The Pulse 04-2014

the

Pulse

April 2014

Osteopathic Emergency Medicine Quarterly

Presidential Viewpoints Mark A. Mitchell DO, FACOEP

Are You Choosing Wisely?

T

here is more focus on health care today than I have ever seen in my career. As a nation we are faced with making significant changes to provide financially sustainable health care that will yield outstanding outcomes. The amount being spent on healthcare has to stabilize and yet we must continue to have results indicative of the many advances in medicine and patient care that have been made over the years. While there are many different opinions regarding the nature of the problems as well as the proper course of action, we as providers must be part of the solution. continued on page 4

Presidential Viewpoints Page 4

Executive Director's Desk Page 6

Advocacy: Time to Get Involved!

Page 15

FOEM Foundation Focus Page 18

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The Pulse

VOLUME XXXV No. 2

Editorial Committee Timothy Cheslock, DO, FACOEP, Chair Drew A. Koch, DO, FACOEP-D, Vice Chair John C. Prestosh, DO, FACOEP Board Liaison/Associate Editor Peter J. Kaplan, Advertising Consultant Stephen Vetrano, DO, FACOEP Kenneth Argo Todd Thomas Andrew Little, DO Danielle Turrin, DO Julia Alpin Peter A. Bell, DO, FACOEP-D David Bohorquez, DO Anthony Jennings, DO, FACOEP Matthew McCarthy, DO, FACOEP Erin Sernoffsky, Communications Manager Thomas Baxter, Media & Technology Specialist 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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Articles may not be reproduced without the expressed, written approval of the ACOEP and the author.

Pulse

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Editorial Staff Timothy Cheslock, DO, FACOEP, Editor Drew A. Koch, DO, FACOEP-D, Assistant Editor John C. Prestosh, DO, FACOEP Mark A. Mitchell, DO, FACOEP Erin Sernoffsky, Communications Manager Janice Wachtler, Executive Director

Osteopathic Emergency Medicine Quarterly

Table of Contents

Presidential Viewpoints...............................................................................................4 Mark A. Mitchell, DO, FACOEP The Editor's Desk.........................................................................................................5 Tim Cheslock, DO FACOEP Executive Director's Desk...........................................................................................6 Janice Wachtler, BAE, CBA What Would You Do?..................................................................................................7 Bernard Heilicser, DO, MS, FACEP, FACOEP Why We Do What We Do..........................................................................................8 John C. Prestosh DO, FACOEP Publication Opportunities for ACOEP Members................................................10 Erin Sernoffsky Changing the Paradigm for Medical Care...............................................................11 Janice Wachtler, BAE, CBA Advocacy: It’s Your Time to Get Involved!...........................................................15 Jaclyn Ronovsky FOEM Foundation Focus.........................................................................................18 Sherry D. Turner, DO, FACOEP Resident Wrap Up.......................................................................................................25 Steve Brandon, DO Resident Research and Resources: A Snapshot of Osteopathic Emergency Medicine.......................................................................................................................26 McKaila Allcorn, DO & Christopher Zabbo, DO Residency Spotlight.....................................................................................................28

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Presidential Viewpoints

Mark A. Mitchell, DO, FACOEP "Wisely" continued from page 1 The Choosing Wisely Campaign was initiated by the ABIM Foundation and since has had over 50 specialty societies join them. The aim of this initiative is to promote conversations between physicians and patients to make decisions that are supported by evidence; not duplicative of other tests or procedures already received; free from harm; and truly necessary.

Specialty organizations were requested to submit five practices or recommendations that represent their area of expertise. As Emergency Physicians many of these recommendations are relative to our day-to-day practices and are worth reviewing. In order to make sure we are doing our part to reduce the cost of health care, and are practicing based upon these guidelines, we must stay abreast of these recommendations and have discussions with our patients. I will review those recommendations that are most relevant to our practices.

• Avoid computed tomography (CT) scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules. Majority of minor head injuries don’t have a fracture or intracranial bleeding. CT exposes the patient to ionizing radiation and increases lifetime risk of cancer. Children – may be observed in ED for period of time before electing to do CT scan.

• Avoid placing indwelling urinary catheters in the emergency department for either urine output monitoring in stable patients who can void, or for patient or staff convenience. Catheterassociated UTI is most common hospitalacquired infection. Indications:

- Output monitoring for critically ill

- Relief of obstruction

-A t time of surgery or end-of-life care.

• Palliative care – Care that provides comfort and relief of symptoms for those with chronic and/or incurable disease. Avoid delaying available palliative and hospice care services in the emergency department for patients likely to benefit.

- Hospice – Palliative care for those in final few months of life.

- Early referral can lead to both improved quality and quantity of life.

• Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up.

- I & D is the appropriate treatment

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for abscesses and antibiotics offer no benefit.

- Even those with MRSA - antibiotics offer no benefit if the abscess is adequately drained and the patient has well-functioning immune system.

-R outine cultures are not needed.

• Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children.

-O ral hydration avoids potential complications and pain associated with an IV.

-T reating nausea frequently allows for oral hydration.

-G ive medications for nausea early in ED course to allow time to work optimally.

• Avoid doing imaging for low back pain within the first six weeks, unless red flags are present.

-R ed Flags include severe or progressive neurological deficits or when osteomyelitis is suspected.

-L ow back pain is the fifth most common reason for all physician visits.

• Avoid routinely prescribing antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.

-M ost sinusitis is due to viral illness that will resolve.

- S ymptoms must include discolored nasal secretions and facial or dental tenderness when touched.

-A ntibiotics are prescribed in more than 80% of outpatient visits for sinusitis and accounts for 16 million visits and $5.8 billion in annual health care cost.

• Avoid doing imaging for uncomplicated headache.

- I maging HA patients absent specific risk factors for structural disease doesn’t change management or outcome.

- I ncidental findings lead to additional medical procedures and expense that do not improve patient well-being.

• Avoid imaging for suspected pulmonary embolism (PE) without moderate or high pre-test probability.

-D VT and PE are rare in the absence of elevated blood d-Dimer levels and certain specific risk factors.

• Avoid admission or pre-operative chest x-rays (CXR) for ambulatory patients with unremarkable history and physical exam.

-R outine admission or pre-op CXR is not recommended for ambulatory patients without specific reasons suggested by history or PE.

- Only two-percent (2%) of such images lead to change in management.

-C XR is reasonable if acute cardiopulmonary disease is suspected or there is history of chronic stable cardiopulmonary disease in patients older than 70 and no CXR within 6 months.

• Avoid admission or pre-operative chest x-rays (CXR) for ambulatory patients with unremarkable history and physical exam.

-R outine admission or pre-op CXR is not recommended for ambulatory patients without specific reasons suggested by history or physical exam.

- Only 2% of such images lead to change in management.

-C XR is reasonable if acute cardiopulmonary disease is suspected or there is history of chronic stable cardiopulmonary disease in patients older than 70 and no CXR within 6 months.

I encourage you to go to the Choosing Wisely website (www.choosingwisely.org) and review all of the recommendations. As this information is on a public website many of our patients may review this information and may be asking you questions such as: • “Why are you ordering a CT scan on my eight-year-old daughter to evaluate for possible appendicitis instead of an ultrasound? How much radiation will she be exposed to?”

• “Why did you put a Foley catheter in my father? He is capable of using a urinal, and won’t that predispose him to an infection?”

• “Are you sure I need a CT scan of my head?

I had no loss of consciousness and I feel fine now?”

ACOEP continues to lobby and advocate for our practices and the patients we serve. To make these efforts maximally effective and to truly be a part of the healthcare solution, please have discussions with your patients and make sure that as a team you are “Choosing Wisely.”

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The Editor's Desk

Tim Cheslock, DO FACOEP

Organized Medicine and Advocacy: Where Do You Stand? agendas. Should they really be self-serving or should they be aimed at fixing healthcare delivery in our country? There certainly needs to be a balance.

M

edical societies all want a piece of your paycheck and in return promise to advocate for your rights as a physician, better pay and to look out for your overall interests as a physician. There is even the never ending pull at the strings to help do what is right for our patients. Each group has their own advocacy agenda. The AMA, AOA, your state and county medical society, ACEP, ACOEP all want your money to support you and your views. Who determines what is in your best interest or what needs to be a legislative priority though? Do they ask you? Do you tell them? For most societies it is their governmental affairs committee or the board of directors of the organization, with little input from the membership itself. The legislative agenda also plays a large role, whether it be at the state or national level. Once the agenda is determined though, they want your full backing and support as you are peppered with almost daily alerts and reminders to call congress and push for the society’s legislative agenda.

I felt compelled to write about this for two reasons. The first is that I am currently being asked by one of the societies to which I belong to get onboard and vote against something that I really do not believe is a bad thing. A bill currently pending in my home state would like to give nurse practitioners (NPs) independent practice rights.

You would think the world is coming to an end in Florida. The sky is falling and nurses are going to kill our patients. That may be a little exaggerated but you get the picture. Expansion of nurse practitioner practice rights can and will do a lot to ease the lack of access to care many patients currently experience. Most nurse practitioners that practice independently do so in the primary care arena. The only people being hurt by not doing this is our patients. I would much rather a person go see a nurse practitioner to have their blood pressure or diabetes managed then to have them show up in my ED with hypertensive crisis or DKA because of lack of access. Almost 25% of the patients I see daily in the ED come because their PCP was unavailable, didn’t have an appointment to give them, or was uncomfortable managing them in the office. The shortage of physicians cannot be denied. There is no clear remedy in sight. Why deny patients the critical access to care that they truly need?

The state medical society is using the argument that broad expansion of scope of practice and allowing NPs to prescribe scheduled narcotics, is unsafe. More than 18 other states already have expanded practice rights for allied health providers and have done so without any earthshattering, life-altering consequences for patients or physicians. Primary care jobs are not going away and there is no shortage of patients to see.

Which begs the question, what is this issue really about? I’ll let you draw your own conclusions there.

The second reason I am writing about this is the unlikely advocate that has come to light in support of the bill. Much to the dismay of the medical society I am sure, an emergency medicine physician has been a staunch advocate for moving the bill forward. I applaud his efforts and going against the tide in this case for what is right for our patients. Coincidently, Dr. Cary Pigman is also a member of the Florida Legislature.

We all need to do more than just write the check and follow blindly. We need to take part in the process and make our personal interests, morals and convictions part of the organization to which we belong. I am very proud of the legislative efforts of the AOA through OPAC and the ACOEP’s contribution in regards to advocacy support as well. They do a great job and the staff in the Washington DC office are outstanding!

We need to give them our full support and that means not only helping with the pitch, but driving the agenda and opening our wallets as well. We can only affect change when we are a part of the process. Good or bad it will go on without us. If it passes us by and we are left in the dust we have no one to blame but ourselves.

Next time you get a dues notice from a group or society, beyond writing the check, ask yourself the question, where do I stand in regards to what this organization is doing for me? Are their goals my goals? Do they listen to me when I want to voice my opinion? Can I count on them to look out for me and my patients? When you look at the ACOEP, I can assure you it is a very strong YES! As always, I appreciate your feedback at tim.cheslock@gmail.com.

First, let me say I clearly understand that in order to affect change you need to have a voice at the table. There is strength in numbers hence the push to get involved. For the most part physicians are complacent in this process and then complain when things don’t go their way. A recent email sent by the AOA suggested that just about 2% of osteopathic physicians contacted Congress to push for SGR reform over a critical time period as legislation was being discussed.

We need to do better! Another area in need of improvement is how we determine our advocacy

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Executive Director's Desk Janice Wachtler, BAE, CBA

Osteopathic Kool-Aid

W

hen I began working for the AOA many years ago, I had no idea who A. T. Still was. From an orientation given to new staff, I thought he was a cool old guy, staring at a bone and professing a ‘new type’ of medicine. I thought okay, I’m good with that. Since I was young and knew everything, I knew ‘osteo’ was a crossword clue meaning bones and even though I had absolutely no idea what this new kind of medicine was all about, I was curious. Then I met George Northrup, D.O., Editor of the JAOA. The Department of Education routinely loaned me out to the Administrative Department to assist with the Board of Trustees and House of Delegates meetings. It was a nice break for someone who wrote policy and curriculum the other weeks of the year and could be a pain when bored. We worked in a room off the kitchen in a Philadelphia hotel hunched over typewriters, creating papers for the House of Delegates. I had been typing reports for the last five hours while another staffer copied papers, one page at a time, and spread out on a table to collate. We bemoaned the fact that our necks and backs hurt as we did our job. Enter Dr. Northrup.

He came in to check on us, bringing sodas and goodies confiscated somewhere. It wasn’t until he clamped his hand on my shoulder that I shouted in pain. He told me to lie on the table and he would do OMT on me. I knew what the initials stood for, but had absolutely no

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idea what he would do. Over the next fifteen minutes he did manipulation on my neck and shoulders. During the treatment I could feel the tension ooze out of my muscles. Then he asked if I snored. I replied, “Like a jet engine,” and he nodded as he massaged my face before grabbing my nose and cracking it. Instantly I thought, “This old fart broke my nose!” and looked up at him, panic evident on my face.

“Don’t worry dear,” he chided, “I didn’t break your nose, but you won’t snore anymore.” He repeated the procedure on the other side, and when I sat up, a little dizzy, he reached in his pocket to pull out a metal tin with aspirin and gave me orders to take a hot shower and two aspirins and report back to work in an hour. As I left the room, much to the displeasure of my supervisor, I did feel better.

knowing that we weren’t treating emergency cases with OMT or differently than they did.

What was realized was that the two professions aren’t that different. The biggest difference was where training takes place and research. Much of allopathic training is university based, with research being done by attending physicians, a totally different model than AOA-approved programs follow.

When I returned my neck, shoulders and back were stiff and I had a little bruising under one eye, but my neck didn’t hurt as we continued to work into the night to finish our task. When I returned home, my family noticed I no longer snored much to their relief.

However, as we move in this direction we cannot forget the profession AT Still established in the waning days of the twentieth century, a holistic approach to allopathic medical principles, that the patient and body were as much a part of successful outcomes as medication. His principles cannot be lost as we move forward. To have the successful outcomes so important for statistics and scores, we will all have to take a large glass of osteopathic KoolAid and incorporate the manual, observational, and core values that make each and every one of you the physician you are and what makes osteopathic medicine so very important to our national medical landscape.

That was my first drink of osteopathic Kool-Aid, and since then I’ve gone back to the fountain many times, reading about techniques, Dr. Still himself and the College at Kirksville.

But most recently I learned that my addiction to this Kool-Aid may have blinded my judgment when it comes to physicians in general.

As someone who screens their physicians based on how they approach my care as a patient, I think I am aware that MDs have different approaches to their patients. Some are very DO-like in their patient approach and care; others are not. We see this same paradigm when we look at ACGME and AOA-accredited training programs and evaluations.

Last spring we had the pleasure of meeting with our MD counterparts as we prepared for the amalgamation that was to occur, if the ACGME and AOA could reach a neutral ground on postdoctoral training. What we found was that emergency medicine standards weren’t all that and could easily modified to fit into a unified format.

Their big question was, what is osteopathic emergency medicine and how did it differ from the emergency medicine they practiced?

When we answered that osteopathic emergency medicine was emergency medicine practiced by osteopathic physicians, they were satisfied,

I think we all recognize that sooner or later this amalgamation of professions will occur, the question is when. The government will see that the professions are similar and will seek to make accreditation and training uniform across the country, and because of the size difference, the ACGME will become the recognized accreditor.

Please don’t ever forget your osteopathic roots or that old man with that bone; he was an innovator, inventor and leader. So when you yearn to be more MD-like, just look over your shoulder and remember AT Still has your back and generations of physicians have established your right to practice and exist in American Society.

Update: I would like to thank all of the members of ACOEP who took time to call me after the January issue to wish me well in my battle with breast cancer. I appreciated the many emails and calls I received and the many prayers that were said on my behalf. At this time, as we go to press, I have completed chemotherapy, and move onto radiation. My cancer markers are now at zero and with medication my recurrence rate has been reduced to 2-3%. I hope they’re right and hope to be here for you for many years to come. My continued thanks and love to all of you.

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Ethics in Emergency Medicine

Bernarnd Heilicser, DO, M.S., FACEP, FACOEP

What Would You Do?

I

EMS transport to ED for evaluation. She is intoxicated, has an altered mental status, and has an altered medical decision-making capacity.

Otherwise, identification of the police is essential.

• If the police are still refusing to assist with transport, I would make sure to get their names and badge numbers for the record.

If there is a bad outcome on this patient, I would want them held responsible.

Unfortunately, EMS allowed the patient to sign a refusal for transport. Without police support, they were concerned that the OD was questionable and were reluctant to force the transport. They did not contact medical control. The outcome was without consequence; however, a profound learning experience was had when this call came to our attention.

We thank Dr. McGovern for her insightful comments. As Dr. McGovern states, our patient appears to be intoxicated and her decision-making capacity is questionable.

Additionally, a 6 year-old child is involved.

Prudent medical oversight would require the patient be transported for evaluation. Indeed, this may require police intervention, but the patient and grandchild are at risk. To facilitate this, direct discussion with the patient and police by telephone or radio may be helpful.

What happened?

If you have any cases in your practice that you would like to present or have reviewed in The Pulse, please email them to us at

WhatWouldYouDo@acoep.org Thank you.

n this issue of The Pulse, we will review the case presented in the January 2014 issue.

Our patient is a 45 year-old female whose boyfriend called EMS, stating she took an unknown amount of antihypertensive pills. When EMS arrived, the patient denied any overdose (OD), but admitted to alcohol consumption. She further stated her boyfriend made up the OD because he wants her out of the house. The patient had slurred speech and a history of possible drug OD in the past. An empty vial of pills was present. The patient is refusing medical treatment.

You are medical control. What would you do when EMS calls in? Would your decision change if the police are hesitant to get involved, and the patient is the legal guardian of her six year-old grandchild, who is in the house?

These types of situations are very difficult and frustrating for EMS and the emergency department. Is the patient being truthful, and are they reliable? What is the safest approach? Patient autonomy would dictate the patient should be allowed to sign a refusal of treatment, provided decision-making capacity is demonstrated. Is our patient decisional?

We received the following response from Cathleen McGovern, D.O., FACOEP: • Since this patient is showing signs of intoxication (slurred speech), I would have

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The On-Deck Circle

John C. Prestosh DO, FACOEP, President-Elect

Why We Do What We Do and her complaints, develop a sound differential diagnosis, and then both see the patient.

W

hat is that harsh sound and where is it coming from? It takes a few seconds, and then I realize that is my announcement for the beginning of another day. Is it that time already? It seems as though I crawled into bed just a few minutes ago. I glare at the clock and sure enough it reads 5:00 AM. I am tempted to hit the snooze function, but I know I will just lie there and wait seven agonizing minutes and not rest. It is time for my day to start. I will drink my obligatory cup or cups of coffee, attempt to eat something for the “most important meal of the day,” catch up on the latest sports news, and then leave for work.

Another day in the emergency department will begin, probably just like every other day. As I enter the department at 6:50 AM, I see patients with real and perceived emergencies already waiting for me. I notice the technicians, nurses, students, and residents all poised to fulfill their duties for those who require their medical skills.

The staff is ready for another day in the world of emergency medicine.

As I log-in to the computer (are we really better off with this technology?), an eager medical student approaches and says she has a case to present. I thoroughly enjoy teaching students, but I inform her that she is to present her case to the senior resident who will be in charge of her and the patient. Of course, I will be listening to what transpires between the two of them and offer any necessary input, but this is part of the learning process for this resident to become the teacher. They discuss the patient

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Suddenly, a familiar tone transmits from behind the nurses’ desk. EMS is calling for command on a trauma patient and requesting a Trauma Alert be called with an ETA of 10 minutes. I acknowledge their request and inform EMS that we will be waiting for them in the trauma bay. As the patient is wheeled into the bay, the entire team is ready to do whatever is necessary for the patient. A first year resident quickly enters the trauma bay and asks for my assistance with another patient who most likely will need to be intubated for severe respiratory distress. I tell him I will be at his patient’s bedside in less than two minutes, and he and the nurses should assist the patient’s breathing until I get there. As I am going to see the respiratory patient, the senior resident who was with the medical student informs me that he believes his patient has an ovarian torsion. We immediately contact OB/GYN to alert them about this patient and send her for a formal ultrasound.

As we prepare to aid the patient in respiratory distress, I hear an angry voice emanating from one of our psychiatric patients who is waiting to be transferred to another facility. The report from the night physician stated that the patient was an involuntary commitment and had not been any problem throughout the night. Of course, the patient was now tired of waiting and

So, I have a cup of coffee and some graham crackers for nourishment. The remainder of the shift flies by quickly, and my replacement arrives early to complete charts from his last shift. He asks how the day has been and gives me that knowing smile that no matter how bad or busy the day may have been, I am going home soon and the department will become his responsibility. I am tempted to say it was a typical day, whatever that means.

My day in the ED is finished, and I look forward to the quiet walk to my car. I purposefully ensure that I have at least a ten minute walk to my car. This is the time to unwind and look forward to family time at home. I have learned over the years never to take my work home, that idea works most of the time, but there are those times . . . you know those patients you cannot forget!

As I travel home, I realize that I can honestly say my shift was not typical. Yes, the disease processes that I encountered during this shift may not have been new; however, the individuals associated with the illnesses were new. It is true that we often see familiar faces in the ED, but in reality, those individuals are in the minority. For the most part, we see new faces every day. Those faces belong to individuals who are concerned about their health and entrust their lives and care to strangers (yes, that’s us). I understand that I had the amazing opportunity to be a caregiver – Benjamin Franklin and engage in the disposition of a very ill young woman who eventually needed an emergent surgical procedure, a trauma victim who fortunately ended up with non-life- threatening bruises, a COPD patient who needed urgent respiratory intervention, a psychiatric individual who needed in-patient treatment, and many other acute and non-acute patients who presented for care. I realize I was a teacher to my students and residents. It is encouraging to watch a student make the correct diagnosis and apply his academic prowess to clinical applications. It is rewarding to see the residents become more proficient with their procedures and care of patients and families. It is humbling to realize I was a student during that shift and learned something from everyone I had contact with during the day. I believe that continued on page 12

" Hide not your talents. They for use were made.

What’s a sundial in the shade?" demanding to go home while yelling, “I will kill myself if you don’t release me!” The control team is called, and the patient realizes our show of force is greater than his resolve to fight and immediately quiets down.

I receive more presentations from the residents, and we discuss the cases and deliberate on courses of treatments. When I return from seeing several patients that we just discussed, I am greeted with more residents with more patient presentations. It seems like I have been in the department for only a short time when my colleague asks if I want to get lunch. I check my watch and realize it is 1 PM! I should have lunch, but we are falling behind with our patient assessments and dispositions and the waiting room is reaching capacity level.

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In Memoriam In early February, the College was saddened to learn of the passing of David C. Welch, D.O., FACOEP of Phoenix, Arizona. Dr. Welch was a graduate of the West Virginia School of Osteopathic Medicine (’83), who completed his internship and residency at Brentwood Hospital in Warrensville Heights, Ohio (’86). During his career he worked at Phoenix General Hospital and Kingman Regional Medical Center.

Dr. Welch’s experience in EMS drove him to work closely with Phoenix Fire Department paramedics, volunteer EMTs and paramedics at Phoenix Emergency Rescue and other area pre-hospital providers. As Pre-Hospital Medical Director at Phoenix General Hospital and Kingman Regional Medical Center, he became involved with the development and implementation of pre-hospital protocols and actively involved in continuing educational programs for pre-hospital providers. Dr. Welch was also the President of Mohave Emergency Physicians, Inc., which staffed several emergency departments in and around the Phoenix area.

Always a presence at our Spring Seminars held in the Phoenix area, Dr. Welch enjoyed off-road exploration of historical sites in the southwest, as well as boating and nature-studies and spending time with his family.

Dr. Welch passed away two days after his sixty-first birthday and is survived by his wife, Carol, and their three sons.

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Publication Opportunities for ACOEP Members Erin Sernoffsky

A

COEP prides itself on providing excellent benefits to its members. From travel discounts to convention sites, to Board prep courses, our partnerships are all created with the goal to increase opportunities for our members. This is why we are so proud of our affiliation with WestJEM, a national publication read by over 16,000 emergency physicians and medical professionals. It is an open-access, peer-reviewed journal which means it can be found for free, in full text, at westjem.org, westjem.com and on PubMed Central.

ACOEP’s collaboration with WestJEM began in 2010 as a result of the work of many ACOEP Board members, including former Board President Peter Bell, DO, FACOEP-D, who currently serves on WestJEM’s editorial board. “One of my goals as President was to secure a partnership with a scholarly journal.

Various board members made queries and Dr. Christensen connected us with

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Dr. Mark Langdorf and Dr. Shahram Lotfipour at UC Irvine. They were essential to establishing WestJEM with California ACEP and helped us to establish a good relationship.” Other ACOEP members have submitted articles in the past, or serve as section editors for WestJEM currently.

So what is WestJEM and how can you get involved? According to their mission statement, “This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.”

Calvin Tan, Editorial Director, said that they look for a wide-variety of topics in their journal. “WestJEM is interested

in publishing almost anything under the umbrella of emergency medicine. We have sections ranging from geriatrics, to trauma, public health, critical care, and can accommodate most any relevant emergency medicine topic. Of particular interest to WestJEM are articles or research pieces that focus on population health and new research that can affect patients on a large scale.”

Not interested in writing but still want to be involved? WestJEM is also looking for reviewers. Says Tan, “If people are interested in the journal and would like to become more involved, we are always looking for quality reviewers, and sometimes also section editors and editorial board members as positions open. If people would like to start their involvement as reviewers in support of the journal, all we ask is that they send a CV to editor@westjem.org to be reviewed by the senior editors.”

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Changing the Paradigm for Medical Care Janice Wachtler, BAE, CBA

R

ecently, the Chicago Tribune reported that despite offering a county-sponsored insurance program prior to the advent of the Accountable Care Act (ACA) emergency departments of county hospitals saw no significant decline in providing care for the ‘working poor.’ Why, you wonder? Two reasons; habit and the inability to get primary care physician appointments after work.

Many of the working poor have utilized the Emergency Department and Emergency Medicine Physicians as their primary care providers, often becoming so familiar with physicians that they rely on the Emergency Physician to care for their healthcare needs.

Since getting insurance through the county or government, they feel more comfortable with the Emergency physicians they have known, to be their Primary Care Provider (PCP).

are the physicians most affected by the "You

non-emergent patient coming to your ED. " Physician training may be another method.

Perhaps non-emergency medicine specialists could have early or late working hours and be trained not to send patients directly to the ED for assessment, but rather to a colleague working in the fast track clinic of the ED. That physician could be an adjunct to the physician’s office and assist in deferring the overuse of Emergency Physicians’ time and expertise.

But what do you think? You are the physicians most affected by the non-emergent patient coming to your ED. Should the various emergency medicine organizations ban together to change EMTALA; have emergency medicine declared a primary care specialty, or should special non-urgent methods of assessment be developed with other primary care specialists?

Email ThePulse@acoep.org and tell us how you would address this problem.

Now, armed with insurance, and asked to select a PCP, these patients are finding many primary care physicians do not have hours that allow the working poor to see them after work, and for the hourly worker, an hour off means lost income. So they again resort to the Emergency Department and its physicians to provide their care.

The healthcare system and physicians are not blameless in this situation, as many primary care practitioners still advise sick patients to report to the Emergency Department for assessment in the event the patients need to be admitted. So the question is how do we change this paradigm? Many surmise it may take generations to change not only patient-thinking but medical practice, as well.

Patient training is one method. The patient utilizing the emergency physician as their PCP and uses the EMTALA criteria to get immediate care, may have to been seen by family medicine or internal medicine physicians and placed in non-urgent care clinic setting as an adjunct to the ED. Triage being done by a non-emergency physician could speed these non-urgent cases from your ED waiting room.

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12 "What We Do" continued from page 8 a shift does not pass by without my knowledge base being increased.

My evening at home goes by quickly, and it will soon be time for this day to be over.

The alarm will be set for 5:00AM, and yes, it may seem like “Groundhog Day” when the cacophony begins tomorrow. However, it will not be the same day. It will be a day of meeting new patients and treating each and every one of them to the best of my ability.

Why do I do this? I do not practice emergency medicine for recognition, financial reimbursement, or awards. I do what I do for the same reason you do. I enjoy helping people in need, and I enjoy teaching students and residents the art of our specialty. There is nothing unique about the day I have chosen to share in this article. This day is similar to that of many emergency medicine physicians. What does make the day unique is the satisfaction each of us shares at the completion of a shift.

We strive to make a positive difference in the life of a human being, and that is what we were trained to do, and that is why we do what we do!

HAVE YOU SEEN THE NEW AND IMPROVED ACOEP WEBSITE? Visit www.ACOEP.org for the latest updates on news, conferences, CME opportunities, member benefits, careers and more!

Our new design makes finding the information you need easier than ever. It's even mobile device friendly!

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Interested in Making a Change in ACOEP? Are You Interested in Making a Change in the American College of Osteopathic Emergency Medicine? Or are you interested in becoming involved in the governance of the College through active involvement on Committees? If so, here’s how you can do it.

Nomination to the Board of Directors of ACOEP is available to any Fellow or Distinguished Fellow member of the College. He or she should be an active member of one of the College’s committees as a member or as a Chair or Vice Chair. Members meeting these criteria may submit a self-nomination that includes a letter explaining your interest in sitting on the Board, what you would add to the Board, a current CV and a photo. Nominees are considered in the spring and, if you are accepted as a candidate you should know that it is a three-year commitment. The Board meets two to three times annually, and conducts regular conference calls. It will mean a minimum commitment of ten days per year and several hours for the conference calls.

Committee nominations are accepted year-round. Generally appointments are made at the end of the calendar year and terms run from January 1 to December 31 annually. Nominations are for three-years, however, if you are completing the term of a member who has resigned or been appointed to another position within the College, your term would run for the remainder of that term.

Like the Board, the nominations are accepted from the individual member. The member simply must complete a form indicating what committee he or she would like to serve on. Committee membership will require that the member attends two-thirds (⅔) of the committee’s activities, which could include twice annual inperson meetings and conference calls of the committee.

If you are interested, please email ThePulse@acoep.org and you will be sent the appropriate documents and information.

Check Out the New ACOEP Mobile App! ACOEP is proud to unveil a new, mobile app for The Edge: Spring Seminar ‘14!

The mobile app is free to all Spring Seminar attendees and will allow you to: • View schedules, sessions, and all event functions, including times, locations, and room numbers • Create your own personalized schedule, including didactic sessions and committee meetings • Receive the latest updates and notifications on the fly • Access speaker handouts and speaker bios • Check out interactive maps of the hotel and surrounding area • Find exhibitors and sponsors, including contact information for post-event resources • Reach out to fellow attendees directly through the app, increasing your networking opportunities …And much more! The app will be available to registered attendees beginning early April, for iOS and Android devices.

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ACOEP Presents

SPRING SEMINAR

‘14

Prime Partner

HURRY, THERE'S STILL TIME TO REGISTER! ACOEP Presents

SCIENTIFIC ASSEMBLY

ACOEP Presents

INTENSE REVIEW

‘14 ‘14

The Edge - Spring Seminar 2014 The Westin Kierland Resort & Spa Scottsdale, Arizona

April 22 - 26, 2014

For More Information Visit: www.acoep.org/spring

15

Advocacy: It’s Your Time to Get Involved!

Jaclyn Ronovsky

M

embers from the ACOEP Governmental Affairs Committee were present at the AOA’s January Bureau of Federal Health Programs (BFHP) meeting in Washington, D.C. Also present were the former U.S. Surgeon General Regina Benjamin, Department of Health and Human Services Deputy Secretary Bill Corr and representatives from the executive branch.

At this meeting, physicians and executive leadership of the specialty groups were able to discuss key issues in health care reform, such as physician payment reform, GME initiatives, and access to care. Continued physician involvement was encouraged to provide access to a primary care physician and to promote a new payment system and the removal of the SGR from any future payment model.

Executive Branch Representatives S enate Health Education Labor & Pensions Committee Senator Tom Harkin (D-IA) Representative: Sara Singleton

is strengthening its representation on "ACOEP

Capitol Hill. " ey Discussion Topics: Workforce K programs created by the ACA, GME Speaker of the House John Boehner (R-OH) Representative: Ashley Palmer Key Discussion Topics: Physician urgency at all-time low, need more physician involvement Senate Finance Committee Senator Max Baucus (D-MT) Representative: David Schwartz Key Discussion Topics: Physician Payment Legislation White House National Economic Policy Council Chris Dawe, Policy Advisor for Health Care Key Discussion Topics: Affordable Care Act, not enough physician involvement, numbers for ACA enrollment increasing

Senator Rob Portman (R-OH) Representative: Joe Shonkwiler, MD, Health Legislative Assistant Key Discussion Topics: Wellness program for seniors, support for GME funding ACOEP is strengthening its representation on Capitol Hill, and encourages all of our members to get involved with advocacy, policy, and health care reform. Members of Congress want to hear from you, so now is the time to speak up!

For more information regarding the Governmental Affairs Committee, and to learn how your voice can be heard to our partners at the AOA and on Capitol Hill, contact the Committee Chair, Joseph Kuchinski, DO, at josephkuchinski@optonline.net, or ACOEP’s Senior Coordinator of Member Services, Jaclyn Ronovsky, at jronovsky@acoep.org.

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ACOEP Presents

SCIENTIFIC ASSEMBLY

ACOEP Presents

INTENSE REVIEW

‘14

Prime Partner

‘14

SAVE THE DATE The Edge - Scientific Assembly 2014 Caesars Palace Las Vegas, Nevada

October 12 - 15, 2014 For More Information Visit: www.acoep.org/edge

17

ACOEP Staffing Updates Already 2014 has been a year of incredible changes! We have welcomed two new staff members as well as developed new departments to better accommodate our ever-growing membership. Below is an updated list of ACOEP staff along with their contact information. Feel free to call or email our staff with any questions, concerns, or needs that you may have.

EXECUTIVE

Administrative Assistant, FOEM and Member Services Gina Schmidt 312.445.5701 gschmidt@acoep.org

Executive Director Janice Wachtler, BAE, CBA 312.445.5705 janwachtler@acoep.org

MEETINGS AND CONVENTIONS

Development Director Stephanie Whitmer 312.445.5712 swhitmer@acoep.org

Manager of Meetings and Conventions Adam Levy 312.445.5710 alevy@acoep.org

Executive Assistant Geri Phifer 312.445.5700 gphifer@acoep.org Manager of Education Services Kristen Kennedy, M.Ed. 312.445.5708 kkennedy@acoep.org

Senior Meetings Coordinator Lorelei Crabb 312.445.5707 lcrabb@acoep.org Education Services and Meetings Assistant Andrea Jerabek 312.445.570 ajerabek@acoep.org

MEMBER SERVICES Director of Member Services Sonya Stephens 312.445.5704 sstephens@acoep.org Sr. Coordinator of Member Services Jaclyn Ronovsky 312.445.5702 jronovsky@acoep.org MEDIA AND TECHNOLOGY Communication Manager Erin Sernoffsky 312.445.5709 esernoffsky@acoep.org Media Technology Specialist Tom Baxter 312.445.5713 tbaxter@acoep.org

the

Pulse Osteopathic Emergency Medicine Quarterly

WE WANT TO HEAR FROM YOU! ER Physicians do incredible things every day and we want your stories! Send your story ideas to ThePulse@acoep.org, we would love to share your experience with our members.

We also encourage you to email ThePulse@acoep.org to share your thoughts on specific articles that you read here. We want to keep the conversation rolling, whether you agree or disagree with a point of view represented in our articles, we want to highlight various perspectives from our diverse membership.

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FOEM | BEACON

masthead_Layout 1 4/18/13 10:24 AM Page 1

• A FOUNDATION DEDICATED TO RESEARCH IN OSTEOPATHIC EMERGENCY MEDICINE

Foundation Focus Sherry D. Turner, DO, FACOEP President

FOEM Proudly Unveils the Research Quality Improvement Initiative

T

here is currently a groundswell of support for the advancement of research by osteopathic residents, their program directors, core faculty, and emergency medicine physicians. Throughout its 15 year history, FOEM has led the charge in these research activities and is pleased to announce the latest endeavor to enrich research and the medical community. Funded through a $17,000 award from the David E. Kuchinski Memorial Grant, FOEM is spearheading the development of the Research Quality Improvement Initiative (RQII), a collaborative effort between FOEM and ACOEP’s Research Committee, Graduate Medical Education Committee, Continuing Medical Education Committee, and Emergency Medicine Program Directors. RQII’s aims are to promote and augment research of osteopathic residents by developing internal resources integrated through the FOEM Research Network, and to provide multifaceted oversight, structure, valuable tools and recommendations to support the research process.

Osteopathic residents in emergency medicine are required to produce a research project, suitable for publication, and submit their completed project to ACOEP six months

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has already made significant inroads in "RQII

better organizing research efforts. " prior to graduation. These projects are designed to provide residents with the essentials of research methods and processes. The resident is tasked with the development of the research project and methods with program directors responsible for project oversight.

In 2012 the Research Committee reviewed a large sample of these research papers and identified some key opportunities for improvement which include a comprehensive overhaul of research requirements, as well as improved information sharing within the College for collaborative efforts. Currently there exists a broad range of interpretation and implementation which has created a number of very promising projects, however they are relatively small-scale and rarely reach publication quality.

RQII will create a tiered system of enhancing research. Mutually agreed upon standards of research and resident effort will be developed and adopted by the Graduate Medical Education Committee. These standards will then be implemented by the program directors, and monitored by the ACOEP Research Committee. To ensure success, these research guidelines must specify acceptable research products and effort levels that are achievable, applicable, and of demonstrable educational value to the profession. Program directors will not only provide clear direction to residents, but also point them toward the needed resources

to achieve these new standards. By training faculty members on a common curriculum, osteopathic research can be improved within residencies, and the potential of grant funding and inter-institutional research may be realized.

FOEM has intensified its funding efforts and is now able to sponsor research competitions and to provide seed money grants for small research projects. Additionally, FOEM is leading efforts to unite osteopathic emergency medicine residencies into a research network in order to coordinate multi-center, collaborative studies. Furthermore, a new Faculty Development Track will premiere at The Edge—Scientific Assembly which will train current and prospective core faculty in how best to take advantage of all that RQII has to offer, grant writing, publication tips, and more.

Moving forward, the Research Committee has identified several short-term goals that include developing a cadre of Research Liaisons who are faculty members within each residency who serve as the link between their program and the ongoing RQII process. Other goals include yearly resident paper reviews, establishment of a Faculty Development Track, increased faculty participation in ongoing basic research training.

The second stage of goals will be completed by 2016 and include advanced research education continued on page 21

FOEM | BEACON

Join FOEM at the 2014 ACOEP Spring Seminar in Scottsdale, AZ! 5K “Run for Research” Wednesday, April 23, 2014 at 6 a.m.

Resident and Student rate $25.00 (includes t-shirt) Normal Rate $50.00 (includes t-shirt)

FOEM 2014 Spring Seminar - Sco sdale Wednesday, April 23, 2014

Back for its third year, the FOEM 5K Run for Research has quickly become a favorite event of the Spring Seminar. Rise and shine for a brisk run to get the blood flowing before another day of didactic sessions. All proceeds from the run benefit FOEM’s mission of advancing research for osteopathic emergency medicine. All are welcome!

Case Study Poster Competition Sponsored by:

Wednesday, April 23, 2014 at 12:30 p.m.

The Foundation for Osteopathic Emergency Medicine (FOEM) is proud to present the annual Case Study Poster Competition. Enjoy live presentations of interesting and unique cases in the emergency department, and earn CME credit just for attending! This exciting competition is open to all ACOEP residents and students and the top three presenters win cash prizes. 4.5 hours of CME credit may be earned by attending the presentations.

FOEM 2014 Ticket to Paradise Raffle

Ca s Lo

! s o b

Enter the 2014 FOEM raffle to win a week of luxury at a Grand Regina Resort in Los Cabos! For only $100 you could experience the incredible Mayan Ruins, picturesque beaches, poolside barbeque, fine dining and more in beautiful Los Cabos!

Raffle tickets are available online and are on sale now through April 24. Thank you to Doug and Mariruth Webster for donating this incredible prize!

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FOEM | BEACON

2014

20

LOS CABOS

RAFFLE

Enter to win one week* in a beautiful two bedroom villa at the Grand Regina Resort in Los Cabos (www.grandregina.com).

OR One week* in a two bedroom unit at any comparable member resort in The Registry Collection (www.registrycollection.com).

Tickets sales will end Friday, March 28, 2014.

Winner will be announced Tuesday, April 1, 2014.

For official rules and regulations, please contact Stephanie Whitmer at swhitmer@foem.org *Week selected is subject to availability and must be used before December 31, 2014.

You may purchase tickets at www.FOEM.org OR mail a check to: Foundation for Osteopathic Emergency Medicine Attn: Stephanie Whitmer 142 E Ontario St, Ste 1500 Chicago, IL 60611 (F) 312-587-9951 the PULSE | APRIL 2014

FOEM | BEACON "Initiative" continued from page 18 and resources through use of Osteopathic Post Graduate Training Institutions, FOEM research network, or institutional development; increased networking between researchers of comparable interest and capabilities; the fostering of new opportunities for funding through collaboration with other institutions; advancement and promotion for FOEM’s research grants; organization of faculty into functional research groups; and the marketing osteopathic research projects to granting organizations and sponsored clinical research entities.

Though still in its beginning stages, RQII has already made significant inroads in better organizing research efforts, providing residents and attending physicians alike with new opportunities for growth, professional development, and the chance to make a real impact in the practice of emergency medicine.

Osteopathic residents and physicians have so much talent, promise, curiosity and passion for the field. Through RQII, FOEM and ACOEP will bring these resources and skills together so that together we can all realize our full potential.

Join the FOEM Board!

The Foundation for Osteopathic Emergency Medicine is looking to expand their Board. If you are interested in becoming a member of this highly engaged group, please send your CV and letter of intent to Stephanie Whitmer at swhitmer@foem.org by March 31, 2014.

142 E. Ontario Street, Suite 1500, Chicago, Illinois 60611 • Phone: 312.587.1765 • Fax: 312.587.9951 • www.foem.org | APRIL 2014 the PULSE

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22

FOEM | BEACON

Core Faculty Academic and Research Skills Development Course Join FOEM for the brand-new Faculty Development Track, at the 2014 The Edge—Scientific Assembly! This one-day course will provide you with insight into how best to take advantage of FOEM’s new Research Quality Improvement Initiative, implement new common core standards, enrich research, and network with other institutions and organizations to improve osteopathic research across a broader spectrum!

Topics will include research design, grant writing, orientation to the FOEM Research Network, tips on getting published and more!

Who should attend?

The Core Faculty Academic and Research Skills Development Course is open to core and prospective core faculty members with an interest in improving research and academic teaching skills.

When are the seminars given?

The Faculty Development Track will debut on October 22, 2014 at the ACOEP Scientific Assembly and run for four consecutive spring and fall meetings.

What is the cost? $50 per session for faculty, and free to residents nominated by their Program Director.

To find out more, contact Stephanie Whitmer at swhitmer@foem.org

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FOEM | BEACON

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24

Are You Making the Most of your Membership?

Visit www.acoep.org/benefits to see the exclusive offers ACOEP members receive from these great partners!

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Resident Wrap Up

M. Steve Brandon, DO ACOEP Resident Chapter President ACOEP Board of Directors

Summer is an exciting time for those in the medical field. Every July hundreds of freshly-trained physicians jump feet first into the next large step in their careers, bringing with them a jolt of excitement and rejuvenation. We are rapidly approaching the time when new residents first dawn a long white coat and recent residency graduates start their first job as an attending physician.

This past February these students received the results from the Osteopathic Match. Emergency medicine continues to be the third largest AOA training specialty, with 52 accredited programs, behind family medicine, with 228 accredited programs, and internal medicine, with 112 accredited programs, respectively.

This year, emergency medicine programs posted 270 available training positions. After the First Round of The Match, Emergency Medicine had filled 267 positions; within 24 hours the remaining three positions were filled.

Program Directors continue to share that there are many more high quality candidates than there are spots. I couldn’t agree more. The number of top caliber students that came through my program alone was astounding. We are no longer a fall back specialty, our programs pick from the cream of the crop.

With internship still fresh in my mind, I know how a new resident can benefit from the support of those with some experience. And I can only assume a new attending right out of residency can benefit from the same. I am excited to welcome this new group of residents into our great specialty. And I invite you all to join me in doing the same for the new residents or attendings in your emergency departments this July.

Thank you,

Steve Brandon, DO

ACOEP Resident Chapter President ACOEP Board of Directors Emergency Medicine Resident, St. Mary Mercy Hospital, Livonia, MI

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Resident Research and Resources

A Snapshot of Osteopathic Emergency Medicine McKaila Allcorn, DO Christopher Zabbo, DO

I

ntroduction

In 2010, the American College of Osteopathic Emergency Physicians (ACOEP) revised the research requirements for residents completing their Emergency Medicine training through an AOA-accredited program. These new requirements state that residents are to complete an original research project during the course of their training, excluding secondary sources and case-based studies1. They provide a step-wise system with various requirements to be submitted during each specific year of training2. There is no doubt that the desire for a more robust research environment in our specialty is supported by not only ACOEP, but multiple other academic organizations within the institution of emergency medicine. Furthermore, such requirements have been shown to contribute to the Emergency Medicine literature3. However, it was casually observed within our program that a number of residents had not only never participated in research, but were also unsure how to properly develop a research question and design a study. As our residents struggled with these questions and independently sought out resources, literature, and faculty to assist them, the question arose as to whether other osteopathic EM programs were making readily available the various resources recommended by the ACOEP research committee. If so, were these programs and their residents producing more publications or presenting at more conferences, and was there any correlation in particular resources and productivity? The intention of this survey was to help identify if there were any particular resources provided to residents that made them more productive, and to identify areas of the Research Committee’s recommendations that were not being developed by programs.

Methods Prior to initiating the study, a PubMed search was conducted using “osteopathic emergency medicine research,” which did not provide any previous studies or literature regarding the subject.

Therefore, a very brief set of questions was

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developed to assess for basic research resources within a program. The project was reviewed with the IRB chairman and considered exempt from formal approval. A confidential email survey was sent to all program directors based on the most recent list-serve sent out for American College of Osteopathic Emergency Physicians correspondence after an annual meeting of program directors (n=49). Of the 49 survey links emailed out, 26 responses were received. Of those 26, one was incomplete and two were from new programs in their first year of residency. These three were eliminated from the sample, leaving a sample size of 23. Consent for participation was implied by the receipt of a completed survey.

All respondents verified their identity as the program director of an AOA or AOA/ACGME dually-accredited Emergency Medicine residency.

Questions in the survey were variable in style and included multiple selection and open-ended questions. All were left open for comments.

Respondents were questioned regarding their personal training, as well as that of their core faculty. Additionally, they were queried regarding the resources they provide to their residents for research activities, particularly those contained in the ACOEP Research Committee’s Proposed Guidelines to Meet Basic Research Standards for Residents in Emergency Medicine, including protected time for research development, access to grant writers and statisticians, and designated faculty research resource. There was no advanced analysis of data.

Results and Interpretation Of the programs surveyed, only sixtyfour percent (64%) reported that they have a designated faculty research director, despite the ACOEP Research Committee recommending a designated faculty research resource. There did not seem to be a specific trend among resources and publications. Responses can be reviewed in Table 1. Of the 41 projects reported to have been submitted for publication, fifty-one percent (51%) came from programs with greater than 30

residents. However, only three of these programs reported access to a local statistician. Twentythree percent (23%) of respondents reported having no access to a statistician, either locally or through their OPTI affiliate.

Eight percent (8%) of respondents reported they had completed either an AOA or ACGME accredited fellowship, while thirty-one percent (31%) claimed faculty who had completed accredited fellowships and four percent (4%) completed non-accredited fellowships. However, the majority (58%) reported that either they or any of their faculty had completed fellowships.

Respondents were asked to comment on the type of fellowships completed by faculty. Toxicology was the most frequent, followed by Critical Care and EMS. Among the residents’ research, surveys and retrospective studies remained the largest reported type of research conducted, followed by prospective studies.

Discussion While the results from the study do not provide a suggestion as to specific resources which may be more helpful for research productivity, they do highlight some general areas of the ACOEP Research Committee recommendations which are not being observed in all programs. For instance, there appears to be a lack of statisticians, even on a regional level. The Committee clearly states that the OPTI should develop or allow access to high level statistical analysis if not present within the residency program1. They also state that one month of available time should be allocated for research project development and processing. Further assessment of this topic would be beneficial to better determine exactly how much time is being allowed, as the answer option in the survey stated “our residents have a dedicated block of 2 weeks or more for research.”

Fortunately, no one answered that their residents have no dedicated time for research.

Despite

the

Research

Committee’s

27 recommendations suggesting a “designated faculty research resource”1, thirty-six percent (36%) of respondents reported they did not have a formal research director (RD).

While this lack of specific faculty did not seem to affect productivity in certain programs, it would seem logical that the development of such positions would be beneficial to productivity. It should be noted however, that even in programs with established RD’s many report limited research training and variable access to research resources4. There was a comment from one of the respondents that may offer some improvement in the area of dedicated research directors and the lack of research fellowship experience among core faculty. The respondent stated that while they did not have anyone who completed a research fellowship, they do send faculty to CME specifically regarding research development. There is an obvious need for continuing education regarding research methods, particularly the initiating and planning Additional questions a study5. that would be useful to further assess resident needs and program productivity might include the age of the program, whether the program is in an academic or community setting, and if residents have previous research experience or education by conducting a survey of osteopathic EM residents.

Conclusion There is certainly more to be assessed and observed as we continue to advance the caliber of osteopathic emergency medicine research and increase our contribution to the EM literature. Further adherence to Research Committee recommendations and evaluation of whether or not programs see improvement with implementation of such proposals is needed, particularly regarding faculty assets and working with OPTI affiliates to develop access to resources.

Literature Cited 1. American College of Osteopathic Emergency Physicians. Research Committee. Proposed Guidelines to Meet Basic Research Standards for Residents in Emergency Medicine. Available at:http://www.acoep.org/files/ Basic_ Research_Guidelines_Proposed_by_the_ ACOEP_Research_Committee.pdf. Accessed on Dec 2, 2013.

Table 1

2. American College of Osteopathic Emergency Physicians. Resident Training Requirements.

Available at http://www.acoep.org/pages/ressta. Accessed on Dec 2, 2013.

L. Assessing Research Methodology Training Needs in Emergency Medicine. Academic Emergency Medicine. 1999; 6:280-285

3.

Homes J, Sokolove P, Panacek E. Ten-year Experience with an Emergency Medicine Resident Research Project Requirement.

Academic Emergency Medicine. 2006; 13:575579.

4. Blanda M, Gerson L, Dunn K. Emergency Medicine Resident Research Requirements and Director Characteristics.

Academic Emergency Medicine. 1999; 6:286291.

5. Supino P, Richardson

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Residency Spotlight ACOEP is pleased to continue to shine a spotlight on three more outstanding Residency Programs!

Program: Newark Beth Israel Medical Center Address: 201 Lyons Avenue City/State/Zip: Newark, NJ 07112 Hospital Information: Type (Community, rural, urban): Urban Trauma Level: no designation but enough trauma to have Level 2 designation Number of Hospital Beds: 673 Number of ED Beds: 75 Adult, 12 Pediatric, 8 Geriatric EM Program Information: Phone: 973-926-6671 Website: http://www.barnabashealth.org/Medical-Education/ Newark-Beth-Israel-Medical-Center/Emergency-Medicine.aspx Total Number of EM Residents: Dually Accredited 28 total Residents to Attending Ratio Working Clinically: 2:1 Accepts Medical Student Rotations? Yes – Fourth year rotations EM Program Curriculum: PGY 1: 8 weeks EM (NUMC), 8 weeks EM, 4 weeks IM (NUMC) , 4 weeks Anesthesia (NUMC), 4 weeks Surgery (NUMC) 4 weeks Surgical Subspecialty (NUMC), 4 weeks Family Practice (NUMC), 4 weeks Ob/Gyn (NUMC), 4 weeks MICU (NUMC), 4 weeks Peds EM (NUMC), 4 weeks Vacation PGY 2: 22 weeks EM, 2 weeks OB/GYN, 4 WEEKS Peds EM, 4 weeks Trauma (UMDNJ), 4 weeks Anesthesia/Dentistry, 4 weeks Musculoskeletal Medicine, 4 weeks MICU, 2 weeks US, 2 weeks Radiology, 4 weeks vacation PGY 3: 32 weeks Adult/Peds EM, 4 weeks Trauma (UMDNJ), 4 weeks CCU, 4 weeks PICU, 4 weeks EMS, 4 weeks Vacation PGY 4: 30 weeks Adult/Peds EM, 4 weeks Administration, 2 weeks Toxicology (New York Poison Control), 4 weeks Trauma (JCMC), 4 weeks Selective, 4 weeks SICU, 4 weeks Vacation.

NUMC – Nassau University Medical Center, East Meadow, NY UMDNJ – University of Medicine and Dentistry of New Jersey, Newark, NJ JCMC – Jersey City Medical Center, Jersey City, NJ EM Program Application Information: Dates applications are accepted: 9/2014 Prefers COMLEX Scores of: >500 Interview Dates: end of October through mid January Number of Letters of Recommendations and who can write the letters: preferably 2 SLOE’s

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Program: St. Mary Mercy Hospital Address: 36475 Five Mile Road City/State/Zip: Livonia, MI 48154 Hospital Information: Type: Community Trauma Level: Level 2 Pending Number of Hospital Beds: 304 Number of ED Beds: 55 EM Program Information: Phone: 734-655-2789 Website: www.stmarymercy.org Total Number of EM Residents: 22 Residents to Attending Ratio Working Clinically: 1:1 Accepts Medical Student Rotations? Yes EM Program Curriculum: PGY 1: 5 months Emergency Medicine, 1 month Radiology/ Ultra Sound, 2 month Internal Medicine, 1 month Cardiology, 1 month OB/GYN, 1 month General Surgery, 1 month Orthopedics, and 1 month Plastic Surgery PGY 2: 6 months Emergency Medicine, 1 month Anesthesia, 1 month Medical Intensive Care Unit, 1 month Pediatric Outpatient, 1 month Trauma, 1 month Pediatric Emergency Medicine and 1 month Surgical Intensive Care Unit PGY 3: 7 months Emergency Medicine, 1 month ENT/ Ophthalmology, 1 month Adult Emergency Medicine, 1 month Pediatric Emergency Medicine, 1 month Trauma, and 1 month Toxicology PGY 4: 7 months Emergency Medicine, 1 month Teaching, 1 month Emergency Medicine Services, 1 month Legal/ Administration, 1 month Elective, 1 month Pediatric Emergency Medicine EM Program Application Information: Dates applications are accepted: July through October Prefers COMLEX Scores of: >500 Interview Dates: Wednesdays from October through December Number of Letters of Recommendations and who can write the letters: 3 with at least 1 from emergency medicine Program: Lakeland HealthCare Address: 1234 Napier Avenue City/State/Zip: St. Joseph, MI 49085 Hospital Information: Type (Community, rural, urban): Community (two hospital sites in St. Joseph, MI and Niles, MI)

29

Residency Spotlight (continued) Trauma Level: Pending Number of Hospital Beds: 339 Number of ED Beds: 40 in St. Joseph; 21 in Niles EM Program Information: Phone: (269) 982-4929 Website: www.lakelandhealth.org/EmergencyMedicineResidency Total Number of EM Residents: 28 Residents to Attending Ratio Working Clinically: 1.5:1 Accepts Medical Student Rotations? Yes EM Program Curriculum: PGY 1: Emergency Medicine (6 blocks) Anesthesiology Cardiology General Internal Medicine (2 blocks) General Surgery Obstetrics Pediatric Medicine PGY 2: Emergency Medicine (7 blocks) Medical Intensive Care Neurology/Neurosurgery Orthopedic Surgery Pediatric Intensive Care Medicine – DeVos Children’s Hospital,

Grand Rapids, MI Radiology/Emergency Medicine Ultrasound Trauma – Spectrum Health, Butterworth Hospital, Grand Rapids, MI PGY 3: Emergency Medicine (7 blocks) Emergency Medical Services (EMS) Emergency Medicine Clinical Investigation Hand Orthopedic Surgery/Plastic Surgery Medical Intensive Care Toxicology – Stroger Cook County Hospital, Chicago, IL Trauma – Spectrum Health, Butterworth Hospital, Grand Rapids, MI PGY 4: Emergency Medicine (9 blocks) Administration/Medical/Legal Medical Intensive Care Elective (2 blocks) EM Program Application Information: Dates applications are accepted: July - December Prefers COMLEX Scores of: > 475 Interview Dates: October - December Number of Letters of Recommendations and who can write the letters: 3 (1 EM LOR required)

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DO Day on the Hill This March, over 1,200 DOs met in our nation's capital for DO Day on the Hill. Together, they made Congress aware of the challenges facing osteopathic physicians, and the medical community everywhere. Pictured here are ACOEP members, leaders and staff with Senator Mike Johanns of Nebraska. Thank you to those of you who took time to speak for all of us, you truly make a difference!

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Check out the recently redesigned online publication

The new version of The Fast Track is more robust, with a combination of both anecdotal experiences, thought provoking articles, and peer reviewed research articles that will propel ACOEP to the next level in the student and resident publication arena.

Here are some articles featured in the Spring 2014 issue: • Featured Political Article by Congressman Joe Heck, DO • Introducing Law and Politics into Medical School • Politics and Emergency Medicine • Appendicitis • Rosh Board Review Questions • Fluid Management

You can view The Fast Track online by going to:

www.acoep.org/fasttrack

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Presorted Standard U.S. Postage

PAID

Chicago, IL Permit No. 2177

142 E. Ontario Street Suite 1500 Chicago, Illinois 60611

Put your game face on.

It’s time to enter the real world.

EMP physicians Dr. Susan O’Malley, Dr. Victoria Selley, Dr. Keia Hewitt, Dr. Alison Sweet and Dr. Jennifer Savino ham it up at EMP’s ACEP party.

At EMP, our game face is the face of physicians who love life and the people they work with. As a physician owned and managed group, we create the world we live in. And in our world, every physician is valued. As an EMP physician, you’ll get the support you need to thrive in your new career, and will become an equal equity owner, just like the rest of us. And benefits? Ours include the best med mal insurance anywhere and a fully-funded 401k that’s worth nearly a quarter of a million in five years. The real world is where the real fun begins – with EMP.

Visit emp.com/jobs

or call Ann Benson at 800-828-0898. abenson@emp.com

Opportunities from New York to Hawaii.

AZ, CA, CT, HI, IL, MI, NH, NV, NY, NC, OH, OK, PA, RI, WV