Pop-Teachers

Salman Khan was featured on 60 minutes last week. He and the Khan Academy have become wildly popular and have officially achieved rock-star status. How many followers does Khan have now? Over 3.5 million unique users.


Now, TED-Talks is soliciting the lessons of teachers. They are attempting to showcase on an international medium, what can only be seen in individual classrooms. This has the potential to radically change the face of teaching as a profession.

People do not chose teaching for fame and money. Many have written op-eds about how we undervalue teachers, and many politicians have given lip-service to the raising of teachers' salaries. But no-one has come up with a salient way to do this.

Perhaps now, if teachers are judged on popular opinion, and their value spreads beyond the classroom and into the homes of millions, teachers will start demanding larger salaries. Our culture puts monetary value on popularity for popularity's sake - perhaps academia can use this to its advantage.



- Teach, MD

ShowMe

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?

Dear ACGME: Please be careful

US News and World Reports must be licking their chops.

The New England Journal of Medicine has published a special report, "The Next GME Accreditation System — Rationale and Benefits."  The report outlines a new process for quality control and accreditation standards for graduate medical education.  This system will be piloted in 7 specialties, including EM, in 2013.  It will be implemented for the remaining 19 ACGME specialties in 2014.

The report cleverly seems to be a call-to-arms to rally the GME community to herald the new program, instead of fight it.  The ACGME is about to implement a very powerful tool which is greatly needed and right in concept and principle.  However, lost in the enthusiasm of the announcement are the dangers involved in wielding such a powerful tool.  The reports "limitations" section is short, and mostly addresses conceptual limitations that the ACGME seem to already have solutions for.

There is one particular sentence in the report that I found concerning:

"The process will generate national data on program and institutional attributes that have a salutary effect on quality and safety in settings where residents learn and on the quality of care rendered after graduation."

To me, this means that soon there will be a rankings list for residencies.

I ranked BIDMC/HAEMR first, and I was lucky enough to match here.  But I ranked it first because it was first for me.  It represented to me, the program that would create the most opportunity to be the particular brand of doctor that I want to become (namely, an educator, an innovator, a leader, and a practitioner).

Take a look at what pops up when you search best emergency medicine residencies on Google.  There is no list.  Instead, there are discussions about going to the program that will make you the happiest.  In a world where US News and World Reports dictates so much of our views on what's good and what's not, this freedom from rankings should be valued and protected.  It is this freedom that allows students to break free of the undue pressures that have dictated so many of their decisions in the past, and make a life-choice based on what is truly best for them.

The ACGME has a responsibility to protect this special attribute of the match process.  I hope they will address this concern directly when implementing NAS.

See the full report here

- Teach, MD

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