Article Review: Rethinking the premed requirements
Think back to your college years. Remember those premed courses that you had to take? Biology, chemistry, physics… oh my. How helpful were these in your preparation for medical school and clinical practice? In 1981, the Association of American Medical Colleges assembled a group, the General Professional Education of the Physician and College Preparation for Medicine (GPEP) to relook at these premed requirements. In 1984, the published a report “Physicians for the Twenty-First Century”. They advocated that the intensive premed requirements overly skews students’ education towards a “narrow objective of medical school admission”. Education is not balanced to include broader [+]
Paucis Verbis card: TIMI risk score
How do you risk-stratify undifferentiated chest pain patients in the Emergency Department? There are a multitude of causes for chest pain. We are always taught to think of the 5 big life-threats: ACS, PE, aortic dissection, tension pneumothorax, and pericardial tamponade. So how do YOU risk-stratify your patients for unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI)? STEMI's are usually obvious. UA and NSTEMIs -- not so much. Fortunately a 2000 JAMA article and a followup Academic Emergency Medicine 2006 study have solidified the TIMI risk scoring system as a reasonable risk-stratification tool for all-comer ED patients with chest [+]
Trick of the Trade: Increasing students responses to the differential diagnosis
Anyone who teaches medicine asks students to list their differential diagnosis when discussing a new clinical case. It’s also part of several models for education including the One-Minute Preceptor and SNAPPS. For the most part, students are good at coming up with answers to the differential, but what do you do when they strike out? Or what if the answer is always the same, i.e. chest pain = myocardial infarction? [+]
Work in progress:Translating videos into Vietnamese
Sometimes you just have to be lucky to get projects done. In anticipation of our Vietnam trip in October to teach clinical decision software to pediatricians (KidsCareEverywhere), we are kicking preparations into high gear. One of my tasks is to create new KCE-PEMSoft training modules not only in English but also Vietnamese. And no, I do NOT speak a lick of Vietnamese. [+]
Article Review: Use of Effective Questioning
Asking effective questions is a valuable skill for any teacher. As a junior faculty member working to improve my teaching, I’m often in awe of my more experienced colleagues when I have the chance to watch them teach. At times, it’s quite easy to pick out the skills that they put into action but occasionally, their expertise is much more subtle. Effective questioning falls into this category. [+]
New guest blogger: Dr. Robert Cooney
Welcome to new superstar guest blogger, Dr. Robert Cooney! Today's post is his first (of hopefully many).
Paucis Verbis card: Croup
The most common cause of stridor in pediatric patients is croup, or laryngotracheobronchitis. The distinct high-pitched, seal-like,"barky" cough can be heard from outside the patient's room often. https://www.youtube.com/watch?v=0lepci-YheI Check out the YouTube clip above. Go to the 1:15 mark (near the end) to hear the barking cough. Poor but cute kid. What is the current treatment regimen? Did you know that the traditional treatment with cool mist or humidified air have shown to be of no added benefit? PV Card: Croup Go to ALiEM (PV) Cards for more resources.
Incorporating debriefing into clinical practice
I’m in the middle of an intense weeklong course on debriefing for medical simulation here in Cambridge, MA. One of the goals many of the participants share is our desire to improve our skills in the art of debriefing after clinical simulations. Although the course focuses on “Debriefing with Good Judgement” 1 today the faculty also offered a simple tool to structure a brief debrief when time is very limited. [+]
Trick of the Trade: Modified HAT trick revisited
I finally tried the Modified HAT (Hair Apposition Technique) trick for the closure of scalp lacerations. I have used the traditional HAT trick multiple times but not the modified technique. What's the difference? Instead of using your fingers, the modified approach involves the use of two instrument clamps to help twist and pull the hair strands taut. It turns out that this makes a huge difference, especially for short hairs. The clamps allow you to grab the hair strands so much more securely, before instilling a tissue adhesive at the twisting points. The nice added benefit was that my chubby [+]
Paucis Verbis card: Acute limb ischemia
Acute limb ischemia (ALI) is a true vascular emergency. It doesn't occur as frequently as the more high-profile conditions as cerebrovascular accidents and acute myocardial infarcts, but it portends similarly high morbidity and mortality risk. How do you stage a patient with ALI, based on the Rutherford classification system? What is the ED treatment plan? Should this patient go to Interventional Radiology or the Operating Room for more definitive management? PV Card: Acute Limb Ischemia with Rutherford Classification Go to ALiEM (PV) Cards for more resources.