The Pulse - April 2015 by ACOEP

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Pulse

April 2015

Osteopathic Emergency Medicine Quarterly

Presidential Viewpoints

| Mark A. Mitchell, DO, FACOEP

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VOLUME XXXVI No. 2 Editorial Staff Timothy Cheslock, DO, FACOEP, Editor Drew A. Koch, DO, FACOEP-D, Assistant Editor Mark A. Mitchell, DO, FACOEP John C. Prestosh, DO, FACOEP Erin Sernoffsky, Association Editor Janice Wachtler, Executive Director Thomas Baxter, Graphic Designer 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 Andrew Little, DO Erin Sernoffsky, Association Editor 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. Display and print advertisements are accepted by the publication through Norcom, Inc., Advertising/ Production Department, PO Box 2566 Northbrook, IL 60065 ∙ 847-948-7762 or electronically at theteam@ norcomdesign.com. Please contact Norcom for the specific rates and print specifications for both color and black and white print ads. Deadlines for the submission of articles and advertisements are the first day of the month preceding the date of publication, i.e., December 1; March 1, June 1, and September 1. The ACOEP and the Editorial Board of The PULSE reserve the right to decline advertising and articles for any issue. ©ACOEP 2015 – All rights reserved. Articles may not be reproduced without the expressed, written approval of the ACOEP and the author.

Pulse

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The Pulse

Osteopathic Emergency Medicine Quarterly

Table of Contents Presidential Viewpoints ..................................................................................................................3 Mark A. Mitchell, DO, FACOEP The Editor's Desk .........................................................................................................................4 Tim Cheslock, DO, FACOEP Executive Director's Desk..............................................................................................................5 Janice Wachtler, BAE, CBA The On-Deck Circle .......................................................................................................................6 John C. Prestosh, DO, FACOEP What Would You Do? ...................................................................................................................7 Bernard Heilicser, DO, MS, FACEP, FACOEP-D Making Success Simple ..................................................................................................................9 Greg Christiansen DO, MEd, FACOEP-D Making the Right Judgments ........................................................................................................10 Andrew Little, DO ACOEP Members in the News...................................................................................................11 The Medicine of Compassion .......................................................................................................13 Frank Gabrin, P.C.O.M. How to Apply for the AOBEM Exams Online .........................................................................16 Jennifer Hausman, MPA International EM Mission Medicine - An interview with Lynn Campbell, DO ...........................17 Tim Cheslock, DO FACOEP Foundation Focus .........................................................................................................................19 Sherry D. Turner, DO, FACOEP Regional Student Symposium ........................................................................................................21 Kaitlin Fries, OMS-IV, OU-HCOM ACOEP-RC President’s Report ..................................................................................................22 Andrew Little, DO

Editor's Note Welcome to the spring edition of The Pulse. Our Administrative Editor, Erin and I had discussed trying to build this issue around a common theme. While our original theme did not pan out, I found an interesting theme did emerge. Osteopathic Emergency Physicians care for their patients like none other. We go above and beyond in the most challenging of circumstances. As a result, the uniqueness of the osteopathic physician is clearly recognized by all those whom we encounter every day. This issue draws a complete picture of what makes osteopathic emergency physicians truly unique individuals. From Dr. Prestosh’s article on our high quality GME programs and how we continue to develop and adjust based on the new single accreditation system, to Dr. Mitchell’s article on Making Transitions and how as EM physicians we are clearly the gatekeepers to the hospital, which is not an envied position on most days. We use our training and our osteopathic skills to deliver compassionate, quality care day-in and day-out. Dr. Christiansen highlights even more challenges in our current healthcare environment and how we can help our patients navigate the challenges they face and encourage them to be more active in their own health. The Emergency Department can challenge our values, cloud our judgment, and make us question why we do what we do. Dr. Little puts it in perspective in his article, Making the Right Judgment, followed by Dr. Garbrin’s input on compassionate care. We all value our contributions to medicine and pride ourselves on our interaction with patients. Some of us have the unique opportunities to care for patients outside of the Emergency Department, like Lynn Campbell, who shared her story of mission travel with us. Continued on Page 4

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Making Transitions You are also fortunate to take care of the following patients:

emergency treatment is properly communicated to other healthcare providers.

• 52 year-old has productive cough, fever of 102◦ F, and O2 saturation of 90% • 83 year-old with a history of atrial fibrillation with heart rate of 118 BPM • 4 month-old who has been vomiting and has had diarrhea for 24 hours and heart rate of 145 BPM

Historically, only three things happened to patients who presented to the Emergency Department: they were (1) admitted, (2) discharged, or (3) expired. However, we now have other options for those patients who don’t clearly need to be admitted to the hospital. Many are placed in an observation status, many of which are within Emergency Departments and under the control of Emergency Medicine Providers, but others may be placed in observation within the hospital. Still other patients are sent home with needed services provided to them in their home. Many of these patients may require nothing more than someone to check on them in the days following the ED encounter. Some communities are utilizing EMS providers to assist with home visits.

What do all these patients have in common? As it relates to disposition, we don’t have enough information to determine if they will need to be admitted or can go home after treatment.

Presidential Viewpoints Mark A. Mitchell, DO, FACOEP

ou are working in the Emergency Department and take care of the following patients:

• 32 year-old with sprained ankle • 8 year-old with a sore throat • 60 year-old with a 2 cm laceration • 23 year-old with flu-like symptoms

What do all of these patients have in common? You know within the first minute that these patients will all be discharged to home care.

It is this group of patients who will consume all of our mental energy while on duty. We order tests and re-evaluate these patients several times during their encounter to make sure we make the best decision. As to the cost of hospitalization, this is one of the most expensive decisions in healthcare, and we must work diligently to make the best decision for the patient and hospital. We, as emergency physicians, are in the middle of ensuring that the “transition of care” is appropriate. We are faced with a complex environment in which we must sift through volumes of information on patients to have a full understanding of their particular healthcare history. The decisions we make are not only important to individual patients, but also directly influence how healthcare dollars are spent. Additionally, to arrive at the proper disposition, we must ensure that the transfer of all patient information regarding their

Unlike other physicians and hospitalists, emergency physicians are on the front end of patient care. We receive patients from EMS, nursing homes, or from their primary care providers with little or no information on previous care provided. This breakdown in communication is frustrating because we don’t have the information we need to understand what is going on with the patient, and as such, lack the correct facts to make rapid decisions. We must keep this in mind as we in turn become accountable for the next “transition of care” for these patients. We have not historically seen eye-to-eye with our hospitalists and physicians, as these two Continued on Page 7

In addition, you take care of the following patients: • 75 year-old with fever of 102.5◦ F, cough, and O2 saturation of 83% • 55 year-old with chest pain, who smokes, had angioplasty 5 years ago, and has not been compliant with his medications • 21 year-old with fever of 101.8◦F, with progressive right lower quadrant abdominal pain for 2 days, anorexia, who couldn’t stand the ride to the ED as it caused pain with every bump in the road What do all these patients have in common? You know within the first minute that these patients will all be admitted to the hospital.

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How Safe Is Your House? departments, open departments, no security what-so-ever. There are probably as many variations as there are days in the year. But why? Shouldn’t there be a more standardized approach to taking care of our staff ? We need to be more active in the protection of ourselves and those with whom we practice day in and day out. Is there a safety or security committee at your hospital? Is there a representative from the emergency department on it? How seriously does the hospital Administrative suite take the safety of their staff ? What will it take to make proactive changes to prevent someone from getting hurt?

The Editor's Desk Tim Cheslock, DO, FACOEP

very day we go to work and spend eight to twelve hours of our life treating what ails the members of our community. We work in a high stress environment, where patients wait, there are not enough beds, we receive push back on the front and back ends to do more with less. We see people from all walks of life and do our best to make people feel better and cure their illness. It seems a daunting task on some days, made worse by varying levels of impatience, unrealistic demands and threats of violence.

As emergency physicians, we are often called upon to initiate physical or chemical restraints on violent patients. We all have a different threshold for what justifies the need for either or both. We also have different degrees of tolerance for verbal abuse and insults from those we are trying to help. When do you terminate a patient care visit and call the police to have a patient removed? Each of you can likely recall patient encounters where a situation escalated rapidly resulting in an ER patient pummeled by staff in order to restrain and sedate the patient so that no one, including the patient, would get hurt. It seems these encounters are occurring with much more frequency than in the past. There are many studies, white papers, and recommendations by ACEP, ENA, JACHO and any number of other professional and regulatory agencies on workplace violence. All sources point to an ever increasing amount of potential violence in the workplace. One has to look no further than recent news headlines to

find instances of assaults on staff that resulted in injury or even fatality to medical personnel. So in closing I ask again, how safe is your house? Are you comfortable that you can perform your duties and not have to fear that someone is going to assault you or your co-workers? Nothing is one hundred percent, but we sure can get a lot closer to that feeling of security than we currently are. I challenge you to ask the tough questions, propose solutions, and follow through. In the end, we are the ones that need to feel safe in our own house. Taking care of our staff is just as important, if not more important than providing services to the community at large. Let’s all do our part to improve the working environment where we spend so much of our time that it really is our second home. "Editor's Note" continued from page 2 What I enjoyed most about this publication is how it truly embodies Emergency Medicine and the osteopathic physicians who practice it. We hear the constant question, “What makes a DO unique?” There is no one word, phrase or story that can completely answer this question. I hope by reading this quarter’s edition, you will agree that much of what embodies our uniqueness is on prominent display by each and every one of our members who have contributed to this publication and that you have to look no further than your DO colleagues on your next shift to reaffirm the commitment we all have to osteopathic medicine. - Tim Cheslock, DO, FACOEP

Security is something that many of us don’t give a second thought to while at work. Who would want to harm us or our co-workers? The clientele of the emergency department is often an unknown. Many have underlying mental health issues, are non-compliant with medical or behavioral therapy. Some have ulterior motives for receiving narcotic medications, and others are just hostile. Still, we show up and see our patients, often not giving it a second thought until a situation develops where a member of our staff or we ourselves are in a position where we may potentially be harmed. How prepared are you and the members of your emergency department for these? I have worked in facilities where there are armed police officers for portions of the day, locked

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Are Smartphones Making Us Stupid? of elementary school, nor were they taught reading and math using flash cards to drill in the knowledge of what the word ‘the’ meant when reading. Ok, maybe I’m just getting old, but this concerns me. When I taught school the multiplication tables were essential to memorize, as was learning phonics and flashcards to draw a line between what is seen and heard. But what concerns me now is how physicians learn if they aren’t memorizing the medical symptoms of a disease, the norms for blood glucose levels or creatinine – will these physicians be able to quickly diagnose someone if they don’t have access to the Internet and WiFi? What happens if the power goes out – how will physicians do their jobs if the only thing they can do is look things up on the smartphones? Scary thought.

Executive Director's Desk Janice Wachtler, BAE, CBA

et’s face it: cellphones and smartphones have changed the way the world communicates, interacts, and thinks. People use Google® regularly. The thought of looking up the spelling of a word in a dictionary is a lost art. Even the Encyclopedia Britannica® is no longer available in a print format. Recently, I overhead two parents conversing about their children’s education and how rote learning was frowned upon. They no longer were required to memorize the multiplication tables in the lower grades

A friend of mine, who went from hospital training to medical school training, told me that to do a history and physical examination the first year students took over an hour – why? Because they looked symptoms up on their phones! What will these physicians do when confronted by patients lined up in a busy ED? Will they have time to look things up if someone is in respiratory distress and dying before them? I know Gene Roddenberry, the creator of Star Trek®, saw physicians with medical scanners and diagnostic beds, some of which exist today, but when I watch reruns of the show, Dr. Leonard ‘Bones’ McCoy didn’t always rely on the equipment in his sick bay. He referred to good old medicine, remembered from medical school.

So I guess my question is – where do we draw the line? There are things that need to be memorized both in elementary education and in medical school. It may not be catastrophic to not know six times seven equals 42, or what the Roman numerals mean and how to write 2015 in them, but what information is crucial for physicians to learn, memorize, and know in order to work in a busy ED or practice? How do we best prepare our young physicians to work in a practice environment that can be a highly tech-savvy university based hospital, or a tech-starved rural area or an inner-city clinic, or a hospital that may not have all the bells and whistles other institutions have? As physicians and educators, how do you teach medical students growing up in this era to be the best doctors they can be using their hands, observations, and the medical knowledge that is stored, not in a hand-held device, but in their brains? By the way 2015 is MMXV … I think. Maybe I'll check Google to make sure!

Parma, Ohio EM Physician Opportunities

Full and part time positions available for excellent board certified, residency trained emergency medicine physicians at UH Parma Medical Center. Parma is one of northeast Ohio's top three living destinations for young professionals, and we recently recognized by Businessweek Magazine as one of the best places in Ohio to raise children. About the ED: Annual Volume of 41,000 36 Hours of Physician Coverage 36 Hours of Independent Midlevel Coverage 39 Bed Emergency Department Stroke & Chest Pain Center Pursuing Level III Trauma Center Status Located 11 miles from Downtown Cleveland Our competitive package includes: Signing Bonus; 401k w. Match; Malpractice w. Tail; Paid Life Insurance; Long & Short Disability; HSA Contribution; Family Health, Dental, Vision Plan To learn more about this opportunity, or others within our organization, please contact Erin Waggoner at ewaggoner@4Mdocs.com Reach us by phone at (888) 758-3999 or visit us online at www.4MDOCS.com.

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Reflective Moments – Musing Thoughts four-year emergency medicine residency. I truly believe the fourth year is extremely beneficial in enhancing the education of residents and preparing them to practice in our healthcare system. I am not saying three year programs do not prepare excellent physicians; however, it is obvious to me that more training cannot hurt, but can only help all residents!

could prepare and present a single clinical presentation which would give them the necessary AOA credit for their ACGME training year. As I was completing this article, I discovered that there is a resolution by the AOA which will even remove this requirement as the Single Accreditation Pathway becomes a reality.

Although I maintain that four years is the most beneficial length of training, I believe this may be the time for ACOEP to consider promoting the establishment of a three year training program for Osteopathic emergency medicine.

As I previously stated, I, and the majority of Osteopathic emergency medicine residency program directors, favor a four year program. However, will the government have the funds to continue future financial backing for that “extra” year of education? It is obvious that the

failing to prepare, you "By are preparing to fail. " – Benjamin Franklin

The On-Deck Circle John C. Prestosh, DO, FACOEP, President-Elect

or this edition of The Pulse I would like to express thoughts that have been on my mind for some time. Of primary importance, I want the readers to understand that these are my personal views and do not reflect those of ACOEP or any other individual. If nothing else, I hope all readers would have an opinion on these issues and that this will serve as a spark for further conversation. I have been in agreement with the AOA and ACGME merger to create the Single Accreditation Pathway for residency training. I believe it is a win-win situation for students and residents. With this new system in place, all residents graduating from accredited Osteopathic training programs will have access to fellowship training if they so desire. It is clear that our Osteopathic graduates would not have this opportunity if the AOA did not agree to the merger. What does concern me, as an Osteopathic program director, is the long-range viability of our Osteopathic training programs. The two main questions that persist are: will Osteopathic training programs continue to “recruit” extremely qualified Osteopathic students with this merger? And will our length of residency training eventually hinder our existence? I have always been a proponent of a

I, like all Osteopathic program directors, have just completed another interview season. I was surprised by the high number of candidates who applied to my program. My concern regarding the ability to “recruit” candidates in the future was partially assuaged. I interviewed many Osteopathic students who seemed genuinely interested in the Osteopathic emergency medicine residency, only to have them contact me and state that they were dropping out of the AOA match and pursuing the ACGME match. I responded and asked them if they were willing to explain their decision. I informed those particular candidates I was not prying but wanted to know if there was something that was lacking with either my program or the AOA match. Several applicants responded and there was indeed a common answer: the “extra” year of training. It was obvious to me these soon to be graduating Osteopathic medical students believed they could learn a sufficient amount of emergency medicine in a three year ACGME program. They also stated they

government places an extraordinary amount of funding into graduate medical education. Will this financial backing continue? This would not only apply to Osteopathic programs but all four year ACGME training programs. With the AOA and ACGME merger taking place, there will be an almost equal split between three and four year emergency medicine training programs! If there are insufficient funds for Continued on Page 11

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"Making Transitions" continued from page 3

What Would You Do?

groups seem to think differently. We must work diligently to ensure our different approaches don’t cause a lack of proper communication about patients, which can result in a negative impact on their care. If there are unique circumstances, we must communicate those. If there are abnormalities that need follow-up, we need to clearly communicate that as well. Since the majority of patients we see are discharged, we also need to ensure proper follow-up patient care. Granted, many have an episode of care that doesn’t necessarily need prompt follow-up, however, many do and we must try to assist in making this happen. We must work within our systems to transfer critical information on these encounters to the next caregiver. Similarly, we transition patients between emergency physicians in our own department. As shifts end, sometimes patients remain to be cared for by the next emergency provider. We all know the importance of these transitions. Best practice is for these transitions to take place at the patient’s bedside between the two providers. Studies have shown a number of medical malpractice claims could have been avoided with a good exchange at shift change. Over time I have found that our work environment and the challenges we face continue to make the emergency department a more difficult place to work. Every decision to admit is highly scrutinized and often done retrospectively. The electronic medical record has created challenges with input of information as well as being used as a tracking tool to measure everything we do. Hospitals are looking at timed events such as door to provider time, total length of stay for discharged and admitted patients, door to EKG time, door to needle for thrombolytics, and many more. At the same time, it’s never been a more exciting time to be an emergency physician. Emergency physicians stand at the crossroads of inpatient and outpatient care. Despite all the changes in healthcare, the volume of patients presenting to the Emergency Department continues to go up. It is obvious that patients know where they can get high quality, compassionate care 24/7/365.

Ethics in Emergency Medicine So a patient who has just returned from West Africa, complains of a fever, headache, extreme vomiting, and diarrhea, collapses in triage. His vital signs are barely perceptible. What would you do? What should you do?

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

n this issue of The Pulse we will review the dilemma presented in the January, 2015 issue.

We posed a question exploring our responsibility for the resuscitation of a questionable, but not confirmed, Ebola patient who crashes in front of you on presentation to the hospital. Should resuscitation be attempted? What is your obligation? Could you substantiate not coding this unconfirmed possible Ebola patient? This situation really challenges our duty to care versus our individual safety. In the absence of an appropriately executed Do Not Resuscitate (DNR) document, our professionalism would dictate a responsibility to attempt resuscitation of this patient. Cardiopulmonary resuscitation is the one aggressive modality that is presumed to be performed without consent, unless otherwise instructed not to.

The safety of the healthcare provider is paramount. We emphasize scene safety first! The ability to correctly don appropriate protective equipment (PPE) is not there. The rush to accomplish this would violate the guidance that has been stated by all agencies. Consequently, the responding medical personnel would be putting themselves, and potentially others, at lethal risk. But, do we know if the patient truly has Ebola? If so, there should be no argument. However, what if the patient has a gastrointestinal illness that has caused severe dehydration with an electrolyte imbalance? This is subsequently demonstrated at autopsy. Were you in violation of your ethical obligation and duty? I would maintain, you are not. I realize this belief is open to question and disagreement. However, would you enter a perceived, but not fully determined, hot zone at a chemical spill without appropriate PPE? Or, would you enter an active shooter situation without appropriate cover or protection before the shooter has been neutralized? Our Ebola patient, tragically, is no different. The mantra of “Myself, My Partner, My Patient” has become a sad lesson from recent history.

Please send your thoughts and ideas to WhatWouldYouDo@acoep.org. Every attempt will be made to publish them when we review this dilemma in the next issue of The Pulse. If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us at WhatWouldYouDo@acoep.org Thank you.

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ACOEP Staff Contact List 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

EVENTS (continued)

Executive Director Janice Wachtler, BAE, CBA Direct Line: (312) 445-5705 Email: janwachtler@acoep.org

Education & Events Assistant Andrea Jerabek Direct Line: (312) 445-5703 Email: ajerabek@acoep.org MEMBER SERVICES

Director, Affiliate Management Stephanie Whitmer Direct Line: (312) 445-5712 Email: swhitmer@acoep.org

Director Sonya Stephens Direct Line: (312) 445-5704 Email: sstephens@acoep.org

Executive Assistant Geri Phifer Direct Line: (312) 445-5700 Email: gphifer@acoep.org

Senior Coordinator, Member Services Jaclyn McMillin Direct Line: (312) 445-5702 Email: jmcmillin@acoep.org

EDUCATION

Director Kristen Kennedy, M.Ed. Direct Line: (312) 445-5708 Email: kkennedy@acoep.org

FOEM & Membership Database Coordinator Gina Schmidt Direct Line: (312) 445-5701 Email: gschmidt@acoep.org

EVENTS

MEDIA AND TECHNOLOGY

Director Adam Levy Direct Line: (312) 445-5710 Email: alevy@acoep.org

Association Editor Erin Sernoffsky Direct Line: (312) 445-5709 Email: esernoffsky@acoep.org

Senior Meetings Coordinator Lorelei N. Crabb Direct Line: (312) 445-5707 Email: lcrabb@acoep.org

Media and Technology Specialist Tom Baxter Direct Line: (312) 445-5713 Email: tbaxter@acoep.org

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Making Success Simple

Greg Christiansen DO, MEd, FACOEP-D

try to appreciate the simple things in life. For me, it is the interaction with my patients. In today’s environment, spending time with a patient is considered costly and relegated to a diminished priority to satisfy perceptions. Perception takes precedent because it satisfies the contract. Managing the simple things has become harder. We have made the delivery of healthcare so convoluted and complex that sometimes we miss the goal. I have learned from the wisdom of people who have prioritized and removed the background noise. They rely on principle when a vision is not readily apparent to the tenants of conventional wisdom. They see the big picture and plot a course to the goal. They might appear to be taking a risk, when in fact the risk is really our own failure to accept their wisdom. After all, we are supposed to be doctors and not technicians or tacticians of medicine. Allow me to present an analogy. Recall the romantic notion of sailing the high seas. With that image, now retrospectively add the twist of being the captain of a wooden sailing ship from centuries ago, supported only by the knowledge of the seas from that time. The crew relied on the captain to use his experience to navigate the uncharted waters and meet the challenges along the way. With nothing but the horizon for a view, it was a harrowing experience to jump aboard and lose the security of sighting land. As you can imagine after only a few days at sea, one could easily lose all perspective of the progress of the journey and fall into despair. The big picture would be the furthest notion from your immediate concerns. Staying the course becomes a struggle. A storm could paralyze one with fear and impair any ability to make a decision. The ship’s fate would be in peril. However, a clear vision of one’s goals would drive one to meet any challenge, even if the results were not immediately apparent.

seek to empower our patients to help "We them achieve health." the least of which is the growing populations of senior citizens and immigrants. We also have to be vigilant to an increasingly violent world which may require our citizens to rely on our skills if attacked. Regardless of the events, there will be changes and adjustments to the healthcare system. We will still care for those who get caught in the storm. As the crisis subsides and in the aftermath, we will identify what needs to be changed so that we can do better the next time. We have to change, but we also need to stay true to our principles and use our adaptive character to make our profession better. These characteristics are at the core of what emergency medicine is all about. I hope our profession will never stray from such ideals. We are willing to help anyone who asks. We help them regardless of where they are in their life. The issues of the day do not sway our resolve. Our principle is to help those in need. We should be mindful of our patients’ complaints and hesitant to dismiss them. There is a reason they ask for our help.

What sets us apart? The answers vary but the common denominator is simple – we are osteopathic physicians and we take a different approach. We seek to empower our patients to help them achieve health. We recognize sickness as a terminal result. Our mindset is to treat survivors of disease. We treat survivors of trauma. Our patients are not victims of disease or trauma. Victims are helpless, literally and figuratively. Our compassion is rooted in humility and based on the tenant that to whom much has been given, much is expected. The expectation is clearly taught in the parable of the talents (a talents was described as being worth 20 years of wages in Biblical times). The two gift bearers who used their talents were rewarded proportionally where as the one who buried the gift was rebuked as ‘wicked’ – a harsh term to describe the highest level of distain. The parable sets the condition that there is no such thing as equality, but rather there is only empowerment. We have that opportunity to offer our patients and by extension to our students. Use your Continued on Page 11

Are we not in a similar situation when we apply these lessons to our profession? The Supreme Court will rule this summer in King vs. Burwell which may strike down the fundamental components of the Affordable Care Act. There are many more changes already set in motion, not

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Making the Right Judgments Andrew Little, DO

s emergency physicians we are trained to rapidly diagnose medical ailments and diseases with limited information, sometimes with limited resources. In doing so, we must often make judgment calls based on the information gathered from a patient’s history and physical exam. During this process we obtain not only medical information, but also social ones, both of which are vital in reaching our diagnosis. The problem is that sometimes in this process we also make small judgments that may not exactly be right Not long ago I was at work, it was busy like it usually is in our ED. My shift was two hours from being over, I was tired from a long day, and I was picking up my last few patients so I could wrap things up for the night. One of the charts I picked was for someone we’ll call Charlie, a man in his mid-40’s who had come to the hospital because he was having chest pain and a cough. In questioning Charlie I came to find out he lived a life far different from the one I live. He was a heavy smoker; he consumed alcohol daily, and did other things that increased his risk for a large number of medical problems. Upon physical examination I noticed Charlie smelled of cigarettes and alcohol, that he surely consumed shortly before coming to the hospital. I also noted his thin frame, his missing teeth, his unkempt appearance, the shirt he was wearing promoting a prominent alcohol company, the tattoos on his arms and legs, and more importantly his decreased breath sounds were worse on the right, wheezing and a tender chest wall to palpation. At the end of my exam Charlie asked why he felt so sick? My first inclination was to point to his smoking, drinking, and other habits that lead him here. I simply told him we would investigate what was going on and get some tests. Our basic work up consisted of labs, an EKG and chest x-ray. We found that Charlie had an abnormally low white blood cell and red blood cell count. He had a 7-inch mass in his right lung that had adhered to his chest wall and a left-sided pneumonia. I went and discussed what we found initially, that we would give him some medicine and would order a cat scan of his chest. He then said he needed to

the right clinical judgments, "Ibuthadthemade wrong social ones." call his wife. I remember thinking “this guy has a wife? Who would want to be married to a man like this?”

and I, that is was wrong of me to make such swift, and wrong judgments and assumptions about him, and that we really were not that different.

After Charlie returned from his cat scan, I was discharging the remainder of my patients and noticed a sort of hustle and bustle in his room. I walked by to see what was going on to find his room overflowing with people. I was introduced to multiple members of Charlie’s family, including his wife, three children, siblings, parents, and grandparents. His room was filled with people who loved and cared for him. I told him I had not looked at his scans yet, but I would, and come right back to give him his results.

Charlie was admitted to the hospital, and I learned a few weeks later he passed away, with all of the people who loved him by his side. I later received a thank you note from his family for the care he had received from our ED staff and myself. As I read that letter I felt sick, that although he received the same care I would give any other patient, he did not receive the benefit of the doubt I would ask someone to give me if I was in a similar circumstance. I had made the right clinical judgments, but the wrong social ones.

I left that room feeling somewhat ashamed. I sat down to look at his cat scan, and my heart sank. After reviewing all of his films, I saw what appeared to be aggressive cancer, with the before mentioned mass, but also four other lung masses, and masses seen incidentally in his liver, spleen, kidneys, and in lymph nodes in his neck and axilla’s. Before I could go back into his room I received a call from our radiologist confirming my worst fears.

Since then I thought a lot about how all of us are not much different from Charlie. How each of us make choices; choices that all too often are bad for us: bad for our waistlines, our bodies, our checkbooks, our careers, our marriages, our relationships with our children. My hope is that each of us can think more of our patients, more of how their situations are not much different than our own.

To this day I remember that 20 foot walk back to Charlie’s room. The few seconds seemed like forever, as I lamented my initial thoughts towards Charlie, how I had so quickly judged him, how I had not seen him for what he was—my fellow being, a patient asking for help.

How easy it is to make these small judgments, and that they might be right in some cases, should be applied generally to all of the patients we see. And that in thinking this way, we won’t find ourselves in a situation like I did with Charlie.

As I opened the curtain to his room, he must have seen my face, that I was unsure how to break this news to him and his family. He asked that I “tell it to him straight.” I honestly do not remember what I said. I know there was crying, by Charlie, his family, and me. I remember hugs, the holding of hands, and being asked to pray with him and his family. As one of his children prayed for her father, I still felt terrible at the idea that although there were things different about Charlie

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"Reflective" continued from page 6

"Simple" continued from page 9

reimbursement of medical education, how many hospitals will continue to maintain four year programs?

talents wisely.

The Graduate Medical Education Committee of ACOEP is a very hard working and well organized group. They seriously evaluate our training standards and are always seeking to make recommendations that will strengthen our programs. I believe they have done outstanding work, and I commend them for their diligence. Times are changing and Osteopathic programs will be challenged to prove why we should continue to exist. I personally believe now is the time to begin serious discussion and planning for a three year “Osteopathic focused” emergency medicine residency. We certainly need to maintain our Osteopathic roots to prove that, in a true sense, our training programs are distinct and different. If we cannot maintain our unique identity, what is our purpose? I strongly believe we need to promote osteopathic principles not only in our academic sessions but also in the day-to-day clinical environment. Is this difficult to do in the setting of an emergency department? Yes it is, but not impossible. The Single Accreditation Pathway is here to stay, and it is the road we, as a profession, have decided to travel. We must ensure that even though we are traveling in the same direction, Osteopathic training programs are not traveling on an accessory road but are on the main route. It is my opinion that the extra year may ultimately be a burden to our programs. I look forward to all our Osteopathic emergency medicine programs continuing to excel in training young physicians in the art of our specialty. What we have accomplished with our past training has had enormous beneficial effects on today’s healthcare. We will continue to provide excellent training for our residents, and we can provide this in a three year program. I sense that with this change in our program training length, we will not have future applicants vanish from the list of potential candidates for our Osteopathic programs.

So it is with a contented heart that I got to watch a fateful meeting with a wonderful and talented resident who is now ready to be an attending. His development as a resident demonstrated how to project empowerment. Like the resident I am describing, I too had very little experience and did not know what the future would hold. However, in seeking wisdom and guidance from those who possess such wisdom, we both managed to achieve goals beyond our imaginations. The act of selflessness I saw from this resident was simple. He served as a mentor to the many students who asked for guidance. He took time from his busy schedule and skyped a group of eager students who had little understanding of the opportunities before them. In intricate detail, he described the match ranking process, the SLOR letter and the behaviors which assured success. He advised them on useful resources and described how to maximize their rotations. For example, he said as a third year medical student, it is not advisable to seek an audition level emergency medicine clerkship. The 3rd year student would have a difficult time competing with more

accomplished 4th year students. Rather it would be wiser to seek an ancillary rotation like an ultrasound clerkship in the ED. The student would still gain experience and exposure to a program under consideration for the match list. His advice offered a creative means to gain insight to a program that otherwise might not be available to the student. He was able to articulate the long view. The resident I once had the privilege to mentor was now mentoring to students better than I ever could. It was a joy for me to watch him succeed in meeting the needs of a new generation. I witnessed the profound impact of his actions and marveled at the way he improved their development. As alluded in the parable, the individual’s success eventually becomes the organization’s success. The simple act of initiating contact and mentoring to our students and residents has many rewards. The impact is consistently cited as a major factor for the achievement of our students and residents. Their growth and development makes our college stronger. These talented members in turn teach us to improve our skills – all the while improving the care of our patients. So take the time from your busy life and teach a student or resident some of your wisdom. In its simplicity, your action will create lifelong relationships and improve patient care.

ACOEP Members in the News In February, ACOEP Immediate Past President Gregory Christiansen, DO, FACOEP-D, attended the White House Physician Roundtable: Bystanders—Our Nation’s Immediate Responders. Among the participants were COL Kevin C. O'Connor, DO, FAAFP, Physician to the Vice President of the United States Joe Biden. The Roundtable brought physician leaders and administrative agencies together to discuss a new initiative focused on building national resilience by providing information and tools the general public could use to save lives.

These are my thoughts, my reflections, and my musings. One may say that I am looking through a glass that is “half-empty.” I would prefer to think that I am visualizing the present scenario through a glass that is “half-full” with the hope to soon be realizing I am looking through a glass that is “completely full.”

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Introducing ACOEP Digital! A Custom App tailored for your digital life! ACOEP is proud to launch ACOEP Digital, your hub for conference information, course materials, and more! Available for all smartphones and tablets, this free app allows you to access current and past course materials, create custom schedules, explore didactic topics, and much more!

To download, search “ACOEP” in your phone’s app store.

SAVE THE DATE! ACOEP Presents

SCIENTIFIC ASSEMBLY

‘15

October 18 - 22, 2015 Loews Portofino Bay, Universal, Orlando, FL

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The Medicine of Compassion Frank Gabrin, DO, FACOEP, PCOM - 1985

or decades we’ve worked to keep our “professional distance” in order to maintain our “clinical objectivity” and be better doctors. Yet, in spite of our efforts, at the end of the process we’re left emotionally drained, unhappy and burned out. Our patients are also left flat and unsatisfied. It seems our current practice of medicine isn’t working on either side of the stethoscope. The big question is why? Previously, we’ve not taken into account how our brains and bodies are hardwired to function in the context of our interpersonal encounters. This is relevant to our practice because the latest research is showing that our most basic human physiology (hardware) is in direct conflict with the current model of care (software). These two aren’t working well together and don’t produce good results, especially for us doctors. What this means is that our hardware and software are incompatible and in desperate need of an upgrade. Science is beginning to show us, through the exploration of our own human neuroanatomy, neurophysiology, neurochemistry and neuroplasticity, that we’ve been misguided and hurting ourselves by clinging to the notion that we can distance ourselves from the pain we’re confronted with every day. What we’re trying to do is impossible. This is because, deep underneath our cognitive awareness, when we come into contact with another human, we automatically connect to whatever they’re feeling because of our hyper-vigilant survival based MNS [Mirror Neuron System]. This connection happens automatically and, unfortunately, no matter how hard we try, there is nothing we can do to stop it from happening. This primal “process” happens almost at the level of our brainstem. It puts our brains and bodies into a state of “affective empathy”, where we can’t help but feel what others are feeling. We have no conscious awareness of this almost instantaneous process. We inherently feel pain when we see pain on the faces of

emotional frequency of compassion is "The different than that of empathy." our patients, their concerned family members and even the emotion on the faces of our colleagues and co-workers. Our brain experiences their pain as if it were our own. The same neurons fire when you are in despair as when you witness someone else who’s hurting. In our brain, imaginary is real. The same nerve bundles and circuits light up for real or imagined events. Think about the last time you saw a horror movie. Our brain doesn’t distinguish between physical, emotional or imagined pain. The pain we feel when we’re disrespected or hurt emotionally by another is the same as when we cut ourselves with a knife while preparing dinner. Which one of us has not experienced heartache or a stomach ache without out having a blocked coronary artery or a peptic ulcer? All pain is the same for our brain. It doesn’t distinguish between the pain of a broken bone or a broken heart.

can we be at our personal best when we’re stressed and suffering? Yet this is exactly what our patients need and are looking for in their doctors. What can we do to escape from this debilitating state of affective empathy? The answer is clearly not in continuing to do what we’ve been doing. Stepping back, trying to stay clinical and focusing on performing the history and physical, ordering the tests and medicines, making the diagnosis, administering the treatment or making the disposition, doesn’t lessen the effects of affective empathy. If this were the case we would all be feeling great about the amazing work that we do each and every day, but we’re not feeling good. Good doctors are feeling bad almost all the time.

It’s impossible to avoid the pain of affective empathy. By the nature of our work, we’re repeatedly confronted with more and more people who’re in physical or emotional pain. With each encounter, the more we suffer from empathetic overload.

The way we override the effects is by allowing the empathetic process to evolve naturally away from the state affective empathy. By stepping back and trying to disconnect from the pain, we effectively shut down the process. If we were to let it progress, our human curiosity would lead us naturally to the next step where we begin to wonder what going on within our patients and what feels like to be in their shoes. It’s here, in this thought, that we begin to transform the painful effects of affective empathy.

In empathetic overload, our centers and circuits that register pain are continually activated and reactivated. Our brains become drained and depleted of the neurotransmitters that allow us to feel good. In our bodies, cortisol levels rise through the roof, our autonomic nervous system is hyper-activated, our blood pressure goes up, our pulse quickens and our breathing becomes shallow.

By allowing our curiosity to lead us this next step, we enter into the phase that researchers are calling “cognitive empathy.” It’s from here that we move from the brainstem and lower levels of our neuroanatomy to the level of our prefrontal and frontal cortexes where we have conscious control. “Cognitive empathy” is how we begin to override the effects of empathetic overload.

The resulting effects are that we feel on edge and our tempers can become short. We’re pushed to the point where one more stressful event could break the camel’s back. How

We can’t possibly shut down our feelings, but we can take conscious control over them and use them to our own personal advantage and, more importantly, to the advantage of our

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patients. By stepping into the pain of others and allowing our curiosity to wonder what it’s like for them, we naturally begin to move away from that painful empathetic place and into the next natural phase of the process, compassion. Compassion is defined as the emotion or feeling that arises when we’re confronted with another’s suffering and feel motivated to relieve that suffering. Although compassion and empathy are both emotional responses to suffering, they are not synonymous. They are part of a spectrum. Try to think of our emotional spectrum much like we understand the spectrum of visible light. Light is light, but some light is perceived as yellow, others as green or purple, and different spectrums of light have different effects on our physiologic system. Our perception of light as red or blue depends on the frequency of the energetic wave.

we become more resilient. Math and higher cognitive functions improve. Integration and diagnostic abilities improve.

effects of compassion and we can say or do something that will make things better for both of us both emotionally and physically.

We become more tolerant and able to see past cultural differences. We become more trusting of others and we’re able to see the interconnectedness between people and situations. It’s when we say something or act within this heightened state of compassion that we can truly make a difference and feel that what we do or say, actually matters.

Although a lot is happening in this process, we actually go through these stages in just seconds. Once we’re lit up with the positive effects of compassion, we can get quickly get back to the tangible physical process of delivering the goods and services that comprise the entire spectrum of modern medicine.

Imagine how this uninterrupted process fits into an upgraded model of care that I call True Care:

With a better understanding of affective empathy and by focusing our efforts on effectively using the process of connection and compassion, we can treat the diseases of compassion fatigue and professional burnout.

The emotional frequency of compassion is different than that of empathy. On the lower end of the spectrum lies affective empathy, which refers more generally to our automatic experience of the emotions of another person. In the middle lies cognitive empathy, which is seen as our ability to take the perspective of and feel another’s emotions in the context of their position. On the highest end lies compassion, which arises when those feelings and thoughts include our desire to help. It’s through compassion that our system gets upgraded, as its effects are incredibly positive. Research shows that when we feel compassion, just feel it, no words or actions, our heart rate slows down, oxytocin, dopamine and other positive neurotransmitters start to be elaborated in our frontal cortex and the centers and nuclei that register pleasure begin to light up—a similar thing happens when we eat chocolate. Not only do we feel better, we do better. Spatial perception becomes heightened and this opens our awareness. We see more possibilities and become more open to novel solutions. Our physical strength is enhanced. Vagal tone is augmented. Heart rate variability re-emerges. Creativity is amplified or augmented and

First, we get fully present and connected with our patient. Next, we focus on our patient’s situation and become aware of the automatic experience of affective empathy within us. Then, instead of turning away from the discomfort, we consciously step deeper into the interaction, letting our curiosity lead us into the state of cognitive empathy, where we try to feel the pain of their situation as if it were our own. It’s from here that the feeling of compassion is naturally generated by just wanting things to be better for our patient. Our brains and bodies will begin to be flooded with the positive

Compassion, this milk of human kindness, is inherit within us all. When we access it, its affect on our human physiology is more powerful than any drug mankind has ever developed. As it turns out, compassion can’t fatigue, it is in fact the ultimate medicine. I’d like to leave you with a personal experience of compassion in action. Clinically, I work in a busy emergency department that sees somewhere between 200 and 230 plus patients a day. Recently, on a night shift in disaster, I was put into the role Continued on Page 15

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"Compassion" continued from page 14 of physician in charge. There were 23 patients in the lobby who’d been waiting for hours and every case was complicated and intense. We were working as hard as we could to get it under control, but it seemed we weren’t making a dent in the number of patients waiting to be seen. At about 2:30 in the morning, I approached a consultant I needed to get two of my patients admitted to the hospital. When I asked for his attention, he put his hand up in the air and said, “Take a number, you are third in line!” He refused to listen to me at all. In that moment, I felt defeated and deflated, and I actually became very angry! I started to feel like a victim of circumstance. As I worked to contain my anger and get back to the business at hand, I looked up at the clock and it was 3:30AM. This is the point in the shift at which we lose staff and bed space. There were still 22 patients waiting in the lobby. As I was in charge, I was feeling pretty much like a failure. It was in this very moment of selfdoubt that the other overnight physician came to me to tell me how completely overwhelmed she was and how she was going to resign in the morning because it was just too hard, too chaotic, and too out of control! When I asked what was happening, she told me the trouble she was having trying to get her infant patient the treatment she needed. This patient had been here for hours, and how no matter how hard she tried, she wasn’t getting anywhere. Her anguish was undeniable and she broke into tears of frustration. I felt her pain. They had just placed several new patients into her rooms, and she just could not get to them. I could understand why she was ready to throw in the towel and walk away. What happened next surprised even me. I had such empathy for her. I could not help but share her suffering. My connection to her led me to that place where I understood her pain and naturally wanted to help her. My arms just automatically opened up and I hugged her. She was caught completely off guard by my gesture. I told her not to worry, that I would go see those patients in her rooms and that she needed to focus all of her attention on getting that baby what they needed. She went about the task at hand and I grabbed my scribe and went to see all the patients waiting for a doctor.

for that baby, and for her, automatically took over. I viscerally wanted things to be better for everyone. It was as if, suddenly, I was larger than usual. Everyone seemed to be following my step. The entire staff was working even harder to help each other to get the job done. The next time I looked up at the clock, it was 6:30 in the morning. Although the squads had never stopped bringing us more and more patients, the lobby was empty. My previously distraught physician had gotten what she needed for the baby. She was back to herself and seeing patients that were supposed to be mine. She was now helping me. She was smiling and actually seemed relaxed. Everyone was feeling better, patients and staff alike. This same shift where we’d both been feeling like a victim and a failure had transformed into a night of triumph through compassion in action. Looking back, I see how I naturally moved through the process of “true care.” When she came to me, I was present for her and automatically felt her pain (affective empathy). I set aside my own situation and put myself in her shoes and felt, as if it were my own, her frustration with the situation (cognitive

empathy). Then I made the conscious decision to move beyond the pain and into the holy grail of compassion. This model of true care, especially in the most challenging of circumstances, changes everything, not only for others, but mostly for ourselves. Compassion enlarges and empowers us as humans. Positive neurotransmitters begin to flow and pleasure centers in our brains begin to light up as we’re transformed from zeros to heroes. What amazed me the most, was the effect that my feeling of compassion had on the rest of the staff. Compassion is emotionally contagious. By upgrading our model of care to one that is compatible with our human physiology, we can move past the painful effects of affective empathy and into the positive flow of compassion. We will experience the difference our care makes. This is what really matters to those of us who chose to work in healthcare. In my humble opinion, there is nothing better than this, except maybe great sex or chocolate! Until next time, go care, make a difference and change (y)our world. All the best.

We Want to Hear from You! Emergency 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.

T e t

The American Osteopathic Board of Emergency Medicine (AOBEM) is seeking interested applicants for the position of Physician Executive Director. Interested parties should forward a letter of interest, and current curriculum vitae to aobem@ osteopathic.org no later than May 15, 2015. Qualified applicants will be forwarded duties and responsibilities of the position.

At this point, my desire to make things better

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How to Apply for the AOBEM Exams Online Jennifer Hausman, MPA

8. Once you are logged in the application will appear. SAVE the application to your desktop/device/computer BEFORE filling it out.

The American Osteopathic Emergency Medicine Board is making it easy for emergency physicians to take their exams online! Simply follow these steps to easily find, complete, and submit your Cognitive Assessment Exam.

9. Fill out the application on your desktop and save.

1. Go to the AOBEM website: www.aobem.org

10. To upload your application to the website go back to the website and click on “Upload/View Document(s):

2. On the left hand column click on the link “Cognitive Assessment Exam (previously FRCE)” 3. Cognitive Assessment Examination (previously FRCE) – Overview and Eligibility Requirements page should come up. Scroll down the page to and click on: Please visit the AOBEM exam portal to view schedules and register for exams.

11. Under “Document Type” click on each circle to browse and upload your document:

4. Choose the exam you are applying for from the bottom of the list, you will see your two options:

5. Once you click on the exam you are applying for, the link will expand with details:

12. Once you have your documents uploaded, click on the “Submit Application for Review” button on the bottom right corner. 13. To make a payment, click on “Make a Payment” on the top right corner of the webpage.

6. Click on the first link under the exam name:

Your application is now done! Once your application is complete, AOBEM staff will now process your application for review by the AOBEM Credential Committee. The deadline to submit your application and payment is February 1st. If you have trouble uploading, you can print and fill out the application along with payment and send to the AOBEM office:

7. Log into the site with your AOA ID/Username and Password:

AOBEM Jennifer Hausman 142 E. Ontario St. 4th floor Chicago, IL 60611 Please let us know if you have questions. Jennifer Hausman, MPA Certification Manager AMERICAN OSTEOPATHIC ASSOCIATION Phone: (312) 202-8293 | Fax: (312) 202-8402 | aobem@osteopathic.org

If you do not know your login information you can click on “First time logging in or forgot your password? Request a password to be sent to your email address.” Or you can call the Client Service Center of the AOA – (800) 621-1773, press 1.

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International EM Mission Medicine An interview with Lynn Campbell, DO Tim Cheslock, DO FACOEP

Many people aspire to be of service beyond their day to day job in the Emergency Department. For most it is a fleeting thought or something on their bucket list, that may be a lot further down the list than we would like. For some however, the call to serve is one that draws you into unique and very satisfying experiences. I recently had the opportunity to catch up with a friend from medical school, Lynn Campbell, DO. She has been on several mission trips and has found the opportunity to be very rewarding. She has agreed to share her story with The Pulse.

feel blessed though to be able to help and "Icare for those less fortunate." seen by a physician. The first patient I saw in Dominican Republic was a 72 year old man that had never been seen by a physician. We ended up doing a general check up on him and diagnosing him with HTN. We have seen anthrax, bad asthmatics, necrotic feet, uncontrolled diabetes, URI, ear infections, and

parasitic infections. Yes, we even do OMT if there is a need, usually about 15-20 patients of the 100+ we would see daily receive OMT treatments. One of the other physicians, Dr. Matt Cannon who is the Chair of Family Medicine, spoke at El Salvadorâ&#x20AC;&#x2122;s Medical Conference about OMM and demonstrated OMT to those attending the conference with the assistance of our 2nd year medical students.

Tim: How did you get involved in mission trips?

Tim: You have made other trips since then as well?

Lynn: One of my partners in the Emergency Department at Spartanburg Dr. Darlene Myles, is Chair of EM at VCOM Spartanburg Campus and was looking for physicians to go on a medical mission trip to Dominican Republic in July. I have always had a heart for missions and felt this would be a great opportunity to start. We took twenty-five medical students with us and ran clinics in different areas of the country each day. They were at churches and schools throughout the Dominican Republic.

Lynn: I had such an amazing time teaching and providing care to the Dominicans that when the school asked me to go back I jumped at the opportunity. In October, we went to El Salvador for eight days. There it was more rural medicine with providing clinics in the mountains. People walked hours to be seen by a physician. We also did exams on the children of two of the Orphanages in El Salvador. At the Heart of Mary Orphanage in Sonsonate and the Shalom Orphanage in Santiago, Texicuangos, and at the Peace Messengers Childrenâ&#x20AC;&#x2122;s Home in San Salvador for those who have HIV/AIDS. We housed

Tim: What types of things are you doing or treating? Do you use your Osteopathic Skills (OMT) at all on the trip? Lynn: We see everyone and anything. Anyone that needs to be seen or wants to be

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clinics at schools, churches and in a field to provide care for the people in need there. VCOM has groups that go on a trip during every semester break. They provide missions to El Salvador, Dominican Republic and to Honduras. Students also have the opportunity to do a clinical rotation in those countries for a month during their third and fourth year. The school sponsors local physicians to run yearlong VCOM clinics there in the countries. Since my first trip in July, the school has asked me to join their staff and I am now an Assistant Professor at VCOM-Spartanburg. I will also be heading on their Honduras trip to Tegucigalpa in April over Easter.

an amazing opportunity. I have to admit I am a little envious and wish I had the chance to participate in an experience like this when I was in medical school as I am sure I would have jumped at the opportunity. I feel blessed though to be able to help and care for those less fortunate and to show the students one aspect of medicine that a lot of physicians never have the pleasure of experiencing themselves. Tim: How does one go about becoming a volunteer physician or participating in these type of mission trips?

Tim: What are some fun things that happened? Lynn: I think the El Salvador trip with the scenarios and the OMM presentation and hands on was amazing opportunity for the students. We were then invited to the Gala they had for the national conference on our last night in the country where our students and the medical students of El Salvador could mingle. A great way to promote being a DO! Tim: Are your trips part of a bigger humanitarian mission or are these individual, one- time events? Lynn: In each country there is a permanent medical clinic where the patients we see during our trip can have a follow-up. Students have the opportunity to do a month long rotation there in their 3rd and 4th year which I feel is

I would like to thank Lynn for sharing her story with us and helping to raise awareness of what we, as osteopathic emergency physicians can do given the opportunity to help in a unique way, serving the less fortunate and bringing both healthcare and education to those in need!

Lynn: Many osteopathic medical schools

Tim: As an Emergency Physician what unique talent did you bring to the mission? Lynn: I was responsible for providing a first responder class to the locals both in Dominican Republic and El Salvador. We taught CPR, first aid and we had 10 of the students dress up in moulage to present scenarios for them to practice stabilizing and treating locals in emergent situations.

offer some type of medical mission work. Sometimes it is international, other times it is within the local community. VCOM has a website dedicated to its humanitarian missions. You can find more information at www.vcom. edu/outreach.

Upcoming Events Preconference OMT Workshop: "Counterstrain for the Upper Half of the Body" June 4, 2015 8 hours category 1-A credit anticipated, pending approval of the AOA CCME Crowne Plaza at Union Station, Downtown Indianapolis Sponsor: Indiana Academy of Osteopathy Contact: IAO, (317) 926-3009 or www.inosteo.org 118th Annual Spring Update June 5 - 7, 2015 25 hours category 1-A credit anticipated, pending approval of the AOA CCME Crowne Plaza at Union Station, Downtown Indianapolis Sponsor: Indiana Osteopathic Association Contact: IAO, (317) 926-3009 or www.inosteo.org

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FOEM Beacon | April 2015 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

pring is upon us and with it The Edge: Spring Seminar. As FOEM heads to Florida, it’s more apparent than ever just how much the Foundation has grown in recent years!

first time, the 5K will kick off in the evening, earning you an extra precious hour of sleep in the morning. Also, for those not up to the entire 3.1 mile course, can opt to join in the 1-Mile DO Dash.

This year there are 32 incredible students and residents, all poised to compete for cash prizes and publication at the annual Case Study Poster Presentation. Every year not only does the number of applicants grow, but the quality of research and presentation skills increases. All conference attendees can earn CME hours while seeing the bright future of emergency medicine!

Last Fall FOEM unveiled the Faculty Development Track, a course dedicated to training current and prospective core faculty members in effective ways to incorporate research into their programs. Part I was a huge success, with topics including include an introduction to the FOEM Research Network, formulating a research concept, creating a teaching environment in residency training, and adapting medical curriculum.

It’s hard to believe after just four years, the FOEM 5K Run for Research has become a staple at Spring Seminar. It’s a great opportunity to get moving, have fun with your fellow attendees, and raise money for FOEM. This year, the fundraising goal for the 5K is $2,000 and donations can be made easily by visiting www.igivehere.org/FOEM. The popularity of this event has forced us to make it more fun for more people. For the

In Fort Lauderdale, FOEM will offer an encore of Part I for those who were unable to attend in the Fall, or looking for a refresher. Additionally, Part II will premier, providing further training physicians on the complexities of grant writing, developing inter-institution research projects, and ethical questions surrounding research. FOEM is also pleased to present a new

opportunity this Spring. The Build-a-Bike Workshop is a free event for conference attendees and their families, and a great chance to have fun and make a difference in the lives of local children in need. Participants will work in teams to crack codes, solve problems, and build a bike which will then be presented to disadvantaged children. The FOEM Research Network continues to thrive, particularly with a new partnership with the American Heart Association! This year, members of the network will also have access to the AHA’s global database. Not only is this a great opportunity to reflect on how far we have come, it’s a chance to look forward to all of the wonderful things to come. Plans are already in full force for the events at The Edge: Scientific Assembly. Competitions, another installment of the Faculty Development Track, the expansion of the FOEM Research Network, and of course the glitzy FOEM Legacy Gala: Dinner and Awards Ceremony, are all promising to be bigger and better than ever.

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2015-FOEM

Annual Run for Research

& 1-Mile DO Dash

Wednesday, April 8, 2015

RATES • One Mile D.O. Dash Rate: $15 • $50 for attending physicians. • $30 for Students, Residents, and Family. All rates include a t-shirt!

Join the Foundation for Osteopathic Emergency Medicine at The Edge: Spring Seminar 2015 in Fort Lauderdale, FL! Annual Run for Research 5K and 1-Mile DO Dash Wednesday, April 8, 2015 5:45 pm - Check In 6:00 pm - Race Begins Get the blood flowing for a good cause! All conference attendees and their families – from walkers and novice runners, to seasoned marathoners – are welcome to join the FOEM 5K Run for Research! If running a 5K isn’t your speed, take part in the 1-mile DO Dash, new this year! Runners and walkers alike will all receive a dry-fit race shirt.

All Proceeds will benefit FOEM! For more information or to register for an event, please contact Stephanie Whitmer at swhitmer@foem.org or 312.587.1765

Case Study Poster Competition Wednesday April 8, 2015 From 1:00 – 5:00 p.m. The Foundation for Osteopathic Emergency Medicine is proud to present the annual Case Study Poster Competition, in which students and residents present interesting or unique cases that have presented at their hospital. Winners receive certificates, cash prizes, and recognition in FOEM publications throughout the year. For more information on how to participate, please contact Stephanie Whitmer at swhitmer@foem.org or 312.587.1765

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the PULSE | APRIL 2015

Regional Student Symposium

We are pleased to offer you a sneak-peak at the excellent work produced by the team at The Fast Track, ACOEP's Student and Resident Publication. To see more of the in-depth articles and studies published, visit www.acoep.org/fasttrack

Kaitlin Fries, OMS-IV, OU-HCOM ACOEP-SC Immediate Past President

n Saturday, February 21, 2015, over 80 students, representing 14 different colleges of osteopathic medicine, traveled to Columbus, Ohio to attend the first annual ACOEP Regional Student Symposium. The event - held at Doctors Hospital in Columbus, Ohio - featured local ACOEP mentors, five area residency programs, and a keynote address by ACOEP President Dr. Mark Mitchell. The goal of the symposium, developed by the Student and Resident Chapters, was to provide students with the benefits of attending a national conference while remaining close to home. The morning kicked off with our popular rapid-fire lecture series given by local members of the ACOEP’s Regional Mentorship Program. Lecture topics included trauma, pediatrics, provider wellness, and how to write a personal statement. ACOEP President, Dr. Mark Mitchell, rounded out the morning with his keynote address to the students. Students had the opportunity to learn about regional residency programs during an interactive lunchtime Resident’s Panel. Five programs were represented on the residency panel, including Doctor’s Hospital, Adena Regional Medical Center, St. John’s Medical

the event functioned as a great "Overall, platform for students at all levels of medical education to learn more about emergency medicine as a specialty

Center, Ohio Valley Medical Center, and Charleston Area Medical Center. The panel allowed students to get a glimpse into what each program looks for in a future resident, learn tips on how to be a competitive emergency medicine applicant, and gain advice on how to navigate the audition and match process. The afternoon consisted of a skills lab titled, “Basic EM Skills Students Should Know”. This two-hour lab had five skills stations, each operated by a participating residency program. Students had the opportunity to learn about lumbar punctures, ENT complaints, laceration repair, direct and video laryngoscopy, and ultrasound. For first and second year students, the skills lab was a great opportunity to get an introduction to the hands-on aspects of Emergency Medicine. For the third years, it served as a chance to become more familiar with basic skills before their upcoming audition rotations.

Overall, the event functioned as a great platform for students at all levels of medical education to learn more about the specialty of emergency medicine. While there were some familiar faces, many students commented this was their first ACOEP event and quickly added it won’t be their last! The Student Chapter Board realizes there are many barriers preventing students from attending our national conferences. Many osteopathic schools have strict guidelines for excusing students from daily requirements, making attending two conferences a year difficult. For others, the financial implications of traveling to conferences pose the problem. The Regional Student Symposium was designed to alleviate this problem for our Student members. The Student Chapter Board hopes that by setting up more of these one-day events across the country, it will be able to reach out to more students and continue to share our passion for Emergency Medicine.

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the PULSE | APRIL 2015

ACOEP-RC President’s Report

his is an exciting time to be involved in the ACOEP-RC!

By the time this article goes to print, we will have participated in DO Day on the Hill where ACOEP-RC’s entire Executive Board goes to Washington, DC to meet with ACOEP’s Governmental Affairs Committee and with other members of the AOA’s leadership. This will be a great opportunity to not only to advocate for the AOA, but for emergency medicine.

Andrew Little, DO ACOEP Resident Chapter President

We are currently finalizing our plans for our upcoming conference at The Edge: Spring Seminar in Ft. Lauderdale, FL and have begun planning for our conference offerings at the The Edge: Scientific Assembly in Orlando which will focus on the specific needs of our resident members: ultrasound lab, airway lab, Chiefs College, Junior Resident Boot Camp, Jeopardy, focused rapid-fire lectures, social events and other networking opportunities. These

conferences will serve as a great chance for our resident members to learn, grow as providers, and genuinely have a great time. For more details please visit the Resident Chapter section of the ACOEP website. As always if you have any questions, comments or concerns about ways we can better serve the ACOEP and specifically our Resident Chapter members please feel free to contact me. . Thank you,

Andy Little, DO ACOEP National Resident Chapter President ACOEP Board of Directors

Official ACOEP Coffee Mugs

Physicians need their caffeine! Have your morning cup in an ACOEP mug or travel mug. Your's for only $15 plus shipping.

+ shippin g

Purchase yours today by contacting Jaclyn McMillin 312.445.5702 or jmcmillin@acoep.org

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Presorted Standard U.S. Postage

PAID

Chicago, IL Permit No. 2177

142 E. Ontario Street Suite 1500 Chicago, Illinois 60611

Fringe benefits.

As an EM physician, you work hard. We get it. We’re emergency medicine physicians just like you. We know that you need downtime to relax, spend time with family and friends, and pursue your passions outside the ED. And because EMP is 100% owned and managed by emergency medicine physicians, we have the power to create the lives and careers we want. Our excellent benefits include more than signing bonuses, they include priceless fringe benefits. Create the life you’ve always dreamed of – join EMP.

Catch more benefits at emp.com/benefits or call Ann Benson at 800-828-0898. abenson@emp.com

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Opportunities from New York to Hawaii. AZ, CA, CT, HI, IL, MI, NH, NV, NY, NC, OH, OK, PA, RI, WV

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