Young docs learn bad habits from TV medical dramas

[Guest guest]

Young doctors learn bad habits from TV medical dramas

Tom Blackwell, National Post Published: Monday, March 23, 2009

When physicians at an Alberta hospital asked why so many medical students and

residents were using a faulty technique for inserting life-saving breathing

tubes in patients, they received an unexpected answer: It's television's fault.

Many of the doctors in training said they had learned the procedure from

watching medical dramas. And a subsequent analysis of the show ER revealed its

fictional MDs and nurses performed intubations incorrectly almost every time.

The findings, just published in the journal Resuscitation, revive an intriguing

debate over whether entertainment TV has an obligation to portray medicine

accurately, and underline what some see as chronic flaws in the system of

training Canada's physicians.

" We were a bit shocked, " said Dr. Brindley, the critical-care specialist

at the University of Alberta Hospital who discovered the students'

extra-curricular secret. " The important lesson here is that we can't leave

medical education to chance alone. "

Intubation is the insertion of a tube down the windpipe, usually so a patient

can be hooked up to a mechanical ventilator when they are unable to breathe

properly on their own.

The first step is to position the head properly so the tube can be quickly and

easily installed.

Dr. Brindley said he and his colleague, Dr. Craig Needham, noticed that many

students and residents - medical-school graduates training in specialities such

as anesthesia, surgery and emergency care - positioned the head incorrectly.

Such a slip-up can make bad outcomes more likely when time is of the essence and

" it's a matter of life and death, " he said.

To find out where the faulty knowledge was coming from, the physicians surveyed

80 students and residents. Many said they learned through " trial and error, " but

a large proportion indicated they had picked up tips from white-coated TV

characters.

ER was the program most commonly cited by the students, so Drs. Brindley and

Needham analyzed a season of the show. Some aspect of the head positioning was

wrong in all 22 intubations that could be fully viewed on screen, their paper

says.

Dr. Brindley said his findings are more evidence that the traditional approach

to teaching doctors needs improving. Medical students typically learn about

procedures such as intubation in a lecture hall, then find themselves practising

on a real, perhaps critically ill patient, often with minimal supervision.

Later, the same doctors sometimes train others.

Known as " see one, do one, teach one, " the concept does not work so well in an

era when the population is ageing, hospitals see more patients with complex

health problems and doctors are chronically over-worked, Dr. Brindley said.

He promotes the use of simulators, computer-assisted dummies that provide

life-like practice for medical students before they start working on real

people. In general, there needs to be a move to evidence-based medical

education: testing teaching techniques the same way that drugs and other

treatments are evaluated, Dr. Brindley said.

Producers with ER could not be reached for comment on Monday.

One resident in emergency-medicine, however, said he was surprised to hear that

some of his colleagues might be learning from television.

Dr. Alim Pardham, a resident at McMaster University in Hamilton, Ont., said

intubation in his experience is taught to students and residents under close

supervision by experienced physicians.

Medical shows are popular with doctors in training, but most take the content

with a grain of salt, he said.

" People just enjoy it as good TV, " Dr. Pardham said. " They're not particularly

accurate in terms of what the hospital is like in real life. "

There has been heated debate, though, about how the shows affect the non-medical

public. A 1996 study in the New England Journal of Medicine found that 75% of

the patients who went into cardiac arrest on three shows - ER, Chicago Hope and

Rescue 911 - were revived, compared to the real rate of six to 15%.

Such small-screen successes " may encourage the public to disregard the advice of

physicians and hope that such a miracle will occur for them as well, " the

authors argued.

Neal Baer, a doctor and producer on ER, later argued in the same journal that

the show takes pains to be accurate, with scripts vetted by multiple experts.

The action, however, is deliberately made fast-paced and dramatic, Dr. Baer

admitted.

" Real life in an emergency room is often quiet, even boring, " he wrote. " If we

were to re-enact a minute-by-minute account of actual events ... we would not

have 35 million viewers each week. "

National Post

http://www.nationalpost.com/most-popular/story.html?id=1419824

[Guest guest]

It's not TV's fault; but rather the fault of these dimwits who are too lazy to crack open a textbook and read up on how to do this correctly. Incorrect intubation could kill a person. They should know that.

Do one thing every day that scares you.

Eleanor Roosevelt

From: <rumjal@...>Flu Sent: Tuesday, March 24, 2009 6:06:01 PMSubject: [Flu] Young docs learn bad habits from TV medical dramas

Young doctors learn bad habits from TV medical dramasTom Blackwell, National Post Published: Monday, March 23, 2009When physicians at an Alberta hospital asked why so many medical students and residents were using a faulty technique for inserting life-saving breathing tubes in patients, they received an unexpected answer: It's television's fault.Many of the doctors in training said they had learned the procedure from watching medical dramas. And a subsequent analysis of the show ER revealed its fictional MDs and nurses performed intubations incorrectly almost every time.The findings, just published in the journal Resuscitation, revive an intriguing debate over whether entertainment TV has an obligation to portray medicine accurately, and underline what some see as chronic flaws in the system of training Canada's physicians."We were a bit shocked," said Dr. Brindley, the critical-care specialist at the University

of Alberta Hospital who discovered the students' extra-curricular secret. "The important lesson here is that we can't leave medical education to chance alone."Intubation is the insertion of a tube down the windpipe, usually so a patient can be hooked up to a mechanical ventilator when they are unable to breathe properly on their own.The first step is to position the head properly so the tube can be quickly and easily installed.Dr. Brindley said he and his colleague, Dr. Craig Needham, noticed that many students and residents - medical-school graduates training in specialities such as anesthesia, surgery and emergency care - positioned the head incorrectly.Such a slip-up can make bad outcomes more likely when time is of the essence and "it's a matter of life and death," he said.To find out where the faulty knowledge was coming from, the physicians surveyed 80 students and residents. Many said they learned through

"trial and error," but a large proportion indicated they had picked up tips from white-coated TV characters.ER was the program most commonly cited by the students, so Drs. Brindley and Needham analyzed a season of the show. Some aspect of the head positioning was wrong in all 22 intubations that could be fully viewed on screen, their paper says.Dr. Brindley said his findings are more evidence that the traditional approach to teaching doctors needs improving. Medical students typically learn about procedures such as intubation in a lecture hall, then find themselves practising on a real, perhaps critically ill patient, often with minimal supervision. Later, the same doctors sometimes train others.Known as "see one, do one, teach one," the concept does not work so well in an era when the population is ageing, hospitals see more patients with complex health problems and doctors are chronically over-worked, Dr. Brindley

said.He promotes the use of simulators, computer-assisted dummies that provide life-like practice for medical students before they start working on real people. In general, there needs to be a move to evidence-based medical education: testing teaching techniques the same way that drugs and other treatments are evaluated, Dr. Brindley said.Producers with ER could not be reached for comment on Monday.One resident in emergency-medicine, however, said he was surprised to hear that some of his colleagues might be learning from television.Dr. Alim Pardham, a resident at McMaster University in Hamilton, Ont., said intubation in his experience is taught to students and residents under close supervision by experienced physicians.Medical shows are popular with doctors in training, but most take the content with a grain of salt, he said."People just enjoy it as good TV," Dr. Pardham said. "They're not particularly

accurate in terms of what the hospital is like in real life."There has been heated debate, though, about how the shows affect the non-medical public. A 1996 study in the New England Journal of Medicine found that 75% of the patients who went into cardiac arrest on three shows - ER, Chicago Hope and Rescue 911 - were revived, compared to the real rate of six to 15%.Such small-screen successes "may encourage the public to disregard the advice of physicians and hope that such a miracle will occur for them as well," the authors argued.Neal Baer, a doctor and producer on ER, later argued in the same journal that the show takes pains to be accurate, with scripts vetted by multiple experts. The action, however, is deliberately made fast-paced and dramatic, Dr. Baer admitted."Real life in an emergency room is often quiet, even boring," he wrote. "If we were to re-enact a minute-by-minute account of actual events ... we would not

have 35 million viewers each week."National Posthttp://www.national post.com/ most-popular/ story.html? id=1419824

[Guest guest]

True, but this shows that tv producers need to realize that their show will have

a teaching function. Accordingly, the medical drama's should be produced with

the cooperation of the national medical societies, as some of the older medical

shows were a couple of decades ago.

>

> It's not TV's fault; but rather the fault of these dimwits who are too lazy to

crack open a textbook and read up on how to do this correctly. Incorrect

intubation could kill a person. They should know that.

>

>

> Do one thing every day that scares you.

> Eleanor Roosevelt