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.

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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.

 

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.

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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.

 

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.

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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.

Fixing what once was broken: Ross Fisher at DFTB18

Cite this article as:
Team DFTB. Fixing what once was broken: Ross Fisher at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19345

Spoilers: There are some minor swears at the beginning of this talk so if you are easily offended or are listening with children around then fast-forward 10 seconds or so.

We have all made mistakes. Some are small – like forgetting to get the milk on the way home, some are huge – like forgetting your wedding anniversary. In this closing talk from DFTB18 Ross talks about the ancient Japanese art of Kintsugi. By fixing shards of broken pottery with molten gold artists created something even more beautiful than that which was broken.

 

What if you make a mistake at work? Can you be fixed?

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.

DFTB19 has just a couple of main conference tickets left but there are still spots for some of the pre-conference workshops.

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
 

Selected references

Callahan K, Christman G, Maltby L. Battling burnout: strategies for promoting physician wellness. Advances in pediatrics. 2018 May 7.

Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. InMayo Clinic Proceedings 2017 Jan 1 (Vol. 92, No. 1, pp. 129-146). Elsevier.

Vicarious Trauma : It’s ok to not be ok

Cite this article as:
Jasmine Antoine. Vicarious Trauma : It’s ok to not be ok, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19256

One afternoon my team broke the news to three different families that their children had a non survivable condition. That same week I was involved with a patient transitioning to a palliative pathway focused on comfort. I returned home to utter the words, “She is so sweet, I hope she dies soon.

For many of us, days like these, occur commonly.

Being a doctor is a privilege, an honour, a calling. Our jobs are stressful, diagnostically challenging, involve managing team members, and effectively communicating and engaging with different families whom have different needs. We are reliant on our knowledge and skills. What sets our job apart from other high stress environments is that any given day can involve death and dying. We see distressing conditions. Our day includes the uncommon, the unlucky and the unfortunate events of life. To the public these events occur few and far between, but for us it may be a daily occurrence -a relentless barrage of traumatic events, poor outcomes and sad stories.

The intensive care environment is difficult to navigate. The rates of burnout, mental health issues and self medication are high amongst our peers. 70% of junior doctors feel burnt out following a neonatal rotation. Strikingly, their (our) rates of suicide are twice that of the general population. Most of us have heard the words compassion fatigue. Some of us may even be familiar with vicarious trauma – the negative experience of working directly with traumatised populations. Compassion fatigue and vicarious trauma are on a spectrum. We initially may feel overwhelmed by our interaction but this can develop into symptoms of post traumatic stress.

At DFTB18, I spoke about some of the things we can do to reduce this happening to us, and the events above reinforced that message;

  • Seek the support of those around you.
  • Reflect with your supervisor.
  • Get together with your team to debrief.
  • Seek professional psychological support.
  • Foster a culture in your workplace that is supportive and open, whilst also taking time for yourself.
  • Make a regular appointment to see you GP.

And remember, it’s ok not to be ok

For more on this topic of the difficulties of dealing with death and burn out hit up DFTB at:

Burning out by Mark Garcia

A short story about death by Andy Tagg

Selected References

Boss RD, Geller G, Donohue PK. Conflicts in Learning to Care for Critically Ill Newborns: “It makes me question my own morals”, Bioethical Inquiry. 2015;12:437-448

Hauser N, Natalucci G, Ulrich H, Sabine K, Fauchere JC. Work related burden on physicians and nurses working in neonatal intensive care units: a survey, Journal of Neonatology and Clinical Pediatrics. 2015;2:2:0013.

Nimmo A, Huggard, P. A systematic review of the measurement of compassion fatigue, vicarious trauma and secondary traumatic stress in physicians. Australian Journal of Disaster and Trauma Studies. 2013;1:37-44.

Stress, burnout and vicarious trauma: looking after yourself. RACGP Webinar Series.

You have brains in your head: Eric Levi at DFTB18

Cite this article as:
Team DFTB. You have brains in your head: Eric Levi at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19241

In honour of CrazySocks4Docs Day it seems only fitting that today we release Eric’s talk on mental wellbeing.

Outside of his interest in ears, noses and throats Eric is passionate about our wellbeing. No doctor or healthcare provider is immune to the risk of depression. Andrew Tagg spoke about his own personal struggles at our first conference. Perhaps part of the same spectrum of work potentiated illness is burnout. Characterized by emotional exhaustion, low professional efficacy and high levels of cynicism it is rampant amongst our profession.

#CrazySocks4Docs day was started by a Melbourne cardiologist, Geoff Toogood, with a view to ending the stigma surrounding mental health ion physicians. For more details check out the website here.

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.

DFTB19 has just a couple of main conference tickets left but there are still spots for some of the pre-conference workshops.

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

Selected references

Callahan K, Christman G, Maltby L. Battling burnout: strategies for promoting physician wellness. Advances in pediatrics. 2018 May 7.

Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. InMayo Clinic Proceedings 2017 Jan 1 (Vol. 92, No. 1, pp. 129-146). Elsevier.

Psychological defences in education: Ben Symon at DFTB18

Cite this article as:
Team DFTB. Psychological defences in education: Ben Symon at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19224

The  audience at DFTB18 were privileged to attend a series of sessions from team at Simulcast, the premier podcast for all things sim and debriefing. 

In this second talk of the session Ben Symon interviews Jannie Geertsema about why we become defensive at work and in the educational space education when we could be connecting.

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.

DFTB19 has just a handful of main conference tickets left but there are still spots for some of the pre-conference workshops.

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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There are people with games: Vic Brazil at DFTB18

Cite this article as:
Team DFTB. There are people with games: Vic Brazil at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19086

The  audience at DFTB18 were privileged to attend a series of sessions from team at Simulcast, the premier podcast for all things sim and debriefing. 

In this first talk of the session Vic Brazil interviews Kara Allen about the place of simulation and asks ‘Is at really all that?‘ Kara Allen is a consultant anaesthetist at the Royal Melbourne Hospital and Clinical Lead at Monash Simulation. Whilst sim seems like an exciting way of doing ‘stuff’ and we all love the chance to get out of our respective departments and play let’s- pretend is it fit for purpose?

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.

DFTB19 has just a handful of main conference tickets left but there are still spots for some of the pre-conference workshops.

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