P Cubed (How to do a Presentation) - #wewillgiveDREEAMpresentations

In a previous blog post I've already sung the praises of Ross Fisher and the p cubed approach to presentations.

In this live recording at the latest DREEAM educators' meeting I talk a bit more about p cubed, how to present information in a way that's not just nice to look but has science behind it.

Here are the slides.  As ever just click to scroll through them.

Topics covered:

• Why bullet points are bad (irony)
• How to storyboard - spark points and lightning slides
• The science of presentations - cognitive overload, the three second rule, the rule of thirds and dual coding
• How to present data

Here is the Take Visually for this episode: 

I hope you enjoy this talk and feel inspired.  That's the purpose of this talk and as a team at DREEAM we have made a Twitter pledge #wewillgiveDREEAMpresentations.

For more information on learning theories (and why it's wrong to think about 'types' of learners) check out Learning Scientists.

Good luck telling people of the amazing things you've seen.

                 - Jamie

UMEC, I MEC, We MEC

It was an honour to be asked to present at the 4th annual Undergraduate Medical Education Conference (UMEC) at the University of Nottingham on 7th July.  It's a great opportunity to see the great work being done to improve the teaching of our students.  

I think we were all impressed by the work of WAMS (Widening Access to Medical School) a programme run by medical students in association with work by the university to widen access to students who might otherwise not go to medical school.  I was very lucky with the support from home I received; many are not so lucky. 

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                                              The DREEAM team out in force for UMEC 2017.

It was great to hear from my fellow podcaster Charley Peal on her work 'Nifty Fifty' giving clinical students a booklet of 50 challenges such as escorting a patient to X-ray to help them orientate and stay on the ward.  Or as she and her fellow medical fellow Becca Noble put it ''avoid being a trip hazard''.  Not saying I actually caused people to trip up when I was a medical student but I certainly had some near misses.

There was a good discussion about the difficulties of sharing educational resources.  This is why I support FOAMed despite its detractors.  No paywall; no firewall.  The challenge is quality control of course but I've often thought that there's great work going on that just isn't celebrated enough.  I've regularly been in conferences and felt it just seems like some institutions are better than others at getting their message out there.  There must be reasons at the individual level to explain this but it must also be due to leadership and the culture of an institution.  

We also discussed the conundrum at the heart of medical education I feel.  Our students want to pass exams.  We want them to be safe doctors.  It's sad but understandable when in the past I've had to cancel sessions because they're near exams and whilst they'd help the students as doctors I know engagement would be poor if I put it on.  

My DREEAM colleague Matt Govan kindly filmed me.  It's actually hard to boil a subject down into 7 minutes and it took a lot of practice.  Looking at it I hope it shows a progression with using the P3 approach to presentation.  The last time I presented I was told I dance about a bit so here I'm routed to the spot by 'anchoring' against the podium.    

In my last blog at Das SMACC I mentioned how SMACC has helped change the approach to conferences at this philosophy was evident at UMEC; short presentations, workshops dotted amongst the schedule with social media being used throughout.  As someone who attends a lot of conferences it's a great development and one to be continued.  Thanks to everyone at the UMEC organising committee.  

Red Flags Here!

Thanks to @JamesPrattACP for pointing out this great video!  Apologies if you're not a geek like me; ask your kids.  It makes me wish we had someone waving red flags at us as we talk to patients.

How important are red flags to your practice?  Despite the continuing negative press aimed at the NHS 111 service I think if we were on the phone hearing a patient describing the ''worst headache ever that came on quickly'' I very much doubt many of us would advise the patient to wait to see their GP.  Red flags exist for a reason.  They can point out the obvious as Watto is doing to Qui-Gon.  Unlike Qui-Gon we should listen.  

''Listen to your patient, he is telling you the diagnosis" - William Osler

I'd imagine every healthcare worker has stories of patients that act as a reminder to be humble and open minded.   These cases can form our reflective practice, our teaching and help make us better at what we do if we handle them properly.  We've all seen the horror stories often misrepresented in the press but if we follow red flags we can practice safely; it's not about fear it's about doing the best for our patient.  It's also about being up to date.  For example through safety alerts from the Royal College of Emergency Medicine or Trauma Audit and Research Network data I know I have changed my approach to elderly patients presenting with abdominal pain or a fall.  On the other hand work such as the MACS decision rule challenges long held clinical convention that 'cardiac sounding chest pain' is always crushing, central and radiates to the left hand with pins and needles.  

There is an interesting paper joint written by a conference of the Royal Collage of Physicians and British Geriatric Society which I recommend reading that takes a systems based approach to red flags.  I think that's a very useful tactic when teaching history taking; by learning red flags and the reasons behind cardinal symptoms we improve our focused history taking and handovers.  

I enjoy teaching on the Enhanced Clinical Skills course run by @JamesPrattACP on which I do a session on red flags and clinical bias.  It is refreshing as someone who exists in the bubble of Emergency Medicine to see the perspective on red flags from community nurses in a variety of specialties; from general practice to psychiatry.  Due to the sheer breadth of presentations in the community there are some great primary care orientated resources based on red flags.  There's often reminders of how my work might have blunted my own perspective such as when I mention haemoptysis and the community based audience all diagnose cancer when pulmonary embolism was actually foremost in my Emergency Medicine biased mind!  

In this session I discuss the inherent biases we all carry.  Some can be unavoidable but we can and need to be aware of them; I use the example of 'the dress' for this as it also works as a good ice breaker.

                                    The dress.  It's white and gold by the way.  Clearly.

 We explore different sorts of biases through some, exaggerated, hypothetical scenarios.  Yes, there's some cliche (the horse vs zebra conundrum is unavoidable) but I hope through the session to get our students to explore their own pre-conceived approaches to common clinical conditions as well as facing up to clinical decision making biases.   

Whilst all important I find two in particular challenge us day to day.

1. Psyche-out error: as far as I'm aware mental illness doesn't protect a patient from medical illness
2. Diagnostic momentum: giving too much value to a diagnosis made by other professionals and not challenging it when the evidence points otherwise

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Knowledge of potential biases as well as insight into our limitations helps make us safer in our practice.  As best explained from former US Defence Secretary Donald Rumsfeld it's all about those unknown unknowns!

Here is a recording of my session on red flags and clinical biases recorded in front of an audience of community and hospital nurses.  I have edited out some of the group work sessions for brevity.  

  - Jamie

"I've seen things you people wouldn't believe..."

"Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhäuser Gate. All those moments will be lost in time, like tears in rain. Time to die."

Blade Runner is one of my all time favourite films and I think this soliloquy by Roy Batty is one of the most beautiful pieces of improvisation ever put to film.

What does this have to do with FOAMed?  Well the metaphor of memories being lost like tears in rain is used rather brilliantly by one of my education heroes Ross Fisher (@ffolliet).  No matter how good the subject matter if the presentation is poor the message is lost.  Like tears in rain.  Through presentations and his own website Ross has helped place a focus on how we can improve the way we teach through the 'p cubed' approach.

I'm not going to repeat his work here other than to say if you teach or present anything about any topic you need to see his website and listen to his podcasts.  You will learn and be inspired.

From a personal point of view I certainly was taught through 'death by PowerPoint' at medical school.  Sadly, this was how I then attempted to teach once I became a fellow.  Thankfully I was introduced to Ross's work by a former colleague @dominic_purnell.  Needless to say, this has had a profound affect on how I teach now.  

Interestingly, there is often some resistance from other colleagues primarily I think because of being used to teaching with PowerPoint as the sole focus - ''as a crutch'' - but if you view it as an aid and make yourself the focus of attention it is amazing what can happen.  

No one can cover every topic in one session but we can inspire and enthuse.  In this presentation I spoke in front of my fellow educators at DREEAM about p cubed and my own 'journey' in teaching.  I also talk about some other useful technology such as Mentimeter, TweetDeck and QRS Codes which I might blog about separately another day.  It is quite personal but I think shows how nearly 2 years of teaching has changed my approach.  It also gave me a chance to reference James Bond (RIP Sir Roger), Indiana Jones, Sir David Attenborough, Robin Williams AND Ferris Bueller - not many presentations can do that!

Hope you enjoy my presentation which does use a lot of Ross's material (why reinvent the wheel?).  Check our his website and podcasts.  And watch Blade Runner if you haven't.  It's amazing.

 - Jamie