Keeping Up in EM: Suggested Educational Resources for Exam Preparation & Lifelong Learning.

Keeping Up in EM: Suggested Educational Resources for Exam Preparation & Lifelong Learning.

Executive Summary

This episode synthesizes key strategies and resources for continuous professional development in Emergency Medicine (EM), tailored for professionals within the Emergency Department. The core challenge addressed is managing the immense and rapidly changing volume of medical information inherent to the specialty, a task often described as daunting and prone to causing resource fatigue [2, 3].

Two principal, complementary strategies are identified for building and maintaining expertise. First, the "Big Book/Little Book" approach provides a structured method for establishing a comprehensive and personalised foundational knowledge base [3, 4]. Second, the practice of Rapid Cycle Deliberate Practice (RCDP)—engaging in small, frequent learning activities—is presented as a sustainable and highly effective method for lifelong learning, skill retention, and professional resilience [3, 4].

Effective implementation of these strategies is supported by the strategic use of technology, such as RSS feed aggregators (e.g., Feedly) and podcast managers, to streamline the flow of new information from curated sources [3, 4]. A critical approach to evaluating online content is essential, using tools such as the Social Media Index (SM-i) [2]. Furthermore, professionals are advised to maximise cost-effectiveness by utilising institutional resources, including NHS Athens for access to services like UpToDate, before making personal purchases [2, 4]. This document provides a curated list of recommended textbooks, online resources, and mobile applications to support these learning frameworks.

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1. Foundational Learning Strategies

To manage the extensive EM curriculum, a structured and sustainable approach to learning is paramount. The following strategies provide a framework for both acquiring core knowledge and ensuring its retention over a career.

1.1 The "Big Book / Little Book" Approach

This technique facilitates the creation of a personalised, comprehensive, and easily revisable knowledge base by combining two types of textbooks [3, 4].

Methodology:

1. Select a "Little Book": Choose a concise, revision-focused text that covers the breadth of the curriculum.
2. Select a "Big Book": Choose a detailed, in-depth textbook that explains concepts thoroughly and aligns with your learning style.
3. Synthesise Knowledge: Read the relevant chapter in the "Little Book" first to gain an overview. Follow this with the corresponding chapter in the "Big Book" to deepen understanding.
4. Consolidate and Personalise: Transcribe key details, clinical pearls, and explanatory notes from the "Big Book" into the margins of your "Little Book". This transforms the revision guide into a single, fully indexed, and personalised reference text.

Resource Recommendation: It is advised to purchase the "Little Book" and borrow the more expensive "Big Book" from a physical or online library to manage costs. NHS Athens may provide free online access to core textbooks [4].

Book Type	Primary Recommendation	Secondary Recommendation	Commentary
"Little Book"	Tintinalli's Emergency Medicine Manual [3, 4]	Adult Emergency Medicine at a Glance combined with Paediatrics at a Glance [3, 4]	Tintinalli's Manual is noted for its comprehensive adult and paediatric coverage, balancing depth with brevity. The At a Glance series offers a familiar layout conducive to revision and note-taking [3, 4].
"Big Book"	Rosen's Emergency Medicine or Tintinalli's Emergency Medicine [2, 3, 4]	Dunn's Emergency Medicine Manual (Online) [3, 4]	Rosen's and Tintinalli's are the standard foundational texts. Dunn's is described as a dense, continuously updated online resource ideal for exam preparation once foundational knowledge is established [2, 3, 4].

A supporting podcast for exam preparation is CRACKCAST, which systematically reviews Rosen's Emergency Medicine chapter by chapter [3].

[For urgent care the above textbooks are useful and the more specific Minor injuries and illness at a glance is a great “little book”. The urgentology podcast provides monthly updates tailored to urgent care]

1.2 Rapid Cycle Deliberate Practice (RCDP)

RCDP is the principle of engaging in learning "a little and often" [3, 4]. This approach is more sustainable and effective for knowledge retention than cramming. It is cited as a key technique for lifelong learning, building resilience, and avoiding moral injury in the high-stress EM environment [3, 4]. RCDP is particularly effective for reinforcing skills that require frequent interpretation, such as analysis of ECGs, blood gases, and radiology images [3].

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2. Managing and Evaluating Educational Resources

The proliferation of online resources necessitates a systematic approach to both consumption and evaluation.

2.1 Streamlining Content with Technology

To avoid being overwhelmed and to facilitate RCDP, the use of technology to aggregate content is recommended. Tools such as Feedly (RSS feed aggregator) and Overcast (podcast aggregator) can automatically collect new content from chosen websites and podcasts into a single, manageable interface [3, 4].

2.2 Critical Evaluation of Online Resources

Before integrating online resources into a study plan, a critical evaluation of their quality is essential [2].

• Quality Checklists: As published in the Winnower and featured on ALiEM, these provide a structured framework for assessment [2].
• Social Media Index (SM-i): This index serves as a surrogate measure of a website's reputability, based on its Alexa Rank, Twitter followers, and Facebook likes. The score ranges from 0 (poor) to 10 (high) [2].
• Critical Appraisal Tools: For assessing research, frameworks like the GATE analysis from the Critical Appraisal Skills Programme (CASP) are essential for making evidence-based decisions [3].

2.3 Cost-Effective Resource Acquisition

Before purchasing books, subscriptions, or applications, consider the following [2, 4]:

• Check for institutional access through your residency program or NHS Athens account.
• Determine if membership in organisations like RCEM or other colleges provides access.
• Inquire if colleagues have copies that can be borrowed.
• Explore the use of residency or departmental educational funds for purchases.

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3. Curated Educational Resources

The following is a synthesised list of recommended resources categorised by topic. SM-i scores are included where available [2].

3.1 Core Knowledge & General EM

Resource	Type	SM-i	Description
Life in the Fast Lane (LITFL)	Website	9.65	A vast FOAMed resource with a comprehensive ECG library, critical care compendium, procedure guides, and case studies [2, 3, 4].
ALiEM	Website	6.55	Academic Life in Emergency Medicine offers educational content, series on best practices, and curated resource lists [2, 3].
Rebel EM	Blog	5.52	Provides reviews and analysis of recent medical literature [2].
St Emlyn’s	Blog	5.42	UK-focused blog with research summaries and discussions on general EM topics [2, 3].
EM Cases	Podcast	-	Canadian-led podcast featuring in-depth discussions with experts, noted for clinical pearls [3, 4].
EM:RAP	Podcast	-	Provides monthly audio updates on a wide range of EM topics [2].
WikEM	Website/App	-	A quick-reference wiki for use on the ED floor [2, 3, 4].
RCEM Learning	Website	-	The Royal College of Emergency Medicine's official learning platform, mapped to the UK curriculum [3, 4].
UpToDate	Database	-	An evidence-based clinical decision support tool. Free access is available via an NHS Athens account, which also tracks CME [3, 4].

3.2 Research, Journals, and Critical Appraisal

Resource	Type	SM-i	Focus Area
The Bottom Line	Blog	-	Provides structured critical appraisal summaries of important critical care and EM trials. Offers a monthly email digest of notable papers [3, 4].
SGEM	Podcast	4.92	The Skeptics Guide to Emergency Medicine offers structured, in-depth analysis of medical literature [2, 3, 4].
JournalFeed	Blog	-	Delivers a free "article a day" summary to keep current with new literature [3, 4].
Emergency Medicine Journal (EMJ)	Journal	-	Key journal for keeping up-to-date with UK-specific EM developments [2, 3].
Annals of Emergency Medicine	Journal	-	A leading peer-reviewed journal in the field [2].
Emergency Medicine Australasia	Journal		Provides updates and research from Australasian practice.

3.3 Specialist Skill Development

Specialty	Key Resources	SM-i	Notes
Critical Care	EMCrit	7.01	A leading resource focused on managing the sickest patients [2, 3, 4].
	Deranged Physiology	-	In-depth content aimed at ICU fellowship preparation, useful for topics not well-covered in standard texts [3].
ECG	Dr. Smith's ECG Blog	5.82	Advanced ECG interpretation from a leading expert [2, 3].
	LITFL ECG Library	-	An extensive, free library of ECGs with interpretations [3].
Paediatrics	Don't Forget the Bubbles	3.36	A comprehensive and highly respected resource for paediatric EM [2, 3, 4].
	Paediatric Emergencies	3.74	Focuses on paediatric emergency medicine and critical care / transport. Specific to UK practice. Also, host a free online conference.
	Paediatric Emergency Playbook	-	Offers practical approaches to paediatric presentations [2, 3, 4].
Radiology	Radiopaedia	-	A vast open-edit radiological resource with articles and case studies [2, 3].
	LITFL Top 100 CXR/CT	-	Curated collections of classic radiology cases for practice [3].
Toxicology	LITFL	-	Toxicology Section. Easy to understand core concepts.
	ToxBase	-	The UK’s definitive source on toxicology [2].
Procedures	Roberts and Hedges'	-	The core textbook for clinical procedures in EM [2, 3, 4].
	LITFL Procedures	-	A free online guide to common EM procedures see also the procedures App[3].
Ultrasound	5 Minute Sono	-	Provides concise, high-yield ultrasound tutorials [2, 3].
	Ultrasound Podcast	5.01	A podcast dedicated to point-of-care ultrasound education [2].

3.4 Clinical Reasoning and Simulation

• Clinical Problem Solvers Podcast: Focuses on the methodology of diagnostic reasoning and how to frame a thought process for patient presentations [3].
• EM Sim Cases (SM-i 1.95): Provides practice simulation cases for training [2, 3].

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4. Mobile Applications for Point-of-Care Use

The following applications are highlighted as useful for education and on-shift clinical support [2].

Application	iOS	Android	Purpose
WikEM	Free	Free	Rapid access clinical reference
MD Calc	Free	Free	Medical calculator for clinical scores and algorithms
Paediatric Emergencies App	£	£	Rapid access to paediatric resuscitation data
Eye Emergency Manual	Free	Free	Guide for diagnosis and treatment of eye emergencies
RESUS-US	Free	Free	Ultrasound educational application
VenTrainer	Free	Free	Hamilton Ventilator simulation app to learn how to use and adjust settings
PMcardio	Free/£	Free/£	AI Driven ECG interpretation for the diagnosis of Occlusion MI.

*Another useful resource is signing up for DVLA updates on driving restrictions due to medical conditions. To easily keep up with any changes in this area. 

References

1. Thoma B, Joshi N, Trueger NS, Chan TM, Lin M. Five Strategies to Effectively Use Online Resources in Emergency Medicine. Ann Emerg Med. 2014;64(4):392-395.
2. Liu EL, Rose C, Dyer S. A Starter’s Roadmap to EM Resources: Books, Websites, and Apps. ALiEM; 2016.
3. Source Document: "Core Reading Strategy to learn the fundamentals and Keeping up in emergency medicine.pdf".
4. Source Document: "Core Reading and Lifelong Learning in Emergency Medicine.pdf".

 

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MEM-EM PODCAST

1.3 Keeping up in EM: A Guide to Sustainable CPD