The Medical Joyworks Monthly


Connect to MJ's thriving community

Issue #25 (October 2021)


Dear Reader,

In honor of Breast Cancer Awareness Month, we decided to share some insights on how medical professionals use our apps to improve their breast cancer diagnosis and management skills. 

For this, we decided to randomly pick and study at our "Lumpy - Fibroadenoma" learning module (LM) from Clinical Sense over a six month period (Dec. 2020 - Jun 2021) — specifically looking at our users' first-time play performance in it.
By first-time play performance, we mean the events that take place during a user's first time playing an LM. 

Clinical Sense LMs are interactive scenarios where users can influence the story in multiple decision points. The "Fibroadenoma" LM has 7 decision points (DPs) for users, and during the time studied recorded nearly 1,500 first time plays in 136 countries. To give you a feel for these users, note that:
  • medical students represented the largest share of users, followed by general practitioners, interns, and residents (39.07%, 8.92%, 8.16% and 7.54% respectively); and
  • users came from all over the world, with the largest representations being from India, the U.S., the U.K., and Nigeria (25.64%, 18.61%, 4.14% and 3.79% respectively).
So what did we find out?
  • Medical students, general practitioners, interns and residents all took approximately 5:55 minutes to complete the LM when playing it for the first time; and
  • these audiences scored on average 2.2 points out of 3 (with 3 being the highest mark).
All this is good, yes. But things are far more interesting when looking at per DP performance:
  • 65% of users got DP-1 right the first time.
  • DP-2 and DP-3 were easy peasy, with users getting them right approximately 94% and 90% of the time respectively.
  • From DP-4 to DP-7, the LM gradually got more difficult for users; by the time users reached DP-7, they got that question right only 50% of the time.
These numbers are remarkably consistent across medical students, general practitioners, interns, and residents; and not too far off from other professional groups. However, one could study this data and derive all sorts of fascinating insights. For instance, on DP-6—crucial to assessing the user's understanding of fibroadenoma treatment—users in most African countries performed better than their counterparts in Asia and the Middle East.

We could go on and on... and maybe we should. But we will have to leave that for another time.

Until then, that is all for now. Have a great month!

Miguel Angel Molina
Chief Operating Officer
Medical Joyworks


The latest from MJ

  • Our first ever IMB Town Hall Meeting is in the works! Expect to hear more about it, with details on the venue and the agenda to be covered.
  • To help us peer-review learning modules, we need specialists in: general surgery, orthopedic surgery, pediatrics, obstetrics and gynecology, neurosurgery, intensive care, critical care, psychiatry, urology, neurology, nephrology, endocrinology, and pulmonology. If you are a specialist (or specialist in training), or know of someone who fits the part, have them contact Julia Botija at


International Medical Board Members

Name: Dr. Rabbinu Rangga Pribadi MD
Speciality: Internal Medicine, Gastroenterology and Hepatology
Designation:  Attending Physician
Work institute: Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Graduated from:  Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
What attracted you to your specialty?
I’m an internal medicine physician subspecialized in gastroenterology and hepatology. Specifically, I’m most attracted to digestive endoscopy. My appeal for gastroenterology and hepatology stems from it being as much a science as it is an art.

What have you learned about your specialty solely from experience?
Understanding gastrointestinal diseases requires considerable knowledge of the gastrointestinal tract’s (GIT) anatomy and physiology. But it also demands an integrated understanding of the human body, especially with regards to the interrelationship among organs and their systems. You can read about this in books, but only through actual practice (e.g., digestive endoscopies, manometries, radiologic imagings, scintigraphies, etc.) can you really appreciate these interrelationships.

What is a common misconception associated with your field of study?
I’m impressed by how fecal occult blood tests (FOBTs) used to investigate occult GIT bleeding result in being the aetiology behind iron deficiency anemia in ward settings. Simply: it is inappropriate to do FOBTs in ward settings due to their low sensitivity. Physicians should remember that the appropriate purpose of a FOBT is to screen for colorectal cancer (CRC) in asymptomatic populations.

What is your biggest research interest today?
I’m quite interested in a lot of things, including: gastrointestinal COVID-19, inflammatory bowel disease, pancreatobiliary disease, and nutrition in general. 

What publication / research are you most proud of?
“Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article.” This article was first published in the Journal of Digestive Diseases in 2019. URL:

In your opinion, what is the greatest challenge in your field today?
For sure, the burden of COVID-19 on gastrointestinal and pancreatobiliary organs; as well as the practice of GI endoscopy while in a pandemic.

What will be a game-changer innovation in your field?
I think that interventional endoscopic ultrasound in pancreatobiliary and GI diseases will have to be something, as well as third space GI endoscopy.

How has MJ helped advance your professional objectives (in terms of teaching, research, management, personal development, etc.)?
Medical Joyworks has helped me gain new knowledge overall. And by reviewing learning modules for them, I have improved my critical thinking skills.


Q&As from our user community

Clinical Sense: Overflowing (Diarrhea)

Q: In this patient with hemolytic uremic syndrome (HUS), could we have attempted plasma infusion rather than plasma exchange?
A: In HUS, plasma infusion is usually used as a temporizing measure until the patient is able to receive plasma exchange. It is generally not recommended as a replacement for plasma exchange, in part because the large infusion volumes required for remission can cause patients to develop symptoms of fluid overload.
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: Inverted (Breast Cancer, Male)

Q: In this patient with male breast cancer, why not perform a CT chest for staging?
A: It is true that chest CT has been frequently used to assess for pulmonary metastases in patients with newly diagnosed operable breast cancer. However, new research has found the clinical utility to be very low, with the incidence of pulmonary metastases being almost 0% in patients with stage I/II disease; and just 1.3% in those with stage III disease. In addition to the low diagnostic yield, CT chest is also associated with a high false positive rate, leading to additional unnecessary procedures and patient stress. The following paper provides 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.


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That's all for now!

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