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!

September 17, 2011

Back from Kos 2011

I am back from the 6th MEMC at Kos 2011, what a great opportunity to meet enthuastic emergency physicians from all around the world! Although not the gigantic size of ACEP the quality was in no way inferior. I couldn't believe my eyes when sat listening to the history of emergency medicine and suddenly Joe Lex was up and speaking, THE Joe Lex! Being a little frontally inhibited I went up to thank him for his freeemergencytalks but he was in an instant surrounded by a crowd so I had no chance to explain him how i thought he was the Osler of our times by bringing all these wonderful lectures online and for free... next time Joe!

I gave a 20 minute talk "IT for emergency physicians", my first one on an international conference and was thrilled with the positive responses I got afterwards despite a little nervous first talk. I even got invitations to further talks so it will be interesting to see where all this leads to. It was extremely difficult to pack this broad topic into such a short presentation, so much was left out or slimmed while practising, leaving only a short introduction and a few examples of IT tools in work. For those of you who are here from the lecture I would like to tip you to try first to read through the "primary resources" from the top of the page, it contains all the links you were expecting in my talk and even more. Then there are a few of the topics in more detail dispersed through the blog archive and in the coming weeks I will be writing about practical use of Google Docs and e-laerning so stay tuned.

As promised, here are my slides and notes right from Google docs, I am planning to make an audio/speaker version of this in the near future so stay tuned. Unfortunately, as I head questions from the audience afterwards, I had to cut out my personal disclosure concerning Google so here it is:

"In the next session I will be talking a lot about Google, a corporation which has in only 10 years come to stand on the shoulders of the giants. I have no affiliations with Google but it is but honest to tell you that there are alternatives to Google’s applications like Microsoft's Live tools. I have tried some of these but Google’s simplicity and yet enormous capabilites of storing and retrieving my hundreds of megabytes of data has kept me there for years. As I often say to my friends, “Google is so much more than just Gmail”.

As I also explained in the talk, to survive the information tsunami requires simplicity - the multiple of websites available out there are too many to hold account on with different logins and ULRs. By using them correctly, the plethora of Google applications suffice most of my needs and there is only a single URL and login I have to remember. As for backup & security issues of having all your data in one place (also was asked about this) - there now is a tool, Google Takeout, which allows you to grab all your data from every single Google app to your computer, it will definitely help you sleep better. So actually - having everything in one place is a plus rather than drawback.

By the way, if you're new to Google Docs and want to try it out, here is a very short introduction to this powerful tool.

If you wan't to contact me you can use dabbi2000(at), you can also follow my Twitter account on!/ZonOfThor

September 1, 2011

Information technology for physicians

Only 10 days more until Kos 2011: The Sixth Mediterranean Emergency Medicine Congress and my slideshow is finally taking shape. In Kos I will in a (all too short!) 20 minute session talk about "Information technology for emergency physicians".

We are living in new times where IT is becoming ever more important for the physician. Ignore it and your medical students will rival your medical knowledge and even your patients will remind you of your gaps. The modern e-patients are so much more informed today, knowing everything about their condition. The typical e-patient will seek the doctor to ask about the diagnosis, not the symptoms. The modern patient is 1000% more informed today than before. Are doctors 1000% more capable?

Every day we are being bombarded with information, wether we ask for it or not. IT skills allow the doctor to comfortably surf the information-tsunami instead of going down under it. This will be the take away home message in my talk in Kos where I will tell you about lots of tips and tools for being more IT-competent.

To warm up I'd like to show you this amazing video which gives us a glimpse of what might be the next thing - online conferences, right in your living room!

ps: I am curious to know if there have been any other talks about IT for physisicans, please tip me if you know of any!