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
Edwina Zaccardo
Ext. 216, ezaccardo@saem.org
Director, IT
Anthony Macalindong
Ext. 217, amacalindong@saem.org
Specialist, IT Support
Dawud Lawson
Ext. 225, dlawson@saem.org
Director, Governance
Erin Campo
Ext. 201, ecampo@saem.org
Manager, Governance
Juana Vazquez
Ext. 228, jvazquez@saem.org
Director, Communications & Publications
Laura Giblin
Ext. 219, lgiblin@saem.org
Sr. Manager, Communications & Publications
Stacey Roseen
Ext. 207, sroseen@saem.org
Manager, Digital Marketing & Communications
Raf Rokita
Ext. 244, rrokita@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, Educational Course Development
Kayla Belec Roseen Ext. 206, kbelec@saem.org
Manager, Exhibits and Sponsorships
Bill Schmitt Ext. 204, wschmitt@saem.org
Director, Membership & Meetings
Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org
Sr. Manager, Membership
George Greaves Ext. 211, ggreaves@saem.org
Sr. Manager, Education
Andrea Ray Ext. 214, aray@saem.org
Sr. Coordinator, Membership & Meetings
Monica Bell, CMP Ext. 202, mbell@saem.org
Specialist, Membership Recruitment
Krystle Ansay Ext. 239, kansay@saem.org
Meeting Planner
Kar Corlew Ext. 218, kcorlew@saem.org
AEM Editor in Chief
Jeffrey Kline, MD AEMEditor@saem.org
AEM E&T Editor in Chief
Susan Promes, MD AEMETeditor@saem.org
AEM/AEM E&T Peer Review Coordinator
Taylor Bowen tbowen@saem.org aem@saem.org aemet@saem.org
Angela M. Mills, MD President
Columbia University, Vagelos College of Physicians and Surgeons
Wendy C. Coates, MD President Elect
Los Angeles County HarborUCLA Medical Center
Members-at-Large
Pooja Agrawal, MD, MPH
Yale University School of Medicine
Jeffrey P. Druck, MD
University of Colorado School of Medicine
Julianna J. Jung, MD
Johns Hopkins University School of Medicine
Michelle D. Lall, MD, MHS Emory University
Ali S. Raja, MD, MBA, MPH Secretary Treasurer Massachusetts General Hospital / Harvard Medical School
Amy H. Kaji, MD, PhD
Immediate Past President Harbor-UCLA Medical Center
Ava E. Pierce, MD UT Southwestern Medical Center, Dallas
Jody A. Vogel, MD, MSc, MSW Stanford University Department of Emergency Medicine
Resident Member
Wendy W. Sun, MD Yale University School of Medicine
3 President’s Comments
SAEM’s 2023 Strategic Plan: Shaping the Future Science, Education, and Practice of Emergency Medicine
4 Spotlight
The SAEM Annual Meeting: Where Education and Science Converge – An Interview With SAEM23 Program Chair Ryan L. LaFollette, MD
8-17
18 Administration & Operations
Health Equity Dashboards: A Key Driver Toward Equitable Patient Care
20 Diversity & Inclusion
The Impact of COVID-19 on Communication in the Health Care Setting for People With Disabilities
22 DEI Perspective
Reflections from the Twilight Zone: Navigating Medicine as a Nonbinary Medical Student
24 Education Hackschooling Residency Education
26 Ethics in Action A Difficult Foley
28 Geriatric EM Increasing Use of Cannabis Among Older Adults in the U.S. and Canada
30 Global EM
EMS Development in Low- and Middle-Income Countries: Considerations for Improving Education Internationally
33 Global EM
Tigray, Ethiopia: The War May be Ending but the Challenges Facing Humanitarian Responders Are Immense
36 Innovation
The Power and Beauty of Design Thinking: 5 stages
42
The Challenges and Rewards of Creating Something Worthwhile
44 Research
Changing Practice in the Hospital Setting: A Tale of Two Teams
46
48 Sex & Gender in EM
50
54 Wellness
Moral Injury: What It Is and What We Can Do About It
58 Wellness
#StopTheStigmaEM: A Call to Action for EM Leaders
60 SAEMF Annual Alliance Donors Make Big Things Happen!
61 Why join the Annual Alliance?
62 Expressing Gratitude to the 2023 Annual Alliance and Legacy Society Donors
66 SAEMF Chairs' Challenge and Vice Chairs' Challenge
66 Briefs & Bullet Points
- SAEM News - SAEM Foundation
- Regional Meetings - SAEM RAMS
68 SAEM Reports
- Academy News: CDEM
Each January the SAEM Board of Directors convenes to finalize the annual strategies that will continue to move our SAEM Strategic Plan forward. These strategies are developed based on a compilation of meetings with members, mega issue discussions at the Board level, and multiyear plans that were previously developed. Goals and objectives have been developed to meet our SAEM mission (“To lead the advancement of academic emergency medicine through education, research, and professional development.”) and the SAEM Board works on specific strategies with measurable outcomes to meet these goals and objectives. In this article I will share several of these strategies to highlight some of the amazing work our members and staff will be engaging in this year.
In alignment with SAEM’s standing as the premier organization for academic emergency medicine (EM) educational resources for both medical educators and learners, our 2023 strategies include launching a brand new, innovative faculty development cohort course, the SAEM Master Educators, which addresses core principles of medical education not covered in our other education-related courses. Last year the Emerging Leader Development (eLEAD) program was introduced, providing leaders in academic EM with a structured, longitudinal, year-long experience to develop foundational leadership skills, cultivate a meaningful career network, and build a bridge to countless opportunities in their field. This inaugural year will be evaluated with the second year being launched in
May at SAEM23. Speaking of our annual meeting, this event encompasses another significant annual strategy with attendance of well over 3,000 members and packed with incredible educational content and cutting-edge research.
Our SAEM research goal is to increase the impact, productivity, implementation, and visibility across the spectrum of emergency care research. Strategies include enhanced collaboration with the National Institutes of Health (NIH) on the goals and objectives of the Office of Emergency Care Research, as well as collaboration with other federal funding agencies, to promote networking, increased funding for our specialty, and enhanced funding strategies for our members. Additional strategies include assisting the SAEM Foundation in fundraising and grant funding for our members, making the largest research investment in academic EM’s future, and strengthening the Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) program, which addresses best practices for common chief complaints based on evidence-based research and expert consensus.
SAEM strives to be an essential contributor to the personal and professional development of the academic EM community. Our professional development and support strategies include expansion and promotion of an online comprehensive DEI curriculum, promotion of mental health awareness to our members and the EM
community through continuation of the Stop the Stigma EM campaign, review and analysis of the membership survey, and development of an SAEM member recruitment and retention plan for our diverse faculty, residents, and students.
A new pillar for workforce development was added to the strategic plan last year specifically to define the evolving landscape and workforce of academic EM to address where SAEM can uniquely support dynamic changes in the workforce. Annual strategies for workforce include developing a comprehensive needs assessment to identify and inform best practices to attract talented and diverse students to EM that encompass the spectrum of academic practice.
SAEM is shaping the future science, education, and practice of emergency medicine. The amount of content being produced by our members and staff through our academies, committees, and interest groups is tremendous. I am excited to see the outcomes of the annual strategies and grateful for the great work by all of you to improve patient care, educate and mentor our learners, and produce impactful scholarship and research discovery to advance emergency care.
ABOUT DR. MILLS: Angela M. Mills, MD, is the J. E. Beaumont professor and chair of the department of emergency medicine at Columbia University Vagelos College of Physicians & Surgeons and chief of emergency services for NewYorkPresbyterian –Columbia
Ryan L. LaFollette, MD, is associate professor of clinical emergency medicine and assistant residency program director for the University of Cincinnati College of Medicine. He also serves as a Cincinnati SWAT physician and is a flight physician with University of Cincinnati’s Air Care.
A native of New York, from a town just outside of Syracuse, Dr. LaFollette completed his medical training at Upstate Medical University followed by residency at the University of Cincinnati where he served as chief resident in the Class of 2016.
In addition to serving as the coeditor of the FOAMed site TamingtheSRU.com, Dr. LaFollette is actively involved with SAEM, having served previously on the SAEM Awards Committee, SAEM Education Committee, and as chair of the SAEM Virtual Presence Committee. He presently chairs the SAEM Annual Meeting Program Committee, on which he previously served as chair of the didactics subcommittee as well as in the Medical Student Ambassador (MSA) program.
Tell us a little about your journey to becoming SAEM annual meeting program committee chair. What led you to this point?
My introduction into SAEM follows a similar path as many of my colleagues. I was brought into the organization during my second year of residency by one of my attendings, Andra Blomkalns, a former SAEM Program Committee Chair and an SAEM past president. Early in my SAEM career, while working with and developing the Medical Student Ambassador (MSA) program, I was exposed to excellent mentors like Drs. Gillian Beauchamp and Ali Raja. After handing the MSA program off to the talented Dr. Riley Grosso, I chaired the SAEM Program Committee Didactics Subcommittee for several years before assuming my current role as program committee cair. I have also been privileged to serve on the SAEM Awards Committee, SAEM Education Committee, and as chair of the SAEM Virtual Presence Committee, during which I led the expansion of streaming options for the annual meeting.
What does serving as the annual meeting program committee chair mean to you?
I continue to be humbled by the talent and dedication of SAEM Program Committee members and staff who make this amazing meeting happen. The opportunity to work with a group of people from around the country dedicated to making our annual meeting a first-rate experience has been a highlight. I love being a part of helping the leaders in our organization find the best ways to showcase the work that SAEM members do all year long.
What unique qualities do you bring to the table as the annual meeting program committee chair?
The integration of science and educational content is a hallmark of the SAEM Annual Meeting and the focus on delivering both
education and clinical science is a unique characteristic that sets SAEM apart. As an assistant program director and FOAMed curator, I am happy to bring my educational lens to that intersection. The work our members do all year is so impressive and I hope I can help ensure that everyone has an opportunity to engage with our members in the most effective way possible.
What excites you the most about this year’s event? What are you most looking forward to at SAEM23?
We have just selected our keynote speakers and I have to say I am very excited! They represent an exciting cross-section of our specialty and what it will become. Dr. Jane Scott will kick off our plenary presentations with the Dr. Peter Rosen Memorial Keynote Address and Dr. Susan Promes will deliver our Wednesday Medical Education Keynote. With so many of our academy and RAMS events spread out across Austin, I am also excited for people to have the opportunity to explore this amazing city. Lastly, I am excited that we can include parents more wholly during this year’s meeting with our Onsite Childcare/Day Camp. (If you’re interested, register by March 14!)
How will you personally measure the success of SAEM23?
I am excited by the successes we have already had in preparing for the meeting! This year we received a record number of didactics, IGNITE!, and innovations submissions, which makes me hopeful that we might break attendance and engagement records as well. I am excited to meet members who have never attended an SAEM Annual Meeting, learn what engages them the most and how we can continue this momentum into Phoenix in 2024!
continued on Page 6
Dr. LaFollette teaching morning report to Isaac Shaw, MD at the beginning of a clinical shift“The integration of science and educational content is a hallmark of the SAEM Annual Meeting and the focus on delivering both education and clinical science is a unique characteristic that sets SAEM apart.”
continued from Page 5
I’m sure you’ve attended other conferences throughout your career; what makes the SAEM Annual Meeting stand out from the rest?
The level of presentation at the SAEM Annual Meeting is what sets it apart. There is no question in my mind that if you walk into a room at SAEM23 there will be something to be gained whether you are a medical student or a senior faculty. There are more opportunities to network at the SAEM Annual Meeting than at any conference I have been to. Our meeting combines all the benefits of a large conference with the intimacy of a community. And this community comes to our annual meeting with an eye toward connecting, networking, and building the next generation of academic leaders. You can’t get that at any other conference.
Why is the SAEM Annual Meeting a “must-attend” event of the year for academic EM professionals and what can they expect to take away from this event?
The SAEM Annual Meeting is a must-attend event for the people who comprise academic EM. You can read the articles and practice the medicine all year, but to engage with the authors who wrote the articles and interact with colleagues across the academic spectrum comes but once a year and this year it will be in May in Austin. Everyone, no matter at what level of their career, should expect to take away a new mentor or mentee, research idea, and very full mind (and belly).
What is your advice to first-time attendees for making the most of SAEM23?
Come prepared! On your drive/flight/uber to the meeting, review the program planner, pick out workshops, didactics, abstracts, and events that are interesting to YOU and add them to your program planner schedule and app. Don’t just attend what your colleagues or friends are attending but build a schedule full of things that fit your vision of the clinician/ educator/researcher you want to be. Attend a session or event led by a presenter you’ve been interested to meet and chat with. All our faculty and presenters are open and interested to talk to you about how their work can connect with yours. And stop by dodgeball, as it will give you a new and enduring view of the skillset of the SAEM Board of Directors!
What makes Austin such a great city for this year’s annual meeting?
Whether you like country music and live music shows or are a blasphemous northerner like myself and enjoy coffee and microbreweries, you’ll find it all in this friendly, vibrant, up and coming city. Be sure to check out the bats at sunset on the
“Our meeting combines all the benefits of a large conference with the intimacy of a community.”
Congress Avenue bridge, take a run on the boardwalk of Lady Bird Lake, and see a show at one of the 250 live music venues.
SAEM is making great strides in addressing issues related to DEI. How does this come into play in a lasting way at the SAEM Annual Meeting?
We continue to take strides in diversity, equity, and inclusion along with the SAEM Board and other SAEM academies and committees by acknowledging bias and studying the makeup of
those delivering the content as well as those grading it. We have taken steps to ensure the diversity of our plenaries and sessions reflect that of our society and have reallocated spaces to ensure that everyone who wants a seat in a meeting has one. Also by making sure the next generation of leaders—our medical student ambassadors—have the opportunity to be exposed to SAEM and its leaders through the awarding of a SAEM RAMS Diversity and Inclusion MSA Scholarship.
Name three people, living or deceased, whom you would invite to your dream dinner party.
1. Chef and travel documentarian Anthony Bourdain for his attitude toward engaging and appreciating others
2. Landscape photographer Ansel Adams for his technical gifts and efforts to share a vision of wilderness with another generation
3. My grandmother for her love of travel and people
What's the one thing few people know about you?
I am a lifelong vegetarian and have never eaten meat — and I am still alive 36 years later! (Although I am also a living warning that healthy eating and vegetarianism are two circles of a Venn diagram that do not entirely overlap!)
What is your guiltiest pleasure (book, movie, music, show, food, etc.)? Running. It takes time away from many things I should be doing — but it cannot be replaced!
Please complete these three sentences: In high school I was voted… most spirited. I wish I was kidding. A song you’ll find me singing in the shower is… No songs, but I appreciate how waterproof the iPhone is because that is quality audiobook time.
Just as music is a huge part of Austin's DNA, education and research are part of SAEM’s strong legacy and what makes our annual meeting THE premier event in academic emergency medicine. We invite you to create an SAEM23 soundtrack that’s all your own, by compiling a playlist from hundreds of sessions, including:
• More than a dozen half- and full-day workshops that aim to strengthen knowledge and skills in specific topic areas
• Dynamic didactics from the best minds in academic EM
• High-quality, cutting-edge research
• Ground-breaking, practice-changing plenary sessions
• Two keynote addresses by renowned speaker-influencers
• Focused educational forums that offer something for everyone, from seasoned faculty to medical students just starting their careers
• Educational and gamified experiential learning competitions like SimWARs and Sonogames®
SAEM annual meetings are renowned for the expansive networking events and career development opportunities they offer. Connect in person with your contemporaries and 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.
SAEM is excited to announce that our emergency medicine pharmacy colleagues will in the house with us for the EMPoweRx (Emergency Medicine Pharmacotherapy with Resuscitation) Conference — a hybrid conference that presenting the latest resuscitation, emergency medicine pharmacotherapy, and administrative issues that are unique to the ED.
We like to think of SAEM as a family, and in that spirit we are providing family-centric annual meeting services such as on-
site childcare (sign up ends March 14!) and a private “family room” equipped with everything to meet the needs of baby and parent(s).
Once you've eaten your weight in barbecue, heard a band that's this close to blowing up, and slammed a Lone Star or two at the city’s hottest honky tonks, you’ll understand why Austin is not only one of America’s the fastest-growing and best cities to visit, it’s also the perfect place to hold an annual meeting that promises to be as big-hearted and boast-worthy as the state of Texas.
The Lone Star State's shining capital is waiting with open arms to welcome you and so are we! On behalf of the Program Committee and SAEM leadership, we can’t wait to see you in Austin!
Register by March 14 to secure your early bird discount!
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 SAEM23 Program Committee is pleased to announce the top eight abstracts selected to be presented during special plenary sessions to be held immediately following the keynote addresses on Wednesday and Thursday. These eight abstracts were chosen as the best from among 1200+ submissions.
Wednesday, May 17, 10:00 AM – 11:00 AM CT
1. Erector Spinae Plane Block for Low Back Pain Reduces Pain and May Reduce Opioid Consumption
Andrew Wayment, Robert Steele, Jacob Avila, Ryan Itoh
2. Emergency Medical Treatment and Labor Act Citations for Failure to Accept Appropriate Transfer, 2011-2022
Jasmeen Randhawa, Genevieve Santillanes, Sameer Ahmed, Zachary Reichert, Katie Hawk, Sarah Axeen, Jesse Pines, Seth Seabury, Michael Menchine, Sophie Terp
3. Emergency Medicine Workforce Attrition Differences by Age and Gender
Cameron Gettel, D Mark Courtney, Pooja Agrawal, Tracy Madsen, Arjun Venkatesh
4. Derivation of a Clinical Decision Rule to Guide Neuroimaging in Older Adults Who Have Fallen
Kerstin de Wit, Mathew Mercuri, Natasha Clayton, Éric Mercier, Judy Morris, Rebecca Jeanmonod, Debra Eagles, Catherine Varner, David Barbic, Ian Buchanan, Mariyam Ali, Yoan Kagoma, Ashkan Shoamanesh, Paul Engels, Sunjay Sharma, Andrew Worster, Shelley McLeod, Marcel Émond, Ian Stiell, Alexandra Papaioannou, Sameer Parpia View full abstracts.
Jane Scott, ScD, MSN, renowned and respected for her work as a leader in emergency medicine research funding and training, will present the SAEM23 Dr. Peter Rosen Memorial Keynote Address, “Advancing Emergency Care Research: Reflecting on Our Past, Looking to Our Future,” from 9:30-10 a.m. on Wednesday, May 17 during the SAEM23 opening session.
Dr. Scott began her career in the emergency care setting as a staff nurse at the Duke University Emergency Department and then as a nurse practitioner at the Johns Hopkins adult emergency department. She presented her first research abstract in 1981 at the University Association of Emergency Medicine meeting, which was followed by numerous emergency care publications. After obtaining a doctorate from Hopkins School of Public Health, Dr. Scott joined the Agency for Healthcare Research and Quality (AHRQ) as a program officer providing oversight to federally funded prehospital and ED studies. In 1995 she joined the University of Maryland National Study Center for Trauma and EMS followed by serving as research director of the program in trauma at the R Adams Cowley Shock Trauma Center. In 2005 Dr. Scott joined the National Institutes of Health (NIH) as director of the Office of Research Training and Career Development, Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI). In 2008 she created the NHLBI K12 program in emergency care research, which she managed until her retirement, working extensively with the emergency medicine researchers at the eight training programs that have trained over 50 K12 scholars.
Dr. Scott has served on the SAEM Research Committee, ACEP-SAEM Federal Research Funding Workgroup, and as faculty at the EMF-SAEMF Grantee Workshop for over eight years. She has educated and mentored countless SAEM members on the K12 programs, presented at numerous SAEM annual meetings, worked closely with program officers on NIH-related matters, and taught many of our investigators how to become independently funded
Susan Promes, MD, MBA, editorin-chief of Academic Emergency Medicine Education and Training journal, and a recognized leader in emergency medicine education, with 25 years of experience, will present the SAEM23 Education Keynote Address, “Perspectives in Medical Education: Past Experiences, Future Possibilities,” on Thursday, May 18 from 9:30-10 a.m.
Dr. Promes is a tenured professor at Penn State University Milton S. Hershey Medical Center and has served as chair of the Department of Emergency Medicine since 2014. Prior to 2014, she spent seven years at the University of California San Francisco (UCSF) where she served as vice chair for education, emergency medicine residency program director, and director of curricular affairs in the graduate medical education office. Additionally, Dr. Promes was the inaugural emergency medicine residency program pirector at Duke University and director of the medical school capstone course.
Promes, a graduate of Washington University in St. Louis, Mo., earned her medical degree from Penn State College of Medicine and did her residency training at Alameda County Medical Center, Highland General Hospital where she served as chief resident.
She is course director for the American College of Emergency Physicians Teaching Fellowship and the inaugural editor-in-chief of Academic Emergency Medicine Education and Training, a journal dedicated to medical education scholarship in emergency medicine which debuted in 2017.
Her scholarly work has centered around topics germane to emergency medicine medical education and clinical guidelines for the practicing emergency physician. In addition to many peer review publications, she has edited multiple McGraw Hill board review books to prepare physicians for the emergency medicine board exam.
An internationally recognized leader in academic EM, Dr. Promes has received numerous awards and honors for excellence in teaching, leadership, and service. She is a graduate of the UCSF Teaching Scholars Program, a member of the UCSF Academy of Medical Educators, and the recipient of the Academy’s Teaching Excellence Award. In 2020 she received the SAEM Hal Jayne Excellence in Education Award and is also the recipient of the Accreditation Council for Graduate Medical Education (ACGME) Courage to Teach Award.
Thursday, May 18, 10:00 AM – 11:00 AM CT
5. Emergency Medicine Bound Fourth-Year Medical Student Performance on a Standardized Substance Use Disorder Patient Case
Tomohiro Ko, Amanda Esposito, Brennan Cook, Archana Pradhan
6. Facilitating Adaptive Expertise in Learning Computed Tomography: A Multicenter Randomized Controlled Trial
Leonardo Aliaga, Rebecca Bavolek, Benjamin Cooper, Amy Mariorenzi, James Ahn, Aaron Kraut, David Duong, Michael Gisondi
7. Geographic Distribution of Emergency Residency Training in Medically Underserved Areas and Current Practice
Mary Haas, Laura Hopson, Caroline Kayko, John Burkhardt
8. Data-Driven Learning: Understanding How Medical Students Utilize a Data Dashboard
Daniel Owens, David Scudder, Wendy Christensen, Rachael Tan, Tai Lockspeiser View full abstracts.
SAEM Annual Meeting abstracts represent the work of thousands of researchers and educators who have created new knowledge and thinking about emergency care that adds valuable confirmation of previous work, presents evidence that might change the practice of EM emergency medicine for the better, and elevates the outcomes and experiences of every patient who seeks emergency medical care. Collectively they reflect a global experience of emergency care that together tell the story of important challenges and the need for more knowledge.
· Plenaries, May 17 and 18, 2023
· Orals, May 17 and 18, 2023
· Lightning Orals, May 17-19,
· ePosters, May 17-19, 2023
Advanced EM Workshop Day
Tuesday, May 16, 8:00 AM – 5:00 PM CT
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 18 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 SAEM23
Full-Day Workshops
• Bringing the Outside In: Incorporating Wilderness Medicine Into Your Curriculum
• EMPoweRx Conference
• Grant Writing Workshop
• SAEM23 Consensus Conference
• World Health Organization Basic Emergency Care Training of Trainers
Half-Day Morning Workshops
• Beyond Microaggressions: Upstander Training for Allyship
• Clerkship Directors Bootcamp
• Emergency Department Operations On-Ramp: A Crash Course
• Medical Education Research Bootcamp
• Simulation Hacks: Building and Validating Do-it-yourself Models
• Ultrasound-guided Nerve Block
Half-Day Afternoon Workshops
• Be the Best Teacher: Medical Education Bootcamp
• Become an Excellent Peer Reviewer
• Developing Effective Education for the Next Generation
• Figuring Out Fiberscope
• Not Your Mother’s Ethics Course: Teaching Medical Ethics
• Virtual Reality Training in Mass Casualty Response
• Vice Chairs Workshop
The 2023 Consensus Conference— Precision Emergency Medicine: How Data Science, -Omics, and Technology Will Transform Emergency Medicine
Wednesday, May 16, 9:00 AM to 5:00 PM CT
Precision emergency medicine is the purposeful use of big data and technology to deliver acute care safely, efficiently, and authentically for individual patients and their communities. Advances in health technology and data science offer emergency physicians the ability to individualize patient care and improve the health of local communities. However, most emergency providers are less familiar with precision medicine and how this new paradigm will transform the practice of emergency medicine. Research is needed to understand how to best implement precision emergency medicine in an effective and equitable manner. Join us for this year’s consensus conference — Precision Emergency Medicine: How Data Science, -Omics, and Technology
Will Transform Emergency Medicine — as we explore the research opportunities, implementation, ethics, and patient outcomes of precision emergency medicine.
Wednesday May 17, 12:00 PM – 5:20 PM CT
Thursday, May 18, 8:00 AM – 5:20 PM CT
Friday, May 19, 8:00 AM – 12:50 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. 156 innovative and interactive sessions cover a range of educational topics in key categories, including: administrative, career development, education, clinical, research.
Taking place May 16–19, 2023, SAEM23 will be held in Austin, Texas. With more than 1,000 educational sessions, presentation opportunities, 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
• Program Planner
• Onsite Childcare/Day Camp
• FAQ
• Accessibility
• COVID-19 Policy
• For International Travelers
• Affiliated Meeting Space Request
• Social Media Best Practices
Wednesday, May 17, 11:00 AM – 12:50 PM CT
Friday, May 19, 10:00 AM – 11:50 AM CT
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.
Thursday, May 18, 11:00 AM – 4:00 PM (Tabletop)
Thursday, May 18, 11:00 AM – 5:00 PM (Orals)
Friday, May 19, 8:00 AM – 9:50 AM
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.
Tuesday, May 16, 8:00 AM – 5:00 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 SAEM23.
Tuesday, May 16, 8:30 AM – 4:15 PM 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. presentations from leaders in emergency medicine administration, education, and research. Add any forum when you register for SAEM23.
Thursday, May 18, 8:00 AM – 3:00 PM CT
Chief Resident 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 SAEM23
Thursday, May 18, 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 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 SAEM23
Thursday, May 18, 3:00 – 5:00 PM CT
Wednesday, May 17, 3:30 PM – 5:20 PM CT
The SAEM Residency & Fellowship Fair lets you explore residency and fellowship programs from across the nation, all under one roof. Meet with representatives from dozens of coveted programs, all waiting to talk to you about their programs and give you advice to help you with the application process. Connect with current residents and fellows to ask questions and get valuable advice and encouragement to help you navigate the next steps of your career. This event is free for residents and medical students, so take advantage of the opportunity to visit with as many programs as time allows!
Residency and Fellowship Directors!
The SAEM Residency & Fellowship Fair is an important and prominent event in the annual emergency medicine application cycle, giving institutions the opportunity to showcase their residency and fellowship programs to hundreds of medical students and emergency medicine residents looking to find their perfect residency or fellowship. Don’t miss this convenient, cost-effective, recruiting opportunity.
Thursday, May 18, 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.
Speed Mentoring matches 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.
• Academy for Women in Academic Emergency Medicine and Academy for Diversity and Inclusion in Emergency Medicine Luncheon
• Association of Academic Chairs in Emergency Medicine Annual Reception and Dinner
This spring, at SAEM23 in Austin, TX, we will pause to remember our SAEM friends and colleagues who left us during the past year.
We are seeking the names of individuals who have passed away since April 1, 2022 for an “In Memoriam” video tribute to be shown during the SAEM23 opening session. Please send your “In Memoriam” submissions (name, institution, and a photo) to Stacey Roseen at sroseen@saem.org by April 3, 2023.
All of the following events take place in the SAEM23 exhibit hall.
Tuesday, May 16
5:00 PM - 6:00 PM CT
Kickoff Party
Wednesday, May 17
7:00 AM - 9:00 AM CT
Exhibit Hall Open
7:00 AM - 8:00 AM CT
Networking Coffee Service
12:00 PM - 1:00 PM CT
Light Lunch
12:00 PM - 4:00 PM CT
Exhibit Hall Open
Thursday, May 18
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
and Exhibitors
Each year at the SAEM Annual Meeting, emergency medicine’s most brilliant minds, from some of the country’s most prestigious medical schools and teaching institutions, gather for the presentation of cutting-edge research and educational content and to learn about the latest innovations in products and services. This year, at SAEM23, May 16-19, in Austin Texas, we’re expecting a record 3,500 of these EM thought leaders, innovators, and early adopters and we invite you to reserve your exhibit booth today for an opportunity to meet them face-to-face!
We’ll help you maximize your exhibitor experience with…
• Events hosted inside the exhibit hall to drive more attendees to your booth, including our popular kickoff party
• Add-ons and upgrades to increase your visibility, such as a bigger booth or improved booth location
• Sponsorship opportunities to generate positive PR, including satellite symposia and our famous dodgeball tournament
Add-ons to increase your exposure to all SAEM23 attendees:
• Exhibitor bingo! - $500
• Bigger booth upgrade - $3,050
• Corner booth upgrade - $500
• Silver booth upgrade - $350
• Gold booth upgrade - $850
View the SAEM23 Exhibitor Prospectus for all the details. Still have questions? Email Bill Schmitt, manager, exhibits and sponsorships, or call (847) 257-7224.
Wednesday, May 17, 1:00 PM – 5:00 PM CT
Friday, May 19, 8:00 AM – 1:00 PM CT
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.
Thursday, May 18, 5:30 PM – 7:30 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 over 300 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 registration closes May 1, 2023.
Join us for Dodgeball 2023, 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! Team registration is now open.
The JW Marriott Austin, 110 East 2nd Street, Austin, Texas, is the official host hotel for meetings, educational sessions, and several social events at SAEM23, May 16-19. Book online by 5 p.m. local time, April 22, 2023 to receive the special SAEM room block rate of $279 for single or double occupancy. A valid major credit card is required to hold a room. Space is limited and rates are available on a first-come, first-served basis. Additional housing is available at the Austin Marriott Downtown, 304 East Cesar Chavez Street (just one block away from our host hotel) and rooms may be reserved online
Connect with peers, leaders, and others who can help you take your career to the next level.
SAEM23 offers more than 150 didactic sessions on wideranging topics. These innovative and interactive presentations 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. For full descriptions, search for any of the titles below in the “Didactics” section of the SAEM23 Program Planner.
• A Fun Acting and Theater-Focused Didactic to Improve Connectedness With Yourself and Your Patients
• Key Concepts in Operations and Management: A Primer for Residents, Medical Students, Fellows, and Early Career Faculty
• Exploring the Evolving Landscape of Resident Unionization
• Firearm Injury Prevention From the Bedside
• Speed Mentoring
• Cocktails with Chairs
• Residency and Fellowship Fair
• AWAEM and ADIEM Luncheon
• RAMS Party at Maggie Mae’s
Don’t miss these energetic, experiential learning competitions!
• SonoGames®
• Dodgeball
• SimWars
• SAEM RAMS Austin Scavenger Hunt
Educational forums focus on leadership skills and practical applications for all career stages, with two developed especially for medical students and residents:
• The Emergency Medicine Job Market: Putting the 2020 Workforce Report Into Perspective
• Taking Your Didactics to the Next Level: Best Practices in Didactic Design
• What’s Your Cup of Tea? An Interactive Infusion of Leadership Skills for Women, Learner Edition
• Making the Most of Your SAEM Membership
• Thinking about a Fellowship? What Residents Need to Know
• Early Career Planning: Avoid Pitfalls and Achieve Success for Residents and Junior Faculty
• Too Much Good Stuff: When, Why, and How To Say No
• Emergency Medicine 2068: Divining the Future of Anyone, Anything, Anytime Medicine
• The Art of Asking Questions as a Gateway to Effective Feedback
• Allyship and Advocacy in #SoMe: Amplifying Voices
• Promote Yourself: Writing Strong Letters
• Outside-In and Inside-Out: Incorporating Wilderness Medicine into Medical Education
• Challenging Conversations When Time Is (Always) Tight: 3 Communication Frameworks to Use in a Pinch
• The FOAM Showcase
• Making Sense of All Those Numbers in Research Papers
• Best Practices for Ensuring High Quality Care for Incarcerated Patients: Patients’ Rights and Our Responsibilities
• Emergency Medicine in the Post-Roe Era: Emergency Department Management of Abortions
• Medical Student Symposium
• Chief Resident Leadership Forum
Choose from among 18 full- and half-day educational sessions that focus on techniques, skills, and practical aspects of emergency medicine and strengthen knowledge and skills in specific topic areas. Here are a few to consider adding to your agenda:
• Figuring Out Fiberscope
• Ultrasound-guided Nerve Block
• SAEM Grant Writing Workshop
• Beyond Microaggressions: Upstander Training for Allyship
• The Dobbs Decision and the Emergency Medical Treatment and Active Labor Act Implications for the Emergency Physician
• Pearls and Pitfalls of Rapid Goals of Care Discussions in the Emergency Department
• Stand Up! An Introduction to Upstander Training to Address Microaggressions in the Emergency Department
• Data Sources in Emergency Medicine: How to Leverage Existing National Datasets for Your Research Projects
This list was compiled by Hamza Ijaz, MD, president of RAMS and Wendy Sun, MD, past president of RAMS and resident member of the SAEM Board of Directors.
Thursday, May 18, 10:00 PM – 2:00 AM
Join us for the SAEM social event of the year: The RAMS Party! Nobody throws a party like SAEM’s residents and medical students (RAMS) and nowhere is there a better place in Austin for a party than the legendary Maggie Mae’s on iconic Sixth Street. As the oldest locally owned venue in the heart of the Historic Entertainment District, Maggie Mae’s on Sixth Street has been serving up tunes since 1978 and is one of the reasons Austin is known as “The Live Music Capital of the World.” Maggie Mae’s is being spruced up to showcase her original charm and historic beauty while giving her a fresh, fun, and trendy vibe. She’ll be refreshed and ready to host all y’all on May 18, so put on your dancing boots and Stetson hat and plan to join us. Everyone is invited to the party, but our special VIP tables are limited and go fast, so if you’re interested you should reserve a table real soon!
Health care has made great strides in quality improvement incorporating lessons from industries including manufacturing and aviation. While many cite the 2001 Institute of Medicine (IOM) report as having “groundbreaking” or “practice changing” impact, not all areas of the report have been incorporated similarly. In this report IOM established six aims of health care quality captured in the acronym STEEEP (safe, timely, effective, efficient, equitable, and patientcentered). Institutional interventions and efforts to provide safe, effective, patient-centered, timely, and efficient care are typically both abundant and highly visible. Two decades following this report, more attention is needed toward the aim of equitable care. A recent ACEP workgroup report highlighted the need for integrating and reimagining quality outcomes in care to promote institutional accountability to overcome health care disparities. Here, we report how these
quality metrics can be presented and organized using dashboards.
While negative social determinants of health and a variety of structural challenges contribute to the health outcome of patients, so do the practices and policies within a given health system. Disparities in health care delivery have primarily been described using large databases supported by research projects. Less common is the approach for individual hospitals to monitor their own performance on care delivery to detect potential disparities and, in turn, use an equity lens in designing interventions. Institutional process measures designed to address disparities that rely on inpatient resources and interventions may not effectively address disparities experienced by patients solely cared for in the emergency department (ED). To truly assess whether we are providing
equitable care at the level of the emergency department, we will have to go deeper.
At least anecdotally, health care systems are increasingly focused on addressing health care disparities experienced by patients. The best practices to address these disparities remains an area of active research; however, many institutions are already deploying tools such as health equity dashboards to define where opportunities to reduce health care disparities exist. With the COVID-19 pandemic came a desire for rapid health care data visualization and public transparency. This led to a surge in the availability of dashboards to provide summary-level data, often with figures and graphs, to aid interpretation. Dashboards have been used for years to track health outcomes, process metrics (wide ranging from timely antibiotics for
sepsis, hand washing in patient rooms, and utilization of time outs before invasive procedures), and clinical operations (including hospital capacity, anticipated discharges, and PPE utilization). In this context, it is not surprising that equity dashboards are now being proposed to aid health care leaders in addressing health care disparities.
The greatest argument for a health equity dashboard centers on the principle that problem identification and planned interventions require the availability of data to describe gaps, set aims, and allow for continued evaluation of interventions. The barrier to creating these dashboards is greatly offset by the existing quality infrastructures built within each health care system. For example, the data source (often an EMR), data analytics, and technical support all rely on existing structures. In practicality, the intervention requires the additional stratification of outcomes by various demographic identifiers known locally or regionally to impact health care disparities.
When creating these dashboards, it is important to identify key stakeholders. While a comprehensive list would require individualization to an institution, we highlight the following individuals: quality/ safety officer, data analyst, community members, DEI leaders, physicians, nurses, and registration personnel. Dashboard designers must also thoughtfully consider the benefits of an integrated versus a standalone product.
Integrated dashboards are akin to adding a “column” or “filter” to an existing dashboard. This approach has the shortest startup time. An integrated approach is more likely to catch the attention of key stakeholders such as quality and patient safety officers. It is also reliant on the agreement of those managing these dashboards that the inclusion of this type of stratification is both important and worthy of report, particularly if a health care disparity is identified. Adding complexity to a dashboard can undermine the intent to provide simplified digestible information.
Administrators may find it distracting to have multiple aims for a given dashboard (e.g., highlighting disparities, evaluating individual performance metrics, and meeting operational/capacity demands). This may represent a significant initial barrier to successful implementation.
On the other hand, homegrown versions of dashboards to address department-specific issues have the benefit of truly building in an equity lens from the ground up. This requires a greater initial investment but can be tailored to the needs and health care disparities experienced in a particular community and may include numerous populations. Routine data collection by existing dashboards may not capture these metrics. For example, an ED may decide to focus on disparities in restraint use or hallway bed utilization by varying demographics. For those with the capacity to prioritize ED-specific dashboards, the homegrown equity dashboard may be the way to identify setting-specific health care disparities and interventions to address them.
Regardless of the approach chosen, there will remain challenges in implementing disparities measurement in the ED. Numerous populations are affected by disparities in care and many of them are not identified by traditional demographic collection practices at time of registration. Many institutions have not yet implemented the infrastructure and personnel training to allow for the gold standard of patient self-reporting on a variety of demographic measures. Furthermore, data collection is often aligned with reporting databases such as the CMS RTI Race Code, which has few options and would benefit from additional disaggregation. For example, the current five options (and other/unknown) do not include North African and Middle Eastern descent, nor do they provide necessary granularity to identify disparities that are only experienced by a subgroup. However, this limitation only amplifies the need to pursue change to provide equitable care when even small disparities are noted.
Evaluation of existing data collection and quality efforts to detect and impact disparities in care for minoritized racial and ethnic groups as well as women, immigrants, the elderly, those with cognitive or physical disabilities, children, those living in rural areas, and LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer) populations is where we must begin our endeavor to truly provide equitable care. While this list may not even be all-encompassing, its length highlights the amount of work ahead of us to provide equitable care
Dr. Norman is an associate professor and serves as the associate chair of health equity, quality and safety in the Department of Emergency Medicine at UT Southwestern Medical Center. She currently serves as chair of the SAEM Equity and Inclusion Committee and is a past president of SAEM’s Academy for Diversity and Inclusion in Emergency Medicine.
Dr. Hammond is an assistant professor of emergency medicine at Atrium Health Wake Forest Baptist Medical Center where she also serves as the assistant medical director for the Adult Emergency Department.
Dr. Hunt, an assistant professor of emergency medicine at the at the Wake Forest University School of Medicine, serves as medical director for the Adult Emergency Department at Atrium Health Wake Forest Baptist Medical Center.
Dr. Tsuchida is an emergency medicine physician and assistant professor at the University of Wisconsin, Madison. Dr. Tsuchida leads the DEI committee for the BerbeeWalsh Department of Emergency Medicine and collaborates with department and institutional leaders in embedding health equity into clinical practice. @rtsuchida
“The greatest argument for an health equity dashboard centers on the principle that problem identification and planned interventions require the availability of data to describe gaps, set aims, and allow for continued evaluation of interventions.”
A critical feature of modern, evidencebased medicine is the importance of establishing a therapeutic alliance, including clear bidirectional communication, between the practitioner and the individual. With proper communication, a therapeutic alliance can be built allowing for shared decision-making; however, this requires both the patient and practitioner to understand each other’s verbal communication, nonverbal language (body language, tone, facial expressions) and cultural nuances. Communication, however, is not without its barriers for many individuals within the disability community (~26% of the US population), which can affect an individual’s health and access to health care. In 2018, Stransky et al. found that individuals with disabilities affecting
communication reported higher rates of “trouble finding a provider” for health care. Additionally, the same group of individuals were found to have higher rates of emergency department (ED) use, longer in-patient hospital stays, and more unmet care needs.
Communication in the health care system was stifled in the disability community in many ways during the COVID-19 pandemic. Information regarding the pandemic has been delayed, incomplete, or inaccessible to those with hearing loss or low vision. A study also found that there were limited exceptions for visitation policies allowing individuals with disabilities to have a
member of their support team present, who is often critical to communication. Among all study sites, only 39% of hospitals reported exceptions for persons with cognitive impairment and 33% had exceptions for persons with physical impairment. Sites with EDspecific policies reported even fewer exceptions for patients with cognitive impairment (29%) or with physical impairments (24%).
With the advent of mask use during COVID-19, difficulties surrounding communication in the emergency department and health care system have been exacerbated. Individuals who rely on visual language, facial expression, and/or lip reading to aid in comprehension have lost that ability with the use of masks. While some patients
have access to masks with clear shields/ windows allowing for parts of the face and mouth to be seen while speaking, these may not be widely available and may still be less than ideal (e.g., fogging up, incorrect mask size/fit, poor visibility/ quality).
Due to COVID-19 and post-COVID-19 hospital and ED overcrowding, patients are often boarding in alternative treatment areas (such as hallway chairs/beds), on hospital floors, and in EDs. In these areas, there is increased background noise, a lack of privacy, and overall increased distractions that perpetuate suboptimal communication between patients and their providers. Moreland et al. studied health care changes in the face of COVID-19 and reported that hospitals now face challenging communicative environments due to noisy equipment alarms, hurried health care teams spending less time with patients, and personal protective equipment (PPE) use that obstructs faces and muffles sounds. Additionally, these alternate treatment areas can be challenging to navigate for people with low vision or blindness and people who use a wheelchair for mobility.
The result of these communication barriers is still being investigated; however, people in impoverished socioeconomic classes and who have more chronic health conditions tend to have more severe disease and death in the setting of the pandemic. Although speculative, logic would suggest the disease burden and death toll to be higher in the disability community.
While 26% of Americans have disabilities, it was found that only 4.6%% of medical students disclose disabilities or request accommodations and current physicians with disabilities only represent only 3.1% of the workforce. Similar to other racial and ethnic minority groups, people with disabilities are more likely to be able to communicate with, relate to, and provide comfort to those with whom they can identify. This is a strong argument for further diversifying our health care workforce to include people with disabilities.
The most meaningful and impactful learning experiences in medicine come from learning from patients’ first-hand experiences and the impact it has on their lives; yet, in 2017 only 52% of
medical schools reported having disability awareness training programs. Of those schools, only 10% had individuals with disabilities involved in the training program creation. Recent research shows that when medical students do receive training on disability, especially when this training is informed by individuals with disabilities, they report greater awareness of issues affecting individuals with disabilities and are able to understand disability through both biomedical and social models. For example, at the University of Rochester School of Medicine and Dentistry, a yearly experience called “Deaf Strong Hospital” is held where medical students participate in a role-reversal exercise during which they are hearing patients in a hospital where all the providers are deaf American Sign Language (ASL) users. In this situation, the students are encouraged to use different modes of communication (gesturing and other visual communication tools) and receive a first-hand view of health care through the lens of deaf individuals. In order to improve education on care of those with disabilities, undergraduate medical education should include more experiential activities related to care for the disability community. These experiences enhance development of alternative modes of communication, improve cultural awareness, and allow development of empathy and improved patient-provider rapport.
Additionally, medical school graduation requirements may also be modified to be more inclusive and meet the educational needs of the learner (with or without a disability). For example, modifying required competencies for the obstetrics clerkship (from completing the delivery of a baby to assisting in a delivery) may provide the necessary education if the student does not intend to pursue obstetrics. Another example is the requirement to perform cardiopulmonary resuscitation (CPR). The ability to perform CPR is often a barrier for applicants with disabilities; however, some programs’ requirements now state that applicants must be able to direct or perform CPR, which is more inclusive, provides the same education, and may better meet the needs of the student, thus changing these technical standards. These small adjustments to competencies allow students with physical disabilities (including those with chronic illnesses), who may otherwise be deemed
“unqualified,” to meet the requirements of their program and increase the disability community presence within physician workforce leading to the aforementioned benefits.
Flexible communication strategies including visual communication (body language, gesturing, writing/ text when feasible, qualified ASL interpreters) and communication technology (tablets, communication boards, communication access realtime translation [CART], etc.) can also increase the information exchange during a patient encounter. Additionally, flexible institutional policies allowing health care/support team members to accompany a patient with a disability during their visit may also enhance communication, information exchange, and access to more equitable care.
With existing communication barriers for patients with disabilities, conveying accurate and accessible health care and health information is a critical responsibility of health care practitioners to minimize misinformation and improve outcomes. While the health care system continues to deal with overcrowding and a thinly stretched workforce, steps must be taken to provide care for individuals with disabilities in the pursuit of positive health outcomes and improved access to their providers.
Dr. Rotoli is associate residency director, Department of Emergency Medicine and director, Deaf Health Pathways, at the University of Rochester Medical Center.
Dr. Donelly is an emergency medicine resident at the University of Rochester '25
Dr. Sapp is a second-year resident in the Harvard Affiliated Emergency Medicine Residency (MGH/BWH) who is passionate about improving health care for individuals with disabilities.
@SappMD
By Mel Ebeling on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine
Less than 1% That’s how many medical students and physicians there are in the U.S. who identify as transgender or nonbinary. What does it look like to be part of that percentage? Right now, for me, it looks like waddling through medical school with T-rex arms, plaid button-ups in the anatomy lab, pausing studying to milk my JP drains, and perhaps most exhaustingly, one too many explanations. “What’s ‘top surgery’?” “Why are you getting it?” “Do you identify as a man now?”
Before beginning this process of transitioning into the right body, the “issue” of my gender identity seemed to reside in my use of they/them pronouns. Who knew the pronoun pin on my white coat could be so controversial… and
so terribly ineffective? Despite their best intentions, I soon began to feel the strain of being misgendered by peers, patients, and preceptors day after day. The pin, measuring just one inch in diameter and weighing only nine grams, quickly began to feel heavier and heavier with each disregard. I gave up on correcting.
Unfortunately, my experience as a nonbinary person — and a nonbinary person in medicine, nonetheless — is not an uncommon one. Misgendering of transgender and gender-expansive physicians in professional settings is reportedly quite common. In the general public, one Canadian report revealed that about 60% of its nonbinary
"about a quarter of transgender individuals avoid getting the health care they need out of the fear of mistreatment."
respondents were misgendered daily. Intentional or not, being misgendered can negatively impact one’s health and wellbeing. Outside of misgendering, another study found that most transgender and nonbinary students and physicians have heard derogatory remarks at their workplace or training program about transgender and nonbinary individuals. Seventy-five percent of this same group of participants spent much of their time at school or work intentionally changing their speech and behavior to avoid being outed. This certainly cannot be good for one’s health either. It comes as no surprise, then, that about a quarter of transgender individuals avoid getting the health care they need out of the fear of mistreatment.
What can we do about this? As with many things, education is always a good place to start. The good news is that physician training in LGBTQ+ health has been increasing over the past decade. Specifically, emergency medicine residency programs have demonstrated a 26% increase in training from 2013 to 2020; however, the amount of training provided does not meet desire, and too many emergency medicine residents feel challenged when performing a history and physical examination on a patient who identifies as LGBT. In light of 40% of transgender individuals attempting suicide, a situation that emergency medicine physicians will likely be tasked with helping mitigate, more action and more education are necessary to promote better care for our transgender/
nonbinary patients and treatment of our transgender/nonbinary colleagues.
Luckily, there are several ways education on LGBTQ+ health can be implemented across the spectrum of physician training. For example, if you are an attending physician wanting to increase your own knowledge on LGBTQ+ health, this could mean doing some continuing education on the topic. If you direct a residency program, this could mean using simulation to enhance your residents’ cultural competence.
If you have a title that grants you the power to revamp undergraduate medical education, maybe this means incorporating a presentation on the Genderbread Person into the curriculum.
As I sit here, recovering from genderaffirming surgery and writing this article, I wonder what it will take for us, the 1%,
to be included in the AAMC’s definition of “Underrepresented in Medicine”? What will it take for our own health care needs to be better met? What will it take for us to be respected more in the training environment and workplace? Frankly, I am unsure of what it will ultimately take, but it will most certainly take more than a pronoun pin.
Mel Ebeling (they/them/theirs) is second year medical student at The University of Alabama at Birmingham Heersink School of Medicine and a practicing emergency medical technician/ hazmat specialist in the fire service mebeling@uab.edu
The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the goal 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. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”
"In light of 40% of transgender individuals attempting suicide, a situation that emergency medicine physicians will likely be tasked with helping mitigate, more action and more education are necessary to promote better care for our transgender/nonbinary patients and treatment of our transgender/nonbinary colleagues.
Current graduate medical education usually revolves around a didactic framework designed as a one size fits all model in which learners are expected to conform to the pace and educational level of the rest of the cohort.
Classically, residents attend a weekly conference that minimally considers their existing knowledge and proficiency on the subject. For the average learner, this approach is not a significant issue as the system is catered to the average. The above average learner is often not challenged by formal curricula. They are left to find opportunities to challenge themselves as the system functionally neglects them; unfortunately, limited free time outside of residency makes this difficult to accomplish. In contrast,
the below average learner will likely be overwhelmed with the proficiency gap and the disparate performance of their peers. Depending on the magnitude of their deficit they may start residency with few true opportunities to progress, further solidifying their limitations.
As medical schools and residency programs increasingly consider moving towards curriculums based on entrustable professional activities (commonly referred to as EPAs) it is important for residency programs to
consider a similar, more customizable educational framework. This strategy engages students at their specific spot in the journey of proficiency regardless of where they fall on the spectrum. This approach allows for more focus on the individual learner’s proficiency and goals.
Originally coined by the homeschooling family of the then 13-year-old Logan LaPlante at his TEDx talk in February 2013, the term was used to refer to
“Hackschooling allows residents who excel to continue to grow regardless of their skill. ”
hacking one’s own education. Though many may have a negative impression of hacking, at its core, it confers a sense of creativity and going outside the established norm to find answers to problems. Even in the most negative light, a hacker must have an extensive understanding of their subject. This in-depth comprehension begets the creativity that makes life-hacking so appealing. It does raise the question, “why can't this be applied towards the medical education model?”
The medical profession prides itself on a culture of lifelong learning which requires us to take charge of our own education post residency. This is no longer just the mark of a good physician, it has become a requirement to stay relevant and practice safe medicine in the era of an ever evolving practice landscape. This necessitates high degrees of curiosity, self-awareness, motivation, and drive. It is not feasible to expect people to spontaneously demonstrate these qualities upon graduating residency after being spoon-fed high yield/necessary information for all of residency (and arguably medical school). Just as in sports, you should practice how you intend to play. These are characteristics which are honed through repetition.
Lifelong learning requires self-awareness to identify knowledge deficits followed by identification of ways to fill gaps. When learners are exposed to a regimented curriculum throughout residency, adjusting to post-residency learning is difficult. Our goal should be to help train the habits which make successful physicians. Self-directed learning is a crucial aspect of that. A hackschooling
approach offers learners more control over their own education allowing them to direct their focus to what they need most.
Such a curriculum also allows people to explore interests within the specialty. Many residency curriculums do not have flexibility to allow subspecialization or exploration of possible fellowship interests due to staffing needs within a department, commitments to off service rotations, etc. A customized and interactive educational journey afforded by hackschooling allows learners to go deeper into topics that they may otherwise have had minimal exposure to in the current framework. This approach also has the potential to engage learners as they are being stimulated and pushed in ways that are meaningful for them.
The pre-residency experience is so unique for each resident that their educational and experiential foundation cannot be assumed to be the same from resident to resident. This is the assumption with a predefined residency curriculum, and it is a faulty one. Even the examples above regarding the average learner is an oversimplification. There are so many subdomains that demand proficiency to be a competent physician. The average learner is almost never truly average in each subdomain. Each person is heterogenous amalgam of these subdomains.
It is more efficient and interactive to provide an educational framework that adapts to the learners needs, meeting them where they are and engaging their interests. Despite attempts within the first few months of residency to homogenize learners’ competency their unique pre-residency experiences ultimately make this challenging, inefficient, and increasingly impractical. Hackschooling allows residents who excel to continue to grow regardless of their skill. Instead of a standardized model where students may be throttled and other students may be pushed to aggressively, facilitating burnout, such a customized curriculum allows all learners to grow simultaneously.
These ideas have already permeated today’s graduate medical education. The Accreditation Council for Graduate Medical Education (ACGME) currently classifies asynchronous learning as a core didactic activity. This sanctioned opportunity encourages learners to engage with the countless available resources at their own convenience.
There are even widely utilized emergency medicine curricula which list multiple types of learning resources (podcasts, FOAMed articles, textbook references, journal publications, etc.) for a given topic. These options give learners the chance to select resources best suited to their self-identified learning style.
Additionally, some programs set aside time in weekly conference for resident directed topics. Just-in-time learning of this nature dedicates time to delve into topics which residents have mentally bookmarked but have not been able to pursue. Another example includes an updated journal club. In addition to literature review, some institutions encourage residents to select a resource from the FOAMed sphere, including podcasts, blog posts, etc.
These strategies help residents navigate through the self-reflective nature of learning, briefly explore a few resources on the subject, and select one based on their interests. While the above examples demonstrate progress, these principles are far from mainstream and there are abundant opportunities for further improvement and innovation.
The existing system is designed to meet a minimum competency instead of allowing for continued growth and support for all learners. Residency should be focused on not only graduating well rounded, competent physicians, but on helping them to develop the habits to continue to learn and grow as a physician and person. Hackschooling provides ample opportunity to ensure not only that minimum competency is met, but also that they are prepared for the rest of their careers.
Dr. El-Kouri is a PGY3 and chief Rresident in the Department of Emergency Medicine at the University of Oklahoma in Tulsa, Oklahoma.
Dr. Milman is an assistant professor of emergency medicine and associate residency program director at the University of Oklahoma School of Community Medicine.
An 82-year-old man presents with urinary retention from a nursing home. He is accompanied by his daughter, who is his next of kin. The patient has chronic prostatic hypertrophy (BPH) and has had a foley catheter in place, intermittently, for most of the past two years. The patient’s urologist removed the foley three days prior to presentation and since that time the patient has only been producing small amounts of urine at a time.
The patient has no significant medical history beyond BPH and the mild dementia for which he was admitted to the nursing home. An ultrasound done soon after arrival shows a post-void residual of 2 liters. A review of prior charts reveals that the patient had presented in severe urinary retention in the past, arriving with a creatinine of 26 on one visit, which rapidly returned to his baseline creatinine of 1.2 after a foley was placed.
The patient states that he does not want any more foley catheters placed, but because of his dementia, the emergency physician (EP) turns to the daughter for consent to place the foley, with sedation if necessary. The daughter refuses, saying that if the foley is placed, her father will be upset with her, and she does not want this to happen. A foley is therefore not placed. At the advice of the ethics consultant, the EP places a consult to psychiatry to formally assess the patient’s capacity. By the end of this shift the consult still has not happened, nor have any labs resulted. The patient has, however, produced around 20cc of urine, which is sent for a urinalysis and is also pending. It is left to the oncoming overnight EP to figure out how to proceed. He personally assesses the patient’s capacity. Although the patient appears to be basically cognitively normal, probing the patient’s willingness to accept a foley and his reasons for refusing (when he did so) produces inconsistent answers. The EP concludes that the patient indeed does not have capacity. The consulting psychiatrist, who is eventually able to see the patient, concurs with the EP’s evaluation. Soon thereafter, the patient’s creatinine result comes back and is at baseline. (The urinalysis is clear.) Given this result, the fact that the patient had previously tolerated significant retention, and that the patient was able to urinate a bit, the EP decides that placing the foley is not emergent and defers it pending further discussions with the daughter. Thirty-six hours later the daughter changes her mind and consents to placing the foley. The patient is sedated and the foley is placed. The patient tolerates the foley well after it is placed and does not require any further sedation to keep him from removing it.
This case raises several important issues related to surrogate decision-making. The first is that capacity is question specific. The patient was able to engage in reasonable conversation and may well have been able to make other decisions on his own. However, when it came to the decision at hand, the patient lacked capacity. He was inconsistent in his willingness to accept the foley and could not provide a clear and consistent explanation for why he refused when he did so. However, were he to have needed to make another decision, his capacity to do so would have had to be evaluated based on his understanding of and consistency about that decision. His lack of capacity for one decision did not necessarily imply a lack of capacity for any other decision.
The second issue this case raises is the appropriate standard for surrogate decision-making. A surrogate is supposed to make decisions for a patient based on the patient’s underlying values, those values he held when he still had capacity, and those which are in the patient’s best interests. However, in this case, the daughter failed to do this, at least initially. Her decision the first day was explicitly based on her own desire that her father not become angry with her. While the patient, with his dementia, may well have become angry, this does not mean that his anger was a true expression of his values and wishes.
The third issue raised in this case is the value of time when dealing with refusal of care, whether by a surrogate, a patient with capacity, or even a patient without capacity. This situation involved two of these scenarios. While it is unclear what made the surrogate change her mind, it is not surprising that additional time and/ or talk to other people, may have caused her to reconsider. Furthermore, although this patient still needed sedation to have the foley placed, it is entirely possible that
in a similar case, the team might have found a moment when the patient was willing to comply. In that case, the patient would have been spared the risks of sedation, as well as the violation of being treated against his will. Even patients without capacity retain their right to be treated in a dignified manner, though we might sometimes override that right. Finally, even in the case of a patient with capacity who is refusing care thought to be essential, time can help. If the patient is, for example, willing to be admitted for observation but not treatment, additional time might cause the patient to reconsider, or consult with others who might persuade the patient to change his or her mind.
A third issue raised here is that although in this case a psychiatrist was involved in determining whether the patient had capacity, the second EP made her own determination and did not really need the psychiatrist. Any treating physician who is familiar with the process of capacity determination can do the assessment. Psychiatrists may be helpful in tricky cases where it is hard to figure out what the patient is thinking, and they can certainly assist when the primary team is not comfortable making capacity determinations, but unless a hospital has a specific policy on the matter, psychiatrists are not necessary for capacity determinations.
A final issue, more hinted at in this case than directly raised, is that sometimes, even with surrogate consent and a clear need, it may not be appropriate to treat a patient without capacity, over his or her objection.
One must consider what comes after the procedure as well. Fortunately, this patient did not require ongoing sedation to continue with the foley once it was in, but it is entirely possible that he might have. Would it be reasonable or practical to sedate the patient long-term so that
he would continue to tolerate the foley? Not necessarily. In the case of surgery, noncompliance with post-operative care may leave the patient worse off than if the surgery had not been done in the first place. Such issues must be considered before treating the patient over his or her objection. The assent of a patient without capacity may not be merely desirable, as mentioned above, but possibly necessary as well.
Dr. Simon is a professor of emergency medicine at the Columbia University Medical Center, in addition to serving as faculty associate at the Columbia Center for Clinical Medical Ethics. Dr. Simon is also a senior research associate for the department of philosophy at the University of Johannesburg.
“Psychiatrists may be helpful in tricky cases where it is hard to figure out what the patient is thinking, and they can certainly assist when the primary team is not comfortable making capacity determinations, but unless a hospital has a specific policy on the matter, psychiatrists are not necessary for capacity determinations.”
By Isabelle Miles, MD, and Fernanda Bellolio, MD, MSc, on behalf of the SAEM Academy For Geriatric Emergency Medicine
Cannabis use has exponentially grown over the past few years with legalization in multiple U.S. states. At the same time, emergency department (ED) visits for cannabis-related adverse events, such as accidental overdose, and intoxication, have increased.
The rate of cannabis use by older adults is increasing more quickly than all other age groups. Older adult beliefs about cannabis use are shifting secondary to legalization, broader social acceptance, and perceived benefits for treatment of chronic conditions. With decrease perception of risk, cannabis use, including high risk use and intoxication, has increased. A study demonstrated that ED visits in California increased from 21 per 100,000 visits in 2005 to 395 per 100,000 ED visits in 2019 — a 1804% relative increase.
Consequently, increased public health education is needed to improve health literacy about cannabis use.
Cannabis is composed of many phytocannabinoids, with delta-9tetrahydrocannabinol (THC) and cannabidiol (CBD) causing most of the effects. THC is responsible for most of the psychotropic effects, including intoxication and re-enforcing properties.
CBD is thought to be non-psychoactive, with anti-inflammatory, analgesic, and immunomodulatory properties. It can attenuate some of the negative effects of THC in appropriate ratios. Cannabis can be purchased in many forms (edibles, oils, tinctures, dried plant) and different combinations of concentrations and ratios of THC and CBD. Over time, THC concentrations have increased
“With decrease perception of risk, cannabis use, including high risk use and intoxication, has increased.”
to 14% or more, while cannabidiol has decreased relatively in combination products; this has been linked to increasing ED presentations related to cannabis.
Medical cannabis is used for several conditions, including pain and insomnia, but evidence supporting these practices is lacking. In one large survey of adults using medical cannabis, cannabis oil was used by 80% of older adults. Among those using cannabis for pain control, 36% reported it helped reduce their total opioids use, and 20% reported it reduced the use of benzodiazepines. However good efficacy data in older adults are lacking and reviews thus far demonstrate significant uncertainty around benefits
for pain management. Side effects include dizziness (18%), nausea (9%), dry mouth (9%), and tinnitus (9%). These are reflected in other studies reviewing cannabis for pain management, where NNT (number needed to treat) for pain relief often overlap with NNH (number needed to harm). Some studies suggest that older adults are at increased risk of developing cannabis use disorder, particularly if there is concurrent substance use.
Evaluation of the cognitive function and emotional functioning among adults aged 60 and older demonstrated that long-term consumers had decreased executive function, processing speed, and general cognition. Additionally,
increased frequency of use was negatively associated with working memory. Long-term recreational cannabis use is associated with lower executive function and processing speed in older adults. In the general population, some of these effects are not reversible even after 6 months of abstinence.
Older adults want more information about cannabis and desire to communicate with their health care providers. Asking about cannabis use and providing education should be a part of routine medical care for older adults. Current low risk guidelines are available to providers to guide conversation around reducing long term risk associated with cannabis use.
Stay tuned for our upcoming Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) on non-opioid substance dependence including management of cannabis hyperemesis syndrome, coming later this year!
Dr. Milles is an emergency physician and addiction medicine specialist in the Department of Emergency Medicine and Division of Addiction Medicine, St Paul's Hospital, Vancouver, BC. Department of Emergency Medicine, University of British Columbia, Vancouver, BC. She is a member of the GRACE-4 committee.
Dr. Bellolio is a professor of emergency medicine in the Department of Emergency Medicine, Department of Health Sciences Research, Division of Health Care Policy and Research, and Department of Medicine, Section of Geriatric Medicine at Mayo Clinic, Rochester, MN. She is a member-at-large of AGEM, and a methodologist for the GRACE guidelines.
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.”
“Long-term recreational cannabis use is associated with lower executive function and processing speed in older adults.”
In the United States, a call to 911 for a medical emergency normally results in an ambulance promptly arriving at the scene. This ambulance is usually stocked with equipment for a variety of chief complaints and, perhaps most importantly, staffed with at least one trained emergency medical technician (EMT) or paramedic with the skills to stabilize the patient. In several areas of the country, a fire truck and/or police officer, depending on the nature of the call, may also have been dispatched and available at the scene to provide additional support to the emergency response.
While the emergency medical services (EMS) systems across the U.S. have their own challenges and inadequacies, reports consistently indicate that
many EMS systems in low- and middle-income countries (LMICs) are underdeveloped to adequately respond to out-of-hospital medical emergencies.
“Lack of skilled personnel has specifically been documented as a barrier to out-of-hospital emergency care in 61% of studies included in a review of prehospital care in LMICs.”
Implementing basic EMS is a highly cost-effective health system intervention capable of averting over 50% of mortality in LMICs. Personnel constitute a critical backbone of any EMS system; thus, training EMS personnel in basic and life-saving medical interventions is a productive approach to strengthening frontline care and bolstering fragile health systems, according to experts
There are several analyses on the state of EMS systems in LMICs that address the critical need for formal, standardized education of EMS personnel. Lack of skilled personnel has specifically been documented as a barrier to out-ofhospital emergency care in 61% of
studies included in a review of prehospital care in LMICs. In Nepal, there was no formal education for EMS personnel until a partnership between the new Nepal Ambulance Service and a U.S. university enabled the provision of EMT training, graduating the first class in 2010. Armenia relies on on-the-job training with no standardized education for EMS personnel. Similarly, no formal system exists to train EMTs in Sri Lanka. In LMICs where formal EMS training programs exist, like India, lack of governmental regulation has resulted in programs with differing academic standards.
The EMS and broader health care system configuration should influence
the breadth and depth of education required of its providers. In high-income countries, the Anglo-American model and the Franco-German model are the two predominant EMS system models. The former favors a “load and go” approach, emphasizing the need for immediate transport of the patient to a higher level of care, usually emergency departments. The latter champions a “stay and play” strategy, focusing on bringing the higher level of care often through specialisttrained physicians to the patient at the scene. There is no evidence to suggest superiority of one model over the
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“Personnel constitute a critical backbone of any EMS system; thus, training EMS personnel in basic and life-saving medical interventions is a productive approach to strengthening frontline care and bolstering fragile health systems.”
other. Conceptually, though, formal standardized EMS curricula should be tailored to the local health care system, while considering a multitude of factors: desired scope of practice of EMS personnel, regulatory environment, and the local burden of disease.
Cost is another significant factor that must be considered when trying to advance EMS personnel education in LMICs. While existing courses, like Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Prehospital Trauma Life Support (PHTLS) could be adopted to readily provide EMS education in LMICs, such courses are often too costly to be implemented or scaled as-is. More cost-effective and locally appropriate training alternatives have been developed to help communicate the same concepts while considering local cultural context and factors. For example, the TEAM course has been well received in Haiti in place of ATLS, which can require an abundance of resources. Additionally, the STEPS course for trauma care has been offered in Egypt as a viable alternative to ATLS,
albeit for physician training rather than EMS personnel. Importantly, this course recognized cultural concerns regarding the use of human cadavers, and instead implemented a veterinary cadaver lab. Other resources being actively used to aid the development of EMS curricula and provider training include Free Open-Access Medicine (FOAMed) and low-cost simulations.
Ultimately, instituting formal education for EMS providers is a universal and continual necessity to achieve effective EMS systems globally. Strengthening EMS education in different parts of the world, though, must consider the unique needs, population, health system configuration, and resources of that particular country or locale. No one country’s standards are entirely sufficient, nor appropriate, for another’s. What works well in one country may not meet the health system and population needs in another. Thus, two tenets hold true: first, that formal education of EMS personnel is important to advancing EMS systems globally, and second, that EMS education must be locally and contextually appropriate to help develop knowledgeable and skillful cadres of EMS professionals whom citizens can rely on in times of need.
Mel Ebeling is a secondyear medical student at the University of Alabama at Birmingham Heersink School of Medicine and an EMT/ HAZMAT Specialist in the fire service. Mebeling@uab.edu
Dr. Schenk is currently a second-year medical student at Dartmouth’s Geisel School of Medicine. Her background is in global emergency care system strengthening, and she holds a PhD in International Health Systems from Johns Hopkins and a Master’s Public Health in global health from Emory University. Ellen.Schenk.MED@dartmouth.edu
Dr. Mould-Millman is an emergency medicine physician-investigator with expertise in global health, trauma, and prehospital care. He is an associate professor of emergency medicine at the University of Colorado Denver and serves as principal investigator of the C3 Global Trauma Research Network. Nee-Kofi.Mould-Millman@cuanschutz.edu
While the ongoing conflict in Ukraine inspired increased attention to global humanitarian efforts, it also exposed imbalances in aid delivery. Armed conflict in Tigray, a northern region of Ethiopia, began in November 2020 and has resulted in one of the world’s greatest humanitarian crises. Yet, according to UN OCHA, Ethiopia received less than half of the humanitarian funding required in 2022. In November 2022, the Government of Ethiopia and the Tigray People’s Liberation Front signed a peace treaty agreeing to a “permanent cessation of hostilities.” This development will greatly increase access in Tigray, which has been cut off from the rest of
the country and the world since the war began. Nonetheless, the humanitarian needs of Tigrayans and the challenges that lay ahead for humanitarian responders are immense.
War between regional Tigrayan forces and the federal government of Ethiopia began in November 2020 and has resulted in the forced displacement of more than 2.3 million people. Many more have been subjected to arbitrary detention, torture, abduction, and enforced disappearances. Particularly troubling are reports of attacks against civilians, including ethnic-based killings, who have taken no direct part in hostilities. All sides, including military
forces from Eritrea, have been accused of engaging in human rights violations, including acts of sexual and genderbased violence. Conflict in Tigray has also spread to neighboring regions of Amhara and Afar, resulting in an expanding area in severe need of humanitarian assistance.
Among the devastating effects of the war in Tigray is the near complete destruction of the region’s health care system. Prior to the conflict, Tigrayans benefitted from a strong system of community-based primary health care known as the Health Extension Program.
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After the war began, this network collapsed due to a combination of the destruction of facilities, disruptions to the supply chain, and loss of health care workers who fled or quit their posts to find an alternate means of income (health care workers have been paid seldom or not at all during the war). An assessment of more than 250 hospitals and health centers by Gesesew et al. in June 2021 showed that only 27.5% of hospitals and 17.5% of health centers were fully functional, and more than 50% of health workers were no longer reporting to their place of work.
The consequences of this collapse have been disastrous. Vaccination coverage rates plummeted, contributing
to disease outbreaks, including cholera and measles, throughout the country. In Tigray, doctors report not having the most basic supplies, such as gauze and saline, and shortages of essential medications including antibiotics and insulin have led to countless preventable deaths. The fuel shortage has made it difficult to keep generators running in hospitals, and those still functioning grapple with intermittent power outages that affect infant warmers, ventilators, and basic lighting. Oxygen is also in short supply: according to data from the regional health bureau, from June 2021 to May 2022 only 13% of the oxygen needed to meet demand was available. Even more devastating is the dramatic and widespread rise in malnutrition, particularly among children under five. A rapid nutritional assessment conducted in July 2021 showed that 28% of
children under five had moderate or severe acute malnutrition, nearly triple as many as in 2019. The World Food Program estimates that 5.2 million people in Tigray (91% of the population) and 12.2 million people across Northern Ethiopia are in need of emergency food assistance.
The peace treaty signed on November 2, 2022, officially brought an end to the conflict in Tigray, but rebuilding their previously robust health care system poses an enormous challenge. Over the past two and a half years, Tigray has been almost completely cut off from the rest of the world, both in terms of communication and physical access. Roadblocks, fighting along aid delivery routes, and damage to infrastructure has made it nearly impossible for humanitarian agencies to get supplies
EM
“Armed conflict in Tigray, a northern region of Ethiopia, began in November 2020 and has resulted in one of the world’s greatest humanitarian crises. Yet, according to UN OCHA, Ethiopia received less than half of the humanitarian funding required in 2022.”
YanBoechat, CC0, via Wikimedia Commons
such as food, medicines, and gasoline into the region. In fact, roads into Tigray and surrounding regions only became accessible to humanitarian responders in early December 2022. Many of the humanitarian aid groups who were previously forced to leave the region are in the early stages of re-establishing operations. Other groups are working to scale up the distribution of aid as access to remote areas remains challenging. However, rebuilding the health system in Tigray will not be the responsibility of international non-governmental organizations (NGOs) alone. It is critically important that humanitarian aid groups work hand in hand with local NGO and government partners with the goal of making Tigray self-sufficient again.
With this in mind, the first priority of humanitarian responders should be to re-establish preventative and acute care systems by repairing health centers and hospitals and staffing them with local health care workers. Humanitarian aid groups must engage existing, highly skilled health care workers at every level, from community health workers, to nurses, to doctors. This may involve salary support provided by international NGOs until compensation for government employees has been restored. The safety and security of both international aid workers and local health care workers will be of utmost importance. As security throughout the region improves, health care workers may be deployed to support health systems rebuilding in more remote areas. Another priority for humanitarian responders will be to re-establish the supply chain for medications and vaccines. This will facilitate the reopening of regional programs for the management
of HIV and tuberculosis as well as routine maternal and child health vaccinations.
Humanitarian aid groups must also prioritize the urgent need to treat and prevent the further spread of malnutrition in Tigray and neighboring regions; this will require the implementation of malnutrition screening and treatment programs. The World Food Program has already distributed food assistance to people across much of Northern Ethiopia, yet funding and supply limitations have created a barrier to more widespread blanket supplementary feeding programs. Funding and supporting logistics for such supplementary feeding is an immediate priority; however, if the people of Tigray are to avoid reliance on external actors for food, then humanitarian groups must help rebuild local agriculture by providing locals with the tools for farming and raising livestock. This will also include adaptations that take into consideration climate change and the drought currently impacting the Horn of Africa. Underlying all these priorities is the imperative for the Government of Ethiopia and nongovernment stakeholders to continue to facilitate access to gas, banking, telecommunications, and safe water supply.
A final priority will be addressing the mental health and rehabilitation needs of this population who has faced unfathomable trauma. Particular attention must be given to survivors of gender-based violence who had immense unmet needs even before the war. Access to mental health and rehabilitation should be embedded into the recovery plan as part of rebuilding primary health care units. As telecommunication resumes, innovative approaches such as
telehealth programs can close the gap in establishing longitudinal mental health support to the area.
As emergency medicine physicians, we are well positioned to contribute our clinical and public health skills during all phases of humanitarian emergencies. With appropriate training, our expertise in emergency care across the spectrum of diseases can be employed not only in the immediate aftermath of conflict-related humanitarian crises but also throughout the recovery phase.
Dr. Roy is an assistant professor of emergency medicine at Loma Linda University. She spent three months in Tigray with Doctors Without Borders in the spring of 2021 providing medical care to internally displaced people. She completed a fellowship in Global Emergency Medicine at Columbia University.
Dr. Leff is an emergency medicine resident at the Mayo Clinic. She is the current resident representative to the Global Emergency Medicine Academy (GEMA) and cochairs GEMA’s pediatrics and humanitarian sections.
Dr. Firew is an associate professor of emergency medicine at Columbia University and serves as a special advisor to the Ministry of Health of Ethiopia. She has responded to humanitarian crises in Haiti and Mosul, Iraq.
The Global Emergency Medicine Academy (GEMA) focuses on improvement of the worldwide delivery of emergency medical care. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”
“The peace treaty signed on November 2, 2022, officially brought an end to the conflict in Tigray, but rebuilding their previously robust health care system poses an enormous challenge.”
By Rahul Nayak, MD, MTM and Prasanthi Govindarajan, MD, MAS
Innovation and scientific discovery are the future of health care and medicine. In medicine, we have unique cohorts of practitioners, including clinicians, clinician-educators, clinician-scientists, and clinician-innovators, who work daily to provide patient care and advance health care. Physician engineers who transform an innovative idea into a product that can be used in a clinical environment to improve patient care and clinical outcomes fall into the clinicianinnovators category.
The first step in improving patient care and outcomes is identifying the problem that challenges good patient care. Many design experts argue that identifying an obvious problem is more important than the solution; however, the need to develop a product to address a challenging problem can arise anytime, and the design process makes this easier. Take, for instance, January 2, 2023, when nationally
televised NFL game, Buffalo Bills safety Damar Hamlin suffered a cardiac arrest. The medical staff was able to quickly rush to the field to begin resuscitation, including cardiopulmonary resuscitation (CPR) and defibrillation. This moment was witnessed by many who were physically present at the game, and by 23.8 million viewers worldwide. Cardiac resuscitation is arguably one of the most critical aspects of our job as emergency medicine physicians. Finding ways to improve the quality and outcomes of resuscitation, specifically in CPR, has been an important area of research in emergency medicine. Why not apply the design process to address this critical need?
In 2021, I led a team of senior bioengineering undergraduate students at the University of California, Berkeley, as part of the
capstone engineering design course to help develop a tool to address decreasing "hands-off time" during CPR. My colleagues, Pranjal Gupta, MD, and Mohanad Alazzeh, MD, served as mentors for the undergraduate students as well. We worked with the engineering students, went through the various design phases, and tackled challenges as they arose.
The five-step design phase for product development was pioneered and taught at the Hasso Plattner Institute of Design at Stanford University. The first step in product design is empathizing. Empathy is at the heart of all medicine and the care we deliver. In design, we must look at a problem from the perspective of others — what it feels like to them — and understand how an issue affects the patient, and the care team (e.g., physician, nurses, technician, respiratory therapist, pharmacist, medical center, family members, and so many more). Thus, gathering perspectives from a diverse group of individuals is salient to this stage of empathizing. Our students applied this concept to their capstone project, reviewed prehospital records, and gathered information from the health care team and clinicians.
The second stage is problem identification. From the information gathered in step one, we started to see a variety of emerging themes that we could categorize into specific and succinct problems. From this, we were able to generate problem statements that considered the user needs, were specific in scope, and utilized action verbs. In our project, we identified minimizing "hands-off" during active CPR time as critical since prehospital providers are multitasking and may find it challenging to reduce the hands-off time.
The third step is ideation, where imagination and creativity play a
significant role. We devised as many solutions to the problem statement as we wanted. For example, the problem of adding numbers could be solved by hand, using spreadsheet, or using calculator. The ideation phase is similar to developing a broad differential diagnosis in the ED.
The next step is to use the solutions proposed in step three and design a prototype. Again, a prototype can be simple, inexpensive, and not necessarily functional since it will undergo many changes over time. In the case of the capstone project, one of the prototypes built by the engineering team was a hands-free pulse sensor that could detect and monitor pulse across a broad spectrum of pronounced bradycardia to tachycardia using a specially designed photoplethysmography sensor that provided feedback through a flashing light and sound.
The final phase is the testing phase, in which we test the prototype to assess if it meets the metrics. The design process, contrary to what sounds linear, is highly iterative. When the prototype doesn't meet the goals during the testing phase, it's time to return to one of the earlier stages of the design process. This process can continue for a long time until a final product is finally built. This iterative process is similar to our clinical environment, where we refine care and treatments as the patient is constantly reassessed. During the capstone project, we tested the prototyped hands-free
sensor on an artificial test bed, (i.e., an engineered system of a pump with a pulse generator, special tubing to replicate the compliance of arteries, and a specially designed plastic polymer overlaying the tubing to replicate skin). Once the product is built and tested, it must go through the proper regulatory channels to be tested in the clinical setting.
In closing, innovation and scientific discovery can significantly improve the quality of care for many patients to impact our communities and the world. This is the power and beauty of design thinking.
Dr. Govindarajan is a physicianscientist in the Department of Emergency Medicine at Stanford University. Dr. Govindarajan’s independent health policy research program focuses on developing best practices in acute stroke care for U.S.based ambulance systems. She also serves on the SAEM nominating and research committees and spend her academic time supporting and mentoring trainees in their scholarly pursuits.
Dr. Nayak is a third-year resident physician at Stanford Emergency Medicine. He is an engineer by trade and his interests are in digital health, medical device development, and innovation.
@RahulNayakMD
“As a kid, on every birthday, I received a toy race car, an electric toothbrush, or some other electronic gadget. I would open the box with great excitement and immediately start dissecting the wires and motors. I recognize now that my interest in engineering started then. I went on to train as an engineer, worked as an innovator in multiple startup environments, was part of several success stories, and learned from many failures. Subsequently, I chose a career in medicine to have the opportunity to deliver health care to one patient at a time, discover the challenges in health care delivery along the way, and utilize engineering to address these challenges and help patients around the world. This journey led me to a path in medicine and, ultimately to specialize in emergency medicine. Today I am a member of a growing group of physician engineers in emergency medicine.”
— Rahul Nayak, MD, MTM, Stanford Emergency Medicine
By Shayan Azizi, MD and Anthony Scoccimarro, MD
Up to one-third of our time on earth is spent sleeping, with each of the remaining two-thirds fractioned respectively between work and life duties. This contrasts with the irregular, and often erratic lifestyles of many U.S. medical residents who spend upward of 13 hours per day, up to six days a week, at their hospitals. This leaves precious little time to take care of life duties, let alone to increase their medical knowledge and prepare for board exams. Hands-on experience trumps all; however, time spent reviewing the literature and understanding the pathophysiology behind our actions in health care are crucial, both for the sake of our patients and for our own
decision-making and self-confidence. With advancements in technology and an overwhelming surplus of resources available to students, residents, and medical providers, the question arises: How can busy residents with limited time continuously and efficiently enhance their medical knowledge?
While our textbooks collect dust on our bookshelves, our smartphones are usually either in our pockets or in our hands. On top of the many free and paid apps that residents can install on their phones to study on the go, the past decade has witnessed the dawn of a new mode of learning and
discussion: WhatsApp threads. With more than two billion users globally, this encrypted instant messaging system has recently become a platform for students and residents to discuss medical cases, dissect daily EKGs, and review board exam material — all while on shift, on the train ride home, or during a lull in the middle of the day. Not surprisingly, a 2017 study by Dr. Sonia Gon amongst MBBS (Bachelor of Medicine and Bachelor of Surgery) students at the department of pathology at Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, Haryana, India, found that one of the top advantages of WhatsApp-based learning was
the real-time presence of the teaching facilitator and the anywhere-anytime nature of learning it allowed. Similarly, in a large, 23-study review by Dr. E. Coleman from the Department of Intensive Care and Anaesthesia, St James’s Hospital, Trinity College, Dublin, Ireland, involving medical students, the common benefit users found was an increase in learning opportunities when face-to-face learning is no longer possible.
With the introduction of any new mode of learning, such as WhatsAppbased education, there are nuances and potentials for improvement. Users can find themselves flooded with messages or unable to retain the information they’ve acquired or use it in a practical way. So now that this new form of instantly and easily accessible, discussion-based education is widely available, a new question arises: how can this mode of pedagogy be improved?
Emergency medicine residents at Lincoln Medical Center, a level one county hospital in the Bronx, New York, participated in a blind, anonymous survey to study the strengths and areas for potential improvement of WhatsAppbased chat groups. During each academic year, attending physicians and residents at all postgraduate levels informally post interesting cases to the threads, including EKG cases, ultrasound findings, and clinical scenarios that offer a take-home learning point. These threads are where all-inclusive, informal fireside chats take place to discuss the unique cases encountered. The survey administered to residents toward the end of the academic year followed a minimum full year of exposure to the respective WhatsApp threads. The survey links were administered to residents during conference hours, with no time limit to complete. The survey included four queries which were to be answered on a rating scale between 0-10, with 0 being
strongly in disagreement and 10 being strongly in agreement. The four queries included: 1.) WhatsApp threads improve my educational confidence; 2.) WhatsApp threads should be continued throughout residency; 3.) WhatsApp threads are more practical than traditional educational resources; and 4.) WhatsApp threads are helpful in consolidating content to memory.
From the 23 responses, the mean score amongst residents for improvement of their education confidence was 7.1. The mean score as to whether WhatsApp threads should be continued throughout residency was 8.3. The mean score regarding whether residents consider WhatsApp threads more practical than traditional education was 6. The mean score pertaining to whether residents consolidated the knowledge on the WhatsApp to memory was 5.5. Furthermore, subjective anonymous comments on factors that may improve the quality of the threads included:
• A summary of the daily learning points
• More consistency with themed weekly topics
• A weekly summary of the learning points discussed
• Discussing one concept at a time
• Not starting a new discussion prior to the previous one concludes
• More structure and moderation
WhatsApp threads are equitable (since everyone who has a phone can participate) although inequivalent to the quality of education and engagement that in-person teaching offers. The quality of these discussion groups can be optimized if a higher degree of moderation occurs by the host to allow participants to equally engage and if an interval summary of the teaching points discussed during the chat is provided. Furthermore, closing remarks and
conclusions should be made prior to starting a new topic of discussion; this would allow students to formulate their thoughts and help retain the concept.
If effectively utilized, WhatsApp based discussions can help fill gaps of knowledge created when meeting with professors in a traditional classroom situation or conference is not feasible.
Dr. Azizi is a second-year emergency medicine resident at Lincoln Medical Center, Bronx, New York City. @ShayanAzizi10
Scoccimarro is assistant program director for Lincoln Emergency Medicine, Bronx, New York City.
Dr.
“…this encrypted instant messaging system has recently become a platform for students and residents to discuss medical cases, dissect daily EKGs, and review board exam material — all while on shift, on the train ride home, or during a lull in the middle of the day.”
By Jeremy Brown, MD
There are dozens of different grant In previous columns I discussed how the Office of Emergency Care Research at the National Institutes of Health (NIH) can help you with submitting a grant application, and the special place of training (K) grants. But why apply for grant support at all? It seems like a strange question to ask, but it is perhaps the most important question of all.
Before you begin a research project, whether it be a simple, single site survey in your own emergency department (ED) or a multicenter double-blind placebocontrolled trial, the second question to address (the first being what it is that you want to study) is: “do I need money to do this?” It may well be the case that you can complete your study goals without any funding at all. You could review ED records in your own institution without funding, and you may be able to deliver a survey to patients with the help of a few volunteer students
from your affiliated or local university. This certainly requires work and careful coordination, but if you don’t need additional funds, then don’t apply for them, as doing so makes the process longer and much more complicated.
If a study is going to involve several sites, or involve additional tests, medications or follow up, you will almost certainly need funding — and often you will need quite a lot of it. Before applying to the NIH, whose process is long and success rate is low, think about other funding possibilities. It is possible that your own emergency department, hospital, university, or health care system may have funds to support your work; if that is the case, then apply for
them. There may also be state funds available and although the amounts are often modest, it is certainly important to investigate this possibility as well. Next, consider private foundations or disease advocacy groups. There are many of these, and finding them may be a challenge, but get help from your medical librarian or grants office. Some patient advocacy groups are very well funded and may allocate hundreds of thousands of dollars towards research funding. The American College of Emergency Physicians (ACEP), SAEM, and other professional organizations may be able to support your work, so spend some time looking into those potential opportunities as well. Finding
“It may well be the case that you can complete your study goals without any funding at all. ”
support is challenging, but you cannot get a grant that you do not apply for. If, for whatever reason, these possible sources of funding do not work out, it may time to consider funding from the National Institutes of Health. There are several important advantages to getting support from the NIH. First, the amount of support is, at least theoretically, unlimited. You can apply for $50,000 of support, or $50 million (though the latter will be rather more challenging to obtain than the former). Second, grant support from the NIH is inherently prestigious, and can help advance your academic career. (This is especially true of R01 support, as in “she is an R01 supported investigator.”) Third, there is substantial indirect support that comes with each NIH award. This money,
which may be as much as 50-70% of the amount you asked for, is used to support intangibles, like lighting and heating, and office or lab space. You will not see these indirect costs; they are sent to the hospital or medical school, although many departments may receive a portion of them. These indirect costs can add up very quickly. If you are awarded $250,000 a year for a fouryear project, your university or medical school could receive an additional $500,000-$800,000 over the life of the project. If you bring in that much additional money, you will become an important player in the system.
The final advantage of getting support from the NIH is that after the study is reviewed, all NIH applicants receive a detailed written summary of that
review, which includes its strengths and weaknesses. This document, known as the summary statement, will be of great help if you did not get finding and need to reapply. Addressing the comments will greatly improve your chances of funding if you apply a second time.
There are, of course, some disadvantages in applying for NIH funding. First, the success rate is low. Only 10-15% of applications are funded, although these numbers vary by grant type and institute, and do increase for those sending in a second, revised application. The process is also slow. It will take 12-18 months from the time you first submit your application until you receive funding, and that assumes you will be funded on your first attempt, which is very unlikely.
What happens if, once you weigh the pros and cons, you decide to proceed with an NIH application? Where do you begin and to whom should you speak? We will address this in our next column.
Dr. Brown is the director of the Office of Emergency Care Research (OECR) where he leads efforts to coordinate emergency care research funding opportunities across NIH. Additionally, Jeremy is the primary contact for the NINDS Exploratory and Efficacy FOAs and serves as NIH's representative in government-wide efforts to improve emergency care throughout the country. He is also the medical officer for the SIREN emergency care research network which is supported by both NINDS and NHLBI. Jeremy.brown@nih.gov
“If a study is going to involve several sites, or involve additional tests, medications or follow up, you will almost certainly need funding — and often you will need quite a lot of it. ”
It was three years ago, Monday, January 13, 2020 and I was nearly two years into my academic medicine journey, with a budding interest in simulation as a teaching tool for medical education. On that day, I had a phone meeting with a virtual reality (VR) software company, hoping to discover a simulation program to use for resident education in emergency medicine. My budget was $0 but my curiosity was incalculable.
I listened with great enthusiasm as they described their virtual simulation program and was immediately ready to sign up. But my jaw dropped when the final cost was revealed, and I realized that I would need tens of thousands of dollars to fund this journey — and that was just for an annual lease.
When the price for this software was unveiled, I realized immediately that this Mississippi educator was completely out of her financial league. So I spent the remainder of 2020 searching every virtual simulation product that I could find, looking for a good fit. After months of meetings and demos, I learned a ton about the world of virtual simulation and quickly realized that there was no such product that would meet all my needs. This year-long search was challenging and exciting but solidified the three characteristics that I desperately needed in a software product for virtual simulation: affordability, adaptability, and accessibility.
Everything I tried would have one of or two of these attributes, but none
of them had them all. The solution? I decided to develop my own program. And why not? When you’re starting from ground zero, you might as well shoot for the moon!
So 2020 came and went and the pandemic loudly underscored the critical need for all of us to re-examine how, where, and why we teach in health care training. Through all my demo-ing and sticker shock, I quickly learned that the economic hurdles of quality medical education are almost as insurmountable for the low budget or no-budget clinical educator as the medical-industrial complex is to an uninsured patient.
By Spring of 2021, I remained wideeyed and optimistic that if an affordable,
adaptable, accessible program didn’t exist then, by damn, I would make one myself. The unique necessities of the pandemic facilitated funding for pandemic-proof medical education, and that’s when my institution entrusted me with funding, made available from the Higher Education Emergency Funds 2 Act (HEERF 2). By this time, a seasoned clinician, simulation educator and researcher from Children’s Hospital of Los Angeles, Dr. Todd Chang, introduced me to a London-based medical education software developer, named AiSolve. The branch of AiSolve that specializes in meded VR software development was i3 and, once I had secured funding from HERRF 2, we were off to the races.
I spent $390,000 on the software and $20,000 on hardware to build SimGym, the software that I envisioned would hold my three A’s for educators such as myself: affordability, adaptability, and accessibility. It is now January 2023 and SimGym is well underway. We began development in November 2021 and
although things are moving slower than I expected, I have full faith that my i3 team and I will build something unique, great, and fabricated from the 3 A’s that form the cornerstone of this learning tool.
Since those early days in 2020, I have grown in my appreciation for simulation as an invaluable teaching and learning tool. SimGym will hopefully form the cornerstone of how I teach, outside of the clinical setting and allow others the same opportunity for affordable, adaptable, and accessible simulation.
Dr. Tarver is an assistant professor of emergency medicine and medical co-director of simulation at the University of Mississippi Medical Center, Jackson, Mississippi
One of our 30 Metahumans in an ER Resuscitation Bay
UMMC ER Faculty Presenting Sim Gym at the International Meeting for Simulation in Healthcare in Orlando Florida (1/23/23)
Dr. Tarver (UMMC Faculty and Sim Gym developer) Trying Out Additional VR Software at the 2022 International Meeting for Simulation in Healthcare in Los Angeles, California
“... I quickly learned that the economic hurdles of quality medical education are almost as insurmountable for the low budget or no-budget clinical educator as the medical-industrial complex is to an uninsured patient.”
Let’s start with a case…
You presented an article during journal club last week that is a game-changer. It showed definitively that intravenous contrast for computed tomography is safe in every patient (BTW, no such article exists, although the evidence is strong for this view — see Dr. Farkas' EmCrit article). You are excited about this and explain to your attending that Mrs. Anderson in room seven can safely receive IV contrast for the pulmonary embolism (PE) study she needs. Your attending laughs and says, “There’s no way radiology will do that study. Her creatinine is 1.9!”
Crestfallen, you cancel her CT and admit her to the floor so she can be “rehydrated.”
There are countless examples like this vignette, in which clinical policy and practice does not reflect the current state of the literature. If you have listened to Ken Milne, the skeptical host of Skeptics Guide to Emergency Medicine (SGEM), you have likely heard that it takes greater than 10 years for high quality evidence to make it from publication to the bedside. The research is poorly developed, but translation from research into clinical practice can take as long as 17 years (Morris, 2013). One might think that with increased engagement of learners and clinicians with high quality free open access medical education (FOAM) that
the lag between paper and practice should decrease. We don’t know, because studies that evaluate the success of blogs, podcasts, and social media measure short term knowledge translation rather than patient-related outcomes.
One goal of the SGEM podcast is to decrease the knowledge translation gap from over 10 years to less than one year. Many other emergency medicine (EM) blogs, podcasts, and social media accounts have similar goals, but we’re not sure that knowledge acquisition is the rate-limiting factor when turning research advances into clinical medicine. Like most things, the problem is complex. In the example of pulmonary embolism, we know
that using a Well’s score, the PERC (Pulmonary Embolism Rule Out Criteria) rules, and a d-dimer can lead to exclusion of PE with high confidence, but this approach languishes in the face of the CT scanner. Westafer et al., (2020) investigated some of the reasons why and found that risk tolerance, need for diagnostic certainty, subject knowledge, confidence in gestalt, time pressure, and lack of institutional resources were some of the reasons that practicing physicians ordered CT imaging when it may not have been indicated. We think the biggest reason is that work — the hard work of educating staff, building a plan, getting buy-in from administration, shepherding policy through hospital committees — is difficult and time demanding. We’ve worked on projects to translate research into practice many times, from acetaminophen overdose protocols to removing Xopenex (levalbuterol) from formulary, and have seen both successes and failures. For the rest of this article we will focus on two initiatives at our shop, one that didn’t work and one that did, and give tips for ways to help translate evidence into practice.
Imagine you’re an emergency physician who has been passionate about hospital crowding since internship. You know that crowding is multifactorial and that your department diligently implements best intradepartmental practices for crowding. For example, you assign patients to rooms immediately, triage in the rooms, physicians meet ambulance patients when they arrive and order beds early in the workup. The department remains overrun, with boarded patients taking up most of your beds, so that new patients go to the waiting room, the hallway, or languish on ambulance cots. It’s dangerous for patients to be in those places (Kelen, 2021), and you decide to join a hospital committee to work on hospital wide initiatives to reduce crowding. This committee includes the CEO, CFO, every major administrator in the hospital — and you. You are sure you know what to do: change hospital policy so that the house is kept at 90% of capacity or less rather than full all the time. Unfortunately, you don’t engage
stakeholders, learn about barriers, or consider individual and group priorities, and the initiative evaporates into a complicated, full capacity plan that is difficult to implement. The hospital remains crowded, which harms patients, providers, and the bottom line.
The second scenario involves the creation of a vancomycin usage reduction initiative using nasal MRSA (methicillin-resistant Staphylococcus aureus) swabs as a decision point. This was another hospitalwide initiative, requiring buy-in from the burn center, critical care, surgery, the ED, pharmacy, and administrators worried about reduction in profitable services. This time, you engage stakeholders early, find out what is possible, and create measurable goals that align with the values of the group. The initiative begins with provider education, is evaluated by both process (MRSA swabs) and outcome (vancomycin use-days/1000 patients) measures and is shown to be budget neutral or positive. Within a year the team cuts vancomycin use at the hospital in half, with some evidence of decreased length of stay for some patient categories.
So, what’s the difference? It’s having a plan. Policy change happens when opportunity meets preparation. This means not just knowing what best practices are but also understanding the dynamics of the organization and the personalities involved. This allows an initiative to be timed to the needs of the organization as circumstances change. For example, a worrisome increase in vancomycin resistant pathogens across service lines created an opportunity for change without resistance from physicians used to a certain practice pattern. You must strike when the iron is hot as windows of opportunity like this do not last. Inertia is a powerful force, and a desire not to change, or to let someone else be the agent of change, is hard to resist. When you are developing the specifics of an intervention, it’s wise to be SMART in program design: Specific. Your goal should be concrete, narrow, and…
Measurable. You should be able to measure both process (what we did) and outcome (what happened to patients)
Achievable. Does the organization have the resources (human, technical, financial) to pull off the intervention? Do key stakeholders agree? Can resistance be overcome?
Relevant. Is there an institutional need for the intervention? Will the project get resource priority?
Time sensitive. Is it the right time for this change? How long will it take? Do the results over time add value, improve processes, or save lives?
SMART design was first conceptualized by Peter Drucker in 1954 and has stood the test of time, but the point is to have a systematic framework for reaching your goal. Most readers of this article understand this intuitively — it’s hard to be successful in medical school without a plan. Reaching one’s goals without a plan may not happen, or will take longer, or cost more. This is true for translating research into practice as well, which is one reason why it takes a decade for game-changing research to translate into lifesaving practice. All of this leads to the conclusion that ED physicians should be involved in changing practice at their hospitals. We are used to complicated problems, resolving interpersonal differences, and managing a team. So, join a hospital committee. Talk to the CEO. Design a plan for your personal research-to-practice desires. You might save some lives.
Dr. Milman is an assistant professor of emergency medicine and associate residency program director at the University of Oklahoma School of Community Medicine in Tulsa, Oklahoma..
Dr. Gentges is an associate professor and the research director for the University of Oklahoma's Department of Emergency Medicine.
“Policy change happens when opportunity meets preparation”
This research focus is an initiative by the SAEM Research Committee to highlight research presented by students and residents at SAEM regional and national meetings. All the projects below were presented at 2022 SAEM Great Plains Regional Meeting at Medical College of Wisconsin, in Milwaukee.
Jamie Jasti, Jonathan Birdsall, Jennifer Hernandez-Meier, Julie Owen, Amy Zosel, Jeffrey Liu
First author
Jamie Jasti is the immediate past resident member of the SAEM Board of Directors and a third-year in the Department of Emergency Medicine at the Medical College of Wisconsin (MCW). He will be graduating this summer and staying on as faculty as the assistant director of the Resuscitation Research Center at MCW with Dr. Tom Aufderheide.
Author conclusion: This education module utilizing an evidencebased emergency department (ED) buprenorphine induction pathway with EMR integration changed the attitudes of emergency medicine physicians towards buprenorphine treatment and demonstrated an
increase in willingness and confidence to prescribe it.
Most rewarding aspect of my work on this project: Working to translate this proven intervention to actual changes in behavior and practice that will benefit our patients with opioid-use disorder.
Alexandra Center, Helena Ikenberry, Rebecca Schwei, Thomas Schneider, Michael Pulia
Alexandra Center is a second-year medical student
at the University of Wisconsin School of Medicine and Public Health in Madison, WI.
Author conclusion: This is the first study to compare diagnostic accuracy of cellulitis in patients with different skin pigmentations. We calculated a point estimate indicating lower odds of diagnostic accuracy of cellulitis in patients with dark skin pigmentation as compared to light skin pigmentation. While not statistically significant, our findings support further investigation of this relationship with studies that include a more balanced representation of skin pigmentation and a larger sample size across all pigmentation levels.
Most rewarding aspect of my work on this project: Learning more about the process of creating a research question and conducting data analysis, as well as bringing attention to racial health disparities in the diagnosis of dermatologic conditions.
Deep Patel, Samantha Boettcher, Nancy Jacobson, Jamie Aranda
Deep Patel is a second-year medical student at the Medical College of Wisconsin located in Milwaukee, Wisconsin. His current academic interests are centered around quality improvement and patientcentered clinical research.
Author conclusion: Emergency physicians attributed consultant delays to consultant-specific behaviors (e.g., batching), poor communication and inappropriate use of emergency department (ED) resources. Efforts to improve consultant interactions with the ED could focus on clarifying expectations for consultant response times, enhanced communication, and education regarding appropriate use of the ED.
Most rewarding aspect of my work on this project: Sharing this work regionally and with departmental and hospital leadership has prompted productive conversations and process improvement projects impacting patients in the ED.
Cole Wymore, Pam Hoogerwerf, Kristel Wetjen, Charles Jennissen
Cole Wymore is a second-year medical student at the University of Iowa Carver College of Medicine. Before starting medical school, he spent two years working in the emergency department at University of Iowa Hospitals and Clinics conducting clinical research. Cole’s academic interests include injury prevention, sepsis care, and he is interested in pursuing a career in emergency medicine.
Author conclusion: Issues of hospital workplace violence focusing on high-risk departments and healthcare providers have been well described; however, our analysis showed that other hospital workers, including those who do not provide patient care, are also at risk for workplace violence and the associated negative consequences.
Most rewarding aspect of my work on this project: Having the opportunity to continue to learn and develop my research skills under great mentors and contribute to work that will hopefully improve the hospital work environment for all people.
Neema Mbele, Zoey Chopra, Joel Moll, John Burkhardt, Daniel Hekman, Marcia Perry, Ryan E. Tsuchida
Neema Mbele is a second-year medical student at University of Wisconsin School of Medicine and Public Health.
Author conclusion: From our study, we were able to deter-
mine the current landscape of diversity, equity, and inclusion (DEI) leadership in emergency medicine (EM). The first phase of the study revealed that there are many DEI leaders in academic EM. In the second phase, we will be capturing the demographics, roles, and responsibilities of these DEI leaders.
Most rewarding aspect of my work on this project: Bringing awareness about the importance of establishing a robust diversity, equity, and inclusion infrastructure in emergency medicine. My hope is for there to be stronger supports in place within academic medicine that will show aspiring underrepresented in medicine (URiM) students that there is a place for them and for current URiM students, that they do belong.
Lisa D. Bell, Daniel P. Runde, Brooks Obr, Cory Wittrock
Lisa Bell is a first-year resident physician in emergency medicine at Harbor UCLA in Torrance, CA. She completed medical school at the University of Iowa in Iowa City, IA, where this project was completed when she was an fourth-year medical student. Her academic interests include medical education, global health, and critical care.
Author conclusion: Most medical students desire early exposure to ultrasound education in both preclinical and clinical phases of training and believe it will have a positive impact on their educational experience. Preclinical students most desired expansion of this curriculum into physical exam skills sessions and gross anatomy; while clinical students most desired creation of a dedicated advanced ultrasound elective, as well as increased integration into their core rotations.
Most rewarding aspect of my work on this project: By conducting this student needs assessment, I had the opportunity to be an advocate for my peers’ educational needs and be a part of implementing real-time curricular change.
Deep Patel Neema Mbele Lisa D. Bell, MD
By Jeremy Towns, MD, on behalf of the SAEM Sex and Gender in Emergency Medicine Interest Group
The recently televised medical tragedy that struck NFL Buffalo Bills safety Damar Hamlin has put cardiac arrest at the forefront of current national health care conversations — and that conversation should include the sex differences seen in out-of-hospital cardiac arrest and cardiac arrest outcomes.
Commotio cordis specifically has been documented overwhelmingly in adolescent boys and young men. The predominance of males may be partially explained by more significant numbers of males involved in sports where commotio cordis is a risk; however, it has also been speculated that there may be sex-related genetic
susceptibility related to cardiac ion channel differences and/or sex hormone influence
Significant sex differences have been noted in other types of out-of-hospital cardiac arrest as well. A study published
in Circulation, which included only patients successfully resuscitated, found that women were more likely to present in nonshockable rhythms, pulseless electrical activity and asystole, as compared to men. Despite this, women
“...even when women are adequately resuscitated, they are less likely to survive to hospital discharge when compared to their male counterparts .”
were more likely than men to experience return of spontaneous circulation with resuscitative efforts. Unfortunately, however, women are less likely to receive bystander resuscitative measures, such as CPR. Researchers have theorized that this gender-related discrepancy may be influenced by bystanders shying away from chest compressions because of social stigma or fear associated with touching a woman’s breasts.
With regard to outcomes, even when women are adequately resuscitated, they are less likely to survive to hospital discharge when compared to their male counterparts. This may be due to women being less likely to receive post-arrest
guideline appropriate therapies such as coronary angiography and targeted temperature management. Women are also more likely to have a “Do Not Resuscitate” or “Withhold Life Sustaining Therapy” order placed. These sexspecific differences in treatment and outcome may be, in part, due to female cardiac arrest victims typically being older than their male counterparts, which may confer additional comorbidities and fragility.
Certainly, more sex-specific research is needed to better understand the observed differences in all types of out-of-hospital cardiac arrest. A better understanding of the sociocultural, biological, and genetic
variables which may be impacting etiology and outcomes could influence prehospital and emergency postarrest care. A better understanding of the sex differences in out-of-hospital cardiac arrest could have profound implications on neurologic survival outcomes for men and women.
ABOUT THE AUTHOR
Dr. Towns is a third-year emergency medicine resident at the University of Alabama at Birmingham.
“...women were more likely to present in nonshockable rhythms, pulseless electrical activity and asystole, as compared to men.
Despite this, women were more likely than men to experience return of spontaneous circulation with resuscitative efforts.”
Written by Jasmine Y. Gale, MD, and edited by Jacqueline Furbacher, MD, and Payal Modi, MD, MPH, on behalf of the SAEM Social Emergency Medicine and Population Health Interest Group
A disheveled 68-year-old male in no acute distress presented with chest pain. The EKG was nonischemic. The history was inconsistent. He interjected to ask for a sandwich because he hadn’t eaten in three days, and my concern for a medical emergency instantly decreased. I asked where he lived, and after asking three different ways, I finally learned he was sleeping on “the streets.”
I reviewed his chart and, as expected, found no recent emergency department (ED) visits. Instead, I discovered that he had an extensive cardiac history. The
concern for a true medical emergency now rose back up on my differential, and he was appropriately worked up for his chest pain. The workup was negative, and he was medically cleared to be discharged home. Now what?
As I make the transition from medical student to emergency medicine (EM) resident physician, competing demands have felt like they have skyrocketed, and with them, so have feelings of defeat, overwhelm, and helplessness. As a medical student, I would have easily spent an hour with this patient, hearing his story, discussing why he
wasn’t taking his medications, and offering resources. While fourth year of medical school is about learning the medicine and maximizing patient care, intern year is about learning the medicine, balancing multiple active patients, and become efficient at doing so, without sacrificing patient care. Priorities shift to learning to think about disposition and department flow. The reality is that there is a waiting room of 30 patients, the orthopedic consult is finally on the phone for your patient next door, you still haven’t gotten around to repairing that facial laceration, and yet another patient is attempting to leave against medical advice. We are trained
exceptionally well in how to approach chest pain, but we can flounder when it comes to addressing social determinants of health. How do we ensure that this patient gets the care he needs, without letting another patient fall through the cracks?
On any given night in 2020, 580,000 individuals experience homelessness in the U.S., and this number has been increasing for four consecutive years. The most recent available statistic demonstrates that in 2017, ED prevalence of unhoused individuals or individuals at risk of being unhoused in
the U.S. was 10.1%. It’s important to note that unhoused does not necessarily mean living on the street. Individuals without stable housing, such as those “couch surfing,” living in their car, or staying with friends or family also constitute homelessness, and most of these individuals are without stable housing only temporarily It’s easy to identify the disheveled patient with a shopping cart full of tattered bags as someone without stable housing, but anyone, regardless of how they appear, can be housing insecure. Patients experiencing housing insecurity utilize the ED at higher rates than the general population. They tend
to be sicker than the general population and have more chronic conditions. Moreover, life expectancy of individuals experiencing homelessness is 25 years less than the general population. Some individuals without stable housing come to the ED for temporary solutions to social needs (e.g., a sandwich or warm bed) yet these can be some of the sickest patients in the ED due to their chronic illnesses, difficulty accessing preventative care, and exposure to environmental elements. In fact, it’s far more likely that patients with housing insecurity will
continued on Page 52
“It’s easy to identify the disheveled patient with a shopping cart full of tattered bags as someone without stable housing, but anyone, regardless of how they appear, can be housing insecure.”
continued from Page 51
avoid seeking medical care until the absolute last minute for a variety of reasons: competing priorities such as shelter and food, past mistreatment, mistrust, financial trouble, or lack of transportation. By the time these patients finally get to the ED, they are often acutely ill with advanced disease. While addressing social determinants of health in the ED is gaining traction, most emergency medicine residency programs have yet to implement a formal curriculum. After spending time in my community, I have observed some strategies — both on and off shift — for addressing housing security within the realistic time constraints.
Ask about housing
Here is a simple, nonjudgmental question that takes only seconds to
ask: “Where are you staying these days?” Learning and using this phrase allowed me to identify patients who were experiencing homelessness, even transiently. Asking every patient this same question limits potential stigma and bias and normalizes the importance of housing to health. While it’s unlikely to find the patient immediate stable housing, understanding housing has changed how I handle a patient’s
discharge plan. Considering prescription cost, follow up, and management of chronic wounds are a few specific areas that I may adjust to better support a patient’s adherence.
Utilize interdisciplinary health care staff
Social workers are experts in community resourcing and are better equipped to match resources to an individual’s need with regard to shelter, substance use
“While addressing social determinants of health in the ED is gaining traction, most emergency medicine residency programs have yet to implement a formal curriculum.”
treatment, mental health counselling, food, insurance, and transportation. Furthermore, social workers may be able make calls to community resources to directly connect patients with an open shelter bed.
Barriers to medication adherence for unhoused individuals include cost, complicated instructions, dose frequency, and theft. Pharmacists are an additional asset in these situations, especially when a patient needs instruction on a specific medication such as using an inhaler. Pharmacists also often know the cheapest prescription option, which medication has the lowest dose frequency, and which has the simplest instructions. A strategy I learned to help prevent medication theft is to prescribe smaller quantities more frequently.
Medical students are another valuable resource toward better understanding of a patient’s story and specific needs. I know that as a student, I would have jumped at this opportunity!
Understanding primary care community resources for housing insecure patients
Familiarizing myself with community resources outside the clinical environment has changed how I practice and improved my ability to care for patients on shift. For example, mobile primary health care clinics provide consistent care access for housing insecure patients and seek to build therapeutic patient relationships outside the traditional clinic setting. Other organizations focus on addressing the trimorbidity of housing insecurity, substance use disorder, and mental health disorders with multidisciplinary care models. Each community resource is unique and learning what’s available in the local area may increase access to care and impact patients in real-time while on shift.
Recognize how to support patients in staying out of the hospital
Medical respite facilities provide temporary housing for individuals who are not sick enough to be admitted to the hospital but are too sick for a shelter. Many shelters require residents to leave during daytime hours, making following discharge instructions for wound care and rest particularly difficult and puts individuals at risk for wound infections and increasing morbidity and mortality. Medical respite facilities can help decrease these risks.
Cultivating a supportive culture is paramount to wellness. Many of us choose emergency medicine because it’s the only specialty that treats anyone who walks through the door, anytime; however, when the same patients walk through that door repeatedly, it can be frustrating. Increased ED volumes and time pressures can exacerbate these feelings. Acknowledging feelings like these and creating spaces to debrief have been key in remembering my own
humanity and that of my colleagues and, most importantly, my patients.
Homelessness and chronic conditions are connected in a vicious cycle — having a chronic illness can lead to homelessness, and homelessness can lead to being unable to care for the chronic illness. While these strategies, do not address the root causes to housing insecurity, they are practical tools to support residents both on and off shift. The ED is uniquely positioned to have access to individuals experiencing homelessness; this also means we, as EM physicians, are in the unique position of being able to do something about it — and that is exactly what we should be doing.
Dr. Gale is an emergency medicine resident at the University of Massachusetts in Worcester, MA. She completed medical school at Tufts University in Boston, MA.
Dr. Furbacher is a second-year emergency medicine health equity fellow at University of Massachusetts in Worcester, MA. She completed her emergency medicine residency at The Ohio State University and medical school at The University of Texas Health Science Center at Houston.
Dr. Modi is an assistant professor at University of Massachusetts Chan Medical School where she serves as the director of the health equity division and fellowship. Dr. Modi is the co-chair of the SAEM Social Emergency Medicine and Population health Interest Group.
“The ED is uniquely positioned to have access to individuals experiencing homelessness; this also means we, as EM physicians, are in the unique position of being able to do something about it.”
Moral injury as a term used to describe the psychological, emotional, and spiritual harm resulting from participating in or witnessing acts that violate one’s deeply held moral and ethical values.
For many of us, moral injury happens not infrequently while working in the emergency department (ED); however, moral injury is not synonymous with burnout. On February 7, 2023, the SAEM Wellness Committee sponsored a national webinar, Moral Injury: What It Is, What It's Not, and What We Can Do About It. The webinar explored how moral injury manifests at work, how it impacts us, and how we may act as individuals and institutions and start healing from it. Healing requires that we name and recognize moral injury.
Participant engagement during the webinar allowed us to learn more about
the extent of impact moral injury has in our practice. It was empowering and disheartening to hear and see reverberations of experiences shared throughout the hour. We also learned collective strategies to combat moral injury.
While searching the PubMed database for “moral injury” yields 578 results, adding “mitigation” narrows the results to five. Despite limited data, our webinar showed that everyone understood and had experienced a moral injury. Here are some ways webinar participants described moral injury:
“When we don’t intervene in a situation when we know we should, we feel guilty.”
“When we struggle with the duty to maintain standard of care when it may not be in line with our beliefs.”
“When what we are asked to do conflicts our personal ideology or values or ethics.”
“Not delivering care as we know we could.”
“Doing what feels wrong.”
“Accumulation of moral distress, betraying myself to do something else for others.”
Beyond sharing our collective experiences of moral injury, we also learned about barriers to addressing it.
First, everyone has unique needs; therefore, no strategy works for everyone. Risk factors, protective factors, and the context and environment within which a person experiences moral injury add to the variability. It does not help that the emergency department is considered a VUCA environment, with a constant flux of volatility, uncertainty, complexity, and ambiguity.
In a field where we bolster decisions with evidence and science, it is challenging when no robust scientific data addresses a relatively ubiquitous experience of moral injury among physicians. (see figure 2)
Drs. Wendy Dean and Simon Talbot, founders of the Moral Injury of Healthcare organization, describe moral injury as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints
that are beyond our control.”
In their paper, they shared strategies they have observed in their careers. One suggestion is for physicians to form relationships with administrators to facilitate shadowing opportunities and workplace empathy.
“An administrator shadows a physician to get a unique perspective on their ED staff. This signals a commitment from leadership to offer support to its employees. I was drawn to this idea as it was a method I saw in practice. Seeing one of the administrators in the trenches with us was inspiring.”
The paper also suggests that physicians take part in political organizations. While it can be frustrating to witness the slow wheels of the political system without physician representatives at the table, the decisions are made without the voice of the day-to-day challenges emergency department physicians experience.
The webinar also highlighted the need for creating spaces to acknowledge and address moral injury, even on shift. For example, think back to when you were a trainee and felt you had no voice or power to make actionable changes. Do you remember that attendee who
stood up for something with you and how that made you feel empowered and supported? As individuals, we can leverage our roles in health care and start modeling this behavior of advocacy and allyship. We can do so on every shift.
One colleague shared that it is not merely “delivering care as we know we could”; it is also navigating “the conflicts between the stated organizational mission and values and what actually happens in our day-to-day practice.”
This requires a level of vulnerability from attending physicians who are willing to share their challenges and acknowledge the compromises in their decision-making. For example, instead of simply continuing to chart on the patient while addressing your moral distress internally and alone, share with your nurses, residents, and medical students how that ethically “gray” case made you feel.
Chances are, that if you felt you somehow transgressed your own values, so did other team members. Sharing this experience may not only create a sense of community, but it may also spark
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some creative solutions that lessen or even avoid the sense of betrayal that was experienced. Perhaps then everyone can go home feeling less guilty about decisions being made at work while managing an overcrowded waiting room, addressing the impacts of social determinants of health and other health care inequities, or simply compromising our own well-being at the expense of caring for our patients.
In an overcrowded, resource-limited environment, the burden of addressing moral injury cannot rest on the backs of emergency physicians tasked with caring for patients who are presenting at their worst. Health care leaders have a critical role to play in protecting their teams. Ensuring that the organization's mission and values are aligned with the realities of the job is vital to reducing moral injury. As another participant shared, moral injury is “doing the ‘best we could,’ instead of doing the best.
Policies should support clinicians who do the right thing for patients, and resources, including technology, should be provided to help staff do their jobs. Transparency in decision-making and clear, consistent messaging may reduce moral injury.
Everyone wants to feel appreciated by their organizations. Beyond recognition for the work, this means having equitable policies on staffing ratios, scheduling flexibility, and staff redeployment. In other words, support means arming clinicians with necessary and appropriate resources and respecting them for their training and potential without expecting more than is reasonable.
Given the importance of community in reducing the impact of moral injury, leaders must continue to foster mutual respect and collaboration among teams. Initiatives like interdisciplinary ethics rounds and reflective debriefings are emerging as strategies for reducing moral distress, but more research is needed to determine the optimal use of these tools.
Where do we go from here?
To begin to heal as a specialty and as individuals, we must acknowledge and understand the impact of moral injury. Moral injury is not the same as burnout, but moral injury can lead to burnout. Moral injury is “what happens when you can’t do what you know is right.” Repeated instances of moral distress leads to moral injury, leaving a residue on us that accumulates over time.
Each of us has a role to play in addressing moral injury. It can start with knowing what is within and beyond our control. We can name the problem and work on creating solutions at the system level instead of simply applying ad hoc patches. As emergency physicians, we’ve learned to navigate uncertainty, making us more susceptible to just taking the emotional hit, compartmentalizing it, and seeing the next patient or showing up to our next shift. This is not sustainable. Together, we can learn better ways of tackling moral injury.
Join us in Austin at SAEM23 on Thursday, May 18, 2023, from 1:00 PM – 1:50 PM local time to explore more about the topic. In the meantime, check out our next Wellness Committee webinar, Beyond Burnout: Achieving Personal and Professional Fulfillment, April 11, at 1 p.m. CT.
Stephanie Balint is a secondyear, EM-bound medical student at Quinnipiac University, Hamden, Conn., Class of 2025. @stephfosterski1
Dr. Karalius is a clinical instructor in emergency medicine and a medical education scholarship fellow at Stanford Emergency Medicine. @vytaskaralius
Dr. Ritchie is a second-year internal medicine/emergency medicine resident at Louisiana State University, New Orleans.
Dr. Alvarez is director of wellbeing at Stanford Emergency Medicine and chair of the SAEM Wellness Committee. @alvarezzzy
Dr. Bitter is associate professor in the department of surgery, division of emergency medicine, at St. Louis University, Missouri.
Dr. Kontrick is associate professor of emergency medicine and medical education at Northwestern University Feinberg School of Medicine, Chicago.
Dr. Deutsch is a clinical instructor in emergency medicine and an emergency medicine wellness fellow at Stanford Emergency Medicine. @amandajdeutsch
SAEM23 is packed with opportunities to expand your knowledge on critical physician wellness topics. It’s also a great way to expand your community! While our specialty is extremely rewarding, what we do is also challenging and greatly demanding. The didactic sessions offered at this year’s annual meeting address issues that often compromise our physical and mental health, lead to burnout, and in extremes, physician suicide. The SAEM Wellness Committee offers a wonderful opportunity to learn how each of us, individually and as a community, can be part of the change in the culture of academic emergency medicine. Check out and plan to attend some of the engaging lectures being offered at SAEM23 that cover career building, mental health, moral injury, self-advocacy, resource utilization, creating a sense of belonging, and much more!
Wednesday, May 17
2:00 PM–2:50 PM CT The Emergency Physician and Suicide: Do No Harm to Yourself – Lone Star Ballroom F: Level Three
3:00 PM–3:50 PM CT Building Vitality and Sustainability in an Academic Career Amid Rising Burnout in Emergency Medicine – Lone Star Ballroom F: Level Three
3:00 PM–4:50 PM CT Workplace Appreciation: The Power of Feeling Valued in the Era of Quiet Quitting – Lone Star Ballroom D: Level Three
4:00 PM–4:50 PM CT Negotiating Favorable Hospital Policies for Pregnant and New Parent Physicians in Emergency Medicine – Lone Star Ballroom G: Level Three
1:00 PM–1:50 PM CT The Acting and Theater Focused FUN Workshop to Improve Connectedness With Yourself and Your Patients – Lone Star Ballroom C: Level Three
1:00 PM–2:20 PM CT Exploring the Evolving Landscape of Resident Unionization – Lone Star Ballroom D: Level Three
Thursday, May 18
2:00 PM–2:50 PM CT Reframe the Education Alliance with Collective Advocacy: Maximize the Learning Environment for Educator and Unions – Lone Star Ballroom H: Level Three
12:00 PM–12:50 PM CT Making the Most of Your SAEM Membership – Lone Star Ballroom C: Level Three
1:00 PM–1:50 PM CT Moral Injury: Definitions, Triggers, and Treatment – Lone Star Ballroom G: Level Three
1:00 PM–1:50 PM CT #StopTheStigmaEM: Shining a Light on the Hidden Mental Health Experiences of Emergency Physicians – Lone Star Ballroom D: Level Three
5:00 PM–5:20 PM CT “I Have a Therapist and You Should Too”– Lone Star Ballroom A & B: Level Three
3:00 PM–3:20 PM CT Outside the Box: Peer Support Structures for Emergency Medicine Physicians– Lone Star Ballroom D: Level Three
Friday, May 19
8:00 AM–8:20 AM CT Challenging Conversations When Time Is (Always) Tight: 3 Communication Frameworks to Use in A Pinch – Lone Star Ballroom: E: Level Three
8:30 AM–8:50 AM CT Switching Jobs In Academic Emergency Medicine: Fast Tips to Avoid Bungling a Job Change – Lone Star Ballroom G: Level Three
11:00 AM–11:50 AM CT Dark nights, Dark Moods: Workforce Solutions to Circadian Disruption, Cognitive Impairment, and Fatigue Management – Lone Star Ballroom G: Level Three
11:00 AM–11:20 AM CT Safe in the Storm: Using Psychological Safety to Improve Bedside Feedback – JW Grand Ballroom 4: Level Four
12:00 PM–12:20 PM CT Inclusion and Not Assimilation: Why Fitting In is Not Enough to Advance Diversity and Equity – JW Grand Ballroom 2: Level Four
By Richard Wolfe, MD, on behalf of the SAEM Wellness Committee
After returning from vacation in March 2020 to find her department drastically changed and then overseeing the treatment of COVID patients early in the pandemic, Dr. Lorna Breen was afraid to seek care for severe depression. Fears of being scorned by her peers or the risk of losing her medical license made her reluctant to access the help she needed. Despite receiving inpatient mental health care, Dr. Breen ultimately died by suicide. After her death, the Department of Emergency Medicine at Columbia University implemented a well-promoted process allowing providers easy access to anonymous mental health care. In the first year, most
of the department used the service. It’s most likely that the tragedy of her death and the additional loss and grief witnessed from the pandemic may have been the catalyst for the exceptionally high use of the service. In subsequent years, the number using the service has dropped. Now, as we’re shifting gears with the pandemic, we need to be more vigilant about emphasizing and normalizing receiving mental health support because even at its nascent stages, many have anticipated the pandemic’s toll on the mental health of health care workers.
Dr. Angela Mills, J. E. Beaumont professor and chair of the departmentof emergency medicine at Columbia University Vagelos College of Physicians and Surgeons, was unsure if the drop in use was in part because some of the providers seen the first year were already engaged in regular mental health care. It is also possible that without constant vigilance, encouragement, and normalization, personal concerns about the professional consequences of seeking mental health will reestablish themselves. As Dr. Mills stressed, mental health care checks for providers should have no more stigma than a check-up with one’s primary care physician or getting a routine vaccination.
At Beth Israel Deaconess Medical Center, when we set up and promoted free and anonymous mental health care for physicians, I followed up with Physician Health Services a month later to see what percentage of my staff had used the service. Not a single emergency provider had presented to them. Six months later, only a tiny percentage had signed up. Even when one overcomes the institutional and regulatory barriers and the service is highly promoted, self-bias remains the most pernicious impediment to access treatment for mental health issues.
For years, despite a high rate of depression and burnout, we’ve known that physicians are notoriously reluctant to self-report mental health issues. In a paper published in 2021, the Department of Emergency Medicine at UC Davis implemented an advanced program for attendings and residents to help with depression. It was only used by a small percentage of the staff, highlighting the challenges of engaging providers. This contrasted with the satisfaction of the minority of physicians who successfully engaged in a treatment referral program.
Self-bias is a significant barrier to accessing mental health care. Canadian centers have developed simple tools such as the Mental Health Continuum to allow clinicians to self-assess their mental health. This has shown moderate reductions in stigma and increased selfreported resilience and coping abilities.
The COVID pandemic has made it clear to everyone the dangers to frontline providers of fatigue, depression, burnout, and suicide. Three years into it, we still lack the knowledge of how best to destigmatize access to mental health as burnout continues to rise. The Lorna Breen Foundation was the first to raise money to create grants and start addressing some of these issues. Superb advocacy by the Lorna Breen Foundation and others has paved the way for bipartisan support to provide considerable funding to The Dr. Lorna Breen Health Care Provider Protection
A critical component in decreasing stigma is sharing stories and normalizing speaking about these mental health experiences for peers and trainees. As part of this, at SAEM23 this May in Austin, TX, a group will be gathering to share such stories anonymously. We need your help, and invite you to submit an anonymous story of your personal experience with mental health challenges here: Share_YOUR_Story
Act, signed by President Biden on March 18, 2022. Specifically, it includes ambitious funding goals to improve the care and well-being of our physicians, nurses, and other healthcare workers:
• Establish funding to train health profession students, residents, and health care professionals on evidenceinformed strategies that reduce and prevent suicide, burnout, mental health conditions, and substance use disorders, as well as improve well-being and job satisfaction
• Establish grants intended for employee education, peer-support programming, and mental and behavioral health treatment, with healthcare providers in “current or former COVID-19 hotspots” receiving precedence
• Identify and distribute evidenceinformed best practices for reducing and preventing suicide and burnout among healthcare professionals and promoting mental and behavioral health and job satisfaction
• Create a national evidence-based education and awareness campaign geared toward healthcare professionals that urges them to seek support and treatment for mental and behavioral health concerns
• Develop a comprehensive study of health care professionals’ mental and behavioral health and burnout, including the understanding of the impact of the COVID-19 pandemic
This support is needed to expand our knowledge of how to best ensure the well-being of the clinicians and to implement the changes that will provide the effectiveness of the safety net of the U.S. health care system. All the benefits will result in the retention of a highly qualified workforce and better care by keeping clinicians fully engaged in delivering the highest quality care to our patients.
Chairs and leadership in emergency medicine need to engage in methods to destigmatize mental health care actively, not just sporadically but as part of a continuous effort to ensure the wellbeing of our staff. As in other areas, we need to provide training in recognizing and overcoming biases that threaten physicians and nurses and impair our ability to deliver high-quality care.
For more information on #StopTheStigmaEM, please check out our website, as well as our social media efforts using the hashtag
Dr. Wolfe is chief of the department of emergency medicine at Beth Israel Deaconess Medical Center, Boston MA, and past chair of the SAEM Wellness Committee.
"Chairs and leadership in emergency medicine need to engage in methods to destigmatize mental health care actively, not just sporadically but as part of a continuous effort to ensure the well-being of our staff.”
Thanks to a cohort of dedicated SAEM members — the Annual Alliance — the SAEMF is making a large research investment in our specialty’s future. This group of generous members is forging a philanthropic coalition that will lead to more discovery and launch the careers of future research leaders who will advance emergency care and carry forward the specialty.
Annual Alliance donors are the key to SAEMF’s investment of close to $850,000 in funding for emergency medicine (EM) research and education grants each year. That funding empowers more emergency physicians, saves more lives, and improves outcomes for more patients everywhere. Annual Alliance donors play a vital role in everything we do to inspire the next generation of emergency medicine (EM) researchers and educators like Katie Lebold, MD, one of our SAEMF/RAMS Resident Research Grantees.
You can play a vital role in ensuring greater investments in EM research and education by joining the growing number of SAEM member donors who support the Annual Alliance each year. A gift of any amount this year will help make more funding available for the SAEMF’s grantees. Donors share why they support the Annual Alliance each year:
“We have so many aspiring researchers and so many questions that could improve emergency care delivery to our patients and I would like to see these come together. I like to support young researchers who are looking to kick start their research careers and SAEMF has given me the opportunity to do it.”
- Prasanthi Govindarajan, MD, MAS, Annual Alliance Donor
“Reading the stories of those who have been awarded grants and the amazing work that they are doing influenced me to donate.”
- Michelle D. Lall, MD, MHS, Annual Alliance Donor
“At each point of my career, from medical student, to resident, to faculty, SAEM has been instrumental in my professional development. The organization has given so much to me - it felt right to give back.”
-
Christopher Bennett, MD, MA, Annual Alliance Donor
As we continue to strengthen and diversify the financial support necessary to elevate research and education grants funding, we see even more generosity from SAEM members who have accepted the invitation to become Annual Alliance Enduring Donors. 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.
Please join us in saluting the generosity and visionary spirit of philanthropy of our Annual Alliance Donors!
As of February 24, 2023
We are grateful to the following Enduring Donors who are leading the way to a stronger specialty through their generous giving.Bill Barsan, MD Wendy C. Coates, MD Deborah B. Diercks, MD, MSc Michelle Blanda, MD Charles B. Cairns, MD Ali S. Raja, MD, DBA, MPH Nicholas M. Mohr, MD, MS Andrew S. Nugent, MD J. Adrian Tyndall, MD, MPH Steven L. Bernstein, MD Gail D'Onofrio, MD and Robert Galvin James F. Holmes, Jr., MD, MPH Robert S. Hockberger, MD Gregory A. Volturo, MD Steven B. Bird, MD Ian B.K. Martin, MD, MBA Gabor D. Kelen, MD James J. McCarthy, MD Megan N. Schagrin, MBA, CAE, CFRE Richard E. Wolfe, MD In memory of Peter Rosen, MD Brian J. Zink, MD In memory of Audrey Zink
On behalf of the SAEMF Board of Trustees 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.
Annual Alliance 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 emergency medicine that are highlighted in our SAEMF Donor Guide
Can we count on you to become an ally for EM research?
• James G. Adams, MD
• Opeolu M. Adeoye, MD
• Brian J. Browne, MD
• Bo D. Burns, DO
• Christopher Robert Carpenter, MD, MSc
• Brendan G. Carr, MD
• Ted A. Christopher, MD
• John DeAngelis, MD
• Jeff Druck, MD
• Robert Eisenstein, MD
• Marie-Carmelle Elie, MD
• Gregory J. Fermann, MD
• Charles J. Gerardo, MD, MHS
• Prasanthi Govindarajan, MD, MAS
• Erik P. Hess, MD
• Ula Hwang, MD, MPH
• Nicholas J. Jouriles, MD
• Stephanie Kayden, MD, MPH
• Babak Khazaeni, MD
• Kevin Kotkowski, MD, MBA
• Lawrence A. Melniker, MD, MS, MBA
• Joseph Miller, MD
• Chadwick Miller, MD
• James R. Miner, MD
• Paul I. Musey, Jr., MD, MSc
• Marquita S. Norman, MD, MBA
• David T. Overton, MD
• Edward A. Panacek, MD, MPH
• Arthur M. Pancioli, MD
• Peter S. Pang, MD
• Ralph J. Riviello, MD, MS
• Robert W. Schafermeyer, MD
• David C. Seaberg, MD
• Peter E. Sokolove, MD
• Benjamin C. Sun, MD, MPP
• Mary E. Tanski, MD, MBA
• J. Jeremy Thomas, MD, MBA
• Jody Vogel, MD, MSc, MSW
• David W. Wright, MD
• Richard D. Zane, MD
• Nestor Rhett Zenarosa, MD
• James M. Ziadeh, MD
• Anonymous
As of February 24, 2023
• Mike Baumann, MD
• Douglas M. Char, MD
• Nathan Kuppermann, MD, MPH
• Bryn E. Mumma, MD, MAS
• Susan A. Stern, MD
• Scott G. Weiner, MD, MPH
SAEMF is grateful to these SAEMF Legacy Society Donors who are strengthening the resources available for tomorrow’s emergency medicine (EM) researchers and educators through their legacy giving. Each of these Donors has generously supported SAEMF throughout their careers, and now they have shared that they have made thoughtful, visionary planned gifts by including SAEMF in their estate plans. Through the Legacy Society, you, too, can solidify future support of this organization that’s been so important to you during your career.
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.
Several longtime SAEM members have already included the SAEMF in their estate plans. If you are one of these donors, please let us know by completing the SAEMF Legacy Society Declaration of Intent and returning it to foundation@saem.org so that we can recognize your generosity.
New this year: name a grant in honor of someone who has made a difference in your career or in the field. Email Julie Wolfe for details.
Your gift of any amount counts toward participation in the Chairs Challenge (if made before March 22nd), Vice Chairs' Challenge (if made before May 31st), and the Academy, Committee, Interest Group Challenge (if made before August 31st). Give once and you are done!
It’s easy to become a Mentor level donor with an annual monthly gift of just $100 (March - December 30, 2023). Pledge that same monthly gift for three years and you’ll be our newest Advocate donor.
Join now to take advantage of 2023 recognition benefits. Your gift will help fund future researchers, educators, and leaders.
Elections are over, the results have been tabulated, and SAEM is pleased to announce the results of recent leadership elections for SAEM, SAEM Academies, Association of Academic Chairs of Emergency Medicine (AACEM), SAEM Foundation (SAEMF), and Residents and Medical Students (RAMS). Thank you to everyone who took the time to vote and congratulations to this year’s winners. The 2023-2024 leadership will take office at SAEM23 in Austin, Tex.
from innovative research to professional development to physician health and wellness. SAEM webinars are a great way to stay current and learn from your colleagues. Here’s what’s coming up:
RLS Webinar: What Your Research Team Wishes You Knew, Mar. 21
Navigating the Financial Transition From MS4 to PGY1, Mar. 23
Beyond Burnout: Achieving Personal and Professional Fulfillment in Academic Emergency Medicine, Apr. 11
of the first Vice Chairs’ Challenge donors by pledging or donating a gift of $500$1,000 between February 14 and May 30, 2023. Donors will enjoy:
• Recognition as an Annual Alliance Mentor ($1,000) or Young Professional ($500)
• Your name on the big screen during the AACEM/AAAEM Annual Retreat
• The opportunity to rub shoulders with grantees and leaders at the SAEMF’s Coffee & Networking session at SAEM23
• Your name in lights on the electronic donor wall at SAEM23
NERDS Annual Gathering is April 5
Registration is now open for the 26th Annual SAEM New England Research Directors (NERDS) regional meeting, to be held April 5 at the Hogan Campus Center, College of the Holy Cross, Worcester, Mass. Sponsored in part by the Brown University Alpert Medical School
Department of Emergency Medicine, the meeting will feature a poster session, lightning orals, plenary orals, and innovations. Dr. Ambrose Wong, research director and fellowship director at the Yale Center for Medical Simulation, will deliver a keynote address, “Patient Agitation, Mental Health Crises, and Workplace Violence in the Emergency Department: A Systems Approach.”
SAEM offers webinars throughout the year on a variety of EM topics ranging
Each year, the AACEM/AAAEM Annual Retreat in March kicks off this important challenge that raises vital funds to help strengthen the pipeline of emergency medicine (EM) researchers who will advance this specialty in the future. Since 2019, you and generous AACEM members have raised over $410,423 to support your own researchers and educators through SAEMF’s grants. Last year alone, you raised over $133,587! The Challenge has resulted in a vibrant annual funding campaign which has led to SAEMF awarding nearly $850,000 back to your departments. In 2023 we hope to turn the challenge map green by achieving 100% participation from AACEM Chairs in each state. Browse the SAEMF Donor Guide to learn about SAEMF’s 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 be one of our first 2023 Chairs’ Challenge donors! No need to wait until the retreat; donate $1,000 today at www.saem.org/donate or by emailing Julie Wolfe at jwolfe@saem.org to pledge
SAEMF’s new Vice Chairs’ Challenge will showcase the generous giving that comes from our vice chairs each year and serve as a rallying call to unite vice chairs in support of more funding for future EM researchers and educators. Become one
Check out the SAEMF Donor Guide to learn about SAEMF’s impact, our researchers and the work they are doing, and how you can join your colleagues in supporting a bold vision for EM research. Become one of the first Vice Chairs’ Challenge donors by donating a gift of $500-$1,000 by May 30, 2023 or email Julie Wolfe at jwolfe@saem.org to pledge.
Note: Gifts and/or pledges from vice chairs who are members of the SAEM Vice Chairs Interest Group and/or who attend the AACEM/AAAEM Retreat in March 2023 will count toward challenge totals.
Medical Students, Celebrate the Match With SAEM and RAMS!
Match Day is right around the corner and we invite you to join SAEM and RAMS as we celebrate this huge milestone in the lives of medical students. On Friday, March 17 — the big day — be sure to tune into SAEM social media. All day long we’ll be 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 medical students who matched. Use #RAMSMatch and tag @SAEMonline and @SAEM_RAMS when you share your good news and you’ll automatically be entered into a drawing for a stethoscope or trauma shears. From all of us at SAEM, may all your hopes, wishes, and matches come true!
Do you remember when you first became interested in emergency medicine (EM)? You might have wondered, “Where and how do I begin to explore this expansive and multifaceted medical specialty?” Fortunately, there is the Society for Academic Emergency Medicine (SAEM)! SAEM provides a pathway for medical students to cultivate their interest in EM through leadership opportunities, scholarship, and networking with the top academic EM physicians in the country. An SAEM membership opens the door to a variety of opportunities to immerse yourself in the various niches of EM and to develop critical academic and clinical skills. Visit this spot in the next several issues of SAEM Pulse and we’ll show you how to make the most of your SAEM medical student membership!
An SAEM membership can be a pathway for students to explore their EM passions and interests, and one route SAEM provides for doing this is via involvement in an SAEM committee. These groups help members further their professional development, serve as leaders, and drive the mission of SAEM. As students on SAEM committees, your input will be warmly welcomed, and your contributions will play a direct role in influencing the future of the specialty. One way to make the most out of your committee involvement is to join a committee subcommittee. For example, the SAEM Membership Committee has a subcommittee dedicated to improving the student experience in SAEM, while the SAEM Virtual Presence committee has a subcommittee that reviews the SAEM website and RAMS microsite and provides feedback that helps to make the online experience more valuable and easier to navigate. These subcommittees are often temporary, lasting only a few weeks, and are often established to accomplish a specific project aim. Subcommittee involvement is ideal for students who are on a less busy rotation or early in a pre-clerkship learning block. Subcommittees are also usually smaller in size, meet virtually, and are led by EM physicians from various locations, types of practice, and with a variety of passions. This can be very helpful as a networking opportunity for students wanting to know about EM career paths and for students applying to residency.
Even if you feel you have nothing to contribute to the discussion, you will learn so much by listening to others, and that is the goal: join a committee that covers something you are passionate about and/ interested in, network with those that have similar interests, and hopefully contribute to the overall growth and advancement of the EM specialty.
Review the Committee Descriptions to find the committees that best match your interests and expertise. Each description also indicates who is eligible to serve. Committee sign up opens in early September each year. The term of service for SAEM committees begins each year at the annual meeting in May and lasts for 12 months.
The following individuals contributed to this report:
– Lauren Diercks, a third-year medical student at the University of Texas Southwestern in Dallas, Texas. Lauren is a Medical Student representative for the RAMS Board and is involved in the Membership Committee.
– Tanner Reed, a third-year medical student at Louisiana State University School of Medicine in New Orleans.
– Dustin Williams, MD, an associate professor of emergency medicine and residency program director at UT-Southwestern Medical Center. Dr. Williams is a member of the SAEM Membership committee and is the current co-chair for the SAEM’s Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) LGBTQIA+ subcommittee.
– Cassandra Kim Bradby, MD, program director at Brody School of Medicine at East Carolina University Health Emergency Medicine Residency and the president-elect of ADIEM.
The Clerkship Directors in Emergency Medicine (CDEM) will celebrate its 15th anniversary this spring at the SAEM Annual Meeting. This landmark allows us to reflect on the organization’s history, evolution, and noteworthy accomplishments.
CDEM was founded in 2008 initially as an independent group The idea of CDEM was conceived during an informal meeting of medical student educators at the 2006 American College of Emergency Physicians (ACEP) Scientific Assembly in New Orleans. As astute medical educators do when developing an innovation, the academy’s founding members constructed and administered a needs assessment survey to emergency medicine (EM) clerkship directors and medical educators to identify target areas of focus. With a clear mission statement set forth, CDEM was officially launched.
In its early years, CDEM began initiatives to address the target needs identified by its membership: faculty development, networking, fostering of educational research, the development of educational resources, and a unified voice at the national level. CDEM partnered with the Council of Emergency Medicine Residency Directors (CORD) to begin a medical student educator track at the organization’s annual meeting which still exists today. CDEM also published an extensive guide for clerkship directors and medical students in EM called the “Medical Student Educators Handbook.” CDEM has been, and continues to be, supported by CORD and SAEM, and ultimately became the first official SAEM academy.
CDEM has since published numerous educational resources for students and faculty in EM, including the first ever comprehensive national curriculum for third- and fourthyear students in EM as well as pediatric emergency medicine which is continuously updated and housed on the SAEM website. CDEM sponsors educational programming at the SAEM Annual Meeting as well as several educational grants, awards, webinars, and a mentorship program. CDEM routinely partners with other SAEM academies on joint educational programming. CDEM also has representatives in other, national medical education organizations, such as the Alliance for Clinical Education, to ensure the voice of student educators in emergency medicine is heard. As the first SAEM academy, CDEM leadership also developed the academy guidelines that are used and updated for all SAEM Academies. In addition, CDEM worked with the National Board of Medical Examiners to form the NBME Advanced Clinical Examination (ACE) taskforce in the fall of 2011, which led to the creation of the NMBE ACE. More recently, CDEM has led initiatives to develop consensus statements for students and advisors in emergency medicine on the topics of clinical rotations and interviews based on equity and issues related to COVID-19. The academy is proud of its collaborative efforts with these other national organizations and always had a focus on advocating for both the medical student educators as well as the students themselves. CDEM continues to put forth new educational material to prepare students in emergency medicine for their clerkships and future careers in the field. In 2022, CDEM launched a mentorship program for medical educators which is open to all faculty members and targeted for those early on in their medical education careers.
Today, CDEM has 250 members. It is incredible to think that what started as an idea from a small group of EM educators has grown into such a robust community over the years. Looking forward, CDEM is excited to meet new members and enthusiastic EM educators and continue the dedication to being the experts on EM education for medical students. Come say “Hi!” at SAEM and help us celebrate 15 amazing years of growth and help us shape our future!
This retrospective was written by Nicole Dubosh, MD, and Sharon Bord, MD, with special thanks to former CDEM presidents Jonathan Fisher, MD, David Wald, DO, and David Manthey, MD, who provided historical context.
Member Benefits Focus: SAEM Online Academic Resources
SAEM Online Academic Resources (SOAR) compiles relevant articles, links, podcasts, and other resources that are available for free to SAEM members. They cover several different topics that can be used to further one’s own interest or expand knowledge in fields gaining a larger share of emergency medicine training.
• Annual meeting content, including video links from the previous four years, in an easy-to-navigate format, sortable by topic, author, and/or year
• DEI Resource Library provides resources to learn more about achieving health equity and eliminating health disparities. The collection covers a wide range of topics and includes a DEI curriculum with tools applicable to the academic EM physician.
• COVID-19 Provider Toolkit provides numerous resources to help care for the vulnerable COVID patient population. This toolkit is particularly helpful when it comes to answering common questions posed by patients during clinical shifts and giving advice that can be incorporated into discharge instructions for patients diagnosed with COVID-19.
• Wellness and Resilience covers a growing collection of SAEM wellness initiatives, partnerships, articles, and other resources supporting the cause of wellness and resilience — a topic that has risen significantly in residency education over the past several years and remains a significant factory in EM physician job satisfaction and burnout. The Stop the Stigma EM Toolkit provides helpful resources to individuals, educators, and institutions interested in joining the cause of breaking down the barriers to mental health care in emergency medicine. NAM Action Collaborative online knowledge hub provides products, strategies, and other resources to improve clinician well-being at both the individual and systems levels. The Clinician Well-Being Knowledge Hub provides a comprehensive repository of articles, research studies, and resources with topics ranging from the systems level to individual level.
Next issue: webinars and podcasts
This report was written by Viral Patel, on behalf of the SAEM Membership Committee. Dr. Patel is assistant professor and assistant residency program director, UMass Chan Medical School, Department of Emergency Medicine.
K. Scott Whitlow, DO, has been promoted to senior associate dean at Touro University California College of Osteopathic Medicine (TUCOM) in Vallejo, CA. This role includes direct oversight of clinical education, clinical service line development, clinical contracting, strategic planning, faculty development, continuing medical education, graduate medical education, project/revenue development, and any other aspects of TUCOM leadership as determined by the dean. Dr. Whitlow served TUCOM previously as the associate dean of clinical education and continues to serve as professor of emergency medicine. His appointment officially began on August 1, 2022.
Arjun Venkatesh, MD, MBA, MHS, is the new chair of the Department of Emergency Medicine at Yale School of Medicine and chief of emergency medicine at Yale New Haven Hospital.
Dr. Venkatesh was previously an associate professor in the department and chief of its section of administration, and a scientist at the Center for Outcomes Research and Evaluation. Dr. Venkatesh earned an MBA in finance from The Ohio State University and an MD from Northwestern University. He completed an emergency medicine residency at Brigham and Women’s Hospital and Massachusetts General Hospital, followed by earning a Master’s in Health Science from Yale, which he attained while a Robert Wood Johnson Foundation Clinical Scholar.
Dr. Venkatesh serves as the principal investigator of the American College of Emergency Physicians Emergency Quality Network. His scholarship has informed numerous emergency and acute care quality measurement standards in federal programs, including the Overall Hospital Quality Star Ratings. He has published approximately 200 peer-reviewed studies and federal technical reports focused on the quality and value of health care delivery.
Megan Ranney, MD, MPH, deputy dean at Brown’s School of Public Health and a regular commentator on national television, has been named as the new dean of Yale
University’s School of Public Health. Dr. Ranney will step down from her current role at Brown effective July 1, 2023.
In 2004 Dr. Ranney completed a medical residency in emergency medicine and a fellowship in injury prevention research at Brown. She has served as an attending physician at the Miriam Hospital and Rhode Island Hospital in Providence since 2008, the year she joined Brown’s Warren Alpert Medical School faculty in the Department of Emergency Medicine. Dr. Ranney earned a Master’s in Public Health from Brown in 2010, and in 2013, became an assistant professor in the Department of Health Services, Policy and Practice in the School of Public Health. She has since held academic appointments in both schools.
In 2019, Ranney became the founding director of the Brown-Lifespan Center for Digital Health, a center where creative minds from Brown and its affiliated hospital partners collaboratively design, test and deploy digital solutions to challenges that affect the health of patients and populations.
Dr. Ranney is known for her work on gun violence and for cofounding GetUsPPE.org, which helped collect badly needed personal protective gear for medical personnel during the COVID-19 pandemic. She will arrive at Yale as its School of Public Health is being formally established as a separate institution from the medical school there.
Dr. Arjun Venkatesh Dr. K. Scott WhitlowRichard Nowak, MD, one of the visionary individuals who helped shape the emergency medicine specialty and lay the groundwork for what would become the Society for Academic Emergency Medicine (SAEM), passed away January 26, 2023.
Dr. Nowak was internationally recognized in emergency medicine for his expertise in cardiac emergencies, resuscitation, asthma, and cardiac biomarker research. In the 1970s and early 1980s, he studied the use of spirometry in the assessment of acute asthma. His work led to the popularity of hand-held peak flow meters that have become a standard in assessing the severity of acute bronchospasm. Dr. Nowak was a pioneer in CPR and cardiopulmonary bypass research, both in the lab and the emergency department. He did “bench to bedside” research decades before the term was even coined.
Dr. Nowak joined the Henry Ford Medical Group in 1975 and in 1976 was a founding senior staff member of the Henry Ford Hospital Department of Emergency Medicine and its residency program. He served as chair of the department from 1988-1992.
Over the course of his long and storied career, Dr. Nowak was published in every high impact journal pertinent to his expertise and served on numerous international editorial boards in cardiology and academic emergency, including Academic Emergency Medicine journal. In addition, his academic work has been recognized across the globe with several honors and awards.
Dr. Nowak served on the executive council, and in 1987 as president, of the University Association for Emergency Medicine, which in 1989 merged with the Society of Teachers of Emergency Medicine (STEM) to become SAEM. Along the way, he participated on several UAEM committees — including long range planning, research, nominating, and international affairs. In addition, Dr. Nowak served as an abstract reviewer and presenter/speaker at several SAEM annual meetings
Dr. Nowak was a mentor to many learners over the years, and his passion for scientific discovery has influenced countless peers the world over. His contributions to SAEM and to academic emergency medicine is immense and will long be remembered.
One of the most powerful things you can do to help break down barriers to mental health is to talk openly about your personal mental health journey. Share your story and help stop the stigma.
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Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine
Department of Emergency Medicine
Medical Director of Quality and Patient Safety
The Department of Emergency Medicine at Boston Medical Center (BMC)/Boston University Chobanian & Avedisian School of Medicine is seeking a Medical Director of Quality and Patient Safety Reporting directly to the Vice Chair of Clinical Affairs of the Emergency Department and the Chief Quality Officer for Boston Medical Center, the Medical Director is a leadership position that provides direction for quality improvement, patient safety, and patient experience initiatives in the Emergency Department
The Medical Director develops and oversees quality improvement committee activities, agendas, and processes. The Medical Director is accountable for critical event reviews, including root cause analyses and follow up action planning. In conjunction with the hospital, the position serves as one of the department liaisons with The Joint Commission, CMS and other pertinent regulatory agencies. The Medical Director, ED Nursing leadership, and BMC Quality & Patient Safety leadership, provide oversight to an Emergency Department Patient Safety Specialist The Medical Director works in collaboration with other departments’ Quality and Safety leaders and the Medical Director of the Adult Emergency Department, Chief APP, EM Residency Program Director, and ED Nursing leadership.
The Department of Emergency Medicine at BMC has over 40 faculty who practice in one of the busiest emergency departments in the country and teach in one of the most prestigious residency programs. The BMC EM residency program is a 4year training program based in an urban, academic, Level-1 trauma center in the heart of Boston. It is the first program in the city and one of the oldest in the Northeast. BMC has a dedicated pediatric ED and a fellowship in Pediatric EM. We have an active research division with a particular focus on health equity, public health, trauma and violence, infectious diseases, substance use disorders, medical education, clinical operations, ultrasound, and EMS.
BMC is steeped in its mission of providing consistently excellent and accessible health services to all in need. As the largest and busiest provider of trauma and emergency services in New England, the ED serves more than 130,000 patients annually. BMC is a not-for-profit, 514-bed, academic medical center that provides a comprehensive range of services in more than 70 areas of medical specialties and subspecialties. BMC attracts an extraordinary community of health care providers devoted to the proposition that every person deserves the best health care and EM plays a critical role providing an essential service to the community. The hospital is the primary teaching affiliate for Boston University Chobanian & Avedisian School of Medicine and APP students do clinical rotations in the ED.
Minimum requirements: Completion of an ACGME-approved Emergency Medicine residency; ABEM certified or eligible; meet requirements for and obtain Massachusetts Medical Licensure and clinical privileges in Emergency Medicine at Boston Medical Center. Quality improvement and patient safety experience in academic emergency medicine. The successful candidate must qualify for a full-time academic faculty appointment at the rank of Assistant Professor or higher in the Department of Emergency Medicine at the Boston University Chobanian & Avedisian School of Medicine
Preferred Qualifications: Completion of an ED Quality and Safety or Administrative Fellowship with an MBA, MPH, Master’s in Healthcare Administration or equivalent
Applications: Required: Cover Letter, Curriculum Vitae. Optional: Diversity Contribution Statement.
Review of applications will begin immediately and continue until the positions are filled or the search is closed. We are an Equal Opportunity/Affirmative Action Employer - applications from women, minority, and protected groups are strongly encouraged.
Please send application materials to: Brian J. Yun, MD, MBA, MPH Vice Chair of Clinical Affairs, Department of Emergency Medicine 1 BMC Place, BCD Building Boston, MA 02118
Email: Brian.Yun@BMC.org
Our strong partnerships with academic medical centers and teaching hospitals, enable you to choose the environment in which you practice and the area where you want to live.
As a leading national medical group, our physicians thrive from our physician- and clinicianled practices and are fully supported on the national level with robust resources, professional development and an unwavering commitment to clinician wellness.
GME Faculty Opportunities
HCA Florida Oak Hill Hospital Tampa, FL
Pediatric Site Medical Director Medical City Dallas Dallas, TX
Residency Program Directorship Centerpoint Medical Center Kansas City, MO
Residency Program Directorship
HCA Florida Lawnwood Hospital Fort Pierce, FL
Research Director
Morristown Medical Center
Morristown, NJ
Ultrasound Physician
St. Joseph Mercy Health System Ann Arbor, MI
Penn State Health is a multi-hospital health system serving patients and communities across central Pennsylvania. We are the only medical facility in Pennsylvania to be accredited as a Level I pediatric trauma center and Level I adult trauma center. The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Health Children’s Hospital, and Penn State Cancer Institute based in Hershey, Pa.; Penn State Health Hampden Medical Center in Enola, Pa.; Penn State Health Holy Spirit Medical Center in Camp Hill, Pa.; Penn State Health St. Joseph Medical Center in Reading, Pa.; Penn State Health Lancaster Pediatric Center in Lancaster, Pa.; Penn State Health Lancaster Medical Center (opening fall 2022); and more than 3,000 physicians and direct care providers at more than 126 outpatient practices in 94 locations. Additionally, the system jointly operates various health care providers, including Penn State Health Rehabilitation Hospital, Hershey Outpatient Surgery Center, Hershey Endoscopy Center, Horizon Home Healthcare and the Pennsylvania Psychiatric Institute.
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 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
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.
Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine
Department of Emergency Medicine
Medical Director of Quality and Patient Safety
The Department of Emergency Medicine at Boston Medical Center (BMC)/Boston University Chobanian & Avedisian School of Medicine is seeking a Medical Director of Quality and Patient Safety. Reporting directly to the Vice Chair of Clinical Affairs of the Emergency Department and the Chief Quality Officer for Boston Medical Center, the Medical Director is a leadership position that provides direction for quality improvement, patient safety, and patient experience initiatives in the Emergency Department.
The Medical Director develops and oversees quality improvement committee activities, agendas, and processes. The Medical Director is accountable for critical event reviews, including root cause analyses and follow up action planning. In conjunction with the hospital, the position serves as one of the department liaisons with The Joint Commission, CMS and other pertinent regulatory agencies. The Medical Director, ED Nursing leadership, and BMC Quality & Patient Safety leadership, provide oversight to an Emergency Department Patient Safety Specialist. The Medical Director works in collaboration with other departments’ Quality and Safety leaders and the Medical Director of the Adult Emergency Department, Chief APP, EM Residency Program Director, and ED Nursing leadership.
The Department of Emergency Medicine at BMC has over 40 faculty who practice in one of the busiest emergency departments in the country and teach in one of the most prestigious residency programs. The BMC EM residency program is a 4year training program based in an urban, academic, Level-1 trauma center in the heart of Boston. It is the first program in the city and one of the oldest in the Northeast. BMC has a dedicated pediatric ED and a fellowship in Pediatric EM. We have an active research division with a particular focus on health equity, public health, trauma and violence, infectious diseases, substance use disorders, medical education, clinical operations, ultrasound, and EMS.
BMC is steeped in its mission of providing consistently excellent and accessible health services to all in need. As the largest and busiest provider of trauma and emergency services in New England, the ED serves more than 130,000 patients annually. BMC is a not-for-profit, 514-bed, academic medical center that provides a comprehensive range of services in more than 70 areas of medical specialties and subspecialties. BMC attracts an extraordinary community of health care providers devoted to the proposition that every person deserves the best health care and EM plays a critical role providing an essential service to the community. The hospital is the primary teaching affiliate for Boston University Chobanian & Avedisian School of Medicine and APP students do clinical rotations in the ED.
Minimum requirements: Completion of an ACGME-approved Emergency Medicine residency; ABEM certified or eligible; meet requirements for and obtain Massachusetts Medical Licensure and clinical privileges in Emergency Medicine at Boston Medical Center. Quality improvement and patient safety experience in academic emergency medicine. The successful candidate must qualify for a full-time academic faculty appointment at the rank of Assistant Professor or higher in the Department of Emergency Medicine at the Boston University Chobanian & Avedisian School of Medicine.
Preferred Qualifications: Completion of an ED Quality and Safety or Administrative Fellowship with an MBA, MPH, Master’s in Healthcare Administration or equivalent
Applications: Required: Cover Letter, Curriculum Vitae. Optional: Diversity Contribution Statement.
Review of applications will begin immediately and continue until the positions are filled or the search is closed. We are an Equal Opportunity/Affirmative Action Employer - applications from women, minority, and protected groups are strongly encouraged.
Please send application materials to: Brian J. Yun, MD, MBA, MPH Vice Chair of Clinical Affairs, Department of Emergency Medicine 1 BMC Place, BCD Building Boston, MA 02118
Email: Brian.Yun@BMC.org
Sarasota Memorial Health Care System, Sarasota, Florida
A two (2) Year Fellowship Track Position for an ACGME Accredited Emergency Medicine Board Eligible / Board Certified Attending who will accomplish the Fellowship with a Fully Funded International Project Based Field Experience, MBA in Project Management, and Certification in Crisis Leadership.
Located in Beachside Sarasota the Fellowship is home to the Florida State University College of Medicine Emergency Medicine Residency Program.
Please contact forwarding a statement of interest and your curriculum vitae.
Dr. Sagar Galwankar , International Emergency Medicine Fellowship Director
Email: gcsagar@yahoo.com
