The task:
In-depth lecture covering Hemodynamic Monitoring of the Critically Ill Patient as well as Respiratory Support and Mechanical Ventilation Strategies.

The audience:
PGY-2 Anesthesiology residents.

The time allotted:
90 minutes.

My response: ARE YOU SERIOUS??

I had to figure out a way to provide a thorough, relevant, topic review of two of the most broad subjects within critical care to residents who were very early in their training and all within a relatively “brief” amount of time. Most importantly, the presentation had to be interesting enough for it not to seem overwhelming so I didn’t lose them halfway through. I shuddered to think how they would feel at the end if I hit them with a bullet rich powerpoint presentation reminiscent of my college and medical school days..Arrrghhhh! (truly Death by Powerpoint).

I needed something that can make them see the BIG PICTURE and not get lost in the details! I have always been a visual learner and I find that drawing my notes, sketching the connections and relationships among things really helped me understand complex topics. I needed a tool that would allow me to teach the way that I like to learn. This is where I found Prezi. Prezi is is a web-based presentation application and storytelling tool that uses a single canvas instead of traditional slides. Instead of presenting slides and bullets, the presenter can zoom in and out as well as pan across the canvas to visually present ideas. It allows the presenter to zoom out to show the big idea and the connections among things and when needed zoom back in to go over the details. Certainly, this is a visual experience much different than a traditional powerpoint presentation. This tool seemed like a perfect fit for me — so I gave it a shot. I recently posted these presentations to the site and they can be seen by clicking on the links below:

1. Hemodynamic Monitoring
2. Mechanical Ventilation

Positive impressions:

• very easy to sign up (used an educator account to signup which took a few minutes
• all the editing was done in a browser which made the whole process very portable. I used chrome and firefox without issues
• very easy to edit, create, embed images and create paths to fly around the screen
• **really made my presentation look and feel like the overview sketch I had created on a piece of paper to show the interactions / connections among topics**
• autosave and undo features are great!
• the file is saved on the prezi servers and anyone can access it — i could control it to be private or shared (needs to be shared to post on blog)
• i could download to my MAC (or a PC) to run as a standalone presentation — this was great for backup in case the website or my internet access was down — i found this a faster way to run the presentation since it relied on the speed of my Mac as opposed to the internet —i can see this being important for LARGE prezis
• presenting was as easy as powerpoint — used the arrow keys to move forward and back — also at any time I could manually control the prezi by using the mouse to zoom in /out and pan around — this was great in case of questions if I needed to go back to a specific point
• i was able to easily embed the prezi in this blog using the simple embed code
• definitely an overall coolness factor to the presentation

Negative impressions:

• I wonder if any of my audience members felt a bit “sea-sick” from the constant panning — there were a couple of times when i wanted to skip a section and clicked through it quite fast. This resulted in a rapid pan-zoom-pan-zoom that even i was uncomfortable with. I had no specific complaints afterwards fromt he audience but I think the presenters have to keep this in mind — what that means is allow the audience to adjust to a motion before moving to the next one. Talk a little slower and move from “slide” to “slide” a little slower
• The path tool which describes how the presentation moves along took a little tweaking – also I found it a bit confusing to go back to the path and change it around. In fact I had to trash the whole path a couple of times. Fortunately, its a pretty quick process so this didn’t add too much to the production time.
• AUDIO!!! this is going to be a big issue for all presenters who would like to make presentations available for viewing on a blog — a lot of us would like the ability to add audio to the presentation that essentially makes this a “prezi-cast” so that viewers online can follow along. Prezi does not make this easy. It only accepts flv/swf audio and adding it to the presentation is not the easiest thing since it has to be individually added in segments as it relates to a step in the path. Even explaining it is difficult for me. Other tools like slideshare make slidecasting very easy allowing presenters to easily add an mp3 file and add timing to it to correlate with the slides. Prezi is definitely behind the eight-ball here and needs to fix this issue.

Overall, I think Prezi is an excellent tool for medical education and it can definitely be used to turn linear (PPT) presentations into a non-linear (canvas like) format which can be visually appealing and allow the audience to really understand the BIG PICTURE first and then focus on the intimate details of the topic. Please watch my presentations and let me know what you think — would you use it to teach complex medical topics?

In this edition of the series, Dr. Molinar provides an excellent review of the different types of hetastarches available along with associated pharmacokinetic and pharmacodynamic profiles.

CLICK HERE TO VIEW THE RECORDED JOURNAL CLUB WEBINAR

This is followed by Dr. Ahn’s review and discussion of the Schortgen et al. study in Lancet 2001. This was thew first “larger” study to evaluate hetastarch and its possible deleterious effect on the kidneys when compared to Gelatin in a multi-center randomized trial in France.

Finally, not until 2008 did we have a large multi-center German study called the VISEP trial published in NEJM which looked at severe sepsis and septic shock patients and compared Hetastarch to Lactated ringers (along with evaluation of intensive vs conventional glucose control). This too as a secondary endpoint ealuated the effects of therapy on renal failure and need for RRT. Although this trial was stopped prematurely because of severe hypoglycemic episodes in the intensive insulin therapy group, it is still the single largest multicenter trial to date looking at the outcomes of septic patients receiving Hetastarch.

These two trials really are the basis of what I have termed the “anti-hextend” movement in the critical care community however they are marked by a myriad of SIGNIFICANT design and statistical FLAWS which have also led to widespread criticism. This journal club webinar aims to dig deep into the analysis of these two trials and was a very engaging and though provoking session. Please FEEL free to comment below and let the discussion continue!!

In keeping with the spirit of ICU 2.0-3.0, I am proud to announce the introduction of the Critical Care Journal Club Series. The series will feature weekly or bi-weekly online, live, real time broadcasts of journal club conferences in the Surgical Intensive Care. The presenters will be residents and fellows rotating through the Surgical ICU and will be moderated by an attending physician. These discussions, much like the anesthesia ones are lively, educational and usually lead to animated conversations on controversial critical care topics facing us today.

Subscribe to the site via twitter or rss to get regular updates and find out how you can attend the next session LIVE online. In the mean time:

CLICK HERE

to get to the list of recordings of the sessions.  As always, comments, suggestions and lively discussion is heavily encouraged!!

Now featuring live online journal clubs on exciting topics in Anesthesia primarily focused on the ambulatory setting.  Follow the link to the Journal Club Series to explore the site and register for the next event. Theses live journal clubs are moderated, live events that lead to lively discussions and feature some of the experts in the field. After the event, you can find a link to the recording of the event where you can review the conference and continue the conversation online …. click on the link and enjoy …

iPad hands on review: Fits in your white coat and is fast enough for Medical point of care use [Healthcare Perspective]

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I apologize for the long delay between posts but I have been working on getting some updates into the website. As you can see, our theme is entirely different and starting today – We are iPhone friendly! now you can visit anytime and have the same ease of use that you do from the computer at home or work. Enjoy!

Her is a presentation that goes over what my vision is for the “FUTURE ICU.” I originally presented this about a year ago during my fellowship. Enjoy!

Here is another fantastic ICU 2.0 resource. You can subscribe to these podcasts in iTunes or listen to them directly on the website. Dr. Jeffrey S. Guy has taken topics he discussed on teaching rounds in the Burn ICU at Vanderbilt and brought them to you as onDemand solutions! It is these sort of resources that are inspirational for me and truly on the forefront of teaching in the 21st century. Well Done Dr. Guy! I hope you enjoy and become a subscriber (as I did).

BTW. Look out for the Critical Care Minutes podcast and vodcast series which will be starting up very soon. Stay Tuned!

You can now follow along with us by signing up for our twitter updates. Just click on the link below. Also you can always subscribe to the site with your favorite RSS reader. Stay tuned, exciting new ICU 2.0 features will be coming to the site very soon including the ability to join in our LIVE! web conferences. Click the logo to follow along!

Here is another excellent and thorough resource I found online in the blogger community that reviews several procedures including Central Line Placement, Thoracentesis, Paracentesis, Arterial Line, Lumbar Puncture, etc. The review is not video based but does have very detailed images used to illustrate the techniques as well as nice decriptive explanations. ClinicalCases.org is a free online case-based curriculum of clinical medicine and is one of the most popular medical blogs on internet. A lot of the information may not be relevant to the ICU but it is still a good resource for topic reviews. I would encourage you to browse the site and get your learn on Incidentally, this website has significant input from the Cleveland Clinic and the Case Western Lerner College of Medicine – The blog was developed by Dr. Vesselin Dimov (Internal Medicine, CCF).

ClinicalCases.org was featured in the British Medical Journal and Medscape.com, and was referenced several times in the medical education literature. The project is hyperlinked in the web sites of 11 medical schools in the U.S., Canada and Europe. This case-based curriculum was started by physicians at Cleveland Clinic and Case Western Reserve University (St. Vincent/St. Luke) Internal Medicine Residency Program for the purpose of medical education.

Check it out Clinicalcases.org.

Here is a link to the Procedural guides.