The Pulse Spring 2022

SPRING 2022

Reconnect.

Refocus.

Renewal REBIRTH AND RENEWAL PG 4

HOW HAS THE PANDEMIC CHANGED US? PG 7

IMPOSTOR SYNDROME PG 8

CREATIVITY IN BLS EDUCATION PG 10

The Pulse VOLUME XLX No. 2

EDITORIAL STAFF Timothy Cheslock, DO, FACOEP, Editor Wayne Jones, DO, FACOEP-D, Assistant Editor Tanner Gronowski, DO, Associate Editor John C. Prestosh, DO, FACOEP-D Christine F. Giesa, DO, FACOEP-D Meagan Comerford, Director of Communications EDITORIAL COMMITTEE Timothy Cheslock, DO, FACOEP, Chair Christine Giesa, DO, FACOEP-D

The Pulse is a copyrighted quarterly publication distributed at no cost by ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors, and liaison associations recognized by the national offices of ACOEP. The Pulse and ACOEP accept no responsibility for the statements made by authors, contributors, and/ or advertisers in this publication; nor do they accept responsibility for consequences or response to an advertisement. All articles and artwork remain the property of The Pulse and will not be returned.

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TABLE OF CONTENTS 4

PRESIDENT’S REPORT G. Joseph Beirne, DO, FACOEP-D

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EXECUTIVE DIRECTOR’S DESK Katie Geraghty

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THE ON-DECK CIRCLE Timothy Cheslock, DO, FACOEP

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YOU ARE NOT AN IMPOSTER. YOU’RE A HUMAN. Joan Naidorf, DO

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CREATIVITY IN BLS EDUCATION FOR MEDICAL STUDENTS Justin D. Doroshenko, DO, MEd, Paramedic, FAWM, Kaitlyn DeStefano, MS-4, AJ Halstein, MS-4, EMT

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WELCOME TO THE ACOEP DOCMATTER COMMUNITY

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WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE Bernard Heilicser, DO, MS, FACEP, FACOEP-D

Deadlines for the submission of articles are as follows: January issue due date is November 15; April issue due date is February 15; July issue due date is May 15; October issue due date is August 15. Advertisement due dates can be found by downloading ACOEP's media kit at www.acoep.org/advertising. ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2022 – All rights reserved. Articles may not be reproduced without the expressed, written approval of ACOEP and the author.

ACOEP is a registered trademark of the American College of Osteopathic Emergency Physicians.

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PRESIDENT’S REPORT

G. Joseph Beirne, DO, FACOEP-D

REBIRTH AND RENEWAL

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ello ACOEP family! As you read this, it will be Spring, but as I write this article, it is Sunday, February 27, 2022. A few days ago, we had sleet and snow. Today, it is sunny and near 50. And by March 3, we will have temperatures near 70 degrees, here in St. Louis! I know it may not stay that way, but this time of year always brings my focus towards Spring -- a transition towards warmer weather, sunny days and the renewal of the spirit.

Over the last two years, our profession has dealt with a pandemic that we will hopefully never see again in our lifetime. As the pandemic unfolded, I told one of my colleagues during a shift in the ER “this is our 1918” (in reference to the 1918 influenza pandemic). We had to be quick learners to combat COVID, to learn how to deal with the devastation of this virus -- and we did. We utilized all of our skills as ER physicians, and as we move towards Spring, it appears the battle is being won more every day. Case numbers continue to decline, and our hope is that we may be seeing the beginning of the end of this difficult time. How did we respond? We did not give up; we forged on and made a difference.

We take solace from the lessons we learned about COVID and continue to renew our commitment to providing excellent care for our patients.

As we move towards Spring, that renewal of our professional commitment and dedication has

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WHEN I THINK OF WHERE WE WERE AT THE START OF 2020 DURING THE PANDEMIC, AND HOW FAR WE HAVE COME, IT TRULY DOES FEEL LIKE A REBIRTH OF OUR SPIRIT AS AN ORGANIZATION AS WELL AS A RENEWAL OF OUR COMMITMENT TO OUR SPECIALTY.” now provided us the opportunity to have our first conference in person since Austin, Texas in 2019. I think most of us are looking forward to returning to this environment. It is the opportunity for all of us to rekindle our relationships with our colleagues who we may not have seen in a few years.

More importantly, it provides all of us with what ACOEP has always stood for -- family. A family of emergency medicine professionals who come together twice a year to share our wisdom, knowledge and passion for our specialty with each other. When I think of where we were at the start of 2020 during the pandemic, and how far we have come, it truly does feel like a rebirth of our spirit as an organization as well as a renewal of our commitment to our specialty.

Our Spring conference in Fort Lauderdale promises to be another fantastic CME conference. In addition

to lectures, there will be ten hours of pre-recorded material for extra CME, as well as Simtastic, Advanced US workshop and COLA/CORE review.

There will be many other activities in the area as well. The Tortuga Music Festival runs during the same block as our conference, which will provide all of us with the opportunity to enjoy the sun, ocean and music!

One of my main interests when I became president last year was to increase the transparency of the college and member involvement.

As we meet in person for the first time in more than two years, I would like all of us to take advantage of this moment -- not only rekindle your relationships with friends from past conferences, but make new friendships! Introduce yourself to others you don’t know. Attend the membership Meet and Greet after the membership meeting and get to

know your fellow college members.

Our conferences provide a wonderful, relaxing environment that fosters learning, creation of friendships and professional relationships that will last a lifetime. ACOEP has always been like a second family to me, and I hope that this in-person event creates that same special feeling for all of you!

Spring is indeed a time of rebirth.

Flowers bloom, trees blossom, and the days become longer and warmer. I see the rebirth of nature every Spring, as well as the happiness and serenity it provides me. From that, I always feel a sense of renewal about how lucky I am to have a loving family, a wonderful life and the best job in the world. That

sense of renewal and rebirth only makes my passion for the specialty of emergency medicine stronger each day. I hope that the changing of the seasons will provide each of you with that same sense of rebirth and renewal. . –•–

THAT SENSE OF RENEWAL AND REBIRTH ONLY MAKES MY PASSION FOR THE SPECIALTY OF EMERGENCY MEDICINE STRONGER EACH DAY.”

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EXECUTIVE DIRECTOR’S DESK

Katie Geraghty Executive Director

OUR ACOEP COMMUNITY

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s the new season approaches, there is a cautious optimism that is also blooming regarding the pandemic. As we climb out of both winter and the cloud of COVID-19, we are excited to connect in person after over two years of being apart. With that said, we are seeing our membership also climbing and the community connecting virtually on DocMatter in between our events.

As an ACOEP member, you have exclusive access to our ACOEP DocMatter Community. It is designed specifically for you to help cut down on the time and effort it takes to educate, collaborate and learn from your peers.

Get started! To access the Community please visit: DocMatter.com/ACOEP Save the date for our next in-person event!

2022 Scientific Assembly October 24-28, 2022 The Cosmopolitan of Las Vegas Las Vegas, Nevada Also, visit our website for year-round CME opportunities in our Digital Classroom, via acoep.org > Education & Events > Digital Classroom.

AS AN ACOEP MEMBER, YOU HAVE EXCLUSIVE ACCESS TO OUR ACOEP DOCMATTER COMMUNITY.”

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THE ON-DECK CIRCLE

Tim Cheslock, DO, FACOEP

HOW HAS THE PANDEMIC CHANGED US?

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ot a day goes by that another article streams across one of the social media feeds about how physicians have weathered the storm of the pandemic and are now realizing the effects of those two long years. Do you feel the same motivation for work as you did before the pandemic? Have your long-term career goals changed?

Where do you see yourself in five or ten years from now? Has burnout set in?

If I asked each of you those questions, I’m sure the answers would be vastly different depending on where you were prior to the start of the pandemic. There may be some common themes or maybe even some surprising answers. Universally though I think it’s safe to say that if nothing else, the events of the last two years have made us all a bit more conscious about our future and our priorities.

I have had many of those conversations with friends, colleagues and others both within the college and outside. Some of the common themes that I have come across include spending less time in their current role either clinically or administratively.

Opting for more time with family.

Reconsidering how much time they spend at the hospital or opting for a slower paced facility. Long-term plans included trying to go part time sooner than originally anticipated or looking for a second career or side gig that did not involve being in the ED. While most EM docs still

…I THINK IT’S SAFE TO SAY THAT IF NOTHING ELSE, THE EVENTS OF THE LAST TWO YEARS HAVE MADE US ALL A BIT MORE CONSCIOUS ABOUT OUR FUTURE AND OUR PRIORITIES.” enjoy the patient contact, the harsh reality is they want less of it and are placing more emphasis on family and other hobbies or second careers.

This isn’t meant to be discouraging to those coming out of training or even those who are unfazed in their current position. It is meant to create a discussion about career longevity, burnout, and a possible new trajectory for an EM doc. There are many docs still in practice that have enjoyed a robust and fulfilling thirty-five or forty years in practice. There is also a subset who have been out for fifteen to twenty years and have said enough.

Then there are the new physicians who are still in the early phases of their career and may or may not have even considered this topic. Wherever you find yourself along the spectrum, remember that you are not alone and there are likely many others in the same situation. There is no one right answer. What is clear though is that there are many possibilities.

The great part about our profession is that we are strong and resilient. We can adapt to change,

and we can embrace it. Wherever you are in your career path, ACOEP has a place for you. You will always be able to find someone to have a conversation with, to bounce ideas off, or to ask opinions. You will have a resource to strengthen your knowledge, mentor you and be there for you as part of the family.

We are here to support each other and help keep our college and our family strong for generations, no matter what challenges we come up against. Take full advantage of what membership in ACOEP has to offer! I look forward to sharing some of your experiences and revelations when we meet in Ft. Lauderdale. Don’t be afraid to come by and say hello! I will be happy to share my experience with you. Also, be on the lookout for my own short little poll in the ACOEP DocMatter Community about this topic. Your opinions are important not only to me but to everyone else in our organization. We are stronger together! –•–

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YOU ARE NOT AN IMPOSTER. YOU’RE A HUMAN.

By Joan Naidorf, DO

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Joan Naidorf, DO, is an emergency physician, author and speaker based in Alexandria, VA. Her book, Changing How we Think About Difficult Patients, (American Association for Physician Leadership) was published in 2022. She blogs at https://www.drjoannaidorf. com/ and at Joan Naidorf – Medium.

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t feels like everyone is talking about imposter syndrome.

Imposter syndrome is defined as doubting one’s abilities or feeling inadequate, like a fraud.

It disproportionately affects high achievers and perfectionists who tend to find fault even with their own marvelous accomplishments. Every human feels it from time to time, even men. Much of the writing and studies seen recently in the media focus on the phenomenon in women and speaking of it in terms of a medical or psychiatric diagnosis.

The Harvard Business Review has gotten in on the movement. Authors Ruchika Tulshyan and Jodi-Ann Burey ask the people in the business world to “Stop Telling Women they have Imposter Syndrome.” They object to taking a “fairly universal feeling of discomfort, second-guessing, and mild anxiety in the workplace and pathologized it, especially for women.

The authors resent the victim blaming of a biased system that makes women feel as though they do not belong.

They write, “For women of color, universal feelings of doubt become magnified by chronic battles with systemic bias and racism.”

In Emergency Medicine News, Dr. Simons (AKA the ER Goddess), wrote

a response to the Harvard Business Review authors and the general public regarding her take on the matter. In “It’s Not Imposter Syndrome—It’s Gender Bias” she frames the issue in medical workplace and training programs. She writes, “The discomfort that women have been convinced is imposter syndrome is not a psychological affliction but a normal response to being female in a culture rife with gender discrimination.”

She concludes, “Labeling female physicians as having imposter syndrome may be easier than changing workplace culture, but it inappropriately blames individuals for natural reactions to persistent sexist overtones in medicine. Rather than helping women fight imposter syndrome, we should be fighting gender discrimination.”

In the blog section of Women in White Coats, Dr. Mary McCrary, wrote of her own experience with imposter syndrome as she rose through the ranks of medical student, intern, OB resident and then OB chief resident.

She noted at every stage of transition, the professionals around her were at a higher level of experience and training and by comparison, she naturally felt inadequate. By the time she reached her chief resident year, she realized

her own thoughts about her skills and what she had to offer to patients and trainees had to change. She wrote, “I knew how to be more aware of my thoughts; I learned how to adjust those thoughts, and ultimately I knew how to have a different opinion of myself. I was able to see these limiting thoughts and reframe them.”

In the Doximity Op-Med section, Dr. Kristin Yates related her own feelings of imposter syndrome as she also rose through the ranks as an OB-GYN resident. She found that the thoughts of inadequacy followed her even as she became more experienced and successfully advanced in her medical training.

Dr. Yates finally realized, “What I know now is that we must deal with impostor syndrome head on if we want to overcome it. Dealing with it head on means recognizing it for what it is: a normal part of being a human being, especially if you are a “high achiever.” Unfortunately, it does not resolve on its own with time and experience. Our brains will think of new excuses about why we don’t belong. That is, of course, unless we teach ourselves how to recognize the thoughts that cause impostor syndrome and provide new thoughts instead.”

I have the utmost respect for my colleagues, and I appreciate the experiences and opinions they have shared online. I agree and disagree with their positions. The imposter syndrome is not an actual disease or affliction that strikes women in our profession. There is no listing in the

Diagnostic and Statistical Manual of Mental Disorders. We do not require medication or treatment. We are not to blame for the condition, nor should we labor in shame.

Yes, there is both racial and gender bias within our society, our medical training system and our workplaces. Yes, we all should be fighting against racial and gender bias within hospitals and offices. Even if we waved a magic wand and all racial and gender bias in the workplace instantaneously went away, women would still question their adequacy because all their current experiences are filtered through their own brains.

No one can force us to feel inadequate. Inadequacy is a feeling caused by a thought like, “maybe I’m not good enough” or “maybe I don’t really belong here.” We get to choose for ourselves what we think in every situation. Like it or not, those of us raised as persons of color and women in our society have internalized the thoughts of bias that were offered to us on television, movies and the classroom. We need to choose better thoughts. Additionally, we judge ourselves harshly. While we wait for the world and society to fix biases, we have to work on our own thoughts first and exercise self-compassion.

The imposter syndrome is just a description of a collection of your own critical, self-talk thoughts. That’s it.

Some high functioning, perfectionistic people, particularly some women, never feel good enough. They always feel like there is something wrong with them or they need to fix the next thing

or get the next fellowship to finally feel okay about themselves. This brutal self-criticism and judgement has got to stop. We need for every person to love themselves first and believe in their own worthiness. Every person needs to bring their best selves to the clinical bedside, the operating room or the meeting. We need to change from within and the way to do that is to change what we think about ourselves first. This is what we can do today, while we wait for society to change.

Did you know that you can change your thoughts just by practicing thinking something new, on purpose, that you can believe?

You have to repeat the desired new thoughts many times for them to stick.

It takes practice to undo a lifetime of habitual self-criticism and internalized bias. When society or your own brain offers you an old-fashioned and un-helpful thought about your own abilities or worthiness, you just need to politely decline that notion. In the human experience, moments of self-doubt will inevitably pop-up and cause us to question ourselves. This is normal. You need to think, “I belong here. I can do this and in fact, I can do this well. I’m amazing. I’m a badass.”

You can think this even when you don’t know the answers to questions on rounds or when you make a mistake (and sooner or later we all will.) This is all part of the human physician experience. Thank you for putting on your scrubs or your white coat to take care of us. We need every one of you to put your best self out there with confidence. –•–

WHILE WE WAIT FOR THE WORLD AND SOCIETY TO FIX BIASES, WE HAVE TO WORK ON OUR OWN THOUGHTS FIRST AND EXERCISE SELF-COMPASSION.” SPRING 2022 THE PULSE

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CREATIVITY IN BLS EDUCATION FOR MEDICAL STUDENTS Introduction As a first-year medical student wearing your new white coat, you embark on your first community experience—a home visit with your geriatric mentor at their house along with a first-year colleague. Over coffee and scones, just as you’re getting to know your mentor while gathering their history, they start complaining of chest pain. Knowing their extensive cardiac history, you immediately go to call 911 and notice they are unresponsive. You contemplate what you, as a first-year medical student, are expected and able to do.

There are more than 350,000 out-of-hospital cardiac arrests each year.1 During medical school, students are taught Basic Life Support (BLS), but schools provide the training at different times over the four years.

Several osteopathic medical schools provide formal BLS education during the first year or even orientation.

At some schools, students take an emergency medical technician class at the beginning of first year. Though BLS certification is provided just prior to clerkship years at the University of New England College of Osteopathic Medicine (UNE COM), a group of medical students at UNE COM believed that BLS is an important set of skills that should be gained earlier

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in medical school education. Preclerkship years at UNE COM include several clinical experiences that involve visiting older adult mentors in their home. UNE COM medical students have encountered sudden cardiac arrests in the local community.

Seeing all of this, that group of medical students within the EM Club at UNE COM, a chapter of the ACOEP RSO, took it upon themselves to host a BLS course. The unique course, drawing from the previous experience and education of EM Club members, was designed and delivered almost entirely by first- and second-year medical students. Offered twice before the COVID-19 pandemic altered course delivery in medical school, over forty medical students were certified in BLS. Setting Expectations Throughout medical education, students are learning alongside clinicians, both dressed in white coats. This most often occurs during clerkships but does occur in preclerkship years when students have minimal clinical training or experience.

It may be difficult for the layperson to distinguish between an experienced clinician and a student. With the white coat comes the price of public perception, even as a first-year student—one that sets expectations for a level of competency, knowledge,

and trustworthiness.2 In fact, patient perception of knowledge was highest for physicians who sport the white coat either formally or with scrubs. 3 This expectation is not reserved for physicians in white coats but is often assumed for all in white coats, thus including medical students.

Though the adults involved in UNE COM’s geriatric programs are aware of students’ status as pre-clerkship learners, most are unaware of medical education curricula and student proficiencies. The gap between expectation and knowledge could be the difference in a medical student initiating BLS in the case of an emergency.

In addition to the pre-clerkship concerns, there is an expectation that students receive sufficient training in BLS and Advanced Cardiovascular Life Support (ACLS) when they move to the next phase of medical education. In fact, 68.9% of residency program directors feel it is important to have BLS skills assessed in the first year of residency, and 90.1% of surveyed directors believe it should be assessed during training at some point.4 The Association of American Medical Colleges (AAMC) requires competency at providing early management of patients in critical condition with basic and advanced life support as requirements for

graduation from medical school.5 Admittedly, there is poor retention of CPR and BLS knowledge. The American Heart Association reports that it may be “reasonable for BLS retraining to be completed more often by individuals who are likely to encounter cardiac arrest.”6 Similarly, there is evidence that medical students with prior BLS training have improved performance in repeat simulations.5 The ability to increase training opportunities with more courses earlier on, supports the improvement in the quality of BLS and ACLS care provided.7 By providing a BLS course early in medical education, there is time for repeated courses and increased knowledge recollection, which hopefully allows increased competency among students in pre-clerkship preceptorships, clinical experiences, and beyond.

Developing a Curriculum Seeing a need for a BLS course earlier in medical school, students in the EM Club at UNE COM designed and taught a course targeted to medical students. The goal of the unique curriculum is to combine standard BLS curriculum with information pertinent to the physician’s role in cardiac arrest management. The course is still the four-hour standard and includes CPR, rescue breathing, and treatment of foreign body obstruction. One distinct advantage of targeting the course toward medical students is their in-depth understanding of anatomy and physiology.

Their knowledge base is greater than the general public or those targeted by standard BLS courses, which allows this curriculum to draw parallels that others might not be able to, including cardiovascular physiology during CPR or human anatomy as it relates to airway maneuvers.

Additionally, the curriculum includes a specific session, led by an emergency physician, that explores the physician’s role in cardiac arrest management. The intent of this session is to highlight the leadership, time management and overall mindset needed by a physician while running a code.

Perhaps the most powerful aspect of the curriculum is that it is primarily delivered by medical students. Many medical students come into medical school with prior educational experience or instructor certification, and the EM Club took advantage of this to ensure proper instruction from organizations like the American Heart Association and the American Safety & Health Institute.

Providing a student-led curriculum not only helps medical

students gain experience teaching—which is not an oftprovided opportunity in medical school—but allows a unique connection between students. Steven Ferro, a 2021 UNE COM graduate, said the student-led BLS course gave him the “ability to connect with people you know and are in the same boat, rather than an instructor not used to medical students.” It is essential for educators to understand the context in which the learners likely need to draw upon the things they have learned. In this situation, perhaps no one understands medical students better than the students themselves.

Why It Matters BLS education for medical students is not well retained, no matter when it is introduced in medical school.

Knowledge of BLS is generally low among medical students despite an expectation that medical students should know how to manage a cardiac arrest.8 Medical students are generally well prepared to understand the pathophysiology behind cardiac arrest but may not actually know how to properly intervene and manage an out-of-hospital cardiac arrest.9 A targeted approach to teaching BLS, such as this student-led curriculum, could be a way to address this larger problem. By providing an early introduction to the basics, there is more opportunity to build and refine skills throughout medical school. In fact, more than 75 percent of the participants in this BLS course at UNE COM had expected to receive CPR training at some point before or during their first year of medical school. An early BLS course also builds confidence early in medical school with a new skill set.

Conclusion While the COVID-19 pandemic has dramatically changed medical education and has prevented the EM Club from offering the student-led BLS course the last two years, there remains a need to continue finding ways to provide medical students with essential skills throughout their years of medical school. Certainly, further research would be needed to determine if targeted BLS courses earlier in medical school with involvement from medical students offer advantages regarding retention and effectiveness. Still, it’s important for students and educators to be creative to expand and evolve the ways medical education is delivered.

…THERE REMAINS A NEED TO CONTINUE FINDING WAYS TO PROVIDE MEDICAL STUDENTS WITH ESSENTIAL SKILLS THROUGHOUT THEIR YEARS OF MEDICAL SCHOOL.” SPRING 2022 THE PULSE

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References 1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association [published correction appears in Circulation. 2018 Mar 20;137(12 ):e493]. Circulation. 2018; 137(12):e67-e492. doi:10.1161/ CIR.0000000000000558 2. Chung H, Lee H, Chang DS, et al. Doctor’s attire influences perceived empathy in the patient-doctor relationship. Patient Educ Couns.

2012; 89(3):387–391. doi:10.1016/j.pec.2012.02.017 3. Petrilli CM, Saint S, Jennings JJ, et al. Understanding patient preference for physician attire: a cross-sectional observational study of 10 academic medical centres in the USA. BMJ Open. 2018; 8(5):e021239. Published 2018 May 29. doi:10.1136/bmjopen-2017-021239 4. Langenau EE, Zhang X, Roberts WL, DeChamplain AF, Boulet JR. Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors. Med Educ Online. 2012; 17:10.3402/meo.v17i0.18812. doi:10.3402/meo. v17i0.18812 5. Gupta R, DeSandro S, Doherty NA, Gardner AK, Pillow MT. Medical and Physician Assistant Student Competence in Basic Life Support: Opportunities to Improve Cardiopulmonary Resuscitation Training. West J Emerg Med. 2020; 22(1):101–107. Published 2020 Dec 15. doi:10.5811/westjem.2020.11.48536 6. Bhanji F, Donoghue AJ, Wolff MS, et al. Part 14: Education: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S561–S573. doi:10.1161/CIR.0000000000000268 7. Lund-Kordahl I, Mathiassen M, Melau J, Olasveengen TM, Sunde K, Fredriksen K. Relationship between level of CPR training, selfreported skills, and actual manikin test performance-an observational study. Int J Emerg Med. 2019; 12(1):2. Published 2019 Jan 10. doi:10.1186/s12245-018-0220-9 8. Willmore RD, Veljanoski D, Ozdes F, et al. Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support? World J Emerg Med. 2019; 10(2):75-80. doi:10.5847/wjem.j.1920-8642.2019.02.002 9. Baldi E, Contri E, Bailoni A, et al. Final-year medical students’ knowledge of cardiac arrest and CPR: We must do more! Int J Cardiol.

2019; 296:76–80. doi:10.1016/j.ijcard.2019.07.016

Justin D. Doroshenko, DO, M.Ed., Paramedic, FAWM Justin is a physician, paramedic, and educator based in Asheville, NC. A graduate of the University of New England College of Osteopathic Medicine, he currently serves as the Director of Education for Hawk Ventures and faculty for NOLS Wilderness Medicine.

Kaitlyn DeStefano, MS-4 Kaitlyn is a fourth-year medical student and EM residency applicant from the University of New England College of Osteopathic Medicine. Originally from Farmingdale, NY, Kaitlyn is a former EMT, medical scribe and Division II Volleyball All American.

AJ Halstein, MS-4, EMT AJ is a fourth-year student at the University of New England College of Osteopathic Medicine and EM residency candidate. In his previous career, he was an EMT and a CPR instructor with the American Heart Association. Beyond medical school, his goal is to continue teaching others in the medical community.

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WELCOME TO THE ACOEP DOCMATTER COMMUNITY The ACOEP family has a new place to collaborate and learn. We are excited to announce the relaunch of the ACOEP DocMatter Community. The platform, accessible only to ACOEP members, is designed to harness the global connectivity of the internet and make it easier than ever to broaden peer learning.

Join a discussion or start one of your own. Recent topics of conversation have included new COVID-19 infections in fully vaccinated healthcare workers and compensation for frontline workers. The Pulse column “What Would You Do? Ethics in Emergency Medicine” from Bernard Hellicser, DO, MD, will also now be featured in the DocMatter Community. Log in and tell us what you would do in this issue’s dilemma of a patient refuses transfusion.

To access the Community please visit DocMatter.com/ACOEP.

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Bernard Heilicser, DO, MS, FACEP, FACOEP-D

What Would You Do? Ethics in Emergency Medicine

In this issue of The Pulse, we present a case submitted by George Miller, DO (recipient of the Bruce D. Horton DO, FACOEP Lifetime Achievement Award).

The patient is a 16-year-old male who was brought to the ED by EMS accompanied by his mother. The patient was in respiratory distress, tachycardia, tachypneic and hypotensive. The mucous membranes were pale. He was conversive and demonstrated decision-making capacity.

Work-up revealed a Hgb of 1.5. When informed he needed a transfusion, he refused, stating his religious beliefs forbade it. When questioned what religion he stated it was his Church and he was the Pastor, and his was the only congregation. The patient’s mother stated he is the Man of the House, (the father left them when the patient was an infant). The patient did agree to be intubated.

Should we honor the patient’s wishes? Or, should we transfuse, and if so, under what premise?

WHAT WOULD YOU DO? Please visit the ACOEP DocMatter forum and share your thoughts on this case.

If you have any cases that you would like to present or be reviewed in The Pulse, email them to us at mcomerford@acoep.org.

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ACOEP Summer Series Wednesdays, July 6, 13, 20, 27 Noon (CDT)

Speakers Include: Rodney Fullmer, DO Yaron Ivan, MD: Fever in Children. Is It Good, Bad and Should It Be Treated or Left Alone?

Kristina Jacomino, MD: POCUS in the Pregnant Patient Miguel Reyes, MD: Onc Emergencies Shana Ross, DO Maria Tassone, DO #ACOEP22

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