The Last Pre-Pandemic Conference: DevelopingEM Reflections, One Year Later
DevelopingEM was the last major in-person Emergency Medicine conference before the world shut down in March 2020. In the following interview with L. Esther Hibbs, Managing Editor of EPI, Drs. Mark Newcombe and Sanj Fernando offer reflections on the event’s facilitation, along with their musings on the past, present, and future of medical conference culture.
Introductions: Who You Are, History, What You Do
Mark Newcombe:
My name is Mark Newcombe. I am an emergency medicine and retrieval physician, so I work half the time in Emergency Departments and half the time with a service that moves patients from either the pre-hospital setting or small hospital to a larger hospital. Mostly by helicopter, but also by rides in an ambulance.
The person who is not here (who we need to acknowledge) is Lee Fineberg. He is a colleague who Sanj and I have known for nearly 20 years. He is really the ideas person behind DevelopingEM. He is also an emergency and retrieval physician. Without him, we really wouldn't have all of this.
Sanj Fernando (Left) and Mark Newcombe (Right)
In 2010 or 2011, Lee came up with the concept of a conference that attempts to bring quality emergency medicine education to places where Emergency Medicine is developing as a specialty. It's a shame that he can't be here today, but without him, this whole conversation wouldn't exist. We've gone through conferences in Australia, Cuba, Brazil, Sri Lanka, back to Cuba, Fiji, and Colombia. We go to places where our specialty (that we love) is evolving and rapidly expanding, often with quite a sizable group of people involved locally. It's become quite a collaborative venture. We've learned a lot from our colleagues in their situations and we've been able to help them, to some degree. It's a small venture, but we have helped them to attend and to meet people that they can then collaborate with. That's actually become a bigger benefit from the conference than the conference itself-- it's people meeting one another and thinking up schemes and plans and collaborating over many years.
Sanj Fernando:
I'm a latecomer! I'm Sanj Fernando. I am an emergency physician and retrieval physician like Mark and Lee. I've just recently taken over as director of Liverpool emergency, a large hospital and trauma center in Southwest Sydney. I collaborated with Mark and Lee on a number of different conferences before I joined the administrative team. Sri Lanka was my first conference as a co-director. [Mark agrees]. I've been to lots of different conferences, and I remember, particularly going to the first Cuba conference, and thinking "This is the best conference I've ever been to." The talks were excellent, the setting was great, and the ethos around giving back to the community, providing support for local acute care infrastructure, and also the people that you meet was excellent. Our conference tends to attract a certain type of professional: a professional that's interested in something outside the narrow realm. So, the people that you meet also made the conference really worthwhile. Early on, I thought this was something I wanted to be involved with more.
Mark and Lee wrote me in to do more and more, and the rest is history, I guess. We put on a number of conferences, all of which have been successful conferences even if they haven't broken even. Financial security is really important, but more important is that we have been able to support the people who are at the front line, developing and delivering acute care to their populace by providing educational resources that otherwise wouldn't be available to them, by providing them contacts that they otherwise wouldn't get exposure to, by providing them materials for educating juniors and mid-grade doctors and hopefully by encouraging them to build health infrastructure. There are a number of examples of that. In the Caribbean, there has been development in trauma care that started from our conference. In Sri Lanka there have been significant developments in pre-hospital care that started from our conference. In Brazil, there's been developments to the Emergency Medicine training that, once again, started from our conference. It's a real inspiration, connecting with the wider community. It is also inspiring to share how we all go through the same thing, we just have different ways of approaching the same problem. And, getting different ideas and getting the bits and pieces that have been shown to work elsewhere. To me, that's been one of the most valuable things about DevelopingEM.
What happened with the Colombia conference in 2020? What was that process like?
Sanj:
Truly, it was just dumb luck. It was the best timing you could ever imagine. In January 2020, the pandemic was not a pandemic. In fact, it became a "pandemic" on the last day of our conference. Things were just starting in Wuhan, and no one quite knew what was happening. I remember having a peripheral discussion about global travel in terms of infectious diseases starting in the Southeast Asian area. We decided, seeing as we were going to South America, most of the routes avoid Southeast Asia, so it should be fine. There were still no cases in Australia, maybe a handful of cases in the US, and no cases in South America in mid-February, when we were going over. We usually arrive a week early to lay the groundwork and make sure everything is in place. Four days before the conference, the cases in the US started to increase, and the college of Intensive Care and the college of Anesthetics both (coincidentally, right after their own conferences) said not to travel for a conference, and suggested people should stay in their current locations. After those missives came out, four days before the conference, we lost six presenters and two workshops. Mark and I were staying in a little flat together. We stayed up most of the night thinking, "Well, that's it." Then, we sent off a whole heap of emails to the people we knew saying "Please help. Is there any way this can happen?" We would have had to cancel or significantly shorten the conference, and we would have been in financial ruin. And, our reputation as a conference location would have taken a hit. So, potentially, it could have been the end of DevelopingEM.
We are really lucky, once again, because we have such a great and loyal faculty, and such a loyal following, that people raised their hands and said, "You know, I'll come. I'll fill in for you." We dropped a couple workshops, but the program actually went off without a hitch. It worked. It exceeded both of our expectations. We were expecting more and more people to withdraw. We did have to twist a few arms, and I still feel guilty about twisting some. I must have sent one colleague at least a dozen emails saying "Please, please, please," but even they came. It was fantastic. It was a really good conference.
We were still not socially distancing. We actually hadn't thought about socially distancing because it wasn't a pandemic yet. But, considering up to four people dropped out and the American College missives, we had begun to take this seriously. There were still no cases in Australia and in the Asia Pacific region, there was not a single case other than the Southeast Asian area. That being said, we went to a wholesaler and bought out their entire supply of hand gel for the conference. We had hand gel everywhere; we had it at the workshops, we had it at the social gatherings. As far as I am aware, not a single person at the conference got sick from our conference. Some of them got sick after they got back home and started working again, but that was after their two week incubation period, so we did well.
Mark:
Everything evolved so quickly. In that first week of March, when we were in the last days of preparing, everything was changing so fast. I think both of us realized "Wow, this is actually going to happen. It's going to be a global pandemic." And honestly, in February, I was buried in the conference and I probably just did not understand what this was going to turn into. Possibly, I was not the only one there. Both Sanj and I have been through preparations for SARS and MERS and nothing happened. We didn't get any cases here at all. It just fizzled out. I thought, "Oh, this is just going to be the same." I was actually annoyed that many people were doing the right thing, because we were in the last little phase of getting what had been a challenging preparation to the conference, up and running. That week before, it was the first time I considered "We could really do some harm here. Have we done something wrong by having this conference?"
By that stage, I was absolutely exhausted. Sanj saved the event by managing to squeeze people in and move people around and put gentle but firm pressure on people. Now, I look back, and I think it was probably the last amazing, fun travel experience that those 300 people had before the world shut down. Literally, the day after our final workshop, so the 13th of March, the conference center was closed by the mayor, right in the middle of our allied Colombian conference. They were devastated, and we got away with it.
In terms of performance, we did some surveys afterwards and we had a fairly good response rate. One of the questions was about whether we should have had the conference, and whether people would come again. The vast majority of people said yes. We've got a fairly adventurous sort of faculty and delegate group that come repeatedly, so they are aligned to us and that wasn't a total surprise. We go to weird places that aren't natural tour places for a lot of people. They are brilliant places, but it's not Cabo or Hawaii. We've got a group of people who are willing to push themselves. We also asked our participants if they got any illness or tested positive for COVID-19. We had probably 20 people have some sort of illness in the subsequent two weeks. Only one person tested positive, about two weeks later, so it is unclear where that came from. So, from a timing point of view, we were extraordinarily lucky, as Sanj says. We could not have planned it better, though we were probably hours away from cancelling the conference at one point.
Sanj:
We had that night, we stayed up talking. We had very serious discussions about whether this should go on, and whether we were actually putting people at risk. Putting aside the financial implications, the priority was actually to keep everyone safe. At the time, while the world was in the process of shutting down, they hadn't shut down yet. There were really very few cases around.
Mark:
In fact, the first cases in Cartagena, which is where we had the conference, were from a cruise ship which docked across from the conference center, on the night we had an outdoor gala dinner. They were 500 meters from us, which is probably socially distanced, I suppose, but we didn't even know if it was airborne at that stage. So, we got extraordinarily lucky and I don't think we credit that enough. Our delegates are sticking with us, which is good. There is the occasional person who has contacted me and said, you know, "That was the wrong thing to do and you shouldn't have held the conference," but it's been random, not people I really know. Some of them have not even attended a conference, they've just emailed me to tell me I was wrong.
We got lucky. I am happy we did it now, though I know we did get lucky. A lot of people have commented that they had a great time and now life is pretty difficult, so they can look back to that week and go "Yeah, we were dancing, hugging each other, and laughing in a fantastic place. Who knows when we will be able to do that again? So, thank you."
Sanj:
The other aspect of it is that some of the feedback has been on the quality of the conference and that indication of opportunities that are few and far between now. Some of the feedback has been around this conference being absolutely essential because we had talks about COVID and what it means to look at developing countries and how they can manage pretty serious infectious diseases. From that point of view, for a year we've had all of our leave revoked, so we haven't been able to go to a conference. Like it or not, the mixture of keeping yourself current and up to date, and the timeliness of talks around COVID mattered in helping people to understand what they are facing when they go home.
What does the future of medical communities look like? Why did you decide to opt out instead of transferring to a teleconference?
Mark:
It would be feasible to have an online conference. The educational stuff is important, and the actual translation of information through the standard conference format is a great way of getting people into a room and getting good information, but it can be done virtually. That is part of the benefit of our events, but the majority of it is something that we didn't anticipate originally: people get to meet one another. People collaborate as a result, on a scale that we had no expectation of. There have been some amazing, ongoing projects around the world, which only happen because people met at our conference. It's not like we are the only system that does that, but we can list 20 different projects that result solely as a product of people meeting one another. That can happen online, I guess, but I think it happens really effectively when people do meet one another and have a party and a drink, coffee, a good meal, and some music to get to know one another. We attract like-minded people, so it probably happens more readily with our group. Because of this, I think we are pretty resistant to the idea of a virtual conference.
Sanj:
I think the virtual conference would make us just another conference. (As Mark mentioned), the benefits of DevelopingEM are more than just the conference. We would lose something by being just a virtual event. For us to survive, we do need to wait until a face-to-face event is feasible again.
What does the future look like for Developing EM?
Mark:
We look at about a 15-month prep period, so with things as uncertain as they are, it is unclear what our next event may look like. We have had one successful conference in Australia. It's a different beast because it was a test conference to demonstrate the style of education we are going to have, but it introduced some of the ideas we have about the DevelopingEM situation. We are looking to see if that might be possible, perhaps in an area where there is a need within Australia. It may just be to keep our focus alive, just to keep the brand alive. It's awful to talk like that, but I think if we were to go four years without a conference, it wouldn't help us. We still want to do good work in the future. There are definitely options in 2024, but I think we have seen interest wane as countries are overwhelmed with day-to-day emergency medicine, unfortunately. That is utterly understandable: they've got bigger priorities than a little conference at the moment, but I think it demonstrates what the sort of issues are.
Sanj:
We need a face to face conference for people to get the benefit and enjoyment out of the conference that we've had at other conferences. Also, our conference relies on international delegates. If we run a conference and our international delegates are still a bit circumspect about flying and traveling internationally, then we won't have a conference. So, it makes sense to delay an international conference. I think the ground is shifting. I think this pandemic will have repercussions for decades to come. The years of people jetting off to meet other people are probably not dead and gone, but I think they will be significantly less. And, the ability to video conference has improved so much in such a short period of time that it now becomes a viable option. I know there are a number of workshops that have moved to a purely videoconferencing format. That leaves us in a rather difficult position because a video conference is much more financially viable and much easier to put on. To some sectors of the population, it is also much more attractive. But, as we've said, for the DevelopingEM brand to thrive, we really need a face-to-face conference. So, we are in a transition phase, trying to figure out what to do for our next step.
Mark:
Overall, we remain excited about the future. We are definitely going to have future conferences in some format. Our aim in helping, assisting, and collaborating with developing emergency medicine systems is still very active. We've got a number of non-conference related projects and are trying our best to help where we can, in a limited fashion. The three of us (Mark, Lee, and Sanj) remain very committed to DevelopingEM, and we are going to persevere.
We will be making a decision in the next month about an Australian setting, with a probable indigenous health focus for a live conference in late 2022.
