tag:blogger.com,1999:blog-24481356245186490612024-03-19T02:47:06.788-07:00Hybrid model for training physical examination and procedural skillsGoh Poh-Sunhttp://www.blogger.com/profile/15716740892811372342noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2448135624518649061.post-5452732053365618772014-11-03T14:26:00.001-08:002015-11-09T18:00:53.953-08:00<script>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Workshop Title:</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Hybrid model for training physical examination and procedural skills</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Workshop Synopsis:</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">The purpose of this workshop is to re-examine physical examination and procedural skills training - by evaluating current educational theory, and empirical best practices; and then proposing a hybrid blended training model; by exploring how the eLearning, simulation, and mastery training paradigms can add value and insights to traditional training curricula. We will use three practical scenarios as illustrations and educational practice examples - abdominal physical examination, suturing, and corneal foreign body removal.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Workshop Website/Interactive digital wall</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><a href="http://padlet.com/dnrgohps/trainPEprocSK" target="_blank">http://padlet.com/dnrgohps/trainPEprocSK</a></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Workshop Program:</i></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">1345 to 1515hrs (90 minutes)</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Introduction</i></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Good morning. There will be three parts to this workshop. Part 1, an individual and table discussion followed by interactive presentation; Part 2, a presentation of one method to think about this teaching and training conundrum; and finally Part 3, an interactive Q and A, followed by reflection and summing up section.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;">Professor Khan sends his apologies for not being able to attend this workshop due to a late logistical problem, and Gominda will deputise on his behalf, by taking down your responses to each question, writing a summary on the Padlet wall, and playing the role of a "traditionalist" if necessary.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Part 1:</i></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Review of workshop participant feedback to questions (15 minutes)</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">(<i><u>posed to workshop participants live</u></i>, by email beforehand, via online Survey)</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Please reflect on the following three questions first individually, for a couple of minutes, write down your answer, and I will then nominate a volunteer from each row to come up to the podium/microphone to share a summary of your responses to the questions with the group.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">(Alternative arrangement if room is organised with participants seated around four tables is for a small group discussion to occur after personal reflection, and one or two nominees from each table to present their responses to the questions to the whole group. Please introduce yourself to your fellow educationalists seated at the table in the first minute or two).</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">A. How do you currently teach physical examination and procedure skills training?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">B. What do you feel are the strengths of the current training program?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">C. What do you feel are the weaknesses of your current training program? What could be improved? How might you do this?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><br />Interactive presentation and discussion, with each row volunteer, or nominee from each table, presenting their comments to the three questions. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Q and A interactive discussion.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Part 2:</i></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Lets use a sporting analogy, and reflect on how this is similar to the training process for physical examination and procedural skills.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Consider the desire to play tennis. From a beginner's or novice's point of view, a good amateur player, or aspiring professional tennis player.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">How would you learn to play tennis. And perform well.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">One process would be to watch videos of a range of tennis players, from good amateurs, to a range of the top professionals. Paying attention to a variety of styles, and strategies. With different competition. On different surfaces. And different playing conditions.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">You would get some coaching. Go for lessons.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Your teacher or coach would explain the principles of stroke making, demonstrate the forehand or serve, get you to role play or mimic his or her action/stroke making, and start you first hitting slow balls tossed on same side of court to you, then from across the net (close first, then further), then hit to you. You make half strokes, then 3/4 stroke actions, then full stroke actions. You would hit gently first, staying in one place, then take increaing steps to hit a ball placed further from you, hit to you at greater pace. You would be asked to repeatedly practice forehands, then backhands and so one. You would eventually play with the coach, before moving on to play with a variety of opponents. While the coach constantly gives you feedback, and you reflect on your performance. Good coaches would video tape your performance, and you and your coach would watch these performances, repeatedly, and then go back to the practice court.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">This process would repeat itself. You would play progressively better players, longer matches, under tougher conditions, with less rest periods. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Does this process remind you of teaching and training for physical examination and procedural skills.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">You would want to view, and watch competent, proficient, and ideally master clinicians. The very best in their area. Not only how they examine patients, but how a variety of master clinicians perform procedures. Train with the very best. Learn from them. Try to model them. Get them to coach you. And keep giving you feedback. You would repeat this process. Again and again. Under more difficult conditions. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Travel to see the best.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Watch videos of the best performers.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Practice with coaching and feedback.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Videotape your own performances.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Watch yourself.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Get respected, and master clinicians to give you feedback.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The analogy between sports, in this case learning and training to be a tennis player, and physical examination and procedure skills training in health professions education should be quite clear.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">A current model which several of you have shared is a live demonstration, with or without an earlier video demonstration, followed by small group student practice either in a simulation centre, or on volunteers, followed by individual instructor feedback, and then further practice and experience with selected patients, either simulated or actual patients.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What we can learn from the sporting analogy, or a training to be a chef analogy, is repeated iterative practice, using a mastery training model. Where progression to the next stage of training is dependent on demonstrating competency and proficiency of each physical examination and procedural technique. Where any deficiencies in performance are picked up, with the student or trainee coming back for remedial focused practice with feedback. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">We can add exposure to a wide range of different techniques, using digital video demonstrations, to illustrate the breadth and range of physical examination and procedural skills which can be applied in a variety of clinical settings. This simulates the previous phenomenon where a motivated trainee or student had to search widely, sometimes worldwide, to find and learn from the best practitioners in a field. We can also consider the use of video reviews of clinical examination and procedural performance, with self critique and reflection, as well as instructor feedback, following a coaching paradigm. The process to scale up this process, by the use of senior students, is used by several groups, and is also used in the sporting and other skill training settings.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Interactive Q and A. </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Concluding statements.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Thank you.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Original planned format of workshop below for your reference.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">_______________________</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Review of current approaches to training (Junaid Sarfraz Khan) 15 minute presentation</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Q and A</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">___________</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Review of how the eLearning and simulation literature and empirical evidence can help refine and improve current training and education programs (Poh-Sun Goh) 15 minute presentation</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Q and A</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">_____________</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Interactive group discussion (30 minutes) </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Workshop review and closing comments (15 minutes) </span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">_______________</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><i>Presentation</i></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Review of how the eLearning and simulation literature and empirical evidence can help refine and improve current training and education programs (Poh-Sun Goh) 15 minute presentation.</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What is the role of comprehensive physical examination when cross sectional imaging is widely available?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Is the role of physical examination to screen, to comprehensively evaluate or to aid decision making (conservative, operate or discharge)?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">How can procedural skills training programs take advantage of the literature from simulation and mastery training literature?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">********</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">********</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What is the purpose/objective of current training and education programs?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***Knowledge</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Skills</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***Attitudes</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***Competencies</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Entrustable professional activities (EPAs)</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What teaching methods do we current use to fulfil these educational objectives?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***Knowledge --> Lecture, Interactive tutorial</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Skills --> Demonstrations, practice sessions with feedback (simulation, volunteer, then clinical patients)</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Attitudes --> Case studies, role-modelling, self-reflection exercises</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Competencies</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***EPAs</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What do we know from the literature?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***Learning</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***Curricula</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***Assessment</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;">***eLearning and Simulation</span><br />
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<a href="http://webmm.ahrq.gov/perspective.aspx?perspectiveID=138">The literature on healthcare simulation: what does it show? (David Cook, 2013)</a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">What do we know from our own experience and empirical practice?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***How do we learn?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***What do we observe on a day to day basis?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Undergraduates?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Postgraduates?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Lifelong learning?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">What are our own successful learning experiences?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***How were we taught in medical school?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***How were we trained (postgraduate)?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***What are our best experiences in later professional practice?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">As participants? </span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">As faculty and program leads?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">How can we refine and improve current training programs?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Keep the best of what we do currently?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***What can we reduce, refine, or add to?</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">How can eLearning, and simulation augment current training programs?</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Deliberate practice</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Mastery training</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Scaffolding</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***See one, do one, teach one</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***On the job training</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Feedback and coaching</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Portfolios and ePortfolios</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Self reflection</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">***Mentorship and modelling</span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">Video records for self reflection and feedback/coaching</span><br />
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<a href="http://vidcast.nus.edu.sg/camtasiarelay/Imaging_of_Respiratory_Tract_Disorders_-_20141105_151527_25.html">http://vidcast.nus.edu.sg/camtasiarelay/Imaging_of_Respiratory_Tract_Disorders_-_20141105_151527_25.html</a><br />
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