SAEM Pulse January-February 2021 by Society for Academic Emergency Medicine

JANUARY-FEBRUARY 2021 | VOLUME XXXVI NUMBER 1

www.saem.org

SPOTLIGHT GLOBAL PIONEER OF EMERGENCY MEDICINE An Interview with

Richard E. Wolfe, MD

ADVICE FOR CONTRACT NEGOTIATIONS FROM A HEALTH CARE ADMINISTRATOR TURNED PHYSICIAN - PART I page 56

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 Manager, Accounting Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Michelle Aguirre, MPA Ext. 205, maguirre@saem.org Director, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Journals and Communications Tami Craig Ext. 219, tcraig@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 Senior Manager, Development for the SAEM Foundation Julie Wolfe Ext. 230, jwolfe@saem.org

HIGHLIGHTS Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Specialist, Membership Recruitment Berenice Lagrimas Ext. 222, blagrimas@saem.org Membership & Meetings Coordinator Monica Bell, CMP Ext. 202, mbell@saem.org Meeting Assistant Maja Keska Ext. 218, mkeska@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 Tami Craig Ext. 219, tcraig@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Associate Editor, Pulse RAMS Section Aaron R. Kuzel, DO, MBA aaron.kuzel@louisville.edu

President’s Comments Welcome to 2021!

Global Emergency Medicine COVID-19 Community Interventions Task Force: Building Bridges Between EM and Community Health Centers

Spotlight Global Pioneer of Emergency Medicine An Interview with Richard E. Wolfe, MD

Meeting at the Crossroads Where Telehealth, Behavioral, and Psychological Interests Meet in Emergency Care

Infectious Diseases and Epidemics Emergency Departments Can Bolster Influenza and Covid-19 Vaccination Programs

2021: New Year Preview

Research in Academic EM Teaming up With Your Inside Advocate: Working With NIH Program Officers for Early- and Mid-Career Investigators

Careers in Academic EM Emergency Medicine Careers: An Update on the Academic vs. Private Pathway

Wellness & Resilience Save of the Month! An Initiative for Improving Resident Wellness Through Gratitude

Hosting Zoom Webinars for Residency Recruitment

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Angela M. Mills, MD Secretary Treasurer Columbia University

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

Ian B.K. Martin, MD, MBA Immediate Past President Medical College of Wisconsin

Christopher R. Carpenter, MD, MSc Washington University in St. Louis School of Medicine Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Michelle D. Lall, MD Emory University Nehal Naik, MD George Washington University

Ava Pierce, MD UT Southwestern Medical Center, Dallas

An Unprecedented Year, An Unstoppable SAEM

Bye, Bye 2020! SAEM Rings in a New Year

SGEM: Did You Know? Sex and Race Matter in Terms of Diagnostic Studies and Treatments Received

Clerkship Directors in EM Mitigating Bias in Evaluations in Medical Education

Climate Change and Health The Year in Review

Disaster Emergency Medicine What Does a Disaster Medicine Doctor Do?

Diversity and Inclusion (Un)Learning What Matters: Dismantling and Restructuring Antiracism Curricula Into an Integrated Framework

Ethics in Action Ethics and Autonomy: Toward Justice in Precision Emergency Medicine

Geriatric Emergency Medicine Palliative Care Resources for COVID-19 Field Hospitals

2020–2021 BOARD OF DIRECTORS James F. Holmes, Jr., MD, MPH President University of California Davis Health System

2020: The Year in Review

Advice for Contract Negotiations from a Health Care Administrator Turned Physician - Part I

Using Virtual Simulation to Bridge the Gap in Medical Education During the COVID-19 Pandemic

Perspectives on a Pandemic

Briefs and Bullet Points

Academic Announcements

Now Hiring

Jody A. Vogel, MD, MSc, MSW Denver Health Medical Center University of Colorado 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 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2021 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 James F. Holmes, Jr., MD, MPH UC Davis School of Medicine 2020–2021 SAEM President

Welcome to 2021!

“I am incredibly thankful for the work that our members and staff did during this pandemic to keep SAEM successful.”

Although starting somewhat innocuously, 2020 quickly became a year we will never forget. A global pandemic centered the spotlight directly on emergency care providers. We faced a pathogen that quickly disrupted and altered not only our ability to care for patients in the emergency department, but our lives in general. Medical education activities went virtual. Emergency care research was put on hold unless it involved COVID-19, and then our Institutional Review Boards acted in record time. Zoom went from a novel, rarely used, tool to an integral part of our everyday lives. We were flexible, innovative, and continued to provide outstanding care to the patients we serve. SAEM was similarly impacted by COVID-19. While many organizations have struggled and most canceled their spring meetings, we adapted and held a very successful virtual meeting in May, much of it focused on COVID-19. We introduced Zoom meetings for all our groups. We held a record number of webinars, including cutting-edge presentations on COVID-19 and a very successful virtual residency and fellowship fair. I am incredibly thankful for the work our members and staff did during

this pandemic to keep SAEM successful. We are now in the process of receiving a COVID-19 vaccine developed in record time. Although we continue to deal with COVID-19 infections, a realistic chance for the end of this pandemic now exists. With this new enthusiasm, let me ask everyone to make a New Year’s resolution that benefits both you and SAEM and thus, the patients you serve. SAEM offers many opportunities for your professional development and career advancement at all stages of your career. I implore you to make a resolution to take advantage of one of the many available SAEM opportunities. I also urge everyone to consider a donation to the SAEM Foundation. Donations to the SAEM Foundation have ignited many successful research careers, including mine. With your increased support, we look forward to a great 2021!

ABOUT DR. HOLMES: James F. Holmes, Jr., MD, MPH, is professor and vice chair for research in the department of emergency medicine at UC Davis School of Medicine.

SPOTLIGHT

GLOBAL PIONEER OF EMERGENCY MEDICINE An Interview With Richard E. Wolfe, MD Dr. Wolfe grew up in Paris and graduated from the Faculté de Médecine Necker-Enfants Malades, France, in 1984. He moved to the United States in 1984, trained for one year in internal medicine at Saint Joseph’s Hospital and for three years in emergency medicine at Denver General Hospital. In addition to working for six years as an emergency medicine attending, he became associate residency director and then residency director for emergency medicine at Denver General Hospital. Dr. Wolfe was recruited to Boston in 1994 to create the Harvard Affiliated Emergency Medicine Residency for Brigham and Women’s Hospital/Massachusetts General Hospital. This was the first emergency medicine residency affiliated with Harvard Medical School. In 1999, Dr. Wolfe became chief of emergency medicine at the Beth Israel Deaconess Medical Center. He is also an associate professor of emergency medicine at Harvard Medical School and chair of the department of emergency medicine at Harvard Medical School. Under Dr. Wolfe’s leadership, the emergency department at Harvard Medical Faculty Physicians (HMFP) has grown into a multi-institutional network seeing more than 350,000 patients a year. It hosts some of the leading experts in the management of sepsis, post-arrest resuscitation and emergency preparedness. His department also has become nationally renowned for its innovative uses of information technology to improve emergency care and to allow seamless communication with multiple hospitals and physician groups. He has remained active in global health, overseeing Beth Israel Deaconess Medical Center's response to the Haitian disaster and personally leading one of the teams providing emergency care to earthquake victims and leading the efforts during the Boston Marathon bombing. Dr. Wolfe is a board member for the Society for Academic Emergency Medicine (SAEM) and has served on numerous SAEM committees, including as a former chair of the SAEM Finance Committee. He is a previous member of the SAEM Foundation (SAEMF) Board of Trustees and is an SAEMF Annual Alliance donor. Among Dr. Wolfe’s areas of expertise are innovative approaches to the management of shock and sepsis, and emergency management of trauma patients.

How is it that you ended up studying medicine in Paris? When was the last time you were in Paris? Do you speak French and if so, how fluent are you? What is your favorite memory from your time in France? Is there anything you miss about the French culture? Although I was born in the United States, I spent my formative years in France. When my mother graduated from law school, she found it hard to find work as a woman and she moved her family to Paris. I was 10 years old and had to switch languages and cultures. Although I missed baseball and root beer, I quickly adapted to cheese and wine and French logic. After high school, I decided that I wanted to spend my life in France and started medical school there. I was 19 years old. I remember one day, as a young and poorly trained medical student, I was left alone in the emergency department (ED) at a small community hospital. The only other provider, a supervising resident, had left the ED to repair his car. In those days, emergency departments were not staffed with attending physicians who felt this sort of work was beneath them. As I was suturing a scalp wound, an elderly woman presented in shock with a wide complex tachycardia. I yelled for help, but the resident could not be found. Trying hard to keep my growing panic under control, I performed my first cardioversion and started an amiodaron drip. The patient cooperated and flipped back into a sinus rhythm with normal vital signs. The next day, the head of geriatrics showed me his appreciation by promising me a job, but that first exposure started me on a path that I have never left. I came to the United States with a plan to train in the specialty and then return and start it in France; however, my attempts at getting any hospital to consider this innovation were rejected with scorn. It took another 20 years before France was ready to consider that emergency medicine was a specialty. The thrill of acting quickly and saving a life triggered a love for the practice of emergency medicine; however, it was not easy to train as an emergency physician in France. The specialty did not exist, but I thought I might be able to help start it. I had a pretty good role model so the idea came easily. My favorite uncle was a physician in the United States and one of the pioneers in starting academic emergency medicine. I told him what I was thinking, and he urged me to come out and rotate in his department in Denver. When Peter Rosen is able to influence you from birth, it is hard to choose to do anything else. He gave me my first exposure to emergency medicine years before medical school. When I was 14, I spent my summer vacation with him in Wyoming. In those days, he was the only board-certified surgeon in the state and covered most of the surgical emergencies over hundreds of square miles. He had a heart as big as the state and took this strange French kid under his wing. I would get to drive his pickup when he was called to the local emergency room and help him in the hospital. There wasnâ&#x20AC;&#x2122;t much compliance or many rules back then. Under his supervision, I examined patients, sutured wounds and received my first lessons in anatomy at the bedside. I still remember the first patient he had me see. It was a rough looking character, altered and cursing as he writhed with abdominal pain on the gurney. Peter asked me to examine him and then provide a diagnosis. Using what I knew from novels and movies, I suggested appendicitis. He laughed, told me the only problem the patient had was that he was drunk. Afterwards, he went through the differential over steaks and then talked about medicine and life. It was glorious.

If you werenâ&#x20AC;&#x2122;t doing what you do, what would you be doing instead? To be honest, I was a total nerd when I was young. I was okay at basketball, but I was really good at mathematics and chess. I also taught myself to code and, in medical school, wrote software to help pay my way through medical school. So emergency medicine saved me from a life in informatics. I might have made a lot more money, but I would not have been anywhere near as happy.

Looking back, what advice would you give to your younger self, just starting out in this specialty? Hard work, honesty, and humility are the secrets to success. Genius is one percent inspiration and 99 percent perspiration. It also makes it easier to learn from your mistakes if you are able to laugh at yourself.

Youâ&#x20AC;&#x2122;ve had many experiences over your long and illustrious career that have shaped you as a physician and person. Are there any, in particular, that stand out and why? In 2010, I went to Haiti with a team from my department. This was one week after an earthquake had devastated Port au Prince, killing hundreds of thousands of people. We joined a group in a field hospital and were given leadership responsibility to oversee the cases of roughly 300 injured patients, 40 of whom were critical and many of these children. My medical team was made up of two of our best nurses, my operations director, Leon Sanchez, and one of our best EM/critical care attendings, Michael Cocchi. We were able to stabilize the most acute, move the walking wounded across the border to a new rehab center, and ultimately evac by Blackhawks the critical patients to a tertiary hospital, two mountain ranges away. We only lost one patient. It was a validation that the training and practice worked in the most adverse environments and allowed us to make a huge difference in patients who desperately needed our help. continued on Page 6

continued from Page 5 With Ron Walls, I was one of the founding chairs of the academic department at Harvard, an epic voyage that took us more than 20 years of hard work and advocacy, but I am most proud of having been part of that milestone for our specialty.

I am worried that many people will refuse to be vaccinated because of misinformation and fear. I'm most worried that this might happen with underrepresented minorities because of the terrible history in this country that gives them a justifiable mistrust in our health care system.

The most significant change has been in how emergency medicine is viewed by other specialties. Early on, we achieved the first step to academic excellence, which is clinical excellence. That was never in doubt. We also were superb educators. But no one believed we could do serious research or that there was a science of emergency medicine. In the last 30 years, we have disproven that bias against us. The quality of our research, which extends from bench to bedside impact as well as in the public health sector, has demonstrated that we are a powerful young medical specialty.

Aside from the pandemic, what do you think are the most pressing issues in emergency medicine today?

How is the COVID medical crisis different from others you’ve faced? COVID has exerted an unparalleled blow on the health of our population, the stability of the economy, and the trust in our health care system. In some parts of the country, the health and wellness of our physicians was battered by a surge of illness without the resources needed to provide safe and effective care. In other areas, we experienced dramatic reduction in the emergency workloads because patients were afraid of catching the disease and delayed care, resulting in preventable harm. The job market has become extremely difficult for this year’s graduates, who will be critically needed in the future to care for the aging population.

SAEM PULSE | JANUARY-FEBRUARY 2021

I believe that the vaccination is the first and most important step toward securing herd immunity, saving millions of lives, and putting an end to this nightmare.

What are the most significant changes or advances that you have seen in emergency medicine in the past 30 years? What do you see as the future of emergency medicine?

From a personal standpoint, I was one of the first adopters of bedside ultrasound in the emergency department. From the early days, when I was repeatedly threatened with dismissal and bodily harm by the chair of radiology at the University of Colorado, I have seen this diagnostic tool become an integral part of our practice.

Your department is one of the first to receive the COVID vaccination… What are your greatest hopes and biggest fears around this vaccine?

On a positive note, the pandemic has taught us how to function virtually in a way we never thought possible. I hope that this may lead to new ways to improve access to care, better dissemination of information, and greater academic productivity in the future.

Before the pandemic, we already knew the cost of care in this country was excessive and the access to care was inequitable. The coronavirus has made it clear that we need health care reform to find a way to end what amounts to rationing of the care needed by vulnerable populations such as the elderly and those suffering from mental disease. We need to design a system where emergency medicine can help ensure the best and fairest health care to all who need us.

What advice would you give mid-career faculty who are contemplating a career as a chair? What do you think are some of the similar challenges or opportunities a new chair may face? To be able to get a job as chair one needs to establish an area of expertise that is needed and write about it as much as possible. To be able to do the job, one needs to care passionately about our mission to the patients and the faculty who will report to you. To be a good chair, you need to be willing to embrace self-sacrifice for your faculty and lead by example. You should be willing to dedicate long hours and realize that a lot of what you do will be mind-numbingly boring but essential to ensure your department remains well supported and a good place to work

What is the most important lesson life has taught you so far? Humility and good listening skills are the best survival traits.

At the end of your career, how would you like to be remembered? He made a difference in the development of the specialty of emergency medicine.

Up Close and Personal

A song you’ll find me singing in the shower is… I got friends in low places.

In high school I was voted most likely to... I attended high school in France. The very concept of being voted most likely for something would, if attempted, be scorned. If implemented, it would result in a mix of sarcastic, grotesque, and vulgar suggestions.

Who would play you in the film of your life and what would that film be called? Robin Williams. “We’re Just Here to Help: The War for Emergency Medicine ”

One quote I live by is… “An appeaser is one who feeds a crocodile – hoping it will eat him last.” Winston Churchill

Name a book you’ve read that has had a lasting effect on you? “Homage to Catalonia” by George Orwell

Who would you invite to your dream dinner party? Samuel Clemens (aka Mark Twain)

â&#x20AC;&#x153;I believe that the vaccination is the first and most important step toward securing herd immunity, saving millions of lives, and putting an end to this nightmare.â&#x20AC;?

THE YEAR IN REVIEW

An Unprecedented Year, An Unstoppable SAEM It just might be the understatement of the year to say that 2020 has been “uniquely trying.” A global pandemic and worldwide lockdowns, racial strife and injustice, the effects of record-breaking wildfires, and a divisive election. Although it didn’t turn out to be the year we envisioned back on January 1, 2020, there have been many bright and shining moments for SAEM.

SAEM PULSE | JANUARY-FEBRUARY 2021

The Brightest Among Us

To begin, we say “thank you” to our amazing members, whose courage and fortitude continued to shine bright in the face of unimaginable challenges. The sacrifices you make every day are worthy of respect and gratitude, but you deserve an extra measure of gratitude this year for your extraordinary commitment to caring for the most vulnerable in our society and elevating the human condition during this time of great need.

Forward Toward a Bright Future Though faced with a series of challenges that no one could have envisioned, your SAEM leadership and staff took it in stride, adapted quickly to the new normal, and navigated forward through challenge after challenge to set SAEM up to accelerate out of the unpredictable present and into a very bright, promising, and solid future. We invite you to explore select highlights and successes from this extraordinary year.

JANUARY SAEM Publishes New Membership Guide Part of the society’s new member onboarding initiative, SAEM publishes a Membership Guide, which highlights all the programs, services, and opportunities the Society offers its members, takes new members through the ins and outs of the organization, shows them the ropes, and gives all members the tools and information to make the most of their SAEM membership… all in one fun, easy-to-use, interactive format.

Annual Meeting Program Committee Announces Pediatric EM Opportunities at SAEM20

Special SAEM19 Proceedings Issue of AEM Education and Training is Published

The SAEM Annual Meeting Program Committee announces that SAEM will be expanding the annual meeting’s pediatric educational content and networking opportunities beyond anything offered before — a welcome development for academic EM physicians with a specialty interest in pediatrics and anyone interested in further exploring the subspecialty of pediatric emergency medicine!

Academic Emergency Medicine Education and Training (AEM E&T) publishes a special, supplemental issue of Academic Emergency Medicine Education and Training (AEM E&T), “Proceedings from the 2019 Society for Academic Emergency Medicine Annual Meeting.”

MARCH

nurses, physician assistants and first responders providing direct care to patients potentially infected with the novel coronavirus (COVID-19) to be provided with adequate personal protective equipment (PPE).

SAEM20 in Denver is Canceled After thoughtful deliberation, the SAEM Board of Directors decides that it is proper and prudent to cancel SAEM20, which was to have taken place May 12– 15 in Denver, Colorado. The SAEM staff, leadership, and Annual Meeting Program Committee immediately begin to explore ways that SAEM20’s educational content can be provided in a virtual format.

SAEM President Dr. Ian B.K. Martin Releases the Society’s First COVID Messaging

AWAEM Publishes a Toolkit for Women in Academic EM The SAEM Academy for Women in Academic Emergency Medicine publishes their new Toolkit — a helpful digital guide offering help and resources for the challenges and opportunities which arise for women in academic emergency medicine.

FEBRUARY SAEM Announces Formation of an Advanced Research Methodology Evaluation and Design in Medical Education Course SAEM announces a new ARMED MedEd course, set to launch in February 2021, and developed to build upon the fundamental knowledge and skills of education researchers and equip them to design a high-quality medical education research project and grant proposal. Five SAEM academies — ADIEM, AEUS, CDEM, GEMA — and AGEM, commit funds for ARMED MedEd scholarships.

Within days of COVID-19 being officially declared a national emergency, 2019–2020 SAEM President, Dr. Ian B.K. Martin, sends words of gratitude and encouragement to our courageous members who are serving on the front lines of the emerging, evolving crisis: “In these times, more than ever before, I am proud to be an emergency physician and honored to be your Society president”…. (Full text).

Emergency Medicine Organizations Publish Joint Letter of Solidarity SAEM, along with eight emergency medicine organizations, issues a joint statement entitled “Solidarity of Purpose,” which is intended for public distribution. The joint letter addresses what the public can do to join with emergency medicine providers to confront COVID-19, mitigate the pandemic, and minimize the loss of life.

SAEM and AAEM Issue Position Statement on Protections for EM Physicians During COVID-19 SAEM, together with the American Academy of Emergency Medicine (AAEM), issues a statement that supports the right of all physicians,

SAEM Launches “Stay at Home” Initiative SAEM jumps on the national bandwagon aimed at slowing the spread of COVID-19 with their own version of “I stayed at work for you; please stay at home for me” signs. PDFs of the message are e-mailed to the Society’s members who are asked to take photos of themselves holding the signs and share them widely on social media. SAEM staff move their offices to their personal living rooms and all of SAEM now operates virtually.

The SAEM Foundation Issues Automatic Six-month Extensions for Grantees The SAEM Foundation, recognizing that the COVID-19 pandemic is having a significant effect on emergency care and emergency care research, offers an automatic six-month extension to all SAEM Foundation grantees.

SAEM Academies Introduce a New Academic Promotion Toolkit An Academic Promotion Toolkit, endorsed by seven SAEM Academies, is published as a “Quick Guide to Promotion for the

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2020 continued from Page 9 Uninitiated.” The guide provides a brief, pragmatic approach to the promotion process and a useful framework to help assistant professors reach the associate professor milestone.

Altmetric Score of AEM Paper Published in 2006 Surges With COVID-19 to the Highest Ever for an SAEM Journal Way back in 2006, Drs. Greg Neyman and Charlene Babcock connected four simulated patients to a single ventilator. Using common parts available in just about any hospital, they installed “T-tube” splitters on the inflow and exhaust tubes. They tested this with lung simulators and found that the system worked. They wrote a paper about it called A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge submitted it to Academic Emergency Medicine journal where it was accepted and published. Flash forward 14 years. The world is at the beginning of a COVID-19 pandemic and health care providers worldwide are struggling with more than one patient needing ventilation, and not enough ventilators to go around. This paper suddenly makes a comeback and is tweeted all over the world, boosting its Altmetric score to 3011, the highest score ever for an AEM paper.

SAEM PULSE | JANUARY-FEBRUARY 2021

APRIL

standardization, telemedicine, followup programs, communications, faculty affairs, and leadership.

SAEM Announces SAEM20 Will Take Place Virtually Days after announcing the cancellation of SAEM20, which was to be held inperson in Denver, SAEM announces that the annual meeting will be held virtually, with much of the educational content to be presented in a virtual and/or online format and other events postponed until a later date.

SAEM Issues Position Statement on COVID-19 Given the rapidly changing COVID-19 pandemic and its impact on emergency care education and research and disruption of usual emergency department operations, SAEM issues a position statement that addresses the Society’s position regarding clinical care, education and training, research, and professional development.

SAEM Issues Position Statement in Support of Adequate PPE in the Emergency Department In response to a growing shortage of and need for personal protective equipment, SAEM issues a statement that strongly supports adequate protections for the health and safety of emergency medicine physicians, advanced practice providers, nurses, and staff.

SAEM Holds First COVID-19 National Grand Rounds Webinar As US COVID cases rapidly rise, medical leaders from Columbia University, Weill Cornell Medicine, and NewYork–Presbyterian present the SAEM National Grand Rounds Webinar, “COVID-19 Response: Lessons Learned from an Academic Health System in New York City.” The webinar is watched by more than 1,000 viewers from around the world and addresses preparation paradigm, care

management at the George Washington University Milken Institute School of Public Health, is selected to present the COVID-19 Keynote Address, Emergency Physicians and Public Health Providers: The New Pandemicists at the SAEM20 Virtual Meeting. Dr. Wen, a frequent contributor to the Washington Post, NPR, CNN, MSNBC, and PBS, is one of TIME magazine’s “100 Most Influential People,” and Modern Healthcare’s “50 Most Influential Clinician-Executives.”

Dr. Jonathan Sherbino Selected to Present Medical Education Keynote at SAEM20 Virtual Meeting Award-winning instructor and clinician educator, Jonathan Sherbino, MD, MEd, is selected to present the SAEM20 Virtual Meeting Medical Education Keynote Address, “Efficiencies in Education: How to Hack Educational Training to Get From 10,000 Hours to 100 Hours.” Dr. Sherbino is assistant dean, health professions education research and professor of medicine at McMaster University, Ontario, Canada and cohost of the KeyLIME (Key Literature in Medical Education) podcast.

SAEM Pilots a New Research Resource From SAEM: Collaborator Connection SAEM introduces a new Collaborator Connection database to connect researchers across the country on projects of mutual interest.

SAEM Presents a Second COVID-19 National Grand Rounds Webinar

Dr. Leana Wen is Named SAEM20 Virtual Meeting COVID-19 Keynote Speaker Leana Wen, MD, MSc, a visiting professor of health policy and

In a webinar entitled “From Katrina to COVID-19: Emergency Care for the Underserved During Times of Crisis,” medical leaders from Louisiana State University Health Sciences Center (LSU Health) New Orleans share their experiences and lessons learned in treating the underserved during the COVID-19 pandemic.

9,000 Viewers Tune Into Historic SAEM Virtual Annual Meeting

SAEM Journals Fast Track COVID-19 Papers, Create Online Repositories To facilitate the rapid dissemination of COVID-19 findings, Academic Emergency Medicine and AEM Education and Training fast-track submissions related to COVID-19 and make the latest research available in an AEM Online COVID-19 Collection and an AEM E&T Online COVID-19 Collection of accepted, citable COVID-19 articles.

Dr. Kim Bambach from The Ohio State University Wins the RAMS 2020 Video Contest The winning video in the SAEM RAMS 2020 Video Contest is submitted by Kim Bambach, MD, of The Ohio State University Wexner Medical Center, around the topic “What makes academic emergency medicine the best field of medicine to practice?”

SAEM Foundation Announces Grant Funding for COVID-19 Research in Emergency Care The SAEM Foundation announces a new funding opportunity for emergency care providers to study the COVID-19 pandemic with plans. $50,000 in grants of various sizes are made available to research the diagnostics, safety, therapeutics, disaster preparedness, or other aspects of emergency patient care during the COVID crisis.

MAY SAEM and ACEP Issue Joint Statement on Research During COVID-19 In the spirit of disseminating best practices, and to provide a consensus on the conduct of emergency medicine research during the COVID-19 pandemic, SAEM, together with ACEP, issues a joint statement of recommendations to investigators, departmental research administration, grantors, institutional offices, and professional organizations.

SAEM Foundation Committee Challenge is Extended to Include Academies and Interest Groups In 2020 the annual SAEM Foundation Committee Challenge is expanded to include SAEM interest groups and academies. The end result is $20,370 pledged to support academic research in emergency medicine.

SAEM20 was to have taken place May 12–15 in Denver, Colorado…and then COVID-19 arrived and much of life, including SAEM’s annual meeting, is suddenly disrupted. In the “cando” spirit of emergency medicine, SAEM pivots, applies a lot of creative thinking and quick decision-making and 18 days later, opens registration to the SAEM20 Virtual Meeting. For many of those disappointed at the lost opportunity to present their research, educational innovations, and/or didactics at SAEM20 in Denver, the virtual annual meeting is a welcome workaround. What the virtual meeting misses with respect to the usual in-person networking activities and experiential learning events, it more than makes up for in high-quality, timely, and relevant educational content… And it does so while helping to “flatten the curve” and safeguarding the health, safety, and well-being of all who serve on the front lines. In all, over 9,000 tune in to watch, and in some cases participate, in four full days of educational programming.

Dr. James Holmes Installed as 2020-2021 SAEM President James F. Holmes, Jr., MD, MPH, is installed during the SAEM20 Virtual Meeting as the Society’s 2020–2021 president. In his acceptance speech, which is broadcast over SAEM social media, he acknowledges the unprecedented changes in emergency medicine, health care, and members’ personal lives as a result of the COVID-19 pandemic and the ongoing concern and preparation for a probable coming second wave. He commends SAEM staff, leadership, and members for adapting quickly to the new environment created by COVID and uses his platform to address the challenges of these uncertain times while reinforcing the Society’s support of medical students, persistence in promoting diversity and inclusion, and pledges to advance emergency care research. He concludes his comments with a poignant video dedicated to our SAEM Front Line Heroes.

Dr. Judd Hollander Headlines Special COVID-19 Session on Telehealth Judd Hollander, MD, presents a keynote address, “EM and Telehealth: Virtually Perfect Together,” to open a special SAEM20 COVID-19 session: “Telehealth in EM During the COVID Crisis: Lessons Learned” in which leading experts share lessons they’ve learned using telehealth during the COVID-19 pandemic.

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2020 continued from Page 11 COVID-19 Special Sessions In response to the outbreak of the COVID-19 pandemic, SAEM presents three special sessions during the SAEM20 Virtual Annual Meeting that address the pandemic from three different focal points: Diagnostics, Therapeutics, and Rebuilding After the COVID-19 Shutdown: Choices for the Healthcare System.

RAMS Present Webinar on Resident and Medical Student Education and Research in the Era of COVID-19 During the SAEM20 Virtual Meeting, SAEM’s Residents and Medical Students (RAMS) present a special session: Maintaining Momentum: Resident and Medical Student Education and Research in the Era of COVID-19. The webinar provides information for navigating present challenges and capitalizing on expected opportunities related to planning an EM career during COVID-19.

SAEM Signs Consensus Statement Regarding the 2020-2021 Residency Application Process SAEM, RAMS, and SAEM’s Clerkship Directors in Emergency Medicine (CDEM) academy join several other emergency medicine organizations in issuing a statement that affirms their agreement with the Coalition on Physician Accountability (CoPA) guidelines regarding COVID-related issues faced by the medical school class of 2021. The letter also offers advice on how to operationalize these guidelines within emergency medicine.

SAEM Announces 2020 Award Winners SAEM announces and congratulates the recipients of its annual awards given in recognition of exceptional contributions to emergency medicine and patient care through leadership, research, education, and compassion. The slate of SAEM awards includes three new awards for 2020: Mentor Award, new Fellow Awards, and RAMS URiM Education Award.

SAEM Releases Statement on the Death of George Floyd In the wake of the police killing of George Floyd, SAEM, in a statement released to the public, joins those calling for reforms on the use of deadly force by law enforcement, the review of discriminatory practices, and justice for those whose lives have been taken as a result of racism targeting people of color.

SAEM PULSE | JANUARY-FEBRUARY 2021

JUNE

RAMS Webinar Gives Advice to Applicants for Navigating the Unprecedented 2020-2021 ERAS Application Cycle SAEM Pulse Publishes Special COVID-19 Issue SAEM proudly presents a special COVID-19 issue of SAEM Pulse. The issue is the Society’s largest ever and contains more than 25 articles covering timely COVID-19 topics including a Spotlight interview with COVID-19 survivor Dr. Dara Kass, who talks about the critical role of academic emergency medicine physicians in directing COVID-19 messaging.

A new webinar from RAMS, Advising Applicants for the 2020-2021 ERAS Application Cycle, addresses the unprecedented application season for emergency medicine-bound applicants and discusses many of the current ongoing topics of concern, including canceled away rotations, SLOEs, nonSLOE letters of recommendation, how to strengthen applications, and more.

SAEM Chief Resident Forum Goes Virtual The SAEM Chief Resident Forum (CRF),

the premiere annual training event for up-and-coming chief residents, moves to a virtual platform for 2020. Emergency medicine leaders from across the country introduce incoming chief residents to key leadership lessons that will help them succeed in this unique role and benefit them throughout the upcoming year and beyond.

X Waiver Training Moves Online SAEM offers online emergency department (ED)-specific X waiver training, which is required by physicians before applying for a waiver to prescribe buprenorphine — one of three medications approved by the FDA for the treatment of opioid use disorder (OUD).

SAEM Signs Joint Statement in Support of the Mental Health of EM Physicians SAEM signs a joint statement that outlines steps to support the mental health of emergency physicians and other health professionals currently risking their lives to treat patients during the COVID-19 pandemic.

RAMS Introduces a New “Biosketch” Podcast Series An interview with Dr. Bernard Chang is the first podcast in a new biosketch series from SAEM Residents and Medical Students (RAMS). The series interviews established researchers in emergency medicine and covers topics of interest to residents.

RAMS and SAEM’s Industry Advisory Council Introduce a New Resource for Residents The SAEM Industry Advisory Council in collaboration with SAEM RAMS, introduces “Fast 15,” designed to give residents critical content in 15 minutes flat around topics such as navigating finances in the era of COVID-19 and physician employment contracts.

JULY AACEM Issues Statement on Systemic Racism The Association of Academic Chairs of Emergency Medicine (AACEM) issues a statement regarding systemic racism, which says, in part: “AACEM and its academic chair members stand united in the fight against systemic bias, racism, and injustice. These

CDEM Hosts New Webinar: Residency Match in the Era of COVID

together form a national crisis with many inequities and adverse impacts, at both an individual and public health level. Addressing racism is a core principle of the specialty of emergency medicine, and we strongly believe it should not be tolerated within our institutions or allowed to harm the health and welfare of our patients of diverse race and ethnicity.”

CDEM Introduces Virtual Rotations and Educational Resources SAEM’s Clerkship Directors in Emergency Medicine (CDEM) academy launches a directory of virtual rotations and educational resources to expose students to emergency medicine topics and give them access to programs that provide virtual rotations.

SAEM Foundation Awards $50,000 in COVID-19 Research Grants The SAEM Foundation awards $50,000 to two emergency care investigators for their studies on COVID-19: Dr. Bernard Chang, for his study on The Psychological Effects of COVID-19 Amongst Emergency Providers and Dr. Evan Bradley for his research on the Nasopharyngeal Microbiome and Clinical Outcomes in Patients with COVID-19. The new COVID-19 Research Grant program was developed by the SAEM Foundation as a response to the coronavirus pandemic that has swept the globe and had a tremendous impact on emergency care.

RAMS Hosts New Webinar About COVID’s Impact on the EM Match In response to changes in the process of rotating, applying, interviewing, etc. for emergency medicine applicants as a result of COVID-19, SAEM RAMS hosts a live webinar, Matching Into EM, How We Got Here and Where Are We Going. The webinar reviews how this year’s guidance addresses far more than social distancing requirements and what is and isn’t likely to be the “new norm” for EM-bound students.

More Than 6,000 Attend FirstEver SAEM/RAMS Virtual Residency & Fellowship Fair When the in-person SAEM/RAMS Residency & Fellowship Fair is canceled due to COVID-19, SAEM pivots quickly to provide a free virtual event. Residents and medical students are able to register from a slate of 144 sessions from 104 institutions. The event is a big hit, with more than 6,000 registered attendees turning out for this important event in the annual EM application cycle.

CDEM M4 Curriculum Site Gets an Update CDEM’s M4 curriculum site updates versions for all 50 M4 chapters and gives all online chapters (including the M3 curriculum and pediatric EM curriculum) a new, reader-friendly format that allows for easy viewing on mobile devices.

SAEM Releases Updated Version of “Statement on Diversity and Inclusion” SAEM issues a revised “Statement on Diversity and Inclusion” which commits to the goal of promoting equity, diversity, and inclusion in all aspects of emergency medicine and respecting, supporting, and embracing the cultural uniqueness of our members and the patients we serve.

A new webinar from CDEM, Residency Match in the Era of COVID: Advice for Medical Educators in Emergency Medicine, provides an overview of the Consensus Statement on the 20202021 Residency Application Process for US Medical Students Planning Careers in Emergency Medicine in the Main Residency Match, and recommends best practices on how to effectively advise medical students in various situations.

New Webinar From RAMS Helps URiM Students Navigate a Challenging Application Cycle RAMS and program directors from across the country host a live webinar, Finding a Home Away From Home: Challenges of the Match Faced by URM Applicants and Those Without an Affiliate EM Program, to discuss the challenges faced by underrepresented in medicine students and those at institutions without an affiliate emergency medicine program who are especially negatively impacted by the COVID-19 pandemic disruption of the residency application process.

50+ Institutions From Seven Regions Are Represented at First Diversity in Medicine Residency Meet-n-Greet SAEM, ADIEM, and RAMS, in collaboration with the American Academy of Emergency Medicine, and the AAEM Resident Student Association, host a Diversity in Medicine Residency Meetn-Greet to give underrepresented in medicine (URiM) students the opportunity to hear presentations from and ask questions of the representatives from more than 50 institutions from seven regions in the U.S.

AUGUST

SOAR Ascends to Even Greater Heights!

Simulation Academy and ADIEM Host Virtual Mentor Hour: Teaching Anti-Racism Through Simulation

After months in the making, SAEM and the SAEM Virtual Presence Committee unveil the newest version of SOAR: SAEM Online Academic Resources, with three years of annual meeting content, more accessibility than ever before, and an enhanced and easy-to-navigate layout that allows the user to view online education resources by topic or view videos from the SAEM YouTube Channel

In response to an urgent need for collaborative content regarding expertlycreated simulation cases related to racism and diversity, the SAEM Simulation Academy, in collaboration with Academic for Diversity and Inclusion in Emergency Medicine (ADIEM) hosts a Virtual Mentor Hour, Teaching Anti-Racism Through Simulation.

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2020 continued from Page 13 (974 videos uploaded in 2020!) for easy sorting, saving, and sharing of favorite content.

SAEM and ADIEM Launch Diversity, Equity, and Inclusion Library SAEM and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) announce the launch of the Diversity, Equity, and Inclusion (DEI) Library. The new online resource is a tool for emergency physicians to learn more about achieving health equity and eliminating health disparities.

SAEM and ACEP Provide Feedback on an Outline for the NIDA Strategic Plan for Fiscal Years 2021-2025 In response to a request from the National Institute on Drug Abuse (NIDA) for feedback on an outline for the NIDA Strategic Plan for Fiscal Years 2021-2025, SAEM and ACEP provide perspectives and suggested modifications on the scientific goals and actions, topics/themes, and other matters relevant to the plan. The feedback reflects input from each organization’s respective members.

SAEM PULSE | JANUARY-FEBRUARY 2021

SAEM Pediatric Emergency Medicine Interest Group Presents the Top Pediatric EM Abstracts From SAEM20

The SAEM Pediatric Emergency Medicine Interest Group hosts a virtual presentation of the top six pediatric emergency medicine abstracts accepted for SAEM20. These abstracts represent a broad range of high-quality pediatric emergency medicine research and include presentations related to the latest research studies from the Pediatric Emergency Care Applied Research Network (PECARN).

ADIEM Launches “How to Be a Successful EM Applicant” Webinar Series The much-anticipated “How to Be a Successful EM Applicant” dynamic series from ADIEM launches with session one, “Fundamentals of the EM Application Process.” There will be six more installments in the series (for eight total) before it closes in October 2020 with a session on “Mentorship and Personal Advocacy.”

AEM Issues Call for Papers for a Special Issue on the Scientific Inquiry Into the Inequities of Emergency Care To address a pervasive and wide knowledge gap about the science of inequities in emergency care, Academic Emergency Medicine journal issues a call for papers for a special issue to publish in 2021 that focuses on the impact of race and ethnicity inequity and includes original-based research that addresses patient-centered topics as well as inequities that affect clinicians of color in their professional roles.

SAEM BOD Approves Equity in Crisis Standards of Care Statement The SAEM Board of Directors approves a joint Equity in Crisis Standards of Care statement put forth by the SAEM Ethics Committee, ADIEM, and the SAEM Social EM and Population Health, Critical Care Medicine, and Palliative Medicine interest groups. The statement summarizes recommendations for revising and creating crisis standards of care that address issues of equity, particularly racial equity.

SEPTEMBER SAEM Interest Groups Launch Webinar Series A new, multi-session webinar series from SAEM’s Climate Change and Health and Wilderness Medicine interest groups launches with session one, The Power of Nutrition. Three more installments have since been added to the timely series, with three more planned before the series closes in April 2021.

AWAEM and SAEM Wellness Committee Host National Physician Suicide Awareness Conference and Webinar Increasing awareness about physician suicide is the goal of the National Physician Suicide Awareness Conference & Webinar, hosted by AWAEM and the SAEM Wellness Committee. The session features a panel of physician wellness and physician suicide experts discussing burnout, prevalence of physician suicide, and inciting and mitigating factors.

SAEM Pulse Publishes Special Issue: “Racism as a Public Health Crisis” SAEM proudly presents a very special issue of SAEM Pulse: Racism as a Public Health Crisis with 15 articles covering timely topics that address implicit bias and racial disparities in health care and medical education. The issue includes a Spotlight interview with Dr. Ava E. Pierce, who talks about the challenges of being a Black woman in academic EM and discusses solutions for improving diversity in the workforce.

The Midwest Regional Is First SAEM Regional Meeting to Be Held Virtually The SAEM Midwest Regional Meeting, “Emergency Medicine Inspires Innovation,” is held virtually from Cleveland, Ohio, becoming the first SAEM regional meeting to move to an online format due to the COVID-19 pandemic.

SAEM Signs Joint Statement Regarding Post-Graduate Training of Nurse Practitioners and Physician Assistants The presidents of several emergency medicine organizations sign a joint statement on behalf of their respective organizations expressing their unified support of physician-led patient care and training.

Simulation Academy Introduces New Faculty Development Podcast Simulation leaders, Drs. Haru Okuda, Ernie Wang, and Teresa Wu, are interviewed for a new SAEM Simulation Academy faculty development podcast called “Ask the Experts.”

SAEM Joins the Medical Society Consortium on Climate & Health

SAEM joins the Medical Society Consortium on Climate & Health along with 29 other medical societies encompassing over 600,000 clinicians who have logged 1,091 environmental health-related activities across 39 states, including 338 policy activities, 38 research publications, 293 media articles and interviews, and 422 presentations.

VIRTUAL MEETING SAEM Announces that SAEM21 Will Take Place Entirely Online! The SAEM Board of Directors announce that SAEM21 will be held virtually, May 11–14, 2021. The decision is made out of an abundance of caution for the health, safety, and well-being of SAEM members and due to the unpredictability of the current COVID-19 situation. Working with a leading virtual event platform, SAEM envisions a full-scale meeting that takes the best elements of the Society’s inperson annual meeting and reimagines them in innovative virtual ways for a first-rate interactive digital experience.

RAMS Roadmaps Adds Geriatric EM Track RAMS adds a Geriatric EM Track to its popular Roadmaps series to provide resources and insider advice to those who are interested in improving care for older adults in the emergency department. Before the end of the year, two more tracks will be added to Roadmaps: Tactical and Clinical Forensics.

SAEM Virtual Consensus Conference on Telehealth and EM

OCTOBER

The 2020 SAEM Consensus Conference, Telehealth and Emergency Medicine: A Consensus Conference to Map the Intersection of Emergency Medicine and Telehealth, moves to an online format. The conference seeks to stimulate emergency medicine (EM) researchers and educators to recognize, investigate, and translate the impact of telehealth on the field of emergency medicine for the purpose of designing a research agenda.

SAEM Fall Committee, Academy, and Interest Group Meetings are Held Virtually

EM Specialty Programs Once Again Oppose Doximity Survey Rankings When Doximity once again surveys emergency physicians to create “rankings” of emergency medicine residency training programs, several emergency medicine specialty organizations issue another joint statement in strong opposition.

Social EM & Population Health Interest Group Publishes Immigration Advocacy Toolkit SAEM’s Social Emergency Medicine & Population Health Interest Group, publishes the Immigration Advocacy Toolkit, designed to provide information, guidance, and resources to emergency department clinicians, staff, and operations teams to give welcoming and person-centered emergency care to immigrants.

SAEM committee, academy, and interest group meetings, ordinarily held in person at the ACEP’s annual scientific assembly, meet virtually to set 2021 goals and work on their ongoing initiatives and future strategic plans.

RAMS Webinar Presents the Inside Scoop on Academic Jobs In a new RAMS webinar, The Inside Scoop on Academic Jobs, academic emergency medicine department chairs from around the country provide insight on how they are adapting to the new economics of EM during COVID-19 and what they look for in new academic EM physicians.

EMTIDE Sponsors Diagnostic CME Symposium The Diagnostic CME Symposium, sponsored by SAEM’s Emergency Medicine Transmissible Infectious Diseases and Epidemics (EMTIDE) interest group bridges gap between emerging diagnostics used in current practice and the vision for how these tools can be used to improve diagnosis and management of patients with known/ suspected infections in the emergency department.

Workshop and Didactic Submissions for SAEM21 Exceed Expectations! The number and quality of SAEM21 didactic and Advanced EM Workshop Day submissions received for SAEM21 exceeds expectations, putting the 2021 virtual annual meeting on track for another stellar success and enabling the program committee to continue to provide the high-level educational content that makes the SAEM Annual Meeting the premier event for academic EM.

AEM E&T Announces Call for Papers for a Special Issue on Dismantling Racism With the Next Generation of Learners Academic Emergency Medicine Education and Training (AEM E&T) journal announces that it is accepting papers for a special edition of the journal dedicated to discussing racism in academic medicine and exploring innovations and solution-driven methods in medical education to address these issues.

The New Frontier: DEI Positions in Academic Emergency Medicine Hosted by AWAEM and ADIEM, a new webinar, The New Frontier: DEI Positions in Academic Emergency Medicine, addresses diversity, equity, and inclusion (DEI) positions in EM departments, position roles responsibilities, areas of need, barriers to making an impact, and other challenges and recommended practices.

NOVEMBER Simulation Academy-hosted Faculty Development Hour Focuses on Academic Promotions The SAEM Simulation Academy Faculty Development Subcommittee hosts an interactive virtual mentoring/

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2020 continued from Page 15 faculty development hour, Simulation Promotions: Pearls, Pitfalls, and Pathways that focuses on academic promotions in simulation. Panelists offer their unique insights into the promotion process, different pathways to promotion, and pearls and pitfalls along the way.

RAMS Announce a New Scholarship for URiM Medical Students SAEM Residents and Medical Students (RAMS) announce the availability of a new scholarship for underrepresented in medicine (URiM) medical students to help offset the costs of board exams, study materials, residency interviews, and other expenses often not included in tuition costs.

ADIEM Town Hall Addresses Racial Bias in Medicine and the Role of BIPOC Physicians

Abstract Scoring Rubric is Revised for SAEM21

Registration Opens for the 2021 Residency & Fellowship Fair!

The SAEM Program Committee revises the scoring rubric that will be used for abstracts submitted to SAEM21. The revisions are made in response to suggestions made by the SAEM Program Committee and several SAEM academies and interest groups to better reflect high quality science in diverse submission categories.

Riding the big wave of success of the first Society’s Virtual Residency & Fellowship Fair in May, SAEM announces that the 2021 event will also be held virtually on not one, but two, separate dates, to provide double the opportunity for institutions to showcase their programs and medical students and residents to find their perfect residency or fellowship fit.

Tactical Track is Added to RAMS Roadmaps RAMS adds a Tactical Track to their popular Roadmaps series to provide resources and insider advice for those interested in providing EM medical support, threat support, and medical care for tactical operations and law enforcement personnel.

2020 SAEM Membership Survey Asks SAEM Members About the Value of their Membership With the goal of making SAEM a better resource for members and the entire academic emergency medicine community for years to come, the Society surveys SAEM members about the Society’s services, programs, and events.

A virtual town hall meeting, “Dual Identity: How Awareness of Racial Bias in Medicine Informs our Role as BIPOC Physicians,” sponsored by the Academy for Diversity and Inclusion in Emergency Medicine, addresses patient concerns about racial bias in the medical field, conscious and unconscious actions being taken to mitigate racial bias, and whether Black, Indigenous and people of color have been complicit.

AEUS Launches New Narrated Lecture Series Quiz Platform

SAEM PULSE | JANUARY-FEBRUARY 2021

AEUS launches a brand-new Narrated Lecture Series quiz platform featuring nearly 30 educational videos and associated exams to help residents master the art and science of emergency ultrasound. The new platform is available to AEUS faculty members.

DECEMBER SAEM Signs Joint Statement Regarding Barriers to Promotion of Women and Underrepresented in Medicine Faculty in Academic EM SAEM, along with ACEP, AAEM, and AACEM issue a joint statement recommending strategies for academic departments and institutions to achieve organizational excellence with respect to the promotion and advancement of women and underrepresented minorities in medicine (URiM) faculty.

Dr. Anthony Fauci is Slated to Headline an SAEM National Grand Rounds on COVID-19 Vaccine Distribution As the U.S. begins the first vaccination distributions, SAEM announces that Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and one of the lead members of the White House Coronavirus Task Force, will share his knowledge and firsthand perspective on the current state of the COVID-19 pandemic in an SAEM National Grand Rounds: COVID-19 Vaccine Distribution and What It Means for the Emergency Department, January 28, 2021.

2020 By the Numbers! $671,380 $71,000 $50,000 23,000 18,500 7,600 6,000 1,364 1,000 975 348 144 112 105 90 66% 52 41% 25

Awarded to 21 grantees in December 2020 Raised in new gifts from three SAEM Foundation challenges COVID-19 grants awarded (Two @ $25,000 each!) SAEM Twitter followers (Up 25 percent!) Attendees and viewers of SAEM-hosted online webinars in 2020 SAEM member count reached (A record number!) Registered attendees at the SAEM/RAMS Virtual Residency & Fellowship Fair Abstracts submitted for SAEM20 (A record number!) Viewers tuned in to the first COVID-19 SAEM National Grand Rounds Webinar Videos uploaded to SAEMâ&#x20AC;&#x2122;s new YouTube channel Didactics submitted for SAEM20 (Another record number!) SAEM/RAMS Residency & Fellowship Fair sessions hosted by 104 institutions Pages in the May-June special COVID-19 issue of Pulse (Largest issue ever!) Nominations for SAEM Awards (Up 36 percent from 2019!) Webinars hosted by SAEM Increase in new/original AEM submissions (AEM E&T has a 45% increase!) COVID-19 papers published by AEM (37 published by AEM E&T!) Increase in Facebook followers Position statements and/or joint letters signed by the SAEM Board of Directors 17

NEW YEAR PREVIEW

Bye, Bye 2020! SAEM Rings in a New Year Almost everything was unprecedented about 2020, from the ways we worked to the ways we interacted with colleagues, friends, and family. We logged a ton of hours on Zoom, had our groceries delivered, ordered dinner out, covered our faces, kept our distanceâ&#x20AC;Śand grew in our appreciation for each other.

SAEM PULSE | JANUARY-FEBRUARY 2021

At SAEM we adapted quickly to the changes, navigated through challenge after challenge, and positioned the Society to accelerate confidently into the new year and a strong and stable future. For this reason, we can proudly report that there are many reasons to look ahead to the coming year as a member of the Society for Academic Emergency Medicine.

Dr. Anthony Fauci to Headline an SAEM National Grand Rounds on COVID-19 Vaccine Distribution

Making the Case for the Future of Emergency Care Research and Researchers

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and one of the lead members of the White House Coronavirus Task Force, will share his knowledge and firsthand perspective on the current state of the COVID-19 pandemic in an SAEM National Grand Rounds: COVID-19 Vaccine Distribution and What It Means for the Emergency Department, January 28, 2021.

SAEM will be sharply focused on increasing the number of emergency care researchers applying for NIH funding, and ensuring the pipeline of future researchers by developing the case for support for medical students, residents, and junior faculty to choose research as a career path. SAEM, along with AACEM, will further develop a case for support for all academic departments to support research.

Advanced Research Methodology Evaluation and Design for Medical Education Course (ARMED MedEd)

level of educational content that make the SAEM Annual Meeting the premier event for academic EM.

The new ARMED MedEd course, which focuses on education research training, kicks off in February. 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.

The SAEM Website to Get a Makeover We’ll be giving SAEM.org a major overhaul in 2021 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 four 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 (including a shortcut to the community pages!) • Improve mobile viewing

SAEM Residency & Fellowship Fair to Expand to Two Events In 2020 the popular SAEM/RAMS Residency & Fellowship Fair held its first virtual event. The event was so successful that in 2021 there will be not one, but two virtual events, each three days long, to provide lots of opportunity for institutions to showcase their programs and medical students and residents to find their perfect residency or fellowship fit.

SAEM21 Will Take Place Entirely Online! SAEM21 will be held virtually, May 11–14, 2021. Working with a leading virtual event platform, SAEM will host a full-scale meeting that takes the best elements of the Society’s in-person annual meeting and reimagines them in innovative virtual ways for a first-rate interactive digital experience. The number and quality of SAEM21 didactic and Advanced EM Workshop Day submissions received for SAEM21 exceeded expectations, putting the 2021 virtual annual meeting on track for another stellar success and enabling the program committee to continue to provide the high-

Dr. Nathan Kuppermann to Deliver the Inaugural Dr. Peter Rosen Memorial Keynote Address Nathan Kuppermann, MD, MPH, the Bo Tomas Brofelt Endowed Chair and a distinguished a professor in the department of emergency medicine at the 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 in 2019.

effectively identify and intervene to address social needs.

SAEM Foundation Keeps on Growing! With the addition of a new senior manager of development for the SAEM Foundation, and more grants than ever before, 2021 will bring exciting updates on research results from grant recipients, enhanced communications from the SAEM Foundation in all SAEM communications channels, and new opportunities for SAEM members to join the Annual Alliance and build the future of academic emergency medicine. In addition, the SAEMF-EMF Grantee Workshop will be held virtually for the first time and will include a full day of interaction with program officers at the NIH, AHRQ, PCORI and more.

Coming to you in 2021 from SAEM Journals…

Pediatric EM Opportunities Will Expand at SAEM21 SAEM is expanding the annual meeting’s pediatric educational content and networking opportunities beyond anything offered before — a welcome development for academic EM physicians with a specialty interest in pediatrics and anyone interested in further exploring the subspecialty of pediatric emergency medicine!

2021 Consensus Conference to Address Ways to Advance Social Emergency Medicine and Population Health Emergency departments (EDs) are uniquely situated to be at the forefront of screening and referral for social risk factors (otherwise known as social determinants of health or SDoH). The 2021 consensus conference, “From Bedside to Policy: Advancing Social Emergency Medicine and Population Health Through Research, Collaboration, and Education” seeks to propel the growing field of social emergency medicine forward, and address ways in which emergency medicine can more

AEM to Publish a Special Issue on the Scientific Inquiry Into the Inequities of Emergency Care To address a pervasive and wide knowledge gap about the science of inequities in emergency care, Academic Emergency Medicine journal will publish a special issue, in the fall of 2021, that focuses on the impact of race and ethnicity inequity and includes originalbased research that addresses patientcentered topics as well as inequities that affect clinicians of color in their professional roles. (Submissions for the issue are due by February 28!) continued on Page 20

2021 continued from Page 19

address these issues. (Submissions for the issue are due by February 28!)

First GRACE Product to Address Recurrent, Low-Risk Chest Pain

AEM E&T to Publish a Special Issue on Dismantling Racism With the Next Generation of Learners Academic Emergency Medicine (AEM) Education and Training journal will publish a special edition of the journal, in the fall of 2021, dedicated to discussing racism in academic medicine and exploring innovations and solutiondriven methods in medical education to

Disseminated for public comment ahead of peer review in the fall of 2020, Recurrent, Low-risk Chest Pain in the Emergency Department, SAEM’s first GRACE (Guidelines for Reasonable and Appropriate Care in the Emergency Department) is set for publication in 2021. GRACE (Guidelines for Reasonable and Appropriate Care in the Emergency Department) addresses the critical need for evidence-based and expert driven recommendations for the clinical care of common chief complaints and syndromes manifested by patients in the emergency department. Stated simply, GRACE addresses 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.

Four New SAEM Awards! SAEM awards are given each year in recognition of exceptional contributions to emergency medicine and patient care

through leadership, research, education, and compassion. The slate of awards presented in 2021 will grow by four: Mentor Award, new Fellow Awards, RAMS URiM Education Award, and an AGEM Innovative Care Award.

Fellowship Approval Program to Launch Online Platform SAEM’s Fellowship Approval Program is launching a new, online application submission in 2021. The SAEM Fellowship Approval Program promotes standardization of training for fellows and is available for eligible programs to earn SAEM endorsement as an approved fellowship in administration, disaster medicine, education scholarship, geriatrics, global emergency medicine, research, and wilderness. To view a list of approved fellowships, visit the SAEM Fellowship Directory.

RAMS and AWAEM Collaborate on New Webinar Series Coming in 2021 is a new webinar series from SAEM Residents and Medical Students (RAMS) and the SAEM Academy for Women in Academic Emergency Medicine: “Match to First Promotion.”

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 2021, 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 PULSE | JANUARY-FEBRUARY 2021

SAEM and wish you and yours a Happy New Year and the very best for 2021!

VIRTUAL MEETING

Essential Event. Exceptional Value. Extraordinary Experience. Real Connections, With Real People, in Real Time Your online annual meeting experience will include an abundance of live content, with interactive Q&A, opportunities to engage with speakers, and authentic connectedness with each other at a time when it’s most needed.

Earn an Epic Amount of CME Credit

After the annual meeting, registered attendees can visit SAEM’s on-demand platform again and again (for six months!) to review and rewatch content and earn more than 200 CME credits.

• SAEM Education Summit • Senior Leadership Forum • Junior Faculty Development Forum • Chief Resident Forum • Medical Student Symposium • Two inspiring keynote addresses • High-quality, groundbreaking plenary abstracts • More than 150 dynamic didactics from the best minds in academic EM • Access to over 800 accepted abstracts, cutting-edge Innovations, and IGNITE!

Everything You Love, Reimagined and Repackaged

• An inventive, interactive exhibit and symposia experience

We’ve contracted with a leading virtual event platform to create a top-notch digital experience that incorporates the very best elements of our in-person annual meeting and delivers them to you online, at an unbeatable price!

• Reimagined virtual SonoGames, SimWARS, and Clinical Image Exhibit

Minimize Your Costs, Maximize Your Time

Registration rates for SAEM21 are drastically reduced; in fact, they are the lowest they’ve ever been for a typical, in-person SAEM annual meeting! And if you register by March 15, 2021, you’ll receive additional Early Bird savings! Plus, with no travel, lodging, or meals to worry about, SAEM21 is not only easy on your budget, it’s also more convenient for your schedule.

Multiple Events, Just One Price

The value of your annual meeting registration has never been greater. Just take a look at all that your registration fee includes: • 18 Advanced EM Workshops • Five Forums

• A lively and engaging Residency & Fellowship Fair

• The ever-popular Speed Mentoring (and Speed Mentoring for Educators!)

Three Ways to Register!

Register today for unlimited access to speakers, education, networking events, and more. There are three ways to sign up: 1. Log in to your account to register online 2. Download a registration form (member, nonmember, international) and e-mail to registration@saem.org 3. Download a registration form (member, nonmember, international) and fax to (847) 813-5450

Medical Students, We Need You More Than Ever

The SAEM21 Program Committee is looking for enthusiastic and responsible medical students to serve in our reimagined Virtual Medical Student Ambassadors Program. This is a great opportunity for you to have a hand in the

planning, coordination, and execution of SAEM’s Annual Meeting — all from the comfort from your home or office. The benefits are many, including a waiver of your SAEM21 Virtual Annual Meeting registration fee, a letter of commendation for your files, and an impressive addition to your CV. Visit the Medical Student Ambassador website for all the benefits and details!

Introducing SAEM EMerging News…Your Resource for All Things SAEM21

SAEM EMerging News will come to you monthly to start and then will increase in frequency as we get closer to the annual meeting. Our intention is to reduce the number of e-mails you receive while providing you with a central, easy-tofind repository for all the latest news and information you need for SAEM21. Check out the first issue here and watch your in-box for future issues!

Don’t Miss These Submission Deadlines! Don’t Miss These Submission Deadlines! Don’t miss out on these golden opportunities to participate in SAEM21: • Innovations are due January 11, 2021 • IGNITE! are due January 11, 2021 • Clinical Images Exhibit are due January 11, 2021 • Medical Student Ambassador applications are due January 11, 2021

CAREERS IN ACADEMIC EM

Emergency Medicine Careers: An Update on the Academic vs. Private Pathway

SAEM PULSE | JANUARY-FEBRUARY 2021

By Autumn Brogan, MD; Elizabeth Avakoff, MPH; Esther H. Chen, MD; Walter L. Green, MD

The SAEM Academic Career Guide 2019 is an excellent in-depth resource for students, residents, fellows, and early career emergency physicians interested in pursuing a career in academic emergency medicine (EM); however, things have been altered during the era of Covid-19. Here we present changes and updates due to the pandemic.

How does compensation compare and how has this changed with COVID-19?

Academic compensation has remained constant while private pay has decreased, narrowing the pay differential between the two. Hence, Covid-19 has led to a complete change in the job

market, as many private groups have had to cut hourly pay and limit total hours. This has caused some graduates to work per diem or parttime at multiple hospitals or alternate care sites in order to increase their hours. Exposure to different health systems has allowed recent residency graduates to continue honing their clinical skills, while also having some of the benefits of their academic institution, such as library resources, conferences, journal clubs, etc. In the current climate, academic jobs now appear more stable from a compensation perspective and many have a yearly guarantee that is now lacking in most of the private settings. While private groups historically offered more flexibility in their benefits, much of

this has been impacted by COVID-19. On-call requirements have been added to both academic and community sites, as more and more providers have fallen ill or called in for quarantine while awaiting COVID-19 results.

Does the lack of a yearly salary guarantee make any difference?

An academic position typically has a yearly salary, while minimum guarantees have recently disappeared from many private contracts. This has a direct impact on obtaining a home mortgage for a new graduate. Without a minimum guarantee or salary, most lenders require two years of IRS tax forms to obtain a loan large enough to

“In the current climate, academic jobs now appear more stable from a compensation perspective and many have a yearly guarantee that is now lacking in most of the private settings.” purchase a suitable home. If there is no salary or minimum guarantee, a resident graduating in June may have to wait 30 months to establish an income pattern large enough to reassure a lender.

How do training requirements differ between academic and private positions?

More and more academic institutions now require fellowship training, even for graduates of four-year residency programs. A fellowship allows an applicant to develop a niche in the field and stand out in an increasingly competitive job market. Furthermore, some academic institutions will no longer hire new residency graduates. We anticipate that non-ACGME fellowships will be seeing more applicants because of hiring freezes in academic and community hospitals due to the pandemic; however, because these fellowships are primarily subsidized by clinical shifts, some departments will not be able to support them this year. Community positions

rarely require additional fellowship training, although the distinction between community and academic medicine is no longer so dichotomous. Many community hospitals are now affiliated with academic institutions and their attending physicians may be considered part of their faculty, with teaching and service requirements.

What are some considerations for job searching during the pandemic recovery?

While some academic organizations have instituted a hiring freeze in the usual hiring cycle of the academic year, this may change suddenly or resume off-cycle, so send your application in and express interest! Some academic institutions continue to hire for their community affiliated sites and may offer hybrid jobs with clinical shifts that are split between the university and community sites. Hiring may also depend on the shifting clinical needs due to the pandemic. Moreover, some academic institutions are still able to hire non-

ACGME fellows, despite the hiring freeze. Because non-ACGME fellows are often categorized as faculty “instructors,” this may be a great opportunity to get your foot in the door and be available when a full-time faculty position opens up. We also recommend being willing to expand your search geographically (particularly since recruitment is mostly virtual) and being flexible with your ideal job. Many community positions also have a hiring freeze, so consider what you might bring to the practice, such as working parttime, being a nocturnist, or contributing your administrative skills to improving a clinical area.

What can I do now to strengthen my application for an academic or private role? This will be a tough year for EM graduates without a niche or subspecialty that comes with fellowship training. Most

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CAREERS IN ACADEMIC EM

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importantly, be ready to articulate your five-year plan and be specific about what skills you bring to the department and what you think the department needs. Consider being flexible about applying for a university-affiliated community site and get involved in activities at the academic institution (e.g., lecturing to the residents, participating in quality improvement projects, serving on committees), even if it’s not required of your community job. For senior residents who might be waiting for hiring to un-freeze, this is the time to get involved in clinical or administrative projects and be recognized for your skills and participation. While scholarship is the main currency for academic institutions, administrative experience in operations, telehealth, or clinical informatics are also valuable to a clinical department and worth highlighting in your application.

What type of clinical support can I expect in each setting?

Academic settings continue to have greater support through consultants and on-call availability. Several physicians and specialties are present on site to assist with patient care. Unfortunately, there is more competition for procedures and the acquisition of procedural skills may take more time. In the private setting, you may be the only physician present in the

hospital and with reduced emergency department volumes, single coverage during the pandemic is more common. Responsibilities may now extend to providing coverage for inpatient cardiac arrest patients, whether regular floor admissions or ICU patients. However, competition for procedures is lower and clinical skills are more quickly developed in private medicine.

Which role has greater flexibility and control over work obligations? Work-life balance can be exceptionally hard to achieve during a pandemic. As many working parents have discovered, childcare and school attendance can change abruptly and without notice. Employees of academic institutions tend to have more daycare options than community hospitals, with some workplaces even providing daycare for sick children. Certain states may also offer government sponsored daycare options for essential workers.

The optimal allocation of shifts and timing of each shift is an important consideration when accepting a job. Balancing a two-person working household may therefore be easier at an academic institution, particularly if one parent needs to be home during the day for online school or childcare. Most hospital systems have implemented COVID-19 on-call requirements to cover sick colleagues or an influx of patients. It is important to weigh the number of oncall shifts as well as on-call compensation

SAEM PULSE | JANUARY-FEBRUARY 2021

Key Points

• Compensation differences have narrowed between academic and private positions • Career opportunities are less dichotomous now and may be hybrid, university-community roles • Academic and community sites may be hiring off-cycle this year, so express your interest and apply, even if there is currently a hiring freeze • While scholarship is the main currency for academia, administrative skills are also highly valuable for a clinical department and a way to distinguish yourself without additional training

when comparing employment opportunities. An additional consideration is whether work meetings can happen remotely if your children require your care and attention.

Are there opportunities for travel?

Academic jobs typically come with an annual stipend for continuing medical education and provide more opportunities than community jobs to travel for teaching and research. Most institutions have significantly limited or eliminated travel because of the pandemic, making the difference in travel opportunities currently less significant.

ABOUT THE AUTHORS Dr. Brogan is an attending physician and assistant professor in emergency medicine at Mayo Clinic. She is the medical director of the Nurse Practitioner/ Physician Assistant (NPPA) Emergency Medicine Fellowship program and the education chair for emergency medicine for the Mayo Clinic Health System-Southwest Region. @AutumnBrogan Elizabeth Avakoff, MPH is a fourth-year medical student at the Philadelphia College of Osteopathic Medicine. She obtained her bachelor’s degree in environmental economics and policy from the University of California, Berkeley and then her master’s degree in public health, with a concentration in health policy and management, from Boston University School of Public Health. Dr. Chen is a professor of emergency medicine and associate residency director at the University of California, San Francisco and the director of graduate medical education at San Francisco General Hospital. Dr. Green is an attending emergency medicine physician at Parkland Hospital, an associate professor of emergency medicine and associate residency director, and the chief of billing and coding at the University of Texas Southwestern Medical center.

SGEM: DID YOU KNOW?

Sex and Race Matter in Terms of Diagnostic Studies and Treatments Received By Ynhi Thomas, MD, MPH, MSC Studies are now reporting inequity in medical care based on the patientâ&#x20AC;&#x2122;s race or ethnicity and biological sex. In the cardiovascular literature, one study assessed primary care physiciansâ&#x20AC;&#x2122; management of chest pain by having participants view a recording of actors portraying patients with scripted symptoms. Participants then completed a survey on their management plan. Analysis of race-sex interactions showed that black women were significantly less likely to be referred for cardiac catheterization, even if they reported concerning symptoms of cardiac ischemia. Similarly, an emergency department-based study assessing the time of presentation with suspected coronary heart disease to the time of electrocardiogram completion, found the median time to be 19 minutes for males and 83 minutes for females. Other areas that have noted sex and race-based differences in care include neurology and trauma. Women are more likely to report pain or present with acute changes in mental status than men when

presenting with strokes. These differences may lead to disparities in early detection and treatment. Pre-hospital recognition of stroke was found to be lower in women and Hispanics. In addition, studies have suggested that women are treated less frequently with tPA and antiplatelet agents. With regards to trauma, in a study on use of morphine among prehospital blunt trauma patients, there were no sex differences, but Black and Hispanic patients were less likely than caucasians to receive analgesia. More research is needed to explore race and/or sexbased inequities in the medical care of other conditions. The extent of such variances should guide future studies, solutions, and interventions behind potential factors related to providers (implicit bias), patients (variations in symptoms based on physiological differences in sex or cultural differences in expression), or systems (social determinants of health). A better understanding of these factors will assist in designing effective quality improvement interventions that are equitable for all.

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 coeditors Lauren Walter and Alyson J. McGregor at sgem@lifespan.org.

CLERKSHIP DIRECTORS IN EM

Mitigating Bias in Evaluations in Medical Education

SAEM PULSE | JANUARY-FEBRUARY 2021

By Emily Earl-Royal, MD, MPH; Al’ai Alvarez, MD; and Danielle Miller, MD, MEd(c) on behalf of the SAEM Clerkship Directors in Emergency Medicine academy.

The impact of the COVID-19 pandemic on the availability of away rotations forced an overhaul on recruiting and selecting learners in medical education. However, structural biases in evaluations undermine our efforts to advance diversity, equity, and inclusion. Pipeline efforts toward equity and representation continue to be leaky due to the biased ways we assess and present learners. Studies have shown that early in the medical education and recruitment process, medical schools produce biased letters of evaluations, including gender and racial disparities in medical student performance evaluations (Eval. Health Prof, PLoS). Another study indicated that disparities also exist in membership at the Alpha Omega Alpha (AOA) National Medical Honorary Society. In emergency medicine residency, there is evidence for gender

“Pipeline efforts toward equity and representation continue to be leaky due to the biased ways we assess and present learners.” bias in milestones in clinical competency (J Grad Med Educ, JAMA Intern Med). Furthermore, according to one study, stereotypical male personality traits reflect an “ideal” resident in emergency medicine. These male-based characteristics include descriptors such as “takes charge,” “leadership in teams,” “autonomous,” “decisive,” “motivated,” “confident,” “doesn’t complain,” and “doesn’t get frustrated.” When evaluated in this category, women

residents have a more challenging time establishing their competence on traits that are traditionally considered masculine. These biased evaluations compound over time to limit access to acquiring highly-sought career opportunities such as becoming chief resident, acquiring prestigious residency and fellowship positions, receiving national awards, and obtaining senior leadership. Understanding the challenges and barriers to overcoming

“Understanding the challenges and barriers to overcoming bias in evaluations is critical to improving our specialty and making our specialty more inclusive and equitable.” bias in evaluations is critical to improving our specialty and making our specialty more inclusive and equitable. Several strategies exist for accomplishing this, including recognizing one’s own biases, developing program-wide bias reduction strategies, and installing institutional efforts to reduce bias. The first and most basic step is to acknowledge that everyone has biases. The Harvard Implicit Association Test, free and easily accessible online, allows one to identify and confront personal bias in various categories, including skin tone, gender, sexuality, race, disability, and many other characteristics. Awareness of individual bias alone, however, does not solve the issue. The Stanford Unconscious Bias Training, also available online free of charge, offers steps to practice overcoming personal biases. Beyond making conscious one’s unconscious bias, residency programs can work on a structural level to ensure that the path to minimally biased evaluation is also the path of least resistance. For instance, instead of free-form narrative evaluation forms, the program can provide a standardized template for faculty to evaluate all learners’ specific technical areas, such as procedural skills, team management, and communication ability. Agree on skills and ability to be assessed ahead of time, and ideally before the start of the academic year, along with a discussion regarding metrics for success. Highlight common areas of bias to each evaluator. Often missed are some biases toward “quiet” learners. Develop a uniform structure that encourages feedback and assessments focused on skills, supported

with specific examples rather than a subjective summary of personality traits. Using examples to highlight behaviors further personalizes assessments. Rather than magnifying isolated or outlier behaviors, regularly collect evaluations (i.e., on every shift), to track trends. This minimizes the pressure to finish letters of evaluations for a large group of learners over a short period, which is susceptible to relying on “gut feeling” and, therefore, bias. This also allows learners to receive mid-rotation feedback that enables their improvement. Evaluators must also receive training on how to challenge bias. One strategy is to avoid specific stereotypic language. For example, instead of describing a female learner as “competent,” use “engaging and effective.” Stereotype replacement is another critical strategy for combating bias. For example, using an image of a Black female leader in a presentation counters unconscious historical and cultural bias toward women and people of color with regard to leadership roles. A fundamental tenet in overcoming bias is getting to know learners better. Individuation requires an increase in contact opportunities for learners to receive more specific descriptors in their evaluations. Another structural method for providing balanced feedback is having a second evaluator review narrative evaluations to specifically look for biased language and balanced representation of both positive and negative narratives. For this system to be effective, these secondary screens should be used as performance data, tracked over time, and reviewed

for improvement. The periodic review of evaluations allows for consistency checks. These data must be transparent to create accountability. It is also essential to have a diversity of reviewers to reflect varying points of view. The holistic candidate review can only be achieved if the data included are also free from bias. Actionable strategies exist to help avoid biased language in letter and grade narratives. It is incumbent upon each of us to recognize our own biases and develop systems that overcome them. It is what is needed to dismantle the structural challenges that affect equity in medicine.

ABOUT THE AUTHORS Dr. Earl-Royal is a recent graduate of Stanford Emergency Medicine and is currently a faculty at Kaiser Redwood City.

Dr. Alvarez is an assistant program director at Stanford Emergency Medicine Residency, and a member of the SAEM Wellness Committee. @alvarezzzy, @StanfordEMED Dr. Miller is a second-year medical education scholarship fellow at Stanford Emergency Medicine. @DTMillerMD, @StanfordEMED

About CDEM Clerkship Directors in Emergency Medicine (CDEM) represents the interests of undergraduate medical educators in emergency medicine. It serves as a unified voice for EM clerkship directors and medical student educators and provides a forum for them to communicate, share ideas, and generate solutions to common problems. For more information, visit the CDEM webpage. As an SAEM member, you may now join as many academies* and interest groups as you choose. Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

CLIMATE CHANGE AND HEALTH

Climate Change and Health: The Year in Review

SAEM PULSE | JANUARY-FEBRUARY 2021

By Caitlin Rublee, MD, MPH on behalf of SAEM’s Climate Change and Health Interest Group

December 2019 marked one year since the 25th United Nations Framework Convention on Climate Change (UNFCCC) Conference of Parties (COP25). I had finished a late-night shift in the emergency department and arrived at the airport before dawn. My golden ticket, as any physician climate change fellow would call it, was close at hand as I waited in the security queue outside COP25 in Spain. Delegates and organizations represented their nations with booths. It was an idea foundry for a global collaborative path forward; my hopes were high. But disappointment soon followed. I met with other physicians at the U.S. Climate Action Center. We listened to local champions discuss their work and then made our way to the closed-door

“As emergency medicine physicians, we understand how climate-related extreme weather events alter patient care. ” session of U.S. delegates. We knocked on the door and were met by a single person. We enthusiastically inquired about socials or meet-and-greets but were told there were none. We quickly handed off a few resources before the door was closed. This was only the first of many lessons learned from attending COP25.

The following days included a climate strike attended by more than 500,000 people and a motivating Global Climate and Health Summit. The result of the conference was certainly not the Paris Agreement, which was adopted by 196 Parties at COP21. As delegates returned home, one question remained: How can public health be included in

“As we humans continue to cause climate change, we can also fix it. And with as many barriers as there was this past year, efforts to advocate for patients and our communities have persisted.” climate policies if communication is so challenged between the policymakers and the health experts? We now know how this experience foreshadowed the following months of the U.S. response to other public health crises that included a global pandemic and racism. Yet, as much as 2020 primed us to expect more bad news, there is a silver lining. Reflecting on my experience at COP25 one year later, I better understand how the U.S. can choose a different trajectory of public health leadership and climate action focused on people. While an open-door policy is important, health professionals collectively need to recognize their unique perspectives and roles in creating lasting change to address climate-related health harms. As members of the Global Climate and Health Alliance recently stated, “health professionals can and must join the growing global community of sciencebased advocates working to achieve the goal of the Paris Agreement.” As emergency medicine physicians, we understand how climate-related extreme weather events — from flood and fire evacuations to surges in demand for patients who require emergent treatments — alter patient care. People are dying prematurely from pneumonia, respiratory diseases, heart disease, and cancers related to air pollution. While everyone is at risk, certain groups are at elevated risk of poor health outcomes. Even so, there is hope. As we humans continue to cause climate change, we can also fix it. And with as many barriers as there was this past year, efforts to advocate for patients and our communities have persisted. The National Academy of Medicine (NAM) Annual Meeting, Confronting Urgent Threats to Human Health and Society: COVID-19 and Climate Change, was held last fall. Presenting scholars articulated the opportunity we have as a nation to change the current path of sickness caused by rising emissions and pollution. A report supported by NAM was released (download here) calling on

the U.S. health care sector to act as well. Feasible solutions are available to reduce greenhouse gas emissions, reduce health disparities, and build resilience against local environmental public health threats. The 2020 Lancet Policy Brief for the United States of America outlined key steps for policymakers to take to advance health in an equitable and just manner in the U.S. The United States Global Change Research Program is planning its Fifth National Climate Assessment, with anticipated delivery in 2023. Researchers continue to collect the most up-to-date climate science to inform interventions and policies that protect people, especially those at greatest risk of dying from adverse health effects (e.g. children and older adults). The Society for Academic Emergency Medicine and the American College of Emergency Physicians joined The Medical Society Consortium on Climate and Health as the 30th and 31st member societies. The Consortium represents more than 60 percent of U.S. physicians. Convinced that climate change electives are not sufficient enough, medical students are investing time and energy in creating their curriculums and demanding climate and health integration. Education leaders are proposing new frameworks for resident education on climate and health. Practicing physicians are dedicating extra training in climate sciences after residency. In a few short years, these individuals will be our leading health professionals. States are increasingly recognizing the economic impact of climate-related events. A study from 2019 estimated $10 billion in health-related costs for just 10 climate-sensitive events in the U.S. over one year. What if these costs were instead turned into financial and health gains? A new report highlights the health impacts of climate change in the state of Wisconsin and, most importantly, the health economic gains to the state by transitioning to 100 percent clean energy. For example, in-state production of 100

percent clean energy would reduce air pollution and result in a savings of $21 billion per year in avoided health damages, the creation of 162,000 net new jobs, and the prevention of 1,910 early deaths, 650 emergency department visits for respiratory concerns, 34,400 asthma exacerbations, and 650 heart attacks. Another recent report assessed climate and health preparedness by state. While some states are ready (Colorado, Maine, Maryland, New Hampshire, Utah, Vermont, Wisconsin, and the District of Columbia are the most prepared), many are not. Every state has an opportunity to adapt and build resilience now to protect the health of its residents, especially the most vulnerable. Good science wins and times are changing. Health professionals recognize the health and economic opportunities of climate solutions. We have seen how evidence-based policies protect health. We have seen the positive impact of diverse teams in addressing complex issues. We have seen the power of modeling behavior for future generations to follow. While COP26 was postponed last year, I look forward to attending in 2021. Health and human rights can be at the center of climate action, allowing us to work together once again in the New Year. As health professionals, we can ensure that the dialogue on climate change is one of justice and healthy lives for everyone.

ABOUT THE AUTHOR Dr. Rublee is an assistant professor of emergency medicine at the Medical College of Wisconsin and faculty in the Institute for Health and Equity. She was the 2019-2020 climate and health science policy fellow at the University of Colorado. Dr. Rublee is chair of SAEM’s Climate Change and Health Interest Group.

DISASTER EMERGENCY MEDICINE

What Does a Disaster Medicine Doctor Do?

SAEM PULSE | JANUARY-FEBRUARY 2021

By Alex Hart, MD, on behalf of the SAEM Disaster Medicine Interest Group

Disaster medicine [DM] is a subspecialty dedicated to optimizing the prevention, mitigation, response, and recovery from disasters on a wide spectrum. It encompasses natural disasters, terrorist attacks, mass casualties and infrastructure damage. Since 2005, there has been increasing interest in DM specialists, leading to the creation of the first disaster medicine fellowships. Disaster medicine fellowships have recently become a recognized subspecialty training program by SAEM. Due to the current SARS-CoV-2 pandemic, DM specialists will likely be in higher demand throughout a range of fields. However, given the young nature of the specialty, there remains confusion about what a career in DM could entail. While many DM practitioners play roles in several of these fields, defining them can allow for a clearer definition of what each one does to protect the population.

â&#x20AC;&#x153;Disaster medicine is a subspecialty dedicated to optimizing the prevention, mitigation, response, and recovery from disasters on a wide spectrum.â&#x20AC;? Many DM careers involve staying active in an academic emergency department. There are still wide swathes of DM yet to be researched and defined. Much of the ever-increasing body of literature about DM comes from practicing emergency physicians with an interest in the field who focus their research endeavors on better describing the events they witness and developing new and improved ways to respond,

thus decreasing morbidity and mortality. One of the more common positions an emergency physician with disaster training takes on is that of improving community emergency preparedness. Many physicians take part in their hospital emergency management committees, developing and drilling disaster plans so that their facility can be prepared to mitigate the worst of any event. Others liaise with community

“Physicians with training in disaster response become even more useful when a disaster event occurs as they can provide hands-on care as well as lead the responding team.” groups ranging from departments of public health, to police and fire, to high risk populations in the community to improve preparedness for likely disasters. This can prime the populace to remain calm, seek help appropriately, and improve the coordination among responding agencies. The government remains one of the biggest players in disaster preparedness and response. As such, a well thought out and effective response is vital, whether from a local municipality or at the federal level. To encourage this, disaster medicine practitioners take positions in all levels of government, ranging from city departments of public health, to the Federal Emergency Management Agency (FEMA). Deploying to disasters and providing care on the ground is one of the most widely known facets of disaster medicine. Physicians with training in

disaster response become even more useful when a disaster event occurs as they can provide hands-on care as well as lead the responding team. For this very reason, emergency physicians are sought after by federal response agencies such as the disaster medical assistance teams (DMATs) and international nongovernmental organizations (NGOS). While the military is capable of incredible sacrifice and are excellent logisticians, there are problems with the military deploying to respond to disasters both domestic and on foreign soil. Disaster medicine training can assist those with interest in coordinating the responses by civilian groups and the military at a disaster. Given emergency medicine’s central position in the response to disasters, pursuit of disaster medicine fellowships could be beneficial additional training for

EM residents. As pandemics, terrorist attacks, and climate-related disasters increase in frequency, the space for disaster medicine-trained physicians will continue to grow.

ABOUT THE AUTHOR Dr. Hart is the director of research for the Beth Israel Deaconess Medical Center disaster medicine fellowship. He graduated from the University of Massachusetts Medical School, and the UMass Memorial emergency medicine residency. Dr. Hart’s research focuses on the development of improved methods of disaster response, especially innovative technology solutions. He can be reached at ahart1@bidmc.harvard.edu.

DIVERSITY AND INCLUSION

(Un)Learning What Matters: Dismantling and Restructuring Antiracism Curricula Into an Integrated Framework SAEM PULSE | JANUARY-FEBRUARY 2021

By Michelle Suh, MD; Daniela Ortiz, MD, MPH; and Anisha Turner, MD on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine

Recent events regarding systemic racism have led to the promotion of “antiracism” curricula and statements within resident programs. While residencies develop and refine their diversity, equity, and inclusion (DEI) pedagogy, it is important that careful consideration of these efforts don’t reinforce the marginalization of racial minorities. Clear examples of marginalization include unequal representation of racial groups in lecture slides and the inclusion of racial stereotypes with diagnoses in case vignettes. Instead of focusing solely on introducing competency-based learning information, we must continuously (un)learn and assess existing curricula

for inaccuracies in concepts of race and diversity. DEI should be promoted and integrated into each aspect of patient-based or case-based learning in order to assure an inclusive and biasfree curriculum. Here we identify and challenge common pitfalls of medical curricula, propose practices for DEI integration, and review existing tools for curriculum evaluation.

Pitfalls and Practices Avoid discussion of race as a pathology. Since the 19th century, medical education has pathologized and insinuated a scientific foundation for

ideas of hierarchy based on race. Today, many conditions such as sickle cell disease, sarcoidosis and cystic fibrosis, are linked to biological differences among racial groups without consideration of environmental factors, social inequalities, genetics, and ancestry. Medical education also perpetuates institutionalized racism by encouraging trainees to identify race as risk factors for several medical conditions such as hypertension, kidney disease, stroke, and glaucoma, when the relationship between disease and race is confounded by multiple factors. Students are commonly rewarded by adopting race as a heuristic throughout standardized exams that inculcates

â&#x20AC;&#x153;Instead of focusing solely on introducing competency-based learning information, we must continuously (un)learn and assess existing curricula for inaccuracies in concepts of race and diversity.â&#x20AC;? patterns based on racial assumptions. These promoted conclusions perpetuate social inequities and subconsciously promote biological differences among racial groups. Instead, we encourage curriculum designers to expound on the true relationship between race and disease, which can be done through incorporation of historical examples or factual explanations. To develop thoughtful physicians that, in turn, understand race as a social construct and avoid misconceiving a potential diagnosis or treatment, clinical educators must be intentional in the discussion of race. Avoid stereotypes in visual representations.

Medical imaging is an invaluable method of conveying information about pathological conditions. Studies comparing visual representation in preclinical visual course material found that people of color were underrepresented compared to their white counterparts. This depiction further perpetuates the idea of whiteness as the assumed norm, which does not correspond with the racial demographics of the U.S. population and does not reflect the racial distribution of every disease process of interest. The absence of darker skin tones can contribute to health inequalities in identification and treatment of dermatological diseases such as skin cancer or anaphylaxis.

Therefore, balanced visual representation is important to reduce health care bias. Avoid noninclusive and deficit-based language. Noninclusive language is exclusionary language that uses words or expressions that may cause underrepresented minorities to feel diminished. Deficitbased language conceptualizes patients and populations solely in terms of their perceived pathologies, deficiencies, or limitations, which obscures the structural factors and prevents learners from thinking critically about how to address

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Online DEI Audit Checklists CHECKLIST LINK Race and Culture Guide for Editors of Teaching Cases

Guidelines for Promoting a Bias-Free Curriculum

Presentation Diversity Audit Tool

The Upstate Bias Checklist

Inclusive and Bias Free Curriculum Checklist

AUTHOR(S)

FORMAT OVERVIEW

BENEFITS OF TOOL

Krishnan A, et al. Addressing race, culture, and structural inequality in medical education: A guide for revising teaching cases. 2019. Acad Med; 94(4): 550-555. SD Appendix 1.

Provides definitions of key concepts and six themes to review representation of disparities as social and structural determinants of health when teaching via patient-case format.

Comprehensive guide with detailed explanations. Includes rationale for revisions of cases that focus on race and ethnic disparities and case examples.

Columbia University Irving Medical Center

Includes list of identity domains and six themes with examples for common issues regarding inclusivity and proposed solutions.

Easy to reference and has a general focus across several social and structural domains.

University of Rochester Medical Center

Includes eight questions to assess educational materials for inclusion and accessibility as well as three questions about language conventions.

Quick reference and easy to utilize if the user has prior knowledge of DEI principles.

Brown AEC, et al. Can a checklist ameliorate implicit bias in medical education? 2019. Medical Education, 53(5): 510.

Survey format asking about 11 domains at high risk for bias including examples of each. Also reviews bias in visual images and patient cases.

Comprehensive survey format where the user answers multiple choice and short answer questions to complete content assessment.

Northwestern University Feinberg School of Medicine (adapted from Checklist for Assessing Bias in Medical Education Content)

Adaptation of checklist by Brown Easy to use interface with 26 AEC with overview of 11 domains questions prompting further high risk for bias and three information about each domain. education modalities, as well as providing examples of biased statements with action items.

DIVERSITY AND INCLUSION

SAEM PULSE | JANUARY-FEBRUARY 2021

continued from Page 33

them. Instead, we recommend the use of inclusive language and asset-based language. With inclusive language, deliberate efforts are made to avoid stereotyping and discrimination when discussing racially diverse patients, specifically when identification of a patient’s racial or ethnic background does not serve to change decisionmaking. The avoidance of deficit-based language allows learners to focus on the deeper understanding of issues, such as social determinants of health, rather than on negative labels, as well as prevents learners from limiting the experiences and circumstances of people of color. Careful use of inclusive and asset-based language when teaching a medical curriculum may influence how health care is provided to underrepresented minority patients.

“Careful use of inclusive and asset-based language when teaching a medical curriculum may influence how health care is provided to underrepresented minority patients.” Avoid racial stereotypes. Racial stereotyping is present in medical education and is especially used as a cue to a diagnosis in casebased formats. Changing the focus from cultural-competency-based to structural-competency-based curricula is an important step in reducing stereotyping in medical education. Curricula should delve into the context of why certain groups may be disproportionately affected by certain medical syndromes (including social, economic, historical factors, etc). Racial or cultural profiling and stereotyping

of patients by providers can result in delayed or missed diagnoses and contribute to poorer patient outcomes. Avoid confounding equity and equality. Physicians in training, especially those at large academic centers that serve underrepresented minority patients, should be well versed in the differences between equal and equitable health care, especially in racially diverse populations. Institution mandated unconscious bias training or cultural competency training are not geared to educate about causes of health

“Changing the focus from cultural-competencybased to structural-competency-based curricula is an important step in reducing stereotyping in medical education.” inequities in a greater structural context. The difference between equal access and equitable access to health care is vast, and health equity is achieved only after civil rights enforcement, access to societal resources, and community and intergenerational reduction of prejudices, morbidity, and improvement of well-being are achieved. Avoid excluding nonracial differences. Because everyone has more than one identity, we must go beyond the onedimensional approach to diversity and inclusion. Inclusivity in medicine goes

beyond just race. Recognizing specific biases against groups such as ableism, religious, socioeconomic, language biases, biases against immigrant populations, gender biases, biases against LGBTQI, and many others should also be kept at the forefront when educating medical professionals and when patient evaluation is occurring. Intersectional education considers the overlap among these factors and demonstrates that each are essential components to understanding how social identities affect health care.

ABOUT THE AUTHORS Dr. Suh is a PGY-1 resident at the Baylor College of Medicine Emergency Medicine Residency. @msuh25

Dr. Ortiz is a PGY-3 resident at the Baylor College of Medicine Emergency Medicine Residency daniela.ortiz@bcm.edu @DaniOrtizMD Dr. Turner is an education and administration fellow at Baylor College of Medicine. anisha.turner@bcm.edu @DestinedDoc

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 health care 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.”

ETHICS IN ACTION

Ethics and Autonomy: Toward Justice in Precision Emergency Medicine By Christian C. Rose, MD and Jennifer A. Newberry, MD, JD, MSc on behalf of the SAEM Ethics Committee

SAEM PULSE | JANUARY-FEBRUARY 2021

Precision Emergency Medicine and Vigilance

Emergency medicine is a high cognitiveload specialty. Attempts to limit the burden of decision-making and prevent medical errors have relied on heuristics and decision rules. But this approach effectively tailors care to the â&#x20AC;&#x153;averageâ&#x20AC;? patient and fosters a one-size-fits-all approach rather than individualized care. Precision emergency medicine aims to augment our decision-making capacity with big data so that we can provide the right care at the right time to the right person. In utilizing a data analytical approach that includes varied sources of information, from genomics to social determinants of health, the hope is that we might be able to evolve from a

one-size-fits-all approach to one tailored to the particular circumstances of the patient in front of us. However, there are unique ethical challenges to actualizing these goals in emergency medicine. Here, we explore three potential ethical pitfalls for precision emergency medicine that stem from the realities of the practice of emergency medicine, the role of the emergency department as the safety net, and the values that emergency physicians have a duty to uphold.

Incomplete Data and Bias

Precision emergency medicine relies on effective and accurate information gathering, the ability to compare patients to other similar individuals, and insight into patientsâ&#x20AC;&#x2122; own preferences

in order to offer a tailored management strategy. Consequently, the ability to gather accurate information is essential to the successful employment of precision emergency medicine. In emergency medicine, however, we are often placed in the challenging position of providing care with minimal information. Patients may be unable to speak, intoxicated, or delirious, and timesensitive conditions require us to limit and prioritize which data is collected. This is particularly true of social and behavioral data.

“In utilizing a data analytical approach that includes varied sources of information, from genomics to social determinants of health, the hope is that we might be able to evolve from a one-size-fits-all approach to one tailored to the particular circumstances of the patient in front of us.” Further, missing data may reflect bias already present in how the history is taken or even in the recording of the data. While missing data may be a normal occurrence in the clinical practice of emergency medicine, when compiling and analyzing large data sets, missing information can be a source of bias which may affect conclusions drawn from the data, leading to inappropriate recommendations. Missing data can impair the statistical significance of findings, lead to type one or two errors, and limit the true representativeness of comparative data for the case at hand, thus limiting the “precision” in precision emergency medicine.

Underrepresentation and Justice

Even when we are able to retrieve patientspecific data, appropriately comparing it to the community may be difficult. Already underrepresented populations in society are even less represented in the databases that are often used for precision medicine models. Fewer members of marginalized communities are included in genetics databases and they have less access to advanced genetic testing methodologies. On the other hand, data from emergency departments may suffer from overrepresentation of these populations driven more by social inequities than particular clinical characteristics. This means that models developed from these databases will be skewed away from an accurate representation of the community, which can entrench health disparities and the social injustices that underlie them. As the nation’s safety net, emergency physicians are obligated to ensure our implemented systems enable equitable access to care and do not perpetuate these injustices. Many hope that computational systems and algorithms will

remove human bias from the decisionmaking process, but the effect of machine learning and artificial intelligence systems may be even more insidious than the humans who build them. The systems used to make recommendations mirror how we already view and value our population, explicitly or implicitly. They can only interpret and make recommendations from data which we have already impacted. Machine learning models trained on the data of populations which is already skewed by years of limited access to quality care or structural racism may find erroneous correlations that are in fact the end product of human or institutional bias. This may then exacerbate disparities.

Model Optimization and Impartiality

Furthermore, our critical eye must not stop at the data going into model development but continue to the recommendations that models suggest. If only those patients most likely to benefit from an intervention receive it, those who do not will continue to suffer the downstream consequences. This would reinforce those models and broaden the already gaping chasm between the haves and have-nots. Our identification of individual differences or risk factors cannot allow for the propagation of their expected outcomes in what would be a new form of “genetic” or “social” determinism. This danger becomes even more precarious when the cost or ability to pay for medical care are considered for recommendations. One aim of precision emergency medicine is to help reduce costs to the individual and system while improving outcomes for both. But these goals may often be contradictory. Our ethical duty to provide the best treatments for our patients may often be at odds with the reality of their financial status or the distribution of limited resources. Our search for optimization, of getting the choice “just right” by adding

continuously more variables may, in effect, risk overfitting the patient in front of us to a model, instead of considering the totality of their experience in our recommendations.

Moving Forward

We believe in the potential of precision emergency medicine and that the aforementioned potential pitfalls can be navigated. Through the intentional evaluation and management of systems with a critical lens toward bias, justice, and impartiality, we can mitigate the risk of entrenching bias and deepening disparities. Focus needs to be given not only to those characteristics that are measured, but also to how we gather and share this information. We must act as data stewards for the safety of our patients, without paternalism, and enable patients’ autonomy to participate. Instead of the smooth, autonomous system some might imagine of precision emergency medicine, we will still need to sit with our patients and remain vigilant against our own biases in order to provide the best care possible. We will need to listen to the breadth of experience of the patient in front of us and avoid simply turning him or her into a number.

ABOUT THE AUTHORS r. Newberry is an assistant D professor at Stanford Emergency Medicine who focuses on global health, gender-based violence, and social emergency medicine. r. Rose is an emergency D medicine informaticist specializing at the intersection of clinical medicine, informatics and innovation. His goal is for our computational systems help to amplify the human presence in medical care.

GERIATRIC EMERGENCY MEDICINE

Palliative Care Resources for COVID-19 Field Hospitals

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By Leah McDonald, MD, submitted on behalf of the SAEM Academy for Geriatric Emergency Medicine

In April 2020, COVID-19 began to overwhelm hospital resources, leading to the development of field hospitals across the country to manage COVID-19 patients in the event there might be a shortage of beds. During this time, the emergency medicine and palliative care departments at Rhode Island Hospital collaborated to create a resource guide and protocol for end-of-life symptom management for COVID-19 patients who were being cared for at the field hospital. Fortunately, due to public health measures, COVID-19 did not end up overwhelming the hospital system this spring. However, the resources provided in the protocol apply to the management of all COVID-19 patients at the end-of-life and may be particularly important now, as much of the U.S. faces another surge.

Here we share some of the resources we created to help providers deliver end-of-life care for patients with COVID-19 (Figure 1). The intended patient population is patients with COVID-19 presenting with lifethreatening respiratory symptoms who have chosen to pursue comfort-focused care. The decision to pursue comfortfocused care should occur in tandem with symptom management and those goals of care conversations can be led by clinicians across specialties with or without palliative care involvement. In this model, patients with symptoms from COVID-19 that are severe enough to require inpatient level of care but with low likelihood of clinical improvement would be cared for by physicians at the field hospital. These clinicians would be recruited from across specialties, so the focus of this resource guide is

to distill down the keys of symptom management to be implemented by all physicians without the need for specific palliative care consultation. First, we highlight how to lead a goalsof-care conversation in this setting (1). Using tools from Center to Advance Palliative Care (CAPC) and Vital Talk, as well as a step-by-step communication model outlined in an article in the Annals of Emergency Medicine, the guide gives practical responses to difficult questions from patients and families and how to align goals. Next, we shift focus to symptom management. Dyspnea and anxiety/ agitation are common symptoms experienced at the end of life by patients with COVID-19. There are nonpharmacologic interventions to assist with dyspnea which should be

“The decision to pursue comfort-focused care should occur in tandem with symptom management and those goals of care conversations can be led by clinicians across specialties with or without palliative care involvement.” implemented initially (2). Opiates are the mainstay of medical management of dyspnea so the guide dedicates a large portion to initiating and titrating opiates to comfort (3). Benzodiazepines play a large role in treating anxiety and terminal agitation (4). A major consideration in care for these patients includes nursing safety. Reducing the exposure of nursing staff to infectious patients factors into the treatment plan; therefore, the final part of the treatment plan guides clinicians on how to transition opiates to a continuous infusion for symptom management (5). As the number of infected patients continues to rise, field hospital protocols that ensure patients receive excellent pain and symptom management are crucial. This field guide may serve as a resource to guide quality end-of-life symptom management for these critically ill patients.

ABOUT THE AUTHOR Dr. McDonald is a practicing emergency medicine and hospice and palliative medicine physician at Rhode Island Hospital and Falmouth Hospital. She received her medical degree from Tufts University School of Medicine. She completed an emergency medicine residency at New York University/ Bellevue Hospital and a fellowship in hospice and palliative medicine at Brown University/ Hope Health Hospice. Figure 1. Field Hospital Palliative Care Guidance, created by Drs. Leah McDonald and Elizabeth M. Goldberg

About AGEM The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM 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.”

GLOBAL EMERGENCY MEDICINE

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COVID-19 Community Interventions Task Force: Building Bridges Between EM and Community Health Centers

By Sindhya Rajeev, MD, MPH; N. Ewen Wang, MD; Jonathan G. Shaw, MD, MS; Jennifer A. Newberry, MD, JD, MSc on behalf of the SAEM Global Emergency Medicine Academy On March 11, 2020 the World Health Organization (WHO) declared the coronavirus 2019 (COVID-19) a pandemic and one that would be “not just a public health crisis, but a crisis that will touch every sector.” At the time, Stanford Medicine had just confirmed treating its first patients with COVID-19, and within a week California’s governor announced a statewide order to shelterat-home. Anticipating a growing need for collaboration and a coordinated response among the community safety net, the Stanford University department of emergency medicine (EM) established

the COVID-19 Community Interventions (CCI) Task Force. Stanford EM’s section of social emergency medicine and global health were uniquely positioned to lead this initiative given their mission to decrease health disparities, expertise in working with multiple public health stakeholders, and connections to community leaders. Faculty initially reached out to different community organizations and federally qualified health centers (FQHCs) to gauge interest. The CCI Task Force now consists of a partnership between

Stanford EM, Stanford’s division of primary care and population health (PCPH), FQHCs in our two neighboring counties, leaders of the community health centers consortium, and local departments of public health to identify and solve regional health care needs during the pandemic. During the first two months, the CCI Task Force held remote meetings weekly, and thereafter biweekly. In addition to the meetings, an online dashboard was created to share resources, solicit questions from

“Working together, the CCI Task Force created a venue for knowledgesharing and identifying community needs, which in turn increased access to testing, personal protective equipment (PPE), and evidence-based protocols, while improving connections with community resources.” members, and extend invitations to our community partners to COVID-19 relevant grand rounds and webinars. This dashboard continues to actively host updates. The collaboration leverages each group’s strengths to fill gaps in knowledge and resources. Working together, the CCI Task Force created a venue for knowledge-sharing and identifying community needs, which in turn increased access to testing, personal protective equipment (PPE), and evidence-based protocols, while

improving connections with community resources.

Collaborative Community Needs Assessment The CCI Task Force’s meetings and dashboard created a collaborative environment in which members not only shared their insights and innovations, but also identified and advocated for the needs of the community. Stanford EM, as an academic health center, recognized its unfamiliarity with how the local community would provide care

during the pandemic and the effect on the community’s needs. Meanwhile, the FQHCs looked to Stanford as the gold standard for the latest clinical information and protocols. The inclusion of public health officers in the CCI Task Force provided the opportunity for discussions between them and safety net clinicians, to bridge the gaps between clinical care and public health approaches to

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GLOBAL EM

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the COVID-19 response. Situated on the border of two large counties, the CCI also presented a setting for cross-county interchange and potential alignment.

Working together, the CCI Task Force helped EM practitioners understand the best way for patients seen in the ED to follow-up with FQHCs, the expansion of telehealth visits at FQHCs, and the resources available to patients without insurance. The CCI Task Force shared with FQHCs leaders the academic medical center’s approach to early COVID-19 testing, antibody testing, and repeat testing. The CCI Task Force saw the need for a comprehensive understanding of what testing options were available to our community, across the patchwork of testing sites that were popping up within and outside of the traditional public health infrastructure. To answer this, the CCI Task Force gathered information regarding testing availability at the FQHCs, Stanford’s public testing locations, Stanford’s emergency department, and free testing sites run by private companies. This helped FQHC leaders identify which patients could receive testing at other facilities and

“Community health care practitioners became a key resource for patients advised to isolate from others by staying at home when those patients have multiple members in their household, or do not have the means to get necessary food and supplies.” which patients to prioritize for the few tests that they were able to administer at the clinics. At the same time, this information allowed Stanford’s PCPH and EM practitioners to understand current testing limitations in the community, and technological obstacles like preregistering online for testing that could prevent the community from accessing testing at Stanford Medicine public testing sites.

Access to Testing, Personal Protective Equipment, and Protocols

In early March, when COVID-19 testing sites were extremely limited throughout the United States, the CCI Task Force produced a detailed protocol on how to operate a walk-in/drive-through testing site, based on Stanford EM’s

successful model. In addition, the CCI Task Force invited FQHC leaders to visit the ED walk-in/drive-through operations, accompanied by a CCI Task Force representative. The walk-in/ drive-through testing protocol and tour helped inform FQHC strategy on how to conduct testing for the community while maximizing safety and minimizing PPE usage. Despite widespread efforts to conserve PPE and advocacy to direct equipment to front line health workers, PPE shortage has been ubiquitous in the U.S., from clinics to ambulances and hospitals. It became quickly apparent that there was a shortage of PPE at local FQHCs. Without adequate PPE, FQHC practitioners would not be able to see patients that required

“To address the PPE shortage in clinics, the CCI Task Force connected FQHC leaders to a Stanford University medical student-led PPE drive, which was able to provide needed PPE.” in-person evaluation. As a result, there was a concern these patients either would go unseen or seek care in the ED for their primary care needs in the midst of a pandemic. Moreover, those patients discharged from the ED would not have a place to follow-up. To address the PPE shortage in clinics, the CCI Task Force connected FQHC leaders to a Stanford University medical student-led PPE drive, which was able to provide needed PPE.

Community Resources

Finally, a major goal of the CCI Task Force was to create a space to highlight community resources and knowledge. This was especially important because the community spanned two different counties. To this end, county public health department representatives from the two neighboring counties attended meetings monthly and provided key updates regarding current disease trends; guidelines on testing, quarantine, and return to work; and community interventions and resources. The CCI Task Force also discussed specific support and guidelines around particularly vulnerable populations, such as those who were homeless, or migrant workers. Community health care practitioners became a key resource for patients advised to isolate from others by staying at home when those patients have multiple members in their household, or do not have the means to get necessary food and supplies. The CCI Task Force identified and shared with the group novel non-local examples of community response, like IsoCare, a volunteer network that supports patients who must isolate at home with practical advice through health education, access to resources, and emotional support. Stanford medical students have begun to adapt the model for our health care system. The CCI Task Force provided

a conduit for community clinicians and organizations to borrow materials and practices from IsoCare to use in their own efforts to help patients address these challenges and successfully isolate. Most recently, the CCI Task Force provided a forum to explore grant partnerships with community partners by inviting representation from the hospital’s community benefits grant office, and hosting Stanford researchers active in community-based participatory research to discuss possible grant collaborations based on community interest.

Conclusion

At the onset of the pandemic, Stanford’s department of EM brought together leaders and practitioners from federally qualified health centers, clinics serving marginalized populations, the local community health centers consortium, departments of public health, and our academic health center, with the goal of hearing the needs of our local community and delivering solutions. Working together, the CCI Task Force has served as an important source of coordination and support for our regional health care safety net, and expanded regional access to testing and PPE, evidence-based protocols, and community resources beyond what any individual group could have accomplished on its own. As we prepare for the winter and spring, we expect new challenges with the COVID-19 pandemic — school reopenings, influenza vaccination, testing, and treatment, and the dissemination of the COVID-19 vaccine. We plan to evaluate which aspects of the CCI Task Force have been most impactful, and how we can continue to leverage this collaboration to promote the health of the community throughout the pandemic, and beyond.

ABOUT THE AUTHORS Dr. Rajeev is a clinical instructor in the department of emergency medicine at Stanford and a global emergency medicine fellow. She is committed to addressing health disparities through health systems strengthening at the hospital, community, and state levels. @SindhyaRajeev Dr. Wang is a professor of emergency medicine, associate director of pediatric emergency medicine and director of the social emergency medicine program. She has an expertise in health services research with an emphasis on identifying health disparities in access to and outcomes of quality emergency and specialty care. Dr. Shaw is clinical associate professor and director of community partnership within the Stanford School of Medicine’s Division of Primary Care & Population Health. He is a practicing family physician at Ravenswood Family Health Center in East Palo Alto, California, and a health service researcher at Stanford University. Jgshaw@stanford.edu Dr. Newberry is an assistant professor at Stanford University. She is currently the research director for Stanford Emergency Medicine International (SEMI) and co-lead for research and strategic planning. Dr. Newberry’s current research seeks to understand how to strengthen crisis support systems for women experiencing gender-based violence and/ or other medical emergencies.

About GEMA The Global Emergency Medicine Academy (GEMA) focuses on improvement of the worldwide delivery of emergency medical care. Joining GEMA 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.”

MEETING AT THE CROSSROADS

Where Telehealth, Behavioral, and Psychological Interests Meet in Emergency Care

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Meeting at the Crossroads is a column dedicated to bringing members of various SAEM interest groups and academies together to explore the areas where they intersect. In this issue, Erica Olsen, MD, chair of the SAEM Telehealth Interest Group meets with Bernard Chang, MD, PhD, chair of the Behavioral and Psychological Interest Group to discuss where telehealth, behavioral and psychological interests meet in emergency care.

Dr. Olsen: Happy New Year! I am really looking forward to our conversation today. As we enter 2021 and still find ourselves fighting the COVID-19 pandemic throughout the country, many of our colleagues are reporting feeling “burnout.”

Dr. Olsen: Absolutely! Do you see a role for telehealth in alleviating some of this provider stress? In my own experience the telehealth encounter is generally calm and allows me to really focus my attention.

Dr. Chang: Great to be here with you Dr. Olsen. As a quick background, I’m an emergency physician and also a research psychologist, with a strong interest in looking at clinician psychological health (such as burnout). Past work has found emergency clinicians already reporting high levels of psychological stress and COVID-19 has only exacerbated that. The data is pretty clear: clinicians are facing unprecedented stressors during this time and reporting significant levels of mental health complaints, from depressive to anxiety symptoms. We need to protect the front line from fraying!

Dr. Chang: We’ve begun looking at the role of occupational stressors and system level issues affecting both patient and clinician mental health outcomes, and have been particularly interested in how innovations, such as telehealth, may make a positive difference. Many of our patients, just like some of our providers, are experiencing high degrees of stress. The telehealth environment may provide unique positive aspects of the clinician-patient dynamic. For example, telehealth encounters often occur in a one-to-one setting, removed from the sounds/stimuli of an in-person emergency department. Such an

environment may pose fewer real-time interruptions and potential distractions, which in turn may allow providers to converse and treat their patients in a more controllable context. This in turn may be associated with decreased stress on the part of both provider and patient, while also influencing patient care outcomes such as management plans and even medical errors. Dr. Olsen: Dr. Chang, this is very exciting work you’re doing. I can’t wait to hear more about what you learn. Both patients and providers are definitely feeling the stress of living in a pandemic for almost a full year now. Some patients report anxiety, but many simply display behaviors that indicate high anxiety and stress levels. One woman did her virtual visit from a local park stating that she stays outdoors as much as possible to avoid catching COVID and fears staying

in her small New York City apartment that she shares with multiple family members. Another mother of two called in from a city bus during her commute to the day care and then did her job with one baby in a carrier, another on foot, and the patient wearing a face mask herself. Telehealth gives us a window into our patients’ lives and it is a humbling experience to say the least. Dr. Chang: Telehealth providers have the unique opportunity to observe patients in their natural environments, compared to the hospital setting. This can hold important contextual clues to their overall health, particularly within their mental health. Some patients will self-identify as having a mental health chief complaint, while others may not. It is important to be mindful of these nonverbal cues when evaluating patients and some of the more subtle signs. How about yourself; have you run into anyone experiencing stress from working with new technology? Dr. Olsen: That’s a great question. In short, YES! Both patients and providers had to adapt to virtual visits in a relatively short amount of time. Some patients are naturally more tech savvy than others or may have family members to assist, but I have had patients apologize profusely at times for perceived mistakes they’ve made with using the software. Minor things like audio not working can really make for a rough start to a visit, with the patient feeling flustered and awkward. Anything that we can do to alleviate the tech-related pressure and improve access for patients should be done. A host of

ideas have been entertained, such as staffing real-time virtual assistants, delivery and retrieval of tablets that have software preloaded, and providing tech stations in the local community where patients can drop in and do a visit. Dr. Chang: Even our colleagues/providers feel that stress with the new technology. We’re worried enough about staying up to date on clinical care literature! Having support for the technology/software/ hardware aspects is important as well. Perhaps via support measures ranging from simple and clear instructional guides to the availability of real-time support by an actual person. Dr. Olsen: I agree. We are all in this together and finding our way through. As chair of the SAEM Behavioral and Psychological Interest Group, is there anything you would like to see as it relates to telehealth? Dr. Chang: Beyond some of the aspects of telehealth on patient and provider mental health, I would be thrilled to see more collaboration between mental health interventions over telehealth and EM led initiatives. We frequently see patients within the emergency department (ED) who get referred to see behavioral health for consultation. Perhaps we could arrange that in real-time and bring consultants into our telehealth visits. There are already robust tele-psychiatry programs across the country, but it would be exciting to build on that and see how those initiatives can be seamlessly integrated into the ED workflow.

Additionally, the ED serves as the primary point of care for many patients for behavioral health issues and represents an opportunity to engage patients either live or over telehealth to address a range of conditions from substance use disorders to broad psychological health. Dr. Olsen: That would be great to be able to offer a suite of mental health services to our patients via telehealth. Dr. Chang, thank you for your time and this informative conversation. Dr. Chang: My pleasure. Would love to continue the conversation. And for all you readers, please consider joining the SAEM Behavioral Health and Psychological Emergencies Interest Group! We’d love to have you. Thank you.

BIOGRAPHIES r. Olsen is the director for D virtual health services in the department of emergency medicine at Columbia University Irving Medical Center / New York Presbyterian Hospital. She is the chair of SAEM's Telehealth Interest Group. Dr. Chang is a professor of emergency medicine at Columbia University Medical Center. He is the chair of the SAEM Behavioral and Psychological Interest Group.

INFECTIOUS DISEASES AND EPIDEMICS

AN EMTIDE SUPPORT STATEMENT

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Emergency Departments Can Bolster Influenza and COVID-19 Vaccination Programs

By Elissa M. Schechter-Perkins, MD, MPH; Richard Rothman, MD, PHD; Kiran Faryar, MD; Michael Waxman, MD; Bhakti Hansoti, MD; Michael Lyons, MD; Yu-Hsiang Hsieh, PhD; Eili Klein, PhD; Larissa May, MD; Jason Wilson, MD; and Daniel R. Martin, MD, MBA on behalf of the SAEM Emergency Medicine Transmissible Infectious Diseases and Epidemics interest group. The coronavirus disease 2019 (COVID-19) pandemic has proven, yet again, that U.S. emergency departments (EDs) are a critical part of the nationâ&#x20AC;&#x2122;s health care safety net. As medical centers throughout the country canceled visits throughout the spring and shifted ambulatory visits to telemedicine, EDs remained open and continued to provide 24/7 care. As coronavirus surges across the nation, EDs will continue to care for patients that might otherwise not have in-person contact with the health

care system. EDs represent a critical component of the heath care infrastructure. There is a unique opportunity for the ED to serve individual patients, meet public health needs, and contribute to the integrity of the health care system itself by helping to maintain hospital capacity: by providing vaccinations during acute ED patient encounters. Pilot programs across the country have demonstrated over several years the viability of using the ED to bolster influenza vaccination programs.1,2,3,4

However, there has not been broad uptake of these programs, despite policy statements that support utilizing the ED as a setting for influenza vaccination programs from national organizations including the Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and the American College of Emergency Physicians (ACEP) itself. With the need to vaccinate millions of people across the country against SARS-CoV-2, this may be the right time

for U.S. EDs to consider implementing vaccination programs. In 2016 there were 144.8 million ED visits in the U.S.5 and the number continues to grow. Compared to the rest of the health care system, individuals who visit the ED are disproportionately minorities, are less likely to have other contacts with the health care system, and less likely to be insured. Thus, we can presume they have lower vaccination rates than the overall U.S. population. These same communities have been disproportionally affected by the COVID-19 pandemic and would most benefit from widespread vaccination efforts. While responding to the COVID-19 pandemic is the challenge of our times, every year hospitalizations, ambulance diversion, and overall demand on ED resources increase in the winter months, partially driven by the influenza season.6 During the COVID-19 pandemic, hospital systems nationwide are more concerned than ever regarding inpatient capacity. Vaccinating their own population against influenza and SARS-CoV-2 may actually improve hospital capacity by preventing cases of influenza and COVID-19 that would otherwise present to the ED, potentially requiring admission. Detractors may suggest that EDs should not engage in public health initiatives, as they can be costly, interfere

with ED throughput, and interfere with our primary mission, which is to provide emergent care. However, prior work by SAEM’s Emergency Medicine Transmissible Infectious Diseases and Epidemics (EMTIDE) interest group on HIV testing in EDs has demonstrated that EDs can facilitate public health initiatives, while continuing to provide high quality emergency care, without negatively affecting patient throughput or health system costs.7,8 The requirement for success of this endeavor will of course require partnership and sharing of, or diversion of, personnel, resources and infrastructure from local, state, regional, and federal partners. The fact that the global pandemic has shuttered vast swaths of outpatient care makes providing these public services a moral imperative for the ED, which is filling the void by remaining open and taking care of patients. EDs are able to be part of a solution to a vast health care problem, which includes reaching out to the underserved, uninsured, and minority patients and therefore, has an obligation to do so. As a specialty, we pride ourselves on our ability to be versatile and adapt to whatever catastrophes the world throws our way. Embracing rather than avoiding imperatives such as this proves our adaptability in the face of a pandemic and can lead to the advancement of our specialty.

REFERENCES 1. Rodriguez RM, Baraff LJ. Emergency department immunization of the elderly with pneumococcal and influenza vaccines. Ann Emerg Med 1993;22(11):1729–32. 2. Slobodkin D, Kitlas J, Zielske P. Opportunities not missed — systematic influenza and pneumococcal immunization in a public inner-city emergency department. Vaccine 1998;16(19):1795–802. 3. Rimple D, Weiss SJ, Brett M, Ernst AA. An Emergency Department–based Vaccination Program: Overcoming the Barriers for Adults at High Risk for Vaccine-preventable Diseases. Acad Emerg Med 2006;13(9):922–30. 4. Casalino E, Ghazali A, Bouzid D, et al. Emergency Department influenza vaccination campaign allows increasing influenza vaccination coverage without disrupting time interval quality indicators. Intern Emerg Med 2018;13(5):673–8. 5. Lane BH, Mallow PJ, Hooker MB, Hooker E. Trends in United States emergency department visits and associated charges from 2010 to 2016. Am J Emerg Med 2020;38(8):1576–81. 6. Schull MJ, Mamdani MM, Fang J. Community influenza outbreaks and emergency department ambulance diversion. Ann Emerg Med 2004;44(1):61–7. 7. Kecojevic A, Lindsell CJ, Lyons MS, et al. Public Health and Clinical Impact of Increasing Emergency Department–Based HIV Testing: Perspectives From the 2007 Conference of the National Emergency Department HIV Testing Consortium. Ann Emerg Med 2011;58(1, Supplement):S151-S159.e1. 8. Galbraith JW, Anderson ES, Hsieh Y-H, et al. High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017. MMWR Morb Mortal Wkly Rep 2020;69(19):569–74.

RESEARCH IN ACADEMIC EM Teaming up With Your Inside Advocate: Working With NIH Program Officers for Early- and Mid-Career Investigators By James H. Paxton, MD; Kori Sauser-Zachrison, MD; Ambrose Wong, MD, MSEd; Joshua J. Davis, MD; Michael A. Puskarich, MD, MSCR; Bernard P. Chang, MD; and Prasanthi Govindarajan, MBBS, MAS on behalf of the SAEM Research Committee In an effort to promote National Institutes of Health (NIH) research opportunities for members of the Society for Academic Emergency Medicine (SAEM) and Association of Academic Chairs of Emergency Medicine (AACEM), the SAEM Research Committee recently established a subcommittee charged with the task of facilitating improved communication between NIH program officers (POs) and interested researchers. This article represents the first installment of an ongoing effort intended to prepare emergency medicine (EM) investigators for conversations with NIH staff members. In this inaugural submission, we present questions from the SAEM research community, answered by Jane D. Scott, ScD, MSN, FAHA, director of the Office of Research Training and Career Development, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health. Additional questions not included here can be submitted by members of the SAEM community to Melissa McMillian, CNP, SAEM Director of Foundation and Business Development. have one or two institutes support a proposal as a primary and secondary funder. So it is important to ask! SAEM: I completed my clinical training and an SAEM-approved research fellowship. What are some of the training and funding opportunities that are available for early stage investigators?

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Jane D. Scott, ScD, MSN, FAHA

SAEM: If my research spans the priorities of two institutes, how should I proceed in choosing an institute? Dr. Jane Scott: Start by discussing with your mentors and reading the NIH institute websites. If the early career person is not sure of the institute, pick the top two contenders and get on the phone to talk with a program officer (PO) at the institute who can help you decide which institute is best. Always check with one program officer at two institutes. Sometimes, one or more institutes may have shared interest in collaboratively funding a proposal. For example, some grants at the NIH may

Dr. Jane Scott: Some of the opportunities for early stage investigators include the career development awards, or the K training grants, in addition to foundation training grants such as those supported by the SAEM Foundation (SAEMF). For training mechanisms (T32, K01, K08, K23, K12), some institutes have program officers who exclusively manage training mechanisms or exclusively manage research grants. At other institutes, program officers provide oversight to training programs and research grants. So an important place to start, before contacting a program officer, is to check the NIH institute-specific websites to determine the scope of the science they support and read through the instituteâ&#x20AC;&#x2122;s strategic goals. The first level of decision-making for the investigator is to find the appropriate institute and then determine whether the institute is supporting funding mechanisms (e.g., program announcements, requests for applications, request for proposals) through which the research may be

funded. Without a current and ongoing funding mechanism, there is no opportunity for funding. One thing to be aware of is that the funding opportunities seldom exactly match research ideas, so consider how the proposed research may fit to meet the goals and objectives of an institute. When planning for additional research training, selecting the appropriate training mechanism is key, since not all institutes support the same mechanisms. SAEM: How do I identify the correct program officer or study section for my idea? Some institutes have more than one PO and how do I connect with the right one? Dr. Jane Scott: There is no simple answer to this question. From the outside, it is very difficult to determine who best to work with. If you know of individuals or colleagues, call them first or get program officer names from the institute website. The most important starting place is knowing the best institute and correct funding mechanism. Please recognize that this is sometimes difficult for areas where scientific domains merge, such as cardiooncology. The answer is not always easy to discern, and it is important to ask the PO. Sometimes you need to check with POs at two or three NIH Instituteâ&#x20AC;&#x2122;s/ Centers (I/Cs). And you may need to talk with more than one PO at a single

â&#x20AC;&#x153;The first level of decision-making for the investigator is to find the appropriate institute and then determine whether the institute is supporting funding mechanisms (e.g., program announcements, requests for applications, request for proposals) through which the research may be funded.â&#x20AC;? institute. I talk to trainees about training mechanisms, cardiovascular health services research, and emergency care research, but beyond that, I send training applicants to the scientific PO experts. It is not uncommon for an applicant to work with several POs. Please take notes of who you talked with and when, and keep track of the advice that you received. The key takeaway here is that you must work with the program officer(s). SAEM: How should I prepare for a call with a program officer regarding a funding opportunity? Dr. Jane Scott: If you want to talk with a program officer about your research

ideas, make an appointment by e-mail. Prior to the call, be prepared to share an updated copy of your NIH biosketch and Specific Aims. Also read the funding announcement fully before the call. The PO needs time to review both documents to better understand the applicant and the proposed research. If you want to talk with your program office about your summary statements, review the statements yourself and then review the summary statements with your mentor. Again, email a request for a telephone appointment to the PO. Your PO can be one of your strongest advocates but please be mindful of their other responsibilities and time. Be prepared

to have a thoughtful discussion with your PO. The PO is not your enemy; listen to their suggestions and go back and discuss their suggestions with your mentor. SAEM: What is the role of the program officer after the review session? Dr. Jane Scott: Following the grant review, the PO can discuss the summary statements with the applicant and help them to plan the next steps for their revised application. The grant score is generally posted within 24 hours of the

continued on Page 50

RESEARCH

SAEM PULSE | JANUARY-FEBRUARY 2021

continued from Page 49

review. The summary statements may take six to eight weeks to be returned to all investigators. Frequently, investigators will ask the PO whether they attended the review, and if so, their summary of the discussion. This is not appropriate, and in revising the application for resubmission, only the comments in the summary statements should be used and responded to. Reports of study section discussion shouldn’t be used. If an investigator believes that there were substantial scientific errors in the review itself, the investigator should discuss these concerns with the PO. Sometimes “an appeal” can be requested. The PO and Scientific Research Organization are both involved in the resolution of the issue as a first step. More often than not, the best advice is to revise and resubmit. SAEM: What are the advantages of being an Early Stage Investigator (ESI)? Dr. Jane Scott: Early stage investigator status is a “program” or “strategy” to

make research funding (R funding) more accessible for first-time R01 applicants. At the National Heart, Lung, and Blood Institute, ESIs are given a ten point bump. That means, if an institute funding line is the 15th percentile for experienced investigators, ESIs are given up to ten points (to 25th percentile). ESI is a one-time opportunity, and therefore early career investigators

must be careful not to jeopardize their eligibility for this opportunity. For example, if an ESI applies for R funding with an experienced investigator, in a co-principal investigator (PI) leadership structure, the ESI advantage is erased and will be lost forever. It is important to use this ESI advantage carefully. SAEM: Occasionally, post-review discussions with the program officers

do not provide a clear direction for the next steps. Is there an alternative approach under these circumstances? Dr. Jane Scott: These are nuanced discussions, and it is important to look at it from both sides. Program officers can provide advice, suggestions, and a bit of guidance, but cannot tell investigators what to do. However, sometimes investigators are asking for more structured answers than the PO can provide.

ABOUT THE INTERVIEWERS Dr. Davis graduated from medical school at Thomas Jefferson University and emergency medicine residency from Penn State Milton Hershey Medical Center. He has a background in research and is now a community physician-scientist in Wichita, Kansas. Dr. Paxton is director of clinical research for the department of emergency medicine at Detroit Receiving Hospital, Wayne State University. He is an active clinical researcher and has served as principal investigator for a wide variety of clinical trials. Dr. Govindarajan is an associate professor and associate vice chair of emergency medicine at Stanford University School of Medicine. She is a health services researcher and is currently funded by the Agency of Healthcare Research and Quality. r. Wong is the director of simulation research D and assistant professor of emergency medicine at Yale School of Medicine. He uses health care simulation to improve teamwork and patient safety. Dr. Puskarich is director of research at Hennepin County Medical Center and an associate professor at the University of Minnesota. He is a clinical trialist and translational researcher with a focus on critical illness. Dr. Zachrison is an associate professor of emergency medicine at Massachusetts General Hospital and Harvard Medical School, and is affiliated faculty with the Onnela Lab at Harvard T. H. Chan School of Public Health. Dr. Chang is an associate professor and vice chair of research at NewYork-Presbyterian / Columbia University Irving Medical Center.

The Role of the NIH Office of Emergency Care Research in Helping Applicants SAEM: What role does the National Institutes of Health (NIH) Office of Emergency Care Research play in reviewing an idea or a planned application? Dr. Jeremy Brown: The NIH Office of Emergency Care Research is able to help prospective applicants in a number of ways: 1. If you are new to the application process, the Office of Emergency Care Research can help connect applicants to POs in institutes across the NIH. 2. The Office of Emergency Care Research can also assess the feasibility of a research idea, and how it might be tailored to the research priorities of the different institutes. 3. The Office of Emergency Care Research can also join in discussions between an applicant and a PO. These three-way dialogues are especially useful in the early planning stages of a project and also help the applicant to find the appropriate grant mechanism. 4. Lastly, funding decisions are only made by the Institute to which the application is assigned and are usually based on the score given by the study section. The Office of Emergency Care Research does not play any role in these decisions. Jeremy Brown, MD, is director of the NIH Office of Emergency Care Research, where he leads efforts to coordinate emergency care research funding opportunities across NIH. He also serves as NIHâ&#x20AC;&#x2122;s representative in governmentwide efforts to improve emergency care throughout the country. He is the medical officer for the SIREN Jeremy Brown, MD emergency care research network, which is supported by both National Institute of Neurological Disorders and Stroke and NHLBI. In addition, he is the medical officer for several other grants focused on emergency care. For further information on which areas of emergency care research are of interest to the Institutes, please see the Notice of Special Interest (NOSI): Research in the Emergency Setting.

SAEM PULSE | JANUARY-FEBRUARY 2021

WELLNESS & RESILIENCE

Save of the Month! An Initiative for Improving Resident Wellness Through Gratitude By Jeffrey T. Sakamoto, MD; Cori Poffenberger, MD; and Al’ai Alvarez, MD, on behalf of the SAEM Wellness Committee Gratitude is a powerful driver of physician wellness. In simple terms, gratitude refers to the emotional response after being provided assistance or a service. Within the context of medicine, this typically emerges from the patient-doctor relationship, when patients thank the physician for caring for them. Receiving gratitude is an essential

acknowledgment of a provider’s work and produces a positive, uplifting response that leads to greater professional fulfillment and worksatisfaction. However, gratitude can have a broader impact. Wood et al. describe gratitude in a Clinical Psychology Review article as “a habitual focusing on and appreciating the positive

aspects of life.” Gratitude, therefore, is not limited to the recognition we receive from patients. Within emergency medicine (EM), gratitude also applies to physicians thanking patients for being brave through health adversity, thanking consultants for productive interactions, and thanking each other for working tirelessly to help our patients at their most vulnerable.

â&#x20AC;&#x153;As emergency physicians, cultivating a culture of gratitude within our work environment can lead to higher professional fulfillment.â&#x20AC;? Wood et al. also discuss a causal relationship between gratitude and well-being: the benefit is not only for the person receiving the appreciation but also for the person conveying it. As emergency physicians, cultivating a culture of gratitude within our work environment can lead to higher professional fulfillment. Physician burnout represents a daily challenge to our work in EM, including among residents and medical students. Initiatives promoting gratitude may be an effective means to improve wellness in our departments. To foster this culture of gratitude, the Stanford Emergency Medicine residency program created a wellness initiative called Save of the Month (SoTM). While the idea of SoTM is not novel, formally acknowledging the significant efforts of residents can improve wellness through gratitude. The intervention is free of cost and easy to implement. QR codes were created that link to a nomination form and are posted throughout the emergency department (ED) in visible areas to allow easy access. Using email, Facebook groups, and chat groups, all ED staff, including nurses, technicians, attendings, residents, and fellows, are encouraged to submit cases. A chief resident, the program director, and an

assistant program director compose the committee that reviews cases monthly, with an added goal of ensuring equity and inclusion among gender and class year. The committee selects three cases per month from a pool of submissions. The committee then announces the recipients of the SoTM awards monthly preceding the departmental grand rounds to amplify recognition. The weekly departmental newsletter further congratulates the winners, and the residents receive a certificate of commendation signed by the chair, vice chair of education, and the program director. The committee also sends a message of acknowledgment to the nominators, thanking them for their efforts in recognizing residents. SoTM promotes gratitude in several ways. First, through resident appreciation, emphasizing the positive and vital impact residents have on patients' lives, cultivating a sense of connection to and meaning in work. Second, SoTM fosters an overall culture of appreciation, where residents feel valued by others within the department. Lastly, SoTM creates an official avenue for faculty and ED staff to express their gratitude to residents for their dedication to patient care. While this intervention may seem simple, creating methods for recognition

and appreciation of residents can help build a culture of gratitude that provides greater professional fulfillment and ultimately leads to an improvement in well-being for the entire department.

ABOUT THE AUTHORS Dr. Sakamoto is a chief resident at Stanford Emergency Medicine Residency and a member of the SAEM Wellness Committee. He also serves as the RAMS board secretary-treasurer. @jtsakamo @StanfordEMED Dr. Poffenberger is director of faculty development and wellness at Stanford University department of emergency medicine and a member of the SAEM Wellness Committee. @coripoff @StanfordEMED Dr. Alvarez is an assistant program director at Stanford Emergency Medicine Residency and a member of the SAEM Wellness Committee. @alvarezzzy @StanfordEMED

Hosting Zoom Webinars for Residency Recruitment

SAEM PULSE | JANUARY-FEBRUARY 2021

By Daniel Novak, DO; Eric Quinn, MD; and Sabena Vaswani, MD

The COVID-19 pandemic created a unique set of challenges for residency recruitment this application season. The standard application cycle consists of students touring hospitals and meeting with residents and faculty in person. In order to limit travel and potential exposure, recruitment pivoted online in 2020. While the virtual model alleviated the financial burden of the interview season for students, the shift made it difficult for residencies to showcase their programs. To combat this, and in order to engage with prospective applicants, dozens of emergency medicine residencies around the country hosted Zoom meetings, ranging from informal happy hours, to more structured webinar style sessions. The emergency medicine residency at Maimonides Medical Center hosted a webinar series for the purpose of giving students a

sense of our program. In order to give an honest depiction of the residency experience, the series was run by residents. We used our personal and residency social media accounts on Twitter, Instagram, and Facebook to advertise the series. Residents and faculty also emailed EM advisors from different medical schools.

Format

Our program hosted a six-part Zoom series over the course of three months prior to the Electronic Residency Application Service® (ERAS®) submission deadline. We used the webinar setting and each meeting was followed by a 20- to 30-minute question and answer session. This setting allowed us to spotlight the hosts and presenters and to mute the audio and video of guests. We encouraged students to use the “raise hand,” “Q&A,”

and chat features to interact with the panelists. The series consisted of the following one-hour Zoom sessions: 1. “Applying to Emergency Medicine & How to be a Rotation Rockstar” This session was geared toward giving fourth-year medical students practical tips to excel in their audition rotations. 2. “Why Maimonides?” This session featured our program director and assistant program directors who spoke about the highlights of our residency program and answered commonly asked interview questions. 3. “Beyond Shift: Research & Subspecialties” This segment featured a faculty panel to showcase the ultrasound, simulation, event medicine, research, and pediatric EM departments.

4. “Reflecting on COVID-19” Residents discussed what life was like as a physician-in-training during the peak of the pandemic in New York City. 5. “Alumni and Resident Panel” 6. “Diversity and Inclusion & Women in Medicine”

Results

We had 40-75 participants for each webinar, totaling 300+ attendees. The highest live attendance was for the first session, “Applying to Emergency Medicine & How to be a Rotation Rockstar.” We recorded the entire Zoom series and uploaded each segment to YouTube. We subsequently published the videos on our residency website to allow students to watch the sessions asynchronously, which accumulated an additional 300+ views. It was a challenging interview season, but the webinars gave us the opportunity to engage with applicants in a novel way and allowed us to cover more information in an organized fashion, (although, at times it felt impersonal because the guests had their video and audio muted). In the future, we plan to

use a combination of the webinar and standard meeting formats to create a more interactive setting. Following the completion of our webinar series, we sent anonymous surveys to participants. Overall, we received positive feedback, and the students reported they were able to get a better feel for our program. Although we were disappointed this interview season could not take place in person, putting this series together was a rewarding experience. We had residents, attendings, and alumni participate in the series in order to help students know what makes our program special and to shed light on our culture.

Future Cycles

Even during a traditional application season, the webinar series would lend additional insight into programs. This platform gives applicants the ability to learn more about the residency directly from faculty, residents and alumni. Our program plans to continue the Zoom series in future application cycles. The online forum allowed us to expand our outreach to students who may not have otherwise applied to our program. In

conclusion, we believe that the online format is a valuable recruitment tool to supplement the in-person interview experience.

ABOUT THE AUTHORS Dr. Novak is a resident in the department of emergency medicine at Maimonides Medical Center, Brooklyn, NY.

Dr. Quinn is a resident in the department of emergency medicine at Maimonides Medical Center, Brooklyn, NY.

Dr. Vaswani is a resident in the department of emergency medicine at Maimonides Medical Center, Brooklyn, NY.

ADVICE FOR CONTRACT NEGOTIATIONS FROM A HEALTH CARE ADMINISTRATOR TURNED PHYSICIAN - PART I By Aaron Kuzel, DO, MBA Dr. Michael Winterton is the founder and CEO of White Coat Contracting. Dr. Winterton is a graduate of Lincoln Memorial University-DeBusk College of Osteopathic Medicine and is a PGY-2 internal medicine resident at the University of Missouri department of medicine. Dr. Winterton was interviewed by Aaron Kuzel, DO, MBA, an emergency medicine resident at the University of Louisville School of Medicine. Dr. Kuzel is the associate editor of the RAMS Section of SAEM Pulse and is a member-at-large on the SAEM RAMS Board. Dr. Kuzel: Can you share your background in contract consulting and negotiations, and how you got started in this field. Dr. Winterton: I came out of undergraduate school with a bachelor’s degree in health care administration and my first job with that degree was as an operations manager for a health system over their clinical services. Part of that responsibility was recruiting and analyzing their current physician contracts and setting up Michael Winterton contracts going forward that would help the organization remain financially healthy. As you can imagine, financially healthy contracts for a hospital or organization may not be a financially healthy contract for a physician. Using this background in undergraduate and my training in business I was able to pick up skills and learn what hospitals want from physicians in terms of contract. Dr. Kuzel: Did you find many resources that assist physicians in this area? Dr. Winterton: I started looking at other organizations to see what services are out there to help physicians with their contracts. There are many financial, business, and legal professionals who will consult with physicians and help them navigate some of the legalities contracts. However, I could

"I AM A BIG BELIEVER IN USING THE CONTRACT AS A TOOL TO PROPEL PHYSICIANS IN ACCOMPLISHING THEIR GOALS." not find many resources for physicians, in terms of medical colleagues, who practice this type of business and have the physician’s best interest as part of their business mission. Dr. Kuzel: From a health care administrator’s perspective, what steps go into developing a contract that new attendings should be aware of as they begin defining their first employment contracts? Dr. Winterton: In the typical or traditional process, recruiters are out there trying to fill spots for hospitals, so they send feelers out to program directors or the programs themselves. This is usually a resident’s first contact with a recruiter. Further down this path the recruiter will make a handsome wage filling open positions. They usually serve as the agent for the hospital or middleman. In this approach, residents communicate to the hospital through the recruiter. Once residents narrow down their employment options, they typically make an on-site visit to the hospital. During this on-site visit they will have the opportunity to meet the administrative team and possible future colleagues. As things get serious, contracts will start coming into play. The second route is circumventing the recruiter and making direct contact. A resident may have a certain location in mind and a connection that enables him or her to reach out to that hospital directly. However, approaching an organization for employment in this way puts the ball into the employer’s court and gives them the leverage. Using this approach takes some tact to get what you want and keep the ball in your court in order to maximize your priorities in the contract. Dr. Kuzel: Are there advantages in circumventing the recruiter? Dr. Winterton: Through the second route there are some advantages of skipping the recruiting fees. If you do reach

out to the hospital directly, you could save the hospital some money, and if the hospital saves some money, you could potentially get a piece of that pie. Dr. Kuzel: You talked about maximizing priorities in one’s contract, can you provide some examples? Dr. Winterton: I am a big believer in using the contract as a tool to propel physicians in accomplishing their goals. For example, a resident might wish to remain in a particular state and may be willing to sacrifice some things in his or her contract in order to do so. For another physician, maximizing income might be the priority and he or she might therefore want the freedom to work as much as possible. This is fine too. I think it’s important for residents to understand what they really want. The question is, “how can residents maximize a contract when they don’t really know what they want?” I encourage residents to sit down and spend time figuring out what they want out of their careers in the next five years and how a contract can work for them to meet these goals. Dr. Kuzel: Since every physician has diverse needs, what advice do you have for residents or new physicians in determining what their goals are five, ten, or 20 years in the future? Dr. Winterton: Look at mentors who are physicians in your specialty who are happy in their careers and ask them why are they happy with their job or lives or what makes them successful in their careers. I think finding someone who has similar passions as you can help you develop these goals. You may consider asking “what are some things you like about your job” or “why does this job make you so happy?” This will give you a few key foundations to build upon as you start on your own personal goals in your own career.

The biggest thing is that residents don’t know what they don’t know. Therefore, residents should explore options — and that’s where I think third-party consultation can play an integral role. In my experience, when colleagues come to me, I immediately ask them what they want in life. Is family most important? Is financial independence or being debt free most important? Do you want to pursue academic opportunities or research? Do you want to work with medical students? Some people have a huge passion for each of these areas; their contract should be a tool to reach these goals. Dr. Kuzel: Why should physicians evaluate and review their own contracts? Dr. Winterton: Physicians should review their own contracts to at least become familiar with the terminology. After you go through about five or six contracts on your own, you become better equipped to know what is really going on. However, like I said, you don’t know what you don’t know. It is unlikely that the group or hospital is going to give you a list of options that you can ask for at their expense. That’s just not going to happen. If a patient has cardiac issues in your emergency department, you consult a cardiologist or an expert in the field. It’s the same for physician contracts. If you have a question about compensation, benefits, or duty hours, why not consult an attorney or contract consultant? Dr. Kuzel: So, what opportunities are available for physicians to negotiate? Dr. Winterton: Hospitals are trying to save on money, so continued on Page 58

CONTRACT NEGOTIATIONS - PART I from Page 57 the majority of contracts are composed of legal terms and “cookie cutter” type verbiage. They don’t want an individual contract for each individual physician in their network because this is costly. The things that are flexible, however, are compensation and benefits. Unfortunately, I have heard from many attendings who just signed a contract because the administration approached them saying, “this is what we offered everyone.” While this may be true, this is only the initial offer they offered everyone. If they really want you and are vested in your best interests, they will want you to be happy, as this translates into productivity and patient satisfaction. If they aren’t willing to work with you to meet your goals, then you may want to ask yourself “do I really want to work for someone who does not have the flexibility to assist me in meeting my goals?” Dr. Kuzel: We talked about unhappy physicians and we know that burnout is becoming a rampant issue among emergency physicians. What are some reasons that physicians are unhappy or frustrated with their contracts? Dr. Winterton: In my experience, the components of the contract that makes physicians most upset or unhappy

are compensation, benefits, duty hours, and — outside of emergency medicine — call hours. In terms of salary, there are various models for compensation. The most popular of these models is a straight salary. For emergency physicians, there is usually a base salary of x amount of dollars per hour. There may be some opportunities for production-based compensation and there can be advantages for production. For example, if you are in a busy emergency department or free-standing department where you are not competing with colleagues for patients, then for each patient that comes in you can be compensated based on productivity. Production-based compensation can be tricky because there are many types of production compensation. For example, one hospital may pay you based on collections. In this model, the hospital has minimal risk as a percentage of whatever is collected from insurance agencies is given to the physician. The hospital is almost always making money in this model. This can be very beneficial to a physician in a good area, busy emergency department, and where the payer mix is favorable, as it is likely to return higher collections and therefore, higher production-based compensation. The problem, however, is that the physician has no control over how efficient the billing department or patient registration is, so if there is a poor collections percentage, the physician could be at a disadvantage.

Dr. Kuzel: How does this work in terms of RVUs, or relative value units? Dr. Winterton: RVUs are value-based metrics established by the Centers for Medicare and Medicaid for each individual diagnosis. RVUs are calculated by taking into account the clinical reasoning used by the physician, staff resources, diagnostic tools used by a department, and the region in the U.S. on average. To simplify, a sore throat or runny nose will have a relatively small RVU, whereas a heart transplant will have a relatively high RVU. If you want to go by production or RVUs for compensation, you are not concerned about which patient comes through the door or the insurance they have, you’re just there to take care of patients. If you are productive and efficient (and good at documentation) this can be very favorable to you. This can be a great way to boost your compensation on your base salary. Dr. Kuzel: How does a physician determine what they are worth in terms of compensation, especially starting right out of residency? Dr. Winterton: There are many compensation banks out there (e.g., Medscape, Merrit Hawkins, and others) that you can search for on the internet to find an average compensation in a particular area. In my opinion, the gold standard is the MGMA Data Group, but you can even go on Glassdoor to see what the average emergency physician is making. I have seen numerous situations where physicians have searched these compensation banks and found that they are getting paid lower than the mean in their region.

"SIGN-ON BONUSES CAN BE A GREAT BENEFIT, ESPECIALLY COMING OUT OF RESIDENCY AND WANTING TO PURCHASE A NEW CAR, A HOME, OR FURNITURE."

thought is to split the bonus over a few paychecks, to avoid a hefty lump sum tax payment on the sign-on bonus. Another component of a contract that residents often overlook is the retention bonus. In certain hospitals, hospital staff see annual salary increases, so why can’t a physician have this same benefit? A retention bonus would be great to use against student loans and to reduce the debt burden much faster, making you more financially independent.

Dr. Kuzel: We’ve talked a lot about one of the most important topics in terms of contracts, compensation, but what about benefits?

What is the harm in asking? The worst they can say is no, right? The alternative is you could come out with better compensation and/or benefits.

Dr. Winterton: One thing I wish to make clear from my experience as a hospital administrator, if it’s not in the contract, it is very rare for a hospital administrator or private group to be altruistic on your behalf. They usually won’t walk up to you and say, “Thank you for doing such a good job this year… here is a $10,000 check!” It does happen, but it is the exception, not the norm.

Dr. Kuzel: What about the fear an employer could pull a contract if you ask for too much?

One of the benefits that is not really talked about is the signon bonus. Sign-on bonuses can be a great benefit, especially coming out of residency and wanting to purchase a new car, a home, or furniture. A sign-on bonus is a great way make these purchases without absorbing a lot of personal debt. The thing to remember about sign-on bonuses is that there are two types: a commencement bonus and a sign-on bonus. In lay terms, they mean the same thing, but in terms of contracts they are a bit different. A commencement bonus means that you receive a monetary bonus on the first day on the job; a sign on bonus (in terms of contracts) is a bonus you can receive when signing a contract, whether in residency or later as an attending. You’ll want to make sure to know when that money is coming to you — whether it is in advance or with your first paycheck at that hospital. Obviously, the employer will prefer to provide a commencement bonus, as this is more of a sure thing for them, but there is a way to make it a win-win for both. In some instances, a physician can negotiate for half of the sign-on bonus in residency and the rest at commencement. Another

Dr. Winterton: It is entirely possible that an employer might pull a contract, which can be disheartening and understandably a huge fear of physicians and residents. However, I ask, if that employer is not willing to work on a few things, not a lot, but a few things…do you really want to work somewhere that does not have your best interest at heart?

In Part 2 in the next issue of SAEM Pulse, Dr. Winterton answers the questions: - What to look for in the contract to maximize revenue and protect your interests. - What power do physicians and residents have when negotiating their contract? - Why are so many physicians disgruntled with their contracts? - How does a contract consulting firm differ from a contract attorney? - What are the costs of a consulting firm and how does a resident afford it on a resident salary? - Connection between physician burnout and their contracts?

USING VIRTUAL SIMULATION TO BRIDGE THE GAP IN MEDICAL EDUCATION DURING THE COVID-19 PANDEMIC By Muhammad Waseem, MD, MS; and Rachel Dahl, MS on behalf of the RAMS Education Committee. The COVID-19 pandemic remains an unprecedented public health emergency. The emergence of the novel coronavirus infection created sudden and significant disruptions in medical education that have changed how training is safely delivered and may continue to do so long-term. This pandemic presents practical and logistical challenges as well as concerns for patient and learner safety — a priority for medical training programs. The disruption from COVID-19 has particularly affected trainees in their third and fourth years of medical school and first year of residency. In mid-March 2020, in compliance with guidance from the Association of American Medical Colleges (AAMC), and for their protection, the protection of patients, and an anticipated lack of personal protective equipment (PPE), the majority of medical students were pulled out of clinics. To return students to the clinics with new guidelines,

some programs quickly developed and offered virtual didactics until plans could be settled. During the bridge back to clinics, the ability to use simulation education offered newly expanded opportunities for potential application. Simulation is a valuable modality that can evaluate and improve system performance. Simulation offers learners hands-on experience and allows them to make mistakes and practice more technically challenging procedures without compromising patient safety. Simulation also improves efficiency in developing skills that would be otherwise rare in actual clinical settings. What simulation is most useful for is assessing the status of the current system and providing answers to the following questions: • What is working well? • What can be done better?

Table: Types of Simulation Types of Simulation Available

Advantages

Disadvantages

Examples

- Inexpensive - Low cost - Portable

- Less real - Manikin - Difficult to engage participants - T ask trainer - Limited ability to perform tasks

High Fidelity Manikin

- Ability to interact with providers

- High cost - Require dedicated space - Difficult to move

- SimMan - NOELLE - PediaSIM - SIMbaby

Virtual Reality

-U ses software to create an immersive simulated environment.; gives the feeling of ‘being there’ - Truly makes users believe they are in a different environment - P rovides three-dimensional and dynamic view - Ability of the users to interact - Repeatable

- Expensive - Software and equipment cost - Requires set up

- HTC Vive - Oculus Rift - Google Cardboard

Augmented Reality

- Ability to overlay digital interfaces upon physical - Completely artificial, computer surroundings generated simulation is - Ability to show virtual objects in the same space as combined with the real world the real world - Technical issues - P rovide an environment that is both real and digital - Privacy concerns

Google Glass

Screen Based Simulation

-R equires very little set-up time -C an be used repeatedly by learners

- ACLS simulator - PALS simulator - Anesthesia simulator

Low Fidelity Manikin

Given the current environment, virtual simulation can further improve medical education without endangering the health and well-being of students and residents while providing meaningful learning and engagement. Simulation has already offered innovative opportunities for education without causing unnecessary patient risk. This article will identify some of the available virtual simulation that is in practice, the cost and benefit of these programs, and the future of simulation in the COVID-19 and post-COVID-19 era.

Types of Simulation: Advantages and Disadvantages

Simulation has the potential to prepare health care providers for the global COVID-19 crisis; however, with restrictions such as limitations on gatherings and social distancing, there are logistical challenges. One of the burdens of the fast transition to the “new normal” of COVID-19 and online learning has been the need to not just be reactive, but to create solutions that work well, particularly given that it is unclear how long COVID-19 will be a barrier. Due diligence requires keeping trainees and faculty safe using appropriate PPE (e.g., masks, shields, other protective barriers) and social distancing. There exists a wide variety of different types of simulation learning activities available for medical education that may provide solutions during this period of social isolation.

- Requires resources and training

High-Fidelity Manikin

The high-fidelity manikin remains a classic tool to assist trainees in developing muscle memory for correctly performing invasive procedures such as intubation, central line placements, lumbar puncture, etc. Similarly, this technology offers feedback for correct and incorrect use of life support methods such as bag valve mask ventilation and chest compressions. Such educational practice on high-fidelity manikins has shown to significantly reduce patient risk in invasive procedures (Barsuk, et al., 2009). The results of another study comparing the amount of simulation practice (none, low, or high) of pediatric trauma resuscitation in trauma centers to pediatric mortality indicated a significant inverse association between a high amount of simulation practice and odds-adjusted risk of mortality (Jensen, et al., 2019). As with most simulation programs, the primary disadvantage is the cost. High fidelity manikins can cost a program tens of thousands of dollars per manikin. In addition to the costly initial investment in high fidelity manikins, they require trained operators to manage and maintain. They also require adequate space in which to use these simulation devices, as well as storage spaces. The

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VIRTUAL SIMULATION from Page 61 upkeep and labor expenses are a significant disadvantage for programs with limited budgetary spending and resources.

Low-Fidelity Manikin

The selection of simulation modality should be based on the objective. A high-fidelity manikin is not always required. Lowfidelity simulation is described by Wenlock, et al. (2020) as one that “uses the minimum resources necessary to achieve its learning objectives.” In this study, the low-fidelity manikins significantly increased participant confidence in their ability to provide life support effectively and safely to COVID-19 patients. Recent research suggests that low-fidelity manikins have filled the gap when the use of high-fidelity manikins is limited. Some simulation events can be continued as they were pre-COVID-19 by simply using a little creativity in maintaining the limitations of social distancing. For example, at the University of Iowa, post-COVID-19 ACLS training has been performed with very basic manikins placed at least six feet apart during megacode practice and testing. Participants donned appropriate PPE (mask and/or face shield) and performed skills of their designated role (ventilations, chest compression, cardiac monitor, defibrillator, etc.) at different

manikins while acting as though they were working on the same “patient.” Though this solution lacked practice of the choreography that a code team develops in reality, it offered the ability to train and certify with due diligence to COVID-19 limitations.

Virtual Reality (VR) Simulation

Virtual reality (VR) simulation has become increasingly relevant in this time of COVID-19 when there is a heightened focus on everyone's safety. It is an effective teaching method that has the power of visualization, immersion, and the ability to interact within the virtual scenario. Some have suggested that almost half of manikin-based simulation could be substituted by virtual simulation. Research has shown that virtual simulation improves learning experience and outcomes (Foronda CL, 2020). This has resulted in a paradigm shift in medical education and has been applied to several disciplines, including specialized surgical services. These experiences, as noted in the literature, translate into improved performance in clinical practice. The innovation of 3-D images or environments may create even more optimal and realistic conditions — from learning anatomy and ultrasound practice to creating virtual renderings of scenarios that allow learners to interact and learn in a safe environment

with the ability to have multiple users practicing at the same time (while working virtually as a team) (Reznek, 2002). For emergency medicine purposes, this is ideal for teaching high-acuity, low-frequency events such as disaster and mass casualty events. For example, the Medical Readiness Training and Command uses a combination of VR and high-fidelity manikins, allowing practice in different environments “outside” of the emergency department (e.g., wilderness, war) (Reznek, 2002). While virtual reality is a new and exciting tool, one of the major disadvantages is the cost associated with programming. One published study by Farra, et al. demonstrated the costs associated with virtual reality versus live demonstration. In their observational study, the team compared the costs of a live evacuation drill for hospital workers compared to a virtual reality evacuation drill. During the first year, the investment in the virtual reality drill proved to be more expensive than the live drill by almost $100 per participant; however, at year three the cost was considerably less while the cost of a live demonstration drill was fixed. The difficulty with virtual reality is the initial investment and the additional investments for new technology as it becomes available (Farra, 2019).

Augmented Reality

Augmented Reality (AR), a form of VR which Louie et al. (2018) describe as akin to applications such as Pokemon Go, shares similarities to other types of VR in its setup and capabilities. However, AR differs in that instead of blocking out reality, it superimposes images and/or text over the actual environment. While these mechanisms are intriguing, there currently exists little proven data of efficacy or applicability to training emergency medicine residents. Augmented reality has potential in exposing emergency medicine residents to rural or international emergency department experiences as well as telehealth. However, the technology is in its infancy and its impact has yet to be determined in medical education.

Screen-based Simulation

Screen-based simulation, previously referred to as “virtual reality,” offers another way for trainees to practice independently. It can be expensive upfront to develop the application, depending on how complex it is and the type of features that it offers. Part of its advantage is that it allows for a lot of creativity, not unlike a video game; however, a major disadvantage of this technology is the lack of a debriefing with a higher-level supervisor, such that the trainee may get less from the overall experience without having appropriate feedback and time for reflection. Two such applications that are similar to manikin simulation that can be downloaded for smartphones or tablets include Resuscitation! and Full Code. These applications provide a case-based scenario and grade individuals on their performance and management of emergency patients. The applications also grade performance with a skill level assessment (e.g., attending, resident, or medical student) as well as a percentage of critically and acceptable orders and procedures. The disadvantage to these programs is that although a case may be correctly conducted, the participant may be scored lower because of a small, missed detail on a checkbox that may not be clinically relevant. Additionally, some applications may charge extra for further cases and feedback on the case; and live feedback is not a provided option.

"SIMULATION CAN BE A VIABLE TOOL FOR TEACHING EM LEARNING OBJECTIVES AT EVERY LEVEL OF TRAINING." Takeaway and Conclusion

As COVID-19 challenges us as health professionals to find new ways to protect the safety of patients and ourselves, it is important that the pipeline of educating emergency physicians continues. Simulation can be a viable tool for teaching EM learning objectives at every level of training; however, it is important to rethink and develop a common educational approach that can provide a platform for demonstrating the feasibility and acceptability of using the various simulation strategies available. Currently, this includes the use of low- and high-fidelity manikins, VR, AR, and screen-based simulation. Emergency medicine as a whole fundamentally embraces the combination of ingenuity with practicality, making it a unique specialty that has the opportunity to lead the way on integration and further development of these newer technologies. ABOUT THE AUTHORS: r. Waseem is a professor of emergency D medicine and pediatrics at Weill Cornell Medical College, New York. In his current role, Dr. Waseem is the research director for the department of emergency medicine and vice chair for the institutional review board at Lincoln Medical Center Bronx, New York Dr. Dahl is a third-year medical student at University of Iowa Carver College of Medicine and concurrently pursuing an online MPH at University of California Berkeley. Rachel plans to pursue a career in either emergency medicine or trauma surgery, with additional interests in community and global health. This article was edited by Aaron R. Kuzel, DO, MBA, an emergency medicine resident at the University of Louisville School of Medicine. Dr. Kuzel is the associate editor of the SAEM Pulse RAMS Section and is a member-at-large on the SAEM RAMS Board.

PERSPECTIVES ON A PANDEMIC By Dhriti Sooryakumar, Christopher San Miguel, MD; Simiao Li-Sauerwine, MD The COVID-19 pandemic has had an unprecedented impact on many facets of medical education. The classroom setting, clinical environment, and application cycle have all undergone significant changes to meet the challenges posed by this pathogen. This perspective piece, written by a medical student, assistant residency program director and clerkship director in the early days of the COVID-19 pandemic, shares personal and professional experiences and provides guidance and advice for learners everywhere.

The Assistant Residency Program Director

Dr. Li-Sauerwine is an assistant residency program director of emergency medicine at The Ohio State University and chief academic officer of ALiEM Wellness Think Tank. Her interests include physician wellness, resident professional development, and implicit bias.

Dhriti Sooryakumar

Christopher San Miguel, MD

Simiao Li-Sauerwine, MD

The Medical Student

Dhriti Sooryakumar is a senior medical student at The Ohio State University and current RAMS Board Member. She is passionate about global health and providing medical services to the under-served.

The Clerkship Director

Dr. San Miguel is the fourth-year EM clerkship director at The Ohio State University. His interests include curriculum development, simulation, and meta-cognition.

What has been your personal experience during this pandemic?

Ms. Sooryakumar: As a medical student, I’ve found myself experiencing a wide range of emotions. While concerned for my mentors and resident colleagues in the hospital, I’ve also been worried for my family. Additionally, I have a desire to help our hospital community and patients, but understandably, for reasons of safety and PPE, am unable to do so. Early on, I was also concerned for the application cycle. Without away rotations, what would my application emphasize? I’ve experienced a spectrum of emotions, gratitude, and inspiration navigating this unprecedented time. Dr. San Miguel: The most challenging thing for me has been how widespread and pervasive change has become.

Especially early on, there were so many unknowns about this pathogen, our response, and societal restrictions that it felt like there was no constancy in life. Usually if things are stressful at home, I can “escape” at work and vice versa; but not so much with COVID-19. One of the biggest changes has been my inability to see my family, who live in North Carolina, with the frequency with which I visited them pre-COVID-19 (usually about every other month). In fact, I wasn’t able to visit them at all for several months. Dr. Li-Sauerwine: Since the onset of the pandemic, I have been closely following the news to anticipate COVID-19’s impact in Columbus, Ohio and the emergency department where I work. Initially there was stress relating to the unknowns: How do I care for patients while staying healthy and preventing spread to my family and the community? At work, our clinical leadership has done a good job implementing evolving best practices. Now, caring for patients in the age of COVID-19 is the new normal. At home, I am focusing on things I can do (riding bikes, taking walks, trying new recipes) rather than things I can’t (going to restaurants).

What have you observed with your colleagues and the situation in the hospital?

Dr. Li-Sauerwine: Initially, there was a lot of stress related to unknowns: What was the risk of contracting COVID-19 as a physician? What would be its impact on daily life? It is now clear that with the appropriate use of personal protective equipment (PPE), physicians can care for patients safely. Our community has been wonderfully supportive of health care workers (e.g., sending cards, meals, and gratitude). At OSU, we have the Kiehl Resident Wellness Endowment and are able provide meals for emergency medicine residents on shift. We’ve started a Slack channel focused on wellness (e.g., everything from photos of pets to discussing Netflix series). From an education standpoint, we’ve adapted to video conferencing for resident conferences, large and small group sessions, and even virtual oral boards practice. Dr. San Miguel: I have been reminded of how lucky I am to work with such a supportive and amazing group of people. When I had to quarantine after an exposure, my shifts were instantly covered and I was inundated with offers of help, both personally and professionally. At a more macro level, our medical center has walked a fine line between being prepared for impending disaster and maintaining as many normal operations as possible to continue caring for patients. We handled the first surge admirably, but I don’t envy those making the high-level decisions as we move forward. Ms. Sooryakumar: I have been inspired by the camaraderie I have seen amongst colleagues. There has been great enthusiasm amongst students to help. Early on, many joined in PPE collection and ran errands for physicians. I’ve also seen younger colleagues anxious about entering clinical years while COVID-19 is prevalent. Many struggled with uncertainty regarding how long they would need to study for board exams while grappling with a lack of social interaction. Seeing students come together in support systems, however, has been truly been inspiring. It gives me great hope for the future of medicine and patients everywhere.

What lessons can we carry forward from this pandemic?

Dr. San Miguel: First of all, I think this has been a reminder to be thankful and appreciate the people who work in essential services who may not often get the recognition they deserve. Before COVID-19, I personally never contemplated the integrity of food supply chains. Now that we have been really forced into it, I also think this pandemic is going to usher in a new wave of telecommuting and the expansion of telemedicine. We have seen big changes and improvements in the technology over the past several months. Ms. Sooryakumar: I believe this pandemic has taught us to cherish our loved ones, and that even more than material possessions or daily activities, our relationships with one another are life-sustaining. I’ve seen immense gratitude for health care workers, grocery store employees, and everyone who has knowingly exposed themselves to the virus for the greater good. I hope this appreciation and unity in times of crisis, with everyone contributing whatever capacities they possess, will carry forward into the future. When we are unified as a nation and world looking out for one another and our most vulnerable, we can overcome anything. Dr. Li-Sauerwine: Since the onset of the pandemic, there has been greater awareness of what front line workers do for the community. I think this is something we should continue to recognize and celebrate. The pandemic has also challenged us to approach the way we do things differently. For example, an increased recognition of the ability of technology to facilitate work and social media to foster connections.

What advice do you have for EM-bound students and those who applied for the 20202021 application cycle?

Ms. Sooryakumar: This has understandably been an anxietyprovoking time, as many variables we once knew with certainty regarding medical education and the residency application process were different. However, take heart in knowing that everyone around the world has experienced a similar situation. Programs have been working in unity to ensure that all students have equal opportunities (including those who may feel they are at a disadvantage). In the end, it will be alright, and we will all reach the goals we hoped to achieve. Dr. San Miguel: This was certainly a more stressful application cycle than in previous years, but take solace in the fact that everyone experienced the same situation, and in March there will still be the same number of EM spots needing to be filled. Furthermore, the leading EM organizations released unified guidelines to help make sure the application process was as equitable as possible. We have all felt anxiety and isolation during this pandemic, however we have also seen laudable resilience and dedication amongst our colleagues and others throughout society. We will come through this — students, physicians, and society as a whole — achieving our goals with greater strength, respect, and unity.

Note: This article was originally written at the onset of the COVID-19 pandemic and submitted for publication in an earlier issue of SAEM Pulse.

BRIEFS AND BULLET POINTS SAEM NEWS

• substance abuse/toxicology • wellness • social EM • ultrasound • wilderness/sports medicine • trauma

From SAEM’s Social EM and Population Health IG: Immigration Advocacy Toolkit

A Friendly Reminder... Renew your membership now so you can keep on accessing your SAEM member benefits. SAEM’s Membership Guide highlights all the benefits available to you. There are three easy ways to renew: 1. Log in to an existing account or create an SAEM account 2. Download a membership form, email membership@saem.org • Make a payment over the phone: (847) 813-9823

Visit the SAEM/ADIEM Diversity, Equity, and Inclusion Library

The Diversity, Equity, and Inclusion (DEI) Library, from SAEM and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM), is an online resource for emergency physicians to learn more about achieving health equity and eliminating health disparities. The DEI Library is organized by media type and categorized in seven subject areas.

SOAR Featured Content

Check out the variety of presentations from SAEM20, SAEM19, and SAEM18. View dozens of recorded presentations online and save or share your favorites. It’s all part of SOAR: SAEM Online Academic Resources, featuring three years of annual meeting content, more accessibility than ever before, an enhanced, easy-to-navigate layout that allows you to view online education resources or from the SAEM YouTube Channel. Check out this issue’s featured categories! • sex and gender • research methods

Sponsored by the Social Emergency Medicine & Population Health Interest Group, the Immigration Advocacy Toolkit is designed to provide information, guidance, and resources to emergency department clinicians, staff, and operations teams to give welcoming and person-centered emergency care to immigrants. This resource can be used to develop a more immigration-informed emergency department that supports a variety of needs for immigrants who seek care in the ED.

Let SAEM’s Expert Consultants Help You With Teaching, Research, and Other EM Practice Issues

SAEM committee and academy members possess expertise in teaching, research and other aspects of academic emergency medicine (EM) practice. Through SAEM Consultation Services, these experts, in consultation with the Association of Academic Chairs of Emergency Medicine (AACEM), are available to assist individuals, departments, and institutions with developing, evaluating, and/or improving various services; developing departmental status for EM divisions; subspecialty expertise (research, ultrasound, etc.); and billing, patient safety, etc.

Research Learning Series Offers Valuable, Online Research Content

SAEM’s Research Learning Series (RLS) features valuable education on popular emergency medicine research topics delivered by experts in the field of emergency research. Sign up for these high-yield, interactive educational events for free, or view previous podcasts and lectures, housed online.

SAEM20 Clinical Image Series

The SAEM Clinical Image Series is a collaborative series with ALiEM (Academic Life in Emergency Medicine)

and features the winners of the SAEM Annual Meeting Clinical Images Exhibit competition. Check out the images, read the case notes, and see if you can figure out the diagnosis before you reveal the answer. •S urfing Sting by Sunny R. Patel, MD, MBA, Stanford University Medical Center •E ye Pain After Assault by Lauren J. Kraut, MD, UT Southwestern • Man vs. Snow Blower by Ivana Marji, MD and Mark Collin, MD, WellSpan York Hospital •S trange Eyes by medical student Krista McEwan and Myto Duong, MD, Southern Illinois University •E ye Injury by Thomas Jauch, MD and Ruth S. Hwu, MD, Emory University School of Medicine •P itching Pain by Cooper March and Lawrence Stack, MD, Vanderbilt University

New From SAEM’s Industry Advisory Council: “Fast-15” on Physician Employment Contracts

Hosted by the SAEM Industry Advisory Council in collaboration with SAEM RAMS, “Fast 15” is designed to give you critical content in 15 minutes flat. In the second “Fast 15” installment, leading health care attorneys provide their expertise for navigating physician employment contracts as you enter the emergency medicine job market.

SAEM Webinars Now on Video! • Dual Identity: How Awareness of Racial Bias in Medicine Informs our Role as BIPOC Physicians • Environmentally Responsible Health Care • Simulation Promotions: Pearls, Pitfalls, and Pathways • Climate and Health Education • The New Frontier: DEI Positions in Academic Emergency Medicine • RAMS: The Inside Scoop on Academic Jobs

SAEM RAMS Drs. Tony Seupaul and Brian O’Neil are Featured in Latest RAMS Ask-aChair Podcasts

Tony Seupaul

Brian O’Neil

Two new RAMS Aska-Chair podcasts feature Tony Seupaul, MD, professor and chair of emergency medicine at the University of Arkansas for Medical Sciences and Brian J. O’Neil, MD, director of basic science research in the department of emergency medicine at Wayne State University/Detroit Medical Center.

New RAMS “Who’s Who In Academic Emergency Medicine” Podcast Features Dr. Ali Raja

Ali Raja, MD, MPH, MBA, executive vice chair for the department of emergency medicine at Massachusetts General Hospital and Ali Raja an associate professor at Harvard Medical School, is the featured guest in the most recent episode of the SAEM RAMS podcast series, “Who’s Who In Academic Emergency Medicine.” Dr. Raja is the author of more than 200 publications. His steadily-funded research focuses on improving the appropriateness of resource utilization in emergency medicine.

help you succeed in tactical EM at every training level. RAMS Roadmaps provides guidance to the second-year medical student looking to get into an emergency medicine residency, to individuals looking for timelines and insider advice on advanced training, and even to seasoned attendings transitioning to academia.

Looking for the Perfect Fellowship?

Check out the SAEM-approved fellowships in the Fellowship Directory. All SAEM-approved fellowships have been vetted by experts in administration, disaster medicine, education scholarship, geriatrics, global health, research, and wilderness medicine. They will provide you with the knowledge and skills you need to excel. Under “Fellowship Type,” just click on those marked “SAEMApproved” to see the list of all programs endorsed by SAEM.

SAEM JOURNALS

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 16, 2021.

Check Out the Latest Additions to the Online COVID-19 Collections for SAEM Journals

Call for Papers: AEM Special Issue on Scientific Inquiry Into the Inequities of Emergency Care

To facilitate the rapid dissemination of COVID-19 findings, Academic Emergency Medicine and AEM Education and Training have been fast-tracking submissions related to COVID-19 and making the latest research available in online collections of accepted, citable COVID-19 articles. These collections are being updated constantly, so be sure to check frequently for the latest COVID-19 research from SAEM journals! • AEM Online COVID-19 Collection • AEM E&T Online COVID-19 Collection

Academic Emergency Medicine

The Latest Podcasts from SAEM Journals!

December AEM Podcast • Identification of the Physiologically Difficult Airway in the Pediatric Emergency Department • I Heard a Rumor – ER Docs are not Great at the Hints Exam

New to RAMS Roadmaps: Tactic Track!

Are you interested in providing medical support, threat support, and medical care for tactical operations and law enforcement personnel? The recently added RAMS Roadmaps Tactical Track provides resources and insider advice to

Call for Resident Members to Serve on the Editorial Board of Academic Emergency Medicine

November AEM Podcasts • Taking Care of Patients Everyday With Physician Assistants and Nurse Practitioners • Opioid-induced Euphoria Among Emergency Department Patients With Acute Severe Pain: An Analysis of Data From a Randomized Trial

To address a pervasive and wide knowledge gap about the science of inequities in emergency care, Academic Emergency Medicine (AEM) will publish a special issue in the fall of 2021. A primary focus of this issue will be on the impact of race and ethnicity inequity, with a preference toward original-based research that addresses patient-centered topics as well as inequities that affect clinicians of color in their professional roles. Priority will be given to papers with intervention-based, original data. For details follow the link.

AEM Editor-in-Chief Commentaries for November and December

For each issue of Academic Emergency Medicine journal, editor-in-chief Dr. Jeffrey Kline selects one paper as having particular significance and/or importance to the care of patients during times of emergency. He shares his thoughts and observations regarding these studies in regular “EIC Pick of the Month” (EIC POTM) commentaries. Read Dr. Kline's November and December EIC POTM's: - You Kids Get Off My Lawn - Send the Packing Packing continued on Page 68

BRIEFS continued from Page 67

SAEM Simulation Academy Virtual Mentoring: Faculty Development Hour

AEM Education and Training

Virtual Mentoring Hour: Teaching AntiRacism Through Simulation

AEM Education and Training is Accepting Applications for Fellow Editor-in-Training Program

AEM Education and Training (AEM E&T) journal is accepting applications for its Fellow Editor-in-Training program for the 2021–2022 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 2021 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 February 16, 2021.

SAEM ACADEMIES Simulation Academy The simulation community has been extremely active over the past few months. • We have continued our successful series of Virtual Mentoring Hours. Our speakers and moderators have engaged in lively discussion. The latest video recordings are posted on the SAEM website.

Working with the CORD Simulation Community, we are excited to offer a simulation consulting service to help troubleshoot simulation education and curricular challenges. To request a consult, visit the webpage. Emergency Medicine Resident Simulation Curriculum for Pediatrics (EM ReSCu Peds), an open-access eBook containing sixteen cases to address critical pediatric topics for EM residents through simulation, is coming soon! Keep an eye out for its launch. Four SAEM Simulation sponsored didactics have been accepted for the SAEM21 Annual Meeting. Register today! For more updates, including upcoming events, follow our twitter account @SAEMSimAcademy

Global Emergency Medicine Academy Congratulations to Drs. Brian Bales, and Shama Patel, recipients of the GEMA/ARMED Scholarship Award. Dr. Bales is an assisBrian Bales, MD, DTMH tant professor at Vanderbilt University. Dr. Bales joins the ARMED course to strengthen his skills in research design and implementation

as he seeks to support teams at both Vanderbilt and in Ghana. Dr. Patel is an assistant professor at the University of Florida–Jacksonville. Shama Patel, MD, MPH She has over 10 years of experience in global health, which has spurred her interest in implementation science. Dr. Patel joins the ARMED course to support her efforts in ongoing research in Ethiopia and locally.

Academy for Women in Academic Emergency Medicine

Accepting Nominations for AWAEM Awards

SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM) is accepting nominations for AWAEM 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, 2021.

Shields Up! By William Bond, MD, MS, director of research, Jump Simulation, a collaboration between OSF HealthCare and the University of Illinois College of Medicine Peoria, and professor of clinical emergency medicine, department of emergency medicine.

ACADEMIC ANNOUNCEMENTS Dr. Romney Appointed Vice President of Operations for NewYork-Presbyterian– Columbia Milstein Hospital

Dr. Bernstein Named Chief Research Officer for Dartmouth-Hitchcock and Associate Dean of Clinical Research at Geisel School of Medicine

Marie-Laure D. Romney, MD, MBA, an assistant professor of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons has been appointed as the vice president of operations for NewYork-Presbyterian–Columbia Milstein Hospital. She is currently the vice chair of Dr. Marie-Laure D. Romney quality and patient safety of the department of emergency medicine at Columbia University.

Steven L. Bernstein, MD, has been named inaugural chief research officer for DartmouthHitchcock (D-H), associate dean of clinical research at the Geisel School of Medicine at Dartmouth, and director of the C. Everett Koop Institute at Geisel. Dr. Bernstein currently serves as professor and vice chair of research Dr. Steven L. Bernstein in the department of emergency medicine at the Yale School of Medicine and professor of public health (Chronic Disease Epidemiology) in the Yale School of Public Health. As chief research officer for D-H, Dr. Bernstein will oversee all aspects of research at D-H, including serving as the designated institutional official for research, leading D-H’s Office of Research Operations, and overseeing development and implementation of a forward-looking strategic plan for growth of the institution’s clinical, translational, population-based research portfolio. Dr. Bernstein will join D-H and Geisel in early February 2021.

Dr. Polavarapu Named Assistant Medical Director of the NewYork-Presbyterian– Columbia University Allen ED Mahesh Polavarapu, MD, an assistant professor of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons, is the new assistant medical director of the NewYork-Presbyterian– Columbia University Allen Emergency Department. He will serve as the fellowship Dr. Mahesh Polavarapu director of the new Dr. Lorna M. Breen Emergency Medicine Fellowship in Healthcare Administration.

Dr. Peter Steel Appointed Vice Chair of Clinical Services at NYP-Weill Cornell Medicine Peter Steel, MD, has been appointed to vice chair of clinical services in the department of emergency medicine at NewYorkPresbyterian–Weill Cornell Medicine. He currently serves as the director of clinical services and has held several leadership roles in the department. In his new role, he will Dr. Peter Steel oversee clinical services for the department of emergency medicine.

Dr. Brenna Farmer Named Vice Chair of Quality and Patient Safety at NYP-Weill Cornell Medicine Brenna Farmer, MD, has been appointed vice chair of quality and patient safety in the department of emergency medicine at NewYork-Presbyterian–Weill Cornell Medicine. In her new role, she will oversee quality and patient safety initiatives for the department. She will also continue to serve as site director Dr. Brenna Farmer at NewYork-Presbyterian–Lower Manhattan Hospital Emergency Department. Dr. Farmer is an associate professor of clinical emergency medicine.

Dr. Di Coneybeare Receives EMF FUJIFILM SonoSite COVID-19 Ultrasound Grant Di Coneybeare, MD, MHPE, an assistant professor of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons is a recipient of the EMF/FUJIFILM SonoSite COVID-19 Point of Care Ultrasound Acceleration Research Grant Award for a multicenter study, "Artificial Intelligence Dr. Di Coneybeare for Prognosis of Ultrasound of the Lung in COVID (AI PULL)". She is the assistant fellowship director of the emergency ultrasound fellowship of the department of emergency medicine at Columbia University.

Dr. Holly Caretta-Weyer Receives $1.25M Medical Education AMA Grant Holly Caretta-Weyer, MD, clinical assistant professor with Stanford University’s department of emergency medicine has received a $1.25 million grant from the American Medical Association as part of their Reimagining Residency program aimed at promoting systemic change in emergency medicine Dr. Holly Caretta-Weyer residency training. Her project will develop specific, measurable outcomes of emergency medicine training in the form of tiered, entrustable professional activities to accelerate a shift toward competency-based medical education utilizing a data-oriented, technology-driven ecosystem of assessment. Dr. Caretta-Weyer is director of evaluation and assessment for the Stanford University emergency medicine residency program, and co-founder of Stanford’s Precision Education and Assessment Research Lab. She also serves on the editorial board of SAEM’s Academice Emergency Medicine Education and Training journal.

Dr. Italo Brown Appointed Stanford Health Equity and Social Justice Curriculum Lead

Dr. Carter Named Vice Chair of Clinical and Faculty Affairs at NYP-Weill Cornell Medicine

Italo Brown, MD, MPH, clinical assistant professor with Stanford University’s Department of Emergency Medicine, has been named health equity and social justice curriculum lead for the Stanford School of Medicine and will help guide efforts to incorporate equity content into the Stanford Dr. Italo Brown School of Medicine curriculum. Dr. Brown, an alum of Stanford’s social emergency medicine fellowship, is also chief impact officer of TRAP Medicine, a Barbershop-based wellness initiative based in California that focuses on strategic partnerships, community outreach, and advocacy.

Wallace Carter, MD, has been named the vice chair of clinical and faculty affairs in the department of emergency medicine at NewYork-Presbyterian–Weill Cornell Medicine. In his new role, he will be responsible for overseeing clinical and faculty affairs matters for the department, including compliance, Dr. Wallace Carter faculty recruitment, and chairing the Committee on Appointments and Promotions (COAP). Dr. Carter is an associate professor of clinical emergency medicine and currently serves as director of clinical and faculty affairs and as the senior associate medical director for NewYork-Presbyterian Emergency Medical Services.

Dr. Michael Gisondi Receives Stanford Franklin G. Ebaugh Award Michael Gisondi, MD, inaugural vice chair of education for Stanford University’s Department of Emergency Medicine, received Stanford’s Franklin G. Ebaugh Award Jr. Advising Award in recognition for demonstrated excellence and dedication in advising medical students. Dr. Gisondi is Dr. Michael Gisondi cofounder of Stanford’s Precision Education and Assessment Research Lab, has served on the board of directors of the Council of Emergency Medicine Residency Directors, and is a graduate of the SAEM Chair Development Program (CDP).

Dr. Shari Platt Named Vice Chair of Pediatric EM at NYP-Weill Cornell Medicine Shari Platt, MD, has been named vice chair of pediatric emergency medicine at NewYorkPresbyterian–Weill Cornell Medicine. In her new role, she will oversee clinical and academic activities for the division of pediatric emergency medicine. She will continue to serve as chief of the division of pediatric Dr. Shari Platt emergency medicine. Dr. Platt is currently an associate professor of clinical emergency medicine and clinical pediatrics and also serves as the vice chair of the Pediatric Emergency North American Chiefs Committee.

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is February 1, 2021 for the March/April 2021 issue.

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.

EM Jobs Now on SAEM Facebook Does your institution have an open position it’s looking to fill? Contact John Landry at 847-257-7224 or jlandry@saem.org to add your name to the career widget on our SAEM Facebook page. Job seekers: Click on “Careers” on the left-hand menu of SAEM’s Facebook page to view recently posted jobs in academic emergency medicine.

Free CV Critique Did you know that EM Job Link offers a free CV critique service to job seekers? As a job seeker, you have the option to request a CV evaluation from a writing expert. You can participate in this feature through the CV Management section of your account. Within 48 hours of opt-in, you will receive an evaluation outlining your strengths, weaknesses and suggestions to ensure you have the best chance of landing an interview.

Job Alert! Are you looking for a job in academic emergency medicine? Create a personal job alert on EM Job Link so that new jobs matching your search criteria will be emailed directly to you. Make sure the perfect opportunity doesn’t pass you by. Sign up for job alerts today on EM Job Link by clicking on Job Seekers and then selecting Job Alerts. You will be notified as soon as the job you’re looking for is posted.

Exciting opportunities at our growing organization • • • •

Emergency Medicine Faculty Positions Pediatric Emergency Medicine Faculty Positions Vice Chair, Clinical Operations 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 Pediatric 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: • Emergency Medicine trained physicians with additional training in any of the following: Toxicology, Ultrasound, Geriatric Medicine, Pediatric Emergency Medicine, Research • Completion of an accredited Residency Program. • BE/BC by ABEM or ABOEM

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 family-friendly 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.

New year, new clinical opportunities

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. Emergency Medicine (EM) Physician opportunities: Utica, New York Full-Time EM Academic Physician

Goodyear, Arizona Full-Time EM Academic Physician

Orange Park, Florida Full-Time EM Academic Physician

Utica, New York Full-Time EM Academic Physician

St. Lukeâ&#x20AC;&#x2122;s Campus - Mohawk Valley Health System

Orange Park Medical Center

Join our team

teamhealth.com/join or call 877.650.1218

Abrazo West Campus

St. Lukeâ&#x20AC;&#x2122;s Campus - Mohawk Valley Health System

Innovation - does joining a team that is re-imagining acute care delivery inspire and excite you? Impact - do you want to shape the future of healthcare? The Department of Emergency Medicine at The Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA continues to expand its faculty complement. Our team is revolutionizing the way emergency care is taught to our students, residents and faculty and how care is provided to patients. We have pioneered emergency telemedicine and design thinking in EM. We have nimbly integrated our diverse faculty and forward-looking enterprise to impact population health, emergency medical services, access to care, patient flow and clinical research. We are interested in emergency physicians that wish to be a part of a department that will contribute to the ongoing transformation of acute unscheduled care. We have an extensive and robust clinical footprint, with the opportunity to practice across the acute care spectrum. We provide faculty and resident coverage at two emergency departments â&#x20AC;&#x201C; TJUH (center city campus), a 700-bed academic quaternary-care, Level 1 trauma center that treats 73,000 patients annually, and the Methodist Hospital Division of TJUH, a 140-bed community hospital that treats 34,000 patients annually. Faculty also provide coverage at seven urgent care centers run by the department as well as the clinical decision unit (CDU) at Thomas Jefferson University Hospital and have the opportunity to provide on-demand direct-to-consumer through our Telehealth Program. Faculty will be responsible for patient care and bedside teaching of students and residents and will have the opportunity to develop their academic focus. Additional information on the department can be found at: http://www.jefferson.edu/university/jmc/departments/emergency_medicine.html We seek the following: Director of Emergency Medical Services The Director of EMS will be the forward-facing leader for prehospital care. This person will have a multifaceted mission with core responsibilities in EMS education, EMS outreach and EMS research. Additionally, they will work collaboratively with JeffSTAT (the ground and air-based program that moves patients across our 14-hospital enterprise). In doing so, there is opportunity for medical command and education at the JeffSTAT training center. This person will also represent Jefferson EMS locally, regionally and nationally while concurrently building relationships and bolstering Jeffersonâ&#x20AC;&#x2122;s presence in these domains. With Jeffersonâ&#x20AC;&#x2122;s focus on innovation and care transformation in mind, specific touch points are working in partnerships with JeffSTAT and the city of Philadelphia to re-imagine prehospital care and safe inter-facility patient movement. Clinical Faculty Clinical faculty provide patient care and bedside teaching of students and residents in the ED, clinical decision unit and urgent care. Additionally, clinical faculty have opportunities to become involved in administration, clinical operations, undergraduate and graduate medical education. The Sidney Kimmel Medical College at Thomas Jefferson University values a diverse and inclusive community as it allows us to achieve our missions in patient care, education, and research and best allows us to serve the healthcare needs of the public. Thomas Jefferson University and Hospitals is an Equal Opportunity Employer. Jefferson values a diverse and inclusive community diversity and encourages applications from women, those underrepresented in medicine, Lesbian, Gay, Bisexual and Transgender (LGBT) individuals, disabled individuals, and veterans. Interested candidates are invited to send their curriculum vitae to: Bernard L. Lopez, MD, MS, CPE, FACEP, FAAEM Executive Vice Chair, Department of Emergency Medicine Bernard.lopez@jefferson.edu

THANK YOU To our brave and dedicated emergency physicians, nurses, and other medical staff who are on the front lines answering the call to care for the most vulnerable in our society during this time of great need.