The Medical Joyworks Monthly


Connect to MJ's thriving community

Issue #19 (April 2021)


Dear Reader,

As the new senior project manager accountable for MJ's new IMB Program Office, I am fascinated by how digital learning is evolving in the medical space.

For the last 20+ years I have worked in the travel and tourism sectors (airlines, hotels, global distribution systems, etc.).
These are heavily hierarchical and regulated environments, where safety and security drive many decisions – including service-related ones. Thus, change can take time.

But despite similarities in regulatory complexity and the emphasis on safety, medicine appears to run at slightly higher revolutions. Perhaps it is because human physiology is infinitely more intricate, with more unknowns than knowns.

Regardless, what I am finding is that doctors from all over the world like to collaborate, work together in helping others, and conduct research. They also dedicate whatever time is necessary to solving problems small and large.

To my mind, this ethos enables the search for new ways of doing things more easily. Naturally, digital learning is a big part of this; and our IMB members eagerness to peer review our learning modules is clear proof of such ethos. I am excited to be a part of this fascinating community through Medical Joyworks, and I am delighted to take on the medical world's challenges with you all.

Julia Botija
Senior Project Manager 
Medical Joyworks


The latest from MJ

  • In this month's edition of Meet Your IMB, Dr. Rosenee Briones shares with us her thoughts on internal medicine, and what matters to her most these days.
  • This month, expect big changes to the Clinical Odyssey user experience, with improvements that will make it easier for you to navigate the site and find content within the ever-growing learning module library (already with 700+ items). Expect to see this upgrade to Clinical Odyssey later this month.
  • We will also be introducing a new free subscription plan for Clinical Odyssey, offering up to 80 Clinical Sense and Prognosis simulations (rotated on a regular basis) and 10 Explain Medicine reference articles (rotated on a regular basis). Our hope is that this plan will help advance our commitment to accessible medical learning worldwide. Details regarding the free subscription plan will be announced soon.
  • Finally, MJ International Medical Board is seeking specialists to join as peer-reviewers for the following specialties: general surgery; orthopedic surgery; pediatrics; obstetrics and gynecology; neurosurgery; intensive care; critical care; psychiatry; urology; neurology; nephrology; endocrinology; and pulmonology.
    Join the program at

    That is all for now. Stay healthy, and curious!


International Medical Board Members

Name: Dr. Rosenee Briones-Ruiz, MD
Speciality: Internal Medicine
Designation: Medical Specialist/Consultant
Work institute: Metro San Jose Medical Center, Philippines
Graduated from: De La Salle University-HSI, Philippines
What attracted you to your specialty?
I was drawn to medicine’s uniqueness: its combination of scientific attitudes, broad subject matter, and the relationships it enables with people. 

What have you learned about your specialty solely from experience?
It is amazing how going the extra mile to reach out to patients in time of need will have a dramatic impact. Doing this really helps establish the long-term relationship with a patient.

You have to listen to patients and figure out how to gain their confidence; then they will tell you what is bothering them and you can provide the best care. Of course, a commitment to lifelong learning is also very important here.
What is a common misconception associated with your field of study?
Because of internal medicine’s expansive nature, internists are well equipped to handle many different conditions. Internists are also well trained to provide primary care to adults where needed.

This can lead to some confusion regarding internists: people sometimes refer to us as “primary care physicians” or “general practitioners,” believing that they are the same as an internist. Internists are specialists who can practice as primary care physicians or general practitioners. Primary care physicians and general practitioners do not have to be specialists.

What is your biggest research interest today?
For sure, the long-term effects of COVID 19. Many people who got infected and were initially asymptomatic later experience memory and concentration problems, difficulties in breathing – even after several months.

What publication/research are you most proud of?
I am pleased with my research on the use of antimicrobials to aid the recovery of patients with acute ischemic stroke. Another area I have worked in and that I am rather satisfied with is the development of an antimicrobial for acute care and community settings.

In your opinion, what is the greatest challenge in your field today?
Given the current urgency, coronavirus mutations. One of the main concerns here is whether any of the variants can affect prevention and treatment.

What will be a game-changer innovation in your field?
Even though telemedicine has been around for several years, the current pandemic has severely impacted hospitals, medical centers, and clinics. Many patients are afraid to have face-to-face consultations due to the risk of COVID 19 infection. This is dramatically changing how physicians provide patient care.

With telemedicine, we can provide timely care to patients while minimizing exposure to them (and us). More and more physicians are providing quality medical care remotely via virtual services, and the trend will only accelerate.

How has MJ helped advance your professional objectives (in terms of teaching, research, management, personal development, etc.)?
Medical Joyworks has been a clinical and intellectual stimulation for me. The learning modules they produce are well presented and very interesting. Peer-reviewing learning modules helps me improve my own clinical care and documentation skills. And best of all, it is a great opportunity for me to share my knowledge with others around the world.


Q&As from our user community

Clinical Sense: Flaccid (SSRI-induced dysfunction)

Q: Isn't tapering sertraline at 25% per week too fast? This runs the risk of discontinuation syndrome, which can be tricky to detect and diagnose.
A: We suggested tapering sertraline over 4 weeks, as this is in-line with current clinical guidelines. You are correct, however, that symptoms relating to rapid withdrawal can have significant impacts, be difficult to detect, and even mask relapse. Hence a cautious approach tailored to the patient and the particular medication is vital. In their practice guidelines, the American Psychiatric Association highlight a lack of systematic research into the precise timing of antidepressant withdrawal, so this is definitely an area requiring further investigation. The following link has more information on this topic:
If you would like to play this scenario or join the conversation, go to the Clinical Sense app in your mobile device.

Prognosis: Your Diagnosis: Displaced (Pacemaker Lead Malposition)

Q: This patient with a TIA is already on warfarin. Why give him aspirin?
A: This is a tricky clinical situation—this patient is already on warfarin due to underlying atrial fibrillation, but his INR is only 1.2, because of poor compliance. He has experienced a TIA and should therefore be started on aspirin immediately.

However, following the initial dose of aspirin, he should not be started on the combination of aspirin and diypridamole. Instead, aspirin alone should be continued, and he should be asked to take his usual warfarin dose (this time with strict compliance) until his INR reaches the therapeutic range—at which point aspirin can be omitted. Please see the following link for more information:
If you would like to play this scenario or join the conversation, go to the Prognosis: Your Diagnosis app in your mobile device.


Recently released stories

Ingested - Play it free online
Malnourished - Play it in Clinical Odyssey
Obstetrics & Gynecology
Early - Play it free online
Inverted - Play it in Clinical Odyssey
Wernicke's encephalopathy - Read it free online
... and more.
That's all for now!

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