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Author: Linda J. Kesselring, MS, ELS, Copyeditor
Originally published: Common Sense July/August 2013
This article marks the last of a series that has aimed to highlight how you can use simple technology to make your learning more efficient and effective. In previous interviews with leaders in emergency medicine (EM) education — Drs. Mel Herbert, Amal Mattu, and Scott Weingart — we learned the value using free websites, blogs, podcasts, and ECG videos to stay current with medical information and save more lives. Continuing that theme, I recently had the pleasure of interviewing Haney Mallemat, MD FAAEM (@criticalcarenow), an EM/IM-trained critical care specialist who works in the adult emergency department at the University of Maryland Medical Center as well as the critical care ICUs in the R Adams Cowley Shock Trauma Center in Baltimore, Maryland.
Dr. Mallemat is a rising star among EM educators. His simple and effective teaching methods have made him very popular on the lecture circuit at an international level. As one of his current residents, I can tell you that he is highly regarded by his colleagues as a stellar clinician and passionate teacher. Aside from his multiple board certifications, he has phenomenal ultrasound skills and is always willing to teach and discuss interesting cases. He has won multiple teaching awards and, most importantly, has been using technology to provide a forum in which cutting-edge EM education is disseminated for free to an audience of thousands of international followers. In this interview, we gave him more than the 140 characters he is used to on Twitter, and he dropped knowledge. He lists his favorite blogs and people you should be following on Twitter to keep up with the wonderful world of free open-access meducation (FOAMed). Whether you are a medical student new to EM or a seasoned attending physician looking to keep up with new literature and best practices, check out Haney’s suggestions to improve your learning.
AF: Tell us a little about your educational background and how you chose to practice emergency medicine and critical care.
Dr. Mallemat: During medical school at SUNY Downstate in Brooklyn, New York, I realized I really liked critical care and decided to stay there and do a combined EM/IM residency. After completing that, I did a critical care fellowship at Dartmouth-Hitchcock Hospital in New Hampshire. It was a two-year internal-medicine based fellowship, but focused on multi-disciplinary care; and allowed me to work closely with anesthesia, surgery, and internal medicine attendings. So, I was fortunate to get a really interesting blend of critical care teaching.
During my years there, I spent a significant amount of time working with cardiologists, learning how to do trans-thoracic and trans-esophageal echocardiography. I liked it so much that I took the echo boards and continue to use ultrasound frequently in my practice. After training, I found myself at the University of Maryland, where I split my time between the emergency department and the ICUs. I also dedicate a significant amount of my time to teaching ultrasound.
AF: What are your thoughts on the role of technology in medical education? How do you use it to help you learn, teach, and simplify your academic life?
Dr. Mallemat: There's so much good stuff out there! When I was in residency, it was all about getting a textbook and trying to read it cover to cover. Now, it's rare that I open a textbook. By the time the textbook comes out, it's likely three or four years old, right? So, I'm really embracing technology, to stay on top of the latest literature and information. I regularly read blogs and learn from audio/video podcasts that discuss the most up-to-date clinical information available. The traditional publications process takes a long time and the information is dated by the time it is printed in many cases. Instead, I can seek information straight from the experts and find out what they're doing in their practice to help make my learning more efficient.
I use a RSS feeder to aggregate my favorite blogs and educational resources, and I read when I can to stay current. To reciprocate, I use Twitter and social media to disseminate information to other people who may not have discovered it yet. It promotes discussion and active learning. When used correctly, technology can be a powerful tool that helps us collectively sift through all the stuff out there and extract the information that matters.
It's also an opportunity for me to reach out to people when I have questions or want to learn more about a controversial topic. There was recently a debate with two very smart guys on Twitter about the use of cricoid pressure during intubation. I learned a lot just by listening to them go at it. Sometimes when I am in a bind, I will just throw out a question to my followers on Twitter to see what I get. Usually within just a few minutes, people write back from across the globe, sharing their practice, complete with references and reasoning. There will be discussion and we'll get on to Skype or Google hangouts and start debating it live. It’s amazing.
Just a few years ago, you would have to wait to go to an annual conference to get a chance to hear the opinion of experts in the field and ask them questions. Today they are tweeting their opinions for free! I can interact with my colleagues from all over the globe from the comfort of my bed … it’s crazy!
AF: What advice are you giving to your students and residents who are looking to use technology to make their learning more effective and efficient?
Dr. Mallemat: This can turn into a double-edged sword. I think the incorporation of technology for the purposes of medical education is still in its infancy. Currently it favors those who have finished their formal training and are looking to stay up to date, purely because they already have a strong medical knowledge foundation. The problem right now is that there's a lot of dialogue on the Internet, and people who don't have a good educational foundation can easily take the information out of context. Just because two experts debate a topic on Twitter, does not mean interns should pick a side and start treating their patients with experimental therapies the next day.
Advanced learners have an advantage in that they can put these discussions into context, but new learners must be cautious not to take short cuts to avoid confusion. Many of the blogs are in their infancy and not “peer reviewed” in the traditional sense, so it is important to have the basics down before you engage the experts. Junior learners should start with their assigned textbooks and curriculum, but not be limited by that, and actively use technology to supplement their education.
AF: What are your top five recommendations for people new to FOAMed and online learning?
Dr. Mallemat:
- To learn about open access resources, the best place to start is lifeinthefastlane.com/foam. Life in the Fast Lane is an amazing website where you can find just about anything FOAM related.
- Use your institutional access to gain access to online textbooks. Access Emergency Medicine has all the main EM textbooks online. Take advantage of resources that are free while you are in school or residency, because they are much more expensive afterwards.
- As your knowledge base improves, start with sites like EMedHome.com to watch video lectures from experts and national conferences. Again, several residencies offer free subscriptions, so make sure you are taking advantage of it.
- Use Medscape or an equivalent resource with an app that you can use for rapid drug and disease information on the go.
- Join Twitter! Start by following @FOAMstarter for 25 of the most popular #FOAMed tweeters.
AF: How about for more advanced learners? What are your favorite top 10 blogs or people you are following on Twitter?
Dr. Mallemat: That is tough because there is so much good stuff out there. Off the top of my head and in no particular order …
- Life in the Fast Lane is also great for advanced learners. That site has great weekly reviews that spotlight the best and brightest from the entire blogosphere.
- EMCast by Amal Mattu (@amalmattu) hosted on EMedhome.com, a podcast that has great case-based panel discussions with lots of practical clinical pearls. He also puts out weekly ECG videos that are a must watch at ekgumem.tumblr.com.
- EMCrit (emcrit.org) with Scott Weingart (@emcrit) is a must read for anyone interested in critical care. It's definitely an advanced forum, mostly senior resident or fellow to attending-level discussions.
- Resus.Me by Cliff Reid (@cliffreid) is another fantastic one. He's on top of the resuscitation literature and does a good job of reviewing it.
- EMRes blog by Bob Stuntz (@BobStuntz) for ultrasound and general EM topics.
- ERCast by Rob Orman (@emergencypdx). Great literature reviews.
- Critical Care Perspectives in EM (@critcareguys) is an awesome podcast hosted by some heavy hitters in the critical care world.
- EM:RAP hosted by Mel Herbert (@MelHerbert) has several experts covering a wide range of EM topics. This can be costly when you are done with training, but RSA members have free access.
- Ultrasoundpodcast.com hosted by Matt and Mike (@ultrasoundpod) is awesome. Check them out and practice.
- Sonospot.com by Laleh Gharabaghian (@Sonospot) is another fantastic ultrasound resource.
AF: EM in particular has been quick to accept FOAMed and use social media for education. Why do you think that is? Are you optimistic about the direction the field is taking? What do expect from the future of FOAMed?
Dr. Mallemat: Because we're amazing people, that's why. I mean, honestly, if you look at the landscape of how emergency medicine does things, you'll notice we are a pretty progressive specialty. We are a young group of talented and capable folks who really had to fight to prove ourselves. The result is that we push things forward.
In regard to the future, I think it's just a matter of time before the classroom is completely dead. We use the classroom to get together and to discuss things, but you and I are talking right now over the Internet. There should be no reason that we should have to meet in person, other than to high-five or just to pound it. The classroom will die, and I think that's the next level for FOAMed, so rather than residencies doing things in isolation, I expect a more collaborative approach.
Emergency physicians as a community will start to teach one another, and there will be this new type of digital classroom where ever we unite to educate ourselves much more efficiently. The best lectures will be crowd sourced and we will work together to be better doctors, avoiding the redundancy and inefficiencies of our current methods.
Editor's Note: It has been a pleasure interviewing these amazing leaders in EM, and I hope you have enjoyed and benefited from the series. I welcome and appreciate your feedback on and thoughts on the advancing role of technology in EM education. Please send comments and suggestions for future articles about technology and emergency medicine to alifarzadmd@gmail.com and follow me on Twitter @alifarzadmd.
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