Did you know that I was gone to Vietnam for the past week and a half? I wrote several of the posts ahead of time and even posted a few from Vietnam. How DID we survive before the internet?
I just returned from Vietnam as part of the
KidsCareEverywhere/UCSF trip to teach a conference for pediatricians at the National Hospital of Pediatrics (NHP) in Hanoi. This is the primary pediatric hospital for the country. The KCE team consisted of Dr. Ron Dieckmann (Chairman of KCE and all-around Pediatric EM guru), Marlowe Dieckmann, Jamie Sharp, Hieu Do, and myself. I was amazed at each of our team member's versatility and creativity in troubleshooting, while also being able to serve as educators (or "intructors" as our misspelled certificates say), photographers, videographers, and ambassadors for KCE. It is incredible what you can get done with a few efficient and competent collaborators.
We were given an all-access tour of the hospital's Emergency Department and Pediatric ICU by our good friend, Dr. Tu Nguyen. As the Vice-Deputy of the Pediatric ICU, he was managing over 30 critical patients, but still was gracious enough to show our team around.
He even took our team out for dinner (despite being on-call). The dinner had turtle dishes along with turtle-blood vodka shots, but that's a whole other story...
It was quite overwhelming to see so many critically ill children with sepsis, ARDS, Japanese encephalitis, seizures, and various terminal diseases. There were high-tech ventilator and monitor equipments in otherwise low-tech rooms. There were no computers in sight in the ED and very few in the Pediatric ICU. Their one-room library had reference books ranging from 1980 to early 2000's.
Because of the paucity of computers in the clinical areas, I became worried about how computer-saavy the pediatricians would be. Our conference would be teaching them how to use a new decision-support software PEMSoft (Pediatric Emergency Medicine Software). This could revolutionize how they could access real-time and reference up-to-date information. We had requested that they bring their own laptops, but we were expecting only a few of the 50 registrants to have them. We each brought laptops to loan for the day and planned for many to pair or triple-up on each computer.
Much to our surprise, we found that almost every one of the 55 attendees had relatively new PC-based laptops. The pediatricians had come from across the country and consisted of almost equal numbers of women and men. I had anticipated that Medicine was still a very male-dominated profession in Vietnam.
We introduced them to the concept of PEMSoft and administered a brief multiple-choice pre-test of their knowledge base. This test was written in both English and Vietnamese. This study was IRB approved by the NHP hospital and UCSF.
Upon completion of the pretest, the pediatricians were given the donated CD software. They immediately began to upload the software even before we began the lecture on how to install it! We had assumed that everyone would be uncomfortable with using computers. Boy, were we wrong. We had to constantly catch up with the group's forward pushing momentum! We just had to watch for the few stragglers who were a little less tech-saavy.
After a demonstration of the concept of length-based resuscitation (using an infant's length to determine medication doses and equipment sizes), we gave everyone a retractable tape measure. This drew oohs and aahs from the audience.
Notice that my wild hair does not fare well in humidity... Plus I don't think my interpreter was amused by my demonstrating how to use the tape measure on him.Ron then reviewed how to use the PEMSoft software. From the back of the room, I could see that they were exploring various features on their own. It was so inspiring to see the enthusiastic nature of the learners, despite being in a crammed, hot, and humid conference room with minimal air conditioning. They really wanted to understand everything about the software.
We then broke for lunch and ate with the National Ministry of Health, who also happens to be a pediatric surgeon in the hospital. He expressed how impressed he was with our efforts and medical software.
Back at the conference, we administered the post-test now that the participants have been taught how to use the software. This was followed by a low-fidelity simulation demonstration of how to use the software in real clinical scenarios. Since the participants were extremely engaged and actively participating, we changed our simulation plans on the fly. Instead of Ron and my demonstrating the use of PEMSoft, we asked for volunteers to navigate the software during the simulation. Ron ran through each simulation scenario, while I guided the volunteer on the LCD-projected computer.
Before we knew it, volunteers were popping up left and right wanting to navigate the computer. Ron ran through at least 9 cases! We started with a simple status epilepticus case. Ron paused every few steps and would ask the volunteer for the equipment size, drug dose, recommendations for the next action, etc. The other participants would follow along on their computer, and the volunteer eagerly would answer his questions. The cases got progressively more difficult. You could just see that they were realizing the power of a clinical decision support software at their fingertips.
Looking briefly at our conference conclusion survey, everyone had universally rated it with top scores. Many wished that it was a 2-day conference. The Ministry of Health surprised us all by announcing that PEMSoft is now being named the official software for the hospital.
What's the next step for KCE?
- Finding funds to set up laptops and desktops in the NHP hospital's ED and Pediatric ICU so that they can use the software for real-time clinical care.
- Return to Vietnam to "train the trainers" in a more advanced teaching conference, where pediatricians would learn how to formally teach PEMSoft to their colleagues.
- Continue to customize PEMSoft to Vietnamese. We already uploaded various Vietnamese manuals and resources into PEMSoft (APLS and Newborn Care textbooks).
- Publish data from pre/post tests and survey.
While I have never considered Global Health as my academic niche, I can now appreciate it's appeal. It takes so few people to make a substantial difference in underserved countries. In a way, Global Health is a form of medical education.
This past year, I went on a KidsCareEverywhere trip to Vietnam where we hosted an educational conference in Hanoi, teaching Vietnamese pediatricians how use a medical software (PEMSoft) to improve their care of kids (prior blog post). We embedded a pre-test/post-test research study question. How well do pediatricians improve their clinical knowledge after spending 3 hours learning an English-based medical decision support software?
Map of Bhutan
This Saturday, KCE is having its inaugural fundraiser (download the brochure) and is going to play my 10-minute video. I have been posting the unfinished video productions on YouTube for feedback from KCE members. I've been sorting through hours of video footage and 1000's of photos, trying to distill and capture the essence of what we accomplished in Vietnam. I am learning tons about the newest version of iMovie, Quicktime, Flash, and Photoshop.
Much to our surprise, we found that almost every one of the 55 attendees had relatively new PC-based laptops. The pediatricians had come from across the country and consisted of almost equal numbers of women and men. I had anticipated that Medicine was still a very male-dominated profession in Vietnam.
After a demonstration of the concept of length-based resuscitation (using an infant's length to determine medication doses and equipment sizes), we gave everyone a retractable tape measure. This drew oohs and aahs from the audience. Notice that my wild hair does not fare well in humidity... Plus I don't think my interpreter was amused by my demonstrating how to use the tape measure on him.
Before we knew it, volunteers were popping up left and right wanting to navigate the computer. Ron ran through at least 9 cases! We started with a simple status epilepticus case. Ron paused every few steps and would ask the volunteer for the equipment size, drug dose, recommendations for the next action, etc. The other participants would follow along on their computer, and the volunteer eagerly would answer his questions. The cases got progressively more difficult. You could just see that they were realizing the power of a clinical decision support software at their fingertips.
Looking briefly at our conference conclusion survey, everyone had universally rated it with top scores. Many wished that it was a 2-day conference. The Ministry of Health surprised us all by announcing that PEMSoft is now being named the official software for the hospital.
For instance, the CDEM organization was built when a small group of undergraduate medical educators went to dinner during a SAEM conference. We conspired to build something bigger and better. Two years later now, we now have over 100 members and are a new member of the major interdisciplinary organization Alliance for Clinical Education.
1. This week, I got a call from Chad Kessler (Univ of Illinois-Chicago) who was interested in bringing medical education more to the forefront of EM. We brainstormed about building a "thinktank" of like-minded educators interested in pushing education to the 21st century. There is so much to be learned in the literature outside of EM and medicine in general. I suggested building a dynamic database somewhere to list the ongoing educational projects and research in EM. We too often work in silos. Collaboration is key in educational research. Any ideas how to build a database that everyone would participate in?
One problem which I'm still a little worried about is the access to laptops and electricity. Because we are testing the participants on their ability to navigate the new technology, we need everyone to have their own laptop. We doubt that participants will all have laptops, but we have backup plans to share. We're more concerned about poor battery life for the existing laptops and something as seemingly simple as access to electrical outlets. I have a feeling we'll be buying long extension cords while in Vietnam.
Check out our new 1 GB USB thumb drives that just came in! We are giving out to the participants, preloaded with the PEMSoft user manual, hospital-specific documents, and the lecture slides.
iPhone photo of the inaugural meeting at Baby Blues BBQ. Sorry it's so blurry - Digital SLR cameras apparently do don't well when dropped on the floor. In the Canon shop.
How can you help?
Have a nice weekend everyone. Should be nice weather here in the Bay Area. I am typing this blog on a beautiful day before my shift starts from my office "deck". This self-photo is taken from my secret, private 2nd floor patio surrounded by 3 brick building walls, accessible only by climbing out my office window.
His little office project, now called PEMSoft, quickly became an internationally-known decision support software for pediatric care. Now that he's retiring in July, it will be hard to keep up with all his big plans for our nonprofit organization, KidsCareEverywhere. His plan in a nutshell - world domination. See the logo? It's crazy- I came up with the preliminary idea on the back of a grocery receipt while cooking dinner one night.
In the hopes of improving advising for medical students interested in EM as a career choice, I have been working on behalf of CDEM (Clerkship Directors in EM) to revamp the now-defunct Virtual Advisors Program. I fully confess that I have been holding it hostage for a year, since I never quite built enough momentum to complete the project. It will be called E-Advisors. And yes, I know that it sounds a little too much like an online dating service.
