Wednesday, September 26, 2012

One week in FOAM

Many residents and faculty have approached me with questions about using Free Open Access Meducation (FOAM) and social media, and often report feeling confused and overwhelmed by the amount of resources out there. On a practical level, they wonder - what does learning from FOAM actually mean?

This post started off as an email to other residents in my program in order to give concrete examples of how I use online resources and our residency's social media account as a part of my education.

For starters, I think the role of online resources - Twitter, podcasts, and blogs - is largely to expand upon traditional textbook learning and published literature to enable dialogue and critical thinking about how we use that information. As someone who finds textbook learning alone challenging, I use online resources to increased the “stickiness of what I’ve learned so that I can remember it, understand it, and apply it in my practice.

Here’s a contextual example of how I used the residency Twitter account recently. At Journal Club, we talked about an article reviewing Haloperidol vs. Midazolam vs. Lorazepam for chemical restraint in acutely agitated patients. I tweeted a link to the article and some of the clinical pearls from our discussion. I haven't used much Midazolam for chemical restraint, and was intrigued by the quick on / quick off argument. Michelle Lin from UCSF responded with her own practice. A Community EM doc who likes to use Lorazepam and Haloperidol in the same syringe wondered about mixing Midazolam and Haloperidol and reached out to an EM pharmacologist for an answer - maybe you can, maybe not.

I went home and read Rosen’s (which I happen to read online/on my phone because the book is too big to carry around) on acutely psychotic patients, which had a helpful review of the diagnostic criteria for schizophrenia, tips on getting a good psychosis related H&P, and an outline of organic illnesses and medications that can also cause acute psychosis. It covered the Haloperidol and Droperidol FDA warnings briefly, and recommended the common Haloperidol 5-10mg and Lorazepam 1-2mg given IM or IV in the same syringe for chemical restraint. It did not discuss Midazolam specifically.
Bedazolam: a sparkly compound rarely encountered in the wild
Then I posted a link from Joe Lex, one of our attendings after ACEP tweeted the full text of a new trial in Annals comparing midazolam +/- olanzapine or droperidol for chemical restraint. EMRAP did an hour on chemical restraints last month with many different perspectives from EPs around the US and abroad, so I posted a link to that as well. (Sidenote: Apparently, there aren’t very many emergencies in Sweden. Sounds like a tremendously healthy and boring country.)

Result: I did some good critical thinking about chemical restraint, combining what I learned from the textbooks, the evidence based literature, and the practical advice of Emergency Med Faculty from Temple, other academic centers, and docs from the community. The process was easy, practically instantaneous, and immediately rewarding.

I’m going to remember that information and use it. I hope that tweeting those resources helps other residents review that information and think critically about it as well.

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