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ACBD to ACLS: UTHSA EMSA Workshops bring multiple-choice theory to life
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by Ina Prevalska

The first two years of preclinical medical education consist of pouring knowledge into the minds of students' at a dizzying rate, with brute force recall and information regurgitation being the means to survival. While stuffing our brains to the brim with the Krebs cycle and hemoglobin curves and mechanisms of respiration, rarely do students take a step back and think, "What exactly am I supposed to do with this information?"

Being unable to bridge this gap can leave many on their heels entering the clinical realm. All of a sudden, it is no longer a matter of plucking the right answer from a multiple-choice question. All the flashcards in the world will not help when it comes to knowing how to act. In an effort to keep students not only engaged with their study materials but also to provide some introduction to the world of clinical care, UT Health San Antonio's Emergency Medicine Student Association (EMSA) has made conducting directly applicable workshops one of its main goals.

When a layperson thinks medicine, one of the foremost scenes that comes to mind is the unstable patient: someone in the OR or ED suddenly becoming unresponsive, triggering the knowledgeable doctor to read their monitor and yell "V-fib! Charge to 200!" Yes, we do spend time during Cardiology learning about arrhythmias and what they look like on an EKG, and we know the correct answer is usually C. defibrillation, but after this our knowledge comes to a screeching halt. The thought of what comes next does not occur because as harried students, we immediately are on to the next factoid to inhale. Here, the September EMSA workshop aimed to bridge the gap with a review of Advanced Cardiac Life Support (ACLS).

Led by PGY3 Dr. Eli Katz, this workshop began with a walkthrough of the Cardiac Arrest Algorithm. For a roomful of second years, this was something that had not been thought of since initial CPR training as bright-eyed and bushy-tailed first years. Step by step, we reviewed the process. Which drugs? How often? Why were we giving those drugs? For many, this was the first time thinking beyond the initial step of putting on the pads and administering shock- 200J one time does not work, so what comes next? What else can we do to bring this person back? The algorithms by the American Heart Association puts out undergo changes every few years, and even those with background EMS training were able to garner new knowledge from the reviews. We used same stepwise approach for the bradycardia and tachycardia algorithms, and this allowed the students to ask questions that get brushed over in class. For example, a procedure such as transvenous pacing is the answer on the exam, but what does that actually entail for the patient? What risks are there? What is physically done? By having smaller group discussions outside of the classroom setting, the actual consequences become significantly more real. It is one thing to bubble an answer and move on, but the actual consideration of putting a wire through someone's jugular vein and into their living heart is an entirely different matter. While this by no means was a replacement for clinical experiences, it makes the procedures and decisions we will soon be faced with all the more tangible.

To wrap up, Dr. Katz presented a few cases from patient presentation all the way to a code. The students had to think about the symptoms and then read the EKG; so far, standard affairs. But once the patient "coded", the oral-boards-style cases became alive and dynamic in a fashion that a multiple-choice exam could never replicate. Going from a shockable rhythm to a regular tachycardia is a plausible scenario, and this was teased out in one of the cases. As future clinicians, students will have to adapt to not knowing what comes next, and how to rapidly shift from one treatment plan to another. Through this workshop, UTHSA's EMSA offered many the first opportunity to react to medicine "in real time," and it is with this idea in mind that the group continues to move forward with useful and relevant workshops. Thus, EMSA strives to prepare its members so they may approach their clinical years with a bit more experience and comfort, allowing them to be as competent as possible from Day

What's next? How to run trauma as a team.

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