Ninja scribes

We have ninja scribes in our department. 
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These are young, eager premeds who follow our attendings from room to room and maniacally type H&Ps into electronic notes on COWs.  They are dressed in all black scrubs, as not to confuse them with the healthcare providers.  They listen to resident presentations and type as we speak. They type the medical decision making of the attending as it occurs in real time.  The ninjas transcribe the EKG and radiology results as the attending dictates their own thoughts into the air.  The ninja-notes can be accessed at any time so the the attending can use them to tighten up official notes.
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I am jealous of these ninjas.
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Ninja Scribe, dressed in black

Why?
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They are getting an extremely high quality premedical education.  I know of no higher.  One ninja tells me that she will see over 700 patients before applying to med school.  She will see 700 cases from chief complaint to disposition and will watch an expert level thinker work up every single one of them.  Before she even starts medical school, she will observe more patients being treated than most of her classmates will see before they graduate med school.  She will have the best H&P skills in her med school, she will have a solid framework to make the preclinical science stick, and she will understand what it is to practice clinical medicine before she attempts to do it herself.
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I wish I had been a ninja.  I'd be a much better resident.
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Who is Henry Mandin? And Why do You Care?

Dr. Henry Mandin had a novel idea: he wanted to teach medical students how to think like doctors.  
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Henry saw that medical schools had begun to use problem based learning (PBL) created by MacMaster University in 1968.  Many of you used this model in your medical training.  PBL is when a small group of students is proposed a problem, and the students figure out how to solve it.  They collect the facts they will need to solve the problem, generate ideas on how to solve the problem, and even figure out what they should learn in the process. 
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This was a marked improvement over sitting in a lecture hall and learning a bunch of scientific facts and then being thrown to the wolves (wards) and asked to make sense of what you had learned on your own.  But Mandin knew something about how people learn and how doctors solve problems.  And so he proposed we use schematic based learning.
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What you do is this: you are presented with a chief complaint.  Then in a classroom, you are taught how an expert clinician would solve the problem.  Along the way, you learn the science that the clinician uses to make his or her decisions. 
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In 1988, Mandin led the University of Calgary to change its entire curriculum to follow schematic based learning.  Now, in the preclinical years, the students are learning the science behind clinical medical decision making, rather than simply learning science.
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In an email conversation with Mandin, he said this: "the one group of physicians that have always supported my curricular approach have been ER physicians. The first reason is that they do tend to approach patients by identifying their chief complaint or clinical presentation, and secondly because almost all ER physicians do use algorithms"
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What if we taught our EM medical students and residents this way?  If you are having a formal lesson about stroke, why not start with a schematic on how to approach the patient with dysarthria.  This is not a case discussion of a patient with a stroke.  This is a discussion about the schema that experts use to approach the patient with dysarthria.  Then, you can talk about the science and management of stroke.  
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For more information on how this curriculum formed, see this paper:
http://www.ncbi.nlm.nih.gov/pubmed/7873005

Shouldn’t the beginning be at the beginning?: The role of the undifferentiated patient in novel patient-centered curricula.

I wrote this opinion piece during my fourth year of medical school.  I was going to submit it to a print journal, but it got lost in the mix of applying for residency, finishing up research projects, and transitioning to residency and a new city.  
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It outlines my argument for medical students in the ED at an early stage in their schooling and the value of the undifferentiated patient.

Thank you to Michelle Lin for choosing the "Web 2.0 Changed my Management," idea.  And congratulations to Jim Campagna for also winning the EM Blog Incubator competition.  I can't wait to start posting! 

Michelle has also been a huge help to Matt Wong and I as we develop our ideas at iClickEM. 

Matt Wong and I would like to invite you to check out our library/review site for EM educational resources called

iClickEM

In short, the site operates like an electronic library for EM educational resources; it also doubles as a review site for EM resources, much like Yelp or Google's review feature.  When you search Google for "pizza in cambridge, mass," [try it for yourself], Google returns a bunch of links to pizza places.  Which pizza place should you choose?  The one that's most highly ranked by users - the one with the most stars.

When you search iClickEM for "ultrasound apps," the site will return a whole bunch of ultrasound apps and ultrasound resources.  Which one should you use in the ED and which one is worth the money to purchase? The one that's most highly ranked by users - the one with the most votes.

Our webiste is almost finished, and we welcome any suggestions you have.  We invite you to sign up for the site and become a member.  Then, you can either post a new resources or write a review on a resource that you love or love to hate.

We're very excited.

- Teach, MD

Time Magazine for Kids

Last month I visited a hi-tech middle school class to teach middle schoolers some anatomy.  We dissected sheep hearts, just like many of you have done in your own studies.  What made this experience different was that we used video cameras, iPads, PCs, and smartboards to run the lesson.  I had a lot of fun, but I was also intrigued by the agility with which the technology made it easy to differentiate or tier lesson plans.  This concept that students' individual needs may each be met at the same time and in the same space has been championed mostly by elementary and secondary school educators.  But it seems to me that it is a perfect educational philosophy to embrace for medical education - especially resident education.
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Every Wednesday, I sit in a large room with my peers.  There are all levels of EM residents present.  The third years know more than the second years who know more than I do.  We all listen to the same lectures.  But I feel over my head at times, and I'm sure the third years feel board some of the times.  Tiering lesson plans is a concept that enables all levels of learners to get the most they they can get out of a lesson while sharing the same space and time.
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Technology has made it possible to easily differentiate lesson plans.  Perhaps medical education can learn from early education, and get on board with the logic behind the process.
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Check it out: Time-for-Kids magazine visited the classroom on the day that I was teaching and produced an on-line video-article about a public middle-school classroom that blows any residency classroom away:  http://www.timeforkids.com/photos-video/video/high-tech-classroom-27391.  If they can do it, why can't we?

- Teach, MD

It's coming . . .

http://iclickem.com/

SOPA and WikEM

The SOPA protest worked.  Without Wikipedia, it turns out, the world isn't as efficient or fun.  You don't know what you have, until you no longer have it.
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Inspired by the protest, I wrote my local congressman (which Google and Wikipedia made extremely easy to do).  Then I joined WikEM. 
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I created content for this page: http://www.wikem.org/wiki/Ultrasound:_Aorta.  As those of you who read my blog know, I recently started compiling a free ultrasound course.  I plan on updating or creating WikEM pages while I continue to create free ultrasound lessons.
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A friend of mine is a banker.  We had drinks the other night and he told me about a co-worker/banker who had some unique ideas on information.  This banker has started to pull his money out of stocks, and started to buy up farm land.  Why?  Because he believes that although information is at a high premium now, it will soon become so ubiquitous and universally accessible, that monetary value will shift toward things that we actually need to survive - like food and water.  This may be an extreme view on the nature of Web 2.0 and the movement for free access to information, but it speaks to the movement's real and powerful presence.
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I don't know what exactly will happen, but I do know that free information is the future.  And if you're not on board, you'll be left behind.  Please join in making information free.

Prezi

The worst lectures are those with PowerPoint slides cluttered with bullet points and words.  Why even get in front of a crowd and speak if everything you are going to say is already on the slides?  Less clutter means more attention to the the speaker.  The best lectures are those that tell a story.

Try Prezi when creating your next presentation.  I played with it last night after a shift, and was able to easily turn earlier blog posts (Venn and 3 Tenets) into a cool presentation.  If I want to teach someone about my ideas, I can easily go on to my Prezi account and use this as my storyboard to explain myself.  

3 Tenets of Medical Education Venn - TeachMD on Prezi

Join Presi and find it here: http://prezi.com/wd5vyzboa360/3-tenets-of-medical-education-venn-teachmd/

Why Should We Embrace Web 2.0: to change medical management

I'm on vacation.  Vacation for me means having the opportunity to have fun with an education project that I don't get to do while I'm busy with residency.  My older sister, Jennifer Maichin and co-teacher Courtney Zaleski invited me to come into their class and dissect sheep hearts.  It was pretty cool.
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The technology at Mineola Middle School (a public school) was unreal.  The classroom has Smartboards, every student has an IPad, and there are 4 computers in each classroom.  Every lesson embraces the concept of Web 2.0.  They are interactive, they are real time, and they facilitate the logical and continuous transitions from teacher to student and back.
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Medicine is behind the times!  I work in a pretty up-to-date ED.  We have an incredibly powerful and user friendly operating and electronic records system.  We have video-conferencing translators, we take notes using Dragon, we use an electronic system to sign out patients to medicine services, and our senior residents carry IPads to better manage the flow of the department they are running. 
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But we haven't figured out how to completely embrace Web 2.0 like public Mineola Middle School has.  They have figured out how to use interactive web usage in a manner that changes management!  Isn't this the holy grail of any contribution to medicine?  When my attending asks me why I have my IPad in the ED, I need to justify it's presence.  And the answer should be, it changes my management in a productive way.
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Michelle Lin is asking for new blog ideas that she can support and help get off the ground (incubate).  This is a dream competition for me, and I'll hand in my submission later today, after I publish this post.  The new blog idea: I'll post about how Web 2.0 influences my management of specific patient encounters; and I will ask guests to write mini-case presentations of sorts, in which they report about seeing a patient and how a Web 2.0 activity changed how they treated that patient.  I think this information will not only be interesting, but extremely helpful to those who want to use the next generation of the Internet to facilitate better patient care. 
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Free EM Ultrasound Lessons 1 - 5 Now Posted

The purpose of this free "course" is for it to continually improved.  I have contributed absolutely no content, but simply arranged free resources in a logical manner.  It takes 10 minutes to set up the course for yourself.  And each lesson ranges from 1 to 2 hours.
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Lesson 1 through 4 are cardiac, aorta, ruq, and renal/ureter/bladder.  Lesson 5 is a review of what you've learned.  The next lesson will be FAST, which you will be able to perform well now that you have knowledge of all 4 views.
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I can't possibly know what all the free resources out there are.  So please comment and contribute and help others teach themselves how to be better at ultrasound.  I'm particularly interested in ultrasound videos that clinically correlate so that we can improve our practice and knowledge base of EM, not just ultrasound.
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I look forward to this project evolving and thank you in advance for all of your help.  A special thanks to Tarina Kang, ultrasound director at Beth Israel - Deaconess Medical Center/Harvard Affiliated Emergency Medicine Residency for supporting this vision.

Find the course here: http://teachmd.blogspot.com/p/free-ed-ultrasound.html
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Teach, MD