Dogma Downed!

The 2013 CICM ASM was a blast, as you would expect given the glorious theme of ‘Down with Dogma: Challenging the Fundamentals of Critical Care’. I got to play a bit part, challenging the dogma that you have to be a proper intensivist to speak at the ASM….

I had the opportunity to talk about ‘Toxicological Myths and Half-Truths’ as well as ‘Social Media and the Internet: The Future of Medical Education’. No masked wrestlers ran onto stage to body slam me, so the talks must have gone better than anticipated. I’ve collected resources for the talks here. I may try to make FOAM versions of the talks to go online if anyone is interested.

Highlights for me were:

  • The recurring theme of ‘The Rise and Fall of the Parachute’ which turned out to be a major unintended feature of the ASM. The sharp witted @expensivecare calls the parachute slide the Godwin’s Law of Evidence-based Medicine. After hearing that I had to add an extra three parachute photos into my second talk… David certaintly wins the award for Tweeter of the conference!
  • Brad Wibrow taking the gold at the awards ceremony was fantastic to see — good on ya mate.
  • Stephen Streat — probably the first intensivist I ever encountered, thanks to the lecture halls of Auckland medical school — railed on about ‘Wiki-truth‘ and ‘gizmo idolatry‘. Surprisingly, I agree with him — though the rest of the conference showed that the medical literature is also just another form of ‘Wiki-Truth’.
  • Charles Natanson’s talk on the neglected concept of practice misalignment was the top talk for me. I first really came to grips with this idea a year ago while preparing a talk on transfusion triggers… It cripples the famous TRICC trial in my opinion and Natanson gave the ARDSnet ARMA trial a good going over too. I highly recommend this paper if you are not familiar with this particular scourge of the RCT:

Deans KJ, Minneci PC, Danner RL, Eichacker PQ, Natanson C. Practice misalignments in randomized controlled trials: Identification, impact, and potential solutions. Anesth Analg. 2010 Aug;111(2):444-50. doi: 10.1213/ane.0b013e3181aa8903. Review. PubMed PMID: 19820238; PubMed Central PMCID: PMC2888723.

  • Gattinoni. Enough said. A true legend of intensive care. Hearing how he had to bribe CT techs in order to come up with the concept of the ‘baby lung’ was fascinating. As was the complete absence of peer review for some of his early publications (shock horror – they might as well as have been blog posts!). One problem I have is that I’m still unsure whether he said that physiology was the ‘porn star’ or the ‘polar star’ of intensive care… ;-)
  • Another of everyone’s heroes in intensive care is Rinaldo Bellomo (of course). His talk on oliguria was pure gold (as you’d expect) — look for his concluding slide in the TwitPics below. Getting him this ‘Bristol Stool Chart Expansion Project’ video in time for his talk was probably the most stressful part of the conference for me (apart from almost missing my flight… but that’s another story). Another take home message from Rinaldo was “if you want to know about defecation, ask the Dutch.”
  • Meeting Derek Angus and Roger Lewis — two of the biggest brains in the business and great blokes to boot. Roger Lewis’ concept of adaptive trial design might be the way of the future for the ANZICs CTG and is exciting stuff. All of Derek’s talks show that as a JAMA Editor he has way too much time on his hands… How can he know “all that stuff”?
  • Stephen Webb exemplified ANZICS CTG hyper-rationality and had us all convinced that EBM ruled over physiology (at least when Gattinoni wasn’t speaking).
  • My former boss Di Stephens ‘owned the mike’ as she ranted in typically dynamic fashion about gender disparity in ICU and ICU training. Interestingly, Di expressed her surprise to me afterwards that she met such little opposition to viewpoints. I suggested that it wasn’t because people agreed with her but a need for self-preservation! Please tweet your disagreements to @Diash13 ;-)
  • ICN‘s Oli Flower brought all his ‘Slideology’ and ‘Presentation Zen’ skills to the fore in with his iconoclastic view of neurocritical care. His unexpected joust/ rite of passage with the legendary Bob Wright was an added bonus! (For the record, I suspect reading the medical literature after a beer or two might be a good thing).
  • SMACC veteran and twitterati member ex-President John Myburgh (@JAMyburgh) gave a truly fantastic talk titled ‘Decompressive Craniectomy: never (for anything)’ — fantastic presentation, backed by science and unrivaled clinical wisdom. The title speaks for itself. If only it was #FOAMed…
  • Jeff Lipman told us that VAP was dead…
  • Bala Venkatesh told us that physical examination was NOT dead…
  • Kiwi President Ross Freebairn told us he doesn’t trust the French… (neither does Gattinoni it seems).
  • … and John Morgan finished us off with his bitter and twisted and undeniably humorous view of the ICU world. He renamed the ICU the ‘inconvenient care unit’, lamented the role of MET teams in transferring REM sleep from the intensivist to other specialties and then defined the modern criteria for ICU admission as “any patient you can’t get out of admitting”. Tongue in check, yes, packed with truth verifiable claims, definitely.

For a comprehensive talk-by-talk summary of the conference head over to the Crit-IQ blog where Todd Fraser gives his account of what went down.

Meanwhile, Alex Psirides drove the @CICMASM account like a demon as he shared links and references relevant to the conference in real time. When I made this suggestion I envisaged an occasional tweet — not this awesome avalanche. Here are all the tweeted references from the conference I could find:

 


Twitter also gives us a vivid pictorial walk-through as various CICM ASM tweeple shared what they saw and experienced:

 


Here is a selection from #CICMASM13 running commentary as the conference happened:


And finally here are the #CICMASM13 twitter stats and participants (up until now):

cicmasm13 analytics

cicmasm13 participants

If you were at CICM ASM and new to FOAM, check out these Ten Tips for FOAM Beginners. Also, take this tweet to heart:

wrong on the internet

Big ups to all the Wellington ICU crew and the College for putting on a great show (and thanks to Paul Young and family for loaning me clothes, feeding me and providing shelter from the blazing sunshine). Next year it is Brisbane’s turn as they take on ‘Risky Business’ in intensive care.

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Comments

  1. Sebastien says

    So Chris, what was your take on no more dual training, or at least Di Stephen’s talk? I’m PGY1 and have had to change my life plans (ACEM/CICM) now that there’s talk of CICM not accepting ACEM primaries.

    • says

      Hi Sebastien

      I’m not sure what the time frame of CICM excluding ACEM primaries is, or whether that will definitely go ahead.

      I definitely don’t agree that mono-training in ICU is mandatory -- and there was much talk among the audience that disagreed with Di’s view.

      The possible roles of dual-trained emergency physician/ intensivists have been recently discussed here:
      http://resus.me/the-ed-intensivist-model/
      http://lifeinthefastlane.com/2013/04/crippens-law/

      Without ACEM primaries, none of these CU docs would be able to be intensivists:
      - Oli Flower and Matt MacPartlin from ICN
      - Paul Young and myself from LITFL
      - Todd Fraser from CritIQ
      - not to mention great docs like Brad Wibrow who got a shout out above

      One pragmatic solution might be to do the ACEM primaries and get them accredited ASAP before any changes happen!

      Chris

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