The St.Emlyn’s Podcast

In this month’s St Emlyn’s podcast, Iain Beardsell and Simon Carley work through some of the most interesting recent posts and papers from the blog.

The conversation ranges from the latest pulmonary embolism guidance to the persistent problem of emergency department crowding, and from pre-hospital whole blood to the uneven availability of enhanced critical care across the UK.

They also look at whether TOE might help us deliver more effective CPR, why arterial pressure may be a more useful resuscitation target than simply watching compressions, and a remarkable report from Gaza that challenges some long-held assumptions about pericardiocentesis in traumatic tamponade.

As ever, the focus is less on simply repeating what the papers say and more on what they mean in practice. Some of the evidence is reassuring, some of it is uncomfortable, and several of the studies raise as many questions as they answer.

It is a discussion about uncertainty, physiology, systems and the importance of being willing to change your mind when the evidence does not fit what feels intuitively right.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

What does it really mean to become an expert in resuscitation and critical care?

It is tempting to think that expertise comes from accumulating enough facts, passing enough exams or simply spending 10,000 hours at work. In this episode, Iain Beardsell is joined by emergency physician, intensivist and medical educator Sara Crager to explore why expertise is less about how much we know and more about how we think.

Sara explains how experts develop high-quality mental models that allow them to organise information, recognise patterns and approach difficult clinical problems. Crucially, these mental models do not have to remain hidden inside the heads of experienced clinicians: they can be identified, explained and deliberately taught.

The conversation moves from the limitations of mnemonics and assessment-driven education to the value of deliberate practice, feedback and safe failure. Sara describes how an expert might organise the differential diagnosis of cardiac arrest into respiratory, haemodynamic and metabolic problems, rather than relying solely on a memorised list of Hs and Ts.

Iain and Sara then discuss Rapid Sequence, the gamified clinical-learning platform Sara created with emergency physician Ryan Ernst. Learners work through realistic cases in a simulated clinical environment, managing several patients while dealing with interruptions, competing priorities and the consequences of their decisions.

After each block, Sara and Ryan deconstruct the cases, make their clinical reasoning explicit and introduce mental models that learners can immediately apply when they try again. It is a cycle of practice, failure, teaching and repetition—without putting a real patient at risk.

They also explore why attention, storytelling and visual design matter in medical education; how “multitasking” may be better understood as rapid task switching; and what Sara has learned from turning an educational passion project into a working product.

In this episode

Why expertise is about cognitive strategies and mental models—not simply knowledge

Why experts are made rather than born

The limitations of the “10,000-hour rule”

How deliberate practice differs from repetition

When learners are ready to be taught expert ways of thinking

Foundational knowledge versus clinically useful organisation

Moving beyond mnemonics such as the Hs and Ts

How experts can make their implicit reasoning explicit

Why acquiring a new mental model can produce a sudden leap in performance

The importance of inspiration—and giving learners an achievable pathway

How Rapid Sequence creates a safe place to make mistakes

Managing several patients, interruptions and cognitive load

Teaching shock, respiratory failure and acid–base physiology

Why engaging design is part of the educational method

The role of games alongside podcasts, lectures and clinical experience

Reframing multitasking as rapid task switching

The “pause and bookmark” technique for managing interruptions

The realities of building an independent medical-education project

Why partnership, persistence and a genuine belief in the project matter

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley catch up on the February blog posts, recorded in the rather unseasonal context of a UK heatwave. They begin with congratulations to Simon on his reappointment as Dean of the Royal College of Emergency Medicine, before reflecting on recent conferences including IFEM in Hamburg and Don’t Forget The Bubbles in Glasgow.

The clinical focus this month is trauma team leadership, with practical tips on interpreting trauma CT reports, maintaining momentum after the scan, performing safer log rolls, and making feedback more useful for learners and colleagues.

Key learning points

Look at trauma CT images yourself as part of your own clinical learning and to integrate the scan with your examination findings.

Treat the first CT report as a primary survey, not necessarily a definitive final report.

Speak to the radiologist and share clinical concerns or uncertainties.

Do not lose momentum after CT; this is a vulnerable phase in trauma care.

Log rolls should have a purpose and should minimise movement, pain and physiological risk.

Use clearer team communication: “Is anybody not ready to move?” and “ready, steady, move.”

Feedback sticks when it is specific. Add “because” to positive feedback so the learner knows exactly what to repeat.

Leadership and followership skills apply everywhere, not just in formal trauma team leader roles.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

In this episode of the St Emlyn’s Podcast, Iain Beardsell speaks with Anna Dobbie, consultant in emergency medicine and pre-hospital care, and Clinical Lead for London HEMS.

Recorded at Trauma 2030 at the Royal College of Surgeons in London, the conversation explores what it means to lead exceptional teams in one of the most high-pressure areas of emergency medicine. Anna reflects on six years as Clinical Lead for London HEMS, sharing lessons on leadership, culture, psychological safety, difficult conversations, managing strong personalities, and supporting clinicians to do their best work.

The discussion also touches on the unique nature of pre-hospital care, where teams move rapidly between downtime and high-intensity clinical decision-making, and where trust, openness and mutual respect are essential. Anna describes the importance of making sure all voices are heard, not just the loudest, and explains why leaders need to be consistent, approachable and willing to have honest conversations when things do not go as well as they should.

Anna also reflects on learning leadership on the job, the value of formal leadership training, the challenge of maintaining boundaries when you care deeply about a service, and the relationship between London’s Air Ambulance and its supporting charity.

Finally, Iain and Anna look ahead to the future of trauma care and pre-hospital medicine, including research, ECMO, marginal gains, quality improvement, and the continuing ambition to reduce preventable deaths from trauma.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Trauma 2030

TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.

In this episode, Iain and Simon catch up on the papers, posts, and conversations that have been sitting with us since the start of the year. Some are familiar. Some are uncomfortable. All of them feel relevant on shift.

We start with the RSI trial — ketamine versus etomidate. A study that generated a lot of noise, and perhaps more certainty than it deserved.

We move through trauma team leadership. Not as a checklist, but as a set of decisions made under pressure — when to call a Code Red, how to structure a handover, and what it means to lead a team that hasn’t worked together before.

There’s a discussion about trauma units. Not the big centres. The places where most patients go. Fewer resources. Different pressures. The same expectations.

We talk about spinal cord injury and blood pressure targets. Numbers are useful. But they’re still just numbers.

And then corridor care. Not a new problem. But one we may have started to accept in ways that should make us uneasy.

We discuss:

• What the RSI trial actually showed — and what it didn’t
• Why secondary outcomes should make you pause, not pivot practice
• How and when to activate a massive haemorrhage protocol
• Why early senior decision-making matters more than perfect diagnosis
• What good trauma handover looks like — and why it often doesn’t happen
• How trauma teams function differently in trauma units
• The limits of blood pressure targets in spinal cord injury
• Why corridor care is not just operational — but ethical

This is not a guideline episode. It’s a conversation about practice. About judgement. About the small decisions that shape outcomes long before the data catches up.

If you’re listening after a shift, you’ll recognise most of it.

If podcasts are part of how you learn, you can log your listening, reflect, and build CPD through MedPod Learn. It works across podcasts, not just this one.

As always, thanks for listening.

these ideas are tested in practice.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.