A Guide to Organising a Training Day

So you got the short straw? Are you looking forward to organising the training day like you are to writing your CTR (Hint: neither of these tasks are fun). But the reality is that you are unlikely to go through your higher training without having to organise one. This is a guide to helping you to think about and get going on organising your day.

A long time before…

Firstly, book a room. It sounds deceptively easy doesn’t it? In reality this will need to be done between 6 and 9 months in advance. Why? Because you’re not the only group of people who want to have a day of learning or meetings. A lot of regular meetings will block nook a room a year in advance. Rooms are generally in short supply irrespective of whether it’s a large teaching hospital or a smaller DGH. You need to find out who to contact and then be charming (it will definitely make a difference if there are no official rooms left). Clearly you will need a room big enough for the size of your group. Having people stand at the back of a crowded room is not a great reflection of the day. AV facilities should be available but it’s worth checking first. If you’ll need internet (to open emailed presentations) double check that it will be available, and the trust doesn’t block the site you want to access.

Three to Six Months before…
If the event has just been assigned to your hospital’s group of trainees, make sure you assign someone to lead. This does come second, but only because the first is time sensitive. Having someone volunteer to lead means that someone is taking responsibility for the day and can be the focus for getting everything done. It’s hard work and a thankless task. Get the other trainees on your site to help. Delegate roles like sponsorship or room booking to them. It’s a good way of spreading the work and the stress but it only works if people are willing to lend a hand

Get a consultant to help and to give ideas for the day. This is a really good way of making sure that the quality of your day is high, and many areas specify that a Consultant should supervise the day’s training. Their suggestions may cover good topics or questions that need answering. They may even be able to suggest inspirational speakers who would be good at delivering certain talks. You may even ask them to cover a section of the day. They will have plenty of experience in teaching and the right consultant will be an invaluable asset to you.

You will no doubt have been given a theme already. Consult the syllabus to know what’s expected. You can use the day to stimulate debate on interesting questions e.g when should we CT scan trauma patients? Or simply ask for a talk on a subject that you and probably your colleagues won’t know much about. Remember that consultants and senior registrars are the target speakers. It’s a difficult balance between covering the curriculum so that people pass FCEM, covering what people actually need to know for shop floor practice, and being interesting – try and get at least one session aimed at each area.

You can have a mix of Emergency Medicine speakers and specialty speakers. A good talk is a good talk whoever gives it. Often a specialty speaker can deliver a viewpoint or topic from an angle that you won’t have been exposed to previously. An Emergency Medicine speaker is more likely to present the information in a way that is congruous with your training and requirements. You can email all speakers (including those from EM) the relevant parts of the curriculum.

What’s the best format to deliver the teaching? Often this will depend on what the topic is on. A training day on major incidents is crying out for a mock major incident, rather than a whole day of lectures. If covering equipment, then practical hands on small group sessions are best (but hard to organise because of space). A session on SAQs or OSCE stations can be a useful, realistic way of delivering content that is directly useful to that big quiz at the end of your training (aka FCEM).

Getting Things Done

If you want to get anything done, always go and ask in person.  People will always find it harder to say no to your face. And you are much likelier to convince them, or get ideas or get one of their colleagues to help out. At least double the time that you think that you will need to organise everything.

For sponsors, ask consultants for contacts they may have. Locum agencies care often a good source of sponsorship. Drug reps may offer sponsorship, but some participants will have ethical concerns about this. Always drive a hard bargain, which should include breakfast snacks, lunch and coffee. In return they must get their pound of flesh, which normally means a small talk to the assembled group. Remember you may well be judged on the quality of the lunch you provide as well as the content of the training day…

A Week Before

Just before the training day, make sure you email out a programme and map to your fellow attendees, so that they know where to be and when. It’s easier to open if you pdf it – everyone can open a pdf on every device. If your hospital is difficult to find, or there’s secret hidden cheap car parking, make sure people know – they’ll be happier with an easier journey.

Confirm all your speakers, and make sure they have your phone number in-case they get lost or are running late on the day.

Think about the “extras” you will need – like direction arrows, registers and feedback forms. You might like to get your speakers a thank you card. One SLEM FOAM training day used the thank you cards and direction arrows to promote FOAM! Are you going to contribute to #FOAMEd or #EMConf or have a specific hashtag for the day?

On The Day

Arrive early, and put up direction arrows. You’ll be surprised how long this takes – and what routes other people will take to your lecture room! Great everyone, and get them signed in. Introduce the first speaker, and then start keeping an eye on the timings, and keep things to time! If you want live tweets from your conference allocate someone else to do it – you can’t do both!

After the day is over, make sure you take down your direction arrows. Once you’re home, it’s good practice to email everyone who has presented to say thank you, and to provide them with any feedback you have received. If you haven’t already received them, you could ask them for a copy of their presentation and any extra resources they would recommend.

It’s useful to debrief the event with your supervising Consultant – they might even fill in a management WBPA for you!

Ultimately you have to care about putting on a good training day for yourself and your colleagues. You will learn a lot from the experience including how to improve for the future, and what trainees value and find useful. Your training day is limited by your time frame, your imagination and your determination.

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Webucation 2/7/15

Web wisdom this edition comes from areas of urology, general surgery, trauma and paeds. As always, give credit to the content creators.

The last link is a gem in mnemonics. It also has a great Rule of 3's for infantile colic. Great site for paeds. Do visit it.

Rektale Suppositorien – wie applizieren?

Vor kurzem bin ich wieder über einen älteren Artikel zur Applikation von Suppositorien gestolpert. Wirklich witziger Beitrag im Lancet aus 1991,

Die Kollegen aus Kairo wollten wissen, wie üblicherweise die ärztlichen Kollegen und Pflegenden ein Zäpfchen verabreichen: Richtig, die “dicke Seite” (=Apex) als Erstes. Anschließend haben Sie systematisch untersucht, was dann tatsächlich die bessere Methode ist: Sehr überraschend ist, dass die Applikation von der “Basis” her (also anders als von uns üblicherweise gemacht und von den Herstellern empfohlen) eine bessere Retention erstellt.
Grund, die eigene Praxis zu ändern? Weiss es nicht. Was denken Sie? Jedenfalls sollten wir nicht vergessen, dass es auch in der Notfallmedizin nicht immer der intravenöse oder intraossäre Zugang sein muss. Auch die rektale Applikation oder auch die nasale Applikation von Medikamenten (mit z.B. dem MAD Applikationsdevice) sind wichtige Alternativen. Auch auf die hohen Konzentrationen der zu verabreichenden Medikamente achten!

Learning to Take the Heat at #smaccUS

We managed to get an elite team together to run the ‘Learning to Take the Heat’ workshop at SMACC Chicago.

Heat workshop title

Our team consisted of:

The "Learning to take the Heat" team

The “Learning to take the Heat” team

as well as myself, with the able assistance of Ali Gould (@intransition2).

The focus of the workshop was to develop an understanding of how stress affects the performance of health professionals when caring for the critically ill, and more importantly, how we can teach others to handle stress.

Recommended resources for this workshop include:



  • Harvey A, Bandiera G, Nathens AB, LeBlanc VR. Impact of stress on resident performance in simulated trauma scenarios. J Trauma Acute Care Surg. 2012;72:(2)497-503. [pubmed]
  • Herzog TP, Deuster PA. Performance psychology as a key component of human performance optimization. J Spec Oper Med. 2014;14:(4)99-105. [pubmed]
  • LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med. 2009;84:(10 Suppl)S25-33. [pubmed]
  • Petrosoniak A, Hicks CM. Beyond crisis resource management: new frontiers in human factors training for acute care medicine. Curr Opin Anaesthesiol. 2013;26:(6)699-706. [pubmed]
  • Saunders T, Driskell JE, Johnston JH, Salas E. The effect of stress inoculation training on anxiety and performance. J Occup Health Psychol. 1996;1:(2)170-86. [pubmed]



Also, look out for the SMACC talks by Chris Hicks (“Making Teams Work”) and Jason Brooks (“Performance Psychology for Resuscitationists”) when they are released on the SMACC podcast.

Here is some of what went down at the workshop via Twitter:

Two step appraisal

Hicks on SIT

Heat sim 2

Heat sim

Heat workshop detritus

… and remember, calm is contagious!

The post Learning to Take the Heat at #smaccUS appeared first on LITFL: Life in the Fast Lane Medical Blog.

Research and Reviews in the Fastlane 089

Research and Reviews in the Fastlane

Welcome to the 89th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors

This Edition’s R&R Hall of Famer

TraumaR&R Hall of Famer - You simply MUST READ this!Mendelow AD et al. Early surgery versus initial conservative treatment in patients with traumatic intracerebral haemorrhage [STITCH(Trauma)]: the first randomised trial. J Neurotrauma. 2015. PMID 25738794

  • This had the making of a great RCT to answer a really important question. Does early surgery improve outcomes for those traumatic intracerebral contusions and haematomas? It had a pragmatic design and you got into the trial if the surgeon had equipoise on whether or not to operate. (the roughly GCS9-12 range). Collapsed due to poor recruitment with about 20% of their needed numbers. Glasgow Outcome Scale of 60% v 50% favouring early surgery (almost exactly what they predicted in their power calculation but due to low numbers not significant). Mortality was 15% v 33% favouring early surgery and the kaplan meier curves look lovely. All in all a great trial that never was. The authors interpret it positively and sound like they lean toward early surgery. Is this a move away from the neurosurgical nihilism? Worth noting that 85% in the trial didn’t have ICP monitoring likely due to the fact that most patients came from india and china
  • Recommended by Andy Neill

The Best of the Rest

Emergency MedicineR&R WTF Weird, transcendent or funtabulous!” width=Fang R. An artificial pneumoperitoneum created by injection of oxygen may prevent acute mountain sickness. Am J Emerg Med 2015. PMID 25910671

  • This may be the future of the treatment of Acute Mountain Sickness, but I don’t think a lot of people will be in line to get this treatment. The authors of this paper recommends the theoretical use of a pneumoperitoneum to prevent AMS. They believe it is a consideration in patients who need to ascend rapidly (like rescuers).
  • Recommended by Daniel Cabrera

TraumaR&R Landmark paper that will make a difference

Joseph B et al. Validating Trauma-Specific Frailty Index for Geriatric Trauma Patients: A Prospective Analysis. J Am Coll Surg. 2014; 219(1): 10-17. PMID 24952434

  • In this study the authors modified an extensive and time consuming 50-variable Frailty Index to a 15-variable Trauma-Specific Frailty Index (TSFI) by selecting the 15 variables with the strongest association for development of unfavorable discharge disposition. The TSFI was then prospective validated in 200 consecutive severly injured (median ISS score 15 (IQR 9 to 20)) geriatric (>65 years , mean age 77 +/- 12,1) in a Level 1 trauma center. Favorable discharge was defined as discharge to home or rehabilitation center and unfavorable defined as discharge to a skilled nursing facility or in-hospital morality.
  • By assigning points in the following categories (cancer history, coronary heart disease, dementia, help with grooming , help managing money, help doing household work, help toileting, help walking, feel less useful , feel sad, feel effort to do everything , falls , feel lonely,f function, sexually active and nutrition, albumin) the authors did ROC curve analysis and found that a TSFI cutoff point of 0.27 was optimal, with sensitivity of 85% and specificity of 75% in predicting unfavorable discharge disposition in geriatric trauma patients. A TSFI score >0.27 was an independent predictor of unfavorable outcomes after trauma.
  • Recommended by Soren Rudolph

Quirky, weird and wonderfulR&R WTF Weird, transcendent or funtabulous!” width=Colman et al. CARTOONS KILL: casualties in animated recreational theater in an objective observational new study of kids’ introduction to loss of life. BMJ. 2014. PMID 25515715

  • Supposedly “family friendly” children’s’ programming is a lot more objectively violent than movies geared for adults. Basically, characters in kids’ movies die a lot.
  • Recommended by Seth Trueger

AirwayR&R Landmark paper that will make a differenceCook TM et al. Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011; 106(5): 632-42. PMID 21447489

  • NAP4 was a huge undertaking – a national audit of UK airway errors and incidents – and it’s findings are an education in airway management. This paper concerns airway events in the ED and ICU. Probable under-reporting bias is a major drawback and trying to figure out the real cause for events in studies such as these is always problematic. A landmark article nevertheless.
  • Results from the entire NAP 4 study are published in this PODCAST series
  • Recommended by Chris Nickson

Critical CareNightingale CE et al. Peri-operative management of the obese surgical patient 2015. Anaesthesia 2015. PMID 25950621

  • STOP BANG, OSA, OHS, AAGA,SOBA?!…..how to manage the obese patient. Solid and easily read British recommendations on perioperative management of the obese patient applicable to most aspects of critical care.
  • See also this easy read in Aneshesiology News on the same topic and the SOBA website
  • Recommended by Soren Rudolph

Emergency Medicine

Schnell F et al. The Recognition and Significance of Pathological T-Wave Inversions in Athletes. Circulation 2015; 131(2):165-73. PMID 25583053

  • Athletes are known to have atypical physiology but what about TWI. This study found that athletes with pathologic TWI (except those in aVR, III, V1) were likely to have underlying cardiac pathology (45% of patients). Hypertrophic cardiomyopathy was the most common finding (81% of cardiac pathology). These authors recommend that all athletes with pathologic TWI be referred for further cardiac testing.
  • Recommeded by Anand Swaminathan

The R&R iconoclastic sneak peek icon key

Research and Reviews The list of contributors R&R in the FASTLANE 009 RR Vault 64 The R&R ARCHIVE
R&R in the FASTLANE Hall of Famer R&R Hall of famer You simply MUST READ this! R&R Hot Stuff 64 R&R Hot stuff! Everyone’s going to be talking about this
R&R in the FASTLANELandmark Paper R&R Landmark paper A paper that made a difference R&R Game Changer 64 R&R Game Changer? Might change your clinical practice
R&R Eureka 64 R&R Eureka! Revolutionary idea or concept R&R in the FASTLANE RR Mona Lisa R&R Mona Lisa Brilliant writing or explanation
R&R in the FASTLANE RR Boffin 64 R&R Boffintastic High quality research R&R in the FASTLANE RR Trash 64 R&R Trash Must read, because it is so wrong!
R&R in the FASTLANE 009 RR WTF 64 R&R WTF! Weird, transcendent or funtabulous!

That’s it for this week…

That should keep you busy for a week at least! Thanks to our wonderful group of editors and contributors Leave a comment below if you have any queries, suggestions, or comments about this week’s R&R in the FASTLANE or if you want to tell us what you think is worth reading.

The post Research and Reviews in the Fastlane 089 appeared first on LITFL: Life in the Fast Lane Medical Blog.

Families stall end of life talks, say doctors. True?

Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision making in the ICU, in a large survey published in JAMA Internal Medicine. About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1-7 scale. Doctors and nurses considered the largest barriers [... read more]

The post Families stall end of life talks, say doctors. True? appeared first on PulmCCM.