Celebrating Our 25th Anniversary
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VOLUME XXIX NUMBER 3
BRETT ROSEN, MD Journey Into Emergency Medicine
ETHICS IN ACTION Refusal of Treatment After Suicide Attempt
RESIDENTS AND MEDICAL STUDENTS Residency: Year One
IMPROVING OLDER ADULT CARE Geriatric Emergency Department Guidelines
To lead the advancement of emergency care through education and research, advocacy, and professional development in academic emergency medicine.
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2013-2014 BOARD OF DIRECTORS Alan E. Jones, MD President University of Mississippi Medical Center Robert S. Hockberger, MD President-Elect Harbor-UCLA Medical Center Andra L. Blomkalns, MD Secretary-Treasurer University of Cincinnati College of Medicine Cherri D. Hobgood, MD Past President Indiana University School of Medicine Kathleen J. Clem, MD, FACEP Loma Linda University School of Medicine D. Mark Courtney, MD Northwestern University Feinberg School of Medicine Deborah B. Diercks, MD, MSc University of California, Davis, Medical Center James F. Holmes, Jr., MD, MPH University of California, Davis, Health System Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center Brett A. Rosen, MD, Resident Member WellSpan York Hospital Sarah A. Stahmer, MD University of North Carolina School of Medicine The SAEM Newsletter is published bimonthly by the Society for Academic Emergency Medicine. The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. For Newsletter archives and e-Newsletters Click on Publications at www.saem.org ÂŠ 2014 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.
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PRESIDENT’S M ESSAGE THE CHANGING OF THE GUARD Alan E. Jones, MD
University of Mississippi Medical Center
Alan E. Jones, MD
It’s hard to believe that a year has passed since I was inducted as president of SAEM. We have accomplished a lot in the past year, but there is a whole lot more growth and accomplishment ahead. Rather than looking back and dwelling on what may or may not have been achieved, I prefer to look forward at the journey ahead. The next year holds exciting times for SAEM: celebrating the 25th Annual Meeting, developing a new strategic plan,
inaugurating the search for a new CEO, exciting new leadership changes, and watching the Foundation reach 10 million dollars! I am optimistic for the future of this society, that it will keep moving forward when times get tough, because of you – its dedicated members. Thank you for entrusting me with this position for a year, thank you to my fellow Board members for your tireless dedication, work and friendship, thanks to all the leaders of academies, committees and task forces who do the bulk of the work of the society. To the members I say….get involved – you can make a difference. Together we all make this society great – as it always will be! See you in Dallas. ◗
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CHIEF EXECUTIVE’S M ESSAGE FACING AND EMBRACING THE FUTURE This SAEM Newsletter will appear just before SAEM’s 25th Anniversary Annual Meeting, but instead of focusing on the history of this association or its leaders and members, it seems appropriate to pause to think about how we, as individuals and as an association, will not only face the future, but also embrace it. A Google or Amazon search on “future” turns up an amazing number of books and pamphlets devoted to Ronald S. Moen the subject. There are numerous individuals who charge significant amounts of money to speak to corporations, association meetings and government agencies on preparing for the future. Clearly there is a market for such presentations, and there are magazines that are basically devoted to material on the future. A quick read of history reveals that this preoccupation with what the future will bring has been a feature of almost every decade and generation in recorded history. Why, you might ask, do we so want to focus on the future? In part, this seems to be part of our innate curiosity, our desire for life to be better and for things to be somewhat predictable and known as we move forward in life. It seems, however, that we need not just to face the future, but to embrace our future, whether that is from a personal perspective or from an association perspective. But how do we not just face, but in fact EMBRACE the future? Some historical perspective may give us some clues. Doris Kearns Goodwin in her book “Team of Rivals” does a masterful job of describing how Abraham Lincoln was able to embrace his rivals, and build a powerful, although somewhat difficult to manage, alliance of individuals to serve in his cabinet and mold the future of the USA. As you read her book or other biographies of Abraham Lincoln, you are always struck by how this man embraced life, no matter what situation confronted him. He was bright, shrewd (some would say cunning) and a very persistent person, from his youth up until the end of his life. He was perceptive and had doubts about a lot of issues that confronted him throughout his personal and professional life. But he had an enduring spirit about him and never flinched at the unknown, and he persevered with a clear mission of what was right and what was needed to be done, both as a young lawyer, as a husband and father, and later as president during the Civil War. One cannot help but be struck by his humanity in the face of tragedy and chaos, but the situations he faced did not alter his faith in what the future might bring and what it might be possible to achieve. In the darkest hours of the Civil War, he never doubted that the future would be much brighter. Can we say the same about ourselves? Do we
have the same passion for our work, have the same dedication to our association, can we see a better future as we muddle through the changes in the health care system, the reduction in research funding, the challenges that residents bring in their quest to become better emergency physicians than their faculty, and to do better research than their mentors? Recently I have been reading another tome by Doris Kearns Goodwin called “The Bully Pulpit,” the story of the friendship and rivalry between Theodore Roosevelt and William Howard Taft. Here again we see two very different men, from very different backgrounds and experiences, who developed a strong friendship in a way that allowed them to survive a variety of difficulties throughout their lives, and yet maintain an incredible perspective on what the future might bring and what it might be possible to achieve. What struck me most in this biography was how each man learned from his experiences, which often were very tragic, and yet because they had a tenacious drive to succeed and create a better world for themselves and others, they thrived on the possibilities of that unknown future. These were two more men who truly embraced the future with every bone in their body, although their individual ways of expressing that passion were very different. If you have not read either of these two books, I commend them to you, as I am certain you will not be the same person after you read them. Within emergency medicine, there are also role models who have throughout their lives embraced the future. If you have not seen the video produced by EMRA in 2012, “24/7/365: The Evolution of Emergency Medicine,” I highly recommend that to you as well. One is struck in the interviews with the early pioneers of emergency medicine by their ability to face and embrace the future, in spite of all the difficulties that had to be overcome in order to create this youngest specialty in the house of medicine. So, as we celebrate the 25th anniversary of SAEM, celebrate the past and what past leaders have made possible, but more importantly, look to the future, face it with confidence and EMBRACE what the future holds for you and the specialty, especially the role that academic emergency medicine must and will play for your future and that of the people you serve. SAEM is facing and embracing the future. During the 2014-2015 program year, we will be embarking on a new strategic planning effort, not so much to produce a five-year plan, but to plan strategically throughout the year and the years to come to make sure that we are serving our members so as to best support you as you too face and embrace your future. ◗
M EM BER HIGHLIGHT BRETT A. ROSEN, MD
Resident Member of the SAEM Board of Directors WellSpan York Hospital
“Life is like riding a bicycle. To keep your balance you must keep moving.”
JOURNEY INTO EMERGENCY MEDICINE I came across this Albert Einstein quote recently and thought it was quite applicable to today. As you are reading this in the MayJune edition of the SAEM Newsletter, I and many other senior residents across the country are graduating very soon. Many think that residency graduation is the end of a long process and that training is finally over. However, the reality is that if we slow down or stop and do not continue learning, we lose our skills that we worked so hard to attain. We must keep moving with the same vigor we have now to continue to be successful in our careers. Emergency medicine trainees go through rigorous training in this country, and very few people outside of those that read this newsletter truly understanding the daily pressures that we face. Be proud every day of what you do and the lives that you touch. Very few people in the world are there for those in their greatest time of need each and every day, and you possess those skills that give you the ability to make a difference. My journey to emergency medicine started in Los Angeles, where I was born and raised in the San Fernando Valley. While in high school, I was a volunteer at UCLA Medical Center, and soon thereafter was employed there for many years. My love for medicine was born here, and I knew very quickly that I wanted one day to be a physician. I took a journey across the country and went to college at Drexel University in Philadelphia, Pennsylvania. I majored in chemistry as part of an accelerated medical track, and entered the Drexel University College of Medicine to start my training. In my first days of medical school, I met someone who would help to shape my career path and serve as a role model. Dr. David Wagner, one of my professors and one of the pioneers of emergency medicine training in this country, had a long talk with me in his office. He encouraged me to come to the emergency department with him to see patients, and even as a first-year student I was taking histories and doing physical exams! I was amazed he seemed to know the patient’s diagnosis in seconds. I went somewhat regularly to the emergency department and found other faculty to shadow. SAEM then entered my life - the 2008 Annual Meeting happened to be relatively close, in Washington, DC. Dr. Wagner encouraged me to go to the meeting. I have not missed one since, and this coming Annual Meeting in Dallas will be my seventh.
The Match landed me in York, Pennsylvania at WellSpan York Hospital, where I had done one of my audition rotations. The hospital has a large community academic emergency department with close to 80,000 visits, serving a large geographic area as a regional stroke, STEMI, and Level-1 trauma center, amongst other functions. The training here has been superb, and I have been supported in my academic and professional endeavors every step of the way by my residency leadership. I am incredibly grateful to Dr. Michael Bohrn and Dr. David Vega for being there for me when I needed schedule changes, letters, and institutional support for my organizational involvement. I want to encourage students out there reading this not to shy away from applying to community academic programs. There are certainly pros and cons to every training program, but I can tell you that the acuity that I see on a daily basis is equivalent to, if not better than, that of my colleagues at university programs. Without many subspecialists available in-house, you will learn to manage patients on your own. And you can still move on to an academic career by training at a community program! I am so excited for the next stage of my career, which takes me away from the snow-ridden environment I have lived in for the past decade and brings me back to my hometown of Los Angeles, California. I will be starting an EMS fellowship under the leadership of two incredible emergency physicians, Dr. Marianne Gausche-Hill and Dr. Bill Koenig at Los Angeles County + HarborUCLA Medical Center and the Los Angeles County EMS Agency. I am equally thrilled to continue my career enjoying the mentorship and brilliance of my fellow SAEM Board members, Dr. Robert Hockberger and Dr. Amy Kaji, who are also at the institution and advocated for me to go there. I cannot say enough about the support, mentorship, and knowledge that has been given to me through the opportunity to work with them this year. I want to give a special thank-you to all of my fellow members of the Board of Directors. All of them have played an important part in my learning this year and have been supportive all year of my academic and personal growth. Each of them has taken his or her time to ensure a worthwhile experience on the Board for me, and has made the resident member position one of importance. Continued on Page 7
Brett Rosen, MD, staffing the medical tent at a joint agency disaster drill in New South Wales, Australia, 2011. Photo Credit: Dr. Cliff Reid Continued from Page 6 SAEMâ€™s chief executive officer, Ron Moen, has also been a wonderful resource to turn to at every step of the way for advice and experience. He has taught me so much about organizational leadership and has been a strong advocate for residents. Being involved in SAEM has allowed me to see the incredible breadth and opportunities that exist in the organization. Certainly, this culminated for me this past year in the privilege of sitting on the Board of Directors with some of the true leaders in our field. Opportunities exist for speaking engagements both here and outside the United States, participation in discussions related to issues in academic emergency medicine, and being an advocate for residents. As we go through strategic planning as a Society, residency training will no doubt be a priority for the organization. For all of the residents and students out there, I encourage you to get involved in something within the Society. There are amazing opportunities for interaction with leaders in our field by joining academies, task forces, committees, and interest groups. I have seen tremendous growth in the organization over
the past seven years, with so much occurring in the past two to three years that will strengthen the Societyâ€™s position within emergency medicine as a whole. The free interest group you can join with your Society membership will give you a chance to pick an aspect of emergency medicine you like and start by being a part of the discussion. Residents can serve on committees, where much of the work of SAEM is conducted. The Society actively looks for motivated residents to be the next generation of leaders. I hope some of you will be motivated by this article to pursue leadership and join those of us looking to make our very special field even better. I want to thank all of the residents for electing me to this position and allowing me to serve on their behalf on the Board this year. It has been an honor and privilege. I want to express my gratitude to everyone who has supported me thus far in my career to enable me to get to this point. Last, but certainly not least, I want to thank my wonderful family, which has been there for me during all the ups and downs of the past year and supportive during my whole life. I look forward to seeing everyone in Dallas for what promises to be an incredible meeting! â——
ETHICS IN ACTION REFUSAL OF TREATMENT AFTER SUICIDE ATTEMPT Jonathan Robbins, MD University of Pittsburgh
Eric Isaacs, MD, FACEP
University of California, San Francisco
CASE PRESENTATIONS Case 1. A 37-year-old woman with a history of suicide attempts, alcoholism, and depression self-presented to the emergency department of a community hospital after an overdose involving unknown quantities of Vicodin, alcohol, and acetaminophen. Her initial vital signs were stable and her physical exam unremarkable. Laboratory values were significant for an APAP level of 160, ALT and AST to approximately 2,000, and an elevated INR to 1.5. The regional poison control center (PCC) was consulted and recommended intravenous N-acetyl cysteine (NAC). The patient refused NAC treatment, but accepted other medications, phlebotomy, and EKG monitoring. The ED physician documented the patient as “alert and oriented, has a right to refuse treatment.” A psychiatry consult was not immediately available given resource limitations of the hospital. The patient’s transaminitis continued to worsen to the tens of thousands, and her INR was increasing. Case 2. An 86-year-old man was brought by ambulance to an urban emergency department after being found unconscious next to an empty bottle of cough syrup with codeine. The patient had been discharged three weeks before, after a pneumonia hospitalization during which numerous pulmonary nodules believed to be metastases from an unknown primary cancer had been discovered. The patient was obtunded, rousing only to sternal rub, and showed signs of respiratory depression unresponsive to naloxone. Despite the presence of DNR/DNI status, the senior resident and an attending began preparing materials for intubation. The patient’s wife, his surrogate decision-maker, was present with family. They pleaded with staff not to intubate the patient and to let him “pass away peacefully.”
DISCUSSION In order to safeguard individual autonomy and limit paternalism, patients must provide informed consent or informed refusal before a medical intervention. At times, these decisions may result in the refusal of treatment that may be lifesaving or life-sustaining, provided that a patient is evaluated for and has decision-making capacity. Capacity is evaluated for a specific aspect of medical care, and a patient may have capacity to make some health care decisions but not others. In general, when patients refuse a highbenefit, low-risk intervention, they must meet a higher threshold for capacity. Emergency physicians may not have the luxury of time to perform an extensive evaluation of patient capacity. The extent of patient autonomy becomes further complicated in the case of treatment refusals after suicide attempts. In case 1, a young woman refuses NAC after polyingestion and acetaminophen overdose. There seems to be misunderstanding about the extent of the patient’s rights after a suicide attempt. While the patient may be awake, alert, communicative, and consistent, the patient’s suicidality implies a lack of rationality. Empirical evidence supports the view that in most suicide attempts, individuals do not have an unambiguous desire for self-destruction.2 Patients who attempt suicide are generally thought of as incapable of refusing interventions that are meant to mitigate the harms of a suicidal act or gesture, but they may retain the capacity to refuse other interventions, if not motivated by self-harm. The fact that the woman self-presented to the emergency department and of her acceptance of some, but not all, interventions implies ambivalence about her will to end her life, and subtle manipulation of the providers. Because early administration of NAC, with its limited-side-effect profile, is a well-studied time-dependent therapy to mitigate hepatotoxicity in acetaminophen overdose with few serious side effects, one can argue that the patient should be treated with NAC against her will. However, it is permissible to engage the patient for her buy-in, involve supportive family, and identify staff with whom the patient has good rapport, before acting. If refusal continues, the treating physicians must continue to evaluate the risk-benefit ratio of the therapy, and consider additional risks of continued Continued on Page 9
Continued from Page 8 therapy such as allergic reaction or the necessity of chemical and physical restraint if present. The goal is not to act on abstract principle, but rather to do what is in the best interest of a patient who temporarily lacks capacity for certain health care decisions. In case 2, an elderly man has lived a full life, and has recently received demoralizing news from physicians. He attempts suicide. There are multiple reasons for which some physicians may take pause prior to intubating this patient. First, some physicians may feel that this suicide attempt is rational and justified: given the patient’s advanced age and poor prognosis, suicide may be a reasonable attempt at avoiding future pain and debilitation. Second, the presence of the patient’s family, who can speak to the patient’s life goals and values, and who presumably have his best interests in mind, would shed some light on the patient’s state of mind when he created the DNR/DNI order and may guide the treating physician’s intuition about the right course of action. Third, it is unclear whether the DNR/DNI order is an absolute prohibition that is still valid, or if it has been voided by suicidal intent. Can the surrogate trump the usual legal support for physician intervention to prevent death and the physician’s misgivings about participating in a suicide? After consulting with the emergency physicians and other family members, the patient’s wife demonstrated a clear understanding of the risks, benefits, and alternatives of intubation, including supportive care. She felt that it was in her husband’s best interests to allow him to die in the ED on the grounds that his underlying prognosis was poor, and with the knowledge that complications from intubation and transfer to the ICU are common. In this case, the surrogate may oppose intubation to spare the patient pain or suffering, and because the
surrogate is not complicit in the patient’s suicidal ideation, and is acting in the patient’s overall interests and in accordance with his life goals, such a refusal of care may be consistent with the court’s ruling. CASE OUTCOMES Case 1. The patient agreed to have IV NAC on the second day of her hospital admission, after frequent conversations with nursing staff and the treating physician. In the meantime, a court order was sought, but proved to be unnecessary. By that time, her transaminitis had peaked and had begun to resolve and her synthetic function improved. She was discharged to an inpatient psychiatry facility once deemed medically stable. Case 2. Despite the wife’s objections, the emergency physician, feeling that he did not have the time for a full analysis of the case, intubated the patient in accordance with his practice in prior cases of attempted suicide. On hospital day 3, there was evidence of an aspiration event and ARDS on chest x-ray. The patient was hemodynamically unstable, requiring multiple pressors. After consulting with the hospital ethics committee, the ICU team decided that continued treatment would be non-beneficial and was not consistent with the patient’s and surrogate’s wishes. The patient was extubated and expired shortly thereafter. ◗
WORKS CITED 1. Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. N Engl J Med. 1988;319:1635-1638. 2. Matthews MA. Suicidal competence and the patient’s right to refuse lifesaving treatment. Calif Law Rev. 1987;75:707-758. 3. Vacco DC. Attorney General of New York, et al. Petitioners v. Timothy E. Quill et al. :2298-2301.
RESIDENT AND STUDENT ADVISORY COM M ITTEE REFLECTIONS ON RESIDENCY, YEAR ONE Joel Brooks, DO, PGY-1
Heart of Lancaster Regional Medical Center As you put on your long white coat and walk into the hospital on July 1, a nurse hurries to you, asking for medication orders, while another reports a critical lab value on a new patient you need to see. Welcome to your first day as an intern. The intern year can be a frightening experience. After years of studying in medical school, it is time to apply all you have learned. In many ways, the intern year is the hardest, because there is a steep learning curve, with much to process in a completely new environment. You are no longer the inquisitive medical student. Instead you are the doctor who makes the decision and accepts the consequences. Your patients and coworkers will expect you to have all the answers. As daunting as this may seem, this year is a great opportunity to learn and experience all medicine has to offer. As an intern in the emergency department, you will likely begin by seeing fewer patients than your senior residents. Some programs may have you see one to two patients an hour, while others will encourage you to see more. This is the first time you will be caring for a patient on your own (usually under both senior and attending supervision), and it can be a challenge. I recommend finding a reference pocket book and/or useful apps for your phone that you can use to look up information. The American Academy of Emergency Medicine (AAEM) and the Emergency Medicine
Residents’ Association (EMRA) published a pocket survival guide that I used as a medical student and as a resident have found to be equally helpful. My preferred medical apps are Epocrates, Medscape, Qx Calculate (useful calculators for risk/severity index), and Micromedex. There is a wealth of online resources available for residents at various association websites, including the SAEM’s (www.saem.org), AAEM’s (www.aaemrsa.org), EMRA’s (www. emra.org), and the American College of Emergency Physicians’ (www.acep.org). I encourage you to check out these resources, as well as the many others available, in order to find one you like that is accurate and easy to use. Remember that you can always ask for help when you need it. It is better to ask for assistance before you become overwhelmed than when it is already too late. There are times during intern year that you will feel isolated, but with the help of your friends, you will not be alone. Speak to your fellow interns, colleagues and mentors. They are likely to have experienced the same difficulties as you are encountering, and together you can work through the challenges. During your floor months, creating templates for writing notes and dictations is a helpful method to ensure your notes are thorough and streamlined. This is important on rotations with a large patient census. When commencing difficult rotations (e.g., surgery, intensive care, or general medicine), it may be of benefit to begin your day earlier than required in order to pre-round. This will help you become better acquainted with your patients and the system. When under time constraints, I find UpToDate® to be a quick and efficient summary of the various conditions I encounter. Continued on Page 12
FIRST MEETING OF THE AAMC COUNCIL OF FACULTY AND ACADEMIC SOCIETIES Cherri D. Hobgood, MD, FACEP
Chair and Rolly McGrath Professor of Emergency Medicine Department of Emergency Medicine Indiana University School of Medicine
David P. Sklar, MD
Editor, Academic Medicine Associate Dean for Graduate Medical Education Emeritus and Professor of Emergency Medicine Emeritus University of New Mexico School of Medicine Cherri D. Hobgood, MD, and David P. Sklar, MD, past presidents of the Society for Academic Emergency Medicine, represented SAEM in March at the inaugural stand-alone meeting of the AAMC Council of Faculty and Academic Societies. Emergency medicine is also represented in CFAS by AACEM members Mark Henry, MD, chair of the Department of Emergency Medicine at Stony Brook University, and Sean Henderson, MD, Cherri D. Hobgood, MS, chair of the Department of Emergency MD, FACEP Medicine at the Keck School of Medicine of the University of Southern California. Drs. Hobgood and Sklar have submitted the following summary of the meeting. This meeting brought together representatives of academic societies and medical schools in an expanded organization now called the Council of Faculty and Academic Societies (CFAS). The Council is one of three (the others representing deans and hospitals) that make up the leadership of the Association David P. Sklar, MD of American Medical Colleges (AAMC). Emergency medicine has been well represented in the previous organization, which did not include medical school representatives, with CORD, AACEM and SAEM all participating. Part of this meeting involved smallgroup organizing sessions to better define the role, identity and communication responsibilities of the faculty representatives. The meeting took place March 6-8, 2014 in Nashville. There were over 200 attendees, and the major focus of the meeting was the changing role of faculty in academic health centers in response to financial pressures and changing institutional priorities. The meeting consisted of two days of lectures, round table discussions, and workshops on a range of topics currently confronting academic health centers (AHC). These included changing national funding and political climates, and the resulting impact on the culture of the AHC and the faculty. The keynote speech, delivered by the former president of the University of California, Mark Yudoff, described changing public commitments to public education as the population has aged and become more concerned about social security, health care and public safety. He suggested that academic medical centers would face the same
pressures, particularly in the area of graduate medical education. He suggested that all of our institutions would need to be looking at where cuts in personnel and changes in educational structure could be made in order to preserve the education mission. We also need to communicate the values of education to the public so that there continues to be public support for education and other basic infrastructure. The next day the same theme was applied more directly to health care and medical education, by Jeff Balser, MD, dean at Vanderbilt, and Janis Orlowski, MD, from the AAMC. The following summary relies heavily on a very excellent presentation by Dr. Orlowski. First, health care is changing rapidly. These changes are largely being driven by the move away from a volume-based reimbursement model to one that is more focused on population health and quality. This evolution is driving change and resulting in more AHC focus on reduction of costs, enhancing the patient experience, learning to manage the health of populations, attention to value-based payment systems, and consolidation of markets. Second, the AHC of the future will be systems-based. This requires consolidation of providers into systems that are both horizontally and vertically integrated. In the development of regional systems, AMCs must manage their brand as well as develop strategic partnerships. To be successful, systems must scale to be sufficient to maintain competitive parity and mission sustainability. This scale will be multi-billion in size, and a major determinant of future system success will be access to capital. Third, AHC systems require strong and aligned governance, organization, and management systems. AHC systems must align clinical services under leadership that is unified strategically or structurally. This leadership will be charged with enhancing clinical coordination and strategic planning, accelerating decisionmaking, and creating accountability for performance, with new emphasis on cross-departmental collaboration. New structures will prove effective because of the trust and commitment to collaboration of their leaders. System organization models will differ, and there are alternative approaches to organizing clinical entities to achieve economic alignment. Fourth, university relationships will be challenged to change as AHC systems grow and develop. In the 1990s there was a shift towards separation of higher education from health sciences â€“ to protect the parent university from the potential financial risk of large medical centers. There now appears to be a reversal of this trend, due to the success that medical centers have enjoyed. Services support should be transferred on a fair-market-basis, with inter-university flows subject to board oversight. Transparency in funds flows between the academic center and the university should be strongly encouraged, and overdependence on clinical income discouraged. University practices and policies should be modified to recognize the clinical system requirements for growth. Intellectual property policies should be updated to encourage closer ties with industry. Fifth, physician leadership and physician practice will change dramatically.
Continued on Page 12
Continued from Page 11 The growth and complexity of AHC systems require evolution in the roles of department chairs and new roles for physician leaders. There is a need for enhanced emphasis on quality of leadership: selection, succession, and training. There must be enhanced emphasis on teamwork among chairs and with system leadership as well as accountability for departmental performance and financial transparency across departments. The role of physician executives, especially CMOs, CMIOs, and group practice management, needs to be strengthened. There will be greater definition of faculty practice plans as they determine if they are to be the sole physician organization for the health system or one of many. There will be processes established for the addition of clinical faculty and affiliate physicians. This method will vary among institutions based on market forces. Sixth, the development of transparency in quality, performance, and financial information at all levels of the organizations will be central to achieving high performance. It is impossible to succeed in taking on risk / bundles without true understanding of costs across hospitals and practices. There is a need for quality reporting and innovation. The demonstration of outcomes over time will be essential to maintain a strong AHC brand. AHCs must be more explicit about value (quality/cost) and how they position themselves in the market. The ability to define quality outcomes to purchasers is as critical as, if not more critical than simply lowering the cost structure. AHCs must have a more efficient operating model. High costs are the AHCs’ primary competitive disadvantage for system success. Commitment to lowering costs is a prerequisite for taking on population health and risk assumption strategies. Reengineering must extend to all aspects of the tripartite mission. The highest potential for AHC innovation in total cost management will be by delivering the best results on utilization. There needs to be broad investment in new skills such as Lean across all faculty and staff. Seventh, AHCs must learn to lead in population health. As the ACO strategy becomes more prevalent, and risk contracting expands, the capacity to effectively manage an assigned group of beneficiaries becomes mandatory. Few academic centers have
Continued from Page 10 If I have the opportunity to study more in depth, I try to read the applicable chapter from Harrison’s Principles of Internal Medicine or Internal Medicine on Call (a personal favorite of mine). It is important to find a reference source you enjoy using so that you will continue to read and expand your knowledge. The most important advice I have to offer is to be courteous to all your co-workers. Always have a smile and be polite to the staff: it is the right thing to do. While this behavior may appear fundamental and obvious, unfortunately it is often overlooked. Physicians and staff will want to work with you if you have a positive attitude and are friendly. This creates a positive working atmosphere and learning environment. Build friendships with the
built this capability, have it at scale, or are expert in this domain. Most organizations will need to assess whether they will build this capacity internally or purchase it. Eighth, AHCs must have a candid assessment of their strengths and weaknesses, which are essential to achieve change. The rapidly changing market and policy dynamics are forcing an assessment of ability and capacity of AHCs to succeed as organized systems of care. Current AHC systems strategy is costly and difficult to execute well. Board and leadership must achieve new clarity and discuss candidly the system’s capabilities. Systems with less strength will require the establishment of strong partners, and investment in new capabilities. Following the presentation by Dr. Orlowski, Dr. Balser described the reasoning behind recent personnel cuts at Vanderbilt, and how the same reasoning might apply to other academic health centers. In brief, the key problem relates to pressure on clinical revenue, which has been subsidizing other missions at academic health centers. However, with the recognition that health care spending is creating huge public debt, and an unwillingness to continue to add to debt, the clinical revenue stream is decreasing. This reduction is destabilizing all missions at academic health centers, and a new balance will need to be found. Following these presentations, there were formal and informal discussions about what academic societies and medical schools can do to address this crisis. The situation for GME funding appears to be particularly dire and will be major priority for AAMC in the coming year. SAEM may want to join with other societies in developing information for advocacy activities around GME funding to assist individual programs. Overall, this was a useful meeting for SAEM in that it allowed for the sharing of information and the development of networking with other national faculty leaders, who became more familiar with the issues facing emergency medicine and how they are related to the bigger picture for all specialties. For more information about the AAMC Council of Faculty and Academic Societies, visit their website at https://www.aamc.org/ members/cfas/ ◗
nurses and other staff members. They are a wealth of knowledge and an invaluable resource. Residency is a challenging time, and it is helpful to have the support of your co-workers. The key to every rotation is this: what you put in is what you get out. This applies to both the learning and knowledge gained, and to personal experiences encountered. A positive attitude leads to a positive rotation (even intimidating rotations like surgery and ICU). There will be long hours, but make the most of the time and enjoy the experience. You are being paid to learn and to do what you love, to live your passion. Good things come with hard work and sacrifice. This is your chance to practice without the full burden of liability on your shoulders, a chance to learn, live, make mistakes, test your strength and grow. ◗
SAEM – THE TIME OF MY LIFE! Donald M. Yealy, MD
Professor and Chair, Department of Emergency Medicine, University of Pittsburgh SAEM President, 2003-2004 As the organization reaches its 25th anniversary, I join other past leaders in sharing my experiences as a member and organizational leader of SAEM. I joined SAEM at the onset – going to my first meeting in Philadelphia the year prior to the UAEM and STEM merger. Since 1989, I’ve missed just one annual meeting - my 6-year-old was born just prior to the 2008 meeting. Each time I attend, and Donald M. Yealy, MD each time I work on a SAEM effort, I find that ground-level and impactful zeal for scholarly emergency medicine excellence – creating, sharing and refining knowledge to improve the heath of those who seek our care. SAEM remains the place for this to happen – each day, each submission, and each meeting. I joined the SAEM Board of Directors in 1999, after serving as Program Committee chair. For the ensuing six years, including as president in 2003-04, I worked with the best and brightest leaders in academic emergency medicine. To transform SAEM, we changed
the way things were while maintaining the core: We opened the membership up to any academic emergency physician (from only those with a university appointment); enhanced membership input into choosing the leadership by allowing voting outside attendance at a session during the annual meeting; and created choice in the leadership positions, a strength of any organization with many talented members. Throughout the six years, we saw increasing membership, stronger finances, and more high-quality scientific submissions to the meeting and journal – each creating impact. These are the traits that continue in SAEM today. SAEM was and is a “force” because of the willingness to focus on academics, and to do “the right things” – even when popular sentiment seems different than those positions. I thank all the members from then and now – notably, Roger J. Lewis, MD, PhD, and Carey D. Chisholm, MD, who were the “bookend presidents” during my time leading. Roger, Carey and I, together with Executive Director Mary Ann Schropp, were able to forge excellent relationships with the key emergency medicine organizations, maintaining the SAEM mission while working collaboratively. This is the essence of every good emergency physician – seeing through the clouds and working together to choose the best path. SAEM was my first organizational home, and it remains a key part of me. I hope it does for you, too. ◗
2014 SAEM MID-ATLANTIC REGIONAL MEETING RECAP Submitted by: Ron Hall, MD; Wayne Lau, MD; and Matt Fields, MD The 2014 SAEM Mid-Atlantic Regional Meeting was held on February 22, 2014 at Jefferson Medical College in Philadelphia, PA. 194 people representing 64 programs attended the meeting from as far north as Boston, as far south as Atlanta, and as far west as Stanford, CA. Six plenary and 142 lightning oral abstracts were presented by 118 presenters. HIGHLIGHTS OF THE MEETING INCLUDED: • A panel session moderated by Bernard Lopez, MD, MS, that explored “The Future of Emergency Medicine Education.” Philadelphia-area program directors (Drew Nyce, MD; Brian Levine, MD; Manish Garg, MD; and Ron Hall, MD) made predictions on the future of technology, GME funding, resident conference and the milestones. • A keynote talk by Charles Pollack, MD, on the use of antiplatelet agents in acute coronary syndromes • A “Jeopardy”-style competition conducted by the SAEM Academy of Emergency Ultrasound (won by the Virginia Commonwealth University Residency Program)
WINNERS OF THE BEST PRESENTATIONS WERE: • Basic Science Yajing Wang, MD (Thomas Jefferson University) Adiponectin Enhances Acetylcholine-induced Aortic Relaxation After Angiotensin II-induced Vasoconstriction • Best Young Faculty Jennifer White, MD (Doylestown Hospital) - An ED Rhythm Control Method for Recent Onset Atrial Fibrillation Improves Outcomes Compared to Standard Therapy. • Clinical Presentation Janet Young, MD (VA Tech Carilion) The Cost of Epidemic Care: Exposure to Contaminated Epidural Steroid Injections • Allied Health Presentation Diana Montez, RN, BSN (Vidacare Corporation) - Lactate Levels In Venous and Intraosseous Blood Correlate; PT/ INR Levels Do Not • Best Medical Student Ashley Parks (VA Tech Carilion) - Rural Primary Care Access for Semi-Urgent Medical Concerns and the Relationship of Distance to an Emergency Department • Best Resident Presentation Jeffrey Chien (Thomas Jefferson University) - Barriers To Learning Ultrasound-Guided IV Placement In ED Nurses And Technicians
IMPROVING OLDER ADULT EMERGENCY CARE: INTRODUCING THE GERIATRIC EMERGENCY DEPARTMENT GUIDELINES Christopher R. Carpenter, MD, MSc (Chair, ACEP Geriatric Section)
Jeffrey Caterino, MD, MPH
(Past-President, SAEM Academy for Geriatric Emergency Medicine)
Ula Hwang, MD, MPH
(President, SAEM Academy for Geriatric Emergency Medicine)
Mark Rosenberg, DO, MBA
(At large member, Executive Committee SAEM Academy for Geriatric Emergency Medicine; Past Chair, ACEP Geriatric Section)
On February 11, 2014, four national emergency medicine and geriatric organizations released Geriatric Emergency Department (GED) Guidelines. (http://www.saem.org/education/geriatriced-guidelines). Boards of directors for these organizations â€“ the Society for Academic Emergency Medicine, the American College of Emergency Physicians, the American Geriatrics Society, and the Emergency Nurses Association - all reviewed, approved, and supported these guidelines and jointly released this list of recommendations to improve the care that older adults receive in our emergency departments. These guidelines represent recommendations for geriatric adult emergency care. They are neither a mandate for every ED to develop and sustain a geographically distinct space or staff for geriatric care, nor a list of recommendations requiring 100% compliance. The GED
guideline authors are practicing emergency physicians, nurses, and geriatricians, who wrote this document for local ED leaders to focus attention on geriatric emergency care within their institutions based upon patient needs and available resources. We anticipate many questions and concerns related to these recommendations; the intent of this introduction is to help SAEM members understand these new recommendations. A session introducing the Geriatric ED Guidelines will be held during the business meeting of the SAEM Academy of Geriatric Emergency Medicine at the 2014 SAEM Annual Meeting on Thursday, May 15 from 10:00 - 11:45 am (Sheraton Dallas Hotel State Room 1, 3rd floor). With that session and this executive summary, we hope to inform readers about: 1) A history of the GED Guidelines development process 2) GED Guidelines derivation methods 3) Specific examples from the GED Guidelines 4) Education, research, and financial imperatives stemming from the GED Guidelines 5) Present and future plans for the GED Guidelines
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Continued from Page 14 Geriatrics and Emergency Medicine – Historical Context In 1991, emergency medicine had no geriatric interest group and scant research to understand the unique ED management requirements of the geriatric population. SAEM took a leading role in the early development of geriatric emergency medicine. The John A. Hartford Foundation, led by Donna Regenstreif, focused on improving geriatric health care outcomes at this time. The Hartford Foundation recognized the cross-disciplinary role of emergency medicine and approached UAEM (a forerunner to SAEM) to develop a body of expertise in geriatric emergency medicine education, research, clinical operations, and policymaking. Dr. Art Sanders, the UAEM president in 1991, accepted a Hartford Foundation pilot grant and organized the first geriatric emergency medicine task force. Subsequently, a series of Annals EM manuscripts described the current state of affairs for geriatric emergency care while outlining future research and educational initiatives. A larger Hartford Foundation grant in 1993 funded the first geriatric emergency medicine textbook (Emergency Care of the Elder Person in 1996), as well as multiple research projects that further defined the epidemiology of geriatric syndromes in the ED (falls, delirium, dementia, polypharmacy). In addition, the Hartford Foundation and the Atlantic Philanthropies supported efforts by the American Geriatrics Society to increase awareness of and knowledge in the care of older adults among surgical and related medical specialists, including emergency medicine. Programs such as the Jahnigen Career Development award funded the next generation of geriatric emergency medicine researchers, educators, and opinion leaders. Continuing to prioritize and emphasize the need to focus on geriatric patient care in the ED setting, the Society for Academic Emergency Medicine Board of Directors convened in 2002 a geriatric task force led by Dr. Lowell Gerson. This group focused on developing quality indicators for geriatric ED care and developed educational initiatives. As the task force grew, it transitioned to the SAEM Geriatric Interest Group in 2005. By 2009, the group’s accomplishments under leaders Dr. Scott Wilber, Dr. Manish Shah, and Dr. Ula Hwang led to the transformation of the interest group into the Academy of Geriatric Emergency Medicine (AGEM). Concurrently, the American College of Emergency Physicians’ Geriatric Section started in 2003. These geriatric emergency medicine groups continued to expand the evidentiary basis to guide optimal older adult acute care. For example, Dr. Teresita Hogan worked with the AMA, ACEP, SAEM, AGS, CORD, EMRA, and multiple other stakeholders to develop geriatric core competencies for every emergency medicine resident in 2010. The expanding memberships of AGEM and the ACEP Geriatric Section highlighted the reality that abstract presentations, lectures, manuscripts, and textbooks were insufficient, unreliable, and inefficient methods to align emergency care of older adults with target outcomes. Emergency medicine needed one document containing best practice recommendations, written by and for geriatric emergency health care providers, educators, researchers, and advocates. With the support of SAEM, AGS, and ACEP, the process of developing such a document began in early 2011. Deriving the GED Guidelines – The Process The Geriatric ED Task Force was formed by and comprised of leaders, experts, and representatives from ACEP, AGS, SAEM’s AGEM, and ENA. The goal of the steering committee was to
establish guidance in the development and operations of geriatric emergency departments. Through a series of teleconferences during 2011-2012, the 14 GED Guidelines co-authors split into two working groups focused on “structural and staffing” and “clinical/operational” content areas. Each group reviewed the literature and provided best-evidence recommendations for essential geriatric emergency care. The entire membership of AGEM and the ACEP Geriatric Section formally reviewed and approved the GED Guideline recommendations in October 2012. Between October 2013 and February 2014, the boards of directors of ACEP, SAEM, AGS, and ENA reviewed and officially approved the guidelines. Components of the GED Guidelines – What They Are and What They Are Not The GED Guidelines do not mandate that all hospitals have geriatric-only EDs. Instead, the guidelines provide a basis for improving care for older adults in the ED setting. In 2007 no geriatric EDs existed in the US, but by 2014 there were over 40 self-designated “geriatric EDs” or “senior ERs.” These guidelines provide recommendations about older adult emergency care that should be considered if an ED designates itself as a geriatric emergency department. We cannot overemphasize that the Geriatric ED Guidelines represent recommendations for older adult emergency care. These are not directives that every geriatric-friendly ED develop and sustain all of these elements. Every ED that provides emergency care for geriatric adults, however, should be aware of these guidelines, the rationale for their recommendations, and potential resources available for transitioning from recommendation to implementation. Improvements would be dictated based on local needs, care patterns, and resources available to individual hospitals. The GED Guidelines consist of 40 specific recommendations in six categories: 1) Staffing; 2) Transitions of care; 3) Education; 4) Quality improvement; 5) Equipment/Supplies; 6) Policies/ Procedures/Protocols. Staffing includes recommendations for the medical director and nurse manager, and accessibility to specialist ancillary services. Transitions of care include discharge processes and large-font instructions, as well as appropriate collaboration with home health services and home safety assessments. Nurse and clinical provider education focuses on contemporary, research-based geriatric-specific material. The quality improvement recommendations provide an exemplar spreadsheet of pertinent and prevalent geriatric emergency care indicators to monitor, including the prevalence of injurious falls and documentation of fall-risk assessment. The equipment and supplies section describes potential physical structure enhancements, such as the use of reclining chairs and pressureredistributing foam mattresses to improve comfort and reduce the incidence of pressure ulcers. Finally, a variety of sample policies, procedures, and protocols are provided to facilitate screening older adults to identify the subset who are at increased risk for post-ED adverse outcomes, as well as validated and ED-feasible screening instruments for geriatric syndromes such as delirium, polypharmacy, falls, and dementia. Educational and Research Advantages of the GED Guidelines With the release of the GED guidelines, educational opportunities for trainees in individual EDs will now be needed to support the shift from stated recommendation to actual implementation. The creation of specific protocols and care plans (medication assessment,
Continued from Page 15 fall risk stratification, comprehensive geriatric assessment, etc.) highlights the need to focus on geriatric-specific issues in these patients and to expose trainees to the rationale for geriatric-specific care and clinical action. The integration of interdisciplinary models into geriatric care will, by increasing the visibility of such models in the ED, provide exposure and experience to the trainee in partnering with geriatrics, case management, social work, pharmacy, physical therapy, palliative medicine - all of which will expand the trainee’s overall clinical practice. Despite the journey to the GED guidelines described above, the evidence base for best practices in geriatric ED care is still thin. In many cases, evidence-based ED care of the geriatric patient must rely on studies conducted in other settings with potentially differing patient populations (e.g., nursing homes, inpatient settings, ambulatory care offices, etc.). With the growing number of GEDs comes an opportunity to conduct studies to determine the impact of geriatric emergency care on the areas described above, including, but not limited to, patient outcomes, resource use, and process measures. In addition, local focus of expertise on the geriatric patient will facilitate clinical research in the care and treatment of the individual geriatric ED patient, with or without a full GED. The involvement of interdisciplinary teams in the care of ED patients should also improve the quality of research generated by ensuring that the most knowledgeable experts in the various areas are part of collaborative efforts. Financial Basis for GED Guidelines In medicine today, the financial complexities of the hospital business often drive resource allocation within a health care system. Consideration of a geriatric ED model of care may be a driver of patient and market share for an emergency department, depending on local and regional patterns. For example, in many communities, a dedicated pediatric ED will become the preferred site of care for children. Similarly, a GED might drive similar patient preferences for a site of care for older adults. Many health care decisions regarding the elderly patient seen in a geriatric ED are made with the input of other family members, usually the middleaged children that accompany their parent(s) to the ED. This is the population that may make the decision to bypass another ED to go instead to a GED. With the aging population, geriatric patient volumes will undoubtedly increase in most health care markets. It is to be expected that a dedicated GED will provide a competitive advantage to a hospital system. To determine if a GED is reasonable for a particular hospital or medical system, it is beneficial to look at future population trends, how this will impact market share, and to evaluate the competitive environment of regional and local hospital systems. Cost considerations when creating a geriatric ED primarily will focus on structural enhancements as well as on personnel charges. As a rough estimate, the total cost would be approximately $12,000 for the renovation of six beds in a typical ED. Personnel costs could include enhancement to existing services and/or addition of services, depending upon community need. If available, geriatrics, case management, physical therapy, pharmacy, and nutrition are all interdisciplinary departments that could partner in facilitating improved geriatric care and transitions in care. Many hospitals already have some of these services. Changing priorities and redesigning workflow may be all that is necessary to initiate improvement in geriatric patient care.
Moving Beyond the GED Guidelines – The Future of Geriatric Emergency Care If we can successfully confront the clinical, education, research, and financial challenges that the baby boomer generation presents to modern medicine, then all patients will be assured a trustworthy, accessible, empathetic, and efficient emergency care system. However, the GED Guidelines are a beginning, not an end. The authors have devised a plan forward that includes dissemination, implementation, adaptation, and refinement. To move forward, geriatric emergency medicine needs sustainable funding opportunities to: 1) enhance the patient-centric evidence upon which the protocols are based; 2) establish whether adherence to these recommendations improves the quality of care delivered; 3) determine whether the recommendations improve health care outcomes for older adults and their caregivers; and 4) sustain the development of future geriatric emergency medicine leaders. One immediate next step is to prioritize the 40 recommendations into essential and non-essential domains for hospital administrators, payers, and research funders to support widespread implementation. For example, routinely screening for delirium using validated instruments has profound implications on ED disposition and management decisions, as opposed to infrastructural changes to lighting, floor material, and wall colors. Prioritizing the guidelines will weigh the relative benefits and harms associated with each recommendation to yield a list of least- to most-important GED guideline recommendations. Another task is to increase GED guideline understanding amongst emergency medicine clinicians, hospital administrators, patient advocacy leaders, and patients through executive summaries such as this essay. However, hands-on learning is both more desirable for learners and more effective in terms of sustained practice change. The GED guideline group is developing a “Geriatric Emergency Department Boot Camp” program through which geriatric emergency medicine leaders will bring the recommendations, a toolbox of resources, real-world examples, and mentorship to interested programs and hospitals. Hospitals interested in “geriatricizing” their ED may not need to travel to learn more about these implementation recommendations. Essential interdisciplinary health care team members like social workers, case managers, geriatric consultants, pharmacists, hospital administrators, and payers, in addition to the ED clinical teams, can also participate. The intent is for participants in the boot camps to develop local and regional needs-based quality improvement projects with which the boot camp faculty can assist and for which one-year outcomes will be assessed. The boot camp concept also provides an observable test tube for evaluating the feasibility and acceptability of and barriers to implementing existing GED Guideline recommendations – knowledge that can be used to refine the 2nd Edition of the GED Guidelines in coming years. Summary The public release of the GED Guidelines represents an effort to transform emergency care for older adults. The unique health care needs of our aging population will challenge all of our health care systems in and beyond the ED. Geriatric EDs will not be a mandate for all hospitals, nor will they be necessary. Geriatricizing our EDs to provide optimal care for older adults, however, will be a necessity. The Geriatric ED Guidelines are the first steps in moving emergency medicine in this direction. ◗
NERDS RULE AT YALE-HOSTED SAEM NEW ENGLAND REGIONAL MEETING Dr. Jeremy Brown, NIH Director Of Emergency Care Research, Keynote Speaker
(LEFT) Keynote speaker Dr. Jeremy Brown with conference coordinators and attendees: (Front row, left to right) Jeremy Brown, MD; Mae Ward, RN; John Nagurney, MD; James Feldman, MD; Blair Parry; Megan Ranney, MD; João Delgado, MD. (Back row, left to right) Kathleen Clem, MD; Patty Mitchell, RN; Howard Smithline, MD; Gail D’Onofrio, MD, MS; Lori Post, PhD. Not pictured are Virginia Mangolds, MSN, and Thomas Stair, MD. (RIGHT) Jeremy Brown, MD, speaks to a packed house
for the Yale School of Medicine Photos by Chris Randall Participants came from as far as Toronto, Canada to attend the 18th Annual SAEM New England Regional Meeting (aka NERDS) on March 26, 2014, at the Omni Hotel in New Haven, Connecticut. Hosted by the department of emergency medicine at the Yale School of Medicine, the aim of the conference was to provide emergency medicine residents and junior faculty the opportunity to present original research in a forum that fosters the development and productivity of new investigators. “The conference was superb,” said Gail D’Onofrio, MD, MS, professor and chair of the Yale department of emergency medicine. “We had a record number of attendees and nearly 200 presenters on exciting topics ranging from education to resuscitation.” The inspiring keynote address from Dr. Jeremy Brown, director of the Office of Emergency Care Research at the National Institutes of Health, focused on the “The Half-Life of Truths in Emergency Medicine.” Virginia Mangolds, MSN, FNP-C, BSEd, RN, CEN, one of the founding NERDS directors, continues to provide pivotal direction to the annual conference. “Our original mission was to offer an avenue for local programs to display research that is not yet ready for prime time,” said Ms. Mangolds. “The conference offers the ideal venue for new investigators to have the opportunity to present in public and to receive developmental feedback from their mentors.” Although they zipped by with lightning speed, the Lightning Oral Sessions demonstrated that yes, you can present a year’s
worth of work effectively in five minutes and answer questions! Dr. Federico Vaca, Yale Professor of Emergency Medicine, was particularly impressed with Dr. John Bedolla’s presentation, “Accident Types and Injury Patterns in Elite Motorcycle Racing.” “As an avid traffic safety researcher, it’s fantastic to know that an EM physician is intimately involved in motorcycle safety at the most elite level of racing and that he is translating his research efforts into formal recommendations that will significantly reduce serious injury and death.” The poster sessions were also a huge success. Out of a record number of 250 poster submissions, with 100 presented, three were awarded prizes. James Dziura, PhD, MPH, deputy director, Yale Center for Analytical Sciences, said, ”First place went to a New York resident, second place to a resident from North Carolina, and we were thrilled that Dr. Joshua Keegan from our department came in third for his poster, ‘The testing threshold for minor head injury.’” The day culminated with a stimulating game of Ultrasound Jeopardy. “The game was more than just a fun way to unwind after an intense day,” said Rachel Liu, MBBChBAO, one of the Jeopardy coordinators. “Ultrasound educators are always looking for new ways to engage learners and to think outside the box of traditional medical education, appealing to both experienced practitioners and younger students alike. Events like these showcase how it can be done. The participants demonstrated the depth and strength of bedside ultrasound enthusiasm, teaching and education in the New England area.” Continued on Page 19
Continued from Page 18 Regional Meeting Program Committee chair Lori Post, PhD, from the Yale University School of Medicine Department of Emergency Medicine, was amazed at not only the high turnout, but also the level of engagement, learning and networking that took place. “We are honored to have had the opportunity to host the largest NERDS ever. We had over 500 submissions from 17 states and two countries. We were also amazed that over 100
spectators showed up the day of the conference just to watch. We are grateful to all the New England research directors who contributed to making this event a success.” “Each year the NERDS ‘rule’ better and better,” said James Feldman, MD, research director at Boston Medical Center. “A heartfelt thanks to all of the people at Yale for hosting such a fantastic conference and to all of the regional directors. One of my residents, a first-time attendee, said it best: ‘I love being a NERD!’” ◗
(LEFT) Joshua Keegan, MD, presents his prize-winning poster. (RIGHT) Rachel Liu, MBBChBAO, hosts Ultrasound Jeopardy.
Join us throughout the week Wednesday, May 14 8:00 am-10:00 am - International Emergency Medicine Oral Abstracts An Academy of the Society for Academic Emergency Medicine
Thursday, May 15 GEMA Meetings - All Are Welcome to Attend 8:00 am-9:00 am - Ultrasound in ResourceLimited Settings (with AEUS)
Saturday, May 17 ~ Atrium 8:00 am - 9:30 am GEMA Business Meeting
9:30 am - 10:30 am GEMA Annual International EM Fellowship Showcase 10:30 am - 12:00 pm GEMA Strategic Planning Meeting
Friday, May 16 9:00 am-10:00 am Ethical Dilemmas in International EM (with Ethics) 10:30 am-11:30 am Federal Funding for Global Health 11:30 am-12:30 pm Global EM Literature Review 5:00 pm - 7:00 pm Special Networking Session - Global EM Projects Showcase An opportunity to meet mentors and collaborators in an informal setting.
ALL I N A DAY’S W O R K Melissa McMillian, CNP SAEM Employee of the Year 2013
“…together we have achieved many victories for emergency medicine.”
“Pass the ball, I’m open!” Crack! “Ouch! My finger! I think it’s broken!” And as you might expect, two minutes later I’m driving my brother-in-law to a local emergency department in Chicago for a dislocated finger that we thought was broken. It probably sounds mundane to you – a simple dislocated finger. Give him something for the pain, pop it back into place, wrap it up, and send him home. On Melissa McMillian, CNP to the next one. But for me, it was the first time I had been on the patient side of the waiting room, and it was fascinating. Yes, I was concerned for my brother-in-law because his finger was twisted in a very painful looking angle, but what really got my attention were the doctors, nurses and staff that treated his injury with immense kindness and attentiveness amidst all of the chaos around us. My curiosity about how the world of emergency medicine works was sparked that day, and what’s more, since I had my first job interview with SAEM the next afternoon, it seemed more than a coincidence that I ended up in the emergency department that evening. It has now been almost four years since I began working with SAEM, and it has been a wonderful experience. The first project I took on was the 2011 AEM Consensus Conference, titled “Interventions to Assure Quality in the Crowded Emergency Department” and organized by Drs. Jesse Pines and Melissa McCarthy at the Annual Meeting in Boston. The conference was a great success, and working with Drs. Pines, McCarthy, and David Cone (AEM Editor-in-chief) introduced me to EM in a positive way. It gave me a strong foundation for my next several years at the Society and helped me to understand some of the unique needs of the emergency department. One great benefit to working for SAEM is that I have the opportunity to collaborate with experts in various areas of emergency medicine that all help to shape the specialty. I have learned a great deal from all of you that have taken the time to share your experiences with me, and together we have achieved many victories for emergency medicine. (I wish I could name each of you here but that would fill up a whole page by itself!) This year in particular has been productive for the academies that I work closely with. The Academy of Geriatric Emergency Medicine (AGEM) released SAEM’s first online educational course, “Abdominal Pain in the Older Adult,” in early 2013, and also completed a two-year collaborative project that resulted in the new Geriatric ED Guidelines, which have gained national attention. The Academy of Emergency Ultrasound (AEUS) successfully hosted the second annual SonoGames® in Atlanta, and this year we are planning an even bigger and better competition for 2014! The Clerkship Directors in Emergency Medicine (CDEM) have been working tirelessly on the redesign of the very popular CDEMcurriculum.org for students and have several other projects underway, including a collaborative effort to create Best Practice Guidelines for Medical Student Advising with CORD, EMRA, and others. These are only a few of the incredible projects that our academies are working on. If you are looking to fill some spare time with a new project, join an academy and ask how you can get involved!
2013 SonoGames®, Atlanta, GA Similar to the academies, many of the committees and task forces I support have also been actively advancing academic EM. The Grants Committee developed the new Education Research Grant to fund innovative projects that enhance education through the SAEM Foundation. And the Fellowship Approval Task Force created the new SAEM Fellowship Approval Programs to provide standards in fellowship training for non-ACGME-accredited fellowships. Both of these programs will allow us to continue to improve emergency medicine education and research training, and I’m honored to be a part of the process. I should also mention that the Research Committee has been working on a new online Grants Guide and Directory to help those interested in starting a research career to become familiar with the types of grants that are available. This should be open on the SAEM website in summer 2014. Outside of my work with the Society, I have also been actively working with the SAEM Foundation and its Development Committee to enhance our outreach and communication with SAEM members. You may have seen invitations in your inbox, in the e-newsletter SAEM Hot Off the Wire, or in your Facebook and Twitter feeds to the Foundation’s Special Event at the Sixth Floor Museum in Dealey Plaza coming up on May 15, 2014. If not, take a look at the SAEM Foundation website http://www. saemfoundation.org! We are celebrating 25 years of SAEM, and, really, 25 years of hard work that you all have put into advancing the specialty. I hope you will come and celebrate your accomplishments with us. The proceeds will benefit the Foundation to support the research and education initiatives of our budding academicians. There will be food and drinks, entry into the museum, and a silent auction with unique items to bid on. All of you who received a foundation grant early in your career understand how important it is to our young investigators that we sustain these training programs. Please join us at the event to support them and the future of academic EM – we need your help to continue the good work. I must say, the last four years have been wonderful, and I want to thank you all for making me feel welcome in the academic emergency medicine community. I am proud to work for you, and beside you, to advance emergency care through education and research, advocacy, and professional development, and I am looking forward to our next four years at SAEM together. ◗
Your Simulation Academy is comprised of emergency medicine physicians who are committed to enhancing education, research, and patient safety through the use of simulation
TRAIN THE TRAINER: ADVANCING SIMULATION FOR EDUCATION Tuesday, May 13th — 8:00 am - 5:00 pm | Lone Star Ballroom, Sheraton Dallas
ACADEMY BUSINESS MEETING AT SAEM Friday, May 16th — 8:00 am to 12:00 pm | Atrium Room 2nd Floor of Conference Hotel There will be 1-2 hours of business, followed by breakout groups to work on projects and networking
SIMULATION DIDACTICS THURSDAY MAY 15TH DS049: Achieving your Milestones through Simulation Faculty: J Siegelman (Sim Acad), D Hart (Sim Acad) Dallas Ballroom D1 (Conf. Center-1st Floor) — 10:30 - 11:30 am DS056 Team Leadership in Emergency Medicine: Opportunities for Measurement and Assessment Faculty: E. Rosenman, J Branzetti (CORD), and R Fernandez (Sim Acad) Dallas Ballroom D1 (Conf. Center-1st Floor) — 11:30 am - 12:30 pm SATURDAY MAY 17TH DS092: Do-it-yourself Simulation: Cutting-edge Simulation on a Shoe-String Budget Faculty: N. Panebianco (U/S Acad), D Morato (U/S Acad), W Bond (Sim Acad) Dallas Ballroom C (Conf. Center-1st Floor) — 8:00 - 9:00 am DS102: Watch a Doctor Get Sued: A Live MedicoLegal Simulation Faculty: M Smith (Sim Acad) Dallas Ballroom B (Conf. Center-1st Floor) — 10:00 am - 12:00 pm
SIM WARS EMRA/SAEM Simulation Academy Resident Sim Wars Wed May 14, 2014 — 8:00 am – 12:00 pm Lone Star Ballroom C1-C2-C3-C4 (Conf. Center-2nd Floor)
THE AMERICAN BOARD OF EMERGENCY MEDICINE UPDATE: PQRS MOC ADDED INCENTIVE PROGRAM There were 4,113 ABEM diplomates who applied for the 2013 PQRS MOC bonus by the March 10, 2014, deadline, an increase from the 3,049 physicians who applied for the bonus in 2012. This could result in over $2.3 million in additional reimbursement to ABEM diplomates, up from last year’s estimated $1.8 million. ABEM has again applied to CMS to participate in the program in 2014. It is anticipated the “more frequently” requirements will be the same, namely, one LLSA test, one patient care practice improvement (PI) activity, and one communications/ professionalism activity. To be eligible for the incentive payment, each of these activities must be completed in 2014. Once completed, participating physicians can apply for the payment through their Personal Access Page on the ABEM website. A webinar (www.abem.org/public/pqrs-moc-additional-incentivepayment/pqrs-moc-incentive-webinar) explaining the PQRS MOC incentive payment and a tutorial (www.abem.org/public/tutorials/ pqrs-moc-incentive-registration) demonstrating how to register are also available on the site. If you have questions after checking these resources, please send an email to firstname.lastname@example.org, or call 517.332.4800, ext. 383.
LLSA TESTS NOW AVAILABLE The 2014 Emergency Medicine LLSA test was posted to the ABEM website on April 1, 2014. Those who take the test can opt to participate in the LLSA CME activity, which will award 11 credits, of which 2 are pediatrics related, and 2 are trauma related. On June 1, 2014, the first EMS LLSA test will be available on the ABEM website. There will also be an optional EMS LLSA CME activity; the number of credits has not been determined at the time of this writing. The cost of both the LLSA tests and optional LLSA CME activities remain the same: $100 for the tests, and $30 for the CME activities. CME credits can be awarded either by ACEP or AAEM.
SUBMIT AN ARTICLE! Have you or your colleagues recently read an article or book chapter that you found particularly fascinating, important, relevant to the practice of EM, or that changed your clinical practice? If so, the ABEM Board of Directors, the EMS Examination Committee, and the Medical Toxicology Subboard encourage you to submit it for consideration as an EM, EMS, or Medical Toxicology LLSA reading. Click here (www.abem.org/public/abemmaintenance-of-certification-(moc)/moc-lifelong-learning-and-selfassessment-(llsa)/llsa-reading-submission-process) for instructions on how to submit an EM article or book chapter, click here (www.abem.org/public/subspecialty-certification/emergency-medicalservices/ems-maintenance-of-certification/llsa-reading-submissionprocess) for instructions on how to submit an EMS article or book chapter, and click here (www.abem.org/public/subspecialtycertification/medical-toxicology/maintenance-of-certification-program/ llsa-reading-submission-process) for instructions on how to submit a Medical Toxicology article or book chapter. (Please view the online version of this SAEM Newsletter for access to links.)
ABOUT ABEM Founded in 1976, the American Board of Emergency Medicine (ABEM) develops and administers the Emergency Medicine certification examination for physicians who have met the ABEM credentialing requirements. ABEM has nearly 30,000 emergency physicians currently certified. ABEM is not a membership organization, but a non-profit, independent evaluation organization. ABEM is one of 24 Member Boards of the American Board of Medical Specialties.
ABEM MISSION The ABEM mission is to ensure the highest standards in the specialty of Emergency Medicine.
THE AMERICAN BOARD OF EMERGENCY MEDICINE ABEM BOARD OF DIRECTORS ELECTS TWO NEW MEMBERS East Lansing, Ml <February 18, 2014> At its winter 2014 meeting, the Board of Directors (BOD) of the American Board of Emergency Medicine (ABEM) elected two new directors: Carl R. Chudnofsky, M.D., and Marianne Gausche-Hill, M.D. Both were nominated by the Emergency Medicine community-at-large. Dr. Chudnofsky is a Professor in the Department of Emergency Medicine at Jefferson Medical College in Philadelphia, Pennsylvania. His clinical practice is with the Einstein Healthcare Network, for which he serves as Chair of the Department of Emergency Medicine and a member of the Board of Overseers and Board of Trustees. Dr. Chudnofsky has over 16 years of service as an ABEM volunteer, having served as an examiner, senior examiner, team leader, and senior case reviewer for the oral certification examination. He currently is chair of the eOral Multiple-Encounter Case Development Panel, and a member of eOral Case Development Panel and eOral Field Test Development Working Group. He also served as chair of the Initial Certification Task Force (ICTF) eOral Pilot Advisory Panel.
Carl R. Chudnofsky, MD
Dr. Gausche-Hill is Vice Chair of the Department of Emergency Medicine, and Chief of the Division of Pediatric Emergency Medicine at Harbor-UCLA Medical Center in Torrance California and Professor of Clinical Medicine and Pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles. She was an ABEM appointee to the Pediatric Emergency Medicine Subboard, for which she served as chair from 1999 to 2001; chair to ABEM and American Board of Pediatrics Committee for SelfAssessment from 2004 to 2006; and member of the ABEM Emergency Medical Services Examination Task Force from 2011-2013. Dr. Gausche-Hill is currently a member of the Marianne Gausche-Hill, MD EMS Examination Committee. Dr. Chudnofsky and Dr. Gausche-Hill will attend the 2014 summer BOD meeting as observers and begin their terms as ABEM directors at the close of that meeting. The ABEM Board of Directors is comprised solely of volunteer, board-certified, emergency physicians who are actively participating in ABEM Maintenance of Certification, a program of continuous learning and periodic assessment and are practicing physicians in Emergency Medicine.
• To improve the quality of emergency medical care • To establish and maintain high standards of excellence in Emergency Medicine and subspecialties • To enhance medical education in the specialty of Emergency Medicine and related subspecialties • To evaluate physicians and promote professional development through initial and continuous certification in Emergency Medicine and its subspecialties • To certify physicians who have demonstrated special knowledge and skills in Emergency Medicine and its subspecialties • To enhance the value of certification for ABEM diplomates • To serve the public and medical profession by reporting the certification status of the diplomates of the American Board of Emergency Medicine
ACADEM IC ANNOUNCEM ENTS Judd E. Hollander, MD, has accepted the position
of Associate Dean for Strategic Health Initiatives and Vice Chair for Finance and Healthcare Enterprises at the Jefferson Medical College and Thomas Jefferson University Hospital. Olan Soremekun, MD, MBA, has accepted the position of Vice Chair of Clinical Operations and New Business Development at the Jefferson Medical College and Thomas Jefferson University Hospital. Both were previously at the University of Pennsylvania.
Benjamin Sun, MD, MPP, an associate professor
of emergency medicine at Oregon Health & Science University, was awarded an NIH/ NIDA R01 4-year award (R01DA036522, $976,838 direct costs) to study “The Effectiveness of Prescription Monitoring Program Use in Emergency Departments.” This study will assess the impact of ED prescription monitoring program use on opioid prescribing, overdoses, and mortality.
Patrick Brunett, MD, an associate professor of emergency medicine at Oregon Health & Science University, received the CORD Academy for Scholarship in Education in Emergency Medicine Distinguished Educator Award in the category of educational leadership.
THE DEPARTMENT OF EMERGENCY MEDICINE IS RECRUITING FOR A HIGHLY QUALIFIED ADMINISTRATOR. Candidates must possess a Master’s degree in Health, Business Administration, Finance or Accounting. A minimum of 5 years of business experience is desired. The UTHSCSA offers a competitive salary, insurance package, and retirement plan. Candidates are invited to send their resume to: Bruce Adams, M.D., FACEP, Professor and Chair, Department of Emergency Medicine, 7703 Floyd Curl Drive, MC 7736, San Antonio, TX 78229-3900. Email: email@example.com. This is a security sensitive position. The UTHSCSA is an Equal Employment Opportunity / Affirmative Action Employer which includes protected veterans and individuals with disabilities. http://emergencymedicine.uthscsa.edu/
SAEM ELECTION RESULTS FOR 2014-2015
APLS TEACHING TOOLS TO AUGMENT EDUCATION
SAEM President-Elect Deborah B. Diercks, MD, MSc SAEM Members-at-Large Steven B. Bird, MD, Ian B.K. Martin, MD SAEM Nominating Committee Wendy C. Coates, MD SAEM Constitution & Bylaws Committee Scott G. Weiner, MD, MPH SAEM Resident Board Member Lauren Hudak, MD
CALLS AND M EETING ANNOUNCEM ENTS Call for Papers 2015 Academic Emergency Medicine Consensus Conference
2. Develop a consensus statement that emphasizes the priorities and opportunities for research in emergency diagnostic imaging that will result in practice changes, and the most effective methodologic approaches to emergency diagnostic imaging research 3. Explore and improve knowledge of specific funding mechanisms available to perform research in emergency diagnostic imaging
Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization The 2015 Academic Emergency Medicine (AEM) consensus conference, Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization, will be held on May 12, 2015, immediately preceding the SAEM Annual Meeting in San Diego, CA. Original papers on this topic, if accepted, will be published together with the conference proceedings in the December 2015 issue of AEM. Diagnostic imaging is integral and beneficial to the practice of emergency medicine. Over the last several decades, emergency department (ED) diagnostic imaging has increased without a commensurate rise in identified pathology or improvement in patient-centered outcomes. Unnecessary imaging results in increased resource use and significant exposure risks. ED diagnostic imaging has become the focus of many stakeholders, including patients and various regulatory agencies. This multidisciplinary consensus conference represents the first coordinated effort to further our evidence-based knowledge of ED diagnostic imaging. This consensus conference will formulate the research priorities for emergency diagnostic imaging, initiate a collaborative dialogue between stakeholders, and align this research agenda with that of federal funding agencies. Consensus Goal: The overall mission of the 2015 AEM consensus conference will be to create a prioritized research agenda in emergency diagnostic imaging for the next decade and beyond. The consensus conference will feature expert keynote speakers, panel discussions including nationally recognized experts, and facilitated breakout group sessions to develop consensus on research agendas by topic. Optimizing diagnostic imaging in the ED is a timely topic that is relevant to all who practice emergency medicine. Furthermore, the conference content spans many other specialties (e.g. radiology, pediatrics, cardiology, surgery, internal medicine), all of which will be invited to participate in the conference to optimize the agenda and for future collaboration in order to improve emergency diagnostic imaging use. Consensus Objectives: 1. Understand the current state of evidence regarding diagnostic imaging utilization in the ED and identify opportunities, limitations, and gaps in knowledge of previous study designs and methodology
Accepted manuscripts will present original, high-quality research in emergency diagnostic imaging in areas such as clinical decision rules, shared decision making, knowledge translation, comparative effectiveness research, and multidisciplinary collaboration. They may include work in clinical/translational, health systems, policy, or basic sciences research. Papers will be considered for publication in the December 2015 issue of AEM if received by April 17, 2015. All submissions will undergo peer review and publication cannot be guaranteed. Contact Jennifer R. Marin, MD, MSc (firstname.lastname@example.org) or Angela M. Mills, MD (email@example.com), the 2015 consensus conference co-chairs, for queries. Information and updates will be regularly posted in AEM, the SAEM Newsletter, and the journal and SAEM websites.
INTERACTIVE CME TRAINING: ABDOMINAL PAIN IN THE OLDER ADULT
How often do you encounter older patients in the emergency department with abdominal pain? Do you find it difficult to communicate with them? Is treatment challenging? Learn how to interact, diagnose, and treat older adults more effectively through this interactive online training tool titled â€œAbdominal Pain in the Older Adultâ€? (http://www.saem.org/education/continuing-education/ saem-online-cme) FREE for non-CME participants; or $95 for 6 AMA PRA Category 1 Creditsâ„˘. This program is brought to you by AGEM (an academy of SAEM) and is funded through the generous support of the Retirement Research Foundation. Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for
Continued on Page 26
CALLS AND M EETING ANNOUNCEM ENTS - CONT. Continued from Page 25 Continuing Medical Education through the joint sponsorship of the University of California, Irvine School of Medicine and the Society for Academic Emergency Medicine. The University of California, Irvine School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Designation Statement The University of California, Irvine School of Medicine designates this enduring material for a maximum of 6 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. California Assembly Bill 1195 This activity is in compliance with California Assembly Bill 1195, which requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. For specific information regarding Bill 1195 and definitions of cultural and linguistic competency, please visit the CME website at http://www.cme.uci.edu. Disclosure Policy It is the policy of the University of California, Irvine School of Medicine and the University of California CME Consortium to ensure balance, independence, objectivity, and scientific rigor in all CME activities. Full disclosure of conflicts and conflict resolutions will be made prior to the activity.
EARLY VIEW for ACADEMIC EMERGENCY MEDICINE Academic Emergency Medicine has been loading articles on "Early View" as soon as they are processed now - so be sure to check this feature regularly on the journal's Wiley Online Library (WOL) homepage, regularly. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)15532712/earlyview Academic Emergency Medicine on the Wiley Online Library Platform Make sure you keep checking the journal’s home page on the recently implemented platform, Wiley Online Library (WOL) http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)15532712. Many new features appear in the form of “modules” and will be updated on a regular basis. The new platform is more robust and easier to navigate, with enhanced online functionality. Visit often and stay tuned for updates! VIRTUAL ISSUES "Virtual Issues" are now a key feature of the journal's home page. A virtual issue is basically just a collection of articles on a given topic. The idea is that a reader will go there to look for a particular issue, but then will see our other offerings on that topic, as well, increasing our full-text download numbers and helping insure the broadest dissemination of our authors' work. We now have four "virtual issues" online. Go to to the journal's home page on the Wiley Online Library (WOL) platform "Find Issues" on the left-hand side and click on the feature. Three additional virtual issues, in addition to the initial geriatrics one, are up and running on: ultrasound, toxicology and injury prevention. Again, consult the "Find Issues" area and click on the desired issue. http:/onlinelibrary.wiley.com/journal/10.1111(ISSN)1553-2712.
SAEM on 25 years of supporting emergency medicine’s academic leaders
Abstracts en Español! Beginning with the September issue, Academic Emergency Medicine will be publishing the abstracts of the various articles in Spanish. They will be presented alongside the English abstracts in the online versions of each paper (pdf, html, and mobile apps). The Spanish abstracts will also be included in the print edition of the journal for any papers that originate in Spanish-speaking countries, or are likely to be of particular interest to emergency physicians in Spanish-speaking countries. This project would not be possible without technical assistance and generous funding from our publisher, John Wiley and Sons, Inc., and the language assistance of Emergencias, the journal of the Sociedad Española de Medicina de Urgencias y Emergencias (SEMES).
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Mid-Level Tenure Track Faculty Position Clinical and Translational Research Cardiovascular Medicine The Department of Emergency Medicine at Wayne State University is seeking applicants for a mid-level tenure track faculty position in clinical and translational research. We are looking for innovative and industrious individuals to join our dynamic and collaborative research team. Individuals with a track record of established funded research that is translational in nature and focused on cardiac arrest, stroke, or cardiovascular medicine (hypertension, acute coronary syndrome, ishemic/non-ischemic cardiomyopathy, and cerebrovascular disease) are encouraged to apply. Applicants with a solid history of research with a bench to bedside component, those who have implemented and disseminated clinical trial protocols, and particularly those with a track record of federally funded research will be given highest priority. The emphasis is to apply discoveries generated through research in the laboratory and in pre-clinical studies to the development of trials and studies in humans. Anticipated rank for the selected applicant will be at the Associate Professor level in the Department of Emergency Medicine. Compensation and benefits are highly competitive. Protected time and research support are commensurate with such projections. Highly qualified candidates may be eligible for appointment to an endowed professorship. Adjunct appointments to the Departments of Physiology or Center for Molecular Medicine and Genetics are available to qualified applicants. Interested applicants should electronically submit a letter of interest, along with a curriculum vitae and brief statement regarding their research interests, as a single PDF, to:
Brian J. O’Neil, MD Munuswamy Dayanandahn Endowed Chair Wayne State University School of Medicine, Department of Emergency Medicine 4201 St. Antoine, UHC-6G, Detroit, MI 48201; firstname.lastname@example.org WSU is an equal opportunity/affirmative action employer.
THIS PLACE IS AMAZING So is the difference you can make.
CLINICAL & ACADEMIC EMERGENCY MEDICINE PHYSICIANS Greenville Health System (GHS), the largest healthcare provider in South Carolina, seeks BC/BE Physicians to staff its academic Level 1 Trauma Center and 3 community hospital EDs in the newly established Department of Emergency Medicine. Grow with us as core or clinical faculty as the department incorporates an Emergency Medicine residency program. Emergency services include the following: • The only Level 1 Trauma Center in Greenville • The Upstate’s only Pediatric Emergency Department, Children’s Hospital and PICU to treat the most severe injuries and illnesses in children • Greenville’s most advanced Chest Pain Center GHS employs over 11,000 people, including 700 physicians. Our system includes clinically excellent facilities with 1,358 beds on 6 campuses. We offer 14 residency and fellowship programs. Faculty appointments are commensurate with experience. Greenville, South Carolina is a beautiful place to live and work and the GHS catchment area is 1.3 million people. We are ideally situated near beautiful mountains, beaches and lakes. We offer great compensation and benefit plans, malpractice insurance and full relocation packages. Qualified candidates should submit a letter of interest and CV to: Kendra Hall, Sr. Physician Recruiter, email@example.com, ph: 800-772-6987. GHS does not offer sponsorship at this time. EOE
TTUHSC at Paso El Pasoisisseeking seeking Board TTUHSC at El BoardCertified Certified Physicians in the area of Emergency Medicine to to Physicians in the area of Emergency Medicine become part of its team of professionals. The become part of its team of professionals. The Department of Emergency Medicine staffs the Department of Room Emergency Medicine staffs theEl Emergency of University Medical Center Emergency Room of University Medical Center El Paso, a level one-trauma center with approximately 60,000 visits annually. The department also assists Paso, a level one-trauma center with approximately in training medical students from the TTUHSC 60,000 visits annually. The department also assists Paul L. Foster SOM. Appointments will be at an in training medical from the TTUHSC assistant professorstudents level, or above, as deemed Paul L. Foster SOM. Appointments will be atat an appropriate. Please contact Christine Carbajal 915-215-4609 firstname.lastname@example.org assistant professororlevel, or above, as deemedfor more information. appropriate. Please contact Christine Carbajal at 915-215-4609 or email@example.com for more information.
CHIEF OF PEDIATRIC EMERGENCY MEDICINE University of California, San Francisco The Department of Emergency Medicine at the University of California, San Francisco (UCSF), School of Medicine, seeks an outstanding leader in Pediatric Emergency Medicine (PEM) to serve as Chief of the Division of Pediatric Emergency Medicine. The Division Chief will direct the vision and manage the growth of pediatric emergency care at several UCSF campuses including San Francisco General Hospital (SFGH), Parnassus Heights (the current location of UCSF Benioff Children’s Hospital), and Mission Bay, the site of a new children’s hospital ED opening in 2015. In addition, UCSF’s affiliation with Children’s Hospital and Research Center Oakland will bring further opportunities for clinical, educational, and academic collaboration. The Chief will mentor the PEM faculty and be a pioneering leader as PEM expands at this premier institution. The Chief will be responsible for the Division’s budget, faculty recruitment and evaluation. The UCSF Department of Emergency Medicine provides comprehensive emergency services to a large local and referral population with approximately 93,000 visits a year at UCSF Medical Center and San Francisco General Hospital. The new UCSF Benioff Children’s Hospital Emergency Department will open in February 2015. SFGH, a level-1 trauma center, paramedic base station and training center, is opening a new hospital in 2015, with a 60-bed emergency department, including a new 8-bed pediatric ED. The Chief will have the opportunity to work with outstanding EM and pediatric residents at all sites. The Department of Emergency Medicine has a fully-accredited 4-year Emergency Medicine Residency Program with 48 residents and directs several fellowship programs. The pediatric training program has 87 residents and 15 fellowships. Research is a major priority, with over 50 ongoing studies and 100 peer-reviewed publications in the Department of Emergency Medicine last year. There are opportunities for leadership and growth within the Department and UCSF School of Medicine. Applicants for this position must have a minimum of 5 years leadership experience in an academic emergency department and must be Board Certified in Pediatric Emergency Medicine. The University of California, San Francisco, is one of the nation’s top five medical schools and demonstrates excellence in basic science and clinical research, global health sciences, policy, advocacy, and medical education scholarship. The San Francisco Bay Area is well-known for its great food, mild climate, beautiful scenery, vibrant cultural environment, and its outdoor recreational activities.
Send cover letter and curriculum vitae to: Ellen Weber, MD, Vice Chair • c/o Natalya Khait UCSF Department of Emergency Medicine • 533 Parnassus Avenue, Suite U575 • San Francisco, CA. 94143 – 0749 • Natalya.firstname.lastname@example.org UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an Equal Opportunity/Affirmative Action Employer. The University undertakes affirmative action to assure equal employment opportunity for underutilized minorities and women, for persons with disabilities, and for covered veterans. All qualified applicants are encouraged to apply, including minorities and women. For additional information, please visit our website at http://emergency.ucsf.edu
Associate Chief Medical Information Officer Department of Emergency Medicine University of Michigan Hospitals and Health Centers The Associate Chief Medical Information Officer for Emergency Medicine (ACMIO-EM) supports technology implementation and adoption and provides oversight for the most appropriate use of existing and future clinical information systems in order to ensure quality care to patients, enhanced clinical training and accelerated health sciences research institutionally and in the Department of Emergency Medicine. The ACMIOEM is a member of the Office of Clinical Informatics and in that role works to maximize value from these advanced health information technologies (HIT). UMHS depends upon a newer level of cooperative workflow, policy changes and ongoing education within, and between, departments and among faculty and staff. The success of clinical information system initiatives is significantly enhanced when physicians are in leadership positions. The ACMIO-EM is a full-time appointment with 50% of time devoted to clinical and 50% devoted to administrative duties. The ACMIO-EM has prior management and leadership experience and successfully demonstrated operational improvement in Emergency Medicine at an academic medical center. Residency trained and boarded in Emergency Medicine or Pediatric Emergency Medicine. Considerable knowledge of IT systems and experience with system optimization is necessary. The ACMIO-EM must display data driven decision-making skill, be facile with analysis of operational data, have excellent verbal and written communication skills, and be able to manage teams and projects successfully.
EM Academic Opportunities WEST VIRGINIA: Charleston
EM Physician/Ultrasound Educator
EM Residency program, Level 1 facility. Includes overseeing ultrasound training, and training within simulation laboratory.
Contact Rachel Klockow, (800) 406-8118, email@example.com. TOLEDO: Ohio
Clinician/Faculty within EM Residency Program
High-acuity, Level I facility, pediatric trauma center, recognized for training within the LifeFlight program.
Contact Amy Spegal, (800) 726-3682 ext. 8118, firstname.lastname@example.org
Flexible Benefit Packages | In-House CME Leadership Opportunities | More...
To view the complete position description, please visit http://umjobs.org/ The University of Michigan is an equal opportunity/affirmative action employer.
Emergency Medicine Academic Opportunity
The Emergency Services Institute at Cleveland Clinic is currently seeking Board Certified/ Eligible Emergency Medicine Physicians for an academic opportunity at our Main Campus. The successful candidate will have an interest in teaching, research and professionally rewarding clinical work.
This dynamic opportunity offers an extremely competitive salary, enhanced by an attractive benefits package and a collegial work environment.If you are attending the SAEM Annual Meeting May 13â€“17 in Dallas, TX and are interested in meeting with one of our staff physicians, please email Lauren Judd at email@example.com
The Emergency Services Institute at Cleveland Clinic is an innovative full service emergency department with particular expertise in treating acute and complex medical and surgical conditions. The main campus ED sees approximately 62,000 adult and pediatric patients per year and is staffed by board-certified emergency medicine physicians, mid-level providers, and 50 hours of emergency medicine resident coverage daily.
Interested candidates should submit an application online by going to www.clevelandclinic.org/careers & search under Physician Opportunities. We are proud to be an equal opportunity employer. Smoke-free/ drug-free environment.
DEPARTMENT OF EMERGENCY MEDICINE MASSACHUSETTS GENERAL HOSPITAL Vice Chair for Network Development
The Department of Emergency Medicine of the University of Rochester Medical Center has open Emergency Medicine Faculty positions for work at our primary academic site, as well as our community affiliates and our free standing emergency department. Our Department includes a well regarded EM Residency Program, Research and Fellowship programs. Our main site, Strong Memorial Hospital, is the regional referral and trauma center. We are seeking BC/BE candidates with dynamic personalities who are interested in a diverse Emergency Medicine experience with great potential for career development, promotion, and career longevity within our department. With these sites, there is also ample opportunity to become involved in academics and administration. Rochester, New York is located in upstate New York offers excellent schools, low cost of living, many opportunities both professionally and personally, and easy access to Canada, including metropolitan Toronto and the northeast United States. Interested applicants please contact: Michael Kamali, MD, FACEP Chair, Department of Emergency Medicine Michael_kamali@urmc.rochester.edu 585-463-2970
The Department of Emergency Medicine at Massachusetts General Hospital is seeking candidates for the position of Vice Chair for Network Development. The Vice Chair for Network Development will manage the growing interface between the Department and its community hospital EM partners and will report directly to the Chair. Academic appointment is at Harvard Medical School as Instructor, Assistant Professor, or Associate Professor and is commensurate with scholarly achievement. The Emergency Department at MGH is a high volume, high acuity level 1 trauma and burn center for both adult and pediatric patients, and includes a 32-bed Observation Unit. The annual ED visit volume is ~104,000. The EM faculty is a group of 42 academic emergency physicians in a department with active research and teaching programs, as well as fellowship programs in research, global health, medical simulation, ultrasonography, and wilderness medicine. MGH is co-sponsor of the 4-year BWH/MGH Harvard Affiliated Emergency Medicine Residency Program. MGH is a founding member of Partners Healthcare. The successful candidate will be board certified in Emergency Medicine with significant leadership and administrative experience in an academic medical center. Inquiries should be accompanied by a CV and may be emailed or addressed to: David F. M. Brown, MD, FACEP, FAAEM Chair, Department of Emergency Medicine Massachusetts General Hospital, Founders 114 Boston, Massachusetts 02114 e-mail: firstname.lastname@example.org Massachusetts General Hospital and Harvard Medical School are equal opportunity/ affirmative action employers. Women and minorities are encouraged to apply.
DEPARTMENT OF EMERGENCY MEDICINE RESIDENCY PROGRAM DIRECTOR University of California, San Francisco The Department of Emergency Medicine at the University of California, San Francisco (UCSF), seeks outstanding candidates for the position of Residency Program Director. The residency program is a fully-accredited four-year program with 48 residents and plans to expand in the near future. Residents are exposed to a diverse patient population with a combined total of approximately 93,000 patient visits a year at their primary sites. Residents rotate at UCSF Medical Center, San Francisco General Hospital and Trauma Center, San Francisco VA Medical Center, Children’s Hospital & Research Center Oakland, and Kaiser Permanente San Francisco Hospital. In 2015, the new UCSF Benioff Children’s Hospital will open in Mission Bay, and a new hospital will open at San Francisco General Hospital, each with a dedicated pediatric ED. The Department of Emergency Medicine serves as the primary teaching site for the residency program, providing comprehensive emergency services to a large local and referral population at both UCSF Medical Center and San Francisco General Hospital. The UCSF Medical Center is ranked among the nation’s 10 best hospitals by U.S. News & World Report. SFGH is a level-1 trauma center, paramedic base station and training center. Research is a major priority of the department, with over 50 ongoing studies and 100 peer-reviewed publications in the past year. There are opportunities for leadership and growth within the Department and UCSF School of Medicine. Applicants for this position must have a minimum of five years educational leadership experience, three years experience as a core faculty member at an ACGME-approved Emergency Medicine Residency Program, and be board certified by the American Board of Emergency Medicine. Candidates must have strong interpersonal skills and be able to work cooperatively and congenially with a diverse academic and clinical environment. Candidates with leadership skills and a vision for enhancing the educational and academic missions of the department are especially encouraged to apply. Appointment level and rank will be commensurate with experience and qualifications. Opportunities exist for an expanded leadership role in the department for qualified candidates. The University of California, San Francisco, is one of the nation’s top five medical schools and demonstrates excellence in basic science and clinical research, global health sciences, policy, advocacy, and medical education scholarship. The San Francisco Bay Area is well-known for its great food, mild climate, beautiful scenery, vibrant cultural environment, and its outdoor recreational activities.
Send cover letter and curriculum vitae to: Ellen Weber, MD, Vice Chair • c/o Natalya Khait UCSF Department of Emergency Medicine • 533 Parnassus Avenue, Suite U575 • San Francisco, CA. 94143 – 0749 • Natalya.email@example.com UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an Equal Opportunity/Affirmative Action Employer. The University undertakes affirmative action to assure equal employment opportunity for underutilized minorities and women, for persons with disabilities, and for covered veterans. All qualified applicants are encouraged to apply, including minorities and women. For additional information, please visit our website at http://emergency.ucsf.edu/
Director of research eDucation Austin, texAs
Position: UT Southwestern-Austin is pleased to offer the opportunity to join our faculty as Director of Research Education for our new Emergency Medicine Residency. Qualifications: An enthusiasm for teaching and a track record in education are a must. Candidates should be ABEM/ ABOEM certified with GME teaching & research experience. Facility: University Medical Center Brackenridge is an urban teaching hospital and Level 1 Trauma Center. A brand new facility is scheduled to open in 2017. Benefits: Emergency Service Partners, L.P. is a democratic physician partnership serving more than 25 EDs across Texas. Share in the success of the practice in as little as one year! Apply today: Send CV confidentially to Lisa Morgan (firstname.lastname@example.org).
Join an exciting new EM Residency program in South Florida Emergency Medicine Residency Director Opportunity Sheridan Emergency Physicians is seeking a dynamic, experienced physician to serve as Residency Director for our new ACGME-Emergency Medicine Residency Training Program starting July, 2015 in Miami, Florida. The Director will join other Residency Program Directors in building a community academic center of excellence that will train residents in both medical and surgical specialties. The Emergency Medicine Residency Director will have the unique opportunity to lead the development of a new ACGME accredited residency program and one of the first allopathic EM programs in South Florida. Qualification requirements include demonstrated clinical excellence, leadership, teaching and research skills. Board certification with a minimum of 3 years’ experience as a core faculty member in an accredited Emergency Medicine program, and a strong commitment to resident and student education is also required. The Emergency Department at Kendall Regional ranks amongst the top hospitals in the nation for efficient ED throughput. The Medical Center is a dynamic facility committed to continual expansion to match the rapid growth and diversity of southwest Miami-Dade. Kendall Regional Medical Center‘s new “State of Art” Emergency Department opened in April 2007 boasting 48 beds in the Adult ED with a separate Pediatric ED and dedicated fast track area. • Trauma Center • 60,000 annual adult ED visits • 60 hours of Emergency Physician coverage + additional MLP coverage in the main ED • Physicians are Board Certified/Eligible in Emergency Medicine For more information regarding this exciting opportunity, please contact Charlotte Dean at Charlotte.Dean@shcr.com or (954)838-2623.
DEPARTMENT OF EMERGENCY MEDICINE University of California, San Francisco The Department of Emergency Medicine at the University of California, San Francisco (UCSF), School of Medicine, seeks an outstanding Emergency Medicine health services researcher to serve as a ladder-rank (tenure track) faculty member. This is a position with substantial protected time for research. The UCSF Department of Emergency Medicine provides comprehensive emergency services with approximately 93,000 visits a year at UCSF Medical Center and San Francisco General Hospital. The Department of Emergency Medicine has a fully-accredited Emergency Medicine Residency Program and directs several fellowship programs. Research is a major priority, with over 50 ongoing studies and 100 peer-reviewed publications in the Department of Emergency Medicine last year. UCSF is one of the nation’s top five medical schools and demonstrates excellence in basic science and clinical research, global health sciences, policy, advocacy, and medical education scholarship. Applicants for this position must focus on Emergency Medicine Health Services Research, be board certified in Emergency Medicine (American Board of Emergency Medicine), hold an MD degree plus an additional advanced degree (i.e. MPH, MPP, MSc or PhD), have previous and current extramural federal grant support, and have published manuscripts in high-impact journals (i.e. JAMA, NEJM or Lancet). Send cover letter, statement of research, statement of teaching, 3 reference letters, and curriculum vitae to: Michael Callaham, MD, Search Committee Chair c/o Natalya Khait UCSF Department of Emergency Medicine 533 Parnassus Avenue, Suite U575 San Francisco, CA 94143-0749 Natalya.email@example.com UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an Equal Opportunity/Affirmative Action Employer. The University undertakes affirmative action to assure equal employment opportunity for underutilized minorities and women, for persons with disabilities, and for covered veterans. All qualified applicants are encouraged to apply, including minorities and women. For additional information, please visit our website at http://emergency.ucsf.edu
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“EmCare offers a fulfilling and challenging career with room for growth. There is never a dull moment at EmCare.”
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EmCare is the nationwide leader in emergency medicine and is a company that is making health care work better, especially for physicians. EmCare provides the resources and support you need so you can focus on patient care. EmCare currently has hundreds of opportunities available for emergency medicine physicians. The company offers:
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SAEM Leadership Forum May 14-15, 2013 SAEM Annual Meeting2015 Topics: May 14-18 SAEM Annual Meeting “Leadership” The Westin Peachtree Plaza, Atlanta, MayGA 13-16 “Developing and Sustaining a Vision” Sheraton Hotel and Marina, San Diego, CA “Strategic Planning” AEM Consensus Conference “Building a Team” May 15, 2013 “Conflict Resolution” 2016 Topic: “Global Health and Emergency Care: “How to Run a Meeting” SAEM Annual Meeting A Research Agenda” “ED Operations Overview” MayMPH 10-14 Co-Chairs: Stephan Hargarten, MD, Management” Hotel, New Orleans, LA Mark Hauswald, MD Sheraton New Orleans“Change “Negotiating for Your Dept./Faculty” Jon Mark Hirshon, MD, MPH “Overview of Dept. Finances” Ian B.K. Martin, MD 2017 “Communication Skills” SAEM Annual Meeting May 16-20 Hyatt Regency Orlando, Orlando, FL 2014 2015 SAEM Annual Meeting May 14-17 Sheraton Hotel, Dallas, TX
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