SAEM PULSE July–August 2017 by Society for Academic Emergency Medicine

JULY-AUGUST 2017

VOLUME XXXII NUMBER 4

EDUCATOR SPOTLIGHT

TEACHING WITH HEART, HUMOR, AND HUMILITY An interview with Dr. Nicole Deiorio

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

SAEM STAFF

HIGHLIGHTS

Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org

Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org

Director, Finance & Benefits Doug Ray Ext. 208, dray@saem.org Accountant Hugo Paz Ext. 216, hpaz@saem.org

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

Director, Operations & Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Manager, Governance & Meetings Monica Bell, CMP Ext. 205, mbell@saem.org IT Database Manager/ Systems Administrator Ahmed Khater Ext. 225, akhater@saem.org IT Support Specialist Jovan Triplett Ext 218, jtriplett@saem.org Director, Communications and Publications Stacey Roseen Ext. 207, sroseen@saem.org Specialist, Digital Communications Nick Olah Ext. 201, nolah@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

Education Manager Mark Nagasawa, MA Ext. 214, mnagasawa@saem.org Assistant, Membership & Education Alex Keenan Ext. 202, akeenan@saem.org Meeting Planner Maryanne Greketis, CMP Ext. 209, mgreketis@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org

AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org

Educator Spotlight

SAEM17 Annual Meeting Wrap-up

20 22

Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio sharonatencio@me.com

Academic Emergency Medicine: The Common Purpose and Shared Values That Make Us a Community

AEM E&T Editor Susan Promes, MD AEMETeditor@saem.org

Presidentâ&#x20AC;&#x2122;s Comments

Teaching With Heart, Humor, and Humility

Diversity and Inclusion

Travel Bans: What Effect Does It Have on Graduate Medical Education?

Ethics in Action

Making Ethically Complicated Decisions About End-of-Life Care

Resident-Student Guide

POCUS Education: A Journey from the Medical Student Perspective

SGEM: Did You Know?

Viewing Intimate Partner Violence Through the Prism of Gender and Sexuality

Briefs and Bullet Points

Academic Announcements

Now Hiring

2017-2018 BOARD OF DIRECTORS D. Mark Courtney, MD President Northwestern University Feinberg School of Medicine

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

Megan L. Ranney, MD, MPH Brown University

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

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

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

Ian B.K. Martin, MD, MBA Secretary-Treasurer West Virginia University School of Medicine

Angela M. Mills, MD Penn Medicine

Jean Elizabeth Sun, MD Mount Sinai School of Medicine

Andra L. Blomkalns, MD Immediate Past President University of Texas Southwestern at Dallas

Ali S. Raja, MD, MBA, MPH Massachusetts General Hospital

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine, 1111 East Touhy avenue, Suite 540, Des Plaines, IL 60018. The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. For SAEM Pulse archives visit http://www.saem.org/publications/newsletters ÂŠ 2017 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 D. Mark Courtney, MD Northwestern University, Feinberg School of Medicine 2017-2018 SAEM President

Academic Emergency Medicine: The Common Purpose and Shared Values That Make Us a Community

"Our capacity as individuals and as a Society to impact the way emergency care is taught and how high impact research is conducted, has never been greater. We should celebrate these achievements and recognize the diverse ways in which our field has grown."

The first SAEM meeting I attended was in the late 1990s in Boston during a time when we still presented slides from carousel projectors and posters were printed, not electronic. I recall the immediate sense of community I felt, where everyone was tied together by the common thread of learning. Today, many aspects of our Society remain the same, while many things have vastly changed. In the past year, SAEM has grown to more than 6,500 members. We launched a second journal dedicated to emergency medicine education and training and relocated our headquarters into a new and more modern space, with room for conferences, meetings, and the work of our highly skilled staff. Through your contributions we have increased the SAEM Foundation’s funding to an all-time high, with increased ability to provide both research and education grants. We are seeing an ever-growing number of members choose fellowships, become promoted, and assume leadership positions in academic departments, medical schools, and health care systems. Our recent annual meeting in Orlando, with more than 3,000 in attendance, offered dedicated formal and informal mentorship events and presented original, high quality continuing education in more than 11 premeeting workshops, 800 research abstracts and poster presentations, 100 didactic sessions, and state-of-the-art National Grand Rounds presentations. In short, our capacity as individuals and as a Society to impact the way emergency care is taught and how high impact research is conducted, has never been greater. We should celebrate these achievements and recognize the diverse ways in which our field has grown. At the same time, we should take a moment to acknowledge the common purpose and sense of community that brings us together at our annual meetings and throughout the year as research and teaching collaborators.

Despite our wide array of practice settings, professional roles, and career trajectories as attending teachers or resident/fellow learners, we all share two common elements. First, is the value we place on the transfer of knowledge. Whether this knowledge is taught and learned through scientific research, educational innovation, or bedside teaching, we all spend a major portion of our days in our respective teaching and learning spaces, thinking, writing, and modeling about how to best take care of emergency patients. Second, is that what links us together, regardless of where we are on the career trajectory spectrum, is mentorship. Every current and future emergency medicine resident, fellow, and attending can identify key relationships, whether formal or informal, that catalyzed their career fulfillment. I urge you to consider these commonalities and to look upon the next year of SAEM programing as an opportunity to re-engage not only with those in your field, but with colleagues from both inside and outside your home institutions who share similar interests and potential to impact emergency care. Challenge yourself to say “yes,” when asked to collaborate; to say “sure” when asked to function in a mentorship role. Consider what you can do for your fellow SAEM members if asked to lead and/or participate, even though there are countless other demands on your time. The future of our Society, and the vitality of our specialty, depends on you.

EDUCATOR SPOTLIGHT

TEACHING WITH HEART, HUMOR, AND HUMILITY “How we spend our days is how we spend our lives.” Dr. Nicole Deiorio is professor of emergency medicine, co-chief of the emergency medicine education section, and assistant dean for student affairs at the Oregon Health & Science University School of Medicine (OHSU). Prior to joining the OHSU Department of Emergency Medicine in 2000, Dr. Deiorio completed her MD and residency training at George Washington University School of Medicine. Dr. Deiorio has been engaged in teaching students at many levels, from directorship of the Principles of SAEM PULSE | JULY-AUGUST 2017

Clinical Medicine course to clinical experiences in emergency medicine

for third- and fourth-year students. She has been instrumental in student affairs in assisting students in understanding their career goals, finding mentors, navigating struggles, and applying to residencies. Her academic interests include education research, especially the residency selection process, and coaching in medical education. Dr. Deiorio has received numerous awards for her work, including the Hal Jayne Excellence in Education award from SAEM in 2017. In her free time she enjoys reading, knitting, boating, spending time with her family, and supporting the Portland Trail Blazers. Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force interviewed Dr. Deiorio for this issue of Spotlight.

SAEM Talks with Dr. Nicole Deiorio Please tell us about how you first became an educator. Did you always know you would teach? I did finish residency seeking an academic career. My first job as faculty was as assistant clerkship director. While at that point I had not fully envisioned what I wanted my career to look like, I quickly discovered that I felt great reward in working with medical students. While some view clerkship director as a stepping stone to residency leadership, for me it was a great fit for a lifelong focus. For me, medical students represent a compelling developmental stage—not college students anymore, but not yet physicians. They often enter medical school feeling like any other graduate student, yet to watch and participate in their journey to becoming a physician is such a special experience. I have maintained my focus in undergraduate medical education and it has been very rewarding for me.

Who are some of the teachers you’ve had in the past who have influenced how you train your students today? I really received great training for medical school and residency at George Washington and I am always trying to pay that forward.

Dr. Deiorio with friends and colleagues at the OHSU Department of Emergency Medicine holiday party

From Dr. Jim Scott, my dean of students and then program director in emergency medicine, I learned that you always have to see if everything’s OK at home— valuable advice as a chief resident and certainly helpful in my role with struggling learners. From Dr. Yolanda Haywood, I learned that the reason people get nosebleeds is that everyone picks their nose—i.e., common things are common, and people might be embarrassed to tell you the full story that is informing what is going on with them today. This is a great lesson to impart to learners and it also helps when I am advising students myself. From Dr. Jeff Love, I realized that you don’t have to know everything to be a credible teacher. While he has an amazing, broad fund of knowledge, I mainly remember his pearls of wisdom related to ophthalmologic and ENT subject areas. So now I just choose areas that I am most passionate about and let that guide my bedside teaching.

to the quote, “How we spend our days is how we spend our lives.” This has really resonated with me in many ways, but I like to use it as an example for residents with regard to time management and keeping up with the literature. A medical career is a marathon, so we have to think up ways to create good habits now (for example, with a daily reading strategy, and exercise, and time for ourselves), so we can sustain the practice in the long term.

At my very first faculty development conference, Michelle Biros introduced me

I try to be human and put myself in their shoes. Residents and students have

Finally, my first chair, Jerris Hedges, met often with me to work with me to define my career goals. He gave me the valuable advice that “every paper has a home.” I now firmly believe this and I try to pass this along to my students and residents so they can have the comfort it gave me at the beginning of my research career.

How do you engage learners and keep them motivated?

"I try to model a willingness to always be learning, and humility in not knowing. "

many competing demands for their cognitive energy. By keeping my teaching practical and humorous, I aim to increase the chance that the knowledge will stick. I try to incorporate personal anecdotes so that the information has more context for them and they can see its relevance. I have been known to teach via haiku, and my knowledge of celebrity medical conditions also comes in very handy.

Tell us about a specific training challenge you encountered and how you dealt with it. I find it really interesting to work with learners who have received corrective feedback in the professionalism domains, because there are often two issues there—the original action, and then the likely difficulty the learner will have with truly hearing and incorporating the feedback. This is challenging, but can be satisfying as well. While not all deficiencies in the professionalism domain can be fixed, I enjoy spending the time to build a relationship with the learner so hopefully there is a sense of trust in me—that I have their best interests at heart—which leads to them being able to see the way they were perceived and the potential negative consequences their behavior has caused. In many cases this leads to small but important changes in their actions over the long term.

Dr. Deiorio finishing a race with her daughter.

What behaviors do you try to model for your trainees? I try to model a willingness to always be learning, and humility in not knowing. It’s important to me to be credible in this regard since as part of the academic coaching program I direct for all of the students, we discuss the never-ending need to form goals around learning, and accept and incorporate feedback from others, whether it’s a student’s clerkship faculty or a faculty member’s clinical dashboard from their chair.

"A medical career is a marathon, so we have to think up ways to create good habits now so we can sustain the practice in the long term."

SAEM PULSE | JULY-AUGUST 2017

What would you like to see change about the residency selection process?

I really think candidates deserve a holistic consideration of their strengths, and programs directors deserve transparency about candidates. Right now the easiest option to sort through a large volume of applications is to simply create an invitation list by board scores! I’d love for us all to let go of the idea that there are perfect applicants. If we can all accept that each candidate has strengths and weaknesses, it will be easier for schools and students to admit what they need to work on, and program directors can decide what qualities they most value in their incoming interns, and what struggles they are willing to work with. I am working with the AAMC on the standardized video interview project, and I think this has great potential to showcase applicants’ communication and professionalism skills, which there is currently no way to filter for when reviewing applications.

What experiences in your life outside of medicine do you feel have made you a better educator? I think running has provided me with some great life lessons as an educator. I like its emphasis on achieving your personal best and it helps me send the right message to my learners— to not get hung up on comparing yourself with others, but to gain insight into your own personal areas you’d like to improve. It’s pretty obvious you need to set goals in running but once you achieve them, it gives you the motivation to set them in other areas of life. So I try to advocate that the students and residents I work with set goals for their learning and their career as well. I also love to read, and I believe that having experienced so many different kinds of people through the world of books

Dr. Deiorio ringing in the New Year with her family.

"It’s important to recognize that everyone is human, and trying to do their best in challenging situations." gives me the ability to more easily put myself in others’ shoes. I wish knitting was able to make me a better educator as well, but sadly it just seems to be an expensive habit!

What advice would you give to a resident who would like to go into teaching? Just keep showing up! There are all kinds of opportunities to get involved no matter where you are in your career. As a resident, you can help out with medical student labs and events both through emergency medicine but also in the medical school— students love learning from someone who is a near-peer. As a new attending, either in the community or at academic center, opportunities abound as well—just ask around. If you would like to have a long-term career in education, if you simply keep saying yes to teaching and show you are effective and reliable, more opportunities will find you.

What qualities do you think are most important in a resident? In a faculty member? I think it is so important to cut other people slack and not assume the worst about any person or situation. I find that if a learner or faculty member is able to do this, then they make the best team members and providers. It’s important to recognize that everyone is human, and trying to do their best in challenging situations. Ninety-nine percent of the time, people (co-workers, trainees, or patients) are not intentionally trying to make your life more difficult, so while it is human nature to see things through a self-centered framework, what’s probably happening is that the other person is just seeing the situation through their own framework as well and not even thinking about you. While I know that this is a perhaps overly-optimistic outlook, I think that if we can all realize that other people have a lot going on in their own lives that we can’t even see, we treat each other more humanely

(TOP) Dr. Deiorio celebrating her promotion to full professor with Drs. Craig Newgard, and Patrick Brunett (BOTTOM) Dr. Deiorio preparing to hand out envelopes at Match Day.

and collegially, and don’t get bogged down in complaining all of the time. These are the kinds of people I like to work with.

What do you do to manage stress, achieve work-life balance, and contribute to your overall health and well-being? I read a lot of wellness and happiness literature as I am interested in it and it greatly informs my work in student affairs. The big take-home points for me are the importance of connectedness, and of doing meaningful work, as influencing happiness and satisfaction. If I surround myself with people to whom I feel a connection, both at home and at work, experiences feel more rewarding and enjoyable. And as long as I can see the meaning in the work I am doing, it feels satisfying and worth the time involved. Luckily for me, it is easy to see the worth in caring for our emergency department patients and training our future providers.

ANNUAL MEETING WR AP-UP

SAEM17 Orlando: A Stellar Success! More than 3,000 attendees convened in Orlando for four days of cutting edge education, state of the art original research, career development activities, and innovation in academic emergency medicine. With 11 pre-meeting workshops, 800 research abstracts and poster presentations, and more than 100 didactic sessions, presented by some of the top names in the specialty, there were many high quality continuing education opportunities from which to choose.

ANNUAL MEETING WRAP-UP

New and Improved

To increase the value of attendees’ takeaway and enhance the annual meeting experience, we added several new features to SAEM17. The inaugural Chair Fair gave attendees an opportunity to meet one-on-one with 48 of the most notable department chairs in the specialty of academic emergency medicine. Our new Speed Mentoring event matched residents and medical students with 60 faculty members and other leaders in academic emergency medicine to answer questions and offer advice. At SAEM National Grand Rounds, some of the top names in the specialty presented a series of educational lectures on diverse topics of current research and interest to academic emergency medicine. Of course SAEM17 had all of the favorites attendees have come to expect

and enjoy, but with a little something extra! We transformed the Plaza International Ballroom into the most amazing Dodgeball court we’ve ever had—complete with bleachers, hot dogs, popcorn, and cold suds. SonoGames® was doubly exciting this year, with more teams, a bigger competition space, and crazier costumes.

Online Ease New scheduling tools, like our synced online program planner and SAEM17 mobile app, allowed attendees to view and build their schedules at home and have it at their fingertips onsite. No printed program to misplace or fumble with. Registration this year was faster and easier than ever! Attendees simply scanned their personal confirmation codes at our convenient, self-serve express kiosks, hit print, and voila! Badges and tickets were ready. No standing in long lines.

Judd Hollander Kicks Off SAEM17 Former SAEM president, Judd Hollander, MD, opened SAEM17 to a packed and eager audience, offering his prognostications on what lies ahead for the EM specialty in an insightful and entertaining keynote addressed titled, "The Future of Emergency Medicine:

What You (and Hopefully I) May Be Doing in 35 Years." Dr. Hollander, a pioneer in emergency medicine and among the most respected and prolific members of the emergency medicine specialty, shared his thoughts on what challenges and changes will mold emergency medicine over the next decades, where the future of emergency medicine is heading, and what will it look like when it gets there. Listen to Dr. Hollander’s full presentation.

Post-SAEM Need-to-Know Claim Your CME

Claim CME credits and download a Certificate of Attendance/CME Certificate, via the SAEM17 Online Program Planner or mobile app by July 31, 2017. You must log in with your SAEM username and password to access the CME credit system and claim credit.

FREE: Up to 300 Hours of Educational Content!

If you were unable to attend SAEM17, or were in Orlando with us but would like to revisit some of your favorite SAEM17 educational sessions, you can enjoy complimentary access to up to 300 hours of convenient online and mobile viewing of select SAEM17 educational sessions via SAEM OnDemand 2017. Just log in with your SAEM ID and password.

“The six plenary abstracts selected for SAEM17 represented a broad diversity of research in emergency medicine. These abstracts were chosen as the best among hundreds of submissions and we were honored to present them at the SAEM annual meeting in Orlando,” said Danny Pallin, MD, MPH, SAEM17 Program Committee Chair.

Daniel Nishijima, MD, MAS

University of California, Davis The Incidence of Traumatic Intracranial Hemorrhage in Head-injured Older Adults Transported by Emergency Medical Services With and Without Anticoagulant or Antiplatelet Use Listen to the presentation

Jay G. Ladde, MD

University of Central Florida/Orlando Regional Medical Center The Loop Technique: A Novel Incision and Drainage Technique in the Treatment of Skin Abscesses in an Emergency Department in a Community-acquired Methicillin-resistant Staphylococcus Aureus Endemic Area

ANNUAL MEETING WRAP-UP

Plenary Session Abstract Presentations

Listen to the presentation

Read the full abstract (#1)

Read the full abstract (#4)

Derek Monette, MD

Brigham and Women’s Hospital The Impact of Video Laryngoscopy on Emergency Medicine Resident Intubation Experience: A Report of 14,698 Intubations Listen to the presentation

M. Kit Delgado, MD, MS

University of Pennsylvania, Perelman School of Medicine National Variation in Opioid Prescribing and Risk of Prolonged Opioid Use for Opioid-naïve Patients Treated in the Emergency Department for Ankle Sprains Listen to the presentation

Read the full abstract (#2)

Read the full abstract (#5)

Nikita Joshi, MD

Amit T. Vahia

University of Michigan/Henry Ford Hospital Severely Elevated Blood Pressure in the Emergency Department is an Independent Predictor of 6 and 12 Month Cardiovascular Events

Stanford University Medical Center Gender Representation in Speakers at Emergency Medicine National Conferences: Analysis of Trends From 2011-2015

Listen to the presentation

Read the full abstract (#3)

Read the full abstract (#6)

These are the Champions!

SONOGAMES®

Congratulations to the 2017 SonoGames® champs: Harvard Affiliated Emergency Medicine Residency (HAEMR)!

SIMWARS

Your 2017 SimWars Champions: NYU School of Medicine!

DODGEBALL

Blunt Force Trauma dived, ducked, dipped, and dodged their way to the tournament title! They are your SAEM17 Dodgeball Champions!

Congratulations to this Yearâ&#x20AC;&#x2122;s Award Recipients!

The Advancement of Women in Academic Emergency Medicine

Recognizing an SAEM member who has made significant contributions to the advancement of women in academic emergency medicine, was presented to Michelle Biros, MD, MS, Interim Head and Professor, Department of Emergency Medicine, University of Minnesota School of Medicine.

The Hal Jayne Excellence in Education Award

ANNUAL MEETING WRAP-UP

Given to a member of SAEM who has made outstanding contributions to emergency medicine through the teaching of others and the improvement of pedagogy, was presented to Nicole M. Deiorio, MD, Professor of Emergency Medicine, Oregon Health & Science University.

The Arnold P. Gold Foundation Humanism in Medicine Award

The Excellence in Research Award

Given to a practicing emergency medicine physician who exemplifies compassionate, patient-centered care, was presented to Angela Mills, MD, Vice Chair of Clinical Operations, Associate Professor of Emergency Medicine, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania.

Given to a member of SAEM who has made outstanding contributions to emergency medicine through the creation and sharing of new knowledge, was presented to Craig D. Newgard, MD, MPH, Professor with Tenure, of Emergency Medicine, Oregon Health & Science University.

The Best Resident Educator Award

Resident Researcher

A new award to be given annually to a senior emergency medicine resident who has demonstrated exceptional aptitude and passion for teaching during residency, was presented this year to Shikha Kapil, MD, Emory University.

A new award to be given annually to senior emergency medicine residents who have demonstrated exceptional promise and early accomplishment in the creation of new knowledge, was presented this year to Michael F. Harrison, MD, PhD, Chief Resident, Henry Ford Health System and Rachel A. Lindor, MD, JD, Resident, Mayo Clinic.

The John Marx Leadership Award Honoring an SAEM member who has made exceptional contributions to emergency medicine through leadership locally, regionally, nationally or internationally, with priority given to those with demonstrated leadership within SAEM, was presented today to Jill M. Baren, MD, MBE, Professor and Chair, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania.

The Young Investigator Award

Recognizing SAEMÂ members who have demonstrated commitment and achievement in research during the early stages of their academic careers, was presented this year to Arjun K. Venkatesh, MD, MBA, MHS, Assistant Professor, Department of Emergency Medicine, Yale University School of Medicine, Keith E. Kocher, MD, MPH, MPhil, Assistant Professor of Emergency Medicine, University of Michigan, Edward R. Melnick, MD, MHS, Assistant Professor of Emergency Medicine, Yale University School of Medicine, and Francesca L. Beaudoin, MD, MS, Assistant Professor, Department of Emergency Medicine, The Warren Alpert School Medical School of Brown University Brown University (not pictured).

ANNUAL MEETING WRAP-UP

Opening Reception

A “big” piano keyboard, carnival style horse-racing and hoops, a life-size Operation game, good food, cool beverages, and fun people… That was SAEM17’s Opening Reception. Hope you were there!

SAEM17 Photo Album

SPEED MENTORING

Our first-ever Speed Mentoring event connected eager residents and medical students with faculty members and other leaders in academic emergency medicine who were happy to answer questions and offer helpful advice.

PRE-MEETING WORKSHOP

Attendees at the “Conceptualized Emergency Ultrasound: Integrating Scenario-Based Learning” pre-meeting workshop learned real-life skills by actively walking through simulated scenarios.

E-POSTERS

Attendees were able to attend three days of e-poster presentations covering a wide array of topics

MORE SAEM17 PHOTO ALBUMS Tuesday, May 16 Wednesday, May 17 CHAIR FAIR

SAEM17 attendees visited with chairs from academic departments across the country at the inaugural Chair Fair

YARD PARTY

Residents and medical students at the Senior Frog's Yard Party proved a fiesta's more fun with confetti!

Thursday, May 18 Friday, May 19 11

2017 Medical Student Excellence in Emergency Medicine Award Recipients The Society for Academic Emergency Medicine congratulates this year’s recipients of the 2017 SAEM Medical Student Excellence in Emergency Medicine Award. The award is offered to each medical school in the United States and internationally to honor an outstanding medical student. Cole Hunter Matthews University of South Carolina School of Medicine Greenville Sandra Lopez Johns Hopkins School of Medicine

Justine Sarah Ko Case Western Reserve University School of Medicine

Courtney Temple University of Massachusetts Medical School

Morgan Oskutis University of Maryland School Medicine

Carter E. Duggan Indiana University

Gerhard Dashi Queen’s University

Clifford Lawrence Freeman University of Louisville School of Medicine

Cameron Upchurch Vanderbilt University Medical Center

Paul Hausknecht Baylor College of Medicine Julian Botta Rutgers-Robert Wood Johnson Medical School Elena James Medical College of Georgia - Augusta University Erica Lash University of Rochester School of Medicine & Dentistry

Shannon Thompson Uniformed Services University of the Health Sciences, F. Edward Herbert School of Medicine Kristin Nicole Podboy University of Pikeville–Kentucky College of Osteopathic Medicine Ryan Gordon University of Virginia Emily Dedonato The Ohio University

Michael Keenan Upstate Medical University

Christopher James Watso The University of Chicago Pritzker School of Medicine

Gretchen Therese Gunn Albany Medical College James Schneider West Virginia University School of Medicine Lana Shaker Rutgers New Jersey Medical School ANNUAL MEETING WRAP-UP

Mary Swiggum University of Minnesota Medical School

Quinton Cooper Campbell Florida State University

Hannah Hughes David Geffen School of Medicine at UCLA

Annaleigh Boggess Oregon Health & Science University

Patrick Callaghan Philadelphia College of Osteopathic Medicine Priyanka Kailash Campbell University, Jerry M. Wallace School of Osteopathic Medicine Seth Atchison University of Kansas School of Medicine Nicholena Etxegoien East Carolina University –Brody School of Medicine Sarah Balgord Wake Forest University School of Medicine

Nathan Marcinkowski The University of Toledo, College of Medicine and Life Sciences Anna Huyler Penn State College of Medicine Walid Hamud-Ahmed University of California, San Francisco School of Medicine Andre Burnier John A. Burns School of Medicine James Thomas VandenBerg Washington University School of Medicine Collin Michels University of South Dakota Sanford School of Medicine Kiyoshi Scissum University of South Alabama Christopher J Reisig Weill Cornell Medicine Anna Condella Columbia University College of Physicians and Surgeons

Rosaline A. Desvarisles East Tennessee State University Quillen College of Medicine Alanna Darling The Warren Alpert Medical School Brown University Lillyanna Jewett University of California, Davis School of Medicine David Nathan Suwondo Yale School of Medicine Anisha Malhotra Rush University Medical School Patrick Grace University of Kentucky, College of Medicine John Schneider University of Missouri Mia Derstine University of Michigan Medical School Joshua Davis Sidney Kimmel Medical College at Thomas Jefferson University

Kyle Grimaldi Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo Michael Joseph University of Connecticut School of Medicine James Li Drexel University College of Medicine James T. O’Neill University of New England College of Osteopathic Medicine Michael Conrardy Northwestern University Feinberg School of Medicine Joshua Ring University of Miami School of Medicine Emeka Egbebike University of Miami School of Medicine Rosalia Mahr Medical College of Wisconsin

Megan Svach University of North Texas Health Science Center, Texas College of Osteopathic Medicine

Rachel Koval Patzer Emory University School of Medicine

Ashley Garispe College of Osteopathic Medicine of the Pacific

George RJ Sontag Wright State University, Boonshoft School of Medicine

Mary Ledoux University of Vermont

Eileen Shi University of California San Diego

David John Barton, Jr. University of Pittsburgh School of Medicine

Jesal Amin University of Missouri - Kansas City

Lukas Ramcharran New York University School of Medicine Brittany Jane Karlovich Arizona College of Osteopathic Medicine Aleksandra Polonetskaya SUNY Downstate College of Medicine Jon Jordan Gray LSUHealth School of Medicine Shreveport Joseph Noack University of Iowa Roy J. and Lucille A Carver College of Medicine Madeline Ross Georgetown University School of Medicine

Jennifer Goines, MD Morehouse School of Medicine

Tara Lewis University of Mississippi Medical Center Vincent Marsh Medical University of South Carolina Joseph Fisher The University of Arizona, College of Medicine Maja Feldman The University of California, Irvine Jessica Sujung Oh New York Medical College Megan Molina Harvard Medical School

Save the Date! SAEM18 will be held May 15-18 at the spectacular JW Marriott Indianapolis. Winner of three distinct Condé Nast Traveler awards including #5 best hotel in the U.S., the luxurious JW Marriott Indianapolis soars 33 stories above the city and is in the heart of world-class shopping and dining and just steps from White River State Park, the Indianapolis Zoo, and many museums.

SAEM18 Submission Deadlines Workshops August 1 – September 15 Didactics August 15 – October 1 Abstracts/Innovations/ IGNITE! November 1, 2017 January 2, 2018

Indianapolis, Indiana May15-18

Thank You to Our SAEM17 Exhibitors and Sponsors! Exhibitors • 3D Systems • AAEM Resident and Student Association (AAEM/RSA) • Air Force Recruiting Services • Allergan USA, Inc • American Academy of Emergency Medicine (AAEM) • ApolloMD • BMS/Pfizer • BRC • CEP America • Challenger Corporation • ConsensioHealth LLC • Eternal Beauty • EmCare • Emergency Medicine Associates (EMA) • Emergency Service Partners LP • EMrecruits • Expo Enterprise • Feel Good, Inc. • Gables Medical Billing • GE Healthcare • Geozio Solutions • Hays Innovations

Sponsors • CEP America • EMrecruits • American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA) • Locum Tenens • EmCare • Emergency Medicine Associates (EMA)

• HCA • Infinity Healthcare • Integrative Emergency Services • IU School of Medicine | Dept. of Emergency Medicine • Janssen Pharmaceuticals • Kaiser Permanente/ The Permanente Medical Group • Leading Edge Medical Associates (LEMA) • MedaPhor Ltd. • Mint Physician Staffing • Northwestern University • Nova Enterprises • OtoSim • Pain Assessment and Management Initiative (PAMI ) & Pediatric Emergency Care Safety Initiative (PECSI) • Penn State Hershey Medical Center • Scientific American Emergency Medicine (SAE) • ScribeAmerica • Sheridan Healthcare • Shift Administrators

• SonoSim • Splash Medical Devices • Staff Care • Swiss innovation systems • Sycamore Physician Contracting • TeamHealth • TeedCo Healthcare Recruiting • The Air We Breathe Campaign, Lymphangioleiomyomatosis • TrueLearn, Inc. • TTUHSC El Paso, Department of Emergency Medicine • University of Florida Department of Emergency Medicine • US Acute Care Solutions • U.S. Army Medical Department • Vapotherm • VisualDX • Wakefield & Associates • WVU Medicine, Department of Emergency Medicine • Your Design Medical

• Emergency Service Partners LP • Gables Medical Billing • Hays Innovations • Leading Edge Medical Associates (LEMA) • OtoSim • Pain Assessment and Management Initiative (PAMI ) & Pediatric Emergency Care Safety Initiative (PECSI)

• Sheridan Healthcare • Splash Medical Devices • Staff Care • TeedCo Healthcare Recruiting • US Acute Care Solutions • VisualDX • TeamHealth

This year’s SonoGames® was sponsored by SonoSim, GE, Medaphor Scan Trainer, Philips, Mindray/ Zonare, SonoSite, GMI/Siemens/Samsung. Everyone says “thank you!”

ANNUAL MEETING WRAP-UP

LOOKING AHEAD

The downtown skyline with Monument Circle at the heart of Indianapolis.

Top 10 Reasons “WHY INDY?” In honor of Indianapolis native David Letterman, here’s your Top Ten List for why Indianapolis is the perfect destination for SAEM18:

1) SAEM PULSE | JULY-AUGUST 2017

INDY IS CONNECTED.

Everything is within reach in downtown Indianapolis. Indy’s compact downtown is easy to navigate, and at its heart is the Circle Center Mall, where more than 100 shops are linked by enclosed walkways to the SAEM18 host hotel, JW Marriott. Indy is not only connected, it’s walkable! Traverse the eight-mile Indianapolis Cultural Trail, passing through six cultural districts complete with shops, art, attractions, and restaurants. Or stroll along one of several pathways, including the beautiful Canal Walk, River Front Walkway, and the Zoo Loop 5K circuit.

INDY IS VIBRANT.

Indy’s energetic downtown offers over 300 diverse restaurants and 50 major attractions, including world-class arts and cultural institutions, award-winning sports facilities, miles of bike paths, a scenic Central Canal, and 250 acres of urban green space.

INDY IS HOSPITABLE.

Indianapolis has a well-earned reputation for providing a warm and welcoming brand of top-notch service known as “Hoosier Hospitality.” No matter how far you’ll travel to reach SAEM18, you’ll feel right at home in Indianapolis.

INDY IS ACCESSIBLE.

Traveling to and around Indy is easy, convenient, and affordable. Indianapolis International Airport, is only 15 minutes from downtown and welcomes over 1,000 flights weekly from 41 nonstop destinations. Airports Council International named IND the Best Airport in North America four of the last five years, and Condé Nast readers voted it Best Airport in America two years running.

INDY IS INNOVATIVE.

The $63 million, eight-mile Indianapolis Cultural Trail is the first of its kind in the world and internationally recognized as a model for urban revitalization. The urban bike and pedestrian path connects visitors to chef-owned restaurants, boutique shopping, and an array of entertainment options in six thriving Cultural Districts. Bikes are available at select hotels, two convenient rental outlets, and through a bike share.

INDY IS GREEN.

If you’re looking for green space, it’s plentiful in Indy. Located in the heart of the city, White River State Park offers 250 acres of green space highlighted by a glimmering Canal Walk and art-lined

pedestrian paths. The park offers plenty to do with a zoo, baseball stadium, concert venue, IMAX theater, war memorials, and museums.

INDY IS LIVELY.

At the end of a long day of SAEM18 educational sessions, Indianapolis comes alive with hundreds of places for good times, good food, good drinks, and good conversation. From happy hour hotspots to late night live music venues, comedy clubs to cabaret shows, Indy is alive with after-hours fun.

INDY IS UNIQUE.

Explore an urban greenway named the biggest and boldest move by any American city, the NCAA Headquarters, the iconic Indianapolis Motor Speedway,

the world’s largest children’s museum, and much more. The city is second only to Washington, DC, when it comes to the number of monuments and memorials dedicated to honoring our nation’s veterans.

INDY IS ARTSY.

Everywhere you go in Indianapolis there is art on display. Visit the gorgeous Indianapolis Museum of Art, with its adjacent 100-acre Woods sculpture garden (one of the largest art parks in the country!), enjoy a free public performance at the iconic, seven-story glass and steel Artsgarden, or spend the afternoon at a world-renowned American Indian and western art museum. From the abstract sculptures dotting the canal to the more than 100 public murals that are spread throughout the city, Indy is artsy to the core.

And the Number One Reason “Why Indy?”…

INDY IS SURPRISING!

Although recognized as a sports capital and home of the world’s largest single-day sporting event (the Indy 500), you will find there is a pleasant surprise in Indy around every turn. If you’ve never visited Indianapolis before, you’ll be surprised by everything this vibrant city has to offer! We can’t wait to have you join us for SAEM18 in Indy!

Where to go, what to do, and how to get there! • Transportation • Dining • Things to Do • Maps and Guides • Coupons and Deals • And more!

Light and open space are prevalent design elements at IND.

The Children's Museum of Indianapolis: The world's largest children’s museum.

Greenspace couples with top attractions in downtown's White River State.

The Indianapolis Cultural Trail extends south to the Fountain Square neighborhood.

Circle Center Mall and the Artsgarden bring energy to the heart of downtown.

DIVERSITY AND INCLUSION Travel Bans: What Effect Does It Have on Graduate Medical Education? By Maria V. Gomez, MD, Cook County Stroger Hospital, Chicago

"Foreigners, as future physicians and as patients, add to the breadth of education that only a diverse health care system

SAEM PULSE | JULY-AUGUST 2017

can provide. "

Ongoing news events, including the repeated attempts to implement a travel ban, have initiated a sense of uncertainty amongst medical residents in the U.S. An initial executive order banning entry into the U.S. of foreign citizens from seven predominantly Muslim countries resulted in thwarting physician international travel and provoked confusion nationwide.1,2 The precursory order was blocked by a federal appeals court3 and precipitated a revised travel ban that has also been diverted by a U.S. district judge in Hawaii. Sixteen other states have sided with Hawaii as well as the American Bar Association, former national security officials, technology companies, religious organizations, and 165 members of congress. Fourteen states, along with nonprofit gun groups, advocates of English first language policies and border control foundations are urging the enforcement of the revised travel ban.4 The redacted order entails a 90-day ban on travelers from six predominantly Muslim countries. Notable changes in the executive order include: Iraqi citizens are no longer barred from travel, exemptions exist for permanent residents and current visa holders, a 120-day freeze instead of an indefinite ban on refugees from Syria, and abdicated language offering preferential status to persecuted religious minorities.5 The revised ban was recently considered to be discriminatory and continues to be blocked, the final fate of this travel order will likely be decided by the Supreme Court.6 Although both travel ban orders are currently in respite, incertitude for many, especially future foreign graduates, remains. In 2015, international medical graduates were reported to make up 24 percent of practicing physicians in the U.S.7 In 2016, 21 percent of all active applicants in the Main Residency Match were not U.S. Citizens, that number dropped to 20 percent in 2017.8,9 Although the number of U.S. citizen

and non-U.S. citizen international medical school students and graduates declined, their match rates increased and were at the highest in more than a decade, according to a National Resident Matching Program press release.10 Despite the increase in matching rates, the number of active applicants that are non-U.S. citizen medical students and international medical graduates is at its lowest since 2012 with only 7,284 active applicants in 2017.11,12 Foreigners, as future physicians and as patients, add to the breadth of education that only a diverse health care system can provide. As Dr. Grover, executive vice president of the AAMC (Association of the American Medical Colleges) states, â&#x20AC;&#x153;usually the US gets the pick of the cropâ&#x20AC;&#x201D;the best doctors in training from around the world. But that situation might not continue if some IMGs think they are not welcomeâ&#x20AC;?.12 It is impossible to know if these numbers are by virtue of these travel ban orders, or if they are in any way corresponding. Only time will tell if this declining number of active international medical graduate applicants will continue. It is evident that immigrants are making significant contributions to the U.S. health system and anything that would negate this formulary would be detrimental to both patients and physicians alike. Many medical associations13,14,15,16 and institutions of higher education17 have issued statements in an unprecedented show of solidarity expressing concern for the implication that these new policies may have for the future of medicine, science, and education. By the time this article is submitted, this travel ban may or may not have had its day with the Supreme Court. What will remain nebulous are the future of foreigners in the U.S., and the impact any changes to immigration policies will have on the health care field. These uncertainties can

Cook County Stroger Emergency Medicine Residents and Attendings, Internal Medicine Chief Residents, Pediatric Medicine Residents

"As an immigrant, a U.S. combat veteran, mother, and Mexican-American emergency medicine physician, I invite all residency programs to accept these precarious times as an opportunity to improve on their approach and fulfillment of diversity and inclusion."

lead to feelings of isolation, frustration, and fear. Considering the diversity of our country, departmental staff, and patient population, it is important that we foster broad and inclusive practices to continue to show support and solidarity for our colleagues and patients that are being directly affected by this ordeal. It is arguably more imperative now than ever to promote tolerance, celebrate our global communities, and to show our advocacy in the emergency medicine field. Tasks such as coordinating opportunities in which residents may express their concerns, and providing resources to

help manage new hurdles, can make an immense difference during these tenuous moments. As an immigrant, a U.S. combat veteran, mother, and Mexican-American emergency medicine physician, I invite all residency programs to accept these precarious times as an opportunity to improve on their approach and fulfillment of diversity and inclusion. REFERENCES

1. O rnstein, C. Trump’s Executive Order Strands Brooklyn Doctor in Sudan. Pro Publica. Jan. 29, 2017 2. O rnstein, C. Hours After Landing in the U.S., Cleveland Clinic Doctor Forced to Leave by Trump’s Order. Pro Publica. Jan. 29, 2017 3. United States Courts for the Ninth Circuit. Feb.4, 2017 4. D olan, M. U.S. 9th Circuit Court of Appeals Hears Arguments on

Trump’s Revised Travel Ban. LA Times. May 15, 2017 5. F ull executive order text: President Trump’s Executive Order on Immigration. March 6, 2017 6. Liptak, A. Appeals Court Will Not Reinstate Trump’s Revised Travel Ban. The New York Times. May 25, 2017 7. Educational Commission for Foreign Medical Graduates. 2015 Annual report 8. N ational Resident Matching Program. Charting outcomes in the Match: international medical graduates: characteristics of international medical graduates who matched to their preferred specialty in the 2016 Main Residency Match. 2nd ed. September 2016 9. National Resident Matching Program. Results and Data. 2017 Main Residency Match. Applicants in the Matching Program. April 2017 10. P ress Release: NRMP 2017 Main Residency Match Report Shows Record-High 31,554 Positions Filled. May 1, 2017 11. N ational Resident Matching Program. Results and Data. 2012 Main Residency Match. Applicants in the Matching Program 2008-2012. April 2012. 12. Terry, K. New Trump Travel Ban Still Affects Foreign Medical Residents. Medscape. March 9, 2017. 13. P ress Releases. AAMC Statement on President Trump’s Executive Order on Immigration. Jan. 30, 2017 14. P ress Release. American Hospital Association. Pollack, R. Statement of President Trump’s Executive Order on Immigration. Jan. 30, 2017 15. AHA News Now. White House Issues Revised Travel Order. March 6, 2017 16. C ouncil of Medical Specialty Societies. CMSS Position on International Collaboration in Medicine. Feb. 8, 2017 17. F ain, P. Forceful Response: The Trump’s Administration Entry Ban Triggered Wide Condemnation from Colleges, Associations, Faculty Groups and others in Higher Education. Inside Higher Ed. Jan. 30, 2017

ABOUT THE AUTHOR: Maria V. Gomez, MD, is an emergency medicine resident physician at Cook County Stroger Hospital in Chicago.

ETHICS IN ACTION Making Ethically Complicated Decisions About End-of-Life Care By Gerald Maloney, DO

THE CASE: It is six hours into a busy shift when you receive notification that your hospital’s air medical service is transferring in a 53-year-old male patient with a self-inflicted stab wound to the chest. He has a simple pneumothorax on chest radiograph from the sending facility and is by report hemodynamically stable. While he consented to the transfer he is refusing any further interventions, such as a tube thoracostomy. When the patient arrives in the trauma bay, he is alert and oriented times three. He is tachycardic, but has a normal pulse oximetry and blood SAEM PULSE | JULY-AUGUST 2017

pressure. The patient states that he wishes

to sign out against medical advice (AMA), and verbalizes his full understanding that he may die as a result. He states he has Huntington’s chorea, saw his father die from it, and wants to die himself before experiencing the same decline his father did. He is refusing all interventions. Should he be allowed to refuse further treatment and sign out against medical advice?

There is very little debate about how to manage a suicidal patient who is intent on self-harm. Protecting such patients from their self-destructive tendencies is an accepted standard of care from clinical, legal, and ethical perspectives, and is one of the few situations where the right to autonomy can be superseded. However, an equally vociferous debate surrounds whether a patient has a right to take his or her own life when confronted with a terminal illness. Euthanasia, while practiced in relatively few western countries, has long been a topic of discussion and ethical debate. Likewise, the concept of physician-assisted suicide, which has been a major component of discussions surrounding end-of-life care for the past several decades, and brought to the forefront of public attention through the advocacy efforts of “death with dignity” groups and the actions of practitioners such as Dr. Jack Kevorkian. Brittany Maynard, a young woman diagnosed with terminal glioblastoma, became an internet sensation through her well-documented last days and physician-assisted suicide in 2014 at the age of 29. Oregon passed a bill in 1994 allowing physicians to assist their terminally ill patients who wished to die, and a similar bill was signed into law in California in 2016, partially due to the lobbying efforts of Maynard before her death. However, these states have imposed significant restrictions on this process to ensure that the full range of their rights are being considered.

die. Nevertheless, the rights of a terminally ill patient to refuse futile or life-prolonging treatment are unquestioned.

Despite the public attention it has garnered, the debate over assisted suicide rarely enters directly into the clinical practice of emergency medicine. We stabilize and hospitalize those who have attempted suicide, or who express suicidal ideations that are unambiguous, yet there has not been any major push to include the emergency department in active or passive physician-assisted suicide. Further, while end-of-life care discussions are commonplace, they have not resulted in honoring the wishes of patients who are suicidal and arrive in the emergency department wanting want to

However, depression frequently accompanies the diagnosis of a life-limiting or terminal disease. Depression is well recognized as a major contributing factor toward suicidal ideation for the terminally ill. Within the growing field of palliative care exists many options to improve the quality of life for the terminally ill and to support them and their families through the end-of-life process. As a result, many feel that greater attention should be given to providing for the needs and comfort of the terminally ill over actively assisting these patients with ending their lives.

"Despite the public attention it has garnered, the debate over assisted suicide rarely enters directly into the clinical practice of emergency medicine."

So where does the case above fit into this discussion? The first question is whether suicide is ever a “normal” act. Proponents of physicianassisted suicide state that suicide is a natural expectation, especially in cases of a drawn-out and debilitating fatal illness such as Huntington’s chorea. The patient in this case, having seen his father die from the same illness, knows exactly what fate awaits him. Given this information, including the knowledge that there does not presently exist any treatment that would effectively slow or cure the disease, many would argue that suicide is a rational option for end-of-life care for this patient.

"Within the growing field of palliative care exists many options to improve the quality of life for the terminally ill and to support them and their families through the end-of-life process. As a result, many feel that greater attention should be given to providing for the needs and comfort of the terminally ill over actively assisting these patients with ending their lives." THE RESOLUTION: In the case above, while we may sympathize with the patientâ&#x20AC;&#x2122;s plight of coping with a terminal illness, appropriate steps are nonetheless required to stabilize and treat his life-threatening injuries and should be taken. The patientâ&#x20AC;&#x2122;s terminal illness should have no bearing on his management; he should be treated as any suicidal patient would be treated. This would hold true even if he has a DNR (Do Not Resuscitate) and is arresting from his attempted suicide, as DNR or POLST (Physician Orders for Life-Sustaining

Treatment) generally apply to dying from natural processes and not from suicide. If treatment includes procedures, such as tube thoracostomy, to save his life, then it is considered acceptable to proceed with these procedures even if they are against the patientâ&#x20AC;&#x2122;s wishes, as it is assumed that a rational person would want the tube thoracostomy as a life-saving measure. As our population ages and the number of medically complex and terminally ill patients increases, end-of-life care issues will become ever more prevalent. As this

case illustrates, situations involving patient autonomy in end-of-life care are frequently ethically complicated and riven with difficult decision-making.

ABOUT THE AUTHOR: Gerald Maloney, DO, is associate chief, Emergency Department, Louis Stokes Cleveland VA Medical Center; attending physician, Department of Emergency Medicine, MetroHealth Medical Center; and associate professor of emergency medicine, Case Western Reserve University.

RESIDENT-STUDENT GUIDE POCUS Education: A Journey from the Medical Student Perspective By Sukrit Narula, Samuel Kebede, and Yonathan Debessai – Icahn School of Medicine at Mount Sinai, New York, NY The benefits of integrating ultrasound training into medical education have been well-documented.1,2,3,4 As an adjunct to the physical exam at the point-of-care, ultrasound competency allows all providers to deliver better care to their patients. Indeed, ultrasound competency provides an important window to the functioning of the human anatomy. When René Laennec invented the stethoscope, he was seeking to indirectly examine hearts without having to perform any invasive procedures. Laennec also experienced great discomfort placing his ear on his patients’ chests, which was standard practice at the time. While the stethoscope has evolved into both an important tool for clinical diagnostics as well as an indelible symbol for the profession, point-of-care ultrasound provides another means to approach the standard physical exam: The ability to look inside.

SAEM PULSE | JULY-AUGUST 2017

Several clinical studies have shown that in comparison to the standard physical exam, point-of-care ultrasound can provide invaluable information. One study found that when comparing medical students who were using ultrasound machines to board-certified cardiologists using physical exam techniques (without ultrasound), 75 percent of the students were able to identify the given ailment as compared to 49 percent of the doctors(1). Even beyond cardiac assessments, another study found medical students using ultrasound were better able to measure liver size as compared to physicians using standard diagnostic methods.5 Since their invention, ultrasound machines have become increasingly more accurate, compact, and cost effective. While in the past, ultrasound machines required a significant investment and space, today they can be as small as a handheld phone. Although image quality and other factors may be less developed on more compact models, features such as 2D modeling and color Doppler can be helpful on a wide diagnostic spectrum.

Despite the increase in affordability and portability of ultrasound equipment, ultrasound training predominantly takes place at the graduate medical education level.6 Bahner, et al, conducted a study in 2014 investigating the current state of ultrasound education in U.S. undergraduate medical education.6 Of the 82 schools that participated, 51 (62.2%) of them reported that ultrasound education was incorporated into their medical school’s curriculum. This represents a significant loss for medical students who attend schools without integrated ultrasound training. It has been documented that medical schools with ultrasound integrated into their school’s curriculum were able to demonstrate improvement in physical examination skills and identification of anatomy amongst medical students.6,7 During the 2013-14 academic year Harvard Medical School introduced a POCUS pilot program incorporated into their first and second year curriculum.7 Much to their delight, students not only were better able to understand human anatomy and learn physical exam skills, but also communicated interest in a more widespread ultrasound curriculum.7

"For students, point-of-care ultrasound provides one of the most effective means for understanding physiological processes quickly and noninvasively."

Despite medical students’ interest in and benefit from ultrasound education, POCUS integration into the medical school curriculum faces several limitations, including space, trained faculty, and financial resources to maintain ultrasound equipment.6,7 In order to overcome such limitations, while still reaping the benefits of POCUS in preclinical and clinical curricula, the creation of national standards for ultrasound education may act as a catalyst for the implementation of ultrasound education across medical school curricula. As stated earlier, for students, point-of-care ultrasound (POCUS), in addition to its utility as a diagnostic tool, provides one of the most effective means for understanding physiological

"It has been documented that medical schools with ultrasound integrated into their school’s curriculum were able to demonstrate improvement in physical examination skills and identification of anatomy amongst medical students."

processes quickly and noninvasively. Our experience as members of the Sinai Ultrasound Interest Group has shown us both effective ways of introducing POCUS as well as challenges that still remain in fully realizing ultrasound integration into medical education. As founders of our school’s point-of-care ultrasound group, we have encountered a series of triumphs and challenges regarding the integration of POCUS within the medical student curriculum. By sharing our experiences, we hope to provide insight to students and faculty on what to expect when initiating an ultrasound program at your institution. In regard to the conversation as to what role point of care ultrasound has in general medical education, we hope to have demonstrated that it is a field of increasing significance and growing importance. What we hope to build as a new area of education at our institution will likely be the national standard in years to come. REFERENCES 1. S olomon, S. D., & Saldana, F. (2014). Point-of-Care Ultrasound in Medical Education — Stop Listening and Look. New England Journal of Medicine, 370(12), 1083-1085. 2. R oyer, D. F. (2016). The role of ultrasound in graduate anatomy education: Current state of integration in the United States and faculty perceptions. Anatomical Sciences Education, 9(5), 453-467. 3. S teinmetz, P., Oleskevich, S., & Lewis, J. (2016). Acquisition and Long-term Retention of Bedside Ultrasound Skills in First-Year Medical Students. Journal of Ultrasound in Medicine, 35(9), 1967-1975. 4. S o, S., Patel, R. M., & Orebaugh, S. L. (2016). Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis. Anatomical Sciences Education. 5. M ouratev, G., Howe, D., Hoppmann, R., Poston, M. B., Reid, R., Varnadoe, J., ... & DeMarco, P. (2013). Teaching medical students ultrasound to measure liver size: comparison with experienced clinicians using physical examination alone. Teaching and learning in medicine, 25(1), 84-88. 6 Bahner, D. P., Goldman, E., Way, D., Royall, N. A., & Liu, Y. T. (2014). The state of ultrasound education in US medical schools: results of a national survey. Academic Medicine, 89(12), 1681-1686. 7 Rempell, J. S., Saldana, F., DiSalvo, D., Kumar, N., Stone, M. B., Chan, W., ... & Kohler, M. J. (2016). Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience. Western Journal of Emergency Medicine, 17(6), 734.

ABOUT THE AUTHORS: Sukrit Narula is an alumnus of Stanford University with a BA in political science. Samuel Kebede is an alumnus of Johns Hopkins University with a BA in public health. Yonathan Debessai is an alumnus of York University with BS in kinesiology. All three served as co-presidents of Mount Sinai's newly formed Ultrasound Interest Group, an organization dedicated to improving clinical and basic science knowledge through holding workshops on point-of-care ultrasound for medical students. Their advisor is Bret Nelson, MD RDMS FACEP.

Tips and Challenges for POCUS Education CHANGING CULTURE Finding ways to develop a new culture or demand for point-of-care ultrasound at your school is important. At our institution, changing the perception surrounding the newly formed ultrasound interest group has been challenging. Many at our school see ultrasound as a modality that is useful solely for the purposes of radiology, OB/GYN, and cardiology. There have been instances in which classmates even referred to us as “heads of the new radiology club” even though our organization’s mission statement is contrary to this appropriation. One way to incorporate ultrasound at your school, and build a demand, would be to meet with course directors and convince them to incorporate POCUS education into their curricula. Integrating hands on POCUS sessions into their respective courses would stimulate interest in the applications of ultrasound as well as grow the demand for ultrasound within the school’s academic environment. MENTORSHIP We benefited from having 4-6 emergency medicine residents and ultrasound fellows in addition to our advisor, Dr. Bret Nelson, consistently attend our POCUS sessions. This allowed for there to be small groups of 2-3 students per doctor which translated into a rich teaching experience for the instructors and learning environment for the students. It is important to note that while we are fortunate to have an advisor like Dr. Nelson, who continues to remind us of the utility of POCUS, students who are not interacting with similar mentors on a consistent basis may be puzzled by our enthusiasm during POCUS sessions. Encouragement from a wider base of mentors and senior clinicians in many different specialties might be necessary in order to stimulate interest in a broader cross section of students. TIMING We had substantially greater success in generating interest in ultrasound education by designing didactics that corresponded thematically with concurrent coursework and lectures. For example, we provided echocardiography didactics during our cardiology pathophysiology course and lung and pleural ultrasound during the pulmonology block. In addition to coinciding with coursework, we also tried our best to target different students based on general availability. First year students at our school generally have a heavier course load in their first semester, and so our first semester didactic sessions were targeted more towards second year students. During the second semester, our sessions were targeted more towards first year curriculum as MS2s began Step 1 preparation. HANDS ON EXPERIENCE/POWERFUL EXAMPLES Informative, yet easy-to-understand didactics, are key to drawing interest. The ability to distinguish A-lines and B-lines and use them to easily distinguish between heart failure and COPD was an incredibly illuminating experience for many students. The ability to recognize cardiac tamponade through immediate visualization was another indelible didactic experience for many students. By bringing to life what students read in textbooks and are taught in lectures, our didactic sessions have left lasting impressions on all of the students who have participated.

SGEM: DID YOU KNOW?

Viewing Intimate Partner Violence Through the Prism of Gender and Sexuality By Rebecca Barron, MD, MPH, Warren Alpert Medical School of Brown University

SAEM PULSE | JULY-AUGUST 2017

Intimate partner violence (IPV) is a major public health problem in the United States and beyond. Historically, IPV research has focused largely on its effects among heterosexual women as well as screening and intervention efforts aimed at this population. According to the Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey, however, women and men face similar rates of IPV (including physical violence, sexual violence, threats of physical or sexual violence, stalking, and psychological aggression), although the prevalence of specific forms of IPV and its impact vary by gender.1 Nevertheless, few studies have explored the prevalence of IPV in the health care setting, the accuracy and efficacy of medical screening for IPV, and the efficacy of health care responses to IPV among men despite the parity in the prevalence of IPV among women and men.2 Additionally, the already at-risk LGBTQ population has also been overlooked with regard to IPV despite the fact that many LGBTQ individuals encounter rates of IPV comparable to, if not greater than, heterosexual women.3 While data are limited, transgender individuals seem to be even more vulnerable to IPV than other sexual minorities. Indeed, with the scope of IPV becoming increasingly clear, it is necessary to adapt the focus of emergency medicine research—and ultimately clinical practice—in order to benefit all patients.

ABOUT THE AUTHOR: Rebecca Barron, MD, MPH, is a Sex and Gender in Emergency Medicine Fellow at Warren Alpert Medical School of Brown University REFERENCES

1. B lack MC, Basile KC, Breiding MJ, Smith SG, Walters ML, Merrick MT et al. The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2011. 2. Kimberg LS. Addressing intimate partner violence with male patients: a review and introduction of pilot guidelines. J Gen Intern Med. 2008;23:2071-8. 3. Ard KL, Makadon HJ. Addressing intimate partner violence in lesbian, gay, bisexual, and transgender patients. J Gen Intern Med. 2011;26:930-3.

Please send contributions for this column to coeditors Lauren Walter and Alyson J. Mcgregor at sgem@lifespan.org. If you are an SAEM member and are interested in adding the Sex and Gender in Emergency Medicine Interest Group (SGEM IG) to your membership, simply sign in to your profile and join today. SAEM members who are already part of the SGEM IG can find more information and resources by visiting the SGEM IG Community Site.

BRIEFS AND BULLET POINTS SAEM NEWS

Introducing a New Course to Jumpstart Your Research Career! SAEM proudly announces ARMED (Advanced Research Methodology Evaluation and Design)—a new research course for junior faculty, fellows, and senior residents taught by leading experts in academic emergency medicine. If you are interested in pursuing a career in research, ARMED will arm you with the fundamental knowledge and skills to design a high-quality research project and write a grant proposal. The ARMED schedule runs from September 2017 through May 2018. Classes are limited to eight to 10 participants each. Interested candidates must submit an application by July 31. Visit the ARMED webpage for complete details.

SAEM REGIONAL MEETINGS 2017 Southeastern Regional Meeting The 2017 Southeastern Regional Meeting, hosted by the University of Florida College of Medicine, Jacksonville, was held February 10 and 11, 2017 at the Conference Center at the Main Library with 84 participants from 16 academic institutions in attendance. Thirty posters and eight oral presentations were given at the conference; additional highlights included:

Congratulations to D. Mark Courtney, MD, the 2017-2018 president of the Society for Academic Emergency Medicine! Dr. Courtney assumed his post during the opening session of SAEM17.

• The EM Zombie Olympics competition—a unique integration of simulation, ultrasound, and emergency medicine knowledge skills for residents and medical students. • A resident in-service exam review session to help prepare for the ABEM in-training exam that was held in February 2017. • The integration of Twitter (#SESAEM17) and the use of moderators to publicize the conference sessions in “real time.” • An evening medical student advising session held in a casual social setting (Intuition Ale Works).

SAEM JOURNALS Academic Emergency Medicine SGEM* Hot Off the Press Episodes of Recent AEM Articles SGEM#177: POCUS – A New Sensation for Diagnosing Pediatric Fractures Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patientcentered outcomes. AEM May 2017.

Meeting

Date

Location

More Info

South Central Regional Meeting

September 8-9

Austin, TX

Midwest Regional Meeting

September 14

Grand Rapids, MI

Great Plains Regional Meeting

October 6-7

Columbia, MO

SGEM#170: Don’t Go Breaking My Heart – Ottawa Heart Failure Risk Scale Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT-proBNP. AEM March 2017. *Skeptics’ Guide to Emergency Medicine

Monthly FOAMed Podcast Now Available Check out AEM Early Access, a FOAMed podcast collaboration between Academic Emergency Medicine journal and Brown Emergency Medicine. Each month, you’ll find digital open access to an AEM Article in Press, with an author interview podcast and links to curated FOAMed supportive educational materials for EM learners. The first two podcasts are now available.

SAEM FOUNDATION

Now Accepting Grant Proposals The SAEM Foundation is accepting grant proposals for the 2018-2019 grant cycle. The following grants will be offered and have a deadline of August 1, 2017. To view the full request for applications, visit www.saemfoundation.org. Contact grants@saem.org with questions. • NEW! Academy for Diversity and Inclusion in Emergency Medicine Research Grant - $3,000 • NEW! Academy of Emergency Ultrasound Research Grant $10,000 • NEW! Simulation Academy Novice Research Grant - $5,000 • Research Training Grant - $150,000

Meet the 2017 SAEMF Grantees

• Education Fellowship Grant – $100,000

Your gifts fund the most promising researchers and educators in academic EM. Meet this year’s bright stars. Learn more at www. saemfoundation.org.

• Education Research Grant – $10,000 • SAEMF/ACMT Michael P. Spadafora Toxicology Scholarship – $2,000

James Daley, MD, MPH, Yale University

Announcing the Next Free Research Learning Series Event

2017 Academy of Emergency Ultrasound Research Grant - $10,000

Building Your Budget July 10, 1PM CST/2PM EST Caroline Freiermuth, MD, Duke University

“Using Focused Bedside Echocardiology to Evaluate for PE in the Unstable Patient”

Elizabeth Rosenman, MD, University of Washington 2017 Education Research Grant - $10,000 “Creating and Validating a Team Leadership Assessment Tool for Emergency Medicine”

Learning Objectives: 1 Describe key components needed for all grants 2 Plan for special budget needs 3 Identify how to determine allowable and non-allowable expenses via the funding announcement 4 Build a spreadsheet to account for all budget line items 5 Justify the components of your budget Register here for this next event in the Research Learning Series.

Robert Ehrman, MD, Wayne State University 2017 Research Training Grant - $150,000 “Is Diastolic Dysfunction Associated with Poor Outcomes in Sepsis”

Sara Hock, MD, Rush University 2017 Simulation Academy Novice Research Grant “Evaluation of a Central Line Checklist for Academic EM Attending Physician Skills”

SAVE THE DATES SAEM Annual Meetings

2018 May 15-18, The JW Marriott Hotel, Indianapolis 2019 May 14-17, The Mirage Casino-Hotel, Las Vegas, NV

SUBMIT CONTENT

The SAEM Pulse “Briefs and Bullet Points” section publishes academic appointments and announcements, calls and submissions, event and meeting dates, deadlines, and SAEM Academy, Committee, Interest Group, and Task Force news and information. Send all content (50 to 75 words each) to newsletter@saem.org. The next content deadline is August 1, 2017 for the September/October 2017 issue.

ACADEMIC ANNOUNCEMENTS Wake Forest School of Medicine R. Darrell Nelson, MD, has been promoted to associate professor in the Department of Emergency Medicine at Wake Forest School of Medicine in Winston-Salem, North. Dr. Nelson received an MD degree from the Wake Forest School of Medicine and then completed residency training at Carolinas Medical Center. After a number of years in private practice where he continued some academic pursuits, Dr. Nelson returned to full-time academic emergency medicine in 2012. Dr. Nelson is subspecialty boarded in EMS and serves as medical director for several agencies in North Carolina, as well as providing leadership for the accredited EMS fellowship at Wake Forest. Bret Nicks, MD, MHA, has been promoted to full professor in the Department of Emergency Medicine at Wake Forest School of Medicine in Winston-Salem, North Carolina. Dr. Nicks is originally from Seattle, where he completed his MD degree at the University of Washington. He later completed residency training at Carolinas Medical Center and his Master of Health Administration at the University of North Carolina at Chapel Hill. Dr. Nicks currently serves as Chief Medical Officer for WFBH–Davie Medical Center, and recently completed his term as president of the NC College of Emergency Physicians. Nicholas Hartman, MD, assistant professor of emergency medicine at the Wake Forest School of Medicine, was recently awarded an Academy Award from the CORD Academy for Scholarship in Education in Emergency Medicine. Dr. Hartman is a valuable member of the residency leadership team at Wake Forest and this award is a recognition of his outstanding achievements as an educator.

Washington University School of Medicine Peter D. Panagos, MD, FACEP, FAHA from the Division of Emergency Medicine and Department of Neurology has been promoted to full professor of emergency medicine and neurology at the Washington University School of Medicine in St Louis. At Wash U, Dr. Panagos serves as director of neurovascular emergencies and co-director of the Washington University/ Barnes-Jewish Hospital Stroke Network. He is a nationally recognized leader in stroke serving on the American Stroke Association Advisory Board, Co-Chair’s Mission: Lifeline Stroke and was recently appointed vice-chair of the American Stroke Association Leadership Council. Tiffany Osborn, MD, MPH, FACEP was recently promoted to full professor in emergency medicine and general surgery/critical care at Washington University School of Medicine in St. Louis. It is believed that she is the first female to achieve this dual role at a U.S. academic medical center. Dr. Osborn completed a Masters of Public Health at the London School of Hygiene and Tropical Medicine before beginning work with the Intensive Care National Audit and Research Centre (ICNARC) in London, England. She received her MD at the University of Texas Health Science Center in San Antonio. She currently serves on the ACEP National Quality Measures Technical Expert Panel for the Clinical Emergency Data Registry (CEDAR) and the national Emergency Quality Network Sepsis Initiative (E-QUAL).

CAREER CORNER FREE CV/Resume Critique for Job Seekers

Did you know…EM Job Link job seekers can request a free, confidential CV/resume evaluation from a resume/writing expert. You can participate in this feature when uploading a CV/resume to EM Job Link and through the CV/Resume Management section of your job seeker 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. To submit a resume when uploading it to EM Job Link: 1. Visit the "Manage Resumes" section of your job seeker account 2. Click "Upload Resume File” 3. Choose the file to be uploaded 4. Click “YES” next to “Submit my resume for a free evaluation from a trusted resume expert at TopResume” 5. When you receive the pop-up, click “Evaluate my resume” 6. Proceed with the upload by clicking "Upload Resume" To submit a resume already uploaded to your account on EM Job Link: 1. Visit the "Manage Resumes" section of your job seeker account 2. Locate the resume you would like to have evaluated 3. Click "Free Evaluation" 4. When you receive the pop-up, click “Evaluate my resume” You will then receive email confirmation from your personal resume expert.

Employers, are your recruiting efforts effective? Specific targeted career websites, like EM Job Link, deliver the most highly qualified talent and have the best return on investment. Our candidates are made up of the specific professionals you want to reach. If you want the best and brightest candidates, you need to go where they job search – EM Job Link. Along with posting your jobs in front of qualified candidates at EM Job Link, you can search our resume bank for talent as well. Post today or speak to an expert who can help create a customized recruiting solution to get you great candidates.

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 August 1. For specs and pricing, visit the SAEM Pulse advertising webpage.

WESTERN PENNSYLVANIA

EMERGENCY MEDICINE UPMC and University of Pittsburgh UPMC has a long history of emergency medicine excellence, with a deep and diverse EM faculty also a part of the University of Pittsburgh. We are internationally recognized for superiority in research, teaching and clinical care. With a large integrated insurance division and over 20 hospitals in Western Pennsylvania and growing, UPMC is one of the nation’s leading health care systems. We do what others dream — cutting edge emergency care inside a thriving top-tier academic health system. We can match opportunities with growth in pure clinical or mixed careers with teaching, research, and administration/ leadership in all settings — urban, suburban and rural, with both community and teaching hospitals. Our outstanding compensation and benefits package includes malpractice without the need for tail coverage, an employer-funded retirement plan, generous CME allowance and more. To discuss joining our large and successful physician group, email emcareers@upmc.edu or call 412-432-7400.

EOE Minority/Female/Vet/Disabled

72714C HRI&E 02/17

CHAIR OF EMERGENCY MEDICINE Baylor College of Medicine seeks to recruit a dynamic leader for the inaugural Chair of Emergency Medicine in the newly created Department of Emergency Medicine. This individual will be recognized for excellent leadership in patient care, education, and research on a scale that merits national preeminence. With several clinical sites including Ben Taub Hospital’s ACS verified Level I Trauma center with 95,000 visits; the flagship Baylor St. Luke’s Medical Center with 35,000 visits (a Catholic Health Initiatives joint venture), and the Michael E. DeBakey VA Medical Center, the Chair will have a unique opportunity to transform Emergency Medicine from a Division within the Department of Medicine into a regionalized, community emergency medicine service. Significant vision, communication and collaboration skills, accompanied by an entrepreneurial spirit and strong business acumen, are required to effectively lead the combined clinical, research, and educational enterprise. The successful candidate will possess significant experience expanding a prominent Emergency Medicine Division/Department within a competitive marketplace. This individual must have the collaboration skills to support faculty in their academic, teaching and clinical endeavors, as well as cultivating their relationship with private practice physicians. Baylor College of Medicine (BCM): The only private medical school in the greater Southwest, BCM is an internationally renowned medical and research institution that attracts students from around the world. BCM consistently ranks among the top of the nation’s 147 medical schools for research and primary care.

Please submit nominations and/or curriculum vitae to the search consultant: Jannah Hodges, Managing Partner, Hodges Partners 2911 Turtle Creek Blvd., Suite 300, Dallas, TX 75219 Phone: 214.902.7901 E-mail: jannah@hodgespartners.com

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Academic Emergency Physician

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The purpose of the “I am SAEM” campaign is to emphasize the importance of stress management, to improve provider well-being, and to promote academic emergency medicine as a career path. If you or someone you know has a unique or noteworthy outside interest or activity that helps you achieve work-life balance, please share your story with us! Read Paul’s full story at "I am SAEM".

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SEE YOU IN

Indianapolis, Indiana â&#x20AC;&#x201C; May15-18