About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

Trick of the Trade: Hair apposition technique (HAT trick)

Scalp lacerations over hair-bearing areas require wound closure, usually with staples. An alternative technique is the Hair Apposition Technique, also known as the HAT trick [1, 2]. This technique provides a more cost-effective, faster, and less painful approach to scalp laceration repair. Imagine the scalp hairs as suture ties already embedded in the skin.


By |2019-11-29T19:02:25-08:00Sep 2, 2009|Tricks of the Trade|

TGIF: The "caffeine nap"

A common problem that emergency physicians share and struggle over is the circadian “dysrhythmia” of working random morning, afternoon, and night shifts. Shift work is the blessing and curse of our profession. I have yet to figure out the best way to adjust back to the daytime world after night shifts. Do you have any tricks?


By |2019-09-10T14:06:16-07:00Aug 21, 2009|Life|

What is a journal "impact factor"?

Journals use the numerical “Impact Factor” as an indirect quantitative measure of a journal’s importance in the medical field and scientific literature. Thompson Scientific calculates the impact factor scores annually. This score provides journals with bragging rights, especially when it comes to marketing. Be aware that there are ways to manipulate the numbers a little and thus brings the true value of this score into question.

How is the impact factor calculated?

The impact factor is a calculation of how frequent a journal’s articles are cited in a 2-year period. As an example, the 2009 impact factor for a journal would be:

Impact Factor = A / B

  • A = Number of times 2007-08 articles are cited from a given journal
  • B = Number of total “citable items” published in given journal during 2007-08

The ambiguous issue is how the denominator of “citable items” is determined. Basically articles which qualify as potentially citable items include original research, reviews, proceedings, and notes. These do not include such items as editorials, coresspondences, and errata. Sometimes it’s unclear which articles don’t qualify. The more articles that you exclude, the smaller your denominator and thus the higher (and better) the impact factor.

Below are impact factors of several journals, relevant to those interested in publishing in EM and medical education. In addition to impact factors, you should also consider the journal’s general focus when deciding where to submit your manuscript. If you read through several back-issues, you will get a sense of each journal’s “flavor”:

Emergency Medicine journals

  • Annals of Emergency Medicine 3.755
  • Academic Emergency Medicine 2.46
  • Emergency Medicine Journal 1.347
  • American Journal of EM 1.188
  • Journal of Emergency Medicine 0.778

Education journals

  • Academic Medicine 2.57
  • Medical Education 2.181
  • Teaching and Learning in Medicine 0.83
By |2019-09-10T14:06:28-07:00Aug 20, 2009|Academic|

Trick of the Trade: Toxic sock syndrome

The olfactory nerve of an emergency physician is exposed to a broad range of smells in the Emergency Department. I’ve learned that the stinky-feet problem is a commonality amongst ED’s around the world! I call it the “toxic sock syndrome”. There are two remedies which I’ve been told of:

  • Nebulized oil of wintergreen
  • Placing a open canister of coffee grounds next to the feet (I’ve never understood this. I would imagine it would smell like stinky feet in a cafe. Plus, what a waste of coffee!)


By |2019-01-28T23:54:04-08:00Aug 19, 2009|Tricks of the Trade|

TGIF: Collaborating creatively with great people

What part of your job do you love the most?

In academic emergency medicine, nothing energizes me more than brainstorming with creative, like-minded, and motivated people. From my experience, most of my past major projects have all started in similar informal, small-group settings.

For instance, the CDEM organization was built when a small group of undergraduate medical educators went to dinner during a SAEM conference. We conspired to build something bigger and better. Two years later now, we now have over 100 members and are a new member of the major interdisciplinary organization Alliance for Clinical Education.

1. This week, I got a call from Chad Kessler (Univ of Illinois-Chicago) who was interested in bringing medical education more to the forefront of EM. We brainstormed about building a “thinktank” of like-minded educators interested in pushing education to the 21st century. There is so much to be learned in the literature outside of EM and medicine in general. I suggested building a dynamic database somewhere to list the ongoing educational projects and research in EM. We too often work in silos. Collaboration is key in educational research. Any ideas how to build a database that everyone would participate in?

2. As a member of KidsCareEverywhere (KCE), I am headed off to Vietnam this month to help teach a conference jointly hosted by our organization and UCSF. This conference will assess pediatricians’ knowledge before and after learning a new decision-support software PEMSoft. The members of the KCE team met for the last time for a dry-run of the conference and a brainstorming session to anticipate potential hiccups.

One problem which I’m still a little worried about is the access to laptops and electricity. Because we are testing the participants on their ability to navigate the new technology, we need everyone to have their own laptop. We doubt that participants will all have laptops, but we have backup plans to share. We’re more concerned about poor battery life for the existing laptops and something as seemingly simple as access to electrical outlets. I have a feeling we’ll be buying long extension cords while in Vietnam.

Check out our new 1 GB USB thumb drives that just came in! We are giving out to the participants, preloaded with the PEMSoft user manual, hospital-specific documents, and the lecture slides.

3. For our residency program, I’m running the Education Area of Distinction (AOD). There are a variety of AODs available, which allow our residents to “specialize” in a niche in EM. I have two rock star residents in the Education AOD – Liz Brown and Eric Silman. We met to discuss how we were going to take the education world by storm. It always helps to do this over a BBQ meal.

iPhone photo of the inaugural meeting at Baby Blues BBQ. Sorry it’s so blurry – Digital SLR cameras apparently do don’t well when dropped on the floor. In the Canon shop.

The first project, spearheaded by Eric, involves posting interesting cases onto this blog. I’m going to open up a Saturday slot called “A Case Presentation from UCSF-SFGH”. Every Saturday, a short case from the residency program’s Follow-Up Conference series will be highlighted to illustrate key clinical pearls.

By |2019-09-10T14:06:37-07:00Aug 14, 2009|Life|
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