Information overload…staying up to date with new medical journal publications

As physicians, some of us love to read the latest journal publication while some of us don’t give a s@#!. Those in the latter category are more than happy to get the information at conferences or journal clubs in due time. There’s nothing wrong with these people…in fact, it could be argued this is a healthier approach than being addicted to your wireless device or computer waiting for the newest publication!

But for those of us who do get turned on by reading then talking about the newest publication the day it comes out “Epub ahead of print”, it can be a daunting task to stay up to date.

In our world where we’re exposed to up to the minute Twitter feeds, blog posts or push notifications, we can easily become overloaded and inundated with how to manage this information. The challenge is particularly difficult with journal publications. I admit, that I really enjoy reading the latest research data and while that doesn’t make me a bad person…it arguably makes me a less attentive husband (one woman’s opinion).

Are there any strategies for improving information intake and staying up to date with recent research? I don’t think this area is well taught in medical school or residency, partly due to the fact it’s a brand new method of information acquistion. Also, it’s rapidly changing with new sites and apps coming all the time.

I follow a few different journal topics including emergency medicine related, critical care, general medicine and medical education. Overall, this probably results in about 15-20 journals per month. I don’t read every article, nor do I read every abstract but I routinely read through table of contents or titles to make sure I’m staying up to date.

I’ve been thinking about this recently and while this post isn’t intended to be comprehensive, it does offer a few strategies that I’ve used to ensure I’m reading the newest evidence (any mention of a product/app below is only because I’ve found them helpful…I take no money from anyone). The following are in no particular order of preference. And if there’s an app or strategy I’m missing, please comment and I’ll add it to the post!

Here we go.

QxMD “Read”: I just started using this app and I really like it and I highly recommend it for any physician trying to keep up with the medical literature. And it’s FREE!  Anyways, it’s a Canadian company that “provides a single place to discover new research, read outstanding topic reviews and search PubMed“. It allows you to sign up through your library Proxy account and access PDFs for any medical journal that your library has available. If your university isn’t supported, email them, I believe they are really working hard to add new institutions. The key component for this app is the user can select which journals they want to receive regular updates from and easily access. Here’s a great review of the product.  For those using Android/non-Mac products I don’t think its available for any other platform than Apple (I only use Mac so I can’t confirm this).

Settings page for "Read"

Settings page for “Read”

Main interface used when reading articles

Main interface used when reading articles

Feedly: I also highly recommend this! and it syncs with GoogleReader which inexplicably is getting shut down. This program provides regular updates to any journal you wish to add to your list. The benefit to this approach is that it syncs well across platforms (both mobile and desktop) and it also houses all of your non-medical blogs and news sites. The difference between Feedly and QxMD is the latter offers a much easier route to read the PDF. Feedly simply provides you with the abstract then its up to you to figure out your own access method.

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Subscribe to a journal’s table of contents (TOC): Most journals allow you to provide your email so that every time a new volume is published, the TOC arrives in your inbox. This is how I started following journals though depending on the number of emails you receive (and the number of journals you follow), this process can easily overwhelm.

Example of "The Lancet" Table of Contents email

Example of “The Lancet” Table of Contents email

Subscribe to programs such as Journal Watch or InfoPOEMs (from Cdn Med Assoc): Essentially these organizations review the literature (typically 1-2 months behind) and send brief summaries of selected articles. This isn’t comprehensive and they’re not always free (e.g. Journal Watch) but it does help you find out about papers that maybe you wouldn’t have read. I use these methods then I download the article myself using my University library account. But it is a bit more labor intensive than Feedly or QxMD.

Follow an up to date medical blog. For those in emergency medicine/critical care, lifeinthefastlane.com is a must. The authors of this blog provide high quality, regular, up to date information about new publications that will interest EM physicians. Sign up to their LITFL review and they outline some of the newest journal articles out there. In addition, they link you up with all the most recent blog posts from around the EM world.

For those interested in medical education – I highly recommend a new blog “Medical Educator 2.0” that compiles medical education (and general education) related topics from sources around the world. Ali Jalali is a medical educator at the University of Ottawa (and happened to be a professor of mine in med school) and he puts together a very high quality site. If you subscribe then you’ll get regular emails when a new version/updates are posted.

Download each journal’s app: Great if you only read 1-2 journals but not sure how useful this is if you’re looking for regular updates from a broad range of journals. Here’s a list of journal apps for download.

Twitter: Either sign up and follow a journal’s twitter account (e.g. @EmergencyMedBMJ) or follow individuals that often retweet or post comments about new articles. This approach really maximizes the power of crowds and can make reviewing new articles much easier. On Twitter, you can also follow hasthtags like #meded and #FOAMed.

So those are a few strategies that I use. I welcome feedback and suggestions that I’ve missed. I’m happy to update this post with any ideas that you feel should be included.

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Google Glass = craziness!

Check out this video – the new Google Glass promo video.

I just watched this video at a conference combining social media & critical care (SMACC 2013 and I thought it deserved a mention). I have no affiliation with Google, but gotta love how they push the limits of awesome!

Imagine how this could work within medicine – what if, as the Resuscitation Team Leader, you were wearing Google Glass…all the drug doses, adverse reactions, algorithms would be available immediately. Or more interestingly, an educator could review the perspective of a trainee who is running a resuscitation. Or perhaps the trainee is provided with this technology to help enhance their learning experience. Or what about improving tele-medicine, where experts in a different city can provide expertise by viewing what’s happening in the trauma room. While this happens now, imagine if it came right from the team leader’s perspective. The possibilities…pretty well endless!

Changing Educational Paradigms (can this be applied to medicine?)

I actually saw this video a little while ago, then came across it just this week on a great new EM education blog iTeachEM and I felt it warranted a post.

It’s a lecture by Sir Ken Robinson who is an educator and who provides big picture ideas on the future of education. It definitely deserves to be watched by anyone interested in education. Ideas like these are important to consider as without them change for the purpose of improvement will be impossible. It’s amazing to think that our current method of education (our whole educational system) is not much different than it was 100 or 200 years ago. Despite our access to technology and information we continue to teach and educate in the same way. It might be time for an educational revolution to follow the technological revolution.

One of my favorite ideas (paraphrased quote) from the video

working together in schools is cheating, while in the workplace its called collaboration

It really is an interesting concept…do we teach enough of collaboration now? I think we still really quite isolate students to answer questions on their own. Yet now we live in a world where with a single keystroke we can connect to anyone with an internet connection, anywhere in the world.

Our current approach to education highlights individualism in problem solving and perhaps this can be counterproductive especially as we’re faced with increasingly complex problems. The concept of Wicked problems is quite interesting…and yet I can’t imagine that the solution will be solved by an individual. Check out the video below.

How do you use Twitter in medical education? A new article outlines “how to” tips

This past week I posted my first tweet.

twitter

I feel like an old man writing “how I walked uphill both ways to school in 5ft of snow”. For many of you, I’m sure I sound like I may have just recently adopted electricity and the wheel…but I figured I should join the masses and test out this “new” technology.

I’m not sure what’s taken me so long to move to the Twitterverse but part of me was still trying to figure out its utility. I guess I wasn’t so sure how I could use something such as Twitter…especially since all my entire impression of the technology was that it existed as a bulletin board for the latest celebrity breakups, hookups or feuds. I figured a few episodes of Entertainment Tonight should suffice as a Twitter replacement and I wouldn’t need this new technology…

However, I thought that there must be some way this can be effective within medicine…I’ve come across some physicians in Toronto who’ve started to use it. So before joining I followed along for a little bit to see how they used it. They often tweeted about new articles or cutting edge technologies…it seemed quite up to date and a great way to follow all that was new in medicine!

Then I came across a great article that was just published in Medical Teacher by a few medical educators in Calgary. They summarized 12 Tips for using Twitter in medical education. For anyone who teaches or is involved in medical education I highly recommend reading this paper. It provides practical reasons for Twitter and nicely summarizes how it has been described in the medical literature!

Not trying to steal the thunder of the authors but wanting to share a few of their tips…In the spirit of the wiki mindset which now pervades our consciousness, I’ve posted a few below. Enjoy!

I’ve picked the ones I thought were best and added a few comments or paraphrased the authors.

  1. Use a twitter account for a specific class or group: be sure to set some ground rules so that learners will have a framework for the discussion
  2. Use a live Twitter chat in your next lecture: I’ve been to a few lectures recently where this was done and it’s really quite interesting. What’s especially cool is if people from outside the classroom tweet a comment! The beauty is that they can be anywhere else in the world. If you’re using it for questions, it might be best to only open it up near the end of the lecture or at least only post it on the projector during a dedicated time as it may serve as distraction rather than an effective tool.
  3. Tweet key resources or new literature for your students to use and read: This is an excellent way to flip the classroom. Have them follow along and get them the material before class so that they can read it, digest it then come to class or academic day and discuss & analyze it. Or simply provide a resource for them to access the latest articles that you’re reading.
  4. Use twitter for real-time feedback: If you can make it anonymous this could be pretty cool. It could be posted in real-time at the end of the lecture or course. Though the logistics of creating anonymous usernames may limit its utility…unless they’re ok with identifiable responses.
  5. Maximize the power of Twitter with emphasis efficient communication: Twitter’s benefits include having only 140 characters to post high yield information. Use this to your advantage in teaching your students concise summaries for case presentations, etc…
  6. Twitter as a tool for self & group reflection:  I love this idea. I think it presents a novel way to gather feedback and one which many learners are comfortable using.
  7. Informal polls & quizzes: I think this is a good option though there may be a better app out there called Socrative which I’ve blogged about previously.
  8. Use it as subject for further study: There’s little out there regarding this topic and could be an outstanding resident research project! I definitely agree with the authors that further study is needed. Most importantly the authors specifically state that valuable studies would not compare Twitter to no intervention but rather evaluate how best to integrate this powerful technology.

I’m looking forward to seeing Twitter become increasingly used and studied within medical education! How will you use it?

Source: SE Forgie et al. Twelve tips for using Twitter as a learning tool in medical education. Medical Teacher 2012 [Epub ahead of print]

Want to save internet content and read it later? Try a new app called Pocket

Ever think…holy &^*S there’s a lot of stuff that I want to read on the internet but then just can’t manage to remember or come back to it? As a mentor of mine often says “it’s like drinking from a fire hydrant”. While this post isn’t exactly sim or chopper related…I thought I’d share this cool new app that helps manage the considerable amount of content we come across on the internet.

pocket-logo-ictcrop_300

Maybe you’re just finishing class or leaving work and you come across an interesting article, video or webpage…you know that staying a bit longer to read/watch it will somehow end up in working a extra weekend because your boss finds you still at the office or in medicine, just seeing one more patient… Moral of the story, you’re in a rush but don’t want to forget about the article – check out this relatively new app called “Pocket“. It saves and organizes online content for you to view it at a later date.

As most new apps do, it syncs across platforms and can be utilized offline. I’m not sure how I first found it but there’s a nice blog post on iTeachEM which reminded me about the app. I use it regularly and it works great when you’re stuck on the Toronto subway (which happens regularly) and you need something to read!

Socrative – amazing app for integrating an interactive student response system

Have you ever given a talk or a lecture and you ask a question or want people to vote…but no one raises their hand? Then you thought, it would be way better to create an interactive session if we just had clickers for each member of the audience…but *&^# those are expensive! And before you know it, you look around and everyone’s on their phones texting or facebooking or pretty much doing anything except listening to your talk…this actually happens to me regularly, both at work and at home with my wife (when I’m talking!). socrative-logo

Well there’s a very cool app that looks to solve this problem using internet access (either with laptop, tablet or smartphone). Its called Socrative. It’s free. And it’s super easy to use. And remember, your audience is already glued to their smartphones since they’re not listening to you… so you might as well capitalize on that!

Here’s how it works – The teacher just creates a log in, and students access the site using any internet access device. The teacher logs in and a classroom number is created. The students log in either using the internet or an app and type in the classroom number. They’ve now entered the class and can begin interacting with the questions/quizzes etc. It’s absolutely brilliant, making larger group teaching much more interactive!

Here’s a few screenshots of the site:

A brief overview of the apps capabilities

A brief overview of the apps capabilities

What the teacher will see once logged in.

What the teacher will see once logged in.

Podcasts in Emergency Medicine and Medical Education

Podcasts have become increasingly popular in medicine over the past 5 years and I would argue that emergency medicine has really been influential in pushing the boundaries of what’s possible. Some of the most well known EM educators have become internationally renowned based on their podcasts. The concept is easy, sit down and record interviews/thoughts/critiques and then disseminate it. However, the practical reality is that the amount of work required is considerable to have a well designed, thoughtful and carefully edited podcast. For me, podcasts add an additional learning method, that allows me to be free from flipping through pages or sitting in front of a screen and over the past 3-4 years I’ve spent a good deal of time listening to EM podcasts. As a result, I wanted to share some of the better podcasts out there with those of you looking to incorporating podcasts into your continuing medical education. This list was compiled with a resident colleague of mine, Max Ben-Yakov. So thanks to Max for putting this together.

Most of these podcasts are by EM physicians around the world who have a passion for education. They go to great lengths to interview leaders in the medical field, read new articles and share their knowledge. However, there’s a growing trend among medical journals to incorporate a monthly podcast which I think is fantastic! These podcasts come in a variety of forms and I’ll include mention of two here in this list. Annals of Emergency Medicine has an excellent monthly summary of all it’s journal articles – this is done by Drs. David Newman & Ashley Shreves (both from NY, USA). They provide an outstanding summary of each article and best of all, its FREE!!! I strongly support any methods to disseminate free medical education and I think the Journal should be commended.

Another journal, Medical Education, has taken an interesting approach which also should be commended. The editor (Dr. Kevin Eva) conducts a conversation with a selected author(s) from a paper published each month. It’s fascinating to listen to the authors take on their own research, why they did the research and what were some of the issues. We learn more about the research then can be conveyed in any published article. This is similar to what you might get at a conference but in a more question and answer format. These podcasts provide an easily accessible (and free) method of disseminating important medical research. As technology becomes increasingly integrated into our lives and culture, we should look for ways to embrace it and make it work for us. I think these journal podcasts do just that.

Just for transparency, I have no conflicts of interest to declare with any of these podcasts. I’m certainly not paid by any of these podcasts (though willing to take money if they want to give me some!) I have published an article in Medical Education but have also been rejected from them too!

Now here’s a list of some of my favorites and ones that I’ve come across. The list isn’t comprehensive and I welcome any feedback or necessary additions.

EM:RAP: Emergency Medicine: Reviews And Perspectives. A monthly audio series for emergency medical practitioners. Born in September 2001, it now is heard by up to 8000 subscribers every month and it is the fastest growing audio publication in Emergency Medicine.

EM:RAP presents the best speakers from across North America, brining lectures from many prestigious Emergency Medicine meetings, all in a tightly edited audio format. Emphasis is added through the lectures by our internationally acclaimed hosts Mel Herbert and Stuart Swadron. It is available with an EMRA subscription.  It is THE most popular podcasts out there – highly recommended.  Some listeners complain that the jokes are immature and there’s occasionally too much banter… I think it just emphasizes why we’re not internists and we know how to have fun. Duration: 1-2 hours. Cost: $50/year for residents or FREE with EMRA subscription.

EMCrit Scott Weingart is an EM physician in NY City who has a serious interest in critical care medicine. He puts together an outstanding podcast that is a must listen for anyone that ever takes care of sick patients. The podcasts are usually 20-30 minutes and he’ll focus on one topic. These range from recent literature, new approaches to old problems or pretty much anything else that’s relevant to critical care in the ED. He has a great website with lots of additional info and often summaries of podcast. Best of all, his podcast is FREE!!!

ERCast Rob Orman is an EM physician on the west coast of the US. He focuses on a different topic each week or month. This is aimed at the everyday EM doctor, and he provides practical insight and advice about how you can be a better clinician.  There are tons of commonsense nuggets of wisdom along with interesting interviews of EM physicians or specialists (e.g. a month ago he interviewed an orthopod about distal radius fractures…). Also FREE!! Check it out.

Emergency Medicine Cases. From my hometown, Toronto, Canada, big shout out to fellow Canadian, Dr. Anton Helman who put together this one. He interviews some of the EM physicians from our neck of the woods about a range of different topics. From his website…“Emergency Medicine Cases (EMC) is Canada’s premier educational website dedicated to keeping staff physicians and emergency medicine residents up to date on the most current topics in emergency medicine. In ten episodes each year we present cases to two of Canada’s leading experts in emergency medicine, and discuss clinical pearls, important management issues and current clinical literature around the cases. We highlight key practical learning points that you can use in your every day practice.

SMART EM. A highly polished podcast from NYC – brought to you by Drs. David Newman and Ashley Shreves. This is the podcast for those who feel that everything you’ve been taught is a lie… and probably isn’t supported by evidence. The authors take “deep dives” into the literature and discuss controversial topics faced by Emergency Medicine while doing an amazing job of doing an exhaustive review. It is a bit on the longer side, but holy shit, if you want a comprehensive review of the literature, then this is what you should listen to.

empem.org. I probably don’t listen to enough peds EM stuff, but I really should. This is a great one from south of the equator (Australia), not too far from where I’m currently sitting as I right this in NZ. Definitely worthwhile checking out.

Free Emergency Medicine Talks: www.freemergencytalks.net. A collection of over 500,000 talks on everything that is emergency medicine from conferences and lectures around the world. This is an excellent resource if you’re looking for a particular topic (e.g. resource for upcoming rounds). It’s put together by a world class educator and emergency physician, Dr. Joe Lex from Temple University, Philadelphia.

Peds Emerg Podcast: http://www.pemed.org/. This one is relatively new, haven’t listened to it enough, but seems quite good and its peds! And sick kids can be scary – so more knowledge is better!

Traumacast. For those of us who are passionate about trauma and taking care of these patients. This is a collection of interviews addressing upcoming research and how it can be applied to the injured patient. This is brought to by EAST (a very influential group of trauma surgeons in the US) who publish many guidelines that we implement in trauma care.

Toxtalk. I think this is a relatively new one and I actually have only heard one episode but its a well done podcast from the tox program at UMass.  http://toxtalk.org/

Finally, from a medical education perspective, ICRE (International Conference for Residency Education) now disseminates podcasts from their conferences which is a great idea. Some fascinating discussions about all that is medical education! I think this a great way to distribute learning to all those who weren’t able to make it!

Low cost SimMan having a seizure!!!

Part of the great thing about simulation is the creativity that can be had while organizing and planning scenarios. Often we’re restricted only by our imaginations (though a small stash of cash is generally quite helpful!).

So this past week as I was designing an out-of-hospital scenario that involved a seizing patient (status epilepticus) I spent some time looking into how I could recreate a seizure in a low-fidelity SimMan. For anyone that has spent time doing simulation, the importance of recreating realism can’t be overstated. It doesn’t necessarily need to be high-fidelity but it should allow the learner to feel like they’re actually in the situation.

I did some research and found one place (www.simactiononline.com) that sells a device called SimSeize that recreates seizures. While it looks great, it was going to run me about $5000 which is slightly outside of my annual operating budget (approximately $50 NZD…or $40 CDN). For anyone is interested, check out their site.  So borrowing from the idea of having the shaking occur under the patient, I developed a slightly lower tech version which I’ve included in the video below. My apologies that the audio is a little distant, but just turn it up full. I’m thinking about patenting it and feel because it’s for medical simulation, it’s probably worth upwards of $300…maybe more!