SAEM PULSE November–December 2018

NOVEMBER-DECEMBER 2018 | VOLUME XXXIII NUMBER 6

www.saem.org

SPOTLIGHT MENTORING AND EDUCATING THE NEXT GENERATION OF EM SCHOLARS AND EDUCATIONAL LEADERS An Interview with

Wendy C. Coates, MD

LIFE HACKS FOR THE RESIDENCY INTERVIEW TRAIL page 30

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

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org Director, Finance & Benefits Doug Ray Ext. 208, dray@saem.org Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Operations & Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Manager, Governance Snizhana Kurylyuk Ext. 205, skurylyuk@saem.org Manager, IT Database Nanette Diaz Ext. 225, ndiaz@saem.org IT Support Specialist Jovan Triplett Ext 218, jtriplett@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Specialist, Digital Communications Nick Olah Ext. 201, nolah@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

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

The Best Predictor of Resident Success? Grit.

Spotlight

Mentoring and Educating The Next Generation of EM Scholars and Educational Leaders

Clerkship Directors in EM

Using the Gallery Walk as an Educational Tool

Diversity and Inclusion

Opiates and Empathy: Room to Improve in the Treatment of Sickle Cell Patients in the Emergency Department

Ethics in Action

Who Can Refuse? Autonomy on the Line

Faculty Development

Best Practices in Faculty Development: An Overview of Programs Offered

Graduate Medical Education

Managing the Sticky Situation: Remediating Professionalism Lapses in Graduate Medical Education

Grants and Funding

How to Develop an SAEMF Grant Application: Five Lessons Learned as a Junior Researcher

Research In Academic EM

Bench to Bedside Research in Acute Illness: Lessons from a Young Investigator

Social Media In Academic EM Maximize Your Twitter Life With Tweetdeck

SGEM: Did You Know?

Sex differences in Acute Presentations of Kidney Disease

Wilderness Emergency Medicine Interest Groups Offer Medical Students an Introduction to Wilderness Medicine

Women in Academic EM

Supporting Women Through Amplification

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Briefs and Bullet Points Academic Announcements Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. Š 2018 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

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

The Best Predictor of Resident Success? Grit.

"Grit is passion and perseverance for very long-term goals. Grit is having stamina. Grit is sticking with your future day in, day out, not just for the week, not just for the month, but for years.

And working really hard to make that future a reality. Grit is living life like it's a marathon, not a sprint."

—Angela Lee Duckworth

No sooner have the new interns arrived and the residency interview season is already upon us. Program directors and department chairs are looking to interview and ultimately match the best medical students — those who will be fantastic residents, fit into the local culture, and go on to do great things. But from a limited body of work, relying mostly upon pass/fail grading systems, largely unhelpful medical student performance evaluations (Dean’s letters), board scores, and a half day of interviews, how can anyone be expected to predict success for any given applicant?

Looking at markers or predictors of success in other areas might be informative.

In 1914, when polar explorer Sir Ernest Shackleton set out on his third voyage to Antarctica (where he planned to cross the last uncharted continent on foot) his ship, Endurance, encountered polar pack ice.

For weeks Endurance slowly worked its way through the pack ice before it finally became completely trapped, only a day’s sail short of its destination. For nine months, the ice-bound Endurance

drifted with the pack ice, until it was finally crushed between the ice floes and had to be abandoned. The crew remained camped on the floes for several more weeks, and when the sea ice began to disintegrate, they used Endurance's three lifeboats to reach isolated Elephant Island. Realizing there was no chance of passive rescue, Shackleton and five others set off on a near-impossible journey, over 850 miles of the South Atlantic's heaviest seas, to the closest outpost of civilization — a whaling station on South Georgia island. Their survival, and the survival of the crew they’d left behind, depended on their small lifeboat successfully finding this tiny dot of land in a vast and hostile ocean. Weeks later, they arrived, but because the whaling ships were not equipped to penetrate Antarctic sea ice it would be another three months — four and a half months total — before the rest of Shackleton’s crew would be rescued. By then, many of the men were ill, frostbitten, and on the verge of starvation. All-in-all the crew of the Endurance spent nearly a year and a half living in the coldest, harshest conditions imaginable, far removed from civilization; yet remarkably just three of the 28 were lost. How does that happen? Is there a word to describe such individuals? I think there is… And that word is GRIT. There is an increasing body of science showing that predictors of success in life and work are related to an individual’s disposition to exhibit passion, motivation, and perseverance for achieving long-term goals — in other words, grit. Possessing grit has been shown to improve performance in spelling bees, to predict success of West Point cadets, to decrease burnout and suicidal ideation, and to be related to continued on Page 6

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SPOTLIGHT MENTORING AND EDUCATING THE NEXT GENERATION OF EM SCHOLARS AND EDUCATIONAL LEADERS

Dr. Coates with three out of four family members, stopping for a photo during a hike at Yosemite National Park.

"Academics is the place to magnify one’s impact on patient care, whether through groundbreaking research or teaching the next generation of clinicians and educators."

SAEM Pulse Talks With Wendy C. Coates, MD Wendy C. Coates, MD, is a Professor Emeritus of Emergency Medicine at the University of California, Los Angeles Geffen School of Medicine and Senior Faculty/Education Specialist at Harbor-UCLA Department of Emergency Medicine. Dr. Coates is committed to the advancement of medical education in emergency medicine (EM) and founded a fellowship in education in 1999. She has published several peer-reviewed articles on the development and need for scholarly fellowships in education for EM graduates who wish to excel in academic research in education as well as teaching. She has been a staunch advocate and leader in medical student education and the field of mentorship in medical education. Dr. Coates also serves as a team physician and educator for dance companies and has created an injury prevention curriculum for professional dancers and advises health care providers who treat them. Dr. Coates has been an active participant in SAEM since its founding in 1989. She serves presently on the editorial boards of Academic Emergency Medicine (AEM) and AEM Education and Training (AEM E&T) journals. In 2018, she was elected to the SAEM Board of Directors. Dr. Coates was interviewed by Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force.

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"As our careers wind down, it is nice to know that a small part of ourselves lives on in our protégés (and their protégés) who can continue to implement what we’ve modeled for years to come."

What led you to choose emergency medicine as your specialty?

Besides all the cliché answers in everyone’s personal statement (all true), I wanted a specialty where I could use my creative side every day and have a chance to make a systemic impact in the specialty.

When and why did you choose to work in academics?

This was never a question — I taught ballet starting at age 16 and chaired/ taught in a high school physics department while I was doing my postbaccalaureate to prepare to apply to medical school. I served on the curriculum committee at my university and taught adult GED classes as a medical student. Academics is the place to magnify one’s impact on patient care, whether through groundbreaking research or teaching the next generation of clinicians and educators.

How did you first become involved with SAEM? In 1989, I applied and was appointed to serve on the brand-new SAEM Education Committee. This was the first year that SAEM existed as a unified organization (upon the merging of the University Association of Emergency Medical Services, UA/EMS, and the Society of Teachers in Emergency Medicine, STEM) and I have been working on or chairing some committee, task force, or interest group to advance the organization’s mission ever since.

Dr. Coates, second from left, with Education Scholarship Fellowship graduates (L-R) Madonna Fernández-Frackelton, Samuel Clarke, Jaime Jordan, Daniel Runde.

What led you to pioneer the SAEM Virtual Advisor Program?

At the time, many medical schools had students interested in EM, but did not have a residency program in EM to advise them effectively about the specialty, where to do a sub-internship, or how to apply. SAEM was aware of this issue and encouraged the Education Committee to develop a solution to close the gap.

We developed the SAEM Virtual Advisor Program as an innovative way to use the “rather new” internet for mentoring.

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

I believe in the mission of the organization to advance academic EM through research and education. In addition to my commitment to support this overall mission, I hope to serve as a resource to expand faculty development and mentorship programs and help enhance scholarship in education so that it is as rigorous as other areas of research in EM and to support all faculty as they educate the next generation of EM physicians.

Tell us about your role on the Editorial Board of Academic Emergency Medicine Education & Training. What makes AEM E&T unique from all other EM journals, including AEM? Who is your reader?

Our specialty is very lucky to have a dedicated journal in medical education. I am one member of a very talented editorial

board. We created submission categories that usually do not fit into standard research journals and we determine the content of each issue. Both AEM and SAEM strongly supported this vision by creating the journal, which provides a home for rigorous educational scholarship, including formal research reports and pedagogical categories, to make every educator’s life easier in the emergency department. I would hope that anyone in academics would find our journal relevant.

You’ve been a powerful advocate of the mentor/mentee relationship. Why should established physicians seek out protégés to mentor?

Everyone should have mentors and protégés throughout their careers.

Specifically, established physicians can benefit greatly from the enthusiasm of their protégés who may take on and shed new light on tasks that have become mundane.

We can learn new things from them, such as technology and pop culture, to remain relevant. We can create mentorship “families” — networks of like-minded people to feel a sense of belonging. As our careers wind down, it is nice to know that a small part of ourselves lives on in our protégés (and their protégés) who can continue to implement what we’ve modeled for years to come.

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

My grandfather was an old-time GP (general practitioner) and took me on

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PRESIDENT’S COMMENTS continued from Page 3 resiliency in surgical residents. As a predictor of success, grit is more important than IQ and social intelligence.

Is grit something you’re born with, or can it be taught, learned, and grown? There is some evidence that grit can be cultivated. Dr. Angela Lee Duckworth, professor of psychology at the University of Pennsylvania, and MacArthur “genius” grant winner, has identified five key ways to becoming grittier: 1) pursue a passion; 2) practice and practice some more; 3) connect to a higher purpose; 4) cultivate hope; and 5) surround yourself with gritty people.

These characteristics of grittiness are directly applicable to residency training. We may not be able to identify medical students who have grit, but we hope that they come into residency with gritty components #1 and #2 already covered!

Dr. Coates and spouse in Australia visiting their daughter (and a friendly koala).

As for characteristic #5 (surrounding yourself with gritty people), I can’t imagine that Sir Ernest Shackleton and his crew could have possibly survived if they weren’t gritty or at least quick studies of how to become grittier. And that is a lesson worth learning.

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.

Five Ways to Grow Your Grit

Dr. Coates playing the “Flirty Maid,” in a production of the Nutcracker a few years ago.

1. Pursue a passion.

Get out there and try different things until you’ve found something interesting — something you’re passionate about.

SAEM PULSE | NOVEMBER-DECEMBER 2018

2. Practice and practice some more.

We’re much more likely to stick with things we’re good at, so put in the work to get a little bit better every day.

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3. Connect to a higher purpose.

Understand how what you do contributes to the greater good and/or well-being of others.

Dr. Coates, front and center, being flexible with some of the Harbor-UCLA emergency medicine faculty.

4. Cultivate hope.

Go after your goals with the belief that you can improve if you work hard at it.

5. Surround yourself with gritty people.

The people around you have a huge influence on your thoughts, feelings, and behaviors.

From the TED Talk, Grit: The Power of Passion and Perseverance and the book of the same name, by Dr. Angela Lee Duckworth, founder and CEO of Character Lab.

Dr. Coates, second from the right, a former classical ballet dancer, during an adult ballet performance.

house calls starting when I was seven years old. Most of the time, I sat in the living room “reading,” but I was really basking in the art of medicine that he embodied. One day, he had an unexpected footling breech delivery and called me to assist. He spoke to me (age eight) as he would to a colleague, outlining the procedure and my (substantial) role. This baby and mom ended up being okay; amazingly, so was the baby with the same presentation that I delivered emergently later on, as an intern on call, hearing my grandfather’s words in my head, while desperately awaiting a “real doctor” to arrive!

My residency director, Marcus Martin, MD, modeled the ideal EM physician every single day. When I became faculty at Harbor-UCLA, Bob Hockberger, MD, was my EM mentor and LuAnn Wilkerson, EdD, was my dean mentor. What they all had in common was an interest in supporting me in reaching my goals and doing their part to make it happen.

Why should EM residents consider doing a fellowship, in general? Why should they consider a fellowship in education, specifically?

A fellowship is a time for residency graduates to focus on their own professional development under the guidance of someone whose job it is to help them succeed. During this time, fellows acquire new skills in their areas, receive dedicated mentorship, and develop networks that will last their entire careers. For education in particular, residency training generates expert clinicians, but there is no time to fully develop a skill set in pedagogy or education research methods.

How did you become a dance company physician? What does that position entail?

I was a professional ballet dancer for several years and actually first considered medical school as a way to help injured dancers. Much like a sports team physician, dance companies need someone who is knowledgeable in acute care and injury prevention strategies for professional dancers, students, and dance teachers. Plus, there’s nothing like watching a production from the wings and taking (attempting) company classes with the current pros!

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

Working with children in the community (e.g. Cub Scout den mother, Girl Scout

troop leader, classroom volunteer) made me realize how all learners, not just the top 10 percent, benefit from attention and patience and can make great strides.

It made me reach out to the medical students who were struggling or were “average,” to help them maximize their potential. This skill was amplified while learning from experts how to teach my deaf son how to talk and advocate for new laws focusing on newborn hearing screening and implementing the Americans with Disabilities Act in California.

Tell us about a particularly satisfying moment you had while training a student or mentee.

As the preceptor of a medical school longitudinal “doctoring” course, we had a standardized patient focused on suicide.

On a whim, I included in the discussion hour a proposal that even though we were all from different social groups within the class, we should make a pact that if any of us should ever consider suicide, we would call a member of this group first.

Months later, a student called me (after a night shift, of course) and a peer as a duty to honor the pact. The entire group mobilized — we saved a life together.

"In order to stay relevant, we must be open to new ideas and embrace them in a careful and organized way" colleague who cared for them; make a difference in an outcome because you were there instead of anyone else. You learn a mom named her baby after you because you saved her life. You get a thank you note from a pediatric drive-byshooting patient years later when he gets into medical school because you told him to pursue his dream despite the obstacles (and maybe wrote him a recommendation letter to get into a magnet school program he didn’t know existed).

You’ve got a pretty lively Twitter account.

How do you think social media and FOAMed contribute to the world of emergency medicine?

A Wrinkle in Time by Madeleine L’Engle had a strong female protagonist in a science field that counteracted the subliminal message I received in elementary school that my only job in life was to have children and maybe be a secretary while waiting for “Mr. Right.”

If you want a “more adult” title: The Overcoat, by Nikolai Gogol, preferably in Russian (to appreciate the satire of the characters’ names).

I’m the subject of an experiment by the SAEM Social Media Committee to see if educators “of a certain vintage” can engage in social media with the intent of connecting with the newer generation. I am thoroughly enjoying this whole new world and feel engaged with a vibrant community of like-minded people who learn in new ways. In order to stay relevant, we must be open to new ideas and embrace them in a careful and organized way. I’m especially grateful to Drs. Mike Gottlieb and Seth Trueger for being my Twitter mentors!

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

In one sentence, what do you think is the future of emergency medicine education?

Since I work in a county hospital setting, our patients face so many obstacles to a comfortable life and present to the ED with such complicated issues that most of us never have to face. I know I can’t fix everything for them, so I try to be respectful, compassionate, and go the extra mile so that they leave the ED in a better state than when they arrived.

The future of emergency medicine education is the community of educators who strive to make our specialty the most dynamic place to be and the learners who will take the reins someday to keep EM on the creative, cutting edge.

Name one book you’ve read (fiction or nonfiction) that has had a lasting effect on you.

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

Sometimes you win. You get to witness an “aha!” moment by a learner; share in the joy or sadness of a patient or the

At the end of your career, what would you like to be remembered for?

She cared. She was dedicated to mentoring and educating the next generation of educational leaders and scholars in emergency medicine and created a sustainable community where creativity and innovation prevailed.

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CLERKSHIP DIRECTORS IN EM Using the Gallery Walk as an Educational Tool

By Sundip Patel, MD and Jace Morganstein, MS4

Sundip Patel, MD

SAEM PULSE | NOVEMBER-DECEMBER 2018

Jace Morganstein, MS4

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The gallery walk is an education technique that fosters small group learning and near-peer education in place of large format lectures. This team-based learning technique promotes collaborative learning, communication skills, and critical reasoning. In the gallery walk format, an instructor prepares several open-ended discussion questions which are written on poster boards and hung around a room.

Students are then divided into teams and assigned to one board initially. The students read their board and then work as a team to try to answer the question; they leave their comments on the board.

After a period of time, which is set by the instructor (usually 10-15 minutes), the groups then rotate to a new board, where they consider a new question as a group. This time, however, their analysis will include the comments left behind by the prior team; they will build on the prior team’s discussion. An instructor may float around the room during this process to help student groups that may be having difficulty with a question or to clarify any key points.

to the poster that poses the following question: “What is the diagnostic approach to diarrhea? Labs, cultures, or nothing?”

The second group will have the question: “Should I treat infectious diarrhea with Antibiotics? Loperamide?” The third group is posed the question: “What bacterial infections cause bloody diarrhea and what are the associated complications?”

Finally, the fourth group will have the question: “What causes of diarrhea do you need to worry about in HIV and immunocompromised patients?” After eight minutes, each group will switch to a new poster. You will move from group to group to see if they are having any issues. At the end of 32 minutes, each group will return to their original posters. You give the groups 10 minutes to summarize everything that is written on the posters. You then give each group 4-5 minutes to present their final findings to everyone. You have now successfully delivered a 60-minute lecture on infectious diarrhea that was informative, interactive, and fun.

The process repeats until all teams have encountered every poster board/question.

Once each team has returned to their original staring board, they will, as a group, summarize the comments written on the board and then present their final findings to the class. A paper/blog post, which all of the students can view, may be substituted in place of a final report. An evaluation component could also be added via a test or short quiz at the end of the session.

The gallery walk technique provides many benefits and improvements over the standard lecture-based educational format. In the gallery walk, students are provided opportunities to discuss topics in an active learning format rather than passively obtaining information.

Communication skills, conflict resolution, and teamwork are all emphasized in this teaching modality. The gallery walk technique provides students with the ability to engage in peer-to-peer learning which they will encounter during residency and as attendings. In addition, instructors are also provided a much easier opportunity to see if their students have a major gap in their knowledge base, which may be hard to ascertain from a traditional lecture format.

How Would This Work in Emergency Medicine?

Let us suppose that you have the duty of teaching infectious diarrhea to 20 students rotating on your emergency medicine clerkship. Truly a dirty job, but someone has to do it. Rather than create another mundane lecture, you decide to use the Gallery Walk technique to cover the topic.

You split your 20 students into four groups of five students. You assign one group

The Benefits

The Downsides A major drawback to the gallery walk education technique is classroom control.

During the activities, students rotate around the room, all talking at the same time. The

"The gallery walk technique provides many benefits and improvements over the standard lecture-based educational format. In the gallery walk, students are provided opportunities to discuss topics in an active learning format rather than passively obtaining information."

potential for distraction can be quite high.

You may not want to do this with 50-60 students. Timing for the activity could be another potential hurdle. Enough time needs to be allowed at each poster board to ensure that adequate discussion occurs. Even with only four groups, you may find that the activity will require an hour or longer to complete. Finally, each student has his or her own learning style and you will have certain students who learn best as individuals and not in a group setting like the gallery walk. There is also the potential for less participation by introverted students.

In Conclusion The gallery walk is an interactive, teambased learning approach to educating students. It is best utilized with fewer than 35-40 students so that the potential chaos of having many students talking all at once

can be controlled and kept to a minimum.

In addition to the students learning about important material, they will also sharpen their abilities to analyze problems and share what they learned with their peers.

You may want to try the gallery walk the next time you are given a not-so-exciting topic to teach your students.

REFERENCES

1. F rancek M. Promoting discussion in the science classroom using gallery walks. J Coll Sci Teach. 2016; 36: 27–31.

2. R odenbaugh DW. Maximize a team-based learning gallery walk experience: herding cats is easier than you think. Adv Physiol Educ. 2015; 39(4): 411-3.

ABOUT THE AUTHORS: Sundip Patel, MD, is a co-clerkship director at Cooper Medical School of Rowan University and an active member of SAEM’s Clerkship Directors of Emergency Medicine (CDEM). Jace Morganstein, is an MS4 at Cooper Medical School of Rowan University. He is an emergency medicine match applicant.

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 EM clerkship directors and medical student educators to communicate, share ideas, and generate solutions to common problems. For more information, visit the CDEM webpage. Joining CDEM is now free! 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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DIVERSITY AND INCLUSION Opiates and Empathy: Room to Improve in the Treatment of Sickle Cell Patients in the Emergency Department

By Tiffany Mitchell, MD “You talk about these ‘sicklers’ as if they’re normal people.”

"There are a number of reasons why emergency department providers may be reluctant to treat sickle cell pain in accordance with national guidelines.

Implicit bias likely plays a role."

This response came from an attending at work after I shared my proposed treatment plan for a patient in the emergency department (ED). The patient was a young male, unfamiliar to our ED, who appeared to be having an uncomplicated sickle cell crisis. I wish I could say that it was the only time I’d heard disparaging remarks from colleagues with regards to sickle cell patients, but far from it. There is a stigma towards patients with sickle cell disease among ED providers. The prevailing opinion seems to be that many, if not most, of the sickle cell patients who present to the ED are drug-seeking addicts looking for their next high. I’ve encountered several attendings who directly refuse to administer opioids to sickle cell patients, incorrectly pointing to low reticulocyte counts, or normal CBC (complete blood count) values as evidence that a patient “isn’t actually in a pain crisis.”

I’ve seen patients refused pain medication because of non-clinical rationale: “She looks fine,” or “he’s on his cell phone, how much pain can he really be in?” As a result, a gap exists between what the evidence-based guidelines recommend and what we actually do in the treatment of sickle cell pain crises.

The National Heart, Lung, and Blood Institute (NHLBI) recommends that adult and pediatric sickle cell patients in vaso-occlusive crisis, presenting with severe pain, should be treated with parenteral opioids, and that pain should be reassessed and, if necessary, opiates should be re-administered every 15-30 minutes until pain is controlled.1 There are a number of reasons why ED providers may be reluctant to treat sickle cell pain in accordance with national guidelines. Implicit bias likely plays a role.

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"A gap exists between what the evidencebased guidelines recommend and what we actually do in the treatment of sickle cell pain crises."

A recent survey administered to ED providers at an American College of Emergency Physicians (ACEP) Scientific Assembly, found that analgesic practices were impacted by provider attitudes towards sickle cell patients.2 Providers with more negative attitudes towards sickle cell patients were less likely to report redosing opioids within 30 minutes for inadequate analgesia, a key guideline in the management of acute sickle cell pain crises. As a result of provider bias, patients are waiting too long for treatment, and their pain is being undertreated, if at all.

Another contributing factor may be the heightened concern surrounding opioid abuse and addiction. In 2017, drug overdoses claimed approximately 70,000 lives, with opioid overdoses accounting for more than half of the reported deaths, according to preliminary data from the Centers for Disease Control and Prevention (CDC).3 Consequently, there is a growing fear among providers that by administering powerful opiates, even in controlled inpatient settings, we may be inadvertently contributing to the opioid crisis.

These concerns are not entirely misplaced. As providers, we are all

expected to exercise good judgment when administering opiates. But we also bear the responsibility to treat pain. In the setting of acute sickle cell pain crises, adequate treatment of pain is an essential aspect of disease management.

It is important that we recognize that the opioid epidemic bears little relation to our management of acute sickle cell pain crises. According to CDC data, from 1999 to 2013, 175,052 people died from opioid overdose. Patients with sickle cell disease accounted for just 95 of those deaths, less than 1 percent.4 In discussing issues surrounding substance abuse, it is important that we remember the crucial distinction between opioid tolerance and opioid addiction.

Addiction, or substance use disorder, as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a pathological pattern of behaviors related to the use of a substance, defined by specific criteria regarding impaired control, social impairment, risky use, and the presence of pharmacological criteria including tolerance and withdrawal.

Tolerance is a state in which a higher dose of a substance is required to achieve the desired effect, or when a reduced effect occurs in response to the usual dose.

Many sickle cell patients do exhibit varying degrees of opioid tolerance, but the presence of opioid tolerance does not, in and of itself, confer addiction.

Furthermore, our perceptions of sickle cell patients are skewed by a minority of sickle cell patients that utilize the ED most frequently. Aisiku et al5 found that from

a sample size of 232 sickle cell patients, approximately one-third reported three or more ED visits per year. Fifty-three percent of patients reported no ED visits during the study period at all. Those reporting more than three ED visits per year, deemed “high utilizers,” reported higher mean pain levels, and used opioids at home significantly more frequently than low utilizers. However, after controlling for the number of pain days and the magnitude of pain levels, the difference in opioid use between the groups was no longer significant. “High utilizers” were also more likely to exhibit higher objective clinical severity of disease, evidenced by lower hematocrit values and need for transfusion treatment, compared to low ED utilizers. The findings suggest that the patients we see most frequently in our ED have more severe disease, and experience more pain.

All patients, including those suffering from substance addiction, should be treated with respect and given the benefit of the doubt. While it is vital that we, as ED providers, evaluate our role in the epidemic of opioid abuse, we mustn’t allow concerns regarding substance abuse to prevent us from treating disease. Our attitudes towards sickle cell patients, and our well-intentioned fears about opiate abuse are negatively impacting patient care. It is our duty as doctors to check our personal biases, and to make sure that the current national conversation around opioid abuse doesn't prevent us from adhering to evidence-based guidelines in the treatment of sickle cell disease.

REFERENCES

1. “Evidence-Based Management of Sickle Cell Disease: Expert Panel Report 2014.” National Heart, Lung, and Blood Institute, Sept 2014, https://www.nhlbi.nih.gov/health-topics/evidencebased-management-sickle-cell-disease 2. G lassberg, Jeffrey A., et al. “Emergency Provider Analgesic Practices and Attitudes Toward Patients With Sickle Cell Disease.” Annals of Emergency Medicine, vol. 62, no. 4, 2013, doi:10.1016/j.annemergmed.2013.02.004 3. “National Center for Health Statistics: Provisional Drug Overdose Death Counts.” Centers for Disease Control and Prevention, 12 Sept. 2018, www.cdc.gov/nchs/nvss/vsrr/drugoverdose-data.htm?67.

4. R uta, Nadia S., et al, “The Opioid Drug Epidemic and Sickle Cell Disease: Guilt by Association.” Pain Medicine, 2016; 17:17931798, doi:10.1093/pm/pnw074 5. Aisiku, Imoigele P., et al. “Comparisons of High Versus Low Emergency Department Utilizers in Sickle Cell Disease.” Annals of Emergency Medicine, vol. 53, no. 5, 2009, doi:10.1016/j. annemergmed.2008.07.050

ABOUT THE AUTHOR: Tiffany Mitchell, MD, is an emergency medicine resident at Jacobi Medical Center in the Bronx, NY. Her academic interests include pediatric emergency medicine, sickle cell disease, and psycho-social determinants of care.

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in health care and outcomes, and insuring that all emergency physicians are delivering culturally competent care. For more information, visit the ADIEM webpage. Joining ADIEM is now free!

Just log into your member profile and click on the "Update (+/–) Academies and Interest Groups" button.

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ETHICS IN ACTION Who Can Refuse? Autonomy on the Line

By Gerald Maloney, DO Consent is one of the most important, and at times most complex, issues in clinical ethics. Refusal of treatment becomes particularly difficult in settings where we, as emergency physicians, are granted the ability to override the patient’s autonomy. This article will discuss two cases in which refusal of care represented ethical challenges.

Case One

"There are cases in which patient autonomy may be partially preserved but may be overridden by the state or medical authorities acting with the authorization of SAEM PULSE | NOVEMBER-DECEMBER 2018

the state to preserve

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life and health."

Emergency medical services (EMS) deliver to the emergency department (ED) a 55-year-old female patient with a deep laceration to her left forearm involving the radial artery. The patient admits that prior to the self-inflicted injury, she consumed several over-the-counter sleep aids, plus alcohol, with the intention of falling asleep and bleeding to death. The patient is hypotensive and labs reveal a hemoglobin of 5.5. She refuses all care and states that her wish is to die. Following established ethical guidelines, and given her stated suicidal ideation and impairment by medications and alcohol, resuscitation and surgical repair of her injuries is planned. When O- blood is brought to the bedside for transfusion, she states that her religious beliefs prevent her from receiving the transfusion; however, she is in hemorrhagic shock and suicidal. Can she refuse the blood?

It is generally accepted that suicidal patients cannot refuse life-saving medical care, as suicidality is viewed as a mental illness and therefore suicidal patients lack

capacity to refuse care as they are not perceived to be making a consistently rational decision (i.e., a rational person would not choose to end his or her life prematurely). There are, however, very specific situations (e.g. in cases of terminal illness), where it can be argued that respect for the autonomy of the patient and beneficence (to reduce end-of-life suffering) may make suicide permissible, and may even merit physician assistance.

Nevertheless, in the clear majority of cases, suicide is not considered a normal, rational thought process and therefore providers can overrule a patient’s autonomy to perform interventions that can save his or her life.

Equally well-described is the validity of a patient’s refusal of certain interventions based on personal or religious beliefs.

One of the most well-known of these types of situations is the refusal of blood products by Jehovah’s Witnesses, which has become a textbook case in patient autonomy. Even if it means likely death, it is ethically acceptable to allow these patients to refuse blood products; it is a rational choice regarding their care based on their personal convictions.

But what to do when these principles collide? In this case, given that the religious convictions of the patient were confirmed by family members and were, indeed, a part of her belief system long before her suicide attempt, it is permissible to let her refuse the transfusions. Withholding other care designed to save her life, such as IV

"While a prisoner may refuse medical care for a minor issue, such as an upper respiratory infection, he or she may be forced to accept care if doing so is in the best interests of the prison population (treatment of a communicable disease) or if it jeopardizes the life or health of the patient (unless a valid DNR order is in place)."

fluid resuscitation, surgical repair of her lacerated artery, and any intervention needed for the medications she ingested would, however, be inappropriate.

While the line may seem blurry, the patient’s refusal of one treatment (blood transfusion) based upon her religious beliefs and not on her suicidality, is permissible, while her refusal of the other treatments is based upon her suicidal ideation and is therefore not permissible.

Case Two A 20-year-old male is brought to the ED by law enforcement officials.

It is suspected that in an attempt to smuggle drugs, he has ingested multiple, narcotics-filled condoms. The patient is alert, not intoxicated, and appears clinically stable, without any signs of toxicity. The plan is for the patient to drink bowel prep solution to facilitate passage of the drug-filled packets.

The accompanying officers intend to confiscate the packets when they are passed. The patient refuses to drink the solution, even though he is aware that if the packets burst he could die. Law enforcement officials, will not return the prisoner/patient to jail until he passes the packets. Can the patient be forced to drink the bowel prep solution?

Prisoners represent a unique population in terms of delivery of health care. Courts have upheld as a constitutional right that

prisoners may receive medical care as a condition of incarceration; however, they also have abridgements on their ability to refuse medical care that non-incarcerated persons do not. For example, while a prisoner may refuse medical care for a minor issue, such as an upper respiratory infection, he or she may be forced to accept care if doing so is in the best interests of the prison population (treatment of a communicable disease) or if it jeopardizes the life or health of the patient (unless a valid DNR order is in place). Courts have, for example, ruled that patients cannot refuse treatments such as hemodialysis or antipsychotics.

While there might be slight differences between prisoners in a jail (usually shortterm confinement pending adjudication of their criminal charges) and those in a prison (for much longer terms after a criminal conviction), prisoners in both instances have a right to necessary medical care, with a limited right to refuse it. As such, in this case, the prisoner may be compelled to accept medical treatment whether he wants it or not.

Depending on the state, delivery of the treatment may require a court order, and there are still ethical questions raised. For instance, his treatment, while preventing a potentially fatal event should a drug packet rupture, also provides evidence law enforcement may use against him in a court of law. Thus, in treating him,

providers risk crossing the line between being an advocate for the patient’s health and becoming an agent of the state.

The patient’s treatment therefore creates an ethical quandary: While expediting passage of the drug packets reduces his risk of having an adverse clinical outcome, it also makes it likely he will face criminal charges and long-term incarceration.

The autonomy issue in this case is straightforward; the larger ethical issues remain a source of fierce contention.

In summary, there are cases in which patient autonomy may be partially preserved but may be overridden by the state or medical authorities acting with the authorization of the state to preserve life and health. There are frequently as many ethical questions created as answered with these types of cases; however, the answers to the questions regarding where, specifically, the line may be drawn regarding overruling autonomy can be answered more readily than some of the other issues raised.

ABOUT THE AUTHOR: Gerald Maloney, DO, is associate chief of the emergency department at the Louis Stokes Cleveland VA Medical Center.

He is an U.S. Army veteran and holds a faculty appointment at Case Western Reserve University as an associate professor of emergency medicine.

Dr. Maloney is a member of the SAEM Ethics Committee.

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FACULTY DEVELOPMENT Best Practices in Faculty Development: An Overview of Programs Offered

SAEM PULSE | NOVEMBER-DECEMBER 2018

By Kiran Pandit, MD

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"Evaluation of the effectiveness of the varied faculty development programs is crucial to establishing models for best practices in building productive, fulfilling careers in academic emergency medicine."

How are we preparing faculty in academic emergency medicine for productive and fulfilling careers? Over the years, our field has grown tremendously in developing standards for educating medical students and training resident physicians and fellows. But then what? What happens after graduation from residency or fellowship? What are the best practices for building careers in academic emergency medicine? How do we develop clinical excellence and remediate those who are struggling? How do we coach junior faculty who are exploring different paths?

How do we mentor faculty who have chosen a particular focus? How do we support faculty working toward academic promotion? How do we teach faculty to keep themselves academically engaged for decades, and to avoid burnout?

A series of key informant interviews conducted at SAEM18 in Indianapolis revealed that academic emergency medicine departments employ a wide variety of systems and programs to achieve these objectives. But how effective are these programs? Here is an overview of programs offered, ranging from the common and general, to the unique and specific.

Programs for general professional growth include speaker series and lunch series on topics ranging from communication skills to conflict resolution to time management to imposter syndrome to work-life balance to goal-setting. Some programs conduct book clubs focusing on personal development, leadership skills, and the psychology of success.

One program broadcasts narrative-style interviews with senior faculty about the stepping stones of their career growth trajectory. Another program runs a writing interest group, where faculty meet for one hour weekly, for 10 weeks, sharing their writings and writing during each session.

Programs offer overviews of the promotion and tenure processes, the peer review

process, turning projects into scholarship, and regional/national engagement. One program brings faculty together in an informal task force for innovation, where faculty give each other feedback on academic ideas. Some programs require all faculty to perform peer review for a journal, or serve on a hospital committee.

One program funds executive coaching for faculty whose behavior is getting in the way of their academic success. Another program monetizes academic contributions and faculty development work into a financial bonus.

Some programs conduct faculty retreats, annually or biennially. Retreat offerings include an assessment of faculty development needs, an overview of career growth offerings, and a discussion of departmental five-year plans. Speakers and workshops focus on clinical skills, the Lifelong Learning and Self-Assessment (LLSA), clinical schedule, academic promotion, research, wellness, and engagement.

Some programs specific to junior faculty include a series of required monthly didactics and workshops, and monthly group dinners. One department requires that senior faculty mentor the first grand rounds presentation given by a junior faculty member.

Programs focusing on improving clinical performance and maintenance of clinical skills include procedure labs (including cadaver labs), ultrasound workshops, and a program providing faculty with feedback on their own reflections of how, in retrospect, they might have managed their bounceback or complex cases differently.

Many programs focus on educator development by offering workshops on bedside teaching, effective feedback/ debriefing, effective didactics, innovations in teaching, curriculum development, speaking without slides, and mentoring students. One program invites participants to earn a teaching college certificate by attending two-hour workshops every

two weeks for several months. Another program offers an annual week-long educator development fellowship to two faculty per department, for 15 departments across the institution. One program requires all faculty to teach for 100 hours per year, and another locates all educators’ offices in one hallway, for informal networking and mentorship.

One program supports researcher development by sponsoring eight faculty per year to participate in research, by reducing clinical requirements for the year.

Departments offer a variety of mentorship programs, from peer coaching to speed-dating style mentorship, to assigned “advocates” with whom faculty meet biannually. As matched mentorship can be unsuccessful and even damaging, some programs offer project-based, time-limited mentorships, or self-identified mentorship via informing the group about particular areas of expertise and skill sets. Some programs first trained faculty to be effective mentors, prior to launching a mentorship program. Some programs offer women’s groups that focus on the specific needs of female faculty, and some use virtual mentorship to connect distant people via regular face-to-face meetings.

Many programs conduct annual reviews of clinical performance and academic productivity. Some programs

require a self-evaluation to be performed first, prior to review by a division head or vice-chair. Some programs use forms required by their institutions, while others are created by the departments. Some require an updated CV with new additions highlighted in yellow, while others incorporate clinical performance metrics and teaching evaluations, or points for citizenship, or a section in which the faculty member can ask for support or resources. Some translate these into individualized growth plans with specific short-term and long-term goals, with feedback on which career aspects to build, and which to cut.

Programs support working towards academic promotion by offering CV workshops, and sessions on promotions processes and how to leave a paper trail leading to promotion. One program makes promotion requirements specific, detailed, and granular, to make the promotion process more objective.

Last, but certainly not least, programs involving departmental administrators include leadership courses at ACEP, assigning administrators the responsibility of nominating faculty for awards and positions, and for notifying faculty about upcoming deadlines for applications for speaking opportunities, conference presentations, etc. One program employs a marketing professional to create

academic posters, and to manage social media, websites, and newsletters highlighting faculty achievements.

Evaluation of the effectiveness of these varied faculty development programs is crucial to establishing models for best practices in building productive, fulfilling careers in academic emergency medicine. Some of the many outcomes which can be assessed include lowerlevel measurements such as workshop evaluations and publication citation rates, and also higher-level quantification such as promotion rates and retention rates, not to mention levels of overall job satisfaction.

ABOUT THE AUTHOR: Kiran Pandit , MD, completed her medical and public health education at Columbia University, followed by residency in emergency medicine at New YorkPresbyterian Hospital. As junior faculty, she worked extensively in capacity building overseas, teaching and training health professionals of all levels in emergency medicine, trauma management, and disaster preparedness. She then created and directed the emergency medicine selective rotation for Columbia University medical students in their major clinical year. For the last three years, she has worked in faculty development, focusing on orientation and advising of junior faculty, along with supporting academic promotion efforts for mid-career faculty. Dr. Pandit is a member of the SAEM Faculty Development Committee.

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GRADUATE MEDICAL EDUCATION Managing the Sticky Situation: Remediating Professionalism Lapses in Graduate Medical Education

By Andrew King, MD

"Educators must overcome the barriers to remediation in order preserve the professionalism that is vital to our profession."

Despite the importance of professionalism to the training of future physicians, residency programs often struggle with educating residents in the various aspects of professionalism. Similarly, they often fail at implementing effective remediation strategies for residents unable to meet expectations.1-4 Among program directors in emergency medicine, 80 percent expressed that deficiencies in professionalism were harder to remediate than deficiencies in other Accreditation Council for Graduate Medical Education (ACGME) core competencies.2 The evaluation of professionalism is complex, interpretive, and contextual, and it must account for individuals, interpersonal relationships, and societal-institutional factors.5,6 It can be further complicated by the lack of consensus on a definition of professionalism in medical education. In 2004, Papadakis and colleagues7 reported an association between unprofessional behavior in medical school and subsequent disciplinary action by a state medical board, underscoring the importance of addressing professionalism lapses early.5

of the incident should be included in the documentation of the professionalism lapse.9,10 Successful remediation requires an organized approach to the learner’s professionalism lapse. Steps include: (1) confirm the lapse, (2) understand the context, (3) communicate and discuss in a safe environment in a mutually respectful manner, (4) encourage self-reflection, (5) agree on a plan for remediation, (6) document the interventions, and (7) construct a clear plan for follow-up.9 Each type of professional transgression requires a different approach and individualized remediation plan. The plan should be clearly written and include the characterization of the lapse, goals, requirements for reading, specific behavioral change goals, a plan for monitoring and reassessing, and consequences for relapse or failure to comply with the defined plan. Learner responses to the professionalism lapse such as remorse or apology, rather than anger or denial, and accepting responsibility for the lapse in professional behavior improve the odds that the lapse is successfully remediated.9

Since these lapses can have significant consequences for patients, it is imperative that medical educators feel comfortable addressing these situations early and often. Despite these high stakes, many educators hesitate to address these issues directly, possibly suggesting a lack of understanding of the consequences or a lack of familiarity with knowing how to best address lapses in professionalism.8

Rougas et al recommend similar important concepts in their twelve tips for addressing unprofessional behavior paper.

These include: (1) model professional behavior with learners, (2) acknowledge the hidden curriculum – the information absorbed by learners based on direct observations within the clinical context, (3) know institutional policies, (4) gather evidence and objective data, (5) know when to obtain perspective on a behavior that is not explicit, (6) utilize colleagues for support, (7) be a good listener when meeting with the learner, (8) create a safe environment, (9) provide direct and explicit feedback, (10) make connections to help facilitate change, (11) know when you’re in over your head, and (12) establish clear follow-up.8

A lapse in professionalism should be categorized as behavior, performance, attitude, or lack of accountability.

Categorizing the lapse in professionalism will help when discussing the lapse with the learner and determining the best course of action for a remediation plan.

Specific information about the context

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The Council of Emergency Medicine Residency Directors (CORD) developed a remediation task force that was charged with developing activities and tools to assist programs with the remediation of residents within each milestone and associated sub-competency. The recommended remediation strategies proposed by this remediation task force for the various professionalism milestones and sub-competencies is provided below.1

Professional Values and Conduct (Maintains honesty, integrity, ethical behavior, respect, empathy, and trustworthiness)

• Pick a mentor role model of professionalism to shadow and/or meet with periodically.

• Solicit specific feedback from faculty that addresses areas of professionalism through evaluations.

• Read specific journal articles regarding professionalism; facilitate mentored small group discussion and reflection.

• Review dangers of social media, discuss infractions, and develop a plan for removal of certain online material.

• Participate in wellness education, including development and presentation of content during a didactic session.

• Review current policies of department, institution, or state and develop a plan for an impaired physician.

• Review policies or literature for disclosing errors and help develop an educational session for residents.

• Accountability (Upholds commitment to patients and society through timeliness, pursuit of professional development, and practice with a sense of duty)

Steps to Remediation 1. Confirm the lapse 2. Understand the context 3. Communicate and discuss in a safe environment in a mutually respectful manner 4. Encourage self-reflection 5. Agree on a plan for remediation 6. Document the interventions 7. Construct a clear plan for follow-up.

Source: Buchanan AO, Stallworth J, Christy C, Garfunkel LC, Hanson JL. Professionalism in Practice: Strategies for Assessment, Remediation, and Promotion. Pediatrics. 2012; 129(3): 407-409.

continued on Page 18

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Twelve Tips for Addressing Unprofessional Behavior 1. M odel professional behavior with learners

6. Utilize colleagues for support

2. A cknowledge the hidden curriculum (the information absorbed by learners based on direct observations within the clinical context)

7. Be a good listener when meeting with the learner

3. K now institutional policies 4. G ather evidence and objective data 5. K now when to obtain perspective on a behavior that is not explicit

8. Create a safe environment 9. Provide direct and explicit feedback 10. Make connections to help facilitate change 11. Know when you’re in over your head 12. Establish clear follow-up

Source: Rougas S, Gentilesco B, Green E, Flores L. Twelve tips for addressing medical student and resident physician lapses in professionalism. Med Teach. 2015; 37: 901-907.

GRADUATE MEDICAL EDUCATION from Page 17 • Review with program leadership monthly adherence to requirements (eg, reporting duty hours, procedure log, assignments).

• Meet with program leadership to discuss professional appearance, punctuality, and wellness techniques; identify barriers to success.

• Responsiveness to Unique Characteristics and Needs of Patients (Embraces cultural competency, humanism, and compassion) • Meet with a set number of patients and summarize reflections of the experience with regards to patients’ perspectives, and the physician role in the patient experience as part of a ‘‘patient advocate shift.”

• Shadow a social worker or patient representative to learn how to advocate for patients and gain patient perspectives; write a reflection.

• Participate in written/simulated case scenarios with emphasis on the impact of physician’s beliefs on patient care and experience.

• Perform a self-reflection analysis regarding perceived difficult patients; develop a plan to care for these patients in an unbiased manner.

SAEM PULSE | NOVEMBER-DECEMBER 2018

Self-Awareness and Betterment

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(Utilizes knowledge of one’s strengths and limitations; practices reflection; and is open to receive feedback) • Perform a monthly self-assessment of professionalism with examples of cases handled effectively and those in need of improvement.

• Participate in patient case scenarios (standardized patients, simulation, or oral cases); debrief performance using a checklist and develop a performance improvement plan.

Follow up with role modeling or self-remediated example.

• Obtain and discuss frequent multisource feedback (faculty, nursing, peer, self).

• Adaptability (Accepts ambiguity and utilizes resources when dealing with uncertainty) • Participate in patient case scenarios (standardized patient, simulation, or oral cases) with an emphasis on shared decision making.

• Review graduated level of responsibility policies and discuss when to request assistance from senior residents or attending physicians.

• Review literature on medical uncertainty and help develop an educational session for residents.

• Document a complex patient case log with analysis on care issues.

A different definition of professionalism involves the professional identity formation (PIF) based perspective.

This perspective is process-based and focuses on the development of a professional identity. This perspective complements the attitude-based and behavior-based perspectives on professionalism. The multi-level professionalism framework, presented by Barnhoorn et al, can serve as a comprehensive framework to guide the remediation of unprofessional behavior, by encouraging reflection on behaviors that influence professionalism. These behaviors include mission, identity, beliefs and values, competencies, behavior, and the environment. The multi-level professionalism framework may offer a practical framework that bridges the various perspectives on professionalism, yet it requires highly skilled remediators. Proficient faculty members must be chosen for remediation, while being offered opportunities for continued development of this important skill.11 Remediation practices for the difficult employee employed by the field of business can be successfully extrapolated to medicine. In her Harvard Business Review article, Gallo illustrates a conceptual framework for managing the difficult employee. The first step is to dig deep and take a closer look at the behavior and what’s causing it. Is the person unhappy in the job? Struggling in their personal life? Frustrated with coworkers? Managers should meet with the employee to check on their personal welfare. If the employee is struggling, the manager should offer to help, provide resources or coaching to address the root of the problem. The next step is to provide direct feedback. In many cases, toxic people are oblivious to the effect they have on others. That’s why it’s crucial to give direct and honest feedback — so they understand the problem and have an opportunity to change.

Explain the consequences. If the carrot is ineffective, try the stick. Accept that some individuals will not change.

One should always hope that a person will change, but in extreme cases, one should recognize that the behavior cannot be remediated and begin exploring more serious

consequences. Document everything — you must document all offenses, responses offered, and remediation provided. Include supporting material such as formal complaints and 360 evaluations. Separate the toxic individual from other members of the team — this is done to prevent the spread of negative or unprofessional behavior throughout other members of the team. Finally, don’t get distracted. Managing a toxic person can eat up your time, energy, and productivity; therefore, surround yourself with positive people.12 In his book, Bridging the Soft Skills Gap, Tulgan defines how to teach the missing basics of professionalism to today’s young talent. He defines the missing basics of professionalism as self-evaluation, personal responsibility, positive attitude, good work habits, and people skills. Self-evaluation involves the regular assessment of one’s own thoughts, words, and actions against clear, meaningful standards. Personal responsibility is defined as staying focused on what one can control directly and controlling one’s responses in the face of factors outside of one’s own control.

Positive attitude involves the maintenance of a positive, generous, enthusiastic demeanor in one’s expressions, gestures, words, and tone. Good work habits are described by wellness, self-presentation, timeliness, organization, productivity, quality, follow-through, and initiative.

People skills involves attentive listening, observing, and reading; perceiving and empathizing. He follows these definitions by providing exercises and lesson plans to address each of these basics of professionalism in the workplace.13 Barriers to remediating professionalism lapses include inappropriate or paucity of tools, the time necessary to intervene, concern over impact to the learner’s future career, professed lack of skills to address the issue, the potential for impaired relationships, and fear of retribution or litigation.9 While many strategies and conceptual frameworks for the remediation of unprofessional behavior exist, education faculty must be aware of the available resources and remain cognizant of the importance of early identification and remediation of unprofessional behavior, given the potential effects to patient care and future careers. Educators must overcome the barriers to remediation in order preserve the professionalism that is vital to our profession.

REFERENCES

1. R egan L, Hexom B, Nazario S, Chinai SA, Visconti A, Sullivan C. Remediation Methods for Milestones Related to Interpersonal and Communication Skills and Professionalism. J Grad Med Educ. 2016; 8(1): 18-23.

2. S ullivan C, Murano T, Comes J, Smith JL, Katz ED. Emergency medicine directors’ perceptions on professionalism: a Council of Emergency Medicine Residency Directors survey. Acad Emerg Med. 2001; 18(suppl 1): 97-103.

3. Torbeck L, Canal DF. Remediation practices for surgery residents. Am J Surg. 2009; 197(3): 397-402.

4. L urie SJ, Mooney CJ, Lyness JM. Measurement of the general competencies of the Accreditation Council for Graduate Medical Education: a systematic review. Acad Med. 2009; 84(3): 301–309.

5. Z iring D, Danoff D, Grosseman S, Langer D, Esposito A, Jan MK, Rosenzweig S, Novack D. How do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools. Acad Med. 2015; 90(7): 913-920.

6. H odges BD, Ginsburg S, Cruess R, et al. Assessment of professionalism: Recommendations from the Ottawa 2010 conference. Med Teach. 2011; 33: 354–363.

7. P apadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med. 2004; 79: 244–249.

8. R ougas S, Gentilesco B, Green E, Flores L. Twelve tips for addressing medical student and resident physician lapses in professionalism. Med Teach. 2015; 37: 901-907.

9. B uchanan AO, Stallworth J, Christy C, Garfunkel LC, Hanson JL. Professionalism in Practice: Strategies for Assessment, Remediation, and Promotion. Pediatrics. 2012; 129(3): 407-409.

10. G insburg S, Regehr G, Hatala R, et al. Context, conflict, and resolution: a new conceptual framework for evaluating professionalism. Acad Med. 2000; 75(suppl 10): S6–S11.

11. B arnhoorn PC, Houtlosser M, Ottenhoff-de Jonge MW, Essers G, Numans ME, Kramer A. A practical framework for remediating unprofessional behavior and for developing professionalism competencies and a professional identity.

Med Teach. 2018. 1-5.

12. G allo A. How to Manage a Toxic Employee. Harvard Business Review. 2016. October 3.

13. Tulgan B. Bridging the Soft Skills Gap. How to Teach the Missing Basics to Today’s Young Talent. Hoboken, New Jersey: Jossey Bass – Wiley. 2015.

ABOUT THE AUTHOR: Andrew King, MD, is an associate professor, the associate residency program director, and the medical education fellowship director in the Department of Emergency Medicine at The Ohio State University.

Principles to Remember Do:

• Talk to the person to try to understand what’s causing the behavior • Give concrete, specific feedback and offer the opportunity to change • Look for ways to minimize interactions between the toxic employee and the rest of your team

Don’t:

• Bring the situation up with your other team members.

Allow them to mention it first and then provide suggestions • Try to fire the person unless you’ve documented the behavior, its impact, and your response • Get so wrapped up in handling the issue that you ignore more important work and responsibilities Source: Gallo A. How to Manage a Toxic Employee.

Harvard Business Review. 2016. October 3.

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GRANTS AND FUNDING How to Develop an SAEMF Grant Application: Five Lessons Learned as a Junior Researcher

By Joseph R. Pare, MD, MHS Dr. Pare is the recipient of the SAEM Foundation’s 2018-2019 Academy of Emergency Ultrasound (AEUS) Research Grant for his study: "Superior Venous Access: Midline vs Ultrasound IVs, a Randomized Clinical Trial.” For information about SAEM Foundation (SAEMF) grants and other funding opportunities, visit the SAEMF website.

Lesson 1: You don’t get something without deserving it.

"While the focus of any training grant is on you as the young budding investigator, having a solid mentor or mentorship team is so paramount that if mentorship is not in SAEM PULSE | NOVEMBER-DECEMBER 2018

place, nothing else

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will matter."

The very first application I submitted was an SAEMF research training grant.

It was not highly scored; in fact, it was hard to read the comments, they were so (deservedly) bad. At the time, I had published three case reports and two book chapters. Although some applicants are successful in spite of limited publications, to become a competitive applicant I was encouraged to obtain research experience. I learned that it is important to display a positive track record. Initial research projects are often unfunded, so starting with ideas that have minimal costs or joining an existing project is a good place to start to build relationships with future co-investigators.

Lesson 2: Learn to write.

In addition to learning that I didn't have the skills to complete the proposed work, I learned that I was not a good writer. I had to learn to convince referees that my work was feasible, that I had the skills to conduct the research, and that the question merited funding. In order to improve my writing, I sought out previous grantees and read their applications. Then, I got back on the horse and took writing workshops, and I asked others to review my drafts (the Academy for Emergency Ultrasound has a network of mentors available on its website). I also signed up for the SAEM Grant Committee to gain experience reviewing applications and

to hear the critiques that accomplished researchers provide.

Lesson 3: Take advantage of resources.

I spoke with other junior researchers to find out how they succeeded. I learned about the CTSI (Clinical and Translational Science Institute). Many universities have a CTSI program to help researchers. The CTSI at my institution provides funding opportunities exclusive to junior faculty, pilot funding, grant writing courses, and a network of faculty willing to read applications and provide feedback. The CTSI also has staff to help prepare applications and holds workshops on topics such as setting up a database, review study design, and statistical support.

Lesson 4: Prepare your application early.

Many awards are offered annually. Select an award you have the experience to compete for and give yourself several months to prepare. New applicants may need up to a year to write a competitive application for a larger grant. Be prepared to edit several drafts and allow enough time for reviewers to read and discuss them and provide feedback. Remember that most grants and contracts departments will require an internal review a week or more before the deadline. Now is a great time to start preparing a grant for the 2019-2020 SAEMF cycle.

Lesson 5: Don't get discouraged.

Applying for grants takes a lot of work and it may not initially seem like the effort is worth it. Writing will become easier with more experience. Don’t expect to get your first application scored for funding as there are usually several other people competing for the same award. Try to find new funding opportunities that you may be qualified for or that give thorough feedback

to improve your “grantsmanship.” SAEMF has offered several new grants recently and applications come with a full review, which can help you become a better writer.

For more resources on grantwriting and developing a proposal, visit SAEM’s Grant Writing Resources.

ABOUT THE AUTHOR: Joseph R. Pare, MD, MHS is as an attending physician at Boston Medical Center (BMC) and Director of Ultrasound Research in the Department of Emergency Medicine at Boston University School of Medicine. Dr. Pare completed residency at BMC and two years at Yale as ultrasound fellow earning his Master of Health Science degree.

Since fellowship he has received grants from SAEMF and EMF/HFSA (Emergency Medicine Foundation/ Heart Failure Society of America).

About AEUS The Academy for Emergency Ultrasound (AEUS) was established as a forum for bringing together clinician sonologists with the common goal of advancing patient care and safety through the use of bedside ultrasound. For more information, visit the AEUS webpage. As an SAEM member, you may now join AEUS for free. Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

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RESEARCH IN ACADEMIC EM Bench to Bedside Research in Acute Illness: Lessons from a Young Investigator

By David H. Jang, MD, MSc, FACMT As a medical toxicologist and an emergency medicine (EM) physician, I have always had a strong passion for bridging the gap between the excellent basic research that typically occurs outside our specialty and the wide range of acute care illnesses we take care of a daily basis — ranging from sepsis, to trauma, to poisoning (a small bias there).

"While the focus of any training grant is on you as the young, budding investigator, having a solid mentor or mentorship team is so paramount that if mentorship is not in SAEM PULSE | NOVEMBER-DECEMBER 2018

place, nothing else

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will matter."

A sizable limitation in our line of business is the time-sensitive nature of many of these diseases, which creates a significant barrier to applying bench-side research.

One of the first steps in overcoming this obstacle is to obtain a career development award (K-award), which provides the time and training to make this type of research a reality. While “how to” obtain a K award (or equivalent) is a whole other discussion in itself, I did find challenges specific to a more traditional basic science approach in acute care research that I would like to share for others, so that they may hopefully avoid some of the pitfalls I faced. The tips below are based on my own experiences.

Background: The Research Just for context, my research is focused on abnormal mitochondrial bioenergetic and motility signatures in acute care illnesses.

(Who knew that my biochemistry class would be useful?) My current K-award allows me the training and time to truly integrate the study of mitochondrial function in blood cells obtained from a wide range of acute care illnesses for the purpose of diagnostics, prognosis, and even therapeutics. It is a very exciting avenue of research whereby I feel I can bring what I have been learning during my K-award to the bedside, in the specialty I trained for.

Tips for Success Find a mentor.

While the focus of any training grant is on you as the young budding investigator, it is my experience that having a solid mentor

"It is important to demonstrate success and propose a training plan that will make you the next noble laurate… or at least someone who has a high probability of getting their first R01." or mentorship team is so paramount (they can literally make or break your research experience) that if mentorship is not in place, nothing else will matter. With basic science research, you will likely only have 1-2 primary mentors as opposed to a large network of mentors, as is more common in clinical emergency medicine research.

In an ideal world, the perfect mentor is someone who will guide your training, develop your science, hit you in the nose with a newspaper when you make a mistake, etc. You will spend a fair amount of time with this mentor so it is important to make sure he or she is a good fit. Since this is basic science research, your mentor should also have his or her own lab, research supplies to conduct experiments, and assistants to help you learn basic lab techniques (the PI is not going to show you how to culture a cell). The mentor will also, ideally, have a track record of independent funding and training young investigators.

Identify a training plan.

It is important to demonstrate success and propose a training plan that will make you the next noble laurate…or at least someone who has a high probability of getting their first R01. Like a Las Vegas, high stakes poker player, reviewers prefer

Research Resources

Figure 1: A novel technique using a combination of fluorescence microscopy and ImageJ/MATLAB to track individual mitochondrion movement in human blood cells obtained in a health control (top) contrasted with two patients with carbon monoxide poisoning (middle and bottom). It is a heat map where the cooler colors (blue) represent less net mitochondrial movement with compared to red (greater net movement).

Jang DH, Greenwood JC, Owiredu S, Ranganathan A, Eckmann DM. Mitochondrial Networking in Human Blood Cells with Application in Acute Care Illnesses. Mitochondrion. 2017 Dec 21. pii: S1567-7249(17)30227-1. [PMID: 29275149] Funding: (1) K08HL136858 (PI); (2) Office of Naval Research N00014 (Co-I)

to “bet” on a sure thing, i.e., someone who has a track record of academic success, of publishing in quality publications, etc. Remember: a career development award is an investment in you to become the future generation of leading clinician-scientists. Because basic science research tends to go slower it does not achieve many first-author publications. To counter this, and to begin to establish a track record for yourself in the area you are proposing, go for low hanging fruit that you can publish quickly.

research in the application of using human blood cells from patients with poisoning.

Establish a research approach.

Another of the particulars surrounding translational research is having access to a lab in which to perform your work.

In today’s competitive funding climate, it is a rarity to find a principle investigator (PI) who is willing to take on a young researcher who is doing his or her “own thing.” Yet, in most cases, you will rely on the PI of the lab to support you with basic supplies like pipette tips, glassware, etc., so it is beneficial to find an area of research within EM that overlaps with the PI’s work.

In addition to finding the right mentor, and identifying an “exciting research plan that not only serves as a training mechanism but also paves the way for your first R01,” I was also challenged to establish what NIH wanted in terms of research approach. Should it be Innovative? Ground-breaking? Cancercuring? In many cases, the approach is applying a new or exciting technique to look at a known public health problem.

In my case it was taking mitochondrial

Secure a work environment and institutional support.

This is without a doubt one of the biggest challenges for emergency medicine researchers. Short of having a career award in place (AHA, NIH K08/23, etc.), it is difficult to find a department that will support your salary to pursue research unless you come with an institutional training grant like a T32 or K12.

The SAEM Research Committee has collated a list of resources to help with the design, implementation, evaluation, and dissemination of research studies.

These resources are geared toward more junior investigators, but may be helpful to senior researchers as well.

I also make it a point to see what other investigators at my shop are doing and reach out to them for collaboration. It is likely that you will be engaging their technicians and/or post-docs in your work, so including these investigators in future studies/manuscripts goes a long way.

Bonus tip.

Talk to everyone! My “informal mentors” and the people I leaned on for advice and/or to review my grants, were a major asset. The established investigators in EM toxicology went out of their ways to help me, by providing copies of their grants, giving me advice, writing letters, and more.

It was clear that the more senior folks in EM want us youngins to succeed!

ABOUT THE AUTHOR: David H. Jang, MD, MSc FACMT, is an assistant professor, Department of Emergency Medicine, Division of Medical Toxicology and Critical Care Medicine (ResCCU), at the University of Pennsylvania Perelman School of Medicine. Dr. Jang submitted this article on behalf of the SAEM Research Committee.

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SOCIAL MEDIA IN ACADEMIC EM

Maximize Your Twitter Life With Tweetdeck

By Eric Lee, MD @EricLeeMD

"For those of you who manage multiple Twitter accounts, Tweetdeck makes it quicker and easier to follow notifications and to tweet from

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different accounts."

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Tweetdeck is a social media management tool designed especially for Twitter. You log in with your Twitter account. It features a customizable dashboard that lets you follow hashtags or trending topics, manage your notifications or direct messages, and respond and tweet. And it conveniently puts everything in one place, on one screen. You can create an infinite number of columns for hashtags, multiple Twitter accounts, and notifications, and you can toggle between or reorder these however you like. The best way to learn about Tweetdeck is just to go there (www.Tweetdeck.com), log in, and give it a try!

Tweetdeck is ideal for following hashtags at conferences. You simply create a column using the specific hashtag for an annual meeting — for example, #ACEP18 or #SAEM19. All of the tweets with that hashtag will then pop up in that column in real time. Whether you are part of the annual meeting social media team that is live-tweeting or just want to be a part of the online conversation, you can then follow all the tweets for that particular conference. I unfortunately wasn’t able to attend #ACEP18 this year because the emergency department still needed to be staffed. Nevertheless, I was able to follow along for the clinical pearls and hot topics at #ACEP18 thanks to all of the active social media users. I also have an #EMConf column activated to follow the weekly pearls from emergency medicine conferences across the country.

For those of you who manage multiple Twitter accounts, Tweetdeck makes it quicker and easier to follow notifications

and to tweet from different accounts.

This is helpful for users who have their own personal accounts but who are also responsible for managing a residency or organization Twitter account. In residency, I managed the @SinaiEM Twitter account and often toggled between @EricLeeMD and @SinaiEM, especially when we were hosting conferences.

Tweetdeck is also helpful for scheduling tweets in advance. If you are a regular creator of content, you can actually use Tweetdeck to schedule a pre-created tweet to go out at a certain time so you don’t have to be on Twitter all day long. You can care for patients or teach residents at conference while your tweets automatically post.

Give Tweetdeck a try. It’s free, it’s easy to use, and it’s web-based, which means you can use it anywhere there’s internet.

It was originally designed for, and now is actually owned by, Twitter. There are many other social media management tools out there (e.g., Hootsuite or Buffer). Some have a cost attached, but allow you to manage other social media platforms (e.g.

Facebook) as well. Check them all out and pick your favorite.

I have no financial disclosures or any relationship with Tweetdeck or Twitter because I’m not financially savvy in that way. I’m just an EM doctor trying to make #SoMe easier for other academic EM doctors out there.

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

SGEM: DID YOU KNOW? Sex differences in Acute Presentations of Kidney Disease

By Lisa M. Curtis, PhD and Vineeta Kumar, MD Kidney-related conditions in the acute setting may be multiple, but the two most commonly occurring clinical scenarios, urinary tract infection (UTI) and acute kidney injury (AKI), have important sex-based differences that emergency medicine providers should be familiar with.

UTI is more common in women than men, primarily due to anatomic differences in urethral length and proximity to vaginal and rectal areas. In postmenopausal women, loss of estrogen-dependent vaginal wall integrity and resultant diminished immunity may also contribute. Higher urinary Tamm-Horsfall protein (THP) levels, also known as uromodulin, in men have also been associated with lesser susceptibility, as it is believed the excretion of this protein may provide defense against UTIs caused by uropathogenic bacteria.

Alternatively, AKI has predominance in male versus female patients. Mechanistic understanding of AKI is well described in preclinical studies of male animals, but more recent studies in female animals suggest significant sex-based differences in the pathophysiology of AKI, with inflammation and immune cell responses, as well as drug-handling by the kidney, playing important roles.

Diagnosis of AKI relies on measures of kidney function, including creatinine and estimated glomerular filtration rate (eGFR). Creatinine as a marker for renal function provides incomplete status in women due to lesser muscle mass, which may lead to under appreciation of compromised renal function (see footnote), an effect that is more pronounced in older women. The resulting, often unintended, overdosing of medication, iatrogenic contrast exposure, as well as decreased fluid resuscitation in women with volume depletion or from conditions requiring aggressive volume resuscitation including acute rhabdomyolysis or DKA, may result in unrecognized kidney injury.

The historic lack of studies on female animal models, lack of inclusion of women in clinical trials and resultant lack of sex-based analysis likely contributes to our lack

of precision in understanding important differences in these conditions in men and women. Appreciating the current known sex-specific characteristics of the most common acute renal- and urologic-based conditions can play an important role in the acute care setting work-up, evaluation, and management.

Footnote: For the same level of a “normal” creatinine value, significant degrees of renal dysfunction may be present. For example, a creatinine of 1 mg/dl in a 30 and 60-year-old translates into an estimated GFR of 69 and 60 ml/min/m2, respectively in females, and 93 and of 81 ml/ min/m2, respectively in males.

REFERENCES:

UTI 1. Foxman B. Infect Dis Clin N Am 28:1–13, 2014.

2. Garimella PS, et al. Am J Kidney Dis. 69(6): 744–751, 2017.

3. Gebäck C, et al. J Hypertens 32:1658–1664, 2014.

4. Gebäck C, et al. Pediatr Nephrol. 30(9):1493-9, 2015.

5. Raz R. Korean J Urol 52:801-808, 2011.

AKI 1. Kang KP, et al. Mol Med Rep. 9(6):2061-8, 2014.

2. Boddu R, et al. Am J Physiol Renal Physiol. 313(3):F740-F755, 2017.

ABOUT THE AUTHORS: Lisa M. Curtis, PhD, is an assistant professor of medicine and Vineeta Kumar, MD, is a professor of medicine at the Medicine University of Alabama at Birmingham.

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

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WILDERNESS EMERGENCY MEDICINE Interest Groups Offer Medical Students an Introduction to Wilderness Medicine

By Hamza Ijaz, MS4 There are several ways for medical students to explore an interest in wilderness medicine, but one particularly useful resource is through their school’s Wilderness Medicine Interest Group (WMIG).

"The experience of practicing medicine in a resource-limited environment can be both challenging

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and thrilling."

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While most students spend the first two years of medical school in classes, the WMIG can serve as a gateway to early clinical exposure. Learning hands-on skills such as performing a primary and secondary assessment of a patient, splinting a fractured bone, or controlling a hemorrhaging wound, offers an experience early on in a student’s training that they ordinarily would not have and provides a refreshing reminder of why they chose to pursue medicine in the first place. Not only do these hands-on skills develop an interest in wilderness medicine, they can also help build a foundation for entering a more resource-rich clinical setting.

Dr. Lara Phillips, faculty advisor of the Wilderness and Disaster Medicine Interest Group at the Sidney Kimmel Medical College at Thomas Jefferson University’s Wilderness and Disaster Medicine Society, points out that the “concepts behind splinting a bone or controlling a bleed aren’t different in the wilderness compared to the emergency department; it’s only the available resources that differ.”

The experience of practicing medicine in a resource-limited environment can be both challenging and thrilling. For those students who are interested in disaster medicine, wilderness medicine is an excellent way to become involved, as both require practicing medicine in austere and resource-limited settings.

WMIGs at the local level can also serve as a practical and accessible introduction into the field of wilderness medicine. If there isn’t a WMIG at your school, start one! According to Dr. Phillips, the success of most WMIGs depend primarily on the students and “letting them take charge of their learning.” Additionally, it is often through this type of experience that creative learning opportunities arise.

Dr. Lara Philips

Dr. Elisabeth Edelstein, an emergency physician at the University of Colorado health system and co-director for the

Wilderness Medical Society medical student elective in Roanoke, VA and Breckenridge, CO, suggests that organizing a WMIG is easier with the help of a local mentor who has “enthusiasm for showing up for concentrated times of learning both in and out of the classroom.” Fortunately, this mentor doesn’t necessarily need to come from emergency medicine, which makes finding one a bit easier. The mentor can be a family physician, a surgeon, an attending, a fellow, a resident, an advanced practice provider, or a paramedic…you name it!

If students are looking for additional ways to get involved in wilderness medicine, there are plenty of other opportunities (such as writing for SAEM Pulse!). Presently more than a dozen wilderness medicine electives exist in the United States. Dr Edelstein co-directs (along with Stephanie Lareau, MD, and Erin Meyer. DO) the Virginia Wilderness Medicine elective, co-sponsored by the Wilderness Medical Society (WMS) and the Carilion Clinic (Virginia Tech School of Medicine).

She also co-directs, along with Dr. Phillips and Josh Rudner, MD, the Breckenridge Wilderness Medicine elective, co-sponsored

by WMS and Sidney Kimmel Medical College of Thomas Jefferson University.

There are also several regional wilderness medicine conferences across the country, including the Mid-Atlantic Student Wilderness Medicine Conference and the Southeastern Student Wilderness Medicine Conference, both of which consist of weekend-long experiences involving classroom didactics and hands-on skills sessions. National leaders in the field of wilderness medicine volunteer their time to make these conferences successful. On a national level, SAEM and ACEP both have WMIGs. There are countless ways to get involved in WMIGs, and students are the driving force behind these organizations. If you make the effort, it will likely pay off for the duration of your career.

ABOUT THE AUTHOR: Hamza Ijaz is a fourth-year medical student at The George Washington University School of Medicine and Health Sciences. He is pursuing a residency in emergency medicine and has a specific interest in wilderness medicine.

Dr. Phillips and the team preparing for an exciting day outdoors to practice their wilderness medicine skills

Getting creative in making a litter to carry an injured person to safety.

Wilderness Medicine Resources • Medical Student Rotations in Wilderness Medicine • Resident and Fellow Opportunities in Wilderness Medicine • CME Courses • Fellowship Opportunities • Research and Scholarship Opportunities in Wilderness Medicine • Wilderness Medicine in Emergency Medicine Physician Opportunities • 2018-2019 Wilderness Medicine Conferences and Events • Wilderness topics on SOAR (SAEM Online Academic Resources)

Dr. Elisabeth Edelstein

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

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WOMEN IN ACADEMIC EM Supporting Women Through Amplification

By Laura Medford-Davis, MD, MS @MedfordDavis (This article first appeared in the September 2018 issue of AWAEM Awareness newsletter.)

In fields like emergency medicine where women remain the minority, particularly in leadership roles, a supportive workplace is critical to maintaining and promoting women. However, women face two challenges to promotion, both of which can be countered by amplification: 1. We allow men to take credit for our ideas.1 2. We don’t brag about ourselves well.

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"The reason amplification is needed is that men tend to speak more loudly in meetings, which can lead to the perception that they

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contribute more."

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“Amplification” was made famous by women working in the Obama White House, a historically male-dominated field.

To ensure their voices were heard and they were appropriately credited for ideas, they stacked hands on this strategy. When a woman made a key point in a meeting, if it was not immediately acknowledged, other women would repeat it, giving credit to the author.3 The reason amplification is needed is that men tend to speak more loudly in meetings, which can lead to the perception that they contribute more.1 Women may suggest an idea, only to have a man repeat and elaborate upon the same idea. Unless the man begins with a specific acknowledgment that he is adding to the woman’s idea, this can lead to the man receiving credit for the entire idea. If you observe this happening in your department or committee meetings, chime in quickly to reattribute the idea to the original author. For example, “Sara makes a good point, we should consider [description of Sara’s idea].”

Amplification can extend beyond real-time idea attribution to give women public credit for their accomplishments in additional ways. Men tend to speak more frequently about their own accomplishments, while women risk being judged unfavorably when perceived to be bragging.2 To achieve equal credit, you can enlist your colleagues to spread the word about your awards, publications, and

Learn more!

1. Speaking While Female 2. W hy It’s Harder for Women to “Brag’ About Themselves at Work — and Why We Really Need To 3. W hite House Women Want to be in the Room Where it Happens 4. H ow a White House Women’s Office Strategy Went Viral 5. H ow Not to Be 'Manterrupted' in Meetings 6. B ragging Rights: Why Women Don’t Talk Themselves Up and How to Do It Effectively

other accomplishments on your behalf.

Colleagues can call out an achievement on your department’s listserv, at the beginning of a department meeting, or in small circles at a social event with coworkers. When tagged, the @AWAEM and @SAEMonline Twitter handles will amplify members accomplishments on social media.

Start a conversation today with your leaders, peers, and mentees to find avenues where you can best amplify one another’s ideas and accomplishments.

ABOUT THE AUTHOR: Laura Medford-Davis, MD, MS, is an assistant professor of emergency medicine at Baylor College of Medicine. She serves on the 2018-2019 Executive Committee of AWAEM as vice president, communications.

About AWAEM The Academy for Women in Academic Emergency Medicine (AWAEM) was established to promote the recruitment, retention, advancement and leadership of women in academic emergency medicine. The success of academic emergency medicine and the ability of the specialty to train future emergency physicians are intrinsically linked with the success of women faculty as they now represent half of the medical student body and almost half of physicians.

For more information, visit the AWAEM webpage. As an SAEM member, you may now join AWAEM for free, at no additional cost beyond your membership dues! Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

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LIFE HACKS FOR THE RESIDENCY INTERVIEW TRAIL

By Victoria Serven, MD Fourth year medical students, you will soon be embarking on one of the most important journeys of your lives: the residency interview trail. This article focuses on (almost) everything you need to know about your interview. It will hopefully get you through the next few months of travel with as few disasters and embarrassments as possible.

Despite the hype that “fourth year is the greatest thing to happen to a medical student since their acceptance letter,” you will soon come to realize that the interview trail can be tough. Long days of smiling, sweating, and socializing, followed by uncomfortable hotel beds and cramped airplanes (or fast-food littered automobiles) will have you screaming “CAN IT BE MARCH ALREADY!” As a freshly-minted intern, I can still recall the taste of anxiety and the smell of my interview suit as I migrated from city-to-city begging people to love me.

Below are some life hacks I wish I had known before suiting up in the most impractical hiking shoes ever.

Care About Credit Cards

"AS A FRESHLY-MINTED INTERN, I CAN STILL RECALL THE TASTE OF ANXIETY AND THE SMELL OF MY INTERVIEW SUIT AS I MIGRATED FROM CITY-TO-CITY BEGGING PEOPLE TO LOVE ME."

It’s definitely worth the effort to look into a credit card that will help lower your travel costs. You’re about to spend thousands of dollars; getting things for free whenever possible makes a huge difference. Pay attention to interest rates, annual fees, and, obviously, rewards. I found that White Coat Investor has a good post about reward credit cards and Nerd Wallet also has solid advice.

Pre-Check is Priceless Speaking of spending money, TSA Pre-Check is definitely worth the extra $$$.

There will be times when you have really quick turnarounds between interviews and need to be able to hop on flights in a hurry… TSA Pre-Check will help you avoid long waits in terrible lines and ensure that you make it on time to your next destination. Pay the extra $100 and apply for Pre-Check at the TSA website. If you play your cards right, some credit cards will even reimburse this fee for you!

Packing Proverbs

Driving, it’s Cheaper than Flying

Make a checklist.

I learned while traveling for away rotations that even when I stopped and asked myself “Did I forget anything?” The answer was always yes. I always left something behind. For interview season, I sat down and wrote out a packing checklist, which put my mind at ease and cut my packing time in half.

Although I love jamming out and singing off key to Whitney and Mariah as much anyone else, eventually boredom strikes, requiring something more engaging to stay alert at the steering wheel. My solution: podcasts. There is a podcast for anything and everything, including several great emergency medicine podcasts (including SAEM- and RAMS-recommended!). Audio books work too, but you usually have to pay for those.

Use the right luggage.

The single most amazing thing I bought for interview season was a garment duffle bag. The bottom folds open so you can lay your suit down flat. Then, through some crazy zipper magic, the bag is transformed into a duffle that you can toss the rest of your stuff in. This must-have was so much easier to manage than a traditional garment bag, and it kept my suit in perfect condition.

Polish Your Look Don’t be memorable for being the sloppy interviewee. Here are a few items I always kept in my purse or car to make sure I was looking fresh.

• A lint roller. To rid your suit of all the little fuzzies and pieces of hair that get stuck to it.

• A hairbrush. Most interview tours will take you outside at some point. Early in the season this means hot, humid weather, and late in the season it means the polar vortex will be blasting your face with 50 mph winds. You probably don’t want to meet the program director of your dreams looking like Hagrid’s hair twin.

• Febreze. You won’t always have time to dry clean between travels, but I found that a few squirts of heavy duty Febreze to the arm pits (and let’s be honest, to the back) of my suit worked to get me through between cleanings.

Car rides can also be a great time to catch up with the family and friends you’ve been ignoring since June. Nothing keeps me awake like a fresh pot of neighborhood gossip. (Thanks Mom!) And don't forget: Get that routine car maintenance and have those tires checked before hitting the road!

Hotel Hacks Rack up the points.

Pick a national hotel chain and sign up for their rewards membership. Then stay at that same chain in every city you travel to. You should be able to get at least one free night out of it. Alternatively, hotels.com will give you a free night for every 10 bookings. Of course, when a friend’s couch is available, choose that instead. Free is always better.

Check in early.

If you’re arriving in a city before your check-in time, either request an early check in when you book the hotel or call the morning of to request one. Getting a pre-interview nap in is probably one of the best things you can do for yourself on the trail.

continued on Page 32

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LIFE HACKS from Page 31 Invest in ear plugs.

Hotels are noisy. Between the air conditioner that is cutting on-andoff every 30 minutes and the “kids” sprinting through the hallways at 3 a.m., hotels can sometimes be where sleep goes to die. If you have any trouble sleeping, do yourself a favor and order a box of earplugs on Amazon; it’ll be the best $8.07 you ever spent.

Interview Day Instructions Conduct a pre-interview reconnaissance.

If you have time the day before your interview, drive by and check out the entrance to the building where your interview is being held and where you will need to park. This will save you time and stress on the actual interview day.

Leave early.

Getting lost is bad, but also traffic, weather, construction, etc. happen at the worst possible moments. I usually left 45 minutes early and sat awkwardly in my car until it was time to go in (20-30 minutes is probably enough time for your average person). Also, don’t be scared to be the first one to show up. It’s a total power move and you get the best bagel.

Beware “The Interview 15.”

Interview season food is really good, but not necessarily good for you.

Barbeque, burgers, tacos, casseroles — all topped off with a brownie for

dessert. You also won’t be working out like you usually do because your time will be spent traveling, interviewing, and making up for the time you missed on rotations. So, do what you can, when you can: • Pack healthy snacks for the airport.

This will also save you money.

• Just say no to fast food during road trips. Stop at a grocery store to raid the fresh fruit and vegetables (this is also a great bathroom break site).

• Make your time count by shortening your workouts, while upping the intensity level. You might not have time to run for an hour but you can probably fit in 20 minutes of sprints, squats, and burpees to give your metabolism the kick in the pants it needs. (Fitness Blender is a great place to start).

Lastly, be Prepared to Troubleshoot One interview morning I was feeling particularly confident, I had a great time at the dinner the night before and was feeling really pumped about the day. I arrived to the correct location with plenty of time to spare. About 15 minutes before I needed to enter the building, Taylor Swift told me to “Shake it Off,” so I gave myself one last wink in the mirror for luck, and I exited my car with enough oomph to take on the world. The next thing I heard was a ripping sound coming from beneath me: my knee-length, conservative pencil

skirt had just ripped up the middle.

At that moment, I recalled the story I heard about one of my residents who had split her pants after falling on ice while walking into an interview. Instead of panicking, she dug a pair of jeans out from her bag, cracked a few jokes about it, and rolled through the rest of her interview day. Apparently, the program was really impressed by the way she handled herself and the program director still speaks very highly of her.

With that story in mind, I dug a few safety pins out of my bag and pulled myself together (literally). Despite feeling a little extra breezy, I didn’t let it affect my day, and I ended up matching at that program! The life hack from this story is “Don’t panic.” No one wants a coworker who falls apart after a minor setback. If you get a flat tire, spill some coffee, split your pants, break a heel… laugh it off and carry on. Above all else, you want to show the people interviewing you that you are able to handle stressful situations with poise and confidence.

Good luck on your upcoming journey and just remember it will all be worth it come March 15!

ABOUT THE AUTHOR: Victoria Serven, MD, is a PGY1 at Carolinas Medical Center. Dr. Serven serves on the RAMS Wellness and Resilience Committee. She is an active member of SAEM.

WHY ACADEMIC EM?

HOW WORKING IN EMS FACILITATED A LIFELONG INTEREST IN PREHOSPITAL MEDICINE RESEARCH

Nella Hendley

In this “Why Academic EM?” column, medical student Nella Hendley and PGY-1 Dr. Nick Ashburn, Wake Forest School of Medicine, explain their shared passion for prehospital medicine, and how their previous work as Emergency Medical Technicians (EMTs) has influenced their drive to advance one of the four most newly recognized subspecialties of the American Board of Emergency Medicine: Emergency Medical Services (EMS).

The patient care that happens in the back of the ambulance is a crucial aspect of our healthcare system. Academic emergency medicine allows us to play an integral role in shaping the interventions and care that occur between “patientcontact” and arrival at the emergency department (ED). Prior to medical school, Dr. Nick Ashburn we both served as EMTs, but were limited to aspirin, nitroglycerin, and oxygen on standard chest pain calls. Today, as prehospital medicine researchers, we are investigating prehospital chest pain risk stratification, point-ofcare field troponin testing, and prehospital ultrasound.

Working together in Emergency Medical Services (EMS) with fast-paced patient care and critically-ill patients, inspired our lifelong-interest in EMS. As a medical student and an emergency medicine resident, we have a passion for advancing prehospital medicine through academic research.

EMS personnel are tasked with quickly separating the patients who need emergent care and those who are less acute. Prehospital decisions often need to be made quickly, similar to the ED, but there is limited, if any, access to lab work, imaging, and consultation; we have experienced those difficult situations and know firsthand the importance of making the right decision in a short amount of time. Our research can help guide and direct EMS personnel on the best way to proceed in optimizing patient outcomes. Exploring questions in EMS gives us the opportunity to improve patient care on a larger scale— even developing protocols for every patient transported on an ambulance.

At Wake Forest School of Medicine, the emergency medicine (EM) faculty is dedicated to simultaneously improving patient care while mentoring rising academicians. The guidance of Wake Forest’s EM faculty allows us to pursue our research interests, including projects on prehospital epinephrine dosing, pediatric drowning, and thrombolysis. EMS sparked our interest in EM, and this passion has been sustained through the encouragement and support of the Wake Forest EM community.

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CONGRATULATIONS TO THE RECIPIENTS OF THE 2018 ARMED SCHOLARSHIP The Society of Academic Emergency Medicine (SAEM) Awards Committee congratulates Cosby Arnold MD, MPH of the University of Tennessee Health Science Center, and Jinny Ye, MD, of Duke Health, as the recipients of the new Advanced Research Methodology Evaluation and Design (ARMED) Cosby Arnold MD, MPH Scholarship. The committee sought applicants with thorough promise of becoming academic research clinicians across many strata in emergency medicine. Although numerous wellqualified applicants were received from across the United States, Dr. Arnold and Dr. Ye stood out to the selection committee as particularly well-suited scholars who are uniquely-equipped to serve the mission of the SAEM ARMED Jinny Ye, MD Scholarship.

Dr. Arnold’s pursuit of academic emergency medicine research stems from her long-standing focus on public health initiatives. After two years of working and bearing witness to the public health needs of the incoming patient population of a tertiary emergency department, Dr. Arnold pursued a Master’s in Public Health degree at Columbia University prior

to matriculation into medical school. During medical school and residency, Dr. Arnold applied her skills in public health towards multiple academic initiatives; such as research, writing a book chapter, and contributing to journal club. The selection committee viewed this as authentic dedication towards serving the needs of vulnerable patient populations.

It also demonstrates a clear desire to improve the academic landscape of emergency medicine. Dr. Arnold’s current research evaluates the use of pulse oximeter plethysmograph waveform as a suitable alternative to auscultation by Doppler for measurement of the ankle-branchial index (ABI).

The selection committee was impressed by the strength Dr. Ye demonstrates in marrying emergency medicine research with global health initiatives. This comes in the form of her multiple publications exploring the geospatial analysis and treatment of mortality in Brazilian snake envenomation. Dr. Ye has also explored the epidemiology of intimate partner violence against women in Brazil. She has also researched the causes for pre-ART loss to follow-up among HIV-positive patients in Mozambique. Similarly, Dr. Ye pursued a program in international Asian Studies at the Chinese University of Hong Kong prior to matriculation into medical school. Now as a current PGY-3, Dr. Ye will take a year to focus on research projects that explore the intersection of global health and emergency medicine.

5 STEPS TO GETTING YOUR FINANCES TOGETHER AFTER RESIDENCY After four years of undergraduate school, four years of medical school, and three to five years of residency, you’re finally done. You’re making more money than at any other time in your life, but you’ve also accumulated student loans and personal debt in the hundreds of thousands of dollars. You know it’s time to begin focusing on your personal finances, but where do you start and how do you figure out which steps to take toward a solid financial future? We’ve come up with several tips to assist you in getting your finances in order after residency.

1 2

Effectively manage your accumulated debt.

Focus on paying down your debt by targeting your most expensive debt first. Your most expensive debt tends to have the highest interest rate and is not tax deductible.

Your guiding principle should be to pay down any non-tax deductible debt with rates above 5 percent before allocating income towards investments and leisure.

Beware of lifestyle inflation.

Once you’ve graduated from a residency program your income is likely to increase tenfold. That big house and fancy car will suddenly seem within your reach. Financial firms with dollar signs in their collective eyes will start soliciting you as a client. “Lifestyle Inflation” will become a big temptation. Avoid it at all costs.

Lifestyle inflation happens when you increase your spending as your income grows. It’s easy to get caught up in lifestyle inflation. After all, you worked hard for 12+ years, you deserve the finer things that money can buy. Two words of caution: Slow down. Take a deep breath and keep this in mind: If you spend all the extra money you make, it’s going to be very hard to get out from under your debt. Why? Well, for one thing, that big percentage increase in income isn’t really what it seems. Remember: Up to one-third of your earnings will go to the IRS. Combine this with the fact that you already have some catching up to do when it comes to saving for retirement and suddenly you’re looking at an increased spending potential that is less than half of what it originally seemed. Plus, consider this: Lifestyle inflation right after residency can prevent you from paying down your student loans faster. And, the longer you drag out your student loan payments, the more interest you’ll pay over time.

So don’t let pent-up deferred gratification entice you to expand your lifestyle to match the extra zeros in your paycheck. It’s a trap and it can reduce the amount you can save while increasing the amount you need to get out from under debt and eventually achieve financial independence.

3 4

Set Up a Sound and Diversified Financial Plan.

A solid financial plan is the key to enhancing your lifetime standard of living. Components of sound financial planning should include:

• Insurance (term and disability).

• Maximize your ROTH IRA contributions.

Get Professional Guidance.

• Maximize employer sponsored retirement plan contributions.

• Invest in inexpensive, well diversified index funds.

Seek professional help from a financial advisor. A financial advisor will help you create strategies for eliminating financial risk and building wealth over the long term. When assessing a financial adviser, there are questions you should ask:

• Is he/she a Certified Financial Planner (CFP)?

– CFPs are licensed, regulated and mandated to take classes and receive certification on various facets of financial planning.

• What is the planner’s pay structure?

– A planner who earns money based on commission rather than a flat or hourly rate could be incentivised to point you towards particular products.

• Is there a Code of Ethics the planner follows?

– Financial planners adhere to codes of ethics. Look for the word “fiduciary” and language that requires planners to look out for your best interests.

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Additional Information.

• Before deciding on moving to a new city, use a “Cost of Living Calculator” to aid in determining affordability.

• Knowing the financial impact of your status as an independent contractor vs. employee can have an additional impact on your finances.

• Seek out advice online. There is an abundance of online advice regarding financial wellness and wealth management for physicians. Some of our sponsors have provided links below: – ApolloMD - Managing Debt After Residency.

– US Acute Care Solutions - Wealth Management for Doctors.

Overwhelmed? Don’t be. Take things one step at a time. Develop a plan to tackle each area over a short period. Periodically revisit your objectives and plans.

Remain disciplined and flexible. Above all, don’t get discouraged. Take care to put your finances in order now and your time will eventually come.

In Association With

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BRIEFS AND BULLET POINTS SAEM Teams Up With ALiEM to Bring You Two Exciting Educational initiatives!

ALiEM AIR Sponsorship

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

Clinical Images Partnership

Effective with SAEM19 in Las Vegas, any images that are accepted for display at SAEM’s popular Clinical Images Exhibit and have patient consent sign-off will also be featured on ALiEM’s (Academic Life in Emergency Medicine’s) wide-reaching blog. The ALiEM blog receives one million page views annually from more than 14,000 cities in more than 200 countries worldwide.

SAEM is proud to bring the best-of-the-best to our members by fostering relationships with organizations like ALiEM and working hand-in-hand with them to bring you “out of the box” educational ideas and innovative products and services.

spectrum of diversity of our membership.

We encourage you to nominate a diverse pool of candidates for all SAEM awards.

Nominations are Open for SAEM, RAMS, Academy, SAEMF, and AACEM Leadership Positions

SAEM is looking for leaders who are committed to the organization and have the relevant skills and range of perspectives to lead! Do you know someone who fits that description? Is it you? Nominations are now open for the SAEM leadership positions below.

Nominate yourself or any SAEM member by clicking one of the links. Deadline for nominations is November 20, 2018.

• SAEM Board of Directors • RAMS Board • AACEM Executive Committee • Academy Executive Committees • SAEM Foundation Board of Trustees •S AEM Nominating Committee and Bylaws Committee

SAEM19 UPDATES SAEM19 Workshop and Didactic Submissions Top All-Time Records

SAEM NEWS

SAEM Academies and Interest Groups Are Free!

As an SAEM member, you may now join as many academies* and interest groups (IGs) as you choose, at no additional cost beyond your membership dues! Just log into your member profile and click on the “Update Academies and Interest Groups” button. It’s just one more way SAEM is working to stretch your dues dollars and increase the value of your membership!

Read all the exciting details! *Excludes AAAEM.

Introducing New AAAEM Member Categories and Benefits!

The Academy of Administrators in Academic Emergency Medicine (AAAEM) has announced the addition of two new categories of membership: Emeritus and

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Associate. The change takes effect with calendar year dues for January 1, 2019 through December 31, 2019. Get the full details on our webpage.

Call for Nominations: SAEM Awards

The Society for Academic Emergency Medicine is accepting nominations for 2019 SAEM Awards. SAEM awards recognize outstanding individuals across the nation for their contributions to academic emergency medicine. National award recognition is an excellent boost for your CV and for potential promotion.

Nominate yourself or a colleague by December 9, 2018 to be considered for this year’s awards. SAEM presents awards in recognition of excellence in our field, for contributions improving the health of society, and for academic achievements. The awards committee is committed to an inclusive process of granting awards, reflecting the full

SAEM19 is still six months away, but it's already smashing records with a 30 percent increase in Advanced EM Workshop Day submissions AND a record number of didactic submissions. Thanks to the efforts of many people, SAEM's annual meeting in Las Vegas is ramping up to be another one for the record books.

Announcing a $100 Credit for Child Care at SAEM19

SAEM is excited to announce that, in partnership with Rosh Review, a $100 credit will be offered at SAEM19 for any attendees who purchase inroom child care services from Nannies & Housekeepers USA. To receive reimbursement, attendees simply bring their receipt to the SAEM19 registration desk onsite in Las Vegas. More information is available on the SAEM19 website!

Save the Date for SAEM’s First Ever MedWAR! SAEM RAMS, along with the SAEM

Wilderness Medicine Interest Group, the SAEM19 Program Committee, and the MedWAR organization, are excited to present the first ever MedWAR, to be held Friday, May 17 at Red Rock Canyon during SAEM19 in Las Vegas. MedWAR, short for Medical Wilderness Adventure Race, is a unique event that combines wilderness medical challenges with adventure racing. The race was developed as a tool for teaching and testing the knowledge, skills, and techniques of wilderness medicine, and for promoting teamwork and collegiality among competitors. Registration for teams of three opens December 1. Save the date, and watch for more information about this exciting competition in the coming weeks. If your institution is interested in sponsoring your team for this inaugural event, please have them complete the sponsorship registration form.

the Future: Cultural and Systems-based Challenges and Solutions, is Tuesday, May 14, 2019, at The Mirage, Las Vegas, NV. The goal of the 2019 SAEM Consensus Conference is to stimulate a research agenda among key stakeholder groups in order to catalyze large-scale solutions to the crisis of unwellness in medicine.

Cultural change to promote wellness in emergency providers must include not just physicians, but residents, nurses, mid-level providers, departmental leadership, and hospital administration. We must maintain a vision of the future that looks beyond wellness interventions at the level of the individual. The themes of the conference have been informed by our Conference Planning Committee of nationally known experts in physician wellness.

Wilderness Medicine IG Invites You to Take a Walk on the Wild Side

The official website for SAEM19 is up and running. Bookmark saem.org/saem19 and check back often for the most upto-date information on SAEM’s annual meeting, May 14-17, 2019 in Las Vegas.

Bookmark SAEM19 Website for Annual Meeting Updates

Exhibit at SAEM19 Put your products and services in front of emergency medicine decision makers, thought leaders, and early adopters…

Exhibit at SAEM19 in Las Vegas — our 30th annual meeting. Visit our exhibitor webpage for information. To become an SAEM19 exhibitor or sponsor, contact John Landry at 847-257-7224, ext. 204.

Registration opens December 1 for the SAEM19 Red Rock Hike, sponsored by the SAEM Wilderness Medicine Interest Group and the SAEM Program Committee. The hike takes place from 4–6 p.m., May 14, 2019 at Red Rock Canyon National Park. The park is a maze of canyons and peaks, known for its spectacular natural beauty, rugged red rock formations, desert vegetation and spectacular vistas around every bend.

Shuttles will be available to transport participants to and from The Mirage host hotel and Red Rock Canyon National Park.

2019 SAEM Consensus Conference is May 14 Mark your calendar! The 2019 SAEM Consensus Conference: Wellness for

SAEM FOUNDATION

Research Committee and Bylaws Committee Win SAEMF Committee Challenge!

The SAEM Research Committee raised $16,947 (the most ever raised by any single committee!) and the Bylaws Committee had 100 percent participation, to win the 2018 SAEM Foundation Committee Challenge. Together SAEM Committees raised a total of $21,201 for research and education grants.

Congratulations to the Research Committee and Bylaws Committee and thank you to everyone who contributed to the 2018 SAEMF Committee Challenge.

If you’d like to know how you can give to the SAEM Foundation, please visit the SAEMF website.

19 SAVE THESE DATES! Register Your Teams for These Events Starting December 1 SimWARS Wednesday, May 15, 2019 Dodgeball Thursday, May 16, 2019 SonoGames® Friday, May 17, 2019

Registration for These Events Opens December 1 Red Rock Hiking Tour Tuesday, May 14, 2019 Speed Mentoring Wednesday, May 15, 2019 AWAEM/ADIEM Luncheon Wednesday, May 15, 2019 Residency and Fellowship Fair Thursday, May 16, 2019

Submissions Open November 1 for…

Abstracts Closes January 2, 2019 IGNITE! Closes January 14, 2019 Innovations Closes January 14, 2019

Donate While you Shop at smile.

Amazon.com.

Did you know that Amazon will donate a percentage of your purchases to SAEM Foundation when you shop online? Just start at http://smile.amazon.com and select SAEM Research Foundation as your charity of choice! It’s an easy way to support your emergeny medicine academicians.

continued on Page 38

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SAEM ACADEMIES

Academy of Geriatric Emergency Medicine

The focus of the Academy of Geriatric Emergency Medicine (AGEM) seeks to be the preeminent resource for geriatric emergency medicine knowledge, education, research, and patient care.

AGEM promotes its members by highlighting their impactful studies in our “Author Spotlight” on the AGEM website.

Each month we shine a spotlight on the work of a different author. Some of the studies we’ve covered include: work on older adults' attitudes of their fall risk and engagement in fall prevention interventions; how geriatric care needs to have advanced planning and a multidisciplinary approach throughout each stage of clinical care, and the effect of nursing follow-up calls on patient outcomes. We’ve also featured the comprehensive work published in Clinics in Geriatric Medicine examining “Care for the Older Adult in the Emergency

Department.” Joining the AGEM is now free! Just log into your member profile and click on the “Update (+/-) Academies and Interest Groups” button. We invite you to visit our website to learn more.

SAEM INTEREST GROUPS

Critical Care Medicine IG

The SAEM Critical Care Medicine Interest Group (CCMIG) 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. At SAEM18 in Indianapolis, the CCMIG had the pleasure of sponsoring an Advanced EM Workshop Day session entitled “Emergency Department Transesophageal Echocardiography,” as well as three didactic sessions that addressed careers in emergency medicine. We look forward to your participation in our SAEM19 Advanced EM Workshop Day presentation and didactic session, May 2019, in Las Vegas!

The CCMIG is working to identify candidates for both the “Young Investigator Award” and the “Excellence in Research Award.” Please use this form to suggest someone you believe has made outstanding strides within the Critical Care specialty.

Joining the SAEM CCMIG is now free!

Just log into your member profile and click on the “Update (+/-) Academies and Interest Groups” button.

REGIONAL MEETINGS

Southeastern Regional

Plan now to attend the Southeastern Regional Meeting, February 22-23, 2019, at the University of South Carolina School of Medicine, Greenville. Abstract submissions open November 1, 2018.

Regional meetings provide opportunities, particularly for young investigators, to present their original research and to participate in sessions designed to teach them essential research skills.

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 December 1, 2018 for the January/February 2019 issue.

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Annual Alliance Donors THANK YOU The SAEM Foundation (SAEMF) thanks the following donors for supporting their academic emergency medicine foundation. The mission of the SAEM Foundation is to improve emergency patient care through supporting the development of innovative researchers, expert educators, and future academic emergency medicine leaders. Unlike other emergency medicine organizations, the SAEM Foundation supports the people with the most promise and the greatest potential to impact emergency care over the course of their careers. Thank you to all of the donors that have allowed SAEM Foundation to award over $500,000 in grants to SAEM members this year! *Donor Alliance Lifetime Members SUSTAINING DONORS

James Adams, MD William Barsan, MD Steven B. Bird, MD Michelle Blanda, MD* Michael D. Brown, MD, MSc Charles B. Cairns, MD Drs. Gail D’Onofrio and Robert Galvin Nathan Kuppermann, MD, MPH Ali S. Raja, MD, MBA, MPH Brian J. Zink, MD

ADVOCATE DONORS

Benjamin Abella, MD, MPhil Harrison Alter, MS, MD Thomas C. Arnold, MD Steven Bernstein, MD (In honor of E. John Gallagher, MD) James Brown, Jr., MD Chris Carpenter, MD, MSc and Panechanh Carpenter D. Mark Courtney, MD David F.M. Brown, MD Deborah B. Diercks, MD, MSc Nina Gentile, MD Andy Godwin, MD Brian C. Hiestand, MD Cherri D. Hobgood, MD Robert Hockberger, MD* and Patricia Pickles James W. Hoekstra, MD Judd E. Hollander, MD James F. Holmes, MD, MPH Andy S. Jagoda, MD Amy H. Kaji, MD, PhD Gabe Kelen, MD Christopher King, MD Phil Levy, MD Louis Ling, MD Maimonides Department of Emergency Medicine Angela Mills, MD Roland Clayton Merchant, MD, MPH, ScD Robert W. Neumar, MD, PhD Andrew S. Nugent, MD Brian O’Neil, MD - In honor of Gloria Kuhn Megan Ranney, MD, MPH Niels Rathlev, MD

Martin Reznek, MD, MBA Michael Runyon, MD, MPH (In honor of John A. Marx, MD) Megan Schagrin, MBA, CAE, CFRE Manish Shah, MD Scott Silvers, MD David Sklar, MD Peter Sokolove, MD J. Scott VanEpps, MD, PhD Gregory A. Volturo, MD David E. Wilcox, MD, FACEP

MENTOR DONORS

Jill M. Baren, MD Michelle Biros, MS, MD Andra Blomkalns, MD William Bond, MD, MS Brian Browne, MD Michael Callaham, MD Theodore Chan, MD Andrew Chang, MD, MS Anna Marie Chang, MD Theodore Christopher, MD Wendy Coates, MD Theodore Delbridge, MD Matt Gratton, MD Azita Hamedani, MD, MPH, MBA Richard Hamilton, MD Katherine L. Heilpern, MD Nicholas Jouriles, MD Michael Kamali, MD Terry Kowalenko, MD Jamie McCarthy, MD Joseph Miller, MD Melissa McMillian, CNP Nicholas Mohr, MD Heather Murphy-Lavoie (In honor of LSU Emergency Medicine) David Orban, MD Edward Panacek, MD Arthur Pancioli, MD Dimitrios Papanagnou, MD Doug Ray Kirsten Rounds, RN, MS Robert Schafermeyer, MD Janyce Sanford, MD Gary Setnik, MD Kaushal Shah, MD J. Adrian Tyndall, MD Terry Vanden Hoek, MD Gary Vilke, MD

Ron Walls, MD Richard Wolfe, MD Richard Zane, MD University at Buffalo, The State University of New York Anonymous

YOUNG PROFESSIONAL

Nicholas D. Caputo, MD, MSc Jestin Carlson, MD Jeffrey Caterino, MD Douglas Char, MD Corrie Chumpitazi, MD Deborah Dean, MD Yves Duroseau, MD Robert Ehrman, MD Phillip Fairweather, MD Gregory Fermann, MD Brandon J. Godbout, MD Charles Gerardo, MD, MHS Elizabeth Goldberg, MD (In honor of Roland Merchant, MD, MPH, ScD) Gregory Hendey, MD Mark Henry, MD Sheryl Heron, MD, MPH (In honor of ADIEM and its mission to improve equity and inclusion) Michael Jones, MD Doug Kaiden, MD Stu Kessler, MD Kevin Kotkowski, MD Resa E. Lewiss, MD Prashant Mahajan, MD Sean Michael, MD Chad Miller, MD Robert O’Connor, MD, MPH James Paxton, MD Michael Radeos, MD, MPH Kristin Rising, MD, MS Chris Ross, MD Margaret Ruttenberg, MD Elizabeth Schoenfeld, MD, MS David Seaberg, MD Rahul Sharma, MD, MBA Vicken Totten, MD, MS James Tsung, MD Michael VanRooyen, MD, MPH Anonymous

Donors are recognized for their gifts from Jan. 1–Oct. 15, 2018.

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ACADEMIC ANNOUNCEMENTS Baystate Medical Center/University of Massachusetts Medical School-Baystate William E. Soares, MD, MS, assistant professor of emergency medicine at Baystate Medical Center/University of Massachusetts Medical School in Springfield, MA has received an NIDA K08 Career Development award William E. Soares, MD, MS (K08DA045933) to explore emergency medicine providers’ opioid prescribing patterns. Dr. Soares completed his medical school training at Harvard Medical School, his residency in Emergency Medicine at Alameda County Medical Center, and his Fellowship in Emergency Medicine Research through University of Massachusetts Medical SchoolBaystate in 2015.

Lauren M. Westafer, DO, MPH, MS, assistant professor of emergency medicine at Baystate Medical Center/ University of Massachusetts Medical School in Springfield, MA has received an NHLBI K12 Research Training Lauren M. Westafer, DO, MPH, MS grant (K12HL138049) to design targeted theory-based implementation strategies to increase the utilization of risk stratification tools in Emergency Department patients with suspected pulmonary embolism. Dr. Westafer completed her medical school training at Nova Southeastern University College of Osteopathic Medicine, her residency in Emergency Medicine at Baystate Medical Center, and her Fellowship in Emergency Medicine Research through University of Massachusetts Medical School-Baystate in 2018.

Elizabeth M. Schoenfeld, MD, MS, assistant professor of emergency medicine at the University of Massachusetts Medical School- Baystate in Springfield, MA has received an AHRQ K08 Career Development award Elizabeth M. Schoenfeld, MD, MS (K08HS025701) to create a decision aide to facilitate the shared decision-making process with regard to the need for emergent CT imaging in young patients with suspected nephrolithiasis. Dr. Schoenfeld, who has previously been awarded an AHRQ Small Project Research grant (R03HS024311), completed her medical school training at the Warren Alpert Medical School and Brown University, her residency in Emergency Medicine at the George Washington University Hospital, Emergency Ultrasound Fellowship at the University of Maryland, and her Masters in Clinical and Translational Science at the Tufts University Sackler School of Graduate Biomedical Sciences.

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Timothy J. Mader, MD, professor of emergency medicine at Baystate Medical Center/University of Massachusetts Medical School in Springfield, MA has received an American Heart Association Innovative Project grant (18IPA34180011) Timothy J. Mader, MD to study the effect of providing glucoseinsulin-potassium during reperfusion after prolonged ventricular fibrillation cardiac arrest on myocardial energy metabolism and ventricular fibrillation ECG waveform morphology in swine. Dr. Mader, who was the recipient of the 2005-2006 SAEM Scholarly Sabbatical award, has since secured numerous institutional, foundation, and federal grants.

Nadia A. Villarroel, MD, an emergency medicine research fellow at Baystate Medical Center/University of Massachusetts Medical School in Springfield, MA has received an NHLBI T32 Research Training grant (T32HL120823) Nadia A. Villarroel, MD to work with Dr. Timothy J. Mader and use data from the Cardiac Arrest Registry to Enhance Survival to determine if the effect of therapeutic hypothermia/targeted temperature management is modified by three presenting rhythm categories — initially shockable, pulseless electrical activity, and asystole. Dr. Villarroel completed her medical school training at Drexel University College of Medicine and her residency in Emergency Medicine at Baystate Medical Center.

Yale University School of Medicine Steven L. Bernstein, MD, professor of emergency medicine and public health at Yale, has been named the founding director of the new Yale Center for Implementation Science. The center is an interdisciplinary unit that seeks to accelerate the translation of evidenceSteven L. Bernstein, MD based treatments, practices, and policies into real-world clinical practice. A K12 institutional training grant from the National Heart, Lung, and Blood Institute, awarded to Dr. Bernstein in 2017, will serve as the training core of the Center.

Federico Vaca, MD, MPH, professor of emergency medicine and in the Child Study Center at Yale, has been awarded two new NIH grants: an R01 from the National Institute on Alcohol Abuse and Alcoholism, “Trajectory Outcomes of Federico Vaca, MD, MPH Teens That Ride with Impaired Drivers and Drive Impaired,” and an R21 also from NIAAA, “Delaying Licensure: Latino Teens Riding with Impaired Drivers and Impaired Driving.”

Fuad Abujarad, PhD

Fuad Abujarad, PhD, assistant professor of emergency medicine at Yale, has been awarded an R01 from the National Institute of Aging for his study, “Feasibility of Virtual Coaching in Making Informed Choices on Elder Mistreatment SelfDisclosure (VOICES).”

Edward (Ted) Melnick, MD, MHS, assistant professor of emergency medicine, and Gail D’Onofrio, MD, MS, professor and chair of emergency medicine at Yale, have been awarded a UG3/UH3 from the National Institute Edward (Ted) Melnick, MD, MHS on Drug Abuse for their study, “EMBED: Pragmatic Trial of User-Centered Clinical Decision Support to Implement Emergency DepartmentInitiated Buprenorphine for Opioid Use Disorder.”

combating the opioid epidemic. Dr Weiner has also been named Chief of the Division of Health Policy Translation in the BWH Department of Emergency Medicine where his recent academic efforts have culminated in him leading the BWH Center for Opioid Innovation.

Edward W Boyer, MD, PhD, Harvard Medical School associate professor of emergency medicine, has been promoted to Chief of Research and Academic Development at Brigham and Women’s Hospital (BWH). Being responsible for Edward W Boyer, MD, PhD increasing the size of the BWH academic footprint, Dr. Boyer has overseen a striking increase in the amount of NIH funding awarded to the department, with awards made under R01, R34, R03, K24, K23 and LRP mechanisms in the last year alone. Dr. Boyer is funded under an additional K24 mechanism to support his mentoring efforts.

J oseph Goulet, PhD, associate professor of emergency medicine at Yale, has been awarded an ID1 grant from the Veterans Healthcare System for his study, “Association of Complementary and Integrative Health Interventions with Opioid Use and Related Risks Among Veterans with Musculoskeletal Disorders and PTSD.”

University of Massachusetts Kavita Babu, MD, has been promoted to professor of emergency medicine at the University of Massachusetts Medical School. Chief of the Division of Medical Toxicology, Dr. Babu previously served as director of UMass’s leading toxicology fellowship program and is currently a Kavita Babu, MD NIH-funded clinician-scientist study fentanyl contamination of heroin and its relationship to lethal opioid overdose. Dr. Babu is an internationally recognized thought leader on opioid use, misuse, abuse, and overdose prevention. Dr. Babu has also been named chief opioid officer for the University of Massachusetts Medical School.

Dr. Babu will oversee opioid overdose prevention efforts at the medical school, their outreach into the surrounding community, and development of research efforts directed toward preventing mortality from opioid overdose.

Harvard Medical School Scott Weiner, MD, of Brigham and Women’s Hospital (BWH), and an ssociate professor at Harvard Medical School, has been awarded NIH funding under a R01 mechanism which will identify predictors of opioid overdose Scott Weiner, MD using state registry data. Dr. Weiner is a regional, national and international leader in issues related to opioid addition and treatment and has advanced the understanding of the roles of health care providers in

Naomi George, MD

Naomi George, MD, instructor at Harvard Medical School and a fellow in the Brigham and Women’s Hospital critical care fellowship training program, has received a NIH Loan Repayment Program award. Her work will focus on palliative care under the mentorship of Edward W Boyer, MD, PhD.

Brody School of Medicine, East Carolina University Timothy Reeder, MD, MPH will be installed as president of the North Carolina Medical Society on October 19, 2018. An Associate Professor and Executive Vice Chair of Emergency Medicine at Brody School of Medicine, Timothy Reeder, MD, MPH East Carolina University, he is the first academic, emergency medicine physician to lead the 12,000-member society whose mission is: To provide leadership in medicine by uniting, serving, and representing physicians and their health care teams to enhance the health of North Carolinians.

Brown Warren Alpert Medical School of Brown University Jeremiah (Jay) Schuur, MD, MHS, has been appointed chair of the department of emergency medicine at Brown Warren Alpert Medical School of Brown University, and physician-in-chief for emergency medicine at Lifespan Jeremiah (Jay) Schuur, MD, MHS Health System, effective December 1.

Dr. Schuur currently serves as vice chair of clinical affairs in the department of emergency medicine at Brigham and Women’s Hospital, and is an associate professor of emergency medicine at Harvard Medical School.

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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 December 1.

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

Associate Professor and/or Full Professor in the Tenure or Non-Tenure Track

The Department of Emergency Medicine at the Perelman School of Medicine at the University of Pennsylvania seeks candidates for an Associate or Full Professor position in either the non-tenure clinician-educator track or the tenure track.

The successful applicant will be accomplished in the area of Emergency Medicine. Responsibilities include experience in the field of Emergency Medicine and a proven track record of emergency medicine based research and extramural grant funding. Applicants must have an M.D. degree and have demonstrated excellent qualifications in education, research, and clinical care. Be certified in emergency medicine.

Ideal candidates/physician scientist are expected to have in place a foundational scientific vision for building a robust and competitive program to unearth new and fundamental research in the following areas: health services research, critical care, clinical research (particularly clinical trials), medical education, resuscitation, or rural-urban medicine partnerships. This position will provide emergency care to patients presented to the emergency medicine department and will supervise and teach residents and medical students.

Penn Medicine is comprised of three hospital emergency departments and observation units (Hospital of the University of Pennsylvania-HUP; Penn-Presbyterian Medical CenterPPMC; and Pennsylvania Hospital-PAH) with a combined

annual emergency department census of 145,000 visits. Each site has a unique, diverse, highly acute patient population consisting of local and referral patients. Penn Medicine is a world class academic institution with superb clinical facilities and programs, one of the top medical institutions in the United States, and a rich and collegial research environment.

The Department of Emergency Medicine has a 4 year, highly successful, academically oriented residency program with 44 residents, multiple fellowships including one of only six NIH funded K12 clinical research fellowships and several nationally acclaimed research programs housed within its Center for Resuscitation Science and the Center for Emergency Care Policy Research. There are over 90 faculty across the three sites and there are close academic affiliations and programmatic alliances with the Children’s Hospital of Philadelphia and the Philadelphia Veterans Affairs Medical Center. Faculty positions will be structured across multiple sites according to skills, interest and clinical availability.

We seek candidates who embrace and reflect diversity in the broadest sense. The University of Pennsylvania is an EOE. Minorities/Women/Individuals with disabilities/Protected Veterans are encouraged to apply.

Apply for this position online: https://www.med.upenn.edu/apps/faculty_ad/index.php/g321/d5151 42

Brookdale is an ACS level 2 and NYS level 1 Trauma Center, a Comprehensive Stroke Center, and a PCI Center located in Brooklyn, NY. The Emergency Department cares for approximately 100,000 visits annually. In addition to the adult and trauma care areas there is a Fast Track area staffed primarily by PAs and NPs and a Pediatric ED staffed by both EM and pediatric EM physicians. We are seeking ABEM/AOBEM BC/BE physicians to join our team as clinical faculty.

EM & PEDIATRIC EM CLINICAL FACULTY • Provide bedside teaching and supervision of EM residents and medical students from NY Medical College, NYIT College of Osteopathic Medicine, and Ross University • Fulfill all department and institutional compliance, administrative and regulatory expectations • Maintain timely and appropriate documentation and medical records • Very competitive compensation commensurate with experience • Outstanding benefits including paid vacation, CME, holiday, health, and malpractice • Must hold or be eligible for active New York State medical licensure

IN ADDITION, WE ARE SEEKING AN ULTRASOUND AND SIMULATION EDUCATION DIRECTOR. EM ULTRASOUND DIRECTOR • Implement a vision for the overall EM US educational, clinical, financial, and academic programmatic goals • Accountable for the on-going CQI process for EM US scanning • Monitor and ensure effective documentation for coding and billing of professional charges for EM US interpretation • Oversight for the credentialing of EM attendings, residents, and PA/NP providers • Core faculty position in our EM 1-3 residency that will graduate its inaugural class June, 2019

EM SIMULATION EDUCATION DIRECTOR • Implement an overarching vision for the educational and research goals for EM simulation education for the Department of EM • Fellowship training in simulation education or medical education highly desirable • Core faculty position in our EM 1-3 residency that will graduate its inaugural class June, 2019

The patient experience is as important to us as technical, procedural, and cognitive skills. Being a flexible team player with excellent communication skills and being open to learning from nurses, ED personnel, our entire health care team, as well as residents, medical students, and patients is an absolute must. We are an EM practice setting which requires both community hospital and teaching hospital skill sets. You have to be ambidextrous here. You will grow professionally and personally here. This is our commitment to you.

All positions are entitled to a competitive salary structure commensurate with qualifications, CME allowance, and a comprehensive benefit package. To inquire, send your curriculum vitae and cover letter (indicating position of interest) to:

Sandra R. Scott, MD Chair, Department of Emergency Medicine at Brookdale Hospital and Medical Center, Aaron Pavilion, Room 101, 1 Brookdale Plaza, Brooklyn NY 11212 sscott@bhmcny.org Brookdale University Hospital is an EEO/AA Employer. Minorities and women are encouraged to apply. A background check will be conducted prior to employment.

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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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Innovation - does being a part of a "think-outside-the-box team" poised to change the way emergency medicine will be provided in the future excite you? Impact - do you want to shape the future of healthcare? If so, come join our team. The Department of Emergency Medicine at The Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA continues to expand its faculty complement aimed at revolutionizing the way emergency care will be taught to our students, residents and faculty and provided to populations of patients. A new and innovative focus on telemedicine, population health, emergency medical services, access to care, patient flow, clinical research and patient outcomes is ongoing. We are interested in emergency physicians that wish to be a part of a department that will revolutionize acute unscheduled care.

We provide faculty and resident coverage at two emergency departments – TJUH (center city campus), a 700-bed academic quaternary-care, Level I trauma center that treats 60,000 patients annually, and the Methodist Hospital Division of TJUH, a 200-bed community hospital that treats 43,000 patients annually. Faculty also provide coverage at seven urgent care centers run by the department as well as the clinical decision unit (CDU) at Thomas Jefferson University Hospital and have the opportunity to provide on-demand direct-to-consumer and ED tele-triage through our Telehealth Program. Faculty will be responsible for patient care and bedside teaching of students and residents and will have the opportunity to develop their academic focus. Additional information on the department can be found at: http://www.jefferson.edu/university/jmc/departments/emergency_medicine.html We seek the following:

Director of Emergency Medical Services

The Director of EMS will be the forward-facing leader for prehospital care. This person will have a multifaceted mission with core responsibilities in EMS education, EMS outreach and EMS research. Additionally, they will provide oversight and education for medical command and work collaboratively with the JeffSTAT training center on prehospital provider education. This person will also represent Jefferson EMS locally, regionally and nationally while concurrently building relationships and bolstering Jefferson's presence in these domains. With Jefferson's focus on innovation and care transformation in mind, specific touch points are working in partnerships with JeffSTAT and the city of Philadelphia to be a part of the national conversation to re-invent out of hospital care in terms of EMS innovation.

Associate/Assistant Director of Clinical Research

The Assistant/Associate Director of Clinical Research will work with the Director for Clinical Research to expand and enhance a robust, interdisciplinary clinical research program and will provide supervision and education to a team of research coordinators and volunteer students. In addition to involvement in clinical trials, this person will provide mentorship for academic faculty members' research. The successful candidate should have the requisite experience and training to continue a successful research career and have a strong foundation of scholarship in clinical research. Of particular interest are candidates who have experience with varied funding mechanisms including industry, foundation, and federal grants.

Clinical Faculty Clinical faculty provide patient care and bedside teaching of students and residents in the ED, clinical decision unit and urgent care. Additionally, clinical faculty have opportunities to become involved in administration, clinical operations, undergraduate and graduate medical education.

The Sidney Kimmel Medical College at Thomas Jefferson University values a diverse and inclusive community as it allows us to achieve our missions in patient care, education, and research and best allows us to serve the healthcare needs of the public. Thomas Jefferson University and Hospitals is an Equal Opportunity Employer. Jefferson values a diverse and inclusive community diversity and encourages applications from women, those underrepresented in medicine, Lesbian, Gay, Bisexual and Transgender (LGBT) individuals, disabled individuals, and veterans. Interested candidates are invited to send their curriculum vitae to: Bernard L. Lopez, MD, MS, CPE, FACEP, FAAEM Executive Vice Chair, Department of Emergency Medicine Bernard.lopez@jefferson.edu

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Assistant, Associate, and Full Professor of Emergency Medicine - Tenure Track

The Department of Emergency Medicine at the Perelman School of Medicine at the University of Pennsylvania seeks candidates for an Assistant, Associate and/or Full Professor position in the tenure track. The successful applicant will have experience in the field of Emergency Medicine. Responsibilities include research, academic, and clinical activities. Applicants must have an M.D. degree and have demonstrated excellent qualification in research, clinical care, and education. Applicants should be BE/BC in Emergency Medicine.

Of particular interest are candidates with post-residency research methodology training or training in one of the following areas: critical care, clinical research (particularly clinical trials) and resuscitation. A reduced clinical schedule is available for these positions. Tenure track application will be expected to establish and maintain independent, extramurally funded research.

Penn Medicine is comprised of three hospital emergency departments and observation units (Hospital of the University of Pennsylvania - HUP; Penn-Presbyterian Medical CenterPPMC; and Pennsylvania Hospital-PAH) with a combined annual emergency department census of 145,000 visits. Each site has a

unique, diverse, highly acute patient population consisting of local and referral patients. Penn Medicine is a world class academic institution with superb clinical facilities and programs, the number two ranked medical school in the nation, and a rich and collegial research environment.

The Department of Emergency Medicine has a 4 year, highly successful, academically oriented residency program with 44 residents, multiple fellowships, and several nationally acclaimed research programs housed within its Center for Resuscitation Science and the Center for Emergency Care Policy Research.

There are over 90 faculty across the three sites and there are close academic affiliations and programmatic alliances with the Children’s Hospital of Philadelphia and the Philadelphia Veterans Affairs Medical Center. Faculty positions will be structured across multiple sites according to skills, interest and clinical availability.

We seek candidates who embrace and reflect diversity in the broadest sense. The University of Pennsylvania is an EOE. Minorities/ Women/ Individuals with disabilities/ Protected Veterans are encouraged to apply.

Apply for this position online at: https://www.med.upenn.edu/apps/faculty_ad/index.php/g/d4959

Employment Opportunity: Assistant Program Director The Department of Emergency Medicine at the University of Nebraska Medical Center located in Omaha, Nebraska is seeking emergency medicine candidates for an academic and clinical faculty position. Potential candidates should hold an M.D. or D.O. degree. Board eligibility/board certification through ABEM or AOBEM is required. UNMC Emergency Medicine has an accredited three-year residency program with 29 residents.

In addition, the Department of Emergency Medicine is looking to expand its residency leadership by recruiting an Assistant Program Director (APD). This faculty member would be part of the Core Academic Faculty in the Department with clinical work in the EDs at our academic health center, The Nebraska Medical Center (Level I trauma center) and a community ED at Bellevue Medical Center. This faculty member would be expected to meet all of the core faculty metrics listed in the ACGME guidelines. They would be joining an experienced and supportive residency team including Program Director, Associate Program Director, Assistant Program Director, Program Coordinator, Assistant Program Coordinator and Vice Chair of Education. While prior experience in residency education is beneficial, it is not required and new graduates are welcome to apply.

This faculty member will benefit from departmental support in establishing an academic niche, with expected future collaboration and engagement at the regional and national levels. We welcome those who would be interested in developing innovative approaches to residency education and evaluation. There is access to a master’s degree program based in medical education on campus and the ability to work with education fellowship trained faculty. A new virtual reality/simulation center is expected to open in Spring 2019, with additional opportunities for educational methodology development and research.

Individuals from diverse backgrounds are encouraged to apply.

Questions may be addressed to : Michael Wadman, M.D., Professor and Chairman Department of Emergency Medicine, University of Nebraska Medical Center 981150 Nebraska Medical Center, Omaha, NE 68198-1150 (402-559-6705)

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Applications are being accepted on-line at http://unmc.peopleadmin.com/postings/26257

Brody School of Medicine

EMERGENCY MEDICINE FACULTY ◊ Clinician-Educator ◊ Clinical-Researcher ◊ Critical Care Medicine ◊ WASHINGTON DC – The Department of Emergency Medicine at the George Washington University is offering Fellowship positions beginning July 2019: Disaster & Operational Medicine

International Emergency Medicine

Medical Leadership & Operations

Medical Toxicology

Emergency Ultrasound

Operations Research

Telemedicine/Digital Health

Health Policy

Extreme Environmental Medicine

Clinical Research

Simulation in Medical Education

Fellows receive an academic appointment at The George Washington University School of Medicine & Health Sciences and work clinically at a site staffed by the Department. The Department offers Fellows an integrated, interdisciplinary curriculum, focusing on research methodologies and grant writing. Tuition support for an MPH or equivalent degree may be provided, as per the fellowship’s curriculum.

Complete descriptions of all programs, application instructions, and Fellowship Director contacts can be found at: https://smhs.gwu.edu/emed/education-training/fellowships

◊ Pediatric Emergency Medicine ◊ Ultrasound ◊ The Department of Emergency Medicine at East Carolina University Brody School of Medicine seeks BC/BP emergency physicians and pediatric emergency physicians for tenure or clinical track positions at the rank of assistant professor or above, depending on qualifications. We continue to expand our faculty to meet the clinical needs of our patients and the educational needs of our learners. We envision further program development in clinical education, emergency ultrasound, EM-critical care, pediatric EM, and clinical research. Our current faculty possesses diverse interests and expertise leading to extensive state and national-level involvement. The emergency medicine residency includes 12 EM and 2 EM/IM residents per year. We treat more than 130,000 patients per year in a state-of-the-art ED at Vidant Medical Center. VMC is a 960+ bed level 1 trauma center and regional referral center for cardiac, stroke, and pediatric care. Our tertiary care catchment area includes more than 1.5 million people in eastern North Carolina. Additionally, we provide clinical coverage at two community hospitals within our health system. We are responsible for medical direction of East Care, our integrated mobile critical care and air medical service, and multiple county EMS systems. Our exceptional children’s ED opened in July 2012 and serves approximately 25,000 children per year. Greenville, NC is a university community offering a pleasant lifestyle and excellent cultural and recreational opportunities. Beautiful North Carolina beaches are nearby. Compensation is competitive and commensurate with qualifications; excellent fringe benefits are provided.

Successful applicants will be board certified or prepared in Emergency Medicine or Pediatric Emergency Medicine. They will possess outstanding clinical and teaching skills and qualify for appropriate privileges from ECU Physicians and VMC.

Confidential inquiry may be made to: Theodore Delbridge, MD, MPH Chair, Department of Emergency Medicine delbridget@ecu.edu ECU is an EEO/AA employer and accommodates individuals with disabilities. Applicants must comply with the Immigration Reform and Control Act. Proper documentation of identity and employability required at the time of employment. Current references must be provided upon request.

Featured Director and Faculty Opportunities www.ecu.edu/ecuem/ ● 252-744-1418

Ultrasound Fellowship Director

Clinical and Core Faculty

Toxicology Fellowship EM Physician forFL Osceola Regional Trained Medical Center.

Kissimmee, Core Faculty EM Residency Program affiliated with the University of

Clinical Faculty Oak Hill Hospital. Tampa Bay, FL

Featured DirectorFL.andColiseum Faculty Opportunities Osceola Regional Medical Center. Kissimmee, Medical Center. Macon, GA. EM Residency Program affiliated with the University of Central New EM Residency Program affiliated with Mercer University’s Florida College of Medicine. Contact Shawn Stampfli at School of Medicine. Estimated start date July 2019. Contact Christie EM Residency Program Director and EM Residency Assistant Program Director 404.663.4770 Sharpe at 865.531.9984 Ultrasound Fellowship Director and Ultrasound Director AventuraCentral Hospital Medical Center.

Miami, Floridaand College of Medicine.

Contact ShawnFL. EM Residency Program affiliated with the Herbert Wertheim Stampfli at 404.663.4770 or Amy Anstett at 954.295.1524 College of Medicine at Florida International University and Nova Southeastern University. Contact Ody Pierre-Louis at 727.507.3621

Toxicology Fellow for Core Faculty Clinical Aventura Faculty Hospital and Medical Center. Miami, FL

Oak Hill EM Hospital.

Tampa FL. with the Herbert Residency ProgramBay, affiliated New EM Residency Program affiliated with the University of South Wertheim College of Medicine at Florida International Florida Morsani College Medicine.

Estimated start date July 2018.

University andofNova Southeastern University.

Contact Ody Pierre-Louis at 727.507.3621 Contact Ody Pierre-Louis at 727.507.3621

Clinical Faculty

St. Lucie Medical Center. Port St. Lucie, FL. New EM Residency Program affiliated with the University PBCGME affiliated Osteopathic EM Residency Program. Contact of South Florida Morsani College of Medicine.

Amy Anstett at 954.295.1524 Contact Ody Pierre-Louis at 727.507.3621

Clinical and Core Faculty Clinical Faculty Southeastern Regional Medical Center. Lumberton, NC. St. with Lucie Medical Port Lucie, FL Affiliated Duke HealthCenter.

University EMSt. Residency Program.

Contact Barbara Lay at 727.507.3608 PBCGME affiliated Osteopathic EM Residency Program.

Contact Amy Anstett at 954.295.1524

Send CV to: MakeAChange@evhc.net Call: 844.437.3233

Brandon Regional Hospital. Tampa Bay, FL. New EM Residency Program affiliated with the University of South For more information contact: Florida Morsani College of Medicine.

Start date E: MakeAChange@evhc.netJuly 2018. Contact Esther Aguilar at 727.519.4851 O: 877.226.6059

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Faculty Positions-Emergency Medicine The George Washington University Medical Faculty Associates, an independent non-profit academic clinical practice group affiliated with The George Washington University, is seeking full-time academic Emergency Medicine physicians. The Department of Emergency Medicine (http://smhs.gwu.edu/emed/) provides staffing for the emergency units of George Washington University Hospital, United Medical Center, the Walter Reed National Military Medical Center, and the Washington DC Veterans Administration Medical Center. The Department’s educational programs include a four-year residency and ten fellowship programs.

Responsibilities include providing clinical and consultative service; teaching Fellows, Residents, and Medical Students; and maintaining an active research program. These non-tenure track appointments will be made at a rank (Instructor/Assistant/Associate/Full Professor) and salary commensurate with experience.

Basic Qualifications: Applicants must be ABEM or AOBEM certified, or have completed an ACGME or AOA certified Emergency Medicine residency, and be eligible for licensure in the District of Columbia, at the time of appointment.

Application Procedure: Complete the online faculty application at http://www.gwu.jobs/postings/56800 and upload a CV and cover letter. Review of applications will be ongoing beginning November 30, 2018 and will continue until positions are filled. Only complete applications will be considered. Employment offers are contingent on the satisfactory outcome of a standard background screening. Questions about these positions may be directed to Department Chair, Robert Shesser M.D., at rshesser@mfa.gwu.edu.

The George Washington University and the George Washington University Medical Faculty Associates are Equal Employment Opportunity/Affirmative Action employers that do not unlawfully discriminate in any of its programs or activities on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity or expression, or on any other basis prohibited by applicable law.

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 December 1, 2018 for the January/February 2019 issue.

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

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

Job Alert!

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

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CHIEF of EMERGENCY MEDICINE UCSF Helen Diller Medical Center University of California, San Francisco

The Department of Emergency Medicine at the University of California, San Francisco (UCSF), School of Medicine, seeks an outstanding leader to serve as Chief of Emergency Medicine at UCSF Helen Diller Medical Center. The position offers an exceptional leadership opportunity within the UCSF Department of Emergency Medicine with the Chief serving as a member of the Department’s executive leadership team and reporting to the Department Chair. The Chief will have major responsibilities for faculty recruitment and evaluation, oversight of clinical operations, research, and education programs at UCSF Helen Diller Medical Center.

UCSF Helen Diller Medical Center, ranked as the best hospital in California, has a 29-bed ED and 10-bed Observation Unit, and serves about 45,000 patients per year. The ED is a stroke and STEMI receiving center and serves patients with a broad range of emergency conditions, including many complex medical and surgical disorders. The Department’s other San Francisco ED sites include Zuckerberg San Francisco General Hospital and Trauma Center and UCSF Benioff Children’s Hospital San Francisco.

The Department of Emergency Medicine has a fully accredited 4-year Emergency Medicine residency program, which currently has 56 residents, and offers fellowships in medical education, EMS, global health, toxicology, research, pediatric emergency medicine and ultrasound. Research is a major priority of the department with over 100 peer-reviewed publications each year.

Successful candidates for this position must demonstrate exceptional leadership, administrative and organizational skills and have a national reputation in academic emergency medicine in the areas of patient care, medical education and research. The applicant must have a minimum of 5 years leadership experience in an academic emergency department, be board certified in Emergency Medicine and qualify for appointment at the Associate Professor or Professor level. An advanced degree in management, public health or a related health care discipline is desirable. Expertise in performance improvement frameworks and methods and successful experience in applying them is also preferred. Candidates should be able to partner with staff from all disciplines and with other operational leaders to promote exceptional patient care, a culture of safety, and outstanding physician satisfaction and engagement.

The University of California, San Francisco, is one of the nation’s top five medical schools and demonstrates excellence in basic science and clinical research, global health sciences, policy, advocacy, and medical education scholarship. The San Francisco Bay Area is well-known for its great food, mild climate, beautiful scenery, vibrant cultural environment, and its outdoor recreational activities.

Send cover letter and curriculum vitae to: Jacqueline Grupp-Phelan, MD, Search Committee Chair c/o Natalya Khait UCSF Department of Emergency Medicine 533 Parnassus Avenue, Suite U575 San Francisco, CA 94143-0749 Natalya.khait@emergency.ucsf.edu UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an Equal Opportunity/Affirmative Action Employer. The University undertakes affirmative action to assure equal employment opportunity for under-represented minorities and women, for persons with disabilities, and for covered veterans. All qualified applicants are encouraged to apply, including minorities and women. For additional information, please visit our website at http://emergency.ucsf.edu

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19 Celebrating

of bringing EM ACADEMICIANS together!

Las Vegas, Nevada – May 14-17