This is in response to a bunch of comments from this Wildcast EM episode.
Please let me know what you think!
Update
Response and my comments just posted on the new Wildcast EM Site
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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thanks Scott for your declarations on this topic. This is an old fear as you know and have attested to. Essentially it boils down to trust, what is truth and what is our duty as ethical physicians. What has muddied this eternal equation is technology and the ability for an individual now to essentially become their own home media mogul. Therefore, it rails against the old fears of the question of truth and who to trust. The internet and social media is being used for lots of personal reasons and larger gains and not necessarily for the good of our… Read more »
Wow. The point of the podcast rant was clearly missed by Scott and Minh. FOAMed is a wonderful adjunct to learning in the modern age, but acting on a podcast without looking at the original literature on which the podcast recommendations are based is foolish and poor practice. That was the point. Did you listen to the whole episode?
Be skeptical. Look at the original literature. This was not an attack on EMCrit or podcasts. It was an attack on lazy educational practices.
The villain in this story
Did not take it as an attack on me /emcrit at all. But new media was definitely put in a separate category in the episode than review articles, grand round lectures, hallway conversations, and perhaps the worst villain of all–things attendings tell learners. I listened to the whole episode. ? is are you remembering or did you relisten. Podcasts and blogs (not my podcast) were def. singled out as somehow different than the already existing. Took no offense on the EMCrit aspects at all.
Well in the presence of you two behemoths of FOAM, I am pretty much a nobody. However, I did listen to both podcasts in their respective entireties and agree with Scott that, Doty did seem to imply that what was said on some of the “more famous podcasts” was somehow not backed by literature. I myself had a bit of a tough time hearing the Wildcast guys simultaneously, kind of, dog podcasting….while podcasting. You sounded (and admitted sounding) outdated. Scott, a lot of bold trailblazers have taken hits. You keep on man. I will say that as much as I… Read more »
If you don’t believe me without checking the sources, then I have done my job well!
It does not matter if the source is a blog, podcast, news article, or highly ranked medical journal. What matters is that there is valid objective evidence that a treatment works. The piece that is missing is the critical judgment to understand the strengths and weaknesses of the research that is published. Recently, the New England Journal of Medicine published two papers by the Resuscitation Outcomes Consortium, which is able to coordinate the treatment of large numbers of patients across diverse EMS organizations. This is great, but . . . . One paper (Trial of Continuous or Interrupted Chest Compressions… Read more »
I think the real conflict here is new ideas vs. accepted norms, dogma vs. evidence, innovation vs. the status quo. Blogs and podcasts are merely getting caught in the cross-fire of this eternal struggle, because they lend a voice to unconventional ideas (which are often otherwise excluded or under-represented in journals, books, etc.). If blogs only contained textbook-type, non-controversial material then nobody would object to them. In reality, I think the most dangerous form of media are consensus guidelines, because these are broadly implemented with minimal critique or individual analysis involved. Everyone thinks that consensus guidelines are trustworthy and accurate,… Read more »
We lamented that it took a full generation of doctors to change medical practice because of slow adoption of medical advances, and now there are those the criticize that things are moving to fast because people are communicating faster.
I’ll take the later. Thank you to all the bloggers and podcasters.
well said!
With you 100% Scott. As medical educators we need to promote critical thinking skills among our trainees and both teach and role model how to keep an mind that is appropriately open and appropriately skeptical. Trainees need to know that ultimately their supervisors are responsible for what happens to their patients, and ensure that the care they provide meets local standards. If you are a clinician or educator and believe a blog/podcast is wrong about something, then politely challenge it by leaving a comment or sending an email to the author (crikey, one could even make a phone call or… Read more »
indeed! and yes it takes a special breed of especially knuckle-headed knucklehead to do emcrit
Scott, Thank you so much for talking about this. I am increasingly concerned that we forget just who are “learners” are. Doctors and other health care professionals are among some of the brightest minds there are, yet we continue to patronise them with the implication being – “be careful what you say because they may not understand”. What utter nonsense. This is not primary school/kindergarten. If we are developing a generation of adult learner automatons who are unable to critical appraise what they hear or read we are doing something very wrong indeed. I am also unsure where all this… Read more »
Totally agree with all of these sentiments
Think Gray. It’s a phrase that comes up in the Contrarian’s guide to Leadership. It references trying to not be a binary, “black-and-white” thinker, but rather to wonder- “What is the likelihood that this is true/works/is a fair model? What could be wrong about this? What are the caveats where I should likely not apply this? Let me reserve judgment here.” One issue with binary thinking is the tendency towards eminence based critique- there is a bias that a more traditional form of media is imbued with a stricter fact-checking/peer-review process and that less traditional newer forms are less rigorous… Read more »
this episode of YANSS may be right up your alley: https://youarenotsosmart.com/2016/04/08/yanss-073-how-to-get-the-most-out-of-realizing-you-are-wrong-by-using-bayes-theorem-to-update-your-beliefs/
Sweet- how did I not know this podcast existed?? Thanks!
and there’s the Black and White Fallacy, right up front.
-pik
Well put. To a point. I fully agree with the value of FOAM in continuous learning both for new learners (medical students and residents) and old learners (such as myself). As Scott and others have said it can significantly accelerate the translation from bench to bedside. FOAM, such as this excellent site, offer many advantages over textbooks and other review sources due to their highly interactive style allowing rapid discussion and critique from users. Where I strongly disagree is the lumping of FOAM with formally peer reviewed journals. There is a completely different degree of rigor of the review process… Read more »
if I discern your meaning correctly (you mentioned review articles in the same vein as FOAM), they we are in complete agreement. FOAM has no transcendence over primary studies in any way shape or form. FOAM is built on the primary literature of medical journals, just as are review articles. Where I think FOAM’s peer review is far more rigorous is when compared to even respected journals’ review articles. The quality of review that a well read or listened to FOAM site enjoys is far in excess to what a review article is exposed to. We wrote about this in… Read more »
Scott,
Thank you for your thoughtful, and well reasoned (as always) reply. And thank you for all you do advancing the quality of medicine around the world.
Bob.
Hi Bob #disagree I contend FOAM is in many ways superior to the traditional peer reviewed journal system. Academic peer review process is a scam. Its voluntary work, done in own time and open to as much personal bias and conflict as FOAM its open to incredible corruption from lots of corporate sources like big drug companies. Look at the MMR/autism LAncet scandal as prime example of how respected peer review journals can be used for less than honourable intentions. The formal peer reviewed journals are open to gaming, have no doubt. The problem is that peer review process by… Read more »
Ketaminh, I will have to give this some thought. Currently, while I agree with the value of FOAM, including it’s value for trainees, I am not as pessimistic about traditional peer reviewed journals and their peer review process. The Lancet MMR/Autism study is an interesting example. Errors and failures are going to happen in any system. The key issue is how systems respond to the errors or failures. As you describe there is excellent feed back in on line media. Lancet did fully retract that article. What I do not know is if they learned from the event. Thank you… Read more »
thanks Bob for your response.
Here are a few other viewpoints on peer review that may provide more commentary than my own.
http://jrs.sagepub.com/content/99/4/178.full
http://www.wsj.com/articles/hank-campbell-the-corruption-of-peer-review-is-harming-scientific-credibility-1405290747
http://www.evolutionnews.org/2012/02/problems_with_p056241.html
http://advan.physiology.org/content/31/2/145.short
A quick diversion on this topic;
a simple dive into this website might open some people up to the fallibility of the literature
http://retractionwatch.com/
Take a look and see the articles fall from supposedly reputable journal.
Scott, Nicely done as always. As a relatively new PD and social media proponent, I understand what some of the PDs have said – it is the fear of your residents getting the wrong info, or just taking expert opinion. As you said, I think many have forgotten that this is what we all did as residents when we went and heard someone speak at ACEP, or read an article in a throwaway journal. Another common complaint I hear from the PD community (and have had myself) is the focus on exciting topics versus core content. PDs are held accountable… Read more »
I personally love that this debate is a “thing”. I love it because it displays our weakness as human beings. When dissected, at the core of this discussion are insecurity, fear and money. I agree Scott, I am 100% convinced that naysayers are insecure that a subordinate may learn something progressive and more effective and somehow this is internalized as a negative reflection, “Why didn’t I know that? Am I losing my edge?”. Perhaps the naysayers even experience fear; fear of isolation, fear of losing a reputation of wisdom or authority. And we can’t forget that in the industrialized world… Read more »
I agree with most of the above. However, I don’t think the WildcastEM podcast you referenced (if anyone listened to the actual show) was trying to “bitch about something [they] didn’t like…” but rather raise questions and have the exact same discussion that 85% of EM and CC educators at academic institutions around the world are already raising and having. In the end, I think the conclusions that they came to were similar to what you stated in your show and has been outlined by other commenters above. It seems like some (most?) haven’t actually listened to what was said.… Read more »
WildcastEM podcast crew are not the bad guys. In fact they are great guys. Rob Rogers is an education superhero! They are FOAM producers, were early adopters and significant contributors to the evolution of medical education. I don’t think there was an intent to vilify them or the point they were raising. If I personally communicated that in anyway, I certainly didn’t intend too. My point is that the debate is superficial. Just as you suggested that those commenting above, “actually listen” to the podcast, I am suggesting that people who scorn FOAM “actually listen/read” the content and who that… Read more »
Hi Peter and Ashley I was the one who made the comment about bitching and I concede my post might be intepreted as a form of vilifcation. I certainly do not mean to censure anyones right to freedom of speech and so I apologise if thats the hurt that is felt. However I did listen to the entire podcast and it did come across as a bitching session to me. Thats my opinion and we can agree to disagree. They asked the question and Scott has provided an adequate answer. If you dont like the FOAM , dont consume it.… Read more »
Guys, So far I can clearly discern that one or two people have actually gone back to the original podcast to listen to the whole thing and see what was actually said. I would suggest that anybody planning to comment on this would listen to the original podcast. What was played by Scott is a snippet of the first 3% of what Doty said. I was one of Doty’s residents and that guy is an absolute machine when it comes to the clinical practice of medicine, clinical judgment, education, and has trained an entire generation of leaders in our specialty.… Read more »
More material on why traditional peer reviewed journals are not the gold standard or at least should not be seen to be
http://www.theguardian.com/business/2014/apr/10/tamiflu-saga-drug-trials-big-pharma?utm_content=bufferebd55&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer
Tamiflu provides an excellent example of a traditional journal gathering all of the relevant information that they could.
http://www.bmj.com/tamiflu
What podcast or blog has the resources available to pursue such an investigation?
A valid example of the problems with journals is tPA for stroke. While there are several excellent criticisms of the research in the traditional journals, there is also this from a blog.
http://www.emlitofnote.com/2015/04/a-laughable-tpa-systematic-review.html
.
BMJ family of journals never gets put in the rubric of traditional in my mind. They are pushing the boundaries on all fronts.
That is one of the great things about science. It evolves as we learn from our mistakes.
The important aspect of science is that “failure of the hypothesis” is not a failure. It is how we learn.
We will probably have to rely on journals (traditional and non-traditional) for the publication of research, but analysis of the problems with research is often better, and more thorough, by blogs and podcasts.
.
Before quickly disregarding this comment, I ask that you consider it on its merit…. I’ll be honest – for a community that I love (i.e. the FOAMed community), I’m deeply disappointed by the fact that simply having a discussion and asking the questions that the Wildcast podcast did is being attacked in the way that it is, not only in Scott’s podcast but also in some of the comments here. What is wrong with having the discussion? Perhaps Scott listened to the whole podcast, but it’s clear that others have not. What this *is* demonstrating, perhaps more than anything, is… Read more »
Hi Peter
I respect your disappointment but it’s equally matched by mine for the Wildcast EM podcast .
What is wrong with agreeing to disagree ?
Come on, dude. Ridiculous statement.
I have had a lot of push back from my management when I suggest new ideas for prehospital care that I have learned through the FOAM world. So for the learners out there Dr. Weingart, how about a podcast on how to vet a podcast? What reasonable actions would you recommend a listener or reader take to ensure info put out on FOAMED is valid. Thanks and keep up the great podcasts. Although I am just a medic and not an MD I thoroughly enjoy listening to all your podcasts, taking notes, and then researching and finding more reading to… Read more »
Interesting discussion. Couple of thoughts about residents who scoff about FOAM as un-peer reviewed: 1. residency is an apprenticeship. This means they learn a lot from books, but have to work with experienced people who apply the learnings in the ever changing context of EM care. Residents have to listen to their staff and learn from them – they all realize that each staff person has a different style. Respected bloggers (the others don’t get well known) are like another staff person – their knowledge may not be perfect, but the trainees can learn from it. Although at one level… Read more »
yep, agree