SAEM Pulse November-December 2020

NOVEMBER-DECEMBER 2020 | VOLUME XXXV NUMBER 6

www.saem.org

SPOTLIGHT ADVOCATING FOR THE BETTERMENT OF HUMAN HEALTH An Interview with

Nehal Naik, MD

DR. ANDREW STARNES ON LEADING RAMS THROUGH A PANDEMIC WHILE SURVIVING — AND THRIVING — IN RESIDENCY page 38

Leading the advancement of emergency care through education and research, advocacy, and professional development in academic emergency medicine.

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org Manager, IT Dan San Buenaventura Ext. 225, DSanBuenaventura@saem.org Manager, Accounting Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Michelle Aguirre, MPA Ext. 205, maguirre@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Digital Communications Snizhana Kurylyuk Ext. 201, skurylyuk@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Membership & Meetings Coordinator Monica Bell, CMP Ext. 202, mbell@saem.org Meeting Assistant Maja Keska Ext. 218, mkeska@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Associate Editor, Pulse RAMS Section Aaron R. Kuzel, DO, MBA aaron.kuzel@louisville.edu

Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

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President’s Comments Elections Are Upon Us

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Education and Training Contouring Your Career: A Brief Guide to Highlighting Achievements in an Educator Portfolio

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Spotlight Advocating for the Betterment of Human Health An Interview With Nehal Naik, MD

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Ethics in Action The Placebo Effect

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Geriatric Emergency Medicine Palliative Care Fellowship: An Option for EPs Passionate About End of Life Issues

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Meeting At The Crossroads Telehealth and Geriatric Care

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The Virtual Educator Interview with an Education Innovator: Insights for Faculty Looking to Teach Differently

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Building a RAFFT: How to Create a Successful Mentorship Program for Women in EM

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Clerkship Directors In EM COVID, Medical Students, and YOU! The Bottom Line for Emergency Medicine Faculty

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Dr. Andrew Starnes on Leading RAMS Through a Pandemic While Surviving — and Thriving — in Residency

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Climate Change And Health Climate Change and Extreme Heat Events: A Hot Topic in Emergency Medicine

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RAMS Leadership in Emergency Medicine Award Recipient Dr. Sriram Venkatesan Talks Research

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Climate Change And Health The Climate-Smart, EnvironmentallyResponsible ED: Helping Patients by Reducing Healthcare Pollution

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COVID-19 Through the Eyes of an AsianAmerican Daughter and Medical Student

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Diversity And Inclusion Mentorship: The Secret to Success for Underrepresented in Medicine Faculty

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Angela M. Mills, MD Secretary Treasurer Columbia University

Amy H. Kaji, MD, PhD President Elect Harbor-UCLA Medical Center

Ian B.K. Martin, MD, MBA Immediate Past President Medical College of Wisconsin

Christopher R. Carpenter, MD, MSc Washington University in St. Louis School of Medicine Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Michelle D. Lall, MD Emory University Nehal Naik, MD George Washington University

Ava Pierce, MD UT Southwestern Medical Center, Dallas

Dismantling Implicit Bias and Microaggressions in EM by Encouraging Communication and Professionalism

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A Perspective on the Complexity of Race in Medicine

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Addressing Racism Awareness Within Your Physician Group: A Case Study

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COVID-19

2020–2021 BOARD OF DIRECTORS James F. Holmes, Jr., MD, MPH President University of California Davis Health System

Racism as a Public Health Crisis

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Behind the Masks

SGEM: Did You Know?

Sex and Gender Differences in Traumatic Brain Injury

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Briefs and Bullet Points

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Academic Announcements

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Now Hiring

Jody A. Vogel, MD, MSc, MSW Denver Health Medical Center University of Colorado School of Medicine Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2020 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

PRESIDENT’S COMMENTS James F. Holmes, Jr., MD, MPH UC Davis School of Medicine 2020–2021 SAEM President

Elections Are Upon Us Very soon Americans will go to the polls and vote for a variety of elected positions, amendments, and propositions. I keep hearing that this election is the most important national election in our lifetime, but I am pretty sure that is said every four years. Regardless, it is our civic duty to vote and I urge everyone to take the time on November 3 to vote in the 2020 general election.

“Serving in a SAEM leadership role not only benefits the society and the patients we serve, but helps you grow both personally and professionally.”

However, the primary reason that I write this column is to discuss another important election that is also quickly approaching. Although the annual SAEM election does not draw the fervor of our national elections, it is nonetheless important for our society and academic emergency medicine. We will be voting in February 2021 on a variety of positions across SAEM, including multiple leadership positions in SAEM’s eight academies. Not only do I urge you to vote in the SAEM election in a few months, but I urge you to consider running for a leadership position.

SAEM is a volunteer organization that comes together to improve academic emergency medicine. We offer many opportunities to our members, including the opportunity for leadership roles.

Serving in an SAEM leadership role not only benefits the society and the patients we

serve, but helps you grow both personally and professionally.

Eight years ago, I received a call from then SAEM President-Elect Alan Jones who inquired about my interests and suggested I run for the SAEM Board of Directors. Prior to that call, I never considered myself “eligible” to be on the SAEM Board, but the prompting from that call changed my career for the better.

Never hesitate to suggest to someone to go after something you believe they would be good for; encouragement from others is often all that is needed to spur a successful career path.

For those who are not yet ready to be in an SAEM leadership position, let me instead urge you to get involved in one of the many SAEM committees, academies or interest groups. These groups span the interests of emergency medicine and welcome everyone from medical student to senior physicians. It is with your contributions that SAEM will continue to improve the care for our patients and career opportunities for our members.

ABOUT DR. HOLMES: James F. Holmes, Jr., MD, MPH, is professor and vice chair for research in the department of emergency medicine at UC Davis School of Medicine.

Nominate Yourself or Someone Else for a Leadership Position!

Nominations are being accepted through November 16 for leadership positions for SAEM, RAMS, AACEM, SAEM Academies, and the SAEM Foundation. Leadership positions should be filled by committed individuals who have a wide range of perspectives and possess the relevant skills and experience to effectively lead. If you, or someone you know, fit that description we invite you to submit a nomination in one or more of the categories listed at the nominations webpage.

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SPOTLIGHT

ADVOCATING FOR THE BETTERMENT OF HUMAN HEALTH An Interview With Nehal Naik, MD, Resident Member, SAEM Board of Directors

SAEM PULSE | NOVEMBER-DECEMBER 2020

Nehal Naik (@NehalSN) is a third-year resident at the George Washington University in Washington DC. An immigrant to the United States and a Californian at heart, he completed his undergraduate degree at the University of California, Berkeley and received his MD from Virginia Commonwealth University/Medical College of Virginia.

Dr. Naik began his service to SAEM in 2017, serving on the inaugural board of SAEM RAMS (Resident and Medical Students) and creating a home for trainees as chair of the RAMS research committee. He continued as the RAMS president from 20192020 and currently serves as the immediate past president of RAMS. Through his leadership, Dr. Naik has led RAMS to become a preeminent organization for the advancement of the future of emergency medicine through the development of resident and medical students into academic leaders. In 2020 Nehal was elected as the resident member of the SAEM Board of Directors. He also served as the Global Emergency Medicine Academy (GEMA) Resident representative from 2019-2020 and has served on several SAEM committees, including the SAEM Virtual Presence, Program, and Membership committees. His academic interests include global emergency medicine development in prehospital systems, medical education, and innovative practice in emergency medicine.

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“Academic emergency medicine needs to consider some of the external factors related to clinician well-being and resilience — especially during the COVID pandemic —and work on structural changes to reduce moral injury.”

How has the COVID-19 pandemic affected you, your practice, your family, and your colleagues and coworkers? What has been your biggest challenges and greatest lessons learned during this time?

COVID-19 has reinvigorated my work as a resident physician in emergency medicine. While the work of a resident physician has always been difficult, the renewed sense of purpose has brought up my spirits. When the pandemic started, emergency physicians were some of the first to raise alarms in our region and hospital. For me, going to work each day in the emergency department (ED) feels like another opportunity to give someone a better

day ahead. Outside of work, it has been tough, with increasing isolation from friends and family. Not seeing my parents from across the country has been the hardest challenge. Facetime or Zoom doesn’t make up for in-person family time. Washington, DC has been a great city to ride out this pandemic, with the nearby National Mall being my local park to play and relax in. The greatest lesson throughout this pandemic has been to constantly include goals of care discussions as a part of my care in the ED. With the many unknowns for COVID-19 patients, I’ve made it a habit to include some palliative discussions to aid in the future care for all patients.

How do you personally manage stress and maintain work/life

balance, particularly during this unprecedented time of COVID? Second, what advice would you give to an individual who is struggling?

And finally, what do you think our specialty as a whole can do to address COVID-related stress and improve physician well-being?

Managing stress and finding balance have definitely been tough in residency.

What gives me the most joy, outside of work, is simply being outdoors. The Mid-Atlantic area with the Shenandoah National Forest and Chesapeake Bay provides opportunities for wonderful hikes

continued on Page 6

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continued from Page 5 and kayaking to help clear my mind.

During COVID, workout applications offering free access to healthcare workers have been great for helping me keep up with exercising while the gyms are closed. Again, Washington DC has been a great city in which to get outside and enjoy some sun.

However, wellness is not isolated to individual activities outside of work.

There are many institutional and organizational strategies that impact physician wellness. The organizational factors of having a collaborative team at work, a supportive EM chair who is a champion for emergency medicine in our institution, and a program director who focuses on resident mindfulness have also been key to maintaining my wellness. Refocusing on spending more time with patients and focusing less on what's on a computer screen has been valuable to my wellness and has further developed my clinician-patient relationships.

To EM residents who are struggling with managing stress and maintaining a work-life balance, my key tip is to refocus your time while at work on patient well-being and the clinicianpatient relationship. It will give you so much joy and return you to the heart of medicine. Wellness is not solely your responsibility, however. While there are individual factors that contribute to wellness which you can control, external factors, often related to your workplace, are harder to control. Advocate within your residency for organizational factors and a learning environment that contributes to and improves wellness. If you're wondering what some of those factors are, look at the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience for more details

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Emergency medicine is leading the way in recognizing the impact of moral injury on physicians, but there's still lots of work to do. Academic emergency medicine needs to consider some of the external factors related to clinician well-being and resilience — especially during the COVID pandemic — and work on structural changes to reduce moral injury.

Any tips on surviving, perhaps even thriving, during residency, especially during this time of COVID? Make time for yourself, enjoy the world around you outside of the oftenwindowless emergency apartment. Even as winter approaches, there's so much outdoors for you to enjoy. Also advocate for yourself and your residents to better your well-being on an organizational and institutional level.

As the resident representative to the SAEM Board of Directors, what issues do you feel are most germane to current and future emergency medicine trainees?

Advocate, advocate, advocate! For your patients, for your profession, for yourself. As a frontline physician, you can truly advocate for your patients in all of their care. Factor in social determinants of health including but not limited to housing, nutrition, racial/gender/social equity, mental health, immigration status. This isn't just awareness on a national scale, but in your day-to-day practice as an EM physician. Give your patients the resources and tools to maximize success outside of the ED. Emergency medicine is taking the lead on FOAMed and medical education research.

We need to become a dominant force within medical research for the betterment of our patients. Finally, we

need to ensure that emergency care is physician-led, and there is no substitute for a residency-trained, board-certified emergency physician.

You were on the inaugural SAEM RAMS board… How have you seen RAMS change, grow, and improve since then and how would you like to see it change, grow, and improve in the next five years?

I've seen RAMS grow from an idea into a preeminent national organization within SAEM. We've created content to guide medical students and residents into a career in academic emergency medicine and find their niche within EM. During the COVID pandemic, we've taken a lead in advising medical students through residency applications and residents through the changing academic EM job market. We've created multiple avenues for mentorship, and increased support for trainees involved in research and education.

For the future, I would like to see RAMS recognized as the leader in creating academic leaders in emergency medicine to advance the standards of patient care. I would like to see our members on the cutting edge of medical research and using the resources within RAMS/SAEM to enrich the academic community of emergency medicine. Finally, I would like to see SAEM’s annual meeting, along with its RAMS events, become the highlight of every resident's and medical student's year.

How and why did you become interested in global health? What are some of the specific issues you’ve become involved with? Why do you feel these are important?

I started working in global health while helping develop a prehospital

notification system for trauma patients in Ecuador. Later, as an NIH Fogarty Global Health Scholar, I worked on creating a prognostic quantitative indicator for patients being treated for TB. In emergency medicine, I've worked through George Washington University’s EM residency training programs in India by capacity building through education. What I love about global health is developing connections with physicians and healthcare workers from around the world and increasing their capacity to provide the best care possible for their patients. I also love growing together with them as they learn alongside me. Medicine is a global community that transcends borders and languages, and each of us should work on fostering that community. It’s how we growth, it’s how we research, it’s how we heal.

Who or what influenced your decision to choose the academic/EM specialty and if you were not doing what you do, what would you be doing instead?

Academic emergency medicine lets you build a better future for emergency care. The work that I do clinically, in research, and within SAEM actively advocates for the betterment of human health. I get to tackle challenges related to social determinants of health, work with the regional team that develops the disaster response to COVID-19, and help improve physician wellbeing. This is only something I can do in academic emergency medicine and I wouldn't change it for the world.

What is the most important lesson working as an EM physician has taught you so far?

The greatest joy you get as an EM physician is spending as much time as possible at the patient’s bedside. Discussing their underlying reason for an ED visit, working through their social determinants of health and goals of care are so much more valuable than anything on a computer screen.

Up Close and Personal What one word would your friends use to describe you?

Encyclopedic Who would play you in the film of your life?

Jeff Goldblum What would that film be called?

BAFERD Takes a Hike What is your guilty pleasure?

Rasmalai, an Indian Dessert What is at the top of your bucket list?

Road trip from California to Patagonia, down the Inter-American and Pan-American highways Who would you invite to your dream dinner party?

Jawaharlal Nehru, the first prime minister of independent India What’s one book you’ve read (fiction or nonfiction) that has had a lasting effect on you?

God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine, by Victoria Sweet

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Dismantling Implicit Bias and Microaggressions in EM by Encouraging Communication and Professionalism

RACISM AS A PUBLIC HEALTH CRISIS

By Cherrelle Smith MD, Youyou Duanmu MD, MPH, Stefanie Sebok-Syer PhD, Avinash Patil MD, Maame Yaa Yiadom MD, MPH, MSCI, and Prasanthi Govindarajan MBBS, MAS

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When presenting a new patient, the resident comments that a Latinx patient’s chief complaint is “total body dolor.” This jargon has not been used in the resident’s report of similar symptoms for nonminority patients.

As emergency physicians, it is crucial to prioritize creating an inclusive environment in which all people feel comfortable seeking and receiving equitable care; therefore, an important aspect of emergency medicine practice must include identifying and addressing implicit biases.

Implicit biases are unconscious associations (usually negative) that are made towards individuals based on their race, ethnicity, gender, sexual orientation, or other identity. These types of biases are problematic and

can result in inadequate patient care due to the dismissal of patient complaints or engendering mistrust of healthcare providers. Bias also creates a negative workplace environment when colleagues who identify with the demographic being discussed are offended, intimidated, or shamed.

Further, the persistent use of language that is laced with bias exposes patients and identifying colleagues to microaggressions, which are defined as indirect, subtle, or unintentional discrimination against members of a marginalized or underrepresented group.

The use of an ethnically specific term like total body dolor is a microaggression that erodes professionalism within our field, yet the ill effects of these comments

and behaviors may be dismissed as harmless humor. Language that discriminates against patients or coworkers needs to change in order to end the perpetuating, damaging effects of biased associations.

Why is challenging bias so uncomfortable?

Discussions about our biases are, for multiple reasons, can be uncomfortable.

Assumptions about the intent behind statements are often perceived as originating from a place of malintent, moral failure, or deficit. Those who want to challenge bias may fear being judged negatively, labeled as overly sensitive, or political. Nevertheless, missing opportunities to confront inappropriate language and interactions when they occur encourages a culture of inequality

What if we created a culture of feedback to dismantle implicit bias and microaggressions?

Using feedback as a means of socially constructing desired behaviors provides an opportunity to have conversations about racism and bias; this is a gateway to culture change. Deliberate dialogue about optimal communication and professionalism within the emergency department establishes a clinical environment where we can help each other refine our language and reframe our practice. Viewing feedback as educational rather than punitive brings about awareness of an unrecognized insensitivity and creates a space where faculty, trainees, staff, and students are all accountable for maintaining an inclusive environment.

Determining how and when to address unprofessional statements and behavior can be challenging.

Directly and swiftly addressing biases, derogatory statements, or microaggressions is ideal; however, this approach can make the person whose language or behavior is being called into question feel targeted or embarrassed, which may undermine one’s ability to engage in a feedback discussion. No two interactions are the same and thus when addressing these situations professional judgement is needed — ideally as close to the occurrence as possible.

Language and behaviors that make an emergency department inclusive and reduce obstructions

“Language and behaviors that make an emergency department inclusive and reduce obstructions to quality care delivery fall within the realm of professionalism.” to quality care delivery fall within the realm of professionalism. Racism, gender insensitivities, and sexism are appropriate topics to address in the emergency department— not only for trainees, but also for faculty and staff as life-long learners.

Calling attention to microaggressions, increasing self-awareness on implicit biases, and modeling ideal communication to trainees and peers by providing direct feedback all promote professionalism and inclusivity.

The attending asks the resident if they have a minute to discuss his communication and explains that “total body dolor” conveys the message that the patient is exaggerating her symptoms and the term targets Latinx in a way that is unprofessional and displays bias even before any medical details have been shared. The attending then asks the resident: How can we communicate in a way that is more respectful and inclusive of our patient?

RACISM AS A PUBLIC HEALTH CRISIS

that could even be perceived as accepting of such language or behavior.

ABOUT THE AUTHORS Dr. Smith is a clinical assistant professor of emergency medicine at Stanford University.

Dr. Duanmu is an assistant professor of emergency medicine at Stanford University and codirector of the ultrasound fellowship.

Dr. Sebok-Syer is an instructor of emergency medicine at Stanford University.

Dr. Patil is a clinical assistant professor in emergency medicine at Stanford University.

Dr. Yiadom is an associate professor of emergency medicine at Stanford University and director of the Emergency Care Health Services Research Data Coordinating Center.

Dr. Govindarajan is an associate professor and associate vice chair of emergency medicine at Stanford University.

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A Perspective on the Complexity of Race in Medicine

By Vanna Albert, MD

RACISM AS A PUBLIC HEALTH CRISIS

"Are you my doctor?"

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Patients often pose this question after I've introduced myself as their emergency medicine physician. As a Black female physician, this question is commonplace on any given shift.

While many might ask this question with incredulity, many minority patients ask with a sense of awe or relief.

My background creates a unique opportunity to establish rapport and increase comfort with my minority patients. Building this rapport in a fast-paced environment allows the patient to be more open and honest as they seek care, which allows me to more accurately assess the patient and provide effective treatment. These types of interactions in the healthcare system are few and far between for minority patients who are often misdiagnosed and misunderstood when seeking treatment. Patients’ distrust in

“Patients’ distrust in the healthcare system, as well as the lack of underrepresented physicians in healthcare, are some of the many challenges the healthcare system faces when working to provide equitable, quality care for Black, Indigenous, and other patients of color.” the healthcare system, as well as the lack of underrepresented physicians in healthcare, are some of the many challenges the healthcare system faces when working to provide equitable, quality care for Black, Indigenous, and other patients of color.

To understand the complexities of the healthcare system that result in racial inequities, we must first examine the country's history with race and health. In the 19th Century, James Marion Sims was lauded as the father of modern gynecology due to his work

RACISM AS A PUBLIC HEALTH CRISIS

“Taking on the structural racism and the existent health disparities require medical providers to look within and acknowledge their own biases.” with the vaginal speculum and surgical techniques. Sims' research methods would be seen as unethical, as much of his work was done on female slaves without anesthesia. In the 1930s, we have yet another example of unethical research with the Tuskegee syphilis experiment. Black men were recruited under the pretense of obtaining free medical care for "bad blood." In reality, the treatment for syphilis was intentionally withheld for research. The Tuskegee Experiment and Dr. Sims’ research are just two examples in the history of medicine that demonstrate the inequitable treatment of marginalized members of society.

Although many believe medicine has made great strides in providing ethical and patient-centered care, we continue to see disparities in our emergency departments. Lee et al. found that black patients were less likely than white patients to receive analgesia for acute pain. A survey of medical students found that up to 14 percent of medical students have false beliefs regarding Black patients' ability to sense pain compared to white patients. This type of implicit bias negatively impacts the care of many patients. In addition to bias, structural racism has been shown to adversely affect many patients' health through segregated neighborhoods, lower-quality schools, poor quality housing, and limited access to care.

The question we must answer is: "How can we fix this?"

Taking on structural racism and existent health disparities requires medical providers to look within and acknowledge their own biases. Taking an implicit bias test and educating one’s self about the history of health and race are two steps physicians can take.

Pipeline programs with undergraduate schools and partnerships with community leaders are ways to increase the number of underrepresented students in medicine. Providing additional support to students who are deterred by financial limitations will alleviate the burden of poverty that so often deters students from reaching the field of medicine.

In addition to creating pipeline programs, recruiting a diverse physician workforce is crucial; however, the recruitment of a diverse workforce must be paired with retention strategies.

Retaining a diverse workforce requires physicians to examine the current state of our academic departments (Schwarz Analytics): • Does the faculty represent the demographics and representation of the patient populations they serve?

• Is a cultural competency course that challenges implicit biases required as part of incentive compensation?

• Do employee engagement scores remain positive when the data is disaggregated by race and ethnicity?

These questions must be answered to create a truly diverse and inclusive workforce and workplace.

Lastly, the complexity of structural racism teaches us that effective change requires a multisystem approach. We must partner with community leaders to dismantle the policies that support an oppressive societal structure and continue to subjugate underserved patients to inadequate care. As physicians, our role is not limited to the treatment of patients in the hospital walls. We must be empowered to advocate for our patients and use our voices to be change agents within our communities.

ABOUT THE AUTHOR Dr. Albert is an assistant chief in the department of emergency medicine at Baystate Medical Center, Springfield, MA.

• Is the culture in the department one of inclusion?

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Addressing Racism Awareness Within Your Physician Group: A Case Study RACISM AS A PUBLIC HEALTH CRISIS

By Kristiana Kaufmann, MD

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Detroit was one of the early hard-hit areas for the COVID-19 pandemic, disproportionately impacting Black communities and Black patients.

Detroit also has a long history of racial unrest and continues to demonstrate significant impacts of systemic racism through health, financial, and social inequity. Medical Center Emergency Services is the democratic nonprofit emergency physician group that has practiced at the Detroit Medical Center emergency departments for over 30 years. Our group of more than 70 physicians run the emergency departments at the three urban centers: Detroit Receiving Hospital, Harper

University Hospital, and Sinai-Grace Hospital —all of which serve primarily Black communities.

With the recent global anti-racist and social justice movement, our physician group has become proactive in promoting education and reflection around racism and our role as antiracist activists. The first step was in June with a discussion during our monthly board meeting. From this discussion, we arranged a social justice grand rounds for our two residency programs. This five-hour grand rounds focused specifically on historical racism in Detroit, implicit bias, and microaggressions and was a combination of didactics and a

specialist-led workshop. A separate workshop has also been offered only for faculty so that residents and faculty alike have a safe space for genuine discussion and reflection. This grand rounds, which is supported by our institutional GME (graduate medical education), will be part of a longitudinal educational series that focuses specifically on social justice and health equity.

In addition to the longitudinal didactic sessions, our group has also found several avenues through which to increase awareness of systemic racism and health inequity within our own working environment. A small team of residents and faculty are working on a quality improvement project in

RACISM AS A PUBLIC HEALTH CRISIS

“With the recent global anti-racist and social justice movement, our physician group has become proactive in promoting education and reflection around racism and our role as anti-racist activists.� conjunction with our social justice and health equity curriculum. This project started first with an inventory of the social resources in the emergency department and a survey of our patients to address what resources they would like improved access to. From there we will build a resource guide for our department and start doing a more focused evaluation and improvement project on issues that are specifically identified by our patient population.

Finally, our physicians started an anti-racism book club. Our first book was Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna Bowen Matthew. Several faculty

members provided chapter reviews and we were able to have a robust discussion and reflection based on this book. We have plans for a quarterly book, movie, or journal club going forward. More importantly, our group has decided to create an implicit bias/ anti-racism policy for our group and incorporate training on the topic into our required annual compliance training.

As the nation reckons with continued structural racism and health inequity impacts, our physician group will continue to work to increase awareness and education around issues of implicit bias and racism here in Detroit.

ABOUT THE AUTHOR Dr. Kaufmann is the director of the Global and Urban Health Section and Global and Urban Emergency Medicine Fellowship at Wayne State University and Detroit Medical Center. She is the emergency medicine advisor for the emergency medicine residency in Lao PDR, the faculty advisor for First Aid First, an instructor and senior patroller with the National Ski Patrol, and the codirector of the Global Health Alliance and their academic course Global and Urban Health and Equity.

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COVID-19

COVID-19

Behind the Masks

By Anish K. Agarwal MD, MPH, MSHP I hold the mask in my hands. It feels insignificant: light and fragile. We’ve all held masks, countless times… before closing wounds, performing lumbar punctures, or intubating patients.

Now I clutch my mask as if it were about to be blown away by a nonexistent gust of wind. I place it gingerly on my face. With my mask on and temperature screened, I walk into our ED. It is a new world, a different place, transformed seemingly within days. Prior to the pandemic, the ED had been a home away from home for me.

The uncertainty of cases and the energy of the team would combine to form a palpable sense of controlled chaos led by people who craved action.

Before, I would stop, look around, and inhale the chaos. I would enjoy soaking it in. This was our ED: busy, crowded and run by people capable of and excited to be caring for anything and everything. Then, early in the pandemic, despite my mask, I could feel myself holding my breath as I crossed the threshold.

My mask takes a journey as I carefully place it into a bag to prolong its use. I hope this bag will protect my mask just

as the mask protects me, my family, and my community. I've learned to wipe down the plastic face shield feeling more like a welder than a physician. We all go through these steps as part of a new routine, a routine where the rules have changed and so have we.

The logistics of ED care are, of course, different. Everything is different.

We speak to one another through layers of PPE and layers of uncertainty. The once brief, refreshing smirks, smiles and facial expressions are hidden. No shaking hands or patting each other on the backs as we change shifts. Just a brief “how are you?” followed by a long pause and an attempt to read each other’s eyes.

Today, my next patient is a young woman with a cough and fever. Before I walk in I try to imagine how she is feeling and what she is thinking: Anxious. Scared. No one to sit with her or to keep her company. The voices on the TV argue about reopening the economy and schools. We strain to connect and attempt to create a doctor-patient relationship. My attempts at empathetic facial expressions are invisible to her —remnants of before.

Her x-ray is labeled with the classic bilateral findings. An “instant classic,”

one of us says and for a moment I can feel our shared smiles behind the masks. A bad joke to clear the air.

I walk out, look around, and my eyes meet those of my team. The overhead emergency haste system blares, piercing and breaking our stares. In the seconds between the initial alarm and the dispatcher’s description of the incoming critical patient, I see flashes of excitement in the eyes around me. The thrill has not vanished, our collective passion for running toward the fire, for helping those in need remains. I take a deep, strained breath under my mask and get ready. The roller coaster of emotions continues. I carefully adjust my mask, address a pesky itch underneath, and take a moment to catch my breath before moving forward.

ABOUT THE AUTHOR Dr. Agarwal is an assistant professor in the department of emergency medicine, Perelman School of Medicine, University of Pennsylvania.

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CLERKSHIP DIRECTORS IN EM

COVID, Medical Students, and YOU! The Bottom Line for Emergency Medicine Faculty

By Amy Cutright MD and Julianna Jung MD, on behalf of the SAEM Clerkship Directors in Emergency Medicine academy

SAEM PULSE | NOVEMBER-DECEMBER 2020

The Year Thus Far

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There is no denying it — 2020 has been a wild ride in all respects, and the world of medical education is no exception! When the COVID pandemic began in March, virtually every medical school suspended in-person instruction, leading to major curricular disruptions for students, particularly those in the clerkship years. In May and June, most schools began bringing students back to the hospital, but the clinical environment was completely different than it had been before the pandemic.

With many schools banning student participation in the care of persons under investigation for COVID, students found themselves severely limited in the number and types of patients they could see, and in the settings where they were permitted to work. Reduced patient volumes meant even fewer learning

opportunities for students. Social distancing mandates impeded student integration into care teams, pushing them out of physician work areas and moving educational activities online.

Students’ clinical experiences were further hampered by many schools choosing to ban away rotations, disallowing travel for their own students, and/or refusing to accept students from elsewhere. In emergency medicine (EM), where away rotations are an essential part of the residency application process, this created considerable distress for students. The problem was compounded for students lacking EM rotations at their home institutions.

These students are completely reliant on away rotations for experience in the specialty, but many had difficulty finding places where they could rotate.

The shortage of away rotation opportunities led national leaders in EM education to take action. CDEM joined forces with the Council of Residency Directors (CORD) and the Emergency Medicine Residents’ Association (EMRA) to draft a consensus statement outlining expectations for the 2020 application year. The statement, which was ultimately endorsed by ten national EM organizations including SAEM, had five main points: 1. Students are only expected to complete one EM rotation, ideally at their home institutions.

2. Students are only expected to have one Standardized Letter of Evaluation (SLOE), derived from their one EM rotation.

3. Non-EM letters should be given greater weight than usual by residency program leadership.

“Websites, social media, informational sessions and virtual residency fairs are now the primary methods students will use to select programs for their application list.”

4. All residency interviews should be conducted virtually.

5. Students should interview at a maximum of 12 programs, going up to 17 programs for students with significant extenuating circumstances.

The goal of the consensus statement is to maximize fairness for students in the residency application process, and to give ALL students a fair chance at pursuing a career in the field. Limiting EM rotations to one per student optimizes rotation availability for students lacking access to EM at their own institutions. Limiting EM SLOESs and increasing emphasis on non-EM letters decreases pressure on students to vie for limited EM rotation spots. Virtual interviews prevent students in areas with higher COVID rates from being disadvantaged in the application process. Limiting student interview numbers prevents highly competitive candidates from over-interviewing, thus maximizing interview availability for more average candidates.

So where are we now? Students have completed rotations and residency applications. Deans’ letters went out on October 21 (three weeks later than usual), and residency programs were able to begin reviewing applications shortly thereafter. The virtual interview season is in full swing, and programs and candidates alike are working hard to put their best (electronic) foot forward to impress one another.

Navigating Virtual Interviews

We are all in for big changes this year with residency recruitment and interviews occurring in a virtual format.

Websites, social media, informational sessions, and virtual residency fairs are the primary methods students will use to select programs for their

application list. Faculty can help advise students through this stressful process with few gentle reminders. All ACGME accredited programs are excellent residency sites providing quality training.

Unvalidated residency rankings and anecdotal information available online through platforms such as Doximity are not reliable. Advise students to review residency program information directly and draw their own impressions.

Reassure them that residency programs are rigorously reviewed and are not permitted to operate if there is any question as to the quality of the training they offer.

By necessity, the interview will increase in importance this year for both residency programs and candidates. We can all prepare for and positively represent our programs with a few basic steps.

The AAMC has created a robust set of recommendations regarding the new interview process that can be accessed here. Content addressing implicit bias, creating and scoring interview questions, and setting up interview space are particularly helpful. While virtual interaction has become commonplace for many of us during the pandemic, it is wise to dedicate time prior to interviews to familiarize yourself with your program’s interview platform. Patience with the inevitable technological challenges and connectivity issues that will arise for all of us will be required.

Limitations on interview numbers are certain to be a source of anxiety for students this year. The stress of the application process leads many excellent applicants to perceive themselves as marginal, and no amount of reassurance can fully convince them otherwise. This insecurity leads to over-application, which in turn leads to over-interviewing.

The number of programs to which EMbound students apply has exploded in recent years, and the pandemic is likely to exacerbate this. And with interviews going virtual, it will be tempting for students to accept every interview offer they receive. As mentioned above, there is real harm in this practice, as it deprives many other qualified candidates of interview opportunities. Data from the National Residency Match Program show that 96 percent of U.S. medical students will match in EM with 12 interviews.

Remind students of this fact and reassure them that more interviews do not lead to a substantially better chance of matching, except in extreme cases. Ultimately residencies need candidates to match, and students need residencies to match into — a worthwhile fact on which to reflect when the inevitable challenges of the upcoming interview season arise.

ABOUT THE AUTHORS Dr. Cutright is an assistant professor of emergency medicine at the University of Nebraska College of Medicine.

She serves as the EM clerkship director and oversees the core clerkship year for the College of Medicine, among other roles. She currently serves as the secretary of CDEM. Dr. Jung is an associate professor of emergency medicine at the Johns Hopkins University School of Medicine, where she directs the core clerkship in EM and serves as associate director for the simulation center, among other roles. Dr. Jung is the current president of CDEM.

About CDEM Clerkship Directors in Emergency Medicine (CDEM) represents the interests of undergraduate medical educators in emergency medicine. It serves as a unified voice for EM clerkship directors and medical student educators and provides a forum for them to communicate, share ideas, and generate solutions to common problems. For more information, visit the CDEM webpage. As an SAEM member, you may now join as many academies* and interest groups as you choose. Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

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CLIMATE CHANGE AND HEALTH

Climate Change and Extreme Heat Events: A Hot Topic in Emergency Medicine

SAEM PULSE | NOVEMBER-DECEMBER 2020

By Catharina Giudice MD, Caitlin Rublee MD, MPH, and Edward J. Otten MD on behalf of the SAEM Climate Change and Health Interest Group

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According to the National Aeronautics and Space Administration (NASA) and National Oceanic and Atmospheric Administration (NOAA), 2019 was the second hottest year, making the last decade officially the warmest ever recorded. As global temperatures continue to rise in an era of climate change, the life-threatening health impacts of extreme heat will be an increasingly important reality for prehospital, emergency medicine, and critical care practitioners.

In 2003, the European Heat Wave brought the lethality of excessive heat exposure to the world’s attention. That summer, Europe saw a death toll that exceeded 70,000, some of which were directly attributed to heat-related illnesses while others were heat-related exacerbations of cardiovascular, respiratory, and all-cause mortality.

In the United States (U.S.), an average of 618 people die every year due to excessive heat exposure, although most experts agree this is an underestimation given the challenges to diagnosis and reporting. While all people are at-risk,

it is important to acknowledge the significant disparity in the number of heat-related deaths among some racial and ethnic minority groups related to a complex set of factors: access to air-conditioning, employment, socioeconomic activities, prevalence of chronic diseases and medications, access to medical care, and urban location which is subjected to heattrapping and heat island effects.

As such, we review heat-related illnesses and management with emphasis on recognition and cooling.

Heat-related illnesses fall under a group of conditions that range from benign processes, such as muscle cramps, to life-threatening emergencies, such as heatstroke. Time-to-intervention is key to reducing morbidity and mortality; therefore, a high index-ofsuspicion and prompt recognition and initiation of cooling takes priority in caring for these patients.

Heat Cramps

Heat cramps are painful involuntary contractions of skeletal muscles

DRUGS WHICH MAY PREDISPOSE TO HEAT-RELATED ILLNESSES Alcohol Calcium channel blockers Alpha adrenergics Clopidogrel Amphetamines Cocaine Anticholinergics Diuretics Antihistamines Laxatives Antipsychotics Neuroleptics Benzodiazepines Thyroid agonists Beta blockers Tricyclic antidepressants of extremities and abdominal wall.

Cramping is due to sodium depletion and can be exacerbated by poor acclimatization and diuretic usage.

Treatment consists of passive stretching, oral rehydration and salt repletion.

Heat Syncope

Heat syncope is a transient loss of consciousness followed by a rapid return to baseline. Peripheral vasodilation and low intravascular volume from dehydration lead to a brief orthostatic event that resolves after patient falls or reaches a supine position. Lack of acclimatization, profuse sweating, alcohol, and cardiac

“As global temperatures continue to rise in an era of climate change, the lifethreatening health impacts of extreme heat will be an increasingly important reality for prehospital, emergency medicine, and critical care practitioners.”

DIFFERENTIAL DIAGNOSIS OF HEATSTROKE Infection Meningitis/Encephalitis Sepsis Malaria Typhoid Tetanus Endocrine Thyroid storm Hypoglycemia Hyponatremia Pheochromocytoma Diabetic ketoacidosis Neurologic Hypothalamic stroke Cerebral vascular accident Status epilepticus Oncologic Lymphoma Leukemia Toxicology Anticholinergic poisoning Sympathomimetic poisoning Salicylate poisoning Serotonin syndrome Malignant hyperthermia Neuroleptic malignant syndrome Sedative/Alcohol/Benzodiazepine withdrawal insufficiency can predispose to heat syncope. Treatment involves removal from the environment, repletion of water deficits, and assessment for secondary trauma caused by a fall from standing.

Heat exhaustion

Heat exhaustion describes a spectrum of symptoms attributed to water and sodium depletion when exposed to excessive heat. Patients often present with elevated core temperature between 38°C (100.4°F) and 40°C (104°F), profuse sweating, and can have an array of symptoms including malaise, fatigue, nausea, vomiting, chills, dizziness, headache, and weakness. This syndrome can be differentiated from heatstroke by the lack of neurologic impairment (encephalopathy, seizures, coma) and the prompt recovery following removal of heat exposure and repletion of water or sodium deficit. Oral rehydration is often sufficient and preferred. If not recognized or treated promptly, heat exhaustion can

progress to a life-threatening form of heat illness known as heatstroke.

Heatstroke

Heatstroke is central nervous system dysfunction plus a core temperature ≥40°C. Classic heatstroke primarily affects those exposed to heat with extremes of age and/or chronic medical conditions, as occurs in heat waves or with vehicular heatstroke. Exertional heatstroke frequently occurs in healthy, young adults – athletes, military trainees, construction workers or other manual laborers. End-organ damage and overall mortality from heatstroke is related to the time cell lines remain in a hyperthermic state; thus, lowering the body temperature as quickly as possible should be the primary objective, in addition to supporting basic airway, breathing, and circulation. This principle should be kept in mind from the very first medical encounter with the patient: if heatstroke is suspected by prehospital personnel, initiation of treatment should begin promptly in the field, even if a core body temperature cannot be obtained first.

A systematic review by Bouchama and colleagues (2007) revealed no prevailing cooling method for heatstroke.

Cold water immersion is considered an effective and safe method of cooling, particularly for exertional heatstroke. In classic heatstroke, mental status and mechanical ventilation may preclude cold water immersion in favor of misting and fans or other evaporative treatments; intravascular cooling catheters have also been successfully used.

A core temperature of 38–39°C has been held as a safe endpoint for cooling. Currently, there is no evidence to support the usage of dantrolene or antipyretics as adjuvant treatments. In addition, antipyretics such as aspirin and acetaminophen can exacerbate heatstroke complications such as coagulopathy and liver injury.

A final controversy in the management of heatstroke is the amount and type of fluid resuscitation. Hypotension and the need for vasoactive agents have been associated with increased mortality

rates and worse neurologic outcomes.

The shock profile of heatstroke shares similarities to that of septic shock, and a combination of fluid resuscitation and vasoactive agents have been supported to achieve adequate tissue perfusion. Acute congestive heart failure and pulmonary edema are documented concerns with aggressive fluid resuscitation. In the emergency department (ED), ultrasound usage may be a beneficial tool to quickly assess volume status and guide resuscitation.

As climate change continues to change the pattern of disease, emergency physicians will have to continuously learn and adapt their practice based on the local community impact. As we have seen throughout history, heat waves are powerful silent killers. Training emergency personnel on prompt recognition and cooling and preparing emergency departments for higher overall volumes is critical to improving morbidity and mortality associated with extreme heat events.

ABOUT THE AUTHORS Dr. Giudice is a second-year emergency medicine resident at Los Angeles County, University of Southern California, CA.

Dr. Rublee is an assistant professor of emergency medicine at the Medical College of Wisconsin. She is the current chair of the SAEM Climate Change and Health Interest Group.

Dr. Otten is a professor of emergency medicine and pediatrics and director for the division of toxicology at the University of Cincinnati. He is past president of the Wilderness Medical Society, Charter Member Environmental Council.

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CLIMATE CHANGE AND HEALTH

The Climate-Smart, EnvironmentallyResponsible ED: Helping Patients by Reducing Healthcare Pollution

SAEM PULSE | NOVEMBER-DECEMBER 2020

By Gayle Kouklis MD and Jonathan E. Slutzman MD on behalf of the SAEM Climate Change and Health Interest Group

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Climate change is an ever-looming public health disaster, touted by The Lancet as the number one public health threat of the 21st Century. The effects of climate change on human health are broad and deep, affecting nearly all body systems. Unfortunately, the impacts of climate change are greatest on the most vulnerable — the young, elderly, pregnant, mentally ill, and those of low socioeconomic status (in other words, the people we see most often in our emergency departments). Unfortunately, our care in the emergency department contributes to the problem. In the United States, healthcare is responsible for nearly 10 percent of all greenhouse gas emissions. Of the different sources of climate-changing pollution from health care, 21 percent are Scope 1 (direct combustion and greenhouse gas releases, like anesthetics), 15 percent are Scope 2 (indirect emissions from purchased energy), and 64 percent are Scope 3 (supply chain, purchased materials, food, business travel, patient and staff transportation). Every clinical choice we make, diagnostic study we order, procedure we perform, and

supply we use has an environmental and subsequent health impact on our community. We need different approaches to reduce each of these sources, with emergency physicians playing key roles in mitigation strategies.

Finding the time

Perhaps you’re thinking, “I already have a full plate caring and advocating for my patients, keeping up with the latest research, and getting through residency… How can I fit this in?”

Residents should consider including environmental issues in a possible quality improvement or research project to fulfill their residency requirements. If you are interested in research, include environmental impacts as a lens for studying whatever clinical question interests you. Start by tackling a small piece, with support from your faculty.

What you can do to reduce the climate footprint of your clinical care

Think of pollution as coming from three sources: 1.) supplies and other things coming to your hospital; 2.) activities involved in patient care; and 3) emissions

associated with waste disposal. While individual emergency physicians arguably have the biggest impacts on numbers two and three, we can nonetheless improve in all three of these areas.

In clinical decision making, we are often faced with diagnostic or therapeutic questions that have multiple answers: Do I need to give antibiotics after an I&D? Does that person need a CT of their belly for these symptoms? The Choosing Wisely campaign has various recommendations for these types of clinical questions. Each recommendation is aimed at decreasing resource utilization while practicing standard care and is backed by one of our very own specialty societies. There are recommendations from nearly 100 medical bodies based on best practices, which can be incorporated into your own practices to help guide interactions with consultants. Every MRI or CT scan avoided represents a little less pollution emitted and harm done to our communities.

Consider the tools you use every day

Every scalpel, angiocath, and bag of

“Every clinical choice we make, diagnostic study we order, procedure we perform, and supply we use has an environmental and subsequent health impact on our community.” vancopime has a story to tell and a carbon footprint trailing behind it. Environmental life cycle assessment is a tool that can give insight into the cradle-to-grave environmental impact of each instrument or pharmaceutical, including raw material acquisition, production, transportation, use, reprocessing, and ultimate disposal. Take the humble laryngoscope, an emergency physician’s best friend. A study done at Yale looked at both the life cycle environmental impacts and financial costs for reusable and single use laryngoscopes. It found that using both reusable handles and reusable blades had the lowest environmental impact and together would save $675,000– $895,000 in one year. Similarly, the environmental impacts of reusable vaginal specula have been shown to be less than that of their disposable counterparts. In fact, nearly every life cycle assessment comparing a single-use disposable device to its reusable counterpart has shown better environmental impacts associated with reusable devices. The studies that included financial costs also found they were less expensive. And who doesn’t prefer using durable instruments over flimsy disposables? Health Care Without Harm and Practice Greenhealth have guides on green purchasing that can direct conversations with suppliers to source items with the lowest environmental impact.

Learning the story of each option available allows for informed purchases that can lower the impact of providing care for patients and decrease costs to the hospital without any change in day-to-day practice.

We need to address our own mess Healthcare generates more landfill waste than almost any other industry, second only to food service at over 7,000 tons per day. The emergency department is a prime source of waste. A waste audit at one of our hospitals showed that we produced 4.4 pounds of waste per patient encounter, which translates to 3,000 kg CO2e emitted daily from one ED just from waste disposal activities alone (not including upstream pollution). Extrapolating to the nearly 150 million annual ED visits in the U.S., that’s 330,000 tons of trash just from EDs each year. Recycling may help a little, with opportunities to divert up to 38

percent of ED waste to recycling; however, recycling doesn’t actually have as big an environmental benefit as many people assume. In an operating room setting, maximal recycling would only improve the environmental footprint of an operation by one percent. Reducing waste through optimized procurement, increasing use of reusable and durable equipment, and reducing packaging, have a much bigger environmental impact. That said, recycling is visible and can motivate staff to think about other ways to improve environmental performance.

What about those red bags?

What actually needs to go in the red bag? What does it even mean when something goes into a red bag? Red bags are for regulated medical waste (RMW), which in the ED includes blood and blood products (including draining, liquid state, and materials saturated or dripping with blood); pathological waste (including human anatomical parts and specimens of body fluids, excluding urine, nasal secretions, sweat, sputum, vomit, or fecal matter that don’t contain visible blood or confirmed diagnosis of infectious disease); and sharps (including medical items that can cause punctures or cuts).

RMW is almost exclusively processed by autoclave sterilization followed by landfill or incineration, costing 5-10 times more than general solid waste to dispose and generating lots more pollutants (including GHG). Minimizing RMW, ensuring that only items that need to be disposed that way go into red bags and sharps containers, should be key to any ED’s environmental stewardship strategy.

Even single-use disposable devices can be reprocessed and made to work “good as new.” Reprocessing is an FDA-regulated service, which can reduce environmental emissions and provide a cost savings to hospitals. Physicians are frequently surprised to learn that 100 percent of all reprocessed items are inspected for quality — a requirement that doesn’t apply to new devices from manufacturers. Emergency physicians can work with their materials management teams to seek reprocessed instruments when available and can

show colleagues in other specialties that reprocessed devices can function just as well as new items.

Instruments and devices

How often do you open a central line or other kit and find parts you don’t need?

Those parts then go directly to the trash, generating no value for anyone. Or, you find not enough tools for a procedure and then need to open extra items. Examining these premade kits, learning what’s useful and what’s commonly thrown away, and reworking the contents of kits may decrease both overall waste and cost.

These ideas just scratch the surface of moving towards a greener healthcare system and don’t even fully address the ways emergency physicians can leverage their breadth of knowledge and interactions with all facets of the hospital to take leaderships roles in hospital and health system environmental stewardship efforts. There is much more to be done, including improvements in energy use, heating and cooling, food supplies, EMS, and other arenas. It is imperative that we communicate to our colleagues and leaders the urgency of the changing climate and its current and future detriments to our patients’ health. Just as with each patient that walks through our doors, this will require a team effort and aligned goals from many people with different priorities. We are here to always redirect towards what is best for our patients.

ABOUT THE AUTHORS Dr. Kouklis is an emergency medicine resident at UCSF Fresno @GayleKouklis.

Dr. Slutzman is an instructor in emergency medicine at Massachusetts General Hospital/ Harvard Medical School.

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SAEM PULSE | NOVEMBER-DECEMBER 2020

DIVERSITY AND INCLUSION

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Mentorship: The Secret to Success for Underrepresented in Medicine Faculty

By Ynhi Thomas, MD, MPH, MSc, Adedoyin Adesina, MD, Richina Bicette, MD, and Dick Kuo, MD on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine Multiple studies have reported that underrepresented in medicine (URiM) faculty receive less mentoring than their non-URiM colleagues. Some of the challenges URiM faculty face include inadvertent and advertent racism, marginalization, and lack of promotion. A study based on the National Faculty Survey from 24 United States medical schools showed that URiM faculty had fewer publications and were less likely to be retained in academic careers. A review of the National Institutes of Health data from 2000 to 2006 showed that Black scientists were 10 percent less likely than their white colleagues to receive R01 grants. The variability in access to mentorship has been attributed to the disparities faced by URiM faculty, as highlighted by the experiences below.

Reflections From an Early Career Faculty Ynhi Thomas, MD, MPH, MSc @YnhiThomas Administrative Fellow Assistant Professor of EM Baylor College of Medicine “I grew up in Mississippi and went to medical school in Alabama. It wasn’t unusual to be one of the few minorities among my colleagues.

Diversity wasn’t commonplace, and I remember my surprise when one of my medical school classmates told me that she hadn’t met someone of Asian descent until college.

"Despite the lack of diversity, I still had incredibly supportive mentors, though they were often white males. I often longed for someone from a similar background to answer questions I felt uncomfortable asking, specifically about how to attain promotions while handling implicit bias. I felt like I had to work twice as hard to disprove the stereotypes against me, especially as a female and mother.

"I’m fortunate to now be faculty in an incredibly diverse department, and I’m receiving mentorship from people who reflect my values and background. More could still be done in terms of formalized mentorship, and I wonder how many unproductive years I and others have faced as we climbed a professional ladder that wasn’t designed for those who don’t fit the traditional mold of success.”

Reflections From a Faculty in Medical Education Adedoyin Adesina, MD Assistant Professor of EM Associate Clerkship Director Baylor College of Medicine “One day, a URiM friend reached out for advice. As part of her medical school requirement, she needed to find a research project. I encouraged her to start by e-mailing some of her professors, but she confessed that she was used to maintaining a lowkey profile. She was intimidated by the thought of approaching her professors and didn't know where to begin.

"As I listened, I reflected on my experiences as a medical student. I could relate to her insecurities. As a first-generation physician and URiM, there is a hidden curriculum. Failure to understand and assimilate to expectations can lead to depersonalization, isolation, and stagnation. This pattern may go unnoticed, resulting in dissatisfaction in an already marginalized population. When it comes to being URiM, part of the 'leak' in the academic pipeline occurs because we never received guidance on integrating and engaging in this complex social system and are often left to figure things out on our own. Things can be challenging for first-generation physicians who don’t have family members to guide and mentor them; many haven’t been offered the same opportunities as their peers, whether research, clinical, or networking opportunities. Efforts directed toward augmenting cultural and social capital can positively impact their academic and career prospects. This support can and should come in the form of mentorship and sponsorship.”

Reflections from a Faculty in Administration and Operations Richina Bicette, MD @DrRichiMD Assistant Professor of EM Baylor College of Medicine Medical Director Baylor St. Luke's Healthcare System “I will never forget the day I first met my undergraduate pre-med advisor. She scrutinized my file and ‘advised,’ that I wasn’t a good candidate for medical school and shouldn’t apply. She was a middle-aged white woman—a stark contrast to me, a young Black woman and first-generation U.S. citizen. A few years later, not only did I earn my M.D. from a top tier medical school, but I also received an academic scholarship.

Where was the disconnect? How could someone who was told that she wasn’t good enough go on to reach such success?

"Unfortunately, my story isn’t unique, and brings to light common themes many URiMs face. The true issue is that there needs to be more access to mentorship for URiMs. At the start of medical school, a senior faculty member decided to engage

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DIVERSITY AND INCLUSION

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with me, and thus began the first real example I had of what a mentor/mentee relationship should be.

"I can unequivocally say that my career would have taken a different course had I not received the mentorship that was bestowed upon me later on in life.

It is imperative as faculty that we continue to propagate the need for access to mentorship for URiMs while also promoting diversity and inclusion in medicine as a whole.”

Reflections From a Faculty in Senior Leadership Dick Kuo, MD Professor and Chairman Henry J.N. Taub Department of Emergency Medicine Baylor College of Medicine

SAEM PULSE | NOVEMBER-DECEMBER 2020

“I have been department chair for three years now.

We recently, even before the most recent highlights on systemic racism, added diversity as one of our core values. I believe this applies to all of our institutions. It may not be overt, but it is subtle and omnipresent. With this understanding, diversity must be intentionally created and built within a department. There is a need to recognize unconscious bias and the creation of pathways to combat evaluation bias to ensure equal opportunity for advancement of all faculty.

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A Call to Action Academic programs with formal mentorship for URiM faculty have reported promising results. The University of California, San Diego implemented a faculty development program for URiM faculty that increased the retention rate in the medical school from 58 percent to 80 percent and retention in academic medicine from 75 percent to 90 percent.

Another program for URiM faculty and students at Creighton University and Wake Forest found similar results. The retention rate for the first year of the Creighton mentoring program was 58 percent compared to 20 percent prior to implementation, with mentees reporting improved career satisfaction and effectiveness in meeting career goals. The New Century Scholars program within the Academic Pediatric Association encouraged 63 percent of the URiM pediatric residents to enter academic careers.

"When I began my career in academic medicine more than 25 years ago, faculty development was not a widespread concept. Speaking with many colleagues, it seems that the “sink or swim” model was commonplace.

The Council of Residency Directors has begun to bridge this gap with their ‘Navigating the Academic Waters’ track, which focuses on faculty development.

Mentorship is critical to career development for URiM faculty within academic medicine, and we should formalize and decrease barriers to establishing mentor-mentee relationships.

Evaluation tools should be created to assess the effectiveness of URiM mentorship program.

It may be helpful to develop national guidelines for program evaluation that allow comparisons of programs. It may also be beneficial to create leadership positions dedicated to mentoring URiM faculty. There is a need to have more URiM representation within the top ranks of academic medicine. URiM faculty may be less likely to reach out for guidance if those leading them do not come from similar backgrounds, hindering academic advancement.

"Many junior faculty find it difficult to engage a system that is unfamiliar. Likewise, engaging junior faculty in a large department with meaningful mentorship remains a challenge for any department, given the lack of senior mentorship. Systemic biases must be combated with systematic solutions such as the creation of programs to formally address the mentoring needs of all faculty.”

Successful retention of underrepresented groups requires an institutional commitment to changing the academic culture and deliberative programming to support the challenges met by URiM faculty.

We are placing a call to action in establishing pragmatic programs that will strengthen and enrich our institutions.

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in healthcare and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Joining ADIEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side.

Select the box next to the academy you wish to join. Click “save.”

own mental and emotional health with regards to secondary traumatic stress we may incur on a daily basis.

SGEM: DID YOU KNOW?

ABOUT THE AUTHORS

Sex and Gender Differences in Traumatic Brain Injury r. Dany Accilien is a PGY2 D and rising chief resident for the 2020-21 academic year at the University of Chicago.

By Katherine Ku, MS4, Touro University California and Angela Jarman MD, MPH, UC Davis Emergency Medicine on behalf of the Dr. Arthur Pope is a PGY2 and Sex and Gender in Emergency Medicine Interest Group rising chief resident for the

While the incidence of traumatic 2020-21 academic year at brain injury (TBI) is higher in men, women who sustain TBI are more likely the University of Chicago.

He to suffer long-term sequelae such as memory loss plans to pursue a fellowship in and difficulty concentrating.

This may be related to medical education. underappreciated biological vulnerabilities to brain injury as well as gender-based differences in reporting and exposure. As TBI is one of the most common injuries leading to mortality in trauma patients, understanding how sex and gender contribute to incidence and mechanisms of injury in TBI has important implications for emergency physicians.

Estrogen has been thought to be neuroprotective in cerebrovascular accident. However, women tend to have worse outcomes and more complications when it comes to TBI. Some studies have shown that estrogen can exacerbate post-injury neurodegeneration and tissue loss in females. One recent study also found that men and women produce different inflammatory markers in the setting of concussion. Other studies have shown that women take longer to recover from TBI and are more likely to develop long-term sequelae such as working memory impairments, dizziness, fatigue, headache, anxiety, and depression. Women were also reported to be twice as likely to develop PTSD following TBI compared to men. Anatomical differences have also been suggested to contribute to increased susceptibility to concussion in women. Because the musculature of the neck is comparatively smaller in females as opposed to males, the head moves with more angular acceleration in females when impacted by the same force.

Gender-differences must also be considered when considering how best to care for TBI patients. A recent report from Pediatrics journal found girls to be at the same risk as boys for sport-related concussion, with concussion rates higher for girls in every sport. Girls tend to take longer to report symptoms of TBI, which may contribute to the longer recovery times. Additionally, intimate partner violence (IPV) as the mechanism of TBI hasn't been as thoroughly studied as sport-related head

injury though it is a significant cause of TBI in women.

This highlights a potential gap in how we model TBI and develop treatment guidelines.

There are clearly sex and gender factors at play when it comes to how TBI manifests in our patients.

But preclinical and clinical studies looking at how sex differences impact trauma have had mixed results, highlighting a complex interplay among hormones, anatomical differences, and gender that is still not fully understood.

SGEM "Did You Know?" is a recurring SAEM Pulse submission designed to represent concise facts that demonstrate how patient sex and gender effect emergency care. We welcome submissions. Please send contributions to the coeditors Lauren Walter and Alyson J. McGregor at sgem@lifespan.org.

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EDUCATION AND TRAINING

Contouring Your Career: A Brief Guide to Highlighting Achievements in an Educator Portfolio

By Jessica L. Nelson MD, David Manthey MD, Muhammad Waseem MD, Suzanne Bentley MD, MPH on behalf of the SAEM Education Committee

SAEM PULSE | NOVEMBER-DECEMBER 2020

What is an educator portfolio?

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An educator portfolio (EP) is a valuable tool for emergency physicians in academic careers, although it can be helpful regardless of practice setting. An educator portfolio is used to collate and highlight an individual’s educational philosophy, goals, and accomplishments; document scholarly activities and teaching; and cultivate multiple sources of educational expertise and progress. An EP serves as a summary and personal statement of the strengths and innovations in an individual educator’s work. In contrast to a curriculum vitae (CV), an EP is designed to be more narrative in format and capture more comprehensive evidence of educational performance; this includes documenting a wide range of teaching and education program details (e.g. teaching methods utilized,

“An educator portfolio serves as a summary and personal statement of the strengths and innovations in an individual educator’s work.” curricular examples, and representative learner evaluations and feedback).

How is an educator portfolio used?

An EP can serve a multitude of purposes depending on an individual’s position and desired advancement.

For example, an applicant for a faculty position at a new site can utilize an EP to document his or her teaching effectiveness. Established faculty can utilize their EPs to demonstrate the

scholarship of their educational work as they progress along the tenure track. As a career evolves based on a physician’s opportunities, talents, and mentors, an EP will similarly evolve.

Many medical schools and academic institutions require faculty to provide their professional achievements in an EP as part of the promotions process.

The EP is often also used during annual performance reviews, grant proposal submissions, and award applications.

Furthermore, an EP can go beyond simply reflecting changes in career trajectory to actually stimulating them.

EPs serve as invaluable tools for professional development by fostering self-directed reflection and periodic evaluation of career progress. Utilizing an EP to assess teaching efforts and programs also encourages educators to find opportunities for continued growth.

Even for senior faculty, the adaptation of an EP to the current time and educational milieu may allow one to find new areas for development or innovation and create a clear roadmap to continued success. In today’s digital world, sharing an EP online also allows peers to comment on one’s accomplishments and philosophies, offer up opportunities for collaboration, and develop avenues for mentorship.

How should an EP be formatted?

The exact format of an EP will vary for each individual and will transform over time with changes in educational philosophy and experience. EPs can also vary significantly in format and content, depending on their intended purpose. There are two main types of EPs (developmental and promotional), each with different objectives and content inclusion. Developmental EPs offer a broader perspective and more comprehensive collection of educational activities. They allow reflection, strategic planning, and demonstration of career and skills evolution. In contrast, promotional EPs are more commonly used to highlight only key educational achievements and activities. Promotional EPs showcase educational impact and should emphasize a faculty member’s involvement and reputation at institutional, regional, and national levels.

Many institutions have at least a basic outline of sections that should be included in an EP, although some may be stricter in their formatting to encourage uniformity for annual reviews and promotions. Faculty are encouraged to maintain both a developmental EP and a promotional EP. The developmental EP should be updated at least annually and be a comprehensive description of educational activities and products, as well as an outline of goals and future plans. This version can then be edited down to a promotional EP that can be submitted for academic promotion or another high-stakes assessment.

A promotional EP can be tailored to emphasize accomplishments that best

exemplify the philosophy or description of the position or promotion desired.

Depending on the reason for submission, an individual may have multiple versions of his or her promotional EP.

What should be included in an EP?

Typically, an EP should begin with a statement that reflects the creator’s educational philosophy and specific goals as an educator; the subsequent sections will then focus on summarizing the activities, products, and evaluations that have presumably fed into the development of this philosophy. The philosophy statement will normally be followed by a section on teaching and scholarly activities. This may be divided into subsections, including: 1.) education leadership, 2.) rotation/course leadership, 3.) curriculum development, 4.) didactic teaching sessions, and 5.) mentoring and advising. The remainder of the EP will also often include sections on publications specific to education, learner assessment, awards, and training to increase experience as an educator.

EPs can also be used to highlight involvement at the regional or national level through presentations, panels, and committee work.

There are multiple sources that can be used for examples of EPs. The Association of American Medical Colleges (AAMC) and multiple professional societies, including the Society for Academic Emergency Medicine (SAEM), have suggested outlines for formatting and sample educational philosophy statements. Because of institutional variations, asking a more senior faculty member to review an EP is strongly recommended prior to submission for promotion. Review by senior faculty and leadership on a regular basis also allows for mentorship and discussion of ongoing goals, thus fulfilling the potential of the EP to be utilized both for strategic career planning and advancement.

How do I start?

Effective documentation is the key to creating an EP. Physicians are encouraged to start compiling information and supporting documents as early as residency; these data can then be used to create an initial EP to facilitate the search for a junior faculty position.

The EP should be updated regularly to reflect career achievements and goals.

Digital resources, ranging from online storage platforms to citation managers to simple email folders, can be helpful in

the compilation of materials and serve as a reminder of accomplishments when it comes time to update an EP. Supporting documents can include, but are by no means limited to, teaching evaluations, awards, descriptions or photos of innovations, and curriculum outlines. Online faculty-created content such as modules, videos, web sites, or blog posts, should also be archived and included in an EP. Whenever possible, details regarding the number of learners who participated in activities and evidence of effectiveness should be incorporated, including qualitative evaluation comments if available. This attention to detail and timely updating of an EP will ensure its success as a powerful tool for career development.

ABOUT THE AUTHORS r. Nelson practices emergency D medicine and critical care at Washington University School of Medicine where she is an assistant professor and an associate program director for the Anesthesiology Critical Care Fellowship. r. Manthey is a professor of D emergency medicine at Wake Forest School of Medicine, founding chair of the Clerkship Directors in Emergency Medicine (CDEM), and medical decision making thread director. r. Waseem is a professor D of emergency medicine and pediatrics at Weill Cornell Medical College, New York and research director for the department of emergency medicine and vice chair for the Institutional Review Board at Lincoln Medical Center. r. Bentley is an attending D emergency medicine physician and the medical director of simulation at NYC Health+Hospitals/Elmhurst, an associate professor of emergency medicine and medical education at the Icahn SOM at Mount Sinai, and an advocate for the use of educator portfolios.

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ETHICS IN ACTION

The Placebo Effect

By Gerald Maloney, DO, on behalf of the SAEM Ethics Committee

SAEM PULSE | NOVEMBER-DECEMBER 2020

The Case

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You are managing a 48-year-old male patient with a history of chronic pancreatitis due to longstanding alcohol abuse who presented to the emergency department (ED) for vomiting and abdominal pain. He visits the ED fairly frequently (once a month) for similar complaints. He rarely has any acute lab abnormalities, and his labs tonight are unremarkable. He usually presents with pain out of proportion to his physical exam and lab findings. The nursing staff believes his complaints are “drugseeking” and he is requesting IV opiates on this visit. The nursing staff is asking you to let them give a saline flush in the IV and tell him he is getting a powerful new opiate called “normalsaline.” You think they are correct and believe he may have an addiction issue and may

be exaggerating his symptoms in an attempt to get opiates. He also has a history of being belligerent; however, you’re unsure if this is the right way to approach this patient. Should you give him the saline placebo, or is there a better way to handle this patient?

One of the most difficult and commonly encountered scenarios in clinical ethics is dealing with difficult patients and balancing aspects of justice, beneficence, autonomy, respect for persons, and non-maleficence. This balance can become even harder to achieve when the patient is challenging to deal with due to mental health issues, intoxication, or other personality issues (e.g. overt sexism or racism). When the patient has characteristics that we perceive as difficult or undesirable, we may find ourselves conflicted in our approach to the patient; subsequently, our view of as to what should constitute

ethical behavior in regard to the patient may be unclear.

Respect for persons underlies all other precepts of clinical ethics. It is a fundamental precept that we should view all patients with respect, irrespective of their circumstances or status. By approaching every patient from the same ethical level playing field, we start off treating everyone with the same level of respect. The other ethical precepts: autonomy, beneficence, nonmaleficence, and justice all flow from our basic concept of respect for persons.

Getting back to our scenario, there appears to be a lack of respect for the patient. The patient visits the ED frequently for chronic pain with an underlying disease process that may not be easily quantifiable with our usual diagnostic testing. He is also reported to be belligerent, loudly requests opiates, and has a history of substance use

“One of the most difficult and commonly encountered scenarios in clinical ethics is dealing with difficult patients and balancing aspects of justice, beneficence, autonomy, respect for persons, and non-maleficence.” disorder. These factors can create a negative impression of the patient among the ED staff and lead to “compassion fatigue.” Over time this can even result in a shift in behavior that results in a loss of respect and with it the rest of the basic tenets of ethical behavior. This makes it easier to engage in behaviors that can become unethical.

The nurse’s request to administer a syringe of normal saline while telling the patient it is a powerful new painkiller called “normalsaline” is unethical for many reasons. First, it violates both the principles of beneficence (we only act in ways to benefit the patient) and nonmaleficence (we do not act in ways that are deliberately not in the patient’s best interest). By not giving the patient pain medication when he is stating he is in pain, we violate these principles.

This does not mean we should give him opiates; there are alternative pain medications (NSAID, IV APAP, ketamine, IV Lidocaine) that are non-opiate and may be beneficial. By failing to administer an analgesic we are acting against his best interests. Further, we are denying him autonomy (ability to make a decision to accept or reject a proposed treatment) by being deceitful. While we may feel he is being deceitful in describing his pain and that we may not be acting in his best interest by administering opiates, by being deceitful ourselves and not treating his pain, we are failing to behave ethically and treat him with a basic level of respect as a human being.

How to proceed?

In this case the ethical way to manage this patient would be to inform him we will

provide pain medication, but that we do not feel opiates are the best treatment for his pain and offer an alternative analgesic.

If the patient becomes belligerent or wishes to refuse treatment because he is not receiving opiates, that is his prerogative. Behaving dishonestly cannot be considered ethical in interactions with patients.

ABOUT THE AUTHORS Gerald Maloney, DO, associate professor of emergency medicine, Case Western Reserve University and associate medical director, Louis Stokes Cleveland VA Medical Center.

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GERIATRIC EMERGENCY MEDICINE

Palliative Care Fellowship: An Option for EPs Passionate About End of Life Issues

SAEM PULSE | NOVEMBER-DECEMBER 2020

By Ashley Shreves on behalf of the SAEM Academy of Geriatric Emergency Medicine

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My emergency medicine (EM) residency director told me he was “surprised” (read “disappointed”) that I was not pursuing a fellowship. It was my third and final year of residency and I was going to stay on as an attending where I had trained, but with no clear niche. I wanted to be passionate about something in EM but none of the available fellowships were a good fit.

The hospital where I worked my first couple of years out of residency was surrounded by long-term care facilities and it seemed like a large part of the job would involve “doing everything,” no matter how uncomfortable or lacking in dignity, to prolong the lives of frail, older patients with advanced dementia.

I suspected that many of these patients would be horrified if their cognitivelyintact former selves could see the “care” they were receiving in their later years. The POLST (Physician Orders for Life-Sustaining Treatment) program was in its infancy in New York City so

“There has been an explosion of fellowship programs over the past decade and essentially all are available to emergency physicians.” advance directives rarely accompanied patients to the emergency department (ED). Unfortunately, when I tried to talk to family members about goals of care, I lacked any appreciable skills to navigate these discussions. In fact, I don’t think I was even familiar with the concept of a “goals of care conversation” and had only a rudimentary understanding of palliative care.

In 2009, I had a particularly challenging end of life case and my failure to advocate for the patient gutted me. I started to question everything.

Fortunately, that same year, a series of

articles were published in the July 2009 Annals of Emergency Medicine about a new subspecialty available to emergency physicians: hospice and palliative medicine. As I read these articles, the proverbial lightbulb went on, and soon after I started to research palliative medicine fellowships. Then in 2010 I read Atul Gawande’s “Letting Go” (the best piece of medical journalism ever written, in my opinion) and any lingering doubts were put to rest. In 2011, four years after completing residency, I started my palliative medicine fellowship at Mt. Sinai. It was a huge leap of faith

“Working in the ED is exciting and intellectually stimulating, but it can be a grind. Working on the palliative care service is deeply meaningful and rewarding but emotionally overwhelming at times. Each offers respite from the other.” for their program, as they had never before accepted an emergency physician, but I am eternally grateful they did. The year was supposed to be educational — instead, it was transformative.

Fellowship training in hospice and palliative medicine is 12 months long and officially recognized by the American Board of Medical Specialties and American Osteopathic Association; 2012 was the last year one could sit for these boards without completing a fellowship. There has been an explosion of fellowship programs over the past decade and essentially all are available to emergency physicians. I used to know a few dual-boarded EM-palliative medicine physicians; now there are too many to count. The application process has been streamlined as these programs now participate in the National Residency Match Program, with applicants using the Electronic Residency Application Service (ERAS). While I completed my fellowship over a one-year period, many programs offer more flexible training programs for the mid-career physician, allowing fellows to complete their requirements over a two-year period so that they can

simultaneously work as emergency physicians. When choosing a program, this is not the year to prioritize time off.

Since there are only 12 months of training, selecting a program with an intense clinical load and educational experience is critical.

Career opportunities abound for those who complete fellowship training. Some bring their unique skill set and knowledge base back to the academic EM setting to improve residency education and/or pursue research. Others split their clinical time between the ED and palliative care departments. Full and part-time hospice work is also an option, particularly for those who want to continue their work in the ED. Some EM physicians complete their fellowship training in palliative medicine and never look back, making the transition to full-time palliative care. For emergency physicians interested in quality improvement and administrative work, there are endless opportunities to integrate palliative care principles into the ED and hospital workflow. I have personally split my clinical time between both specialties, working in the ED and inpatient palliative care service at my hospital. Both jobs

are challenging and complex, but in completely different ways. Working in the ED is exciting and intellectually stimulating, but it can be a grind. Working on the palliative care service is deeply meaningful and rewarding but emotionally overwhelming at times. Each offers respite from the other.

There are endless opportunities in the form of online and in-person courses for those who want to improve their endof-life (EOL) skill set. But for emergency physicians deeply passionate about EOL issues, for those who want to devote their careers to the care of patients at or near the EOL, hospice and palliative medicine fellowship is a terrific option to consider.

ABOUT THE AUTHOR r. Shreves is an assistant D professor of emergency medicine specializing in geriatrics and palliative medicine at Mount Sinai’s Icahn School of Medicine. She is a member of SAEM’s Academy of Geriatric Emergency Medicine.

About AGEM The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

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MEETING AT THE CROSSROADS

SAEM PULSE | NOVEMBER-DECEMBER 2020

Telehealth and Geriatric Care

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Meeting at the Crossroads is a new column dedicated to bringing members of various SAEM interest groups and academies together to explore the areas where they intersect. In this inaugural column, Erica Olsen, MD, chair of the SAEM Telehealth Interest Group sits down with.James Kenny, MD, a member of SAEM’s Academy of Geriatric Emergency Medicine (AGEM) to discuss telehealth as a tool for delivering care to geriatric patients.

Dr. Olsen: Thank you for meeting with me today. I think our first conversation on this topic took place after the spring COVID surge subsided in New York City and we realized that a significant number of our virtual urgent care visits came from geriatric patients (older than 65 years of age).

Dr. Kenny: Yes, as we looked more closely at some of the patient characteristics, we saw that in several instances these geriatric patients had never accessed this telehealth service

previously, yet they were able to do so in the midst of a crisis.

Dr. Olsen: Let’s talk about that for a minute… as a telehealth provider, I can say that from my experience, family members — either adult children and/or grandchildren — are sometimes involved in assisting geriatric patients with access. What is your take on that?

Dr. Kenny: I think family members and caregivers can be valuable partners for older patients during telehealth visits.

We have some preliminary data from

our emergency department (ED) that more than 40 percent of patients 65 years of age and older required some form of assistance during their telehealth encounter. Caregivers have the potential to help older patients navigate obstacles such as using unfamiliar technology, adjusting the audio for patients with hearing difficulties, and providing an accurate history for patients with dementia or other cognitive impairments.

Dr. Olsen: I agree that family members were helpful. For those patients who do

not have family or caregivers nearby, we need to consider how we may facilitate access for this vulnerable population.

For example, we may offer to assist with downloading apps and provide education for all of our geriatric patients during their ED stay, or we may consider delivering technology and WiFi to patients in conjunction with our community paramedicine programs.

Dr. Kenny: Another area where telehealth may be integrated into ED operations is in the management of our stable geriatric patients who may be discharged home with close follow-up or observation. Some geriatric EDs have developed pathways where discharged patients have robust follow-up via phone calls. Integrating telehealth into such models may provide a more comprehensive reassessment.

Dr. Olsen: Right, it sounds like you’re talking about remote patient monitoring (RPM) whereby patients utilize home monitoring kits containing things like tablets, glucometers, pulse ox devices, blood pressure machines, scales to detect fluid retention, and cardiac monitors and then this information is transmitted to

medical professionals who determine whether or not a patient needs to come into the emergency department. It has potential to cut down on unnecessary ED visits and downstream effects of this, but it also provides patients with a level of security to know that they can receive guidance if and when they need to at their fingertips.

Dr. Kenny: Yes, we may also consider providing support and guidance to our geriatric patients that reside in long-term care facilities. Some health systems utilize telehealth for EM providers to consult with community skilled nursing facilities (SNFs).

In this way they may partner to assist with determining who may stay in place and who should come to the hospital. This communication bridge between the ED and SNF benefits all parties, especially the patient.

Dr. Olsen: It sounds like we agree that telehealth has the potential to enhance emergency medical care for our geriatric patient population. The recent expansion of covered services through CMS/ Medicare has allowed many patients and providers to experience these capabilities

(some, for the first time). We will need to keep this conversation going and continue to research these services if we want Congress to consider more permanency of these waivers that were temporarily put into effect during the COVID national health crisis.

BIOGRAPHIES r. Olsen is the director for D virtual health services in the department of emergency medicine at Columbia University Irving Medical Center / New York Presbyterian Hospital. She is the chair of SAEM's Telehealth Interest Group.

Dr. Kenny is the medical director for the Columbia Geriatric Emergency Department at New York–Presbyterian Hospital. He is a member of SAEM's Academy of Geriatric Emergency Medicine.

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THE VIRTUAL EDUCATOR

Interview with an Education Innovator: Insights for Faculty Looking to Teach Differently

SAEM PULSE | NOVEMBER-DECEMBER 2020

By Alexis del Vecchio MD on behalf of the SAEM Virtual Presence Committee

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COVID has upended how education is delivered. Over the next year, this column will interview innovators in academic emergency medicine education. For this issue we interviewed (virtually!) Venkatesh R. Bellamkonda, MD, an assistant professor in emergency medicine at Mayo Clinic, who shares insights for instructors to deliver engaging virtual content to learners. Dr. Bellamkonda has been involved in education since 2005. He was the curriculum director for the Quality Academy at Mayo Clinic, which involved teaching healthcare quality to more than 60,000 learners across the enterprise and served as the chair of education for all of Mayo’s emergency department (ED) service lines. Most recently, Dr. Bellamkonda shepherded the transition of Mayo’s emergency

medicine (EM) didactics to a virtual learning environment. He has also cocreated several virtual reality initiatives.

Tell us a bit about yourself and your path to emergency medicine education.

I have been involved in education since 2005. I was the Curriculum Director for the Quality Academy at Mayo Clinic, which involves Venkatesh R. Bellamkonda teaching healthcare quality to more than 60,000 learners across the enterprise. I serve as the chair of education for all of our emergency department (ED) service

lines. Most recently, I shepherded the transition of our emergency medicine (EM) didactics to a virtual learning environment. I also have co-created several virtual reality initiatives.

Embrace the power of performance and engage your learners.

How do you make your virtual lectures?

I taught ultrasound via Zoom to medical students. I knew my delivery had to be over the top. If I use hand gestures, if I use inflection, my delivery is more meaningful and efficacious. Be animated and aware of your speech. Don’t speak in monotone. Include striking visuals.

Tell a story utilizing your physicality

I edited down and created interactions between them and included case-based vignettes and questions, coming up with an asynchronous module for knowledge review and acquisition. We still conducted the hands-on donor body lab portion utilizing masks and social distancing.

This approach actually resulted in higher satisfaction scores from learners, reduced operational costs for the department, and the instructors enjoyed the experience as well.

To this end, which software has the lowest barrier to entry for instructors? and emotionality so you can create an experience that augments the talk. These are frankly the same challenges we faced pre-COVID.

How can you maximize your presence when teaching virtually?

You have to be aware of the camera.

Don’t look down. I also have a separate screen with my speaker notes that I put close to the camera. I try to memorize participants’ names. There might be resistance to mandating cameras from participants, but I would recommend doing so, if possible. You can also use virtual backgrounds.

How do you keep learners engaged in the talk?

For one of my lectures, I asked learners to pick a word that’s very challenging to use in common sentences. They picked anachronistic. I weaved the word in and asked them to raise their hand or give me a thumbs up when they heard it. You can even just intertwine people’s names.

When I see someone zoning out, I might say “Alexis would put the transducer right here.” Not calling you out, but bringing your consciousness back into the talk.

Welcome constructive feedback.

What is your advice to facilitate learner-centered virtual didactics?

Learners expect a lecturer to stand at a podium and deliver content via a slide show. If they are exposed to a different way of learning, just because it’s not the product they expect, they will be more critical of it. Also, the teacher may not be comfortable doing it, so they can look uncomfortable, rigid, or tentative.

Whenever faced with an educational endeavor, I ask myself: “What does the learner need?” and “What resources, including platforms and time, are available?” Then I match my content and approach to these answers.

What if your initiative is not well received? How do you get over negative feedback?

The difference between a really successful educational product and one that everyone thinks is horrible might be very small. Recognize you may not be far from being effectual, think about whether the product can be converted, and don't abandon it. As an innovator, you cannot be deterred by negative feedback. Also, ask yourself if the person providing you with feedback has actually thought about your goals.

What unexpected opportunities does our new virtual environment provide?

Since transitioning to Zoom and Google Classroom we’ve seen a 30 percent increase in participation in all levels of didactics, including Grand Rounds. We’re now getting viewers from the greater Mayo Health system. Next, I hope we can have early adopters at our sites in Arizona and Florida. Imagine the level of quality dialogue when we involve others from our community sites and around the world!

Utilize the full breadth of virtual platforms.

Can faculty be efficacious combining live teaching and virtual platforms?

I video recorded Drs. Rich Levitan and Ken Butler for our annual Levitan Airway Course for about five hours of content.

Zoom is very accessible. Rise360 is another option. Articulate Storyline requires more time. When teaching on Zoom, you can log in on your iPad and use Notability to doodle or draw on your slides. Our neurology department teaches quality improvement using RedCap. It’s like an educational “choose your own adventure” where if you get a question wrong, it directs you to read a paper or watch a video.

How can we make virtual lectures more hands-on and participatory?

Zoom has underutilized features. You can have breakout rooms with faculty as moderators. For Journal Club, you can assign the interns to discuss the methods for a paper, the senior residents can talk about the results, then you designate a speaker to share on behalf of each group and rejoin the main room and teach one other. You can poll your audience directly without third-party software. Also, Zoom doesn’t have to be stationary! I could go to the ED with a mobile camera. You could have a suturing workshop with different faculty demonstrating on pigs’ feet in different rooms. The possibilities are only limited by your own imagination.

ABOUT THE AUTHOR Dr. del Vecchio is an emergency medicine resident physician at Mayo Clinic, with a passion for education innovation. A professional actor, he created an acting-based course to improve the communication and interpersonal skills of healthcare professionals. He can be reached on Twitter @TheActorDoctor and at delvecchio.alexis@mayo.edu.

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Building a RAFFT: How to Create a Successful Mentorship Program for Women in EM

SAEM PULSE | NOVEMBER-DECEMBER 2020

By Kimberly Bambach MD, Kelli Robinson MD, Jackie Furbacher MD, Natalie Elder MD, PharmD, and Simiao Li-Sauerwine MD, MSCR

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Women in academic emergency medicine (EM) face unique challenges with respect to professional development and advancement. This year, our department successfully implemented a longitudinal mentorship program for female emergency medicine faculty, fellows, and residents. Inspired by sea otters that band together in “rafts,” we founded our own supportive RAFFT — a Resident And Faculty Female Tribe.

To create an engaging curriculum, we utilized Kern’s six-step approach. Here we outline the steps to implement a similar program within your own department, including pearls and pitfalls we encountered along the way.

Step 1: Problem Identification and General Needs Assessment

The first step focuses on opening up a conversation in your department.

Through these discussions, we recognized that female physicians in our department were searching for mentorship, sponsorship, and a forum to discuss issues related to gender disparities. After identifying this need, we asked for support from department leadership to implement our program.

Pearl: Get buy-in from all stakeholders including residents, chiefs, faculty, and departmental leadership.

Step 2: Targeted Needs Assessment

To understand the needs of our members, we sent a survey to the

female faculty, fellow, and resident members of our department. We asked our colleagues about their perceived need for a women in EM program, expectations of such a program, and how they felt such a program would contribute to their professional development, professional identity,

and personal wellness. Respondents also ranked their current knowledge and interest in 15 specific topics based on a Likert scale. Almost all of the respondents felt that a program for women in EM was needed. Support, mentorship, and professional development were common themes related to their expectations of the program. Listening to your colleagues’ priorities guides the next steps.

Pearl: Create a prioritized list of key session topics with your planning group (e.g. imposter syndrome, clinical communication, mentorship) and ask survey respondents for feedback.

Step 3: Goals and Measurable Objectives

What matters most in your program and what do you hope to achieve? Our goals included: • Creating a platform for professional advancement, mentorship, and sponsorship • Fostering a community of empowerment • Promoting personal wellness and worklife balance Your goals may change as your program grows. For example, after implementation of this program, our goals expanded to include research related to gender equity in emergency medicine.

Pearl: Be flexible and responsive to the needs and interests of your RAFFT

Step 4: Educational Strategies

What educational methods best fit your program’s needs? For our first sessions we utilized a flipped classroom approach with small groups to create a safe space for discussion. We curated presession resources, including brief videos, online articles, and academic journal articles, to serve as a framework to guide conversation on our chosen topic. We also developed a session guide for facilitators with the main points from each resource and thought-provoking questions for the participants.

Pearl: Let your creativity flow! For example, interactive infographics to advertise your session can be made on websites like Canva or in Powerpoint. To decrease time barriers, aim to limit prep time to 20-30 minutes.

Step 5: Implementation

This is the fun step! Get together with your RAFFT to engage in conversation and community. We found our discussions went beyond the curriculum to create a sense of togetherness that is especially beneficial in these difficult times. Due to the current pandemic, we met in local parks for safe social distancing and to enjoy the outdoors together. For planning purposes, the schedule for the academic year was sent in advance. Scheduling chiefs ensured protected time off for residents to attend.

To help with childcare and fluctuating schedules, we alternate evening and morning times.

Pearl: Choose a different location for each session so attendees can get out and explore.

Step 6: Evaluation and Feedback To date, our primary means of program evaluation has been in the form of attendance (despite clinical shifts and outside-of-work commitments, greater than 50 percent of women faculty and residents attend each session). We have also received positive verbal feedback from members who are grateful to be a part of such a program. We plan to evaluate the curriculum at the end of the academic year through a survey sent to all female physicians to obtain comprehensive data on the program’s impact.

Women in EM face unique challenges; however, we do not have to face them alone. By creating our RAFFT, we hope to reap tangible benefits in professional advancement, spark meaningful relationships, and create a culture of empowerment. We share our experiences so our EM RAFFT can grow. We wish the same for your program as well!

ABOUT THE AUTHORS Dr. Li-Sauerwine is an assistant residency program director and assistant professor of emergency medicine at The Ohio State University and the chief academic officer of the ALiEM Education Research Lab and Incubator. Her professional interests include physician well-being, resident professional development, and implicit bias in medical education. r. Robinson is one of the chief D residents in the emergency department at The Ohio State Wexner Medical Center. Her professional interests include emergency medical services, diversity, equity, and inclusion in medicine and education. r. Furbacher is a chief resident D in the emergency department at The Ohio State Wexner Medical Center. Her professional interests include social emergency medicine, health equity, and physician wellness.

Dr. Elder is a chief resident at The Ohio State University emergency medicine residency, alongside Drs. Furbacher, Bambach, and Robinson.

Her interests include geriatric emergency medicine and pain management. Outside of her clinical responsibilities, Dr. Elder enjoys spending time with her geriatric cats Shoshanna and Marcel.

Dr. Bambach is one of the chief residents at The Ohio State University. Her professional interests include medical education, podcasting, gender equity, and physician wellness.

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DR. ANDREW STARNES ON LEADING RAMS THROUGH A PANDEMIC WHILE SURVIVING — AND THRIVING — IN RESIDENCY Now as a third-year resident do you have any tips on surviving, perhaps even thriving, during residency?

The first thing is to start out right by picking the right specialty. Be very real about what your strengths and weaknesses are, then find the specialty (and residency) that best fit them. Each specialty offers unique benefits and challenges. Make sure the combination is well suited to your priorities and natural tendencies.

For instance, I think the hardest part of emergency medicine is the combination of oscillating sleep schedules with a hectic and high-pressure practice environment. Add on an often difficult social work component and it’s pretty clear how it would wear on someone. I personally don’t mind the sleep issues as much as most, generally enjoy the pressure, and don’t mind the social work aspects. If you like emergency medicine but struggle with one of these things, look for ways to change your perspective. If you really find more than one aspect challenging, it may not be the field for you.

Born in Portland, Oregon, Dr. Andrew Starnes was raised in Quilcene, WA, a small logging town on the Olympic Peninsula, Washington, where he graduated from a high school class of 25 students. He graduated from medical school at the University of Oklahoma where, after deciding on emergency medicine, he added an additional year for an MPH with a focus in health administration and policy. Dr. Starnes is presently a third-year emergency medicine resident at Wake Forest Baptist Medical Center.

While a third-year medical student at Oklahoma he applied to be a medical student ambassador for SAEM16 in New Orleans. This was followed by a one-year term serving on the inaugural RAMS (Resident and Medical Students) Board of Directors as a member at large. After serving for a year on the SAEM Membership Committee he was elected to the RAMS Board of Directors as the secretary-treasurer and, subsequently his current position as RAMS Board President.

Dr. Starnes was interviewed by Aaron R. Kuzel, DO, MBA, a PGY-2 at the University of Louisville School of Medicine, and the new associate editor of the RAMS section for SAEM Pulse.

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As for thriving, have wholesome activities that keep you grounded and help you decompress. For me it’s spending time with my family and hiking. Binging on TV is easy but engaging in something that allows you to unwind while building or achieving something else is ultimately more fulfilling and will help you recharge better than being entertained.

Who are some mentors who’ve helped shape your career so far and how did you find these mentors?

I had two docs in undergrad whom I spent around 200 hours shadowing. Dr. Michael Packer and Dr. Edwin Wells were wonderful examples who showed me early on that providing the highest quality of care requires really caring about the patients. I found them by asking around and was really lucky to have met them both.

In medical school Dr. Bo Burns at the University of Oklahoma was a terrific mentor. As our department chair he looked for opportunities to provide encouragement and that meant the world to me as a student. It helped me see what kind of a leader I would want to be if I were to find myself in a similar position someday.

At Wake Forest there are many incredible people and I have a handful of faculty members who I go to for several things; however, the person who first comes to mind is Dr. Henderson McGinnis whom I met at an SAEM annual meeting. Dr. McGinnis recruited me to Wake and has been a great voice over the last few years checking in with me, pushing me to do better where I can, and reminding me to stay centered. He is part of the reason I encourage students and residents to get involved in RAMS. The people you meet there really do shape your career and provide opportunities you never would have expected.

What are a few of your favorite FOAMed resources?

I use WikEM the most as it is succinct and useful in the daily practice of emergency medicine. Life in the Fast Lane (LITFL) is also good. As podcasts go, I really like Emergency Medicine Cases as they have just the right amount of depth without being too esoterically deep. Blake Briggs with EM Board Bombs has great 15-minute morsels that are entertaining. I know it’s not FOAMed, but I use EMRap a bit too, especially on a long drive.

What research topics get you fired up?

For the most part I’ve been largely opportunistic through medical school and into residency and think it’s important to be like that until you’ve had a variety of experiences and can figure out what you enjoy the most. I have an interest in operations, public health, and administration. I stumbled into looking at prehospital transport in Oklahoma with Kenneth Stewart, the state trauma registrar. We found that when comparing ground versus air EMS transport in pediatric trauma patients, distance rather than injury severity, was the main determinant for triage to air transport. We also saw that flying didn’t appear to provide a mortality benefit (at least with inhospital mortality), in spite of the greater cost.

From the prehospital work, I transitioned to more operationsand outcomes-focused subjects. Specifically, in residency I’ve looked at traumatic brain injury and heart failure outcomes in

Wake’s emergency department observation unit. This has been a great chance to look at the intersection of outcomes and systems operations.

One thing that students don’t realize is that while you do probably need some help with study design and statistics, you don’t have to be an expert to do research. In fact, picking something you don’t know a lot about but have an interest in and diving into that will help you learn so much. If you’re willing to take the initiative and put the time in, you can be the driving force of a project even as a student. It’s great for your development as a provider and a huge line on your CV to have first-hand research experience starting something from the ground up.

If you couldn’t be in emergency medicine, what would be your alternate career?

That’s a great question. I’ve wanted to be a doctor since I was a little kid, but I have had other jobs that I really enjoyed.

After high school I spent a summer working on a commercial salmon fishing boat in Alaska. It was one of my favorite jobs and in some ways prepared me for emergency medicine because I got used to working terrible hours around the clock. It was “wake up, clear the net, sleep for a few hours” and repeat. I also started out in undergrad as an English literature major and have always loved reading. So maybe a mix of teaching literature and working on a fishing boat in Alaska.

How and when did you first become involved with SAEM? With RAMS?

I was a third-year medical student at Oklahoma and I had several people tell me, “emergency medicine is great, but if you only see patients all the time, you’re going to get burned out.”

I wanted to find something that would make me even more competitive for residency, and something that allowed me to continued on Page 40

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ANDREW STARNES from Page 39 leave an imprint and change things for the better. I took a chance and applied to be a medical student ambassador for SAEM16. Attending the SAEM Annual Meeting and being involved in the Medical Student Ambassador (MSA) program changed the trajectory of my career. It really made me realize how emergency medicine is a community that isn’t hard to break into. I was very lucky too because the year I participated as an MSA was around the same time SAEM organized the inaugural RAMS Board, which I then got to serve on. It was a culmination of being in the right place at the right time and saying “yes” to everything. I never realized the opportunities nor the possibilities for me until I became an MSA.

What would you tell a medical student or fellow resident who asked you why he or she should become involved with RAMS? Would your answer differ pre- and postCOVID and, if so, how and why?

I think the real question is, why not? The cost is nominal and the experience is fantastic. It’s the best way to be involved in some facet of emergency medicine. No matter your area of interest, by being involved with RAMS you’ll find ways to get experience, network with leaders in the field, and add opportunities to your CV. The world shrinks a lot when you go to the meetings and take a look around.

As for pre- or post-COVID, I think the opportunities have always been present despite COVID. I actually think there have been even more opportunities to be involved given the ease of virtual interaction. The collaboration has continued despite the issues of social distancing, but I do miss the ability to meet with my board in-person and attend the regional and annual meetings.

What are the most pressing issues emergency medicine residents face today?

At the forefront of my mind are burnout and the proliferation of contract management groups that promote practices incompatible with physician wellness. I also consider provider education and longstanding debates regarding scope of practice to be pressing issues. We really need to be deliberate in how we shape the system not just for the interest of one party but with a collaboration among the many stakeholders. There is a lot of work to be done on these various fronts and I’m glad SAEM is taking a role on each of them.

How did COVID impact and/or alter your plans/goals for RAMS for 2020? How have you adjusted as a group to the limitations COVID has placed on the ability of RAMS to meet in-person?

Yes, COVID changed the way we were able to operate, but at the same time, RAMS is a nimble entity that is enthusiastically supported by SAEM leadership. COVID shook things up in

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that it accelerated much of what we wanted to accomplish anyway, especially from a digital products and outreach perspective. Don’t get me wrong, there is nothing like going to the annual meeting is an awesome experience and we can’t necessarily replace it, but the move to virtual has provided opportunities to improve our digital content, grow our RAMS brand, and ultimately reach even more students and residents.

How do you personally manage stress and maintain work/life balance, particularly during this unprecedented time of COVID?

I don’t think COVID changes people, but the added stressor definitely puts a spotlight on the difficulties of the job. For me, it has been more of a personal stressor as my kids’ schedules were significantly changed and, in turn, my wife and my schedules were altered along with them. Honestly, there is nothing we can do about it, but we are a “make lemons out of lemonade” type of family. We’ve engaged in more outdoor activities, had more family movie nights in the middle of the afternoon, and used this time as an opportunity to re-center and reinvest in a couple of things. While we miss the social stuff, it’s been good to refocus as a family and cut out some of the distractions that weren’t really fulfilling.

Second, what advice would you give to an individual who is struggling?

You’re not alone. With or without COVID, medical school and residency are tough. Remember, this is a process everyone goes through. There are many resources out there to help you — peers, family, mentors, faculty, and/or your program director.

These are people who want to see you succeed. Don’t get caught up in the common mistake of thinking it’s a competition or diminish your accomplishments because you think someone else is ahead. Everyone has had their successes and failures.

Enjoy the ups, learn from the downs, and if you are really having a hard time seeing that you have a lot to be proud of, talk to someone who can help you open your eyes.

What do you think our industry as a whole can do to address COVID-related stress and improve physician well-being

Take a look around. We’ve gotten a lot of love from many places and many people. Everywhere there are signs that say things like “heroes work here” or “not all heroes wear capes.” I don’t know about your department, but no one was saying those things to me last year. There has been a lot of positive media and outpouring of support for healthcare workers. I think it’s nice to take a moment and be grateful. It’s hard for me to be grateful and frustrated at the same time.

The dynamics of emergency medicine are both rewarding and demanding. This practice style disposes people toward burnout.

I would like to see our industry leaders apply the literature and really make positive interventions to address physician burnout and improve the longevity of emergency physician careers. There are clear factors that expedite burnout yet they remain common practice; for example, 12-hour shifts and unsafe volumes. It may cost more money to address these issues, but doing so will save people.

The impact of COVID has been felt profoundly in the area residency application. Any advice for medical students entering the match this year with all the virtual changes.

I’d first tell them it’s going to be ok. The number of positions and applicants hasn’t changed. I recognize this is a stressful time, but they will be just fine and the vast majority of applicants will match successfully into supportive programs just like last year and the year before that. The numbers are still on their side.

There are programs that may not be a great fit for some people, but the reality is that no matter where you match, it’s up to you to make the most of your training. Great residents are great no matter where they are and as long as you apply yourself, you’re going to do well.

We are entering the final months of 2020…

What would you say has been your most significant contribution to RAMS during your tenure?

Our biggest accomplishment was the SAEM Virtual Residency Fair because this event embodied everything that RAMS was designed for. The SAEM Virtual Residency Fair met the needs

"THERE HAS BEEN A LOT OF POSITIVE MEDIA AND OUTPOURING OF SUPPORT FOR HEALTHCARE WORKERS. I THINK IT’S NICE TO TAKE A MOMENT AND BE GRATEFUL." of our membership, was innovative, and made more students aware of the opportunities SAEM and RAMS has to offer.

What would you like to see the next president accomplish?

I would like to see the next president continue growing and expanding the digital products RAMS has to offer, but I also hope he or she offers another innovative direction and builds resources for our members in other areas. I would think it the ultimate compliment if the new president, at the start of his or her tenure, reviewed what I accomplished and said, “well I can’t think of anything to add so let’s do something else.”

Where do you see yourself in five years?

Owning my craft as a physician and really learning how to manage an emergency department. Once I get to that level, I hope to apply my skills toward making the system better from an administrative perspective and get involved more in education.

…20 years?

Honestly, I hope to be practicing regular clinical hours parttime, participating in some clinical education part-time, and doing something really crazy like having an affiliation with a clinic in South America and living the quintessential emergency medicine life: treating disease, investing in myself and family, and having adventures through medicine in ways I could never have imagined. And fishing. Lots of fishing.

Anything else you’d like to add?

I am very proud of this year. RAMS has really come together, even with the challenges of COVID. Everything we have accomplished has been doable because of the many wonderful colleagues I have as board members. I am confident this next group of leaders is going to accomplish amazing feats over the next few years and I'm excited to see where they take RAMS.

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RAMS LEADERSHIP IN EMERGENCY MEDICINE AWARD RECIPIENT DR. SRIRAM VENKATESAN TALKS RESEARCH Sriram Venkatesan MD (@SriramVenkatMD) is an MS4 at Sri Ramachandra Medical College and the 2019 RAMS Leadership in Emergency Medicine Award recipient. While a medical student, he founded his institution's first Emergency Medicine Interest Group (EMIG) in India, developed a framework for the development of EMIGs Sriram Venkatesan, MD throughout the country, and wrote curricula for EMS physician and prehospital providers which paved the way for establishing a disaster response team in his city.

Dr. Venkatesan was interviewed for this article by Adrian Cotarelo MD.

Can you give us a little background on your particular interest in the field?

Growing up, I always wanted to pursue a career in healthcare.

It was not until junior year of high school that I was introduced to the emergency department of a local hospital as a volunteer. Within the first six months of volunteering, I fell in love with the specialty. Starting medical school in India, I focused on my strengths and spent a great deal of time helping out in the emergency department (ED). The physicians were very warm and always up for teaching me something new. It was there that my interest in emergency medicine was solidified.

I love the idea of taking care of undifferentiated patients of all age groups, from neonates to older adults and across a broad spectrum of conditions: cardiovascular, respiratory, and trauma. Often in emergency medicine, we are entrusted with taking care of patients at some of the most difficult times in their lives, and it is my honor to be an advocate for my patients who may not be able to advocate for themselves.

Can you briefly summarize the highlights of your research?

Our study, “Retrospective Study Comparing the Scoring Systems Used in the Emergency Department in Predicting the Mortality of Critically Ill,� focused on comparing the two most commonly used scoring systems for predicting the mortality risk of critical care patients in the ED: The Rapid Emergency Medicine Score (REMS) and Modified Early Warning Score (MEWS). It was our objective to find out which one of them

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"I LOVE THE IDEA OF TAKING CARE OF UNDIFFERENTIATED PATIENTS OF ALL AGE GROUPS, FROM NEONATES TO OLDER ADULTS AND ACROSS A BROAD SPECTRUM OF CONDITIONS: CARDIOVASCULAR, RESPIRATORY, AND TRAUMA."

was more effective in calculating the mortality risk in the ED. We concluded that though both had similar performances, MEWS performed better than REMS.

What are the next steps moving forward for this research; do you plan to build on this?

Our original plan was to develop a new scale, incorporating effective aspects from both of the scales. However, my move back home to the U.S., along with the COVID-19 pandemic, has made international collaboration difficult, so our project is currently on hold.

What have been the major challenges of this research project? Any advice for future researchers pursuing this field?

This was the first research project I pursued during medical school, and at the time I did not have much formal guidance

on writing up a research proposal or presenting my proposal for IRB approval. For any medical student/resident interested in getting into the research, I would highly recommend that you spend time background researching your topic of interest and find a mentor (preferably in emergency medicine with significant research experience) you think would be interested in investing time and guiding you through the entire process.

Did you have a mentor when you first started out your research career? What is the key to a successful mentoring relationship?

Though I did not have a specific research mentor for this project, my personal mentor, who also happened to be the chair of our emergency department, was more than happy to answer my questions and help me out along the way. I think a successful mentoring relationship is key to any research project, especially when you’re just starting off your research career. Some of the key elements of a mentor’s job is to help you define your scientific focus, set goals, and work with you along the way to fine tune different aspects of the study in order to reach your goals. Good communication and frequent debrief sessions with your mentor are probably the two most important factors that would establish a closed loop communication and maintain clear expectations between both of you.

In completing this project, did you collaborate with anyone from fields or departments different from yours? If so, please comment on how this collaboration impacted your research.

Towards the end of our project we collaborated with the department of community medicine, a sub-specialty of public health, to help us out with crunching the numbers and analyzing the data we collected.

What have you found most satisfying about incorporating research into your medical career?

Getting started on research so early on in my career is probably one of the best decisions I have made. Working on research articles, often in new areas of interest, is pretty exciting and I would say the fact that the work we do today has the potential to impact healthcare and the world for years to come, has definitely pushed me to work on more projects.

ABOUT THE AUTHOR: Dr. Cotarelo (@AdrianCotarelo), is a PGY-2 at St. John's Riverside Hospital in Yonkers, NY where he serves as the director of resident research. Dr. Cotarelo is a RAMS board member-at-large as well as a RAMS Board Liaison to the SAEM Research Committee.

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"RACISM IS A DEEP-ROOTED DISEASE THAT IS HIGHLY INFECTIOUS AND SPREAD VIA PREJUDICE AND XENOPHOBIA. TREATMENT IS DIFFICULT AS IT REQUIRES THE PATIENT TO HAVE AN OPEN MIND AND BE RECEPTIVE TO INFORMATION. IT MAY TAKE GENERATIONS TO OVERCOME."

COVID-19 THROUGH THE EYES OF AN ASIAN-AMERICAN DAUGHTER AND MEDICAL STUDENT

By Hanh Duong, MS4, Ross University School of Medicine As the fear of COVID-19 grew back in March 2019, many medical students were removed from their clinical rotations, I included.

Soon after, I received an email from Prometric and USMLE (United States Medical Licensing Examination) stating that my STEP 2 Clinical Knowledge (CK) exam had been canceled until further notice. I decided to return home to San Jose — one of the few spots in California that had large numbers of COVID cases. Both of my parents were older and in high-risk groups; however, they did not believe in the severity of COVID at that time. Despite medical advice, my parents, 70-year-old Vietnamese Americans with multiple comorbidities, stubbornly continued to frequent grocery stores, restaurants, and church gatherings without facial covering. Not until significant numbers of deaths and cases rose, and the local church was forced to shut down did they finally acknowledge its seriousness.

Among the Asian community most continued to believe that COVID was part of a political agenda started by foreign enemies. In other words, that it was a flu-like illness that was blown out of portion to cripple the American economy. Even despite over 200,000 deaths now due to COVID, people continue to cling to this conspiracy theory, my parents included.

California has always been a diverse state, home to people of all ethnicities, and San Jose— specifically East San Jose — was composed of mostly Chinese and Vietnamese families.

However, due to the circulating theory that COVID had been produced by China, hate crimes began to rise. My neighborhood became a target as it was the center of the Asian community. Many homes were vandalized and a few older Asian folks were victims of burglary and assaults. Online, there were multiple threats of organized looting and rioting by autonomous, extreme and militant political groups. I remember getting a text from my friend with a screenshot from an online Facebook

group listing different Asian populated areas that were targeted for vandalism — our neighborhood was listed. Between worrying about my parent’s safety, exams, and clinical rotations, my anxiety peaked. I had to protect my family, not just from this highly infectious virus, but also another invisible virus: racism.

Other than carrying pepper spray and installing security cameras and extra locks, what more can a person do to protect themselves? Yes, these tangible barriers are adequate in preventing bodily harm, but what about the mind? Racism is a deep-rooted disease that is highly infectious and spread via prejudice and xenophobia. Treatment is difficult as it requires the patient to have an open mind and be receptive to information. It may take generations to overcome.

COVID-19 has brought to the surface many issues in America, ranging from racism to healthcare disparities. I wish I could say there have been improvements since six months ago, but unfortunately, from where I am at, things remain much the same. My hospital still has an unstable supply of PPEs. Nurses continue to weekly ration their N95 masks. My parents and their neighbors still live in fear of the possibility they may be the next victim of hate crime. I believe that through this pandemic, people will become more aware of the many issues that surround them. Only then, can we grow and emerge as a stronger community and nation.

ABOUT THE AUTHOR: Hanh Duong is an MS4 from Ross University School of Medicine and an aspiring emergency medicine physician.

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BRIEFS AND BULLET POINTS SAEM NEWS & INFORMATION

Coming December 1: Environmentally-Responsible Health Care

REGISTER for EnvironmentallyResponsible Health Care, next in a series of webinars from the Climate Change and Health and Wilderness Medicine interest groups. Health care providers have a responsibility to protect all our patients, and that means also being aware of and minimizing our pollution.

Learn the environmental impacts of health care, their downstream harms to our communities, and the tools that can be used to reduce them.

Reminder: Nominate Your 20212022 Leaders!

Nominations are being accepted through November 16, 2020 for leadership positions for SAEM, RAMS, AACEM, SAEM Academies, and the SAEM Foundation. Leadership positions should be filled by committed individuals who have a wide range of perspectives and possess the relevant skills and experience to effectively lead. If you, or someone you know, fit that description we invite you to submit a nomination in one or more of the categories listed at the nominations webpage.

and RAMS awards. These awards recognize outstanding individuals for their contributions to academic emergency medicine. National award recognition is an excellent boost to your CV and for potential promotion. Nominate yourself or a colleague by December 9, 2020 to be considered for this year’s awards.

development, advising, and mentorship.

Applications for the 2021–2022 class are being accepted through November 6, 2020. Three CDP scholarships, which cover the full tuition plus a travel stipend are available. Visit the scholarship webpage for details and application links.

Dr. Aaron Kuzel Named Associate Editor of the RAMS Section for SAEM Pulse

The newest version of SOAR (SAEM Online Academic Resources) gives you a variety of recorded presentations from three years of SAEM annual meetings, all in an enhanced, easy-to-navigate and share format. Check out this issue's featured categories!

Aaron R. Kuzel, DO, MBA is the new associate editor of the SAEM Pulse RAMS Section. Dr. Kuzel is an emergency medicine resident Aaron R. Kuzel at the University of Louisville School of Medicine and is currently serving as a member-at-large on the SAEM RAMS Board and as co-chair of the SAEM Membership Committee’s Learners Subcommittee. Dr. Kuzel is a graduate of the DO/MBA program at Lincoln Memorial University College of Osteopathic Medicine where he received induction into Sigma Sigma Phi (SSP), the Gold Humanism Honor Society (GHHS), and Omega Beta Iota (OBI) the Osteopathic Health Policy Honor Society.

Prior to medical school, Dr. Kuzel was employed as a Forensic Scientist for the United States Department of Justice and continues to explore his interest in forensic emergency medicine, tactical emergency medicine, health policy, rural emergency medicine, and EMS. In his 12-month appointment as a Pulse associate editor, Dr. Kuzel is responsible for ensuring that each issue of the SAEM Pulse RAMS section contains timely and relevant RAMS-focused content.

Accepting Applications and Scholarship Applications for the 2021-2022 AACEM Chair Development Program Accepting Nominations for the 2021 SAEM Awards and RAMS Awards SAEM and RAMS invite you to nominate your exceptional colleagues for one of several SAEM awards (including the NEW Mentor Award and Fellow Awards)

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The Association of Academic Chairs in Emergency Medicine (AACEM) Chair Development Program (CDP) is a leadership training initiative designed to enhance the capabilities and effectiveness of new and aspiring academic emergency medicine department chairs through skill

SOAR Featured Categories

•S imulation •R AMS •C ritical Care/Resuscitation •E thics •H ealth Policy •N eurology/Psychiatry •P ediatrics

Let SAEM’s Expert Consultants Help You With Teaching, Research, and Other EM Practice Issues

SAEM committee and academy members possess expertise in teaching, research and other aspects of academic emergency medicine (EM) practice. Through SAEM Consultation Services, these experts, in consultation with Association of Academic Chairs of Emergency Medicine (AACEM), are available to assist individuals, departments, and institutions with developing, evaluating, and/or improving various services; developing departmental status for EM divisions; subspecialty expertise (research, ultrasound, etc.); and billing, patient safety, etc.

Visit the SAEM/ADIEM Diversity, Equity, and Inclusion Library

The Diversity, Equity, and Inclusion (DEI) Library, from SAEM and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM), is an online resource for emergency physicians to learn more about achieving health equity and eliminating health disparities. The DEI Library is organized by media type and categorized in seven subject areas.

SAEM’s Research Learning Series Offers Valuable, Online Research Content

SAEM’s Research Learning Series (RLS) features valuable education on popular emergency medicine research topics delivered by experts in the field of emergency research. Sign up for these high-yield, interactive educational events for free, or view previous podcasts and lectures, housed online at the RLS webpage.

A Resource from Inflammatix: Challenges in Diagnosing Infection in the ED

Acute infections account for 15 million visits to U.S. emergency departments every year. Inflammatix Inc. has developed a series of educational videos* on subjects related to acute infection and sepsis diagnosis, and how to address them with 3-score testing. Visit the website to learn more and watch the latest episode.

Now on Video!

SAEM Webinars •C limate Change and Health Interest Group and Wilderness Medicine Interest Group Webinar Series

–T he Climate Crisis, COVID-19, and Emergency Medicine: Parallels, Intersections, and a Health Recovery

–T he Power of Nutrition

• PEM IG Virtual Presentation of Top Abstracts from SAEM20 • Virtual Mentoring Hour: Teaching Anti-Racism Through Simulation •A DIEM Webinar Series: How to Be a Successful EM Applicant

–F undamentals of the EM Application Process

–M aking Your ERAS Program List

–H ow to Ace Your EM Rotation

–S pecial Considerations

–C linical Scenarios

– Evaluating Which Program is Right for You

–T he Interview

–M entorship and Personal Advocacy

*SAEM is providing this content as a resource for members, and does not imply endorsement of the products, resources, or information provided.

Let SAEM Help Connect Your Talent With Job Opportunities

Looking for your next emergency medicine job? Check out who’s hiring in the “Now Hiring” section of this issue of SAEM Pulse and on EM Job Link. Your dream job is waiting… let SAEM help you find it! Have a job opening you wish to fill?

Contact John Landry, SAEM manager, business development, for details on how we can help: (847) 257-7224.

SAEM JOURNALS AEM E&T is Accepting Papers for a Special Issue on Dismantling Racism With the Next Generation of Learners

Medicine is not immune to overt acts of racism and continues to enable the pervasive economic, educational, racial, gender, gender identity, and healthcare inequities that are held up by the infrastructure of our country. How do we reconcile these long-standing issues in our daily practice and in our medical education? What are the solutiondriven methods that will enable us to incorporate advocacy as a separate milestone of emergency medicine beyond system-based practice to hold our training up to the standards that reflect the socially conscious morals we profess to have in our specialty? And, how can we interweave these tenets throughout the continuum of medical education from undergraduate, to graduate, to board certification standards, and to our r esearch agenda and departmental policies? A special edition of Academic Emergency Medicine (AEM) Education and Training will be dedicated to this discussion and to the exploration of innovations in medical education to address these issues. Follow the link for details.

Call for Papers: AEM Special Issue on Scientific Inquiry Into the Inequities of Emergency Care To address a pervasive and wide knowledge gap about the science of inequities in emergency care, Academic continued on Page 48

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BRIEFS continued from Page 47 Emergency Medicine (AEM) will publish a special issue in the fall of 2021. A primary focus of this issue will be on the impact of race and ethnicity inequity, with a preference toward original-based research that addresses patient-centered topics as well as inequities that affect clinicians of color in their professional roles. Priority will be given to papers with intervention-based, original data. All papers will undergo peer review. Deadline is February 28, 2021. For details follow the link.

Drs. Lee and Brazil Named to AEM E&T Editorial Board

Victor Lee, MBBS, MHPE and Victoria Brazil, MBBS, MBA have accepted an invitation from Academic Emergency Medicine Education Victor Lee and Training (AEM E&T) Editor-in-Chief Susan Promes to join the AEM E&T Editorial Board as decision editors. Dr. Brazil is a professor of emergency Victoria Brazil medicine and director of simulation at Gold Coast Health and faculty of health sciences and medicine at Bond University, Queensland, Australia.

Her main interests are in connecting education with patient care through healthcare simulation, team development,

and listening at conferences. She also serves as a faculty member with the Harvard Macy Institute. Dr. Lee is an associate professor in the Centre for Integrated Critical Care, University of Melbourne and co-director of emergency medicine training, Austin Health, Melbourne, Australia. He has a master’s of health professions education and has experience in undergraduate, postgraduate and simulation based education.

AEM Editor-in-Chief Commentaries for September and October

To facilitate the rapid dissemination of COVID-19 findings, Academic Emergency Medicine and AEM Education and Training have been fast-tracking submissions related to COVID-19 and making the latest research available in online collections of accepted, citable COVID-19 articles. These collections are being updated constantly, so be sure to check frequently for the latest COVID-19 research from SAEM journals!

For each issue of Academic Emergency Medicine journal, editor-in-chief Dr. Jeffrey Kline selects one paper as having particular significance and/or importance to the care of patients during times of emergency. He shares his thoughts and observations regarding these studies in regular “EIC Pick of the Month” commentaries. Dr. Kline’s September and October commentaries are below:

• AEM Online COVID-19 Collection

• Clots in COVID

The SAEM21 Program Committee was thrilled with the number and quality of SAEM21 didactic and Advanced EM Workshop Day submissions received! We are on track toward a stellar virtual annual meeting, May 11–14, 2021! Thank you to everyone who submitted; your contributions enable us to continue to provide the highlevel of educational content that make the SAEM Annual Meeting the premier event for academic EM.

• Getting Serious

AEM E&T October EIC Pick: Empowering Clinician Education With POF

Academic Emergency Medicine Education and Training (AEM E&T) Editorin-Chief Susan Promes, MD, selected Empowering Clinician Education With Patient-Outcome Feedback by Kenneth V. Iserson MD, MBA as her EIC Pick for the October issue of AEM E&T. She shares her thoughts and observations regarding the study in a recent EIC pick commentary.

The Latest Podcasts from SAEM Journals!

September AEM Podcasts

• Diagnostic Performance of Emergency Physician Gestalt for Predicting Acute Appendicitis in Patients Age 5 to 20 Years • We Didn’t Start the Fire But Can Antacid Monotherapy Stop the Fire?

October AEM Podcast • Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting October AEM E&T Podcast • Emergency Medicine Resident Education on Caring for Patients with Disabilities: A Call to Action 48

Check Out the Latest Additions to the Online COVID-19 Collections for SAEM Journals

• AEM E&T Online COVID-19 Collection

ANNUAL MEETING UPDATES Workshop and Didactic Submissions Exceed Expectations!

SAEM20 Clinical Image Series:

The SAEM Clinical Image Series is a collaborative series with ALiEM (Academic Life in Emergency Medicine) and features the winners of the SAEM Annual Meeting Clinical Images Exhibit competition. Check out the images, read the case notes, and see if you can figure out the diagnosis before you reveal the answer. Images from the SAEM20 virtual meeting are posted below; all images will be highlighted throughout the coming year in SAEM Weekly at the ALiEM website.

SAEM Clinical Image Series: Knee Pain

by Eric R. Friedman, MD, Garrett A. Cavaliere, DO, and Diane Kuhn, MD, PhD, University of Maryland Medical Center Red, White, and Blue by Andrew D’Alessandro, MD, and Elena James, MD, Vanderbilt University Medical Center Man vs Pneumatic Nail Gun by Jillian Merica, MD, University of North Carolina Hospital Systems

Worsening Sore Throat by Victoria Silver, DO, Katherine Braxton, MD, and Stephen Lim, MD, Louisiana State University – New Orleans

Ask-a-Chair podcasts are also available on iTunes.

SAEM Foundation Announces Challenge Winners!

Distended Abdomen After ROSC by Sheri-Ann Olivia Kaltiso, MD, Emory University Juvenile Snake Bite by Keegan McNally, MD, and Larissa Dub, MD, University of Central Florida College of Medicine An Oropharyngeal Mass by Matthew Sherman, MD, Cassandra Mackey, MD and Stacey Hail, MD, University of Texas Southwestern Medical Center

Mark Your Calendars!

Abstracts Nov. 1, 2020 – Jan. 4, 2021 Innovations Nov. 1, 2020 – Jan. 11, 2021 IGNITE! Nov. 1, 2020 – Jan. 11, 2021 Clinical Images Exhibit Dec. 1, 2020 - Jan. 11, 2021 Medical Student Ambassadors Applications open Dec. 1, 2020

RESIDENTS AND MEDICAL STUDENTS Dr. Andrew Nugent is Featured in Latest RAMS Ask-a-Chair Podcast

SAEM RAMS has compiled your most pressing questions and posed them directly to some of the top EM department chairs in the country. They discuss their answers in the SAEM RAMS Ask-a-Chair podcasts.

Andrew Nugent The latest RAMS Ask-a-Chair podcast features Andrew S. Nugent, MD, University of Iowa Hospitals and Clinics. Dr. Nugent reveals what motivated him to start an EM residency, what it took to achieve this goal, and how the department has changed since then. He offers guidance on making difficult decisions and gives advice on what residents and early career faculty can do to position themselves for senior leadership roles as their careers progress.

SAEM FOUNDATION

New to RAMS Roadmaps: Geriatric EM Track!

Are you interested in improving emergency care for older adults? The recently-added RAMS Roadmaps Geriatric EM Track provides resources and insider advice to help you succeed in geriatric EM at every training level.

RAMS Roadmaps provides guidance to the second-year medical student looking to get into an emergency medicine residency, to individuals looking for timelines and insider advice on advanced training, and even to seasoned attendings transitioning to academia.

Looking for the Perfect Fellowship?

Check out the SAEM-approved fellowships in the Fellowship Directory.

All SAEM-approved fellowships have been vetted by experts in administration, disaster medicine, education scholarship, geriatrics, global health, research, and wilderness medicine. They will provide you with the knowledge and skills you need to excel. Under “Fellowship Type,” just click on those marked “SAEMApproved” to see the list of all programs endorsed by SAEM.

Now on Video!

RAMS Webinars • Finding a Home Away From Home: Challenges of the Match Faced by URM Applicants and Those Without an Affiliate EM Program • RAMS: The Inside Scoop on Academic Jobs • RAMS: Matching Into EM, How We Got Here and Where Are We Going Webinar

Together SAEM committees, academies, and interest groups raised a total of $20,370; SAEM will match that amount with an additional $10,000, for a grand total of $30,370 for EM research and education grants. On behalf of SAEM and SAEM Foundation, thank you to everyone who contributed to the 2020 SAEMF Challenge. If you’d like to know how you can give to the SAEM Foundation, please visit the SAEMF website.

Most Money Raised

Committees - SAEM Grants Committee — $6,295 Academies and Interest Groups - Academy for Diversity & Inclusion in Emergency Medicine (ADIEM)—$16,917 Honorable Mention - Academy of Women in Academic Emergency Medicine - Research Directors Interest Group

Most Participation

Committees - SAEM Bylaws Committee Academies and Interest Groups - Research Directors IG Honorable Mention - Finance Committee

Shop Online at Amazon and a Percentage of your Purchases Will be Donated to the SAEM Foundation

Do your holiday shopping at Amazon Smile and select SAEM Research Foundation as your charity of choice and Amazon will donate a percentage of your purchases dollars to the SAEM Foundation. It’s an easy way to support your emergency medicine academicians while you do your online holiday shopping!

SAEM MEMBERSHIP Renew Your Membership and Keep Your Career Goals On Track Renew your SAEM membership now to ensure you continue to receive all the

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benefits you’ve come to expect including:

• Access to SAEM’s Community Sites — your online space for connectedness, collaboration, and communication

• SOAR (SAEM Online Academic Resources), our database for free, open access medical education

• View our SAEM Membership Guide to acquaint yourself with everything that’s available to you as a member of SAEM.

• SAEM Pulse our member magazine with in-depth articles on the trends, issues, and best practices that affect academic emergency medicine

Renewing is easy! Just select one of the options below:

• Academic Emergency Medicine (AEM), SAEM’s monthly journal, featuring the best in peer-reviewed, cuttingedge original research relevant to the practice, investigation of emergency care, and its quarterly sister journal, Academic Emergency Medicine Education and Training (AEM E&T).

• Download and complete a membership form

BRIEFS continued from Page 49

• Log in to an existing account or create an SAEM account

• SAEM Weekly weekly e-newsletter of current emergency medicine news, trending articles, and “need to know” SAEM information • Members-only content at SAEM.org • Free membership in SAEM academies and interest groups for those interested in networking, sharing ideas, and learning more about a specific topic or specialty area • Grant opportunities to help fund innovative research and education in the field of emergency medicine • Opportunities to further your professional development, expand your professional network, gain leadership experience, and strengthen your ties within the specialty by serving on one (or more) of the Society’s many committees and in leadership positions in SAEM • Research resources to help you with study design, implementation, evaluation and dissemination

• Make a payment over the phone: (847) 813-9823

Medical Students: Renew Your RAMS Membership for as Little as $20 When You Sign Up With a Group of 50!

RAMS member benefits and opportunities will bolster your resume, guide you in choosing a specialty, broaden your knowledge, connect you with a network of mentors, and provide resources to give you a leg up in your career. The cost for membership is only $25 per student or $20 if you sign up with an institution of 50 or more medical students. View our SAEM Membership Guide to acquaint yourself with everything that’s available to you as a member of SAEM, including automatic membership in RAMS — our exciting home for the next generation of emergency medicine academicians and leaders, where you have the opportunity to serve on committees and in leadership roles developing educational content, annual meeting programming, and mentorship and career opportunities of interest and importance to you and your peers!

Contact SAEM at membership@saem.org for more details and renew today!

REGIONAL MEETINGS Midwest Regional Cleveland Rocked at Midwest Regional SAEM Virtual 2020!

The music was rocking and the cameras were rolling at the Midwest Regional SAEM 2020 Virtual Meeting, September 23. "Thank you" to every one of the 255 registrants who attended, with a great mix of students, residents, and staff physicians. With “Emergency Medicine Inspires Innovation” as the theme, the immediate pivot to a virtual event felt more innovative than ever. Produced

by Cleveland-based “Rock The House” (we can’t sing their praises enough), the day was filled with cutting-edge content.

The lecture series, highlighted by the plenary “On the Shoulders of Giants” by Dr. Richard Wolfe, featured innovations in education, resuscitation, ultrasound, medical education, and innovative approaches to the opioid epidemic. Our “Meet the Experts” sessions provided guidance for medical students and early-career faculty and residents as they navigate our specialty with the challenges of today. Over 60 quality research presentations provided a much needed opportunity, especially for young investigators, to present their research and get valuable feedback. The CPC competition, won by University Hospitals of Cleveland, will hopefully begin a fun Midwest rivalry for years to come. I guess they get to name the inaugural trophy.

Thanks again to “Rock The House” for their excellent production and thanks also to SAEM for the opportunity to host The Midwest Regional SAEM 2020 Virtual Meeting in the Home of Rock and Roll.

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is December 1, 2020 for the January/February 2021 issue.

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ACADEMIC ANNOUNCEMENTS Dr. Martin Confirmed to City of Milwaukee Board of Health Ian B. K. Martin, MD, MBA, professor with tenure and system chairman of the department of emergency medicine at the Medical College of Wisconsin (MCW), was confirmed this week by the Milwaukee Common Council’s Public Safety and Health Committee to the Board of Health of the City of Milwaukee. Recommended by Mayor Tom Barrett, Dr. Martin joins this governing board responsible for advising the city’s Ian B. K. Martin health department on priorities, taking public stances on public health policy issues, and being champions for public health in Milwaukee.

Dr. Martin is the immediate past president of SAEM.

Dr. Adeoye Named Head of New Emergency Medicine Department at Washington University School of Medicine in St. Louis Opeolu M. Adeoye, MD, has been named head of the new department of emergency Medicine at Washington University School of Medicine in St. Louis (WUSTL) and the inaugural BJC HealthCare Distinguished Professor of Emergency Medicine, effective Feb. 1. Dr. Adeoye joins the WUSTL School of Medicine from the University of Cincinnati College of Medicine, where he is Opeolu M. Adeoye a professor of emergency medicine and of neurosurgery and vice chair for research in the department of emergency medicine.

Dr. Ouchi Receives Paul B. Beeson Emerging Leaders Career Development Award in Aging Kei Ouchi, MD, an assistant professor of emergency Medicine at Harvard Medical School has been selected to receive the National Institution on Aging (NIA) Paul B. Beeson Emerging Kei Ouchi Leaders Career Development Award in Aging. The award is give to earlystage physicians and other health professional investigators with a commitment to aging and/or aging-related diseases to advance their research and leadership skills in their specialty and in the broader field of aging and geriatrics research.

Dr. Ouchi is clinically active as an associate physician in the emergency department (ED) and a home hospital physician in the department of medicine at Brigham and Women’s Hospital.

Dr. Ouchi is a member of SAEM’s Academy of Geriatric Emergency Medicine (AGEM).

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NOW HIRING POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES! Accepting ads for our “Now Hiring” section!

Deadline for the next issue of SAEM Pulse is December 1.

For specs and pricing, visit the SAEM Pulse advertising webpage.

Emergency Medicine, Injury Prevention Center Faculty MD-MPH or PhD, Senior Scientist The Department of Emergency Medicine (EM) at the Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) seeks an academic faculty member, for our Injury Prevention Center (IPC). Applicants can be at the Assistant, Associate or Professor level, with IPC leadership opportunity for applicants with significant experience.

BMC is a level-one trauma center with an annual census of over 130,000, serving as Boston’s major safety net hospital. The Department of Emergency Medicine is an independent academic department within BUSM and BMC. The BMC ED is the medical control hub and academic base for Boston EMS. We seek candidates with a demonstrated record of injury prevention research to join and assume leadership roles in the IPC. The BMC IPC, founded in 2000, is an ED-based research, education, and advocacy collaborative with focus on opioid harm reduction interventions, violence intervention advocacy, traffic fatalities, youth concussion/brain injury, and older adult falls epidemiology and intervention. IPC personnel include PhD researchers and EM clinicians who collaborate closely with the BUSM Departments of Surgery, Pediatrics, Neurology, and Geriatrics, the Boston University School of Public Health, the Massachusetts Department of Public Health, and other regional and national injury research centers.

Successful candidates will have a MD, PhD, or equivalent degree, and will demonstrate a commitment to the training of EM residents and students and mentoring of junior faculty. Candidates may have expertise in one or more of the current IPC focus areas or in other areas of injury prevention. Preference will be given to applicants with a proven track record in injury prevention research and grant funding. The position comes with competitive salary commensurate with experience, an excellent benefits package, and a faculty appointment.

BMC/BUSM is an equal opportunity/affirmative employer. The BMC Department of Emergency Medicine is exceptionally committed to diversity and inclusion within our faculty and residents and welcomes applicants from diverse backgrounds.

For further information, contact: Jonathan Olshaker, MD Professor and Chair Department of Emergency Medicine Boston University School of Medicine Chief, Department of Emergency Medicine Boston Medical Center BCD Building, 1st Floor Boston, MA 02118 Email: olshaker@bu.edu

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Exciting opportunities at our growing organization • • • •

Emergency Medicine Faculty Positions Pediatric Emergency Medicine Faculty Positions Vice Chair, Clinical Operations Vice Chair, Research

Penn State Health, Hershey PA, is expanding our health system. We offer multiple new positions for exceptional physicians eager to join our dynamic team of EM and PEM faculty treating patients at the only Level I Adult and Level I Pediatric Trauma Center in Central Pennsylvania.

What We’re Offering: • Salaries commensurate with qualifications • Sign-on Bonus • Relocation Assistance • Retirement options, Penn State University Tuition Discount, and so much more!

What We’re Seeking: • Emergency Medicine trained physicians with additional training in any of the following: Toxicology, Ultrasound, Geriatric Medicine, Pediatric Emergency Medicine, Research • Completion of an accredited Residency Program.

• BE/BC by ABEM or ABOEM

What the Area Offers: We welcome you to a community that emulates the values Milton Hershey instilled in a town that holds his name.

Located in a safe family-friendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences.

We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC.

FOR MORE INFORMATION PLEASE CONTACT:

Heather Peffley, PHR FASPR at: hpeffley@pennstatehealth.psu.edu Penn State Health is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

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Innovation - does joining a team that is re-imagining acute care delivery inspire and excite you? Impact - do you want to shape the future of healthcare? The Department of Emergency Medicine at The Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA continues to expand its faculty complement. Our team is revolutionizing the way emergency care is taught to our students, residents and faculty and how care is provided to patients. We have pioneered emergency telemedicine and design thinking in EM. We have nimbly integrated our diverse faculty and forward-looking enterprise to impact population health, emergency medical services, access to care, patient flow and clinical research. We are interested in emergency physicians that wish to be a part of a department that will contribute to the ongoing transformation of acute unscheduled care.

We have an extensive and robust clinical footprint, with the opportunity to practice across the acute care spectrum. We provide faculty and resident coverage at two emergency departments – TJUH (center city campus), a 700-bed academic quaternary-care, Level 1 trauma center that treats 73,000 patients annually, and the Methodist Hospital Division of TJUH, a 140-bed community hospital that treats 34,000 patients annually. Faculty also provide coverage at seven urgent care centers run by the department as well as the clinical decision unit (CDU) at Thomas Jefferson University Hospital and have the opportunity to provide on-demand direct-to-consumer through our Telehealth Program. Faculty will be responsible for patient care and bedside teaching of students and residents and will have the opportunity to develop their academic focus. Additional information on the department can be found at: http://www.jefferson.edu/university/jmc/departments/emergency_medicine.html We seek the following: Director of Emergency Medical Services The Director of EMS will be the forward-facing leader for prehospital care. This person will have a multifaceted mission with core responsibilities in EMS education, EMS outreach and EMS research. Additionally, they will work collaboratively with JeffSTAT (the ground and air-based program that moves patients across our 14-hospital enterprise). In doing so, there is opportunity for medical command and education at the JeffSTAT training center. This person will also represent Jefferson EMS locally, regionally and nationally while concurrently building relationships and bolstering Jefferson’s presence in these domains.

With Jefferson’s focus on innovation and care transformation in mind, specific touch points are working in partnerships with JeffSTAT and the city of Philadelphia to re-imagine prehospital care and safe inter-facility patient movement.

Clinical Faculty Clinical faculty provide patient care and bedside teaching of students and residents in the ED, clinical decision unit and urgent care. Additionally, clinical faculty have opportunities to become involved in administration, clinical operations, undergraduate and graduate medical education.

The Sidney Kimmel Medical College at Thomas Jefferson University values a diverse and inclusive community as it allows us to achieve our missions in patient care, education, and research and best allows us to serve the healthcare needs of the public. Thomas Jefferson University and Hospitals is an Equal Opportunity Employer. Jefferson values a diverse and inclusive community diversity and encourages applications from women, those underrepresented in medicine, Lesbian, Gay, Bisexual and Transgender (LGBT) individuals, disabled individuals, and veterans. Interested candidates are invited to send their curriculum vitae to: Bernard L. Lopez, MD, MS, CPE, FACEP, FAAEM Executive Vice Chair, Department of Emergency Medicine Bernard.lopez@jefferson.edu

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THANK YOU for the remarkable work and sacrifices you are making during the COVID-19 pandemic.

You refused to indulge fear as you put the needs of others before your own.

Join our team

teamhealth.com/join or call 877.650.1218

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Nominate a Medical Student, Resident, or Attending for an SAEM Award!

The Society for Academic Emergency Medicine recognizes outstanding individuals across the nation for their contributions to academic emergency medicine. National award recognition is an excellent boost for your CV and for potential promotion. Nominations open October 1 for the award categories below.

Nominate yourself or a colleague by December 9, 2020 to be considered for this year’s awards.

John Marx Leadership Award Honors an SAEM member who has made exceptional contributions to emergency medicine through leadership — locally, regionally, nationally or internationally — with priority given to those with demonstrated leadership within SAEM. Hal Jayne Excellence in Education Award Honors an SAEM member who has made outstanding contributions to emergency medicine through the teaching of others and the improvement of pedagogy.

Advancement of Women in Academic Emergency Medicine Award Honors an SAEM member who has made significant contributions to the advancement of women in academic emergency medicine.

Marcus L. Martin Leadership in Diversity & Inclusion Award Honors an SAEM member who has made exceptional contributions to advancing diversity and inclusion in emergency medicine through leadership RAMS Awards Honor emergency medicine residents and medical students for exceptional contributions in research, education and leadership. and many more . . .

Go to www.saem.org/awards to nominate someone today!

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Emergency Medicine, Injury Prevention Center Academic Faculty Position The Department of Emergency Medicine at the Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) seeks an academic faculty member for our Injury Prevention Center (IPC). Applicants can be at the Assistant, Associate or Professor level, with IPC leadership opportunity for applicants with significant experience.

BMC is a level-one trauma center with an annual census of over 130,000 ED visits, and serves as Boston’s major safety net hospital. The Department of Emergency Medicine is an independent academic department within BUSM and BMC. The department is home to Boston’s first EM residency, a nationally recognized PGY1-4 residency program as well as an ultrasound and EMS fellowship. The BMC ED is the medical control hub and academic base for Boston EMS. The BMC IPC, founded in 2010 is an ED based research, education and advocacy collaborative with a focus on opioid harm reduction interventions, violence intervention advocacy, traffic fatalities, youth concussive/brain injury, firearm injury, and older adult falls reduction research and interventions. IPC personnel include PhD researchers and EM physician scientists who collaborate closely with the Department of Surgery, Pediatrics and Geriatrics. We seek candidates with a demonstrated record of injury prevention research to join and assume leadership roles in the IPC. Successful candidates will be ABEM board certified/eligible and demonstrate a commitment to the training of EM residents and students, and mentoring of junior faculty. Candidates may have expertise in one or more of the current IPC focus areas or in other areas of injury prevention. Preference will be given to applicants with a proven track record in injury prevention research and grant funding. The position comes with competitive salary and title commensurate with experience, an excellent benefits package and a faculty appointment in the BUSM. BMC/BUSM is an equal opportunity/affirmative employer. The BMC Department of Emergency Medicine is exceptionally committed to diversity and inclusion within our faculty and residents, and welcomes applicants from diverse backgrounds.

For further information, contact: Jonathan Olshaker, MD Professor and Chair Department of Emergency Medicine Boston University School of Medicine Chief, Department of Emergency Medicine Boston Medical Center BCD Building, 1st Floor Boston, MA 02118 Email: olshaker@bu.edu

Vice Chair for Clinical Operations Department of Emergency Medicine The Department of Emergency Medicine at the Medical College of Wisconsin (MCW) seeks a visionary and highly-motivated board-certified Clinician Leader to join the Department as an Associate or Full Professor for the position of Vice Chair for Clinical Operations.

The Vice Chair will report directly to the System Chair of the Department of Emergency Medicine and be responsible for the development and implementation of strategic plans for the patient care mission of the Department in conjunction with Department Chair. The successful Vice Chair for Clinical Operations shall provide oversight, direction, and leadership for the clinical operations of all practices staffed by the Medical College of Wisconsin Department of Emergency Medicine.

Our Department maintains a thriving clinical practice including: Froedtert and MCW (F&MCW) Froedtert Hospital Emergency Department (level 1 adult trauma center); Children’s Wisconsin (level 1 pediatric trauma center); Clement J. Zablocki Veterans Affairs Medical Center Emergency Department; F&MCW Froedtert Moorland Reserve Health Center (free-standing) Emergency Department; F&MCW Froedtert Menomonee Falls Emergency Department; and a series of soon-toopen, community-based, neighborhood hospital Emergency Departments. Across this myriad of clinical practices, our faculty, fellows, residents, and advanced practice providers (APPs) care for more than 200,000 patient visits each year.

Our Department is home to a competitive training program of 36 residents, which attracts top-notch housestaff from medical schools across the nation. Many of our faculty members, fellows, residents, APPs, and staff are engaged in a host of extramurally-funded, cutting-edge, investigative research.

Inquiry in the areas of cardiac arrest and resuscitation, injury, EMS, and others have garnered MCW a reputation as an Emergency Medicine research powerhouse.

Successful candidates should be residency-trained and board-certified in Emergency Medicine by the ABEM. Desired qualities and skills include prior management and leadership experience at Service Chief or Medical Director level in an academic medical center. The candidate should have successful demonstration of operational improvements and innovations in clinical operations. The candidate should have documented academic accomplishments to be appointed at the Associate Professor or Professor level, with or without tenure, at the Medical College of Wisconsin.

 Please submit a CV, letter of interest, and a list of references to: Ian B.K. Martin, M.D., M.B.A., FACEP, FAAEM Professor with Tenure and System Chairman, Department of Emergency Medicine, Professor, Department of Medicine The Medical College of Wisconsin Medical School at imartin@mcw.edu.

The Medical College of Wisconsin is an equal employment opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.

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Department Emergency Medicine Department ofof Emergency Medicine Department of Emergency Medicine Department of Emergency Medicine University Schoolof ofMedicine Medicine Department ofSchool Emergency Medicine YaleYale University Yale University School Yale University Schoolof ofMedicine Medicine

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The Department of Emergency Medicine at the YaleYale University School totalofoffour fourclinical clinical sites: Adult Emergency Services at Street York Street Campus; Shoreline The Department of Emergency Medicine at the University SchoolofofMedicine Medicine has aa total sites: Adult Emergency Services at York Campus; Shoreline Medical Medical Saint Campus; and thethe West Haven VA Emergency Department with aa combined ED of 195,000 per per year.year.

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renowned faculty, obtaining federal and private foundation funding,and mature research research infrastructure supported by by aAdult faculty Research Director, a staff ofstaff research associates and The Department Emergency Medicine at the Yale University School ofand Medicine has aWe total ofafour clinical sites: Emergency Services atcollaboration Street Campus; Shoreline renowned faculty, obtaining federal and private foundation funding, aamature infrastructure supported arecord faculty Director, aYork of research associates and Medical We offer anof extensive faculty development program for junior and more senior faculty. have well-established track ofResearch interdisciplinary with other administrative assistants. the We offer anadministrative extensive faculty development program for junior and more senior faculty. Weahave a well-established record of interdisciplinary collaboration with Center; Saint Raphael’s Campus; West Haven VA Emergency combined ED volume oftrack 195,000 visits per year.

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Candidates interest and/or experience inof observation medicine begin immediately and will continue until theand position is filled. begin immediately and willbe continue until the position is filled. is a plus.

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Review of will Candidates will enter at theshould Instructor/Assistant/Associate commensurate with experience and Candidates interest and/or experience observation medicine Applicants submit their coverclinician letter, curriculum vita and of reference to Interfolio by followingmedicine the links below: The successful candidate may be aresidency-trained full-time committed to three excellence inin patient care andcredentials. emergency education or one that would want in toapplications join the academic faculty begin immediately and willtheir continue until the position isvita filled. is a plus.

Candidates must be residency-trained and board-certified and trained in of emergency medicine at least one yearbelow: of post-doctoral training. Review of applications will Applicants should submit cover letter, curriculum and three letters reference to Interfoliowith by following the links promoting scholarship to enhance the field of emergency medicine. begin immediately andshould will continue until the letter, position is filled.vita and three letters of reference to Interfolio by following the links below: Applicants submit their cover curriculum Candidates will enter at the Instructor/Assistant/Associate level, commensurate with experience and credentials. Candidates with interest and/or experience in observation medicine Applicants should submit their be cover letter, curriculum and three letters of reference to Interfolio by following links Title Interfolio Link is a plus.

Candidates must residency-trained andvita board-certified and trained in emergency medicine with atthe least onebelow: year of post-doctoral training. Review of applications will begin immediately will continue until the position is filled.

Titleand Interfolio Link Instructor, Clinical http://apply.interfolio.com/79376

Title Interfolio Link Applicants should submit theirClinical cover letter, curriculum vitaEducator and three letters of referencehttp://apply.interfolio.com/79251 to Interfolio by following the links below: Instructor, http://apply.interfolio.com/79376 Assistant Professor, Clinician

Clinical http://apply.interfolio.com/79376 Title Instructor, Interfolio Link Assistant Professor, Clinician Scholar http://apply.interfolio.com/79329 Assistant Professor, Clinician Educator http://apply.interfolio.com/79251 Assistant Professor, Clinician Educator http://apply.interfolio.com/79251 Assistant Professor, Clinical Scholar http://apply.interfolio.com/79373 Instructor, Clinical http://apply.interfolio.com/79376 Assistant Professor, Clinician http://apply.interfolio.com/79329 TitleAssistant Interfolio Link Professor, Clinician Scholar http://apply.interfolio.com/79329 Associate Professor, Clinician Educator http://apply.interfolio.com/79374 Assistant Professor, Clinical http://apply.interfolio.com/79373 Assistant Professor, Clinician Educator http://apply.interfolio.com/79251 Assistant Professor, Clinical http://apply.interfolio.com/79373 Instructor, Clinical http://apply.interfolio.com/79376 Associate Professor, Clinician Educator http://apply.interfolio.com/79374 Assistant Professor, Clinician Scholar http://apply.interfolio.com/79329 Should you have any technical difficulties with Interfolio, please reach out to: Associate Professor, Clinician Educator http://apply.interfolio.com/79374 Assistant Professor, Clinician Educator http://apply.interfolio.com/79251 Assistant Professor, Clinical http://apply.interfolio.com/79373 Jamie.Petrone@yale.edu or Teretha.Brooks@yale.edu Should you Educator have any technical difficulties with Interfolio, please reach out to: Assistant Professor, Clinician Scholar http://apply.interfolio.com/79329 Associate Professor, Clinician http://apply.interfolio.com/79374 Should you have any technical difficulties with Interfolio, please reach out to: Jamie.Petrone@yale.edu orhttp://apply.interfolio.com/79373 Teretha.Brooks@yale.edu Assistant Professor, Clinical Jamie.Petrone@yale.edu or Teretha.Brooks@yale.edu Associate Professor, Clinician Educator http://apply.interfolio.com/79374 Shouldis anyou haveAction/Equal any technical with Interfolio, please reach out Yale University Affirmative Opportunitydifficulties employer. Yale values diversity among its students, staff, and faculty andto: strongly

Jamie.Petrone@yale.edu or Teretha.Brooks@yale.edu UCONN International Disaster Medicine Fellowship Should you have any technical difficulties with Interfolio, please reach out to: welcomes applications from women, persons with disabilities, protected veterans, and underrepresented minorities

Yale University is an Affirmative Action/Equal Opportunity employer. Yale values diversity among its students, staff, and faculty and strongly Yale University is an Affirmative Action/Equal Opportunity employer.

Yale values diversity among students, staff, and faculty and strongly welcomes applications from women, persons with disabilities, veterans, anditsunderrepresented minorities Jamie.Petrone@yale.edu orprotected Teretha.Brooks@yale.edu welcomes applications from women, persons with disabilities, protected veterans, and underrepresented minorities

Applications being accepted for July 2021!

UCONN International Disaster Medicine Fellowship

Yale University is an Affirmative Action/Equal Opportunity employer. Yale values diversity among its students, staff, and faculty and strongly welcomes applications from women, persons with disabilities, protected veterans, and underrepresented minorities

Applications being accepted for July 2021!

Yale University is an Affirmative Action/Equal Opportunity employer. Yale values diversity among its students, staff, and faculty and strongly welcomes applications from women, persons with disabilities, protected veterans, and underrepresented minorities

This is a one or two-year SAEM approved fellowship for emergency medicine residency trained physicians. Throughout the program, the fellow will work clinically as an attending Emergency Medicine physician in the Emergency Department at UConn Health in Farmington, CT. They will Thissupervise is aThis one is orand SAEM approved fellowship for emergency residency trained physicians.

Throughout atwo-year one or two-year SAEM approved fellowship formedicine emergency medicine residency trained teach residents from the UConn Emergency Medicine Program and medical students the program, the fellow willphysicians. work clinically as an attending Emergency Medicine physician in the Emergency Department at UConn Health in Farmington, CT. Throughout the program, the fellow will they work fellow clinically as complete an attending Emergency from the UConn School of Medicine.

If they so desire, may a Master of Public They will supervise and teach residents from the UConn Emergency Medicine Program and medical students from the UConn School of Medicine in thefellowship.

EmergencyThe Department atuses UConn Health intype Farmington, CT.to They willskills Health duringphysician the two-year fellowship milestone progression build Medicine. If they so desire, they fellow may complete a Master of Public Health during the two-year fellowship. The fellowship uses milestone supervise andpersonal teach residents from UConn Emergency Medicine medical students and improve resiliency bythe experience and inoculation withProgram various and increasingly complex type progression to build skills and improve personal resiliency by experience and inoculation with various increasingly complex deployments. from the UConn School of Medicine. If they so desire, they fellow may complete a Master of Public deployments. during the two-year fellowship. The fellowship uses milestone type progression to build skills ForHealth More information: and improve personal resiliency by experience and inoculation with various increasingly complex https://health.uconn.edu/graduate-medicaldeployments. education/international-disaster-medicine-fellowship/ For More information:

https://health.uconn.edu/graduate-medicalIf interested in applying for this fellowship, contact education/international-disaster-medicine-fellowship/ James Gorman Jr. at 860-679-3486 or gorman@uchc.edu.

If interested in applying for this fellowship, contact James Gorman Jr. at 860-679-3486 or gorman@uchc.edu.

University of Connecticut Health Center University of Connecticut Health Center

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THANK YOU To our brave and dedicated emergency physicians, nurses, and other medical staff who are on the front lines answering the call to care for the most vulnerable in our society during this time of great need.