Date: June 28th, 2019
I had the pleasure of presenting at the Royal Society of Medicine (RSM) in London, England today. The RSM is one of England’s major providers of postgraduate medical education. Independent and apolitical. It promotes an exchange of information and ideas on the science, practice and organisation of medicine.
The theme for the day was Education and Learning for the 21st Century Emergency Medicine Physician. The title of my talk was Mind the (Knowledge Translation) Gap.
The knowledge translation (KT) gap has been beautifully illustrated in a model by Dr. Pathman and it is called the leaky pipe model. At the top of the model is the high quality, clinically relevant information. Then there are seven leaks with the first Leak being awareness. These leaks means patients do not getting the best care, based on the best evidence. The number quoted is 17 years for high quality clinically relevant information to reach the patient’s bedside.
Some Examples of the KT Gap:
- Myth – Epinephrine in local anesthetics will cause the tips of things to fall off (SGEM#9).
- Myth – Antipyretics can prevent recurrent febrile seizures (SGEM#95).
- Myth – Topical anesthetics for simple corneal abrasions will make you go blind (SGEM#145).
Social Media Solution: Social Media Solution can be a solution (blogs, podcasts, twitter, etc) to the KT Gap. Dr. Joe Lex is a Legend of Emergency Medicine and has been referred to as the Godfather of #FOAMed. He has a famous saying about medical education, knowledge translation and social media:
- If you want to know how we practiced medicine five years ago, read a textbook.
- If you want to know how we practiced medicine two years ago, read a journal article.
- If you want to know how we practice medicine last year, go to a (good) conference.
- If you want to know how we practice medicine now and in the future, listen to the conversations in the hallway and use social media.
Marshal McLuan was a professor at the university of Toronto. Most people know him for the quote “the medium is the message”. My favourite McLuan quote is:
“Anyone who tries to make a distinction between education and entertainment doesn’t know the first thing about either.”
Critical Appraisal: Critical appraisal can be fun. To demonstrate this we put on a cooking show. Two wonderful volunteers and Dr. Kirsty Challen (#PaperinaPic) helped show the audience how to perform a critically appraisal of a randomized control trial (RCT). If you want to make a taste apple pie you need great ingredients. If you want to make a great RCT you need great methods. If you don’t have great methods you can end up with a cow pie (poor quality study). Quality check lists are available to probe the validity of a study. Some of these lists have been created by the Best Evidence in Emergency Medicine (BEEM) and can be download from SGEM Xtra: Make is So.
Part of the presentation included telling the importance of randomization in an RCT. This was illustrated using the story of Dr. Alexander Hamilton and blood letting for camp fever.
You can watch the video on the SGEM Facebook page. All the slides from the presentation are also available to be downloaded as a PDF. The three take home points from the presentation were: There is a KT gap that can be cut down with social media, critical appraisal can be fun and be a skeptic.
The SGEM will be back next episode with a structured critical review of a recent publication. Cutting the knowledge translation window down from over ten years to less than one year with power of social media. The SGEM’s ultimate goal continues to be that patients get best care on best evidence.