Well, here is a cool little app that has recently been released. It's an app that can predict what a child's height will be as a mature adult. This is not a joke.

A free mobile application developed by the International Center for Limb Lengthening (ICLL) at the Rubin Institute for Advanced Orthopedics (RIAO) of Sinai Hospital (right in our very own Baltimore) can predict the future mature height and bone lengths of children with the input of basic information.

That's right people. The formula has amazing accuracy and has been studied in many different centers. It's supposedly 97%+ accurate in predicting height.

The Multiplier App, available for Android, iPhone and iPad devices, is based upon the Multiplier Method, a series of formulas used to calculate and predict height and bone length in children. These formulas were developed by a team that included members of the ICLL.

Here is what it looks like. Just click on "Height" (see enclosed jpg image of the app) and then type in the child's birthday and current height in either inches or cm. The formula will then calculate what there predicted height will be.

Very, very cool ( at least I think)

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Every heard of the Khan Academy website? If you have, you will instantly recogize what a powerful force this website has become in education. If you haven't, what are you waiting for? Head to http://www.khanacademy.org/ and check it out! This site gets millions of hit PER DAY.

The Khan Academy was developed by, guess who, a guy named Kahn, Salman Kahn. This website is amazing. My kids use it for some of their school work. Trust me, check it out. If you want to know just how good this guy is...check out the size of the check Bill Gates wrote him.

What does this have to do with medical education? The videos put together by Khan utilize a teaching modality called a "whiteboard." This type of teaching technology is changing they way educators deliver material. Programs like Doceri (www.doceri.com) utilize this concept. You can build presentations and teaching materials with audio included.

My pearl for you today is really more of an assignment...go to the two websites and check them out. First, visit the Khan Academy site and then the Doceri site. THIS kind of thing is the future of education...

Getting tired of the same old Power Point presentations? Getting bored with Apple's Keynote? Looking for something new to excite learners?

Well, you might want to consider using a newer presentation tool, a tool designed to eliminate those boring bullet points...

Say hello to Prezi...

This really cool presentation tool allows you place all of your content (words, pictures, video, etc) on one canvas and then manipulate the sequence you want to show it in.

Check out the website and give it a try: www.prezi.com

Simply click on some of the sample Prezi presentations on the site. It's very cool and quite addictive.

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In a 1991 article published by Wrenn and Slovis, the ten commandments of emergency medicine are discussed. This is an awesome article and a must read for everyone in EM.

Michelle Lin recently mentioned these on her blog, Academic Life in Emergency Medicine....

The Ten Commandments of Emergency Medicine:

1. Secure the ABC's
2. Consider or give naloxone, glucose, and thiamine
3. Get a pregnancy test
4. Assume the worst
5. Do not send unstable patients to radiology
6. Look for common red flags
7. Trust no one, believe nothing (not even yourself)
8. Learn from your mistakes
9. Do unto others as you would do to your family (and that includes coworkers)
10. When in doubt, always err on the side of the patient

These are great teaching pearls for new interns and for the rest of us as well....

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I found this neat little pearl on Michelle Lin's blog, Academic Life in Emergency Medicine, and thought it was worth sharing with everyone:

"In my theme of detoxifying malodorous smells in the ED (see Toxic Sock Syndrome and abscess drainage), I recently learned of a new way of masking odors. Imagine the stress on your olfactory nerves from the combined effects of urinary and fecal incontinence from a nursing home patient.

An ingenious nurse proposed nebulizing actual coffee within the room. Unfortunately, our ED was out of coffee at the moment.

Trick of the Trade:
Nebulized orange juice

I only learned of this trick after walking into the patient's very subtly foggy room. About 4 cc of orange juice had been nebulizing for a few minutes. The room smelled a little like a Jamba Juice (a smoothies/ juice shop). Quite pleasant actually. I was shocked to find that it masked the odors quite well."

Thanks for the tip, Michelle. Freshly-squeezed anyone??

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Dear Readers,

Thank you for your continued interest in the University of Maryland's EM Pearls program. We are conducting a survey to assess whether our pearls are meeting your needs. Data collected will be used to refine and improve our educational program. Please take 1 minute to complete our survey by clicking the link below. 

http://umem.org/surveyor/index.php?sid=86815&newtest=Y&lang=en

If you regularly forward pearls to other readers, please forward this message as well. We wish to capture as many readers' opinions as possible.

If you have any questions or problems, please contact: admin@umem.org

Sincerely,

Dan Lemkin, MD MS
EM Pearls Development Team
University of Maryland School of Medicine
Department of Emergency Medicine

Some Tips for Designing an Insanely Great Talk

Here are just a few things you can do to create a fantastic presentation:

• Remember: great talks mix education, entertainment, and inspiration
• Limit the number of bullet points. Text can be your enemy. Better yet, try to develop your talk without bullet points!
• Use more pictures and video. The more the better. 
• Tell stories and use emotion (people love stories and learn well from stories)
• In order to improve your speaking skills listen to recordings of yourself and watch videos of your presentations
• Spend extra time of developing an excellent opening and closing. Bombing these will seal your fate. 

Great website for making great, memorable slides:

http://www.brainslides.com/

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Risk Stratification in Pulmonary Embolism

The following are the principal markers useful for risk stratification:

• Clinical markers (shock, hypotension)
• Markers of RV dysfunction (RV dilatation, hypokinesis or pressure overload on echo, RV dilatation on CT, BNP elevation)
• Markers of myocardial injury (elevated troponin)

Patients with one or more of these markers have a higher mortality rate.

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Teaching When Time is Limited

We all know how difficult it can be to teach in the ED when it is busy. So how do the experts do it when there is so little time?

Just a few considerations that might make your teaching more effective and easier to do when it is busy:

• Identify the learner's needs. The time-saving rule of thumb: target, then teach. After all, how do you know what to teach if you don't know what the learners knows or needs.
• Teach rapidly. And I mean rapidly. Many of us have really come to realize over the years that less is better. As Amal says, be a sniper and don't use a shotgun. Teach one thing quickly and move on. Pick a pearl (or pitfall, etc.), lock and load, then deliver it...then STOP teaching. Much more effective than spending 20 minutes talking about stuff nobody will ever remember!
• Provide some type of feedback. Feedback is one of the most underused yet powerful teaching tools available. 

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The Art of Pimping-And How to Protect Against

This monday's pearl (ok, I know, it's tuesday now) comes from Michelle Lin's blog: academic life in emergency medicine. It is more gem than pearl, and it discusses what medical students and residents do to avoid being pimped. It is a must read!

Here is the link to the discussion on Michelle Lin's blog:

http://academiclifeinem.blogspot.com/2009/11/trick-of-trade-essential-skills-for.html

Just a few note worthy "pimping protection procedures":

• The "Muffin"-person being pimped raises a muffin (or some other food item) to their mouth as they are being pimped. And if the person with the muffin stills gets the question, the pimpee pretends to choke, thus avoiding future pimp questions
• The "Eclipse"-eclipsing your head with someone in front of you, that way the pimper can't see you.
• The "Politician's" approach-answering the question you wished you were asked.

Happy pimping!

Well, this monday's pearl is a bit different than prior pearls. I wanted to let you know about a very cool website I came across recently called Clinical Reader. There is a whole lot in the recent medical education literature that discusses "Web 2.0." Web 2.0 involves learning through interactive websites, blogs, podcasts, etc. Medical education is really starting to head out of the classroom, and I wanted to mention a newer website that a lot of folks are talking about. 

Clinical Reader is a new medical RSS aggregator. What, you might ask, does this mean?

An RSS aggregator is a site that puts together information for you, that's right, for you. It actually does the work for you. Did I mention that it does the work for you? On this site, for example, if you are interested in "Emergency Medicine," the site finds all (or almost all) EM journals and brings you all of the latest information and updated articles. If you are into "Medical Education," you simply choose that category from a drop down menu and poof, you have all of the latest publications/reviews from the major medical education journals. Just choose your category and/or specialty and you are off and running. 

Try it out. It isn't 100% perfect, but it is very cool.

http://clinicalreader.com/

Todays pearl pertains to a great new blog put together by Dr. Michelle Lin, entitled "Academic Life in Emergency Medicine." The blog is superb and is a great resource for anyone interested in academic EM.

Today's posting is about teaching when time is limited and Michelle discusses a really good article written by Irby, et al. This article addresses a topic that is very pertinent to us in the ED, how to teach when it is busy. Isn't it always busy?

Tips from the article:

1. Identify the learner needs (can't be successful without this important step)
2. Teach rapidly (great tips for how to do this in the ED)
3. Provide feedback (students are starving for this)

Want more??? Gotta check out the article....

Here is the link to the site:

http://AcademicLifeinEM.blogspot.com/ 

Enjoy!

Some Pearls on ED Teaching:

• Don't teach so much. Limiting the number of points taught will lead to increased retention. Quality, not quantity.
• Make sure your learners are "with you." If the learner isn't attentive, forget it. Move and and return to teaching when the learner is ready. You are wasting your time if they are paying attention.
• Be creative in adapting your teaching style when it is busy. You don't have to be at a dry erase board drawing metabolic pathways (sorry Fermin) to be teaching. Simply discussing your thought process outloud is a great way of teaching "on the fly."
• Be flexible and remember: the focus should be on the learner (what they get out of it) and not the teacher. Many forget that when they teach in the ED.

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Giving a Lecture-Pearls and Pitfalls

Giving a lecture is filled with many potential pearls and pitfalls. Here are just a few important points that are frequently discussed:

• Stick to NO MORE than 3-4 take home points (people cannot remember more than that)
• Really spend a lot of time on the opening and closing (know them cold). This is what people will remember.
• Try to divide your talk into 5-10 minute chunks of material and DO NOT try to cover too much material....big mistake
• Perhaps one of the most important aspects of giving a really good talk is practice. You should know your material well enough that you could give it if the power went out and the computer crashes. Practice is essential...and it should "out loud." This is often neglected and it shows when unprepared speakers get up in front of an audience.
• Practice speaking without the use of verbal fillers ("ums"). This will improve as you practice more and more. Getting rid of these fillers may make the difference between a really good talk and an average talk. PRACTICE, PRACTICE, PRACTICE speaking without using them!

For an entertaining discussion of the pearls and pitfalls if giving a presentation check out the May episode of EMRAP: Educators' Edition on iTunes (also on the website www.emrap-ee.com). There is a great discussion by Greg Henry, Mel Herbert, and Amal Mattu. Check it out. It's free!

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Questioning Learners in the ED-Wait Times

When teaching medical students and residents, consider that the literature shows that we tend to wait only a few seconds (some studies say 3 seconds-which seems like a long time when you are waiting for a response) for a response. Bottom line, it has been demonstrated that many learners have the answer and will respond if simply given the time. Hard to do sometimes in a busy ED. Learners who aren't given time to respond will quickly learn that if they simply wait long enough the answers will be given to them.

So, when asking a question (NOT pimping) to a medical student or resident, simply wait a little longer. They may very well surprise you with the answer.

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The One Minute Preceptor Model of Teaching in the ED

This is a teaching strategy that most of us are very familiar with. Why? Because many, if not most, of us do it every day. We listen to a case, get a committment from the learner, probe for supporting evidence, and then give a teaching pearl and offer learning resources.

Perhaps one of the biggest pitfalls in teaching is NOT WAITING for the learner to answer to question. How often have you asked a question to a medical student and gave the answer? How often has a student presented a case and then they clammed up and didn't commit to a diagnosis or treatment plan?

A simple strategy for teaching success:

• Make learners "jump out there" and give you a diagnosis and treatment plan, i.e. get a commitment. Do your best to keep your mouth closed for a few seconds
• Give learners time to answer. You will be surprised. A few more seconds of waiting makes a big difference.

The One Minute Preceptor-Microskills in Teaching

Most clinical teaching takes place in the context of busy clinical practice where time is at a premium. Microskills enable teachers to effectively assess, instruct, and give feedback more efficiently. This model is used when the teacher knows something about the case that the learner needs or wants to know.

Most of already do this on a daily basis when a learner (student or resident) presents a case to us.

• Get a commitment (Make them commit to a diagnosis and/or management strategy)
• Probe for supporting evidence (why do they think this patient with CP has an MI?)
• Teach general rules
• Reinforce what was right
• Correct mistakes

One of the biggest pitfalls in teaching, particularly to medical students, is the first skill, getting a commitment. Let (i.e. make) the student commit to a diagnosis and treatment plan and avoid spoonfeeding them.

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