I love your reference to “antifragile simulation”. Not only is that what the service I work for has been trying to achieve for the last few years, but it’s one of the key messages in a talk I’m giving at an education conference on Monday. I note your observation that “we need to recognize that we cannot all be antifragile” – perhaps antifragility should be a trait selected for when recruiting to critical care specialties? Regarding simulation, and the Tyson factor – this is a line from my talk: “As educators we need to face these realities if our teaching… Read more »

I’m glad to see this discussion of Antifragile here. I enjoyed the book and thought that most of it did apply to emergency medicine and critical care, in one way or another. Taleb’s discussion of medical iatrogenics seems to me most directly applicable. My short version is: if the patient is not sick, be very reluctant to take risks (give meds, do procedures, etc.) If the patient is sick, be aggressive! In the sick patient, the risk of iatrogenic injury is small relative to the risk of decompensation and death if you do nothing. As I read this section of… Read more »

As much as I love reading about/listening to all the latest stuff in EM and critical care (despite that I won’t be able to use it in 5+ years!) – these posts on mindset, decision making, stress conditioning etc are really inspiring. Reading posts like this brings me back to our first simulation experiences, when we were really new at the clinical stuff. Taking on the role as team leader because everything was just chaos, directing people and keeping track of everything. Realizing that “hey, maybe I’m good at this”, despite my initial thoughts about myself when I started med… Read more »

Great post! I agree that in simulation we have that permission to fail and the consequence is not real. Where I work we simulate in front of our peers and record the simulation so that we can review and learn and that part is beneficial. For most, simulation is stressful but quite different than what is required for context as mentioned above. The challenge, as an educator and preceptor, is to recreate that stressful environment that further promotes failure and that ability to learn from that failure.

Very nice blog entry. I look forward to meeting you at SMACC (George, Cliff, and the rest of you!!). Teaching Antifragility will require some experimentation on our part–that is the great news of the FOAM community. I have a couple thoughts about this, let me just share one, and utilize it or run with it if you find it useful, let it pass if it does not fit the bill. Let me suggest that antifragility can be encouraged through teaching honesty to our trainees and ancillary staff. Honesty takes courage. Honesty can give the caregiver the courage to take up… Read more »