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I’ve traded away my privacy around my own deeply personal medical issues for the chance – the mere hope really – that maybe someone will listen, will learn.

This is what validation feels like:
I was being worked up in the ED one night for a small bowel obstruction, the imaging was _very_ concerning.

The surgical team came through, reviewed the EMR, peppered me with questions, felt my abdomen, and then left.

Except the surgical resident came back in a minute later.
She saw how scared I was, felt my unasked questions as her team treated me like a talking, anatomically interesting, mannequin that they were subjecting to a rapid-fire pit-stop...

And so she came back in to make sure I was ok. I wasn’t.
Read 5 tweets
Curious about how #POCUS is taught? This #Tweetorial is for U
#Preview for #ASEchoJC 🔜9/4 8pm EST

Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri

#POCUS not 🐇🎩, not short #TTE
2/ Current #goals #Cardiac #POCUS #MedEd

(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills

(2) develop scanning techniques➡️ basic competence

(3) recognize & differentiate b/w normal anatomy & basic pathology
3/ When Do We Start? Prerequisite knowledge for #POCUS teaching

"priming effect" of preclinical education

Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC

Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
Read 10 tweets
There are no winners in the senseless withdrawal of Saudi residents and fellows from Canadian teaching hospitals, by @picardonhealth theglobeandmail.com/opinion/articl… via @GlobeDebate
Withdrawal of Saudi trainees exposes vulnerability of Canadian health care cmaj.ca/content/early/… via @CMAJ @drstanbrook #MedEd
Saudi medical trainees' recall sparks a crisis in Canadian hospitals thelancet.com/journals/lance… via @DrIvyBourgeault @TheLancet @jocalynclark
Read 7 tweets
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Why is your pt's ALT (or AST) >1000?
A #livertwitter #tweetorial

Take-homes:
1. Top 3 causes of acute liver injury
2. I always say it's ischemic hepatitis; 50% of the time, I'm right every time

Brought to u by:
@tonybreu et al. What causes severe ALI?
cghjournal.org/article/S1542-…
The liver is awesome.

Yet its vocabulary is ... limited.

We can all tell when it is upset - high ALT, AST.

But that could mean anything!

So what's your specific patient's specific reason for high ALT?
First - a poll:
What's the most common cause of severe acute liver injury
(ALT or AST > 10xULN)?
Read 11 tweets
#PregnancyCardiology Primer courtesy of a fantastic lecture by Dr. Sabrina Phillips from Mayo Clinic. Follow the thread #ACCFIT s for a good overview of considerations. #FelllowsFirst #MedEd

How does plasma volume and erythrocyte volume change during pregnancy? 1/12
#PregnancyCardiology Primer

Other important factors in the cycle of volume expansion and decreased SVR
2/12

#FellowsFirst #ACCFIT
#PregnancyCardiology

Cardiac Output changes in Pregnancy

3/12

#FellowsFirst #ACCFIT
Read 12 tweets
1/n #Tweetorial: As an Assistant PD for @OHSUIMRes focused on scholarship, #medtwitter, & #hcsm (health care social media), I’m often guide residents and colleagues on how to best use Twitter for academics, networking, learning, etc...
2/n recently, while welcoming newbies (esp students) and “onboarding” them to #medtwitter & #hcsm, I was asked to put together advice for IM applicants on how to best use social media during application/interview season. I think this advice is applicable beyond IM, too.
3/n First, tell me about yourself:
Read 28 tweets
1/ Thread: This morning I gave Dept of Medicine #GrandRounds @OHSUSOM @OHSUNews. In #medtwitter’s spirit of sharing & learning, here is my first #Tweetorial summarizing highlights & crediting #hcsm’s incredible contributors & source material
2/ 4 months ago EBM & cardiology expert Dr. Milton Packer published a blog post detailing how he found Twitter uninformative and emotion/opinion driven
Is this the reality of #medtwitter??
medpagetoday.com/blogs/revoluti…
3/ #SoMe is digitally based mediums that helps us
CREATE
SHARE
PARTICIPATE
60% of physicians say their most popular activity on #hcsm = Following what colleagues are sharing and discussing
Channel the “look at me” negative stereotype of #SoMe into “look at THIS” learning etc...
Read 28 tweets
Ryan's Rules of PowerPoint (abridged)
(1) Not using PowerPoint is the new PowerPoint. Just let the people talk and throw up key images. People want to talk. #MedEd
(2) You are the expert on the topic - you're the only one who read about this before your talk. Don't underestimate yourself. Be prepared and have minimal slides (have back-up slides if someone in the audience is contrary and insists on seeing slides).
(3) no cartoons or funny slides. People take in jokes or gifs are different speeds. So you end up with a staggered polite laugh. You can make jokes that sound spontaneous, but staged slides are never as funny to anyone else (fka the GaryLarson rule of PPT)
Read 11 tweets
1/ Content warning: sexual harassment and assault. The @theNASEM released a report on sexual harassment in medicine. Disturbing quotes by #womeinmedicine from the report are in this thread (17). #MeToo #MeTooSTEM #heforshe @womeninmedchat @physcianwomen bit.ly/2JzUunm
2/ Residency. "But, the thing is about residency training is everyone is having human rights violations. So, it’s just like tolerable sexual harassment." (Nontenure-track faculty) #believewomen #MeToo #MeTooSTEM #womeinmedicine #metoophd #metoomed #MedEd #sheforshe #heforshe
3/ Culture. "I still don’t think that the prospect of being sexually assaulted was as bad as watching the next generation of sexual harassers being formed. I think that was the worst part for me." (Nontenure-track faculty) #MeToo #MeTooSTEM #womeinmedicine #MedEd #heforshe
Read 19 tweets
1/This article highlights an urgent need for training faculty and administrators on issues related to gender violence and discrimination in #meded. We have five concerns with the article. #metoo #meded #womeninmedicine #sheforshe #heforshe @caroline_a_king @womeninmedchat
2/ Title IX. This article is missing information about federally mandated reporting processes and protections that legally protect medical students (and all students in the U.S.).
3/Anecdotal beliefs perpetuate harms. A physician expert states “the trainee must amass allies before lodging this complaint…” This is legally incorrect, a single report is enough to trigger Title IX and this reinforces the notion that single reports will not be believed.
Read 7 tweets
In commemoration of 3 years of emailing hundreds of papers/ resources to my @OHSUIMRes ward teams & thanks to the amazing educators here and on #medtwitter #meded

My 10 greatest hits based on learner feedback:
10/ AGC “Approach to abnormal LFT” guidelines - for all those times when it’s not acute liver failure, but those LFT’s look like they need some investigating - ht Dr Jou gi.org/guideline/eval…
9/ “Normotensive ischemic acute renal failure” - can’t tell you how many times this has come in handy where I’ve slipped this to my resident, antihypertensives were backed down and a mysterious AKI disappeared; ht Dr Chiovaro nejm.org/doi/full/10.10…
Read 11 tweets
How to make your
correlations correlate.
Even if they don't.
==============

A practical tweetorial for aspiring research fraudsters, cardiology fellows doing research, and others in need of a strong association when there isn't one.

#meded #foamed

Please retweet to fellows.
Thank you to @rallamee for loaning me the use of her garden and boating lake to do a few demonstrations in this weekend's tweetorial.
Thank you also to a colleague, for sending me this just now. It is enlightening and I am genuinely sorry.
Read 58 tweets
This is my commentary on #twitter #movements. Before I go I want to preface this with a statement: I love humans. We're amazing creative & powerful beings. I'm fascinated by human behaviour and the hidden motivations underlying our basic need to belong. 1/
I've observed some movements taking off on Twitter. Some for #MedEd, raising awareness, knowledge sharing, inspiration and sharing failings, wounds & triumphs. Generally they support creative expression in 280 characters. Awesome! 2/
As these movements gain momentum, more people want to join in b/c #belonging. I'm seeing a disturbing trend of sharing experiences of patients/clients to promote how deep & human they are. Some are purely intended, some not. 3/
Read 21 tweets
Risk Ratio, Odds Ratio, Hazard Ratio
========================

2nd and final part of the tweetorial, from ORBITA-HQ!

Fun, easy and informative [*]

#MedEd #FOAMed #cardiology #cardiotwitter
[*] Results may vary and are not guaranteed. See small print.

Not all fears are alike.

* Some fears are one-and-done:
I get a cold which progresses to pneumonia. Will I die, or recover?

* Other things hang over us for much longer, perhaps all your life.
Will you get hit by a bus?
Get a heart attack?
There's no "sell by" date on the fear.
Practice Qs

You are walking through Hyde park, minding your own business.
Hardly causing any trouble at all.
Perhaps the odd humorous tweet.

You get a Direct Message:
"Enough of ur abuse!
You will be hearing form my agent shortly.
kthxbai
AJ Kirtane"

You see the agent:
Read 89 tweets
RELATIVE RISK, ODDS RATIO, HAZARD RATIO
=============================

What are they?
Why do we need 3 of the damn things?
Which should I use?
Are they the same, or different, or a bit samey?

An #ORBITA-HQ #tweetorial.
#Meded #FOAMed
All 3 of these are about comparing the scale of dangerousness of one thing AGAINST ANOTHER.

Suppose you are walking through an unfamiliar forest and the road comes to a fork: you have to choose one path.

As you stand, uncertain, a troll pops out of the ground.
You ask for advice on which path is safer.

As always, the advice he offers is scrupulously correct, but not necessarily instantly interpretable to the layperson.
Read 65 tweets
What does a P value mean?
==================

A microtweetorial because I have been watching @anupampom and @JohnTuckerPhD chase each other like this for the last hour, which is distracting me from doing work.

Answer this and save them from circular argument.
#foamed #meded
Francisomycin, my new natural anti-atherosclerotic antibiotic, has now been published in NEJM to reduce atherosclerosis by 173 arbitrary units (p=0.03).

I am really, really pleased with the result and the fact that I have the patent on this magical stuff.
What does p=0.03 mean?

A. 3% of pts had reduced atherosclerosis?
B. 97% of pts had reduced atherosclerosis?
C. If a drug is ineffective, 3% chance that it produces an effect this extreme.
D. 3% probability that THIS drug is ineffective, i.e. that these results occurred by chance
Read 57 tweets
Intention To Tweet
============

1. Why is intention-to-treat the ONLY right way to interpret trial results?
2. Why are these fine gentlemen wasting their prayers?

Tweetorial for cardiology fellows from ORBITA-HQ
#cardiology #meded #foamed
Thank you to Ali Jazayeri for suggesting this subject on the highly secret DM contact address (@ProfDFrancis).
At first I hesitated over whether this was truly needed amongst such an elite body of scienntific minds as we have reading this thread.

But Pascal Meier insisted that it was.
He said he was watching a whole session dedicated to not understanding this at a conference. Sent a pic!
Read 104 tweets
MYOCARDIAL VIABILITY
================

Lazarus revisited

[Tweetorial from ORBITA-hq: "Making cardiologists think again"(TM)]

Please retweet to cardiology fellows or anyone who might be interested to practice data interpretation.
Let's start our story here, when I was first informed that viability testing saves lives.
A few weeks later, a decisive meta-analysis.

3000 patients
Read 30 tweets
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