SAEM PULSE January–February 2019

JANUARY-FEBRUARY 2019 | VOLUME XXXIV NUMBER 1

www.saem.org

SPOTLIGHT WORKING TO ENSURE THAT SAEM REMAINS A HUB OF KNOWLEDGE FOR ITS TRAINEE MEMBERS An Interview with

Christopher Bennett, MD Resident Member, SAEM BOD

RESEARCH HIGHLIGHTS FROM THE SAEM GREAT PLAINS REGIONAL MEETING page 34

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

SAEM STAFF

HIGHLIGHTS

Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org

Membership Manager George Greaves Ext. 211, ggreaves@saem.org

Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org

Education Manager Andrea Ray Ext. 214, aray@saem.org

Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Manager, Governance Snizhana Kurylyuk Ext. 205, skurylyuk@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Specialist, Digital Communications Nick Olah Ext. 201, nolah@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org

Meeting Planner Alex Elizabeth Keenan Ext. 218, akeenan@saem.org Membership & Meetings Coordinator Monica Bell Ext. 202, mbell@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org

Ian B.K. Martin, MD, MBA President Elect Medical College of Wisconsin Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Christopher Lee Bennett, MD, MA Brigham and Women's Hospital and Massachusetts General Hospital Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center

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AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org

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Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com

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Associate Editor, SAEM BOD D. Mark Courtney, MD

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James F. Holmes, Jr., MD, MPH Secretary-Treasurer University of California Davis Health System

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D. Mark Courtney, MD Immediate Past President Northwestern University Feinberg School of Medicine

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Megan L. Ranney, MD, MPH Brown University Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

Working to Ensure that SAEM Remains a Hub of Knowledge for its Trainee Members

How to Make Diversity and Inclusion a Residency Program Priority in One Year

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Ali S. Raja, MD, MBA, MPH Massachusetts General Hospital

Spotlight

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AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org

Angela M. Mills, MD Columbia University

A Ray of Hope in Tumultuous Times: EM Talks, ACGME Listens

SAEM 2018

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Associate Editor, RAMS Shana Zucker, szucker@tulane.edu

President’s Comments

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AEM E&T Editor Susan Promes, MD AEMETeditor@saem.org

2018-2019 BOARD OF DIRECTORS Steven B. Bird, MD President University of Massachusetts Medical School

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The Year in Review

SAEM 2019

A Preview of the New Year

Diversity and Inclusion

In and Out on the Trail: Two Perspectives on the LGBTQ Emergency Medicine Application Experience

Disaster Medicine

SAEM Recognition of Disaster Medicine Fellowships.

Important? You bet!

Ethics in Action

Conflict of Interest Disclosures What Academic EM Physicians Need to Know

Research In Academic EM

In Constant Search of the Next Great Idea (and the Money to Support It): Two Takeaways on Burnout Among Emergency Care Researchers

Social Media In Academic EM The Role of Social Media in Advocacy

SGEM: Did You Know?

More Sex Differences to Consider in Acute Coronary Syndrome: Broken Heart Syndrome

Wilderness Emergency Medicine

Practicing Emergency Medicine on a Remote Island: Life in the Catalina Island Emergency Department What is Due Process and What Does it Have to do With Academic Emergency Medicine?

From Assistant to Assistant: 12 Tips to Share With Your Administrative Support Staff

Briefs and Bullet Points Academic Announcements Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. Š 2019 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

PRESIDENT’S COMMENTS Steven B. Bird, MD University of Massachusetts Medical School 2018-2019 SAEM President

A Ray of Hope in Tumultuous Times: EM Talks, ACGME Listens

"These are tumultuous times. But in such tumultuous times, banding together with unified voices offers all of us in emergency medicine an opportunity to change the times."

A few months ago, we learned that the residency review committee for emergency medicine (RRC-EM) would institute fundamental changes to the structure of academic departments. Designated residency core faculty would no longer have mandatory protected time to contribute and add to the atmosphere of scholarly inquiry.

The definition of “scholarship” would also be relaxed to the point that a blog post would count as much as a peer-reviewed article. And, rather than all core faculty having to contribute scholarly works, publications would be averaged across all faculty — thereby allowing just one or two productive faculty to meet a department’s scholarly expectations.

But these tumultuous times have given the larger community of emergency physicians the opportunity to unite and try to effect change — to emphasize nationalism rather than tribalism. In response to the possible RRC-EM changes, organizations including the Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), American Academy of Emergency Medicine (AAEM), and Council of Emergency Medicine Residency Directors (CORD) all wrote letters to the Accreditation Council for Graduate Medical Education (ACGME) outlining in vivid detail why proposed RRC-EM changes are bad.

Spectacularly bad. Over the course of a few days the emergency medicine (EM) organizations shared ideas, data, and edits to craft persuasive letters.

By means of a brief survey, which resulted in 865 core faculty responses, we learned that EM faculty value tremendously the ability and responsibility of training and molding future emergency physicians.

On a 10-point Likert scale, faculty rated their ACGME-mandated protected time an 8.6 in terms of its impact on their own

well-being. When queried “Do you think the loss of this core faculty protected time would impact your ability to perform your current academic duties for the residency?” the response was a remarkable 8.8. It is not hyperbolic to state that the proposed changes to core faculty protected time is an existential threat to residency training.

Fortunately, it appears that the ACGME has heard our unified voices. At least some of the proposed changes have been tabled. We don’t yet know all the details, but we are cautiously optimistic. I would like to publicly say “thank you” to the SAEM members who completed our survey.

Tumultuous and trying times help to define who we are as individuals and who we are as larger organizations. The degree to which the various EM organizations worked quickly together to express our mutual concern about the proposed changes was remarkable.

I would like to personally thank everyone for their efforts and collegiality. I am fortunate and blessed to serve as president of SAEM, and to work with a wonderful group of individuals within emergency medicine. Even in these tumultuous times, there is a lot to be thankful for.

ABOUT DR. BIRD: Steven B. Bird, MD, is vice chair for education in the Department of Emergency Medicine, and the emergency medicine residency director, at the University of Massachusetts Medical School.

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SPOTLIGHT WORKING TO ENSURE THAT SAEM REMAINS A HUB OF KNOWLEDGE FOR ITS TRAINEE MEMBERS

"There is something to be said about teaching: Taking knowledge and experiences and passing it down to others taking a similar path as yours."

An interview with Christopher Bennett, MD, resident member of the SAEM Board of Directors Christopher Bennett, MD, serves on the Society for Academic Emergency Medicine (SAEM) Board of Directors and is a third-year resident in the Harvard Affiliated Emergency Medicine Residency Program at Massachusetts General Hospital and Brigham and Women’s Hospital. His interests are in medical education, workforce diversity, and medical ethics. Bennett graduated with honors with a bachelor’s degree in biology from Winthrop University, earned a graduate master’s degree in genetics and genomics from Duke University, and was awarded his medical degree from the University of North Carolina at Chapel Hill School of Medicine. In addition to his formal graduate training, Bennett was previously a scientist with the Lineberger Comprehensive Cancer Center and was a Howard Hughes Medical Institute Fellow at Johns Hopkins’s McKusick-Nathans Institute of Genetic Medicine. His research has appeared in the New England Journal of Medicine, the Journal of Graduate Medical Education, Nature Genetics, the American Journal of Medical Genetics, and the Journal of Virology. His writing has appeared in The American Journal of Bioethics, STAT News, KevinMD.com, and Forbes. Dr. Bennett was interviewed for this article by Sharon Atencio, DO, an emergency medicine resident at Conemaugh Health System and chair of the SAEM Pulse Editorial Advisory Task Force.

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What led you to choose emergency medicine as your specialty?

I always joke that it was mostly Dr. Judith Tintinalli’s doing. As a medical student at the University of North Carolina, I remember the first shift of my emergency department rotation with a physician everyone kept calling “Dr. T.” I was about halfway through my shift with her when she asked me about what I wanted to do for a patient. I cited something I’d read in Tintinalli’s Emergency Medicine Manual.

Only then did I realize who I was working with. The rest is mostly history.

Admittedly, my childhood did set the stage. Growing up, my father was an EMT and that had a huge impact on me. There was always something medical around the house. In late high school I also started to volunteer with the rescue squad that served our rural town in South Carolina. But I was not the typical undergraduate to medical school to residency applicant. I took a bit of a detour after undergraduate in the form of graduate school and then additional research after that. In the end, however, it was the acuity, the breadth of pathology, the patients and their stories, and the ability to help the underserved in the emergency department that drew me in.

When and why did you choose to work in academics?

Admittedly, I fell into the academic mindset well before medical school. As an undergraduate I worked in a research lab and earned extra money for college working as a teaching assistant. In 2009, I started a PhD program in genetics at Duke. As a doctoral student, my research and teaching were the typical academic model, but after leaving my PhD with a master’s degree, and before starting medical school, I continued academic work in a research lab. You could argue that I stuck with it out of habit, or maybe it was simply what I knew, but the bottom line is that I love the academic approach and scientific method. Although I’m not sitting behind a microscope or sequencer anymore, academic basic science is quite similar to academic emergency medicine —just with fewer zebrafish and more bloody scrubs. There is science all around. Outside of the emergency department, I find that some of my most rewarding interactions are spent with collaborators, speaking with statisticians, or working with my research teams on a project. The core methodology I picked

"There is a hugely unmet need for academic emergency medicine researchers and I think we all owe society a little more academic time spent in research, teaching, and scientific advocacy." up in graduate school remains the viable, go-to approach I’ve used since then.

Academics is something I just don’t think I can give up. There is a hugely unmet need for academic emergency medicine researchers and I think we all owe society a little more academic time spent in research, teaching, and scientific advocacy.

How did you first become involved with SAEM? Shortly after the point in medical school when I identified an interest in emergency medicine, I met Dr. Ian Martin. He, along with the other faculty at Carolina, encouraged me to engage with SAEM to explore residency options, network, and learn about what emergency medicine physicians were doing in research. After that, while still in medical school, I joined the SAEM Graduate Medical Education Committee and then in 2017 was elected to the SAEM Board of Directors as the resident member.

Congratulations on your election to the SAEM Board of Directors.

What do you personally hope to accomplish during your tenure?

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

My goal has always been to try and best represent the large population of residents that make up the SAEM membership. This is in parallel with the awesome group of clinicians on the

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SAEM PULSE | JANUARY-FEBRUARY 2019

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SAEM RAMS (Residents and Medical Students) Board — individuals who serve as an absolute inspiration to me given their dedication to the resident and medical student members within SAEM. As many of us somewhat-recent grads remember from medical school, the approach to medical education has changed. We are online learners.

In residency, we seek content that is online, easily accessible, and in some cases crowd-sourced. There is a beauty and a danger to that. One of the biggest issues for trainees today is to identify digital content that can be clinically useful to our practice, relevant to our preparation for in-service and board exams, and at the same time, is correct!

Just because you see content on line does not mean it is the best available content, or even correct information.

I hope to help ensure that SAEM remains the hub of knowledge for its trainee members.

Who are the mentors or peers who most shaped your thinking?

Tough question. From a clinical standpoint I don’t think I would be where I am today without the early guidance of Dr. Judith Tintinalli and Dr.

"From a research standpoint, much of my ongoing successes can be credited to the strong support and mentorship I received during and after graduate school."

Ian Martin. Present at the time I was first introduced to emergency medicine, they were both fundamental in shaping my foundation in emergency medicine.

From a research standpoint, much of my ongoing successes can be credited to the strong support and mentorship I received during and after graduate school from Dr. Douglas Marchuk at Duke and Dr. Blossom Damania at UNC. My rationale and approach to science remains mostly unchanged, albeit I’m asking different questions with different datasets.

What experiences in your life outside of medicine have made you a better educator?

For a brief time in high school I was a student teacher for sixth graders.

Try keeping the attention of a room full of sixth graders on the topic of how a potato grows. I’ll take a trauma resuscitation any day! In all seriousness though, my time as a teaching assistant and student in graduate school laid the foundation. My mentor, Dr. Douglas Marchuk, remains one of the best educators I’ve had the opportunity to work with. Being very specialized in a field of vascular genetics, we knew early on that it was important to be able to take our work and make it understandable to scientists in other branches of genetics and to the greater scientific community.

What did you do during your years as a scientist? Why did you decide to move on?

So much microscopy, and so much computational work. In additional to several projects that turned into publications, I also successfully developed carpal tunnel from the

mouse clicking and pipetting. My original work at Duke was mostly on the topic of rare genetic diseases. Our group’s work was centered on identifying and characterizing the underlying genetics behind these diseases, and then understanding how these genetics played into altered cellular signaling pathways. This transitioned into viral genetics work at UNC-Chapel Hill focused on better understanding mechanisms by which viruses that can result in human malignancies evade the host immune response. My brief stint at Hopkins then circled back on genetic diseases and centered on vascular genetics. Although I enjoyed the work, sometimes wax poetic about mornings spent at my bench, and remain appreciative of the unparalleled teaching and mentorship I received, it became more and more obvious to me that something was missing from my life. As my work became more clinical, I realized it was this clinical work (patient interactions) that made me the happiest and gave me a sense of fulfillment.

Not many people have been published in both the Journal of Virology and Forbes. What made you pursue writing for the lay person?

I remain a strong believer that peerreview writing should present facts.

Although there is a place for commentary in academic writing to guide the reader through a piece, the interpretation of a work should be for the reader. The data should tell the story. Most of my writing outside of peer-review has been in an attempt to separate my scientifically supported statements, based in data, from my personal opinions. My old mentor, Dr. Douglas Marchuk, always reinforced an approach to academic writing that was based in simple declarative sentences, and I’ve become a believer myself. (This was admittedly counter to the teachings from my English professors and writing colleagues!). It must also be stated that behind it all is a simple love of writing. The ability to take a clinical situation or research finding and bring it to a larger audience provides a sense of fulfillment that parallels the excitement I get when I see a paper pop up on PubMed. Writing for an outlet like Forbes gives me the ability to tell a story in a way I don’t think I can (or should) with scientific work.

"There needs to be more writing that takes advancement in clinical medicine and puts it into text that can be easily digested by everyday readers, regardless of the reader’s background."

What would be your dream writing gig?

Optimistically? Food critic. And not because I claim to be anything other than a horrible cook! But mostly because I want an excuse to eat food. I’d not be opposed to just dedicating my life to praising all the positives of a good meal.

I’d even be willing to toss in medical advice to land the gig. Realistically, however, there needs to be more writing that takes advancement in clinical medicine and puts it into text that can be easily digested by everyday readers, regardless of the reader’s background.

We, as a group, benefit greatly from the work of our respective specialties (emergency medicine included), but this information needs to be readable and available for our patients. We all benefit from an informed society.

What’s one book you’ve read (fiction or nonfiction) that has had a lasting effect on you?

The House of God. At the start of medical school, my clinical advisor (a psychiatrist) asked me to read it. And then I read it again while in residency. At first look, the book feels satirical— as it should, and is intended. But at the same time, it forces you to reflect on what residency does to a person. How you cope with seeing an 11-year-old die in front of you. How do you stand at the foot of a bed during a trauma and orchestrate a resuscitation?

How do you survive in a system plagued with burnout and depression? And how do you take care of your patients in the context of being a learner yourself.

What do you find most challenging about the work you do?

Beyond the clinical challenges and always recognizing that there is so much more to learn, what is most challenging is defining and keeping true to the worklife balance I want to have. Walking out of the emergency department after a busting-at-the-seams night, where you

didn’t have time to do a single note and felt that everyone in the city was in the department with you, exists in parallel with online modules, didactics, research, and my own learning attempts and additional activities. These have to exist in the context of the life outside of emergency medicine that I want to have for myself and my loved ones. Although I remain committed to being a physician and a scientist, I have to be a person as well. It’s tough and, as a resident, intrinsic to just how little control you have over your life. It remains the most challenging aspect of my work and life.

What do you find most rewarding about the work you do?

Without a doubt, the stories heard and experiences had. They are what remind me that I have the greatest job in the world. Being able to sit with patients and hear their stories is a continually rewarding experience. The trust that complete strangers place in you, in what is oftentimes their most vulnerable moments, is absolutely humbling. At the same time, the experience of seeing anything and everything that can and will come through the front door continues to amaze me.

Where do you see yourself in five years? Twenty-five?

Academics or bust. After residency, my goal is to pursue an academic emergency medicine faculty position. In 25 years, I will have either made it to professor or will have become a food critic (see above). I don’t know if my ability to recite rocuronium doses at the drop of a dime qualifies me to comment on pastries, but if passing the MCAT and all of the Steps has taught me anything, it is that if there is a will (and online prep course), anything is possible. There is something to be said about teaching: Taking knowledge and experiences and passing it down to others taking a similar path as yours. I love the concept and hope to find a place of my own in the process.

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The Year in Review

SAEM PULSE | JANUARY-FEBRUARY 2019

If there is one word that adequately sums up the past year at the Society for Academic Emergency Medicine, it is GROWTH. It’s a relatively small word that for SAEM means really big accomplishments in several key areas: Membership numbers, meeting attendance, program expansion, funds awarded and more.

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Growth is never by chance; it is the result of forces working together. In SAEM’s case, those forces are the countless individuals — committee members, board of directors, academy leaders, and so many others, who directed their individual talents and abilities toward working together to achieve the common goals of identifying, communicating, and delivering excellent programs and services to our members. When that happens — when leaders throughout an organization take an active, genuine interest in their members’ needs, and invest real time and effort toward identifying how to meet those needs — they create a climate for growth.

And so, it is no wonder that in 2018 SAEM experienced another year of unprecedented growth. Here’s our snapshot of highlights from a memorable year:

Success by the Numbers Numbers are a tangible indicator of success, and we are proud to report to you that last year was successful for SAEM by every measure: • SAEM Membership reached a new alltime high of 6,700+

• Resident membership soared to a recording setting 3,166 • Medical Student membership increased by 85 percent What’s more, SAEM18 in Indianapolis surpassed previous records in several categories:

• Three new and innovative, senior-level sessions: Professor Rounds, Master Secret Series, Master Scholars • A first-ever appearance by the RAMS mascot who livened up the crowds with his dance moves and high fives.

• Most total attendees in history for an SAEM annual meeting • Highest-ever number of submissions for Advanced EM Workshop Day, didactics, abstracts, and clinical images • Greatest combined number of resident and medical student attendees • Largest exhibit hall/most exhibitors ever • All-time high attendance at the SAEM18 RAMS Party • SIMWars largest attendance ever • Dr. Gail D’Onofrio, international expert on opioid intervention and treatment in the emergency department, who headlined the plenary session with a timely keynote on the opioid crisis

More SAEM18 Highlights SAEM18 received an impressive 99 percent attendee satisfaction rating, and it’s easy to understand why. Not only was the meeting a statistical success, it also included several exciting highlights, including: • An improved abstract review process that cut review times in half

SAEM Foundation Expands Grant Portfolio, Receives Most Grant Applications Ever In 2018, the SAEM Foundation (SAEMF) increased funding for its grant programs, awarding more than $662,000 to SAEM members in 10 different grant categories. The new grant categories included topic-specific grants in partnership with the SAEM academies; resident and medical student grants in partnership with RAMS; and a new grant

in partnership with the National Institute on Drug Abuse (NIDA). SAEM members responded by more than doubling the number of applications submitted in 2017. This year’s committee challenge was also the most successful to date with SAEM committees raising a total of $21,201. The SAEM Research Committee took the lead in most funds raised and the Bylaws Committee was the first committee to reach 100% of members donating.

SAEMF Expands Board of Trustees The SAEM Foundation expanded its Board of Trustees from 11 members to 19 and adjusted the roles and responsibilities of each member. This will allow SAEM Foundation to have a unique leadership that will further its mission to improve emergency patient care through supporting the development of innovative researchers, expert educators and future academic emergency medicine leaders.

AACEM Has a Stellar Year The Association of Academic Chairs of Emergency Medicine (AACEM) boasted an impressive list of accomplishments in 2018: • Celebrated the 10th anniversary of the AACEM/AAAEM Joint Retreat by welcoming the highest number of attendees in the ten-year history of the event.

• Created the Chair Mentorship Program and launched a Vice Chair Track • Increased applications for the 2018 Chair Development Program (CDP) by 23 percent; including the highest number of women participants ever • Recorded the inaugural and popular Ask-a-Chair podcasting series for RAMS

SAEM Welcomes New Committees and Interest Groups!

In 2018 SAEM stretched its organizational boundaries to include a new Wellness Committee and two new Interest Groups: Climate Change and Health and CRUX: Clinical Researchers' United Exchange. SAEM Committees give direction to SAEM’s activities and play a critical role in advancing the Society’s vision and mission. Interest Groups

provide members of the Society who are interested in a specific topic or area, to meet, share ideas and network with others who share the same interest.

Memberships in Interest Groups are free with SAEM membership.

• Created SOAR for RAMS, a digital space on SOAR, with 100 percent resident and student-driven content • Started RAMS Twitter

Academies Eliminate Membership Fees There was great news last year for anyone thinking of joining an SAEM Academy...

Effective October 2018, membership in SAEM Academies became free.

That means you can now join as many academies as you’d like and it won’t cost you an extra dime! It also means that all the great content that’s being created by SAEM academies, as well as academy networking, mentoring, and volunteer opportunities, are now available and accessible to all SAEM members at all stages of their careers.

New and Improved SAEMTests Launches Along with the Clerkship Directors in Emergency Medicine (CDEM) academy, SAEM launched a new and improved SAEMTests platform with a sleek, modern design and enhanced features, such as profile creation and management and the ability to easily establish new users and student groups.

RAMS Shows No Sign of Slowing Down In only its second year in existence, SAEM’s Residents and Medical Students (RAMS) continued its rapid march forward, seating its first, fully elected RAMS Board and launching several additional new programs and initiatives in 2018: • Developed a dedicated section in SAEM Pulse for RAMS news and information • Launched the RAMS Ask-a-Chair podcast series • Created the bi-weekly “From the RAMS Desk” e-newsletter • Established new, RAMS-centric awards, grants and scholarships

The Year of Podcasts The other big news for 2018: Podcasts.

SAEM’s podcasts exploded in 2018 with the creation of a new series of podcasts from AEM, AEM E&T, the Research Learning Series (in collaboration with ALiEM), the RAMS Ask-a-Chair podcasts featuring resident- and student-submitted questions for chairs, and more!

SOAR Spreads its Wings SOAR, SAEM’s Online Education Library, grew by leaps and bounds in 2018 with the addition of several monthly podcasts, SAEM18 content, academy open access education, contributions from RAMS, and the introduction of SAEM Digital Highlights, featuring digital content from SAEM committees.

New Fellowship Approval Categories are Announced In 2018 SAEM added Administrative Fellowship, Disaster Medicine Fellowship and Wilderness Medicine Fellowship to its list of emergency medicine fellowship approval categories.

The SAEM Fellowship Approval Program has been developed for eligible programs to earn the endorsement of SAEM as an approved fellowship. Fellows who complete a program at an SAEMapproved institution also receive recognition for earning the standard qualifications and skills needed.

ARMED Graduates First Class The Advanced Research Methodology Evaluation and Design (ARMED) held its

continued on Page 10

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2018 continued from Page 9 inaugural courses in 2018, graduating 17 in the first class. Taught by leading experts in academic emergency medicine, the purpose of the course is to "arm" junior faculty who are interested in pursuing a career in research with the fundamental knowledge and skills to design high-quality research projects and grant proposals.

Research Learning Series Expands, Collaborates with ALiEM In 2018, SAEM partnered with the popular podcast, Academic Life in Emergency Medicine (ALiEM), to bring new topics to the Research Learning Series. The Research Learning Series is SAEM’s free, live online education covering popular emergency medicine research topics.

Physician Wellness/ Resilience Plan Launches The past year kicked off a comprehensive, multi-year plan for SAEM’s involvement in physician wellness/resilience. In accordance with the SAEM Statement on Commitment to Clinician Well-Being and Resilience, the initiative has resulted in a new SAEM Wellness Committee, annual meeting wellness activities, and a Wellness Portal — a comprehensive resource repository on clinician burnout and wellbeing. Most significantly, the initiative led to an important partnership with the National Academy of Medicine (NAM) through SAEM’s participation as an

inaugural sponsor of NAM’s Action Collaborative on Clinician Well-being and Resilience — a network of more than 130 organizations committed to reversing trends in clinician burnout.

The Action Collaborative is composed of four working groups that will meet over the course of two years to identify evidence- based strategies to improve clinician well-being at both the individual and systems levels.

The 2019 SAEM Consensus Conference will also be dedicated to establishing a research agenda on “Wellness for the Future: Cultural and Systems-based Challenges and Solutions.”

SAEM PULSE | JANUARY-FEBRUARY 2019

Industry Advisory Council Established

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SAEM Teams Up with ALiEM For Two Exciting Educational Initiatives SAEM is now the exclusive, multi-year sponsor of ALiEM AIR (Academic Life in Emergency Medicine Approved Instructional Resources)! ALiEM AIR curates and grades open-access blog posts and podcasts in the field of emergency medicine (EM) to identify and provide high quality, social media-based, educational resources for EM residents.

In addition, effective with SAEM19 in Las Vegas, any images that are accepted for display at SAEM’s popular Clinical Images Exhibit will also be featured on ALiEM’s wide-reaching blog.

The SAEM Industry Advisory Council (IAC), in collaboration with the leadership of SAEM, and the SAEM Foundation, launched three new products in 2018: 13 Questions to Find the Perfect Job for You; 5 Steps for Getting Your Finances Together After Residency; and the SAEM Industry Advisory Council Podcast.

The IAC works to increase the connection between SAEM members working in industry and academia, and to promote the Society within the business sector.

AEM Passes 1,000 Submissions!

Submissions for Academic Emergency Medicine (AEM) this year surpassed

1,000 submissions — an increase of a whopping 12 percent over the same period in 2017. For AEM Education and Training (AEM E&T), submissions were up 16 percent over last year — a very healthy trajectory for a new journal!

AEM E&T Receives Indexing In July 2018 AEM E&T was accepted for indexing in PubMed Central, which means that all content published since its launch is now discoverable within the PubMed and PubMed Central archives. Admission into PubMed Central is typically the first indexing milestone for newly published journals.

Indexed journals are considered to be of higher scientific quality as compared to non-indexed journals. PubMed Central indexation will improve the visibility of articles accepted by the AEM E&T and will increase the journal's exposure for authors and readers.

WHAT A YEAR! THANK YOU. We couldn’t have done it without you.

Top-5 Most Accessed AEM Articles of 2018 Rank

Article Title

Total Downloads

1

Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial

4,289

2

A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

2,607

3

Emergency Department Discharge of Pulmonary Embolus Patients

2,137

4

Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners

1,773

5

SAEM Annual Meeting Abstracts

1,738

Top-5 Most "Buzzed About'" AEM Articles of 2018 Rank

Article Title

Total Downloads

1

Emergency Department Discharge of Pulmonary Embolus Patients

318

2

Complex Febrile Seizures, Lumbar Puncture, and Central Nervous System Infections: AÂ National Perspective

203

3

A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

185

4

Effect of a Data-driven Intervention on Opioid Prescribing Intensity Among Emergency Department Providers: A Randomized Controlled Trial

174

5

Validation of the Pediatric NEXUS II Head CT Decision Instrument for Selective Imaging of Pediatric Patients with Blunt Head Trauma

81

Top-5 Most Accessed AEM E&T Articles of 2018 Rank

Article Title

Total Downloads

1

Identifying the Emergency Medicine Personality: A Multisite Exploratory Pilot Study

1,542

2

Not Another Bedside Lecture: Active Learning Techniques for Clinical Instruction

865

3

Poverty Simulation: An Experiential Learning Tool for Teaching Social Determinants of Health

835

4

Learning Analytics in Medical Education Assessment: The Past, the Present, and the Future

686

5

Development of an Emergency Medicine Wellness Curriculum

651

Top-5 Most "Buzzed About'" AEM E&T Articles of 2018 Rank

Article Title

Total Downloads

1

Learning Analytics in Medical Education Assessment: The Past, the Present, and the Future

49

2

Factors Important to Top Clinical Performance in Emergency Medicine Residency: Results of an Ideation Survey and Delphi Panel

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Personal Finance Education for Residents: A Qualitative Study of Resident Perspectives

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4

Clinical Cadavers as a Simulation Recourse for Procedural Learning

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CanadiEM: Accessing a Virtual Community of Practice to Create a Canadian National Medical Education Institution

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2019

A Preview of the New Year A new year is traditionally a time for focusing on renewal, growth, and new beginnings. Thanks to your commitment to our specialty and your continued support of our Society, this New Year begins with the launch of several new programs and initiatives that represent exciting milestones in the history of the Society for Academic Emergency Medicine.

SAEM PULSE | JANUARY-FEBRUARY 2019

Happy Anniversary to SAEM and Friends

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In 1989 the University Association for Emergency Medicine (UAEM) and the Society of Teachers of Emergency Medicine (STEM) came together to form the Society for Academic Emergency Medicine (SAEM). This year celebrates three decades that SAEM has been at the forefront of providing outstanding educational opportunities to emergency medicine academicians; 2019 is also a significant landmark year for several of our SAEM “friends”: • SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM) celebrates 10 years • It’s the 10th Anniversary of the founding of the Academy of Administrators in Academic Emergency Medicine (AAAEM) • Academic Emergency Medicine (AEM) has been publishing cutting edge research for 25 years, since 1984

“The greatest thing in this world is not so much where we stand as in what direction we are moving.”

—Johann Wolfgang von Goethe

• SAEM19 is the Society’s 30th annual meeting and we’ll be celebrating with an anniversary party at 1 OAK Nightclub — one of the most sought out hotspots in Las Vegas

Special Gender Issue of AEM to Publish in Early 2019

in-box in early 2019! The issue will include original research papers and systematic reviews that focus on the role of biological sex and/or female gender identity with respect to workplace experiences, professional advancement, practice environment, work satisfaction and burnout, and the general clinical practice of emergency medicine.

Look for a special issue of Academic Emergency Medicine dedicated to the “Influence of Gender on the Profession of Emergency Medicine” to hit your

Wellness Survey on Tap for the New Year

Vol. 25 No. 9

September 2018 ISSN 1553-2712

Academic Emergency Medicine A GLOBAL JOURNAL OF EMERGENCY CARE

Elevating the human condition during times of emergency EDITOR’S PICK Comparison of Emergency Medicine Malpractice Cases Involving Residents to Nonresident Cases Kiersten L. Gurley, Shamai A. Grossman, Margaret Janes et al.

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ORIGINAL CONTRIBUTIONS Multicenter Evaluation of the YEARS Criteria in Emergency Department Patients Evaluated for Pulmonary Embolism Christopher Kabrhel, Astrid Van Hylckama Vlieg, Alona Muzikanski et al.

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Emergency Department Discharge of Pulmonary Embolus Patients W. Frank Peacock, Craig I. Coleman, Deborah B. Diercks et al.

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Understanding Pediatric Caretakers’ Views on Obtaining Medical Care for Low-acuity Illness Whitney V. Cabey, Judy A. Shea, Shreya Kangovi et al.

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Prospective Validation of Clinical Criteria to Identify Emergency Department Patients at High Risk for Adverse Drug Events Corinne M. Hohl, Katherin Badke, Amy Zhao et al.

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Preprocedural Ultrasound for Infant Lumbar Puncture: A Randomized Clinical Trial David Kessler, Vartan Pahalyants, Joshua Kriger et al.

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Bedside Sonography Performed by Emergency Physicians to Detect Appendicitis in Children Marie Nicole, Marie Pier Desjardins, Jocelyn Gravel

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Contents continued inside.

Acem_v25_i9_issueinfo.indd 1

In 2019 the SAEM Wellness Committee will conduct SAEM’s first ever Wellness Survey. The survey will be customized to allow targeted questions to be posed to various subgroups (faculty, residents, administrators, etc.) for the purpose of acquiring specific data around wellness and burnout that will enable us, as a specialty organization, to better define wellness and more adequately address the problem of burnout.

06-Sep-18 1:12:44 PM

ABEM to Accredit Ultrasound Fellowships On October 26, 2018 the American Board of Medical Specialties approved the Designation of Focused Practice (DFP) in Advanced Emergency

Medicine Ultrasonography. This success is the culmination of more than seven years of hard work in the emergency ultrasound community and will be the first DFP in emergency medicine.

SAEM and its Academy of Emergency Ultrasound (AEUS) are working closely with the Society of Clinical Ultrasound Fellowships (SCUF), the American Academy of Emergency Medicine (AAEM), and the American College of Emergency Physicians (ACEP) to develop a collaborative accrediting body that will work with ABEM to certify fellowships beginning in 2019.

SAEM19 Keynote Address to Focus on Firearm Injury

and saving lives. As the primary member organization to this country’s academic emergency physicians, SAEM is wellpoised to tackle the issue of firearm trauma head on. That’s why we’ve invited two longtime advocates for gun violence research to deliver this year’s annual meeting keynote address. Dr. Rebecca Cunningham is director of the CDC-funded University of Michigan Injury Prevention Center. She has a distinguished career in researching injury prevention, particularly of youth and young adult populations and currently leads the Firearm Safety Among Children and Teens (FACTS) Consortium. Dr. Garen Wintemute is the founding director of the Violence Prevention Research Program (VPRP) and holds the BakerTeret Chair in Violence Prevention at the University of California, Davis. He also directs the new University of California Firearm Violence Research Center.

They will open SAEM19 with a timely and relevant keynote presentation titled “Firearm Injury: Facts, Myths, and a Public Health Path Forward.”

Inaugural Education Keynote Added to SAEM19 Lineup

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New to the 2019 SAEM Annual Meeting We’re still months away from SAEM19, but with record-high submissions for Advanced EM Workshops and didactics, along with several exciting new additions to the program agenda, the 2019 SAEM annual meeting in Las Vegas is ramping up to be another extraordinary event.

Here’s what’s new for SAEM19: •E ducation Keynote. John Prescott, MD, chief academic officer of the Association of American Medical Colleges (AAMC), will be the keynote speaker for the Society’s inaugural education address at SAEM19 in Las Vegas. Dr. Prescott will present on “The Future Landscape of Medical Education.”

•T he first SAEM MedWAR will be held May 17 at Red Rock Canyon in Las Vegas. MedWAR combines wilderness medical challenges with adventure racing and is used as a tool for teaching and testing the knowledge, skills, and techniques of wilderness medicine, and for promoting teamwork and collegiality among competitors.

Rebecca Cunningham, MD

John Prescott, MD

Garen Wintemute, MD, MPH Firearm related injuries and deaths have risen to public-health-crisis-levels in the United States. In emergency departments across the country, emergency physicians are "in their lanes" bearing witness to the trauma and managing the epidemic by extending care, repairing damage, treating injuries, giving comfort,

What does the future of medical education look like? John Prescott, MD, chief academic officer of the Association of American Medical Colleges (AAMC), will offer his insight into the emerging trends that are taking shape amid a continuously evolving healthcare landscape and how they might impact the future of medical education. Dr. Prescott will be the keynote speaker for the Society’s inaugural education address at SAEM19 in Las Vegas. He will present on “The Future Landscape of Medical Education.”

•S AEM19 Red Rock Hike, sponsored

by SAEM Wilderness Medicine Interest Group and SAEM Program Committee, is another SAEM first. The hike is through Nevada’s Red Rock Canyon— known for its spectacular natural beauty, rugged red rock formations, desert vegetation, and beautiful vistas around every bend.

• Blackout Dinner is new to the Las Vegas nightlife scene AND to the SAEM annual meeting. Blackout dining turns out the lights on the typical dining experience for a pitch-black foodie adventure where flavors and textures are enhanced and all your senses are heightened.

continued on Page 14

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2019 continued from Page 13 • The RAMS Hangout, located in the SAEM19 Exhibit Hall, is a dedicated fun zone where SAEM’s residents and medical students can connect, wind down, and recharge with foosball, basketball, ping pong, and more!

RAMS Role Bigger Than Ever Residents and Medical Students (RAMS) will continue to play a big role in 2019.

Here’s what you can look forward to in the coming year from your SAEM residents and medical students: • RAMS Learning in Style. A repository of resources for residents and medical students based on learner-type (hands on, audio, visual).

• RAMS Wellness Survey. Developed by the RAMS Wellness and Resilience Committee, the survey will ask questions of clinical or non-clinical medical student and residents for the purpose of gaging the wellness activities at institutions.

• “Who’s Who in EM” podcast.

Developed by the RAMS Career Development and Mentorship Committee, these monthly podcasts will interview faculty members who have been an inspiration or have an inspiring story to tell.

SAEM PULSE | JANUARY-FEBRUARY 2019

• RAMS Roadmaps. Launching in early January 2019: The Definitive Guide to Academic Careers in Emergency Medicine for Residents & Students: 1st Edition

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A New Look for SAEM Communities It's a new year, and what better way to kick it off than with a fresh new look for community.saem.org! In 2019, we’ll be giving our community site a digital facelift of sorts.. So stay tuned for the big reveal… coming later this month!

SAEM to Add a Pair of Committees Two new committees will launch at SAEM19 in Las Vegas: The ED Administration and Clinical Operations Committee, and the Education Committee, bringing the total number

of SAEM committees to 18. SAEM committees give direction to SAEM’s activities and play a critical role in advancing the Society’s vision and mission.

SAEM Foundation Looks Toward the Future The SAEM Foundation (SAEMF) will hold its first strategic planning retreat for the Board of Trustees in 2019.

The retreat will allow the Board of Trustees to evaluate the current state of the Foundation, identify needs and gaps in the overall environment, and create a measurable plan of action to further its mission to develop innovative researchers, expert educators and future academic emergency medicine leaders.

New Grants from SAEM Foundation The SAEM Foundation (SAEMF) is expanding its grant offerings again in 2019 with a new grant in partnership with the American College of Medical Toxicology (ACMT).

Announcing a New Speakers Bureau Focused on Diversity Topics SAEM’s Academy for Diversity and Inclusion in Academic Emergency Medicine (ADIEM) is creating a speaker’s bureau to provide residencies, hospitals, and community organizations with expert, geographically-available speakers who specialize in specific topics such as racism in medicine, microaggressions, implicit bias, and creating a welcoming environment.

Five New Awards for 2019 SAEM received a record number of nominations for the society’s 2019 awards, including a whopping 22 nominations for our new RAMS awards!

SAEM presents awards each year in recognition of excellence in emergency medicine, for contributions improving the health of society, and for academic achievements. In 2019 the slate of SAEM awards expands to include these five new awards: •F OAMed Excellence in Education Award •M arcus L. Martin Leadership in Diversity and Inclusion Award

Second ARMED Class Largest Ever The second class of Advanced Research Methodology Evaluation and Design (ARMED), which “graduates” in May 2019, is the largest in the history of the program, with 31 participants (up from 17 in the previous class). Taught by leading experts in academic emergency medicine, the purpose of the course is to "arm" junior faculty who are interested in pursuing a career in research with the fundamental knowledge and skills to design high-quality research projects and grant proposals.

Watch for New SAEM Directories Launching prior to the SAEM annual meeting in May will be all-new SAEM directories, with a mapping feature and the ability to compare multiple institutions. SAEM’s fully-searchable directories are the most powerful and comprehensive listing of emergency medicine clerkships, residencies, and fellowships.

2019 2019

•R AMS Leadership in Emergency Medicine Award

•R AMS Innovative Educator Award

•R AMS Excellence in Research Award

It’s a New Year and we couldn’t be more excited to share it with you! To take advantage of all of that’s coming up in 2019, please make sure your member profile is up-to-date. On behalf of everyone at the Society for Academic Emergency Medicine we thank you for your ongoing commitment to SAEM and wish you and yours a Happy New Year and the very best for 2019!

How to Make Diversity and Inclusion a Residency Program Priority in One Year

By Jessica A. Shuen, MD and Amber M. Peterson, MD As an emergency medicine (EM) residency program in the greater New York City area, we interact with patients, ancillary staff, residents and attendings from other specialties who come from all socioeconomic backgrounds, races, ethnicities, religions, and sexual orientations. We felt compelled to answer the following questions: how can we mirror that kind of diversity in our residents, and how can our residency program better prepare our residents and attendings to appropriately interact with each other, our patients, and the community? Our residency program’s desire to prioritize diversity and inclusion in EM is a stance shared by the American College of Graduate Medical Education (ACGME), who have recently updated

their Common Program Requirements to state that residency programs “must focus on...ongoing, systematic recruitment and retention of a diverse and inclusive workforce.” Over the course of a single academic year, we developed an authentic culture of diversity and inclusion within our residency program with a few key initiatives. We share our experiences in this “how to” guide in hopes that other residency programs can avoid reinventing the wheel and instead draw on our lessons to launch similar measures.

How to Form a Residency Diversity and Inclusion Committee One of the first and most important steps was the formation of a residentled Diversity and Inclusion Committee.

Composed of EM attendings and residents, we began meeting bi-weekly in August 2017.

Seek guidance. We looked to other programs that had already established diversity and inclusion committees for guidance on how to get started. During one of our first meetings, we held a conference call with Dr. Renee King, Director of the Diversity and Inclusion Committee at University of Colorado EM Residency, to hear about their experiences and learn from her words of wisdom (Tunson, Boatright, Oberfoell, et al. 2016).

Establish purpose. Our first course of action was to collectively define “diversity and inclusion” through a mission

continued on Page 16

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DIVERSITY continued from Page 15 statement. After reviewing SAEM, ACEP, and various medical school and residency statements on diversity and inclusion, we developed our own statement that reflected our ideals and goals. We then designed a diversity and inclusion webpage with our mission statement, and linked it to our EM residency website.

Be visible. Our Committee made recruitment and visibility during the 2018 interview season a priority.

• Pre-interview dinners: At the preinterview dinners, held before every interview day to allow residents and interviewees to interact, we ensured that at least one person from our Committee was present to promote our work and answer questions.

Hackensack University Medical Center Diversity and Inclusion Committee- including residents, attendings, spouses, and administrative staff- holding a meeting in September 2018 to summarize the accomplishments of the first year and discuss ideas moving forward to the second year.

• Interview day: During the interview day, we arranged for at least one resident from the Committee to talk with the interviewees during lunch.

We also tried to have one of our Committee members as one of the resident interviewers every week. We developed a handout with our mission statement which we included in the interview day packet.

SAEM PULSE | JANUARY-FEBRUARY 2019

• Post-interview follow-up: A resident from the Committee sent a followup email on behalf of the Committee to applicants who self-identified as traditionally underrepresented minorities in medicine. The residents offered to answer any questions and invited the applicant to a brief shadow shift in our ED if they were interested.

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Be active. In an effort to make our emphasis on diversity and inclusion known to applicants, we sent a few residents from the Committee to local medical school-sponsored residency fairs to hand out information and speak with students about our program.

How to Launch a Visiting Medical Student Rotation Scholarship Logistics. Following Match Day 2018, we, as a committee, decided to pursue sponsoring visiting fourth year medical students who are passionate about our mission. This was an idea we were inspired to take on after talking to several other residency programs who had already implemented it

Hackensack University Medical Center EM residents Dr. Jessica Shuen, Dr. Yomi Fashola, and Dr. Amber Peterson (L to R) at Howard University College of Medicine’s Residency Fair in February 2018.

with success. First, we spoke with our clerkship director and secured a few spots during peak away rotation months. Next, we approached the chair of emergency medicine and pitched our idea. We successfully secured funding to support two students for our Scholarship for Underrepresented Students, a $2,000 stipend which would be large enough to support their travel and/or living expenses.

Dissemination. As a committee, we created a one-page brochure/ application with information about our

residency program, our committee, the requirements needed to apply for the scholarship, and two short answer questions about the role of diversity and inclusion in EM. Each resident on the committee emailed the brochure to his/her medical school. We also distributed the brochure to residency program director list serves and national organization websites such as SAEM. Recipient selection. We wanted everyone on the committee to participate in selecting the scholarship recipients. In late August 2018, we

compiled all the applications and had each member vote for his or her top preferences. The two students with the most votes were selected as the recipients. One rotated with us in October 2018 and the second rotated with us in November 2018.

females. We also doubled the number of underrepresented minorities and LGBTQA from one incoming class to the next, creating the most diverse class in our program’s history.

How to Engage Administration, Faculty, and Residents

Recruitment. We aim to participate in national conferences like SNMA, LMSA, and APAMSA in addition to local residency fairs. We are also launching a social media presence on Twitter and Instagram.

Education. For all the faculty and residents involved in interview season activities, we made it mandatory to participate in implicit bias testing prior to the start of interview season. We also invited an expert on diversity and inclusion in residency programs to a faculty development day to speak to our faculty and interested residents.

Participation. Since the formation of the Diversity and Inclusion Committee, our residency administration and leadership have been intimately involved in decision-making and idea generation.

Our department chair, program director, assistant program directors, residence coordinator, and several members of our core faculty as well as other EM attendings have been present at nearly all committee meetings. They are able to support the committee’s efforts to make diversity and inclusion a priority through resource allocation, departmental funding, and administrative assistance.

Achievements After implementing our diversity and inclusion efforts, we went from an incoming class of 25 percent females to an incoming class of 42 percent

How to Move Past Year One

Interviews. We plan to invite interviewees who self-identify as underrepresented minorities back for a second look event with our Committee.

Education. We are organizing an entire conference day for our residency and other local residencies on the topic of Diversity and Inclusion, slated to be held in April 2019, the conference will include guest speakers, specialized panels, small group discussions, and a journal club.

Research. We are actively discussing research topics that would contribute to improving care for the diverse community we serve.

How to Apply Our Lessons Learned Based on our experiences, first and foremost there must be a dedicated formal Diversity and Inclusion Committee to lead all efforts to make diversity and inclusion a priority in a residency program. There must be 1) a commitment by residents and residency program leadership to address diversity and inclusion with an open and solutions-

oriented mindset, 2) education for other residents, faculty, and administration on cultural competency and unconscious bias training, and 3) dedication to increasing leadership, mentorship, and educational opportunities for underrepresented medical students and residents.

Acknowledgements: We would like to thank all members of the Hackensack University Medical Center Diversity and Inclusion Committee, past and present, for their hard work and dedication. Our deepest gratitude to those who provided invaluable input on this article.

Read two perspectives on the LGBTQ emergency medicine residence application experience…On page 18 of this issue of SAEM Pulse.

ABOUT THE AUTHORS Jessica A. Shuen, MD, is a chief resident at the Hackensack University Medical Center Emergency Medicine Residency.

Amber M. Peterson, MD, is an attending physician at the University of Maryland Charles Regional Medical Center in LaPlata, MD. She is an alum of the Hackensack University Medical Center Emergency Medicine Residency. Dr. Shuen and Peterson are founding members of the residency’s Diversity and Inclusion Committee.

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DIVERSITY AND INCLUSION

In and Out on the Trail: Two Perspectives on the LGBTQ Emergency Medicine Application Experience

SAEM PULSE | JANUARY-FEBRUARY 2019

By Caitlin Ryus MD, MPH and Abbie Saccary, MD

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As another interview season closes, we find ourselves reflecting on how we can strive to make the application process more inclusive to Lesbian, Gay, Bisexual, Trans, and Queer (LGBTQ) applicants. Many students struggle about whether or not — and how — to include sexual and gender identity in their applications. Unfortunately, there is minimal data on the subject. One small study by Merchant, Jonco, and Woodward (2005) found in a survey of 45 physicians and medical students that 52 percent of medical students were unsure, 33 percent planned to, and 15 percent did not plan to disclose their sexual orientation. Only 52 percent of the attendings surveyed had disclosed during their residency applications and interviews. For applicants who do wish to self-identify, how to do so can be challenging to navigate.

There is a multitude of factors that inform applicants’ decisions to disclose sexual orientation. There is a big difference between being out and proud in one’s daily life and being explicitly out on a job application that will circulate to a faceless crowd of program directors around the country. For many medical students, residency applications are stressful enough without the prospect of facing possible judgement and rejection based on sexual orientation.

Furthermore, because the Electronic Residency Application Service (ERAS®) does not have indicators for sexual or gender identity, clearly communicating your identity through ERAS is difficult if you aren’t in a relationship that you want to discuss or don’t have any LGBTQ-relevant school activities. Not to mention, if you are concerned about outing yourself, and you omit LGBTQ activities, you appear less involved or accomplished. Thus, the anxiety surrounding whether or not to disclose is more likely to be experienced among average or below average applicants.

However, by self-identifying, you will inherently attract programs that prioritize LGBTQ as part of its program’s diversity.

Self-identifying weeds out programs that are not comfortable with these details, thereby sparing applicants the threat of some future “coming out” decision.

We took time to reflect on our own recent journey through the application processes and explored the pros and cons of being “out versus in” during emergency medicine residency applications.

Applications In perspective: After all the years of studying and tuition dollars that went into preparing me to even apply for residency, I wasn’t eager

to open myself up to any additional discrimination. Not to mention that being queer is something that I didn’t have a convenient way to bring up — no wife to casually mention, and LGBTQ research and leadership weren’t focal points of my curriculum vitae (CV).

Without a natural opportunity to disclose and no click box on ERAS, I would have had to go out of my way to make a point of disclosing. I didn’t want to take on that risk. That being said, had there been a click box for sexual orientation, I would likely have checked it.

I think not having a box to click for sexual orientation is a deterrent to disclosure. It carries an implication that sexual orientation and gender identity are either not relevant or that they are not a classification of diversity that requires special consideration. I’m a big supporter of an optional checkbox, even if just for the sake of contributing to demographic data collection for LGBTQ applicants… And it would ease the stress of how and when and to whom you disclose.

Out perspective: Since there is no distinct click box on ERAS (yet) to identify as a member of the LGBTQ community, deciding how to highlight my identification was more challenging than I had anticipated.

I didn’t want to be weird and just

write “Hey, I’m GAY!” at the top of my “hobbies” section, but I also wanted to make sure my message was clear, even to the most obtuse. Some of my school activities spoke for themselves (GSA leadership, Diversity Committee LGBTQ representative), while the “hobbies” section offered another opportunity for identification. I spoke of my wife while describing life outside of medicine. Astute programs that value diversity will pick up these references. Until ERAS catches up with the times and includes an LGBTQ identification option on its application, we are unfortunately left to invent our own ways to identify in language that will speak to all who are listening.

Interviews In perspective: One could argue that I was covertly assessing the friendliness of programs from the comfort of the closet. I noticed whether people used gender-neutral pronouns when inquiring about partners.

I noticed which programs proactively promoted their diversity initiatives. I appreciated programs with open invites to diversity events because they didn’t require me to blindly email some chief I’d never met to ask about the issue.

But I might have missed out on direct diversity recruitment efforts by not overtly disclosing. I also probably spent unnecessary time and money interviewing at programs that weren’t going to be good fits on that front.

Out perspective: Making my queerness clear on my application helped alleviate some of the anxiety associated with interviews; however, I knew the residents at the pre-interview dinner had not read my application and therefore offered an opportunity for me to honestly assess the overall culture of the program. I paid attention to pronouns residents used when asking about my significant other and made sure to mention my wife to

gauge their reaction. I also listened to my fellow applicants, since these were possibly the physicians with whom I would spend countless hours over the next 3-4 years. Some programs even made overt recruiting efforts for underrepresented groups in medicine, such as second look opportunities. For one program on my list, this second look catapulted them from the bottom of my list to near the top. The second look gave me an in-depth view of the residency that I did not appreciate on my interview day and, maybe more importantly, it made me feel welcome on a deep and personal level. I strongly advocate that programs looking to recruit LGBTQ applicants consider implementing a second-look opportunity for qualified and highly desired applicants.

Conclusion We, as a specialty, should consider how we can better approach applicant recruitment. A handful of small studies have shown that sexual identity influences residency choice and career paths among medical trainees (Risdon, Cook, and Willms, 2000). Program diversity was in the top 10 most important factors contributing to emergency medicine residency selection by applicants (Love et al, 2012). We, the authors, advocate for inclusion of a sexual and gender identity indicator on ERAS. This past year (2018) was the first year that American Medical College Application Service (AMCAS®) included gender identity and preferred pronouns on the medical school application. An indicator on ERAS would not only make the outing process less convoluted for applicants but also LGBTQ-based data collection would allow for evaluation of systemic biases within the residency selection process.

In the meantime, we’d like those in leadership to keep in mind that LGBTQ applicants to emergency medicine might benefit from safe and comfortable opportunities to self-identify during the application process.

We the authors, despite our different approaches, both landed at programs

that welcomed us. We are now both involved in recruitment and diversity at our home institutions as well as through ADIEM. Obviously, choosing to out yourself on an application with as much gravity as ERAS is a deeply personal undertaking, and we encourage applicants to be true to themselves.

Just because sexual orientation is not something ERAS has a standardized way to identify, does not mean that there aren’t programs actively recruiting LGBTQ applicants. And we would like to reassure students that the power balance is shifted way more in the applicants favor than you realize. Whether one chooses to openly identify as LGBTQ or decides to keep such details private, we encourage applicants to seek the most genuine and supportive environment possible in which to spend the most formative years of physician life.

Read how one residency program made diversity and inclusion a program priority… In one year...On page 15 of this issue of SAEM Pulse.

ABOUT THE AUTHORS Caitlin Ryus (@CaitlinRyus) MD, MPH is a second year emergency medicine resident at Yale New Haven Hospital, New Haven CT and co-chair of ADIEM’s LGBT Committee. She received her MD from Warren Alpert Medical School at Brown University and her MPH from Columbia University’s Mailman School of Public Health.

Abbie Saccary, MD is a second year Emergency Medicine resident at Yale New Haven Hospital, New Haven CT, and co-chair of ADIEM’s LGBT Committee. She received her MD from Mercer University School of Medicine in Savannah GA. She is a 2006 graduate of the United States Military Academy, West Point NY.

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in health care and outcomes, and insuring that all emergency physicians are delivering culturally competent care. For more information, visit the ADIEM webpage. Joining ADIEM is free! Just log into your member profile and click on the "Update (+/–) Academies and Interest Groups" button.

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DISASTER MEDICINE

SAEM Recognition of Disaster Medicine Fellowships. Important? You bet!

SAEM PULSE | JANUARY-FEBRUARY 2019

By Carl Schultz, MD

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As academic emergency physicians, we spend a great deal of our energy striving to advance the science of our profession. While we are, to a large extent, self-actualized in this pursuit (yes, I am actually old enough to remember the 1960s), the acknowledgement and reward by our peers still matters. That is why the decision by the SAEM Fellowship Approval Committee to add disaster medicine to the list of fellowships eligible for formal recognition by the Society is a significant milestone.

Disaster medicine fellowships sponsored by academic departments of emergency medicine are relatively new, beginning about 10-15 years ago.

Driven by the increasing number and complexity of disasters over time, the demand for knowledgeable experts in the field has also expanded. Responding to this need, significant enthusiasm

now exists among emergency medicine residency graduates for pursuing further education and training in the developing specialty of disaster medicine by participating in fellowships.

With increasing expansion of the specialty’s knowledge base and footprint, the goal will be the eventual creation of an Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship in disaster medicine. There is increasing justification for moving in this direction.

Three textbooks on the subject of disaster medicine are available and two have recently published their second editions. One of these texts has already been translated into Mandarin Chinese and Arabic, with a Turkish translation in the works. Multiple credible journals dedicated to disaster medicine are publishing peer-reviewed research, as are such esteemed journals as The

Lancet and The New England Journal of Medicine. Both SAEM and ACEP support presentation of unique disaster medicine research abstracts at their annual meetings. The evidence for both a unique body of knowledge and a clinical skill set is building.

Despite this progress, the specialty will need additional guidance and support.

Until recently, the expansion of the specialty’s fellowship training has been somewhat idiosyncratic and haphazard.

No centralizing force currently exists to guide development and each program operates essentially as an island unto itself. Now, however, a sort of “critical mass” has been achieved. With 20 disaster medicine fellowship sites in operation, the time has arrived to begin a more formal developmental process to standardize program organization, training, and education.

This is where SAEM’s role becomes important. While achieving ACGME accreditation remains the goal, this will

not happen overnight, and those of us involved in the specialty of disaster medicine are not exactly household names, so using our reputations to facilitate this process is not likely to prove a winning strategy. However, SAEM can play a critical role by supporting the development and evolution of a more structured and standardized specialty. By providing both oversight and recognition, SAEM can positively impact the further maturation of disaster medicine fellowships. As an example, the process administered by SAEM can assist with standardization of curricula and creating measurable objectives that will further stimulate the specialty’s advance.

SAEM recognition of disaster medicine fellowships will also elevate their prestige and provide further confidence by applicants in the quality of education and training provided. Individuals that apply to programs approved by SAEM will know these fellowships meet standards created by a national body and are reviewed for compliance. They will also know that the

knowledge they acquire will essentially be uniform regardless of the fellowship in which they enroll.

SAEM’s addition of disaster medicine to its approved list of specialties marks a significant benchmark and supports the movement toward eventual ACGME accreditation.

ABOUT THE AUTHOR Carl Schultz, MD is a professor emeritus of emergency medicine and public health at the University of California Irvine School of Medicine, director of the EMS and Disaster Medical Sciences Fellowships for the Department of Emergency Medicine at UC Irvine Medical Center, and associate EMS Medical Director for Orange County, California. schultzc@uci.edu For more information about SAEM’s Disaster Medicine Fellowship visit the webpage.

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ETHICS IN ACTION

Conflict of Interest Disclosures: What Academic EM Physicians Need to Know

SAEM PULSE | JANUARY-FEBRUARY 2019

By Daniel Nogee, MD

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Every medical school lecture starts out with the same tired joke: the conflicts of interest disclosure, or rather the lack thereof, on the second slide. Every time, the same wisecrack: “I wish I had some conflicts of interest, then I might actually have money!” Far from being a joke, a quick glance at recent news shows the devastating fallout from a scandal around lack of conflict of interest disclosure by a prominent Sloan Kettering oncologist. Every few years it seems a new scandal breaks about a physician failing to disclose ties to industry that might have influenced their research, leading to a wake of amended and retracted papers. Many are listed in the archives of Retraction Watch, a website dedicated to the mission of highlighting and investigating retracted papers, although fortunately there are few examples from our field. Historically, many of the retractions for lack of conflict

of interest disclosure stem from sources familiar with the author (close enough to know authors had a financial interest worth disclosing), who voiced their concerns either to journal editors or to independent investigative journalists like Propublica. This changed several years ago with the passage of the Physician Payments Sunshine Act, resulting in the publicly-accessible online publication of any payments greater than $10 made to physicians by pharmaceutical companies and medical product manufacturers.

Today anyone — students, coworkers, even patients — can look up online payments made to any physician through the Center for Medicare & Medicaid Services (CMS) Open Payments website.

Physicians must be more vigilant than ever about disclosing any real (or potentially perceived) conflicts of interest when publishing research.

To report accurately, we must first determine what constitutes a “conflict

of interest” as it relates to academic publication. The straightforwardlynamed International Committee of Medical Journal Editors (ICJME) defines conflicts of interest as follows: “A conflict of interest exists when professional judgment concerning a primary interest (such as patients' welfare or the validity of research) may be influenced by a secondary interest (such as financial gain).

Perceptions of conflict of interest are as important as actual conflicts of interest.

They further elaborate that while financial conflicts of interest are most common, others may occur due to “personal relationships or rivalries, academic competition, and intellectual beliefs.”

To make the disclosure process easier (and thus increase compliance), the ICJME and many individual journals publish tools for authors to use to create disclosure statements. The

"A conflict of interest exists when professional judgment concerning a primary interest (such as patients' welfare or validity of research) may be influenced by a secondary interest (such as financial gain)."

—International Committee of Medical Journal Editors expectations are neither unrealistic nor overly burdensome: just to disclose any potential relationships that could be reasonably thought to influence how others might “receive and understand” academic work. i.e., if you (as an author) think a relationship might be relevant, others may think the same, so it should be disclosed The ICJME’s downloadable conflicts of interest tool offers an elegant method for tracking and reporting potential conflicts of interest appropriately.

Much like a curriculum vitae, it benefits from regular small updates (hopefully as one accumulates financial research support, invited paid talks, and similar potential conflicts) so that it’s “ready to go” at manuscript submission time.

Of course, submitting a manuscript is not the only time to think about appropriate disclosures. Any academic work, including podium and poster presentations, other research forums, and classroom presentations to medical students, residents, and other learners, should include a relevant conflicts of interest disclosure statement. Appropriate recognition and disclosure of conflicts of interest is just as important when serving

as a peer reviewer of others’ work: the ICJME recommends that “reviewers must disclose to editors any conflicts of interest that could bias their opinions of the manuscript, and should recuse themselves from reviewing specific manuscripts if the potential for bias exists.” Journal staff and editors are held to similar standards of recusal if conflicts of interest exist. In this setting, personal relationships, especially collaborations or rivalries, are more relevant than financial ones. Think about these scenarios: would you want your manuscript reviewed by someone you compete with in the same narrow academic niche? On the other hand, do you want people to think that your article only got accepted because the journal editor was a former mentor of yours? While we would like to believe that everyone in academia acts honestly, it’s easy to find many examples of the opposite; and as mentioned above, the perception of conflicts of interest is as important as their actual existence in the peer review setting. “Blinded” peer review does address this issue, but still leaves plenty of openings for conflicts of interest to worm their way in the peer-review and publication process.

While it may seem excessive to list any potential personal or financial conflict, especially at the $10 level reportable on the CMS Open Payments websites (how much do you think that water bottle or t-shirt you got while wandering around a conference exhibition hall cost?), the perception that physicians can be “bought” is very real, and when that perception becomes reality it often makes the news. Are you comfortable with what a journal editor or coauthor might find if they look you up on CMS Open Payments or Google? Neglecting, intentionally or unintentionally, to disclose conflicts of interest can lead to embarrassment at best and careerending scandals at worst. Every academic physician should want to be mentioned in the commentary of major journals or even the lay press, but make sure it’s for the merit of your work and not for how it was financed.

ABOUT THE AUTHOR Daniel Nogee, MD, is a fourth-year resident physician in emergency medicine in the Yale program and also as a resident member of the Academic Emergency Medicine editorial board.

Dr. Nogee would like to thank Dr. Mark Mycyk (editorial board member of Academic Emergency Medicine) and Dr. Catherine DeAngelis (former Editor-in-Chief of JAMA) for their support and mentorship in writing this article.

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RESEARCH IN ACADEMIC EM

In Constant Search of the Next Great Idea (and the Money to Support It): Two Takeaways on Burnout Among Emergency Care Researchers

SAEM PULSE | JANUARY-FEBRUARY 2019

By Bernard P. Chang, MD, PhD

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While there has been a recent flowering of interest in the study and support of “burned out” clinicians, burnout is also a significant problem amongst those engaged in research. Faced with the challenges of carrying out high quality science, alongside the perpetual specter of seeking, or maintaining, funding to support one’s research program, physician-scientists frequently encounter unique stressors that may adversely impact career longevity and well-being.

You’re not alone.

Burnout, defined by emotional exhaustion, physical fatigue and cognitive weariness, results from high and sustained levels of stress and is associated with adverse effects

on career longevity, psychological health, and potentially general health (Shanafelt, Hasan, Dyrbye, et al. 2015) (Lee, Ashforth 1990). Researchers face many potential challenges during their professional development that may provoke symptoms of burnout and impact well-being and career longevity. Early investigators may feel a sense of intimidation by the myriad pathways to funding and the alphabet soup of grants, coupled with a sense of “imposter syndrome” when attending conferences and hearing the incredible contributions to science our colleagues dazzle us with at the latest symposium or didactic. On the other end of the podium, for many of the established investigators doing the dazzling, behind the scenes are the daunting tasks of operating a large study/lab, and maintaining the

administrative machinery akin to a medium to large sized business. And throughout this whole process, hovering over most investigators, from early to established, is the search for funding to create or support the time and facilities to make your research idea happen.

These potential stressors, may serve to foster many of the symptoms of burnout that we have frequently seen among emergency care providers on the frontline. While there have been no comprehensive assessments specifically of emergency physician researcher burnout to date, data from academic researchers in other medical specialties and academic disciplines suggest that burnout rates among researchers are high and may have similar adverse outcomes as seen in clinician burnout (Lackritz 2004).

"Faced with the challenges of carrying out high quality science, alongside the perpetual specter of seeking, or maintaining, funding to support one’s research program, physician-scientists frequently encounter unique stressors that may adversely impact career longevity and well-being."

Don’t be an island.

In the spirit of team science and in recognition of the benefits of multiinvestigator collaborations, researcher burnout can also be conceptualized as a challenge that can be potentially helped by a team based approach.

Just as having colleagues to rely on to debrief and garner emotional support following a challenging case or outcome in the Emergency Department, having an analogous network of friends and colleagues can be invaluable for research support, from bouncing ideas about the next great idea, or for comfort and

motivation after a challenging grant submission or study hiccup. Strong mentorship is also as a critical salve for both the emotionally exhausted mentee and mentor. For the mentee, having a trusted adviser and advocate, can help with study specific challenges but also with broader questions of career development and guidance. For mentors, being able to help support and guide mentees may also serve to benefit one’s one sense of professional well-being.

Just as witnessing the sense of awe and excitement of an intern’s first successful critical care procedure, watching a young colleague’s joy over seeing their ideas to

fruition may help sustain and rekindle the spark that one felt when embarking on one’s research career.

Like full time clinicians, emergency researchers are often tasked with managing a broad range of challenges that may place them at risk for the development of burnout. Describing and recognizing the existence of this problem is a first step and can help guide the development of interventions and support structures to help optimize researcher well-being, improve career longevity, and enhance the creation of cutting edge acute care science.

ABOUT THE AUTHOR Bernard P. Chang, MD, PhD, is an assistant professor of emergency medicine at Columbia University Medical Center in New York City. Dr. Chang submitted this article on behalf of the SAEM Research Committee, of which he is a member of the SAEM Research Committee.

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SOCIAL MEDIA IN ACADEMIC EM

The Role of Social Media in Advocacy

By Eric Lee, MD If you’re not following social media at all, then you may be missing out on important conversations that are happening in emergency medicine right now.

SAEM PULSE | JANUARY-FEBRUARY 2019

When the NRA told doctors to “stay in your lane” in response to a series of research papers on gun violence and death in November of 2018, the reaction from the medical field was critical and swift. Physicians from all specialties and both sides of the aisle responded back with #ThisIsMyLane and #ThisIsOurLane, posting heartbreaking messages about our experiences trying to save victims of gun violence and pictures of blood-soaked scrubs and trauma bays. Once again, a debate originating in social media became viral and made national headlines.

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Tragically, only a few hours after the NRA’s initial tweet, another mass shooting occurred in Thousand Oaks, California, and then later that same month, we lost one of our own, Dr. Tamara O’Neal, to an act of gun violence while she was at work in the emergency department. While we may seem inured at times to the senseless violence that we witness at work, the tragic loss of one of our own during this contentious debate hit close to home, and the outpouring of grief and support in our specialty was palpable.

The important role that social media has played in public health precedes this current contentious issue.

Physicians have been using their voices on social media to advocate for public health topics for a long time now. It has been a valuable outlet for education and public policy work. We can look to leading physician advocates like Drs. Esther Choo (@choo_ek), Megan Ranney (@meganranney), Dara Kass (@darakass), and Cedric Dark (@realcedricdark) for great examples of emergency physicians who have helped steer the conversation on gun violence and the role that physicians play in the crisis. They are among a chorus of physicians from all specialties who have been a part of the discussion, and physicians are now successfully bringing the issue of gun violence out of the highly politicized domain into the public health arena.

Social media platforms can be an amazing vehicle for activism. They have played a critical role in the current gun violence discussion by providing everyday physicians with an outlet to directly participate and advocate. Of course, tweets and retweets in and of themselves don’t do anything. But they can be a call to action, and it’s often the actions that follow that make the real difference. The discourse, the inspiration, and the alliances that are built from social media can be powerful tools in public health advocacy. In the case of gun violence, physician leaders have banded together to educate the public and have also created AFFIRM Research (@ResearchAffirm), an

"The discourse, the inspiration, and the alliances that are built from social media can be powerful tools in public health advocacy." organization that seeks to support further research into firearm injuries in the United States.

Physicians will continue to be leaders in public health advocacy. Harnessing social media properly and effectively will help us build and drive many more public health movements in the years to come.

ABOUT THE AUTHOR Eric Lee, MD, (@EricLeeMD) is an attending physician at Maimonides Medical Center in Brooklyn, NY. Dr. Lee submitted this article on behalf of the SAEM Social Media Committee.

SGEM: DID YOU KNOW? More Sex Differences to Consider in Acute Coronary Syndrome: Broken Heart Syndrome

By Alexandria Gregory There has been increasing awareness that acute coronary syndrome (ACS) often manifests differently in females, who may present with fatigue, nausea, weakness, or other vague symptoms in the absence of chest pain. However, there are several other important sexspecific trends and differences in the diagnosis and management of ACS of which to be aware, including that of “Broken Heart Syndrome.”

“Broken Heart Syndrome,” commonly called takotsubo cardiomyopathy (TC) or stress cardiomyopathy, is characterized by transient systolic dysfunction of the left ventricle in the absence of coronary artery obstruction. Definitive diagnosis also requires new EKG abnormalities, such as ST elevation or T wave inversion, or an elevated troponin. TC predominantly affects postmenopausal women; systematic review has shown 82-100% of cases are in women, with an average age of 65-72 years. It accounts for a small yet non-negligible 1-2 percent of patients in whom ACS is suspected and troponin is elevated (Gianni, Dentali, Grandi, et al. 2006).

The pathogenesis of TC is not well understood, but it is thought that the catecholamine excess may result in myocardial stunning or direct myocardial toxicity. This may account for the noted sex differences as myocardial adrenergic receptors have been shown to be more sensitive in women due to their increased density, particularly in left ventricular

myocardium (Kneale, Chowienczyk, Brett, et al. 2008). TC, if suspected, should be treated like routine ACS including cardiac catheterization, aspirin, and heparin (Bybee, Prasad 2008). Complications include cardiac arrest and cardiogenic shock, but overall prognosis is favorable with a lower complication rate than STEMI (Zalewska-Adamiec, BachorzewskaGajewska, Tomaszuk-Kazberuk, et al. 2016).

While there has been improvement in our understanding of sex differences in cardiovascular disease, Broken Heart Syndrome is an example of how these differences require continued consideration and additional research to improve patient care.

ABOUT THE AUTHOR: Alexandria Gregory is a fourth year medical student at Saint Louis University School of Medicine.

About the Sex and Gender in Emergency Medicine Interest Group The purpose of the SAEM Sex and Gender in Emergency Medicine (SGEM) Interest Group is to raise consciousness within the field of emergency medicine on the importance patient sex and gender have in the delivery of emergency care and to assist in the integration of sex and gender concepts into emergency medicine education and research. Joining SGEM is now free! Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

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WILDERNESS EMERGENCY MEDICINE Practicing Emergency Medicine on a Remote Island: Life in the Catalina Island Emergency Department

By Isabel M. Algaze Gonzalez, MD Imagine this: You’ve just finished managing a respiratory arrest and in comes an active GI bleeder in full cardiac arrest. On top of that you are the only doctor on an island that’s located 25 miles from the mainland. That’s exactly what happened to Dr. Christopher MccCoy, one of several capable (University of California, Irvine), doctors providing medical care in the Catalina Island Medical Center Emergency Department of on the rocky and remote island of Santa Catalina, off the coast of California.

“I think that the Catalina Island Medical Center (CIMC) emergency department is where I’ve had the most challenging cases, mostly because it is so remote,” said Dr. Dan Davis, another of UCI’s staff at Catalina.

SAEM PULSE | JANUARY-FEBRUARY 2019

In orientation you hear the quintessential stories, such as the one Dr. Wirachin Hoon tells of the time she was 22 weeks pregnant with twins and had to resort to performing a cricothyroidotomy for a severe case of anaphylaxis. Hers is one of many anecdotes that demonstrates what it is like to perform in these unique situations.

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I have also had substantial firsthand experience practicing at CIMC. The last time I was on shift, I opened a textbook to review the "fern test." Then, I personally verified the patient's fluid under the microscope for "ferning."

Knowing whether or not my patient had broken her water was going to make a difference in my management of the situation. I wouldn’t want be caught alone with a difficult birth late at night; at the same time I wouldn't want to transport a pregnant patient via helicopter, on such a short notice, for a false alarm.”

Most emergency medicine doctors train in quaternary referral centers where there is always direct support and usually level one trauma, stroke, and cardiac centers. In the majority of mainland

emergency departments (ED), pregnant patients above 20 weeks go directly to an obstetrician; but not on Catalina Island. The island has one medical center with a free-standing emergency department covered by one doctor who is on call for sometimes days at a time.

When weather permits, evacuation from the island is by helicopter. Dr. J. Christian Fox recounts: “I once had a two-year-old patient who swallowed 100 mg of grandma's Atenolol. I called poison control and a toxicologist who both said to get the patient into a pediatric ICU as soon as possible. Both helicopter companies agreed that cloud ceiling was too low to fly, and they refused transport, so I sat bedside for the next 12 hours awaiting a sudden decompensation with all medications drawn with proper dosages for stabilization.”

At Catalina, you do things you wouldn’t ordinarily find yourself doing in a big medical center. Dr. Davis narrates one true-life example: “A couple was hiking and came too close to a notoriously disagreeable buffalo who decided to charge. The chivalrous husband picked up his wife and tossed her off a small cliff into a cactus patch, 10 feet below. He followed that up by jumping feet-first into the same patch. Each of

these individuals had literally hundreds of small cactus needles to deal with –– his involved only the lower legs but hers were distributed throughout her body, including her perineum. After substantial intravenous analgesia and a tortuous sequence of plucking the cactus spines out individually, the charge nurse suggested that we try a wax-removal kit that she had purchased from the grocery store. The trick worked brilliantly, saving the patients hours of torture.”

Catalina’s emergency department has basic, but adequate, resources, including a temporary CT scanner and a limited laboratory — and most of the ancillary staff are on call. There are success stories that detail how the

Catalina doctors, using ultrasound, were able to diagnose ectopic pregnancies, cholelithiasis, abdominal aortic aneurysm, and pulmonary embolism.

Doctors receive significant exposure to divers and sea related pathologies due to Catalina’s famous water activities.

Even with Wilderness Medicine training, there are challenging cases where you need to differentiate drowning and decompression syndrome. Diving injuries, which need to be stabilized, arrive to our center and we transfer the patients to hyperbaric treatment if needed. The island’s hyperbaric chamber is operated by another institution.

“Being in a small town, you really get to know people and their stories” said Dr. Megan Boysen Osborn, another UCI staff serving in the Catalina Island ED. In addition to its current population of about 4,300 people, Catalina brings an excess of one million visitors annually.

Tourists bring joy and life to the island…

Sometimes a little too much joy!

Summers are characterized by a surge of intoxications and traumas. Doctors are challenged with complex sutures, reductions and splinting.

Dr. Fox recalls one such incident: “A non-English speaking patient from Korea hit the guardrail on a high velocity electric rental bike and flipped over the rail, falling

down the hill, bouncing through cacti along the way. His helmet was cracked in half. Other than a bunch of cactus spears and some road rash, the patient recovered quite well. In fact, his family returned him back to his cruise ship that very evening!”

“Another time, we heard on the emergency department radio that a plane had disappeared off the end of the notorious Catalina runway, which drops 10-15 feet to the ground below. By local protocol, we all gathered outside to look for black smoke. Fortunately, we saw no smoke and received four patients about 10 minutes later. It turned out that a teenage boy was desperately trying to impress his girlfriend's mother with a quick trip to Catalina for lunch. Unfortunately, the mother did not receive lunch but instead suffered a pelvic fracture that bought her a return flight (via medical helicopter) to the mainland.”

Many of us staffing Catalina Island find working here to be refreshing.

Sure, working in a remote island has its challenges, but at the end of the day you get to practice patient-centered medicine.

There are no patients-per-hour productivity measures, and there is no overcrowding, boarding or dealing with common ED deficiencies. You can really hone in your skills, be hands on and actually talk to your patients. Isn’t that what Emergency Medicine is all about?

ABOUT THE AUTHOR Isabel M. Algaze Gonzalez, MD, is an attending physician at University of California, Irvine and Catalina Island Medical Center and assistant professor of emergency medicine and Wilderness Medicine Fellowship co-director at UCI. Dr. Algaze is trained in primary hyperbaric, avalanche and mountain medicine, and serves as an emergency medical teams coordinator for the Pan-American Health Organization. Dr. Algaze also has traveled with field experts and explorers to 11 countries and15 locations as the expedition doctor for TCS World Travel, and National Geographic's expeditions. She spent three months in a remote aid post at 14,500 feet in Nepal, serving as site physician for locals, trekkers and climbers while she researched cognition in altitude and its relationship to altitude sickness. Dr. Algaze also cared for one of the two patients first diagnosed Irukandji-like syndrome in Puerto Rico, and was awarded NIH funding with Drs. Yanagihara and Seto from the University of Hawaii, to conduct a clinical trial comparing box jellyfish sting first aid approaches. She is excited to launch and serve as co-director of the University of California, Irvine, Department of Emergency Medicine's new Wilderness Medicine Fellowship.

About the SAEM Wilderness Medicine Interest Group The SAEM Wilderness Medicine Interest Group (WMIG) was established to focus on the practice of resource-limited medicine in austere environments. Joining the SAEM WMIG is now free! Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

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What is Due Process and What Does it Have to do With Academic Emergency Medicine?

SAEM PULSE | JANUARY-FEBRUARY 2019

By Lisa Moreno-Walton, MD, MSCR, FAAEM

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I stood in front of an audience of about 25 residents, six faculty members, and a handful of medical students; something I often do while giving grand rounds and the American Academy of Emergency Medicine (AAEM) presentation covering topics related to physician and patient advocacy and the business of emergency medicine. This was a typical emergency medicine residency weekly conference audience. The attending docs all had contracts, the residents were looking forward to signing on for their first jobs, and the medical students were just focused on getting a residency. They were a group of highly educated, highly intelligent people.

“Does anyone know what due process is?” I asked. No one raised their hand.

Again, typical. Sometimes I get one hand

raised, rarely two. Knowledge about due process is rare, and yet it impacts the emergency physician profoundly.

Due process is defined by dictionary. com as “fair treatment through the normal judicial system, especially a citizen's entitlement to notice of a charge and a hearing before an impartial judge.”

This right is guaranteed by the Fifth and the Fourteen Amendments of the US Constitution. In his decision in Goldberg v Kelly 397 US 254 (1970), Supreme Court Justice William J. Brennan held that the Constitutional right of due process “includes an individual's right to be adequately notified of charges or proceedings, the opportunity to be heard at these proceedings, and that the person or panel making the final decision over the proceedings be impartial in regards to the matter before them.” According to the Centers for

Medicare & Medicaid Services (CMS), a condition of participation for hospitals is that the medical staff governing body uphold “peer review policies and due process rights guarantees.” The American Medical Association Code of Ethics Opinion 9.4.1 includes the statement that “Fairness is essential in all disciplinary or other hearings where the reputation, professional status, or livelihood of the physician or medical student may be adversely affected”, and they go on to describe the fair conduct of due process. The AAEM Mission Statement clearly iterates that “The Academy supports fair and equitable practice environments necessary to allow the specialist in emergency medicine to deliver the highest quality of patient care. Such an environment includes provisions for due process and the absence of restrictive covenants.”

Yet, despite the fact that the right to due process is guaranteed by our Constitution, required for hospital participation in CMS, and endorsed by the AMA and the AAEM, emergency physicians are often waiving this right as a requirement to employment.

The contracts of many of the national and regional contract management groups and the contracts of many small, nondemocratic groups include a clause stating that the physician can be terminated without statement of cause or notice and waives the right to a hearing by his peers or the right to appeal the decision of management. Management is inherently not impartial; another violation of due process.

Physicians must be not only healers but educators and advocates for their patients.

As emergency physicians, we treat the most vulnerable: the medically unstable, the mentally ill, the intoxicated, the prisoner, the poorest, the undocumented.

We have a duty to advocate for them “even when such advocacy requires opposition to hospital interests…(therefore) as a matter of public policy and medical ethics, all physicians require due process rights in hospitals” (Weiss 2007).

Many of us are also in the position of being educators and advocates for our residents and medical students.

As contract management groups are increasingly approved to run residency programs, the line between the academic and the community physician becomes increasingly blurred and the issue of where the physician’s loyalty lies will increasingly become a challenging question. While AAEM and SAEM stand solidly in the position that the best interest of resident and medical student education supersedes the best interest of a corporation staffing an emergency department and running a residency program, the individual physician who has to choose between losing her job for prolonged throughput times and higher

"It is essential that every emergency physician have the right to due process in order to protect our ability to do the right thing for our patients and our learners." than average number of tests ordered on the uninsured versus providing high quality, high contact bedside teaching will find it a difficult choice indeed. It is for this reason that we must stand together to insure due process rights for every physician, starting with the house of emergency medicine.

AAEM has taken the initiative of working with Congress on bipartisan legislation introduced earlier this year, which, if passed into law, would mandate that emergency physicians be given due process at their place of employment and that they cannot be required to waive this right as a condition of employment.

The bill, H.R. 6372, has been formally proposed and referred to the House Energy and Commerce Committee for consideration. We ask that every member of SAEM join us in supporting this bill. It is essential that every emergency physician have the right to due process in order to protect our ability to do the right thing for our patients and our learners. It is only in this way that we can insure the future of our specialty with integrity and the only way that we can protect the public against the competing interests of for-profit medical corporations. Educate your peers about what due process is, what it means to

our daily practice as physicians and educators, and why it matters to us, our families, our patients and the general public.

Contact your Congressperson and urge them to support this bill. While this may appear to be an impotent action, it is not.

When AAEM goes to the Hill, staffers tell us that when they are inundated with calls, emails and texts about a particular issue, they DO inform the Congressperson that their constituency is focused on the issue.

Thank you for making a difference every day in the lives of your patients and your trainees. Join us now in ensuring that we can continue to make this difference and that we will not be punished for doing so.

ABOUT THE AUTHOR

By Lisa Moreno-Walton, MD, MSCR, FAAEM is professor of emergency medicine at Louisiana State University Health Sciences Center and presidentelect, American Academy of Emergency Medicine.

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From Assistant to Assistant: 12 Tips to Share With Your Administrative Support Staff SAEM PULSE | JANUARY-FEBRUARY 2019

By Andrew Vincent and Celeste Bradley

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“The emergency department is a harried place. Although most emergency physicians thrive in this environment, as their assistants, we can support departmental leadership and add some structure to their lives when they are not working clinically. We learned these tips by trial and error and offer them in the hopes that they will make the transition easier for your administrative support staff and will open lines of communication so you can dialogue about how best to work together. We hope you’ll share these tips with your assistants.” —The Authors

1. Explain events on the calendar An assistant’s work life usually revolves around their boss’s calendar. Although an executive may request a meeting, they prefer to stay out of the actual scheduling process.

The scheduling requires that the assistant communicate with multiple parties, so if meeting details are not sent out or updated correctly, confusion may ensue. Equally important is

the communication that occurs between the assistant and the executive. When the assistant adds or removes events from the executive’s calendar, it is imperative that the executive be informed and told why, so that he or she will be in the right place at the right time, and prepared in the right way.

2. Discuss travel arrangements Imagine going on vacation and realizing upon arrival that you have no reservation and nowhere to stay. Could anything be more upsetting? Avoid this happening to your boss by discussing travel details well in advance of his or her travel date.

Creating a checklist is another easy solution to avoiding traveling chaos. Most people have their personal preferences for airlines, flight times, and hotels — know your boss’s preferences.

3. Prepare for meetings An assistant should always confirm the number of people who will be attending a meeting and secure a room that will best accommodate the size of the group. If it’s a lunchtime

meeting, clarify if food will be served.

Some meetings require audio and visual capabilities; others only need equipment for conference calls. Know what is required for your meeting and prior to the start, do a room check to ensure that everything you requested has been provided and that all technology is in working order. It makes leadership look bad when a meeting does not begin on time due to equipment malfunction or for any other reason.

4. C alendar invites should include detailed information Calendar invites should be clear, concise, and include all pertinent information.

Invites without the necessary information are open to interpretation and may result in a flood of questions to the organizer. The name of the meeting should specifically spell out the topic of discussion. When scheduling recurring meetings, be sure to update the agenda in the invite each month.

5. B lock out travel time and downtime Most executive calendars are packed with meetings and conference calls, barely allowing enough time for lunch.

In order to prevent burnout, an assistant should schedule downtime for the executive between his or her meetings and/or shifts. This period of rest can allow time for the busy executive to reply to emails, eat, or merely relax.

Additionally, when scheduling meetings for the executive off-site, consider travel time to and from the meeting location. An EM doc may be tired and a little grumpy after a clinical shift; give him or her some scheduled time to decompress.

6. K eep tabs on office supplies.

Nothing is more frustrating than searching the office for a particular supply, like

paper or ink, and coming up empty.

There’s really only one thing worse, and that’s running out of coffee! To ensure the office runs smoothly and is always fully stocked with the daily necessities (like coffee), assistants should plan to order supplies on a regular basis.

Nobody wants to work for someone who is under-caffeinated and cranky? (And nobody wants to BE under-caffeinated and cranky!)

9. Keep the office clean.

7. F ine tune your communication and networking skills

10. P rocess reimbursements in a timely manner.

Stay on top of the latest news, information, trends, and events that may be of interest to your boss.

Develop networking relationships with people from different disciplines (e.g., maintenance, office supply vendors, information systems and technology support, etc.) so you will know who to contact when you do not have an answer or you need help. Do these things and you will be an irreplaceable asset to your boss and praised for your ability to use your communication and networking skills to solve problems quickly and efficiently.

The only thing worse than a delayed or absent reimbursement is having to constantly inquire after it. Avoid this irritation by 1) processing reimbursements in a timely manner and 2) keeping a log of purchases to be reimbursed, including the date the reimbursement was submitted, for how much, and when the reimbursement was paid.

8. Know your boss’s style.

Try to complete tasks in the manner your boss prefers. For example, some bosses give their assistants hard deadlines to work with; other times it is up to the assistant to decide timeframes. In some instances, a boss might require that the assistant prioritize tasks; therefore, some requests will need more attention/ administrative oversight than others. This could be in terms of follow up on emails, meetings, calls, etc. Regardless of your boss’s preferences, when it comes to confidential information, every boss has the same expectation: You are being trusted to keep information under wraps, and should do so.

A clean office conveys discipline and good work habits to outside guests, so keep the office neat and tidy. Make sure the office is periodically vacuumed and once or twice a year, thoroughly cleaned. Don’t let clutter get ahead of you… Staying on top of cleaning makes cleaning generally easier to do. Less mess, less stress!

12. M istakes happen. Learn from them.

There is no such thing as a perfect world, and mistakes are bound to happen. But with time comes experience, and the ability to look back and define key areas for improvement. So don’t sweat the mistakes, learn from them — it’s the best way to ensure they will not happen again.

ABOUT THE AUTHORS: Andrew Vincent is an administrative assistant and Celeste Bradley, M.Ed., is assistant to the chair, in the Department of Emergency Medicine at Sidney Kimmel Medical College of Thomas Jefferson University. They submitted this article with the encouragement of Judd Hollander, MD, associate dean for strategic health initiatives at Sidney Kimmel Medical College at Thomas Jefferson University and professor and vice chair of finance and healthcare enterprises in the Department of Emergency Medicine.

Andrew Vincent

Celeste Bradley, M.Ed.

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RESEARCH HIGHLIGHTS FROM THE SAEM GREAT PLAINS REGIONAL MEETING

By Ryan D. Pappal, David Cisewski, SAEM RAMS Research Committee The 2018 SAEM Great Plains Regional Meeting was held September 21-22 at Washington University in St. Louis, Eric P. Newman Education Center. This article highlights some of the research presented at the meeting. Both interviews were conducted by Ryan Pappal, a second-year medical student at Washington University School of Medicine in St. Louis.

Effectiveness and Safety of Droperidol in the Emergency Department Charlene Gaw is a fourth-year medical student at the Mayo Clinic School of Medicine, currently pursuing a Master’s in Public Health with a concentration in Health Policy at the Harvard T.H. Chan School of Public Health. Charlene is interested in health policy formulation to support patient access to quality care in the emergency department.

Charlene Gaw She is the lead author on a study presented at the SAEM Great Plains annual meeting as well as ACEP Annual Meeting regarding the safety and effectiveness of droperidol use in the emergency room, using a large observational cohort study of administrations in the Mayo Clinic Rochester Emergency Department.

Please give us a little background on your particular interest in the field…

I am interested in the intersection of public health and the emergency department — the emergency room is a unique space where we meet the surrounding community in their personal moments of crisis. I enjoy the variety, teamwork, excitement, and opportunity to assist patients who may not be able to receive care elsewhere. Health care reform often targets the emergency department, and I hope to be a part of these conversations!”

Briefly summarize the highlights of your research…

Droperidol is a dopamine-2 (D2) receptor antagonist that was extensively used by emergency medicine physicians,

psychiatrists, and anesthesiologists worldwide since 1967 as an analgesic, sedative, and antiemetic. In 2001, based on a few case reports, FDA released a black box warning of QT prolongation, greatly decreasing the accessibility of droperidol around the nation. The black box warning led to discontinued production of droperidol by pharmaceutical companies, therefore physicians in the United States have extremely limited, if any, access to droperidol. Extensive literature has found safety in droperidol use at low doses in the emergency department (ED), specifically for headaches and for behavioral sedation. There is no literature on its effectiveness as an analgesic for general pain. At Mayo Clinic, our pharmacy is fortunate enough to create our own droperidol, so we continue to use it, with caution, in patients from the ED to the OR. Thus, we plan to use our robust cohort of droperidol administrations to determine the effectiveness and safety of droperidol as an analgesic, antiemetic and sedative for patients in the ED. This is an observational cohort study of all droperidol administrations from 1/1/2012 to 4/19/2018 at an academic ED with 77,000 annual visits. The primary endpoint was mortality within 24 hours of droperidol administration. Secondary endpoints included use of additional analgesia after the use of droperidol, called ”rescue analgesia.”

A total of 6,881 patients received droperidol over the study time period. Zero deaths were recorded within 24 hours of droperidol administration from the entire sample of patients who received droperidol in the ED. Rescue analgesic medication was relatively rare – 4.5% (N=233) of patients with pain complaints received one or more analgesic 30 to 60 minutes after droperidol. Less than 2% (N=104) of pain patients received opioids after droperidol.

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

The development of novel pain management strategies is a national priority due to the opioid epidemic. Our findings suggest droperidol is a safe and effective opiate sparing analgesic in the emergency department.”

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

Absolutely. I am currently in the process of conducting a chart review on the incidence of akathisia, non-documented arrhythmias, symptoms resolution, and any other adverse effects of droperidol administration. Additionally, we plan to report on disposition of patients, demographic variables, QTc length, and dosage of droperidol. Furthermore, pending results of our findings supporting the safety of droperidol use, I plan to look into contacting the FDA to alter its black box warning on droperidol, to ultimately help increase the availability of this medication for patients and providers.

The major challenge of the project was in the study design — to select which variables to measure to obtain the outcomes of interest. After this, the analysis of the data is relatively straightforward, only dependent on researcher availability.

My advice for future researchers is to allocate a certain amount of time per week towards to project—it can be difficult to get research done expediently when one has multiple commitments.”

Did you have a mentor when you first started out your research career?

Yes. Dr. Fernanda Bellolio, who has been instrumental towards helping me articulate the research questions and inform best ways to answer it with her experience and greater access to resources.”

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

The opportunity to share my findings with others, present at conferences, and meet and learn from emergency medicine providers from across the nation. This experience is extremely rewarding, and I look forward to pursuing further research throughout my career!”

Practice Variation in the Management of Aneurysmal Subarachnoid Hemorrhage: A Survey of US and Canadian Emergency Medicine Physicians Aarti Kumar is currently a secondyear medical student at the University of Pittsburgh School of Medicine.

Aarti attended the University of Pittsburgh and graduated with a degree in Sociology and minors in Spanish and Chemistry. Aarti was first author on an abstract presented at the SAEM Great Plains Regional Conference and was selected to be Aarti Kumar featured in the Academic Emergency Medicine Journal. The study used a survey design to assess physician knowledge on diagnostic test performance for subarachnoid aneurysmal hemorrhage (SAH) and case-based scenarios to assess practice pattern, variation, and adherence to current ACEP clinical policy for the diagnosis of SAH. The results of this study demonstrated variation in the use of CTA by site and academic setting and divergence from ACEP Clinical Policy.

Please give us a little background on your particular interest in the field…

Clinical guidelines and implementation are two topics of huge interest to me. I have always been interested in research, and as a medical student I wanted to explore the field of Emergency Medicine based on my experiences with ultrasound and shadowing my first year. Emergency medicine is a very intriguing field in that you get to be a part of the initial diagnosis. Being able to work on a project that looks at practice variation allowed me to learn more about the field and the skillset it entails.”

Briefly summarize the highlights of your research…

Using a survey design, we assessed physician knowledge on imaging and LP tests performance. We also used case-based scenarios to assess their practice pattern, variation, and

continued on Page 36

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RESEARCH HIGHLIGHTS from Page 35 adherence to ACEP clinical policy. Our results indicate a strong agreement among physicians on non-contrast CT imaging performance. Nonetheless, we observed that physicians prefer to use newer imaging techniques like CTA. This finding varied by practice setting and indicates a divergence from current ACEP Clinical Policy.”

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

Yes, I hope to build on this research with Dr. Prasanthi Govindarajan. I would like to expand the survey to more sites nationally, and also produce a qualitative survey that explores the reasons for practice variation. Our next steps would be to compare the effectiveness of newer imaging techniques with traditional diagnostic approach and disseminate the results to inform guidelines.”

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

The major challenges of this research included ensuring generalizability of our results since the study only took place at three sites. Additionally, physician responses were to case scenarios only and may not be as accurate a representation

of their clinical practice. I want to thank my mentor Dr. Prasanthi Govindarajan for guiding me through the process of survey design and collection and Kian NIknam and Dr. Michael Kohn for working with me on the analysis of our survey results!”

Did you have a mentor when you first started out your research career?

I started research when I was a sophomore in high school working on breast cancer and learning basic science lab techniques. Quickly after, I got involved in working with drosophila flies at the University of Dayton, where my mentor challenged me to persevere when experiments were difficult and constantly question our hypothesis. I learned how to work through the scientific method and learned how powerful of an impact a mentor can make on your learning process.”

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

Research provides a reason to investigate the “why” to our practices. Working towards a medical career has helped me understand the significant impact I can have on a patient’s knowledge of their health issues. With this responsibility, comes the duty to understand how science and clinical procedures change over time. Additionally, learning how to understand results and apply them to clinical practice makes sure that we can provide evidence-based care.

FINANCIAL TIPS AND RESOURCES FOR RESIDENTS AND MEDICAL STUDENTS

By Ryan Latulipe, MD Finances are the last thing anyone wants to think about after a long week in the emergency department; in fact, most medical students and residents would like to avoid the topic altogether, and for good reason! According to the 2018 Education Debt Manager For Graduating Medical School Students, published by the Association of American Medical Colleges, the median level of debt for a 2017 medical school graduate was $192,000. But periodically reviewing your finances — and talking about them— can ultimately help ease the anxiety most people have about their budgets, which will contribute to your overall well-being. With that in mind, the RAMS Wellness and Resilience Committee shares the following financial tips and resources: 1. Set aside a short amount of time each month to go over your finances. This does not need to be a five-hour, in-depth examination of all of your finances, nor a meeting with a financial planner. Simply review what you’re spending, and compare it to what you have budgeted for each month.

2. T he White Coat Investor is an excellent resource for anyone in the medical field. The book is an easy read, and Dr. James Dahle gives a framework to help physicians start to save. The book is a worthwhile investment as you transition from medical school to residency to the rest of your career, plus you’ll be supporting a fellow EM doc!

3. There are plenty of apps and websites available to help you track your finances, and everyone has a personal favorite. I use Personal Capital, which allows you to link all of your accounts in one place. The scary part is that it also calculates your net worth — which for most students and residents is a very large, negative number. But after the shell-shock, you’ll find that the app allows you to easily track and stay up-to-date on your finances.

4. Start saving! This is a hard tip for medical students to apply, as most are living off of loans. But for residents, start taking advantage of Roth IRAs and your program’s 401k/403b programs. Putting away a little amount of money now will turn into big savings for retirement later.

5. D octoredmoney.org is a great resource for learning saving strategies. It has some great resources for calculating payments under different loan plans as well as tips for putting away extra savings. This is especially important for students and residents who are about to transition to the next steps in their careers and, along with that, into a larger salary bracket.

ABOUT THE AUTHOR: Ryan Latulipe, MD, is a first-year emergency medicine resident at New York Presbyterian–Columbia & Cornell and a member of the SAEM RAMS Wellness & Resilience Committee.

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TIPS, TRICKS, MYTHS, AND LEGENDS: A COUNTDOWN TO SAEM MEDWAR 2019

By Jeffrey Wayland, MS-4 This column will be a regular series of wilderness medicine-themed articles tailored to the students, residents, and physicians who work in austere environments, enjoy the outdoors, or just want to hear about why you probably shouldn’t suck the venom out of a snake bite (more on that later). Each article will address some element of wilderness myth, some advice on how to optimally handle a situation in the field, and, as is the tradition around the wilderness med campfire, some tips on how to MacGyver a solution when you’re S.O.L and need to act fast. Keep in mind that you should always use your clinical judgement when making medical decisions, so please don’t hold us accountable for any Bear Grylls-style medicine you may feel the need to perform after reading.

Ssssssssetting the Sssssssscene

We’re starting off with a classic wilderness scenario: you’re hiking with your friends in Moab, Utah. You’re about five miles from the trailhead when you hear your buddy Jeff let out a yell. You turn around and see him clutching his left ankle. Clearly visible about 15 centimeters above his medial malleolus are two puncture marks. Looks like poor Jeff has been bitten by a snake!

not need to bring your doctor the snake that bit you. Please do not try to catch the snake! Remember what I said earlier about not becoming a patient? Instead, if you or anyone in your group can still see the snake, now might be a good time to snap a quick photo with a cell phone camera — but only if you can do so safely. This will help once you reach definitive care. (It will also give you something to Instagram during the ambulance ride without violating HIPAA).

No Step on Snek

Back to Our Scenario…

Your first instinct might be to run over to Jeff to try to help him, but something we often forget when we’re in the (relatively) controlled environment of the emergency department is that the most important part of caring for your patient is to make sure you don’t become a patient yourself.

Although most snakes will “bite and bail,” you want to make sure you aren’t accidentally running directly into the path of a petrified python. This brings us to our first myth: you do

You’ve safely reached Jeff. He’s sitting on the ground and looks up at you and says, “You’re the medical person…what do I do?”

What You Do

Most of the homebrew remedies for snake bites tend to revolve around trying to stop venom from leaving the bite site. While this sounds good in theory, research really doesn’t support it. As is the case in much of wilderness medicine,

the goal of treating a snake bite in the field is to stabilize the patient, prevent further harm, transport if able, and seek definitive care.

(WMS) guidelines recommend that all restrictive clothing and jewelry is removed from the area, the bite is irrigated with water or saline, and a sterile dressing is (lightly) applied.

Our first step is to calm Jeff down. Have him sit or lie down with the affected extremity below the heart, if possible.

Remove any constrictive jewelry or clothing (more on this later) and irrigate the wound, if possible. Mark the leading edge of erythema and note the time of bite. If resources allow, it might be prudent to send a pair of friends back down the trail to get help or get to a place where cell phone reception is available.

Don’t Run. This one speaks for itself. Remember, in an emergency, the first pulse you should take is your own (Kanaan, et al., 2015). Keep the scene calm, keep your patient comfortable, and focus on accessing definitive care. If your patient is feeling pessimistic, reassure them that at least we no longer recommend electro- or cryotherapy (Dart 1988) (Shem, 1978)

“Many smaller treatment centers might not have antivenom on the shelf,” says Dr. Nicholas Kanaan, co-author of “The Wilderness Medical Society (WMS) Guidelines for the Treatment of Pitviper Envenomations in the United States and Canada,” and an emergency department physician, “but if you call ahead, they can probably have some ready by the time you arrive...As in most wilderness medical scenarios, the best treatment is really extrication. Do what you can to get to definitive treatment.”

Luckily, you’ve been keeping up with reading your “best practices,” and you confidently handle the situation. Now let’s talk about the things you were smart enough to omit in your management and treatment plans.

What you Don’t Do

To help you remember the things NOT to do, we’ve devised the handy phrase: “Don’t cut, don’t suck, don’t squeeze, don’t run.” The “squeeze” part being a stand-in for using a tourniquet or compression device, since “tourniquet” is a difficult word and we’re really not that good at making mnemonics.

Don’t Cut. My favorite mythical treatment for a snake bite appears to originate from many different sources, but always seems to pop up in cowboy movies. Cowboy Jeff gets bitten and his partner immediately takes out a dull bowie knife and slashes an “X” over the wound. I really can’t imagine anything more appealing than bloodletting after being bit.

Remember, the goals are to calm and to transport. Slicing and dicing pretty much does the opposite, while conveniently introducing some great potential infections.

Don’t Suck. This one sometimes goes along with the previous one: PLEASE never put your mouth on an open wound.

Besides once again introducing a ton of bacteria to your patient, you are putting yourself at risk for bloodborne infection, while not reducing venom risk in any way, shape, or form. Although some commercial suction devices have been marketed as a way to still suck without having to be a vampire, these have failed to show any clinical benefit (Bush, et al., 2000). Save your first aid kit budget for more ducttape.

Don’t Squeeze. Another common myth is that the application of a commercial tourniquet, belt, or compression bandage will stop the flow of blood from the wound, and thus the flow of venom. Unfortunately, clinical trials have shown that this is ineffective at best, and at worst can cause greater local damage to the limb. Current Wilderness Medical Society

Epilogue

You manage to walk Jeff out to the trailhead, where you are met by the local ranger who drives you to the nearest clinic.

It is determined that no venom was injected in the bite, and Jeff is successfully managed with supportive care.

If you’re looking for more info on the treatment of snake bites, we recommend the Field Guide to Wilderness Medicine

by Paul S Auerbach, et al (chapter 37). (Note: we’re not being paid by Dr. Auerbach, but if he’s reading this and is interested in a sponsorship deal, I have a LOT of loans to pay.)

ABOUT THE AUTHOR: Jeff is a medical student at Ochsner Health System and president of the Ochsner Medical Student Association Emergency Medicine Interest Group (EMIG).

If you have a request for a wilderness medicine topic to be covered, please send an email to jeffreywayland@gmail.com.

Happy trails!

Save the Date for SAEM's First Ever MedWAR! Registration for teams of three is now open for the first ever SAEM MedWAR, May 17 at Red Rock Canyon during SAEM19 in Las Vegas. MedWAR, short for Medical Wilderness Adventure Race, is a unique event that combines wilderness medical challenges with adventure racing. The race was developed as a tool for teaching and testing the knowledge, skills, and techniques of wilderness medicine, and for promoting teamwork and collegiality among competitors. If your institution is interested in sponsoring your team for this inaugural event, please complete the sponsorship form.

MedWAR is sponsored by SAEM RAMS, along with the SAEM Wilderness Medicine Interest Group, the SAEM19 Program Committee, and the MedWAR organization.

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BRIEFS AND BULLET POINTS SAEM NEWS

RAMS Announces Video Award Contest Announcing the SAEM RAMS 2019 Video Award Contest!

This year’s video topic is, “What makes academic emergency medicine the best field of medicine to practice in?” Grab your fellow residents and record your response for a chance to win a cash prize of $1,000! Extra points for originality, inspirational power, and wow-factor! The winning participant(s) and institution will be featured on the SAEM and RAMS web pages, social media accounts, and at SAEM19. Deadline is March 31, 2019.

Register for AACEM/AAAEM Annual Retreat Register for the 11th Annual AACEM/AAAEM Annual Retreat, to be held March 10-13, 2019 at the Condado Vanderbilt Hotel in beautiful San Juan, Puerto Rico. Please visit the retreat webpage to view the schedule or for more information.

2019–2020 CAEMA Program Registration is Open Registration is open through Feb. 2019 for the 2019-2020 Certificate in Academic Emergency Medicine Administration (CAEMA) Program. The purpose of the CAEMA is to acknowledge professionals who have attended the program and demonstrated proficiency in the body of knowledge required of administrators

Apply for SAEM Approval of Your Fellowship In an effort to promote standardization of training for fellows, the SAEM Fellowship Approval Program has been developed for eligible programs to earn SAEM endorsement as an approved fellowship in Administration, Disaster, Education Scholarship, Geriatrics, Global EM, Research and Wilderness. Programs may apply at any time. To view a list of approved fellowships, visit the SAEM Fellowship Directory.

SAEM ACADEMIES

Clerkship Directors in Emergency Medicine Nominations for CDEM Awards Ends January 30 Clerkship Directors in Emergency Medicine (CDEM) is accepting nominations through January 30 for four awards to be given at the annual CDEM meeting, May 2019, in Las Vegas. CDEM awards recognize medical student faculty educators from across the country for their national dedication, innovation, and achievements to undergraduate medical education. The four CDEM awards are the CDEM Award for Innovation in Medical Education, CDEM Distinguished Educator Award, CDEM Young Educator of the Year Award, and the CDEM Clerkship Director of the Year Award.

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CDEM, EMRA, and CORD Release New Educational Video Clerkship Directors in Emergency Medicine (CDEM), along with the Emergency Medicine Residents Association (EMRA), and the Council of Emergency Medicine Residency Directors (CORD), have released a new educational video entitled “Effective Consultation in Emergency Medicine.”

This video joins earlier productions on patient presentations and transitions of care to provide learners in emergency medicine with instruction on optimizing different forms of communication that take place in the emergency department.

Effective consultation reinforces the importance of structured communication and shares the 5Cs of Consultation as a validated model. Illustrative examples are provided for both medical students and residents.

SAEM FOUNDATION January 30 is EMIG Grant Deadline

The SAEM Foundation is accepting applications through Jan. 30 for medical student Emergency Medicine Interest Group (EMIG) grants. EMIG grants are intended to promote growth of emergency medicine education at the medical student level and to support the educational activities of these groups. For details and complete instructions on applying, please visit the EMIG Grants webpage.

Apply for Medical Student Research Grant SAEM Foundation partners with the Emergency Medicine Foundation (EMF) to provide the EMF-SAEMF Medical Student Research Grant. You can apply for this grant along with other opportunities ranging from medical student and resident research to mid-career investigator “bridge funding.” Deadline for applications is February 28, 2019

SAEM19 UPDATES

Closing Soon: Clinical Images, IGNITE!, Innovations Submissions for IGNITE! and Innovations will be accepted through January 14. The deadline for the SAEM Clinical Images Exhibit is also January 14. Submit your original, high-quality clinical images relevant to the practice of emergency medicine.

Accepted images will be featured on Academic Life in Emergency Medicine’s (ALiEM) wide-reaching blog. Medical students and residents are invited to participate in the 2019 Visual Diagnosis Contest for a chance to receive a free registration to attend SAEM20 in Denver, CO, among other awards.

Early Bird Registration for SAEM19 is Open!

Early bird registration is open through March 18 for SAEM19 — the Society’s 30th Anniversary, to be held May 14–17 at the extraordinary Mirage Las Vegas! Be sure to bookmark the SAEM19 website for all the latest annual meeting news and information.

Advanced EM Workshop Day Schedule Set

The slate of full- and half-day workshops is set for SAEM19, May 14–17, in Las Vegas. For a complete list and descriptions of workshops, please visit the SAEM19 Program Planner.

You may add a workshop to your SAEM19 registration for an additional fee.

Event Registration

Registration is now open for the following SAEM19 events: • AWAEM/ADIEM Luncheon • Blackout Dinner • Dodgeball • Residency & Fellowship Fair • SAEM19 MedWAR

• SAEM19 Red Rock Hike • SimWars • SonoGames® • Speed Mentoring

Western Regional

22nd Annual Western Regional Meeting is This March Registration is now open for the Western Regional Meeting, to be hosted by the UC Davis School of Medicine, March 21–22, 2019 in beautiful Napa Valley, CA. Additional information is available via the Save the Date flyer.

SAEM COMMITTEES

Graduate Medical Education Committee SAEM Regional Meetings: A Survey of Current Practices

Save the Date

Mark your calendars for the following SAEM19 events: • SAEM’s 30th Anniversary Party, hosted by RAMS

SAEM REGIONAL MEETINGS

• Exhibitor Kickoff Party • Opening Reception

SAEM JOURNALS

Call for Applications: Resident Member of the AEM Editorial Board

Applications are now being accepted for the resident-in-training appointment to the Editorial Board of Academic Emergency Medicine (AEM). The 12-month resident appointment is intended to introduce the resident to the process of peer review, editing, and publishing of medical research manuscripts and will provide the resident with an experience that will enhance his/her career in emergency medicine and in scientific publication. All residents in an accredited Emergency Medicine program who anticipate completing their residency training in June 2020 are eligible for the 2019-2020 position (current PGY2 residents in a 1-3 program and current PGY3 residents in a 1-4 program are eligible or PGY3 or PGY4 in a combined 5-year program). For information about the selection process, required application materials, and a rundown of duties and responsibilities, visit the website. Application deadline is February 8, 2019.

Submit questions to Associate Editor Mark B. Mycyk, MD at mycyk.md@gmail.com or mmycyk@cookcountyhhs.org.

The SAEM Graduate Medical Education (GME) Committee surveyed prior SAEM regional meeting chairs to better understand their perspectives regarding current processes and recommended strategies for success. A synopsis of the survey findings may be viewed online.

IN OTHER NEWS

NSTC Seeks Comment on Draft Report of the FTAC on Health Science and Technology Response to the Opioid Crisis The White House National Science and Technology Council (NSTC) is seeking public comment on the Draft Report of the Fast Track Action Committee (FTAC) on Health Science and Technology Response to the Opioid Crisis. Comments regarding the FTAC report, “Health Research and Development to Stem the Opioid Crisis: A National Roadmap,” are requested by December 5, 2018 and may be submitted to OpioidsRoadmap@OSTP.eop.gov. The NSTC chartered the Opioid FTAC to support the President’s response to the opioid crisis by identifying (1) research and development (R&D) critical to addressing key gaps in knowledge and tools, and (2) opportunities to improve coordination of Federal R&D essential to combating the opioid crisis.

ACADEMIC ANNOUNCEMENTS Hackensack University Dr. Joseph Underwood, MD, was recently appointed Chair of Emergency Medicine at Hackensack University Medical Center, Bergen County, NJ. Dr. Underwood previously served as Chief of the Division of Emergency Medicine at New York-Presbyterian Hospital/Columbia University College of Physicians and Surgeons, where he was honored with a Physician of the Year Award and a Faculty Teaching Award. He led a team recognized by the Intelligent Healthcare Association with a 2018 Improving Patient Safety and Healthcare Delivery Award for creating a novel and innovative telehealth care delivery model. Dr. Underwood holds a medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical Dr. Joseph Underwood, MD School, and completed his residency at New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell. He is a Diplomate of the American Board of Emergency Medicine. Dr. Underwood's professional affiliations include the American College of Emergency Physicians; Ridgewood Medical Society; Society of Academic Emergency Medicine; and Association of Academic Chairs in Emergency Medicine. He has conducted research and published in his field.

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

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

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

Congratulations & Happy Anniversary CELEBRATING

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10 YEARS OF PROGRESS

{ Job Opportunities } Division Chief, Pediatric Emergency Medicine EMS Fellowship Director/EMS Medical Director Assistant Medical Director PEM/EM Core Faculty Vice Chair Research Emergency Medicine

What We’re Offering: • We’ll foster your passion for patient care and cultivate a collaborative environment rich with diversity • Salaries commensurate with qualifications • Sign-on bonus • Relocation assistance • Retirement options • Penn State University Tuition Discount • On-campus fitness center, daycare, credit union, and so much more!

What We’re Seeking: • Experienced leaders with a passion to inspire a team • Ability to work collaboratively within diverse academic and clinical environments • Demonstrate a spark for innovation and research opportunities for Department • Completion of an accredited Emergency Medicine Residency Program • BE/BC by ABEM or ABOEM • Observation experience is a plus

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

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

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

FOR ADDITIONAL INFORMATION PLEASE CONTACT: Susan B. Promes, Professor and Chair, Department of Emergency Medicine c/o Heather Peffley, Physician Recruiter, Penn State Health Milton S. Hershey Medical Center 500 University Drive, MC A595, P O Box 855, Hershey PA 17033 Email: hpeffley@pennstatehealth.psu.edu or apply online at: hmc.pennstatehealth.org/careers/physicians Penn State Health is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

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Featured Leadership and Staff Positions EM Residency Program Director and Ultrasound Fellowship Director Osceola Regional Medical Center. Kissimmee, FL EM Residency Program affiliated with the university of Central Florida College of Medicine.

Contact Shawn Stampfli at 404.663.4770

Toxicology Fellowship Trained EM Physician for Core Faculty Aventura Hospital and Medical Center. Miami, FL EM Residency Program af liated with the Herbert Wertheim College of Medicine at Florida International University and Nova Southeastern University.

Contact Ody Pierre-Louis at 727.507.3621

Director of Ultrasound and Simulation Director to serve as Core Faculty Oak Hill Hospital. Tampa Bay, FL New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Contact Ody Pierre-Louis at 727.507.3621

Clinical Faculty St. Lucie Medical Center. Port St. Lucie, FL PBCGME affliated Osteopathic EM Residency Program. Contact Amy Anstett at 954.295.1524

For more information contact: E: MakeAChange@evhc.net O: 877.226.6059

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BrodyBrody School of Medicine School of Medicine

EMERGENCY MEDICINE FACULTY EMERGENCY MEDICINE FACULTY ◊ Clinician-Educator ◊ Clinical-Researcher ◊ Critical Care Medicine ◊ ◊ Clinician-Educator ◊ Clinical-Researcher ◊ Critical Care Medicine ◊ ◊ Pediatric Emergency Medicine ◊ Ultrasound ◊

◊ Pediatric Emergency Medicine ◊ Ultrasound ◊

The Department of Emergency Medicine at East Carolina University Brody School of Medicine seeks BC/BP emergency physicians and pediatric emergency physicians for tenure or clinical

he Department of Emergency Medicine at East Carolina University Brody School of Medicine track positions at the rank of assistant professor or above, depending on qualifications. We eeks BC/BP emergency pediatric emergency physicians for tenure or clinical continue tophysicians expand our and faculty to meet the clinical needs of our patients and the educational ack positions atneeds the rank assistant professor or above, qualifications. of ourof learners.

We envision further program depending development on in clinical education, We emergency ultrasound, EM-critical care, pediatric and clinical research.

Our educational current faculty ontinue to expand our faculty to meet the clinical needsEM, of our patients and the possesses diverse interests and expertise leading to extensive state and national-level eeds of our learners.

We envision further program development in clinical education, involvement. The emergency medicine residency includes 12 EM and 2 EM/IM residents per mergency ultrasound, care, pediatric EM, research. Our faculty year. WeEM-critical treat more than 130,000 patients perand yearclinical in a state-of-the-art ED atcurrent Vidant Medical ossesses diverse interests expertise tocenter extensive statereferral and national-level Center.

VMC isand a 960+ bed levelleading 1 trauma and regional center for cardiac, and pediatric care. Our tertiary care catchment includes more than 1.5 million volvement. Thestroke, emergency medicine residency includes 12 area EM and 2 EM/IM residents per people in eastern Northpatients Carolina. per Additionally, provide clinical coverage two community ear. We treat more than 130,000 year in we a state-of-the-art ED atatVidant Medical hospitals within our health system. We are responsible for medical direction of East Care, our enter. VMC is aintegrated 960+ bed level 1 trauma center and regional referral center for cardiac, mobile critical care and air medical service, and multiple county EMS systems. Our roke, and pediatric care. children’s Our tertiary care in catchment area includes more than 1.5 million exceptional ED opened July 2012 and serves approximately 25,000 children per Greenville, NC isAdditionally, a university community offering a pleasant lifestyleatand excellent cultural eople in easternyear.

North Carolina. we provide clinical coverage two community and recreational opportunities.

North Carolina beaches are nearby. is ospitals within our health system.

We areBeautiful responsible for medical direction of Compensation East Care, our competitive and commensurate with qualifications; excellent fringe benefits are provided. tegrated mobile critical care and air medical service, and multiple county EMS systems. Our Successful applicants will be board certified or prepared in Emergency Medicine or Pediatric xceptional children’s ED opened July and serves approximately 25,000 Emergency Medicine.in They will2012 possess outstanding clinical and teaching skills children and qualifyper for privileges from ECU Physicians and VMC. ear. Greenville,appropriate NC is a university community offering a pleasant lifestyle and excellent cultural nd recreational opportunities. Beautiful North Carolina beaches are nearby. Compensation is Confidential inquiry may be made to: ompetitive and commensurate with qualifications; excellent fringe benefits are provided.

Theodore Delbridge, MD, MPH uccessful applicants will be board certified or prepared in Emergency Medicine or Pediatric Chair, Department of Emergency Medicine mergency Medicine. They will possess outstanding clinical and teaching skills and qualify for delbridget@ecu.edu ppropriate privileges from ECU Physicians and VMC. ECU is an EEO/AA employer and accommodates individuals with disabilities. Applicants must comply with the Immigration Reform and Control Act. Proper documentation of identity and employability required at the time of employment. Current references must be provided upon request.

Confidential inquiry may be made to: Theodore Delbridge, MD, MPH www.ecu.edu/ecuem/ ● 252-744-1418 Chair, Department of Emergency Medicine delbridget@ecu.edu

BRIGHAM HEALTH AND WOMEN ’S FAULKNER HOSPITAL DIRECTOR OF CLINICAL OPERATIONS, BRIGHAM BRIGHAM HEALTH

DIRECTOR CLINICAL OPERATIONS , BRIGHAM AND WOMEN Brigham HealthOF is seeking a Director of Clinical Operations in the Department of ’S FAULKNER HOSPITAL Emergency Medicine at Brigham and Women’s Faulkner Hospital (BWFH).

Brigham Health is seeking a Director of Clinical Operations in the Department of

The successful candidate will have completed a 4-year residency in emergency Emergency at The Brigham and Faulkner (BWFH). medicine and beMedicine board certified. candidate willWomen’s possess the ability to workHospital within an integrated health system as a member of a team of other Emergency Medicine operations directors at Brigham Health and easily transition between community and The successful candidate will have completed a 4-year residency in emergency academic practices. This position will require teaching of medical students and medicine and be board certified. The candidate will possess the ability to work within residents.

an integrated health system as a member of a team of other Emergency Medicine

The position is eligible for an academic appointment at Harvard Medical School at a operations directors at Brigham Health and easily transition between community and rank of Instructor or Assistant Professor or Associate Professor, commensurate with academicachievement, practices.recognition, This position will require teaching of medical students and experience, and teaching.

The position also offers a competitive residents.salary and an outstanding comprehensive benefit package. Brigham Health is committed to the personal and professional development of our providers.

Additional information may be found at The position is eligible for an academic appointment at Harvard Medical School at a https://fa.hms.harvard.edu/files/hmsofa/files/642jr_bwh_inst.asst_.assoc_.emergency medicine.dir_.clinicaloperations_11-30-18.pdf rank of Instructor or Assistant Professor or Associate Professor, commensurate with

experience, achievement, recognition, and teaching. The position also offers a

Interested candidates should send a letter and Curriculum Vitae to Michael competitive and anand outstanding comprehensive benefit package. Brigham VanRooyen, MD,salary MPH, Professor Chair, Department of Emergency Medicine, Brigham Women’s Hospital.

Please apply byand confidential email to development of our providers.

Healthand is committed to the personal professional mdeloge@bwh.harvard.edu.

Additional information may be found at

https://fa.hms.harvard.edu/files/hmsofa/files/642jr_bwh_inst.asst_.assoc_.emergency We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, medicine.dir_.clinicaloperations_11-30-18.pdf national origin, disability status, protected veteran status, gender identity, sexual orientation, pregnancy and pregnancy-related conditions or any other Interested candidates should send a letter and Curriculum Vitae to Michael characteristic protected by law.

VanRooyen, MD, MPH, Professor and Chair, Department of Emergency Medicine, Brigham and Women’s Hospital. Please apply by confidential email to mdeloge@bwh.harvard.edu.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, gender identity, sexual orientation, pregnancy and pregnancy-related conditions or any other characteristic protected by law.

CU is an EEO/AA employer and accommodates individuals with disabilities. Applicants must comply with the Immigration Reform nd Control Act. Proper documentation of identity and employability required at the time of employment. Current references must be provided upon request.

www.ecu.edu/ecuem/ ● (EM) 252-744-1418 The Department of Emergency Medicine at the University of California Davis, Health is conducting a faculty search for EM physicians in either a clinician/educator or clinician/researcher track. Candidates must be residency trained in EM (or Pediatric EM training) with board certification/eligibility and be qualified for licensure in California.

At least one year of post-residency clinical experience and/or fellowship training is preferred. Candidates are expected to enter at the Assistant/Associate level, commensurate with experience and credentials. EM faculty members at UC Davis who have preference for night shifts work fewer clinical shifts each month.

The University of California, Davis, Medical Center, one of the nation’s “Top 50 Hospitals,” is a 613 bed academic medical center with approximately 80,000 emergency department visits annually, including approximately 20,000 pediatric visits.

The emergency services pavilion opened in 2010 and is state-of-the-art. Our program provides comprehensive emergency services to a large local urban and referral population as a level 1 trauma and burn center, paramedic base station and training center. The department also serves as the primary teaching site for a fully accredited EM residency program and nine different EM fellowship programs. Our residency training program began more than twenty years ago and currently has 54 residents.

The Department has a separate area for the care of children and is one of the leading centers in the Pediatric Emergency Care Applied Research Network (PECARN).

Salary and benefits are competitive and commensurate with training and experience.

Sacramento is located near the northern end of California's Central Valley, close to Lake Tahoe, San Francisco, and the "wine country" of the Napa and Sonoma Valleys.

Sports enthusiasts will find Sacramento's climate and opportunities ideal.

Interested candidates should submit a letter outlining interests and experience, and curriculum vitae to: recruit.ucdavis.edu/apply/JPF02202 Erik Laurin MD, Professor and Search Committee Chair (eglaurin@ucdavis.edu) UC Davis Department of Emergency Medicine 2315 Stockton Blvd., PSSB 2100 Sacramento, CA 95817 The University of California is an affirmative action/equal opportunity employer.

WASHINGTON DC – The Department of Emergency Medicine at the George WASHINGTON DC – The Department of Emergency MedicineJuly at the George Fellowship Washington University is offering positions beginning 2019: Washington University is offering Fellowship positions beginning July 2019: Disaster & Operational Medicine

International Emergency Medicine

Medical Leadership & Operations

Medical Toxicology

Emergency Ultrasound

Operations Research

Disaster & Operational Medicine Medical Leadership & Operations Emergency Ultrasound

Telemedicine/Digital Health

Telemedicine/Digital Health

Extreme Environmental Medicine

Extreme Environmental Medicine

Simulation in Medical Education

International Emergency Medicine Medical Toxicology Operations Research

Health Policy

Health Policy

Clinical Research

Clinical Research

Simulation in Medical Education Fellows receive an academic appointment at The George Washington University School of Medicine & Health Sciences and work clinically at a site Fellows an academic at The George staffed byreceive the Department.

The appointment Department offers Fellows an Washington integrated, University School of Medicine & Health Sciences and work clinically at a site interdisciplinary curriculum, focusing on research methodologies and grant staffedTuition by thesupport Department.

Fellows integrated, writing. for an The MPHDepartment or equivalentoffers degree may beanprovided, curriculum, focusing on research methodologies and grant asinterdisciplinary per the fellowship’s curriculum.

writing. Tuition support for an MPH or equivalent degree may be provided,

as per the fellowship’s curriculum.

Complete descriptions of all programs, application instructions, and Fellowship Director contacts can be found at: Complete descriptions of all programs, application instructions, and Fellowship

https://smhs.gwu.edu/emed/education-training/fellowships Director contacts can be found at:

https://smhs.gwu.edu/emed/education-training/fellowships

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19 Celebrating

of bringing EM ACADEMICIANS together!

Las Vegas, Nevada – May 14-17