SAEM Pulse March-April 2022 by Society for Academic Emergency Medicine

MARCH-APRIL 2022 | VOLUME XXXVII NUMBER 2

www.saem.org

SPOTLIGHT A CHAMPION FOR THE UNDERSERVED AND UNDERREPRESENTED IN MEDICINE An Interview with

Pooja Agrawal, MD, MPH

TRANSITION FROM TRAINEE TO FACULTY page 20

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, Accounting Hugo Paz Ext. 216, hpaz@saem.org Director, IT Anthony Macalindong Ext. 217, amacalindong@saem.org Director, Governance Erin Campo Ext. 201, ecampo@saem.org Manager, Governance Michelle Aguirre, MPA Ext. 205, maguirre@saem.org Coordinator, Governance Juana Vazquez Ext. 228, jvazquez@saem.org Director, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Journals and Communications Tami Craig Ext. 219, tcraig@saem.org Specialist, Digital Communications Mig Torres Ext. 244, mtorres@saem.org Sr. Director, Foundation and Business Development Melissa McMillian, CAE, CNP Ext. 203, mmcmillian@saem.org

Sr. Manager, Development for the SAEM Foundation Julie Wolfe Ext. 230, jwolfe@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org Manager, Educational Course Development Kayla Belec Ext. 206, kbelec@saem.org Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org Manager, Education Andrea Ray Ext. 214, aray@saem.org Sr. Coordinator, Membership & Meetings Monica Bell, CMP Ext. 202, mbell@saem.org Meeting Planner Sandi Ganji Ext. 218, sganji@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org Manager, Journals Tami Craig Ext. 219, tcraig@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Associate Editor, RAMS Aaron R. Kuzel, DO, MBA aaron.kuzel@louisville.edu

2021–2022 BOARD OF DIRECTORS Amy H. Kaji, MD, PhD President Harbor-UCLA Medical Center

Wendy C. Coates, MD Secretary Treasurer Harbor-UCLA Medical Center

Angela M. Mills, MD President Elect Columbia University, Vagelos College of Physicians and Surgeons

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

Pooja Agrawal, MD, MPH Yale University School of Medicine

Ava Pierce, MD UT Southwestern Medical Center, Dallas

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

Ali S. Raja, MD Massachusetts General Hospital/Harvard

Jamie Jasti, MD, MS Medical College of Wisconsin Michelle D. Lall, MD Emory University

Jody A. Vogel, MD, MSc, MSW Stanford Medicine

HIGHLIGHTS 3

President’s Comments The Light at the End of the COVID Tunnel is Shining Bright!

Spotlight A Champion for the Underserved and Underrepresented in Medicine: An Interview With Dr. Pooja Agrawal

Article titles appearing in red font in the table of contents have been identified as potentially being of particular interest to emergency medicine residents and medical students.

Sex & Gender in EM The 2021 Sex and Gender Health Education Summit and Steps for Inclusion of Sex and Gender Transformative Educational Content

Virtual Presence The Resident Dashboard: Creating a Virtual Interface for Trainees

Wellness in EM Understanding the Effects of the COVID-19 Pandemic on All Categories of EM Providers

Clerkship Corner Coaching Emergency Medicine Trainees Toward Their Full Potential

Preparing for the Next Pandemic, Today: A Call to Action

Diversity & Inclusion Transition from Trainee to Faculty

Women In Academic EM Charting Your Course for Leadership

ED Admin & Clinical Operations Alternative Pathways to Admission: The Use of Telehealth in Transfer Coordination

EM Research A Career in Research? EM-Bound Students Have Concerns

Ethics in Action Navigating Ethical Principles in an Adolescent Behavioral Health Patient in a Pediatric Emergency Department

21 Preview

Geriatric EM Ageism in the Emergency Department

Global EM A History of the Global Emergency Medicine Literature Review

The Experiences and Challenges of EM-Bound International Medical Graduates

Oncological EM Addressing Tobacco Use in the Emergency Department? If Not, Maybe You Should Be!

Join the SAEMF Annual Alliance Today

Annual Alliance Benefits

Expressing Gratitude to the 2022 Annual Alliance and Legacy Society Donors

Briefs and Bullet Points

Academic Announcements

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SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine, 1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2022 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 Amy Kaji, MD, PhD Harbor-UCLA Medical Center 2021–2022 President, SAEM

The Light at the End of the COVID Tunnel is Shining Bright!

“Innovation and scientific discovery truly arise and take form in an environment of inquiry where individuals can connect and network.”

With cautious optimism we began to plan again for in-person reunions and weddings, face-to-face conferences and meetings, and vacation travel. And then Omicron arrived and our previously seen beacon of hope at the end of the Delta tunnel turned dark. Like before, we postponed our plans, canceled in-person gatherings, and shifted our meetings to virtual formats. With Omicron we found ourselves shortstaffed because record numbers of health care providers were falling ill and needed periods of rest and quarantine. Boarding became even more problematic because there were no staffed beds in the hospital. Pandemic fatigue was all around us and our hopes of returning to some degree of pre-COVID normalcy were tempered once again. Fortunately, as of this writing, the number of COVID cases are rapidly declining. Staff are returning from their quarantine periods and the light at the end of the long COVID tunnel appears to be flickering on again. We realize that COVID resurgences with mutants are likely to occur again and we will take on each surge as it comes, with improved knowledge, supported by evidence, that will allow us to better manage and care for our patients. The increasing number of vaccinated individuals, the newly discovered and effective oral medications, and Omicron’s extremely high transmissibility provide us with the hope that our populations are slowly developing herd immunity. Throughout the pandemic we became Zoom experts, grateful for the platforms that enabled us to stay connected when in-person interaction became impossible. SAEM pivoted to a virtual format for almost everything, including the last two SAEM annual meetings. This virtual SAEM world provided a community and forum for

friendship, support, and understanding during a time when we needed it most. But nothing can replace what happens when we meet face-to-face. Innovation and scientific discovery truly arise and take form in an environment of inquiry where individuals can connect and network. And so it is with great joy that I can officially invite you to SAEM’s first live and in-person annual meeting in two years, to be held May 10-13 in New Orleans. This moment has been a long time coming and we’re pulling out all the stops to provide you with a well-deserved time to revive and reconnect and a chance to celebrate each other in an atmosphere of gratitude and camaraderie. In addition to our usual cutting edge research and groundbreaking educational content, we are honored and privileged that Sheryl Heron, MD, MPH, will present the SAEM22 Dr. Peter Rosen Memorial Keynote Address, “Justice, Equity, Diversity, and Inclusion: Are We Accountable?”. Dr. Heron is a national leader in emergency medicine with more than two decades of experience related to diversity, equity, and inclusion. And because we know you’ve missed seeing each other, we’ve planned lots of opportunities for you to connect in person with your contemporaries and take advantage of the expansive social, networking, and career development events for which SAEM annual meetings are renowned. I look forward to seeing you in New Orleans for SAEM22 — a reunion to remember!

ABOUT DR. KAJI: Amy Kaji, MD, PhD is a professor of clinical emergency medicine and vice chair of academic affairs in the department of emergency medicine at Harbor-UCLA Medical Center at the David Geffen School of Medicine at UCLA.

SPOTLIGHT A CHAMPION FOR THE UNDERSERVED AND UNDERREPRESENTED IN MEDICINE An Interview With Pooja Agrawal, MD, MPH Pooja Agrawal, MD, MPH, is the director of global health education in the Yale University Department of Emergency Medicine, where she has been on faculty since 2012. She is a member-at-large of the SAEM Board of Directors and is past president of SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM). Dr. Agrawal is a public health specialist with a specific focus on refugees, immigrants, and other displaced populations. Her academic work explores the long-term physical and mental health effects of displacement and forced migration on resettled populations in the U.S. In collaboration with international, national, and local community partners, she works to implement interventions to assist in the resettlement process by assessing health literacy, acute care utilization, and access to healthcare and insurance. As a member of the board of directors of the Integrated Refugee and Immigrant Services (IRIS) of New Haven, she has developed a community-based research and education partnership designed to improve the linkage between refugees in the New Haven community and local health and social services. Dr. Agrawal is actively engaged in exploring gender disparities in medicine and sponsoring women in the field. She has published and spoken extensively in this area. She was awarded Yale Women’s House-staff Outstanding Mentor Award in 2020. She is also a recipient the Momentum Award from AWAEM, in recognition of her extraordinary service in moving the mission and values of AWAEM forward. Dr. Agrawal is a graduate of Cornell University, received her MD from the Case Western Reserve University School of Medicine, and completed her emergency medicine residency at the Harvard Affiliated Emergency Medicine Residency at Brigham and Women's and Massachusetts General Hospitals. She is a graduate of the Brigham and Women’s Hospital Global Health and International Emergency Medicine Fellowship and received her MPH from the Harvard School of Public Health. Dr. Agrawal holds faculty appointments in the Yale University School of Medicine, the Yale Center for Asylum Medicine, and the MacMillan Center for Conflict, Resilience and Health.

Dr. Agrawal, her husband, and children, at a cousin's wedding.

Dr. Agrawal, second from left, catching up with friends at a previous SAEM annual meeting.

What would you say is a valuable benefit of serving on a board of directors and the number one thing you’ve learned during your time on the SAEM Board?

possessions, the land you consider your home, etc.—with the possibility that you may never return. And then proceed to exist in a condition of “statelessness,” where people may acknowledge that you’re living through immense trauma, but still would rather you not do so on their land. Displacement is a protracted traumatic life event that effects one’s physical, mental, and psychosocial health and refugees will carry that trauma with them for the rest of their lives.

I’ve learned that every voice matters. My personal experiences and interactions have shaped me into the leader I am today. Acknowledging that journey, while considering the larger mission of SAEM, has given me important perspective about my purpose for being on the Board. Serving on the SAEM Board has helped me recognize the diverse priorities of such a broad membership and understand how to best support the prolific work that is going on. I also appreciate the influence that a board can have on external groups and how representation matters — representation of our diverse membership in the policies SAEM creates and the direction it takes, and representation of the SAEM membership among other EM organizations, medical specialties, and healthcare organizations.

How and why did you become interested in global health? Is there anything that inspired your specific focus on refugees and displaced populations? As I was “finding myself” after college by backpacking through West Africa, I began working with an NGO (nongovernmental organization) outside of Accra, Ghana. I befriended another expat working with a local legal aid NGO who pulled me in (with my limited premed knowledge!) to help with forensic medical evaluations of Somali asylum seekers to include in their applications for asylum. Hearing their stories and seeing the physical evidence of their trauma and upheaval was life changing. I recognized the privilege I had always enjoyed and knew that I had a responsibility for service. From then on, I dedicated myself to learning more about humanitarian crises, refugee health, and how I could personally have an impact. Each step I’ve taken since then has built upon that first experience. My work in the humanitarian space continues to evolve and given the state of the global refugee crisis today, I am sadly confident that it will continue to do so.

What is it that most people don’t understand about the physical and mental health impact of displacement on resettled populations in the U.S. and how do we begin to address this issue? Most of us are fortunate enough to never experience what it means to leave your entire life behind—loved ones, material

Upon resettlement in the U.S., refugees must start from scratch. They often don’t know the language, don’t have a community for support, are used to different social norms, and must navigate incredibly complicated systems. There are, of course, changes at the national political, policy, and financial levels that can help support refugees better, and necessary mental health services are as difficult to come by for refugees as they are for the rest of the population. But there are also things that each of us can do in our spheres of influence. The most basic yet valuable thing we can do is offer compassion. It’s hard on a busy emergency department shift, but taking the extra time to truly listen with the aid of a real time translator, make an extra call or two to help facilitate follow-up care, and reach out to social workers or refugee case managers to close the loop on your interaction will go a long way. You will begin to understand their personal journey, and they will begin to feel at home in their new home.

What do you wish your male colleagues, and the rest of the world, knew about the challenges of being a woman in emergency medicine? The gender gap in medicine is real, and emergency medicine (EM) is proof. There is a workforce gap: women make up more than half of medical school graduates, but less than 30% of the EM workforce. There is a leadership gap: The pipeline continues to leak up the hierarchy in EM – less than 20% of EM full professors, department chairs, or medical school deans are women. There is a pay gap: women make roughly $19,000 less than men after adjusting for absolutely everything (happy to provide references for all these statements!). On top of that, the pandemic placed an even more disproportionate burden on women in EM. With women often taking on greater childcare

continued on Page 6

Dr. Agrawal and husband on a "bucket list "trip to Easter Island.

“Displacement is a protracted traumatic life event that effects one’s physical, mental, and psychosocial health and refugees will carry that trauma with them for the rest of their lives.” continued from Page 5 responsibilities and kids being out of classrooms, academic productivity and the resultant career advancement has taken a back seat — which will create an even bigger leadership gap in the future. When any group doesn’t feel supported, fully represented, or appropriately compensated, it leads to challenges of satisfaction, retention, and elevation.

SAEM PULSE | MARCH-APRIL 2022

When you delve into the many reasons behind these gaps, you can begin to understand the challenges women in EM face. Competing family priorities, sexual harassment, implicit bias, infertility, lack of support/mentorship/sponsorship, imposter syndrome, and burnout are just a few. We all need to be cognizant of these challenges and thoughtful about how we can start to combat them. We also need to be mindful of the “minority tax” — expecting women to be the ones to change the system that is failing them. We’re asking our male colleagues and leadership to be intentional in making changes towards equity.

Stigma is a leading barrier to mental health care for emergency physicians. Many fear that treatment for mental illness could jeopardize their careers or their licenses to practice. What would you say are the key challenges to addressing this stigma? Doctors have historically taken on the persona of the solitary, unaffected, and unflappable superhuman. It conveys strength, control, and allows us to move forward, regardless of what tragedy we see. But we need to put the days of physician stoicism behind us because we are, in fact, human. We should approach mental health challenges with the same long view we apply to other chronic diseases. We must destigmatize it by talking about it, just as we do with diabetes or hypertension, since it won’t simply “go away.” We need to acknowledge that we all struggle at times and share

those personal challenges with others, so that they may feel comfortable sharing their own. Departments can help by facilitating access to coaches, therapists, and focusing on faculty well-being. Only once we normalize this very real and prevalent issue in our workforce can we collectively take a step towards better mental health.

What can be done to create a sense of safety for EM physicians and medical trainees that would encourage them to ask for help or self-report when they’re struggling with their mental health. Mental health is dynamic. We all have ups and downs, and we need to acknowledge that. During this pandemic, we have been through unthinkable stress and trauma. Recognizing our shared experiences will make us better doctors, colleagues, and family, and will empower those who are also struggling, to talk about their challenges. Several things may help. Removing mental health questions from credentialling and licensing applications, creating anonymous ways to seek help without the fear of retribution from an employer, and facilitating wider access to mental health services could help us reach out when we’re struggling. We should also consider using newly developed and available telemental health services that can offer physicians the degree of privacy and anonymity they prefer by receiving care from a distant provider in the privacy of their home.

How have you managed stress and attended to your mental health during this unprecedented time of COVID-19? What do you think the EM specialty and/ or SAEM can do to address COVID-19-related stress and improve physician well-being? Emergency physicians have had a singular experience with COVID-19. While the rest of the world shut down, we ran toward the fire. And more than two years later, many of us are experiencing incredible levels of stress, burnout, and

perhaps PTSD. I’m not even sure when this happened, but at some point last year, I started giving myself a break. I extended my own personal deadlines for things, I gave myself daily “protected time” to focus on my family, I restarted reading for pleasure, and I made a point to re-engage with friends and activities outside of my work life, so that I could, at least for a while, think and talk about something other than COVID. We all need to give ourselves a break. We need to be sensitive to the burnout within our workforce and consider what things are contributing, both within and external, to our control. We can affect some in the short term, like our own work-life integration and task prioritization. And we can collectively strategize with entities like SAEM to address larger issues, such as intentionally and aggressively reducing disparities in our specialty to create a more equitable playing field.

What are you most looking forward to when we meet again, in person, at SAEM22 in New Orleans? Seeing my people and catching up with old friends, with (COVID appropriate) hugs! SAEM (and AWAEM) have been such a formative part of my professional and personal development. I’ve so missed seeing people who have known me since I was just starting out in residency, and those who have made me into who I am today.

Dr. Agrawal and husband at the Hôtel de Glace (ice hotel), Quebec City, Canada.

Up Close and Personal Who would play you in the movie of your life and what would that movie be called? Gal Gadot, “The Juggler” Name three people, living or deceased, whom you invite to your dream dinner party. Only 3? That’s impossible. I’ll shorten my list to 5: • Michelle Obama — American attorney, author, and former first lady of the United States • Elizabeth Blackwell —first woman to receive a medical degree, she championed the participation of women in the medical profession and ultimately opened her own medical college for women • Malala Yousafzai — Pakistani activist for human rights and female education and the youngest ever Nobel Peace Prize laureate • Neil Degrasse-Tyson — American astrophysicist, planetary scientist, author, and science communicator. • Mindy Kaling — American actress, comedian, screenwriter, producer, director, and author. What's the one thing about you few people know about you? I played the piano for 12 years growing up and probably haven’t stayed awake through an entire movie in almost as long. What is your guiltiest pleasure (book, movie, music, show, food, etc.)? Mindlessly binge-watching TV You have a full day off… what do you spend it doing? Sleeping in, going for a run, taking each of my kids out for solo dates, curling up with a good book, and cooking dinner with my husband. And then mindlessly binge-watching TV. What is at the top of your bucket list? Solving wordle with the first word! But a trip to the Galapagos is probably more achievable. What is a favorite FOAMed resource? ALiEM (Academic Life in Emergency Medicine)

22 PREVIEW

SAEM22: Live and In-Person in New Orleans! A Message From Daren M. Beam, MD, SAEM22 Program Committee Chair WELCOME BACK… two words that hold extra special meaning this year as we gather to celebrate our first live meeting since 2019. So much has changed in the two years we’ve been apart, but one important thing remains: the SAEM Annual Meeting is still the premier forum for the presentation of original education and research in academic emergency medicine.

ANNUAL MEETING PREVIEW

The Same Top-Quality Education

Expect our usual agenda of cutting-edge education, stateof-the-art original research, and innovation in academic emergency medicine, including: • 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. • cutting-edge research and dynamic didactics from the best minds in academic EM • expert educational content from world-class faculty • high-quality, groundbreaking plenary abstract sessions • two keynote addresses by renowned speakers • educational forums that offer something for everyone from seasoned faculty to medical students just starting their careers

• energetic experiential learning competitions like MedWAR, SimWARS, and Sonogames

A Return to In-Person Networking

SAEM annual meetings are renowned for the expansive networking events and career development opportunities they offer. Connect in person with your contemporaries for the first time in two years. Take advantage of opportunities like Speed Mentoring, Speed Mentoring for Educators, and the Residency & Fellowship Fair to talk to peers, leaders, and others who can help you take your career to the next level.

Let the Good Times Roll… Again!

Nobody throws a party like SAEM’s residents and medical students (RAMS) and nowhere is there a better place for a welcome back bash than the House of Blues (HOB) in New Orleans! It’s been a long time since we were last together, so we’re pulling out all the stops and throwing a reunion-worthy, NOLA-style celebration for all our SAEM friends! On behalf of the SAEM Program Committee, and everyone at SAEM, thank you for your unwavering support and commitment these past many months. We can’t wait to welcome you, IN-PERSON, to New Orleans!

Announcing the Top 8 Plenary Abstracts Abstracts present research data, including study background and methodology, research limitations and results, and the conclusions/significance of the study. Abstract session lengths vary depending on the presentation type: plenary (15 minutes), full oral (12 minutes), lightning oral (eight minutes), ePoster (seven minutes). The SAEM22 Program Committee is pleased to announce the top eight abstracts selected to be presented during a special plenary session to be held immediately following the keynote addresses on Wednesday and Thursday. These eight abstracts were chosen as the best from among 1045+ submissions.

Opening Session Plenaries

Wednesday, May 11, 10:00 AM – 11:00 AM Following the Dr. Peter Rosen Memorial Keynote Address

1. Validation of the Pediatric Emergency Care Applied Research Network Abdominal Trauma Prediction Rule James Holmes, Kenneth Yen, Irma Ugalde, Paul Ishimine, Pradip Chaudhari, Nisa Atigapramoj, Mohamed Badawy, Kevan McCarten-Gibbs, Donovan, Grant Tatro, Daniel Tancredi, Jeffrey Upperman, Nathan Kuppermann

2. Performance of European Society of Cardiology 0/1-Hour Algorithm in Patients With Known Coronary Artery Disease James O'Neill, Nicklaus Ashburn, Anna Snavely, Brennan Paradee, Brandon Allen, Robert Christenson, Richard Nowak, Gentry Wilkerson, Bryn Mumma, Troy Madsen, Jason Stopyra, Simon Mahler

3. Observed Disparities in Emergency Department Initiated Buprenorphine Across Five Health Care Systems From the EMBED Pragmatic Trial

Wesley Holland, Fangyong Li, Bidisha Nath, Molly Jeffery, Maria Stevens, Edward Melnick, James Dzuira, Rachel Skains, Gail D'Onofrio, William Soares

4. Predicting Myocardial Injury From Continuous Single-Lead Electrocardiography in the Emergency Department David Kim, Tom Jin, Raj Palleti, Siyu Shi, Andrew Ng, James Quinn, Pranav Rajpurkar

Sheryl Heron, MD, MPH, a national leader in emergency medicine with more than two decades of experience related to diversity, equity, and inclusion and a current lens towards justice in emergency medicine (EM), will present the SAEM22 Dr. Peter Rosen Memorial Keynote Address from 9:30-10 Sheryl Heron, MD, MPH a.m. on Wednesday, May 11 during the SAEM22 opening session. In her presentation, titled “Justice, Equity, Diversity, and Inclusion: Are We Accountable?”, Dr. Heron will discuss the history and importance of justice, equity, diversity, and inclusion (JEDI) and how it has expanded over the past several decades. She will examine how recent events in the nation have highlighted how much further we need to go to ensure equality, fairness, and justice for our patients, our colleagues, and our community and discuss what needs to be done to create a more unified, diverse, and inclusive culture in academic EM.

ANNUAL MEETING PREVIEW

Dr. Sheryl Heron to Present the Dr. Peter Rosen Memorial Keynote Address at SAEM22

About Dr. Heron

Sheryl Heron, MD, MPH is professor and vice-chair of faculty equity, engagement, and empowerment in the department of emergency medicine at Emory University School of Medicine. She is also the inaugural associate dean for community engagement, equity and inclusion and associate director of education and training for the Injury Prevention Research Center at Emory (IPRCE) at Emory. Dr. Heron is a past chair of the emergency medicine section of the National Medical Association. She has received numerous awards including the Partnership Against Domestic Violence HOPE Award, the Woman in Medicine Award from the Council of Concerned Women of the National Medical Association, and the Gender Justice Award from the Commission on Family Violence. She was named a Hero of Emergency Medicine by the American College of Emergency Physicians (ACEP) and as the inaugural president of SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM).

Dr. Sally Santen to Present the MedEd Keynote Address at SAEM22 Sally Santen, MD, PhD, a recognized leader in emergency medicine for her teaching and educational research, is the featured speaker for the SAEM22 MedEd Keynote Address on Thursday, May 12 from 9:30-10 a.m. Dr. Santen’s expertise in medical Sally Santen, MD, PhD education research includes assessment and program evaluation across the continuum from medical students to practicing physicians. Her work brings together medicine, education, research, teaching, mentoring and innovation.

ANNUAL MEETING PREVIEW

About Dr. Santen

Sally Santen, MD, PhD, is professor of emergency medicine and medical education at the University of Cincinnati College of Medicine and vice-chair of education research in the department of medical education. She is the senior associate dean, assessment, evaluation, and scholarship and professor of emergency medicine at Virginia Commonwealth School of Medicine. Dr Santen is the recipient of several awards for her work in education, including the SAEM Hal Jayne Excellence in Education Award which recognizes outstanding contributions to emergency medicine through the teaching of others and the improvement of pedagogy. She is also a Hedwig van Ameringen Executive Leadership in Academic Medicine® (ELAM) Program fellow. Dr. Santen has published more than 200 papers, including over 30 papers in Academic Emergency Medicine journal, as well as perspectives in JAMA and New England Journal of Medicine. She is currently the evaluator for a Virginia Department of Health grant and a Health Resources and Services Administration well-being grant. She is an evaluation and scholarship consultant for the American Medical Association Accelerating Change in Medical Education consortium.

Thursday Session Plenaries

Thursday, May 11, 10:00 AM – 11:00 AM CT Following the MedEd Keynote address 1. Comparison of Performance Data From EM1-3 and EM1-4 Programs Michael Beeson, Melissa Barton, Wallace Carter, Diane Gorgas, Marianne Gausche-Hill, Kevin Joldersma, Earl Reisdorff, Sally Santen 2. Racial Bias in Medical Student Standardized Letters of Evaluation Al’ai Alvarez, Alexandra Mannix, Dayle Davenport, Katarzyna Gore, Sara Krzyzaniak, Melissa Parsons, Danielle Miller, Daniel Eraso, Sandra Monteiro, Teresa Chan, Michael Gottlieb 3. Are Residents at For-Profit Affiliated Emergency Medicine Programs Underpaid? Jared Lassner, James Ahn, Armaan Singh, Paul Kukulski 4. Early Validity and Reliability Evidence for the American Board of Emergency Medicine Virtual 3 - Oral Examination Diane Gorgas, Carl Chudnofsky, Mary Johnston, Kathleen Ruff, Earl Reisdorff

General Information Taking place May 10–13, 2022, SAEM22 will be held in New Orleans, Louisiana, the perfect city for an in-person reunion and celebration of emergency medicine’s resiliency. We hope you share our excitement about getting together with colleagues face to face this year! With more than 1,000 educational sessions, presentation opportunities, expanded pediatric content, and valuable networking, you won’t want to miss this essential event. These links will help you navigate the general information you need to know. • Pricing and Registration • Schedule-at-a-Glance • For International Travelers • FAQs • Accessibility • Environmental Sustainability • COVID 19 Policy • Affiliated Meeting Space Request

The 2022 Consensus Conference— Diversity, Equity, and Inclusion: Developing a Research Agenda for Addressing Racism in Emergency Medicine

Wednesday, May 10, 8:00 AM – 5:30 PM CT

ANNUAL MEETING PREVIEW

Featured Workshop

Health outcomes and health care utilization patterns of U.S. Emergency Departments

Educational Sessions

vary disproportionately by race, and we aim

Advanced EM Workshop Day

race influences the utilization and outcomes

to examine the different aspects of how

Tuesday, May 10, 8:00 AM – 5:00 PM CT

of emergency care. Join us for this year’s

Advanced EM Workshops are intensive educational sessions that focus on techniques, skills, and practical aspects of the specialty. This year’s Advanced EM Workshop Day offerings includes 17 half- and full-day sessions that cover specialized areas in emergency medicine and strengthen knowledge and skills in specific topic areas. Add any workshop when you register for SAEM22.

consensus conference — Diversity, Equity, and

• Bringing the Outside In: How to Incorporate Wilderness and Resource-Limited Medicine Into Your Curriculum • First, Reduce Harm: Compassionate and Evidence-Based Emergency Department Management of Substance Use Disorder • SAEM Grant Writing Workshop • SAEM22 Consensus Conference • World Health Organization Basic Emergency Care Course Using a Training of the Trainers Model • Clerkship Directors Boot Camp • Enhancing Emergency Care Through Artificial Intelligence: Six Steps for Success • Beyond Diversity Recruitment: Next Steps to Ensure That Diverse Emergency Medicine Residents Thrive • Clinical Teaching Educational Boot Camp: Be the Best Teacher • Simulation Hacks: Innovations and Advances in Do It Yourself Simulation Model Building • Reframing Conflict: How to Master Difficult Conversations in Emergency Medicine From a Sex and Gender Lens • Medical Education Research Boot Camp: Improve Your Educational Research • Vulnerable Populations and Climate in Emergency Medicine • Health Equity Rounds: Creating Space for Conversations on Race, Health Disparities, and Social Justice • From Holistic Review to Inclusive Interviewing: A Step-byStep Guide for Mitigating Bias in Residency Recruitment • Emergency Department Operations On-Ramp: A Crash Course for Medical Directors, Administrators, and Researchers • SAEM Education Summit: How to Do Education Scholarship Well

network, and dissemination plan for evidence-

Inclusion: Developing a research agenda for addressing Racism in Emergency Medicine — to support the development of a consensusdriven research agenda, research collaboration based practices related to the care of health disparity populations in emergency care settings. The 2022 SAEM Consensus Conference aims to develop a prioritized research agenda that identifies gaps in the current literature which need to be explored to better understand and address how structural racism impacts emergency care. The conference will focus on three pillars, incorporating social determinants of health into each: 1) education (UME, GME, CME), 2) leadership (recruitment, mentorship, sponsorship), and 3) research.

Didactics

Wednesday May 11, 8:00 AM – 5:50 PM CT Thursday, May 12, 8:00 AM – 5:50 PM CT Friday, May 13, 8:00 AM – 1:50 PM CT 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 165 innovative and interactive sessions cover a range of educational topics in key categories, including: administrative, career development, education, clinical, research.

Featured Didactic SAEM #FOAMed Showcase Friday, May 13, 9:00 AM – 9:50 AM This session 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. Creators of online content will be preselected with attention to impact to the medical community at large, innovation in approach, and commitment to diversity and equity in product design and team members. Those selected will have an opportunity to impress the audience and a panel of judges with their quality academic EM social media content at this year’s FOAM Showcase in New Orleans! One presenter will be awarded the SAEM FOAMed Excellence in Education Award and earn the title of best FOAMed project!

Tuesday, May 12, 8:00 AM – 4:30 PM CT SAEM 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. Add any forum when you register for SAEM22.

Junior Faculty Development Forum Tuesday, May 12, 8:00 AM – 4:00 PM CT

Are you a social media innovator and a FOAMed content creator? The SAEM Virtual Presence Committee is looking for the most innovative Free Open-Access Medical Education (FOAMed) creations of the past year for the #FOAMed Showcase. Submit your FOAMed innovation by March 18, 11 p.m. CT.

Junior Faculty Development Forum is designed to enable junior faculty to engage with senior leaders in the field; develop strategies for promotion, productivity, and academic advancement; and become the next generation of academic emergency medicine faculty leaders. The forum 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 emergency medicine administration, education, and research. Add any forum when you register for SAEM22.

Wednesday, May 11, 12:00 PM – 1:20 PM CT

ANNUAL MEETING PREVIEW

SAEM Leadership Forum

Accepting FOAMed Projects

IGNITE!

Interactive Forums

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 11 4:00 PM – 5:50 PM CT Thursday, May 12 1:00 PM – 2:30 PM CT (tabletop) Thursday, May 12 2:00 PM – 4:50 PM CT 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.

Chief Resident Forum

Tuesday, May 12, 8:00 AM – 3:00 PM CT Chief Resident Forum is designed to help aspiring residents refine their skills as leaders in their residency programs and is the preeminent opportunity for rising chief residents in emergency medicine to gain the skills to successfully lead their residency programs. The forum gathers chief residents from around the nation to discuss traits of effective leaders, network with peers, and get a crash course on keeping their residencies thriving. Engaging sessions by national leaders will emphasize the practical aspects of being a chief resident, including optimizing resident schedules, developing innovative curricula, recruiting the program’s next generation, and balancing wellness with leadership. Add any forum when you register for SAEM22.

Medical Student Symposium Tuesday, May 12, 8:00 AM – 3:00 PM CT

Medical Student Symposium serves as an overview of emergency medicine (EM) and the application and match process for applicants of allopathic, osteopathic, international and military backgrounds. In this day-long session, thought

Experiential Learning Competitions Simulation Academy SimWars

Wednesday, May 11, 1:00 PM — 5:00 PM CT

Secluded in a forest full of slash pine and live oak trees, LOOP NOLA is the city’s only high-ropes challenge course. The adventure-based, expeditionary learning facility offers initiative problems, challenges, and trust activities that develop teamwork and improves interpersonal skills. Register your team for this event online or by completing and returning the team registration form.

SonoGames®

Friday, May 13, 8:00 AM – 1:00 PM CT SonoGames® is a national ultrasound competition in which emergency medicine (EM) residents demonstrate their mad skills and knowledge of point-of-care ultrasound in an exciting and educational format. Don’t miss the winner-take-all, no-holds-barred action as teams of emergency medicine residents in crazy costumes battle it out in front of hundreds of spectators to prove they have mastered the “SonoSkills” to become SonoChamps and take home the SonoCup. Team registrations are being accepted through March 14, 2022.

ANNUAL MEETING PREVIEW

leaders in the specialty discuss the process of applying for an EM residency position. The session includes specific discussions about clerkships, away rotations, personal statements, the match process, and interviews. Ample time is provided for questions and discussions during a lunch with EM program directors and clerkship directors. Add any forum when you register for SAEM22.

Don’t Miss These Special SAEM Events Clinical Images Exhibit May 10 – 13 Simulation Academy SimWars is the premier national simulation competition for emergency medicine residents. Created and brought to you by the SAEM Simulation Academy, SimWars is a simulation-based competition between teams of clinical providers that compete in various aspects of patient care in front of a large audience. This type of learning emphasizes experiential learning, which involves the learner in the moment, mentally, physically, and emotionally in the moment, whether a simulated experience, reliving the past, or through collaboration (community of practice). Additionally, SimWars offers learning opportunities for those watching and instructing, as every person involved can benefit from observing and reflecting on decision making, as well as viewing and discussing practice variations across disciplines and institutions. SimWars combines a grouplearning format with individual skill assessment to enhance global knowledge and skill performance.

SAEM MedWAR

Friday, May 13, 8:00 AM – 12:00 PM CT SAEM MedWAR, short for Medical Wilderness Adventure Race, is a unique event that combines wilderness medical challenges with adventure racing. The race was developed as a tool for teaching and testing wilderness medicine knowledge and hands-on skills and techniques of wilderness medicine in a team competition environment. The SAEM22 MedWAR event will take place in magical City Park in New Orleans. One of the oldest parks in the country, the 1300-acre outdoor oasis is 50 percent larger than Central Park in New York City. In this enchanting urban greenspace, you’ll find a rambling network of lagoons, the World’s largest grove of mature live oak trees and the LOOP NOLA City Park Challenge Course.

Clinical Images Exhibit showcases accepted, original highquality, image-based educational case submissions relevant to the practice of emergency medicine. Submissions are selected based on their educational merit, relevance to emergency medicine, image quality, the case history, and appropriateness for public display. Images that are accepted for display and have patient consent sign-off, will also be featured on Academic Life in Emergency Medicine’s (ALiEM) wide-reaching blog.

Program Officer Event

Thursday, May 12, 2:00 PM – 4:30 PM CT Are you stumped on how to choose the right funding agency for your research proposal, or how you might improve your investigator score? If you have these questions and more, you’ll want to attend the SAEM22 Program Officer Event. Program officers from federal funding agencies will be available to answer your questions. Researchers can apply to meet one-on-one with a PO of their choosing. Attendees will be selected for an individual meeting with a PO through a competitive application process. Deadline to apply is April 1, 2022. A networking and social event will immediately follow.

Lion’s Den

Thursday, May 12, 2:00 PM – 2:50 PM CT A perennial issue for junior emergency medicine (EM) investigators is lack of guidance in, and experience with, development and funding of initial, small-scale study proposals. Many senior investigators believe that creating and receiving funding for a research proposal is like the entrepreneurial process of developing/funding a business proposal. Drawing on the innovative format of the popular “Shark Tank” television show, and adapted for the academic

EM specialty, SAEM Lion’s Den invites junior researchers to pitch their research ideas to a panel of experienced investigators who will consider “investing” in the presenter and idea through mentorship, editorial expertise, and more! Interested participants should apply by 5 p.m. CT, April 15, 2022. Selected presenters will pitch their ideas during the Lion's Den event at SAEM22.

Featured SAEM Academy Events • Academy for Diversity and Inclusion in Emergency Medicine LGBTQ Mixer • Academy for Women in Academic Emergency Medicine and Academy for Diversity and Inclusion in Emergency Medicine Luncheon • Academy of Geriatric Emergency Medicine Anniversary Gala • AACEM Annual Reception and Dinner

Career Building Opportunities Speed Mentoring

Wednesday, May 11, 3:30 PM – 5:20 PM CT

no cost to you. Meet face-to-face with current residents and fellows, ask questions, and seek application and interview advice, all in one place.

Residency and Fellowship Directors Don’t miss this convenient, cost-effective, recruiting opportunity. Showcase your institution’s programs and meet face-to-face with hundreds of medical students and residents looking to find their perfect residency or fellowship. Register for this event online or by completing and returning the registration form.

For the Fun and Health of It! Opening Reception

Wednesday, May 11, 6:00 PM – 8:00 PM CT The Opening Reception is always a highlight of the SAEM Annual Meeting, but this year’s kickoff party — our first inperson and all together since 2019 — promises to be extra in every way. We’ll fill both levels of the Sheraton’s magnificent lobby with NOLA hospitality, beads galore, and classic New Orleans-style cocktails, cuisine, and music. It will be a welcome back party for the ages and you won’t want to miss it!

Dodgeball

Thursday, May 12, 6:00 PM – 8:00 PM CT

Speed Mentoring will match resident and medical student mentees into small groups of 5-10 attendees 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. Add this event to your annual meeting registration at no additional cost!

Mentors needed! If you are interested in serving as a mentor, sign up when you register for the annual meeting.

Speed Mentoring for Medical Educators

ANNUAL MEETING PREVIEW

Thursday, May 12, 11:00 AM – 11:50 AM CT

Speed Mentoring for Medical Educators offers faculty an opportunity to engage in short discussions with mentors who have 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.

Mentors needed! If you are interested in serving as a mentor, sign up when you register for the annual meeting.

Residency & Fellowship Fair

Thursday, May 12, 3:00 PM – 5:00 PM CT The onsite Residency & Fellowship Fair will be held in person during SAEM22 at the Sheraton Hotel New Orleans. Residents and medical students should plan to attend this convenient, cost-effective, career-building opportunity. Explore residency and fellowship programs from across the nation at

Dodgeball is back! Join us as we transform a basic ballroom into THE most amazing dodgeball court ever, complete with bleachers, hot dogs, cold suds, and cheering fans! 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. Limited spots are available, so pull your team together soon and sign up for an opportunity to dodge, duck, dip, dive...and dodge to victory! (Sponsored in part by: AAEM/ RSA and RAMS). Team registration is now open.

SAEM RAMS Party at House of Blues Thursday, May 12, 10:00 PM – 2:00 AM CT

Join us for a return of the SAEM event of the year: The SAEM RAMS Party! Nobody throws a party like SAEM’s residents and medical students (RAMS) and nowhere is there a better place for a welcome back bash than in the spectacular multistory music hall at the House of Blues in New Orleans! It’s been a long time since we were last together, so we’re pulling out all the stops and throwing a reunion-worthy celebration for all our SAEM friends. Everyone is invited to the party, but our special VIP tables are limited and go fast, so if you’re interested you should reserve your table soon!

Thursday, May 12, 5:15 PM – 9:30 PM CT

SAEM22 Exhibit Hall Exhibit Hall Hours All of the following events take place in the SAEM22 exhibit hall.

Tuesday, May 10 Learn about Louisiana wildlife, culture, and history from knowledgeable and entertaining guides on this fun Airboat Swamp Adventure. Surround yourself with exotic creatures and otherworldly scenery and see alligators and other swamp creatures up close as you explore 20,000 acres of cypress swamps. Register for this RAMS-sponsored event when you register for SAEM22. Space is limited so register early!

Virtual Yoga

May 11 – 13, 7:00 AM – 8:00 AM CT Daily virtual yoga sessions will combine physical exercise, mental meditation, and breathing techniques to strengthen your muscles and relieve stress. Complimentary with registration. Sign up for each session you wish to attend.

SAEM22 Host Hotel Group Rate Available Through April 13

6:00 PM - 7:00 PM CT Exhibitor Kickoff Party

ANNUAL MEETING PREVIEW

Airboat Swamp Adventure

Wednesday, May 11 7:00 AM - 9:00 AM CT Exhibit Hall Open 7:00 AM - 8:00 AM CT Networking Breakfast 12:00 PM - 4:00 PM CT Exhibit Hall Open 12:00 PM - 1:00 PM CT Light Lunch 2:30 PM - 3:00 PM CT Power Break

Thursday, May 12 7:00 AM - 1:00 PM CT Exhibit Hall Open 7:00 AM - 8:00 AM CT Networking Coffee Break 12:00 PM - 1:00 PM CT Light Lunch

Sponsors and Exhibitors — SAEM22 Puts Your Products and Services in Front of 3,000+ EM Decision Makers and Thought Leaders! The Sheraton New Orleans Hotel, 500 Canal Street, New Orleans, Louisiana, is the official host hotel for meetings, education, and several social events at SAEM22, May 10-13. Located on the historic Canal Street streetcar line bordering the French Quarter, and just four blocks from the Mississippi River, the Sheraton New Orleans Hotel is steps from worldfamous restaurants, legendary nightlife, prime shopping, and Harrah’s Casino. Relax in the Sheraton’s refined guest rooms and suites, which boast plush bedding, spacious work areas, modern technology and floor-to-ceiling windows overlooking the French Quarter and the Mississippi River. Reboot in the fully equipped Sheraton Fitness Center, kick-start your day at Starbucks®, enjoy Cajun flavors at Roux Bistro, or wind down with refreshing cocktails at the Pelican Bar or while lounging beside the Sheraton’s rooftop pool. The group rate of $249 is available on a first come, first-served basis, through April 13, 2022, so make your reservation now! Book your room online, or by calling (888) 627-7033. A valid major credit card is required to hold a room.

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 web page to learn why you should add your name to our growing list of exhibitors and sponsors.

CLERKSHIP CORNER

Coaching Emergency Medicine Trainees Toward Their Full Potential SAEM PULSE | MARCH-APRIL 2022

By Grace Hickam, MD, Andrew Golden, MD, Keme Carter, MD, and Nathan Lewis, MD, on behalf of the SAEM Clerkship Directors in Emergency Medicine academy

Coaching has become a focus for professional development within medical education training programs. Formal coaching programs have been integrated across the medical education continuum in undergraduate medical education (UME), graduate medical education (GME), and continuing medical education (CME). The evidence for coaching programs continues to grow, and the feasibility of such programs has been well described. Coaching programs have been shown to improve the clinical skills of trainees, with the best evidence for improving procedural and surgical skill training.

Additionally, these initiatives have demonstrated positive effects on trainee well-being, and overall, they have been very well received by trainees.

What is a coach?

Medical education has shifted from a paternalistic model to a competency model that reflects a learner-based approach. This evolution has highlighted both the need for and the role of coaches. Coaching focuses on helping individuals meet their full potential through specific and targeted feedback on observations as well as by asking questions to challenge and encourage

the trainee. The coach should be an individual who is invested in the personal and professional growth of the trainee rather than evaluation or assessment. This helps to reduce stress for the trainee and to develop an honest self-assessment. Deorio et al. (2021) describes that the focus of coaching is driven by the learners, and the coach helps the learners develop their own conclusions about their weaknesses and strengths through the coach’s provocation and inquiry. This role is often confused with mentorship and advising; however, it differs in the emphasis of goals and direction.

Why is coaching important?

Coaching adapts to the changing landscape of medical education in that it is learner driven and individualized to meet self-identified needs and goals. This helps to facilitate learner participation and “buy-in,” which is key to a successful coaching relationship. A literature review by Lovell (2018) highlighted several studies suggesting that coaching programs can help to reduce error, improve technical skills and exam scores, and identify students who may be at risk academically. Educators and trainees have traditionally focused on the role of summative assessment in clinical training; however, coaches are invested in the holistic development of a learner. Instead of simply providing feedback to trainees, coaches emphasize the importance of developing plans in response to prior feedback to achieve the learner’s goals. These plans can be dynamic and should adapt to changing assessments and priorities of the trainee. With this shift to personal and professional development over assessment, learners can instead focus on targeted strategies to improve specific knowledge and skill gaps.

Tips for Becoming a Coach

Establishing coaching relationships with trainees requires explicit understanding

“Coaching programs have been shown to improve the clinical skills of trainees, with the best evidence for improving procedural and surgical skill training.” of the differences between this and other traditional relationships, such as mentor-mentee or advisor-advisee. When this approach is agreed to be the most appropriate, we recommend utilizing the following tips to increase the effectiveness of your coaching:

Separate coaching from assessment.

Trainees should be allowed a safe space to reflect on their professional challenges. Integrating coaching into roles with the additional responsibility of trainee assessment threatens a trainee’s ability to be honest and open about opportunities for growth. When faculty are responsible for assessment or advising, trainees are unlikely to be comfortable disclosing weaknesses, focusing more on their positive attributes and aspects of their performance.

to become coaches should familiarize themselves with these models, choose one they believe best suits their strengths as a prospective coach, and utilize the techniques associated with that approach. Some examples of current models include the R2C2 model developed by Sargeant et al. (2015) and the GROW framework developed by Whitmore. Additionally, the American Medical Association has published an extremely helpful, comprehensive guide — Coaching in Medical Education — for creating faculty coaching programs within medical education.

Encourage self-reflection.

A foundation of coaching is the empowerment of trainees to self-identify priorities for development. To achieve this ideal, coaches must regularly encourage

Experiment with existing coaching models. Several models currently exist within the coaching literature. Faculty hoping

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Without this mentality, trainees will largely be unsuccessful in achieving these goals without transitioning into a more traditional advisor or mentor relationship where the faculty member has more control.

Conclusion

Coaching focuses on using the values and motivation of trainees to self-identify opportunities and associated methods to work toward continued clinical and professional growth. Using these tools will help to create effective coach-trainee relationships and ultimately encourage trainees to guide their own development toward their full potential.

ABOUT THE AUTHORS Dr. Hickam is a second-year medical education fellow and clinical Instructor at the Virginia Commonwealth University Department of Emergency Medicine. Dr. Golden is a medical education fellow and clinical associate at the University of Chicago Section of Emergency Medicine.

CLERKSHIP CORNER

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SAEM PULSE | MARCH-APRIL 2022

trainees to reflect on the gaps in their current performance, ultimately identifying goals to fill these gaps and action plans to achieve these goals. These should be individualized, based on the values and priorities of each trainee.

Actively listen.

Unlike mentors and advisors, coaches are not expected to outline a path toward success. Rather, they should

listen carefully and ask questions to allow their trainee to dictate their own trajectory. Coaches will find they spend most of their time listening, questioning, and providing small pieces of insight based on the values and goals of the individual trainee.

Emphasize accountability.

Coaching relies on the motivation of the trainee to work toward their selfidentified goals. This requires active awareness and attention to ensuring there is steady progression toward these objectives. Coaches must emphasize that trainees are the drivers of their own growth and development.

Dr. Carter is an associate professor at the University of Chicago Pritzker School of Medicine where she serves as the emergency medicine clerkship director and associate dean for admissions. r. Lewis is an associate D professor at the Virginia Commonwealth University School of Medicine where he serves as the emergency medicine clerkship director and assistant residency program director.

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

There’s nothing selfish about SELF-CARE #StopTheStigmaEM

DIVERSITY & INCLUSION

Transition from Trainee to Faculty By Moises Gallegos, MD, MPH; Tiffany N. Mitchell, MD; Cortlyn Brown, MD; Arthur Pope, MD, PhD; Ashlea Winfield, MD, MSPH; and Alden Landry, MD, MPH, on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine

SAEM PULSE | MARCH-APRIL 2022

The SAEM Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) recently sponsored a titled the “Transition from Trainee to Faculty.” Dr. Tiffany Mitchell welcomed Drs. Cortlyn Brown, Arthur Pope, and Ashlea Winfield in an insightful discussion of their experiences as junior faculty members. Highlights from the webinar are shared in this article. The full recording of the session may be found online.

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The first year after residency is characterized by a steep learning curve. New doctors learn how to practice as (and not under the supervision of) an attending. They discover how medicine is practiced in different health systems and continue to develop their personal and professional selves. In academic medicine, this transition also involves stepping into roles in administration, education, and scholarship. The demands of being both a clinician and a faculty member can be challenging to anticipate and navigate.

“What was the biggest thing that surprised you as an attending?” The first six months can be challenging.

If you are leaving the location of your residency, where you have spent some considerable time and formative years, the geographic move can be difficult. Additionally, whether you relocate or not, you will find yourself looking for a new community of people as your coresidents move and start their attendingships. Clinically, you must adjust to a new medical system and the way that your new health care system practices. You’re working through the self-questioning process to solidify your personal practice pattern. Add to these stressors the need to study for boards and it’s easy to feel overwhelmed. “It was almost like being a first-year resident again….”— Dr. Pope

You’ll be busier than ever.

It’s common to walk away from the final shifts of residency looking forward to

all the free time that will come with an attending schedule— until you realize that your schedule is suddenly busier than it was before. While you may find yourself working fewer shifts, your excitement to start in a new role will result in you volunteering for things, showing up to extra meetings, and trying to get your foot in the door. This is important and will help you find your niche, but it can quickly overload your schedule. During your first year, try to advocate for yourself. Protect your time, advance your interests, and promote your career. “I’m busier now than I was as a chief resident.” — Dr. Winfield

What’s important to you might not be valued by the institution.

As you step into your new role as a faculty member, you’ll start to take on projects that seem important. While it seems harsh to say, projects that are important to you may not always contribute to your career advancement.

“It was almost like being a firstyear resident again….” — Dr. Pope This may be because your institution may not value the deliverable within their promotions process or may not allot clinical shift reductions for the work you complete. Before taking on new tasks or projects, assess if you have time, whether the project/task will help or hinder your career development, and whether or not you will enjoy the project. “It was surprising to me to learn the different things that are valued.” — Dr. Brown

“What has the process been like trying to find information about the criteria and requirements for promotion? When did you initiate the process?” Start early and understand the requirements.

It’s important to start thinking about the process of promotion from the day you join the faculty. Advancing from clinical instructor to professor looks different across institutions and among individuals. Review the criteria and requirements early to ensure you understand expectations or have time to seek clarification. While it may be several years before you come up for consideration, putting together a portfolio is a lot of work. Start early to compile an easily accessible folder of everything that can/should be included in a promotion application (e.g., student reviews, letters of support, acknowledgments, etc.) Waiting until the last minute may result in you needing things you didn’t know were required and therefore didn’t save or keep handy.

Different situations exist.

Institutions may have different pathways and criteria for promotion for the various faculty. Clinical faculty may not need much in the way of research or presentations, but research faculty may have a set number of expected publications and scholarship requirements. Some institutions may have a “grace period” during which junior faculty are not held accountable for productivity while they settle into their

“It was surprising to me to learn the different things that are valued.” — Dr. Brown

roles. It’s important to understand the policy in your department. Additionally, what is true in one system may not be the same in another. For example, achieving promotion in your current system may not seem immediately necessary as it may not affect your role, responsibilities, or compensation, but if you were to leave for another institution the promotion might impact your transition and time allocation.

“Did each of you have a clear idea of what you wanted to accomplish and what you wanted your role to look like before you started your job?” It’s OK not to know, but don’t forget yourself.

Starting off it can feel like you’re all over the place—doing this and doing that; interested in this, curious about that. This is how to easily find yourself overcommitted and burning out. It’s important to take a step back and remember what your passions are, what brings you joy, what you want to achieve, and who you are or want to be. “As long as I ‘come back to what drives me,’ I’m good.” — Dr. Winfield

Advocate for your interests.

If you have a specific set of skills or have worked heavily in a particular discipline, make this known. You may not be able to negotiate all aspects of your contract in every academic setting, but you can advocate for your interests. When looking for a job, ask questions that help you determine if the institution or department aligns with your work and/or interests. Sometimes the answer will be yes, sometimes no. To help you determine if you can thrive in a setting, discuss the topics of protected time and buydown, titles, projects, and administrative support. “This is who I’m going to be, this is what I’m going to bring, I’m going to focus on these efforts, do they fit within your mission statement?”— Dr. Brown

“What if you need to make a shift?” You might hit a wall.

You will probably start off strong and hit the ground running with excitement about projects, energy for the job, and a drive to advance. Consider your mental health. Reach out to mentors and support systems. Figure out what you need to let go. If you find yourself in a place where you feel you are unable to make the changes needed to take care of yourself due to unsupportive leadership, it may be a sign that you need to go elsewhere.

“How do I ask for buydown?” The topic of salary and clinical buydown in academic medicine can be difficult to navigate, especially as a junior faculty member. Upon starting their careers, many junior faculty find that they do not have as much time protected for academic projects, especially as new items are added to their plates. You may be wondering how to advocate for time off to pursue academic projects without coming across as complaining. You deserve recognition and compensation for what you’re doing. Here are some suggestions:

Be clear about departmental expectations as well as paths to promotion and clinical buy down.

In academic medicine, you will generally receive one hour of clinical shift buydown for every two to three hours of nonclinical work (e.g., teaching, research endeavors, serving on departmental committees), but this will vary per institution and by department. Your full-time employment (FTE) may be specifically allocated as percentages to different tasks, roles, and projects. The best time to advocate for reduced clinical duties may be before you even start the job. In your initial discussion with your potential employer be sure to ask what deliverables you are expected to produce at your current FTE; if you feel the expectation is not appropriate, negotiate. Also, be clear about projects you want to do and ask continued on Page 22

DIVERSITY & INCLUSION

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if there is a path to protected time to complete those projects. This may be especially important for those doing work that is not traditionally leveraged in promotions processes, such as social justice initiatives, community volunteerism, etc.

Promote your contributions to the department.

Present data about your accomplishments and your progress to leadership. In the case of academic projects that are not quantifiable via surveys or numerical categorizations (e.g., “my project has resulted in an X increase in patient satisfaction”) it may be helpful to track how your time was utilized (e.g., time spent designing a simulation scenario or building a procedural model). The goal is to be clear about the impact you are having. If you are unsure how to present your work to leadership, consider asking a more senior faculty sponsor to serve as an advocate.

Look beyond the department.

Find the mentorship and support needed to advocate for your interests and productivity. If the department can’t give you protected time, find a role in the medical school or undergraduate campus for salary support. Roles within your associated medical school, such as teaching or serving on the interview committee, can also lead to additional pathways to buydown. If you are not affiliated with a medical school or university, explore institutional committees and leadership opportunities.

“As a junior faculty member at a new institution how did you navigate finding mentorship?” SAEM PULSE | MARCH-APRIL 2022

Make it a part of the interviewing process.

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During your interview, ask about mentoring programs available to junior faculty. Do programs exist for URiM faculty within the department, or does the medical school provide opportunities? What existing programs are there for faculty development that are related to your areas of interest? If I pursue faculty development outside of the department (e.g., SAEM ARMED MedEd or Emerging Leader Development Program), are there departmental funds pay for these experiences, and am I able to have

“As long as I come back to what drives me, I'm good.” — Dr. Winfield reduced clinical duties during that time to pursue them?

Mentorship vs. Sponsorship.

As you dive into your new role, embrace the variety of mentors you will have: formal, traditional, focused, project-based, etc. Mentorship can come in various ways and will help all along the path. You will also need a sponsor who will act on your behalf and promote your career. As previously mentioned, sponsors can be helpful when negotiating for changes to FTE. If there are no mentors for specific areas in your institution, consider joining national committees such as SAEM interest groups where you can build relationships with faculty from across the county. Even if you have mentors in house, it is worth establishing contacts from other programs to collaborate for research and to gain additional perspectives.

promotes your successes. You may develop partnerships and relationships that can help you further delineate whether fellowship is the right fit for you.

3-year vs. 4-year

Some institutions will not hire a threeyear grad without either a fellowship or an additional year of experience. This can be the case for some four-year programs that prefer attendings and fellows to be a year further along in experience than the trainees they will work with.

“Were there any challenges in shifting from being a learner to a teacher? How do you balance teaching and taking care of patients?” It’s a balance.

“Talk more about the need to do fellowship before an academic job. We are told at 3-year programs that it will be necessary to do a fellowship before academic job”

You’ll need to figure out what kind of attending you want to be. You will discover with which residents and in what contexts you can observe and be more hands-off. While you should always “trust but verify,” you will have to find your own level of comfort working with each resident. You’ll find a balance between providing autonomy and providing support.

It depends.

Don’t compare yourself to other people.

While fellowships are meant to afford EM physicians the opportunity to become experts in their field, not all academic positions will require fellowship training. If you’re already doing the work as a resident and can show scholarship or productivity either through teaching or publications this may be enough. Having an advanced degree or demonstrating proficiency in other ways may still make you a competitive applicant. Be mindful that there are some positions, such as simulation or positions that include a directorship role, where fellowship training may be desired.

Set yourself up to succeed.

Talk to as many people as you can about the strength of your application. Understand what the institution is looking for. If you see that they traditionally only hire faculty with fellowship training, it may be hard to navigate this otherwise. During residency, work to build your CV in a way that frames your interests and

You will become your own “type” of attending. Some people will sit and talk about a paper, going through the evidence-based discussion of decision making. Others are great at teaching procedures just-in-time. You may be the attending that can teach flow, efficiency, and charting. Don’t compare yourself to your colleagues. Instead, focus on what you consider your strength and how you can teach that strength to others. “I am who I am, I teach the way I am, my strengths are my strengths, and that’s enough.” — Dr. Winfield

“What was it like to go from having a cohort of your peers, to being the youngest or most junior?” Bonding with residents while staying professional.

As early faculty, you will often find yourself closer in age and experience to the residents than your faculty

peers. The hardest thing can be finding a balance between bonding with new residents, earning their trust, and remaining professional as their supervisor. There is no hard rule that says you can’t hang out with residents. Recognize, however, that you may find yourself at times needing to provide critical and constructive feedback. It’s important to maintain professional boundaries. This might be as simple as clarifying early on whether you’re “okay” with first names, or prefer to be called by the title “Dr.”

Keep up with your residency group.

Maintain an active GroupMe, WhatsApp, etc. with your resident cohort. “Should I pull this out?” “Would you discharge this?” “You’ll never believe what I did tonight.” Those 3:00 a.m. texts can be centering and help create some levity. They can also be a quick poll/show-of-hands to remind you that you know what you’re doing.

Meet as many people as you can.

Some institutions will hold orientation activities or meet-and-greets for new hires. Seek out any new faculty from your own department or others. Summer welcome picnic for the nurses- get to know as many of them as you can!

“My future academic job doesn’t have any black faculty. I feel supported, but do you have any tips or suggestions for situations where mentorship by URiM colleagues isn’t an option?” Find your colleagues.

While mentorship traditionally comes from senior people in your field or department, URiM mentorship may come from colleagues going through it along with you. Stay in touch with people you meet along the way.

Look outside your institution.

If you do not have fellow URiM faculty in your department, make connections at other institutions. You will find people in the same shoes looking for the same thing. Find a community that you can build through conferences, talks, chance encounters. Start your network. Consider nonmedical and community partners as possible professional connections.

“Are there moments where you feel stuck in academics, and do you feel you can explore opportunities in the community?” Look for an opportunity to work in the community.

Working without residents or in a nonacademic site can be very useful in your first years out in that it will help you maintain a skill set, develop practice patterns, and continue to build your identity as a physician. Some institutions have clauses that don’t allow you to work at outside facilities, so if working solo shifts is important to you, try to find a job that allows you to work independently or allows the opportunity to moonlight.

Final Thoughts Know that you have put in the work.

A huge struggle is imposter syndrome and feeling the need to prove you’ve earned your title. You have earned your title you don’t need to prove it. You may feel that you need to show you’ve earned your title and you can find yourself committing to too much as a result. You have earned your role, you don’t need to prove it.

Take care of yourself, physically and mentally.

It’s okay to feel overwhelmed. You will be going through a lot: studying for boards, new autonomy, new responsibility, new role, ongoing pandemic, etc. Consider proactively looking into self-help or mental health resources that can contribute to your well-being.

trajectory.” If you need more time to think about it or want more specifics about the project, don’t be afraid to ask. “You are competent, you are confident, you are great.” — Dr. Winfield.

ABOUT THE AUTHOR Dr. Gallegos is clinical assistant professor and clerkship director, department of emergency medicine, Stanford University School of Medicine.

ABOUT THE WEBINAR MODERATOR Tiffany N. Mitchell, MD, is an emergency medicine instructor at Mount Sinai School of Medicine. Dr. Mitchell is chair of the SAEM Equity and Inclusion Needs Assessment Committee and chair of ADIEM’s Social Media and Publications Committee.

ABOUT THE WEBINAR PANELISTS Cortlyn Brown, MD, is vice director of diversity, equity, and inclusion and assistant professor of emergency medicine at Carolinas Atrium Health, Charlotte, NC. Arthur Pope, MD, PhD, is clinical assistant professor of emergency medicine at Penn Medicine, Philadelphia, PA.

Find agency and find your voice.

Underrepresented minority physicians and female physicians frequently feel compelled to accept every opportunity and not miss a chance. It can be hard to say no, but it’s important to learn to advocate for yourself.

Learn to say no gracefully.

Don’t feel bad about saying “no,” but do so in a professional manner: “Thank you for thinking of me. I’m not sure this fits my interest.” “This sounds great, unfortunately, it doesn’t fit my career

A shlea Winfield, MD, MSPH, is assistant director of the Cook County Health Simulation Center and assistant professor of emergency medicine and chair of the diversity and inclusion committee at Cook County Health, Cook County, IL.

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

ED ADMIN & CLINICAL OPERATIONS

Alternative Pathways to Admission: The Use of Telehealth in Transfer Coordination SAEM PULSE | MARCH-APRIL 2022

By K. Noelle Tune, MD and Emily M. Hayden, MD, MHPE, on behalf of the boarding and crowding subcommittee of the SAEM ED Administration and Clinical Operations Committee

As we continue to experience recurrent Covid-19 surges, increased utilization of telehealth for transfer coordination could alleviate strain on academic referral centers, while also providing high-quality care at local, community hospitals. A goal of such programs is to leverage telehealth technologies to accurately identify the need for a higher level of care. The potential avoidance of unnecessary transfers can keep health care dollars within local hospital systems and communities while simultaneously maintaining bed availability in tertiary care centers.

Many health care systems, and emergency departments (EDs) in particular, have implemented telehealth systems to provide quality care to patients in alternative sites, such as the home or other affiliated health care facilities. It is commonplace for community EDs to utilize telehealth to access specialists in many fields, such as Psychiatry or Neurology, and there has been ample evidence suggesting that rural EDs have expedited dispositions when telehealth is utilized in the coordination of care. As such, telehealth infrastructure exists

for emergency medicine to further leverage telehealth for improved transfer coordination across a more generalized patient population. Pre-pandemic, however, the vast minority of EDs used telehealth to assist with transfer coordination. We have witnessed the successful management of patients at affiliated hospitals utilizing telehealth capabilities coordinated through our academic ED to avoid unnecessary transfers. Video-based telehealth is available for use during the discussion between the clinicians at the originating and the

“Telehealth infrastructure exists for emergency medicine to further leverage telehealth for improved transfer coordination across a more generalized patient population.” tertiary care EDs in the determination of patient disposition. For example, similar to ED colleagues going to a patient’s bedside to enhance their discussion of the patient’s care, video is available when the ED clinicians from the originating and referral sites want to use video to go to the patient’s bedside. A clinical example could be a patient with a particular neurologic finding that may be hard to describe verbally. Similar tele-emergency medicine programs exist in other regions of the United States. Multiple articles suggest that the availability of telehealth consultation, especially in sepsis, can result in avoidance of transfers and potentially improved outcomes. By providing teleconsultation with subspecialists, a significant percentage of transfers can be avoided. Neonatal resuscitation and hand surgery are two other examples of how utilization of telehealth can be impactful for transfer coordination. Telehealth transfer coordination programs provide access to specialty consultations to patients in community

hospitals, as well as critical access and rural sites, without the financial strain and disruption caused by long-distance transfers. Importantly, telehealth transfer coordination programs also allow medical personnel in community hospitals to provide high quality care with support from academic-centered specialists. The pandemic has spurred innovative thinking in the emergency setting around ways to avoid transfers while also providing outstanding care to patients in community and rural hospitals. The challenge put forth to us by the pandemic likely expedited changes that would otherwise have taken a decade or more to evolve. We expect many of these innovations to remain active post pandemic and advocate for policy makers to opt for appropriate reimbursement of unique, patient-centric treatment models. Questions certainly remain, including ways to arrange financial relationships between facilities providing and utilizing telehealth services and how payors value and compensate systems for employing telehealth in transfer coordination.

ABOUT THE AUTHORS Dr. Tune is a telehealth fellow in the department of emergency medicine at Massachusetts General Hospital. She also practices emergency medicine at various community sites in eastern Massachusetts. Dr. Tune is focused on how telehealth can improve the quality of care in rural and underserved communities. Dr. Hayden is the director of telehealth and associate director of the virtual observation unit, department of emergency medicine, Massachusetts General Hospital and was chair of the 2020 SAEM consensus conference on telehealth in emergency medicine. She aims to facilitate the thoughtful transformation of the specialty using the tools of telehealth.

EM RESEARCH

A Career in Research? EM-Bound Students Have Concerns

SAEM PULSE | MARCH-APRIL 2022

By Maurice Dick and James H. Paxton, MD, MBA on behalf of the SAEM Research Committee

Engagement in medical research has been shown to stimulate and enhance medical students' learning capacity, influence academic achievements, build critical thinking skills, and solidify learning outcomes. However recent evidence suggests that medical students may have very specific concerns about pursuing a research career after graduation. Studies by AlGhamdi et al. and Funstun et al. found both welcoming and unwelcoming views of research among medical students. Some of the negative perceptions articulated by students include lack of adequate training courses, difficulties in obtaining approvals from relevant departments,

lack of funding, stress, lack of professional supervisors, excessive time requirements, perceived lack of clinical significance, and low availability of study participants. Conversely, students acknowledged potential benefits as well, including enhanced academic achievement, the opportunity to increase scientific knowledge, and an opportunity to contribute positively towards the welfare of patients.

female medical student respondents ranked careers in patient care and community service most highly, while male respondents were more likely to prefer a career in research and medical education. Female students appeared to be more likely to report concerns that responsibilities such as raising children, caring for elderly parents, and providing financial support might hinder them from pursuing a research career.

According to results from a study by Snyder et al., perceptions of a researchoriented career may also vary according to gender, influenced by considerations such as work-life balance, patient care responsibilities, perceived autonomy, and financial security. In that study,

Early intercalation of research training into medical school curricula may help to dispel some of these concerns. Studies by Bierer et al. and Sorial et al. both showed intercalated students to have a significantly higher research self-efficacy rating and other academic

“Female students appeared to be more likely to report concerns that responsibilities such as raising children, caring for elderly parents, and providing financial support might hinder them from pursuing a research career.” benefits. Intercalation also had careerenhancing effects and positively impacted participants’ overall perception of the importance of research. A correlation between students’ interest in clinical research careers and their perception of research was also observed. DiBiase et al. found that the incorporation of a scholarly concentrations program boosted students’ research self-efficacy scores, self-perceived research skills, and the probability that they would pursue scholarly work. In their study of an eightweek research elective module, Howell et al. found that participants could convey a greater understanding of medical

research than controls. Participants also recommended opportunities for early exposure to structured research electives and modules such as fundamentals of research to advance their knowledge and experience in research. While medical students’ perceptions of research are clearly influenced by a variety of factors, effective methods of encouraging our best and brightest to pursue a career in emergency medicine research remain elusive. Additional studies are needed to identify ways to overcome these obstacles to increase research engagement for EM-bound students.

ABOUT THE AUTHORS Maurice Dick is a third-year medical student at Saint James School of Medicine and a 2021 SAEM Medical Student Ambassador. His aspiration is to become an emergency medicine physician devoted to underserved communities. His major interests in emergency medicine include critical care, pointof-care ultrasound, and simulation education. James H. Paxton, MD, MBA, is the Director of Clinical Research at Detroit Receiving Hospital (DRH) and an Associate Professor in the Department of Emergency Medicine at Wayne State University (WSU) School of Medicine (Detroit, Michigan). He is currently Chair of the SAEM Research Committee, and a long-time advocate for medical student research.

ETHICS IN ACTION

Navigating Ethical Principles in an Adolescent Behavioral Health Patient in a Pediatric Emergency Department By Mindy Stimell-Rauch, MD and Joan Bregstein, MD, on behalf of the SAEM Ethics Committee

SAEM PULSE | MARCH-APRIL 2022

The Case

A 16-year-old female is brought to the pediatric emergency department (ED) by emergency medical services (EMS). She is accompanied by her mother who says her daughter has refused for several days to take the aripiprazole prescribed for her for nonspecific psychosis. She is now showing signs of psychosis and violent behavior. There is no suicidal ideation. On arrival, the patient is disoriented, uncooperative, and agitated. She is experiencing auditory and visual hallucinations and is speaking incoherently. Her thought content is paranoid and delusional.

“The ethical question is whether the mother, by refusing, increased the risk of harm to her daughter, the ED staff, and other ED patients.” The patient is seen by the pediatric psychiatry consult service which recommends aripiprazole 5 mg PO at bedtime and lorazepam 1 mg PO as needed for mild agitation. For more severe agitation, or if the patient refuses oral medications, the consult recommends intramuscular (IM) administration of lorazepam, with the

possible addition of IM haloperidol. As this hospital has no inpatient adolescent behavioral health service, the patient remains in the crowded tertiary care ED, in a queue for transfer to an outside behavioral health facility. While awaiting transfer, the patient refuses all medications and her mental status deterioraes. Despite round-

“There is a fine line between what is reasonable, shared decision-making and what is obstructionist behavior that compromises medical care.” the-clock security and 1:1 clinical observation, she manages to punch and damage the exam room wall and assault a physician. By day three, the medical team becomes concerned for dehydration, as the patient has refused food and drink and has not urinated. The mother expresses anger that the ED staff will not “force feed” her daughter the aripiprazole, stating that by failing to treat her daughter, staff is contributing to her worsening condition. The mother, however, refuses to permit IM interventions, e.g., lorazepam, which the staff feels might sufficiently calm her daughter so that she will take the aripiprazole, or haloperidol, which would calm her and possibly also treat her psychosis. On ED day five, the patient is approved for transfer to an inpatient psychiatric facility. This is unacceptable to the mother, who refuses to approve the transfer, stating that she prefers that her daughter be transferred to the hospital to which she had previously been admitted, which has no open adolescent beds and is out-ofnetwork for the patient’s insurance. On ED day six, the patient is accepted for transfer to a hospital acceptable to the mother, although insurance authorization will take at least 24 hours to obtain, if it is obtained at all. The mother pays outof-pocket for the transfer, and the child leaves by ambulance. This case features troubling themes often experienced with ED patients with behavioral health emergencies. A further complication is the patient’s age—she is old enough to have reached age of assent but incompetent to make independent decisions and therefore dependent on the decision-making of her guardian mother. This case brings up the following questions: • Can an older minor,14-17 years of age, with psychosis be forced, without her assent, to accept treatment per medical recommendation? • To what extent can the guardian of the advanced age minor direct care, and at what point does the ethical principle of autonomy endanger the integrity of beneficence?

• Can a physician sedate a pediatric patient against the guardian’s will if the minor is deemed harmful to herself and/ or the staff? • Can a guardian refuse care, or transfer to a higher level of care, if refusal is causing a threat to life or limb? To what extent does EMTALA conflict with ethical principles, and which one should prevail? • To what extent should prioritizing the needs of a single patient be allowed if the care of other patients in the department is impacted? The patient was a psychotic patient refusing medication, without which she would be a danger to herself and others. Based on her psychiatric illness, she lacked the capacity to fully understand her situation and appreciate the consequences of her medication refusal which would include danger to herself and her providers. In this circumstance, it would be ethically acceptable to administer sedation without patient assent. In pediatrics, when reasonable, we routinely engage in shared decisionmaking and family centered care. In this case, the mother refused the sedation, arguing it would delay the patient’s definitive treatments. She instead favored force-feeding her the aripiprazole, which was unacceptable to the medical staff because of the potential risk to the patient of personal restraint or choking, and to the staff of biting, spitting, or physical injury. To be sure, the administration of an IM sedative to an agitated patient can be a dangerous procedure to both patient and staff. But the benefit of restraining her to administer parenteral sedation and haloperidol would have been to quickly ensure her safety and lessen her psychotic symptoms. This would have been in her best interest. This case also highlights the issue of EMTALA, which requires consent from patient or guardian for transfer to an outside facility, usually for higher level of care. In the case of this patient, the mother refused to sign consent for transfer to the first facility offered to her daughter. The ethical question is whether the mother,

by refusing, increased the risk of harm to her daughter, the ED staff, and other ED patients. It would be an additional 24 hours before the mother would deem the transfer to be acceptable, and during that time, the ED was at over-capacity. Denied the higher level of care she required, the patient became dehydrated, and her psychosis worsened. There is a fine line between what is reasonable, shared decision-making and what is obstructionist behavior that compromises medical care. In this case, the wishes of the mother were honored, and the patient waited in the ED. In the end, the child may have suffered more than was necessary because EMTALA prevailed at the expense of the expeditious care of the child. Additionally, this patient— in a private room for six days — consumed scarce resources of a 1:1 clinical tech, security guard, social worker, nurse, pediatrician, and psychiatry staff in a busy ED during the COVID 19 pandemic. The mother, desperately seeking help for her daughter, freely wandered through the department “shopping” for staff who would listen to her concerns, interrupting the care of other patients. The extensive resource requirement by this one patient impacted the care and safety of all patients in the department.

ABOUT THE AUTHORS r. Stimell-Rauch, is an D assistant professor of pediatrics in emergency medicine) at Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians & Surgeons, New York. r. Bregstein, is an associate D professor of pediatrics in emergency medicine) at Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians & Surgeons, New York.

GERIATRIC EM

Ageism in the Emergency Department By Anita Chary, MD, PhD; Lauren Cameron-Comasco, MD; Anita Rohra, MD; Scott Dresden, MD, MS; Alden Landry, MD, MPH; Shan W. Liu, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine and the Academy for Diversity and Inclusion in Emergency Medicine

SAEM PULSE | MARCH-APRIL 2022

This article summarizes content from an inaugural webinar jointly sponsored by the Academy of Geriatric Emergency Medicine and the Academy for Diversity and Inclusion in Emergency Medicine. A recording of the webinar is accessible to SAEM members at: https://youtu.be/cJWO3fIf73I

Older adults, often defined as those aged 65 and older, represent a vulnerable patient population in emergency medicine. While many adults age healthily, others develop comorbidities that may limit their functional status and ability to independently perform activities of daily living. Physiologic changes that occur with aging lead to geriatric syndromes such as frailty, falls, and delirium, while changes in social position and relationships may lead to elder abuse and neglect. These issues necessitate a thoughtful approach to evaluation, treatment, and disposition of older patients in the emergency department (ED). While older adults have unique clinical and social needs, we must also be wary of the differential treatment they may receive based on their age.

Ageism is defined by the World Health Organization as “the stereotypes, prejudice, and discrimination towards others or oneself based on age.” While it can affect people of any age, in the world of medicine, we have particular concern about the impact of ageism on older adults. Clinicians may conflate increasing age with frailty, comorbidity, and disability. We may dismiss pathology due to old age, conceptualize physiologic changes associated with aging as disease, or make assumptions about our older patients that do them a disservice. Consider these examples: • A clinician omits a sexual history when interviewing a 74-year-old patient with dysuria, because the clinician doubts the patient is sexually active. • A clinician decides to shave the head of a long-haired older patient to repair a scalp laceration, neglecting the value the patient may place on their appearance. One strategy for combating ageism in emergency medicine is reflecting on and responding to our own biases. Implicit association tests and careful interrogation of our interactions with geriatric patients

can reveal our unconscious biases about older adults. A common manifestation of ageism in medicine which implicates many clinicians is “elderspeak,” a form of communication that uses inappropriately juvenile and overaccommodating lexical choices. Examples include referring to older patients as “dear” or other terms of endearment, speaking slowly with short sentences, using an over-nurturing or high-pitched voice, or directing one’s gaze at a bedside caregiver rather than the patient. Elderspeak arises from implicit or unconscious bias. Those who employ elderspeak often intend to express care or facilitate communication. Instead, elderspeak works to exert a clinician’s control over the patient, reinforcing the old-age stereotype, and perpetuates negative self-perceptions among older patients. Studies show that older adults generally find elderspeak from health care workers patronizing and makes them feel incapable and impaired. Recognizing the negative impact that elderspeak can have on our patients, regardless of our intentions, can motivate us to change our communication styles for the better.

Examples of Elderspeak in Medicine Category of Communication

Examples

Content of Speech

- Inappropriate terms of endearment: “honey,” “dear,” “young lady” - Collective pronoun substitute: “Do we need to use the restroom?”

Delivery of Speech

- High-pitched vocal adjustments - Over-nurturing voice - Exaggerated intonations, smiles, nods - Short, slow sentences

- Standing over patient Nonverbal Features - Yelling into patient’s ear - Patting patient on the head Ageism operates not only at the level of interpersonal interactions, but also at institutional and structural levels. The COVID-19 pandemic, which has disproportionately affected older adults, has laid bare the ways that institutional policies can lead to disparate outcomes and decrease opportunities for advancement for people over the age of 65. One of the most obvious examples of institutional ageism during the pandemic has been the heavily weighted use of age in crisis standards of care, or standards used during emergencies to guide medical providers when rationing potentially life-saving treatments. Emergency clinicians have advocated against using age as a tiebreaker or relying on the concept of “life-years saved” to allocate ventilators and ICU beds, questioning underlying assumptions that devalue older adults’ contribution to and value in society. A less obvious example of institutional ageism—but one that impacts our daily clinical practice—relates to masking. Hearing impairment affects approximately one-third of adults over the age of 65 and prevalence increases by decade. Mask mandates, while incredibly important as an infection control measure, can compromise communication with older adults who rely on reading lips or whose hearing aids are displaced by masks’ ear loops. Providing hearing amplifiers and masks with ties, rather than loops, represent simple solutions that can improve these patients’ ED experience. These forms of advocacy for systems-level change are crucial in mitigating ageism in medicine. Ultimately, decreasing ageism in emergency medicine will require a multipronged approach involving policy and educational changes as well as increased intergenerational interactions and exposure to adults who are aging healthily. As we clinicians consider our own knowledge gaps and implicit biases about older adults and work to fill them, we can take steps towards improving experiences and outcomes for our geriatric patients.

ABOUT THE AUTHORS Dr. Chary is an emergency physician and health services researcher at Baylor College of Medicine, Waco, TX. She is an anthropologist whose research focuses on health disparities and health care delivery for vulnerable populations. She is the resident representative on the SAEM Academy of Geriatric Emergency Medicine (AGEM). r. Cameron-Comasco, is assistant professor of emergency medicine D at Oakland University William Beaumont School of Medicine, Rochester, MI. She is the director of geriatric emergency medicine and the Geriatric Emergency Medicine Fellowship Director at Beaumont Hospital in Royal Oak, MI. She is the current president-elect of AGEM and has served on the AGEM Executive Committee since 2018. Dr. Rohra is the director of simulation and assistant program director in charge of education for the department of emergency medicine at Baylor College of Medicine (BCM), Waco, TX. Dr. Rohra was lead faculty for diversity in her department from 2016 to 2019 and established a group promoting women in leadership within the department. Dr. Dresden is associate professor of emergency medicine and director of Geriatric Emergency Department Innovations (GEDI) at Northwestern University, Feinberg School of Medicine, Chicago. He is the current president of the SAEM Academy of Geriatric Emergency Medicine (AGEM) D r. Landry is an assistant professor of emergency medicine at Beth Israel Deaconess Medical Center, faculty assistant director of the Office for Diversity Inclusion and Community Partnership, associate director and advisor for the William B. Castle Society, and director of health equity education at Harvard Medical School. He also serves as senior faculty at the Disparities Solutions Center at Massachusetts General Hospital Dr. Liu is associate professor of emergency medicine at Harvard Medical School and an associate physician emergency medicine, Massachusetts General Hospital, Boston, MA. She serves on the research advisory committee and is aa principal investigator for the Mass General Research Institute. Dr. Liu is the immediate past president of the SAEM Academy of Geriatric Emergency Medicine (AGEM)

Looking for a Geriatric EM Mentor? Are you a trainee or junior clinician who is interested in finding a mentor in geriatric emergency medicine? Please complete this form to be matched with a mentor.

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 EM

A History of the Global Emergency Medicine Literature Review SAEM PULSE | MARCH-APRIL 2022

By Austin Lee, MD, on behalf of the SAEM Global Emergency Medicine Academy

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The Global Emergency Medicine Literature Review (GEMLR) was started in 2005 and was intended to collate and highlight high quality research in international emergency medicine. The project, which is completely volunteer led, with no financial funding or support, has now been continuously running for over 16 years, with the 17th iteration currently underway. The review was never intended to be a comprehensive systematic review, but rather a platform to aggregate and discuss the most important research in global EM (GEM).

Inception The international emergency medicine literature review initially was brought together by members of the Emergency Medicine Residents’ Association (EMRA) International Emergency Medicine Committee alongside several members of the Society for Academic Emergency Medicine International Interest Group (now the Global Emergency Medicine Academy). Starting in 2005, a small team set out to scope and summarize the most useful recent literature in global emergency medicine (EM). The

“The number of articles that are screened each year has grown precipitously, from a few thousand, up to nearly 36,000 in 2020, and there are now several hundred full articles scored each year.” first year, 44 articles met the screening criteria and 10 articles were reviewed in detail. As the authors first year noted in their manuscript, one of the greatest obstacles for global EM researchers and practitioners “remains the lack of a high-quality, consolidated, and easily accessible evidence base of literature.” They went on to aspire that the review could “act as a forum for disseminating best practices, while also stimulating further research in the field of international emergency medicine.” Dr. Adam Levine, who spent 13 years as the editor-in-chief, was a part of that initial startup team, and reflects on the early days of the review: “At that time there was Journal Watch and EM Abstracts, but no one was really looking at the international EM literature.” The GEMLR group has remained independent of ACEP, SAEM or any particular external group, while maintaining a symbiotic relationship with Academic Emergency Medicine journal, where the review has consistently been published.

Growth of GEMLR For the first several years, the review team was composed of EMRA members and almost everyone was a resident physician. As the methodology and search strategy evolved, the literature search quickly expanded from a few dozen articles to several thousand articles. As the inset graphs show, the number of articles that are screened each year has grown precipitously, from

a few thousand, up to nearly 36,000 in 2020, and there are now several hundred full articles scored each year. In the late 2000s and again over the past year, there have been significant increases in articles related to pandemic disease (previously H1N1 influenza and more recently COVID-19). As the project grew over time, the process became increasingly formalized with positions such as managing editor and assistant editors. The literature search also began to be split into two separate tranches covering six months, to give reviewers time to sort through the large number of screening and scoring articles. The language of the journal articles included has been an evolving target, with different languages meeting the inclusion or exclusion criteria based on the fluency of the review and editorial teams. Further, the methodology for determining the “top scoring articles” for a full review (which includes both a summary and commentary) has evolved over time. Dr. Tom Becker, the current GEMLR editor-in-chief and review member since 2008, notes that the editorial board has developed a number of committees and has several avenues for both formal and informal feedback: “Over time, we have added new instructions or policies to address emerging issues or to standardize aspects of the review.” Former managing editor Dr. Indi Trehan highlights how the editorial team considers the impact of potential protocol

changes: “As ideas and problems come up, the committees are tasked to explore different solutions, which often means rerunning prior years’ reviews to see how outcomes might change”

Systematic Review Group About six years ago, the GEMLR group also spun off a systematic review subgroup, which expanded the number of people able to participate with the project, while looking to answer more targeted questions in a systematic review format. The GEMLR group produces about one systematic review per year on a specific topic; this team is working to broaden the global EM evidence base while also increasing the exposure of GEMLR. To date, reviews have looked at pediatric nutrition interventions in humanitarian emergencies, bystander assistance for trauma victims in LMICs, the effectiveness of interventions for responders’ mental health in responding to disasters, and mobile health technologies and EM care LMICs.

Challenges As the GEMLR has grown, there have been obstacles. Current GEMLR Managing Director, Dr. Sean Kivlehan, has observed the challenging task of managing the “ever growing number of articles that are reviewed each year.” Dr. Trehan expanded on this theme, remarking that many of the current data

continued on Page 34

GLOBAL EM

continued from Page 33 management steps feel a bit clunky, from the manual extraction of abstracts from PubMed, to cutting and pasting large amounts of text, to the large spreadsheets with numerous data columns. There has also been a growing recognition of the need for geographic and practice environment diversity among the reviewers, editors, and GEMLR leadership. Historically, the GEMLR team has been predominantly represented by volunteers from the global north, with a small minority living and working in the low- and middleincome countries (LMICs). Dr. Levine has observed that GEMLR has not yet fulfilled its full potential to serve as a forum for disseminating best practices into the LMIC clinical environment. The full benefit that could come from better communicating the findings and highest quality research from the annual review to EM providers in LMICs is yet to be realized. Similarly, the goal of the review to stimulate research from international EM providers in LMICS indicates that more needs to be done. Dr. Trehan points out that despite a growing number of research articles each year, the predominance of funding from and to institutions in the global north perpetuates the colonization of global health research. Consequently, “the questions being asked are often not the questions that frontline LMIC providers are actually interested in as they won’t really help improve their clinical practice or patient outcomes.”

SAEM PULSE | MARCH-APRIL 2022

Successes and Future

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“We have benefited greatly from the hard work of so many motivated volunteers, and I think many of them have had the chance to learn how to better appraise literature, as well as to develop and critique a literature review,” remarked Dr. Levine. Dr. Becker makes light of the fact that the growth and consistent approach from the working group has made the GEMLR a “household name” in the global emergency medicine (GEM) community. He reflects on the joy he and many others have gained from the “networking and lifelong friendships that

have evolved among members of the group.” As described by Dr. Kivlehan, “the biggest success has been to build a major network of academic GEM practitioners across the globe. This network has led to extensive mentorship arrangements and collaborations outside of GEMLR.” Over the past several years, the GEMLR leadership team has focused on expanding the global participation and representation among the pool of reviewers and editors. As GEM is growing as a field and more people are interested and there are more fellowships, the leaders have put term limits into place for editors to create scheduled turnover and allow others to contribute and move into leadership roles. Among the growing population of EM practitioners in LMICs, as well as medical students, residents, and global EM fellows, the GEMLR serves as a very useful way to better understand the strengths and weaknesses of the current research and is a great tool in finding articles to discuss for a journal club or scholarly presentation. For those who are interested in joining the Global Emergency Medicine Literature Review group, there is an annual call for applicants (historically due in July or August). As noted in the 2010 publication, the GEMLR continues to grow, and

hopefully it can continue onward in its aims to “foster further growth in the field, highlight evidence-based practice, and encourage discourse” around global EM.

ABOUT THE AUTHOR Dr. Lee is a senior reviewer for the GEMLR, and currently is a fellow in global emergency medicine at Brown University. He is interested in strengthening emergency care, particularly in low- and middle-income settings. @gemlrgroup

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The Experiences and Challenges of EM-Bound International Medical Graduates By Adebisi Adeyeye, MBBS, and Oluwarotimi Vaughan-Ogunlusi on behalf of the SAEM Global Emergency Medicine Academy Emergency medicine (EM) has grown since its inception, becoming the 4th most popular residency choice amongst senior medical students and thus increasing the competition to match. Interest is not isolated to the United States alone as EM continues to grow internationally. However, there are few international EM training programs available, leaving many international medical graduates (IMGs) searching for opportunities to train in the United States. In this article, we shed light on the experiences and challenges of EMbound students from the perspectives of a United States (U.S.) IMG and non-U.S. IMG trained in medical schools in Europe and West Africa, respectively. This article highlights the plight of IMGs striving for advanced medical training in a specialty that has not historically favored them.

Since the 1970s, EM has been recognized as a specialty in the U.S., and over the past 50 years many countries around the world have begun to offer EM residency training. South Africa was the first African country to offer EM residencies in 2004. As of 2017, an additional 11 countries, out of the 54, have introduced emergency medicine residency programs (EMRPs). According to the European Society for Emergency Medicine (EUSEM), 29 European countries recognize EM as a primary specialty. Of those, only 16 meet the European Union ‘Doctors’ Directive’ criteria, which requires training programs of at least five years. Many international medical students and doctors are left without the opportunity to pursue EM in their home countries, particularly in Lowand Middle-Income Countries (LMICs).

In Nigeria, EM became a recognized specialty in 2019, and efforts to start a residency at the University College Hospital, Ibadan are underway. As a result, there are currently no EMRPs or formal EM clerkship rotations for Nigerian medical students. Additionally, Nigerian students discover the possibility of pursuing EM late in their education or not at all. The exposure to emergency care is minimal, mostly tending to emergencies whilst on core rotations in surgery, medicine, pediatrics, or ob/gyn. For example, during a 12-week pediatrics rotation, only one week is dedicated to gaining experience in the children’s emergency room. In most cases, the patient has been assessed, resuscitated,

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GLOBAL EM

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SAEM PULSE | MARCH-APRIL 2022

and stabilized with a working diagnosis in place, limiting student exposure to the core of emergency care. Students in Irish medical schools face similar issues, as access to clinical teaching in the emergency department (ED) is limited. Emergency treatment is covered in didactic lectures, but the principles of the specialty are not taught from an ED perspective unless students seek out international EM electives in their final year of medical school.

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IMGs are eager to join the EM community despite the challenges they face. In Nigeria, these include no nationally accepted professional organizations, only four EM-trained physicians in the country, and little to no mentorship opportunities available. A student’s sole option is to join international professional EM organizations for the opportunity to network, participate in scholarly activity, further their knowledge about the specialty, and learn details of the match process. In 2021, 4,332 applications were submitted to Electronic Residency Application Service (ERAS®) for an EM residency position. Of these, approximately 747 (17%) came from IMGs. In this process, 2,826 applicants

“In 2021, 4,332 applications were submitted to Electronic Residency Application Service (ERAS®) for an EM residency position. Of these, approximately 747 (17%) came from IMGs.” successfully matched, of which 178 (6.3%) were IMGs, 143 were U.S. IMGs and the remaining 35 were nonU.S. IMGs. The table below from the NRMP 2021 Match Data illustrates the difference in match rates amongst the most matched specialties. EM not only has a low match rate relative to other specialties, but regularly receives fewer applications from IMGs as well. As the number of residency applications increases, it is likely the declining trend of IMGs matching to EM will worsen. In our view, the following are just a few contributing factors linked to the low success rates IMGs experience in the EM match:

The Standardized Letter of Evaluation (SLOE)

The SLOE is ranked as one of the most important factors in choosing applicants to interview and rank. SLOEs can only

be obtained from a rotation done in the United States. The COVID-19 pandemic has thus created difficulty for IMGs due to travel restrictions and institutions’ decisions to limit external clerkship rotators. Additionally, this rotation must be done whilst one is still a medical student, thereby disqualifying many IMGs who have completed their studies from applying to EM.

No Home EM Experience

For many potential candidates, rotating in the U.S. may be the only chance for an EM rotation at all, removing the chance for IMGs to complete graded EM clerkships that can be used to obtain other letters of recommendations for ERAS applications. Even those students who have secured a U.S. EM clerkship have the additional concern of being perceived as less competitive when compared to their American

COMPARATIVE MATCHES FOR IMGS ACROSS SPECIALTIES Specialty

Total Number of Applications

IMG Applicants

Total Matched Applicants

IMG Matched

4332

747

2826

178 (6.3%)

Surgery (categorical)

5,329

1,961

1,564

156 (9.97%)

Pediatrics (categorical)

5,685

2,713

2,860

552 (19.3%)

Family Medicine

12,422

7,708

4,472

1224 (27.3%)

Internal Medicine

24,788

13,375

8,632

3416 (39.6%)

Medical Graduate (AMG) counterparts who may have done more clerkships.

Generating a Competitive ERAS Not having a home EM program or opportunities contributes to the overall perception of IMG candidates being less competitive. Opportunities for EM research, mentorship, membership, and leadership in EM-based organizations help create rich applications for many AMGs but are not replicated in the IMG experience.

These challenges constitute a series of hurdles that IMGs must overcome to match. With that in mind, we have compiled a few strategies that have been proven effective for IMG applicants:

Join a Professional EM Organization

Joining professional organizations can be advantageous for students preparing to match into EM. Organizations like SAEM, ACEP, and AAEM offer student memberships, which can be fruitful places for students to get involved with EM, attend conferences, and form important connections. Although beneficial, these networks are based in the U.S. and can be inaccessible to IMGs. This may be caused by travel and financial restrictions or difficulty attending meetings with time zone differences. In our experience, online networks for medical students pose a superior alternative. Networks, such as Advocates

for IMGs and TheIMGJourney on Twitter, are creating spaces for IMGs to share information, connect, and network.

U.S.-Based Mentors

Mentorship is one of the most useful tools a medical student can utilize in preparing for their career; however, EM-specific mentorship can be difficult to come by in countries where it is not a recognized specialty and there are few physicians in the field. Students can benefit from connections with U.S.-based EM physicians, in particular other IMGs who have matched to the U.S. Developing these connections can be helpful in many ways, from finding clerkship opportunities to having support with the various aspects of the ERAS process. IMGs pursuing EM training in the U.S. work exceptionally hard to be competitive in the current residency application landscape. For some, chasing their dreams means leaving behind their home, which is a significant sacrifice. And, of those interested in EM, few actualize this dream and overcome the aforementioned challenges. The unfortunate reality is that the challenges faced by IMGs overshadow their strengths; namely their dedication to the specialty and unique point of view posed by training in different health systems and working with diverse populations. IMGs increase the diversity of the EM workforce, which has been linked to improved patient outcomes. In many cases, IMGs are qualified doctors who

bring valuable patient care experience that supplements the U.S. medical workforce. An IMG perspective brings benefits ranging from promoting improvement in residency training to supporting new outputs in global health and international EM. EM is a dynamic specialty that is constantly changing and progressing. As the specialty advances, the tides will turn for EM-bound IMGs and we expect to see an improvement in perceptions and opportunities for IMGs.

ABOUT THE AUTHORS Adebisi Adeyeye, MBBS, is a graduate of the College of Medicine, University of Lagos, Nigeria. She is currently undergoing her housemanship at a general hospital in Lagos State, Nigeria. She currently serves as president of the Emergency Medicine Interest Group in Nigeria and as a co-vice-president of the African Federation for Emergency Medicine (AFEM) Student Council. Oluwarotimi Vaughan-Ogunlusi is a fourth-year medical student at the Royal College of Surgeons in Ireland (RCSI). He currently serves as the president of the RCSI Emergency Medicine Interest Group. @timi_von

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.”

ONCOLOGICAL EM

Addressing Tobacco Use in the Emergency Department? If Not, Maybe You Should Be!

SAEM PULSE | MARCH-APRIL 2022

By Nicholas Pettit, DO, PhD, on behalf of the SAEM Oncological Emergencies Interest Group

Tobacco use is common among emergency department (ED) patients, as ED patients have higher smoking rates compared to the general public. Around 5% of all ED visits are due to tobacco related illnesses, and tobacco use leads to many preventable chronic diseases. Promotion of tobacco cessation is easy and addressing tobacco use during the ED visit has the potential to address many health disparities related to tobacco use. Tobacco cessation is not routinely taught in emergency medicine education, but it is easy to learn and can be performed by nearly any member of the health care team. ED patients frequently experience inequities in health care, such as equitable access to primary care and primary/secondary preventions. Millions

of smokers utilize the ED every year, and thus the ED represents a desirable location to offer tobacco cessation interventions, especially for hard-toreach populations. Feasibility and efficacy for initiating tobacco cessation in the ED has been demonstrated by a 2019 systematic review and metaanalysis of randomized controlled trials. It has been said that getting low-acuity patients to engage in smoking cessation would likely be far more impactful for their health than nearly any other intervention available to them during their ED visit. These interventions need only take 60 seconds to perform and are both cost effective and sustainable to getting patients to stop smoking. There are various strategies available for tobacco cessation in the ED, many

of which can be self-taught, however official training certificates are available. If someone is interested in quitting, physicians have both pharmacotherapy and behavioral interventions at their disposal. The simplest intervention that can be performed at the bedside is a referral to the tobacco Quitline (1-800-QUIT-NOW) which offers nearly every available tobacco cessation resource for all patients. The typical model for addressing tobacco cessation in the ED is known an SBIRT (Screening, Brief Intervention, and Referral to Treatment). Pharmacotherapy is considered the mainstay therapy for tobacco cessation for nonpregnant adults, and various

“Promotion of tobacco cessation is easy and addressing tobacco use during the ED visit has the potential to address many health disparities related to tobacco use.” options exist including varenicline, bupropion, and nicotine replacement therapy (NRT). Varenicline and bupropion are uncommon prescriptions in the ED physician’s toolkit but are safe and acceptable prescriptions. More commonly offered to patients from the ED is NRT, which can include gum, patch, lozenges, inhalers, and sprays. Each of these therapies has specific dosing based on the patient’s individual tobacco use and several are available over the counter. Many resources are available instructing physicians and patients on how to use each of the various NRT modalities. For

pregnant patients, children, and patients not interested in pharmacotherapy, behavioral therapy is the mainstay of treatment. Tobacco use affects millions of Americans every day and EDs are uniquely situated to offer tobacco cessation interventions. Intervening with ED smokers can be easy, quick, and has the benefit of “meeting patients where they are.” Patients are more likely to sustain from tobacco use if they have a team “in their corner,” thus physicians should also discuss tobacco cessation with those that accompany the patient during the ED visit.

tobacco cessation and that includes offering tobacco cessation during an ED visit. You are sure to encounter a tobacco user on your next shift — consider addressing tobacco cessation with that patient.

ABOUT THE AUTHOR r. Pettit is an assistant D professor of emergency medicine, Indiana University School of Medicine, and chair of the SAEM Oncological Emergencies Interest Group. @DrNickDr

Health systems should encourage opportunities to engage patients in

SEX & GENDER IN EM

The 2021 Sex and Gender Health Education Summit and Steps for Inclusion of Sex and Gender Transformative Educational Content

SAEM PULSE | MARCH-APRIL 2022

By Mehrnoosh Samaei, MD, MPH, on behalf of the Sex and Gender in Emergency Medicine Interest Group

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The 2021 Sex and Gender Health Education (SGHE) Summit was a threeday summit, held virtually, November 12-14 2021. The SGHE summit brought together educators from institutions around the United States and internationally to advance sex- and gender-specific health education across a multiprofessional network. There is a growing recognition of the importance of sex and gender considerations in health outcomes, however, the incorporation of sex and gender differences into the health education has not uniformly and adequately happened. While sexand gender-based medicine (SGBM)

principles are directly related to all health care settings across all specialties including acute care, emergency medicine (EM) residents do not typically receive dedicated and structured education in this area. The SGHE Summit provided the opportunity to highlight innovative and sustainable curriculum methods for teaching sex- and gender-specific health. Participants learned about the “sex and gender integrative educational toolkit” to help educators assess and modify their content to become sex and gender transformative. The toolkit includes the following five steps:

Step 1

Assess the status of the current educational content which could fall into one of the following five categories: Sex and gender biased. • Stigmatizing, reinforcing stereotypes, wrong use of language Sex and gender blind. • Ignores sex and gender differences Sex and gender sensitive. • Acknowledges the differences in sex and gender without mentioning the mechanisms or contributing factors Sex and gender specific. • Acknowledges the differences

“To promote health equity and reduce systemic disparities, EM trainees need to learn how to apply an intersectionality lens to clinical context and to develop conceptual framework for considering social determinants of health during each patient encounter.” • Discusses the reasons or contributing factors or knowledge gaps • Doesn’t discuss how this information could be applied to clinical settings Sex and gender transformative. • Acknowledges the differences • Considers gender norms, roles, and relations for people of all genders • Discusses contributing factors or mechanisms of the differences or the knowledge gap • Includes knowledge translation strategies to improve patient care

Step 2

Use a checklist to identify what’s not accurate, what’s missing, and what could be improved in education materials. The checklist is derived from the book “How Sex and Gender Impact Clinical Practice”

Step 3

Identify existing resources. The following resources are examples of some that are free, available, and easy to use: • Sexandgenderhealth.org for slides and videos that can be inserted into existing presentations. • Relevant chapters from the book, “How sex and Gender impact Clinical Practice” • The sexandgenderhealth.org PubMed search tool for the most recent data

Steps 4 & 5

Use the resources to then edit the educational materials and reassess the modified content per steps one and two. Additionally, the Summit aimed to increase awareness of the

intersectionality of sex, gender, race, and social determinants of health to include a panel discussion focused on “Intersectionality and LGBTQ+ Health Education.’’ Emergency physicians observe the inequities experienced by underrepresented and marginalized communities during each shift. To promote health equity and reduce systemic disparities, EM trainees need to learn how to apply an intersectionality lens to clinical context and to develop conceptual framework for considering social determinants of health during each patient encounter. The exclusive event of the Summit was the special screening of the documentary “Ms. Diagnosed”, a film that followed the stories of real women, often through the lens of emergency department care, who suffered from being misdiagnosed,

and whose lives and families have been significantly affected by sex- and genderbased health care inequities. (Official trailer of the movie) The recordings of the Summit and all the materials are still available for anyone interested in enhancing interprofessional education through a sex and gender approach. (Registration link).

ABOUT THE AUTHORS Dr. Samaei is a research fellow in the division of sex and gender in emergency medicine, department of emergency medicine, Warren Alpert Medical School of Brown University.

About SGEM The Sex and Gender in Emergency Medicine (SGEM) Interest Group works to raise consciousness within the field of emergency medicine on the importance patient sex and gender have on the delivery of emergency care and to assist in the integration of sex and gender concepts into emergency medicine education and research. Joining SGEM is 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.”

VIRTUAL PRESENCE

The Resident Dashboard: Creating a Virtual Interface for Trainees

SAEM PULSE | MARCH-APRIL 2022

By Ryan LaFollette, MD and Robbie Paulsen, MD on behalf of the SAEM Virtual Presence Committee

Throughout the COVID pandemic, emergency medicine (EM) programs have needed to intermittently move to remote learning, remote feedback, and remote relationships. These times underscore the importance in keeping a holistic look at resident performance as well as maintaining a rigorous process of feedback. While Milestones 2.0 created behaviorally-anchored data points to report performance over time, program leadership are increasingly awash in a world of qualitative and quantitative metrics and the need for a way to summarize and translate these to their residents. At this intersection of resident-sensitive quality metrics and big data comes a potential dream for residents and program leadership to have a visual dashboard that gives a more complete look at real time resident performance.

“At this intersection of resident-sensitive quality metrics and big data comes a potential dream for residents and program leadership to have a visual dashboard that gives a more complete look at real time resident performance.” Competency Based Medical Education (CBME) and associated Entrustable Professional Activities (EPAs) have been a transformational grounding of specialty-specific metrics which create an Accreditation Council for

Graduate Medical Education (ACGME)derived data set for each resident that can be trended over time. These are generated from supervising physicians after clinical exposure and may be prone to a halo effect that may homogenize

“This breadth of information and new integration of big data can create a holistic sense of resident performance that embraces a growth mindset, is learner-centric, and generates actionable feedback.” data. There have been recent efforts within medicine, including EM, to move to Observable Practice Activities (OPAs) that map to EPAs to objectively quantify micro skills of residency training (Warm et al. 2014). While these can demonstrate a resident’s progression toward entrustment and reveal potential programmatic weaknesses when viewed in aggregate, they do not necessarily ensure adequate patient and/or procedural exposure. Resident Sensitive Quality Metrics (RSQM), which are patient-centered outcomes that can be attributed to a resident’s care, are a critical aspect of resident feedback. These are specialityspecific and have been derived and visualized well in radiology (Durojaiye et al). In broad medical specialties like internal medicine and pediatrics, RSQM have been made through Delphi-derived EMR-based metrics, but these have yet to be meaningfully defined and applied in EM. In their absence, institutional morbidity and mortality triggers, or national quality metrics such as doorto-balloon times, can be used, though these metrics involve work-intensive chart review, lack context, and are not solely within the resident’s control. Operational metrics such as patientsper-hour, door-to-disposition time, and admission rates are easily available within Electronic Medical Records (EMRs) and are used to assess attending physician performance in academic and community settings. These metrics are already being integrated into many residency reviews,

showing improved satisfaction with feedback without creating quantitative change. Potentially, other expansion of EMR quantitative data may include a resident’s case-mix by chief complaint or diagnosis to ensure adequate coverage of the American Board of Emergency Medicine (ABEM) model of clinical practice throughout training. 360-degree assessments have been used extensively in industry but are newer in medicine. Quantitative and qualitative multisource feedback from nurses, patients, and learners can provide essential bottom-up feedback to trainees, particularly on communication and professionalism skills. It can be a challenge to collect sufficient data from these often-untrained evaluators, however these assessments can serve as another perspective on a comprehensive resident dashboard. Ideally, each of these data points could be combined into a comprehensive transparent dashboard. The dashboard can illustrate how each resident is performing, individually or compared to their current or historical peers, and can be used to identify specific clinical and behavioral metrics to which they may target performance improvement. An excellent framework is described by Epstein et al who present a residentcentric model of dashboard generation and management in a Canadian EM residency, which includes a model of performance metrics, quality data, as well as quantitative and qualitative integrated feedback. This breadth of information and

new integration of big data can create a holistic sense of resident performance that embraces a growth mindset, is learner-centric, and generates actionable feedback. As graduate medical education (GME) and future employers are likely to continue trends towards accountability in care, having these dashboards and quality metrics will be critical to defining how the specialty of emergency medicine defines its own quality and feedback mechanisms in this data-driven and virtual world.

REFERENCES - Phillips RL Jr, George BC, Holmboe ES, Bazemore AW, Westfall JM, Bitton A. Measuring Graduate Medical Education Outcomes to Honor the Social Contract. Acad Med. 2022 Jan 11. - Warm et al. Entrustment and Mapping of Observable Practice Activities for Resident Assessment. J Gen Intern Med 29(8):1177-82.

ABOUT THE AUTHORS Dr. LaFollette is an associate professor of emergency medicine at the University of Cincinnati and assistant program director and former chair of the SAEM Virtual Presence Committee Dr. Paulsen is an associate professor of emergency medicine at the University of Cincinnati and assistant program director in charge of resident assessment and evaluation

WELLNESS IN EM

Understanding the Effects of the COVID-19 Pandemic on All Categories of EM Providers

SAEM PULSE | MARCH-APRIL 2022

By Richard Wolfe, MD; León D. Sánchez, MD, MPH; and Al’ai Alvarez, MD, on behalf of the SAEM Wellness Committee

The long and devastating effects of the COVID-19 pandemic on the wellness of the different categories of emergency medicine (EM) staff raises questions about postpandemic consequences. Each pandemic wave has added to the stress, sense of powerlessness, and isolation of health care workers, especially those of us in EM. Each wave has caused variable degrees of dysfunction at a systemslevel, preventing consistent delivery of safe care, and putting staff at risk for contagion and moral distress. The first wave was a call to arms that exposed our unpreparedness — evidenced by the limited PPE available. EM frontline workers went to work not knowing if they would contract the infection and expose their families. Many lived isolated from their families for

months to try to protect them. This selfimposed isolation compounded existing stressors resulting from the inability to care for patients safely and adequately due to the lack of ventilators and critical care beds. While there was optimism that the pandemic would abate after the first wave, providing much-needed relief, we soon encountered overwhelming workloads due to critical emergency department (ED) crowding —especially during the Delta and Omicron surges. As EM physicians, we are used to sprinting. Like firefighters going into a burning building, we work at 110% capacity and push through until the fire is over. The problem is that while EM physicians were built to be sprinters, we were running a marathon. With the vaccine rollout we thought we were

close to the finish line, but we weren’t even halfway there, and instead of a marathon, we found ourselves running an ultramarathon. We faced new challenges of balancing work and home life—remote meetings became the norm and continued to encroach on everyone’s personal time. And, of course, the despair and betrayal from the bipolar attitude of the public towards health care workers was especially demoralizing. In the beginning we were regarded as superheroes; then we became the target of anger and apathy caused by societal polarization and demonization of preventive health care measures. During this crisis, the growing lack of trust in physicians continued on Page 46

WELLNESS & RESILIENCE

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and nurses has been exceptionally unjust and hurtful and undermines the patient-caregiver bond that drives our motivation and professionalism. We are exhausted, and with the latest Omicron surge, we have also found ourselves in the reversed role of patients.

SAEM PULSE | MARCH-APRIL 2022

Nurses, Residents, and Attendings

Nurses, residents, and attendings experienced the effects of the pandemic in even different ways. During the first wave, many providers had fears of contracting an unknown disease and spreading it to friends and family. Hospital leadership appropriately imposed rigorous precautions to prevent the spread of infection in the workplace and preserve staff. Still, a side effect was that these isolation requirements contributed to staff anxiety over risk of contagion. Nurses, who had the most significant exposure to this frightening unknown infection, felt abandoned by the shortage of PPE and the unequal application of standards for patient/ nurse ratios and distancing precautions from one part of the hospital to another. Faced with the same salary but better working conditions, EM nurses questioned whether working in limitedresource units versus other parts of the hospital (such as the endoscopy suites) was worth it. This sense of

“During this crisis, the growing lack of trust in physicians and nurses has been exceptionally unjust and hurtful and undermines the patient-caregiver bond that drives our motivation and professionalism.” betrayal, which permanently damaged institutional loyalty from this group, continues, a year later, to contribute to the extreme difficulties in retaining experienced nurses.

Attendings

Attendings in the first wave experienced a collapse in the number of emergency department (ED) visits, as the public feared the ED was a source of contracting COVID-19. In some cases, this fear translated to austerity measures, and physicians found themselves concerned for the financial security of their families, even as they were being praised in the press as heroes. Attendings also constantly navigated the moral dilemma of doing the best for their patients while at the same time not being able to provide the best of care due to increasing limitations in essential critical care resources such as ventilators and PPE. Some even had to resort to rationing care.

Residents

Residents experienced sudden isolation during times of stress because of the loss of the in-person activities of residency training. This loss of inperson gatherings came at a time when many residents were experiencing the adjustment of moving to a new city and would have typically been developing the social networks that provide needed support for surviving residency training. The curtailing of personal interactions through work and the loss of routine social activities as the pandemic shuttered society, left many feeling isolated at a time of high stress. Residency training was already isolating and rigorous even without pandemic; with the pandemic, the resolve of residents was constantly tested as previously unappreciated sources of connection, such as journal club meetings and didactic conferences, moved to virtual platforms. Elective time

“The problem is that while EM physicians were built to be sprinters, we were running a marathon. With the vaccine rollout we thought we were close to the finish line, but we weren’t even halfway there, and instead of a marathon, we found ourselves running an ultramarathon.” and away rotations were canceled, and many were asked to volunteer their nonED time to serve in the COVID-19 ICU units. For the graduating residents at the end of 2020, reports of job offers being rescinded were not uncommon. Subsequent waves of the pandemic have added to the problem in new ways. The vaccine roll out at the end of 2020, and declining infection rates by spring, offered a period of hope which quickly waned due to the public’s resistance to health care recommendations and vaccinations. The growing hostility of a significant part of the population toward the efforts needed to prevent the spread of the infection has been a new experience for physicians and nurses who have traditionally been among the most trusted and respected professionals. The seemingly unending course of this pandemic forced residents to realize that every component of their training, from the bedside to the classroom, was being impaired.

New Variants Expose Staff Shortages

Latter waves, due to new variants, exposed a shortage in most categories of providers, which further disrupted the patient flow and added to the workload of those who continued to staff the ED. This was amid already not having a readily available pool or hiring up to unburden the already tired and frustrated caregivers. Experienced EM nurses have left their home institutions in unheardof numbers to work in less stressful environments or find better opportunities as traveling nurses. Some have left health care altogether. This mass exodus of health care workers also comes during an unprecedented need for staffing the ED. The wellness of attendings, residents, and nurses has never faced a more significant challenge. Ensuring the mental health of the workforce to mitigate the long-term effects on retention and performance needs to start immediately. However, to be most effective, we still need to understand the specific causes

for each provider category and design interventions that prioritize sustainability and well-being. There is a paucity of randomized controlled trials for COVID-19 and burnout and even less data on granular interventions to match the specific problems linked to residents versus attendings versus nurses. With extensive vaccination and mutation of the virus to more contagious but less lethal variants, it is hoped that the pandemic will slowly morph into a milder endemic and allow the return into something close to the conditions that existed before 2020. An informal survey of the chairs in emergency medicine through the Association of Academic Chairs of Emergency Medicine (AACEM) listserv has shown that burnout experiences are common. All report evidence of burnout in attendings, residents, and advanced practice providers. It is no surprise that EM and critical care rank the highest in burnout and depression across medical specialties. Unlike our community physician colleagues, academic centers may also have been insulated from the most severe economic challenges. Regardless, to date, there have been very few physician departures or resignations from EM—evidence of strong resilience that seems part of our specialty. In most academic centers, we have witnessed significant departures of experienced nurses. Equally important, we see shortages in all types of clerical and support staff, with a worsening trend inverse to one’s total compensation. The ethics and resilience seen in the physician workforce may mask long-term instability as many may have suffered sufficient damage to impair the quality of their work and cause them to leave clinical medicine in the future when faced with a new stressor. As we look deeper, the most significant difference from pre-2020 to now is that we have been exposed to a higher level of sustained trauma. By now, many of us are surrounded by colleagues who are, in ways, traumatized and even

broken. While we may have a sense of responsibility to keep forging ahead, once this pandemic cools off, do we continue, or just like other professions, will we find respite in changing careers or even enjoying early retirement? How do we prepare ourselves for the next novel pandemic? It is critical to address these questions to prepare us for the postpandemic reality. To achieve this, we must prioritize the wellness needs of the workforce now. We cannot afford to wait while the residue of trauma and moral injury continues to accumulate. As academic EM physicians, we must band together to investigate which interventions are available to effectively address the damage created by COVID-19 and study how they can be implemented within the constraints of the pandemic — with the scarcity of time, funding, and continued social distancing. If we do not invest in our people now, we may face outcomes — that could have been prevented — later.

ABOUT THE AUTHORS Dr. Wolfe is chief of emergency medicine, Beth Israel Deaconess Medical Center, and associate professor of emergency medicine, Harvard Medical School, Boston, MA. Dr. Sánchez is chief of emergency medicine, Brigham and Women’s Faulkner Hospital, and associate professor of emergency medicine, Harvard Medical School, Boston, MA. Dr. Alvarez is director of wellbeing and clinical assistant professor, department of emergency medicine, Stanford University School of Medicine, Stanford, CA. @alvarezzzy

Preparing for the Next Pandemic, Today: A Call to Action

SAEM PULSE | MARCH-APRIL 2022

By Al’ai Alvarez, MD, and León D. Sánchez, MD, MPH, on behalf of the SAEM Wellness Committee

The latest Omicron surge pushed the emergency department (ED) infrastructure to limits we have never seen before. Our colleagues, and ourselves, became vulnerable to contracting this latest strain of COVID-19 virus not only at work but from everyday routines. We had to adapt quickly to this new set of challenges. Within two short weeks during the winter holiday break, significant numbers of our workforce contracted COVID-19. The CDC outlined new isolation measures to preserve the ability to provide care for the public. As we braced ourselves for another unprecedented surge, it was heartwarming to see our emergency departments take on more deliberate efforts to address our well-being. We hope to learn from this and urge everyone to create spaces to discuss these experiences as we forecast the recovery phase of the pandemic. Before the COVID-19 pandemic, so many of us pushed ourselves to extremes and never called in sick,

regardless of our state of being. In contrast, during the pandemic, referring to Maslow’s hierarchy of needs, we saw institutions subsidizing or offering free hotel stays for physicians who contracted COVID-19 or had family members at home with COVID19 and needed to isolate themselves from them in order to avoid catching the virus. Some institutions even sent care packages and offered mental health support. These measures allowed the effected to convalesce, heal, and catch up on much-needed sleep. Centralized information during times of chaos was critical. Our department relaunched weekly “COVID Chronicles” to update faculty, staff, and trainees on the latest information on testing, isolation, and other lessons learned. We also set up virtual listening sessions and gatherings to foster a sense of community and share stories and experiences. These gatherings reminded us that two years into this pandemic, childcare continues to be challenging, and the burden of shouldering this problem falls on our colleagues who are parents and, disproportionately,

women. Hearing about the stress and frustrations of others helped all of us to acknowledge the challenges many of our colleagues, mostly mothers, have been experiencing. Solutions were offered, such as creating pods to provide support and last-minute childcare, and a reminder from our medical director that the backup-call system is designed for emergencies (including last-minute childcare), helped mitigate the unrealistic expectations we held for ourselves. Our department also instituted shift forgiveness for the duration of the CDC five-day isolation period. It also helped to hear our leaders, including the chair, normalize expectations to mend and heal and take a break while on shift to clear our minds, grab a snack, and/or get some fresh air.

Taking Steps Toward Healing Yet we need to think beyond these short bursts of support to the longer term. Here are suggestions from members of the SAEM Wellness Committee. We acknowledge that some of these suggestions may not

“Two years into this pandemic, childcare continues to be challenging, and the burden of shouldering this problem falls on our colleagues who are parents and, disproportionately, women.” be realistic for your department, but we urge you to nevertheless have an open discussion with your leadership to allow for customization. We must start somewhere. Beginning this July, consider offering one week off for each attending in the scheduling pool. Do not make this time off a part of the attending’s usual monthly clinical time complement (i.e., do not deduct the from the attending’s monthly allotment of shifts). This can serve as a small token of recognition for the 110% effort everyone has contributed since the beginning of the pandemic. We suggest doing this sequentially for however many faculty your emergency department schedule can accommodate per month. This signals to everyone that you hear their concerns, notice their exhaustion, and acknowledge that what they experienced was real and consequential, with long-term effects that need to be addressed. This is just the first step to allow for healing. Most of us have yet to catch our breaths, let alone have time to process and accept the trauma we’ve endured and reflect on where we’re at and how far we’ve come. We need to be able to process our lived experiences, which is not unlike the posttraumatic stress experienced by combat personnel. The institutional provisions for safe, confidential, subsidized mental-health support are critical to this success. Beyond these short-term solutions, we must acknowledge the need to reimagine how we practice in our specialty. The way we have practiced in our specialty is no longer sustainable. For years, many of us showed up to work sick, without ever considering calling in. Paternity leaves were not commonplace, which further put the onus on women to take care of their families at the cost of their advancement. Many of us do not even take breaks while working on shift. This must change.

Hard Truths and Tradeoffs

This will require open discussion about hard truths and tradeoffs, but after all, EM is all about maximizing how we use our limited resources.

Here are other tangible examples to ponder: • What are realistic patients-per-hour metrics? • Is there enough time to do documentation on shift, or are people working unaccounted hours? • Do we build additional staffing to account for boarders? • Do we schedule enough people to allow for an actual time break on shift? • How many shifts a month should be considered full-time? • What are optimal hours even when there are no other academic responsibilities? • Should there be financial incentives for evenings, nights, weekend shifts? • At what age should we stop doing overnight shifts? • Should we pay for call systems to cover emergency absences? These proposed solutions will come at a cost, but we must be willing to discuss the tradeoffs (e.g., seeing fewer patients, having a lunch break, having real vacation time, etc.) even if it means being paid less. Salary cuts should not be on an individual basis either; instead, investments must be reallocated with calculated risks and benefits of prioritizing well-being. We believe that generational differences in some of these solutions need attention and customization. While there is no one-size-fits-all solution for any group, we need to come together to understand and discuss our limits and boundaries and make explicit what we are ready to sacrifice. As EM physicians, we have risen to every challenge that has come our way. For as long as our specialty has existed, we’ve worked under the belief that “If no one else will do it, we will.” This includes initiating Buprenorphine in the emergency department, boarding psych patients, etc. At some point, we have to say, “no.” Every time we take on a new task without getting additional resources, we degrade both the patient and clinician experience in the emergency department. We have accepted hallway care, boarding, and a litany of other tasks because no one else was willing to. Questions such as “Is this the best

for our patients,” alongside “Who will take care of us?” should be included in any conversation on reform. We cannot continue to provide a patch to a broken system fueled only by our sense of responsibility and can-do attitude as emergency medicine physicians. We can learn from our first responder colleagues, especially the Fire Department of New York (FDNY). Three to four percent of the FDNY workforce died on 9-11. After the search and rescue subsided, we heard these familiar narratives: “I just can’t. I’m done. I have nothing else to give.” FDNY retirements in the first six months of 2001 were 274; in the first six months of 2002, 661 retired. In the next five years, how will our specialty handle another pandemic, another local disaster, or the 15th surge of COVID-19? Without intentionality for healing, we could see mass resignations not unlike what we are now witnessing outside of our specialty. Worse, we could see a rise in deaths by suicide. We don’t want another empty “thank you.” We want actions to show that leadership, and we, acknowledge our lived experiences. We need to discuss a future work environment that promotes longevity and healing. What got us here will not sustain us. In the long run, we must adapt to preserve our specialty and our wellbeing. The time for change is now.

ABOUT THE AUTHORS Dr. Alvarez is clinical assistant professor, department of emergency medicine, and director of well-being, Stanford University School of Medicine. @alvarezzzy Dr. Sánchez is associate professor of emergency medicine, Harvard Medical School and chief, emergency medicine, Brigham and Women’s Faulkner Hospital, Boston, MA.

WOMEN IN ACADEMIC EM

Charting Your Course for Leadership By Wendy C. Coates, MD

SAEM PULSE | MARCH-APRIL 2022

This article first appeared in the December 2021 issue of AWAEM Newsletter.

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If you ask a group of middle schoolers to describe what a leader looks like, chances are you’ll hear all sorts of adjectives like, “strong, big, forceful, popular, athletic, smart, aggressive… male.” Historically, women with equivalent or superior credentials have experienced barriers to leadership roles, but in 2022, women have more opportunities than ever to travel existing avenues to leadership or pave their own paths, drawing on life experiences to gain traction and develop expertise. This article highlights practical tips to harness your inner leadership style, devise your roadmap to leadership, and set goals to define your success as a leader. You may want to grab a notebook and reflect on how you relate

“Your values guide your leadership style.” to these scenarios. Can you think of a similar time in your life? Using these reflections, you can envision your role as the leader you want to be and chart your course to get there.

to do what you believed in. Leading by example is a tried-and-true strategy. Your values guide your leadership style.

Myth 1: “I’ve never been given the opportunity to lead.”

Fact 2: Quiet actions demonstrate your leadership!

Fact 1: You’ve always been a leader!

Example: An elderly patient cries out urgently in the busy emergency department (ED), “Nurse, nurse, I need the bedpan!” Your female medical student and resident authoritatively point out to the patient, “I am not the nurse, I am your doctor. I will tell your nurse.” Observing this scene, you quietly collect a bedpan, walk to the patient’s bedside, draw the curtain and provide

Example: In elementary school, you get along with all the girls in your class. Suddenly, a new girl joins in 3rd grade and your friends imply that you should join them in ignoring her. Instead, you risk your comfortable position in the crowd and invite the girl to play with you, even though the other girls glare at you disapprovingly. You had the courage

Myth 2: “Leaders must be forceful and stand their ground.”

“No job is beneath the leader when it helps accomplish the goal.” aid. This simple action demonstrates to the trainees (and the rest of the ED staff) that patient care should be everyone’s first priority. No job is beneath the leader when it helps accomplish the goal. Myth 3: “Leaders have to know everything.” Fact 3: Your vision is enhanced by empowering your team to share ownership. Example: You have been appointed to lead a task force to create an enrichment experience for women in the pipeline, including a programmatic assessment strategy. You reflect that you are passionate about pipeline programs and have opinions on the target beneficiaries and desired activities; however, you know nothing about assessment science. The good news is that you really care about this program and want it to succeed! Leverage the shared enthusiasm and diverse talents of your teammates to create a program that belongs to everyone. Your vision will be extended and improved by the richness of invested stakeholders. Empower your diverse team to realize your vision. Myth 4: “I don’t have enough experience to be the leader.” Fact 4: The journey to leadership takes place one step at a time. Example: You want to be the residency program director for your department. However, you’ll be much more effective if you truly understand the components of this role and have time to grow under the mentorship of those with more experience. Begin by participating in group activities, such as the department’s education committee, review of Electronic Residency Application Service (ERAS®) applications, and the rank list meeting. As you gain proficiency, you can take on individual leadership tasks. Some examples: take ownership of completing the program information form (PIF), remediate a struggling resident, manage

the budget for the recruitment social events, etc. After assuring a thorough understanding of individual tasks, a logical progression may be to serve as associate program director (PD). When it’s time, you’ll be ready to step into the ultimate role of PD. Every step along the path teaches you valuable skills that will make you a better leader. Myth 5: “Asking for help is a sign of a weak leader.” Fact 5: Leaders stand on the shoulders of giants and walk alongside those whom they lead. Example: You have secured a leadership role as department chair and are unsure how of to meet some of your goals. You worry that asking senior colleagues for help will make you look weak, causing a loss of respect, and that asking your faculty for suggestions will diminish your authority. Senior leaders want you to succeed and can serve as invested consultants. The faculty will respect you more if they understand your questions are motivated by your desire to help achieve their career goals. Keep your eye on the prize, solicit opinions, but have the courage to make the final decisions. The coxswain of a rowing team is rarely the biggest, burliest member, but their constant guidance and vision leads to a winning outcome. Successful leaders focus on service and empower team members to achieve the ultimate goal.

What should you do next?

• Identify a leader to emulate. What do they do? What do you admire about their leadership style? How do they get things done? How do they cope with failure? Do they blame their team or own the responsibility? • Improve your knowledge. Give yourself the gift of a dedicated leadership course so you can focus on your professional development and build a network of like-minded peers.

• Take advantage of leadership opportunities. Devote time to leading initiatives that align with your personal mission. Find a mentor and be deliberate about what success looks like to you. • Practice saying “no.” If an opportunity doesn’t align with your professional mission, it is best to decline, but inquire if there is a more suitable opportunity available. When you do say, “yes,” make sure you give it your all! You and your team deserve your best effort. • Spread your talents and empower others. There’s always someone in the leadership pipeline! Be generous about sharing your talent to help others realize their potential. Be a supportive mentor to cultivate the next generation of leaders. You’ll be rewarded by enjoying your mentees’ successes and you’ll expand the network of capable leaders! A good leader can accomplish any task under favorable conditions. A great leader can navigate stormy waters and unify her team to meet and exceed goals together. Aspire to being a great leader! Serve and amplify others and remain true to your mission.

ABOUT THE AUTHOR Dr. Coates is a professor of emergency medicine at Harbor-UCLA Emergency Medicine, UCLA Geffen School of Medicine. She is 20202021 secretary-treasurer on the SAEM Board of Directors and serves on the editorial boards of Academic Emergency Medicine (AEM) and AEM Education & Training journals. @CoatesMedEd

About AWAEM The Academy for Women in Academic Emergency Medicine works to promote the recruitment, retention, advancement and leadership of women in academic emergency medicine. Joining AWAEM 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.”

Join the SAEMF Annual Alliance Today Invest in your specialty’s future and inspire the work of the most promising researchers and educators in emergency medicine At a time when the life-saving importance of emergency medicine has never been more widely understood, less than one percent of National Institutes of Health (NIH) funding supports research in the specialty. The COVID-19 pandemic shines a light on the need for expert, evidence driven care in medical crises from the everyday to the epidemic—and the quality of that care depends on the strength of the research that supports it. The SAEM Foundation is our specialty’s leader in funding research that empowers emergency physicians, saves lives, and improves outcomes for patients everywhere. At a time of great need, we’re ready to make a large research investment in our specialty’s future. Browse our SAEMF Donor Guide to learn about the Foundation’s impact, our researchers and the work they are doing, as well as our bold vision for EM research. You will also read about a cohort of dedicated SAEM

members, the Annual Alliance, who are forging a philanthropic coalition that will lead to more discovery and launch the careers of future research leaders who will carry forward the specialty and EM patient care in new and better ways.

Donate Today! You can ensure investments in emergency medicine research and education continue by joining the growing number of SAEM member donors who support the Annual Alliance. A gift of any amount in 2022 will enable us to welcome you as the next Annual Alliance donor – making even more funding available to researchers like Bernard P. Chang, MD, PhD, featured below.

SAEMF Grantee Update SAEMF grantees like Dr. Chang contribute significantly to EM’s body of knowledge. Many go on to receive additional funding from NIH and other sources and some choose to pay it forward through mentorship of colleagues.

“Thanks to our SAEMF grant, we were able to use this pilot work to submit an R01 grant to NIH that was favorably reviewed and received a fundable score. Thank you to SAEMF donors!”

$ 52

donation to SAEMF

federal funding

Bernard P. Chang, MD, PhD SAEMF COVID-19 Research Grant $25,000, 2020-21

For every $1 donated to SAEMF, more than $3 in subsequent federal funding is generated for emergency medicine research.

Donate Annual Alliance Benefits

before March 21 to take advantage of all the perks that Annual Alliance donors enjoy at SAEM22!

Individual Donor Benefits

All Dues Medical Young Resident Mentor Advocate Sustaining Enduring Donors Check Off Student Professional

Naming

Online Donor Listing Donor Ribbon on Community Website Annual Meeting - VIP Ticket to RAMS Party Annual Meeting - Name on Donor Board Annual Meeting - Early Notice of Hotel Registration Annual Meeting - Early Notice of Course Registration Annual Meeting VIP Lounge Access Social Media Recognition Annual Donor Pin Name in SAEM PULSE Annual Meeting Coffee and Networking Annual Meeting - Name on Slides at Opening Plenary Session Annual Meeting - Photo on Slides at Opening Plenary Session Annual MeetingGuaranteed Room at the Conference Host Hotel Annual Meeting - Limo Transportation Conference Invitation to SAEM Board Reception Named Recognition for Select Grants and Programming

Any

$200

$25

$100

$250

$3,000 $5,000 $10,000 $10,000+ $1,000 paid over paid over paid over in one 3 years 3 years 2 years year

Your Annual Alliance Donation Makes a Difference! $100

$250

$500

$1,000

Funds a research assistant for a day for an SAEMF-funded investigator

Provides a fellow with 2.5 hours of dedicated training time

Brings together medical students for an Emergency Medicine Interest Group

Empowers a young investigator to learn research skills through a gift of 10 hours of dedicated time

Find out more about the Annual Alliance today!

Thank You to Our Enduring Donors! Enduring Donors This year, as we continue to strengthen and diversify the financial support necessary to elevate research and education grants funding, we also continue to see even more generosity from SAEM members who have accepted the invitation to become Enduring Donors of the Annual Alliance. Together with the strength of our endowment — and our entire cadre of Annual Alliance Donors — our Enduring Donors are positioning us to make the biggest leap forward in research funding in our foundation’s history.

We are grateful to the following Enduring Donors who are leading the way to a stronger specialty through their generous giving.

Bill Barsan, MD

Steven L. Bernstein, MD

Steven B. Bird, MD

Michelle Blanda, MD

Wendy C. Coates, MD

Gail D'Onofrio, MD and Robert Galvin

James F. Holmes, Jr., MD, MPH

James J. McCarthy, MD

Angela M. Mills, MD

Andrew S. Nugent, MD

Ali S. Raja, MD, MBA

Megan N. Schagrin, MBA, CAE, CFRE

J. Adrian Tyndall, MD, MPH

Gregory A. Volturo, MD

Richard E. Wolfe, MD In memory of Peter Rosen, MD

Brian J. Zink, MD In memory of Audrey Zink

Please join us in saluting the generosity and visionary spirit of philanthropy of our Annual Alliance Donors!

As of February 18, 2022

Donate Today!

Thank You to Our Sustaining Donors! On behalf of the SAEMF Board and our grantees, we extend gratitude to our Sustaining Donors who have made a significant gift to ensure more and larger grants are possible in the future.

Sustaining Donors

Thomas C. Arnold, MD

Andra L. Blomkalns, MD, MBA

David F.M. Brown, MD

James E. Brown, Jr., MD

Katherine L. Heilpern, MD

Brian Hiestand, MD, MPH

Robert S. Hockberger, MD

James W. Hoekstra, MD

Amy H. Kaji, MD, PhD

Nathan Kuppermann, MD, MPH

Michelle Lall, MD, MHS

Ian B.K. Martin, MD, MBA

Roland C. Merchant, MD, MPH, ScD

Nicholas M. Mohr, MD

Susan B. Promes, MD, MBA

Niels K. Rathlev, MD

Michael Runyon, MD, MPH

Manish N. Shah, MD, MPH

David P. Sklar, MD

Benjamin C. Sun, MD, MPP

J. Scott VanEpps, MD, PhD

Jody A. Vogel, MD, MSc, MSW

In memory of John A. Marx, MD

As of February 18, 2022

In memory of Lou Binder, MD & John Marx, MD

Anonymous Donor

Thank You to Our Advocate Donors! The Annual Alliance’s Advocate Donors provide a three-year commitment that is essential to sustaining our grant funding and education programs, year-after-year. Many of these generous donors have stepped up this year to increase their commitment to help address challenges facing EM that are highlighted in our Donor Guide.

Donate Today!

Can we count on you to become an ally for EM research? • Harrison J. Alter, MD, MS • Brian J. Browne, MD

• Prasanthi (Prasha) Govindarajan, MD, MAS

• Arthur M. Pancioli, MD

• Babak Khazaeni, MD

• Peter S. Pang, MD – In honor of Yung-soo and Jungsook Pang

• Kevin Kotkowski, MD, MBA

• Ralph J. Riviello, MD, MS

• Carl Chudnofsky, MD and Keck School of Medicine of the University of Southern California

• Terry Kowalenko, MD

• Elizabeth M. Schoenfeld, MD, MS

• Robert F. McCormack, MD

• David C. Seaberg, MD

• Jim Comes, MD

• Zachary F. Meisel, MD, MPH, MSc

• Peter E. Sokolove, MD

• John DeAngelis, MD, RDMS

• Lawrence A. Melniker, MD, MS, MBA

• Mary E. Tanski, MD, MBA

• Deborah B. Diercks, MD, MSc

• Joseph Miller, MD

• David W. Wright, MD

• Marie-Carmelle Elie, MD

• Robert W. Neumar, MD, PhD

• James M. Ziadeh, MD

• Gregory J. Fermann, MD

• David T. Overton, MD

As of February 18, 2022

• Charles J. Gerardo, MD, MHS

• Edward A. Panacek, MD, MPH

See the full list of donors.

• Chris Carpenter, MD, MSc and Panechanh Carpenter

Did You Know... Your gift now counts toward participation in the Chairs Challenge and the Academy, Committee, Interest Group Challenge. Give once and you are done!

ew this year: name a grant in N honor of someone who has made a difference in your career or in the field. Email Julie Wolfe for details.

It’s easy to become a Mentor level donor with an annual monthly gift of just $83. Pledge that same monthly gift for three years and you’ll be our newest Advocate donor. Join now to take advantage of 2022 benefits. Your gift will help fund future researchers, educators, and leaders. 56

LIANCE ANNUAL AL S PORTUNITIE OP NG MI NA

Celebrating the SAEMF Legacy Society Donors

Paul S. Auerbach, MD, MS

Michelle Blanda, MD

Andy S. Jagoda, MD

Cherri D. Hobgood, MD

David P. Sklar, MD

Robert S. Hockberger, MD

Brian J. Zink, MD

Many SAEM members have helped shape today’s EM through their research and intellectual contributions on SAEM or SAEMF committees or related organizations, through their generous giving, and possibly even as leaders. Or, maybe they received a grant, or benefitted from research education and training. The SAEM and SAEMF have touched members in unique ways and supported their careers and patient care for many years. Through the Legacy Society, SAEM members can solidify future support of this organization that’s been so important to them during their careers. Conversely, this initiative provides SAEMF a wonderful way to thank and applaud our thoughtful, visionary donors who commit to including the SAEMF in their estate plans or to a planned gift. If you are interested in learning more about legacy giving or the Legacy Society, please let us know. We will coordinate time for you to visit with one of your fellow members who has already made this decision. It may be easier than you think to make such a gift. If you’ve already made similar plans, please let us know so that we may honor you as a Legacy Society donor – contact Julie Wolfe.

SAEMF Donors Support Meaningful Research and Education Projects SAEM Foundation donors make possible projects like Christine Luo, MD, PHD’s "Faculty Development for Academic Emergency Physicians: A Needs Assessment” – check out her video below to learn how receiving a $50,000 SAEMF Education Research Grant will make a difference in EM and in her career. Learn about other SAEMF grantees in our Donor Impact section of saemfoundation.org. 57

BRIEFS AND BULLET POINTS SAEM NEWS Introducing Your 2022-2023 Leaders!

Elections are over, the results have been tabulated, and SAEM is pleased to announce the results of recent elections for your SAEM, Association of Academic Chairs of Emergency Medicine, SAEM Foundation, SAEM Residents and Medical Students, and Academy leaders! Thank you to everyone who took the time to vote and congratulations to this year’s winners. The 2022-2023 leadership will take office at SAEM22 in New Orleans. Here are your newly elected leaders!

Introducing New SAEM COVID-19 Toolkit for Providers

and educational videos that help them understand next steps and treatment options as well as:

• Video Dr. Ramsy Explains: Tested

Positive for COVID-19? Now What?

• Video Dr. Ramsy Explains: What is • • • •

Monoclonal Antibody Treatment? What to do after discharge How to stop the spread Guidelines for quarantine and isolation What to do after diagnosis and monoclonal antibody treatment for high-risk patients

This educational initiative is supported by an unrestricted educational grant from GlaxoSmithKline. For more information about this initiative, contact SAEM.

The COVID-19 Provider Toolkit equips providers with “need to know” information and trusted resources, such as posters, educational videos, and downloadable information, including:

• Video Dr. Ramsy Explains: • • • • • •

Communication With COVID-19 Patients Video Dr. Ramsy Explains: Treatment Options for COVID-19 Patients Tips and tools to break down communication barriers Facts about treatment recommendations Evolving and emerging therapeutics Use of monoclonal antibodies EPIC SmartPhrases fact sheet

This educational initiative is supported by an unrestricted educational grant from GlaxoSmithKline. For more information about this initiative, contact SAEM.

Announcing a New SAEM COVID-19 Toolkit for Your Patients The informative COVID-19 Patient Toolkit features basic information to share with your newly diagnosed patients, including downloadable resources, posters,

Introducing MedEd Sound Bites: A New Podcast Series From the SAEM Education Committee

In the inaugural episode of MedEd Sound Bites, Teaching in the Emergency Department, Drs. Ryan Pedigo and Dina Wallin provide an overview of the series, and kick things off with a discussion on the basics of teaching in the chaos of the emergency department. Get ready to learn some (sound) bite-size morsels of goodness that you can use on your next shift, featuring guest host Dr. Michael Gisondi. In the second episode, “On Shift and Bedside Teaching, Drs. Ashley Heaney and Julie Tondt, with guest host Dr. David Manthey, expand on the basics learned in episode one to discuss how to best teach at the bedside, including teaching procedures and providing effective feedback.

SAEM22 UPDATES Submit Your Project by March 18 for the 2022 SAEM FOAM Showcase Are you a social media innovator and a FOAMed content creator? The SAEM

Virtual Presence Committee is looking for the most innovative Free Open-Access Medical Education (FOAMed) creations of the past year. Those selected will have an opportunity to impress the audience and a panel of judges with their quality academic EM social media content at this year’s FOAM Showcase in New Orleans! One presenter will be awarded the SAEM FOAMed Excellence in Education Award and earn the title of best FOAMed project of 2022! Submit your FOAMed innovation by March 18, 11 p.m. CT.

Accepting “In Memoriam” Submissions for SAEM22 Tribute

This spring, at SAEM22 in New Orleans, 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 have passed away since April 1, 2021, for an “In Memoriam” video tribute to be shown during the SAEM22 Annual Meeting. Please send your “In Memoriam” submissions (name, institution, and a photo) to Stacey Roseen at sroseen@saem.org by April 4, 2022.

Wanted: Junior Researcher Ideas for 9th Annual SAEM Lion’s Den

Junior researchers are invited to pitch their research ideas to a panel of experienced investigators who will consider “investing” in the presenter and idea through mentorship, editorial expertise, and more! Interested participants should complete this form or email Dr. Anish Agarwal at anish. agarwal@pennmedicin.upenn.edu by 5 p.m. CT, April 15, 2022. Selected presenters will pitch their ideas during the Lion's Den event on Thursday, May 12, 2022, from 2-2:50 PM CT during the 2022 SAEM Annual Meeting in New Orleans.

REGIONAL MEETINGS Coming April 1-2: SAEM Western Regional Meeting

The SAEM Western Regional Meeting, “Innovation and Inclusion,” April 1-2 in Palo Alto, California will feature two days of didactics, interactive workshops

and simulations, and speakers sharing expertise on research innovations, medical education, and clinical practice. The meeting will highlight work on diversity, equity, and inclusion (DEI) and precision emergency medicine. Register online for the conference or become an institutional event sponsor. This year’s event is hosted by Stanford University Department of Emergency Medicine. Visit the event website for details.

New England Regional Meeting is April 6

The New England (NERDS) Regional Meeting, with in-person and virtual options, will take place April 6 at the Hogan Campus Center, Worcester, MA. The in-person segment will feature a traditional poster session, lightning orals, plenary orals, innovations, and a keynote address, “Measuring Emergency Care Globally: What’s Feasible and What Truly Matters,” from Dr. Junaid Razzak, vice chair for EM research at Weill Cornell Medicine. The virtual portion of the conference will include posters, lightning orals, innovations and a keynote address from Dr. Lise Nigrovic, associate professor of pediatrics and emergency medicine at Harvard Medical School. Included with the in-person registration is access to all virtual sessions starting April 7 for 30 days. Visit the event website for more information and to register.

Future EM Physicians: Tag Us With Your Match Day News and Win Prizes!

SAEM sends good vibes and best wishes to all our medical students for Match Day 2022, and we’d like to help you celebrate with a chance to win great prizes. Just use #RAMSMatch and tag @SAEMonline and @SAEM_RAMS when you post your Match Day announcement photos and you’ll be entered to win a stethoscope or trauma shears. SAEM will randomly select and announce the two lucky winners on Match Day, March 18. May all your hopes, wishes, and matches come true. Your friends at SAEM are pulling for you!

Academy of Geriatric Emergency Medicine

Dr. Addie Burtle, Washington University in St. Louis, Wins 2021 RAMS Video Contest!

Pete Serina, MD, is an emergency medicine resident at Northwestern University Feinberg School of Medicine, Chicago. He is the Dr. Pete Serina recipient of the 20212022 Academy of Geriatric Emergency Medicine (AGEM) Advanced Research Methodology Evaluation and Design (ARMED) scholarship.

SAEM RAMS is pleased to announce that the winning video in the 2021 RAMS Video Contest was created by Addie Burtle, MD, Washington University in St. Louis. Dr. Burtle’s winning submission: “A Chance to Change Things for the Better,” hit all the right marks for theme, originality, inspirational power, and wow-factor. Congratulations Dr. Burtle and WUSL!

SAEM JOURNALS AEM Education & Training

Join us all week long March 14-18, as we celebrate this huge milestone in the lives of medical students. Then, on Friday March 18 — the big day — be sure to tune into SAEM social media. All day long we’ll be highlighting your match day announcements (tag @SAEMonline and @SAEM_RAMS and use #RAMSMatch) and posting congratulatory videos from residency program directors and chairs from around the country who will be sharing their words of wisdom and welcome to all the 2021 medical students who matched.

AGEM ARMED Scholarship Recipient Grateful for Opportunity

“Emergency medicine research is a small but growing community, and it has been exciting to meet and learn from existing leaders in the field and other course participants like myself who are just getting their careers started.

SAEM RAMS

Celebrate Match Week With SAEM and RAMS!

ACADEMY REPORTS

AEM Education & Training is Accepted into Emerging Sources Citation Index

Academic Emergency Medicine Education and Training (AEM E&T) has been accepted into the Emerging Sources Citation Index (ESCI). Part of the Web of Science Core Collection™, ESCI contains quality publications selected by expert editors for editorial rigor and best practice at a journal level. Indexing improves the visibility of the journal, provides a mark of quality, and is good for authors, as articles in ESCI-indexed journals are included in an author’s h-index calculation. Congratulations to editor-in-chief, Susan Promes and the AEM E&T Editorial Board!

“The ARMED course provides an excellent overview of the nuts and bolts necessary to design a research project and grant proposal. Coming up with a great idea is only the first step for a successful research project. Through lectures and workshops the ARMED faculty has done a wonderful job breaking down what it means to take a project from the start to finish. Your idea needs to address an important question, but it also needs to be testable and feasible. What literature already exists on the subject? What study design would best answer your question? What group would be willing to fund your research and how do you convince them that they should? And most importantly, how do you continue to ask questions that you are passionate about? “One of the most powerful lectures in the course was led by Dr. Mark Courtney, a former SAEM president and currently the

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BRIEFS AND BULLET POINTS continued from Page 59 vice chair of emergency medicine at UT Southwestern. Dr. Courtney encouraged us to self-reflect and provided the framework for creating a Personal Strategic Plan (PSP). This concept of a PSP is from the business world and was new to me. Through the framework he provided, I performed a 360 review of myself, doing a self-assessment, interviewing research mentors, coresidents, and friends. As I finish up residency and move on to my research fellowship in gerontology next year, I have used this opportunity to reflect and create a PSP with a set of actionable, sustainable goals and future steps. ARMED with this new self-awareness and a plan, I feel ready to make the most of my training program and achieve my long-term goal of becoming a physician-scientist working to understand how to improve the outcomes and experiences of older adults in the emergency department.” For more information on the ARMED course, visit the webpage.

Simulation Academy

Announcing the 2022 Simulation Fellows Forum

You are nearing the end of your simulation fellowship. You have learned all about debriefing, mastery learning, deliberate practice, how to troubleshoot the mannikin, and return on investment. You have been working on your project all year and you want to show it off and maybe get some feedback. Where do you go? To the SAEM Simulation Academy Fellows Forum! The fellows forum was started nine years ago by the SAEM Simulation Academy during Josh Hui’s tenure as the president. The idea was proposed by Michael Falk when he realized that simulation fellows needed a venue to present their research ideas and receive feedback from established faculty outside of their home institutions. Josh and Mike developed the format that is still used today, whereby fellows give short presentations of their research or innovation and the faculty provides focused feedback about the project. Feedback often relates to evaluation tool use, innovation testing, or building on work done. Fellows and attendings alike benefit from the forum

and the many opportunities for mentoring, networking, and collaboration. The Simulation Academy Fellows Forum continues to develop in response to fellows’ needs and interests. We now award prizes for the best innovation in addition to a prize for best research which reflects the significant work done to improve simulation modalities, learning, and evaluation. Projects are evaluated by a panel of simulationists who note the project’s originality, methodology, impact, and presentation quality. The numbers of fellows that present continues to grow. During the last two years, 10 people presented at each forum—an increase of five from our inaugural session. Over the last nine years, more than 50 fellows have presented their work at the forum. Projects have covered novel task trainer creation, validation and testing, novel teamwork tool evaluation, VR/ AR adaptations, and usability testing. We adapted to a videoconferencing format two years ago due to the COVIDpandemic and have benefited from a larger audience and the ability to crowdsource feedback from Simulation Academy members joining virtually. Read more about it here. The Simulation Academy Fellows Forum helps fellows to connect with the larger simulation community and hone their research ideas. It is one of the essential services we offer to the membership. Plan now to join the next Simulation Academy Fellows Forum, on Thursday May 19, 2022, in New Orleans! Stay tuned for the call for presenters coming in April. For more information email Stephanie Stapleton snstaple@bu.edu

COMMITTEE REPORTS Fellowship Approval

Fellowship Approval Program Spotlight

Sari Lahham, MD, MS, Thomas Jefferson University Fellowship Type: Telehealth Leadership

Dr. Sari Lahham

Year of completion: 2020

Q. What advice would you give to someone who is on the fence about doing a fellowship? What did you see as the cost-benefit? A. Pursue a field of massive growth. I entered telehealth when people felt it may or may not be the future. Then COVID-19 hit and almost suddenly it was the most important fellowship training one could have. Q. What was the most career-enhancing, or eye-opening thing you gained from the fellowship? A. Trial by fire. Blazing new trails and frontiers that had never been pursued before was extremely challenging and rewarding. Q. Who is best suited for this type of fellowship? A. Those who are business-minded and interested in hospital operations. For more information visit the Fellowship Approval Program webpage.

INTEREST GROUPS Accepting Applicants for 2022 Social Emergency Medicine Research Funding Award

The Social Emergency Medicine and Population Health interest group is accepting applications for a new Social Emergency Medicine Research Funding Award to support pilot studies and other formative work for junior researchers engaged in social emergency medicine. Topics in social emergency medicine that face barriers to funding through traditional sources (such as gun violence) will be considered of high potential impact for the award. Topics that combine other disciplines within emergency medicine (SIM, toxicology, ultrasound, etc.) with social emergency medicine principles and objectives are also encouraged. Deadline to apply is March 31, 2022.

Last Call for Submissions for Rakesh Engineer Award

Did you have an implementation science abstract recently accepted to the SAEM Annual Meeting? The EvidenceBased Healthcare and Implementation Interest Group is seeking submissions

of accepted abstracts that are focused on implementation science for the first annual Rakesh Engineer Award! This award honors the late Dr. Rakesh Engineer, who was passionate about implementation methodology and bringing science to the bedside. Accepted abstracts are eligible if they are focused on a project or study that evaluates the implementation, or deimplementation, of a process that leads to an evidence-based improvement in patient care. Written abstracts will be judged by members of the EvidenceBased Healthcare and Implementation Interest Group and the top 3 finalists will be judged live at SAEM22. Click here for more information.

IN OTHER NEWS AACEM, SAEM, ACEP, AAEM Publish 2030 Strategic Goals for EM Research

To support the specialty of emergency medicine’s mission to continuously create new knowledge that will improve patient care and outcomes, the Association of

Academic Chairs of Emergency Medicine (AACEM) Research Task Force developed and published a set of 2030 strategic goals for the EM research enterprise. These goals have been endorsed by the AACEM Executive Committee and the boards of Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), and American Academy of Emergency Medicine (AAEM). Follow the progress of these goals by bookmarking and visiting the task force dashboard.

ABEM Releases Two Additional MyEMCert Modules

Two additional MyEMCert modules were released in early February by the American Board of Emergency Medicine (ABEM): 1) head and neck and 2) nontraumatic musculoskeletal. With the release of these two new modules, ABEM-certified physicians can now choose from eight different MyEMCert module topics. Additionally, new Teaching Points are available with the two new modules and can be used to focus areas of study and preparation. ABEM recommends reviewing these

prior to taking the head and neck and nontraumatic musculoskeletal modules.

CME is Now Available for Completing MyEMCert Modules You can now opt to obtain nine AMA PRA Category 1 Credits™ for successfully completing each of ABEM’s MyEMCert modules. The distributions of specialty credits in pediatrics, stroke, and trauma have also been determined. The cost of the credits is $30 and the credits are provided by either AAEM or ACEP. You must register for the credits before taking a module; credits cannot be awarded retroactively. ABEM’s MyEMCert modules are the alternative to the high-stakes, single point-in-time, traditional recertification exam and the ongoing lifelong learning and self-assessment reading lists and associated tests. MyEMCert modules were designed with the uniqueness of emergency medicine in mind and are informed by the preferences and feedback of ABEM-certified physicians.

SAEM FOUNDATION Attention Academic EM Department Chairs: It’s Almost Time for the Chairs’ Challenge Each year, our AACEM/AAAEM Annual Retreat in March kicks off this important Challenge that raises vital funds to help strengthen the pipeline of EM researchers who will advance this specialty in the future. Browse our SAEMF Donor Guide to learn about SAEMF impact, our researchers and the work they are doing, and how you can join your colleagues in supporting a bold vision for EM research. Then donate today to join the Annual Alliance. Since 2019, you and generous AACEM members have raised over $276,836 to support your own researchers and educators through SAEMF’s grants. The Challenge has resulted in a vibrant annual funding campaign which has led to SAEMF awarding nearly $800,000 back to your departments. Last year, you raised over $113,000 and had the most participation since the Challenge began…

2022 is the year to turn the Challenge map green by achieving 100% participation from AACEM Chairs in each state!

Why wait until March? Pledge or donate $1,000 today! www.saem.org/donate or email Julie Wolfe at jwolfe@saem.org Not sure you've donated yet? Check the Donor list. In 2021 the states on the left, highlighted in green, had 100% of their Chairs participate in our Chairs’ Challenge. Let’s turn the map green this year!

ACADEMIC ANNOUNCEMENTS Dr. Tania Strout Promoted to Professor of EM at Tufts University School of Medicine

Dr. Samuel Francis Receives Duke Strong Start Award

Tania D. Strout, PhD, RN, MS, was recently promoted to professor of emergency medicine at the Tufts University School of Medicine. Dr. Strout is the director of research in the department of emergency medicine at Maine Medical Center. She has been highly engaged with research, Dr. Tania D. Strout education, and quality improvement activities, serving on many departmental, institutional, medical school and national committees. In addition to her administrative and educational responsibilities, Dr. Strout’s scholarship has focused on areas such as expanding access to medications to treat opioid use disorder in the emergency department, uncertainty tolerance in medicine, professional burnout and health care workforce issues, diversity in academic medicine, integrating palliative medicine in the emergency setting, triage systems, and youth bullying.

Samuel Francis, MD, assistant professor of emergency medicine, has been awarded the Duke Strong Start award. This threeyear career development award identifies promising laboratory-based physician scientists and provides mentorship and training to facilitate their transition to Dr. Samuel Francis research independence. A prior recipient of the SAEM Research Training Grant, Dr. Francis will investigate the mechanisms underlying platelet marker heterogeneity in both healthy donor and disease states under the tutelage of Gowthami Arepally, MD, professor of medicine and pathology in the Duke Division of Hematology.

Dr. Michael Pulia Awarded $2.4 Million Grant to Study Impact of COVID-19 on Antibiotic Prescribing and Bacterial Resistance Michael Pulia, MD, MS, assistant professor and director of the emergency care for infectious diseases research program in the department of emergency medicine at the University of Wisconsin-Madison, was awarded a $2.4 million R01 grant from the Agency for Healthcare Research and Dr. Michael Pulia Quality to examine the impact of COVID-19 on antibiotic prescribing and bacterial resistance patterns in the acute care setting and develop an implementation toolkit highlighting strategies to enhance antibiotic stewardship resiliency during operational upheaval.

Dr. Pappal Recipient of 2022 ACEP/EMRA National Outstanding Medical Student Award Ryan Pappal, a fourth-year student at Washington University School of Medicine in St. Louis, has been selected to receive a 2022 ACEP/EMRA National Outstanding Medical Student Award. The award recognizes fourth year emergency medicine-bound medical students who Ryan Pappal excel in humanism/professionalism, leadership/service to medical organizations, community service, research, and academic excellence. Ryan is the 2021-2022 medical student representative on the SAEM RAMS (Resident and Medical Student) Board.

Dr. Sreeja Natesan Promoted to Associate Professor Sree Natesan, MD, was promoted to associate professor at Duke University. She serves as associate program director, faculty within Duke School of Medicine, and cofounded the Duke GME Medical Education Leadership Track, a longitudinal multispecialty resident/fellow as teachers Dr. Sree Natesan program. Dr. Natesan is dedicated to advancing justice, diversity, equity, and inclusion (JEDI). She cofounded the Duke Emergency Medicine JEDI committee, leads monthly community outreach, and works on institutional and national committees for the advancement of diversity and education.

Dr. Christy Hopkins Named Interim Chair of New EM Academic Department at University of Utah Christy Hopkins, MD, MPH, MBA, an associate professor in the department of emergency medicine, has been appointed interim chair of new emergency medicine academic department at the University of Utah’s Spencer Fox Eccles School of Dr. Christy Hopkins Medicine. Dr. Hopkins joined University of Utah faculty in 2002 and was appointed medical director for clinical services in 2004. Since that time, she has also assumed the role of chief value officer and medical director of integrated emergency services. Dr. Hopkins is known for her collaborative leadership, administrative expertise, and commitment to education, service, diversity, and research. She is a current member of the 2022 SAEM/ Association of Academic Chairs of Emergency Medicine Chair Development Program (AACEM CDP).

Dr. Hassan Mohamed Appointed Assistant Director of Quality and Patient Safety for the Columbia Department of EM Hassan Mohamed, MD, has been appointed assistant director of quality and patient safety for the Columbia University Department of Emergency Medicine. Dr. Mohamed has been an assistant professor of emergency medicine at Columbia since Dr. Hassan Mohamed 2019, leading the morbidity and mortality sessions for the emergency medicine residency conference and working on multiple quality initiatives and operational improvement processes for the emergency department sites.

Dr. Joan Bregstein Promoted to Professor at Columbia University Vagelos College of Physicians and Surgeons Joan Bregstein, MD, has been promoted to the rank of professor of emergency medicine at Columbia University. Dr. Bregstein has been pediatric emergency medicine faculty at Columbia University for over 27 years, serves on numerous Dr. Joan Bregstein committees, and teaches and mentors learners at all levels. As chair of the Department of Emergency Medicine Committee on Appointments and Promotions, Dr. Bregstein has mentored many faculty to promotions. She has been active in community and public health initiatives including an annual health fair for neighboring public school children, voter registration, and COVID-19 vaccination efforts.

Emergency Medicine Achieves Department Status at University of Utah School of Medicine Emergency medicine is the newest department at the University of Utah’s Spencer Fox Eccles School of Medicine. Previously a division within the Department of Surgery, the Department of Emergency Medicine becomes the 23rd department in the school. To transition from division to department status, Emergency Medicine successfully achieved specific requirements in education, research, and clinical care, and received formal approvals from the University of Utah School of Medicine Executive Committee, the academic senate, and the university’s board of trustees.

Dr. Helen Ouyang Promoted to Associate Professor at Columbia University Helen Ouyang, MD, MPH, has been promoted to the rank of associate professor of emergency medicine at Columbia University. Dr. Ouyang’s academic focus has been in narrative medicine, medical journalism, and global health, publishing numerous publications in high profile print Dr. Helen Ouyang media. Her New York Times article, The City Losing Its Children to H.I.V., supported by a grant from The Pulitzer Center, was selected for The Best American Science and Nature Writing and was a National Magazine Award Finalist.

Dr. Rishi Goyal Promoted to Associate Professor at Columbia University Rishi Goyal, MD, PhD, has been promoted to the rank of Associate Professor of Emergency Medicine at Columbia University. With a PhD in English and Comparative Literature, his academic focus is in narrative medicine, holding appointments in EM and at the Dr. Rishi Goyal undergraduate campus as the Founding Director of the Medical Humanities undergraduate major in the Institute for Comparative Literature and Society in the Columbia College of Arts and Sciences.

SAEM's Melissa McMillian Earns Certified Association Executive Credential Melissa McMillian, CAE, CNP, SAEM Sr. Director of Foundation and Business Development, on achieving her Certified Association Executive (CAE) designation. The CAE is the highest professional credential in the association industry. Melissa McMillian Less than five percent of all association professionals have achieved this mark of excellence. The CAE is awarded by the American Society of Association Executives (ASAE). All those with the CAE designation have fulfilled prescribed standards (including education, professional development, and years in association leadership positions), passed a rigorous examination on all association management domains, pledged to uphold the ASAE's Standards of Conduct, and are committed to ongoing professional development in the practice of association management.

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, 2022 for the May-June 2022 issue.

NOW HIRING POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES! Accepting ads for our “Now Hiring” section! Deadline for the next issue of SAEM Pulse is April 1. For specs and pricing, visit the SAEM Pulse advertising webpage.

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

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

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

Envision Physician Services is currently featuring a number of emergency medicine leadership and staff positions at highly desirable facilities across the nation. Emergency Medicine Physicians Choose Envision Because… We provide the support our teammates need to experience an exceptional quality of practice while focusing on what matters most—caring for patients. Diverse practice environments in attractive locations nationwide Competitive compensation and benefits Physician-led practices and collaborative work environments

Flexible scheduling Career development and leadership opportunities Comprehensive physician wellness support

Visit booth 213 at SAEM22, May 10-12, to learn how you can advance your career with Envision.

Ready to learn more? Contact our experienced recruiters today!

847.908.9524 EVPS.com/SAEM

Emergency Medicine Vice Chair of Research University of Kansas Health System, Kansas City, KS

Seeking a Vice Chair of Research as an integral member of a growing emergency medicine program.

About our institution:

The University of Kansas Health System • Quaternary care center • Greater than 63,000 patient ED visits per year • Certified STEMI & Advanced Cardiac Care center • Advanced Comprehensive Stroke Center • Nationally certified adult and pediatric burn center • Nationally certified Poison Control Center • ED expansion scheduled to be completed in 2023 The University of Kansas Medical School • Sole academic medical center in the state serving over 800 medical students and over 3,500 students across all disciplines • Over $50 million in NIH-funded research • Opportunities for paid teaching positions in newly-redesigned medical school curriculum, including in small-group facilitation and simulation TUKHS Emergency Department • Dynamic, award-winning faculty • Emergency Medicine Residency Program (30 residents) • Nationally recognized Emergency Nursing • Fellowships in Education, Administration and Ultrasound • Plans for future fellowship in EMS We are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disability status, or genetic information.

Responsibilities to include:

• Growth and vitality of emergency care research including, but not limited to, clinical research, health services and medical education • Advance the national reputation of the department by means of research excellence and securing of departmental NIH, other federal research support and industry support • Clinical shifts in the emergency department • Clinical and/or didactic teaching of medical students and residents • Possess the ability to work across disciplines within a large, diverse organization

Position compensation and incentives:

• Highly competitive salary • Industry-leading benefits and retirement • Collaborative and supportive multi- disciplinary environment.

Qualified candidates must have:

• PhD, MD or DO designation • MD or DO must be BC/BE in emergency medicine • PhD must have secured extramural funding source

Please send inquiries to:

Chad Cannon, MD Professor & Chair, Department of Emergency Medicine The University of Kansas Health System Email : ccannon@kumc.edu Or apply online at : https://kumc.wd5.myworkdayjobs.com/kumcjobs/job/Kansas-City-Metro-Area/Emergency-Medicine-Vice-Chair-of-Research_JR000867-1

NEW CAREER OPPORTUNITIES IN ACADEMIC MEDICINE

We’re focused on shaping the future of emergency medicine and we need strong Academic Physicians to lead-the-way. Join the team at one of our academic medical centers across the nation!

Join our team

teamhealth.com/join or call 877.650.1218

Penn State Health Emergency Medicine About Us: Penn State Health is a multi-hospital health system serving patients and communities across 29 counties in central Pennsylvania. The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Children’s Hospital, and Penn State Cancer Institute based in Hershey, PA; Penn State Health Holy Spirit Medical Center in Camp Hill, PA; Penn State Health St. Joseph Medical Center in Reading, PA; and more than 2,300 physicians and direct care providers at more than 125 medical office locations. Additionally, the system jointly operates various health care providers, including Penn State JOIN OUR TEAM Health Rehabilitation Hospital, Hershey Outpatient Surgery Center, Hershey Endoscopy Center, Horizon Home Healthcare and Pennsylvania Psychiatric Institute. EMERGENCY MEDICINE OPPORTUNITIES In December 2017, Penn State Health partnered with Highmark Health to facilitate creation of a value-based, AVAILABLE community care network in the region. Penn State Health shares an integrated strategic plan and operations with Penn State College of Medicine, the university’s medical school. We foster a collaborative environment rich with diversity, share a passion for patient care, and have a space for those who share our spark of innovative research interests. Our health system is expanding and we have opportunities in both an academic hospital as well community hospital settings.

Benefit highlights include: • Competitive salary with sign-on bonus • Comprehensive benefits and retirement package • Relocation assistance & CME allowance • Attractive neighborhoods in scenic Central Pennsylvania

FOR MORE INFORMATION PLEASE CONTACT: Heather Peffley, PHR CPRP - Penn State Health Physician Recruiter

hpeffley@pennstatehealth.psu.edu

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person’s perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.

You’re a human, not a superhero. It’s okay to need help. #StopTheStigmaEM

SAEM Pulse March-April 2022

Articles inside

Now Hiring

Academic Announcements

21 Preview

Join the SAEMF Annual Alliance Today

Women In Academic EM Charting Your Course for Leadership

Diversity & Inclusion Transition from Trainee to Faculty

The Experiences and Challenges of EM-Bound International Medical Graduates

Preparing for the Next Pandemic, Today: A Call to Action

Briefs and Bullet Points

Geriatric EM Ageism in the Emergency Department