Cite this post as:
Scott Weingart, MD FCCM. EMCrit Wee – Tacit Knowledge and Medical Podcasting. EMCrit Blog. Published on February 13, 2013. Accessed on March 19th 2025. Available at [https://emcrit.org/emcrit/tacit-knowledge-podcasting/ ].
Financial Disclosures:
The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.
CME Review
Original Release: February 13, 2013
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027
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Thanks for addressing such a sensitive and complex topic. I am very interested in this topic and I am researching this topic in the world of education via MOOCs (Massive Online Open Courses). I came across Dave Cormier’s website, one of the first people to coin the term MOOC in Canada during a course with other people very involved in education. He has further explored this online community and address the subject of how people learn in these types of environments. His conclusion is that when people come together in a network environment the conversation looks more like a rhizome.… Read more »
I found his lecture v. interesting if a bit ivory tower. I suppose this would be the FOAM now comes on top of a ginger beer.
Hi, I think your comparison of a medical podcast to a grand rounds talk is a good one… “Grand rounds aren’t peer-reviewed”. It’s not meant to replace one’s judicious search and critique of available literature. It’s a tool in one’s toolbox for knowledge transmission. The great thing about podcasts and FOAMed in general (from what I’m learning and experiencing) is that the WAY in which one learns is enhanced by innovative methods. We all learn in different ways; we all are impacted by knowledge in different ways…some by reading, some listening, some by creating (writing a blog post, making a… Read more »
Elle,
Thanks for those kind words. No frustration. I am so lucky to have my listeners, who obviate any questions of peer review or external validation. It would be much more difficult to be just starting to enter the FOAM world and have to wrestle with issues of legitimacy of form.
Hi,
I can relate to what you’re saying, “wrestling with issues of legitimacy of form.” When I first stuck my toes in the FOAMed waters a few months ago, I was jolted a little bit by thoughts of peer review, trustworthiness…am I consuming content that is valid and evidence-based? But after wading through the waters and now beginning to swim, I realize FOAMed is not meant to replace scientific inquiry.
FOAMed provides resources to learn about current research, enhance knowledge, inspire investigation, spark conversations and debate. Your post here is a prime example.
It’s disheartening to hear that EM residents, so early in their career, are already discounting internet/podcasting/blogs as a form of learning. I completely agree with all the points you made in your podcast. I think those that dismiss podcasts as a tool for transfer of tacit knowledge are missing the point. This isn’t and never was meant to represent primary literature. This isn’t the format to present the results of RCTs. It’s absolutely a straw man argument to criticize podcasting for not being “peer reviewed”. I’m glad you made the analogy of a podcast being comparable to grand rounds. How… Read more »
Thanks Todd!
One of the reasons I listen to podcasts and read EM blogs is that exact point you made: transmission of tacit knowledge. Textbooks can provide me wth background knowledge but I am often left unsure how to actually apply that knowledge in clinical practice. It’s like an extension of bedside teaching. Except with FOAM now I have access to expert clinician teachers from all over the world. And there’s an additional bonus, I don’t have to sit at my desk with a textbook open! From an avid listener and emergency medicine registrar (resident) in Australia. Looking forward to seeing you… Read more »
SMACC is going to be amazing and a validation of all you just mentioned.
Kath, agree! There are literally hundreds looking forward to seeing Scott at SMACC! No pressure, boss! For those who follow EMcrit podcast and blog closely, you will know that occasionally Scott and I disagree on certain points. we discuss and debate and offer points of reference and opinion. This is peer review. It happens quicker and more openly than traditional methods of academic discourse. Scott is being modest by comparing his podcasts to grand rounds. It is so much more than grand rounds. Where else would you get references and weblinks to video, audio learning resources? Most grand rounds you… Read more »
Minh, you are too kind.
I think that Scott’s blog highlights important concepts or issues that are helpful for relatively experienced and insightful clinicians but I am also wary of junior registrars misapplying information from EmCrit and doing something dangerous or causing harm. The technological and computer age brings itself its own challenges of information overload. More important than just disseminating information, there is now a pressing need to teach novice clinicians how to filter, process, analyse, integrate and apply information. Hopefully as the readership of social media sites expands, the rigour and robustness of debate improves and provides useful examples for other doctors to… Read more »
I think that Scott’s blog highlights important concepts or issues that are helpful for relatively experienced and insightful clinicians but I am also wary of junior registrars misapplying information from EmCrit and doing something dangerous or causing harm. The technological and computer age brings itself its own challenges of information overload. More important than just disseminating information, there is now a pressing need to teach novice clinicians how to filter, process, analyse, integrate and apply information. Hopefully as the readership of social media sites expands, the rigour and robustness of debate improves and provides useful examples for other doctors to… Read more »
Hi Scott, I really appreciated this podcast and think that it was done at a relevant and important moment. We have all seen Twitter explode with back and forths over what is peer review and what makes good medical content. But I think the key to the email that you received is very nature of how the podcasts are being used by this residency. It sounds like they have pretty much stated that everything you state is fact, just like rosens. They have replaced an hour of their conference with your podcasts, which is great. But unless they use the… Read more »
I would love it if they assigned the podcasts and then spent an hour as a group discussing and debating the points made with support of the referenced literature and any additional literature they could find. This is the concept of the “flipped” classroom.
actually thats a good point that Nikita raises. I dont ever intend nor am sure does Scott that our podcasts are used to replace traditional lectures or tutorials. I only ever see them as supplementary material not core. I would never want my podcast to breed laziness or lack of academic discipline into the profession. It would be a stretch of intent if anyone regards listening to a 30 minute or less podcast to be covering all aspects of that topic. I intend them to stimulate discussion, inspire personal learning and help with practical application of knowledge. If say I… Read more »
Exactly, Seth addressed this point in his blog
“Not that you shouldn’t read or listen to this stuff, but recognize that the topics covered are generally things that are sexy: interesting, controversial, or very practical or technical tips & tricks. But those are all different than a core curriculum.”
My understanding is that podcasts like emcrit, ercast, smartem, pharm are intended for more complex discussions where there is plenty of uncertainty. At the same time embasic podcast, which is not a discussion, deals with core concepts. There is a distinction.
Seth Trueger (@MDAware): Residents: Please Read
http://mdaware.blogspot.com/2012/07/residents-please-read.html
Hey…I think I covered some of this in last month’s acep news.
I haven’t heard the emcrit wee yet but hopefully this goes along with the issue:
http://www.acepnews.com/views/commentaries/singleview-enewsletter/podcasts-take-2-the-medium-is-the-message/40630fed5d315e5684e6b816cc6700da.html
It does sounds like someone at that residency is being a tad lazy if its a case of instead of booking a speaker here’s a podcast. Getting to teaching and having trainees together is such a logistical problem in shift based specialities that the time together can’t be wasted on didactics. Asynchronous content with group discussions (the flipped classroom mentioned above) is I believe the way forward. Online lecture, group discussion then maybe simulation rather than sit in a room being talked at by someone who mumbles their way through the latest guideline with a look of boredom on their… Read more »
Most programs outside of large academic centers do not have the budget to birng in Grand Rounds speakers more than a few times a year. Even big power house places like my residency that have the budget have instituted an async component.
There are many attendings that seem to be opposed to their residents listening to podcasts because the residents don’t research the topic and use the podcasts as a shortcut to really understanding the content.
There was a nice piece in ACEP News recently http://www.acepnews.com/views/commentaries/single-article/podcasts-take-1-podcasts-are-great-but/a61c84dd2f9e3a3e05ac78fc3a14ee71.html that nicely articulates why podcasts are so great for residents. The spontaneity in learning keeps a level of excitement to read topics that might be on the fridge of the core competency reading lists plus podcast allow everyone to hear great “grand rounds” no matter where they train.
I imagine that the number if journal articles that residents read actually goes UP once they start listening to podcasts regularly. It’s easier to engage in the literture if you think about the issues being covered in the podcasts. Once you’ve heard about an article in a podcast, you’re probably more likely to seek it out, or even just read it when you later happen to see it, or to debate it in academic settings. I don’t think most people hear podcasts and then stop thinking. I think, rather, that it inspires further interest and gives people a sense of… Read more »
Jeremy, I like to think you are right which is why I always talk about audio casts with my residents to show them how to integrate multiple ways of learning into residency training
Peer reviewed data is the science of medicine.
Tacit knowledge (whether podcast or grand round) is the art.
We need both.
I could say more but it’s been covered above!
absolutely
Scott, thank you for this excellent wee! I´m a resident EM doc that often has to defend my practice. I´m pioneering in Emergency medicine in a small University hospital in Sweden. I see a big difference in evidence based practice and what is accepted as “this is how we do things here since the past decade” You managed to address our main challenge in a very nice way! I try to do the best I can for my patients but sometimes my practice is questioned especially when it comes to resuscitation because I tend to be more goal focused and… Read more »
Thank you for that comment. You and your colleagues are breaking new ground, which is incredibly hard. But your efforts will save more lives in the long term than many of us.
It seems some people have a difficult time understanding their own education. Some of what we learn is hard science, some of what we learn is theoretical. A large part of what we learn and why we do residency is experience based art of medicine. This is how we learn to be a doctor. The huge benefit of shows like yours is that we can access the art of medicine, the experiential, the art and vast knowledge of many more great doctors. Those denigrate this are blind to how much this shapes their own education. We all do things the… Read more »
Eric, you may want to write a letter to the editor on this. I believe this is the first case of peds DSI. Happy to co-author with you if it would be helpful.
Awesome. I’ll start writing something up.
Scott, I must admit, I was a bit angered that some folks were bashing EM podcasts. I work in rural ER’s and up until you started EmCrit I felt like I was stagnant in my knowledge of EM. I don’t have access to all the journals, grand rounds, or interactions with academic EM docs. Since you started your pod casts I feel as though I am back in residency–constantly learning. Learning not only the basics of EM critical care but also the most advanced EM practiced by some of the brightest folks in EM. Since your pod cast started, I… Read more »
James, Thanks for those kind words; makes it all worthwhile. The questioners don’t bother me at all. We need to explore the pluses and minuses of this new educational format.
Right on James! I heard one of the coolest things a couple of months ago. I teach on a national emergency care course for rural and remote providers ( docs, nurses, paramedics, indigenous workers) One of our instructors on a recent course got asked about apnoeic oxygenation via nasal cannula. The delegate had read about on a blog. My colleague was not too sure about it so I got asked to comment. I had all these great FOAMEd references, videos, talks, presentations to refer our faculty too. When new concepts that help save lives can reach the most remote practitioner… Read more »
Ditto Minh I’m a rural doc and attend annual upskilling conference in anaesthesia in the big city. It’s a sort of pilgrimage supposed to ensure I am current Couple of other FOAMites there, who stuck out like a dogs nuts when asked Qs about NODESAT, DSI, TXA etc. – blank looks from the (mostly anaesthetics) Faculty FOAM has made me read more, improve my practice and benefit my patients – sure, I will read peer-reviewed articles – but the exchange of ideas is so much more enriching and swift than turgid Grand Rounds, annual conferences or even traditional teaching ‘thats… Read more »
Scott, This podcast was a great response to the bashers of this new forum of learning. You delivered a well executed SMACC-down! Without wanting to repeat everything that has been said above, let me just say I agree wholeheartedly with their comments. You are doing a fine job and this new forum of communal e-learning will improves the lives of patients around the world. I personally have found it very enriching. I would just like to add one additional point about the relationship between the literature and these podcasts. Through the robust debate and e-peer review that is occurring, there… Read more »
One of the better ways I’ve found for low-tech transmission of “tacit” knowledge to new clinicians is scenario training. Higher fidelity is better, of course, but old-school verbal scenarios can also work, particularly when it comes to the cognitive components (the decisions) rather than the psychomotor skills. What I’ve found particularly helpful is eschewing traditional scenarios — ritualized, “textbook” cases that are clearly designed to teach a specific point, and in which that point can often be guessed — in favor of more “realistic” scenarios. These focus on the realistic environment the student works within, the real everyday challenges and… Read more »
great suggestion!
Great comments, all.
I would add that just because something is “peer reviewed” doesn’t mean that it’s correct. The literature is packed with peer reviewed articles which are incorrect or misleading. Peer review provides some quality control, but it doesn’t guarantee anything.
Ultimately we are responsible for maintaining a healthy skepticism toward information from all sources (whether it’s the New England Journal, EMCrit, or something taught by an attending on teaching rounds). Caveat emptor.
Josh
Absolutely
While I am late to the game, I wanted to add a couple of things. I am currently an EMT-B, who is returning to Paramedic School in January. While taking classes and during my long commute to work, I frequently listen to a couple of medical podcasts (one being EMCrit, the other two are produced by a doctor, the other a paramedic/RN). I have found not only do I value the information provided given by others who have more experience than I do, I find the few podcasts have made me a very good critical thinker. Generally while listening to… Read more »
Thanks Cassandra!
Really late this this! (but demonstrated the power of the Social Media in keeping things like this alive) I am really interested in the evaluation dynamic of this. Personally I think we really do need to think of FOAM as a differently paradigm when it comes to evaluation http://rolobotrambles.com/2013/06/24/the-foamed-universe-normal-laws-of-evaluation-dont-work-here/#comments However on a different tack I remain astounded that no-one in their right mind would read on solitary journal article and then fundamentally change their practice without further discussion/referencing. Yes it appears if you create #FOAMed type material that is exactly what people might do….! This argument hangs no fire with… Read more »
Apols – errant typo in the double ‘this’
Damian, If I understand what you are saying, it is:
It would be a poor doc indeed that changes their entire practice based on 1 article or 1 podcast. Same situation; the medium is not to blame.
If so, totally agree.
That’s what I was saying!
– and wish I had put it as simply as you have 🙂
This is what I think should be used as the disclaimer in every FOAMed site: ‘Best’ evidence and ‘best’ practice? At one stage or another, a medical student or clinician will explore broader sources of information to enhance their medical knowledge. These include: – Sub-specialised textbooks – Journals – Review articles – Meta-analyses (Cochrane review) – Non conventional online sites (e.g. FOAMed) Some of the information can be invaluable in elaborating or refining current understanding. However, despite what conclusions are made or drawn from this material, the novice needs to be wary of indiscriminately applying this in the clinical setting… Read more »
fantastic comments Derek