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Special Report

Special Report: Attend the Lectures, See the Sights, Eat a Red Hot, and Brave the Ledge

Scheck, Anne

doi: 10.1097/01.EEM.0000455714.61761.20
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    The ideas you'll hear at this year's Scientific Assembly of the American College of Emergency Physicians are things you probably already know — but with a twist. One lecturer will tell you the key to Twitter is following your mom's sage advice. (Be nice.) Another will explain why you want your patients to be happy. (They have better outcomes.) A third will convince you that a freewheeling problem-solving approach using apps is better than what you're doing now. (It's faster and more practical.)

    The college is offering those lectures and more than 350 other courses, labs, and workshops for attendees at this year's conference, scheduled at McCormick Place in Chicago Oct. 27-30.

    Tweets & PokesMonday, Oct. 27, 2 p.m.

    The need to use a keyboard and screen is a thing of the past. “I communicate with physicians all over the world every day in my social media network. It's not uncommon at all to run generic cases by doctors who I know via social media, just like I would in an ED with a colleague who's working there,” said Matthew Dawson, MD, who will lecture on how to make the most of the Internet in “Rapid Fire: Tweets & Pokes: The Pearls and Pitfalls of Social Media Use.” Dr. Dawson is the director of emergency ultrasound, an assistant professor of emergency medicine at the University of Kentucky in Lexington, and part of the team, with Mike Stone, MD, and Mike Malin, MD, behind Also find Dr. Dawson on Twitter: @ultrasoundpod.

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    He will summarize the advantages, along with some of the drawbacks of social media use, for attacking task saturation, a problem in every emergency department. The benefits of “education, collaboration, and accelerated innovation make [social media] worth the risk,” he said, citing an intubated patient who was transferred from an outside hospital with a congestive heart failure diagnosis. An ultrasound of the heart and inferior vena cava didn't match up with CHF, and something looked strange on the lung image.

    Dr. Dawson said his colleague, who was managing the case, wouldn't have thought much of it except that it reminded him of a tweet that he had recently seen about a new study on ultrasonography in viral pneumonia. “So he looked up the tweet, looked up the article it mentioned, and then changed the management of the patient based on what he found in this article,” Dr. Dawson said, noting that the article hadn't yet been published.

    “I would say it's nearly impossible to get the same depth and breadth of education and stay as up-to-date through traditional methods like journals and textbooks,” he said.

    “Participating in discussions, tweets, and comment exchanges on blogs can really revitalize a doc who's on his own somewhere just going in shift after shift,” he said. Just follow some simple rules, like “don't be stupid” and “be nice,” he said. Using patient names is verboten, too. Even when not disclosing patient information, assume that “whatever you put on social media sites will be up forever,” he said. “So be nice, and don't embarrass yourself.”

    Top Ten Quality TipsMonday, Oct. 27, 3:30 p.m.

    Jennifer Wiler, MD, MBA, will offer tactics and tools aimed at helping prevent errors and boosting quality in the delivery of emergency medicine in “Top Ten Quality Tips: Best Provider Practices Around Quality and Patient Safety.” The presentation precedes what many are predicting will be a period of unprecedented performance-tracking for emergency physicians.

    Beginning next year, the Centers for Medicare and Medicaid Services (CMS) will require quality-measure reporting by all emergency departments. Patient experience is one of those quality indicators — a significant one, Dr. Wiler noted, though no specific ED experience metric has been mandated by CMS. “We do know that happier patients who like their doctors have better outcomes,” she said. “As a provider you play a critical role in that.”

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    Meeting the need for such metrics may be a challenge for EDs, where variation in practice is common, said Dr. Wiler, an assistant professor of emergency medicine at the University of Colorado School of Medicine in Aurora. “We work in chaotic environments, with different team members, with limited information, with many hand-offs, and a lot of multitasking trying to deliver the best outcomes,” she said. “This makes the delivery of emergency care error-prone.”

    Often team members are from other specialties, and add another potential complication: patient handoffs. Should quality be gauged in terms of successful teamwork? Should more weight be given when patients are happy with the entire encounter, not just a single doctor? And how should physicians be assessed — on who skillfully imparts information at the close of a shift or by good case outcomes? “It depends on how you define quality,” she said.

    One way her own institution has addressed this was by establishing “care pathways,” which are protocols that provide a way to decrease variability and improve outcomes that are based on best evidence, such as treating headache, evaluating transient ischemic attacks, and assessing acute coronary syndrome.

    “Know what you are being measured on,” she advised. As these measures become more influential in federal payment models, private insurance is starting to follow suit, affecting hospital and physician compensation. “Incentive-based payments are here to stay,” she said.

    The Flipped ClassroomWednesday, Oct. 29, 2 p.m

    But not even the best use of handheld mobile devices can completely replace the classroom, although traditional course work is undergoing its own technological overhaul. Michael Stone, MD, will offer examples from his workshops on ultrasound in “The Flipped Classroom: Emergency Medicine Education the Khan Academy Way.” He now teaches by asking participants to view online videos prior to the course so that class time can be spent in hands-on practice, question-and-answer sessions, and discussion periods.

    He once held the workshops in a more traditional way, but “everyone always said in the evaluations that they needed more hands-on time. Initial video-viewing on the Internet — a homework-first approach, as Dr. Stone calls it — is a better teaching strategy, he said, noting that he has offered the ultrasound course scores of times over the past decade using both methods.

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    It's not difficult to adopt this new way, either, he said. Good educational videos can be done on a laptop, thanks to step-by-step systems that can be used successfully by any emergency physician. “A lot of educators were once wowed or intimidated by the technology,” he said. But now it's no more complicated than any other basic program.

    “I think this is a very natural thing for emergency medicine for those who choose to use it,” said Dr. Stone, the division chief of emergency ultrasound at Brigham and Women's Hospital in Boston. He said this method is a boon to medical students and residents, and in continuing medical education. “They can stop at a part that may not be easy for them to understand, then rewind it, and watch it all over again to really understand,” he said. Further clarification can be sought, if need be, during rounds or in class. “It is just so much more interactive,” he said.

    The aim of the presentation is to demystify the process involved in this “flipping” technique for class-based learning; it's not meant to compare the relative merits with a traditional lecture, he explained. “It can get hard to keep things fresh” for an instructor, Dr. Stone said, because of the risk of glossing over an important area or forgetting it entirely after delivering the same information over and again. Videography can hit all those learning targets.

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    Figure. C:
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    “This way, you can work on areas that are typically more challenging,” he said. “It may be more freewheeling, but I believe it's more practical and representative of the problem-solving approach we take in our daily practice.”

    Hand-Helds and AppsThursday, Oct. 30, Noon

    Smart phones and PDAs have made using a computer often unnecessary and a less useful tool. Why use a keyboard when you can carry a virtual textbook in your pocket? In “There's An App for That: Hand-Held Devices and Applications That You Should Know About,” Jason Wagner, MD, will offer an overview of the best apps for emergency medicine, discussing which are most valuable for the ED.

    By now, most emergency physicians are familiar with apps, and use them on a regular basis, he said. “My goal is to introduce apps that you may not have heard of yet and, with luck, add a half dozen or so to your armamentarium,” said Dr. Wagner, who is also known by the Twitter handle @TheTechDoc, where he comments on medical education, technology, and life as an academic physician.

    Five great apps can be purchased for only $20 that can assist with everything from fast clinical decision-making to organizing workflow, he said. He has found, for example, that he is occasionally faced with treating a child, though he works in an adult ED. “Pedi Safe is a crutch that I pull out immediately,” said Dr. Wagner, an assistant professor of emergency medicine at Washington University in St. Louis, MO. Pedi Safe lists medication dosages, abnormal vital signs, and special considerations for kids.

    The problem with apps is there are hundreds from which to choose. “In general, what's needed is curation,” he explained, adding that he plans to provide that in his talk.

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