SAEM PULSE May–June 2019

MAY-JUNE 2019 | VOLUME XXXIV NUMBER 3

www.saem.org

SPOTLIGHT FIREARM INJURY: FACTS, MYTHS, AND A PUBLIC HEALTH PATH FORWARD An Interview with the

SAEM19 Keynote Speakers

Rebecca Cunningham, MD

Garen Wintemute, MD, MPH

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

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

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Membership Manager George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Meeting Planner Alex Elizabeth Keenan Ext. 218, akeenan@saem.org Membership & Meetings Coordinator Monica Bell Ext. 202, mbell@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com Associate Editor, SAEM BOD D. Mark Courtney, MD Associate Editor, RAMS Shana Zucker, szucker@tulane.edu

2018-2019 BOARD OF DIRECTORS Steven B. Bird, MD President University of Massachusetts Medical School Ian B.K. Martin, MD, MBA President Elect Medical College of Wisconsin Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Christopher Lee Bennett, MD, MA Brigham and Women's Hospital and Massachusetts General Hospital Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center

James F. Holmes, Jr., MD, MPH Secretary-Treasurer University of California Davis Health System D. Mark Courtney, MD Immediate Past President Northwestern University Feinberg School of Medicine Angela M. Mills, MD Columbia University Ali S. Raja, MD, MBA, MPH Massachusetts General Hospital Megan L. Ranney, MD, MPH Brown University Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

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President’s Comments

Viva Las Vegas! Here’s What’s in Store for You at SAEM19…

Spotlight

Firearm Injury: Facts, Myths, and a Public Health Path Forward

SAEM 2019 Know Before You Go Academic Emergency Medicine

A Year in Review: Resident Editors, AEM Editorial Board

SGEM: Did You Know?

The Opioid Epidemic: Why Are So Many Women Dying?

Clerkship Directors In EM

Tips for Using Simulation for Medical Students

Climate Change And Health

Environmental Sustainability and Your Hospital: Quick Tips for Greening Your Institution

Clinical Research In EM

Success with Emergency Medicine Research: The CRUX of the Matter

Diversity and Inclusion

Importance of Mentoring for Underrepresented Minorities in Medicine

Ethics in Action

Pain Management in a Patient with a Substance Abuse History

Global Emergency Medicine Misjudging Measles

Research In Academic EM

Increasing Resident Engagement in Research

Social Media In Academic EM Infographics in Academic Medicine

5 Effective Statements Every New EM Physician Should Master Wilderness Emergency Medicine Academia at the 2019 Ouray Ice Festival

The Role of Philanthropy in Emergency Medicine EM Critical Care

Research at the Edge: An Interview With Dr. Kusum Mathews

Briefs and Bullet Points Academic Announcements Now Hiring

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

PRESIDENT’S COMMENTS Viva Las Vegas! Here’s What’s in Store for You at SAEM19…

Steven B. Bird, MD University of Massachusetts Medical School 2018-2019 SAEM President On the eve of the 30th anniversary of the first SAEM annual meeting, I would like to present to you a “know before you go” to highlight what the Society has in store for you in Las Vegas.

First of all, this will again be one of the largest annual meetings by registrants we have ever had. We expect more than 3,000 of you to spend a few days learning, networking, meeting new people, and also having a bit of fun.

Approximately half of SAEM19 attendees will be medical students and residents; the annual meeting is particularly important for these junior physicians and physicians-to-be. I encourage you to use your time at the annual meeting to meet at least three new people every day. Each of you will practice emergency medicine for three decades, and the people you meet are important to your career and to longevity in our specialty. Use the time at the annual meeting to build and strengthen relationships.

For the first time at an SAEM annual meeting, there will be two keynote addresses. As the United States continues to struggle with response to firearm injury, we have Drs. Rebecca Cunningham and Garen Wintemute discussing, "The Facts, Myths, and the Public Health Way Forward," on Wednesday, May 15, during our opening session. We are also fortunate to have

Dr. John Prescott from the Association of American Medical Colleges discussing the future landscape of medical education on Thursday, May 16 during our first-ever education keynote address. Preceding Wednesday’s opening keynote address will be the SAEM Awards Ceremony, where your peers from our Society will be recognized for their notable contributions to SAEM and to the specialty. You should plan on coming to support them. Following the keynote address on Wednesday we will also have the plenary session where seven of the top scoring submissions to the annual meeting will be presented by the authors. This is a great way to meet people in the Society who are doing cutting edge research.

On Wednesday afternoon the Simulation Academy of SAEM is presenting SimWARS. Fully subscribed again, SimWARS pits teams of residents against each other as they work to problem solve and collaboratively care for a simulated patient in front of a huge audience. For those ultrasound gurus among us, we have Sonogames on Friday morning. If you haven't either participated or observed this competition, then you should make a point of showing up and taking in the spectacle that is Sonogames. New this year, we have MedWARS — a medical wilderness adventure race. This all-day event allows participants to learn wilderness medical knowledge and hands-on skills in a team competition environment.

It is been said that a picture is worth a thousand words, and that may be no more true and relevant than in clinical medicine, so be sure to stop by the clinical images exhibit. This fantastic exhibit will have pictures and images of various clinical findings where you can test your knowledge against that of your friends, and learn a lot by doing so.

For chief residents and junior faculty looking for career development, we offer both the Chief Resident Forum and the Junior Faculty Development Program.

This is a great way to meet colleagues as well as leaders in emergency medicine. It is also a great way to concretely develop a roadmap to put your career on a steep trajectory.

SAEM RAMS and the AAEM Resident Student Association are hosting the always fun and popular annual dodgeball competition. This is not like your childhood playground dodgeball.

Dodgeball will take place on Thursday from 5:30–7:30 p.m. If you are not participating, join us in cheering on your friends and enjoying hot dogs and cold drinks. (And there may just be an appearance by Elvis!)

Following the dodgeball tournament, on Thursday from 10 p.m. until 2 a.m., will be SAEM's 30th Anniversary Party hosted by RAMS at the 1 Oak nightclub in the Mirage host hotel. A DJ, open bar, no cover charge, and state-of-the-art sound and lighting will provide everyone with an evening fitting of a Vegas party.

While I can’t promise that I’ll be there at the END of the party, I do look forward to seeing you at the beginning.

It has been a privilege to serve as president of SAEM for the last year.

SAEM is in great shape, thanks to the hard work of SAEM staff and you, the volunteer members. The SAEM19 meeting promises to be one of our best ever, and for all of that, I’d like to end with an expression from one of Vegas’ bestknown entertainers: “Thank you. thank you very much.”

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

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SPOTLIGHT FIREARM INJURY: FACTS, MYTHS, AND A PUBLIC HEALTH PATH FORWARD

SAEM Pulse talks with SAEM19 Keynote Speakers Rebecca Cunningham, MD and Garen Wintemute, MD, MPH Firearm violence is a major public health and public safety problem, associated with nearly 40,000 deaths and nearly 100,000 emergency department visits in 2017. Mass public shootings are changing the character of American public life, and more than 40 percent of Americans are concerned that they might become victims of firearm violence.

Rates of firearm homicide, firearm suicide, nonfatal firearm injury, and mass shootings are all increasing. Emergency physicians are uniquely positioned to study firearm violence and take action to prevent it.

In their SAEM19 keynote address on Wednesday, May 15 at 9:30 a.m., Dr. Rebecca Cunningham and Dr. Garen Wintemute will

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illustrate why it is appropriate to view firearm violence as a health problem and then provide an overview of the basic epidemiology of firearm violence for adults and children, including mass shootings, homicide, and suicide. Their presentation will emphasize differences between risk- and populationbased epidemiologic approaches and points on which common understandings are incorrect; it will include an overview of data on how firearm injuries stack up to other common causes of death, trends over the past 20 years, comparisons to our global peers, and health disparities. They will also discuss what is known about the effectiveness of common risk- and population-based

policy interventions, including those directed at firearm violence specifically and those with broader impact. Their presentation will address our relative lack of knowledge about firearm violence, as compared with other comparable health and social problems, and will detail the reasons why little research has been done. They will briefly review opportunities for research, in clinical settings and otherwise. The keynote address will close by reviewing opportunities for risk screening and direct preventive action in clinical settings, based on the “What You Can Do� initiative for physicians for adults developed by emergency physicians at UC Davis, as well as the FACTS video trainings developed for pediatric

Rebecca Cunningham, MD

patients. Throughout, reference will be made to particularly salient events in recent years that have shaped our understanding of firearm violence or our ability to conduct research and intervene effectively.

Dr. Cunningham is director of the CDC-funded University of Michigan Injury Prevention Center, associate vice president for Health Sciences Research for the University of Michigan’s Office of Research, professor for the University of Michigan’s Department of Emergency Medicine, and professor in Health Behavior & Health Education, U-M School of Public Health. Dr. Cunningham has a distinguished career in researching injury prevention, particularly of youth and young adult populations. She has been continuously funded by NIH and CDC for over 20 years to reduce the burden of injury with a focus on emergency department as a key location of contact. Dr. Cunningham is director of the 2017 NICHD funded Firearm-Safety Among Children and Teens Consortium (FACTS).

Dr. Wintemute, MD, MPH, is the founding director of the Violence Prevention Research Program (VPRP) and holds the Baker-Teret Chair in Violence Prevention at the University of California, Davis. He also directs the new University of California Firearm Violence Research Center. He was among the first to study firearm violence as a public health problem, and firearm violence remains the primary focus of his research and policy work.

He practices and teaches emergency medicine at UC Davis Medical Center and is a professor of emergency medicine at the UC Davis School of Medicine. His current research focuses on violence risk factors and interventions to prevent violence.

Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force, interviewed Drs. Cunningham and Wintemute for this issue.

Garen Wintemute, MD, MPH

Can you give us a sneak preview of the points you plan to cover in your keynote address? What is the message you would like attendees to take away? What changes can we make in our clinical practice?

Cunningham: Firearm injuries are the second leading cause of death among children one to 18 years old and the leading cause of death among highschool age kids ages 14–17. These injuries are preventable and well within our scope of practice in emergency medicine to be addressing. A few main messages from our keynote address: The focus is on gun safety. Strike the words “gun control” from the narrative; this is an injury prevention issue, not a “control” issue. We can accomplish massive injury prevention goals while respecting Second Amendment rights.

In your practice, be knowledgeable about guns and safe gun storage. You can refer to our training videos on the Firearm Safety Among Children and Teens Consortium (FACTS) website to familiarize yourself with these options, as well as for examples of patient counseling for safe gun storage. Ask your high-risk patients, parents, and teens about guns in the home, recognizing that the leading cause of death for teens in your practice is by gunshot injury. Start giving this topic the priority it needs in health encounters.

And finally, support SAEM and other professional organizations’ advocacy for more research focused on this topic to find evidence-based solutions.

Wintemute: Firearm violence is a health problem, and it can be studied and intervened with on that basis. There is an epidemiology of firearm violence, and interventions can be targeted to produce

the greatest effect while minimizing unintended consequences. Clinicians can contribute by addressing access to firearms when circumstances warrant.

Resources are available at our program’s website, including an instructional video.

More are on the way.

What originally led you to pursue medicine? What drew you to emergency medicine specifically?

Cunningham: Like most emergency medicine docs, I like a challenge, and I like seeing all sorts of patients. Growing up in a resource-poor, working-class neighborhood, and spending my elementary years attending night school with my mother while she worked toward her own college degree, I appreciate taking care of patients regardless of income level or insurance status.

Wintemute: Medicine is an ideal way to combine science and service to others.

I can think of no better way to live a life.

Emergency medicine combines breadth of practice with high intensity. It is a highrisk, high-reward specialty. Again, what’s not to like?

What originally sparked your work on gun violence?

Cunningham: Many answers here. One answer certainly is that I was frustrated at the number of young people who were arriving in our trauma bay in Flint, Michigan, and felt that our national standard of care—to treat and street— was inadequate and insufficient.

Wintemute: Work with refugees in Cambodia, just after Pol Pot’s time. That was a very intensive exposure to the power of violence to shape the lives of individuals and whole populations.

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What is something you feel the general public does not understand about firearm violence?

Cunningham: Firearm violence is not too complex to study or solve. It is not more complicated then reducing strokes or HIV. We just have not applied our scientific knowledge and resources to solve it. Also, great reductions can be made while preserving Second Amendment rights. We have more cars on the road and more miles driven than in 1959, but 76 percent fewer children and teens dying in motor vehicle accidents.

Dr. Cunningham Can you tell us more about your work at the Injury Prevention Center?

“I direct one of the 10 CDC injury prevention centers in the country. The center focuses on leading causes of injury: opioid overdose, motor vehicle collision, concussion, and violence prevention including youth violence and Intimate partner violence. Some of the key projects from our injury prevention center relevant to emergency medicine are the creation of an evidence-based youth violence prevention program, which was highlighted recently by the CDC Best Practices for Youth Violence Prevention. The toolkit on how to implement the program in your local ER is at www.safERTeens.org.”

SAEM PULSE | MAY-JUNE 2019

You are also Principal Investigator of the Firearm Safety Among Children and Teens Consortium (FACTS). What do you hope to accomplish with your $5 million NIH grant?

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“Our FACTS consortium seeks to jumpstart the research field of firearm injury prevention among children and adolescents. In our first year, we have accomplished much already with over 25 faculty across the country working diligently. We have reviewed the literature and have published five scoping reviews (Journal of Behavioral Medicine, in press) that summarize the current state of the science as well as created a consensus paper that summarizes the 25 most urgent research questions to work on to change the rates of firearm injury and death among children in the next five years (JAMA Pediatrics, in press). Finally, our FACTS team has begun research on 10 studies that will add to our knowledge on firearm injury prevention from safe storage in rural areas to the effects of trauma of witnessing firearm injury as seen on social media. We are also training future researchers; with three post-doctoral fellows and more than a dozen student interns, we are growing the field of knowledgeable firearm scientists. Finally, we are making it easier for researchers in EM and other fields to find data and start analysis that will contribute to the field. We have a growing data repository of data sets on firearm injury that will be close to 100 in number by late summer ready for free download from the FACTS website for secondary analysis.”

Wintemute: We still do not understand the importance of suicide, which is substantially more common than homicide and has a very different risk profile. We significantly overestimate our risk of involvement in a mass shooting. This is very sad; those events are reshaping the character of American public life, and not for the better.

What would you say to a physician who does not feel it is his or her responsibility to ask a patient about access to weapons in the home?

Cunningham: We don’t get to choose in emergency medicine, or any specialty, to not take care of or ignore threats to health of our patients. I can’t choose not to risk stratify my chest pain patients, or ignore the blood sugar reading of 500. Look at any and all of the next 100 high school age kids you take care of and know that they are more likely to die by gun then by anything else. How can that not be our responsibility to increase their safety?

Wintemute: I would ask a question or two.

Would you please lay out your thinking here?

How does access to firearms differ from other topics, such as tobacco and alcohol use, obesity, and high blood pressure, which also arise from a mix of individual and social factors and can adversely impact health? I would also make it clear that I don’t ask about firearms when I don’t think it’s relevant.

What is the largest obstacle to meaningful change in preventing gun violence?

Cunningham: Not working from common ground—we all agree that we want fewer children and kids dying by gun. We need to start with that premise and work toward solutions.

Wintemute: There is no single largest obstacle; I would put several together at the top of the list. We need to believe that violence is not acceptable and is everyone’s problem. We need to believe that, individually and collectively, we can make a difference. As a scientist, I will

add that knowledge is power; we need more and better evidence on which to base our actions. As a clinician, I will close by saying we already know enough to make a difference for the better.

What endpoint would make you realize that your life’s work in studying and preventing firearm violence has been a success?

Cunningham: Well, in my lifetime we have seen a 76 percent reduction in children and teen death by MVC. A 76 percent reduction in children dying by gun would certainly be a success. In the meantime, I would like to see the same number of research centers focused on gun injury prevention as there are on cancer prevention and treatment and transportation death.

Wintemute: I laughed out loud at this question.

There is no such thing. On the wall behind me at this moment is a quotation from playwright Samuel Beckett: “Ever tried. Ever failed. No matter. Try again.

Fail again. Fail better.” Right above that is a reminder I wrote: “Remember why you’re doing this, and for whom. Be patient. Be grateful.”

Dr. Wintemute What impelled you to found the Violence Prevention Research Program?

“We faced a major health problem, and almost no one was working on it. California provided an ideal setting, with uniquely rich data and policymakers ready to put the results of scientific research into practice.”

Why is it so difficult to obtain legitimate research about the impact of gun violence? What led you to continue funding the Violence Prevention Research Program yourself after the CDC ended your funding?

“There was an organized, sustained, and successful effort to limit federal funding for research, led in part by Congressman Jay Dickey. Mr. Dickey himself had a change of heart, and toward the end of his life advocated for an increase in funding. I contributed because the work was important, and I could. We have funding from other sources, but I will contribute as long as I am able.”

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KNOW BEFORE YOU GO

Welcome to Las Vegas: City of Lights!

• “Active” Volcano • Variety of Dining Options • Nightlife That Lasts All Night • “The Best Poker Room in Vegas” • 20,000 Gallon Saltwater Aquarium • Pools and Spa • View all

World Class Shows

ANNUAL MEETING

The Mirage: Your SAEM19 Host Hotel

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The Mirage Las Vegas, located centerStrip at 3400 S Las Vegas Blvd. Las Vegas, is the site for SAEM’s educational sessions and most of its events and activities. The Mirage is the original Vegas mega-resort — a Four Diamond award-winner with an iconic volcano welcoming you to a 24-hour paradise.

Activities and Amenities

At the end of a full day or week of SAEM19 meetings and events, you’ll find plenty of things to do at The Mirage— from spa days to shopping trips to lounging by the pool or soaking at the spa.

No vacation to Las Vegas is complete without taking in a show and the entertainment options at Mirage do not disappoint! Ranging from the familyfriendly Siegfried & Roy’s Secret Garden to nightly performances at the Aces of Comedy. Top Entertainers like Boyz II Men and the winner of season two of America’s Got Talent, Terry Fator, are official staples of the Mirage Resort.

• The Beatles LOVE by Cirque du Soleil • Secret Garden & Dolphin Habitat • Terry Fator • Boyz II Men • Aces of Comedy • View all

Mirage Restaurants

There are a number of fine and casual dining restaurants throughout

The Mirage. Choose from poolside bars to quick eats to romantic dinners at a top-notch steakhouse.

• Pantry • Osteria Costa • Tom Colicchio’s Heritage Steak • Carnegie Deli • The Still • LVB Burgers & Bar • Cravings Buffet • View all

Business Services

The on-site FedEx Office® Business Center is located in the Terry Fator Theater Lobby next to Roasted Bean.

The staffed hours of assistance are Monday to Friday from 7 a.m.–6 p.m. and Saturday and Sunday from

8 a.m.–4 p.m. Services offered include posters, signs and banners; printing, copying and binding; presentations and handouts; scanning and faxing services; event and office supplies, equipment rental; and 24 hour access to computer rental stations with internet and printing.

If you have questions call (702) 8930196 or email usa5714@fedex.com.

The Mirage is located in the heart of the Las Vegas Strip, fewer than than 30 minutes from McCarran International Airport. A taxi to the hotel will cost about $30. You do not necessarily need a car to get around town, as many of the attractions are within walking distance or a short cab ride from The Mirage; however, you may want a car to visit sites outside of the city, such as the Hoover Dam and Red Rocks Canyon.

The Mirage offers several options to get you where you want to go!

Limousines, Town Cars & Public Transportation

The Mirage Concierge can help you arrange transportation to and from The Mirage, answer questions about stops and pricing for public transportation, and assist with any other related needs.

For more information, contact the Concierge at (702) 791-7416.

Avis Rental Cars MGM Resorts Mobile App

The official app from MGM Resorts is your digital concierge: access digital key and mobile check-on; make reservations; browse shows and nightlife; receive personalized recommendations; and earn exclusive access with M life Rewards. Download from the App Store or get it on Google Play!

Getting Around

Like most Las Vegas resorts, The Mirage is massive! With 3,049 hotel rooms, on 30 floors, and 1.1 million square feet of public space it is among the largest hotels in the world. This map of The Mirage meeting space will help you make your way to and from SAEM19 educaitonal sessions and events, while this handy property map will help guide you as you make your way around The Mirage’s casino, theatres, restaurants, shopping, lounges, and other attractions.

Feel like taking a cruise in a Corvette?

Need a ride with good gas mileage to drive to Hoover Dam? Wherever you're going, AVIS car rental, conveniently located at the front desk in the lobby of the Mirage, can help you find the right vehicle.

Taxi

Taxi assistance is available 24 hours a day from the main entrance.

Uber and Ride Share

The Mirage and Uber have teamed up to help you get the most out of your stay in Las Vegas. The Mirage has a designated pick up and drop off location at the north valet entrance across from valet. Simply open the Uber app, request and meet your driver. New to Uber? Sign up here to create a new Uber account, then download the app and enter promo code MIRAGE2 for a free ride up to $20.

Exploring Las Vegas Have some down time? Get exploring! Here are some helpful links to get you started: • What’s New

• Sports

• Cool Museums

• Entertainment

• Acrobatic Shows

• Eat & Drink

• First Time In Vegas

• Inspiration

• Things To Do

• Free Visitors Guide

Bet You Didn’t Know!

• The Mirage is not in Las Vegas… It’s located in Paradise, Nevada, as is most of the Las Vegas Strip • The original marquee sign in front of The Mirage is the largest freestanding marquee in the world.

ANNUAL MEETING

Out and About

• The Mirage was almost named the “Golden Nugget” after Steve Wynn’s Golden Nugget hotel-casino in downtown Las Vegas.

• At the time of its opening, The Mirage was the largest hotel in the world, with 3,044 rooms.

• When it opened, The Mirage was the first casino to use security cameras full-time on all table games.

• The swimming pool at the Mirage is one-quarter-mile long • The volcano soundtrack at the Mirage features the work of Grateful Dead drummer Mickey Hart • The 53-foot-long, 8-foot-tall aquarium behind The Mirage registration desk is home to nearly 1000 specimens.

• The Mirage was featured on The Amazing Race 15, where one team member had to bungee the other into the air to grab a bouquet of flowers presented in the Love theater.

• In 2014, The Mirage was featured in The Amazing Race 24, where teams had to replace the lightbulbs in the letter "I" in "Mirage".

•T erry Fator, who currently performs at The Mirage, won season two of America’s Got Talent.

• The poker room at The Mirage was the dream destination of Matt Damon’s character in the movie Rounders.

• The movie Vegas Vacation was filmed mainly at The Mirage.

• The Mirage is parodied in at least three video games: Grand Theft Auto: San Andreas as "The Visage," Need For Speed: Carbon as "The Mirror," and Hitman: Blood Money as "The Shamal."

• The Mirage was one of the three casinos that Danny Ocean and his crew robbed in the 2001 version of the film Ocean’s Eleven.

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KNOW BEFORE YOU GO

Getting the Most Out of SAEM19 Registration

ANNUAL MEETING

If You Preregistered…

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You received a barcoded email confirmation. Please save this to your mobile device or print it out to scan at our convenient, self-serve, preregistration kiosks, located near the SAEM19 registration desk. Forget your confirmation? No problem! Just touch “User Lookup” on the screen and search for your name. Hit print and your badge and any applicable tickets will print out.

Badge holders and lanyards will be available at the kiosks.

If You Are Registering On Site…

As always, we will have a fully-staffed registration desk available for those who need to add sessions or register on site.

The SAEM19 registration area is located in the Rotunda. Registration hours are: • Monday, May 13, 3–6 p.m.

• Tuesday, May 14, 7 a.m.–6 p.m.

• Wednesday, May 15, 7 a.m.–7:30 p.m.

• Thursday, May 16, 7 a.m.–5 p.m.

• Friday, May 17, 7 a.m.–2 p.m.

Please note that annual meeting participants (members, nonmembers, partners, children, guests) must register and wear badges for admission to sessions, the exhibit hall, and most events.

Speaker Ready Room Presenters who need to upload presentations on site must bring their presentations saved on a USB/flash drive to the Speaker Ready Room

(Andros A) at least six hours before the start of their sessions. Onsite aids will be on hand to upload your presentation from your flash drive. There will not be an opportunity to preview or edit your presentation on site, so please be sure your presentation is in its final form.

Hours

• Monday, May 13, 3–6 p.m.

• Tuesday, May 14, 7 a.m.–5:30 p.m.

Online Scheduling Tools Program Planner

the program planner, but in a simple, easy-to-use mobile version. Need help downloading your app? Visit the App Desk located across from Montego A for assistance in downloading or navigating the SAEM19 App.

The SAEM19 Online Program Planner provides pre-meeting access to the SAEM19 program. Log in using your SAEM username and password and browse through the full list of Advanced EM Workshops, educational sessions, meetings, events, and more. Browse by category or date. Review abstracts, learning objectives, and speakers for educational sessions. Find links to travel information and local dining and activities. Scope out the exhibit hall with the online floor plan and create your must-see list of exhibitors.

Additional Information

As you browse, customize your schedule by clicking the star to add items to your “favorites” list. Create your individualized program before you arrive. Save it and/or print it out as your personalized daily itinerary. Use it at the annual meeting to remind you what not to miss and where to go next. Then install the SAEM Annual Meeting app (see below), log in using your SAEM username and password, and voila!

Your schedule is synced from the online program planner.

As a service to annual meeting registrants, SAEM will provide free wireless Internet access, sponsored

by Roche Diagnostics. Wi-Fi will be available in designated areas of the Mirage host hotel during SAEM19.

Username: SAEM19. Password: RocheGen5

Mobile App

Navigate SAEM19 like a pro by downloading the SAEM Annual Meeting app! Simply download the app from the App Store or Google Play, then sign in with your SAEM username and password to launch the app.The app will be synced to your SAEM19 Program Planner and offers all the same functionality as

News and Updates

SAEM news and updates will be announced via a nightly annual meeting e-newsletter and via SAEM social media. Follow us on SAEM Facebook and Twitter @SAEMOnline (#SAEM19) during the annual meeting for up-todate meeting announcements...and be sure to share your insights with other meeting attendees.

Wireless Internet Access

SAEM19 Online Education

SAEM19 educational content will be open access and available online at SOAR (SAEM Online Academic Resources) in early July. Experience convenient online and mobile viewing of Advanced EM Workshops, didactics, forums, abstracts — more than 300 hours of original educational content from SAEM19. Downloadable PDFs and MP3 files provide convenient, on-the-go viewing. Watch presenters’ slides while listening to fully synchronized audio.

Just log in with your SAEM username and password to enjoy the content.

Lactation Room

A comfortable lactation room will be provided for nursing mothers in Office B, located near the SAEM19 App Desk, during the following hours: • Tuesday, May 14, 7 a.m.–6 p.m.

• Wednesday, May 15, 7 a.m.–7:30 p.m.

• Thursday, May 16, 7 a.m.–7:30 p.m.

• Friday, May 17, 7 a.m.–2:30 p.m.

ANNUAL MEETING

• Wednesday, May 15, 7 a.m.–5:30 p.m.

• Thursday, May 16, 7 a.m.–5 p.m.

• Friday, May 17, 7 a.m.–3 p.m.

Childcare

SAEM, in partnership with Rosh Review, is pleased to offer a $100 credit to attendees who purchase in-room childcare services from Nannies & Housekeepers USA during educational hours at SAEM19. Any SAEM19 registrant who purchases childcare just needs to bring a receipt to the SAEM19 registration desk and we'll provide reimbursement up to $100.

Take the Walking Challenge!

Pack your Fitbit, Garmin, Apple Watch, or just use your smartphone, and participate in the SAEM19 Walking Challenge, brought to you by RAMS Wellness Committee. Join in some friendly competition with your peers as you work your way up the leaderboard and try to exceed the Challenge Step Goals to win prizes! Start time is Wednesday, May 15; end time is Friday, May 17. Download the Heka Walk app from your App Store or Google Play.

Need Assistance?

SAEM's Medical Student Ambassadors will be stationed throughout the Mirage Host Hotel to help. They will be wearing blue, SAEM-branded jackets, so they'll be easy to spot. Additionally, SAEM staff will be at the registration desk during registration hours and at SAEM Booth #112 during exhibit hours to lend a hand.

New to SAEM or the Annual Meeting?

Will this be your first time attending the annual meeting or are you a new member of SAEM? Please stop by SAEM Booth #112 in the exhibit hall during exhibit hours and introduce yourself, have a professional headshot taken, and let us tell you about SAEM's programs and services and how to get the most from the annual meeting.

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“Happy 30th Anniversary SAEM!” From Medical College of Wisconsin, Tower Health, and Roche Diagnostics USA SAEM is commemorating 30 years of providing outstanding educational opportunities to emergency medicine academicians, and our friends at Roche Diagnostics, Medical College of Wisconsin, and Tower Health are adding their support to the celebration. SAEM thanks these friends, and all of our 30th Anniversary sponsors, for their good wishes and support.

ANNUAL MEETING

30th Anniversary Party VIP Table Sponsors

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University of Iowa Hospitals and Clinics, Department of Emergency Medicine

Boston Medical Center, Department of Emergency Medicine

LSU Health Sciences Center – Shreveport, Department of Emergency Medicine

Columbia University, Department of Emergency Medicine

Stanford University School of Medicine, Department of Emergency Medicine

University of Cincinnati, College of Medicine, Department of Emergency Medicine

Medical College of Wisconsin, Department of Emergency Medicine

The Ohio State University, Wexner Medical Center, Department of Emergency Medicine

Thomas Jefferson University and Hospitals, Department of Emergency Medicine

University Hospitals, Cleveland Medical Center, Department of Emergency Medicine

Penn State Health Milton S. Hershey Medical Center, Department of Emergency Medicine

Henry Ford Health System, Department of Emergency Medicine

Spectrum Health/Michigan State University, Department of Emergency Medicine

Massachusetts General Hospital, Department of Emergency Medicine

ANNUAL MEETING

SAEM19 Exhibit Hall Plan time in your schedule to visit the SAEM19 Exhibit Hall in Mirage Events Center B. Have a complimentary professional headshot taken and visit with 60-plus exhibitors who will be on hand to showcase their latest products and services. Use the SAEM19 Online Program Planner to scope out the exhibit hall with the online floor plan and create your must-see list of exhibitors.

Hours Tuesday, May 14 • Exhibitor Kickoff Party, 5–6 p.m.

• RAMS Hangout, 5–6 p.m.

Wednesday, May 15 • Networking Breakfast, – 7–9 a.m.

• RAMS Hangout, 7–9 a.m.

• Exhibit Hall Open, Noon–4 p.m.

• RAMS Hangout, Noon–4 p.m.

• Light Lunch, Noon–1 p.m.

• Power Break, 2:30–3 p.m.

• RAMS Hangout, 5:30–7:30 p.m.

• SAEM19 Opening Reception, 5:30–7:30 p.m.

Thursday, May 16 • Exhibit Hall Open, 7 a.m.–1 p.m.

• RAMS Hangout, 7 a.m.–1 p.m.

• Networking Coffee Service, 7–8 a.m.

• Light Lunch, Noon–1 p.m.

SAEM19 Exhibitors EXHIBITOR BOOTH American Academy of Emergency Medicine (AAEM) AAEM Resident Student Association (AAEM/RSA) AcelRx Pharmaceuticals, Inc. ACEP Geriatric Emergency Department Accreditation Program Alteon Health American Physician Partners ApolloMD Arkansas Children’s Hospital Atlantic Pension Planning Corp.

BMS/Pfizer BTG International Ltd. Cambridge University Press Clarius Mobile Health ConnectMe Solutions DA Technology DAG Worldwide Education Management Solutions Emergency Medicine Network EMrecruits Envision Physician Services (EVPS) Happy Doc Summer Camp Integrative Emergency Services (IES) iSimulate Indiana University School of Medicine Department of Emergency Medicine Intelligent Ultrasound Kaiser Permanente/The Permanente Medical Group, Inc. Leading Edge Medical Associates (LEMA) Logix Health McGraw-Hill Education MDocHaus Medi Lazer

125 224 206 322 419 111 113 410 305 413 204 508 104 522 512 400 201 423 216 310 504 212 411 223 117 417 213 422 222 301 307

EXHIBITOR BOOTH Medical College of Wisconsin 119 Medvision 405 Mindray North America 225 My Bio Medical Solutions 207 PACE MD Global Health 105 Patient Forecaster 108 Penn State Health - Hershey Medical Center 211 Physician Affiliate Group of New York (PAGNY) 404 Portola Pharmaceuticals 306 Riverside Health System 123 RoyalZ Beauty 510 Schumacher Clinical Partners 324 Shift Administrators 218 Simulab Corporation 205 Society for Academic Emergency Medicine 112 SonoSim 311 Splash Medical Devices 122 Sycamore Physician Contracting LLC 325 Tereson 406 The Dental Box 106 Tower Health 412 University of Maryland - Department of Emergency Medicine 300 US Acute Care Solutions 323 VEP Healthcare 110 VisualDx 210 Vituty 313 WVU Medicine - Department of Emergency Medicine 107

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The 16 highlighted exhibitors are participating in bingo.

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ANNUAL MEETING

Must-Attend Sessions and Events for Resident and Medical Student Attendees at SAEM19

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Christine Luo, MD, PhD

Simanjit Mand, MD

RAMS Education Committee members Christine Luo, MD, PhD, The Ohio State University College of Medicine and Simanjit Mand, MD, University of Cincinnati College of Medicine, poured over the offerings that SAEM19 has in store. As residents (and former medical students) themselves, in tune with what medical education provides today and what presentations would uniquely supplement the knowledge of residents and medical students alike, Drs. Luo and Mand identified several events and sessions which are well-suited to RAMS. While a few of the sessions overlap, with careful planning, see how many of the these you can attend!

RAMS Members‌ Look for This Icon When you see the RAMS head icon next to an abstract, didactic, or workshop, event, or meeting, in the SAEM19 Program Planner, you will know that it is something you’ll find value in attending. Click here to browse the full-slate of offerings for RAMS at SAEM19.

ANNUAL MEETING

Career Symbiosis: Mentors and Mentees Creating a Mutually Beneficial Relationship May 14 1:00 PM - 5:00 PM Implicit Bias in Residency Evaluations: The Current State and What You Can Do About It May 15 8:00 AM - 8:50 AM Leadership Education in Advancing Diversity: The Imposter Syndrome, Microaggressions, and Implicit Bias May 14 8:00 AM – 12:00 PM Masters Secrets Series May 15 1:00 PM - 2:20 PM Speed Mentoring May 15 3:30 PM – 5:30 PM So You Want to Get a Job? Unlocking the Secrets to the Perfect Interview Beyond Residency May 15 4:00 PM – 4:50 PM Medical Student Symposium May 16 8:00 AM –3:00 PM Residency and Fellowship Fair May 16 3:00 PM – 5:00 PM Don’t Drown! How to Transition Swimmingly From Resident to Faculty in Academic Emergency Medicine May 17 12:00 PM - 12:50 PM

Research Wilderness Medicine Research: Approaches to Involving Students, Residents, and Fellows May 15 3:00 PM - 3:50 PM Pearls and Pitfalls of Resident and Medical Student Research May 15 5:00 PM - 5:20 PM Meet the Editors: Top 10 Mistakes Made in Education Research and How To Avoid Them May 16 8:00 AM - 8:50 AM Lion’s Den 2019: Sixth Annual Real-world Research Proposal Development May 16 2:30 PM - 3:50 PM Short, Deep, and Flipped: Five Ways to Improve Your Research Curriculum and Inspire Your Residents May 16 3:00 PM - 3:20 PM

Developing the Right Question for Medical Education Research May 17 12:00 PM - 12:50 PM

Education Low-Cost Simulation Models: Caviar Tastes on a Tuna Fish Budget May 14 8:00 AM – 12:00 PM SAEM Grant Writing Workshop May 14 8:00 AM - 5:00 PM Simulation Workshop: Critical Strategies in Simulation Procedural Skills Training for High-Risk/LowFrequency Procedures May 14 1:00 PM - 5:00 PM SAEM Jeopardy 2019 May 15 8:00 AM - 8:50 AM SIMWars May 15 1:00 PM – 5:30 PM SAEM’s Got Talent: A FOAMed Showcase May 15 3:00 PM – 3:50 PM Education Keynote Address: The Future Landscape of Medical Education May 16 11:00 AM - 11:45 AM Innovative Bedside Teaching: Quick Tips to Teach Like a Pro While on Shift May 16 4:00 PM - 4:20 PM SonoGames May 17 8:00 AM – Noon

Hang Out With Us! The SAEM RAMS Wellness and Resilience Committee is proud to sponsor an area for Residents and Medical Students (RAMS) to hang out during SAEM19 in Las Vegas. The RAMS Hangout will be conveniently located inside the exhibit hall and will be available during the hours below. Residents and medical students will have their own roped-off space to call their own! Stop by and wind down.

Challenge your friends to a game of foosball, ping pong, cornhole, or just be a spectator and enjoy the camaraderie!

RAMS Hangout Hours Tuesday, May 14, 2019

5–6 PM (Exhibitor Kickoff Party)

Wednesday, May 15, 2019

SAEM19 MedWAR May 17 8:00 AM – 4:00 PM

7–9 AM / 12–4 PM 5:30–7:30 PM (Opening Reception)

Resuscitate Your Dying Lectures!

Create Engaging Presentations Using Evidence-Based Techniques May 17 10:00 AM - 10:50 AM

Thursday, May 16, 2019

SAEM Clinical Images Exhibit May 14 - May 17

Wellness Not Another Yoga Class: Wellness Initiatives of Residency Programs May 16, 4 p.m.

Wellness, Inclusion, Diversity, Equity: The Wide and the Why...That is the Question May 17, 8 a.m.

The Science of Physician Wellness: Is the Truth Out There?

May 15 2:00 PM – 2:20 PM

7 AM–1 PM

Follow RAMS Twitter for SAEM19 RAMS Updates SAEM residents and medical students, if you’re on Twitter, you’ll want to follow @SAEM_RAMS for exclusive SAEM19 news and information, including recaps of resident and medical student events and education sessions. Spread the word!

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ACADEMIC EMERGENCY MEDICINE A Year in Review: Resident Editors, AEM Editorial Board The resident-in-training (“resident”) appointment to the Editorial Board of Academic Emergency Medicine (AEM) is intended to introduce residents to the process of peer review, editing, and publishing of medical research manuscripts. The appointment provides the selected resident(s) with an experience that will enhance his/her career in emergency medicine and in scientific publication. Below, the 2018-2019 AEM Resident Editors reflect on their experiences serving on the AEM Editorial Board.

Daniel Nogee, MD

Lauren M. Maloney, MD

Resident, Emergency Medicine Yale School of Medicine 2018-2019 AEM Resident Editor

Chief Resident, Emergency Medicine Stony Brook Medicine 2018-2019 AEM Resident Editor

“No one has ever designed a perfect study,” wrote one of the Academic Emergency Medicine (AEM) editorial board members to me early this year, in response to my thoughts about the design flaws in a paper I was reviewing. This was one among many lessons that the AEM Editorial Board, reviewers, and staff imparted to me over the last year that I served as a resident editor. This particular one resonated, as I had realized that my initial approach to reviewing was too much like journal club-style criticism: pointing out flaws and faults as a reason to reject findings, instead of looking for ways to help the authors reconcile and resolve them. The “limitations” section used to be the least interesting part of a paper for me; now, I find myself examining it much more thoroughly, in order to contextualize authors’ results and rein in conclusions. On a personal level, I reflected on my own work, shifting my thoughts on an upcoming research proposal away from designing a “perfect” study and more towards designing a feasible one with reasonable limitations.

SAEM PULSE | MAY-JUNE 2019

Of the many manuscripts submitted to AEM every year, only a minority are accepted, and even then, often with significant revisions.

Going into this year, I expected more to act as a “gate-keeper,” working to select only the best manuscripts. Instead, this year has made me appreciate the roles of peer reviewers to not only select appropriate works, but to improve them as well.

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However, this was not just a reviewer position, but that of an editor as well, which included additional opportunities and a chance to see the other side of the publication process. I found learning about the intricacies of ethical issues faced by editors intriguing, and was happily surprised to see one of those editorial side projects, a “paper-in-a-pic” infographic I helped create, pop up in the Facebook feed of a large physician group I follow.

I am grateful to Dr. Mark Mycyk, Dr. Jeff Kline, and many others at AEM for helping me to learn the peer review and editorial processes over the last year. They are far from simple processes, and formal education in how to correctly conduct them is lacking. In the future, I hope to share these lessons with the residents and students I work with, “paying forward” the education experience AEM offered me.

The Academic Emergency Medicine Resident Editor Program first piqued my interest while perusing the SAEM website as an intern. Having stumbled through peer review as an author several times before, I was curious to see that process from a different perspective. It also sounded like a unique and refreshing opportunity outside of the usual residency-sponsored journal clubs. While it’s one thing to critique already published manuscripts, I wanted to learn how to put action to those words and contribute to the production of a manuscript as a reviewer and editor.

Admittedly I began the year feeling like a bit of an imposter. After all, what could a PGY-3 emergency medicine (EM) resident seriously offer to some of the most esteemed researchers in our field? As it turns out, I didn’t need to be a master of every subject to play a productive role in the process. More importantly, it seems, is to be passionate about helping our colleagues polish their work by offering constructive, specific feedback — the same feedback I hope to get on my own work.

At the same time, I got to indulge in a deep dive of the literature about what exactly conflicts of interest are, and why I need to be concerned about them as a researcher and EM physician. I am truly grateful for the mentorship through the writing process and learned pearls which have already proven to be quite useful.

I am genuinely excited to be able to pay the lessons I learned this year forward as faculty to future mentees, as well as to my colleagues, with continued volunteerism as a reviewer. As my biggest take away from this year, I learned how service to a journal in this capacity is an important, meaningful way to advance emergency medicine scholarship.

For more information about the AEM Resident Editor Program, contact Mark B. Mycyk, MD, director of the Resident Member of the Editorial Board Program, at mycyk.md@gmail.com or mmycyk@cookcountyhhs.org.

SGEM: DID YOU KNOW? The Opioid Epidemic: Why Are So Many Women Dying?

By Margaret Yates, MD, University of Alabama at Birmingham Opioid drug abuse and overdose represent an urgent public health crisis in the United States. As this epidemic continues to evolve, opioid-related deaths remain high and are implicated as a contributor in more than half of drug overdose deaths nationally.1 While overdose deaths have impacted both sexes, a recent trend has highlighted the staggering impact the opioid epidemic is having on women.

In fewer than two decades, the overdose death rate for women aged 30-64 has skyrocketed 260 percent, with opioid-related deaths, including from synthetic opioids and heroin, topping the list.2 While men are more likely than women to use almost all types of illicit drugs, women are more likely to have opioids prescribed and prescribed at higher doses, in addition to being more likely to have multiple overlapping prescriptions.

This may be due to known sex-specific differences in pain sensitivity (i.e. biological sex differences in endogenous opioid systems), as well as how gender roles impact pain reporting.3 Increased opioid prescription exposure may also play a role in recent sex differences in opioid trends.

In addition, although women are more likely to be introduced to opioids through the medical system, older women in particular are typically not considered a “high risk” cohort and therefore may not be routinely screened by care providers for substance overuse or abuse, even if regularly using prescription opioids.4 It has also been suggested that many of these reported overdoses may be accidental rather than abuse related, resulting from lack of provider education regarding opioid medication use as well as the effect of mixing medications.

The influence of stereotypical gender roles has also been suggested as a contributor to recent opioid trends. As women’s roles continue to evolve in society, many women may struggle to balance increasing expectations of work and family. Older women, who may have spent a majority of their lives caring for others due to historically constructed gender roles, may suddenly find themselves without a “purpose” as children leave home. Additional “high risk” associated demographics, including unemployment, concomitant alcohol use, comorbid mental health disorders (i.e. anxiety, depression) and medical illnesses, including obesity, diabetes and chronic pain syndromes, increase the likelihood of opioid abuse in women, particularly older women.5 When considering addiction and opioid abuse treatment specifically, women are less likely to enter and stay in inpatient treatment programs when compared to men. Social stigma of substance abuse as well as familial and work responsibilities

are large barriers to entering treatment programs whether male or female; however, women seem to be more affected.6 The sex-specific rehab “dropout” rate has been attributed to issues that arise for women when away from their families, including guilt at being away from children, and domestic obligations. Concluding treatment prematurely carries a higher risk of subsequent relapse, which is also more likely to occur in women.7 As the opioid epidemic increasingly takes center stage as a U.S. public health crisis, extending regularly into the emergency department, more thought and consideration of pain management and risk of opioid abuse needs to be given to women in general, and particularly to women aged 30-64 who appear to be at highest risk. Increased funding for and creation of “women-friendly” substance abuse programs with appropriate support for a women’s unique societal needs, including day treatment options as well as child/elder support, deserve urgent consideration and implementation.

References: 1. S choll, L., et al. Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017.

MMWR, 67(5152); 1419-1427.

2. VanHouten, J.P., et al. Drug Overdose Deaths Among Women Aged 30-64 – United States, 1999-2017. MMWR, 68(1); 1-5.

3. B artley, E.J., et al. Sex Difference in Pain: A Brief Review of Clinical and Experimental Findings. British Journal of Aneasthesia. 2013, 111 (1); 52-58.

4. M azure, C.M. and Fiellin, D.A. Women and Opioids: Something Different is Happening Here.

The Lancet. 2018. 392; 9-10.

5. S erdarevic, M., Gurka K.K., Striley, C.E. Vaddiparti, K., Cottler, L.B. Prevalence of Concurrent Prescription Opioid and Hazardous Alcohol Use Among Older Women: Results from a Cross-Sectional Study of Community Members. Journal of Community Health. 2019, 44(1): 172-177.

6. S tringer, K.L. and Baker, E.H. Stigma as a Barrier to Substance Abuse Treatment Among Those with Unmet Need: An Analysis of Parenthood and Marital Status. Journal of Family Issues. 2018, 39 (1): 3-27.

7. G rella, C.E. From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment. Journal of Psychoactive Drugs. 2008, suppl 5: 327.

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

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CLERKSHIP DIRECTORS IN EM

Tips for Using Simulation for Medical Students

By Nikita Joshi, MD, Andrew Grock, MD, and Glenn Paetow MD

patients and because the experience is meant to be educational.

Here’s How it Works

In some clerkship models, simulation is even being used as an assessment tool, whereby students manage a case with specific learner outcome objectives (either individually or as a team), and are graded based on their performances.

However, in this case of assessment, in order to be transparent, it is important to be clear to the students how assessment will be performed as simulation can already be a stressful activity.

Over the past fifteen years, emergency medicine residency programs have accelerated the use of simulation to train residents. Now, it is increasingly being used as a teaching modality for medical students. This learner population can greatly benefit from the hands-on experience in a safe learning environment, but educators need to be mindful of some potential pitfalls in order to maximize learning.

SAEM PULSE | MAY-JUNE 2019

Simulation as Medical Student Education

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Simulation, when used effectively, is more than just manikins with fancy bells and whistles. It fits within medical education theories and can be used as a way to move students up the pyramid of Bloom’s taxonomy, from the “remembering and understanding” levels to the “application and analysis” levels. It allows students to practice what they have learned in the classroom setting, and apply it to a clinically relevant scenario. Psychological safety is maintained because there is no risk to

Here are a few ways to use simulation effectively with medical students, including pro tips, and potential pitfalls (and how to avoid them).

Procedural Task Trainers Students are just beginning to understand the indications, contraindications, anatomy, and technique of certain procedures in emergency medicine. Simulated task trainers provide students the opportunity to practice in a safe environment, where they can become familiar with the required equipment, practice specific techniques, and apply their knowledge of anatomy to a procedure. Both commercially available and homemade

Simulation, when used effectively, is more than just manikins with fancy bells and whistles. It fits within medical education theories and can be used as a way to move students up the pyramid of Bloom’s taxonomy, from the “remembering and understanding” levels to the “application and analysis” levels. task-trainers are available for a multitude of procedures, including peripheral and central venous access, laceration repair, abscess incision and drainage, paracentesis, lumbar punctures, and endotracheal intubation.

Pro tips. Consider do-it-yourself options, such as homemade latex skin covers, to avoid excessive costs that commercial products can lead to. Learn more about low cost simulation here.

Pitfalls. Avoid falling into the lecture trap.

Do not review medical concepts that are too complicated. These are medical students after all, and the knowledge they possess is more basic. Do not get involved emotionally.

Pitfalls. It can be enticing to want to show medical students some of the wildest procedures we do in our specialty; however, there may not be as much to learn from performing a thoracentesis or perimortem c-section as there is to learn with how to suture well on a pig’s foot.

recommend being cautious with patients who die in the course of the case. If it is a palliative care case, or hospice case, then it makes sense; however, avoid having the patient “die” because of poor management. The students may end up feeling so badly, that learning is hindered.

High-Fidelity Simulation Cases

Pitfalls. Before the start of the case, make sure to properly orient the students to the simulation room and how to use equipment. To not do so will hinder learning. Make sure to point out areas where fidelity is lacking. Always realize that students know they are being watched, which may make them selfconscious.

Running students through scenarios involving patient encounters with the high-fidelity manikin can be a powerful teaching tool and presents a great opportunity to segue into talking about management of the standard emergency department patient based upon common chief complaints, such as someone presenting with shortness of breath, vaginal bleeding, or presentation after trauma. Medical students enjoy being the “doctor” in the room and reviewing the emergency department management for the patients.

Pro tips. Because they are the cases with the most educational value, we suggest sticking with bread and butter cases, even if they are boring to the educators. Avoid too many distractions, such as screaming family members or difficult consultants. Because the medical students do not have as much of a firm knowledge base as advantaged learners, they will not be able to deal as well with distractors. And although death is a part of the emergency department, we

Debriefing Debriefing is a powerful tool and the foundation of simulation. Debriefing is the facilitated discussion that occurs after the simulation, to review educational objectives and discuss the case flow.

While debriefing can be emotional and highly charged, it is important to include, regardless of the learner type.

Pro tips. Ensure the educator has debriefing training so that they can avoid lecturing and stay aware of the emotional state of the learners. Consider the location and timing of debriefing.

It may be worth waiting a few days before debriefing, especially in special circumstances of extremely poor performance.

Medical students are less experienced than residents in medical decision making, especially given that the bulk of their training relates to knowledge acquisition instead of knowledge application. Because of this, the simulation leader should emphasize that the simulation experience is confidential, that errors are an expected part of learning, and that they will not result in any punitive or evaluative consequences.

Additionally, the simulation leader may cue the learner’s progress from knowledge to practical application. If all of this can be done, simulation can be a powerful learning tool in the clerkship.

ABOUT THE AUTHORS Nikita Joshi, MD, is an assistant professor of emergency medicine at Alameda Health System, Oakland California.

Andrew Grock, MD, is a faculty physician, Division of Emergency Medicine, Greater Los Angeles VA Healthcare System, and assistant clinical professor of emergency medicine, David Geffen School of Medicine, UCLA. Glenn Paetow, MD, is an assistant professor of emergency medicine, University of Minnesota, and director of simulation, Interdisciplinary Simulation & Education Center, Hennepin Healthcare.

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

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CLIMATE CHANGE AND HEALTH

Environmental Sustainability and Your Hospital: Quick Tips for Greening Your Institution

SAEM PULSE | MAY-JUNE 2019

By Emily Sbiroli, MD

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When we think about the intersection between our carbon footprint and our workplace, it’s easiest to think about it in different “areas” of impact: waste, water, energy, air pollution, purchasing, and food. Here are a few insights you may not know, a few people who are helping out (Is your hospital on the list?), and some quick, actionable tips on how you can make your hospital a little greener. Some of these will be obvious reminders, some of them perhaps a little more nuanced.

WASTE One active hospital bed produces 5.3 tons of waste per year on average.

"One active hospital bed produces 5.3 tons of waste per year — about 25-30 pounds of waste per day."

That’s about 25-30 pounds of waste per day, which includes regular waste and “red bag waste.” One little known fact is that red bag waste is 20 times more energy-intensive to process (and more expensive). If you’ve ever wondered what happens to that central line kit once you’re done, hospitals typically burn or bury their waste.

Mercury released from medical and pharmaceutical waste incinerators makes it into our local environment and food chain. Some hospital systems

have taken strides toward mitigating this problem. In 2017, Inova Health System in Virginia reduced its annual regulated medical waste stream by one million pounds through recycling and source reduction programs.

YOU. Be cognizant of what you put in red bag waste. A general guideline for what can go into the red bag waste bin includes anything caked, soaked, or filled with blood. Blood-tainted items, like a piece of gauze, gloves, sterile drapes or speculum with blood on it

do not have to go in the red bag waste bin. Other simple tips for reducing your hospital’s waste stream include basic recycling such as throwing out your noncontaminated plastic wrappings from that lumbar puncture kit in a recycling bin and using electronic prescribing instead of paper.

WATER Hospitals account for seven percent of all commercial and institutional water use in the United States. This percentage used to be much higher, but with the advent of new technologies such as digital x-ray processing instead of traditional film, we have significantly reduced one of our most water-intensive processes.

YOU. There are many states in the U.S. that frequently suffer from drought or water shortages. When our local governments call for a state of emergency to help us limit our water usage, hospitals are typically exempt from these restrictions. The habits you would normally practice at home during these

"Hospitals account for seven percent of all commercial and institutional water use in the United States." times, e.g., shorter showers (showers use less water than taking a bath), turning off the water when brushing your teeth, washing your face, doing dishes, etc. can also be applied when you’re at work.

ENERGY Hospitals are the second most energyintensive commercial buildings in the U.S. Given their round-the-clock status, the emergency department is one of the most—if not the most—energy-intensive sections of the hospital (the intensive care unit and the operating room typically being the other heavy utilizers). Our energy usage has a direct impact on our local air quality. It is well documented that poorer air quality leads to an increase in the number of cardiovascular and respiratory exacerbations in vulnerable populations, particularly in the chronically

ill, the elderly, and pediatrics. In addition, rising local and global temperatures can lead to toxic blue-green algae outbreaks in our water systems. Last summer, northern Florida experienced several outbreaks related to microcystin, a toxin released by heat-loving algae, which contaminated local waterways to 10 times the World Health Organization acceptable limit. Some hospitals are making new commitments to cleanerburning energy sources. For instance, since 2014, Gundersen Health System in Wisconsin has stopped investing in companies that extract fossil fuels, preferring to contract with companies that focus on renewables such as wind and solar energy.

continued on Page 22

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CLIMATE continued from Page 21 YOU. Being conscious of your energy usage is one of the easiest things you can do to help keep your carbon footprint in check. You can turn off computer display monitors that aren’t in use during those overnight shifts. Take the stairs when you can. Turn off the lights in patient rooms that aren’t being used.

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AIR POLLUTION

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The healthcare industry is responsible for an estimated 12 percent of total acid rain in the U.S. and 8 percent of total greenhouse gas (GHG) emissions. This puts the U.S. healthcare sector alone in front of the entire United Kingdom when it comes to total GHG emissions.

More emissions generally equate to more air pollution, which in turn affects our health. While delivering healthcare, we consume energy, use chemicals, and produce waste that inadvertently impacts the environment we all live in. The indirect health burdens of our environmental impact are comparable to the 44,000–98,000 people who die

each year as a result of preventable medical errors.

YOU. Simple changes can make a big difference. Warm and hot water require more energy to heat than cold water, so when washing your hands (as we do so many times during the day), avoid using excessively hot water.

Part of an institution’s carbon footprint includes employee commuting. You can opt for carpooling, public transportation, or even cycling for your daily commute.

PURCHASING The healthcare sector represents 17 percent of the U.S. marketplace, and we are the single largest user of chemicals.

Medications, cleaning products, heavy metals, sanitation, procedural agents, and so on are all critical to a hospital’s functioning. How often do we as providers think about where that bottle of Propofol came from and where it’s going once we’ve finished using it? It’s entering the waste stream coming out of the hospital and going into our communities.

The very agents we use to treat our patients with the intent of improving their

health may actually be indirectly affecting their health. Hospital water runoff and chemical waste enters our local water supply and contributes to water pollution coming out of our faucets. UCSF Health System acted on this several years ago and stopped purchasing Tricoslan, an antibacterial compound and carcinogen in hand soaps that has been known to negatively affect the environment and human health when it enters our water system.

YOU. When you’re doing an incision and drainage, be cognizant of what you’re ordering and choose the 5mL or 10mL bottle instead of a larger default bottle. When you’re irrigating a small wound and you find that your department has only purchased large 1000mL saline bottles, take note of that and mention it at your next departmental meeting.

FOOD We hardly associate hospital food with a gourmet chef and a French accent, thus it is no wonder that about 20 percent of the average hospital’s waste stream

is food. In general, the average piece of food travels 1,700 miles from farm to plate. These two facts together have many implications, including emissions associated with food processing and detraction from the local food economy.

Many hospitals serve over-processed fruits and vegetables exposed to excessive pesticides simply because it is the cheaper option. Pesticides in our food chain have been linked to motor and developmental delays in children. The most energy-intensive and problematic food sources when it comes to creating a low-carbon footprint meal are meat and dairy. Both have been linked to increasing antibiotic resistance and zoonotic disease. One of the simplest ways a hospital can contribute to the solution is to serve more plant-based and locally sourced food. University of Washington Medical Center has pledged to increase its use of antibiotic-free pork and poultry products to 90 percent. UC San Diego Health System has pledged

"About 20 percent of the average hospital’s waste stream is food." to decrease the amount of meat served, and to increase the quality of meat dishes with antibiotic-free and grass-fed animals.

Many other hospitals are following suit.

YOU. Patients often ask, “Hey doc, can I get something to eat before I go?”

If no specific requests have been made, why not grab the patient the veggie option? For yourself, have at least one plant-based meal per day.

There you have it: A quick overview of our workplace and its interaction with the environment, and a handful of ways you can do your part to help out. If you’re interested in learning more, check out Health Care Without Harm and find out if your organization is already a part of Practice GreenHealth. These are two

reputable organizations dedicated to helping the healthcare sector do their part in keeping the world a healthy place.

ABOUT THE AUTHOR Emily Sbiroli, MD, is a secondyear emergency medicine resident at UC San Diego Health. She obtained her medical degree from SUNY Downstate College of Medicine in Brooklyn, and a Bachelor’s degree from the Gallatin School of Individualized Study at NYU in environmental sustainability and green design. @ESbiroliMD essbiroli@ucsd.edu

About the SAEM Climate Change and Health Interest Group The overall aim of the SAEM Climate Change and Health Interest Group is to foster education, research, and advocacy in the realm of Climate Change and Health. Joining the Climate Change and Health IG is free. Just log in to your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

23

CLINICAL RESEARCH IN EM

Success With Emergency Medicine Research: The CRUX of the Matter

By Cassandra Hall, and Nicholas Giordano

SAEM PULSE | MAY-JUNE 2019

We can all recognize it, but its etiology is often elusive. What makes an emergency department’s (ED’s) research program successful? High enrollments, publications, and a steady source of funding are all metrics typically recognized as characteristics of “success”; but these are just byproducts of a successful emergency medicine research group. The real question is: how do departments produce such achievements?

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The SAEM Clinical Researchers’ United Exchange (CRUX) Interest Group has a vested interest in identifying the answer to this question. As a newly formed and highly novel interest group, CRUX was developed to engage those often not included in the national dialogue of emergency medicine (EM) — the nonclinical specialists who are responsible for conducting and administering the work of research in all its varied forms. Success is found in the details. The foundational concept of CRUX is to create a unified front among the clinicians conceiving

"When investigators communicate to non-physician research team members the motivation for a study, update personnel on the enrollment milestones, or ask staff about their opinions regarding difficult enrollments, it creates “buy-in” and inspires employees." research and the research professionals executing upon it so that together they can pursue the shared common goal of leading advancement in emergency care research. Here lies the CRUX of the matter.

Inevitably, as a research department grows, it necessitates the integration of clinical research personnel. With clinical research coordinators, a department can bolster study enrollment, increase departmental funds, and provide additional data to publish. One of the first initiatives CRUX undertook was to study EM research departments around the country collecting data from qualitative interviews among both

researchers and research staff. When interviewing sites around the country about the leading causes for their selfidentified success, there were three common themes: 1. Communication 2. Challenges and recognition 3. Resourcefulness In a fast-paced environment like the ED, it is not surprising that the most common answer was communication; however, it was the extrapolation of this answer that was interesting. We found that when investigators communicate to non-physician research team members, update personnel on the

Dr. Christopher Kabrhel, a member of CRUX, regularly sits down with study staff members to discuss research topics and touch base on research operations.

Dr. Jeffrey Kline’s research group relies heavily on the integration of clinical research personnel.

enrollment milestones, or ask staff about their opinions with difficult enrollments, it creates “buy-in” and inspires employees.

in his or her studies and that person would win a box of donuts. Such games may seem trivial, but their enrollment increase was not. Month after month, when challenging her team, she saw consistent highs in her enrollment targets.

Karen Miller, director of clinical research operations for Vanderbilt, identified topdown communication as a key characteristic of success within her department.

Vanderbilt’s EM research group showed drastic improvement in enrollment when investigators regularly communicated with study staff. During a staff meeting, one clinical research coordinator noted that when a principal investigator picks up the phone and asks for his opinion on a patient, it “means the world to him.” Karen attributes her department’s success to having a strong foundation of communication between clinical investigators and research personnel.

Once a site has a solid foundation of communication, setting up a positive culture was shown to organically grow enrollments. Dr. Christopher Kabrhel, director of the Center for Vascular Emergencies at Massachusetts General Hospital, attributes his culture of cohesion and teamwork to the success of his Center. By celebrating major milestones with his team, he maintains an engaging culture of high energy and shared success that drives the progression of research. Megan Rowland, a clinical research project manager at Northwestern University, implemented a culture of “enrollment games.” At the end of each month, she would tabulate which staff member enrolled the most patients

Driven by culture, we found that research teams get impassioned about their craft. Time and time again we saw that passion within an EM research group fueled a department to adapt and overcome any challenge that threatened its success. The same was found by Shannon McNabb, clinical research program manager at UT Southwestern.

When facing limited departmental funding, Shannon worked with her local university to create an undergraduate course to advance her self-initiated study to lower the rate of patients leaving the ED without being seen. Not only did the undergraduate course raise funds for UT Southwestern through tuition fees, but students were engaged in communicating with patients and learned about patient care in the ED. Preliminary data shows that by having a student talk to ED patients, the number of patients leaving the ED without being seen dropped significantly. Currently there are more than 100 students enrolled in the Texas Emergency Medicine Research Program (TEMRAP) and the program is still growing.

Communication, culture, and passion were all identified as common features among successful ED research

departments. Subsequently, the stories we heard throughout our interviews led us to conclude that when employed in unison, these features reinforce one another with compounding benefits.

Want to keep a pulse on these findings? Ask your research staff members to consider becoming an SAEM members and join the discussion.

CRUX is building the nation’s largest EM research staff network and our members bring a wealth of information to the discussion. Join us for our next call and become part of the group. We’re certain you’ll discover something new to bring back to your program.

ABOUT THE AUTHORS Cassandra Hall, CCRC, is a clinical research specialist and project manager at Indiana University School of Medicine, Department of Emergency Medicine. Cassandra is a co-chair of the SAEM Clinical Researchers United Exchange (CRUX) Interest Group.

Nicholas Giordano is a clinical research program manager and an instructor for the Center for Clinical Research Education at Massachusetts General Hospital.

Nick is a co-chair of the SAEM Clinical Researchers United Exchange (CRUX) Interest Group.

About the SAEM Clinical Researchers United Exchange (CRUX) Interest Group The Clinical Researchers United Exchange (CRUX) Interest Group’s goal is to develop a group for clinical researchers to further their professional development, integrate them into the SAEM community, and create a unified front in which research coordinators and physicians can pursue the shared goal of leading advancement in academic emergency medicine. Joining the CRUX IG is free. Just log in to your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

25

DIVERSITY AND INCLUSION The Importance of Mentoring for Underrepresented Minorities in Medicine

SAEM PULSE | MAY-JUNE 2019

By J.C. Wiggins III, MD, V. Ramana Feeser, MD and Joel L. Moll, MD

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With the excitement of Match Day 2019, we look ahead to welcoming our next class of emergency physicians.

As we prepare for them, we should be thinking about mentoring, even before they arrive. Mentorship is a fundamental component of education, personal growth, career development and overall engagement in emergency medicine. In particular, as emergency medicine strives to mirror the population that it serves, we recognize the importance of fostering diversity, inclusion, and equity through mentorship of underrepresented minorities in medicine (URMM).

Diversity and inclusion continue to be engaging and relevant topics within the medical field. It is well recognized that certain demographics in the United States are and continue to be underrepresented in medicine.

Initiatives have tried to address the underrepresentation of those from various social, racial, ethnic, sexual orientation, and gender backgrounds.

Diversity has become a focal point that defines institutional excellence; however, underrepresentation persists and is still a focus of concern in medicine, including emergency medicine. Recruitment is not sufficient to ensure success of the underrepresented learner once they arrive to medical school or residency.

Mentorship within the aforementioned underrepresented groups is essential to survive and thrive, but information and guidance in seeking mentorship remains sparse.

Medicine is a lifelong voyage of learning and, as such, many of the necessary skills and practices are taught and learned via seasoned mentors; however, finding promising mentors for underrepresented persons can be clouded by the fact that a significant majority of faculty and teachers may have limited ability to relate to their mentees. This may serve as a barrier to effective mentorship, at least in some aspects of mentee development.

"Mentorship is an effective and essential component to developing outstanding emergency physicians and can play a transformative role in the careers of underrepresented learners in emergency medicine."

J.C. Wiggins, MD: A Mentee’s Perspective Just under two years removed from medical school, I’ve been in a unique situation where I’ve experienced the role of both the mentee and mentor.

My involvement with professional organizations such as Student National Medical Association (SNMA) and the Society for Academic Emergency Medicine (SAEM) has led me to realize the importance of mentorship and how much of an impact it has had on my early success in the specialty of emergency medicine. SAEM is one of the premier national organizations within emergency medicine that seeks to promote the improvement

of patient care by education and research. SNMA’s mission supports underrepresented minorities and communities while also encouraging clinical growth via publications, scholarship, and national conferences.

At regional and national conferences there are always residents and faculty to offer advice to those in circumstances similar to mine. As a first-generation physician who came from a single parent household, navigating the medical field without appropriate direction was an arduous task. Finding mentors who comprehended my social background while also being knowledgeable and influential has been instrumental thus far in my progressive development. Invaluable instruction

has enabled me to match into my desired specialty at an excellent program, find resources for continued advancement, and learn of practices that will add longevity to my calling as an emergency physician. Moreover, the influence of my mentors has driven me to become a mentor myself. Through professional networking and collaboration, I’ve had the opportunity to teach workshops at national conferences, with my most recent venture being at the annual American Medical Education Conference (AMEC), which serves as SNMA’s largest national meeting. Within these workshops, I’ve seen my role transition from that of a novice learner and mentee to that of a practicing physician and mentor. Experiencing this transition has provided me with a sense of pride, as I now see myself as an ambassador in the field of emergency medicine who can provide direction to future learners. Furthermore, understanding what has benefited me through years of advisement will also allow me to effectively pay the same guidance forward to those I instruct.

V. Ramana Feeser, MD: A Mentor’s Perspective As a long-time faculty member, my view of the importance of mentoring has increased exponentially and I continue to identify and incorporate changes in how I participate in mentorship, as both a mentor and as a mentee. As an Asian-American female physician, I don’t belong to a group in the traditional definition of URMM; therefore, some of my mentorship experiences have been different while others have been similar to what any minority group in the United States experiences. For many of us, serving as a mentor is as rewarding as serving as a mentee, but often more challenging.

When it comes to mentor characteristics, most of my mentors have been non-Asian males. Studies have shown that same gender and race are not required for successful mentorship pairings. This is important for URMM where there is less opportunity to have matched characteristics; however, many underrepresented in medicine

also desire mentorship from those with similar experiences as they navigate their development. This can lead to the problem of “minority tax,” where the burden of extra responsibilities is placed on minority faculty in the name of diversity It wasn’t until recently that I learned about this term “minority tax,” and as I reflect on my roles interviewing candidates for medical school, residency, and faculty, I sometimes wonder whether I was chosen because I am an outstanding interviewer or because I am a non-white female. These feelings, questioning my achievements and role, my Imposter Syndrome, was exacerbated by my identity. I can appreciate how those underrepresented mentors may feel similarly, and that may cause further reluctance or discomfort in mentoring others.

For me, outstanding mentors have been those who offer support both academically and personally, commit their time and expertise, and serve as a role model for how to be my best. Most of my own experiences as a mentor have been while serving as faculty leader for one of the four medical student societies that medical students at Virginia Commonwealth University belong. In this role, I get to connect with a quarter of our medical students in a structured program with outlined roles and expectations. I serve not only as mentor, but also as sponsor and coach. With the number of students I come into contact with, I have had varied experiences, including the mentoring of URMM. Some of these are mandated responsibilities, such as reviewing individualized learning plans and working on curriculum vitae, but other aspects are less prescribed and vary depending on the needs of each student. The enthusiasm and compassion found at the medical student level reenergizes my passion for medicine in a way that leaves me wondering who is benefitting more — me or the student?

My biggest challenge as a mentor was when I served as faculty advisor for an emergency medicine resident. For the first time ever, and hopefully for the last time ever, the resident requested a change to another advisor. As I reflect on what may have gone wrong, one

observation I made is that this was the first male resident I had ever advised.

Another observation is that we had different viewpoints and personalities.

Although mentor-mentee relationships are a two-way street, I ultimately was not effective in tailoring my mentorship to successfully support the needs of that resident. This failed experience has made me a better mentor — one who recognizes the importance of critical analysis and obtaining feedback to improve how I serve.

ABOUT THE AUTHORS JC Wiggins, MD, is PGY-2 emergency medicine resident at Virginia Commonwealth University (VCU) Health System, Richmond, Virginia. He obtained his medical degree at the University of Virginia School of Medicine and has been a member of the Student National Medical Association (SNMA), the American College of Emergency Physicians (ACEP), and the Society for Academic Emergency Medicine (SAEM).

Ramana Feeser, MD, is faculty and director of quality and safety for emergency medicine at VCU Health System. She obtained her medical degree at George Washington University School of Medicine, completed emergency medicine residency at Johns Hopkins Hospital and is amember of SAEM, SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM), and ACEP. Glenn Paetow, MD, is an assistant professor of emergency medicine, University of Minnesota, and director of simulation, Interdisciplinary Simulation & Education Center, Hennepin Healthcare.

Joel Moll, MD, is faculty and residency program director for emergency medicine at VCU Health System. He obtained his medical degree at Ohio State University College of Medicine, completed emergency medicine residency at Carolinas Medical Center and is a member of SAEM and ACEP. Dr. Moll is a member and past president of ADIEM.

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

27

ETHICS IN ACTION

Pain Management in a Patient with a Substance Abuse History

By Gerald Maloney, DO

SAEM PULSE | MAY-JUNE 2019

The Case

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The patient is a 51-year-old male who presents with back pain following a fall from a ladder from a height of five feet. The fall occurred two days prior, while the patient was intoxicated with ethanol. He has arrived at the emergency department because the pain has become intolerable. The patient complains of low back pain with radiation down both legs. He denies any motor weakness, further sensory changes, or other “red flags.”

He has used a friend’s Percocet, with minimal relief. The patient has a history of alcohol, marijuana, and cocaine abuse. When he feels he needs it, he occasionally acquires prescription pain medication from friends. The patient’s trauma workup is positive only for a L3 compression fracture with retropulsion of fragments into the canal. He is unable to tolerate lying supine for an MRI. You admit the patient to the medical service as orthopedics feels uncomfortable managing any potential

"As medical providers, our job is not to punish patients but to treat each patient on the basis of his or her medical needs." ethanol withdrawal. The patient receives two doses of hydromorphone in the emergency department, with some relief. When you call the report, the medicine resident wants you to make it clear to the patient that he will not be receiving IV opioids because “we don’t give IV pain meds to drug users.” Is this the right move, in light of the patient’s substance abuse history?

The ongoing epidemic of opioid abuse and addiction in our country has led to ever-increasing calls at both the state and federal levels to limit opioid prescribing for outpatients and to find alternatives to the use of opioids in the hospitalized patient. In the name of patient safety and to reduce the risk

of creating new opioid addicts and feeding the addiction of those with an established problem, there are also many hospitals that have enacted policies, either formally or informally, to restrict use of parenteral opioids.

This response to the opioid crisis has occurred with some urgency, and the resultant guidelines/policies/regulations have been enacted with the best of intentions. However, can things go too far?

The answer is of course, yes.

Any steps can go too far. In terms of pain management in the patient with substance use disorder, especially opioid use disorder, the ethical question concerns how best to balance the

need to help the patient by reducing pain, with the goal of not harming the patient by perpetuating an underlying addiction. This frame of mind can help guide choices when the best choice may not be clearly apparent. In dealing with pain management in a patient with polysubstance abuse, this is frequently the case.

Is the medicine resident’s viewpoint correct, medically or ethically?

From a medical standpoint, we have a patient with an acute lumbar spine compression fracture with retropulsion of fragments into the spinal canal, presumably causing his radicular pain.

As this is an acutely painful condition, and use of nonsteroidal anti-inflammatory drugs may be problematic given that he may be going to surgery shortly, use of opioids in this patient is medically sound.

While other options can be explored (e.g., topical anesthetics, ketamine), use of opioids in this patient is certainly not unreasonable.

What about from an ethical standpoint?

Can we speak of trying to curb addiction and reduce opioid use, yet administer opioids to someone with

a clear substance abuse history? The answer, ethically, is yes. If the patient did not have a substance abuse history there would likely be little debate about use of opioids for this patient. While tolerance may be present due to his prior substance abuse, and he may require larger or more frequent doses of pain medication, he should not be allowed to suffer more than someone without a substance abuse history. This would essentially be punishing him for having a psychiatric illness. While the attitudes of many in society would agree that this is appropriate, as medical providers our job is not to punish patients but to treat each patient on the basis of his or her medical needs.

How should pain management be approached in patients with substance use disorder, especially opiate use disorder?

There will be cases in which opioids are still the best choice, or an appropriate adjunctive choice to other pain management interventions. Clear expectations will need to outlined at the start when determining a pain management plan, including any limitations on the use of medications and plans for alternatives to opioids if indicated. Some patients with a history

of opiate use disorder may choose to decline opioids even if they are the best choice for pain management, and that decision should be honored as well.

While a certain degree of paternalism may be needed to allow for appropriate parameters in use of opioids, patient input into their treatment plan and autonomy should be respected.

The Conclusion Pain management is a topic of evolving discussion from a legal, ethical, and clinical perspective. Regardless of what advances we make in non-opioid pain management, there will be a role for opioids in the treatment of acute pain in the emergency department setting.

In our case study, while there will be controversies that will arise, the best approach is to treat the patient in the manner that has his most pertinent best interests at heart.

ABOUT THE AUTHOR Gerald Maloney, DO, Louis Stokes Cleveland VA Medical Center, U.S. Department of Veterans Affairs, is an associate professor of medicine and emergency medicine at Case Western Reserve University.

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GLOBAL EMERGENCY MEDICINE

Misjudging Measles

By William Weber, MD, MPH

SAEM PULSE | MAY-JUNE 2019

While anti-vaccine groups make light of measles as a benign childhood disease, measles is the leading cause of vaccinepreventable death around the world. A global context of the disease sheds light on measles’ significant threat and steps emergency physicians can take to help.

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Measles in the United States In 2000, the Centers for Disease Control declared measles eliminated in the United States, meaning that there had been no continuous transmission of measles over the past 12 months.

Yet in March 2019, Rockland County (just north of New York City) declared a

state of emergency during an outbreak of measles involving more than 150 people. Similar outbreaks have occurred in other states, with the total number of reported cases of measles in 2019 on course to triple those reported in 2018.

Though measles cases have increased over the past four years, anti-vaccine groups call the infection a “natural” part of childhood, even writing children’s books about the benefits of measles.

Measles Outside of the United States Despite active global vaccination efforts, measles still leads to the deaths of more than 100,000 people annually. The measles virus is one of most contagious viruses known (Fig.1), contributing to rapid spread in areas of incomplete vaccination. For instance, an outbreak in Madagascar that started in September 2018 has led to more than 100,000

cases and nearly 1,000 deaths, mostly among children ages five years of age and younger. Measles outbreaks are not limited to low-income countries— the World Health Organization’s (WHO) European Region reported 80,000 cases of measles in 2018, the region’s highest number in over a decade, also associated with gaps in vaccination.

Your Role in Measles Management Emergency physicians can play a crucial role in supporting outbreak control efforts and identifying new cases, both domestically and internationally.

Eric Nilles, an emergency physician at Brigham and Women’s Hospital, spoke about his time working in conflict settings in Darfur and Chad with Doctors without Borders, where he diagnosed and treated measles and coordinated a mass vaccination effort during a large outbreak: “Many emergency physicians work internationally, including in humanitarian settings where measles outbreaks are more common. Understanding not only how to identify cases and provide clinical care, but also how to intervene with

“Can we go and visit Melanie so I can catch her measles?” Tina asked.

“That sounds like a great idea,” laughed Tina’s mother.

– from the book, Melanie’s Marvelous Measles vaccination or other measures to prevent ongoing transmission is critical.”

Domestically, emergency providers often identify the first presenting cases of measles. Reviewing the presentation (high and prolonged fever, upper respiratory symptoms, and descending maculopapular rash (Fig. 2) can help expedite identification of an outbreak.

Alerting local public health officials about suspected cases can help contain the spread. Supporting advocacy efforts for vaccination can also work as a preventive measure to keep communities safe.

The global perspective on measles morbidity serves as a reminder that measles is merciless. By diagnosing, supporting containment efforts, and advocating for vaccination, emergency providers can help prevent measles epidemics, no matter where they work.

ABOUT THE AUTHORS William Weber, MD, MPH, is a second-year emergency medicine resident at the University of Chicago. He has worked on public health projects in Zambia, Ecuador, and South Africa, and serves on the Public Health and Injury Prevention Committee of ACEP. The author would like to thank Eric Nilles, MD, MSc, who worked with the WHO, Médecins Sans Frontiers (also known in English as Doctors Without Borders), and currently directs the program on infectious diseases and humanitarian emergencies at the Harvard Humanitarian Initiative and works as an emergency physician at Brigham and Women’s Hospital.

Talking Points About Measles •M easles kills more than 100,000 people annually, mostly young children •T he measles vaccine is safe and has prevented an estimated 20 million deaths over the past 20 years •A vaccinated population helps protect infants who cannot get vaccinated but have the most measles complications

About ADIEM The mission of SAEM’s Global Emergency Medicine Academy (GEMA) is to lead the advancement of academic emergency medicine by improving the global delivery of emergency care through research, education, and mentorship. Joining GEMA is free! Just log in to your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

31

RESEARCH IN ACADEMIC EM

Increasing Resident Engagement in Research

SAEM PULSE | MAY-JUNE 2019

By Adrienne N. Malik, MD

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Residents are required to complete a scholarly project during their training, but only a small number will go on to pursue research careers. Yet, innovative and prolific clinician-scientists are integral to the continued success and growth of emergency medicine (EM).

Thus, it is critical that research-focused emergency physicians share their interests and passion with residents in order to ensure continued excellence in EM research. The task of increasing resident interest and engagement in research is as complex and varied as the breadth of EM research. While there is no single solution to this complex problem, there are a number of steps that can be taken to begin the process.

The first and most important step is to seek help for your projects — not simply because you need something done, but because you want to share your passion with a learner. Ideally, ask someone with an interest in your subject. The help you request should be concise, clear, and achievable within a few weeks or months. Early success with a poster or abstract helps pique interest in research. Save the review of 800 charts for someone’s second or third project, especially if the end product is years away.

The helper’s work should contribute to the overall success of the project and be meaningful to you as the principal investigator. Token roles lead to lassitude from all parties, which is

"A simple, easily completed project that appeals to a resident can foster long-term research interests more than a small, complex part of a larger endeavor."

detrimental to residents. It is better to turn away an interested party or refer him or her to a colleague than to set the helper up for a lackluster experience. The type and amount of help you request should also be commensurate with the helper’s level of experience and time availability.

Complex, time-intensive projects are not likely to get completed during a PGY-1 ICU block. A simple, easily completed project that appeals to a resident can foster long-term research interests more than a small, complex piece of a larger endeavor.

or coauthor papers (start with one section at a time, such as the introduction or methods).

Being flexible and understanding the extensive and varied demands on a resident’s time is necessary, but setting expectations at the outset is also critical.

Before accepting help, lay out a detailed plan of what is needed and when (the more specific, the better). Clear goals and a timeline help keep everyone on track, including you. While flexibility is important, so is accountability. When agreed upon goals are not met, it should be discussed directly. Expect success, but plan for failure. Jettison non-productive team members (after discussing unmet expectations) and save larger, timecritical projects for those who have demonstrated past success. Recognize efforts by letting residents present posters

At the outset, getting residents involved in research takes time, effort, and commitment from faculty. Expect several false starts before finding a good fit, but don’t get frustrated or judge all residents negatively as a result. Be honest about the time you have available to support and mentor residents, as learners will sense when you are not engaged in a project and their behavior will mirror yours (the origin of the “research is boring” stereotype). Research isn’t boring, but ill-conceived projects given minimal attention make it seem so. I spent three weeks in a sub-basement reviewing paper charts as a PGY-3, not because the topic was enthralling, but because the PI was supportive and

"It is critical that research-focused emergency physicians share their interests and passion with residents in order to ensure continued excellence in EM research." motivated me. Clinical research is a labor of love, and spotting and developing talent is similarly challenging, but equally rewarding. The key to success is providing clear instructions and goals, maintaining realistic expectations about your residents’ career choices, and giving them the level of support and instruction to match the level of effort we expect from them.

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

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SOCIAL MEDIA IN ACADEMIC EM Take a look at these infographics designed by the @ALiEMteam for the PECARN Head CT Rules for great examples.

PECARN Pediatric Head CT Rule

LOC > 5 sec or

Non-frontal hematoma or

Not acting normally or

Severe mechanism* NONE

No CT Required! *SEVERE MECHANISMS > 3 ft no helmet

PECARN Pediatric Head CT Rule

2 years or older AMS or

GCS < 15 or

Signs of basilar skull fx NONE

History of LOC or

ABOUT THE AUTHOR Eric Lee, MD is an attending physician at Maimonides Medical Center in Brooklyn, NY. He can be reached on Twitter @EricLeeMD. He wishes to thank @TChanMD, @AylC1989, and @ThisIsSYMH for first introducing me to the use of infographics in medical education.

History of vomiting or

Severe headache or

Severe mechanism* NONE

Discharge

SAEM PULSE | MAY-JUNE 2019

Finally, the use of infographics in medical education is an interesting development as well. Our learners are increasingly on visual social media platforms like Instagram, and infographics can be a valuable medium for knowledge translation in medical education. Some concepts in medicine are more amenable for translation into infographics than others, but they nonetheless are another tool that we can utilize as medical educators.

NONE

Observation vs. CT Head

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Second, you may have started noticing infographics showing up in peer-reviewed academic medical journals. The BMJ and JAMA, as well as increasingly many other journals, have started regularly using infographics to summarize key points of research articles and abstracts. These are particularly useful for sharing on social medial platforms. Instead of posting a plain link to a paper or abstract, you can now include an infographic when you share it on social media. This helps to

catch the attention of readers who can read the main points and helps drive traffic to the actual journal articles.

or

Palpable skull fx

CT Head Recommended

Infographics have arrived on the scene in medicine in several ways. First, they are great tools for public health information. The Centers for Disease Control (CDC) and other public health organizations regularly utilize them in public health campaigns to disseminate knowledge among the public. Graphic representations of statistics and health recommendations can help make otherwise difficult concepts easier to understand.

"...infographics can be a valuable medium for knowledge translation in medical education."

or

Discharge

An infographic is a visual representation of information composed of images, charts, and very little text. Itâ&#x20AC;&#x2122;s meant to be easily digestible, shared, and visually appealing. Infographics originated from the world of business, and it drew on elements in graphic design and marketing. They are a great way to distill what could be complex information into a more easily disseminated and understood form.

AMS GCS < 15

Observation vs. CT Head

By Eric Lee, MD

CT Head Recommended

Infographics in Academic Medicine

younger than 2 years

No CT Required! *SEVERE MECHANISMS > 5 ft no helmet

5 Effective Statements Every New EM Physician Should Master

By Kiran Pandit, MD, MPH You’ve spent years in medical school and residency learning how to diagnose and treat critical conditions. Along the way you learned how to interview patients and how to communicate with patients, their loved ones, and hospital staff. Just as life-long learning is important in the medical aspects of emergency medicine (EM), so is life-long learning in communication skills, as these continue to grow with experience working in the emergency department (ED). Here, I’ll share with you five powerful statements I’ve grown to appreciate since becoming an attending; these are statements I seldom used as a student or resident, but today use almost daily to ensure smooth, efficient care for patients, leaving them not only satisfied, but happy and grateful, and resulting in fewer interruptions in my workflow and quicker disposition (shorter length-ofstay). I’ll demonstrate through a series of vignettes, how these statements can be used.

Scenario #1 After a junior EM resident presents a case of chest pain to you, you go to see the patient. What do you say to him?

A. “Are you Mr. Ward? Are you still having pain?”

B. “I heard about your chest pain, we're going to admit you to the hospital."

C. “Hello, my name is Dr. Bell, and I'm in charge of this area of the emergency room today."

D. "Ms. Smith, can you tell me about your chest pain?"

I choose C. When I’m working in the acute care area, I am rarely the first ED staff member to greet a stable patient; more often, I’m the third, or the sixth, after the triage nurse, registration clerk, medical student or resident physician or physician assistant, primary nurse, medical technician, or a number of other professionals working in the

ED. Patients and families often find it challenging to understand the roles of these various hospital staff, and they can become easily frustrated by having to repeat their stories over and over again. Using this quote differentiates you from the other staff, and it leads patients and families to want to talk to you and listen to you. Patients and families know that talking to someone in charge is a good way to ensure good care. Taking ownership of the responsibility for “this area of the ED” does not come easily for all new attendings, but saying the words repeatedly helps with professional identity formation as you transition to this new role, and increases comfort with your newfound responsibility.

Being in charge doesn’t mean barking orders; it means motivating everyone to work toward common goals — and that starts with making your role and responsibility clear to those around you.

continued on Page 36

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5 STATEMENTS continued from Page 35

Scenario #2 You are working alone in the sub-acute side of the ED, without any students, residents, or advanced practice providers. You go to see a patient whose chief complaint, according to the triage information, is diarrhea. You introduce yourself to the patient. What do you say next?

A. "Ms. Rivera, what brings you to the hospital?"

SAEM PULSE | MAY-JUNE 2019

B. "I understand you are here for diarrhea. Can you tell me the whole story? How can we help you today?"

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C. "When did your diarrhea start?"

D. "Are you vomiting too?"

I choose B. Patients want to know that they are being listened to. A simple acknowledgement of the fact that they reported diarrhea to the triage nurse avoids the “Didn’t they tell you why I’m here?” reaction that comes when asked “What brings you to the hospital?” for

the third time in one hour. This reflection of their own words also shows them that the ED is a place of professionals who listen to patients and communicate with each other. The second part of the phrase — asking for the whole story — lets patients know that this is the time to share all the details of their story, and that we are listening. You might worry that patients will speak at length, but in reality, most patients talk for fewer than 30 seconds. The last part of this phrase — asking how we can help — adds a twist: it lets the patient know that we want to focus not only on her concerns and needs, but on what we, the ED staff, can do about those concerns and needs. It’s the difference between reporting a problem, and suggesting what should be done about the problem.

Scenario #3 The patient with diarhhea speaks about her symptoms for approximately a 90 seconds. When she stops speaking, what do you say?

A. " What about fever or chills or abdominal pain?"

B. " Did you try Pepto Bismol?"

C. "What is your past medical history?"

D. " Ok, got it, what else?"

I choose D. We are taught in medical school to gather all the details of the history of present illness, so that’s usually our agenda in our interaction with the patient—We want answers. When did it start? Constant or intermittent?

Associated symptoms? Exacerbating factors? Relieving factors? Travel?

Recent antibiotics? The closedended questions are endless. But the patient has a different agenda: He wants you to listen to his needs and concerns. And so these two agendas collide, with both sides becoming increasingly frustrated as each side desperately tries to focus on his or her own agenda. The doctor is frustrated that the patient isn’t answering the questions, and the patient is frustrated that the doctor isn’t listening. The “what else?” quote resolves this

beautifully. I keep saying “what else?” until the patient makes it clear at least once, sometimes twice, that they have said everything they wanted to say.

This usually takes 60-90 seconds, but the impact is huge. Patients are so relieved and happy that the doctor actually listened, and their stress levels and anxiety levels drop because they no longer have to worry that they only have two minutes with the doctor during which they might forget to mention something. From that moment on, they are usually very happy to answer all of my closed-ended questions, and I’m able to gather all the information I need very quickly.

It’s also very important that I understand their needs and concerns at the start of the visit, rather than at hour four or eight of their stay. By addressing those needs and concerns up front, in parallel with my own agenda of evaluating their signs and symptoms, the whole visit goes more smoothly, and the overall length of stay is shorter.

"Just as life-long learning is important in the medical aspects of emergency medicine (EM), so is life-long learning in communication skills, as these continue to grow with experience working in the emergency department (ED)."

Scenario #4

Scenario #5

You see a patient for abdominal pain and vomiting and order blood tests and a CT scan, along with treatment for symptoms.

When the results are available, you return to the patient. What do you say?

You're in the middle of a complex laceration repair when a nurse says to you "I just brought this guy in. He's here with headache, his blood pressure is high, and he was saying something about his arm not feeling right. I think the left arm, but his right arm is bothering him too. He had the same thing last week. I think it has been going on since then."

What do you say?

A. “I have the results of your cat scan. It’s normal.”

B. “Your blood tests show a problem with your kidneys.”

C. “How are you feeling?”

D. "We're going to discharge you now."

I choose C. Often, when we receive the results of laboratory or radiologic testing, we are ready for the final step in caring for an ED patient: disposition. We are eager to move patients along, and keep length of stay short. But if a patient is not feeling better, our agenda can be met not only with resistance, but with a sense that the doctor doesn’t really care, which impacts satisfaction scores and also increases risk of lawsuits. A great way to show you care is to ask your patients how they are feeling, and to address their responses before sharing with them whatever it is you want to communicate. The patient needs to understand what the next step is for managing or treating his or her symptoms.

A. "Did you activate our acute stroke pathway?”

B. "Can you ask the intern to order a stat head CT?" C. "Why are you telling me? What do you want me to do right now?"

D. "Thank you for telling me. How can I help?"

I choose D. When we are busy in the ED, we can become frustrated with people who ask for our attention but don’t make their needs clear. Sometimes it’s a staff member who is unsure of what’s happening with a patient. Sometimes it’s a patient who is vague or rambling.

Sometimes people are so intimidated by the attending physician that they don’t want to be direct about their needs. It makes us want to yell “Just tell me what

you want me to do!” But that doesn’t go over well with patients or staff. An alternative way to say the exact same thing is “How can I help?” The patient or staff member is usually then comfortable being direct in saying “I’m not sure whether to activate stroke or not” or “Can you please come evaluate this patient now?” or “Can you please order pain meds?” or “I don’t need anything, I was just letting you know” or “I want a cat scan,” etc. This allows us to rapidly address the patient’s or staff member’s need and then move on to our other tasks. Patients feel that you care, and staff feel that you are a team player.

These statements are simple to implement in your daily work. Try them out and see for yourself the impact they have on your practice. They will make your shift go more smoothly, run more efficiently, and with less frustration for you and everyone around you.

ABOUT THE AUTHOR Kiran Pandit, MD, MPH, is the director of faculty development in the Columbia University Department of Emergency Medicine.

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WILDERNESS EMERGENCY MEDICINE

A member of the University of Colorado Wilderness Medicine Section treats an ice climber in the field.

Academia at the 2019 Ouray Ice Festival

SAEM PULSE | MAY-JUNE 2019

By Chase Nelson, Hillary E. Davis MD, PhD, and Martin Musi MD, FAWM, DIMM

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Over the past decade, ice climbing has transformed from a sport limited to elite alpinist participation to a popular wintertime activity for the masses. The ever-increasing popularity of ice climbing was evident during the 24th Annual Ouray Ice Festival as thousands of ice climbers descended upon the town to learn skills from the professionals, demo the latest equipment and of course — climb! Ouray is a quaint mountain town in southwest Colorado that transforms every winter into an ice climber’s paradise. The town is complete with a park where ice is “farmed,” creating world-class routes of various difficulty, along with local hot-springs to soak in after a day of activity.

This year the festival was joined by volunteers to provide medical coverage for the event. The group was formed

from members of the University of Colorado Wilderness Medicine Section in collaboration with Event Medical Specialists (Boulder, Colorado); it included emergency medicine faculty, a wilderness and environmental medicine fellow, an emergency medicine resident, a physician assistant, several emergency medical technicians, and a pre-medical student.

A centralized medical tent was staffed and equipped throughout the festival to provide care for common conditions such as blisters, lacerations, and contusions, but also for initial stabilization of complex emergencies including cardiac conditions, fractures, allergic reactions, hypothermia, hypoxia, and dehydration. Roaming teams also supported patients in the field and assisted with observing for potential hazards. During the festival, the team provided treatment, consisting mostly

of minor wound care, to more than 25 patients; however, the closure of small, clean, uncomplicated lacerations did prevent the need for some climbers to leave the festival and seek care at the urgent care facility located more than 40 minutes from the park.

Aside from providing medical support, members of the team used the festival as a means to conduct research.

In collaboration with the University of California San Francisco- Fresno Wilderness Medicine Program, a survey was distributed among festival participants to characterize types of ice climbing injuries and estimate injury rates, the results of which are to be presented at a national conference.

The Ouray Ice Festival is the largest annual gathering of ice climbers in North America, providing a natural and intuitive environment to obtain data among participants of this sport. The

Dr. Martin Musi interacts with members of the Ouray Mountain Rescue Search and Rescue Team.

hope is that this study, along with future work, will be useful for participants, health care practitioners and the ice climbing consumer industry to guide future care and safety regulations.

The festival also served as an opportunity to review and practice technical mountain rescue techniques.

Prior to the festival, team members met with the local search and rescue team, Ouray Mountain Rescue, to coordinate efforts should a major incident arise requiring expedient patient transport.

Afterwards, several sessions were held among team members reviewing highangle rope skills and icy terrain transitions.

Naturally, these sessions often ended with team members enjoying a few climbs themselves.

The presence of the University of Colorado Wilderness Medicine Section and Event Medical Specialists was well received by festival organizers and participants, and many were surprised that this was the first instance of medical direction for the event. In turn, the festival also provided team members a unique educational and research environment.

There are already plans to continue this symbiotic relationship in upcoming seasons and even offer wilderness medicine educational opportunities to the climbing community during the festival.

Collaborations such as this between academia and the ice climbing community are ultimately beneficial to all involved.

Members of the University of Colorado Wilderness Medicine Section and Event Medical Specialists in front of the medical tent.

ABOUT THE AUTHORS Chase Nelson is a climbing guide in the Cascades and the Tetons who has recently set his sights on getting into medical school. Lately he has been working as a medical scribe in the University of Colorado Hospital Emergency Department and plans on applying to schools in 2019.

Hillary Davis, MD, PhD, is the 2018-2019 University of Colorado Wilderness and Environmental Medicine Fellow.

She completed her emergency medicine residency at the University of Rochester, NY and her medical school and PhD in biomedical engineering at the University of California, Davis.

Martin Mus, MD,i is an assistant professor of emergency medicine at the University of Colorado, Denver. He attended Buenos Aires University School of Medicine in Argentina and emigrated to the United States to complete his emergency medicine residency at North Shore University Hospital. After working as an attending at Columbia University / New York Presbyterian hospital, he traded the skyline for the ridgeline and moved to Colorado. He is a mountain rescue doctor, a wilderness medicine fellowship director and the founder of the Diploma in Mountain Medicine of the Andes.

About the SAEM Wilderness Medicine Interest Group The mission of the Wilderness Medicine Interest Group is to focus on the practice of resource-limited medicine in austere environments.

The skills of wilderness medicine are applicable to any setting defined by the use of limited equipment and extreme environmental conditions: from remote wilderness settings, to developing world outposts, to urban disaster settings. Joining the Wilderness Medicine IG is free. Just log in to your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

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The Role of Philanthropy in Emergency Medicine

By Henry Jewell Giving is a core part of who we are as people and the culture in which we live.

We feel moved to help those that we love.

The origin of the word philanthropy captures this intent to be a participant in helping others:

SAEM PULSE | MAY-JUNE 2019

Word Origin for philanthropy. c.1600, from Late Latin philanthropia, from Greek philanthropia "kindliness, humanity, benevolence, love to mankind"

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It is only more recently that philanthropy has become synonymous with money. In reality, there are many ways to be philanthropic — giving money is just one mechanism. We live in a datadriven world and it seems that the easiest thing to measure for the philanthropic sector is how much money was given or raised. Before diving into the numbers, it is important to highlight that philanthropy is not all about the money. Philanthropy is about engaging people in an important topic that they are passionate about to improve lives today and to create a brighter future for all. Done correctly, philanthropy can create a powerful, positive impact in medicine and society.

Philanthropic giving is a large component of the culture and economy

of the United States. According to Giving USA, in 2018, “Americans Gave $410.02 Billion to Charity in 2017, crossing the $400 Billion mark for the first time.” Philanthropy is also increasing each year. Total giving in 2017 increased 5.2 percent over 2016, continuing a trend of steady year-onyear increases. Seventy percent of this giving was by individuals.

Why Emergency Medicine?

Beyond the numbers, it is important to note that philanthropy is changing.

Younger donors want to be more directly involved in the causes they care about and this is driving a change in the way the entire donor base is thinking about their philanthropy. Historically, organizations were the gateway to “doing good.” A donor would write a check to an organization they liked and in return they would get some high-level reporting on how the money was spent. Today, donors are focusing more on the impact of their donations.

They are entrusting organizations with a valuable resource — either their time or their money. In return, they expect the recipients of their philanthropy to create maximum impact with their generous gifts. The new generation of donors may want to be more involved in the specific planning of how funds are used, and may expect regular accounting of the progress of a project.

Emergency medicine is the youngest major U.S. medical specialty; therefore, the majority of EM alumni are busy building their careers and their resources are going to family and other needs.

When it comes to grateful patients, emergency physicians will note that they may have saved the life of a potential donor who had cardiac arrest, sepsis, or major trauma, but due to the shorter time of interaction and the fact that very ill patients may be unconscious or not remember their emergency department (ED) experience, philanthropic gifts are more likely to go to the physicians who provide longer term care. However, if this conversation is flipped to focus instead on the incredible work that EM is doing, there is a really strong narrative around how emergency medicine is both improving lives in the present and helping to create a better future.

Emergency medicine (EM) has traditionally been underrepresented within the development community in health care due to some significant challenges relating to donors. Two of the most common donor profiles are alumni (for academic medical centers) and grateful patients (including family members).

Unlike 50 years ago, acutely ill or injured patients can go to an ED

"Philanthropy is about engaging people in an important topic that they are passionate about to improve lives today and to create a brighter future for all." almost anywhere in the country and receive excellent, lifesaving care from highly trained, experienced emergency physicians and staff. EDs have become the great crossroads of American medicine. Emergency medicine interfaces with prehospital care, inpatient care, and is the safety net for our communities — whether for mass casualty incidents or for the current, tragic opioid epidemic.

One of the best things to ask potential donors is to imagine for a moment, a community without an emergency care system: What would happen if you had an emergency medical situation? What would happen if the community had an emergency situation? In your crucial “golden hour” after an illness or injury who do you rely on? Having the right treatment, by the right person, at the right time is paramount to better outcomes for individuals and the community. This is the message that resonates with the public.

As EM continues to push the boundaries of what is possible, philanthropy can play a pivotal role. Other traditional sources of funding make it difficult to be innovative and daring. How do you fund that great idea that could have a huge impact but is deemed too early and too risky for federal funding?

Money from philanthropic sources can allow for the department to fund early stage research that government funding mechanisms deem “too risky.” Through this proof of concept, larger resources can then be unlocked, allowing us to try new things. As revenue from clinical operations and research sources become tighter and less predictable, philanthropy becomes more important. No other source of EM funding has the growth potential of philanthropic funding.

Due to its unique place in the hospital system, emergency medicine also plays an important role in breaking down silos within the medical community. The ED serves as the front door to the hospital; emergency physicians interact on a daily basis with all other parts of the system; therefore, the potential for collaborative care and collaborative philanthropy must be pursued.

Many of the key health care problems we

face are complex and require partnerships across departments, disciplines, and even outside the walls of our own institutions to move the needle toward solutions.

Ethical Questions EM is often referred to as the moral compass for medicine at large; this should also hold true for philanthropy in medicine.

As noted, philanthropy can be powerful force for good if is it done well and in the right way. A recent article in the NY Times highlighted the work that is being done around grateful-patient fundraising and raised some ethical question that surround this practice. Ethical concerns are also a major reason that physicians are reluctant to engage in philanthropic activities.

Emergency physicians do not want to be responsible for “the ask” of money from a grateful patient or family, but in reality, physicians are not expected to ask for funds; their role is to educate potential donors on the difference emergency medicine can make for individuals and communities in crisis. Only after a potential donor has received information and education, and an understanding relationship has been established, is it be appropriate to inquire if a person might consider supporting EM efforts. The final “ask” is best handled by a development expert, not by the physician.

Philanthropy is a voluntary decision, fueled by passion for a cause or entity.

The goal is not to coerce people into giving money— that is both unethical and unproductive. Our goal is to create real partnerships with people to help create positive change that is evident to the donor. When donors see their funding lead to significant achievements in clinical care, research, or education, they are joyous at the impact and often pledge to contribute more resources to the cause.

Physicians are good at medicine; development experts are good at philanthropy. It is critical for EM departments to form strong partnerships with development professionals in order to have success with philanthropy.

Lobbying the parent institution for a development professional who focuses

on emergency medicine may be the first step. Once the relationship is established, conversations need to occur that define roles and responsibilities as well to set clear guidelines around interactions with potential donors.

Looking Forward Just as emergency medicine was in a neophyte stage a few decades ago, we are just at the beginning of a journey to build a philanthropic culture for emergency medicine. There are many examples of EM having success with philanthropy, including endowed chairs and professorships, fellowships, research programs, and educational support. But we remain far behind most other specialties in making philanthropy a significant driver of our academic missions. The more we can collaborate in promoting philanthropy in emergency medicine, the more we can all succeed in creating impact in our local communities, nationally, and even globally.

ABOUT THE AUTHOR Henry Jewell is the assistant director of development, emergency medicine at the University of Michigan. He completed both a bachelor’s degree in marine geography from the University of Wales Cardiff and a masters’ degree in geography from George Washington University.

Henry has more than 12 years of experience in organizational management, strategic planning, and community engagement in non-profit and academic environments.

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EM CRITICAL CARE

Research at the Edge: An Interview With Dr. Kusum Mathews

SAEM PULSE | MAY-JUNE 2019

Kusum S. Mathews, MD, MPH, MSCR

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Dr. Kusum S. Mathews, MD, MPH, MSCR, is an adult intensivist and a health services researcher in the Division of Pulmonary, Critical Care, & Sleep Medicine and Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai. She received her MD and MPH from Tufts University School of Medicine and completed her internship and residency at Yale University School of Medicine (YSM)/ Yale-New Haven Hospital. Building upon quantitative training obtained

in her MPH, Dr. Mathews completed a clinical and T32-funded research PCCSM fellowship at Yale. She joined the faculty at Icahn School of Medicine at Mount Sinai (ISMMS) in 2013 and was granted a K-12 scholar position in the NHLBI-funded Mount Sinai Emergency Medicine Research Career Development Program for two years.

During her K12 scholar period, Dr. Mathews completed advanced research training at ISMMS with a Master’s of Science in Clinical Research degree. Dr. Mathews currently serves as an advisor/ consultant to the ISMMS Department of Scientific Computing and Mount Sinai Data Warehouse, collaborating with data analysts to create more dynamic tools and harness big data to address clinical research needs in emergency medicine and critical care. Dr. Mathews also serves as a coinvestigator for Mount Sinai on the NHLBI Prevention and Early Treatment of Acute Lung Injury (PETAL) Clinical Trials Network. Dr.

Mathews was the recipient of the 2016 American Thoracic Society Foundation Unrestricted Grant in Critical Care and is currently funded on an NHLBI K23 mentored research career development award, examining ICU triage decisions for critically ill emergency department patients in respiratory distress at the ED-ICU interface, using advanced mixed methods strategies and integrating innovative tools from business and computer science in clinical research.

What draws you to the interface between emergency medicine and critical care?

Throughout my residency, I was struck by the impact of health system operations on actual health care delivery. As an internal medicine (IM) resident, we rotated through the very busy, high-intensity section of the emergency department (“Major Med”)—an eye-opening experience about the struggles both emergency medicine (EM) and IM face with moving patients into the right bed

as quickly as possible. These inefficiencies became my research focus as I explored the field of health care operations and care transitions, especially the ED-ICU interface.

There are so many opportunities for both improved clinical practice and research innovation in this space, with direct effect on our patients’ care.

Are there unique challenges working at the interface between different departments?

Many of us trained during a time when there was significant “silo-ing” among departments and within subspecialties of critical care. Each department has its own resource limitations, and I’ve experienced clinical hiccups with transitions of care, conflicting approaches to clinical management, and even researchers working in parallel on similar topics.

I’m excited to see that the interactions between EM and ICU are evolving to where we are seeing far more interdisciplinary communication and collaboration. Having a dual appointment in both emergency medicine and internal medicine, as well as starting my time at Sinai on an EM-funded training grant, I have benefited from a more interconnected and collegial academic environment.

In terms of research at this interface, what is your specific focus?

My current research focuses on decision making and care delivery at the EDICU interface. Triage decisions around ICU admission for ED patients and the clinical decisions we make regarding management have profound implications for patient outcomes and utilization of ED and ICU resources, and variation in this decision exists beyond what is explained by patient-related factors and bed availability. My K23-funded research examines the interaction between subjective and objective factors on triage decision-making at the ED-ICU interface using a mixed methods approach, and develops a clinical decision support tool to aid in triage. I also study how we provide critical care services, both in terms of clinical management as well as models of care delivery, in the pre-ICU setting.

"I’m excited to see that the interactions between EM and ICU are evolving to where we are seeing far more interdisciplinary communication and collaboration."

Would you be interested in collaborating with other sites for your research?

Always! (Especially if you are on EPIC!)

What is your near-term and long-term aspirations for EM-CC?

We have already taken efforts to desilo critical care (e.g., interdisciplinary research training programs like K-12 EM programs, institutional CCM departments, and working groups like SAEM’s Critical Care Medicine Interest Group), but we are still crippled by departmental blockades and differing opinions on the “right” way to do this, as well as conflicting priorities of the key stakeholders. In an ideal world, critical care provision should be patient-focused. From the patient’s perspective, they are not focused on getting an ICU bed, per se; they demand, and have a right to, the best clinical care possible in whatever setting that might be and to whatever extent that the care is appropriate. It is up to clinicians and hospital leaders to ensure that the services provided are optimal and individual patient-centered, despite the constraints of an ever-changing health care system milieu. Near-term, I would

love to see more integrated clinical training for trainees interested in critical care medicine, with increased clinical and research job opportunities for those interested in working at the ED-ICU interface. Long-term, of course, I want to see more funding opportunities in health services research.

Any final advice to those interested in getting involved in EM-CC research?

Be persistent and be vocal in your interest. Find out who is working in the space at your institution, even if it means going outside your department. We welcome the help and collaboration!

ABOUT THE AUTHOR Jarone Lee, MD, MPH, is an associate professor at the Harvard Medical School and medical director of the Blake 12 ICU at Massachusetts General Hospital. He is a board member of the SAEM Critical Care Interest Group.

About the SAEM Critical Care Medicine Interest Group The mission of the Critical Care Medicine (CCM) Interest Group is to be a forum for academic physicians with specialized training or interest in critical care medicine to share their expertise and interests, mentor junior faculty members, advocate for our field, and enhance our knowledge via education and research. Joining the Critical Care Medicine IG is free. If you are an SAEM member and are interested in joining the CCMIG, simply log in to your member profile and click on the "Update (+/-) Academies and Interest Groups" button. SAEM members who are already part of the CCMIG can find more information and resources by visiting the SAEM CCMIG Community Site.

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BRIEFS AND BULLET POINTS

Newly elected SAEM leaders, L to R: James F. Holmes, Jr., MD, MPH; Amy H. Kaji, MD, PhD; Christopher R. Carpenter, MD, MSc; Michelle D. Lall, MD; Stephen C. Dorner, MD, MPH, MSS; Steven B. Bird, MD; Nikhil Goyal, MD; Kathy Hiller, MD, MPH

SAEM NEWS

Members-at-Large Christopher R. Carpenter, MD, MSc, Washington University in St. Louis School of Medicine

Elections are over, the results have been tabulated, and SAEM is pleased to present your leadership for 2019–2020.

Congratulations to the individuals whose names are shown in italic, who join their esteemed colleagues in the following leadership categories. The 2019–2020 SAEM leadership will take office at SAEM19 in Las Vegas.

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

Introducing Your 20192020 SAEM Leaders!

The Board of Directors of the Society

Michelle D. Lall, MD, Emory University Angela M. Mills, MD, Columbia University, Vagelos College of Physicians and Surgeons Megan L. Ranney, MD, MPH, Brown University Richard E. Wolfe, MD, Beth Israel Deaconess Medical Center/Harvard Medical School Resident Member Stephen C. Dorner, MD, MPH, MSS, Massachusetts General Hospital, Brigham and Women’s Hospital

The SAEM Nominating Committee Chair James F. Holmes, Jr., MD, MPH

SAEM Immediate Past President Steven B. Bird, MD Ian B.K. Martin, MD, MBA

President Ian B.K. Martin, MD, MBA, Medical College of Wisconsin President-Elect James F. Holmes, Jr., MD, MPH, University of California Davis Health System Secretary-Treasurer Amy H. Kaji, MD, PhD, Harbor-UCLA Medical Center Immediate Past President Steven B. Bird, MD, University of Massachusetts Medical School

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Elected Members Nikhil Goyal, MD Bernard L. Lopez, MD, MS Committee/Task Force Representative To be elected by the Board of Directors in 2019-2020 Past President Representative To be elected by the Board of Directors in 2019-2020

The SAEM Bylaws Committee Chair Jason Hoppe, DO Kathy Hiller, MD, MPH Louis J. Ling, MD

Academy Leaders

The following individuals were elected to their respective academy executive committees for the 2019–2020 term and will take office at SAEM19 in Las Vegas. For a full slate of each academy’s leadership, click the academy link.

Academy of Administrators in Academic Emergency Medicine (AAAEM) Treasurer Amy Jameson, MPhil, MA, MBA Members-at-Large Tim Sullivan, MHA David W. Calder, MBA Steven Camp Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) President-Elect Jeffrey Druck, MD Secretary-Treasurer Dawn Jung, MD Academy of Emergency Ultrasound (AEUS) President-Elect Rob Huang, MD Secretary Kristin Dwyer, MD Education Officer Elaine Situ-LaCasse, MD Academy of Geriatric Emergency Medicine (AGEM) President-Elect Shan Liu, MD, SD Secretary Lauren Cameron Comasco, MD Treasurer Scott Dresden, MD, MS Members-at-Large Elizabeth M. Goldberg, MD, ScM Kalpana Narayan Shankar, MD Resident Representative Natalie Elder, MD, PharmD

Medical Student Representative Allison G. Mohr Academy for Women in Academic Emergency Medicine (AWAEM) President-Elect Tracy Madsen, MD, ScM

Global Emergency Medicine Academy (GEMA) President-Elect Kelli O’Laughlin, MD, MPH

Vice President: Communications Michelle P. Lin, MD, MPH, MS

Treasurer Adam Aluisio, MD, MSc, DTM&H

Secretary Devjani Das, MD

Members-at-Large Naz Karim Sean Kivlehan, MD, MPH

President Michael D. Brown, MD, MSc, Michigan State University College of Human Medicine

Medical Student/Resident Representative Nehal Naik, MD

President-Elect Peter Sokolove, MD, University of California, San Francisco

Development & Grants Officer Saadiyah Bilal, MD, MPH

Secretary-Treasurer Deborah Diercks, MD, MSc, UT Southwestern Medical Center, Dallas

Treasurer Amy Zeidan, MD Resident Member Caitlin Ryus, MD, MPH Clerkship Directors in Emergency Medicine (CDEM) President-Elect Julianna Jung, MD, MEd

Secretary Shama Patel, MD, MPH

IT Chair Taylor Burkholder, MD, MPH

Treasurer Jessica Hernandez, MD, MEHP Members-at-Large Ryan McKenna, DO Nur-Ain Nadir, MD, MHPE

The AACEM Executive Committee

Secretary Sundip Patel, MD

SAEM Program Committee Liaison Jennifer A. Newberry, MD, JD, MSc

Immediate Past President Andrew S. Nugent, MD, University of Iowa Hospitals and Clinics

Treasurer Joseph B. House, MD

Simulation Academy President-Elect Michael Falk, MD

Members-at-Large Richard J. Hamilton, MD, Drexel University College of Medicine

Secretary Ambrose H Wong, MD, MSEd

Lewis S. Nelson, MD, Rutgers New Jersey Medical School

Members-at-Large Sharon Bord, MD Gregory Suares, MD

The 2019–2020 RAMS Board President Nehal Naik, MD, George Washington University Secretary-Treasurer Andrew Starnes, MD, MPH, Wake Forest School of Medicine Immediate Past President Chad L. Mayer, MD, PhD, The Ohio State University Wexner Medical Center

Nehal Naik, MD

Christine T. Luo, MD, PhD

Andrew Starnes, MD, MPH

Jeff Sakamoto, MD

Members-at-Large Chris Counts, MSc, Johns Hopkins Medicine John J. Hurley, MD, Brody School of Medicine at East Carolina University James Li, MD, University of Cincinnati Emergency Medicine Christine T. Luo, MD, PhD, The Ohio State University Jeff Sakamoto, MD, Stanford-Kaiser Emergency Medicine Residency Program

Members-at-Large Wendy W. Sun, MD, Virginia Commonwealth University Amanda L. Ventura, MD, University of Cincinnati Medical Student Representatives Fola Omofoye, University of North Carolina School of Medicine Shana Zucker, Tulane University School of Medicine

Chad L. Mayer, MD, PhD

Chris Counts, MSc

John J. Hurley, MD

James Li, MD

Wendy W. Sun, MD

Amanda L. Ventura, MD

Fola Omofoye

Shana Zucker

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SAEM RAMS

New Series Features Leading Figures in Academic EM

Dr. Amal Mattu, MD, vice chair of education, director of the Faculty Development Fellowship and co-director of the Emergency Amal Mattu, MD Cardiology Fellowship at the University of Maryland is the featured guest in the first episode of a new SAEM RAMS podcast series, “Who’s Who In Academic Emergency Medicine.” Dr. Mattu is a leading voice in emergency cardiology. He has lectured and run workshops on advanced ECG interpretation, written two case books on advanced electrocardiogram interpretation, and is the founder of ecgweekly.com.

New Ask-a-Chair Podcast Spotlights Dr. Deb Diercks The newest RAMS Ask-a-Chair podcast features Deborah Diercks, MD, professor and chair of the department of emergency medicine Deborah Diercks, MD at UT Southwestern Medical Center, who dishes out advice for women struggling to find their footing in a male-dominated EM administrative world, discusses how her first job prepared her for the rest of her career, and more!

SAEM ACADEMIES ADIEM

Advisory Council on Equity, Diversity and Inclusion Team

SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) Is proud to announce the launch of the Advisory Council on Equity, Diversity and Inclusion Team (ACEDIT). This resource provides residencies, hospitals, and other community organizations with a list of experts who are available to speak on specific topics such as racism in medicine, microaggressions, implicit bias, gender equity, LGBT and transgender health, and more. Visit the webpage for a full list of available topics and speakers.

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AWAEM

AWAEM-FemInEM Anniversary Podcast Features Women Leaders in Academic EM

The first episode of the AWAEM-FemInEM podcast series, “Anniversary Interviews: 10 Years of Progress,” features Kathy Clem, MD, a pioneer of emergency medicine and the first female division chief in the department of surgery as well as the first chair of the academic department of emergency medicine at Duke. In the second episode, Sheryl Heron, MD, professor and associate dean at Emory University, talks about the intersection of AWAEM and ADIEM (Academy for Diversity and Inclusion in Emergency Medicine). The third podcast is an interview with Michelle Lall, MD, current president of AWAEM and the associate residency director and associate professor at Emory University.

Dr. Lall talks about how critical AWAEM has been to her career and how 10 years ago, when AWAEM began, she wouldn’t even have called herself a feminist…and what changed her mind. In the fourth, and most recent podcast, Tracy Sanson, MD, a consultant and educator on leadership development and medical education, gives advice about why you should work harder on yourself than you do at your job and the importance of not doing it alone. The podcast series celebrates the 10th anniversary of SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM) and is a joint venture with FeminEM.

CDEM

The latest Faculty Highlight from SAEM’s Clerkship Directors in Emergency Medicine (CDEM) Academy, features Mark D. Levine, MD, associate Mark D. Levine, MD professor of emergency medicine and medical student education course director at the Washington University and assistant medical director of the St. Louis Fire Department. Dr. Levine offers his advice to clerkship directors and shares his most memorable moments of teaching, biggest influences, and an interesting “factoid” or two about himself.

AAAEM

Schuelen, Schmitz, and Archual are Named Award Recipients James J. Scheulen, PA, MBA, has been named as the recipient of AAAEM’s

Lifetime Achievement Award for his outstanding work as a founding member and past president of AAAEM and for his unparalleled James J. Scheulen, PA, MBA work in leading the Benchmark and related surveys, increasing AAAEM’s visibility within SAEM, and facilitating the merger with the AACEM on joint collaboration around academic emergency medicine key data and information. Scheulen is the Chief Administrative Officer for Emergency Medicine and Capacity Management for Johns Hopkins Medicine and the founder of the Johns Hopkins Access Line and Johns Hopkins Lifeline critical care transportation service. He is a founding member of the Academy of Administrators in Academic Emergency Medicine.

Travis Schmitz, PhD, MBA, has been named the recipient of the AAAEM Annual Achievement Award for taking on co-leadership of CAEMA, being an Travis Schmitz, PhD, MBA active member of the Benchmark committee and a thought leader in emergency medicine, as well his general guidance and support for membership development. Schmitz is the department administrator for emergency medicine at Northwestern Memorial HealthCare and Northwestern University’s Feinberg School of Medicine. Travis also serves as the director of operations for the Office of the Chief Medical Officer for the healthcare system. Starting in 2019, Travis will join Kirsten Rounds, creator of the CAEMA program, to co-direct the Certificate in Academic Emergency Medicine Administration program.

Greg Archual, MBA, has been named as the recipient of the AAAEM Significant Contributions Annual Award for his development Greg Archual, MBA and advocacy of the academy, including development of the Member Assistance Program (MAP) and new membership categories, and the reestablishment of the AAAEM Insight newsletter. Archual is the chief operating officer and administrator of the Department of Emergency Medicine at

The Ohio State University. In 2018, he also was a member of the first AAAEM CAEMA graduating class. He is currently Immediate past president of AAAEM and is faculty for the CAEMA program.

SAEM INTEREST GROUPS Critical Care IG

The SAEM Critical Care Interest Group (CCM IG) supports a forum for academic physicians with specialized training or interest in critical care medicine to share their expertise, advocate for our field, and enhance our knowledge via education and research. The CCM IG has the pleasure of sponsoring the didactic Downstairs, Upstairs, and Beyond: Conducting Transdisciplinary Research at the ED-ICU Interface at SAEM19 at the Mirage Las Vegas.

Please join us for this important discussion on Thursday, May 16, 10–10:50 a.m., Bermuda A. The CCM IG’s annual meeting will be held Friday May 17, 10–10:50 a.m., Barbados A. Please join us for a report of the CCM IG’s activities, announcement of newly elected officers, and a lively Q&A with a career panel of experienced emergency medicine intensivists.

We look forward to seeing you in Las Vegas! For more information about our interest group, please contact John Arbo, MD at arboj1@nychhc.org

SAEM COMMITTEES Fellowship Approval Committee

Dr. Anna Marie Chang is a Fellowship Approval Committee “Success Story”

Anna Marie Chang, MD, is next in a series of Success Stories from graduated fellows, sponsored by SAEM’s Fellowship Approval Committee.

Anna Marie Chang, MD If you’re interested in becoming a Research Fellow, check out the advice from Dr. Chang, a research fellow and associate professor at Thomas Jefferson University, who shares insights from her own experience doing an international emergency medicine

fellowship, including the most careerenhancing thing she learned.

Research Committee A New Podcast for Researchers: Exception From Informed Consent

In the newest podcast episode from the SAEM Research Learning Series (RLS), Dr. Jill Baren from the Perelman School of Medicine Jill Baren, MD at the University of Pennsylvania, discusses the hot topic of how to conduct emergency research under the domain known as “Exception From Informed Consent,” or “EFIC,” for short. Provided in partnership with Academic Life in Emergency Medicine (ALiEM), the SAEM Research Learning Series provides live, online education on popular emergency medicine research topics.

SAEM JOURNALS AEM Education and Training

Dr. Fujimoto Selected for Fellowin-Training Program

Jessica Fujimoto, MD, chief resident in the department of emergency medicine at Temple University Hospital, has been selected for the Jessica Fujimoto, MD Fellow-in-Training Editor Program for AEM Education and Training (AEM E&T) journal. The fellow appointment to the editorial board of AEM E&T is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts.

Congratulations Dr. Fujimoto!

Now Available for Download on the Google Play Store: The New AEM Education & Training Mobile App! AEM Education and Training is now available on your tablet and phone.

Download the app today and keep up to date with the latest AEM E&T content, anytime, anywhere: • Receive alerts when new issues are available (opt in) • Download articles and issues for offline perusal

Congratulations to the 2018 AEM and AEM E&T Outstanding Reviewers!

The Outstanding Peer Reviewer designation is given annually to peer reviewers who meet a set of predetermined criteria for excellent performance. Peer reviewers are essential to presenting the highquality, original research and academic contributions that fill the pages of Academic Emergency Medicine (AEM) and AEM Education and Training (AEM E&T) each issue.

We appreciate all of our AEM and AEM E&T peer reviewers and are especially grateful to these Outstanding Reviewers for their dedicated, conscientious, and exceptional service to AEM and AEM E&T in 2018 in contributing timely, rigorous, and thoughtful peer reviews.

Academic Emergency Medicine • Jane Brice, MD, MPH • Edward J. Brizendine, MS • Brian Driver, MD • Elizabeth Goldberg, MD • Jeffrey Hom, MD • Seth Kunen, PhD, PsyD • Jennifer Martindale, MD • Brandon Maughan, MD • William Meurer, MD • Michael Puskarich, MD • Jill Stoltzfus, PhD Academic Emergency Medicine Education and Training • William Bond, MD • Holly Caretta-Weyer, MD • Joshua Davis, MD • Douglas Franzen, MD, MEd • Michael Gottlieb, MD • Nikhil Goyal, MD • Phillip Harter, MD • Ryan Pedigo, MD • Dina Wallin, MD • Save your favorite articles for quick and easy access • Full screen figure and table viewer • Access your personal or institutional subscription

Call for Papers: AEM E&T Annual Meeting Proceedings Issue AEM Education and Training (AEM E&T) invites submissions from SAEM

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academies, committees, and interest groups for a special issue of the journal that will publish in early 2020 and will highlight the proceedings from the 2019 SAEM annual meeting relevant to education and training. Details and submission instructions can be found online. Deadline is August 31, 2019.

Editor Promes Chooses “Empathy” Paper for April Pick

Academic Emergency Medicine Education and Training (AEM E&T) Editor Susan Promes, MD, selected Coming in Warm: Qualitative Study and Concept Map to Cultivate Patient-Centered Empathy in Emergency Care, by Dr. Katie Pettit, et al, as her editor pick for the April issue of the journal. Read Dr. Promes’s commentary. Download a full PDF of the April issue of AEM E&T or read it online.

Academic Emergency Medicine Drs. Kuhn and Lupton Appointed as Resident Editors to Editorial Board for 2019-2020

Diane Kuhn, MD

Joshua Lupton, MD

Diane Kuhn, MD, University of Maryland and Joshua Lupton, MD, Oregon Health & Science University have been selected for the AEM “Resident Member of the Editorial Board” program for the 2019-2020 term.

The resident-in-training appointment to the AEM editorial board provides an introduction to the process of peer review, editing, and publishing of medical research manuscripts. The resident appointment begins each year at the SAEM annual meeting and runs for 12 months.

Drs. Meisel and Quest Named to the AEM Senior Editorial Board

AEM Editor-in-Chief, Jeffrey Kline, MD, announced the following appointments to the AEM Senior Editorial Board: Zachary F. Meisel, MD, MD MPH MSHP, University of Pennsylvania, Senior Associate Editor for Health Communication Tammie E. Quest, MD, Emory University, Senior Associate Editor for Palliative Care

Special Issue Publishes in March: “Influence of Gender on the Profession of Emergency Medicine” The March issue of Academic Emergency Medicine, Influence of Gender on the Profession of Emergency Medicine, was dedicated to the careers of women in academic emergency medicine and focused on the role of biological sex and female gender identity with respect to professional advancement, scholarly opportunities, practice environment, work satisfaction, salary, and burnout.

The issue included papers that highlight progress that is needed to solve the issues of equal pay and advancement for equal work; explore positive steps being made in the areas of child care and family leave; and describe the value and power of women’s professional networks. In a corresponding AEM podcast, She Works Hard for the Money - Time’s Up in Healthcare, Dr. Esther Choo, a guest editor for the special issue, and a nationally-recognized expert in gender bias in medicine, discusses one study that shows a persistence of gender-based salary and rank disparities in academic emergency medicine. In a second podcast, lead author Chris Bennett, MD, discusses a study that found that female academic EM physicians are less likely than their male counterparts to hold the rank of full professor.

Editor-in-Chief Announces April Pick of the Month

Academic Emergency Medicine (AEM) Editor-in-Chief, Jeffrey A. Kline, MD, selected Randomized Clinical Trial Comparing Procedural Amnesia and Respiratory Depression Between Moderate and Deep Sedation With Propofol in the Emergency Department as his pick of the month for April 2019.

Read EIC Kline’s commentary, “Safer.”

Add These April Journal Podcasts to Your Listening Lineup Zachary F. Meisel, MD

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Tammie E. Quest, MD

AEM journal podcasts cut down on knowledge translation by providing

top-quality audio content, with links to accompanying articles. All SAEM podcasts, including journal podcasts, are also available on iTunes

Blue Monday- Screening Adult ED Patients for Risk for Future Suicidality Original AEM Journal Research

Comparing Procedural Amnesia and Respiratory Depression Between Moderate and Deep Sedation with Propofol in the ED Original AEM Journal Research

IN OTHER NEWS Farewell to the Emergency Care Translational Research Collaborative

After more than six years and an impressive track record of grants and publications as a result of networked research the 53-site Emergency Care Translational Research Collaborative (ECTRC) is ending. Begun in 2013, as a grassroots a voluntary research effort to integrate emergency care research into the more formalized structure of the Clinical and Translational Science Awards (CTSA) network, the ECTRC formed partnerships with CTSAs that advance translational science and to both utilize and contribute to CTSA resources. The ECTRC also provided a multi-site structure for emergency care research, as well as opportunities for young investigators to learn and perform multi-site science. The ECTRC was productive: 14 grants (including 3 x R01s, R24, K23, T32, and F32) and 32 research publications (see attached).

Since 2013, the field of emergency care research has progressed. There are now multiple networks focused on emergency care research and many others created for specific projects.

Multi-site research is now the norm.

CTSAs have since developed the Trial Innovation Network (TIN), in which several of ECTRC members have pursued emergency care projects. There is no longer the same need and niche for ECTRC to fill. For these reasons, ECTRC leaders felt the time was right time to sunset the Collaborative.

Although the ECTRC was not a standalone SAEM activity, it was led by SAEM research leaders. To them, and to all of the members of the ECTRC, SAEM says, “Well done!”

SAEM REGIONAL MEETINGS New England (NERDS) Regional Meeting

The 23rd annual New England Regional Meeting, “EM New England Research Showcased,” hosted by Boston Medical Center/Boston University School of Medicine, took place March 27 in Worcester, MA. This was the largest New England Regional Meeting to date, with more than 370 participants in attendance and a total of 130 abstracts presented.

MHS, Yale School of Medicine. His story, as well as the results of his research, delivered a sobering message about how much work still remains to create a truly diverse physician workforce. After Dr. Boatright’s speech, participants beseiged him with requests for autographs, selfies, and advice about how to make their own programs more effective in this arena.

SAEM board member, Ali Raja, MD, MBA, MPH, Massachusetts General Hospital/Harvard Medical School, opened the day with a BOD update, a chronicle of how SAEM has impacted his career, and a convincing rendition of “What can SAEM do for you?” His inspired audience members were filling out membership forms from their seats.

One investigator from each of the 10 emergency medicine academic institutions in New England gave a plenary oral presentation and answered hard-hitting questions from the audience.

A total of 83 lightning oral and 37 poster presentations were also provided from medical students, residents, and faculty.

Representatives from SAEM’s Academy of Women in Academic Emergency Medicine (AWAEM) led a lunch workshop: “Time Management Toolkit.”

The keynote address, “The State of Diversity in the Physician Workplace,” was presented by Dowin Boatright, MD, MBA,

Western Regional Meeting disaster medicine experience by Austin Johnson, MD, PhD, and “The Value of Scholarship in Residency” by current SAEM President Steve Bird, MD. The plenary abstract session included seven of the meeting’s most outstanding abstracts. Many participants additionally took advantage of an advanced airway management session offered to those arriving early.

The 22nd Annual SAEM Western Regional Meeting, hosted by the University of California, Davis, was held March 21-22, 2019 in Napa, California.

The event hosted more than 225 participants, and 133 abstracts were presented over the two-day conference.

Day one was highlighted by the keynote address “Wellness in Academic Emergency Medicine: Is the Truth Out There?” presented by Andra Blomkalns, MD. Dr. Blomkalns asked “What is wellness in academic emergency medicine?” and highlighted areas that both detract from and contribute to wellness in our lives. Additional day one presentations included a personal

The outstanding presentations continued on day two and included highlights from recent important articles in both pediatric and social emergency medicine, care of LGBQTI patients in the emergency department, and exercise in medicine. The education plenary was a thought-provoking presentation by Michael Gisondi, MD on “The Future of Emergency Medicine Education.”

A conference highlight for many of the medical students and residents was The Western SAEM Challenge, featuring teams from across the western region testing their skills in a unique format that blended simulation, ultrasound, and toxicology. The top two teams (UC Davis and Stanford) from the morning session competed in the afternoon championships ultimately won

by Stanford. Abstract presentations

continued throughout the day with awards to the following presenters: • Most Outstanding Research Abstract to Nick M. Levin, MD, University of Utah for “Changes in Patients’ MEWS Scores while in the ED Predict Mortality, ICU Admission and LOS” • Best Young Investigator/Fellow Abstract to Tiffany Abramson MD, USC for “Recognition of Active Pediatric Seizures: Prehospital Provider Sensitivity and Specificity” • Best Resident Research Abstract to Christopher Winstead-Derlaga MD MPH Stanford University for “Novel Day of Ascent Dosing of Acetazolamide for Prevention of Acute Mountain Sickness” • Best Medical Student Research Abstract to Scott Casey, Albert Einstein College of Medicine for “Reclassification With a High-Sensitivity Cardiac Troponin Assay” Abstracts from the meeting can be accessed on the SAEM Western Regional webpage. For summaries and highlights of talks and events from the SAEM Western Regional, listen to wrapup episodes by EM Pulse Podcast.

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ACADEMIC ANNOUNCEMENTS Brown University

Rush University

Megan Ranney, MD, an associate professor at The Warren Alpert Medical School, Brown University and a nationally known gun safety advocate, was named the Rhode Island Medical Womenâ&#x20AC;&#x2122;s Association Woman Physician of the Year for excellence Megan Ranney, MD in the field of medicine along with outstanding community involvement. Dr. Ranney serves as chief researcher and co-founder of The American Foundation for Firearm Injury Reduction in Medicine, and was appointed by Gov. Gina M. Raimondo to co-chair the Governorâ&#x20AC;&#x2122;s Gun Safety Work Group. She is also a member of the SAEM Board of Directors.

Tarlan Hedayati, MD, an assistant professor at Rush University School of Medicine, was recently appointed division chair of education in the Department of Emergency Medicine at Cook County Health (CCH). In her role she oversees, develops, and promotes Tarlan Hedayati, MD innovation of all educational programs for the Department of Emergency Medicine at CCH, which includes resident, fellow, medical student, physician assistant, and nursing education.

Harvard Medical School Ali Raja, MD, MBA, MPH, associate professor, and executive vice-chair of the Department of Emergency Medicine Harvard Medical School, MassGen, has been selected as the new editorin-chief of The New England Journal Ali Raja, MD, MBA, MPH of Medicine Journal Watch Emergency Medicine. NEJM Journal Watch is used by practicing clinicians to stay informed and current in their fields. With over 500,000 monthly readers from 178 countries, NEJM Journal Watch summarizes and puts into perspective the most important research, medical news, drug information, public health alerts, and guidelines across 12 specialties. Dr. Raja is a 2018-19 member of the SAEM Board of Directors.

Michael Schindlbeck, MD, an assistant professor at Rush University School of Medicine, was recently promoted to the position of program director for the emergency medicine residency program at Cook County Health, a PGY1-4 program with 68 residents.

Michael Schindlbeck, MD Dr. Schindlbeck is a graduate of this residency program where he served as a Chief Resident and most recently as an Assistant Program Director.

University of Queensland-Ochsner Mike Smith, MD, the founding director of the Ochsner Clinical Simulation and Patient Safety Center, was recently promoted to professor of emergency medicine at University of QueenslandOchsner Clinical School and runs the emergency medicine course for Mike Smith, MD Ochsner-UQ students. He was also honored as a Distinguished Educator in Emergency Medicine by the Academy of Scholars for CORD.

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 June 1, 2019 for the July/August 2019 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 June 1.

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

POST-ARREST CARE AND TARGETED TEMPERATURE MANAGEMENT A PRACTICAL TRAINING COURSE FOR HEALTH CARE PROVIDERS

JUNE 21-22, 2019

Law Auditorium | Jordan Medical Education Center at Penn Medicine 3400 Civic Center Blvd., Philadelphia, PA 19104

CME/CE-ACCREDITED CONFERENCE

The purpose of this educational activity is to educate relevant care providers on emergency care of cardiac arrest patients, most specifically to teach about postarrest care, including the use of targeted temperature management, cardiac catheterization, internal cardiac defibrillator (ICD) consideration and advanced ICU care. In addition to scholarly presentations and discussions, a key goal is to help each attendee discover an integrated, multidisciplinary system of both cardiac arrest and post-cardiac arrest care, through hands-on experience with cardiac arrest scenarios and exploration of various protocols currently being used around the country. By the conclusion of the course, each attendee will have a firm grasp of developing and implementing a comprehensive in-hospital high quality post-arrest care resuscitation program. This conference is designed to meet the educational needs of physicians, advance practice providers, physician assistants, nurses, residents, fellows and students specializing in or with interest in the evaluation and management of targeted temperature management.

FOR MORE INFORMATION: 215-898-6400 or 215-898-8005 | penncme@pennmedicine.upenn.edu https://upenn.cloud-cme.com/ttm2019

ACCREDITATION In support of improving patient care, Penn Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

DESIGNATION OF CREDIT Physicians: Penn Medicine designates this live activity for a maximum of 15.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 15.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Nurses: This program provides 15.0 contact hours.

Physician Assistants: AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 15.0 Category 1 credits for completing this activity.

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EMERGENCY MEDICINE PHYSICIAN at Level 1 Trauma Center, SYRACUSE, NY Exceptional opportunities for EM trained physicians interested in an academic career. Clinical responsibilities include patient care and attending supervision in EDâ&#x20AC;&#x2122;s at Upstate University Hospital adult and pediatric areas, Community Campus Hospital and the VA hospital. Protected academic time includes teaching and scholarly activity. Upstate University Hospitals are 750 beds, including Level 1 Trauma Center, Burn Center and Childrenâ&#x20AC;&#x2122;s hospital. Department activities include: EM Residency Program, Poison Control Center, Hyperbaric Medicine and Wound Care Center; Fellowships in Pediatric EM, EMS, Hyperbaric Medicine, Medical Toxicology and Ultrasound; Simulation Training/Research Center; Paramedic Training Program; EMS Physician Response Team and Flight Program. EM offers an excellent compensation and benefit package, including relocation expenses. Protected time is also provided for research and academic missions. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran status or disability. Candidates are invited to send a letter of interest, CV, and the names of 3 references to: Gary Johnson, MD, Chair, Department of Emergency Medicine Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210 Office: 315-464-9500 or Fax: 315-464-9501 http://upstate.edu/emergency

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

Full-Time Faculty Full-time faculty are currently being recruited for Administration, Research and Ultrasound.

Fellowship Openings are available in the areas of Administrative leadership, Education, Geriatrics, Research, Global Health and Ultrasound. Successful applicants will be Board Certified/Board Prepared in Emergency Medicine. UNC Hospitals is a 750-bed Level I Trauma Center. The Emergency Department sees upward of 69,000 high acuity patients per year.

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

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

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

Advancing the Science and Practice of Emergency Medicine Advancing the Science and Practice of Emergency Medicine The Department of Emergency Medicine at the Yale University School of Medicine has a total of 4 clinical sites: The Department of Emergency Medicine at the Yale University School of Medicine has a total of 4 clinical sites: Adult Emergency Services at York Street Campus; Shoreline Medical Center; Saint Raphael’s Campus; and the West Adult Emergency Services at York Street Campus; Shoreline Medical Center; Saint Raphael’s Campus; and the West Haven VA Emergency Department with a combined ED volume of 195,000 visits per year. We are seeking faculty at all Haven VA Emergency Department with a combined ED volume of 195,000 visits per year. We are seeking faculty at all ranks (Clinician, Assistant Professor,etc.) etc.)with withinterests interestsininclinical clinical care, education ranks (Clinician, AssistantProfessor, Professor,Associate Associate Professor, Professor, Professor, care, education or or research to enhance our existing strengths.

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

The successful research to enhance our existing strengths. Interest and/or experience in observation medicine is a plus. The successful candidate may bebea full-time in patient patientcare careand andemergency emergencymedicine medicine education or one candidate may a full-timeclinician cliniciancommitted committed to to excellence excellence in education or one thatthat would want totojoin scholarshipto toenhance enhancethe thefield fieldofofemergency emergency medicine. offer would want jointhe theacademic academicfaculty facultypromoting promoting scholarship medicine.

WeWe offer an an extensive faculty more senior seniorfaculty. faculty. We Wehave havea awell-established well-established track record extensive facultydevelopment developmentprogram programfor for junior junior and and more track record of of interdisciplinary collaboration obtainingfederal federaland andprivate privatefoundation foundation funding, interdisciplinary collaborationwith withother otherrenowned renowned faculty, faculty, obtaining funding, andand a a mature research infrastructure Director,aastaff staffofofresearch researchassociates associates and administrative mature research infrastructuresupported supportedby byaa faculty faculty Research Research Director, and administrative assistants. assistants.

Eligible candidatesmust mustbeberesidency-trained residency-trained and and board-certified/-prepared board-certified/-prepared ininemergency protected time Eligible candidates emergencymedicine. medicine.Rank, Rank, protected time salary will commensuratewith witheducation, education, training training and andand salary will bebecommensurate and experience. experience.

Yale University a world-classinstitution institutionproviding providing aa wide wide array Yale University is isa world-class array of ofbenefits benefitsand andresearch researchopportunities. opportunities. apply, please visit:http://apply.interfolio.com/52744 http://apply.interfolio.com/52744 to inquiries about thethe ToTo apply, please visit: to upload upload your yourCV CVand andcover coverletter. letter.Specific Specific inquiries about position may be sent to the Chair: Gail D’Onofrio, MD, MS, via email: jamie.petrone@yale.edu. position may be sent to the Chair: Gail D’Onofrio, MD, MS, via email: jamie.petrone@yale.edu.

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

The University of Washington School of Medicine Department of Emergency Medicine seeks a Medical Director The University of Washington (UW) School of Medicine, Department of Emergency Medicine (DEM) is seeking a Medical Director for the University of Washington Medical Center (UWMC) Northwest Hospital (NWH) Campus Emergency Department (ED). The UWMC-NWH is a community hospital, serves as a Level 4 Trauma Center, a Primary Stroke and Cardiac Center, with an annual patient volume of 35,000. The Department of Emergency Medicine encompasses the UWMC main, the UWMC-NWH, and the Harborview Medical Center EDs. This position will join a broader team of operational and quality improvement directors that spans the three EDs of the three medical centers with opportunity to additionally participate in the teaching and research mission of the DEM and the UW Medicine healthcare system. The position holds tremendous opportunity for growth and program development.

The UW DEM supports a 4-year Emergency Medicine Residency Program and several fellowships.

This is a full-time position that would serve at the rank of Assistant Professor, Associate Professor, or Full Professor, commensurate with experience. Candidates for this position must hold an M.D. degree. Candidate should possess or be eligible for full medical licensure in Washington State. Must be board prepared/eligible in Emergency Medicine.

For consideration, please send your CV and cover letter to: Dr. Susan Stern, Professor and Chair, Department of Emergency Medicine at sstern@uw.edu or call 206-744-2122 for questions.

The UW is building a culturally diverse faculty and strongly encourages applications from women and minority candidates. The University is an Equal Opportunity/Affirmative Action employer.

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The University of California, Davis, School of Medicine, Department of Emergency Medicine is conducting a faculty search for five emergency medicine physicians as Assistant/Associate/Full Professors in either a (HSCP) clinician/educator or (Clin X) clinician/researcher track. Commensurate with experience and credentials.

Requirements include M.D. degree or equivalent, Board Certification or eligibility in Emergency Medicine, valid CA Medical License or eligibility for licensure, experience teaching medical students, residents, and fellows, the ability to work cooperatively and collegially within a diverse environment, and the ability to adhere to policies and procedures. Fellowship training with at least one year of posttraining clinical experience is desired. We especially welcome applicants whose research, teaching, and community outreach demonstrably attest to their commitment to inclusion of under-represented and/or non-majority individuals into their respective area of specialization within their discipline.

The Emergency Department provides comprehensive emergency services to a large local urban and referral population as a Level One Trauma Center, paramedic base station, and training center. The fully accredited residency training program in Emergency Medicine at UC Davis Medical Center began more than a decade ago and currently has 40 residents. All faculty members are required to provide both bedside and didactic teaching to residents, medical students, and others rotating through the Emergency Department. The successful candidate will show a commitment to educating and mentoring a diverse student body to expand opportunities and enhance personal growth, retention, and academic success.

For full consideration, applications must be received by April 30, 2019; however, the position will remain open until filled through June 30, 2019. To apply please upload the following: letter of interest, curriculum vitae, and a statement of contributions to diversity to: https://recruit.ucdavis.edu/apply/ JPF02773. All files should be in PDF format.

This position may, at times, require the incumbent to work with or be in areas where hazardous materials and/or infectious diseases are present. Specific hazards of the position may include, but are not limited to, treating Hepatitis B patients, HIV patients, other infectious diseases, and also patients who may inflict physical harm.

UC Davis commits to inclusion excellence by advancing equity, diversity and inclusion in all that we do. We are an Affirmative Action/Equal Opportunity employer, and particularly encourage applications from members of historically underrepresented racial/ethnic groups, women, individuals with disabilities, veterans, LGBTQ community members, and others who demonstrate the ability to help us achieve our vision of a diverse and inclusive community.

Under Federal law, the University of California may employ only individuals who are legally able to work in the United States as established by providing documents as specified in the Immigration Reform and Control Act of 1986. Certain UCD positions funded by federal contracts or sub-contracts require the selected candidate to pass an E-Verify check. More information is available at http://www.uscis.gov/e-verify.

UC Davis is a smoke & tobacco-free campus (http://breathefree.ucdavis.edu/). If you need accommodation due to a disability, please contact the recruiting department. For additional information: Erik Laurin, M.D., Professor and Search Committee Chair (eglaurin@ucdavis.edu) UC Davis Department of Emergency Medicine 2315 Stockton Blvd., PSSB 2100, Sacramento, CA 95817

Mount Sinai Health System - New York Residency Program Director - Emergency Medicine The Mount Sinai Health System is an integrated health care system providing exceptional medical care to our local and global communities. The Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai is committed to excellence in emergency clinical care, education, and research. Providing exceptional emergency care to all patients, of all ages, we use an integrated approach that maximizes the resources of the Mount Sinai Health System in order to meet the individual needs of our patients and their families. Our Department is one of the largest in the country, affiliated with Elmhurst Hospital Center, trauma center & part of NYCâ&#x20AC;&#x2122;s public health system.

Mount Sinai Hospital has an amazing Residency Program Director Opportunity available. We are looking for a talented Emergency Medicine Provider that can continue leading our growing residency program. The Mount Sinai Emergency Medicine Residency is recruiting a new Program Director for its PGY- 4 Program. Based in Manhattan, the program is expanding and approved for 100 trainees making it one of the largest residencies in the country. Its three training sites, Mount Sinai Hospital, Elmhurst Hospital Center, and Mount Sinai Beth Israel Hospital provide an unparalleled training experience bridging the unique urban landscape of New York City. Well established with a mature and productive core faculty, the residency has a tradition of clinical, research, and academic excellence. The program has an impressive track record in recruiting and developing leaders of emergency medicine. The Department has a strong commitment to faculty development; over half of the 46 faculty on the main campus have reached the associate or full professor level; the Department had 156 publications last year, 39 book chapters, and 45 abstracts.

The research division is ranked #3 in the country in NIH funding; the medical student clerkship is ranked #1 in the medical school by the medical students. There are established fellowships in Simulation, Education, Ultrasound, Research, Informatics, and Pediatrics. The Department is fully integrated into the medical school curriculum and hospital leadership; there is strong participation of residents on a number of committees at both the local and national level. Associate and Assistant PDs are outstanding and the residency support staff is experienced and excellent.

Salary and benefits are highly competitive.

For more information contact Andy Jagoda, MD, System Chair of Emergency Medicine, at 212 824-8050 or andy.jagoda@mssm.edu. Mount Sinai is an Affirmative Action, Equal Opportunity Employer. For more information visit: https://icahn.mssm.edu/education/residencies-fellowships/list/msh-emergency-residency and https://icahn.mssm.edu/about/departments/emergency-medicine How to Apply: Please send your Cover Letter and CV directly to Andy Jagoda at Andy.Jagoda@mssm.edu and Veronica Fernandez at Veronica.Fernandez@mountsinai.org

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

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

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

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

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

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

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

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Yale University School of Medicine Department of Emergency Medicine Fellowship Programs For specific information including deadlines and requirements, visit: http://medicine.yale.edu/emergencymed/ The Implementation Science fellowship is a 2-3 year program that will train investigators in the principles and practice of dissemination and implementation science. Supported by a K12 grant from NIH’s National Heart, Lung, and Blood Institute, fellows will receive training at the new Yale Center for Implementation Science (YCIS), the Yale Center for Clinical Investigation, and the National Clinician Scholars Program. Eligible candidates may receive a Masters in Health Sciences degree. Mentors come from the Yale Schools of Medicine, Nursing, and Public Health, as well as many community-based organizations in New Haven. For further information, contact Steven L. Bernstein, MD, steven.bernstein@yale.edu.

The Research fellowship is a 2-3 year program focused on training clinician scholars as independent researchers in Emergency Medicine. Scholars will earn a Master of Health Sciences degree from Yale combining clinical experience with extensive training in research methods, statistics, and research design. With the guidance of research content experts and professional coach mentors, the scholar will develop a research program, complete a publishable project and submit a grant application prior to completion of the program. The program is credentialed by the Society for Academic Emergency Medicine. For further information, contact Steven L. Bernstein, MD, steven.bernstein@yale.edu.

The Yale Drug use, Addiction, and HIV Research Scholars (DAHRS) Mentored Career Development Program (NIDA K12) provides a 3 year post-doctoral interdisciplinary, research training experience preparing investigators for careers focusing on drug use, addiction, and HIV prevention and treatment in general medical settings. Scholars earn the Master in Health Sciences degree that combines vigorous research methodology, statistics and design didactics in small group sessions and seminars covering topics related to drug use, addiction and HIV, leadership, grant writing and responsible conduct of research. Candidates complete mentored research project(s), multiple manuscripts, and apply for independent funding. For further information, visit www.medicine.yale.edu/dahrs or contact Gail D’Onofrio, MD, MS, dahrs@yale.edu.

The fellowship in Emergency Ultrasound is a 1 or 2 year program that will prepare graduates to lead an academic/community emergency ultrasound program. The 2-year option includes a Master of Health Sciences or Master of Public Health with a focus on emergency ultrasound research. This fellowship satisfies recommendations of all major societies for the interpretation of emergency ultrasound, and will include exposure to aspects of program development, quality assurance, properties of coding and billing, and research. The program consists of structured time in the ED performing bedside examinations, examination QA and review, research into new applications, and education in the academic/community arenas.

We have a particular focus on emergency echo and utilize state of the art equipment, as well as wireless image review. Information about our Section can be found at http://eus.yale.edu . For further information, contact Rachel Liu MD, rachel.liu@yale.edu, or apply online at www.eusfellowships.com.

The Administration fellowship is a 2-year program that will prepare graduates to assume administrative leadership positions in private or academic emergency medicine as well as hospitals and health systems. The fellow will acquire experience in all facets of emergency department clinical operations, with close mentorship from department and hospital administrative leaders. Fellows will complete the recently #1 ranked Executive MBA program at the Yale School of Management. In addition, the candidate will assume graduated leadership roles on one or more projects supporting departmental activities usually culminating as Assistant Medical Director in the second year of the fellowship. For further information, contact Arjun Venkatesh, MD, MBA, MHS, arjun.venkatesh@yale.edu.

The Global Health and International Emergency Medicine fellowship is a 2-year program offered by Yale in partnership with the London School of Hygiene & Tropical Medicine (LSHTM). Fellows will develop a strong foundation in global public health, tropical medicine, humanitarian assistance and research. They will receive an MSc from LSHTM, a diploma in Tropical Medicine (DTM&H) and complete the Health Emergencies in Large Populations (HELP) course offered by the ICRC in Geneva. In addition, fellows spend 6 months in the field working with on-going Yale global health projects or on an independent project they develop. For further information, contact the fellowship director, Hani Mowafi, MD, MPH, hani.mowafi@yale.edu.

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

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

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

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

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

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

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

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

Ultrasound Fellowship Director Osceola Regional Medical Center. Kissimmee, FL EM Residency Program affiliated with the University of Central Florida College of Medicine.

Contact Shawn Stampfli at 404.663.4770

PEM Faculty Oak Hill Hospital. Tampa Bay, FL New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Contact Ody Pierre-Louis at 727.507.3621

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

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

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

Learn more at SAEM19 at booth #312

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Mount Sinai Health System - New York Emergency Medicine Faculty Positions The Mount Sinai Health System is currently seeking several full-time Emergency Medicine Physicians to join our six hospital-based emergency departments in Manhattan, Queens and Brooklyn. There is flexibility to work at both a community and academic site (single or multiple sites). The Department of Emergency Medicine is committed to excellence in emergency clinical care, education, and research. Our Department is one of the largest in the country, affiliated with Elmhurst Hospital Center, trauma center & part of NYC’s public health system.

The Emergency Medicine Service Line has more than 180 faculty and treats more than 600K patients annually. We have two emergency medicine residencies along with fellowships in Pediatric EM, Global Health, Ultrasound, Informatics, Sports Medicine, Administration, and Simulation. Each year, our (2) EM training programs educate about 150 residents and more than 15 fellows. Our research division is ranked #2 in the country based on NIH funding.

The Emergency Medicine Service at Mount Sinai Health System have the following opportunities available: Emergency Medicine Full Time Faculty (All Sites), Associate Medical Director (Mount Sinai Hospital), Associate Medical Director (Mount Sinai Queens), Director, Emergency Medicine Simulation (Sinai) & Medical Director (Mount Sinai West) Emergency Medicine Services at the Mount Sinai at Health System include the following sites: • • • • • • • •

Mount Sinai Hospital (Academic) Mount Sinai St. Luke’s (Academic) Mount Sinai West (Academic) Mount Sinai Beth Israel (Academic) Mount Sinai Brooklyn (Community) Mount Sinai Queens (Community) Mount Sinai Downtown Urgent Care Center Mount Sinai Express Care Please send your curriculum vitae to Veronica Fernandez, Director, Emergency Medicine at Veronica.Fernandez@mountsinai.org or contact (212) 731-3581

DEPARTMENT OF EMERGENCY MEDICINE

Tipton

Currently seeking research scientists outstanding clinical educators and researchers for faculty positions at all of our academic health centers and community-based hospital sites.

ACADEMICS

RESEARCH

Largest medical school student body in the U.S. with required EM clerkship, ACGME accredited emergency medicine and emergency medicine/pediatrics residency programs, multiple ACGME accredited fellowships

Robust departmental research focus. High institutional and departmental NIH ranking

BENEFITS Generous employer-sponsored retirement plans, access to employee contributed plans including 401k, 403b and 457b, medical (including HSA and FLEX saving options), dental, vision, life insurance, short and long-term disability insurance

COMPENSATION Competitive salary with annual academic and quality bonus opportunities. Generous CME allowance, licensure, DEA, CSR, ISMA, EM Board expenses, ACEP and SAEM memberships, public service loan forgiveness eligibility, IU tuition benefit

JOB BUILDS Dual Employment opportunities with both IUHP practice plan and IU School of Medicine, full-time academic, community, split model job builds available

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Muncie Fishers

Carmel Avon

Indianapolis

SITES Currently staffing physicians and APPs at 10 sites including our academic medical center: IU Health Methodist, IU Health Riley Hospital for Children and Eskenazi Health Hospital; and our community-based sites: IUH West, IUH Ball, IUH North, IUH Saxony, and IUH Tipton

Find us at the SAEM Annual meeting at booth 223 Enter to win an Amazon Echo!

Bring your CV for on-the-spot job interviews

emjobs@iu.edu

(317) 880-3881

Indiana University is an EEO/AA employer, M/F/D/V

LIFE-THREATENING BLEEDING IN PATIENTS PRESENTING TO THE ED: INDICATIONS, THERAPY AND REVERSAL AGENTS TWO DAY EVENT: LUNCH PROVIDED Wednesday May 15th and Thursday May 16th, 2019 12:00 PM – 1:00 PM

DAY 1: Wednesday May 15, 2019 - 12:00 Noon-1:00 PM

Mirage Events Center C3

DAY 2: Thursday May 16, 2019 - 12:00 Noon-1:00 PM Grand Ballroom D

Indications for Oral Anticoagulation in Patients (DVT/PE, AFib/Stroke etc) Using Warfarin, a Factor IIa Inhibitor, or Factor Xa Inhibitors Arthur M. Pancioli, MD University of Cincinnati

Appropriate Therapy for the Patient Presenting to the ED With Severe Bleeding From Vitamin K Antagonists, Factor IIa Inhibitor, or Factor Xa Inhibitors Charles V. Pollack, Jr. MD Thomas Jefferson University

Treatment of Major Bleeding in the Anticoagulated Patient in the ED: The EMCREG-International Severe Bleeding Algorithm Joshua Kosowsky, MD Brigham & Women’s Hospital/Harvard

The ED Management of the Anticoagulated Patient with GI Bleeding and Mucosal Bleeding William A. Knight, IV MD - EM/Critical Care University of Cincinnati

Treatment of Severe Bleeding in the Anticoagulated Trauma Patient in the ED Gregory J. Fermann, MD University of Cincinnati

Critical Care Management of Intracranial and Intraspinal Bleeding in the Anticoagulated Patient Natalie E. Kreitzer, MD - EM/Critical Care University of Cincinnati

The Management of Intracranial Bleeding in Anticoagulated Patients Presenting to the ED Opeolu Adeoye, MD - EM/Critical Care University of Cincinnati

Critical Care Management of the Anticoagulated Trauma Patient and Patients On Oral Anticoagulants Presenting to the ED Requiring an Emergent Operation Babak Sarani, MD - Trauma Surgery/Critical Care George Washington University

W. Brian Gibler, MD University of Cincinnati (Moderator)

www.emcreg.org

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19 Celebrating

of bringing EM ACADEMICIANS together!

Las Vegas, Nevada â&#x20AC;&#x201C; May 14-17