{"version":"1.0.0","segments":[{"startTime":27.42,"endTime":30.040000000000003,"body":"A student once asked me, how do you"},{"startTime":27.42,"endTime":30.040000000000003,"body":"remember everything in medicine?"},{"startTime":30.130000000000003,"endTime":32.95,"body":"How can you possibly learn it all and"},{"startTime":30.130000000000003,"endTime":32.95,"body":"keep track of everything you need to know?"},{"startTime":33.5,"endTime":36.120000000000005,"body":"There's so much to learn,"},{"startTime":33.5,"endTime":36.120000000000005,"body":"there's so much to do and see."},{"startTime":36.120000000000005,"endTime":38.034000000000006,"body":"Visit How can you possibly do it all?"},{"startTime":38.695,"endTime":39.864000000000004,"body":"Well, medicine is difficult."},{"startTime":39.915,"endTime":42.005,"body":"It's hard to remember things,"},{"startTime":39.915,"endTime":42.005,"body":"but you've got to work out a"},{"startTime":42.005,"endTime":43.435,"body":"technique that works for yourself."},{"startTime":44.464,"endTime":47.234,"body":"Today we're going to discuss a technique"},{"startTime":44.464,"endTime":47.234,"body":"that I used going through many years ago."},{"startTime":47.955,"endTime":50.375,"body":"It's a way of dividing things up"},{"startTime":47.955,"endTime":50.375,"body":"into simple little aliquots of"},{"startTime":50.375,"endTime":52.045,"body":"information to help me remember things."},{"startTime":52.474000000000004,"endTime":53.944,"body":"It's called the rule of threes."},{"startTime":54.455,"endTime":56.444,"body":"G'day, and welcome to Aussie Med Ed."},{"startTime":58.565,"endTime":61.725,"body":"G'day and welcome to Aussie Med Ed, the"},{"startTime":58.565,"endTime":61.725,"body":"Australian medical education podcast"},{"startTime":62.035000000000004,"endTime":64.965,"body":"designed with a pragmatic approach"},{"startTime":62.035000000000004,"endTime":64.965,"body":"to medical conditions by interviewing"},{"startTime":64.965,"endTime":66.244,"body":"specialists in the medical field."},{"startTime":66.845,"endTime":69.774,"body":"I'm Gavin Nimon, an orthopaedic"},{"startTime":66.845,"endTime":69.774,"body":"surgeon based in Adelaide and"},{"startTime":69.775,"endTime":71.105,"body":"I'm broadcasting from Kaurna Land"},{"startTime":71.125,"endTime":74.525,"body":"I'd like to remind you that this"},{"startTime":71.125,"endTime":74.525,"body":"podcast is available on all podcast"},{"startTime":74.535,"endTime":77.33500000000001,"body":"players and is also available"},{"startTime":74.535,"endTime":77.33500000000001,"body":"as a video version on YouTube."},{"startTime":78.005,"endTime":80.305,"body":"I'd also like to remind you that"},{"startTime":78.005,"endTime":80.305,"body":"if you enjoy this podcast, please"},{"startTime":80.33500000000001,"endTime":83.914,"body":"subscribe or leave a review or give us"},{"startTime":80.33500000000001,"endTime":83.914,"body":"a thumbs up as I really appreciate the"},{"startTime":83.914,"endTime":85.164,"body":"support and it helps the channel grow."},{"startTime":85.84,"endTime":88.34,"body":"I'd like to start the podcast by"},{"startTime":85.84,"endTime":88.34,"body":"acknowledging the traditional owners"},{"startTime":88.34,"endTime":91.30000000000001,"body":"of the land on which this podcast"},{"startTime":88.34,"endTime":91.30000000000001,"body":"is produced, the Kaurna people,"},{"startTime":91.61,"endTime":94.36,"body":"and pay my respects to the Elders"},{"startTime":91.61,"endTime":94.36,"body":"both past, present and emerging."},{"startTime":99.08,"endTime":100.42,"body":"G'day and welcome to Aussie Med Ed."},{"startTime":100.83,"endTime":104.51,"body":"Today we're going to talk about a study"},{"startTime":100.83,"endTime":104.51,"body":"technique, one that relies on a simple"},{"startTime":104.51,"endTime":105.944,"body":"pattern using the rule of threes."},{"startTime":106.665,"endTime":109.485,"body":"It's a method I use going through"},{"startTime":106.665,"endTime":109.485,"body":"medicine, and one that I tend"},{"startTime":109.485,"endTime":110.865,"body":"to use in teaching orthopaedics."},{"startTime":111.375,"endTime":114.72500000000001,"body":"I'll start off by saying that it's only"},{"startTime":111.375,"endTime":114.72500000000001,"body":"one method, and one that works for me,"},{"startTime":114.815,"endTime":116.355,"body":"but it may not be suitable for everyone."},{"startTime":116.69500000000001,"endTime":118.755,"body":"This method can be used for any"},{"startTime":116.69500000000001,"endTime":118.755,"body":"study or learning technique."},{"startTime":118.965,"endTime":122.08500000000001,"body":"But obviously my area is medicine, and"},{"startTime":118.965,"endTime":122.08500000000001,"body":"that's what I'm applying to it today."},{"startTime":122.775,"endTime":124.324,"body":"Now there are methods"},{"startTime":122.775,"endTime":124.324,"body":"of learning medicine."},{"startTime":124.734,"endTime":128.175,"body":"One technique that many of my"},{"startTime":124.734,"endTime":128.175,"body":"colleagues would use was using acronyms."},{"startTime":128.555,"endTime":131.265,"body":"This is where a letter of a word"},{"startTime":128.555,"endTime":131.265,"body":"is used to spell out a list."},{"startTime":131.635,"endTime":133.775,"body":"Often the acronym might"},{"startTime":131.635,"endTime":133.775,"body":"involve a catchy phrase."},{"startTime":134.374,"endTime":136.904,"body":"Despite having an amazing musical"},{"startTime":134.374,"endTime":136.904,"body":"type memory, I always found"},{"startTime":136.904,"endTime":138.024,"body":"these very difficult to remember."},{"startTime":138.034,"endTime":140.115,"body":"I also found them not that relevant."},{"startTime":140.635,"endTime":144.19400000000002,"body":"The classic one that I always did remember"},{"startTime":140.635,"endTime":144.19400000000002,"body":"was vitamin D, as a way of recalling a"},{"startTime":144.195,"endTime":147.89499999999998,"body":"generalised list and attempting to provide"},{"startTime":144.195,"endTime":147.89499999999998,"body":"a differential diagnosis for a condition."},{"startTime":148.625,"endTime":151.114,"body":"The clinician might have asked me,"},{"startTime":148.625,"endTime":151.114,"body":"so Gavin, what's the differential"},{"startTime":151.114,"endTime":152.385,"body":"diagnosis for chest pain?"},{"startTime":152.945,"endTime":157.03500000000003,"body":"I never found that recalling vascular,"},{"startTime":152.945,"endTime":157.03500000000003,"body":"inflammatory, traumatic, etc."},{"startTime":157.265,"endTime":158.12400000000002,"body":"was all that helpful."},{"startTime":158.505,"endTime":161.274,"body":"Whilst it produces a list, often it"},{"startTime":158.505,"endTime":161.274,"body":"starts with quite rare conditions and"},{"startTime":161.27499999999998,"endTime":162.745,"body":"the list always seems quite haphazard."},{"startTime":163.37400000000002,"endTime":166.575,"body":"On top of this, the numerous lists of"},{"startTime":163.37400000000002,"endTime":166.575,"body":"acronyms were always difficult to recall."},{"startTime":166.935,"endTime":170.56400000000002,"body":"My approach to this was going down a"},{"startTime":166.935,"endTime":170.56400000000002,"body":"very keep it simple approach, breaking up"},{"startTime":170.56400000000002,"endTime":172.62400000000002,"body":"diagnoses into how patients might present."},{"startTime":173.094,"endTime":175.675,"body":"That is, picturing how I might come"},{"startTime":173.094,"endTime":175.675,"body":"across the patients with a condition."},{"startTime":176.235,"endTime":179.594,"body":"This involves dividing into small"},{"startTime":176.235,"endTime":179.594,"body":"divisions which builds upon themselves."},{"startTime":180.39,"endTime":183.57,"body":"I always did this for many years, but I"},{"startTime":180.39,"endTime":183.57,"body":"didn't realise this technique had a name."},{"startTime":184.389,"endTime":186.97899999999998,"body":"Years ago, my daughter asked"},{"startTime":184.389,"endTime":186.97899999999998,"body":"me to check an English essay."},{"startTime":187.45999999999998,"endTime":190.39999999999998,"body":"I came across obvious metaphors and"},{"startTime":187.45999999999998,"endTime":190.39999999999998,"body":"similes which she discussed, which"},{"startTime":190.39999999999998,"endTime":193.23000000000002,"body":"I all knew about, but then I noted"},{"startTime":190.39999999999998,"endTime":193.23000000000002,"body":"that she had classified one part of"},{"startTime":193.23000000000002,"endTime":194.67000000000002,"body":"her essay into the rule of threes."},{"startTime":194.89,"endTime":196.139,"body":"I didn't even know what this was."},{"startTime":196.55,"endTime":198.99900000000002,"body":"I went and looked it up and"},{"startTime":196.55,"endTime":198.99900000000002,"body":"thought, God, that's the technique"},{"startTime":199.00900000000001,"endTime":200.14999999999998,"body":"that I've been using all my life."},{"startTime":200.82,"endTime":204.39,"body":"I realised my technique, which involved"},{"startTime":200.82,"endTime":204.39,"body":"learning small subsets using a very"},{"startTime":204.64,"endTime":207.89999999999998,"body":"simple approach, had a name, and"},{"startTime":204.64,"endTime":207.89999999999998,"body":"that's called the Rule of Threes."},{"startTime":208.56,"endTime":212.36,"body":"This approach of learning less"},{"startTime":208.56,"endTime":212.36,"body":"helps you learn more, in my mind."},{"startTime":212.64,"endTime":213.66000000000003,"body":"But what is this Rule of Threes?"},{"startTime":213.66000000000003,"endTime":214.48000000000002,"body":"What does it involve?"},{"startTime":214.91000000000003,"endTime":217.03000000000003,"body":"The concept of Rule of Threes"},{"startTime":214.91000000000003,"endTime":217.03000000000003,"body":"is a writing principle."},{"startTime":217.17000000000002,"endTime":220.64999999999998,"body":"It's actually one where you divide things"},{"startTime":217.17000000000002,"endTime":220.64999999999998,"body":"up into three subsets of information."},{"startTime":221.14,"endTime":223.66000000000003,"body":"In doing this, it helps you recall"},{"startTime":221.14,"endTime":223.66000000000003,"body":"information, and when answering a"},{"startTime":223.66000000000003,"endTime":227.29000000000002,"body":"question, offering three options, that"},{"startTime":223.66000000000003,"endTime":227.29000000000002,"body":"gives you some substance to your answer."},{"startTime":228.19,"endTime":230.45,"body":"It's probably something you've been"},{"startTime":228.19,"endTime":230.45,"body":"exposed to throughout your life."},{"startTime":230.635,"endTime":234.95499999999998,"body":"You might have heard nursery rhymes or"},{"startTime":230.635,"endTime":234.95499999999998,"body":"children's stories involving it, the"},{"startTime":234.95499999999998,"endTime":239.135,"body":"three blind mice, Goldilocks and the three"},{"startTime":234.95499999999998,"endTime":239.135,"body":"bears, the story of the three little pigs."},{"startTime":239.865,"endTime":242.875,"body":"Popular music often involves three"},{"startTime":239.865,"endTime":242.875,"body":"chords or has three divisions,"},{"startTime":242.91500000000002,"endTime":244.315,"body":"verse, chorus and bridge."},{"startTime":244.64499999999998,"endTime":247.765,"body":"And of course, famous speeches also"},{"startTime":244.64499999999998,"endTime":247.765,"body":"often involve just three words."},{"startTime":248.08499999999998,"endTime":250.45499999999998,"body":"Julius Caesar, I came, I saw, I conquered."},{"startTime":250.945,"endTime":253.53500000000003,"body":"And also when you talk about"},{"startTime":250.945,"endTime":253.53500000000003,"body":"location, you know, in property"},{"startTime":253.53500000000003,"endTime":255.675,"body":"market, location, location, location."},{"startTime":256.445,"endTime":259.495,"body":"Even in social life, how often do"},{"startTime":256.445,"endTime":259.495,"body":"you go out with two other friends,"},{"startTime":259.495,"endTime":260.685,"body":"making up a group of three?"},{"startTime":261.324,"endTime":264.144,"body":"And when you're going for job interviews,"},{"startTime":261.324,"endTime":264.144,"body":"a structured answer to the question of"},{"startTime":264.314,"endTime":267.144,"body":"what your goals are in life sounds so"},{"startTime":264.314,"endTime":267.144,"body":"much better when answering about your"},{"startTime":267.395,"endTime":269.535,"body":"short, intermediate and long term goals."},{"startTime":270.15,"endTime":272.7,"body":"In the same way, when offering advice,"},{"startTime":270.15,"endTime":272.7,"body":"or if someone asks you, what do"},{"startTime":272.7,"endTime":275.72,"body":"you think the options are, thinking"},{"startTime":272.7,"endTime":275.72,"body":"of the three things sounds so much"},{"startTime":275.72,"endTime":277.3,"body":"better, they just roll off the tongue."},{"startTime":277.74,"endTime":279.96,"body":"When you try to think of anything"},{"startTime":277.74,"endTime":279.96,"body":"further, it makes it hard, and if"},{"startTime":279.96,"endTime":282.819,"body":"you only offer one or two options,"},{"startTime":279.96,"endTime":282.819,"body":"it doesn't look quite as impressive."},{"startTime":283.889,"endTime":286.189,"body":"In medicine, diagnosis is the key."},{"startTime":286.54,"endTime":288.469,"body":"The diagnosis is what dictates treatment."},{"startTime":288.92,"endTime":291.089,"body":"The role of assessing a patient"},{"startTime":288.92,"endTime":291.089,"body":"is to determine diagnosis."},{"startTime":292.45,"endTime":295.909,"body":"Diagnosis is formed by taking a"},{"startTime":292.45,"endTime":295.909,"body":"history, performing an examination,"},{"startTime":296.11,"endTime":297.76,"body":"and then undertaking investigations."},{"startTime":298.27000000000004,"endTime":299.08000000000004,"body":"Three things again."},{"startTime":300.91,"endTime":303.309,"body":"History is predominantly what"},{"startTime":300.91,"endTime":303.309,"body":"helps you make the diagnosis."},{"startTime":304.195,"endTime":305.14500000000004,"body":"It's the most valuable."},{"startTime":306.115,"endTime":310.83500000000004,"body":"Examination helps you confirm the"},{"startTime":306.115,"endTime":310.83500000000004,"body":"diagnosis, while the investigations again"},{"startTime":310.845,"endTime":314.40500000000003,"body":"help you back up the diagnosis, but help"},{"startTime":310.845,"endTime":314.40500000000003,"body":"you stage your conditions, determine"},{"startTime":314.40500000000003,"endTime":316.365,"body":"treatment options and determine prognosis."},{"startTime":316.60400000000004,"endTime":320.035,"body":"Investigations then also help you"},{"startTime":316.60400000000004,"endTime":320.035,"body":"further confirm the diagnosis, but also"},{"startTime":320.045,"endTime":323.034,"body":"assist you in staging the condition,"},{"startTime":320.045,"endTime":323.034,"body":"one, determine treatment options"},{"startTime":323.034,"endTime":325.259,"body":"two, and determine prognosis three."},{"startTime":326.13,"endTime":329.019,"body":"Now whilst I would always start"},{"startTime":326.13,"endTime":329.019,"body":"by stating that in medicine you"},{"startTime":329.019,"endTime":330.04900000000004,"body":"don't need to know everything."},{"startTime":330.56,"endTime":332.719,"body":"We need to know most common"},{"startTime":330.56,"endTime":332.719,"body":"and serious conditions."},{"startTime":333.16,"endTime":334.709,"body":"But often we have the advantage of time."},{"startTime":334.719,"endTime":337.79,"body":"In what I call, who wants to"},{"startTime":334.719,"endTime":337.79,"body":"be the millionaire approach."},{"startTime":338.31,"endTime":340.51,"body":"If you don't know the answer"},{"startTime":338.31,"endTime":340.51,"body":"you can always phone a friend."},{"startTime":340.6,"endTime":342.92,"body":"That's when you get a specialist"},{"startTime":340.6,"endTime":342.92,"body":"opinion or consult someone."},{"startTime":344.14000000000004,"endTime":346.26,"body":"You might, you might"},{"startTime":344.14000000000004,"endTime":346.26,"body":"need to ask the audience."},{"startTime":346.6,"endTime":349.81,"body":"I, therefore you present the"},{"startTime":346.6,"endTime":349.81,"body":"scenario at a grand round, two."},{"startTime":350.24,"endTime":352.31,"body":"Or you may need to come"},{"startTime":350.24,"endTime":352.31,"body":"back and play the next day."},{"startTime":352.649,"endTime":353.849,"body":"See the patient back again."},{"startTime":354.119,"endTime":357.48900000000003,"body":"After you've had, this is after you've"},{"startTime":354.119,"endTime":357.48900000000003,"body":"had time to research the diagnosis, three."},{"startTime":358.79,"endTime":360.28000000000003,"body":"So really medicine can be quite simple."},{"startTime":360.42,"endTime":363.15000000000003,"body":"If you keep getting into this sort of"},{"startTime":360.42,"endTime":363.15000000000003,"body":"rule of threes it makes it even easier."},{"startTime":363.37,"endTime":366.34000000000003,"body":"The most and best way of being safe and"},{"startTime":363.37,"endTime":366.34000000000003,"body":"effective doctor is by learning the more"},{"startTime":366.34000000000003,"endTime":368.07,"body":"common things and then expanding upon it."},{"startTime":368.53000000000003,"endTime":370.74,"body":"This will help you learn"},{"startTime":368.53000000000003,"endTime":370.74,"body":"medicine in a very effective way."},{"startTime":371.72900000000004,"endTime":374.329,"body":"Returning to the rule of threes has"},{"startTime":371.72900000000004,"endTime":374.329,"body":"benefits in that dividing things up"},{"startTime":374.329,"endTime":378.139,"body":"into three helps memory retention"},{"startTime":374.329,"endTime":378.139,"body":"by combining brevity and rhythm to"},{"startTime":378.259,"endTime":379.88,"body":"combine into a creative pattern."},{"startTime":380.83000000000004,"endTime":384.159,"body":"Now I can hear you say, do we really"},{"startTime":380.83000000000004,"endTime":384.159,"body":"divide everything up into threes?"},{"startTime":384.159,"endTime":385.03000000000003,"body":"Does it always work?"},{"startTime":385.05,"endTime":388.81,"body":"Well, if you think of a three as the"},{"startTime":385.05,"endTime":388.81,"body":"most common And you think of a Gaussian"},{"startTime":388.84000000000003,"endTime":392.44,"body":"distribution of numbers, the bell curve,"},{"startTime":388.84000000000003,"endTime":392.44,"body":"if 3 is the most common number, then"},{"startTime":392.44,"endTime":395.61,"body":"I think we can stretch the scenario to"},{"startTime":392.44,"endTime":395.61,"body":"occasionally incorporate the rule of 4s."},{"startTime":396.37,"endTime":399.62,"body":"So you might say to me, okay, that's"},{"startTime":396.37,"endTime":399.62,"body":"all very good, but how is this useful"},{"startTime":399.62,"endTime":400.93,"body":"for learning the whole of medicine?"},{"startTime":401.079,"endTime":404.209,"body":"Well again, when I'm assessing a patient,"},{"startTime":401.079,"endTime":404.209,"body":"I'm trying to form a diagnosis, and"},{"startTime":404.209,"endTime":409.295,"body":"unless you know all the possible common"},{"startTime":404.209,"endTime":409.295,"body":"diagnoses, The way I can remember what"},{"startTime":409.295,"endTime":411.95500000000004,"body":"conditions can occur is by thinking"},{"startTime":409.295,"endTime":411.95500000000004,"body":"about how the patient might present."},{"startTime":412.615,"endTime":414.615,"body":"They usually can present"},{"startTime":412.615,"endTime":414.615,"body":"in one of three ways."},{"startTime":414.644,"endTime":418.144,"body":"They can present in an emergency scenario,"},{"startTime":414.644,"endTime":418.144,"body":"traumatic condition, or an elective"},{"startTime":418.14500000000004,"endTime":422.055,"body":"scenario to a clinic, or as a mixed"},{"startTime":418.14500000000004,"endTime":422.055,"body":"picture, something that comes in through"},{"startTime":422.095,"endTime":423.714,"body":"casually but then becomes more elective."},{"startTime":424.344,"endTime":425.755,"body":"And that's my three definitions."},{"startTime":425.755,"endTime":429.505,"body":"In my area, with a shoulder"},{"startTime":425.755,"endTime":429.505,"body":"condition, traumatic conditions"},{"startTime":429.505,"endTime":430.745,"body":"can be one of three options."},{"startTime":431.365,"endTime":433.725,"body":"Fractures, dislocations and infections."},{"startTime":434.5,"endTime":438.02000000000004,"body":"Now you can actually get a fourth option"},{"startTime":434.5,"endTime":438.02000000000004,"body":"of which involves tendon tears, such as"},{"startTime":438.02000000000004,"endTime":441.73,"body":"if you get a tear of the rotator cuff,"},{"startTime":438.02000000000004,"endTime":441.73,"body":"but this often is usually an elective"},{"startTime":441.73,"endTime":443.869,"body":"presentation, it usually presents slowly."},{"startTime":444.26,"endTime":445.82,"body":"But you can think of"},{"startTime":444.26,"endTime":445.82,"body":"three or four conditions."},{"startTime":446.3,"endTime":448.889,"body":"In the shoulder, I often say to"},{"startTime":446.3,"endTime":448.889,"body":"the student, what can be fractured?"},{"startTime":449.12,"endTime":451.83500000000004,"body":"When I ask a medical student what"},{"startTime":449.12,"endTime":451.83500000000004,"body":"can be fractured, You often get a"},{"startTime":451.83500000000004,"endTime":455.26500000000004,"body":"bit confused when I pick a bone at"},{"startTime":451.83500000000004,"endTime":455.26500000000004,"body":"random, like a clavicle or a humerus."},{"startTime":455.26500000000004,"endTime":458.005,"body":"But if you break it down in"},{"startTime":455.26500000000004,"endTime":458.005,"body":"the shoulder, there are three"},{"startTime":458.035,"endTime":459.175,"body":"bones that make up the shoulder."},{"startTime":459.475,"endTime":461.974,"body":"The clavicle, proximal"},{"startTime":459.475,"endTime":461.974,"body":"humerus and scapula."},{"startTime":462.355,"endTime":463.755,"body":"I say then what can be dislocated?"},{"startTime":464.115,"endTime":468.004,"body":"Well obviously a joint, and the three are"},{"startTime":464.115,"endTime":468.004,"body":"sternoclavicular joint, chromioclavicular"},{"startTime":468.005,"endTime":469.644,"body":"joint and the glenohumeral joint."},{"startTime":470.325,"endTime":471.374,"body":"Now what can be infected?"},{"startTime":471.435,"endTime":474.485,"body":"Well either the bones, the joints"},{"startTime":471.435,"endTime":474.485,"body":"or the soft tissues around it."},{"startTime":475.385,"endTime":478.325,"body":"If we consider what can be torn or"},{"startTime":475.385,"endTime":478.325,"body":"ruptured, well obviously the tendons."},{"startTime":478.885,"endTime":481.625,"body":"And these tendons can be the most"},{"startTime":478.885,"endTime":481.625,"body":"common ones of the rotator cuff,"},{"startTime":481.714,"endTime":485.375,"body":"of which there are four tendons,"},{"startTime":481.714,"endTime":485.375,"body":"the supraspinatus, infraspinatus,"},{"startTime":485.375,"endTime":487.344,"body":"subscapularis, and teres minor."},{"startTime":487.79400000000004,"endTime":490.144,"body":"But in reality, the teres minor"},{"startTime":487.79400000000004,"endTime":490.144,"body":"doesn't really tear quite as"},{"startTime":490.264,"endTime":491.365,"body":"easily as the other three."},{"startTime":492.49,"endTime":495.82,"body":"Obviously, you can have a rotator cuff"},{"startTime":492.49,"endTime":495.82,"body":"torn, but the other tendon that tears"},{"startTime":495.82,"endTime":497.499,"body":"quite commonly is the long headed biceps."},{"startTime":498.15000000000003,"endTime":500.99,"body":"And again, the third one we should"},{"startTime":498.15000000000003,"endTime":500.99,"body":"think about is the pectoralis major."},{"startTime":501.459,"endTime":503.52000000000004,"body":"So again, you've got to get"},{"startTime":501.459,"endTime":503.52000000000004,"body":"group of three to think about."},{"startTime":504.779,"endTime":506.879,"body":"So you can see why knowing"},{"startTime":504.779,"endTime":506.879,"body":"anatomy is quite useful."},{"startTime":506.93,"endTime":509.7,"body":"And in our course, we actually"},{"startTime":506.93,"endTime":509.7,"body":"combine and do a revision of"},{"startTime":509.7,"endTime":512.3,"body":"anatomy as a way of trying to help"},{"startTime":509.7,"endTime":512.3,"body":"learn medicine and orthopaedics."},{"startTime":513.749,"endTime":516.229,"body":"Now, if we look at elective"},{"startTime":513.749,"endTime":516.229,"body":"conditions, it's a similar scenario."},{"startTime":516.709,"endTime":519.579,"body":"However, the rule of threes doesn't"},{"startTime":516.709,"endTime":519.579,"body":"always apply quite as easily when it"},{"startTime":519.579,"endTime":521.944,"body":"comes to the elective conditions, as"},{"startTime":519.579,"endTime":521.944,"body":"we need to know more about just that."},{"startTime":522.405,"endTime":525.305,"body":"More than just the anatomy,"},{"startTime":522.405,"endTime":525.305,"body":"more the specific diagnoses."},{"startTime":525.614,"endTime":527.614,"body":"But often there are only a"},{"startTime":525.614,"endTime":527.614,"body":"few conditions that can occur."},{"startTime":528.285,"endTime":530.485,"body":"For instance, when it comes to"},{"startTime":528.285,"endTime":530.485,"body":"the shoulder, there's only really"},{"startTime":530.485,"endTime":532.435,"body":"about four conditions, effectively."},{"startTime":532.9449999999999,"endTime":536.0939999999999,"body":"Um, and only really three of"},{"startTime":532.9449999999999,"endTime":536.0939999999999,"body":"these relate to the shoulder."},{"startTime":536.145,"endTime":539.084,"body":"You've got the rotator cuff spectrum,"},{"startTime":536.145,"endTime":539.084,"body":"you've got the frozen shoulder"},{"startTime":539.084,"endTime":541.064,"body":"condition, and you've got arthritis."},{"startTime":541.3739999999999,"endTime":544.4939999999999,"body":"The fourth thing that can occur in the"},{"startTime":541.3739999999999,"endTime":544.4939999999999,"body":"shoulder is preferred pain from the neck."},{"startTime":544.995,"endTime":547.0949999999999,"body":"Now again, looking at the rotator"},{"startTime":544.995,"endTime":547.0949999999999,"body":"cuff, there are four muscles"},{"startTime":547.0949999999999,"endTime":548.405,"body":"that make up that rotator cuff."},{"startTime":548.805,"endTime":551.385,"body":"Really, there's only three stages"},{"startTime":548.805,"endTime":551.385,"body":"of rotator cuff conditions."},{"startTime":552.2149999999999,"endTime":555.9649999999999,"body":"There's the bursitis or tendinopathy,"},{"startTime":552.2149999999999,"endTime":555.9649999999999,"body":"there's rotator cuff tears, and"},{"startTime":555.9649999999999,"endTime":557.515,"body":"then there's secondary arthritis."},{"startTime":558.395,"endTime":561.4649999999999,"body":"So in other words, initially the person"},{"startTime":558.395,"endTime":561.4649999999999,"body":"may present with bursitis and tendinopathy"},{"startTime":561.4649999999999,"endTime":565.3639999999999,"body":"with a painful arc, then they may have"},{"startTime":561.4649999999999,"endTime":565.3639999999999,"body":"similar features with a small rotator cuff"},{"startTime":565.3639999999999,"endTime":569.0939999999999,"body":"tear, but as it gets bigger it can lead to"},{"startTime":565.3639999999999,"endTime":569.0939999999999,"body":"weakness, and then as it gets even bigger"},{"startTime":569.0949999999999,"endTime":570.985,"body":"again it can lead to secondary arthritis."},{"startTime":571.675,"endTime":573.934,"body":"If we think about frozen shoulder,"},{"startTime":571.675,"endTime":573.934,"body":"there are actually three main"},{"startTime":573.934,"endTime":575.2439999999999,"body":"stages of frozen shoulder."},{"startTime":575.4549999999999,"endTime":578.7249999999999,"body":"There's the acute painful stage,"},{"startTime":575.4549999999999,"endTime":578.7249999999999,"body":"then there's the stiff phase, and"},{"startTime":578.7249999999999,"endTime":580.0849999999999,"body":"then there's the thawing phase."},{"startTime":580.694,"endTime":584.3549999999999,"body":"Again, three type stages of a,"},{"startTime":580.694,"endTime":584.3549999999999,"body":"of a frozen shoulder condition."},{"startTime":584.6239999999999,"endTime":587.544,"body":"When it comes to arthritis, I like to"},{"startTime":584.6239999999999,"endTime":587.544,"body":"think of arthritis as being primary"},{"startTime":587.544,"endTime":590.9839999999999,"body":"osteoarthritis, one that occurs out of"},{"startTime":587.544,"endTime":590.9839999999999,"body":"the blue and is related to genetics."},{"startTime":591.2149999999999,"endTime":594.264,"body":"Secondary, secondary trauma or"},{"startTime":591.2149999999999,"endTime":594.264,"body":"infection or post rheumatoid"},{"startTime":594.264,"endTime":596.044,"body":"conditions or inflammatory arthritis."},{"startTime":597.0649999999999,"endTime":600.4839999999999,"body":"And then you get a inflammatory"},{"startTime":597.0649999999999,"endTime":600.4839999999999,"body":"type conditions, rheumatological"},{"startTime":600.485,"endTime":602.4649999999999,"body":"conditions, which is a huge number."},{"startTime":602.9749999999999,"endTime":606.2439999999999,"body":"And of course, we can look at"},{"startTime":602.9749999999999,"endTime":606.2439999999999,"body":"that in a separate, separate talk."},{"startTime":606.5849999999999,"endTime":609.0749999999999,"body":"We've already got two very good"},{"startTime":606.5849999999999,"endTime":609.0749999999999,"body":"talks on Aussie Med Ed from"},{"startTime":609.0749999999999,"endTime":610.305,"body":"Sam Whittle regarding this."},{"startTime":611.64,"endTime":613.7299999999999,"body":"Finally, if you look at referred"},{"startTime":611.64,"endTime":613.7299999999999,"body":"pain from the neck, you can divide"},{"startTime":613.7389999999999,"endTime":615.0,"body":"that up into three aspects too."},{"startTime":615.0,"endTime":618.3,"body":"You can either get referred pain,"},{"startTime":615.0,"endTime":618.3,"body":"mechanical pain into the scapula."},{"startTime":618.76,"endTime":622.38,"body":"You can get neck pain with radiculopathy,"},{"startTime":618.76,"endTime":622.38,"body":"secondary to nerve entrapment."},{"startTime":622.699,"endTime":626.12,"body":"Or you can get cervical spine pain with"},{"startTime":622.699,"endTime":626.12,"body":"actually long track signs of myelopathy."},{"startTime":626.51,"endTime":629.709,"body":"Finally, when I'm thinking about causes of"},{"startTime":626.51,"endTime":629.709,"body":"shoulder pathology, I've already mentioned"},{"startTime":629.7099999999999,"endTime":631.029,"body":"traumatic and elective conditions."},{"startTime":631.3299999999999,"endTime":635.149,"body":"There's also that mixed picture,"},{"startTime":631.3299999999999,"endTime":635.149,"body":"the third type of presentation."},{"startTime":635.409,"endTime":638.2199999999999,"body":"In the shoulder, this involves an"},{"startTime":635.409,"endTime":638.2199999999999,"body":"acute dislocated shoulder becoming"},{"startTime":638.2199999999999,"endTime":641.649,"body":"elective with recurrent subluxation"},{"startTime":638.2199999999999,"endTime":641.649,"body":"episodes, secondary to label tears,"},{"startTime":642.159,"endTime":643.3,"body":"after the initial acute dislocation."},{"startTime":644.8499999999999,"endTime":647.9989999999999,"body":"Therefore, you can see that by dividing"},{"startTime":644.8499999999999,"endTime":647.9989999999999,"body":"things up into groups of threes, it's a"},{"startTime":648.009,"endTime":649.959,"body":"simple way of easily remembering things."},{"startTime":651.0889999999999,"endTime":652.9799999999999,"body":"This rule of threes can also"},{"startTime":651.0889999999999,"endTime":652.9799999999999,"body":"be used when looking at other"},{"startTime":652.9799999999999,"endTime":654.3199999999999,"body":"things, such as complications."},{"startTime":654.8789999999999,"endTime":658.019,"body":"You think about complications as being"},{"startTime":654.8789999999999,"endTime":658.019,"body":"divided up into short, intermediate"},{"startTime":658.019,"endTime":661.5799999999999,"body":"and long term complications, and of"},{"startTime":658.019,"endTime":661.5799999999999,"body":"course being localised or generalised."},{"startTime":662.505,"endTime":664.5849999999999,"body":"Rule of threes can also be"},{"startTime":662.505,"endTime":664.5849999999999,"body":"used for investigations."},{"startTime":665.1049999999999,"endTime":669.795,"body":"Start off with simple bloods or ECGs,"},{"startTime":665.1049999999999,"endTime":669.795,"body":"basic radiology, x rays and ultrasounds,"},{"startTime":669.795,"endTime":672.545,"body":"or more advanced radiology, CT or MRI."},{"startTime":672.905,"endTime":675.204,"body":"When it comes to treatment options,"},{"startTime":672.905,"endTime":675.204,"body":"particularly in fractures, you might"},{"startTime":675.2049999999999,"endTime":678.375,"body":"think of non operative procedures,"},{"startTime":675.2049999999999,"endTime":678.375,"body":"manipulation under anesthetic and"},{"startTime":678.375,"endTime":680.534,"body":"plaster, or surgical fixation."},{"startTime":680.674,"endTime":682.0649999999999,"body":"Again, three different options."},{"startTime":682.6049999999999,"endTime":684.615,"body":"So my technique of trying to"},{"startTime":682.6049999999999,"endTime":684.615,"body":"remember things in a simple"},{"startTime":684.615,"endTime":686.3549999999999,"body":"approach is to keep it simple."},{"startTime":687.1049999999999,"endTime":688.1949999999999,"body":"Use the rule of threes."},{"startTime":688.615,"endTime":692.055,"body":"And by doing this I can honestly say I"},{"startTime":688.615,"endTime":692.055,"body":"learnt medicine using only the rule of"},{"startTime":692.055,"endTime":693.655,"body":"threes or knowing only three things."},{"startTime":694.015,"endTime":696.255,"body":"Albeit it's quite a wide"},{"startTime":694.015,"endTime":696.255,"body":"selection of three things."},{"startTime":697.164,"endTime":699.735,"body":"Over the next few months I'll look"},{"startTime":697.164,"endTime":699.735,"body":"at other conditions and how they can"},{"startTime":699.735,"endTime":701.314,"body":"be divided up into smaller groups."},{"startTime":701.904,"endTime":704.0849999999999,"body":"Remember three is the most common"},{"startTime":701.904,"endTime":704.0849999999999,"body":"number and of course you can always"},{"startTime":704.0849999999999,"endTime":705.485,"body":"have two, threes, fours or fives."},{"startTime":706.2099999999999,"endTime":709.89,"body":"But having smaller aliquots of"},{"startTime":706.2099999999999,"endTime":709.89,"body":"information, expanding upon it, also"},{"startTime":709.89,"endTime":711.38,"body":"helps you remember things in more detail."},{"startTime":711.8399999999999,"endTime":714.3199999999999,"body":"Thanks very much for listening to"},{"startTime":711.8399999999999,"endTime":714.3199999999999,"body":"Aussie Med Ed, it's really been great"},{"startTime":714.3299999999999,"endTime":715.64,"body":"to have you on board again today."},{"startTime":716.13,"endTime":718.9989999999999,"body":"Remember, this is just my technique of"},{"startTime":716.13,"endTime":718.9989999999999,"body":"learning things, it may not work for you,"},{"startTime":719.04,"endTime":721.5989999999999,"body":"but it's a good technique as a way of"},{"startTime":719.04,"endTime":721.5989999999999,"body":"trying to help people for the long term."},{"startTime":722.0899999999999,"endTime":724.15,"body":"Thanks again, and until"},{"startTime":722.0899999999999,"endTime":724.15,"body":"next time, stay safe."},{"startTime":724.439,"endTime":726.37,"body":"Thank you very much for"},{"startTime":724.439,"endTime":726.37,"body":"listening to our podcast today."},{"startTime":726.67,"endTime":728.99,"body":"I'd like to remind you that the"},{"startTime":726.67,"endTime":728.99,"body":"information provided is just general"},{"startTime":728.99,"endTime":731.29,"body":"advice and may vary depending"},{"startTime":728.99,"endTime":731.29,"body":"on the region in which you are"},{"startTime":731.29,"endTime":732.51,"body":"practicing or being treated."},{"startTime":733.0749999999999,"endTime":735.154,"body":"If you have any concerns or"},{"startTime":733.0749999999999,"endTime":735.154,"body":"questions about what we've"},{"startTime":735.154,"endTime":737.665,"body":"discussed, you should seek advice"},{"startTime":735.154,"endTime":737.665,"body":"from your General Practitioner."},{"startTime":738.2049999999999,"endTime":740.285,"body":"I'd like to thank you very much"},{"startTime":738.2049999999999,"endTime":740.285,"body":"for listening to our podcast"},{"startTime":740.535,"endTime":742.9549999999999,"body":"and please subscribe to the"},{"startTime":740.535,"endTime":742.9549999999999,"body":"podcast for the next episode."},{"startTime":743.2539999999999,"endTime":744.7249999999999,"body":"Until then, please stay safe."}]}