Tuesday, 20 January 2015

Students of Emergency Medicine in a Transitional Academic Environment: Each One Teach One!

From the Desk of: Sagar Galwankar, MD

“Change is always challenging. When you want to bring the Change, You have to convert the challenge into opportunity and that Opportunity is the Real Change”: I have learnt this dictum from my Father who learnt it from his father (My Grand Father).  My Two preceding Physician generations had spent their entire life transforming Rural Health Care in India. Coming from a Family who will soon complete a Centenary in Patient Care- Transforming HealthCare is our DNA which can’t be altered.

Transitional Academic Environments of Emergency Medicine are vibrant places for discovery. These are places where History is being written and future is being chiseled.

These Departments have teachers who are new to the specialty. There are the HealthCare system administrators who have accepted to transform and transition towards better healthcare and there are students who have accepted this new specialty. These students have embarked on an exciting journey to master the unknown.

These Students of Emergency Medicine will spearhead the Future of HealthCare. How they learn and how the grow will shape how the nation will proceed. Nurturing their ideas and Fostering their talent is crucial to this growth story.

This task becomes very challenging when the Academic Fraternity is in the Neonatal Stage itself.

How do these students learn, How do they transform, How do they become competent, how do they become confident and how do they change?

The answer is simple: Teaching can facilitate learning but until learner wants to learn nothing can happen, hence effort is always by an individual, only now the effort increases exponentially. Innovative strategies have to be deployed to learn so that complete knowledge can be effectively mastered.

Emergency Medicine is Dynamic Process. There are nations which have progressed and are progressing fast, there are nations who are now starting to progress and there are nations where there is no Emergency Medicine. Every Health System goes through transition.

Today media, internet and technology has brought the knowledge of Progress closer to those who want to progress.

The Students of Emergency Medicine in Transitional Academic Environments have to understand that they have to learn on their own and what they learn will change the future of the country.

From my experience of learning Emergency Medicine since the last 14 years , I have a Ten Step Ladder for my “Students of Change”:

1.    Students of Change have to take extra efforts to master the theoretical body of knowledge. Choose one textbook and master it from First Page to the last page. Line by Line Page by page. I often hear that students see a case in the ED and then go and read about it. That is a good strategy but a Complete Strategy is to read from First Page to Last Page. In the three years of Training a students should read the whole textbook three times. Stick to one Textbook-Divide it into 12 Sections to be read over 12 Month-Divide the monthly reading into 30 parts and then read those number of pages daily-religiously.

2.    Try to practice history taking and clinical examination on every patient, you will see that as you go along your history and clinical exam skills will speed up.

3.    Learning procedural skills is considered very crucial by many students of Emergency Medicine. “A Fool with Tools and Techniques is still a Fool”. Learn the knowledge behind it. Try to go to the Operating Rooms early morning and learn Controlled Intubation. Try to attend Central Line Workshops on Cadavers and attend IV Line sessions in pediatrics. Chest Tube, Foley Catheterization and NG Tube placement can be learnt in a similar manner. Attend Orthopedic Calls and learn splinting and reduction of joints and attend cardiology lectures to learn EKG. There are less than 40 Rhythms one has to master as an Emergency Physician. Ultrasound can be learnt by attending workshops which are held across the country. Online Videos and Posts are available in ample to help a student learn the skills.

4.    Read the various Journals focused on Emergency Medicine. Learn what is new, what is happening. Stick to Three Journals and read the articles religiously every month.

5.    Try to work with other departments when they attend the ED Calls. Try to discuss with them based on the knowledge given in your text book – The Textbook of Emergency Medicine. Example: Admitting Chest Pain Patients: This is a situation of immense debate across the world and an area of conflict between EM and Cardiology. Use your knowledge to debate this subject and learn about ACS. Remember whatever the cardiology perspective maybe it is your Textbook which is always right for you. No need to fight just stand by the principles in your book.

6.    Master your Resuscitation Algorithms. ATLS, ACLS, PALS, NALS should be on the fingertips of students and should be practiced naturally. No Deviation from the algorithm should be entertained.

7.    Chest Pain, Shortness of Breath, Focal Weakness, Altered Metal Status, Abdominal Pain, Bleeding from Orifices, Fever, Airway Management and Procedural Sedation should all have protocols clearly mentioned. If you don’t have such protocols in your department then work to create them. If this warrants engaging the other departments then engage the other departments. In a Transitional Academic Set Up Get Other Departments to commit to one protocol whatever it may be. Remember the patient should be cared for and that has to be FAST because it’s Care in the Emergency Department. So protocols should focus on this principle.

8.    Students may have teachers who claim to be Emergency Experts, there may be enthusiasts who believe that they are educators , there may be teachers who have accepted Emergency Medicine as a career option and there many genuine teachers who really want to be educators in emergency medicine. Students should try and learn the positive points from all the different genera of Educators available. Again how will a student know what is right and what is not right? The student will only know this when he has mastered the Textbook of Emergency Medicine.

If your educator is from a Surgical background the try to learn surgical skills like suturing central line chest tube from the surgeon. Try to master the examination of Hernia, Torsion testis and all surgical emergencies. Knowledge is everywhere, students should be ready to absorb it. What to absorb can only be learnt if a student knows exactly what to absorb! A student will know this only when he/she has read the whole textbook.

9.    Attending Seminars, Symposia and Conferences is helpful but that is not training in Emergency Medicine. Real Knowledge is gained in the residency program where all the action is. Focus on Learning is important. Attending a conference to present research papers, or participate in academic competitions is helpful when the student is a religious reader and a vibrant learner. You can’t learn EM by attending a conference. There is a lifetime to attend conferences.

10.  Remember that there are only 1000 Days to Learn in a 3 Year Residency. The mistakes can be forgiven in these 1000 days. After that you are on your own.

A Nation where students believe that they need a Degree to Learn is a nation where the growth of quality healthcare is nothing but a distant dream. The students who believe the above have a difficult path ahead and are misleading no one but themselves.

Getting a Qualification is Important but more than that the training and the knowledge gained is more important. These are human lives that are at stake…. And Seconds Count!





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