A wrinkle in time: Kerry Woolfall at DFTB19

Cite this article as:
Team DFTB. A wrinkle in time: Kerry Woolfall at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.21185

Kerry Woolfall is a social scientist and senior lecturer at the University of Liverpool. This talk, our second from the PERUKI track, she talks about doing research without prior parent and patient consent.  Following legislative changes in 2008 it is now possible (in the UK at least) to enter a child into a trial of potentially life-saving treatment then seek consent after the fact. But how would parents react to this? How would clinicians? What would happen if a child died during the trial, as may understandably occur if we are looking at potentially life-saving interventions?

This talk is not just about a researchers point of view but also details Kerry’s experience from the other side of the clipboard as a NICU parent.

The research embodies a core principle of engagement.

 

You can read some of the research here.

 

Woolfall K, Young B, Frith L, Appleton R, Iyer A, Messahel S, Hickey H, Gamble C. Doing challenging research studies in a patient-centred way: a qualitative study to inform a randomised controlled trial in the paediatric emergency care setting. BMJ open. 2014 May 1;4(5):e005045.

Woolfall K, Frith L, Gamble C, Gilbert R, Mok Q, Young B. How parents and practitioners experience research without prior consent (deferred consent) for emergency research involving children with life threatening conditions: a mixed method study. BMJ open. 2015 Sep 1;5(9):e008522.

 

You can follow Kerry on Twitter here.

 

 

#DoodleMed below by @char_durand

 

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

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Night shift anxiety

Cite this article as:
Ana Waddington. Night shift anxiety, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20744

As I cycle home after a gruelling 12 hour shift, I see strange flashes from the corner of my eye. At the cafe where I have breakfast with my partner, I accidentally start buttering a tomato. I’m struggling to follow the flow of the conversation – all I can think of is sleep. Back home, I turn on the shower, expecting the water to hit my head – and realise that I’m still wearing my helmet. When I do finally get to bed, pulling the curtains closed on the beautiful day outside is physically painful. While everybody else is having fun – in the park, at the pub, enjoying the sun – I’m trying to ignore the slivers of light which creep into the bedroom, scrunching my eyes so tightly closed that I think might pull a muscle. And on top of all this – the exhaustion, the mental lapses, the irritation – I’m worrying about whether I’m going to be able to get enough rest to avoid feeling jet-lagged for the next two night shifts. 

Blowing the whistle: Kim Holt at DFTB19

Cite this article as:
Team DFTB. Blowing the whistle: Kim Holt at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20736

You may recall the headlines surrounding the case of Baby P. Back in 2007 a 17 month old boy died as a result of injuries suffered over months of abuse. During that ordeal he had been seen by the London Borough of Haringey Children’s services and multiple concerns were raised. But nothing happened. Not until it was too late. Eight years earlier the same council had failed to intervene possibly leading to the death of eight year old Victoria Climbie.

Compassion to the Core: Mary Freer at DFTB19

Cite this article as:
Team DFTB. Compassion to the Core: Mary Freer at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20653

Mary Freer has been with us from the start. After a heartfelt keynote at our first conference we knew we had to keep in touch. In London we set her a challenge. We asked her to set the intention for the day for us, to frame our conversations around care.

The Medicines Handbook: Simon Craig at DFTB18

Cite this article as:
Team DFTB. The Medicines Handbook: Simon Craig at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20590

Ask any paediatrician what the hardest, tricksiest procedure that you might ever have to perform and they would all be in agreement – calculating drug doses in the middle of a paediatric resuscitation. In this talk Simon Craig, from Monash, takes us through the how we can do better than scratching out rough calculations on the whiteboard at 6am. He asked the key question…

 

 

 

 

 

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

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*Lori was once one of Andy Tagg’s trainees but he is quick to point out that none of the situations depicted are about him.

 

An approach to obesity: Matt Sabin at DFTB18

Cite this article as:
Team DFTB. An approach to obesity: Matt Sabin at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20580

Associate Professor Matt Sabin is the Chief Medical Officer of the Royal Children’s Hospital in Melbourne. It was not in this role that we asked him to speak but rather in his clinical role as a paediatric endocrinologist running the largest tertiary hospital obesity service in Australia.

Exercise induced wheeze: Rob Roseby at DFTB18

Cite this article as:
Team DFTB. Exercise induced wheeze: Rob Roseby at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20582

Associate Professor Rob Roseby is a respiratory physician. You might see many adults huffing and puffing around the local park every Sunday, bright red in the face, gasping for breath. This shouldn’t be the case for the children in their charge. In this talk Rob reminds the reluctant athletes in the audience that exercise and sport is good for children – both in terms of mental health and physical health. 

 

So, should we prescribe sport for our younger patients? Does it actually make a difference? And if they can’t play the sport that they love how can we get them back to it? Listen to this talk from Rob to find out how we can make that all important difference

 

 

 

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

iTunes Button
 

 

*Lori was once one of Andy Tagg’s trainees but he is quick to point out that none of the situations depicted are about him.

 

Mentoring in Medicine: Melanie Rule at DFTB18

Cite this article as:
Team DFTB. Mentoring in Medicine: Melanie Rule at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20557

Mel Rule is one of the founding members of the extraordinary WRaPEM group. They are a group of passionate educators and clinicians waim to bring back Wellness, Resilience and Performance coaching for the everyday doctor.

Giving Feedback: Lori Chait at DFTB18

Cite this article as:
Team DFTB. Giving Feedback: Lori Chait at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20517

When we learn about feedback it is often from the side of the wise expert, the person giving it. Whilst they might be very good at what they do it is worth considering how the person on the receiving end feels. In this talk from 2018 Lori Chait, a paediatric trainee*, reflects on what it is like to be on the receiving end and how we might do a better job.

 

 

 

 

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

iTunes Button
 

 

*Lori was once one of Andy Tagg’s trainees but he is quick to point out that none of the situations depicted are about him.

 

High Flow Nasal Cannula Oxygen: Franz Babl at DFTB18

Cite this article as:
Team DFTB. High Flow Nasal Cannula Oxygen: Franz Babl at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19674

Given that DFTB18 was held in Melbourne it was important to highlight the work of PREDICT (the Paediatric Research In Emergency Department International Collaborative)* This talk, by Franz Babl, centred around the management of bronchiolitis and focussed on the recent PARIS trial.

Ben Lawton took a closer look at the trial here and you can see the infographic we developed to go with the paper below.

You can find the paper here.

So what does the expert think? Here is A/Professor Franz Babl from the Melbourne stage.

Selected references

O’Brien S, Borland ML, Cotterell E, Armstrong D, Babl F, Bauert P, Brabyn C, Garside L, Haskell L, Levitt D, McKay N. Australasian bronchiolitis guideline. Journal of paediatrics and child health. 2019 Jan;55(1):42-53.

Haskell L, Tavender EJ, Wilson C, O’Brien S, Babl FE, Borland ML, Cotterell L, Schuster T, Orsini F, Sheridan N, Johnson D. Implementing evidence-based practices in the care of infants with bronchiolitis in Australasian acute care settings: study protocol for a cluster randomised controlled study. BMC pediatrics. 2018 Dec;18(1):218.

Schlapbach LJ, Straney L, Gelbart B, Alexander J, Franklin D, Beca J, Whitty JA, Ganu S, Wilkins B, Slater A, Croston E. Burden of disease and change in practice in critically ill infants with bronchiolitis. European Respiratory Journal. 2017 Jun 1;49(6):1601648.

*COI – Both Ben and Andy have done or are doing work under the auspices of PREDICT

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

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A Simulcast journal club: Ben, Vic and Jesse at DFTB18

Cite this article as:
Team DFTB. A Simulcast journal club: Ben, Vic and Jesse at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19640

We were very privileged to be joined in Melbourne by the team from Simulcast. This piece of radio theatre was recorded in front of a live studio audience.

The team discussed, amongst others, these papers…

Ben Symon, Jesse Spurr and Victoria Brazil

Bearman M, Molloy E. Intellectual streaking: The value of teachers exposing minds (and hearts). Medical teacher. 2017 Dec 2;39(12):1284-5.

Ingrassia PL, Franc JM, Carenzo L. A novel simulation competition format as an effective instructional tool in post-graduate medical education. Advances in Simulation. 2018 Dec;3(1):17.

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

iTunes Button

Mirror Mirror

Cite this article as:
Andrew Tagg. Mirror Mirror, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19303

This blog post complements the talk I gave in the closing session of DFTB19. It has been recorded and will be released as FOAMed later in the year.

As part of my ongoing professional development I decided to volunteer for an experiment the Australasian College for Emergency Medicine were running. As a consultant it is really hard to get feedback on how you are doing, both clinically and professionally. You could ask your colleagues face-to-face but how honest an answer are you really going to get? So I enrolled in a pilot multi-source feedback program. Unlike traditional peer feedback and yearly assessments where you receive one-on-one feedback from the head of department, this was was something different.

I had to nominate 15 colleagues to complete an online survey about my professional behaviours. Anonymized to makes sure that things would not be seen as personal. I chose colleagues from all levels of my work life – from interns, registrars, peers, my immediate bosses and the Chief Medical Officer of the hospital. I chose doctors from specialities that I refer to on a regular basis and I chose non-clinical staff too. And in order to increase the actual worth of the project I included some people that I feel that I don’t get on with as well as I could (yes, they do exist!).

The findings were…interesting. There were the usual comments about drinking less coffee and learning to say no, both of which I fail at miserably on a regular basis. And then there was this one.

Now clearly this says more about the author than it does about me, but it did get me thinking about the impact we have in the workplace.

Emotional contagion

Human beings are social animals. We thrive in groups and, despite having had language for approximately 100,000 years, we rely on non-verbal communications to let members of our tribe know how we are feeling.

Charles Darwin, in his three-quel to The Origin of the Species, wrote that, despite their fleeting nature, our emotions are written large on our faces and this process is far beyond our control. But what is more fascinating is what happens when someone witnesses that unbidden display of emotions. Watch someone smile, genuinely smile, a mirror neurons light up in your brain. In a series of fMRI studies Rizzolatti et al. showed that the same are of the brain fires up when you witness an emotional display as if you had experienced it yourself. This reflexive, sub-thalamic response is emotional contagion.

Whilst our emotions influence our physiological state the reverse is also true. If I smile (more on that later) I feel happier. If I frown I feel more sad. And if I cannot frown – perhaps I have succumbed and finally got some botox to rid me of these troublesome wrinkles – then I will actually feel happier. Well, that is what some scientists have found.

Negative states

The problem is that negative states – fear, anger, boredom – are much more readily transmitted than positive ones – kindness, compassion, calm. Perhaps because they often come unbidden and out-of-control they are more likely to leak out before they can be contained.

This can cause major problems in the workplace as a doctor infects all those around them.

The work we do has a high level of emotional labour, moving from high intensity states such as dealing with life-affecting resuscitations to low intensity states of chronic constipation, without pause.

Some people are more susceptible to emotional contagion than others. Take a look at Docherty’s 15 part emotional contagion susceptibility scale and see where you might fall.

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154

And if you are the sort of person that finds themselves crying at the movies then you are not alone. I’ve left a little something for you on our YouTube channel for the next time you want to cut loose.

There are some highly infectious people that we can find in any department.

We’ve all met the MAVERICK – the hot shot doctor that thinks they know everything. They don’t need to follow the guidelines because they know better. They can send home the febrile 28 day old because they look fine to them. They can make the half-baked referrals because it’s the end of their shift and they have to get to their beach volleyball game. Besides the team will sort it out.

They make us fearful, nervous, a little afraid. Their arrogance spreads as they achieve more success, until…. They make a mistake. And they will.

So how can we help them? How can we protect ourselves and the department from their contagion? They need to be reminded, gently, that even Tom Cruise wears a safety harness. Guidelines are there for a reason. It’s okay not to agree with them but you have to be able to defend your actions. If you want to go your own way you need the evidence to back you up. Rather than ignore the MAVERICK and allow the worry to fester it’s important to head them off (whilst allowing them to save face). You set the tone!

What about the MOANER? You only have to go into the staff room of an y department in the hospital to spot one of these creatures. They are the ones drawing everyone into their spiral of doom as they complain about so-and-so from X (insert particular out-group here). Before long the rest of the group has been infected but their particular brand of emotional catharsis and everyone begins to moan.

It’s easier to not become one of them than it is to change their mind. This is the time for herd immunity. The more positive people there are in the room the better. Rather than joining in it is time to point out the dangers of stereotypes and labels. And should the opportunity to moan about your lot at work arise then it is time to take the higher ground. Remember, you set the tone!

And finally there is the MAGNET. Years of bad experience has led to a degree of learned helplessness. The more times they have been crushed by the chaos of the system the more they feel it is pointless to do something about it. At the mention of the Q word – the-word-that-should-not-be-named – they predict an apocalypse worse than any Private Frazer could dream up. Equipment will fail, stock will be missing or fall apart and there will be nobody around to help at the critical juncture – all because you said the word q.u.i.e.t.(shhhhh!)

So what can you do? It is time to role model the desired behaviour. You cannot control what is happening outside of your department but you can claw back a little control from the chaos within. At the beginning of every shift I check the key equipment that I might need to make sure it is working, I make sure that nothing is missing and I make sure roles have been allocated before the inevitable happens. I set the tone!

Manipulation?

All of this behaviour, including the examples I give in my talk, could be seen as manipulative, perhaps even a little sly? Teams that have a happier outlook, with members that embrace positive emotional contagion are safer and more efficient. Whereas when experimental psychologists have planted a MOANER as a confederate they found that teams became much less efficient.

Which sort of team would you rather work in?

Selected References

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154.