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Jessica: Hi guys. Welcome back to The Absite Smackdown Podcast. This is your host, Jessica, and I'm here today with Dr. David Kashmer. And we are going to talk about how Absite Smackdown! helps you on rounds. And the reason we're going to talk about this is that, last week, we went over odd facts and little silly facts that are absolute facts that you still need to know for the test, even though they're a little crazy. It made me wonder how many of these facts do we actually use. David, can you tell us a little about that?
Dr. Kashmer: Hey, Jessica, good to be back with you again talking on the show. I do remember last week, it was a really fun one about whether the facts are sort of useful and we focused on the five most inane facts that you have to learn for the Absite. And some were quirky and some were funny and some were weird and you know, it got us wondering, just like you said, how useful on a day to day basis are the facts that we learned for the Absite? How directly applicable are they? And so I thought it was a really cool idea when you guys said, "Could you take the book with you on rounds or something, and just kind of mark down how often you use facts directly from it and not even in the teaching capacity, just how often you use it when it comes to patient care?"
So I thought it was a really good idea to find out, or just kind of get a sense of how and whether all these things we learned for the Absite are useful. And so that's what I did.
Jessica: So it was a success?
Dr. Kashmer: Well, I mean, I think the idea was like you said to see whether and how useful it was. And so it was successful in that. I noticed that we were using facts during rounds which are directly from the Absite Smackdown! book.
So with the book on rounds, just as we finished rounding on a patient, anything that came up from the book (and of course having lived through two editions to the book now I kind of know where everything is really well) it really just took a second to say, okay, I used this fact or these facts for this patient. And so when you say, was it successful...well, I mean, it was sure interesting to see on one rounds one day how much we used!
Jessica: Well, that is super awesome. How many facts did you use?
Dr. Kashmer: Well, we had 12 patients. And in 12 patients, we used 14 facts and some facts were the same fact used, you know, several times during rounds. And again, these are the ones that are just directly straight up Absite facts. There's times where you could say, well, we kind of talked about this, or we talked about this, but just straight cold direct facts that we learned from the Absite? Like I said, on those 12 patients, we used 14 facts. And, if I look at the numbers here, 10 of them were distinct facts.
Jessica: What one do you think came up the most with the patients?
Dr. Kashmer: Well, these were critical care rounds. These were surgical ICU rounds. And so the two things that really came up a lot were focused on pulmonary dynamics and also oxygen delivery and offloading. So we mostly used oxygen delivery, particularly the oxygen delivery equation and certain factoids about it, multiple times during rounds.
Jessica: Were there any other ones that you found specifically useful that you didn't even think about being in the Absite until we asked you to do this exercise?
Dr. Kashmer: One thing that I can never remember where I had to pick it up (whether it was critical care boards or Absite or gen surg boards) is the oxygen onloading and offloading sigmoidal curve.
We have this curve associated with delivering oxygen to tissues beyond the delivery equation that we always talk about. And it's this S shaped curve. And we always talk about what shifts it. You know, for example: banked blood. When we have to give patients a massive transfusion protocol, the curve shifts to the left, and because it shifts the curve to the left, oxygen is not offloaded as easily to the tissues.
And the reason that massive transfusion protocol is left shifted that blood, that banked blood is left shifted, and does not give up oxygen to the tissues as well, is because the blood is cold. Also because it's low in 2,3-DPG.
I couldn't remember, was it for the Absite that I learned this? We first hear about this curve in medical school and its role in oxygen delivery. And I didn't really understand it or put most of it all together until surgical residency. So that was a fact that this helped remind me; oh yeah, it really was the Absite for me that focused on how these things come together.
Jessica: So did you feel like you used one chapter of the book more than any other chapter or was it just spread out throughout the book?
Dr. Kashmer: You know, again, with it being critical care rounds, it actually seemed to be a cardiovascular fact related to critical care, like the oxygen delivery equation, like the Starling curve, those came up a lot. And so yeah, it really clustered in those things and then fact about ARDS, adrenal insufficiency, etc., so really critical care related facts and the way that the review book is organized, some of those come from the cardiovascular section, some of those come from like a pulmonary section. So, yeah, that the thing's really clustered there.
Jessica: So basically if we just sent you on ER rounds with this book, we would get a whole new set of facts that you used.
Dr. Kashmer: I think what you, what you mean, and I think you're exactly right. Is if you sent us to the endocrine surgery service yeah. You'd see all the thyroid facts about thyroid cancer getting used like Wolff Chaikoff effect, all these kinds of things get used a lot, but you're right. It's because of the venue we were in that you saw certain facts used and I was really impressed by how useful it was. It was just a great reminder to me of how useful Absite study is for improving things on a daily basis. Good refresher course for you. Yeah. It was really interesting to see how often it all comes up.
Jessica: Seems like the book is applicable to every day use. What other goals did you have with the project?
Dr. Kashmer: Whether we're residents or attendings that what we're learning we really can bring to the bedside. And this shows that this stuff we're studying, it can come to the bedside very easily. It does. And I think that this also shows that this fits with a lot of the goals for Project Smackdown in general. And that is to keep the knowledge in front of us in a way that's easy to get at. And some of the ways I think you and the team have done that, which I've really appreciated, are the Instagram posts or it's just one fact every day, directly from the book with, some kind of visual reference that kind of helps cement things. It just very simple, really clean, and it keeps the facts in front of us. So that's the @daily.app site.
Jessica: This podcast keeps it in front of us. I know that you guys have posted some of the reviews from other sections, thyroid trauma, colorectal, the audio from those is on the podcast homepage on SoundCloud and Spotify.
And that makes it accessible. I know you guys have been big into trying to give away a lot of content for free. And I think that is exactly in keeping with the goals of this book. We tried to create a comprehensive Absite study guide, a book that matches a lecture series. So you can have both right in front of you and you can do them from anywhere. And then beyond that to keep the facts right in front of us. So they're top of mind on things that people are doing anyway on social media. And it's a great use of social media for something positive, other than, you know, a lot of the other things we go on, we see, go on with social media everyday. So I really think this fits with goals of the book really
Jessica: Well. And I think it's important to know that it's not just the book, it's not just the video that comes with it. It's all the tools in the arsenal from the blog and the podcast and the daily fact, you know, we have the page on Facebook, we have SoundCloud, there's so many ways to access the knowledge to have it there in front of you. Like you said, so much of the content is free. it's just really exciting to work on.
Dr. Kashmer: Well, I do. I think you're right. It's been a great ride so far. I'm looking forward soon enough to version three, which I can't believe is coming out. The versions come out around July and we just got version two out and now the team is working on version three with all of the updates and thoughts, and the feedback from the group of users already. And it's really been fulfilling to see that entire residencies are now using the program. There's some medical schools that are using it for their surgical students. I just, I've really been amazed by how quickly it's growing, from, you know, version one now to two and as soon enough to version three. So, just really can't wait to see what happens next with it.
Jessica: Never stop growing. All right, guys. Well, thanks so much for tuning in and again, this was The Absite Smackdown Podcast. Please follow us on all the social media sites #AbsiteSmackdown!