#SMACC report March 2013 Peter Jordan
What was it? Questions I went with Some answers Highlights Some Negatives Where is it all going? Gratuitous Tips
What was it? 60% EM, 20% ICU, 10% prehospital, anaesthetists, GPs (rural and remote) EM/ Crit Care/ Pre Hospital Meducation Social Media heroes Podcasts/Vodcasts/PK Talks (screencasts) Digital Posters Simwars/Sonowars SMACC club Twitter feeds (streamed)
Why I went..questions These guys are great and I’m all for egalitarianism but.. Q1. How will quality be controlled Q2. Do these guys cut it live? Q3. How can I filter, assimilate(and curate) this mountain of content? Q4. Am I relevant?
Q1. How will quality be controlled on the level playing field? Still a work in progress GMEP.org - explicit votes - 5 votes down = out ( goes to review) Open peer review Good stuff is retweeted, reverberates and amplified. Crap dies a quick, natural death.
Q2. Do these guys cut it live? Scott Weingart, Joe Lex , Victoria Brazil, Simon Carley, Cliff Reid, Mike Cadogan, Chris Nickson et al... Passionate and informed + engaging
Scott WeingartEMCrit The pathway from novice to expert.. • Novice - just don't want to look stupid • Advanced beginner can solve probs but can't see the whole picture • Competent - noone says anything negative. independent - can prob solve • Proficient – engages in reflection and incorporates meta cognition • Mastery – conscious competence – able to teach “Reading is fundamental”
“intuition = expression of subconscious knowledge” “You need knowledge to be creative” “Practice PracticePractice” • Until you can't fail • Visualise • Verbalise
Law & Order & Social MediaJulian Walter Rush + wide audience = trouble Legal concerns arising from social media are the same as in the traditional world Inappropriate Advertising Boundaries & behaviour – sexual, financial, beliefs Confidentiality & consent Rule of thumb: Would you post it in the hospital cafeteria?
Law and Order & Social Media Disclosure - within the reasonable expectation of the patient only use information if primary purpose is that for which it was primarily intended. Images - Passing an image to one individual = assume global dissemination General clinical images - written consent (images) not required Images for research education – written consent is required
Sonowars Bedside Echocardiography: Stick to big 4: LV dysfunction PE Tamponade Sepsis/ tox = Hyperdynamic low vol Echo during CPR useful Continue CPR until ready
Gadgets Video Laryngoscopy CMAC v Glidescope iMac Ultrasound – Sonosite v Phillips Fibre Optic devices e.g. Ambu A-scope “cheap” Simulation software Non Invasive Cardiac Output Monitors
Time is Spinal CordOliver Flower icn.org.au ASIA = American Spinal Cord injury Association (see website) Standard definitions here Excellent form for initial assessment Pressure areas appear v quickly Get off spine board ASAP Transfer/ retrieve early Miami J collar or Philadelphia early Soft collars only at RBH
Stroke ThrombolysisDomhnallBranniganhttp://underneathEM “Hello” effect - A good story trumps the available evidence Evidence Review Conclusion: Treatment squashes the outcome Bell curve - More bad ( death) and More good
Mechanical ThrombectomyDr Ken FaulderRNSH interventional neuroradiologist Angiographic data demonstrates IV therapy doesn't open large proximal arteries eg ICA occlusion13% MCA 22%* Since 2009 - Effective mechanical device (2nd generation) Better outcomes with proximal clots – (Recannalisation > 96%) Window for benefit (IATx) currently 6/24 IV Tx better for more distal occlusions e.g. Perforators *Del Zoppo et al neurology 2003
CommunicationDr Victoria Brazil “Communication is our most useful clinical tool” "Multitasking doesn't work“ “Building relationships over time sharpens communication at the pointy end when it matters..” “Flip the classroom” Standardised Patient Simulation - Scenarios using live models Creates conflict which challenges learners and enables powerful feedback
Q3. Tips for assimilation/ curation of content Tweetdeck RSS feeders – Google Reader now defunct Others: Netvibes/ Feedly (chrome/ firefox), Newsblur, Feedler Pro etc.. Dropbox Others...
Negatives? Expertise Discussion largely limited to Twitter Information overload – retweets Signal to noise ratio Soundbites and graphics Distraction Fast thinking ≠ quality thinking? ADHD
Q4. Am I relevant ? Lectures ? (Self-directed e-)learning – guide (?) Case review/ reflection - probably Watch a procedure on YouTube, Do one, then film ourselves doing one and post it online as a vidcast for others to learn from... Supervised practice – yes Mentorship - hopefully Observed Clinical Encounters - yes Skills sessions – yes.. Simulation (partly) Feedback - yes Assessment - yes
Where is it all going? Global Grand Rounds Global Journal Club E-conferences #FOAM/ GMEP.org = here to stay The textbook is dead – long live the textbook! Who knows...
Gratuitous Advice This is a revolution - get involved Pick a few quality voices (start with 2 or 3) Think before you tweet Gain consent before you disseminate Think about curation/ assimilate as you go Don’t neglect the Fundamentals/ Syllabus Remain sceptical
Be like a brewer.... “We are brewers and always have been and in our practice we have sought and we seek to ally the traditions and craftsmanship of the past with the best that science has to teach us.” Rupert Guinness (via DomhnallBrannigan @dreapadoirtas http://underneathem.com)
Home viewing.. PK talk competition winner: http://vimeo.com/57874509 others: http://smacc.net.au/pk-smacc-talk/ SMACC channel: https://www.youtube.com/user/TheSMACCchannel