Paper tigers – not quite ready to be tamed? by: Ken Locke

Fascinating reflection on the utility (or lackthereof) of moving away from paper-based learning in medical education. This post summarizes a session at CCME 2013 (Canadian Conference for Medical Education). While I didn’t attend it, I read this post and thought it provided a thoughtful summary.


Saturday April 20, 2013

Blogger: Ken Locke, Director, Transition to Residency Program and UME Faculty Lead for Portfolios
Assistant Professor, Department of Medicine
Faculty of Medicine, University of Toronto

The ‘Faculty Perspective’ Post

I spent Saturday afternoon at a very engaging session at CCME 2013 entitled “Taming the Paper Tiger: Transitioning to a Mobile Curriculum”. This was a very well attended and fast-paced session focused on how medical schools may (or may not) be moving their learning materials out of the traditionally distributed bundles of printed pages, and into digital formats that students access from mobile devices, amongst other means.

Chaired by David Lampron from UBC, this was a symposium put on by 3 faculty members and one medical student, from 4 different institutions, each of which had a different perspective on this issue. The collected tweets from this presentation can be found under the hashtag #papertiger, or at Storify

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ARHT Surgical Airway Skills Session

Most recent Auckland Rescue helicopter training session on surgical airway.

Auckland HEMS

One of the challenges of resuscitation and pre-hospital medicine is that there are multiple high-risk but rarely performed procedures that clinicians must be ready to perform. The difficulty is that we may go our entire careers and only perform them once or even more likely never. However, the difference from success and failure for these procedures can mean life or limb. Consequently we must remain competent despite the challenges with practice.  There is an excellent article that articulates these issues by Cliff Reid & M Clancy which I highly recommend reading (for anyone interested in the topic).

(a primer video I integrated into a recent cric teaching session to get our participants into the mood!)

These life-saving, rarely performed procedures happen to be an interest of mine. It’s a fascinating exercise in education and cognition to maintain competence in performing these procedures yet have virtually no real-life patient practice. The…

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A well written article that addresses the impact of duty hour restrictions in residency. Hoping to have a review of the new article that is cited shortly.

Some pretty wild footage (at the 40min mark) of a surgical airway in-flight on a BlackHawk helicopter. Check it out on AucklandHEMS blog.

Auckland HEMS

Fast-forward to 40 minutes – soldier with severe maxillofacial trauma has scalpel-finger-tube cricothyroidotomy performed under IM ketamine in the back of a Blackhawk

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Auckland HEMS

In Helicopter Emergency Services (HEMS) around the world, winching to critically ill patients is an important aspect for those in patients otherwise inaccessible by road transport.

Most HEMS services have paramedics as the primary medical responders who are winched to patients, however, in some services physicians who are on-board are also winched resulting in a two clinician operation. For a North American (like myself, Andrew Petrosoniak) this idea of physicians on board the helicopter, nevermind winching to patients is completely foreign! But in HEMS operations around the world, this is a reality.

At ARHT we routinely winch highly trained paramedics to patients but less commonly are physicians required to be winched during a job. However, all our physicians are trained and ready depending on our task assignment. I wrote this post after conducting a recent simulation involving a two-clinician stretcher winch. The simulation was designed after discussion with our paramedics…

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Some new evidence about requirements of chest tubes for patients who underwent needle decompression in pre-hospital.

Auckland HEMS

The authors of a recent study tried to answer this question. The authors evaluated patients who got needle decompression in the field using prospective, observational methodology (though I wonder if truly prospective given the lack of data). Anyways, they noted that in their population very few patients (5/52 decompressions) escaped without requiring a follow-up chest tube. Only 1/15 penetrating trauma patients did not get a chest tube.  A few important questions remain including how many of the needle decompressions actually reached the pleural cavity or the technique used for decompression (appears later in Q&A that it was probably anterior axillary line). 

The authors conclude to have a low threshold for chest tube insertion based on CXR however, not shockingly a CT chest will provide more information. This study certainly doesn’t support withholding a chest drain if needle decompression is performed in the field. There was a nice suggesting by another…

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