EM NEWS “Dr Collman is the premier educator in the US for EM Board Preparation!” Jan 2009 Issue.
Expertise: Dr Collman [DrC] has practiced EM since 1981 and has been a live test item writer for Two EM boards/He trained examiners how to administer the oral exam for about a decade twice a year/He has the most accurate, well illustrated education and many organizations have ranked him as the “premier educator” for both clinical practice and all of the EM certification examinations. Over 400 US hospitals and virtually every branch of the US military has employed Dr Collman to train their physicians in the most rigorous conferences he created: The Oral Board Tutorial! For the part II exam and the 8-Day Interactive Review! For the EM part I certification exam and the ConCert Exam. He has been for over 3 decades. His content is detailed and directly from the EM core content yknowledge as outlined by the ACEP…he teaches in an informal style with easy to understand test items that are mandatory [so they are complex subjects] to certify any emergency physician!
Dr C helped over ⅓ of the world’s emergency physicians by 2005. Brand new lectures await you full of new hi-res images and illustrations. Dr Collman will soon host a video Youtube channel. Dr Collman has been teaching EM board preparation but his underlying goal is always to maximize physicians clinical performance and teach facts that decrease physician errors. This site is dedicated not to just board prep but to s improving the quality of EM care and now he has chosenit EMedNation.com to be the site to list his programs for all providers from many EM organizations…it is for our nation to come together and solve the problems faced by busy emergency departments as well as all other departments that we work with daily. We work by the second … and we must be accurate and have a large working knowledge of all specialties. This is unique to EM. This site is dedicated to both certification prep/clinical practice.
Dr Collman is committed to teach emergency medicine using his well-proven interactive methods [and being an artist he is comfortable illustrating any EAm topic in the classroom or at the bedside]. .
This is the new website for the Collman Institute Inc., which was recently redesigned in 2021..
Enjoy the case study…G Hutchinson…a sample of the 52 cases that make up the Oral Board Tutorial [OBT! ]…There are actually 100 cases that were used to certify actual board candidates from prior years and over 1000 Live test items that he wrote that were also used by two of the three recognized ABMS [AMA] Emergency Medicine Boards. Dr Collman recorded 33 audio CDs [33 h of listening of his live analysis at the Oral Board Tutorial! [the case management of those cases are the classics and many other products he has to offer you that will improve your confidence and understanding of the pathophysiology and how the ABEM, AOBEM and other boards create their critical actions and how they define their 8 performance ratings that create your scores.
MedBeing board-certified creates pride and better clinical performance. .
What can I do for you? Prefer to be tutored privately? No problem! Call/receive a personal evaluation – absolutely free advice! I’m almost always available…and you can txt me with your contact info. I usually respond immediately.
About Dr C…His CME programs began in 1989. Dr C began practicing Clinical EM in 1981. Here is his background and expertise:
Accomplishments in his youth: Inventor of ECMO using a silicone membrane to exclude the blood gas interface making this device a technology for prolonged use in premature neonates. He won first place in the world in an international competition in medicine in 1974. Sterling Scholar 1974. Elected Student Body President, Roy High School 1973-74. Dual Enrolled Weber State University [WSU] and Roy High School age 16 [Chemistry Major/Math and history minor]. Studied art for 10 years [oils]. Graduated 1st ever “Chemistry Student of the Year” 1976, Weber State College….Ogden, Utah. He was accepted to his first choice for medical school [The University of Utah, School of Medicine] [he was accepted for entrance just after his 20th birthday and completed his MD degree age 24 [this included a Fellowship in General Anesthesia]. He completed an Internship General Surgery [rotating] at UCLA Center for the Health Sciences in 1981; He moved to VA to begin a career as a medical illustrator [publisher: WB Saunders] and full-time clinical emergency physician in 1981..a decision he made because it allows him to use his surgical skills, to lead a more balanced life and he was contracted to illustrate the entire first significant textbook devoted to pediatric emergency care: Emergency Management of Pediatric Trauma; this text has the first RSI PROTOCOL ALGORITHM FOR PEDIATRIC PATIENTS.
He was immediately identified as a talented leader/scholar and his illustrations have appeared in numerous emergency medicine texts, health magazines as well as his two most well known CME programs; The 8-Day Interactive Review! and The Oral Board Tutorial! These programs are so well recognized that authors of many of the Chapters in the 8-Editions of Tintinalli’s texts have attended. All are brilliant and many have other board certifications. They attended because of word of mouth comments that Dr C is a unique educator with a vast fund of knowledge and clinical expertise who doesn’t have to rely on notes and a podium [he never uses one]. .
Work done well, with a personal touch. You are mentored by Dr Collman. He has 52 cases each about 10-13 pages with visuals of studies, and scoring sheets. He has created a true simulation of the oral examination because he created his cases when the rules for their creation were published. That information is no longer available. He made a huge commitment! to give you a true simulation of the oral examination and has taught it live probably over 100 times. In addition, you have access to other self-study cases and his Miniprep cases he created to teach just before the oral exam in Chicago.
Our job starts with you: understanding what you need, so we can offer you options that make sense.. Near the end of the program Dr Collman reviewed actual video footage of candidates from each group to show them that a few days of practice is not adequate to break a lifetime of habits . It does not always produce confidence. It may show deficits in knowledge but he is not going to criticize anyone. It helps candidates gauge the real time they need to prepare. You can order the syllabus a year in advance and this is highly advisable. This is the most rigorous program you will ever attend.
Our job starts with you: understanding what you need, so we can offer you options that make sense. Scoring of the ABEM ORAL EXAM HAS CHANGED YEARS AGO!
Dr Collman keeps all of your conversations with him completely private! It just adds stress when you tell all your colleagues you are preparing for board exams. This is your career and physicians don’t need to know your business unless you put it in a contract.
Dr Collman asks that you try to schedule a time when you are are at home relaxed! Your first consultation is always no at charge for the for 45 minutes to give you a focused plan to prepare. Most residencies do not adeqautely prepare their residents for oral exams and many residents miss these sessions. 2020 will be the year many had no time for study due to pandemic. Dr Collman has videotaped every prior client and the tapes prove everyone needs to rehearse what they plan to say and actually say those words repeatedly so they sound natural…you must sound natural and not like you are emulating another’s words or sound robotic…they want to hear the “process of emergency medicine.”. By giving a drug dose on any case you will improve your score even if it is not a life threatening case…that is your goal…maximize your score. YOU MUST KNOW ALL ACLS, PALS, anaphylaxis [anaphylactoid reaction] doss and drips. Dr Collman has developed a simplified easy to verbalilze system that is accurate to 1/10th of a microdrop!. On video an author of the PALS manual failed the PALS simulation. The same was true for the world expert for th ACLS case. Dr Collman has proven that whatever area one is an expert, that is the most likely type of case which is at most risk of a failing score., e.g., an EP who has toxicology boards fails the toxicology case. This is because they have fear of failing of what they are “famous for” or most skilled with…and most simply have fear of public speaking in front of an examiner who has the answers typed that he can just read. EXRs call when they lose their EXR status to teach; ABEM has declined to allow them to teach board prep but ABEM’s chief examiner was invited and did review every word of Dr Collman’s cases so everyone knows he created a set of cases that then he became a consultant for two EM boards.
You need to maximize all of the points because the oral exam is now scored on a curve with your group and you can now fail with a mean of 5.28 when the group you test with has a mean of 5.31. This seems impossible for examiners to be this exacting in their scoring. Prior to this rule change a pass was a mean of 5.00 (one could “kill” or injure 4 of 11 patients [i.e., a raw score of 66%] and pass the exam…but the candidate had to fail the “right 4 cases” [each of the lowest scores on a multiple patient encounter was averaged with the other 2 cases [easy to get a mean of 5.00], the field test item [FTI-not score] and the low of the “high-low single encounters” which were previously averaged. So it was relatively easy to obtain an average of 5.00 [4.99 = 1 missed [CA] critical action or 1 dangerous action and produced a case score of 4.99]. A mean of 5.00 was a pass. This is no longer true. Now with the test scored on a curve with the group, candidates have failed with a mean of 5.28 when the group scored 5.31. [~1 SD below the group]!
Advice: Prepare a list of questions especially if Dr C gave you a sample test. Only rehearse oral cases near exam time with Dr Collman or a candidate who studied his methods. Often doing otherwise is a recipe for disaster. One helps the unprepared candidate and doesn’t help themselves. Dr Collman can help 12 participants he trained the 3 days prior to the examination. He has a few experts he has trained to call if more require help. DO NOT PROCRASTINATE. Study his manual [330 p and all 52 of his cases repeatedly-we review them each up to four times at a conference [its like you seeing the cases from 4 points of view]. Then the candidates “flow” with their words.
Dr Collman can also show you how to enhance your memory and totally defeat any examination fatigue!
The !2 LEAD ECG: This is a classic example of a test item every emergency physician will see [or one as serious] because it is so dangerous yet not always obvious in a rhythm strip. Some forget to ask for a 12 lead EKG [some] because it is automatically given to them at work: the final diagnosis is a classic example test item every Emergency Physician will likely see because it is so dangerous yet not always obvious even with 12 leads – the final diagnosis Torsade de Pointes.
There are both in general and acquired forms of this serious form of [VT ] ventricular tachycardia. It is always related to a prolonged QTc interval. VT w/o a pulse requires immediate unsynchronized cardioversion [but in this case starting w200 J]. The right answer for the alcoholic patient is to administer intravascular [IV] Magnesium sulfate starting with 1 to 6 G. [Initially patients receive 1G IV over ~15 minutes] and this shortens the QT interval. The answer that is correct for all cases is to increase the heart rate with a temporary transvenous pacer or without that-transcutaneous pacing if capture can be obtained.
This is beyond the knowledge of many primary care providers [not EPs] who also often misdiagnose a rhythm strip which could also be an examination question TI [test item] since TDP can look like VF especially if one looks at just a portion of a strip. Most have never thought about this and that is what an interactive review does…it reveals the real-time actual most common clinical errors! Physicians know that the QT this must be measured by the ECG algorithm and the measured QT must be corrected by dividing that initial value by the square root of the R-R interval [ but most might not know any potential correct answer about the question: What is the name of the formula? Most of you don’t care! [Bazetts equation-but your examiner might care].
Because the QT interval changes with underlying HR [heart rate] QT What is the basis for the calculation. This was presented in an early chapter of Tintinalli in 1986 Ed 3 [aks T3] [by the Virginia cardiologist so well-known for his work on radioisotope cardiac scanning that when he attended to prepare for his board examination Dr Collman had to stop the meeting and get physicians to treat this physician like a normal human…meaning get this group to sit near-the “genius” cardiologist. He was called out of the room because Dr C explained he would like everyone to be nonreactive and treat the man normally…it’s part of the training and boards do bring out the “weird” in all of us. He has seen physicians yell at this programs…and it’s just practice.
Sometimes people are truly in awe of others [they all wear a name badge and if they completed an Emergency Medicine residency they likely knew his name as the author of the chapter or years ago as a prestigious residency program director; so why is he at board prep? He only knows the heart…in his mind. Fame comes mostly with benefits but can also be detrimental [In this class he was being sort of ostracized because no one would sit near him and he truly had big “holes” in non-cardiac medicine.
He knows the classic combination of a mycin ABX plus an antihistamine was rapidly id’d as a strong etiology of TDP and sudden death-TDP! The very interaction that they have never named in the COVID daily presidential updates. I never had a single case in 40 years of practice but had they discussed it the public would die more!
The combination of a particular histamine + a macrolide was so bad they banned the antihistamine in the United States in the 1990s and this was published in the Annals of Emergency Medicine and the NEJM.
There is no such thing as “a low profile on the internet”! And no one owns a calculator to calculate the QTC we all know that never happens because it’s done by an algorithm when you get a print out of an ECG tracing; it won’t be on your exam but one of these will-I’m trying to tell you they will know you better than you after part I!
Since it can be acquired they could ask a list, “Which is not an acquired cause of TDP?”… that answer could include on of the two congenital etiologies plus 4 additional choices, only one of which is the false answer [the correct answer]. The two congenital forms are Romano-Ward syndrome and Jervel Lange Nielsen syndrome. Hypokalemia, hypothermia, alcoholism [because it causes both a low s-K] but especially the low magnesium [the 2nd MC intracellular cation [2nd only to K] are the common answers most EPs [emergency physicians] would know].
This was a prior question also on the prior ACEP PEER examination . “Expecting the unexpected “…a good concept for EPs also includes any subtle simple wording… “What is the overall Tx of choice for all TDP” …A subtle word change which changes the answer to overdrive pacing.
The Tx of choice for an alcoholic with TDP w/a pulse [BTW TDP is often misDxed]…Yet there is a very long list of medication-induced forms of TDP & calling this up by old modem-memory is quite a feat. The list Dr C published in the 2-Volume program syllabus and in the slide program for the 8-day Interactive Review! that was published in Keynote this year [And if you attend the five or 8-day version of the program you’ll see this in the conference slides and Doctor Collman will review all of this because he has a strong believer in repetition and reinforcement of lists & pathophysiology.
That is why he is really a trainer/educator and not an educator. He is teaching doctors to memorize by repeatedly activating the limbic hippocampal connection which makes new permanent atonal connects. So if he asks you to come up with some emotional story something silly or something otherwise emotional and unsavory it’s because you will keep that information stored in your memory for a recall usually forever! That’s if he does his job right which means he has to repeat some data each day and build on concepts-and that leads to the idea of why it is important to attend every single day of the program and why he is the only presenter.
There is no other program in the world whether it’s one person who teaches the entire curriculum for a rapid review and most reviews are just two or three days possibly four days long which is a fraction of the time he spends with his participants. This year and in future years he is hoping to gather up all of the APP‘s and train them in a separate program because he will have to slow the pace because they simply do not have a proper background in medicine because their education is so truncated 500h to 24 months and then they are on the job taking your income and adding to your stress and malpractice risk. Oh sorry…”pulpit speech again”…stop them or train them…but allow that you will lies more high ground.
Now to finish up other drugs that are well known etiologies of TDP include antimalarial agents [add that to a ZPAK]…that might change the election outcome if some suddenly die!
[For most that would be tough to remember like just like the newer now listed [T7/T8] 5th species of plasmodium-knowleski. It is this unique use of mental muscle memory in which Dr C combines what seem to be unrelated facts but are related in the sense that these words or conditions are repeated throughout the literature for the course content that has been described as the curricula to complete an emergency medicine residency as defined by the American College of emergency physicians.
Some of you might remember that Isuprel also increases heart rate yet it is so rarely use in emergency medicine [MC used in the ICU]. If you don’t treat with a drug you are less likely to choose it…it has serious adverse effects in small OD and it would also decrease the QTc & thus treat TDP! Even the dose is a typical minimal knowledge Dr C walks around with and thinks about every day because you expect him to know it but it’s you taking the test. When you build a conference over and over with the same data it is emotional and even annoying and for you he will tell you if it is in the AMA ACLS/PALS manual know it for at least a week. Tip your head to side side it will all fall out of your ear and there won’t be any permanent damage. Ok some psych damage.
EM is recognized by the AMA as a body of knowledge-of all 23 ABMS/AMA recognized board specialties! It’s almost bizarre because the number 23 is now 24 but at the time the 23rd specialty was declared EM that happens to be the day of Dr C’s birthday! He doesn’t believe in numerology but he certainly believes in using statistical analysis to determine test items and to recall facts and your birthday number is a key number that he teaches you how do you use to promote your own long-term memory! Wow that was a long explanation about TDP! It is not the complete list of drug-induced causes but it is a pretty good start!
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Always happy to talk so he can best serve you. Text or call Dr Collman direct and soon we will post an email address for this site. It will be: Dwight@EMedNation.com. There will be a notice on the site when this email is active.
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Dr C teaches emergency medicine for board preparation and he is always prepared to teach a grand rounds, cases studies that every emergency provider should know. Text him 7 days a week: 561.305.8163!
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Copyright 2020 Dwight Collman MD DABEM, DABFM and the Collman Institute, Inc. “DrCollman teaches Emergency Medicine for EM Board Preparation” – All rights reserved.