SAEM PULSE March–April 2019

MARCH-APRIL 2019 | VOLUME XXXIV NUMBER 2

www.saem.org

SPOTLIGHT AT THE INTERSECTION OF DIGITAL HEALTH AND VIOLENCE PREVENTION An Interview with

Megan Ranney, md, mph

REJECTING RESIDENT WELLNESS, EMBRACING RESIDENT WELL-BEING page 34

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

SAEM STAFF

HIGHLIGHTS

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

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

Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org

Education Manager Andrea Ray Ext. 214, aray@saem.org

Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Manager, Governance Snizhana Kurylyuk Ext. 205, skurylyuk@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Specialist, Digital Communications Nick Olah Ext. 201, nolah@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org

Meeting Planner Alex Elizabeth Keenan Ext. 218, akeenan@saem.org Membership & Meetings Coordinator Monica Bell Ext. 202, mbell@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 Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com Associate Editor, SAEM BOD D. Mark Courtney, MD Associate Editor, RAMS Shana Zucker, szucker@tulane.edu

2018-2019 BOARD OF DIRECTORS Steven B. Bird, MD President University of Massachusetts Medical School Ian B.K. Martin, MD, MBA President Elect Medical College of Wisconsin Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Christopher Lee Bennett, MD, MA Brigham and Women's Hospital and Massachusetts General Hospital Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center

James F. Holmes, Jr., MD, MPH Secretary-Treasurer University of California Davis Health System D. Mark Courtney, MD Immediate Past President Northwestern University Feinberg School of Medicine

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President’s Comments

SAEM Expands Its Horizons, Continues Upward Climb

Spotlight

At the Intersection of Digital Health and Violence Prevention: An Interview With Megan Ranney, MD, MPH

SAEM 2019 Preview Clerkship Directors In EM

Jigsaw Teaching Technique Puts Pieces of the Puzzle into the Hands of Students

SGEM: Did You Know?

Sex-based Differences in Severe Cutaneous Adverse Drug Reactions

Diversity and Inclusion

“I Matched! But What If They Made a Mistake?”

Imposter Syndrome Among Early Residency Trainees

Ethics in Action

The Case of the Meddlesome Mother

Graduate Medical Education

Air Force Readiness and Residency Training: Emergency Medicine Gets Its Wings

Social Media In Academic EM Measuring Quality in FOAMed

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Briefs and Bullet Points

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Academic Announcements

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Now Hiring

Angela M. Mills, MD Columbia University Ali S. Raja, MD, MBA, MPH Massachusetts General Hospital Megan L. Ranney, MD, MPH Brown University Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. © 2019 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 Steven B. Bird, MD University of Massachusetts Medical School 2018-2019 SAEM President

SAEM Expands Its Horizons, Continues Upward Climb

"This year, SAEM also received the greatest number of award nominations, representing the greatest number of institutions, in the history of the Society."

The SAEM staff and Board of Directors has been hard at work these past couple of years expanding the footprint of the Society beyond the annual meeting.

While the annual meeting has always been an important highlight of the year for the Society, in today's busy digital world, opportunities for networking, collaborating, and engaging with each other 24/7/365 has become increasingly imperative.

As SAEM has grown in numbers (we now have a record-setting 6,700 members!), there has been a need to grow specific areas within the Society.

For instance, the RAMS (Resident and Medical Students) Board has been busy expanding opportunities for this critically important resident and medical student segment of SAEM. We have also greatly expanded our educational footprint, creating a first-ever, all-encompassing SAEM Education Committee. The Education Committee will address not only undergraduate medical education and graduate medical education, but continuing medical education as well.

Furthermore, recognizing the importance of clinical operations and departmental administration within all of our home institutions, we have created a new Emergency Department Administration and Clinical Operations Committee.

This committee will allow the Society to develop programming for these valuable groups, while also giving members with expertise and interest in these areas a natural home within SAEM. The 2019–2020 SAEM elections saw a record-breaking number of individuals

run for committee leadership as well as for SAEM Board of Directors positions.

(By the time this column publishes, we will know the new members of the SAEM Board.) The elections also included the most diverse and inclusive ballot in the Society’s history, and while we should be proud of this, we still have a ways to go.

This year, SAEM also received the greatest number of award nominations, representing the greatest number of institutions, in the history of the Society.

Those of you who took the time and effort to nominate a colleague for an award should be proud of yourselves.

Oftentimes, those who have been nominated for an award have no idea that someone took the time to do it; so, on their behalf, I would like to thank you.

While all of this has been going on, the SAEM Program Committee — those charged with putting together our annual meeting — has been hard at work scoring didactics and scientific abstracts (both of which, again this year, experienced the greatest number of submissions ever).

In my next Pulse column, I will highlight some of the offerings that will take place at SAEM19 in Las Vegas, but you should know that Society members are hard at work to make it the best annual meeting in SAEM history.

ABOUT DR. BIRD: Steven B. Bird, MD, is vice chair for education in the Department of Emergency Medicine, and the emergency medicine residency director, at the University of Massachusetts Medical School.

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SPOTLIGHT AT THE INTERSECTION OF DIGITAL HEALTH AND VIOLENCE PREVENTION

"Every step of the way, my focus has been on providing new, needed services to my colleagues — toward making SAEM a true service organization."

SAEM Pulse talks with Megan Ranney, MD, MPH Megan Ranney, MD, MPH, is an associate professor in the Department of Emergency Medicine at the Warren Alpert Medical School, Brown University. She is director and founder of the Brown Emergency Digital Health Innovation Program; director of special projects in the Department of Emergency Medicine; and chief research officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM). Dr. Ranney’s primary expertise is in developing and testing digital health interventions for high-risk emergency department patients. She has held multiple national leadership positions,

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including member-at-large of the SAEM Board of Directors and editor at Annals of Emergency Medicine. Dr. Ranney graduated from Harvard University summa cum laude with a Bachelor of Arts degree in the history of science. She served as a Peace Corps volunteer in Cote d'Ivoire, West Africa prior to attending medical school at Columbia University, graduating with Alpha Omega Alpha (AOA) status and receiving the Leonard Tow Humanism in Medicine Award from the Arnold P. Gold Foundation. Dr. Ranney completed internship, residency, and chief residency in emergency medicine, as well as a

fellowship in injury prevention research and a master’s degree in public health at Brown University. The NIH, PCORI, and various private foundations fund Dr. Ranney’s research, which focuses on technologybased interventions for mental health and injury prevention. She also works to implement promising programs in the clinical sphere, and is an active teacher on social media, including Twitter and various blogs. Dr. Ranney speaks frequently at national meetings inside and outside of emergency medicine, and has appeared on international media from Fox News to the Canadian Broadcasting Corporation.

"If I can teach my kids how to be kind to each other, then I can teach anyone anything."

What path led you to medicine, and specifically to emergency medicine?

As long as I can remember, I have cared about improving the lives of the vulnerable and underserved. I wasn’t always sure how I’d do this, and my path was a little winding.

In college, I studied the history of science. I was intrigued by the ways in which the political context of a society, including societal inequalities, influences the practice of medicine and public health (look at Tuskegee, or the identification and treatment of people with HIV, or the labeling of women as “hysterical” at the turn of the 1900s). At that time, I thought I’d become an international aid worker or journalist, to raise awareness of how societies “create” and influence patterns of illness.

After college, in the late 1990s, I went to West Africa as a Peace Corps volunteer. It was during the height of the AIDS epidemic. I was devastated by my inability to help my many friends and neighbors who died of the virus. I wanted to be able to heal, as well as to describe, the epidemic. So medical school became an obvious choice.

I thought I would specialize in infectious disease so I could go back to West Africa and help my friends. But then I had the honor of working with Dr. Joshua Stillman in the emergency department as a medical student at Columbia, and I fell in love with emergency medicine for a gazillion reasons. The practice of emergency medicine is public health at its best. It’s constant change. It’s humbling. It’s a team sport. And, most of all, as I learned with Josh, emergency medicine is fun.

What inspired you to pursue a fellowship in injury prevention research?

I was connected to Dr. Debra Houry, now head of the CDC’s National Center

for Injury Prevention and Control, early in my career through SAEM, and I had Dr. Michael J. Mello, a well-funded injury prevention researcher and educator, as a local mentor. Once I learned a little about what they did, injury prevention became an obvious fit. One-third of emergency department visits are due to injuries; and the causes of injuries — particularly violent injuries — are so intertwined with the deeper societal issues that I care about.

SAEM Research Committee, also as chair for three years. I’ve been actively involved in AWAEM (Academy of Women in Academic Emergency Medicine) since its inception. I’ve made great friends and developed strong mentor and mentee relationships through this organization.

Every step of the way, my focus has been on providing new, needed services to my colleagues — toward making SAEM a true service organization.

How did you first become involved with SAEM? What positions have you held? Do you have a favorite assignment or accomplishment?

I’ve loved so much of what I’ve done, but my favorite accomplishment was developing the “Lion’s Den” with Dr. Judd Hollander. It’s fun and a little out of the box, and it gives junior researchers a great chance to get feedback and mentorship from senior faculty at other institutions. And yes, Lion’s Den will be coming back for more at this year’s SAEM annual meeting in Las Vegas. Feel free to reach out to me, or to this year’s organizers, Drs. Kristin Rising and AnnaMarie Chang, if you are interested!

I’ve been involved in SAEM since residency. I was incredibly fortunate to be elected as the resident member of the SAEM Board in 2007. Since then I’ve held leadership positions on the SAEM Program Committee, as chair of didactics for three years; the Public Health Interest Group, as chair for three years; and the

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Congratulations on your election to the SAEM Board of Directors.

What do you personally hope to accomplish during your tenure?

Thank you! I’m completely honored and humbled to have been elected.

My primary goal is for SAEM to experience tremendous growth as a member-led and member-responsive organization. Whether as chair of our Digital Innovation Task Force, or as a voice for diversity and inclusion, I try hard to represent the needs of all of our colleagues and trainees. I’m quite proud that we as a board are working to enhance so many member-requested services, ranging from podcasts to the ARMED Course to a new education committee to the development of new partnerships with great programs like ALiEM (Academic Life in Emergency Medicine). I sincerely invite anyone to come to me any time with ideas or issues. As a board member, I depend on you to help me advocate for what you want and need.

SAEM PULSE | MARCH-APRIL 2019

The American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) is a nonpartisan organization that seeks to fill persistent, obvious gaps in quality research on firearmrelated violence. As chief research officer and a board member, please explain AFFIRM’s role in helping to generate this type of public health research.

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I could talk about AFFIRM for pages, but briefly: as all of us know, there has been virtually no federal funding for firearm injury prevention research since 1996, and the issue of firearm injury has been politicized. I have spent a lot of time advocating for federal funding for firearm injury research, to no avail.

And meanwhile, over 100 Americans die and 200 are injured by a firearm each day across the United States.

There are no sidelines in this epidemic; we are all in it together.

I’m proud that AFFIRM is providing a path forward for so many of us.

We have the partnership of over 15 medical societies and 40,000 healthcare professionals across the United States.

We have received donations from people across the globe to support

"I hope that I’m remembered for making a difference, and for helping to lift up others." our work. We are funding research (including a research fund in the memory of Dr. Tamara O’Neal, the emergency physician was murdered in November) and then are working to disseminate best practice to colleagues throughout our network. Our goal is to give our colleagues — and our communities — hope.

You’re an active participant in social media. You’re also a popular interviewee and subject matter expert for various media outlets. Do you have a favorite way to interact with people? Have any responses from any of your media interactions surprised you?

My favorite way to interact with people is Twitter, hands down. At its best, it’s a virtual community of support, levity, and intellectual discourse that crosses geographic and partisan boundaries.

One small example: I have an ongoing thread with two emergency physicians where we compete on our times in the daily NY Times mini-crossword. We kvetch, offer emotional support, and ask for advice on academic pursuits.

And when we started, I hadn’t met either of them in person. I won’t, of course, comment on Twitter at its worst. Regarding media interactions, the biggest surprise is that people, honestly, don’t have hope about gun

violence. I’m honored to be able to help provide that hope, and to create a space where everyone can contribute to creating change.

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

Being a mom!! If I can teach my kids how to be kind to each other, then I can teach anyone anything.

What three words would your friends and family use to describe you?

Empathetic, energetic, and passionate.

What do you enjoy doing when you’re not at work? How you do approach work-life balance and the specter of burnout?

I’m a total extrovert, so my enjoyment mostly comes from being with other people. These days my non-work life largely revolves around family: my kids, ages seven and 10; my husband; and my parents, who recently moved from Michigan to live 15 minutes away from me. Their happiness makes me happy.

Plus, blocking off family time in my calendar forces me to take breaks. I’m also a big fan of exercise (my personal zen), reading fiction (recent favorite book: “Pachinko,” by Min Jin Lee), and sleep (I always want more!).

Learn More To learn more about Dr. Ranney’s work in firearmsafety research, read her recent piece, “#ThisIsOurLane — Firearm Safety as Health Care’s Highway,” written in collaboration with Dr. Emmy Betz and Dr. Cedric Dark, and appearing in a recent issue of The New England Journal of Medicine.

Dr. Megan Ranney, in an audio interview with on the #ThisIsOurLane movement and health care professionals’ role in advocating for solutions to the gun violence epidemic. (09:05)

Looking back, which mentors, academic or otherwise, have had the greatest impact on your career development?

positions, five babies, two K grants, untold paper rejections, the early days of Twitter, and so much more. (If Brian Zink is reading this: hiring us together was, arguably, the best thing you ever did!)

innovative, evidence-based, public health solutions.

There are soooo many! One of my non-medical friends recently teased me about how many people I talk about as a “mentor,” so this list could go on for pages. But I would identify three main categories. First, my fourth grade teacher, Dr. Vanderwerf, who was the first to believe in me. Second, my numerous mentors in academic emergency medicine: among others, Deb Houry and Judd Hollander, who ushered me into academic EM; Mike Mello and Brian Zink, who encouraged and supported me in my early years as a fellow and faculty member; and Rebecca Cunningham, who showed me that it was possible to create a career as a violence prevention researcher (federal funding be darned).

Finally, my peers and trainees. Here I have to specifically call out Esther Choo, who has been my partner in so much of my post-residency life: we shared an office through six years, two new faculty

Tell us about a particularly satisfying moment you’ve had while training a resident or other mentee.

I think we’re going to see completion of the transition from classic, hierarchical, inperson education to new online modalities.

I’m fortunate to get to work closely with Gita Pensa, a fellow faculty member at Brown, who inspires me with her everinventive (and much-loved) methods for engaging new learners in online media, both asynchronously and in real-time.

Work like hers, and that of Michelle Lin, of ALiEM, Teresa Chan, of McMasters University, and others, will lead us into some really innovative new paths to teach and learn. Personal plug: Gita and I have a new digital innovation fellowship at Brown.

Applications are open!

My favorite moments are when I see a trainee transition from unsureness to confidence. Those a-ha’s, when they OWN their knowledge and strength, are so amazing and inspiring. One example: I recently spent a while talking with one of my favorite junior residents who was struggling in the trauma rooms. Watching her transition soon thereafter from quiet and hesitant to absolutely owning the resuscitation was a beautiful thing.

What is something you wish the general public understood about the work you do?

I wish they understood that I really mean it when I say that I don’t want to take away people’s guns. My goal is to create

What do you see on the horizon for emergency medicine education?

What would you most like to be remembered for?

I hope that I’m remembered for making a difference, and for helping to lift up others.

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19 PREVIEW

Happy 30th Anniversary SAEM! A Message From Jody Vogel, MD, SAEM19 Program Committee Chair “SAEM19 is a milestone in the history of the Society for Academic Emergency Medicine (SAEM); It’s SAEM’s 30th anniversary and the Society’s 30th Annual Meeting!

For three decades, SAEM has been at the forefront of providing outstanding educational opportunities to emergency medicine academicians. For at least that long, SAEM members have been making tremendous contributions to emergency medicine research, teaching, and practice.

In celebration of what we as a professional community have achieved, and in recognition of 30 years of excellence in academic emergency medicine research and training, the SAEM19 Program Committee is proud to bring you another unparalleled annual meeting program.

In addition to our usual agenda of cutting-edge education, state-of-the-art original research, and innovation in academic emergency medicine, you can look forward to high-quality career development opportunities, energetic networking events, and all the fun you would expect out of an annual meeting in Las Vegas.

ANNUAL MEETING PREVIEW

This special annual meeting section of SAEM Pulse will give you a sneak peak of what you can expect at SAEM19 in Las Vegas. For the most current annual meeting news and information, be sure to follow SAEM on Facebook and Twitter (@SAEM_Online, #SAEM19) and bookmark the SAEM19 website. Then browse the SAEM19 Online Program Planner by category or date and customize your schedule by clicking the star to add items to your “favorites” list.

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We can’t wait to celebrate with you in Las Vegas!”

Keynote on Firearm Injury to Headline Plenary Session

Rebecca Cunningham, MD

Garen Wintemute, MD

Keynote speakers Rebecca Cunningham, MD and Garen Wintemute, MD will op Path Forward.” Dr. Cunningham is director of the CDC-funded University of Mic Office of Research. She is also professor for the UM Department of Emergency joined by Dr. Wintemute, who is the founding director of the Violence Preventio Davis. He also directs the new University of California Firearm Violence Researc SAEM Pulse!

ANNUAL MEETING PREVIEW

Announcing the Top 6 Plenary Abstracts Presented at the Opening Session Wednesday, May 15

Following the Opening Keynote Address Grand Ballroom A & F The SAEM19 Program Committee is pleased to announce the top six abstracts selected to be presented during a special plenary session to be held immediately following the keynote address on the opening day of SAEM19. These six abstracts were chosen as the best from among a record 1,300+ submissions.

1. Aortic/Great Vessel Injury in the Pan-scan Era

Louis Yu, Robert Rodriguez, Ali Raja, Bill Mower, Mark Langdorf

2. Prospective Multicenter Validation of the Canadian Transient Ischemic Attack (TIA) Score for Predicting Subsequent Stroke within Seven Days

Jeffrey Perry, Marco L.A. Sivilotti, Marcel Emond, Andrew Worster, Jacques Lee, Judy Morris, Grant Stotts, George A. Wells, Ian Stiell, Ka Wai Cheung, Nicolas Chagnon, Heather Murray, Mukul Sharma

3. Serum Biomarker Panel Outperforms the Canadian Computed Tomography Head Rule for Diagnosing Traumatic Intracranial Injury Robert Welch, Linda Papa, Jeff Bazarian, Rob Howard, James Chen, Art Weber, Syed Ayaz, Lawrence Lewis

4. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults

Jonathan Casey, David Janz, Derek Russell, Derek Vonderhaar, Aaron Joffe, Kevin Dischert, Ryan Brown, Aline Zouk, Swati Gulati, Brent Heiderman, Michael Lester, Alexandra Toporek, Itay Bentov, Wesley Self, Todd Rice, Matthew Semler

5. Sex and Race Differences in Safety and Effectiveness of a Chest Pain Accelerated Diagnostic Protocol

Nella Hendley, Kristin Lenoir, Anna Snavely, Jason Stopyra, David Herrington, Brian Wells, Brian Hiestand, Chadwick Miller, Simon Mahler

6. Emergency Care Quality Imaging Benchmarks in a Statewide Collaborative: Estimated Excess and Associated Spending

Keith Kocher, Rajan Arora, Benjamin Bassin, Lee Benjamin, Michaelina Bolton, Blaine Dennis, Jason Ham, Seth Krupp, Kelly Levasseur, Macy Michelle, Brian O’Neil, James Pribble, Robert Sherwin, Nicole Sroufe, Bradley Uren, Michele Nypaver

pen SAEM19 on May 15 with a timely presentation titled “Firearm Injury: Facts, Myths, and a Public Health chigan (UM) Injury Prevention Center and associate vice president for Health Sciences Research for the UM y Medicine, and professor in Health Behavior & Health Education, UM School of Public Health. She will be on Research Program and holds the Baker–Teret Chair in Violence Prevention at the University of California, ch Center. Watch for a Spotlight profile of the SAEM19 opening keynote speakers in the May-June issue of

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Brand New This Year!

Education Keynote: The Future Landscape of Medical Education Thursday, May 16 11 a.m.–Noon Grand Ballroom A & F Medical education represents the future of medicine. The medical students of today will become the doctors of tomorrow.

Medical educators stand at a unique point in time, with the role of the physician and practice methods in a state of constant flux and technology and science capabilities growing at an unprecedented rate. Where John E. Prescott, MD is medical education heading and what will it look like when it gets there? What trends will affect the future of medical education? How is technology transforming medical education? What should medical educators be doing today to equip medical students with these future qualities and prepare tomorrow’s doctors to meet the needs of the future?

RAMS is Throwing SAEM an Anniversary Celebration We’re Going to Party Like it’s 1989!

Thursday, May 16 10 p.m.– 2 a.m.

1 OAK Nightclub, The Mirage

ANNUAL MEETING PREVIEW

We’ve booked 1 OAK Nightclub — one of the sexiest, swankiest, most sought out hotspots in Las Vegas — for a private celebration on Thursday, May 16, with all our SAEM19 friends.

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This will be the experience that is literally what your friends think of when you tell them you were partying in Vegas: live DJ, open bar, and state-of-the-art sound and lighting set against a visually stunning aesthetic that fuses upscale, avant-garde New York style and the flash, glitter, and club culture of classic Las Vegas.

John E. Prescott, MD, chief academic officer of the Association of American Medical Colleges (AAMC), will offer his prognostications of “The Future Landscape of Medical Education” when he delivers SAEM’s first-ever education keynote address.

It’s a topic with which Dr. Prescott is well-acquainted. As chief academic officer of the AAMC he oversees efforts to prepare and assist deans, faculty leaders, and future physicians for the challenges of 21st century academic medicine. Dr. Prescott, a board-certified emergency physician, leads a staff that addresses critical medical school data, administrative, and operational issues; explores new models of successful mission alignment; focuses on key student and faculty issues; and supports medical school accreditation activities. Dr. Prescott is the association’s primary liaison to the Department of Defense and the Department of Veterans Affairs, serving on the VA’s National Academic Affiliations Council. He also works closely with several international organizations to address key academic issues.

Sessions Creating a Buzz Teach the Teacher Workshop: Awake Flexible Fiberoptic Intubation

1 OAK is located in the refined atmosphere of the SAEM19 host hotel, The Mirage, which means when you’re all done partying for the night all you have to do is take the elevator back to your room.

Tuesday, May 14

So… when you pack for SAEM19, be sure to bring along a sparkly dress, take your nicest Top Man dress shirt, and plan to join us for a 30th Anniversary Party that promises to be off the chain!

SAEM’s only workshop that comes with a caution! Workshop attendees should be prepared to undergo topical anesthesia and to be scoped with the device by fellow attendees during the small group live procedural practice portion of the workshop.

Faculty and Residents! Reserve a table for you and your guests. Table selections are first come, first served, so you'd better act soon because these will fill up fast!

8 a.m. – Noon Grand Ballroom A & F

Confirmed presenters: Erik Nordquist, MD, Rob Reardon, MD, David Saloum, MD, MACM, Marc Martel, MD, Rebecca Kornas, MD

So You Want to Get a Job? Unlocking the Secrets to the Perfect Interview Beyond Residency Wednesday, May 15 4–4:50 p.m.

Grand Ballroom A & F You have worked for a quarter of a decade as a student or resident and the time has come to enter the real world. Whether you are seeking an academic position, a hybrid partial academic job, or a pure community practice job, this interactive session will help you prepare for your interview.

Led by academic and non-academic leaders in emergency medicine who have interviewed and hired hundreds of people for their first jobs, this interactive session will feature a mock interview, led by actual hiring managers who will demonstrate what to do and what not to do when you interview for a job after residency. You will not only learn what questions you may be asked but, more importantly, what questions you should be asking to determine if a potential job is a good fit for you.

Exceptional Events: From TimeHonored to Brand-New MedWAR Friday, May 17 Red Rock Canyon SAEM’s first-ever SAEM MedWAR (short for Medical Wilderness Adventure Race) is a unique event that combines wilderness medical challenges with adventure racing. The race was developed as a tool for teaching and testing the knowledge, skills, and techniques of wilderness medicine, and for promoting teamwork and collegiality among competitors. MedWAR is sponsored by SAEM RAMS, along with the SAEM Wilderness Medicine Interest Group, the SAEM19 Program Committee, and the MedWAR organization. Register your team of three now. If your institution is interested in sponsoring your team for this inaugural event, please complete the sponsorship form.

ANNUAL MEETING PREVIEW

This Advanced EM Workshop will cover the indications, contraindications, and complications for the use of flexible endoscopes in airway management. The didactic portion of the workshop will discuss patient selection for the procedure, patient preparation with topical anesthesia, pharmacology, flexible endoscope mechanics, and best practices for introducing the scope and passing the endotracheal tube.

Finally, the hands-on portion of the session will include practice using the endoscope on mannequins to review the workings of the scope, followed by live procedural practice on workshop participants. Add this, or any other Advanced EM Workshop, when you register for SAEM19.

SonoGames® Friday, May 17, 2019 8 a.m.–Noon Mirage Events Center B Whether you’re a spectator or a participant, you won’t want to miss this winner-take-all, noholds-barred action as teams of emergency medicine residents in crazy costumes demonstrate their mad skills and knowledge of point-of-care ultrasound in front of hundreds of spectators to prove that they have the SonoSkills to bring home the SonoCup. Does your team have what it takes to be the SonoChampions?

You’ll never know if you don’t register.

Academy of Emergency Ultrasound of SAEM

Confirmed presenters: D. Mark Courtney, MD, MSCI and Deborah Diercks, MD, MSc

Advanced EM Workshop Day This year’s Advanced EM Workshop Day offerings include more than a dozen half- and full-day sessions that cover specialized areas in emergency medicine and strengthen knowledge and skills in specific topic areas. Advanced EM Workshop Day is Tuesday, May 14.

Add any workshop to your SAEM19 registration for an additional fee.

Want to know what all of the hullabaloo is about? Check out footage from Sonogames 2018 in Indianapolis and then make plans to join us for Sonogames 2019.

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Register Your Teams for These SAEM19 Events • Dodgeball, Thursday, May 16, 2019 • SonoGames®, Friday, May 17, 2019 • MedWAR, Friday, May 17, 2019

These Sessions Will be Hot, Hot, Hot!

Your Favorites Are Back!

SAEM Leadership Forum Tuesday, May 14 8 a.m.– 4 p.m.

St. Croix B Jessica Lueck, PhD, a consulting manager and career coach specializing in transition and change, will kick off a stellar roster of speakers at the 2019 SAEM Leadership Forum with a presentation on “Emotional Intelligence and Its Impact on Your Leadership Style.” Attend the SAEM Leadership Forum and learn how to effectively use emotional intelligence to successfully lead your team. The forum will provide exposure to core leadership topics with an emphasis on experiential learning and practical application. Forum faculty presenters are recognized experts with extensive leadership experience.

Add this unique forum to your SAEM19 registration.

Confirmed presenters: Brian Zink, MD and Jessica Lueck, PhD

SAEM Professor Rounds/ e-Poster Hall Wednesday, May 15 1–2:30 p.m.

SAEM President Steven B. Bird, MD, aka “The Professor,” will serve as an expert facilitator for this curated session featuring a small but diverse selection of exceptional e-posters that cover a variety of emergency medicine topics. Professor Rounds will be held in the e-poster hall where “The Professor” will discuss each of the selected Steven B. Bird, MD e-posters, providing his unique assessment and insight. The Professor Rounds is the “kickoff” event for SAEM19 e-Posters.

National Grand Rounds, Sessions One and Two

ANNUAL MEETING PREVIEW

Wednesday, May 15

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2:30–3:20 p.m. (Session 1) 3:30—4:20 p.m. (Session 2) Grand Ballroom B

Residency & Fellowship Fair

The goal of National Grand Rounds, Session One is to highlight high quality research and high impact research results from established and federally funded investigators from disparate scholarly domains. This session will bring together three established emergency medicine researchers for a series of short presentations featuring topical, latebreaking, innovative and rigorous methods and results. In Part 2 of National Grand Rounds, senior investigators in emergency medicine, in conjunction with selected National Institutes of Health (NIH) program officers, will be available for informal conversations about research, research methods, and career advice.

3–5 p.m.

Mirage Events Center C2

Thursday, May 16 Medical Students and Residents: Explore residency and fellowship programs from across the nation, meet with current residents and fellows, ask questions, and seek application and interview advice, all in one convenient location!

Residency and Fellowship Directors: Showcase your institution’s programs and recruit hundreds of medical students and emergency medicine residents looking to find their perfect residencies or fellowships. Register your institution today for this popular, returning event!

Wednesday, May 15 1–2:30 p.m.

Grand Ballroom B The “Masters Secrets Series” is a unique opportunity for attendees to engage directly with leaders in academic emergency medicine. Four panelists will address questions related to their “secret sauce” (i.e. their guiding principles for academic success, their biggest mistakes or leadership challenges and how they overcame them, and achieving balance). The session will include information relevant to success in all aspects of academia, including leadership, education, administration, and research. The session is designed to reengage senior leaders and enhance career development for session attendees; it will include time for discussion and engagement among leaders and attendees.

ANNUAL MEETING PREVIEW

SAEM Masters Secret Series

within emergency medicine; details about the residency match program process; strategies to excel in emergency medicine rotations; tips for how to complete an away rotation; key components of a successful personal statement; suggestions for preparing the best application for success in the match; and advice for nailing the interview (including details about the Standardized Video Interview). A networking lunch with emergency medicine program directors and clerkship directors is included. The Residency & Fellowship Fair, which showcases many of the emergency medicine residency programs in the country, will immediately follow. Add this event to your SAEM19 registration.

Confirmed presenters: W. Gannon Sungar, DO, Kathy Hiller, MD, MPH, Dara Kass, MD, Ben Ma, MD, Jody Vogel, MD, Nicole Dubosh, MD, David Story, MD, Christine Kulstad, MD, Tom Morrissey, MD, Amy Pound, MD, Joseph House, MD, Doug Franzen, MD, MEd, Cynthia Price, MD, Henderson McGinnis, MD, Michael Gisondi, MD, Nicholas Kman, MD, Joshua Wallenstein, MD

SAEM Master Scholars Wednesday, May 15 1–2:30 p.m.

St. Thomas A Chad Miller, MD, Wake Forest University

Thursday, May 16 9–10 a.m.

St. Thomas B Brendan Carr, MD, MA, MS, Thomas Jefferson University 1–2:30 p.m.

St. Thomas A Alan Jones, MD, University of Mississippi Three Master Scholars will moderate never-before-presented 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-the-art “Master Scholar Update” on current and future research opportunities in the topic areas.

Medical Student Symposium Thursday, May 16 8 a.m.– 3 p.m.

Mirage Events Center C3 The 2019 Medical Student Symposium will provide an overview of emergency medicine and in-depth information about the process of applying for an emergency medicine residency position, including training and practice options

Chief Resident Forum Thursday, May 16 8 a.m.–3 p.m.

Mirage Events Center C1 The Chief Resident Forum will feature didactic presentations, interactive sessions, panel discussions, and networking sessions with fellow resident leaders and established senior leaders in emergency medicine administration, education, and research.

The agenda includes; pearls and pitfalls of chief residency; tips for resident recruitment; strategies and tactics for dealing with conflict management; ideas for wellness and self-care activities; leadership, time management, and communication skills; suggestions for establishing wellness as a program priority.

A highlight of the event will be a panel session with recently graduated and current emergency medicine chiefs who will provide their personal perspectives on leadership and navigating year-one as a chief resident. The session includes a strategy session with fellow chief residents, a luncheon with faculty, and one-on-one "expert consultations" with presenters. Add this forum to your SAEM19 registration.

Confirmed presenters: Carolyn Holland, MD, Med, Andra Blomkalns, MD, Jon Davis, David Snow, MD, Cynthia Price, MD, Lauren Siewny, MD, Henry Young, MD, Shannon Toohey, MD, Christopher Miller, MD, MS, Anwar Osborne, MD, MPM, FACEP, Mary Calderone Haas, MD, Aaron Brody, MD

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Building and Leading an Opioid Stewardship Program From the Emergency Department to the Hospital Friday, May 17 9–9:50 a.m.

Grand Ballroom G & H

Don’t Miss These High-yield Sessions IGNITE! Wednesday, May 15 1–3:00 p.m.

Grand Ballroom A & F (Session 1)

Friday, May 17 10 a.m.–Noon Grand Ballroom A

ANNUAL MEETING PREVIEW

IGNITE! talks are some of the most popular, energetic, and engaging sessions at the SAEM annual meeting. Speakers are selected from all levels of training from all parts of the country.

A panel of faculty judges selects a “Best of IGNITE!” winner from each IGNITE! session. Because there are no limitations on submission topics, the audience will be exposed to a wide variety of interesting issues in emergency medicine (EM).

Speakers in the past have talked about their experiences in disaster relief, waxed poetic about the role of machine learning in EM, and challenged core practices in EM critical care and education.

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An opioid stewardship program (OSP) is a hospital- or health system-wide initiative to implement best practices, metrics, and iterative processes that address the spectrum of concerns from non-opioid pain modalities to comprehensive treatment of opioid use disorder. In this didactic, experts will discuss opioid stewardship programs focusing on creative ideas and lessons learned that attendees can take back to their home institutions. Dr. Nelson will discuss how OSPs can address primary and secondary prevention of new opioid use disorder cases by introducing programs that emphasize alternative modalities of pain treatment, use of lower doses of opioids when given, and prescription drug monitoring program enhancements. Dr. Perrone’s presentation will include how OSPs can improve the care of patients with opioid use disorder through expansion of buprenorphine use, warm handoffs to low barrier opioid use disorder treatment sites, and distribution of naloxone. Finally, Dr. Weiner will describe useful metrics to measure the success of such an intervention as well as novel information technology interventions that can be adopted in other hospitals as well, to ease provider compliance with best practices.

Confirmed presenters: Jeanmarie Perrone, MD, Lewis Nelson, MD, Scott Weiner, MD, MPH

Mentoring the Mentors: Advising Emergency Medicine Educators for Promotion and Advancement (CDEM Sponsored)

Friday, May 17 10–10:50 a.m.

Grand Ballroom C Mentorship of junior faculty and emergency medicine clerkship directors offers support and enhances the progress of those who are new to academic medicine. Effective mentoring

RAMS Members…

Look for This Icon When you see the RAMS head icon next to an abstract, didactic, or workshop in the SAEM19 program planner you will know that an educational offering, event, or activity is something you’ll find value in attending!

The SAEM19 Online Program Planner is up and running and ready for you to start using for all your pre-meeting needs! Log in using your SAEM user name and password and browse through the full list of Advanced EM Workshops, educational sessions, meetings, social events, and more.

• Browse by category or date.

• Review abstracts, learning objectives, and speakers for educational sessions.

• Find links to travel information and local dining and activities.

• Scope out the exhibit hall with the online floor plan and create your must-see list of exhibitors.

As you browse, customize your schedule by clicking the star to add items to your “favorites” list.

Create your individualized program before you arrive. Save it and/or print it as your personalized daily itinerary, then use it at SAEM19 to remind you what not to miss and where to go next. relationships have been shown to increase research outcomes and improve job satisfaction for faculty in academic medicine.

This session will define best practices for formal mentoring programs for emergency medicine educators with a focus on clerkship directors and will identify areas for promotion and advancement of an academic emergency medicine career.

Confirmed presenters: Listy Thomas, MD, Nicholas Kman, MD, Luan Lawson, MD, MAEd, David Manthey, MD

Telehealth in Emergency Medicine: The Current and Future State

(SAEM Telehealth Interest Group Sponsored)

Friday, May 17 9– 9:50 a.m.

Grand Ballroom B This session will provide an overview of the current state of telehealth in emergency medicine and describe future possibilities for acute, unscheduled care. It will include sug-gestions for encouraging participation in telehealth programs and orienting current providers to telehealth programs. The session is suitable for any providers or emergency medicine leadership considering telehealth or are in the early stages of implementation of a telehealth program.

ANNUAL MEETING PREVIEW

SAEM19 Online Program Planner

Academic Health System Administration as an Avenue for Career Development: Forging a Pathway in Administration

(SAEM Faculty Development Committee Sponsored)

Friday, May 17 11–11:50 a.m.

Grand Ballroom B The focus of this interactive didactic session is to educate emergency medicine physicians on how to achieve a career in health care administration. Each of the speakers — health care administration professionals with emergency medicine expertise — will give a short overview of his/her specialty area and outline the training and potential pathways that can lead to a career in health care administration. Participants will also learn how an administrative fellowship and/or leadership program can assist in developing a career in health care administration. A question and answer session with the participants will enable audience members to dive deeper into the positions that are of greatest interest.

Confirmed presenters: Nancy Kwon, MD, MPA, Judd Hollander, MD, John D’Angelo, MD, Nicole Franks, MD

Confirmed presenters: Emily Hayden, MD, Judd Hollander, MD, Claritza Rios, MD, Neel Naik, MD, Aditi Joshi, MD, MSc, Peter Greenwald, MD MS

“Happy 30th Anniversary” to SAEM from Medical College of Wisconsin, Reading Hospital-Tower Health, and Roche SAEM is commemorating 30 years of providing outstanding educational opportunities to emergency medicine academicians, and our friends at Roche Diagnostics, Medical College of Wisconsin, and Reading Hospital-Tower Health are adding their support to the celebration. SAEM thanks these friends, and all of our 30th Anniversary sponsors, for their support.

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Emergency Medicine Physician Wellness‌ SAEM19 Didactics Have it Covered!

In accordance with SAEM’s Statement on Commitment to Clinician Well-Being and Resilience, SAEM supports endeavors related to physical health and wellness and the fight against burnout. In alignment with that cause, the SAEM Wellness Committee in its inaugural year set as an objective to submit a number of wellness-, resilience-, and burnout-related didactics to SAEM19. The committee partnered with other committees, academies and RAMS to complete this objective. The accepted didactics are below. Add a wellness didactic to your SAEM19 schedule by following the link to SAEM19 Didactics on the SAEM19 Program Planner.

Not Another Yoga Class: Wellness Initiatives of Residency Programs (SAEM Wellness Committee Sponsored)

ANNUAL MEETING PREVIEW

May 16, 4 p.m.

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What are best practices for EM residency programs? What does the literature support and what do residents feel that they most need?The wellness committees of SAEM Resident and Medicals Students (RAMS) and the Emergency Medicine Residents' Association (EMRA) surveyed emergency medicine residents and medical students to find out what are wellness best practices for residency programs and what is the evidence supporting them? Topics may include: trade-offs between time off, team building and individual wellness; managing shift work, weekends and holidays; electronic medical record (EMR) efficiencies; recognizing and coming back from burnout; substance use and physicians; financial wellness for new graduates; victim blaming; financially survive residency; team management; litigation stress, and more.

Wellness, Inclusion, Diversity, Equity: The Wide and the Why...That is the Question (SAEM Wellness Committee, ADIEM, and AWAEM Sponsored)

May 17, 8 a.m.

There has been proliferation in the literature addressing physician wellness and diversity, equity, and inclusion with emergency medicine being one of the top specialties suffering from burnout. Little has been discussed regarding the link among wellness, inclusion diversity and equity as they pertain to the underrepresented in medicine (URiM) and women.

Downey et al, examined the belief that workplace well-being and engagement would be mediated by a trust climate that is stronger when employees experienced feelings of inclusion in the workplace. This workshop will address the unique challenges faced by URiM and women that impact their

Wellness for the Future: Cultural and Systems-based Challenges and Solutions May 14, 8 a.m.–5 p.m.

ANNUAL MEETING PREVIEW

The 2019 Consensus Conference

Cultural change to promote wellness in emergency providers must include not just physicians, but residents, nurses, mid-level providers, departmental leadership, and hospital administration. The goal of the 2019 Consensus Conference is to stimulate a research agenda among key stakeholder groups in order to create large-scale solutions to the crisis of unwellness in medicine. With that as the goal, the consensus conference looks at the current state of wellness and envisions where we go from there. Add the consensus conference to your schedule when you register for SAEM19.

wellness and well-being in emergency medicine. This includes the challenges of recruitment, retention, and advancement in the specialty by these groups. The workshop will also address the realities that URiM and women face by providing perspectives and some solutions to address the realities of how unconscious bias and microaggressions impact physician wellness and impede advancement in the specialty.

The Science of Physician Wellness: Is the Truth Out There?

(SAEM Wellness Committee Sponsored)

May 15, 2 p.m.

In this didactic, presenter Andra Blomkalns, MD, MBA, Stanford University School of Medicine, will summarize literature pertinent to wellness within the academic emergency medicine environment and setting the stage for a thoughtful research agenda for the Society moving forward.

#MeToo in Emergency Medicine: A Discussion of Gender, Ethnic, and Sexual Discrimination and Harassment in Medicine (SAEM Wellness Committee and SAEM Graduate Medical Education Committee Sponsored)

May 17, Noon The recently released National Academies of Science, Engineering, and Medicine (NASEM) report on sexual harassment of women in medicine revealed alarming results:

Approximately 50 percent of female medical students at two large academic institutions reported experiencing sexual harassment. Despite the increasing numbers of women who are entering medicine, it has been well documented that women in medicine continue to experience disparities in salary and career advancement. Previous reports have also noted that ethnic and sexual minority trainees perceive barriers to success in medicine. This session will begin with a summary of the NASEM report on sexual harassment of women in medicine. This will be supplemented by a review of the latest literature on discrimination and harassment experienced by women and ethnic and sexual minorities in medicine. This will be followed by a case-based discussion among panelists regarding recommendations for dealing with instances of discrimination and harassment; future research directions; and steps to changing the culture and climate in medicine.

Dynamic Didactics More than 115 innovative and interactive didactic sessions are on tap for SAEM19. Spanning three full days, May 15–17, this year’s didactics cover a range of educational topics in key categories, including: administrative, career development, education, clinical, research.

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ANNUAL MEETING PREVIEW

The Mirage – Your SAEM19 Host Hotel: A Tropical Oasis in the Middle of the Desert

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The Mirage, 3400 S. Las Vegas Blvd. Las Vegas, is the official host hotel for meetings, education, and social events at SAEM19. The sleeping room block is now open. Book your room early! The group rate is available on a first come, first-served basis. Reserve your room until May 17 to take advantage of a full week of education that extends all the way through Friday!

The Mirage, with its Polynesian jungle vibe inside and bellowing volcano outside, is exactly what its name implies — a tropical oasis set smack-dab in the middle of the desert.

The Mirage is the original Vegas mega-resort — a AAA Four Diamond award-winner with all the trimmings, centrally located center-Strip. With all it has to offer, you won't even have to leave the premises to have a great time! Take a look:

Boom, Pow, Wow:

Fireballs, water cannons and booming percussion highlight the nightly “eruptions” of the 55-foot-tall working volcano, located outside on the three-acre lagoon that fronts The Mirage. The pyrotechnics go off SundayThursday at 7 p.m. and 8 p.m., with an additional show on Fridays and Saturdays at 9 p.m. Best of all… It’s free!

Under the Sea: When you’re checking in, check out the

60-foot-long, 20,000-gallon saltwater fish tank behind the main registration desk. One of the most elaborate and technically advanced in the world, the aquarium is home to 450 fish, from 85 different tropical species, including sharks and stingrays.

ANNUAL MEETING PREVIEW

Fun for Everyone: The Siegfried & Roy’s Secret Garden

and Dolphin Habitat is a serene retreat filled with gorgeous flowers, lush foliage, palm trees — and the roars of the jungle, as you come face-to-face with white tigers, white lions, and leopards. (Claim to Fame: Siegfried and Roy first performed here in 1989!) Or, you can watch, train, and interact with bottlenose dolphins in a 2.2-million gallon dolphin habitat. Get even closer with a behind-the-scenes VIP tour, Trainer for a Day, Painting with the Dolphins, and Yoga With the Dolphins.

A Dozen Dining Options: With 12+ dining options and

eight bars/lounges on the premises, you won’t go hungry or thirsty at The Mirage. Ranging from the Japanese-themed Otoro for sashimi, shared small plates, and grilled robata bites to Osteria Costa for wood-fired pizzas, handmade pastas, and fresh seafood, and including Tom Colicchio’s Heritage Steak— a classic steakhouse with a modern twist.

Looking for a quick bite and a killer cucumber martini before a night out on the town? Try STACK. Want a fun place to hang out with your friends after a long day of meetings? The Still has crafts, drafts, eats a refurbished Airstream trailer that’s been turned into a fully functioning kitchen. Craving a classic burger, fries, and a rich and creamy milkshake (including a spiked, “adult” version)? LVB Burgers and Bar has you covered.

Pool Complex

After the Sun Sets: After the sun goes down, the party

gets started at The Mirage. From the hottest nightclubs in Vegas, to the swankiest bars and lounges on The Strip, you can plan for a good time after hours at The Mirage. Mix and mingle at Rhumbar, what Eater calls “one of the five great rum bars in Las Vegas.” Rhumbar’s palm-shaded patio is the perfect setting to enjoy a rum-centric drink and a Cuban cigar. Or keep it classy at the Parlor Cocktail Lounge where you can sip a hand-crafted cocktail in elegant surroundings while being serenaded from a Steinway grand piano.

FABulous Entertainment: Thrillist calls “The Beatles

Love” one of the best shows in Vegas — a city known for its top-notch entertainment options. In fact, of the eight shows from Cirque du Soleil presently showing on The Strip, “Love” may be the best of all. Cirque du Soleil combines iconic songs by the Fab Four (via a three-time Grammy winning soundtrack) with their soaring acrobatics, bodybending gymnastics, aerial stunts, incredible choreography, and engaging video projections. It all happens in 360º glory in the psychedelic ‘60s-themed The Beatles Love Theatre, at The Mirage.

Parlor Cocktail Lounge

Best Dip on the Strip: Named by Thrillest as one of the

10 best swimming pools in Vegas, the pool complex at The Mirage encompasses five acres of pools, lagoons and waterfalls surrounded by lush palm trees. Also available are 16 private luxury cabanas all outfitted with 32-inch flat screen TV’s, iPod docking stations, a private deck, chaise loungers and a personal cabana host.

Ahhh, the Spa: A peaceful oasis, tucked away from the

hustle and bustle of the casino, The Spa and Salon at The Mirage offers steam rooms, saunas, and whirlpools, as well as relaxing meditation rooms. Take a break from the busyness of the annual meeting to refresh yourself with a therapeutic massage or soothing treatment.

Secret Garden 19

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ANNUAL MEETING PREVIEW

Save Your Quarters for the Slots: 12 Hotels on the Strip With Free Shows and Attractions

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You’ll need lots of cash if you want to play poker at the highstakes table or sip cocktails by the hotel pool, but there are plenty of unforgettable experiences, in Las Vegas, from the quirky to the captivating, that won't cost you a dime. For starters, there are the hotels themselves. A walk down the strip and you’ll see a life-sized pyramid, a castle, a Coney Island roller coaster, and replicas of The Eiffel Tower. the Arc de Triomphe, and Venice’s Rialto Bridge.

2. The Golden Nugget Hotel and Casino

If it’s glitz and glamor you’re after, step inside the elegant lobbies of luxury hotels like the Bellagio, the Venetian, the Palazzo, Wynn, and Encore… All are breathtaking attractions in themselves.

3. The Bellagio Hotel and Casino

Beyond their amazing interiors and exteriors, several Las Vegas hotels also have daily shows and attractions that are open to the public and free (or nearly free) of charge. Here are 12:

1. Circus-Circus Hotel and Resort The world’s largest permanent circus can be found at CircusCircus where you can watch wild and wacky circus clowns amuse guests on the Midway Stage while, unicyclists, highflying acrobats, and trapeze artists perform death-defying acts under the 90-foot tall big top, high above the casino floor.

Performances are free and start at 11:30 a.m. daily.

Circus-Circus, 2880 S Las Vegas Blvd; +1 702/734-0419

It’s no surprise that the largest gold nugget in the world is right at The Golden Nugget. Found in Australia in 1980 and sold to the casino for more than a million dollars, you can gaze longingly at the 61-pound “Hand of Faith” in the Gold Tower hotel lobby.

The Golden Nugget, 129 East Fremont St; +1 702 385-7111

As far as iconic Vegas images go, the Bellagio Fountains rank at the top. In the choreographed show, water dances like ballerinas to lights and music, while cannons shoot water hundreds of feet in the air. The performances take place on the artificial lake in front of the Bellagio. The spectacle happens weekdays every 30 minutes between 3 p.m. and 8 p.m., and every 15 minutes between 8 p.m. and midnight.

Also at the Bellagio… The 14,000 square foot Conservatory and Botanical Gardens, featuring tens of thousands of flowers crafted into intricate designs that change with the season. The elaborate scenery is on display beneath a 50-foot-high atrium.

It’s one of the most photographed places on the Strip and it, too, is free.

The Bellagio, 3600 Las Vegas Blvd. S.; +1 702 693-7111

Luxor Sky Beam, a 42.3 billion candela tunnel of light (the strongest in the world) shines exactly vertical from the 39 xenon lamps on top of the 111-meter high pyramid-shaped Luxor Hotel and Casino. On a clear night, the Sky Beam is visible from 275 miles away by aircraft at cruising altitude, such as over Los Angeles, a five-hour drive away.

8. Caesar’s Palace At the Forum Shops at Caesars, the newly revamped Fall of Atlantis show is an animatronic display of fire, water and nine-foot-tall talking statues that recount the legendary fall of Atlantis. The costumes and props — a 20-foot winged dragon — were created by the same geniuses who worked on Thor and Pirates of the Caribbean. The show is free and plays every hour on the hour, starting at 11 a.m. While you’re there, check out the 50,000-gallon aquarium nearby which is home to more than 300 saltwater fish.

4. The Venetian Resort In the heart of the Grand Canal Shoppes between the Venetian and Palazzo, is a re-creation of St. Mark’s Square, ancient site of art, learning, and trade, and home to some of the most remarkable and noteworthy sights of Venice. Stop at a water front café, eat gelato on the piazza, enjoy the roaming opera singers and performance artists, watch canoodling couples glide by in gondolas as striped-shirted gondoliers boom out Italian love songs, and take a selfie with one of the “statues” throughout the Grand Canal Shoppes. (If they seem realistic and lifelike it’s because they are! Performers are painted and dressed to look as if they’ve been carved from the finest stone.)

Venetian, 3355 Las Vegas Blvd., S.; +1 702 414-1000

5. Harrah’s Las Vegas Resort and Casino There are Elvis impersonators, and then there’s BIG ELVIS — one of the best of all time. Big Elvis who, as the name gives away, is a plus-sized Elvis impersonator, performs Monday, Wednesday, and Friday between 2 p.m. and 6 p.m. in the Piano Bar at Harrah’s. This act is the longest running Elvis tribute show in Las Vegas and still completely free. Later in the evening, identical twins Kim and Tamara Pinegar will compete for your applause in the ultimate sibling rivalry. Catch the sisters in their dueling piano show nightly at 9 p.m. at The Piano Bar. Harrah's, 3475 S Las Vegas Blvd.; +1 800 214-9110

6. Planet Hollywood Resort & Casino Located in the heart of the Miracle Mile Shops at Planet Hollywood Resort & Casino, is a multi-million-dollar water feature with lighted effects, five-story-high eruptions, color changing fog, bursts of light and drama, and an original soundtrack broadcast via a state-of-the-art surround sound system. Water fountain showings run daily from Noon-11 p.m. every hour. Just a few stores down, catch the indoor rainstorm, featuring thunder, lightning, fog and pouring rain.

Rainstorm plays on the hour, Mon - Thurs at the top of each hour noon to 11 p.m., and on the half hour on Fri - Sun. Planet Hollywood, 3667 S Las Vegas Blvd; +1 866 919-7472

ANNUAL MEETING PREVIEW

7. The Luxor Hotel & Casino

Caesars Palace, 3570 Las Vegas Blvd.; +1 702 893-4800

9. Binion’s Gambling Hall If you’ve ever wanted to see what a million bucks in cash looks like in person head on over to Binion’s. A million dollars in a variety of denominations is stored and secured in a pyramid-shaped display case. Pose for a free pic and receive a 6-by-8 glossy photo in a souvenir frame.

Binion’s Gambling Hall, 128 Fremont St; +1 702 382-1600

10. Flamingo Las Vegas On the grounds of the Flamingo hotel, is a 15-acre scenic wildlife habitat that’s home to 60 exotic birds (including Chilean flamingoes) turtles, and koi fish. There’s also lush foliage, a waterfall, and an island in the center of it all. The Flamingo Wildlife Habitat is free and open daily. To see the animals in their most active states, swing by for one of the twice-daily feedings, held in a section dubbed “Pelican Island” at 8:30 a.m. and 2 p.m.

Flamingo Las Vegas, 3555 Las Vegas Blvd., S., Las Vegas, NV 89109; +1 702 733-3111

11. Wynn Las Vegas The lobby of the Wynn Hotel is loaded with trees, plants, and elaborate colorful floral installations that include a 20-foottall hot air balloon and a 16-foot-wide carousel. Also at the Wynn…The Lake of Dreams, comes alive when the sun sets, in a dazzling spectable of music and imagery created by over four thousand lights, stunning holographics, and puppetry accompanied by a transcending soundtrack and backed by a 40-foot waterfall and pine-topped mountain. Shows run nightly, every half hour beginning at 8 p.m. until 12:30 a.m.

The Wynn, 3131 S Las Vegas Blvd; +1 702 770-7000

12. Hard Rock Hotel & Casino The lobby of the Hard Rock Hotel & Casino in Las Vegas is like a walking tour through the history of music. Memorabilia includes a drum set from Def Leppard, clothes from Madonna, and special exhibits dedicated to Journey, Imagine Dragons, and other acts who’ve headlined at The Joint theater.

Hard Rock, 4455 Paradise Rd; +1 702 693-5000

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Four More Fun Things to Do After You’ve Spent Your Casino Allowance Downtown Container Park More than 40 repurposed shipping containers just east of Las Vegas Boulevard have been turned into a popular spot for shopping, dining and nightlife. Don’t miss the craft cocktails at Oak & Ivy, and be sure to take the 33-foot-long slide down from the three-story “treehouse” in the center play area. The giant fire-breathing praying mantis sculpture out front was created for the Burning Man festival but was apparently too cool to burn. Find the free entertainment calendar, including a new outdoor family movie series, on the park’s website.

Grand Bazaar Shops

ANNUAL MEETING PREVIEW

At the corner of the Strip and Flamingo, the Grand Bazaar Shops captures the essence of the world’s greatest open-air markets. While browsing local and world-renowned shops and dining options, enjoy the sparkling light and sound spectacle, showing nightly at 9 p.m. and midnight. Find more free events and special offers at the website.

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The Fremont Street Experience The Fremont Street Experience, in the heart of downtown Vegas, is a five-block pedestrian-only entertainment district that’s covered by a 1,400-foot-long canopy with Viva Vision, the world’s largest LED screen underneath and a booming sound system. The Fremont Experience has everything from the SlotZilla, a 12-story slot machine in the middle of the street, to a zipline that lets you fly superhero-style the entire length of the Fremont Street canopy at speeds faster than 35 miles per hour. Oh, and there’s also a zombie-themed maze and live music every night. For a calendar of live music and events, and all the inside scope, visit the website.

Fremont East Entertainment District Take a self-guided tour of this pedestrian-friendly dining and entertainment district after dark to get the full effect of the refurbished vintage neon signs, which include the famous horseback rider from the Hacienda Hotel, a red slipper and a martini glass, and a 30-foot-tall Pabst Blue Ribbon. For a list of eats, drinks, and entertainment, visit the website.

Bring the Kids to SAEM19, Receive a Childcare Credit SAEM, in partnership with Rosh Review, will offer a $100 credit to attendees who use Nannies & Housekeepers USA to purchase in-room childcare services during educational hours at SAEM19 in Las Vegas. Just bring your receipt to the SAEM19 onsite registration desk and SAEM will reimburse you up to $100. Visit the webpage for all the details.

Rim of the Grand Canyon, just over four hours away.) The 10-foot-wide, horseshoe-shaped glass bridge extends 70 feet out over the rim of the Canyon. Looking down, you will be able to see right through the glass platform 4,000 feet to the floor of the canyon below.

1. N eon Museum. Features a dazzling pile of obsolete neon

Hoover Dam – 40 miles

signage, from past casinos such as the Stardust, Caesar’s Palace, and Moulin Rouge. Guests enter the "Boneyard" through the mid-century modern visitor center, which actually is the former lobby for the La Concha motel.

2. T he Mob Museum pays homage to Las Vegas’s criminal

underbelly. Highlights include bricks from the wall of the St. Valentine’s Day Massacre, a mock-up of the electric chair where a number of mobsters met their end, and an interactive crime lab. There’s even a speakeasy in the basement bar offering a complimentary shot of moonshine for those over 21.

A marvel of modern engineering, the 726-foot-high Hoover Dam contains Lake Mead, the largest reservoir in the United States. Built during the Great Depression as a way to put unemployed men back to work, today the dam provides hydroelectric power to much of Nevada, Arizona, and California. Near the dam is a visitor center and parking. From

ANNUAL MEETING PREVIEW

Five Quirky Museums That are Classic Vegas

3. N ational Atomic Testing Museum is affiliated with

the Smithsonian Institution. Among its exhibits covering American nuclear history is a “Ground Zero Theater” which simulates the experience of observing an atmospheric nuclear test.

4. P inball Hall of Fame is a “memorial to a pop culture touchstone” where players can spend hours reliving childhood memories with their favorite games.

5. B urlesque Hall of Fame is a museum that documents

the history of American burlesque from its 19th Century origins through its golden age in the mid-20th Century, and displays artifacts commemorating historic burlesque performers such as Gypsy Rose Lee and Dita Von Teese.

Six Scenic Roadtrips Within Two Hours of Sin City

there, you can walk out on the dam for fantastic views.

Death Valley National Park – 103 miles Although Death Valley is in California, you can easily visit the park on a day trip from Las Vegas. Death Valley is the largest national park in the United States outside of Alaska. Below sea level yet surrounded by snow-capped peaks, Death Valley is far from dead. This wildly diverse landscape ranges from dunes and fields of wildflowers to lakes that come and go with the rain. In spring, the valley bursts with life.

Red Rock Canyon – 14 miles

Just beyond the noise and bright lights of Las Vegas is a spectacular landscape of red rocks, deep gorges, majestic mountains, and desert scenery. If you have time, be sure to get out and see the sites beyond the city limits. Here are six day trips, all within about a two-hour drive from Las Vegas.

Red Rock Canyon is Nevada’s first National Conservation Area. Located 17 miles west of the Las Vegas Strip, it offers the quickest nature escape from the city. A one-way, 13-mile scenic drive loops through the park, with numerous areas to stop along the way. You’ll find miles of hiking trails off this road, leading to peaks, into box canyons, and through the red rock landscape to experience some spectacular desert scenery and beautiful vistas

Grand Canyon Skywalk – 130 miles

Valley of Fire State Park – 15 miles

If you are only going to do one day trip from Las Vegas, a trip to the Grand Canyon Skywalk at Eagle Point is a must-do, especially if you have never seen this natural wonder. Only 2.5 hours from Las Vegas. (The more famous area is the South

Valley of Fire State Park is world-renowned for its 40,000 acres of bright red Aztec sandstone outcrops nestled in gray and tan limestone. Other highlights include ancient, petrified trees and petroglyphs dating back more than 2,000 years. Hiking trails here are generally short but land you in some exceptional scenery. If you aren’t a hiker, you can still appreciate the views from a drive through the park.

Lake Mead National Recreation Area – 30 miles Lake Mead National Recreation Area has been called America’s most diverse national recreation area. With striking landscapes and brilliant blue waters, this year-round playground spreads across 1.5 million acres of mountains, canyons, valleys and two vast lakes. See the Hoover Dam from the waters of Lake Mead or Lake Mohave, or find solitude in one of the park’s nine wilderness areas.

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CLERKSHIP DIRECTORS IN EM Jigsaw Teaching Technique Puts Pieces of the Puzzle into the Hands of Students

By Sundip Patel, MD Are your residents tired of the traditional lecture format? Are you putting your students to sleep with your PowerPoint presentations? Are you simply tired of giving the same boring lecture over and over again? If you answered yes to any of these questions, maybe it’s time to try the jigsaw technique. The jigsaw technique is an active learning method whereby learners contribute to their own education.

Here’s How it Works

SAEM PULSE | MARCH-APRIL 2019

A topic is divided into smaller, interrelated topics (puzzle pieces), which are then assigned individually to each member of the group — one puzzle piece per group member. Group members are expected to read up on their assigned topics and be prepared to present their information to the group. On the day of the session, each member is then asked to teach the group about his or her assigned topic.

Once these individual puzzle pieces/ topics are presented, the “puzzle” is complete.

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Here’s an example: Say you have to give a lecture on asthma. Rather than risk a not-so-memorable presentation, you decide to do a jigsaw on the topic.

You assign one student to read about asthma triggers, one student to focus on the pathophysiology of asthma, and one student to read about treatment of asthma — all reading to be completed before the presentation. You can make multiple groups of three in this fashion.

On the day of the presentation, each student takes turns sharing with

the group what they learned so that by the end everyone knows about asthma triggers, pathophysiology, and treatment. The puzzle is complete!

everyone in the group misses out on a key teaching point.

Benefits and Downsides

You should try the jigsaw teaching method at least once to see if it suits you and your learners. It’s a great way to engage in some active learning and will help make an otherwise boring lecture interactive and interesting.

One “pro” to doing a jigsaw is that it is less threatening for some students than being called out unexpectedly in front of their peers. The jigsaw method is less instructor-dominated and allows learners the opportunity to teach themselves.

Because everyone is required to contribute a piece to the puzzle, the jigsaw method also encourages participation, which can help with your quieter, more bashful learners. One downside of this method is that in order for it to work, all of your learners must come prepared prior to the session. If one person is unprepared to present,

Conclusion

ABOUT THE AUTHOR Sundip Patel MD, is co-clerkship director at Cooper Medical School of Rowan University, Camden, New Jersey, and an active member of the SAEM Clerkship Directors of Emergency Medicine (CDEM).

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

SGEM: DID YOU KNOW? Sex-based Differences in Severe Cutaneous Adverse Drug Reactions

By Madalene Boyle, MD It is well established that sex-based differences exist in the pharmacokinetic and pharmacodynamic profiles of medications.1,2 The emerging recognition of the influence of sex on drug efficacy has highlighted a need to better understand the implications of sex on drug toxicity and propensity for adverse reactions. It has been reported in numerous studies that women are at an increased risk for adverse drug reactions.2,4 Among the most severe adverse drug reactions are Steven-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) associated most frequently with use of sulfonamides, allopurinol, anticonvulsants, and nonsteroidal anti-inflammatory drugs.7 Building upon previous literature that reported a higher female prevalence of SJS/TEN, a retrospective review was conducted of patients diagnosed with SJS/TEN at a Burn Center in San Francisco between 2003 and 2014.

Researchers again found a higher prevalence of SJS/TEN in female patients. The group further found that females had a worse prognosis and higher mortality compared to male patients.7 Although the precise pathogenesis for differences between males and females in severe cutaneous adverse drug reactions remains unclear, SJS/ TEN eruptions are immunologically mediated and thought to involve an inappropriate T-cell response.2,4 Women have a higher incidence of diseases mediated by immunologic mechanisms such as systemic lupus, lichen planus, and systemic sclerosis. These findings point to a sex-based difference in immune function and drug hypersensitivity.2 Emergency medicine providers need to be aware of sexbased differences in severe cutaneous drug reactions. A low index of suspicion for severe cutaneous reactions should be executed in any patient, particularly female, presenting with a rash and history of exposure to a potential causal drug. Importantly, vulvovaginal involvement can undoubtedly be missed unless the appropriate history is obtained and physical exam is pursued. Any patient presenting with a suspected drug-induced rash that offers genitourinary complaints should have a pelvic exam. Vulvovaginal findings in SJS/TEN can include vaginitis, vulvar bullae and vaginal synechiae8. A pelvic exam can reveal important and easily

overlooked findings of mucous membrane involvement that may be crucial to diagnosis.8 Further, with increasing numbers of studies suggesting an enhanced risk for women to develop severe mucocutaneous drug eruptions, special thought should be given to prescribing certain agents to female patients when alternative therapies exist. Although it may not always be feasible to modify prescribing practices, if a substitute to certain high-risk medications (such as TMPSMX, allopurinol, phenytoin) exists, it may be beneficial to consider using a different medication.

REFERENCES:

1. F reire AC, Basit AW, Choudhary R, Plong CW, et al. Does sex matter? The influence of gender on gastrointestinal physiology and drug delivery. Int J Pharm. 2011;415: 15-28.

2. I slam MM, Iqbal U, Walther BA, et al. Gender-based personalized pharmacotherapy. A systemic Review. Arch Gynecol Obstet. 2017; 295(6):1305-1317.

3. Yang CY, Chen CH, Deng ST et al. Allopurinol use and risk of fatal hypersensitivity reactions: a Nationwide Population-Based Study in Taiwan. JAMA Intern Med. 2015; 175: 1550–1557.

4. Alvestad S, Lydersen S, Brodtkorb E. Rash from antiepileptic drugs: influence by gender, age, and learning disability. Epilepsia. 2007;48(7):1360–5.

5. L im VM, Do A, Berger TG et al. A decade of burn unit experience with Stevens–Johnson syndrome/toxic epidermal necrolysis: clinical pathological diagnosis and risk factor awareness. Burns. 20016;42(4): 836-843.

6. K aser DJ, Reichman DE, Laufer M. Prevention of Vulvovagina Sequelae in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Rev Obstet Gynecol. 2011; 4(2): 81-85.

ABOUT THE AUTHOR: Madalene Boyle, MD, is in the emergency medicine residency program at Brown University, The Warren Alpert Medical School.

About the Sex and Gender in Emergency Medicine Interest Group The purpose of the SAEM Sex and Gender in Emergency Medicine (SGEM) Interest Group is to raise consciousness within the field of emergency medicine on the importance patient sex and gender have in the delivery of emergency care and to assist in the integration of sex and gender concepts into emergency medicine education and research. Joining SGEM is now free! Just log into your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

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DIVERSITY AND INCLUSION

“I Matched! But What If They Made a Mistake?” Imposter Syndrome Among Early Residency Trainees

By Daniel Hernandez, MD, and Nancy Rivera, MD, MS

SAEM PULSE | MARCH-APRIL 2019

With the excitement of The Match upon us, thousands of applicants and residency programs across the country are eager to learn the results. At this time, I find myself reflecting about my personal experience leading to Match Day last year. Countless hours of work during medical school, traveling across the country interviewing, meeting other applicants and learning about different programs — all culminating into one piece of paper folded inside an envelope with my name on it.

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After the long-awaited countdown with my family by my side, I opened the envelope to find my first choice residency program written on my letter. I felt a sense of accomplishment that my hard work and my parents’ sacrifices as immigrants to this country had paid off.

This was an unbelievable milestone that I had reached with the help of numerous mentors and the support of my family.

Tears of joy streamed down my face, but very soon after, I began to think, “What if they made a mistake? What if I am not good enough to be their resident?”

It had not been five minutes since I had opened my envelope and I was

already doubting myself. Was this normal? Does everyone else feel this way? As a first-generation college graduate, and first in my family to become a physician, I have been all too familiar with feeling like an imposter.

Fast forward three months and intern orientation began with a presentation by our residency program director. The words, “Imposter Syndrome” filled one slide, along with her words: “If you are in this room, you belong to this program.

You are now a part of our emergency medicine family.”

She’d read my mind! I started to wonder how many of my co-residents— or even faculty members—had experienced the same thoughts of not belonging. By starting the discussion, my program director named our feelings and acknowledged the effect that it can have on our training experience.

The term “imposter syndrome” was coined in 1978 by Clance and Imes as an “internal experience of intellectual phoniness in people who believe that they are not intelligent, capable or creative despite evidence of high achievement.” It is a belief that you are less intelligent or less

capable than your peers—or utterly feeling like a fraud. Imposter syndrome has been documented in medical education, and it is believed to affect a disproportionate number of minorities.

A study of imposter syndrome among family medicine residents concluded that one-third of resident subjects had feelings consistent with imposter syndrome during their training, although 90 percent of them felt the training they received was adequate.

Another study among medical students revealed a correlation with features of burnout including cynicism, emotional exhaustion, and depersonalization.

Imposter syndrome can negatively impact residents, the efficacy of their training, their wellbeing, and the morale of their residency program. Consider the following suggestions for addressing imposter syndrome:

Trainees You Belong, We Belong. Residency is challenging. The process can make trainees believe that they are not good enough, despite devoting their maximal effort. Residents can’t be expected to know everything and mistakes do not

will find some prevalence of imposter syndrome. In times of career transition (e.g., student to resident, resident to attending), imposter syndrome becomes even more common. Since trainees are constantly transitioning into new roles in the clinical work environment, it is particularly important for residency programs to create a safe space to discuss their common challenges.

Acknowledge imposter syndrome and help learners develop a sense of belonging.

The authors on Match Day.

make them imposters. They are trainees for a reason, and with time, experience, and resilience, competency will come.

Remind yourself that you are human and acknowledge the hard work you’ve already put into your education. Own your story and the unique skills and assets you are able to contribute to the care of your patients. Your program wanted you. Your patients need you.

Self-Compassion. It is normal to take time to get acclimated to any new environment. As medical professionals, we tend to focus on what we do not know and what we have done wrong; however, reframing to focus on our successes and what we do know can be beneficial. Be kind to yourself, and remember to reflect on the obstacles you have overcome. Know that you are not alone in feeling inadequate. Be present with your emotions; acknowledge when you see yourself engaging in negative self-talk. Remember that what you do really matters.

Find Mentors. If you recognize the negative thinking of imposter syndrome in yourself, know that you are not alone. Seek out peer mentors or faculty mentors with whom you can share and acknowledge these feelings. You will soon realize this feeling is not unique to you. You are not the only one going through this.

Be a Mentor. There is power in your story. Share your narrative of how you got to where you are now. You will recognize the distance you have traveled, and you will inspire others. You are worth more than you give yourself credit.

Residency Programs Be Authentic. Any residency program, if they monitor their learning climate,

The Power of Storytelling. Increasing awareness of the prevalence of imposter syndrome can be very powerful. Start the dialogue. Be vulnerable and share your experiences dealing with imposter syndrome. Research suggests imposter syndrome limits trainees from applying to and pursuing other advanced trainings or promotions. Provide coaching and mentoring, conduct regular check-ins with your trainees, and offer easilyaccessible mental health support.

Diversity 3.0. It’s not enough to increase the numbers of underrepresented minorities and women in medicine if they feel they do not belong once they are in the program. Create opportunities to empower these residents to develop leadership skills. Allow trainees to explore all career paths. Provide a safe space to speak with mentors. Strive for inclusivity in hiring and promotions.

While imposter syndrome is welldocumented and gaining attention, more research is needed to understand the impact it has on the medical field, particularly during training and in clinical

practice. By sharing your story and taking pride in your accomplishments, you’ll inspire others to expose and overcome the same feelings of being an imposter.

Lastly, congratulations on matching!

Welcome, and you now belong to our emergency medicine family!

ABOUT THE AUTHORS Daniel Hernandez, MD, (@DanHernandezMD) is a PGY1 in the Stanford University/Kaiser Emergency Medicine Residency Program. Dr. Hernandez is a member of the Leadership Education in Advancing Diversity (LEAD) Program at Stanford.

Nancy Rivera, MD, MS is a pediatric PGY1 resident at Lucile Packard Children's Hospital, Stanford Children's Health. Dr. Rivera is a member of the Leadership Education in Advancing Diversity (LEAD) Program at Stanford.

The authors would like to thank Carmin Powell, MD,( @carminmari) co-director of LEAD and clinical instructor at the Stanford Pediatrics Residency Program and Al'ai Alvarez, MD, (@alvarezzzy) steering committee member of LEAD and assistant residency program director of the Stanford Emergency Medicine Program for their mentorship and support in this article.

The LEAD Program provides year-long leadership training and mentorship to residents and fellows in creating scholarly works around diversity and inclusion topics.

SAEM19 Advanced Workshop Day Session to Address Imposter Syndrome Join Drs. Hernandez, Rivera, Powel, and Alvarez for the Advanced Workshop Day session, Leadership Education in Advancing Diversity: The Impostor Syndrome, Microaggressions, and Implicit Bias, from 8 a.m–noon, May 14 at SAEM19 in Las Vegas. This workshop may be added to your SAEM19 registration!

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in health care and outcomes, and insuring that all emergency physicians are delivering culturally competent care. For more information, visit the ADIEM webpage. Joining ADIEM is free! Just log into your member profile and click on the "Update (+/–) Academies and Interest Groups" button.

27

ETHICS IN ACTION

The Case of the Meddlesome Mother

SAEM PULSE | MARCH-APRIL 2019

By Jeremy Simon, MD, PhD

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THE CASE: A 21-year-old female with cerebral palsy presents to the emergency department (ED) accompanied by her mother. She has a history of seizures, and has suffered multiple seizures on the day of admission. After the first two seizures she returned to baseline; however, after a third seizure in the ambulance, she did not return to baseline. The patient had a witnessed seizure in triage, and again soon after being placed in a treatment bay. Each seizure lasted approximately two minutes, and in all cases broke before lorazepam could be administered. The patient continued to seize intermittently in the ED. As the patient was in status epilepticus, the clinical team discussed various options for the management of her seizures. As the patient had no other family present (the patient was unmarried and her father was deceased), her mother was considered the surrogate decision maker during the patient’s period of altered mental status.

However, the mother was extremely suspicious of the medical staff, and

"‌a surrogate decision maker has all the rights and authority the patient herself would have." argued extensively with them at every step: the location and gauge of each IV attempt; gaining intraosseous access when intravenous access was lost; the type of anti-epileptic to be used; intubation, when that was felt necessary for airway protection; and potential deep sedation for seizure control. The mother would eventually relent with each issue, but only after periods of extensive discussion, which delayed adequate control of the patient’s seizure activity and potentially put the patient at risk of permanent neurologic damage. The team wondered whether it would be appropriate to escort the mother to the waiting room and continue appropriate treatment without interferences.

Respect for autonomy is a core principle of medical ethics. The primary way we honor patient autonomy is by allowing patients to make all relevant

health care decisions in line with their goals and values. When a patient is unable to make a decision, whether because of temporary or permanent cognitive impairment, we say that they lack the capacity to make the decision.

(It is important to note that lack of capacity, when it is not profound, must be assessed for the particular decision in question.) When a patient lacks capacity to make a given decision, we turn over decision-making to a surrogate. This can be either a person designated by a health care proxy or medical power of attorney form, or, if this has not been done, the next of kin.

(Laws may vary somewhat by state.

Also, the presence of written advance directives could potentially complicate the case, but that is not our focus here.)

In general, a surrogate decision maker has all the rights and authority

the patient herself would have. The surrogate can weigh in on the same questions, and has the same options the patient would have. Ideally, the surrogate would also make the same decision the patient would. The principle that should guide surrogate decision makers is that of substituted judgement, i.e., what the patient herself would choose were she able. This standard is often contrasted with the best interest standard, but this is a false dichotomy. The patient whose choices we are imagining is an idealized version who is able to make reasonable decisions. It is difficult, if not impossible, to identify the best interests of a patient independent from the decisions he would make were he able, at least not if we value autonomy as a means of deciding what is in one’s best interests.

In practice, it is impossible for anyone to know what a patient would have decided, and little basis usually exists on which to question a surrogate’s judgement. Thus, for most decisions, a surrogate’s decision is accepted without justification, just as a patient’s is. The primary exception is when the surrogate seems to be clearly acting not in the patient’s interests. The most dramatic reason for this is a conflict of interest, though there may be more complicated emotional and psychological reasons as well. In this case, one may consider disqualifying or bypassing the surrogate, although this is not a decision to be taken lightly. If the surrogate himself seems to lack capacity, this too could trigger his removal. Regardless of the reason, if a surrogate is disqualified, whether temporarily or permanently, one would move on to the next closest family member. The medical team does not automatically take over decision making.

In the case described above, the patient is unresponsive and her mother is clearly her surrogate. However, her mother’s decisions in the case are problematic for two reasons. First, she does not appear to be engaging in reasoned decision making; rather, she is slowing things down, exposing her daughter to serious risk of harm.

Moreover, she is doing this largely by inserting herself into decisions patients usually do not weigh in on, such as gauge of IV and choice of anti-seizure medication. Certainly, choice of medication is something that can have some negative effects, and if a patient

"When a patient lacks capacity to make a given decision, we turn over decision-making to a surrogate." with capacity insisted on discussing it we would; however, absent prior bad drug reactions, which can be communicated briefly, concern for such matters is not normal in a patient who is facing an emergent life and brain threatening condition — and neither should it be the focus of a surrogate. Unless the mother can convincingly explain why her prolonged involvement in these purely medical decisions is appropriate when her daughter is facing potential brain damage, the team could reasonably consider ignoring the mother’s involvement, if necessary taking the step of removing her from the bedside.

This is not a decision to be taken lightly, and must be done carefully and respectfully. Inform hospital administration immediately, and if possible, allow them to weigh in first. When bringing the decision to the surrogate, explain that your only motivation is to protect the patient from potentially catastrophic, irreversible harm. It is important to remember (and to inform the mother) that she is not being removed as decision maker permanently, but only being bypassed

temporarily. The medical team and the mother will still need to collaborate on the care of the patient going forward, and so it is important to maintain as much trust as possible. Also remember that in cases such as these, where a surrogate (or even a patient) seems to be involved in decision making but is in fact interfering with the provision of necessary emergency care, the underlying factor may be something else. In this case, given the seriousness of her daughter’s illness, the mother’s actions are perhaps compelled by fear and concern for her daughter. Therefore, although we might be inclined to feel anger and resent towards those who, like this mother, make our jobs difficult, they are deserving of our compassion and respect.

ABOUT THE AUTHOR Jeremy Simon, MD, PhD, is an assistant clinical professor of clinical medicine at Columbia University Vagelos College of Physicians and Surgeons.

He is a member of the SAEM Ethics Committee.

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GRADUATE MEDICAL EDUCATION

Air Force Readiness and Residency Training: Emergency Medicine Gets Its Wings

SAEM PULSE | MARCH-APRIL 2019

By Rory P. Stuart, MD, Roderick W. Fontenette, MD, and David K. Barnes, MD

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Military leaders have long recognized that emergency medicine (EM) physicians are highly versatile medical assets capable of tactical, critical, and routine clinical care from stateside medical treatment facilities to remote locations around the globe. The United States Air Force (USAF) unique role in patient transport has pushed emergency and critical care to the frontlines with EM physicians delivering world-class medicine anywhere at any time. Air Force Critical Care Air Transport Teams (CCATT), Tactical Critical Care Evacuation Teams (TCCET), and Ground Surgical Teams (GST) are redefining the boundaries of point of injury and en route care with EM physicians leading the way. In addition to operational missions, EM physicians are increasingly involved in leadership positions such as the USAF Air War College.

Training Options Currently, all three branches of the armed services train EM physicians in military and civilian programs across the country. Candidates from the Uniformed Services University of the Health Sciences (USUHS) and Health Profession Scholarship Program

(HPSP)-affiliated programs, and current active duty physicians apply to residency programs through the Joint Services GME Selection Board, a match-like collaborative that serves all military branches. At present, the USAF sponsors emergency medicine residents at San Antonio Military Medical Center (Texas), Wright State University (affiliated with Wright Patterson Medical Center in Dayton, Ohio), University of Nevada School of Medicine (affiliated with Mike O’Callaghan Military Medical Center at Nellis Air Force Base, Nevada), and most recently the University of California, Davis Medical Center in Sacramento, California (affiliated with David Grant Medical Center at Travis Air Force Base, Fairfield, California). Upon graduation, physician-officers serve in clinical and leadership positions across the Air Force.

The EM program at San Antonio comprises a partnership with the Army while the three remaining programs are “integrated” Air Force residencies, describing their collaboration with civilian academic institutions. Integrated Air Force residents complete the same ACGME-accredited three or four-year core emergency medicine curriculum

as their civilian counterparts. While integrated residents are on active duty orders throughout their training, deployment is unlikely. These residents are entitled to pay and benefits commensurate to their rank and grade, and program graduates are eligible for board certification by the American Board of Emergency Medicine. Upon completion of integrated residency training, Air Force graduates will enter into the Air Force Medical Corps (AFMC) as emergency medicine physicians.

Military Matching The Military match cycle begins in July and applicants rotate and interview with programs through early fall. Applications are typically due in mid-October to the Joint Services GME Selection Board whose members convene in November and announce match results in early December. Applicants are offered one of four distinct training positions: an active duty position, civilian sponsorship, a deferral to enter the civilian match, or a preliminary PGY-1 position. Civilian sponsorship is a unique opportunity

care, academic, Level 1 adult and pediatric trauma center and burn center.

With a catchment area for millions of Californians, UCDMC serves as a critical referral facility for northern California and its bordering states. The Air Force affiliation allowed the program to expand by five additional residents (one additional position was added but funded through a community partnership).

whereby highly qualified applicants are granted full Air Force sponsorship at a civilian EM residency program. Like their traditional active duty counterparts, sponsored residents are on active duty orders and receive full military pay and benefits during their residencies. Civilian sponsored residents are still required to apply to their desired civilian programs through the National Resident Match Program (NRMP). Select civilian EM programs have worked extensively with the ACGME, NRMP, and USAF to streamline the application and interview process for Air Force students who are entering the match with military sponsorship.

The UC Davis Experience In 2016, the Air Force entered into a partnership with the University of California to integrate active duty residents into the emergency medicine residency program at UC Davis Medical Center (UCDMC). The EM residency program at UCDMC accepted 14 civilian residents each year prior to integration. The choice of clinical training sites is based on the potential for trainees to have consistent and robust experience caring for trauma patients. UCDMC is a 600+ bed, urban, tertiary

The preparatory phase took more than two years and required support from hospital, department, and program stakeholders. It was necessary to obtain ACGME approval for the necessary complement increase, initially through annual temporary complement increases, and finally through a permanent complement increase. It was also necessary to adjust the program’s NRMP match quotas, to request a unique NRMP match code for civilian sponsored applicants (separate from the program’s main match code), and to apply for exemptions to NRMP’s all-in policy because active duty positions are filled outside the formal match process.

Although the learning environment changed little except for the size of the program, messaging to current and prospective residents was critical given the potential for a larger residency class to change the program dynamics and culture.

After filling two active duty positions in December 2016, the program matched three civilian sponsored positions in March 2017. In June of 2017, the five Air Force residents entered the newly expanded class of 20 total residents. This process was repeated in the 2017-18 match cycle with five more Air Force residents entering the program. Given the initial success, the Air Force expanded the traditional active duty positions from two to four for 2018-19 with plans to continue to match one additional civilian sponsored resident through the NRMP match.

The value to the Air Force of an expanded training presence at a top tier academic medical center cannot be overstated. The augmented class size not only boosted the number of Air Force EM physicians in the training pipeline but also created a multitude of training and partnership opportunities for the host program. Along with the five residents in each class, the Air Force sponsors two board certified emergency medicine physicians who work full time at UC Davis Medical Center to supervise and teach all EM residents and offer unique instruction in military medical curriculum to the Air Force residents.

The Future Today’s military medical corps is undergoing transformation unseen since the onset of the Cold War. The stresses of prolonged deployed operations and a diminished active duty patient population have created the need for continued clinical currency in critical trauma and emergency medical skills. Civilian partnership is vital to the medical corps’ maintenance of clinical competency.

Partnerships with civilian institutions offer opportunities for military physicians and trainees to have access to unparalleled clinical experiences while allowing civilian programs to expand and diversify during times of static or even diminishing GME funding. Partnerships for Air Force EM faculty will continue to grow with additional opportunities to embed EM physicians at civilian level 1 trauma centers in geographical proximity to select Air Force bases. These physicians will practice high acuity emergency medicine and deploy with a higher level of clinical proficiency.

The Air Force increasingly recognizes the value added to the medical corps by emergency medicine physicians. Today’s Air Force EM physician is just as likely to attend Air War College as to lead a CCATT (Critical Care Air Transport Team) mission down-range. With a diverse clinical skill set and effective leadership attributes, Air Force EM physicians will ensure the success of the next generation medical corps.

ABOUT THE AUTHORS Rod Fontenette, MD, Major, USAF, is an assistant professor in the department of emergency medicine at the University of California, Davis Rory Stuart, MD, Major, MC, USAF, is an assistant professor in the department of emergency medicine at the University of California, Davis David K. Barnes, MD, is professor of clinical emergency medicine and residency program director in the department of emergency medicine at UC Davis Health, Sacramento, California.

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SOCIAL MEDIA IN ACADEMIC EM

Measuring Quality in FOAMed

SAEM PULSE | MARCH-APRIL 2019

By Eric Lee, MD

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The number of blogs and podcasts dedicated to emergency medicine has grown substantially over the years.

More and more learners are obtaining a significant part of their education from FOAMed. However, the perceived ease of creating a blog or podcast raised questions about the potential quality of its educational content. These were important questions that would need to be addressed for FOAMed to flourish and gain further acceptance in traditional academic venues.

Fortunately, medical educators and researchers recognized early on that quality control would be an important element in FOAMed — and the first step would be learning how to measure quality in FOAMed. Since the inception of FOAMed, there has been a large and growing body of

"A concrete body of knowledge on FOAMed quality helps to underscore the legitimacy of FOAMed in academic medicine for the few remaining who may still not be fully convinced." research focused on measuring quality in FOAMed. Leaders to follow in the field include Brent Thoma (@Brent_Thoma) and Teresa Chan (@TChanMD), as well as a team of collaborators from various institutions who have spent the last few years studying several validated and reliable rubrics for measuring quality. Some of the most interesting research comes from Academic Life in Emergency Medicine (ALiEM)

(@ALIEMteam) and the METRIQ Study (@METRIQstudy), which has produced 17 published studies to date on the topic, looking at and comparing various systems for measuring quality in FOAMed including educator gestalt, ALIEM Air scoring rubric, METRIQ-8 criteria, and the Social Media Index.

In the FOAMed spirit, the METRIQ Study research team recognized the

importance of free open access to research as well, and it has conveniently provided access to all of these studies in one place. If you are interested in FOAMed, I highly recommend reading more of the specifics. You can find PDFs of their research publications at https://metriqstudy.org/research-agenda/.

In some ways, FOAMed already undergoes a more rigorous review process than traditional academic textbooks. Rosen’s and Tintinalli’s emergency medicine guides get revised every few years, but FOAMed is subject to continuous real-time critical appraisal from users around the world. Most blog posts of popular emergency medicine websites and podcasts are peer-reviewed by other knowledgeable educators in emergency medicine.

Nevertheless, this research is critically important to medical education. A concrete body of knowledge on FOAMed

quality helps to underscore the legitimacy of FOAMed in academic medicine for the few remaining who may still not be fully convinced. This research is also very valuable to both producers and consumers of FOAMed. Producers and editors are able to use the best practice recommendations and guidelines that are developed from the research to ensure high quality FOAMed creation, and learners are able to critically evaluate the quality of their educational resources and make more informed choices.

ABOUT THE AUTHOR Eric Lee is an attending physician at Maimonides Medical Center in Brooklyn, NY. He can be reached on Twitter @EricLeeMD

"Most blog posts of popular emergency medicine websites and podcasts are peer-reviewed by other knowledgeable educators in emergency medicine."

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REJECTING RESIDENT WELLNESS, EMBRACING RESIDENT WELL-BEING

By Alina Fomovska, MD, Lily Muldoon, MD, MPH, and Stephen Villa, MD We hear it over and over again: “Our institution supports resident wellness!”

We all recognize that resident burnout is real and that emergency medicine residents are at particularly high risk.

In national studies, burnout among emergency medicine residents ranges from 49 percent to 65 percent. Moreover, the impact of burnout during residency is not a transient experience, and emotional distress and depersonalization can persist into professional life and practice.

These days, many conferences, academic forums and newsletters have a section on supporting resident “wellness.”

But what does this really mean?

Experienced physicians, administrators, and clinical psychologists make recommendations. We are told to eat healthier, exercise, meditate, do yoga, create a sleep schedule and spend time with friends and family. We are warned that alcohol, caffeine, and sugar are not healthy or sustainable means of processing difficult emotional states. Institutions even implement these concepts into formal training to “construct a personal strategy for coping with sleepiness.”

Yet, residents seem to dread “wellness” talks. While well-intentioned, many of the advised interventions place the burden of achieving wellness on the resident alone, bestowing a marker of personal failure upon those who become affected by burnout. We need to pivot our framework and nomenclature to prioritize resident health and consider “well-being” on a system-wide level.

Emergency medicine residents do not work within systems where well-being can be achieved with quick and easy interventions. Residents may feel unable to leave a busy emergency department to eat, let alone “eat healthier.” It is not feasible to schedule quality time with loved ones when we leave for work before our partners wake and return after they have gone to sleep. We cannot rely on our co-residents to help process difficult experiences as our conflicting schedules prevent us from connecting with one another.

Strained to juggle rotating shift schedules and didactic requirements, residents often drive home in dangerously

"WHILE WELL-INTENTIONED, MANY OF THE ADVISED INTERVENTIONS PLACE THE BURDEN OF ACHIEVING WELLNESS ON THE RESIDENT ALONE, BESTOWING A MARKER OF PERSONAL FAILURE UPON THOSE WHO BECOME AFFECTED BY BURNOUT. "

tired conditions. This is just a short selection of system-level challenges faced by residents in the emergency department.

As chief residents at the University of California, San Francisco–Zuckerberg San Francisco General Hospital emergency medicine residency, we are working to change our approach towards well-being. We cannot control hospital systems, graduate medical education (GME) requirements, or off-service rotations; however, we can address the challenges faced by our colleagues within the emergency department, and allow our field to lead the way in evolving medical training culture.

Our goal is to generate a discussion of realistic efforts that residency programs may take on in order to reject “wellness” and embrace resident “well-being.” Below, we outline five initiatives. Our ideas are not novel, and certainly invite further development and discussion, but may present an approach for programs taking on these priorities.

1. Provider Rounds

We are not “immune to the same basic physiology that we have devoted our lives to understand.” (Humikowski) It is

important for residents, as humans, to eat food on a regular basis. Yet despite this, across the country, many residents often work full shifts without food, water, or even bathroom breaks.

Generalized directives of “make sure you eat well-balanced today!” garner as much success as the above-mentioned wellness lectures. To combat this, we have implemented “Provider Rounds”: a designated time every shift for residents to have a meal. The senior resident takes responsibility for reminding the team to convene. Provider Rounds are announced overhead at a scheduled time. Nursing and ancillary staff know that non-emergent issues and questions can be addressed after Provider Rounds, thereby minimizing interruptions. As a result, the majority of our residents are able to eat a meal during a shift, recharge, and engage as more productive, empathetic, and less hypoglycemic members of the team.

2. Schedule Requests

We prioritize optimizing resident schedules, generating schedules that not only respect the circadian rhythm but also give residents more of their requested time off. Our scheduling software is inadequate at granting individual schedule requests and so we make significant manual adjustments to maximize residents getting requested days off. While we cannot change the number of hours residents work, we can, to a degree, change the hours when they work. With these modifications, residents may engage in activities that promote their well-being outside of the hospital. We aim to release the schedule at least

six weeks in advance, allowing residents to plan vacations and travel. This system is possible because of our administrative support as well as our chief resident structure, which allows our chiefs designated time to make these frequently-laborious schedule changes.

3. Holidays

The winter months are often the most difficult time of year for burnout and mental health. Missing the opportunity to see loved ones during the holiday period can further exacerbate the added stress felt during this time. Our program has created a system that permits residents six consecutive days off during the holiday season, allowing for an opportunity to travel and connect with loved ones. This goal is achieved by rearranging the schedule without affecting scheduled vacation weeks. The holiday season is divided into two six-day blocks, spanning either Christmas/Hanukkah or New Years. Residents expect to work a heavier shift load during one block and be free from clinical duties during the other. Our residency leadership has prioritized holiday staffing by assigning more emergency medicine residents to emergency department blocks during the holiday period (by limiting elective, and when possible, offservice rotations in December), thereby allowing time off while maintaining adequate staffing.

continued on Page 36

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REJECTING RESIDENT WELLNESS from Page 35

4. Class Day

During difficult times, we rely heavily on our community to process and endure. A great bulwark may be the class structure of residency, with small groups of individuals undergoing a shared experience. However, overlapping and conflicting schedules often make it difficult for residents to access this invaluable resource. In order to foster community and provide an opportunity for residents to bond, process, and debrief together, we have created “Class Days.” Twice per year, each class is scheduled a collective “off” day from emergency department duties (for us, 7 a.m. Saturday to 7 a.m. Sunday). Because we cannot control off-service schedules, two days per year are needed to maximize the ability of residents to attend at least one Class Day. Residents have taken this time to take trips together, throw baby showers, celebrate each other’s life events, and share with one another their families and passions. In short, they are able to support one another.

5. Relationships

We are all familiar with the frustrating feeling of taking a difficult conversation with a consultant home with us.

Negative relationships at work contribute to stress and burnout, while strong and positive relationships support us during challenging times. We implemented conscious efforts focused on fostering interdisciplinary connections in our work environment. Through regular nursing-resident social hours, quarterly emergency/internal medicine meet-ups, and annual faculty versus resident sports games, we strive to create a space to build a feeling of teamwork and personalization among our co-workers. Promoting these relationships creates a supportive work environment and allows us to have more resilient connections.

We conducted an internal chief's survey mid-way through the year after implementation of these initiatives. The results showed a very favorable response from the residents and we are moving to expand these programs across our sites.

None of these efforts would be possible without the strong support of our residency leadership and administration. We acknowledge our leadership who give inspired residents latitude to make effective change and value our well-being as a priority. We certainly do not have all of the answers, but once we accept that the current paradigm of wellness is flawed, and recognize our system failures, we can make strides to improve the health and happiness of residents and thereby our patients and communities.

ABOUT THE AUTHORS: Alina Fomovska, MD, University of California, San Francisco–Zuckerberg San Francisco General Hospital Emergency Medicine Residency, Class of 2019.

Lily Muldoon, MD, MPH, University of California, San Francisco–Zuckerberg San Francisco General Hospital Emergency Medicine Residency, Class of 2019.

Stephen Villa, MD, University of California, San Francisco–Zuckerberg San Francisco General Hospital Emergency Medicine Residency, Class of 2019.

MAKING THE CASE FOR GREATER PARAMEDIC INVOLVEMENT IN PREHOSPITAL CLINICAL RESEARCH

By Ryan D. Pappal, BS, BA, NRP Imagine you’re a medic in the middle of a busy shift when you receive a call for a 63-year-old male experiencing sudden crushing chest pain — a situation you’ve handled a hundred times before. Vitals reveal HR 102, BP 146/92, and SpO2 98 percent. Your partner moves to put on high-flow oxygen.

Remembering a recent change to oxygen administration guidelines, you stop him, pointing out the sufficient SpO2 on room air. During transport, you administer 325 mg of aspirin and start an IV. A 12-lead ECG reveals a STEMI, and you transport your patient to the nearest appropriate facility where he is treated and makes a full recovery.

After you return to the station, you talk over the call with the other medics on duty. You ask why the protocols were recently changed for uncomplicated chest pain to give oxygen only when SpO2 drops below 94 percent. One of your partners mentions that the 2015 update to the American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care made the change, although she can’t recall the reason. Before you have time to look it up, you are dispatched to your next call.

The changes and updates in EMS protocols are regularly informed by research. In the 2015 AHA ECC guidelines, the authors cited a study showing that routine oxygen use in cases of uncomplicated myocardial infarction (MI) may worsen the infarction. Other classic treatments have been supported or reversed from research discoveries. Several studies have shown the Trendelenberg position ineffective in treating shock, and it has since been phased out. In the past few years, video laryngoscopy has been shown to improve intubation first-pass success rate, overall success rate, and time-to-ventilation by paramedics. Recently, research has even challenged the role of epinephrine in out-of-hospital cardiac arrest, noting poor neurologic outcomes following its use. As we continue to push for improvements in our medical treatment, research will play an integral role in prehospital advances.

However, the additional stress of a service’s research projects on its on-duty medics may be overwhelming.

Paramedics report that the time necessary to consent patients for studies, fill out obligatory paperwork, and select and administer experimental interventions significantly contributes to their workload. This can lead to some prehospital providers resenting research studies.

As EMS researchers, we should be creative in improving the quality of prehospital research while also making data collection procedures more efficient and reasonable for the on-duty medics tasked with collecting it. I argue one solution is regularly including medics on research teams. Medics could provide valuable insight on how to streamline data collection to have less of an impact on on-duty personnel during patient

care. Research has also shown that interdisciplinary teams are better at solving complex problems, and therefore a medic’s perspective may help in designing higher-quality studies. With medical researchers under the gun to conduct more robust, accurate studies that are impactful on how we treat patients, I would argue it’s more important than ever to include medics regularly in prehospital research.

Additionally, including medics on research teams would provide a robust form of continuing education as it promotes deeper understanding of scientific principles. Some experts have long called for the advancement of EMS education to include deeper understanding of prehospital care, and I argue that exposure to prehospital research is a critical supplement to medics’ initial education.

Why do we give less epinephrine for anaphylaxis than for cardiac arrest? Why do we use normal saline extensively but lactated Ringer’s rarely? Why do we avoid giving ondansetron to pregnant women? It’s one thing to know these facts as a set of protocols and another to understand the scientific bases underlying them. As an EMT and paramedic for more than five years, I’ve seen EMS education focus more on protocolization and less on understanding scientific and medical principles. I believe the benefits of bringing medics onto research teams are two-fold: to improve the quality of prehospital research, and to provide medics a unique opportunity to improve their medical science knowledge base.

As we move the field of EMS forward, we must continually push for higher expectations for our medics, beginning by supporting their intellectual growth in novel ways.

ABOUT THE AUTHOR: Ryan D. Pappal, is a second-year medical student at Washington University School of Medicine in St. Louis.

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TIPS, TRICKS, MYTHS, AND LEGENDS: A COUNTDOWN TO SAEM MEDWAR 2019

By Jeffrey Wayland, MS-4 Hello and welcome to the second installment of “Tips, Tricks, Myths, and Legends.” As a reminder, this series will discuss both awful and optimal ways to manage various wilderness scenarios as part of a countdown to MEDWARS with the hope that it will encourage and embolden you to join with your friends in our all-our wilderness medicine simulation race during the 2019 SAEM conference in Las Vegas!

PART 2: HEAT EMERGENCIES Feelin’ Hot, Hot, HOT!

It might be cooling down wherever you are right now, but in Vegas it will just be warming up! Imagine that you and your mate Jeff have decided to arrive a few days early to SAEM19, rent some mountain bikes, and hit the trails. You’re two hours in and you’re near the end of a long climb, and you notice that Jeff has started to lag behind. As you crest the top and look back, you see he’s dismounted his bike and is sitting on the ground. You pedal back to him and ask how he’s doing. You notice he’s bright red and breathing heavily. He looks up at you, mumbles something incoherent, vomits all over your new bike shoes, and passes out.

Back to Basics

Before we talk about how to treat poor Jeff, let’s talk about what went wrong. Exertional heat stroke is one of those sneaky emergencies that most often affects young, healthy people. Not only that, but initial signs and symptoms might mimic normal physiologic changes you are likely to see following athletic activity.

Is the 23-year-old woman who just ran a marathon and is flushed, tachycardic, tachypneic, and having trouble walking in imminent danger or did she just exert herself to a high degree while running a tough race? Does Jeff need urgent medical treatment or just some time in the shade?

Back to Jeff "THE NUMBER ONE TOOL YOU HAVE IN YOUR TOOL BOX AS A WILDERNESS PROFESSIONAL IS EXTRACTION. "

Often the most important aspects of heat emergencies in austere environments is simply recognizing that they’re happening. Think about risk factors such as poor acclimatization, sympathomimetic drug use, burns (even sunburns), and/or extremes of age. Look for confusion, nausea, flushing, tachycardia, tachypnea, and syncope as good signs that things are not going to resolve on their own and that your buddy might need medical management. If resources allow, obtaining a rectal temperature (sorry Jeff!) above 40° C should push you over the edge towards “big sick.” This also helps you rule out the heat stroke mimic of hyponatremia, which can produce similar physical symptoms but usually without high temperature.

Homeopathologic

So we remember from our wilderness medicine epidemiology courses that we took in medical school that Jeff’s mortality with heat stroke can be as high as 33 percent. (Austin and Berry) Obviously, the first thing we do is run to the side of the trail, grab some belladonna root, and shove it in his mouth to increase his chances of a good outcome. Wait. That’s actually the opposite of what we want to do. Believe it or not, Belladonna (or DEADLY NIGHTSHADE) is still recommended by some as an herbal remedy for heat stroke. I’m sure you remember from your herbology classes in medical school that the active ingredient in Belladonna is atropine, which is an anti-muscarinic, which INHIBITS SWEATING! Please excuse my excessive use of journalistic yelling here, but the number two rule of wilderness medicine is “don’t poison your patients by giving them poisonous plants.” Do you know what the number one rule is?

GTFO!

That’s right! The number one tool you have in your tool box as a wilderness professional is extraction. The best treatment for almost any wilderness ailment is to get to definitive care.

But While you Wait…

Although strong evidence is hard to come by, (imagine designing that RCT) current wilderness medicine guidelines recommend immersive cooling as the first line for exertional heat stroke. (Lipman, et al) Throw your friend into a pool of water filled with ice and get his core temp down as quickly as possible. Obviously, this is hard to do in the middle of a desert, which again is why evacuation is your friend.

Since you don’t have a kiddie pool full of water along your ride route, you make do, and dump some water over Jeff.

Soaking his jersey and removing his helmet will increase evaporative cooling; moving him to the shade will reduce the radiant heat source. If oral fluids are tolerated, opt for something with carbohydrates and electrolytes such as diluted Gatorade. Remember: thirst centers aren’t stimulated until plasma osmolality climbs to 1-2 percent above normal, so it’s a poor indicator of heat illness. Finally, if you have access to ice, pack the axillae, groin, neck, and chest wall.

Luckily for Jeff, you are close to a fire road and are able to call for help. He is evacuated to definitive care, treated appropriately, and begins to think you might be a bad friend to travel with.

As always, if you want to learn more, we recommend The Field Guide to Wilderness Medicine by Paul S. Auerbach, et al (Chapter 5) and, if Dr. Auerbach is reading, we’re still open to an advertising deal!

ABOUT THE AUTHOR: Jeff is a medical student at Ochsner Health System and president of the Ochsner Medical Student Association Emergency Medicine Interest Group (EMIG). If you have a request for a wilderness medicine topic to be covered, please send him an email.

Save the Date for SAEM's First Ever MedWAR! Registration for teams of three is now open for the first ever SAEM MedWAR, May 17 at Red Rock Canyon during SAEM19 in Las Vegas. MedWAR, short for Medical Wilderness Adventure Race, is a unique event that combines wilderness medical challenges with adventure racing. The race was developed as a tool for teaching and testing the knowledge, skills, and techniques of wilderness medicine, and for promoting teamwork and collegiality among competitors. If your institution is interested in sponsoring your team for this inaugural event, please complete the sponsorship form.

MedWAR is sponsored by SAEM RAMS, along with the SAEM Wilderness Medicine Interest Group, the SAEM19 Program Committee, and the MedWAR organization.

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olor Guide Roadmaps C Critical Care Critical Care

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RAMS INTRODUCES ROADMAPS: THE DEFINITIVE GUIDE TO ACADEMIC CAREERS IN EMERGENCY MEDICINE FOR RESIDENTS AND STUDENTS

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Meanwhile, Research Ultrasound Wilderness Research Ultrasound Wilderness Roadmaps Chief Editor John Hurley, an MD candidate in The Medicine Brody School of Medicine at East Carolina University explains Medicine how the project came about and why it’s important.

part of this project speaks to the successful navigation of preclinical and clinical years, VSLO, Away rotations, SLOEs, and Wilderness Pediatric Ultrasound interviews to name a few.

Medicine How will you use RAMS Roadmaps during your residency?

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How would you have benefited from a RAMS Roadmaps resource during medical school?

I would have certainly kept it a favorite as the foundations

for each student to build their career of off. Every great structure needs a skeleton in place or scaffolding to support it. I am excited that our team was able to come together, gain support from legends in the various academic tracks and create a user friendly, hassle free instruction manual.

Everyone needs a map if they are navigating an unknown.

Allow Roadmaps to support you on your quest!

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the mentorship of medical students globally who desire to conduct away rotations here, apply here for residency, Fellowship and or get their license to work here in the US as a consultant. As stated before, this a Roadmap to support those in emergency medicine to achieve their personal goals however they look.

Absolutely there was. The biggest one was when I finally grasped that this was not intended to be a guide to Fellowships. Instead this gives guidance and support to the individual who has an academic interest and wants to explore it. However, if you would like to pursue fellowship Any advice to medical students looking at opportunity then you will need to plan in advance for the a career in emergency medicine? timelines and requirements.

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41

BRIEFS AND BULLET POINTS SAEM NEWS In Memoriam

This spring, at SAEM19, 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 since April 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.

New Ask-a-Chair Podcasts From RAMS

Angela M. Mills, MD

Gail D’Onofrio, MD, MS

The newest RAMS Ask-a-Chair podcasts feature Angela M. Mills, MD, chair of emergency medicine and the J.E. Beaumont Professor of Emergency Medicine at Columbia University Vagelos College of Physicians and Surgeons, and Gail D’Onofrio, MD, MS, professor and chair of emergency medicine, Yale School of Medicine.

Dr. Mills discusses differences between being vice chair and chair, the challenges facing emergency medicine chairs, and how residents interested in administration can position themselves to become medical directors or to take similar leadership roles in academic emergency medicine.

Dr. D’Onofrio discusses her biggest challenges as founding chair of the emergency medicine program at Yale University and how she juggles the responsibilities of that role with conducting research. She also offers advice to medical students, residents, and junior faculty looking to make their entrances into research and to female medical students and physicians looking to further their careers in research or administration.

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SAEM Premieres Academy Podcast Series From RAMS

In January 2019, SAEM Residents and Medical Students (RAMS) introduced a new SAEM academy podcast series. The first podcast features Christopher Strother, MD Christopher Strother, MD, past present of the SAEM Simulation Academy. David Lewandowski, PGY-4 from Lincoln Medical and Mental Health Center, moderates.

In the second podcast of the series, 2018– 2019 AEUS (Academy of Emergency Ultrasound ) president Creagh Boulger, MD, takes a deep dive into Creagh Boulger, MD SonoGames. Caitlin Rublee, MD, MPH, a PGY-3 at The Ohio State Wexner Medical Center, moderates.

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, Disaster, Education Scholarship, Geriatrics, Global EM, Research and Wilderness. To view a list of approved fellowships, visit the SAEM Fellowship Directory.

A New Podcast for Researchers: How to Turn Your Interest into Research

In the newest podcast episode from the SAEM Research Learning Series (RLS), Dr. Zachary Meisel, associate professor of emergency medicine Dr. Zachary Meisel at the Hospital of the University of Pennsylvania and chair of the SAEM Research Committee, shares practical advice, framed by his own personal path to building a successful research career.

Provided in partnership with Academic Life in Emergency Medicine (ALiEM), the SAEM Research Learning Series provides live, online education on popular emergency medicine research topics.

SAEM REGIONAL MEETINGS Plan to Attend an Upcoming Regional Meeting

SAEM regional meetings provide opportunities to present original research and to participate in sessions designed to teach essential research skills. Register now for an upcoming regional meeting near you.

Western Regional Napa Valley, CA, March 21-22 New England Regional Worcester, MA, March 27 Mid-Atlantic Regional Washington, DC, March 30

SAEM ACADEMIES

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 Simulation Academy Business Meeting on May 16 during SAEM19. Deadline: March 15.

AAAEM New Executive Committee Members Announced The Academy of Administrators in Academic Emergency Medicine (AAAEM) has announced that the following individuals were elected to the AAAEM Executive Committee: Treasurer Amy Jameson, MPhil, MA, MBA, University of New Mexico School of Medicine

Faculty Assessment of Emergency Medicine Resident Grit: A Multicenter Study Original AEM E&T Article

Turning Your Educational Work Into Scholarship Original AEM E&T Article

ICYMI: AEM January and February Editor-in-Chief Picks of the Month

Members-at-Large Tim Sullivan, MHA, FACHE, Thomas Jefferson University David W. Calder, MBA, Loma Linda University School of Medicine In addition, Steven Camp, Medical College of Wisconsin Affiliated Hospitals, was appointed the SAEM President Associate to the AAAEM Executive Committee.

AAAEM Executive Committee members will be installed at the AAAEM annual retreat in March.

SAEM JOURNALS

AEM E&T Accepting Applications for Fellow-in-Training Editor Program The AEM Education and Training (AEM E&T) Fellow-in-Training Editor Program is open to any SAEM member who is a current resident and who will start a medical education fellowship in the summer of 2019 OR is a current fellow in a 1- or 2-year medical education fellowship program. The fellow appointment to the Editorial Board of AEM E&T is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts.

Application deadline is March 15.

AEM Education and Training Accepted for Inclusion in Scopus

AEM E&T was recently accepted for inclusion in Scopus — the world’s largest abstract and citation database of peer-

reviewed literature. All journals covered in the Scopus database are reviewed each year to ensure high quality standards.

The complete Scopus list is on the SCImago Journal Rank (SJR) website.

The SJR indicator is a measure of scientific influence of scholarly journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals from where such citations come.

Add These January-February Journal Podcasts to Your Listening Lineup

AEM journal podcasts cut down on knowledge translation by providing top-quality audio content, with links to accompanying articles. All SAEM podcasts, including journal podcasts, are also available on iTunes. You must be signed you must be signed in with your SAEM login information in order to view these original journal research articles.

MAGNESIUM AF Original AEM Journal Research Accompanying Blog Post

Prognostic Accuracy of the HEART Score for Prediction of MACE in Patients With Chest Pain Original AEM Journal Research

Test Characteristics of POCUS for Retinal Detachment in the ED Original AEM Journal Research

Wake Me Up Before You Go-Go Original AEM Journal Research Accompanying Blog Post

Academic Emergency Medicine (AEM) Editor-in-Chief, Jeffrey A. Kline, MD, selected the following papers for his picks of the month for January Jeffrey A. Kline, MD and February 2019.

Please note you must be signed in at saem.org to access the papers online.

January

Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study EIC Kline’s Commentary “What to do With Lazarus?”

February

Access to Federally Qualified Health Centers and Emergency Department Use Among Uninsured and Medicaidinsured Adults: California, 2005 to 2013 EIC Kline’s Commentary “Science Trumps Empiricism (Humans Are Bad at Math)”

“Grit” is the Focus of the Latest AEM E&T Editor Pick

Academic Emergency Medicine Education and Training (AEM E&T) Editor Susan Promes, MD, selected two manuscripts to highlight in her editor Susan Promes, MD pick commentary for the most recent issue of the journal, published in January 2019: • The Relationship Between Grit, Burnout and Well-being in Emergency Medicine Residents • Faculty Assessment of Emergency Medicine Resident Grit: A Multicenter Study Download a full PDF of the January issue of AEM E&T or read it online.

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SAEM FOUNDATION Meet the 2019 SAEM Foundation Grantees!

Scott Pasichow, MD, MPH and Rachel Solnick, MD, MSc Rhode Island Hospital 2019 SAEMF/AWAEM Research Grant - $5,000 Family Leave in Residency: Program Director Survey Read Abstract

Gifts to the SAEM Foundation fund the most promising researchers and educators in academic emer-gency medicine.

Here are this year’s bright stars:

Samuel Francis, MD Duke University 2019 Research Training Grant - $298,465 Platelet Kinetics in Acute Thrombus Formation in Healthy and VTE Patients Read Abstract

Colin Greineder, MD, PhD University of Michigan 2019 Research Large Project Grant $150,000 Resuscitating the Endothelial Protein C Pathway Post-Cardiac Arrest Read Abstract

Ryan Coute, DO University of Alabama at Birmingham 2019 SAEMF/RAMS Residents Research Grant - $5,000 Disability-adjusted Life Years Following Outof-hospital Cardiac Arrest Read Abstract

Callan Fockele, MD, MS University of Washington 2019 SAEMF/NIDA Mentor-Facilitated Training Award- $12,000 Creating a Safety Net in Washington: Establishing a Regional Program for the Initiation of Buprenorphine for Opioid Use Disorder from the Emergency Departments in King County Read Abstract

Lyudmila Khait, MD Wayne State University 2019 Education Project Grant - $20,000 Point-of-Care Echocardiography Learning Curves: Establishing Resident Proficiency Read Abstract

Austin Kilaru, MD Perelman School of Medicine at the University of Pennsylvania 2019 SAEMF/NIDA Mentor-Facilitated Training Award - $12,000 Connecting Emerging Policy and Research to Improve Linkage to Treatment for Opioid Use Disorder Read Abstract

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Anjni Joiner, MD Duke University 2019 SAEMF/GEMA Research Pilot Grant $10,000 Healthcare Access Barriers and an Evidence Based Solution in a Low-Income Country Read Abstract

Melissa Joseph, MD Yale Center for Medical Simulation 2019 Education Project Grant - $20,000 Creating a Stress Inoculation Course Using Biofeedback and Physiologic Response Read Abstract 019 Simulation Academy Novice Research 2 Grant - $5,000 Task Stress State and Physiologic Response during Medical Simulation Read Abstract

Adrian Haimovich, MD, PhD Yale School of Medicine 2019 SAEMF/RAMS Residents Research Grant - $5,000 Computational Phenotyping of Heart Failure Patients in the Emergency Departments Read Abstracts

Travis Murphy, MD University of Florida 2019 SAEMF/RAMS Residents Research Grant - $5,000 Adaptation of Piglet Model to Adult Swine Ventricular Fibrillation Arrest Resuscitation with Perfluorocarbon Emulsion Read Abstract

Eric Reed, BS The MetroHealth System 2019 SAEMF/RAMS Medical Student Research Grant - $2,500 Utilization and Efficacy of Novel Emergency Department Based Peer Recovery Coach Program to Combat Substance Use Disorder Read Abstract

Timothy Gleeson, MD University of Massachusetts Medical School 2019 SAEMF/AEUS Research Grant $8,825 Point of Care Ultrasound to Predict Progression of Dengue Fever Read Abstract

Nicholas Pettit, PhD, DO Indiana University 2019 SAEMF/RAMS Residents Research Grant - $5,000 The Incidence of Diagnosing Cancer in the Emergency Department Read Abstract

Phillip Summers, MD, MPH University of California, Davis 2019 SAEMF/RAMS Residents Research Grant - $5,000 Improving Resident Empathy and Effectiveness in Caring for People Who Use Drugs Read Abstract

Jinny Ye, MD Duke University 2019 SAEMF/RAMS Residents Research Grant - $5,000 Prehospital Termination of Resuscitation in Outof-Hospital Cardiac Arrest Read Abstract

Farhan Chaudhry, MS Wayne State University 2019 SAEMF/RAMS Medical Student Research Grant - $2,500 Single-Cell Transcriptional Profiling of Circulating Lymphocytes Associated with Cardiac Fibrosis Read Abstract

Spencer Seballos, BA Cleveland Clinic Foundation 2019 SAEMF/RAMS Medical Student Research Grant - $2,500 Lab Sample Hemolysis: Emergency Nurses’ Knowledge, Attitudes and Practice Read Abstract

Ryan Pedigo, MD Harbor-UCLA Medical Center 2019 Education Research Grant - $100,000 Development and Implementation of a Standardized Emergency Medicine Formative Evaluation Tool Read Abstract

Jason Rotoli, MD University of Rochester 2019 SAEMF/ADIEM Diversity and Inclusion in EM Research Grant - $3,000 Prehospital Communication Barriers and the Deaf ASL User Read Abstract

Norah Kairys, MD Temple University 2019 SAEMF/RAMS Residents Research Grant - $5,000 The Utility of Immediate Qualitative EEG Evaluation in the Emergency Department Read Abstract

ACADEMIC ANNOUNCEMENTS UT Southwestern Larissa Velez, MD, professor, vice chair of education, and program director in the Department of Emergency Medicine, was named the recipient of the 2018 UT Southwestern Medical Center Mentoring Award. This Larissa Velez, MD award celebrates clinicians who demonstrate exceptional commitment and effectiveness as a mentor to health care providers.

As the leader of the Emergency Medicine Residency Program since 2002, Dr. Velez has established a foundational building block to the success of medical students, residents, fellows, and faculty.

Kurt Kleinschmidt, MD, professor and division chief of medical toxicology in the Department of Emergency Medicine was named the recipient of the UT Southwestern 2018 Program Development Award. This Kurt Kleinschmidt, MD award celebrates the innovation and collaboration that are foundational to the success of UT Southwestern Medical Center.

Parkland Memorial Hospital’s Perinatal Intervention Program, led by Dr. Kleinschmidt, optimizes the care of pregnant women who have substance use disorders (SUD) through education and the development of a multidisciplinary process.

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc.

Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is April 1, 2019 for the May-June 2019 issue.

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

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

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

The Department of Emergency Medicine at Denver Health is recruiting energetic and talented academic emergency physicians who are dedicated The to serving our patients and leading our specialty in the areas of: clinical operations, medical education, and clinical research. The Department of Emergency Medicine at Denver Health is recruiting energetic and talented academic emergency physicians who are Department of Emergency isand specifically recruiting an assistant medical director focusing on patient dedicated to servingMedicine our patients leading our specialty infor thethree areas positions: of: clinical operations, medical education, and clinical research.

The experience, a medical student clerkship director, and a isphysician-scientist at the intersection of emergency medicine public health.a Department of Emergency Medicine specifically recruitingworking for three positions: an assistant medical director focusing on and patient experience, medical student clerkship director, and a physician-scientist working at the intersection of emergency medicine and public health.

The emergency department (ED) at Denver Health includes a 44-bed adult ED with an additional 9-bed observation unit, a 22-bed adult urgent care, The emergency department (ED) at Denver Health includes a 44-bed adult ED with an additional 9-bed observation unit, a 22-bed adult urgent care, and a 19-bed pediatric ED and urgent care. With a combined annual census of more than 127,000 patients, the ED at Denver Health is the second and a 19-bed pediatric ED and urgent care. With a combined annual census of more than 127,000 patients, the ED at Denver Health is the second busiest in Colorado and home thetoErnest E. Moore Shock Center Denver Health, the primary traumacenter referral center busiest in Colorado and to home the Ernest E. Moore ShockTrauma Trauma Center at at Denver Health, the primary trauma referral for the Rockyfor the Rocky Mountain Mountain Region. Additionally, the acuity managed bybythe EDisishigh, high, with a 25% admission rate. Staffing in the adult and EDs is Region. Additionally, the acuity managed theadult adult ED with a 25% admission rate. Staffing in the adult and pediatric EDspediatric is provided by board-certified emergency physicians, PGY1-1-44residents, residents, emergency medicine subspecialty fellows, fellows, and advanced providers. provided by board-certified emergency physicians, PGY emergency medicine subspecialty and practice advanced practice providers. and extremely collaborative relationships exist among physicians, physicians, advanced practice providers, nursing,nursing, and consultative services.

Strong andStrong extremely collaborative relationships exist among advanced practice providers, and consultative services.

Additionally, Denver Health is the major academic affiliate of the University Of Colorado SOM, and the home institution for the Denver Health Additionally, Denver Health is the major academic affiliate of the University Of Colorado SOM, and the home institution for the Denver Health Residency in Emergency Medicine.

Residency in Emergency Medicine.

All faculty report to the Director of Service for the Department of Emergency, and contribute to our mission of patient care, educational, research,

All faculty and report to the Director of Service for the Department ofthe Emergency, and contribute to our mission of patient care, educational, research, professional development, and hold faculty appointments in School of Medicine. and professional development, and hold faculty appointments in the School of Medicine.

The ideal candidate is an experienced emergency physician with a strong emphasis in his/her area of interest, excellent leadership and communications skills, and a passion for innovation and scholarship. Fellowship and an academic track record are strongly preferred. BE/BC in The ideal candidate is an experienced emergency physician with a strong emphasis in his/her area of interest, excellent leadership and emergency medicine is required. communications skills, and a passion for innovation and scholarship. Fellowship and an academic track record are strongly preferred. BE/BC in submit their CV and a cover letter to: emergencyApplicants medicine should is required.

Aaron Ortiz, Manager, Provider Recruitment (aaron.ortiz@dhha.org) and ApplicantsJason should submit CV and a cover letter to: Committee (jason.haukoos@dhha.org).

Haukoos, MD,their MSc, Chair, Department Recruitment

Aaron Ortiz, Manager, Provider Recruitment (aaron.ortiz@dhha.org) and Jason Haukoos, MD, MSc, Chair, Department Recruitment Committee (jason.haukoos@dhha.org).

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{ Job Opportunities } Division Chief, Pediatric Emergency Medicine EMS Fellowship Director/EMS Medical Director Assistant Medical Director PEM/EM Core Faculty Vice Chair Research Emergency Medicine

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, daycare, 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: hmc.pennstatehealth.org/careers/physicians Penn State Health is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

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Emergency Medicine Research Fellowship Opportunity The Department of Emergency Medicine at Baystate Medical Center sponsors a one-year Certificate Program or two-year Master’s Degree fellowship in EM Research, available through the University of Massachusetts Medical School. The program integrates training in clinical and basic research with didactics in clinical and translational science through either the University of Massachusetts School of Public Health and Health Sciences or through Tufts University Sackler School of Graduate Biomedical Services.

The purpose of the fellowship is to provide young investigators with the mentored experience and didactic necessary to become successful independent clinical or basic science investigators. Research is an integral part of everything we do at Baystate Health. Last year, Baystate Health, as a whole, received research funding of $14+ million, $9.5 million of which was federal funding.

The Baystate Medical Center Emergency Department is a Level 1 trauma center with 126,000 visits annually in an urban setting. We have a 3-year EM residency with 16 residents per year. Clinical responsibilities are at BMC and affiliate hospitals. We offer positions to BC/BE emergency physicians who have completed an EM residency. In 2015, to help improve the health and well-being of our medically under-served rural and urban communities, Baystate Health partnered with the University of Massachusetts Medical school to establish a regional campus in Springfield, MA Please visit www.baystatehealth.com for further information on Research at UMMS-Baystate. Inquiries should be made to Tara Rivest at (413)794-5999 or tara.rivest@baystatehealth.org

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Featured Leadership and Faculty Positions EM Residency Program Director and Ultrasound Fellowship Director Osceola Regional Medical Center. Kissimmee, FL EM Residency Program affiliated with the University of Central Florida College of Medicine.

Contact Shawn Stampfli at 404.663.4770

Clinical Faculty Kendall Regional Medical Center. Miami, FL EM Residency Program affiliated with the Herbert Wertheim College of Medicine at Florida International University. Contact Lisa Chamerski at 727.507.2508

Assistant Program Director, Core Faculty and PEM Faculty Oak Hill Hospital. Tampa Bay, FL New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Contact Ody Pierre-Louis at 727.507.3621

EMS Faculty and PEM Faculty Brandon Regional Hospital. Tampa Bay, FL New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Contact Esther Aguilar at 727.519.4851

Clinical Faculty St. Lucie Medical Center. Port St. Lucie, FL Palm Beach Consortium for Graduate Medical Education Osteopathic EM Residency Program.

Contact Amy Anstett at 954.295.1524

Research Director and Core Faculty Ocala Regional Medical Center. Ocala, FL EM Residency Program affiliated with the University of Central Florida College of Medicine.

Contact Craig McGovern at 727.437.0846

For more information contact: E: MakeAChange@evhc.net O: 877.226.6059

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EMERGENCY MEDICINE AND MEDICAL TOXICOLOGY ARIZONA, PHOENIX (DMG/MIHS) Join one of the most respected Emergency Medicine programs! The Department of Emergency Medicine at Maricopa is hiring Emergency Physician and Medical Toxicologist with a passion for medicine, education and safety net care to serve as core faculty for our expanding program.

EMERGENCY MEDICINE FACULTY OPPORTUNITY Located in Springfield, MA, Baystate Medical Center (BMC) is Baystate Health’s flagship hospital. BMC is a 716-bed, independent academic medical center and a training site for the University of Massachusetts Medical School - Baystate. We offer over 30 residency and fellowship programs and have recently launched our new University of Massachusetts Medical School - Baystate regional medical school campus. BMC is a major referral care center and the only Level 1 trauma center and pediatric trauma center in the area. We offer a diverse culture that provides outstanding opportunities for physicians to start and advance their career.

We are seeking fellowship trained Emergency Medicine physicians to join our team at Baystate Medical Center, home to the busiest ED in Massachusetts and one of the busiest EDs on the east coast.

POSITION HIGHLIGHTS:  Experience diverse pathologies and acuity as we serve over 122,000 adult and pediatric patients annually.

Maricopa is a major affiliate of both the University Of Arizona College Of Medicine, and Creighton University School of Medicine. The residency hosts 14 residents/year.

Candidates must have an M. D. or D.O. degree, valid Arizona license, and be Board-certified or Board through ABEM or AOBEM. Clinical and academic appointments commensurate with experience.

DMG is a not-for-profit faculty practice plan owned and operated by physicians consisting of more than 350+ providers who represent all the major medical and surgical specialties and sub specialties.

DMG offers an outstanding work environment, competitive compensation plan/benefits package, paid time off, CME allowance with paid time off and employer paid malpractice insurance.

For consideration please submit a cover letter and CV to: practice@dmgaz.org. Correspondence should be addressed to: Dr. Eric Katz, Chairman, Department of Emergency Medicine, Maricopa Integrated Health Systems.

 Our 72,000 square foot ED is equipped with 94 private rooms, separate pediatric ED, separate behavioral health rooms and top-ofthe-line technology.  Faculty appointment at University of Massachusetts Medical School and strong academic involvement with our 42 residents as well as fellows in pediatric emergency medicine, research, wilderness medicine, administration and ultrasound.  Strong support for clinical and health services research plus stateof-the-art simulation programs.  Career path opportunities in our clinical, education and research tracks. Protected time for research available to qualified candidates.  Opportunity exists to split time between our academic campus and our community ED at Baystate Wing Hospital in nearby Palmer MA. The Pioneer Valley is a thriving area located in western Massachusetts and provides extensive access to urban, suburban and rural amenities. Anchored by the city of Springfield, our region boasts a myriad of opportunities for recreation, music, education and art enthusiasts. When you live and work in the Pioneer Valley, you will enjoy picturesque four-season living, excellent schools and year-round social and cultural events. In fact, Massachusetts was once again ranked #1 in Education nationally by U.S. News and World Report.

Learn more and apply online: choosebaystatehealth.org You may also contact: Dr. Niels Rathlev, Chair of Emergency Medicine, Baystate Health c/o Melissa Hale, Lead Senior Recruiter Phone: 413-794-2624 • Fax: 413-794-5059 Email: Melissa.Hale@baystatehealth.org Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability or protected veteran status.

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HEALTH BRIGHAMBRIGHAM HEALTH EMERGENCY MEDICINE VICE CHAIR OF RESEARCH

EMERGENCY MEDICINE VICE CHAIR OF RESEARCH

The Department of Emergency Medicine at Brigham Health is currently seeking a Vice Chair Research. The of successful candidate must haveatanBrigham MD or a MD/PhD TheofDepartment Emergency Medicine Healthdegree is currently seeking a Vice in a field related to Emergency Medicine, as well as the post- doctoral education that Chair of Research. The successful candidate must have an MD or a MD/PhD degree completes their training, and board certification. We. seek candidates with current in a fieldresearch relatedfunding, to Emergency as well as the postextra-mural such as NIH.Medicine, Having success in programmatic grantdoctoral education that funding requiringtheir a team of independent investigators is important, since a goalcandidates of this completes training, and board certification.

We. seek with current position is to enhance departmental faculty engagement the spectrum of the extra-mural research funding, such as NIH.across Having success in programmatic grant field. Another goal of this position is to enhance industry sponsored projects and funding clinical trialsrequiring within the a team of independent investigators is important, since a goal of this department, so to candidate experience in clinical trial implementation and analysis is the spectrum of the position is enhance departmental faculty engagement across desired.

The candidate haveposition expertise is in health data analytics, such sponsored as field. Another goalshould of this to enhance industry projects and bioinformatics and biostatistics. The candidate must be experienced in successfully clinical trialsand/or within thefaculty in research enquiry, and promoting the training learners junior department, so candidate experience inDepartment clinical trial implementation and analysis is independent research careers of these trainees. The of Emergency Publication Medicine's of Research is a critical roleexpertise in the ongoing growth and desired.Vice TheChair candidate should have in health data analytics, such as innovation of the department's research portfolio. This position is eligible for an bioinformatics biostatistics.

The candidate must be experienced in successfully Run Dateand academic appointment at Harvard Medical School.

Additional qualifications and training are learners and/or junior in Affairs research enquiry, and promoting the information posted on the HMS Officefaculty of Faculty webpage

Sectionresearch careers Size: 3.5”ofx 9.75” independent theseCOLOR trainees. The Department of Emergency growth and innovation of the department's research portfolio. This position is eligible for an Interested candidates should send letter and Medical CurriculumSchool.

Vitae to Michael academic appointment at aHarvard Additional qualifications and Price VanRooyen, MD, MPH, Professor and Chair, Department of Emergency Medicine, information are posted on the HMS Office of Faculty Affairs webpage Brigham and Women’s Hospital. Please apply by confidential email to https://fa.hms.harvard.edu/files/hmsofa/files/657jr_bwh_asst.assoc.emergency_ Medicine's Vice Chair of Research is a critical role in the ongoing medicine.vicechair.research_1-23-19.pdf Size

Ad# mdeloge@bwh.harvard.edu.

https://fa.hms.harvard.edu/files/hmsofa/files/657jr_bwh_asst.assoc.emergency_

We are an equal opportunity employer and all qualified applicants will receive medicine.vicechair.research_1-23-19.pdf consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, gender identity, sexual orientation, pregnancy and pregnancy-related conditions or any other Interested candidates should send a letter and Curriculum Vitae to Michael characteristic protected by law.Professor and Chair, Department of Emergency Medicine, VanRooyen, MD, MPH,

Brigham and Women’s Hospital. Please apply by confidential email to mdeloge@bwh.harvard.edu.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, gender identity, sexual orientation, pregnancy and pregnancy-related conditions or any other characteristic protected by law.

Emergency Medicine Administrative/Leadership Fellowship The UMass Department of Emergency Medicine is actively recruiting qualified candidates for our Richard V. Aghababian Emergency Medicine Administrative/Leadership Fellowship.

The mission of our fellowship is to train emergency physicians with key leadership and administrative skills to excel as leaders in the delivery of high quality and efficient healthcare, and our program has a track record of placing fellows into EM administrative positons upon graduation.

Fellows have access to extensive resources both within the UMass Medical School as well as the university in general, highlighted by the MBA program at the Isenburg School of Management. The affiliated clinical institution, UMassMemorial Health System, is the dominant, healthcare entity in central Massachusetts with multiple, diverse hospitals and out-pt facilities. A particular strength of our department is that our leadership and faculty are active in multiple leadership positions within the medical school, health system, as well as regional, state and national professional organizations. This affords the fellows exposure to management and leadership learning opportunities well beyond ED operations.

In addition to superior training, our location in the heart of New England offers affordability with easy access to activities to satisfy all interests and lifestyles. Worcester, the second largest city in New England, has excellent museums and restaurants and hosts several minor-league sports teams.

The amenities of Boston are only 40 minutes away, and world-class outdoor activities are either right outside your door or easily reached in 1-2 hours.

Fellows will assume limited clinical responsibilities at one or more of our Emergency Departments. Prior to starting, fellows must have completed an ACGME-accredited EM residency program, must be EM board-certified or eligible, and must be eligible for full medical licensure in the Commonwealth of Massachusetts.

For more information, please refer to our web site: http://www.umassmed.edu/emed/ and contact our Fellowship Coordinator, Jeffrey Abbott - jeffrey.abbott@umassmed.edu, (508) 421-5522

Department of Emergency Medicine Department of Emergency Yale University School of Medicine Medicine Yale University School of Medicine Department of Emergency Medicine Department ofPractice Emergency Medicine Advancing the Science and of Emergency Medicine Advancing the Science and Practice of of Emergency Medicine Yale University School of Medicine Yale University School Medicine The Department of Emergency Medicine at the Yale University School of Medicine seeks to fill the position of Assistant / Associate Residency Program Director.

The Department has a fully accredited four-year residency hosting 60 residents at two teaching hospitals, including the Level One Trauma Center at Yale-New Haven TheHospital, Department Emergency at the Yale School of Medicine seeks toof fillsmall-group the positiondiscussions, of Assistantaudience / Associate Residency Programe-learning, Director. whichoftreats 100,000 Medicine patients annually.

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The Department has total of 4 clinical sites: Emergency Services at York Campus; Shoreline Medical Center; Saint Raphael’s and the West The Department hasbea residency-trained totalaof 4 clinical sites: AdultAdult Emergency Services atmedicine, York Street Campus; Shoreline Medical Center; SaintProfessor Raphael’s Campus; and the West Eligible candidates must and board-certified in emergency andStreet eligible for appointment at the Assistant level orCampus; above.

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Haven VAofEmergency Department withproviding awith combined ED volume of 195,000 visits per year.

We offer an extensive faculty development program for junior and senior At least 3University years experience in resident education, is required.

Rank, time andvisits salary be commensurate with education, training andprogram experience. faculty.

We ahave a well-established of interdisciplinary collaboration with other renowned faculty, obtaining federal and private foundation funding, faculty.

We have well-established track track recordrecord of interdisciplinary collaboration with other renowned faculty, obtaining federal and private foundation funding, and a and a apply, please visit: https://apply.interfolio.com/59261 toarray upload your Director, CVand cover letter.

Specific inquiries about the position may be sent to the Chair: mature infrastructure supported by a faculty Research aof staff of research associates and administrative assistants.

YaleToUniversity is aresearch world-class institution providing a wide of Director, benefits research opportunities. mature research infrastructure supported by a faculty Research aand staff research associates and administrative assistants.

Gail D’Onofrio, MD, MS, via email: jamie.petrone@yale.edu. Review of applications will begin immediately and continue until the position is filled.

Eligible candidates must be residency-trained andupload board-certified in emergency medicine, and eligible for appointment at thebeAssistant Professor level or above.

To apply, please visit: https://apply.interfolio.com/59261 to yourinCV and covermedicine, letter.

Specific inquiries the position sentProfessor to the Chair: Eligible candidates must be residency-trained and board-certified emergency and eligible for about appointment at themay Assistant level or above.

University is an Affirmative Opportunity employer. values diversity among its students, and until faculty and strongly welcomes applications At 3least 3 years of experience in resident education, is required.

Rank, protected time and salary bestaff, commensurate with education, training and experience.

GailYale D’Onofrio, MD, MS, via email:inAction/Equal jamie.petrone@yale.edu.

Review of Yale applications will begin immediately and continue position is filled.

At least years of experience resident education, is required.

Rank, protected time and salary will bewill commensurate withthe education, training and experience. from women, persons with disabilities, protected veterans, and underrepresented minorities.

Yale isUniversity is a world-class institution providing wideYale array of benefits and among research Yale University an Affirmative Action/Equal Opportunity values diversity itsopportunities. students, staff, and faculty and strongly welcomes applications Yale University is a world-class institution providing a employer. widea array of benefits and research opportunities. from women, persons with disabilities, protected veterans, and underrepresented minorities.

To apply, visit: https://apply.interfolio.com/59261 to upload yourand CVcover and cover Specific inquiries the position may betosent the Chair: To apply, pleaseplease visit: https://apply.interfolio.com/59261 to upload your CV letter.letter.

Specific inquiries aboutabout the position may be sent theto Chair: Gail D’Onofrio, MD,via MS, via email: jamie.petrone@yale.edu.

Review of applications will begin immediately and continue until the position is filled.

51 Gail D’Onofrio, MD, MS, email: jamie.petrone@yale.edu.

Review of applications will begin immediately and continue until the position is filled.

Advancing Science Practice Emergency Medicine Advancing thethe Science andand Practice of of Emergency Medicine

Yale University is an Affirmative Action/Equal Opportunity employer.

Yale values diversity its students, and faculty and strongly welcomes applications Yale University is an Affirmative Action/Equal Opportunity employer.

Yale values diversity amongamong its students, staff, staff, and faculty and strongly welcomes applications from women, persons with disabilities, protected veterans, and underrepresented minorities.

Emergency Medicine Fellowship Opportunities The Brown Department of Emergency Medicine is proud to sponsor diverse fellowship training programs and is accepting applications for positions beginning July 1, 2019.

We offer educational experiences in:

• Pediatric EM* • Emergency Medical Services* • Sex and Gender in EM • EM Ultrasound • Medical Education Research • Leadership & Administration • Digital Health Innovation • Global Emergency Medicine • Medical Simulation • Injury Prevention Research • Disaster Medicine (*ACGME accredited program)

Brown fellows gain practical experience in a variety of ED settings. Brown Emergency Medicine staffs the busiest Level 1 Trauma Center in New England, a premier academic ED, a dedicated Pediatric ED, and a top performing community ED. Across all four sites, we care for more than 275, 000 patients annually.

Fellowship benefits include: •Mentoring by Brown faculty who are nationally recognized for education, research, service, and leadership.

•Extensive research training, support and funding.

•Career development programs specifically designed for fellows.

•Tuition support for advanced coursework and/or Master's degree programs.

•Academic appointment at Brown University.

•Competitive CME benefits.

Please visit us at the 2019 SAEM Residency Fair or at our website. https://www.brownemresidency.org/fellowships

EMERGENCY MEDICINE FELLOWSHIP OPPORTUNITIES EMERGENCY MEDICINE FELLOWSHIP OPPORTUNITIES New York Presbyterian-Weill Cornell Medicine is pleased to offer fellowship opportunities for graduating residents and junior faculty.

EMERGENCY MEDICINE FELLOWSHIP New York Presbyterian-Weill Cornell Medicine is pleased to offer fellowship opportunities for graduating residents and junior faculty.

EMERGENCY MEDICINE FELLOWSHIP OPPORTUNITIES

OPPORT

The New York Presbyterian-Weill Cornell Emergency Department is an academic, high volume, Level I trauma center, burn center, and stroke New York Presbyterian-Weill Cornell Medicine is pleased to offer fellowship opportunities for graduating residen The New York Presbyterian-Weill Cornell Emergency Department is an academic, high volume, Level I trauma center, burn center, and stroke center, caring for over 90,000 adult and pediatric patients annually. New York Presbyterian-Lower Manhattan Hospital, is our busy culturally EMERGENCY MEDICINE FELLOWSHIP OPPORTUNITIES The New York Presbyterian-Weill Cornell Emergency Department is an academic, high volume, Level I trauma ce center, caring for over 90,000 adult andMedicine pediatricispatients annually.

New Yorkopportunities Presbyterian-Lower Manhattan Hospital, our busy culturally Newcommunity York Presbyterian-Weill Cornell offer fellowship for graduating residents andisjunior faculty. diverse hospital, caring for over 45,000 pleased patientstoannually.

We recently launched the first innovative virtual ED Telehealth caring for 90,000 adult and pediatric patients annually. Newinitiative York Presbyterian-Lower Manhattan H diverse community hospital, caring for over 45,000 patients annually. We recentlycenter, launched theover first innovative virtual ED Telehealth initiative diverse community hospital, caring for over 45,000 patients annually.

We recently launched the first innovative inNew New City and plan expand this program with the full support of New Yorkand Presbyterian YorkYork Presbyterian-Weill Cornellto Medicine is pleased to offer fellowship opportunities for graduating residents junior faculty. and Weill Cornell Medicine. inThe NewNew YorkYork CityPresbyterian-Weill and plan to expandCornell this program withDepartment the full support New Yorkinhigh Presbyterian and Cornell Medicine.

New volume, York City and planWeill to expand this program with the full support New York Presbyterian and Weill Corn Emergency is anofacademic, Level I trauma center, burn center, andofstroke The New York Presbyterian-Weill Emergency is an academic, volume, Level I trauma burn center, and stroke center, caring for overCornell 90,000 adult Department and pediatric patientshigh annually.

New Yorkcenter, Presbyterian-Lower Manhattan Hospital, is our busy culturally New York Presbyterian is is aand ininhealthcare.

For 2017-18 periodHospital, inNew theYork News World Report Best Hospitals, York Presbyterian is a national leader in healthcare.

For the New 2017-18 period in the US News & World Report center, caring forPresbyterian over 90,000 adult pediatric leader patients annually.

New York Presbyterian-Lower Manhattan isUS our busy culturally New York anational national leader healthcare.

For the the 2017-18 period in the US News && World Report Best Hospitals, New York diverse community hospital, caring for over 45,000 patients annually.

We recently launched the first virtual initiative Presbyterian ranked No. 8 ininnovative the nation and No. 1 inED theTelehealth New York Metropolitan area. diverse community hospital,No. caring over 45,000 patients annually.

We recently launched the first innovativearea. virtual ED Telehealth initiative Presbyterian ranked 8for in the nation and No. 11inin the New York Metropolitan Presbyterian ranked No. 8 in the nation and No. the New York Metropolitan area. inYork New York Citytoand plan expand program the Presbyterian full support New York Presbyterian and Weill Cornell Medicine. in New City and plan expand thisto program withthis the full support ofwith New York andof Weill Cornell Medicine.

Healthcare Leadership and Management Fellowship with Executive MBA/MS: and Management Fellowship withExecutive Executive MBA/MS: New York Presbyterian is a national leader inHealthcare healthcare.

For Leadership the 2017-18 period in the US News & World Report Best Hospitals, New York MBA/MS: Healthcare Leadership and Management Fellowship with New York Presbyterian is aand national leader in healthcare.

For the 2017-18 period in the News & World and Report Best Hospitals, Newalso York Two yearUS Healthcare Leadership Management Fellowship, which includes completion of the combined Presbyterian ranked No. 8 in the nation No. 1 in the New York Metropolitan area.

Healthcare Leadership program offered through Weill Cornell Medicine and the Cornell University SC Johnson C Presbyterian ranked No. 8 in the nation and No. 1 in the New York Metropolitan area.

Two year Healthcare Leadership and Management Fellowship, which also includes completion of the combined Executive MBA/MS in • Two year non combined ACGME fellowship with PGYMBA/MS level salary in Healthcare Leadership and Management Fellowship with Executive Two year Healthcare Leadership and Management Fellowship, which alsoMBA/MS: includes completion of the Executive • University Full tuition for Executive MBA/MS in Healthcare Leadership from the SC Johnson College of Business Healthcare Leadership program through Weill Medicine and Fellowship the Cornell Cornell SCJohnson Johnson College Business.

Healthcare Leadership programoffered offered through WeillCornell Cornell Medicine and the University SC College ofof Business.

Healthcare Leadership and Management with Executive MBA/MS: • Clinical shifts built around MBA/MS program Two year Healthcare Leadership and Management Fellowship, which also includes completion of the combined Executive MBA/MS in • Two year non ACGME fellowship with level salary Two year non ACGME withPGY PGY salary Ideal candidates are recent Emergency Medicine Residency graduates or Junior Faculty with a proven Healthcare•Leadership program offered throughfellowship Weill Cornell Medicine andlevel the Cornell University SC Johnson College of• Business. records, are committed gaining invaluable leadership Full tuition forfor Executive MBA/MS ininHealthcare Leadership the SC SCJohnson Johnson College ofBusiness Business&toExecutive &Weill Weill Cornell Medicine • • •Two year non ACGME fellowship with and PGY level salary Full tuition Executive MBA/MS Healthcare Leadership fromincludes the College of Cornell Medicine Two year Healthcare Leadership Management Fellowship, which also completion ofwho the combined MBA/MS in experience while earning a graduate-lev • • FullClinical forshifts Executive MBA/MS in Healthcare Leadership from the SC Johnson College of Business & Weill Cornell Medicine built around MBA/MS program • tuition Clinical shifts built around MBA/MS program Healthcare Leadership program offered through Weill Cornell Medicine and the Cornell University SC Johnson College of Business.

• Clinical shifts built around MBA/MS program Please EMBA/MS program information at: https://bit.ly/2RWkVDh Ideal candidates arerecent recent Emergency Medicine Residency Junior Faculty with && leadership track candidates Emergency graduates or Juniorfind Faculty with provenmanagerial managerial leadership track • • •Ideal candidates are recent Emergency Medicine Residency graduates orResidency Junior with a proven or managerial & leadership tracka aproven • Ideal Two year nonare ACGME fellowship withMedicine PGY level salaryFaculty graduates records, who committed tocommitted gaining invaluable leadership experience while earning a graduate-level degree records, who arecommitted gaining invaluable leadership experience while earning aagraduate-level who are totogaining invaluable leadership experience while earning graduate-level management degree • records, Fullare tuition for Executive MBA/MS in Healthcare Leadership from the SCmanagement Johnson College of Business &management Weill Cornell degree Medicine

Interested candidates should submit their CVs to: • Clinical shifts built around MBA/MS program Please find programare information at: https://bit.ly/2RWkVDh Sharma, MD, MBA, CPE, FACEP • EMBA/MS Ideal candidates recent Emergency Medicine Residency graduates Rahul or Junior Faculty with a proven managerial & leadership track Please find EMBA/MS program gaining information at: https://bit.ly/2RWkVDh Please find EMBA/MS https://bit.ly/2RWkVDh Chairman, Department of Emergency Medicinedegree ras2022@med.cornell.edu records, who are program committed toinformation invaluableat: leadership experience while earning a graduate-level management Interested candidates should submit their CVs to: Rahul Sharma, MD, MBA, CPE, FACEP Robert Tanouye, MD, MBA Interested candidates should submit their CVs CVsat: to:https://bit.ly/2RWkVDh Interested candidates should submit their to: PleaseDepartment find EMBA/MS program information Chairman, of Emergency Medicine ras2022@med.cornell.edu Assistant Fellowship Director - rot9046@med.cornell.edu

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Rahul Sharma,MD, MD,MBA, MBA,CPE, CPE,FACEP FACEP Rahul Sharma, Robert Tanouye, Department MD, MBA Chairman, of Emergency Medicine ras2022@med.cornell.edu Chairman, Department Emergency Interested candidatesofshould submitMedicine their CVsras2022@med.cornell.edu to: Assistant Fellowship Director - rot9046@med.cornell.edu Rahul Sharma, MD, MBA, CPE, FACEP Robert Tanouye, MD,MBA MBA Chairman, Department of Emergency Medicine ras2022@med.cornell.edu Robert Tanouye, MD, Assistant Fellowship Director rot9046@med.cornell.edu Assistant Fellowship Director - -rot9046@med.cornell.edu

Emergency Medicine Fellowship Opportunities The UMass Medical School Department of Emergency Medicine invites qualified candidates to consider our fellowship training opportunities. Nationallyrenowned fellowship directors and faculty oversee intensive, focused curricula that prepare fellows to assume leadership roles in their chosen areas. Our department’s nationally-recognized track record in leadership, clinical care, education, and research, coupled with a strong stature within our medical school and 5-hospital health system, as well as the opportunity for pursuing UMass master’s-degree education when applicable, makes our institution an ideal place to gain exceptional sub-specialty expertise and launch highly successful careers.

Our fellowship opportunities include: • Administration/Leadership • Disaster Medicine (may be taken in sequence with EMS) • Emergency Medical Services (may be taken in sequence with disaster medicine) • Emergency Ultrasound • International EM & Global Health • Medical Toxicology • Research (PhDs also considered) In addition to superior training, our location in the heart of New England offers affordability with easy access to activities to satisfy all interests and lifestyles.

Worcester, the second largest city in New England, has excellent museums and restaurants and hosts several minor-league sports teams. The amenities of Boston are only 40 minutes away, and world-class outdoor activities are either right outside your door or easily reached in 1-2 hours.

Fellows will assume limited clinical responsibilities at one or more of our Emergency Departments. Prior to starting, fellows must have completed an ACGMEaccredited EM residency program, must be EM board-certified or eligible, and must be eligible for full medical licensure in the Commonwealth of Massachusetts.

For more information, please refer to our web site: http://www.umassmed.edu/emed/ and contact our Fellowship Coordinator, Jeffrey Abbott - jeffrey.abbott@umassmed.edu, (508) 421-5522

Department of Emergency Medicine

University of North Carolina at Chapel Hill, Department of Emergency Medicine is currently recruiting for per diem faculty and full-time fellowship openings for 2019-2020.

Fellowship openings are available in the areas of Administrative leadership, Education, Geriatrics, Research and Global Health. Successful applicants will be Board Certified/Board Prepared in Emergency Medicine. UNC Hospitals is a 750-bed Level I Trauma Center. The Emergency Department sees upward of 69,000 high acuity patients per year.

Applicants should send a letter of interest and curriculum vitae to: Gail Holzmacher, Business Officer at 919-843-1400 gholzmac@med.unc.edu or Kelly_armstrong@med.unc.edu HR Consultant, Department of Emergency Medicine, CB #7594, Chapel Hill, NC 27599-7594. FAX (919) 966-3049.

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

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VICE CHAIR OF EDUCATION Weill Cornell Medicine’s new academic Department of Emergency Medicine, led by Dr. Rahul Sharma, is recruiting a faculty member at the associate or professor level to serve as the inaugural Vice Chair of Education. We are seeking a national leader to advance the academic mission of the Department with a focus on educational innovation, curriculum development and new program implementation.

In addition to devising the academic strategic plan with the Chair, providing excellent clinical care, and teaching house staff and medical students, the new Vice Chair of Education will mentor junior colleagues, engage in the fellowship and education programs, and foster collaborations throughout the institution.

The successful candidate will have a minimum of ten years of medical education experience at the undergraduate and/or graduate medical education level with leadership experience as a residency program director, vice chair or director of undergraduate medical education. The position will report directly to the Chair of Emergency Medicine and will oversee all of the Departmental educational programs, including medical student education, residency education, fellowships, faculty education and departmental education conferences. We are particularly interested in candidates who have the requisite experience and training to continue a successful academic career as well as a strong record of leadership in education with excellent interpersonal and communication skills.

We offer a highly competitive salary, a generous support package to ensure the candidates transition and continued success, a comprehensive benefits package, and a generous retirement plan.

The Emergency Department at New York Presbyterian-Weill Cornell Medical Center serves as one of the major campuses of the fully accredited four-year New York Presbyterian Emergency Medicine Residency Program. Our Emergency Department is a high volume, high acuity regional trauma, burn and stroke center caring for more than 90,000 adult and pediatric patients. Faculty also have the opportunity to work at our New York Presbyterian-Lower Manhattan Hospital ED campus, which is a busy community hospital seeing 45,000 annual visits.

We offer programs in Telemedicine, Medical Toxicology, Geriatric Emergency Medicine, Wilderness Medicine, Global Emergency Medicine, Simulation and Ultrasound. In addition, we offer fellowships in Geriatric Emergency Medicine, Healthcare Leadership and Management, Pediatric Emergency Medicine as well as PA and NP residencies in Emergency Medicine.

Please send curriculum vitae and cover letter to: Rahul Sharma, MD, MBA Chair, Department of Emergency Medicine New York Presbyterian-Weill Cornell Medicine ras2022@med.cornell.edu

New York Presbyterian Hospital-Weill Cornell Medicine is an equal opportunity employer-Minorities/Women/Vets/Disabled encouraged to apply.

Own your future in Pittsburgh!

Become an owner in one of the largest, fastestgrowing physician-owned groups in the nation.

• Highly competitive compensation package • Physician equity ownership

• Industry-leading, company funded 401(k)

Join USACS! ED Director Opening at Allegheny General Hospital We’re looking for a dynamic and charismatic EM physician to lead and deliver USACS’ commitment to patient care, culture and values to this revolutionary joint venture’s flagship hospital.

The joint venture between Allegheny Health Network and US Acute Care Solutions has taken healthcare to a whole new frontier. For the first time, physician, hospital, and payor are aligned to do what’s best for patients, creating an unprecedented partnership for delivering high quality, innovative and efficient models of care that put patients first. At USACS, our mission has always been, and will always be: To care for patients.

Allegheny General Hospital (AGH) is the first hospital in the region to be designated a Level I Trauma Center, the LifeFlight aeromedical service was the first to fly in the northeastern U.S. AGH is a leader in cardiovascular, cancer, neuroscience and orthopedic and rehabilitation care, and offers a wide array of medical and surgical specialties. AGH hosts residency training programs in twenty-two specialties including Emergency Medicine, as well as EMS and EM Ultrasound fellowships.

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(an additional 10%)

• Yearly CME/BEA (Business Expense Account) • Student loan financing as low as 2.99% • Groundbreaking Paid Parental Leave • Pioneering Paid Military Leave

• Short- and long-term disability (own occupation) • Comprehensive medical, dental, vision and

Rx coverage

• The best medical malpractice including tail

coverage

• Outstanding Professional development programs

• Location flexibility and stability of a national group

To learn more about our PA locations: Jim Nicholas | Physcian Recruiter jnicholas@usacs.com or 800-828-0898

Mount Sinai Health System - New York Emergency Medicine Faculty Positions The Emergency Medicine Department is currently seeking Emergency Medicine Leadership Physicians as well as full-time Emergency Medicine Physicians and to join our 6 hospital-based emergency departments in Manhattan, Queens and Brooklyn. There is flexibility to work at both a community and academic site (single or multiple sites). The Department of Emergency Medicine is committed to excellence in emergency clinical care, education, and research. Our Department is one of the largest in the country, affiliated with Elmhurst Hospital Center, trauma center & part of NYC’s public health system.

The Emergency Medicine Service Line has more than 200 faculty and treats more than 500K patients annually. We have two emergency medicine residencies along with fellowships in Pediatric EM, Global Health, Ultrasound, Informatics, Sports Medicine, Administration, and Simulation. Each year, our EM training programs educate about 150 residents and more than 15 fellows. Our research division is ranked #2 in the country based on NIH funding.

The Emergency Medicine Service at Mount Sinai Health System have the following opportunities available: Emergency Medicine Full Time Faculty (All Sites), Associate Medical Director (Mount Sinai Hospital), Associate Medical Director (Mount Sinai Queens), Director, Emergency Medicine Simulation (Sinai) & Medical Director (Mount Sinai West) Emergency Medicine Services at the Mount Sinai at Health System include the following sites:

- Mount Sinai Hospital (Academic)

- Mount Sinai St. Luke’s (Academic)

- Mount Sinai West (Academic)

- Mount Sinai Beth Israel (Academic)

- Mount Sinai Brooklyn (Community)

- Mount Sinai Queens (Community)

- Mount Sinai Downtown Urgent Care Center

- Mount Sinai Express Care

Please send your curriculum vitae to Veronica Fernandez, Director, Emergency Medicine at Veronica.Fernandez@mountsinai.org or contact (212) 731-3581

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Join our department of nationally and internationally recognized experts in EMS and Disaster Medicine, Toxicology, Injury Prevention and Control, Cardiac Resuscitation, Global Health, Ultrasound, Medical Education and Process Improvement. Ranked in the top 20 NIH funded departments of Emergency Medicine, the MCW Department of Emergency Medicine is growing! We are currently recruiting for four highly-motivated board-certified Clinician Leaders to join the Department as an Associate or Full Professor for one of four leadership roles.

• •

•

•

The Vice Chair of Education and Training will be responsible for, undergraduate medical education, graduate medical education, post graduate medical education, and continuing medical education.

The Vice Chair for Faculty Development and Advancement shall effectively provide oversight, direction, and leadership of professional and career development for all MCW Department of Emergency Medicine faculty members.

The Vice Chair of Research and Scholarship will be responsible for the development, implementation, and monitoring of mentorship programs for faculty members and house staff engaging in research; representation of the Department internally to the College and externally with respect to research endeavors; development and communication of departmental research strategy in coordination with the Department Chair. The Vice Chair for Research and Scholarship is expected to maintain his/her own robust externally funded research program The Vice Chair of Clinical Operations will over see the Patient Care aspect of our mission.

About our Practice: • • •

•

Located in beautiful Milwaukee, WI, a medium-sized Midwest City nestled along the shore of beautiful Lake Michigan, MCW is the only private Medical School in Wisconsin.

Milwaukee Regional Medical Center is a comprehensive 225-acre medical campus located in an attractive suburban setting Our Department maintains a thriving clinical practice including: Froedtert and MCW Froedtert Hospital Emergency Department (level 1 adult trauma center); Children’s Hospital of Wisconsin (level 1 pediatric trauma center); Clement J. Zablocki Veterans Affairs Medical Center Emergency Department; Froedtert and MCW Moorland Reserve Health Center (free-standing) Emergency Department; and a series of soon-toopened, community-based, neighborhood hospital Emergency Departments. We care for over 170,000 patients each year.

Our Department is home to a competitive training program of 30 residents attracting house staff from medical schools across the nation.

The Medical College of Wisconsin is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Please submit a CV, letter of interest, and a list of references to: Ian B.K. Martin, M.D., M.B.A., FACEP, FAAEM, Professor with Tenure and System Chairman, Department of Emergency Medicine, Professor, Department of Medicine, The Medical College of Wisconsin Medical School at imartin@mcw.edu.

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

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

Job Alert!

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

Congratulations & Happy Anniversary CELEBRATING

10 YEARS OF PROGRESS 57

19 Celebrating

of bringing EM ACADEMICIANS together!

Las Vegas, Nevada – May 14-17