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Letters to the Editor

The Benefits and Risks of Asynchronous Education

Pescatore, Richard DO; Salzman, Matthew MD; Cassidy-Smith, Tara MD; Freeze, Brian MD

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doi: 10.1097/ACM.0000000000000821
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To the Editor:

We read with interest the article by Mallin and colleagues1 in the April issue. Resident education in emergency medicine continues to evolve, shifting from traditional textbooks to asynchronous education, harnessing the collective experience and knowledge of physicians across the globe. Anchored by the “#FOAMed” (free open-access medical education) movement, the once-strict didactic model now utilizes podcasts, blogs, and social media to bring evidence-based medicine to the bedside. However, just as Mallin and colleagues demonstrate near-universal adoption of asynchronous education, their study also shows a troubling lack of skepticism—an abandonment of the verification culture that has given rise to evidence-based medicine. With the majority of respondents reporting “rare” investigation of references, there is danger of misapplication of materials and contradiction with accepted and traditional teaching. Clearly, further study into the utility of these tools as meaningful resources is warranted.

We have seen exuberant adoption of podcast practices firsthand. For example, a recent EM:RAP podcast segment on pediatric bronchiolitis compared nasal decongestants, leading an intern at our institution to interpret their use as recommended practice, unaware of American Academy of Pediatrics guidelines to the contrary.2,3 The episode contained a debate between the hosts and a toxicologist who suggested harm with the use of intranasal oxymetazoline, with the podcasters recommending use of phenylephrine. A literature search revealed two studies investigating intranasal vasoconstrictors, neither showing benefit. While such discussions are invaluable to the practicing physician and helpful to the residents, we worry that utilization of asynchronous methods at the expense of traditional teaching may lead to knowledge gaps.

We are fortunate to practice our specialty during a cornucopia of evidence-based knowledge translation, accelerated by the power of global connectivity. Online resources available to emergency medicine residents will help them to develop into more capable emergency physicians. In our haste to utilize our innovative tools, though, we must be careful to remember the foundational instruments that have enabled our growth thus far.

Richard Pescatore, DO

Emergency medicine resident, Cooper University Hospital, Camden, New Jersey;

Matthew Salzman, MD

Assistant professor of emergency medicine, Cooper University Hospital, Camden, New Jersey.

Tara Cassidy-Smith, MD

Assistant professor of emergency medicine, Cooper University Hospital, Camden, New Jersey.

Brian Freeze, MD

Emergency medicine resident, Cooper University Hospital, Camden, New Jersey.


1. Mallin M, Schlein S, Doctor S, Stroud S, Dawson M, Fix M.. A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med. 2014;89:598–601
2. Herbert Mproducer. . Emergency Medicine: Reviews and Perspectives [audio podcast]. 2014 Accessed May 22, 2015
3. Ralston SL, Lieberthal AS, Meissner HC, et al.American Academy of Pediatrics. Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134:e1474–e1502
© 2015 by the Association of American Medical Colleges