I reckon that I am lucky to be a rural doctor. It wasn’t an area of medicine to which I was exposed as a student or trainee, and it was only good fortune that lead to my career evolving the way it has. Rural medicine offers all of the “best bits” of medicine without the tedium of being confined to one area as a “partialist”. Whilst much of the work of a rural generalist involves office-based primary care, we also have responsibility for emergency medicine via the local hospital and some of us will participate in elective and emergency procedural skills, such as anaesthesia, obstetrics and surgery.
It’s no secret that my interests revolve around trauma, prehospital care and anaesthesia, particularly in the rural context. But I am also interested in palliative care, paediatrics, chronic pain, depression, internal medicine and chronic disease management. As my colleague Casey Parker at BroomeDocs put it, the generalist rural doctor is the “swiss army knife” compared to the partialists “scalpel”. Each has their uses. In the bush, you need the multitool!
And therein is the dilemma for the generalist – how to maintain skills and clinical knowledge across such a broad array of clinical arenas? Particularly in fast-moving areas such as emergency medicine and critical care, where evidence-base may be rapidly evolving?
The answer, of course, is to use FOAMed – Free Open Access Medical Education – the rapid dissemination of ideas and learning resources, via the tools of Web2.0, to allow distributed, non-hierarchical, asynchronous learning “anywhere – anytime – anyone”. To my mind, FOAMed is particularly useful for those seeking to develop mastery, rather than teach the basics (for that, it remains textbooks and standard alphabet courses). The use of Web2.0 (blogs, podcasts, social media such as twitter, Google+, even Facebook) affords rapid sharing of ideas amongst peers – and extends the reach from local colleagues to allow exchange with a global community of like-minded peers and experts….all of whom willing to share ideas and content for free.
This is not a new concept in medicine – as Joe Lex points out, it dates back to Hippocrates “and to teach them this art – if they desire to learn it – without fee and covenant” – this is from the Hippocratic Oath and sharing of knowledge is part of being a clinician. But for some, the technology and terminology in social media and FOAMed can be a barrier.
This is a shame. FOAMed has been a revelation for my practice. A few years ago I was “comportable” in my practice. I met the required needs of credentialling (attendance at an entry-level emergency course every triennium), easily accrued my CPD points with my College and felt pretty happy in my practice. But I was not challenged. My interest in trauma and airway management lead to some online resources, at about the same time that Chris Nickson and Mike Cadogan were launching the “lifeinthefastlane” website for emergency physicians and the concept of FOAMed.
Since then I’ve been swept up in a rich learning environment, that has forced me to be challenged, to engage in discussion of concepts in my areas of interest which I would never have been able to do before. It’s made me submit papers for publication, to abandon traditionally safe roles (such as directing on EMST) and join the faculty of more modern courses, to speak at conferences, lead simulation training with paramedic and nursing colleagues and to run airway workshops. I feel connected to a rich information flow, of which I was previously oblivious. And trather than drown in a sea of information overload, apropriate use of filters allows me to receive and engage only in content which interests me.
It’s well worth exploring.
And so leads to the topic of this post – “Being Expert Enough”. I am helping out at the inaugural “Critically Ill Airway” workshop at The Alfred in May – the brainchild of Chris Nickson and anaesthetic/intensive care/emergency medicine colleagues. It should be a good course – Scott Weingart is an external consultant, there will be the likes of Andy Buck from ETMcourse and many others as Faculty.
“This is the challenge and discipline of rural medicine – our specialty is providing care across a broad range without immediate backup”
I will be speaking to a topic dear to my heart – that of the “occasional intubator” – this is pretty much is the default setting for much of the work we do as rural doctors, and requires us to have sufficient expertise to be safe and competent without backup across a large range of competencies.
To that end, Chris is ‘flipping the classroom’ and including some content prior to the airway course itself. Above is a “teaser” of my lecture and skills station for the CIA course. It should be fun…
Even if airway management in the critically unwell is not your “thing”, do consider exploring FOAMed – I reckon it’s the best paradigm for post-Fellowship learning. I am glad that both RAGP and ACRRM are allowing such online learning to be counted for CPD, not so much for the need for points – but because with increasing interaction amongst clinicians comes acceleration in learning and knowledge translation…which flows to us being better clinicians and patient benefit.
For us rural generalists, separated by distance and needing to maintain knowledge across a broad array of domains, FOAMed means that deficits in knowledge are no longer an excuse as the weak link in patient care.
LINK – REGISTER HERE for CRITICALLY ILL AIRWAY COURSE, May 7-8 The Alfred, Melbourne