Episodios

  • REBEL MIND Ep7 - Growth vs Fixed Mindset in Medicine

    REBEL MIND Ep7 - Growth vs Fixed Mindset in Medicine
    Apr 1 2026
    🔑Key Points 🌱 Growth mindset transforms learning – Residents and students who believe skills can be developed are more open to feedback, more resilient after failure, and more engaged in practice.🧠 Language matters in feedback – Simple reframes such as "You're developing procedural skills" instead of "You're not strong at procedures" encourage persistence and normalize the learning curve.🤝 Mindset shapes team culture – Growth mindset leaders foster psychological safety, invite input, and create collaborative teams. Fixed mindset hierarchies, on the other hand, silence voices and can compromise patient care.🔥 Growth mindset protects against burnout – By reframing mistakes as part of the process, clinicians reduce perfectionism and shame, bolstering resilience and wellness.🔍 Practical steps start with self-talk – Add the word "yet" to limiting beliefs ("I'm not good at X…yet") and shift feedback questions toward improvement ("What's one thing I can do better next time?").🛠️ Embracing mistakes with a growth mindset – Leads to more effective feedback loops and improvement do this by building a culture of psychological safety is crucial for growth and reducing medical errors. 👀Previously Covered and Related Content: REBEL EM: The EM MindsetREBEL EM: Titles Dont Make LeadersREBEL EM: Mind of the Resuscitationist with Scott WeingartEM Crit: Making Things Happen with Cliff Reid 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Mindset shapes everything we do in medicine—from how we teach and learn to how we show up for patients at the bedside. Drawing from Carol Dweck's influential book Mindset, this episode of REBEL MIND explores the critical difference between a fixed mindset (believing abilities are innate and static) and a growth mindset (seeing skills as things that can be developed through effort and feedback). We sat down with Dr. Kim Bambach, an emergency medicine physician and medical educator, and Dr. Frank Lodeserto, a dual-trained intensivist and internal medicine program director, to unpack how mindset influences medical education, bedside performance, and physician wellness. In this episode, we delve into how the mindset of clinicians can profoundly influence their performance, professional growth, and ultimately patient care 🤔Cognitive Question How does adopting a growth versus a fixed mindset influence clinical performance, medical education and patient outcomes? 🌱What is Growth vs Fixed Mindset? In Carol Dweck's research, two primary mindsets are highlighted: Fixed mindset: Which sees intelligence and skills as static In the medical field, adopting a fixed mindset might lead a clinician to avoid complex cases due to fear of failure.Growth mindset: Which views abilities as improvable through dedication and effort. In contrast, a growth mindset encourages embracing challenges as opportunities for learning and development. 🏥How This Applies to the Emergency Department or ICU? In high-stakes environments like the ICU or the ED, the mindset adopted by healthcare providers can distinctly shape patient care and team dynamics.A fixed mindset might lead to defensive behaviors and a reluctance to engage in challenging cases, potentially stunting personal and professional growth.Conversely, a growth mindset not only fosters resilience and adaptability but also enhances team collaboration and patient outcomes by encouraging open communication, continuous learning, and acceptance of constructive feedback. ⏩Immediate Action Steps for Your Next Shift **Monitor Self-Talk**: Notice your internal narrative when faced with challenges. Replace negative, fixed-mindset thoughts with growth-oriented ones like "Not yet" or "What can I learn from this?" **Promote a Culture of Inquiry**: Challenge yourself and your team to engage in constructive questioning and explore alternative diagnoses or treatment plans to encourage a growth-centered environment. **Model Vulnerability**: Share personal learning experiences and mistakes with colleagues to normalize the growth process and reduce the stigma of imperfection. **Reframe Feedback**: Instead of broadly asking, "How did I do?" inquire, "What's one thing I can improve on next time?" This shift helps maintain focus on growth rather than performance validation Feedback is a whole another topic that we plan to have dedicated episodes and blog posts. This is an area where sometimes faculty struggle and often learners are asking for more/improved feedback. 💬Conclusion Cultivating a growth mindset in medicine isn't merely about staying ...
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    33 m
  • REBEL MIND Ep6 – How to Sleep When the World Says You Can't

    REBEL MIND Ep6 – How to Sleep When the World Says You Can't
    Mar 4 2026
    🔑Key Points ☕ Try the coffee nap! Where you combine caffeine and a 30-minute nap to then have that boost energy and alertness by the time it kicks in. 💤 Sleep isn't optional—it's crucial for memory, mood regulation, and physical recovery. It is fundamentally different from rest ❌ Replacing sleep with caffeine isn't effective and can have negative health impacts. Make getting enough sleep a priority 🌞 Sunlight exposure is important for maintaining circadian rhythms and sleep quality. This applies even if you work as a nocturnist 💡 Creating a personalized sleep system enhances quality and consistency. It gives you back control of a schedule that you may feel like is out of your hands. 🧩 If you've tried these strategies and you're still struggling, consider true sleep pathology (insomnia, shift work disorder, sleep apnea) and get help—this is not a "be tougher" problem. 🩺 Better sleep isn't just about feeling good; it's directly tied to error reduction, patient safety, and longevity in EM/ICU careers. 👀Previously Covered and Related Content: REBEL Core Cast: Sleep HygieneREBEL MIND: Rest Is Not Sleep: The Seven Dimensions of True RecoveryRebellion in EM: Care For Yourself – Sleep HygieneFirst10EM: Some Evidence For Working Night ShiftsREBEL MIND: Dunning Kruger Effect 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Today we are exploring the imperative topic of rest and why it's not just about sleeping. The second of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, continue our discussion but this time on the multifaceted nature of sleep, how it serves as medicine and how we can use our tools deliberately to get more of it! 🤔Cognitive Question How would your clinical performance, patience with families, and long-term career sustainability change if you treated sleep as a non-negotiable clinical intervention rather than a flexible "nice-to-have"? 💤How is Sleep Different From Rest? 1. Rest reduces load; sleep repairs systems We previously talked about the 7 types of rest and you can check that out hereExamples of physical rest include: pausing tasks, stepping away from the monitor, taking a walk, stretching, breathing, journaling, connecting with a colleague. This lightens your cognitive/emotional burden.Sleep is fundamentally different in that it's an active biologic process that helps: Consolidates memory and learning (yes, including the tough cases from last night).Regulates mood, impulse control, and emotional reactivity.Supports immunity, metabolic health, and cardiovascular function.Repairs tissue, replenishes neurotransmitters, and fine-tunes neural networks. You can have "rested but underslept" days (you took breaks but got 4 hours in bed), and "slept but unrested" days (you got hours, but all junk sleep). Both matter, but they are not interchangeable. 2. Sleep architecture vs. "knocking out" True restorative sleep cycles through NREM and REM in predictable patterns.Alcohol, late caffeine, and fragmented nights may help you fall asleep faster but: Suppress REM.Shorten deep sleep.Increase awakenings and light sleep. The result: you technically slept, but your brain didn't get the "software updates" it needed. Biology isn't built for your schedule Circadian rhythms were designed for light-day / dark-night cycles, not: 10 pm–7 am ED shifts.24-hour calls.6 nights in a row followed by days. Your body can adapt partially, but not instantly and not perfectly. That's why: You can feel "jet-lagged" even when you haven't traveled.Sleep before and after nights feels odd and fragile. Recognizing that "this is biologically unnatural" is key: you're not weak; you're fighting physiology. 🏥How This Applies to the Emergency Department or ICU? Performance & safety Sleep deprivation: Slows reaction time and increases error rate.Impairs risk assessment and complex decision-making.Drops your frustration tolerance with consultants, families, and staff. In both emergency medicine and critical care, that translates into: Anchoring on the wrong diagnosis.Missing subtle clinical changes.Snapping at a tech, nurse or resident and damaging team culture. Chronic health for chronic shift workLong-term sleep disruption is associated with: Hypertension, diabetes, obesity.Depression, anxiety, burnout.Arrhythmias (e.g., AFib) and increased stroke risk.Possibly increased all-cause mortality. You're already in a high-stress, high-exposure specialty. Chronically poor sleep amplifies that risk profile and can end a career early—or make you miserable while you're still in it. Culture of "heroics" vs...
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    28 m
  • REBEL MIND Ep5 - Applying Performance Science In and Out of the Emergency Department

    REBEL MIND Ep5 - Applying Performance Science In and Out of the Emergency Department
    Feb 18 2026
    📌 Key Points 🔍 Understanding the Why: The significance of understanding underlying causes, beyond initial diagnoses, in both sports and emergency medicine is explored. ⏱️ Recovery Focus: Emphasizing the importance of recovery time and small daily choices in optimizing performance for both athletes and emergency physicians. 📊 Data-Driven Insights: The Arena Labs approach uses personalized data, leveraging wearable technology and expert coaching to tackle burnout and enhance well-being. 🤝 Personalization and Partnership: Arena Labs' collaboration with emergency clinicians sheds light on personalized performance solutions rooted in scientific evidence. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, we're excited to continue collaboration with Arena Labs, where host Dr. Mark Ramzy interviews Allyn Abadie, Arena Labs' Principal Scientist on how we can apply performance science in and out of the emergency department. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies. 🔙Previously Covered on REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite Teams The Power of Performance Coaching in Medicine Rest Is Not Sleep: The Seven Dimensions of True Recovery 🤔Cognitive Question How can emergency department clinicians utilize techniques inspired by athletic performance to better manage stress, prevent burnout, and optimize recovery? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🏥How This Applies to the Emergency Department or ICU? Emergency medicine, akin to high-performance sports, demands intense energy and quick decision-making under pressure, often leading to stress and burnout. By applying principles from athletic recovery and personalized data tracking, clinicians can moderate their performance intensity, enhance their recovery even in short breaks, and prevent long-term burnout. This approach allows emergency physicians to maintain endurance and clarity, improving patient care and team dynamics. ⏩ Things You Can Do on Your Next Shift Measure and Reflect: Start tracking your vital health metrics like heart rate with wearable sensors. Reflect on how daily activities impact these measurements to identify stress patterns.Implement Quick Recovery Techniques: Use short, actionable exercises such as deep breathing or the de-stress breath method between patient encounters to moderate stress levels.Invest in Self-Care: Dedicate brief time slots for essential self-care activities like hydration or quick reflection journaling, aiming to enhance mental resilience throughout your shift.Utilize Coaching Tools: Engage with personalized coaching apps or resources that offer science-backed recovery strategies tailored to your personal and professional needs. 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs' website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that's equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for.
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    34 m
  • REBEL Core Cast 150.0: Emergency Medicine Consults: How to Call a Consult + Handle Pushback

    REBEL Core Cast 150.0: Emergency Medicine Consults: How to Call a Consult + Handle Pushback
    Feb 12 2026

    In this episode of Rebel Core Content, Swami breaks down one of the most important (and most underrated) skills in emergency medicine: how to give a clean, effective consult—and what to do when you get pushback. Learn a simple 4-step framework to structure every consult (introduce yourself, lead with the ask, give a focused summary, and close the loop), plus ready-to-use scripts for common scenarios. We also cover how to respond to refusals, keep conversations professional, and escalate appropriately when patient safety or disposition is at risk.
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    8 m
  • REBEL CAST: The RSI Trial – Ketamine vs Etomidate in Rapid Sequence Intubation

    REBEL CAST: The RSI Trial – Ketamine vs Etomidate in Rapid Sequence Intubation
    Feb 8 2026

    REBEL Cast: The RSI Trial — Ketamine vs Etomidate in Critically Ill Adults

    In this episode, we break down the 2025 NEJM RSI trial comparing ketamine and etomidate for tracheal intubation in critically ill adults (Casey et al., PMID: 41369227).

    This multicenter randomized trial enrolled 2,365 patients across ED and ICU settings and asked a clinically important question: does ketamine improve 28-day mortality compared with etomidate?

    What we cover:

    • Primary outcome: no statistically significant difference in 28-day mortality

    • Secondary signal: higher "cardiovascular collapse" with ketamine, largely driven by new/increased vasopressor use, not clear increases in arrest or profound hypotension

    • Trial strengths: strong randomization, high protocol adherence, excellent follow-up

    • Trial limitations: no blinding, equipoise-only enrollment, trauma exclusion, ketamine dose strategy (actual body weight; commonly higher than many bedside practices)

    Clinical Bottom Line:

    This trial does not support abandoning ketamine for RSI.

    Etomidate remains a strong first-line option, particularly in patients at high risk of peri-intubation hemodynamic decompensation.

    At the same time, a small potentially meaningful mortality difference in favor of ketamine remains possible and would require a larger study to confirm.

    Read the full post on REBEL EM:

    "The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation"
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    30 m
  • REBEL CAST - RENOVATE Trial: HFNC vs BPAP in Acute Respiratory Failure

    REBEL CAST - RENOVATE Trial: HFNC vs BPAP in Acute Respiratory Failure
    Feb 5 2026
    📌 Key Points 💨 HFNC met criteria for non-inferiority to BPAP for preventing intubation or death within 7 days in four of the five ARF subgroups.🧪 Bayesian dynamic borrowing increased power across subgroups but created variable certainty, especially in smaller groups such as COPD.🫁 The immunocompromised hypoxemia subgroup did not meet non-inferiority, leading to early trial stopping for futility.⚖️ Rescue BPAP use, subgroup-specific exclusion criteria, and non-standardized BPAP delivery are important contextual factors that influence how subgroup results should be interpreted. 📝 Introduction Bilevel Positive Airway Pressure (BPAP) has long been a foundational modality in the management of acute respiratory failure (ARF), particularly in COPD exacerbations and cardiogenic pulmonary edema, where it can rapidly reduce work of breathing and improve gas exchange. It remains a core tool in our respiratory support arsenal. High-flow nasal cannula (HFNC), however, has expanded what we can offer patients by delivering many of the same physiologic benefits through a far more comfortable interface. With high flows, modest PEEP, and effective dead-space washout, HFNC can improve oxygenation and decrease work of breathing while preserving the ability to talk, cough, eat, and interact with staff and family. This combination of physiologic support and tolerability makes HFNC especially attractive in patients where comfort, anxiety, or cardiovascular stability are key considerations, and in settings where prolonged noninvasive support may be needed. Rather than competing with BPAP, HFNC broadens our options in ARF and allows us to better match the modality to the patient and their underlying disease process. The RENOVATE trial set out to answer a high-impact question across five distinct etiologic groups: Is HFNC non-inferior to BPAP (NIV) for preventing intubation or death in acute respiratory failure? ⚙️ What They Did CLINICAL QUESTION Is HFNC non-inferior to BPAP for rate of endotracheal intubation or death at 7 days in patients with acute respiratory failure due to a variety of causes? STUDY DESIGN Multicenter, randomized non-inferiority trial33 Brazilian hospitalsNov 2019 – Nov 2023Adaptive Bayesian hierarchical modeling with dynamic borrowingOpen label, outcome adjudicators blindedPatients were classified into 5 subgroups 💪 Strengths Broad, multicenter design: Large multicenter randomized trial comparing HFNC vs BPAP across several etiologies of acute respiratory failure in ED and ICU settings.Etiology-based and COVID-specific subgroups: Patients were stratified into prespecified clinical subgroups (COPD with acidosis, ACPE, immunocompromised hypoxemia, non-immunocompromised hypoxemia), and COVID-19 was later added and analyzed as a separate subgroup rather than being combined with the original ARF categories.Bayesian hierarchical model with dynamic borrowing: The primary analysis used a Bayesian hierarchical framework that allowed information to be borrowed across subgroups when treatment effects were similar and reduced borrowing when subgroups differed.Prespecified non-inferiority and futility rules: Each subgroup had predefined non-inferiority and futility boundaries, and enrollment in the immunocompromised subgroup was stopped early after crossing a futility threshold.Standardized BPAP delivery system: BPAP was delivered using a single BPAP system/interface across participating centers.Single healthcare system and population: All sites were within one national healthcare system, with broadly similar clinician training, practice patterns, and patient populations for that country.Current practice relevance: The trial addresses a post-COVID era question in which HFNC is widely used, providing comparative HFNC vs BPAP data across multiple ARF etiologies in a pragmatic ED/ICU population. ⚠️ Limitations Small subgroup sizes: The COPD (35 vs 42) and immunocompromised (28 vs 22) subgroups included relatively few patients compared with the other etiologic groups.Dependence on borrowing for COPD estimates: COPD treatment-effect estimates in the primary model were heavily influenced by borrowing from other subgroups, and no-borrowing sensitivity analyses showed wider intervals.Pre-randomization BPAP and exclusion criteria: COPD patients could receive up to 6 hours of BPAP before randomization, and ACPE patients judged to require immediate BPAP were excluded from enrollment.Rescue BPAP in the HFNC arm: Patients assigned to HFNC could receive rescue BPAP; BPAP settings were not standardized, and detailed reporting of rescue BPAP management and outcomes (including number of episodes) was limited.Non-standardized weaning strategies: Weaning protocols for HFNC and BPAP were not tightly protocolized or aligned, and HFNC weaning permitted flows down to 25–30 L/min.Single-country setting: All participating centers were located in one ...
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    19 m
  • REBEL MIND Ep4 – Rest Is Not Sleep: The Seven Dimensions of True Recovery

    REBEL MIND Ep4 – Rest Is Not Sleep: The Seven Dimensions of True Recovery
    Feb 4 2026
    🗝️Key Points Rest isn't a luxury; it's a necessity and differs significantly from sleep in terms of mental and physical recovery needs. Uncovering the seven types of rest can highlight diverse needs: physical, mental, sensory, creative, emotional, social, and spiritual. Rest from high-stress environments such as the ED is crucial for reducing exhaustion, enhancing decision-making, and maintaining empathy. The necessity for intentional rest: tailor your rest strategies to meet personal recharge needs effectively. Rest should be deserved, not earned—it's a vital component of overall health and wellness, on par with nutrition and hydration. 📝Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Today we are exploring the imperative topic of rest and why it's not just about sleeping. The first of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, our discussion sheds light on the multifaceted nature of rest, especially in the demanding field of emergency medicine. If you're a clinician striving to perform at your best under pressure, this episode offers valuable insights into achieving the rest you deserve. 🤔Cognitive Question How do healthcare professionals in high-stress environments distinguish between rest and sleep, and how can they effectively incorporate various types of rest into their routines to manage stress and improve performance? 💤How is Rest Different From Sleep? Sleep is biological. It's essential—but it's only one form of recovery.Rest, on the other hand, is intentional, multifaceted, and active. You can sleep for 8 hours and still feel depleted—because what you needed wasn't sleep, it was rest—in a different dimension. 🏥How This Applies to the Emergency Department or ICU? In the fast-paced, high-pressure world of the ED or ICU, medical professionals often overlook the importance of rest, perceiving it as unproductive. Yet, rest is crucial for maintaining cognitive function and emotional resilience. The unique concept of rest outlined in the 'seven types of rest' can be particularly beneficial. Understanding and implementing these can help practitioners handle the rigors of patient care and decision-making more effectively. 7️⃣The Seven Types of Rest 1️⃣Physical Rest: Passive (like sleep) and active (like stretching, massage, gentle movement).2️⃣Mental Rest: Reducing decision fatigue. Tools like brain dumping, meditation, or taking real breaks during work.3️⃣Sensory Rest: This involves reducing the input from your senses, such as limiting screen time, turning off the lights, or enjoying quiet time.4️⃣Creative Rest: Reconnecting with awe. Nature, art, music—things that refill your inspiration tank5️⃣Emotional Rest: Being around people you don't have to perform for. Saying "I'm not okay." spaces and people where you can be your authentic self and be at peace6️⃣Social Rest: Taking space from draining interactions; spending time with life-giving people. 7️⃣Spiritual Rest: Connection to a greater purpose—faith, community, reflection, meditation ⏩Immediate Action Steps for Your Next Shift **Identify Your Rest Needs**: Reflect on what kind of fatigue you're experiencing and tailor rest activities accordingly, whether it's sensory detox or emotional unwinding.**Practice Sensory Rest**: Take brief moments to close your eyes, or step outside for fresh air to manage overstimulation during shifts.**Plan Intentional Breaks**: Schedule specific times for rest that focus on particular dimensions you identify as lacking.**Engage in Active Rest**: Incorporate activities like stretching or meditation during your breaks to enhance mental clarity and reduce physical exhaustion.**Connect with Supportive Colleagues**: Seek interactions with peers who offer emotional and social support, promoting a healthy work-life balance. 🛌🏽The Many Aspects of What Makes Up Rest Rest is multifaceted – it comes in more than one form Rest is productive – it improves performance, decision-making, empathy Rest is intentional – it requires thoughtful engagement, not autopilot. Make a real plan Rest is layered – especially sensory, which uses all 5 senses Rest is about input and detox – what you consume, and what you remove. Social rest is a good example Rest is personal – one person's recharge is another's stressor Rest is deserved, not earned – full stop. 💬Conclusion Rest is a pivotal, multi-dimensional tool that extends beyond mere sleep. For healthcare professionals navigating the strenuous environment of an emergency setting, recognizing and implementing ...
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    20 m
  • REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia

    REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia
    Feb 2 2026

    🗝️ Key Points

    • 💉 Hydrocortisone Saves Lives:
      The 2023 Cape Cod Trial (NEJM) showed a clear mortality benefit and reduced need for intubation in severe CAP patients treated with hydrocortisone.
    • 📊 Guidelines Are Catching Up:
      The SCCM (2024) and ERS now recommend steroids for severe CAP, while ATS/IDSA updates are still pending.
    • 🔥 Redefining "Severe":
      Patients requiring high FiO₂ (>50%), noninvasive or mechanical ventilation, or PSI >130 meet criteria for steroid therapy — even outside the ICU.
    • 🍬 Main Risk = Hyperglycemia:
      Elevated glucose was the most consistent adverse effect, but rates of GI bleed and secondary infection were not increased.
    • 🧭 Early, Targeted Use Matters:
      Start hydrocortisone within 24 hours of identifying severity — especially in patients with high CRP (>150) or strong inflammatory response.

    📝 Introduction

    Corticosteroids have long sparked debate in the treatment of bacterial pneumonia — once viewed with skepticism, now increasingly supported by high-quality evidence. In this episode, Dr. Alex Chapa joins the REBEL Core Cast team to explore how the 2023 Cape Cod Trial (NEJM) reshaped practice and guideline recommendations for severe community-acquired pneumonia (CAP).
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    22 m