The Council of Residency Directors (CORD) in Emergency Medicine is next week in Denver.  This year's hot-button topic are the Milestones, the foundation of a new outcomes-based resident evaluation process.






I'll be presenting a research abstract called, "How Do Practicing Emergency Attendings Self-Evaluate on the Emergency Medicine Milestones?" at the Milestones Bootcamp session on March 6th.  It is a study which attempts to begin the process of independently validating the milestones.

As part of its Next Accreditation System, the ACGME commissioned committees to draft, endorse, and implement specialty specific milestones.  For EM, what ensued was a collaborative step wise process to create milestones which centered around the clear definition of what would be come to be known as Level 4, the minimum standard of competency needed to graduate residency and practice emergency medicine successfully.  The EM milestones will be used to track resident progress by residency programs beginning in the 2013 academic year. 

We have begun to attempt validation of the ACGME EM Milestones.  We will be recruiting representatives from residencies across the country to partner with us to explore the creation of a multicenter effort to continue to study the Milestones.  We will have a sign up after the talk on March 6th as well as at the poster session.

If you're interested in validating the milestones, post a comment or let's meet at CORD.

Excited,

Timothy Peck

Many in academic medicine have not yet accepted the values of the social media revolution.  Many tell me that it is clumsy, disjointed, and the dilution of information makes that information less valuable.  Although my instinct is to be defensive of this medium in which I function, I unfortunately cannot disagree with these sentiments.

The other day I went to see Samuel Shem speak.  For those of you not familiar, he is the author of House of God which was a pivotal tell all semi-fiction novel about his intern year at Beth Israel in Boston.    



He spoke in an auditorium at Beth Israel-Deaconess, and it was the first time he had set foot on campus since he had written the book.  He was received with a large applause, and his talk was both funny and poignant - much like the book.


One theme he spoke of was loneliness: the demands of residency force you to sometimes mentally remove yourself from difficult situations in order to continue to meet your responsibilities.  You may have just had an unsuccessful resuscitation of a cardiac arrest patient, and then in the next room you may have someone who is asking for Tylenol for their sprained ankle - this ebb and flow of human emotion can cause a functional isolation from your patients and your peers.  Surrounded by people, it is still possible to be lonely.

The Association of American Medical College (AAMC) has a blog called "Wing of Zock," which is a reference to House of God.  The scope of the blog is to encourage open communication among those in the academic medicine community.



When I first saw the name of this blog, I did not completely understand the logic behind the name.

But as I listened to Dr. Shem speak, I thought of the role of social media and mobile technology in my life.  I live in Boston now, but I am in constant virtual contact with my friends and family in New York.  Through Web 2.0 resources like Twitter, and Facebook, and GMEP, and G+,  I'm in constant virtual contact with  the medical community at large around the world.  It has attempted to solve my loneliness - yet it has not been entirely successful.

Web 1.0 was an internet that spoke to us.  It consisted of pages of information that told us what we could just have found in books, but made it easily accessible.  Web 2.0 is an internet in which we can have conversations with one another and with those who host websites - information is no longer a one-way valve.

Web 2.0 is still in it's adolescence; this means it is disjointed.  The information is erratically thrown about and moderation and patience is often sacrificed for volume and speed.  But social media will grow up; it has the power to connect us in a novel manner that has never before existed in the history of our world.  We should not turn away from the medium because it is imperfect, but instead work to mold it into it's adult form in which it can have sound structure.

Web 3.0 will be an internet in which the internet itself has the ability to have directed and organized conversation with you, it's user.  It will have the ability to address your questions with logical answers rather than pages of sites that match your search engine query.  The internet will be able to host real-time conversations and will not only give you facts, but also challenge you to provide answers.  It will be able to debate you, challenge your ideas, teach you things in real time, help you with tasks while you're performing them.  It will get to know you.  And most invitingly, it will perform these functions with you in community with other humans.  Web 3.0 will not be an alternative to our physicality but rather facilitate it.  Web 3.0 will attempt to dissolve our loneliness.

To those who refuse to embrace social media: perhaps you can keep an open mind while we all give it a chance to grow up.

Mike Cadogan and friends have taking a historic step in medical education.

FOAM is a concept of free open access meducation.

Help make medical education social, smart, and free.

Support FOAM here,

and check out the Global Medical Education Project here



- Timothy Peck, MD

Calling all Med Students:

The 3rd annual Northeast Emergency Medicine Student Symposium will be held on September 29th, 2012 at 12 noon to 5 PM on the Harvard Medical School Longwood Campus in Boston.

The symposium is hosted by the Harvard Emergency Medicine Interest Group (HMS EMIG) and a special thanks goes to the group's student leader Joshua Feblowitz for his hard work organizing the event.


Last year there were approximately 65 students from around the region.  This year we hope for more; students from New York City to New Hampshire have already registered.  Please note there is a small $10 registration fee to cover some of the costs.

The symposium is a key opportunity to network with other students interested in EM as well as with residents and faculty from Boston area programs.  Faculty and residents from both the Partners and the Beth Israel Deaconess HAEMR programs as well as from Boston Medical Center will be speaking.  The afternoon will wrap up with your choice of a splinting, SIM, or radiology workshop.

Sign up and I'll see you there,

- Timothy Peck, MD


 

Calling all Med Students:

The 3rd annual Northeast Emergency Medicine Student Symposium will be held on September 29th, 2012 at 12 noon to 5 PM on the Harvard Medical School Longwood Campus in Boston.

The symposium is hosted by the Harvard Emergency Medicine Interest Group (HMS EMIG) and a special thanks goes to the group's student leader Joshua Feblowitz for his hard work organizing the event.


Last year there were approximately 65 students from around the region.  This year we hope for more; students from New York City to New Hampshire have already registered.  Please note there is a small $10 registration fee to cover some of the costs.

The symposium is a key opportunity to network with other students interested in EM as well as with residents and faculty from Boston area programs.  Faculty and residents from both the Partners and the Beth Israel Deaconess HAEMR programs as well as from Boston Medical Center will be speaking.  The afternoon will wrap up with your choice of a splinting, SIM, or radiology workshop.

Sign up and I'll see you there,

- Timothy Peck, MD


 

If I may, a piece of advice to the new intern class of emergency medicine residents.

When you are on your surgery rotations, remember that you are an EM resident. If you operate on a patient, ask the anesthesiologist to intubate that patient too. It is very cool to be on one side of the table, scrub, and then assist the surgeon on the other side of the table. You are a multitasker.


The scrub nurse will not know what to make of you. After the surgery, ask the nurse to see their op-report. It will say that you intubated the patient and that you operated on the patient. This makes you special - you will be the only person in the hospital that will do this.

 - Tim Peck, MD

If I may, a piece of advice to the new intern class of emergency medicine residents.

When you are on your surgery rotations, remember that you are an EM resident. If you operate on a patient, ask the anesthesiologist to intubate that patient too. It is very cool to be on one side of the table, scrub, and then assist the surgeon on the other side of the table. You are a multitasker.


The scrub nurse will not know what to make of you. After the surgery, ask the nurse to see their op-report. It will say that you intubated the patient and that you operated on the patient. This makes you special - you will be the only person in the hospital that will do this.

 - Tim Peck, MD

Want to write a case for Modern EM?

Modern EM is a blog in which case presentations are used to illustrate how Web 2.o resources can be used in the management of our patients.

Thanks to the support of the EM Web 2.o world (such as Academic Life in Emergency Medicine, Life in the Fast Lane, Wing of Zock, The Poison Review, and Rahul's EM Blog), the blog has hit the ground running and already received thousands of hits!

If you've had a case in which your managment was augmented or even changed by the likes of blogs, Twitter posts, web-based audio-visual resources, or apps, please don't keep it to yourself!  Sharing your story can help the EM community members be better practitioners. 

Together we can advocate for the improved use of technology in the ED. 

If you have an idea, contact me at iclickem.com@gmail.com.

- Timothy Peck, MD

Want to write a case for Modern EM?

Modern EM is a blog in which case presentations are used to illustrate how Web 2.o resources can be used in the management of our patients.

Thanks to the support of the EM Web 2.o world (such as Academic Life in Emergency Medicine, Life in the Fast Lane, Wing of Zock, The Poison Review, and Rahul's EM Blog), the blog has hit the ground running and already received thousands of hits!

If you've had a case in which your managment was augmented or even changed by the likes of blogs, Twitter posts, web-based audio-visual resources, or apps, please don't keep it to yourself!  Sharing your story can help the EM community members be better practitioners. 

Together we can advocate for the improved use of technology in the ED. 

If you have an idea, contact me at iclickem.com@gmail.com.

- Timothy Peck, MD

The SAEM released its educational milestones on their website this week; these are a comprehensive set of skills that every emergency physician should possess by the time they graduate residency.  The resident's level of competence for each skill is graded on a 5 point scale.

The significance of the publication of these milestones is great.  I have often advocated to reevaluate the arbitrary means of granting graduation in medical education.  Just because you got through 3 or 4 years of residency, does not mean that you deserve to graduate residency (the same goes for medical school).  To be elevated from one level to the next, you should be required to prove that you have hit the necessary milestones to move on to the next level.  The recently published milestones can help make that a reality, and introduce a better system to ensure our patients that the physicians who take care of them are truely competent.  The ridiculousness of standardized paper board exams may be done away with or at least deprioritized.

The SAEM released its educational milestones on their website this week; these are a comprehensive set of skills that every emergency physician should possess by the time they graduate residency.  The resident's level of competence for each skill is graded on a 5 point scale.

The significance of the publication of these milestones is great.  I have often advocated to reevaluate the arbitrary means of granting graduation in medical education.  Just because you got through 3 or 4 years of residency, does not mean that you deserve to graduate residency (the same goes for medical school).  To be elevated from one level to the next, you should be required to prove that you have hit the necessary milestones to move on to the next level.  The recently published milestones can help make that a reality, and introduce a better system to ensure our patients that the physicians who take care of them are truely competent.  The ridiculousness of standardized paper board exams may be done away with or at least deprioritized.

I love the inflammatory, attention getting title of this NPR piece:

"Hospitals Warn Smartphones Can Distract Doctors."

The most distracting part of my job, by far, is my pager.  I did a lumbar puncture yesterday, and I turned off my phone.  My pager, however, rang 3 or 4 times during the procedure.  Good thing I have perfected the use of my elbow to scroll through pages.

click here to listen

 
Our art as physicians is to manage distractions and being a resident is learning to be someone who develops tools and skills to filter distractions.

Our patients attempt to distract us with details and non sequiturs, but we filter our histories and gather the pertinent details.  We anticipate the needs of our consults before we call them, in order to limit their questions.  We make sure to order our morphine as MR1, so as to be asked one less question by nursing.  We use decision algorithms and we run our primary and secondary surveys the same way each time to streamline our decision making.

Our phones can be distracting, but we can also learn to filter them as we do the countless other distractions we face in the hospital.  And moreover, if used properly, phones can be one more useful tool to keep us on track.

- Teach, MD

- thank you to Abigail Ballou for leading me to this NPR piece

I love the inflammatory, attention getting title of this NPR piece:

"Hospitals Warn Smartphones Can Distract Doctors."

The most distracting part of my job, by far, is my pager.  I did a lumbar puncture yesterday, and I turned off my phone.  My pager, however, rang 3 or 4 times during the procedure.  Good thing I have perfected the use of my elbow to scroll through pages.

click here to listen

 
Our art as physicians is to manage distractions and being a resident is learning to be someone who develops tools and skills to filter distractions.

Our patients attempt to distract us with details and non sequiturs, but we filter our histories and gather the pertinent details.  We anticipate the needs of our consults before we call them, in order to limit their questions.  We make sure to order our morphine as MR1, so as to be asked one less question by nursing.  We use decision algorithms and we run our primary and secondary surveys the same way each time to streamline our decision making.

Our phones can be distracting, but we can also learn to filter them as we do the countless other distractions we face in the hospital.  And moreover, if used properly, phones can be one more useful tool to keep us on track.

- Teach, MD

- thank you to Abigail Ballou for leading me to this NPR piece

My sister has been featured in a new online commercial for the product ShowMe.

You know you're watching a good presentation when the message is powerful enough to carry the medium without in-your-face graphics or people yelling their sale's pitch.  Usually there's background music that signifies a mood of importance and innovation too.

This clip has both.  Check it out:


Is anyone out there using ShowMe for their asynchronous learning?

My sister has been featured in a new online commercial for the product ShowMe.

You know you're watching a good presentation when the message is powerful enough to carry the medium without in-your-face graphics or people yelling their sale's pitch.  Usually there's background music that signifies a mood of importance and innovation too.

This clip has both.  Check it out:


Is anyone out there using ShowMe for their asynchronous learning?