78 posts · 80,452 views
What is academic emergency medicine all about? What's new in the specialty of EM? This blog aims to give you a "behind the scenes" peak into this exciting world. My perspective comes from that of a medical educator with an interest in emerging technologies.
Academic Life In Emergency Medicine
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- July 8, 2011
- 06:00 AM
- 1,191 views
Paucis Verbis: Cardiac tamponade or just an effusion?
by Michelle Lin in Academic Life In Emergency Medicine
What is a cardiac tamponade is a clinical state where pericardial fluid causes hemodynamic compromise. With bedside ultrasonography in most Emergency Departments now, it's relatively easy to detect a pericardial effusion.But what we more want to know in the immediate setting is: Is this cardiac tamponade?You can look for RA systolic or RV diastolic collapse. What if it's equivocal? How good is the clinical exam and EKG in ruling out a tamponade?Answer: Poor to average, at best. The Beck's triad ........ Read more »
Roy, C., Minor, M., Brookhart, M., & Choudhry, N. (2007) Does This Patient With a Pericardial Effusion Have Cardiac Tamponade?. JAMA: The Journal of the American Medical Association, 297(16), 1810-1818. DOI: 10.1001/jama.297.16.1810
- July 1, 2011
- 06:00 AM
- 1,260 views
Paucis Verbis: Imaging for blunt cerebrovascular injuries
by Michelle Lin in Academic Life In Emergency Medicine
In the setting of blunt trauma, it is easily to overlook a patient's risk for blunt cerebrovascular injuries (BCVI). These are injuries to the carotid and vertebral arteries. Often they are asymptomatic with the initial injury, but the goal is to detect them before they develop a delayed stroke.Who are at risk for these injuries? What kind of imaging should I order to rule these injuries out? Do I really treat these patients with antithrombotic agents even in the setting of trauma to r........ Read more »
Burlew CC, & Biffl WL. (2011) Imaging for blunt carotid and vertebral artery injuries. The Surgical clinics of North America, 91(1), 217-31. PMID: 21184911
- June 27, 2011
- 06:00 AM
- 1,145 views
Article review: Carnegie's vision for medical education
by Michelle Lin in Academic Life In Emergency Medicine
In 2010, the Carnegie Foundation for the Advancement of Teaching published recommendations for the future reform of medical education. This same Carnegie Foundation had also commissioned and published the landmark 1910 Flexner report on medical education, exactly 100 hears prior.Here is a summary of the four major recommendations:1. Standardization and individualizationCompetency-based education is the future. Students enter medical school with a diverse background of knowledge and experien........ Read more »
Irby D. (2011) Educating physicians for the future: Carnegie's calls for reform. Medical teacher, 33(7), 547-50. PMID: 21696280
- June 20, 2011
- 06:00 AM
- 868 views
Article review: Professionalism in the ED through the eyes of medical students
by Michelle Lin in Academic Life In Emergency Medicine
Teaching professionalism in a formal curriculum is so much different than demonstrating professionalism in the Emergency Department. So much of what students and residents learn about professionalism are from observed behaviors of the attending physicians -- that is, the hidden curriculum.In a qualitative study assessing medical student reflection essays during an EM clerkship, the authors (my friends Dr. Sally Santen and Dr. Robin Hemphill) found some startling results. The instructions to........ Read more »
Santen SA, & Hemphill RR. (2011) A Window on Professionalism in the Emergency Department Through Medical Student Narratives. Annals of emergency medicine. PMID: 21624702
- June 13, 2011
- 10:51 PM
- 658 views
Article review: Inconvenient truths about effective teaching
by Michelle Lin in Academic Life In Emergency Medicine
At the CDEM meeting during the SAEM national meeting this past week, the keynote speaker (Dr. Charles Hatem from Harvard) mentioned a great editorial article called "Inconvenient Truths About Effective Clinical Teaching."Here's a summary of the opinion article from Lancet:Clinician-educators are increasingly pressured to do more with less time and support (i.e. release from clinical responsibilities). Learners are the victims of this calculated move.The author talks about 8 habits to emulate as ........ Read more »
Reilly BM. (2007) Inconvenient truths about effective clinical teaching. Lancet, 370(9588), 705-11. PMID: 17720022
- June 13, 2011
- 10:51 PM
- 535 views
Article review: Inconvenient truths about effective teaching
by Michelle Lin in Academic Life In Emergency Medicine
At the CDEM meeting during the SAEM national meeting this past week, the keynote speaker (Dr. Charles Hatem from Harvard) mentioned a great editorial article called "Inconvenient Truths About Effective Clinical Teaching."Here's a summary of the opinion article from Lancet:Clinician-educators are increasingly pressured to do more with less time and support (i.e. release from clinical responsibilities). Learners are the victims of this calculated move.The author talks about 8 habits to emulate as ........ Read more »
Reilly BM. (2007) Inconvenient truths about effective clinical teaching. Lancet, 370(9588), 705-11. PMID: 17720022
- May 30, 2011
- 06:00 AM
- 595 views
Article review: Improving case presentations with theater training
by Michelle Lin in Academic Life In Emergency Medicine
"To be or not to be?"What could be more strange on a medical school curriculum than a theater training course? The authors of this study in Medical Humanities innovatively designed a 1-week elective course to help medical students at Mayo Medical School to improve their case presentation skills in partnership with the Guthrie Theater.In this pilot course, seven medical students (six 1st year students, one 4th year student) participated. The learning objectives were:Hear stories: those told by pa........ Read more »
Hammer RR, Rian JD, Gregory JK, Bostwick JM, Barrett Birk C, Chalfant L, Scanlon PD, & Hall-Flavin DK. (2011) Telling the Patient's Story: using theatre training to improve case presentation skills. Medical humanities, 37(1), 18-22. PMID: 21593246
- May 30, 2011
- 06:00 AM
- 504 views
Article review: Improving case presentations with theater training
by Michelle Lin in Academic Life In Emergency Medicine
"To be or not to be?"What could be more strange on a medical school curriculum than a theater training course? The authors of this study in Medical Humanities innovatively designed a 1-week elective course to help medical students at Mayo Medical School to improve their case presentation skills in partnership with the Guthrie Theater.In this pilot course, seven medical students (six 1st year students, one 4th year student) participated. The learning objectives were:Hear stories: those told by pa........ Read more »
Hammer RR, Rian JD, Gregory JK, Bostwick JM, Barrett Birk C, Chalfant L, Scanlon PD, & Hall-Flavin DK. (2011) Telling the Patient's Story: using theatre training to improve case presentation skills. Medical humanities, 37(1), 18-22. PMID: 21593246
- May 27, 2011
- 07:29 PM
- 767 views
Article review: Self-reflection using blogs
by Michelle Lin in Academic Life In Emergency Medicine
Self-reflection is an unique metacognition learning tool. It is increasingly being used in medical education (another prior blog entry). Traditionally, reflection pieces are writing assignments which are shared amongst peers in faculty-facilitated, small-group discussions.With the advent of new technologies, such as blogs (web-logs), how does blogging one's self-reflection pieces compare to the traditional method?Some of the research questions included:How does the level of reflection evide........ Read more »
Fischer MA, Haley HL, Saarinen CL, & Chretien KC. (2011) Comparison of blogged and written reflections in two medicine clerkships. Medical education, 45(2), 166-75. PMID: 21208262
- May 27, 2011
- 06:00 AM
- 648 views
Paucis Verbis: Outpatient treatment for diverticulitis
by Michelle Lin in Academic Life In Emergency Medicine
The classic teaching for the treatment of diverticulitis includes:Hospital admissionBowel rest (NPO)IV fluidsBroad spectrum IV antibioticsDo ALL patients need to be admitted? There is some early literature suggesting that there is a small sub-population who fare well with outpatient treatment.This article from Annals of EM in the "Best Available Evidence" series summarizes the existing literature well. Plus, I was one of the journal reviewers for the article and am thrilled to see this coming ou........ Read more »
Friend, K., & Mills, A. (2010) Is Outpatient Oral Antibiotic Therapy Safe and Effective for the Treatment of Acute Uncomplicated Diverticulitis?. Annals of Emergency Medicine. DOI: 10.1016/j.annemergmed.2010.11.008
- May 20, 2011
- 06:00 AM
- 560 views
Paucis Verbis: International Registry on Aortic Dissection (IRAD)
by Michelle Lin in Academic Life In Emergency Medicine
What do these three people have in common? Lucille Ball (comedienne)Jonathan Larson (wrote the musical "Rent")John Ritter (comedian)They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with aortic dissections.I find this list helpful, because it illustrates the fact that the cla........ Read more »
Hagan, P. (2000) The International Registry of Acute Aortic Dissection (IRAD): New Insights Into an Old Disease. JAMA: The Journal of the American Medical Association, 283(7), 897-903. DOI: 10.1001/jama.283.7.897
- May 20, 2011
- 06:00 AM
- 531 views
Paucis Verbis: International Registry on Aortic Dissection (IRAD)
by Michelle Lin in Academic Life In Emergency Medicine
What do these three people have in common? Lucille Ball (comedienne)Jonathan Larson (wrote the musical "Rent")John Ritter (comedian)They all died from an aortic dissection. We commonly consider this diagnosis for Emergency Department patients presenting with severe chest pain. There is an International Registry on Aortic Dissection which published a retrospective, descriptive study of 464 patients with aortic dissections.I find this list helpful, because it illustrates the fact that the cla........ Read more »
Hagan, P. (2000) The International Registry of Acute Aortic Dissection (IRAD): New Insights Into an Old Disease. JAMA: The Journal of the American Medical Association, 283(7), 897-903. DOI: 10.1001/jama.283.7.897
- April 18, 2011
- 10:27 AM
- 1,312 views
Article review: What's wrong with self-guided learning?
by Michelle Lin in Academic Life In Emergency Medicine
There is a constant tug-of-war between self-guided learning and supervised learning. With the advances in technology for medical education such as asynchronous learning modules, simulation, there has been a movement away from traditional, instructor-led teaching and towards more independent, self-guided learning. There is less supervision of learning.But left unsupervised, are learners learning the right things and doing so optimally? The authors, in this review, say yes and no. How can lea........ Read more »
Brydges R, Dubrowski A, & Regehr G. (2010) A new concept of unsupervised learning: directed self-guided learning in the health professions. Academic medicine : journal of the Association of American Medical Colleges, 85(10 Suppl). PMID: 20881703
- April 13, 2011
- 06:00 AM
- 741 views
Trick of the Trade: Oblique CXR to look for pneumothorax
by Michelle Lin in Academic Life In Emergency Medicine
CT chest demonstrating a large left pneumothoraxSupine chest xrays have an extremely low sensitivity (12-24%) in detecting pneumothoraces. Because a pneumothorax layers anteriorly on an AP CXR film, the xray beam is perpendicular rather than tangential to the pneumothorax edge. This makes visualizing a small to moderate sized pneumothorax extremely difficult. So you are left to look for indirect signs such as a deep sulcus at the costophrenic angle or subcutaneous air. I'm often surprised at how........ Read more »
Matsumoto S, Kishikawa M, Hayakawa K, Narumi A, Matsunami K, & Kitano M. (2011) A method to detect occult pneumothorax with chest radiography. Annals of emergency medicine, 57(4), 378-81. PMID: 20864214
- April 11, 2011
- 06:00 AM
- 1,046 views
Article Review: Medical education can learn from the neurobiology of learning
by Michelle Lin in Academic Life In Emergency Medicine
The brain is a mysterious thing. How do we learn? Can we apply what we know about the neurobiology and sociology of learning towards medical education? This review article in Academic Medicine presents 10 strategies to improve teaching and curricular development.1. RepetitionRevising topics from varying perspectives helps to solidify learning. Currently much of medical school education focuses on non-overlapping curricular material to cover the gamut of clinical information. For the pu........ Read more »
Friedlander MJ, Andrews L, Armstrong EG, Aschenbrenner C, Kass JS, Ogden P, Schwartzstein R, & Viggiano TR. (2011) What Can Medical Education Learn From the Neurobiology of Learning?. Acad Med, 86(4), 415-420. PMID: 21346504
- April 8, 2011
- 06:00 AM
- 1,305 views
Paucis Verbis: AMI and EKG Geography
by Michelle Lin in Academic Life In Emergency Medicine
(click to see enlarged view) Sometimes a picture is worth MORE than a 1000 words. Such is the case of the above illustration that I saw on the Life In The Fast Lane blog. When I first saw it, I knew that I immediately had to find out who made the graphic. It turns out it is the multitalented Dr. Tor Ercleve, who is an emergency physician at Sir Charles Gairdner Hospital and an established medical illustrator.This graphic demonstrates the EKG findings for the various types of acute MI's as b........ Read more »
Trowbridge, R. (2003) Does This Patient Have Acute Cholecystitis?. JAMA: The Journal of the American Medical Association, 289(1), 80-86. DOI: 10.1001/jama.289.1.80
- April 4, 2011
- 06:00 AM
- 1,240 views
Article Review: Reframing research on faculty development
by Michelle Lin in Academic Life In Emergency Medicine
Every once in a while, an education article makes me pause and rethink things.Faculty development is a concept which I have always taken for granted. Sure, our institution has a multitude of faculty development workshops such as:Giving effective feedbackEducator's portfolioTeam-based learningBut are these workshops effective? What evidence is there on whether faculty development workshops even make a difference to the educator, learner, or patients? This article was written by two of our ed........ Read more »
O'sullivan PS, & Irby DM. (2011) Reframing research on faculty development. Academic medicine : journal of the Association of American Medical Colleges, 86(4), 421-8. PMID: 21346505
- April 1, 2011
- 06:00 AM
- 1,241 views
Paucis Verbis: Post-exposure prophylaxis (non-occupational)
by Michelle Lin in Academic Life In Emergency Medicine
You know how chief complaints present to the ED in multiples? In one week, I had several cases where patients were asking for post-exposure prophylaxis treatment NOT in the content of a sexual assault. I haven't had to manage such cases in a long time and so needed to look up the recent guidelines from the CDC.The trick is not to forget about all the co-existing problems and infections beyond just HIV. Specifically, don't forget about gonorrhea, chlamydia, and trichomonas. The 2010 CDC website o........ Read more »
Trowbridge, R. (2003) Does This Patient Have Acute Cholecystitis?. JAMA: The Journal of the American Medical Association, 289(1), 80-86. DOI: 10.1001/jama.289.1.80
Landovitz, R., & Currier, J. (2009) Postexposure Prophylaxis for HIV Infection. New England Journal of Medicine, 361(18), 1768-1775. DOI: 10.1056/NEJMcp0904189
- March 30, 2011
- 06:00 AM
- 1,037 views
Trick of the Trade: Steristrip-suture combo for thin skin lacerations
by Michelle Lin in Academic Life In Emergency Medicine
Lacerations of elderly patients or chronic corticosteroid users can be a challenge because they often have very thin skin. Sutures can tear through the fragile skin. Tissue adhesives may not adequately close the typically irregularly-edged laceration.How do you repair these lacerations?Do you just slap a band-aid on it?Trick of the Trade:Use a steristrip-suture combination approach.Apply steristrips to reapproximate the wound edges. Reinforce the steristrips with suture material, as demonstrated........ Read more »
Davis M, Nakhdjevani A, & Lidder S. (2011) Suture/Steri-strip combination for the management of lacerations in thin-skinned individuals. The Journal of emergency medicine, 40(3), 322-3. PMID: 20880653
- March 28, 2011
- 06:00 AM
- 708 views
Article Review: Role of instructional technologies in medical education
by Michelle Lin in Academic Life In Emergency Medicine
A conference called "A 2020 Vision of Faculty Development Across the Medical Education Continuum" was held at Baylor College of Medicine in 2010. At this conference, experts convened to discuss the changing role of technologies in medical education.Their conclusions were summarized in this Academic Medicine article, which discusses 5 trends and 5 recommendations.Trends:Explosion of new information: It has been postulated that the world's body of knowledge will double every 35 days by 2........ Read more »
Robin BR, McNeil SG, Cook DA, Agarwal KL, & Singhal GR. (2011) Preparing for the Changing Role of Instructional Technologies in Medical Education. Academic medicine : journal of the Association of American Medical Colleges. PMID: 21346506
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