September 19, 2011

E-learning in emergency medicine

I had the fortune to be a medical student in the early beginnings of the Internet. These were the days when we sat in the library and were amazed that a message could be sent to the next table computer, making a window pop up on the screen just like that. In these days the specialists of the hospital were godlike idols, nobody would doubt their words or rival their knowledge in any way. Knowledge originating from hugging the textbooks, reading the journals and seeing patients and. After many many years of seeing one, doing one and teaching one they were walking libraries of not only facts but experience.

The basic ways of learning and gaining experience haven’t changed at all with the coming of the Internet but what has changed is that the cases, books, facts and learning points are now accessible everywhere and anytime. That is - ;if we know how to find them. The new method is called "e-learning" and here below are my tips for e-learning emergency medicine. Your medical students know these methods and that's why they are outsmarting you on your patient-rond. If you miss the e-train, you will also be outsourced by your medical students!

Google groups

As one of Scandinavia’s first emergency medicine programs we’ve had our ups and downs while trying to earn respect in the hospital. With strenuous working hours, corridor chat is essentially none and so we had no opportunity to discuss interesting cases or matters related to work. Google groups relieved this isolation. They key to it’s success was that it required no new logins or websites - a process bound to kill every kind of innovation involving busy doctors. Google groups uses the current email addresses to send out discussions but in the background also stores them in a closed, online archive which can be browsed and even searched afterwards. This way we share our important learning points; ECGs, blood gases etc. and in only one year our way of educating ourselves has reached a new level. Speaking of, there is actually an ongoing experiment to make an international Google groups list of emergency physicians, check out the link if you are interested.


Although I prefer RSS to email based postlists, there is an exception because their quality is exceptional. University of Maryland has a list where you will get one email per day with invaluable clinical pearls. I hope they don't mind me copy-pasting today's pearl from non other than Amal Mattu:

"SVT is rarely, if ever, the presenting rhythm associated with an acute MI. As a result, physicians should not feel compelled to send troponin levels and perform rule-outs purely based on an SVT presentation. Instead, the decision to rule out a patient presenting with SVT should be based on whether there is a constellation of other concerning symptoms, exclusive of the SVT (e.g. if the patient presented with chest pressure radiating down the arm and diaphoresis, in addition to the SVT). Two recent studies confirmed that routine troponin testing in patients with SVT is extremely low-yield, and instead often produces false-positive troponin results that lead to unnecessary admissions and workups. In other words, mild troponin elevations may occur in SVT but they do not correlate with true ACS."
Say no more. This is... da shit!


I have previously written a thorough post about blogs, podcasts and videocasts where you will find more details about the technologies themselves. Here I intend to introduce you to some of the big ones in emergency medicine, just to get you started. In my Stayin' alive post you will find a longer list of links to the 'rest of the best'.

If you're a newbie in the EM blogosphere, your first visit must be Life in the Fast Lane. It is an australian wondersite which is not only an awesome blog with regular news from the world of EM but also presents clinical cases and topics in thorough yet entertaining way to read. LITFL is run by EPs by heart and as such cuts out the crap, creating short and useful lists of diagnosis instead of Uptodate's style - ddx lists which can span pages. LITFL also has various databases for you to browse through like the ECG- and image database containing >100.000 free online medical images. Actually, LITFL is so huge that it would require a separate blogpost to review it but the fact that I list it here as the first blog you should try out is no coincidence. So get your eyes there right now, mate!

For updates in prehospital management you should read Cliff Reid's fantastic Resus Me (Australia). Then you can follow the latest interesting journal articles in EM from Emergency Medicine Literature of Note (Ryan Radecki, The University of Texas Health Science Center at Houston), a nice to read blog with the author's short and concise personal opinion of the articles he presents.

Most blogs have some interesting cases every now and then but nobody presents them in a more structured way, simple yet detailed as Emergency Medicine Forum does (Charlene B. Irvin, St. John Hospital and Medical Center).

One tip a day will make your vertigo go away - that is the motto of Michelle Lin (San Francisco General Hospital) who started the Academic Life in Emergency Medicine blog. Her well-applicable tips and amazing Paucis Verbis cards are what have made her famous in the blogosphere. Every now and then she has very nice posts on academics and IT in EM.

Emergency Medicine Ireland (Andy Neill) has an excellent mixture of article reviews and interesting cases, just the kind of thing you want to read over your first cup of coffee before the first trauma patient enters your ED.

As I've said earlier this is just the tip of the iceberg and I'd like to recommend that you put all these in your RSS reader - that will be your turning point in your learning curve. If you feel that's too much you could also try just reading the awesome and weekly LITFL review where they summarize what has been going on in the blogging community and shout out the most interesting stories. Too good to be true almost!

Podcasts & videocasts

If you feel ready for trying out the world of emergency medicine podcasts you are truly getting IT-hot. On the top of the mountain here is Free emergency talks which hosts a collection of podcasts (mp3s) from various major and minor EM conferences from around the world. Joe Lex is the mastermind behind FET and in in my opinion should be titled as today's Osler - such has the impact of his lectures been on my learning curve. Not only has he collected the podcasts but also tagged them with meticulous detail so that you can easily browse through topics, speakers or presentation years of your choice. I suggest you start trying out Amal Mattu's renowned cardiology updates. Stuart Swadron's "Chief complaint: Coughed up blood" also is a good starter (as well as most of his talks). Or Peter Rosen's (yes, the book author!) epic story about the first years of emergency medicine...

More in the spirit of podcasts (Free emergency talks is a collection of audio recorded lectures) is Scott Weingart's EmCrit, a well deserved winner of the "Best medical weblog" of 2010. Check out his teachings and you will see why.

To start you off in the world of video recordings I would hint you to try out HqMeded, there is simply none to rival their outstanding teaching modules and 4-5min short case presentations, mostly based on ultrasound findings that turned the tables.

If you want to have a big conference talk right in your living room try out All LA Conference, an amazing work of the genius Mel Herbert. It's totally free but even better are his other productions (require subscription), check out the link for a special post of video lectures for emergency physicians.
OK folks, this was a quick walk through the jungle of e-learning just to introduce you to this ever growing world our colleges are creating every minute. There's more to discover and for that I recommend you to read through my big collection of links in the "primary resources" posts.

Making it stick!

There is another side of the coin we haven't discussed and that is how to store everything you learn and keep organised for later retrieval. Our brains were not built for neither keeping or organizing such wast amount of information, you'll repeatedly frustrate yourself as you find out that what you learned just a month ago is gone!

What you need is a tool not only to store all your notes and documents but one that also allows you to easily browse and search through all your information. I will soon share my tips on this important topic so stay tuned!