Article review: Unannounced standardized patients

During medical school and residency, standardized patients, simulation cases, observed structured clinical exams (OSCE), direct observation serve as evaluation tool to assess learner competencies and skills. The inherent problem is the observer effect. This means that people change their behavior because they know that they are being observed.



The authors of this study introduce a novel approach of using unannounced standardized patients who present for "fake" medical reasons. Although this could potentially take the resident away from treating other patients, this exercise seemingly best reflects the resident's true actions and interactions with patients.

The study aimed to assess resident communication and professionalism skills. Fifteen PGY-2 EM residents were only told that they would be seeing standardized patients sometime in their next 4-6 weeks in the Urgent Care.

Because of scheduling difficulties, only 17 of the 27 planned standardized patients presented themselves to the resident. The standardized patients, who were paid actors, were trained to portrait two cases. The first was an angry patient who had a film misread and called back. The second was a dissatisfied, "frequent-flier" patient with chronic pain. The actors also received training on how to evaluate the residents on the following items:

Communication

• Information gathering
• Relationship development
• Education and counseling

Professionalism

• Accountability
• Manage difficult situation
• Giving bad news
• Treatment plan and management
• Patient centeredness
• Despite the small sample, the data showed a range of scores for communication and professionalism.

Overall recommendation

What did the results show?
The residents detected only 44% of the unannounced standardized patients. Furthermore, most residents did not feel uncomfortable or suspicious of patients. I personally might feel a little suspicious, but then I'm always a little paranoid.

• The mean resident score for communication items with a rating of "well done" was 60%.
• The mean resident score for professionalism items with a rating of "well done" was 53%.
• Areas of weakness: Patient education and counseling (43%), information gathering (68%), and relationship development (62%).

I applaud the authors of this study for this creative approach to accurately assess resident behavior. The results suggest where we need to focus our teaching efforts within the areas of communication and professionalism.

On a bigger picture level, this methodology is directly in line with the ACGME's Phase 3 push for more assessment tools which focus on patient outcomes and external measures. Unannounced standardized patients provides educators another tool in their assessment "toolbox".

Reference:
Zabar S, Ark T, Gillespie C, Hsieh A, et al. Can Unannounced Standardized Patients Assess Professionalism and Communication Skills in the Emergency Department? Acad Emerg Med. 2009 Aug 10; 16:1-4.

TGIF: Since we don't have a desk job, try Paper Toss game

Paper Toss

As emergency physicians, we don't have traditional desk jobs. I've always wondered what we're missing out on. That's why I'm partly intrigued by this free iPhone app game. In this game, you have to toss a crumpled ball of paper into a waste bin while accounting for a fan's wind factor .

















Take a sec to play it and see if you can get 41 straight shots in a row on the Medium level! Don't knock this until you've tried this addictive game. Have a nice weekend.

Novel use of Twitter at Univ of Chicago's Law School

As I continually try to look for how to harness Twitter's novelty and potential in education and medicine, I ran into this creative website "TweetChicago" by the University of Chicago School of Law. On this site, tweets are posted by a variety of students and professors from the law school.



While website displays a mix of personal and professional tweets, I am trying to see if I can incorporate a similar concept (with primarily work-related tweets) onto my own site. I envision faculty posting thoughts about their research, educational projects, day-to-day clinical issues, deep thoughts, etc.

Anyone interested?

Trick of the Trade: Reverse sugar tong splint

Distal radius fractures traditionally require a sugar tong splint to prevent the patient from ranging the wrist and elbow. The sugar tong splint essentially sandwiches the forearm with a splint, folded at the elbow. At this elbow fold, however, the splint often uncomfortably and inconveniently buckles and wrinkles when a wrap is applied.

Trick of the trade: Reverse sugar tong splint
A reverse sugar tong splint accomplishes the same degree of immobilization as a classic sugar tong splint by stabilizing the volar and dorsal aspect of the wrist and elbow. The splint fold, is located distally at the first webspace of the hand, instead of the elbow.

• At the mid-length of 3-inch fiberglass splint material, transversely cut the splint such that the entire fiberglass material is cut through, leaving a "bridge" of padding intact.
  
• Rest the padding bridge in the first webspace of the patient’s hand, folding the two halves of the splint to sandwich the volar and dorsal aspect of the wrist, forearm, and elbow. The ends of the splint should overlap each other and curl snugly around the elbow.
  

The reverse sugar tong splint provides an equally effective alternative to the traditional sugar tong splint, while avoiding splint buckling at the elbow.

Work in Progress: Acute Limb Ischemia handout for ACEP's Scientific Assembly

Better than than never! I finally finished the last of my handouts for the 2009 ACEP Scientific Assembly. My talk is on Acute Limb Ischemia (ALI). By definition, this is limb ischemia caused by arterial compromise which has lasted for less than 14 days.

"Time is life and limb" in acute limb ischemia.

In my talk I will briefly review the vascular anatomy of the extremities, along with the causes and mimickers of ALI. The focus will be on the Emergency Department recognition and management of this disease. I'll also discuss a little about the dilemmas that the vascular surgeons face with regards to inpatient management. Should the treatment be catheter-directed thrombolysis (intra-arterial injection of thrombolytic agents), percutaneous thrombectomy, open thrombectomy, or limb amputation?

Here's a quick synopsis of my take-home points:

• To diagnose ALI, obtain an ankle-brachial index (ABI) measurements.

• When listening for arterial blood flow using the Doppler, document not only the presence of arterial flow but also the sound waveform heard. Normal arterial flow should be triphasic. Notice how stenotic arterial blood flow sounds monophasic:

Normal triphasic arterial Doppler flow


Stenotic monophasic arterial Doppler flow


Venous Doppler flow

• Determine the ALI grade on the Rutherford classification scheme. Grades I and IIA generally benefit from catheter-directed thrombolysis (in the interventional radiology suite). Grade IIB generally requires open thrombectomy in the operating room. Grade III generally requires limb amputation.

Click on table to view see larger font.

• When you diagnose ALI, the ED management includes: aspirin, unfractionated heparin, dependent positioning of the extremity, pain control, and avoiding extremes of temperature.

Article review: Twitter for emergency physicians

I'm going to begin this post by stating my conclusion. My task to you -- Get a Twitter account and follow some fellow Tweeters. See what all the fuss is all about. As much as you may try avoid to Twitter, it's here to stay. Might as well jump in.

What is Twitter?
Twitter is a social media platform which allows you to microblog. You can only post 140 characters per post. It forces you to be concise. However, you actually don't have to post anything. You can just read the posts of those whom you "follow". To avoid having Twitter be idle chatter and noise for you, be selective in who these people are. Avoid those who post trivial things like "eating dinner now" or "the sky is blue".

For example, I use Twitter primarily for work-related posts (and Oprah, of course). A snapshot of my twitter page looks like:


As an emergency physician, I have found a few interesting people and sites to follow for work. For instance, I follow CNN Breaking News, CDC Emergency, Dr. Mel Herbert (USC), and ACEP News. You can check Tweets from your computer or your handheld device. I check and post from my iPhone, using the free app called TwitterFon.

In this month's Annals of Emergency Medicine, Dr. Eric Berger eloquently explains the power of Twitter and its potential impact for us as emergency physicians. An example of Twitter's potential to quickly disseminate critical information was the real-time updating of the 2007 San Diego fire.

Sample Twitter posts:
("RT" means that it's a "re-tweet", or re-posting from another person/site.)

CNN - Aspirin fights heart attacks, but daily doses aren’t for everyone. Read what experts have to say http://bit.ly/aUpZC


CDCemergency - RT @CDCFlu Update 8/14/09: 7,511 hospitalized cases of novel H1N1 flu, 477 deaths, 51 states/territories reporting: http://is.gd/2gXiV


ACEPNews - Study shows quality improvement in a trauma center more important than experience of surgeon http://bit.ly/AOz99


melherbert - Rounds LIVE tomorrow at www.emrap.tv/live. ETOH withdrawal, sedation, C-Spine injuries, vertebral dissection, board review etc. 9am PST


m_lin Wishing I could clone myself. SELF A would see patients and deal with hospital inefficiencies. SELF B would teach. Lots of eager learners.


Resource:
Berger E. This Sentence Easily Would Fit on Twitter: Emergency Physicians Are Learning to “Tweet”. Ann of Emerg Med. 2009 Aug; 54(2):A23-25.

TGIF: The "caffeine nap"

A common problem that emergency physicians share and struggle over is the circadian "dysrhythmia" of working random morning, afternoon, and night shifts. Shift work is the blessing and curse of our profession. I have yet to figure out the best way to adjust back to the daytime world after night shifts. Do you have any tricks?

Also, does anyone else find it disturbing to be writing the same date on the chart as your last shift, as you start your night shift? You went home at 7 am and are now back at 10 pm!

I encountered an interesting concept of a "caffeine nap", which arose out of the sleep literature in the UK. The pilot study focused on assessing ways to combat driver sleepiness, using a driving simulator. The drivers reported their drowsiness on a 9-point Karolinska Sleepiness Scale and also underwent EEG monitoring.

What is the Caffeine Nap?
The caffeine nap involves drinking 1 cup of coffee and then immediately napping for only 15 minutes. The coffee apparently helps to eliminate adenosine stores, which contribute to fatigue. After your 15 minutes, the wakeful effects of caffeine will kick you off to a running start. The caffeine nap kept drivers more alert than caffeine or napping alone.

I'm going to try this the next time I'm having a hard time switching back from my night-owl to normal daytime hours. I recently tried Philz Coffee, a local favorite in San Francisco. I'm not a coffee snob, but this could be my new favorite coffee place.

What is a journal "impact factor"?

Journals use the numerical "Impact Factor" as an indirect quantitative measure of a journal's importance in the medical field and scientific literature. Thompson Scientific calculates the impact factor scores annually. This score provides journals with bragging rights, especially when it comes to marketing. Be aware that there are ways to manipulate the numbers a little and thus brings the true value of this score into question.

How is the impact factor calculated?
The impact factor is a calculation of how frequent a journal's articles are cited in a 2-year period. As an example, the 2009 impact factor for a journal would be:

Impact Factor = A / B

• A = Number of times 2007-08 articles are cited from a given journal
• B = Number of total "citable items" published in given journal during 2007-08

The ambiguous issue is how the denominator of "citable items" is determined. Basically articles which qualify as potentially citable items include original research, reviews, proceedings, and notes. These do not include such items as editorials, coresspondences, and errata. Sometimes it's unclear which articles don't qualify. The more articles that you exclude, the smaller your denominator and thus the higher (and better) the impact factor.

Below are impact factors of several journals, relevant to those interested in publishing in EM and medical education. In addition to impact factors, you should also consider the journal's general focus when deciding where to submit your manuscript. If you read through several back-issues, you will get a sense of each journal's "flavor":

Emergency Medicine journals

• Annals of Emergency Medicine 3.755
• Academic Emergency Medicine 2.46
• Emergency Medicine Journal 1.347
• American Journal of EM 1.188
• Journal of Emergency Medicine 0.778

Education journals

• Academic Medicine 2.57
• Medical Education 2.181
• Teaching and Learning in Medicine 0.83

Trick of the Trade: Toxic sock syndrome

The olfactory nerve of an emergency physician is exposed to a broad range of smells in the Emergency Department. I've learned that the stinky-feet problem is a commonality amongst ED's around the world! I call it the "toxic sock syndrome". There are two remedies which I've been told of:

• Nebulized oil of wintergreen
• Placing a open canister of coffee grounds next to the feet (I've never understood this. I would imagine it would smell like stinky feet in a cafe. Plus, what a waste of coffee!)

One trick which I learned at SF General is the antacid booties trick. The premise of the trick falls back on basic chemistry. Feet with poor hygiene and trapped perspiration within socks are the perfect environment for moisture-loving bacteria to produce isovaleric acid. Isovaleric acid is the culprit behind the foul smell.

To combat the acidic environment, adding a base will neutralize the pH and thus the odor. A readily-available basic product that most ED's have are antacid liquids, such as Maalox or Mylanta.

Start by pooring about 30 mL of antacid into each disposable paper boot.

Apply the boot to the patient's feet so that the antacid contacts the skin.

And like magic, the odor almost completely disappears!

Hot off the press: Outcomes of 2009 Residency Match

For senior medical students and those of us advising them, we all know that the Electronic Residency Application Service (ERAS) opens on September 1. This is currently the time when students reflect about who they are, what they are going to write about in their personal statement, and how competitive they may be in the residency match.

It is always difficult for me to say how competitive each student will be, based on his/her credentials. My starting number is to tell students to apply to 30 residency programs. With each added solid accomplishment (honors grade in 3rd year and EM rotations, research experience, publications, work experience, community service, and board scores), I then recommend that they apply to fewer programs. Remember that you can always cancel interviews, but you can't really add more programs to apply to late in the game. Overall, students should have 10-12 programs on their rank list, after interview season is over.

To help students determine how they would have compared in the 2009 match, the National Resident Matching Program (NRMP) and Association for American Medical Colleges (AAMC) just released: "Charting Outcomes in the Match: Characteristics of Applicants who Matched to Their Preferred Specialty in the 2009 NRMP Main Residency Match". Download the document.

Some interesting statistics for U.S. seniors who matched (unmatched in parentheses):

• Mean USMLE Step 1 score = 222 (207)
• Mean USMLE Step 2 score = 230 (209)
• Mean # of research experiences = 1.8 (1.5)
• Mean # of volunteer experiences = 6.1 (5.1)
• Percentage who are AOA members = 11% (4.3%)

Interestingly having an advanced graduate degree or PhD did not seem to improve the applicant's chances to match.

I'm glad I don't have to apply in the increasingly competitive world of the EM residency match. I'm not sure I would have fared so well... Students are increasingly doing amazing things.

Article review: Making an effective poster

Have you ever had your research abstract accepted for a poster presentation at a scientific meeting? How did you learn how to make your poster so that it was effective and clear? I never was officially taught how to make an effective poster and am thrilled to see a review article in Medical Teacher, which nicely lays out some of the key principles. It is a nice guide for those who are new to making posters (and even is a nice review for those who have made posters before).

Posters serve as an important visual tool for communication, teaching, and assessment. An effectively designed poster draws viewers to your poster, visually communicates your research findings, and engages the viewer in conversation. Remember that the poster should be designed as a stand-alone product because posters are often displayed all day in a conference hall. The presenter is only beside the poster for 1-3 hours of the day.

The author summarizes the key points in making an effective poster, drawn from various "how-to" guides:

• The title should be short, large-font, and results-oriented to attract attention.
• Build visual elements to convey your message (photos, graphs, diagrams).
• Minimize the use of text.
• Use large, easy-to-read font. (I personally use a sans sarif font such as Verdana or Arial. Check out the following sentences.)
• Fonts make a huge difference in appeal. (Arial)
• Fonts make a huge difference in appeal. (Verdana)
• Fonts make a huge difference in appeal. (Times)
• Fonts make a huge difference in appeal. (Georgia)

• Use appropriate headers to organize and break your poster up into sections.
• Prepare a stack of summary handouts so that people can take with him.

Also interestingly one of the references points to an online 60-second poster evaluation checklist. It provides an assessment of the general appeal and visual layout of the poster. The basic criteria are:

• Overall appearance
• Amount of white space (less is more!)
• Text-graphics balance
• Text size
• Organization and flow
• Author identification
• Research objective
• Main points
• Summary

Also in the references, there is an useful website by Hess, Tosney, and Liegel on "Creating Effective Poster Presentations: An Effective Poster". There are annotated examples of effective and not-so-effective posters.

Reference:
Hess GR, Tosney KW, Liegel LH. Creating effective poster presentations: AMEE Guide no. 40. Med Teach. 2009 Apr;31(4):319-21.

TGIF: Collaborating creatively with great people

What part of your job do you love the most?

In academic emergency medicine, nothing energizes me more than brainstorming with creative, like-minded, and motivated people. From my experience, most of my past major projects have all started in similar informal, small-group settings.

For instance, the CDEM organization was built when a small group of undergraduate medical educators went to dinner during a SAEM conference. We conspired to build something bigger and better. Two years later now, we now have over 100 members and are a new member of the major interdisciplinary organization Alliance for Clinical Education.

1. This week, I got a call from Chad Kessler (Univ of Illinois-Chicago) who was interested in bringing medical education more to the forefront of EM. We brainstormed about building a "thinktank" of like-minded educators interested in pushing education to the 21st century. There is so much to be learned in the literature outside of EM and medicine in general. I suggested building a dynamic database somewhere to list the ongoing educational projects and research in EM. We too often work in silos. Collaboration is key in educational research. Any ideas how to build a database that everyone would participate in?

2. As a member of KidsCareEverywhere (KCE), I am headed off to Vietnam this month to help teach a conference jointly hosted by our organization and UCSF. This conference will assess pediatricians' knowledge before and after learning a new decision-support software PEMSoft. The members of the KCE team met for the last time for a dry-run of the conference and a brainstorming session to anticipate potential hiccups.

One problem which I'm still a little worried about is the access to laptops and electricity. Because we are testing the participants on their ability to navigate the new technology, we need everyone to have their own laptop. We doubt that participants will all have laptops, but we have backup plans to share. We're more concerned about poor battery life for the existing laptops and something as seemingly simple as access to electrical outlets. I have a feeling we'll be buying long extension cords while in Vietnam.

Check out our new 1 GB USB thumb drives that just came in! We are giving out to the participants, preloaded with the PEMSoft user manual, hospital-specific documents, and the lecture slides.




3. For our residency program, I'm running the Education Area of Distinction (AOD). There are a variety of AODs available, which allow our residents to "specialize" in a niche in EM. I have two rock star residents in the Education AOD - Liz Brown and Eric Silman. We met to discuss how we were going to take the education world by storm. It always helps to do this over a BBQ meal.

iPhone photo of the inaugural meeting at Baby Blues BBQ. Sorry it's so blurry - Digital SLR cameras apparently do don't well when dropped on the floor. In the Canon shop.

The first project, spearheaded by Eric, involves posting interesting cases onto this blog. I'm going to open up a Saturday slot called "A Case Presentation from UCSF-SFGH". Every Saturday, a short case from the residency program's Follow-Up Conference series will be highlighted to illustrate key clinical pearls.

Educator's portfolio

Are you a medical educator and can't quite illustrate the importance and impact of your work in your CV?

I've always had this problem when compiling and updating my CV. The traditional CV format caters especially to academic physicians who are active in public service, traditional research, and leadership positions. What about the great procedural course that you ran with stellar evaluations? What about the lecture you gave at a national conference?

A few years ago, I discovered the existence of an Educator's Portfolio. This is a supplementary document to your CV. It allows me to document scholarly activity in education and to provide reflection on my career path. There are variants of the portfolio template, but the overarching theme is to highlight an individual's educational mission, efforts, project evaluations, and publications.

The UCSF Educator's Portfolio focuses on your strengths in the five prime areas of education:

• Direct Teaching
• Curriculum Development, Instructional Design and Assessment of Learner Performance
• Advising and Mentorship
• Educational Administration and Leadership
• Educational Research

A great resource is Dr. Gloria Kuhn's 2004 article in Academic EM. From Wayne State, Gloria's a great resource for anything related to education (and actually life in general, if you ask me.) If you email me (Michelle.Lin@emergency.ucsf.edu), I'd be happy to email you a pdf copy.

What I learned most from this new format for presenting your academic pursuits is the importance of obtaining evaluations. This means getting detailed evaluations of the course that you taught, of the lecture you gave, or of the online module that you built. As an academic faculty member, assessment of your product/project is crucial in showing your Promotions and Tenure committee that you are worth promoting. Creating a cool product per se is not as valuable. Wish someone had told me that early in my career...

Trick of the Trade: Needle thoracostomy

On a shift last week, we had a patient present with a spontaneous pneumothorax. Not only that, but it was a tension pneumothorax. Although the patient was hemodynamically stable, he was very uncomfortable and really short of breath. To give us more time to prepare for the chest tube, it was decided to perform a needle thoracostomy.

Before I could even ask "does anyone have a 16 gauge angiocatheter?", one of our residents Dr. Caitlin Bilotti was already prepping the patient's skin. Apparently she carries such an angiocath at all times with her for this very purpose! (I did the same thing during residency! I'm the firm believer that he/she would wields the equipment gets to do the procedure. Nice job, Caitlin.)

After the procedure, one of our fantastic nurses (who is also a paramedic) James Burhn showed us a trick with a three-way stopcock. Attaching a stopcock to the end of the angiocatheter serves as a means of controlling the "venting" of the pneumothorax.


He uses the stopcock to shrink the size of the pneumothorax. Start with the pneumothorax venting to the outside air. Next, have the patient take a forceful breath OUT. This maximizes the intrathoracic pressure and vents the pneumothorax air out through the stopcock. Then close the stopcock. When the patient breathes in, the outside air can no longer be sucked back into the intrathoracic cavity. After several rounds of this timed inhalation-exhalation routine with the stopcock, our patient felt significantly better.

This was a trick that James learned while serving in Iraq. Needle thoracostomies were performed as a temporizing measure, while patients were moved to safety. Also on a side note, I've never seen someone so excited to teach us about this neat trick. Like a kid in a candy store. Love it. Thanks, James!

Hot off the press: Podcast on ED crowding and education

Dr. Rob Rogers (Univ Maryland) has come up with yet another podcast edition for the EMRAP Educator's Edition website. In this recording, Rob interviews EM faculty about education issues. Go to EMRAP Educator's Edition website to listen to podcast.


In this 53-minute podcast, Rob, Dr. Philip Shayne (Emory), Dr. David Manthey (Wake Forest), and little ol' me are featured just shooting the breeze about the problems with crowding from an educator's perspective. I sure wish I had a British accent to sound smarter. Also, do I really talk this fast? Hmm.

In all seriousness, this is a prime example that great collaborative opportunities will come to you if you just hang out with great people.

Article review: Scholarly management as a medical educator

Are you interested in pursuing a career in medical education in Emergency Medicine? Do you know what that exactly means and entails? It's not just teaching medical students or residents. It's now much more than that.

The academic niche of medical education in EM (and all of Medicine actually) is still a very ill-defined field with limited opportunities for funding and career development. We all know that educators are important and should be valued, but how does one build a successful career in academic medical education? As someone trying to build a niche in such an area, I sadly haven't found the answer yet but am constantly on the lookout for it. Part of the reason is that it is hard to navigate somewhere without a known end-target in mind.

So what is the definition of academic medical education? The professional identity of academic medical education is still in evolution. As mentioned in an earlier blog post, Boyer categorized the definition of scholarship into 4 equally important areas: Discovery, Integration, Application, and Teaching. Each of these areas are relevant for the academic medical educator:

• Discovery: Conduct original research in medical education
• Integration: Draw on insights from various disciplines to improve medical education
• Application: Involvement in professional services and organizations related to medical education to enact more global and systems changes in medical education
• Teaching: Transmit and maintain the continuity of medical knowledge across generations

This has since spawned debate that "teaching" per se (eg. bedside teaching of a medical student) doesn't really count as scholarship. While important, it's not scholarship. "Scholarly teaching" instead means more that one is utilizing the evidence-based literature to design, apply, or evaluate an educational process AND subsequent submission of this work for peer-review publication and dissemination.

Thank goodness for my CDEM colleagues who constantly are pushing me to submit my works for peer-review publication, and vice versa. It's annoying sometimes since you just want to bask in the glory of building/teaching something, but it's super-important to study and disseminate it thereafter. All of us in academics need to surround ourselves with colleagues who look out for us and our careers. I'm happy to be your annoying reminder, if you just let me know!

The authors of this article suggest that the medical educator's role should be defined not only by the criteria of Teaching and Research, but also by a new criteria -- Scholarly Management. This means serving in some leadership role, such as a course director, professional society position, or medical school dean. This creates a triangle framework for defining the role of the medical educator.
Where do you fall on the teacher-researcher, teacher-manager, and research-manager lines? If I plot myself out along each of the lines, you can see where I am with the red dots. Realistically, we constantly shift ourselves along these lines as our career develops, and now we can more visually define and track it.

Give this article a read. It shed new light on medical education for me. The role of the academic medical educator is still a little fuzzy for me but now it's slowly becoming clearer.

Reference:
Bligh J, Brice J. Further insights into the roles of the medical educator: the importance of scholarly management. Acad Med. 2009 Aug;84(8):1161-5.

TGIF: Inspirational TED videos about creativity

Recently, I discovered the existence of TED talks. TED is a nonprofit group, devoted to "ideas worth spreading". It now hosts several conferences annually to bring together leaders from the worlds of Technology, Entertainment, Design. Every time I watch a talk, which are each around 18 minutes, I get inspired just by listening to greatness. It constantly amazes me that these remarkable, uplifting talks are free. I currently subscribe to the TED Twitter feed to get periodic updates.


If you ever feel like you are getting buried under an avalanche of minutia, tunnel-visioned in day-to-day academic or clinical work, or uninspired in general, listen to a TED talk. I do. The talks constantly reset my perspective on work life.

• Keep your big-picture work goals in mind. Don't get lost in the little things in the office or Emergency Department.
• You need to think big to do big things.
• When it comes to creativity, you can't be afraid to be wrong.
• Creativity takes work and should be cultivated.

Two talks have started me thinking about the concept of creativity. I think you have to be extremely creative and innovative in medical education to keep up with the new generation of Web 2.0 learners. Although these two talks do not necessarily focus on medicine or medical education, the underlying themes resonant on a universal level.

Creativity expert, Sir Ken Robinson, makes a hilarious and moving case for how creativity is stifled by the education system. After watching this video, two thoughts came to me.

• How does one become a "creativity expert"?
  
• Having a British accent just makes you sound smart - I should work on getting one.

Elizabeth Gilbert, the author of Eat, Pray, Love, gives an insightful and humorous talk about how each of us "have" a genius with us.

Dr. Art Kellerman's keynote talk at 2009 SAEM Consensus Conference

With HD camcorders more commonly available now, large video file size is increasingly a problem when finding a server to host videos. YouTube has a file limit of 100MB for the standard user. I recently learned about Vimeo.com, which allows the basic user free access to upload 500 MB of videos weekly.

I was pleasantly surprised when I found Dr. Art Kellerman's keynote talk at the 2009 SAEM Consensus Conference. I had arrived a day after the whole-day Consensus Conference on "Emergency Medicine & Public Health: Stopping Emergencies Before the 911 Call". Dr. Kellerman is a legendary leader in our specialty as a Professor and Associate Dean at Emory. As an example of his many accolades, he is the founding director for the Center for Injury Control at the Rollins School of Public Health (collaborates with the WHO) and joined the Professional Staff of the United States House Committee on Oversight and Government Reform in Washington D.C.

Take a listen to a really inspirational, eloquent, and alarming insight into American health care. You won't regret it.

Go to Vimeo video link.