SGEM Xtra: Skeptico Evidentium – SGEM Season#10 Book - The Skeptics Guide to Emergency Medicine

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Date: August 20th, 2023

Reference: Milne WK, Challen K, Young T. Skeptics’ Guide to Emergency Medicine Season #10 Book

Dr. Kirsty Challen

Guest Host: Dr. Kirsty Challen is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). She completed undergrad and postgrad training in North West England, acquiring a History of Medicine BSc, a PhD in Health Services Research, an anesthesiologist husband and four children along the way. She is Chair of the Royal College of Emergency Medicine Women in Emergency Medicine group, and involved with the RCEM Public Health and Informatics groups. Kirsty also produces all those wonderful Paper in a Pic Infographics summarizing each SGEM episode.

Dr. Tayler Young

Guest Skeptic: Dr. Tayler Young is a second year Family Medicine resident at Queen’s University in Kingston, Ontario, Canada. Her interests are quality improvement, Free Open Access Medical Education (FOAMEd) and point of care ultrasound (POCUS).

This is an SGEM Xtra to announce that SGEM Season #10 is now available as a FREE pdf book. The SGEM provided the content and Tayler designed the book. She has designed infographics for the Emergency Medicine Ottawa Blog and has summarized SGEM Season #8 and Season #9 with the Avengers and Batman themes.

Tayler chose a Harry Potter theme for Season #10 as she is a huge fan of the films and the books. Her favorite character is Norbert the dragon who was secretly hatched by Hagrid in Book 1.

Kirsty’s favourite character from the Harry Potter series (being a woman in academic EM, still a male-dominated world – see SGEM #352 on the gender pay gap and our Xtra from October 2021 with the wonderful Dr. Suchi Datta about gender inequity) is Hermione Granger. She is the competent skilled witch who faces pushback for knowing the answers and ostracism for not fitting in. She also confesses to having a soft spot for Neville Longbottom, who is quietly ignored and disregarded until trouble really happens and he comes through with the sword of Gryffindor.

SEASON #10 Foreword by Dr. Kirsty Challen

Harry Potter arrived in our consciousness in 1997 as an unsupported orphan venturing into the magical world for the first time, facing the ever-present but initially under-appreciated threat of Voldemort with Ron and Hermione. The Skeptics Guide to Emergency Medicine was a few years behind, emerging into the #FOAMEd-o-sphere in 2012, but as Harry and his world developed through the books, so has the SGEM.

This 10th Edition arrives as advocates of Evidence-Based Medicine continue to tackle the forces of misinformation and pseudoscience. Like Voldemort rising slowly back to power, many in the Ministry of Magic office of academic medicine failed to spot or believe the level of influence social media would have in the world of 2023. Ken Milne was an early adopter of using social media to narrow the knowledge translation gap and reduce the time it takes for quality research to percolate into clinical practice.

This isn’t always easy; as Dumbledore says in the Goblet of Fire “there will be a time when we must choose between what is easy and what is right”. As clinicians it might sometimes seem easier to adopt the line of least resistance; blindly and unthinkingly to follow the “rules” of specialty guidelines or the preferences of consultants. But things are not always what they seem; many initially promising treatments fail to translate to benefit in the longer term and it can be tricky to know which is the Scabbers (apparently benign and well received, eventually found to be treacherous and deadly) and which is the Snape (initially unpleasant but at his core hugely valuable).

Dr. Dennis Ren

As Harry’s group of friends and allies grew wider through the books, so Ken has grown the SGEM faculty; the rotating cast of the SGEM-HOP has been joined by Dennis Ren leading SGEM-PEDS and an ever-increasing number of guest skeptics from many backgrounds (no exclusion of the mudbloods here) ensuring a clinician- and patient-relevant gaze is cast on the medical literature. The structured critical appraisal provides readers and listeners with a Marauder’s Map to see through the complexity and (sometimes) obfuscation of published articles and reach their own, sometimes surprising, conclusions.

Like Voldemort (or Harry) some things never seem to die; this 10th edition features the perennial topics of where, if anywhere, thrombolytic agents should feature in the management of ischemic stroke, plus whether the choice of crystalloid for resuscitation really matters at all. New topics with wider relevance also appear, including the strength of the overall evidence base in Emergency Medicine and Orthopedics, and the persistent gender gap in EM remuneration.

Even Ron Weasley recognises “when in doubt, go to the library”. Emergency clinicians are well advised “when in doubt, listen to or read the SGEM”. You too can be a skeptic, Harry!

SGEM SEASON #10

Each chapter starts with Harry introducing the title, the clinical question the bottom line and the guest skeptic. Then Tayler summarizes in the following sections:

Hedwig brings the case presentation and some background information.
Phoenix wings surround the PICO question with population, intervention, comparison/control and outcome.
The authors’ conclusions and an appropriate quality checklist come from a potions lab.
The key results are presented in the Gryffindor common room.
Talk Nerdy is examined through Harry’s glasses.
To finish, Fawkes the phoenix provides the clinical application, what do I tell the patient and a case resolution, and links to the end notes with other FOAMed resources, twitter poll results and the Paper in a Pic infographic.

An important part of the SGEM is the theme music. With the addition of Dr Dennis Ren to the SGEM faculty leading on SGEM-PEDS the theme music has diversified a little from our core loyalty to the 1980s. There is a full list at the end of the book of all the theme music with a QR code directly linked to the SGEM Spotify Season#10 playlist.

It’s been another hard year in Emergency Medicine. Where I am in the United Kingdom we have seen ER nurses, residents and even attending physicians striking over conditions and pay. Canada has seen multiple rural emergency departments have to close due to lack of staff, our colleagues in the United States face the challenges of providing care after the overturning of Roe v Wade. It’s great to have the SGEM family to help us carry on being the best version of ourselves we can be. As Tayler says, find the people that believe in you.

All nine previous SGEM seasons are available as PDF books at this LINK.

The SGEM will be back soon with a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. So, patients get the best care, based on the best evidence.