SAEM PULSE March–April 2020 by Society for Academic Emergency Medicine

MARCH-APRIL 2020 | VOLUME XXXV NUMBER 2

www.saem.org

SPOTLIGHT ADVANCING THE PRACTICE OF PEDIATRIC EMERGENCY MEDICINE An Interview with

Nate Kuppermann, md, mph Inaugural Dr. Peter Rosen Memorial Keynote Speaker

ANNUAL MEETING PREVIEW: SCALING NEW HEIGHTS IN THE MILE HIGH CITY

page 8

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

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org Manager, IT Dan San Buenaventura Ext. 225, DSanBuenaventura@saem.org Manager, Accounting Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Marisol Navarro Ext. 205, mnavarro@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Digital Communications Snizhana Kurylyuk Ext. 201, skurylyuk@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

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

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

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

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

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

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

President’s Comments The Impact of Advanced Practice Providers on Academic Emergency Departments

Spotlight Advancing the Practice of Pediatric Emergency Medicine

8 24

Diversity and Inclusion What Is Structural Competency and Why Do We Need It in EM?

ED Administration And Clinical Operations Provider in Triage: An Operations Perspective

Educational Download Five Tips for Building a Successful Didactic Talk

Ethics in Action Self-Plagiarism in Peer-Reviewed Publishing

SGEM: Did You Know? Breathe Easier: Appreciating Sex-based Differences in COPD

Geriatric Emergency Medicine The Growth of Geriatric Emergency Medicine: Celebrating the 10th Anniversary of the Academy of Geriatric Emergency Medicine

Global Emergency Medicine A Novel Coronavirus (2019-nCoV): What is Known So Far

Reflection The Stray Bullet Project

Social Media In Academic Em Ultrasound in Digital Media

SAEM to Participate in 2020 Emergency Medicine Day, May 27

50 55 56

Briefs and Bullet Points SAEM Foundation Grantees….54 Academic Announcements Now Hiring

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

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

Megan L. Ranney, MD, MPH Brown University

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

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

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. © 2020 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

PRESIDENT’S COMMENTS The Impact of Advanced Practice Providers on Academic Emergency Departments

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

“Increasingly, APPs have become an integral part of ED care teams around the country. This trend has been driven by several factors including real or perceived workforce needs as well as health system economics”

Each winter, the SAEM Board of Directors attends an off-site retreat. In addition to conducting usual business, this retreat affords Board members an opportunity to tackle “mega” issues affecting academic emergency medicine. Of the topics discussed this year, the Board—led by the subgroup of Drs. Amy Kaji (secretary-treasurer), Christopher Carpenter (member-at-large), and me—explored the impact of advanced practice providers (APP) on academic emergency departments (EDs). Increasingly, APPs have become an integral part of ED care teams around the country. This trend has been driven by several factors including real or perceived workforce needs as well as health system economics. We have witnessed a similar trend in academic EDs from coast to coast. Underlying this change is a growing demand for emergency care in the face of a physician shortage and anemic graduate medical education (GME) expansion in the United States. Associations, including the American Academy of Emergency Medicine (AAEM) and the American College of Emergency Physicians (ACEP), are critically considering the clinical workforce needs and scopes of practice of physicians and APPs in our specialty. Given our Society’s mission and focus, the SAEM Board has begun to delve into this issue through the lens of potential educational and operational impact in an academic setting. As you might imagine, there are pros and cons to consider in examining the effect of APPs in an academic clinical environment. First, let us consider two advantages of including our APP colleagues in an academic emergency department environment: 1. W ith inadequate resident levels given ED volume demand, as well as duty hour restrictions, our APP colleagues often make it both possible for patient care to continue uninterruptedly and residents to participate in important didactic activities. 2. B eyond that, APPs with additional education and/or research interest and training can also be substantial contributors to the onshift and didactic learning environment for emergency medicine residents and medical, physician assistant, and nurse practitioner students. By contrast, a few potential cons or ramifications must also be considered: 1. W ith an increasing presence in academic EDs, our APP colleagues may contribute to a dilution of the clinical training experience for our residents by performing procedures

and caring for patients emergency medicine residents otherwise would have. 2. Most emergency medicine residents, and many emergency medicine attendings, have had little to no formal preparation for the supervision of advanced practice providers. This lack of role preparation can result in inadequate supervision of our APP colleagues as they care for ED patients, ineffective interprofessional interactions, and potential medicolegal exposure in an academic, clinical setting. 3. With no standardized training for physician assistants (PA) and nurse practitioners (NP) working in emergency departments, clinical performance, supervision requirement, and scope of practice can vary widely— particularly in a high-acuity, high-volume academic ED. 4. And finally, with many academic medical centers seeing nonphysician providers as an economical alternative for helping to meet growing patient care demand, inviting our APP colleagues into academic EDs may put additional downward pressure on GME funding for new resident positions. If our APP colleagues are to be a part of academic ED care teams, SAEM could and should look to mitigate any drawbacks by: 1. Collaborating with physician assistant and nurse practitioner schools and/or national associations such as the Society of Emergency Medicine Physician Assistants (SEMPA) and/or Association of Postgraduate PA Programs (APPAP) to standardize curricular preparation for APPs working in academic or nonacademic EDs. (ACEP has already embarked on such a collaboration.) 2. Lobbying the American Board of Emergency Medicine (ABEM) to incorporate supervision of advanced practice providers into the Model of the Clinical Practice of Emergency Medicine (EM Model). Thank you for taking time to read this edition. I would love to hear your thoughts on this controversial topic, so please email me at president@saem.org. Until next time … ABOUT DR. MARTIN: Ian B.K. Martin, MD, MBA, is professor and system chair of the Department of Emergency Medicine and professor of medicine at the Medical College of Wisconsin (MCW). He served SAEM previously as president-elect, secretary-treasurer, and an at-large member of the Society’s Board of Directors. Dr. Martin is a founding member and past-president of SAEM’s Global Emergency Medicine Academy (GEMA).

SPOTLIGHT ADVANCING THE PRACTICE OF PEDIATRIC EMERGENCY MEDICINE An Interview With Dr. Nathan Kupperman, SAEM20 Dr. Peter Rosen Memorial Keynote Address Speaker

SAEM PULSE | MARCH-APRIL 2020

Dr. Peter Rosen Memorial Keynote Address

The Kids Have Grown Up: The Rise of Academic Pediatric Emergency Medicine through Collaborative Research Networks May 13, 2020 9:30–10:00 a.m. Sheraton Denver Downtown Hotel

Nathan Kuppermann, MD, MPH, is Distinguished Professor of Emergency Medicine and Pediatrics and the Bo Tomas Brofeldt Endowed Chair of the Department of Emergency Medicine at UC Davis. He is a pediatric emergency medicine (PEM) physician and clinical epidemiologist as well as a leader in emergency medical services for children, particularly in multicenter research. His research foci include 1) infectious emergencies in children including the laboratory evaluation of young febrile children, 2) evaluation of children at risk of diabetic ketoacidosis-related cerebral injury, and 3) laboratory and radiographic evaluation of the pediatric trauma patient. His focus is on clinical trials and clinical prediction rules using large cohorts of acutely ill and injured children. Dr. Kuppermann has published works in all three focus areas in high-impact journals such as the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), British Medical Journal (BMJ), and The Lancet. Dr. Kuppermann has received more than $30 million in federal grants and contracts as a PI over the past decade and has published more than 230 peer-reviewed publications. Dr. Kuppermann has been a leader in multicenter research in PEM, starting by chairing the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics (AAP)—the first U.S. research network in PEM—from 1996– 2000 and leading several investigations there. He then became one of the founding investigators and founding Chair of the Steering Committee of the Pediatric Emergency Care Applied Research Network (PECARN) from its inception in 2001 until late 2008, and he remains one of seven network principle investigators. He recently completed a four-year term as chair of the executive committee of the (global) Pediatric Emergency Research Network (PERN), an international consortium of PEM research networks. Dr. Kuppermann has been recognized nationally for his research and mentorship. In 2009 Dr. Kuppermann received the Miller-Sarkin Mentoring Award from the Academic Pediatric Association and in 2012 he received the Jim Seidel Distinguished Service Award from the Section on Emergency Medicine of the AAP for outstanding contributions to Pediatric Emergency Medicine. In 2010 and 2011 he received national research awards from the Emergency Medical Services for Children (EMSC) program of the Health Resources and Services Administration (HRSA), the Society for Academic Emergency Medicine (SAEM), and the American College of Emergency Physicians (ACEP). In 2015, he was recognized with the ACEP/ EBSCO/PEMSoft Achievement Award for outstanding contributions to pediatric emergency evidence-based medicine. In 2017 a PEM Scientific Research Mentoring award was named after him by the SAEM. He was elected to the National Academy of Medicine in 2010. Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force, interviewed Dr. Nathan Kupperman for this issue.

Dr. Kuppermann at home in San Francisco, California enjoying a gathering with international friends from global Pediatric Emergency Research Network (PERN).

Congratulations on being named the Dr. Peter Rosen Memorial Keynote speaker for SAEM20. Can you give us some highlights in advance? Thanks so much. I am honored to be selected for this keynote presentation. Dr. Rosen was such an icon in emergency medicine, and I had the privilege of working with him (in San Diego) and listening to and learning from his presentations and musings! In my keynote presentation, I will discuss how the field of pediatric emergency medicine has developed and expanded substantially in the past two decades, largely through its leadership in collaborative research networks, nationally and globally. The development of research networks has enhanced the level of evidence we now use and expect in the care of acutely ill and injured children. I will also highlight the collaboration between pediatric emergency medicine and general emergency medicine providers in these endeavors.

How have collaborative research networks advanced the practice of pediatric emergency medicine? Before the development of collaborative research networks in pediatric emergency care, we were greatly dependent on

"Peter Rosen was a trailblazer, innovator, and leader with the ultimate “glass-is-half-full” attitude — or rather, a “glass-is-almost-completely-full” attitude." single-center and retrospective chartreview studies to get our “clinical evidence.” Although well intentioned, the single-center studies were frequently too small to provide the necessary accuracy and precision to answer pressing clinical questions, and retrospective studies are always at risk for producing biased results. Equally important, we had no data to guide us about the best tools and processes to implement the results of high-quality, definitive research. The power of research networks rests on their ability to generate accurate, precise, and generalizable results. This is achieved by the high methodological quality of network studies, the large numbers of patients enrolled, and the diversity of the study populations. The evidence that results from these collaborations is ripe for translation and can be incorporated into clinical practice; however, we still face a substantial hurdle in getting clinicians to follow the evidence!

How will this change our daily practice? Pediatric research networks around the globe have now produced seminal evidence on a variety of topics including the evaluation of potential appendicitis, head and abdominal trauma (including concussions), and management of status epilepticus, febrile infants, diabetic ketoacidosis (DKA), gastroenteritis, cardiopulmonary arrest, and many other topics. The evidence generated from these studies is of high quality and ready for translation and incorporation into practice. It is now up to the practitioners who care for acutely ill and injured children to incorporate this evidence into practice and to shorten the “researchto-practice” time lag. Incorporation of evidence through use of decision support embedded in the electronic health record continued on Page 6

continued from Page 5

and through other implementation tools will greatly facilitate this process.

What are some myths of PEM that are being dispelled by new clinical evidence? There are different types of myths, but let’s start with “clinical myths.” And there are many that pediatric emergency care research networks have dispelled. These include the notion that every child with head or torso trauma needs a CT scan, that one second-line pharmacological agent is better than another in status epilepticus, that corticosteroids are effective in the treatment of bronchiolitis, that IV fluid causes cerebral edema in pediatric DKA, that all febrile infants younger than two months old need lumbar punctures. And there are many more! A more academic and professional myth about the field of PEM is that it is purely a clinical field. In fact, the field of PEM is sophisticated and academic, both in the pedagogy of education/instruction and in discovery and translation! Researchers with a focus on emergency medical services for children sit at the table with researchers from all medical fields, no different than our sisters and brothers who study adult emergencies. Furthermore, much of the research in pediatric emergency care has resulted from collaborations between pediatric emergency medicine and general emergency medicine researchers, along with our colleagues in trauma care, critical care, and a variety of other subspecialties.

Could this paradigm be adapted to other aspects of emergency medicine? Organized research networks in general emergency medicine have transformed the care of ill and injured adults in ways similar to what we have observed more recently in pediatric emergency care. In fact, I am regularly approached by investigators from other disciplines for advice on the creation of research networks in their specialties. It is acknowledged that network collaborations and team science are helping pave the way for more evidencebased care in general. As a reflection of this, the percentage of clinical research

Dr. Kuppermann with a lion in Lujan, Argentina

"I would love to see an NIH institute dedicated to emergency care, both adult and pediatric. I would love to see as many NIH K-awards and R-awards in our field as we see in other similarly sized fields." articles published in high-impact journals resulting from network research has increased over time. Anecdotally, my clinical colleagues and I frequently turn to the medical literature resulting from network research to help answer our daily clinical questions.

SAEM’s annual meeting keynote address has been permanently renamed in honor of the great Peter Rosen, MD. Did you ever meet Dr. Rosen? What did he mean to you? Peter Rosen was a trailblazer, innovator, and leader with the ultimate “glass-ishalf-full” attitude — or rather, a “glassis-almost-completely-full” attitude. All emergency care practitioners owe him a debt of gratitude for his pioneering

efforts in establishing our field. I met him during my first job out of fellowship at San Diego Children’s Hospital, during which I would do some shifts at the University of California, San Diego where he worked at the time. Although occasionally feisty, he was someone you better listen to because he was almost always right! And when he was our visiting research day judge at UC Davis Health, he enlightened us with his scholarship and experience, and entertained us with his sassy stories (to put it mildly!). What a pioneer and icon!

How has your participation in SAEM fit into your extremely prolific career? SAEM has been at least half of my academic home over the decades. As a PEM provider, I took a bit of an

Dr. Kuppermann podcasting on the UC Davis-produced EM Pulse Podcast

Dr. Kuppermann on the Bondi to Coogee walk, Australia, with his family (wife Nicole, and daughters Maya, Elie, and Cianna)

alternative path compared to many of my colleagues. Although trained in PEM at a freestanding children’s hospital (Boston Children’s Hospital), I learned early in my career that one of the biggest clinical/educational impacts I could have was training general emergency medicine learners on the care of acutely ill and injured children. This is because approximately 85-90 percent of acutely ill and inured children in the United States are attended at general rather than pediatric EDs. Therefore, I chose to work in an outstanding general academic ED with a great PED embedded… And UC Davis became my professional home. I still have another academic home in the Pediatric Academic Societies (PAS), but the SAEM is where I established my collaborations with outstanding general emergency physicians that continue to this day, learned at great didactic sessions at the annual SAEM meetings, and helped craft a home for PEM providers at SAEM. I feel that I have the best of both worlds with a foot in the SAEM and another in the PAS.

What advancement in PEM would you love to see occur in your lifetime? Tantalizing question, and I have a lot to say, but will try to be brief! I would love to see an NIH institute dedicated to emergency care, both adult and pediatric. I would love to see as many NIH K-awards and R-awards in our field as we see in other similarly sized fields. I

Dr. Kuppermann on a scooter in Melbourne, Australia

would like to see the “learning health care system” incorporated into EDs, in which discovery is quickly translated to improved care, which in turn results in more discovery. I would love to see the elimination of health care disparities in the ED and throughout the health system, and the diversity of health care providers match that of the patients for whom we

provide care. And I would love to see the behavioral health infrastructure in this country develop substantially so that this special population of patients with mental health care needs can be cared for in a more appropriate patient-centered location. And finally, I would like to see the end of ED boarding of inpatients! And there is more…You asked!

20 PREVIEW

SAEM20 in Denver: Scaling New Heights in the Mile High City A Message From Jody Vogel, MD, SAEM20 Program Committee Chair

ANNUAL MEETING PREVIEW

“Situated at an elevation of exactly one mile above sea level, Denver is known as the “Mile High City” for obvious reasons. In Denver’s rarified air, golf balls go ten percent farther, alcohol packs more punch, and the sun shines warmer. If you like mountain activities (hiking, climbing, etc.) or just enjoy a view of the mountains, there are 200 named peaks aligned in a 140-mile panoramic view within eyesight of Denver.

Denver is the perfect backdrop for scaling new heights in academic emergency medicine. It is the ideal location for SAEM’s Annual Meeting to continue its ascension as the country’s premier forum for the presentation of original education, research, and innovation in academic emergency medicine. The SAEM20 Program Committee is proud to bring you another unparalleled SAEM Annual Meeting program. In addition to the largest presentation of pediatric didactics we’ve ever had, you can look forward to two keynote addresses by renowned speakers along with our usual agenda of cuttingedge education, state-of-the-art original research, and innovation in academic emergency medicine. The Annual Meeting also includes high-quality career development opportunities, energetic networking events, a few exciting surprises, and all the “extracurricular” fun and camaraderie you have come to expect from the SAEM Annual Meeting. This special annual meeting section of SAEM Pulse will give you a sneak peak of what you can expect at SAEM20 in Denver. For the most current annual meeting news and information, be sure to follow SAEM on Facebook and Twitter (@SAEMOnline, #SAEM20) and bookmark the SAEM20 website. Then browse the SAEM20 online program planner by category or date and customize your schedule by clicking the star to add items to your “favorites” list.

ANNUAL MEETING PREVIEW

Plenary Abstracts Abstracts present research data, including study background and methodology, research limitations and results, and the conclusions/significance of the study. The SAEM20 Program Committee is pleased to announce the top eight abstracts selected to be presented during two special plenary sessions to be held immediately following the keynote addresses on Wednesday and Thursday. These eight abstracts were chosen as the best from among a record number of 1,300+ submissions.

Opening Session Plenaries

Wednesday, May 13, 10:00 AM – 10:50 AM Following the Dr. Peter Rosen Memorial Keynote Address

1. Comparative Effectiveness of Two Individualized Acute Pain Treatment Communication Tools: The Life Stories for Opioid Risk Reduction in the Emergency Department (STORRIED) Study Zachary Meisel, Karin Rhodes, Carolyn Cannuscio, Jeanmarie Perrone, Marilyn Schapira, Erik P. Hess, Erica Goldberg, Melissa Rogers, Venketesh Bellamkonda, Frances Shofer, Jeffrey Bell, Abby R. Dolan, Michael Zyla, Sharon McCollum

2. Disparities in Gender Representation and Salary in Emergency Medicine Leadership Roles

Jennifer L. Wiler, Kirsten L. Rounds, Becky McGowan, Janette Baird

3. A National Evaluation of Emergency Department Pediatric Readiness and Outcomes Among United States Trauma Centers

Craig Newgard, Amber Lin, Lenora Olson, Jennifer Cook, Marianne Gausche-Hill, Nathan Kuppermann, Jeremy Goldhaber-Fiebert, Susan Malveau, McKenna Smith, Mengtao Dai, Avery Nathens, Nina Glass, Peter Jenkins, John McConnell, Katherine Remick, Hillary Hewes, Clay Mann

4. One and Done? Performance of a Single, Low High-Sensitivity Troponin in a Multisite United States Cohort Brandon Allen, Robert Christenson, Scott A. Cohen, Richard M. Nowak, R. Gentry Wilkerson, Bryn E. Mumma, Troy Madsen, James McCord, Maite Huis in ‘t Veld, Michael Massoomi, Jason P. Stopyra, Cindy Montero, Michael Weaver, Kai Yang

Dr. Nathan Kuppermann to Present Inaugural Dr. Peter Rosen Memorial Keynote Address at SAEM20 Nathan Kuppermann, MD, MPH, the Bo Tomas Brofelt Endowed Chair and a distinguished a professor in the department of emergency medicine at the UC Davis School of Medicine, has been selected to deliver the society's first-ever Dr. Peter Rosen Memorial Nathan Kuppermann, MD, MPH Keynote Address, established in honor of emergency medicine's founding father who passed away November 11, 2019. Dr. Kuppermann’s address, “The Kids Have Grown Up: The Rise of Academic Pediatric Emergency Medicine through Collaborative Research Networks,” will be presented on May 13 during the opening session of SAEM20.

Thursday Session Plenaries

Thursday, May 14, 10:00 AM – 10:50 AM Following the Featured Keynote Address 5. FEED-ER: A Novel Tool for Assessing the Quality of Feedback in the Emergency Room Khuansiri Narajeenron, Brett Todd, Robert S. Hsu, Ryan Clark, Ronnie K. Ren, Geoffrey Jara-Almonte, Joao Ricardo Nickenig Vissoci, Sreeja Natesan

8. Prevalence of Bacteremia and Meningitis in Febrile Infants Less Than or Equal to 60 Days With Positive Urinalyses Prashant V. Mahajan, Leah Tzimenatos, Andrea Cruz, Melissa Vitale, Elizabeth C. Powell, Aaron N. Leetch, Michelle Pickett, Rachel Richards, John M. VanBuren, Octavio Ramilo, Nathan Kuppermann, Pediatric Emergency Care Applied Research Network (PECARN)

6. Wellness in Academic Emergency Medicine: Initial Exploration of 2019 Survey of the SAEM Physician Membership Andra L. Blomkalns 7. Evaluating Mental Health and Substance Abuse Disorders as Associations With Missed Emergency Department Acute Myocardial Infarction Diagnoses Adam L. Sharp, Aileen Baecker, Scott Riccomini, Rani Pallegada, Najlla Nassery, Stacy Park, Visanee Musigdilok, Ahmed Hassoon, Ming-Sum Lee, Susan Peterson, Samantha Pitts, David Newman-Toker

ANNUAL MEETING PREVIEW

ACGME's Dr. Eric Holmboe to Present Thursday Keynote Address

Eric S. Holmboe, MD, senior vice president, Milestone Development and Evaluation for the Accreditation Council for Graduate Medical Education (ACGME), will present a keynote address, “Achieving Eric S. Holmboe, MD Desired Outcomes in Graduate Medical Education: A Look Back and Forward,” on Thursday, May 14, 9:30–10 a.m. during SAEM20 in Denver, Colorado. The plenary will review lessons learned from the early years of competency-based medical education (CBME), the first six years of Emergency Medicine Milestones use, and recently-introduced learning analytics. The session will conclude with a discussion about the next steps needed to realize the full promise of outcomes-based education.

Educational Sessions Advanced EM Workshop Day Tuesday, May 12, 8:00 AM – 4:00 PM

Add any workshop when you register for SAEM20. Advanced EM Workshops are intensive educational sessions that focus on particular techniques, skills, and practical aspects of the specialty. 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. • Academic Wilderness Medicine Education • Build an Academic Department Within a Corporate Structure • Clerkship Director Boot Camp • Clinical Teaching Educational Boot Camp • Creating Change Beyond the ED • Emergency Medicine X Waiver Training • Firearm Injury Prevention: An ED How-to Guide • Improve Your Educational Research • Leveraging Passion in an Academic Career • Low-cost Simulation Models and Techniques • P2 Network • Poverty Immersion • Promoting Diversity, Equity, and Inclusion in EM Residency • SAEM Grant Writing Workshop • Critical Strategies in Simulation Procedural Skills Training • Defining the Future of Assessment in Medical Education • The Opioid Crisis and Children

ANNUAL MEETING PREVIEW

Didactics

Wednesday May 13, 8:00 AM – 5:20 PM Thursday, May 14, 8:00 AM – 5:20 PM Friday, May 15, 8:00 AM – 12:50 PM Didactics are presentations that are designed to teach on a particular subject and can vary in structure from lecture and flipped classroom formats to panels and small group discussions. More than 100 innovative and interactive sessions cover a range of educational topics in key categories, including: administrative, career development, education, clinical, and research.

IGNITE!

Wednesday, May 13, 1:00 PM – 2:50 PM Friday, May 15, 8:00 AM – 9:50 AM IGNITE! talks are fast-paced, highly energetic, captivating, and engaging presentations on a variety of topics. The IGNITE! format is five minutes in length with 20 auto-advancing slides. A panel of judges selects a “Best of IGNITE!” winner from each IGNITE! session. An “Audience Choice Award” is also given at each session based on audience polling. All topics are accepted. Speakers in the past have talked about their experiences in disaster relief, waxed poetic about the role of machine learning in emergency medicine, and challenged core practices in EM critical care and education.

Innovations

Wednesday, May 13, 3:00 PM – 5:20 PM Thursday, May 14 (tabletop), 1:00 PM – 5:00 PM Friday, May 15, 8:00 AM – 12:50 PM Innovations present novel ideas, new products, innovative procedures, and unique approaches in medical education, faculty development, wellness, operations, and patient care. Innovations are presented in either a seven-minute oral presentation or as a tabletop/ hands-on demonstration.

Training + Networking SAEM Leadership Forum

Tuesday, May 12, 8:00 AM – 4:00 PM Add this forum to your SAEM20 Registration SAEM Leadership Forum provides exposure to core leadership topics with an emphasis on experiential learning and practical application. The SAEM20 Leadership Forum is designed for all levels of aspiring leaders who are interested in improving their leadership skills. The session will provide exposure to core leadership topics with an emphasis on experiential learning and practical application. Presenters are recognized experts with extensive leadership experience. The agenda includes segments on emotional intelligence and its impact on leadership style, strategies for successful leadership, increasing visibility, and managing conflict.

Junior Faculty Development Forum Tuesday, May 12, 9:00 AM – 4:00 PM

Add this forum to your SAEM20 Registration Junior Faculty Development Forum is an opportunity for early-career faculty to engage with senior leaders in emergency medicine to develop strategies for promotion, productivity, and academic advancement. The forum is designed to enable junior faculty to engage with senior leaders in our field, to develop strategies for promotion, productivity, and academic advancement, and to enable them to become the next generation of leaders in our field. It is intended for fellows and early-career faculty who have recently secured faculty positions within academic emergency departments. The forum will feature focused didactic presentations from leaders in EM administration, education and research, as well as a Q & A panel of current and former Department Chairs.

Medical Student Symposium Thursday, May 14, 8:00 AM – 3:00 PM Add this to your SAEM20 Registration

SAEM Education Summit

Wednesday, May 13, 1:00 PM – 5:20 PM Add this to your SAEM20 Registration The Education Summit is a half-day track devoted entirely to medical educators. This free-to-attend, special track is designed to help improve your education knowledge and expertise ranging from bedside teaching to education research provided by internationally-recognized experts in medical education. This session will include a mix of TEDMed-style presentations, lectures, panels, and small group workshops. Attendees will learn about evidence-based and cutting-edge medical education topics, how to be an effective education researcher, and strategies for increasing productivity while maintaining work-life balance.

Speed Mentoring

Wednesday, May 13, 3:30 PM – 5:20 PM Add this to your SAEM20 Registration Speed Mentoring matches residents and medical student mentees into small groups of 5-10 attendings for quick-fire, 10-minute mentoring sessions. Resident and medical student mentees will be matched into small groups of 5-10 attendings who share their interests, for quick-fire, 10-minute mentoring sessions. Participants will have an opportunity to start new mentoring relationships with mentors from around the country as well as socialize with fellow residents and medical students.

Chief Resident Forum

Thursday, May 14, 8:00 AM – 3:00 PM

ANNUAL MEETING PREVIEW

Add this forum to your SAEM20 Registration

Chief Resident Forum features 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 SAEM20 Chief Resident Forum is the preeminent opportunity for rising chief residents in emergency medicine to gain the skills to successfully lead their residency programs. The forum gathers chiefs from around the nation to discuss traits of effective leaders, network with peers, and get a crash course on keeping their residency thriving. Engaging sessions by national leaders emphasize the practical aspects of being chief, including optimizing resident schedules, developing innovative curricula, recruiting the program’s next generation, and balancing wellness with leadership.

Medical Student Symposium provides an overview of emergency medicine and in-depth information about the process of applying for an emergency medicine residency position. A networking lunch with emergency medicine program directors and clerkship directors is included. The SAEM20 Medical Student Symposium (MSS) will include an overview of emergency medicine (EM) as a career choice and will discuss the residency application process for students with allopathic, osteopathic, international, and military backgrounds. This day-long symposium, presented by thought leaders in the specialty, will include specific discussions about clerkships, away rotations, personal statements, the match process, and interviews. There will also be ample time for questions and discussions during a lunch with EM program directors and clerkship directors. The SAEM Residency and Fellowship Fair, which showcases residency and fellowship programs from across the nation, will immediately follow the MSS and is part of the registration fee for this session.

New! Speed Mentoring for Medical Educators Thursday, May 14, 11:00 AM – 11:50 AM Add this to your SAEM20 Registration Similar to the popular speed mentoring event offered at previous SAEM annual meetings, this model for medical educators offers faculty an opportunity to engage in short discussions with mentors who have the expertise and significant experience in medical education. Participants will have an opportunity to sample potential mentoring relationships and identify a medical education mentor whose experience and personality aligns with their professional interests, desired career trajectory, and personality traits.

New! Meet, Greet, and Tweet Thursday, May 14, 2020, 4:00 PM - 5:20 PM

Social media is playing an increasing role in how learners, educators, and researchers engage in the academic community. This fun, first-of-its-kind event involves some of EM’s biggest social media influencers, giant face cutouts (yes, like the kind you see at athletic events), a live Twitter feed, and refreshments. Participants will learn first-hand from some of EM’s top social media influencers what it takes to be an influencer themselves and best practices for promoting scholarship through social media. The session will incorporate screens alternating between highlighted tweets from panelists and a live feed of the event. The initial 45 minutes of the session will consist of an introduction to the panelists who will introduce themselves with an overview of their contributions to the advancement of the practice of emergency medicine through FOAMed and social media. After the introductions, there will be a question and answer session and panel discussion. The final 30 minutes will be a social session, allowing participants to interact with panelists on a more personal level. During this portion of the session, there will be a live twitter feed of the event. #MGT2020

MedWAR is sponsored by BTG.

ANNUAL MEETING PREVIEW

a learning competition that combines wilderness medical challenges with adventure racing to teach the skills and techniques of wilderness medicine and promote teamwork. MedWAR is looking for volunteers to run challenges, judge scenarios, play “victim,” give directions or gear to racers, and/or tracking racers. No experience is necessary. If you can help, let us know!

Residency & Fellowship Fair Thursday, May 14, 3:00 PM – 5:00 PM Add this to your SAEM20 Registration Residency & Fellowship Fair is an opportunity for medical students and residents to explore residency and fellowship programs from across the nation, meet current residents and fellows, ask questions, and seek application and interview advice. Looking to find your perfect residency or fellowship? Top institutions from across the country will be showcasing their residency and fellowship programs at the SAEM20 Residency & Fellowship Fair. Explore some of the country’s best residency and fellowship programs, meet with current residents and fellows, ask questions, and seek application and interview advice...all in one convenient location! The Residency & Fellowship Fair is sponsored by Kaiser Permanente Undergraduate and Graduate Education and Vituity.

SimWars

Wednesday, May 13, 1:00 PM – 5:30 PM SimWars is an entertaining, educational, simulation-based competition in which teams of clinical providers face off in timed, interactive scenarios to demonstrate their clinical skills, teamwork, communication, and problem-solving abilities. SAEM’s Simulation Academy SimWars is THE premier national simulation competition for emergency medicine residents.

Residency and Fellowship Directors!

Showcase your institution’s programs and recruit hundreds of medical students and emergency medicine residents looking to find their perfect residency or fellowship. Register your institution today!

Experiential Learning Competitions

SonoGames®

Friday, May 15, 8:00 AM – 12:00 PM Register your team of three.

MedWAR

Friday, May 15, 8:00 AM – 4:00 PM Register your team of three. Denver’s beautiful Chatfield State Park is the site of SAEM20 MedWAR (short for Medical Wilderness Adventure Race),

SonoGames® is an innovative, game-style approach to emergency medicine ultrasound education in which residency teams representing more than half of all emergency medicine residencies in the country, face off in an energetic competition that demonstrates their hands-on skills, knowledge of pointof-care ultrasound, and clinical decision-making abilities. SonoGames® is supported by our 2020 Gold Sponsors EchoNous and Philips.

NEW! Program Officer Event Wednesday, May 13, 2:30 PM – 3:50 PM 4:00 PM – 4:50 PM (Networking Event)

Clinical Images Exhibit

Tuesday, May 12, 8:00 AM – 5:00 PM Wednesday, May 13, 8:00 AM – 5:00 PM Thursday, May 14, 8:00 AM – 5:00 PM Friday, May 15, 8:00 AM – 1:00 PM SAEM Clinical Images Exhibit, daily Tuesday–Thursday, May 12–14, 8 a.m.–5 p.m. and Friday, May 15, 8 a.m.–1 p.m., displays the most original, high-quality clinical images relevant to the practice of emergency medicine selected from more than 120 submissions.

SAEM’s Got Talent

Thursday, May 14, 11:00 AM – 11:50 AM SAEM’s Got Talent is a FOAMed-based competition that uses an “America’s Got Talent” game show format to showcase the most innovative Free Open-Access Medical Education (FOAMed) creations of the past year. Top social media innovators, selected in advance, will have seven minutes to impress the audience and a panel of judges with their quality academic emergency medicine social media content, including blogs, podcasts, apps, and more! Following a 10-minute review and commentary by the judges, a “Best of SAEM20” will be named. Are you a #FOAMed contributor? Present your work at #SAEM20, SAEM›s Got Talent.

SAEM Jeopardy 2020

ANNUAL MEETING PREVIEW

Wednesday, May 13, 8:00 AM – 8:50 AM

This innovative session will use a “Jeopardy-style” game show format to engage and educate EM colleagues about the importance of considering the variables of sex and gender in their clinical care, academic projects, and teaching, and to appreciate the value that neurodiversity brings to teams and leadership.

Attendees selected to attend this new session will have the opportunity to meet one-on-one with program officers from major federal agencies and institutes, including the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Patient Centered Outcomes Research Institute, to engage in discussions around important topics such as how to choose the right institute for a proposal, how to improve a grant’s impact score, how to approach and interact with a program officer, and more. This one-on-one session will be followed by a networking social event. Attendees for this session will be selected through a competitive application process. Priority will be given to applicants who have unique research ideas and a demonstrated record of academic accomplishments. Those selected to attend the event must purchase either a full or oneday (Wednesday) SAEM20 registration. To be considered for this event, please complete the form.

Lion’s Den 2020

Thursday, May 14, 1:00 PM – 2:50 PM Drawing on the innovative and humorous format of the popular “Shark Tank” television show and adapted for the emergency medicine (EM) specialty, a panel of senior EM researchers will provide real time guidance on proposal development, present the critical elements of a junior research study/grant proposal, and introduce the components of a successful study proposal. Residents, fellows, and junior faculty are invited to submit their research ideas by completing this form or emailing moderator Kristin Rising (Kristin.rising@ jefferson.edu) by April 1. Junior researchers whose proposals are accepted will then have chance to present their study ideas to our “Lion’s Den” panel. Each proposal will be presented using a standard format and will be critiqued by the panelists. The most successful proposals will be offered a true “investment” in the form of distance mentorship, editorial expertise, and more!

ANNUAL MEETING PREVIEW

Just for Fun Dodgeball

Thursday, May 14, 5:30 PM – 7:30 PM This grownup twist to the classic playground game pits emergency medicine residency teams from all over the country in an epic battle to the finish and the right to call themselves dodgeball champs. Spectators can enjoy hot dogs and cold suds while they cheer on their favorite players. Dodgeball is sponsored in part by SAEM Residents and Medical Students (RAMS) and AAEM Resident and Student Association (RSA).

Axe Throwing

Thursday, May 14, 7:00 PM - 9:30 PM Enjoy an evening of axe throwing, beer, and art at Downtown Art Gallery and Axe Room (DAGAR for short). Expert DAGAR coaches will guide you through the basics of axe throwing. They’ll teach you how to throw, build your confidence through a practice period, and prepare you to go head to head tournament style with your colleagues and friends! Register today.

EscapeWorks Denver

Tuesday, May 12, 7:00 PM - 9:00 PM Escape rooms are the hottest, most fun team building activities around and EscapeWorks is Denver’s premier escape room. Your puzzle-solving team will enter one of five unique, theme-based rooms: Murder at the Speakeasy, Zombie Outbreak, Egyptian Tomb, Casino Heist, War Games. Each room is designed to provide a completely immersive experience. You’ll feel the pulse-pounding thrill of trying to break into a casino vault or being transported back to the time of prohibition and the excitement of finding your way into a gangster’s speakeasy. Within each room are puzzles, clues, and codes that must be deciphered as you race with your friends against a ticking clock. One hour, one room, one way out… Can you escape? Sign up to find out.

Complimentary Daily Yoga

Wednesday–Friday, May 13–15, 7:00 AM - 8:00 AM Join Linda Davis-Moon, MSN, APRN-BC each morning as she leads attendees in complimentary yoga. These daily sessions will combine physical exercise, mental meditation, and breathing techniques to strengthen your muscles and relieve stress. Sign up when you register for SAEM20.

SAEM20 Party at Temple Nightclub Denver Hosted by RAMS Thursday, May 14, 10:00 PM - 2:00 AM Academic EM’s biggest bash of the year will be held this year at Temple Nightclub Denver. Temple has been described as “otherworldly,” “futuristic,” and a “Tron- and Blade Runner-inspired world.” You can expect a live DJ, open bar, killer sound system, fully immersive state-of-the-art lighting and visuals, and cohesive artistic experience that promises to “teleport you into a higher dimension of nightlife.” The RAMS-hosted SAEM20 Party promises to be out of this world! 15

2020 Society for Academic Emergency Medicine Consensus Conference

Telehealth and Emergency Medicine: A Consensus Conference to Map the Intersection of Emergency Medicine and Telehealth Tuesday, May 12, 8:00 AM â&#x20AC;&#x201C; 5:00 PM

Judd Hollander, MD

ANNUAL MEETING PREVIEW

The 2020 SAEM Consensus Conference is designed to stimulate emergency medicine (EM) researchers and educators to recognize, investigate, and translate the impact of telehealth on the field of emergency medicine. In addition to breakout group planning sessions and a consensus-building process, the conference will include state-of-the-art didactics led by nationally recognized keynote speakers Judd Hollander, MD, professor of emergency medicine and associate dean, Strategic Health Initiatives, at Sidney Kimmel Medical College, Thomas Jefferson University, and Aaron Martin, executive vice president and chief digital officer, Providence St. Joseph Health. Specific topics to be explored are: healthcare access; quality and safety; educational needs and outcomes; research facilitation; and the impact of telehealth on the EM workforce.

Aaron Martin

Consensus Conference gathers junior and senior researchers, thought leaders, and other stakeholders in emergency medicine to generate research agendas for the important, unanswered questions facing emergency care, leading to high-quality, funded research projects of varying scopes from a variety of funding sources. Previous topics have included pediatric emergency medicine, wellness, simulation, shared decision making, imaging, and gender-specific research.

For additional details, including an agenda, roster of all scheduled speakers, and an explanation of the process, visit the consensus conference webpage.

Exhibit Hall Hours Thursday, May 12

5:00 PM - 6:00 PM Exhibitor Kickoff Party in Exhibit Hall

Wednesday, May 13

Take the Conservation Pledge and Help SAEM Work Toward an Environmentally Sustainable Annual Meeting! The SAEM20 Program Committee and the SAEM Climate Change and Health Interest Group are working together to ensure an environmentally sustainable SAEM20 and you can help! Registered SAEM20 attendees have the opportunity to participate in our conservation efforts by completing a Conservation Pledge to take environmentally-responsible steps to reduce their ecological footprints. Those who complete the pledge will be recognized on the SAEM20 website, announced on social media, and acknowledged during the SAEM20 plenary session. Visit the Conservation Pledge webpage for more information.

SAEM20 Welcomes International Attendees! The Society for Academic Emergency Medicine (SAEM) welcomes our international emergency medicine global partners to SAEM20 in Denver, CO. Planning to travel to SAEM20 from outside the continental United States? Check to see if you qualify for discounted international attendee rates for SAEM20 and be sure to visit our international travel webpage for helpful information, including tips for applying for a Visa.

SAEM20 Online Program Planner The SAEM20 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 SAEM20 to remind you what not to miss and where to go next.

ANNUAL MEETING PREVIEW

SAEM20 Exhibit Hall

7:00 AM - 9:00 AM Exhibit Hall Open

7:00 AM - 8:00 AM Networking Breakfast in Exhibit Hall 12:00 PM - 4:00 PM Exhibit Hall Open 12:00 PM - 1:00 PM Light Lunch in Exhibit Hall 2:30 PM - 3:00 PM Power Break in Exhibit Hall

Thursday, May 14 7:00 AM - 1:00 PM Exhibit Hall Open

7:00 AM - 8:00 AM Coffee Service in Exhibit Hall 12:00 PM - 1:00 PM Light Lunch in Exhibit Hall

Sponsors and Exhibitors… SAEM20 Puts Your Products and Services in Front of 3,000 EM Decision Makers and Thought Leaders! The SAEM annual meeting is the premier forum for the presentation of high-quality academic emergency medicine research and education. The annual meeting hosts more than 3,000 attendees and includes presentations from the most brilliant minds in the specialty. Sponsoring and/or exhibiting at the SAEM annual meeting puts your products and services in front of these EM decision makers, thought leaders, and early adopters. For more information on becoming an exhibitor or sponsor, please contact: John Landry, Manager, Business Development at 847-257-7224, ext. 204. Visit our exhibits and sponsors webpage to learn why you should add your name to our growing list of exhibitors and sponsors.

Pediatric Emergency Medicine Opportunities at SAEM20 If you are an academic emergency medicine physician with a specialty interest in pediatrics, or if you are interested in further exploring the subspecialty of pediatric emergency medicine, SAEM20 in Denver is the place to be! We’ve expanded our pediatric educational content and networking opportunities beyond anything we’ve offered before. Here’s a glimpse of what you can expect: • More than 20 pediatric related-didactics • Advanced EM Workshop: The Opioid Crisis and Children: How Do We Manage Pain and Protect Them From Harm? • P2 Network Workshop — PEM POCUS leaders will review recent research, discuss current projects, and introduce ways to incorporate research into clinical practice

ANNUAL MEETING PREVIEW

• Dr. Peter Rosen Memorial Keynote Address: The Kids Have Grown Up: The Rise of Academic Pediatric Emergency Medicine through Collaborative Research Networks

IN MEMORIAM

Now Accepting Submissions for SAEM20 Tribute This spring, at SAEM20, 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 1, 2019 for an “In Memoriam” video tribute to be shown at SAEM20. Please send your “In Memoriam” submissions (name, institution and a photo, if you have one) to sroseen@saem.org by April 1, 2020.

Your SAEM20 Host Hotel Puts the Mile High City at Your Fingertips! The Sheraton Denver Downtown Hotel, 1550 Court Place, in Denver, Colorado is the official host hotel for meetings, education, and social events at SAEM20. Situated in the heart of the city, Sheraton Denver Downtown Hotel provides easy access to the best of the Denver. Ideally located on the popular 16th Street Mall, a mile-long pedestrian promenade brimming with shopping, dining, nightlife and entertainment, the hotel places the city at your fingertips. Arrive with ease — the light rail is close by —then settle into our upscale guest rooms and suites, each with our signature Sheraton Sleep Experience Bed, high-speed

Wi-Fi and sweeping views of the city and mountains. Enjoy an abundance of hotel amenities including a heated outdoor rooftop pool, 5,000 square foot fitness center, and multiple dining options. The SAEM20 group rate closes April 15 and is available on a first come, first-served basis and the room block is filling up fast, so be sure to reserve your room soon! When booking your room, be sure to extend your reservation through May 15 to take advantage of the educational offerings available through Friday. For more details visit the SAEM20 Housing webpage.

MANAGEMENT OF THE ANTICOAGULATED PATIENT WITH LIFE-THREATENING BLEEDING IN THE ED: AN INTERACTIVE, CASE-BASED APPROACH TWO COMPLIMENTARY CME EVENTS: LUNCH PROVIDED

DAY 1: Wednesday May 13, 2020 - 12:00 -1:00 PM

DAY 2: Thursday May 14, 2020 - 12:00 -1:00 PM

Sheraton Denver Downtown - Silver Room

INDICATIONS, THERAPY, AND REVERSAL AGENTS AND MANAGEMENT OF INTRACRANIAL, INTRASPINAL, AND GASTROINTESTINAL BLEEDING

DEVELOPING A CRITICAL PATHWAY AND TREATMENT OF ANTICOAGULATED CRITICALLY INJURED PATIENTS IN THE ED, OR, AND SURGICAL ICU

Indications for Anticoagulation and Agents: Coumadin, Factor IIa & Factor Xa Inhibitors Arthur M. Pancioli, MD University of Cincinnati Cincinnati, OH

Developing Your Own Hospital Critical Pathway for Severe Bleeding in the Anticoagulated Patient Joshua M. Kosowsky, MD Brigham & Womenâ&#x20AC;&#x2122;s Hospital/Harvard Boston, MA

Management of Life-Threatening Bleeding in the Anticoagulated ED Patient Gregory J. Fermann, MD University of Cincinnati Cincinnati, OH

Treatment of Severe Bleeding in the Cardiovascular ICU and ECMO Patients Jordan B. Bonomo, MD - EM/Medical Critical Care University of Cincinnati Cincinnati, OH

Intracranial and Intraspinal Bleeding in the Anticoagulated Patient Natalie E. Kreitzer, MD - EM/Neurocritical Care University of Cincinnati Cincinnati, OH

Management of the Bleeding Anticoagulated Trauma Patient in the ED William A. Knight, IV MD - EM/Surgical Critical Care University of Cincinnati Cincinnati, OH

Treatment of Severe Gastrointestinal Bleeding in the Anticoagulated Patient James W. Hoekstra, MD Wake Forest University Winston Salem, NC

Preparing the Anticoagulated Trauma or Surgical Emergency Patient for the OR Babak Sarani, MD - Trauma Surgery/Critical Care George Washington University Washington, DC

MODERATOR:

W. Brian Gibler, MD President, EMCREG-International University of Cincinnati Cincinnati, OH

COLLABORATE | INVESTIGATE | EDUCATE

20 PREVIEW Denver Art Museum

Enjoy Denver Like a Local! Discover the best the Mile High City has to offer by following the advice of SAEM members who live and work in Denver and know their city and surrounding area inside and out.

ANNUAL MEETING PREVIEW

Our Panel

Jody A. Vogel, MD, MSc, MSW

Emmy Betz, MD, MPH

Andrew A. Monte, MD, PhD

SAEM20 Program Committee Chair

Associate Professor, Department of Emergency Medicine, University of Colorado School of Medicine Research Physician, Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), Veterans Health Administration Deputy Director, Program for Injury Prevention, Education and Research (PIPER)

A ssociate Professor, Emergency Medicine & Medical Toxicology Department of Emergency Medicine & Pharmaceutical Sciences University of Colorado Denver-Anschutz Medical Center, Aurora, CO Rocky Mountain Poison & Drug Center Denver Health & Hospital Authority

Associate Professor Denver Health Medical Center University of Colorado School of Medicine

ANNUAL MEETING PREVIEW

Steuben's

Best Casual Restaurants

Best Breakfast/Brunch

Jody’s pick:

Jody’s and Emmy’s picks:

• Rioja, 1431 Larimer St, Denver, CO – Locally sourced, imaginative Mediterranean dishes and wines in a highenergy dining room.

Emmy’s picks:

• Steuben's, 523 E 17th Ave, Denver, CO — Classic regional American favorites and cocktails make up the menu at this buzzing, retro-style diner. • Linger, 2030 W 30th Ave, Denver, CO 80211 — This old mortuary is now a lively restaurant with a rooftop lounge and global small plates.

• Snooze an AM Eatery, 1701 Wynkoop St #150, Denver, CO (and other locations) — Vibrant, retro chain serving a seasonal menu of creative breakfast and lunch fare, plus cocktails. • Steuben's and Rioja

Andrew’s pick

• Anyplace that looks low brow and has breakfast burritos. (Read Why Denver’s Breakfast Burrito is a Gift Straight From the Breakfast Gods for several ideas.)

Andrew’s pick:

• CRU Food & Wine Bar, 1442 Larimer St, Denver, CO — Relaxed, Napa-style wine-bar chain serving New American fare, stone-fired pizzas and cheese plates.

Favorite Downtown Restaurants Jody’s pick:

• Tavernetta, 1889 16th St Mall, Denver, CO — Upscale, buzzy Italian hot spot from an acclaimed team with an open kitchen and a fireplace lounge.

Emmy’s picks:

• Ophelia’s Electric Soapbox, 1215 20th St, Denver, CO — Huge, multilevel “gastro-brothel” with live music and a restaurant offering eclectic American food. • Bistro Vendome, 1420 Larimer St #1705, Denver, CO — Traditional Left Bank-style cafe with a garden crafting slightly modern twists on French standards. • Steuben's and Rioja

Best Cup of Coffee Jody’s picks:

• Novo Coffee Glenarm , 1600 Glenarm Pl, Denver, CO — Sleek, stylish coffee cafe serving snacks plus pour-overs and espresso drinks from a local roaster. • Crema Coffee House, 2862 Larimer St, Denver, CO — A chill hipster vibe fills this all-day haunt run by coffee mavens, who also offer eclectic noshes.

Snooze 21

Favorite Place to Imbibe Jody’s pick:

• CRU Food & Wine Bar, 1442 Larimer St, Denver, CO — Relaxed, Napa-style wine-bar chain serving New American fare, stone-fired pizzas and cheese plates.

Emmy’s pick:

• Casa Bonita, 6715 W Colfax Ave, Lakewood, CO — Mexican eats and pageantry such as divers plunging into a pool below a 30-ft. waterfall and puppet shows. (Tip from Emmy: watch this episode of South Park first!)

Best After-hours Hotspot: Emmy’s pick: Terminal Bar

• Terminal Bar at Union Station, 1701 Wynkoop St, Denver, CO — Union Station restaurant located in the historic ticketing office inside The Great Hall. A fabulously restored space appointed with period-correct finishes from the building’s turn-of-the-century heyday. Also features a large outdoor patio with views of Wynkoop Plaza and 17th Street. Offers craft beer from Colorado breweries and microbreweries, a complete selection of spirits, an extensive list of carefully curated wines, and great burgers.

Favorite Place to Spend an Evening Out Andrew’s picks: Wynkoop • Wynkoop Brewing Company, 1634 18th St, Denver, CO — Colorado’s first brewpub (started by former Colorado governor and presidential candidate John Hickenlooper) offers craft beers and New American pub grub in a pool hall/ bar setting.

Andrew’s pick:

• Coors Field/Colorado Rockies, 2001 Blake St, Denver, CO — Take in a Rockies game for a fun, affordable way to spend a warm afternoon and evening... and within walking distance of the Sheraton Downtown Denver. • Denver Performing Arts Center, 1101 13th St, Denver, CO — A showcase for live theatre and world-class plays and a preferred stop on the Broadway touring circuit.

Red Rocks Park & Amphitheater

ANNUAL MEETING PREVIEW

• Rioja, 1431 Larimer St, Denver, CO — Locally sourced, imaginative Mediterranean dishes & wines in a high-energy dining room.

Best Burger Joint Jody’s pick:

• 5280 Burger Bar, 500 16th St Mall Suite 160, Denver, CO — Creatively topped burgers, housemade ice creams and craft beer served in a casual, contemporary space.

Worth Ubering To Jody’s picks:

• Fruition, 1313 E 6th Ave, Denver, CO — Tiny destination drawing foodies for refined farm-to-table New American cuisine.

• Red Rocks Park and Amphitheater, 18300 W Alameda Pkwy, Morrison, CO — A mountain park known for its large red sandstone outcrops. Within the park boundaries is an award-winning, open-air amphitheatre built into a rock structure.

ANNUAL MEETING PREVIEW

Can’t Miss Tourist Attraction Emmy’s pick:

• Brewery tour, various locations in Denver and outside the city. Guided private tours and personal walking tours give you a behind-the-scenes look at Denver’s thriving beer scene, including the largest single-site brewery in the world, as well as specialty microbreweries.

Andrew’s picks:

• Pearl Street Mall, runs several blocks east to west, between Walnut and Spruce Streets, in Boulder, Colorado, and is a lively and eclectic hub for dining, arts, shopping, and people watching.

Best Spa Emmy’s pick:

• Denver Spa & Wellness, Four Seasons Denver, 1111 14th St, Denver, CO — Offers a wide variety of massage therapies and a menu of luxurious spa treatments including, facials, acupuncture, seasonal offerings, and more.

Golden, Colorado

Best Place to Spend a Rainy Day

Best Place to Take a Scenic Photo

Jody’s picks:

Andrew’s pick:

• Denver Museum of Nature and Science, 2001 Colorado Blvd, Denver, CO — Premier natural history and science museum with a variety of exhibitions, programs, and activities.

Wings Over the Rockies Air & Space Museum

• Historic Downtown Golden, Colorado, close to Denver and nestled between North and South Table Mountains and the spectacular foothills of the Colorado Rocky Mountains. This idyllic former gold rush town, "Where the West Lives," includes the historic 12th Street Neighborhood and over 50 historic buildings.

Best Place to Spend the Day Outdoors Jody’s pick:

• Rocky Mountain National Park, 1000 US Hwy 36, Estes Park, CO — 415 square miles encompass and protect spectacular mountain environments. Enjoy Trail Ridge Road, which crests at 12,000 feet and includes many overlooks, along with over 300 miles of hiking trails, wildflowers, wildlife, starry nights.

Emmy’s pick:

• Red Rocks Park and Amphitheater, 18300 W Alameda Pkwy, Morrison, CO — In addition to its world-renowned open-air amphitheatre, this mountain park has 868 acres of pine tree-speckled geological marvels, meadows, wildlife habitats and dinosaur fossils to investigate, and a variety of hiking and biking trails. • Wings Over the Rockies Air & Space Museum, 7711 E Academy Blvd, Denver, CO — Dedicated to inspiring, educating and entertaining the public about aviation and space endeavors of the past, present and future with over 50 iconic aircraft and realistic flight simulators.

Emmy’s and Andrew’s picks:

• Denver Art Museum, 100 W 14th Ave Pkwy, Denver, CO — One of the largest art museums between Chicago and the West Coast, with a collection of more than 70,000 works of art divided between 10 permanent collections including African, American Indian, Asian, European and American, modern and contemporary, pre-Columbian, photography, Spanish Colonial, textile and western American art.

Andrew’s picks:

• Hiking in Boulder, Golden, and Rocky Mountain National Park • Fly fishing excursion on one of the local rivers or trout streams, chartered through Trout’s Fly Fishing or Golden River Sports • Mountain biking in Golden, Colorado. Because of its spectacular location, Golden has become one of the most popular biking capitals of Colorado for all types of biking enthusiasts. • Skiing (still possible in May) at Arapahoe Ski Basin Ski and Snowboard Area, 28194 US-6, Dillon, CO 80435, home to the longest ski and ride season in Colorado!

DIVERSITY AND INCLUSION

What Is Structural Competency and Why Do We Need It in Emergency Medicine?

SAEM PULSE | MARCH-APRIL 2020

By Bisan A. Salhi, MD, PhD and Bernard L. Lopez, MD, MS

In recent years, emergency medicine (EM) has made significant progress towards describing and understanding how symptoms, disease, and patient treatment and outcomes are influenced by “upstream” social determinants of health. With this revolution in understanding our patients and our own role in the American health system (and society more generally) comes a pressing need to translate these findings into a coherent educational framework for medical students and residents.

teaching strategy, cultural competence oversimplifies profound variations within racial, ethnic, or religious groups, and glosses over the fact that many people belong to multiple groups at once. Moreover, cultural competence does not explain the ways in which experiences of class may be similar across religious, racial, or ethnic lines. Within this model, health is inadvertently conceptualized as a product of subjective beliefs and attitudes rather than being influenced by material deprivation and systemic inequalities.

act on the systemic causes of health inequalities. While such an approach is relatively new to emergency medicine, many healthcare professionals (e.g., public health practitioners) and social scientists (e.g., historians, sociologists, and anthropologists) have long addressed structural determinants of health. Structural competency draws on the experience and expertise of our colleagues to develop a language and interventions to reduce health inequalities at the neighborhood, institutional, and policy levels.

Until now, cultural competency was the most developed tool emergency physicians had to understand patients and their life circumstances beyond the clinical encounter. Yet the concept of culture, which refers to a group’s ingrained “beliefs” or “way of life,” falls short as an explanatory model for the social determinants of health. As a

To address these shortcomings, structural competency calls for a new approach to teaching the relationships among race, class, gender, sexual orientation, disease expression, and health outcomes. It bridges robust research on social determinants of health to the clinical encounter to prepare trainees to understand and

What does structural competency look like in practice?

Over the past several decades, emergency physicians have endeavored to challenge and address injustice, racism, exclusion, and inequity through legislation, awareness raising, rights

“...structural competency calls for a new approach to teaching the relationships among race, class, gender, sexual orientation, disease expression, and health outcomes. It bridges robust research on social determinants of health to the clinical encounter to prepare trainees to understand and act on the systemic causes of health inequalities.” education, and an anti-bias curriculum. Structural competence reinforces and builds on this work.

• Do you have friends, family, or other people who help you when you need it?

and regional conditions beyond the emergency department (ED).

• Who are the people on whom you rely?

In practical terms, structural competence can be divided into five core components:

Physicians should also reflect on their position within an interaction, asking themselves questions such as:

1. R ecognizing the social structures that influence and shape clinical interactions. On a fundamental level, this means addressing the material and social circumstances of patients in the history and acting upon them in the dispositional planning. Examples of questions include:

• May some service providers (including me) find it difficult to work with this patient?

• Do you have enough money to live comfortably (e.g., pay rent, get food, pay utilities, telephone?)

Importantly, the answers to these questions are not simply idiosyncratic to individual patients, they represent important insights into neighborhood

2. D eveloping an extra-clinical language of structure to understand patients beyond presenting signs and symptoms of disease. Drawing on information gained from core component number one, emergency physicians should draw upon scholarship from other disciplines (e.g., history) to understand how structural inequalities observed today are byproducts of longstanding racialized attitudes and policies that reflect other societal attitudes and prejudices.

• Could the interactional style of this patient alienate some providers, eliciting potential stigma, stereotypical biases, or negative moral judgment?

continued on Page 26

“Structural competence involves a commitment to understand patients in the context of their historical and material circumstances at the bedside and beyond. It requires a will to strengthen security and work towards equality in conditions and health outcomes.”

SAEM PULSE | MARCH-APRIL 2020

DIVERSITY continued from Page 25

For instance, emergency physicians often note that African Americans represent a disproportionate segment of the U.S. homeless population and are more likely to experience eviction and live in substandard housing than their white counterparts. This finding is not merely an “accident,” but is a byproduct of more than a century of federal, state, and local housing policies deliberately designed to promote neighborhood segregation and exclude African Americans from home ownership and its commensurate benefits in American life. 3. R earticulating “cultural” presentations in structural terms.

Attributing patient presentations to attributes of their predefined group inadvertently reinforces stigma and stereotypes (e.g., “This patient believes X because s/he is Y and will therefore not comply with treatment.”). Rather than relying on preconceptions, structural competence encourages emergency physicians to prioritize patient material conditions, barriers to health maintenance, and adherence to treatment plans. 4. O bserving and imagining structural intervention. Having learned the challenges facing their patients and their communities, we hope that residents will be motivated to form partnerships with community leaders

and become involved with health policy, advocacy, and the legislative process to better serve their patients beyond the bedside. 5. D eveloping structural humility. Structural competency advocates that emergency physicians become actively engaged with social issues and cultivate their self-awareness without furthering an unrealistic or grandiose narrative about “changing the world.” Instead, emergency physicians are encouraged to recognize and act on available opportunities while simultaneously recognizing the limits of their knowledge and respecting the expertise of other scholars and community partners.

Structural competence involves a commitment to understand patients in the context of their historical and material circumstances at the bedside and beyond. It requires a will to strengthen security and work towards equality in conditions and health outcomes. This commitment is a never-ending journey involving critical reflection, learning to understand how people experience the world and navigate their challenges. These conditions are not static, and our level of structural competence changes in response to new situations.

How to Cultivate Structural Competency in the EM Curriculum

Given that emergency physicians practice in environments that vary by region and across time, there is no “one size fits all” approach to achieving or fostering structural competency. It is important, however, that residency leadership and EM educators make an intentional effort to encourage residents to think about the difficulties besetting their patients outside the ED. To foster structural competency, we make the following suggestions for residency leaders and EM educators: • Encourage residents to partner or participate longitudinally within local organizations (e.g., housing advocacy organizations, food banks); • organize resident visits to city council or state legislature meetings to demystify the legislative process and to demonstrate the role physicians can play in the political process; • encourage residents to participate in their hospital or university committees; • partner with residents to write op-eds and participate in public scholarship; • invite non-physicians (social scientists, public health practitioners, community partners, and/or patients) to share their perspectives and expertise (e.g., at departmental grand rounds or journal clubs); • encourage residents to seek advice or feedback from social scientists

Join in the Conversation! Join us in Denver at SAEM20 for a didactic session cosponsored by the SAEM Academy for Diversity and Inclusion in Emergency Medicine and the SAEM Education Committee: Incorporating Structural Competency in Emergency Medical Education May 15, 2020 — 11:00 a.m.–11:50 a.m. Governor's Square 11: Concourse Level Sheraton Denver Downtown Hotel Sign up for this session when you register for SAEM20 and/or community organizations when developing scholarly or quality improvement projects; • support resident advocacy with time, institutional resources, or funding, and recognize their achievements through public acknowledgment and praise. While this list is not all-inclusive, we believe these efforts demonstrate the value of our colleagues’ perspectives outside of emergency medicine and model structural competency and humility for our trainees. There is no shortage of issues or opportunities for engagement and advocacy. Residents should be reminded of the social capital that comes along with their medical training and should be given the tools to deploy their social capital on behalf of their patients. Using his framework, we can incorporate principles of social medicine into our practice and advocacy and work together to improve health outcomes for our patients.

ABOUT THE AUTHORS r. Salhi is an assistant D professor in the department of emergency medicine at Emory University School of Medicine. She is a member of SAEM’s Academy for Diversity and Inclusion in Emergency Medicine. Dr. Lopez is associate provost for diversity and inclusion, Jefferson (Philadelphia University + Thomas Jefferson University) and associate dean for diversity and community engagement and professor and executive vice chair in the department of emergency medicine at Sidney Kimmel Medical College of Thomas Jefferson University. He is a long-time member of SAEM’s Academy for Diversity and Inclusion in Emergency Medicine and served as the academy’s president from 2015-2017.

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

ED ADMINISTRATION AND CLINICAL OPERATIONS

Provider in Triage: An Operations Perspective

SAEM PULSE | MARCH-APRIL 2020

By Josh Joseph MD, MS, MBE and the SAEM ED Administration and Clinical Operations Committee

Should your emergency department (ED) put a physician in triage? The answer is a resounding, “maybe!” In addition to reducing the ED’s everimportant door-to-provider time metric, there are obvious clinical benefits to be gained from making your patients’ first contact with a provider happen as early as possible. Having a provider in triage also initiates diagnostic testing earlier, which seems like it should reduce patient length of stay; however, these benefits can be negated by other structural and process issues within the ED. Placing a provider in triage also comes with significant potential costs, not all of which are immediately apparent. The primary putative benefit of placing a provider in triage is that it reduces the amount of time that patients wait to be seen. Patients who have simple, straightforward complaints, like a

“The primary putative benefit of placing a provider in triage is that it reduces the amount of time that patients wait to be seen.” request for suture removal or a small foreign body in their ear canal, can be immediately treated and discharged from triage. Conversely, patients who present with subtle but important signs of more serious disease, like a patient who seemingly presents with benign paroxysmal vertigo, but actually has direction-changing nystagmus, can be recognized and brought back for further evaluation more quickly. The benefit of this approach is dependent on the experience of the

physician performing the triage and the amount of space available within the ED. Some studies have failed to show significant throughput benefits from residents and mid-level providers at triage (but have improved other metrics, such as patient satisfaction). Most emergency departments depend on experienced ED nurses to perform triage, and simply adding a provider to the process provides limited benefits. Comparatively, at least 12 larger, academic EDs have

“In addition to reducing the ED’s ever-important door-to-provider time metric, there are obvious clinical benefits to be gained from making your patients’ first contact with a provider happen as early as possible.” reported replacing nurse-based triage entirely and redesigning the ED front-end around an attending physician-driven intake process; additionally, community hospitals have also reported significant benefits from front-loading physician evaluations. Even with an experienced attending physician in triage, if there are free beds consistently available within the ED, then some patients may be better off being brought back immediately and evaluated at the bedside. If possible, a policy of direct bedding, often referred to as “getting rid of the waiting room,” has the benefit of having patients seen by their primary ED team sooner and, at present, has more robust evidence for its effects on throughput and patient satisfaction.

Similarly, if there are often patients waiting to be seen who have already been brought back within the ED, then the provider’s time is better spent within the ED proper than at triage. Placing a provider in triage can also help facilitate ordering diagnostic testing for patients earlier on in their ED visit, but this isn’t always to their benefit. If the CT scanner has a three-hour backlog, then ordering a patient’s scan 20 minutes earlier in their stay does little to affect this bottleneck. Early and hastily ordered diagnostic testing can also add headaches downstream. Consider if your colleague takes a quick history on a patient with chest pain at triage, and orders a d-dimer… If you interview the patient later on, and don’t think that a

d-dimer is warranted, only to find the test is already positive, your patient may ultimately stay several more hours for an unnecessary CT scan. Thus, placing a provider in triage should be weighed in light of other front-end strategies to expedite having patients seen by their primary team of providers.

ABOUT THE AUTHOR Dr. Joseph is assistant professor of emergency medicine at Harvard Medical School and director of emergency operations research at Beth Israel Deaconess Medical Center in Boston, MA. jwjoseph@bidmc.harvard.edu

EDUCATIONAL DOWNLOAD

Five Tips for Building a Successful Didactic Talk

SAEM PULSE | MARCH-APRIL 2020

By Eric Steinberg, DO, MEHP and Doug Franzen, MD, MEd

Despite recent interest in varied teaching modalities, the didactic lecture remains a staple of emergency medicine education.1 Preparing and delivering a memorable didactic talk is no easy task. Whether you are speaking in front of a handful of colleagues in a conference room or hundreds of strangers in a packed auditorium, the following key strategies will help you achieve lecturing success.

Passion + Purpose = Engagement

Passion is contagious. If the audience senses how much you care about your topic, they will feel more invested. Choose a topic that you crave to learn more about or share with others. Even if you are assigned a topic, find something personally interesting within that topic. Find a story to frame your talk. In an editorial on storytelling in medicine, Ofri2

“Passion is contagious. If the audience senses how much you care about your topic, they will feel more invested.” stated “Medical caregivers are always telling stories because stories provide meaning to much of their working lives … the compulsion to tell a story is largely motivated by the profound emotions kindled by the clinical experience.”

that “most presentations make the supportive media (i.e. the slides) the focus of the presentation without thought about the story or the delivery.”3 This is not to say you must present a case—but you should put the key points into a larger organizing framework.4, 5

We share stories all the time—we just happen to call our stories “cases.” Stories bring a sense of humanity to a scientific talk and engage clinicians more than a collection of facts. A commonly encountered pitfall is

Know Your Audience

Understanding the demographics of your audience is essential to delivering a successful talk. Adult learners tend to ask “Why do I need to know this?” before committing their attention and

“Little nuances such as stage presence, posture, voice, tone, transitions, and cadence separate the outstanding from the average.” will be more engaged if they see how the knowledge can be put to use.6 Miller7 suggests that we progress from fact gathering and interpretation to demonstrating and integrating our knowledge into practice as we become experts. A primary audience of new interns may need an overview of a topic and a few key details, focusing on what to do when they see this in the emergency department (ED). A more seasoned audience will appreciate an exploration of the latest research with a summary of what to consider the next time they encounter it in the ED. A typical weekly EM didactic setting may include all levels of competence, so it is prudent to ascertain the details of your expected audience ahead of time. In addition to differing levels of expertise, audience members have individual learning styles: visual, auditory, read/write, and kinesthetic.8 Although each learner has a tendency to prefer one learning style, a majority of learners are multimodal, preferring a combination of learning styles dependent on the content or situation. Presenting information in multiple formats will engage more of your audience. Even kinesthetic learning can happen in a large group lecture by

incorporating audience participation or passing around models.

Bones and Flesh

Once you know your topic and your audience, choose three to five key points that you want your audience to walk away with. Fit these into your organizational framework to create the skeleton of your talk. Start fleshing out the talk by adding details such as examples, diagrams, current research, and/or a case. This brainstorming process should begin the moment you are assigned the talk—keep a template available and add ideas as they come (e.g., notepad, index cards, notes app, word doc on laptop). Gathering ideas often helps solidify key points and you may realize you need to change your structure. Don't feel you need to include everything. The details you ultimately include will depend on the key points you are trying to emphasize. If you find great resources that you don't have time or space to include, consider creating a handout listing these extra resources. As you deliberate what to include, you should also consider how you will present it. Find ways to engage your audience through active participation, rather than passive listening, with techniques like

think–pair–share or clarifying questions.9 Instead of summarizing the latest research, compare recommendations from the literature with the practice patterns of your audience. A commonly used strategy is to have the audience work through a case. By asking “What would you do?” you increase engagement by allowing audience members to relate their own experience, another strategy that resonates with adult learners. Small-group discussions, polling software, or a show of hands engages more audience members than calling out a single member of the audience. Alternatively, asking an expert to comment may provide nuance that group discussion or polling cannot. The education literature and the Internet are rife with suggestions to increase audience engagement; a full review of potential techniques is beyond the scope of this article. Finally, it is essential to consider the overall length of your talk. Evidence suggests that learners’ attention levels begin to fade approximately 15 to 20 minutes into a standard lecture and that only three to five items can be retained at once.10 continued on Page 32

"...choose three to five key points that you want your audience to walk away with. Fit these into your organizational framework to create the skeleton of your talk." FIVE TIPS continued from Page 31

SAEM PULSE | MARCH-APRIL 2020

Pictures Speak 1,000 Words, Your Text Shouldn't

Images on slides should support what you are saying, not repeat it. Less is more: keep your slides simple, with as few words as possible. Audiences prefer talks with more image-based slides.11 Avoid overusing gimmicks such as animations or video clips. “Exercise restraint and always keep these three words in mind: simplicity, clarity, and brevity.”12 This technique will resonate with the audience and as result will be more impactful. The quality of the images you choose represents the quality of your entire talk, so choose high-resolution images. Shutterstock has a vast library of highresolution images, for a fee. Free sites include Flickr, Pixabay, Pexels, and Freepik. Never apologize for a poorquality slide—don't include it. Find or create a slide that does not need

to be accompanied by an apology. When presenting a case be sure to include all relevant clinical images (e.g., x-rays, ECGs) and a clear, uncluttered presentation of key data like lab values and vital signs. Highlight relevant abnormalities or key findings.

Practice Makes Perfect

Now that you have a rough draft of your talk, it is time to practice. The first time you actually hear yourself speak should not be during the presentation itself! It is critical to rehearse multiple times. Initial solitary rehearsals should still be out loud: when reviewing slides, we process information much faster in silence than when we actually have to speak the words. Speaking aloud as you rehearse gives you a much more realistic sense of how long your presentation will take. Rehearsing aloud also allows you to practice enunciating tricky words, altering your tone to stress certain points, fine-tuning the transitions between topics, and cementing the timing of slide changes.

Practice your blocking: where will you stand? When will you walk to the other side of the stage? What gesture best emphasizes your point? As you rehearse you may realize you need to add or delete content or change your slides. Additionally, familiarity with the room arrangement can help you plan your delivery. Activities that work when the audience is seated at tables in a small room may not work in an auditorium. Finally, consider videotaping your rehearsal lectures. This will allow you to assess and fine-tune your pace, voice, and posture—subtle details that have a large impact on your overall presentation. Undoubtedly, it is beneficial to do this well in advance, with time to practice, rather than the morning of your talk. As your presentation solidifies, the next step is to deliver your talk in front of a mock audience. This will allow you to gauge their captivation, try out some “test material,” and ensure you end on time. Choose colleagues who

will provide you with brutal, open, honest feedback. Incorporate their suggestions and rehearse again. As Dr. Scott Weingart says, “The mark of an amazing presenter is that they've said the words countless times before … every presenter that seems so at ease, so capable of adlibbing, of ‘never preparing their talk’ has probably prepared more extensively than you'd ever be able to imagine.”13 Your mantra should be: Present … Reflect … Perfect … Repeat. If possible, arrive early to ensure that your presentation is loaded and displays properly. This is critical if your presentation is being loaded onto another computer. During your talk, remember to speak loudly, slowly, and clearly, which is easier to do if you've practiced. If possible, have someone record your talk. It is also wise to obtain feedback from your audience. Review both and reflect on how you might further improve your presentation. Little nuances such as stage presence, posture, voice, tone, transitions, and cadence separate the outstanding from the average. Finally, after investing this much time and effort, don't make your presentation a one-off. Look for opportunities to present again.

Conclusion

In the era of TED talks, a successful presentation is no longer about the slides but rather the unification of genuine passion, poignant stories, and stunning

visuals that leave your audience moved and inspired. Top-notch presentations don't just happen; they require planning, preparation, and practice. Follow these steps to give your learners the unforgettable presentation they deserve. Five Tips for Building a Successful Didactic Talk was reprinted from the January 2020 issue of Academic Emergency Medicine Education and Training journal. REFERENCES 1. Gottlieb M, Riddell J, Njie A. Trends in national emergency medicine conference didactic lectures over a 6-year period. J Contin Educ Health Prof 2017; 37: 46– 9. 2. Ofri D. The passion and the peril: storytelling in medicine. Acad Med 2015; 90: 1005– 6. 3. Swaminathan A. REBEL Cast Ep 45: How to Build a Great Presentation REBEL EM Blog. Available at: http:// rebelem.com/rebel-cast-ep-45-how-to-build-a-greatpresentation/. Accessed December 6, 2018. 4. Wolff M, Wagner MJ, Poznanski S, Schiller J, Santen S. Not another boring lecture: engaging learners with active learning techniques. J Emerg Med 2015; 48: 85– 93. 5. Reynolds G. “ Why Storytelling Matters.” Kyoto, Japan. Presented at TEDx Kyoto. Oct 30, 2014. Available at: https://www.youtube.com/watch?v=YbV3b-l1sZs. Accessed May 23, 2019. 6. Merriam SB. Andragogy and self-directed learning: pillars of adult learning theory. New Direct Adult Contin Educ 2001; 89: 3– 14. 7. Miller GE. The assessment of clinical skills/ competence/performance. Acad Med 1990; 65: 563– 7. 8. Fleming ND, Mills C. Not another inventory, rather a catalyst for reflection. To Improve Academy1992; 11: 137– 55.

9. Wlodkowski R. Enhancing Adult Motivation to Learn. 2nd Ed. San Francisco: Jossey-Bass, 1999: 190– 1. 10. Gottlieb M, Riddell J, Crager SE. Alternatives to the conference status quo: addressing the learning needs of emergency medicine residents. Ann Emerg Med 2016; 4: 423– 30. 11. Ferguson I, Phillips AW, Lin M. Continuing medical education speakers with high evaluation scores use more image-based slides. West J Emerg Med 2017; 18: 152– 8. 12. Reynolds G. Presentation Zen: Simple Ideas on Presentation Design and Delivery. 2nd ed. San Francisco: New Riders, 2007: 144– 5. 13. Weingart S. Podcast 192 – Powerpoint and Meth – Presentation Creation from #TTC. EMCrit Blog. Published February 6, 2017. Available at: http:// emcrit.org/emcrit/powerpoints-meth/. Accessed December 6, 2018.

ABOUT THE AUTHORS Dr. Steinberg is program director of the emergency medicine residency at St. Joseph’s Regional Medical Center, Paterson, NJ and assistant professor of emergency medicine – New York Medical College. Dr. Steinberg tweets @estein54. Dr. Franzen is an associate professor and associate program director in the emergency medicine residency program at the University of Washington School of Medicine, Seattle, WA.

ETHICS IN ACTION

Self-Plagiarism in Peer-Reviewed Publishing

SAEM PULSE | MARCH-APRIL 2020

By Joshua Lupton, MD, MPH, 2019-2020 Resident Editor, Academic Emergency Medicine

This past year I found myself facing the blank page on the computer, preparing to write up a manuscript from a research study. The study itself was a secondary analysis of clinical trial data, unique in its overall conclusions to the parent study, but most of the data collection and methods were already described in the published trial and a prior secondary analysis I had published. Must I rewrite nearly half of a methods section that should, logically, be nearly identical to the previously published manuscripts? My sense was that I needed to start from scratch, and I could not simply copy or reuse sections and reference the parent text. However, I began to wonder where the line was and if I was overly concerned about self-plagiarism.

What is self-plagiarism?

Self-plagiarism refers to any reproduction of oneâ&#x20AC;&#x2122;s own text, figures,

or data in a way that is misleading and meant to give the impression of a new production. The Committee on Publication Ethics (COPE) refers to self-plagiarism as synonymous with text recycling. Although some may argue that certain aspects of text recycling should be allowed, given that self-plagiarism is often used as a tool to mislead an audience into receiving old information as novel, it should be avoided. In academic publishing, complete duplication is the clearest form of self-plagiarism. The best example of this is an author submitting an already-published work for publication elsewhere. Very rarely may the same work be legitimately published across multiple journals (guidelines produced by multiple societies, for example). For most journals, authors are required to confirm and disclose if the work is under consideration for publication elsewhere.

Partial duplication refers to selected text recycling of small sections of a manuscript. This is most commonly done in the methods section for multiple publications that used similar methods. While it is common to find an overlap in methods between multiple publications of legitimately unique research from a single research study, when possible authors need to reference the source manuscript and avoid word for word recycling of entire passages from already published text. If the methods of two manuscripts were truly identical then one would surmise that the newer manuscript should not come to unique conclusions not already published. Rather, for secondary analyses or other instances where there is significant methods overlap, the authors should cite the original published methods while explaining them briefly, and thereafter provide clarity to how the

“Though some may argue that certain aspects of text recycling should be allowed, given that self-plagiarism is often used as a tool to mislead an audience into receiving old information as novel, it should be avoided.” current analysis was done to meet the aims of the new manuscript. Other sections of a manuscript are also subject to recycling, such as the discussion, where an author writing a review may recycle his or her own prior manuscript’s thoughtful discussion of the literature. Nor is it only the text of a manuscript that is subject to selfplagiarism. Authors will also recycle figures or parts of figures for use in future publications. Each of these instances of self-plagiarism are not only ethical issues but also an issue of copyright. Both the written text and figures of a manuscript almost always become the copyright of the journal in which they are published; thus, future duplication of any or all of a prior published manuscript is likely in violation of copyright agreements. Perhaps the most covert form of self-plagiarism is using the same data to produce new manuscripts without novel results or conclusions. This is covert because it is hard to detect for even the

most diligent editors and reviewers, and also because in many ways publishing pieces of data in different journals may be an acceptable form of peer-reviewed publication. However, when authors deliberately recycle an entire dataset for an analysis that has already been published as the main or secondary finding of another manuscript, this is another form of self-plagiarism, even if there is no word for word copying throughout the text.

Why is self-plagiarism important?

From the standpoint of the scientific and academic community, higher instances of self-plagiarism occurring in publications can give a false sense of the significance of a body of literature supporting an idea. A single study’s data that are recycled to multiple publications with the same conclusion and then referenced as separate studies in a review or future publications may give a false sense of weight to a particular conclusion where

the breadth of legitimate literature suggests the opposite. There are few items more important in the academic advancement of an individual than their publication record and the pressure to publish can result in the self-plagiarism violations aforementioned. Preventing self-plagiarism is critical to maintaining the integrity of the academic process. As mentioned previously, self-plagiarism can be used as a tool to mislead the academic community into a false impression of novel work. Promoting those who participate in self-plagiarism based on their increased publication record will result in the slow erosion of ethical behavior in academic institutions and underscores the importance of stopping this behavior as early as possible, especially when it is unintentional. Finally, copyright infringement is the legal companion to the ethical dilemma continued on Page 36

ETHICS continued from Page 35 of self-plagiarism. Journals that are not careful may find themselves in copyright disputes or need to withdraw a manuscript due to recycling of previously published text and figures.

How common is selfplagiarism?

SAEM PULSE | MARCH-APRIL 2020

There is little data exploring the incidence or prevalence of selfplagiarism in literature. As noted previously, the search results with keywords “self-plagiarism” have increased from 8000 in 2005 to more than two million in 2016. Of course, this hardly confirms the problem has increased and may reflect instead an increased awareness of this phenomenon.

A survey of arts, humanities, and social science journal editors via COPE published in 2019 indicates that issues of self-plagiarism are in the top 20 concerns of journal editors, with 23 percent reporting it as the most serious concern and 50 percent feeling that it is the most widespread. In comparison, a 2009 study of scientific journal editors did not specifically mention self-plagiarism, although the most serious issue identified by editors in that study was redundant publications — just above concerns for plagiarism in general.

Potential solutions

As with plagiarism, solving the issue of self-plagiarism will take efforts at all levels of academics and publishing.

“Promoting those who participate in self-plagiarism based on their increased publication record will result in the slow erosion of ethical behavior in academic institutions and underscores the importance of stopping this behavior as early as possible, especially when it is unintentional.” Avoiding this practice must be emphasized throughout high school, college, and graduate education. Authors wishing to submit manuscripts should be aware that this is not allowed and required to disclose any lack of self-citation of copied work or text. Additionally, if authors are self-citing they should bring this to the attention of peer reviewers so they may be more aware of the need to review past publications for duplication. Finally, new software like that used to detect plagiarism can be utilized to detect self-plagiarism.

Conclusions

After reflection from my research on self-plagiarism, I opted to continue to write anew my methods section de novo, with proper reference to the previously-published manuscripts and a concise description or the original methods followed by a detailed account of the methods unique to my secondary analysis. Self-plagiarism is a common phenomenon in academic publishing,

and awareness to this issue appears to be increasing. With concerted efforts of authors, peer-reviewers, and editors, we can better detect and deter attempts at self-plagiarism in publishing.

ABOUT THE AUTHOR Dr. Lupton is a current emergency medicine resident at Oregon Health & Science University. He is a 2019-2020 resident editor of Academic Emergency Medicine (AEM) journal. The resident-in-training (“resident”) appointment to the AEM editorial board is intended to introduce residents to the process of peer review, editing, and publishing of medical research manuscripts. The appointment provides the selected resident(s) with an experience that will enhance his/her career in emergency medicine and in scientific publication. For more information contact AEM Associate Editor Mark B. Mycyk, MD at mycyk.md@gmail.com or mmycyk@cookcountyhhs.org.

SGEM: DID YOU KNOW? Breathe Easier: Appreciating SexBased Differences in COPD By Laurie Goyack, MD and Stephanie DeMasi, MD Case: A 48-year-old cisfemale with no reported prior past medical history presents to the emergency department (ED) with a chief complaint of shortness of breath. She states that she has had debilitating fatigue and “trouble catching breath” for four days. She is a second-grade teacher and states that many of her students have upper respiratory infection-like symptoms. She recalls that several times a year, usually in the winter, she has similar symptoms and has been told she may have “asthma” but has never had a formal diagnosis. She quit a half-pack per day smoking habit several years ago. Her initial ED vital signs were notable for tachypnea with respiratory rate in the mid 20s, SpO2 89 percent on room air, and heart rate 89 bpm. On physical exam, she was speaking 3-4 words at a time and had significant subcostal retractions as well as diffuse expiratory wheezing. Discussion: As the temperature drops during the winter months, bundle up for the impact of pneumonia, upper respiratory infections, influenza, asthma and chronic obstructive pulmonary disease (COPD) exacerbations flooding your ED. With the hustle and bustle have you ever paused and thought about the difference in men and women presenting with an acute COPD exacerbation? Contrary to the modern society belief that COPD is a “male smokers” disease, women are 37 percent more likely to have COPD than men. Although overall the prevalence of tobacco use is more common in males compared to females, the gender gap in cigarette smoking rates continues to narrow. Data from 2017 demonstrated that chronic lower respiratory diseases, primarily COPD, has become the third leading cause of death among American women. Why are women more susceptible? Several reasons have been proposed in the literature. Women tend to be diagnosed later in their disease course; therefore, they are at a more advanced stage during treatment initiation which unfortunately is then less effective. Additionally, due to anatomically smaller airways, women receive a proportionately greater exposure to inhaled smoke particles from a single cigarette as compared to men. Estrogen has also been found to induce the cytochrome p-450 enzyme system forming reactive oxygen species, causing damage at

the cellular level. In 2017, the fetal lung development gene CELSRI was discovered to be a potential sex-specific risk factor in women for developing COPD. Research has shown that women express different manifestations and severity of COPD. Women present with complaints of dyspnea, fatigue and tend to have less sputum production and cough compared to men. Anxiety, depression, lower exercise tolerance, and worse quality of life in women has been supported by multiple studies. A 2018 study revealed that younger women were more likely to manifest severe dyspnea, have greater risk of exacerbations, and have more severe airflow limitation compared to younger men. This analysis revealed that the associations were less pronounced as patients aged (≥65), however older women continued to manifest more severe COPD than older men, despite lower pack-years smoking. The TORCH study revealed that the time to first exacerbation was shorter and the rate of exacerbations was 25 percent higher in women than men, however the number of hospital admissions caused by exacerbations were similar among both sexes. Appreciating sex-specific differences in COPD presentation, with particular regards to history and chief complaint, as well as sex-specific implication for COPD pathology and severity, can be an important aspect of the emergency physician’s assessment and medical decision making.

About the Authors: Drs. Laurie Goyack and Stephanie DeMasi are year-two residents in the University of Alabama at Birmingham, Emergency Medicine Residency Program.

SGEM "Did You Know?" is a recurring SAEM Pulse submission designed to represent concise facts that demonstrate how patient sex and gender effect emergency care. We welcome submissions. Please send contributions to the co-editors Lauren Walter and Alyson J. McGregor at sgem@lifespan.org.

GERIATRIC EMERGENCY MEDICINE

The Growth of Geriatric Emergency Medicine: Celebrating the 10th Anniversary of the Academy of Geriatric Emergency Medicine

SAEM PULSE | MARCH-APRIL 2020

By the Academy of Geriatric Emergency Medicine Membership and Communications Sub-Committee and Executive Committee

Recognition of the importance of geriatric emergency medicine (GEM) as a subspecialty and interest in improving emergency care provided to older adults has increased. As the Academy of Geriatric Emergency Medicine (AGEM) celebrates its 10th anniversary, we reflect on the history and growth of this subspecialty as well as the contributions of AGEM and its members, and we consider opportunities for the future.

Older Adults in the ED

Due to increased life expectancy and the aging of baby boomers, total U.S. adults aged older than or equal to age 65 will double to 83 million by 2050. The population of oldest old adults, equal to or older than 85, will triple in the same

period. Additionally, older adults are increasing how frequently they seek care in emergency departments (EDs). Some projections suggest older adults may represent as much as 33 percent of ED patients by 2030. Many EDs have been designed solely to manage acute injuries and illnesses rather than to care for heterogeneous, complex older adults with atypical presentations, multiple chronic conditions, polypharmacy, and cognitive impairment. Caring for older adults requires more ED resources, with older adults having longer ED stay lengths and a higher likelihood of admission and transfer to the intensive care unit. Optimizing care for geriatric patients

is particularly challenging in modern emergency medicine (EM), given the increased focus on rapid assessment, throughput, early disposition, and changing reimbursement models. Evidence suggests, however, that an ED visit may be a critical opportunity for an older adult, as high-quality care has the potential to make a dramatic impact on an older adultâ&#x20AC;&#x2122;s health, both in managing his or her acute complaint and in potentially identifying modifiable factors to avoid ED re-presentation or functional decline.

The Beginning of Geriatric Emergency Medicine

EDs have always treated older patients, however, systematic interest

"Pioneers, including Lowell Gerson, an epidemiologist at Northeast Ohio Medical University, and Arthur Sanders, an emergency physician at the University of Arizona, grew the focus on GEM through research, education, advocacy, and recruitment and mentorship of junior colleagues." in improving ED care for older adults began in the 1980s. Pioneers, including Lowell Gerson, an epidemiologist at Northeast Ohio Medical University, and Arthur Sanders, an emergency physician at the University of Arizona, grew the focus on GEM through research, education, advocacy, and recruitment and mentorship of junior colleagues. They and others contributed to the formation of SAEM’s Geriatrics Task Force and SAEM’s Geriatrics Interest Group, both of which were predecessors to AGEM. The Gerson-Sanders Award, the most prestigious award given annually by AGEM to an individual who has made

significant contributions to improving care for older adults in EM, is named for them. Subsequently, interest in the field grew gradually, with recognition of the importance of geriatric syndromes, including falls and delirium, and research exploring the potential role of EMS in contributing to care for older adults. The careers of several EM researchers were launched through Jahnigen scholarships funded by the John A. Hartford Foundation. (SAEM Foundation and the Emergency Medicine Foundation have continued to fund the GEMSSTAR Supplemental Funding for EM since the Jahnigen funding ended.) Geriatrics-

focused EM resident curricula and GEM textbooks were developed to begin to disseminate existing knowledge.

Acceleration During the Last Decade: Geriatric Emergency Departments, Guidelines, Accreditation, and Fellowships The growth of geriatric emergency medicine has dramatically accelerated in the last decade. In 2008, the first self-identified “geriatric emergency department” opened and many more quickly followed. In 2014, the first

continued on Page 40

"interest in the field grew gradually, with recognition of the importance of geriatric syndromes including falls and delirium and research exploring the potential role of EMS in contributing to care for older adults."

SAEM PULSE | MARCH-APRIL 2020

GERIATRIC continued from Page 39

Geriatric Emergency Department (GED) Guidelines were published and endorsed by four key professional associations including SAEM, the American College of Emergency Physicians (ACEP), the Emergency Nurses Association, and the American Geriatrics Society. The GED guidelines were designed to facilitate improvements in the care of older adults in the ED, focusing on staffing, education, enhanced policies and procedures, transitions of care, equipment, and performance improvement measures. Based on these guidelines, and to ensure that EDs that claimed to be geriatric-friendly were held to standards, ACEP launched

the Geriatric Emergency Department Accreditation (GEDA) program in 2018. The GEDA program accredits EDs for geriatric expertise at different levels (Levels 1, 2, 3) based on an EDâ&#x20AC;&#x2122;s initiatives to improve and measure quality of care for older adults, with more than 120 EDs already accredited and many more applying. Additionally, the Geriatric ED Collaborative (GEDC) was created with funding from the John A. Hartford Foundation and the Gary and Mary West Foundation. The GEDC assists hospital systems in improving ED care for older adults using the guidelines through on-site faculty led workshops, assistance with quality improvement projects, information sharing, and collaboration with local leadership. The GEDC leadership has created the Geriatric

Emergency Care Applied Research (GEAR) network, which is establishing research priorities, standardized data approaches, and measures for common geriatric ED syndromes. This network is also building a data bank to facilitate future multicenter studies. Geriatric ED research has been funded by NIH and the National Institute of Justice. Additionally, many emergency physicians have used NIHâ&#x20AC;&#x2122;s Grants for Early Medical/ Surgical Specialists' Transition to Aging Research (GEMSSTAR) and Paul B. Beeson Emerging Award in Aging career development awards to conduct mentored research. Specialized fellowship training in geriatric emergency medicine has been created at several institutions to develop the next generation of emergency physician

leaders in this field, and 25 fellows have graduated from these programs. AGEM was formed 10 years ago, and the organization, leadership, and members have made critical contributions to each of these exciting advances. AGEM membership has grown dramatically and steadily since its formation and is currently at its highest level. Many members are funded investigators conducting innovative, transformative GEM research. Others are thought leaders driving forward clinical and educational initiatives in their institutions, health systems, regionally, nationally, and internationally. AGEM has developed into an extraordinary mentorship network, with more senior members advising, guiding, and supporting early career members. AGEM serves emergency physicians at all levels of training, having recently released a Geriatrics Road Map in collaboration with RAMS and with many members actively mentoring medical students in research projects. The AGEM Executive Committee includes medical student and resident representation, and multiple people who served the organization as trainees now are serving again as attendings. Each year, AGEM sponsors a student, resident, and fellow to attend the SAEM Annual Meeting and present their geriatrics-themed research projects.

The Future of Geriatric Emergency Medicine: The Next 10 Years

We anticipate that geriatric emergency medicine is going to continue to change dramatically in the next decade. New research will inform and even transform practice, accreditation standards will continue to evolve, potential new regulatory requirements may be released, and more and more older adults will present to EDs. AGEM is poised to meet these challenges, through continuing to focus on our mission: to improve the quality of emergency care received by older patients through advancing research, education and faculty development.

AGEM at SAEM20 AGEM is planning to celebrate our 10th Anniversary at SAEM20 and we hope that all attendees consider participating.

Pioneers of Geriatric EM

AGEM will be recognizing and awarding several “Pioneers of Geriatric EM,” whose leadership and critical contributions have been integral to our organization and the progress the field has achieved.

NIA Program Officer Presentation

NIA Program Officer Sue Zieman is scheduled to attend SAEM20 to share her unique perspective on NIH’s support of Geriatric EM, new funding opportunities, and strategies for investigators.

Looking Back and Looking Ahead

In addition to reflecting on AGEM’s first decade and planning for the future, the AGEM business meeting will include updates from the GEAR initiative, explore next steps to support geriatric ED accreditation, and discuss potential approaches to update the geriatric ED guidelines with new research.

Geriatric-Themed EM Didactics

There are many geriatric EM themed didactics exploring topics highly relevant to emergency physicians including: • At the Intersection of Geriatrics and Emergency Medicine: National Institutes of Health Research Priorities and Funding Opportunities • Grandma's Two-Day Emergency Department Stay: Adapting Emergency Department Operations and Benchmarking Metrics for Older Adults • My Quality Improvement Project Has Fallen and It Can't Get Up: Implementing a Falls Program (AGEM & Evidence-Based Healthcare and Implementation Interest Group Sponsored) • A Practical Approach to Determining Goals of Care for Seriously Ill Elderly Patients With Cognitive Impairment • Doctoring in the Sandwich Generation: Practical Advice for Clinicians, Administrators, and Sandwich Caregivers

About AGEM The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

GLOBAL EMERGENCY MEDICINE

A Novel Coronavirus (2019-nCoV): What is Known So Far

SAEM PULSE | MARCH-APRIL 2020

By Shama Patel, MD, MPH

Coronaviruses (CoV) are a large family of viruses that cause an array of respiratory illnesses ranging from the common cold to Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Recently a novel coronavirus (2019nCoV) has emerged first detected in Wuhan City, Hubei Province China. The 2019-nCoV is a betacoronavirus originating in bats. Early in the outbreak, patients with 2019-nCoV had links to animal and seafood markets suggesting animal-to-person spread; however, subsequent reports indicate personto-person transmission via respiratory droplets. On January 30, 2020 2019nCoV outbreak was declared as a public health emergency of international concern. Confirmed cases of 2019-nCoV infections range from mild symptoms to severe illness. Symptoms include fever, cough, and shortness of breath appearing 2-14 days after exposure. It is thought people are most contagious when they are most symptomatic, but

there have been reports of spread from an asymptomatic infected patient to a close contact. Much is still unknown about the transmissibility, severity, and other features associated with 2019nCoV. Currently there is no vaccine to prevent 2019-nCoV infection. Centers for Disease Control (CDC) recommends the following actions to prevent the spread of respiratory viruses: • Avoid close contact with people who are sick. • Avoid touching your eyes, nose, and mouth with unwashed hands. • Stay home when you are sick. • Cover your cough or sneeze with a tissue, then throw the tissue in the trash. • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe. • Follow CDC’s recommendations for using facemask. o CDC does not recommend that people who are well wear facemask to protect themselves from respiratory

viruses, including 2019-nCoV. o Facemask should be used by people who show symptoms of 2019 novel coronavirus, in order to protect others from the risk of getting infected. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility). • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. o If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60 percent alcohol. Supportive treatment is the mainstay for the management of those with confirmed or suspected 2019-nCoV. The World Health Organization (WHO) recommends that all suspected cases of 2019-nCoV infection be isolated (contact and droplet precautions) and monitored in the hospital setting.

Flowchart to Identify and Assess 2019 Novel Coronavirus For the evaluation of patients who may be ill with or who may have been exposed to 2019 Novel Coronavirus (2019-nCoV)

U.S. Departme Health and Hu Centers for Dise Control and Pre

Identify

if in the past 14 days since first onset of symptoms a history of either

 

Close contact with

Travel to China

a person known to have 2019-nCoV illness*

AND the person has

Fever or symptoms of lower respiratory illness (e.g., cough or shortness of breath)

if both exposure and illness are present



The CDC has developed clinical criteria for patients under investigation (PUI) for 2019-nCoV described below. A detailed travel history is needed for all patients being evaluated for fever and acute respiratory illness. Health care providers are advised to immediately notify their hospital infection control personnel as well as local or state health department if these criteria or other concerning findings are present. As of now, diagnostic testing can only be done at CDC which will be coordinated by local/state health departments. Further information can be found at the WHO and CDC websites. As of January 27, 2020, the CDC recommends avoiding all nonessential travel to China. Both the WHO and CDC will have updated travel advisories and current situation assessments for further information on 2019-nCoV.

Isolate

Place facemask on patient Isolate the patient in a private room or a separate area Wear appropriate personal protective equipment (PPE)

Assess clinical status

2. 3.

EXAM

Is fever present? Subjective? Measured? _____°C/F

Is respiratory illness present? Cough? Shortness of breath?

Inform

Contact health department to report at-risk patients and their clinical status Assess need to collect specimens to test for 2019-nCoV Decide disposition

If discharged to home



Instruct patient

As needed depending on severity of illness and health department consultation

Home care guidance Home isolation guidance

Advise patient

If the patient develops new or worsening fever or respiratory illness

Call clinic to determine if reevaluation is needed If reevaluation is needed call ahead and wear facemask

* Documentation of laboratory-confirmation of 2019-nCoV may not be possible for travelers or persons caring for patients in other countries. For more clarification on the definition for close contact see CDC’s Interim Guidance for Healthcare Professionals: www.cdc.gov/coronavirus/2019-nCoV/hcp/ clinical-criteria.html

ABOUT THE AUTHOR Dr. Shama Patel has her MD from Medical College of Georgia and MPH from Emory University. She has completed an International Emergency Medicine Fellowship at Columbia University and works as an emergency physician in New York City while continuing work in global emergency medicine.

CLINICAL FEATURES

AND

EPIDEMIOLOGIC RISK

Fever (subjective or confirmed) or signs/ symptoms of lower respiratory illness (e.g. cough or shortness of breath)

AND

Any person, including health care workers, who has had close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of symptom onset

Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath)

AND

A history of travel from Hubei Province, China within 14 days of symptom onset

Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization

AND

A history of travel from mainland China within 14 days of symptom onset

About GEMA The Global Emergency Medicine Academy (GEMA) focuses on improvement of the worldwide delivery of emergency medical care. Joining GEMA is free! Just log in to your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

REFLECTION The Stray Bullet Project By Maria Abou Nader, MD, and Rana Sharara-Chami, MD July 7, 2017, 11:50 pm—American University of Beirut Medical Center, Beirut, Lebanon. I was examining a patient in the pediatric intensive care unit (PICU) when I received the call. I ran to the emergency department (ED) to see Adam. He was intubated, waiting for transfer to the PICU.

SAEM PULSE | MARCH-APRIL 2020

Adam was a beautiful 7-year-old boy with spiky hair and blond highlights. He was rushed to the ED by his parents, still in his tailored suit and black bowtie after collapsing while playing the tambourine at his uncle’s engagement party. He arrived pulseless; circulation returned after two cycles of cardiopulmonary resuscitation (CPR), his physical exam was nonfocal except for a pinpoint hole, as small as the tip of a pencil, on the left side of his head. Imaging revealed a penetrating bullet injury to the brain and the spinal cord. The bullet had entered from the

“People take for granted the very poignant line drawn by the trajectory of a stray bullet. In an instant, a celebration irrevocably becomes a tragedy.” left parietal brain, traveled through the corpus callosum and the medulla, and lodged behind T1 and T2 in the subarachnoid space. When Adam’s parents were informed of their son’s diagnosis, the word “bullet” rippled across the room. The moment of comprehension was palpable, the room transformed into a scene from a horror movie: his mother and grandmother burst into tears, kissing his hands and face, his father sat on a chair next to them breathing heavily and listening to his uncle’s screams: “I will find that shooter and send him to jail.”

People take for granted the very poignant line drawn by the trajectory of a stray bullet. In an instant, a celebration irrevocably becomes a tragedy. Adam was another victim of a senseless tradition: celebratory gunfire. It is imperative to note that firearms are readily available in Lebanon—a country torn by past civil wars—and have become ubiquitous during celebrations and tragedies alike: a shower of hailing bullets to mark an engagement, a funeral, election results, and high school graduations. People fill the skies with bullets that eventually come back down claiming innocent lives, often children’s, on their way.

"Our hope is for our message to permeate younger generations, who will work with us toward an end to this archaic practice once and for all." Stray bullet injuries have become an epidemic all over the world. Since 2016, at least seven reported victims have died from stray bullets shot during weddings, engagement parties, political speeches, elections, and official exams results in Lebanon, annually.1 Failure to enforce already lenient antifirearm and shooting laws has made ownership, carrying, and shooting of firearms a common occurrence.2 July 15, 2017. 12:00 PM: Adam succumbed to his injury six days later. My attending physician and I went straight to the second stage of grief: anger. Something had to be done. Our rage compelled us to advocate for change. Along with two pediatric residents, we launched the Stray Bullet Project. This project aims to 1) raise awareness about the brutality of celebratory gunfire, 2) encourage the Lebanese to cooperate with internal security forces to trace shooters, and 3) (re)enforce the laws. The last has been our greatest challenge. After months of research, we were finally able to get some statistical data from the Lebanese Internal Security Forces. According to the data, there were approximately seven casualties and 167 injuries each year (2016, 2017, 2018), 50

percent of those injured were children, and three of the seven were children below the age of 10.1 These numbers are an underestimation, given most injuries remain unreported.

the tradition of shooting during public occasions—a practice that has claimed lives of children and adults in a country barely recovering from a history of conflict.

Despite many challenges, our team remains motivated; we have continued our campaign by telling Adam’s story at grand rounds, at national and international conferences, and by lobbying for change with politicians. The Stray Bullet Project has been adopted as one of the American University of Beirut’s corporate responsibility projects. We even collaborated with a local NGO on behavioral economics to brainstorm on ways we could spread awareness and change behaviors around celebratory gunfire. Our hope is for our message to permeate younger generations, who will work with us toward an end to this archaic practice once and for all. After all, our role as physicians—especially as pediatricians—is not only limited to diagnosis and treatment of illness and disease. Our mission provides us with unique opportunities to offer guidance through awareness and prevention, ultimately improving the health of individuals, populations, and even nations. We hope that our efforts result in policy and law change regarding

The Stray Bullet Project was reprinted from the February 2020 issue of Academic Emergency journal. REFERENCES 1. Lebanese Internal Security Forces. Statistical report on random shootings leading to stray bullets injuries in 2016. Beirut: Lebanese Internal Security Forces Equivalent to the Police in the United States 2018; 2. 2. Lebanese Government. Criminalization of random shooting (Law 71). Lebanon Official J 2016; 2: 3354– 55.

ABOUT THE AUTHORS Maria Abou Nader, MD, pediatric resident, Pediatrics and Pediatric Critical Care Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Rana Sharara-Chami, MD, associate professor, Pediatrics and Pediatric Critical Care Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

SOCIAL MEDIA IN ACADEMIC EM

Ultrasound in Digital Media SAEM PULSE | MARCH-APRIL 2020

By Sirivalli Chamarti, MD and Eric Lee, MD

For someone who is following the twitter hashtag #sonotwitter closely, it’s no surprise to hit “refresh feed” and find a constantly updating stream of black and white ultrasound images. Today, ultrasound images and videos are taking social media by storm. In fact, in the latter half of the past decade alone, the presence of ultrasound in online social media has seen a steep rise. To understand why this is becoming increasingly popular and what this means, let’s delve a little further.

In order to better understand this phenomenon, it’s important to define what we are talking about. Let’s take a sample tweet, which may contain a brief description of a patient case followed by a question about the image or video displayed. People generally respond with comments prompting the creation of threads or discussions. These simple discussions encourage users to interact with the case itself, and is in that way, a unique platform for learning and knowledge dissemination. A single point or key concept may be easily and consistently reinforced.

In translating education from the classroom to the bedside, digital media might be an integral part of the transition. In academic medicine, ultrasound is becoming an important component of medical education. Many ultrasound departments and ultrasound-trained emergency medicine physicians on social media are redefining the presence of ultrasound on the Internet. For residents, this means easier access to knowledge experts in the field. For educators, this means more resources and cases to which to refer learners.

"Many ultrasound departments and ultrasound-trained emergency medicine physicians on social media are redefining the presence of ultrasound on the Internet. For residents, this means easier access to knowledge experts in the field. For educators, this means more resources and cases to which to refer learners." In our increasingly tech-savvy society, it is important to recognize the impact that ultrasound in digital media has already made. Some accounts on Twitter garner thousands of retweets of ultrasound videos. This brings up several important questions: What does this mean for the future of emergency medicine training and practice? Will handheld ultrasound devices prompt more posts? Will there be a higher standard for posts? Will there be stricter regulations on content? How can educators integrate social media into their practices more? Will a digital media presence become a requirement for every program?

Thereâ&#x20AC;&#x2122;s more awareness of what a sonogram is now than there has ever been. When a patient walks into the emergency department and needs a sonogram, they might have a better idea of what to expect. The presence of ultrasound on social media may help physicians to educate their colleagues, future trainees, or patients. As emergency medicine physicians, we are already at the forefront of medical social media. It is our responsibility to use our unique position to guide this new and exciting tool to the next level.

ABOUT THE AUTHORS r.Chamarti is a senior resident D at Maimonides Medical Center in Brooklyn. She will be an ultrasound fellow next year at Columbia. She tweets @heysirimd. Dr. Lee is assistant clerkship director at Maimonides Medical Center in Brooklyn. He tweets @EricLeeMD

SAEM to Participate in 2020 Emergency Medicine Day, May 27 By Christopher R. Carpenter, MD, MSc, SAEM Board of Directors Citizens of the developed world often assume that emergency medicine will be available for anyone, anything, anytime – regardless of where one lives or their ability to pay. For just one moment, imagine an alternate timeline in which Robert Kennedy never published the “Oration on Trauma” identifying emergency care as the weakest health care link; the Alexandria Plan never materialized; seven Michigan physicians never convened in 1968 to form the American College of Emergency Physicians; and academicians never came together in 1989 to merge the University Association of Emergency Medicine and Society of Teachers of Emergency Medicine into the Society for Academic Emergency Medicine (SAEM). From the patient’s perspective, what would acute illness or injury care look like in this world devoid of emergency medicine? Reminiscent of 1950s America, individuals with an acute injury might have no ambulance service to call or might have to depend on the transportation services provided by the local mortuary. Upon arrival to the hospital that patient would find no “emergency room” per se, but rather a difficultto-find spot in the hospital staffed by a tired junior resident from internal medicine, psychiatry, or surgery who possesses zero training in emergency principles and has no oversight or back-up. The patient-centric benefits of emergency care in sepsis, cardiac, neurologic, orthopedic, pediatric, and geriatric situations observed over the last 50 years would likely have not occurred, not to mention advances in prehospital medicine, point-of-care ultrasound, airway management, and toxicology. The void left by a non-existent emergency medicine would reverberate through every hall in the House of Medicine. For the last two years, Emergency Medicine Day has been celebrated on May 27 around the world. The objective of this

annual international event is to unite the world population and decision-makers to think and talk about emergency medical care. By highlighting emergency medicine’s around-the-clock rapid responses to all unplanned situations for each patient subgroup, while simultaneously serving as the safety net for the vulnerable and forgotten, “Emergency Medicine Day” provides an opportunity for the global emergency medicine community to remind our citizens and political leaders from whence emergency medicine came and where we need to go. For these reasons, the SAEM Board of Directors voted to join “EM Day” in 2020 and beyond.

What You Can Do to Support Emergency Medicine Day SAEM PULSE | MARCH-APRIL 2020

1. Follow Emergency Medicine Day on Twitter @EmergencyDay, Facebook, and LinkedIn

2. F eature Emergency Medicine Day on your social media. Post a message to explain why emergency nedicine is important to you — #emergencymedicineday #isupportemday. On the Emergency Medicine Day material page you can download files, like a Facebook cover or a website slide, to dress up your social media channels and spread the importance of emergency medical care! 3. Share your personal story that illustrates the value of emergency medicine to society. 4. O rganize an event or an activity that focuses on the importance of emergency medical care. Let the organizers know about it (isupport@emergencymedicine-day.org) and your activity will be put on Emergency Medicine Day activities page. Here are a few ideas: • Create and spread educational sheets with instructions for: CPR, Heimlich maneuver, etc. • Organize a simulation to show people the scope of emergency medicine. • Write an article or give an interview for your local media. • Come up with a social media competition.

Emergency Medicine Day 2019: Celebrating Around the World

Dutch emergency doctors celebrating Emergency Medicine Day with a twitter picture.

EReplica project: Seven emergency medicine departments in Turkey reproduced six different medical paintings in order to show the team spirit, creativity, innovative and modern structure of emergency medicine.

Introducing the children to first aid, minor injuries, the use of an ambulance, Asthma, and head and spinal injuries at the Ballylinan National School, Ireland

Radio show on All India Radio Channel, Bilaspur, Chhattisgarh State, India

First Emergency Medicine Day celebration in Yemen. A symposium was held with several valuable scientific lectures, interventions and extensive discussion that enriched the symposium with new information in the field of emergency medicine.

Trainers at the Ballylinan National School, Ireland

Teaching children about first aid in a school in Kouty nad Desnou, Czech Republic

Training session in Ballylinan National School, Ireland, to take the fear away from emergency medicine and show the children equipment used whilst in the emergency department

Dutch emergency doctors celebrating Emergency Medicine Day with a twitter picture.

After a grueling 12-hour difficult shift, this picture was taken for Emergency Medicine Day in Malta

Check out this 2019 Emergency Medicine Day campaign video from the European Society of Emergency Medicine.

BRIEFS AND BULLET POINTS SAEM NEWS Introducing the Advanced Research Methodology Evaluation and Design in Medical Education Course!

The ARMED MedEd course builds upon the fundamental knowledge and skills of health professions education researchers and equips them to design a high-quality medical education research project and grant proposal. Taught by leading experts, the course is recommended for individuals who have already completed an introductory course in health professions education research or are presently enrolled in a fellowship or graduate degree program. Applications for the inaugural ARMED MedEd course will be accepted beginning May 1, 2020. Accepted applicants will be required to attend the inaugural ARMED MedEd workshop at SAEM headquarters in Chicago February 5-7, 2021 and to participate in a longitudinal program with peers and national experts. The course will culminate with a dedicated scientific session at SAEM21 at which results and course progress will be presented to the education research community. For the most up-to-date information, visit the ARMED MedEd webpage.

Education Researchers… Give Us Your Input! As we finalize the ARMED MedEd curriculum, we are seeking input from expert stakeholders like yourself to ensure we address the most important needs for ARMED MedEd participants. Please complete this short survey.

Making New Connections in EM Research!

Participants in a recent ARMED live workshop, February 6 and 7, 2019, at SAEM headquarters. The Advanced Research Methodology Evaluation and Design (ARMED) course prepares future investigators for success.

Check Out SAEM’s New Membership Guide

and cases in the SAEM Clinical Image Series, then plan to attend the 2020 Clinical Images Exhibit at SAEM20, May 12–15, in Denver. Tick Bite by Nicholas Pokrajac, MD, Stanford University Uncommon Cause of Right Groin Pain by Drs. Jason Raggi and Karlene Hosford, Lincoln Hospital, Bronx, NY

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

The Latest from the SAEM19 Clinical Image Series

More than 120 photos were exhibited in the popular “SAEM Clinical Images” photo competition at SAEM19 in Las Vegas. They were featured a second time in Academic Life in Emergency Medicine’s (ALiEM’s) wide-reaching blog. Visit www.aliem.com to view all images

Fever and Aches by Brianna Miner, MD, Advocate Christ Medical Center and Michael Cirone, MD, the University of Illinois Chicago A Multifactorial Skin Eruption by Drs. Erwin Kong, MD, Adrian Thomas, MD, and Tommy Kim, MD, Riverside Community Hospital/UC Riverside

Newest RAMS Who’s Who In Academic EM Podcast Features EMCrit Podcast Creator Dr. Scott Weingart

Scott Weingart, MD, an emergency department intensivist and professor of emergency medicine at Stony Brook University, is the featured guest in the most recent episode of the SAEM RAMS podcast series, “Who’s Who In Academic Emergency Medicine.” Dr. Weingart is also chief of the Division of Emergency Critical Care and director of the Resuscitation and Acute Critical Care Unit at Stony Brook.

He is also the creator and host of EMCrit, the popular podcast on resuscitation and emergency department critical care. Dr. Weingart tweets as @emcrit.

Chairs and Administrators: Don’t Forget to Register for the 2020 AACEM/AAAEM Annual Retreat

Registrations are still being accepted for the 12th Annual AACEM/AAAEM Annual Retreat, March 15-18, 2020, at the, JW Marriott Desert Springs Resort & Spa in Palm Desert, CA. Chairs and administrators may register online. For a pricing breakdown and hotel and flight information, as well as a general schedule of events, please visit the webpage.

Vice Chairs…There’s an SAEM Interest Group Just for You!

Vice chairs advance a wide range of departmental missions through content expertise in education, research, clinical operations, academic affairs, and strategy. The SAEM Vice Chairs Interest Group provides a forum for these members to collaborate, seek advice, share best practices, and network. If you are a vice chair and wish to join this interest group, just log in to your SAEM account and click the “Update Academies (+/-) or Interest Groups” button under your name. Check the box next to the Vice Chairs Interest Group and click save. Then, go to the SAEM Community webpage to join in the discussion! Questions? Contact membership@saem.org.

SAEM ACADEMIES Introducing a New Toolkit from the Academy for Women in Academic Emergency Medicine

The new AWAEM Toolkit is now available for your review! This useful digital guide offers help and resources for the challenges and opportunities which arise for women in academic emergency

medicine. Chapters cover topics including professional development, mentoring, promotion, recruitment/ support, grant writing, developing scholarship, wellness, and genderspecific needs.

SAEM RESIDENTS AND MEDICAL STUDENTS Announcing the SAEM-RAMS 2020 Video Contest!

during SAEM20 in Denver and move on to the second topic of “Recurrent Abdominal Pain.” Based on the current workload, GRACE plans one new guideline per year with the objective to synthesize best emergency medicine practices for the most common chief complaints based upon evidence and/ or consensus. The criteria for GRACE topics include conditions causing diagnostic or treatment uncertainty manifesting in practice variability and substantial concern for malpractice risk. The GRACE Steering Committee has put together this survey of potential topics. Please indicate which topics you would like to see reviewed in 2021 and beyond. Learn more about GRACE in the September-October 2019 issue of SAEM Pulse.

Last Call for Applicants: AEM Education and Training Fellow-inTraining Editor Program The topic of the SAEM-RAMS 2020 Video Contest is “What makes academic emergency medicine the best field of medicine in which to practice?” Grab your fellow residents and record your response for a chance to win a cash prize of $500. Extra points will be awarded for originality, inspirational power, and wow-factor. The winning participant(s) and institution will also be featured on SAEM and RAMS web pages, on SAEM social media platforms, and at SAEM20. Deadline: March 31, 2020.Visit the contest webpage for rules, details, and submission instructions.

AEM Education and Training (AEM E&T) journal is accepting applications through March 15 for its Fellow-in-Training Editor Program for the 2020-2021 term. This one-of-a-kind opportunity is open to any SAEM member who is a current resident and who will start a medical education fellowship in the summer of 2020 or is a current fellow in a one- or two-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.

SAEM JOURNALS

Editor-in-Chief Picks for January and February

GRACE is Seeking Your Input on Future Topics!

Over the last eight months, the GRACE (Guidelines for Reasonable and Appropriate Care in the Emergency Department) team has been constructing the first iteration around the topic of “Recurrent Low Risk Chest Pain.” The GRACE team will finalize that guideline

Drs. Jeffrey Kline and Susan Promes, editors-in-chief of Academic Emergency Medicine (AEM) and AEM Education and Training (AEM E&T) journals, respectively, have selected the following papers as their most recent Editor-in-Chief (EIC) Picks. EIC Picks are selected from each journal issue as having particular Continued on Page 52

relevance and importance to the specialty of academic emergency medicine. January AEM EIC Pick Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting? by Alfred Z. Wang, MD, et al. Read AEM Deputy EIC, Dr. Christopher R. Carpenter's, guest commentary Getting to the Heart of the Matter in Geriatrics. January AEM E&T EIC Pick Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department by Jessica L. Perniciaro, MD, et al. Read EIC Promes’s commentary Busy Bees: Take an Opportunity to Swarm and Optimize Your Efficiency and Teaching While on Shift. February AEM EIC Pick Randomized Control Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department by Naveendran Rajendran, MD, et al. Read EIC Kline’s commentary Something Beats Nothing.

Special SAEM19 Proceedings Issue of AEM Education and Training is Available

Drs. Good and Espinera Named AEM Resident Editors for 2020–2021 Term

Alyssa Espinera, MD

Academic Emergency Medicine (AEM) is pleased to announce two residents have been selected to join the AEM editorial board for the 2020-2021 term. Alyssa Espinera, MD from Louisiana State University (LSU) and Daniel Good, MD, MPH from UT-Southwestern were selected from our most competitive application pool ever. According to Mark B. Mycyk, MD, associate editor and director of the resident-in-training program for AEM, “I feel confident about the future of medical journals because so many talented residents continue to show interest in this program. Narrowing the pool was again difficult this year; I wish we could offer each applicant a position on the board.”

During their one year-term on the AEM Editorial Board, these senior residents will be immersed in every aspect of peer review, editing, and publishing of medical research manuscripts. In addition to experiencing the duties involved in journal editing, the resident editors will participate in a mentored curriculum to learn about all aspects of publication ethics. Daniel Good, MD, MPH

Alyssa Espinera will be entering the final of year of a four-year emergency medicine residency program at LSU. She has done research in neuroscience before her residency in emergency medicine and hopes to learn more about the editorial process, because scientific peer review aims “to improve the quality of literature and uphold high standards for publication in order to ensure that literature is trustworthy and useful.” Daniel Good will be entering his final year of a three-year emergency medicine residency at UT Southwestern. Daniel describes himself as “an avid consumer of medical literature and proponent of evidence-based medicine” who looks forward to a mentored year improving his own skills as a critical reviewer and sharpening his research writing.

A special, supplemental issue of Academic Emergency Medicine Education and Training (AEM E&T), “Proceedings from the 2019 Society for Academic Emergency Medicine Annual Meeting,” is now available and ready for review. Download a full PDF of the issue or read the special issue of AEM E&T online.

Listen to the Latest Journal Podcasts

Podcasts from the January and February issues of Academic Emergency Medicine (AEM) and the January issue AEM Education and Training (AEM E&T) are available for your listening enjoyment. AEM podcasts are also available on iTunes.

Their one-year term begins during the SAEM Annual Meeting in May 2020. For more information on the resident-in-training editor program, please contact Mark B. Mycyk, MD at mmycyk@cookcountyhhs.org. January AEM Podcast Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department: The SyMoNE Multicenter Study February AEM Podcast Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult Emergency Department Tracheal Intubations: A National Emergency Airway Registry (NEAR) Study. January AEM E&T Podcast The Correlation Between Emergency Medicine Residents’ Grit and Achievement.

Defining “Swarming” as a New Model to Optimize Efficiency and Education in an Academic Emergency Department

SAEM REGIONAL MEETINGS New England Regional Meeting is Right Around the Corner!

New England Research Directors (NERDS) Regional Meeting, March 25, 2020, the Hogan Campus Center on the campus of the College of the Holy Cross, Worcester, MA. Sign up!

Scenes From the SAEM Southeastern Regional Meeting February 21 & 22

Corey Slovis, MD, chair and professor of emergency medicine at Vanderbilt University, presents “Teaching, Teaching...More Than 5 Causes, 5 Steps, 5 Reasons”.

Christina Shenvi, MD, PhD, assistant professor of emergency medicine at the University of North Carolina–Chapel Hill, presents "Creating a Courageous Leader".

Dr. Michelle Lall, associate professor of emergency medicine, Emory University School of Medicine, presents “Bias: Impact on Medical Education”.

Thank You SAEMF Annual Alliance Donors!

AACEM Chair Development Program Class of 2019

SAEMF grantees pose for a group photo during the SAEMF Grantee Workshop, January 29, in Bethesda, MD, to say thank you to all the Annual Alliance donors making their dreams a reality.

The Association of Academic Chairs of Emergency Medicine (AACEM) Chair Development Program (CDP) Class of 2019, January 12 in Phoenix, AZ.

SAEM FOUNDATION Meet the 2020 SAEM Foundation Grantees! Gifts to the SAEM Foundation fund the most promising researchers and educators in academic emergency medicine. Here are this year’s bright stars:

Taylor McCormick, MD, MSc

Denver Health and Hospital Authority SAEMF Research Training Grant $300,000 “Population-based Assessment of Pediatric Trauma Triage”

Danielle Miller, MD

Stanford University SAEMF Education Research Grant $98,826 “Development of a Simulation Curriculum and Web-Based Modules to Teach Core EPA 10”

Jane Xiao, MD, MSE

Oregon Health & Science University SAEMF Education Project Grant - $19,879 “eyeTrainer: Describing the Learning Curve in Bedside Cardiac Ultrasound Interpretation”

Paul Musey, MD, MS

Indiana University SAEMF Research Large Project Grant $150,000 “Psychological Contributors to Cardiovascular Disease Risk in ED Patients”

Dana Sacco, MD

Columbia University SAEMF/NIDA Mentor Facilitated Training Award in Substance Use Disorders Science Dissemination Solicitation $12,000 “Increasing Provider Awareness and Prescription of Buprenorphine for Opioid Use Disorder in a New York City Emergency Department”

Julianna West, BS

The University of Texas Health Science Center at Houston SAEMF/RAMS Medical Student Research Grant - $2,500 “Emergency Department Visits and Hemodialysis by Uninsured Patients in Texas”

Katherine Hunold Buck, MD

The Ohio State University GEMSSTAR for Emergency Medicine Supplemental Funding Program - $25,000 “Improving Diagnostic Accuracy for Older Emergency Department Patients with Suspected Pneumonia: The Role of Diagnostic Criteria and Novel Antimicrobial Peptides”

Phillip Moschella, MD, PhD

Prisma Health SAEMF/NIDA Mentor Facilitated Training Award in Substance Use Disorders Science Dissemination Solicitation $12,000 “Mentored Training to Combat the Opioid Crisis: Emergency Medicine Meets Addiction Medicine”

Bayu Sutarjono, BSc

Brookdale University Hospital and Medical Center SAEMF/RAMS Medical Student Research Grant - $2,500 “Serial Optic Nerve Sheath Diameter in Mid-to-Moderate Traumatic Brain Injury”

Alexis del Vecchio

University of South Carolina School of Medicine - Greenville SAEMF/RAMS Medical Student Research Grant - $2,500 “FACILITATE: A Theater-Based Course to Improve Physicians’ Communication Skills”

Eric Boccio, MD

Yale New Haven Hospital SAEMF/RAMS Resident Research Grant $4,985 “End-Tidal Oxygen as a Measure of Preoxygenation During Rapid Sequence Intubation”

Joshua Davis, MD

The Pennsylvania State University SAEMF/RAMS Resident Research Grant $5,000 “Aorta to IVC Ratio to Predict Severity of Pediatric Dehydration”

Patrick Ng, MD

University of Colorado, Denver MTF/SAEMF Toxicology Research Grant $10,000 “Oral Sodium Thiosulfate for Severe Acute Oral Cyanide Exposure”

Lauren Fryling, MD

Harbor Emergency Medicine Education Foundation SAEMF/RAMS Resident Research Grant $5,000 “Effect of SB1152 (Safe Homeless Discharge Legislation) on Emergency Department Length of Stay and Recidivism”

Youyou Duanmu, MD, MPH

Stanford University SAEMF/Academy of Emergency Ultrasound (AEUS) Research Grant - $10,000 “The Effect of the Serratus Anterior Plane Block on Pain and Respiratory Function”

Kyle Schoppel, MD

Boston Medical Center SAEMF/Simulation Academy Novice Research Grant - $5,000 “Are We Optimizing Pediatric Education for Emergency Medicine Trainees?”

Ava Pierce, MD

UT Southwestern Medical Center SAEMF/Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) Research Grant - $3,000 “Recruitment of URM Students in the Texas Emergency Medicine Research Associates Program”

Amy Zeidan, MD

Emory University SAEMF/Academy for Women in Academic Emergency Medicine (AWAEM) Research Grant - $5,000 “Barriers to Reporting Incidents of Gender and Sexual Harassment in Training and Practice (BRIGHT)”

Joshua Silverberg, MD

Albert Einstein College of Medicine SAEMF/Clerkship Directors in Emergency Medicine (CDEM) Innovations in Undergraduate Emergency Medicine Education Grant - $5,000 “Teddy Bear Sim: A Randomized Study of a Novel Curriculum for EM Clerkships”

Amelia Pousson, MD, MPH

Johns Hopkins University SAEMF/Global Emergency Medicine Academy (GEMA) Research Pilot Grant - $10,000 “Are They Fit for Service? Understanding LMIC EM Residency Curricula Development”

ACADEMIC ANNOUNCEMENTS Dr. Lumba-Brown Promoted to Clinical Associate Professor at Stanford Angela Lumba-Brown, MD has been promoted to clinical associate professor of emergency medicine and pediatrics at Stanford University School of Medicine. A pediatric emergency medicine physician, Dr. Lumba-Brown is also a recognized leader in the study of traumatic brain Angela Lumba-Brown, MD injury and was lead author on three new mild traumatic brain injury treatment guidelines released by the Centers for Disease Control and Provention. Her work established a new, evidence-based classification for traumatic brain injury, defining subtypes of concussion, and modeled post-injury treatments.

Dr. Brendan Carr Named New Chair of EM at Icahn School of Medicine Brendan G. Carr, MD, MA, MS, has been named the new chair of emergency medicine for the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System. Dr. Carr, who will also have a secondary appointment in the department of population health Brendan G. Carr, MD, MA, MS science and policy, is a health policy researcher who has dedicated his career to blending research, policy, and practice to advance acute care delivery. Dr. Carr was recruited from the Sidney Kimmel Medical College at Thomas Jefferson University, where he is professor of emergency medicine, vice chair for health care policy in the department of emergency medicine, and associate dean for health delivery innovation.

Rahul Sharma, MD, Awarded Rank of Full Professor at Weill Cornell Rahul Sharma, MD, MBA, has been promoted to the rank of full professor at Weill Cornell Medicine, with a dual appointment in the departments of emergency medicine and the department of healthcare policy and research. Dr. Sharma is the inaugural chair of the department of emergency medicine and Rahul Sharma, MD, MBA also serves as the emergency physicianin-chief for New York Presbyterian-Weill Cornell Medical Center. Dr. Sharma is also a professor of clinical healthcare policy and research and serves as the academic chair for the NYP-Weill Cornell Medicine-affiliated emergency departments at New York Presbyterian-Queens and New York Presbyterian-Brooklyn Methodist. In addition, Dr. Sharma holds several other executive leadership roles, including chief and medical director of emergency medical services for the NewYork Presbyterian enterprise, member of the New York State Board for Medicine, and vice president of the New York Presbyterian Hospital Medical Board.

NOW HIRING POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES! Accepting ads for our â&#x20AC;&#x153;Now Hiringâ&#x20AC;? section! Deadline for the next issue of SAEM Pulse is April 1. For specs and pricing, visit the SAEM Pulse advertising webpage.

Department of Emergency Medicine University of North Carolina at Chapel Hill, Department of Emergency Medicine is currently recruiting for full-time faculty openings for 2020-2021. Full-time faculty are currently being recruited with expertise in Administration, Research and Ultrasound. Successful applicants will be Board Certified/Board Prepared in Emergency Medicine. UNC Hospitals is a 950-bed Level I Trauma Center. The Emergency Department sees upward of 70,000 high acuity patients per year. Applicants should send a letter of interest and curriculum vitae to: Gail Holzmacher, Business Officer (gholzmac@med.unc.edu), Department of Emergency Medicine, Phone: (919)843-1400. The University is an equal opportunity, affirmative action employer and welcomes all to apply without regard to age, color, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, or sexual orientation. We also encourage protected veterans and individuals with disabilities to apply.

MISSION

JOIN US AND APPLY FOR AN EMERGENCY MEDICINE FELLOWSHIP AT NEW YORK PRESBYTERIAN QUEENS FEATURES OF THE PROGRAM • • • • • • •

Teaching site for Emergency Medicine Residents, Advanced Practitioners and Medical Students High Volume with Approximately 120,000 Visit Emergency Department at New York Presbyterian Queens, NY Academic Appointment as Clinical Instructor in Emergency Medicine at a Weill Cornell Medical School. Work at an American College of Surgery verified Level 1 Trauma Center, AHA Receiving STEMI center and Joint Commission Primary Stroke Center Tremendously diverse patient population Employee of Envision Healthcare, the Nation’s Largest Physician Practice Management Company Medical Scribes available 24/7

WE ARE SEEKING ACCREDITED EMERGENCY MEDICINE TRAINED GRADUATES TO APPLY TO OUR FELLOWSHIP PROGRAMS. FELLOWSHIP TYPES ADMINISTRATIVE MEDICAL EDUCATION SIMULATION ULTRASOUND BENEFITS COMPETITIVE COMPENSATION PACKAGE ACADEMIC FACULTY APPOINTMENT CME PACKAGE 401K WITH MATCHING

APPLICANT REQUIREMENTS

HSA OPTION WITH HEALTH BENEFITS

CONTACT US An ideal candidate for our emergency medicine fellowships is motivated with a dedication and commitment to excellence in academic Emergency Medicine. We focus on individuals who have a desire for growth and national recognition. Candidates should be innovative and have progressive ideas with a focus on high quality research. Our team prides ourselves in the ability to provide excellent clinical care and service for our patients while working in a high volume, high acuity Emergency Department.

MANISH SHARMA, DO, MBA, FACEP CHAIR OF EMERGENCY MEDICNE NEW YORK PRESBYTERIAN QUEENS MAS9064@NYP.ORG TEL: (718) 661-7305

Yale University School of Medicine Department of Emergency Medicine Fellowship Programs For specific information including deadlines and requirements, visit: http://medicine.yale.edu/emergencymed/ The Implementation Science fellowship is a 2-3-year program that will train investigators in the principles of dissemination and implementation science. Supported by a K12 grant from NIH National Heart, Ling, and Blood Institute, fellows will receive training at the new Yale Center for Implementation Science (YCIS), the Yale Center for Clinical Investigation, and the National Clinician Scholar Program. Eligible candidates may receive a Masters in Health Sciences degree, Mentors come from The Yale Schools of Medicine, Nursing, and Public Health, as well as many community-based organizations in New Haven. For further information, contact Steven L. Bernstein, steven.bernstein@yale.edu. The Research fellowship is a 2-3-year program focused on training clinician scholars as independent researchers in Emergency Medicine. Scholars will earn a Master of Health Sciences degree from Yale combining clinical experience with extensive training in research methods, statistics and research design. With the guidance of research The Implementation Science fellowship is a 2-3-year program that will train investigators in the principles of dissemination and content experts and professional coach mentors, the scholar will develop a research program, complete a publishable project and submit a grant application prior to implementation science. by a K12bygrant fromfor NIH National Heart,Medicine. Ling, and Institute, fellows will L. receive training completion of the program. TheSupported program is credentialed the Society Academic Emergency For Blood further information, contact Steven Bernstein, MD, at steven.bernstein@yale.edu. the new Yale Center for Implementation Science (YCIS), the Yale Center for Clinical Investigation, and the National Clinician The Yale Drug Use, Addition, and HIV Research Scholar (DAHRS) Mentored Career Development Program Mentors (NIDA K12) provides a 3 The year post-doctoral Scholar Program. Eligible candidates may receive a Masters in Health Sciences degree, come from Yale Schools of interdisciplinary, research training experience preparing investigators for careers focusing on drug use, addition, and HIV prevention and treatment in general medical Medicine, Nursing, and Public Health, as well as many community-based organizations in New Haven. For further information, settings. Scholars earn the Master in Health Sciences degree that combines vigorous research methodology, statistics and design didactics in small group sessions and contact covering Steventopics L. Bernstein, steven.bernstein@yale.edu. seminars related to drug use, addition and HIV, leadership, grant writing and responsible conduct of research, Candidates complete mentored research project(s), multiple manuscripts, and apply for independent funding. For further information, visit www.medicine.yale.edu/dahrs or contact Gail D’Onfrio, MD, MS dahrs@yale.edu. The Research fellowship is a 2-3-year program focused on training clinician scholars as independent researchers in Emergency The fellowship in Emergency Ultrasound is a 1 or 2-year program that will prepare graduates to lead an academic/community emergency ultrasound program. The 2-year Medicine. Scholars will earnSciences a Master of Health Sciences degree Yale combining clinicalThis experience extensive training option includes a Master of Health or Master of Public Health with a focusfrom on emergency ultrasound research. fellowship with satisfies recommendations of in all major societies for the interpretation of emergency and will exposure aspects ofcontent program experts development, assurance,coach properties of coding and research methods, statistics and researchultrasound, design. With theinclude guidance of toresearch andquality professional mentors, the billing, and research. The program consists of structured time in the ED performing bedside examinations, examination QA and review, research into new applications, scholar willindevelop a research program, a publishable project and submit grant prior to completion of the and education the academic/community arenas. Wecomplete have a particular focus on emergency echo and utilizea state of application the art equipment, as well as wireless image review. program. The credentialed by the Society For forfurther Academic Emergency Medicine. ForRachel.liu@yale.edu further information, contact Steven Information aboutprogram our Sectioniscan be found at http://eus.yale.edu. information, contact Rachel Liu MD, or apply online at www. L. eusfellowships.com. Bernstein, MD, steven.bernstein@yale.edu. The Administration fellowship is a 2-year program that will prepare graduate to assume administrative leadership positions in private or academic emergency medicine as well as hospitals and health systems. The fellow will acquire experience in all facets of emergency department clinical operations, with close mentorship department and The Yale Drug Use, Addition, andcomplete HIV Research Scholar (DAHRS) Development Program (NIDA hospital administrative leaders. Fellows will the recently #1 ranked Executive MBAMentored program at Career the Yale School of Management. In addition, theK12) candidate will assume graduated leadership roles on one or more projects supporting departmental usually culminating as Assistant Medical Directorfocusing in the second of use, the provides a 3 year post-doctoral interdisciplinary, research training activities experience preparing investigators for careers onyear drug fellowship. For further Arjun Venkatesh, MD, MBA, MHS, arjun.venkatesh@yale.edu. addition, and HIV information, preventioncontact and treatment in general medical settings. Scholars earn the Master in Health Sciences degree that The Global Health and International Emergency Medicine fellowship is a 2-year programin offered Yale in partnership with seminars the London covering School of Hygiene Tropical combines vigorous research methodology, statistics and design didactics smallbygroup sessions and topics &related Medicine (LSHTM). Fellows will develop a strong foundation in global public health, tropical medicine, humanitarian assistance and research. They will receive an MSc to drug use, aaddition HIV, leadership, grant responsible conduct of Populations research, Candidates mentored research from LSHTM, diploma inand Tropical Medicine (DTM&H) andwriting completeand the Health Emergencies in Large (HELP) coursecomplete offered by the ICRC in Geneva. In addition, fellows spend 6 manuscripts, months in the field working Yale global health projects or on an independent project develop. For further information, contact project(s), multiple and applywith foron-going independent funding. For further information, visit they www.medicine.yale.edu/dahrs or the fellowship director, Hani Mowafi, MD, MPH, hani.mowafi@yale.edu. contact Gail D’Onfrio, MD, MS dahrs@yale.edu. The fellowship in EMS is a 1-year program that provides training in all aspects of EMS, including academics, administration, medical oversight, research, teaching, and clinical components. The ACGME-accredited program focuses on operational EMS, with the fellow actively participating in the system’s physician response team, and The fellowship in Emergency Ultrasound 1 or MPH 2-year program that will prepare graduates to lead antraining. academic/community all fellows offered training to the Firefighter I or II level.isAa1-year program is available for fellows choosing additional research The fellowship graduate will be prepared for a career in academic The EMS 2-year and/or medical of a alocal or regional EMS system, and for new ABEM subspecialty examination. For further emergency ultrasound program. optiondirection includes Master of Health Sciences or the Master of Public Health with a focus on information, contact David Cone, MD, david.cone@yale.edu. emergency ultrasound research. This fellowship satisfies recommendations of all major societies for the interpretation of emergency The Medical Simulation fellowship is a 1-year program that provides training in all aspects of healthcare simulation, including high fidelity mannequin simulation with ultrasound, andtraining, will include exposure to aspects of program assurance, properties of coding andwillbilling, andin computer program acquisition of debriefing and teaching skills, use development, of novel wearable quality technologies, and procedural simulation. The fellow participate all educationThe programs for medical students, nurses, residents at the Yale Center bedside for Medical Simulation. The examination program includesQA options train in research research. program consists of structured timeand in faculty the ED performing examinations, andtoreview, research methodology through the Research Division of in thethe Department of Emergency Medicine and participate medical education coursework through Yaleand School into new applications, and education academic/community arenas. We haveinathe particular focus on emergency echo utilize of Medicine. The fellow will include attendance of the one-week Comprehensive Instructor Workshop at the Institute for Medical Simulation in Boston. For further state of the art equipment, as well as wireless image review. Information about our Section can be found at http://eus.yale.edu. For information, contact Leigh Evans MD, leigh.evans@yale.edu. further information, contact Rachel MD, program Rachel.liu@yale.edu or apply The Educational Leadership fellowship is a Liu 1 or 2-year that provides the training and online educationattowww.eusfellowships.com. develop academic emergency physicians to have the skills, knowledge and experience to be strong educators and leaders in Emergency Medicine education with the focus on developing leaders in EM residencies or in Undergraduate Medical Education. The fellow will be an Assistant Residency Program Director and an integral member of the education faculty. They will be supported The Administration is aother 2-year program that willand prepare graduate to education. assume administrative leadership in private to attend leadership trainingfellowship as well as using internal resources, CORD ACEP to further their For further information, contact positions David Della-Giustina, or academic emergency medicine as well as hospitals and health systems. The fellow will acquire experience in all facets of MD, FACEP, david.della-giustina@yale.edu. emergency department clinicalisoperations, with mentorship department hospital will care in The Wilderness Medicine fellowship a 1-year program thatclose provides the core content of medicaland knowledge andadministrative skills in being ableleaders. to plan forFellows and to provide an environment is limited resources and geographically separated from definitive all types of weather and evacuation Thewill fellow will be complete thethat recently #1byranked Executive MBA program at the Yale medical Schoolcare of in Management. In addition, thesituations. candidate assume supported to obtain the Diploma in Mountain Medicine and other Wilderness Medical education. The fellow will become a leader and national education in the growing graduated leadership roles on one or more projects supporting departmental activities usually culminating as Assistant Medical specialty of wilderness medicine. For further information, contact David Della-Giustina, MD, FACEP, david.della.giustina@yale.edu. Director inInformatics the second year ofisthe fellowship. Forprovides further information, contact Venkatesh, MD, MBA, The Clinical fellowship a 2-year program that ACGME-approved training inArjun all aspects of clinical informatics. TheMHS, program is administered through the Yale Department of Emergency Medicine. In the first year, the fellow will rotate between the Yale-New Haven Health and Veterans Affairs. Major blocks will arjun.venkatesh@yale.edu. be devoted to electronic health records, clinical decision support, databases and data analysis, and quality and safety. Experimental learning will be combined with didactic classes and conferences. The second year is dedicated to advanced learning and project leadership. The fellow will attend the American Medical Informatics Association annual meeting. The program prepares fellows for Clinical Informatics Board examination. For further information, contact Ted Melnick, MD, MHS, Edward.melnick@ yale.edu. All require the applicant to be BP/BC emergency physicians and offer an appointment as an Instructor to the faculty of the Department of Emergency Medicine at Yale University School of Medicine. Applications are available at the Yale Emergency Medicine web page http://medicine.yale.edu/emergencymed/ and are due by November 15, 2020, with the exception of the Clinical Informatics Fellowship, the Wilderness Fellowship, and the Educational Leadership Fellowship, which are due by October 15, 2020. Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women, persons with disabilities, protected veterans, and members of minority groups are encouraged to apply.

Exciting opportunities at our growing organization • Core Emergency Medicine and PEM Faculty positions • EM Medical Director • EMS Medical Director / EMS Fellowship Director • Vice Chair, Clinical Operations & Strategy Development • Vice Chair, Research Penn State Health, Hershey PA, is expanding our health system. We offer multiple new positions for exceptional physicians eager to join our dynamic team of EM and PEM faculty treating patients at the only Level I Adult and Level I Pediatrics Trauma Center in Central Pennsylvania. What We’re Offering: • Salaries commensurate with qualifications • Sign-on Bonus • Relocation Assistance • Retirement options, Penn State University Tuition Discount, and so much more! What We’re Seeking: • Core Emergency Medicine trained physicians with additional training in any of the following: Toxicology, Ultrasound, Geriatric Medicine, Pediatric Emergency Medicine, Research • Completion of an accredited Emergency Medicine Residency Program and Fellowship for PEM positions • BE/BC by ABEM or ABOEM • Observation experience is a plus

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

FOR MORE INFORMATION PLEASE CONTACT:

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

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

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

Vice Chair for Clinical Operations Department of Emergency Medicine The Department of Emergency Medicine at the Medical College of Wisconsin (MCW) seeks a visionary and highly-motivated board-certified Clinician Leader to join the Department as an Associate or Full Professor for the position of Vice Chair for Clinical Operations. The Vice Chair will report directly to the System Chair of the Department of Emergency Medicine and be responsible for the development and implementation of strategic plans for the patient care mission of the Department in conjunction with Department Chair. The successful Vice Chair for Clinical Operations shall provide oversight, direction, and leadership for the clinical operations of all practices staffed by the Medical College of Wisconsin Department of Emergency Medicine.

Our Department maintains a thriving clinical practice including: Froedtert and MCW (F&MCW) Froedtert Hospital Emergency Department (level 1 adult trauma center); Children’s Wisconsin (level 1 pediatric trauma center); Clement J. Zablocki Veterans Affairs Medical Center Emergency Department; F&MCW Froedtert Moorland Reserve Health Center (free-standing) Emergency Department; F&MCW Froedtert Menomonee Falls Emergency Department; and a series of soon-toopen, community-based, neighborhood hospital Emergency Departments. Across this myriad of clinical practices, our faculty, fellows, residents, and advanced practice providers (APPs) care for more than 200,000 patient visits each year. Our Department is home to a competitive training program of 36 residents, which attracts top-notch housestaff from medical schools across the nation. Many of our faculty members, fellows, residents, APPs, and staff are engaged in a host of extramurally-funded, cutting-edge, investigative research. Inquiry in the areas of cardiac arrest and resuscitation, injury, EMS, and others have garnered MCW a reputation as an Emergency Medicine research powerhouse. Successful candidates should be residency-trained and board-certified in Emergency Medicine by the ABEM. Desired qualities and skills include prior management and leadership experience at Service Chief or Medical Director level in an academic medical center. The candidate should have successful demonstration of operational improvements and innovations in clinical operations. The candidate should have documented academic accomplishments to be appointed at the Associate Professor or Professor level, with or without tenure, at the Medical College of Wisconsin.

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

VICECHAIR CHAIR OF OF RESEARCH VICE RESEARCH The newly established Department of Emergency Medicine at Weill Cornell Medicine, led by Dr. Rahul

The newly established Department of Emergency Medicine at Weill Cornell Medicine, led by Dr. Rahul Sharma, is seeking a highly motivated Vice Chair of Research at the Associate Professor or Professor Sharma, is seeking a highly Chair of Research theChair Associate Professor or Professor level, preferably tenure motivated track, to joinVice the leadership team. Theat Vice of Research position level, preferably tenure track, to join the leadership team. The Vice Chair of Research position represents a major leadership appointment in the Department. The individual will report directly to the represents a major leadership appointment in the individual will directly to the Department Chair and will provide leadership and Department. oversight of theThe research mission forreport the Department. The Vice Chair must be visionary, demonstrate expertise in leading research in EM, and possess Department Chair and will provide leadership and oversight of the research mission for thethe Department. ability to work disciplinesdemonstrate within a large,expertise diverse organization. The Vice Chair mustacross be visionary, in leading research in EM, and possess the ability to work across disciplines within a large, diverse organization.

The Department has a highly-dedicated faculty, including junior, mid-career, and senior members with a diverse mix of clinical, research and educational interests. The Vice Chair of Research will be expected to The Department has a highly-dedicated faculty, including junior, mid-career, and senior members with a develop and lead research education and mentorship for faculty and residents. Successful candidates diverse mix of clinical, research and educational interests. The Vice Chairpublication of Research will be expected to will have a demonstrated track record of independently funded research, in high-impact, develop and lead research and mentorship for faculty and residents.the Successful peer-reviewed journals,education strong mentorship skills and clear evidence of promoting academiccandidates careers will have a demonstrated track record of independently funded research, publication in high-impact, of junior faculty.

peer-reviewed journals, strong mentorship skills and clear evidence of promoting the academic careers Wefaculty. offer a highly competitive salary, a generous support package to ensure the candidates transition of junior and continued success, a comprehensive benefits package, and a generous retirement plan.

We offer a highly competitive salary, a generous support package to ensure the candidates transition The Emergency Department at New York Presbyterian-Weill Cornell Medical Center serves as one of the and continued success, a comprehensive benefits New package, and a generous retirement plan. major campuses of the fully accredited four-year York Presbyterian Emergency Medicine Residency Program. Our Emergency Department is a high volume, high acuity regional trauma, burn and stroke

The Emergency Department at 90,000 New York Cornell Center serves asto one of the center caring for more than adultPresbyterian-Weill and pediatric patients. FacultyMedical also have the opportunity major work campuses of the fully accredited four-year New Hospital York Presbyterian Emergency Medicine Residency at our New York Presbyterian-Lower Manhattan ED campus, which is a busy community hospital seeing 45,000 annual visits. 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 Weour offer programs in Telemedicine, Medical Toxicology, GeriatricED Emergency work at New York Presbyterian-Lower Manhattan Hospital campus, Medicine, which is aWilderness busy community Medicine, Global Emergency Medicine, Simulation and Ultrasound. In addition, we offer fellowships in hospital seeing 45,000 annual visits. Geriatric Emergency Medicine, Healthcare Leadership and Management, Pediatric Emergency Medicine as well as PA and NP residencies in Emergency Medicine.

We offer programs in Telemedicine, Medical Toxicology, Geriatric Emergency Medicine, Wilderness Medicine, Global Emergency Medicine,Vitae Simulation and Ultrasound. Inofaddition, weCommittee offer fellowships in Please submit a Curriculum and Cover Letter to the Chair the Search Clark, MPH, ScD Geriatric Emergency Medicine, HealthcareSunday Leadership and Management, Pediatric Emergency Medicine emjobs@med.cornell.edu as well as PA and NP residencies in Emergency Medicine.

emed.weill.cornell.edu Please submit a Curriculum Vitae and Cover Letter to the Chair of the Search Committee Sunday Clark, MPH, ScD emjobs@med.cornell.edu New York Presbyterian Hospital-Weill Cornell Medicine is an equal opportunity employerMinorities/Women/Vets/Disabled encouraged to apply.

emed.weill.cornell.edu

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

MARK MITCHELL, DO, FACOEP-D, FACEP

Featured Academic Leadership and Faculty Positions ■

Research Director

■

Ultrasound Director

■

Core Faculty

Ocala Regional Heath Ocala, FL

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

Ready to join us?

Internationally recognized leader in biomedical informatics

seeking outstanding candidates

for ACGME-accredited clinical informatics training program Apply by: March 31, 2020 Positions start: July 2020 Want to apply? Contact: Jess Halterman jrhalter@regenstrief.org 317-274-9450

Fellows will: • participate in creating clinical systems used in day-to-day patient care • work toward a health informatics certificate in their career path • attend national conferences and network with others in the field • write and present informatics research.

Participants remain clinically active to maintain skills. Qualified applicants must be board eligible or board certified in a primary specialty. This fellowship is offered by the Regenstrief Institute Center for Biomedical Informatics in partnership with the IU School of Medicine and is generously supported by Eskenazi Health and Indiana University Health.

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, 2020 for the May/June 2020 issue. 64

SEE YOU AT 20 Denver, Colorado May 12-15, 2020 Sheraton Denver Downtown Hotel