The Medical Joyworks Monthly


Connect to MJ's thriving community

Issue #26 (November 2021)


Dear Reader,

As part of our data crunching roll, this month we decided to continue sharing our insights on how medical professionals use our apps to improve their diagnosis and management skills.

This time, and because it is Gastroesophageal Reflux Disease (GERD) awareness week in the United States, we chose a Clinical Sense learning module (LM) on GERD over a six month period (Dec. 2020 - Jun 2021).
Specifically, we looked at our users' first-time play performance in it. By first-time play performance, we mean the events that take place during a users' first time playing an LM.

Recall that Clinical Sense LMs are interactive scenarios where users influence the story in multiple decision points. The GERD LM has 5 decision points (DPs), and during the time studied (~2 years and 5 months) we recorded nearly 1,500 first time plays in 104 countries. 

For starters, here is what we know of our users:
  • senior medical students represented the largest share of users, followed by general practitioners, residents, and interns (46.3%, 7.4%, 6.6%, and 6.4% respectively); and
  • users came from all over the world, with the largest representations being from India, the U.S., the U.K., and Indonesia (23.1%, 16.4%, 4.7%, and 3.8% respectively).
So what did we find out this time?
  • Medical students, general practitioners, residents, and interns all took approximately 5min 54s to complete the LM when playing it for the first time.
  • Compared to all other audiences (which averaged 5min 36s), our four top groups took almost 20 seconds longer.
  • Scorewise, our four top groups earned an average of 1.8 points out of 3 (with 3 being the highest mark). 
  • All other audiences scored an average of 1.7 points out of 3 (with 3 being the highest mark).
Not the easiest learning module, it seems. But let's look at per DP performance. Recall that this LM had 5 DPs:
  • DP-1 and DP-2 seem fairly easy, with users getting it right the first time 88.5% and 70.4% of the time respectively.
  • DP-3 is where things start to go astray, with a whopping 73.0% of users getting it wrong the first time.
  • Most users redeem themselves with DP-4, as 92.9% of users get it right the first time. 
  • However, DP-4 marks the end of the game for users who get the question right. The 7.1% who get DP-4 wrong must continue until they reach DP-5. And here, unfortunately, 56.7% get it wrong the first time.
To avoid ruining the gameplay experience for readers who have yet to try this LM, we will refrain from discussing actual DPs in detail. But it is worth pointing out that DP-3 is a question that challenges the user to carefully consider what must be done versus what should be done. Doctors and other healthcare professionals face this conundrum all the time, especially when interacting with patients. How medical advice is given can change an outcome.

I think we will stop here for now. We will do more of these mini analyses in the coming months. But if you would like for us to explore a particular topic or LM, let me know.

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 is set for December. Remember to sign up—the invite was sent via email. If you did not receive an invitation, kindly contact Julia Botija for details at
  • 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. Gerardo Gerundo MD
Speciality: Geriatrics and Gerontology
Designation:  Attending Physician
Work institute: Department of Geriatrics/ Intermediate Care Unit, A.O.U. Federico II - Naples, Naples, Italy
Graduated from:  Medical School, University of Naples Federico II, Naples, Italy
What attracted you to your specialty?
Geriatrics, in its entirety—and especially its complexity. I value the wide look into all organs and systems. Moreover, the most common patho-physiological conditions can be a challenge among the elderly since they appear in different manners each and every time.
But as if that were not enough, the Covid outbreak is giving us new challenges. During my studies, I focused on advanced cardiovascular complications in the elderly. Covid is presenting us with all sorts of respiratory failures and the emergency management of its many complications. There’s more to discover than ever!

What have you learned about your specialty solely from experience?
I have learned to manage multiple acute diseases at once, and in a same patient. In most cases, scientific societies worldwide publish guidelines where adult patients have only one or two pathological conditions.
The elderly hardly fit these guidelines. Often, they will present three to four acute conditions at a time. Thus, one has to take into account the interactions among prescribed drugs; always making a risk-benefit analysis in order to find the best balance for the patient. Such considerations only come through practice many patients.

What is a common misconception associated with your field of study?
Geriatrics is often thought of as doctors caring for people with dementia only. This is not the case, of course. The elderly face many other problems, and geriatricians specialize in these. In fact, it is becoming increasingly common to refer elderly patients to geriatricians. 

What is your biggest research interest today?
I am interested in the clinical applications of new technologies, internet communications and social media platforms.

People worldwide are increasingly searching the web for answers on just about anything, even for health matters; and I think it is important that they receive good advice. For this, social media can be a very helpful tool for sharing information rapidly and extensively. Think of the Covid outbreak and other such events. Communications via the internet are widely accessible and can easily be used to help patients move a step forward. Not only that, medical research is also incorporating new technologies that will soon lead to new discoveries.

What publication / research are you most proud of?
Some of my publications are in revision at the moment. However, one I have really enjoyed writing was “Type 2 myocardial infarction: is it a geriatric syndrome?” It is available at:

In your opinion, what is the greatest challenge in your field today?
I think that the most important challenges are comorbidities and poli-pharmacy among the eldest populations. The elderly should be included in clinical trials and drug experiments more often to help address these issues.

What will be a game-changer innovation in your field?
Treating patients with complex illnesses at home just as if they were at hospital will really change things. Just imagine, a full patient-centered hospital but a domestic setting! 

Also, the elderly are facing ever more strained healthcare systems; with their needs being greater than those of younger patients. This situation is increasing the risk of nosocomial infection, disorientation, delirium, and even mortality among them. Treating the elderly in hospital-at-home settings will help reduce hospital admissions and the associated risks, help relieve the healthcare system somewhat, and improve the overall quality of the patient experience.

How has MJ helped advance your professional objectives (in terms of teaching, research, management, personal development, etc.)?
It’s great being an IMB peer-reviewer with Medical Joyworks. I get to study carefully and deepen my knowledge of topics that relate to my field while helping the up-and-coming generations of physicians.


Q&As from our user community

Clinical Sense: Infested (Schistosomiasis)

Q: In this scenario, you perform an MRI to evaluate the patient's bladder schistosomiasis. This may not be an option in resource limited settings—in which schistosomiasis is the most common.
A: Your point is well taken; it is unfortunate that the parts of the world that experience the most schistosomiasis are the ones least equipped to investigate and manage complications; and that while MRI is often mentioned as a good test to investigate for bladder and urinary tract pathology, it is not always practical. 

Many references also mention CT,  ultrasound, and even plain x-rays  to look for bladder calcifications. CT will also pick up strictures. Of course, CT involves exposure to radiation, and plain x-rays and ultrasound are less sensitive as compared to both CT and MRI.

The following recent article explores the imaging of schistosomiasis in detail:
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: Out of comfort 2 (Cardiac Tamponade)

Q: There is no debate that this patient has cardiac tamponade. However, I do not agree with not performing D-dimers here. D-dimers are not limited to being of use in patients with potential pulmonary embolism or deep vein thrombosis; a negative D-dimer can be a cheap and rather sensitive way of ruling out aortic dissection—which can cause cardiac tamponade.
A: You make a good point—it is important not to pigeonhole particular tests as only useful in particular presentations; and to consider the most cost-effective and efficient approach to reach a diagnosis.

That said, a systematic review and meta-analysis in 2015 found that D-dimer testing is not sensitive enough to rule out aortic dissection in high-risk patients. In this context, high risk patients included persons with severe chest, back, or abdominal pain—i.e., the majority of persons in whom one might suspect aortic dissection. Please find a link to the paper below:
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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... and more.
That's all for now!

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