Below we have listed our selection of the 8highest quality blog posts related to 4 advanced level questions on trauma topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:
When to give tranexamic acid in the trauma patient
The pregnant trauma patient
Transfusions in the trauma patient
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
In this module, we have 6 AIR-Pro’s and we did not include any honorable mentions to prevent redundancy of the topics covered. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.
AIR-Pro Stamp of Approval and Honorable Mentions
In an effort to truly emphasize the highest quality posts, we have 2 subsets of recommended resources. The AIR-Pro stamp of approval will only be given to posts scoring above a strict scoring cut-off of ≥28 points (out of 35 total), based on our AIR-Pro scoring instrument, which is slightly different from our original AIR Series scoring instrument. The other subset is for “Honorable Mention” posts. These posts have been flagged by and agreed upon by AIR-Pro Board members as worthwhile, accurate, unbiased, appropriately referenced, and have a score of 26-27. All posts will still be part of the quiz needed to obtain III credit. To decrease the repetitive nature of posts relating to these advanced concepts, we did not always include every post found that met the score of ≥28 points.
After reading, please take the quiz. Feel free to ask questions in the blog comment section below. The AIR Board faculty will answer them within 48 hours of posting. Be sure to include your email or contact information where requested in the Disqus blog comment area, so that you will be notified when we reply.
Trauma Module 2015: Recommended III credit hours
2.5 hours (20 minutes per article, 30 minutes for articles with podcasts)
Take the quiz below, or click HEREto take you to the quiz site. Be sure to enter your name and program, if you desire III credit.
Background Information About the AIR-Pro Series
The ALiEM Approved Instructional Resources (AIR) Series is an effort to reward our residents for the reading and learning they are already doing online. We have created an Individual Interactive Instruction (III) opportunity utilizing Free Open Access Meducation (FOAM) resources for U.S. Emergency Medicine residents. For each module, the AIR-Pro Board curates and scores a list of blogs and podcasts specifically answering questions tailored to the senior resident. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private Google Drive database, which participating residency program directors can access to provide proof of completion.
Do you belong to a residency program that is not currently participating? No problem! Any one can read the AIR-Pro series curated post and complete the quiz for educational value!
If a residency program is interested in participating, please contact us!
Fareen Zaver, MD
Department of Emergency Medicine
George Washington University
Dr. Matt Fields is an emergency physician and Director of the Ultrasound Fellowship program at Thomas Jefferson University. For Dr. Fields, a large part about staying well is prioritizing and keeping things in perspective. His strategies for wellness include constant reflection, knowing your limits, and having activities that allow you to decompress. His love for running, allows him to stay active and appreciate his surrounding environment. Check out how he stays healthy in emergency medicine!
Name: Matt Fields
Location: Philadelphia, Thomas Jefferson University
Current job(s): Ultrasound Director
One word that describes how you stay healthy: Perspective
Primary behavior/activity for destressing: Running or other physical activity
What are the top 3 ways you keep healthy?
Leave work at work. I make it a point to not take work home with me.
Reflect. Constantly taking the time to clear my mind, helps keep me on point.
Have a de-stressing activity. This can be many things. Personally, I like to run.
What’s your ideal workout?
Night running. A night jog along the Schuylkill or across the Ben Franklin bridge can be amazing, especially when the skyline comes into view.
Do you track your fitness? How?
I use the Nike app for running, but that is more just for fun. Internally, I notice that when I don’t work out regularly I am more tired and less happy.
How do you prepare for a night shift? How do you recover from one?
Anchor sleep!! Getting in good sleep is key. I try to go to sleep 4-6 hours prior to my shift. If you can, build yourself a windowless soundproof extra bedroom. If that is not feasible earplugs and a sleeping mask may do.
How do you avoid getting “hangry” (angry due to hunger) on shift?
Iced coffees and protein bars. I’ve recently discovered that drinking lots of water helps quite a bit.
How do you ensure you are mentally in check?
I constantly tell myself that I’m good enough, smart enough and, gosh darnit, people like me! Thankfully, I’ve learned to stop saying these things out loud at the patient’s bedside.
What are the biggest challenges you face in maintaining a longstanding career in EM? How do you address these challenges?
The biggest challenge I see in EM is the evolution of healthcare and the potential for burnout. More and more EM physicians are being pushed into non-traditional roles including doctor triage models, telemedicine, and observation. These are roles that many of us did not anticipate and may lead to burnout. It is important to find a balance in your group and seek out a work environment that suits you. Most importantly it is important to find that part of EM that you really love and embrace that. Try to make that part of your actual job with clinical buy down if possible. Also make sure you have hobbies and interests outside the hospital that you can turn to when you just need a break.
Best advice you have received for maintaining health?
Don’t stress. As one of my mentors said, “the patient’s blood pressure may go up, but yours shouldn’t.”
Avoid getting into fights or arguments with patients or other services in the hospital. No one ever wins.
Who would you love for us to track down to answer these questions?
ALiEM Assistant Editor,
How I Stay Health in EM series
Emergency Medicine Resident
University of Saskatchewan
As a busy Emergency Physician, I find that I am always happier when I have a mystery novel to read during my free time. I’ve been a mystery fan since I was a kid, growing up on Nancy Drew and Encyclopedia Brown. Below I’d like to share some of my favorites. These authors are chosen for quality and readability with a preference for the prolific. If you like one of their books, you will likely find ten more.
I think most Emergency Physicians aspire to be a little bit like Sherlock, with his keen eye for detailed observation and renowned deductive reasoning power. Conan Doyle, a physician himself, based the character on one of his medical school professors. Most of these mysteries are in short-story format. Even better, most of Conan Doyle’s writings are available to download for free. [Link for Free eBook]
This 1939 novel is Christie’s masterpiece, and the all time best selling mystery novel ever. Ten strangers are invited to an island where a recorded message charges that each individual had a role in an someone’s death for which they avoided punishment. They are unable to escape the island as an unknown killer in their midst starts to enact revenge. This classic is a must read for any mystery fan. [Link for Free eBook]
P.D. James gets creative with the basic mystery novel plot structure with intriguing results. She rarely stops with one murder and experiments with unique endings. I liked the Cordelia Gray series best, in which a young woman strikes out on her own as a private detective. [Amazon Link]
Admittedly, the Inspector Gamache series is one of my guilty pleasures. These character driven stories take place in a seemingly sweet and isolated small community in Quebec, where incidentally, someone is always getting killed off. There’s a delightful character development arc over the course of the series, and I enjoy the focus on themes related to family and relationships, recovery from trauma and addiction, and ultimately, forgiveness and redemption. [Amazon Link]
ALiEM Bookclub: Beyond the ED – Recommendations by Dr. Shannon McNamara
Edited by Dr. Nikita Joshi
* Disclaimer: We have no affiliations financial or otherwise with the authors, references or hyperlinks listed, the books, or Amazon.
Shannon McNamara, MD
Associate Simulation Division Director
Department of Emergency Medicine
Mount Sinai St. Luke's - Roosevelt Hospital Center
As a practicing Emergency Medicine physician, I have spent almost the last decade of my life immersed in a culture of medical education. Actually, not quite accurate, as I have spent my life since middle school years either studying for one standardized test to another, or buffing my CV with medical related volunteering experiences in pursuit of my medical aspirations. Even prior to beginning medical school, I was drawn to the culture of medicine, what I saw as a commitment to altruism, and dedication to preserving patient health and quality of life.
In my actual training, most apparent during those grueling residency years, I was exposed to another culture of medicine; this period of my life was composed of fatigue, imposter syndrome, fear that my actions or ineptitude could directly cause patient harm or death. These emotions and feeling were just as present as my desire to heal and serve. I know that my experience is not unique, but what I didn’t know was the fascinating history of how this culture of medicine, and medical education has evolved since before the original establishment of residency education at Johns Hopkins in 1889. As the famous quote states, “those who don’t know history are destined to repeat it”, which underlies the importance of reading and reflecting upon Let Me Heal: The Opportunity to Preserve Excellence in American Medicine by Dr. Kenneth M. Ludmerer [Link].
Let Me Heal by Dr. Ludmerer is dedicated to the “ideals of the Johns Hopkins Medical School and Hospital” which is appropriate given that Johns Hopkins Residency was unique, and an American answer to the previous traditional of Americans traveling to Europe for medical training. The focus of these residencies was to provide a blend of clinical medicine with basic science research. According to Ludmerer, what Johns Hopkins did differently was to:
Provide resident staff with full responsibility for patients, under the supervision of faculty
Instill in their learners an attitude of inquiry and investigation
Encourage residents to educate students, nurses, and their peers
Require multiple years for training
If this sounds familiar, this is because these are the same values that are inherent to graduate medical education today, almost 125 years later. And this is a testament to have strong these values were woven within graduate medical education.
Like any other history book, Dr. Ludmerer thoroughly documents the historical origins of the founding of graduate medical education. He then goes through the timeline of how important world events such as World Wars I and II impacted this. With great attention to detail, the use of primary resources such as personal letters and correspondences, and quotations from medical giants such as Sir William Osler, Let Me Heal paints a vivid portrait of the educational system, the day to day life of residents, and impact on patient care. The final chapters of the book give an excellent overview of current issues impacting graduate medical education such as work hour restrictions, burnout, and patient safety.
An interesting and recurrent theme in the book is what Dr. Ludmerer describes as the dual origin of graduate medical education: basic science research (originates from the German University system) and medical practice (apprenticeship). Over the course of the last 125 years, the two branches have intertwined to create our current system which views residents as both graduate level medical learners and as an important member of the patient care team. Today, we see a reference to the dual roots used in a work versus education debate. There is divide between those who advocate for a work hour reduction as means to improve patient safety, and those who lament that limited hours makes it difficult to residents to gain enough clinical exposure to become excellent clinicians.
Another interesting theme arises from the detailed description of the work life balance of residents. In the early days of medical education, residents lived in the hospital, which is where the term “house officer” came from. In fact, they were forced to live in the hospital. And yet, Dr. Ludmerer describes that these young doctors, who were in the prime of their years apparently loved these experiences. And in fact, he credits this forced confinement to setting the stages for life long friendships, that were often sealed over midnight meals and late night teaching sessions over complicated patients admitted to the hospital. At that time, in the early stages of graduate medical education, these doctors were even forbidden from marrying, because of the fear of distractions. Burn out apparently was a nonissue during those days.
But this changes over time, as Dr Ludmerer describes over the chapters how economic changes, increased administrative aspect of hospitals, the adaption of wide spread insurance, the decreased usage of “charity” patients essentially lead to a decrease in the average length of stay for patients, increased patient load per resident, and increased illness severity of these patients. Residents of today probably are not looking back fondly at midnight meals shared with their colleagues, rather given the combination of reduced work hours and increased patient load, they are working hard just to keep up with their work load. All the while, lamenting over the lack of actual learning experiences. And this is the reality of today’s medical education system.
Application to Medical Education
This is an excellent book for any one who is interested in medical education and the history of medicine. This is applicable for anyone, of any specialty, but in particular those in leadership positions. It is truly fascinating to understand that many of the current issues in medical education either were inherently there from the beginning, or stem from decisions made at critical junctions in the development. This is a great book also to learn about the history of medicine, and to go beyond the commonly quoted Osler, and to learn about the other leaders who shaped graduate medical education.
As one reads this book, you cannot help but notice the lack of information about the issues that minorities and women have gone through in medical education. While, minorities and women did not make up a significant number of doctors at that time, it would be worthwhile to learn more in depth about their struggles and successes. Additionally, while the paternalistic nature of medicine in the early stages is noted, it is not detailed either. This is important as so many tend to immortalize the “fathers” of medicine including Dr. Osler without understanding the full extent of how medicine was practiced in those times, especially on “charity” patients.
Do you agree with Dr Ludmerer’s assessment of the origin of Burnout? What are solutions that you feel would be helpful to combat this?
Many argue that restricted work hours actually makes graduate medical education more difficult for residents to learn, what are ways that we can current implement solutions to increase the educational value of residency education?
What are your thoughts on the current attitudes of Work and Life in graduate medical education?
How do you envision the future of graduate medical education?
Andolsek KM. Chasing perfection and catching excellence in graduate medical education. Acad Med. 2015 Sep;90(9):1191-5. [Link]
Goitein L. Training Young Doctors: The Current Crisis. 2015. New York Review of Books. [Link]
Sorensen MJ. Let’s Heal Ourselves. JGME. 2014. Vol. 6, No. 3, pp. 449-450. [full commentary link]
* Disclaimer: We have no affiliations financial or otherwise with the authors, references or hyperlinks listed, the books, or Amazon.
Nikita Joshi, MD
ALiEM Associate Editor
Editorial Board Member
ALiEM Social Media and Digital Fellowship Director
Stanford University, Department of Emergency Medicine
The use of blogs and podcasts within health professions education is rapidly increasing, especially among emergency medicine and critical care learners [1-5]. However, there are no standardized quality assessment methods for the learners and educators that use and produce them. This dilemma led the MedEdLife Research Collaborative to launch a research agenda with the goal of developing a tool to assess the quality of blogs and podcasts. This was done through the series of studies that are presented in this blog.
Paterson Q, Thoma B, Milne WK, Lin M, Chan TM. A Systematic Review and Qualitative Analysis to Determine Quality Indicators for Health Professions Education Blogs and Podcasts. J Grad Med Educ. (in press). DOI: JGME-D-14-00728.1
A systematic review of the literature was used to identify quality indicators that have been applied to other secondary educational resources. Lead author Quinten Paterson noted that:
“It was incredible to see all of the potential quality indicators that could be used to assess a resource.”
These quality indicators then underwent a qualitative analysis to categorize and theme the results and to determine which potential indicators of quality that could be applied to health professions blogs and podcasts. A focus group of bloggers and podcasters identified additional quality indicators relevant to blogs and podcasts that were not found in the literature. Ultimately, a list of 151 quality indicators was developed across three main categories:
This list, while comprehensive, was too lengthy to be of practical significance to producers, editors, users, and researchers. As such, our team next tried to determine how this list could be further refined.
Thoma B, Chan TM, Paterson QS, Milne WK, Sanders JL, Lin M. Emergency medicine and critical care blogs and podcasts: establishing an international consensus on quality. Ann Emerg Med. 2015. PMID: 25840846
The quality indicators from the previous study formed the basis of a modified Delphi process. This consensus-building study used two iterative surveys to identify the quality indicators most important for blogs and/or podcasts. Content producers (established bloggers/podcasters on the Social Media Index ) served as experts. The initial 151 quality indicators were narrowed to items that reached ≥90% consensus within the group:
14 quality indicators for blogs
26 quality indicators for podcasts
“This study is the first to assess the relative importance of blog and podcast features for quality. The results have already influenced the content I produce at BoringEM and ALiEM. I hope that it gives other content producers ideas for how they can make the great resources that they are producing even better.” – Dr. Brent Thoma
As content producers (bloggers and podcasters) could be perceived as a biased audience for determining quality, our next step was to approach traditional medical educators for their input.
Lin M, Thoma B, Trueger NS, Ankel F, Sherbino J, Chan T. Quality indicators for blogs and podcasts used in medical education: modified Delphi consensus recommendations by an international cohort of health professions educators. Postgrad Med J. 2015 PMID: 26275428 
In this study, a population of expert medical educators participated in a second modified Delphi process. The expert group of participants was composed of attendees of the 2014 International Conference on Residency Education’s (ICRE) Social Media Summit. The educator community identified a short list of 13 quality indicators that reached ≥90% consensus:
3 quality indicators for blogs
1 quality indicator for podcasts
9 quality indicators for both blogs and podcasts
“This study involving the educator community was a key step in my mind towards building a legitimate list of consensus recommendations about what comprises quality and trustworthiness for blogs and podcasts. I hope this is a major first step towards legitimizing blogs and podcasts as legitimate educational resources and academic scholarship in the health professions community.” – Dr. Michelle Lin
Quality Checklists for Blogs and Podcasts
The results of the two Delphi studies were analyzed and amalgamated to form the Quality Checklist for Blogs [PDF] and the Quality Checklist for Podcasts[PDF].
This marks the first in a planned series of knowledge translation products that serve to help end-users operationalize this research. These analogous, platform-specific tools display the quality indicators that were identified as being of utmost importance in the appraisal of online health professions blogs and podcasts by expert populations of bloggers/podcasters and medical educators. We believe that these resources may benefit researchers and three key populations:
Producers: who can use these items as a guide to ensure they are producing content of the highest quality possible
Editors and curators: who can apply these checklists to the resources they are assessing before disseminating them to end-users
Users: who can utilize these tools to help determine if the resources are of good quality.
Admittedly, the present studies have not derived these insights from the end-user perspective. Further research is underway to examine this critical issue.
We hope you all find these checklists helpful. We have done our best to develop them using a rigorous process based on expert consensus and are still working to improve them. We would love to hear your feedback! Please provide it by following this link and reviewing their formal publication on The Winnower. They are also available for download by following the links below.
Note: Please do NOT cite this blog post to reference these checklists. Rather, please cite their formal publication from The Winnower . They can be cited as:
Cadogan M, Thoma B, Chan TM, Lin M. 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. PMID: 24554447
Loeb S, Bayne CE, Frey C, et al. Use of social media in urology: data from the American Urological Association (AUA). BJU Int. 2014; 113(6): 993-8. PMID: 24274744
Mallin M, Schlein S, Doctor S, Stroud S, Dawson M, Fix M. A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med. 2014; 89(4): 598-601. PMID: 24556776
Purdy E, Thoma B, Bednarczyk J, Migneault D, Sherbino J. The use of free online educational resources by Canadian emergency medicine residents and program directors. CJEM. 2015; 17(2): 101-6. PMID: 25927253
Thoma B, Chan T, Benitez J, Lin M. Educational Scholarship in the Digital Age: A Scoping Review and Analysis of Scholarly Products. The Winnower. 2014; 2:e141827.77297. DOI: 10.15200/winn.141827.77297
Paterson QS, Thoma B, Milne WK, Lin M, Chan TM. A Systematic Review and Qualitative Analysis to Determine Quality Indicators for Health Professions Education Blogs and Podcasts. Journal of Graduate Medical Education. In-Press; doi: JGME-D-14-00728.1
Thoma B, Chan TM, Paterson QS, Milne WK, Sanders JL, Lin M. Emergency Medicine and Critical Care Blogs and Podcasts: Establishing an International Consensus on Quality. Ann Emerg Med. 2015; 66(4): 396-402.e4. PMID: 25840846
Lin M, Thoma B, Trueger NS, Ankel F, Sherbino J, Chan T. Quality indicators for blogs and podcasts used in medical education: modified Delphi consensus recommendations by an international cohort of health professions educators. Postgrad Med J. 2015; PMID: 26275428
At the recent 2015 ACEP Scientific Assembly in Boston, many of emergency medicine’s (EM) finest speakers arrived to share their expertise with the EM community. Two were ACEP Live talks, hosted and recorded by the Annals of Emergency Medicine, featuring Dr. Seth Trueger (@MDAware, Assistant Social Media Editor for Annals of EM) and Dr. Iltifat Husain (@iMedicalApps, Founder and Editor-in-Chief of iMedicalApp.com). Do you agree or disagree with their lists? What are your favorite apps?
Apps for the ED
Audio only edited version:
Essential Emergency Medicine Apps
Audio only edited version:
Thank you to Annals of Emergency Medicine for allowing us to create audio files for our followers who are podcast-enthusiasts.