Friendship, Motivation, and Altruism @ SMACCGold

I just attended the SMACC Gold conference in the Gold Coast, Australia, and I have to tell you it was the best conference I have ever been to. I have been to a lot of medical conferences over the years, some good, some average, and some not so great. SMACC Gold is by far the best one I have attended! This is a true gem of a conference. Roger Harris (@RogerRdharris),  Oli Flower (@oliflower), Chris Nickson (@precordialthump), and the rest of the crew have developed an incredibly unique conference. Attention conference organizers all over the world: If you want to have a better course you should carefully study what the SMACC conference has done right….everything!

Listen to Damian Roland (@Damian_Roland) explain why YOU should attend this conference:

http://www.youtube.com/watch?v=rLItXBDEluU

Why is this such an awesome conference? 3 reasons…(there’s more but these 3 come to mind first)

Friendship (The People of SMACC)

I have to say that the most important part of this trip was meeting new friends. It was an amazing experience to meet such interesting, nice, and pleasant people at the conference. I won’t be able to name everyone (mainly because I am still a bit jet lagged), but a few include Aidan Baron, Natalie May, Simon Carley, Cliff Reid, Oli Flower, Louise Cullen, Damian Roland, Victoria Brazil, Sarah Webb, Bishan Rajapakse, Grace Leo, Casey Parker, Iain Beardsell, Minh Le Cong, Jeremy Faust, Jesse Spurr, Irma Bilgrami, Tor Ercleve, Andy Buck, Roger Harris, Todd Slesinger, Mike Mallin, Jen Williams, Matthew MacPartlin, Andy Neill, Tessa Davis, Michelle Johnston, Peter Fritz, and Nicholas Chrimes. If I left your name of this list please know that it’s only because I am operating on about 3 neurons at the present moment.

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I have never been to a conference that had such wonderful integration of physicians, nurses, EMS providers, techs, etc. Everyone attended to gain skill in their profession and to collaborate within the FOAM spirit. FOAM truly does bring people together.

I do need to mention that one important ingredient was missing during this course-my good friend, Mike Cadogan. Mike couldn’t make it this year, and he was missed.

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Oh, and of course, I was lucky enough to be traveling with my trusty side kick (actually, I am the side kick), Haney Mallemat (@CriticalCareNow)…

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The folks who attend SMACC (we’ll call them “SMACCers) are the nicest folks I have been around. The conference is worth attending for this reason alone. If you didn’t attend SMACC this year in Australia you simply must attend when it comes to Chicago…you must go.

Even the foam on the lattes was heart shaped. That says it all folks!!

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Motivation

Another really cool thing about this conference is that you get to meet folks who are really motivated and who want to do better at their profession. The conference has some expected medical and surgical presentations, but many of the talks are very unique in that they are truly motivational and inspirational. I still remember listening to Cliff Reids’s talk on “Being a Hero” from last years SMACC conference. Simply amazing.  This year there were also some incredible talks by folks like Cliff and a PK talk that will simply bring you to tears. Taken together, the talks at SMACC will motivate you to do better, to strive to improve how you treat patients and their families, and to “fire up the FOAM machine” and contribute to the wonderful world of FOAMed. I have never left a conference with as much motivation as I have right now. If you are looking for the “feel good” conference of the century, then you have to get yourself to SMACC…

Altruism

One of the most interesting things about the people I met was their altruism and desire to simply do better for their patients. I haven’t encountered a group of people with such altruism at a conference before. The speakers and the attendees at SMACC truly love taking care of patients, and it shows. Going from presentation to presentation you truly get a feel for how much this group of providers likes patient care. And it’s infectious. You will leave this conference with a renewed spirit to provide the very best medical care you can provide. This is the ONE conference that has reminded mw why I went into medicine to begin with.

If you are looking for a conference that will “grill your corn,” then look no further….SMACC is your conference. Get thee to SMACC!!

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The 2015 SMACC Conference is in the USA…Chicago. #smaccUS

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UMEMLive Brings You Live FOAMed!

FOAMed has become an essential part of our lives in emergency medicine and critical care education and has revolutionized the way we learn, teach, and assimilate information. There are lots of great things out there in the FOAMed world, and we at the University of Maryland would like to take it to the next level. Ladies and gentlemen, we bring you….UMEMLive.

FOAMed and how it’s delivered:

  • Blogs (lots and lots of great FOAMed blogs out there)
  • Websites
  • Podcasts
  • Tweets
  • Google Hangouts
  • Online videos (e.g. Amal Mattu’s ECG video series)
  • Text documents
  • And a whole lot more…

Check out the fantastic post about FOAMed on Life in the Fast Lane by Chris Nickson.

What is UMEMLive?

UMEMLive is a new program developed by the University of Maryland Department of Emergency Medicine. The goal is to take FOAMed to the next level and provide live, high quality educational sessions and FOAMed content. What better way to spread the FOAMed wealth than to do it live?

UMEMLive

Follow us on Twitter @UMEMLive

How do we provide UMEMLive content?

The Livestream HD500 is our new baby. It’s a multifunctional, multicamera live production studio. We have piloted it during our grand rounds (www.umem.org), and we will be using it during the 3rd annual International Teaching Course in April 2014. The really neat thing about the HD500 (and the broadcaster below) is the ability to moderate live comments that come in through our personal Livestream blog. People watching the live presentations can type in comments and ask the speakers questions. Truly awesome. Here is the link to our Livestream site where you can watch the most recent recording of our grand rounds: UMEMLive

LivestreamHD500

http://new.livestream.com/

We also use the Livestream Broadcaster. I have used this for the past 2 years to broadcast the International Teaching Course. It’s relatively inexpensive, $500 USD, and is very easy to use. All you need is an internet connection and a camera and you are up and running. I should also note that you need a Livestream account (~$50 USD per month) to be able to broadcast. Videos are streamed live and stored on your very own Livestream site. You can send out the site link on Twitter, and people can watch live on the site as well. Very easy and very cool.

 

Livestream-Broadcaster-Poster-Shot

What does UMEMLive encompass?

  • Live tweets during emergency department shifts at the University of Maryland Hospital (Tweeting While Treating)
  • Live video feeds from the University of Maryland Emergency Medicine Residency Education Conference (Wednesdays 7:30am-11:30am)-Schedules will be sent out via Twitter
  • Live video feeds from select CME conferences run out of the Department of Emergency Medicine (more on that later)
  • Live video feeds from conferences around the world (in the planning process for this)
  • Live lectures from the International Teaching Course (www.theteachingcourse.com)-held twice yearly in Baltimore, Maryland
  • Live cadaver/procedure labs with the Grandfather of Procedure Education, Mak Moayedi
  • Live simulation sessions with George Willis and other UMEM faculty (with the ability for viewers to ask questions and interact)
  • Future potential for live video feeds from the emergency department (patient privacy issues to be worked out)-UMEMLive ED Teaching (Teaching While Treating)
  • Future potential for livestreaming with Google Glasses-more on that in a future post
  • Updates on Twitter (Follow us: @UMEMLive)
  • UMEMLive audio updates on the iTeachEM podcast-audio file links sent out via Twitter
  • FOAMTv…yes, that’s what I said, FOAMTv. What about a live stream event where people can watch topics they want to hear about? Big plans being made…

Live Emergency Medicine Grand Rounds and Educational Conference-What’s the Content?

  • Emergency Medicine Board Review
  • Medical-Legal lectures
  • Grand Rounds
  • Core Content emergency medicine lectures
  • Code Blue sessions (resuscitation simulation)
  • ECG rounds with @amalmattu
  • and much, much more…

What happens if I miss a live event? The “UMEMLive DVR” is there for you

Well, it’s not actually a DVR, but it’s almost a DVR. Don’t worry, live lectures recorded at conferences and grand rounds are housed on our Livestream site. The link to archived presentations will be sent out on Twitter. That way you have your very own FOAMed DVR! Miss the latest educational offerings from the University of Maryland Department of Emergency Medicine? Don’t worry, you can watch them anytime you want-day or night, rain or shine. It just doesn’t get better than this.

Doesn’t UMEMLive cost a lot of money to access?

The simple answer….NO! Remember, it’s FOAMed. Live FOAMed from The University of Maryland. It just can’t get much better than that!

UMEMLive & Future Collaboration with the FOAMed World


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We are currently looking for partners to work with on livestreaming EM/CC educational events. Of course, we are also open to the idea of streaming and collaborating on non-EM/CC courses and presentations. We have teamed up with the brilliant minds (Matt Dawson and Mike Mallin) who run the CastleFest ultrasound course and will be helping broadcast 2 days of content during their course in April. It’s an absolutely awesome ultrasound course, by the way. You can follow them on Twitter @ultrasoundpod

If you have an interest in learning how to live broadcast a course feel free to contact us. You can also leave a comment in the comment section.

 

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A podcast explaining the ins and outs of UMEMLive is currently being edited and will be up soon. Cheers.

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Teaching Procedures-the Moayedi Way

Teaching medical procedures is one of the most rewarding aspects of medical education. Physicians-in-training place a high value on mastering clinical procedures and often link their confidence to their procedural skills.

It is important to provide an opportunity for the student to prepare to learn a new procedure. This phase of learning should occur in a more didactic format, aside from the laboratory or patient bedside where the actual mechanics of the procedure will be performed. The goal of this preparatory time is to ensure that the student understands the large amount of prerequisite information needed to perform the procedure appropriately. This information includes a review of the indications and contraindications for the procedure, the human anatomy involved, the tools used to perform the procedure, and the expected outcome of the procedure.  Students are often able to uncover and retain more information if they consult multiple sources, including colleagues, texts, nurses, and Web-based media. The prospect of learning and performing a new procedure typically serves as adequate motivation for this active learning to occur.  Furthermore, many teaching institutions have developed and evaluated computer-assisted modules that incorporate images, short video clips, and instructional texts for this phase of learning.

While students prepare to learn a procedure, the instructor must prepare to teach it. This involves task analysis, a skill in which the instructor breaks down the procedure into small, more digestible components for teaching purposes. For example, when teaching the placement of a central line, one of the microskills that needs to be acquired before attempting the procedure is the ability to draw back on a syringe using a single-handed method. Without accomplishing this smaller component of the motor skill, the physician will never learn to place a central line independently. As this example demonstrates, instructor preparation can be challenging because many of the microskills required to perform procedures are taken for granted once the procedure is mastered. Therefore, instructors must take the time to deconstruct the components of the procedure in preparation for the learning session and create a task analysis.

The long-standing tenet “see one, do one, teach one” does not provide an optimal framework for the learner or the instructor to ensure mastery of a procedure. Instead, a multistep process of learning the procedure and then practicing it with a declining level of supervision and guidance is more effective:

Steps in the process of learning a procedure

  • Conceptualization—understanding the reasons for performing a procedure, the overall process, the tools involved, and the risks/benefits.
  • Visualization—observing a demonstration of the procedure, performed in a fluid and competent manner by the master teacher
  • Verbalization—reviewing a verbal deconstruction of the procedure while it is performed by the expert, with opportunity for interruptions and clarifications.
  • Guided practice—performing the sequential steps of the procedure under the supervision of an expert physician.

When an error is identified, it is best to have the instructor place his or her hand on the trainee’s hand to stop the incorrect action and physically redirect the student to the correct motor action while providing verbal instruction regarding the proper method. It is important that learners be told that this will happen and for them to expect this hand-on-hand contact. One common pitfall is allowing learners to perform procedures with errors and then providing feedback regarding those errors after the procedure has been completed. The idea is to stop the error before it is imprinted in the learner’s motor memory.

Practice without guidance can precipitate errors and result in imprinting of inappropriate actions, which is dangerous to patients and a disservice to the learner. Immediate feedback, both positive and negative, is invaluable throughout the learning process. More specifically, effective feedback is performance based, highlighting portions of the procedure that were done well and pointing out areas for improvement, with specific tips on how to improve the skill attempted.

Although performing a procedure at the bedside should be reserved for learners who have already been instructed regarding the procedure and practiced it in a more structured setting, other phases of procedural learning can occur at the bedside as well. For example, a medical student who has only read about a procedure can accomplish the visualization phase of learning at the bedside by observing the teacher performing the procedure in a fluid manner from start to finish. Those who have observed the procedure once or twice can be asked to verbalize the procedure and prompt the expert performing the procedure regarding the next step to be taken and how it is to be done. In addition, the learner who has practiced a procedure in laboratory can be guided to assist with certain steps of the procedure, whereas the overall performance is primarily by the teacher. As learners gain experience at the bedside, the number of steps that they perform can be increased until they are able to attempt the entire procedure under direct guidance. In this manner, the bedside can be a suitable environment for a variety of levels of learning procedural skills. The key is to recognize the stage of the learner and create the appropriate, safe experience based on that stage of learning.

Thanks to Mak Moayedi, the Godfather of procedure education, for this post!

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Don’t forget to listen to the podcast associated with this post. It’s a teaching procedures redux from the EMRAP Educators Edition Podcast….great stuff, Mak!

 

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How we are flipping EM education

“But in an era with a perfect video-delivery platform — one that serves up billions of YouTube views and millions of TED Talks on such things as technology, entertainment, and design — why would anyone waste precious class time with lecture?”
— Charles Prober and Chip Heath1

Lately, lecture, that venerable tool in the educator’s toolkit, has come under considerable fire for being inefficient and ineffective2. This is not entirely the fault of lecture. The lecture is simply a tool and its effectiveness is dependent upon the user. Unfortunately, too few teachers engage in deliberate practice to improve their lectures (or design their presentations). Additionally, medical education has become too reliant on the lecture as the “best” tool to deliver our message. Perhaps this is why, in recent years, we have seen a rapid expansion in alternative teaching strategies, from problem-based learning to simulation. The Flipped Classroom is one such strategy that captures the advantages of lecture AND active learning strategies.

What is the Flipped Classroom?

At its most basic, Flipped Teaching is a form of instruction where students are given the content, usually in the form of a video, to independently view by themselves. Class time, previously used by the teacher to deliver the lecture, is now used for application of the knowledge, problem solving, and practical experience.

While Salman Khan, creator of the Khan Academy, popularized the concept in his 2011 TED Talk, the credit for initially applying the concept belongs to Eric Mazur. A physics teacher at Harvard, he noticed that despite consistently high evaluations for his teaching, his students couldn’t apply basic concepts in physics. He inadvertantly discovered that peer to peer discussion was critical in clarifying student misperceptions and went on to create an early flipped classroom in which students watched videos and then interacted with each other in order to solve complex problems.

Fast-forward to Valentine’s Day, 2005. YouTube is born. Suddenly, technology that was previously only available to educators with resources becomes universally available. As a platform, YouTube made it easy for educators to share videos with their learners. Educational innovators quickly seized upon this opportunity to provide instruction to their learners. Jonathan Bergmann and Aaron Sams, authors of Flip Your Classroom, took advantage of this early technology as an attempt to support learners who are frequently absent from their rural classroom3. After some experimentation, they came to realize that Flipped Learning offered many advantages:

  • Efficiency
  • Reproducible, scalable, and customizable content
  • Student centered content
  • Increased student to teacher interaction
  • Increase student and student interaction
  • Students assume the responsibility for learning

After several years, they have expanded their curriculum into what is now is termed ‘Flipped Mastery’. In the mastery model, students are allowed to progress through the curriculum in an asynchronous fashion, learning the objectives of the curriculum at their own pace.

With this model, the teacher’s role changes. Instead of being the “Sage on the Stage,” the teacher becomes a “Guide on the Side.” The teacher’s role within the flipped model is to provide:

  • Accountability
  • Expert feedback
  • Concept Clarification
  • Project/activity oversight

Notice that lecture does still have a role within this model. Instead of using class time to deliver the content using a passive delivery vehicle, they utilize class time for active learning. Students view the lectures as videos. These videos offer several advantages. Students can pause and rewind their teacher. In addition, lectures delivered through video are easily reusable from class to class. The best videos also take cognitive load into account and are appropriately brief.

How to Implement Flipped Education

Similar to the experience of Bergmann and Sam’s, our residency “accidentally” stumbled into flipped education, albeit a low-tech version. When our program started in 2008, we were faced with providing high-quality education by very few faculty members. If we were to use other models and provide a majority of the content via a weekly lecture series, each faculty member would have to deliver a lecture a week. Given the inordinate amount of time this would require, we sought another solution. Instead, we turned to the medical literature. We looked for “classic” papers in emergency medicine and succinct review articles. Residents were assigned several papers to read every week and then met in small groups to discuss and debate the topics. A comparison is provided below:

“Traditional Residency”

  • Lecture: 50 minutes
  • Break: 10 minutes
  • Lecture: 50 minutes
  • Break: 10 minutes
  • Lecture: 50 minutes
  • Break: 10 minutes
  • etc

“Our Model”

  • Updates: 20 minutes
  • Test: 10 minutes
  • Small group discussions: 80 minutes
  • Break: 10 minutes
  • Simulation/Oral boards: 50 minutes
  • Break: 10 minutes
  • Guest lecture/Morbidity and Mortality Conference/Clinical Case Presentation: 50 minutes

Initially, we hit many roadblocks. Our chosen literature was not received positively by the learners. The weekly modules did not have a logical flow (asthma one week, DKA the next, back to Pulmonary thromboembolic disease). We also faced technology problems. We were utilizing a platform to host the PDF files that didn’t allow for customization. Instead, hundreds of documents were in a single file folder. We took the learner feedback and have been continually making improvements. We created a wiki and used it to host the entire curriculum. This also allowed us to incorporate images, podcasts, and videos into the curriculum. We also continuously assess the included literature for its relevance. Each week learners give us feedback on articles that they found helpful and eliminate those that do not add to our clinical practice. Currently, the Model of the Clinical Practice of Emergency Medicine is taught in 82 separate modules, delivered twice throughout a residents education.

As an educator, the most enjoyable part of flipped education is observing the learners taking responsibility for their own learning. The learners are able to ask critical questions of their practice after reading the literature. The discussion also allows them to explore the experiences of their faculty in great depth, thus gaining tacit knowledge. When we meet as a small group, the instructor is given free reign to determine how to utilize that time. This variety keeps the small groups interesting and the learners engaged.

Activities that we have utilized during our group time include:

  • Peer led discussions
  • Case-based instruction
  • Pro-Con debates
  • Projects, such as developing a departmental postpartum hemorrhage protocol
  • Shared Mind Map creation
  • Hands-on demonstrations (slit lamp, ENT toolbox, neuro exam)

Our curriculum is constantly evolving. New this year is the Clinical Case Presentation. This hour-long “cognitive apprenticeship” allows learners to present interesting or difficult cases to a panel of faculty members. As the case is revealed, we must think out loud, elaborating our reasoning for asking specific questions or ordering specific tests, until the diagnosis is revealed. We have also begun team-based quality improvement projects in an attempt to teach 21st-century skills to our learners.

The Future

The next logical progression of our curriculum is to incorporate components of mastery learning. Within this model, students are allowed to progress through a curriculum at their own pace. Mastery learning is directly applicable to Competency-Based Medical Education, and offers the promise that we may finally have an alternative to the “tea-steeping” model of medical education4.

References

  1. Prober, C.G., Heath, C. (2012). Lecture Halls without Lectures-A Proposal for Medical Education. NEJM. 366(18): 1657-1659. PubMed PMID: 22551125.
  2. Lambert, C. (2012). Twilight of the Lecture. Harvard Magazine. Mar-Apr. 23-27. [Free Full Text]
  3. Bergmann, J., & Sams, A. (2012). Flip Your Classroom: Reach Every Student in Every Class Every Day. ISTE. Washington, DC. [Google Books]
  4. Hodges, B.D. (2010). A Tea-Steeping or i-DocModel for Medical Education? Acad. Med. 85(9): S34-S44. PubMed PMID: 20736582.

 

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How to Make Journal Club Work

As part of a drive to create asynchronous learning resources for the SMACC Education Workshop, Chris Nickson talked to Simon Carley to find out ‘How to make Journal Club work”. It also ties in nicely with the SMACC EBM Workshop that Simon is running. They cover the objectives, structure and setting, the people involved, content and conduct, tech and resources to help with journal club and what the oucomes should be.
Check out Simon’s St. Emlyn’s post on Journal Clubs for an introduction.

Key Journal Club references

  • BMJ Careers, 2011: Are journal clubs an essential tool for postgraduate education? Yes by Sophie Cook [Free Full text] No by Helen MacDonald [Free Full Text]
  • Deenadayalan Y, Grimmer-Somers K, Prior M, Kumar S. How to run an effective journal club: a systematic review. J Eval Clin Pract. 2008 Oct;14(5):898-911. doi: 10.1111/j.1365-2753.2008.01050.x. Review. PubMed PMID: 19018924. [Free Full Text]
  • Patil P. Establishing an Effective Journal Club: A Postgraduate Educational Tool.Education In Medicine Journal, 2013 5(3). doi:10.5959/eimj.v5i3.134 [Free Full Text]
  • Pitner ND, Fox CA, Riess ML. Implementing a successful journal club in an anesthesiology residency program. F1000Res. 2013 Jan 16;2. doi: 10.12688/f1000research.2-15. PubMed PMID: 24358844; PubMed Central PMCID: PMC3752701.

Also, this is the iTeachEM post on NB that was mentioned in the podcast for collaborative document annotation: NB Helps Flip the Classroom

Free websites with journal club archives

Useful critical appraisal resources

Come meet Simon and the iTeachEM team at smaccGOLD.

Vive la FOAM!

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Text, Slides and Videotape

Damian Roland is a meducation marvel from the UK. He’ll be part of the faculty for the SMACC Education Workshop in the Gold Coast next year (March 18th 2014, to be exact). He has already got his pre-course materials online here, amd it is all FOAM available to to everyone — even if you’ve missed out on a ticket to the workshop.

Damian’s session is on “Text, Slides and Videotape”, which he describes thus:

The Education Workshop contains a short session on “Text, Slides and Videotape” hosted by yours truly. The aim of this session is to aid delegates use of audio-visual tools to maximise the impact of their teaching. There will be lean towards the use of video as resources on other medium are easily found elsewhere (and its the area in which the greatest gains for least effort can be made IMHO)

I will also be offering an individual feedback session on videos/pictures used in teaching/assessment for attendees. Please send me your cases in advance (secure if needs be) and I’ll touch base at SMACC. There might be a prize for the best use of audiovisual material for teaching….

To see Damian’s recommended resources, and to leave comments, visit “Text, Slides and Videotape”: #SMACCGold Workshop Pre-reading. Register for smaccGOLD here.

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