.sg 6516 8144

Duke‐NUS VAP Management Team VOGEL, Silke Faculty Supervisor silke.vogel@duke‐nus.edu.sg HARMON, Jennifer Senior Manager jennifer.harmon@duke‐nus.edu.sg 6516 8144 KHANASHAT, Christine

Manager christine.khanashat@duke‐nus.edu.sg

6601 2287

SHAH, Shruti Executive shruti.shah@duke‐nus.edu.sg 6516 5438 SEAH, Eugene Executive (AV support) eugene.seah@duke‐nus.edu.sg 6601 1994

SINGARAM, Vani Executive (VAP scrubbing) vani.singaram@duke‐nus.edu.sg 6601 2523 Duke‐NUS VAP AdministrativeTeam MAI, Serene Executive, CFA serene.mai@duke‐nus.edu.sg 6601 1415 CHONG, Rachel Executive, CFA [email protected] 6394 8202

Duke‐NUS VAP IT Team STARMER, Frank Associate Dean, Learning

Technologies frank.starmer@duke‐nus.edu.sg 6516 5668

BUANG, Samsul samsul.buang@duke‐nus.edu.sg 6516 1959 LAU, Hwee Hwee [email protected] 6601 1534 WORTH, James james.worth@duke‐nus.edu.sg 6516 6524

Duke‐NUS VAP Steering Committee Faculty (alphabetically) Projects* CHUA, Terrence Cardiology [email protected] COOK, Sandy Senior Associate Dean sandy.cook@duke‐nus.edu.sg 3 KAMEI, Robert Vice Dean, Education robert.kamei@duke‐nus.edu.sg 1 KOONG, HN Surgery Clerkship [email protected] 3 KRISHNAN, Ranga Dean ranga.krishnan@duke‐nus.edu.sg all RUSH, John Vice Dean, Clinical Science john.rush@duke‐nus.edu.sg 2 SARRAF, Shiva Medical Education shiva.sarraf@duke‐nus.edu.sg 1 STARMER, Frank Associate Dean frank.starmer@duke‐nus.edu.sg all SUMMERS, Scott Director, Graduate Studies scott.summers@duke‐nus.edu.sg 2 TAN, Thiam Chye O&G Clerkship [email protected] 1 Duke University School of Medicine Contacts ATHERTON, Alison

Singapore Education and Student Life Liaison

[email protected] 1

GENTRY, Tammy Administrative Liaison [email protected] 1 LOFTIN, John Audio‐Video specialist,

Office of Curriculum [email protected]

all

YEE, Linton Pediatric Emergency Medicine, Faculty Liaison

[email protected] 1

*Projects in Particular 1. LIT (learning in ten) – Clinical Reviews 2. Clinical Science Library 3. Clinical Clerkships


APPENDIX

APPENDIX A.I— Instructions on voice‐annotated recording with PowerPoint 2010

Starting a New Recording 1. To create a new VAP, open a PowerPoint presentation file (use template).

2. To begin recording, choose the <Slide Show> tab and select <Record Slide Show>.


3. Choose the <Start Recording from Beginning> option from the drop‐down menu.

4. Ensure that both checkboxes are selected.

5. To start recording, click on <Start Recording>. The presentation will go into the slideshow mode

and you can start to narrate slides.


6. Once in slideshow mode, there is a recording toolbar with which to navigate slides.

“Recording Paused” Message Box

Advance to Next Slide

Pause/Resume Recording of Current Slide

Repeat (re‐record current slide)

Recording Toolbar


7. To end the recording process, press the <ESC> key on the upper top corner of the keyboard.

8. Any recorded slide will display a speaker icon at the lower right corner of the slide. Recording a Specific Slide or Recording from a Specific Slide 1. To record a specific slide, navigate to that slide, choose the <Slide Show> tab, and select the

<Record Slide Show>.

2. Choose the <Start Recording from Current Slide> option from the drop‐down menu


3. Ensure that both checkboxes are selected.

4. To start recording, click on <Start Recording>. The presentation will go into slideshow mode and you can start narrating slides.

5. To end recording, press the <ESC> key on the upper top corner of the keyboard.


APPENDIX A.II— Instructions on voice‐annotated recording with PowerPoint 2007

Starting a New Recording 1. To create a new VAP, open your PowerPoint presentation file (use template).

2. To begin recording, choose the <Slide Show> tab and select <Record Narration>.


3. A Record Narration box will appear. Follow the sequence:

1) Link narrations in: Check this box to link the recorded file (rather than embedding it) to the

presentation slides. 2) Change Quality: This button changes the recording resolution. Higher sampling and bit rates

improve resolution of the recorded narration, but increase size of recorded files.

3) Set Microphone Level: Ensure the meter does not hit the red zone.

4) OK: Click on <OK> to start recording. The presentation will go into slideshow mode and you can

start narrating slides.

4. To end the recording, press <ESC> key on the upper top corner of the keyboard.

5. A popup message will appear asking if you wish to save the timing of the slides. Click <Save>.

6. Any recorded slide will display a speaker icon at its lower right corner.

3. Set Microphone Levels

2. Change Quality of Recording

1. Check the checkbox to links the recorded file to the presentation slides

4. Start Recording


Recording over/from a Specific Slide 1. To record a specific slide, navigate to that slide, choose the <Slide Show> tab, and select <Record

Narration>

2. Ensure the checkbox for "Link narrations in" is checked and click <OK>.

3. A popup message will appear.

4. Select <Current Slide> and proceed to narrate slides once in slideshow mode.


APPENDIX B – Recommended Resources for Persuasive Presentations

To improve upon presentation skills, we recommend the following resources:

1. Presentation Zen by Garr Reynolds. This book provides useful design tips and suggestions for powerful presentations. The website (http://www.presentationzen.com/) also contains lots of ideas for presentations.

2. “Death by PowerPoint” is an expression first coined by Angela R Garber in an article she wrote: (http://www.smallbusinesscomputing.com/biztools/article.php/684871); it is also highlighted in presentations by Alexei Kapterev (http://www.slideshare.net/thecroaker/death‐by‐powerpoint), and Life After Death by PowerPoint 2010 by Don McMillan (http://www.youtube.com/watch?v=KbSPPFYxx3o)

3. Pecha Kucha (http://www.pecha‐kucha.org/) is a worldwide organization allowing people to create “20x20” presentations, 20 picture slides with 20 seconds of narration per slide. This site has gained popularity in over 230 cities, as users find it a useful platform to share their work with others.

4. Steve Jobs was legendary for his captivating presentation skills. You can read more about this in a book by Carmine Gallo, “The Presentation Secrets of Steve Jobs: How to be Insanely Great in Front of Any Audience”.


APPENDIX C – A Brief Guide to USMLE Step 2 CK (Clinical Knowledge) Examination About USMLE Step 2CK Step 2 CK is a broadly based, integrated examination, consisting of multiple‐choice questions focusing on the principles of clinical science deemed important for the supervised practice of medicine as a postgraduate trainee. It frequently requires interpretation of tables and laboratory data, imaging studies, photographs of gross and microscopic pathologic specimens, and results of other diagnostic studies. A few sample questions are provided at the end of this appendix.

USMLE Step 2CK Content Outline/Distribution

Normal Conditions: Deals with normal growth and development, basic concepts, and general principles.

Relatively small %

Disease Categories: 1. Promoting Preventive

Medicine and Health Maintenance

Encompasses assessment of risk factors, appreciation of epidemiologic data, and application of primary and secondary preventive measures.

15%‐20%

2. Understanding Mechanisms of Disease

Encompasses etiology, pathophysiology, and effects of treatment modalities in the broadest sense. 20%‐35%

3. Establishing a Diagnosis

Pertains to interpretation of history/physical findings and results of laboratory, imaging, and other studies to determine the most likely diagnosis or the most appropriate next diagnostic step.

25%‐40%

4. Applying Principles of Management

Concerns the approach to care of patients with chronic and acute conditions in ambulatory and inpatient settings. Questions focus on the same topics covered in the diagnosis sections.

15%‐25%

From a pool of 132 sample questions provided on the USMLE website (www.usmle.org), fewer than 25% involved “management”. These questions do not simply provide a diagnosis followed by a query on the best management option. Rather, the student has to generate a diagnosis based on the vignette’s history, physical, and/or other clinical findings before choosing a management option.


APPENDIX C (cont’d) Suggested List of USMLE Review Topics

Cardiopulmonary Medicine Cardiology 1. Chest pain (approach) 2. Abdominal aortic aneurysm 3. Pulmonary edema, acute cardiogenic 4. Acute Coronary Syndrome 5. Aortic dissection 6. Myocardial infarction 7. Acute myocardial infarction –

Management 8. Atrial fibrillation 9. Cardiac tamponade 10. Congestive heart failure 11. Dilated cardiomyopathy 12. Heart failure 13. Aortic regurgitation 14. Aortic stenosis 15. Mitral regurgitation 16. Mitral stenosis 17. Hypercholesterolemia 18. Hypertension— Essential 19. Hypertrophic Obstructive

Cardiomyopathy 20. Pericarditis 21. Peripheral vascular disease 22. Heart block 23. Wolff‐Parkinson‐White Syndrome

Skin & Soft Tissue: Dermatology/Surgery Dermatology 1. Acanthosis nigricans 2. Acne vulgaris 3. Atopic dermatitis 4. Basal cell carcinoma 5. Bullous pemphigoid 6. Herpes simplex 7. Kaposi sarcoma 8. Lichen planus 9. Molluscum contagiosum 10. Pemphigus 11. Pityriasis rosea 12. Psoriasis 13. Stevens‐Johnson Syndrome 14. Varicella‐Zoster Virus 15. Tuberous sclerosis 16. Onychomycosis 17. Melanoma Surgery 18. Necrotizing soft tissue infection 19. Hidradenitis suppurativa 20. Breast lump (approach) 21. Fibrocystic Breast Disease 22. Breast Cancer – Screening 23. Breast Cancer – Diagnosis

Pulmonary 1. Cough (approach) 2. Acute respiratory failure (approach) 3. Acute Respiratory Distress Syndrome 4. Asthma 5. Pneumonia 6. Chronic Obstructive Pulmonary

Disease 7. Emphysema 8. Lung cancer 9. Idiopathic Pulmonary Fibrosis 10. Mesothelioma 11. Pulmonary embolus 12. Pleural effusion 13. Pulmonary hypertension 14. Sarcoidosis 15. Tuberculosis 16. Sleep apnea

Endocrinology 1. Acromegaly 2. Cushing's syndrome 3. Adrenal insufficiency (Addison's

Disease) 4. Diabetes insipidus 5. Diabetes Mellitus, Type I 6. Diabetes Mellitus, Type II 7. Diabetic ketoacidosis 8. Hyperthyroidism (Graves' Disease) 9. Hyperaldosteronism 10. Hyperparathyroidism 11. Hypothyroidism (Hashimoto's

Thyroiditis) 12. Multiple Endocrine Neoplasia, Type I 13. Multiple Endocrine Neoplasia, Type II 14. Metabolic syndrome 15. Osteoporosis 16. Paget's disease of bone 17. Pheochromocytoma 18. Syndrome of Inappropriate

Antidiuretic Hormone Secretion 19. Thyroid Nodule 20. Subacute Granulomatous Thyroiditis

(de Quervain's Thyroiditis) 21. Obesity effects on health


Hematology & Oncology 1. Acute Myelogenous Leukemia 2. Acute Lymphoblastic Leukemia 3. Amyloidosis 4. Chronic Lymphocytic Leukemia 5. Factor V Leiden 6. Fanconi's anemia 7. Glucose‐6‐Phosphate Dehydrogenase

Deficiency 8. Hairy cell leukemia 9. Hemophilia 10. Hodgkin's lymphoma 11. Microcytic anemia 12. Multiple myeloma 13. Idiopathic Thrombocytopenic Purpura 14. Neutropenia 15. Polycythemia 16. Sickle cell anemia 17. Thalassemia 18. Hemorrhage, Drug‐Induced 19. Thrombotic Thrombocytopenic

Purpura; Hemolytic Uremic Syndrome 20. Porphyria 21. Transplant Rejection 22. von Willebrand's Disease 23. Disseminated Intravascular

Coagulation Solid Tumors not covered elsewhere 24. Testicular cancer 25. 26. 27.

Gastroenterology/Surgery Gastroenterology 1. Jaundice (approach) 2. Hiatal hernia 3. Peptic Ulcer Disease 4. Celiac disease 5. Cirrhosis 6. Primary Sclerosing Cholangitis 7. Spontaneous Bacterial Peritonitis 8. Viral hepatitis 9. Wilson's disease 10. Hemochromatosis 11. Pseudomembranous colitis 12. Crohn's disease 13. Irritable Bowel Syndrome 14. Esophageal cancer 15. Gastric cancer 16. Colorectal cancer – Screening/Diagnosis 17. Pancreatic cancer 18. Liver cancer Surgery 1. Abdominal Pain (approach) 2. Acute Cholecystitis 3. Acute Pancreatitis 4. Acute Appendicitis 5. Acute Mesenteric Ischemia 6. Ulcerative Colitis 7. Small Bowel Obstruction 8. Diverticulitis 9. Gastroesophageal Reflux Disease 10. Achalasia 11. Carcinoid Tumor 12. Zollinger‐Ellison Syndrome 13. Large bowel obstruction 14. Colorectal Cancer – Management

Infectious Diseases 1. Chlamydia 2. Gonococcal Infection 3. Histoplasmosis 4. Infectious Mononucleosis 5. Lyme Disease 6. Malaria 7. Methicillin‐Resistant Staphylococcus

aureus 8. Neutropenic Fever (approach) 9. Osteomyelitis 10. Pneumocystis 11. Endocarditis 12. Rocky Mountain Spotted Fever 13. Septic Arthritis 14. Thrombophlebitis 15. Urinary Tract Infection 16. Primary Syphilis


Neurology 1. Delirium (approach) 2. Headache (approach) 3. Dementia 4. Amyotrophic Lateral Sclerosis 5. Epidural abscess 6. Duchenne Muscular Dystrophy 7. Epidural hematoma 8. Glaucoma 9. Glioblastoma Multiforme 10. Guillain‐Barre syndrome 11. Huntington's disease 12. Infantile spasms 13. Internuclear ophthalmoplegia 14. Benign Positional Paroxysmal Vertigo 15. Meningitis 16. Multiple Sclerosis 17. Myasthenia Gravis 18. Stroke (divided into multiple VAPs) 19. Seizures, partial complex 20. Seizures, tonic‐clonic 21. Subacute Combined Degeneration 22. Subarachnoid hemorrhage 23. Subdural hematoma 24. Parkinson's disease 25. Tabes dorsalis

Psychiatry 1. Amphetamine Intoxication 2. Alcoholism 3. Attention‐Deficit/Hyperactivity

Disorder 4. Autism 5. Eating Disorders: Bulimia, Anorexia

Nervosa 6. Substance Abuse 7. Opioid Withdrawal 8. Conduct Disorder 9. Dissociative Fugue 10. Factitious Disorder 11. Generalized Anxiety Disorder 12. Major Depression 13. Personality Disorder, Cluster A 14. Personality Disorder, Cluster B 15. Personality Disorder, Cluster C 16. Bipolar I Disorder 17. Schizophrenia 18. Posttraumatic Stress Disorder 19. Somatization Disorder 20. Tourette's Syndrome 21. Suicidal Ideation

Rheumatology 1. Ankylosing Spondylitis 2. Carpal Tunnel Syndrome 3. Dermatomyositis 4. Wegener's Granulomatosis 5. Gout 6. Fibromyalgia 7. Juvenile Rheumatic Arthritis 8. Legg‐Calve‐Perthes Disease 9. Osteosarcoma 10. Rheumatoid Arthritis 11. Scleroderma 12. Spinal Stenosis 13. Systemic Lupus Erythematosus 14. Slipped Capital Femoral Epiphysis 15. Osteoarthritis 16. Takayasu Arteritis 17. Temporal Arteritis 18. Polymyalgia Rheumatica

Renal Medicine 1. Acid‐Base Disorders 2. Acute Interstitial Nephritis 3. Acute Kidney Injury 4. Acute Tubular Injury 5. Chronic Kidney Disease 6. Glomerulonephritis 7. Hypercalcemia (including malignancy‐

induced) 8. Hyperkalemia 9. Hypernatremia 10. Hyperosmolar Hyperglycemic State 11. Hypocalcemia 12. Nephrotic Syndrome 13. Polycystic Kidney Disease 14. Renal Tubular Acidosis 15. Renovascular hypertension/Secondary

hypertension 16. Nephrolithiasis 17. Renal cell carcinoma


Obstetrics & Gynecology Obstetrics 1. Abortion 2. Contraception 3. Deep Venous Thrombosis in pregnancy 4. Disseminated Intravascular Coagulation

in pregnancy 5. Ectopic Pregnancy 6. Fetal Monitoring 7. Gestational Diabetes 8. Hydatidiform Mole 9. Hypertension in pregnancy 10. Infertility 11. Isoimmunization 12. Mastitis 13. Normal Labor 14. Normal Physiology of Pregnancy 15. Nutrition in Pregnancy 16. Placental Abruption 17. Perineal Laceration 18. Placenta Previa 19. Postpartum Infection 20. Postpartum Hemorrhage 21. Preeclampsia 22. Postterm pregnancy 23. Prenatal screening 24. Preterm labor 25. Premature Rupture of Membranes 26. Pyelonephritis in pregnancy 27. TORCH infections 28. Sheehan's syndrome Gynecology 1. Amenorrhea, Primary 2. Amenorrhea, Secondary 3. Bacterial Vaginosis 4. Cervical Cancer 5. Chancroid 6. Endometriosis 7. Fibroids 8. Genital warts 9. Menopause 10. Ovarian cancer 11. Cervicitis 12. Pelvic Inflammatory Disease 13. Polycystic Ovarian Syndrome 14. Postmenopausal bleeding 15. Toxic Shock Syndrome 16. Trichomonas 17. Urinary incontinence 18. Vulvovaginal candidiasis

Pediatrics/Pediatric Surgery 1. Failure To Thrive (approach) 2. Abuse 3. Chronic Granulomatous Disease 4. Congenital Adrenal Hyperplasia 5. Congenital infections 6. Developmental dysplasia of the hip 7. Croup 8. Developmental Milestones 9. Down Syndrome 10. Duodenal Atresia 11. Febrile Seizure 12. Henoch‐Schonlein Purpura 13. Hirschsprung Disease 14. Intussusception 15. Kawasaki Disease 16. Meningitis 17. Necrotizing Enterocolitis 18. Omphalocele/Gastroschisis 19. Otitis Media 20. Physiologic jaundice 21. Pyloric stenosis 22. Respiratory Distress in the Newborn 23. Respiratory Syncytial Virus Infection 24. Tay‐Sachs disease 25. Tetralogy of Fallot 26. Varicella 27. Ventricular Septal Defect 28. Wilm’s tumor 29. Minors (approach to consent)

Select Topics in Emergency Medicine/Trauma & Critical Care 1. Acetaminophen Overdose 2. Anaphylactic Shock 3. Bites, Animal and Human 4. Burn, Thermal 5. Carbon monoxide poisoning 6. Cardiac arrest 7. Deep Vein Thrombosis (DVT) 8. Drowning 9. Organophosphate poisoning, Acute 10. Retinal detachment 11. Supraventricular tachycardia 12. Syncope (approach) 13. Sore Throat (approach) 14. Testicular torsion 15. Wernicke's encephalopathy 16. Bioterrorism 17. Back pain (approach) 18. Herniated lumbar disk

1. Sepsis 2. Pneumothorax 3. Compartment syndrome 4. Trauma, Fracture, Orbital 5. Trauma, Fracture, Pelvis 6. Trauma, Penetrating, Neck 7. Trauma, Penetrating, Abdomen 8. Trauma, Urethral Injury 9.


Statistics (topics covered under “Research Methods in Clinical Science” VAPs) 1. Bias and Confounding 2. Incidence and Prevalence 3. Randomized Clinical Trials 4. Cohort Studies 5. Reliability and Validity 6. Sensitivity and Specificity 7. Positive Predictive Value, Negative

Predictive Value

Ethics and Legal Issues 1. Confidentially and Disclosure 2. End‐of‐life Issues (Advance Directives,

Withdrawal of Care) 3. Informed Consent 4.

Any takers? 1. Erectile Dysfunction 2. Domestic Violence 3. Health Screening 4. Benign Prostatic Hyperplasia


APPENDIX C (cont’d) Examples of USMLE Step 2 CK Questions Following examples are taken from the 2011 USMLE Step 2 Clinical Knowledge Content Description and General Information brochure accessed Sep 2011 from http://www.usmle.org/examinations/step2/step2ck_content.html. 1. A 42‐year‐old man comes to the physician for a routine follow‐up examination. He has a 15‐year history of

type 1 diabetes mellitus and an 8‐year history of hypertension. Current medications include insulin, lisinopril, and hydrochlorothiazide. He is 173 cm (5 ft 8 in) tall and weighs 68 kg (150 lb); BMI is 23 kg/m2. His pulse is 80/min, and blood pressure is 124/74 mm Hg. Examination of the lower extremities shows hair loss over the shins. No other abnormalities are noted. His hemoglobin A1c is 6.3%. Which of the following is most appropriate to reduce diabetic complications in this patient? (A) Reduction of systolic blood pressure to less than 120 mm Hg (B) Annual ophthalmologic examination (C) Annual exercise stress test (D) Add metformin to the regimen (E) Switch from lisinopril to atenolol

2. A 24‐year‐old primigravid woman with type 1 diabetes mellitus delivers a 3856‐g (8‐lb 8‐oz) newborn at 38

weeks' gestation. The pregnancy was complicated by poor control of her diabetes. The labor lasted 4 hours. Apgar scores were 7 and 7 at 1 and 5 minutes, respectively. Which of the following is the most appropriate neonatal blood test in the first 30 minutes after birth? (A) Determination of blood group and Rh (B) Measurement of hematocrit (C) Measurement of pH (D) Measurement of serum bilirubin concentration (E) Measurement of serum glucose concentration

3. A 62‐year‐old man comes to the physician because of a 3‐month history of progressive fatigue and joint pain, a 2‐month history of sinus congestion, a 3‐week history of cough, and a 1‐week history of blood‐tinged sputum. He has not had fever, nausea, vomiting, or diarrhea. He has hypercholesterolemia, stable angina pectoris, and hypertension. Medications include atorvastatin, labetalol, isosorbide, and aspirin. Over the past 3 weeks, he has been taking over‐the‐counter ibuprofen as needed for the joint pain. His pulse is 84/min, respirations are 12/min, and blood pressure is 132/76 mm Hg. Examination shows clear nasal discharge with no nasal or oral lesions. The joints are diffusely tender with no warmth or erythema; range of motion is full. Laboratory studies show:

Hematocrit 36% Mean corpuscular volume 83 μm3 Leukocyte count 14,000/mm3 Segmented neutrophils 74% Eosinophils 1% Lymphocytes 14% Monocytes 11% Platelet count 275,000/mm Serum Urea nitrogen 28 mg/dL Creatinine 3.2 mg/dL

Antinuclear antibodies 1:256 Rheumatoid factor negative Antineutrophil cytoplasmic antibodies positive Urine Blood 3+ Protein 3+ RBC 15–17/hpf WBC 1–2/hpf RBC casts rare

Which of the following is the most likely underlying mechanism of this patient's renal failure?

(A) Atheroembolic disease (B) Cold agglutinins (C) Interstitial nephritis (D) Lyme disease (E) Septic arthritis (F) Vasculitis

4. A 57‐year‐old man comes to the emergency department because of fever, shortness of breath, chest pain,

rigor, and cough productive of blood‐tinged sputum for 4 hours; the chest pain is sharp, nonradiating, and located just below the scapula on the right. He says that he has had a cold for the past week. He has a history of alcoholism, cholelithiasis, hypertension, and seasonal allergic rhinitis. He does not smoke cigarettes and has been abstinent from alcohol for 6 months. He appears diaphoretic and slightly cyanotic.


His temperature is 39.9°C (103.8°F), pulse is 110/min, respirations are 34/min and shallow, and blood pressure is 130/70 mm Hg. There is dullness to percussion and bronchial breath sounds over the right posterior lung field. The remainder of the examination shows no abnormalities. Laboratory studies show:

Hemoglobin 14 g/dL Leukocyte count 18,000/mm3 Segmented neutrophils 60% Bands 30% Lymphocytes 10% Platelet count 500,000/mm3

An x‐ray of the chest shows a right lower lobe infiltrate. This patient most likely has which of the following types of pneumonia? (A) Aspiration (B) Haemophilus influenzae (C) Histoplasma capsulatum (D) Klebsiella pneumoniae (E) Legionella pneumophila (F) Moraxella catarrhalis

(G) Mycoplasma pneumoniae (H) Nocardial (I) Pneumococcal (J) Pneumocystis jiroveci (formerly P. carinii) (K) Pseudomonas aeruginosa (L) Staphylococcal

5. A 22‐year‐old man is brought to the emergency department 30 minutes after he sustained a gunshot wound

to the abdomen. His pulse is 120/min, respirations are 28/min, and blood pressure is 70/40 mm Hg. Breath sounds are normal on the right and decreased on the left. Abdominal examination shows an entrance wound in the left upper quadrant at the midclavicular line below the left costal margin. There is an exit wound laterally in the left axillary line at the 4th rib. Intravenous fluid resuscitation is begun. Which of the following is the most appropriate next step in management? (A) Upright x‐ray of the chest (B) CT scan of the chest (C) Intubation and mechanical ventilation (D) Peritoneal lavage (E) Left tube thoracostomy

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