Critical Thinking: Minimizing NOT knowing what you do not know
Socratic questioning, a dialectic approach to acquiring knowledge, has been around for ages. If done appropriately, it’s a rigorous method of learning. Questioning reveals our knowledge base, reasoning, and want for clarification; invites a dialogue; and establishes a relationship with others. Socratic questioning can also aid in the development of critical thinking. [+]
MEdIC Series: The Case of the Exasperated Educator
Image credit: wstera Teaching in the emergency department can be a challenge. Distractions and interruptions are everywhere and there always seem to be more things to do than there are people to do them. These challenges are magnified when our learners are struggling. In The Case of the Exasperated Educator, we will discuss these issues and how we, as educators in emergency medicine, can address them as effectively as possible. [+]
Trick of the Trade: Nail Bed Repair With Tissue Adhesive Glue
Patients with fingertip injuries involving the nail bed typically present to the emergency department and require meticulous repair of the nail bed to prevent long-term cosmetic and functional disability. There are several methods to repair nail beds, typically involving absorbable suture, but maybe there is a faster way with similar cosmetic and functional outcomes. [+]
Assessment in medical education: Finding the signal in the noise
This past December it was reported in the Harvard Crimson that the median grade at their prestigious University was an A-.1 A flood of articles followed bemoaning grade inflation at educational institutions with a former Harvard President noting cheekily that “the most unique honor you could graduate with was none”.2 This might be alright if well-developed criterion-based instruments are used to grade the students, but given the variability in courses taught at the University and difficulty of developing such tools, it is unlikely. That being the case, if the median is an A-, one wonders how sub-par performance must be [+]
Ondansetron: Has it reduced need for IV rehydration in vomiting kids?
A 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother states that the child has had fewer wet diapers today but has made tears when crying. On physical examination you note no rebound or guarding of the abdomen and determine that the child is moderately dehydrated. Your initial plan is to administer ondansetron and rehydrate the child orally. This is what you have been taught but is it actually efficacious? A just published 2014 JAMA Pediatrics article attempted to answer this question. [+]
Piperacillin/Tazobactam and Risk of Acute Kidney Injury with Vancomycin
There are a few reasons why piperacillin/tazobactam (Zosyn) is not usually my first choice for a broad-spectrum gram-negative agent in the ED. First, at my institution, the Pseudomonas aeruginosa susceptibilities to pip-tazo are lower than that for cefepime. Second, pip-tazo does not have great CNS penetration, especially compared to ceftriaxone, cefepime, or even meropenem. Third, do we really need the anaerobic coverage that pip-tazo provides for every sick patient? Pip-tazo is great for empiric treatment of intra-abdominal and severe diabetic foot infections, but may not be needed for a hospital-acquired pneumonia. Fourth, with its frequent dosing (every 6 hours), too often the second dose is missed if the [+]
Getting Semmelweised: An Essay on Fear and Medical Innovation
The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution—unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800’s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing. [+]
Improving debriefing skills: Two-column case and learning pathways grid
Being a learner in a medical simulation case can be tough. But equally challenging, is the role of the Debriefer. This person has to balance the important task of debriefing the small group, provide feedback, and still maintain a positive and open learning environment. A 2013 paper by Rudolph et al attempts to show methods how to balance these demands while improving as a Debriefer through the use of 2 Column Case Analysis and Learning Pathway Grid. [+]
ALiEM Bookclub: How We Die
DNR/DNI, Code Blue, Cardiac Arrest, Traumatic Brain Injury, Exsanguination, Septic Shock, Respiratory Arrest… and the list goes on. As healthcare providers, we are well versed in the medical and emergency resuscitations that can spiral into these dangerous arenas. Even if we don’t always know the exact cause, we know the mantra of ABCs and we stick to it until the end. The very last end… But the end of what? Where is the dignity in resuscitating a body that has already died? Ultimately the question becomes, are we as practitioners as well versed in letting go, in letting the body [+]
MED STUDENTS: The ALiEM-EMRA Social Media and Digital Scholarship Fellowship
HOT OFF THE PRESS! We would like to announce a great opportunity for U.S. MEDICAL STUDENTS. In collaboration with the Emergency Medicine Residents’ Association (EMRA), we at ALiEM are launching the 2014-2015 ALiEM-EMRA Social Media and Digital Scholarship Fellowship for medical students! This is in parallel to the just-announced similar ALiEM-CORD fellowship for EM residents, except that this is for U.S. medical students, who are members of EMRA. The application process for this virtual fellowship is open as of right now. [+]