I recently returned from a 4 day convention titled “smaccDUB”, the conference otherwise known as “social media in critical care”, this year held in Dublin, Ireland. The conference stayed true to its founding virtues of learning, education and innovation in pursuit of excellence within critical care. Smacc is also the ideological meeting place for all those passionate about promoting “free open access meducation” (a.k.a. #FOAMed) as a means of disseminating and translating knowledge to improve the world of medicine. However, for me this years conference had something a little extra within it, something rather special. The opening laser ceremony touted the themes of exploration, connection, and inspiration and by the end of the conference I couldn’t help but feel this was exactly where we had journeyed. I hope to share some of the reasons why I felt this way through the musings of this blog post.
Diversity and creativity
SmaccDUB pushed boundaries, moving beyond the diverse range of resuscitation and education themes that I’ve grown enjoy at the 2 previous Smacc conferences I’ve attended. The talks expand further than ever before on the spectrum of leadership, communication, teamwork, and ethics in the critical care.
Many of the talks showed a progression from pure science to the humanities, and even the philosophy of modern health care and science as we know it was repeatedly challenged during the course of the 4 day convention. To this end the use of the current journal system as a means of knowledge creation and dissemination was questioned in an interesting debate. The panel included former BMJ editor, Richard Smith, and the current editor in chief of the New England Journal of medicine, Jeff Drazen, who argued their differing perspectives on the benefits, or shortcomings, of the current peer review system.
Perhaps exploration of this nature, challenging entire paradigms, is called for at this point in history. For anyone who has witnessed the rapid technological advances that health care has seen over the last 20 years, will be forgiven for wondering just where we are going in the future. With the increasing focus on protocol driven investigations and treatments, it was refreshing to note that the conversation amongst the Smacc speakers seemed to continually bring the focus of conversation back to the “human aspects” of care.
On the other hand, creativity was an equally important theme embraced by the conference, which itself was a highlight for me. It seemed as if fun and creativity, branded by the use of music, lights and live performance, were like the vessels through which the content was delivered. It was as if “science” and “art” seemed to be inextricably linked at every stage. This was particularly evident for me in the pre-conference sessions which included a workshop on creative writing, design and fine art in order to help make educational content more interesting. But it persisted every step of the way, from the rock-concert style opening ceremony, with laser lights display, right up until the final act of the grand finale.
The additional daily antics that included choreographed ultrasound displays and competitions, and finally interactive debates, making use of rap and rhyme to argue out positions on issues like thrombolysis in submissive PE, was all part of the mix.
Mindfulness, leadership and communication
The conference opened with the “John Hinds” plenary, named as such in honour of the individual whose career long contribution will continue to inspire, as much as his loss will be felt amongst this community of critical care workers, following his relatively recent tragic death. In this section, Victoria Brazil (@SocraticEM) kicked off by entertaining us with a high quality role play. She cleverly illustrated to a captive live audience, the potential negative and positive impacts that our everyday communication can have on the quality of education, trainee self-esteem and ones motivation to learn.
Scott Weingart (@emcrit), of the EM Crit blog, similarly pushed the boundaries of a traditional talk by discussing Vipassana meditation and the role of this practice in his life. He opened minds and hearts by delivering a plenary session on a topic that perhaps has never before been delivered in a conference of this nature. Speaking from direct experience, his talk endorsed the personal and professional values of meditation when looked at entirely from a scientific perspective. Scott likened this practice to a structured “training”, or exercise for the mind – coining the phrase “kettle bells for the brain” to describe what meditation was analogous to in his mind.
To me this was a groundbreaking talk because here was a leader in our field highlighting a practice that is still relatively unfamiliar amongst our medical community, despite its great potential to improve self-awareness, communication and decrease stress. It was also encouraging to see Scott maintain a completely scientific approach, and alerting the audience of the growing evidence base for mental health and performance benefits following a meditative practice. The benefits of mindfulness is something that I have experienced in my own life, and I thus my encourage whenever I get the opportunity. The talk even included a short demonstration of the practice meditation, and provided a motivating discussion of how the philosophy of mindfulness could potentially help in stressful settings such those that are commonly encountered in emergency medicine and intensive care.
Multiple talks furthered the leadership theme, including those by TEDMed speakers such as Resa Lewiss (@ultrasoundREL), and visionary talks about the future of medicine, by senior clinics such as Simon Carly (@EMManchester) who blogs at St Emlyn’s virtual hospital. Simon provided an insightful back track into the journey that modern medicine has taken over the last 20, and providing an insight into where it is headed. He also provided a live demonstration of an iPhone ECG trace being delivered through a $100 gadget that is easily accessible already – indeed it appears to be brave new world of health care which we are heading towards at great speed!
War, fear, and love
Building on the theme of mindfulness and self-awareness the conference also included a talk on “fear”, and heart-felt presentations about working in emergency situations of terrorism and war. A wake up call was delivered to our small room audience when Kass Thomas (@KassThomas4) presented recent real life experience of falling victim to US led gunship attacks on the Kunduz Trauma hospital where she was working during her first MSF mission in Afganistan. Her courageous and chilling talk detailed how she survived the ordeal of seeing so many friends, colleagues and patients die in front of eyes on that frightful October night. Her talk in particular highlighted an urgency to address the plight of hospital aid workers across the globe as there continues to be increasing numbers of hospitals suffering the same fate by being targeted under the hospices of war.
The theme of critical care workers experiencing trauma beyond the realms of normal experience was continued in other talks such as that by Christina Hernon (@emedtox) who was an immediate responder in the Boston Marathon bombing, and Ashley Liebig (@ashleyliebig), who is a flight nurse who recounts a story fo a heart wrenching paediatric field resuscitation. In a similar vein both these speakers courageously revealed the human behind the professional veil.
Through their captivating stories they took us, the audience, into that vulnerable space of humanity, that nobody voluntarily enjoys. These talks generated a magnitude of interesting discussion both on the twittersphere and in-person discussions amongst other delegates. Perhaps the common theme that was uncovered was a respectful appreciation of the vulnerability that goes with the human side of the critical care, a side that rarely discussed in fast pace of daily business, and I am grateful to these speakers for creating that space.
In keeping with this gloves off approach, nothing was more “on the mark” than the unplugged presentation by Ross Fisher (@ffolliet), a TEDx speaker and Paediatric surgeons who discussed the inward reaching topic of “what scares me”, “what scares you”. In his day 2 plenary session, he challenged the audience, and guided them through recounts of salient challenges in his own professional career, towards taking a long and hard introspective view at our own personal fears.
One of the most memorable experiences for me in that talk was Ross’s request for the audience to join him in a journey of exploring one’s own worst fear. Despite the vast majority of the audience coming from a critical care background where perhaps the intense nature of the job lends itself to forge patterns of adopting a fearless stride we walk, on this occasion, when asked by Ross, whether we could identify our fear and its debilitating nature, I can’t recall a single person who was left seated. “That was fear”, acknowledge by all, and together we stood.
Many other talks that also provided a compelling discourse about other human factors that are often given secondary importance, were covered with vigor and passion, such as the importance of palliative care, bedside teaching and team training, and the topic of physician and trainee burnout.
However, perhaps one other memorable talk that pushed the boundaries, again,was that by the experienced and entertaining social worker, wellbeing specialist, researcher Liz Crowe (@LizCrowe2) who gave the first talk I’ve heard in a critical care conference whose title and focus centred on “LOVE”. With great passion and enthusiasm, and a large dose of wit, Liz delivered a very serious and important message that “love can revolutionise the way we deliver critical care”.
Liz advocated that there is science that supports what mechanistically makes sense, humans have an improved ability of to make good decisions when they work in an environment where they feel supported and cared for, as opposite to when they feel intimidated and stressed. This talk was laden with culture changing gold and I can’t wait it to come out on the smacc video cast so that we can “share the Love” that Liz speaks of!
Dublin, its surroundings and the Socials
Dublin was a wonderful city, that could provide no better a venue that offered history and culture, as well as fun and frivolity that only a Smacc participatory audience could dream of. Daily #smaccPUB, with rotating venues along the old temple bar, along with the grand finale party at the 5 story Guinness storehouse complex, fully equipped with live bands and DJs ranging from house, to rock to Irish folk – not to mention the highly acclaimed FOAMeoke, and few cats who decided to so some street jamming as part of the after party– who could ask for more?!
From physical reality, back to the twittersphere…
So I will end this post with a handful of crafted tweets by the arguably the biggest component of the conference itself, the delegates, speakers and followers both locally and afar. After all perhaps half the magic of this conference is to do with the emphasis that has been placed on audience participation and interact, that arguably no medium does better than 160 summary of words/photo/or link which the average “tweet” offers as a communication tool.
So congratulations if you made it this far in the entry that I started writing on the plane home, as part of the #smaccdown process. I tried to cut it down but there really was so much happened in such a short period of time, a fact that I’m sure those who also attended will attest. There were many other innovative talks that I attended on resuscitation, hospital systems and medical education that unfortunately couldn’t make it into this post, but hopefully some of them can be covered in the tweets below.
It is clear to see that I thoroughly enjoyed this conference, leaving energised and inspired, but as always I’m keen to hear from you, if you attended or simply were intrigued by what I have shared in these words, and images, so please leave your comments below.
Thank you to the smaccDUB organising team who did a great job, in particular Chris, Roger and Oli, and their team! Also farewell to the other delegates who are part of this friendly ever-growing social media driven med-ed community.
Hope to see you all next year at #DASsmacc!
Scott Weingart: on Vipassana meditation
Andrew Tagg: Don’t forget the bubbles- smaccDUB summary
Richard Carden: St Emlyns – A trainee perspective
Suzie Edge: Primary survey – Speaking out: teams, juniors, leaders and what smaccDUB taught me