The only reason we get away with giving such large doses of epinephrine to these patients is that they are already dead.

- Rogue Medic

Remote CPR Skills Testing Online – A Crazy Idea?

ResearchBlogging.org
 

On the MedicCast, Jamie Davis interviews Roy Shaw of SUMO about a method of remote CPR certification for health care providers.
 

The Single Use Manikin Option, or SUMO™, is an AHA-compliant way of getting certified in CPR completely online.[1]

 


BlendedCPR.com
 

It looks too simple, but how complicated should we make it?

One of the problems with EMS is that we do not maintain skills that we do not use frequently. We know that we lose our skills very quickly, but we only retrain every couple of years (or every year) for the skills considered most important. If we care about our patients’ outcomes, we need to do better.
 

Not only have varying rates of skill acquisition been documented after traditional American Heart Association (AHA) training classes, but also universally poor skill performance of varying providers 3 to 6 months after CPR training has been established.11,–,15 [2]

 

Supervised on-line mannequin practice may be the most practical way for us to increase the rate of providing hands-on practice. As cameras become cheaper and smaller, as cell phones become much more interactive, we may have a way to do the same for intubation. Is there any good reason for practicing intubation less than once a month?

We need to improve our intubation, but everyone seems to think that the problem is with other medics and they do not need any practice. When the research is done, the problems continue. We like to intubate. We assume we are good at it. We hate to practice. we really like to make excuses. Our patients are the ones who are harmed. Other than bad assessment, bad intubation is probably the most deadly skill we have.
 

Training sessions occurred at entry into the study (time 0: initial skill acquisition) and then 1, 3, and 6 months after study entry.[2]

 

Each training session was less than five minutes long (one minute of testing, then two minutes of training), so the interference with work would be minimal, while the benefit would be significant.
 

In this study, lower rates of retention were observed in the training group that did not use a live instructor (automated defibrillator feedback only) compared with the group that used an instructor without automated feedback (instructor-only training).[2]

 

They suggest that the participants relied on the feedback from the automated devices and may not have learned to assess their performance themselves. During testing, the lack of machine feedback may have put them at a disadvantage. If machine feedback can be provided at the time of initiating compressions, The machine feedback could help. currently, that does not seem likely, so the use of only machine feedback is not as good an option as feedback from an instructor or from an instructor and a machine.
 

Although the automated feedback provided was targeted to CPR psychomotor skill errors, these systems do not provide constructive positive feedback. Instructors have an advantage: they were able to comment not only on skills done incorrectly, but also praise good performance.[2]

 

How well would this work in EMS?

We could make this something that is done once a week, or even at the beginning of each shift, on a different skill each time. Intubation/Airway management is the weak spot of EMS, so we could use this to improve.

If are only retraining on intubation/airway management once a year, or once every other year, we obviously are not taking patient care seriously and are trusting our luck, rather than any skill.
 

Go listen to the podcast on the Single Use Manikin Option (SUMO™) and consider if that would be a better way of recertifying. Maybe it is one way of implementing brief low-dose, high-frequency booster training in addition to recertification.

Also check out the site –

BlendedCPR.com

-

Footnotes:

-

[1] SUMO Remote CPR Skills Testing Online and Episode 392
By podmedic
June 30, 2014
MedicCast
Podcast/videocast page

-

[2] Low-dose, high-frequency CPR training improves skill retention of in-hospital pediatric providers.
Sutton RM, Niles D, Meaney PA, Aplenc R, French B, Abella BS, Lengetti EL, Berg RA, Helfaer MA, Nadkarni V.
Pediatrics. 2011 Jul;128(1):e145-51. doi: 10.1542/peds.2010-2105. Epub 2011 Jun 6.
PMID: 21646262 [PubMed - indexed for MEDLINE]

Free Full Text from Pediatrics.

-

Sutton RM, Niles D, Meaney PA, Aplenc R, French B, Abella BS, Lengetti EL, Berg RA, Helfaer MA, Nadkarni V. (2011). Low-Dose, High-Frequency CPR Training Improves Skill Retention of In-Hospital Pediatric Providers PEDIATRICS, 128 (1) DOI: 10.1542/peds.2010-2105d

.

FREE Webinar from Annals of Emergency Medicine, the AHA, Dr. Bentley Bobrow, Dr. Christopher Crowe, Dr. Ashish Kumar Aggarwal, and Mark Venuti (paramedic)

 

Do you have questions about the best way to perform CPR?

If this FREE webinar does not answer them, there will be time to ask questions at the end.

Tuesday, July 8th 2014, 1pm EST (17:00 Universal Time).
 

Register for FREE at this link.
 


 

Dr. Bobrow is one of the people who has been focusing on improving the quality of chest compressions and minimizing interruptions. Two things that we know about CPR are that improving the quality of compressions and minimizing pauses in compressions make a big difference in neurologically intact survival.

These two improvements may be responsible for most of the improvement in survival since the 2005 ACLS guidelines.

That is the difference between the old focus on ALS (Advanced Life Support) because everybody knows the paramedic/nurse/doctor makes all of the difference and the new focus on compressions and keep the paramedics/nurses/doctors from doing things that interfere with compressions.

We are still waiting for some evidence that resuscitation rates would not increase even more if we just kept the paramedics/nurses/doctors away from the patient until after ROSC (Return Of Spontaneous Compressions).

You can read the guidelines, and the protocols, and the research at any time, but there are not many times when you are able to ask the experts responsible for creating all of them.
 

Register for FREE at this link.
 

Tuesday, July 8th 2014, 1pm EST (17:00 Universal Time).
.

Is a 48 Hour Paramedic Class Possible?


 

Maybe the Is this going to be on the test? people are in charge.

Is this a case of bad reporting, is Brownsville, TX trying to find a way to force people out of the fire department, is Brownsville, TX trying to suggest that a 48 hour paramedic refresher course is an acceptable initial paramedic course?

Well over 20 years ago, my paramedic class was around a thousand hours long. A few years earlier, my EMT class was over a hundred fifty hours long.
 

Oakerson claims he is being retaliated against because of an expert opinion he offered that stated firefighters needed more than a two-week refresher course to take and pass the National Registry Exam to become paramedics.[1]

 

If someone does not know the difference between a refresher course, which assumes the successful completion of initial paramedic education and experience as a paramedic, and an initial course, should we trust them to make any important decisions?
 

BFFA president Carlos Elizondo said the union sued Brownsville over allegations that Fire Chief Lenny Perez was forcing 13 firefighters to take a 48-hour refresher course over two weeks before taking the National Registry Exam to become paramedics, which is a condition of employment set out in the collective bargaining agreement.

That lawsuit was settled and dismissed March 13.[1]

 

If you know nothing about EMS, a 48 hour course might sound reasonable to become a paramedic, but this is not a feel good movie, or The Secret,[2] or something that Deepak Chopra is selling as quantum[3] education.

These charlatans take advantage of misunderstanding.

Maybe we need to develop more understanding of what medicine/EMS is, if only to protect the public from those who would harm them.

-

Footnotes:

-

[1] Lawsuit alleges retaliation – EMS service takes action against city
Monday, April 21, 2014 10:21 pm.
The Brownsville Herald
Mark Reagan
Article

-

[2] The Secret is wishful thinking nonsense that claims positive thinking causes positive results and the cause of our misfortunes are negative thoughts.

In other words, children born with birth defects, or cancer, are the victims of their own negative thoughts, but they could be cured by positive thinking.

This works in movies – actually started out as a movie and was later adapted to a book. Unfortunately, many of us think this way. We ignore the bad things that happen and claim that the good things that happen are proof. This is self-deception.

-

[3] Deepak Chopra is just as ridiculous, only he throws in the word quantum to explain everything. People do not understand quantum, so they will be afraid to challenge him. I do not understand quantum, but I do recognize a scam and this is as much of a scam as when electricity was new and the frauds described their scams as electric. The words change, but the dishonesty remains.

.

Belly flops with cliches, proves he’s a Satirist (You have a dirty mind if you’re thinking what I think you’re thinking this means)

 

What happens when EMS becomes so distorted that it is embarrassing?

Things get silly.
 

Image credit.
 

By silly, I mean the satire starts off simply, but then becomes a multi-layered satire that deserves its own Wikipedia page. There is no page, yet, or is there?

Kelly Grayson started us off with an article about EMS cliches.
 

From the blank stares I got from all assembled, I realized that none of them had ever seen Bull Durham. So while I educated them in the Tao of Crash Davis, I started thinking about the clichés we spout in EMS. Every cliché has at its root a central truth; that’s how they get to be clichés in the first place.

But nothing is so good as a well-placed cliché as a substitute for real wisdom and knowledge. Just insert one of these babies into a social media comment thread and watch the “Likes” pile up!

. . .

If you learn to use these simple EMS clichés, I guarantee that you will develop a reputation as a paramedic sage in no time. Especially to people who don’t know better.[1]

 

You’re going to have to read the full article yourself. Polonius would have been skewered several acts earlier if Kelly had been there, but this gets better.

Then Happy Medic turns up the satire by responding to Kelly.

 

8. “We cheat death.” We do, daily! I have a T-shirt with the Grim Reaper being slapped in the face by a bad ass medic with sunglasses and everything. You are so narrow minded you can’t see how we bring the dead back everyday. Epi works Kelly![2]

 

Go read the rest, too.
 

Ridicule is the only weapon which can be used against unintelligible propositions. Ideas must be distinct before reason can act upon them; – Thomas Jefferson.
 

Finally, Tor eckman takes it to Eleventy!!11!!! in the comments.
 

I also teach them to think and look for clues on scene, like just last week I got to see the lights come on in this “newb” Paramedic when he wasn’t going to spinal a patient in a MVC until I had him walk down the bank and look at the car, after seeing the mechanism he came back up, told the patient that he was lucky he wasnt paralyzed for walking up the bank. We did a standing take-down right then and there. By the time we got to the hospital the pt had pretty bad back pain, can you imagine if we hadn’t put him on the backboard? lawsuit. So go ahead and make fun of the noobs, I’ll take them and teach them.[3]

 

I think that someone should Call the Cops for all of this abuse of the witless, because the giggles just keep on coming.
 

Maybe this is an example of Poe’s law (a legitimate comment from some person who is so blind to their bias that they do not notice the self-parody)?[4],[5]

Maybe, but Tor eckman[6] is a character from Seinfeld. Tor eckman is a ridiculous alternative medicine practitioner, much like our ridiculous EMS providers who do not understand what it means for a treatment to improve outcomes.

Go spend some time reading the comments on social sites and you will see that this might not be satire, but somebody should take credit for it if it is satire – and somebody should be ridiculed for it if it is not satire.

-

Footnotes:

-

[1] The stupid EMS cliche usage guide – Using phrases like ‘We cheat death’ is so much easier than actually thinking
September 30, 2013
The Ambulance Driver’s Perspective
by Kelly Grayson
EMS1.com
Article

-

[2] Kelly Grayson belly flops with cliches, proves he’s a Noob
Happy Medic
October 3, 2013
Article

-

[3] Tor eckman’s comment
Kelly Grayson belly flops with cliches, proves he’s a Noob
Happy Medic
October 3, 2013
Comment

-

[4] Poe’s law
Wikipedia
Article
 

Without a blatant display of humor, it is impossible to create a parody of extremism or fundamentalism that someone won’t mistake for the real thing.

 

-

[5] Poe’s law
Conservapedia
Article

The site’s description of Poe’s law appears to qualify as a parody of extremism or fundamentalism that someone won’t mistake for the real thing. Or is it the real thing that someone will mistake for parody?

Will Andrew Schlafly wait until his mother is dead before he admits that he was just trying to please his mother, just not as violently as Norman Bates? Or is he the real thing that someone will mistake for parody?

-

[6] The Heart Attack
Wikipedia
Seinfeld
Article

.

Bad Patient Care – Literalists


 

There are many ways that we harm patients.

One way is by claiming that we need to literally interpret some rule, such as a protocol.

Once we start to try to do this, we come across contradictions.

What is most important in patient care?

Doing what is best for the patient?

What is most important in literal interpretation of anything?

Protecting the literal interpretation.

But it is literally what is written, it is not open to interpretation.

All writing is open to interpretation. We can try to simplify it as much as possible. We can try to make it as clear as possible. Someone will read the writing as meaning something else. Some of those people will have valid points about what the writing means.

For EMS protocols, are all penetrating injury patients the same?

Of course not, so we try to be specific.

Are all penetrating injuries to the neck the same?

Of course not. When I shave, I occasionally penetrate the skin of my neck with the razor, thus lightly slashing my neck.

Should that be treated the same as the slashed neck of someone who is slashed with a knife in an attempt to kill the person?

Of course not.

You may claim that I am being ridiculous.

That is the point. Literal interpretation is ridiculous.

That is why protocols should be written as guidelines that are flexible enough to deal with the real world.

Assessment is the way we determine the difference between a penetrating injury to the neck that needs a trauma center and the minor injury that does not.

Competent assessment does not work with attempts at literal interpretation.

Literal interpretation is an excuse to lower standards so that the least intelligent people can participate.

We need to raise our standards.

If raising our standards mean that some people cannot play with the lives of others, that is a real shame. :oops:

How little do we care about our patients that we are more worried about offending dangerous instructors and dangerous medics, rather than worried about protecting patients from the results of dangerous instructors and protecting patients from dangerous medics?

.

One Laceration, Two Helicopters, Third Part

 

There is also a comment from steve mauch on Two Children Abducted by EMS Helicopter for One Laceration that deserves comment.
 

Rouge, I see what you’re getting at, but the problem is not so much with the medic, its what/how he was taught. If in his area they are taught if you see skull you fly, then he did everything right.

 

Exactly.

That is what I am criticizing.

We are supposed to be doing what is best for the patient.

We are not supposed to be blindly following protocol, nor blindly following the local culture of fly everyone and let the trauma center discharge them right away.

We need to hold the medical directors and the EMS agencies accountable for this ridiculous approach to patient care.
 

Where is your outcry against the flight crew that made the decision to fly the second child?? Why not crucify the flight nurse too?!

 

It was not my intent to crucify the medic.

It is my intent to crucify the system.

I just need some people with hammers and nails and we can nail the system to a Star of Life. ;-)

OK. I will settle for metaphorical crucifixion, but we didn’t have to settle for metaphor in the good old days.
 

I agree with rick in the fact that we should not be ridiculing each other, we get enough of that.

 

Sometimes ridicule is an excellent way to expose a problem.

Again, I was not focused on the medic, but on the actions that are commonplace in EMS.

Look at that mechanism!

We can’t be out of service for an hour! What if a call comes in and our dangerous neighboring service has to cover for us? Many of the people in the neighboring service work for both EMS services, because that is the way EMS works. So how dangerous is the neighboring service, if they have the same employees?

This encourages us to take a helicopter out of service for real emergencies, so that we can fly someone for vehicular damage, yet vehicles are designed to deform to protect the occupants of the vehicle – and that kind of design works very well.

My response to the doctors in the trauma center who have questioned me about why I did not fly a patient, why I did not call for a trauma alert, and/or why we took our time driving with traffic, rather than using lights and sirens is this –

Assess the patient and tell me what you find that is unstable, then we will talk.

I also am familiar with the research. There is no valid research that supports flying patients within a 45 minute drive of a trauma center.

There is no valid research supporting the idea that we are not using HEMS enough.

The helicopters are often in the wrong place. Many are close enough to the trauma centers that EMS should be driving patients, but that is not where a helicopter would make a difference in outcomes. Helicopters make a difference in outcomes for unstable patients who are well over an hour drive time from the trauma centers.

We are encouraging the helicopters to flock near the trauma centers, so that they can service the medical directors who write mechanism-only flight protocols that endanger patients.

Maryland changed their protocols so that medical command permission is required for a mechanism-only flight. Helicopter transports were cut by over half. Where are the dead bodies that Dr. Thomas Scalea predicted would be the result of this cut in flights?
 

But I agree with you that issues DO need to be addressed, but we need to look at the initial educators. As a fairly recent paramedic graduate, I can tell you that medics are being taught to be cookbook medics, we are not taught to think.

 

I agree.

But, each paramedic program is different.

We need to encourage those medic programs that do a great job. There are many out there.

We need to discourage those medic programs that teach people to be protocol technicians, IV technicians, monitor technicians, alarm technicians – Oh, look! The asystole alarm is going off. I need to start CPR. There are many out there.
 


Download YouTube Video | YouTube to MP3: Vixy | Replay Media Catcher
 

How much have we changed from the days of calling for orders and being told to give one amp of the yellow box?

If we do not understand pharmacology, we do not understand the most important part of pharmacology – when not to give a drug.

The same is true for procedures. We need to understand when not to use a procedure. Defibrillation, as in the video, or cricothyrotomy, or intubation, or synchronized cardioversion, . . . .

When needle decompression is used, the use almost always appears to be inappropriate.

Needle decompression does save lives when used appropriately.
 


Click on the image to make it larger.[1]

The chart is for all patients stuck in the chest at least once with a needle in an attempt to decompress a suspected tension pneumothorax.

Many patients never had any kind of pneumothorax.

Was needle decompression used appropriately on any of these patients?

Maybe. Maybe not. We do not know.

It seems that many in EMS need a lot of work in learning when not to attempt needle decompression.
 

One of the biggest things I recall is SVT. I was “taught” greater than 150=SVT. I went on thinking this was fact. I was not taught svt is a class of rhythms, not a rhythm by itself.

 

SVT – SupraVentricular Tachycardia.

The sinus node is supraventricular.

Sinus rhythms do not benefit from adenosine or synchronized cardioversion.
 

Do not blame the medic for not knowing what someone else never took the time to pass along.

 

Yes and No.

We need to take responsibility for our own education.

Education does not stop once we put on a patch or get authorized to work on our own.

I was supposed to be writing about the presentations at EMS Expo this week, but it is looking as if that will be next week. If we attend EMS conferences, we can learn about the things our instructors misinformed us about.

Backboards probably do more harm than good, especially for the patients with unstable spinal injuries.

Helicopters do save lives, but probably only for unstable trauma patients over an hour from the trauma center.

How to interpret 12 lead (and 15 lead and 18 lead, . . .) ECGs and how to identify unusual rhythms.

Now I am off to once again demonstrate that a heart rate faster than my calculated maximum heart rate is possible and can still be sinus tachycardia. When I wake up, my heart rate will be a respiratory arrhythmia sinus bradycardia. All of these are arrhythmias/dysrhythmias, but they are not bad rhythms and they are not the absence of rhythm.[2]

These arrhythmias/dysrhythmias are better than normal sinus rhythm.

Arrhythmias/dysrhythmias are treatable, but most do not benefit from treatment.

Should anyone ever use the term normal sinus rhythm?

What do we base normal on?

Does that mean that the patient’s heart is healthy?

How much beat-to-beat irregularity is permitted while still calling the rhythm normal?

What is the difference between normal and healthy?

If a patient is having a normal episode of angina, is that a good thing?

If a patient is having a normal seizure, is that a good thing?

If a patient is having a normal case of hypoglycemia, is that a good thing?

Based on what?

We often use terms we do not think about. Does that mean that it is not normal for us to think?

Is normal good?
 

In all of that I forgot to mention, I agree that they should not have been flown, ESPECIALLY since mom was against it, but I wasn’t there and it wasn’t my call. I do think way too many people are flow, and even more people are backboarded that don’t require it. We need to improve critical thinking and assessments BEFORE applying devices and treatments, but that’s a whole new blog!

 

Again, this is about highlighting the problem, not the person.

We have a big problem. Making a scapegoat out of one individual does not change the problem.

-

Footnotes:

-

[1] Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study.
Blaivas M.
J Ultrasound Med. 2010 Sep;29(9):1285-9.
PMID: 20733183 [PubMed - in process]

Free Full Text from J Ultrasound Med.
 

When Should EMS Use Needle Decompression
Rogue Medic
Thu, 10 Nov 2011
Article
 

Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study – Full paper
Rogue Medic
Mon, 14 Feb 2011
Article
 

Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study – abstract
Rogue Medic
Tue, 07 Sep 2010
Article

-

[2] dys-
The Free Dictionary
Definition
 

dys-
pref.
       1. Abnormal: dysplasia.
       2.
               a. Impaired: dysgraphia.
               b. Difficult: dysphonia.
       3. Bad: dyslogistic.
[Latin dys-, bad, from Greek dus-; see dus- in Indo-European roots.]
The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.

 

.

Do We Have a ‘Bigotry of Low Expectations’?

Kelly Grayson writes that -
 

The biggest obstacle to the advancement of our profession is not the limitations imposed upon us by others, but the lies we tell ourselves[1]

 

Image credit.
 

Is this an unreasonable assessment?

No, it may be too subtle for most to understand, because Kelly does not appear to have received the usual hate mail that comes with the exposure of EMS problems.

What lies do we tell ourselves?

 

“We don’t diagnose.”[1]

 

We have no idea of what we are doing, but we give deadly drugs and perform deadly procedures based on this no idea.
 

“We work under the physician’s license.”[1]

 

Using similar logic, when I drive a car, truck, ambulance, . . . I am driving on the Governor’s driver’s license. If I drive dangerously, the Governor will share liability, since I am driving on his license.

It may state in the health code that medics in some states do practice on the license of the medical director, but please provide some evidence of action against that license because of a paramedic’s actions.

Where is the command responsibility?[2]
 

“The protocol says…”[1]

 

This is usually followed by misinterpretation.

This is not because protocols are so well written that they do not encourage bad treatment, but the approach is to find absolute rules to prevent the person from thinking. The person is afraid of his own thinking. This does not suggest that he does a good job of thinking. Therefore, whatever interpretation he makes can be expected to be a misinterpretation.
 

“Right or wrong, he’s the doctor. We have to follow orders.”[1]

 

That excuse has failed before.
 

despite the fact that the medication was ordered by a physician, each of these individuals knew from the Advanced Cardiac Life Support guidelines that the medication could have “lethal,” “disastrous” consequences when administered to someone like the plaintiff, and they recognized that the standards of care applicable to them required that they exercise independent judgment and not just “blindly follow a doctor’s order that they knew posed an extreme degree of risk to the patient”

Columbia Medical Center of Las Colinas v. Bush, 122 S.W.3d 835 (Tex. App.—Fort Worth 2003, pet. denied).[3]

 

We are responsible for our actions.

If you are looking to avoid responsibility, you should not be in any position of trust.
 
 

Where does all of this lowering of standards lead?
 

Never mind all that. We can’t meet our goal. Let’s lower the standard.

Allow me paint for you a little self-fulfilling prophecy:

  1. Paramedics gripe because they are underpaid and disrespected, and have difficulty obtaining reciprocity in other states.
  2. ED physicians complain because we bring them patients whose airways are poorly managed.
  3. . . . .[1]

 

Where does this lead?
 

Go read the full article.
 

-

Footnotes:

-

[1] The bigotry of low expectations – The biggest obstacle to the advancement of our profession is not the limitations imposed upon us by others, but the lies we tell ourselves
By Kelly Grayson
EMS1.com
August 13, 2013
Article

-

[2] Command responsibility
Wikipedia
Article

-

[3] Malice/gross negligence.
Thornton RG.
Proc (Bayl Univ Med Cent). 2006 Oct;19(4):417-8. No abstract available.
PMID: 17106507 [PubMed]

Free Full Text from PubMed Central.

.

The Path to Insanity

 

With this podcast,[1] Dr. Weingart is preaching to the choir in many ways.

Insanity is looking at the world and seeing something different from what normal people see.

Normal people don’t want to know about that, but curious people do.

Curiosity is the basis of science and learning.[2]

Curiosity is the antithesis of dogma.

Curiosity will lead us to think about what others call insane.
 

Go listen to the podcast.

 


 

I do have a couple of points to criticize, but these are slips of the tongue by Dr. Weingart. They are not errors of judgment, nor are they errors of fact.

He refers to Malcolm Gladwell as Gladstone. His brain is probably well ahead of what he is saying and he did not realize that what came out of his mouth was not what he intended.

The other is more likely to be confusing.

This homophony has the possibility of confusing the listener, because it is difficult to tell if he is using the word confidence or competence. Just a few sentences before, he was discussing competence, but now he is discussing confidence, specifically unjustified confidence. For the Australian listener, it may have been more difficult to understand with Dr. Weingart’s American accent. Written, it should be clear which word Dr. Weingart intends.

At 19:30 –
 

“To become competent you must feel bad”Hubert Dreyfus[1]

 

Unless we push ourselves beyond our current comfort zone abilities, we are only treading water, or we are sinking. This is the way we learn.

If we do not understand how our students feel, maybe it is because we have stopped learning. Maybe we have stopped putting ourselves in positions where we are novices.

If we are comfortable at everything we do, we are not trying anything truly new to us. If we do not try anything new to us, how do we understand the experiences of our students, who are often overwhelmed by the amount of new information they are expected to learn?

At 19:50 –
 

Charles Darwin put it even better – ignorance more frequently begets confidence than does knowledge.[1]

 

At 20:15 –
 

Unconscious incompetence – You don’t know and you don’t know that you know.[1]

 

It should be obvious that Dr. Weingart did not misunderstand the Dunning-Kruger effect.[3] He makes it clear through the rest of this excellent presentation that he understands what Dunning and Kruger demonstrated. However, he does appear to have had a slip of the tongue.

The Dunning-Kruger effect can be summed up by adding back the dropped don’t.
 

Unconscious incompetence – You don’t know and you don’t know that you don’t know.[1]

 

The title of the paper by Dunning and Kruger is -

Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments.[4]

Later, Dr. Weingart states –
 

Never assume your own excellence.[1]

 

We should always consider that we may be wrong. This is the way to not fall victim to dogma.

How much less likely will we be to automatically give a medication, because it is the customary thing to do, if we consider that we may be wrong?

How much less likely will we be to automatically perform a procedure, because it is the customary thing to do, if we consider that we may be wrong?

How much less likely will we be to automatically follow custom, if we consider that we may be wrong?
 

though I am native here
And to the manner born, it is a custom
More honor’d in the breach than the observance,

Hamlet Act 1, scene 4,
explanatory notes from eNotes.com

 

Go listen to the podcast.

 

Also look at the excellent references provided by Dr. Weingart in the show notes.

-

Footnotes:

-

[1] Podcast 105 – The Path to Insanity
EMCrit
Dr. Scott Weingart
Podcast/Videocast page.

-

[2] Curiosity
NASA
Name the Rover Contest
Winning entry by Clara Ma.
 

Curiosity is an everlasting flame that burns in everyone’s mind. It makes me get out of bed in the morning and wonder what surprises life will throw at me that day. Curiosity is such a powerful force. Without it, we wouldn’t be who we are today. When I was younger, I wondered, ‘Why is the sky blue?’, ‘Why do the stars twinkle?’, ‘Why am I me?’, and I still do. I had so many questions, and America is the place where I want to find my answers. Curiosity is the passion that drives us through our everyday lives. We have become explorers and scientists with our need to ask questions and to wonder. Sure, there are many risks and dangers, but despite that, we still continue to wonder and dream and create and hope. We have discovered so much about the world, but still so little. We will never know everything there is to know, but with our burning curiosity, we have learned so much.

 

If we do not question everything, we must be satisfied with ignorance.

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[3] Dunning-Kruger effect
Wikipedia
Article

Science denialism is excellently described by the Dunning-Kruger effect. A comedian claims to know more about vaccines than scientists – and people believe the misinformation. Some politicians claim to know more about climate than scientists – and people believe the misinformation. Some preachers claim to know more about biology, geology, paleontology, . . . than scientists – and people believe the misinformation.

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[4] Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments.
Kruger J, Dunning D.
J Pers Soc Psychol. 1999 Dec;77(6):1121-34.
PMID: 10626367 [PubMed - indexed for MEDLINE]

Free Full Text PDF Download from Emory.edu.

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