The Pulse - Spring 2021

SPRING 2021

RevitalizED For Spring

HERE COMES THE SUN PG 7

SURVIVING & THRIVING ON NIGHT SHIFT PG 8

ACOEP’S SPRING SEMINAR KEYNOTE SPEAKERS PG 10

Save the Date!

OCTOBER 11 – 15

WASHINGTON HILTON | WASHINGTON D.C.

#ACOEP21

The Pulse VOLUME XLIX No. 2

EDITORIAL STAFF Timothy Cheslock, DO, FACOEP, Editor Wayne Jones, DO, FACOEP-D, Assistant Editor Tanner Gronowski, DO, Associate Editor Justin Grill, DO, FACOEP John C. Prestosh, DO, FACOEP-D Christine F. Giesa, DO, FACOEP-D Meagan Comerford, Director of Communications Donald Rolfe, Senior Marketing Communications Manager Jaishri Atri, Marketing Communications Manager EDITORIAL COMMITTEE Timothy Cheslock, DO, FACOEP, Chair Justin Grill, DO, FACOEP Christine Giesa, DO, FACOEP-D

The Pulse is a copyrighted quarterly publication distributed at no cost by ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors, and liaison associations recognized by the national offices of 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.

Display and print advertisements are accepted by the publication through ACOEP, 111 West Jackson Boulevard, Suite 1412, Chicago, IL 60604, (847)686-2235, or to drolfe@acoep.org. Please contact ACOEP for the specific rates, due dates, and print specifications.

TABLE OF CONTENTS 4

PRESIDENT’S REPORT Robert E. Suter, DO, MHA, FACOEP-D, FIFEM

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EXECUTIVE DIRECTOR’S DESK Emily Burch

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THE ON-DECK CIRCLE G. Joseph Beirne, DO, FACOEP-D

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SURVIVING & THRIVING ON NIGHT SHIFT Christina Hornack, DO

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UP CLOSE AND PERSONAL WITH ACOEP’S SPRING SEMINAR KEYNOTE SPEAKERS

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CORE EXAM Christopher P. Zabbo, DO, FACEP, FACOEP

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WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE Bernard Heilicser, DO, MS, FACEP, FACOEP-D

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THE PECK BEFORE DAWN (THEN OUT THE DOOR) John Scranton, DO, MFA, FACOEP

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. Advertisement due dates can be found by downloading ACOEP's media kit at www.acoep.org/advertising. ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2021 – All rights reserved. Articles may not be reproduced without the expressed, written approval of ACOEP and the author.

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

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PRESIDENT’S REPORT

Robert E. Suter, DO, MHA, FACOEP-D, FIFEM

GET INVOLVED IN YOUR COMMUNITY

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s we continue together down the difficult path of the COVID pandemic, the insight and wisdom of Einstein resonates on multiple levels.

Dealing with the pandemic has been an enormous professional burden. Paired with the personal tragedy of distancing us and even losing dear friends and loved ones, it has drained many of energy and emotion. With all respect to the many other events and tragedies, in many ways it has been the greatest difficulty our country has faced in the past 100 years.

Unfortunately, this tragedy is superimposed over the many other seismic changes in GME and certification impacting the osteopathic community, challenges that we were already grappling with when the COVID virus arrived on our shores. Changes that brought us challenges, but also opportunities.

These opportunities were the focus of ACOEP’s Strategic Plan released a year ago.

Structural changes in the AOA have made some of what ACOEP did in the past less relevant. But what hasn’t changed is our desire to be part of a comfortable family, and our need to be a community that provides its members tools and opportunities to achieve their dreams. Dreams not just limited to us but for success in the broader specialty and world.

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IN THE MIDDLE OF DIFFICULTY LIES OPPORTUNITY” ALBERT EINSTEIN

As someone who has achieved a modicum of success outside of the osteopathic community, I am dismayed that many of our members are not taking full advantage of our organizational opportunities. Sure, some have achieved professional success without having participated in ACOEP, but this is not the norm.

More common is that a role in our community prepared us to be more successful elsewhere. In my case, becoming President of EMRA was preceded by working with Paula Willoughby, DO and the ACOEP Board to establish what was then called the Student Chapter. This created a national network of friends that could be built upon to elect the first DO EMRA, and later ACEP Presidents.

These organizational experiences also prepared me for other leadership

positions and opportunities at many levels including in my hospitals and groups. My point is that these successes did not occur apart from ACOEP participation, but in conjunction with it.

ACOEP provides tremendous infrastructure for our members to build personal and professional success. This is especially true for those involved in academics. Service on our committees and presenting at ACOEP/FOEM events count for the same number of points toward promotion as those of other national organizations. Committees in other areas allow us to network, prepare to lead and have an impact from the local to international levels. Our community should see ACEOP as their best gateway to kick start their ambitions, even if those ambitions

ultimately take their focus elsewhere.

Increasing your participation is a win-win. Whether your interests are in leveraging ACOEP to change the world, or just our community, you can position yourself to benefit professionally and we as a community are enriched by your involvement.

With increasing numbers of emergency physicians in the EM workforce, advocating for our community and each other is more important than ever. Ground level opportunities in the bigger house of emergency medicine will become even more competitive and the importance of the experience that we

can give our members more valuable.

So, get involved to enrich both our College and yourself – participate!

Volunteer for committees by letting us know what your interests are and we will link you up. Support our students and residents as a mentor. If you are not sure where your participation might be the best fit, contact me or our staff and we will help you find it.

COVID may have restricted us in many ways, but it cannot hold back our participation in ACOEP. You can do these things now. Get started virtually and soon we will be together again.

The latest word is that experts believe that by the fall we can

have in person conferences again.

Perhaps with proof of vaccination and continued precautions, but live, nonetheless. Personally, I really hope so. It would be wonderful to end my term in the way it began, in the company of my friends and our community.

Get involved in your community.

If we all continue to work together to sustain our community in these tough times, our best days are ahead of us.

–•–

Robert E. Suter, DO, MHA, FACOEP-D, FIFEM

“IF A WINDOW OF OPPORTUNITY APPEARS, DON’T PULL DOWN THE SHADE.” – TOM PETERS

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EXECUTIVE DIRECTOR’S DESK

Emily Burch

SPRING IS IN THE AIR

T

he start of a new season is always an exciting time.

But when it follows a year of unprecedented change, challenge and sustained disruption, warmer weather and daylight savings time are welcomed with open arms as they signal the arrival of spring and for ACOEP members, new opportunities for learning.

Though once again virtual, ACOEP has worked hard to ensure that this year’s Spring Seminar delivers cutting-edge content from respected leaders and practitioners in emergency medicine. Our educational sessions, FOEM research competitions and COLA/CORE review will enhance your skill sets and help you provide exceptional care to patients, and keynote speakers, Rick Pescatore, DO, FAAEM, Nicholas D. Caputo, MD, MSc, FACEP, FAAEM, MAJ (MC, USAR), and George C. Willis, MD are sure to inspire.

I would also like to take this opportunity to thank each of you, and all of our volunteers, for your amazing work and dedication that not only sustains but inspires us all. As things appear to be improving by the day, we hope to soon be able to gather in-person again as a community to learn from and support each other.

Like yours, our doors at ACOEP are always open. We encourage you to reach out with questions, ideas or suggestions for how we can make ACOEP membership more valuable and, like you, essential.

I look forward to seeing you online at the Spring Seminar! –•– Emily eburch@acoep.org

LIKE YOURS, OUR DOORS AT ACOEP ARE ALWAYS OPEN.”

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THE ON-DECK CIRCLE

G. Joseph Beirne, DO, FACOEP-D

HERE COMES THE SUN

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s I write this, it is March 2, 2021.

Two weeks ago, on February 15, we had a major winter storm that dumped about 10-12 inches of snow on the St. Louis area.

This was preceded by single digit temperatures and after the snow, a few nights of sub-zero temperatures.

In typical midwestern weather fashion, temperatures the next week were near 60 degrees. Now, we are seeing signs of spring. Today, when I left for my shift in the ER, the sky was blue without a single cloud.

While driving to the hospital, the change in weather and the sunshine reminded me of why spring is such a wonderful time of year. It is a time of transition to warmer temperatures, blooming trees, flowers, and a sense of spiritual renewal.

In my last article in the winter issue of The Pulse, I wrote about how COVID had affected me personally and professionally, and that this was a “new hope and new year.” As spring draws closer, the sense of spiritual renewal and hope is clearly here. Our department has seen lower numbers of COVID cases. Most of the patients I am seeing are COVID recovered, and our ER seems to be turning the corner towards a sense of “quasi-normal.”

There is a buzz in our department that perhaps we are getting closer to that feeling of normal that we all embrace and long for. We recognize that COVID variants are still out there, and that we may see spikes in these cases. Yet we now realize that we are not helpless and that the end of this pandemic is on the horizon. We

AS SPRING DRAWS CLOSER, THE SENSE OF SPIRITUAL RENEWAL AND HOPE IS CLEARLY HERE.” never gave up hope, we continued to fight and won the daily battles. Now, as winter begins to fade towards spring, that sense of spiritual renewal becomes stronger each day, creating in each of us a desire to do more for our profession and our patients, our own “eternal flame,” so to speak.

Spring also means the ACOEP Spring Seminar! Our event this year promises to be another excellent event, spearheaded by our dedicated CME Committee. The title, “ReimaginED,” is especially appropriate as we are “reimagining” our conference and our existence back towards a sense of normal following the year of devastation we all faced. Our Spring Seminar will allow each of you to create a personalized experience for your own CME needs. As the year progresses, we sincerely hope that the Scientific Assembly in the fall will be an in-person event!

Spring truly demonstrates a changing environment. Our College has undergone many changes recently, and our transition to Kellen for association management has had its challenges. But together we are working to improve the services we offer to our members, ensure

that our College is the best in the AOA, and that our members receive the information and services they need to advance their professional development. If you have questions, please reach out to us!

So, how do I define the spiritual refreshment that comes with spring?

I look back over the last year and think about what has happened to our profession. The people we lost.

The daily victories and defeats that defined who we are as physicians, leaders, parents, brothers and sisters.

As spring nears, every day I see the sunrise, with rays that slowly creep above the horizon and remind me of who I am and why I became an ER doc. Rays of hope that refresh one’s spirit and soul. Rays of hope that, no matter what life throws at you, allow you to succeed.

Ralph Waldo Emerson said it best, “What lies behind us and what lies before us are tiny matters compared to what lies within us.”

Here comes the sun…indeed! Let it fuel your eternal flame and allow you to be a leader and part of the ACOEP family.

Happy Spring!!! –•–

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SURVIVING & THRIVING ON NIGHT SHIFT

By Christina Hornack, DO PGY-3 Adena Emergency Medicine Resident ACOEP-RSO Immediate Past President AOA TIPS Fellow 2020-2021

W

hether you are a full-time nocturnist or just doing your share, night shift is a reality most of us face. This article represents the collected wisdom of those brave warriors who willingly face the dark side as their permanent shift. Learn to not just survive, but thrive, and maybe even enjoy yourself.

enjoy not only a more tailored schedule but often get a differential in any hourly pay structure. Lastly, the environment will often be more relaxed, the team more cohesive, and the interruptions from the senior brass, thankfully, few.

WHY

The primary issue with working nights is getting restorative sleep. It can be difficult to get sleep during the time when the rest of the world is awake, mowing their lawns, and ringing your doorbell to sell magazines. While sleep is usually a very personalized thing, most people find that cold, dark, quiet rooms are the best environment to facilitate those much-needed Zs. Getting them can require a combination of: • Blackout curtains to block daylight • Removable insulation panels that can be slid into the windows as needed • A ceiling fan or window air conditioner to drop the temperature a few degrees • A sound machine to block out more distant sounds by taking advantage of physics You may also benefit from some adjuncts to environmental control, including a comfortable

Why anyone would choose full-time night shift work is often a mystery to those who can’t conceive of a more terrible fate. But there are many benefits to being a full time nocturnist – chief amongst them is that your schedule is regular and always the same. You know you will be able to make a 6:00 p.m. meeting no matter what day it is because your shift doesn’t start until 9:00 p.m. Further, doctors willing to work primarily nights are a premium to any group and

Special thanks to Jennifer Himmel Salch, DO, Jacqueline M Dziedzic, DO, and the entire Women in Emergency Medicine Committee of ACOEP for their collaboration on this article.

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SLEEPING

sleep mask that utilizes an elastic strap instead of Velcro, which can pull long hair, get caught on things and making loud noises when it opens.

In addition, many people swear by ear plugs, of which there are many varieties available including foam, silicone, and fancy high end electronic “sleep buds.” Some are lucky enough to be heavy sleepers that don’t require any additional help blocking out the world.

The final ingredient in good sleep is turning off your brain. While some people can instantly fall asleep wherever and whenever, most of us are not as fortunate. Many of us require help in the form of chemicals.

Bilayer melatonin with a quick dissolve layer and another layer engineered to dissolve more slowly in your small intestine is a game changer for many of us. Others prefer Unisom, Ambien, or Benadryl to help fall asleep.

Another issue that may arise is staying asleep long enough to be fully restored. Many of us can fall asleep relatively easy after a long night shift, but our brains and our bodies will quickly revolt and wake us up after only a few hours. How do you fall back asleep and not be in a fog when you finally wake up? One of our members suggests taking children’s dissolving

Benadryl tablets. The 12.5mg dose is just enough to help you get those last few hours without causing any lingering side effects. And it’s available in grape flavor!

MAINTAINING WELLNESS Now that we’ve covered why we want to do this and how to get great sleep, we need to identify ways to keep yourself well. While wellness looks different for everyone, there are a few key factors that long-term nocturnists insist on across the board.

Some type of regular exercise was an almost universal suggestion, whether it’s just a few minutes of yoga after a long shift, or an hour-long sweat session after a lighter shift.

The endorphins help you sleep, and most centenarians agree that the key to maintaining health is maintaining movement.

Another key factor is determining your limit of shifts in a row. If you find that on the sixth night shift you keep losing track of which abdominal pain is in Room 5 and which consultants you’ve spoken to, you may want to reduce limit your run of shifts to one fewer. For people having to switch back and forth, limiting the number of runs in a month can be helpful but comes at the cost of having more

days in a row. You need to know your own personal limit so you can be the most effective, and therefore the most well as possible.

On the matter of changing from night shift to day shift, the most successful nocturnists maintain mostly the same schedule whether they are working or off. This allows your body to adjust to whatever your schedule is, and gives you that all-important cortisol spike right when your body knows you’re about to wake up.

People who only work a few night shifts a month will inevitably have to shift back and forth. Many people suggest taking a short two to four hour nap on the morning of your last night shift in order to start moving your schedule back to normal. No one suggested just trying to stay up the whole day after your last night shift.

Remember those 24s in residency?

No one wants to repeat those if they can avoid it!

Regardless of your reasons for needing or wanting to do night shifts, with a few adjustments to your home environment, your approach to sleep, and your commitment to regular exercise, it can be possible to not only survive but thrive on the dark side.–•–

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UP CLOSE AND PERSONAL WITH ACOEP’S SPRING SEMINAR KEYNOTE SPEAKERS RICK PESCATORE, DO, FAAEM Tuesday, April 6 9:00 a.m. – 10:00 a.m. (CDT) A graduate of the US Naval Academy and Philadelphia College of Osteopathic Medicine, Dr. Rick Pescatore completed his residency in Emergency Medicine at Cooper University Healthcare where he was Chief Resident. Rick is active in medical education and has presented on emergency medicine topics worldwide. He writes a monthly column, “What to DO,” for Emergency Medicine News and co-hosts the “EMN Live” podcast. Currently, Rick serves as Chief Physician for Delaware Division of Public Health and is an attending emergency physician at Einstein Medical Center in Philadelphia.

Has your DO background given you any insights or perspectives which you found valuable in providing emergency care during the pandemic?

Dr. Pescatore: My medical school training

NICHOLAS D. CAPUTO, MD, MSC, FACEP, FAAEM, MAJ (MC, USAR) Wednesday, April 7 8:00 a.m. – 9:00 a.m. (CDT) Dr. Nicholas Caputo is Associate Chief of the Department of Emergency Medicine at NYC H+H/Lincoln Medical Center in the South Bronx. He is currently an Associate Professor of Clinical Emergency Medicine at the Weill Medical College of Cornell University and an attending emergency physician at Columbia University Irving Medical Center/New York Presbyterian Hospital. Certified in emergency medicine, Dr. Caputo completed his internship in General Surgery at Beth Israel Medical

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reinforced the importance of the whole-person and whole-system approach—considerations that became invaluable as I worked in the pandemic to harness cooperation from and coordination of multiple community partners in the response to COVID-19.

What are some questions you’d love to hear from audience members during your keynote session?

Dr. Pescatore: I’m happy to answer any and all questions, but am particularly excited to discuss the role of the emergency physician in public health and how we can practice public health from the ED. What’s your favorite guilty pleasure (tv show or snack) to indulge in between shifts?

Dr. Pescatore: My wife and I are trying to watch classic movies together once a week—Gone with The Wind, Citizen Kane, etc. The movies are often terrible, but the times are tremendous.

Center, his residency training in Emergency Medicine at NYC H+H/Lincoln, where he served as a Chief Resident and his Fellowship training in Critical Care/Retrieval Medicine at Royal Darwin Hospital/Careflight in Darwin, Northern Territory, Australia. Dr. Caputo’s research seeks to understand the evidence behind the efficacy of management strategies practiced in emergency departments worldwide (such as preoxygenation in RSI, apneic oxygenation during intubation, non-invasive markers for occult shock) to improve safety and quality outcomes for patients. He focuses jointly on medical pathology and socioeconomic disparities in medicine. Dr. Caputo also serves as a Major in the US Army Reserve and is currently assigned to the 947th

Forward Resuscitative and Surgical Team based in West Hartford, Connecticut.

system, from those in the concierge service I work at, and in the Army Reserve.

What do you think is the top challenge in emergency care in a post-coronavirus world?

Dr. Caputo: There are several challenges to emergency care in the post-COVID world, but I think one of the most daunting is being able to provide telehealth to the broader general public especially for patients with known disease in order to help guide home management. If we are able to keep patients with more mild disease from utilizing inpatient beds by preventing progression to a more severe stage of the process it will help prevent a shortfall of hospital beds if a surge were to occur again.

Do you have any tips or tricks for managing stress and maintaining balance in your life?

Dr. Caputo: I try not to equate wellness in my personal life with wellness at work. This means I don’t look at my exercise or going out with friends or vacationing as a means of making my life in the ER better. I do those things regardless of what’s going on in the ER. I try to find wellness in the ER through helping to improve the processes, services and quality of care we give to our patients. I do this by learning about my patient population through research; seeking answers to throughput/logistical challenges; discussing ideas with my peers for ways we can do things differently in order to make our shifts more smooth and pleasurable, not only for the staff, but for the patients as well.

What is something attendees should ask you about at ACOEP 2021 Spring Seminar?

Dr. Caputo: Ask how my experiences in the public system differed from those in the private

GEORGE WILLIS, MD Thursday, April 8 8:00 a.m. – 9:00 a.m. (CDT) Dr. Willis is the Director of Undergraduate Medical Education and Assistant Residency Program Director for the University of Maryland Department of Emergency Medicine. He is fellowship trained in Faculty Development and a graduate of ACEP’s Teaching Fellowship. Dr. Willis is an outstanding educator and frequently lectures locally, nationally, and internationally on endocrine emergencies, aortic emergencies, efficient teaching, and effective feedback. He has received numerous teaching awards including the UMEM Residency Program’s Outstanding Teaching Award and ACEP’s Junior Faculty Teaching Award. He was also selected as one of EMRA’s 25 Under 45 Top Influencers in Emergency Medicine.

What is one thing you know now about emergency medicine you wish you could have known 20 years ago?

Dr. Willis: Well, 20 years ago, I was an undergraduate student. So, we will just modify it to what I wish I knew 15 years ago when I was in medical school. I would say I wish I knew how much of a load emergency physicians carry.

When I first discovered emergency medicine, I thought emergency physicians were the physicians who cared for the really sick and dying. What I’ve come to realize is that we are truly the safety net for all of medicine. We are the

resource that patients can utilize when they have nowhere else to go. We are the resource when specialists don’t have the resources to care for their patient. This past year, on the frontlines of this horrible pandemic, we are the resource the world needed to stare this pandemic in the face and bear the brunt of it. A very commonly used term I hear used is “hero,” but to me hero means you go out of your way to perform a task. For us, we just do what we are supposed to do, our job.

This is what we trained for. I call it a load because it is heavy, but we are willing to carry it, so it’s not a burden.

What insights do you hope to impart at ACOEP’s Spring Seminar?

Dr. Willis: The main focus of my keynote is what kind of process we as physicians go through when we fail. Some of us break and quit. A lot of others remain broken and never repair themselves. A few repair themselves and become better as a result of their failures. This latter scenario is the focus so that we don’t fall into the trap of chasing perfection.

What’s a memorable patient moment that made you love your job?

Dr. Willis: Wow, there are so many. Probably my favorite patient encounter was an elderly African American lady who presented suicidal. She said all her family and friends had died and she wondered why she was still around. Being very faith-based, I told her that if God was ready for her he would’ve taken her by now. She retorted, “Well I don’t know (continued on page 13)

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CORE EXAM

AOBEM’S NEW OSTEOPATHIC CONTINUOUS CERTIFICATION EXAMINATION

T

he American Osteopathic Board of Emergency Medicine (AOBEM) recently announced the launch of its new annual Osteopathic Continuous Certification (OCC) examination. The Continuous Osteopathic Recertification Examination (CORE) will replace the 10-year examination known as the Cognitive Assessment Recertification Examination.

By Christopher P. Zabbo, DO, FACEP, FACOEP Clinical Associate Professor of Emergency Medicine Secretary, American Osteopathic Board of Emergency Medicine

OVERVIEW If you have an active AOBEM certification, you are eligible to participate in the Continuous Osteopathic Recertification Exam (CORE).

You DO NOT need to enter CORE until your certification expiration year. You MUST enter CORE by your certification expiration year. If your certification expired in 2019 or before, please review the process for the OCC Cognitive Assessment Examination. All new diplomates will enter directly into CORE upon successful completion of the initial certification process.

(Example: A physician obtains initial board certification in 2021 would begin CORE in 2022.)

WHAT IS MY CME REQUIREMENT? A physician must earn 60 CME credits for the 2019-2021 CME cycle. AOA specialty certifying boards will not require diplomates to obtain specialty-specific CME during the 20192021 CME cycle. View the 2019-2021 CME Guide for more information on activities that may serve to meet the requirement.

For the 2019-2021 CME cycle, all nontime-limited diplomates will be required to earn 120 total CME credits, unless they choose to voluntarily participate in OCC.

WHO NEEDS TO DO COLA AND WHO NEEDS TO DO CORE? CORE is an annual examination that will replace your COLA requirement and the 10-year recertification exam. To enter CORE, you need to have a specific number of COLAs completed. You DO NOT need to enter CORE until your certification expiration year. You MUST enter

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CORE during your certification expiration year.

You need to successfully complete eight COLA modules to enter CORE during your certification expiration year. You DO NOT need to start CORE early. If, and only if, you want to begin CORE early, you may enter the CORE with a pro-rated COLA requirement based on your certification expiration year. View the AOBEM Core phasein plan on the CORE homepage to learn more about your COLA requirement.

COLA MODULES The COLA modules are available on the AOA Online Learning Platform. Scroll to the bottom of the webpage and select APPLY NOW.

WHAT EXACTLY IS CORE? Taken annually, CORE is an online exam that can be completed anytime via the AOA’s Online Learning Platform. You may use the educational resources typically available to you in the emergency department. Yes, it is open book!

Upon logging in, you will gain access to two exam sections: • Section 1: Two required core content modules • Section 2: Eight article-based modules. You are required to take and pass four of the eight modules Upon completing all six required modules (two core content and four article-based), you will complete a short survey and receive a certificate of completion.

From time of sign-up, you have until the end of the year of the CORE administration to complete the exam. CORE 2021 application is open now and closes November 15, 2021. You have until December 1, 2021 to successfully complete the CORE 2021.

A passing score of 75% is required for each module. You will have three attempts for each module, with the following stipulations: • You must wait one week after each attempt before retaking the same module. Be sure to take this into account when completing modules near the December 1 deadline.

• You have the option to move on to a different module, if available, without delay.

CORE Content The exam consists of 40-60 questions based on two or three content areas from the Table of Specifications (shown below) and four current practice articles: 2020: Respiratory/Thoracic, Hematology/Immunology 2021: Musculoskeletal; Nervous System 2022: Toxicology; Cutaneous 2023: Trauma; Psychiatry 2024: ID, EMS/Disaster 2025: Environmental, Cardiovascular 2026: Abdominal/GI, Administration 2027: OB/Gyn, Endocrine/Metabolic 2028: HEENT, Renal/Urogenital

ACCESSING CORE Upon registering, allow five to seven business days to receive access to your exam. Following review of your application and OCC status, you will receive an email with CORE login instructions.

WHAT ABOUT QI, PPA’S, ATTESTATIONS…?

Component 4: Practice Performance Assessment & Improvement remains in effect.

As practicing EM physicians, it is likely that we are already participating in these activities. All you need to do is go online an attest to participating in the activities.

Diplomates must complete two attestations every ten years.

Keep in mind that this is not a comprehensive list of all possible QI activities, but rather a list to help you recognize activities you may already be participating in that qualify for credit.

Meaningful Use Attestation for EMR atient Satisfaction / Patient Experience of Care (PEC) P / Physician Communication Skills (patient surveys, CAHPS, Press Ganey) Core Measures CMS PQRS Quality Measures ACRA / Merit-based Incentive Payment System M (MIPS) participation rescription Drug Monitoring Program (annual P registration) ommittee service (participation as a member of an C institutional / departmental QI / clinical quality / safety review committee hysicians can visit the AOA Physician Portal to fill out P an attestation form.

WHERE DO I STAND IN THE CERTIFICATION PROCESS? To check your progress with OCC, visit the AOA Physician Portal.

Visit the ACOEP website at https://acoep.org/ education-events/core-exam/ for links to a FAQ sheet, a webinar that covers all of this information, and information regarding the phase-in plan.

The American Osteopathic Board of Emergency Medicine has worked hard to make this a smooth process for all diplomates and appreciates feedback to make the experience even better. Those with individual issues are encouraged to reach out to have their concerns addressed directly.–•–

UP CLOSE AND PERSONAL WITH ACOEP’S SPRING SEMINAR KEYNOTE SPEAKERS (continued from page 11) what he’s waiting for!” So, I asked her what she did during her free time. She said that she was a foster mother to 7 teenagers, and I knew I had her. I told her that God hadn’t taken her yet because she hadn’t fulfilled her mission. Where would those teenagers go if she was to die? She broke down and cried. We talked for another 15 minutes or so about a

few other things and I discharged her. She thanked me and hugged me as she left. I did nothing medical for her except provide a listening ear. We focus so much on metrics and medicine that sometimes we forget to listen to our patients.

So, I tell that story to my students and residents to remind them to listen to their patients. –•–

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Bernard Heilicser, DO, MS, FACEP, FACOEP-D

THE PECK BEFORE DAWN

(then out the door)

What Would You Do? Ethics in Emergency Medicine

In this issue we will review the situation previously presented in the Winter 2021 issue of The Pulse, in which a nursing home patient sustained a cardiopulmonary arrest and was successfully resuscitated even though a valid Do Not Resuscitate form was present.

This patient arrested, and while endotracheal intubation was being attempted, the DNR was produced. An aspirated piece of hot dog was visualized and successfully removed. Soon after, the patient regained a pulse and respirations during CPR.

WAS EMS WRONG TO NOT FULLY HONOR THE DNR? This case challenges us to think about what the DNR really means. Does it simply mean that no action should be taken if the patient has a cardiopulmonary arrest or another event? Or does it mean medical intervention should be provided unless the patient will not survive, wind up vegetative with a tube in every orifice, or survive only to continue suffering with underlying medical conditions that will ultimately be fatal, but not immediately (i.e. chronic lymphocytic leukemia)?

What if a patient presents with a bullet wound? Do I withhold resuscitation, knowing they can survive the gunshot wound and return to their current baseline and a longevity where they will probably succumb to an intercurrent disease 10-20 years later?

Sometimes, our DNRs are not fully relative to the true medical situation.

Our patient with the aspirated hot dog no doubt had other medical conditions, but were we wrong to save his life?

I was on this call as a volunteer firefighter and EMS Medical Director. I instructed the paramedics to continue the resuscitation. I am comfortable with my decision.

But I have no adequate response if you were to challenge me.

If you have cases that you would like to present or have reviewed in a future issue of The Pulse, email them to us at drolfe@acoep.org.

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THE PULSE SPRING 2021

It’s later on, you wish it’d been more On the two lane highway When you picture those headlights Crossing the double solid Coming at yours head on Or worse, her in the Honda With the kids Hit by a van that sped Through the yellow turned red “T-boned” the medics relay “With major compartment intrusion And prolonged extrication” Silently You pray with the staff For airbags deployed And not someone you love.

Then after your shift Heading home In the hum of the highway The day’s bloodied faces reappear Leaving all your split decisions To take hefty seconds from your mind Yet when you arrive and see her Standing in the light of the door And smiling That kiss and caress You’ll embrace a lot longer.

John Scranton, DO, MFA, FACOEP

John Scranton is assistant clinical professor in emergency medicine at the Zucker School of Medicine at Hofstra University and currently practices urgent care medicine at Northwell Health-Go Health in Hampton Bays, New York. He received his DO from PCOM (‘87) and his MFA in English and writing from Southampton College.

STUDENT LOAN REFINANCING

You could save thousands on your student loans1 Using the link below ACOEP members receive a $300 cash bonus2 when refinancing.

Plus, you could get rates as low as 1.64%3 variable APR when you refinance your student loans and open a Laurel Road Linked SavingsSM account.

To learn more and access this offer online, visit LaurelRoad.com/ACOEP At Laurel Road, we recognize the dedication it takes to be a physician.

That’s why we’ve created an easy online experience with low rates, personalized service, and technology that makes refinancing student debt easier – so you can focus on the future, not your past.

All credit products are subject to credit approval.

1. Savings vary based on rate and term of your existing and refinanced loan(s). Refinancing to a longer term may lower your monthly payments, but may also increase the total interest paid over the life of the loan. Refinancing to a shorter term may increase your monthly payments, but may lower the total interest paid over the life of the loan. Review your loan documentation for total cost of your refinanced loan.

2. The 0.25% American College of Osteopathic Emergency Physicians (ACOEP) member interest rate discount is offered on new student loan refinance applications from active ACOEP members. The ACOEP rate discount is applied to your monthly payment and will be reflected in your billing statement. The discount will end if the ACOEP notifies Laurel Road that the borrower is no longer a member. This offer cannot be combined with other member or employee discounts.

3. Rates shown with discounts applied for making automatic payments and having a Laurel Road Linked SavingsSM balance of $5,000 throughout the life of the loan. Variable APRs subject to change. Visit laurelroad.com/doctors/linkedsavings for specific rate discounts.

Laurel Road is a brand of KeyBank National Association offering online lending products in all 50 U.S. states, Washington, D.C., and Puerto Rico. All loans are provided by KeyBank National Association, a nationally chartered bank. ©2021 KeyCorp® All Rights Reserved. Laurel Road is a federally registered service mark of KeyCorp.

2021_ACOEPAprilPrintAd SPRING 2021 THE PULSE

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