Problematizing leadership learning facilitation through a trickster archetype: An investigation into power and identity in liminal spaces

This study uses the archetype of a ‘trickster’ to reflect back on, and hence problematize, the role of the educator/facilitator identity in leadership learning. This is based on the view that a trickster is a permanent resident in liminal spaces and that these liminal spaces play an important role in leadership learning. Our approach was based on the reading of the trickster literature alongside reflective conversations on our own experiences of facilitation of leadership learning, development and education. We suggest that paying attention to the trickster tale draws attention to the romanticization of leadership development and its facilitation as based on a response to crisis that leads to a further enhancement of the leader as a hero. Hence, it also offers ways to problematize leadership learning by uncovering the shadow side of facilitation and underlying power relations. We therefore contribute by showing how, as facilitators, we can use the trickster archetype to think more critically, reflectively and reflexively about our role and practices as educators, in particular, the ethical and power-related issues. In our conclusions, we make recommendations for research, theory and practice and invite other facilitators to share with us their trickster tales

Troponin Limit of Detection Plus Cardiac Risk Stratification Scores to Rule Out Acute Myocardial Infarction and 30-Day Major Adverse Cardiac Events in ED Patients

When screening for acute myocardial infarction (AMI), troponin levels below the 99th percentile, including those below the limit of detection (LOD), are considered normal. We hypothesized that a low-risk HEART score (0-3) or ACS Pretest Probability Assessment <2% plus a single troponin below the LOD would rule out both AMI and 30-day major adverse cardiac events (MACE). We studied all patients who presented to a single academic emergency department and received a troponin I (Siemens Ultra Troponin I) from September 1, 2013, to November 13, 2013 (n=888). Demographic and clinical data were abstracted from the electronic medical record. Primary outcome was a final encounter diagnosis of myocardial infarction. Secondary outcome was 30-day MACE, defined as composite of myocardial infarction, revascularization, or death from a cardiac or uncertain etiology. Sensitivities of low-risk HEART score and ACS Pretest Probability <2% alone were 98% (95% confidence interval [CI], 89%-100%) and 96% (95% CI, 86%-100%) for AMI and 94% (95% CI, 86%-98%) and 95% (95% CI, 88%-99%), respectively, for 30-day MACE. When combined with troponin below the LOD, sensitivity for AMI was 100% (95% CI, 93%-100%; difference 2%; 95% CI, -2% to 6%) for low-risk HEART Score and 100% (95% CI, 93%-100%; difference 4%; 95% CI, -1.5% to 10%) for ACS Pretest Probability <2%. When combined with troponin below the LOD, sensitivity for 30-day MACE was 100% (95% CI, 95%-100%; difference 6%; 95% CI, 1%-12%) for low-risk HEART Score and 100% (95% CI, 95%-100%; difference 5%; 95% CI, 0.2%-10%) for ACS Pretest Probability <2%. Addition of a single troponin below the LOD to these scores improves sensitivity for 30-day MACE