Ask students to make predictions

how_learning_worksA student’s previous knowledge helps them establish new learning. By creating connections to this old material, they are able to build off it and solidify the new content in their minds.

While teaching in the emergency department, this can be done by asking them to use their prior knowledge to make a prediction. They then test this prediction by seeing if it comes true or not. Whether they predicted correctly or not, it can be used as a teaching point later.

  • “Do you think this patient will be admitted or discharged? Why? Let’s see what happens and talk about it later.”
  • “Do you think this troponin on will be positive or negative? Let’s see and talk about use of troponins when it comes back.”

Try it out during a shift and let me know how it worked.

Evenomations

Snakebite management is a complaint unique to Emergency Medicine. There are really two main snakes we’ll discuss here, rattlesnakes and coral snakes. We’ll also discuss spider bites and bee stings!

More

Qualities of the best and worst teachers

Some decided to poll a bunch of students across the country about what qualities defined a good teacher. They then took these results and put it into a site called wordle.net which creates word clouds. Here are the results of the qualities of the best and worst teachers…

If you want the original size PDF’s of these files, click here for the best and the worst.

How to read an EKG

You should not leave medical school without a basic understanding of how to read an EKG. So watch these videos then download the unlabeled EKG’s for you to read prior to class (or in class). See how you do. If there are some you have trouble with, ask me or anyone of the other Emergency Physicians in the department.

I welcome any feedback on the quality of this as a learning experience for you.

How to perform an ECG

Electrodes to leaads

Rate and Rhythm

Axis

PR Interval

QRS Interval

QT Interval

ST-segments, Q-waves and T-waves (MI’s)

Neonatal Resuscitation

If resuscitation of children is anxiety provoking, resuscitation of neonates is downright terrifying.

Here we go through the 2010 Guidelines for the management of the neonate or newly born child requiring resuscitation. Remember that these are predominantly respiratory emergencies, even when presenting with bradycardia.

Here’s part I

and part II

And here’s the worksheet for these videos.

Giving Effective Feedback in the ER

Giving feedback to students in the ER is easy. If they did well, you say “STRONG WORK!” and if they did poorly… “READ MORE.” Of course, this provides nothing the student can use to improve. Drs. Ester Choo and Michelle Lin from San Francisco General Hospital created this video on how to give effective feedback.

Concrete and on-the-spot feedback is important to allow students to understand how they are doing and make changes to their behavior. Be nice, but don’t be afraid to give constructive criticism. Remember our goal is to help create good doctors.

One trick I like to use is to have the student at the beginning of their shift identify one area they want to work on. This may be reading EKG’s, creating appropriate differential diagnoses or presenting in a concise and focused way. If they don’t provide something, then you can suggest something: “Today, why don’t we concentrate on appropriate ordering of testing.”

Having one item to work on makes it easier to observe the student’s performance and offer a plan for them to improve. Offer this feedback, at several times during the shift and announce it as such.

“Let me give you some feedback on how you’re doing so far on your presentation. Your HPI was disjointed, you can really tighten it up by using your differential to come up with the pertinent positives and negatives. Why don’t you you see this lady with chest pain and try that before the next patient you present to me.”

Reversing Anti-Coagulation

So you got a patient who’s throwing up blood all over the place, is on coumadin and has an INR of 400. What do you do? Well, after you change your underwear.

The first two videos go over the basic science of clotting (platelets and the coagulation cascade) and the next three then go over what to do in the above situation. Please feel free to put any questions or comments below.

Primary Hemostasis

Secondary Hemostasis

Reversing Coumadin

Reversing Other Drugs

End Tidal CO2 Monitors

We have some new toys in the ER, end-tidal CO2 monitors. The 2010 ACLS Guidelines incorporates these so we better learn how to use them. In this video, Tess shows us how to hook them up (and just how tachypneic she is).

In the second half of the video, we look at the waveforms. Namely, for use in

  • asthmatics,
  • during procedural sedation monitoring, and
  • during resuscitations.

If you have any questions, please put them in the comments below.