Monthly Archives: October 2012

GET FOAMed – “quality care, out there”

Stay tuned – should be some underground guerilla broadcasting from the “GET FOAMed” mob shortly

(GET FOAMed = generalist emergency training free open access meducation)

Come on in and enjoy the FOAM

 

Online hangouts with rural docs and specialists, covering topics to help us all bring ‘quality care, out there’ to rural patients

I am so excited…

Is the medical conference dead?

Just got back from Fremantle and the #RMA2012 Rural Medicine Australia conference hosted by ACRRM and RDAA. To be honest I was disappointed. Some pearls amongst the three day academic programme. But perhaps recent exposure to high-quality asynchronous #FOAMed learning has raised my expectations.

That said attendance was high at over 450 delegates and it was great to hear fellow South Australian doctors Martin & Fiona Altman of Murray Bridge, SA get the ‘rural doctor of the year’ award.

 

Enjoying PubMed in Fremantle

 

However a conference shouldn’t be just about the venue or the quantity of attendees – for my money I want quality medical education and networking.

So in no particular order, here are some thoughts…

1/ not enough hands on skills sessions for frontline rural doctors, too much on training pathways and RTPs etc

A real bugbear of mine. As isolated rural docs we may struggle to engage in high quality education events. It makes sense to host them at the annual Rural Medicine conference.

On offer before the academic conference were the two-day REST course and one day sessions on burns, obstetrics and ultrasound (the latter hosted by Broome Docs author and blog-o-sphere #FOAMed guru Dr Casey Parker). Casey has posted his thoughts on ‘courses for horses’ this week – have a read of his thoughts and the comments.  Add your own, please…

Whether the College will pick up on this is anyone’s guess.

There was also a hands on demo in mucosal atomisation techniques from Tim Wolfe, ED doc and innovator, who was also over for the Australian Trauma Society do in Perth. A really useful technique for rural docs (as well as retrievalists and EM docs) – but old hat to those of us swimming in the soup of #FOAMed. Better than nowt though. More info at http://www.intranasal.net

2/ turgid education sessions, mostly delivered to large lecture theatres

A conference should be about dynamism and rapid turnover of ideas, preferably in small groups – which in turn engenders breakout discussion in breaks, over meals & outside the confines of the lecture hall.

Maybe I signed up to the wrong events, but a whole day session on telehealth? C’mon, it’s not that complicated – an iPad, Skype and a robust referral pathway is all that is needed. OK, perhaps that’s oversimplification, but this session would have benefitted from more hands on, not repeated talks of existing telehealth examples and pilot studies. I lasted about an hour then drifted in/out. Similar reports from other attendees.

Shame as telehealth and social media will revolutionise medicine, especially for the rural doc. Better to offer small group sessions repeatedly throughout the event to maximise coverage. Same for other sessions, which seemed more weighted to the medical educationalista than the frontline rural doctor.

There were a few more sessions on dermatology, parallel consulting with medical students, Nextplanon and Mirena insertion etc…but sadly all held on the last day when most delegates had to check out and catch flights back to East Coast fairly early, thus cutting short these potentially valuable sessions. Bah!

I was of course excited to present my data on difficult airways and rural docs – although to be honest this would be far better and more valuable as hands on workshop aimed at anyone who is an ‘occasional intubator’. Thankfully there’s a wealth of resources out there, including Minh le Cong’s excellent online airway training at www.prehospitalmed.com. I did run an impromtu airway workshop for interested docs over a PubMed session in the hotel bar…you can download more from the ‘resources’ and ‘videos’ sections on this site.

I have reflected that using FOAMed I could’ve presented this data back in March…getting the paper published in October and presenting two weeks later was just by chance. But next time I;ll get message out sooner using #FOAMed.

Unfortunately the paper presentations were run in 4 separate venues, with erratic timekeeping making it difficult to move between concurrent sessions. I was a bit gutted to miss Dave Townsend’s talk on SoMe in medicine, but true to form he’s bunged his slides up on the interweb for all to see at http://www.davidtownsend.com.au/blog/articles/rma2012-social-media-resources/

3/ Failure to embrace #FOAMed and the power of the interweb

Well, Joe Lex put’s this better than I ever will :

If you want to know how we practiced medicine 5 years ago – read a textbook
If you want to know how we practiced medicine 2 years ago – read a journal
If you want to know how we practice medicine now – go to a (good) conference
If you want to know how we will practice medicine in the future – use FOAM

FOAM of course being Free Open Access Medical education as exemplified by medical bloggers such as http://www.lifeinthefastlane.com, www.BroomeDocs.com and ww.prehospitalmed.com etc

Gerry Considine @ruralflyingdoc summed it all up in a cheeky manner, just in a single Tweet

if you want to know how we practiced medicine last century, ask a rural doctor

Perhaps a that was a little harsh – rural docs aren’t deliberately obtuse. But the systems we work in are slow to adapt.

Examples abound – my airway survey showed that few rural docs have access to the same up-to-date kit as their city specialist colleagues. Of course cost and caseload constraints factor in this, but to hear rural docs having to practice without a minimum standard of equipment is of concern.

Similarly access to bedside ultrasound is constrained – resources like the newly launched iBook (Introduction to Bedside Ultrasound) will help improve training. The cost of a decent USS machine may seem prohibitive, it will pay for itself if it means avoiding a costly transfer out of Dingo Creek to tertiary centre.

Finally, sitting in the medicopolitics session, one of the founding fathers of RDAA commented to me that ‘nothing has changed’ in 25 years of such debates. Sobering stuff, more so when the politicians are talking about linking pay to performance – despite the clear concerns elsewhere about such systems.

If you haven’t already read it, see Dr Clare Gerada’s address to the GPs at RACGP conference last week – key points about problems inherent in the overzealous measuring, medicalisation and marketisation which have destroyed UK medicine.  This does not bode well for us in Australia – read Dr Gerada’s thoughts at http://tinyurl.com/GeradaSpeech

SoMe has the potential to link doctors concerned with such events – we’re seeing this with the #interncrisis campaign which has snowballed in past few days to maximise media exposure.

As isolated rural doctors, using these resources could help us do two main things

(i) speak with a common voice on medico-political matters

and

(ii) vastly raise the bar in ongoing medical education and the delivery of ‘quality care, out there’ – not through the turgid medium of conferences, papers and ALS courses, but through evolving, dynamic, cutting-edge media bringing evidence-based practice to rural docs and their patients.

So, what for the future?

Despite my gripes about medical conferences, I am going to attend #SMACC2013 www.smacc.net.au next year. Although a critical care conference, there are valuable lessons applicable to my workplace in rural emergency medicine. Besides, casey Parker @BroomeDocs owes me a beer.

I’m also going to focus more on the maxim of delivering ‘quality care, out there’.

From 2013 I’ll move try and focus http://www.ki-docs.com towards more hypothetical case discussions – not so much though on ins/outs of EBM (www.broomedocs.com does that well) – but explore concepts such as situational awareness, logistics over strategy, audit and other topics to help “get things done” to aid the rural doctor improve his/her practice.

“Quality care, out there” – the future is #FOAMed

Rural Medicine Australia is nearly here!

Well Rural Medicine Australia 2012 to be held in Fremantle, WA is nearly here. I’ve got 15 mins to talk about my topic of difficult airways and rural docs, which isn’t much. I’ll try and keep it sensible…

So in the true spirit of FOAMed, here’s a video on an affordable ‘Rural GP toolkit’. I think that my paper adequately demonstrates that not all rural GP-anaesthetists have access to the appropriate equipment to manage a difficult airway, especially in a challenging environment with no specialist backup.

This toolkit makes some suggestions on affordable equipment for doctors in the bush.

What then is the appropriate kit? Well, there’s a plethora of devices out there. Selection of any device needs to be a compromise of affordability and effectiveness.

For example, there are excellent videolaryngoscopes systems out there, that really are superb – but they’ll come in at around A$15K. A small rural hospital cannot afford these. Some of the less expensive devices are both functional and affordable.

But one needs to choose wisely. As one astute respondent to my 2012 survey stated “a good familiarity with a small range of commonly used options is much more efficient and safer to organise, find, assemble, replace, troubleshoot than a supermarket shelf full of toys from the sales reps”.

Have a look at the video and make up your own minds.

Hopefully I will see you a few of you at RMA2012…I’ll be the one with the @KangarooBeach T-shirt…

Other resources

Rural Medicine Australia (#RMA 2012)

ANZCA PS 56 “Guidelines on Equipment to manage a Difficult Airway”

Rural GP-Anaesthetists – 2012 Survey paper

Video summary of 2012 survey

Vimeo presentation for RMA2012

EM-Crit discussion on “Needle or Knife?

BroomeDocs on ‘Can’t Intubate, Can’t Ventilate – the low down on code brown

Andy Heard’s videos on CICV