Friday, July 02, 2010

Lessons Learned From ICEM 2010 (Part A)

From personal experience of having attended many conferences in the past, both nationally and internationally, I realize that although I learned many things from these conferences, I hardly remember much of the precious gems that I have gathered months or years later.

This is where note-taking comes into the picture. For many of us, we think that note-taking is only for secondary and university students. Worse still, in today’s digital age, many think that taking notes is fast becoming a lost art. Read an article here on the “Recovering The Lost Art of Note Taking” at

The secret to effective note taking, according to that article by Michael Hyatt, is taking time to review your notes.

Besides giving two talks in two different scientific tracks in the conference, I must say I learned a lot from ICEM 2010. Most of the talks that I chose to attend are research tracks. And although most of the talks in the 13th International Conference on Emergency Medicine already have their salient points highlighted in the conference proceedings, this set of notes are compiled from the personal notes that I scribbled together with spontaneous ideas that came to me while listening to the talks.

Because these notes merely represent my understanding and interpretation of what the speakers are trying to say, they may not necessarily reflect precisely what the speakers originally intended message.

The notes here also, are by no means, comprehensive. I only scribbled down points that personally appealed to me. In some cases, I only took home one or two points from a talk. Furthermore, for other talks I attended where the information can be easily obtained from journals, textbooks and in the world wide web, I have not noted them down here. In some of these notes, I have incorporated points from the speakers as well as my own thoughts and ideas.

Lessons learned from:

World Economic Recession: Impact On Emergency Care by Prof Arthur Kellermann

Professor Arthur Kellermann started off his plenary talk by alluding to the fact that although the world economic recession affects many countries, disparity exists in the way this recession affects the high-income countries as compared to middle and low-income countries.

For high-income countries, the mortality rate (particularly for traumatic deaths) in emergency departments (ED) may paradoxically decrease due to the fact that fewer people will have the luxury for over-indulgence. This leads to a slower pace and a more prudent way of life, a more prudent way of driving to save fuel, etc. On the other hand, morbidity may increase as more people will have less income to spend on medications, especially for chronic illnesses requiring long-term medications. As a result, many patients may default treatment. Therefore, we may see a resurgence of acute decompensation of chronic illnesses presenting to the EDs.

Conversely, for many low-income countries, where up to 60% of the people’s income may actually be spent on basic needs such as food, mortality rate may increase due to malnutrition, starvation, infective diseases, etc. In fact, for some of these countries, the healthcare system is heavily depended on external aid and sponsor, and therefore, the current crisis may result in a significantly reduced budget when people have less to donate. Child mortality, logically, would be increased as well. The number of motor vehicle crash cases would also be increased, and this increase usually involves pedestrians and bicycle riders.

During the audience feedback session, Assoc Prof Goh Siang Hiong’s sharing of continuing IV antibiotics in patient’s home is certainly a very creative and interesting idea of shifting the trend from a paternalistic healthcare model to a shared care model, where the community is empowered to a form of partnership in healthcare delivery system.

It would be interesting to see how this current economic recession actually impacts or changes the health seeking behavior of our Malaysian patients. The Malaysian government heavily subsidizes the public healthcare system. But one of the major problems of public healthcare system is the long queuing time. Many patients who can afford it will therefore go to a private healthcare center. As such the economic recession may actually cause a significant increase in patient load to the public healthcare centers, including EDs of public hospitals. Many patients who previously had the luxury to seek private medical treatment, may in this current economic crisis, “migrate” to the public healthcare centers, choosing to wait and pay RM 1 – RM 5 for treatment rather than paying an exorbitant fee in the private sector for the same types of medications. Hence, we may actually expect to see an increase in terms of the number of green zone cases presenting to our EDs. Unfortunately, while this economic recession results in an increase of patient load, it disproportionately results in shrinkage in terms of budgets and allocations, as experienced in many public hospitals in this year. Such studies can be carried out in collaboration with researchers in the field of business and economics. Certainly a research in this area is worth doing.


Lessons learned from:

International Emergency Medicine Curriculum by Dr. Mike Clancy

In this session, the speaker shared on the current curriculum development for emergency medicine, specifically from the UK College of Emergency Medicine curriculum development. One of the things he mentioned that interest me is this: the development of the non-technical skills. According to the speaker, more and more colleges and academic organizations are recognizing the importance of non-technical skills. Non-technical skills (also better known as “soft skills” in the Malaysian context) include:

· Team working

· Communication

· Time management

· Management of patients’ flow

· Leadership skills, both within and outside, of emergency medicine

I feel that these non-technical skills are not tested enough in our local postgraduate emergency medicine training system. Our challenge is: how we can incorporate the teaching and the testing of these skills in emergency medicine curriculum development?

Another keyword that the speaker mentioned caught my attention: sustainability. The speaker said that in the process of curriculum development for emergency medicine, one should ensure sustainability, and not to be burnt out immediately after starting the program. The question that comes to my mind is: how? How can we ensure sustainability of our emergency medicine curriculum development? Or rather, putting it in another more challenging way: what are the factors that hinder sustainability of our program?


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