SAEM PULSE March–April 2018

MARCH-APRIL 2018

VOLUME XXXIII NUMBER 2

SPOTLIGHT ED-Initiated Treatment for Opioid Use Disorder

PHYSICIAN AT THE FOREFRONT An Interview with

Gail D’Onofrio, MD, MS

IMPOSTER SYNDROME:

The Shame We Wear Beneath the White Coat page 32

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 & Benefits Doug Ray Ext. 208, dray@saem.org Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Operations & Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org IT Database Manager/ Systems Administrator Ahmed Khater Ext. 225, akhater@saem.org IT Support Specialist Jovan Triplett Ext 218, jtriplett@saem.org

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Membership Manager George Greaves Ext. 211, ggreaves@saem.org Meeting Planner Alex Elizabeth Keenan Ext. 218, akeenan@saem.org Membership & Meetings Coordinator Monica Bell Ext. 202, mbell@saem.org

Director, Communications and Publications Stacey Roseen Ext. 207, sroseen@saem.org Specialist, Digital Communications Nick Olah Ext. 201, nolah@saem.org

AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org

Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com Associate Editor, RAMS Shana Zucker, szucker@tulane.edu

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President’s Comments

A Curated List of Can't-Miss Didactics

Spotlight

ED-initiated Treatment for Opioid Use Disorder Physician at The Forefront

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SGEM: Did You Know?

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SAEM 2018 Preview

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Double Vulnerable: Young and LGBT

Diversity and Inclusion

Humanitarian Crises, Asylum Evaluations and the Emergency Medicine Physician

Ethics in Action

Refusal and Capacity: Beyond the Basics

Graduate Medical Education The ACGME Self-Study: Guidelines and Best Practices

Social Media in Academic EM

#FOAMed and International Emergency Medicine

RAMS

Imposter Syndrome: The Shame We Wear Beneath the White Coat

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 Š 2018 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

A Curated List of Can't-Miss Didactics Despite the trends that have come and gone since the first SAEM annual meeting I attended in 1995 (e.g., more tech, more attendees, more innovation, more impact, etc.) the annual meeting has not changed with respect to where we get our content: We get it from YOU.

"These offerings represent our ability as a Society to focus on both timeliness and impact as we consider the forces that shape the way we practice, teach, and explore research questions and methods."

While abstracts are submitted by members, non-members, and many soon-to-be medical student and resident members, the didactics are a function of what YOU want to share and discuss.

In this way, the SAEM annual meeting didactics are a fantastic sampling of the most up-to-the-minute and compelling topics in the field of emergency care. These didactics comprise a major portion of our annual meeting and help to set SAEM18 apart from all other educational meetings by addressing the most current challenges and opportunities in our field.

Michelle Biros, MD has been a long-time role model of mine. She is an enduring leader in emergency medicine—as a former editor-in-chief of Academic Emergency Medicine for many years and as an accomplished researcher and teacher. At many SAEM annual meetings she can be found personally guiding groups of learners from the University of Minnesota around the posters and other sessions. Likewise, in my comments this issue, I would like to provide my own “tour” of some of the outstanding, high-impact didactics you will see in Indianapolis. These are the didactics I hope to catch personally, and they highlight some of the most important work being done in our field in the domains of: Academic Practice, Research, Education, and Clinical Care.

Academic Practice

How we, as academic leaders, cope with boarding, epidemics, natural disasters, and constantly changing practice relationships will be a test for future relevance. Of the

more than 17 didactics dedicated to Academic Practice, I am eager to see the following four timely topics by SAEM thought leaders: • Integration of Advance Practice Providers into Academic Emergency Departments • Beyond Meaningful Use: Patient Portals and Their Role in Emergency Department Quality Outcomes and Patient Experience • Undocumented Emergency Department Patients: We Can Do Better (This is one of many instances where the newly conceived domain of social emergency medicine will be highlighted at SAEM18.)

• Emergency Medicine X: Creating Innovations Toward Equity (ExCITE)

Research

In didactic sessions such as the ones below, SAEM18 will highlight senior research leaders, novel research concepts, and ways to connect with federal funding research and training assistance: • Multicenter Pragmatic Clinical Trials in Emergency Medicine: Design and Applied Implementation Strategies for Large-scale Comparative Effectiveness Research • National Grand Rounds (Some of the most successful senior researchers across diverse areas of expertise will provide state-of-the-art comments on their domain, field questions, and meet informally in a network session.)

• Big Data Applications in Emergency Medicine • What You Need on Social Needs: Key Social Emergency Medicine Papers of 2017 • Separate sessions with NIH Connections: 1) Funding Aging Research in Emergency Medicine: An Update from the National Institute of Aging; 2) Molding Future Leaders: National Institutes of Health Training Programs in Emergency continued on Page 10

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SPOTLIGHT ED-Initiated Treatment for Opioid Use Disorder

PHYSICIAN AT THE FOREFRONT

"It is not only important to keep the roads clear and paved (i.e. use evidence-based best practices) but we must always be building new roads."

SAEM PULSE | MARCH-APRIL 2018

SAEM Pulse Talks With Dr. Gail D’Onofrio, SAEM18 Keynote Speaker

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Gail D’Onofrio, MD, MS is professor and the inaugural chair of the Department of Emergency Medicine at Yale University and physician-in-chief of Emergency Services at Yale-New Haven Hospital. She is internationally known for her work in substance use disorders, women’s cardiovascular health, and mentoring physician scientists in developing independent research careers. For the past 25 years she has developed and tested interventions for alcohol, opioids, and other substance use disorders, serving as principal investigator on several large National Institutes of Health, Substance Abuse and Mental Health Services Administration, and Centers for Disease Control and Prevention studies. Dr. D’Onofrio has a long track record of mentoring junior and senior faculty members both at Yale and throughout the United States in multiple specialties. She is the principle investigator of a National Institute on Drug Abuse K12 establishing the Yale Drug Use, Addiction, and HIV Research Scholars (Yale-DAHRS) program, a three-year postdoctoral, interdisciplinary, mentored career development program with focused training in prevention and treatment of drug use, addiction, and HIV in general medical setting. She is a founding board member of Addiction Medicine, now recognized as a new subspecialty by the American Board of Medical Specialties. Dr. D’Onofrio will open SAEM18 on Wednesday, May 16, with a keynote address titled The Opioid Crisis: Emergency Physicians as Innovators, Policymakers, and Heroes. Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force, interviewed Dr. D’Onofrio for this issue.

Before medical school, you were a nurse, a consultant for Hewlett-Packard, and then founder and president of your own consulting firm. How did these experiences lead you to medicine?

I always wanted to be a doctor for as far back as I can remember. I did special science projects in elementary and middle school and enrolled in all advanced science classes in high school. I am not sure how the transition occurred that I entered college for nursing. I can tell you there were few role models back then and NO advice given to me by guidance counselors. To make a long story short, I followed my first husband to Boston as he had a full ride to MIT for graduate school. Eventually the marriage dissolved and I followed my passion and applied to medical school.

Prior to that I had completed a master’s

in education, fully funded by the Nurse Training Act, and worked as an ICU Clinical Specialist. I loved my job but I wanted to be a doctor. My nursing and consulting work proved to be a valuable resource, as I could work and support myself through medical school.

What sparked your interest in addiction medicine?

I was always interested in trauma and wanted to be a trauma surgeon.

However, while working with the trauma service at Boston City Hospital (BCH), I learned that the first emergency medicine residency program in Boston was starting at BCH. After much reflection and a leap of faith I matched in emergency medicine at BCH and joined the first official PGY-2 class.

At BCH in the 1980s, the emergency department was a war zone with perpetual penetrating trauma due to the cocaine crisis. After saving lives every day and losing others, it became apparent that the root cause of the trauma was substance use. So, when I was asked by my original mentor (Dr. Jeffrey Samet, currently chief of Internal Medicine at Boston University) to be part of a faculty development grant

"After saving lives every day, and losing others, it became apparent that the root cause of the trauma was substance use." offered by the Substance Abuse and Mental Health Services Administration to prepare investigators with a focus on substance use and addiction, I agreed.

I have been conducting clinical trials related to interventions for substance use disorders ever since.

We’ve witnessed a great deal of fingerpointing when it comes to the root causes of the current opioid epidemic.

How do you think we got to where we are now—with American life expectancy actually decreasing as a result of the increase in drug overdoses?

This current epidemic was pharmaceutically driven when in the mid-1990s Purdue Pharma pioneered “academic detailing” and marketed OxyContin to physicians as safe and effective for chronic pain “with little abuse potential”—despite lack of evidence. Physicians then,

unfortunately, contributed to the problem by dispensing large amounts of prescription medications to the public.

All of this occurred in combination with the fact that pain became the “fifth vital sign” in 1996, and in 2001 the Joint Commission released new pain management standards. To make matters worse, the Centers for Medicare and Medicaid Services linked our reimbursement with pain management through HCAHPS (Hospital Consumer Assessment of Healthcare Providers and System survey), and the perfect storm was created. Now, these pills can be manufactured easily along with other more potent synthetic opioids such as fentanyl. Opioids have become a great source of revenue from China and Central America, easily bought on the dark web. The availability of cheap product combined with depressed economies in many parts of the United

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SAEM PULSE | MARCH-APRIL 2018

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"There are profound neurobiological changes with addiction, and this is not a moral failing."

"These real heroes have done what emergency physicians are great at: They problem-solved their way out of major barriers and have saved countless lives."

States, including the Ohio Appalachian Valley, have left people with a sense of hopelessness and despair, who easily succumb to addiction.

Have there been any particularly memorable instances of emergency department patients you’ve identified as having opioid or alcohol dependence disorder and intervened on?

Treating patients with opioid use disorder can be immensely fulfilling. First, just seeing the change in a person’s behavior 30 minutes after initiating buprenorphine in the emergency department to someone who is withdrawing is amazing. Then, to follow these patients and see that they can get back their lives and become able to relate to their families, friends, and return to work is unbelievable. I have had families thank me as well, and tell me how their lives have changed for the better.

There are not many other diseases on which we can make such an impact.

What would you say to an emergency physician who feels that it’s not his or her job to start addiction treatment in the emergency department because “it’s not an emergent condition?”

I would say that the emergency department is the front door of our community and it is our responsibility to improve the health of the public. We have no problem starting medications for hypertensive urgency or hyperglycemia and referring for ongoing care. This is no different. Said best by Walter Ling, MD, whose pharmacotherapy research was pivotal for approval of buprenorphine: “We SAVE a LIFE with naloxone reversal of an overdose patient, but we need to KEEP them ALIVE by initiating treatment and referral so that in the end the person can GET A LIFE.” Do we really want to perpetuate what has been described in a recent New York Times editorial by Helen Ouyang, MD, that “...the emergency room is one of the hardest places to actually get [patients] help. Instead [the patient] is rushed out the door and labeled a ’drug seeker.’ Where else is medicine do we identify that a patient has an illness, document that it exists in the medical chart, but not try to help treat it?”

Your research has highlighted the efficacy of buprenorphine for treatment of opioid dependence. Do you feel there are roles for other medications (naltrexone, gabapentin, etc.)? What about for alcohol dependence?

The only evidence-based treatment for moderate to severe opioid use disorder is opioid agonist therapy with methadone or buprenorphine. Only certified opioid treatment programs can offer methadone. Emergency physicians CAN administer

buprenorphine in the emergency department under the 72-hour rule that permits our bridging patients to treatment. Under this rule, a patient can receive two subsequent days of dosing if they return to the emergency department. However, emergency physicians who obtain a DATA 2000 waiver by completing the prerequisite eight-hour training can prescribe (write a prescription) for buprenorphine. Naltrexone has not been shown to be as effective as buprenorphine and cannot be started until a person undergoes detoxification. This limits its use in the emergency department setting and is a major barrier for individuals seeking treatment. Naltrexone does have a place in opioid use disorder when individuals leave abstinence programs or incarceration. Naltrexone may also be used in severe alcohol use disorder and could potentially be used in the emergency department; however, the cost is often prohibitive.

What advice would you give to an emergency department trying to initiate interventions but without adequate resources for outpatient follow-up?

First, most of the time there are resources in the community that can be accessed, but the emergency department needs to partner with these resources and develop processes for referral. In some circumstances, these resources are very scarce and any delay can lead to potential loss of life.

Remarkably, emergency physicians around the country have stepped up to the plate and started their own buprenorphine clinics. These real heroes have done what emergency physicians are great at: they've problem-solved their way out of major barriers and have saved countless lives.

Your keynote address to be given at SAEM18 is titled “The Opioid Crisis: Emergency Physicians as Innovators, Policymakers, and Heroes.” Can you give us a sneak preview of what’s to come? How can emergency medicine physicians begin to see themselves as pivotal figures on the front lines?

I think you will have to wait and see, but I have given you some clues.

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

Individuals did not get to where they are overnight and they will not be able to get out of their situation easily. They need to want to make a change and this may take time, but offering an option is a start. There are profound neurobiological changes with addiction, and this is not a moral failing. Often patients are very dysphoric after naloxone reversal and this may not be an optimal time for conversations regarding entering treatment, but we can still talk about harm reduction.

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best opportunities for all of us come

moving forward in medicine as well as in other fields including politics. This year, for the first time, women have exceeded men in medical school enrollment. With this comes great responsibility. We will need to be attracted to all specialties, including those that traditionally have fewer women, such as orthopedics. We will need to work full-time or we will have the potential to drastically limit the pipeline of physicians.

from having a diverse workforce."

What do you do to manage stress, achieve work-life balance, and contribute to your overall health and well-being?

"We do know that women at higher levels attract other women, and the

SAEM PULSE | MARCH-APRIL 2018

What advice would you give to residents and faculty about establishing a mentoring relationship?

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Mentors are important for everyone throughout life.

Unfortunately, there is no single perfect mentor. We can have several mentors throughout our lives, and sometimes we just need to gather skills and advice from a variety of sources.

What specific challenges have you faced as a woman in the highest echelons of emergency medicine?

We still represent a small group in emergency medicine and in leadership positions within our institutions and professional organizations. We are often not heard, whether due to smaller stature, softer voices, or biases. We therefore continually strive to be better and are driven and persistent. We do know that women at higher levels attract other women, and the best opportunities for all of us come from having a diverse workforce. That being said, I am excited that we are

Well, I never think that there is such a thing as work-life balance. To believe so would make everyone feel incompetent.

We learn to juggle. Being the mother of triplets who are now 28, as well a wife, I can tell you that problems get bigger as the children get bigger. Parents need to be more accessible as their kids get older than when they are young, so taking a lot of time off in the early years is not the way to go. One may choose to limit clinical time and take less pay, for example, but if you are interested in academics you should stay on target and be ruthless about your goals and objectives. Often parttime only means part pay, so you need to be careful about this option. Exercise is always good for everyone’s well-being, so if I have any free time that is what I do.

The other bit of advice I have for all couples is “date night.� This needs to be a routine part of your life if you want a relationship to grow. We often become managers of households, kids, and work, letting the relationship slide. As I often say, a healthy relationship is like keeping a precious

plant alive. You cannot over-water it or under-water it. It needs consistent attention!

What experiences in your life outside of medicine do you feel have made you a better educator?

Probably being the mom of triplets. I have both ends of the spectrum, from incredibly talented and bright to a daughter, Ali, with special needs—specifically cognitive delays. We are all better for having Ali in our lives. We appreciate the small things, we've developed tolerance and kindness for others, and we can always recognize others with disabilities.

DR. GAIL D’ONOFRIO’S OPIOID RESEARCH STUDY • Read the JAMA Article • Watch the JAMA Video Clip

You’ve founded a well-respected residency program; you’ve been published in every major emergency medicine journal as well as JAMA; you’ve won a long list of distinguished awards and accolades for your work. What else would you like to accomplish in your career?

I am committed to developing independent investigators to move the field of emergency medicine forward. We are at risk of becoming a hospital department providing clinical care only.

It is essential that we continue to create new knowledge and push the limits further and further. It is not only important to keep the roads clear and paved (i.e. use evidence-based best practices) but we must always be building new roads.

If you could choose just one thing to be remembered for, what would it be?

I guess it would be “She made a difference.” Perhaps it is still the nurse in me.

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PRESIDENT’S COMMENTS continued from Page 3 Medicine; and 3) The SIREN Network: The National Institutes of Health’s Next Big Investment in Emergency Care Research

Education

Issues of resilience and wellness and the impact of technology in teaching and learning continue to be hot topics in emergency medicine education. At SAEM18, this will be addressed in several ways: • Happiness: How Resilience, Grit, and a Positive Outlook Can Ensure Career Longevity (one of the components of a new Education Summit Series) • An Educators Guide on How to Leverage Resilience to Improve Resident and Medical Student Wellness (also a component of a new Education Summit Series)

SAEM PULSE | MARCH-APRIL 2018

• Tech Tools: Information Management in the Age of Information Overload

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• Making Invisible Emergencies Evident: Teaching your Colleagues about Recognizing and Caring for their Trafficked Patients • Good Outcomes for Great Educational Research: How to Demonstrate That Your Educational Innovation Worked

Clinical

In addition to an abundance of clinically-relevant education and research abstracts, the following didactics further exemplify our Society’s collective creativity in addressing the most up-to-date and pertinent topics in patient care: • Widening the Safety Net: Buprenorphine for Opioid Use Disorder in the Emergency Department • Building Bridges at the Emergency Department Intensive Care Unit Interface: Models of Care for the Boarding Critically Ill Patient

• Integration of Disaster/Hurricane Response and the Academic Emergency Physician • New Frontiers: Management of Acute Ischemic Stroke in the Extended Time Window These are a mere sampling of all you have to choose from when you create your agenda for this year’s annual meeting.

These offerings represent our ability as a Society to focus on both timeliness and impact as we consider the forces that shape the way we practice, teach, and explore research questions and methods—all of which go back to the patient at the center of emergency care. This is YOUR content, this is YOUR meeting, this is YOUR career. Come to share it and to build it. See you in Indy.

ABOUT DR. COURTNEY: D. Mark Courtney, MD, MSCI, is director of research and an associate professor in the Department of Emergency Medicine at Feinberg School of Medicine, Northwestern University, Chicago. Dr. Courtney is the 20172018 president of the Society for Academic Emergency Medicine (SAEM).

SGEM: DID YOU KNOW? Double Vulnerable: Young and LGBT

By Joel Moll, MD Growing into a physically and emotionally mature adult is a journey each of us takes, and we likely have distinct memories of our unique struggles. Being young is a vulnerable time, where both desire for conformity and individuality may conflict. Lesbian, gay, bisexual, and transgender (LGBT) teens have concerns that may be more fundamental than their straight counterparts and may lack family and social support as they confront, challenge, and accept a nonconforming identity. In one national survey, the top three cited concerns from students aged 13-17 were classes and grades (25%), college/career (14%), and financial pressures related to college or job (11%). However, the top three concerns among LGBT youth in the same survey were family acceptance (26%), bullying at school (21%), and fear of being open or out (18%).1 In a 2015 CDC report, two percent of teens self-identify as gay or lesbian, six percent identify as bisexual, and just over three percent were unsure of their sexual identities.2 The body of knowledge on LGBT teen health inequities and disparities is limited; however, what we do know is alarming: • Up to 40 percent of homeless teens are LGBT • LGBT youth use drugs and alcohol at a higher rate than non-LGBT youth (52% to 22%) • More than half (51%) of LGBT youth have been verbally harassed at school (25% non-LGBT), 28 percent of LGB teens are bullied online (14% non-LGB).

• More than 1 in 10 LGB students have missed school in the past 30 days due to safety concerns • LGB teens are more than three times as likely to be physically forced to have sex (18% LGB vs 5% non-LGB) • 23 percent of LGB teens experience sexual dating violence (9% non-LGB), and 18 percent experience physical dating violence (8% non-LGB) • 60 percent of LGB students reported having been so sad or hopeless they stopped doing usual activities • 40 percent of LGB students considered suicide, and 29 percent have attempted suicide during the past year Once an adult, LGBT individuals have less access to care, are less likely to be insured, and are at higher risk of eating disorders, depression, anxiety, substance abuse, cigarette smoking, certain types of cancer, and sexually transmitted infections. Large cohort studies are limited in the LGBT population as most medical records until recently did not collect data on sexual orientation or gender identity.

What you can do:

As emergency physicians, we care for vulnerable populations every day. Awareness of health disparities is the first step toward eliminating the health care inequities that create them. Unfortunately, most emergency medicine residency training programs do not meet this need.3 As academic emergency physicians, we can make a difference by a commitment to the inclusion of biological sex and gender identity in research design and generalizability of results.

Sexual orientation should also be studied and appreciated as an important health determinant in emergency medicine research and education. Compassion and commitment to understand and be knowledgeable of our patient’s unique challenges is truly patient-centered care.

ABOUT THE AUTHOR: Dr. Joel Moll is residency program director and associate professor of emergency medicine at the Virginia Commonwealth University School of Medicine.

REFERENCES

1. G rowing Up LGBT in America. Human Rights Campaign Youth Survey Report. 2012. Accessed January 25, 2018 at: http://www.hrc.org/files/assets/resources/Growing-Up-LGBT-inAmerica_Report.pdf 2. S exual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. Morbidity and Mortality Weekly Report. Surveillance Summaries / Vol. 65 / No. 9 August 12, 2016 3. M oll J, Krieger P, Moreno-Walton L, Lee B, Slaven E, James, T, Hill D, Podolsky S, Corbin T and SL Heron. The Prevalence of Lesbian, Gay, Bisexual, and Transgender Health Education and Training in Emergency Medicine Residency Training Programs: What Do We Know?

Academic Emergency Medicine. 21(5): 608-611. 2014.

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 SAEM 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.

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PREVIEW Gail D'Onofrio, International Expert on Opioid Intervention and Treatment in the ED, to Headline SAEM18 The Opioid Crisis: Emergency Physicians as Innovators, Policymakers, and Heroes Wednesday, May 16, 2018, JW Marriott Downtown, Indianapolis Gail D’Onofrio, MD, MS, professor of emergency medicine and founding chair, Department of Emergency Medicine, Yale School of Medicine, will kick off SAEM18 with a timely and compelling keynote address titled “The Opioid Crisis: Emergency Physicians as Innovators, Policymakers, and Heroes.”

Dr. D’Onofrio, who is internationally known for her work in screening emergency department patients for unhealthy alcohol and other drug use, brief intervention, and referral to treatment (SBIRT), will discuss research conducted by emergency physicians that has been instrumental in moving the field forward, as well as how research has directly contributed to policy making and practice change. Real emergency physician heroes — from Syracuse, New York; Camden, New Jersey; Oakland, California; and New Hampshire — will be highlighted, along with innovative solutions emergency physicians have implemented to save lives.

Background

The opioid crisis has reached epidemic proportions and emergency physicians are on the front lines. Why? Because the emergency department is where the patients are. They present with overdose, seeking care, complications from drug use, as well as related health problems.

ANNUAL MEETING PREVIEW

As with past epidemics, physicians were part of the problem. The first opioid epidemic was created by Bayer marketing Heroin, and was fueled by physicians prescribing it for a wide range of problems and complaints. The current epidemic was created with unscrupulous marketing of opioids for pain management and fueled by physician overprescribing, the creation of pain as the 5th vital sign, CMS payment, and patient satisfaction scores. Now however, emergency physicians are uniquely positioned to develop solutions, initiate treatment, refer for ongoing treatment, and take a lead in harm reduction and preventing deaths. But digging our way out of the current epidemic is extremely challenging. The ready availability of synthetic opioids, along with social factors that have led to large pockets of despair in New England, the Appalachian and Ohio Valleys, and the Southwest, have intensified the crisis. What can we do?

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Emergency physicians around the country have partnered with state entities to develop a spectrum of innovative strategies. These strategies entail increasing access to care, identifying those at high risk for overdose, safe prescribing, offering access to Naloxone, sharing data among agencies, and decreasing stigma by recognizing not only that words matter, but accurate words matter.

ABOUT DR. D’ONOFRIO: Gail D’Onofrio, MD, MS, is professor and founding chair of the Department of Emergency Medicine at Yale University School of Medicine and physician-in-chief of the Yale-New Haven Hospital Emergency Department. Dr. D'Onofrio is known nationally and internationally for her work as an independent investigator in drug and alcohol research. She is a recognized leader in emergency medicine and has participated in many NIH panels and on review committees, including the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Heart, Lung and Blood Institute (NHLBI). Read more about Dr. D’Onofrio and her considerable list of accomplishments and credentials, then plan to join is at SAEM18 to hear what promises to be an inspiring and timely keynote address.

that one of the plenary presentations at SAEM18 will be ‘Laryngeal Tube vs Endotracheal Intubation in Adult Out-of-Hospital Cardiac Arrest: The

ANNUAL MEETING PREVIEW

“It is very exciting to know

Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial.’

Game-Changing EMS Airway Study Among Top 6 Abstracts Laryngeal Tube vs Endotracheal Intubation in Adult Out-of-Hospital Cardiac Arrest: The Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial Endotracheal intubation (ETI) is the most common advanced airway technique used in the resuscitation of out-of-hospital cardiac arrest (OHCA), but Supraglottic airway devices such as the King Laryngeal Tube offer simpler airway management alternatives. Which is associated with better clinical outcomes?

This multicenter, pragmatic clinical trial compared the effectiveness of initial LT insertion versus initial ETI upon outcomes in adult OHCA. What were the results?

Henry E. Wang, MD, MS, professor and vice chair for research at the University of Texas Health Science Center at Houston, presents findings of this study at the opening Plenary Session, Wednesday, May 16.

The results of this study will help answer an important question regarding EMS airway management for outof-hospital cardiac arrest patients. This study is a game changer and will have national and international impact.”

—William F. Toon, EdD, NRP, EMS educator and consultant and former EMS Manager for Loudoun County (Va.) Fire, Rescue, and Emergency Management.

Announcing the SAEM18 Plenary Abstracts Presented at the Opening Session, Wednesday, May 16 The SAEM18 Program Committee is pleased to announce the top six abstracts selected for presentation during a special plenary session to be held immediately following the keynote address on the opening day of SAEM18, Wednesday, May 16 at the JW Marriott Downtown Indianapolis.

“We are delighted to announce our six plenary abstracts, representing a broad diversity of research in emergency medicine. These abstracts were chosen as the best among hundreds of submissions and we look forward to presenting them at the SAEM annual meeting in Indianapolis,” said Danny Pallin, MD, MPH, SAEM18 Program Committee chair.

1. Laryngeal Tube vs Endotracheal Intubation in Adult Out-of-Hospital Cardiac Arrest: The Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial 2. Socioeconomic Status and Bronchiolitis Severity Among Hospitalized Infants 3. Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department 4. Assessing Emergency Department Guideline Concordance and Outcomes after Outpatient Cardiac Stress Testing 5. Balanced Crystalloids vs Saline for Intravenous Fluid Therapy: Results of Two Pragmatic Trials 6. Prospective Multicenter Validation of the Canadian Syncope Risk Score Be sure to register soon to take advantage of early bird rates!

Visit saem.org/ saem18 for details of all annual meeting education and events. Early bird registration ends March 19.

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PREVIEW Advanced EM Workshop Day Wednesday, May 16, 2018, JW Marriott Downtown, Indianapolis This year's workshop offerings include more than a dozen half- and full-day advanced sessions that cover specialized areas in emergency medicine and strengthen knowledge and skills in specific topic areas. Add any workshop to your SAEM18 registration for an additional fee.

• Bridging the Gap and Strengthening Our Community: Building Our Understanding of Microaggressions, Implicit Bias, and Cultural Humility • Clerkship Director Boot Camp • Climate Change and Health: Implications for Practice, Teaching, Research, and Advocacy in Emergency Medicine • Diversity, Inclusion, and Equity in Emergency Medicine Research, Education, and Clinical Practice • Educator’s Boot Camp • Effective Debriefing With Challenging Learners • EM Talk: Goals of Care and a Roadmap to Master Difficult Conversations • Female Leaders in Emergency Medicine: Helping You With Your Next Career Move • Grant Writing Workshop

ANNUAL MEETING PREVIEW

• Resuscitative Transesophageal Echocardiography and Advanced Transthoracic Echocardiography: Applications in Emergency Critical Care

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• Technology in Medical Education: Educating the Next Generation • Trash Into Treasure: Low-cost Simulation Strategies and Models • Wilderness Medicine: Learning the Fundamentals and Implementing Innovative and Practical Educational Curriculums Into Residency and Medical School

Female Leaders in Emergency Medicine: Helping You With Your Next Career Move In this workshop, on Tuesday, May 15, from 1–5 p.m., prominent women in Academic Emergency Medicine, in four separate sessions, will cover topics to help anyone successfully take the next steps in their careers.

1. T he Next Step: Finding a Personal and Institutional Fit. This session will delve into the different ways to advance one’s academic career, keeping in mind personal and institutional goals. This will be followed by a panel Q & A discussing strategies to assess advancement opportunities that gain placement and stature within the hospital system.

2. L etters After Your Name: Does Your Career Need the Third Degree? This session opens with a Ted Talkstyle presentation discussing the advantages and disadvantages to additional degrees and how best to pursue and finance them. This will be followed by a small group breakout session with emergency department colleagues who have obtained additional degrees and can offer advice to help participants prioritize their goals.

3. F ight or Flight: Taking Wise Professional Risks & Dead-end Jobs and How to Get Out of Them. In this session, participants will learn to identify “dead-end” positions with limited advancement opportunities. This will be followed by a panel discussion, with Q & A, that will address how to exit without burning bridges and key items to consider before accepting a new position. This will be followed by a crowdsourcing exercise, allowing participants to share their recommendations.

Confirmed Speakers/Panelists • Deborah B. Diercks, MD, MSc, professor and chair of the Department of Emergency Medicine at UT Southwestern Medical Center where she holds the Audre and Bernard Rapoport Distinguished Chair in Clinical Care and Research.

• Susan B. Promes, MD, professor and chair of the Department of Emergency Medicine at Penn State University, Hershey Medical Center and editor, Academic Emergency Medicine Education and Training journal.

• Cherri D. Hobgood, MD, Rolly McGrath professor and chair of the Indiana University School of Medicine Department of Emergency Medicine.

• Elizabeth Datner, MD, chair of the Department of Emergency Medicine at Einstein Healthcare Network, Associate Professor of Emergency Medicine at the Ruth and Ray Perelman School of Medicine at the University of Pennsylvania, and Adjunct Senior Fellow of the Leonard Davis Institute for Health Economics.

• Azita Hamedani MD, MPH, MBA, founding and endowed chair of the BerbeeWalsh Department of Emergency Medicine at University of Wisconsin School of Medicine & Public Health.

Add this workshop to your SAEM18 registration.

medicine has been noticeably quiet, despite emergency physicians’ inherent place on the front lines of disaster medicine. As a specialty, emergency medicine was built as the 24-7-365 access point with providers who can collaborate across all boundaries, provide care for the vulnerable, and act as the disaster response experts. Additionally, those of us whose careers are focused on this critical area believe that the EM specialty will be among the most impacted by the health consequences of climate change. Thus, we believe it is the ethical obligation of academic emergency medicine to become climate change and human health champions within the realms of education, research, and advocacy. To that end, this workshop , on Tuesday, May 15, from 1–5 p.m. has been specifically planned to facilitate education and networking within the EM community around this important topic.

ANNUAL MEETING PREVIEW

4. R isk it for the Biscuit: Squashing the Imposter Syndrome.

The concluding session will be a moderated roundtable discussion focusing on developing strategies to embrace and highlight strengths and learning to express one’s value in the professional setting. This will be followed by an “open mic” exercise where participants will practice expressing their unique strengths.

Designed for: • Clinicians: Learn how climate change impacts your clinical practice in the walls of the emergency department.

• Researchers: Learn how to incorporate the lens of climate change into your existing research infrastructure.

• Educators: Learn the implications climate change will have on education of medical students, residents, fellows, and faculty.

• Administrators: Learn how climate change will impact the delivery of emergency medicine.

• Health Care Providers: Learn more about the biggest global health threat of the 21st century that is having a growing impact on both your patients and your practice.

Add this workshop to your SAEM18 registration.

Trash Into Treasure: Low-cost Simulation Strategies and Models By combining high-yield, targeted didactics with extensive hands-on training, participants in this workshop, on Tuesday, May 15 from 8 a.m–noon, will learn novel cost-saving techniques and principles resulting in their ability to create several low-cost, high-fidelity models to enhance their home institution’s simulation training and their own professional development. This workshop will consist of six unique interactive stations that will run simultaneously over the duration of the workshop. Each station instructor will guide participants on how to use specific techniques to build the exhibited model. In addition, one group lecture will be given periodically by each of the instructors to highlight their specific models and techniques.

Individual participants can choose the length of time learning at each station. This format will allow participants the flexibility to maximize their time and participation with as many instructors as possible to focus on specific skill acquisition.

Six Stations

Climate Change and Health: Implications for Practice, Teaching, Research, and Advocacy in Emergency Medicine The Lancet Commission on Health and Climate Change declared climate change “the biggest global health threat of the 21st Century” with “potentially catastrophic risk to human health.” Yet, while there has been a growing concern regarding climate change within the medical community, emergency

1. Reducing Cost AND Waste in Simulation 2. Resident Lead Creation of a Peri-Mortem C-section Model 3. Fellowship Projects 4. Priapism Simulation 5. Ultrasound Simulation Models 6. Lateral Canthotomy and PTAs

Add this workshop to your SAEM18 registration.

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PREVIEW Dynamic Didactics

First-Rate Forums

May 16–18 at the JW Marriott

All week long at the JW Marriott

More than 90 innovative and interactive didactic sessions are on tap for SAEM18. Spanning three full days, and offered in two formats (20-minute/1-2 speaker Focused Session or a 50-minute, multiple speaker Expanded Session), this year’s didactics cover a range of educational topics in key categories, including: administrative, career development, education, clinical, research. Take a look, then take your pick.

Half- and full-day Forum sessions are designed for specific audiences, including chief residents, junior faculty, medical students, and upcoming leaders.

•D idactics - Wednesday, May 16, 2018 •D idactics - Thursday, May 17, 2018 •D idactics - Friday, May 18, 2018

• SAEM Education Summit • Junior Faculty Development Forum • Medical Student Symposium • Resident Academic Leadership Forum • SAEM Leadership Forum

National Grand Rounds Sessions from Senior Faculty Research After a hugely successful inaugural appearance at SAEM17, National Grand Rounds is back on Wednesday, May 16 from 2:30–5:20 p.m. with some of the top names in the specialty featured in three unique sessions focusing on academic emergency medicine research, research methods, and career advice.

Session 1: Senior Faculty Research Highlights

A select group of well-established, federally-funded senior investigators are on hand to present their most up-to-date, impactful, and innovative research in a series of short, highquality, and topical presentations.

ANNUAL MEETING PREVIEW

Session 2: Senior Faculty Research Q & A Forum

In this moderated question and answer session, brought to you by the SAEM Research Committee, conference attendees will have an opportunity to ask a panel of senior academic EM investigators, about research topics, research methods, and career advice. Attendees will have an opportunity to submit questions in advance, or in real time at the forum.

Session 3: Senior Faculty Research Networking Session

In this informal mentorship and networking session, Senior investigators in academic EM, along with select NIH program officers, will be available to interact informally with attendees regarding research, research methods, and career advice.

Add this didactic to your SAEM18 registration.

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SAEM Education Summit The SAEM Education Summit (SAEMES), on Wednesday, May 16, from 1–5 p.m., provides exposure to core leadership topics with an emphasis on experiential learning and practical application. Highlight best practices and cutting-edge innovation in education across emergency medicine, this session will provide insights and inspiration to every level of medical educator who is looking to build and innovate the experience for their learners.

Sign up for SAEMES when you register for SAEM18

ANNUAL MEETING PREVIEW

Exceptional Events Throughout the week From traditional activities like Dodgeball, to upgraded events like the RAMS Party, there's no shortage of "extra-curricular" pursuits at SAEM18.

• AWAEM/ADIEM Luncheon • Chair Fair • Clinical Images Exhibit • Dodgeball • Exhibitor’s Kick-Off Party • Visit the Exhibit Hall • Networking Breakfast in Exhibit Hall • Opening Reception • RAMS Party • Residency & Fellowship Fair

Dodgeball

• Simulation Academy SimWars

Returning on Thursday, May 17, from 5:30–7:30 p.m.: THE most amazing dodgeball court ever, complete with bleachers, hot dogs, and cold suds. New this year: Dodgeball winners receive their very own, private, VIP area at the RAMS party! So get your teams together and come battle it out for the coveted title of 2018 Dodgeball Champs!

• SonoGames® • Speed Mentoring • Wellness Activities • Indiana University Scavenger Hunt • IU-AWAEM Wine Tasting • AACEM Annual Reception and Dinner • Simulation Academy Mentoring-Mixer

Simulation Academy SimWars On Wednesday, May 16, from 11:30 am.–3:30 p.m. only...

Your chance to see THE premier national simulation competition for emergency medicine residents! Watch from the safety of your seat as teams of clinical providers demonstrate their teamwork, communication, and clinical management skills in a simulated clinical environment in front of a live audience. Upon completion of each simulated clinical encounter, judges assess and discuss participants’ clinical actions and team dynamics. Following the critique and debriefing, a vote determines which contestants move on to the next round of competition… Until at least a champion is crowned. It’s a fun, fast-paced educational event for participants and audience alike, and you won’t want to miss it! Be sure to add SimWars 2018 to your program planner.

AWAEM/ADIEM Luncheon The Academy for Women in Academic Emergency Medicine (AWAEM) and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) are together again for the AWAEM/ADIEM Luncheon, on Wednesday, May 16, from noon until 1:30 p.m. This annual gathering over good food and great company is an excellent opportunity to network with old friends and new and explore common issues. This is always a “hot ticket” event that sells out early, so if you’re interested to attend, you’d better register soon!

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PREVIEW SAEM18 for RAMS Four days of events and activities for residents and medical students The SAEM18 Program Committee has planned lots of educational content and networking events of particular interest and importance to up-and-coming emergency medicine academicians, to help guide and advise future EM researchers and educators along their career paths. This year, the program committee has added several new features and improved on a few favorites, to enhance the annual meeting experience and increase the takeaway value for SAEM residents and medical students.

•W ellness Yoga •A WAEM/ADIEM Luncheon

• SonoGames®

•W ellness Meditation

• Clinical Images Exhibit

•W ellness Run •S peed Mentoring •L ion’s Den 2018 •M edical Student Symposium • Resident Academic Leadership Forum •C hair Fair •S AEM Education Summit

ANNUAL MEETING PREVIEW

• Dodgeball

•S imWars

•S AEM Jeopardy

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• Residency & Fellowship Fair

• RAMS Party • SAEM Master Secret Series • SAEM Master Scholars Series • SAEM Professor Rounds • Simulation Academy Mentoring-Mixer • Indiana University Scavenger Hunt

The Annual RAMS Party at Revel Nightclub in Indy!

We’ve RAMped up the revelry for SAEM’s annual party for residents and medical students! RAMS Party 2018 is at Revel Nightclub and Lounge, Indy’s newest posh hot spot, featuring two tiers, a huge dance floor, and giant video screens.

Revelers can expect a high energy over-the-top Vegas nightclub experience with extended hours (until 2 AM!), an open bar, live DJ, and catering from Kilroy’s Bar ‘n’ Grill. There will be a special guest appearance from the SAEM RAMS mascot, and party goers will receive the red-carpet treatment, including fun photo ops to help you capture the memory of what promises to be an amazingly good time! So mark your calendar for Thursday, May 17 starting at 9 p.m. for what's shaping up to be the party of the year! This event is FREE for residents and medical students who are registered for SAEM18.

RAMS Members…

Look for This Icon When you see this icon next to an abstract, didactic, or workshop in the SAEM18 program planner or in the on-site printed program, you will know that an educational offering, event, or activity is something you’ll find value in attending!

ANNUAL MEETING PREVIEW

New to SAEM18 Don’t miss these exciting new senior-level series, making their appearance for the first time ever at SAEM18:

SAEM Master Secret Series Recognized leaders in academic emergency medicine will highlight important lessons learned throughout their careers; share techniques for career longevity and success; and discuss differences in life and career successes among different leaders and their styles.

This interactive session will conclude with a Q&A period.

SAEM Master Scholars Series Three Master Scholars will moderate never-beforepresented oral abstracts of the highest quality, in three distinct topic areas pertinent to emergency care. These Master Scholar Sessions will be followed by a state-of-theart “Master Scholar Update” on current and future research opportunities in the topic areas.

SAEM Professor Rounds Specially selected e-poster presenters will provide synopses of their study findings while senior-level academicians, i.e., “The Professors,” provide commentary and lead a lively post-presentation open discussion. This session will kick off the e-posters session and will include refreshments. (Date TBD)

Focus on Wellness In keeping with the SAEM Statement on Wellness, SAEM invites you to take a break from the “business” and “busyness” of the annual meeting and take part in one, two, or all three of the wellness-related activities we have planned to help you master mindfulness and achieve relaxation:

Wellness Yoga Wednesday, May 16, 7– 8 a.m., JW Marriott Indianapolis, Grand Ballroom 7 Bring energy, clarity and relaxation to your day with complimentary Wellness Yoga, sponsored by the AWAEM Wellness Committee. Join us in a relaxing 60-minute workout with a certified yoga instructor to guide you. This free event is first-come, first-served. Bring your own mat or one will be provided.

Wellness Meditation

SAEM18: Three Ways to Save 1. Reserve your sleeping room by April 19, 5 p.m. ET and receive our special SAEM18 rate.

2. Register by March 19 to receive Early Bird pricing and save the additional cost of on-site fees.

3. Renew your SAEM membership to avoid paying the non-member registration fee for SAEM18.

Wednesday, May 16, 2:30 –3 p.m., JW Marriott Indianapolis, Exhibit Hall

Peace out at our first guided Wellness Meditation session, designed to help you reduce stress, calm and center yourself, and find focus before taking on the rest of the annual meeting.

Wellness Run Thursday, May 17, 7–8:15 a.m., White River State Park, Indianapolis

The inaugural Wellness Run, sponsored by the Sports Medicine Interest Group, will take place at the beautiful White River State Park in downtown Indianapolis, within walking distance to the JW Marriott host hotel. The cost to register is only $20 for an abundance of exercise, fresh air, and fun!

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PREVIEW

SAEM18 Host Hotel: World-class Luxury in the Heart of Indy Winner of four distinct Condé Nast Traveler awards, including Best Hotel in Indiana, the luxurious JW Marriott Indianapolis is the Official Host Hotel of SAEM18. Reserve your sleeping room at our special SAEM18 rates. Additional hotel rooms with special conference rates are available at the Courtyard

by Marriott Downtown Indianapolis,the Fairfield Inn & Suites Indianapolis Downtown and Springhill Suites Indianapolis Downtown. Part of Marriott IndyPlace, this collection of interconnected Marriott brand hotels is just a short, covered walk from the JW Marriott Host Hotel.

ANNUAL MEETING PREVIEW

The JW Marriott Host Hotel is centrally located in the heart of world-class shopping and dining and just steps from Indy’s most famous attractions. Guest rooms feature Marriott’s signature REVIVE® bedding, 40” LCD high-definition TVs, marble vanities and breathtaking views of an art-filled plaza.

Within the JW Marriott itself, you can enjoy two full-service restaurants:

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• Osteria Pronto, situated off the beautiful and modern lobby of the JW Marriott and serving authentic, locally sourced contemporary Northern Italian cuisine in a comfortable setting that evokes a Tuscan feel.

• High Velocity, a TripAdvisor Certificate of Excellence award winner, this sports bar extraordinaire serves delicious food, and thirst-quenching drinks and features a state-of-the-art audio system and hundreds of premium channels on plasma and flat-screen HDTVs. With everything the JW Marriott offers, you won’t need to leave the premises to enjoy a good meal or have a great time. But should you decide to venture out, Indianapolis has a flourishing culinary and brewing scene, thriving cultural institutions, cool shops and streets, just waiting to be explored. Read on for recommendations from three SAEM members who call Indianapolis “home.”

Mass Avenue: Where It’s at in Indy Massachusetts Avenue, known affectionately as Mass Ave, is a five-block area just northeast of Monument Circle and one of six designated cultural districts in Indianapolis. Here’s where you’ll find many of the dining and drinking establishments recommended by our panel of locals. This trendy, free-spirited cultural district is filled with independently owned restaurants, night spots, eclectic shops, galleries and theaters. Want to have a great time in Indianapolis? Talk a stroll down Mass Avenue.

There are more than 500 reasons that make Indianapolis one of the best kept cool spots in the nation, and the folks who live there take pride in every one of them. Discover the best Indianapolis has to offer by following the advice of SAEM members who live and work in Indy and know their city inside out. Coming in May-June Pulse: Indy's memorable monuments, best places to take a pic, where to take the kids, and maybe a bonus "best of" or two!

Our Panel of Naptowners (i.e. someone from IndiaNAPolis)

Jeffrey A. Kline, MD

Editor in Chief, Academic Emergency Medicine Professor of Emergency Medicine and Cellular & Integrative Physiology Vice Chair and Division Chief, Research Indiana University Department of Emergency Medicine

Stephen John Cico, MD, MEd

Assistant Dean for Graduate Medical Associate Professor of Clinical Emergency Medicine & Pediatrics Fellowship Director for Pediatric Emergency Medicine Indiana University School of Medicine & Riley Hospital for Children

Jennifer M. Lommel, DO

Emergency Medicine Resident Indiana University School of Medicine

Best Breakfast/Brunch Jeff and Jennifer agree:

• MilkTooth, 534 Virginia Ave – Hip, modern diner serving espresso, cocktails & inventive breakfast & brunch items.

Steve’s pick:

• Café Patachou, 225 W Washington – Billed as a “student union for adults,” serves eclectic daytime plates and fair-trade coffees in bright, hip digs.

Jennifer’s bonus pick:

• Garden Table, 342 Massachusetts Ave #100 – Chic farm-totable specialist serving inventive New American fare plus fresh pressed juices.

Best Cup of Coffee Jeff’s pick: • Mo’Joe Coffeehouse, 222 W Michigan St. – Low-key coffee shop draws a student crowd for light lunches and snacks with diverse seating spaces.

ANNUAL MEETING PREVIEW

Enjoy Indy Like a Local!

Steve’s pick: • Hubbard & Cravens Coffee and Tea, 11 S. Meridian Street Suite 102 – Single origin coffees, hand-crafted blends, quality teas in a cool, hip atmosphere

Jennifer’s picks: • Quills, 335 W 9th St. – Sleek cafe in the lobby of a luxury apartment building offering high-level coffee drinks.

• Foundry Provisions, 236 E 16th Street – The red-orange former metal workshop in the historic Herron-Morton Place neighborhood serves coffee, breakfast, and lunch.

• Calvin Fletchers Coffee Company, 647 Virginia Ave. – Nonprofit café and coffee roaster along Indianapolis Cultural Trail, serves organic drinks and locally baked pastries and donates profits to other nonprofit groups.

Restaurant Worth Ubering to Steve’s pick: • Meridian Restaurant and Bar, 5694 N Meridian St. – In the Meridian historic district. Upscale New American comfort food served in a refined, rustic-chic 1880s log structure with a patio and fireplace.

Jennifer’s pick: • Tinker Street Restaurant and Wine Bar, 402 E 16th St – Inventive New American plates, full-flavored seasonal foods, an international wine list in a cozy urban cottage with a patio.

MilkTooth

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PREVIEW Best Burger Joint Jeff and Steve agree:

• Punch Burger, 137 E Ohio St. – Hip spot serving up burgers made from locally raised beef, plus waffle fries, beer, and wine.

Steve and Jennifer agree:

• Bru Burger Bar, 410 Massachusetts Ave. – Gourmet burgers, creative bar snacks & craft beers in a modern yet cozy space with a patio.

Best Place to Imbibe Jeff’s picks

• Nicky Blaines, 20 N Meridian St. – Nightclub offering cocktails, small plates & cigars to a jazzy beat against a vintage backdrop. (“A must!” —Jeff Kline) • 1933 Lounge at St. Elmo Steakhouse, 127 South Illinois Street Classic cocktails in an elegant, speakeasy-style, relaxed space.

Steve’s picks

The Eagle

Best Casual Restaurant

• Peace Water Winery, 747 N. College Ave. – Local roots, California wines, cool patio along the Cultural Trail, 50 percent of profits donated to charity. Cool!

Jeff and Steve agree:

Jennifer’s picks

Jennifer’s picks:

• Louie’s Wine Dive, 345 Massachusetts Ave. – Fresh, seasonal twists on traditional comfort foods paired with expertly selected wines from around the world.

• Louie’s Wine Dive, 345 Massachusetts Ave. – Fresh, seasonal twists on traditional comfort foods paired with expertly selected wines from around the world.

• The Eagle, 310 Massachusetts Ave. – Rustic-chic eatery and beer hall dishing up Southern classics in sprawling digs with a patio.

ANNUAL MEETING PREVIEW

• Bakersfield, 334 Massachusetts Ave. – Cool, industrial hangout featuring authentic Mexican street fare, plus tequilas, whiskeys and beers.

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• The Rathskeller, 401 E. Michigan – Indoor/outdoor beer hall offers Bavarian surroundings with German food & brew, plus live music.

• Ralston’s Drafthouse, 635 Massachusetts Ave. – Buzzy tavern offering updated American pub grub and wines on tap, plus darts and shuffleboard.

• The Tap, 306 N Delaware St. – Great pub food and 450+ craft beers including house beers from The Tap’s Indiana brewery.

After-hours Hotspot: Jeff’s pick:

Cherri Hobgood’s house

Steve’s picks:

• Tini, 717 Mass Ave. – Tiny, trendy martini bar, craft cocktails, small plates, and throwback music videos all night long.

• The Ball & Biscuit, 331 Mass Ave. – Arty cocktails & small plates served amid pendant bulbs, a copper bar and a speakeasy vibe.

“If you prefer your burger in the shape of a meatball, then you must try Mimi Blue Meatballs at 870 Mass Ave.” —Steve Cico

Jennifer’s picks:

• Tin Roof, 36 S Pennsylvania St. – Unpretentious shotgun shack bar & music venue with creative takes on American pub food.

• The Rathskeller, 401 E. Michigan – Indoor/outdoor beer hall offers Bavarian surroundings with German food & brew, plus live music.

ANNUAL MEETING PREVIEW

Tinker Street Restaurant

Louie's Wine Dive Hotel Tango

The Rathskeller 23

DIVERSITY AND INCLUSION Humanitarian Crises, Asylum Evaluations and the Emergency Medicine Physician

By Utsha G. Khatri What is asylum?

"The physician’s role is not to diagnose or to rule out life-threatening diagnoses and initiate treatment, but rather to listen to the client’s story

SAEM PULSE | MARCH-APRIL 2018

and assess whether

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his or her exam findings corroborate the story that is told."

The number of people globally displaced as a result of war, civil conflict, or other mass humanitarian crises has recently reached record numbers.1 Of the 59.5 million people who were forcibly displaced in 2014, more than 1.66 million applied for asylum and approximately 120,000 did so in the United States.2 In accordance with U.S. law, foreign nationals who have been persecuted in their country of origin, or who fear future persecution, have the right to apply for protection in the form of asylum.

Being granted asylum allows displaced individuals to legally reside and work in the country and provides them with limited financial and medical assistance.

What Is The Process For Applying For Asylum?

Applicants who apply for asylum must prove that they have a “credible fear” of persecution or torture if they were to return to their home country. Applicants must demonstrate persecution on the basis of race, religion, nationality, political opinion, and/or membership in a particular social group. To receive asylum, the applicant must apply within one year of arrival, which is called an “affirmative application,” or, after being ordered for deportation, called a “defensive application.” In either case, applicants must produce the evidence to prove persecution. While applicants have a right to a lawyer, the U.S. government is not obligated to provide one if the applicant is unable to afford one or find one pro bono. If applicants are fortunate enough to obtain legal representation, a vital component of the asylum application is the medical evaluation.

Medical Evaluation

The medical evaluation for asylum seekers consists of a physical and/or psychiatric exam to document manifestations of trauma and torture. While the medical evaluation is not a mandatory component of the asylum application, it can be incredibly valuable if performed

appropriately. In a retrospective analysis, investigators found that the asylum grant rate among U.S. asylum seekers who received medical evaluations was 89 percent compared to the national average of 37.5 percent.3 The study concluded that medical evaluations may be critical in the adjudications of asylum cases when maltreatment is alleged.

The burden of proving persecution can be quite difficult, as many applicants have fled their homes in a rushed and chaotic manner. Being able to locate and retrieve evidence once abroad and detached from relatives and neighbors is equally challenging. Thus, the claim for asylum often depends heavily upon the physical or psychological manifestations of trauma that applicants carry with them; the body becomes “the place that displays the evidence of truth.”4

A Call To Action

As the number of people being displaced due to violence and life-threatening conditions continues to rise, the U.S. has received an increasing number of asylum claims. In 2015, over 26,000 persons were granted asylum in the U.S.5 However, with a lack of resources allotted to respond to the global refugee crisis, there has been an enormous backlog at the United States Citizenship and Immigration Services (USCIS) Asylum Division and within the immigration courts. In fact, the average wait time for an initial asylum

interview is more than two years and it is predicted that there are more than 600,000 asylum and removal cases pending in immigration courts.6 More physicians trained to perform asylum evaluations are needed to meet this demand. As emergency medicine physicians, we are uniquely trained to examine and evaluate for both physical and psychiatric evidence of trauma. We examine and treat patients who present with injuries from both accidental and non-accidental trauma on daily basis.

Our emergency departments often serve as the only access of care for individuals with psychiatric illness and, accordingly, we are skilled at recognizing signs and symptoms of depression, anxiety, and psychosis.

While the individual physician may have little control over the administration’s anti-refugee and anti-immigration policies, backlog of asylum evaluations, the increased denial of requests by Trump-era ICE officials, or the increased detainment of applicants awaiting hearings, his or her role in supporting an evaluation of those applicants lucky enough to have their cases heard in court is immense. A forensic medical and psychiatric examination by a trained clinician can offer corroborative support for an asylum seeker’s claim through written documentation of the physical and psychological sequelae of torture or other forms of persecution.

Not Your Typical Patient Encounter

The asylum evaluation is quite a different kind of encounter than what we are typically used to in the emergency department. First, the relationship established in the encounter is not one of patient and physician but rather of expert evaluator and client. The physician’s role is not to diagnose or to rule out life-threatening diagnoses and initiate treatment, but rather to listen to the client’s story and assess whether his or her exam findings corroborate the story that is told.

Additionally, unlike during a busy shift when we are often juggling the care of a dozen or so patients at a time, the asylum evaluation allows for the unique experience of an hour or two of empathetically hearing a person’s story while methodically and thoughtfully gathering necessary pieces of data.

Similar to emergency department encounters, proper documentation will

be of vital importance. However, quite different from electronic medical record (EMR) documentation of review of systems and medical decision-making, in the asylum evaluation, the emergency medicine physician will explore a wholly different type of documentation. The evaluations generally cover standard domains of relevant medical, surgical and social history, details of the torture, physical and/or psychiatric exam findings, interpretations of such findings, and a statement of opinion on the consistency of evidence and allegations of torture.

Physicians can also supplement findings with photographs and/or drawings of physical evidence. These documents are then notarized and submitted to the court as a medical-legal report. On occasion, the physician may also testify as an expert witness.

How To Get Involved

In order to perform credible forensic evaluations for asylum, physicians must be properly trained. Physicians for Human Rights is the largest organization that leads and promotes training sessions for interested physicians. Many institutions have created student-run clinics, where interested medical students work with lawyers to match clients with trained physicians in their networks. The asylum evaluation serves as a unique opportunity for the emergency physician to exercise his or her medical expertise while also learning to appreciate the effects of

trauma, persecution, and torture on the most vulnerable among us. As emergency physicians, we constantly yearn for an opportunity to use our training and skills to save a life. The role of an asylum evaluator creates this opportunity to save a life in a different, but equally important, way.

REFERENCES

1. U NHCR. World at war: UNHCR Global Trends Forced Displacement in 2014. UNHCR: UN Refugee Agency; Available from: http://www.unhcr.org/556725e69.html. Accessed November 25, 2017.

2. D epartment of Homeland Security. Annual Report 2014: Citizenship and Immigration Services. Citizenship and Immigration Services Ombudsman U.S. Department of Homeland Security; Available from: https://www.dhs.gov/sites/ default/files/publications/cisomb-annual-report-2014.pdf.

Accessed November 26, 2017.

3. L ustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health. 2008;10(1):7-15 4. F assin D, D’Halluin E. The Truth from the Body: Medical Certificates as Ultimate Evidence for Asylum Seekers. Am Anthropol. 2005;107(4):597–608 5. D HS, Office of Immigration Statistics. (2016). 2015 Yearbook of Immigration Statistics. Washington, DC: DHS, Office of Immigration Statistics.

6. H uman Rights First. (2016). In the Balance: Backlogs Delay Protection in the U.S. Asylum and Immigration Court Systems.

Available from: http://www.humanrightsfirst.org/sites/default/ files/HRF-In-The-Balance.pdf. Accessed November 27, 2017

ABOUT THE AUTHOR: Dr. Utsha Khatri (@UtshaKhatriMD) is a third-year emergency medicine resident physician at the Hospital of the University of Pennsylvania. She is interested in vulnerable populations and she volunteers for the Philadelphia Human Rights Clinic.

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ETHICS IN ACTION Refusal and Capacity: Beyond the Basics

By Jeremy R. Simon, MD, PhD

"Before we consider a patient’s capacity in a case of refusal of care, we should first ask whether there is some way in which we failed in our interaction with

SAEM PULSE | MARCH-APRIL 2018

our patient."

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In the September/October 2017 issue of SAEM Pulse, in an article about the basic principles behind capacity and refusal of care by patients, we discussed that we generally listen to patients’ wishes because we respect their autonomy, but that this respect has to be balanced against our responsibility to help patients. In particular, when patients lack capacity to make their own decisions, they have essentially lost their ability to act autonomously, and so someone else must make decisions for them in their best interests. Usually this “someone else” will be a legally identified surrogate, although sometimes, in exigent circumstances, it may be the treating physician.

The first thing to know, after understanding the basics, is that before we consider a patient’s capacity in a case of refusal of care, we should first ask whether there is some way in which we failed in our interaction with our patient. Although there are certainly cases where a patient will disagree with us about what is best for him or her, frequently, the problem is one of communication, or more generally, rapport.

We are asking a lot when we expect our patients to trust someone whom they have never met (us) with important decisions about their health. If we want our patients to take our advice, we must do all we can to develop their trust. Ideally, this occurs from the beginning of our interaction with them, but even after discovering the problem, and even when they refuse care or admission, it is not too late.

Perhaps the most important tool in gaining trust is clear communication.

Beyond speaking the patient’s language, this means using language the patient understands. Too often, when explaining to patients what is wrong and what the treatment should be, doctors use medical jargon unfamiliar to the patient. We can hardly expect patients to trust and listen to us when they cannot even understand what we are saying.

There are of course, other ways of gaining a patient’s trust: Draw on the

"Perhaps the most important tool in gaining trust is clear communication. Beyond speaking the patient’s language, this means using language the patient understands." patient’s trust for others (e.g., a family member or a primary physician) by inviting these individuals into the conversation.

Attend to patient comfort by offering a blanket or a sandwich. Show patients you care and are interested in what they have to say by engaging with them, or at least giving them your full attention. Perhaps a patient’s concerns are due to something external, such as a prior commitment; if so, assist him or her in resolving the matter.

Attending to these matters are valuable regardless of whether the patient has capacity. While it is true that we don’t need agreement from a patient who lacks capacity, it certainly makes things easier when the patient assents to the care being given. Even patients who lack capacity deserve to have their dignity respected, and working with them to gain assent is one way to show respect.

While it is true that a patient with capacity who refuses care is free to leave, this is hardly the ideal outcome if our concern is for the patient’s well-being. You should always strive to find a compromise somewhere between your Plan A and the patient’s walking out. Perhaps there is an alternative plan (antibiotics instead of surgery, for instance) which, while not your first-line standard of care, is considered

potentially effective and to which the patient would likely agree. Or perhaps the patient will agree to being admitted for monitoring without immediate intervention. This too is preferable to having the patient leave the emergency department, and may allow us to realize that the patient is not as sick as he or she initially appeared, or allow the patient to reconsider the value of the treatment we are recommending.

When dealing with a patient who apparently lacks capacity, a psychiatry consult can be helpful, but it is not usually necessary. Any physician who is comfortable with the components of capacity can determine whether a patient possesses capacity. Nor is it necessary to determine whether the patient suffers from mental illness. Mental illness, including psychosis, can certainly interfere with a patient’s capacity, but it need not. A psychotic patient can still have capacity, as long as the psychosis is not interfering with the decision at hand.

How, then, does one assess capacity?

As mentioned in the previous article, the three primary components of capacity are 1) an ability to understand the relevant information; 2) the ability to reason with that information to reach a practical goal; and 3) the ability to express that decision.

Assessing capacity means assessing each of these components. To assess

understanding, we must first give patients the relevant information in a way we can expect them to understand it. Then, we simply ask them to paraphrase what was told to them. This can be framed as a request to make sure you were clear rather than a test of the patient.

If they cannot repeat the information, then they have already demonstrated a lack of capacity. Then you must find out the patient’s decision and ask him or her to explain the decision, which usually having them explain why they are refusing, as we rarely assess the capacity of patients who agree with us. If their reasons show that they are actually weighing relevant pros and cons, they are demonstrating capacity. If they seem not to be processing things clearly, as when giving a strange or inappropriate answer (e.g., “I don’t want you to remove my organs” when considering a syncope work-up or “I promised my brother I would call him tomorrow.”), then they are not demonstrating capacity. One pitfall to avoid, however, is assuming that giving no reason at all necessarily demonstrates lack of capacity. Sometimes the patient is just being ornery. Orneriness may not be pleasant for the provider, but it does not necessarily indicate lack of capacity.

As the above procedure makes clear, capacity is context dependent. The patient has to understand and process

specific information relevant to the procedure in question. It is possible that a patient can do this for a simple decision but not for one involving more complicated factors. Furthermore, the degree of understanding that is required varies by the decision at hand. Less clarity of thought is required to consent to a simple incision and drainage than to consent to a risky procedure with questionable benefits. Capacity is also time dependent. A patient’s capacity to make a decision may vary based on the progress of the disease as well as the stage of treatment. While loss of capacity may be permanent, it can also be transient, as in the case of febrile delirium or a patient receiving narcotic analgesia.

To conclude, allow me to reiterate and reframe the most important point: Compassion, patience, and clarity will resolve the majority of cases of refusal of care in the emergency department.

ABOUT THE AUTHOR: Jeremy Simon, MD, PhD is an assistant clinical professor of clinical medicine at Columbia University and a Scholarin-Residence at the Center for Bioethics, also at Columbia. He serves as the chair of the SAEM Ethics Committee, the Associate Editor of Theoretical Medicine and Bioethics, and as a member of the International Philosophy of Medicine Roundtable.

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GRADUATE MEDICAL EDUCATION

Harsh Sule, MD, MPP

David K. Barnes, MD, FACEP

Andrew King, MD, FACEP

The Accreditation Council for Graduate Medical Education Self-Study: Guidelines and Best Practices

By Harsh Sule, MD, MPP, David Barnes, MD, and Andrew King, MD, FACEP

SAEM PULSE | MARCH-APRIL 2018

Over the past five years, the Accreditation Council for Graduate Medical Education (ACGME) has implemented the Next Accreditation System (NAS). In addition to changes that included moving away from high-stakes and frequent site visits, as well as from making program requirements too prescriptive, NAS has encouraged innovation, improvement, and public accountability, without increasing the burden on individual programs.1 A critical part of this new process is the self-assessment referred to as the “Self-Study.” The 10year site visit officially follows completion of the Self-Study in approximately 12-18 months.

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While some emergency medicine programs have completed their Self-Study over the past year and half, this is still a new process. We hope that this article will offer a quick summary with some best practices and guidelines to assist programs in their upcoming Self-Study. In addition to the Self-Study documents themselves, the ACGME offers several useful resources to help prepare for the Self-Study.2,3,4 Key points to keep in mind while going through the Self-Study process are that step one is an introspective self-assessment that is coupled with step two, which is a shorter-term and realistic self-improvement plan. This document also serves as a guide for the 10-year site visit.

The Eight Step Process

The ACGME recommends an organized eight-step process for the Self-Study:5

1. Assemble the Self-Study Committee 2. Engage program leaders and constituents in a discussion of program aims 3. Aggregate and analyze data from successive Annual Program Evaluations and the Self-Study to create a longitudinal assessment of program strengths and areas of improvement 4. Examine the program’s environment for opportunities and threats 5. Obtain stakeholder input on strengths, areas of improvement, opportunities and threats to prioritize actions 6. Interpret the data and aggregate the Self-Study findings 7. Discuss and validate the findings with stakeholders 8. Develop a succinct Self-Study document for use in further program improvement as documentation for the program’s 10-year site visit

Operationalize and Execute

To operationalize these steps and execute a successful Self-Study, think about the process as follows: People. While the Self-Study Committee (SSC) may replicate the membership of the Program Evaluation Committee (PEC), programs should be cognizant to not simply re-create a group that would result in an echo chamber. Given that the goal of the Self-Study is improvement and innovation, and not just evaluation, the SSC is an opportunity to look beyond the PEC. Size and personality of the SSC is also critical. Too large a group can slow things down and be cumbersome – management literature leans to a number around seven, with more than 10 becoming challenging.6,7 Too many individuals in positions of leadership or with seniority can also negatively impact the performance of the committee since this may generate a hierarchy in opinions that can result in junior members being self-conscious about expressing their opinions. Therefore, consider a SSC of six to 10 individuals including the program leadership, a mix of both junior/senior and academic/clinical faculty, and residents. Ancillary staff such as nurses may be a useful adjunct, but their inclusion is dependent on the style of the program and institution.

Timeline. Given varying emergency medicine schedules, serious thought should be given to the timeline for the Self-Study process. What might take other specialties a few weeks to accomplish in weekly meetings, may take a lot longer in emergency medicine, simply from a scheduling standpoint. It is worth considering alternatives to inperson meetings, whether they include conference calls, Google Hangout® or the use of other online collaboration tools such as Slack®. Other alternatives include a shared Self-Study document or spreadsheet (using Google Docs®, Dropbox® or Microsoft OneDrive®) that all members of the SSC can edit and provide recommendations. Substantial portions of the self-assessment phase can thus be accomplished asynchronously, including via the use of brief and iterative surveys.

Process (Self-Assessment). Rather than strictly anecdotal, the first phase of this process should be as data-driven as possible. Data sources to be considered include milestones data, faculty and resident annual surveys, past Annual Program Evaluations (APEs), and alumni/

employer surveys. Program leadership should take the lead on presenting this data in an organized and straight-forward format since members of the SSC may not be as well-versed in ACGME terminology.

The building blocks for the next phase of Self-Assessment are identifying the aims, opportunities and threats for the program. Aims need to be nuanced and specific to the program environment. Developing an aim to train excellent emergency physicians does not really further the process as this is an aim that is hopefully shared by all emergency medicine residency programs. Think beyond to the specific focus and strengths of the program, such as research, sub-specialty areas, business, community engagement, etc. Opportunities and threats can be “macro,” such as health system mergers, changing patient demographics, or growing “competition” from similar programs, as well as “micro,” such as a new faculty hire with an innovative area of interest, or local GME funding challenges.

Remember that these are challenges specific to your program and not just the specialty of emergency medicine.

While some groups may find it easy to identify these especially newer programs that recently applied for accreditation, we suspect older programs may have to do some soul-searching to go beyond what they’ve done successfully in the past and take an insightful look at themselves.

A practical option, in addition to online collaboration tools, is to use a Delphi process to generate a short-list for this section. This not only takes a systematic approach to the process, but also adds a level of anonymity such that junior members feel empowered to express their opinions freely. Further, such an organized process helps validate findings in the minds of leaders and key stakeholders.

Process (Self-Improvement). Based on the outcomes of the Self-Assessment, the SSC must generate a plan to move the program forward and “take this to the next level.”5 This stage is challenging since several programs might wonder “why fix something if it isn’t broken?”

Innovation and improvement are what the ACGME is seeking from programs rather than simply doing what was done successfully for the past several years. The diversity of opinions and backgrounds of the SSC members is key to this process. Once again, the goal is to think outside the box—not just

about what needs to be done to keep the program afloat (which is important), but creatively about how we educate and train future generations of emergency physicians. Incorporating new clinical models and current educational theory are good strategies to generate an innovative plan. Part of the Self-Study document also needs to be a vision for the future (five years). This vision should effectively tie into the strengths of the program and plans for the future.

The ACGME’s NAS with the Self-Study process are an opportunity for programs to take a different and introspective look at themselves with the goal of moving their programs and, collectively, the specialty of emergency medicine forward.

Using the right mix of people, technology, introspection, and planning can effectively generate Self-Study output that is useful and actionable.

REFERENCES

1. P otts JR. Implementing the Next Accreditation System. ACGME Webinar. Nov 2013. Accessed at: https://www.acgme.org/ Portals/0/PFAssets/Nov4NASImpPhaseII.pdf 2. Self-Study: Eight steps for conducting the ACGME program self-study. Accessed at: https://www.acgme.org/What-We-Do/ Accreditation/Self-Study 3. Philibert I, Lieh-Lai M. A Practical Guide to the ACGME Self-Study. J Graduate Medical Educ. 2014;6(3):612–614. doi:10.4300/JGME-06-03-55.

4. G uralnick S, Hernandez T, Corapi M, et al. The ACGME SelfStudy—An Opportunity, Not a Burden. J Graduate Medical Educ. 2015;7(3):502–505. doi:10.4300/JGME-D-15-00241.1.

5. What We Do. Accessed at: http://www.acgme.org/What-WeDo/Overview.

6. J ay A. How to run a meeting. Harvard Business Review. March 1976. Accessed at: https://hbr.org/1976/03/how-to-run-ameeting.

7. B lenko MW, Rogers P & Mankins MC. Decide and Deliver: Five steps to breakthrough performance in your organization.

Harvard Business Press (2010).

ABOUT THE AUTHORS: Harsh Sule, MD, MPP, is an assistant professor of emergency medicine and residency program director at Rutgers New Jersey Medical School. David Barnes, MD, is an associate Professor of emergency medicine and residency program director at the University of California – Davis. Andrew King, MD, FACEP, is assistant professor of emergency medicine and assistant residency program director, and medical education fellowship director at The Ohio State University Wexner Medical Center.

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SOCIAL MEDIA IN ACADEMIC EM #FOAMed and International Emergency Medicine

By Eric Lee, MD

"Social media has long connected emergency physicians in countries with wellestablished emergency medicine programs

SAEM PULSE | MARCH-APRIL 2018

and systems."

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This month, I’m writing the column from Vientiane, Laos where I’m spending the month working with the first emergency medicine residency in the country. In its inaugural year, the three-year residency is training the very first generation of emergency physicians ever in Laos.

Teaching the residents and witnessing the challenges that they face in the hospitals, I am constantly reminded of what the early days of emergency medicine were like back home in the United States. I have had a longstanding interest in the development of emergency medicine training and systems in places where it does not yet exist, and this month in Laos has also led me to reflect on the supportive role that #FOAMed can and has played in this important space.

Connecting Emergency Physicians Around the World

Social media has long connected emergency physicians in countries with well-established emergency medicine programs and systems. We have been able to discuss the full spectrum of emergency medicine topics — from new-onset atrial fibrillation to resuscitative thoracotomies— with colleagues in the United States, the United Kingdom, Australia, South Africa, and countless other (albeit mostly Englishspeaking) locales around the world. We have learned how similar and how different our practices can be. We have shared triumphs and failures with one another.

We have built a wonderful and supportive learning community on line.

Not to be overlooked, however, emergency providers from countries in which emergency medicine training and programs are much less established are also a part of the conversation. They not only learn about emergency medicine from #FOAMed, but also draw inspiration from it as they work to build emergency medicine in their own countries.

#FOAMed: The Places You’ll Go

#FOAMed resources show up regularly in the education of the Laos residents. In their trauma module, the airway management

"The field of international emergency medicine is burgeoning on line and off line. Digital resources will continue to play an increasingly important role in global health and medical education internationally."

lectures featured content from @EMBasic as well as from the Life in the Fast Lane (LITFL) blog. They watched video clips from SMACC (Social Media and Critical Care) that illustrated how to run a trauma code.

Resources from #FOAMsim and #FOAMus have been a regular part of their didactic conferences during my month here. We even built homemade ultrasound models with instructions from #FOAMed sources to help the residents practice ultrasoundguided peripheral IV placement. The videos and other media are especially valuable because English language often poses an additional hurdle in their medical education.

I’m also working with the Laos residents to develop an airway checklist for Laos.

To introduce them to the concept, I showed them intubation checklists from my teachers @SinaiEM, including @emupdates and @emcrit. I showed them pictures from my own Twitter account of what my hospital and airway set up looks like from my own Twitter account. Together, we assessed what airway resources were available to them in Laos and what we could improve.

These #FOAMed resources are arguably even more important in these types of settings because other resources may be more limited. Donated copies of various textbooks, including Tintinalli’s Emergency Medicine and an online subscription to UpToDate, are what’s readily available as primary resources to the Laos residents at the present time.

The impact of #FOAMed resources for these learners is substantial.

The Future of #FOAMed and International Emergency Medicine The field of international emergency medicine is burgeoning on line and off line. Digital resources will continue to

play an increasingly important role in global health and medical education internationally.

International emergency medicine has a strong and growing presence on line.

If you’re just as interested in international emergency medicine as I am, then you should check out @globalfoamed, a Twitter account that is dispersing global health knowledge one tweet at a time.

You can follow organizations like @IFEM2, @ACEP_IEM, @GEMLR, and leaders in the field like @tmulligan. I also enjoy following active FOAMers with global health proclivities like @apousson and @umanamd. The list truly goes on.

So, on behalf of the Laos residents, and the many other learners from areas where emergency medicine is still in its earliest stages, thank you to the #FOAMed content creators out there. It’s hard to know all the places in the world where learners are benefiting from #FOAMed right now, but we can acknowledge the important role it plays in helping build emergency medicine around the world.

ABOUT THE AUTHOR: Eric Lee, MD (@EricLeeMD) is a senior resident in the Department of Emergency Medicine at Mount Sinai in New York City. He is the current resident lead of the Social Media Division at SinaiEM.

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Imposter Syndrome: The Shame We Wear Beneath the White Coat By: Jessica Johnson MD, Jordan Marks MD, Chad Mayer MD, Victoria Serven

Jessica Johnson MD

Chad Mayer MD

Jordan Marks MD

Victoria Serven

Your medical team is discussing a clinical vignette. As the case unfolds, those around you seem to catch on quickly and eventually someone shouts out a diagnosis that everyone else agrees is the obvious answer—everyone but you. You were thinking of an entirely different diagnosis and were clearly very wrong. Suddenly, thoughts of “I’m not nearly as naturally smart or talented as these people” fill your head. You try to calm yourself with examples of times where you managed to make the correct diagnosis; surely all of those high exam scores, glowing evaluations and positive patient outcomes mean you know something, right? But that was just because you studied so much, other people probably didn’t have to study as much as you did, and what about all those times where you just made a lucky guess? Surely other clinicians don’t have to rely on luck. And speaking of luck, you know yours is going to run out eventually. You don’t belong here and it’s just a matter of time before everyone else realizes it, too.

This is the internal dialogue of someone with Imposter Syndrome (IS)—a phenomenon characterized by an inability to internalize one’s accomplishments and a persistent fear of being exposed as a fraud despite overwhelming evidence to the contrary. Rather than serving as a useful harbinger for poor performance, Imposter Syndrome occurs almost exclusively among high achievers across all disciplines.

In fact, an estimated 70 percent of successful people endorse feelings consistent with this syndrome at some point in their careers.

Notable people who have publicly disclosed their experiences with Imposter Syndrome include award-winning actors and producers, best-selling authors, celebrated poets and Supreme Court justices.

The late Maya Angelou once divulged, “I’ve written 11 books, but each time I think, ‘Uh, oh, they’re going to find out now. I’ve run a game on everybody and they’re going to find me out.”5 Amidst this universal commonality, the cultural tendencies towards perfectionism, competition, and non-disclosure of shortcomings give Imposter Syndrome particularly strong footholds in the medical community, an arena where professionals are continuously evaluated

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and reviewed by other high-achieving people.2 In prior studies, 30 percent of family medicine residents and 44 percent of internal medicine residents surveyed reported imposter feelings and at one nationally recognized emergency medicine residency program, an informal survey revealed that 75 percent of respondents felt that some parts of their achievements were not merited. 2,4 While adjustment periods in medical training, such as internship, the transition from preclinical to clinical training, and the long-awaited start of independent post-residency practice are the obvious places for Imposter Syndrome to rear its head, research shows that the phenomenon doesn’t disappear as we gain confidence and experience in our roles. Imposter Syndrome instead variably affects clinicians throughout all career stages.4 By definition, Imposter Syndrome prevents us from internalizing our accomplishments, so that even as we mature and grow externally, internally we remain plagued by feelings of inadequacy.

SO, WHY DO WE CARE? Imposter Syndrome is a strong predictor of psychological distress, and with the rampancy of physician burnout, early retirement from the field, and suicide in the setting of a baseline national physician shortage, it’s an undeniable matter of both personal and public health concern.3 While presumably there’s utility in maintaining a certain degree of self-doubt and internal questioning in a high-stakes field like medicine,

By definition, Imposter Syndrome prevents us from internalizing our accomplishments, so that even as we mature and grow externally, internally we remain plagued by feelings of inadequacy.

Imposter Syndrome is not a healthy component of self-motivation. Not only is it associated with mental disorders such as anxiety and depression, Imposter Syndrome also threatens to hold us back professionally. As we shy away from any added responsibilities that may increase the risk of being “found out,” the fear of being exposed as a fraud can have an immobilizing effect, thereby negatively impacting career advancement.1

OKAY, NOW WHERE DO WE GO FROM HERE? Renowned researcher, author, and public speaker, Dr. Brené Brown defines shame as the fear of unworthiness, disconnection, and “not belonging.”

This makes Imposter Syndrome really a variation of shame specific to the

professional world. Imposter Syndrome, like all other forms of shame, is a social concept and thus needs a social solution. That solution is dialogue.

Because it’s a phenomenon that thrives on self-doubt disproportionate to one’s competence, inaccurate self assessment and, above all else, a relative inadequacy as compared to one’s peers, the single most effective way to combat Imposter Syndrome is to talk about it. By promoting awareness, what was once a powerful isolative force can instead be utilized as a tool for authentic human connection. Once that happens, Imposter Syndrome loses all its power. If we no longer have to worry about being “found out,” because we’ve already claimed our imposter feelings and realized that so many others—the very ones we compared ourselves against—have claimed them too, then we’re free to fully engage with our careers from a place of courage, connection, and sometimes doubt…but without the paralyzing, career-corrosive fear of unworthiness attached to it.

REFERENCES

1. B orhart, J. (2015, June). News: Imposter Syndrome You Are Not Alone. Emergency Medicine News, 37(6), 24-24. doi:10.1097/01.EEM.0000466612.70499.c1 2. B roderick, K., & Breyer, M. (2016, May). Confronting the Imposter Within. Emergency Physicians Monthly. Retrieved January 24, 2018, from http://epmonthly.com/article/ confronting-imposter-within/ 3. H enning, K., Ey, S., Shaw, D. (1998). Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ., 32, 456- 464.

4. L aDonna, K., PhD, Ginsburg, S., PhD, & Watling, C., PhD. (2017). “Rising to the Level of Your Incompetence”: Exploring What Physicians’ Self-Assessment of Their Performance Reveals About the Impact of the Imposter Syndrome in Medicine. Academic Medicine. Retrieved January 20, 2018, from https://journals.lww.com/ academicmedicine/Abstract/publishahead/_Rising_to_the_ Level_of_Your_Incompetence___.98058.aspx.

5. R ichards, C. (2015, October 26). Learning to Deal With the Impostor Syndrome. New York Times. Retrieved January 24, 2018, from https://www.nytimes.com/2015/10/26/yourmoney/learning-to-deal-with-the-impostor-syndrome.html

ABOUT THE AUTHORS: Jessica Johnson is a Stanford University emergency medicine resident who is passionate about humanism in medicine, physician wellness and the power of narrative writing in healthcare. Jordan Marks: is a PGY1 at Mount Sinai St. Luke’s/Roosevelt. He beats down burnout with cooking, biking, and good music. Victoria Serven is a fourth-year medical student from Louisiana State University New Orleans. Chad Mayer is currently a PGY2 in The Ohio State University emergency medicine program. When he’s not on shift he’s busy with his two kids or biking and exploring Columbus with his fellow residents.

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BRIEFS AND BULLET POINTS SAEM NEWS In Memoriam This spring, at SAEM18, we will pause to remember our SAEM friends and colleagues who have left us during the past year. We are seeking the names of individuals who passed away between January 2017 and May 2018 for an “In Memoriam” video tribute. Please send your “In Memoriam” submissions (name, institution and a photo, if you have one) to sroseen@saem.org.

Thank you.

SAEM is a Proud Sponsor of the NAM Action Collaborative

SAEM is an inaugural sponsor of the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience — a network of more than 130 organizations committed to reversing trends in clinician burnout. The Action Collaborative is composed of four working groups that will meet over the course of two years to identify evidencebased strategies to improve clinician well-being at both the individual and systems levels. Products and activities of these four working groups include an online knowledge hub, a series of NAM Perspectives discussion papers (read the first one in the New England Journal of Medicine), an all-encompassing conceptual model that reflects the domains affecting clinician well-being, and a common set of definitions. In February, the Action Collaborative hosted a webinar to release several resources and provide a first look at an online repository aimed at providing users with resources related to clinician burnout and promising solutions to promote clinician well-being.

SAEM Directories: Update Your Listings

Is your fellowship program listed in the SAEM Fellowship Directory? Is it up to date? Be sure to take a look at our current opportunities, or update your listing via the Fellowship Directory Form.

Likewise, if you have a listing in the SAEM Clerkship Directory, updates may be submitted via the Clerkship Directory Form. Send questions to Directory@ saem.org.

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Apply for SAEM Approval of Your Fellowship Program

In an effort to promote standardization of training for fellows, the SAEM Fellowship Approval Program has been developed for eligible programs to earn SAEM endorsement as an approved fellowship in Administration, Research, Geriatrics, Global EM, and Education Scholarship.

Programs may apply at any time. The approval process may take up to eight weeks, so plan ahead. To view a list of approved fellowships, visit the SAEM Fellowship Directory.

Job Seekers This Widget’s for You

Have you checked out the new career widget on SAEM’s Facebook page?

Go to “Careers” on the left-hand menu to view recently posted jobs in academic emergency medicine.

Do You Have a Blog or Podcast?

We’d love to add your EM blog or podcast to SOAR (SAEM Online Academic Resources) – SAEM’s digital home for open access medical education. If you’re willing to share, simply complete the form on the FOAMed Resources page and we’ll get your information posted on SOAR.

SAEM Membership and Meetings Director Celebrates 10 Years!

SAEM congratulates our Membership and Meetings Director, Holly Byrd-Duncan, for reaching 10 years with the organization.

The overwhelming success of SAEM’s annual meetings is largely due to Holly’s hard work and organizational skills. Her work ethic is infectious at SAEM and we are so fortunate to have her on our team.

Congratulations, Holly!

There’s an App for That!

SAEM members, download the SAEM Community mobile app to keep up with conversations within your SAEM academies, interest groups, committees, etc., even when you’re on the move!

Download the SAEM Community app at iTunes or Google Play.

SAEM’s Digital Home for Open Access MedEd Continues to SOAR

SOAR (SAEM Online Academic Resources) is SAEM’s digital home for open access medical education, with new blogs, podcasts, and other resources recently added! SOAR features all SAEM17 presentations organized by topic, as well as Academy Open Access Education Resources, which houses free open access medical education in many forms, courtesy of participating SAEM academies.

SAEM REGIONAL MEETINGS Meeting

Date

Location

More Info

Mid-Atlantic Regional Meeting

March 9, 2018

Baltimore, MD

Register now

New England Regional Meeting

March 28, 2018

Worcester, MA

Register now

SAEM FOUNDATION Meet the 2018 Grantees Gifts to the SAEM Foundation fund the most promising researchers and educators in academic emergency medicine.

Here are this year’s bright stars:

Peter Pruitt, MD Northwestern University 2018 Research Training Grant - $300,000 Improving Triage Precision in Patients with Subdural Hematoma Read abstract

Anne M. Messman, MD Wayne State University 2018 Education Fellowship Grant - $100,000 Faculty Development of the Novice Medical Educator: Turning LIMEs into LEMONs Read abstract

Nicole M. Dubosh, MD Beth Israel Deaconess Medical Center 2018 Education Research Grant - $20,000 A Multi-Modal Educational Intervention to Improve Resident Physician Communication in the ED Read abstract

Joseph R. Pare, MD, MHS Boston Medical Center 2018 Academy of Emergency Ultrasound Research Grant - $10,000 Superior Venous Access: Midline vs Ultrasound IVs, a Randomized Clinical Trial Read abstract

Kavita Joshi, MD UT Southwestern Medical Center 2018 Simulation Academy Novice Research Grant - $5,000 How to WIN at Resuscitation – A New Model for Intra-Resuscitation Recaps Read abstract

SAEM JOURNALS 2018 AEM Consensus Conference Register to Attend

The 2018 AEM Consensus Conference, “Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps,” will take place on Tuesday, May 15, 2018 at the JW Marriott Indianapolis, IN. Register for SAEM18 now at early bird rates, and add the 2018 AEM Consensus Conference to your schedule.

Call for Papers

Original research papers are being accepted for the 2018 Academic Emergency Medicine (AEM) Consensus Conference, “Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." The 2018 AEM Consensus Conference will be held on May 15, 2018 at the JW Marriott Indianapolis.

Paper on this topic, if accepted, will be published together with the conference proceedings in a special issue of Academic Emergency Medicine.

2017 Proceedings Now Available

The Proceedings of the 2017 AEM Consensus Conference: Catalyzing System Change Through Healthcare Simulation is now available online, or download a full PDF version.

AEM Education and Training Fellow-in-Training Editor Program

The fellow appointment to the Editorial Board of AEM E&T is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts. Candidates must be an SAEM member or become an SAEM member during the 12-month period. In addition, candidates must be a current resident who will start a medical education fellowship in the summer of 2018 or a current fellow in a 1- or 2-year medical education fellowship program.

Applications for the AEM E&T Fellow-in-Training Editor Program will be accepted until March 15.

SAEM ACADEMIES Academy of Administrators in Academic Emergency Medicine (AAAEM) Election Results Announced

Ambrose Hon-Wai Wong, MD, MSHPEd Yale School of Medicine 2018 Academy for Diversity & Inclusion in EM Research Grant - $3,000 ell-Being and Mistreatment of Sexual and W Gender Minority Medical Students Read abstract

The Academy of Administrators in Academic Emergency Medicine has announced that the following individuals have been elected to the AAAEM Executive Committee: • Treasurer: Kain Robbins • Members at Large: Jennifer Muir and Tim Sullivan Executive Committee members will be installed at the annual retreat in March.

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Simulation Academy Call for Submissions: Simulation Fellows Forum

The SAEM Simulation Academy is inviting submissions from simulation fellows to present briefly on their fellowship research projects at the SIM Academy Business Meeting on May 17, 2018 at SAEM18 in Indianapolis, Indiana. Submissions will be accepted for research proposals/projects that are at any stage of the process (e.g., planning, just started, data analysis, etc.).

Submission details may be found online.

Submissions will be accepted until March 14, 2018 at SimFellows@saem.org.

Simulation MentoringMixer

The Simulation Academy is sponsoring a mentoring-mixer event in conjunction with SAEM18 in Indianapolis. The event will take place on Wednesday, May 16 from 4:30-5:30 p.m. (following SimWars) and is designed to promote interaction between faculty from all levels and environments who are pursuing a career in healthcare simulation. Mentoring sections will include: • Administrative simulation careers • Research and publishing in simulation • Simulation in community settings • Navigating academic careers in simulation • Mentoring for fellows and senior residents pursuing simulation All sections will include junior and midcareer mentoring in healthcare simulation.

Light appetizers and drinks will be

provided. If you are interested in joining us for engaging interactions to help advance your career in healthcare simulation please RSVP. (Note: Walk-in attendance will also be welcome, so long as space allows.)

Academy for Diversity & Inclusion in Emergency Medicine ADIEM Leadership Finds No Bias in SVI

Do you have Emergency Medicine Program Applications and the Standardized Video Interview (SVI) on your mind? You’ll be happy to note that the leadership of the Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) met with AAMC leaders during ACEP17 to discuss the SVI, particularly perceived identity versus declared identity as next steps to evaluate bias, as well as the subtler forms of bias, and bias related to school and financial status. The conclusion? ADIEM believes that AAMC has the best intentions to minimize bias; however, should this program continue or expand, we hope for ADIEM to be given an ongoing role in evaluating and detecting any potential for bias.

FOR RAMS Twitter for RAMS!

Residents and medical students… are you on Twitter? Follow @SAEM_RAMS for news and informational content pertaining to YOU!

Rwanda Research Fellowship Open to Aspiring Medical Students

The Global Emergency Medicine Academy (GEMA) wants you to know about the Tina and Richard V. Carolan Rwanda Research Fellowship, which will be open to an aspiring medical student who wishes to take a gap year in order to gain valuable experience in emergency care research in a resource-limited setting. Please read the requirements carefully and, if interested, apply by April 1.

Residents Needed for Upcoming Conference

Join SAEM and ADIEM at the Student National Medical Association Conference March 28–31, 2018 in San Francisco. We are looking for resident volunteers to staff our booth (cosponsored by EMRA, ACEP, CORD), and to develop and run a reception on the evening of March 30. If you are interested and will be in attendance, please contact joel.moll@vcuhealth.org.

ADIEM Offers Mentorship to LGBT Residents and Medical Students

ADIEM is proud to offer career advice and LGBT Mentorship to LGBT emergency medicine students and residents. If you would benefit from e-mentoring by a member of the ADIEM LGBT community, or are interested in becoming a mentor yourself, please contact Kat Nagasawa.

ACADEMIC ANNOUNCEMENTS Memorial Hermann Health James “Jamie” McCarthy, MD, FACEP was recently appointed to executive vice president and chief physician executive at Memorial Hermann Health System, one of the largest healthcare James “Jamie” systems in the state of McCarthy, MD, FACEP Texas. Dr. McCarthy will oversee Memorial Hermann’s entire physician organization and further establish a physiciancentric, integrated network of care across Greater Houston. His appointment is effective March 19, 2018. Most recently, Dr. McCarthy served as associate professor and chair of the Department of Emergency Medicine at McGovern Medical School at UTHealth.

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Icahn School of Medicine at Mount Sinai Alex Manini, MD, MS, FACMT, FAACT has been promoted to the rank of full professor of emergency medicine at the Icahn School of Medicine at Mount Sinai in New Alex Manini, MD, MS, FACMT, FAACT York City. He was also recently awarded a grant from the National Institute on Drug Abuse and Emergency Medicine Foundation (NIDA-EMF) to mentor Dr. Michael Chary, a future toxicology fellow, in dissemination research for substance use disorders.”

American College of Osteopathic Emergency Physicians Christine Giesa, DO, FACOEP-D, became the 21st Board President of the American College of Osteopathic Emergency Christine Giesa, Physicians at DO, FACOEP-D ACOEP’s Scientific Assembly in Denver, Colorado, in November. Dr. Giesa is a residency program director in the emergency department at Delaware County Memorial Hospital.

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 April 1.

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

Chair of the Department of Emergency Medicine at The Warren Alpert Medical School of Brown University and Physician-in-Chief for Emergency Medicine at the Rhode Island Hospital, The Miriam Hospital, and Newport Hospital

Brown University, Lifespan, and University Emergency Medicine Foundation are seeking an outstanding clinician to serve as Chair of the Department of Emergency Medicine at The Warren Alpert Medical School of Brown University, as Emergency Medicine Physician-in-Chief at the Rhode Island Hospital, Hasbro Children’s Hospital, The Miriam Hospital, and Newport Hospital, and as President of the University Emergency Medicine Foundation. This individual is expected to qualify as Professor of Emergency Medicine at The Warren Alpert Medical School of Brown University. The individual will be expected to plan, manage, and implement academic programs that foster the professional and scholarly growth of a multi-institutional Department of Emergency Medicine, a well-developed academic program, and to provide leadership as Emergency Medicine Physician-in-Chief to the Emergency Medicine faculty and Medical staff at the Rhode Island Hospital, The Miriam Hospital, and Newport Hospital.

Applicants must possess experience in working in an academic medical center environment in a position of senior responsibility and must have a demonstrated record of excellence in scholarship, clinical service and administration. Demonstrated success in attracting extramural peerreviewed research funding on a competitive national basis is preferred.

Applicants must hold a senior faculty rank in an accredited medical school and be qualified for the rank of Professor at The Warren Alpert Medical School of Brown University. Administrative experience as Chair of an academic department of Emergency Medicine, Division Chief, or Emergency Medicine Physician-in-Chief in a major teaching hospital is desirable.

Applicants should have attained national and/or international recognition as evidenced by active involvement with academic professional societies, publications in refereed professional journals and formal presentations at academic meetings.

Applicants should send a letter of interest, curriculum vitae and five names of possible references to: Karen L. Furie, MD, MPH, Search Chair, The Warren Alpert Medical School, Department of Neurology, 593 Eddy Street, APC5, Providence, RI 02903. Documents should be submitted electronically to both kfurie@lifespan.org and jboulanger@lifespan.org as well as submitted through interfolio at https://apply.interfolio.com/47483.

Screening of applications will begin immediately and will continue until the search is successful or closed. Brown University and Lifespan are EEO/AA employers and actively solicit applications from minorities and women.

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WASHINGTON DC – The Department of Emergency Medicine at the George Washington University is offering Fellowship positions beginning July 2019:

WASHINGTON DC – The Department of Emergency Medicine at the George Disaster & Operational Medicine International EmergencyJuly Medicine Washington University is offering Fellowship positions beginning 2019: Medical Leadership & Operations Disaster & Operational Medicine

Medical Toxicology Emergency Medicine International

Emergency Medical Ultrasound Leadership & Operations

Operations Research Medical Toxicology

Telemedicine/Digital Health

Health Policy

Extreme Environmental Medicine

Clinical Research

Emergency Ultrasound

Telemedicine/Digital Health

Simulation in Medical Education

Extreme Environmental Medicine

Operations Research Health Policy Clinical Research

Fellows receive an academicEducation appointment at The George Washington University Simulation in Medical School of Medicine & Health Sciences and work clinically at a site staffed by the Department. The Department offers Fellows a common interdisciplinary curriculum, focusing on research methodologies and grant writing. Tuition support for an MPH or Fellows receive an academic appointment at The George Washington University equivalent degree may be provided, as per the fellowship’s curriculum.

School of Medicine & Health Sciences and work clinically at a site staffed by the

Complete descriptions of all programs, application instructions, and Fellowship Department.

The Department offers Fellows a common interdisciplinary curriculum, Director contacts can be found at: focusing on research methodologies and grant writing. Tuition support for an MPH or

equivalent degree may be provided, as per the fellowship’s curriculum.

https://smhs.gwu.edu/emed/education-training/fellowships

Complete descriptions of all programs, application instructions, and Fellowship Director contacts can be found at: https://smhs.gwu.edu/emed/education-training/fellowships

Employers, are your recruiting efforts effective?

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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.

EMERGENCY MEDICINE The newly formed Department of Emergency Medicine (EM) of the Columbia University College of Physicians & Surgeons, to be led by Dr. Angela Mills, is seeking successful leaders in EM to join her leadership team.

VICE CHAIR OF RESEARCH

The Department of EM is seeking a highly motivated Vice Chair of Research at the Associate Professor or Professor level, preferably tenure track. This position will report directly to the Chair of EM and will provide leadership and oversight of the research mission for the Department. Successful candidates will have a demonstrated track record of independently funded research, publication in high-impact, peer-reviewed journals, strong mentorship skills and clear evidence of promoting the academic careers of junior faculty. The Department is looking to grow its research and scholarly output and, as such, is seeking a visionary Vice Chair to build a nationally recognized research program. The Vice Chair must demonstrate expertise in leading research in EM and possess the interpersonal skills to engage, inspire and work across disciplines within a large, diverse organization.

The faculty group at Columbia staffs three New York City EDs with 200K combined annual visits: Columbia University Medical Center with an ED currently undergoing a $100 million state-of-the-art renovation; the Morgan Stanley Children’s Hospital with an ACS accredited Level I Pediatric Trauma Center; and The Allen Hospital. Our academic EM and pediatric EM faculty supervise residents from our highly successful 4-year residency program of 48 residents, the 6 fellows in our highly competitive Pediatric EM Fellowship program, the 4 fellows in our well-established and respected International Emergency Medicine Fellowship, as well as medical students and other rotating residents.

NewYork-Presbyterian | Columbia is a premier academic institution with world-class clinical facilities and programs committed to excellence in patient care, research, education, and community service. NewYork-Presbyterian Hospital is ranked #1 in the NY metropolitan area and repeatedly named to the Honor Roll of “America’s Best Hospitals”; Columbia University College of Physicians & Surgeons is a top ten medical school in the nation with a superb, collaborative research environment. EM faculty enjoy the academic benefits of working in one of the country’s premiere academic health centers. Columbia University Medical Center is an internationally recognized leader in the creation of new knowledge and therapies to improve health in individuals and populations with sponsored research totaling more than $600 million annually.

We seek applicants who embrace and reflect diversity in the broadest sense. Columbia University is an Affirmative Action, Equal Opportunity Employer.

Please send a letter of interest, curriculum vitae, and names of 3 references to: Angela M. Mills, MD, Professor & Chair amm2513@cumc.columbia.edu

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EMERGENCY MEDICINE

Join new energetic employed hospital group Charleston Area Medical Center is seeking to employ full-time and per diem emergency medicine physicians (ABEM or AOBEM). Serving a multi-county area, the four emergency departments see more than 100,000 patients per year. This regional, tertiary medical center also sponsors an accredited emergency medicine residency program.

Facility opportunities: CAMC Memorial Hospital – 30 beds with 4 assessment beds CAMC General Hospital – Level 1 Trauma Center with 26 beds and additional fast flow areas CAMC Teays Valley Hospital – 10 beds with 2 assessment beds CAMC Women and Children’s Hospital – 20 beds • Mid-level coverage all shifts • 24/7 hospitalists coverage • Complete specialty and surgical support • Strong administrative support

Salary and benefits: Competitive compensation package based on national benchmarks Generous sign-on bonus Retention bonus Critical staffing bonus Night shift bonus Complete CAMC benefit package Occurrence based malpractice insurance CME stipend plus 5 CME paid days off Professional fees/dues and subscriptions allowance Charleston, WV is a vibrant diverse community and offers an excellent family environment, with unsurpassed recreational activities and outstanding school systems. If quality of life is important to you and your family, Charleston is the perfect balance of lifestyle and career.

For consideration, please submit CV to carol.wamsley@camc.org or call (304) 388-3347 for additional information.

33446-A18

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EMERGENCY MEDICINE The newly formed Department of Emergency Medicine at Columbia University College of Physicians & Surgeons, to be led by Dr. Angela Mills, is seeking highly qualified, full-time BC/BE Emergency Physicians at the Instructor, Assistant, Associate, and Full Professor levels.

Candidates for both tenure and non-tenure tracks are urged to apply.

Faculty candidates with a strong desire for clinical, academic, and administrative excellence are encouraged to apply. Of particular interest are candidates with demonstrated academic interest and/or fellowship training in the following areas: Clinical and health services research, ultrasound, critical care, medical education, faculty development, quality and safety, toxicology, PEM, EMS, and other EM subspecialties.

The faculty group at Columbia staffs three New York City EDs with 200K combined annual visits: Columbia University Medical Center with an ED currently undergoing a $100 million state-of-the-art renovation; the Morgan Stanley Children’s Hospital with an ACS accredited Level I Pediatric Trauma Center; and The Allen Hospital. Our academic EM and pediatric EM faculty supervise residents from our highly successful 4-year residency program of 48 residents, the 6 fellows in our highly competitive Pediatric EM Fellowship program, the 4 fellows in our well-established and respected International Emergency Medicine Fellowship, as well as medical students and other rotating residents.

NewYork-Presbyterian | Columbia is a premier academic institution with world-class clinical facilities and programs committed to excellence in patient care, research, education, and community service. NewYork-Presbyterian Hospital is ranked #1 in the NY metropolitan area and repeatedly named to the Honor Roll of “America’s Best Hospitals”; Columbia University College of Physicians & Surgeons is a top ten medical school in the nation with a superb, collaborative research environment. EM faculty enjoy the academic benefits of working in one of the country’s premiere academic health centers. Columbia University Medical Center is an internationally recognized leader in the creation of new knowledge and therapies to improve health in individuals and populations with sponsored research totaling more than $600 million annually.

We seek applicants who embrace and reflect diversity in the broadest sense. Columbia University is an Affirmative Action, Equal Opportunity Employer.

Please send a letter of interest and curriculum vitae: Angela M. Mills, MD, Professor & Chair amm2513@cumc.columbia.edu

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DEPARTMENT OF EMERGENCY MEDICINE

Tipton

Currently seeking research scientists outstanding clinical educators and researchers for faculty positions at all of our academic health centers and community-based hospital sites.

ACADEMICS

RESEARCH

Largest medical school student body in the U.S. with required EM clerkship, ACGME accredited emergency medicine and emergency medicine/pediatrics residency programs, multiple ACGME accredited fellowships

Robust departmental research focus. High institutional and departmental NIH ranking

BENEFITS Generous employer-sponsored retirement plans, access to employee contributed plans including 401k, 403b and 457b, medical (including HSA and FLEX saving options), dental, vision, life insurance, short and long-term disability insurance

COMPENSATION Competitive salary with annual academic and quality bonus opportunities. Generous CME allowance, licensure, DEA, CSR, ISMA, EM Board expenses, ACEP and SAEM memberships, public service loan forgiveness eligibility, IU tuition benefit

JOB BUILDS Dual Employment opportunities with both IUHP practice plan and IU School of Medicine, full-time academic, community, split model job builds available

Clinton

Muncie Fishers

Carmel Avon

Indianapolis

Terre Haute

SITES Currently staffing physicians and APPs at 10 sites including our academic medical center: IU Health Methodist, IU Health Riley Hospital for Children and Eskenazi Health Hospital; and our community-based sites: IUH West, IUH Ball, Union Terre Haute, IUH North, IUH Saxony, IUH Tipton, Union Clinton

Find us at the SAEM Annual meeting at booths 302, 305 & 404.

Looking forward to seeing you in Indianapolis!

Bring your CV for on-the-spot job interviews

emjobs@iu.edu

(317) 880-3881

Indiana University is an EEO/AA employer, M/F/D/V

Featured Director and Faculty Opportunities Ultrasound Director

Clinical and Core Faculty

Toxicology Fellowship Trained EM Physician for Core Faculty

Clinical Faculty

Osceola Regional Medical Center. Kissimmee, FL. EM Residency Program affiliated with the University of Central Florida College of Medicine. Contact Ody Pierre-Louis at 727.507.3621.

Aventura Hospital and Medical Center. Miami, FL. EM Residency Program affiliated with the Herbert Wertheim College of Medicine at Florida International University and Nova Southeastern University. Contact Ody Pierre-Louis at 727.507.3621.

Academic Emergency Medicine Program Director

Oak Hill Hospital. Tampa Bay, FL. New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Estimated start date July 2018.

Contact Ody Pierre-Louis at 727.507.3621.

Clinical and Core Faculty

Coliseum Medical Center. Macon, GA. New EM Residency Program affiliated with Mercer University’s School of Medicine. Estimated start date July 2019. Contact Craig McGovern at 727.437.0846.

St. Lucie Medical Center. Port St. Lucie, FL. PBCGME affiliated Osteopathic EM Residency Program. Contact Sabrina Hadzimesic at 727.507.2509.

Clinical and Core Faculty

Southeastern Regional Medical Center. Lumberton, NC. Affiliated with Duke Health University EM Residency Program.

Contact Barbara Lay at 727.507.3608.

Send CV to: MakeAChange@EmCare.com Call: 844.437.3233

Brandon Regional Hospital. Tampa Bay, FL. New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Estimated start date July 2018.

Contact Ody Pierre-Louis at 727.507.3621.

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The University of Nebraska Medical Center, Department of Emergency Medicine is recruiting additional faculty members committed to developing an academic career. With an accredited three-year emergency medicine residency program with 28 residents, this is a great opportunity to help shape the future of emergency medicine in this region.

The Center for Clinical Excellence, which opened in November 2005, houses the Emergency Department and provides services for approximately 60,000 annual visits. Applications are being accepted online at http://unmc.peopleadmin.com/postings/. Individuals from diverse backgrounds are encouraged to apply.

EMERGENCY MEDICINE The newly formed Department of Emergency Medicine (EM) of the Columbia University College of Physicians & Surgeons, to be led by Dr. Angela Mills, is seeking successful leaders in EM to join her leadership team.

VICE CHAIR OF EDUCATION

The Department of EM is seeking a talented, highly motivated Vice Chair of Education to develop and promote a departmental vision of education.

This position will report directly to the Chair of EM and will oversee all of the department’s educational programs including fellowship and residency training programs, undergraduate education programs, faculty development as educators, and other departmental educational initiatives. Successful candidates will have a minimum of 10 years of medical education experience at the UME or GME level with at least 5 years in a leadership role as Vice Chair, Residency Program Director, Director of Medical Student Education, or Assistant/Associate Dean preferred. The Department is looking to grow the education mission and is seeking visionary candidates with strong interpersonal and communication skills to work collaboratively across the organization to promote excellence in training, teaching, and educational scholarship within the department.

The faculty group at Columbia staffs three New York City EDs with 200K combined annual visits: Columbia University Medical Center with an ED currently undergoing a $100 million state-of-the-art renovation; the Morgan Stanley Children’s Hospital with an ACS accredited Level I Pediatric Trauma Center; and The Allen Hospital. Our academic EM and pediatric EM faculty supervise residents from our highly successful 4-year residency program of 48 residents, the 6 fellows in our highly competitive Pediatric EM Fellowship program, the 4 fellows in our well-established and respected International Emergency Medicine Fellowship, as well as medical students and other rotating residents.

NewYork-Presbyterian | Columbia is a premier academic institution with world-class clinical facilities and programs committed to excellence in patient care, research, education, and community service. NewYork-Presbyterian Hospital is ranked #1 in the NY metropolitan area and repeatedly named to the Honor Roll of “America’s Best Hospitals”; Columbia University College of Physicians & Surgeons is a top ten medical school in the nation with a superb, collaborative research environment. EM faculty enjoy the academic benefits of working in one of the country’s premiere academic health centers. Columbia University Medical Center is an internationally recognized leader in the creation of new knowledge and therapies to improve health in individuals and populations with sponsored research totaling more than $600 million annually.

We seek applicants who embrace and reflect diversity in the broadest sense. Columbia University is an Affirmative Action, Equal Opportunity Employer.

Please send a letter of interest, curriculum vitae, and names of 3 references to: Angela M. Mills, MD, Professor & Chair amm2513@cumc.columbia.edu

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{ Job Opportunities }

Assistant Medical Director Pediatric Emergency Medicine Leadership Assistant Program Director Vice Chair, Research

What We’re Offering: • We’ll foster your passion for patient care and cultivate a collaborative environment rich with diversity • Salaries commensurate with qualifications • Sign-On Bonus • Relocation Assistance • Retirement options • Penn State University Tuition Discount • On-campus Fitness Center, day care, credit union and so much more!

What We’re Seeking: • Experienced leaders with a passion to inspire a team • Ability to work collaboratively within diverse academic and clinical environments • Demonstrate a spark for innovation and research opportunities for Department • Completion of an accredited Emergency Medicine Residency Program • BE/BC by ABEM or ABOEM • Observation experience is a plus

What the Area Offers: We welcome you to a community that emulates the values Milton Hershey instilled in a town that holds his name.

Located in a safe 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 ADDITIONAL INFORMATION PLEASE CONTACT: Susan B. Promes, Professor and Chair, Department of Emergency Medicine c/o Heather Peffley, Physician Recruiter, Penn State Health Milton S. Hershey Medical Center 500 University Drive, MC A595, P O Box 855, Hershey PA 17033 Email: : hpeffley@pennstatehealth.psu.edu or apply online at: http://hmc.pennstatehealth.org/careers/physicians The Penn State Health Milton S. Hershey Medical Center is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

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The University of Florida Department of Emergency Medicine Advancing health care in Florida, our nation and the world through excellence in education, clinical care, discovery and service.

Vice Chair of Research Academic Rank of Associate or Full Professor The University of Florida College of Medicine’s Department of Emergency Medicine is seeking a talented and highly motivated emergency medicine physician to join our faculty in the role of Vice Chair of research at the rank of Associate or Full Professor. The Department of emergency medicine is part of the UF Health Shands Hospital and Academic Health Center, which is north Central Florida’s largest teaching institution, a level 1 trauma center and burn center and a major referral center for the southeast region. The Department manages over 130,000 patient visits a year with a separate main campus Pediatric Emergency as well as hospital based remote emergency departments.

The Department continues to grow with an expanding faculty, a core residency program of 14 residents per year and fellowship offerings including critical care, EMS, bedside ultrasound, Sports Medicine, and a Neuro sports Trauma research fellowship, with plans to develop fellowships in Global Health, Administration, Education and Research.

The Departmental research mission is both federally and industry supported with a clinical trials unit serving as a clinical as well as a coordinating site for several sponsored clinical studies with past and future collaborations including PETAL and SIREN. The Department is home to a basic science laboratory of two PhD investigators and a staff that include graduate students and visiting scholars. The laboratory is focused on biomarker research development with multiple current national and international collaborations. Our research mission is also supported by an active Clinical Translational Science Institute that has provided both T32 and KL2 support to clinician investigators as well as facilities essential to conducting human research. The Department has core areas of focus and collaborations in health services research including addiction medicine, sepsis, out of hospital cardiac arrest, traumatic brain injury, acute coronary syndrome, palliative care and infectious diseases. Our Department of Emergency Medicine was the first unit at the University of Florida to be awarded PCORI funding. The University of Florida is one of a few major universities in the United States where six health related professional colleges, nine major research institutes and versatile research facilities are located on a single contiguous major university campus. The Department of Emergency Medicine maintains robust collaborations with multiple colleges and institutes across the University campus and has the ability to leverage the educational mission of the University to advance research education. The Vice Chair will have oversight of the entire research mission including the staff of the clinical trials unit including clinical coordinators, research nurses and an active research associate program that can facilitate 24/7 enrollment of subjects into clinical studies. Highly desired traits of a successful candidate are a track record of leadership in the research mission, a record of independent funding and a passion for collaboration.

Gainesville is a beautiful, dynamic and vibrant college town, centrally located in north Florida. Residents are close to major airports, family entertainment and some of the best beaches in the world. Home of the Gator Nation, award-winning college sports and year-round outdoor activities. Join the UF College of Medicine faculty and earn an extremely competitive salary commensurate with experience and duties along with the full range of University of Florida state benefits.

When applying, please address correspondence, including a CV and cover letter to Joseph A. Tyndall, MD, MPH, chair of the department of emergency medicine.

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SEE YOU IN

Indianapolis, Indiana – May15-18