Embracing Science: #dasSMACC Hardcore EM handout

A handout for the EBM portion of the Hardcore EM seminar at #dasSMACC

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Sweet 16 (papers of the year for NYGH EMU 2017)

At this year’s North York General Emergency Medicine Update, I was asked to review the most important emergency medicine literature from the past year. These are the 10 papers I decided to talk about. If you have questions or comments, please join the discussion at the bottom of the post.

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Performance Under Pressure

How well do you perform when the pressure is high? This is one of my favorite emergency medicine topics. Emergency personnel pride themselves on thriving under pressure. Doctors like to think of themselves as perfect, maybe even god-like. Combine the two, and you can imagine the ego of the average emergency physician. But underneath all that bravado, we are all human. We all experience stress, and we all respond to stress in distinctly human ways.

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Lecture handout: Social Media in Medicine (University of Toronto Anesthesia and Surgery Faculty Development Day)

This handout accompanies the social media in medicine seminar as part of the University of Toronto Anesthesia and Surgery Faculty Development Day. It is primarily a collection of links to good resources explaining FOAM and how you can get involved in this fantastic online medical community.

What is FOAM?

This is how Salim Rezaie of REBEL EM explains FOAM:

FOAMed quite simply stands for Free Open Access Medical Education

It might be easier to get a couple of misnomers out of the way right off the bat:

  • FOAM IS NOT Social Media (Twitter, FaceBook, Google+, etc…)
  • FOAM IS NOT a Teaching Philosophy
  • FOAM IS independent of platform or media (Blogs, Podcasts, Videocasts, etc…)
  • FOAM IS an interactive collaboration of like minded individuals, free of geographic hindrances and time zones, with one single goal…to make the world of medicine better.

Quite simply, FOAM is the concept, #FOAMed is the conversation

Here are a few resources that further explain this FOAM concept:

What is FOAM? On the original FOAM site Life in the Fastlane

And of course, watching Mike Cadogan (the creator of the term “FOAM”) is essential. This is a video from ICEM 2012, but unfortunately the quality is not great:

Consuming FOAM

Salim’s “Got FOAM” post will cover basically everything you want to know about how and why to access free open access medical education resources.

EMCrit has an excellent review of FOAM in the post The online hierarchy of needs – social media and FOAM

StEmlyns has a great post entitled How to integrate #FOAMed into #MedEd

Andy Neil also has an excellent guide to consuming FOAM on Emergency Medicine Ireland

If you prefer a more traditional guide to using FOAM, there is a publication by Brent Thoma in the Annals of Emergency medicine (that is thankfully free, open-access) that covers how to effectively use online resources in emergency medicine. (I think these lessons apply to other specialities as well). The strategies are:

  1. Use a RSS (really simple syndication) reader
  2. Use a podcast application
  3. Use compilations to find quality resources
  4. Use social networks to connect with content producers and peers
  5. Use custom search engines to find resources when they are needed

Blogs (RSS reader)

Feedly_Logo.pngYou will want something to collect new blog posts for you, so you don’t have to check all the blogs you follow manually. This is called a news aggregator or a RSS reader. My personal choice is Feedly, but there are many options out there.
Another essential service is Pocket. There are a lot of new blog posts but only so much time. When you see something that looks interesting, but don’t have time to read it right away, saving it to Pocket is a good idea. This way you can collect interesting pieces for when you have free time, and they are also available offline, which is really helpful when you are stuck on an airplane.

Podcasts

You will also want something to automatically download new podcasts (as well as play them). You can use iTunes, or any of a numbers of other options. Personally, I use Downcast, because it had the best features when I chose it a few years ago, but it does cost a small amount of money, and other options are free.

Joining the conversation

Twitter300.pngOnce you have started to consume the FOAM resources out there, you are bound to have something you want to say. Probably the best way to get involved in the conversation is by getting yourself a Twitter account and replying to the content creators. You can also join the discussion by leaving comments on the bottom of blog posts, or joining specific google plus or Reddit communities.

Here are a series of videos from Rob Rogers (of the Teaching Institute) that go over how to use twitter




Producing FOAM

As you become more comfortable with blogs and podcasts, you might find yourself wanting to join the conversation. After all, you are probably already creating high quality educational material for rounds or other teaching sessions. Why not share it with the world? Here are some guides that can help you with that process:

Andy Neil’s blog post on producing FOAM covers everything from recording podcasts, recording screen-casts, creating a blog, using google plus, to creating videos

How to start a medical podcast on EMCrit

Some related (old-school) publications about FOAM

Nickson CP et al. Free Open Access Medical education (FOAM) for the Emergency Physician. Emergency Medicine Australasia (2014) 26, 76–83. (PDF)

Cadogan M et al. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002–2013). Emerg Med J 2014; 31(e1):e76-7 (PDF)

Mallin M et al. A Survey of the Current Utilization of Asynchronous Education Among Emergency Medicine Residents in the United States. Acad Med. 2014 Apr;89(4):598-601. PMID: 24556776

Scott KR, et al. Integration of Social Media in Emergency Medicine Residency Curriculum. Ann Emerg Med 2014 DOI 10.1016/j.annemergmed.2014.05.030

Kind T, et al. Twelve tips for using social media as a medical educator. Medical Teacher 2014; 36: 284

Mending Medical Myths (lecture notes for St. Pauls Emergency Medicine Update 2016)

Medical myths matter. All of our decisions, although they often seem small to us in the middle of a busy shift, have real impacts on people’s lives. To be a truly expert clinician, you have to understand not just what to do, but why you are doing it.

The primary myth covered in this talk was the use of topical anaesthetics in the management of simple corneal abrasions. The full handout and list of articles can be found here.

First10EM corneal abrasion handout cover.png

I also covered Salter-Harris 1 injuries, the myth that ligament is stronger than bone, and that concept that not all of these injuries need a cast. A full handout with references on the topic can be found here.

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If you are interested, a few of the other medical myths that I mentioned during the talk were:

The use of PPIs for upper GI bleeds

The benefit for stress testing in low risk cardiac patients

As physicians, we are trusted sources of medical information. We are relied upon not just by our patients, but also our families and friends to be knowledgeable and credible sources of information about health. We should all probably be aware of common medical myths, such as the need to drink 8 glasses of water a day, the idea that we only use 10% of our brains, or the thought that eating turkey might make you sleepy, because even these seemingly benign misunderstandings can have tremendous impacts on people’s lives. For a short, fun read on some of these topics, see:

Vreeman RC, Carroll AE. Medical myths. BMJ (Clinical research ed.). 335(7633):1288-9. 2007. PMID: 18156231 [free full text]

Charles Sidney Burwell, the dean of Harvard medical school at the time, famously said, “Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.” This may still be true today, but I don’t think this has to be true. If we taught the complexity of science, rather than just a collection of facts, we wouldn’t be wrong. We would understand the need for replication of studies and the limitations of p values. We would be able to differentiate treatments with great evidence (ASA in MI) from those with bad evidence (tamsulosin for renal colic), and we wouldn’t be so surprised by the constant updates that are part of the normal scientific process.

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There is a lot of evidence to keep track of and not many of us are laden with free time. How is one supposed to keep up with everything? In this day and age, I think the answer is crowdsourcing the work. There are so many great, free EBM resources available not that I don’t think there is any excuse in falling behind. This handout covers my favourite sources of evidence based medicine and critical appraisal.

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If anyone takes up my challenge and finds an interesting answer while exploring why we do what we do, feel free to contact me and we can share it here with everyone else. You can use this contact page or else e-mail me at first10em at gmail dot com.

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Surviving the first 10 minutes (lecture notes for North York Emergency Medicine Update)

Lecture notes to accompany 2016 NYGH EM Update talk on performance under pressure and mental practice: Surviving the first 10 minutes

In this talk, we focused on mental practice as a technique to help improve our performance under pressure. For the full notes and references on performance under pressure and mental practice, see this blog post.

Mental practice First10EM.PNG

Mental practice evidence summary First10EM.PNG

We want to use mental practice to ensure that we have all the resources we need, in order to deal with the demands placed on us.

Demands greater than resources is a threat First10EM.PNG

Resources greater than demands is a challenge First10EM.PNG

We discussed three cases to demonstrate the role of mental practice:

In order to make mental practice work for you, you want a simple script that guides you through your approach to the patient. Most importantly, the script needs to be specific to you, taking into account your skills and your practice environment. Then, to practice, you should actually picture yourself in the resuscitation room and visualize not just the steps, but specifically how you are going to get each step done. Where in the room is the required equipment? How does the equipment work? How are you going to organize your team? Who is doing what, in what order?

I think this kind of dedicated practice, combined with the simplified action script for you to fall back on when under pressure, will ensure that you have the resources you need to meet the crazy demands of emergency medicine.

Medical Myths (lecture notes for North York Emergency Medicine Update)

Medical myths matter. All of our decisions, although they often seem small to us in the middle of a busy shift, have real impacts on people’s lives.

The primary myth that we discussed today was the harms of topical anaesthetics in the management of simple corneal abrasions. The full list of articles and resources can be found here.

If you are interested, a few of the other medical myths that I mentioned during the talk were:

I also mentioned a few every day medical myths, such as the need to drink 8 glasses of water a day, the idea that we only use 10% of our brains, or the thought that eating turkey might make you sleepy. For a short, fun read on some of these topics, see:

Vreeman RC, Carroll AE. Medical myths. BMJ (Clinical research ed.). 335(7633):1288-9. 2007. PMID: 18156231 [free full text]

As the dean of Harvard medical school, Charles Sidney Burwell famously said, “Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don’t know which half is which.” This may still be true, but I don’t think this has to be true. If we taught the complexity of science, rather than just a collection of facts, we wouldn’t be wrong. We would understand the need for replication of studies and the limitations of P values. We would be able to differentiate treatments with great evidence (ASA in MI) from those with bad evidence (tamsulosin for renal colic), and we wouldn’t be so surprised by the constant updates that are part of the normal scientific process.

There is a lot of evidence to keep track of, and not many of us are laden with free time. How is one supposed to keep up with everything? In this day and age, I think the answer is crowd-sourcing the work. There are so many great, free EBM resources, I don’t think there is any excuse in falling behind. This is a blog post on my favourite sources of evidence based medicine and critical appraisal.

If anyone takes up my challenge and finds an interesting answer while exploring why we do what we do, feel free to contact me and we can share it here with everyone else. You can use this contact page, or else e-mail me at first10em at gmail dot com.

First10EM in dogma there is no art.png