#Medutainment and Emergency Medicine. Part 2. Why are we talking about it?

Why is Medutainment in the news now?
I think there are two linked driving factors that have led us to start considering medutainment as a important component in medical education.

Technological change
Changes in medical decision making

The modern digitally connected world has changed the way that we consume information and thus how we practice medicine.

When I was a medical student I knew my anatomy, physiology and biochemistry really well. I prided myself on the ability to retain and regurgitate facts. We developed into walking libraries of information because we had to be. As an aspiring surgeon (I got better) my anatomy knowledge was excellent and I had pretty much memorized the anatomy texts in preparation for my surgical exams. We needed that repository of information as access to data was a completely different experience back then. Imagine a world without the internet, without smart phones and where literature searches literally had to be completed by hand using massive reference texts. I was the data bank because I needed to be.

Education thus focused on the transfer of facts, data and storage. Long hours were spent listening, absorbing and memorizing facts.

Whilst data acquisition and retention is still important for current medical students and doctors today technology has changed the way we practice and indeed the way that we think. Data from neurpsychologists even  suggests that the internet is changing the way that we think, that the internet is increasingly being used as an outsourced storage system for your brain.

In the western world access to data is increasingly straightforward and portable. Computers, smart phones and the internet allow us to practice in a way that we can describe as distributed intelligence. Instead of the clinician being required to carry all data with them, detail can exist in the cloud leaving the mind free to formulate. In my early years of practice access to information was needed literally at my fingertips and it still is today. The difference is back then the information flowed from the storage centres in my brain down, whereas in the modern world information flow is in the opposite direction from guidelines, google, websites, #FOAMed through touch and then back to the brain for use. I have the world at my fingertips via internet and I can then use my brain for processing rather than storage. Ideas, concepts, juxtapositions, relationships, interactions, assessment, probability and risk are now the main features of my mind and my practice, and whilst medicine still requires the acquisition of many facts (as it should – and in order to get through those pesky exams) it is the relative importance of simple data acquisition that has changed.

Medical education must change too as it is no longer simply the requirement to stuff facts into people’s heads. Rather the task for today is to develop our cognitive skills and that requires a different focus. Today’s educators need to engage with learners in a way that enhances these emotive elements of our learning. Learning can no longer simply be a passive acquisition of facts it requires processes that engage and entice learners to think.

Where are we seeing Medutainment coming into the modern world of EM education?

Social Media & reusable learning objects

#FOAMed and RLOs
We have seen an explosion in the use of free open access medical education (FOAMed) in recent years. Chris Nickson is speaking about this at EuSEM and we are obviously very keen on it here at St.Emlyn’s. Whilst #FOAMed is often thought of as being associated with social media activities interactions such as twitter and facebook, I would argue that its true benefit in medical education goes beyond this. Arguably the most influential long term benefit of #FOAMed is in the creation of reusable learning objects (RLOs). In essence educational components that can be captured, stored and accessed via the internet. For example a lecture given face to face may be fantastic, but it is lost in a moment of time and usually forever if it is not captured in some way. #FOAMed captured content, sometimes translating it between media (e.g. lecture – blog) and then stores and shares it for wider use. That interaction of learning then takes place within the internet where the medium itself alters and influences the message (Marshall McLuhan). Education is translated not just for the content, but also to the media itself. In the use of the internetand other technologies the message (the learning content) is itself altered by the form, with the expectation that the internet is an engaging place. This is a great concept and if you’re still struggling with this as an idea reflect on whether the experience of reading a book is different from listending to an audio book, although the content is the same, the experience and the message become altered. Those who are succesfull have  embracedof graphic design, personality, music, even dancing to engage with an online audience.

Screenshot 2015-10-10 19.25.32

For the generation of learners who have grown up with online immersion there is thus a requirement for online learning to engage and to embrace the technological capabilities of the medium.

For all that #FOAMed offers as a social movement it is the development of engaging RLOs that will most likely stand as it’s legacy.

Conferences too have changed in my time as an doctor. Those of you familiar with TED talks will know that there is a style associated with a modern presentation which might be described thus.

• The talks are short
• The talks are entertaining
• The package is familiar (like a TV series)
• There are clear messages – but no more than three.
• They are data light (in most cases), but context and idea heavy.

Screenshot 2015-10-10 18.40.51

Many are based around narratives, personal experiences and interesting stories, because stories entertain and entice people into a subject and allow them to place it within their own real or imagined narratives. Stories are not data but they are so powerful – they create emotions in listeners and so engage an audience.

Screenshot 2015-10-10 19.21.02

In emergency medicine we many of you will be familiar with the SMACC conferences which everyone on stage has spoken at and which Chris Nickson organizes. SMACC is the medical equivalence of TED where speakers are encouraged to be innovative in medical delivery and to share ideas and not just data. The phrase from one of the conference organisers ‘you’re only as good as your chat’ typifies the approach of the new socially aware and entertaining conference. It’s not just the data that matters, what makes a difference is how it presented, is it entertaining?

Tim Leeuwenberg from Kangaroo Island, SA. He's the one on the right.

Tim Leeuwenberg from Kangaroo Island, SA. He’s the one on the right.

A good example would be Tim Leeuwenberg’s talk on vulnerability in emergency practitioners. By chance both Tim and myself were talking at SMACC, at the same time but in different conference streams. My talk went well, really well I thought, but it did not have the same impact as compared to Tim’s talk. You can watch a screencast of the talk below, and watch out for the full talk later this year on the smacc website.

Tim presented himself as the vulnerable clinician, exploring the personal impact of adverse clinical outcome, dealing with bureaucracy and post-traumatic stress. Burnout, depression and substance abuse are all real threats to anyone involved in emergency medicine, but infrequently discussed. The talk built through great slides and presentation to the moment where he expressed his vulnerability by taking his clothes off on stage, almost naked apart from a strategically placed bag valve mask. There is no doubt that a bit of semi nudity associated with a bag valve mask is something that drives home the message and makes the talk instantly memorable. Again linking to a moment in time and a message rather than the detail. Enhancing the thinking part of our brain and not just the library.

A dramatic end to a presentation that enhanced the message and led to lots of conversations about the subject.

A dramatic end to a presentation that enhanced the message and led to lots of conversations about the subject.

Ask yourself which of these talks was more likely to be engaging and which you would be able to recall and remember in the future? Entertainment, engagement and innovation lead to moments of clarity and intellectual enhancement.

Conferences and presenters have been influenced by the need to perform. Presentations are no longer acceptable as simply a data transfer exercise and poor quality presentations are increasingly mocked. I was at a conference recently where one presenters slides were so awful that people were taking pictures of them and then sharing them round friends as examples of how not to present.There was audible laughter when yet another slide appeared with dense data and no assistance to the audience on understanding which of the 100+ data points were relevant.

The audience is increasingly expecting a standard to be met when presenting at conference. When used well the principles of performance, engagement, drama and #Medutainment can enhance and engage an audience. When the performance is poor the message is lost.

Final thoughts for part 2

I asked Twitter for thoughts on Medutainment and got some great replies. I particularly like this from Jan Hansel. He’s right. Emotion, whatever that might be is important. I believe the route to that emotion is through great presentations which engage and excite the audience.




Further reading.

Part 1: What is #Medutainment?

Part 2: Why are we talking about #Medutainment now?

Part 3: How do we develop our #Medutainment skills, and what are the risks?

Google is your hard drive:  http://academicearth.org/electives/internet-changing-your-brain/

Continuous partial attention http://lindastone.net/qa/continuous-partial-attention/

The Medium is the Message https://en.wikipedia.org/wiki/The_medium_is_the_message


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