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Edited by Jonathan Vernon, Saturday, 1 Feb 2020, 09:15

Using Lego Bricks to help orthopaedic surgeons understand different kinds of break of the upper humerus

Showing her true metal and drilling through every piece of information available relating to a displacement fracture of the upper humerus, and comparing French with English approaches, is now touching on my knowledge and experience of online learning in interesting ways.

A fall on a ski slope and thoughts of a dislocated shoulder saw us in a Cabinet Medical oat the bottom of the slope (Flaine) then a visit to a French Hospital. Triaged and seen within 90 minutes, an x-ray then a wheelchair to a room. Would a CT scan be required? Would it be taken then and there, or the next day? Would there be surgery involved?

Two days later we were in England, once again in A & E and once again faced with the question of whether a CT Scan was necessary. The CT Scan finally took place 9 days after the accident. X Rays had put the break on the cusp of needing further investigation to decide if surgery was required. It isn't - apparently.

In France surgery had been thought likely the day after the accident, then delayed to the following week. In England it was thought highly unlikely that there would be surgery - so no invasive procedure to add nails or plates to stabilise the two displaced fractures that had been identified.

Here comes the online learning bit. The 'Virtual Treatment' that has a dependency of online content, and video tutorials. Needless to say we are given bits of paper printed out, needless to say a copy of the CT scan comes on a disc, not via WeTransfer or Dropbox, needless to say 'we' (It is of course my wife) is on the phone and I am taking her in to see someone to change an unsatisfactory sling, or to seek more convincing advice on exercises required for her break at this time.

The issue when it comes to e-learning is this:  what does replacing the human face to face contact of a subject matter expect, a mentor (1 to 1), a tutor (small group) or a teacher (class) have either advantages or disadvantages? Thinking we must do away with one and do everything online is foolish. Indeed, I am rather wondering that by directing people online and by default inviting those with any aptitude to search online they come away with far, far more unanswered questions that will have to be dealt with by a person.

If I had £500,000 to spend on education in an institution am I going to spend it on tablets, desktops and Virtual googles, or a some informed, bright and motivated teachers? 

Links > Lego Humerus Fracture article 

As a patient my wife has access to the Virtual Fracture Clinic. Here we have there are clear, excellent direct to camera explanations and demonstrations. However, not embedded correctly these are difficult to use on an old iPhone. They of course assume that patients have ready access to the Internet - is that likely where those presenting with this kind of injury have an average age of 72? And then too much of the text is aimed at management and senior clinicians. When nursing her arm and struggling to understand the right approach to take to pain relief, one of three different slings she has now used and physiotherapy does she really need to be made to feel that the primary goal and achievement of the Virtual Fracture Clinic is to save money? £250,000 we are told since it was set up.

Wherein we can once again make a comparison to education.

The aim is to teach more students well for less money. To have fewer teachers managing more students and getting at least the same results (ideally better) and so saving money. 

I feel a backlash is over due. More and better teachers in front of smaller classes, with more face to face time for personalised feedback is the answer.

Take these videos on how to put on a sling for a fractured limb. Useful as an aide memoire after a face to face demo, but think of the differences between a child, teenager, fit middle age or over weight elderly person, make or female ? There is no one-size fits all video. Rather a consultation should be recorded and shared with the online savvy patient. 

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