SAEM PULSE July–August 2019

JULY-AUGUST 2019 | VOLUME XXXIV NUMBER 4

www.saem.org

SPOTLIGHT DEDICATED TO IMPROVING THE DELIVERY OF EMERGENCY CARE AROUND THE GLOBE An Interview with

Ian B.K. Martin, md, mba

PERSPECTIVES ON PARENTING DURING RESIDENCY page 30

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

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org Manager, IT Dan San Buenaventura Ext. 225, DSanBuenaventura@saem.org Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Marisol Navarro Ext. 205, mnavarro@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Digital Communications Snizhana Kurylyuk Ext. 201, skurylyuk@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Membership Manager George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@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 AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com Associate Editor, SAEM BOD D. Mark Courtney, MD Associate Editor, RAMS Shana Zucker, szucker@tulane.edu

2019-2020 BOARD OF DIRECTORS

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President’s Comments

SAEM19: A Meeting for the "Record Books!"

Spotlight

Dedicated to Improving the Delivery of Emergency Care Around the Globe

SAEM19 Annual Meeting Wrap-Up

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Diversity and Inclusion

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Ethics in Action

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What Does “Empowerment” Really Mean?

Planning for the End of Life

Research In Academic EM

Increasing Resident Engagement in Research: Part II — A Resident’s Perspective

Social Media In Academic EM Managing Group Messaging in Your Residency Program

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SGEM: Did You Know?

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Strategic National Stockpile

Sex-based Differences in Stress Fractures

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

Amy H. Kaji, MD, PhD Secretary-Treasurer Harbor-UCLA Medical Center

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Briefs and Bullet Points

James F. Holmes, Jr., MD, MPH President Elect University of California Davis Health System

Steven B. Bird, MD Immediate Past President University of Massachusetts Medical School

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Academic Announcements

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Now Hiring

Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center

Michelle D. Lall, MD Emory University Angela M. Mills, MD Columbia University

Stephen C. Dorner, MD, MPH, MSS Brigham and Women's Hospital and Massachusetts General Hospital

Megan L. Ranney, MD, MPH Brown University

Christopher R. Carpenter, MD, MSc Washington University in St. Louis School of Medicine

Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. © 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 Ian B.K. Martin, MD, MBA Medical College of Wisconsin 2019–2020 SAEM President

SAEM19: A Meeting for the "Record Books!"

".... SAEM has been a crucial catalyst in fulfilling this mentorship need for me — and that is why, I suppose, this Society means so much to all of us."

Over the next year, I hope to explore with you a number of important, contemporary topics related to medical education, research, and faculty. If there are particular topics on which you would like me to comment, I welcome suggestions by emailing me at imartin@mcw.edu.

For those of you who missed SAEM’s annual meeting in Las Vegas, you missed a meeting for the “record books.” SAEM19 was our best-attended annual meeting to date! But this meeting was also great beyond our record-setting numbers, so let me mention a few highlights: First, we continued to provide innovative programming like National Grand Rounds and the Master Secret Series—both of which were highly attended this year and last.

National Grand Rounds showcases some of the best science of senior researchers in emergency medicine. In the Master Secret Series, senior leaders in academic emergency medicine share lessons they have learned over the course of their successful careers. (I was humbled to have been invited to speak at this year’s event.)

Dr. Garen Wintemute, founding director of the Violence Prevention Research Program and director of the University of California Firearm Violence Research Center, and Dr. Rebecca Cunningham, director of the University of Michigan Injury Prevention Center, delivered a timely and moving keynote address entitled, “Firearm Injury: Facts, Myths, and a Public Health Path Forward.” Their presentation destigmatized and depoliticized the discussion around firearm injury, focusing our attention on the public health epidemic at hand, in need of quick, dramatic action.

For the first time ever, we hosted a second keynote address and plenary session spotlighting medical education. Dr. John Prescott, chief academic officer for the

Association of American Medical Colleges (AAMC), opened his talk, “The Future Landscape of Medical Education,” with a vivid story of the terrible car crash in the desert that led him to a career in emergency medicine. With that captivating start, the audience listened with rapt attention as Dr. Prescott shared his ideas for what is to come in American medical education.

The Resident and Medical Student (RAMS) Board hosted an epic party at The Mirage’s One Oak Night Club — marking SAEM’s 30th anniversary. This special gathering brought members together from across the Society to celebrate all that we have accomplished together over the past 30 years toward the advancement of the science and practice of emergency medicine.

Lastly, in case you missed it, I used my presidential address during the opening ceremony to mark important milestones in our Society’s 30-year history. I also used the occasion to outline the current state of SAEM and of academic emergency medicine and to explore some of the challenges we as a medical education and research community face (and have to navigate) both now and in the future. But the real point of my address was to drive home the importance of mentorship in the lives of each and every one of us. Like so many of you, SAEM has been a crucial catalyst in fulfilling this mentorship need for me — and that is why, I suppose, this Society means so much to all of us.

ABOUT DR. MARTIN: Ian B.K. Martin, MD, MBA, is professor and system chair of the Department of Emergency Medicine and professor of medicine at the Medical College of Wisconsin (MCW). He served SAEM previously as president-elect, secretary-treasurer, and an at-large member of the Society’s Board of Directors.

Dr. Martin is a founding member and past-president of SAEM’s Global Emergency Medicine Academy (GEMA).

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SPOTLIGHT DEDICATED TO IMPROVING THE DELIVERY OF EMERGENCY CARE AROUND THE GLOBE

SAEM Pulse talks with Ian B.K. Martin, MD, MBA Ian B.K. Martin, MD, MBA is professor and system chair of the Department of Emergency Medicine and professor of medicine at the Medical College of Wisconsin (MCW).

Previously he served as professor and chair of emergency medicine at the West Virginia University (WVU) School of Medicine. Dr. Martin earned his undergraduate degree from Duke University, MD from Medical College of Pennsylvania–Hahnemann School of Medicine in Philadelphia, and MBA from the University of North Carolina (UNC) Kenan–Flagler Business School. He trained in emergency medicine and internal medicine and eventually served as chief resident at the University of Maryland Medical Center/R. Adams Cowley Shock Trauma Center in Baltimore. Dr. Martin has devoted his academic career to improving

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the delivery of emergency care globally through program development, investigative research, and direct clinical care. His research interests include elucidation of optimal models for emergency department-based HIV and hepatitis C testing and acute care disease burden epidemiology in developing countries.

Dr. Martin was installed as the Society’s 2019–2020 president at SAEM19 in Las Vegas. He served previously as a presidentelect, secretary-treasurer, and an at-large member of the Society’s Board of Directors.

He is a founder and past-president of SAEM’s Global Emergency Medicine Academy. In 2018 Dr. Martin was awarded the Marcus L. Martin, MD Leadership Award — the highest honor given by SAEM’s Academy of Diversity and Inclusion in Emergency Medicine (ADIEM).

Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force, interviewed Dr. Martin for this issue.

Congratulations on your election as the new president of SAEM. What do you hope to accomplish during your tenure?

A one-year term goes by quickly, so I have to be modest in my aspirations, which are to execute faithfully on our 2019 strategic work plan, which I helped drive. As part of this, we plan to expand education research career development opportunities for our members; outline and set in motion a set of strategies aimed at assuring greater diversity and inclusion in our SAEM leadership at all levels—including of committees, academies, and the Board; and lastly, scan the association “horizon” identifying key partners with whom to collaborate to help advance our agenda.

You have served in many other leadership positions with SAEM. Which were your favorites, and why?

First, SAEM Board Secretary-Treasurer.

In this role, I really learned the “inner workings” of our Society, as well as how high-level decisions are largely made in SAEM. I believe serving in this role is critical to the sound preparation of our society presidents. Also, serving as the founding president of the SAEM Global Emergency Medicine Academy (GEMA). I love starting things and helping transition the SAEM International Emergency Medicine Interest Group to an academy played to my leadership interest and strength. I now love seeing all the amazing things GEMA is doing — how it’s grown in size, scope, reach, and impact.

I’m proud to have played a role in its amazing evolution.

How did you first get involved with SAEM? I have been a member since the early days of my first faculty position at Duke University. My then-division chief, Dr. Kathleen Clem, encouraged me to join SAEM.

I understand you’ve been to something like a dozen different countries in Africa. How did you become interested in global health, and specifically East Africa? What are some of the specific issues you’ve become involved with?

I had an inkling since my days in college at Duke University that I might have interest in global health. Back in those days, it was not common for college students, medical

"I am so grateful to be doing EXACTLY what I want to be doing, and few folks are able to say this." students, or even residents to participate in global health experiences, as few of these organized experiences existed then. In the time I took off between college and starting medical school at MCP (Medical College of Pennsylvania) – Hahnemann, I had the opportunity to live and work in Cameroon in West Africa. I chose Cameroon because it is a French-speaking country, and I speak French (much better at it in those days). I also chose it because I had never had a chance to see and experience any African country, and that was important to me, being of African descent. As I reflect on the things I have done in my life, the time I spent in Cameroon was pivotal, and that experience continues to this day to shape my personal and professional interests and values.

As I mentioned, my first faculty job was at Duke, where I completed my undergraduate studies. Knowing my interests, Dr. Kathleen Clem, who was then division chief of emergency medicine, got me involved in her global health work in Kenya and Tanzania. When Dr. Clem left for bigger and better things, I took over much of the work we were doing together at Duke. In my early years, I did a lot of direct patient care in Kenya and Tanzania — organizing troops of volunteer physician, nurses, and learners to help meet some of the care needs of some of the most in-need patients in the region. While I enjoyed this work immensely, I ultimately felt the impact of taking care of just one patient at a time

was limiting. I then turned my attention to education program development as a means of increasing the impact of my global health work. Essentially, I began to focus on “training the trainers.” My efforts to increase emergency care capacity in a region where EM was just starting were amplified by teaching on-the-ground leaders in Kenya and Tanzania who then would teach others. To aid in this, while I was still at Duke, I started the Duke International Emergency Medicine/Global Health Residency Program. When I was on faculty at the University of North Carolina (UNC) at Chapel Hill, I started the UNC EM Global Health and Leadership Program. Both programs live on and have graduated a number of really talented faculty members focusing on global health and emergency care.

Later, I got more involved in global health and emergency care-related research as a means for further increasing the impact of my efforts. By asking important questions, finding answers to them, and widely disseminating this data/ information, my work has the opportunity to inform care and/or teaching methods of an even wider swath of patients and learners in the region. Most of the work I have done with collaborators at UNC, Hennepin County Medical Center, and Kenyatta National Medical Center in Nairobi (among others) is around assessing the impact of care system changes on emergency care.

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"As I reflect on the things I have done in my life, the time I spent in Cameroon was pivotal, and that experience continues to this day to shape my personal and professional interests and values."

What do you think are the most urgent issues in emergency medicine in the United States?

SAEM PULSE | MAY-JUNE 2019

Managing overcrowding in emergency departments. Mitigating social determinants of health (e.g., poverty, homelessness, low health literacy, etc.) in patients presenting to emergency departments. Helping many emergency department patients access primary and specialty care upon discharge. And finally, providing quality care at a lower cost in the landscape of rapidly rising health care costs.

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What made you decide to pursue your MBA? As many, including myself, say, an MBA is essentially a degree in leadership. As part of a career development program in which I participated at UNC, the program director reviewed the organizational chart for UNC Health System and UNC School of Medicine. A couple of things were clear: Many of the senior leaders in the UNC Health System and UNC School of Medicine had some other advanced degree in addition to an MD, and many times. this additional degree was an MBA. With this I knew (at least at that institution) that in order to become a senior leader, I probably needed to pursue some other degree. At the time, the UNC Kenan-Flagler Business

School and the UNC School of Medicine cosponsored a scholarship for school of medicine faculty members to pursue an MBA. I availed myself of this opportunity and, as they say, the rest is history. Getting my MBA has also proven to be one of the pivotal experiences of my professional development. I certainly don’t think I would have been a chair — now twice — without the experience of getting my MBA and all the accompanying leadership lessons.

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

I was briefly a middle school science teacher before I went to medical school. Teaching is in my blood, as I come from a family of educators. From day one of medical school, I knew I wanted to teach in a medical school — not just see patients in a private practice.

What advice would you give to a resident who would like to go into academics? Into global health?

With reference to global health and emergency care-related work, I might suggest the following to students and residents: Take advantage of the global health experiences now readily available at most medical schools and as part of many emergency medicine residency programs. Perhaps factor that into your choice of schools and training programs. If you don’t get started until later, don’t fret: I didn’t get to do my first global health experience until I was a faculty member at Duke! Depending on your career aspirations (e.g. a career in academics versus at a governmental organizational versus at a nongovernmental organization, etc.) you might consider getting a master’s of public health or Master of Science in global health degree. Also, depending on your career aspirations, you might want to consider fellowship training in global health and emergency care. I would also advise anyone interested to strive for sustainability from the start so as to avoid medical tourism. How? Options include: 1.) live abroad,

"By asking important questions, finding answers to them, and widely disseminating this data/information, my work has the opportunity to inform care and/or teaching methods of an even wider swath of patients and learners in the region." providing care to individual patients; 2.) train local practitioners to provide the care you would provide if you were always there (i.e. the “train-the-trainers” model); or 3.) attempt to answer important research questions that will impact the care and health of similar patients under similar conditions around the world.

What do you think is the future of emergency medicine education?

In the not-too-distant future, I’d say possibilities might include coming to consensus whether EM training should take three years or four years; incorporating supervision of advanced practice providers to EM residency education; and incorporating alternate care models (e.g., telemedicine, community paramedicine, etc.) into EM residency education. In the distant future, I’d speculate about incorporating the use of drone and other remote technologies in the care of emergency patients into EM residency education.

What would you be doing if you weren’t an EM physician?

Hard question, because now I cannot imagine doing anything else. Outside of medicine, I would have probably been a university professor. I had some interest in serving as a judge, but I never wanted to be an attorney. I am so grateful to be doing EXACTLY what I want to be doing, and few folks are able to say this.

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ANNUAL MEETING WR AP-UP

A Record 3,287 Attendees Convene in Las Vegas for SAEM’s 30th Annual Meeting SAEM19 at the Mirage in Las Vegas smashed several previous annual meeting records, and turned out the highest-ever numbers in several categories: • Advanced EM Workshop Day submissions • Didactic submissions • Abstracts submitted and accepted ANNUAL MEETING WRAP-UP

• IGNITE! and Innovations submissions

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• Clinical images • Combined number of resident and medical student attendees • Medical Student Ambassadors • Total annual meeting attendees A total of 3,287 attendees—the most in history for an SAEM annual meeting— convened in Las Vegas for four days of high-quality career development opportunities, cutting edge education, state of the art original research, and

innovation in academic emergency medicine presented by some of the top names in the specialty.

Keynote on Firearm Injury Opens SAEM19 In their SAEM19 keynote address on Wednesday, May 15, Dr. Rebecca Cunningham and Dr. Garen Wintemute illustrated why it is appropriate to view firearm violence as a health problem and provided an overview of the basic epidemiology of firearm violence for adults and children, including mass shootings, homicide, and suicide. Their presentation emphasized differences between risk- and population- based epidemiologic approaches and points on which common understandings are incorrect; it included an overview of data on how firearm injuries stack up to other common causes of death, trends over the past 20 years, comparisons to our global peers, and health disparities.

They also discussed what is known about the effectiveness of common risk- and population-based policy interventions, including those directed at firearm violence specifically and those with broader impact. Their presentation addressed our relative lack of knowledge about firearm violence, as compared with other comparable health and social problems, and detailed the reasons why little research has been done. They

Dr. Rebecca Cunningham and Dr. Garen Wintemute delivering their SAEM19 Keynote address.

SAEM19 Twitter Pearl Speaking about firearm injury at #SAEM19, @StrohCunningham quotes former US Surgeon General David Satcher: “If it’s not a health issue, then why are people dying of it #ThisIsOurLane from@MKleinMD

such as Dr. Kathy Clem, who gave him his career start at Duke, introduced him to global health, and nominated him for his first leadership position in SAEM. He ended the first segment of his presentation with a challenge to attendees: “…my call to you is to actively offer advice, counsel, and guidance to others – as it really can make a difference!”

The second half of Dr. Martin’s opening remarks looked toward the next 30 years and SAEM’s role in the EM education, research, and in workplace issues of the future.

He asked several, difficult questions and charged those in the audience to discover the answers.

ANNUAL MEETING WRAP-UP

briefly reviewed opportunities for research in clinical settings and closed by reviewing opportunities for risk screening and direct preventive action in clinical settings, based on the “What You Can Do” initiative as well as the FACTS video trainings developed for pediatric patients.

“It is within your power to elevate interest, engagement, and new knowledge in the field of emergency medicine for those we teach and for the patients for whom we care.”

Dr. Martin concluded his opening his remarks by announcing a new, soon-to-be-launched, full-spectrum SAEM Education Committee to deal with the issues and other “hot button” topics as well as an Education Research Task Force to explore member and specialty needs.

Watch Dr. Martin’s full presentation!

SAEM19 Twitter Pearl

“Those who have achieved success in their careers often attribute it to someone who inspired them, encouraged them, and provided sage counsel to them

This quote. This quote is everything. Dr Prescott calls out “chronic hunger” caused by lack of #DiversityandInclusion, burnout, social determinants of health income inequality .... within our profession, & within society at large @AAMCtoday #SAEM19 via @meganranney

during challenging times.”

Dr. Ian Martin Installed as Society’s 2019–2020 President Ian B.K. Martin, MD, MBA, was installed at the SAEM19 opening ceremony as the Society’s 2019–2020 president.

His first “act” as president was to introduce a 30th Anniversary video highlighting historical milestones of the Society since its founding in 1989. The video was followed

by Dr. Martin’s opening remarks, which began with an interactive exercise: He asked audience members who have a mentor as well as those who have ever been a mentor to rise. With most in the room standing, Martin commented on the impact of mentorship in SAEM: “Look around you. Mentorship matters! It is often the key to career and personal success.”

Dr. Martin went on to give examples of both well-known mentor-mentees (e.g. Mark Zuckerberg and Steve Jobs) and lesser known examples (e.g. Polish medical student, Max Talmey and a 10-year-old, Albert Einstein). He included examples of how his own career was shaped by mentors,

AAMC Chief Academic Officer, John Prescott, MD, Delivers the Society’s First-ever Education Keynote Address Where is medical education heading and what will it look like when it gets there? What trends will affect the future of medical education?

How is technology transforming medical education? What should medical educators be doing today to prepare tomorrow’s doctors to meet the needs of the future? John E. Prescott, MD, chief academic officer of the Association of American Medical Colleges (AAMC), offered his prognostications of “The Future Landscape of Medical Education” at the Society’s first-ever education keynote address Thursday, May 16, at the Society’s 30th annual meeting.

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These are the Champions!

SONOGAMES® CHAMPIONS

MedWARS CHAMPIONS

SIMULATION ACADEMY SIMWARS CHAMPIONS

DODGEBALL CHAMPIONS

ANNUAL MEETING WRAP-UP

The University of North Carolina vanquished all other teams to earn the right to take home this year’s SonoCup!

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The University of Michigan is your Simulation Academy SimWars title holders for 2019! Hail to the victors!

“Team Movin' Meat” from Augusta University earned the #1 spot in SAEM’s first-ever MedWARS competition.

The Paul Bunions from Regions Emergency Medicine Residency, St. Paul, Minnesota dived, ducked, dipped, and dodged their way to the tournament title! They are your SAEM19 Dodgeball Champions!

Claim Your Annual Meeting CME by July 31

Claiming CME for SAEM19 is as simple as 1-2-3-4: 1. Log in to the SAEM19 App or Program Planner 2. Click “Claim CME” 3. Complete CME Required Tasks 4. Print your completed CME certificate

ANNUAL MEETING WRAP-UP

Post-SAEM19 Need-to-Know

SAEM19 Education Content Now Available on SOAR

SAEM19 educational content is open access and available online at SOAR (SAEM Online Academic Resources).

Experience convenient online and mobile viewing of Advanced EM Workshops, didactics, forums, abstracts, and more — 300+ hours of original educational content from SAEM19.

Downloadable PDFs and MP3 files provide convenient, on-thego viewing. Watch presenters slides while listening to fully synchronized audio.

Miss Out On SAEM19?

Livestream Videos are Now Available

SONOGAMES® BEST TEAM UNIFORM

Pontificia Universidad Católica De Chile “Forget About Chili” (top); St. John’s Riverside Hospital “Giuseppe Piezo and the Electric Crystals” (middle); University of Arizona Tucson “The Deadly SINs” (bottom)

If you weren’t able to make it to out to Las Vegas for SAEM19, there’s good news! Videos from two full days of SAEM19 livestreaming — 15 hours of educational programming — are now available for viewing. So, gather your colleagues, pop some popcorn, and have a watch party!

Download Your Headshot

SONOGAMES® BEST TEAM NAME

L: “The Last Ureteral Jedi,” Beth Israel Deaconess Medical Center; C: “Edgar Allen Poes,” University of Maryland; R: “The Cardi B-Mode,” The John H. Stroger Jr. Hospital of Cook County

If you took advantage of the free professional headshot photos offered at the SAEM booth during SAEM19, they are now available.

Just open the link, locate your photo, and download. It’s just our way of saying “thank you for dropping by our booth!”

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ANNUAL MEETING WRAP-UP

Congratulations to this Year’s Award Recipients!

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John Marx Leadership Award

Organizational Advancement Award

Excellence in Research Award

Roger J. Lewis, MD, PhD SAEM's most prestigious award honors an SAEM member who has made exceptional contributions to emergency medicine through leadership - locally, regionally, nationally or internationally. Dr. Lewis is chair, Department of Emergency Medicine, HarborUCLA Medical Center.

Deborah B. Diercks, MD, MSc Honors an SAEM member who has made significant contributions to programs, services, or leadership within the Society that has advanced the mission and trajectory of SAEM. Dr. Diercks is a professor and chair, Department of Emergency Medicine, UT Southwestern Medical Center.

Rebecca Cunningham, MD Presented to a member of SAEM who has made outstanding contributions to emergency medicine through the creation and sharing of new knowledge.

Dr. Cunningham is a professor, Department of Emergency Medicine, University of Michigan.

Hal Jayne Excellence in Education Award

Marcus L. Martin Leadership in Diversity and Inclusion Award

Advancement of Women in Academic Emergency Medicine

Brian Clyne, MD, MHL Awarded to a member of SAEM who has made outstanding contributions to emergency medicine through the teaching of others and the improvement of pedagogy. Dr. Clyne is an associate professor and vice chair of EM Educaiton, Alpert Medical School, Brown University.

Christian Arbelaez, MD, MPH Honors an SAEM member who has made exceptional contributions to emergency medicine through advancing diversity and inclusion in emergency medicine. Dr. Arbelaez is an associate professor and vice chair of EM Academic Affairs, Alpert Medical School, Brown University.

Dara Kass, MD Recognizes an SAEM member who has made significant contributions to the advancement of women in academic emergency medicine. Dr. Kass is an assistant professor, emergency medicine, Columbia University Medical Center.

Arnold P. Gold Foundation Humanism in Medicine Award

Resident Researcher

Resident Educator Award

Katherine Hunold Buck, MD Awarded annually to a senior emergency medicine resident who has demonstrated exceptional promise and early accomplishment in the creation of new knowledge. Dr. Buck is chief resident, The Ohio State University.

Lauren Maloney, MD Given annually to a senior emergency medicine resident who has demonstrated exceptional aptitude and passion for teaching during residency.

Dr. Maloney is chief resident, Stony Brook University Hospital.

Hanni M. Stoklosa, MD, MPH

(Pictured: Dr. Stephanie Kayden accepting the award on behalf of Dr. Stoklosa)

Given to a practicing emergency medicine physician who exemplifies compassionate, patient-centered care. Dr. Stoklosa is director, Global Women's Health Fellowship, Mary Horrigan Connors Center for Women's Health & Gender Biology; and executive director, HEAL Trafficking, Brigham and Women's Hospital.

The SAEM FOAMed Excellence in Education Award honors an SAEM member who has made outstanding contributions to the online learning community of emergency medicine through innovative and engaging FOAMed (Free Open Access Meducation) content. This was the first year for the award, which was shared by two individuals:

Young Investigator Award Anthony E. Rosen, MD, MPH; Bernard P. Chang, MD, PhD; Patrick M. Carter, MD Recognizes those SAEM members who have demonstrated commitment and achievement in research during the early stage of their academic career. Dr. Carter is an assistant professor of emergency medicine, University of Michigan; Dr. Chang is an assistant professor of emergency medicine, Columbia University Medical Center. Dr. Rosen is an assistant professor of emergency medicine, Weill Cornell Medicine.

ANNUAL MEETING WRAP-UP

FOAMed Excellence in Education Award

Ross I. Donaldson, MD, MPH ross@wikem.org Director of the Global Health Program, Department of Emergency Ross I. Donaldson, MD, MPH Medicine, HarborUCLA Medical Center; associate professor of clinical medicine, David Geffen School of Medicine at UCLA; adjunct associate professor of epidemiology, UCLA – Fielding School of Public Health.

Dr. Donaldson is the founder and editor-in-chief of WikEM, The Global Emergency Medicine Wiki, is the world's largest emergency medicine open-access reference resource.

RAMS Innovative Educator Award Jennifer Lee, MD Given to an emergency medicine resident or medical student member who has made outstanding and innovative contributions to emergency medicine education. Dr. Lee is chief resident, Harbor-UCLA Medical Center.

RAMS Excellence in Research Award Lauren Maloney, MD Awarded to an EM resident or a medical student who has had a role in the development of evidencebased medicine in the specialty. Dr. Maloney is chief resident, Stony Brook University Hospital.

RAMS Leadership in Emergency Medicine Award Sriram Venkatesan Honors a medical student or practicing emergency medicine resident taking a leading role in their student interest group or residency program and making an impact on the local, regional, national, or international level through their efforts. Sriram Venkatesan is a medical student at Sri Ramachandra Institute of Higher Education and Research, India.

Ken Milne, MD, MSc @TheSGEM Chief of staff, South Huron Hospital Association; Senior Editor for Ken Milne, MD, MSc Social Media for Academic Emergency Medicine journal.

Dr. Milne is creator and host of The Skeptics’ Guide to Emergency Medicine, a weekly podcast with more than 40,000 subscribers.

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2019 Medical Student Excellence in Emergency Medicine Award Recipients The Society for Academic Emergency Medicine congratulates this year’s recipients of the SAEM Medical Student Excellence in Emergency Medicine Award. The award is offered to each medical school in the United States and internationally to honor an outstanding medical student.

Priyan Chandra Wickremesinghe Albany Medical College Jaclyn Matsuura Arizona College of Osteopathic Medicine John Wooten Brody School of Medicine at East Carolina University Fardis Tavangary College of Osteopathic Medicine of the Pacific-Noethwest Matthew S. White Columbia University Vagelos College of Physicians & Surgeons Julia Moon Cooper Medical School of Rowan University Caitlin Oldenkamp David Geffen School of Medicine at UCLA Stephen Rogers Drexel University College of Medicine Kelly McHugh Duke University School of Medicine Benjamin Eric Nolt East Tennessee State University Quillen College of Medicine Jasleen Singh Eastern Virginia Medical School

ANNUAL MEETING WRAP-UP

Scott D. Wilder Edward Via College of Osteopathic Medicine - Auburn Campus

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Darren Heath Garner Louisiana State University School of Medicine - Shreveport

Clelia Clark University of California Irvine School of Medicine

Erica Koch Loyola University of Chicago - Stritch School of Medicine

Ivan Shevchyk University of California, Davis School of Medicine

John C. Schupbach Mayo Clinic Alix School of Medicine

Axel Adams University of California, San Francisco School of Medicine

Samuel K. Berry University of Pikeville - Kentucky College of Osteopathic Medicine

Cheyenne Smith University of Chicago Pritzker School of Medicine

Harmony Belle Yourish University of Pittsburgh School of Medicine

Kelly Stewart University of Colorado School of Medicine

Katherine Wegman University of Rochester

Alexis Cordone University of Connecticut School of Medicine

Christopher C. Musselwhite University of South Alabama Department of Emergency Medicine

Stephanie Winslow University of Florida - College of Medicine

Jessica Wright Edgar University of South Carolina School of Medicine - Greenville

Keegan Nicodemus Medical College of Georgia Katherine S Kuefler Medical College of Wisconsin John M. Sawyer, MD Medical University of South Carolina Cody Dunne Memorial University of Newfoundland Steven Ignell Northwestern University Feinberg School of Medicine Forrest Wells Oregon Health and Science University Arjun Agrawal Penn State College of Medicine Alexandra Digenakis Philadelphia College of Osteopathic Medicine Helene Morakis Queens University Simisola Alalade RUSH Medical College

Sophia Meziani Florida International University

Marc G Berenson Rutgers New Jersey Medical School

Seth Thomas Fielding Florida State University College of Medicine

William Haussner Rutgers Robert Wood Johnson Medical School

Sarah Perez George Washington University School of Medicine & Health Sciences

Alexandria Gregory Saint Louis University School of Medicine

Allyson Raymond Georgetown University School of Medicine

Jared Marshall Sidney Kimmell Medical College at Thomas Jefferson University

Ryan Steven DesCamp Indiana University School of Medicine

Gabe Lancaster University of Iowa Roy J. & Lucille A. Carver College of Medicine Laurel Gardner University of Kansas School of Medicine Benjamin Mogni University of Kentucky College of Medicine Randall Beaupre University of Louisville School of Medicine Madison Kommor University of Louisville School of Medicine Lucy Liu University of Maryand School of Medicine

Lauren Apgar University of North Texas Health Science Center - Texas College of Osteopathic Medicine Cameron Leafloor University of Ottawa

Catherine Divingian University of South Florida Joshua Hays University of Texas Medical Branch Daniel F. Lewandowski University of Toledo, College of Medicine and Life Sciences Colleen Andrews University of Wisconsin School of Medicine and Public Health James Sutton UT Southwestern Wendy Sun Virginia Commonwealth University

Ryan Burns University of Massachusetts Medical School

Clare Sanders Wake Forest University School of Medicine

Grant Barker University of Miami Miller School of Medicine - Miami Campus

James Tanch Warren Alpert Medical School at Brown University

Robert Kim SUNY Downstate

Stephen Gassner University of Miami Miller School of Medicine - Regional Medical Campus

Ryan Rees, MD Washington University School of Medicine in St. Louis

Jonathan D Woo John A Burns School of Medicine

Alison Rosser SUNY Upstate Medical University

Dr. Adam James University of Minnesota Medical School

Philip O'Donnell Weill Cornell Medicine

Christopher Counts Johns Hopkins School of Medicine Department of Emergency Medicine

Thomas Fox Tulane University School of Medicine

Jonathan Redding University of Mississipi Medical Center

Kristin Meigh West Virginia University

Mushtaba Yuridullah Larner College of Medicine

Scott Szymanski Uniformed Servies Universty of the Health Sciences, F. Edward Hebert School

Rachel Plate University of Missouri - Columbia

Nathan Whelham Western Michigan University Homer Stryker MD School of Medicine - EM

Brandon Wilkinson Lincoln Memorial University - DeBusk College of Osteopathic Medicine

Daniel Escobar University of Arkansas for Medical Sciences

Alana Elizabeth Harp Loma Linda University

Hurnan Vongsachang University of California - Riverside

Cameron James Douglas University of New England College of Osteopathic Medicine Andrew Petrilli University of North Carolina - Chapel Hill

Tyrel Fisher Wright State University Boonshoft School of Medicine Michael Jarvis Boyle Yale School of Medicine * New Institutions/programs

Emergency medicine academicians in six plenary presentations explored a variety of subjects related to the practice of emergency medicine, during a special plenary session held on the opening day of SAEM19. Representing a broad diversity of research in emergency medicine, these six abstracts were selected by the SAEM Program Committee as the best from among more than 800 submissions. Watch the presentations.

Plenary Abstract Presenters Jeffrey Perry, MD, MSc

Keith Kocher, MD, MPH

University of Ottawa

University of Michigan

Prospective Multicenter Validation of the Canadian Transient Ischemic Attack Score for Predicting Subsequent Stroke Within Seven Days

Emergency Care Quality Imaging Benchmarks in a Statewide Collaborative: Estimated Excess and Associated Spending

Nella Hendley, MA, MS4

Robert Welch, MD, MS

Wake Forest School of Medicine

Wayne State University School of Medicine

Sex and Race Differences in Safety and Effectiveness of a Chest PainAccelerated Diagnostic Protocol

Serum Biomarker Panel Outperforms the Canadian Computed Tomography Head Rule for Diagnosing Traumatic Intracranial Injury

ANNUAL MEETING WRAP-UP

Plenary Session Abstract Presentations

Louis Yu, MD, MA University of California, San Francisco Aortic/Great Vessel Injury in the Pan-Scan Era

Jonathan Casey, MD Vanderbilt University Medical Center Bag-Mask Ventilation During Tracheal Intubation of Critically Ill Adults

Top Education Abstract Medical Knowledge and Burnout in Emergency Medicine Residents Dr. Kelly Williamson, assistant residency program director, Advocate Christ Medical Center Watch the Presentation

VIP Table Sponsors at SAEM’s 30th Anniversary Party Hosted by RAMS University of Iowa Hospitals and Clinics Department of Emergency Medicine LSU Health Sciences Center – Shreveport Department of Emergency Medicine Stanford University School of Medicine Department of Emergency Medicine Medical College of Wisconsin Department of Emergency Medicine Thomas Jefferson University and Hospitals Department of Emergency Medicine Penn State Health Milton S. Hershey Medical Center Department of Emergency Medicine Spectrum Health/Michigan State University Department of Emergency Medicine Boston Medical Center Department of Emergency Medicine Columbia University Department of Emergency Medicine University of Cincinnati College of Medicine Department of Emergency Medicine The Ohio State University Wexner Medical Center Department of Emergency Medicine University Hospitals Cleveland Medical Center Department of Emergency Medicine Henry Ford Health System, Department of Emergency Medicine Massachusetts General Hospital, Department of Emergency Medicine

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Many Thanks to Our SAEM19 Exhibitors and Sponsors!

Exhibitors American Academy of Emergency Medicine (AAEM)

DAG Worldwide

M Clinic

Simulab Corporation

Education Management Solutions

McGraw-Hill Education

Society for Academic Emergency Medicine

Emergency Medicine Network

AcelRx Pharmaceuticals, Inc.

Medi Lazer

EMrecruits

ACEP Geriatric Emergency Department Accreditation Program

Medical College of Wisconsin

Envision Physician Services (EVPS)

MedVision

AAEM Resident Student Association (AAEM/RSA)

Alteon Health American Physician Partners ApolloMD Arkansas Children’s Hospital Atlantic Pension Planning Corp.

Bristol-Myers Squibb/Pfizer BTG International Ltd. Cambridge University Press Clarius Mobile Health

Happy Doc Summer Camp Indiana University School of Medicine | Department of Emergency Medicine

MDocHaus

Mindray North America My Bio Medical Solutions PACE MD Global Health Patient Forecaster

Integrative Emergency Services (IES)

Penn State Health - Hershey Medical Center

Intelligent Ultrasound

Physician Affiliate Group of New York (PAGNY)

iSimulate Kaiser Permanente/The Permanente Medical Group, Inc.

SonoSim Southeast Health Splash Medical Devices Sycamore Physician Contracting LLC Tereson The Dental Box Tower Health University of Maryland Department of Emergency Medicine US Acute Care Solutions (USACS)

Portola Pharmaceuticals

VEP Healthcare

Riverside Health System

VisualDx Vituty

Schumacher Clinical Partners

WVU Medicine - Department of Emergency Medicine

ConnectMe Solutions

Leading Edge Medical Associates (LEMA)

RoyalZ Beauty

DA Technology

LogixHealth

Shift Administrators

SonoGames® Sponsors:

SIMWARS Sponsors:

Childcare Sponsor:

30th Anniversary Sponsors:

Clarius Mobile Health PHILIPS FUJIFILM/SonoSite Mindray North America SonoSim

MedVision SAEM Simulation Academy

Rosh Review

Wifi Sponsor:

AAEM Resident Student Association (AAEM/RSA)

Tower Health Roche Diagnostics Medical College of Wisconsin

Sponsors

Roche Diagnostics

Dodgeball Sponsor:

ANNUAL MEETING WRAP-UP

Thank You to Our Sonogames Sponsors!

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Residents demonstrate their skills and knowledge of point-of-care ultrasound at SonoGames 2019.

Program Committee Chair, Jody Vogel, MD, kick's off the SAEM19 opening session.

ANNUAL MEETING WRAP-UP

SAEM19 Photo Album

LOOKING AHEAD Save the Date!

Each year, members of AWAEM and ADIEM gather for their annual lunch and to network with old friends and new, explore joint issues, and discuss the hottest topics in EM.

MedWAR participants braved the desert landscape, chilly temps, and an unexpected hailstorm to compete in SAEM's first Medical Wilderness Adventure Race.

The SAEM20 Program Committee, under the guidance of 2019–2020 Chair, Jody Vogel, MD, is already hard at work to make SAEM20 another stellar success. We look forward to seeing you in Denver, May 12–15, 2020 at the Sheraton Denver Downtown Hotel.

SAEM20 Submission Deadlines Advanced EM Workshop Day: Teach the Teacher Workshop: Awake Flexible Fiberoptic Intubation.

Opportunities for sharing ideas, discussion, and brainstorming were in steady supply at SAEM19.

Advanced EM Workshops Submission dates: Aug. 1–Sep. 16, 2019 Didactics Submission dates: Aug. 15–Oct. 1, 2019 Abstracts Submission dates: Nov. 1 2019–Jan. 2, 2020 Innovations/IGNITE! Submission dates: Nov. 1 2019–Jan. 13, 2020

SAEM19 was an opportunity to share ideas, learn from others, and network with some of the top minds in academic EM.

With four full days of cutting edge educational offerings on the agenda, there was something for everyone SAEM19.

Keynote Sep. 9 – Oct. 31, 2019 17

ANNUAL MEETING WRAP-UP

SAEM19 Photo Album

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The aisles were packed and the conversations plentiful at the SAEM19 Residency & Fellowship Fair

SAEM19 attendees immersed themselves in the natural world and fueled their wellness during a Tuesday hike at stunning Red Rock National Park.

The SAEM BOD was in the building and ready to take on all competitors at Dodgeball 2019. Viva Las Vegas and viva SAEM!

Attendees "peace out" at the opening reception in the SAEM19 exhibit hall.

An SAEM19 e-poster session captivates the crowd.

Team AEM gave it a heroic effort, but were edged out by the superstars from Team RAMS in this year's SAEM Jeopardy competition.

There was much to see at the SAEM19 Clinical Images exhibit.

Consensus Conference participants worked hard to develop a wellness research agenda.

Lots of questions were asked and many answers were discovered at SAEM educational sessions.

The competition was fun and friendly, but fierce, at SAEM19 Dodgeball.

More than 1,100 SAEM friends, dressed to slay and primed to celebrate, turned out for SAEM’s 30th Anniversary party at the Mirage’s swanky 1 Oak Nightclub.

The new RAMS hangout gave SAEM residents and medical students a fun spot to grab some swag, kick back and relax, or challenge friends to a game of foosball, ping pong, or cornhole.

The opening reception in the exhibit hall gave attendees a chance to mingle, enjoy a tasty bite, and visit with exhibitors.

SAEM19 YouTube Videos If you weren’t able to make it to out to Las Vegas for SAEM19, no worries! These and other videos from two full days of SAEM19 live streaming are available for viewing on SAEM’s YouTube channel:

ANNUAL MEETING WRAP-UP

SAEM19 Photo Album

• 30th Anniversary VideoSAEM19 • Dr. Ian Martin’s Opening Ceremony Address • SAEM19 Plenary Session • SAEM Keynote: Firearm Injury: Facts, Myths, and a Public Health Path Forward (Part 1) • SAEM19 Keynote: Firearm Injury: Facts, Myths, and a Public Health Path Forward (Part 2)

This year's Simulation Academy SimWars once again lived up to its reputation as "the premier national simulation competition for EM residents."

Quirky costumes and mad point-of-care ultrasound skills were on display at SonoGames 2019.

• SAEM19 Education Keynote: The Future Landscape of Medical Education • SAEM19 Education Keynote: The Future Landscape of Medical Education

It was standing room only at the SAEM19 Opening Ceremony

SAEM19 attendees got a chance to meet with exhibitors in the exhibit hall.

SAEM19 FACEBOOK PHOTO ALBUMS Photo albums from SAEM19 are up and ready for you to view.

Feel free to tag yourself!

• Tuesday, May 14 • Wednesday, May 15 • Thursday, May 16 During quick-fire mentoring sessions, Speed Mentoring participants had an an opportunity to start new mentoring relationships with mentors from around the country.

• Friday, May 17 19

DIVERSITY AND INCLUSION

What Does “Empowerment” Really Mean?

SAEM PULSE | MAY-JUNE 2019

By Lisa Moreno-Walton, MD, MS, MSCR

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Every decade seems to have a theme and some buzzwords that characterize this theme; this seems to be the decade of "empowerment." We talk about empowering others to live their best lives, and we talk about the current political climate in which some Americans have been empowered to speak their hate. We use the term frequently, but as with many buzzwords, we also often use it ambiguously and vaguely. I have recently given thought to what empowerment means to me as an emergency physician, for whom social justice and public health are integral to the life I live; to me as a member of SAEM, a founding member of ADIEM, and the president-elect of AAEM. How does empowerment look when I am living it as an individual, a physician, and in community with the groups with which I have chosen to align myself?

Empowerment is defined as “the granting of the power, right or authority to perform various acts or duties”

(Merriam-Webster Dictionary). Another definition is “the process of becoming stronger and more confident, especially in controlling one's life and claiming one's rights” (Dictionary.com). A glance through Brainy Quotes reveals that today’s thinkers define empowerment in many ways: getting involved with climate change mitigation, embracing New Age values, doing dishes, controlling the fertility of third world women, cooking with children, grabbing a gun, being Miss Universe, and rapid economic development (Brainy Quotes).

Each of the quoted thinkers is certain that she or he has tapped into the true definition of empowerment. But what does empowerment really look like? I think there’s a third definition.

students and residents, attested to through board certification and maintenance of certification, gives us the power, right, and authority to practice emergency medicine.

This is the simplest and most basic empowerment of the emergency physician. We know the facts and have the information that allow us to practice emergency medicine safely and effectively. We have learned to exercise clinical judgement and to value the humanity in every patient we treat. This is informational learning. We have memorized the facts, acquired the skill set, seen enough to recognize the disease patterns, and learned the process of differential diagnosis and treatment.

The Old Testament, a source document for the three major world religions, tells us that knowledge is power, and this concept holds to the first definition of empowerment. The knowledge we acquire as medical

While we are empowered to do the work of an emergency physician, and while the role of the physician in society is indeed a powerful one, this type of learning has no power in and of itself. It is not inspirational and it is not

"Mentorship is empowering. Academic physicians know this, and we seek to light the spark of curiosity and inquiry in our mentees." transformational. The student may have become an emergency physician, but the person has not been transformed. This type of power characterizes the average physician who we see every day around us. They know they have power, they mostly use their power for good, but they are not transforming the lives of their patients, their colleagues or our specialty.

And they are not themselves transformed.

Mentorship is empowering. Academic physicians know this, and we seek to light the spark of curiosity and inquiry in our mentees. We encourage them to question why things are the way they are. We encourage them to look at the variables that influence the disparities in disease and injury outcomes; to consider the social and economic factors that affect the percentages of racial minorities applying to, matriculating in, and completing medical school; to investigate and mitigate the factors that contribute to the disproportionately high suicide rates among physicians and sexual minorities.

Those of us who are mentors know all too well that our mentorship alone will not result in the transformation of our mentees. It will not genuinely empower them in the way described by the second definition. One of my pipeline program pre-med students once joked, “Dr. Moreno aspires to mentor students who aspire to greatness, and doesn’t waste her time on students who aspire to be average.” As mentors, we recognize that success does not only depend on what we put into the mentoring relationship.

What the mentee puts into relationship is actually more predictive of the success of our mentoring.

Assessment is empowering, both self-assessment and assessment of the society, the medical system, and the world in which we live. “The unexamined

life is not worth living” (Plato*) and the examined life is often painful to live.

Examining our stories as a society, a profession, and an individual strip away the myths that all persons have equal justice under the law, that all lives have equal value, that all patients have equal access to the best care our hospital can provide, that all babies born in the same country have the same life expectancy, and that all candidates for medical school are equitably assessed. Examining our stories compels us to admit that the fairy tales are far from true, the public personas are not the real people, the injustice is overwhelming and we are not as righteous as we want to believe that we are. Keeping it real means admitting that what we think we believe, and what we know we should believe are not always consistent with what we actually do believe. What we actually do believe, composed of our unconscious biases as well as the conscious stories we make up about other people so that we can justify the way we relate to them, is all too often something we’d rather keep to ourselves and from ourselves. Transformational learning, however, demands painful, honest examination of ourselves, the profession and the world we have helped to create. Really, keeping it simple and painless is our default behavior. It is what it is. Except it’s not. It is what we allow it to be, and it is what we make it.

Transformation is owning what we have created, and creating the possibility of what could be. This is the ultimate definition of empowerment.

Empowerment must take place in the context of community. Since the dawn of humankind, people have sought to live in community. In medicine, we are constantly forming more societies, academies, and organizations of like-

minded individuals seeking to accomplish similar goals. Afro-Caribbean cultures identify “who I am” as being part of a tribe. In academic emergency medicine, our tribe is ADIEM. Here, empowerment goes beyond the second definition. It extends to changing ourselves, changing our community, changing medicine, and changing the world. As the late Ermias Asghedom said, “We play the long game.

It’s a marathon.” The victory lap got us to the first definition of empowerment, and starting the marathon got us to the second. Let’s create a third definition of empowerment; the kind of empowerment that transforms the world. The SAEM Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) is committed to the long game, and we encourage our brothers and sisters in emergency medicine to be part of that transformation of our learners, our profession, our community, our world, and ourselves. Be truly empowered.

Commit to the long game, even when it’s painful, even when you’re too tired, even when it seems impossible. Be transformed and transformational.

Create the possibility of what can be in emergency medicine. The Marathon Continues. Be a part of it. *It is debated whether Plato himself said this, or whether Plato wrote in his essay The Apology of Socrates that Socrates made this statement to the jury at his trial.

ABOUT THE AUTHOR Dr. Lisa Moreno-Walton, MD, MS, MSCR is director of the Division of Research, Division of Diversity, Viral Testing Program Section of Emergency Medicine and director of the Latino Health Scholars Program. She is a clinical associate professor of surgery at Tulane University School of Medicine at Louisiana State University Health Sciences Center. Dr. MorenoWalton is a founding member of SAEM’s Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) and is the current president-elect of the American Academy of Emergency Medicine.

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in healthcare and outcomes, and insuring that all emergency physicians are delivering culturally competent care. 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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ETHICS IN ACTION

Planning for the End of Life

By Ray Fowler, MD and Amy Vandenbroucke, JD

SAEM PULSE | MAY-JUNE 2019

Life happens in three phases: the beginning, the middle, and the end.

Much of life’s focus is on planning for the beginning of life and on the development and care for those lives during the long, active middle years.

More recently, the management of the “end of life” has begun to receive long overdue attention.

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Patients clearly have a right — indeed an obligation if they are able — to coordinate the medical details of their life’s end, but in the frenetic atmosphere of the emergency department through which many pass as they near the end of their lives, examinations are frequently hurried and the information available to physicians is often incomplete. The “POLST” (Physician Orders for LifeSustaining Treatment) movement, which prioritizes focused eliciting,

documenting, and honoring patient treatment preferences using a portable medical order, is available in almost every state and offers a resource that can make the wishes of the patient clear.

The Intended Population & Guidance for Health Care Professionals states that “the POLST decision-making process and resulting medical orders are intended for patients who are considered to be at risk for a lifethreatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty.” At the polst.org website you will find information addressing a mechanism for this process. While both POLST forms and advance directives are tools that help patients share treatment preferences when they cannot participate in their own care, they differ in function. All adults should consider creating an advance

directive, i.e., a legal document, to share general wishes. The POLST Form is “not an advanced directive” but rather a portable medical order for those nearing the end of their lives.

Indeed, the differences are clear during an emergency: emergency personnel are able to follow treatment orders on a POLST form precisely because they are medical orders signed by a healthcare professional, but they cannot follow an advance directive because it provides no orders and is not signed by a healthcare provider.

The POLST document is “a portable, actionable medical order that helps ensure patient treatment wishes are known and honored.” Its second intent is to help prevent the initiation of treatment that is against the patient’s wishes. The purpose of the POLST form is to provide medical orders at the time of greatest need. Absent a

POLST form, and with or without a DNR (Do Not Resuscitate) form, the patient would typically receive all treatments that are necessary and appropriate to preserve life; however, unlike a DNR, the POLST form provides clarity about patient treatment preferences beyond merely stating that the patient prefers not to be resuscitated.

In addition to confirming the patient’s resuscitation preferences (CPR or DNR), within the POLST document resides a “hierarchy” of levels of treatment: Full treatment. The goal is to attempt to sustain life by all medically-effective means and provide all treatments necessary and appropriate to preserve life. Such a plan would provide all lifesustaining treatment including advanced airway care, mechanical ventilation, cardioversion, and transfers for intensive treatment as indicated.

Limited or select treatment. The goal is to attempt to restore function with treatments for reversible medical conditions while avoiding burdensome measures. This option would provide basic care but would avoid mechanical ventilation and intensive care. This selection would treat promptly reversible conditions and/or exacerbations of underlying disease targeted toward restoring a current state of health.

Comfort measures only/allow natural death. This path maximizes patient comfort through promoting management of symptoms, allowing natural death.

Comfort should be a priority, and hospitalization should be avoided unless needed to ensure the patient’s desire for comfort. Antibiotics may be considered as an adjunct in comfort measures.

"The POLST program is a worthy effort that deserves the support of emergency physicians specifically and the entire field of medicine broadly."

An area of emphasis may be found in the need to have the appropriately completed document available to the emergency treatment team at the time of patient presentation to a medical facility.

How this document is maintained and transported with the patient is obviously vital to following the patient’s wishes. This availability, by necessity, applies to the emergency medical services teams that may be called to transport the patient during critical times.

Approximately half of the United States has POLST programs that are either “mature” or “endorsed” (Six states have an active statewide registry as of this writing. In an informal survey of the EMS medical directors of some of the largest cities in the United States, physicians were queried as to whether they are familiar with the POLST program, if POLST information is received on patients and, if so, if it is received in writing. Replies ranged from “POLST being including in Termination of Resuscitation EMS guidelines” (Honolulu) to “no information” (St. Louis, Missouri). Comments varied from "written documents often rarely accompany patients” to “NEVER receive the documents”; from “medics may not be able to follow the document without calling online medical control” to “both written and electronic document availability in real time” (Portland, Oregon). It is worth

noting that EMS protocols in many states specifically mention POLST, or whatever term is used in a particular state. (There are 13 terms used for the process across the country. See www.polst.org/map for a full list).

The POLST program is a worthy effort that deserves the support of emergency physicians specifically and the entire field of medicine broadly. Barriers to enabling legislation should be broken down, data management systems should be expanded to include POLST-type documents, and heightened awareness of the existence of these documents should be an integral part of our systems of care.

ABOUT THE AUTHORS Ray Fowler, MD, is professor and chief of the division of emergency medical services and James M. Atkins professor of emergency medical services, Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX. Dr. Fowler is also vice chair, Texas MOST (Medical Orders for Scope of Treatment) Coalition. @EaglesGather Amy Vandenbroucke, JD, is executive director of the National POLST (Physician Orders for LifeSustaining Treatment) Paradigm.

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RESEARCH IN ACADEMIC EM

Increasing Resident Engagement in Research: Part II — A Resident’s Perspective

By Adrienne N. Malik, MD

SAEM PULSE | MAY-JUNE 2019

The “Research in Academic EM” column in the May-June SAEM Pulse provided a faculty perspective for how to increase resident engagement in research. In this issue, Adrienne N. Malik, MD, provides a resident’s perspective.

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Research is an intimidating field in which most residents have minimal experience and no idea where to start.

Ignorance of the subject matter and lack of experience with how to initiate or design projects adds to the intimidation factor. How can these obstacles be overcome so that more residents will become involved in research? As a reformed research hater, and now somewhat of a research evangelist, I offer the following advice from a resident’s perspective: Be approachable, genuinely willing to help, and understanding with early researchers.

"Fear of having one’s self or one’s project idea perceived as foolish by an established faculty member is a major barrier to many residents attempting research projects."

Fear of having one’s self or one’s project idea perceived as foolish by an established faculty member is a major barrier to many residents attempting research projects. It took me finding two approachable, understanding faculty members to admit the breadth of my ignorance (e.g. What is an IRB?) and receive some very basic instruction on the steps required to move a study from start to finish.

Outline the steps of anything you ask a resident to do.

A resident with no background in research is unlikely to independently learn how to navigate an IRB submission or intuitively complete a protocol correctly if they have never participated in creating one. Being asked to complete these tasks with no guidance or experience is daunting for

a resident and likely to lead to orphaned projects. Clearly outline the steps of anything you ask a resident to do.

Provide examples of accepted protocols, published manuscripts, case reports or posters if you have them (residents excel in mimicry prior to mastery).

Don’t ask too much too fast.

Dropping a resident with no research experience into a larger project with significant responsibility is a recipe for failure. Start new researchers out with small studies or a single responsibility in a larger endeavor. Although not considered robust contributions to evidence-based medicine case reports, small retrospective studies, IRB exempt projects, or QI projects provide a good starting place for a research novice.

Successfully completing smaller projects builds the confidence and skills necessary to participate meaningfully in more traditional research.

When residents ask for feedback, give honest, constructive criticism, and do so in a timely fashion.

We have very little free time, and don’t want to waste it on something that is subpar or unlikely to be well received. Be excited for residents when a submission is accepted or published. Residency can be so thankless; the positive impact of a successful research endeavor can provide a much-needed, fulfilling experience in a sea of burnout. A small success positively reinforces the desire to participate in future projects.

Six simple steps to increasing resident engagement in research: 1. B e approachable, genuinely willing to help, and understanding with early researchers.

2. Outline the steps of anything you ask a resident to do.

3. Don’t ask too much too fast.

4. W hen residents ask for feedback, give honest, constructive criticism, and do so in a timely fashion.

5. Suggest next steps.

6. Support residents who are passionate for an idea. suggested new conferences for abstract submissions, gave my name to other faculty looking for resident help, and offered me increasing opportunities and responsibilities on their own projects. I would not have sought these opportunities out myself because I thought my projects were too insignificant to submit and myself too inexperienced to be useful on larger studies. I had no idea that some of the conferences that accepted my abstracts and posters even existed. Had I not been prompted to pursue other research endeavors after my initial QI project I likely would have stopped at that.

Suggest next steps.

Support residents who are passionate for an idea.

This, in particular, was very impactful for me. After successfully completing a project, my mentors consistently

No research project is more likely to get completed than the one a resident cares about. Last year I pitched to one

of my mentors an overly ambitious idea for a pilot study. Four months later my completed grant proposal was submitted.

I am deeply passionate about that project. Do whatever is necessary to provide resources to and help a resident with passion for an idea. If you are not interested in his or her project, connect the resident with someone else who is.

ABOUT THE AUTHOR Adrienne N. Malik, MD, is a PGY-3 emergency medicine resident and future Ultrasound Fellow at DMC Sinai Grace Hospital in Detroit, Michigan.

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SOCIAL MEDIA IN EM Managing Group Messaging in Your Residency Program

Traditional text messaging is now passé, particularly with the explosion of popular, easy-to-use messaging apps. Here are a few top picks:

By Eric Lee, MD As with many social media platforms, group messaging apps present both promise and peril. They are a great way to disseminate information to a group and bolster morale, but they can also spread rumors and contribute to cynicism and negativity in the group. Understanding and managing these apps are a common challenge for any residency program.

Ultimately, the benefits of these open forums for our learners can still outweigh the potential downsides. Here are a few tips that may help.

Be Inclusive

Make sure all members of the group are included in the group messaging. Before the era of popular group message apps, residents may have communicated on informal group texts or email chains.

Informal text groups are unwieldy and can inadvertently exclude members of group; this can build animosity and resentment among members.

Encouraging a designated group messaging platform for your incoming class of interns can help get everyone on the same page from the start. You can employ the help of current residents to help direct incoming interns on what social media platform works best. In residency, we started a Groupme, and all subsequent classes did the same. At my current institution, we made an effort to get everyone started on Slack, our platform of choice.

SAEM PULSE | MAY-JUNE 2019

Set Ground Rules

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At intern orientation, we outline the ground rules for all social media. There are the usual rules: No sharing of patient-identifying information anywhere; be wise about what you post to your Twitter and Instagram accounts; project a professional image, etc. Basically, we remind everyone that all of these rules should be applied to conduct within both public and private group messaging apps as well.

Have Moderators

Just as your Twitter and Instagram accounts likely have some oversight, the

4 Apps That Get Your Message Across

public group messaging forums should also have some moderators. These may be your chief residents or other trusted individuals who help enforce the rules and provide guidance in public group chats. The residents will likely have their own private group that you cannot directly moderate, and that’s okay! It’s important to give your residents a space to openly express themselves and discuss whatever they want. In residency, our class Groupme was a source of encouragement and support through many stressful and difficult times.

Use the Platform

Encourage faculty to join in on the platform as well. In order to maximize the potential of group messaging, I created a Slack workspace at my institution for both faculty and residents.

At the same time, we encouraged our residents to choose Slack as their preferred group messaging app. The benefit of using the same platform as the residents is that we can host communications on faculty-resident collaborative projects and committees on the same platform that the residents are already using. We currently have a Slack channel for our Education Task Force and the Social Media Team, with more to come.

ABOUT THE AUTHOR Eric Lee, MD is an attending physician at Maimonides Medical Center in Brooklyn, NY. He can be reached on Twitter @EricLeeMD.

WeChat Android, iOS: Free Free mobile instant messaging, video, and voice calls, group chat, and multimedia messaging (images, video, audio, stickers, etc). Also includes quirky features such as “Friend Radar,” “People Nearby,” and “Shake,” to quickly find new people to chat with nearby.

Whatsapp Android, iOS: Free Easy setup, automatic syncing with your phone’s contacts, and a featurerich, ad-free experience. Send text, photos, voice, and short video messages to WhatsApp contacts.

GroupMe Android, iOS: Free Easily create groups and add contacts by searching for them through phone numbers or email address for easy solo and group chatting. There’s a support for group chats over SMS, for relatives and contacts who don’t have a smartphone, and an in-app Gallery that helps you keep track of photos and videos shared in your groups.

Slack Android, iOS: Free Productivity and team-oriented messaging app. Mix of messaging, scheduling, management tools, and app integration. Real-time messaging synced across devices and supports file sharing, and direct and group messaging tools.

Features a system of chat channels, to quickly set up subgroups for task or topic-oriented discussions. Archives communications, allowing you to search through old messages, channels, and shared files.

SGEM: DID YOU KNOW? Sex-based Differences in Stress Fractures

By Anjali Das, MD and Erin Snyder, MD, University of Alabama at Birmingham School of Medicine CASE: A 23-year-old female dancer presents to your emergency department with right foot pain. She has noted a dull ache on the ball of her foot that has progressed in severity over the past week which now makes it difficult for her to bear weight. She denies any direct trauma to the area.

Musculoskeletal issues are a common complaint and result in 13.8 percent of emergency visits, per one 2004 national survey.1 Stress fractures, in particular, pose a difficult diagnostic challenge as 70 percent of X-rays obtained at initial presentation do not show evidence of fracture. Therefore, emergency physicians must have a high clinical suspicion and be aware of environmental and biological sex-related differences to guide history and physical examination in order to arrive at the correct diagnosis and management.

Stress fractures are a form of overuse injury caused by repetitive, low-magnitude forces that exceed the pace of bony remodeling/adaption. The incidence of stress fractures is less than one percent in the total population, but they are among the most common injuries in active populations, approaching 31 percent in military recruits and as high as 52 percent in distance runners.2,3 Risk factors include sudden increases in volume or intensity of activity and prior stress fracture. Female sex is also a risk factor, with stress fractures being four to 10 times more prevalent in women.4 Female athletes, in particular, can suffer from this condition because of what’s referred to as athlete energy imbalance (formerly female athlete triad). This is defined by a pattern of restrictive eating, where energy expenditure exceeds caloric intake, and results in a low BMI. This in turn disrupts the normal cycling of steroid hormones, resulting in menstrual irregularities and ultimately suboptimal bone microarchitecture susceptible to fracture under tensile and mechanical stress.

Presentation of stress fractures is nonspecific, although patients typically report pain at the site of injury, exacerbated with activity and relieved by rest. Restricted range of motion and erythema may be noted as well. Physical exam may elicit tenderness over bony areas, and a positive hop test (pain is elicited when the patient is asked to hop on the affected lower extremity) can support the diagnosis. Imaging should start with an X-ray, however if symptoms persist and clinical suspicion is high, patients may need MRI to make

the diagnosis.3,4 This is especially true if the suspected site is at the femoral neck, tibial shaft, medial malleolus, talus, or metatarsals, as these sites are at high risk for nonunion and associated complications. Management is conservative with minimization of load-bearing activity, although high risk fractures may require bracing and orthopedics follow up.5 Recognition of high-risk patients for stress fractures will ensure appropriate management of these injuries, ultimately decreasing risk of a complicated recovery.

CONCLUSION: Returning to your patient, you ask her to hop, and she experiences a sharp pain between the first and second metatarsal. Plain films show no evidence of fracture. She does report a recent increase in training for an upcoming dance performance. With this information, you counsel her about a possible stress fracture and recommend an MRI which later confirms a first metatarsal fracture. She remains non-weight bearing on the right lower extremity for six weeks and gradually returns to normal activity.

References:

1. G aieski DF, Mehta S, Hollander JE, Shofer F, Bernstein J. Low-severity musculoskeletal complaints evaluated in the emergency department. Clin Orthop Relat Res. 2008;466(8):1987–1995.

2. K elsey JL, Bachrach LK, Procter-Gray E et al. Risk Factors for Stress Fracture among Young Female Cross-Country Runners. Medicine & Science in Sports & Exercise: 2007;39(9): 1457 – 1463 3. R aukar N, Templeton K. Orthopedics and Sports Medicine, In Sex and Gender in Acute Care Medicine. Ed. McGregor AJ, Choo EK, Becker BM. Brown Emergency Medicine.

4. Tendeforde AS, Savres LC, McCurdy ML et al. Identifying Sex-Specific Risk Factors for Stress Fractures in Adolescent Runners. Medicine & Science in Sports & Exercise. 45(10):18431851, October 2013 5. D uignan M, O’Connor N. Female athlete triad: At breaking point. International Emergency Nursing 2017 (34): 51-54

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

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Strategic National Stockpile

SAEM PULSE | MAY-JUNE 2019

By J. Austin Lee, MD MPH and Chris Holstege, MD

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Many healthcare workers have never heard of the Strategic National Stockpile (SNS). As events such as natural disasters and terrorist incidents (which stretch the limits of local hospitals and health departments) occur with increasing frequency, readers should be aware of the public health resources that exist in the United States that may be of benefit in a time of need.

The SNS is an enormous collection of resources managed by the Federal Government that can be dispersed in emergent situations. It is important for emergency medicine providers to know what resources they can call upon in the event of an emergency.

In the late 1990s, the U.S. government created a federal stockpile of pharmaceutical supplies in order to prepare for the possibility of a biological terrorist attack. The Federal Government has maintained and grown the stockpile of medical resources that can be used in the event of an emergency. Previously under the guidance of the Centers for Disease Control and Prevention, this stockpile of resources is now overseen

"The Strategic National Stockpile is an enormous collection of resources managed by the Federal Government that can be dispersed in emergent situations." by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR). While some of the supplies have been utilized in instances of bioterror threats and disease outbreaks, resources have also been deployed to assist state and local entities in disasters such as floods and hurricanes.

Today, the Strategic National Stockpile is an estimated $7 billion inventory of medications (including antibiotics and antivirals, vaccines, and medical supplies) held in a number of warehouses throughout the United States. Out of safety and security concerns, the exact contents and storage locations (or even the number

of locations) are not publicly released.

The stockpile is rotated according to FDA standards, and ongoing medication and vaccine monitoring and testing has helped lengthen use-by dates by several years. Supplies come in readyto-dispense, single-use, individually packaged units to minimize any need to repackage prior to end use. While many of the supplies are kept at room temperature, some of the biologic drugs and vaccines require cold storage and are kept in refrigerated storage units.

Any time the Federal Government decides to deploy any assets from the stockpile for a given outbreak, disaster, or emergency, the supplies are transported and delivered to a pre-designated location in each state

or territory. Once delivered, the materials become the responsibility of the state and local health entities and must be properly stored and secured. The state health department must then unpack and distribute the supplies appropriately to their end destination.

intravenous fluids, airway equipment including endotracheal tubes, oropharyngeal airways, ambu-bags, as well as other medical supplies such as bandages and wound care items.

The Department of Health and Human Services has human resources that can help to assist state and local health departments in how to best utilize and distribute any materials provided.

These are prepackaged healthcare units that contain patient beds as well as supplies and medications for either 50 or 250 patients.

There are several types of supplies that are known to be part of the stockpile cache, including: • Rapidly deployable, ready-to-go packages, called the “12-hour push pack” • Federal medical stations • CHEMPACKs containing nerve agent antidotes • Vaccines, medications, and medical equipment

Push packages These are prepackaged crates filled with 50 tons of supplies that can be delivered to any U.S. state or territory within 12 hours of the decision to do so. Included among the supplies are broad-spectrum antibiotics (oral and intravenous), other medications for emergent conditions,

Federal Medical Stations

CHEMPACKs CHEMPACKs are crates of nerve agent antidotes that are prepositioned and stored in hospitals and EMS locations around the country. In fact, almost every American lives within one hour of these CHEMPACK storage locations. In total, there are nearly 2,000 containers in more than 1,000 locations around the U.S., and they are stocked for either 500 or 1000 individual casualty events.

Supplies in each CHEMPACK include “Mark-1 auto-injectors” (kit injectors of atropine and pralidoxime), as well as additional doses of atropine, pralidoxime, and diazepam. Because these caches are strategically placed around the country, each box is secured with a monitoring device that alerts the Federal Government if it is tampered with or opened.

Finally, it is worth noting that the contents of the federal stockpile have continued to change and evolve with time and the rise of new threats, such as Ebola. Going forward, the contents of the stockpile and CHEMPACKs will likely evolve and change. While it is our hope that you will never need to request, access, or utilize the contents of your local CHEMPACK or a 12-hour push pack, part of our job as emergency medicine providers is to know what resources are available and utilize them if the need may arise.

ABOUT THE AUTHORS J. Austin Lee, MD MPH, is a chief resident in the department of emergency medicine at the University of Virginia, and has an interest in emergency medicine as well as domestic and international public health.

Chris Holstege, MD, is a professor of emergency medicine and pediatrics and the chief of the Division of Medical Toxicology at the University of Virginia, as well as the director of the Blue Ridge Poison Center.

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PERSPECTIVES ON PARENTING DURING RESIDENCY

By Kathleen Li, MD, and Andrew D’Alessandro, MD

THE RESPONSIBILITY FOR NURTURING AND FORMING A CHILD’S LIFE IS NO LIGHT LOAD. CONSIDERING THAT RESOURCES, FAMILY STRUCTURES, AND VALUES ARE AS VARIABLE AS REASONS FOR HAVING A CHILD IN THE FIRST PLACE, THERE TRULY IS NO ONE, SET PATH FOR CARRYING THE EXTRA RESPONSIBILITY OF AN ADDITIONAL CHILD.

Starting a family during residency can feel like a daunting task, but you are not alone. According to a 2016 survey of almost 650 residents and fellows, 40 percent planned to have a child during residency training. Here are a few of the many matters to consider when planning for a family.

WHEN TO START? This is, of course, a personal choice, and it can feel like there is no “right” time, but in reality there is likely no “wrong” time either. For medical students, the preclinical years are more flexible than clinical years. There is often a lot of free time during fourth year as well, but timing with away rotations and interviews can be challenging, and there is the consideration of starting intern year with an infant to care for. Residents may prefer to wait to start a family until their last year of residency, which generally has the most elective time; however, if a different timeline works for your family, you may be able to rearrange your rotations to move elective time from one year to another.

MATERNITY LEAVE Once pregnancy is confirmed, it is important to let your program director and scheduling chiefs know as soon as you are comfortable sharing the news, in order to plan for maternity leave. None of the national emergency medicine organizations has an explicit policy regarding residency parental leave, which leaves expected practice patterns to be determined. According to one study, trainee mothers (from all specialties) reported taking a median of five to eight weeks of maternity leave, although the author’s experience in a four-year emergency medicine program has been that people choose to take anywhere

from eight to 12 weeks off. This amount of leave can be accomplished by rearranging elective and/or vacation time. More leave may be possible, but at the risk of extending your training by a month or two.

Predicting the start of maternity leave is also difficult, as some circumstances may require the mother to be on bedrest or to deliver early. At the same time, starting maternity leave too much in advance of baby's birth may reduce the time the mother has to recover and adjust to parenthood before returning to work.

Far from being a vacation, maternity leave is typically an exhausting blur of interrupted sleep and trying to keep a tiny human alive. Maternity leave offers a precious time for mother and newborn to bond, but it is also a time for mother to recover from the delivery, which may have involved vaginal tears, urinary incontinence, hemorrhoids, and/or possibly a C-section. It can be tempting to plan to work on a project or paper during this time, but moms should not be surprised if they can barely muster the energy for a daily shower during those first weeks. At the same time, cabin fever may make the prospect of attending a resident conference or grabbing a meal with co-residents especially appealing.

for safe patient care.” How proximate that space needs to be to the emergency department is not defined, but nursing mothers should ask their residency leadership or other female attendings to help find a good and practical solution. Breastfeeding mothers might also consider introducing a bottle at least a few weeks before going back to work so that your child has time to get accustomed to (this may be easy or it may require trying a few different nipple types). One solution that worked well for the author was to pump once a day and have the spouse give a middle-of-thenight feed. The result was longer sleep for mom and a daughter who got used to the bottle.

Childcare. Who will take care of baby once mom returns to work? Whether it is a grandparent, spouse, nanny, daycare, or some combination of the above, it is a good idea to think about this well in advance — even before the birth of baby. Many hospitals have on-site daycare centers, but these often have lengthy waitlists. Given the odd hours of emergency medicine, a nanny may be a more flexible solution.

Nannies can be found through friends, online communities such as local mom Facebook groups, or through larger

websites like Care.com. To make the first days back at work less stressful for everyone, consider having the nanny do a few trial runs or start part-time while one parent is still at home on leave.

Some couples choose to stagger their parental leave so that one parent can be home with the baby for a longer period of time.

PATERNITY LEAVE The policies and cultures regarding paternity leave across the country are vast. Notably, nine out of 10 fathers in the U.S. take some time off work for the birth or adoption of their child; however, 70 percent of fathers take ten days or fewer of leave. Residents are unlikely to be the exception to this norm considering full use of the Family and Medical Leave Act (FMLA) policy of 12 weeks of unpaid leave may create a challenge for residents to meet the requirements of intensive graduate medical education.

While there is no data regarding the prevalence of paternity leave policies among emergency medicine programs, 2016 survey data of general surgery programs found less than half (48 percent) had formal paternity leave policies. Of the standing paternity leave policies there is significant variability

Returning to work after leave is another challenge. In addition to the feelings of guilt a new mom often experiences over leaving her infant child, she now must also figure out the logistics of nursing/feeding and childcare.

Pumping. Mothers who choose to breastfeed, and subsequently pump, will need to buy a pump, build up a small supply of stored breast milk, and find time and space during shift to pump.

All health insurance plans are required to cover the cost of a breast pump, although they will likely not cover all brands or models. Breastfeeding mothers may want to consider splurging on cups and/or pumps that fit inside their bras (e.g. Freemies, the Elvie, Willow) to make pumping on-the-go a bit easier.

Beginning July 1, 2020, ACGME Common Program Requirements will require “clean and private facilities for lactation that have refrigeration capabilities, with proximity appropriate

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from one day to seven weeks. In the absence of formal policy guiding paternity leave, cultural norms and specific hospital policies will drive practice patterns. Not surprisingly, when the work culture is supportive, fathers are more likely to take leave and to take longer leaves.

To garner support from the program director, chiefs, and co-residents, be transparent about your hopes and anticipated needs for a set course of paternity leave. In the author’s case, the program director and chief knew that he and his spouse were expecting a second child even before their families were made aware. This transparency aided in scheduling and planning of responsibilities during the calendar year, especially around the due date.

The author took a “vacation” week following the birth of his son and used previous shift trades to open up his schedule — all while being on a less time intensive rotation. In sum, he was able to be home to bond with his newborn, support his partner, help out with the older child, and navigate the shifting ebbs and flows of home life.

PATIENCE IS REQUIRED FOR HOW AND WHEN BASIC ADULTING TASKS (E.G., GROCERY SHOPPING, HOUSE CLEANING, CAR REPAIRS) GET DONE. BE PATIENT WITH THE DISRUPTIONS AND RECOGNIZE THAT LEARNING TAKES TIME. PARENTING MULTIPLES The ideal logistical, financial, and psychological time for having children (if there is one) is likely after residency, however, the realities of life are far from ideal. Adding one child, let alone two, brings increasing degrees of responsibility and uncertainty into one’s life. The responsibility for nurturing and

forming a child’s life is no light load.

Considering that resources, family structures, and values are as variable as reasons for having a child in the first place, there truly is no one, set path for carrying the extra responsibility of an additional child. Here are three realizations from a recently “multipled” father to help guide you through the transition from one child to two or more: Practice patience. Be patient with yourself, your spouse, and your children as all adapt to the new demands on your time and a changed dynamic in the home. Although adding a second (third, etc.) child to your family does not carry the same explosion of “OMG this breathing ball of flesh and bones depends on me” as when the first child comes into the world, the addition of another child does force a greater redistribution of routine and responsibility. This reset will take everyone, including yourself, time to learn and adopt. Seemingly simple tasks, like mobilizing the whole family and getting them out the door on time in the morning, becomes a jumbled exercise in corralling and carrying kids and remembering their many belongings. Patience is required for how and when basic adulting tasks (e.g., grocery shopping, house cleaning, car repairs) get done. Be patient with the disruptions and recognize that learning takes time.

Divide and conquer. Time is a precious commodity for a resident. With the extra responsibility of an additional child (or two), your time must be divided by a larger denominator.

There are now two (or more) times the clothes to wash, diapers to change, bodies to bathe, nails to trim, etc. You may be nimbler than your spouse at changing diapers, swaddling infants, and managing bath time, but these just touch on all the work to be done. Keep an open line of communication with your partner to discuss tasks needing division and new challenges needing to be conquered. Set up individual time with your partner to reconnect, recharge, and revisit evolving dynamics in the home. This may mean letting

dishes and clothes pile up for a day in order to forge a united front.

Enlist flexibility. Whether in medicine or in family life, flexibility is important.

Be flexible and patient with yourself and your partner as your emotional and physical limits are tested and stretched.

Allow “routine” to take on a new meaning as you shuffle and reshuffle your days, your priorities, and your schedules.

Order and organization are beneficial, but being flexible with “routines” can lead to greater productivity. After having a second child, the author found that research and writing had to be completed in more frequent brief intervals rather than longer, uninterrupted stretches of time. The point is this: there is usually more than

one way to accomplish something.

Discovering alternative routes to accomplish your goals can be a lifesaver when things are most stressful.

ABOUT THE AUTHORS: Andrew D’Alessandro, MD, is an emergency medicine resident at Vanderbilt University Medical Center.

Kathleen Li, MD, is a PGY-4 in the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai.

SET UP INDIVIDUAL TIME WITH YOUR PARTNER TO RECONNECT, RECHARGE, AND REVISIT EVOLVING DYNAMICS IN THE HOME. THIS MAY MEAN LETTING DISHES AND CLOTHES PILE UP FOR A DAY IN ORDER TO FORGE A UNITED FRONT.

FOR MORE INFORMATION 1. B lair, JE, et al. Pregnancy and Parental Leave During Graduate Medical Education.

Acad Med. 2016; 91:972-978.

2. L ewin MR. Pregnancy, parenthood, and family leave during residency. Ann Emerg Med. 2003; 41:568-573.

3. N epomnyaschy L, Waldfogel J. Paternity leave and fathers’ involvement with their young children. Community Work Fam. 2007; 10(4): 427-453.

4. J agsi R, Tarbell NJ, Weinstein DF. Becoming a doctor, starting a family — leaves of absence from graduate medical education. N Engl J Med, 2007;357(19), 1889–1891.

5. S andler BJ, Tackett JJ, Longo WE, Yoo PS. Pregnancy and parenthood among surgery residents: results of the first nationwide survey of general surgery residency program directors. J Am Coll Surg. 2016; 222(6), 1090–1096. doi: 10.1016/j.jamcollsurg.2015.12.004 6. P hilibert I, Bickel J. Maternity and parental leave policies at COTH hospitals: an update. Council of teaching hospitals. Acad Med. 1995;70:1055-1058 7. O ’Brien M. Fathers, parental leave and infant quality of life: international perspectives and policy Impacts. Ann Am Acad Pol Sci. 2009; 624: 190-213.

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SUBSTANCE USE HAS ITS BENEFITS, BUT WE MUST REMEMBER OUR OATH TO DO NO HARM, EVEN TO OURSELVES, AND ENDEAVOR

OPINION: SUBSTANCE USE IN MEDICAL TRAINING

TO MITIGATE THE NEGATIVE CONSEQUENCES OF DRUG USE IN OUR COMMUNITY.

By M. Asher, MS-4 The National Survey on Drug Use and Health has been tracking the use of alcohol, tobacco, and drugs in the United States since the 1970s. From this data, DrugAbuse.com synthesized information across the generations of respondents. While alcohol is a common thread throughout the generations, other drugs fluctuate in popularity. Millennials, for example, tend to use painkillers significantly more than any other generation, while use of other substances seems to have decreased from the Baby Boomers to Millennials. How do social factors in the general population influence substance use among current medical students and residents, and what are the consequences?

Many substances have been shown over time to be beneficial in moderation, but harmful in excess. The biggest trick is figuring out where the line is drawn and where you stand.

Caffeine, for instance, allows medical trainees to stay awake longer and focus more. Of course, this is not a replacement for actual sleep, although many people use it that way. Does it benefit us to use caffeine or does the acceptability and ubiquity of caffeine simply change the baseline expected amount of sleep needed for trainees? What about other “uppers” like amphetamines? Outside of prescription use, does the focus and productivity gained from taking these provide a net benefit or is it a detriment?

Alcohol consumption is common at social gatherings in our society, including at those of medical professionals. At the same time, we counsel patients constantly about the dangers of alcohol misuse and dependence. Recreational marijuana use, now becoming more widely accepted, and increasingly legal, is another way people manage stress. Do these “downers,” which medical trainees and professionals may find useful to cope with the stress of their jobs, help or hurt?

This contrasting use — an upper to get to work and a downer to decompress from work — is a common trope in high stress jobs. The drugs that our generation tend to use may be influenced by our society, but the use of drugs to improve performance or ease stress isn’t anything new, especially in medicine. In some ways, it’s obvious that this is a problem.

Long-term heavy use of any of these substances has been shown to have adverse health outcomes and a negative effect on work performance. But in the short term, for the few years of medical school and residency, substances may be important to keep from failing classes, from falling asleep during a test, from drifting off during surgery. So what is the solution?

Substance use among medical trainees and its association with the significant pressures of being a trainee may be a “chicken and egg” scenario. Regardless of cause and effect, however, we must ask ourselves as a medical community whether the dangerous consequences of heavy substance use are worth the benefits of widespread moderate use.

Recent data and shifting opinions may be leaning towards approaching substances with greater hesitancy and sensitivity to reduce the possibility of misuse.

Addiction is more widely accepted as a disease to be treated, rather than a fault of the addict to be punished, as discussed in Dr. Stanbrook’s 2012 article, “Addiction is a disease: We must change our attitude towards addicts.” Horien et al. speak to the importance of including substance use issues when discussing the more popular topics of wellness and burnout in their 2018 article, “Substance Use in Medical Trainees: Current Problems and Future Directions.”

For our patients, we advocate moderation of drugs like caffeine and alcohol and abstinence of others like heroin and tobacco. If this is the way we discuss health with our patients, it seems reasonable that we should listen to our own advice. This would mean, however, that certain training practices, and even the way we approach training, may need to change in order to allow for students and residents to use substances more responsibly. If that is the case, we must then target research towards identifying modifiable aspects of medical training and then apply that research to our medical schools and residency programs.

Substance use may have benefits, but we must remember our oath to do no harm, even to ourselves, and endeavor to mitigate the negative consequences of drug use in our community.

If you or someone you know is struggling with substance abuse, treatment referral and information can be found at www.samhsa.gov or by calling 1-800-622-HELP (4357).

NARRATIVE MEDICINE:

ONE SMALL BOX

By Madeline Brockberg, MD PGY-2, Boston Medical Center Who can hold this box for me?

It is so small but so heavy.

It fits in my locker but isn’t big enough To store your blue striped pants and your black onesie.

What could be big enough for that?

They’re all cut up but they still belong to you.

I didn’t use to know (or ever want to know) they made boxes so small.

I don’t think it fits on any of my usual shelves.

They’re not that crowded and I guess there is room But I would rather give you all away.

I just don’t know who to give you to.

Maybe I could divide you up.

Give parts of you away to people who seem worthy.

My oldest brother could have your pudgy arm where we couldn’t get an IV. And my husband could take your broken ribs.

Someone else who loves me could hold your pinky sized breathing tube.

And my parents could share your newly braided hair with the purple pom poms.

Would that make the box lighter?

“How was work today?”

“A little girl died, do you think you could carry this box for me?”

I stood next to you and prayed for a miracle

ABOUT THE AUTHOR:

And it didn’t take long for our miraculous efforts to feel cruel.

M. Asher is a fourth-year medical student at the University of Queensland – Ochsner Clinical School.

So we packaged you up And the small box could have filled the bay, the side, the whole street.

So heavy and so small, so big and so light.

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BRIEFS AND BULLET POINTS SAEM NEWS

will highlight the proceedings from the 2019 SAEM annual meeting relevant to education and training. Details and submission instructions can be found online. Deadline is August 31, 2019.

Submit Your Suggestions for the Next Big Research Topic in Emergency Medicine!

Introducing the First Installment in the New ALiEM-SAEM Clinical Image Series

Proposals are now being accepted for the 2021 SAEM Consensus Conference, May 11, 2021, in Atlanta, GA. For more than 20 years, the Consensus Conference has gathered junior and senior researchers, thought leaders, and other stakeholders in emergency medicine to generate research agendas for the important, unanswered questions facing emergency care, leading to high-quality, funded research projects of varying scopes from a variety of funding sources. Deadline for submissions is September 2. For details, guidelines, and a list of previous topics, visit the webpage.

Dysphagia and Dyspnea in a Well Digger,

by Drs. Moises Gallegos, MD, MPH and Shane Jenks, MD, from Baylor College of Medicine, is the first SAEM19 clinical image to be showcased in the new ALiEM-SAEM Clinical Image Series.

Clinical Images from SAEM’s 2019 annual meeting will be posted throughout the coming year at www.aliem.com.

July 31 is the Deadline to Apply for the Next ARMED Course

Taught by leading experts in academic emergency medicine, the purpose of the ARMED course is to equip junior faculty (within five years of graduation), fellows, and senior residents who are interested in pursuing a career in research with the fundamental knowledge and skills to design a high-quality research project and grant proposal. Applications are due July 31, 2019. Class begins September 2019 for those who are accepted into the program.

Call for Papers: AEM E&T Annual Meeting Proceedings Issue

AEM Education and Training (AEM E&T) invites submissions from SAEM academies, committees, and interest groups for a special issue of the journal that will publish in early 2020. The issue

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The Academic Career Guide is a useful tool for anyone who is still growing in his or her academic EM career.

Renew Your Membership in SAEM and Keep the Benefits Coming!

Please renew your investment in an SAEM membership today to continue to enjoy all the benefits and privileges of membership. Renewing your SAEM membership has never been easier‌ just log in to your SAEM profile or call our membership department at (847) 813-9823 ext. 202, to renew over the phone.

Upgraded Directories for Clerkships, Fellowships, and Residencies

The new and improved directories for emergency medicine clerkships, fellowships, and residencies are open! SAEM directories are the most comprehensive online listings accessible to the public. The enhanced directories are easier to update, simple to search, and more detailed in presenting vital information. The most obvious change is that each directory is now searchable via a map view. Search by specific criteria, save your favorites, and compare up to three saved institutions. See an institution's most up-to-date information and access their website through the directory. Questions?

Email directories@saem.org, or call (847) 257-7225.

SAEM FOUNDATION Apply for SAEM Foundation Grants

by August 1 Check Out the Updated SAEM Academic Career Guide

The newly-updated SAEM Academic Career Guide is a comprehensive how-to manual for students, residents, fellows, and early career emergency physicians interested in pursuing a career in academic emergency medicine (EM). It includes tips and strategies for working toward positions such as department chair, residency program director, clerkship director, and dean.

Two new grants, totaling $15,000, are among several grants from the SAEM Foundation that are presently accepting applications until 5 p.m. CT on August 1, 2019. The SAEM Foundation, in partnership with SAEM, provides grants to national and international universities and medical schools to help fund innovative research and education initiatives in the field of emergency medicine. For policies, procedures, and submission guidelines, please visit How to Apply.

SAEM RAMS

SAEM Academy Podcasts

• AACEM/AWAEM Scholarship Form

Check Out the Latest Podcasts from RAMS!

•C . Christopher King Memorial Scholarship Form

Ask-a-Chair

2019-2020 SAEM President Ian B.K. Martin, professor and system chair of the Department of Emergency Medicine and professor of Ian B.K. Martin, MD, MB medicine at the Medical College of Wisconsin (MCW) is featured in the latest RAMS Ask-a-Chair podcast. Dr. Martin discusses how he became a department chair, the steps he took on his path to becoming a leader in emergency medicine, what residents and medical students can focus on now to set them up for leadership roles later, and how he balances his research and leadership responsibilities with his personal life.

Who’s Who In Academic Emergency Medicine

Megan L. Ranney, MD, MPH

Richard Cantor, MD

Megan L. Ranney, MD, MPH, associate professor in the Department of Emergency Medicine at the Warren Alpert Medical School, Brown University, and Richard Cantor, MD, section chief of pediatric emergency medicine professor and division chief of emergency medicine at SUNY Upstate Medical University are the featured guests in the most recent episodes of the SAEM RAMS podcast series, “Who’s Who In Academic Emergency Medicine.” Dr. Ranney is director and founder of the Brown Emergency Digital Health Innovation Program; director of special projects in the Department of Emergency Medicine; and chief research officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM). Dr. Cantor is medical director of the Poison Control Center at Syracuse University and is nationally known for his work as a researcher and educator in the fields of pediatric emergency medicine and toxicology.

RAMS Who’s Who Podcasts are also available on iTunes.

• AACEM/ADIEM Scholarship Form

•A ACEM Chair Development Program (CDP) Application Form Ava Pierce, MD

Marquita Norman Hicks, MD

The most recent SAEM Academy Podcast features Ava Pierce, MD, UT Southwestern Medical Center and Marquita Norman Hicks, MD, Wake Forest University School of Medicine, president and presidentelect, respectively, of SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM). The doctors talk what makes ADIEM unique, the best ways for residents and medical students to get involved, and resources available to them through ADIEM. They discuss their personal paths in academic EM and give advice for those who wish to follow in their footsteps.

Need Help With Teaching, Research, and Other EM Practice Issues? SAEM Expert Consultants Are Here for You!

Members of the Society for Academic Emergency Medicine possess expertise in teaching, research and other aspects of academic emergency medicine practice. Through SAEM Consultation Services, these experts from SAEM committees, academies, and in consultation with the Association of Academic Chairs in Emergency Medicine, are available to provide individuals, departments, and institutions with assistance aimed at developing, evaluating, or improving various services, including but not limited to new residency or fellowship programs; developing departmental status for emergency medicine divisions; subspecialty expertise (research, ultrasound, etc.); and emergency department billing, patient safety, etc.

Call for Scholarship Applications: AACEM Chair Development Program September 25, 2019, is the application deadline for the Association of Academic Chairs of Emergency Medicine Chair Development Program (AACEM CDP) and for the following AACEM scholarships, which cover the cost of CDP tuition ($4,200) and an additional travel stipend ($2,500).

The AACEM CDP is a leadership training initiative designed to enhance the capabilities and effectiveness of new and aspiring academic emergency medicine department chairs through skill development, advising, and mentorship.

AWAEM-FemInEM Release Six More Episodes of Joint Podcast Series: “Anniversary Interviews”

In the latest six episodes in the AWAEMFemInEM podcast series, “Anniversary Interviews: 10 Years of Progress,” host Michelle Lin, MD, MPH, MS, interviews the following leading women in academic emergency medicine. The podcast series celebrates the 10th anniversary of SAEM’s Academy for Women in Academic Emergency Medicine and is a joint venture with FemInEM.

Wendy Coates, MD

Basmah Safdar, MD

Stacey Poznanski, MD

Dara Kass, MD

SAEM Board Member, Wendy Coates, MD, senior faculty and education specialist at Harbor-UCLA Los Angeles County, and a pioneer in emergency medicine education.

Former AWAEM President, Basmah Safdar, MD, associate professor at Yale University and expert in sex and genderspecific research.

Former AWAEM President Stacey Poznanski, MD, assistant professor, Department of Emergency Medicine, and director of the EM clerkship at Wright State University.

Dara Kass, MD, founder of FemInEM and director of equity and inclusion in the Department of Emergency Medicine at Columbia University.

Continued on Page 38

37

Alexandra Mannix, MD

Melissa Parsons, MD

Alexandra “Lexie” Mannix, MD, an assistant professor, assistant residency director and assistant clerkship director at the University of Florida – Jacksonville Melissa Parsons, MD, an assistant professor and assistant program director at the University of Florida College of Medicine – Jacksonville

SAEM JOURNALS Academic Emergency Medicine Add These AEM Podcasts to Your Listening Lineup

AEM Education and Training Dr. Susan B. Promes is Named Editor-in-Chief of AEM Education and Training

Susan B. Promes, MD, MBA, has been named editor-in-chief of Academic Emergency Medicine Education and Training (AEM E&T) journal effective June Susan B. Promes, MD, MBA 1, 2019. She had been serving as editor for the journal since its founding in 2017. AEM E&T is dedicated to emergency care educational research and training methodology and is the sister publication to Academic Emergency Medicine, the Society’s flagship journal.

ICYMI: Here Are the April-June AEM E&T Podcasts

ICYMI, here are the most recent podcasts, from the May and June issues of Academic Emergency Medicine journal:

Here are the most recent podcasts, from the April–June issue of AEM Education and Training (AEM E&T) journal:

“Capturing Emergency Department Discharge Quality with the Care Transitions Measure: A Pilot Study,” featuring first author Amber K. Sabbatini, MD, MPH, assistant professor in the Department of Emergency Medicine at the University of Washington.

“Attitudes, Behavior, and Comfort of Emergency Medicine Residents in Caring for LGBT Patients: What Do We Know?” featuring first Joel Moll, MD author Joel Moll, MD, residency program director and associate professor in the Department of Emergency Medicine at Virginia Commonwealth University School of Medicine.

“The Yield of Head CT in ED Syncope Eval: A Systematic Review,” featuring first author J. Alexander Viau, MA, BMBS, a Y-4 medical student at the University of Limerick, Limerick, Ireland and J. Alexander Viau, MA, BMBS a research assistant at the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

“Civil Monetary Penalties Resulting From Violations of the Emergency Medical Treatment and Labor Act (EMTALA) Involving Psychiatric Emergencies, 2002 to 2018”, featuring first author Sophie Terp MD, MPH, assistant professor, clinical emergency medicine, Keck School of Medicine of University of Southern California.

AEM journal podcasts are also available on iTunes.

“Coming in Warm: Qualitative Study and Concept Map to Cultivate Patientcentered Empathy in Emergency Care” featuring first author: Katie E. Pettit, MD Katie E. Pettit, MD, Assistant Professor of Clinical Emergency Medicine and Associate Program Director for the Emergency Medicine residency program at IU School of Medicine Academic Emergency Medicine Education and Training podcasts are also available on iTunes.

SUBMIT YOUR ANNOUNCEMENT! 38

REGIONAL MEETINGS Now Accepting Abstracts for SAEM Regional Meetings Midwest Regional Southfield, MI, Sept. 19 Abstract submissions: midwestregion@saem.org Great Plains Regional Springfield, IL, Sept. 20–21 Abstract submissions: greatplainsregion@saem.org South Central Regional Dallas, TX, Sept. 6–7 Abstract submissions: southcentralregion@saem.org

IN OTHER NEWS ABEM-Developed Alternative to ConCert to be Piloted in 2020

MyEMCert, the ConCert alternative currently under development by the American Board of Emergency Medicine (ABEM), will be piloted in 2020 and, pending results of the pilot, be available in 2021. Visit ABEM’s MyEMCert webpage for the latest information and a set of FAQs. If you have questions, please contact ABEM at 517.332.4800, ext.

383, or moc@abem.org.

ABEM Releases New LLSA Reading List and Test

The 2019 Pediatric Emergency Medicine LLSA (Lifelong Learning and SelfAssessment) reading list and test are now available on the ABEM website. ABEMcertified physicians can choose this or any other LLSA test to fulfill their LLSA requirement.

The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to newsletter@saem.org.

The next content deadline is August 1, 2019 for the September-October 2019 issue.

ACADEMIC ANNOUNCEMENTS Columbia University

Southern Illinois University

ernard P. Chang, MD, PhD, has been named vice B chair of research for the Department of Emergency Medicine at Columbia University. A psychologist and emergency physician, he is the principal investigator of several federally-funded studies on neurological disease and mental health. Dr. Chang is a member of the SAEM Grants Committee and the SAEM Research Bernard P. Chang, MD, PhD Committee and is a graduate of the inaugural class of the SAEM ARMED research training program.

Christopher McDowell, MD, MEd, MS, an emergency medicine physician with SIU Medicine and the medical director of the Memorial Center for Learning and Innovation, is the first recipient of the newly created David L. Griffen, MD, PhD, Endowed Chair of Emergency Medicine. McDowell is also associate professor and vice chair of education with the Christopher McDowell, MD, MEd, MS Department of Surgery at SIU School of Medicine.

Thomas Jefferson University ernie Lopez, MD, MS, CPE, professor and executive B vice chair in the Department of Emergency Medicine at the Sidney Kimmel Medical College of Thomas Jefferson University has been appointed to the National Academies of Science, Engineering and Medicine’s Committee on Addressing Sickle Cell Disease: A Strategic Plan and Blueprint for Strategic Bernie Lopez, MD, MS, CPE Action. The committee’s charge is to develop the strategic plan and blueprint for the treatment of sickle cell disease in the United States.

University of California, San Francisco

Maria Raven, MD, MPH

University of California, Irvine J. Christian Fox, MD, RDMS, professor of clinical emergency medicine, was appointed chair for the Department of Emergency Medicine at the University of California, Irvine. Before serving as interim chair for two years, he was the vice chair for faculty affairs.

Harvard University hristopher L. Bennett, MD, a resident in emergency C medicine at Brigham and Women’s Hospital/ Massachusetts General Hospital, has been appointed to the Committee on Publications of the Massachusetts Medical Society. This committee, which oversees the editorial board of the New England Journal of Medicine (NEJM), offers a deep insight into Christopher L. Bennett, MD the editorial decisions of NEJM as well as the business of medical publishing. Dr. Bennett recently completed a one-year term as the resident member of the SAEM Board of Directors.

Edward W Boyer, MD, PhD

E dward W Boyer, MD, PhD, associate professor of emergency medicine at Harvard Medical School and director of academic development at Brigham and Women’s Hospital, has received a $3.18 million grant from the National Institutes of Health (NIH).

Funded under a R01 mechanism, the study compares several different methods of measuring adherence to antiretroviral therapy in HIV-positive individuals taking opioid analgesics.

South Huron Hospital Association Ken Milne, MD, MSc, CCFP-EM, FCFP, FRRMS, chief of staff at South Huron Hospital Association in Exeter, Ontario, Canada, has been selected to be presented with the Judith E. Tintinalli Award from the American College of Emergency Physicians.

Ken Milne, MD, MSc

r. Milne is on the Senior Editorial Board for D Academic Emergency Medicine (AEM) and produces a monthly podcast for the journal through his wellknown Skeptics Guide to Emergency Medicine, a weekly podcast with over 40,000 subscribers. He is

also a co-recipient of SAEM's first-ever FOAMed Excellence in Education Award.

Maria Raven, MD, MPH, associate professor of clinical emergency medicine at the University of California, San Francisco (UCSF) has been named chief of emergency medicine at UCSF Medical Center. Dr. Raven was the recipient of the 2018 SAEM Academy for Women in Academic Emergency Medicine (AWAEM) Mid-Career Faculty Award.

J. Christian Fox, MD, RDMS

Megan Boysen Osborn, MD, MHPE, associate professor and vice chair of education for the Department of Emergency Medicine the University of California, Irvine has been appointed the associate dean for students for the UC Irvine School of Medicine. She will oversee student affairs, admissions, and diversity and inclusion.

Megan Boysen Osborn, MD, MHPE

Shannon Toohey, MD, MAEd, assistant professor at the University of California, Irvine was named program director for the emergency medicine residency program. Dr. Toohey has served as associate and assistant program director for the past three years. She was honored with the CORD Academy for Scholarship in Education Scholar Award Shannon Toohey, MD, MAEd for enduring materials in April 2019.

University of Massachusetts

Edwin D. Boudreaux, PhD

Edwin D. Boudreaux, PhD, along with Bo Wang, PhD, both of the University of Massachusetts School of Medicine, have received an NIH R01grant award. The study will derive a clinical decision rule to support universal suicide risk detection in the emergency department and optimize patient care workflow. The results will help reduce confusion regarding which specific indicators to assess and help avoid over- or under-evaluating patients with suicide risk.

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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 August 1.

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

University of North Carolina at Chapel Hill, Department of Emergency Medicine is currently recruiting for per diem faculty and full-time fellowship openings for 2019-2020.

Fellowship openings are available in the areas of Administrative leadership, Education, Geriatrics, Research and Global Health. Successful applicants will be Board Certified/Board Prepared in Emergency Medicine.

UNC Hospitals is a 750-bed Level I Trauma Center. The Emergency Department sees upward of 69,000 high acuity patients per year.

Applicants should send a letter of interest and curriculum vitae to: Gail Holzmacher, Business Officer at 919-843-1400 gholzmac@med.unc.edu or Kelly_armstrong@med.unc.edu HR Consultant, Department of Emergency Medicine, CB #7594, Chapel Hill, NC 27599-7594. FAX (919) 966-3049.

The University is an equal opportunity, affirmative action employer and welcomes all to apply without regard to age, color, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, or sexual orientation. We also encourage protected veterans and individuals with disabilities to apply.

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Pediatric Emergency Medicine Physician Atrium Health Levine Children’s Emergency Department is hiring additional pediatric emergency medicine subspecialists in the clinician educator role. The Division of Pediatric Emergency Medicine, in the Department of Emergency Medicine, at Atrium Health Carolinas Medical Center and Atrium Health Levine Children’s Hospital seeks qualified candidates to help us expand pediatric emergency medical expertise across the system. Levine Children’s Hospital is the largest children’s hospital between Atlanta and Washington, DC.

About our Emergency Department: •

Level I trauma center staffed by an inclusive group of pediatric emergency medicine subspecialists and emergency medicine specialists.

• •

We sponsor a pediatric emergency medicine fellowship program with two fellows per year.

We provide state of the art pediatric emergency medical services to the diverse community of Charlotte using a family centered care model with the help of child life specialists, interpreters, social workers, patient care representatives, and psychiatric care navigators Our facility is expanding to 21 beds in 2020 while designing a brand-new children’s emergency department expected to open in 2024.

•

Candidates with the following training will be considered: • •

Combined Emergency Medicine and Pediatrics residency training Emergency Medicine residency AND Pediatric EM fellowship training

•

Pediatrics residency AND Pediatric EM fellowship training

About the community: •

•

Located in the heart of the Southeast, Charlotte is the largest and most accessible city between Washington, DC and Dallas, TX. Due to its mid-Atlantic location, getting to Charlotte is easy from anywhere in the country or the world, hence its nickname “the International Gateway to the South.”

The current population of the immediate metropolitan area is 2.4 million. Charlotte ranks 1st in economic strength while maintaining a cost of living below national average. As the 17th largest city in the United States, Charlotte has significant cultural and education resources. The arts are well supported by the community and the educational system is progressive, with strong schools in both public and private sectors. Charlotte is 2 hours from the Blue Ridge Mountains and 3 hours from many coastal resorts.

EM Jobs Now on SAEM Facebook Does your institution have an open position it’s looking to fill? Contact John Landry at 847-257-7224 or jlandry@saem.org to add your name to the career widget on our SAEM Facebook page. Job seekers: Click on “Careers” on the left-hand menu of SAEM’s Facebook page to view recently posted jobs in academic emergency medicine.

Free CV Critique Did you know that EM Job Link offers a free CV critique service to job seekers? As a job seeker, you have the option to request a CV evaluation from a writing expert. You can participate in this feature through the CV Management section of your account. Within 48 hours of opt-in, you will receive an evaluation outlining your strengths, weaknesses and suggestions to ensure you have the best chance of landing an interview.

Job Alert!

Are you looking for a job in academic emergency medicine? Create a personal job alert on EM Job Link so that new jobs matching your search criteria will be emailed directly to you. Make sure the perfect opportunity doesn’t pass you by. Sign up for job alerts today on EM Job Link by clicking on Job Seekers and then selecting Job Alerts. You will be notified as soon as the job you’re looking for is posted.

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{ 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.

42

Emergency Medicine Residency Program Director

Level 2 trauma center with high acuity

JOB DESCRIPTION

seeks Program Director to help develop and

» Develop and lead the operation of the EM Residency Program » Oversee the activities of the residents and other faculty members » Recruit, interview, and select residents, and facilitate the involvement of residents » Assist the Medical Center in recruiting a sufficient number of appropriately trained and qualified faculty members to conduct the program. » Participate with the DME/DIO and VPMA in the overall formulation, review and revision of policies and procedures, and structure and content of the curriculum for the program. » Structure, coordinate, and participate with the faculty in providing a didactic program for residents in compliance with ACGME requirements » Ideal candidate will have experience developing a program from beginning through implementation & will have strong administrative and team-building skills. » Additional responsibilities as outlined by ACGME & available to interested candidate

implement a NEW ACGME EM residency. This is an exciting opportunity for an experienced, motivated physician leader to have input in building a program from the ground up.

The Program Director will be responsible for the development and operation of the Emergency Medicine Residency Program and will oversee the activities of the residents and other faculty members.

POSITION BENEFITS » Competitive salary including but not limited to paid vacation, matching retirement, health, dental and vision insurance options » Commencement bonus and relocation allowance » CME allowance , paid malpractice and paid licensing fee » Protected time minimum 50% (20 hours/week) dedicated to program educational and administrative duties

FOR MORE INFORMATION PLEASE CONTACT

Sarah Purvis Director, Southeast Health Physician Recruitment

office: 334-793-8145 • cell: 334-797-5090 sbpurvis@southeasthealth.org

REQUIRED QUALIFICATIONS » Minimum of 3 years’ experience as a core faculty member in an ACGME accredited EM program & 3 years demonstrated exp. in an ACGME leadership role » Current certification by ABEM or AOBEM; » Evidence of ongoing involvement in scholarly activity, including peer-reviewed publications

43

Department of Emergency Medicine Yale University School of Medicine Advancing the Science and Practice of Emergency Medicine Department of Emergency Medicine Department of Emergency Medicine University School Yale University School ofYale Medicine The Department of Emergency Medicine at the Yale University School of Medicine has a of totalMedicine of 4 clinical sites:

Adult Emergency Services at York Street Campus; Shoreline Medical Center; Saint Raphael’s Campus; and the West Haven VA Emergency Department with a combined ED volume ofScience 195,000 visits year. WeofareEmergency seeking faculty at all Advancing and per Practice Medicine Advancing the Science and Practice ofthe Emergency Medicine ranks (Clinician, Assistant Professor, Associate Professor, Professor, etc.) with interests in clinical care, education or research to enhance our existing strengths. Interest and/or experience in observation medicine is a plus. The successful The Department of athas theaYale of Medicine has a total of 4 clinical sites: The Department Emergency Medicine at the Yale University School ofMedicine Medicine total ofemergency 4 clinicalSchool sites: candidate mayofbe a full-time clinician committed to Emergency excellence in patient care andUniversity medicine education or one Adult Emergency Services at York Street Campus; Shoreline Medical Center; Saint Raphael’s Campus; Adult Emergency Services at York Street Campus; Shoreline Medical Center; Saint Raphael’s Campus; and the West that would want to join the academic faculty promoting scholarship to enhance the field of emergency medicine. We offerand the West Haven VAED EmergencyofDepartment withper a combined ED seeking volume faculty of 195,000 Haven VA Emergency Department with a combined 195,000 visits year. We are at allvisits per year. We are seeking faculty at all an extensive faculty development program forvolume junior and more senior faculty.

We have a well-established track record of ranksProfessor, (Clinician,Professor, Assistantetc.)

Professor, Associate Professor, Professor, etc.) ranks (Clinician, Assistant Professor, Associate with interests in clinical care, education or with interests in clinical care, education or interdisciplinary collaboration with other renowned faculty, obtaining federal and private foundation funding, andisaa plus. The successful to enhance our existing strengths.medicine Interest is and/or experience in observation medicine research to enhance our existing strengths. research Interest and/or experience in observation a plus.

The successful maturemay research infrastructure supported a faculty a staff of research associates and administrative candidate may be a full-time tomedicine excellence in patient emergency medicine education or one candidate be a full-time clinician committed toby excellence in Research patientclinician careDirector, andcommitted emergency education or care one and that would want to join the faculty scholarship toWe enhance that would want to join the academic faculty promoting scholarship to academic enhance the field promoting of emergency medicine. offer the field of emergency medicine. We offer assistants.

development fora junior and more senior faculty.of We have a well-established track record of an extensive faculty development program an forextensive junior andfaculty more senior faculty.program We have well-established track record Eligible candidates mustwith be other residency-trained and board-certified/-prepared infaculty, emergency medicine.

Rank, protected interdisciplinary collaboration withand other renowned obtaining and private foundationtime funding, and a interdisciplinary collaboration renowned faculty, obtaining federal private foundation funding, andfederal a mature research infrastructure by a faculty Research Director, a staff of research associates and administrative and salary be commensurate with education, training experience. mature researchwill infrastructure supported by a faculty Research Director,and asupported staff of research associates and administrative assistants. assistants.

Yale University is a world-class institution providing a wide array of benefits and research opportunities.

Eligible candidates must be residency-trained board-certified/-prepared in emergency medicine. Rank, protected time Eligible candidates must be residency-trained and board-certified/-prepared in emergencyand medicine.

Rank, protected time To apply, please visit: http://apply.interfolio.com/52744 to upload your CV and cover letter. Specific inquiries about the and salary will and be commensurate and salary will be commensurate with education, training experience. with education, training and experience.

position may be sent to the Chair: Gail D’Onofrio, MD, MS, via email: jamie.petrone@yale.edu.

University a world-class institution providing a wide array of benefits and research opportunities.

Yale University is a world-class institution Yale providing a wideis array of benefits and research opportunities.

Yale University is an Affirmative Action/Equal Opportunity employer.

Yale values diversity among its students, staff, and

and strongly welcomes applications from women, withletter. disabilities, protected veterans, and letter. Specific inquiries about the To apply, please visit: http://apply.interfolio.com/52744 upload your CV Tofaculty apply, please visit: http://apply.interfolio.com/52744 to upload your persons CV and cover Specifictoinquiries about theand cover underrepresented positionMD, may MS, be sent the Chair: Gail D’Onofrio, MD, MS, via email: jamie.petrone@yale.edu. position may be sent to minorities. the Chair: Gail D’Onofrio, viato email: jamie.petrone@yale.edu.

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

IT’S A NEW DAY @COLUMBIA EM JOIN US AS WE BUILD OUR ACADEMIC DEPARTMENT AND CREATE THE FUTURE OF EMERGENCY MEDICINE! The newly formed Department of Emergency Medicine at Columbia University Vagelos College of Physicians & Surgeons is seeking highly qualified Emergency Physicians with a strong desire for clinical & academic excellence.

Candidates with demonstrated academic interest and/or fellowship training in the following areas are encouraged to apply.

Pediatric Emergency Medicine

Research

Critical Care

Quality and Safety

Medical Education

Toxicology

Disaster and Emergency Preparedness

Simulation

Submit a letter of interest and CV to Dr. Angela M. Mills, MD, FACEP, J. E. Beaumont Professor and Chair EMrecruiting@cumc.columbia.edu Columbia University is an Affirmative Action, Equal Opportunity Employer.

©Lester Ali

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For more information

WASHINGTON DC – The Department of Emergency Medicine at the George Washington University is offering Fellowship positions beginning July 2020: International Emergency Medicine

Medical Leadership & Operations

Medical Toxicology

Emergency Ultrasound

Clinical Research

Telemedicine/Digital Health

Health Policy

Extreme Environmental Medicine

Sports Medicine

Medical Education and Simulation

Academic and Community Faculty Positions Available “All Ranks”

• Administration, Operations & Quality • Climate & Health Science Policy • Critical Care/ Anesthesiology • Education Quality • Emergency Medical Services • Global Health

Fellows receive an academic appointment at The George Washington University School of Medicine & Health Sciences and work clinically at a site staffed by the Department. The Department offers Fellows an integrated, interdisciplinary curriculum, focusing on research methodologies and grant 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:

Fellowship Opportunities

& olicy y

s

Disaster & Operational Medicine

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

• Palliative Care • Research • Toxicology • Ultrasound • Wilderness Medicine

The largest academic health care center in the Rocky Mountain region, Denver has also been named one of the best places to live, play, and raise a family. CU Anschutz is leading the way in education, research and patient care. We provide coverage to three hospital based EDs and several freestanding EDs.

SUBMIT YOUR ANNOUNCEMENT!

Learn more www.medschool.ucdenver.edu/em email: emed.recruitment@ucdenver.edu

The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc.

Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is August 1, 2019 for the September/October 2019 issue.

45

Yale University School of Medicine Department of Emergency Medicine Fellowship Programs

Department of Emergency Medicineof Emergency Medicine Department Yale University School Yale of Medicine University School of Medicine

For specific information including deadlines and requirements, visit: http://medicine.yale.edu/emergencymed/

The Implementation Science fellowship is a 2-3 year program that will train investigators in the principles and practice of dissemination and implementation science.

Supported by a K12 grant from NIH’s National Heart, Lung, and Blood Institute, fellows will receive training at the new Yale Center for Implementation Science (YCIS), the Yale Center for Clinical Investigation, and the National Clinician Scholars Program. Eligible candidates may receive a Masters in Health Sciences degree. Mentors come from the Yale Schools of Medicine, Nursing, and Public Health, as well as many community-based organizations in New Haven. For further information, contact Steven L. Bernstein, MD, steven.bernstein@yale.edu.

Advancing the Science and Practice of Emergency Medicine

Advancing the Science and Practice of Emergency Medicine

The Research fellowship is a 2-3 year program focused on training clinician scholars as independent researchers in Emergency Medicine. Scholars will earn a Master of Health Sciences degree from Yale combining clinical experience with extensive training in research methods, statistics, and research design. With the guidance of research The Department of Emergency Medicine the Yale University School of Medicine a total of project 4 clinical content experts and professional coach mentors, theat scholar will develop a research program, completehas a publishable and sites: submit a grant application prior to The Department of Emergency Medicine at the Yale University School of Medicine has a total of 4 clinical sites: completion of the program.

The program credentialed by the Society Medical for Academic Emergency Medicine. For further and information, Adult Emergency Services at York isStreet Campus; Shoreline Center; Saint Raphael’s Campus; the Westcontact Steven L. Bernstein, MD, Adult Emergency Services at York Street Campus; Shoreline Medical Center; Saint Raphael’s Campus; and the West steven.bernstein@yale.edu.

Haven VA Emergency Department with a combined ED volume of 195,000 visits per year. We are seeking faculty at all

Haven VA Emergency Department with a combined ED volume of 195,000 visits per year. We are seeking faculty at all

ranks Assistant Professor, Associate Professor, Professor, etc.)Career with Development interests in clinical education or a 3 year post-doctoral The Yale(Clinician, Drug use, Addiction, and HIV Research (DAHRS) Mentored Programcare, (NIDA K12) provides ranksScholars (Clinician, Assistant Professor, Associate Professor, Professor, etc.) with interests in clinical care, education or research to enhance our existing strengths.

Interest and/or experience in observation medicine is a plus.

Theprevention successfuland treatment in general medical interdisciplinary, research training experience preparing investigators for careers focusing on drug use, addiction, and HIV research to enhance our existing strengths. Interest and/or experience in observation medicine is a plus. The successful candidate mayearn be athe full-time clinician committed to that excellence patient research care andmethodology, emergency medicine education or one in small group sessions and settings.

Scholars Master in Health Sciences degree combinesinvigorous statistics and design didactics candidate may be a full-time clinician committed to conduct excellence in patient care and emergency medicine education or one seminars covering related to drug use,faculty addiction and HIV, leadership, grant writing and of research.

Candidates that would wanttopics to join the academic promoting scholarship to enhance theresponsible field of emergency medicine.

We offercomplete mentored research that would want to join the academic faculty promoting scholarship to enhance the field of emergency medicine. We offer project(s), multiple manuscripts, and apply for independent For further www.medicine.yale.edu/dahrs or contact an extensive faculty development program for juniorfunding. and more senior information, faculty. Wevisit have a well-established track record of Gail D’Onofrio, MD, MS, an extensive faculty development program for junior and more senior faculty. We have a well-established track record of dahrs@yale.edu. interdisciplinary collaboration with other renowned faculty, obtaining federal and private foundation funding, and a interdisciplinary collaboration with other renowned faculty, obtaining federal and private foundation funding, and a

mature research infrastructure supported byora2 faculty Research Director, agraduates staff of research and administrative The fellowship in Emergency Ultrasound is a 1mature year program that will prepare to alead anassociates academic/community emergency 2-year research infrastructure supported by faculty Research Director, a staff ofultrasound research program. associatesThe and administrative assistants. option includes a Master of Health Sciences or Master of Public Health with a focus on emergency ultrasound research. This fellowship satisfies recommendations of all assistants. major societies for the interpretation of emergency ultrasound, and will include exposure to aspects of program development, quality assurance, properties of coding and billing, andcandidates research. The program consists of structured in the ED performing bedside examinations, examination QAprotected and review, research into new applications, and Eligible must be residency-trained andtime board-certified/-prepared in emergency medicine.

Rank, time Eligible mustonbe residency-trained and board-certified/-prepared emergency Rank, protected time education in the academic/community We have acandidates particularand focus emergency echo and utilize state of the art equipment, asinwell as wirelessmedicine. image review. and salary will be commensuratearenas. with education, training experience. and salary will be. For commensurate with education, training and experience.

Information about our Section can be found at http://eus.yale.edu further information, contact Rachel Liu MD, rachel.liu@yale.edu, or apply online at www.eusfellowships.com.

Yale University is a world-class institution providing a wide array of benefits and research opportunities.

Yale University is a world-class institution providing a wide array of benefits and research opportunities.

The Administration fellowship is a 2-year program that will prepare graduates to assume administrative leadership positions in private or academic emergency medicine as well hospitals and visit: healthhttp://apply.interfolio.com/52744 systems. The fellow will acquire experience in all facets emergency department clinical operations, with Toas apply, please to upload your CVofand cover letter.

Specific inquiries about theclose mentorship from department Tocomplete apply, please visit:#1http://apply.interfolio.com/52744 to Yale upload yourofCV and cover In letter.

Specific inquiries about the and hospitalmay administrative Fellows the recently ranked MBA program at the School Management. addition, the candidate position be sent toleaders. the Chair: Gailwill D’Onofrio, MD, MS, via email: Executive jamie.petrone@yale.edu. may be sent to the Chair: Gail D’Onofrio, MS, via jamie.petrone@yale.edu. will assume graduated leadership roles on one orposition more projects supporting departmental activities usuallyMD, culminating as email: Assistant Medical Director in the second year of the fellowship. For further information, contact Arjun Venkatesh, MD, MBA, MHS, arjun.venkatesh@yale.edu.

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

The Global Health and International Emergencyfrom Medicine fellowship is awith 2-year program offered

by Yale in partnership faculty and strongly welcomes applications women, persons disabilities, protected veterans, and with the London School of Hygiene & Tropical faculty and strongly welcomes applications from women, persons with disabilities, protected veterans, and Medicine (LSHTM). minorities.

Fellows will develop a strong foundation in global public health, tropical medicine, humanitarian assistance and research.

They will receive an MSc underrepresented underrepresented minorities. from LSHTM, a diploma in Tropical Medicine (DTM&H) and complete the Health Emergencies in Large Populations (HELP) course offered by the ICRC in Geneva. In addition, fellows spend 6 months in the field working with on-going Yale global health projects or on an independent project they develop. For further information, contact the fellowship director, Hani Mowafi, MD, MPH, hani.mowafi@yale.edu.

The fellowship in EMS is a 1-year program that provides training in all aspects of EMS, including academics, administration, medical oversight, research, teaching, and clinical components. The ACGME-accredited program focuses on operational EMS, with the fellow actively participating in the system’s physician response team, and all fellows offered training to the Firefighter I or II level. A 1-year MPH program is available for fellows choosing additional research training. The fellowship graduate will be prepared for a career in academic EMS and/or medical direction of a local or regional EMS system, and for the ABEM subspecialty examination. For further information, contact David Cone, MD, david.cone@yale.edu.

The Medical Simulation fellowship is a 1-year program that provides training in all aspects of healthcare simulation, including high fidelity mannequin simulation with computer program training, acquisition of debriefing and teaching skills, use of novel wearable technologies, and procedural simulation. The fellow will participate in all educational programs for medical students, nurses, residents and faculty at the Yale Center for Medical Simulation. The program includes options to train in research methodology through the Research Division of the Department of Emergency Medicine and participate in medical education coursework through Yale School of Medicine. The fellowship will include attendance of the one-week Comprehensive Instructor Workshop at the Institute for Medical Simulation in Boston. For further information, contact Leigh Evans, MD, leigh.evans@yale.edu.

The Educational Leadership fellowship is a 1 or 2-year program that provides the training and education to develop academic emergency physicians to have the skills, knowledge and experience to be strong educators and leaders in Emergency Medicine education with the focus on developing leaders in EM residencies or in Undergraduate Medical Education. The fellow will be an Assistant Residency Program Director and an integral member of the education faculty. They will be supported to attend leadership training as well as using other internal resources, CORD and ACEP to further their education. For further information, contact David Della-Giustina, MD, FACEP, FAWM, david.della-giustina@yale.edu.

The Wilderness Medicine fellowship is a 1-year program that provides the core content of medical knowledge and skills in being able to plan for and to provide care in an environment that is limited by resources and geographically separated from definitive medical care in all types of weather and evacuation situations. The fellow will be supported to obtain the Diploma in Mountain Medicine and other Wilderness Medical education. The fellow will become a leader and national educator in the growing specialty of wilderness medicine. For further information, contact David Della-Giustina, MD, FACEP, FAWM, david.della-giustina@yale.edu.

The Clinical Informatics fellowship is a 2-year program that provides ACGME-approved training in all aspects of clinical informatics. The program is administered through the Yale Department of Emergency Medicine. In the first year, the fellow will rotate between the Yale-New Haven Health and Veterans Affairs. Major blocks will be devoted to electronic health records, clinical decision support, databases and data analysis, and quality and safety. Experiential learning will be combined with didactic classes and conferences. The second year is dedicated to advanced learning and project leadership. The fellow will attend the American Medical Informatics Association annual meeting. The program prepares fellows for Clinical Informatics Board examination. For further information, contact Ted Melnick, MD, MHS, edward.melnick@yale.edu.

All require the applicant to be BP/BC emergency physicians and offer an appointment as an Instructor to the faculty of the Department of Emergency Medicine at Yale University School of Medicine. Applications are available at the Yale Emergency Medicine web page http://medicine.yale.edu/emergencymed/ and are due by November 15, 2019 with the exception of the Clinical Informatics Fellowship, the Wilderness Fellowship, and the Educational Leadership Fellowship, which are due by October 1, 2019.

Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women, persons with disabilities, protected veterans, and members of minority groups are encouraged to apply.

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For over 25 years, AAEM has been a leader in protecting board certification in EM and confronting the harmful influence of the corporate practice of medicine. We advocate for fair and equitable environments that allow emergency physicians to deliver the highest quality of patient care. No matter the practice setting, we are in your corner.

We provide top-tier education, advocacy, and professional resources throughout your journey as an emergency physician.

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Register for a Pre-Congress Course Advanced EKG Chemical Warfare Agents Ultrasound: Beginners and Advanced Is there a Doctor on Board?

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Featured Leadership and Faculty Positions Residency Program Director Cartersville Medical Center. Greater Atlanta, GA New EM Residency Program slated to begin July 2020. Contact Barbara Lay at 727.507.3608

Ultrasound Fellowship Director and Clinical Faculty 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

Core Faculty and PEM 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

Research Director and Simulation Director Brandon Regional Hospital. Tampa Bay, FL New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Contact Esther Aguilar at 727.519.4851

Clinical Faculty Kendall Regional Medical Center. Miami, FL EM Residency Program affiliated with the Herbert Wertheim College of Medicine at Florida International University. Contact Lisa M. Chamerski at 727.507.2508

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

Research Director and Core Faculty Ocala Regional Medical Center. Ocala, FL EM Residency Program affiliated with UCF Health Morsani College of Medicine and HCA GME Consortium. Contact Craig McGovern at 727.437.0846

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DepartmentofofEmergency Emergency Medicine Department Medicine YaleUniversity UniversitySchool School Medicine Yale ofof Medicine Advancing the of of Emergency Medicine Advancing the Science Scienceand andPractice Practice Emergency Medicine The Department Department of at at thethe Yale University School of Medicine seeksseeks to fillto thefill the The ofEmergency EmergencyMedicine Medicine Yale University School of Medicine position of Assistant / Associate Residency Program Director. The Department has a fully accredited position of Assistant / Associate Residency Program Director. The Department has a fully accredited four-year residency hosting 60 residents at two teaching hospitals, including the Level One Trauma four-year residency hosting 60 residents at two teaching hospitals, including the Level One Trauma Center at Yale-New Haven Hospital, which treats 100,000 patients annually. Our didactic curriculum Center Yale-New Haven Hospital, which treats 100,000 patients annually. Our didactic curriculum makes at extensive use of small-group discussions, audience response technologies, e-learning, simulation, makes extensive use of small-group discussions, response technologies, simulation, and Areas of Concentration Program. The successfulaudience candidate will be expected to helpe-learning, lead the residency and Areas of Concentration Program.

The successful candidate will be expected to help lead the under the direction of the Residency Program Director and to perform scholarly activity to advance theresidency under theand direction Residency Program Director and to perform scholarly activity to advance the science practiceof of the Emergency Medicine. science and practice of Emergency Medicine.

The Department has a total of 4 clinical sites: Adult Emergency Services at York Street Campus; Shoreline Medicalhas Center; Campus; and the West Haven VA at Emergency Department The Department a totalSaint of 4Raphael’s clinical sites: Adult Emergency Services York Street Campus; with a combined EDCenter; volumeSaint of 195,000 visitsCampus; per year. and We the offerWest an extensive faculty development Shoreline Medical Raphael’s Haven VA Emergency Department program for junior and senior faculty.

We have a well-established track record of interdisciplinary with a combined ED volume of 195,000 visits per year. We offer an extensive faculty development collaboration with other renowned faculty, federal and private foundation funding, and a program for junior and senior faculty.

Weobtaining have a well-established track record of interdisciplinary mature research infrastructure supported by a faculty Research Director, a staff of research associates collaboration with other renowned faculty, obtaining federal and private foundation funding, and a and administrative assistants. supported by a faculty Research Director, a staff of research associates mature research infrastructure and administrative assistants.

Eligible candidates must be residency-trained and board-certified in emergency medicine, and eligible for appointment at the Assistant Professor level or above. At least 3 years of experience in resident Eligible candidates must be residency-trained board-certified in emergency medicine,training and eligible education, is required.

Rank, protected time and and salary will be commensurate with education, for appointment at the Assistant Professor level or above.

At least 3 years of experience in resident and experience.

education, is required. Rank, protected time and salary will be commensurate with education, training and Yaleexperience.

University is a world-class institution providing a wide array of benefits and research opportunities.

Yale University a world-class institution providing atowide array of CV benefits and research To apply, please is visit: https://apply.interfolio.com/59261 upload your and cover letter. opportunities.

Specific inquiries about the position may be sent to the Chair: Gail D’Onofrio, MD, MS, via email: jamie.petrone@yale.edu.

Review of applications will begin immediately and CV continue until the position To apply, please visit: https://apply.interfolio.com/59261 to upload your and cover letter. is filled. inquiries about the position may be sent to the Chair: Gail D’Onofrio, MD, MS, via email: Specific

jamie.petrone@yale.edu. Review of applications will begin immediately and continue until the position University is an Affirmative Action/Equal Opportunity employer. Yale values diversity among its isYale filled. students, staff, and faculty and strongly welcomes applications from women, persons with disabilities, protected veterans, andAffirmative underrepresented minorities.

Yale University is an Action/Equal Opportunity employer. Yale values diversity among its

students, staff, and faculty and strongly welcomes applications from women, persons with disabilities, protected veterans, and underrepresented minorities.

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SEE YOU IN 20 Denver, Colorado May 12-15, 2020 Sheraton Denver Downtown Hotel