SUPPLEMENT

October 2013

specialist training. This will require us to CEM news increase funding and numbers available for these posts. Improving recruitment rates into higher specialist training will require “Time and tide waits for no man” and so College to the Keogh Review Evidence both short and long term recognition of the although my first newsletter as president Base. I am obliged to the hundreds of indi- workload, and the intensity and proportion has yet to be published, I am tasked with vidual contributions that were then col- of antisocial hours worked. putting pen to paper again, to ensure early lated to produce our final submission. Our current strategy to the emergency receipt at the printers to accompany the I and the vice-presidents have attended medicine challenges we all currently face conference supplement. As I write, I am several further meetings to discuss ­‘models can be summarised as: (1) promoting short sat a short distance from my boat (dinghy) of care’ and ‘delivery of care’—our contri- term training incentives; (2) building on the Riviera (Devon). I trust you too butions have been grounded in the medium term capacity; and (3) ensuring have had the opportunity for some rest responses, suggestions and experiences of long term sustainability. and relaxation this summer. fellows and members. These ‘demands’ are not the stuff of By the time you read this, the Autumn Further to my remarks last time, and by dreams, in contrast with the current night- Scientific Meeting will have seen many of way of emphasis of the key issues of mare of inadequate and incomplete rotas. us gather for learning and networking, as recruitment and retention, I am meeting We know that last year the average locum well as engaging in the witty banter, pene- with the BMA Trainees Committee and spend per emergency department was in trating analysis and exchanges of ironic Consultant Committee negotiators to out- excess of £600 000. There is also good evi- anecdote that are the hallmarks of the well line our thoughts on how the contract in dence that senior emergency medicine doc- rounded emergency medicine doctor. England can be amended to promote both tors use resources more efficiently and I will have completed several firsts, interest and sustainability in an emergency make better decisions, thereby reducing including awarding the William Rutherford medicine career. Clearly these discussions waste and increasing productivity. We need Prize and giving a ‘Keynote address’—I will relate to the contract in England as this to persuade governments to spend more regret to inform you that the organisers is currently the only one to which both par- wisely, more strategically and to do so now! have declined to offer refunds to those ties have agreed to consider negotiating. Finally, I would wish to urge us all to polite enough to have listened. Nevertheless, were we to persuade the avoid adopting ‘the victim role’. To do so What I can announce however is the BMA of our case, and they in turn able to will further undermine our morale at a time appointment of Katherine Henderson as persuade the Government, this would be when our skills and aptitudes are more nec- College Registrar and Francis Morris as a powerful exemplar to the governments essary than ever. Emergency department CPD Director. The College is immensely of Wales, Northern Ireland, Republic of doctors have embraced the finest ideals of a grateful for the time each has committed to Ireland­ and Scotland. service predicated on altruism. We hold the these unpaid roles, and from a personal per- The other key driver for the College cur- moral high ground. In these times of both spective, Katherine at least can only do bet- rently is the need to increase the number of austerity and evidence based practice, it is ter than the last bloke! training posts, particularly in the first few for others to prove their value; ours is not in Moving from speculation to informa- years. We need to avoid being ‘hostages to question. tion, I hope that you will all have had the fortune’ with respect to the proportion of opportunity to read the response of the trainees who select to enter higher Clifford Mann

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and Turkish). For a more practical clinical FOAM: the Internet, social media learning experience, visit St Emlyns virtual hospital, based in the UK (and the world!). These sites function as single platforms and medical education retrieving updated from over 100 emergency medicine and critical care web- “If you want to know how we practiced from where they can be followed (Twitter, sites, allowing you to access a rich variety of learning. Some sites offer a wide range medicine 5 years ago, read a textbook. Facebook, Google + , Vimeo). and RSS feeds are the most popular media of emergency medicine related topics while If you want to know how we practiced others focus on specific areas, such as aca- medicine 2 years ago, read a journal. through which most of the learning can be easily accessed by mobile devices. demic emergency medicine, ultrasound, If you want to know how we practice For many doctors and nurses, FOAM is trauma or critical care. Below are high- medicine now, go to a (good) conference. now an indispensible tool to keep them up lighted a few of the resources available: If you want to know how we will be to date in their practice. It dispenses with –– The EMCrit , authored by Scott practicing medicine in the future, lis- the old nomenclature of ‘social media’ and Weingart, gives insightful reviews of ten in the hallways and use FOAM.” is changing the medical education para- topics related to the management of Joe Lex, 2012, Emergency Physician digm to a more distributed, less controlled critically ill patients in the emergency and, arguably anarchic, embracement of department. Social media has changed the way the online learning. While there are many –– Traumacast (The Eastern Association world interacts with each other. Not only vocal advocates of FOAM, there are also of Trauma Surgeons—EAST) delivers has it brought together old friends, but it some concerns about how it will fit into interviews and reviews specific details is also evolving into an essential tool for the future of medical learning and how it is about the acute and chronic manage- medical education. The Internet pervades quality controlled. ment of trauma patients. our lives through smart phones and high –– Trauma.org—this site is divided into speed Internet access. A global audience three main sections: a library of educa- now exists that listens and watches the Identifying FOAM tional material, a community section of creation and sharing of cutting edge medi- A Google search will identify a lot of con- blogs and research, and a resources cal knowledge freely distributed by tent badged under #FOAM. The quantity area with information on conferences, experts in their field. Expert discussions of educational material can be overwhelm- training and links to other resources. are taking place right now that are both ing, making it difficult to know which sites –– EM ED podcast is a distinctive pro- free and available for you to learn from to focus on and which offer the highest gramme designed to give indepth knowl- and join. It is no surprise that emergency quality material. The user needs to decide edge of the management of children by medicine, a speciality that prides itself on not only which sites to use but also in EPs. innovation, is leading the way in the crea- which format to access them. This article –– SMART EM offers indepth topic spe- tion and sharing of online content. hopes to give some brief guidance to cific analyses of best practice. FOAM that focuses on emergency medi- cine and critical care. FOAM offers access Table 1 lists some high quality popular What is FOAM? to knowledge that many around the world #FOAM resources that provide a good FOAM is Free Open Access Medical Edu- simply could not otherwise afford. place to learn about the range of educa- cation. The term was coined by Mike tional material available. From these sites Cadogan at the 2012 International Emer- you can access podcasts and their social gency Medicine Conference (ICEM) in So where to start? media links. Dublin to highlight the increasing quan- 1. Make sure that you can access the tity and quality of the free, high quality Internet! medical education available on the Inter- 2. Think about how you want to learn The practicalities of accessing FOAM net, created and shared by experts in criti- and what format best suits you. Access to podcasts is simple by searching cal care and emergency medicine. video? audio? text? websites? or a bit through the iTunes Podcast library, FOAM is available as podcasts (some of everything? for Windows phones, Yahoo or Google formatted for audio but some including 3. Visit some #FOAM sites to get a taste Play. Accessing the RSS feeds is easy by lecture slides, radiographs, ECGs and/or of what is available. downloading and installing a good RSS ultrasound images), tweets, email notifica- 4. Ask a friend who already uses #FOAM reader (examples include , , tions, webinars, videos and blogs. It is dif- and get help. Pulse on the iPhone or iPad; NewsBlur, ficult to know which of these to focus on , Digg Reader, Newsvibe, or how to do so. Each author decides how For a great introduction to FOAM with Pulse on your desktop; NewsBlur, Digg to make his education available, but most links to many other FOAM sites, try the Reader, Pulse on Android operating sys- of them broadcast through websites with Life in the Fast Lane (this site is run pre- tems). The added advantage of using an added iTunes Podcasts, Facebook, Twitter, dominantly by Australian and New Zea- RSS reader, or social media sites such as Google+ circles and Rich Site Summary land based doctors; links to many FOAM Twitter and Facebook, is that you can also (RSS) feeds (a family of formats resources, offers blogs, articles and includes get updates on the journals you prefer to used to publish frequently updated an educational resource library) or FOAM. read (eg, Academic Emergency Medicine works—eg, entries—in a standard EM (blogs, links to articles, links to other (AEM), New England Journal of Medicine format). Most of these sites will have a FOAM sites and available in English, (NEJM), Journal of the American Medical Soci- presence on popular social media sites French, German, Italian, Polish, Spanish ety (JAMA), Critical Care Medicine (CCM)).

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Table 1 FOAM in emergency medicine and critical care building blocks are expressed in different Web address Podcast Social media links ways through websites and online com- munities (such as Facebook and Twitter). Academiclifeinem.com ALiEM G,F,T,R There is no confidentiality, and whatever Broomedocs.com Broomedocs Podcast G,T,L,R you say will stay out there forever. The East.org Traumacast T,F,R,Y freedom with which material and com- ment may be placed online means that EMCrit.org EMCrit T,F,G,R,V the risk of unreviewed/censored ideas, Emrap.org EMRAP T,R perhaps contradictory to widely accepted Ercast.org Ercast F,G,T,Y,Gl,R practice or even dangerous, is significant. Foamem.com R There is no formal editorial control or prepublication review; rather, the Hq-meded.blogspot.co.uk G,F,T,R ­emphasis is on open peer review post- Intensivecarenetwork.com SMACC2013 The Intensive Care Podcasts T,F,R publication. However, it also offers an Iteachem.net iTeachEM F,G,T,L,Y,V,R,Gl opportunity for real time worldwide information exchange, and discussion on Lifeinthefastlane.com T,F,G,Z cases, ideas and research. If you see com- Olly flowers critical care podcasts THE INTENSIVE CARE PODCASTS ments with which you disagree, you too PeerView Emergency Medicine Podcasts in emergency medicine have the opportunity to comment and Pemed.org PEM ED Podcasts R,F,T receive timely feedback. Some sites offer rating systems by which papers and Practical evidence Practical evidence other material are marked and debated, Prehospitalmed.com PHARM G,T,R so providing immediate feedback on Pulmccm.org G,R,F,T their content. Resus.me Resus.ME! F,T,R Medical information is expensive, and finding the most recent up to date mate- Ruraldoctors.net T,R rial frequently involves costly journal Sccm.org Icritical care F,G,T,R ­subscriptions, expensive conferences and Sinaiem.us F,R,T,V,Y paid access medical education websites. Open access journal articles remain in the Smartem.org SMART EM F, T minority, and the privilege is often pur- Stemlynsblog.org St.Emlyn’s and EBM in Emergency Medicine T,L,G,Gl,R chased at great expense to the author or Thepoisonreview.com G,R,F,T their institution. However, open access Toxtalk.org Toxtalk R,F,T,Fl journals are rapidly increasing their circu- lation (and impact factor). Trauma.org The second issue associated with FOAM Ultrasoundpodcast.com Ultrasound Podcast F,G,T,Y,R is that the source of the education is usu- F, Facebook; Fl, Flickr; G, Google + ; Gl, Global Medical Education Project; L, LinkedIn; R, RSS feed; T, Twitter; ally from a single or a few people. Local V, Vimeo; Y, YouTube; Z, Zazzle. practices may vary. It is difficult to verify that the information is authoritative and independent of vested interests (eg, drug There are also extensive FOAM libraries http://lifeinthefastlane.com/2012/10/ companies). The final responsibility for that offer training in ultrasound, imaging ultrasound-in-emergency-medicine/ the management of patients still lies with and ECG interpretation. Many sites allow http://emergencyultrasoundteaching. the individual treating clinician and not and encourage downloading of material com/ with the FOAM source. Care should be for educational use. www.crticalecho.com taken not to breach local policies or prod- Useful databases for ECGs include: uct licenses. Most educational sources will Useful databases for ultrasound images http://www.ecglibrary.com/ecghome. state that they take no responsibility for include: html the decisions of people educated by their http://www.ultrasound-images.com/ http://lifeinthefastlane.com/ecg-library/ content. http://www.ultrasoundvillage.com/ http://hqmeded-ecg.blogspot.co.uk/ imagelibrary/ http://www.ultrasoundcases.info/ So is face to face learning doomed? http://lifeinthefastlane.com/2012/10/ How do I know if FOAM is any good? #FOAM is not just about online learning. ultrasound-in-emergency-medicine/ There are two fundamental issues that Conferences are now embracing concom- http://www.ultrasoundpodcast.com need to be highlighted. Firstly, there is a itant social media learning through the (and sonocloud.org) lot of stigma and fear attached to the use live tweeting and blogging of content. www.criticalecho.com- https://www. of social media in the medical context. This will likely increase in the next few stanford.edu/group/ccm_echocardio/ Social media is built on seven building years. SMACC (Social Media and Critical cgi-bin/mediawiki/index.php/Main_ blocks, making it very different from Care) in Sydney 2013 showed just how Page other forms of education: identity, con- powerful a #FOAM enabled conference http://www.yale.edu/imaging/echo_ versations, sharing, presence, relation- can be, with live interaction between atlas/contents/index.html ships, reputation and groups. These speakers, audience and experts around

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the world coming together live, free and FOAM is here to stay and will continue medical education, but will also transcend with open access to an international audi- to grow. Free education, created and sup- our current medical paradigms in ways ence of thousands (and with a massive ported by our colleagues’ hard work and we do not even know about yet. reduction in carbon footprint/costs). voluntary donation, is difficult to find fault SMACC Gold takes place in Australia with. Not engaging in this exciting and Johann Grundlingh, Barts Health NHS Trust next year, and even if you cannot attend rapidly developing educational field is Professor Tim Harris, Queen Mary University you will be able to participate through leaving you behind the ­cutting edge. of London and Barts Health NHS Trust #FOAM. This provides a paradigm of FOAM and social media will continue to Professor Simon Carley, Centre for Effective cheap, high quality, environmentally grow and will not only bloom into the Emergency Care, Manchester Metropolitan friendly education. next evolutionary step in high quality University

Consultant appointments August 2013

The information for the consultant appointments is provided by the College and any errors should be notified to them and not the journal Name Hospital Date appointed Previous post Sherif Hemaya Sheffield Teaching hospital NHS FT July 2013 Locum Consultant Hasan Qayyum Sheffield Teaching hospital NHS FT July 2013 Locum Consultant Sundara Manou Leeds Teaching hospital NHS Trust July 2013 STR Jeremy Smith Sandwell and West Birmingham Hospitals NHS Trust July 2013 STR Cliona Magee Sandwell and West Birmingham Hospitals NHS Trust July 2013 Consultant Mohamad Yakoob Wani Sandwell and West Birmingham Hospitals NHS Trust July 2013 STR Dilip Dacruz Sandwell and West Birmingham Hospitals NHS Trust July 2013 — Leesa Parkinson Betsi Cadwaladr University Health Board July 2013 STR Helen Salter Betsi Cadwaladr University Health Board July 2013 Consultant Thomas O’Driscoll Betsi Cadwaladr University Health Board July 2013 STR Ed Valentine Aneurin Bevan Health Board July 2013 Locum Consultant Nirmal James Aneurin Bevan Health Board July 2013 STR Julian Garside James Paget University NHS FT July 2013 Staff Grade Gyorgyi Kamaras Luton & Dunstable Hospital NHS FT July 2013 Consultant Dean Burns Luton & Dunstable Hospital NHS FT July 2013 STR Ashid Kodumayil Nottingham University Hospitals NHS Trust July 2013 Locum Consultant Christopher Gough Nottingham University Hospitals NHS Trust July 2013 STR Abigail Millet University Hospitals of Leicester NHS Trust July 2013 — Asif Malik University Hospitals of Leicester NHS Trust July 2013 Consultant Catherine Carrick-White Barts Health NHS Trust July 2013 STR Matthew Warner Barts Health NHS Trust July 2013 STR Johann Grundlingh Barts Health NHS Trust July 2013 STR Anna Morgan Barts Health NHS Trust July 2013 STR Sarah Nunn Barts Health NHS Trust July 2013 STR Neal Durge Barts Health NHS Trust July 2013 Locum Consultant Derek Hicks Barts Health NHS Trust July 2013 Consultant Neil Slabbert Barts Health NHS Trust July 2013 Consultant Rosie Furse Royal United Hospital Bath NHS Trust July 2013 Consultant Chris Peter Royal United Hospital Bath NHS Trust July 2013 STR Teresa Bentley Royal United Hospital Bath NHS Trust July 2013 Consultant Rob Greig Jersey General Hospital November 2012 STR

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