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.

Making education free for everyone

Nothing quite like kicking back one evening and watching an inspiring TED talk!


I am always amazed when people can think big ideas and then make it happen. Coursera creators wondered why only educate a lecture hall of 100 or 500 or even 1000 people when there is an entire global online community seeking high-quality postgraduate education. The course creators decided that they would push the envelope and simply make it happen. This is actually mind boggling. More than 100,000 people in a single course. I can only imagine the number of people that told them this can’t be done. Coursera is one of several organizations that is now offering massive open online courses (MOOC). It is partnered with several high profile universities including Standford and UPenn. Recently several international universities have joined as well.

What is most impressive is that currently this education is free! This idea that higher education should only be available to those who can pay should be obsolete. While unlikely, efforts such as Coursera strive to make high-quality education available to anyone around the world. It’s an interesting (and sad) situation that we provide free “education” to athletes who don’t even attend classes when there are millions of people globally who would love to learn so they can provide for their families.

This talk is by Daphne Koller, from Standford University, who was one of the Coursera developers.

Medical error…an unbelievable story

This past year (2012) was apparently aviation’s safest year ever!

I’m not sure the same can be said for medicine. I don’t know if we have similar global data as aviation but my guess is that we haven’t made the impressive strides our pilot friends have made.  While considerable efforts are being made to improve patient safety, medical errors continue and often despite identified solutions.

I wanted to share this amazing & shocking video (see below), narrated by Martin Bromiley who is the husband of a woman (Elaine Bromiley) who died as a result of medical error during a routine surgery in the UK (around 2007). Martin is a commercial pilot and using his experience with crisis resource management, teamwork and critical decision making he sought to determine what factors lead to his wife’s death. More impressively, he developed efforts and programs within the NHS based around human factors.  Listening to Martin speak is quite remarkable and for a man who has suffered a such devastating loss, he has made an amazing effort to make medicine safer. His efforts should be congratulated and shared. Watching this video provides powerful evidence that educators must incorporate simulation that elicits stress among the participants. In medicine, we should practice scenarios where clinicians must function and make decisions in a high-stress environment. This must be implemented with caution however, as there is some emerging evidence (and another study) that when stress levels are too high, trainees may experience cognitive overload that actually inhibits learning.

Kahn Academy – an amazing innovation in education

For many of you, this may not be new but I wanted to put up a post on the Kahn Academy. While this isn’t specifically related to medical education, this is enough of a game-changing concept in education that I thought it be great to include on the blog.

Here’s the TED talk video where the founder of the Kahn Academy was met by Bill Gates on the stage afterwards. If you have ANY interest in education – WATCH THIS VIDEO! It’s AWESOME!

The brief story:

Salman Kahn, a Harvard and MIT graduate who worked as a hedge fund analyst, is the founder of this online non-profit education academy. This project started in 2006 after he started posting math tutorials on the youtube for his cousins who lived across the country. Eventually he discovered that his cousins preferred this method and soon hundreds then thousands around the world were also watching these videos. Now he has developed a massive inventory of videos on 100s of subjects with millions of views daily. For a nice summary of his story, then check out the always reliable  wikipedia page!

He advocates a “flipped classroom” approach since students can watch the video at home and then come back to class the next day and do their homework. There are affliated questions with each lecture and students must get 10 in a row before they can progress. But what’s really interesting is this model is a form of “competency-based education”. Something that we’ve started to integrate into medical education. In the video from his TED talk (above) he describes how crazy it is that we allow students to progress through their education knowing only 80% and then expect in next unit (or class) to build on their previous knowledge. Often this includes the 20% they didn’t actually learn. He uses the example of riding a bike: we don’t just learn how to turn right then progress to a unicycle. Instead we should learn how to turn right and left, and how to brake (and probably have a good handle on things) before progressing to a unicycle.

Its strange that in education we’re ok with learning “enough” then moving on. In medicine, we’re beginning to ensure junior doctors gain competent regardless of the time it takes – this differs from the traditional method where doctors complete rotations and progress regardless of how much they learn.

It’s interesting to see how this “competency” model is being adopted not only in the medical education realm but also elementary and high-school education.

Helicopter Underwater Escape Training (HUET) course

It’s been a busy week so I’ve been a bit delayed getting up this post.

Our choppers at the base are extremely well maintained by a whole crew of super experienced staff, but regardless, there remains the possibility that we’ll “ditch” into the water during a flight. Ideally this occurs in a “controlled” manner but it’s possible that it happens suddenly. This unlikely occurrence has been the impetus for the HUET course that’s occurred at the base for the past 20 years. This course really highlights lots of stuff we can be doing in medicine – practicing rarely performed, high-stakes procedures in a simulated setting. The concept is fantastic and what’s great is that not only do we discuss what to do, we actually go out and practice.

We just finished up a really solid day at the base where we completed our Helicopter Underwater Escape Training (HUET) course. There was a combination of flight crewman, pilots, physicians, paramedics and surf rescue guards who all came together for an excellent day of training.

We started off the day with a full review of our lifejackets, seat belts and exit from the chopper.

Letting off flares over the bay

Then we headed out to the pier where we channelled our inner caveman, got to play with fire and let off  a bunch flares (ones usually kept in our life vests). I think there’s a genetic element (left over from the prehsitoric era) that provides us with great satisfaction from setting off fire into the air and watching fireworks launch into the air. Nothing quite like challenging your manhood with “my flare went further than yours”.

We then headed up to the local dive pool to practice our underwater escape plans. The Trust has a great training apparatus – a mini chopper known as the “dunker”! This thing functions as a practice model for escaping as the chopper is flipped upside down. As it was described in our course, we have to wait at least 7 seconds once we hit before we escape. By then all the chopper blades will have stopped and it will be safer to exit. This simulation process helps you gain appreciate for the complete clusterf*#)@ that it would be if the helicopter crashed into the water. While we couldn’t recreate the likely injuries you’d suffer, the gasoline in the water, the inability to see, the hectic ocean swells, we were at least able to go through the motions of our exit plans. When my wife asked, “how was your day?”, I started explaining what we were up to.  Judging by her reaction on my training for a possible helicopter crash, it appears that such things are best left on the list “things not to tell your wife”.

We had 4 divers in the water watching us as we got dunked under and to help us escape if we ended up down too long.

Two crewman getting the dunker back to “right side up” for another simulation

Imagine being in a set of rapids, hanging upside down without an idea of which way is up and completely disoriented while not being able to breath. This is exactly what we went through today…except in real life we’d then probably have to get to the surface (some 30-50m away). There’s little around to help you navigate except the simple technique of opening the door first then seat belt (otherwise you can float away and have no idea of your bearings).

This was a fascinating experience that helped emphasize the importance of in-situ training. When experiences are vastly different than what we’re used to, we must engage this environment and practice in a foreign situation.

A nice side-profile of the dunker! What a sweet ride!

I’ve included a video of the dunker, so that it can be observed in action! You’ll see the two that were belted in, pop up right at the end of the clip! Another successful escape!

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 ( 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!

Crew Resource Management…and a shocking video of Airbus’ first attempt at automated pilot technology

We just had a great session today with the pilots about crew resource management (or crisis resource management) which essentially is a way of thinking about a high stakes environment, who’s involved and how to manage the factors involved. Often this includes human factors and the goal is to reduce threats & errors.

It’s fascinating to hear from the aviation guys about their progress since we have so much to learn still in medicine. They were asking us if we have anything like “standard operating procedures” or protocols to follow for our acutely sick patients. We replied that we didn’t. We have general algorithms in our minds that we’ve committed to memory but it’s rare for someone to be actually going through a checklist in a crisis situation. The pilots were surprised to learn that we didn’t rely on such protocols or tools. There’s growing discussion about this in medicine in the literature and a recent book “Checklist manifesto” by Atul Gawande have started to address these concepts.

We watched this fascinating but shocking video of the first automated pilot program in an Airbus attempting to land. This is a key example of the value of human input despite the inevitability of human error in any task, as it’s been stated previously, “To err is human” but we just need to learn to manage these incidents.