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  • REBEL MIND Ep13– The One Minute Preceptor

    REBEL MIND Ep13– The One Minute Preceptor
    2026/10/05
    10 分
  • REBEL MIND Ep12– The Nature Reset

    REBEL MIND Ep12– The Nature Reset
    2026/09/07
    24 分
  • REBEL MIND Ep11 - Teaching Towards Expertise with Gamification

    REBEL MIND Ep11 - Teaching Towards Expertise with Gamification
    2026/08/03
    🔑 Key Points 🎮Gamification in medical education can deeply engage learners and improve clinical skills. 🕹️Rapid Sequence alternates between game blocks, where learners act in clinical scenarios, and teaching blocks, where insights are shared. 📈True expertise is about developing effective cognitive strategies, not just accumulating knowledge. 🧠Building mental models involves not just learning, but practicing decision-making in complex environments. 🌐The learning environment should foster psychological safety and encourage growth through reflection and feedback. 📝 Introduction Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, we introduce an innovative teaching tool called Rapid Sequence, aimed at revolutionizing how clinicians learn critical care through gamified experiences. With host Dr. Mark Ramzy, we invite Drs. Sarah Crager, and Ryan Ernst, to explore what it takes to become an expert and how gamification can transform learning in the medical field. 🤔Cognitive Question What does it truly mean to be an expert in emergency and critical care medicine? ⁉️What Is Rapid Sequence?? It's a gamified clinical case simulation tool consisting of different "blocks" where you have individual learners that can work through cases in non-multiple choice format. You're basically working on shifts, seeing multiple patients with your team.There's a cast of characters, interruptions, distractions, and you enter orders just like you would as if you were on shift, and then the cases advance to see the outcome of your decisions, good or badFor more information check it out the Rapid Sequence website here. Use the following Promo Code: REBEL2026 at checkout page to receive a 20% off coupon 🏃🏽‍♂️‍➡️Learning Must Be An Active Not Passive Process An important part of the process when acquiring new skills or information is making it an active processIt is not just passively listening, but actively participating, providing answers that aren't multiple choice, and then responding to the outcomeThis provides the engagement, and increases both the comprehension and retainability of new conceptsWhen you then apply those same concepts in future times of questioning (or in Rapid Sequence's case "Blocks") it helps expedite active recall through spaced repetition 🏥How This Applies to the Emergency Department or ICU? In high-stakes environments like the ED or ICU, clinicians must make fast, informed decisions often without complete data. Rapid Sequence provides a simulated space where clinicians can make mistakes without risk to real patients, receive feedback, and build the cognitive resilience needed for actual shifts, mirroring the chaotic nature of these departments. ⏩Immediate Action Steps for Your Next Shift **Embrace Gamified Learning**: Engage with or seek out platforms like Rapid Sequence that offer a practice ground for real-world medical scenarios. **Develop Mental Models**: Start by breaking down complex cases into mental models that you can refer back to during your shift. **Prioritize Feedback and Reflection**: After each shift, allocate time to reflect on decisions and seek peer feedback to refine your cognitive strategies. **Foster a Safe Learning Environment**: Encourage open discussions in your team where all members can express uncertainties and learn from one another. 💬Conclusion Embracing innovative teaching methodologies such as gamification can lead to significant improvements in clinical education and practice. By integrating tools like Rapid Sequence in training, healthcare professionals can not only enhance their skills but also foster a culture of continuous learning and psychological safety. 🚨Clinical Bottom Line Effective medical education isn't about rote memorization—it's about developing the ability to think critically and adapt rapidly in ever-changing environments. Gamified tools offer an engaging path to achieve true expertise, ensuring clinicians are well-equipped to provide the best patient care possible.
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    51 分
  • REBEL MIND Ep10– Mastery Learning and Deliberate Practice

    REBEL MIND Ep10– Mastery Learning and Deliberate Practice
    2026/07/06
    📌 Key Points 🧠 Mastery Learning: A unique educational framework focusing on achieving high competence with minimal variability among learners. 🔍 Deliberate Practice: Involves learner-driven improvement, guided by expert feedback and breaking skills down into micro steps. 🦺 Psychological Safety: Essential in mastery learning, allowing open feedback without fear or shame, enhancing growth. Embrace the productive struggle! 🔁 Practice to Prevent Skill Decay and Improve Clinically: Application of mastery learning principles helps maintain high proficiency levels in both common and rare procedures. 📝 Introduction Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, host Dr. Kim Bambach chats with master educator Dr. Jennifer Yee about the science of performance through mastery learning and deliberate practice. Jennifer Yee, DO is an associate residency program director for OSU Emergency Medicine, the OSU EM director for assessment and evaluation, and an associate professor of emergency medicine. She is from Akron, Ohio and earned her bachelor degree from Ohio University and her medical degree through the Ohio University College of Medicine. Her residency training was completed through Summa Akron City Hospital. After serving as chief resident, she completed a simulation medicine fellowship at Summa. She completed Northwestern's Designing and Implementing Simulation-Based Mastery-Learning Curricula, as well as Ohio State's Master of Art's program in Biomedical Education. She established a mastery-based procedural curriculum for OSU's EM residency program before creation of an institution-wide mastery-based central venous catheter (CVC) curriculum for all housestaff expected to place CVCs during their clinical training. 🤔 Clinical Question How can mastery learning and deliberate practice transform traditional medical training to improve both competency and confidence in clinical settings? 🏥 What is Mastery Learning? Unlike traditional clinical training, which is time-bound (e.g., "you are competent after a 3-year residency" or "after 10 chest tubes"), Mastery Learning is outcome-bound. The goal is to get every single learner from their unique baseline to an identical, objectively high level of performance with minimal variation. In this framework, learners start with a pre-brief, followed by baseline assessment, targeted debrief, deliberate practice, and a final evaluation using a checklist with a strict minimum passing standard (often set via methods like the Mastery Angoff). The mastery learning framework has been shown to improve patient safety. The Northwestern Central Line Study: Research demonstrated that requiring residents to achieve a set benchmark on a simulator prior to clinical performance led to fewer needle passes, a decrease in mechanical complications (such as accidental arterial punctures), and a subsequent reduction in catheter-associated infection rates in the intensive care unit. High-Acuity, Low-Occurrence (HALO) Procedures: Studies have demonstrated that for rare, critical procedures like emergency cricothyrotomies or transvenous pacing, baseline testing shows that very few trainees can meet a standard passing score initially. However, following targeted simulation training and deliberate practice, 100% of participants successfully achieved the minimum standard required to perform the procedure competently. 🎯 The Anatomy of Deliberate Practice We often assume experience or confidence equals competence, but humans are notoriously poor self-assessors (plug for our Dunning-Kruger episode!). True deliberate practice isn't just repeating a task for 10,000 hours; it is purposeful, learner-driven micro-skill improvement guided by an expert coach. High-Quality Feedback: Avoid vague phrases like "good job" or "read more." Effective coaching relies on strictly objective, real-time observations (e.g., "I am watching your needle angle. If you enter the skin more steeply, you will hit the vessel faster"). Embrace a Growth Mindset: Stripping away your ego to be silently watched and critiqued is inherently awkward. Normalize deliberate practice to create psychological safety. Overcoming this requires building an environment centered on patient safety, where baselines are treated as data points rather than judgments. True growth happens with the "productive struggle". Adaptive Expertise: True mastery means moving past a rigid checklist. It requires learners to understand the reasoning behind their actions and anticipate next steps, complications, and plot twists in real time. ✨ How this Applies to the ED/ICU? In high-stakes environments like the ED or ICU, where quick, accurate ...
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    25 分
  • REBEL Core Cast—Nitrous Oxide Toxicity: Neurologic Complications of Whippet Abuse

    REBEL Core Cast—Nitrous Oxide Toxicity: Neurologic Complications of Whippet Abuse
    2026/06/15
    What Is Nitrous Oxide? Nitrous Oxide (N2O) is a colorless, odorless inhaled anesthetic that has been used for centuries, particularly in the surgical world. Mechanistically, it can induce euphoria, anxiolysis, and intoxication via NMDA receptor antagonism. During the late twentieth century, nitrous oxide was increasingly used recreationally due its accessibility and perceived benign nature. The modern day slang term for nitrous oxide is "whippets" – which tends to refer to the canisters that contain this agent and are frequently used as whipped cream foaming agents. Despite the legal nature and benign perception of nitrous, frequent use can lead to lasting and permanent neurologic effects. How Nitrous Oxide Causes Toxicity Nitrous oxide toxicity results from its ability to oxidize the cobalt moiety in Vitamin-B12, thus leading to a functional B12 deficiency, despite adequate consumption and absorption.1 Functioning B12 is needed as a cofactor for methionine synthase.2 This enzyme has two critical roles: The conversion of 5-methyl tetrahydrofolate to tetrahydrofolate; tetrahydrofolate is essential for the synthesis of our DNA. And the conversion of homocysteine to methionine; methionine is needed to maintain the integrity of the myelin sheath of our axons. As a result, nitrous toxicity leads to: a megaloblastic anemia and demyelination of both the dorsal columns and the lateral corticospinal tracts (also known as subacute combined degeneration). Clinical Manifestations of Nitrous Oxide Toxicity These patients will have a combination of both upper and lower motor neuron symptoms due to demyelination of the dorsal columns, lateral corticospinal tracts, and peripheral nerves. As a result, the following may manifest: Dorsal Columns: diminished sense of proprioception, vibration, and fine touch. Lateral Corticospinal Tracts: upgoing plantars, hyperreflexia, weakness of voluntary distal muscle control Peripheral Nerves: numbness/tingling and weakness in a glove and stocking pattern (symptoms that start initially in the feet and hands that progressively spread proximally to the ankles and wrists) Taking all of this into account, patients may present with difficulty ambulating, positive Romberg sign, dysmetria (difficulty with finger to nose or heel to shin), upgoing Babinski reflex, and decreased strength and sensation in a glove and stocking pattern. How to Diagnose Nitrous Oxide Neurotoxicity History is key! As with a lot of pathologies in toxicology, identifying the exposure will expedite management. A thorough neurologic exam will narrow the differential – with a particular focus to fine, peripheral motor and sensory deficits, dysmetria, proprioception, and ability to ambulate. Magnetic resonance imaging of the spine may identify enhancement and/or edema of the dorsal columns, specifically on T2 weight axial imaging – sometimes referred to as the "inverted V" or "inverted rabbit ears appearance."3 Serum B12 concentrations may be normal as the issue is with a functional deficiency as opposed to a vitamin absence. However, patients have elevated concentrations of both homocysteine and methylmalonic acid, both of which are metabolized in the presence of functional B12. Management of Nitrous Oxide Toxicity First and foremost, cessation of nitrous oxide abuse is crucial to limit/prevent toxicity. While there is no universally agreed upon treatment regimen, supplementation with intramuscular B12 is recommended. Approaches vary from daily or every other day injections until symptoms improve at which point injections can be spaced out to weekly and then monthly. Physical and occupational therapy may be needed depending on the degree of functional debility. It is important to note, that depending of the severity and chronicity of toxicity, some proportion of patients may not fully return to their baseline. Take-Home Points Though legal and seemingly benign, nitrous oxide abuse can lead to permanent neurologic dysfunction.Nitrous oxide toxicity can affect the dorsal columns, lateral corticospinal tracts, and peripheral nerves.Thus leading to a constellation of both upper and lower motor neuron deficits, particular in a glove and stocking pattern: deficits in proprioception and fine motor skills, positive Romberg, upgoing Babinski, peripheral numbness, tingling, and weakness.Magnetic resonance imaging may identify symmetric high signal intensity in the dorsal columns.Treatment includes B12 supplementation and physical/occupational therapy as needed. References Long H. Chapter 81. Inhalants. In: Nelson LS, et al. Goldfrank's Toxicologic Emergencies. 11th ed. New York: McGraw-Hill; 2019Shah K, Murphy C. Nitrous Oxide Toxicity: Case Files of the Carolinas Medical Center Medical Toxicology Fellowship. J Med Toxicol. 2019 Oct;15(4):299-303. doi: 10.1007/s13181-019-00726-x. Epub 2019 Aug 6. PMID: 31388940; PMCID: PMC6825085.Schmitz ZP, ...
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    11 分
  • REBEL MIND Ep9 – Human Factors: The Hidden Architecture of Emergency & Critical Care Medicine

    REBEL MIND Ep9 – Human Factors: The Hidden Architecture of Emergency & Critical Care Medicine
    2026/06/03
    🔑 Key Points 🧩 Human Factors: The unseen behaviors, distractions and considerations critical in emergency medicine and the ICU, influencing patient care beyond just medical knowledge. 🎯 System Design: Effective system design directly impacts team performance by creating environments that facilitate optimal decision-making. 🏥 Real-world Application: The application of human factors in healthcare leads to better team dynamics, reduced stress, and improved patient outcomes. 👷🏽‍♀️It's Everyone's Job: Building a culture of adaptability and openness to change can lead to better healthcare delivery, communication and interprofessional relationships 🛠️ Practical Solutions: Start the conversation in departments for actionable and pragmatic changes to current healthcare environments to enhance practitioner efficiency and patient care quality. 📝 Introduction Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, host Dr. Mark Ramzy chats with special guests and master educators about the concept of human factors. Dr. Chris Hicks is an emergency physician and trauma team leader at St. Michael's Hospital in Toronto, Assistant Professor in the Department of Medicine at the University of Toronto, and co-founder of Advanced Performance Healthcare Design, a physician-led simulation and design group. Dr. Andrew Petrosoniak is an emergency physician and trauma team leader at St. Michael's Hospital, and Medical Director of the Unity Health Toronto Simulation Program. He's an Assistant Professor at the University of Toronto where his research focuses on simulation for systems and design improvement and optimizing the care of the bleeding patient. Along with Dr. Hicks, he's also President of Advanced Performance Healthcare Design, a consulting firm that works with high-performance teams and uses simulation to enhance and design better healthcare spaces 🤔Cognitive Question How can the integration of human factors improve decision-making and performance in emergency medicine and critical care environments? ⁉️What are Human Factors? In the context of healthcare, human factors encompass the interplay between humans, the systems they work within, and the effectiveness of their interactions. It includes elements like communication, system design, environmental conditions, and behavioral patterns affecting individual and team decision-making processes. It's the collective impact of individual behaviors, team dynamics, and the physical environment on performance and outcomes. The aim is to eliminate issues arising from human error by creating systems and environments that naturally guide and support optimal performance. 🏥How This Applies to the Emergency Department or ICU? - Efficient integration of human factors in high-pressure settings like the Emergency Department (ED) or Intensive Care Unit (ICU) helps mitigate the risks associated with stressful and chaotic environments. - By focusing on system designs that account for human behavior, healthcare professionals can reduce errors, enhance team coordination, and ultimately improve patient care. - This is crucial as teams are often required to make rapid, life-saving decisions in these environments - The design of clinical spaces can either hinder or help efficient care. Poorly arranged equipment or cluttered workspaces increase stress and impede decision-making. - Implementing structured design principles, such as dedicated equipment zones and clear visual cues, can streamline workflows and enhance team coordination - It actually helps pave the way for more efficiency because you end up "working smarter instead of harder". - It speaks directly to the Daniel Kahneman's theory of Type 2 Thinking – which is a slow, analytical cognitive process requiring deliberate thought - We'll likely create a whole dedicated episode to this but if you want to read more ahead of time on it, check out his book Thinking, Fast and Slow ⏩Immediate Action Steps for Your Next Shift **Assess Your Environment**: Take note of any clutter, noise, or layout issues in your workspace that could hinder optimal performance. Identify problem areas that could be optimized. **Recognizable Hard-Stop** – Implement a "Stop-Point" Check for areas or issues that involve more than just patient safety (ie. workflow inefficiencies, sign-out, throughput, etc). Use predefined benchmarks during procedures to ensure clarity and efficiency. **Foster Open Communication** – Encourage an environment where every team member feels comfortable discussing their thoughts and decisions without fear of judgment. **Prototype Solutions** – Work with colleagues to identify problems and brainstorm quick, cost-effective solutions ...
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    32 分
  • REBEL MIND Ep8 – The Mental Jump: Moving from Junior to Senior Leadership in Emergency Care

    REBEL MIND Ep8 – The Mental Jump: Moving from Junior to Senior Leadership in Emergency Care
    2026/05/06
    📌Key Points 🧠Parallel Tasking: Transitioning from junior to senior roles in medicine involves both personal growth and the development of leadership skills, often simultaneously. 🚀Psychological safety: Creating this within teams is critical for fostering an environment where all members feel empowered to speak up and share insights. 🔎 Big and Small Picture View: Effective leadership requires the ability to zoom in on specific tasks and zoom out to manage the big picture, ensuring comprehensive patient care. ⌚Timing is Everything: The act of asking the right questions at the right time can significantly enhance team dynamics and patient outcomes in high-pressure situations. 🗣️Talk the Talk: Creating and practicing clear, structured communication strategies can assist in smooth transitions and effective leadership during medical emergencies. 👀Previously Covered and Related Content: REBEL EM: Titles Don't Make LeadersEM Cases: Four Key Learnings from a Career in Emergency Medicine Leadership 📝Introduction Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. Hosted by Dr. Mark Ramzy, with special guest Dr. Dan Dworkis, an emergency physician and author of "The Emergency Mind," this episode dives into the complex journey from junior to senior leadership in medical settings. You can learn more about Dan's work and the Emergency Mind Project here He has a phenomenal book called "The Emergency Mind: Rewiring Your Brain for Performance Under Pressure" that you can purchase here! 🤔Cognitive Question How do medical professionals effectively transition from junior to senior roles, and what mental shifts are necessary to manage these evolving responsibilities? 🏥How This Applies to the Emergency Department or ICU? Transitioning from a junior to a senior role in the emergency department or ICU is akin to stepping onto a new stage where the performance demands are higher, and the stakes significantly greater.While juniors focus on learning their craft and understanding themselves, seniors are expected to manage and lead entire teams, often making life-saving decisions under pressure.This transition challenges not only their clinical skills but also their ability to lead effectively and maintain psychological safety within their teams.By fostering an environment where every team member feels valued and heard, senior leaders can harness the collective intelligence of the group, ensuring better patient outcomes and a more effective response to emergencies. ⏩Immediate Action Steps for Your Next Shift **Exercise Intentional Questioning**: Start your next shift by focusing on how you ask questions. Aim to frame queries in a way that invites discourse and challenges assumptions. **Develop Peripheral Awareness**: As you conclude critical tasks, practice expanding your focus from the immediate to the wider context, considering broader departmental needs. **Promote Inclusive Participation**: Encourage junior team members to share their observations and insights by specifically inviting their input during debriefs and planning. **Conduct Leadership Experiments**: On your next shift, try altering your leadership approach—whether it's how you communicate or delegate—and reflect on its effectiveness with colleagues. **Create Psychological Safety**: Work towards fostering a safe environment for open communication, ensuring that all team members feel comfortable speaking up without fear of retribution. 💬Conclusion Transitioning from a junior to a senior leadership role in the medical field is not just about honing your clinical skills but also about growing as a leader who can guide a team under intense pressure. By focusing on intentional communication, fostering psychological safety, and keeping an eye on both the details and the bigger picture, you can enhance your effectiveness as a leader. Continuous reflection and feedback are essential to mastering these skills, ensuring that both you and your team provide the highest level of care for your patients. 🚨Clinical Bottom Line Leadership in medicine is about more than making decisions—it's about creating an atmosphere where every voice is heard, ensuring optimal functioning of the team. As you grow into your senior role, remember that fostering psychological safety and practicing strategic communication can make all the difference in patient outcomes and team dynamics. 📚 Further Reading Collins-Nakai R. Leadership in medicine. Mcgill J Med. 2006 Jan;9(1):68-73. PMID: 19529813Chen TY. Medical leadership: An important and required competency for medical students. Tzu Chi Med J. 2018 Apr-Jun. PMID: 29875585
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    48 分
  • REBEL MIND Ep7 - Growth vs Fixed Mindset in Medicine

    REBEL MIND Ep7 - Growth vs Fixed Mindset in Medicine
    2026/04/01
    🔑Key Points 🌱 Growth mindset transforms learning – Residents and students who believe skills can be developed are more open to feedback, more resilient after failure, and more engaged in practice.🧠 Language matters in feedback – Simple reframes such as "You're developing procedural skills" instead of "You're not strong at procedures" encourage persistence and normalize the learning curve.🤝 Mindset shapes team culture – Growth mindset leaders foster psychological safety, invite input, and create collaborative teams. Fixed mindset hierarchies, on the other hand, silence voices and can compromise patient care.🔥 Growth mindset protects against burnout – By reframing mistakes as part of the process, clinicians reduce perfectionism and shame, bolstering resilience and wellness.🔍 Practical steps start with self-talk – Add the word "yet" to limiting beliefs ("I'm not good at X…yet") and shift feedback questions toward improvement ("What's one thing I can do better next time?").🛠️ Embracing mistakes with a growth mindset – Leads to more effective feedback loops and improvement do this by building a culture of psychological safety is crucial for growth and reducing medical errors. 👀Previously Covered and Related Content: REBEL EM: The EM MindsetREBEL EM: Titles Dont Make LeadersREBEL EM: Mind of the Resuscitationist with Scott WeingartEM Crit: Making Things Happen with Cliff Reid 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Mindset shapes everything we do in medicine—from how we teach and learn to how we show up for patients at the bedside. Drawing from Carol Dweck's influential book Mindset, this episode of REBEL MIND explores the critical difference between a fixed mindset (believing abilities are innate and static) and a growth mindset (seeing skills as things that can be developed through effort and feedback). We sat down with Dr. Kim Bambach, an emergency medicine physician and medical educator, and Dr. Frank Lodeserto, a dual-trained intensivist and internal medicine program director, to unpack how mindset influences medical education, bedside performance, and physician wellness. In this episode, we delve into how the mindset of clinicians can profoundly influence their performance, professional growth, and ultimately patient care 🤔Cognitive Question How does adopting a growth versus a fixed mindset influence clinical performance, medical education and patient outcomes? 🌱What is Growth vs Fixed Mindset? In Carol Dweck's research, two primary mindsets are highlighted: Fixed mindset: Which sees intelligence and skills as static In the medical field, adopting a fixed mindset might lead a clinician to avoid complex cases due to fear of failure.Growth mindset: Which views abilities as improvable through dedication and effort. In contrast, a growth mindset encourages embracing challenges as opportunities for learning and development. 🏥How This Applies to the Emergency Department or ICU? In high-stakes environments like the ICU or the ED, the mindset adopted by healthcare providers can distinctly shape patient care and team dynamics.A fixed mindset might lead to defensive behaviors and a reluctance to engage in challenging cases, potentially stunting personal and professional growth.Conversely, a growth mindset not only fosters resilience and adaptability but also enhances team collaboration and patient outcomes by encouraging open communication, continuous learning, and acceptance of constructive feedback. ⏩Immediate Action Steps for Your Next Shift **Monitor Self-Talk**: Notice your internal narrative when faced with challenges. Replace negative, fixed-mindset thoughts with growth-oriented ones like "Not yet" or "What can I learn from this?" **Promote a Culture of Inquiry**: Challenge yourself and your team to engage in constructive questioning and explore alternative diagnoses or treatment plans to encourage a growth-centered environment. **Model Vulnerability**: Share personal learning experiences and mistakes with colleagues to normalize the growth process and reduce the stigma of imperfection. **Reframe Feedback**: Instead of broadly asking, "How did I do?" inquire, "What's one thing I can improve on next time?" This shift helps maintain focus on growth rather than performance validation Feedback is a whole another topic that we plan to have dedicated episodes and blog posts. This is an area where sometimes faculty struggle and often learners are asking for more/improved feedback. 💬Conclusion Cultivating a growth mindset in medicine isn't merely about staying ...
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    33 分