SGEM Xtra: If I Could Turn Back Time – 14 Seasons of Skepticism, Kindness & Evidence-Based EM

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Date: September 4, 2026

This is an SGEM Xtra looking in the rearview mirror at 14 years of The SGEM and looking forward to Season#15. Season 15 is traditionally the crystal anniversary. Crystal is transparent; it can help us see things more clearly, and it can also shatter if you drop it. So, basically, a great metaphor for medical evidence.

Cue some 80s music. Because if I could turn back time. Unfortunately, I don’t have a DeLorean, a flux capacitor, or 1.21 gigawatts. What I do have is a microphone, a large collection of papers, and what may be an unhealthy willingness to discuss p-values and confidence intervals.

PICOT for this SGEM Xtra Episode:

Population: SGEMers
Intervention: 14 years of skeptical knowledge translation
Comparison: Practising emergency medicine before the SGEM
Outcome: Thinking better leading to better care
Type of Study: Not really a study, but more of an unblinded observation, heavily confounded by nostalgia, that has been funded primarily by enthusiasm and coffee.

When the SGEM began, the goal was straightforward but ambitious: to shorten the knowledge-translation window from more than 10 years to less than 1 year with the power of social media. We wanted to identify clinically relevant emergency medicine research, critically appraise it, and deliver that information to the front-line clinicians caring for patients. Medical education for anyone, anywhere, at any time. Very similar to the EM philosophy of seeing anyone, anytime, for anything. Listen to the podcast and turn your car into a classroom. That was the idea.

I am very thankful to my evidence-based medicine (EBM) mentor, Dr. Andrew Worster from McMaster University. He started the BEEM project and took a chance on me about 20 years ago. Andrew also taught me the EBM answer of “it all depends”. I pitched the idea to him in ~2011 about doing a podcast while riding a ski lift at the Silver Star ski resort in BC. He said…what’s a podcast? Andrew also suggested I attend the University of Oxford and take a mini-fellowship course from the Centre for Evidence-Based Medicine (CEBM) on how to teach EBM. My idea was to create a blog and podcast to encourage skepticism, critical thinking and demonstrate how to review a publication. That is how this whole thing got started.

There was no five-year strategic plan, no glossy prospectus and no venture-capital funding. There was a blog, a podcast, social media, a standardized critical-appraisal process adopted from the BEEM group, and a growing group of people who believed emergency clinicians deserved timely access to the best available evidence. It was fortunate that it happened at the same time as the Free Open Access to Medical Education (FOAMed) movement was launched in 2012.

Not the newest evidence simply because it was new. Not the loudest evidence because someone had a good marketing department. And not the most prestigious evidence merely because it appeared in a high-impact journal. As I like to say, the only thing you can conclude when something is published in the NEJM is that it was published in the NEJM. All your work to determine its validity is still in front of you.

The goal was to find and critically appraise the emergency medicine literature, interpret it in the context of clinical expertise and what matters to individual patients. Fourteen seasons later, the SGEM has more than 85,000 subscribers. It has been translated into five languages, and more than 100 SGEM critical appraisals have been published in peer-reviewed journals.

Those numbers are wonderful, and I am very proud of them. But numbers can only tell part of the story. I don’t want this to be an argument from popularity. A download does not tell you whether someone reconsidered an old habit. A subscriber count cannot capture the moment a clinician paused before ordering a low-value test, questioned an impressive relative risk rather than considering the absolute risk reduction, or had a better shared decision-making conversation with a patient.

The real outcome has always been what happens at the bedside. Did the episode help someone think more clearly? Did it help them recognize uncertainty? Did it help a patient receive better care? Those are the outcomes that matter. Especially the patient-oriented outcomes (POOs).

One of the major developments over the years was the SGEM Hot Off the Press, or SGEMHOP, series. This was created with my BFF, Chris Carpenter. Chris has been a friend, mentor, collaborator and occasional enthusiastic supplier of methodological questions that require three cups of coffee to understand. I’m thankful that the editor-in-chief of Academic Emergency Medicine (AEM), Jeffery Kline, saw the value in the SGEMHOP and supported the initiative.

The idea behind SGEMHOP was to take important new papers, appraise them while they were still hot off the press, speak directly with the authors, and have an open discussion with the wider emergency medicine community. Over the years, that series benefited from an outstanding group of co-hosts: Lauren Westafer, Chris Bond, Corey Heitz, Kirsty Challen, Justin Morgenstern, Neil Gupta & Suchi Datta. Each brought a different perspective, a different area of expertise and, importantly, a willingness to disagree. That matters.

A panel in which everyone agrees may be comfortable, but it is not necessarily informative. The goal was never to build an echo chamber. It was to create a respectful space where methods could be challenged, conclusions could be examined, and uncertainty could be acknowledged.

We invited authors onto the SGEM knowing we were going to ask difficult questions, but critical appraisal was never meant to be a gotcha exercise. Research is difficult; I know I’ve been doing it for 42 years. It involves designing the study, conducting the research, submitting it for peer review, and facing post-peer-review criticism from potentially thousands of skeptical emergency clinicians who aren’t shy about telling you what they think. The focus was always on the paper, the evidence, the logical arguments and not the person.

Challenge the methods. Question the interpretation. Be curious about the choices that were made. Recognize the limitations. And be kind to the people who did the work.

Dr. Dennis Ren

Another terrific addition to the SGEM was Dr. Dennis Ren and the SGEMPeds episodes. He took over where PedsEM superhero Dr. Anthony Crocco (SketchyEBM) left off. Dennis brought expertise, enthusiasm and an important reminder that children are not simply small adults. He also shares my love of Batman.

Pediatric emergency medicine has its own evidence base, uncertainties, and challenges in communicating risk to families. Dennis helped us explore those questions while keeping the episodes practical for anyone who cares for children in an emergency setting.

Dr. Kirsty Challen

Then there is Dr. Kirsty Challen and her wonderful Paper in a Pic summaries. Every Thursday, Kirsty takes an entire critical appraisal and turns it into something clear, memorable and visually engaging. A picture may be worth a thousand words. Kirsty’s pictures are also worth a thousand likes and shares on social media.

Kirsty’s Paper in a Pic also allows SGEMers to revisit the clinical question, key results and bottom line in a format that can be understood quickly and shared easily. That is knowledge translation in its purest form: preserve the nuance but make the information accessible.

The SGEM has also expanded beyond traditional journal club episodes. The SGEM Xtras let us explore popular culture and ask a different kind of question: Can movies and television help make us better clinicians?

We looked at Star Trek, Buffy the Vampire Slayer, Batman, Ted Lasso, Top Gun, A League of Their Own, Mission: Impossible and others.

From Star Trek, we considered the balance between logic, leadership and humanity (Spock, Kirk and McCoy).
From Buffy, courage, teamwork and the family we choose.
Batman taught us the value of preparation (although billionaire vigilante medicine may have limited external validity).
Ted Lasso reminded us that kindness is not weakness, and we should be more curious and less judgmental
Top Gun gave us teamwork, communication and the importance of not letting confidence become overconfidence.
A League of Their Own reminded us that women have always belonged on the field, in the emergency department and in academic medicine.
Mission: Impossible? That one mostly prepared us for Monday mornings during respiratory-virus season, which is right around the corner.

The SGEM book reviews gave us another opportunity to slow down and think more deeply. We spoke with Timothy Caulfield about misinformation and celebrity culture, Brian Goldman about kindness, Steven Novella about skepticism, Darren McKee about AI superintelligence, and Mel Herbert about the extraordinary power of being average.

We were also fortunate to welcome some extraordinary guests. Noah Wyle joined us to talk about The Pitt, emergency medicine, and why his portrayal of an emergency physician felt so authentic to people who do the actual job. Terry O’Reilly from Under the Influence helped us think about communication, storytelling and making an idea memorable without overselling it.

Over the years, we have also worked to ensure that the SGEM reflects the full team caring for emergency patients. Emergency medicine is not practised by one profession in isolation. We should all be on Team Patient. Our patients are cared for by emergency physicians, other medical specialists, nurses, physician assistants, nurse practitioners, physiotherapists, pharmacists, paramedics, respiratory therapists and many others.

No profession has exclusive ownership of a good idea. And bias does not check your credentials before influencing your judgment. Bringing different clinicians into the conversation made the appraisals better, the discussions richer, and the clinical applications more realistic.

Another issue I have advocated for over the years is gender equity in the house of medicine. We have done multiple episodes on this topic because inequity affects us both as clinicians and as patients. Women physicians continue to be paid less, are underrepresented in leadership positions and can face barriers to academic advancement. We have talked about these issues with people like Dara Kass, Jen Gunter and our friends at FemInEM.

This is not just a workforce issue; it’s also an EBM issue. For decades, women were underrepresented or excluded from clinical research, including cardiovascular research, and then we applied those results to women as though biological sex did not matter. You do not need to be a woman to care about gender equity, just like you do not need to have cardiovascular disease to care about cardiology. This should be a Team Patient issue. I have tried to use whatever platform the SGEM has to amplify women’s voices and advocate for change. We have made progress, but we are not there yet. As skeptics, we should be willing to examine bias wherever it exists, including in our research, our institutions and ourselves.

Now, after 14 years, I could just tell you about all the things that worked. But that would be a little bit of reporting bias.

Some things did not work. We tried to provide CME and CPD credits. Let us simply say that the administration required to support continuing medical education did not make me want to continue with the project. We also tried crowdsourcing paper selection by asking SGEMers to rate potential articles. The crowd was successfully sourced. The ratings, not so much. There was even the SGEM Global, which posted episodes in French, Spanish, German, and Portuguese. We were unable to sustain this KT project across multiple languages.

But a knowledge-translation project should be willing to learn from its own negative results. Not every intervention reaches statistical significance. Not every statistically significant intervention is clinically important. And sometimes an idea that looks great on the whiteboard does not survive contact with the real world. That is not failure. That is data.

Through all the changes, additions and experiments, the core SGEM format has remained remarkably consistent. We critically appraise a paper using a standardized form intended to mitigate bias. We try to find the right mixture of education and entertainment. Too much entertainment and the message becomes superficial. Too much education without any personality, and even the host may begin looking for the skip ahead 30 seconds button. We practise skepticism with kindness. Skepticism is not cynicism.

Skepticism is not automatically rejecting a result, guideline or expert opinion. It is asking:

How do we know what we know?
How large is the effect?
How precise is the estimate?
What biases could move us away from the “truth”?
Does this population resemble my patient?
Were they patient-oriented outcomes?
And do the probable benefits outweigh the potential harms, burdens and costs?
How do we successfully communicate that with patients?

And the other half of skepticism with kindness is, of course, the kindness. It means recognizing the people behind the paper and the patient in front of us. You can disagree without being disagreeable. You can challenge a conclusion without questioning someone’s character. You can be uncertain without being paralyzed with indecision.

Most importantly, the SGEM has tried to teach people how to think, not what to think. I do not want SGEMers replacing one authority-based answer with another authority-based answer that happens to come through their headphones.

The goal is not for people to say, “Ken said it, so it must be true.” That would be the opposite of the project. The goal is to help people read the paper, identify its strengths and weaknesses, understand the magnitude and uncertainty of the results, and decide how or whether it applies to the individual patient in front of them.

And sometimes we got it wrong. Or new evidence came along and changed the answer. That’s not something to hide. That’s how science is supposed to work. Being skeptical doesn’t mean you never change your mind. It means being willing to change your mind when sufficient evidence is provided.

The SGEM bottom line is a conclusion, not a commandment. Just like clinical guidelines should guide care, not dictate care.

We are now getting ready for Season#15. As we enter the crystal season, there will be some changes. We will be retiring the SGEMHOP series. Not because it was unsuccessful; quite the opposite. I am deeply grateful to Chris Carpenter, the co-hosts, the authors, Jeff Kline, AEM and all the SGEMers who participated in those conversations. But every intervention should be reassessed occasionally. Sometimes even a successful intervention deserves thoughtful deprescribing. SGEMHOP accomplished more than we imagined when it started, and this feels like the right time to celebrate its achievements and bring that chapter to a close.

Season 15 will also do more with artificial intelligence (AI) and evidence-based medicine. AI can retrieve information, summarize papers, identify patterns and assist with repetitive work. It can also misunderstand context, reproduce bias, invent references and present an incorrect answer with the confidence of a first-year resident who has just discovered UpToDate.

We need to assess AI tools the same way we assess any other diagnostic or therapeutic intervention. AI is a tool. Like every other tool in medicine, it can help, it can harm, and it needs to be evaluated. So, let’s apply the same skeptical approach we use for everything else.

What is the reference standard?
How accurate is it?
Does it recognize EM Medical Myths and Zombie Ideas?
In which population was it tested?
Does it improve a patient-oriented outcome (POO)?
What are the unintended harms?
Who is represented in the training data, and who is missing?

We will also continue the book reviews, including a new discussion with Professor Melanie Trecek-King, whose upcoming book on critical thinking fits naturally with the SGEM mission. There will be other changes and new ideas as the season develops. Some will work. Some may not. We will remain open to both possibilities.

Finally, I want to thank the SGEMers. Thank you to everyone who listens while driving to work, walking the dog, exercising, doing housework or recovering after a difficult shift.

Thank you to those who read the blog, share the Paper in a Pic, discuss an episode at journal club, send an email, leave a comment or respectfully challenge the SGEM bottom line.

It is always wonderful to meet SGEMers virtually. It is even better to meet you in person at conferences and courses. When someone comes up and says, “I listen to the SGEM,” it means more than you probably realize.

Each weekly critical appraisal takes about 8 hours of unpaid, unprotected time. That includes selecting and reading the paper, completing the critical appraisal, arranging a guest skeptic, preparing the discussion, recording, editing, post-production, writing the blog, distributing the episode and sharing it on social media. Sometimes it takes longer. That is a lot of work for an episode that may last only 30 minutes. It is a little like emergency medicine documentation: the part after the encounter can take longer than the encounter.

Knowing that someone is listening, and that the episode helped them think, teach or care for a patient, makes the effort worthwhile.

Please continue to send your feedback, suggestions and comments. Tell us what you enjoy. Tell us what does not work. Tell us which papers we should cover, which books we should read and which voices are missing from the conversation.

The SGEM will remain free and open access. No paywall. No premium evidence tier. No secret handshake. The mission remains the same: to provide clinicians with the best available evidence so they can give patients the best possible care. A rating or review on Apple Podcasts also helps other clinicians discover the SGEM.

The methods will continue to evolve. The technology will change. Some old dogma will finally disappear, and some will return like a medical version of an eighties movie franchise that refuses to end. But the commitment will remain: critical appraisal, clinical relevance, patient-centred care, intellectual humility, a little entertainment and skepticism delivered with kindness.

Thank you for coming along on this journey.