SAEM Newsletter January/February 2016 by Society for Academic Emergency Medicine

NEWSLETTER 2340 S. River Road, Suite 208 | Des Plaines, IL 60018 | 847-813-9823 | www.saem.org

JANUARY - FEBRUARY 2016

VOLUME XXXI NUMBER 1

SPOTLIGHT: THREE DECADES ON THE FRONT LINES OF EMERGENCY MEDICINE MULTIPLE APPROACHES TO UNDERSTANDING & PREVENTING ELDER ABUSE GUIDE TO CHOOSING AN EM FELLOWSHIP

Leading the advancement of emergency care through education and research, advocacy, and professional development in academic emergency medicine.

SAEM Staff Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org Director of Finance & Benefits Doug Ray Ext. 208, dray@saem.org Director of Communications & Publishing Stacey Roseen Ext. 207, sroseen@saem.org Director of Operations and Governance Kat Nagasawa Ext. 206, knagasawa@saem.org Grants & Foundation Manager Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Marketing & Membership Manager Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org

2015-2016 BOARD OF DIRECTORS Deborah B. Diercks, MD, MSc President University of Texas Southwestern at Dallas Andra L. Blomkalns, MD President-Elect University of Texas Southwestern at Dallas D. Mark Courtney, MD Secretary/Treasurer Northwestern University Feinberg School of Medicine Robert S. Hockberger, MD Immediate Past President Harbor-UCLA Medical Center

Meeting Planner Maryanne Greketis, CMP Ext. 209, mgreketis@saem.org

Steven B. Bird, MD University of Massachusetts Medical School

IT Project Manager Angela Lasky Ext. 217 alasky@saem.org

Kathleen J. Clem, MD, FACEP Loma Linda University School of Medicine

Digital Communications Specialist Kataryna Christensen Ext. 201, kchristensen@saem.org

James F. Holmes, Jr., MD, MPH University of California Davis Health System

Accountant Hugh Paz Ext. 216, hpaz@saem.org

Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center

Membership Coordinator George Greaves Ext. 211, ggreaves@saem.org

Ian B.K. Martin, MD, MBA University of North Carolina School of Medicine

Systems Administrator/Database Analyst Michael Reed Ext. 205, mreed@saem.org

Richard Wolfe, MD Beth Israel Deaconess Medical Center/Harvard Medical School

Education Administrative Assistant Elizabeth Oshinson Ext. 204, eoshinson@saem.org Assistant Newsletter Editor Sharon Atencio sharon.atencio@rvu.edu

AEM Staff

Kavita Joshi, MD Resident Member University of Texas Southwestern at Dallas The SAEM Newsletter is published bimonthly by the Society for Academic Emergency Medicine. The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM.

Editor in Chief Jeffrey Kline, MD jefkline@iu.edu

For Newsletter archives visit http://www.saem.org/publications/newsletters

Editorial Coordinator Taylor Bowen tbowen@saem.og

ÂŠ 2016 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

Journal Manager Stacey Roseen Ext. 207, sroseen@saem.org

Table of Contents

PAGE 6 EM PHYSICIAN IN THE SPOTLIGHT THREE DECADES ON THE FRONT LINES OF EMERGENCY MEDICINE

An interview with Kenneth Frumkin, MD

PAGE 10 MULTIPLE APPROACHES TO UNDERSTANDING AND PREVENTING ELDER ABUSE

PAGE 16 A GUIDE TO CHOOSING WHICH EM FELLOWSHIP IS RIGHT FOR YOU

PRESIDENT’S COMMENTS Elevate the EM Specialty: Contribute to EM Journals

CEO’s MESSAGE 10 Steps to Help You Avoid Burnout

EM PHYSICIAN IN THE SPOTLIGHT Three Decades on the Front Lines of Emergency Medicine An interview with Kenneth Frumkin, MD

Multiple Approaches to Understanding and Preventing Elder Abuse

ADIEM FEATURE Residency Interview Experiences as a Black Male in Emergency Medicine

ETHICS ON CALL Communicating with Parents Who Don’t Vaccinate

A Guide to Choosing Which EM Fellowship is Right for You

Acute Coronary Syndrome: Sex Specific Symptoms

20 22

Simulation Academy: An Interview

24 26

Emergency Medicine Podcast Picks

2015 Midwest Regional Meeting Report

EM News and SAEM Announcements November / December 2015

WANT TO ELEVATE THE EM SPECIALTY? CONTRIBUTE YOUR BEST WORK TO EM JOURNALS AND MEETINGS Deborah B. Diercks, MD, MSc

Professor and Chair University of Texas Southwestern at Dallas

Winter in the emergency department can be tough. Many of us go to work when it is dark and leave work when it is dark. Residents have experienced mid-year burnout and residency directors are exhausted from the interview season. But this is also the time of year when we find out the status of our presentation submissions for the SAEM Annual Meeting. I have always enjoyed the camaraderie in our academic office as the news of acceptances and rejections spreads. Sharing excitement with a resident or junior faculty who has received his or her first acceptance, or condolences when someone is disappointed that his or her research or didactic was not chosen, is part of what makes working in academic emergency medicine feel like a team sport. As I reflect back on the many SAEM Annual Meetings to which I have submitted research, I find that my motivation for doing so has evolved. As a resident and junior faculty member, I viewed the SAEM Annual Meeting as an opportunity to share my work with people in my field whom I admire and view as experts. As I advanced in my career, my submissions to the SAEM Annual Meeting became more focused on allowing colleagues to present collaborative work. I, in turn, began to direct my research submissions primarily to cardiology meetings. I also tended to submit manuscripts of my best work to cardiology journals. My rationale was that I needed to establish myself as a researcher in the cardiology arena. Looking back, my strategy did, in fact, allow me to identify collaborators and establish a presence in the cardiovascular space. Now, as SAEM president, I wonder if this was the best decision for emergency medicine. By focusing on cardiology meetings and journals as the places to present my research, I may have inadvertently propagated the idea that emergency medicine is a second-rate specialty whose main academic meeting is not worthy of my best work.

November / December 2015

Perhaps earlier in my career, before the global availability of abstracts and articles through the Internet, my decision was wise; however, in this current era, anyone can perform a key word search and locate an abstract or manuscript. This nearly instantaneous access to our research allows a level of visibility of our work that was not present 5-10 years ago. Yet, emergency medicine journals have not reached the impact factor that one would expect from a specialty as large as ours. If we are to establish ourselves as the experts in emergency care, we have to elevate our own emergency medicine publications to a level equivalent to other specialty journals. This will never occur if we continue to send our transformative research to be published by those outside of emergency medicine. As a senior member of my academic team, my role should be to focus on the future. This can be done by mentoring academicians, but also by working to elevate our specialty by contributing to the success of emergency medicine journals. I am realistic that this will take time, but I will look towards emergency medicine journals as a home for my best work. I hope that many of you will join me.

â&#x20AC;&#x153;If we are to establish ourselves as the experts in emergency care, we have to elevate our own emergency medicine publications to a level equivalent to other specialty journals.â&#x20AC;?

Is work-life balance part of your New Year’s resolutions?

10 Tips to Avoid Burnout in 2016 Megan Schagrin, MBA, CAE, CFRE

SAEM CEO

I love celebrating the New Year (I mean, L-O-V-E it!). As soon as the 4th of July holiday is over I begin planning my annual New Year’s Eve bash. Maybe that’s because I like to throw big parties, or it could be because I am a goal setter. Whatever the reason, it seems to me that New Years is the perfect holiday. There is no better time than the end of one year and the beginning of the next to evaluate where we’ve been and resolve to do better going forward. The New Year holiday provides an opportunity for both reflection AND celebration. Think about it: How many times during the year do you have a chance to truly pause and take stock of your life while throwing excessive amounts of confetti? At our New Year’s Eve party each year, we hang a board on which our guests are encouraged to write their resolutions. Some resolve to diet, others to treat people better… We’ve had folks decide to learn a second language or to take lessons in country line dance. But if I had to guess what an academic emergency medicine professional might resolve for the new year, it would be to “avoid burnout.” My guess is based on the number of shares, retweets, and likes we’ve received for our recent social media posts on “burnout” and “work-life balance.” Clearly these are topics that matter to you. In 2012, a JAMA article defined burnout as: “… a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment. Although difficult to fully measure and quantify, findings of recent studies suggest that burnout may erode professionalism, influence quality of care, increase the risk for medical errors, and promote early retirement. Burnout also seems to have adverse personal consequences for physicians, including contributions to broken relationships, problematic alcohol use, and suicidal ideation.” And, according to a recent article in Medpage Today:

“Rates of burnout vary markedly by specialty, but generally the highest rates are found among front-line physicians: family medicine, general internal medicine, neurology, and emergency medicine. The mean average of those reporting burnout was 45.8%, but the emergency physicians had the dubious distinction of being the specialty with the highest burnout rate: more than 60%.” To help you be successful with your resolution to avoid burnout in 2016, I’ve gleaned some of the best tips from SAEM’s social media posts and outlined them below. Some of these tips might seem obvious, but they are futile unless applied, so why not resolve to give them a try? 1. FIND SUPPORT IN THE WORKPLACE – A GOOD FRIEND AND/OR MENTOR 2. REMIND YOURSELF WHY YOU DO WHAT YOU DO 3. CARVE OUT TIME FOR EXERCISE AND SLEEP 4. GET YOUR ANNUAL PHYSICAL AND KEEP UP HEALTHY HABITS 5. TAKE THE VACATION YOU’VE BEEN PUTTING OFF 6. SET LIMITS ON PROFESSIONAL COMMITMENTS 7. SET A FEW PERSONAL GOALS, NOT JUST PROFESSIONAL GOALS 8. TAKE UP A HOBBY 9. SPEND TIME WITH FAMILY AND FRIENDS 10. THROW A PARTY (IT WORKS FOR ME!)

Have you discovered any other creative ways to avoid burnout? Email your tips to our Digital Communications Specialist, Kat Christensen, at kchristensen@saem.org and we will post them via social media throughout 2016. Also be sure to visit SAEM via Facebook, at the beginning of every week when we post a #MondayMotivation to inspire you for the important work you do! Happy New Year and cheers to accomplishing your 2016 resolutions!

November / December 2015

SPOTLIGHT Three Decades on the Front Lines of Emergency Medicine An interview with Kenneth Frumkin, MD Disclaimer: The views expressed are Dr. Frumkin’s and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. You received a PhD in physiological psychology. What made you decide to continue on to get a medical degree? The Vietnam War and the draft were ongoing. I had an Army Reserve commission and a service obligation in return for being allowed to finish my doctorate. I went from graduate school to the Army’s Biomedical Laboratories, mainly conducting basic research on the psychological mechanisms underlying opioid dependence. I first perceived medicine as an opportunity to solve, through research, bigger questions of life, death and disease. However, in medical school, I found that I really liked caring for patients. I used to say that the success of a research career in physiological psychology could be measured by the size of a pile of papers bearing one’s name. While a worthwhile endeavor, I came to realize that, for me, I would rather measure my life’s work by the number of patients my students and I had helped. Once in medical school, why did you decide on emergency medicine? For years I said that I went into emergency medicine because I enjoyed so many aspects of medical practice that I did not want to limit myself to one organ or system or disease. In reality I loved the theater, the stories, the staff; never knowing what the day, the night or the ambulance would bring. I love the variety and the immediacy of it all. As a medical student,

November / December 2015

I rotated through one of the early EM residencies at the Medical College of Pennsylvania. Jerris Hedges was my resident; Jim Roberts was my staff. As an intern, a month at San Francisco General’s Mission Emergency (at the time an old-school county hospital and trauma center, with no hint of emergency medicine presence) sealed the deal. As my career progresses, I realize that now my favorite part is the daily challenge of problem solving: e.g., there are three elderly patients in my beds. Each one is “weak and dizzy” with marginally normal vital signs. One will go home, one will go to the ICU and one will require all of my skills to diagnose, treat and disposition.

“In reality I loved the theater, the stories, the staff; never knowing what the day, the night or the ambulance would bring.” As part of emergency medicine for 30+ years, have you had any mentors or peers who shaped your thinking? Mentors (along with the most supportive wife in the world) have been extremely important in shaping my life. I came to college as an English major. After my first psychology course I was offered a job by Professor Kenneth Brookshire as a research assistant, startling rats with loud noises. I became hooked on

research by his excitement in discovery, the challenge of attempting to find definitive answers to scientific questions and by the camaraderie amongst his team of nocturnal research assistants. In emergency medicine, I was privileged to work for and learn from one of the founders of our specialty, Col, (Ret.) Barry W. Wolcott, an internist. He started the military’s first EM residency at Brooke Army Medical Center and the Section of Operational and Emergency Medicine at the Uniformed Services University of the Health Sciences. Wolcott fathered algorithm-directed emergency department triage, was an early member of the Residency Review Committee in Emergency Medicine, and was the only internist on the National Faculty of the American College of Surgeons Committee on Trauma overseeing the initial expansion of ATLS. He also served on the editorial board of the Journal of the American College of Emergency Physicians as it transitioned to the Annals of Emergency Medicine and served as President of The University Association for Emergency Medicine (UA/EM— SAEM’s predecessor) in 1982. His coaching, involvement, and example in administrative medicine got me through the escalating administrative tasks given to the first trained and certified EM physicians in the Army. Barry had a lot of great medical and administrative aphorisms that I continue to follow and quote. The best was on his business card as Hospital Commander at West Point. It read: “If it’s stupid, it’s not our policy.”

“If it’s stupid, it’s not our policy.” What is your favorite part of your job? What is the hardest? Favorites: Solving patients’ problems (the “thank you” that sometimes follows is a bonus). Little kids without an emergency. Saying, “That’s interesting” to myself at least once a shift. Learning (or relearning) something every day. Having a resident or graduate say, “I remember what you said.” Hardest: The failures to reverse a tragic course. Breaking the news. Dealing with “If only …” for my patient, their family or myself. How has emergency medicine changed? Except for the patients, the smells, the sounds and the presence of terrific nurses who keep us straight, EM is pretty much unrecognizable compared to when I started. There was no EMTALA, 24-hour staff coverage, textbook of emergency medicine, trust or respect. An “amp” of epinephrine came with a 3” needle for direct intracardiac injection, SVT was treated with IV neosynephrine and the “cardiac arrest tray” held a rib spreader, epi and a #10 scalpel. My two-year residency was co-chaired by a surgeon and an internist. Staff supervision was during business hours. I learned all the other specialties’ content from rotating on their services. I was the first and only residency-trained emergency physician in the EM residency program I was sent to staff.

We saw 120,000 patients per year and ran a residency with a teaching staff that could best be described as “one each”: internist, surgeon, family physician, pediatrician and me. In my earliest civilian ED experiences I was often relieving or signing out to the moonlighting gynecologist or dermatologist.

“…EM is pretty much unrecognizable compared to when I started.” You were a military emergency physician and now teach at a military emergency medicine residency. What benefits have you gotten out of that opportunity? My career has come full circle; I began teaching emergency medicine in a military residency program immediately after my residency, and I am finishing my career doing the same. In the first job, I had the opportunity to influence the development of emergency medicine in the Army, working to ensure the quality and viability of our training programs, while attempting to define the role our new specialty played. In July of 1985 there were just 69 emergency physicians on active duty in the Army; 57 were residency-trained. Twenty of those had just graduated. It was time for emergency physicians to be taught by emergency physicians, so most were needed to staff our (then three) EM residencies. The rest went to the busiest military community hospital EDs, where they were the only trained emergency physicians, tasked with safely and efficiently running departments staffed with doctors of widely varying training and experience.

“It was time for emergency physicians to be taught by emergency physicians” A huge benefit of my military service was the opportunity to gain administrative experience. Rapid transition from military EM resident to responsible ED administrator was the norm. The development of emergency physicians as administrators evolved like our growth on the clinical side, from the same unmet needs for professional emergency care that created the specialty. My example (going from residency grad to academic department chair and Emergency Medicine Consultant to the Army Surgeon General in two years) would never happen in civilian programs, even then. Rapid administrative advancement still seems a big difference versus civilian programs. Much of that comes from the turnovers, deployments and job changes necessary for the mission or career advancement that are inherent in military medical practice. When my civilian contemporaries were starting out, if you wanted to be a department chair or residency director you had to wait for someone to die or retire, start your own program or (in private practice) steal someone’s contract. In the military, you only have to wait for the boss to be reassigned or get out. Many military EM graduates have gone on to significant administrative careers in and out of the services, as department chairs, program directors, generals, admirals, deans, etc.

November / December 2015

The benefits from my current practice, training Navy EM residents, have been transformative. My residents and fellow staff have taught me way more than I have to offer them. The single most engaging hour in my over 40 years of medical education was presented by a colleague returned from a Role 3 hospital in Afghanistan. The topic: Battlefield Medical Ethics. A close second was the talk on traumatic brain injury that began with a video of the speaker sustaining his own TBI as an IED impacted his vehicle on an Afghan highway. There are no civilian equivalents for the challenges for which our military programs must prepare residents. Our women and men practice trauma resuscitation in the back of an armored “mobile trauma bay,” wearing body armor in 100+ degree heat, trailing 100 meters behind the Marines as they engage the enemy. With the most common lethal injury being IED-associated multiple amputations and related intra-peritoneal injuries, the “Golden Hour” shrinks to minutes. If the docs and other providers aren’t right there with them, the wounded are way less likely to go home. The Navy emergency physician describing his practice to me had saved all 15 of the Marines he had seen with those injuries. He carried pictures of one of those men, competing in a race, running on bilateral prostheses.

“There are no civilian equivalents for the challenges for which our military programs must prepare residents.”

Did your military background help you in community practice? How? I mention the invaluable administrative exposure above. Without that I don’t think I would have landed my first civilian job as the director of a very busy, high-quality ED. Practicing within the military medical system in those crucial post-residency years had a big impact on my clinical skills. I could develop my personal practice patterns without compromise. There are few financial, organizational or social constraints on getting my patients what they need. I learned how to optimally manage care without having to alter diagnosis and treatment plans for considerations beyond the medical (financial, access to care, lack of social supports, homelessness, etc.). I could later apply that knowledge to the often-narrower range of options available to my much more diverse community hospital patients.

November / December 2015

You have been a member of SAEM for a long time, serving as a reviewer for Academic Emergency Medicine and on the Membership Survey Task Force. Why did you join SAEM? And why did you get involved? I started practicing two years after ABEM recognition and 13 years after ACEP was founded. As members of medicine’s newest specialty, emergency physicians had to stick together. We were in daily conflict between our paradigms and those of the traditional specialties. We even fought over what our workspace was called (“ER” vs. “ED”). In order to earn respect and credibility, we needed political and professional representation (only ACEP at that time) and also academic and scientific standing within the “house of medicine.” We had University Association for Emergency Medicine (UA/EM) meetings to present and learn the science of our emerging specialty, and the Society of Teachers of Emergency Medicine (STEM) meetings (held jointly with UA/EM) to teach us how to pass that knowledge along. SAEM was formed from those two in 1989. These three organizations formulated the research agendas, organizational principles, practice management techniques, government relations and relations with the rest of the house of medicine—the basics of a new medical specialty. Not to be a part of that process would be to leave our fate to others. I cannot stress enough how important the SAEM Annual Meeting and the friends and connections I made there were to the quality of my 24 years of high-volume, high-acuity community hospital practice. Plus, the meetings have always been great fun. As testament, since I began going to UA/EM, STEM, then SAEM meetings after residency, I only recall missing one (no offense to Cincinnati). You can meet, talk, argue, and share a drink with the brilliant (and extremely interesting) leaders of our specialty. Friendships formed there are rekindled yearly and form the basis for much joyful networking. I have been in academic EM for a third of my career. In my years of private practice, SAEM membership and meeting attendance kept me in touch with many who shape our specialty and kept me apprised of the latest and best evidence-based medicine for my practice. One of my current goals is to attract more military emergency physicians to the organization.

“I cannot stress enough how important the SAEM Annual Meeting and the friends and connections I made there were to the quality of my 24 years of high-volume, high-acuity community hospital practice.” What do you do in your free time? My wife of 46 years and I delight in our incredible extended families. We have no kids, but there are four to five dozen relatives and children of friends (ages two–58) who call us “uncle” and “aunt.” Our joy is spending time with them. We also enjoy theater and regional lecture series. I volunteer at our local free clinic and have served on its board.

How do you manage work and life stress? I have been blessed with great jobs, great personal and professional relationships and terrific coworkers. For personal stress: Count those blessings you have and focus on them. For work stress: Be self-aware. Consider mindfulness or other similar techniques to identify stressors as the source of unspecified unease or imbalance in your life. Exercise, work/life balance, health maintenance, the science of “wellness”—all should come naturally to physicians, but often don’t. Try harder. For professional stressors (e.g., academic or administrative progression), learn to say no. If you are reading this, you are competent, accomplished and capable of doing more. A very successful friend of mine says the best professional advice I ever gave him was: “Just because you can, or just because they ask, it doesn’t mean you have to say ‘yes’”. If you weren’t a physician what would you do? Try to become a physician.

hospital emergency physician, alone, in the middle of the night, managing whoever comes in the door. That “gold standard” physician should be your product. To department chairs and program directors: don’t underestimate the value of bringing teachers into your program from that community hospital experience. There is a long tradition of keeping your best residency graduates. Share them with other programs instead; inbreeding can stifle innovation. Value new perspectives, new ideas and real-world experience. We are the broadest specialty; keep it that way. To SAEM, be more inclusive: Reach out to emergency physicians outside the academic centers. I never came back to my partners from an SAEM meeting without something new to inform and improve our practice and benefit our patients. Include military emergency medicine in your educational and research collaborations. The contribution of military emergency physicians to basic and clinical trauma research has been long-standing and transformative. The Department of Defense has put considerable effort and much financial support into research for trauma, but also for areas like suicide, substance abuse, PTSD and traumatic brain injury. Almost all of these large and well-funded studies involve collaboration with civilian institutions. Unique research opportunities abound. Where else could you compare interventions on two demographically equal populations, each with over 5000 potential subjects, with 100% capture and 100% follow-up? (Think two simultaneously deployed aircraft carriers.) Are there any final words you wish to share? I am flattered and grateful for the opportunity to address the membership of an organization I have valued for my entire career. I am incredibly proud to be an ER doc, a teacher of military emergency physicians and an SAEM member. Keep up your good work. Continue to expand our knowledge and skills. Continue to teach me and those who follow.

What would you say to someone interested in emergency medicine today? The same thing I said in 1992: “Our work is occasionally thrilling, often repetitive, quite frequently sad, sometimes dangerous, generally described as stressful, and on occasion incredibly rewarding. We are perhaps America’s greatest source of unquestioned and unquestioning care for the poor. The acutely ill and injured need us desperately, every hour of every day. No one who comes to the door of any ED needing our services fails to receive our best efforts.” If that appeals to you, join the team.

“No one who comes to the door of any ED needing our services fails to receive our best efforts.” To physicians specifically interested in academic emergency medicine I would say the following: Remember that the vast majority of emergency medicine is practiced outside academic centers. Teach to what Carey Chisholm called the gold standard of emergency medicine: the community

Kenneth Frumkin, Ph.D., MD, FACEP is currently a staff physician in the Emergency Medicine Residency Program at Naval Medical Center, Portsmouth, Virginia. After obtaining a Ph.D. in physiological psychology from McGill University and serving as a researcher in the U.S. Army’s Biomedical Laboratories toward the end of the Vietnam War, Dr. Frumkin attended Hahnemann Medical College. He completed a flexible internship, then the EM residency at Brooke Army Medical Center followed by five years at the Madigan Army Medical Center Residency Program. After two decades of community emergency medicine practice, he returned to teaching military EM residents in 2008. Dr. Frumkin can be reached at kenneth.frumkin.civ@mail.mil.

November / December 2015

Multiple Approaches to Understanding & Preventing Elder Abuse: Synopsis of an NIH Workshop By Tony Rosen, MD Christopher Carpenter, MD, MSc Jeremy Brown, MD and prevention of elder abuse. Participants also included government officials, policy-makers, funders, and legislative advocacy groups. A committee of NIH scientists from several institutes planned the workshop, including Dr. Jeremy Brown, an emergency physician who leads the Office of Emergency Care Research.

Epidemiologic research suggests that elder abuse and neglect are common and have serious consequences but are under-recognized. As many as 5-10% of U.S. older adults experience elder mistreatment each year,1-6 with victims have dramatically increased mortality and morbidity.7-9 Elder mistreatment includes physical abuse, sexual abuse, emotional / psychological abuse, neglect, financial exploitation, and abandonment.1,5,6 Unfortunately, fewer than 1 in 24 cases of elder abuse are identified and reported to the authorities.1,5 Emergency department (ED) assessment represents a critical but often missed opportunity to identify elder abuse, as medical evaluation for acute injury or illness is frequently the only non-family contact available to isolated older adults.10,11 The SAEM-endorsed Geriatric Emergency Department Guidelines recommend further evaluation by emergency personnel when elder abuse is suspected, but the screening tools, resources, and implementation strategies to effectively address this public health crisis remain largely undefined.12-15 Interest in improving understanding of elder abuse and care for these vulnerable older adults has been increasing among researchers and policymakers. Elder Justice was one of the four topic areas focused on during the 2015 White House Conference on Aging. The Centers for Disease Control and Prevention recently announced plans to release uniform definitions and recommended core data elements for use in elder abuse surveillance. On October 30, 2015, the National Institutes of Health (NIH) hosted a one-day workshop of leaders in nursing, medicine, social work, and public policy focused on interpersonal violence and gerontology to improve the understanding

November / December 2015

The workshop consisted of three panel discussions and work groups. The first panel discussed screening and identification of elder abuse and included presentations by emergency physicians and SAEM Academy for Geriatric Emergency Medicine (AGEM) members Dr. Tony Rosen and Dr. Chris Carpenter. Dr. Rosen discussed his ongoing work in identifying injury patterns suggestive of physical elder abuse in comparison to accidental falls among ED patients. Dr. Carpenter discussed his work in implementation science within geriatric emergency medicine. Researchers from intimate partner violence and child abuse also offered insights on how research in their areas might inform elder abuse screening. They focused on opportunities for collaboration and possible paths forward so that elder abuse researchers do not “re-invent the wheel.” The second panel focused on the history and current state of elder abuse research and its relation to other types of interpersonal violence. Panelists discussed the importance of incorporating improved understanding of sub-types of victimization (which may have very different characteristics and risk factors) and poly-victimization (when an individual is a target of many different kinds of victimization at the hands of a variety of offenders) into elder abuse research. They debated the value of funding additional large-scale elder abuse population prevalence studies and emphasized the importance of focusing research on interventions for prevention and mitigation, for which little evidence exists. The third panel focused on research strategies surrounding intervention and prevention strategies. Child abuse experts reported on the success of “effective parenting” programs, which include social support, to prevent child abuse but emphasized that fewer effective interventions exist to prevent child abuse after it has occurred. Intimate partner violence researchers reported that successful interventions typically involve multiple integrated programs targeted to a broader community. Elder abuse researchers reported on the preliminary successes of multi-disciplinary teams which work together to develop solutions to challenging cases. Also discussed were novel methods to measure success of an intervention in elder abuse, particularly for victims who are cognitively impaired, such as goal attainment scaling.

Table 3

During lunch, attendees split into four work groups to discuss critical aspects of improving understanding and prevention of elder abuse:

Risk Factors of Diminished Cognitive and Decisional Capacity – Research Priorities

• Health disparities and cultural dimensions of research

• Understand the trajectories of decisional capacity and individual differences

• Preventing mistreatment in familial environments

• Differentiate cognitive/decisional deficits from other sources of deficit (sensory impairment, mood disorder) and consider their interactions

• Risk factors of diminishing cognitive and decisional capacity • Bioethics and law in elder abuse During the afternoon, these work groups reported back to all attendees with a synopsis of their discussions and most compelling research issues.

(interventions for the “delicate conversation”)

• Provide education and training on the assessment of diminished capacity among the full range of professionals who work with older adults

Table 1 Health Disparities & Cultural Dimensions of Abuse – Research Priorities

(adult protective services investigators, police, bankers, lawyers, and medicine)

• Recognize the value of qualitative research • Longitudinal studies on elder abuse with under-represented populations • Derive measures that work across cultures • Under-represented groups need foundational research to establish a baseline Table 1 summarizes the key research priorities identified by the “health disparities” group. Attendees recognized that randomized controlled trials were unlikely to occur in the field of elder abuse and advocated for more research funding to support qualitative research that better defines the epidemiology of elder abuse in multiple under-represented populations. Additionally, participants recognized that cultural norms differ and that critical to the field was identifying measurable boundaries whereby cultural discrepancies in treatment of older adults cross into undoubted abuse.

Table 2 Preventing Mistreatment in Familial Environments – Research Priorities • Fund the “so what” outcomes research consistently • Evaluate types of interventions that are effective, including cost-analysis of intervention vs. non-intervention

• Develop and translate processes and steps for professionals interacting with older adults where there is a concern of diminished capacity or where abuse is suspected

• Evaluate victimization sub-types and poly-victimization Table 2 summarizes key research priorities from the “familial environment” breakout group, which noted that funders must consistently support research that evaluates factors, such as characteristics of the community that other forms of research devalue or underemphasize. In addition, future cost-analyses should evaluate the financial implications of non-intervention. Finally, definitions for victim sub-types and poly-victimization are needed to fully understand the short- and long-term consequences of elder abuse on the family unit and individuals within the family longitudinally.

• Evaluate how social capacity changes and affects decisional capacity and risk of elder abuse • Study how appreciation of impairment changes and factors that affect that change Table 3 contains the key research issues identified by the “diminished cognitive and decisional capacity” breakout group. The first priority was to describe the trajectory of decisional capacity decline in various sub-types of neurodegenerative disorders and the recognition of inter-individual differences in decline in decision-making capacity. Also emphasized was emerging understanding of important differences between cognitive impairment and decisional capacity that will need to inform interventions surrounding financial exploitation. One attendee highlighted the importance of sensory impairment (in particular, hearing impairment) in potentially increasing vulnerability and emphasized that elder abuse researchers will need to fully describe cognitive and non-cognitive patient factors that can increase the risk of elder abuse. Ethical and feasible mechanisms to initiate conversations about elder abuse are needed for diverse settings such as the medical clinic and ED. Increasing awareness about the problems of elder abuse by non-medical professionals in banking, law enforcement, and prosecution will be essential to establishing broad, sustainable recognition of the various sub-types of elder abuse.

Table 4 Bioethics & Law – Research Priorities • Include victims and all involved shareholders in elder abuse research, including IRBs

• Communicate the importance of the elder abuse problem to a wide range of constituencies • Create an ongoing community of researchers and practitioners who meet regularly and support one another • Explore the possibility of guidelines for elder abuse research with regard to IRBs

November / December 2015

Table 4 provides a synopsis of research issues identified in “bioethics and law” by that breakout group. The group recognized the unique ethical and legal challenges of conducting research in elder abuse victims, who are vulnerable both because they are crime victims and because, in many cases, they have advanced cognitive impairment that precludes consent to participate. The breakout group emphasized that educating Internal Review Boards about the importance of elder abuse research and identifying ethically safe research methods in this challenging area is essential. They suggested that increased collaboration, including regular meetings of researchers and practitioners, similar to the network developed by the Alzheimer’s Disease Research Centers, would accelerate the science of elder abuse and allow novel solutions to methodological, bio-ethical, and legal challenges to be shared between researchers.

2015;373:1947-56.

The workshop concluded with a summary and discussion of important next steps. Experts emphasized the importance of:

12. Rosenberg M, Carpenter CR, Bromley M, et al. Geriatric Emergency Department Guidelines. Ann Emerg Med 2014;63:e7e25.

• collaboration

13. Carpenter CR, Bromley M, Caterino JM, et al. Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine. Acad Emerg Med 2014 21:806-9.

• incorporating knowledge, experience, and research techniques from other types of inter-personal violence • developing research to improve understanding of elder abuse and, most importantly, to identify interventions for prevention and mitigation Many participants discussed the potential value of developing multiple national research centers to facilitate achieving these goals. Organizers and participants also expressed an interest in developing several “state of the science” papers from this workshop to be published in the coming months in the Journal of Elder Abuse and Neglect and other journals.

7. Dyer CB, Pavlik VN, Murphy KP, Hyman DJ. The high prevalence of depression and dementia in elder abuse or neglect. J Am Geriatr Soc 2000;48:205-8. 8. Lachs MS, Williams CS, O'Brien S, Pillemer KA, Charlson ME. The mortality of elder mistreatment. JAMA 1998;280:428-32. 9. Dong XQ, Simon MA, Beck TT, et al. Elder abuse and mortality: the role of psychological and social wellbeing. Gerontology 2011;57:549-58. 10. Bond MC, Butler KH. Elder abuse and neglect: definitions, epidemiology, and approaches to emergency department screening. Clin Geriatr Med 2013;29:257-73. 11. Heyborne RD. Elder abuse: keeping the unthinkable in the differential. Acad Emerg Med 2007;14:566-7.

14. Fulmer T, Guadagno L, Bitondo Dyer C, Connolly MT. Progress in elder abuse screening and assessment instruments. J Am Geriatr Soc 2004;52:297-304. 15. Platts-Mills TF, Barrio K, Isenberg EE, Glickman LT. Emergency physician identification of a cluster of elder abuse in nursing home residents. Ann Emerg Med 2014;64:99-100.

References 1. Acierno R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study. Am J Public Health 2010;100:292-7. 2. Lachs MS, Pillemer K. Elder abuse. Lancet 2004;364:126372. 3. Under the Radar: New York State Elder Abuse Prevalence Study: Self-Reported Prevalence and Documented Case Surveys 2012. Available at: http://ocfs.ny.gov/main/reports/Under%20 the%20Radar%2005%2012%2011%20final%20report.pdf. Accessed November 27, 2015. 4. Bonnie J, Wallace RB, eds. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington, DC: National Academy of Sciences Press; 2003. 5. National Center for Elder Abuse. The Elder Justice Roadmap: A Stakeholder Initiative to Respond to an Emerging Health, Justice, Financial, and Social Crisis. Available at: http://ncea. acl.gov/Library/Gov_Report/docs/EJRP_Roadmap.pdf. Accessed November 27, 2015. 6. Lachs MS, Pillemer KA. Elder Abuse. N Engl J Med

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About the Authors: Tony Rosen, MD MPH, is a Geriatric Emergency Medicine Fellow and Instructor in Medicine, Division of Emergency Medicine, Weill Cornell Medical College, Cornell University Christopher R. Carpenter, MD, MSc, FACEP, AGSF, is Associate Professor of Emergency Medicine at Washington University in St. Louis School of Medicine; PresidentElect of AGEM, Chair of the SAEM Evidence Based Healthcare & Implementation Interest Group; and Deputy Editor-in-Chief, Academic Emergency Medicine Jeremy Brown, M.D., is director of the NIGMS-housed Office of Emergency Care Research, where he leads efforts to communicate about and coordinate emergency care research funding opportunities across NIH. He also serves as NIH’s representative in government-wide efforts to improve emergency care throughout the country.

Academy for Diversity & Inclusion in Emergency Medicine

Resident Perspective: Reflecting on Residency Interview Experiences as a Black Male in Emergency Medicine By Joffre Johnson, MD This article was published with permission from the Fall 2015 issue of the ADIEM Newsletter, a publication of the Academy for Diversity & Inclusion in Emergency Medicine. For more information about ADIEM, visit Academies at www.saem.org or visit the community page.

In August, the AAMC published an excellent article addressing the decrease in the number of black males applying to U.S. medical schools from 1978 to 2014 titled, “Altering the Course: Black Males in Medicine.” As a black male, I was overjoyed to see a topic that I have discussed with many of my friends and colleagues gain national awareness. I would encourage everyone to read it. This article inspired me to look into some of the AAMC match data from 2014, the year I matched into Emergency Medicine. Out of 2116 EM residency applicants from U.S. medical schools (including osteopathic institutions), only 198 identified as black or African American. The gender breakdown of applicants by ethnicity is not readily available from the AAMC’s posted data, but with an applicant pool of just 9.3%, it is safe to say that the overall number of black matriculants, let alone black male matriculants, into EM residencies leaves much to be desired. After looking at this data, I began to reflect on some of my own experiences on the interview trail. My CV and personal statement were full of sentiments expressing my desire to work with underserved populations and the importance of inspiring underrepresented minorities to pursue careers in medicine. These topics invariably led to lively discussions during my residency interviews. I would question the more homogenous programs about their plans and efforts to address increasing diversity within their ranks. More often than not, I would be met with the same response:

“Out of 2116 EM residency applicants from U.S. medical schools, only 198 identified as black” The chair of one program even stated, “I’ll be honest with you. I wish we had more brown people in our program. I have a significant demographic of patients from the West Indies that I feel at times is grossly underserved simply due to the fact that we don’t look like them, creating a barrier in our interactions at the most basic level.”

In return, sometimes interviewers would ask me, “Do you think you would be comfortable here as the only black person (person of color, etc.—pick your variant)?” Considering that I was one of 12 black people out of a medical school class of 186 that was predominately white, this question felt almost insulting to me. However, I can’t say I was genuinely surprised. These programs seemed to have a problem with attracting diverse residents from underrepresented backgrounds and were trying to address the issue in a matter-of-fact way. Furthermore, as an applicant, I perceived that programs that had a strong commitment to diversity didn’t really have problems attracting a heterogeneous population of residents year after year.

“In order to increase the number of black males within emergency medicine, we must first increase the number of black male medical school applicants.” Hence, here is the crux of the matter. In order to increase the number of black males within emergency medicine, we must first increase the number of black male medical school applicants. I hope my brief reflections will help foster discussions and encourage even greater recruitment efforts within your own institutions. This same philosophy can be applied to all underrepresented groups within medicine. By doing so, we can foster an even greater cultural exchange within the medical school classroom in order to help create more culturally competent physicians.

About the Author:

Joffre Johnson, MD, is a second-year emergency medicine resident at the University of Chicago and ADIEM member.

November / December 2015

ETHICS ON CALL Give It a Shot: Communicating with Parents Who Don’t Vaccinate By Naomi Dreisinger, MD, MS It is a summer afternoon in the Pediatric Emergency Department (PED). The weather is perfect outside, and it seems that patients are taking advantage of this, because the PED is quite calm. A seven-year-old boy is brought in by his mom after sustaining a laceration while skateboarding on the playground—a typical summer day complaint. You enter the room, examine the patient, and begin the general history-taking process. As you attempt to fly through the usual questions of past medical history, allergies and immunizations, you are stopped dead in your tracks when the mom replies, “No, she is not immunized.” Although it is not uncommon to see patients in the PED that are not fully immunized, your initial reaction is always one of surprise. Upon completion of the history and physical exam you exit the room. What should your approach be for this patient who has sustained a dirty wound yet never received a tetanus shot?

“As you attempt to fly through the usual questions of past medical history, allergies, and immunizations, you are stopped dead in your tracks when the mom replies, ‘No, she is not immunized’.” 14

November / December 2015

In medicine we are taught that individuals have autonomy to make their own decisions. At times, decisions made by patients are different than what their doctor would recommend. Autonomous individuals have the right to hold views, make choices and take actions based on their personal values and beliefs. The main caveat of this concept is that for patients to make an autonomous decision, they must possess decisionmaking capacity. A pediatric environment is different from the norm in that the patient does not have the capacity to make decisions. Parents are considered to be their children’s legal surrogates; this is because it is generally presumed that parents will act in the best interests of their children. The concept that an individual would and should act in the best interest of those for whom they care is called the best interest standard. Broadly speaking, this means that the individual who is making a decision—in this case the parent— would make that decision based on maximizing the well-being of their child while minimizing risks, pain, suffering and loss of function. Being a parent can be a very emotional role. It is understandably difficult for parents to see their child experience anguish, and most parents do not want to bring about suffering in their child. Unfortunately, vaccines hurt. The needle used to immunize causes actual pain; but with immunizations, parental concern goes beyond pain. Parents have become fearful of vaccines because of potential side effects that have been sensationalized and misrepresented by the media.

“The needle used to immunize causes actual pain; but with immunizations, parental concern goes beyond pain.” Pediatricians are seeing increasing numbers of unvaccinated children, and in some communities, deferring vaccination is considered the norm rather than an exception. It therefore behooves the pediatric provider to develop a plan and be ready to interact with these patients and their parents. As pediatricians we make an effort to be empathic of the feelings of both children and adults. We try to explain clearly the medical needs of children so that parents understand the logic behind painful procedures and treatments, but there are times when a medical need must override parental request. The problem lies in identifying and dealing with these cases. Pediatricians encounter many situations in which they might question the decision of a parent. We employ our communication skills to help the parent understand the logic of a recommended treatment, yet sometimes even in the office of a pediatrician who has an established relationship with a family, communication skills fail. Perhaps it is not failure on our part, but the strength of the media, unexplained fears, or the depth of a religious viewpoint that does not allow a parent to comprehend the importance of recommended medical care. Imagine, then, what might happen in an emergency room. The physician has a very limited relationship with both patient and family, yet it has become this doctor’s responsibility to make them grasp the importance of a particular treatment. This can be very difficult to accomplish. What is the right approach to these types of situations? In the PED, parents are often resistant to certain procedures or treatments. Physicians in the PED often bargain their way through a procedure, trying to help parents understand the need and logical reasoning behind its necessity. Would it be possible to use this type of reasoning with a parent who is objecting to a tetanus shot? Logical and empathic reasoning may work with some families, yet often families that have chosen not to immunize remain firm. The doctor in the PED is then stuck. What is the right approach?

“Physicians in the PED often bargain their way through a procedure” An unimmunized patient with a dirty wound must receive both tetanus immunoglobulin and tetanus vaccine, but a delay of up to 72 hours is considered acceptable. Although the ideal situation would be immediate treatment in the PED, often this complex situation calls for a discussion with the family’s primary care physician and follow-up for treatment the next day.

The Pediatric Emergency Department is a stressful environment, and having a child with a wound causes extreme discomfort in many parents—not the optimal situation for reconsidering their position on vaccination. Interaction with a child’s pediatrician is often the best route to gaining trust with an unwilling family. As PED providers, our initial response to a child missing or lacking immunizations may be exasperation, but it is our job to confront this dilemma constructively, for the best care of our patient.

About the Author:

Naomi Dreisinger, MD, is the Director of the Pediatric Emergency Department at Mount Sinai Beth Israel in Manhattan. She has served in this capacity for the past 12 years. While there she has been instrumental in the development of a focused program in pediatrics in the ED.

New Orleans

2016 SAEM Annual Meeting Educate The Mind, Entertain The Soul

May 10-13 November / December 2015

FELLOWSHIP GUIDE Fellowships in Emergency Medicine: A Guide to Choosing Which One’s Right for You By Ashley Deutsch, MD

More opportunities than ever now exist for emergency medicine residents who want to gain specialized training through fellowships after residency. While this is great news for residents everywhere, it can also make choosing and applying to a fellowship confusing. Emergency medicine residents often have wide and varied interests, which is why understanding what each fellowship track entails, as well as how much flexibility each individual fellowship program offers, is the key to determining which fellowship is the right fit for you.

Administration Administrative fellowships are a newer option offered to emergency medicine graduates, and therefore vary widely from institution to institution. For graduates interested in getting their MBA and understanding the ins and outs of the business of emergency medicine, this is a great option. Programs are non-ACGME accredited and usually vary between 1 and 2 years. Responsibilities also vary greatly. There is no defined timeline for all applications to administrative fellowships, so as soon as you decide you may be interested in an administrative fellowship it is important to contact individual institutions to determine their respective application process.

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Critical Care Critical care fellowships have just recently become more standardized. In general, there are three possible pathways to board certification and all apply equally to emergency physicians who have completed residency. Critical care fellowship applications can be complicated by the multiple pathways and it would be well worth the effort to find a mentor who has gone through the application process to help guide you.

“When considering an emergency medicine subspecialty, the sky’s the limit!” • Surgical Critical Care (SCC) The pathway most commonly used by emergency medicine residency graduates, the Surgical Critical Care pathway is run through the American Board of Surgery (ABS). Unlike their surgical colleagues, emergency medicine trained residency graduates will be required to complete a first year in advanced surgical residency followed by a second year in surgical critical care training. Board certification is

through the ABS. Applicants should contact individual programs to get a timeline of their application process and unique requirements, as not all applications are standardized. Most SCC programs use the NRMP to match in the fall of the year prior to the start of training. • Internal Medicine - Critical Care Medicine (IM-CCM) The IM-CCM pathway is a joint program between the American Board of Internal Medicine and the American Board of Emergency Medicine. An ACGME accredited fellowship training includes 1 year of clinical training and 1 year of research. These programs require that 75% of their fellows be internal medicine residency graduates, meaning only up to 25% may be emergency medicine trained. When applying to these programs it is well worth your time to investigate this ratio to make sure the program you want has a spot available for you. To be eligible for this fellowship, a resident must have 6 months of training in “direct patient care” in internal medicine, with 3 months in a medical ICU. Each program defines what “direct patient care” means, but usually this means rotations on internal medicine run services. Some fellowships allow fellows to complete this during the course of the fellowship. The ICCM has no formal match process. Usually applications are submitted in early fall and offers are made by the end of October, however each program operates differently. Contacting each program to understand their respective application processes and timelines is important. • Anesthesiology - Critical Care Medicine (ACCM) The ACCM pathway was designed primarily for anesthesiology residency graduates but can accept emergency medicine residency graduates. Traditionally this pathway for anesthesiology residents was 1 year long as it took into account prior anesthesiology training. This means that ACCM fellowship programs interested in training an emergency medicine graduate must apply to the American Board of Anesthesiology for prior approval of a 2-year training curriculum specifically for emergency medicine graduates. The first year of this training involves rotations on primary surgical services. It is very important to know if a program you are applying to has obtained this prior authorization as it requires great effort on their part. To be eligible for this fellowship, applicants are required to have completed 4 months of critical care training while in residency. The application process is more accelerated than for the other pathways through the “San Francisco Match.” There is a common application, and interviews usually take place the winter before your start in July and rank lists are due in May.

Education For emergency medicine graduates interested in expanding their teaching skills, learning how to conduct education research, or eventually becoming residency

assistant program directors and program directors, education fellowships offer many opportunities. Like many emergency medicine fellowships, education fellowships vary widely from institution to institution in responsibilities and expectations of the fellow. Some programs combine SIM training with the education fellowship; others use the fellow as their associate program director. Some are 2 years and include a master’s degree program (ranging from a master’s degree in public health to a master’s degree in education); others are 1 year in length and focus on teaching within the individual program. The application process is similarly variable and individual institutions should be contacted to understand their respective processes and timelines.

“Emergency medicine is an exciting field because it is so varied and applicable to many medical subspecialties.” Emergency Medical Services An emergency medical services fellowship offers graduates who are interested in pre-hospital medicine an opportunity to learn about EMS and the responsibilities of a medical director. Fellows often are involved in pre-hospital medicine research and in training local EMS services. In depth review of EMS protocols as well as coordination between prehospital and in-hospital services are cornerstones of these fellowships. In order to obtain an EMS certification from the American Board of Emergency Medicine, a fellow has one of two pathways. If a fellowship is ACGME-accredited, a certification from ABEM will be granted through the “EMS Fellowship Training Pathway.” If a fellowship is not ACGMEaccredited, it can be granted a certification through the “EMS Practice-Plus-Training Pathway.” This pathway requires the unaccredited fellowship, as well as 24 months of EMS practice, totaling at least 400 hours per year. “EMS practice” includes working as an assistant medical director, associate medical director, medical director, or in another leadership role within EMS, or providing direct pre-hospital care.

Global Emergency Medicine Also known as “international emergency medicine,” global emergency medicine programs offer graduates the chance to learn about health care in different countries. Knowing what particular part of the world you want to practice in will help inform what fellowships you choose to apply to, as many programs have specific connections that allow them to send fellows to various health care systems around the

November / December 2015

world. These fellowships tend to be flexible with both time and location, offering part time practice at their home institutions and part time practice in foreign countries. Application processes are similarly varied, and individual institutions should be contacted for specifics.

Pediatric Emergency Medicine Specializing in pediatric emergency medicine can mean expanding skills not used frequently during residency training and can help make a physician increasingly marketable in both academic and community institutions. All pediatric emergency medicine fellowships are a minimum of 2 years of training for emergency medicine residency graduates, with some fellowships encouraging an additional third year. Some allow moonlighting at their or other institutions in the adult emergency department to help fellows keep skills fresh. Knowing how much time is available for moonlighting and research will help potential fellows understand what additional work might be needed to keep adult emergency medical knowledge up to date. Pediatric emergency medicine fellowships participate in the ERAS application process and match in the fall prior to the fellowship start date.

Research For those residency graduates interested in furthering the field of emergency medicine through research, a research fellowship can help advance these goals. Research fellowships are typically 2 years and include a master’s degree in either clinical research or a Masters of Public Health in Epidemiology/Biostatistics. This training solidifies a fellow’s knowledge on how to conduct and evaluate clinical research. In addition to gaining a master’s degree, fellows conduct research within their institutions. Individual institutions should be contacted regarding their unique application process.

Simulation Simulation fellowships offer applicants the chance to learn how to effectively teach by way of using medical simulation and cutting edge technology. Located in academic centers with extensive simulation facilities, fellows use medical simulation to teach residents, students, and faculty in real-time. A mix of education and technology, simulations allow hands-on demonstration of rare emergent conditions. Applications are not standardized, and interested graduates should contact institutions directly to learn about their specific application process.

Toxicology Medical toxicology fellowships train fellows on the diagnosis and management of poisoning. Training by board certified medical toxicologists provides fellows with education in the pharmacology and management

November / December 2015

of drugs, environmental poisons, and biological agents. Toxicology fellowship is not limited to emergency medicine residency graduates, but does not have special requirements depending on residency specialty. The match process is controlled by the NRMP, with a match day in November of the year prior to the fellowship start. Toxicology fellowships are 2 years in length.

Ultrasound One of the most popular fellowships currently, emergency ultrasound fellowship is intended to train fellows in the use of bedside ultrasound to answer specific clinical questions and to perform targeted procedures. Ultrasound fellowship graduates have gone on to train faculty in ultrasound at other institutions, run ultrasound teaching programs in academic facilities, or simply add this useful skill to community institutions that wouldn’t otherwise have accredited faculty. Research in the field of emergency ultrasound is relatively new and rapidly increasing. Applications begin being accepted in August of the year prior to the start of fellowship and can be submitted through www.eusfellowships.com.

Wilderness Medicine Wilderness medicine fellows can expect the outdoors to be their classroom. With 11 fellowships around the country, fellows are given the chance to learn how to practice medicine with limited resources in outdoor environments. There is no standardized curriculum between fellowships, however most offer certification in Advanced Wilderness Life Support (AWLS) as well as training in search and rescue. Asking where past fellows have traveled to train and what certifications are available will allow applicants to gauge how a program aligns with their personal interests, as the field is quite expansive. Applications are through individual institutions, and interested graduates should contact these programs to better understand their application timelines. Emergency medicine is an exciting field because it is so varied and applicable to many medical subspecialties. Other fellowships that often accept emergency medicine residency graduates include hospice and palliative care, medical informatics, sports medicine, cardiovascular emergencies, undersea and hyperbaric medicine, disaster medicine, and many others.

About the Author:

Dr. Ashley Deutsch is Chief Resident Baystate Medical Center, Tufts University School of Medicine

DID YOU KNOW? Acute Coronary Syndrome: More than just sex differences in symptoms Academic, VA, and Community Opportunities

Academic, VA, and Community Opportunities

Located in beautiful Milwaukee, WI, the MCW Department ofMilwaukee, Emergency Medicine is growing! Located in beautiful WI, the MCW Department of Emergency Medicine is growing! Our ED at Froedtert Hospital is completing an expansion in January 2016, and we are increasing

Our ED at Froedtert Hospital is completing an expansion in January our daily physician coverage hours. We are recruiting for two faculty to complete our coverage. 2016, and we are increasing our daily physician coverage hours. The Department also seeks faculty who are interested in joining our Zablocki Veterans Affairs We Medical are recruiting twocomplement, faculty towhich complete our coverage. TheWe are Center (VA)for staffing will be initiated in August, 2015. Department also seeks faculty whotoare interested in joining our adding two positions to our faculty in order provide Monday-Friday, daytime coverage at the Zablocki Veterans Center (VA)a staffing complement, VA. Additionally, theAffairs FroedtertMedical Health System is opening free-standing ED at the Moorland which willHealth be initiated inare August, We Reserve Center. We recruiting2015. six faculty forare singleadding provider two coverage at this new positions to ED, ourtofaculty to provide Monday-Friday, daytime community be openedininorder July, 2016. All faculty members could have clinical responsibilities one orAdditionally, more of these sites. coverage at theat VA. the Froedtert Health System is opening a free-standing ED at the Moorland Reserve Health The Department of Emergency Medicine at MCW has nationally and internationally recognized Center. We are recruiting six faculty for single provider coverage experts in EMS and Disaster Medicine, Toxicology, Injury Prevention and Control, Cardiac at this new community to be opened in July,and 2016. faculty The Resuscitation, Global Health,ED, Ultrasound, Medical Education, ProcessAll Improvement. members could have clinical responsibilities at one or more of Department is ranked in the top 20 NIH funded departments of emergency medicine. these sites.applicants should submit a curriculum vitae and letter of interest to Dr. Stephen Interested Hargarten, Department Chairman and MCW Associate Dean, at hargart@mcw.edu.

The Department of Emergency Medicine at MCW has nationally and internationally recognized experts in EMS and Disaster Medicine, Toxicology, Injury Prevention and Control, Cardiac Resuscitation, Global Health, Ultrasound, Medical Education, and Process Improvement. The Department is ranked in the top 20 NIH funded departments of emergency medicine. Interested applicants should submit a curriculum vitae and letter of interest to Dr. Stephen Hargarten, Department Chairman and MCW Associate Dean, at hargart@mcw.edu.

DEPARTMENT OF EMERGENCY MEDICINE MASSACHUSETTS GENERAL HOSPITAL A Major Teaching Affiliate of Harvard Medical School

The Department of Emergency Medicine at Massachusetts General Hospital is seeking candidates for academic faculty positions. Special consideration will be given to those with an established track record in clinical or laboratory research and a commitment to excellence in clinical care and teaching. Academic appointment is at Harvard Medical School and is commensurate with scholarly achievements. MGH is co-sponsor of the 4-year BWH/MGH Harvard Affiliated Emergency Medicine Residency Program. The ED at MGH is a high volume, high acuity level 1 trauma and burn center for both adult and pediatric patients, and includes a 32-bed Observation Unit. The annual ED visit volume is ~108,000. The successful candidate will join a faculty of 48 academic emergency physicians in a department with active research and teaching programs, as well as fellowship programs in administration, research, global health, medical simulation, ultrasonography, and wilderness medicine. Candidates must have completed residency training in EM and have at least 4 years of training/experience.

By Lauren Walter MD, FACEP, FAAEM

While the most common symptom of acute coronary syndrome in both men and women is chest pain, women are more likely than men to present with non-chest pain symptoms, including nausea or ‘indigestion,’ fatigue or generalized weakness, and shortness of breath. Sex-specific details that explain differences in symptom presentation have emerged about anatomic and pathologic differences in the pattern of ischemic heart disease (IHD) between men and women. These include differences in coronary artery size, cardiovascular autonomic nervous system innervation, microvascular abnormalities, and atheromatous disease patterns. As sex-specific differences in IHD continue to emerge, additional research is needed to clarify the anticipated clinical implications regarding diagnostic testing and disease management in the emergency department. For further information and resources on Sex and Gender in Emergency Medicine, visit the SGEM Interest Group website at http://community.saem.org/communities1/ interestgroups1. Reference: Sanghavi M, Gulat M. Sex Differences in the Pathophysiology, Treatment, and Outcomes in IHD. Curr Atheroscler Rep (2015) 17:34.

Inquiries should be accompanied by a curriculum vitae and may be addressed to: David F. M. Brown, MD, FACEP, FAAEM Professor & Chair, Department of Emergency Medicine Massachusetts General Hospital, Founders 110 Boston, Massachusetts 02114 e-mail:

dbrown2@partners.org

Massachusetts General Hospital is an equal opportunity/affirmative action employer.

SGEM “Did You Know?” is a recurring SAEM Newsletter submission designed to present concise facts that demonstrate how patient sex and gender effect emergency care. We welcome submissions! Please send contributions to the Co-Editors Lauren Walter and Alyson J. McGregor at sgem@lifespan.org.

November / December 2015

Developing the Collaborative Networks That Are Key to Academic Success An interview with SIM Academy member-leaders, Drs. Michael Smith, Joshua Hui, and William Bond

What are some of Simulation’s successes over the last year? The Simulation Academy has many active and committed members, some of which have formed the nucleus for the recently accepted 2017 Consensus Conference in Simulation to be held at that year’s SAEM annual meeting. Many more will be involved in the breakout sessions and will submit papers for the consensus issue. The chairs of the conference are Bill Bond, Josh Hui, and Rose Fernandez. The academy has multi-institutional research collaborations ongoing around the EM milestones and a simulation fellowship curricular inventory. The consensus conference will seek to further develop the research network concept. Members submitted several sessions of didactic content to the SAEM didactic content at the AM and will do so again this year. Mike Falk has promoted a forum for fellows presentations during our simulation business meeting which was very successful last year and promises to be even more so next year. Lisa Jacobson, one of our past academy executive committee members, continues to lead SimWars The members have been able to do all of this while still being active academic faculty at their home institutions. What is Simulation’s goal for the upcoming year, what do you hope to accomplish? We want to help contribute to our members serving on the Consensus Conference planning committee, find innovative ways to recruit new members and engage them, and show the value of membership. Also, an EM-specific sim-based research grant for novice research is currently being finalized. Why should someone join the Simulation Academy? One of the most difficult tasks for any membership organization is to demonstrate value: “Why should I spend $100 on your academy?” The Simulation Academy is a group of very active, engaging, and inclusive members which offers several arenas for faculty development and academic progress. It’s very easy to network with members with any number of skill sets or expertise. We share curricular

November / December 2015

and assessment insights that can prevent young researchers and educators from re-inventing, and instead build on past accomplishments. Nearly anyone active in the academy will tell you that collaborative networks are absolutely key to academic success. Relationships built through the academy have led many of our members to become national leaders in simulation. Several have gone on to secure federal research funding, and many have secured private foundation funding. When you put this in perspective, the low percentage of the academy cost relative to your annual salary makes Simulation Academy membership a worthy investment.

“One cup of coffee with some of these individuals can help you redefine what’s possible.”

What are Simulation’s biggest issues? In prior years, it took a fair amount of work to demonstrate the value of simulation to hospital administrators and to find simulations home within healthcare systems. Now, it seems hospital administrators are seeking us out for simulation’s role in medical education, patient safety, and staff development (with things such as team training). However, as much as hospital administrators have financial means to purchase physical simulators, the development of simulation faculty and human resources are comparatively lacking. Faculty should be thought as more important than the physical simulators alone because physical mannequin is just one small part of simulation modality overall. Also, the advances of simulation-based research appear to have reached a plateau, i.e. pre and post test for sim-based educational value is no longer considered novel. Therefore, our Academy planned the consensus conference will suggest novel and a more comprehensive approaches — to look at the interaction between simulation and the system overall.

Do you work with other Academies? Collaborate with any organizations? How?

What would you say to someone about joining the Simulation Academy?

We’ve worked with CDEM the most in the past. We have collaborated with the Ultrasound Academy on a lowcost simulation didactic. We are encouraging more EMRA resident involvement. We believe there is ample room for collaboration and we encourage other academies and interest groups to strike up conversations with our members and leadership. Almost every area crosses into simulation based education at some point.

If you have any interest in simulation based education, educational research involving simulation, or changing systems of care with simulation, then you want to meet our other members. One cup of coffee with some of these individuals can help you redefine what’s possible. That means not just joining, but showing up to the annual business meeting, and other satellite meetings when available, and setting up collaborative and/or mentoring relationships. All academic relationships flourish only with investment, and those relationships begin with introductions that occur in forums like ours.

How long have you been a member of the Simulation Academy? Since before it was an academy. I’ve watched it evolve from an interest group, to a committee, to an Academy. As an academy we are part of the life blood of SAEM.

“All academic relationships flourish only with investment, and those relationships begin with introductions that occur in forums like ours.”

Michael D. Smith, MD, is an attending Emergency Physician and Associate at Ochsner Clinical School, University of Queensland. Dr. Smith is president of the SAEM Simulation Academy Joshua Hui, MD, is Director of Simulation at UCLA Medical Center/Olive View William Bond, MD, is Director of Simulation Research, Jump Trading Simulation and Education Center at the University of Illinois College of Medicine at Peoria

The University of Washington Division of Emergency Medicine and the Washington Poison Center SEEKING EM PHYSICIAN / TOXICOLOGIST The University of Washington (UW) School of Medicine (SoM), Division of Emergency Medicine, in collaboration with the Washington Poison and Drug Information Center (WAPC), is seeking qualified applicants for the joint position of WAPC Medical Director and UW Emergency Medicine faculty. Successful applicants will be highly motivated, board prepared/certified in Emergency Medicine and Toxicology, academically oriented, and have leadership and administrative experience within a poison center. This position is 75% Medical Director of WAPC and 25% faculty member in the UW Division of Emergency Medicine. Faculty will work clinically at Harborview Medical Center ED, which is the only Level I Trauma Center for a 4-state region with an annual volume of 66,000 patients per year. WAPC is an AAPCC accredited poison control center serving the state of Washington (population approximately 7 million). The WAPC handled 63,000 calls in 2014 and managed 90% of those at home. The WAPC has a strong working relationship with health care professionals statewide as well as public health officials and other stakeholders. This individual will have the opportunity to lead the ongoing development of a robust Toxicology program, to include a Toxicology Fellowship. There are abundant collaborative academic opportunities with the well-established Harborview Injury Prevention and Research Center, the UW School of Public Health, the UW School of Pharmacy, and the UW SoM Department of Medical Education and Biomedical Informatics. The UW SoM is a regional resource for WA, WY, AK, MT, and ID - the WWAMI states and is recognized for its excellence in clinical training, its world-class research initiatives, and its commitment to community service. Interested applicants should send their CV to: Susan Stern, MD Professor and Division Head Division of Emergency Medicine Harborview Medical Center sstern@uw.edu The UW is building a culturally diverse faculty and strongly encourages applications from women and minority candidates. The University is an Equal Opportunity/Affirmative Action employer.

November / December 2015

2015 Midwest Regional Meeting

Mentorship and Medical Devices are Keynote Topics By Michael Plewa, MD Mercy St. Vincent Medical Center Emergency Medicine Residency Program proudly hosted a successful 2015 SAEM Midwest Regional Meeting September 24–25, 2015, in Toledo, Ohio. On Thursday evening, 40 students, residents and faculty met at Mercy Healthcare Center Simulation Lab for refreshments and a Gino’s pizza and Chipotle burrito dinner. Attendees then practiced advanced ultrasound and airway skills with SonoSite and Karl Storz C-MAC fiberoptic equipment. Friday’s full-day conference at the historic Toledo Club drew 190 attendees, including 71 students and 91 residents, representing 34 institutions and 11 states. All 20 lightning oral presentations and 30 moderated electronic poster presentations were well attended and sparked active, informative discussions. Both keynote speakers addressed timely and thoughtprovoking topics. Mark Courtney, MD, SAEM Secretary/ Treasurer and research director, Emergency Medicine at Northwestern University, discussed “Mentorship: Trends, Tools and Techniques for Both Mentors and Learners.” Richard Schwartz, MD, inventor, entrepreneur and chair, Department of Emergency Medicine at the Medical College of Georgia, Georgia Regents University, explored “Medical Device Development—Concept to Commercialization.” In addition to utilizing electronic posters, the Midwest Regional Meeting again went “green” with the Whova smartphone app providing the agenda, abstracts and speaker slides as well as the ability to comment on presentations, share business cards and message other

Several awards were presented for best abstract presentations: • Best Student Presentation: Randy Bitrus, medical student, Oakland University William Beaumont, Rochester, MI: “Pumping Against Gravity: Cardiac Function Affects Fluctuations in Cerebral Blood Flow Caused by Head Position Change in Acute Ischemic Stroke” • Best Clinical Presentation: Hannah F. Lu, medical student, Rosalind Franklin University of Medicine and Science, Chicago, IL: “Comparison of Interpreters in the Emergency Department” • Best Basic Science Presentation: David Eisenbrey, medical student, Oakland University William Beaumont, Rochester, MI: “Laryngeal Cuff Expansion and Force Application on a Laryngeal Analog During Aeromedical Evacuation Modeling” • Best Resident Presentation: Meghan Williams, MD, University of Toledo Medical Center, Toledo, OH: “Video Triage Project: Can an Informational Video Improve the Patient Experience?” • Best Faculty Presentation: Adrianne Haggins, MD, University of Michigan, Ann Arbor, MI: “Assessment of Michigan Emergency Department’s Access to Primary and Specialty Care Follow-up Prior to Health Care Reform Implementation” The Midwest Regional Meeting hosts would especially like to thank the many regional faculty on the RMPC, the SAEM board and staff who helped make this event a success.

attendees and complete surveys and CME information. An entertaining lunchtime session featured Ignite-format presentations of Midwest Regional EM Residency Programs by Central Michigan University Saginaw, Henry Ford Hospital, Mercy St. Vincent Medical Center, Summa Akron City, University of Toledo Medical Center, Wayne State University and Wright State University. Dr. Matthew Wiepking, a second-year resident at University of Toledo Medical Center, delivered an enthusiastic and humorous presentation to win the best Ignite session award.

November / December 2015

About the Author:

Michael C. Plewa, MD, is an emergency medicine physician in the Department of Emergency Medicine at Mercy St. Vincent Medical Center, Toledo, OH. He is chair of the 2015 Midwest Regional Meeting Planning Committee. Dr. Plewa can be reached at michael_plewa@mercy.com or (419) 251-4354

May 10, 2016 | Sheraton New Orleans Hotel Shared Decision Making (SDM) in the Emergency Department: Development of a Policy-Relevant, Patient-Centered Research Agenda Making Decisions With Patients Victor Montori, MD Professor of Medicine at Mayo Clinic Dr. Montori is a practicing endocrinologist, researcher, and author and also a recognized expert in evidence-based medicine and shared decision-making. Dr. Montori developed the concept of minimally disruptive medicine and works to advance personcentered care for patients with diabetes and other chronic conditions.

Tears to Transparencyâ&#x20AC;Ś The Story of Michael Skolnik Patty and David Skolnik, Founders, Citizens for Patient Safety

Taught by harrowing real-life experience, Patty and David Skolnik are patient safety advocates for shared decision-making, informed consent, dignity for the patient and provider, and patient and provider relationships in healthcare. They founded Citizens for Patient Safety to promote those conversations in healthcare settings that are proven to reduce medical harm. Patty and David travel worldwide to educate consumers, train medical professionals, and advise lawmakers about how to foster relationships, systems, and environments where shared decision-making and informed consent is the working platform. Having lost their only son Michael to poor and lacking communication, The Skolniksâ&#x20AC;&#x2122; promised him they would leave the medical profession better than he found it. Their work through Citizens for Patient Safety is that promise in action. For information visit: www.saem.org/annual-meeting Funding for this conference was made possible [in part] by grant number 1R13HS024172-01 from the Agency for Healthcare Research and Quality (AHRQ); grant number 1R13MD010171-01 from the National Institute on Minority Health and Health Disparities and contract #0876 from the Patient-Centered Outcomes Research Institute (PCORI). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services or PCORI; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

November / December 2015

Emergency Medicine Podcast Picks By Lauren Westafer, DO, MPH

Social media has pushed common, but often neglected, topics in emergency medicine to the forefront of the emergency medicine discussion, into emergency medicine curriculum, and into the minds of the most cutting-edge resuscitationist in the emergency department. Podcasts discussing techniques for mental readiness, statistics, and end of life discussions have garnered incredible attention and have even become niche topics with significant support.

Here are a few top picks in podcasts for select EM topics: Mental Readiness Emergency medicine requires diagnostic aptitude, procedural expertise, and resiliency. The former attributes are carefully crafted throughout training, but resiliency is often left to the individual to develop. • EMCrit, Podcast 118, “On Combat by Dave Grossman.” Dr. Scott Weingart’s EMCrit podcast is the biggest name in EM social media, focusing on critical care. • ERcast,“How to Run a Code” http://blog.ercast.org/run-code/ In this episode Dr. Rob Orman discusses one of the most critical aspects of running a code— communication. While many podcasts have traditionally focused on fancy techniques such as ECMO, or on technicalities such as whether one should administer epinephrine for out of hospital cardiac arrest, this popular podcast discusses how to build the resuscitation team through words.

Geriatrics Due to hearing or cognitive barriers, dementia, or other vague symptoms, older patients can be challenging and sometimes frustrating. Given the volume of geriatric patients seen in the ED, it’s not surprising that a geriatric niche has developed in the social media realm. • GEMCAST

https://soundcloud.com/gemcast (available on iTunes) In this podcast devoted entirely to geriatric EM, Dr. Christina Shevni and colleagues address issues such as polypharmacy, delirium, and other topics that might otherwise be neglected.

November / December 2015

Pediatrics The pediatric population comprises approximately one-fifth of ED visits nationwide [1]. Many of these patients have mild illnesses but having plans for the spectrum of pediatric disease process is vital. • PEM Playbook www.pemplaybook.org Dr. Tim Horeczko provides reviews of nerve-racking pediatric presentations such as the child with indwelling equipment (ventriculoperitoneal shunts, g-tubes, etc) as well as primers for various pediatric resuscitation situations. • PEMBlog/PEMcurrents www.pemcincinnati.com/blog/ Dr. Brad Sobeleski tackles the most common pediatric presentations and controversies on this podcast, and provides frequent reviews of the pediatric literature.

Evidence Based Medicine “Oh, I can’t wait to talk biostatics,” is a rather infrequent refrain in EM, yet this niche is vibrant in the social media realm. • EMNERD http://emnerd.com/ Dr. Rory Spiegel proclaims his blog is about “nihilism, medicine and the art of doing nothing”; in fact, each post highlights a complex statistical or methodological pearl. This blog has accrued significant attention, earning it the “FOAM(er) of the Year Award” from the Emergency Medicine Residents’ Association. • The Skeptic’s Guide to Emergency Medicine http://thesgem.com/ Each week Dr. Ken Milne reviews an article using a critical appraisal checklist. While often addressing interesting clinical questions, the podcast delves into methodology and instructs how to read and appraise articles.

Palliative Care Broaching goals of care with patients and families can be time-consuming and unnatural. This podcast on Weingart’s famous EMCrit website sparked increased focus on this aspect of EM. • EMCrit, Podcast 93, “Critical Care Palliation” http://emcrit.org/podcasts/critical-care-palliation/

Dr. Ashley Shreves’ lecture delivers concrete tools one can use on the next shift to reframe the resuscitation conversation. This talk has become widely popular and sparked the notion that palliative care is critical care. Dr. Shreves gave a similar talk at the inventive SMACC conference in Chicago, “What is a Good Death.” (http://intensivecarenetwork.com/what-is-a-gooddeath-by-ashley-shreves/). • “When to Stop Resuscitation” http://intensivecarenetwork.com/when-to-stop- resuscitation-by-roger-harris/ As resuscitationists, it is our responsibility to know when to halt resuscitative efforts, this presentation, by Dr. Roger Harris at the SMACC Conference, helps us know when.

Reference 1. Wier LM, Hao Y, Owens P, Washington R. Overview of Children in the Emergency Department, 2010. HCUP Statistical Brief #157. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb157.pdf.

About the Author:

Lauren Westafer, DO, MPH, is Emergency Medicine Chief Resident at Baystate Medical Center/Tufts University and SAEM Social Media Resident Scholar

Administrator of Emergency Medicine Emory University School of Medicine Atlanta, GA The Emory Department of Emergency Medicine, the largest academic EM program in the country, provides care to more than 290,000 patients annually in five metropolitan Atlanta locations. The Administrator serves as a resource and advisor to the departmental chair in all clinical, business, administrative, academic, research and financial matters, and manages sizeable operations and research budgets. The ideal candidate will be a seasoned, polished professional with significant business/finance acumen and interpersonal skills with a graduate degree from an accredited institution. Ten plus years of professional management experience in a high volume, complex academic department is required. A thorough understanding of the interrelationships of academic, clinical, teaching and research activities is essential, as well as the ability to get things done. Respond confidentially to: Jane Fischer, Tyler & Company. jfischer@tylerandco.com 610-558-6100

November / December 2015

EM NEWS Lance Becker, MD, Named Chair of Department of Emergency Medicine at North Shore University Hospital and LIJ Medical Center Lance B. Becker, MD, FAHA, is the new chair of the Department of Emergency Medicine, and chair and professor of emergency medicine, at the Hofstra North Shore-LIJ School of Medicine, in New York. He had been founder and director of the Center for Resuscitation Science at the Hospital of the University of Pennsylvania in Philadelphia, and professor of the Center for Mitochondrial and Epigenomic Medicine at The Children’s Hospital of Philadelphia. Prior to that, he was founder and director of the Emergency Resuscitation Center at the University of Chicago and Argonne National Laboratory. A national and international leader in academic emergency medicine, critical care, and the science of resuscitation, Dr. Becker has research interests that are translational and extend across the basic science laboratory into animal models of resuscitation and to human therapies. Dr. Becker has received numerous honors and, as a recipient of prestigious teaching awards, has mentored many successful research fellows. He is a renowned, well-funded researcher who holds many patents for his discoveries. His many professional affiliations include membership in the Society for Academic Emergency Medicine. In addition, he holds many offices in professional and scientific societies, and has organized many national and international scientific meetings. He is an elected member of the Institute of Medicine/National Academy of Medicine. Dr. Becker received his medical degree from the University of Illinois College of Medicine, and completed his residency in internal medicine at Michael Reese Hospital and Medical Center in Chicago.

Thomas Jefferson University Researchers Approved for $1 Million Funding Award from PCORI A research team at the Sidney Kimmel Medical College at Thomas Jefferson University (TJU), led by principal investigator (PI) Kristin Rising, MD, and co-PI Marianna LaNoue, PhD, has been approved for a $1 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) to study novel methods for identifying patient-important outcomes for use in research. “Patients are often minimally engaged about their priorities or needs when seeking medical care, leading to treatment plans that may not be optimally designed to meet their needs,” states PI Dr. Rising. “The goal of this work is to develop a better approach for identifying patient-important outcomes for use in the development of research and clinical interventions.”

November / December 2015

TJU’s study was selected for PCORI funding through a highly competitive review process in which only 11.7 percent of applicants were eventually accepted. Patients, clinicians, and other stakeholders joined clinical scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders, and their methodological rigor among other criteria. The award to Drs. Rising and LaNoue has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

Jackson Memorial Hospital Becomes First ACGME EM Residency Program in South Florida Beginning next summer, a group of future physicians will be the inaugural class of Jackson Memorial Hospital’s Emergency Medicine Residency Program – the first of its kind in South Florida accredited by the Accreditation Council for Graduate Medical Education (ACGME). The three-year program will offer a patient-centered and innovative educational experience designed to develop compassionate and highly-trained future Emergency Medicine physicians. The Emergency Medicine Residency Program will offer first class supervision and training to 15 residents starting in July 2016. Physicians in the program will care for patients with a variety of complex medical issues at Jackson Memorial Hospital, University of Miami Hospital, and Holy Cross Hospital in Fort Lauderdale. Jackson Health System physicians with extensive experience in emergency medicine in large, academic medical centers will lead the program, which will follow the curriculum that conforms to the standards of the ACGME to develop outstanding future clinicians and scholars. Fellowship opportunities in critical care, research, education/simulation, prehospital/disaster planning, and administration will also be available as an optional fourth year.

SAEM ANNOUCEMENTS SAEM16 is Now Live! SAEM is excited to announce that the website for its 27th Annual Meeting, to be held May 10-13 in New Orleans, is now live. Visit our annual meeting website at www.saem.org/annualmeeting for a taste of what’s in store for you at SAEM16. The annual meeting website is your essential source for up-to-theminute information on SAEM16, so please be sure to check back often. We look forward to seeing you in New Orleans!

Dr. Jeffrey Kline Takes the Helm of AEM Journal The Society for Academic Emergency Medicine is delighted to announce Jeffrey Kline, MD, as the new Editor-in-Chief of Academic Emergency Medicine (AEM), effective January 1, 2016. AEM is the official medical journal of the SAEM and a world leader in the publication of peer-reviewed novel research in academic emergency medicine.

Dr. Kline received his MD from the Medical College of Virginia, and then did an emergency medicine residency, followed by a research fellowship, at the Carolinas Medical Center. He now serves as Vice Chair of Research, Department of Emergency Medicine, and Professor, Department of Cellular and Integrative Physiology, at Indiana University School of Medicine. Dr. Kline’s diagnostic research interests focus on human affect analysis, pretest probability and capnography to reduce medical imaging. His human treatment research includes mechanisms of resistance to fibrinolysis, use of inhaled nitric oxide to overcome pulmonary vasospasm during PE. His laboratory work focuses on mechanisms and treatment of acute pulmonary hypertension with attention to hyper-activated platelets from pulmonary embolism, and nanoparticle-delivered plasmin for clot lysis.

SAEM Debuts Stroke PSA The Society for Academic Emergency Medicine debuted its newest public service announcement at the Green Bay Packers vs the Chicago Bears Thanksgiving Day football game, November 26, 2015. SAEM is honored to be a part of the effort to raise awareness of the warning signs of stroke. The PSA aired on the Jumbotron 2 times per hour to an estimated 80,000 people in attendance at the game. During the event, representatives interviewed spectators and shared information about the warning signs of stroke, what to do if someone is having a stroke, and how to prevent stroke. Find out more at www.saem.org/stroke.

Put These SAEM Regional Meetings on Your Radar for 2016 SAEM Regional Meetings provide opportunities, particularly for young investigators, to present their original research and to participate in sessions designed to teach essential research skills. Be sure you plan to attend the Regional Meeting scheduled in your area. • Great Plains, Sep 23-24 University of Iowa College of Medicine, Iowa City, IA • New England, March 30 Hogan Campus Ctr, College of the Holy Cross, Worcester, MA • Mid-Atlantic, March 12 Location TBD

Orleans Hotel. We expect record-setting attendance this year, so don’t miss out on your chance to be part of this exciting SAEM Annual Meeting event. For more information, visit the Residency & Fellowship Fair section under the events tab on the SAEM16 website at www.saem.org/annual-meeting.

SAVE THE DATE! Announcing the 2017 Consensus Conference: “Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes”

May 16, 2017 in Orlando, FL

• Midwest, Sep 9-10 Eskenazi Hospital, Indianapolis, IN • Western, April 1-2 Los Angeles-Marina Del Ray Marriott

Residency & Fellowship Fair is Your Institution’s Chance to Shine The SAEM16 Residency & Fellowship Fair is a unique opportunity to showcase your institution’s programs and recruit hundreds of medical students and emergency medicine residents looking to find their perfect residency or fellowship. This combined Annual Meeting event will be held on Friday, May 13 from 3-5 p.m. at the Sheraton New

November / December 2015

Apply or Renew Your SAEM Fellowship Approval Program In an effort to promote standardization of training for fellows, the SAEM Fellowship Approval Program has been developed to help eligible programs earn the endorsement of SAEM as an approved fellowship. Fellows that complete an SAEM-approved fellowship are also considered by SAEM to have earned the standard qualifications and skills of an emergency medicine fellow in the specialized area of training. The application fee is $400 for the first approval cycle, and $500 for renewals. For more information visit the Fellowship Approval Program section under the education tab of the SAEM website at www.saem.org. The deadline to apply or renew is April 1, 2016.

A Correction An article entitled “Introducing a New SAEM Interest Group: Sex and Gender in Emergency Medicine,” which appeared on page 12 of the November/December issue of SAEM Newsletter incorrectly listed the wrong author in the “About the Author” box at the bottom. The correct author, as bylined, is Alyson J. McGregor, MD MA FACEP, an Associate Professor of Emergency Medicine at The Warren Alpert Medical School of Brown University and Co-Founder and Director for the Division of Sex and Gender in Emergency Medicine (SGEM) at Brown University’s Department of Emergency Medicine. Dr. McGregor also serves as the Co-Director for the SGEM Fellowship and is a Co-Founder and Board of Director for the Sex and Gender Women’s Health Collaborative.

Access to Subspecialty LLSAs If you have an area of interest that you would like to brush up on that is not included in your usual literature reviews or LLSA reading lists, you now have the option of doing so by taking a subspecialty LLSA test. All ABEM diplomates will be able to take LLSA tests in Emergency Medicine, Emergency Medical Services (EMS), and Medical Toxicology (MedTox) to fulfill LLSA test requirements. This includes diplomates certified by ABEM in EMS and MedTox. Any successfully completed test can be used to fulfill LLSA requirements in EM, EMS, or MedTox. Each test has an optional CME activity. The costs of all of the tests and CME activities are the same. The subspecialty tests and CME activities can be accessed on the ABEM website in the same manner as the EM tests and CME activities. Go to www.abem.org, sign in to your ABEM MOC Personal Page, and click on the “LLSA tests” button on your MOC Requirements and Status grid. Remember, if you would like to participate in the optional CME activity, you must register and pay for the CME before starting the LLSA test. If you have any questions, please email moc@abem.org, or call (517) 332-4800, ext. 383.

Conference Proceedings: ABEM MOC Summit In October 2014, ABEM convened a summit of representatives from every major Emergency Medicine (EM) stakeholder organization, including SAEM, to critically review the ABEM Maintenance of Certification (MOC) Program. One purpose of the Summit was to provide current information about the ABEM MOC Program to the EM community, and solicit ways in which the program might be improved. The newly introduced 2015 MOC Standards require that ABMS member boards, including ABEM, “engage in continual quality monitoring and improvement of its Program for MOC . . .” Roundtable discussions centered on the strengths of the ABEM MOC Program and opportunities for improvement; defining, teaching, and assessing professionalism; identifying and filling competency gaps; and enhancing relevancy and adding value to the ABEM MOC Program. Several suggestions to improve the ABEM MOC Program also were discussed. ABEM will consider these recommendations when developing its next revision of the ABEM MOC Program. A summary of the ideas discussed is now available in the Journal of Emergency Medicine (Counselman et al. J Emerge Med 2015 Nov;49(5):722-8.)

November / December 2015

Careers.SAEM.org

SAEM CareerCenter Where Greater Opportunities Start

CALL FOR PROPOSALS 2018 AEM Consensus Conference Submission deadline: April 8, 2016

The editors of Academic Emergency Medicine are now accepting proposals for the 19th annual AEM consensus conference to be held on May 15, 2018, at the SAEM Annual Meeting in Indianapolis. Previous topics have included and will include (2016 and 2017): 2010: Beyond regionalization: integrated networks of emergency care 2011: Interventions to assure quality in the crowded emergency department 2012: Education Research in Emergency Medicine 2013: Global Health and Emergency Care: A Research Agenda 2014: Gender-Specific Research in Emergency Medicine: Investigate, Understand, and Translate how Gender Affects Patient Outcomes 2015: Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization 2016: Shared decision-making in the emergency department: development of a policy-relevant patientcentered research agenda. 2017: Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes

Proposals must advance a topic relevant to emergency medicine that is conducive to the development of a research agenda, and be spearheaded by thought leaders from within the specialty. Consensus conference goals are to heighten awareness related to the topic, discuss the current state of knowledge about the topic, identify knowledge gaps, propose needed research, and issue a call to action to allow future progress. Importantly, the consensus conference is not a “state of the art” session, but is intended primarily to create the research agenda that is needed to advance our knowledge of the topic area. Well-developed proposals will be reviewed on a competitive basis by a sub-committee of the AEM editorial board. Proceedings of the meeting and original contributions related to the topic will be published exclusively by AEM in its special topic issue in December, 2018. Submitters are strongly advised to review proceedings of previous consensus conferences, which can be found in the past November and December issues of AEM, to guide the development of their proposals. These can be found open-access on the journal’s home page (www. aemj.org). Submitters are also welcome to contact the journal’s editors or leaders of prior consensus conferences with any questions, or for copies of submissions from prior years.

Proposals must include the following: 1. Introduction of the topic • brief statement of relevance • justification for this topic choice 2. Proposed conference chairs, and sponsoring SAEM interest groups, committees, or academies (if any – not required) 3. Proposed conference agenda and proposed presenters • plenary lectures • panels • breakout topics and questions for discussion and consensus-building 4. Anticipated audience • stakeholder groups/organizations • federal regulators • national researchers and educators • others 5. Anticipated budget, to include such items as: • travel costs • audiovisual equipment and other materials • publishing costs (brochures, syllabus, journal) • meals 6. Potential funding sources and strategies for securing conference funding. How to submit your proposal. Proposals must be submitted electronically to aem@ saem.org no later than 5:00pm Eastern Daylight Time on April 8, 2016. Late submissions will not be considered. The review sub-committee may query submitters for additional information prior to making the final selection, which will be announced prior to the 2016 SAEM Annual Meeting, to allow for scheduling a planning meeting. Questions may be directed to aem@saem.org or to the editor-in-chief at editor@saem.org.

November / December 2015

MEMBERSHIP Visit the SAEM Website to Renew your Dues, or Join us as a new member & see what Youâ&#x20AC;&#x2122;ve been missing!

Emergency Medicine Fellowship Opportunities UC Irvine Department of Emergency Medicine is seeking HS Clinical Instructors for fellowships starting July 1, 2016. UC Irvine Medical Center is rated among the nationâ&#x20AC;&#x2122;s best hospitals by U.S. News & World report 14 years in a row and is a 412-bed tertiary and quaternary care hospital with a nationally recognized three-year EM residency program since 1989. The progressive 35-bed ED sees more than 50,000 patients/year and serves as a Level I adult and Level II Pediatric Trauma Center with more than 3,800 annual trauma runs. The hospital is also a Comprehensive Stroke & Cerebrovascular Center, Comprehensive Cancer Center, Cardiovascular receiving center and regional Burn centers, with Observation and an After Hours clinic in urban Orange County. Completion of an ACGME accredited EM Residency is required. Salary is commensurate with qualifications and proportion of clinical effort. For more information visit: http://www.emergencymed.uci.edu/fellowships.asp (To apply: https://recruit.ap.uci.edu).

1. 2. 3. 4. 5.

Disaster Medicine Fellowship (JPF03020) EM Education and Faculty Development (JPF03026) Medical Simulation Fellowship (JPF03023) Multimedia Design Education Technology Fellowship (JPF03051) Point-of-Care Ultrasound Fellowship (JPF03018)

The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer advancing inclusive excellence. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.

November / December 2015

Should we be guaranteeing an interview for our visiting students?

Get answers to the questions that are keeping you up at night by joining CDEM.

Already a member of CDEM? Don't forget to renew your CDEM membership when you renew your SAEM membership dues.

Emergency Physicians Hershey, PA

The Emergency Medicine Department at Penn State Milton S. Hershey Medical Center seeks energetic, highly motivated and talented physicians to join our Penn State Hershey family. Opportunities exist in both teaching and community hospital sites. This is an excellent opportunity from both an academic and a clinical perspective. As one of Pennsylvania’s busiest Emergency Departments with 26+ physicians treating over 70,000 patients annually, Penn State Hershey is a Magnet® healthcare organization and the only Level 1 Adult and Level 1 Pediatric Trauma Center in PA with state-of-the-art resuscitation/trauma bays, incorporated Pediatric Emergency Department and Observation Unit, along with our Life Lion Flight Critical Care and Ground EMS Division. We offer salaries commensurate with qualifications, relocation assistance, physician incentive program and a CME allowance. Our comprehensive benefit package includes health insurance, education assistance, retirement

options, on-campus fitness center, day care, credit union and so much more! For your health, Hershey Medical Center is a smoke-free campus. Applicants must have graduated from an accredited Emergency Medicine Residency Program and be board certified by ABEM. We seek candidates with strong interpersonal skills and the ability to work collaboratively within diverse academic and clinical environments.

Apply online: www.pennstatehersheycareers.com/ EDPhysician For additional information, please contact: Susan B. Promes, Professor and Chair, Department of Emergency Medicine c/o Heather Peffley, Physician Recruiter, Penn State Hershey Medical Center, Mail Code A590, P.O. Box 850, 90 Hope Drive, Hershey, PA 17033-0850, Email: hpeffley@hmc.psu.edu

The Penn State Milton S. Hershey Medical Center is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

November / December 2015

2340 S. River Road, Suite 208 Des Plaines, IL 60018

NON PROFIT ORGANIZATION U.S. POSTAGE PAID SAEM

2015 SAEM ANNUAL MEETING MAY 12 – 15, 2015

EARLY BIRD REGISTRATION IS OPEN REGISTER BY MARCH 13

November / December 2015