The Internet is a powerful tool.

It has provided us with myriad opportunities to review the way we look at education. Social media and web 2.0 has increased the level of engagement at a global level and allowed high quality information to be written, read, heard, seen and shared. This sense of global community education is the very essence of the modern day version of asynchronous learning.

Asynchronous learning is a student-centered teaching method that uses online learning resources to facilitate information sharing outside the constraints of time and place among a network of people. Asynchronous learning is based on constructivist theory, a student-centered approach that emphasizes the importance of peer-to-peer interactions

We are seeing an increased number of engaged, interested readers who are enjoying learning for the sake of learning. It has led to the development of ‘anyone-anywhere-anytime-anything‘ learning …picking apart the standard educational models

Working online, and without a syllabus has allowed us to provide a complimentary strategy to solution driven problems (Problem Based Learning) and physical scientific constructivism (contextual learning) and be a little more creative in our educational approach. We have the opportunity to go beyond conventional classroom learning and develop a community based teaching model based on asynchronous contextual online learning. This will allow more time for reflection on complex ideas, which is great for continuous professional development.

With this is mind, we have a number of new projects underway at LITFL…

• Basic Science in Clinical Context - Starting with Clinical Anatomy and the Physiology Philes
• Global Medical Education Project allowing social engagement, knowledge acquisition and content sharing across the web by doctors, nurses, paramedics, and students of life
• The Rapid Fire clinical context project covering anatomy, physiology, pharmacology and physiology in 90 second vivas relating directly to a clinical case

Finally the iMac box structure is being built…slowly

References:

• According to Hull’s (1993) definition of contextual learning, learning occurs only when learners connect information to their own frame of reference
• Karweit (1993) defines contextual learning as learning that is designed so that students can carry out activities and solve problems in a way that reflects the nature of such tasks in the real world. Research supports the effectiveness of learning in meaningful contexts (Carraher, Carraher & Schleimer, 1985; Lave, Smith & Butler, 1988).
• Resnick (1987) points out that schools emphasize symbol manipulation and abstraction instead of the contextualized learning that is used in the world outside of school. She says the problem is that the symbols are detached from their real-world referents. Because they are decontextualized, they have no meaning for students.
• Design for Contextual Learning: Web-based Environments that Engage Diverse Learners
• Critical investigation of the problems with PBL [PDF]
• Definitions of contextual learning
• Asynchronous and Synchronous eLearning [PDF]

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Emergency Medicine Diagnosis and Management 6e has been turned into an eBook on SkyScape Medical resources and will be available on

• Android OS >1.5
• BlackBerry® OS >4.1
• iPhone/iPod Touch  >2.0 and iPad

…so time for another simple and straight forward competition

 In 100 words or less tell us WHICH social media tools are most useful in delivering/discussing/disseminating health and medical education on the web and WHY

The lucky winner will be chosen by the least social media savvy of our guest contributors and receive a free

• TO ENTER: Leave a comment at the bottom of this post
• CLOSING DATE: Sunday 27th May (somewhere in the world)
• WINNER: Announced Tuesday 29th May
• PRIZE: Complete Copy of Emergency Medicine Diagnosis and Management Online Version

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Life in the Fast Lane has it’s roots firmly in Australia – despite having a Welshman and a Kiwi at the helm!

As such…this year we have been collating short editorial reviews from our local journal – Emergency Medicine Australasia which publishes peer-reviewed articles, reports, reviews and opinions on the research and clinical practice of emergency care.

Emergency Medicine Australasia, with its strong interest in the effectiveness of emergency diagnostic and therapeutic techniques, is the journal of choice for anyone concerned with improving patient care in the pre-hospital and hospital emergency settings. As the leading journal in the specialty of emergency medicine in the Asia Pacific region, Emergency Medicine Australasia is committed to the furthering of scientific research, the support of educational objectives, and the dissemination of information to the emergency medicine community.

We will be hosting short editorial comments on the key papers from each issue of the journal – and encouraging the publishers to allow us access to the full-text version online of these articles. Each issue will be hosted on LITFL (e.g. the resuscitation guidelines, Vol. 24, Issue 1 and Issue 2) will will then be collated on the EMA Journal page on LITFL.

Hopefully these will provide insight into some of the great academic work being performed in the Southern Hemisphere.

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Recently I wrote about research performed into changing the paradigm of progressive deterioration in multiple sclerosis (MS). The article was based on an Australian longitudinal cohort study which reported remarkable improvements with lifestyle changes.

As anticipated this produced a wide variety of comments and responses ranging from sceptical disbelief, through academic rebuttal to acceptance and confirmation…

Now the group of academics at Overcoming Multiple Sclerosis (OMS) have commenced a major international research project trying to determine which lifestyle factors may contribute to the progression of MS. The study, approved by St Vincent’s Human Research Ethics Committee in Australia, hopes to enrol many thousands of people with MS (PwMS).

PwMS who consent to the study will fill in an online questionnaire about factors related to their lifestyle (eg. diet, exercise, sun exposure, vitamin D, Omega-3 supplementation, stress reduction) and their health-related quality of life, amongst other questions. Over time the OMS group intend to follow this group at yearly intervals to see if there is a relationship between changes in these lifestyle factors and the health of the group.

This information will be analysed to determine which factors best predict the health of PwMS. Potentially this research may answer some of the most vexing questions in MS related to consumption of particular foods and fats, vitamin D and sun exposure, and the influence of meditation on disease progression.

The survey should take around 30 minutes. This may be the opportunity for the MS community to provide real data on some of the more elusive questions about the disease, potentially affecting the health of hundreds of thousands of PwMS in the future.

If you have been diagnosed with MS, and are over 18 years of age and would like to find out more about this important research go to the link below

HOLISM SURVEY LINK

Further reading:

• Health-related quality of life outcomes at 1 and 5 years after a residential retreat promoting lifestyle modification for people with multiple sclerosis. Hadgkiss EJ, Jelinek GA, Weiland TJ, Rumbold G, Mackinlay CA, Gutbrod S, Gawler I.  J Neurol Sci DOI 10.1007/s10072-012-0982-4  [PDF Download]
• Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis. Li MP, Jelinek GA, Weiland TJ, Mackinlay CA, Dye S, Gawler I. Qual Prim Care. 2010;18(6):379-89. PMID 21294980
• Overcoming Multiple Sclerosis [Review] [Website] [Facebook] [Twitter]

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

It is the end of the week – for some people – and time to reward yourself with some audiovisual stimulation, Something to energise your very core…

Visual graphics bring familiar music to life and allow the listener to really ‘see’ the music

Stephen Malinowski experiments with his Music Animation Machine to provide a visual manifestation of timbre, rhythm, tonality, reflection and triadic relationships. His experimental work on demonstrating bowing structure is well demonstrated with his experimental work on Bach Cello Suite No.1 in G, prelude (BWV 1007). In this video we see a ”caterpillar” walking between notes, with the notes highlighted by ”harmonic colouring“. The colour of the caterpillar is a mixture of the color of the current note and the note that was just previously played and the width of the caterpillar corresponds to the loudness.

http://www.youtube.com/watch?v=XziwXVxUdA4

Performed by Vito Paternoster; recording courtesy of Magnatune

If you prefer the full orchestral score then…sit back and relax to this audiovisual extravaganza on full screen.

http://www.youtube.com/watch?v=Qglck7rpI3w

If you enjoyed the audiovisual stimulation – then check out this documentary – A brief history of The Music Animation Machine and related musical explorations of Stephen Malinowski

http://www.youtube.com/watch?v=SQfzNJGnqnw

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Just a quick update from the LITFL team regarding RSS feeds…

Recently we had an issue with our email notifications from LITFL. Unfortunately new subscribers to the LITFL email feed were receiving automatic updates for every blog post as soon as it was posted…this led to a ‘spam effect’ as the feed included EVERY page and post we publish.

We have rectified this issue, and ceased the old email notification system and re-instated our old feedburner account with a daily digest only – this change affects the last 500 subscribers who will no longer receive email updates from the site.

…so here is the list of options to subscribe to updates

• EMAIL updates – with DAILY DIGEST
• RSS feed for updates on new posts
• Facebook page
• Vimeo Feed (NEW)

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Short editorial snippets from Vol. 24 Issue 2 of Emergency Medicine Australasia published online on 5 April 2012.

Telephone triage (Full text)

Despite government media releases to the contrary, the National Health Call Centre Network (healthdirect Australia, after-hours GP helpline) is not helping to ease demand on emergency departments, according to this editorial by Nagree and colleagues. Access block, not low acuity patients, is the key driver of ED over-crowding.

Goal-directed resuscitation

Resuscitation targets to facilitate the early detection and appropriate management of circulatory shock are considered in a two-part review series. In Part 2 of this series Holley at al review the methodology and evidence for current technologies used in directing resuscitation at the microcirculation and cellular level. This follows on from Part 1 (in the February issue) which explored global haemodynamic end-points for guiding resuscitation and their potential limitations.

Pain management

This qualitative study by Bennetts et al identified important barriers and enablers to implementing best-practice pain management guidelines in the Australian EDs. High workload and insufficient resources are major barriers that need to be overcome. Staff engagement, a clinical culture of learning best practice and strong leadership by senior staff are key enablers. The findings of this study informed the design of the National ED pain management initiative (2008-2010).

Reflections on professional longevity (Full text)

Twenty-five years after gaining Fellowship, Jelinek reflects on career progression in emergency medicine. He contends that, as a result of the pressures of working in the ED, unique solutions may be required if the emergency physicians are to continue in clinical practice in the later stages of their professional lives. Otherwise the accumulated expertise of this group of experienced and capable clinicians may be lost to the healthcare system.

Further reading:

• Full Table of Contents Vol. 24 Issue 2
• Emergency Medicine Australasia database

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Short editorial snippets from Vol. 24 Issue 1 of Emergency Medicine Australasia published online on 9 February 2012.

CT Pan-scan

Asha and colleagues from the University of New South Wales report on a large cohort study comparing radiation exposure to trauma patients before and after the introduction of a CT pan-scan diagnostic algorithm, finding that pan-scan increased the proportion of trauma patients receiving a radiation dose >20mSv. This increased risk occurred regardless of age or injury severity.

• Cowan et al, in their research letter, also argue that in major trauma the clinical impact of any abnormal findings should be considered in order to address the true risk–benefit balance of CT pan-scan.
• Stengel’s editorial on this CT pan-scan topic argues that the therapeutic index for pan-scan could be improved by developing more accurate decision criteria so that only those patients who really need this imaging are scheduled for the procedure.

Palliative Care in EM

A growing interest in palliative care in EM reflects common experiences with patients who have chronic life-limiting illness who present to EDs without being offered palliative care services that could ease symptoms and address their need to subsequently attend ED.

• The perspective by Lukin et al discusses instigating palliative care through the ED, including engaging palliative care colleagues to increase clinical support for these vulnerable patients.
• Todd’s editorial on this topic explores the likely barriers to ED-based palliative care and argues for Emergency Medicine to play an important role in calling for improvements in end-of-life care planning.

Goal Directed Resuscitation

Resuscitation targets to facilitate early detection and appropriate management of circulatory shock are considered in a two-part review series. In part 1, Holley at al explore global haemodynamic end-points for guiding resuscitation and their potential limitations. Part 2 of this series will be published in the next issue.

Surgical Cricothyrotomy

Paix and Griggs of MedSTAR SA, two experienced Australian medical specialists with backgrounds in Anaesthesia and Aeromedical Retrieval, report on their experience of emergency surgical airway cases, leading to their adopting a simple ‘scalpel–finger–tube’ method for cricothyrotomy. They suggest this technique is useful for trauma patients and other occasions where emergency surgical airway access is required.

ED Demand Increase

FitzGerald and colleagues from the Queensland University of Technology report demand for public ED care has grown by 37% over the past decade. This increase in demand exceeds population growth, and variability between states in utilisation rates and overall trends cannot be readily explained. However, population ageing, rather than overuse by lower-acuity patients or ‘inappropriate use’ based on retrospective clinical judgement, is likely to be a significant factor.

Further reading:

• Full Table of Contents Vol. 24 Issue 1
• Emergency Medicine Australasia database

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Spending time away from the family – in a highly charged sporting atmosphere evokes many emotions…

I think these two videos best sum up the inspirational work of parents, mothers and leaders – not only in sport, but in every aspect of our lives

http://www.youtube.com/watch?v=NScs_qX2Okk

http://www.youtube.com/watch?v=7zV6dm3VbB0

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

You are at handover. The day shift registrar stumbles towards the weary tunnel of egress and casually relates the story of your next patient…

“Finally, there is a 64 year old lady who presented with left sided abdominal pain and haematuria. I have placed an IV line, taken bloods and given some analgesia. Her pain is now under control. Just check the abdominal XR before sending her home…”

Your review of the abdominal XR takes a little longer than you had suspected…can you determine her past medical history and current pathology?

Review the abdominal XR

Click to view full size image

Case submitted by Dr Rahul Goswami, Changi General Hospital

...the official answer

1. CABG sternotomy wires
2. Prosthetic heart valve – old notes say aortic valve replacement. It is seen from its side – therefore it looks like a linear thin rectangle.
3. Right nephrostomy tube (J coil)
4. Stoma bag
5. Left renal calculus
6. IVC filter
7. Surgical thumb tacks in the sacral region during hysterectomy

Life in the Fast Lane Medical Blog - Emergency Medicine education blog