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What to believe and when to change. St.Emlyn’s at SMACC

Screenshot 2014-06-23 06.51.21My second talk at SMACC Gold. This followed on from the earlier talk on do risk factors factor  in the ED. In this talk I try and link evidence to population and individual practice. I personally ‘ believe’ that the single biggest influence on clinical practice is how we think, how we value evidence and how we use the evidence. If we are to be better clinicians then we truly need to understand that our thoughts, our interpretations and our internal arguments strongly influence what we do.

Cliff Reid does some great talks on ‘Making things Happen’. Hopefully this talk will help us understand ‘what we decide to make happen’. My good friend Scott Weingart gets a mention as he is right up there as one of the most important leaders of what we do in resuscitation.  I make a cheeky mention of his talk at the beginning of the talk, but don’t take that view second hand. Listen to his talk here, which is in my opinion one of the best from #SMACC. It’s a great talk that left me with so many questions and desires to do better for our cardiac arrest patients. I love Scott’s work as without clinicians like Scott and Cliff we are doomed to mediocrity and that would be a dreadful place to be. Yet we must also be wary of some historical lessons that tell us to be cautious and fearful of change, and not everyone can or should be at the innovation end of the curve. This talk hopefully explores why it’s so hard to make the right decision at the right time, and arguably why the right decision is almost impossible to make at the right time.

Also worth mentioning my thanks to Lauren Westfaler for some of the slides. As ever she is ahead of the game in metacognition.

So, a talk on why we need innovators, lagards, resuscitationists, cynics and dreamers. All are welcome in the #SMACC house.

Here are the slides.


If you want to hear more from SMACC then don’t forget to book you place to meet Joe Lex on the 3rd July in Manchester. Don’t forget to listen to Iain’s talk on pain and suffering and keep coming back to hear more from the St.Emlyn’s team. There is much more to come……

If you liked this lecture then you MUST also listen to Scott Weingart’s SMACC Back. Absolutely superb, I agree with pretty much all that he says but most of all I welcome the debate.

Then, and only then listen to the SMACC BACK – BACK from our podcast site.


Don’t forget to check out the Intensive Care Network for more amazing talks from SMACC, and in particular this amazing talk by Tony Brown on ‘Is the peer reviewed journal dead?’ You may also like Louise Cullen’s talk on a similar theme at SMACC Gold. Like me she is a bit of a sceptic (but also a bit of an early adopter 😉 ).

If you like this talk then go read this paper. It will scare you!


Viva la #FOAMed



Cite this article as: Simon Carley, "What to believe and when to change. St.Emlyn’s at SMACC," in St.Emlyn's, June 23, 2014,

Posted by Simon Carley

Simon Carley MB ChB, PGDip, DipIMC (RCS Ed), FRCS (Ed)(1998), FHEA, FAcadMed, FRCEM, MPhil, MD, PhD is Creator, Webmaster, owner and Editor in Chief of the St Emlyn’s blog and podcast. He is visiting Professor at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. He is co-founder of BestBets, St.Emlyns and the MSc in emergency medicine at Manchester Metropolitan University. He is an Education Associate with the General Medical Council and is an Associate Editor for the Emergency Medicine Journal. His research interests include diagnostics, MedEd, Major incidents & Evidence based Emergency Medicine. He is verified on twitter as @EMManchester

  1. […] Also, please read the original post on St. Emlyn’s. […]


  2. […] I have to agree with all the sentiments about SMACC being the best conference in the world for a blend of science and practicality for critical care medicine. I also find that SMACC conference talks delve into topics that many others do not venture. Some of them as unsexy, but important, as those around principles of research, evidence and reporting. One such was this talk I was fortunate to give at SMACC Gold titled “Why most research is wrong”. As someone who has found myself in the blended tribe of clinical researchers, I found this topic confronting. Many times over my career I have found myself influenced to change my practice, and only with the passage of time (with of course more research performed), have I and the medical community realised we have headed down the wrong track. Looking back, I clearly used to be an ‘early adopter’ of new treatments and innovation reported in the literature (see Simon Carley’s talk on ‘What to believe and when to change’). […]


  3. […] the world. What do we truly believe in? If you haven’t already done so please head over to my talk on belief, and Louise’s talk on evidence to get a feel for what people have been saying. You can also […]


  4. […] think the answer comes from Prof. Simon Carley’s two excellent lectures at #SMACCgold. One on what to believe and when to change  and one on risk factors in […]


  5. […] Neil asked the question of whether we can and should use these tests for the management of paediatric coagulopathy. Although not on the card it is something our haematologists are very keen on and so I believe that we will see it being used in the future. Again, I’d be interested to hear on whether other trauma centres are using it in kids. I will certainly be thinking about it when I next see a bleeding child and I think I’ll probably do it (Ed – don’t you have a view on early adoption). […]


  6. […] also, I’m sure, have checked out the stories behind the talks from our own awesome team. Simon, Natalie and Iain have all shared their SMACC Gold talks at St. Emlyn’s and given us the low […]


  7. […] hits keep coming from SMACC Gold. Simon Carley again discusses metacognition on when to change and the dangers of being early and late adopters to new medical interventions. His talk inspired […]


  8. […] Tom Evens on his experiences as coach to an elite athlete and their applicability to performance culture for trauma teams (with mentions of marginal gains and metacognition) […]


  9. […] to reach every day practice for our patients is 14 years. Everything we do is filtered through awareness, judgement, opinion and belief and this is a theme that we have been exploring within St.Emlyn’s for many years.  Knowledge […]


  10. […] [Disclaimer: First of all, I would like to declare that I am severely biased as combining (but temporally separating!) ketamine and propofol for ED sedation as this has been my own practice for a couple of years now. I had high hopes in this paper as it touched on an area of my work I really enjoy delivering and teaching on: procedural sedation in the ED. It furthermore assessed the safety profile of an analgeso-sedative combo I am a big fan of. I think it’s important to declare this at the beginning of the discussion as our prior beliefs influence how we think and implement new evidence (Ed – if you want to know more see Simon’s smacc talk on exactly this).] […]


  11. […] In Virchester we will continue to use POCUS ECHO in cardiac arrest to guide therapy and to prognosticate until further evidence is available though we recognise that at least some of this is based on faith5. […]


  12. […] I am not sure it will really. I stopped giving steroids to all patients with septic shock a long time ago. Now I reserve this therapy for those who are terrifically sick, exemplified by resistant shock. Do I think the modest benefit in secondary outcomes shown within this trial warrants extending this practice to less sick individuals? I am not sure I do. Mortality is unchanged as previous, benefits are marginal and the heterogeneity of international practice regarding ICU LOS, transfusion and cessation of mechanical ventilation make me sceptical about whether it is the steroid that achieves these benefits (Ed – plus we should always be especially skeptical about secondary outcomes in any trial). Prescribing any immunosuppressant to a critically ill patient makes me nervous and the secondary endpoint data seen here does not do enough to assuage my nerves. Would I consider it if asked directly? Of course – I think then I would make the point that in this data, maximal benefit appears to be in those less sick, when given at a particular timepoint and that the adverse event rate, whilst low, may treble. Do I think this trial definitely tells me that those on higher doses of vasoactive medications gain nothing from the addition of steroids? No to that also. In fact, I would argue that one of the main signals from this trial is a trend towards mortality benefit in this specific subgroup. But then maybe I am just searching for evidence to support my practice. No-one likes change you know.……. […]


  13. […] Lecture presented at SMACC Gold in Australia, Sydney. Retrieved September 01, 2018, from […]


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