The St.Emlyn’s Podcast

St Emlyn's November 2018 Review: Key Highlights and Insights Hello and welcome to the St Emlyn's Podcast and blog. I'm Simon Carley, and I'll be guiding you through the exciting topics and developments we've covered on the blog in November 2018. From leadership insights to groundbreaking medical research, this month has been incredibly informative. Let's dive into the highlights! Leadership Insights from the FIX Conference We begin our review in New York, where Natalie May attended the FIX (FeminEM) Conference. In her second post about this event, Natalie explores profound themes, particularly around leadership and motivation in the medical field. Key Takeaways on Leadership and Motivation Jennifer Walthall's talk emphasized the importance of acting within the system to drive change. When joining an organization that may not align with your values, you can either work within the system to improve it or fight from the outside. Walthall advocates for influencing change from within, suggesting that once embedded, you can effectively drive improvements. Lara Goldstein's session on leadership identified four critical attributes of a good leader: Listening: Truly understanding your team. Recognizing the Impact of Small Actions: Little things add up. Conflict Management: Not everyone will like you, and that's okay. Gratitude, Kindness, and Decency: Core values that should guide every leader. Natalie's detailed reflections on the FIX Conference are a must-read for those interested in these themes. Attending FIX in 2019 should be on your list if possible! POLAR Trial: New Insights into Hypothermia Post-Brain Injury Dan Horner analyzed the POLAR trial in one of our journal club posts. The POLAR trial is a significant randomized control trial investigating the effects of hypothermia in the early stages after a brain injury. This study follows the Eurotherm trial, which explored hypothermia's role in patients with severe brain injuries in the ICU. What the POLAR Trial Reveals The POLAR trial involved 511 patients with severe brain injuries, randomized to either hypothermia (cooling to 33-35°C) or maintaining normothermia for 72 hours. Despite strong pathophysiological evidence supporting hypothermia, the trial found no significant difference in outcomes after six months. Initial results suggest that routine hypothermia for early-stage brain injury might not be beneficial, but long-term data follow-up is crucial. This trial, published in JAMA, is essential reading for anyone involved in emergency medicine or critical care. The Case for Whole Blood Transfusion in Trauma: Insights from Zaf Qasim Zaf Qasim, a former Manchester trainee now making waves in the US, contributed an enlightening post on the use of whole blood in trauma resuscitation. This approach, which makes intuitive sense—replacing lost whole blood with whole blood—contrasts with the UK practice of separating blood into components for transfusion. Advantages of Whole Blood Transfusion Zaf argues that whole blood could simplify and improve trauma care, reducing the time and complexity of reconstituting blood components in the body. Although not yet standard in the UK, this method is gaining traction in places like London HEMS and various European centers. As data continues to emerge, this could revolutionize trauma care, harkening back to practices from the Second World War and Vietnam. Challenging the Use of "Sexy" in Clinical Medicine Natalie May returns with a provocative post challenging the use of the term "sexy" in clinical medicine, especially in resuscitation-related specialties. Often used to describe procedures or equipment, this term can inadvertently perpetuate gender biases and undermine professionalism. Redefining Professional Language Natalie, supported by her husband Oli May's humorous yet insightful critique, urges us to reconsider such language. The term "sexy" in a medical context is not a compliment and can contribute to a culture that sexualizes women in the workplace. This reflection is especially relevant for departments striving to maintain professionalism and inclusivity. Understanding Cognitive Load Theory with Nick Smith In the realm of medical education, Nick Smith's debut blog post introduces us to cognitive load theory. As a clinical educator in Manchester, Nick explores how intrinsic, extrinsic, and germane cognitive loads affect learning and teaching. Applying Cognitive Load Theory in Medical Education Nick's post is a valuable resource for educators aiming to optimize their teaching strategies. By understanding and managing cognitive load, we can create more effective and supportive learning environments for our trainees. This post is part of a broader series on educational theories that are crucial for medical educators. Elective Experience in South Africa: Lessons from Claire Bromley Medical student Claire Bromley shares her transformative elective experience at Mitchell's Plain with the BAD EM team. Working with leaders like Katya Evans and Craig Wylie, Claire's reflections offer deep insights into the challenges and rewards of emergency medicine in South Africa. Bridging UK Training with South African Realities Claire highlights the stark differences between UK and South African healthcare systems, particularly the intense workload and resource constraints in the public sector. Her experience underscores the importance of preparation, respect, and adaptability for anyone considering working in a different health economy. Promoting Diversity in the Emergency Department Natalie May's final post for November reflects on promoting diversity and inclusivity in the emergency department. She emphasizes that the ED is unique in its diversity, seeing patients from all walks of life. Embracing and Understanding Diversity Natalie advocates for a broader understanding of diversity beyond ethnicity, including gender, disability, and sexual orientation. Her insights are essential for ED professionals committed to providing equitable care and fostering an inclusive environment. Learning in the Social Age: Embracing Medutainment I had the pleasure of discussing "Learning in the Social Age" at the Emerge 10 conference in Scotland. This presentation, supported by a blog post, explores how the internet and social media are transforming medical education. The Impact of Medutainment We are now competing on a global scale as educators, with learners accessing information from various sources worldwide. This shift necessitates embracing new methods of engagement, ensuring our teaching remains relevant and impactful. Beyond ALS: Innovations in Cardiac Arrest Management We wrapped up November with a highlight from St Emlyn's Live, featuring Salim Rezaie from the RebelEM blog and podcast. Salim's presentation on "Beyond ALS" challenges us to rethink cardiac arrest management, focusing on advanced techniques and evidence-based practices. Advancing Cardiac Arrest Protocols Salim's talk covers crucial aspects such as minimizing shock pauses, effective adrenaline administration, and optimizing IV/IO access. For anyone serious about improving their ALS skills, this blog, podcast, and accompanying videos are indispensable resources. Looking Ahead November was a whirlwind of activity and learning at St Emlyn's, and we have plenty more in store for December. As we approach the holiday season, we hope you find time to explore these posts and integrate their lessons into your practice. Thank you for being part of the St Emlyn's community, and we look forward to continuing this journey of learning and improvement together.

This podcast was recorded at the Intensive Care Society State of the Art meeting in London 2018. Simon Carley interviews Prof Peter Brindley on the interface of technology, humans and humanity in critical care. The audio was recorded live and at the venue so there is a fair bit of background noise, but we hope that this does not distract from a wide ranging and fascinating podcast.  

Five strategies to improve your resuscitations. 1. Zero point survey 2. Peer review 3. 10 in 10 4. Hot debriefs 5. Fly the patient You can read about these strategies, watch the video and learn about the background on the St Emlyn's blog here https://www.stemlynsblog.org/stemlynslive-five-free-strategies-to-improve-your-resuscitation-practice-st-emlyns/ 

Salim Rezaie from the REBEL EM podcast takes us through the optimal management of cardiac arrest and also explores some of the controversies and difficulties that make the difference to our patients.  You can read a lot more about the background to this talk, see the evidence and watch the video on the St Emlyn's site. Just follow this link. https://www.stemlynsblog.org/beyond-acls-salim-rezaie-at-stemlynslive/ 

Welcome to the St Emlyn's Podcast: October 2018 Highlights Hello and welcome to this St Emlyn’s podcast. My name is Simon Carley, and today I'm thrilled to take you through all the exciting events and updates we've been involved in this October 2018. This month has been bustling with activities, learning opportunities, and insightful experiences that we are eager to share with you. The Inaugural St Emlyn's Live Conference We kicked off October with a bang by hosting the first-ever St Emlyn’s live conference in Manchester. This landmark event brought together a diverse group of delegates and speakers, creating a vibrant atmosphere of learning and collaboration. The focus was on the four pillars of emergency medicine as we see it at St Emlyn’s: Emergency and Spades Medicine Excellence in Critical Care Wellbeing The Philosophy of Emergency Medicine We had an incredible day filled with discussions on why we do what we do and how we can continue to improve our practices. The energy and enthusiasm from the participants were palpable, and we are excited to share all the presentations and insights from this event over the coming months. Stay tuned to our blog and media channels for updates. Five Ways to Improve Your Resuscitation Skills One of the highlights from the conference was my presentation on "Five Things You Can Do to Improve Your Resuscitation." Although the video is not yet released, the blog post is available, and I want to give you a sneak peek into some practical tips that can make a significant difference in your practice. 1. The Zero Point Survey The zero-point survey is a concept introduced by Cliff Reid, emphasizing the importance of preparation before patient contact. Your resuscitation process should begin the moment you hear about the patient, not when you meet them. This preparatory phase includes ensuring your physical readiness, team coordination, and environment setup. Key Steps: Self-preparation: Ensure you are physically and mentally ready. Team readiness: Identify team roles and confirm competency. Environmental setup: Check equipment, ensure visibility, and prepare necessary tools. 2. 10 in 10 The 10 in 10 concept involves taking 10 seconds every 10 minutes during a resuscitation to reassess and communicate with your team. This regular pause helps in reappraising the situation and updating your mental models, ensuring everyone is on the same page. 3. Fly the Patient and Then Think In emergency medicine, drawing from aviation, one person should focus on maintaining the basics (aviate) while another makes higher-level decisions (navigate and communicate). In a resuscitation scenario, one team member should follow the algorithm and manage immediate life support, while another considers broader strategies and decisions. 4. Peer Review Peer review is essential for growth and self-awareness. Having someone observe your practice and provide feedback can uncover blind spots and improve your performance. This process benefits both the observer and the observed, fostering a culture of continuous improvement. 5. Hot Debriefs Adopted from the Edinburgh emergency departments, hot debriefs are quick, five-minute sessions immediately after an event. This practice allows teams to reflect on their performance, discuss what went well, and identify areas for improvement. Implementing hot debriefs can enhance team dynamics and overall performance. Enhancing Education in Busy Environments In another educational blog this month, I discussed how to teach and learn effectively in a stretched environment, drawing from a talk at the Royal Society of Medicine in London. Contrary to popular belief, being busy does not preclude learning opportunities. Data from the GMC survey indicates that exposure to relevant cases and support in learning significantly impact trainee satisfaction, rather than workload alone. Effective Teaching Strategies: Post-it Polls: Write down interesting cases or learning points throughout the day and display them on a board for everyone to see and discuss. FOAMed Prescriptions: Share relevant online resources with trainees to reinforce learning through spaced repetition. Social Media Utilization: Use platforms like WhatsApp and message boards to discuss cases and share insights while maintaining confidentiality. Cricoid Pressure and RSI: Ongoing Debates We revisited the controversial topic of cricoid pressure in rapid sequence intubation (RSI) with a journal club post. Despite longstanding debates, recent evidence, including a study published in JAMA, suggests that cricoid pressure may not significantly impact laryngoscopy success rates. However, it might still be beneficial in specific high-risk scenarios. The key takeaway is to make informed decisions based on the latest evidence rather than following traditional practices blindly. FemInEm Conference Highlights Natalie May attended the FemInEm conference in New York and shared her insights in a detailed blog post. The FemInEm group focuses on promoting gender equity in emergency medicine but offers valuable resources for all practitioners. Natalie’s presentation on avoiding the use of the word "sexy" in emergency medicine was particularly thought-provoking. Stay tuned for more from this inspiring conference. Pursuit of Excellence in Emergency Medicine Natalie May also delivered a keynote presentation at St Emlyn’s Live on the pursuit of excellence. Drawing from her experiences in the UK and Australia, she emphasized the importance of continuous learning and collaboration with colleagues. Her talk highlighted that achieving self-actualization in emergency medicine requires support from a dedicated team, reflection, and a commitment to improvement. Addressing PTSD in Emergency Medicine Rusty Carroll continued his series on PTSD, exploring novel therapies such as eye movement desensitization and reprocessing (EMDR), now approved by NICE. This installment provides valuable insights for those dealing with PTSD, offering hope and practical solutions. Looking Ahead As we wrap up October, we have an array of exciting content lined up for November and beyond. We will be releasing more materials from St Emlyn’s Live and sharing insights from our Teaching Co-Op course. The course was a fantastic experience, and we are considering hosting it again due to popular demand. In the meantime, we encourage you to engage with our blogs, videos, and social media channels. Join us in our journey to improve emergency medicine practices and enhance patient care. Stay connected, stay curious, and enjoy your adventures here at St Emlyn’s. Thank you for being a part of the St Emlyn’s community! By following these tips and strategies, you can optimize your practice, foster a culture of continuous learning, and improve patient outcomes. Don’t forget to subscribe to our blog and podcast for the latest updates and insights from the world of emergency medicine.    

  This presentation was given at the inaugural #stemlynsLIVE conference on the 8th of October 2018 in Manchester. You can read more about the presentation and the conference here. https://www.stemlynsblog.org/in-pursuit-of-excellence/

September Review: Key Insights from the Sentemlyns Podcast Welcome to the latest edition of the Sentemlyns podcast blog. I’m Simon Carly, and today we're diving into the significant papers and events from September. We're a tad late this month due to the bustling activities surrounding the Sentemlyns conference and the Teaching Court course, both of which were tremendous successes here in Manchester. Stay tuned as we delve into the highlights of September, from groundbreaking studies to enlightening conferences. Management of the Airway in Cardiac Arrest Key Studies by Ashley Levy We kick off with a comprehensive look at two pivotal papers by Ashley Levy, focusing on airway management in cardiac arrest. These studies, eagerly awaited by the medical community, provide critical insights into pre-hospital care. Airways 2 Study Published in JAMA in August, the Airways 2 study examined over 9,000 patients in the UK pre-hospital environment who suffered cardiac arrests. The study excluded patients who quickly returned to spontaneous circulation after a couple of shocks. The remaining patients were randomized into two groups: those receiving a supraglottic airway and those receiving an endotracheal tube. Findings: The study revealed no significant difference in outcomes between patients who received endotracheal intubation versus those with a supraglottic device. This challenges the long-held belief that intubation is superior in cardiac arrest scenarios. Implications: The findings suggest that in pre-hospital settings, the choice of airway device might be less critical than previously thought. It underscores the importance of managing ventilation effectively, regardless of the airway device used. For many practitioners, this means opting for the quickest and easiest airway device, typically a supraglottic airway. However, in prolonged or complex cases, converting to an endotracheal tube might still be preferable. Laryngeal Tube vs. Endotracheal Intubation in the US Study Another study published in JAMA, conducted in the US, compared endotracheal intubation with the use of a laryngeal tube. Similar to the Airways 2 study, it found no significant advantage to using an endotracheal tube. Interestingly, this study hinted at a slight benefit for the laryngeal tube, though this requires further investigation. Conclusion: Both studies indicate that for pre-hospital cardiac arrest, the priority should be securing an airway quickly and effectively. While supraglottic airways may suffice in many cases, endotracheal tubes remain a viable option in more complex scenarios. Global Health and Responsibility Stefan Brujins’ Perspective Stefan Brujins, a friend and colleague now working in the UK, provided a thought-provoking post on our responsibilities toward global health. Reflecting on his experiences growing up in South Africa, Stefan challenges us to reconsider our assumptions about equality and diversity in healthcare. He directs us to an impactful presentation by Annette Alenio at SMACC, emphasizing the need for togetherness in global health. This presentation is a must-watch for anyone interested in global health, offering valuable insights on how we can contribute more effectively to the global medical community. Highlights from the EUSEM Conference Diverse Learning Experiences The EUSEM conference, a combined event with the Royal College of Emergency Medicine, held in Glasgow, was a highlight of September. This event is renowned for its diversity and the unique learning opportunities it offers. Treatment of Massive PE by Dan Horner Dan Horner kicked off the conference with an insightful presentation on managing massive pulmonary embolism (PE). His update reflects the latest advancements and the complexities involved in clinical decision-making for thrombolysis in emergency settings. The emphasis on shared decision-making between clinicians and patients was particularly noteworthy. European Simulation Cup Victory Members of the Sentemlyns team joined the Royal College of Emergency Medicine team in the European Simulation Cup and emerged victorious. This competition, involving around 14 teams, culminated in a major incident simulation. The win was a testament to the team's skill and collaboration. Narrative Learning and Storytelling in Emergency Medicine Simon Carly’s Presentation I had the opportunity to present on the use of narrative learning and storytelling in emergency medicine. While not a traditional clinical topic, the importance of engaging learners through storytelling cannot be overstated. Case reports, despite being viewed skeptically in literature, remain powerful tools for education when used correctly. I drew heavily on the work of Jonathan Gottschall, particularly his book "The Storytelling Animal." Understanding the science behind storytelling can transform educational strategies, making them more effective and memorable. Managing Sick Neonates Natalie’s Comprehensive Guide Neonates, with their unique physiology, often present challenges in emergency medicine. Natalie provided an excellent post on managing sick neonates, using the analogy of micro machines to explain various aspects of neonatal care. From glucose metabolism issues to identifying cardiac problems in premature babies, her guide is invaluable for practitioners who may not regularly deal with neonates. Monkeypox Awareness Janis Byombi’s Expertise Monkeypox, a relatively obscure virus related to smallpox, has seen a recent outbreak with cases imported to the UK. Janis Byombi, our expert in international and tropical diseases, detailed the symptoms, diagnosis, and management of monkeypox. While generally self-limiting, awareness and proper handling are crucial, especially for healthcare workers who might be at risk. RecessTO Conference Insights Innovative Approaches to Learning Ashley Liebergen shared her experiences from the RecessTO conference organized by Chris Hicks in Toronto. The conference's innovative approach combined traditional knowledge sharing with practical workshops and simulations, enhancing the overall learning experience. This method of building knowledge progressively throughout the day was particularly effective and engaging. EMS Gathering in Ireland Learning with Leisure The EMS Gathering in Cork, Ireland, offered a unique blend of formal lectures and experiential learning. This “learning with leisure” approach took attendees to various locations around Cork for hands-on experiences, from airport emergencies to extrications. Emotional Learning Experience One standout session was a cardiac arrest scenario staged in a theatre, focusing on the interaction between medical teams and the patient's relatives. This emotionally charged and theatrically presented scenario highlighted the importance of communication and empathy in emergency medicine. Zero Point Survey Enhancing Resuscitation Preparedness Finally, I rounded off September with a post on the zero-point survey. This concept emphasizes that resuscitation begins before the patient arrives, utilizing the critical minutes from the initial alert to prepare thoroughly. This proactive approach can significantly improve resuscitation outcomes and efficiency. Conclusion September was a month of substantial learning and reflection for the Sentemlyns team. From groundbreaking studies in airway management to innovative approaches in global health and emergency medicine education, we've covered a broad spectrum of topics. As we look forward to October and beyond, we remain committed to bringing you the latest insights and developments in emergency medicine. Thank you for joining us on this journey. Stay tuned for more updates and have a great day!

St Emlyn’s Monthly Round-Up: August Highlights and Key Insights Hello and welcome to the St Emlyn’s blog! I’m Simon Carley and today; I’m thrilled to share with you some of the standout moments and key insights from our blog in August. Yes, I know it’s October now, but we’ve been incredibly busy organizing the St Emlyn’s Live and the teaching course in Manchester. More on that in a later post. It’s been a fantastic period for us, and even though we’re a bit behind, it’s perfectly okay. Let’s dive into some spaced repetition and revisit the exciting content from August. Natalie May’s Adventures Down Under In August, we featured a series of blogs by Natalie May, chronicling her experiences at the Emergency Medicine of South-Os conference in Australia, where she served as a keynote speaker. Natalie covered several essential topics during her time there, providing valuable insights and lessons for emergency medicine professionals. One of the key sessions she highlighted was about the effective use of apps in emergency medicine. This session was particularly interesting as it covered various clinical applications that can enhance productivity and patient care. Natalie shared top tips from her session, many of which she personally uses. This collection includes clinical tools and productivity apps, making it a must-read for anyone looking to optimize their practice. Many of these tips also tie back to a post by Scott Weingart from a few years ago about getting things done in emergency medicine. Natalie’s update builds on Scott’s foundation, providing new insights and practical advice for today’s busy and complex medical environment. Lessons Learned at the Conference Another highlight from Natalie’s posts was a session on lessons learned. This session brought together five respected professionals—Gary Birk, Jesse Spur, Natalie herself, Ian Summers, and Tim Lewinburg—who discussed instances where things didn’t go as planned. These stories weren’t just about clinical errors but also about soft skills, which, as we know, are anything but soft. The panel covered communication issues, handover challenges, and awareness of equality and diversity in the emergency department. One poignant story involved an equality and diversity issue where Natalie acknowledged a consultation that didn’t go as expected. These discussions are crucial as they address elements that are challenging to learn from textbooks but significantly impact patient care and team dynamics. Rick Body’s Troponin Insights Moving on, we had an exceptional post by Rick Body on troponin, specifically focusing on high-sensitivity troponin samples. Rick is a leading authority on troponin, and his insights are invaluable. One particularly critical point he raised was the impact of biotin supplements on troponin assays. Rick explained that patients taking biotin might show negative troponin results even when there is a myocardial infarction. This is a significant finding as it could lead to missed diagnoses. Rick advises emergency departments to either determine the type of analyzer their lab uses or routinely check biotin levels in patients to avoid potentially serious errors. This post is a must-read for anyone involved in emergency medicine as it provides practical advice to enhance diagnostic accuracy. SMAC Conference and the CESR Route August was also a month of anticipation for the upcoming SMAC conference. We discussed the excitement surrounding this event, which promises to be an incredible gathering of emergency medicine professionals. If you haven’t registered yet, make sure to do so as this will be the last SMAC, and it’s set to be unforgettable. We also explored the CESR route in the UK. For those unfamiliar, the CESR (Certificate of Eligibility for Specialist Registration) is an alternative path to becoming a consultant in emergency medicine. Unlike the traditional six-year training program, the CESR route is portfolio-based and has recently undergone some changes. Gareth, who has successfully navigated this process and joined us as a consultant, shared his experiences and offered practical advice. His insights are particularly valuable for anyone considering this path, emphasizing the importance of early preparation and understanding the requirements. Intravenous Fluids in Critical Care One of the standout academic reviews we featured in August was on the use of intravenous fluids in critical care. Authored by Silam Lam, John Myberg, and Armando Bellomo, it provides a comprehensive overview of current best practices and evidence in fluid management. The review highlights several key points. Firstly, the evidence base for most IV fluids is surprisingly weak, which is concerning given how widely they are used. The traditional approach of aggressive fluid resuscitation (fill them up until they can’t take any more) is now considered potentially harmful. Instead, a more cautious and mindful approach is recommended. The review also discusses the importance of choosing the right type of fluid and adjusting the volume based on the type of shock. Dynamic assessment tools like point-of-care ultrasound are emphasized as they provide real-time insights into patient status, making fluid management more precise. The paper also touches on the role of the glycocalyx, an essential barrier between intravascular and extracellular fluid, which plays a critical role in fluid management during illness. Avoiding Harmful Fluids In addition to general fluid management principles, the review provides specific recommendations on which fluids to avoid. Hydroxyethyl starch solutions, for instance, should not be used, a point we have reiterated on the blog before. Gelatin, another fluid type, is also not recommended due to its limited benefits and potential risks. Human albumin, although used more frequently in critical care, especially for conditions like sepsis, does not show significant advantages in most scenarios and should be avoided in traumatic brain injury. The ongoing debate between balanced solutions and normal saline is also addressed, with the review suggesting that balanced solutions may offer slight advantages in certain contexts. Moral Injury in Emergency Medicine Finally, we revisited a fantastic paper and podcast on moral injury by Esther Murray. This topic has resonated deeply with many in the emergency and critical care fields. The paper explores the psychological and emotional challenges faced by healthcare professionals, particularly those working in high-stress environments. Esther’s discussion on moral injury—how the distress from perceived ethical transgressions impacts healthcare workers—is incredibly poignant. Given the increasing focus on mental health and well-being in our profession, understanding and addressing moral injury is crucial for sustaining our workforce. This small but significant study sheds light on an issue that many of us have experienced, even if we haven’t fully acknowledged it. Wrapping Up August’s Highlights August was indeed a month packed with valuable insights and crucial updates for the emergency medicine community. From Natalie May’s adventures and lessons learned to Rick Body’s troponin wisdom and the comprehensive review on intravenous fluids, there was a wealth of information to absorb and apply in practice. We also delved into the practicalities of the CESR route, providing a roadmap for those considering this alternative path to consultancy. The discussion on moral injury, led by Esther Murray, reminded us of the importance of addressing the emotional and psychological well-being of healthcare professionals. As we move into the latter part of the year, we look forward to bringing you more cutting-edge research, practical tips, and thought-provoking discussions. Stay tuned for the September podcast and the exciting content we have lined up from recent conferences. Thank you for being a part of the St Emlyn’s community, and here’s to continuing our journey of learning and improving patient care together.

EMS Gathering round up 2018 with Simon Carley and Aidan Baron. See www.stemlynsblog.org Apologies for the sound quality on this one, it was all done in a fairly noisy environment. Don't forget to listen to special guests from 23 mins onwards.

This week we recorded a podcast inspired by a recent publication in the EMJ. Esther Murray aka @EM_Healthpsych is a psychologist working in London. Her recent paper on whether the experiences of medical students might precipitate moral injury during their pre-hospital experiences gives  an insight into how we all cope with and respond to the clinical work we do. Some of the work we do is traumatic, painful and morally difficult to rationalise. We are witness to the very worst aspects of some of our patient’s lives and there may be a price to pay. I was delighted to explore some of the concepts around moral injury in this podcast and would really recommend that you read the paper 1 and consider whether this is something that can affect ourselves and our colleagues. The paper is open access at the moment so there is no excuse not to 😉 Although the paper is based on a small number of participants from only one aspect of the healthcare system it does recognise this limitation and alludes to future work with different groups of clinician. What is Moral Injury? Esther describes ‘moral injury’ as a concept emerging from work with military veterans. It is used to describe the psychological sequelae of ‘bearing witness to the aftermath of violence and human carnage