Coda Change

Ross Fisher gives his take on how to make your presentations better! Delivering a presentation is a skill like any other, yet few people are actually develop this skill. Instead, they merely copy those they observe and reach the same level of mediocrity. There is more to a presentation than your slides. Ross gives his three main elements of any presentation: The story, the media, and the delivery. In Ross’ view, these elements are all equally crucial to delivering a great presentation. He calls this concept ‘p cubed’ where each element is represented by P1, P2 and P3 respectively, and these elements are multiplied together to give the overall quality of the presentation. The lesson here is that a small improvement in any area will garner and overall improvement in the presentation. Ross will guide you through practical tips for each of his key elements. Firstly, your presentation needs to be grounded in an engaging concept in order for the audience to care about what is going on. Moreover, Ross discusses the use of media and why slides of text are unhelpful and why PowerPoint sucks! Along the way he teaches you how you can utilise PowerPoint to you advantage to effectively get your point across and to avoid the strikingly common errors used. Lastly, Ross gives his thoughts on the delivery and performance and how you can utilise these skills to improve your presentations. Ross will make you uncomfortable when he highlights the wrongs that we are all guilty of in giving presentations. The p cubed concept gives an understanding of presentation design that will change your presentations forever. How to Give the Greatest Presentation in the World: Ross Fisher For more like this, head to our podcast page. #CodaPodcast

Suman Biswas is an anaesthetist from London, however probably more famous for his satirical song writing career, gives a poignant talk about communication. Suman provides his ideas about talking and communicating with patients. As everyone knows, anaesthetists do not need to talk to their patients! Quite the contrary, as Suman divulges they indeed do. They need to establish rapport, gain trust and share information – much like every other member of the healthcare team. Therefore, Suman will provide his musings on the use of language and the words we use when we attempt to succeed in these domains. Suman touches on the use of both verbal and non-verbal communication and the importance of nailing both when attempting to get a message across. He similarly gives guidance on communication with patients who speak a different language to your own. This includes pointers on the use of interpreters. Suman moves on to communication with colleagues. He talks about Anaesthetic Non Technical Skills (ANTS) – teamworking, task management, decision making and situation awareness. These are most prominent when under pressure, be that in a simulation or in an emergency. They are all crucially important – as much as gaining a successful airway! Punctuated with some classic songs and delivered with his stand-up comic timing and panache, this is what SMACC is all about: an important message that could change your practice, delivered in a unique and unforgettable way. Language warning. Communication in Healthcare (via Music): Suman Biswas For more like this, head to our podcast page. #CodaPodcast

Jenny Beck-Esmay, Dara Kass and Stacey Poznanski tell the story of FemInEM and celebrate women in Emergency Medicine. Jenny shares the story of Casey Drawert, a doctor who was tragically shot to death by her husband. This incident opened the discussion regarding how common domestic violence in physician relationships is. In response to this incident, Esther Choo wrote "Intimate partner violence, a physician mother and our call to action" for FemInEM. Esther's post garnered a lot of attention and led to numerous women and physicians to come forward with their story of violence. Dara talks about an incident regarding changing gender dynamics that led to the birth of FemInEM. A female physician received a call from her son' s school when he missed his class. This was despite the primary contact being specified as the stay-at-home father. This incident motivated the formation of FemInEM. Even though there are multiple women organisations, women seldom know what is happening beyond the boundaries of such organisations. So, they decided to take the fundamentals of FOAM and build upon it to learn how women survive in emergency medicine. Dara explains the data to prove that gender inequity exists in the field of medicine. Female doctors are only paid 64% compared to their male counterparts. She also points out the pipeline leakage where the percentage of women keeps decreasing as the job hierarchy increases. Stacey talks about Dr Jullette Saussy who had to resign from her post as EMS and assistant fire chief in Washington D.C. This was because of the resistance that she faced at every level. Stacey points out that FemInEM is not only about maternity leave and the gender pay gap. Instead, it is about providing support and connection to women, like Jullette, who try to make a difference in patient care. By connecting with women through various platforms, they have been able to identify specific problems faced in emergency medicine. FemInEM recognises the accomplishments of women in emergency medicine and has opened discussion on topics that were previously taboo. She believes that open access and open communication will have a positive impact on gender equity in emergency medicine. The FemInEM Story: Celebrating Women in Emergency Medicine For more like this, head to our podcast page. #CodaPodcast

Sandra Viggers delves into the art of learning medicine. Sandra asks the question: can students choreograph their own education? On one hand, people believe students cannot choreograph their own education for various reasons. She calls such people behaviourists who push others back in line if they do not agree with their views. Behaviourism is a top to bottom approach. The teacher is not a facilitator but an instructor. It produces MDs with knowledge that is not applicable to real life. On the other hand, can students choreograph their own education? In educational psychology, these people are called humanists. In the humanistic approach students are active learners. The problem with this approach is that it is dependent on intrinsic motivation. Hence, it is important to realise when the student is intrinsically or extrinsically motivated. Sandra points out that both behaviouristic and humanist approaches fail to include the skill of reflection. While the humanist will expect the learner to self-realise reflection, the behaviourist does not even believe in the concept. This causes the Dunning-Kruger effect, producing either over-confident or under-confident fools. Behaviourism trains people by correcting their behaviour. They are trained to work in an 'ideal world.' Therefore, they often fail to perform in unpredictable settings. The humanist approach produces people who are interested in specific topics. The solution is realising that both a humanist and behaviouristic approaches are inadequate. Students today are independent, love to learn but do not like to be forced. Importantly, they are aware of their needs and use connectivism. Connectivism believes in learning via social interaction. According to Sandra all these theories are flawed. She believes that the solution is adaptive expertise. We want doctors to apply their knowledge to different situations. To achieve this, we first must challenge or question everything that we have learnt. Make students aware that there is more than one solution to a problem. The second step is to encourage reflection. Sandra endorses adaptive expertise via transfer of learning. She wants educators to create a playground where students can play, replay, fail, try and challenge themselves. Sandra concludes by listing what she expects from her educators. She wants us to embrace learning as bidirectional and to encourage the art of reflection. This will help students become creative, adaptive, lean mean machines of excellence. For more like this, head to our podcast page. #CodaPodcast

Tom Evans wants to bring lessons from elite sport development and training to medical education. Caring for the critically unwell is an important and difficult task. So, preparing our people to meet this challenge should be all about excellence. These are all true of sport – and Tom contends perhaps medical training! Nothing happens quickly in sport. It takes time, often many years. There are a number of challenging tests along the way for an athlete to reach the pinnacle of representation. So hard are the tests that not everyone will make it to the end. However, when one does make it, how the performance in those tests to get there has no bearing on how they will perform in the race or on game day. Standards are rigorous because there are no second chances. You do not get another go at the Olympic final. Elite athletes often only have a handful of coaches during their career. Coaches are accountable for the performance of their athlete and talent will not rise on its own. Tom contests the medical training should look more like training for elite performance in sport. He tells the success story of the Great Britain Olympic Team and how they managed to increase their gold medal tally from a single gold in the 1996 Games to 29 by the London games just sixteen years later. This was done by targeted spending by developing coaching and developing systems to identify and subsequently develop talent. Too often, the structures and pressures that define medical training focus on competence rather than excellence. Competence is measurable. It can logged, assessed, and can be applied across big organisations. But aspiring only to competence limits us – our patients need more. So can we learn from how other high-performance organisations train? For Olympic teams, aiming for competence just isn’t good enough. These organisations develop their athletes over many years – equipping them, ready to deliver an excellent performance under pressure. Successful coaching relationships operate on an individual level. They are long-term. They are flexible. And they are measured not by exams or assessments, but by whether the person being coached can perform in the real world. Join Tom and discover why he believes the paradigm should shift from medical trainers to medical coaches and how we should strive not for competence but excellence. Lessons from elite sport brought to medical training by Tom Evans For more like this, head to our podcast page. #CodaPodcast

This will be a panel discussion with a focus on the different styles of training and education in prehospital care.

Ross Hofmeyr divulges some stories from his experience of wilderness and expedition medicine. In his words, wilderness and expedition medicine is the epitome of practical, pragmatic, minimalist and thoughtful care. Austere and extreme environments require special knowledge, critical thinking, innovative practice, and sometimes cunning improvisation. Moreover, diagnosis in the wilderness relies heavily on clinical examination skills. Monitoring is limited and treatment options are determined by the individual practitioner’s hands-on skills. Furthermore, the implications of extreme environments – high pressures and altitude, frigid and sweltering temperatures, hypoxia, and high-intensity endurance exercise – can provide us with great insight into the physiology of humans responding and adapting to critical illness. Join Ross as he displays his deep love of the wilderness and nature, and the lessons he has taken from the outdoors. These lessons, whilst useful for medical practice, transcend medicine. His stories are funny and engaging and show a side of medicine rarely talked about! He discusses lions, ships, dental procedures, meningitis and much more in this fast-paced talk. In this presentation, Ross shares trials and tribulations and draws on experiences from wilderness rescue, and expeditions around the world, which provide lessons for wilderness medics. Evidently, we can translate these lessons into practicing better acute and critical care medicine in our day-to-day settings. Lessons from Wilderness Medicine: Ross Hofmeyr Finally, for more like this, head to our podcast page. #CodaPodcast

Kathleen Thomas describes her harrowing experience of a warzone whilst working in the ICU and ED of the Médecins Sans Frontières run Kunduz Trauma Centre (KTC) in northern Afghanistan. Kathleen describes her work during a week where she found herself caught up in an eruption of war. The Taliban forcibly took control of Kunduz from the US backed Afghan Military. This marked the beginning of a challenging week of heavy conflict in which the hospital was the only facility providing impartial medical care to war wounded civilians and soldiers from both sides of the conflict. Despite the proximity of the rapidly changing front line, Kathleen believes that the hospital is the safest place. Both warring parties had agreed to respect the protection provided to us under International Humanitarian law. Kathleen’s work in KTC came to a grinding halt when a US Gunship fired over 200 missiles into our hospital. This destroyed the main building and killed 42 people including 14 of her colleagues. It was a scene of nightmarish horror that Kathleen will never forget. More than 250 hospitals in Syria and 130 in Yemen have been attacked. This shows a growing disregard for the rules of war. Despite the condemnation by the UN, the attacks on medical facilities continue, unabated. Following an eyewitness account of the attack on KTC, Kathleen asks some important questions: Is international humanitarian law no longer respected by warring parties? Are we entering into a new paradigm of war where hospital attacks are a legitimate military tactic? What does this mean for the future of critical care delivery in war zones across the world? Bombing of Hospitals in Warzones: Kathleen Thomas For more like this, head to our podcast page. #CodaPodcast  

Trish Henwood talks on all things point of care ultrasound (POCUS) in resource limited environments. According to the World Health Organisation, 80-90% of all diagnostic problems can be solved by basic radiograph (x-ray) and ultrasound (US) examinations. However, the problem is that two-thirds of the world’s population currently has no access to imaging technologies. From refugee camps in Greece, to rural clinics in Australia, to Everest Base Camp, POCUS is one of the most powerful diagnostic and procedural tools in any austere clinical setting. This transformative technology allows front line providers who have direct responsibility for patient care to rule in or rule out diagnoses rapidly. Moreover, it ensures safety in performing procedures with real-time image guidance. For example, POCUS training can allow a midwife to identify a massive amount of free intra-abdominal fluid in a 30 year-old Ugandan mother presenting to gynaecology clinic with her third pregnancy and new abdominal pain. She can then notify the surgeon of her concern for a ruptured ectopic pregnancy. This leads to patient survival in environments where they would otherwise die. Waiting for imaging facilities and specialists leads to delay in definitive care and poor outcomes for patients. Ultrasound machines have become increasingly portable, user-friendly, and less expensive over the last decade. This is resulting in a growing presence in otherwise resource poor environments. POCUS trained clinicians can afford imaging capacity to health facilities that may have very limited on-site diagnostics. There is no ionising radiation, nothing invasive, and it is cost-efficient. POCUS provides the potential to quickly narrow differential diagnoses by facilitating a look inside the body during the patient encounter. Research studies support its use to solve information gaps in resource-limited settings. Moreover, the potential for this digital technology to be shared – and to leverage global expertise and consultation – increases the range of application beyond one individual’s knowledge base. Join Trish as she highlights the amazing capacity of POCUS with real world stories. For more like this, head to our podcast page. #CodaPodcast

David Carr teaches you how not to miss the diagnosis of aortic dissection. David breaks down the key pearls on history and physical exam that guide you into correctly suspecting a dissection. Aortic dissection is a challenging diagnosis that you cannot afford to miss. The talk aims to give you the framework to avoid missing the diagnosis. Firstly, David begins by teaching you what questions to ask in the history to raise the suspicion of an aortic dissection. These include onset, quality, and radiation. As he explains, these simple three questions will raise the suspicion in the vast majority of cases. If you do not ask these three questions, you may as well be flipping a coin! Secondly, David goes on to an in-depth explanation of the pain patterns that can present in an aortic dissection. He describes the concept of chest pain plus one. David delves into what he sees as the questions and considerations only a ‘master clinician’ will think of. He implores you to join this group. Evidently, the physical exam provides vital clues to the diagnosis of aortic dissection. In this talk, David breaks down the key points that he always considers in a busy and noisy Emergency Department to lead him towards the correct diagnosis. Next is the diagnostics, where David will spend some time sharing his insights into the diagnostic tests of choice when ruling in or out an aortic dissection. He discusses the plain x-ray which may or may not be useful, troponin, which need to be interpreted with care and d-dimer. Finally, David concludes by giving some pearls surrounding the judicious use of imaging, how to begin the treatment promptly and how to become a champion in the diagnosis of aortic dissection. Sit back and be ready to see dissections in a different light. How Not To Miss Aortic Dissections: David Carr For more like this, head to our podcast page. #CodaPodcast