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#RCEM 15 – Music and EM- How we can change our training and our practice?

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The content you’re about to read or listen to is at least two years old, which means evidence and guidelines may have changed since it was originally published. This content item won’t be edited but there will be a newer version published if warranted. Check the new publications and curriculum map for updates

Author: Sarah Edwards / Codes: CC12, CC15, CC8 / Published: 05/11/2015

Medicine, like music, is a performance. So much of what we do in EM is about 1st impressions. Unlike a lot of other specialties, EM is unique. We have to create a positive first impression very quickly, in sometimes very difficult and life challenging situations

Jeremy talked about Performance in the first part of this talk.

EM is a series of 1st impressions. What matters is the first impression, that first time we meet our patient can we be trusted? The music world is very aware of this. Platz and Kopiez (2013) wrote about when first impressions count. This work looked at how people enter a stage to preform and their perceived perception by the audience. Things such as nodding, direction of gaze, touching ones self, stance width, step size, resolute impression were looked at. The essential question was if the entrance is so bad do you want to listen to the music? In short yes was the answer.

Why does this matter? We all know patients care about how professional we are and how we look. If we are perceived unprofessional, our patients may not trust us. Jeremy went on to discussing about our other skills; when listening what skills dont you use? Have you ever asked a patient do you smoke? They say no but they smell of cigarette smoke. In medicine like music, all senses are important. We need to use them all.

We (the audience) then got to watch and listen to a series of clips. The clips consisted of either a silent video, a video with sound or just a sound recording. Amateurs were asked if they could pick the winner compared to the professional judges out of each group of clips. Both amateurs and professionals were able to pick the winner every time on the silent video clips. Neither group could agree on who were the winners in either of the other groups. In short, despite music being stated as the most important factor in picking a winner, it was clear visual cues are more important. In EM perception is everything, if you have a winning performance you are likely to be perceived and believed. This therefore may help patients trust you more and believe in what you say.

The second part of the talk discussed about pedagogy and practice.

How do we learn to do our practical skills? Jeremy talked about the 3 approaches

See one, do one, teach one

Amateurs practice until they get it right. Professionals practice until they cant get it wrong attributed to many

If I dont practice for one day, I know it.”

If I dont practice for two days, my critics know it; and if I miss three days the audience knows it Arthur Rubinstein (a Polish- American Pianist)

In medicine we tend to talk about the former approach when leaning new skills See one, do one, teach one. This method is engrained in medicine, however is this effective if we want to be truly skilled at the procedures we do. Many papers have compared music students verses medical students/ residents and how we learn. Watling et al. 2013 wrote about how in medicine we could learn form how music is taught (summarised here by @jeremyfaust)

Medical Students/ Residents/ Junior Doctors Music Students
Pedagogical approach Learn by doing Learn by lesson
Performance goal Competence even better
Ideal teacher Clinical skills > teaching Teaching > performance
Feedback Self-assessment possible External review essential.

In medicine perhaps we need to move from being good at a skill, to being the best at a skill and never getting it wrong.

Jeremy Faust Don’t practice until you get it right. Practice until you can’t get it wrong. He talked about how he started teaching residents blind folded chest tubes and USS IV access. He made this more and more difficult, by changing handedness, vibrating the platform it is on and putting time constraints

Scott Weingert talked in his video about breaking complex skills into mirco-tasks i.e. CVC insertion taking each step and practicing it until you can do it any which way. His video is here http://emcrit.org/wee/central-line-micro-skills-deliberate-practice/

What actually helps us learn/ retain?

  1. Spaced repetition
  2. Practice tests
  3. Mnemonics No knowledge weeks later to fall back on.

The third part of the talk discussed you use of music in pain reduction.

How we process pain is different.There has been much work to see how music can be used in medicine, but more importantly for us, in our emergency departments. Holm and Fitzmaurice (2008) showed that music versus aromatherapy in the waiting room, significantly reduced stress and anxiety that neither. Several papers support music as an effective intervention that can lessen symptoms related to mechanical ventilation and promote effective weaning. Also a recent Cochrane review (Bradt, 2014) has shown music can reduce the amount of sedation mechanically ventilation patients need.

At the end of this talk we were all left more relaxed with an inspiration to take music back to our departments.

Key papers

Bradt, J; Dileo, C. (2014). Music interventions for mechanically ventilated patients. Cochrane Database Syst Rev. http://www.ncbi.nlm.nih.gov/pubmed/25490233

Platz, F. (2013) The influence of performers stage entrance behavior on the audiences performance elaboration. International Symposium on Performance Science. 345-352. http://www.performancescience.org/ISPS2013/Proceedings/Rows/080Graduate_Platz.pdf

Platz, F; Kopiez, R. (2013) When the first impression counts: Music performers, audience and the evaluation of stage entrance behavior. Musicae Scientiae. Jun; 17 (2): 167-197 http://msx.sagepub.com/content/17/2/167

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