Horses for courses, or Courses for horses?
I just got back from beautiful Fremantle (Perth) – completed the REST (Remote Emergency Skills Training) course and then spent a day running an introduction to ED Bedside US for rural GPs. So I got to be on both sides of the educational table this week.
Whilst there I had the chance to catch up with Dr Tim Leeuwenberg (@KangarooBeach ki-docs.wordpress.com ) and we chewed the fat over the value of these rather pricey and time-consuming courses in the context of FOAMed. So I thought I would write my opinion: where are we at with “ongoing professional development”? Including a review of the REST course and my own “ED USS for GPs” course. I know – how could I be biased – well read on….
The REST course was designed to be a 2 day intensive training course for rural & remote doctors. It is really intended for the PGY2 – 4, the newly arrived OTD or even the city doc who is contemplating a semi-retirement in locum land – servicing the remote communities of Australia. As a rural ED / Proceduralist type of Doc it was not really what I had expected after reading the comprehensive, if slightly dated manual pre-course. The basis of the REST course is sound – DRSABC….primary, secondary surveys – a structured and safe platform for dealing with sick and traumatized patients. And there was even an inkling of “newer practices”.
The REST course is taught well by the ACRRM crew – a big ask for such a diverse group of students and a lot to cram into 2 days. The atmosphere was nice, friendly and open for discussion – though the pressure of time was evident. The use of simulation was OK, however I thought it could have been made more complex / realistic, forcing the students to think and think again.
Now for the downside – I have concerns – the REST course is designed to get new country docs “up to speed”, however the syllabus is really not in touch with modern practice. I think if you were a new grad or OTD going bush for the first time and RESTed on your ‘REST laurels’ – you would end up being competent, but the experienced nurses you would go out into the bush and work alongside will be practicing (and expecting you to practice) a more evidence-based, up to date version of emergent care.
REST is like most “resus guideline” based courses – it follows simple algorithms that are really designed for the layperson or volunteer to apply in the community – once we walk into a modern ED we practice very differently. Resuscitation is about prioritization and resource management – it relies on a practical skill set also which are not really covered in the REST course.
In fairness the REST course is up for a review this year. However, I think it might be impossible to cater to all levels of training in the current format.
REST is an entry-level course and certainly has its place as the minimum requirement for remote practice. For more experienced rural doctors though there really is not a course that offers contemporary training in Emergent care in the GP sphere. More on this to come….
When I was asked to run a full-day workshop for novice US users I had to think long and hard about the format, the audience and the material. I decided to offer a superficial taste of all the modalities that I find useful or “life-saving” in my practice. In the era of FOAMed I think that the role of the face-face workshop is to correct and perfect the hands-on minutia of US – the learning can all be done online in advance. The individual needs to commit to a long, uncomfortable period of trial in practice to learn technique once the basics have been taught. The workshop really just acts as a focus – a date , a place, a commitment to learn.
My goal was to try to inspire my colleagues by showing the enormous advantage of US in common clinical scenarios – to try and spread the US bug and encourage them to engage in their own online learning. I am not convinced many would have walked away with much in the way of usable skills – but hopefully some got the bug – a desire to try to improve care with bedside US.
OK, so it seems a bit bleak! So how do I see the future of GP education?
Well this gets right at the heart of why I started this blog in the first place. I don’t believe there should be any distinction between patient care based on geography, who is at the bedside or what “specialty” covers their disease process. If there is a g0od answer to a problem, evidence-based therapy then it should be delivered no matter when, where or who. So how does this apply to GP education?
There are 2 basic options available to us:
(1) develop great, competitive, evidence-based and cutting edge training opportunities for GPs –
(2) Join in on the specialist education – take our place at the table and eat up the knowledge these docs have. Who knows – we might even have a bit to offer ourselves!
Up until recently I was a fan of option (1) – but now I am leaning to option (2). The power of FOAM has shown me how applicable specialist knowledge and practice can be to us as remote generalists.
Next March in Sydney there will be a conference not quite like any other – there will still be beer, but this time we (the GPs) will be there – learning and sharing our collective wisdom. In case you have been living under a rock – check out SMACC 2013 at smacc.net.au . For me this is the answer to our educational woes – a chance to get involved and learn how to deliver great care anywhere. SMACC is the physical manifestation of all the great free, online education that has exploded over the past few years.
Hope to see you there. Casey
great article Casey! Yes everyone should come to SMACC 2013. not only because you will learn cutting edge, practical information on resuscitation and emergency medicine by experts and colleagues..but more importantly you will learn a better way of learning.
entrylevel courses are an acceptable method of delivering core content in emergency medicine and resuscitation. but they are like fast food outlets.
How would you ever know fresh fruit existed if you were only ever given Macdonalds as a child?
Macdonalds is quick, cheap and instantly available. you know what you are getting. there is no need to be creative or make an effort.
unlike fresh fruit where you need to know whats the best time to buy it, where to get it the best produce, then to select ripe fruit etc. that takes much more effort….
or should it?
Casey and I have a secret we want to share about our own learning. Its called FOAMEd.
we work in remote locations and cant often get away to big cities to attend these courses. When we do, we often find its all the same, there is no evidence based updating of knowledge, the manuals are irrelevant and more saliently, the teaching just does not translate to where we work in rural and remote Australia. we want to know what is best practice, we dont want our patients to be second class citizens. so we want the best knowledge from the best minds and help us apply this to our remote communities. this allows us to mold that best practice into something practical .
Its like saying that rather than going to the city to eat out at Macdonalds, it might be better to go to an organic food restaurant and be more selective about what you are filling your mind and body with.
but aFOAMEd allows us to be selective about our educational consumption and get expert input in real time and in off time from a global perspective…all remotely!..and for the most part its totally free.
ok let me get on a soap box here. I have an interest bordering on obsession on emergency airway management. here in Australia, the main accepted method of learning airway skills is to go to elective anaesthesia lists in hospitals and practice supervised airway management by anaesthetists. I think this is a good way to impart core skills and knowledge. now many fall into a trap that this is considered the best way to maintain and attain further proficiency in airway skills.
this is wrong..in fact in one way it is risky.
in fact if you really want to improve your airway skills , you must look to other disciplines and indeed other professions. Surgical airway, active oxygenation techniques, non technical skills..these are all things that other discipines and professions can help us with. I learnt this via a variety of sources but in last two years, it is via FOAMed that I have learnt the most to improve my airway skills management. Most of my FOAMEd airway teachers I have never met in person. I certainly have not spent time in an OT with them . but they have taught me simple resilient, physiologically based airway techniques that you would never learn in anaesthesia currently as its practiced and taught. several of these techniques are done simply with plain gear you wuld find in any remote hospital.
Ultrasound is another area where you can learn an incredible amount via FOAMEd and make a major improvement in your bedside care of patients.
Courses for horses
Big Mac vs mango
I still think a ‘rural doc’ masterclass has got legs – more so if bolstered by FOAMed and delivered by ACRRM as the peak body for rural docs (smacc.net.au looks awesom, but may be too far weighted to crit care for some rural generalists)
Ideal world? Rural GP masterclass delivered by enthusiastic bods who are embedded with FOAMed cutting edge concepts applicable to the ruralist….a smorgasbord of EM, trauma, obs, paeds, anaes etc, smallgroup hands on sessions and perhaps sim. Crisis management, human factors, logistics over startegy and ‘making things happen’
Content evolves over time and run in bite-sized chunks…
I’m game. Lets hope the College listens…
guys, I think You are both right.
I propose we actually deliver this rural masterclass in FOAMEd style. At least a lot of it can be delivered online, live and recorded. by us, the rural GP FOAMEd club and friends
what I have discovered via my FOAMEd online airway training program is that there is a hunger for this stuff and this is the way to deliver it.
Ultrasound for the rural GP proceduralist via FOAMEd online sessions..why not?
Critical care airway and anaesthesia for the rural resuscitationist via FOAMEd online sessions…why not?
Ventilation masterclass for the occasional intensivist via FOAMEd online sessions…why the heck not?
Close quarter airway skills for the nightmare larynx via FOAMEd online…absolutely!
The Hitchhikers guide to procedural sedation in strange and austere places via FOAMEd…bring it on.
Taming the tiger , the occasional psychiatrists guide to acute agitation management in remote settings via FOAMEd…
is that enough for a basic online rural masterclass curriculum.?
how to proceed?
how bout the three of us commit to at least a monthly broadcast, starting with the above topics?
if it gets lots of hits and feedback, we can ramp it up as we see fit.
happy to setup the show.
just need my co hosts