SAEM Pulse July-August 2022

JULY-AUGUST 2022 | VOLUME XXXVII NUMBER 4

www.saem.org

SPOTLIGHT DIVERSITY, EQUITY, INCLUSION, AND JUSTICE: A HUMAN PRIORITY An Interview with

Jeffrey Druck, MD

INTRODUCTION TO PREFERENCE/PROGRAM SIGNALING IN EMERGENCY MEDICINE page 26

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, Accounting Edwina Zaccardo Ext. 216, ezaccardo@saem.org Director, IT Anthony Macalindong Ext. 217, amacalindong@saem.org Specialist, IT Support Dawud Lawson Ext. 225, dlawson@saem.org Director, Governance Erin Campo Ext. 201, ecampo@saem.org Coordinator, Governance Juana Vazquez Ext. 228, jvazquez@saem.org Director, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Digital Marketing & Communications Raf Rokita Ext. 244, rrokita@saem.org Sr. Director, Foundation and Business Development Melissa McMillian, CAE, CNP Ext. 203, mmcmillian@saem.org Sr. Manager, Development for the SAEM Foundation Julie Wolfe Ext. 230, jwolfe@saem.org

Manager, Educational Course Development Kayla Belec Ext. 206, kbelec@saem.org Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org Sr. Manager, Education Andrea Ray Ext. 214, aray@saem.org Sr. Coordinator, Membership & Meetings Monica Bell, CMP Ext. 202, mbell@saem.org Specialist, Membership Recruitment Krystle Ansay Ext. 239, kansay@saem.org Meeting Planner Sandi Ganji Ext. 218, sganji@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 Peer Review Coordinator Taylor Bowen tbowen@saem.org Associate Editor, RAMS Aaron R. Kuzel, DO, MBA aaron.kuzel@louisville.edu

2022–2023 BOARD OF DIRECTORS Angela M. Mills, MD President Columbia University, Vagelos College of Physicians and Surgeons Wendy C. Coates, MD President Elect Los Angeles County HarborUCLA Medical Center Members-at-Large Pooja Agrawal, MD, MPH Yale University School of Medicine Jeffrey P. Druck, MD University of Colorado School of Medicine Julianna J. Jung, MD Johns Hopkins University School of Medicine Michelle D. Lall, MD, MHS Emory University

Ali S. Raja, MD, MBA, MPH Secretary Treasurer Massachusetts General Hospital / Harvard Medical School Amy H. Kaji, MD, PhD Immediate Past President Harbor-UCLA Medical Center Ava E. Pierce, MD UT Southwestern Medical Center, Dallas Jody A. Vogel, MD, MSc, MSW Stanford University Department of Emergency Medicine Resident Member Wendy W. Sun, MD Yale University School of Medicine

HIGHLIGHTS 3

President’s Comments SAEM is Shaping the Future Education, Science, and Practice of Emergency Medicine

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Spotlight Diversity, Equity, Inclusion, and Justice: A Human Priority – An Interview With Dr. Jeffrey Druck

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Critical Care Identifying and Correcting the Performance Errors of Video Laryngoscopy: The Next Step in Emergency Airway Education

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Diversity & Inclusion Intersection of Disability and Race or Gender (Then and Now): A Disproportionate Effect

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Admin & Clinical Operations Integrating Public Health with Emergency Department Care

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Ethics in Action Salami Slicing: What Is it and Is it Ethical?

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Geriatric EM Communicating with Older Adults in the Emergency Department

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Global EM Technology in Humanitarian Response: Developments and Limitations

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Reflection Working Alongside the Ohio National Guard in a Community ED During the COVID-19 Pandemic

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Reflection Run the List: A Story of Language, Culture, and Love

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Rams Special Feature Introduction to Preference/Program Signaling in Emergency Medicine

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Sex & Gender Effects of Sex and Gender on Obesity and Cardiovascular Disease

Article titles appearing in red font in the table of contents have been identified as being of particular interest to emergency medicine residents and medical students.

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Wellness Duality, COVID-19, and 2022: Being a Caregiver and a Patient

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Wellness Financial Stability and Its Impact on Resident Wellness

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Celebrating the SAEMF’s 2022 Annual Alliance and the Impact of a Gift

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SAEMF Donor Perspectives: Prasanthi (Prasha) Govindarajan, MD, MAS

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Thank You! 2022 Annual Alliance Donors

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SAEMF Grants Deadline Is August 1

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Briefs & Bullet Points - Education Development - Residents & Medical Students - SAEM22 Updates - SAEM Journals - SAEM Foundation

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SAEM Reports - Academy News - Interest Group Updates - Committee Info

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Academic Announcements

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Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine, 1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2022 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 Angela M. Mills, MD Columbia University Vagelos College of Physicians & Surgeons 2022–2023 President, SAEM

SAEM is Shaping the Future Education, Science, and Practice of Emergency Medicine

Our SAEM members make our Society all that it is, and I couldn’t be any prouder of all that you have done, especially over the past two years: the patient care you provide, the education and mentorship for our learners, the scholarship and research discovery to advance emergency care, and all your volunteer service, especially to SAEM, making us better than ever.

For my inaugural SAEM Pulse column, I want to share some incredible SAEM highlights.

Because of the great work by all of you and our staff, SAEM and our Foundation are now a combined $20 million organization.

We are over 8,300 strong — our highest membership ever. I am proud of what we have accomplished through the pandemic where we have seen the sharpest trajectory in our membership numbers over the past two years. The amount of content being produced by our academies, committees, and interest groups is tremendous, with significant group membership growth, expansion of executive boards with many new leaders, and countless new products and services for our members.

All the emergency medicine (EM) organizations, including SAEM, have been collaborating over the past two years to tackle the topic of the EM workforce. In addition, we have created a new Workforce Development Committee within SAEM specifically to define the evolving landscape and workforce of academic EM and to develop a multiyear plan to address where SAEM can uniquely support dynamic changes in the workforce.

We know that diverse teams are smarter and more successful, and I am proud of SAEM’s commitment and intentionality to diversity, equity, and inclusion (DEI) within all aspects of our organization. SAEM will be leading an all-emergency medicine organizations DEI task force so that we may work together to advance our specialty.

SAEM is the premier organization for developing and supporting academic leaders.

In response to you, we started the eLEAD course this year with the highest application for any course ever.

As educators, we strive for both innovation and high-quality standardization of education in an extremely complex specialty. We have advocated, and continue to advocate, for protected time for our faculty educators and quality scholarly activity requirements of our residents. The pandemic created unique challenges for medical students, clerkship directors, program directors, and student advisors. Through the leadership of SAEM’s Clerkship Directors in Emergency Medicine

Academy (CDEM) academy, we continue to lead in multiple aspects of the residency application process and in advising our students in areas such as away rotations.

At SAEM we are proud to increase the impact, productivity, implementation, and visibility across the spectrum of emergency care research. Academic Emergency Medicine Education and Training Journal has (AEM E&T) moved to a continuous publication model and substantially increased the number of high-quality education papers being published. And it was just announced that our flagship journal, Academic Emergency Medicine, just received it's highest impact factor ever: 5.221! In May, the GRACE team released the second publication in the series of Guidelines for Reasonable and Appropriate Care in the Emergency Department, which focuses on abdominal pain.

The SAEM Foundation is our specialty’s biggest foundation, and, together with SAEM, has awarded over $9 million to more than 400 academicians! SAEMF is in a position of strength with a $12 million endowment enabling it to award over $850,000 in grants this year — more grants than ever before.

Over the last two years, we have had a significant increase in donations, especially from our members. My thanks to everyone who has donated and, in so doing, invested in the most promising educators and researchers in emergency medicine.

SAEM is shaping the future education, science, and practice of emergency medicine. I am proud to be your president this year and am committed to advancing and strengthening our Society and specialty.

Thank you for entrusting me with this incredible opportunity and responsibility.

ABOUT DR. MILLS: Angela M. Mills, MD, is the J. E. Beaumont professor and chair of the department of emergency medicine at Columbia University Vagelos College of Physicians & Surgeons and chief of emergency services for NewYork-Presbyterian –Columbia

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SPOTLIGHT DIVERSITY, EQUITY, INCLUSION, AND JUSTICE: A HUMAN PRIORITY An Interview With Jeffrey Druck, MD Jeffrey Druck, MD, is a professor of emergency medicine, assistant dean for student affairs, and codirector of the University of Colorado’s Office of Professional Excellence. He previously served as the associate residency program director in the department of emergency medicine at Denver Health, as well as the president of the Faculty Senate, and the director of the school’s Integrated Clinician’s Course. In 2012, he cofounded the Denver Health, Residency in Emergency Medicine’s Diversity Committee, pioneering recruitment, and inclusion efforts of diverse residents which has served as a road map for residencies nationally and spanning all specialties. He is a past president of SAEM’s Academy for Diversity and Inclusion for Emergency Medicine (ADIEM) academy and was cochair of the recent SAEM Consensus Conference, “Diversity, Equity, and Inclusion: Developing a Research Agenda for Addressing Racism in Emergency Medicine.”

Dr. Druck and his family at the musical, “Dear Evan Hansen.”

“...training the next generation around health equity will be imperative to give our patients the care they deserve.”

Understanding that diversity has been linked to improved patient care, it is crucial that emergency medicine (EM) keep pace with the changing face of medicine; increasing the exposure and recruitment of UiM applicants in EM training programs is imperative to accomplishing this. What would you say is the number one criterion underrepresented in medicine (UiM) applicants look for in considering a residency program? What are some key ways a residency program can improve its diversity?

Interestingly, we did a survey on this several years back, although we never published it. The number one answer was faculty who were UiM also. Number two was a patient population that was underrepresented, and number three was a program that valued inclusion and mentorship where they could feel supported. For some programs, number one may be a challenge based on current demographics of faculty, but programs that have little to no diversity within their faculty should have intentional efforts to increase this. Number two may vary depending on physical location and hospital systems, but every residency program should aspire to accomplish number three.

Although Black and African Americans compose 13 percent of the nation, they account for only four percent of the physician workforce. Clearly much work remains to be done to align the diversity of the health care workforce with the racial and ethnic backgrounds of patients, especially in the field of emergency medicine. In your experience, how far have we come (i.e., what are some positive steps/signs you’ve seen), how far do we still have to go, and do you believe we will ever “get there?”

It would be wonderful to see a physician workforce that represents our communities accurately, but the data is not very encouraging. The fact that there is the same percentage of Black male physicians as there were 120 years ago is both discouraging and sobering. There are small strides being made; for example: White Coats 4Black Lives being a force on academic campuses; call outs of systemic racism like Dr. Dowin Boatright’s work on the inherent bias in Alpha Omega Alpha selection; promotion criteria recognizing elements of diversity with the weight it deserves; an increase in pipeline/pathway programs’ authorities in diversity equity and inclusion (DEI), like Drs Bernie Lopez and Sheryl Heron, being recognized on the national level; changes to admissions policies to encompass a truly holistic view. However, when I see the racism that is

Dr. Druck takes a selfie with a mannequin during an advanced trauma life support class.

“I hope to continue to advocate for SAEM to be an inclusive space that sees the individual value each of our members brings and invites those unheard voices to join.” inherent in our culture playing out daily in the national headlines, I have trouble maintaining hope. Nevertheless, it is imperative that allies and advocates continue to do the hard work and believe we will improve, even while the timeline remains slower than what we hope for.

What do you think are some other urgent issues facing emergency medicine (EM) in the U.S. today? What issues do you feel are most germane to current and future emergency medicine trainees?

I think the workforce issues are a critical concern. How many emergency medicine physicians are needed, and how we interact with advanced practice providers is a problem that concerns many of us. From a clinical care perspective, I see EM pushing the boundaries of where care will be delivered, with more critical care occurring in the emergency department (ED), and more patients having completed care plans from the ED. Obviously, I believe that change in our physician workforce from a DEI perspective is a crucial element that every one of us should be involved in. Additionally, training the next generation around health equity will be imperative to give our patients the care they deserve.

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Congratulations on your election to the SAEM Board of Directors. What do you personally hope to accomplish during your term?

“...diversity, equity and inclusion, and justice are not a minority priority but a human priority.”

I really hope I will be able to represent all SAEM members well, while advancing policies that benefit emergency medicine as a whole and creating connections among our members that help them advance both their careers and our specialty. I hope to continue to advocate for SAEM to be an inclusive space that sees the individual value each of our members brings and invites those unheard voices to join.

You have played many roles/served in many ways with SAEM over the years… Which experiences have been your favorites and why? What have your leadership roles within SAEM taught you?

How has being involved with SAEM benefitted you professionally?

SAEM PULSE | JULY-AUGUST 2022

My first experience with SAEM was as part of the program committee in 2005, and that began my love of involvement with the only specialty organization dedicated to advancing academic emergency medicine from a research, education, administrative and advocacy perspective. That initial introduction was wonderful, as I was exposed to so many leaders in EM and so many brilliant colleagues with such different ideas, all pulling in the same direction. My experiences with ADIEM have also shown me how multiple people can be more than the sum of their individual parts, and how diversity, equity and inclusion, and justice are not a minority priority but a human priority.

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Dr. Druck at a Colorado Avalanche hockey game.

Dr. Druck in a cooking class in China.

Dr. Druck’s prized 1964 MGB.

Up Close and Personal Who would play you in the movie of your life and what would that movie be called?

I was nicknamed “Goose” in med school, due to my resemblance to Anthony Edwards (ER Anthony Edwards, not Top Gun Anthony Edwards) and my interest in emergency medicine, so I guess I would tap him for the role. As for a title, I think the movie title of my life would be “Trust but Verify” (one of my favorite statements to make around how to use patient histories).

Name three people, living or deceased, whom you would invite to your dream dinner party?

Presidents Barak Obama and John F. Kennedy…Trevor Noah. I figure Trevor would keep it from being too weighty.

What's the one thing about you few people know about you?

I once worked as a lifeguard at a psychiatric hospital.

What is your guiltiest pleasure (book, movie, music, show, food, etc.)?

I love to read — usually science fiction, but I love book recommendations. Please send me your favorites!

You have a full day off… what do you spend it doing?

(Umm, that never happens!) Sleeping in, reading in bed, a workout at the gym, a bike ride, grilling on the deck with family. I try to make each of these things happen as often as I can, but it is rare to get them all in the same day!

When you were a child, what did you aspire to be when you grew up?

I wanted to be a doctor ever since I was seven and at Disneyworld, when, during a show, someone stood up and asked if there was a doctor in the house. I wanted to be able to help others, no matter the situation, and I found my perfect fit in emergency medicine — Anywhere, Anyone, Anytime!

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SAEM PULSE | JULY-AUGUST 2022

CRITICAL CARE

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Identifying and Correcting the Performance Errors of Video Laryngoscopy: The Next Step in Emergency Airway Education

By Ryan N Barnicle, MD, MSEd; Alexander Bracey, MD; and Scott Weingart, MD on behalf of the SAEM Critical Care Interest Group Endotracheal intubation (ETI) is one of the most performed high-risk procedures in emergency medicine.

For this reason, the Accreditation Council for Graduate Medical Education (ACGME) has set an Emergency Medicine Defined Key Index Procedure Minimum of 35 intubations that must be

performed by the time of graduation.

Additionally, the ACGME allows for up to 30% of these required procedures to be performed in a simulation environment.

Certainly, many residents successfully perform more intubations while training, but this minimum number should seem shockingly low for such a critical skill.

Given the limited time constraints of residency training, it is necessary to explore how to augment exposure to laryngoscopy and maximize that educational impact.

It is unclear whether the individual opportunities to perform endotracheal

“Routine review of recorded video laryngoscopy attempts can add true quality assessment to every attempt (i.e., perfect practice makes perfect).”

Table 1 ERRORS OF LARYNGOSCOPY BLADE INSERTION

ERRORS OF VALLECULA MANIPULATION

ERRORS OF ENDOTRACHEAL TUBE DELIVERY

Inadequate suctioning

Inadequate lifting force

Bougie delivery issue

Entry off midline

Failure to engage midline– median glossoepiglottic fold

View too close

Insertion too deep

Lost seating in vallecula

Tube delivery issues

No anatomical structure recognition

Not fully seated in vallecula

Premature withdrawal of camera

Too much force in vallecula

intubation have increased or decreased for residents now training in 2022. With an aging population seeking care in the emergency department for exacerbations of chronic disease, one might suspect that this has increased; however, when considering the widespread adoption of noninvasive positive pressure ventilation and expanding emergency medicine residency class sizes, the chance to intubate may be shrinking for modern day trainees. The truth is unknown and needs to be investigated.

Regardless, exposure to more emergency intubations very likely benefits emergency medicine residents as they strive for competence and, ultimately, mastery of the skill of ETI; however, quantity is not everything. Currently, there is no widely accepted standard approach for quality assurance of actual video laryngoscopy technical skill; rather, we judge laryngoscopy attempts as a binary outcome of “successful” or “unsuccessful” and potentially track the adverse events surrounding intubation (e.g., hypoxemia, hypotension, periintubation arrest). But few receive direct feedback on the quality of the individual components of laryngoscopy which lead to a successful or unsuccessful intubation.

This is an area where video laryngoscopy (VL) technology has the potential to further revolutionize airway education. Routine review of recorded video laryngoscopy attempts can add true quality assessment to every attempt (i.e., perfect practice makes perfect). The evidence supporting the use of VL over direct laryngoscopy (DL) for intubation success is growing and has been summarized in a recent Cochrane review. While the debate for VL versus DL superiority will continue for the foreseeable future, the educational benefit of using VL to improve resident performance remains largely unexplored.

It is known that the learning curve for VL is less steep compared to DL during residency training. Still, it is unclear why this is the case and few suggestions have been made formally to address the issue.

One powerful function that is underutilized for teaching purposes is the “record” function present on most modern video laryngoscopy devices.

Recording intubation attempts allows for retrospective review of technique in both common and challenging scenarios in a low-stakes classroom learning environment or individualized operator feedback. Important to these discussions, however, is a language for corrective

feedback in airway teaching, which is currently lacking.

To this end, we are developing a taxonomy of performance errors with the aim of generating a universal language for airway educators to use when reviewing recordings for pitfalls and providing instruction or feedback to trainees.

An extensive analysis of recorded laryngoscopy attempts over the course of several years revealed 13 distinct performance errors of varying frequency that were repetitively committed by the emergency medicine residents at one suburban academic emergency department. Identifying these errors was the first step towards utilizing VL to its maximum potential.

The performance errors identified can be naturally organized into three phases of intubation that should be already familiar to emergency physicians: 1) errors of blade insertion; 2) errors of vallecula manipulation; and 3) errors of endotracheal tube delivery. Interestingly, after excluding error-free videos, identified errors never occurred in isolation but were always present with other errors,

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CRITICAL CARE

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some with statistical significance. This sample was specifically selected for the presence of performance errors and Table 1 lists each error within our data set.

It is important to note that many of these errors also apply to the direct laryngoscopy technique. While it is true some are unique to the use of video devices, all are certainly more obvious on review of recordings due to the ability to pause, rewind, and replay critical actions for an audience of learners to better appreciate. For example, one of the more commonly seen errors— failure to engage the midline—was

“Recording intubation attempts allows for retrospective review of technique in both common and challenging scenarios in a low-stakes classroom learning environment or individualized operator feedback.” recently well described by Driver et al. As that study points out, this is not an error easily visualized with direct laryngoscopy but is readily apparent on video. Since engagement of the blade tip at this precise position increases

glottic view, failure to do so is an error that can compromise an intubation attempt; however, it can be mitigated in the future by revealing and reviewing it with trainees as a specific objective to strive for or error to mitigate.

“Mastery of emergency intubation goes beyond traditional research metrics like first pass success or time to intubation.

While competence may be simplified to failure or success, true mastery is something much more.”

Recorded performance errors are particularly powerful when they occur in the presence of unique situations.

For instance, a recorded and reviewed performance error can reveal how best to navigate the manipulation of the omega epiglottis or how to adequately suction during laryngoscopy with massive gastrointestinal hemorrhage. These relatively rare occurrences are amenable to performance error mitigation and perhaps the true benefit lies in collective review of a program’s intubations. This allows both novice trainees and expert operators to see the actual laryngoscopy attempts of their peers. Of course, these should be deidentified and kept in a secure digital library, but the chance to learn about difficult laryngoscopy scenarios preemptively before they are encountered in real life can be a crucial educational tool.

Mastery of emergency intubation goes beyond traditional research metrics like first pass success or time to intubation.

While competence may be simplified to failure or success, true mastery is something much more. Laryngoscopy is a procedure that consists of many discrete microskills that require technical precision. Performance errors committed

during a laryngoscopy attempt can, expectedly, lead to delayed intubation, repeat attempts, and adverse outcomes for patients. Failing to appropriately respond to difficult factors encountered during a laryngoscopy attempt should also be considered a performance error.

Our complete study reviews each performance error in further detail and even addresses recommendations on how to mitigate them, but we submit here simply to introduce readers to the concept that performance errors are perhaps what we should truly be tracking and training to avoid. To our knowledge, our data will be the first to not only identify the performance errors but also attempt to establish the frequency and prevalence of each. These technical goals should be part of the feedback given to residents, both in real time and afterwards during review. This taxonomy creates the language and highlights the organization of the performance errors that we found.

It is our hope that attendings responsible for supervising emergency intubations will be encouraged to utilize recorded video laryngoscopy attempts with this taxonomy to provide structured education and feedback to residents.

ABOUT THE AUTHORS Dr. Barnicle works at Yale University School of Medicine in the department of emergency medicine where he serves as one of the assistant residency program directors.

Dr. Bracey works at Albany Medical Center and is a member of the critical care consult service in the department of emergency medicine. He is an assistant residency program director and is the fellowship director of the inaugural class of the Resuscitation and Emergency Critical Care Fellowship beginning August 2022.

Dr. Weingart is a dual boarded emergency department/surgical critical care physician, having completed his fellowships in trauma, surgical critical care, and extracorporeal membrane oxygenation at Shock Trauma Center in Baltimore, Maryland. He is faculty at Nassau University Medical Center. Dr. Weingart is best known for his podcast on resuscitation and ED critical care called EMCrit.

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DIVERSITY & INCLUSION

Intersection of Disability and Race or Gender (Then and Now): A Disproportionate Effect

By Anika Backster, MD; Wendy Coates, MD; Jeff Siegelman, MD; and Jason Rotoli, MD, on behalf of the Accommodations Committee Subgroup of the SAEM Academy for Diversity & Inclusion in Emergency Medicine

SAEM PULSE | JULY-AUGUST 2022

Introduction

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People with disabilities represent the largest minority group in the United States (U.S). Native Americans and African Americans stand out as the U.S. groups with the highest prevalence of disability. Both racial minorities and people with disabilities experience marginalization — but what happens when you identify with both groups? In 1989, Kimberle Crenshaw introduced the concept of intersectionality as the complex interaction between social forces, social identities, and ideological instruments through which power and disadvantage are expressed and legitimized. She discussed how singleaxis analyses (i.e. viewing only one’s race or gender or ability but not any combination of them) of a person often fails to capture the complexity of one’s lived experience.

Are there compounded socioeconomic, educational, or health effects

of being a member of more than one minority group? There may be challenges to finding such information because the traditional medical perspective of disability pervades our culture and scholarly research, often dismissing disability as a natural consequence of biological deficiency or aging and conflating disability with poor health.

Historical Perspective

Use of disability to justify slavery was common in U.S. history. Both sides in the U.S. civil war promoted the idea of slaves having intellectual disability. The antislave movement expressed the horrors of intellectually impaired slaves being mistreated, and the pro-slavery side expressed the need for continued slavery to “protect the weak.”(Forret). Such is our history, that the entanglement or intersection of race and disability should not be overlooked, much less ignored.

Marginalization from society and the sustaining of cultural normalcy was

often accomplished using oppressive discourses. These took place between the majority and minority groups and often between different minority groups to pit the oppressed groups against each other. Thus, groups felt the need to stress being “abled” and a woman, or “abled” and black as a reason for their equality. For example, ableism was sometimes used to advocate for a marginalized group’s rights. If a marginalized group was “able” then they could and should be equal. The 1848 Declarations of Sentiments and Resolutions (the Seneca Falls Women's Rights Convention) states: "the equality of human rights results necessarily from the fact of the identity of the race in capabilities and responsibilities.”

Here we see, ableism prevails, and disability is seen as being less than.

Another example is seen in the case of Sojorner Truth (a women’s rights activist and abolitionist). If you look, her

“Kimberle Crenshaw introduced the concept of intersectionality as the complex interaction between social forces, social identities, and ideological instruments through which power and disadvantage are expressed and legitimized.”

photographs depict her holding knitting needles with her disabled right hand (with knitting being a task she would not have been able to perform). Also consider the line from Truth’s famous speech, "I have plowed, and planted, and gathered into barns, and no man could head me —and ar'n't I a woman?” Here you can see how she portrays her own ableism in order to challenge the cultural discourses that sustained race and gender hierarchies (Minister).

Recent History

Health impact Despite this more evolved understanding of race and disability, there is still evidence to show that racial minorities receive more negatively stigmatized disability labels in comparison to white counterparts with the same disability. For example, “learning disability” was initially created to justify underperformance of white middle class children. More recently, this term (and intellectual disability) is more commonly applied to racial minorities and economically disadvantaged children while white children are more commonly diagnosed with attention-deficit/ hyperactivity disorder (ADHD) or autism.

Another place where health, race, and disability intersect is with COVID-19. The COVID-19 pandemic disproportionately impacted racial minorities both in acute disease and Long Covid resulting in significant numbers of disabled people.

These patients, who are also majority female, must now face many hurdles including protecting their family’s income through Social Security Disability Insurance (especially for an invisible illness like Long COVID) and worker’s compensation, as well as long standing dismissiveness of doctors towards invisible illnesses.

Education Impact Cumulative effects of disability and race are seen in the early educational system: minority students may have reduced opportunities in early education.

Additionally, they may have disabilities identified later or may not receive the same level of accommodation as others. Over time, this widens the gap.

The school suspension rate of children with disabilities for Black boys is one in four and for Black girls it is one in five.

As of 2015–2016, schools suspended black students (8 percent) at rates more than twice as high as white (3.8 percent) and Hispanic students (3.5 percent).

Further, schools suspended children with disabilities (8.6 percent) at rates more than twice as high as children without disabilities (4.1 percent).

What’s Next?

Increasing our awareness of the intersectionality between race or gender and disabilities helps us address individuals and become more inclusive.

Listen to each other’s lived experiences and learn from them. Lastly, recognize that someone may belong to more than

one marginalized group and there may be socioeconomic, educational, and health implications for this intersectionality.

ABOUT THE AUTHORS Dr. Coates has been a disability rights advocate for more than 25 years. She is a professor of emergency medicine at UCLA Geffen School of Medicine/ Harbor-UCLA Emergency Medicine where she specializes in education research. She is the 2022-2023 president-elect on the SAEM Board of Directors. r. Backster is an assistant D professor of emergency medicine, Emory School of Medicine. Dr Backster is interested in promoting and educating on all forms of diversity and creating an inclusive environment for them. r. Seiegelman is associate D program director in the department of emergency medicine, Emory University School of Medicine, and an attending emergency medicine physician at Atlanta's Grady Memorial Hospital.

Dr. Rotoli is the associate residency director of the emergency medicine residency and director of the Deaf Health Pathways at the University of Rochester. He has a passion for improving the health literacy and health care for anyone who requires an accommodation, especially the deaf ASL user.

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

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ADMIN & CLINICAL OPERATIONS

Integrating Public Health with Emergency Department Care

SAEM PULSE | JULY-AUGUST 2022

By Tehreem Rehman, MD, MPH, on behalf of the SAEM ED Administration and Clinical Operations Committee

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As emergency physicians, we see every patient that walks through the door no matter what language they speak, what their insurance status is, or whether they are a citizen of this country. The emergency department subsequently acts as a safety net setting for patients, especially those with complex social needs. Serving on the front lines of the community, emergency physicians are inevitably interacting with public health whether they realize it or not.

I hope that at the end of this article, you will come away with a better understanding of how to leverage public health principles to your benefit to improve the experience and well-being of both patients and physicians in the emergency department.

Similar to how a patient’s vital signs provide us with significant information about the patient’s physical status and risk for potential decompensation, “community vital signs” entail a more holistic inclusion of structural determinants of health to fully understand the factors driving a patient’s clinical presentation. These “community vital signs” include both individual-level structural determinants of health data and population-level data such as the Social Vulnerability Index derived from U.S. Census Bureau data. However, as we become more sophisticated with clinical informatics and information exchange systems, we will likely have the capacity to use more real-time data.

One recent study found that data from 211 helpline calls may be more effective for risk stratification of patients with high emergency department (ED) utilization compared to more aggregate and less dynamic measures such as U.S. Census Bureau data.

Incorporation of “community vital signs” into electronic health record data can help optimize understanding of all factors that inform the patient’s clinical presentation, treatment adherence, and ability to appropriately follow up. Thus, integrating public health with emergency department care allows physicians to successfully deliver “context-informed care,” ideally improving both health outcomes and patient satisfaction in the long term.

“Incorporation of 'community vital signs' into electronic health record data can help optimize understanding of all factors that inform the patient’s clinical presentation, treatment adherence, and ability to appropriately follow up.”

While integration of public health with clinical care in the ED is clearly important, we also need to be mindful of the time and other resource constraints that emergency physicians must navigate while also caring for critically ill patients. Subsequently, we cannot expect physicians to adequately address structural determinants of health among their patients without necessary organizational support. Department and hospital leaders must take the initiative in leveraging existing infrastructure and resources to spearhead change management and support physicians caring for patients with complex social needs on the frontlines.

One specific next step leaders can take is to push for the incorporation of “community vital signs” into clinical decision support and population management tools. This change management will likely require interdisciplinary stakeholder engagement and can produce deliverables such as dashboards and clinical workflows that yield actionable data.

As mentioned, efforts to integrate public health with emergency department care must be mindful about not increasing physician workload and, rather, be innovative about task-shifting with respect to screening and intervention delivery. That said, there is also mounting research demonstrating that physicians tend to experience disempowerment when it comes to addressing patients’ social needs, which in turn has been attributed to burnout. Ensuring that

physicians are operating within a perceived organizational capacity to address structural determinants of health is pivotal to alleviating growing burnout.

Additionally, as hospital capacity remains finite and ED overcrowding becomes an increasingly significant barrier to providing high quality care, physicians are incentivized to integrate public health frameworks with their care.

The benefit is twofold. On the one hand, patients who can obtain help with their complex social needs are less likely to clinically decompensate to the point of requiring an inpatient or ICU hospitalization. On the other hand, patients may be less likely to utilize the ED altogether with department resources now available for resuscitation and critical care efforts. In the long-run, emergency physicians can deliver high-quality care through minimized adverse effects of boarding in the ED while still feeling empowered to address underlying social factors contributing to a patient’s poor health.

Addressing structural determinants of health has been shown to improve the health and well-being of patients and entire communities; however, the need to demonstrate financial viability remains.

Social need interventions typically take place outside of the walls of the hospitals and rely on cross-sector partnerships. As a result, it is not as simple to demonstrate a positive return on investment.

Hopefully, as we become more successful in integrating community

vital signs into our electronic health record data, we will be able to better show the positive impact of social need interventions on both quality of care and cost reduction. For now, hospitals can take advantage of growing incentives for insurance companies to address structural determinants of health. For instance, North Carolina’s Medicaid system recently announced that it will start reimbursing social welfare agencies to provide services that address issues such as food insecurity, housing instability, and transportation barriers.

Emergency departments, at the nexus of interdisciplinary and front-line care, can facilitate such services as well. Ultimately, integrating public health with emergency department care can minimize costly care, such as of ambulatory care sensitive conditions, that yields increased ED utilization, inpatient hospitalizations, and more importantly, worse health outcomes.

ABOUT THE AUTHOR Dr. Rehman is a physician and clinical instructor in the department of emergency medicine at the University of Colorado Anschutz Medical Campus. She is also an American College of Emergency Physicians Informatics and Quality Fellow and a section editor for the ED Administration, Quality and Safety section of the Western Journal of Emergency Medicine.

15

ETHICS IN ACTION

Salami Slicing: What Is it and Is it Ethical?

By Madeline Schwid, MD

SAEM PULSE | JULY-AUGUST 2022

Salami is a cured sausage made of fermented and dried meats that is stuffed into a log-shaped casing and cut up and served as slices. In academic writing, a salami publication refers to cutting a single study into multiple segments that are published separately.

This is a pervasive problem in scientific writing. We will examine this issue further through the following case:

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You are ready to submit a manuscript for consideration to a journal about a well-received study that you just presented at a national emergency medicine meeting. One of your mentors suggests you take your basic study, break it up, and submit it to three different journals. Is this considered salami publication and is it allowed?

Salami publication is when a single study is broken up into multiple publications or segments. Each piece reports on data from a single study that is split into segments known as

a “minimal publishable unit,” meaning that they are just large enough to have reasonable results and conclusions. It is considered a form of self-plagiarism in which the author’s own previously published ideas and content are used without proper attribution. This is in contrast to other forms of plagiarism in which another author’s words are used.

Salami slicing is unethical for a variety of reasons, but one of the most problematic is that it misleads the scientific community and distorts medical evidence that can directly influence patients and clinical practice.

For one, duplicate data can be incorporated and double counted into large scale analyses such as a metanalysis, thus influencing the overall data. Splitting data into smaller units can also make it harder to see overall trends in data and so may hinder analysis and conclusions. When these issues translate into clinical practice, patients can be harmed.

Salami slicing gives undeserved credit to authors and wastes journal resources. Academic standing, promotion, and project funding often at least partially rely on academic output and publications. This pressure to publish can be productive in some ways. It encourages people to continue to push the cutting edge of science and develop new ideas but can also encourage quantity of publications at the expense of quality. Through salami slicing, authors can artificially increase the number of publications and can receive more credit for lower value work.

Given that it is very difficult to detect, the frequency of salami publication is unknown. The overall number of journal articles per health science study has increased over time. Among this increase, salami publication is likely common based on studies that have assessed for redundancy in systematic reviews and journals. Unlike more obvious forms of self-plagiarism, there is often no text redundancy in

“Salami slicing is unethical for a variety of reasons, but one of the most problematic is that it misleads the scientific community and distorts medical evidence that can directly influence patients and clinical practice.” salami publication and so it is difficult for antiplagiarism software to detect. In some cases, it may be identified during editorial review as these articles often have the same sample size, hypothesis, research methodology, results, and authors, although this is also challenging given the articles may be spread through various journals.

Journal policies regarding salami publication are variable, but policies regarding duplicate publication are more common and strict. Duplicate publication is defined as a manuscript that is the same or very similar to a previously published article or data. Unlike salami publication, this has a narrower definition and is more consistent across journals.

It is also easier to detect and more universally discouraged.

The definition of salami publication varies between journals and includes vague terms that are subjective and can be open to debate. Because of this, cases of suspected salami publication are often considered on a case-by-case basis, making strict policies difficult to enact. The Committee of Publication Ethics (COPE) has suggested guidelines regarding cases of suspected or confirmed salami publication. Despite this, in addition to the lack of consistent

definitions, there is also inconsistency among journals in the consequences for these cases.

The Society for Academic Emergency Medicine has a statement regarding plagiarism that includes duplicate and salami publication in its policy, although salami publication is not explicitly named. Its definition of plagiarism includes “submission of material which ‘overlaps substantially with [material] already published, without clear, visible reference to the previous publication.’”

This statement acknowledges the lack of standardized definition of what “substantial overlap” means, but states it is when materials “share the same hypothesis, data, discussion points, or conclusions.” Since substantial overlap includes more than just pure duplication, this statement refers to both duplicate and salami publication. Given the subjectivity of this criterion, cases are determined by two independent reviewers. To avoid salami publication and plagiarism, the previously published manuscripts should be referenced and disclosed. If salami publication is detected, the work will be rejected and depending on the extent of unethical activity, the authors’ institutions may be notified.

Returning to our case, you reply to your mentor that you are concerned that this would be an example of salami publication and suggest you keep the study as one. You explain that you’re worried this could be unethical and highlight the benefit of having a stronger overall manuscript if you keep it as a single manuscript. You are hoping to submit it to a journal with a high impact factor and feel confident that it will be accepted. Your mentor agrees that it is more important to have one good study with a wide audience than many small nonimpactful studies and is glad you brought up your concerns and knowledge about research ethics.

ABOUT THE AUTHOR Dr. Schwid is a resident physician in the Harvard Affiliated Emergency Medicine Residency program at Massachusetts General Hospital Brigham and Women's Hospital. She served as a 20212022 resident editor on the editorial board of SAEM’s Academic Emergency Medicine journal.

17

GERIATRIC EM

Communicating with Older Adults in the Emergency Department

SAEM PULSE | JULY-AUGUST 2022

By Surriya Ahmad, MD on behalf of the SAEM Academy of Geriatric Emergency Medicine

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On any given shift, the groups of people an emergency physician communicates with can be broken down into at least three large categories: between departments, intradepartment, and with patients and families. Communication breakdown (i.e., miscommunication) can happen in any one of these groups; likewise, compromise in the ability to communicate in any one area can lead to preventable medical errors and affect patient care.

Although one may find that communication in one area poses problems for them, communication in another area may be a strength. There is also evidence that suggests that higher communication competence correlates with higher patient satisfaction,

physician empathy, and lower physician burnout; however, more studies are needed. (AMA, WSJ, NEJM Catalyst, PubMed) There are unique challenges in the emergency department — distractions, volume, lack of space, time — that make communication difficult, especially with older patients. For example, hearing and visual impairment, which make communicating in a noisy emergency department especially challenging, and difficulties with manual dexterity, cognitive impairment, and language barriers. However, there are certain communication tips that can be used with older patients specifically with the aim of improving their experience in the emergency department (the

following are adapted from the American Academy of Family Physicians): • Allow extra time.

• Avoid distractions. (In a busy emergency department this is hard; however, it is doable.) Give your undivided attention for the first 60 seconds of the interaction, utilizing the limited time you have and being fully present in the moment.

• Sit face to face.

• Maintain eye contact and utilize other nonverbal communication. Looks, head nods, body positioning and posture, gestures, facial expressions, and even breathing contribute to the relationship and communication

between caregiver and older patients.

Mirroring a patient’s actions or tone of voice can also enhance trust.

• Listen to understand rather than to respond. When talking to older patients, they will often surprise you and can tell you most of the story and often lead you to understand exactly what is going on with them. Listen to them. Even if you cannot reliably gain a history, do not miss the opportunity to try and simply connect with the patient in any way you can prior and in conjunction with conversations with caretakers and family members.

• Speak slowly, clearly, loudly.

• Use short simple words and sentences.

• Stick to one topic at a time and be specific. Abstract thinking can be challenging for some older adults.

• Simplify and write down instructions.

Use charts, models, and pictures, and summarize the most important points.

• Allow time for questions.

“There is also evidence that suggests that higher communication competence correlates with higher patient satisfaction, physician empathy, and lower physician burnout.”

It’s important to point out that many of the tips of communicating with older adults are really just good communication tips in general and can be adapted to any patient interaction. Ultimately, it is not just about basic communication tips, but also mixing these with empathy and compassion, with the goal of creating a therapeutic alliance and narrative: do not judge, be sincere, and build trust with your patient. Ultimately, this could reduce social isolation, and associated loneliness, depression, and anxiety in this vulnerable patient population. The emergency department may be the one opportunity your patient has to connect

with someone — give your patient your undivided attention, even if for just 60 seconds.

ABOUT THE AUTHOR Surriya Ahmad a geriatric emergency medicine fellow, assistant attending physician in emergency medicine, and instructor in clinical emergency medicine at Weill Cornell/ NewYork Presbyterian Hospital in New York City. @emergencyimprov

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

19

GLOBAL EM

Technology in Humanitarian Response: Developments and Limitations

SAEM PULSE | JULY-AUGUST 2022

By Sonya Naganathan, MD MPH on behalf of the SAEM Global Emergency Medicine Academy

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In 2021, the United Nations Office for the Coordination of Humanitarian Affairs reported 235 million persons in need of humanitarian assistance and projected that number to increase to approximately 274 million people in 2022 (with projected costs of USD $41 billion). Afghanistan, Syria, and Yemen are the three most expensive crises.

Afghanistan, which carries the highest cost, will require 4.4 billion dollars in assistance to reach the 24.4 million people in need.

Most recently, the war in Ukraine has catapulted the world of humanitarian relief back into the daily news cycle.

There have been numerous reports of civilians, hospitals, and humanitarian aid workers being intentionally targeted

by the Russian military—leading to tragic loss and destruction of lives and infrastructure. As a result, the humanitarian crisis and response has rapidly decompensated, marred by myriad safety and logistics concerns.

Over the last decade, a series of catastrophes have spurred the development of digital and other technologies to attempt to mitigate some of the risks and inherent challenges to these settings. There has been an ever-growing call for more.

Let’s look back.

Open Source Software

Towards the end of 2007, two months of political unrest following the election of then Kenyan President Mwai Kibaki

led to efforts focused on harnessing the power of the public to generate real-time information. Ushahidi, a company born out of this crisis, crowdsourced information using text message and email and mapped the reports of protests and violence (via their open-source platform) to various public websites including Google Maps.

Ushahidi has since grown to develop its technology, demonstrating its use in different settings. Notably, Ushahidi’s crisis mapping efforts were instrumental in disseminating vital information in the immediate aftermath of the Haitian earthquake in 2010. By allowing others to send text messages to a centralized location, Ushahidi volunteers were able to map the GPS coordinates and

provide the information to rescue teams on the ground.

Cash Transfers

Cash transfers have been a tried-andtrue method of post conflict humanitarian assistance. Cash assistance lets the affected individuals decide exactly where they want to spend their money – and do so locally. Especially in places with good infrastructure, cash transfers are more frequently used. As its use increases, the technology develops, too.

The use of biometric data, which is used to facilitate transfer and ensure cash is being exchanged out of and into the right hands, is the leading technology in this area. It has been used in multiple locales including Yemen, Jordan, Uganda, and the Philippines. In fact, in a Jordanian refugee camp, Syrian refugees purchase groceries via iris scans.

Security Risk

Nevertheless, security breaches plague the community still. While biometric data, for example, allows an organization to easily confirm an individual identity, identity fraud and the security of large data sets remains controversial.

Governments and private companies have access to the immense data of vulnerable populations, creating additional risk. Similarly, the use of humanitarian notification systems has been used to allow warring governments access to civilian locations. Those coordinates can denote locations for governments to avoid in order to lessen the targeting of innocents and areas of humanitarian activity. Over the last two decades, there have been numerous reports of intentional targeting of humanitarian and medical facilities in South Sudan, Syria,

and most recently the bombing of several hospitals in Ukraine by the Russian government.

The next decade will allow for these technologies to further develop.

ABOUT THE AUTHOR Dr. Naganathan is an assistant professor in the Department of Emergency Medicine at UT Southwestern Medical Center in the Emergency & Disaster Global Health Division. She completed an emergency medicine residency at Washington University in St. Louis and a fellowship in global emergency medicine at Brown University. @SNagMD

About GEMA The Global Emergency Medicine Academy (GEMA) focuses on improvement of the worldwide delivery of emergency medical care.

Joining GEMA is free! Just log in to your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

21

REFLECTION

Working Alongside the Ohio National Guard in a Community ED During the COVID-19 Pandemic

SAEM PULSE | JULY-AUGUST 2022

By Ariel Klusty, DO, and Alison Southern, MD, MSEd

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Since the beginning of the COVID-19 pandemic, hospitals have been focused on ensuring they have adequate supplies and resources to meet increased patient care demands, while also combating staffing shortages.

In December 2021, Ohio Governor Mike DeWine announced that Ohio COVID-19 hospital admissions had hit an all-time high with more than 4,700 hospitalizations — an average of one in five people. With inadequate resources and staffing, many hospitals were spread thin and were nearing a crisis in patient care. In hopes of relieving the burden of the pandemic surge on hospitals, on December 17, 2021, Governor DeWine deployed members of the Ohio National Guard to hospitals located in the Cleveland, Akron, and Canton areas. The deployments included medical, transport, and domestic/environmental duties.

As a first-year emergency medicine resident in Canton, Ohio, I had the privilege of personally working alongside these guard members and wanted to share their experiences. After contacting the Ohio National Guard Public Affairs Department, I was granted the opportunity to interview some of the guard members deployed in our hospital.

Sergeant Christopher Ogle

For Sergeant Ogle, a combat medic, who has served almost six years in the military. For Sergeant Ogle, a combat medic, who has served almost Christopher Ogle six years in the military, this was not his first pandemic deployment. His prior deployments

consisted of assisting COVID-19 testing centers and federal prisons. In our hospital, he helped relieve our staffing shortage by carrying out duties similar to an emergency department technician.

He worked in triage performing EKGs, recording vital signs, and collecting blood work. He also assisted in patient transport. When asked to describe his experience, Sergeant Ogle had only positive recollections. He felt welcomed by both patients and staff. He was also able to refine his skills acquired in his military training by applying them in our emergency department. Sergeant Ogle further stated that he was able to gain new skills from the emergency nurses such as how to float an IV. When asked what he felt was the Ohio National Guard’s most significant impact in our hospital, he responded, “taking the burden off the nurses.” With Sergeant Ogle helping the emergency department

“the National Guard’s biggest impact was in triage.” team, this enabled nurses to focus their time on critically ill patients. Overall, he stated that his one-month experience in our hospital increased his interest in pursuing a career as a paramedic.

Corporal Dalton Ray

Corporal Ray, a six-year military medic, had a similar experience in our community emergency department. He felt that by helping the Dalton Ray staff in triage, he was able to assist in ensuring that all patients received appropriate medical care in a timely manner. Moreover, he stated that he felt he was trained efficiently and effectively in triage management by our emergency department staff.

Sergeant Dawn McGuire

For Sergeant McGuire, her deployment struck closer to home. For 15 years, Sergeant McGuire has been enlisted in the Air Force National Dawn McGuire Guard, and despite her multiple deployments, this was her first local deployment. This was special to Sergeant McGuire because not only was she able to give back to her hometown community, but she was also able to work alongside her mother, an employee in our hospital. Contrary to her role as a paramedic, Sergeant McGuire was deployed to our hospital as a nonclinical staff member, and she was assigned to work in our environmental service department. By assisting with the cleaning of nonCOVID-19 rooms, Sergeant McGuire helped allow our trained environmental service employees to focus on sanitation of COVID-19 rooms.

“With inadequate resources and staffing, many hospitals were spread thin and were nearing a crisis in patient care.”

Arielle McFadden

Arielle McFadden, one of our nurses, also had a positive experience with the National Guard deployment. She felt the National Guard’s biggest impact was Arielle McFadden in triage. By helping with patient centered tasks such as EKGs and blood work, Arielle personally felt that our emergency department was able to care for more patients in a timely manner, thus allowing our hospital to function as efficiently as possible. Moreover, for some, the guard members were the first medical personnel patients encountered in our hospital. According to Arielle, once patients found out the National Guard was present in our hospital, their attitudes toward their care changed — they were more interested and appreciative.

She further felt that it helped patients understand the severity of the pandemic.

Overall, the deployment of the Ohio National Guard not only supplied aid to our hospital in our time of need, but it also provided a positive experience for the guard members and hospital staff interviewed. If the Ohio National Guard were to be called upon again during this pandemic, I asked our guard members

how community emergency departments could better prepare for their services in the future. The resounding consensus was for hospitals to supply clearly defined positions and tasks for military personnel. This would ensure guard members as well as hospital employees are aware of all duties, thus ultimately allowing the medically trained guard members to be utilized to their greatest potential. Moreover, the guard members recommended having an orientation which would allow guard members to have a smooth and efficient transition into future hospital systems.

ABOUT THE AUTHORS Dr. Klusty is an emergency medicine resident (PGY-1) at Aultman Hospital in Canton, Ohio.

Dr. Southern is the program director for Aultman Emergency Medicine, Canton, Ohio, and an associate professor of emergency medicine at Northeast Ohio Medical University.

23

REFLECTION

SAEM PULSE | JULY-AUGUST 2022

Run the List: A Story of Language, Culture, and Love

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By Alina Mitina, DO It was the end of my intern year and I was carrying the most active patient roster I'd ever had — just another day in emergency medicine. “Run the list,” I said in my head repeatedly. As I determined the best next steps for each patient and carefully mapped out the most efficient pathway through the department to see all of them, I saw ambulances start to line up in the ambulance bay. They were all waiting on one patient: an elderly woman.

I walked over to the charge nurse and the emergency medical technicians, who were looking wearily at the patient.

As the charge nurse spotted me, she perked up, hope shining from her eyes, and asked: "You speak Russian, right?"

Of course, I do. I’d immigrated to America from Ukraine at the age of seven, and I still remember my mother tongue. I walked over to the patient and introduced myself. Her whole face lit up as I began speaking her language. She

spelled her name for me in Russian and told me she had come to America with her husband from Ukraine 30 years ago.

The patient told me her story, about falling on the street and being unable to stand up. I helped triage and comfort her until she was placed in a room. The next morning, I followed up on her and found out that she had been admitted.

Two days later, the charge nurse told me they needed my Russian interpreter skills once again. “How odd,” I thought,

“By taking the time to engage with my patients on such a personal level and using my native language to communicate with them, I helped reunite this lovely couple and brought a little happiness to their time in the hospital.” as it was very rare to have Russianspeaking patients in the area where I was working.

I went to the patient, an elderly man, who was standing in the ambulance bay with a middle-aged man. The middleaged man introduced himself as the man’s caretaker and told me the elderly man was there for depression and weakness.

I learned that the elderly man had become weakened over the previous two days after he had “lost his wife.” The Russian home health agency had called four of the local hospitals looking for her, but had been unsuccessful. “Interesting,” I thought, and I asked the patient to describe what his wife looked like.

Suddenly it all clicked. I told the elderly

man "I know exactly where your wife is!”

His face lit up in the most delightful way.

The next morning, I again encountered the Russian caretaker walking into the emergency department through the ambulance bay. He was holding two large bags of groceries — Passover food for the elderly Ukrainian couple. The caretaker had forgotten his vaccination card so wasn’t allowed into the hospital.

“Would you take the food to them?” he asked. “Of course!” I agreed.

The couple was sharing the same room and when I entered, I found them sleeping soundly. I gently awakened them and when they saw me, their faces lit up with joy that we were able to connect again.

By taking the time to engage with my patients on such a personal level and using my native language to communicate with them, I helped reunite this lovely couple and brought a little happiness to their time in the hospital. I think that is a list well-run.

ABOUT THE AUTHOR Dr. Mitina is a PGY-1 emergency medicine resident physician at St. John’s Riverside Hospital, Yonkers, New York.

25

RAMS SPECIAL FEATURE

Introduction to Preference/Program Signaling in Emergency Medicine SAEM PULSE | JULY-AUGUST 2022

By Elizabeth Barrall Werley, MD; Melanie Camejo, MD, MHPE; Ryan D. Pappal, Hamza Ijaz, MD; and Alexis Pelletier-Bui, MD, on behalf of SAEM Residents and Medical Students

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Introduction

Emergency Medicine (EM) will be participating in Preference/Program Signaling (PS) as a pilot in the 20222023 residency application cycle through the Association of American Medical Colleges (AAMC) Electronic Residency Application Service (ERAS) Supplemental Application (SuppApp).

Our specialty will be joining 15 other specialties in utilizing the ERAS SuppApp, but is one of only two specialties that will only be participating

in the PS component and not the past experiences or geographic preferences sections. PS gives EM applicants the option to signal their genuine interest in up to five participating residency programs.

What is Preference/Program Signaling? What is its goal and how does it help applicants and residency programs?

PS was first implemented in labor economics in 2006 after experiencing

issues similar to the increasingly complex residency application process.

Applicants were overapplying for positions and employers were struggling to holistically review applicant files and identify truly interested candidates who were a good fit for their organizations.

PS provided applicants the ability to denote genuine interest in a limited number of potential employers, helping them gain better visibility with the organizations in which they were most interested. In turn, employers

“The goal of program signaling in medicine is the same across all specialties: increase transparency early in the application process to help applicants and programs find each other.” could focus their attention on high-yield prospects.

PS made its debut in the residency application process in 2020, first with otorhinolaryngology (ENT) via their specialty society. The following year, urology implemented PS through their specialty society, while internal medicine, surgery, and dermatology utilized the ERAS SuppApp. The goal of PS in medicine is the same across all specialties: increase transparency early in the application process to help applicants and programs find each other.

There have been concerns of virtual interviews leading to a maldistribution of interviews to top applicants, but PS has the potential to minimize this by allowing programs to identify and offer interviews to truly interested candidates earlier in the interview cycle.

PS has been used as a pilot in ENT, urology, general surgery, dermatology, and internal medicine. How “successful” has PS been based on available data?

Existing data suggest PS is a win for both programs and applicants. Most outcome-based data is from ENT, given its two-year experience with PS compared to less than one year in other specialties. Program directors (PDs) who have participated in PS in other fields noted that it helped them identify candidates they would have previously overlooked, helped facilitate a more holistic review of specific applicants, and served as a tiebreaker for interview offers between a signaling applicant versus a similarly matched nonsignaling applicant.

Most surveyed PDs strongly favored continuing PS. From the ENT data, we know that PS demonstrated benefits for applicants as well, increasing interview yield across all applicant groups by more than twofold, with the largest benefit to those in the lowest quartile of competitiveness,

increasing their yield by more than threefold. The majority (93%) of applicants received an interview from at least one signaled program, with 61% receiving three or more interviews from their signaled programs. The rate of receiving an interview offer was significantly higher from signaled programs (58%) than from nonsignaled programs (14%). While most ENT applicants felt PS did not allay their fears associated with interview season and the match process, the majority did feel that PS allowed applicants to be noticed by programs in which they had the most interest and that it was an equitable process that benefitted both programs and applicants. Most (77%) strongly favored continuing the program.

With the understanding that this is the first year we are trialing this in EM and there is no universal advice for all students, what advice and recommendations can you provide to applicants in approaching the PS process?

The “Sheriff of Sodium” said it best in his blog post about PS: “Signals should be utilized at programs where an applicant has a nonzero, but less than certain, probability of receiving an interview, provided the applicant has a real interest in that program.” It does not make sense to waste a signal at a program that would not otherwise consider you; therefore, we recommend reviewing program websites and existing databases (EMRA Match, Texas Star, AAMC Residency Explorer Tool, etc.) to determine whether or not you could be filtered out of consideration based on board exam requirements (United States Medical Licensing Examination versus Comprehensive Osteopathic Medical Licensing Examination minimum scores), visa status, etc. On the contrary, it is not wise to signal a program where it’s highly likely that you will obtain an interview, which is why EM applicants should not signal their home programs or programs

at which they’ve performed an away rotation.

Given that PS is so new to medicine, we have no data on how to best assign signals, and best practices may differ depending on the specialty. We do know that about a quarter of programs in each specialty received about half of all signals.

When the number of signals received by these competitive programs increases, the value of the signals decrease. If an applicant does not have the strongest application and they utilize all their signals at competitive “reach” programs, the emphasis behind their signals may be lost. We strongly suggest that applicants work with an experienced EM advisor to reflect honestly on the strength of their application and discuss how to maximize the yield of their signals. If an applicant does not have access to an experienced advisor, they can request one through CORD at distanceadvising@ cordjobboard.com.

Regardless of the data or an applicants’ competitiveness, the one recommendation that remains constant is to send signals to programs in which you are genuinely interested.

What potential limitations do you foresee in this pilot program?

1. While PS participation is optional for students, those who opt out may be at a disadvantage as interviews may be allocated to similarly competitive signaling candidates. To avoid potential bias, there is no mechanism for programs to tell which applicants are not participating versus those who are participating but did not send a signal.

PS will shift some decisions earlier in the process for applicants, which could disadvantage applicants who may be unclear on their preferences.

continued on Page 28

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SAEM PULSE | JULY-AUGUST 2022

RAMS SPECIAL FEATURE

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continued from Page 27

2. Applicants who lack advising may not utilize their signals to the fullest potential.

3. Programs that receive an abundance of signals may not see as large a benefit of PS as those who receive fewer signals. The choice of five signals may not be ideal for our specialty and may need to be amended in the future, pending EM’s experience this year.

4. There is no way for applicants to communicate the reasoning behind their signal. For both applicants and programs, the “why” behind the signal might be the most important piece of the puzzle.

Conclusion

The residency application process is broken. While we do not expect PS to be the panacea, we do hope it will help provide clarity to an overly complicated process in an equitable, low-cost, low-effort manner for both applicants and programs. While PS is optional for

programs and applicants, we hope all will consider participating in PS to fully assess its usefulness and impact in EM. This pilot will be closely assessed and researched throughout the year to determine utility in future application cycles and to develop best practices and recommendations in EM. For further details and up to date information on the implementation of PS in EM, please visit https://www.cordem. org/resources/preference-programsignaling/.

ABOUT THE AUTHORS

“Regardless of the data or an applicants’ competitiveness, the one recommendation that remains constant is to send signals to programs in which you are genuinely interested.”

Dr. Barrall Werley is an assistant professor of emergency medicine at Penn State University College of Medicine/ Penn State Health Milton S. Hershey Medical Center.

She currently serves as the Vice Chair for CORD's Application Process Improvement Committee. @ebwerley r. Camejo is currently the assistant residency program D director, comedical education fellowship director and emergency medicine clerkship director at the University Health/Truman Medical Centers associated with the University of Missouri-Kansas City School of Medicine (UMKC-SOM). She is also chair of the CORD Application Process Improvement Committee (APIC) and active in the CORD Advising Students Committee in EM (ASC-EM). @EMelaniecamejo r. Pelletier-Bui is an assistant professor of emergency D medicine at Cooper Medical School of Rowan University, where she is also the associate program director and an emergency medicine subspecialty advisor. She is the immediate past chair of the CORD Application Process Improvement Committee and a past chair of the CORD Advising Students Committee in Emergency Medicine (ASC-EM). @PelletierBui R yan Pappal is graduating from Washington University School of Medicine in St. Louis and will be starting his residency at Beth Israel Deaconess Medical Center.

He attended undergrad at Rice University and was a paramedic and a member of the leadership board of Rice Emergency Medical Services. Ryan has served as a medical student representative on the RAMS Board for two terms as an SAEM-RAMS Board Member-at-Large. @RyanDPappal amza Ijaz is a rising PGY-4 emergency medicine H resident at the University of Cincinnati. He has served on numerous SAEM committees including the Program Committee, ED Administration and Operations Committee, Faculty Development Committee, and Virtual Presence Committee. He is the current president of SAEM RAMS. hijaz93@gmail.com

Free Webinar! Preference/Program Signaling: A Crash Course for the Upcoming Application Cycle Wednesday, July 13, 2022 | 6:00 PM CT – 7:00 PM CT Preference/program signaling (PS) is a concept rooted in game theory and developed in labor economics to address the challenge of employers not being able to perform a detailed analysis of all potential applicants and aiding them with identifying high-yield employee prospects. There have been a lot of questions about the role PS will play in the upcoming 2022-2023 residency application cycle in emergency medicine. The webinar will cover the background on PS, provide general advice for how to approach signal utilization, and discuss potential limitations of this process.

Learn more. Register now.

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SEX & GENDER

Effects of Sex and Gender on Obesity and Cardiovascular Disease

SAEM PULSE | JULY-AUGUST 2022

By Nina Faynshtayn, Ynhi Thomas, MD, MPH, MSc; and Connie Newman, MD, on behalf of the SAEM Sex and Gender in Emergency Medicine Interest Group

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Consideration of sex and gender is crucial for improving medical care.

Historically, in terms of research and clinical practice, differences between men and women have seldom been considered and analyzed thoroughly.

One example is cardiovascular health.

Women and men present with varying symptoms of acute coronary syndrome, and women are less likely to be diagnosed and treated. Research has focused primarily on men’s bodies, yet there are significant sex differences that need to be studied, such as the effects of cardiovascular drugs and patterns of coronary artery plaque distribution.

Obesity is a risk factor for cardiovascular disease and sex differences in obesity should be

“Beyond physiological differences, lifestyle differences based on sex and gender may influence obesity.” considered. Fat deposition differs between males and females. In males, fat is mainly located in the visceral area (which is associated with increased risk of cardiovascular disease), and in premenopausal females, fat deposits are largely subcutaneous. Fat may be dysfunctional in obesity and release substances called cytokines that have negative effects on the heart. Genetic,

epigenetic, and hormonal factors are responsible for sex differences in adipose tissue distribution. Estrogen plays a critical role in energy balance, acting on the brain to reduce food intake and increase physical activity and energy expenditure. Also, it is important to note that estrogen deficiency, which occurs during menopause, is associated with diabetes and obesity.

“Historically, in terms of research and clinical practice, differences between men and women have seldom been considered and analyzed thoroughly.”

Beyond physiological differences, lifestyle differences based on sex and gender may influence obesity. Specifically, men and women differ in terms of their macronutrient consumption, as well as food cravings, with women consuming more total sugar, total fat, and saturated fat, while also craving more sweet foods.

Greater understandings of sex and gender differences in adipose tissue and obesity could lead to novel approaches to weight reduction and weight management. In studies comparing effects of lifestyle changes on body weight in men and women, results were inconsistent, with several showing small sex differences in weight loss, but not prespecifying the comparison of sex and gender differences. Other limitations of studies on sex and gender differences in weight loss include an unequal number of men and women, limited data for percent change in body weight, lack of studies that defined sex differences in weight loss as a primary end point, and data collection and research methods.

Some studies suggest sex differences in preferences for types of lifestyle

interventions, though more research is needed on sex and gender tailored interventions.

In anthropological terms, obesity can be considered a “social contagion,” which is a concept proposed by Christakis and Fowler. With this idea, social networks play a crucial role in the “spread” of obesity, such as with peers and in friendships. Thus, these networks may be implicated by gender as well. However, a review of various studies demonstrated inconclusive findings regarding the consideration of obesity as a gendered social contagion.

Overall, more research is needed, especially with randomized controlled trials, extensions of studies, comparisons of interventions, and the effects of geography, social networks, access to healthy foods, and educational levels.

Elucidating the state-of-the-art concept of obesity as a gendered social contagion may identify areas for novel emergency medicine research with immense public health significance.

ABOUT THE AUTHORS Nina Faynshtayn is an undergraduate research assistant at Brown University.

Dr. Thomas is assistant director of justice, equity, diversity, and inclusion in the Henry J.N. Taub Department of Emergency Medicine at Baylor College of Medicine and assistant medical director of operations research and assistant medical director of behavioral health initiatives at Ben Taub Emergency Center, Harris Health System.

Dr. Newman is an adjunct professor of medicine, New York University Grossman School of Medicine, New York, NY and past president of the American Medical Women’s Association

About SGEM The Sex and Gender in Emergency Medicine (SGEM) Interest Group works to raise consciousness within the field of emergency medicine on the importance patient sex and gender have on the delivery of emergency care and to assist in the integration of sex and gender concepts into emergency medicine education and research. Joining SGEM is free! Just log into your member profile.

Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side.

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

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WELLNESS

Duality, COVID-19, and 2022: Being a Caregiver and a Patient

SAEM PULSE | JULY-AUGUST 2022

By Al’ai Alvarez, MD, on behalf of the SAEM Wellness Committee

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A year into the pandemic we saw a glimmer of hope thanks to unprecedented scientific breakthroughs in vaccine development. Concurrently, vaccine misinformation spread like wildfire, adding to the increasing death toll from COVID-19. Within a short year, the virus mutated several times, and what was deadly at the start of 2020 evolved into something milder but more highly contagious. We saw recordbreaking numbers of new cases, and many of us saw our roles, our own lived experiences, and perspectives change.

2022 has been a year of duality.

While so many of us have been vigilant about this virus (we washed our hands, masked up, socially distanced ourselves) transmission rates are nevertheless significantly higher with Omicron. Consequently, we have found ourselves in roles we have tried to avoid:

• as caregivers receiving care • mourning during times of celebrations • angry at someone we love and care for deeply because of misinformation and decisions about how to handle this pandemic • hopeful and scared for the future On December 19, 2021, a few days before a much-anticipated vacation with my family, I started feeling myalgia after a day of hiking with colleagues to celebrate the closing of 2021. I did not think much of it. I thought maybe I was no longer fit to do that much hiking — another consequence of the sedentary virtual meetings the pandemic brought.

By nightfall, I was shivering, my head was pounding, and I felt congested.

I’d heard about Omicron, but as an emergency physician, I looked back and convinced myself that I could not

possibly have become infected. After all, I did everything right, including getting triple vaccinated. Maybe it was rhabdomyolysis, I told myself. But why the chills?

I isolated myself starting on day one of the symptoms. By day two, I still could not compel myself to be tested. I felt partly ashamed, as if getting a positive test would mean I, too, am now like “them.” But wait! How could that be?

After all, I had been “good” (as if “being good” had any bearing on contracting COVID-19). I set my sights on a shortterm goal: vacation in three days.

The relief that thought brought was fleeting. My mind started racing. I could get my family sick! And what about everyone on the plane? I woke up early on day three to drop off my PCR test.

I’d taken two tests to be sure: one by mail and another dropped off at the

hospital. Taking the tests offered me a sense of relief. At least, I would know.

I texted my family about my symptoms and spent the rest of the day at home, isolated, and waiting. I received no news that day, nor did I hear back on day four.

Testing sites were overwhelmed too, and the turnaround time increased.

That same afternoon, a dear friend and fellow emergency physician whom I’d had dinner with five nights prior texted that she had a sore throat. She told me the rapid test she took was positive. I became even more certain of my own test results.

I could have asked my friends sooner if they had any symptoms. I could have asked my colleagues, with whom I went hiking, if they had any symptoms. But I didn’t. I could not. I was ashamed that I may have exposed them and would cause them to miss their family reunions during the holidays. My isolation offered me time to reflect, ponder, and rationalize the “what-ifs” and “shoulda-couldawouldas.”

But maybe I was negative! It was as if the possibility of contracting the virus would suddenly become my identity.

At 12:30 a.m. on day five of symptoms, the first of two tests came back positive.

I woke up later that day to a few missed calls from the hospital confirming the other test I took was also positive. The thought that I may have exposed others weighed heavily on me. Unequivocally, I had contracted the COVID-19 virus that had killed so many and upended how we lived.

Armed with confirmed tests, I overcame the guilt and shame and started texting colleagues with whom I’d been in contact to alert them of my positive results. For every ounce of trepidation, there was significant relief whenever I heard back: “no symptoms.”

The hospital offered me hotel accommodation if I needed to isolate myself from family members. They also offered a gift box and support. But I felt so guilty! I initially thought about not calling back. I was then reminded of the practice of self-compassion and allowed myself to receive the care. The kindness and generosity I experienced reminded me of how good it felt to be cared for when sick.

Omicron allowed me to slow down.

The key, I am learning, is to embrace the dualities. We do not have to be one or the

“This experience forced me to understand that we can coexist with the virus, even while in pursuit of work-life balance, because the virus is everywhere, and it is here to stay.” other all the time; we can be both. This experience forced me to understand that we can coexist with the virus, even while in pursuit of work-life balance, because the virus is everywhere, and it is here to stay.

My experience was also a reminder that doctors are humans, too and we must allow ourselves to get help. And while we have been vigilant about keeping ourselves safe, perhaps boundary-setting means more than just being on one side versus the other; perhaps it also means accepting what we cannot change, embracing the emotions that come with this realization, and holding space within us to still hope and see the goodness around us.

The recent COVID surge has affected our emergency departments, with hundreds of physicians becoming sick and their clinical shifts needing coverage.

Guilt, shame, and disappointment are some of the many emotions surfacing as a result. But we can learn to embrace the dualities. For instance, we can embrace the duality of acknowledging disagreements about this virus and showing compassion for ourselves and

others. We can hear our colleagues’ frustrations about work, exacerbated by COVID, and continue to find things about our profession that give us meaning.

Every day, as we make our choices, we must remember to hope. What gives me hope are colleagues who step up and cover empty shifts and colleagues who check in with each other. What gives me hope are the creative solutions we make as emergency physicians. While we may not always have the answers, we can use the lessons we’ve learned from this experience to educate our patients.

We can use turn this experience into an opportunity to prepare our colleagues for the inescapable. I wish it had not taken me catching COVID-19 to understand this.

ABOUT THE AUTHOR Dr. Alvarez, is the director of well-being at Stanford Emergency Medicine and chair of the SAEM Wellness Committee. @alvarezzzy

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WELLNESS

Financial Stability and Its Impact on Resident Wellness

SAEM PULSE | JULY-AUGUST 2022

By Kevin Hon, DO, and Ryan Pappal, MD, MSCI on behalf of the SAEM Wellness Committee

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After the marathon that is medical school, residents cross the finish line to do what we dreamt of and sacrificed so much for: practicing medicine. Our progression into “adulting” and finally holding that first paycheck as a doctor is often an exciting one; however, depending on where some of us end up and after paying off the necessary evils of rent and (the elephant in the room) student loans, that first paycheck might not look so great. For some, emergency expenses, childcare costs, and family financial obligations, can quickly turn one’s financial situation into a significant source of stress and professional unwellness. As new residents, we’re expected to be completely devoted to our patients. Further, as newly minted doctors there’s an assumption that now that we have income, we can focus all our energy on learning. But surprise! We are not at all financially stable! In an ideal world, residents wouldn’t have to go

home after caring for patients and worry about making ends meet from paycheck to paycheck; but we do.

PAYE or REPAYE, this debt comes with the side effect of an ever-growing loan principal.

Modern Day Context

During the COVID-19 pandemic, with the interest-free provision from the government, most residents have not had to make any payments; however, the future of COVID-related student debt relief is uncertain and may not continue to be extended.

So how did we get here? In 2021, the average intern salary was $58,921.

While resident wages tend to go up each year, they don’t always follow the inflation curve. Furthermore, raises tend to vary even between institutions. For example, this year, Yale’s resident senate negotiated an 8% raise, whereas most other programs have only given raises in the 2-4% range. As inflation hit 8% this year, our salaries have yet to catch up. Thus, residents do not necessarily have more buying power than they did previously; in many cases, they have less.

The average intern starts with $200,000 of medical school loans.

Because residents are not expected to make a meaningful dent in their loans at minus $300 per month, if they opt for

To account for the variable cost of living, some programs provide housing stipends and even increase resident salaries proportionally. Paying for a tiny studio apartment or living with a roommate in New York City would be nearly equal to a mortgage in Texas or Ohio. Moonlighting could be a viable way to earn extra income, provided that it doesn’t violate duty hours; however, some states, like California, have passed laws that essentially limit the ability of new residents to engage in this venture.

“In an ideal world, residents wouldn’t have to go home after caring for patients and worry about making ends meet from paycheck to paycheck; but we do.”

Challenges of Addressing the Current System

What can residents do? Negotiating for more pay during one’s residency is extremely difficult. After all, most of us acquire employment via The Match process. Negotiations are impossible when you do not know who your employer will be until the March preceding the start of your residency training. We are then contracted to our hospital for the duration of our residency.

Everyone in that hospital receives the same contract with the same benefits. At the end of the day, the hospital gives us a paycheck.

True resident salary reform that puts financial stability and fair value for our labor into our salaries can likely only be achieved at the federal level. Realistically, the difficulty of forming a concerted lobbying effort that may overhaul the way the Centers for Medicare & Medicaid Services handles medical trainees probably puts such reform out of reach of medical trainees for the time being.

Among the challenges is a lack of resident representation at the political level and the lack of stable resident leadership to push for those changes. There may be other options, however.

Unions

At some residency programs across the country, residents have taken it upon themselves to negotiate for their financial wellness by unionizing. Historically, these efforts have yielded perks involving parking, food, educational stipends for conference travel, childcare, and board prep resources. Resident unions have entered the public eye more recently with Los Angeles County-USC’s (LACUSC) union voting on a possible strike for improved pay and housing stipend after their contract expired. At the time of this writing, Service Employees International Union-Committee of Interns and Residents announced via their Instagram page that Los Angeles County+USC Medical Center voted 99% in favor of a strike. It is uncertain if a strike will occur

as contract negotiations are still ongoing.

The Accreditation Council for Graduate Medical Education requires all programs to have a house staff association to advocate for residents. Nevertheless, some trainees may feel that these groups do not have enough bargaining strength to effect positive changes for their residents.

For residency programs not part of a union, it’s important first to gauge interest and weigh the pros and cons of unionizing. While pushing for higher salaries can undoubtedly be part of collective bargaining, residents may have some understandable reservations, such as possibly having to strike and its associated implications on patient care responsibilities; fear of retaliation from hospital leadership; having to pay union dues (typically taken as a percentage of one’s new salary after negotiations); and the possibility that ineffective local union leadership may make things worse instead of better. Here are additional perspectives from the AMA Journals of Ethics and Reddit.

Some residency programs can provide for their residents out of their budget; whether your program is financially capable of doing so depends on how much it’s getting from the hospital, which is a whole other issue. What may be a helpful starting point is assessing the landscape in the local area: How does your residency salary and benefits compare with the salaries and benefits of other local residency programs?

Medical Student Aspect

What does this mean for medical students? When deliberating your Match rank list, consider the financial argument for each program. How much are residents paying for rent or a mortgage?

Are they living with roommates? How comfortable would you be in that situation?

Residencies provide information regarding salaries and benefits on their websites, but don’t forget to ask about other perks a program can

provide its residents. If you don’t ask, you won’t know what to factor into your consideration. For example, some programs offer a housing stipend to offset rent in expensive areas of the country.

While it might be overkill to use that information to create a skeleton budget for each program on your rank list, it might be worthwhile to do so for your top ranks, to give yourself an idea of how much you’d be earning and spending in residency. Being proactive in these respects can help address essential conversations you’ll be having with your family members or significant others when you do make that decision to begin the next step of your career.

Financial well-being is shaping up to be the next frontier of resident wellness. As residents help develop wellness initiatives, a vigilant focus on the financial burden of residency may be beneficial in developing new and creative ideas to address this issue beyond residency salary and benefits. We must continue to educate ourselves on financial literacy, just as we are trying to understand cost-effective care. The more these issues are openly and honestly discussed, the better the chances we have for making meaningful change — not only for ourselves but also for our profession's future and sustainability.

ABOUT THE AUTHORS Dr. Hon is a PGY-2 at NewYork-Presbyterian–Queens.

He attended medical school at Western University of Health Sciences College of Osteopathic Medicine, Pomona, California.

Dr. Pappal is a PGY-1 at Beth Israel Deaconess Medical Center in Boston . He attended medical school at Washington University School of Medicine in St. Louis.

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Celebrating the SAEMF’s 2022 Annual Alliance and the Impact of a Gift Each year SAEMF makes a significant investment in emergency medicine’s future by funding close to $850,000 in research and education grants. This is only possible through the generosity of our Annual Alliance donors.

These visionary donors make SAEMF’s work possible by partnering with us to award more and larger grants and to ensure vital resources for initiatives that build emergency medicine's pipeline of researchers and educators. Take a look at the SAEMF Donor Guide for details about the accomplishments being made possible through our donors and to read about this year’s grantees. Please join us in celebrating the generosity of the Annual Alliance and their commitment to advancing EM.

Together with SAEM, the SAEM Foundation has awarded over $9 million to more than 400 academicians.

For every $1 donated to SAEMF, more than $3 in subsequent federal funding is generated for emergency medicine research.

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$9M 400 academicians

$

1

donation to SAEMF

3

$

federal funding

“We, as emergency medicine practitioners, educators, and scientists, can and should work together to make the world a better, safer place. SAEMF is here to help us accomplish these goals. This requires ongoing investments in research and education, boundless wonder and fearless creativity.”

- Katherine L. Heilpern, MD

More Research Grants To Launch More Careers Today, the SAEM Foundation is able to fund roughly 20 grants per year, supporting rising researchers at nearly that many institutions. Yet it is not uncommon for the Foundation to have to turn down 10 to 15 additional high-quality applicants.

A greater research fund will, first and foremost, allow the Foundation to say yes to more qualified applicants, supporting more talented physicians as they work to build research careers in support of our field, and launching more research projects with the power to change lives.

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Prasanthi (Prasha) Govindarajan, MD, MAS Stanford University School of Medicine, Advocate Donor of the Annual Alliance

SAEMF Donor Perspectives How has your engagement with SAEM / SAEMF impacted your professional or personal life?

SAEM has had a very positive impact on my professional life in emergency medicine. The networking and collaboration opportunities, learning from and mentoring others, being able to contribute to the growth of research, diversity, and inclusivity are some of the major ways in which SAEM has impacted my professional work.

What compelled you to support the SAEMF? Why do you feel now is the right time to support more grants for emergency medicine research/education?

We have so many aspiring researchers and so many questions that could improve emergency care delivery to our patients and I would like to see these come together. I like to support young researchers who are looking to kick start their research careers and SAEMF has given me the opportunity to do it.

How do you feel SAEMF makes a difference for SAEM members, future EM practitioners, and EM patients?

The SAEMF impacts us all by promoting science, by building

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a community of researchers, by inspiring others to engage in research, and by encouraging questions that are important for our patients.

What impact do you hope your donation will have?

Through my gift, I am very hopeful that I can help support our investigators from diverse backgrounds, and that over time, my support will lead to impactful research.

Is there an important moment, person, or special occasion that influenced your decision?

It takes a village to build a research career and I was fortunate to have so many mentors who provided the support I needed for my research career. They each influenced my decision to pay forward.

Do you have any sentiments to share with others who may be considering a gift?

I get a lot of fulfillment in contributing to science, in seeing our emergency care research grow, and knowing that our patients and investigators are benefiting from our collective action. I urge everyone to start small and contribute in ways they can.

Just for fun…

What did you aspire to be when you were a child?

A Doctor!

What type of music do you enjoy?

I love Indian Classical vocal and instrumental music.

What is your hobby?

I love spending time with my son and dog and going on hikes with my family.

What is the first thing that comes to mind when you think of SAEMF? Research and bright minds.

We’re grateful to Dr. Govindarajan and all our Annual Alliance donors. oY u can join her and the rest of the Annual Alliance, a community of academic emergency medicine leaders, as they connect, network, and infiuence the future of emergency medicine. It’s easy: donate online today and your gift will help fund future researchers, educators, and leaders.

Annual Alliance Benefits Individual Donor Benefits

All Dues Medical Young Resident Mentor Advocate Sustaining Enduring Donors Check Off Student Professional

Naming

Online Donor Listing Donor Ribbon on Community Website Annual Meeting - VIP Ticket to RAMS Party Annual Meeting - Name on Donor Board Annual Meeting - Early Notice of Hotel Registration Annual Meeting - Early Notice of Course Registration Annual Meeting VIP Lounge Access Social Media Recognition Annual Donor Pin Name in SAEM PULSE Annual Meeting Coffee and Networking Annual Meeting - Name on Slides at Opening Plenary Session Annual Meeting - Photo on Slides at Opening Plenary Session Annual Meeting- Guaranteed Room at the Conference Host Hotel Annual Meeting - Limo Transportation Conference Invitation to SAEM Board Reception Named Recognition for Select Grants and Programming

Any

$200

$25

$100

$250

$3,000 $5,000 $10,000 $10,000+ $1,000 paid over paid over paid over in one 3 years 3 years 2 years year

Learn more about the impact of your SAEMF donation.

DONOR GUIDE

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Thank You!

2022 Annual Alliance Donors Enduring Donors

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Bill Barsan, MD

Steven L. Bernstein, MD

Steven B. Bird, MD

Michelle Blanda, MD

Wendy C. Coates, MD

Gail D'Onofrio, MD and Robert Galvin

James F. Holmes, Jr., MD, MPH

James J. McCarthy, MD

Angela M. Mills, MD

Andrew S. Nugent, MD

Ali S. Raja, MD, MBA

Megan N. Schagrin, MBA, CAE, CFRE

J. Adrian Tyndall, MD, MPH

Gregory A. Volturo, MD

Richard E. Wolfe, MD In memory of Peter Rosen, MD

Brian J. Zink, MD In memory of Audrey Zink

Sustaining Donors

Ted Corbin, MD, MPP

Chris Fox, MD

Anonymous (1)

John DeAngelis, MD, RDMS

Joshua Goldstein, MD

Pooja Agrawal, MD, MPH

Deborah B. Diercks, MD, MSc

Chris Goode, MD

Thomas C. Arnold, MD

Jeff Druck, MD

Richard J. Hamilton, MD, MBA

Andra L. Blomkalns, MD, MBA

Marie-Carmelle Elie, MD

Gregory W. Hendey, MD

James E. Brown, Jr., MD

Gregory J. Fermann, MD

Erik P. Hess, MD

David F.M. Brown, MD

Charles J. Gerardo, MD, MHS

Christy Hopkins, MD, MPH, MBA, FACEP

Jim Comes, MD

Prasanthi (Prasha) Govindarajan, MD, MAS

Stephanie Kayden, MD, MPH

Katherine L. Heilpern, MD

Ula Hwang, MD, MPH

Gabor D. Kelen, MD

Brian Hiestand, MD, MPH

Nicholas J. Jouriles, MD

Lilly Chi Lee, MD

Robert S. Hockberger, MD

Stephanie Kayden, MD, MPH

Eric L. Legome, MD

James W. Hoekstra, MD

Babak Khazaeni, MD

Robert F. McCormack, MD

Amy H. Kaji, MD, PhD

Kevin Kotkowski, MD, MBA

Christopher McDowell, MD, MBA, MEd

Nathan Kuppermann, MD, MPH

Terry Kowalenko, MD

L. Kendall McKenzie, MD

Michelle Lall, MD, MHS

Robert F. McCormack, MD

Bryn Mumma, MD, MAS

Ian B.K. Martin, MD, MBA

Lawrence A. Melniker, MD, MS, MBA

(In honor of Dr. Christopher King)

Zachary F. Meisel, MD, MPH, MSc

Joseph Miller, MD

Lewis S. Nelson, MD

Roland Clayton Merchant, MD

James R. Miner, MD

Marquita S. Norman, MD, MBA

Nick M. Mohr, MD

Paul I. Musey, Jr., MD

Brian J. O'Neil, MD

Ava Pierce, MD

Robert W. Neumar, MD, PhD

David T. Overton, MD

Susan B. Promes, MD, MBA

David T. Overton, MD

Scott W. Rodi, MD, MPH

Niels K. Rathlev, MD

Edward A. Panacek, MD, MPH

Robert W. Schafermeyer, MD

Michael S. Runyon, MD, MPH – In memory of John A. Marx, MD

Arthur M. Pancioli, MD

Jeremiah Schuur, MD, MHS Rahul Sharma, MD, MBA

Elizabeth Schoenfeld, MD, MS

Peter S. Pang, MD -- In honor of Yungsoo and Jungsook Pang

Manish N. Shah, MD, MPH

Ralph J. Riviello, MD, MS

Jeffrey Stowell, MD

David P. Sklar, MD – In memory of Lou Binder, MD and John Marx, MD

David C. Seaberg, MD

J. Jeremy Thomas, MD, MBA

Peter E. Sokolove, MD

Terry L. Vanden Hoek, MD

Benjamin C. Sun, MD, MPP

Mary E. Tanski, MD, MBA

Michael C. Wadman, MD

David W. Wright, MD

Elizabeth Lea Walters, MD

Richard D. Zane, MD

Anthony J. Weekes, MD, MSc

Nestor Rhett Zenarosa, MD, FACEP

Sandy L. Werner, MD

James M. Ziadeh, MD

Taneisha Wilson, MD

J. Scott VanEpps, MD, PhD Arjun Venkatesh, MD, MBA Jody Vogel, MD, MSc, MSW David Evan Wilcox, MD

Advocate Donors James G. Adams, MD Harrison J. Alter, MD, MS Brian J. Browne, MD Bo D. Burns, DO Chris Carpenter, MD, MSc and Panechanh Carpenter Ted A. Christopher, MD Carl Chudnofsky, MD and Keck School of Medicine of the University of Southern California

Susan A. Stern, MD

Stephen J. Wolf, MD

Mentor Donors Opeolu M. Adeoye, MD Michael R. Baumann, MD Jane H. Brice, MD, MPH Michael D. Brown, MD, MSc Yvette Calderon, MD, MS Chad M. Cannon, MD

We are also grateful to the hundreds of Young Professional Donors, Resident Donors, Medical Student Donors, Staff Donors, and Additional Donors. See the full SAEMF donor list online. If your

Jeffrey M. Caterino, MD, MPH

name was omitted from this list, or if it

Theodore Chan, MD

is incorrect, we apologize and ask that

Douglas M. Char, MD

you contact jwolfe@saem.org.

Elizabeth Datner, MD Robert Eisenstein, MD

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Who Will Win the 2022 Academy, Committee, Interest Group Challenge?

Competition Period May 1 – August 31

Donations Deadline August 31

Winners Announced October 2022

Visit www.saem.org/challenge for details or to donate This Challenge helped make it possible to award close to $850,000 in grants in 2022!

Winning the Challenge

Goal 1:

Be the first group to reach 100% participation in your group’s Challenge category

Goal 2:

Be the group that donates the most money to SAEMF in your group’s Challenge category

Bragging Rights: When your group succeeds, it will have bragging rights as a winner of this year’s Challenge. Winners will be celebrated beginning in Fall, on social media, in SAEM Pulse, via online communications, and at SAEM23.

3 Ways You Can Help Your Group Win

Who’s In the Lead?

1 Donate online at www.saem.org/donate 2 Pledge now and pay later by emailing jwolfe@saem.org 3 Or, send a check to SAEMF, 1111 East Touhy Ave, Suite 540, Des Plaines, IL 60018 (reference Committee Challenge) If you are a group leader, email jwolfe@saem.org for a copy of your Challenge Leader Toolkit SAEM is doubling gifts! SAEM will match all donations received during this Challenge period, dollar for dollar, up to $10,000.

See www.saem.org/challenge for more information.

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See the latest leaderboards, donor lists, and learn about how the Challenge impacts EM

BRIEFS & BULLET POINTS EDUCATION DEVELOPMENT

training, inclusion of medical students, and research in emergency medicine.

Apply by December 31, 2022.

SAEM JOURNALS

Now Accepting Applications to the 2023-2024 ARMED MedEd Class

RESIDENTS & MEDICAL STUDENTS

2021-2022 Fellow Editor-in-Training Shares Experience Serving on the Editorial Board

SAEM is proud to offer the Advanced Research Methodology Evaluation and Design in Medical Education (ARMED MedEd) course. This course builds upon the fundamental knowledge and skills of health professions education researchers and equips them to design a high-quality medical education research project and grant proposal. The course is for those who have an interest and basic level of understanding or experience in medical education research, although this is not a requirement. Apply by November 31, 2022. Scholarships are available.

Apply by July 31 for the 2022-2023 ARMED Class

SAEM is excited to bring you the Advanced Research Methodology Evaluation and Design (ARMED) course for junior faculty. Taught by leading experts in academic emergency medicine, the purpose of this course is to arm participants with the fundamental knowledge and skills to design a highquality research project and grant proposal to jumpstart their research career. Participants will also develop deeper ties and mentorship within the SAEM research community. The course is targeted to assist junior faculty within five years of graduation, fellows, and senior residents who are interested in pursuing a career in research. Apply by July 31, 2022. Scholarships are available.

Accepting Applications to the 20232024 CAEMA Program The purpose of the Certificate in Academic Emergency Medicine Administration (CAEMA) program is to provide education and a certificate for those professionals who have attended the program and demonstrated proficiency in the body of knowledge required of administrators in academic emergency medicine. The program is specifically geared towards the knowledge base of administrators in an academic environment, encompassing resident education, post residency

Registration Is Open for July 25-28 Virtual Residency & Fellowship Fair

Residents and medical students, it’s time to register for the 2022 Virtual Residency & Fellowship Fair (RFF), to be held July 25-28, 2022. Meet online with representatives from coveted residency and fellowship programs from around the country — all waiting to video conference with you in real time about their programs and give you advice to help you with the application process. Register now!

Program Directors: Program registration is now open! The RFF is your opportunity to showcase your residency and fellowship programs to medical students and emergency medicine residents looking to find their perfect residency or fellowship.

SAEM22 UPDATES Claim Your CME by July 31!

The deadline is July 31 to claim your SAEM22 continuing medical education (CME). Claim CME in four easy steps: 1. Log in to the SAEM Annual Meeting App or SAEM22 Program Planner using your SAEM username and password 2. Click “Claim CME” 3. Complete the CME required tasks 4. Print your completed CME certificate

Coming in August: SAEM22 Educational Content

Couldn’t make it to SAEM22 or didn’t get to see all there was to offer? Coming in August, you’ll be able to access the annual meeting presentations anytime, anywhere via SOAR (SAEM Online Academic Resources)! Experience convenient online and mobile viewing of Advanced EM Workshops, didactics, forums, abstracts and more!

AEM Education & Training

Each year Academic Emergency Medicine Education & Training (AEM E&T) journal selects a medical education fellow from a selective pool of Carrie Commissaris candidates to serve as 2021-2022 Fellow an editor on the AEM Editor-in-Training E&T editorial board for one term. The fellow appointment is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts. Learn more about the program here or by contacting AEM E&T decision editor Esther Chen at esther.chen@ucsf.edu. Applications for the 2023-2024 Fellow Editor-in-Training program opens in early January.

"Peer review is a foundational part of the scientific process, whether in basic science, clinical research, or medical education. From a trainee perspective, it is also one of the most mysterious and impenetrable processes.

As a medical education fellow, I found myself seeking exposure to the peer review process. However, due to a combination of imposter syndrome and lack of experience, I wasn’t sure where to start. The fellow editor-in-training role for Academic Emergency Medicine Education and Training (AEM E&T) fit this need perfectly.

"As a fellow editor-in-training, I was able to build skills and confidence in peer review by completing peer reviews with focused direction and mentorship from decision editors. I was also able to learn more about the behind the scenes work of academic publishing from interaction with the AEM E&T board members, as well members of the publishing and peer review teams. This provided an excellent

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BRIEFS & BULLET POINTS continued from Page 43 “behind the scenes’’ tour of academic publishing. Prior to this experience, I had no concept of all the moving parts in play that begin once an author hits “submit” and waits for the journal’s response.

"The fellowship also allowed me to collaborate with a broad group of medical education leaders, mentors, and scholars from across the country.

Through this experience, I was able to participate in an SAEM didactic with a group of mentors that I otherwise would not have met, as well as write an SAEM pulse article channeling our reflections of the new ACGME milestone for resident well-being. Because of this fellowship and the excellent mentorship by Dr. Esther Chen and the rest of the AEM E&T board, my confidence in doing peer review is greater, my mentorship circle is broader, and my understanding of medical education scholarship is deeper."

Accepting Submissions: 2022 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 2023 and highlight the proceedings from the SAEM22 annual meeting relevant to education and training. Details and submission instructions can be found online. Deadline is September 12, 2022.

Academic Emergency Medicine SAEM Publishes GRACE-2 Guideline for Low-Risk, Recurrent Abdominal Pain

SAEM is pleased to announce the release of the second publication in the series of Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-2), which focuses on abdominal pain. The article titled “Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE): Low-Risk, Recurrent Abdominal Pain in the Emergency Department,” published in the May issue of Academic Emergency Medicine (AEM).

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SAEM FOUNDATION SAEMF Grant Applications: Apply by August 1

Every year, SAEM Foundation (SAEMF) awards over $850,000 to SAEM members to enhance their career development and to study the most critical challenges in EM. Take a look at some the funding opportunities available this cycle and submit your application by 5 p.m. CT August 1, 2022.

Funding Opportunities • Research Training Grant (RTG) $300,000

• Research Large Project Grant (LPG) $150,000

• Education Research Training Grant (ERG) - $100,000

• SAEMF Emerging Infectious Disease and Preparedness Grant - Up to $100,000

• Education Research Training Grant (ERG) - $100,000

• SAEMF Toxicology Research Grant $20,000

• SAEMF/Clerkship Directors in

Emergency Medicine (CDEM) Innovations in Undergraduate Emergency Medicine Education Grant - $5,000

• And many more!

To view a full listing of grant offerings through the SAEMF, visit the SAEMF website under What We Fund.

For additional information • View the Grant Submission Tutorial to learn how to submit your proposal.

• Take a look at our Grant Writing Resources before you apply.

• Check out our 2022 Grantees and their work.

• Checkout the Donor Guide for

information about prior grantees and the SAEMF’s mission.

• Contact us at foundation@saem.org or visit What We Fund.

New This Year: Pilot Training Grant The SAEMF Board of Trustees and Grants Committee are pleased to introduce a new Advanced Research Methodology Evaluation and Design in Medical Education (ARMED MedEd) Pilot Training Grant of $25,000.

Seeking Funding for a WellnessFocused Project?

Check out the SAEMF's Notice of Special Interest (NOSI) which is intended to develop the science of physician wellness in emergency medicine and to contribute to building the career of researchers focused on physician wellness.

SAEM Announces Academy Leadership for 2022-2023 The Society for Academic Emergency Medicine is pleased to present your academy leadership for 2022-2023. Congratulations to the newly elected academy leaders who were installed at SAEM22 in New Orleans this past May.

Academy for Diversity and Inclusion in Emergency Medicine (ADIEM)

• Ynhi Thai Thomas, MD, Vice-President of Education

• Edgar Ordonez, MD, MPH, President

• Corrie Chumpitazi, MD, MS, Vice-President of Corporate Development

• Cassandra Kim Bradby, MD, President-Elect • Jason Rotoli, MD, Secretary-Treasurer

• Amy Zeidan, MD, Vice-President of Communications

• Giovanni Rodriguez, MD, Resident Member

• Alden Landry, MD, MPH, Immediate Past President

Clerkship Directors in Emergency Medicine (CDEM)

• Tiffany Mitchell, MD, Member-at-Large

• Sharon Bord, MD, President

• Melanie F. Molina, MD, Member-at-Large

• Joseph B. House, MD, President-Elect

• Jacqueline A. Ward-Gaines, MD, Member-at-Large

• Amy Cutright, MD, Treasurer

• Moises Gallegos, MD, MPH, Development Officer

• Jose V. Nable, MD, Secretary

Academy of Emergency Ultrasound (AEUS)

• Nicole Dubosh, MD, Immediate Past President

• Yiju “Teresa” Liu, MD, President • Christopher Thom, MD, RDMS, President-Elect • Emberlynn Liang Liu, MD, Treasurer • Petra Duran-Gehring, MD, Secretary • Lindsay Taylor, MD, RDMS, RDCS, RVT, Immediate Past President • Frances Russell, MD, Research Officer • K. Meera Muruganadan, MD, Education Officer

• Keme Carter, MD, Member-at-Large • Bradley S. Hernandez, MD, Member-at-Large • Nathan J. Lewis, MD, Member-at-Large • Kendra P. Parekh, MD, MHPE, Member-at-Large

Global Emergency Medicine Academy (GEMA) • Sean Kivlehan, MD, MPH, President • Naz Karim, MD, MHA, MPH, President-Elect • Megan Rybarczyk, MD, MPH, Treasurer

Academy of Geriatric Emergency Medicine (AGEM)

• Saadiyah Bilal, MD, MPH, Secretary

• Lauren Cameron Comasco, MD, President

• Jennifer Newberry, MD, JD, Immediate Past President

• Elizabeth M. Goldberg, MD, ScM, President-Elect

• Morgan C. Broccoli, MD, MPH, MSc, Member-at-Large

• Surriya Colleen Ahmad, MD, Treasurer

• Shama Patel, MD, MPH, Member-at-Large

• Kalpana Narayan Shankar, MD, MSc, MS, Secretary

• Rebecca Leff, MD, Medical Student/Resident Representative

• Scott M. Dresden, MD, MS, Immediate Past President

• Adam R. Aluisio, MD, Development & Grants Officer

• Fernanda Bellolio, MD, MS, Member-at-Large

• Stephanie Chow Garbern, MD, MPH, DTMH, IT Chair

• Katherine Hunold Buck, MD, Member-at-Large

• Sonya Naganathan, MD, MPH, Program Committee Liaison

• Mary Mulcare, MD, Member-at-Large

Simulation

• Thom Ringer, MD, JD, CCFP, Member-at-Large • Kyle R. Burton, MD, MPP, Resident Representative • Sarah E. Pajka, Medical Student Representative

• Ambrose H. Wong, MD, MSEd, President • Sara M. Hock, MD, President-Elect • Tiffany Moadel, MD, Treasurer

Academy for Women in Academic Emergency Medicine (AWAEM)

• Suzanne (Suzi) Bentley, MD, MPH, Secretary

• Valerie Dobiesz, MD, MPH, President

• Michelle Hughes, MD, Member-at-Large

• Kathleen Ogle, MD, President-Elect

• Jane Kim, MD, EdD, Member-at-Large

• Andrea Fang, MD, Treasurer

• Neel Naik, MD, Vice President of Social Media & Communication

• Alexandra Leigh Mannix, MD, Secretary • Devjani Das, MD, Immediate Past President • Taylor Stavely, MD, Vice-President of Membership

• Nur-Ain Nadir, MD, MHPE, Immediate Past President

• Tina Chen, MD, Vice President of Education • Christina Matulis, MD, Fellow

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SAEM REPORTS ACADEMY NEWS Academy of Geriatric Emergency Medicine The ARMED Course Sets You Up for the Future

Dr. Sarah Keene

Sarah Keene, MD, PhD, a Geriatric Emergency Medicine Fellow, Beaumont Health, Royal Oak, MI, was a participant in SAEM’s Advanced Research Methodology, Evaluation, and Design (ARMED) course this past academic year. She shares her experience below:

“The ARMED course is SAEM’s leading course on research methodology and grant writing. The ARMED course functionally has two components: 1) a series of lectures on research opportunities, methods, and grant writing best practices; and 2) three workshops on grant writing, with direct feedback on your grant. Lectures are spread throughout the year and are virtual. The workshops are before the ACEP annual conference, the SAEM annual conference, and an additional workshop in February, usually held in Chicago.

“Didactics range in topic from the different components of a grant to various funding opportunities. The first workshop is an intensive overview of how funding research works in emergency medicine. The second two workshops focus on your specific aims page, as this is the make-or-break section of your grant.

Specific aims pages are shared and edited in small groups. I found the workshops to be the greatest value of the ARMED course. The specific aims page I wrote for the course was the first specific aims page I had ever written by myself, and it showed! Writing a specific aims page is a skill that is separate from the skill required to write the rest of a grant (or a paper), as specific aims pages must be both comprehensive and extremely succinct. Achieving one takes practice, but achieving both at the same time requires effort, dedication, and a great deal of editing.

While I wouldn’t say that my first draft was the worst specific aims page ever written, it certainly was not something that would have resulted in anyone giving me money. After spending multiple days (and multiple drafts) receiving edits from both peers and the experienced leaders of the course, my specific aims page has turned into something that can be the foundation of a grant – hopefully a successful one.

“I hope to have an EM career that is productive both clinically and academically. Part of my academic success will be dependent on my ability to score funding and turn that funding into research that moves the specialty of geriatric emergency medicine forward.

I feel fortunate to have had the opportunity to learn from the many generous leaders of the course. Additionally, having completed the ARMED course allows you to apply for a specific ARMED SAEM grant, which is a nice bonus for early researchers!”

Applications are now being accepted for the 2022-2023 Advanced Research Methodology Evaluation and Design (ARMED). Apply by July 31. Scholarships are available.

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Clerkship Directors in Emergency Medicine Announcing a New Mentorship Program for CDEM Members

The executive committee of SAEM’s Clerkship Directors in Emergency Medicine (CDEM) academy is pleased to announce a new mentorship program run by the CDEM Career Development and Mentorship Committee. The mentorship program will aspire to develop and provide resources, mentoring, and activities that support emergency medicine educators to transition to multiple roles in undergraduate medical education. Any CDEM member in good standing may apply to be a mentee and any CDEM member in good standing with greater than three years in a leadership position as a medical student educator may serve as a mentor. To participate in this program either as a mentor or mentee, please complete the CDEM Mentorship Form. Once you sign up, the CDEM Career Development and Mentorship Committee will match you with a mentor or mentee based on your responses and provide you with resources to optimize the relationship. For more information, please contact Juana Vazquez.

Global Emergency Medicine Check Out the New Video from GEMA

In a new video from SAEM’s Global Emergency Medicine Academy hear about what decolonizing global health means to trainees from around the globe and how they envision the path forward. The video, “Decolonizing Global Health for The Next Generation- Perspectives of Trainees from Around the World” was produced by GEMA members Nikkole Turgeon, MD, Boston Medical Center, Oluwarotimi Vaughan-Ogunlusi, MB, BCh, BAO, Royal College of Surgeons in Ireland, and Fahad Ali, MD, Brown University.

INTEREST GROUP UPDATES Informatics and Data Science The SAEM Informatics and Data Science Interest Group is excited to announce new leadership and this year’s agenda.

The interest group met in May at SAEM22 in New Orleans to vote on its new leadership. Christian Rose, MD, Stanford University, and Robert Turer, MD, UT Southwestern, new chair and vice chair, respectively, assumed the reins from immediatepast chair Andrew Taylor, MD, MHS, Yale. This year, the interest group aims to share works in progress and educational sessions during monthly meetings, to be held the third Thursday of each month at 11 a.m. CT. We welcome members with varied backgrounds and experience to collaborate and create digital solutions for patients and providers alike. Joining an interest group is free for SAEM members. Simply log in to your SAEM account and clicking the button “Update (+/-) Academies and Interest Groups.”

Vice Chairs Announcing the 2023 Consensus Conference, Precision Emergency Medicine: Setting a Research Agenda Save the date for the 2023 SAEM Consensus Conference, Precision Emergency Medicine: Setting a Research Agenda, to take place May 15, 2023, at the JW Marriott hotel in Austin, TX. The meeting will include an innovative mix of educational, networking, and consensus-building activities aimed at developing a 10-year research agenda for fundable, high-quality, health services research in precision emergency medicine.

Precision emergency medicine is the purposeful use of big data and technology to deliver acute care safely, efficiently, and authentically for individual patients and their communities.

This paradigm builds upon the concept of precision medicine, in which clinical decisions are tailored to individual patients through the application of biological, genomic, public health, and environmental data. In this model, emergency physicians could leverage many emerging sources of patient data derived from technologies such as rapid point-of-care testing, -omics, wearable and implantable devices, and community-based and public health databases. Machine learning and other artificial intelligence applications would strengthen analyses of these data and improve the accuracy of clinical decisionmaking. The use of multisource data, technology, and analyses contextualized to the local community can allow for emergency care individually tailored to patient specific needs.

Though precision emergency medicine seems decades away, the data streams and analytics are already available.

The adoption of precision medicine principles would represent a paradigm shift in emergency medicine towards technologyenhanced, data-driven, higher quality, individualized care.

However, most emergency providers are unfamiliar with these new data sources, how to interpret them, and how to modify their clinical practices accordingly. Research is needed to understand how to best implement precision emergency medicine in an equitable and effective manner. For this purpose, will convene experts and thought leaders from academia and the technology sector to examine the key catalysts of precision emergency medicine, identify implementation challenges, and develop an actionable research agenda with relevant patientcentered outcomes.

The conference will introduce precision emergency medicine as a conceptualization of translational science that results in timely, specific, patient-centered, emergency care.

Conference outcomes will stimulate further research to examine precision emergency medicine as a higher-quality, safer, more equitable, and more accessible clinical care paradigm than current practices. To accomplish these goals, the consensus conference will meet the following aims: (1) develop a shared mental model of precision emergency medicine, (2) establish a research agenda for precision emergency medicine for the next decade, and (3) identify educational gaps that must be addressed for emergency providers.

Join this diverse group of national thought leaders in emergency medicine and precision health, industry and technology partners, policy makers, and patients to shape the future adoption of precision emergency medicine.

We welcome your engagement!

We invite your participation in one of eight pre-conference working groups: 1.) Informatics; 2.) Omics; 3.) Data Science; 4.) Technology and Digital Tools; 5.) Healthcare Delivery Systems and Access to Care; 6.) Population Health and Social Emergency Medicine; 7.) Biomedical Ethics; 8.) Health Professions Education. These working groups will meet several times in the months leading up to the conference to craft the overarching research questions to be discussed at the meeting.

To join a working group, please email Dr. Matthew Strehlow, 2023 Consensus Conference co-chair.

Evidence Based Healthcare and Implementation Announcing the Inaugural Rakesh Engineer Award Winner

The SAEM Evidence Based Healthcare and Implementation Interest Group is pleased to announce the winner of the inaugural Rakesh Engineer Award, named in honor of Dr. Rakesh Engineer (1970-2019), a leader in the field of emergency medicine implementation and knowledge translation science. The award recognizes a high quality oral or poster presentation at the SAEM Annual Meeting in implementation science showing sustained positive change. After a rigorous process of abstract review using a modified RE-AIM rubric, the final winner was selected: “Development and Implementation of ED QI Initiative to Improve the Treatment of Patients with OUD”

by Natalija M. Farrell, PharmD; Jessica Taylor, MD; and Lauren M. Nentwich, MD, from Boston Medical Center.

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SAEM REPORTS continued from Page 47

The winning project utilized a multidisciplinary approach to help patients with opioid use disorder engage in treatment while in the Emergency Department (ED). Working to find a creative way to meet state regulations and still reach these patients at their point of access to healthcare, their team developed “take home kits” for these patients that included doses of buprenorphine-naloxone and naloxone, along with medication education and referral information. These kits were distributed out of the ED and patients were referred to prompt follow-up at the hospital’s Faster Paths substance use disorder bridge clinic.

Their novel program showed significant success. Their ED nearly doubled the use of take-home kits from 193 to 397 over the 4-year period, their use of medication for opioid use in the ED increased 5-fold, and the percent of patients who followed up at the bridge clinic increased from 43% to 77%. Perhaps most notable is that they have not only maintained but also grown the program over their 4 years since starting it.

We interviewed the Dr. Farrell (@NatalijaFarrell) and her team about the success of their project and what learning points they had to share with others.

What made you decide to do this project, in particular?

Boston Medical Center is located at the center of the opioid epidemic in Boston. Our patients commonly present tonthe emergency department (ED) following overdose, in opioid withdrawal, or for complications related to opioid use disorder (OUD). Long boarding times also make it more likely that our patients will go into opioid withdrawal during their ED visit.

Our ED has a long history of providing naloxone take home kits and connecting patients with Project ASSERT’s team of licensed drug and alcohol counselors; however, we weren’t actively treating opioid withdrawal with medications for OUD (MOUD) and had very few providers that were X-waivered.

We recognized that we could be doing a lot more to make our patients more comfortable during their ED stay and better engage them with the substance use disorder (SUD) resources available at our institution.

How did you form your team?

We had ED nurse, physician, and pharmacist champions for improving the care of patients with OUD. We formed a work group of key stakeholders, which included leaders from ED nursing, ED physicians, ED pharmacists, Project ASSERT, addiction medicine, and our SUD bridge clinic (Faster Paths).

We met several times early in the project to identify barriers and create solutions. Afterwards, the quality improvement project leads continued to meet regularly to assess the impact of our interventions and obtain feedback from frontline staff. The full work group received monthly updates on the project, which have since been spaced out to at least quarterly.

services. Project goals can evolve as frontline staff and patients become more familiar with the practice change. For example, our project first focused on staff education, guideline creation, and stocking MOUD in the ED. As our ED became more comfortable treating opioid withdrawal and prescribing buprenorphine at discharge, we have been able to implement additional changes, such as buprenorphine-naloxone take home kits, applying the methadone “72-hour rule” at our SUD bridge clinic with rapid linkage to opioid treatment program, and expanding naloxone take home kit ordering privileges to pharmacists, to meet the needs of our patients.

What are your future plans for this work? What do you think is the next step?

We continue to evaluate how we can further provide access to OUD treatment and harm reduction strategies to our patients.

Some of our plans include to further optimize MOUD order sets, expand naloxone take home kit ordering privileges to other healthcare team members, create and assess the impact of interventions on improving MOUD access to racially and ethnically diverse patients, to evaluate the retention of patients receiving outpatient addiction medicine services, and to evaluate the impact of ED MOUD on long term ED utilization rates. We also plan to submit our work for publication.

Do you have any tips for others interested in doing a similar project?

Developing and refining the care our patients with OUD receive in the ED has been rewarding. Changing culture and practice can take a long time. Implementing a limited number of key low effort, moderate to high impact interventions can help get the project started. Sharing success stories through data and patient stories always helps to create buy-in from the frontline.

Sustainability is often difficult for implementation science projects. Why do you think you did so well with this?

Sustainability is challenging, but regularly engaging our frontline staff and patients have helped us maintain and build momentum.

We have actively sought out and included nurses, pharmacists, resident physicians, attending physicians, medical students, and pharmacy students with interests in substance use disorders to help us determine next steps for the quality improvement initiative. Their fresh ideas and excitement continuously reinvigorate and betters the care our patients receive.

COMMITTEE INFO Fellowship Approval A Medical Education Fellow Success Story: Dr. Jared Kilpatrick

What do you think is the take home message from your project for others?

A multidisciplinary approach is essential to successfully developing and implementing strategies that increase patient access to MOUD, naloxone, and outpatient addiction medicine

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Jared Kilpatrick, MD, Clinical Instructor Thomas Jefferson University Hospital Fellowship Type: Medical Education Year of Completion: 2022 Dr. Jared Kilpatrick

What advice would you give to someone who was on the fence about doing a fellowship? i.e., What did you see as the cost-benefit?

I initially had hesitancy about doing a medical education fellowship during my last year of residency as it is difficult to give up on the salary of a full-time attending. The deciding factor was thinking about the time saved. I knew I wanted to have a career in academic medicine when I was looking at the opportunities that the fellowship programs offered. Specifically, the fellowship programs gave me the opportunity to complete multiple faculty development programs (ex. master’s program, ACEP teaching fellowship etc.) in a relatively short two-year period. If I was working full-time, I estimated it would have taken me 5-10 years to accomplish everything that I did in the two-year fellowship. The second deciding factor for me was the opportunity for mentoring during a fellowship. Experienced medical educators lead the programs that I was considering, and it is difficult to obtain great mentorship outside of a fellowship program, especially from someone with dedicated time and training meant for advancing my skills and career as another medical educator.

What was the most career-enhancing, or eye-opening thing, you gained from the fellowship?

The most eye-opening aspect of fellowship was the variety of career opportunities in medical education. Prior to fellowship, I thought medical education was focused on GME and Clerkship education. Through the opportunities in my fellowship, I have learned about all the opportunities for faculty development, pre-clinical medical student education, procedural education and education administration. Additionally, I was surprised by the amount of research opportunities. Medical education is an underdeveloped area of research, so it is easy to find research projects.

Who is best suited for this type of fellowship?

The most important factor for a future applicant is to have a passion for education and research. If you don’t enjoy teaching and research this is going to be a very frustrating couple of years. The second most important trait is a strong work ethic.

Fellowship is better than residency when it comes to worklife balance, but there will be times when you are working a residency-level schedule again.

You can’t pour from an empty cup.

Take care of yourself first. #StopTheStigmaEM

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ACADEMIC ANNOUNCEMENTS Dr. Bernard Chang Named Inaugural Endowed Dr. Matthew Chinn Promoted to Associate Associate Professorship in Emergency Medicine Professor of EM Bernard Chang, MD, PhD, has been endowed the Tushar Shah and Sarah Zion Associate Professorship in Emergency Medicine. Dr. Chang is the Columbia University department of emergency medicine vice chair of research. He is Dr. Bernard Chang a national expert in mental health care research, and the principal investigator of four NIH R01s, including a recent five-year R01 grant for $2.5 million to study health care clinician psychological and cardiovascular health during the COVID-19 pandemic. Dr. Chang has authored over 90 publications and is the recipient of numerous prestigious awards in research including the SAEM Young Investigator Award, and the NY ACEP Established Investigator Award.

Matthew Chinn, MD, has been promoted to associate professor of emergency medicine, on the clinician–educator pathway, at the Medical College of Wisconsin Medical School. This accomplishment comes on the heels of Dr. Matthew Chinn Dr. Chinn’s appointment as senior medical director of the Froedtert & MCW Froedtert Hospital emergency department in February. As senior medical director, Dr. Chinn will lead a capable team and manage and provide oversight of daily operations of the Froedtert Hospital emergency department.

Dr. Penelope Lema Accepted into Elite Virginia Apgar Academy of Medical Educators

Dimitri Papanagnou, MD, MPH, EdD(c), professor and vice chair for education, department of emergency medicine, Sidney Kimmel Medical College at Thomas Jefferson University, was selected by the National Academy of Medicine for the Dr. Dimitri Papanagnou 2022 National Academy of Medicine Scholars in Diagnostic Excellence Program.

Dr. Papanagnou’s project will help disseminate interprofessional training for students and residents to communicate diagnostic uncertainty to patients at the point of discharge, and specifically address how providers can foster more equitable conversations with patients during times of diagnostic uncertainty.

Penelope Lema, MD, was selected as a member of the 2022 Virginia Apgar Academy of Medical Educators, an elite group of advanced educators at Columbia University Vagelos College of Physicians and Surgeons. Dr. Lema is the vice chair of faculty affairs and division director of Dr. Penelope Lema emergency ultrasound for the Columbia University department of emergency medicine. She has been recognized for her leadership and mentorship with numerous awards, including the 2019 NY ACEP Physician of the Year Award and the 2020 ACEP AAWEP Outstanding Mentor Award.

Dr. Tiffany Murano Accepted into Elite Virginia Apgar Academy of Medical Educators Tiffany Murano, MD, was selected as a member of the 2022 Virginia Apgar Academy of Medical Educators, an elite group of advanced educators at Columbia University Vagelos College of Physicians and Surgeons. Dr. Murano is the vice chair of education for the Columbia University Dr. Tiffany Murano department of emergency medicine and an associate designated institutional official at NewYork– Presbyterian. Dr. Murano is a nationally recognized leader in education and is the immediate past president of the Council of Residency Directors in Emergency Medicine (CORD).

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Dr. Dimitri Papanagnou Selected for NAM Scholars of Diagnostic Excellence Program

Dr. Michael Pulia Selected for NAM Scholars of Diagnostic Excellence Program Michael Pulia, MD PhD, assistant professor and director of the emergency care for infectious diseases research program, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, was selected by the National Academy of Dr. Michael Pulia Medicine for the 2022 National Academy of Medicine Scholars in Diagnostic Excellence Program. Dr. Pulia’s project will focus on developing a new diagnostic pathway for suspected pneumonia in older adults that leverages innovations in rapid pathogen identification and host response measurement to reduce diagnostic error and improve antibiotic prescribing.

Dr. Manish Shah Named Chair of the Department of Emergency Medicine Manish N. Shah, MD, a pioneer in the field of geriatric emergency medicine, will be the next chair of the BerbeeWalsh Department of Emergency Medicine at Dr. Manish N. Shah the University of Wisconsin School of Medicine and Public Health. Dr. Shah, a professor of emergency medicine at the school, is currently vice chair of research for the department.

One area of his work focuses on improving emergency care for people with Alzheimer’s disease and related dementias. The school was one of four sites awarded a total of $7.5 million in 2020 from the National Institutes of Health for the project, which is co-led by Dr. Shah. He also co-led a project funded by the school’s Wisconsin Partnership Program to improve emergency department preparedness for surges of COVID-19 patients by developing and testing advanced surveillance systems and providing training to front-line providers.

Dr. Shah’s appointment will begin on September 1, 2022.

Dr. Ronny Otero is New Vice Chair of Clinical Operations Ronny Otero, MD, MSHA, is the new vice chair of clinical operations for the department of emergency medicine at the Medical College of Wisconsin. In this Dr. Ronny Otero role, Dr. Otero will oversee direction and leadership for operations of all clinical practices in the department. In addition, he will also lead and mentor site medical directors across eight clinical practice locations within the Froedtert & the Medical College of Wisconsin Health Network. Dr. Otero has 20 years of experience in designing, implementing, and leading clinical operations.

Let SAEM Pulse Share Your Good News!

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

Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is August 1, 2022 for the September/October 2022 issue.

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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.

Employers, are your recruiting efforts effective?

Specific targeted career websites, like EM Job Link, deliver the most highly qualified talent and have the best return on investment.

Our candidates are made up of the specific professionals you want to reach. If you want the best and brightest candidates, you need to go where they job search – EM Job Link. Along with posting your jobs in front of qualified candidates at EM Job Link, you can search our resume bank for talent as well.

Post today or speak to an expert who can help create a customized recruiting solution to get you great candidates.

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PEDIATRIC EMERGENCY MEDICINE FACULTY POSITION IN THE DEPARTMENT OF EMERGENCY MEDICINE AT HARBOR-UCLA, TORRANCE, CA Clinical Duties: The Pediatric Emergency Medicine (PEM) faculty position will provide clinical coverage in the Adult and Pediatric Emergency Departments and will be assigned shifts providing direct patient care, including on nights, weekends, and holidays, according to Department of Emergency Medicine (DEM) practices. The shift load may vary at the discretion of the Chair, based on Department needs.

Administrative and Teaching Duties: The primary administrative duties will be: performance of emergency medical services (EMS) and disaster duties in collaboration with the Director of Prehospital and Disaster Services; education of the PEM fellows (clinical supervision, provision of didactics, mentorship in research projects as appropriate); support of DEM operational needs, including quality improvement initiatives; and assisting with efforts to build a collaborative hub for out-of-hospital medical policy, knowledge, and education at Harbor. Faculty candidates for this position must be board certified in emergency medicine and board eligible or certified in pediatric emergency medicine and will be expected to dedicate sufficient time to administrative duties, typically 8 to 12 hours per week to achieve excellent results.

C. Research Activities: The candidate will be expected to produce academic and creative work. These efforts should result in peer-reviewed publications that advance knowledge and demonstrate the impact of the faculty member’s work.

The applicants all must apply for the position. The link below is the bulletin that is up for the position in LA County. Anyone interested in applying should apply at the link: https://www.governmentjobs.com/careers/lacounty/ jobs/2914495/physician-specialist-non-megaflex-various-specialties

Choose where you live.

Choose your practice environment.

Choose the trajectory of your career in emergency medicine.

Working with a leading national medical group gives you options.

Featured Opportunities GME FACULTY OPPORTUNITIES HCA Florida Kendall Hospital Miami, FL

PEDIATRIC EMERGENCY MEDICAL DIRECTOR Morristown Medical Center Morristown, NJ

RESIDENCY PROGRAM DIRECTOR HCA Florida Lawnwood Hospital Fort Pierce, FL

ULTRASOUND DIRECTOR New York Presbyterian Queens Flushing, NY

Reach out to our experienced recruiters today to learn more about these featured opportunities.

754.203.3724 EVPS.com/SAEM

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Penn State Health Emergency Medicine About Us: Penn State Health is a multi-hospital health system serving patients and communities across 29 counties in central Pennsylvania.

The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Children’s Hospital, and Penn State Cancer Institute based in Hershey, PA; Penn State Health Holy Spirit Medical Center in Camp Hill, PA; Penn State Health St. Joseph Medical Center in Reading, PA; and more than 2,300 physicians and direct care providers at more than 125 medical office locations. Additionally, the system jointly operates various health care providers, including Penn State JOIN OUR TEAM Health Rehabilitation Hospital, Hershey Outpatient Surgery Center, Hershey Endoscopy Center, Horizon Home Healthcare and Pennsylvania Psychiatric Institute.

EMERGENCY MEDICINE OPPORTUNITIES In December 2017, Penn State Health partnered with Highmark Health to facilitate creation of a value-based, AVAILABLE community care network in the region. Penn State Health shares an integrated strategic plan and operations with Penn State College of Medicine, the university’s medical school.

We foster a collaborative environment rich with diversity, share a passion for patient care, and have a space for those who share our spark of innovative research interests. Our health system is expanding and we have opportunities in both an academic hospital as well community hospital settings.

Benefit highlights include: • Competitive salary with sign-on bonus • Comprehensive benefits and retirement package • Relocation assistance & CME allowance • Attractive neighborhoods in scenic Central Pennsylvania

FOR MORE INFORMATION PLEASE CONTACT: Heather Peffley, PHR CPRP - Penn State Health Physician Recruiter

hpeffley@pennstatehealth.psu.edu

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person’s perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

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THE NEXT STEP IN YOUR EMERGENCY MEDICINE CAREER STARTS HERE At TeamHealth, our purpose is to perfect the practice of medicine, every day, in everything we do. To improve the experience of our clinicians, we empower them to act, free them from distractions, invest in learning and development, and foster an environment where continuous improvement is a shared priority.

SCAN QR CODE TO LEARN MORE ABOUT ACADEMIC EM JOBS To apply, go to teamhealth.com/emergencymedicine Search Emergency Medicine

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FEL L O WSH IPS UNIVERSITY OF WISCONSIN EMERGENCY MEDICINE

ACADEMIC EMERGENCY MEDICINE FELLOWSHIP POSITIONS AVAILABLE Continue your academic training at the University of Wisconsin School of Medicine and Public Health, a recognized international, national, and statewide leader in medical education, research, and service. The BerbeeWalsh Department of Emergency Medicine, located in Wisconsin's capital and second largest city, sponsors several advanced training programs for early career physicians.

Our primary ED at UW Health's flagship hospital in Madison, WI: #1 hospital in Wisconsin for the last ten years ACS-certified, Level 1 adult and pediatric trauma and burn center One of only 25 U.S. hospitals named to Newsweek’s “Top 100 Global” list

University Hospital ED: 77,000+ patient visits annually

ACCREDITED EMS FELLOWSHIP This one-year, ACGME-accredited fellowship combines ground, aeromedical and tactical EMS exposure with advocacy, administrative, research, QA/QI, and leadership activities. Our program trains physicians to provide exceptional medical direction and education to prehospital agencies with advanced competencies in EMS and/or HEMS operations, administration, and clinical care. Graduates are well-prepared to pass their ABEM EMS board certification and become leaders in prehospital emergency care.

GLOBAL HEALTH FELLOWSHIP This one-year global health fellowship develops physicians' skills to advance emergency medicine in low resource areas through 1-2 months of fieldwork abroad, teaching, curriculum development and research while offering ample flexibility to develop or continue individual global health projects. Fellows are supported to pursue advanced training through the UW Global Health Institute's graduate capstone certificate. Past fellows have engaged in global health projects and research in Uganda, Rwanda, Kenya, local NGOs and the UNDP.

RESEARCH FELLOWSHIP This two-year fellowship trains physicians to become independent investigators and nationally recognized leaders in emergency care research, capable of conducting externally-funded clinical or health services research.

SAEM-certified with the option to pursue an MSCI or other graduate degree and benefit from UW–Madison’s world-class research enterprise, which the National Science Foundation ranked 8th nationally in 2020.

SIMULATION FELLOWSHIP This one-year fellowship develops physicians' expertise to create and administer simulation-based learning experiences. Fellows have access to a state-of-the-art 7,500 sq. ft. clinical simulation facility with resources such as high fidelity manikins, wet lab, task/virtual reality simulators, advanced audio-visual capture and playback system and a virtual environment simulation cave, as well as extensive interdisciplinary training opportunities with subspecialty areas such as EMS and Med Flight.

LEARN MORE AND APPLY AT EMED.WISC.EDU

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The UMass Chan Medical School Department of Emergency Medicine invites candidates to consider our fellowship training opportunities. Nationally-renowned fellowship directors and faculty oversee intensive, focused curricula that prepare fellows to assume leadership roles in their chosen areas. Our department’s nationally-recognized track record in leadership, clinical care, education, and research, coupled with a strong stature within our medical school and 5hospital health system, as well as the opportunity for pursuing UMass master’s-degree education when applicable, makes our institution an ideal place to gain exceptional subspecialty expertise and launch highly successful careers.

Fellowships in: • Administration/Leadership • Disaster Medicine • Emergency Medical Services • Emergency Ultrasound • Health Equity • Medical Education • Medical Toxicology • Research (PhDs also considered)

The Heart of the Commonwealth Worcester, the second largest city in New England, offers affordability with easy access to activities to satisfy all interests and lifestyles. The city boasts excellent museums and restaurants and hosts several minor-league sports teams. The amenities of Boston are only 40 minutes away, and world-class outdoor activities are either right outside your door or easily reached in an hour or two.

FOR MORE INFORMATION PLEASE CONTACT Jennifer Bernstein - Fellowship Coordinator jennifer.bernstein@umassmed.edu Fellows will assume limited clinical responsibilities at one or more of our Emergency Departments. Prior to starting, fellows must have completed an ACGMEaccredited EM residency program, must be EM board-certified or eligible, and must be eligible for full medical licensure in the Commonwealth of Massachusetts.

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Department of Emergency Medicine FELLOWSHIP TRAINING OPORTUNITIES

TAKE YOUR CAREER TO THE NEXT LEVEL – Exceptional Care Without Exception The Department of Emergency Medicine (EM) at the Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) is recruiting Fellowship candidates in the areas of: Addiction Medicine

Emergency Department Administration

Global Health Equity

Emergency Medical Services (EMS)

Local Health Equity

Emergency Ultrasound (EUS)

Neurocritical Care(NCC)

We offer 1- and 2-year Fellowship Training opportunities for graduates of accredited Emergency Medicine Residency Programs. We train 6-8 Fellows per year in a collaborative and nurturing community of practice and support them from orientation to graduation through the Fellowship Academy. BMC Emergency Medicine provides exceptional training in the care of critically ill/injured patients, point-of-care ultrasound, prehospital & EMS, public health, social EM, and research.

BMC is the safety-net hospital for the city of Boston, serving a diverse, multicultural population in a ‘county’-type practice environment, set in a world-renowned tertiary hospital system.

Applications are being accepted now, please send your letter of interest to BMCFellowships@bmc.org for further instruction.

At BMC we welcome and support those who have faced barriers to practicing medicine, specifically those who identify as minorities, whether defined on the basis of race, ethnicity, socioeconomic status, gender, sexual orientation, physical ability, religion, first generation in higher education, or otherwise. In 2022, the Lown Institute ranked BMC 4th in the nation for racial inclusivity and in Massachusetts, Boston Medical Center is ranked #1.

BMC EMERGENCY DEPARTMENT is a LEVEL 1 TRAUMA CENTER · 130,000 annual patient visits · Care for 70% of penetrating trauma victims in Boston · 4 year EM Residency Program · Provides medical control and oversight for Boston EMS · In-person interpreters for 17 languages · 22% of residents are URM (national average is 11%)

BMC ED PATIENT DEMOGRAPHICS · 70% Black or Hispanic · 32% do NOT speak English as their primary language · >50% have annual household income <$20,400 · Black or African American: 24.4% · Hispanic or Latino of any race: 17.5% · Native American: 0.4% · Asian: 8.9%

BMC ED is the medical control hub and academic base for Boston EMS. EM clinicians who collaborate work closely with the BUSM Departments of Surgery, Pediatrics, Neurology, and Geriatrics, the Boston University School of Public Health, the Massachusetts Department of Public Health, and other regional and national injury research centers.

Successful candidates must be a graduate of an ACGME-accredited Emergency Medicine residency an can apply for a 1 year or 2 year program, if pursuing an advanced degree (MPH or MBA).

Fellows are expected to work alongside and train EM residents and medical and PA students. The position comes with an excellent benefits package, and a faculty appointment. BMC/BUSM is an equal opportunity/affirmative action employer. The BMC Department of Emergency Medicine is exceptionally committed to diversity and inclusion within our faculty and residents and welcomes applicants from diverse backgrounds. Find out more @ BMCFellowships@bmc.org

Emergency Medicine Administrative/Leadership Fellowship The UMass Department of Emergency Medicine is actively recruiting qualified candidates for the Richard V. Aghababian Emergency Medicine Administrative/Leadership Fellowship.

Our mission: to instill emergency physicians with key leadership and administrative skills so that they will excel as leaders in the delivery of high-quality and efficient healthcare. Our program has a track record of placing fellows into EM administrative positions upon graduation.

Fellows have access to extensive resources both within UMass Chan Medical School and the wider university, exemplified by the MBA program at the Isenberg School of Management. The affiliated clinical institution, UMass Memorial Health, is the dominant healthcare organization in central Massachusetts, with multiple hospitals and outpatient facilities. A particular strength of our department is that our leadership and faculty are active in leadership positions within the medical school and health system, as well as regional, state, and national professional organizations. This affords the fellows exposure to management and leadership learning opportunities well beyond ED operations.

Our location in the heart of New England offers affordability with easy access to activities to satisfy all interests and lifestyles. Worcester, the second largest city in New England, boasts excellent museums and restaurants and hosts several minor-league sports teams. The amenities of Boston are only 40 minutes away, and world-class outdoor activities await--either right outside your door or easily reached in an hour or two.

Fellows will assume limited clinical responsibilities in our Emergency Departments. Prior to starting, fellows must have completed an ACGMEaccredited EM residency program, must be EM board-certified or eligible, and must be eligible for full medical licensure in Massachusetts.

For more information, please contact our Fellowship Coordinator, Jennifer Bernstein - jennifer.bernstein@umassmed.edu

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There’s nothing selfish about SELF-CARE #StopTheStigmaEM

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See You in Austin, Texas

May 16-19, 2023 | JW Marriott Austin