The Pulse: 10-2014

the

Pulse

October 2014

Osteopathic Emergency Medicine Quarterly

Presidential Viewpoints

Mark A. Mitchell, DO, FACOEP

Emergency Medicine: Past, Present, Future

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mergency medicine has come a long way in a short time. It really wasn’t that long ago that it was the responsibility of the interns to run the Emergency “Room.” As part of their training they had to take care of whoever came in and simply do the best they could.

I am sure they learned to rely upon the experience and guidance of some great nurses during those days, just as we do today. This practice was one that must have been frightening for the apprentice physician, and an accepted norm for the continued on page 4

Executive Director's Desk Page 6

What Would You Do? Page 7

FOEM Foundation Focus Page 20

Resident Wrap Up Page 23

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The Pulse

VOLUME XXXV No. 4

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, 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.

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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, Association Editor Janice Wachtler, Executive Director Thomas Baxter, Graphic Designer

Osteopathic Emergency Medicine Quarterly

Table of Contents

Presidential Viewpoints.................................................................................. Cover/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-D Do You Have Dreams?................................................................................................8 John C. Prestosh, DO, FACOEP Update on the Committee for Continuing Medical Education..........................10 Nilesh Patel, FACOEP, FAAEM Twenty Years and Only One Gray Hair..................................................................11 Christine Giesa, DO, FACOEP AOBEM Update.........................................................................................................16 Donald Phillips, DO, FACOEP FOEM Foundation Focus.........................................................................................20 Sherry D. Turner, DO, FACOEP Resident Wrap Up.......................................................................................................23 M. Steven Brandon, DO Residency Spotlight.....................................................................................................24

Interested in running for the ACOEP Board of Directors?

Please send your letter of intent and updated CV to: Dr. Gregory Christiansen, Chair, Nominating Committee ACOEP 142 E. Ontario Street, Suite 1500 Chicago, IL 60611 All candidate information must be received by March 1, 2015.

©ACOEP 2014 – All rights reserved.

Articles may not be reproduced without the expressed, written approval of the ACOEP and the author.

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Presidential Viewpoints

Mark A. Mitchell, DO, FACOEP "Crossroads continued from page 1 unsuspecting patients. Many of the protocols we accept as part of our daily routine today weren’t even developed at that time.

In addition, they didn’t have the technology that we take for granted today. There were no EKG machines with computer interpretation that are extremely accurate. There were no high speed, multiple slice CT scanners that can take images of the whole body in no time at all. By the way, the radiologist who reads these images is possibly on the other side of the globe and when you get the report you wouldn’t know they weren’t in the room beside you. Lab testing was basic and it took hours to get results. They had no “point of care” testing that could give you reliable results in a matter of minutes. Today’s tests have a specificity that greatly assists us in the care of patients and rules in or out certain clinical conditions. For example, we have the D-dimer, troponin, and quantitate beta HCG. As a third year medical student I did a primary care rotation with twin sisters who practiced together in Mendenhall, Mississippi.

There was a local hospital in this small town with an Emergency Room. However, there was no ‘emergency physician’ to cover the ER and all the physicians in the town took their turn to cover it, even the single general surgeon. If a patient came in during the day and the nurse felt the patient was stable, she would send the patient to the “on call” doctor’s office to be seen. There were also times I would be making rounds on patients in the hospital (by myself) and would be called to the ER to see a patient.

The patients had no idea of the lack of training of the “doctor-to-be” taking care of them had.

Fortunately, those days are in the rearview mirror and we’ve come a long way in a short time. We have outstanding emergency medicine residency programs turning out high-quality, dedicated physicians. Emergency medicine training is one of the most sought after specialties by graduating medical students. The technology they now take for granted includes things like bedside ultrasound, telemedicine, and electronic medical records.

However, there is something to be said for those days when interns ran the emergency rooms. They didn’t have advanced testing and had to learn to rely on a good history and physical examination. They knew how to palpate, auscultate, and percuss the abdomen. They relied on their clinical skills and made decisions without the availability of extensive testing. Yes, patients actually went to surgery for an appendectomy without a confirmatory CT scan.

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Today our environment is much different as we have evidence-based protocols that assist us and technology that wasn’t even dreamed about 30 or 40 years ago. Laboratory testing has transitioned from one test at a time to machines that are capable of running many specimens at the same time. We even have bedside or “Point of Care” handheld machines that can provide crucial data in a matter of minutes. Radiologic services have made tremendous advancements over the past 30 years. We have moved from plain films to multiple slice CT scanners and readily available MRI. In addition, the large ultrasound machines are now handheld and part of the routine training of emergency medicine residents today. In addition, many facilities have the availability of interventional radiologist who can perform procedures that in the past were only performed in the operating room.

influence the patient satisfaction survey results and it isn’t just the interaction and skill of the EM provider.

We also have financial pressures placed on us as emergency physicians and emergency departments have been made the safety net of the entire healthcare system. There is nowhere else in the healthcare system, that patients can get high quality care 24/7/365 regardless of their ability to pay. However, there is a gap in the revenue collected to provide much of this service and the cost of providing the care. That cost is not only the direct cost of providing services by the hospital, but also the compensation required to hire high-quality providers.

Emergency physicians have become the experts in many different arenas including EMS, toxicology, critical care, wilderness medicine, wound care, pediatric emergency medicine, air transport, disaster medicine, and many more areas. We also are beginning to make significant strides in other areas that include geriatric emergency medicine and palliative care thanks to leaders such as Mark Rosenberg, D.O.

I firmly believe emergency physicians are now in a unique position as the delivery of healthcare evolves and changes. We simply have to be more accountable on how the healthcare dollars are spent. We can’t continue to have a larger portion of the GDP going to healthcare.

We sit at the crossroads between the inpatient and outpatient worlds. As the reimbursement dollars transition from acute care facilities being paid for hospital admissions (“number of heads in beds”) to capitated reimbursement to provide care for a patient population, our role will become even more vital to the entire system. We have the opportunity to become leaders in this new healthcare paradigm.

All emergency physicians know that we are currently forced to admit patients due to the lack of timely, proper outpatient follow-up.

We need to be advocating for increasing the options to patients who need a transition of care other than admission to the hospital.

While we have always practiced in a fish bowl and been subject to being judged by our fellow physicians who retrospectively have the benefit of time and additional information.

Today the pressure is even greater. We have publically reported data on our personal and departmental performance. Yet we know this data often reflects factors that we have little or no control over. Our “door to provider” time is affected by many factors including staffing levels, lab and radiology turnaround times, and prolonged boarding times of admitted patients.

We also know there are many factors that

The past has been great, the present is still in a transition, but the future is ours to create. What we need in emergency medicine is those who will stand up and lead. I am not talking about leading necessarily on a nation level, even though that is needed. I am talking about leading in your own ED, your own hospital, and your own community. Those who are willing to not accept the future as one that will be cast upon you, but one that you can help to mold. One that you can help design to make sure that we will always be able to provider high quality, compassionate, cost effect care to all those who need our services.

As the demand for emergency medicine services has dramatically increased with everincreasing patient visits, we have not been able to meet that demand with the number of trained emergency physicians. Therefore, there are many different providers that make up the emergency medicine provider team. This is includes primary care providers, nurse practitioners, and physician assistants.

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The Editor's Desk

Tim Cheslock, DO, FACOEP, Major, USA

Serving to Heal, Honored to Serve or electronic means. The interesting part of the assignment was the cadre that I was able to work with side by side.

The CCU is set up as a medical home on steroids. There is a medical component that coordinates medical care, a social worker to help deal with emotional support and family issues, and line staff consisting of a squad leader, platoon sergeant, and commander that direct ongoing soldier duties that are required as part of the program. The Warrior Transition Program provides vocational rehab and educational support to soldiers that need to gain skills in order to transition out of the army into a civilian career, or need additional skills in order to remain in the army under a different status than they were originally assigned.

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t’s not often that I discuss my status as a soldier. Don’t get me wrong, I am very proud of wearing the uniform of our country and serving as a physician in the National Guard. I have been serving for seventeen years, including weekend drills, annual training, one overseas assignment to Afghanistan, and most recently a three month tour at Fort Knox in Kentucky. I had the privilege to serve as an active duty physician with the Warrior Transition Battalion as the Primary Care Manager for the new Community Care Company. This new unit was structured to allow ill and injured soldiers to receive medical care near their home via civilian or VA providers while living at home and working to return to active duty or transition out of the military to a civilian career.

As an emergency physician I couldn’t help but wonder what my training and background would bring to the table as a primary care manager (PCM). The army doesn’t discriminate when selecting physicians for an assignment. EM physicians are interchangeable with several other specialties such as internal medicine and family practice. The army takes to heart the fact that all physicians have a general medical knowledge and can perform the duties of a General Medical Officer. What was even more interesting about this assignment is that it was dealing with soldiers in a remote care setting. We had very little contact physically with the soldiers we managed other than maybe a few days of in or out processing. Otherwise, all of the communication and dealings with the soldiers are done via phone

The benefit to the soldier is that each is assigned to a team that is there to assist in his treatment and rehab process. Nurse case managers coordinate with civilian or VA providers to ensure efficient and appropriate care for each individual soldier. They work with Tricare, the federal services insurance program, to coordinate referrals and approval of procedures. Everything the soldier does medically goes through the case manager. This ensures that the soldier is being cared for appropriately and that there is no delay in getting the soldier back to his full potential.

As the primary care manager I worked with the nurse case managers to review care plans and intervene on a soldier’s behalf if needed in order to get their medical needs met. One of my other primary duties was determining when a soldier had met their point of maximal recovery.

At this point the soldier was either entered back to duty with the army or began the process of medical review board to medically process them out of the army because despite maximal medical therapy, they no longer met retention standards to remain in the service.

As an Emergency Physician I believe I brought a unique perspective to the PCM role. Making quick decisions about how to address critical injuries or illness now became how do we expedite an arthroscopy or neurosurgical evaluation for a soldier? How long to we let someone continue physical therapy without substantial progress before we start the medical board process? Not the most exciting stuff, but things that have an impact on the soldier and his future as well as his status in the military. I found that in some cases providers are afraid to make that final decision and often prolong the inevitable. By doing this, it is not helping the soldier or the army. Adherence

to guidelines and standards is essential in carrying out the process in a fair and equitable manner. I believe the cadre and the soldiers respected that approach. I received many compliments on my job performance. It is an accomplishment of which I am proud to have been a part.

During the course of the three months I participated in this process, one thing was clearthe team of soldiers and civilians taking care of our soldiers is nothing less than exceptional.

Despite the headlines we have seen recently about the VA crisis, the Warrior Transition Battalions provide a service that it above and beyond.

During my tour I had an opportunity to speak with several soldiers that had been in the Warrior Transition program for some time. They had nothing but praise for their case manager and care team. It was great to hear that something designed to give our wounded and ill soldiers that have served our country overseas and in armed conflict the best care possible, was doing just that.

I often take for granted the Army Medical Department and what it provides to our soldiers on a daily basis. Being on active duty has given me a new viewpoint on the AMEDD as a whole and my role within it. I felt a tremendous sense of satisfaction and pride in being able to help our men and women in uniform receive the care they needed and the help the deserved in order to get back to as normal a life as possible. Some cases are truly heartbreaking, the wounds and scars or war are often deep and unimaginable.

Many times it’s not only the physical injuries but the mental anguish as well. PTSD, flashbacks, anxiety and stress take their toll on soldiers and family. The support the army provides in regard to these conditions has come a long way over the last decade, but there is room for so much more.

The army is dedicated to taking care of their troops. I am honored to be a part of that process and look forward to continuing to serve. I have now returned back to my National Guard status and my full time job in Florida and will resume that less active role in the army, while maintaining readiness for the next call to serve.

The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

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Executive Director's Desk Janice Wachtler, BAE, CBA

The New Path So what does this mean, exactly? We will have to wait as the details are worked out as each specialty has its own issues with their practice partners. For emergency medicine, one of the youngest specialties, the practice differential is almost negligible. For years ACOEP and ACEP have worked side-by-side on issues never differentiating between the fact that two systems of medicine (MD and DO) practiced emergency medicine, but that all emergency physicians needed the recognition and rights to practice. We have shared training standards with the ACGME and embraced their innovations and ideas as they have ours.

The remaining question is how osteopathic emergency physicians practice differentiated from allopathic emergency physicians.

W

ith eyes set on the future, the osteopathic profession took that first step toward total equality at its House of Delegates meeting on July 19th, 2014, when it approved the Single Pathway for GME Accreditation. This acceptance came, not with clashing of swords and waving of flags, but with the acknowledgement that the time had come. There were nods and thanks given to those in the 1970’s and 1980’s who fought the fight for equality; praise given to the physicians of the 1990’s who proved that DOs were as good or better physicians than their MD counterparts and breached the walls of hospital credentialing biases to practice side-byside in faculty roles.

The afternoon was spent hearing heartfelt speeches for and against the suggested system.

Student groups praised the ruling as they looked ahead to the plethora of positions now available to them. Some specialties stated their fears about 100% acceptance of their program directors and core faculty physicians, yet others felt their specialties stood on safe ground accepted on par with their MD counterparts.

Some worried as to what would happen to specialty certification or the financial stability of their certification boards and specialty colleges. But when it was all done with thirtytwo minutes left on the discussion clock, when the question was called, the proposal was accepted by the vast majority of representatives in the House.

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That is what we now must bring to the table – the difference of the DO. We will need to not fold our tent to the fact that we are the minority of practicing emergency physicians, but stand proud in the knowledge that we are the best emergency physicians.

Throughout the history of medicine, the MD model has changed from the physician who practiced in the home to the hospital practitioner. From the distant physician to the physician who was compassionate toward his patient's condition. Osteopathic medicine has been the impetus for the change. Society no longer accepts the aloof physician who tells the patient the diagnosis without explanation

and says, “I know because I’m the doctor” but to the physician who explains to the patient what the diagnosis means, what can be done and how it will affect the patient’s life. He or she will be there for the patients, provide other practitioners to support the patient and be, as an old advertising line for the AOA said, the “one hand to hold, one hand to heal” type of doctor the public wants.

There will be scary times ahead for all of us, there will be days when we feel our way was best, but we must look forward to what we can be to our members and ourselves.

As we move forward, a quote from a book The Red Dragon comes to mind. In the book he’s referring to growing up reflects on the everlasting child, Peter Pan. “I know,” said Peter, “Perhaps better than anyone. But you can’t stay a child forever. To choose to speak into Echo’s Well is to choose illusion; to choose to avoid the responsibilities of being an adult. The real trick—the real choice—is to keep the best of the child you were, without forgetting when you grow up.”

“It is the best of both worlds, Jack. Being a child is to believe in magic everywhere . . .” “. . . but even Peter Pan had to grow up one day.”

We all must leave the security of what we know, but like Peter Pan we must grow up someday to enhance and embrace our destiny.

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Ethics in Emergency Medicine

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

What Would You Do? 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 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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n this issue of The Pulse, we will review the question presented in the July, 2014 issue.

You are driving along in your two-seater sports car on a wild, stormy night. You pass by a bus stop, and you see three people waiting for the bus: 1. An old lady who looks as if she is about to die.

2. An old friend who once saved your life.

many never be able to find your perfect dream lover again.

3. The perfect manor woman you have been dreaming about

The job interviewer who was posed this question responded:

Which one would you choose to offer a ride to, knowing that there could only be one passenger in your car?

“I would give the car keys to my old friend, and let him take the lady to the hospital. I would stay behind and wait for the bus with the woman of my dreams.�

This was a moral and ethical dilemma that was once actually used as part of a job application. How would you answer?

You could pick the old lady, because she is going to die, and thus you should save her first; or you could take the old friend because he once saved your life, and this would be the perfect chance to pay him back. However, you

How many of us would have come up with that simple answer? In emergency medicine, as in life, (of which emergency medicine is a microcosm) being creative may often be the best thing for our patient.

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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.

the PULSE | OCTOBER 2014

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The On-Deck Circle

John C. Prestosh, DO, FACOEP, President-Elect

Do You Have Dreams? families and friends with my colleagues? This surely would not be too taxing. Or does the perfect shift lie somewhere in the middle of the two aforementioned scenarios? I cannot answer that question for you, but I believe you know what would constitute your perfect shift.

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would like to explore the realm of dreams. We have all experienced dreams when we are in the rapid eye movement stage of sleep. The range of dreams is vast and includes those that are sad, happy, thought-provoking, indescribable, and even the dreaded nightmares. It is possible you may have had dreams concerning the Single Accreditation Pathway for Graduate Medical Education. That venture is now a reality, since the American Osteopathic Association House of Delegates voted to approve this undertaking on July 19th at their annual meeting in Chicago.

However, these are not the dreams I want to share with you at this time. Instead, I want to discuss dreams related to our work place.

Dreams that ask, "Will my shift of today be the illusive perfect shift? Will I be able to make the exact correct diagnosis for 100% of the patients I see today? Will a senior administrator visit the department today with the sole purpose of expressing to me what a positive asset I am to the hospital?" These are dreams I have had prior to beginning a shift, have you?

I am not completely certain what I consider the perfect shift. Is it being extremely busy caring for critically-ill patients for an 8-10 hour stretch? This would assuredly involve practicing all the skills I have learned over the years. Or is the perfect shift one that is not overly busy and gives me time to talk about

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Have you ever been absolutely sure of the exact diagnosis for every patient you encountered during a given shift? Is it your dream to be 100% correct? Emergency medicine physicians are very good at narrowing down the correct diagnosis for patients; however, we still document “Undifferentiated Abdominal Pain” when we cannot be certain of what is exactly wrong with their abdomen. For me, it is a dream to be correct all the time. Emergency Medicine physicians receive excellent training, but there are those times when we cannot provide the absolute answers to our patients’ questions.

We use the art of taking a complete history and perform a thorough physical examination.

complaint and they want to hear your version of that particular visit. You actually remember that patient…the one that you took extra time with because their complaints were so vague and nothing you did could appease them.

Yes, they complained because they were in the emergency department too long. They waited for test results, and after what seemed like an eternity in the department for them, you did not have a specific diagnosis to give them. Or maybe the administrator is checking to see why patient flow is not faster for admission dispositions. They seem to forget there are “no rooms in the inn,” and the emergency department has to hold these patients.

I know I dream of my perfect shift, I will let you decide what that is for you! I aspire to be 100% correct with every patient diagnosis during an emergency department shift. I enjoy caring for critically-ill patients, but I certainly enjoy slower times to share updates on co-workers and their families. I would also appreciate hearing positive news regarding

advances confidently in the direction " Ioff one his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours.

"

– Henry David Thoreau

We analyze results from ordered laboratory and radiological tests. We may even reflect on a patient seen long ago with similar symptoms to help formulate the correct diagnosis. We use all these “helps” to ensure the correct diagnosis for a given patient presentation. I believe we are correct the great majority of times, but there are those certain patients who cannot be defined with a specific diagnosis.

When was the last time a senior administrator visited your emergency department to inform you how valuable you are to the hospital?

More than likely they are coming to discuss information regarding a hospital lawsuit that will involve you. Maybe they are coming to discuss your personal RVUs (relative value units) and how they should be higher so the hospital can better meet its financial goals.

Or maybe their visit is regarding a patient

my association with my department and institution. These are my dreams! It is quite true that dreams are not always associated with reality but represent what could be. I hope you approach every department shift with hopeful and positive dreams. Do these dreams always come true? No! However, these types of dreams are helpful to me and make it less stressful to return to work the next day. I consider dreams important, but there is a more fundamental factor I consider when entering the emergency department for every shift. I realize I will strive to do my best to ensure giving 100% in caring for my patients and their families, respecting all my department co-workers, and reflecting positively on my hospital. I believe that most emergency medicine physicians share these same dreams.

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

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

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

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

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

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

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

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

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

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

Webinar Coordinator George Reuther Direct Line: (312) 445-5714 Email: greuther@acoep.org

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

9.5 weeks PTO, Tail Insurance & $30K Signing Bonus in Massachusetts Award-winning, nationally recognized Health System in western Massachusetts seeks Emergency Medicine physicians to join growing department. We have diverse options to meet your needs, including high acuity, low acuity and nocturnist. We enjoy tremendous support from our PA and Scribe programs. On-site, accredited residencies bring an academic flair to our facility and involve our staff in hands-on teaching. In addition to residents, we have medical, PA, nursing and EMT students rotate through our ED. Our technology and imaging services are state-of-the-art and we, in the Emergency Department, “want for nothing”.

We offer excellent compensation, including Premium Pay for overtime or sick calls, productivity incentives, shift differentials, and a very generous benefits package.

Board certification/eligibility in Emergency Medicine preferred. ATLS and ACLS certification required.

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

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Update on the Committee for Continuing Medical Education Nilesh Patel, FACOEP, FAAEM Chairman, Committee for Continuing Medical Education

A

COEP has worked hard to position itself as one of the largest Osteopathic Specialty Colleges in the United States, and offering high quality continuing education programs continues to be one of our top priorities. Over the past year, I, along with several other dedicated members, have worked with ACOEP staff to improve nearly every aspect of our primary CME events and CME offerings, and layout an ambitious, yet important plan for the future of the College’s CME program. The lecturers at our conferences and review courses are renowned for both their clinical knowledge, and speaking ability, and we continue to receive a high amount of interest from potential speakers.

We also continue working on a path of creating new availability to earn CME, as well as tutorials and general education.

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As part of this plan, we’ve also made some changes to the Committee on Continuing Medical Education (CCME), that we are truly excited to share. The key change is via the creation of three primary subcommittees which now make up the CCME: 1) ACCME Subcommittee, focused on acquiring, and maintaining accreditation for the college through the Accreditation Council for CME. 2) Program Subcommittee, focused on ACOEP’s CME Events 3) Online CME Subcommittee, focused on creating, producing, and enhancing ACOEP’s online Educational Offerings

In order to meet these goals, the CCME has opened a very limited number of positions to join current members serving on these subcommittees (and on the CCME overall). We are looking for dedicated individuals with a solid knowledge of CME, educational programs, ACCME accreditation, and awareness of medical speakers.

If you are interested, please email cme@ acoep.org, or call ACOEP at 312.587.3709.

This is truly your chance to make an impactful change in the emergency medicine community.

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Twenty Years and Only One Gray Hair Christine Giesa, DO, FACOEP

When I was first asked to write an article for The Pulse, I thought, “What could I possibly write about?” While in sunny Scottsdale, Arizona, I contemplated several topics, but none sparked my interest. On the first day of the conference, I was excited to hear about Dr. Levine’s experiences in the aftermath of the 2013 Boston Marathon. I clipped my name badge to the lapel of my jacket, and as I looked down, I saw the “20 year member” ribbon attached to my name tag. I knew that I was one of the oldest physicians in my group, but I failed to realize that I have been out of residency for 20 years. - Reality check!

Somewhere through the years I became one of those “seasoned” ED docs. I can’t say exactly when that happened. You experience years of excitement, but also uncertainty with every shift. At some point during your career, you stop questioning your medical decisions and worrying about the diagnosis that you may have missed. At the end of the day, you stand and reflect on all the craziness of the shift, and there is a feeling of self-satisfaction with what you accomplished amid the chaos.

One day you wake up and realize that the transition has occurred. Playing on the words of biographer Joe Adamson, I would like to be able to claim “20 years and only one gray hair,”1. but my hairdresser knows otherwise.

“What’s new Doc?” you ask. Read on.

ook, all I know is what they taught me at " Lcommand school. There are certain rules

about a war and rule number one is young men die. And rule number two is doctors can’t change rule number one.

"

2

– Col. Henry Blake, MASH 4077

and at that time Judith Tintinalli’s textbook Emergency Medicine: A Comprehensive Study Guide was in its second edition. It consisted of 21 sections and 1033 pages including the index. Since that time, we experienced the first World Trade Center bombing in 1993, the Oklahoma City bombing in 1995, and the 9/11 attacks. Tintinalli’s textbook is now in its seventh edition and consists of 2208

pages, 27 sections, plus 17 additional chapters on CD-ROM. All of the sections have been expanded and most notable are the sections on disaster medicine and preparedness, chemical agents and bioterrorism, natural disasters, and blast injuries. continued on page 12

I began my residency in 1991,

the PULSE | OCTOBER 2014

12 "Gray" continued from page 11 As residents we routinely placed oral gastric lavage tubes in our overdose patients. We placed 32 Fr chest tubes for a simple pneumothorax.

We performed culdocenthesis on our patients with suspected ectopic pregnancy who were too unstable to go to ultrasound. We performed deep peritoneal lavage (DPL) on our trauma patients to ascertain whether internal hemorrhage was present, which mandated that the patient go straight to the OR. We knew how to place a Sengstaken-Blakemore tube to control bleeding esophageal varices, and everyone knew where to find the football helmet. We were adept at airway procedures. We knew how to perform a needle circothyroidotomy with jet insufflation, retrograde intubations over a guide wire, and nasally intubated our CHF patients with ease.

We worried about runaway pacemakers and knew that the best way to disable them was to cut the wires.

Our practice certainly has changed. We no longer perform oral gastric lavage on our overdose patients. When was the last time that you gave a patient charcoal? Most of our overdose patients are treated symptomatically and they receive an antidote, if indicated.

Acetaminophen toxicity due to chronic and acute ingestions is now ever present in the back of our minds, and we do not hesitate to administer acetadote. We use the RumackMatthew nomogram. We still remember “140 and 70”- acetaminophen toxicity is a level greater than 140 µg/mL at 4 hours; a toxic ingestion in children is greater than 140 mg/kg (actually it’s 150mg/kg); and N-acetylcysteine given orally is an initial dose of 140 mg/ kg followed by 17 more doses of 70 mg/kg every 4 hours. We no longer use the Done nomogram for salicylate toxicity.

Bedside ultrasound, the FAST exam, and ED CT scanners have pretty much supplanted the need for DPL and culdocdenthesis. I performed one culdocdenthesis as a 3rd year resident.

It was the most barbaric procedure I had ever performed, and I have never performed one since. Maybe, if I were on a deserted island, and I needed to make the diagnosis of a ruptured ectopic then I would consider performing a culdocenthesis, but if I were on a deserted island would the diagnosis would it change my management? I seriously doubt it!

I haven’t performed a DPL in about 15 years.

There’s the FAST exam and patients can be quickly moved to the ED CT scanner and the images are read in real time. Many hospitals no longer stock Sengstaken-Blakemore tubes.

Variceal bleeds are now initially treated with endoscopic variceal ligation or sclerotherapy.

Although Blakemore tubes are still discussed in the literature, younger gastroenterologists have

the PULSE | OCTOBER 2014

not had any experience placing those tubes.

We now observe an apical pneumothorax and smaller pneumothoraces can be treated with insertion of a catheter.

We are still adept at airway procedures, but we now have new devices to rescue us.

The LMA was a rescue adjunct that proved beneficial to ED physicians as well as EMS personnel. Anesthesiologists would even place an LMA instead of orally intubating patients for a short procedure. Newer video devices have given us greater confidence in securing difficult airways after failed attempts. The first time that I used a fiber-optic video device, I successfully intubated the patient while looking at the screen over my left shoulder. How awesome is that? Now I make sure the video cart is always positioned in front of me. Nasal intubations may have become a trick of the past, with RSI and the use of BiPAP, however, I still believe that it is a very worthwhile skill to maintain. In 20 years, I have never seen a runaway pacemaker; however, I still carry a cardiac magnet in my red tool bag in case I need it. I did have the opportunity to use my magnet recently to turn off a malfunctioning AICD that kept shocking it’s owner.

Chart documentation has certainly gone through many phases in the past 20 years. I started off handwriting my charts. My charts were legible and quite thorough. Dictated medical records were supposed to save us time; however, you had to wait for the typed chart to return, proofread it, phone in corrections, wait for the corrections to come back, read the chart for the corrections, and then sign it.

It was a very tedious process and not unusual to have a 48-hour turnaround time. There were documentation systems that consisted of preformed templates. We chose a sheet based upon the patient’s chief complaint and checked off all the pertinent positive and negative findings. This form of documentation was quick and could be readily performed at the bedside. The downside to the check off system was that it didn’t really tell the patient’s story. Now we are mandated to have electronic medical records (EMRs). EMRs allow us to free type, check a series of pertinent positives and negatives, and many also allow us to make preformed templates of our review of systems and physical examination findings based upon the chief complaint. “Writing” the chart in some respects has become easier, but in other respects much more complicated. The EMR is designed to give us a more complete and accurate medical record; however, it does not save us time. More time is spent with documentation than at the bedside with our patients. Many emergency departments are currently using scribes for their medical documentation. Physicians I have spoken to

state that the use of scribes have made them much more efficient. They are able to see more patients. They have improved their door-todoctor and length- of- stay times; however, like any good marital relationship, the physicianscribe team must be able to understand each other’s communication style and work well together.

In the past 20 years, a lot has changed in the practice of emergency medicine. Patients with an acute myocardial infarction now go straight to the cardiac catheterization lab. Patients with acute stroke now receive thrombolysis.

Perhaps in the future these patients will go straight to the stroke catheterization lab instead of receiving thrombolysis. Brain freeze no longer refers to an “ice cream headache”, but to hypothermic protocols that are now instituted on post-cardiac arrest survivors to protect cerebral function. Early goal directed therapy has become the standard of care, and many more patients survive sepsis. Organ transplantation is quite common and gives patients a better chance at life. With early detection and advancements in chemotherapy there are many more cancer survivors. Our understanding of HIV has grown exponentially, and antiretroviral therapy has provided a better quality of life and longer survival years in HIV patients. As ED physicians, we all have stories about how we “boldly go where no man has gone before”. Hand held ultrasound machines, video capsule colonoscopies, and hand held tablets that allow us to interact with our environment no longer make life on the Starship Enterprise so futuristic.

Despite all of our medical advancements, patients still die. The memory of some patients will be forever burned on our hearts and in our conscience. We all have our favorite stories that we will always remember. We all have our ghost stories that we will never forget. Sometimes patients die no matter how hard we try to save them. Early on in my career, I adopted the wisdom of a certain surgeon: As physicians, one of the most difficult things to accept is that sometimes, despite our best efforts, patients die. It does not mean that we should be cold and uncaring. It does not mean that we are bad physicians. We need to find some comfort in the fact that sometimes we cannot change rule “number one”.

1.

Adamson, J. 50 Years and Only One Grey Hare. New York: Henry Holt and Company Inc., 1990 2. www.mash4077.co.uk/quotes.html

13

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!

Committed Physicians Interested in Serving on College Committees ACOEP's most valuable resource is our incredible membership base. Your experience, expertise, and insight are an indispensable tool in shaping the future or emergency medicine! Share your vies by becoming involved in one of our dynamic committees! Visit www.acoep.org/committees to learn what opportunities are available!

Committees are open to any physician and we encourage interested physicians to sit in on meetings of Committees that you are interested in being appointed to.

Appointees must attend 66% of all meetings, conference calls and must participate in the activities of the Committee.

Failure to do so will cause the appointee to be removed from the committee.

Send your information to: Jan Wachtler, Executive Director, ACOEP, 142 E. Ontario St., Suite 1500, Chicago, IL 60611

the PULSE | OCTOBER 2014

What is CEP America to me?

It’s beyond the Partnership, the democracy, the transparency, and the equity—it’s a family.

At CEP America, we bring the group together.

And it can be felt and seen by the patients —that we work together for them.

—JOE GINEJKO, DO Clovis Community Medical Center

CEP America’s culture of caring puts the patient first.

Visit us at ACOEP’s 2014 Scientific Assembly in Las Vegas Booth #20 To learn more about a career with CEP America, visit go.cep.com/joestory

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ACOEP Presents

SPRING SEMINAR

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April 7 - 11, 2015 Marriott Harbor Beach, Ft. Lauderdale, FL

SCIENTIFIC ASSEMBLY

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SAVE THESE DATES!

ACOEP Presents

16

AOBEM Update Donald Phillips, DO, FACOEP AOBEM Secretary

T

his summer, AOBEM has seen us continue to prepare for our move to the AOA building in downtown Chicago at the end of the year. Jennifer Hausmann has been named our incoming Certification Manager. Jen is working with Josette now to smooth the transition. Jen will be introduced to ACOEP members at the membership meeting during The Edge: Scientific Assembly 2014 in Las Vegas. She will also be manning our table along with Josette and board members. We invite all of our present and future diplomates, and candidates to stop by and meet Jen and Josette. We will be at table 27.

As the candidates applying for the 2015 primary certification are aware, we are moving to online credentialing for our examinations.

Since this is a new process for AOBEM, we want to hear comments. Please make all comments in writing through one of the links

the PULSE | OCTOBER 2014

s the candidates applying for the 2015 " Aprimary certification are aware, we are moving to online credentialing for our examinations.

"

on near the bottom of our homepage (www. aobem.org). Expect as we go forward more of our applications will be online.

AOBEM will be sending representatives to the next ABEM oral examinations. Both organizations are beginning a collaborative process to ensure the most accurate and reproducible examinations and all utilize best practices. ABEM will be sending representatives to the November oral examinations in Philadelphia. Both organizations have enjoyed

a collegial environment and we look forward to enhancing that relationship.

As everyone prepares for the Single Accreditation System (SAS) beginning in 2015, rest assured that AOBEM will remain the board certification that ensures excellence in osteopathic emergency medicine. Our mission will remain to protect the public through the certification of excellence in emergency medicine.

17

the PULSE | OCTOBER 2014

18 ACOEP Presents

INTENSE REVIEW

‘15

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CHICAGO, IL

Earn up to 42 Hours of 1A CME Credit!

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January 13 & 14, 2015 the PULSE | OCTOBER 2014

Register Online at:

www.acoep.org

19

Call to Meeting Membership Meeting Sunday, October 12 5:00 - 7:00pm Caesars Palace - Florentine Ballroom 3570 Las Vegas Blvd, Las Vegas, NV 89109 The ACOEP Membership Meeting is an excellent opportunity to hear from leaders, members, and policy-makers, and we want to hear from you!

Do you have concerns or issues that you would like the ACOEP Board to address? From the Single GME Pathway, to ACOEP’s future leadership, we want to address the needs of ACOEP members.

Visit www.surveymonkey.com/s/MemMeeting14 to enter your questions and they will be presented to the Board prior to the meeting.

Thank You to EmCare, ACOEP’s 2014 Prime Partner!

the PULSE | OCTOBER 2014

20

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

Congratulations to the 2014 Honorees of the Legacy Gala!

President’s Circle Award ($10,000 and above) Robert E. Suter, D.O., MHA, FACOEP-D, FACEP FIFEM Pillar Award ($5,000 and above) Joseph Calabro, D.O., FACOEP-D Mark A. Mitchell, D.O., FACOEP Bryan D. Staffin, DO, FACOEP-D Partner Award ($2,500 and above) Fahim Shan Ahmed, DO, MS, FACOEP, FACEP Rudolph D. Bescherer, DO, FACOEP Thomas Brabson, DO, MBA, FACOEP-D Gregory M. Christiansen, DO, M.Ed., FACOEP-D Jack B. Field, DO Christine F. Giesa, DO, FACOEP-D Drew A. Koch, DO, FACOEP-D William Lynch Steven J. Parrillo, DO, FACOEP-D John C. Prestosh, DO, FACOEP Plus, 3 Anonymous Donors

the PULSE | OCTOBER 2014

FOEM | BEACON

Monday, October 13 7:00 pm

Caesars Palace Las Vegas, Nevada

Raise a glass, throw the dice, and take a spin on the dance floor with Lady Luck at the Fourth Annual FOEM Legacy Gala: Dinner and Awards Ceremony!

Indulge in world-class cuisine, entertainment, and all the style that Las Vegas has to offer, while honoring the generous individuals whose support has taken FOEM soaring to new heights!

Supporting Sponsor:

Friend Level Sponsors:

VIP Reception Sponsor:

the PULSE | OCTOBER 2014

21

22

Core Faculty Academic and Research Skills Development Course Sponsored by a David E. Kuchinski Memorial Grant from the Foundation for Osteopathic Emergency Medicine

WHEN: October 14, 2014 WHERE: Las Vegas, NV CME: 7 hours of Category 1A

Approval Pending

FOEM invites core faculty members and program directors with an interest in improving research and academic teaching skills to the new Faculty Development Track, on October 14, 2014 at The Edge—Scientific Assembly in Las Vegas!

This one-day course will explore: • FOEM’s new Research Quality Improvement Initiative • Implementation of new common core standards • Ways to enrich and encourage research among physicians, residents, and students • Networking with other institutions and organizations to promote osteopathic research across a broader spectrum • Improvement of grant writing to successfully fund vital research • Effectively securing publication and recognition for your work Only $50 per session for faculty, and FREE to residents nominated by their Program Director.

Two Ways to Register!

ONLINE

www.acoep.org/fall

the PULSE | OCTOBER 2014

PHONE

(800) 521-3709 ext: 8

23

Resident Wrap Up

M. Steve Brandon, DO ACOEP Resident Chapter President Greetings from the Resident Chapter! Our resident board has been diligently working to put together a strong fall schedule, I wanted to let you all know about a few highlights.

New Resident Welcome Packets For the second consecutive year, all incoming DO emergency residents received a welcome packet filled with gifts and survival guides to both welcome them to the ACOEP family and help them through that transition from student to resident. I want to give a special thanks to the amazing ACOEP office staff, without whose amazing efforts these packets would never come to fruition. We appreciate their support!

Fall Conference: Resident-specific events at The Edge: Scientific Assembly in Las Vegas will run from October 11 - 14. Highlights include: • Membership meeting • Multiple sponsored nights out (free food and drinks!)

• Resident Jeopardy • Both an Airway and a Dental Lab • Residency Program Expo – a chance to recruit and promote your program • Chief's College • Many FOEM sponsored research competitions Chief ’s College: On Monday October 13, the Resident Chapter will host its second annual Chief ’s College. Here resident leaders and aspiring leaders will be educated by a stellar lineup of speakers. We will hear from Nevada State Senator, Joe Hardy, who is also a physician.

Attendees will also have specific training on speaking and presenting from Mr. Darren LaCroix, a world-renowned speaking coach and presenter who also happens to be the 2001 World Champion of Public Speaking. There will also be a hands-on resume workshop.

Leadership Opportunities: Any resident interested in a leadership position within our chapter is encouraged to run for a position on our board. More information about this can be found in the resident section on www.acoep.org/residents. I would be happy to answer any questions about this, my contact information can also be found on the website.

I lastly want to thank the ACOEP Board of Directors, our mentors, and the staff at the ACOEP office for all of their help and support. WWithout your support and guidance, our Resident Chapter would not be able to accomplish nearly half of what we have been able to.

Thank you,

Steve Brandon, DO ACOEP National Resident Chapter President ACOEP Board of Directors St Mary Mercy Hospital Chief Resident

the PULSE | OCTOBER 2014

24

Residency Spotlight Program: St. John Providence Health System – Osteopathic Division Address: 12000 E. Twelve Mile Rd. City/State/Zip: Warren, MI 48093 Hospital Information: Type (Community, rural, urban): Community with urban rotations Trauma Level: 3 & 2 Number of Hospital Beds: 535 (Oakland Campus + Macomb Campus); 772 (Urban Campus rotations) Number of ED Beds: 29 (Oakland Campus); 57 (Macomb Campus); 70 (Detroit Campus) EM Program Information: Phone: 248-967-7795 Website: h ttp://www.stjohnprovidence.org/osteopathicdivision/ oakland/programs/EmergencyMedicine/ Total Number of EM Residents: 20 Residents to Attending Ratio Working Clinically: 2-3 Res: 1 Attnd (Oakland Campus); 1 Res: 1-2 Attnd (Macomb Campus) Accepts Medical Student Rotations? Yes. EM Program Curriculum: PGY 1: 4 months Emergency Medicine 1 month Internal Medicine 1 month Internal Medicine Elective 1 month Pediatrics 1 month Obstetrics/Gynecology 1 month General Surgery 1 month General Surgery Elective 1 month MICU 1 month House Officer/Admit Service PGY 2: 7 months Emergency Medicine 1 month Cardiology 1 month Trauma Surgery 1 month Radiology (2 weeks of Radiology and 2 weeks of Emergency Department Ultrasound) 1 month Neurology 1 month Pulmonology PGY 3: 7 months Emergency Medicine 1 month Orthopedics 1 month MICU 1 month PICU (Beaumont Hospital, Royal Oak) 1 month Pediatric EM 1 month Toxicology (Detroit Poison Control Center) PGY 4: 8 months Emergency Medicine 1 month EMS 1 month Administration 2 months Electives EM Program Application Information: Dates applications are accepted: July 1st Prefers COMLEX Scores of: N/A Interview Dates: Oct 1st, Oct 8th, Nov 5th, Nov 12th Number of Letters of Recommendations and who can write the letters: 3

the PULSE | OCTOBER 2014

Program: St. Joseph’s Regional Medical Center Address: 703 Main st.

City/State/Zip: Paterson NJ 07503 AOA Accredited since July 2004 - Program # 157432 ACGME Accredited since September 2013 - Program # 1103300212 Dual Accredited EM Residency Program Hospital Information: Type (Community, rural, urban): Urban Hospital Trauma Level: 2 Number of Hospital Beds: 640 ED Volume: 160,000 patient visits, includes 39,000 pediatric ED visits (Busiest ED in New Jersey and 5th busiest in the United States) Number of ED Beds: 92 beds with separate Pediatric and Geriatric/ Palliative Care EM Departments EM Program Information: Program Director: Otto F Sabando DO FACOEP Associate Program Director: Nilesh Patel DO FACOEP Residency Coordinator: Judy Callender Phone: 973-754-2918 Website: https://www.stjosephshealth.org/ Total Number of EM Residents: 24 total, 6 per year Residents to Attending Ratio Working Clinically: 1:1 Accepts Medical Student Rotations? Yes EM Fellowships: EM Ultrasound EMS Disaster Pediatric EM Pain Management Neuro Critical Care EM Program Curriculum: PGY 1: Weeks PGY-2 Emergency Medicine 18 Emergency Medicine Pediatric EM 8 Neurology Internal Medicine 4 Orthopedics Ophthalmology 2 EM Ultrasound Psychiatry 2 EM Research OB/GYN 4 Trauma/SICU CCU 4 MICU OMFS 2 Pediatric EM General Surgery 4 Vacation Vacation 4 PGY 3: Emergency Medicine EM/Wayne Community Pediatric EM EMS EM Administration Trauma/SICU MICU Toxicology Infectious disease Vacation

Weeks PGY-4 20 Emergency Medicine 4 EM/Wayne Community 4 EM Teaching 4 Pediatric EM 2 PICU 4 Selective 4 Research 4 Vacation 2 4

Weeks 24 2 4 2 2 4 4 4 4 Weeks 30 4 2 2 4 4 2 4

25 EM Program Application Information: Dates applications are accepted: July 15 Prefers COMLEX Scores of: 550 Interview Dates: Oct through December (Subject to change) Number of Letters of Recommendations and who can write the letters: At least three letters of recommendation with Standard Letters of Evaluation (SLOE) preferred.

Program: St. Luke’s University Hospital Address: 801 Ostrum Street City/State/Zip: Bethlehem, PA 18015 Hospital Information: Type (Community, rural, urban): Urban Trauma Level: Level 1 Number of Hospital Beds: 450 Number of ED Beds: 36 EM Program Information: Phone: 484-526-4903 Website: https://residency.slhn.org/ Total Number of EM Residents: 40 Residents to Attending Ratio Working Clinically: 3:1 Accepts Medical Student Rotations? Yes EM Program Curriculum: PGY 1: 5 months of ED, 1 month of Peds, Surgery, SLIM, OB, and MICU and ½ month of Cardiology, Neurology, ENT, and Ophthalmology PGY 2: 7 months of ED, 1 month of Orthopedics, Trauma, Elective, and SICU and ½ month in Anesthesia and Radiology PGY 3: 5 ½ months of ED, 1 month of Trauma, Surgical Subspecialty, MICU, Selective, and EMS and ½ month of Pediatric ED, PICU, and Research PGY 4: 8 ½ months in ED and 1 month in MICU, Trauma, and Elective and ½ month in Administration

EM Program Application Information: Dates applications are accepted: August 15, 2014-December 31, 2014 Prefers COMLEX Scores of: 525 Interview Dates: begin 10/22/14 Number of Letters of Recommendations and who can write the letters: At least 3 letters of recommendation should be included in the application. Letters of recommendation can be written by faculty, clerkship director, or the dean of students.

Program: St. Joseph Health Center Address: 667 Eastland Ave. S.E. City/State/Zip: Warren, Ohio 44471 Hospital Information: Type (Community, rural, urban): Community Trauma Level: 3 Number of Hospital Beds: 141 Number of ED Beds: 27 EM Program Information: Phone: 330-841-4774 Website: HMPartners.org Total Number of EM Residents: 8 Residents to Attending Ratio Working Clinically: 1:1 Accepts Medical Student Rotations? Yes EM Program Curriculum: PGY 1: EM x4, Surg. Sub x2, Gen. Surg., IM, Critical Care, Peds, OB/ GYN, House Nights PGY 2: EM x 6, MICU, Cardiology, Peds/EM, IM, Ortho, Plastics.

PGY 3: EM x7, Peds/EM, EM/Research, ENT/Opthalmology, Neurology, Trauma/SICU PGY 4: EM x 9, SICU, EMS, Elective EM Program Application Information: Dates applications are accepted: July 15, 2014 – Nov. 1, 2014 Prefers COMLEX Scores of: 500 Interview Dates:10/7/2014, 11/4/2014, 12/2/2014 Number of Letters of Recommendations and who can write the letters: 3 – at least one ED Physician

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the PULSE | OCTOBER 2014

Check out the recently redesigned online publication

e ER ke it to th ta , s a g e y in V esnt sta egas, do V in s n ppe What ha

k c a r T t s a F e h T on ublicati dicine P ency Me rg e m E An

2014 Summer

- Issue 12

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 Fall 2014 issue:

ut Stand O ent on rotations. o t w o H ical stud t as a med stand ou How to s aseerSenet rpreiesentations, three iff d STEMI C e thre you! ses, ith Three ca that will stick w lts cath resu

• CV's and personal statements

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• 3 STEMI's, a case study

PS onal Statments helping or CV’suraCVn’sd and Pers ! side info Are yo the in you? Get hurting

14 rencSeA2N0D GET fe n o C Fall ES OF VEGA GET TO

2 11 - Issue March 20 sendam

non estiatus non ptatem doluptio Comnia eatem ex et volu s venditiu

TO THE SIT U NEED VEL ENJOY INFO YO THE NEXT LE THE EM

• How do well on audition rotations • Tricks of the trade • Toxicology session

You can view The Fast Track online by going to:

www.acoep.org/fasttrack

Will your salary cover your student loans?

Tr y our Salar y and Student Loan Calculator

Scan the QR code or go to www.erdocsalary.com/ACOEPDisplayOctDec2014

Contact Dr. Kas Oganowski (800) 726-3627 x3468 Visit us in booth #35 at Scientific Assembly

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142 E. Ontario Street Suite 1500 Chicago, Illinois 60611

We’re all in.

We love what we do,

EMP physicians get their “Chicago” on at a photo shoot for display materials that will be used at this year’s ACEP SA in Chicago.

and at EMP, we’re empowered to do it better than anyone else. Every physician in our group has an equal voice day one, and becomes an equal equity partner.

Our 100% EM physician ownership creates a culture where we’re all in. We’re passionate about the care we provide our patients, the solutions we provide our hospital partners, and the careers we create for ourselves.

Visit us at booth 1418

Visit emp.com/jobs What’s the price of living a life well-led? or call Ann Benson at 800-828-0898. abenson@emp.com

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