SAEM PULSE January–February 2020

JANUARY-FEBRUARY 2020 | VOLUME XXXV NUMBER 1

www.saem.org

SPOTLIGHT SHAPING THE PRESENT AND FUTURE OF EM EDUCATION An Interview with

Luan E. Lawson, md

FINE-TUNING SEPSIS RESUSCITATION… IS THERE EQUIPOISE?

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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, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org Manager, IT Dan San Buenaventura Ext. 225, DSanBuenaventura@saem.org Accounting Manager Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Marisol Navarro Ext. 205, mnavarro@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Digital Communications Snizhana Kurylyuk Ext. 201, skurylyuk@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Membership Manager George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Meeting Planner Alex Elizabeth Keenan Ext. 218, akeenan@saem.org Membership & Meetings Coordinator Monica Bell, CMP Ext. 202, mbell@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com Associate Editor, SAEM BOD D. Mark Courtney, MD Associate Editor, RAMS Shana Zucker, szucker@tulane.edu

2019-2020 BOARD OF DIRECTORS Ian B.K. Martin, MD, MBA President Medical College of Wisconsin

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

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

Steven B. Bird, MD Immediate Past President University of Massachusetts Medical School

Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center

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President’s Comments Moving the Needle on Equity, Diversity, and Inclusion

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Spotlight Shaping the Present and Future of EM Education

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SAEM 2019 The Year in Review

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SAEM 2020 New Year Preview

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Diversity and Inclusion Diversity in Residency: Recruiting a Physician Workforce that Resembles the Patient Population

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Diversity and Inclusion Opportunity Cost to Advancing Diversity and Inclusion: The Hidden Fees of the Minority Tax

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Ethics in Action Let's Be Honest: The Ethics of Telling the Truth About Medical Errors

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Reflections Providing Care or Caring

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SGEM: Did You Know?

Females and Males Process Pain Differently

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Emergency Ultrasound Advanced EM Ultrasonography is the First ABEMFocused Practice Designation

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SAEM Foundation An Interview With Education Research Grant Recipient Dr. John Burkhardt

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Briefs and Bullet Points

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Academic Announcements Now Hiring

Michelle D. Lall, MD Emory University Angela M. Mills, MD Columbia University

Stephen C. Dorner, MD, MPH, MSS Brigham and Women's Hospital and Massachusetts General Hospital

Megan L. Ranney, MD, MPH Brown University

Christopher R. Carpenter, MD, MSc Washington University in St. Louis School of Medicine

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

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. Š 2020 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.

PRESIDENT’S COMMENTS Ian B.K. Martin, MD, MBA Medical College of Wisconsin 2019–2020 SAEM President

Moving the Needle on Equity, Diversity, and Inclusion

“In the end, diversity, in all its forms, benefits everyone and the whole of the organization.”

In 2019, the SAEM Board of Directors included improving all aspects of diversity and inclusion in its annual work plan for the Society. In doing so the board elevated this work to the highest level. To start, the board created a new Diversity and Inclusion Strategies Task Force and charged the task force with the following: • Development of a scorecard for measuring Society efforts around diversity and inclusion; and • development of a 3-, 5-, and 10-year strategic plan for diversity and inclusion.

The task force, under the leadership of SAEM Board member Dr. Angela Mills, included SAEM diversity and inclusion thought leaders—many of whom are from SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) and Academy for Women in Academic Emergency Medicine (AWAEM). The task force met several times in the months following the SAEM annual meeting in Las Vegas, to develop the following work products, which were approved by the board in October 2019: • A newly-developed scorecard; • A first-ever Strategic Inclusion and Diversity Plan; and • A recommendation for the formation of a new SAEM committee focused on diversity and inclusion in SAEM. The new committee was named the SAEM Equity and Inclusion Committee. The goals of the committee are: • To improve equity, diversity, and inclusion in programs, activities, and membership at all levels of SAEM;

• to support the SAEM Board in advancing the Society’s equity, diversity, and inclusion efforts; and • to ensure that all selected avenues to improve equity, diversity, and inclusion are in alignment with SAEM’s strategic priorities.

The SAEM Equity and Inclusion Committee will complement the amazing work being done by ADIEM and AWAEM. As is the case with all SAEM committees, the Equity and Inclusion Committee will “cut across” the whole of the organization and will execute specific objectives as charged by the SAEM Board of Directors.

I am excited about the formation of this new committee as well about our Society’s commitment to the issues of equity, diversity, and inclusion. I believe the committee’s work, coupled with the expertise of ADIEM and AWAEM, will “move the needle” on diversity, inclusion, and belonging in a meaningful and impactful way in our Society. In the end, diversity, in all its forms, benefits everyone and the whole of the organization.

ABOUT DR. MARTIN: Ian B.K. Martin, MD, MBA, is professor and system chair of the Department of Emergency Medicine and professor of medicine at the Medical College of Wisconsin (MCW). He served SAEM previously as president-elect, secretary-treasurer, and an at-large member of the Society’s Board of Directors.

Dr. Martin is a founding member and past-president of SAEM’s Global Emergency Medicine Academy (GEMA).

“I believe the addition of the SAEM Equity and Inclusion Committee will elevate the importance of diversity, equity and inclusion in emergency medicine by expanding the accountability for diversity, equity, and inclusion efforts across SAEM at the Board level and be a model for other specialties within academic medicine.”

— Marquita Hicks, MD, MBA, ADIEM president “This endeavor to be more inclusive of all members in our workforce and organizational structure is encouraged and supported by AWAEM. We look forward to finding ways in which AWAEM and this new committee can work together to advance our common goals and objectives.”

— Pooja Agrawal, MD, MPH, AWAEM president

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SPOTLIGHT

SHAPING THE PRESENT AND FUTURE OF EM EDUCATION SAEM Pulse talks with Luan E. Lawson, MD Luan E. Lawson, MD, is an associate professor and the Associate Dean of Curricular Innovation in Medical Education at the Brody School of Medicine at East Carolina University. Her academic interests have focused on undergraduate education, with expertise in curriculum development, assessment, and team training. She is a member of CORD (Council of Residency Directors in Emergency Medicine) and past president of SAEM’s Clerkship Directors in Emergency Medicine (CDEM) academy. Dr. Lawson has designed and implemented curriculum throughout all four years of medical school, from M1 Foundations of Medicine to a required M4 Emergency Medicine Clerkship and Transition to Residency course. Dr. Lawson serves as the PI of ECU’s Redesigning Education and Accelerating Change in Healthcare (REACH) grant, one of the 11 grants awarded by the American Medical Association’s Accelerating Change in Medical Education program. The REACH grant has resulted in the implementation of the Teachers of Quality Academy faculty development program, the Leaders in Innovative Care Distinction Track for medical students, and a longitudinal curriculum in Health Systems Science. Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force, interviewed Dr. Lawson for this issue.

SAEM PULSE | JANUARY-FEBRUARY 2020

Why emergency medicine?

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Emergency medicine was a late career decision for me. I enjoyed every rotation in medical school from oncology to surgery. Early in my fourth year I was strongly considering trauma surgery and particularly enjoyed the trauma resuscitations and procedures.

While working on the trauma service with a surgery resident I admired and respected, he suggested that I consider EM since it combined my love for patient interaction, higher acuity, and procedures in a diverse patient population. He introduced me to the EM program director and residents. It turned out to be a perfect fit and fulfilled my desire to meet the needs of all patients at their most vulnerable and difficult moments.

As an emergency medicine physician, I love providing a safety net for patients who are underserved and underresourced.

Dr. Lawson with colleagues, Kathy Hiller and Doug Franzen, presenting at the Mediterranean Emergency Medicine Congress in Croatia.

How did you first get involved in undergraduate medical education?

Tell us about how you learned to be an educator. Did you have formal training?

After practicing emergency medicine in a community setting, I returned to academic medicine in a clinical educator role. In those early years of clinical practice, I noted several gaps between preparation during residency training and skills needed for community practice.

As I returned to academic medicine, I hoped to fill these educational gaps for residents, but I did not see myself in a formal education role. Despite my preconceived notions, I eagerly took on opportunities to increase my involvement in education—from designing simulation experiences to implementing an Advanced Pediatric Life Support course for residents and faculty. As a result, I was asked to become the EM clerkship director when the prior director unexpectedly became ill. This rapid immersion in a formal educational role was one of the most fulfilling and most humbling experiences of my professional career. I quickly recognized that I did not have the educational background to empower me to be as effective an educator as I hoped to be. As a result, I

"Seize opportunities to explore your own personal interests and identify mentors who will keep you honest with yourself."

completed the ACEP Teaching Fellowship and pursued an MAEd in Adult Education and used these skills to develop curricula for the EM clerkship that was instrumental in EM becoming a required clerkship for fourth year medical students.

Who are some of the teachers or mentors you’ve had in the past who have influenced how you train your students today?

I’ve been fortunate to have many wonderful mentors and couldn’t possibly name them all! Among others in my residency training, Charles Brown and Walter “Skip” Robey demonstrated incredible patience for learners and always took the time to teach. Karen Kinney took our then-small group of female residents under her wing and mentored us with a candid but nurturing approach. My prior chair, Ted Delbridge, encouraged me to dream big and set lofty goals even after I told him I had no interest in research or administration.

Elizabeth Baxley provided me with opportunities to innovate, but was available to support me and nudge me forward when needed. My career would not be the same if not for the mentorship and collaboration of Dave Wald, Kathy Hiller, Jules Jung, and Doug Franzen through CDEM. Finally, my colleague and “work wife” Leigh Patterson has been my perpetual peer mentor, confidant, and sounding board since we embarked on our careers at East Carolina University.

Could you tell us more about your work on the REACH initiative?

I have the privilege of serving as the principal investigator of the Redesigning Education to Accelerate Change in Healthcare (REACH) initiative that received a five-year, million-dollar award from the American Medical Association’s Accelerating Change in Medical Education grant program in 2013. continued on Page 6

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The grant addresses the substantial gap in physician training and the skills needed to prepare physicians to practice effectively in 21st century health systems. Training for future physicians must be grounded in Health Systems Science that includes patient safety, quality improvement, population heath, social determinants of health, and interprofessional team-based care. We have been fortunate to receive ongoing funding to advance curricula in Health Systems Science that has enabled us to be on the leading edge of change for our students and our patients. We are working to address an immediate need to provide health professionals with the knowledge and skills required to prepare them to lead and transform health systems of the future.

How did you first become involved with SAEM? I became involved with SAEM after returning to academic medicine, but the formation of CDEM as the first SAEM Academy in 2008 became a haven for me as a fledgling EM educator.

Fellow CDEM educators served as invaluable mentors, collaborators, and advisors as I embarked on my journey as a clerkship director. Through my involvement with SAEM and CDEM, I have had the opportunity to contribute to the M4 curriculum revision in 2008 and the development of online CDEM modules for students, the M4 National Emergency Medicine Exams, and the National Board of Medical Examiners Emergency Medicine Advanced Clinical Exam. Serving on the SAEM Program Committee and on the CDEM Executive Board has helped me better understand the viewpoints of various EM stakeholders.

What would you tell a student about why he or she should join SAEM? SAEM offers a wonderful opportunity to contribute to the future of emergency medicine and impact education, research, and clinical care. There are boundless opportunities to network, receive mentorships from diverse faculty and residents, form lasting friendships, and obtain leadership experience that will benefit you throughout your career, regardless of your path in emergency medicine.

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Dr. Lawson and Cassandra Bradby at CORD.

What behaviors do you try to model for your trainees?

I always try to model kindness, compassion, and an interest in the person. Optimal outcomes (patient care or educational) rely on genuine respect, honest communication, and adaptability.

What’s a valuable lesson you’ve learned from your patients?

I’ve learned so many valuable lessons from patients over the years. Most importantly, I’ve learned that every patient has a story to tell if you take the time to listen. At times, it is more important to “hear” what is not being said and delve further into their unvoiced concerns.

What experiences in your life do you feel have made you a better physician and educator?

In my final year of residency, my father was diagnosed with metastatic cancer.

In that single moment, I suddenly understood the challenges that our patients face on a daily basis. Even as a

physician, it was difficult to navigate an incredibly complex healthcare system.

I came to better understand the impact that communication and simple gestures have on patients and their families.

Being a mother is the most rewarding and humbling experience I can imagine.

It is filled with uncertainty, hope, and love. All the things you took for granted as easy are suddenly not the way you imagined! These experiences have helped me be more patient and understand that life doesn’t always happen as planned.

If you couldn’t be an emergency medicine physician, what else could you see yourself doing?

I couldn’t imagine doing anything different!

What advice would you give to a resident who would like to go into administration or teaching?

Seize opportunities to explore your own personal interests and identify mentors who will keep you honest with

Dr. Lawson With her husband Lee in Croatia.

Dr. Lawson teaching a group of medical students in the simulation lab.

yourself. At times you will be tasked with responsibilities that may not be your direct interest, but look for ways in which these tasks will provide you with professional growth and development that will enhance your career in the future.

Retrospectively, many of these daunting tasks have provided me with experiences I needed for the next phase of my career.

Don’t panic if your career doesn’t play out exactly how you thought it would be.

Life will offer you opportunities that you never imagined if you are open to pushing yourself outside your comfort zone.

What do you think is the future of emergency medicine education?

As medicine has rapidly evolved over the past several decades, medical

education has undergone transformative changes that demand that medical educators design educational experiences that prepare learners to take on new professional identities that are as multifaceted as the patients and communities we serve. Physicians must be prepared to serve on interprofessional teams that improve the health of patients and populations while incorporating principles of health systems science.

Rapid changes in medicine require that physicians are self-directed learners, but these skills must be guided and developed throughout the educational process. Artificial intelligence and large data hold promise for improving care delivery, but I don’t believe that the human connection can be replaced.

Dr. Lawson with her husband, Lee, and children, Kaitlyn, Avery, and Aidan.

"I’ve learned that every patient has a story to tell if you take the time to listen."

Medical education is embarking on an exciting time where we have the opportunity to develop innovative strategies that harness the strength and diversity of our learners and provide a framework for them to become master adaptive learners that are transformative leaders in healthcare.

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THE YEAR IN REVIEW

What a Year It’s Been!

SAEM PULSE | JANUARY-FEBRUARY 2020

Thanks to your continued support, 2019 was another banner year for the Society for Academic Emergency Medicine. The Society experienced another expansion in membership numbers and meeting attendance, made important improvements to existing programs, and launched several new initiatives that raised the bar for quality member service even higher.

This excellence has not happened by chance; it is the result of many forces working together and countless individuals — committee members, board of directors, academy leaders, and so many others, directing their individual talents and abilities toward working together to achieve the common goals of identifying, communicating, and delivering excellent member programs and services. When leaders throughout an organization like ours take an active, genuine interest in their members’ needs, and invest real time and effort toward identifying how to meet those needs, they create a climate for growth and excellence. Thus, it is little wonder that in 2019 SAEM continued its upward trajectory with another year of unprecedented advancement. Here is a snapshot of highlights from another memorable year at SAEM:

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Membership Numbers are a tangible indicator of success, and we are proud to report to you that 2019 was successful for SAEM by every measure, but especially membership, which reached a new alltime high of 7,000+.

SAEM Social Media In the period between August 2018 and August 2019, SAEM Social Media experienced unprecedented growth in numbers of followers on all platforms, reaching a combined total of 23,000+: Twitter was up 12 percent, Facebook

increased 19 percent, and LinkedIn experienced a whopping 63 percent growth.

SAEM News Dr. Ian B.K. Martin Installed as 2019-2020 SAEM President Ian B.K. Martin, MD, MBA was introduced during the opening session of SAEM19 as the society’s 2019–2020 president. Dr. Martin is a professor and system chair of the Department of Emergency Medicine and a professor of medicine at the Medical College of Wisconsin (MCW).

Demographic Information Collection (Academic Rank, Ethnicity, Gender, & Race) In April, SAEM IT launched an initiative to gather demographic information from SAEM members as a way to assess the society’s progress in achieving its diversity and inclusion goals and provide a baseline for future improvements to the diversity of the Society’s leadership.

SAEM Graduates Second ARMED Class This year, SAEM graduated its second class of the Advanced Research Methodology Evaluation and Design (ARMED) Course and kicked off the third class in September. Several graduates of the ARMED course have already seen tremendous success in starting their research careers by receiving federal and foundation grants for emergency care research.

SAEM Approves Creation of a New Committee and Two New Interest Groups ED Administration and Clinical Operations Committee The new ED Administration and Clinical Operations Committee was created to provide resources and information to SAEM members on methods that improve clinical operations within the academic emergency department; monitor operational trends and strategies; disseminate clinical operations-related best practices; and create and promote opportunities for original research through SAEM channels.

Award Nominations Top All Previous Records Nominations for SAEM awards were higher than any previous year and SAEM introduced several new awards in 2019 including the Marcus L. Martin Leadership in Diversity and Inclusion Award, FOAMed Excellence in Education Award, and SAEM Organizational Advancement Award. In addition, the Medical Student Excellence in Emergency Medicine Award program welcomed 10 new residency programs in 2019. This award is made available to each medical school to select a senior medical student who has demonstrated excellence in the specialty of emergency medicine.

SAEM Wellness Committee Survey Surpasses Goal In October SAEM members were asked to share their experiences dealing with burnout by completing the SAEM Wellness Survey. More than 1,000 SAEM members took the time to complete the survey and provide the SAEM Wellness Committee with the critical information needed to begin to create burnout and wellness research that will specifically represent academic emergency medicine.

Two New Fellowships Endorsed Through Fellowship Approval Program The Disaster Medicine Fellowship and Wilderness Medicine Fellowship were added in 2019 to a list of fellowships endorsed by SAEM through the SAEM Fellowship Approval Program. Fellows that complete an SAEM-approved fellowship are considered by SAEM to have earned the standard qualifications and skills of an emergency medicine fellow in the specialized area of training.

Vice Chairs Interest Group SAEM Academic Career Guide Gets an Update The past year saw a comprehensive update of the SAEM Academic Career Guide, a how-to manual and useful tool for anyone pursuing or growing in his or her academic EM career. The guide includes tips and strategies for working toward positions such as department chair, residency program director, clerkship director, and dean.

Upgraded Directories for Clerkships, Fellowships, and Residencies New and improved directories for emergency medicine clerkships, fellowships, and residencies opened for business in May of 2019. The enhanced directories are easier to update, simple to search, and more detailed in presenting vital information.

SAEMTests Expands In 2019, the SAEM Clerkship Directors in Emergency Medicine (CDEM) academy expanded SAEMTests with the addition of the M4 practice test and 31 disease state quizzes. In total, 16,000 tests/quizzes were taken in 2019 by the 11,000+ students registered.

In July, SAEM announced a new interest group for vice chairs in academic emergency medicine as a forum to collaborate, seek advice, share best practices, and network on a wide range of departmental issues such as education, research, clinical operations, academic affairs, and strategy.

Behavioral and Psychological Interest Group A new Behavioral and Psychological Interest Group was created as a social and professional hub for SAEM members interested in behavioraland psychological-themed topics to collaborate, share ideas, and disseminate ongoing and planned work.

SAEM RAMS RAMS Shows No Sign of Slowing Down Since launching in 2016, SAEM’s Residents and Medical Students (RAMS) have continued a rapid progression forward. Among the several new programs and projects initiated by RAMS in 2019 are the following:

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2019 continued from Page 9 • Establishment of new RAMS Awards for leadership, research, education, ARMED, and the chief resident forum

• The largest group of Medical Student Ambassadors SAEM19 also introduced several “firsts” for an SAEM annual meeting:

• Creation of the RAMS Diversity and Inclusion Subcommittee • Development of a standing RAMS spotlight in SAEM Pulse for regional meeting abstracts

SAEM Journals

• Premier of a new RAMS podcast series

AEM 5-Year Impact Factor Climbs Past 3.0!

• Introduction of “RAMS Roadmaps: The Definitive Guide to Academic Careers in Emergency Medicine for Residents and Students,” a digital tool that provides guidance and information about how to succeed in specific EM academic tracks

SAEM Annual Meeting

SAEM19 in Las Vegas

SAEM PULSE | JANUARY-FEBRUARY 2020

A Record 3,287 Attendees Convene in Las Vegas for SAEM’s 30th Annual Meeting

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work collaboratively to set a research agenda to create solutions for the future health and well-being of the healthcare provider. Timothy P. Brigham, MDiv, PhD, co-chair of the ACGME Physician Well-Being Task Force and a leading expert on physician well-being, presented the concluding remarks.

In 2019 SAEM celebrated three decades of being at the forefront of providing outstanding educational opportunities to emergency medicine academicians and making tremendous contributions to emergency medicine research, teaching, and practice.

SAEM19 at the Mirage in Las Vegas smashed several previous annual meeting records and turned out the highest-ever numbers in several categories: • Most total attendees in history for an SAEM annual meeting • Greatest number of submissions for Advanced EM Workshop Day, didactics, abstracts, and clinical images • Record attendance at the RAMS Party – more than 1,145 celebrated our anniversary at 1 OAK Nightclub in Las Vegas

Academic Emergency Medicine

• MedWAR (Medical Wilderness Adventure Race), a combination of wilderness medical challenges and adventure racing, was held at Red Rock Canyon.

• John E. Prescott, MD, chief academic officer of the Association of American Medical Colleges (AAMC), delivered SAEM’s first-ever education keynote address, “The Future Landscape of Medical Education” • Those who were unable to make it out to Las Vegas for SAEM19 were able to tune into SAEM Facebook for two full days of live streaming of more than 15 hours of educational programming.

• Fun new “extracurricular” events, such as the Red Rock Hike through Nevada’s Red Rock Canyon, the Blackout Dinner, and the Walking Challenge • Many of the 120+ photos that were exhibited in the popular “SAEM Clinical Images” exhibit at SAEM19 were also featured throughout the year on the Academic Life in Emergency Medicine’s (ALiEM’s) wide-reaching blog and shared each week in SAEM Weekly and on SAEM social media.

2019 Consensus Conference Sets Research Agenda to Create Solutions to the Crisis of Physician Unwellness The 2019 SAEM Consensus Conference: Wellness for the Future: Cultural and Systems-based Challenges and Solutions, brought together key stakeholders from across the country to examine the current crisis of physician unwellness in emergency medicine and

Academic Emergency Medicine (AEM) journal achieved a 5-year Impact Factor of 3.389, placing it in the top three of all emergency care journals. In addition, AEM maintained an Altmetric Mentions index of 42.2, ranking it as the number two journal in emergency medicine.

Vol. 26 No. 3 March 2019 ISSN 1553-2712

Academic Emergency Medicine A GLOBAL JOURNAL OF EMERGENCY CARE

Elevating the human condition during times of emergency Influence of Gender on the Profession of Emergency Medicine Guest Editors: Esther K. Choo, MD, MPH and Stephanie Abbuhl, MD

EDITORS’ PICK Defining the Problem—and the Solutions—to Our Stubborn Challenge of Gender Equity Esther K. Choo, Jeffrey A. Kline, Stephanie Abbuhl

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ORIGINAL CONTRIBUTIONS Gender Differences in Faculty Rank Among Academic Emergency Physicians in the United States Christopher L. Bennett, Ali S. Raja, Neena Kapoor et al.

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Continuation of Gender Disparities in Pay Among Academic Emergency Medicine Physicians Jennifer L. Wiler, Kirsten Rounds, Becky McGowan et al.

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Inclusion of Sex and Gender in Emergency Medicine Research—A 2018 Update Basmah Safdar, Kimberly E. Ona Ayala, Syed Shayan Ali et al.

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Impact of a Women-focused Professional Organization on Academic Retention and Advancement: Perceptions From a Qualitative Study Michelle P. Lin, Michelle D. Lall, Margaret Samuels-Kalow et al.

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The Birth of a Return to Work Policy for New Resident Parents in Emergency Medicine Alexandra June Gordon, Stefanie S. Sebok-Syer, Ann M. Dohn et al.

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Contents continued inside.

Special “Gender” Issue of AEM Publishes in March Acem_v26_i3_issueinfo.indd 1

3/11/2019 9:26:29 AM

The March 2019 issue of Academic Emergency Medicine was dedicated to the careers of women in academic emergency medicine and focused on the role of biological sex and/or female gender identity with respect to professional advancement, scholarly opportunities, practice environment, work satisfaction, salary, and burnout.

The issue, "Influence of Gender on the Profession of Emergency Medicine,” included papers that highlight progress that is needed to solve the issues of equal pay and advancement for equal work; explored positive steps being made in the areas of child care and family leave; and described the value and power of women’s professional networks.

AEM Education and Training Dr. Susan B. Promes is Named Editor-in-Chief of AEM Education and Training In June, Susan B. Promes, MD, MBA, was promoted to editorin-chief of Academic Emergency Medicine Education and Training (AEM E&T) journal. She had been serving as the editor for the journal since its inception in 2017.

AEM Education & Training Accepted for Inclusion in Scopus The first of the year saw AEM E&T accepted for inclusion in Scopus — the world's largest abstract and citation database of peer-reviewed literature. The complete Scopus list is on the SCImago Journal Rank (SJR) website. The SJR indicator is a measure of scientific influence of scholarly journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals from where such citations come.

AEM E&T Announces First Fellowin-Training Editor Jessica Fujimoto, MD, chief resident in the department of emergency medicine at Temple University Hospital, was selected as the first appointment to the new AEM Education and Training (AEM E&T) Fellow-in-Training Editor Program.

The fellow appointment to the editorial board of AEM E&T is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts.

SAEM Aligns With EM Representative Groups to Issue Joint Policy Statement RE: Faculty Protected Time In July, SAEM, AACEM, and SAEM RAMS, in unified support with several of emergency medicine’s largest representative groups, agreed on a policy that all emergency medicine core faculty should be allocated protected time.

SAEM Academies Academy and IG Dues Are Free!

In 2019 SAEM made membership in SAEM academies (with the exception of AAAEM) and interest groups FREE. As a result, membership in these groups skyrocketed! Eliminating these extra fees is one of the ways SAEM worked in 2019 to stretch your dues dollars and increase the value of your SAEM membership.

AAAEM Introduces Associate and Emeritus Member Categories The Academy of Administrators in Academic Emergency Medicine (AAAEM) in 2019 announced two new membership categories: The "Associate" level of membership gives this important, righthand person access to the AACEM/ AAAEM annual retreat, community site, AAAEM-produced education, and more.

The "Emeritus" membership category allows those who have been active AAAEM members for five or more years, but are no longer administrators, to continue to participate in the academy.

In February SAEM joined 165 other national, state, and local organizations in signing CDC gun violence prevention research funding letters.

SAEM Withdraws Support From SVI Project In October, after three years of supporting the pilot of the Standardized Video Interview (SVI), SAEM, CDEM, AACEM, and RAMS, along with several other emergency medicine organizations, announced the withdrawal of their support of the SVI and opposition to any further use or study of the project.

Every Academy Contributes to the Pages of Pulse In 2019, for the first time in the editorial calendar, every SAEM academy had at least one article published in the pages of SAEM Pulse. SAEM’s Academy for Diversity and Inclusion in Emergency Medicine (ADIEM), by the end of 2019 had contributed an article fo the Diversity and Inclusion section of SAEM Pulse for every issue since October 2016.

SAEM Foundation SAEM Foundation Has Another Monumental Year For the SAEM Foundation, 2019 was a hugely successful year that saw the realization of several goals, including: • Growth to over $11 million, making it the largest Emergency Medicine Foundation • An increase in grant applications by 44 percent from 2018 • An increase in grants for distribution of more than $662,000 in 10 different grant categories • Partnered with the National Institute on Drug Abuse (NIDA) to fund two new mentored scientist awards • Developed a new partnership with the American College of Medical Toxicology (ACMT) for a new $10,000 grant

SAEM Takes a Stand SAEM Joins Other Organizations in Signing CDC Gun Violence Prevention Research Funding Letters

Team (ACED-IT) to provide residencies, hospitals, and other community organizations with a list of experts who are available to speak on specific topics such as racism in medicine, microaggressions, implicit bias, gender equity, LGBT and transgender health, and more.

AWAEM Celebrates 10th Anniversary With Video Series Throughout 2019, SAEM’s Academy of Women in Academic Emergency Medicine (AWAEM), in a joint venture with FemInEM, celebrated their 10th anniversary as an SAEM academy by producing a podcast series, “AWAEM Anniversary Interviews: 10 Years of Progress.”

ADIEM Launches Advisory Council on Equity, Diversity, and Inclusion Team

• Developed a new $25,000 grant for SAEM ARMED (Advanced Research Methodology Evaluation and Design) course participants Cheers to a successful 2019! We look forward to working with all of you in 2020 to advance academic emergency medicine.

WHAT A YEAR! THANK YOU. We couldn’t have done it without you.

In April, SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) announced the launch of the Advisory Council on Equity, Diversity and Inclusion

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NEW YEAR PREVIEW

What a Year It’s Going to Be! A new year is traditionally a time for focusing on renewal, growth, and new beginnings. Thanks to your commitment to our specialty and your continued support of our Society, the New Year will introduce several new programs and initiatives that represent exciting milestones in the history of the Society for Academic Emergency Medicine:

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Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE)

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In 2019 SAEM launched an initiative to produce clinical practice guidelines, (known as GRACE, defined in the title).

Stated simply, GRACE will address the best practices for the care of the most common chief complaints that can be seen on the tracking board of any emergency department in the country based upon research and expert consensus. These guidelines are designed with de-implementation as a guiding principle, to reasonably reduce wasteful testing, and provide explicit criteria to reduce foreseeable risk and define sensible and prudent medical care. Each GRACE product will undergo peer review for anticipated, but not guaranteed, publication in Academic Emergency Medicine and formal endorsement from the SAEM

Board of Directors. The first GRACE document (re: management of patients with recurrent low risk chest pain) will be disseminated for public comment ahead of peer review by August 2020.

New, Digital, Tips and Tools!

Academic Promotion Toolkit

The Quick Guide to Promotion For the Uninitiated

By Elizabeth Goldberg, MD, ScM

Academic Promotion Toolkit. SAEM Academies are proud to present a new, digital academic promotion toolkit to provide SAEM members with a brief, pragmatic approach to the promotion process. There is no “one size fits all,” when it comes to the promotion process, but this guide provides a useful framework and a “quick guide to promotion for the uninitiated.”

AWAEM Toolkit. Supported by SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM) and developed by a collection of AWAEM members and women in academic emergency medicine with a diversity of career experiences and professional goals, this helpful digital resource offers help and resources for the challenges and opportunities which arise for women in academic emergency medicine: professional development, mentoring, promotion, recruitment/ support, grant writing, developing

scholarship, wellness, and genderspecific needs.

SAEM Membership Guide. Part of SAEM’s new, member onboarding initiative, the SAEM Membership Guide highlights what the Society offers its members, takes new members through the ins and outs of the society and shows them the ropes, and gives all members the tools to make the most of their SAEM membership.

Launching at SAEM20: Equity and Inclusion Committee SAEM believes that attaining equity, diversity and inclusion in emergency medicine that reflects our multifaceted society is a desirable and achievable goal that enhances and strengthens the organization. To that end, SAEM is proud to announce the new SAEM Equity and Inclusion Committee, to officially launch in May at SAEM20 in Denver. The goals of the committee are to improve equity, diversity and inclusion in SAEM programs, activities, and membership at all levels of SAEM; support the SAEM Board in advancing the Society’s equity, diversity and inclusion efforts; and ensure that all selected avenues to improve equity, diversity and inclusion are in alignment with SAEM’s strategic priorities.

Advanced Research Methodology Evaluation and Design for Medical Education Course (ARMED MedEd) Registration for the new ARMED MedEd course, which focuses on education research training, opens this summer.

(The course is set to launch in 2021.)

Patterned after the popular, original SAEM ARMED course, the purpose of the ARMED MedEd course is to provide participants who already possess fundamental knowledge, with advanced level skills to design high quality medical education research projects in a mentored environment.

SAEM ANNUAL MEETING Annual Meeting Didactic Submissions Skyrocket With didactic submissions for SAEM20 up by more than 24 percent over last year, the annual meeting Program Committee has more quality material than ever from which to choose, and that means you can expect the very best of the best in educational content when you attend SAEM’s annual meeting in Denver!

The RAMS-Hosted SAEM20 Party Will Be Out of This World!

The SAEM20 Party, EM’s biggest bash of the year will be held this year at Temple Nightclub Denver. Temple has been described as “otherworldly,” “futuristic,” a “Tron- and Blade Runner-inspired world.” You can expect a live DJ, open bar, killer sound system, fully immersive state-of-the-art lighting and visuals, and cohesive artistic experience that promises to “teleport you into a higher dimension of nightlife.”

SAEM to Honor the Life and Legacy of Dr. Peter Rosen With SAEM20 Memorial Keynote Address Nathan Kuppermann, MD, MPH, the Bo Tomas Brofelt Endowed Chair and a distinguished a professor in the Department of Emergency Medicine, UC Davis School of Medicine, will deliver the society’s first-ever Dr. Peter Rosen Memorial Keynote Address, established in honor of emergency medicine’s founding father who passed away November 11, 2019. Dr. Rosen was known for his passion for teaching, reverence for emergency medicine, and respect for patients and is widely recognized for his many contributions to academic emergency medicine. A second, Thursday keynote address will be presented by Eric S. Holmboe, MD, chief research, milestones development and valuation officer at the Accreditation Council for Graduate Medical Education (ACGME).

SAEM20 Attendees Can Pledge to Go Green!

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Academic conferences such as the SAEM annual meeting create a sizeable environmental footprint. While air travel is

the largest impact of conferences, there are other steps that can be taken (e.g. using reusable eating utensils, taking public transit to and from the airport, reusing linens and towels, etc.) to improve an event’s environmental impact. In an effort to make the SAEM annual meeting more environmentally sustainable, registered SAEM20 attendees will have the opportunity to complete an online pledge to take environmentallyresponsible steps while at the annual meeting to reduce their environmental footprints. Those who complete the online pledge form will be recognized on the SAEM20 website, acknowledged during the SAEM20 plenary session for the efforts to “Go Green,” and announced on social media surrounding the event.

We’re Expanding Our CareerEnhancing Medical Student Ambassador Program SAEM’s medical student ambassadors (MSAs) are instrumental to the success of the SAEM annual meeting. MSAs work directly with the Program Committee to assist in the planning, coordination, and execution of SAEM's annual meeting.

In 2020 we’re upping the number of medical students accepted into the program to 70, giving aspiring emergency medicine academicians the opportunity to participate in this career-enhancing program.

2020 SAEM Consensus Conference to Define an Emergency Medicine Research Agenda on Telehealth Designed to stimulate emergency medicine (EM) researchers and educators to recognize, investigate, and translate the impact of telehealth on the field of emergency medicine, the 2020 SAEM Consensus Conference will include state-of-the-art didactics led by nationally recognized keynote speakers, breakout group planning sessions, and a consensus-building process. Specific topics to be explored are: healthcare access; quality and safety; educational needs and outcomes; research facilitation; and the impact of telehealth on the EM workforce.

New to the 2020 SAEM Annual Meeting…

Education Summit. The Education Summit will feature the presentation, continued on Page 14

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Two New Awards for 2020

2020 continued from Page 13 “Efficiencies in Education: How to Hack Educational Training to get from 10,000 Hours to 100 Hours.” This will be followed by TED-style talks on gender/ diversity, wellness, and mentorship in education as well as small group sessions on qualitative research, mixed methods, and the delphi and nominal group technique for medical education research. The Summit will conclude with a panel of medical education experts who will provide tips for educator success and guidance on ways to maximize your educational efforts.

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Speed Mentoring for Medical Educators. Similar to our popular speed mentoring event, this model for medical educators offers faculty an opportunity to engage in short discussions with mentors with significant expertise in medical education. Participants will have an opportunity to sample potential mentoring relationships and identify a medical education mentor whose experience and personality align well with their desired career trajectory and professional interests.

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Federal Program Officer Event.

Registered attendees will have the opportunity to meet one-on-one with Program Officers from various federal agencies and institutes, including the National Institutes of Health (NIH).

Session participants will benefit from important insights from Program Officers, including “How might I improve my grant’s impact score?” and “How do you recommend I approach and interact with my Program Officer?”

Axe Throwing at DAGAR. Introducing a thrilling new addition to the SAEM20 lineup of offsite events: Axe throwing!

Specifically, axe throwing, beer, and art at Downtown Art Gallery and Axe Room (DAGAR for short). Expert DAGAR

coaches will guide you through the basics of axe throwing. They will teach you how to throw, build your confidence through a practice period, and prepare you to go head-to-head tournament style with your colleagues and friends!

Free Emergency Medicine X-Waiver Training. The recently approved version of "X Waiver Training” was written by a team of emergency medicine physicians. This case-based learning workshop is designed for front line clinicians and trainees challenged with helping patients with substance use disorders. Participants will be credentialed to register for their DATA 2000 (X) waiver and be prepared to manage Opioid Use Disorder patients.

Meet, Greet, and Tweet. Social media is playing an increasing role in how learners, educators, and researchers engage in the academic community. This fun, first-of-its-kind event involves some of EM’s biggest social media influencers, giant face cutouts (yes, like the kind you see at athletic events), a live Twitter feed, and refreshments. Participants will learn first-hand from some of EM’s top social media influencers what it takes to be an influencer themselves and best practices for promoting scholarship through social media.

EscapeWorks Denver. At Denver’s premier escape room, your puzzlesolving team will enter one of five unique, theme-based rooms: Murder at the Speakeasy, Zombie Outbreak, Egyptian Tomb, Casino Heist, or War Games. Each room is designed to provide a completely immersive experience. You’ll feel the pulsepounding thrill of trying to break into a casino vault or being transported back to the time of prohibition and the excitement of finding your way into a gangster’s speakeasy. Within each room are puzzles, clues, and codes that must be deciphered as you race with your friends against a ticking clock. One hour, one room, one way out… Can you escape?

SAEM broke another record for number of nominations for the society’s 2020 awards, receiving 105 and besting last year’s record of 77, with nominations up 36 percent! SAEM presents awards each year in recognition of excellence in emergency medicine, for contributions improving the health of society, and for academic achievements. In 2020 the slate of SAEM awards expands to include these two new awards: • Mid-career Investigator • Public Health Leadership

PODCASTS RAMS Launching a New Biosketch Podcast Series for Researchers The RAMS Research Committee in 2020 will introduce a new podcast interview series with established researchers in emergency medicine and covering topics of interest to residents.

First up in the new RAMS Biosketch Series: Bernard P. Chang, MD, PhD, vice chair of research and assistant professor of emergency medicine at Columbia University.

New Interest Group and Annual Meeting Programming for Vice Chairs SAEM’s new Vice Chairs interest group gets going strong in 2020. They are already busy planning educational content specific for vice chairs at SAEM20! Vice chairs advance a wide range of departmental missions through content expertise in education, research, clinical operations, academic affairs, and strategy. The new SAEM Vice Chairs Interest Group provides a forum for these members to collaborate, seek advice, share best practices, and network.

New Narrated Lectures from AEUS The Academy of Emergency Ultrasound (AEUS) is adding new, peer-reviewed lectures in 2020 to the popular AEUS Narrated Lecture Series. The site also houses videos from SonoGames(R), the premiere gamified educational event for emergency medicine residents created by our innovative AEUS leaders.

A New Scholarship for URM Medical Students Effective with the SAEM 2020 annual meeting, underrepresented minority medical students who apply to and are accepted into the Medical Student Ambassador Program will have the opportunity to apply for one of two $600 MSA Diversity and Inclusion Scholarships to support their attendance at SAEM20 in Denver.

SAEMF Committee Challenge to be Extended to IGs and Academies In 2020 the annual SAEM Foundation Committee Challenge will be expanded to include SAEM interest groups and academies. Winners of the challenge will not only walk away with the satisfaction that they’ve contributed to the academic careers of promising educators and researchers, they will receive bragging rights for the year and shout outs on SAEM social media.

SAEM Foundation is Going Digital!

The SAEM Foundation is launching new online submission platform for applicants.

Effective with grant proposals that are due August 1, 2020, submissions will be made electronically to SAEM Foundation through a new platform designed to help applicants manage their applications with ease. Tutorials will be available spring of 2020 to guide applicants in navigating the new platform.

Updates to SAEM.org We’ll be giving SAEM.org a major overhaul in 2020 so it's easy, friendly, and more enjoyable to find the information you want and get the support you need.

Our last website update was three years ago; this time around our goals are to • Refresh and update the look and feel • Allow for more features and content • Enhance accessibility • Increase interactivity • Improve navigation

Streamlined Regional Meeting Submissions SAEM has invested in a new component to our education platform that will bring the same technology in 2020 to SAEM Regional Meetings for managing abstract submissions that we are currently using for our national meeting. This will lighten the load on leaders at our Regional Meetings who have had to use more manual tracking and review of abstracts for the Regional Meetings.

Membership Sign-up and Sign-in Made Easier Two significant advancements from SAEM IT, to take effect in 2020, will make joining SAEM, signing into your account, and updating your member record easier than ever!

1. New Join Process for Members. The current new member join wizard will be updated to provide more detail for member profiles and easier interface.

2. Enhanced User Account Management Functionality. Updates to our current “forgot username” or “forget password” will be easier to use and will reduce the number of duplicate member profiles.

SAEMF Dinners Return to Boston, Philadelphia and New York, New Dinner Locations to be Announced Your favorite networking events are back in Boston, Philadelphia and New York in 2020. Enjoy a fabulous dinner and networking with academic emergency physicians in your region all while supporting emergency care research and education. Watch www.saem.org/dinner for updates on new locations, to be announced in 2020.

It’s a New Year and we couldn’t be more excited to share it with you!

To take advantage of all of that’s coming up in 2020, please make sure your member profile is up-to-date. On behalf of everyone at the Society for Academic Emergency Medicine we thank you for your ongoing commitment to SAEM and wish you and yours a Happy New Year and the very best for 2020!

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DIVERSITY AND INCLUSION

Diversity in Residency: Recruiting a Physician Workforce that Resembles the Patient Population

SAEM PULSE | JANUARY-FEBRUARY 2020

By Christy Angerhofer, Jeffrey Druck, MD, David Duong, MD

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Understanding that diversity has been linked to improved patient care, it is crucial that emergency medicine (EM) keep pace with the changing face of medicine.1,2,3 Resident diversity is one of the cornerstones in the effort to create a physician workforce that resembles our patient populations, which in turn can address healthcare disparities.3,4 The ethnic composition of enrolled residents in Accreditation Council for Graduate Medical Education (ACGME)accredited U.S. categorical emergency medicine training programs has largely remained stagnant over the past several years. The proportion of Black residents (four percent) and Hispanic residents (five percent) has not changed since at least 2014. Demographic comparison of EM residents and residents in related specialties from the National

GME (Graduate Medical Education) census shows that our specialty is one of the least diverse.5 New ACGME rules require that residency programs, departments, and hospital systems all have a focus on recruitment and retention of a diverse and inclusive workforce.6 With this increased support for diversity, equity, and inclusion from the ACGME, a review of strategies can help training programs identify deficiencies and opportunities within their overall strategic plan in recruiting and building a diverse residency program. There are multiple recruitment elements for a residency program to consider from a diversity perspective.

Diverse patient population

The number one criteria underrepresented minority (URM) applicants

look for in considering a residency program is a diverse patient population (unpublished data). Emphasizing elements of your patient demographics addresses concerns and inspires confidence that, as physicians in training, they will be assisting specific communities, use their individual cultural or language skills, and exercise the opportunity to give back. Also, listing the resources your department and institution has to care for a diverse patient population conveys your dedication and mission to your patient population.

Publicity around Diversity

Advertising diversity of the program, diversity of the city, and a diversity of thought processes through all marketing materials is imperative to

“Resident diversity is one of the cornerstones in the effort to create a physician workforce that resembles our patient populations, which in turn can address healthcare disparities.” changing perceptions and attracting URM applicants. Elements of advertising include explicit material (such as a separate page for D and I), as well as implicit advertising, such as including URM faculty, residents, students and patients on images for school and departmental websites. Systematically reviewing the program’s website, social media presence, presence at conferences such as the Society for Academic Emergency Medicine (SAEM), the American College of Emergency Physicians (ACEP), the Student National Medical Association (SNMA), and the Latino Medical Student Association (LMSA) shows URM applicants a program’s commitment to diversity and inclusion, and introduces the inclusive

environment in which they could practice.

Ensuring that you have a statement on diversity and inclusion easily reinforces your commitment to diversity and displays your program’s core values. Try doing a web search of your department and add the word “diversity” and see what your applicants see.

Diversity Committee

In general, a diversity and inclusion committee acts as the primary method of including residents in the various aspects of advocacy, outreach, advertising, education, and recruitment. Having a group of dedicated individuals can be the thread through residency to make sure all aspects of diversity and inclusion are being prioritized. For example, a diversity

and inclusion committee can suggest grand rounds guests and workshops that can enrich a program’s knowledge of diversity and inclusion and why it is important. Retention can be promoted by creating events in the community that bring URM and like-minded individuals together to do mission-based work outside of their clinical work. Social media can be used through Twitter, Instagram, and a program’s website to raise awareness and amplify voices across the country of URM physicians and can be used to solidify the program’s commitment to addressing issues of disparity and inequity. If residency

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DIVERSITY continued from Page 17

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leadership allows, and there is faculty involvement in the diversity and inclusion committee, this group of faculty and residents can band together as a powerful force to advocate for holistic application review (see below) and for diverse applicants in the ranking process.

URM Externship

Having a dedicated externship that is geared toward URM applicants shows a commitment from the department and institution to go above and beyond to attract URMs to their specific program. Generally, URM externships come with a stipend that can curtail the financial constraints that can come with an away rotation.

Lastly, it provides the opportunity for URM applicants who may not have considered your city or program to 1) visit and see for themselves the patient

“The number one criteria underrepresented minority (URM) applicants look for in considering a residency program is a diverse patient population.” populations you serve, 2) to experience the diversity and cultural aspects of the city, 3) to witness the commitment to diversity and inclusion from the hospital, program, and department and 4) to network with current residents, program leadership, and faculty. If you have a diversity scholarship and not a specifically designed URM externship, you should consider ways for your scholarship recipient to meet with URM residents/faculty and get exposure to your department’s mission and work in community engagement, social determinants of health, and professional development for trainees.

Holistic Application Review

The residency interview and ranking process is one of the most important aspects in enhancing and maintaining a diverse residency. It is also one of the most difficult cultural changes a residency must make. You cannot have a diverse residency class if you do not interview enough URM applicants and if you do not prioritize enough URM applicants at the top of your rank list.

Holistic application review is a missiondriven and diverse-aware process in which a program aligns its values with the type of applicants they’d like to recruit. Providing a holistic application review of applicants allows a program

to review the applicant as a whole person instead of distinguishing out platitudes of scores that may exclude them from further review. There is mounting evidence of disparities in aspects of medical school evaluation, including AOA status7, core clerkship grades8,9, and standardized test scores10,11.

Understanding an applicant’s background (being a person of color, first generation college graduate, first generation physician, former life in other profession) can highlight the inequities that exist for many URM applicants and can provide programs with comprehensive perspective on the predicted success of the applicant in their program. Implicit bias training for all individuals who are reviewing applications, interviewing, or ranking applicants is important to ensure that people who will be most important in your recruitment are aware of their unconscious biases and that there is a safe space to discuss these biases when they arise. It is important for the group of interviewers, decision-makers, and rankers to have a common understanding of the group’s commitment to recruiting applicants from diverse backgrounds to enhance diversity.12

Second Look

Providing an opportunity for URM applicants to visit your program on either a dedicated URM interview day or to return for a coordinated second look event can be beneficial for the following reasons: First, it gives an applicant who may have reservations about a program an opportunity to see what the program would be like for them. Second, it allows the program to cater its recruitment to this specific group of individuals, highlighting aspects of the program that are favorable for applicants (e.g., global health, community work, patient population, well-being, and livability of the city). Inviting the applicant back for a second recruitment day also displays commitment to the individual. These types of commitments are spread by word of mouth and benefit a program’s reputation.

“Advertising diversity of the program, diversity of the city, and a diversity of thought processes through all marketing materials is imperative to changing perceptions and attracting URM applicants.”

Pipeline Programs

By giving residents the opportunity to mentor and support future generations, pipeline and outreach programs provide a means for them to give back, a way for them to impact their communities, and a chance to change the face of medicine.

In turn, this may provide meaning and a sense of larger purpose, which many residents have found to be one of the most inspiring aspects of residency.

In summary, a multimodal approach and deliberate strategy can help guide and focus a program’s efforts toward improving diversity. Emergency medicine is a particularly collegial community and we encourage anyone interested to reach out to each other and to members of organizations such as ADIEM to exchange ideas and advice on creating a more diverse specialty. Having a physician workforce that reflects the composition of our patient populations can further your department's values and mission and is an important step toward addressing healthcare disparities.

References

1. Cohen JJ1, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff (Millwood).

2002 Sep-Oct;21(5):90-102.

2. Johnson RL, Roter D, Powe NR, et al. Patient Race/Ethnicity and Quality of Patient-Physician Communication During Medical Visits. Am J Public Health. 2004;94(12):2084-90.

3. Alsan M, Garrick O, Graziani GC. Does Diversity Matter for Health? Experimental Evidence From Oakland.

NBER Working Paper No. 24787. Sept 2018.

4. B erger JT. The influence of physicians' demographic characteristics and their patients' demographic characteristics on physician practice: implications for education and research. Acad Med. 2008 Jan;83(1):100-5 5. N elson LS, Keim SM, Beeson MS, et al. American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2018-2019). Ann Emerg Med. 2019;73(5):524-541.

6. ACGME common program requirements https://www. acgme.org/Portals/0/PFAssets/ProgramRequirements/ CPRResidency2019-TCC.pdf

ABOUT THE AUTHORS Christy Angerhofer, University of Colorado School of Medicine, Office of Diversity and Inclusion

J effrey Druck, MD, is an associate professor in the Department of Emergency Medicine, University of Colorado School of Medicine, and associate director of the Denver Health Emergency Medicine Residency Program David Duong, MD, Department of Emergency Medicine, Alameda Health System, is an associate program director for the Highland Hospital Emergency Medicine Residency Program

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in healthcare and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Joining ADIEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

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DIVERSITY AND INCLUSION

SAEM PULSE | JANUARY-FEBRUARY 2020

Illustration by: Moises Gallegos, MD, MPH

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Opportunity Cost to Advancing Diversity and Inclusion: The Hidden Fees of the Minority Tax

By Edgar Ordonez, MD, MPH Organizational efforts to increase diversity and achieve inclusive excellence have been in the spotlight over the last few decades, especially in higher education. Many institutions have developed strategic initiatives to promote a mission of a diverse, inclusive, and equitable culture through various means. These may include implementing task forces, committees, and appointing leaders of diversity

within their organizations. In the medical field, this has been partly in response to the marked disparities in medical education and the healthcare workforce, particularly for those underrepresented in medicine (URM).

More than one hundred years after the Flexner Report, which impacted the training of Black and AfricanAmerican physicians, we are still seeking a more equitable distribution amongst racial and ethnic groups in academic medicine. However, the duty

to respond to these disparities primarily falls on the shoulders of members of these minoritized groups, which can lead to unintended consequences.

While this article centers around underrepresented racial/ethnic groups in medicine, these responsibilities also exist within all marginalized groups who have experienced discrimination due to gender, sexual orientation, religious affiliation, ability, socioeconomic, and immigrant status.

When the Minority Tax Becomes a Series of Opportunity Costs The minority tax can be subdivided into several forms of "taxes." The accumulation of these taxes can become barriers to the promotions and tenure process and contributes to the fact that URM faculty are less likely than their non-URM counterparts to be promoted in the academic ranks, receive research funding, and hold highlevel leadership positions.

The isolation tax.

The most recent data from the American Association of Medical Colleges (AAMC) shows that in 2019, medical school enrollment for students who identified as Black/African-American or Hispanic/Latino was 13.9 percent. Medical school faculty that identified in these same racial/ethnic groups was 9.1 percent for the year ending in 2018. To put that into perspective, Black or African-American individuals make up 13.4 percent of the U.S. population while Hispanic/Latinos of any race make up 18.3 percent in the most recent census. While there has been an uptick in the enrollment of URM students over the last few years, the numbers do not measure up to the standard they should. When inequities such as this exist, who carries most of the weight and obligation to organize for change?

Due to URM faculty and trainees being the targets of racism, discrimination, microaggressions, and subjects of implicit bias.

The mentorship tax.

Due to a lack of effective mentors available to guide URM faculty on how to navigate the academic waters and institutional culture.

The gratitude tax.

Due to feelings of appreciation (and a sense of obligation) minorities have for being given opportunities in their institutions.

The clinical assignments and diversity efforts tax.

Due to the expectation to provide care for the underserved, have an increased community presence, become involved in diversity-related committees and organizations, and take part in health equity research.

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Illustration by: Moises Gallegos, MD, MPH

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DIVERSITY continued from Page 21

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The extra set of responsibilities hoisted upon faculty and trainees that are URM or from other traditionally marginalized groups within their organizations and academic institutions is known as the "minority tax" or the "diversity tax." The URM workforce is often disproportionately tasked with leading diversity efforts. These responsibilities may include committee work, community outreach, and mentorship activities. Although these experiences offer significant value to the individual in terms of academic promotion, they are generally less valuable to academic institutions than traditional scholarly pursuits.

This misalignment between individual efforts to promote diversity and career advancement further exacerbates the impact of the minority tax.

The minority tax can further be subdivided into several forms of "taxes," as outlined by Rodriguez et al. The isolation tax can be due to URM faculty and trainees being the targets of racism, discrimination, microaggressions, and subjects of implicit bias. Feelings of not fitting in with the institutional culture may then rise to the surface. These effects

can be emotionally harmful and may hinder the progress of URM faculty in their institutions. The mentorship tax is due to a lack of effective mentors available to guide URM faculty on how to navigate the academic waters and institutional culture. Meanwhile, there is an expectation to function as mentors themselves. The gratitude tax stems from feelings of appreciation minorities have for being given opportunities in their institutions. Thus, there is a sense of obligation, which at times prevents them from seeking outside opportunities that may advance their careers. The clinical assignments and diversity efforts tax are due to the expectation that URM faculty must provide care for the underserved, have an increased community presence, become involved in diversity-related committees and organizations, and take part in health equity research.

The accumulation of these taxes can become barriers to the promotions and tenure process. It undoubtedly contributes to the fact that URM faculty are less likely than their nonURM counterparts to be promoted in the academic ranks, receive research funding, and hold high-level leadership positions. The minority tax can become a series of opportunity costs.

Knowing that the minority tax exists, the challenge is finding solutions to these hidden fees. To help mitigate their effects, institutions must create a culture that values a diverse and inclusive workforce and aims for transformative change through intentional recruitment efforts. They must reform curricula to provide training on microaggressions, implicit bias, systemic racism, and health inequities.

Diversity efforts also need to be considered with similar value to other scholarly pursuits in the promotions process. Additionally, providing mentorship for URM faculty and trainees is imperative. As individuals, we can help decrease the burden through collaboration and understanding of the intersectional experiences of groups to which we do not necessarily identify.

The push should be to hold everyone accountable and be advocates, allies, and accomplices in supporting their efforts. Being self-reflective and aware of one's prejudices, challenging practices that create barriers, and recognizing the systemic injustices that are a result of unearned societal privileges are critical to alleviating this burden. We must have these difficult conversations instead of avoiding them.

Advocating for diversity and inclusion

Illustration by: Moises Gallegos, MD, MPH

within organizations benefits everyone, from faculty to trainees, to patients, but it is not enough. The minority tax is real, and we must share the responsibility of paying the "tax" in order to achieve equity and justice.

ABOUT THE AUTHOR Edgar Ordonez, MD, MPH, is an assistant professor of emergency and internal medicine at Baylor College of Medicine. He is an assistant program director of the emergency medicine residency and is an active member SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM). @TheEMIMdoc

“To help mitigate their effects, institutions must create a culture that values a diverse and inclusive workforce and aims for transformative change through intentional recruitment efforts.”

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in healthcare and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Joining ADIEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

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ETHICS IN ACTION

Let's Be Honest: The Ethics of Telling the Truth About Medical Errors

SAEM PULSE | JANUARY-FEBRUARY 2020

By Gerald Maloney, DO

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You are in the middle of a busy emergency department shift when the nurse alerts you that one of your patients is acutely decompensating.

You enter the room to find your patient in severe respiratory distress and profoundly hypotensive. You quickly determine that the patient is having an anaphylactic reaction, and requires intubation, epinephrine, steroids, diphenhydramine, and fluid resuscitation. After the patient is stabilized, the nurse informs you that your patient received medication meant for another patient with a similar name.

There had been issues with the barcode medication administration system and the nurse had overridden the medication and administered a drug the patient was allergic to. You ask your attending how to discuss the matter with the patient’s family and she recommends you talk to hospital risk management who instructs

“One of the tenets of the growing safety culture/ high reliability organization movement in healthcare has been the concept of openness about errors.” you not to admit to any errors and to avoid saying anything that may lead to a malpractice case.

Medical errors are associated with substantial patient morbidity and mortality each year; however, the actual scope varies by study and by definition of error. To Err is Human: Building a Safer Health System, the seminal publication on error in medicine (released in 1999), estimated that up to 88,000 deaths per year are due to medical error (more recent publications have looked at numbers two to three

times higher). One of the tenets of the growing safety culture/high reliability organization movement in healthcare has been the concept of openness about errors.

In studies from medical and legal journals regarding why patients file suit, two prominent reasons were given: 1) lack of ability to obtain information about what happened and 2) suspicion that the hospital or physicians are engaging in a cover-up regarding the incident. Similarly, when during discovery the plaintiffs are provided with

more information, lawsuits are frequently dropped, as the information that is discovered frequently makes continued pursuit of the litigation nonviable.

There is also the ethical consideration of our obligation to our patients. From a standpoint of both beneficence and justice, withholding information from the patient — particularly about an iatrogenic harm — is unethical. Advocates of disclosure have focused on this ethical imperative for honesty following medical error. Disclosing “harms resulting from care” is consistent with the ethical standards of the major medical societies.

Many facilities have what are commonly referred to as communication-andresolution programs (CRP). These programs include disclosure of the error, apologizing for the error, and offering compensation. All of this is, of course, in addition to providing whatever care is needed as a result of the error. The Lexington (KY) VA Medical Center was the first to publish its experience with CRPs and the University of Michigan has what is probably the best known of these programs. Those that have published their experiences have noted that this program of disclosure, apology, and resolution has reduced both lawsuits and total amount paid out by the facility.

“Fear that disclosure will lead to more lawsuits has resulted in some resistance to these programs and limited adoption in many places.”

Fear that disclosure will lead to more lawsuits has resulted in some resistance to these programs and limited adoption in many places. There are variable protections for apology programs across the states; some make an apology inadmissible as evidence, while others do not. Providers remain fearful of exposing themselves to increased jeopardy should they admit to a mistake, especially in states where such disclosures are not protected.

As a result of this uncertainty, adoption of CRP programs remains limited.

From the standpoint of an emergency department physician (or any physician), disclosure and apology are the ethically appropriate steps. There are training programs for how to have these conversations, and involvement of department or hospital leadership is very helpful, particularly in answering

questions about how the situation will move forward. Conversely, lack of support from leadership can certainly make disclosure more problematic. If your hospital does not have a disclosure/CRP program, then have a discussion with risk management to determine the best way to engage in an honest and ethical conversation with the patient following a medical error.

ABOUT THE AUTHOR Gerald Maloney, DO, associate professor of emergency medicine, Case Western Reserve University and associate medical director, Louis Stokes Cleveland VA Medical Center.

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REFLECTIONS Providing Care or Caring

By Jonathan T. Miller, MD What do you want to do?” Matt asked.

I looked up from the blue, gasping baby to the physician asking the question. “Well, back home I would have intubated her already.”

“Then you should do that here,” he responded.

Intubating the newborn was easy, and as the adrenaline rush passed, I looked up and asked the obvious question, “Now what?”

“Now you bag her until you think she can be extubated... or you think it’s futile.” He headed for the door. “I’ll be back.

Emergency called with a critical patient.”

For the next half hour, I stood at the infant warmer, sweating in the tropical heat trapped so effectively by the concrete block, bagging the baby. I prayed, asking God for the child’s life. It shouldn’t be like this. There should be a NICU, a ventilator, a neonatologist. But this child had only me: a jetlagged visitor on his first day in Papua New Guinea (PNG), unsure of what to do next as the flies buzzed in and out of the open window behind me.

She had endured 12 hours of labor that stalled. When we delivered her by C-section a thick slime of meconium stained the amniotic fluid. Suctioning worked well enough and the nurse whisked her off to the nursery.

SAEM PULSE | JANUARY-FEBRUARY 2020

The same nurse returned shortly after. “The baby is not breathing well,” she said, understating the issue. Walking into the nursery, I spotted our recent delivery: ashen, blue-gray color with agonal respirations. I intubated her, the nurse moved on to attend to other newborns, and Matt went to emergency.

I was left alone with the baby, the heat, and my prayers as I bagged.

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Five years ago, I was asking Matt what he wanted to do. He was my intern then. “Let's tap it,” he said without hesitation.

“You know how?” I asked. He replied confidently, prepped the patient and performed a good arthrocentesis. As we walked away, I asked Matt how many he had done before.

“None. I watched it on YouTube,” he replied. “You've never done that procedure?”

“Nope.”

“But I asked if you knew how to do it.”

“I do. I just never had.”

The boldness he displayed in residency has made him an excellent physician in this resource-constrained environment.

The baby was pink now and breathing regularly on her own.

Relieved, I extubated her shortly before Matt returned. Over

Photo Title: Operating Theater

the next week, her respirations improved steadily. When we saw her later that month in outpatient clinic she had become a happy, healthy baby. In PNG, children are not named until three months of age, given the prevalent infant mortality, but in a gesture of faith, her mother had already named her.

Returning to practice in the United States, I see that I provide much care. I order tests, call consultants, per- form procedures, but none of that work requires me to care. Most of it keeps me from the patient’s bedside. In PNG, without those distractions, I had to provide care in an environment that exposed my limitations. The acute knowledge of my limitations fostered greater empathy for the suffering patient and allowed me to care boldly for them. In the United States, I provide technologically superior care. In PNG, I was able to provide emotionally superior care precisely because the technology was absent. I couldn’t put a patient on a ventilator and walk away. I couldn’t create emotional distance between myself and the patient. I was tied to the bedside by the lack of technology.

Within these limits, I found the freedom to be a physician.

"Providing Care or Caring" was reprinted from the November 2019 issue of Academic Emergency Medicine journal.

ABOUT THE AUTHOR Dr. Jonathan T. Miller is associate program director for the University of Pittsburgh Medical Center (UPMC) Hamot Emergency Medicine Residency, Hamot Hospital, Erie, PA.

SGEM: DID YOU KNOW?

Females and Males Process Pain Differently

By Jessie Werner MD, Warren Alpert Medical School of Brown University Emerging data suggests that females and males process pain differently, which may be modulated by both immune cells and hormonal regulation. Understanding pain pathways in males and females has important implications for emergency medicine physicians. Currently, the choice of pain medications and the dose given is the same for everyone, but if the pathways by which males and females process pain differ, drugs may need to be tailored to account for this. While research historically has tended to use male mice exclusively, biological sex is now recognized as an important factor to consider in biomedical research.

In fact, in 2016, the National Institutes of Health (NIH) began requiring grant applications to explicitly address sex as a biological variable and provide justification if a single sex was selected for use in research.

Recently, a news feature, “Why the sexes don’t feel pain the same way,� published in Nature, emphasized the importance of incorporating both sexes into research by highlighting several studies. Linnstaedt and colleagues found genes on the X chromosome in humans that encode RNA molecules that are more likely to be elevated in females versus males who develop chronic neck, shoulder, or back pain after a motor-vehicle accident, hinting at a female genetic predisposition for chronic pain. Animal

models have also shown differences by sex. For instance, while studying mice and their response to pain, two researchers discovered that pain is mediated by distinct pathways and cell types in males versus females. They found that microglia, central nervous system immune cells, played a role in pain processing in male mice, but not in females. Rather, females seemed to mediate pain via T cells.

Interestingly, when T cells were absent or when the females were pregnant, female mice processed pain via microglia, just as in males. Testosterone was also found to play a role. Castrated male mice processed pain via the pathway observed in females, and female mice provided testosterone switched to the pain pathway seen in males. Similar results have been found in rat models, which suggest that microglia in the periaqueductal grey are more active in female rats than male rats, leading to an increased pain response.

Both animal and human models have found that females require higher doses of morphine to adequately control pain.

The interplay of hormones, immune cells and genetics, and their roles in pain processing is complex and still poorly understood. What we do know is that sex differences matter, and more research needs to be done in order to equitably treat pain in our patients of all sexes.

SGEM "Did You Know?" is a recurring SAEM Pulse submission designed to represent 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.

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EMERGENCY ULTRASOUND

SAEM PULSE | JANUARY-FEBRUARY 2020

Advanced EM Ultrasonography is the First ABEM-Focused Practice Designation

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By Resa E. Lewiss, MD and Lori Stolz, MD The American Board of Medical Specialties has approved a Focused Practice Designation (FPD) in Advanced Emergency Medicine Ultrasonography (AEMUS). Emergency medicine academic leaders and members of the emergency ultrasound community have been in discussions for many years and have decided to create a pathway that standardizes the training of emergency physicians acquiring additional skills in emergency ultrasound. An FPD is an advanced designation awarded

by ABEM after an individual has

demonstrated competence and expertise in AEMUS. Only American Board of Emergency Medicine (ABEM)certified physicians will be eligible for the designation.

a greater breadth and depth of knowledge in advanced techniques, research, education, program administration and quality improvement skills.

The FPD will recognize expertise held by emergency physicians with sophisticated, comprehensive knowledge of Advanced Emergency Medicine Ultrasonography. While residency-trained emergency physicians have acquired basic expertise applying ultrasound in the emergency department, those physicians who specialize in AEMUS will have acquired

ABEM and the Society of Clinical Ultrasound Fellowships (SCUF) signed a Memorandum of Understanding (MoU) in April 2019 in which ABEM delegated its authority for AEMUS fellowship accreditation to EUFAC, the Emergency Ultrasound Fellowship Accreditation Council. EUFAC is currently housed under the umbrella of SCUF, but its function is separate and distinct from

that of SCUF. (EUFAC is an accrediting body whereas SCUF serves the role of mentor, program leader, and educator.)

AEMUS fellowships that meet the requirements for eligibility for ABEM’s FPD will be accredited by EUFAC, not by the Accreditation Council for Graduate Medical Education.

There will be a time-limited training-plus-practice pathway, and a practice-only pathway. Candidates will be required to pass a secure, written examination to earn this designation. ABEM has selected eight examination item writers to create the first examination. Each item writer has more than five years in clinical practice and is a recognized subject matter expert. An implementation timeline and eligibility criteria are available on the ABEM website.

To date, SCUF has assembled members of the EUFAC. The following EUFAC members were appointed by the respective organizations: American Association of Emergency Medicine (Katie Burns, MD and Melissa Myers, MD), the American College of Emergency Physicians (Teresa Liu, MD and Vivek Tayal, MD), the Society for Academic Emergency Medicine (Creagh Boulger, MD and Kristin Carmody, MD), and SCUF (John Bailitz, MD and Sara Damewood, MD). SCUF has also completed a call for nominations, vote, and appointment by the emergency ultrasound community of two EUFAC members (Lawrence Haines, MD and Robert Strony, DO).

SCUF provides clarifying information that AEMUS Fellowships will not be accredited by the ACGME.

SCUF has a Twitter account, @SCUFellowships, led by Jennifer Carnell, MD, Viveta Lobo, MD, and Javier Rosario, MD. This has proven an effective means of disseminating updates and information as the FPD is further clarified to the community. SCUF has also used Twitter to provide clarifying information. SCUF completed its second year with the National Resident Matching Program for applicants to match into a fellowship program. This year 129 programs participated in the match and 52 programs with 117 positions were filled.

The development of an FPD for Advanced Emergency Medicine Ultrasonography will be a major milestone for the field and an exciting development for all of emergency medicine. We look forward to sharing more with the greater community.

Applicants for fellowship apply through SCUF and match through the NRMP.

ABOUT THE AUTHORS Resa E. Lewiss, MD, is professor of emergency medicine and director, point-of-care ultrasound, Thomas Jefferson University. She is the 2019–2020 president of the Society of Clinical Ultrasound Fellowships (SCUF). @ultrasoundREL

Lori A. Stolz, MD, is an associate professor of emergency medicine and director, emergency ultrasound, at the University of Cincinnati.

Dr. Stoltz is the 2019–2020 president of SAEM’s Academy of Emergency Ultrasound (AEUS). @sonostolz ABEM will certify the FPD. Thus only physicians who are ABEM-certified will be eligible for the AEMUS FPD. Internal medicine and Pediatrics may be the next Boards to develop an FPD in AEMUS.

About AEUS The Academy of Emergency Ultrasound is an international forum bringing together clinician sonologists with the common goal of advancing patient care and safety through the use of bedside ultrasound. Joining AEUS is free! Just log in to your member profile.

Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

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SAEM FOUNDATION

An Interview With Education Research Grant Recipient Dr. John Burkhardt

SAEM PULSE | JANUARY-FEBRUARY 2020

John Burkhardt, MD, PhD, was the recipient of a $100,000 SAEM Education Fellowship Grant (now called the SAEM Education Research Grant).

Dr. Burkhardt is assistant professor of emergency medicine and assistant professor of learning health sciences at the University of Michigan Medical School.

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How did you become involved in emergency medicine education research?

I have been involved in medical education scholarship since my emergency medicine residency training at the University of Michigan where I completed a master’s degree in higher education that had a specific focus in medical education. Even before then, I had a long-term interest in medical education as I believe it is the oftenunderappreciated scaffold on which all of healthcare in this country is based.

Educators, in large part, choose who

"I think we are on the precipice of an era in professional education practice and research where much of these issues will be improved upon and basing a career in medical education research will be much more understandable to outsiders and generally supported within academia." gets to be a physician, what students and residents learn, how they are assessed, what medical fields they choose to enter, and what constitutes the standards necessary to remain component as a practicing physician.

All of these educational policy choices in turn impact who gets care, the skill of that care, and the overall health of the U.S. population. Almost every aspect of the healthcare system is impacted by

medical education, but this connection is often not appreciated when policy reforms are discussed.

Tell us about your project and training funded through the SAEM Foundation Education Fellowship Grant.

My time spent during the Educational Fellowship Grant (EFG) (now the Education Research Grant) was a

"My time spent during Educational Fellowship Grant (EFG) (now the Education Research Grant) was a transformative experience for my early academic career in almost every area." transformative experience for my early academic career in almost every area.

The support provided by the SAEM Foundation allowed me to complete a national study of factors influencing medical specialty career choice, with a special focus on diversity issues in emergency medicine. That study utilized data from the Association of American Medical Colleges (AAMC), the National Board of Medical Examiners (NBME), and the American Medical Association (AMA) to follow students longitudinally from the beginning of medical school out to practice. The study results indicate both issues in the pre-medical environment and medical school training period that perpetuate underrepresentation of women and students of color in the field of emergency medicine. Furthermore, my EFG project eventually became the basis of my dissertation and the time to focus on my scholarships, provided by the SAEM Foundation, allowed me to complete my PhD (also in higher education) in 2019.

Describe some of the challenges you encountered when starting your research.

How did you overcome them?

While I believe medical education research to be a critical area of inquiry, it has not always received the recognition or financial support that other fields have in the past. This is no doubt a combination of its relative newness as a distinct discipline, an early history of research that was less rigorous in its methods, and a culture in the health professions that favored “hard sciences” versus “social sciences” in ways of understanding the world. In the past, I have had to convince others that my research interests were just as valid as investigations into diabetes or heart disease while being determined in finding opportunities to both support my research and demonstrate its importance in the language of existing scholarly metrics. I have had the great fortune of being in a department of emergency medicine and an institution that has been

incredibly supportive even when the extramural funding resources in medical education have appeared limited. All that said, I think we are on the precipice of an era in professional education practice and research where much of these issues will be improved upon and basing a career in medical education research will be much more understandable to outsiders and generally supported within academia.

What advice would you give to others who are interested in starting a career in education research?

As I said earlier, I think that anyone interested in making educational scholarship a major component of their career could not have picked a better time to get involved. That said, with increasing visibility and appreciation of educational research comes higher expectations of both the quality and quantity of scholarship. The best thing I did in my career, to date, was to take the time to learn about the educational process outside of my personal training experiences and then ask myself why does medical education work the way it does? This has allowed me to have both a perspective not bounded by

the cultural norms of the medical field as well as some of the tools that other disciplines have brought to bear on the types of social science inquiry needed to study education. Most importantly, I think longevity and success is directly tied to finding what you are most passionate about, whether it be understanding why some learners succeed when others fail, improving the fairness of the educational system for the next generation, or just the joy of generating new knowledge about the world around us.

Read Dr. Burkhardt’s research “Emergency Medicine Career Interest: Leaks in the Pipeline”

Dr. John Burkhardt thanks the SAEM Foundation and its contributors for their support.

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FINE-TUNING SEPSIS RESUSCITATION… IS THERE EQUIPOISE?

By Emily M. Ball, MD There is an ongoing clinical trial on sepsis management called the Crystalloid Liberal Or Vasopressor Early Resuscitation in Sepsis (CLOVERS) trial. Sponsored by the National Heart, Lung, and Blood Institute’s (NHLBI’s) Prevention and Early Treatment of Acute Lung Injury (PETAL) Network, the study is a large multicenter prospective randomized controlled trial that is actively enrolling participants. “The aim of the study is to determine the impact of a restrictive fluids strategy (vasopressors first followed by rescue fluids) as compared to a liberal fluid strategy (fluids first followed by rescue vasopressors) on 90-day, in-hospital mortality in patients with sepsis-induced hypotension.” Extensive controversy exists with CLOVERS in the mainstream media. In fact, a consumer advocacy organization, called Public Citizen, called for a halt of the trial due to concerns for patient safety and a breach of

ethical standards for research, citing “unacceptable risks of harm.” The group is concerned that neither experimental arm has been previously tested and there will not be a control group that would receive usual care. Specifically, concerns surrounding inclusion of patients with “variable degrees of disease severity” and that the protocol is “so outside the norms of treatment that it is obvious they carry unacceptable increased risk of organ failure and death.” Additionally, the story was featured in the Wall Street Journal and on National Public Radio along with other news outlets.

The question is are these criticisms are warranted?

What developments in the treatment of sepsis proceeded CLOVERS and brought about the clinical question it addresses? Does CLOVERS introduce unnecessary exposure to risk? In 2001 when Dr. Rivers and colleagues published Early Goal-Directed Therapy (EGDT) that brought ICU level of care to the ED, mortality from sepsis was as high as 60

percent. The EGDT strategy focused on early identification of illness, timeliness of treatment interventions, targeted physiological end-points, and demonstrated improved survival with these interventions. Regardless of the critiques of EGDT, it marked the beginning of a paradigm change in the treatment of septic patients. Subsequently, as sepsis treatment continued to evolve, we have witnessed improvements in mortality. However, sepsis continues to portend unacceptably high mortality, likely between 15 and 30 percent.

This brings us to the main discussion point; what is “usual care” for sepsis today? Specifically, with reference to the CLOVERS study, what would a “usual care” arm entail? Care of septic patients today hinges on timely identification of patients with sepsis followed by early administration of antibiotics, monitoring of lactate clearance, end-organ function, and resuscitation with fluids and vasopressors. Early identification of sepsis, cultures, source control, and rapid treatment with antibiotics has been consistently recommended. Each of these interventions, and other common practices all warrant their own discussion regarding levels of evidence, but this is beyond the scope of this piece. With regards to vasopressors and fluids, we arguably have equipoise. What is the usual care of fluids and vasopressors in sepsis?

A direct comparison of resuscitation strategies with all other treatments being held constant has not, until now, been performed with CLOVERS. What evidence do we have that supports the use of crystalloids as a resuscitation strategy?

One of the cornerstones of EGDT was fluid resuscitation where the participants of the original Rivers trial received 500 mL of crystalloid every 30 minutes. By the end of the 6-hour study period the standard care group had received an average of 3.5 L and the intervention group received 5 L. All participants received fluid in an aggressive manner that is similar to the “fluid liberal” branch of the CLOVERS trial. The study was widely accepted and EGDT was the premise for 2004 and subsequent Surviving Sepsis Campaign Guidelines. After EGDT came ProCESS, ARISE, and ProMISe, three large trials designed to externally validate EGDT. These studies demonstrated non-superiority of EGDT over usual care. However, the amount of fluid given to all study participants were 2–2.6 L prior to enrollment and 1.7–2.8 in the six hours after randomization between the three studies. In the intervention arm, the volume of fluids given overall ranged 2.3–4.4 liters, and in the usual care arm, the volume of fluids given were 2.1–4.3 liters. This shows that a wide range of fluids is given in the “usual care” arm.

In 2012 the Surviving Sepsis Campaign Guidelines were published promoting the administration of a 30 cc/kg bolus of crystalloid within three hours of presentation despite being based on what was deemed to be low-quality evidence, but has remained a component of the guidelines ever since. Centers for Medicare & Medicaid Services adopted the SSC recommended three-hour bundle and have created a core measure around its completion. Arguably, the current standard of care is large volume fluid resuscitation.

On the other hand, the current trend in academic centers seems to be reduced volume of fluid administered reflexively and support of hypotensive patients with vasopressors earlier.

There is evidence that the crystalloids remain in the vasculature only transiently, leading to edema later on in the clinical course.

Certain patients are not responsive to fluid challenges. In other

"CARE OF SEPTIC PATIENTS TODAY HINGES ON TIMELY IDENTIFICATION OF PATIENTS WITH SEPSIS FOLLOWED BY EARLY ADMINISTRATION OF ANTIBIOTICS, MONITORING OF LACTATE CLEARANCE, END-ORGAN FUNCTION, AND RESUSCITATION WITH FLUIDS AND VASOPRESSORS. " words, they do not have an expected rise in cardiac output with fluid administration, or do not demonstrate improved end-organ function despite increased cardiac output, and that by targeting vascular tone we can more effectively reverse the pathophysiologic state induced by sepsis. Critical care experts and others have been outspoken about the harms done by over resuscitation with fluids. Patients with underlying heart failure, renal failure, or other chronic conditions resulting in baseline volume overload seem at risk for pulmonary edema with aggressive fluid resuscitation. Prospective evidence supporting early vasopressor use is also beginning to appear in the literature. The Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) trial published this year found early low-dose norepinephrine when added to usual care resulted in improved shock state at six hours post-randomization. This represents high quality evidence to support the practice of early vasopressor use, at worst demonstrates safety and non-inferiority, and, in fact, this may turn out to be a superior strategy when evaluated more thoroughly in the CLOVERS trial.

Equipoise, a term used in clinical research to denote a genuine uncertainty of superiority, exists between aggressive early fluid resuscitation in sepsis and the use of vasopressors early in the clinical course. There is likely a balance that exists between the two strategies, a sweet spot, a ratio of the two therapies continued on Page 34

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SEPSIS from Page 33 that best serves various subsets of patients. As mortality rates drop it becomes more and more difficult to make further improvements. We are at a point where fine-tuning the approach becomes essential. However, high-quality, prospective, up to date research specifically designed to evaluate resuscitation strategies as a nuance of care while concurrently providing otherwise equivalent and evidenced based care for septic patients does not yet exist. CLOVERS will hopefully address this equipoise by filling the void of evidence addressing this aspect of resuscitation. The large, prospective study design will ensure inclusion of a variety of practice environments, racial and ethnic minority patients, and women. The study is powered to detect a 4.5 percent difference between the groups assuming a 15 percent mortality rate. Subset analysis is planned based on history of chronic heart failure, pneumonia as the cause of sepsis, age, blood pressure at enrollment. Both treatment arms represent safe approaches to treatment, at any time the treating physician can over-ride the randomization, and the cohort represents a subset of critically ill patients defined by strict inclusion criteria. The CLOVERS trial reflects the finesse with which we are treating sepsis, and is a statement to how far we have come in the last 20 years. It is relevant and safe, assesses two approaches that are well within the norms of treatment, and I look forward to the results.

ABOUT THE AUTHOR: Emily M. Ball, MD is a PGY3 at Jackson Memorial Hospital.

"EQUIPOISE, A TERM USED IN CLINICAL RESEARCH TO DENOTE A GENUINE UNCERTAINTY OF SUPERIORITY, EXISTS BETWEEN AGGRESSIVE EARLY FLUID RESUSCITATION IN SEPSIS AND THE USE OF VASOPRESSORS EARLY IN THE CLINICAL COURSE. THERE IS LIKELY A BALANCE THAT EXISTS BETWEEN THE TWO STRATEGIES, A SWEET SPOT, A RATIO OF THE TWO THERAPIES THAT BEST SERVES VARIOUS SUBSETS OF PATIENTS."

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Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis - Full Text View - ClinicalTrials.gov [Internet]. [cited 2019 Jul 24];Available from: https://clinicaltrials.gov/ct2/show/NCT03434028 Letter to OHRP Calling for a Halt to Unethical, Reckless Sepsis Clinical Trial Funded by NIH [Internet]. Public Citiz. [cited 2019 Jul 24];Available from: https://www.citizen.org/article/letter-to-ohrpcalling-for-a-halt-to-unethical-reckless-sepsis-clinical-trial-fundedby-nih/ Watchdog group calls for NIH to halt “dangerous” study of sepsis treatment - STAT [Internet]. [cited 2019 Jul 24];Available from: https://www.statnews.com/2018/08/28/nih-sepsis-study-publiccitizen/ Burton TM. NIH Blocks Two Doctors From Speaking Out to Investigators [Internet]. Wall Str. J. 2019 [cited 2019 Aug 6];Available from: https://www.wsj.com/articles/nih-blocks-two-doctors-fromspeaking-out-to-investigators-11556456520 Critics Trying To Stop A Big Study Of Sepsis Say The Research Puts Patients At Risk [Internet]. NPR.org. [cited 2019 Aug 6];Available from: https://www.npr.org/sections/healthshots/2018/08/28/642315546/critics-trying-to-stop-a-big-study-ofsepsis-say-the-research-puts-patients-at-r Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med Boston 2001;345(19):1368–77.

Osborn TM. Severe Sepsis and Septic Shock Trials (ProCESS, ARISE, ProMISe): What is Optimal Resuscitation? Crit Care Clin 2017;33(2):323–44.

Sterling SA, Miller WR, Pryor J, Puskarich MA, Jones AE. The Impact of Timing of Antibiotics on Outcomes in Severe Sepsis and Septic Shock: A Systematic Review and Meta-Analysis. Crit Care Med 2015;43(9):1907–15.

Sherwin R, Winters ME, Vilke GM, Wardi G. Does Early and Appropriate Antibiotic Administration Improve Mortality in Emergency Department Patients with Severe Sepsis or Septic Shock? J Emerg Med 2017;53(4):588–95.

Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.

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Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014;371(16):1496–506.

Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 2015;372(14):1301–11.

Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580–637.

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Measure Details [Internet]. [cited 2019 Sep 14];Available from: https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=5175 Malbrain MLNG, Marik PE, Witters I, et al. Fluid overload, deresuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice.

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Silversides JA, Perner A, Malbrain MLNG. Liberal versus restrictive fluid therapy in critically ill patients. Intensive Care Med [Internet] 2019 [cited 2019 Aug 30];Available from: https://doi.org/10.1007/ s00134-019-05713-y National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354(24):2564–75.

Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. Am J Respir Crit Care Med 2019;199(9):1097–105.

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JAMA 2017;317(8):847–8.

Details of the CLOVERS Trial The Crystalloid Liberal Or Vasopressor Early Resuscitation in Sepsis (CLOVERS) trial, sponsored by the National Heart, Lung, and Blood Institute’s (NHLBI’s) Prevention and Early Treatment of Acute Lung Injury (PETAL) Network, is a large multicenter prospective randomized controlled trial that is actively enrolling participants. Those being recruited are patients with sepsis-induced hypotension despite initial fluid resuscitation. “The aim of the study is to determine the impact of a restrictive fluids strategy (vasopressors first followed by rescue fluids) as compared to a liberal fluid strategy (fluids first followed by rescue vasopressors) on 90-day in-hospital mortality in patie.” Adult patients identified as septic within 24 hours of hospital arrival with hypotension despite at least 1 L of crystalloid resuscitation, but no more than 3 L are eligible for inclusion. Exclusion criteria include, but are not limited to pregnancy, inability to provide informed consent, concomitant condition that is associated with hypovolemia such as diabetic ketoacidosis, and overt hypovolemia. The primary outcome of the study will be all-cause in mortality at 90 days. Patients will be followed until they are discharged to the place where they resided before admission, i.e. baseline, this may be their home or another facility. Both patient-oriented and biomarker based secondary endpoints will be assessed, such as 28-day ventilator and organ support free days, renal function, and sequential organ failure assessment (SOFA) score change by 72 hours. Roughly 2,320 participants will be randomly divided into two groups. Participants randomized to the restrictive fluids group with be started on a vasopressor, preferentially norepinephrine. Vasopressors will be titrated to keep mean arterial pressure (MAP) of 65-75 mmHg. A 500 cc bolus of crystalloid fluid may be administered meeting rescue criteria such as refractory hypotension with norepinephrine doses at least 20 mcg/min, tachycardia above 130 beats per minute for more than 15 minutes, evidence of severe volume depletion by ultrasound or straight leg raise demonstrating fluid responsiveness. Participants randomized to receive liberal fluids will receive an additional 2 L crystalloid fluid trial administered as 500 cc aliquots to a maximum of 5 L total fluid over the first 24 hours, or if “rescue criteria” are met. Fluid administration is triggered by many criteria such as hypotension, elevated lactate, tachycardia, hypovolemia on clinical assessment. Any balanced crystalloid such as lactated ringer, Hartman’s, Plasmalyte, or equivalent may be used.

Vasopressors are to be added for overt volume overload or other indicators suggesting failure of response. All participants return to usual care at 24 hours. Treating physicians may at any time decide to break protocol in the best interest of their patients.1 Source: Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis - Full Text View - ClinicalTrials.gov [Internet]. [cited 2019 Jul 24]; Available from: https://clinicaltrials.gov/ct2/show/ NCT03434028

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RESEARCH HIGHLIGHTS FROM THE 2019 MID-ATLANTIC REGIONAL MEETING Submitted by Ryan D. Pappal, SAEM RAMS Research Committee The SAEM Mid-Atlantic Regional Meeting was held March 30, 2019 at George Washington University, Washington, DC. The following two interviews highlight some of the research presented at that meeting.

Analgesia Administration to Black and Hispanic Patients: A Systematic Review & Meta-Analysis Presented by Paulyne Lee, MS3, The George Washington School of Medicine & Health Sciences Can you give us a little background on your particular interest in the field?

My interest in emergency medicine first began when I worked as an ED scribe before attending medical Paulyne Lee school. I realized that the acute nature of the profession suits my personality and I embrace the challenge to think, multi-task, and act in highly stressful situations. Since I do not want to be limited by a certain demographic of individuals, I value how the ED functions as a front door for all types of patients. Moreover, the team dynamic of emergency medicine appeals to me, and every ED working environment I have seen so far feels like a family. All of these interests have been reinforced as I continue to explore the field as a medical student.

Can you briefly summarize the highlights of your research?

Our research looked to see if there were differences in analgesia administration for ethnic and racial minorities in acute pain. Most of these studies were in the ED setting and the results revealed that there were significant disparities, particularly in Black and Hispanic patient populations. This was interesting because when I closely examined the primary studies individually, I found conflicting data about the presence of these differences. This is also the first systematic review to look only at acute pain.

What are the next steps moving forward for this research‌ do you plan to build on this?

We are beginning another study that focuses on qualitative interviews. By interviewing patients in the ED with acute abdominal pain, we hope to deeply understand their perceptions of their pain, care, and expectations, as well as the cultural factors affecting their discomfort.

What have been the major challenges of this research project? Any advice for future researchers pursuing similar research in this field?

In terms of the nature of a systematic review, the major challenge has been to be as organized and systematic as possible. In regards to the topic of this study, defining the type of pain as specifically as possible is vital since pain is a complexity that involves, biology, culture, and psychology.

Lastly, it can be difficult to know what language to use in regards to race, ethnicity, and people from minority groups.

How to respectfully classify these groups can be difficult, so doing some further research on these topics before writing will be helpful.

Did you have a mentor when you first started out your research career? What is the key to a successful mentoring relationship?

The summer of my first year, I was very fortunate to find my mentor, Dr. Andrew Meltzer, who was willing to guide me on how to use my interests and form an appropriate PICO question and study. It took some searching and initiation on my part to find a mentor who had the research experience and resources as well as practiced emergency medicine. I think some keys to a successful mentorship is for the mentee to take responsibility in driving a project forward, meeting the deadlines, and simply fulfilling as much as they can that is within their capacity without always waiting for the next steps from the mentor. Dr. Meltzer on his side of the mentorship would help me with finding other professional collaborators, reviewing my work, and pursuing opportunities to publish and present in conferences.

In completing this project, did you collaborate with anyone from fields or departments different from yours? If so, please comment on how this collaboration impacted your research.

We had a major collaboration was with Dr. Yan Ma and Chen Chen from the GW school of public health. They were our statisticians and assisted with the meta-analysis, which would have been very difficult to run without them.

What have you found most satisfying about incorporating research into your medical career?

The topic of my research is very meaningful to me, and I feel that it could make a difference in addressing disparities of care.

Incorporating research has also broadened my scope during my preclinical years from beyond the classroom setting, and also serves as a personal reminder to treat patients and their pain with a more understanding heart. Last of all, incorporating research challenges me to keep thinking and questioning about what can be improved in the medical community in order to serve our patients to the best of our ability.

Are There Associations of Clinical Information and Objective Data for False Positive STEMI When Compared to True Positive STEMI Activations in the Emergency Department?

Presented by Zakaria Abdulnabi, MD, University of Chicago Emergency Medicine Can you give us a little background on your interest in the field?

As an emergency provider, one of the most significant and life-threatening conditions that I deal with regularly is ST elevation myocardial infarction.

Zakaria Abdulnabi When these patients arrive, there is often debate between the ED and the Cardiology teams regarding the decision to take the patient to cath lab. We felt that we had access to a great set of retrospective patient data at our large urban center and felt that we could significantly add to the understanding of how clinical information can predict cath lab results so we teamed up with some cardiologists and began sorting through the data.

Can you briefly summarize the highlights of your research?

We compared false positive cath lab activations (activations where the patient was taken to the cath lab but no culprit lesion was identified) to a control group of true positive activations (activations where a culprit lesion was found). We found that between the two groups, inferior STEMIs were far more common in the true positive group, HEART scores

were significantly higher in the true positive group and that activations for criteria other than classic ST elevations (eg new LBBB, aVR elevation with diffuse depressions) were more likely to result in false positive caths.

What are the next steps for this research; do you plan to build on this?

We are currently in the process of submitting to journals. We have a few additional questions we would like to investigate with our data set.

Did you have a mentor when you first started out your research career? What is the key to a successful mentoring relationship?

Yes, Dr. Mirela Dobre at Case Western was a terrific first PI. The key to a successful mentoring relationship is understanding the level of your mentee and to focus on balancing teaching with autonomy.

In completing this project, did you collaborate with anyone from fields or departments different from yours? If so, please comment on how this collaboration impacted your research.

Yes, we collaborated with the Cardiology department. It was vital to have input throughout the course of a cath lab activation and they provided great guidance for us.

What have you found most satisfying about incorporating research to your medical career?

I truly enjoy adding to the body of knowledge we all draw from to care for our patients daily. I feel it is the duty of every provider to contribute something, no matter how small, to this body of knowledge.

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BRIEFS AND BULLET POINTS SAEM to Memorialize the Life and Legacy of Dr. Peter Rosen With Memorial Keynote Address

Dr. Peter Rosen

Dr. Peter Rosen, emergency medicine’s founding father, known for his passion for teaching, reverence for emergency medicine, and respect for patients, passed away November 11, 2019 at his home in Tucson, Arizona. Dr. Rosen is widely recognized for his many contributions to academic emergency medicine.

The impact he had on academic emergency medicine is a gift to our Society and to all who have entered the specialty. For this reason, SAEM wishes to memorialize the life and legacy of Dr. Rosen by naming, in perpetuity, the opening keynote at the SAEM annual meeting, The Dr. Peter Rosen Memorial Keynote Address. An endowment fund has been set up to support this event. All SAEM members and friends of Dr. Rosen are invited to make a donation at www.saem.org/peter-rosen.

Throughout his long and fruitful career, Dr. Rosen spoke, wrote, and consulted on all matters of emergency medicine, specifically focusing on the establishment of emergency medicine as a specialty and creating EM residency programs.

“For many of us, Dr. Rosen was an unparalleled mentor and friend and his loss will be felt greatly. He was one of our greatest visionaries. Back when care was provided in an “emergency room,” before there were academic departments, textbooks, journals, or board exams, he saw our specialty as a unique and wonderful discipline that needed to be developed, recognized, and supported. He dedicated his life to making that come true.” — Dr. Richard Wolfe.

Generations of emergency medicine physicians have trained under Dr. Rosen in programs he started; many have gone on to chair their own departments and achieve success in the field.

“Peter was a friend and advisor to me, frequently reaching out via email when he had some idea about geriatrics to convey. Every one of his emails ended in ‘Love, Peter.’ I'll miss his wisdom, humor, and EM history lessons — but mostly his friendship.” — Dr. Christopher Carpenter At the time of his passing, Dr. Rosen was a senior lecturer at Harvard Medical School and a visiting professor in the Department of Emergency Medicine at the University of the Arizona College of Medicine in Tucson. He was also professor emeritus at the University of California at San Diego School of Medicine. Emergency medicine is grateful to Dr. Rosen for his vision and wisdom and indebted to him for helping craft the EM specialty into what it is today. Please consider honoring Dr. Rosen with a contribution toward The Dr. Peter Rosen Memorial Keynote Address.

SAEM News The Latest from the SAEM19 Clinical Image Series

you can figure out solutions to recently highlighted cases before you take a peek at the answers! Visit www.aliem.com to view all images, to date, in the SAEM Clinical Image Series.

• “Chest Wall Mass,” by Harry Stark MD, MBS, an emergency medicine resident at St. John’s Riverside Hospital, Yonkers, NY

More than 120 photos were exhibited in the popular “SAEM Clinical Images” photo competition at SAEM19 in Las Vegas. They are being featured again on Academic Life in Emergency Medicine’s (ALiEM’s) wide-reaching blog. See if

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• Facial Burn, is by Samuel Southgate, a medical student and Meghan Herbst, MD, an associate professor in the Department of Emergency Medicine at the University of Connecticut School of Medicine • Rash and Headache in Acute Myeloid Leukemia, by Jessica Shuen, MD and Young-Min Kim, MD, from Hackensack University Medical Center

•M ysterious Blood Sample, by Sarah Monks, MD, UNC Emergency Medicine •B elly Button Mass, by Caroline Molins, MD, assistant recruiting director, Florida Emergency Physicians and curriculum director, Florida Hospital Emergency Medicine Residency

More From SOAR: 300+ Hours of SAEM19 Educational Content

Experience convenient online and mobile viewing of original educational content from SAEM19, now on SOAR (SAEM Online Education Resources)! Here’s a sample of what you will find: •W atch a Doctor Get Sued: A Live Medicolegal Simulation •T he Educator’s Lexicon: What Does It All Actually Mean?

• Exploring Opportunities to Improve Outcomes of Older Adults by Targeting Their Social Determinants of Health • An N-of-1: When is the Best Time to Start a Family?

• Competency-Based Medical Education: The Good, the Bad, and How We Can Shape the Future • Developing the Digital You: Creating a Strong Social Media Presence to Expand Your Professional Network • Research Career Mentoring Over the Academic Life Cycle: Tips for Mentors and Mentees • Why Your Department Needs a Faculty Skills Development Program and How to Provide It • Short, Deep, and Flipped: Five Ways to Improve Your Research Curriculum and Inspire Your Residents • So You Want to Get a Job? Unlocking the Secrets to the Perfect Interview Beyond Residency • Caveat Emptor: Informed Decision Making in United States Helicopter Emergency Medical Service • Six Effective #Shemergency Strategies for Recruitment and Retention of Female EM Residents • Strategies for Increasing Diversity and Inclusion in Emergency Medicine • Medical Education Journal Club: A Discussion on the Latest and Greatest • Building Leadership Skills: Consider a Positive Angle • Fulfilling Emergency Medicine Resident Ultrasound Milestones: An 18-Month Systems-Based Ultrasound Simulation Curriculum • Tips for Faculty Success From Department Chairs • Wellness, Inclusion, Diversity, Equity: The Wide and the Why...That is the Question • Leadership Education in Advancing Diversity: Diversity 3.0 • #MeToo in EM: A Discussion of Gender, Racial and Sexual Minority Discrimination and Harassment in Medicine

Announcing the Creation of the SAEM Equity and Inclusion Committee!

SAEM believes that attaining equity, diversity and inclusion in emergency medicine that reflects our multifaceted society is a desirable and achievable goal that enhances and strengthens the organization. To that end, the SAEM Board of Directors, in October 2019, accepted the recommendation of the Diversity and Inclusion Strategies Task Force to create the SAEM Equity and Inclusion Committee. The goals of the committee are to improve equity, diversity and inclusion in SAEM programs, activities, and membership at all levels of SAEM; support the SAEM Board in advancing the Society’s equity, diversity and inclusion efforts; and ensure that all selected avenues to improve equity, diversity and inclusion are in alignment with SAEM’s strategic priorities. Requests to become a member of the SAEM Equity and Inclusion Committee closed December 16, 2019.

“How To Write a Winning Abstract” Webinar is Now on Video

You may have missed the deadline for SAEM20 abstract submissions, but it’s not too late to start working on your abstract for SAEM21 in Atlanta! The SAEM Program Committee-hosted “How To Write a Winning Abstract” webinar is now available on YouTube and provides plenty of good guidance about how to prepare and submit a high-impact SAEM abstract. Take a look and start preparing that abstract now.

SAEM Residents and Medical Students Newest RAMS Who’s Who In Academic EM Podcast Features EM Social Media Guru Dr. Seth Trueger and FemInEM Founder Dr. Dara Kass Seth Trueger, MD, MPH, assistant professor of emergency medicine, Feinberg School of Medicine, Northwestern Seth Trueger, MD, MPH University and Dara Kass, MD, an assistant clinical professor at Columbia University School

of Medicine, are featured in the two most episodes of the SAEM RAMS podcast series, “Who’s Who In Academic Emergency Medicine.” Dr. Trueger, Dara Kass, MD the current digital media editor at @JAMANetworkOpen, discusses how he developed an interest in social media and what steps he’s taken to successfully integrate social media into his career. Dr. Trueger tweets as @MDaware and blogs at mdaware.org.

Dr. Kass is the director of Equity and Inclusion for Columbia’s Emergency Department, and the founder of FemInEM, an advocacy and resource site for women in emergency medicine.

She is active in SAEM’s Academy of Women in Academic Emergency Medicine (AWAEM) and was the recipient of SAEM’s Advancement of Women in Academic Emergency Medicine award.

Dr. Kass tweets as @darakass.

SAEM Academies SAEM Academies are Accepting Nominations for Awards

SAEM’s Global Emergency Medicine Academy (GEMA) is accepting nominations for awards in several individual and group categories: Presidential Lifetime Achievement Award, EM Globalization and Advancement Award, Academic Achievement Award, Humanitarian Service Award, Young Physician Award, Health Endeavors Department Award, Global Emergency Medicine Education Award, Outstanding Contribution to Global Emergency Medicine Research Award. For full details, including eligibility criteria and submission requirements, visit the GEMA awards webpage. The deadline for all award nominations is January 15, 2020.

SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM) is accepting nominations for awards in several categories: Faculty and Department Awards, Faculty Scholarships, and Resident Scholarships and Awards. For full details, including eligibility criteria and submission requirements, visit the AWAEM awards webpage. The deadline for all award nominations is January 15, 2020.

Continued on Page 40

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SAEM’s Clerkship Directors in Emergency Medicine (CDEM) is accepting nominations through January 30, 2020 for four awards, to be presented at the annual CDEM meeting in May 2020 in Denver, CO: CDEM Award for Innovation in Medical Education, CDEM Distinguished Educator Award, CDEM Young Educator of the Year Award, CDEM Clerkship Director of the Year Award. CDEM awards recognize medical student faculty educators from across the country for their dedication, innovation, and achievements in undergraduate medical education.

SAEM Journals Call for Resident Members to Serve on the Editorial Board of Academic Emergency Medicine Applications are being accepted for the resident appointment to the editorial board of Academic Emergency Medicine (AEM). The 12-month resident appointment is intended to introduce the resident to the process of peer review, editing, and publishing of medical research manuscripts and will provide the resident with an experience that will enhance his/her career in emergency medicine and in scientific publication.

Application deadline is February 7, 2020.

AEM Education and Training is Accepting Applications for Fellowin-Training Editor Program

AEM Education and Training (AEM E&T) journal is accepting applications for its Fellow-in-Training Editor Program for the 2020-2021 term. This one-of-akind opportunity is open to any SAEM member who is a current resident and who will start a medical education fellowship in the summer of 2020 OR is a current fellow in a 1- or 2-year medical education fellowship program. The fellow appointment to the Editorial Board of AEM E&T is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts.

Application deadline is March 15, 2020.

AEM Editor-in-Chief Picks for November and December

For each journal issue, the editor-in-chief of Academic Emergency Medicine (AEM) journal selects one paper he feels is of particular relevance and importance to the specialty of academic emergency medicine. For November and December,

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AEM EIC Jeffrey Kline, MD, selected the following: For November AEM Editor-in-Chief, Jeffrey A. Kline, MD, selected, Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs, by James I. Daley MD, MS, MPH, et al., as his EIC Pick of the Month for November.

Read EIC Kline’s commentary, “Sounding Out Pulmonary Embolism.”

For December AEM Editor-in-Chief, Jeffrey A. Kline, MD, selected A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC2 Randomized Controlled Trial, by Danielle M. McCarthy MD, MS, et al., as his EIC Pick of the Month for December. Read EIC Kline’s commentary, “The Two-Three Punch.”

Listen to the Latest AEM Podcasts

Podcasts from the November and December issues of Academic Emergency Medicine are available for your listening enjoyment. AEM podcasts are also available on iTunes.

From the November Issue Focus on PE in Patients with Abnormal Vital Signs Freestanding Emergency Department Entry and Market-level Spending on Emergency Care From the December Issue A Multifaceted Intervention to Improve Patient Knowledge and Safe Use of Opioids: Results of the ED EMC2 Randomized Controlled Trial

AEM E&T Podcasts

In the newest AEM E&T podcasts, author Geremiha Emerson, MD, The Ohio State University Wexner Medical Center, talks about his team’s paper, Geremiha Emerson, MD Does the Emergency Medicine In-training Examination Accurately Reflect Residents’ Clinical Experiences? In a second, authors Casey

MacKenzie, MD and Shawn Mondoux, MD, MSc, the Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada, talk about Casey MacKenzie, MD their team’s paper Clinical Improvement Interventions for Residents and Practicing Physicians: A Scoping Review of Coaching and Mentoring for Practice Shawn Mondoux, MD, MSc Improvement.

SAEM Regional Meetings Registration is Open for New England Research Directors Regional Meeting

Registration is open for the New England Research Directors (NERDS) regional meeting, to be held Wednesday, March 25, 2020, in the Hogan Campus Center at the College of the Holy Cross, Worcester, MA. Now in its 24th year, the NERDS meeting is the primary forum for presenting original emergency medicine research in the New England area. This year’s NERDS meeting is hosted by the University of Connecticut School of Medicine. For the most up-to-date information about registration, housing, and program agenda, please visit the SAEM New England Regional Meeting webpage.

Register for the Southeastern Regional Meeting, February 21–22

Registration is open for the Southeastern Regional Meeting, to be held February 21-22, 2020 in Greenville, SC. Highlights include keynote speakers, a hands-on ultrasound session, and a team-based resident board review competition. For the most up-to-date information, please visit the SAEM Southeastern Regional Meeting webpage.

SAEM20 Updates It’s Time! Registration is Open for SAEM20

Registration opened December 1 for SAEM20, to be held May 12–15 at the Sheraton Denver Downtown Hotel. The SAEM20 Program Committee has planned another unparalleled annual meeting, with the largest presentation of pediatric didactics we’ve ever had, two keynote

addresses by renowned speakers, and our usual agenda of cutting-edge education, state-of-the-art original research, and innovation in academic emergency medicine. Attendees can also look forward to high-quality career development opportunities, energetic networking events, and all the usual “extracurricular” fun and camaraderie. Register today!

Submit IGNITE! and Innovations Proposals Through January 13

IGNITE! and Innovation submissions are being accepted through January 13, 2020. Fun, fast-paced IGNITE! talks are some of the most popular, energetic, and engaging sessions at the SAEM Annual Meeting. Innovations present novel ideas and approaches to undergraduate and graduate medical education, faculty development, operations, and more, in either oral or tabletop format. Direct any questions to education@saem.org.

January 13 is the Last Day to Submit Clinical Images for SAEM20!

Medical students and residents are invited to submit original, high-quality clinical images relevant to the practice of emergency medicine for presentation at the SAEM20 Clinical Images Exhibit, May 12–15 in Denver. Accepted images that have patient consent sign -off will also be featured on the popular and widereaching Academic Life in Emergency Medicine (ALIEM) blog. Direct any questions to education@saem.org.

The Lottery to Enter SimWars is Now Open

Accepting Applications Until January 11 for SAEM20 Medical Student Ambassador Program

The SAEM20 Program Committee is accepting applications from enthusiastic and responsible medical students who are interested in serving as ambassadors and working directly with SAEM leadership to assist in the planning, coordination, and execution of SAEM's annual meeting. Visit the MSA website for a list of perks and duties, read Austin Tam’s first-hand account of his MSA experience. Deadline is January 11, 2020.

New: MSA Diversity and Inclusion Scholarship: A $600 stipend to support two underrepresented minority medical student ambassadors to attend SAEM20. If you wish to be considered for this scholarship, click “yes” on the application.

The Popular AWAEM/ADIEM Luncheon is Returning to SAEM20…Save The Date!

The AWAEM/ADIEM Luncheon is one of the most popular functions at SAEM’s annual meeting and it’s returning to SAEM20 in Denver! The 2020 AWAEM/ ADIEM Luncheon, May 13 at noon, is an excellent opportunity to network with old friends and new, explore joint issues, and learn about the hottest topics in emergency departments. This event sells out quickly every year, so be sure to save the date and sign up soon!

The SAEM SimWars lottery is officially open. SimWars is THE premier national SimWars event. This year’s event takes place Wednesday, May 13, from 1–5:30 p.m. in Denver. Will your residency reign supreme at SimWars 2020? You’ll never know if you don’t enter your team for the chance to compete. Deadline for submission is March 1, 2020, at 5 p.m. CT.

IN OTHER NEWS Advanced Emergency Medicine Ultrasonography

The American Board of Emergency Medicine (ABEM) continues to develop special recognition for emergency physicians with expertise in advance emergency ultrasonography. Program requirements for Advanced EM Ultrasonography (AEMUS) fellowship training are now available on the ABEM website. Approval of fellowship training programs under a focused practice designation falls outside of the purview of ACGME. The Emergency Ultrasound Fellowship Accreditation Council (EUFAC) accredits training programs based on AEMUS Program Requirements.

Additional information is available on the EUFAC website. Questions can be addressed to inquiries@EUFACouncil.org, or FPD@abem.org.

UpToDate® Now Available to ConCert™ Exam Takers

Beginning with the spring 2020 administration, Wolters Kluwer’s online, evidence-based clinical decision support resource, UpToDate, will be available to physicians during the ConCert Examination. UpToDate will be a click away while answering questions during the test.

Combined Subspecialty Training in Addiction Medicine and Medical Toxicology

Register Your Team for SonoGames

Team registration is now open for SAEM20 SonoGames— the ultrasound game-based educational event. Don’t miss the winner-takes-all, no-holds-barred action as teams of emergency medicine residents in crazy costumes demonstrate their mad skills and knowledge of pointof-care ultrasound. Does your team have the “SonoSkills” to take home the SonoCup? There’s only one way to find out: Put a team together and register.

(Never participated in a SonoGames?

Here’s what you’ve missed!)

minds in the specialty. Exhibiting at the SAEM annual meeting puts your products and services in front of these EM decision makers, thought leaders, and early adopters. Join us at SAEM20 in Denver and reap the benefits! Please visit our exhibits and sponsors website to learn why you should add your name to our growing list of exhibitors and sponsors.

Exhibit at SAEM20 and Put Your Products and Services in Front of 3,000 EM Decision Makers and Thought Leaders

The SAEM annual meeting is the premier forum for the presentation of high-quality academic emergency medicine research and education. The annual meeting hosts more than 3,000 attendees and includes presentations from the most brilliant

Combined subspecialty training in Addiction Medicine and Medical Toxicology has been approved by American Board of Emergency Medicine (ABEM) and the American Board of Preventive Medicine (ABPM). Normally, an Addiction Medicine fellowship is one year in length and a Medical Toxicology fellowship is two years; however, the combined fellowship training requires just two-and-a-half years of training, decreasing training time by six months. Program guidelines and application are available on the ABEM website. The application must be submitted to both ABEM and ABPM.

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Spotlight on Featured SAEM20 Sessions and Events advancement. Designed to develop and cultivate the next generation of academic leaders in research, administration and education, the session will feature focused didactic presentations from leaders in EM administration, education and research, as well as a Q & A panel of current and former department chairs.

Residency & Fellowship Fair, May 14, 3–5 p.m.

Plan to attend the following annual meeting sessions and events when you register for SAEM20, May 12–15, 2020 at the Sheraton Denver Downtown Hotel. View full descriptions and speaker bios, and add sessions to your personal schedule, at the SAEM20 Program Planner. Stay up to date on all that’s in store for you at the 2020 SAEM annual meeting by visiting (and bookmarking) the SAEM20 website — your essential source for all the latest annual meeting news and information.

Clerkship Director Boot Camp Workshop, May 12, 1–5 p.m.

This workshop will train writers and clerkship leaders who are members of the Clerkship Directors in Emergency Medicine (CDEM) on how to write multiple-choice questions and formative and summative assessments to use in emergency medicine clerkships. Training will be provided by CDEM leaders who possess experience in item-writing.

Consensus Conference: Telehealth and Emergency Medicine: A Consensus Conference to Map the Intersection of Emergency Medicine and Telehealth, May 12, 8 a.m.–5 p.m.

Designed to stimulate emergency medicine (EM) researchers and educators to recognize, investigate, and translate the impact of telehealth on the field of emergency medicine, the conference will include state-of-the-art didactics led by nationally recognized keynote speakers,

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breakout group planning sessions, and a consensus-building process. Specific topics to be explored are: healthcare access; quality and safety; educational needs and outcomes; research facilitation; and the impact of telehealth on the EM workforce.

Academic Wilderness Medicine Workshop, May 12, 8 a.m.–5 p.m.

Participants will learn the fundamentals of wilderness medicine (WM), practical ways to implement wilderness medicine curriculum, and innovative teaching modalities. The workshop will be taught primarily though interactive small group and design teaching modules.

Junior Faculty Development Forum, May 12, 9 a.m.–4 p.m.

In this forum for fellows and early-career faculty who have recently secured faculty positions within academic emergency departments, participants will have opportunities to engage with senior leaders in academic EM and develop strategies for promotion, productivity, and academic

Medical Students and Residents: Looking to find your perfect residency or fellowship? Explore residency and fellowship programs from across the nation, meet with current residents and fellows, ask questions, and seek application and interview advice, all in one convenient location! Residency and Fellowship Directors: Showcase your institution’s programs and recruit hundreds of medical students and emergency medicine residents looking to find their perfect residency or fellowship.

Register your institution today!

Grant Writing Workshop, May 12, 8 a.m.–5 p.m.

In this workshop, researchers at all levels of practice and training will learn grant writing from leaders in emergency medicine, obtain feedback on their draft grant proposals, and receive topic and method mentorship from senior emergency medicine researchers.

Be the Best Teacher: Clinical Teaching Educational Boot Camp, May 12, 8 a.m.–5 p.m.

Designed as a medical educator boot camp for clinical teaching. This workshop will cover the fundamentals of emergency medicine clinical teaching through facilitated discussions, application, and practice.

The Opioid Crisis and Children: How Do We Manage Pain and Protect Them from Harm? May 12, 8 a.m.–5 p.m.

Starting with best techniques to efficiently and easily measure pain across the pediatric age spectrum, this workshop will guide attendees through best evidence for medication options, new and innovative treatments, and how to implement pediatric pain management change.

Improve Your Educational Research: Medical Education Research Boot Camp, May 12, 1–5 p.m.

Designed to improve faculty skills in educational research, attendees learn how to develop well-designed study questions within an appropriate conceptual framework in order to present research with feasibility, meaning, and importance.

SAEM Leadership Forum, May 12, 8 a.m.–4 p.m.

Designed for all levels of aspiring leaders, this session will provide exposure to core leadership topics with an emphasis on experiential learning and practical application, including segments on emotional intelligence, strategies for successful leadership, and managing conflict.

Dodgeball, May 14, 5:30–7:30 p.m.

This grownup twist to the classic playground game pits emergency medicine residency teams from all over the country in an epic battle to the finish and the right to call themselves dodgeball champs.

EscapeWorks Denver, May 12, 7–9 p.m.

At Denver’s premier escape room, your puzzle-solving team will enter one of five unique, theme-based rooms: Murder at the Speakeasy, Zombie Outbreak, Egyptian Tomb, Casino Heist, or War Games. Each room is designed to provide a completely immersive experience. You’ll feel the pulse-pounding thrill of trying to break into a casino vault or being transported back to the time of prohibition and the excitement of finding your way into a gangster’s speakeasy. Within each room are puzzles, clues, and codes that must be deciphered as you race with your friends against a ticking clock. One hour, one room, one way out… Can you escape?

SAEM20 MedWAR, May 15, 8 a.m.–4 p.m.

Denver’s beautiful Chatfield State Park is the site of SAEM20 MedWAR (Medical Wilderness Adventure Race), a unique event that combines wilderness medical challenges with adventure racing. The

race is a tool for teaching and testing the knowledge, skills, and techniques of wilderness medicine, and for promoting teamwork and collegiality among competitors.

Speed Mentoring, May 13, 3:30–5:30 p.m.

Resident and medical student mentees will be matched into small groups of 5-10 attendings who share their interests for quick-fire, 10-minute mentoring sessions. Participants will have an opportunity to start new mentoring relationships with mentors from around the country as well as socialize with fellow residents and medical students

Speed Mentoring for Medical Educators, May 14, 11–11:50 a.m.

Similar to the popular speed mentoring event offered at previous SAEM annual meetings, this model for medical educators offers faculty an opportunity to engage in short discussions with mentors who have the expertise and significant experience in medical education. Participants will have an opportunity to sample potential mentoring relationships and identify a medical education mentor whose experience and personality aligns with their professional interests, desired career trajectory, and personality traits.

AWAEM/ADIEM Luncheon, May 13, Noon–1:30 p.m.

The Academy for Women in Academic Emergency Medicine (AWAEM) and the Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) are excited to announce the AWAEM/ADIEM Luncheon will once again be a part of SAEM’s annual meeting! The AWAEM and ADIEM Luncheon is an excellent opportunity to network with old friends and new, explore joint issues, and learn about the hottest topics in emergency departments.

Medical Student Symposium, May 14, 8 a.m.–3 p.m.

The Medical Student Symposium will include an overview of emergency medicine (EM) as a career choice and will discuss the residency application process for students with allopathic, osteopathic, international, and military backgrounds. This day-long symposium, presented by thought leaders in the specialty, will include specific discussions

about clerkships, away rotations, personal statements, the match process, and interviews. There will also be ample time for questions and discussions during a lunch with EM program directors and clerkship directors. The SAEM Residency and Fellowship Fair, which showcases residency and fellowship programs from across the nation, will immediately follow the MSS and is part of the registration fee for this session.

Building an Academic Department Within a Corporate Structure, May 12, 8 a.m.–Noon

This workshop will provide a framework of how to build an academic emergency department within a nontraditional structure, and/or with limited resources.

Participants will develop a roadmap with tangible targets for scholarly activity deployment in their departments.

Take and Bake: Low-cost Simulation Models and Techniques Taught by the Pros, May 12, 8 a.m.–Noon

This workshop will provide the knowledge, tools, and networking necessary to teach residents and faculty how to utilize cost saving techniques and create low-cost, low- to highfidelity simulation models for improving simulation training. Participant responses will contribute toward the validity evidence for each model discussed.

Poverty Immersion: A Novel Approach to Teaching the Social Determinants of Health, May 12, 8 a.m.–Noon

In this experiential poverty simulation workshop, learners will experience what it is like to be in the shoes of lowincome patients and feel the stress of time, resource, and financial limitations/ constraints. The session will be followed by a debrief to discuss the emotions evoked by the simulation and the understanding gained about the social determinants of health (SDOH). Following the debrief, attendees will discuss with faculty how to integrate the simulation into their existing curricula and how to teach about the SDOH.

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ACADEMIC ANNOUNCEMENTS Dr. Charles Gerardo Promoted to Rank of Professor at Duke University

Dr. Julian Hertz is Awarded NIH Pilot Grant from Duke University’s Center for AIDS Research

Charles Gerardo, MD, has been promoted to the rank of professor at Duke University. Dr. Gerardo is considered the foremost expert in copperhead envenomation. He led the Duke Emergency Medicine Acute Care Research Team in conducting the trial that established the only available antivenom treatment for Charles Gerardo, MD this condition and is an author on the majority of peer reviewed primary literature on the topic. He is a much sought-after speaker on the topic nationally and internationally, in both lay and academic venues, and continues to actively conduct clinical, translational, and health services investigation to improve outcomes for patients globally. During his 16 years at Duke University, he has played an integral role in all of the signature academic programs within emergency medicine and has served as a mentor for dozens of trainees and faculty.

Julian Hertz, MD, from Duke Emergency Medicine and the Duke Global Health Institute was recently awarded an NIH pilot grant from the Center for AIDS Research (CFAR) at Duke.

This one-year pilot grant will provide him with $60,000 to conduct a case-control study in northern Tanzania to assess the burden of Julian Hertz, MD prior myocardial infarction among persons living with HIV. The study will build off his prior work as an NIH Fogarty International Fellow studying misdiagnosis of myocardial infarction in Tanzania.

Dr. Ralph Riviello is Appointed Chair of the Department of Emergency Medicine at Long School of Medicine Ralph Riviello, MD, MS has been appointed chair of the Department of Emergency Medicine at the Long School of Medicine (LSOM), San Antonio, Texas. Dr. Riviello was previously the vice-chair of clinical operations for the Department of Emergency Medicine at Drexel University where he integrated three Ralph Riviello, MD, MS separate emergency medicine practice sites under the clinical responsibility of the department and expanded clinical trials research within the department, including several NIH-funded trials. Dr. Riviello also co-founded, and is the current medical director of, the Philadelphia Sexual Assault Response Center, where sexual assault victims can receive medical and forensic care by specially-trained clinicians. Dr. Riviello has successfully led initiatives to improve emergency department metrics and and advance the field of clinical forensic medicine.

Dr. Edwin Boudreaux and Tech Provider Q2i Receive NIH Grant to Develop New Digital Health Platform Edwin Boudreaux, PhD, a professor in the University of Massachusetts Department of Emergency Medicine, and Q2i, a provider of technology that helps improve care for individuals with opioid use disorder, have been awarded an NIH grant to develop and evaluate a digital health platform Edwin Boudreaux, PhD to increase engagement in medicationassisted treatment after an acute care visit. The intervention will incorporate a reward-based approach, referred to as contingency management, along with other innovative features that promote adherence to treatment.

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Dr. J. Jeremy Thomas to Chair the University of Louisville Department of EM Jarred Jeremy Thomas, MD, will assume the role of chair of the Department of Emergency Medicine at the University of Louisville effecive January 24, 2020. Dr. Thomas is presently professor and executive vice chair in the Department of Emergency Medicine, University of Alabama School of Medicine Jarred Jeremy Thomas, MD (Birmingham, AL). In addition, he is the director of emergency services and the director of observation medicine for UAB Hospital, where he also serves as assistant chief medical officer of emergency services and sepsis.

Dr. Steven B. Bird is Promoted to Chief Experience Officer at UMass Steven B. Bird, MD, immediate-past president of SAEM has been promoted to Chief Experience Officer (CXO) of the UMassMemorial Healthcare System and the University of Massachusetts Medical School. In his new role, Dr. Bird is responsible for creating and coordinating all physician Steven B. Bird, MD wellness and engagement activities across the system and school. Dr. Bird previously held the position of vice-chair of education and residency program director for nearly nine years.

Dr. Limkakeng Receives NIH U24 Grant to Develop Duke Pain Early-Phase Clinical Research Center Alexander T. Limkakeng Jr., MD, MHS, vice chief of research for the Duke Division of Emergency Medicine, and Francis Keefe, PhD., professor in the Department of Psychiatry and Behavioral Sciences. Received a NIH U24 grant (U24 NS114416-01) for approximately $1 million over five years to Alexander T. Limkakeng Jr., MD, MHS develop a clinical center research network to conduct Phase 2 trials of non-addictive pain interventions.

The clinical center, called the Duke Pain Early-Phase Clinical Research Center aims to enroll patients in trials in early 2020.

Dr. Bernard Chang is Awarded $3.9 Million From NIH to Study EM Physician Burnout Bernard Chang MD, PhD, assistant professor of emergency medicine at Columbia University Irving Medical Center, has been awarded a $3.9 million R01 grant from the National Institutes of Health as principal investigator (PI). His study, a longitudinal study of cardiovascular and psychological Bernard Chang MD, PhD risk (e.g. "burnout") among emergency physicians and nurses will be among the largest prospective studies of clinician health carried out. This will be Dr. Chang’s second R01 as PI since completing his emergency medicine training in 2012.

Dr. Erik Hess is Named Interim ED Department Chair at the University of Alabama Erik Hess, MD, MSc, is the new interim chair of the Department of Emergency Medicine at the University of Alabama at Birmingham (UAB). Dr. Hess, a physician-scientist, currently serves as a professor and as vice chair for research in the Department of Emergency Medicine. He previously served Erik Hess, MD, MSc for more than 12 years on the faculty of the Mayo Clinic in Rochester, Minnesota. Since his return to UAB in 2018, Hess has led and co-led several interdisciplinary clinical operations initiatives. He collaborated with the Division of Cardiovascular disease to establish an outpatient Chest Pain Transitional Clinic that provides a reliable method for urgent outpatient follow-up for emergency department patients with chest pain. As part of this initiative, he also implemented an evidence-based, patient-centered approach to risk stratification, risk communication, and shared decision-making in patients with low to moderate risk chest pain, known as the Chest Pain Choice Pathway. Dr. Hess recently received a $1.5 million grant from the Substance Abuse and Mental Health Administration to combat the opioid epidemic in Jefferson County, Alabama. Most recently, Dr. Hess was named to the Interdepartmental Substance Use Disorders Coordinating Committee by the secretary of the Department of Health and Human Services.

Duke EM Residency Coordinator Kim Brown is Named Recipient of ACGME Award Kim Brown, program coordinator for Duke University's emergency medicine residency, has been named by the Accreditation Council for Graduate Medical Education (ACGME) as a recipient of the Debra L. Dooley GME Program Coordinator Excellence Award. The award Kim Brown recognizes program coordinators among all medical specialties who have an in-depth understanding of the accreditation process, excellent communication and interpersonal skills, and projects to improve residency programs. She will be among five coordinators out of 11,200 programs honored during the ACGME 2020 Annual Educational Conference in February in San Diego, CA.

Duke promotes Dr. Catherine Staton to Associate Professor Catherine Staton, MD, MS, an assistant professor of surgery, emergency medicine, and global health at Duke University, has been promoted to the rank of associate professor. Dr. Staton is an injury-control researcher conducting work in low- and-middle income countries around the world. She established the KCMC Emergency Department Research Team at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, and is a mentor and team leader for the Global Health Section of Duke Emergency Medicine and the Duke Global Health Institute.

In addition to her work in Tanzania, Dr. Staton is a globally recognized scholar who has received several national awards for her research. To support this work, she has been awarded a coveted Gates Foundation grant as well as substantial federal funding. She has been the primary investigator on 14 grants totaling more than $4 million in direct funds, including a K01 grant from the NIH Fogarty International Center (1 K01 TW010000-01A1) and an R21 (TW010456-01A1) to study care transitions in Tanzania as well as its supplement to create a GRID: Global Repository for Injury Data.

Dr. Jeffrey Caterino Named Next Chair of The Ohio State University Department of EM Jeffrey Caterino, MD has been named chair of the Department of Emergency Medicine at The Ohio State University Wexner Medical Center where he is presently an associate professor of emergency medicine and internal medicine, vice-chair of research and chair of Evidence-Based Practice Jeffrey Caterino, MD Committee. He replaces Dr. Mark G. Angelos effective January 31, 2020. Dr. Caterino’s primary research interest is in geriatric emergency medicine with a specific focus in the diagnosis and treatment of geriatric infectious diseases. In 2010, he received an NIH K23 Paul B. Beeson Patient-Oriented Research Development Award in Aging from the National Institute on Aging, John A. Hartford Foundation, and American Federation for Aging Research. Dr. Caterino is an active member of SAEM'S Academy of Geriatric Emergency Medicine (AGEM) and has served as AGEM’s chair.

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NOW HIRING POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES! Accepting ads for our “Now Hiring� section!

Deadline for the next issue of SAEM Pulse is February 1.

For specs and pricing, visit the SAEM Pulse advertising webpage.

Department of Emergency Medicine University of North Carolina at Chapel Hill, Department of Emergency Medicine is currently recruiting for full-time faculty openings for 2020-2021.

Full-time faculty are currently being recruited with expertise in Administration, Research and Ultrasound.

Successful applicants will be Board Certified/Board Prepared in Emergency Medicine. UNC Hospitals is a 950-bed Level I Trauma Center. The Emergency Department sees upward of 70,000 high acuity patients per year.

Applicants should send a letter of interest and curriculum vitae to: Gail Holzmacher, Business Officer (gholzmac@med.unc.edu), Department of Emergency Medicine, Phone: (919)843-1400.

The University is an equal opportunity, affirmative action employer and welcomes all to apply without regard to age, color, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, or sexual orientation. We also encourage protected veterans and individuals with disabilities to apply.

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Emergency Medicine Fellowship Opportunities The Baystate Medical Center Emergency Department is a Level 1 Trauma center with 122,000 visits annually in an urban setting. We have a 3year EM residency with 14 residents per year. Clinical responsibilities are at BMC and affiliate hospitals. We offer positions to BC/BE emergency physicians who have completed an EM residency.

Research: We have a one-year Certificate Program or two-year Masters Degree fellowship in EM Research available through the University of Massachusetts Medical School. The program integrates training in clinical and basic science research with didactics in clinical and translational science through the University of Massachusetts School of Public Health and Health Sciences or through Tufts University Sackler School of Graduate Biomedical Sciences. The goal is to provide young investigators with the mentored experience and didactics necessary to become successful independent clinical or basic science investigators. Research is an integral part of Baystate Health. Last year, Baystate Health, as a whole, received research funding of $14+ million, $9.5 million of which was in federal funding.

Wilderness Medicine: One-year fellowship that provides training in the care of patients with limited access - often in extreme environments. We hope to recruit enthusiastic fellows interested in providing excellent medical care while studying in some of the most amazing places on earth.

Eight to ten weeks per year of protected travel time.

Ultrasound: One-year fellowship focused on expanding basic US skills gained in residency and learning new applications. Development of teaching skills is stressed, as are aspects of US program development including QA processes, hardware/network integration, documentation, billing, and purchase of equipment. The goal is to provide the tools necessary to become an effective US director.

Administration: A one- or two-year fellowship ideal for Emergency Medicine residency graduates with a particular interest in ED Administration.

The fellowship incorporates capstone and didactic classwork through the American College of Physician Executives and the University of Massachusetts Isenberg School of Management. Fellows gain exceptional training in Emergency Medicine practice quality improvement, finance, billing/coding, health policy, risk management, process improvement, leadership, operations, and staffing.

Education: A one or two-year fellowship focused on Emergency medicine education. The two-year track includes as masters of health care education. The fellowship will teach you the skills to be an effective educator with both practical and didactic level experiences. We hope to recruit fellow interested and growing their expertise as teachers.

Please visit www.baystatehealth.com for further information on Fellowships at UMMS-Baystate. Inquiries should be made to Tara Rivest at (413)794-5999 or Tara.Rivest@baystatehealth.org.

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MARK MITCHELL, DO, FACOEP-D, FACEP

Featured Leadership and Faculty Positions ■ Research Director and Simulation Director Brandon Regional Hospital Tampa Bay, FL

■

Research Director, Ultrasound Director and Core Faculty Ocala Regional Hospital Ocala, FL

■

Clnical Faculty

Osceola Regional Medical Center Kissimmee, FL

■

Clinical Faculty

St. Lucie Medical Center Port St. Lucie, FL

For more information, contact: 877.226.6059 Success@EnvisionHealth.com

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Exciting opportunities at our growing organization • Core Emergency Medicine and PEM Faculty positions • EM Medical Director • EMS Medical Director / EMS Fellowship Director • Vice Chair, Clinical Operations & Strategy Development • Vice Chair, Research Penn State Health, Hershey PA, is expanding our health system. We offer multiple new positions for exceptional physicians eager to join our dynamic team of EM and PEM faculty treating patients at the only Level I Adult and Level I Pediatrics Trauma Center in Central Pennsylvania.

What We’re Offering: • Salaries commensurate with qualifications • Sign-on Bonus • Relocation Assistance • Retirement options, Penn State University Tuition Discount, and so much more!

What We’re Seeking: • Core Emergency Medicine trained physicians with additional training in any of the following: Toxicology, Ultrasound, Geriatric Medicine, Pediatric Emergency Medicine, Research • Completion of an accredited Emergency Medicine Residency Program and Fellowship for PEM positions • BE/BC by ABEM or ABOEM • Observation experience is a plus

What the Area Offers: We welcome you to a community that emulates the values Milton Hershey instilled in a town that holds his name. Located in a safe familyfriendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences. We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC.

FOR MORE INFORMATION PLEASE CONTACT:

Heather Peffley, PHR FASPR at: hpeffley@pennstatehealth.psu.edu Penn State Health is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

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Opportunities in Academic Emergency Medicine TeamHealth is dedicated to the high quality training of residents and medical students, as well as offering superior continuing medical education for attending physicians and leaders. We have a long history of commitment to the graduate and continuing medical education processes. Join our team as an academic leader at one of these locations to become part of an organization focused on cultivating leaders and shaping the future of healthcare.

Assistant Program Director Coliseum Medical Centers in Macon, Georgia n Join the leadership team in planning and coordinating academic and operational activities of the emergency medicine residency program n Become part of the team in this key role to ensure program requirements are being met n Lead the team in delivering patient care at this 310-bed facility in middle Georgia

Assistant Program Director AdventHealth East Orlando in Orlando, Florida n Help lead a three-year accredited emergency medicine residency program n Join part of the AdventHealth System in delivering care to 600,000 patients per day n Ideal candidates should have at least three years of experience as core faculty with an ACGME emergency medicine residency program

Program Director Del Sol Medical Center — East in El Paso, Texas n Lead the development and implementation of a new emergency medicine residency program n Ideal candidates should maintain a current board certification by the American Board of Emergency Medicine n Previous experience as a motivated leader with at least three years of experience as a clinical administrator and educator in emergency medicine required

Join our team

teamhealth.com/join or call 866.650.1218

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TH-12383 2019 TH Visual Presence size: 7.5 x 9.75 non bleed pub: SAEM (DEC 2019)

BRIGHAM HEALTH

BRIGHAM HEALTH BRIGHAM HEALTH EMERGENCY MEDICINE ATTENDING EMERGENCY MEDICINE EMERGENCY MEDICINE ATTENDING PHYSICIAN: NOCTURNIST PHYSICIAN: NOCTURNIST

ATTENDING PHYSICIAN: NOCTURNIST The Brigham Health Department ofisEmergency Medicine is currently seeking a nocturnist The Brigham Department of Emergency Medicine Medicine currently is seeking a nocturnist The BrighamHealth Health Department of Emergency currently seeking a emergency physician for our two emergency departments, emergency medicine physician for medicine our two emergency departments, Brigham and Women’s Brigham and Women’s nocturnist emergency medicine physician for our two emergency departments, Brigham Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH). BWH is a 760-bed Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH). BWH is a 760-bed hospital and aofpillar teaching affiliate ofFaulkner Harvard Medical School.

It is a level 1 trauma and Women’s and Brigham and Women’s Hospital (BWFH).

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TheBWFH successful will have completed a 4-yearhospital residency The successful candidate will have completed a 4-year residency in emergency medicine orin aemergency medicine or a

EMERGENCY MEDICINE RESEARCH FACULTY EMERGENCYUniversity MEDICINE RESEARCH FACULTY of California University of California San Francisco San Francisco

3-year followed by at least year intoclinical practice, ability to work within an 3-yearsuccessful residency followed by atresidency least yearcompleted in clinical practice, abilityresidency work within The candidate willone have a one 4-year in an emergency integrated health system and easily transition between academic teaching and community The University of California, San Francisco (UCSF) Department of Emergency Medicine is recruiting integrated health and easily transition between teaching andincommunity medicine or a system 3-year residency followed by academic atforleast one year clinicalat practice, ability The Medicine University of California, San Francisco (UCSF) Department practices.

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Department of Emergency Medicine provides comprehensive emergency services to large local and

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UCSF Benioff Children’s Hospital opened in 2015 with a 19-bed emergency department. law. successful candidate law.

The will have completed a 4-year residency in emergency Zuckerberg San Francisco General (ZSFG), and UCSF Benioff medicine or a 3-year residency followed by at least one year in clinical practice, ability The Department of Emergency Medicine as the primary for a fully accredited 4-year We are actively committed increasing the diversity of our faculty; people with We aretoactively committed to and increasing the diversity of our faculty; people with Children’s Hospital Sanserves Francisco.

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This position is eligible for an academic appointment as a top hospital in the nation, has a 33-bed ED and a 10-bed therefore strongly encouraged to apply encouraged to apply therefore strongly EMS, global health, toxicology, research, pediatric emergency medicine, emergency ultrasound, and at Harvard Medical School. More information is posted https://fa.hms.harvard.edu/ Observation Unit.

ZSFG,is the only priority level 1oftrauma center with in San pediatric emergency ultrasound.

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Please applyHEALTH by confidential email to mdeloge@bwh.harvard.edu of other disciplines within pediatric EM. ThereED. are The substantial opportunities leadership Hospital and growth within the dedicated new UCSF BenioffforChildren’s BRIGHAM

EMERGENCY MEDICINE ATTENDING PHYSICIAN: NOCTURNIST Department andopened UCSF School of with Medicine.

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MEDICINE PHYSICIAN: NOCTURNIST consideration for employment without regard to race, color, religion, sex, national origin,

Board certification eligibility inof emergency medicine or pediatric medicine is required. disability status, Health protected Department veteran status, gender identity, sexual orientation, pregnancy The orDepartment Emergency Medicine servesemergency as the primary The Brigham of Emergency is currently seeking a The Brigham ofMedicine Emergency Medicine is currently adegree Candidates holding anseeking advanced or specialized training in Emergency research are preferred.

In addition to and pregnancy-related conditions orHealth any otherDepartment characteristic protected by law. teaching site for a fully accredited 4-year Medicine nocturnist emergency medicine physician for physician our two emergency departments, having excellent research skills, all applicants should excel in bedside teaching and have a strong ethic emergency medicine for our two emergency departments, We are activelynocturnist committed to increasing the diversity of our faculty; people with residency program, which currently has 56 residents and Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner ofand service to their patients and profession. disabilities, veterans, womenand and members of underrepresented minority and groupsBrigham are Brigham Women’s Hospital (BWH) Women’s Faulkner Hospital BWHtoisapply a 760-bed academic hospital and a pillar teaching fellowships in education, EMS, global health, toxicology, research, therefore (BWFH). strongly encouraged Hospital (BWFH). BWH is a 760-bed academic hospital and a pillar teaching University of California, San Francisco (UCSF) is one of the nation’s top five medical pediatric emergency medicine, emergency ultrasound, and schools and affiliate of Harvard Medical School. It is a level 1 trauma and burnThe referral center affiliate of Harvard Medical School. It is a level 1 trauma and burn referral center demonstrates excellence in basic science and clinicalResearch research, is global healthpriority sciences, pediatric emergency ultrasound. a major ofpolicy, the advocacy, and offers the full spectrum of medical and surgical specialties. BWFH is a 150medical education The San Francisco Bay Area is well-known for its great food, mild and offers the full spectrum of medical and surgical and specialties.

BWFHscholarship. is awith 150-over department 100 peer-reviewed publications each year. We bed community teaching hospital in Jamaica Plain. scenery, vibrant cultural environment, and its outdoor recreational activities. bed community teaching hospital in Jamaica Plain. climate, beautiful have a highly successful health services research group, particilate ONLINE AT: in multiple clinicalPLEASE researchAPPLY networks (i.e., PECARN, SIREN), and The successful candidate will have completed a 4-year residency in emergency The successful candidate completed in research emergency https://aprecruit.ucsf.edu/JPF02773 have expertise in a number of other disciplines within EM. medicine or a 3-year residency followedwill by have at least one yearain4-year clinicalresidency practice, medicine a 3-year residency followed by at least one year in clinical practice, There substantial opportunities for leadership and growth within ability to work within anorintegrated health system and easily transition between UC San Francisco seeksare candidates whose experience, teaching, research, or community service has ability to work within an integrated health system and easily transition between academic teaching and community practices. This position is eligible for them an tothe Department UCSF School of Medicine. prepared contribute to our and commitment to diversity and excellence. academic teaching and community practices.

This position is eligible for an academic appointment at Harvard Medical School.

More information is posted Board certification or Opportunity/Affirmative eligibility in emergency medicine or pediatric University of California is an Equal Action Employer.

All qualified academic appointment at Harvard Medical School. The More information is posted https://fa.hms.harvard.edu/files/hmsofa/files/738jr_bwh_inst.asst_.assoc_.emergmed.noct applicants will receive consideration for employment regard holding to race, color, religion, sex, sexual emergency medicine is required.without Candidates an advanced https://fa.hms.harvard.edu/files/hmsofa/files/738jr_bwh_inst.asst_.assoc_.emergmed.noct urnist_10-25-19.pdf orientation, gender identity, national origin, disability, age or protected veteran status.

All qualified degree or specialized training in research are preferred.

In addition urnist_10-25-19.pdf applicants are encouraged apply, including minorities For additional information, please to havingtoexcellent research skills,and allwomen. applicants should excel in visit our website at http://emergency.ucsf.edu/. bedside teaching and have a strong ethic of service to their patients and profession.

Specific targeted career websites, like 1 The University of California, San Francisco (UCSF) is one of the 1 EM Job Link, deliver the most highly qualified nation’s top five medical schools and demonstrates excellence in basic science and clinical research, global health sciences, policy, talent and have the best return on investment. advocacy, and medical education scholarship. The San Francisco Our candidates are made up of the specific Bay Area is well-known for its great food, mild climate, beautiful scenery, vibrant cultural environment, and its outdoor recreational professionals you want to reach. If you want activities.

Employers, are your recruiting efforts effective?

the best and brightest candidates, you need to go where they job search – EM Job Link. Along with posting your jobs in front of qualified candidates at EM Job Link, you can search our resume bank for talent as well.

Post today or speak to an expert who can help create a customized recruiting solution to get you great candidates.

PLEASE APPLY ONLINE AT: https://aprecruit.ucsf.edu/JPF02773 UC San Francisco seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence.

The University of California is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. All qualified applicants are encouraged to apply, including minorities and women. For additional information, please visit our website at http://emergency.ucsf.edu/.

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DIRECTOR OF EMERGENCY MEDICINE ULTRASOUND Emory’s Department of Emergency medicine Seeks a full-time faculty member to serve as Director of EM Ultrasound Applicants that will be considered are: •

Board certified in Emergency Medicine

•

Ultrasound fellowship trained

•

Eligible for medical licensure in the state of Georgia

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Committed to excellence in patient care, clinical operations, scholarship, and education

The successful applicant will join an academic faculty who are active in research, medical education, simulation, toxicology, EMS/prehospital medicine, global health and observation medicine. We are a department committed to wellness, diversity, equity, and inclusion. The Emory Department of Emergency Medicine directs four academic clinical sites with various learners: Emory University Hospital, Emory University Hospital Midtown, Grady Memorial Hospital and the Atlanta VA Medical Center and two primarily clinical sites at Emory Saint Joseph’s Hospital and Emory Johns Creek Hospital. This position provides competitive compensation, an excellent benefits package and the opportunity to join committed faculty members and outstanding residents who are dedicated to academic excellence.

Apply Here https://faculty-emory.icims.com/jobs/47066/job

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