#dasSMACC Day 3. St.Emlyn’s on tour

 

#dasSMACC

Day 3 at #dasSMACC

After a gala dinner of somewhat epic proportions it was back bright and early to the Tempodrom to get back to work.

Simon chaired the first panel of the day on the future of medical education. An amazing panel of leaders in simulation, online education and bedside teaching tackled the tough questions in medical education.

The main themes were around the challenges of delivering education in a clinical, political and technological landscape that is so fluid and complex. In effect we are often teaching for a workforce who will need competence not just now, but also for how medicine will be in 5 years and beyond. This is a real challenge for many educators and in the end comes down to focusing on those skills that are transferable across an unpredictable future.

Technology is hugely influential on our practice already, but the likelihood of increasing automation, decision aids, machine learning and even artificial intelligence may change what the clinician of the future excels in. Dan Cabrera made the point that we  should perhaps be focusing on those skills that machines may not be able to do. Balancing risk, perspective, and uncertainty, combined with human and empathetic skills may well be areas that define the senior clinician of the future. Back in Virchester we’ve seen this at undergraduate level as the universities are shifting focus to developing generic skills around complexity and uncertainty. Complexity and uncertainty are things to value and train for.

Simulation was a hot topic throughout the conference. The panel were challenged on how we quantify its impact. Clearly there are issues with access to what we might perceive as classical ‘simulation’ sessions. Walter, Jenny and others reminded us that sim might be most effective in changing our skills and abilities to feedback in all situations, with sim becoming a training tool to improve all our teaching, and with a continuing emphasis on the need to promote and value bedside teaching. This was a key point for me in understanding how sim training can improve all aspects of our practice and more widely the whole experience of being an emergency or critical care clinician. Consider simulation as a tool to train for and develop our debriefing and feedback skills across our entire practice and not just in a teaching session.

Assessment next, and the complexities of making sure that the assessment tool we use is suitable for the task we are testing. Vic reminded us that there is a wealth of science behind assessment that can help us tailor the right assessment to the right task. Sadly, this is not always the case in practice and I think the panel accepted that we need better, more reliable and more aligned assessment processes. Simon asked the question ‘how do you know if you are any good?’ to the panel and the audience and once again found it a surprisingly difficult question to answer. I guess that it’s tricky to know for yourself, but your colleagues may well know… Getting that honest feedback is challenging and I liked Vic’s idea that we should seek out and have some degree of formal arrangement with a ‘peer coach’ to seek out the honesty and objectivity that we need.

If you want to know more about the first session than can we point you at this amazing summary from Jesse Spurr.

How to fail – Kevin Fong

Kevin is a great speaker with a CV that he described as ‘complicated’. His how to fail talk built on the one he gave in Chicago, and reminded us that healthcare systems are so complex that failure is inevitable. It is just not possible to see all of the small parts within the system that might go wrong, and so whilst we can’t avoid failure, we can try to fail in the best way possible. Modern computer systems have moved on from the blue screen of death failures, and are able to keep running despite components giving up. This is called graceful degradation, and is a concept we can try to take into our world. Failure is inevitable. Plan to fail. But plan to do it well.

You can see more of Kevin here, on a BBC program where he goes through the science of failure in healthcare.

Helping without harming – Jenny Rudolph

I’m sure most will agree they switched off their ears and switched on their phones around 30 seconds into Jenny’s talk, giving a masterclass in how not to deliver a lecture. Luckily Vic Brazil stepped in to save the day, and there was a collective gasp and sigh of relief when we realised Jenny had fooled us all. She then went to give what was a standout talk for me, and something I can really use to change my outlook. When a friend of ours makes a mistake, we want to help them, we want to find out if they’re ok, and why the mistake happened. If it’s someone we don’t particularly care for, this empathy and concern is replaced by the feeling of WTF?? but why? Shouldn’t we be compassionate towards all our colleagues? Change WTF? to What’s Their Frame? Are they hungry? Bad day? Look out for others. We’re all one big team.

It chimed with another strategy that we’ve used in the past when looking at error (or success) which is to not ask ‘why did someone make that crazy decision?’, but rather ‘why did that decision seem to be the right one at the time’. It basically takes some of the reactive judgement out of the (very dangerous) retrospectoscope and is a much kinder approach.

 

The global refugee crisis – Vera Sistenich

Wow. What can we say about Vera’s talk. I can honestly say she opened my eyes and probably the eyes of most in the room to what’s really going on in the world, how dire the situation is for some, and how the changing political climate is affecting how safe people feel not just in their own country, but in other countries too. “Crisis” doesn’t just refer to the fact that 65 million people have been displaced from their homes, and 25 million of these are refugees in other countries. It also refers to the crisis of how others view the situation. How we think that refugees cause an economic problem when in fact the cost is minimal, and with good rehabilitation refugees could contribute great value to their new country. The horrendous xenophobia hijacking that occurs as a result, despite the fact that the risk of an American being killed by a refugee terrorist is 1 in 3.6 billion. Her emotion and drive shone through, and with no doubt led to her receiving the first standing ovation of the day.

 

How to fail, part 2 – Martin Bromiley

Martin is well known for his fantastic work on human factors after his late wife, Elaine Bromley, passed away from complications relating to a can’t intubate, can’t ventilate situation, where such human factors had a huge role to play. He’s a deeply inspirational speaker and I was very excited to get to hear him talk at #dasSMACC. His journey in understanding what happened to Elaine, but also to what happens in wider healthcare, and then doing something about it, is incredible. In our opinion he has undoubtedly saved more lives through his work than anyone else in the room. Is he intubating, cannulating and defibrillating? No, but he as much an influence on resuscitation as any one of us, and we think that he is clearly deserving of the title honorary resuscitationist.

Martin’s talk and the final panel need more time to reflect on and we plan to revisit in a later post. It was so powerful, so emotive and so important that it needs its own space.

 

Peter Brindley interrogates Liz Crowe, and then finds redemption courtesy of Iain Beardsell

The highlight for some of the three days, Peter Brindley. After a love-fest with Liz Crowe, exploring resilience, and how we can support families and patients through the worst days of their lives, we got to hear about the worst days of Peter’s life. His struggles with burnout struck a cord with the many doctors, nurses, paramedics and other health care professionals at #dasSMACC. I’m sure we all know someone who has worn themselves out, or close to it, as a result of the job we do. His openness and honesty about his own battle with his mind was powerful. Both he and Liz shared some wonderful strategies to help to avoid burnout, and how to seek help if it does happen. It’s crucial to find other things in your life to help you leave the world of medicine behind. Meditate. Play sport. Something to take you away from our world and into your own. Liz reminded us that we need to get better at helping people to cope with burnout…

Trending towards togetherness – Annet Ngabirano

Was this the talk of dasSMACC? For many people, I’ve no doubt it was. Annet brought the whole audience together for a rollercoaster ride of emotions as she took us through a story of how she, together with two other medical students and a nurse, sweated and toiled to try to save a child’s life. Annet has a truly incredible gift as a storyteller and this is a talk I will watch and share widely when it comes out.

What was important was that how Annet drew parallels between all emergency care workers irrespective of where we work or the health care economies we are subjected to. She expertly interwove the similarities and the differences between emergency medicine in Uganda and other countries. She was inspirational as the first emergency physician in her country and the obvious fantastic efforts to improve emergency care there.

It was not without challenge. Annet asked how many African delegates we see at conferences and I think we know the answer. Time, cost and opportunity stand in the way of progress, but we can do something about this. Have you considered sponsoring an African delegate to attend a conference? Well perhaps you should think about doing that through the Supadel system.

It think we should all visit the Supadel site and donate. Annet also introduced us to the beautiful concept of Ubuntu. A unifying belief that we are all connected, that we are all bonded together in our humanity and that our destiny lies together and not apart. In a world of increasingly polarised politics this was really inspiring and was a great message for the SMACC community. This was truly a stand out talk ably supported by our friends in the crew from Brave African Discussions. Please go to Supadel and consider donating to Supadel, if the SMACC community donated even a small amount as a whole then we could really do something remarkable.

 

Critical Illness Panel chaired by Liz Crowe.

Gosh, this was amazing, deep, inspiring and yet so uncomfortable at times. We’re not going to review it now, but let it digest and come back to it next week. There were tears, joy, laughter and stunning moments throughout. Not a dry eye in the house……… At this time we just have to thank Martin Bromiley and James Piercy for their candour and honesty. Incredible stuff and for anyone who thinks they know the Elaine Bromiley story, then I’m not sure you do. This was a brutally honest insight into what it feels like to be the recipient of critical care. Just an incredible learning experience and an epiphany for so many of us.

And the end

Thankfully no #smaccFINALE this year (Simon still has nightmares), just thanks and best wishes to everyone who contributed. SMACC is over, and not just for another year, for another 591 days (at the time of writing). Put the 12th-14th February 2019 in your diaries, because we’re going to Sydney! We at St. Emlyn’s can’t wait to see you there.

 

vb

Chris and Simon

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2 Comments

  1. Pingback: #dasSMACC Day 2. St.Emlyn's - St.Emlyn's

  2. Pingback: Lessons Learned and Take Home Points from dasSMACC - Day 3 - R.E.B.E.L. EM - Emergency Medicine Blog

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