CorePendium: An Emergency Medicine Origin Story

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Assembling a better one stop resource.

Everyone loves an origin story. Where did Wolverine get those claws? Where did Superwoman come from? Why is the Joker so evil?

In medicine we also have our origin stories, but we are often too busy with the importance of the daily work to write them down. While it is fresh and new, before time fades the memories and turns what is now technicolor into black and white, I want to tell you the origin of CorePendium.

EM:RAP launched CorePendium in late October 2019. It’s completely online, fits in your pocket, is continuously updated, and is written by the best and brightest in the field. It hosts thousands of beautiful pictures, videos, illustrations and has extensive cross-links to 40 years of relevant EM:RAP content. It’s a remarkable educational experience unlike anything EM has ever seen.

This superhero text came out of a series of unrelated, but interlinked events.

One of the first was watching my cousin, Davey, studying for the Australian EM board exams. These exams are extensive, very in depth and wide ranging. They also happen to have a terrible first-time pass rate (in the low 20 percent range!).

I’ll never forget watching him in a little room on Hopewell Ave in Sydney, looking so overwhelmed. He had multiple textbooks open on the desk, several online board reviews open in a series of tabs on his computer and question sets (oh, so many question sets!), all strewn out across his desk.

“There has to be a better way to do this!” I thought.

Another happened while traveling in Kenya. While visiting friends, we were presented with a sick and dying patient in a low-resource setting. We previously wrote about this very experience right here in EP Monthly. On our way to see this patient, I longed for a fast internet connection or number of recently-published textbooks.

Treatment needed to be given, adequate and appropriate antibiotic coverage chosen, and some reasonable prognostication calculation made. I had none of the tools I really wanted—really needed—because to carry all those textbooks is impossible. In that part of the world, electricity and internet access is intermittent at best. What I needed then, and what clinicians in these situations need all the time, is an extensive, up-to-date textbook for emergencies that can be accessed online when the connectivity is good, and downloaded for use offline when it is not.

Yet another example was hearing from an author of one of Emergency Medicine’s most used and respected textbooks. One of the most notable chapter authors was concerned because the information in her contribution was now outdated. Five years had passed since she wrote the first draft. Since then, her field had exploded in knowledge and her chapter was hopelessly out of date.

Again, there had to be a better way to do this!

We learned about yet another need through our work with our nonprofit, EM:RAP GO. As we worked more closely with residents across the world it became abundantly clear that these residents, and indeed their residencies in general, need more traditional educational materials that they can work through systematically to help attain the vast knowledge base required for Emergency Medicine and Rural Medicine practice.

“EM:RAP could, and should provide that!” I thought.

While we are incredibly proud of the educational products we create at EM:RAP, I have always felt this nagging sensation that something essential was missing. I felt that while we were keeping people up-to-date with the latest and best EM information, we needed to do more. Unlike a traditional textbook, EM:RAP and all its various components were not continually reviewing the vast majority of the knowledge base of Emergency Medicine in a systematic way.

Add to all this the fact that some of the best-produced and most-watched procedure videos lived on EM:RAP’s HD section. After initial publication, these videos and “explainers” were soon buried under a mountain of newer content. The same was true for the exceptionally-reviewed research papers on EMA and Right on Prime. It turns out that when you have 40 years of educational content on your site, it’s quite difficult to present it all in a way that is easily accessible.

How could we keep this content relevant?

All of these issues could be solved with a new kind of publication, one to bring all the elements of the program together. A kind of superhero of reference texts! Take a traditional textbook and give it a radioactive spider bite, expose it to an alien yellow sun, or inject it with a lethal dose of some kind of DNA-changing super steroid. That’s CorePendium!

We asked some of the best and brightest people to write the next great Emergency Medicine reference text. We asked Amal Mattu and Stuart Swadron to oversee it as Editors-in-Chief. We recruited the likes of Megan Fix, Bill Brady, Mike Winters, Semhar Tewelde, Dale Woolridge, Jessica Mason, Diane Birnbaumer, Sean Nordt, and Ken Milne to be our associate editors. We asked too-many-to-name content experts to be our section editors and literally hundreds of the best authors in the field to write chapters.

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But this is not just any textbook, and this is not just a one-time commitment for them.

The commitments were and are many: we had to complete it in less than a year, it had to be continually updated, it had to have the best illustrations; photos; videos and other imagery. It had to cross-link to the best EM:RAP content, and It had to have the best technology for presenting the information.

It really had to be two textbooks: one that can be used in the clinical setting where the clinicians need to be able to get the information on what to do and give to the “crashing patient,” immediately. No introduction and epidemiology section to lead off. No, it had to have the “give me the dose of epinephrine in anaphylaxis and give it to me now!” content right up front. It had to link to the best parts of EM:RAP, which means the video link on how to drop a pacemaker needed to be right in the beginning of the pacemaker chapter.

Why? Because I have a patient with a pulse of 20 and I need a fast, visual refresher and I need it NOW!Then it had to give a deep-dive section for when I get home and pour a glass of wine and geek out on information related to the patients I found most challenging that day. Or maybe I need a dive deep on topics I know that I (or cousin Davey!) am going to be tested on for board exams.

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It had to include all the controversies and discussions that the authors and editors struggled with before deciding on the final written versions. It had to give the board perspective on the topic, provide the key history and controversies, but without being verbose for the sake of it.

For clinicians all over the world, CorePendium needed to be accessible offline. For those who could not afford the true cost of the program, we needed to get it to them at low or no cost via our non-profit program.

Now, just about a year after we set off on this journey, CorePendium has come to EM:RAP. Just like those superhero origin stories, this superhero doesn’t even know, at least at the beginning, just how much power it has. Learning to fly is not so simple. Discovering you can look through walls comes at first as a shock. Learning to sift through all the voices you can hear for miles around can initially be disquieting.

Since CorePendium is a new superhero, we released it with a “beta” label. This will remain as we add more functions, content, imagery, improve integration and check accuracy with our 30,000+ users. Just like the superhero that first runs, jumps and then flies, CorePendium will gradually reach fully mature superhero status.

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CorePendium is the pinnacle of my academic career, it is the unification of years of work on all the components of EM:RAP. It will allow us to continue to give back to the specialty and to the people who have given me so much. I can’t believe a little kid from Tooleybuc in rural Australia gets to do this work! I feel so privileged.

In reality, CorePendium is the work of hundreds of people. Many are household names in Emergency Medicine and many you will never know. Superheroes in their own right, these people have worked incredibly hard, stayed up late, missed sleep, ingested way too much caffeine⁠—all to make this amazing story happen. This incredible team from across the world made the impossible happen in an impossible time frame and they will be the ones working tirelessly to continually update and improve the resource.

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What is the key magic element that drives this project and the people creating it? Well, I think you know it, and no, it is not adamantium. It is a simple truth understood by the entire team:

What you, the everyday superheroes of EM—who rush to save lives when hope is all but lost—what you do, it really, truly matters. That’s why we built you a superhero textbook!.

Ladies and gentlemen, boys and girls, CorePendium is here. Let the adventures begin!

ABOUT THE AUTHOR

Dr. Herbert is the CEO of EM:RAP and EM:RAP Global Outreach.

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