I remember having to travel all the way to Singapore 5 years ago. I enjoy travelling but not when I am nursing and that day I still remember hubby sending me off to KLIA in the when it was still dark (he goes to HKL roughly 7am, so we would have left home before that).
Then, waiting for flight and travelling to NUS, luckily traffic wasn't that bad in comparison to rush hour in KL. I remember the simulation unit in NUS was quite large, one whole floor. The staff were friendly. I cant remember much about the demonstration, but again we had a very mixed group ranging from lab technicians to medical lecturers, same as today's crowd from cardiologists to nurses, all the way from Thailand and Indonesia. I lucked out, only heard about the workshop a few days ago.
When I joined USM, I was impressed with the huge Clinical Skills Centre they have there because I dont remember using one as a student. The only remote thing I remember to using simulation as a student was performing a per vaginal exam and inserting a speculum in a mannequin, and using manneqins for basic life support, paediatric life support and advanced cardiac life support during training after graduation.
Then I joined Taylors and was very impressed with Harvey. I remember the murmur clinic we attended during final year, it was one cold morning where they gathered about 30-40 patients in an outpatient clinic, and all us 100 or so medical students went around listening to all the murmurs, taking on average maybe 3-5 minutes per patient and we were done by lunch time.
I have never heard so many different murmurs in so many different patients in one day, the rest of my life so far. It was a very intense session, and I'm sure more beneficial than not having any at all. But my point is, murmurs are not easy, even after many years of practice. So Harvey is a brilliant idea. You can listen as long as you want, whenever (depending on the opening hours of the clinical skills unit) you want, and keep practising as much as you need until you are confident. I wish my medical school had a Harvey when I was a student. Another point I'd like to make is that murmurs, although not that common in clinical practice, is extremely common in internal medical exams, both at the undergraduate and postgraduate level because patients are usually well, and the physical signs are usually stable, the ideal exam patient.
Harvey is also the ideal exam patient, and more ideal that patients themselves as Harvey does not get tired and doesn't mind being poked and prodded. One setback is you may require more than one unit if your OSCE has more than one cycle. Sometimes, it may also overheat. So remember to let it cool during the break.
I learnt today that Harvey is named after a cardiologist by a doctor who created Harvey, whose name is Gordon. Dr Gordon was so impressed with Dr Harvey, who basically uses bedside skills and a stethoscope to make diagnoses equivalent to what other doctors would need an echo to do.
Upcoming developments for Harvey: they will soon release more diseases (currently there are only 30) between 10-20 more and will also feature a faster heart rate of 90 beats per minute (currently Harvey's rate is 60 beats per minute).
No, they are not planning to have an Asian version, nor a female version, nor a paediatric version of Harvey. And the reason Harvey is big is that they need the space for all the contraptions that make it work.
Points for students:
Do not eat or drink near Harvey.
Do not use a pen near Harvey (use only pencils). Ink will stain and become a permanent tattoo.
Do not press too hard on the arterial pulses or you might obliterate it (I think this is the same for real patients).
You can palpate the jugular venous pulse in Harvey but it is not palpable in real patients (this is due to the mechanics of how the pulse is formed)
Other points for students:
Revise the JVP double flicker or complex wave components.
Understand why a and v waves are formed.
Describe why cannon v waves are formed.
Apex beat/PMI - why is it felt and what are the reasons the wave or impulse could be slow-rising.
Other abnormalities of the pulse such as parvus at tardus, bisferiens
Causes of displaced apex beat
The effects of increased preload - hypertrophy, increased afterload - dilatation
I was disappointed that the session did not start 9am as planned as I arrived 15 minutes earlier. Prof Scalese was there even earlier. We started 9.15am because we had to wait for people who were late.
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