The Pulse - April 2017

APRIL 2017

IN THIS ISSUE: Would You do it Again?

Pg 7 ACEOP’s 2017 Scientific Seminar Pg 11 White Coat to White House Pg 13

White Coat to White House:

A profile of ACOEP member Kamal Kalsi, DO, and his fight for inclusion.

Presidential Viewpoints | John C. Prestosh, DO, FACOEP-D

Remembering our Roots, Forging our Future (Page 3)

2017

Save the Date Monday, November 6, 2017 • Denver, Colorado Celebrate a year of achievement, commitment, and progress at at the the 2017 2017 FOEM FOEM Legacy Legacy Gala: Gala Dinner and Awards Ceremony.

Tickets available soon!

Sponsored By

The Pulse VOLUME XXXVIII No. 2 Editorial Staff Timothy Cheslock, DO, FACOEP, Editor Wayne Jones, DO, FACOEP-D, Assistant Editor Tanner Gronowski, DO, Associate Editor Drew A. Koch, DO, MBA, FACOEP-D, Board Liaison John C. Prestosh, DO, FACOEP-D Christine F. Giesa, DO, FACOEP-D Erin Sernoffsky, Editor Janice Wachtler, Executive Director Gabi Crowley, Digital Media Coordinator Editorial Committee Timothy Cheslock, DO, FACOEP, Chair Wayne Jones, DO, FACOEP-D, Vice Chair Drew A. Koch, DO, MBA, FACOEP-D, Board Liaison John C. Prestosh, DO, FACOEP-D Stephen Vetrano, DO, FACOEP John Ashurst, DO John Downing, DO Tanner Gronowski, DO Erin Sernoffsky, Director, Communications The Pulse is a copyrighted quarterly publication distributed at no cost by the ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors and liaison associations recognized by the national offices of the ACOEP. The Pulse and ACOEP accept no responsibility for the statements made by authors, contributors and/ or advertisers in this publication; nor do they accept responsibility for consequences or response to an advertisement. All articles and artwork remain the property of The Pulse and will not be returned.

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Deadlines for the submission of articles are as follows: January issue due date is November 15; April issue due date is February 15; July issue due date is May 15; October issue due date is August 15. Advertisements due dates can be found by downloading ACOEP's media kit at www.acoep. org/advertising. The ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2017 – All rights reserved. Articles may not be reproduced without the expressed, written approval of the ACOEP and the author.

ACOEP is a registered trademark of the American College of Osteopathic Emergency Physicians.

TABLE OF CONTENTS Presidential Viewpoints..............................................................................................................................3 John C. Prestosh, DO, FACOEP-D The Editor's Desk............................................................................................................................................4 Timothy Cheslock, DO, FACOEP Executive Director's Desk........................................................................................................................5 Janice Wachtler, BAE, CBA The On-Deck Circle......................................................................................................................................6 Christine Giesa, DO, FACOEP-D ACOEP- RC President’s Report..........................................................................................................8 Kaitlin Bowers, DO ACOEP’s 2017 Spring Seminar Treats the Whole Physician.........................................11 You Spoke, We Listened! FOEM’s New Take on Competitions................................12 White Coat to White House ................................................................................................................ 13 Gabi Crowley Ethics in Emergency Medicine: What Would You Do?.....................................................18 Bernard Heilicser, D.O., M.S., FACEP, FACOEP-D New Physicians In Practice (NPIP)..................................................................................................20 Nicky Ottens, DO, FACOEP ACOEP’s Council for Women in Emergency Medicine.................................................. 22 Nicky Ottens, DO, FACOEP

Remembering our Roots, Forging our Future All you need to do to receive guidance is to ask for it and then listen. — Sanaya Roman Presidential Viewpoints John C. Prestosh, DO, FACOEP-D

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have written previous articles about how the American College of Osteopathic Emergency Physicians has united with other groups in the House of Emergency Medicine to face the unknowable future. I believe it is prudent for all of emergency medicine to speak with a unified voice as we are confronted with various issues in our specialty. I believe our joint venture is extremely important for the success of all our physicians. However, I would like to travel a different route for this issue of The Pulse and reflect upon the heritage of our College. I feel it is interesting to revisit how ACOEP began, the road we have traveled to reach our presentday status, and how the future can be addressed.

I would first like to acknowledge the past presidents of our College. These individuals gave of their time and talents to help forge the ACOEP into its position as a significant institution in emergency medicine: Bruce Horton, Robert L. Hambrick, Donald Cucchi, John W. Becher, James Grate, Robert D. Aranosian, Edward J. Sarama, Ben H. Chlapek, George J. Miller III, Benjamin A. Field, Theodore A. Spevack, Joseph J. Kuchinski, Victor J. Scali, Paula Willoughby DeJesus, Peter

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A. Bell, Thomas A. Brabson, Gregory M. Christiansen, and Mark A. Mitchell. We owe all of you a great big thank you! If not for the hard work of all past Board of Directors and the leadership of these individuals, our College would not have the firm foothold in emergency medicine that we now possess.

Our College began in 1975 when a small group of physicians met around a kitchen table in Toledo, Ohio. These physicians had the foresight that emergency medicine could be a specialty unto itself and formed ACOEP. The College was officially recognized by the AOA in 1975.

The year of 1978 also saw the formation of four residency training programs in Illinois, Michigan, and Pennsylvania; as of December 2016, the AOA had 62 emergency medicine training programs.

Just as the number of training programs has increased, so has the general membership of ACOEP. The College has always recognized the value of residents and students; both groups have always been welcome to join us. We have valued their input so much that the resident and student presidents have been invited to join our Board of Directors representing their respective groups. It has been gratifying to observe several individuals progress through the student and resident leadership ranks and ultimately be elected by the College

membership to a seat on the Board of Directors.

Our College has not grown in a positive direction without making important decisions along the way. For many years, ACOEP held our Scientific Assembly in conjunction with the AOA’s major educational venue. This joint venture had worked for many years; however, not too long ago, our College decided upon a different direction to meet the needs of our membership. The leaders of ACOEP heard the requests from the members that they wanted stronger emphasis on cutting-edge topics in emergency medicine. After considerable debate and research, the decision was made to break away from the AOA venue. ACOEP was going to go solo and find their own venues and present their own standalone Scientific Assembly. I know the ACOEP leadership believed they were making the right decision for our College and time has confirmed their beliefs as witnessed by the excellent programs ACOEP is delivering to its membership.

Our programs not only consist of main lectures, but now offer various specialty tracks and multiple labs. Attendance numbers further prove the wisdom of the change as they continue to surpass previous records every year. Attendees not only include DOs, but MDs, nurse Continued on Page 22

Quality of GME Medical residents expect and deserve a protective environment in which to learn and develop their skills.

The Editor's Desk Timothy Cheslock, DO, FACOEP

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t has been a few years since I was a resident. In retrospect, it was a great time in my life. Yes, the hours were long and the training demanding, but there was structure, purpose, and the umbrella of supervision helped to assure you that someone has your back.

Medical residents expect and deserve a protective environment in which to learn and develop their skills. It’s a time that will shape their entire future as attending physicians. We often say the products of our programs are a testament to our hard work and dedication. I never realized back then the amount of hard work that goes on behind the scenes to ensure a successful GME program.

Recent events in the media have brought to light just how important supervision is and how the checks and balances of the GME process are there to ensure quality in training. There are probably as many opinions as there are media posts about the situation at the Summa EM residency in Ohio, wherein the hospital lost its accreditation following a bitter internal dispute, and claims of a hostile work environment. What is not subject to debate is the swift action by ACGME to withdraw the program’s accreditation when it became clear the standards set

forth were being violated. Some may call the action brash and excessive, but in the end, it was likely the right move. Why put residents in a position where lack of supervision may hinder appropriate care? Moreover, why compromise patient safety? It is unfortunate that a group of residents are caught up in the middle of an ongoing issue with the hospital and its emergency department coverage. Did anyone consider them in the lead up to this debacle? While I don’t want to dwell on it any longer, the one thing I can say is that ACGME took the reports of violations very seriously. A site visit reportedly revealed a program that was nothing close to what was seen on its most recent prior accreditation visit.

Our College has been fortunate to oversee osteopathic emergency medicine training programs for many years. Most of you reading this have been the product of one of these programs. I recently became the board liaison to our OGME committee and participated in one of their recent meetings. I was amazed at the amount of hard work and dedication of those serving on this committee to ensure the success and highest quality of our programs.

These dedicated members review the EM program crosswalks completed by our training programs. They review the inspection results conducted by AOA inspectors and evaluate the paperwork with a fine-tooth comb, all to ensure we are providing the highest quality of education to our residents. Everything

from core faculty appointments, to research, to block schedule consistency, and duty hours concerns are on the table; all are subject to review for adherence to the standards set forth by the AOA in conjunction with ACOEP. When an issue arises the first question becomes, what can we do to help this program correct the situation? It is not a punitive forum, rather one that looks to be as supportive as possible.

In situations where the issues prove more significant, a more in-depth process takes place to ensure that training and education is not compromised and patient care is vouched safe. I am proud to say that our current EM residents are in good hands and that they have the support of the College behind them.

As we continue to transition to single accreditation it is clear ACGME has a similar process of checks and balances and that the system works. There are osteopathic emergency physicians assigned to the ACGME’s EM RRC to keep the unique aspects of the osteopathic profession represented. It is exciting to see that the future of our profession is strong, thanks to the dedication of so many individuals and a College that is always maintaining the highest standards of our profession!

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WWATD? What Would AT (Still) Do? Sit down, listen to your patient, they can tell you more about their condition than any stethoscope or test can.

Executive Director's Desk Janice Wachtler, BAE, CBA

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f I could somehow summon Andrew Taylor Still, MD, DO to 2017 and ask him only a few questions, I wonder what would he think? This year, he will be dead one-hundred years; a hundred years which have seen medicine change dramatically. I wonder if he would think medical practice is good?

What would he think of the changes in medical schools; the acceptance of DOs in MD institutions; the development of specialties, like emergency medicine?

Well, let’s see—let’s imagine...

Museum of Osteopathic Medicine, Kirksville, MO [1981.600.05]

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My interview would start with welcoming him into the AOA’s National Office at 142 East Ontario in downtown Chicago. I imagine him, looking at the obelisk out front and then, slowly, very slowly, letting his eyes rise to look at the very top of the building. He may have seen the AΩA on the building sides. I see a sly smile cross his lips, as he holds his hat in his large hands, and nods, affirming to himself that osteopathic medicine has made an impact on the medical community.

I escort him to the ACOEP Office and give him the ‘quarter tour.’ He leans over the shoulders of staff as they show him the computer and internet; and again, he smiles that smile. As I have him sit in my office and welcome him to 2017, I find someone who is curious, and marvels at technology. He walks to my window and looks at the traffic on Michigan Avenue and mutters under his breath, “Everything is so fast nowadays, doesn’t anyone stop and just look?” Then taking off his hat he sits down and crosses his arms and begins to listen.

We talk about changes in the world since 1917, the World Wars, conflicts like Korea, Vietnam, and the continuing threat of terrorism at home and abroad. Then we talk about medicine. He smiles and says he remembers patients being cared

for in wards with nurses in pinafores and white caps. Many patients died from things like consumption, diphtheria, and flu. He’d place his elbows on his knees and shake his head. “We never had much privacy in our hospitals; surgery was sometimes done right in the ward in a sectioned off part of the ward. Nurses administered ether as an anesthetic

Museum of Osteopathic Medicine, Kirksville, MO [2001.59.126]

agent, and things weren’t always all that sanitary. Today, just looking at a hospital, everyone’s in a room by themselves, and nurses and doctors come and go, wiping this sanitizer on their hands. Heck, don’t they know soap and water kills as many germs as that stuff? And, if you wipe out all the germs, only the bad germs will survive?”

“So, Dr. Still,” I begin, “what do you think of Osteopathic Medicine, today?”

“Well,” he’d say, lighting his pipe, and inhaling deeply; maybe coughing a bit Continued on Page 17

How’s Your Fatigue Threshold?

Many of us tend to feel that we are superhuman and that we can perform under periods of intense stress with minimal sleep.

The On-Deck Circle Christine Giesa, DO, FACOEP-D, President-Elect

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he Accreditation Council for Graduate Medical Education (ACGME) limits residents’ work hours to 80 hours per week. Overnight call is limited to no more than once every three nights with a maximum of 30 hours of continuous work. Residents must have at least 10 hours off between shifts and at least four, 24 hour periods off over a four-week rotation.

If only that could be the reality for every physician. Practicing physicians, across all specialties, routinely work hours that would be prohibited in a residency program. According to the 2014 Work / Life Profiles of Today’s Physician, most physicians work between 40 and 60 hours per week, but nearly one quarter of them work between 61 and 80 hours per week. They are required to operate a robust office practice, complete their admissions, and round on their hospital patients after office hours. Depending on the number of physicians in their group, they may be on call every other night. It is not unusual for one physician to be on call an entire weekend and to return to the office on Monday morning. Surgical specialties present a unique concern,

because the surgeon may be required to perform emergent surgery during the night followed by a full operating room schedule in the morning.

Emergency physicians (EPs) are unique in that their work hours are limited by shiftwork. EPs typically work 8 to 12 hour shifts, and at the end of their shift, they go home. But we all know that the potential for fatigue doesn’t end there. The ideal shift schedule follows the circadian pattern.

Shifts should be rotated in a clockwise manner, day to evening to night. This pattern should be maintained even when there are intervening days off. The optimal schedule for night shift coverage is either an isolated night shift or a prolonged stretch of night shifts, so that the physician’s sleep patterns can adjust. Physicians should not be scheduled for stretches of consecutive shifts and should have regular 24-hour periods off work. Non-clinical duties should be limited between night shifts and should not replace a day off after a stretch of shifts.

Unfortunately, these limits are rarely a reality.

is not unusual for us to take a one week vacation only to return home and subsequently work the next nine out of 10 days. It’s not unusual for us to work an evening shift and to return in the morning so that we can meet a social or family obligation that evening. Those of us who work as clinical faculty in emergency medicine programs, do not think twice about working in the office either before or after a clinical shift in the emergency department. We think that combining a clinical shift and an office day maximizes time off. What we fail to remember is that each time we do this we spend that extra day off fatigued. Is it really worth it?

It must be, because we continue to have high expectations for that “stolen” day off Continued on Page 8

Emergency medicine is the one specialty where physicians should not have to worry about working long hours. However, many of us tend to feel that we are superhuman and can perform under periods of intense stress with minimal sleep. It

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ACOEP - RC President’s Report Kaitlin Bowers, DO ACOEP Resident Chapter President ACOEP Board of Directors

the foundation for the new Resident and Student Organization (RSO). We feel that by combining to form one unified leadership we will be able to better serve our membership. This transition comes at an important time as we begin to recruit ACGME residents and allopathic medical students into our ACOEP family.

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his is an exciting be involved in the RC! Our executive working hard with Chapter leadership

time to ACOEPboard is Student to build

“Fatigue” continued from page 6 despite how we waste the day. We need to be continually mindful that extra-long work days, and multiple high-volume and high-acuity shifts eventually take their toll on our personal and professional lives.

The Federal Aviation Administration limits pilots to 10 hours of flight time and a minimum of 10 hours rest after completion of a flight. The Federal Motor Carrier Safety Administration limits drivers to 11 hours driving daily, with scheduled driving breaks, and a maximum of 70 hours of driving per week. Should practicing physicians be subject to similar duty hour restrictions? We know that continually working long hours and bouncing around on shift work is associated with chronic fatigue, increased risk for medical error, and the development of serious health conditions. Arguably, I think most physicians are able to recognize their own fatigue threshold. The problem arises when we do not recognize we are

We are currently finalizing our plans for the upcoming Spring Seminar in Bonita Springs, FL. Resident Chapter events will be taking place on April 19th and 20th. Offerings include an ultrasound competition, mini mock oral board prep,

fatigued until we are deeply entrenched in a shift or a string of shifts, and we hit the proverbial “wall”. Unfortunately, when we “hit the wall” we must keep moving forward until our shift ends. Sadly, many times we do not recognize that our professional fatigue spills over into our personal lives until we see our significant other’s suitcase by the front door.

I cannot remember the last time my inbox did not have at least one email regarding physician well-being or burnout. None of us would have made it through medical school and residency if we were not highly dedicated and responsible individuals, but let us not fool ourselves. We need to be vigilant and monitor our crazy schedules and fatigue threshold, or someone else will do it for us. Regulation may come from the National Academy of Medicine (formerly the IOM) in the form of practicing physician duty hours; from tougher scheduling policies in our own practices; or it could come from family

FOEM research competitions, target lectures and evening social events. For more details please visit the resident chapter section of the ACOEP website.

As always, if you have any questions, comments or concerns about ways we can better serve our resident members please feel free to contact me.

Thank you, Kaitlin Bowers, DO ACOEP Resident Chapter President ACOEP Board of Directors

members who have had enough of us just being present because we are so exhausted we are not capable of participating.

One year ago I pledged to live in the moment. I would be fully engaged with my family physically, mentally and emotionally. I would be cognizant of my life balance. It has been a tough path to walk, but it’s worth it! I have been reigning in my clinical schedule and doing less “creative” scheduling. After a 5pm – 2am shift, I now go home and take the next day off instead of sleeping in a call room for a few hours and then heading to my office for the day. I am learning to say “Sorry, I can’t help out,” when it means a long stretch without a day off.

At the end of the day, the only suitcases that I want to see by the front door are the ones going on a family vacation. Are you monitoring your fatigue threshold?

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FOEM IS PROUD TO PRESENT

TUESDAY, MAY 23, 2017 A Day Of Giving To Support The Foundation For Osteopathic Emergency Medicine Join us for a virtual fundraiser in support of osteopathic emergency professionals nationwide!

Making an impact has never been easier— volunteers will be taking donations online, over the phone, or by mail so be prepared to give generously to help us reach our goals.

For more information, or to sign up as a volunteer, please contact Stephanie Whitmer at swhitmer@foem.org

ACOEP’s 2017 Spring Seminar Treats the Whole Physician

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or osteopathic emergency physicians, a patient is more than a set of symptoms, they are a multifaceted individual with a unique history, a complex network of systems that all interact and effect one another. You treat the whole patient, taking into consideration mind, body and spirit.

At ACOEP’s 2017 Spring Seminar, we view physicians in the same way. Every attendee is a unique individual with their own needs for their career advancement, personal growth, mental health, and physician well-being. The conference in Bonita Springs, Florida April 18-22, is carefully designed to incorporate every aspect and need of the unique physician audience we attract.

ACOEP’s world-class faculty will engage attendees with crucial, cutting-edge updates, however, there are many more ways to learn. Spring Seminar Course Chair Chris Colbert, DO, FACOEP and his team have assembled the best faculty possible, including keynote speaker

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Samuel Shem, author of The House of God and Mount Misery. Other highlights include new faculty member Seema Awatramani, MD, host of Peds Check In on Sirius Radio, and Julian Bales, MD whose breakthrough work changed the NFL and inspired the movie Concussion.

But the Planning Committee knows engaging attendees means going beyond the traditional lecture format. Breakout sessions allow attendees to customize their experience with tracks that matter the most to their practice. Hands-on learning opportunities include the Active Shooter Scenario Training, Advanced Airway Course, the ever-popular COLA Review, as well as the FOEM Case Study Poster Competition.

“Over the years our Spring Seminar Planning Committee has worked hard to consistently stand out with the best education possible,” say Colbert. “But we go beyond that. We know that didactic lectures are only part of what keeps attendees coming back, which is why we offer so much more.”

ACOEP’S SPRING SEMINAR April 18-22, 2017 Bonita Springs, Florida www.acoep.org/spring ACOEP has long appreciated the importance of community and serves as a home for practitioners across the country.

Connecting with fellow physicians to network, share experiences and build lasting friendships is just as important as earning CME credit. This year’s Welcome Reception celebrates “The Good Life”. A poolside party, delicious food, and summertime cocktails kick off a great week. A partnership with All Water Excursions provide attendees and their families with an easy way to embrace the Sunshine State and take off on adventures like backwater fishing, guided kayak trips, and dolphin watching excursions.

SPRING SEMINAR LECTURE TOPICS Tummy Times: The Role of US and

You Spoke, We Listened!

the Acute Abdomen • Fifty Shades of Ketamine • The Walking Dead: A Guide to Resuscitation • A Tale of Two Tummies: POC US with Blunt Trauma

Other educational events combine great ways to learn with the chance to have fun with other attendees.

Experienced doctors know that often in medicine things are not clear cut.

The new lunch event, “That’s Debatable”, features experts debating hot-button issues in medicine, while attendees enjoy a catered meal. Other events include a book signing and meet-and-greet by author Samuel Shem, a pool party for the New Physicians in Practice and residents, annual Membership Meeting, and sponsored nights out for students and residents.

Physician wellness is a crucial component to improve care across the country, and staying healthy and rested are key. Get the blood moving with the FOEM 5K and 1-Mile DO Dash; runners and walkers of all abilities are welcome.

Also, stop back in the expo hall for special perks like massage chairs and refreshments!

The new location, the Hyatt Regency Coconut Point in Bonita Springs, Florida, is the perfect spot for relaxation and fun. An easy cab ride from Ft. Meyers International Airport, this family-friendly resort boasts great restaurants, beautiful pools with a cold-plunge waterfall and waterslide, a boat that ferries guests to a beautiful private island and gorgeous beach, and so much more.

“I’m so proud of everything that we have planned,” says Dr. Colbert. “I hope doctors everywhere come for the CME, and come back for the chance to relax, recharge, and return to work ready to tackle any obstacle.”

• Emergency Nose to the Toes: ENT • The Fab Five: Top Trauma Articles in 2016 • The World View: Global Medicine • The Dollar Diet: Financial Medical Management • Catch the Beat • Heartbreak Hotel: Looking into the Heart via Ultrasound • Just Beat It • Diagnosing Double Trouble: Updates in Pregnancy Complications • Eye Don’t Know: Management of Blunt Ocular Trauma • Eye Can’t Wait: Top Five Emergency Management Options • Medical Malpractice • The A to Z of Geriatric Management • From PALS to Besties: 2015 Pediatric Updates • AIR on the Side of Caution: Definitive Airway • It’s Just Not Miller Time: Alternative Airway • I See You: Pre-Intubation with Hypotension • A Critical Look: A Deeper Understanding of ECMO • I See You: Intubation with Post-Hypotension • A Critical Look: A Deeper Understanding of VADS • Recognizing Pediatric Sexual Abuse • The A to Z of Geriatric Management • How to Properly Document and Report Pediatric Sexual Abuse • Lit Review • Managing Medical Meanies (Updates in ID) • Now You See Me; Now You Don’t: ID Upd ates • To Trick or Treat? That is the Question: Neutropenia • All Tox All the Time: Updates in Toxicology • A Match Made in Heaven (TUSH) • Active Shooter Course • Advance Airway Course • Strokes and Notes: New Literature on CVA Management • Ah Ha Ha Ha Stayin’ Alive Staying Alive: Physician Resilience • The Touchy Feelies: OMM

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ast summer, the ACOEP Resident Chapter met with ACOEP staff to delve into some strategic planning. One major impact of this meeting was combing the ACOEP Resident and Student Chapters to form one organization—the ACOEP Resident and Student Organization (ACOEP-RSO).

However, this was not the only major decision made that day.

The residents felt strongly that the Foundation needed to update the format and quality of their competitions to attract a younger audience. Specifically, they hoped that the Foundation poster competitions could use digital pods instead of PowerPoint lectures in a dark room. After reviewing costs and logistics, the Foundation board decided to invest in this important change, and the new format will debut on Wednesday, April 19 at the Case Study Poster Competition in Bonita Springs, FL. This new format allows us to accept more than double the cases we have been able to accept in the past. The competition will consist of six digital viewing areas (pods) at which several presenters will give seven minute presentations followed by three minute Q&A sessions. Every presentation will be given twice, so if you missed it the first time, you can still catch it later. Snacks and beverages will be served, and the event still offers three hours of CME for all attendees. We hope to see you there!

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White Coat to White House How Major Kamal S. Kalsi, DO, Made His Mark on US Military History

By Gabi Crowley, ACOEP Digital Media Coordinator

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uring a time where tension runs high and support for minorities and immigrants is crucial, ACOEP member, Major Kamal S. Kalsi, DO, has made his mark in the military not only as an osteopathic emergency physician, but as an advocate for minorities.

“You have to be in it for the long haul if you’re interested in changing policy, especially in an institution that is as conservative and resistant to change like our military,” Kalsi said.

Dr. Kalsi trained in Israel in Disaster Preparedness and Response, and has served in the Army for over 15 years.

He was awarded a Bronze Star for his service treating hundreds of combat casualties in Afghanistan supporting Operation Enduring Freedom in 2011. He served as EMS Director at Fort Bragg for three years, and currently serves as EMS Medical Director to St. Clare’s Health System in New Jersey. Major Kalsi’s operational experience includes mass casualty planning and response, triage, tactical medicine, and expeditionary care in austere environments. He has recently transitioned back into the Army Reserves and is the medical officer for the 404th Civil Affairs Battalion.

Earlier this year, after much effort to prove that one’s religious accommodations do not in fact interfere with a soldier’s duties, the military loosened its restrictions and these accommodations can now be granted by brigade-level commanders, making it a much less daunting process. This newly-changed policy also does not require soldiers to keep applying for temporary religious accommodations once they have been granted them, as they were required to do in previous years.

In 2009, Kalsi was the first Sikh in over 20 years to be granted rights to serve in the United States Army wearing a religious Sikh uniform, including a turban and a beard, and since then has fought for other minorities to have the same rights. Before 2017, soldiers wishing to serve wearing religious accommodations including turbans, hijabs, and beards, had to receive special permission from commanders at a secretary-level, making the process a difficult one

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Several years of hard work brought about this victory. This was done through a joint effort of several different organizations; including, The Sikh Coalition, a pro-bono law team from McDermott Will & Emery, the Becket Fund for Religious Liberty, and The Truman National Security Project.

Bringing these diverse groups to the table was far from simple, however it was a crucial first step.

“The biggest challenge, in my opinion, was changing culture at the highest levels of the Pentagon, and showing them that diversity is truly a strategic imperative; that is, the fact that a diverse military that looks like the people it protects will be a stronger and more resilient force,” Kalsi said.

Major Kalsi believes the setbacks minorities face in the military limit countless individuals from pursuing significant opportunities.

“When a young Asian American recruit joins the military, chances are that [they] won’t see another minority in their entire chain of command. That soldier may begin to internalize that they will not be allowed to take a leadership position in the military and ultimately that hurts all of us,” he said.

Policies, including the need to grant soldiers religious accommodations in the

Although he is one of the few doctors in The Truman Project, Kalsi feels as if it’s a part of his civic duty to be involved.

He also believes being an osteopathic emergency physician allows him to see things more holistically and compares his work as a DO to advocacy.

That’s what we do for our patients...we fight to get them [and] the care that they need. Advocacy is not much different, except that we are fighting for the rights of large groups of people. military, could ultimately end up hurting the nation instead of helping.

with US foreign policy and both national and global issues.

“We need the best and the brightest from all communities to come help defend our nation. When we start limiting the applicant pool or inadvertently push good soldiers away from leadership, we begin to erode at the foundations of our pluralistic democracy and the organization charged with defending it,” he said.

“The other Trumans I serve with are all exceptionally talented people, and I’m truly honored to be a part of the organization. We all share a patriotic value set that wants to see our democracy flourish,” he said.

Among his many roles, Kalsi is a member and Fellow of the Truman National Security Project, an organization made up “post-9/11 veterans, frontline civilians, policy experts, and political professionals that share a common vision of U.S leadership abroad.”1 On this Project, Major Kalsi is a Truman National Security Fellow where he serves in a group of “policy experts, academics and other thought leaders who anticipate and articulate new global challenges and opportunities.”1 He also serves on the Project’s Defense Council, providing his expertise

Although unable to discuss a specific strategy or next steps, The Truman Project plans to take action on President Donald Trump’s executive order regarding immigration, Kalsi says each member of the Project is dedicated and willing to stand up for the same beliefs, including truth, loyalty, duty, respect, service, honor, integrity, and personal courage.

“There are those of us that will be focused on issues of diversity in the years to come. This means fighting Islamophobia and irrational fears against immigrants [and] refugees. It means looking at data, statistics, and boots-onthe-ground experience to back up our arguments so that they’re rooted in truth,” he said.

“As a physician, I’m used to paperwork and red-tape. But I know that with persistence, I can overcome any bureaucratic obstacle. That’s what we do for our patients...we fight to get them [and] the care that they need. Advocacy is not much different, except that we are fighting for the rights of large groups of people. Sometimes that fight begins with one person, and I’m glad that I’ve helped make a difference,” he said.

Despite meeting congressmen, senators, celebrities, Pentagon officials, and even shaking Barack Obama’s hand, Kalsi says his most memorable moment in his career is still the day he returned home from deployment and was reunited with his family. Kalsi says the support of his wife and son is really what helped him get to where he is today, though that support comes at a cost.

“My son was two years old when I deployed, and on a video call one day, he said ‘Dada, I miss you...do you still remember me?’ It’s heartbreaking hearing that, but the sacrifices all of our soldiers make are not in vain,” he said.

Having experienced challenges along with triumphs throughout his journey thus far, Major Kalsi plans to continue to honor and defend our country whenever he is called to serve again.

“I am proud to be an officer in the Army and will gladly deploy again whenever I’m called to duty. This country and everything we represent is worth fighting for.”

References 1. Membership. (n.d.). Retrieved February 22, 2017, from http://trumanproject.org/home/ about/membership/

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“WWATD ” continued from page 5 and pulling a piece of tobacco from the tip of his tongue. “I’m mighty impressed with this building. Although they need to replace my statue in the lobby—I look so stern...and old!

“As I look over at all the schools, well, I never thought we’d be training so many doctors. They are all over the country, in all the states, and the military, all over the world. You know, I even read they were training doctors in China, and my doctors were learning acupuncture. Who’d have thought?

“And, these medical students...they’re so bright.” He’d lean his arms on his knees, “And young women, they compete sideby-side with young men. Heck, I thought all along women were better listeners than us fellows, but when I brought them into my school and my clinics—you know some of these sick folks just got up and walked out. Can’t figure that one out; if you’re ailin’, who cares who takes care of you? If they know what they’re doing; that’s what counts.

“Never could figure out why those medical doctors had to train them women in institutions that were separate. They kept that up for a good while, but now they’ve come ‘round. Guess I was ahead of my time.” He leans back, smiling, his long legs covered in the narrow-legged trousers and high top boots, and takes a draw on his pipe.

“You know,” he says sitting forward again, “I’m really proud of these DO doctors, I heard a lot of them fought hard for practice rights in all the states some time back; me, I never figured they’d be in all the states. Figured, we’d stay pretty much in Missouri. But then we started gettin’ popular. A’ course sometime, we got paired up with all that snake oil stuff that went on at the turn of the century.

You know people believin’ in junk like spiritualism and congerin’ of spirits, and laying on of hands.

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“But I always felt if a doctor touched his patient, he could tell what’s worryin’ him. Sort of akin to feeling the Chi, I think that’s what they call it in Chinese Medicine. But sometimes, you just know when something’s not right. You observe a patient’s gait to find out if he’s got knee pain; sometimes you look ‘em in the face and just know what they’re fretting about.

“These DO doctors have kept that up, even with all these fancy do-dads and tests. They’re different, and I’m proud of each and every one of ‘em. Yep, they keep showin’ people you can do a lot with looking and observing, and knowing the body systems and how one system affects others. Now, a’ course, time is a factor, nobody has time to do much full manipulation. But you can still use your eyes and hands.”

“What do you think about this Single Accreditation System, where DOs and MDs will be able to enter in to any program, in any specialty, and train side-by-side?” I ask. “Well now,” he says, raking his hand through his hair, and pausing to re-light his pipe; which I believe is a way of gathering his thoughts.

“At first, I wasn’t so sure. You know there were a lot of prayers about doing the right thing during that early period. I heard them discussions—these were brand new rows to plow and when the mule doesn’t trust the driver—you have problems.”

“Now, I think people are seeing that one type of medicine isn’t always the right fit. Sometimes you need doctors who use the osteopathic approach and manipulation. Observe the patient, talk to them, get that familiarity and assess them from both proof, like tests, and what you see and do. I mean if someone has appendicitis, you’re not going to do manipulation, you’d have a surgeon remove it.

He leans back and stretches, and then stands, he’s tall and a little stooped over as he walks to my window, relighting his pipe. He turns now, and points the stem

of his pipe at me squinting his eyes a bit, “You know, thinking back on that change in learning; this Single Accreditation System, and I gotta tell you, I’m pleased and worried at the same time. You know most of the osteopathic training hasn’t been in big academic centers. Heck, I remember when there were hospitals called, osteopathic hospitals,” he says making air quotes. “Now those were the ones generally founded by doctors who couldn’t practice in MD hospitals.

Those other doctors, well, they just didn’t get us. They thought we were quacks.

That is, until we began to get good or better outcomes and the patients liked us better.

“Now, though,” he says sitting back down, “Now, all of a sudden, they want to be our best friend. I think, why do you want us to be your friends, ain’t never had no need of us before. Are you going to treat us fairly, openly and on an even playing field? I been pondering this for a long time, and you know when you’re dead and watching the world from afar, you have a different view of things.

“I think it’s a good thing. After all, you might teach these MDs something they had at one time but lost over time. That’s that the patient is the number one thing in medicine. You care for them from cradle to grave and when it’s all over, you know you did the best you could for them. You gave them the best of you.

You took them in your hands and cared for them, tried you’re best to prevent ailments; took care of injuries and put them back on the path to good health.

After all that’s what medicine is all about, taking care of patients—doing no harm— but never forgetting that your training as an osteopathic physician gives you something those other guys don’t have.

It’s intangible and as individual as each and every physician with DO after their name.”

“Dr. Still, our time is getting short, but what would you tell osteopathic physicians today?” I’d ask. “Well,” he

says, crossing his arms on his chest, “I’d say, don’t be in such a hurry. Sit down, listen to your patient, they can tell you more about their condition than any stethoscope or test can. They’ll tell you what they do, and how they live, and when they have pain and when they don’t. You can tell if they drink or smoke, by looking at them. Do they have a lot a wrinkles around their mouths—good sign they smoke—a lot. Do they have veins running up their cheeks and nose or esophageal varices and general redness in their face, well dollars to donuts they hit the booze a bit too often.

“Good doctors see this—that is, if they take time,” he says raising a finger to emphasize remembering this fact.

“Being a good doctor sometimes means sitting and talking a little. The heck with government regulating your time. You just take time and you’ll stave off some serious disease. So, I’d tell these DO doctors to just be good and true to your patients, and use the powers you were trained to use. Yep, that’s what I’d tell ‘em.”

“Never forget the battles that were fought for your rights to practice; or those who have gone before you. Never forget where you came from and you’ll never go silently into the future. Be proud of who you are, what you’ve attained and what was given to you. Fight for that identify and the patients you care for. Remember that those initials, DO, were hard fought for and earned through adversity. Don’t let those letters, DO, be lost.”

He stands up now, taking his hat, saying he must leave. I feel honored to have taken this hour of his time, and he smiles as he leaves, content in knowing his legacy will live on.

What Would You Do? Ethics in Emergency Medicine troubled as to whether they should simply attach an internal letter, or change the chart.

What would you do?

Bernard Heilicser, DO, MS, FACEP, FACOEP-D In this issue of The Pulse we will review the dilemma presented by a municipal ambulance EMS coordinator.

The crew was dispatched to a local nursing home for an unresponsive patient.

The paramedics were handed paperwork from the staff, provided ALS care, and transported the patient to the hospital.

Unfortunately, the patient did not survive.

The next day, it came to light that the paperwork was for a different patient.

The hospital was unaware of this mistake and had called the wrong family, having them come to the hospital to see the deceased. Obviously, the family was upset that this was not their mother.

EMS was never formally notified of this event, and had already sent a bill to this wrong family.

The Fire Chief requested that the crew write a supplemental note on the chart, essentially to change the EMS run sheet.

The EMS coordinator was uncomfortable doing this, especially since they still did not have the patient’s real name, and was

What a mess! The crew was not concerned about billing. The nursing home has that responsibility. We have all learned that honesty in documentation should never be altered or compromised. Not only is this unethical and illegal, it will eventually catch up to you and bite you when you don’t expect it. Sometimes, being forthright and honest may be difficult and put us in danger of litigation. Nevertheless, patients and families want the truth, and may be more understanding when dealt with in an open and truthful manner. Of course, we all know this is easier said than done. However, our professional integrity is at stake. This is much easier than trying to remember your mistruth two years later in court.

The treatment of the patient with wrong medical information could also be most harmful to EMS. So, an honest explanation of what occurred on this EMS call is necessary and should be so entered on the run sheet.

If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us ThePulse@acoep.org. Thank you.

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CHALLENGE YOURSELF AS A U.S. ARMY EMERGENCY MEDICINE PHYSICIAN.

As part of the U.S. Army health care team, you can make a real difference treating the immediate medical needs of Soldiers and their families while also growing in your career: • You’ll work with the most advanced emergency technology and have the opportunity to experience a variety of settings.

• You’ll develop as a leader, learn from the best and have the ability to make quality patient care your main focus.

• You’ll receive excellent benefits such as special pay, as well as the potential for continuing education and career specialty options.

To learn more about joining the U.S. Army health care team, visit healthcare.goarmy.com/gx07, e-mail usarmy.knox.usarec.list.9c2d@mail.mil or call 847-541-7326.

©2014. Paid for by the United States Army. All rights reserved.

Council of New Physicians In Practice (NPIP) Nicky Ottens, DO, FACOEP ACOEP Board of Trustees, NPIP Liaison

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enior residents! In less than five months all of you will be graduating and finally entering the world of an attending. What an exciting and nerve-racking transition! From the exit interviews where Aunt Sallie Mae reminds you how much you owe her, to the board preparations and test taking, and then the house hunting and negotiating the final contract, before you walk one last processional line in your educational career and head out into the adult world to finally get to make all those decisions alone! It’s finally here! At long last, you will be done with your training.

We l l . . . s o r t o f . . . u n t i l yo u r C M E requirements start to kick in, but trust us when we say it isn’t nearly as bad. If any of this transition seems overwhelming, you are not alone. We’ve all been there and the NPIP is here to help you! In fact, we are here specifically for you and for anyone else who is out in practice recently and is still trying to transition and adjust to all the tasks and responsibilities that you have now that you’re an attending. You might not have to take any more in-service exams or go to morning report, but you will now have COLAs and CME hours to obtain as well as licensure exams to take. And while your salary is going to take a well-deserved jump, so will your taxes.

And then there’s the loans. And the investments, assets, financial planning,

We’ve all been there and the NPIP is here to help you! insurance and fiscal futures to think about. We’ve got your back on that too!

In fact, we’ve got lots of ways to help you. Our council meets twice yearly with the seminars. In the fall, we have our own CME track geared just towards you and your educational needs. We also have a Facebook page for ACOEP’s New Physicians in Practice (www.facebook. com/acoepnp) or you can find us on the ACOEP website where we have our NPIP Membership Guide that answers a lot of the questions you have about CME, COLA’s, ACOEP membership, fellowship application, timelines, committee involvement and more.

But we will also be around at ACOEP’s Spring Seminar in Bonita Springs, FL. Our council will be meeting Wednesday, April 19 from 3:00-3:30pm and afterwards we will be having a social event with the residents from 3:30-5:00pm. Additionally, we will be holding a mock oral boards preview for the residents on Thursday, April 20th from 8:00-11:00am. Please come join us, mingle and get some of your questions answered. We’d love to have you involved in our Council also!

Contact us anytime and best wishes, the end is in sight!

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ACOEP’s Council for Women in Emergency Medicine Nicky Ottens, DO, FACOEP ACOEP Board of Trustees Member ACOEP Council for Women in Emergency Medicine, Chair

T

hanks again to everyone who attended ACOEP’s Council for Women in Emergency Medicine’s 2nd Annual luncheon in San Francisco.

Honoring pioneering women in our profession never gets old! And we can’t wait to do it again in November when we gather at ACOEP’s Scientific Assembly in Denver, Colorado. We will

also meet in Bonita Springs, Florida for a social event in association with the Spring Seminar. There will be a wine and cheese reception on Wednesday, April 19th at from 7:00-8:00pm. We hope to see you there! This is an excellent opportunity to network, learn from your fellow medical professionals, and enjoy time together in Florida.

Looking ahead a bit, the Women’s Council is in the process of creating a CME track for the Spring Seminar in 2018.

“Remembering ” continued from page 3 practitioners, physician assistants, and of course, students. A difficult decision was made and it proved to be the right move for the ACOEP and its membership.

ACOEP is now facing uncertainty with the move to the Single Accreditation System. There are concerns that ACOEP could potentially lose future resident members who are training in ACGME programs, which eventually every training program will be. Our message is one of maintaining stability and relevance in our specialty. We believe that wherever you have received your residency training, you will find relevant, cutting-edge programs at every conference offered by our College.

Our present Board of Directors has made

it a priority to visit student emergency medicine clubs and residency training programs across the country. Yes, this is a present and future concern facing the ACOEP. Our present leadership does not pretend to have all the answers as to where our future exists. We are seeking information regarding this concern, and I believe one very important place to obtain ideas is from our past leaders.

There is a wealth of information and knowledge that ACOEP has not fully utilized—our past presidents. These leaders have experience that I believe can help us chart our path into the future. We will be inviting all of the ACOEP Past Presidents to meet with the Board of Directors during this year’s Scientific Assembly in Denver, Colorado. Our Board of Directors would

Looking ahead a bit, the Women’s Council is in the process of creating a CME track for the Spring Seminar in 2018.

We will be partnering with influential groups such as the Physician Moms Group (PMG) and FemInEm to address some of the issues facing women in medicine today and to further support one another. If you are interested in helping grow this Council or creating a dynamic educational track, please contact us. You can connect with us on twitter or Facebook at www.facebook. com/acoepcouncilforwomeninem. You can also reach us directly by emailing gcrowley@acoep.org.

prefer to make this gathering an annual event. The Board is eagerly looking forward to hearing from our past leaders. We desire to hear how they assess the present stance of ACOEP and hear their ideas on how we could proceed in the future. I believe this type of meeting will yield positive effects. As I have progressed through my presidential term, I have relied on several individual past presidents for their input and guidance when difficult decisions had to be made. I have appreciated their willingness to help. I have no doubts that as we look to our past leaders for their input, it will add to the vision of our future leaders and the direction our College establishes.

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