Bridging the quality gap: Becoming a peer-reviewed blog

We are now a peer-reviewed blog.
Starts today.

I have been frustrated (in a good way) by the recent social media discussions (see BoringEM.com) about how social media content is viewed with a skeptical eye by medical educators, academicians, and professionals because of the lack of formal quality-control mechanisms.

Common questions from skeptics:

• "Is it peer-reviewed?"
• "How can I tell that it is a quality blog post?"

These are reasonable questions to ask. These questions, however, can not be answered with traditional answers.

• Blogs with greater web traffic most likely have higher-quality content by word of mouth and external linking from other websites. 
• The power of the crowd "course-corrects" for errors, such as Wikipedia. 

Still these are not very satisfying answers. Can we do better?

Social media-based medical education (FOAMed = Free Open Access Meducation) has gained much popularity through a grass-roots approach, but now faces a glass-ceiling effect. Learners gravitate towards it, but traditional educators still shy away from it. Blogs often fall short when compared to the gold standard of print journals, which have a formal peer-review editorial system for quality control. This remains the gold standard despite known faults and biases in the system.

So this past weekend, I was frustrated into action!

I experimented with several blog models (example) to create a more formal peer-review process. The basic premise is that the power of the crowd should not be undervalued, as demonstrated by the star ranking system on commercial sites such as Amazon, Yelp, and Netflix. Think about the last time you revised your purchases based on reviews. Similarly, our star-rating system, which will be seen at the top of our blog posts, can now help readers assess the quality of each blog post, to assist less discriminating readers regarding content quality.

To make this work, I hope that our readers will help the FOAMed community by rating each blog topic that they read using the following criteria, which mirrors similar metrics for journal manuscripts:

At the bottom of each blog post, raters will be asked to give optional, anonymous demographic information about themselves to help demonstrate external validity.

Under this form will be a public link to the Demographics results (sample Google Docs sheet), in case people are interested.

In this past weekend's experiment, I received 6 peer reviews in the first 4 hours, which included 1 medical student, 1 resident, 3 practicing physicians, and 1 paramedic from 2 countries. (Thanks to those who responded!) How amazing is that? Contrast that to print journals who typically have 2-3 peer reviewers read your manuscript.

Now the question is: How many crowd-sourced reviewers will be needed to demonstrate an adequate quality-control process? I don't know. The more the better, I assume.  

Comments?

Welcome to the blog team: Dr. Javier Benítez

It is with great pleasure that I introduce the newest member of the Academic Life in EM blog team -- Dr. Javier Benítez. He is an extremely active EM Twitter educator (@jvrbntz), who can efficiently convey key concepts in 140 characters or less! Got a short attention span? Follow Javier's Twitter feed.

Currently, Javier is posting "Question of the Day" tweets, which reference the Paucis Verbis pocket cards on this site. It is a perfect example of a bridge between blogs and Twitter for medical education. He'll also be posting on the blog as well.

Here's a short blurb from Javier:
I went to medical school in SUNY Downstate in New York City where I became interested in emergency medicine and critical care. My other interests include medical education and social media as a tool for medicine. My goals are to practice medicine in an academic institution where I can work closely with medical students and residents. I have used Academic Life in EM as a learning tool and it has proven to be quite effective. It’s an honor to take part on this blog. My hopes are to inspire and educate other learners about the wonderful world of emergency medicine.

Live blogging tomorrow

Tomorrow is the beginning of our department's 2nd annual High Risk Emergency Medicine conference in Hawaii. The day's focus is on ultrasonography. I'm going to try to live-blog some of the clinical pearls that I glean from the day.

Blog incubation project: New 2 winners!

And the winners of the first ever EM Blog Incubator competition are...

Dr. Jim Campagna (Emergency physician at St Joseph's Hospital Health Center in Syracuse, NY) and Dr. Timothy Peck (Beth Israel Deaconess EM resident in Boston, MA)

Both submitted really fascinating concepts for their blogs. I'm really looking forward to reading each of their 3-part introductory series in the upcoming weeks, as they prepare to launch their own blogs.

Dr. Jim Campagna

Jim plans to focus on the all-things-technology in Emergency Medicine. This includes reviewing and aggregating lists of medical apps and hardware which are relevant to the specialty. Furthermore, he will provide up-to-date literature reviews of other technologies, such as electronic medical records and computer physician order entry, and their impact on clinical practice.

Dr. Timothy Peck

Tim isn't a newcomer to the blogging world. He has a fantastic blog "Teach, MD: Rethinking medical education" since July 2011. On his new blog, Web 2.0 Changed My Management, will feature examples of how Web 2.0 influenced the management of specific patient encounters. Also guests will be allowed to contribute mini-case presentations where they will report how a Web 2.0 activity changed how they managed a patient.

I can't wait to see what Jim and Tim come up with!

Crowdsourcing all of your burning questions about EM

Have you noticed that on "Who Wants To Be A Millionaire", asking the audience as a lifeline almost always results in the right answer (over 90% of the time)?

Dr. David Thorisson (Lund University, Scandinavia) recently approached me with a novel idea of doing the same for Emergency Medicine questions. These questions are currently posted to a public Google Docs document, which allows anyone to post and answer questions.

Google Docs link:
http://bit.ly/sWx7if

Some questions already posted include:

• Can you share your tips for distinguishing between paroxysmal SVT & atrial fibrillation (when the rate is regular)?
• What are the contraindications to low-dose ketamine (0.1-0.5 mg/kg) for sedation or agitation? 
• What is an accepted rate of miss for 1) ACS 2) PE 3) SA 4) Aortic dissection 5) C-spine fractures (requiring and not requiring treatment)?

Read about how David got started with this intriguing and innovative new project on his blog site Priceless Electrical Activity. Feel free to post more questions or take a stab at answering a question.

The future of the ALEM blog

It has been over 2 years now that my guest bloggers and I write blog posts 5 days a week. The process of writing, maintaining, and collaborating on ideas for the blog has completely changed my career. It has opened new doors, introduced me to new colleagues and friends worldwide, and clarified the direction of my career.



Now as I find myself involved with more projects, I need to re-structure my time (unless someone can find me an extra hour a day to work). It was a good run though. Honestly, I'm surprised that I maintained this pace for so long. The blog was meant to be my little experiment and foray into the Web 2.0 world to catalog my personal thoughts and learning.

So after much consideration, I will be moving from a Monday-Friday schedule to a Tues and Friday model. Whenever I encounter interesting resources, I will post them on an intermittent, unscheduled basis. This contradicts the teachings that one can only gain blog followers with a very regular schedule, but then that was never my goal. So here is the schedule, based on popularity trends that I have noticed:

• Tuesday:  Tricks of the Trade tips


• Friday: Paucis Verbis cards

I still welcome readers to contribute ideas, tricks, and Paucis Verbis cards. Often these get more internet traffic than my own posts!

Happy Friday the 12th

OK, I just made up a holiday. 

I totally ran out of time to make a new Paucis Verbis card today, because I'm at a big 3-day retreat on developing a new online software resource for EM. I'm the co-Editor in Chief of this online and mobile app tool. Looking to take over the world. I want to divert from traditional practice where authors are invited by colleagues, based on the fact that they are friends or the topic relates to their area of research. Instead I'm soliciting the virtual collective for interested authors!



If you are a faculty member and interested in being an author for a digital textbook chapter in the EM areas of Trauma or Psychiatry, please email me. I can provide more details.

Joining the Facebook age

With the recent "awesome" news about Facebook teaming up with Skype for video chatting yesterday, I thought it was time for the blog to also join the Facebook world. Thanks to Dr. Hans Rosenberg for pushing me to do this.

I finally created Academic Life in Emergency Medicine's Facebook Page. I think that it works. By clicking on the Facebook "Like" icon in the right column of this blog, your Facebook stream should import each blog post automatically. Suggestions for improvement on the Facebook Page are welcome.

Building the page was a rather user-UNfriendly process. Briefly, here are the steps if you are interested in building your own Facebook Page.

1. After creating a Facebook Page, click on Edit Page button in the upper right.

2. From the left column, select "Apps". One of the apps is "Notes". Click on "Go to App" under Notes.

3. In the bottom left column, click on "Edit Import Settings". This will then ask you to enter the URL of the blog that you want to import.

Practical Teaching in EM - Second edition coming in 2012

For educators in Emergency Medicine, there is a great handbook called "Practical Teaching in Emergency Medicine" by the super-star team of Drs. Rob Rogers, Amal Mattu, Mike Winters, and Joseph Martinez. While I don't have any financial relationship with the publisher, I do have a chapter on "Teaching Off-Service Residents".

In the upcoming second edition of the book, I'll be co-authoring with a friend Dr. Amer Aldeen who has recently published articles on this topic. He's also the lead author on the paper describing the NURRC videos.

Should be a fun chapter to revise.

Computer simulation DIEM case goes live!

Welcome to the new age in medical education for EM!

I've been working on building these interactive, online simulation cases for CDEM for the past 2 years. Finally, the pilot case (a patient with chest pain) is finally out! EM medical students across the country are trying their hand at diagnosing and managing the patient. Preliminary data shows that the case is easy to navigate and students enjoy the ability to make decisions autonomously.

This is the first case in a series called "Digital Instruction in Emergency Medicine", or DIEM cases. These cases allow the user to navigate through a variety of patient complaints and presentations. Similar to high-fidelity simulation, these cases are dynamic, contain multimedia content, and provide a realistic approach to patient management; however in contrast, users can complete these cases anytime and anywhere. All you need is internet access and a computer with Flash capability.

The DIEM modules are especially unique in several ways:

• There is a timer built into the cases to enhance a sense of realism.
• Many parts of the physical exam are displayed for the user to interpret (rather than telling the user what was found).
• When ordering laboratory tests, each test must be justified.
• At the end of each case, the user is required to write up the Emergency Department chart. Documentation is a crucial skill, which medical students often do not get to practice enough in the age of Electronic Medical Records.
• Similar to true simulation exercises, case debriefing is just as important as participation in the case. There is a debriefing section for each DIEM module, which includes an area for self-reflection, a discussion of Critical Actions, and the "ideal" chart writeup.'

It really helps to watch the short instructional video above to help you navigate the case. You'll need about 45-60 minutes for the whole case (if you include the chart writeup and all of the debriefing info that follows the case).

Go to the DIEM case on Chest Pain

The DIEM cases will all live on the CDEM Curriculum site, which also houses the online EM textbook available for free. This was written by CDEM faculty members for the senior medical student level.

Work in progress:Translating videos into Vietnamese

Sometimes you just have to be lucky to get projects done.

In anticipation of our Vietnam trip in October to teach clinical decision software to pediatricians (KidsCareEverywhere), we are kicking preparations into high gear. One of my tasks is to create new KCE-PEMSoft training modules not only in English but also Vietnamese. And no, I do NOT speak a lick of Vietnamese.

Luckily a friend referred me to Dr. Phuc Nguyen, who is a retired physician from Moncrief Radiation Oncology Center/UT Southwestern Medical School. We still haven't spoken in person yet, but he is my new best friend! It's rare to find a physician, who speaks fluent Vietnamese, is computer saavy enough to record voice audio, generous with his time, and able to volunteer on short notice.

In less than 2 weeks, he has translated our modules and recorded his own voice to overlay the videos. Each sentence was recorded separately into individual audio files so that I would know where to insert the sentences.

Check out the videos below. How COOL is that?

Work in progress: iShowU HD software

Have you ever needed to create a video that required screen-capture recording? As an educator, I have managed to do this using Quicktime Player's "New Screen Recording" option. This allows you to record everything on your screen. Unfortunately, this includes recording the area of interest (good!), plus your messy folders and an embarrassing background photo on your desktop (bad).

There are a few free video-capture tools out there, but I find that the resolution is poor, especially if you want to zoom up on particular aspects of the screen.

Recently, I discovered a relatively affordable software called iShowU. Although I am not intentionally a Macintosh-snob, this software is only for Macs. There are three tiers of functionality: iShowU ($20) , iShowU HD ($30) , and iShowU HD Pro ($60). I bought the middle one. Demo versions are available for free, but they have a subtle watermark on them.

What do I love about iShowU HD?

1. You can select what part of the screen you want to video-capture.

2. If you have watched training videos before, the mouse and mouse-clicks can be difficult to appreciate and follow. This software automatically creates a "click" noise and animates the click with an expanding green circle halo. These audio and video cues are critical to keep the viewer's eyes focused on your teaching point. Go to the 00:45 mark in Training Module #1 below to see the mouse-click feature in action!

3. When you type anything on the keyboard, the software automatically displays these letters/numbers simultaneously at the bottom of the screen for emphasis.

4. The resolution of the videos are amazing.

I am in the process of creating English-language and Vietnamese-language training videos on using a medical decision software PEMSoft. In case you were curious, here's how they were made:

• Video captured using iShowU HD
• Audio captured using Quicktime Player ("New Audio Recording" feature) - Each sentence is a separate audio AIFF file.
• Matched video with audio on iMovie
• Exported video without audio into Flash CS4 - to create simple animations and overlay text
• Re-imported Flash-edited video back into iMovie where it was re-matched with the audio
• Uploaded into Youtube from iMovie

These updated videos are up at our KidsCareEverywhere website and the PEMSoft website as well.

Training Module:

An Introduction

Training Module #1:

Basic Navigation and Utilization of PEMSoft

Training Module #2:

Phoenix Resuscitation Calculator

Disclaimer: I do not have any financial ties with this software company. Just a fan.

Need your help: Blog is joining the Facebook world

Last week, after reading more about blogs and their integration with Facebook, I thought I would give it a try. For those who check their Facebook accounts frequently, this may be an easier way to check-in on my blog posts. I initially built a Facebook Fan Page which imported this blog. It was supposed to then automatically import the updated daily content using a RSS feed. Unfortunately, this automatic feature doesn't work. So, I gave up on the idea and deleted the Page.

Just before abandoning all hope, I encountered a workaround third-party application called Networked Blogs. This application automatically imports your blog content in real-time. You can supposedly "follow" my blog from your personal Facebook page through this interfacing app.

You can access the link by clicking on the Facebook icon above or on the upper right of this screen. The only foreseeable downside is that you'll have to allow this third-party app access to your Facebook account. Click on the blue box "Follow". I would love to hear if this works or not.

Do my posts appear in your News Feed list or in an obscure section, such as the "Applications" page? Thanks for your help.

Work NOT in progress: ACEP Tricks of the Trade column

Since 2006, I have been the ACEP News columnist on "Tricks of the Trade in Emergency Medicine." Four years later, I've published and co-published 33 articles on various both low-tech and high-tech pearls.

It's official -- I'll be stepping down from the ACEP News columnist position and handing off the reins to someone with fresher ideas. Frankly, I'm running out of innovative ideas worth publishing about.

It was a tremendous opportunity for me to share some of my ideas with interested readers and I wanted to thank ACEP News, my editor at ACEP News (Terry Rudd) who fixed all my images and bad grammar, and Dr. Mary Jo Wagner (Synergy Medical Education Alliance) for trusting me to write the column.

Looking back, people have asked me how I came to be the Tricks of the Trade columnist. Like everything that I've done in academics, it's all about 50% luck and 50% hard work.

I had worked on writing a few chapters for a 2005 textbook that Mary Jo was involved in. I kept to deadlines and worked hard to make the chapters as well-written and updated as possible. Concurrently, I was building my lecturing skills by speaking at various AAEM and ACEP conferences. It was at one of these conferences at Mary Jo curbsided me and asked if I was interested in writing something for ACEP News. It would be a new column intended to help practicing emergency physicians to troubleshoot common dilemmas and obstacles in the ED, using innovative tools and approaches. The only instructions I got were -- Make it fun, make it practical, and include lots of photos.

It took me all of 2 seconds to overcome my insecurities and questions of "why me?" to jump at this awesome offer!

So if you too are looking for opportunities to get involved with various projects, I would say --

• Keep an open mind (and ear) about interesting projects.
• Always work hard. The quality of your work reflects directly on your skills, accountability, and reputation. Trust me -- it'll pay off in the long run.
• Don't burn bridges. You never know how your network of colleagues may help you down the road.
• Attend 1-2 national conferences annually. It's almost impossible to be present at these conferences and NOT get involved with meeting new people, listening to fascinating discussions, and joining collaborative endeavors.

Blog's one year anniversary

The blog is already one year old! What started initially as a little educational experiment has now evolved into a potentially long-term endeavor. It was initially built as a sort of personal journal of what I've learned and read about in the field of academic emergency medicine and educational technologies. Now I've it focuses on academics, clinical emergency medicine (Paucis Verbis cards), faculty and resident development, and technologies.

Here are some statistics over the past 12 months:

• 36,085 visitors from 4,713 cities
• Recently about 100-180 visits per day

Looking back, the most popular posts based on number of hits:

• Diagnosing Retinal Detachment Using Ultrasound
• Article Review: Career in Academics
• Article Review: Family Presence in Resuscitations
• Trick of Trade: Subclavian Line Gone North

Most popular posts based on number of comments:

• My Poster on Blogging
• Trick of Trade: Minimizing Abscess Odor
• Trick of Trade: Chemical Sedation Options

As this blog continues to evolve, what would YOU like to see more of?

I hope to recruit a few academic emergency physicians to create a team of recurring super-star authors. Keep a lookout for them.

Choosing a font

When speaking to a graphic designer or graphic artist, I found that font selection is a major decision in any product. Once I innocently asked, "What's your favorite font?" The answer started with "Well it depends..." One hour later, I still didn't have an answer.

As more people are writing their own blogs and e-newspapers, designing their own logos and invitations, and publishing their own do-it-yourself books, appropriate font selection is crucial. Readability and spacing make and break first impressions. If you don't have time to take classes in typefaces (i.e. fonts), I found this very useful and funny algorithm to serve as a guide.

Generally, the algorithm guides font-selection for:

• Books
• Invitations
• Infographics
• Logos
• Newspapers

Check out the larger version here: Typeface algorithm

Managing Twitter accounts - Hootsuite

Do any of you have a Twitter account? Do you have MULTIPLE Twitter accounts? As a quick, social media format, Twitter has allowed us to learn of everything in the world as it happens in real-time. This includes Gary Coleman's death, oil spills, natural disasters, ongoing conference events, and updates from the CDC.

Increasingly so, people are managing multiple accounts. This helps you divide personal "tweets" from work-related "tweets". For now, I personally think Twitter is ideal for work-related and world-related news. Thus I follow such "feeds" as:

• @CDCemergency
• @ACEPNews
• @TED_Tweets
• @CNNbrk (stands for CNN Breaking News)
• @Oprah

Just recently, I joined the Society of Academic Emergency Medicine's (SAEM) Social Media Committee, which is headed by my friend and colleague Nick Genes (@blogborygmi) at Mount Sinai. Nick is leading the charge to revamp the SAEM Facebook page and Twitter account (@SAEMonline).

In anticipation of the upcoming SAEM meeting during the first week of June 2010, those who subscribe to the @SAEMonline feed have been getting routine "tweets" of high-profile abstracts being presented at the meeting.

Since I've been posting a few tweets recently under the @SAEMonline account, I learned how to use Hootsuite at http://hootsuite.com. Here are screen captures from my personal Twitter account (@MLin) and SAEM (@SAEMonline).

@M_Lin

@SAEMonline

Hootsuite is an amazing website that allows you to easily navigate, read, post, and manage multiple Twitter accounts, instead of logging into and out of Twitter every time you want to post from a different account name. You can even schedule tweets to be released. Oh, and did I mention that there is a free iPhone app, which allows you to manage these accounts on the go?

Check it out at http://Hootsuite.com. I would even consider using this even if you have a single account. It has a nice layout and logical flow to the site.

Disclaimer: I have no financial affiliation with Hootsuite.

Work in progress: Videoconference talk at Stony Brook EM Residency

I am about to give videoconferencing another try Wednesday. My friend Dr. Taku Taira (Assistant Program Director at SUNY Stony Brook EM Residency Program) invited me to give a talk to his residents this week. I'm giving my "Tricks of the Trade in Emergency Medicine" lecture, which summarizes a list of my favorite practical tips in the ED.

As with any high-tech endeavor, preparation and backup plans are critical. Taku and I always assume that there will be a technical glitch and we have several backup options.

I recently came across a helpful list of do's and don'ts in videoconferencing by Dierdre Bonnycastle (Clinical Teaching Development Coordinator at the Univ of Saskatchewan's College of Medicine).

• Preplanning Stage
• On the Day of the Videoconference

The issues covered include:

• Slide font size and layout
• Pacing of the talk
• Attire (avoid whites and bright colors to improve camera focusing on you)
• Be wary of the audience and what they can see (use the mouse instead of a laser pointer)
• Have a "spotter" in the audience who will interrupt speaker if there are questions.

In my case where I am giving a talk from my laptop at home, I would also add at few more tips:

• Position the camera so that it is at eye level with the speaker. It seems a bit awkward having the speaker looking down towards the audience.
• Put a post-it note on the camera saying "LOOK HERE". Instead of looking at the slides, the speaker should really be looking directly at the green or red light from the camera. I find it distracting when the videoconference speaker is looking down and to the side all the time. I think psuedo-direct eye contact engages the audience more (even though I can't really see the audience).
• Don't wear eyeglasses. The light from the screen or other ambient lighting will likely reflect off of them causing a distracting glare on the screen.
  

Embedding Powerpoint slides into website using Picasa

Have you ever wanted to post your powerpoint slides onto your blog or website? It's actually easier than you think. You'll need:

1. Your Powerpoint file
2. A free Google Picasa account
3. Your target website or blog

Steps:

• Within your Powerpoint file, select "Save As..."
• Save your files in PNG format. This will convert each slide into a PNG image file.
• From your network browser, open your Picasa account.
• Upload the individual PNG files into a New Album (see below for example).

• Select "Embed Slideshow" (bottom right of browser page).
• A new window will pop up. Choose what size slideshow you want and copy the HTML text provided.

• Paste the HTML text into your website or blog.
• This will create a Flash-based slideshow.
  

Below are slides from my talk at the 2010 UCSF Education Day conference on the negative impact of ED crowding on education.

Joining the Research Blogging community

Yesterday, I posted a review of an Academic Medicine education article on how to prepare medical students for their clinical clerkships, based on the Kolb learning cycle model. My blog post is now also linked and searchable from the Research Blogging network at http://researchblogging.org. Thanks to Life in the Fast Lane, who told me about the site.

What is Research Blogging?
It is a website, which aggregates blog posts that write about peer-reviewed articles. These articles span the entire spectrum of academic research and not just Medicine. My post about the education article is now linked and searchable from this website.

Here is a review of the website from Wired Magazine.

What a great idea to build an aggregator website with a focus in peer-reviewed academic research. It is a perfect bridge between the two worlds of traditional academic research and the Web 2.0 era of blogs and interactivity. I wish I had thought of this idea.