94 SAVEL et al.
, iCritical Care Podcast
Implementation Brief 䡲
The iCritical Care Podcast: A Novel Medium for Critical Care
Communication and Education
RICHARD H. SAVEL, MD, EVAN B. GOLDSTEIN, DO, ELI N. PERENCEVICH, MD, MS,
PETER B. ANGOOD, MD
A b s t r a c t Podcasting is a recent creation combining old and new technologies allowing rapid, inexpensive
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delivery of media content (primarily audio) to the end user, both via the desktop environment and personal
media players. The authors’ group (the Society of Critical Care Medicine) saw the educational and communication
potential for the podcasting concept, and have successfully designed and implemented the first podcast of a
national medical society. As of this writing, there are an average of (mean ⫾ SD) 664 ⫾ 290 total downloads per
podcast, and their podcast feed has been hit over 68,000 times in its first seven months. In this manuscript, the
authors provide documentation of their successful endeavor, as well as a structured framework for other
organizations to create similar products.
䡲 J Am Med Inform Assoc. 2007;14:94 –99. DOI 10.1197/jamia.M2205.
Introduction (usually in the form of an audio MP3 file) is automatically
Multiple recent changes in the field of information technol- downloaded to the user’s computer and, subsequently, his
ogy have changed the way clinicians can obtain access to the or her portable device: the subscriber being required to do
information required to care for the critically ill patient. no more than obtain the initial subscription. It is this
Some of these enhancements include: the availability of simplicity that leads to the true power of the concept behind
high-speed internet access; the increasing popularity of podcasting, which can be thought of as a series of time-
portable media players; and the dramatic decrease in phys- shifted radio shows to be heard whenever and wherever it is
ical size of mass storage devices, with a simultaneous most convenient for the user. Importantly, an iPod device is
increase in their capacity. This confluence of technological not required to listen to podcasts; they can be heard on any
enhancements has contributed to the development of a new portable digital media player, and on personal computers.
form of media content delivery technology called podcast- Given the worldwide educational potential that podcasting
ing. represents for critical care clinicians, the Society of Critical
The term podcast is a portmanteau of the words “iPod”—the Care Medicine (SCCM) decided to design and implement
popular portable media player by Apple Computer (Cuper- the first podcast for an international medical society: named
tino, CA, USA)—and “broadcast.” In brief, when a user the iCritical Care Podcast. This manuscript describes basic
subscribes to a podcast, audio content is downloaded over aspects of subscribing and listening to a podcast, as well as
the internet to a user’s computer; when his or her portable providing a “how-to” guide for those wishing to create their
media player is attached to that computer, the new audio own medical podcast; and explaining how this technology is
content is automatically placed on the portable device.1 As currently being used to enhance the educational experience
new editions of the podcast become available, the content of the members of SCCM.
System Design and Implementation
Affiliations of the authors: Department of Surgery, Maimonides
Medical Center (RHS, EBG), Brooklyn, NY; VA Maryland Health
Subscribing and Listening to a Podcast
Care System and Department of Epidemiology and Preventive There are multiple ways in which someone can experience
Medicine, University of Maryland School of Medicine (ENP), Balti- the iCritical Care Podcast. The simplest manner is through
more, MD; Joint Commission International Center for Patient Safety the combination of an iPod and iTunes (the free, download-
(PBA), Oak Brook, IL. able software that accompanies every iPod). The first step is
Dr. Savel is an Assistant Professor of Medicine at the Mount Sinai to visit the SCCM podcast Web page (http://www.sccm.
School of Medicine in New York City. org/podcast) and select the “iTunes” icon (Figure 1). In so
The authors thank the following people for assistance with this doing, the iTunes software opens and is directed to the
project: David J. Martin, David W. Reid, Julian Corlaci, Deborah L. SCCM podcast (Figure 2). The subscriber simply needs to
McBride, Melissa Nielsen, Thomas G. Savel, MD, and Isabel Savel. click on the “subscribe” button—no further steps are neces-
Correspondence and reprints: Richard H. Savel, MD, Department of sary. The software allows the most recent episodes of the
Surgery, Division of Surgical Critical Care, Maimonides Medical podcast to be downloaded to the person’s computer. The
Center, 4802 10th Avenue, Brooklyn, NY 11219; Tel: (718) 283-7991; subscriber can then listen to the various podcasts directly on
Fax: (646) 219-2129. e-mail: ⬍rhsavel@yahoo.com⬎. the computer through the iTunes software. However, the
Received for review: 07/15/06; accepted for publication: 10/05/06. full potential does not become realized until the user plugs
Journal of the American Medical Informatics Association Volume 14 Number 1 Jan / Feb 2007 95
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F i g u r e 1. SCCM iCritical Care Podcast Web page at http://www.sccm.org/podcast.
the iPod (usually via a universal serial bus [USB] 2.0 port) interface can easily be connected to a personal computer
into the computer. When this is done, updates for the through its USB port.
downloaded podcasts will then be placed onto the iPod Another important piece of equipment is a digital audio
every time the device is connected to the computer and hybrid (DAH) (Innkeeper PBX, JK Audio, Sandwich, IL, cost
synchronized. $459 US). Since a major component of the iCritical Care
Alternatively, one can subscribe to the podcast using a portable Podcast is interviews, this equipment is necessary as it
media player other than an iPod. In order to do this, it is facilitates recording a telephone interview in a high-quality
necessary to download another piece of (free) software called a fashion. Unfortunately, audio signal captured from a tele-
“podcast aggregator” or “podcatcher.” For a list of podcast phone is inherently low quality, and the DAH optimizes the
aggregators, please see http://www.podcastingnews.com/ signal obtained from a phone line similar to that of a
topics/Podcast_Software.html. Once this software is installed, professional radio call-in show.
the podcast subscription process remains very similar.
The final step in the creation of a high-quality audio file is
Creating a Podcast I: Construction of MP3 Files the audio recording software. A freeware program entitled
The construction of a high-quality audio file is the single Audacity was used as the primary tool for audio creation
most important aspect of creating a podcast to which users and editing (http://audacity.sourceforge.net, Figure 3).
will remain subscribed. The first step in the audio chain is a Once produced, the audio file is saved in MP3 format
professional microphone: the one utilized for the iCritical (sample rate 44100 Hz, sample format 16-bit, bit rate 96
Care Podcast is a dynamic microphone (SM58, Shure Inc., kbps), and is then ready for posting as a podcast.
Niles, IL, cost $99 US). This microphone is then connected to
a USB audio interface (UA-25, Roland Corporation, Los Creating a Podcast II: Distribution of MP3 Files
Angeles, CA, cost $239 US). The USB audio interface is a Once the ability to create professional-quality audio files has
critical component, as this is where the analog signal from been arranged, the final step is to develop the podcast feed.
the microphone is converted to a digital signal, which can be The technology behind podcasting is called “RSS feeds with
stored and edited on a computer. Finally, the USB audio enclosures,” with RSS standing for “really simple syndica-
96 SAVEL et al., iCritical Care Podcast
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F i g u r e 2. SCCM iCritical Care Podcast on iTunes™ software.
tion.”2 An RSS feed consists of a text file written in XML clinicians (our target audience consisting primarily of inten-
(extensible markup language); RSS is often described as a sivists, critical care nurses, respiratory therapists, and phar-
dialect of XML.3 XML is a markup language (similar to macists) would be interested in three major areas: audio
HTML [hypertext markup language] used to create Web companions to articles published in SCCM journals (Critical
pages) that—in the case of an RSS feed/podcast—provides Care Medicine, Pediatric Critical Care Medicine, and the
the podcatching software the information necessary to allow bimonthly newsletter Critical Connections), interviews with
a user to subscribe to a particular podcast, i.e., where the prominent members of the critical care community, and a
content files are located, their names, as well as their forum for the leaders of SCCM to keep in touch with the
descriptions. members of SCCM throughout the year. Conceptually, busy
Every time the podcatching software checks the RSS feed to see clinicians could then integrate the podcasts into their sched-
if new audio content is available, it does so by analyzing the ule (such as during commuting or when exercising) as a
RSS feed and determining if there are any audio files listed in method of keeping up with the rapidly changing critical care
the feed that are not on the subscriber’s computer. If new literature. Alternatively, the podcast could provide in-
content exists, it will be downloaded to the user’s computer. creased depth for articles a clinician may have read, and
Alternatively, there are a plethora of commercial podcast offer a richer understanding of the material. The target
hosting companies available that can simplify the process by duration for the podcasts was approximately 20 minutes,
delivering the hosting services (appropriate server, storage, with a delivery schedule of between once a week to once
and bandwidth facilities), as well as dynamically generating an every two weeks.
RSS feed. A list of such companies can be found at http:// The iCritical Care Podcast is very much a work-in-progress;
www.podcastingnews.com/topics/Podcast_Hosts.html. nevertheless, there is evaluative data that people are listen-
Creating a Podcast III: Focus on High-quality ing. There are an average of 664⫾290 (mean ⫾ SD) total
Content downloads per podcast (Table 1), and the RSS feed has been
After the technical steps of creating podcast files have been accessed 68,194 times from the release of the first podcast on
accomplished, the focus then shifts to content creation. The August 2nd, 2005 to March 17, 2006. Additionally, the
vision for the iCritical Care Podcast was that critical care podcast was chosen from among thousands and featured in
Journal of the American Medical Informatics Association Volume 14 Number 1 Jan / Feb 2007 97
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F i g u r e 3. Audio editing software, Audacity®.
the “new and notable” section of Apple Computer’s iTunes family presence during CPR and invasive procedures;11 a
music store because of its “deep, professional content” consultant’s perspective on the future of critical care;12 and
(personal communication, Pete Alcorn, Apple Computer, the unique career of a chairman of a department of surgery
Inc., November 2, 2005). who, in addition to being a molecular biologist, is a re-
An important logistical step was the development of a searcher with NASA focusing on critical care in outer
structured process for the selection of topics for the pod- space.13 Finally, the iCritical Care Podcast was used as a
casts. This involved the initial approval of the podcast novel medium for the members of SCCM who were affected
concept by the SCCM leadership, as well as developing by or volunteered in the aftermath of hurricane Katrina to
ongoing, close coordination with the SCCM director of share their experiences with others regarding this unprece-
publications and managing editor of member communica- dented natural disaster.
tions. Initially there were legal concerns that statements
made during the podcasts not be taken to be official state- Discussion and Conclusion
ments of SCCM, and, as such, an audio disclaimer was In summary, the successful design and implementation of
placed at the beginning of each podcast. the first podcast of an international medical society has been
Though a complete list of podcasts can be seen on the SCCM documented. Although the initial product has been well
Web site, examples of interviews include: a recent article in received, there is clearly much work to be done. Two
Critical Care Medicine correlating early changes in organ primary areas to develop at this point are: 1) grappling with
function and outcomes in severe sepsis;4 an update on what the fact that the newest generation portable media players
is new regarding the landmark ARDSnet trial;5 the chal- have the built-in capability to present video as well as audio,
lenges of providing critical care in the combat setting; a and that this video content can easily be integrated into the
series of interviews focusing on the complex issue of end- RSS/podcast feeds; and 2) working closely with the mem-
of-life in the ICU as well as family conferences and giving bers of SCCM to get structured feedback as to what the
bad news,6 –9 and interviews with the current and former10 membership, and other listeners, would best want from this
president of SCCM. Examples of our plenary lecture pod- new medium. For example, SCCM is in the process of
casts include: a discussion of holistic nursing as well as performing a longitudinal survey of which SCCM members
98 SAVEL et al., iCritical Care Podcast
Table 1 y Number of Downloads/Podcast as of March 8, 2006
SCCM Podcast Date Posted Downloads
SCCM Pod-24 Implementing the Surviving Sepsis Campaign Mon, 06 March 2006 252
SCCM Pod-23 Preventing Pediatric Trauma Fri, 24 Feb 2006 542
SCCM Pod-22 Early Indicators of Sepsis Survival Tue, 14 Feb 2006 874
SCCM Pod-21 Congress Keynotes Up Close: ARDSNet Tue, 7 Feb 2006 597
SCCM Pod-20 Critical Care in Combat Thr, 2 Feb 2006 685
SCCM Pod-19 Congress Keynotes Up Close Thr, 19 Jan 2006 859
Message from the SCCM Leadership: The Future of Critical Care, Dr. Durbin Fri, 30 Dec 2005 1140
December 2005 CC: Improving Family Conferences. . . Wed, 14 Dec 2005 797
December 2005 CC: Getting Our ICU Language Straight Wed, 07 Dec 2005 850
December 2005 CC: Pediatric End of Life Wed, 30 Nov 2005 932
Message from the SCCM President: Closing Thoughts. Dr. Angood Fri, 11 Nov 2005 783
PCCM: The 1st International Sepsis Forum on Sepsis in Infants and Children Tue, 1 Nov 2005 1358
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Congress Keynotes Up Close: Family Presence During CPR and Invasive Procedures Thr, 27 Oct 2005 883
Congress Keynotes Up Close: The Future of Critical Care with Brian Silverstein Tue, 25 Oct 2005 757
Congress Keynotes Up Close: Critical Care in Space with Dr. Dulchavsky Thr, 6 Oct 2005 770
Katrina Response: Caring for Evacuees Thr, 6 Oct 2005 472
Katrina Response: Providing Relief on the Front Lines Mon, 19 Sep 2005 730
Interview with Peter B. Angood, MD, FCCM Thr, 15 Sep 2005 280
SCCM Annual Congress—New Dates and New Location Announced Fri, 9 Sep 2005 227
Critical Care Pharmacists Fri, 9 Sep 2005 480
PICU Care of Children with Cancer Wed, 10 Aug 2005 328
Advocacy Caucus in Washington, D.C. Tue, 09 Aug 2005 257
Pharmaceutical Dilemmas in the ICU Cancer Patient Mon, 08 Aug 2005 432
Critical Care of Cancer Patients Mon, 02 Aug 2005 646
Average number of downloads per podcast 664⫾290
are listening to the podcast, how they are listening (com- rently, this educational potential is no longer limited by
puter, iPod, or other media player), and what future topics technology, but by resources, needs, time, and imagination.
they would want addressed. The plan is to utilize Web-
based, e-mail-based, and paper-based surveys to provide References y
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