SAEM Pulse May-June 2022 by Society for Academic Emergency Medicine

MAY-JUNE 2022 | VOLUME XXXVII NUMBER 3

www.saem.org

SPOTLIGHT CONNECTING RESIDENTS AND MEDICAL STUDENTS TO ACADEMIC LEADERS IN EM An Interview with

Hamza Ijaz, MD

KNOW BEFORE YOU GO page 8

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

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org Manager, 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 Michelle Aguirre, MPA Ext. 205, maguirre@saem.org Coordinator, Governance Juana Vazquez Ext. 228, jvazquez@saem.org Director, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Journals and Communications Tami Craig Ext. 219, tcraig@saem.org 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, Business Development John Landry, MBA Ext. 204, jlandry@saem.org Manager, Educational Course Development Kayla Belec Ext. 206, kbelec@saem.org Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org 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 Sandi Ganji Ext. 218, sganji@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org Manager, Journals Tami Craig Ext. 219, tcraig@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Associate Editor, RAMS Aaron R. Kuzel, DO, MBA aaron.kuzel@louisville.edu

2022–2023 BOARD OF DIRECTORS 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

HIGHLIGHTS 3

President’s Comments United in Facing the Major Issues That Face Us

Spotlight Connecting Residents and Medical Students to Academic Leaders in EM: An Interview With Dr. Hamza Ijaz

21 Know Before You Go

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

Global EM Strengthen Global Toxicology: An Antidote to Disparities in Global and Country-Level Toxicology Systems

Emergency Medicine: A Venezuelan Perspective

Health Policy The Blurred Lines Between Employee, Government Contractor, and Private Citizen Revealed in Recent SCOTUS Decision

Observation Care Psychiatric Observation: Driving Improvement and Capturing Opportunity

Sex & Gender The Female Athlete Triad Examined Under the New Lens of Sex and Gender Evidence

Clerkship Corner Defining Excellence in Diverse Ways: A Necessary Shift in Medical Student and Resident Trainee Selection

Critical Care Clinical Resuscitation Fellowships and the Role of the Emergency Department Resuscitationist

Wellness Work-Life Balance: Why It Doesn’t Work and How to Design a Life With Harmony

Diversity & Inclusion Can You Tell I’m Pregnant?

Prioritizing Sleep for High-Performance Teams in the Emergency Department

One Step at a Time

EM Wellness Initiatives: Oregon Health & Science University

Diversity, Equity, and Inclusion in EM Research: A Call to Action

Education On-Shift Leadership: Teaching Beyond the “Hidden Curriculum”

Increased Mental Workload for Academic Women Physicians Since the Pandemic Era

Research Congratulations on Your R01! A Q&A Series With First-Time Recipients

Demystifying the Institutional Review Board

Emergency Medicine Network is Forging Ahead

Ethics in Action End-of-Life Care: Implementation of POLST and MOLST Forms

Geriatric EM When Is It too Late? Lifestyle Medicine for Older Adults

Announcing the 2022 SAEMF Research and Education Grantees

Behind the Scenes: Piloting an SAEM Resident Reviewer Program to Foster the Next Generation of Emergency Medicine Researchers

SAEMF Grant Applications Now Open

Briefs and Bullet Points

Academic Announcements

Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine, 1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2022 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

PRESIDENT’S COMMENTS Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center 2021–2022 President, SAEM

United in Facing the Major Issues That Face Us

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

After what seemed like a whirlwind of a year, this will be my final column in SAEM Pulse. Looking back on the accomplishments over the past year, SAEM has much to be proud of: we reached record membership numbers, launched a new website, hosted over 9,000+ attendees on live webinars, awarded close to $700,000 for the 2021-2022 cycle of research and education grants, announced new funding opportunities, and had record submissions for our journals. We also led our first ARMED MedEd cohort and are excited to be hosting our first eLEAD cohort. Over the past 12 months we've partnered with our sister emergency medicine (EM) organizations to issue more than a dozen joint statements which reflect our Society’s commitment to addressing issues at the forefront of our specialty. I encourage you to take the time to read through them. More than ever, our specialty is united in facing the major issues that face us. As Federal funds allocated for medical research continue to diminish, SAEM will continue to advocate for our specialty and think outside the box in terms of funding sources. In doing so, we will look to not just our sister EM organizations, but to other medical and surgical specialties where we have overlapping research interests. COVID-19 initially led to a stark decrease in emergency department (ED) visits, thereby seemingly decreasing the need for EM providers. While we welcomed 2,702 newly matched residents into the emergency medicine family in 2022, our specialty had 219 unfilled positions in the 2022 Match. Yet, outside of the deviation of 2021, the number of 2022 applicants appears in line with recent years. There were 81 more positions to fill in emergency medicine in 2022 than in 2021. This continues a pattern of significant and swift growth for the specialty – since 2018, emergency medicine has added 643 residency positions, an increase of 28.2 percent. Still, we will need to better understand all of the different factors that may be affecting applicant career decision-making.

We have now all largely returned to preCOVID visit numbers and are experiencing boarding and nurse staff shortages. COVID-19 highlighted the need to reconsider the scope of EM practice, as it is clearly moving beyond the physical space of the adult and pediatric ED and into paramedicine, telemedicine, urgent care, observation medicine, critical care, street medicine, etc. How we define our specialty is dynamic, and our workforce will need to be sized accordingly. In a nutshell: The future of our specialty is full of opportunities and remains bright. More specifically, the future of SAEM is bright. I will soon turn over the reins to Dr. Angela Mills, who is extraordinary in her abilities to effectively lead, collaborate, and achieve consensus to move forward toward our vision and carrying out SAEM’s mission. Dr. Mills has carefully shaped the objectives for the upcoming year for the SAEM committees and task forces and is committed to supporting SAEM academies and interest groups to be productive and innovative. We are drawing close to May 10, which marks the first day of the 2022 SAEM Annual Meeting in New Orleans! After living in the virtual meeting world for two long years of COVID 19 and its associated variants and surges, our members are ready to embrace one another in person. While we are grateful for the virtual platforms that allowed our society to support one another through the uncertainty of the management of the disease, being faceto-face uniquely facilitates knowledge transfer, intellectual discourse, and the strengthening personal connections. Replete with cuttingedge educational content, networking events, career development opportunities, experiential learning competitions, and other activities, SAEM22 will be extra special to all of us, and I look forward to seeing you there!

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

SPOTLIGHT CONNECTING RESIDENTS AND MEDICAL STUDENTS TO ACADEMIC LEADERS IN EM An Interview With Hamza Ijaz, MD Hamza Ijaz, MD, is a PGY-3 emergency medicine resident at the University of Cincinnati. He is the incoming SAEM RAMS President and currently serves as the RAMS Secretary-Treasurer. Dr. Ijaz has served on numerous SAEM committees including the Program Committee, ED Administration and Operations Committee, Faculty Development Committee, and Virtual Presence Committee. His interests include medical education, health care leadership and administration, and emergency department operations. Dr. Ijaz grew up in northern Virginia and graduated from George Washington University School of Medicine and Health Sciences.

As the new president of SAEM RAMS, what issues do you feel are most germane to current and future emergency medicine trainees? What steps do you hope to take toward addressing these issues during your tenure as RAMS president? A lot has impacted our trainees over the past year, starting first with the ACEP Workforce Report and recently with the 200+ unfilled spots for emergency medicine. Despite these hurdles, I am certain that the future is bright for our specialty. For our emergency medicine-bound medical students, SAEM RAMS needs to lead the way in educating and providing advising resources as we incorporate preference signaling into the Electronic Residency Application Service (ERAS®) applications and transition towards a more “normal” application cycle as the pandemic improves. For our emergency medicine (EM) residents: We hear you. We see you. It has been an incredibly long and enduring couple of years. Nonetheless, you have continued to persevere, advocate, and provide exceptional care for your patients. SAEM RAMS and our entire community owes you our gratitude for your countless sacrifices. We will ensure that we continue having a seat at the table where decisions are made regarding the future of our specialty. SAEM RAMS will advocate on your behalf to ensure that the graduating classes of emergency physicians are held to a high standard. As RAMS President, I feel that it is important to listen to the concerns of our members and to advocate on their behalf. I hope to do just that during my term. RAMS is exceptionally well-positioned within SAEM to provide opportunities to its members by partnering with the academic leaders in our field. It is my hope to bridge the gap in connecting our exceptional faculty with our members. By connecting our Dr. Ijaz and his wife, Danya, enjoying a relaxing honeymoon in Santorini.

Dr. Ijaz celebrating his medical degree graduation ceremony with his family.

“For our emergency medicine residents: We hear you. We see you. It has been an incredibly long and enduring couple of years. Nonetheless, you have continued to persevere, advocate, and provide exceptional care for your patients.” SAEM faculty with our RAMS members, we can foster a growing community of mentorship and help produce dedicated academicians to advance our specialty. I believe it is important to provide programming relevant to RAMS members at the SAEM Annual Meeting, in addition to frequent webinars and updates in SAEM Pulse to keep our members informed of our efforts. This new term brings exciting opportunities that I hope will be beneficial to all our members.

within SAEM. Through these relationships, we have been able to help our members find and develop their niche. RAMS also seeks to bolster mentorship within our community and enhance the opportunities available to our members so that they may enjoy a prolific career in EM. By getting involved with RAMS, EM residents and medical students should expect their career advancement to occur at a faster pace than would’ve been possible otherwise.

When, why, and how did you first become involved with RAMS?

Who or what influenced your decision to choose the academic/EM specialty and if you were not doing what you do, what would you be doing instead?

My first exposure to SAEM was through the Medical Student Ambassador program. There, I met and learned from countless leaders within our field. Some of my earliest mentors were a result of this program. Eager to gain more exposure and continue developing lasting bonds of friendship and mentorship, I applied for the RAMS Board Member-At-Large position and was fortunate enough to be elected. Since then, I’ve had the pleasure of serving as the RAMS Secretary-Treasurer and now, humbly, your RAMS President. My experiences within RAMS continue to strengthen my belief that RAMS is a community of developing long-term mentorship and leaders within academic emergency medicine.

Why should EM residents and medical students become involved with RAMS? What needs does the group meet or concerns does it address? It is my belief that RAMS is the premier organization for medical students and residents aspiring to advance our specialty and develop into leaders. RAMS is strategically aligned to benefit its members because of its close interactions with the leaders

I was always enamored by the field of emergency medicine. I volunteered as an EMT through the fire department also worked as a scribe in the emergency department (ED) while in college. Those experiences of watching emergency physicians lead resuscitations and help anyone and everyone that walked through the front door, laid the foundation for my interests in EM. During my fourth-year EM rotation, I noticed how EM physicians expertly resuscitate undifferentiated patients while communicating with their loved ones while also discussing complexities in patient management with consultants in a manner that they would also understand. I was in awe. Our specialty’s ethos of taking care of anyone, anytime, anywhere; regardless of their ability to pay resonated strongly with me when I was making my decision and it still holds true to this day. On top of all that, EM is truly a team sport. We are fortunate to work alongside and learn from a variety of professions in the ED to take care of our patients. Add on the community of academic continued on Page 6

Dr. Ijaz with his EM-bound medical students on Match Day at George Washington University.

continued from Page 5 EM and it’s a complete package. There is a strong sense of support, mentorship, sponsorship, and drive to help you succeed in your endeavors that would be hard to match if I weren’t in academics. If I couldn’t do what I do today, I would probably become a teacher. I have always enjoyed teaching and consider helping to educate the next generation a humble yet incredibly rewarding act of service. Regardless of where my career in academics takes me, I hope to never lose sight of that mission.

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

SAEM PULSE | MAY-JUNE 2022

During college, I worked at a clothing retail store as a sales manager. It was very fast-paced and driven by numbers. One of the things I learned during my time in retail was how to quickly connect with the customer to figure out what they needed/wanted. I relate this to medical education in that we face learners with varying backgrounds and levels of interest and as educators, we must meet them where they are and provide them with what they need in that moment.

Stigma is a leading barrier to mental health care for emergency physicians. Many fear that treatment for mental illness could jeopardize their careers or their licenses to practice. What would you say are the key challenges to addressing this stigma? Although we have made significant strides in recent years, there are still key challenges in addressing the stigma. It starts with educating ourselves and understanding the facts. From there, we need to work on creating a culture of openness and vulnerability within our departments and institutions. When everyone is fixated on showing no flaws, those struggling with their mental health suffer even more.

“By connecting our SAEM faculty with our RAMS members, we can foster a growing community of mentorship and help produce dedicated academicians to advance our specialty.” As a medical profession, we must acknowledge that our work in the ED can be extremely taxing and requires an extensive network of resources for those seeking help with their mental health. We, as emergency physicians, must support and encourage our colleagues seeking mental health resources, not penalize them. The passing of the Dr. Lorna Breen Health Care Provider Protection Act is a monumental step towards improving access to mental health resources and reducing the stigma; however, the work isn’t finished. We must continue to advocate for our colleagues.

What can be done to create a sense of safety for EM physicians and medical trainees that would encourage them to ask for help or self-report when they’re struggling with their mental health? It starts with the leadership and driving a culture of vulnerability and openness. Creating a strong peer and social support system within our institutions can also serve as a useful adjunct in the mental health resource network. Ensuring that resources are available and easy to access with a trainee’s demanding schedule are essential.

“When everyone is fixated on showing no flaws, those struggling with their mental health suffer even more.” Any tips on surviving, perhaps even thriving, during residency? Similarly, how have you managed stress and attended to your mental health, especially during this unprecedented time of COVID-19? Find your people. Whether its your coresidents, faculty, friends outside of work, family, or any combination of the above, find your people! Residency is incredibly challenging for a variety of reasons and the Covid-19 pandemic has made it even harder. Identifying activities or individuals that help recharge your wellness “battery” early on in residency is essential to dealing with the ups and downs of the training years. I’ve had the endless support of my loving wife, Danya, who has helped me get through the lows through residency. From early in the lockdown to the recent Omicron surge, having her by my side to talk through the struggles and feelings of frustration, sadness, anger, exhaustion, has been monumental in maintaining my mental health. I’ve also found solace in exercising frequently. Even if it’s for a little bit, I have noticed that on the days that I exercise, I feel not only more energized but happier as well. I strongly encourage everyone to consider physical health as an essential component of mental health.

What do you think the EM specialty and/or SAEM can do to address stress, particularly COVID-19related stress and posttraumatic stress, and improve physician well-being? I think we need to normalize talking about these topics. SAEM can also advocate on behalf of EM physicians on a national scale. Something SAEM already does is provide an online toolkit for individuals, educators, and institutions, aimed at stimulating education, awareness, advocacy, and policy action related to breaking down barriers to mental health care in EM. Another, relatively easy to accomplish resource, would be to consolidate a list of resources on physician well-being and posttraumatic stress and have them easily accessible across SAEM’s website and social media platforms. Another step we can take as SAEM is to encourage more didactics/abstract submissions on these topics for the SAEM Annual Meeting. Hopefully by bringing these topics to the forefront of our specialty and national meetings, we can create change to improve the well-being of our physicians.

What are you most looking forward to when we meet again, in person, at SAEM22 in New Orleans? Meeting everyone in person! It’s been two years since we had an in-person annual meeting and I can’t wait to interact with all the incredible people in our specialty. Networking is going to be huge and the excitement of the return to an in-person event is already picking up steam. Can’t wait!

Dr. Ijaz cuddling with his cat, Goku, before going to a shift.

Up Close and Personal What one thing can you not do without while on shift? A great attitude! Even with all the tough outcomes we see in the ED, having a great attitude and trying to stay lighthearted (very hard to do) goes a long way towards building team morale. What is your “go to” work/on-shift hack? Documenting EKGs in real-time. You look at them and compare them to priors, so might as well document them simultaneously and avoid tracking them down at the end of the shift. What is a favorite FOAMed resource? RebelEM What would most people be surprised to learn about you? I have an unhealthy love for ice cream. You can ask my coresidents! Who would play you in the film of your life and what would that film be called? Andy Samberg in a crossover of Brooklyn Nine-Nine and Scrubs What is your guilty pleasure? Ice cream! What is at the top of your bucket list? Snowboarding in the Swiss Alps Who would you invite to your dream dinner party? Barack Obama, Stephen Colbert, Jon Stewart

KNOW BEFORE YOU GO

We Can't Wait to Welcome You to SAEM22! SAEM is looking forward to welcoming 3,000+ attendees to our first in-person annual meeting since 2019! If you’re planning on joining us for what’s shaping up to be a record-breaking event, this “Know Before You Go” will give you everything you need to make the most of your annual meeting experience.

See You in New Orleans

New Orleans is a feast for the senses, a vibrant city filled with rhythm and soul and memorable flavors. A true melting pot of people and cultures. A city unlike any other in the world, where everyone is welcome. It’s a perfect place for an SAEM “homecoming” and this article will give you everything you need to “Know Before You Go.”

ANNUAL MEETING

The Sheraton New Orleans: Your SAEM22 Host Hotel

The Sheraton New Orleans Hotel, 500 Canal Street, New Orleans, Louisiana, is the official host hotel for meetings, education, and several social events at SAEM22. The Sheraton New Orleans Hotel meeting space is located on floors 1-5 and is accessible via escalator with additional space on the eighth floor, which is accessible by elevator.

Getting Around New Orleans

The SAEM22 Host Hotel’s central location and close proximity to the French Quarter, downtown, and the Arts/ Warehouse District, means you may be able to walk to all of your destinations, but if you’re looking for alternative ways to explore the city and access NOLA’s diverse neighborhoods, there are lots of options for transportation. • New Orleans Maps

• Ride-sharing

• Streetcars

• Bike Share

• Cabs/Taxis

• Accessible transportation

• Limousines

• Transportation directory

ANNUAL MEETING

Things to Do

Whether this is your first time to New Orleans or you’re a seasoned visitor, the city’s invigorating spirit is sure to inspire, captivate and motivate you to jump in and see and do. While the nightlife in New Orleans is legendary, there are also tons of great places to wind down and relax (there’s a reason it’s nicknamed “The Big Easy.”) Whether your jam is music, culture, history, art, architecture, or something else, New Orleans has something for you. • Tours • French Quarter

• New Orleans for First Time Visitors

• Nightlife

• History

• Attractions

• Family

• Music

• LGBTQ

• Cultural Arts

• Recreation & Outdoors

• Shopping

• Architecture

• Mystical/Haunted New Orleans

Where to Eat and Drink

The New Orleans dining scene is a brilliant reflection of the city’s diverse history, culture, and neighborhoods. Choose from more than 1,000 eateries where top chefs are waiting to spoon the gumbo, blacken the redfish, smoke the pork, and plate the dishes. You can dine healthy, eat fried seafood, devour po-boys, and explore ethnic cuisine at Vietnamese pho houses and Salvadoran pupuserias. There’s really no better place to feed your body and soul than New Orleans. • Find Restaurants

• Find a Place to Drink

• Where to Eat

• Where to Drink

• Top Cajun Restaurants in New Orleans

• Classic New Orleans Cocktails

Facts About the French Quarter The heart and cultural center of New Orleans is the French Quarter — the “Vieux Carre.” Often called the Crown Jewel of New Orleans, the French Quarter is where the old and new come together to create a charm found nowhere else in the world. The reimagined French Market, modern boutiques, and artisan cocktails mix with beloved antique stores, time-honored restaurants, and an historic collection of French, Spanish, and Creole architecture. Come dusk, swallows glide above the fortunetellers on Jackson Square, St. Louis Cathedral’s butter-crème-colored walls reflect the fiery sunset, ghost tours troop past mad Madame LaLaurie’s mansion, and neon signs flutter to life on Bourbon Street. As night falls, horse hooves clop, music throbs, and gaslights flicker in a place full of long-told legends and those waiting to be born.

• French Quarter Attractions • French Quarter Restaurants • French Quarter Nightlife • French Quarter Shopping 9

KNOW BEFORE YOU GO

Getting the Most Out of SAEM22 Registration

ANNUAL MEETING

If You Preregistered…

You received a barcoded email confirmation. Please save this to your mobile device or print it out to scan at our convenient, self-serve, preregistration kiosks, located near the SAEM22 registration desk. Forgot your confirmation? No problem! Just touch “User Lookup” on the screen and search for your name. Hit print and your badge and any applicable tickets will print out. Badge holders and lanyards will be available at the kiosks.

If You Are Registering On Site

As always, we will have a fully staffed registration desk available for those who need to add sessions or register on site.

The SAEM22 registration area is located on the Grand Ballroom Foyer: Fifth Floor. Registration hours are:

• • • • •

Monday, May 9, 3–6 p.m. Tuesday, May 10, 7 a.m.–6 p.m. Wednesday, May 11, 7 a.m.–8 p.m. Thursday, May 12, 7 a.m.–6:30 p.m. Friday, May 13, 7 a.m.–2:30 p.m.

Please note that annual meeting participants (members, nonmembers, partners, children, guests) must register and wear badges for admission to sessions, the exhibit hall, and most events.

Speaker Ready Room

Presenters who need to upload presentations on site must bring their presentations saved on a USB/flash drive to the Speaker Ready Room

(Gallier AB: Fourth Floor) the night before your presentation. Onsite aids will be on hand to upload your presentation from your flash drive. There will not be an opportunity to preview or edit your presentation on site, so please be sure your presentation is in its final form. Speaker ready room hours are:

• Monday, May 9, 3–6 p.m. • Tuesday, May 10, 7 a.m.–6 p.m..

Mobile Tools

SAEM Annual Meeting App

Navigate SAEM22 like a pro by downloading the SAEM Annual Meeting app! Simply download the app from the Apple App Store or Google Play, then sign in with your SAEM username and password to launch the app. Browse through the full list of Advanced EM Workshops, educational sessions, meetings, events, and more. Review abstracts, learning objectives, and speakers for educational sessions. Find links to travel information and local dining and activities. Scope out the exhibit hall with the online floor plan and create your must-see list of exhibitors. As you browse, customize your schedule to create your individualized program before you arrive.

Especially for Residents and Medical Students!

ANNUAL MEETING

• Wednesday, May 11, 7 a.m.–6 p.m.. • Thursday, May 12, 7 a.m.– 6 p.m. • Friday, May 13, 7 a.m.–2 pm.

Residents and medical students, RAMS Members… when you see this icon next to Look for This Icon an abstract, didactic, workshop, event or activity, that’s your sign that it is something you will find extra value in attending. For more tips to help prepare you for the upcoming SAEM Annual Meeting in New Orleans, check out this awesome video courtesy of SAEM RAMS. In the video, Mariame Fofana, MD, RAMS Board Member-at-Large, highlights suggestions to help you get the most from #SAEM22 in New Orleans.

Visit the App Desk located at the Napoleon Ballroom Foyer: third floor for assistance in downloading or navigating the SAEM Annual Meeting App.

Additional Information Social Media

Follow us on SAEM Facebook and Twitter @SAEMOnline and @SAEM_RAMS (#SAEM22) during the annual meeting for up-to-date meeting announcements...and be sure to share your insights with other meeting attendees. Look here for social media best practices and suggestions on what to share.

Wireless Internet Access

As a service to annual meeting registrants, SAEM will provide free

wireless Internet access. Wi-Fi will be available in the meeting space of the Sheraton New Orleans host hotel during SAEM22. Username: MarriottBonvoy_Conference Password: SAEM2022

provide convenient, on-the-go viewing. Watch presenters’ slides while listening to fully synchronized audio. Just log in with your SAEM username and password to enjoy the content.

SAEM22 Online Education

Our private family room, located on Rampart: Fifth Floor, will be equipped with everything to meet baby and parent needs: refrigerator, wipes, sanitizer, burp cloths, changing table, comfy chairs, water and snacks. Visit the SAEM22 Family Room during these hours:

SAEM22 educational content will be open access and available online at SOAR (SAEM Online Academic Resources) beginning August 1. Experience convenient online and mobile viewing of Advanced EM Workshops, didactics, and forums — more than 120 hours of original educational content from SAEM22. Downloadable PDFs and MP3 files

Family Room

• • • •

Tuesday, May 10, 7 a.m.–6 p.m. Wednesday, May 11, 7 a.m.–8 p.m. Thursday, May 12, 7 a.m.–6:30 p.m. Friday, May 13, 7 a.m.–2 p.m.

COVID-19 Policy and Protocols

SAEM continues to monitor and follow the latest CDC guidelines for the SAEM Annual Meeting. To that end we welcome, but do not require, wearing face masks while at SAEM22 sessions, meetings, and events. We also ask that attendees complete a personal health screening each morning prior to joining the conference. If you are feeling unwell or experiencing any symptoms, please isolate and do not attend.

Need Assistance?

ANNUAL MEETING

App Help Desk

Visit the App Desk located at the Napolean Ballroom Foyer: Third Floor for assistance in downloading or navigating the SAEM Annual Meeting app.

Medical Student Ambassadors

SAEM’s Medical Student Ambassadors will be stationed throughout the Sheraton New Orleans Host Hotel to help. They will be wearing blue, SAEM-branded jackets, so they’ll be easy to spot. Additionally, SAEM staff will be at the registration desk during registration hours and at SAEM Booth #212 during exhibit hours to lend a hand.

New to SAEM or the Annual Meeting?

Will this be your first time attending the SAEM Annual Meeting or are you a new member of SAEM? Please stop by SAEM Booth #212 in the exhibit hall during exhibit hours and introduce yourself, have a professional headshot taken, grab a tee shirt and some SAEM swag, enter a for a drawing to win some fun prizes. Our friendly staff are excited to mee you and tell you about SAEM’s programs and services and how to get the most from the annual meeting.

Plan time in your schedule to visit the SAEM22 Exhibit Hall in Grand Ballroom C, D, E: Fifth Floor. Have a complimentary professional headshot taken, Visit with the 47 exhibitors who will be on hand to showcase their latest products and services. Use the SAEM22 Online Program Planner to view the online floor plan and browse by company name or booth to create your must-visit list of exhibitors.

ANNUAL MEETING

SAEM22 Exhibit Hall

Exhibit Hall Hours 5:00 PM - 6:00 PM 7:00 AM - 9:00 AM 7:00 AM - 8:00 AM 9:00 AM - 12:00 PM 12:00 PM - 4:00 PM 12:00 PM - 1:00 PM 2:30 PM - 3:00 PM 7:00 AM - 1:00 PM 7:00 AM - 8:00 AM 12:00 PM - 1:00 PM 1:00 PM - 3:00 PM

TUESDAY, MAY 10, 2022

Exhibitor Kickoff Party

WEDNESDAY, MAY 11, 2022

Exhibit Hall Open Networking Breakfast in Exhibit Hall Exhibit Hall Closed Exhibit Hall Open Light Lunch in Exhibit Hall Power Break in Exhibit Hall

THURSDAY, MAY 12, 2022

Exhibit Hall Open Networking Coffee Service Light Lunch in Exhibit Hall Exhibitor Move Out

SAEM22 Exhibitors EXHIBITOR

BOOTH

EXHIBITOR

BOOTH

3rd Friday

403

Ceribell, Inc

102

MorTan, Inc (The Morgan Lens)

406

Abbott Point of Care

114

Clarius

414

Penn State Hershey Medical Center

311

American Board of Emergency Medicine

307

Cytovale

217

Philips

206

American College of Emergency 404 Physicians (ACEP) Accreditation Programs

EMrecruits

116

Rare Disease Therapeutics, Inc.

201

Emergency Care Partners

111

Splash Cap

410

AMBOSS

107

Emergent Medical Associates

202

Surgical Science – Simbionix Simulators

416

Apollo MD

305

Envision Physicians Services

213

Team Health

315

AstraZeneca

402

EPOWERdoc Inc.

303

The Permanente Medical Group, Inc.

317

AstraZeneca

401

Fisher & Paykel Healthcare

312

Atlantic Pension Planning

313

212

306

The Society for Academic Emergency Medicine

Auburn University, Physicians Executive MBA Program

400

Icahn School of Medicine at Mount Sinai

University of Colorado Denver

301

Integrated WealthCare

304

Baxter Healthcare Corporation

412

Janssen Pharmaceuticals, Inc.

117

US Army - 5th MRB Health Care Medical Recruiting

409

115

LumiraDx

302

USACS

300

BRC

200

Mayo Clinic

105

Vituity

210

bioMérieux

203

Medical College of Wisconsin

314

BioXcel Therapeutics

207

101

Medical Reimbursement Inc.

407

Yale School of Medicine, Department of Emergency Medicine

BioXcel Therapeutics - Medical Affairs

405

Me-Med

316

BTG Specialty Pharmaceuticals

103

Mindray

215

Money Script Wealth Management

204

Caire Health

113

EXHIBITOR

GO BIN

BOOTH

The highlighted exhibitors are participating in bingo.

VIP Table Sponsors: SAEM RAMS Party at House of Blues • University of Cincinnati, College of Medicine, Department of Emergency Medicine

• The Ohio State University, College of Medicine, Department of Emergency Medicine

• Massachusetts General Hospital, Department of Emergency Medicine

• Washington University at St. Louis, School of Medicine, Department of Emergency Medicine

• LSU Health - Shreveport, Department of Emergency Medicine

• Emergency Medicine Residents' Association (EMRA)

• Columbia University, Department of Emergency Medicine • Medical College of Wisconsin, Department of Emergency Medicine • Stanford University, School of Medicine, Department of Emergency Medicine

CLERKSHIP CORNER

Defining Excellence in Diverse Ways: A Necessary Shift in Medical Student and Resident Trainee Selection

SAEM PULSE | MAY-JUNE 2022

By Keme Carter, MD and James Ahn, MD, MHPE on behalf of the SAEM Clerkship Directors in Emergency Medicine academy

In 2022, medicine continues to suffer from a lack of diversity. This continuing problem in medicine, and especially in academic medicine, is multifactorial; however, we must acknowledge that this problem has deep historical roots in the inequitable educational system of our country and the selection practices in higher education and training. With the passage of the Civil Rights Act in 1964, overtly discriminatory student and resident selection practices and policies became unlawful, and the Association of American Medical Colleges (AAMC) launched initiatives to increase the number of Black students enrolled in medical schools. While these initiatives did result in increased numbers of Black medical students, we continue to see that the percentage of medical students and residents who are underrepresented in medicine (URiM) does not reflect the

percentage of residents in the United States (U.S.) who share those identities. The AAMC reports that although 13% of the U.S. population identifies as Black, only 3.6% of academic physicians identify as Black or African American. This nation has a compelling interest in recognizing that the underrepresentation of the American public in medicine hinders the health care system, and the ability to address inequities within said system. Further, the lack of diversity in academic medicine is deleterious to the training of all trainees, as a diverse workforce can inform new frameworks of education, research, and training. In addition to addressing “leaky pipelines” within the educational continuum, we propose a reframing of how selection committees evaluate applicants. More specifically, medicine, as a discipline, needs to fundamentally change

traditional definitions of excellence that deem students and residents as “qualified” to join their training programs. This paradigm shift can serve as a critical intervention point to increase diversity along the continuum of medical training. Currently, entry into medical school and residency relies heavily upon traditional metrics of excellence that can be described as monolithic at best. Despite many types of evaluation measures showing evidence of racial bias, the indelible belief that these measures inherently deem an applicant worthy of medical school and residency selection may be cemented in the consciousness of some selection committees. As an example, standardized tests scores have demonstrated racial bias; these are not novel findings. Yet, these scores

“This nation has a compelling interest in recognizing that the underrepresentation of the American public in medicine hinders the health care system, and the ability to address inequities within said system.” persist as key markers for entrance into the house of medicine. And, while we acknowledge that the use of standardized test scores will vary by program and by stage of the selection process, they assuredly remain an important factor in medical school admissions and residency selection. Those who hold the keys to medical school and residency entry cannot deny the existence of deeply embedded economic, social, and educational structures and their significant influence on the pathway to medicine. Indeed, these structures disproportionately and negatively affect the test scores of URiM students decades before they even apply to medical school or residency. High intellect is, most certainly, required to care for patients, drive innovation, and advance the discipline of medicine. What is equally true is that using the historical standard of metrics to primarily define excellence, narrow the applicant pool, and predict success as a physician is inequitable and unfounded. Continuing to rely on these standards that have demonstrated significant flaws as primary indicators of

excellence will unquestionably continue to limit the diversity of our physician workforce.

• and the enhanced ability of the future workforce to solve problems in medicine.

As educational program leaders who have had success in diversifying our medical school and emergency medicine residency training programs in our institution, we submit that a move toward holistic review is a crucial step toward increasing representation in medicine. The practice of holistic review (giving balanced, flexible, and individualized attention to applicants’ experiences and metrics) was developed in response to the opposition to race-conscious selection practices. Implementing holistic review allows for the selection of more missionaligned applicants and is one way to work towards diversifying training programs. The benefits of this process are many and include:

For holistic review to be successful, however, we have found that a deliberate approach and a willingness to define excellence in diverse ways is necessary. We propose the following framework to approach holistic review:

• an enriched learning environment for all; • the advancement of population health (as URiM trainees have been shown to be more likely to serve under-resourced communities); and

1. Define a mission. This mission statement will provide the lens through which your committee review all applicants. 2. Develop application screening and interview evaluation rubrics that are clearly tied to the program’s mission. Similarly, de-emphasize traditional metrics that have been documented as racially biased or otherwise flawed 3. Consciously reframe how excellence is defined and ask different questions that indicate potential for success as a physician. Examples:

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towards more equitable review and selection processes. Leaders that can grant entrance to the house of medicine must continue to recognize the historical context and barriers to medical education and training, acknowledge that systems of training were not originally built to accommodate learners of diverse educational and identity backgrounds, and lead the change required to enrich our educational environments to best serve our communities. This begins with a systematic and informed renovation of our evaluation and selection structures to fundamentally change how we select our physicians of the future. We acknowledge that such efforts will be difficult and strenuous, but the importance of holistically evaluating applicants and defining excellence in diverse ways cannot be overstated as the well-being of our patients, our trainees, and the health care system is at stake.

ABOUT THE AUTHORS

CLERKSHIP CORNER

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• How did the applicant perform and what were they able to accomplish with the resources they had? • How did the applicant demonstrate altruism and compassion? • How did the applicant demonstrate industriousness and resourcefulness?

SAEM PULSE | MAY-JUNE 2022

• How did the applicant demonstrate resilience?

• How did intellectual curiosity manifest in the application? • In what ways did the applicant show potential for leadership?

• What is the applicant’s academic or clinical performance trajectory? • How has the applicant demonstrated the intrinsic motivation to serve the patient population that we serve? While holistic review to inform selection is important, this cannot be the sole action to solve the diversity problem that is apparent at the medical student, residency, and faculty levels. Ensuring adequate representation at every level of training and practice requires the collective work of everyone. Medical school admissions and residency program leadership have the responsibility of not only applying best practices such as holistic review, but also continuously pushing

Dr. Carter is an associate professor in the section of emergency medicine at the University of Chicago where she serves as associate dean for admissions at the Pritzker School of Medicine, associate vice-chair for diversity, equity, and inclusion education in the Department of Medicine, and emergency medicine clerkship director. @KemeCarter Dr. Ahn is an associate professor in the section of emergency medicine at the University of Chicago where he serves as emergency medicine residency program director and director of the emergency medicine medical education fellowship program. @ahnjam

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

There’s nothing selfish about SELF-CARE #StopTheStigmaEM

CRITICAL CARE

Clinical Resuscitation Fellowships and the Role of the Emergency Department Resuscitationist

SAEM PULSE | MAY-JUNE 2022

By Alexander Bracey, MD; Luke J. Duncan, MD; Neil Dasgupta. MD; Gregory P. Wu, MD; Ryan N Barnacle, MD; Arman A. Sobhani, MD; Scott D. Weingart, MD, and Brian J. Wright, MD, on behalf of the SAEM Critical Care Interest Group

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Emergency medicine (EM) is quintessentially defined by adaptability. It is evident in our daily operations, in every patient encounter in which we manage undifferentiated presentations with little contextual information, and when we routinely provide care in every nook of the emergency department (ED). Furthermore, EM has pioneered asynchronous learning, Free Open Access Meducation (FOAMed), and fellowships in a wide breadth of fields. Since its inception, our field has innovated to meet the growing needs of our patients. The recent explosion in critically ill patients presenting to the emergency department has posed unprecedented challenges to patient care. Meanwhile,

inpatient hospital beds, particularly ICU beds, have not expanded to meet this additional volume, and thus, EDs have been forced to accommodate the overflow. It is now routine to have patients remain within the emergency department for prolonged periods while awaiting placement to a physical hospital bed (commonly called “boarding”). Various models have been proposed to address the boarding of critically ill patients, though there is no single solution to this complex issue. While identification and subsequent resuscitation of the critically ill patient is at the core of EM training and practice, the management of such patients beyond the acute and immediate post-resuscitation phases of care is

traditionally performed by intensivists. Moreover, critically ill patients boarding in the ED are associated with worse outcomes, including increases in length of stay, ventilator days, organ dysfunction, and mortality. The COVID-19 pandemic has further accentuated these issues. EM has again been called on to adapt. To address the needs of the increasingly prevalent and complex critically ill patients in the ED, Stony Brook University Hospital developed the first Clinical Resuscitation Fellowship (CRF) and graduated its inaugural class of resuscitationists in 2016. The aim of a CRF is to provide additional specialized training to emergency physicians (EPs) in the management of critically

“The aim of a Critical Resuscitation Fellowship is to provide additional specialized training to emergency physicians in the management of critically ill patients from the time of emergency department arrival through stabilization and disposition.” ill patients from the time of ED arrival through stabilization and disposition. A CRF focuses on the first 24 hours of critical care, extending beyond the traditional duration and scope of ED care. EM residencies typically focus on the immediate steps of stabilization and differentiation of clinical pathology in critically ill patients to a point where an ICU bed or operative theater is available and a transition of care occurs. CRFs aim to deepen the knowledge of critical care during and after the initial resuscitation period, building upon the broad foundation of the EP’s knowledge base to incorporate common critical care procedures and techniques, while developing mastery of rapid escalation of critical care interventions. CRFs also expand on the core knowledge of EPs to include a fluency in the maintenance and de-escalation of critical care, which is of particular importance as the frequency of critically ill patients presenting and subsequently boarding in EDs continues to increase. This is accomplished by providing trainees with an expanded clinical experience that includes a primary focus on the care of critically ill patients in the ED, supplemented with additional rotations in a variety of ICU settings. This additional training experience allows fellows to refine their management skills beyond the experience provided in a three- or four-year EM residency. Clinical Resuscitation Fellowships focus on EPs that desire an expanded critical care skill set, but do not wish to

practice in a dedicated inpatient ICU setting. A broader scope of practice for such resuscitation specialists, or “resuscitationists,” can reduce the demands on increasingly limited, resource-intensive environments (e.g., intensive care units, intermediate care units) by accomplishing resuscitative goals in the ED-ICU environment in patients with time-limited critical illnesses. Examples of patient presentations that benefit from a strategy of aggressive ED-based resuscitation include diabetic ketoacidosis, undifferentiated dyspnea requiring non-invasive positive pressure ventilation, agitated delirium, intubated trauma patients not requiring operative intervention, among others. Through the interdisciplinary lens of EM, fellows gain skills and knowledge beyond the typical scope of the EP and draw best practices and evidence-based methods from the spectrum of intensive care disciplines. During the training year, resuscitation fellows function primarily as dedicated physicians for the critically ill patients within the emergency department. In this role, fellows can focus on providing immediate and continuous comprehensive care to critically ill patients. This focus allows fellows to gain valuable experiences without the additional cognitive burden of managing the entirety of a busy emergency department. Fellows have additional opportunity for refinement and extension of core emergency medicine resuscitation knowledge, including cardiac arrest

“Critical Resuscitation Fellowship are an emergency medicine-based solution to the specific and prevalent problems surrounding the care of critically ill patients in increasingly crowded emergency departments.”

management, management of the shocked patient, ventilator management, advanced ultrasound techniques, fluid management, vasopressor use, and mastery of emergent procedures. Immersion in a critically ill patient population provides opportunities for frequent repetition of essential resuscitative concepts, thereby allowing fellows to achieve a level of expertise beyond that obtainable in residency training, more in line with a critical care subspecialist. Additional discrete skills can also be developed around the resources available to individual training programs: resuscitative transesophageal echocardiography and extracorporeal membrane oxygenation are some specific examples. Importantly, clinical resuscitation fellowship trained physicians occupy a distinct subspecialty of EM from traditional critical care fellowship trained physicians with a parallel, yet distinct knowledge base and scope of practice. Critical care fellowships through medicine, surgery, neurology, or anesthesia pathways are often focused on care of patients with defined disease pathology in an ICU setting. Furthermore, traditional critical care training focuses substantially on long-term critical care, de-escalation of critical care interventions, prevention of iatrogenic consequences of ICU care, and transitions of care within the hospital, to rehabilitation/extended care facilities, or discharge home. In contrast, the EM resuscitationist works in the ED setting or an ED ICU to simultaneously stabilize and differentiate the critically ill patient’s pathology, performs rapid interventions where needed, de-escalates care where possible, and transitions to traditional critical care environments for the continued management of protracted disease processes. While dual trained emergency medicine-critical care intensivists undoubtedly serve an integral

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CRITICAL CARE

SAEM PULSE | MAY-JUNE 2022

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role within the EM community, there is a significant portion of their critical care training that is not directly applicable to the practice of emergency medicine. CRFs are an EM-based solution to the specific and prevalent problems surrounding the care of critically ill patients in increasingly crowded EDs. CRFs also opens a pathway for additional EPs that are interested in critical care as it pertains to the ED but are not interested in inpatient ICU care or training. Therefore, a pathway that focuses on the aspects of critical care most germane to the ED will be beneficial for patient care, research, and

“This subspecialty can help to directly address the ongoing ICU boarding crisis by training emergency physicians with an expanded breadth of practice appropriate to care for these patients.” education — and the future of EM as a specialty. Graduates of CRFs are uniquely qualified to staff high acuity areas of ED. With many EDs moving towards a split model for patient acuity or even

dedicated ED-ICUs, resuscitationists have a highly desirable skill set to fill this niche within the ED, given the extra training and focus of patients commonly encountered in such zones. Furthermore, this subspecialty can help

ABOUT THE AUTHORS Dr. Bracey is a graduate of the Advanced Resuscitation Training Program at Stony Brook University Hospital and is now faculty at Albany Medical Center. He is the fellowship director of the inaugural class of the Resuscitation and Emergency Critical Care Fellowship beginning August 2022. r. Duncan is dual boarded in EM/surgical critical D care, having completed his fellowship at Albany Medical Center. He serves as the chief of the division of emergency critical care at Albany Medical Center and assistant fellowship director for the Resuscitation and Emergency Critical Care Fellowship. Dr. Dasgupta is a graduate of the Advanced Resuscitation Training Program at Stony Brook University Hospital and is now faculty at Nassau University Medical Center where he serves as director of emergency critical care. r. Wu is a dual boarded emergency medicine D and critical care medicine physician at Albany Medical Center. He completed his fellowship at Brigham and Women’s Hospital. He is the associate fellowship director Resuscitation and Emergency Critical Care Fellowship and chair of the SAEM Critical Care Interest Group. Dr. Barnacle is a graduate of the Advanced Resuscitation Training Program at Stony Brook University Hospital and is now faculty at Yale University School of Medicine where he serves as assistant program director for the Yale emergency medicine residency.

to directly address the ongoing ICU boarding crisis by training EPs with an expanded breadth of practice appropriate to care for these patients.

Dr. Sobhani is a graduate of the Advanced Resuscitation Training Program at Stony Brook University Hospital and is now faculty at Los Robles Regional Medical Center.

Finally, CRF training adds value beyond direct patient care. Graduates are well-suited to fulfill roles in quality improvement initiatives, critical care division or departmental leadership, resident education, hospital committee membership, and logistics, particularly with regards to the care of critically ill patients within the emergency department. Currently, there are two operational CRFs: Stony Brook University Hospital and Hartford Healthcare. A third program at Albany Medical Center welcomes its first class in August 2022.

r. Weingart is a dual boarded ED/surgical critical D care physician, having completed his fellowships in trauma, surgical critical care, and extracorporeal membrane oxygenation at Shock Trauma Center in Baltimore, MD. He is faculty at Nassau University Medical Center. Dr. Weingart is best known for his podcast on resuscitation and ED critical care called the EMCrit.

The landscape of emergency medicine has shifted. Our patients are sicker, more complex, more numerous, and remain under our care for longer. Emergency medicine training provides a unique skillset towards the care of these patients. CRFs can help to further refine and advance these skills and can help our specialty continue to adapt to meet the needs of our most vulnerable patients.

Dr. Wright MD is dual boarded in EM/neuro critical care, having completed his fellowship at North Shore University Hospital. He is faculty at Stony Brook University Hospital where he serves as fellowship director of the Advanced Resuscitation Training Program.

DIVERSITY & INCLUSION

Can You Tell I’m Pregnant? SAEM PULSE | MAY-JUNE 2022

By Michelle Suh, MD, on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine

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Can you tell I’m pregnant? I don’t want people to know until after I match.” As the fourth-year medical student turned to her side, the other applicants and I tried to tell if we could see any telltale bump. Now three years later, on the other side of the now virtual residency application process, I have grown familiar with the regular cadence of recruitment conversations about a program’s acuity, the city’s benefits, then the sudden awkwardness before

an applicant hesitantly asks if there’s a parental leave policy. As an emergency medicine resident, I have watched eagerly as residency programs roll out initiatives to try to increase racial diversity among trainees. However, emergency medicine must do better to support trainees trying to be parents during residency. Emergency medicine should discuss issues of family planning and parental leave more openly, as it is an issue

that affects all genders. Even writing this article, I have an urge to clarify that I am not pregnant nor planning to have children until my formal training is complete. Additionally, parental leave is not an issue exclusively for women or even applicable for all women. As Dr. Anita Chary astutely observed in a recent ACEP Now article, conflating women’s issues with motherhood reinforces an oversimplified view of women as a homogenous group with

“Emergency medicine should discuss issues of family planning and parental leave more openly, as it is an issue that affects all genders.” no nuance in personal circumstance or needs. That said, I recall being warned as a medical student that working overnight and punishing pace of emergency department shifts made motherhood and being an emergency physician a hard combination. Having never been pregnant, I cannot speak from personal experience, but I have seen my coresidents and attendings, with institutional support, navigate pregnancy and motherhood with grace. From a residency perspective, we must understand that during the application and interview process, applicants may be reluctant to ask for information about family planning in residency for a variety of reasons. First, it may be private information they do not feel comfortable disclosing. Second, there is a common fear that pursuing a family in residency

signals a lack of commitment to our professional training and development. Third, especially in programs without adequate support and policies, there is a hesitation to burden our colleagues with picking up additional shifts or call when someone is out on parental leave. Residency programs must signal their clear support of trainees becoming and being parents during residency. Part of the success of recruitment season “Diversity Days” and underrepresented (URiM) in medicine scholarships, lies in the clear commitment of residency programs to racial diversity. Similarly, programs could include a one-pager in their recruitment materials about parental leave and other policies. Websites could contain a dedicated section that addresses their current policies. Of course, the promotion of

these resources and support rely on the presence of institutional support. Further conversations are needed to develop sustainable institutional practices that support all trainees, including those navigating parenthood during residency.

ABOUT THE AUTHOR Dr. Suh is a second-year Baylor College of Medicine emergency medicine resident. Her interests include race and gender, carceral health, and medical education. She can be reached on Twitter at @MSuh25 or michelle.suh@bcm.edu.

SAEM PULSE | MAY-JUNE 2022

One Step at a Time By Anne Messman, MD, MHPE “Pick up your feet!” I pleaded with my mother while trying to guide/drag her up the flight of stairs, as if she had any control over the situation. It was a nighttime ritual when I was in college if my dad was out of town and my brother was not available; driving home from Ann Arbor to get mom into bed. She had daytime caretakers, but this was

too much to ask of them. Her legs had failed her many years prior, and she spent most of my life in a wheelchair getting worse and worse, which seemed an impossibility given that she had already lost the ability to walk. Years later, she would come into the hospital as a medical code while I was working a shift. We would bring her home a couple of weeks later to terminally wean her in the peace of her own bed.

My mother’s disability and illness were central to my childhood. So, when my right foot became numb when I was a junior in high school, hundreds of miles away from my family in boarding school, I had a sinking feeling that I knew exactly what the problem was. The formal diagnosis would come a few weeks later, on March 1, 1999, after several appointments with a neurologist and an MRI: Multiple Sclerosis. Until that

“Whether or not you are aware, I am certain that you are working with disabled colleagues or learners. For their sake and for our future colleagues and learners, we need to make sure that disability has a seat at the table of any conversation surrounding DEI.” day, I knew I wanted to be a doctor. But the diagnosis had me wondering if all the work would be worth it. My mother had been diagnosed while she was an OB/ GYN resident at Northwestern University in the 1970s. She did all the grueling work decades before “duty hours” was a phrase that meant anything and practiced as an attending for such a short amount of time before the disease took her out of the game. Would history repeat itself? Ultimately, I decided that I shouldn’t act like I’m in a wheelchair until I’m actually in one, so I moved forward with my plans. Undergraduate, medical school, residency. I did all of it, never disclosing my disease to anyone, even close friends. When I would have an exacerbation or an abnormal MRI and needed IV steroids, I would get outpatient infusions and hide my IV access site under a long-sleeved shirt, even in the summer. I never missed a day of work. No one ever noticed or suspected what was really going on. I was very good at hiding things. Even as an attending physician, I did not disclose my illness. I wanted to feel like I had “made it” before I disclosed

anything. I worried, maybe irrationally, that if I disclosed my illness and disability, that opportunities would be taken away from me, that someone else would decide for me what I could or could not do. So, I kept my secret to myself until I was ready. It took another 10 years. By then, I was a vice chair in my department and an associate dean at the medical school. Also, the limp in my right leg was impossible to hide, so it was time. With the tremendous support of my husband, I told everybody — faculty and residents — about my illness. I forwarded the email to my former program director. The secret was out, and the outpouring of support was remarkable.

to make sure that disability has a seat at the table of any conversation surrounding DEI. Our colleagues and learners need to know they are accepted, safe, and that opportunities will not be taken away from them because of their disability— as I feared so many years ago. My ask is this: reexamine your department’s mission statement, your recruitment efforts, and the efforts of your DEI committee. Is disability addressed? We are all doing such amazing work, let’s be sure to include this important, but sometimes hidden, group.

As a profession, medicine has made incredible strides in diversity, equity, and inclusion (DEI). But very infrequently do I hear “disability” as part of these efforts. According to the CDC, 26% of adults have some form of disability, with mobility issues being the most common. Whether or not you are aware, I am certain that you are working with disabled colleagues or learners. For their sake and for our future colleagues and learners, we need

Dr. Messman is the vice chair of education for the Department of Emergency Medicine and the associate dean of graduate medical education/designated institutional official of the Wayne State University School of Medicine in Detroit, Michigan.

ABOUT THE AUTHOR

Diversity, Equity, and Inclusion in EM Research: A Call to Action

SAEM PULSE | MAY-JUNE 2022

By Angela Lumba-Brown, MD; David Fernandez, MD; and Nancy S. Kwon, MD, MPA, on behalf of the SAEM Research Committee and SAEM Equity & Inclusion Committee

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Diversity, equity, and inclusion (DEI) are cornerstones of the mission of emergency medicine. Similarly, emergency medicine research requires thoughtful and deliberate focus on DEI to impact meaningful change and advance our field. While specific DEI definitions vary in wording, we example the American Association of Colleges and Universities definitions here and offer the SAEM DEI Resource Library and Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) for further information on SAEM’s mission to impact DEI in emergency medicine. Scientific literature across many disciplines in medicine, including emergency medicine, repeatedly

demonstrates the prevalence of inequities in patient diagnosis, management, and treatment. Health care inequities span widespread topics including wait times, admission, rates, TERM

presentations for various disease states and injuries, pain treatment, mental and health support. In one well-known study from the New England Journal of Medicine, black women were DEFINITION

DIVERSITY

Individual differences, group and social differences, historically underrepresented populations, and cultural, political, religious, or other affiliation.

EQUITY

Creation of opportunities for historically underrepresented populations to have equal access to and participate in programs that can close the achievement gaps

INCLUSION

Active, intentional, and ongoing engagement with diversity in ways that increase awareness, content knowledge, cognitive sophistication, and empathic understanding of the complex ways individuals interact within systems and institutions

“...diversity, equity and inclusion” represents the non-negotiable pillars on which strong cultures must be built.” significantly less likely to be referred for a cardiac catheterization than white men. More recently, multiple studies demonstrate the immense race and ethnic inequities that occurred during the Covid-19 pandemic and the impact on health outcomes. These are just a couple examples of health care inequities that occur secondary to race, ethnicity, and sex, and many other unrepresented groups. The imminent need for DEI focus in research is not limited to topical disease-based approaches; a constant commitment to examining representation of physicians and health care personnel in emergency medicine is also important. The specialty will not address health inequity if we overlook DEI in the health

care teams that care for our patients. Although this area of research continues to expand, further research is needed specifically in emergency medicine. The gender gap is a prime example of inequity in emergency medicine that has received recent scientific attention. In a study comparing male vs. female faculty evaluations of emergency medicine residents, males and females received similar evaluations at the start of residency, but males received higher milestone attainment than females throughout residency. Scientific examinations of disparities in DEI is incredibly important, but research is not effective without implementation of positive change. Christopher Johnson, a board member at the Nonprofit

Leadership Center, writes that “diversity, equity and inclusion” represents the nonnegotiable pillars on which strong cultures must be built.” He highlights eight beliefs of leaders who authentically embrace diversity, equity and inclusion: 1. Diversity, equity, and inclusion are everyone’s responsibility. 2. No marginalized population is more important than another. 3. One person’s life experience doesn’t discredit another’s; we have a responsibility to see people through each lens. 4. Words do matter. 5. Actions mean more than words.

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“A first step to effect change in emergency medicine is to support clinician-scientists and further funding streams that advance research and implementation efforts in DEI realms.” 6. Embracing allies is important. 7. Change starts by meeting people where they are. 8. There is no finish line. Taking his conceptual framework into mind, what actions have emergency medicine and SAEM taken to address DEI in research and beyond? The SAEM22 Consensus Conference on May 10, 2022 in New Orleans is titled “Diversity, Equity, and Inclusion: Developing a Research Agenda for Addressing Racism in Emergency Medicine.” The goals of this conference are “to support the development of a consensus-driven research agenda, research collaboration network, and dissemination plan for evidence-based practices related to the care of health disparity populations in emergency care settings.” The goals of this conference are both patient- and physician-centered and include 1) clarifying knowledge gaps and prioritizing research questions to improve community health and develop best practices; 2) developing research agendas, disseminating innovations, and addressing research priorities with key stakeholders; 3) Creating resident/ faculty programs to enhance recruitment, retention, and advancement of diverse groups. SAEM has many new (and enduring) DEI initiatives, including the work of the Equity and Inclusion Committee and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). The Equity and Inclusion Committee was founded in 2020 following the recommendation of the 2019 SAEM Diversity, Equity, and Inclusion Task Force, chaired by SAEM’s new president, Dr. Angela Mills. ADIEM provides grant funding to support research that examines 1) the state of DEI in the field; 2) evaluates interventions to improve DEI; and/ or 3) studies disparities in health care outcomes among underrepresented or marginalized groups. The Academy

for Women in Academic Emergency Medicine (AWAEM) also supports research in DEI and provides research awards to investigators who wish to address a research question in line with its core ideology. This core ideology includes (but is not limited to): 1) enhancing the recruitment, promotion, and retention of women in academic emergency medicine throughout their careers; 2) identifying gender gaps and organizational practices that hamper the advancement of women emergency medicine practitioners and researchers; and 3) advancing research that leads to an understanding of the role that sex and gender play in emergency patient care. A first step to effect change in emergency medicine is to support clinician-scientists and further funding streams that advance research and implementation efforts in DEI realms. Awareness and transparency of gaps are supported by data publication. Along these lines, promoting the diversity of our researchers and research disseminators (scientific journal reviewers and editors) is also key. Studies evaluating the data on the diversity of emergency medicine researchers it is limited. In a study from the American College of Emergency Physicians (ACEP) reporting on the diversity of research awardees and barriers that researchers face, gender was perceived as one of the largest barriers to success. In data from an academic emergency medicine program, only one woman was awarded the Faculty Teacher of the Year Award and the Resident Teacher of the Year award in over 17 years. Examining such trends and bringing forth implicit biases is a data-driven step to highlight change that must occur. Investigators from this program are in the process of researching the gender disparity of similar awards across multiple programs to provide more data on implicit bias, and a call to action

that such data should promote change. It is time to take ownership over what needs to be fixed. As SAEM continues to embrace a constant commitment to DEI and research, our emergency medicine programs across the country must do the same, and many have. SAEM members, the SAEM Board of Directors, SAEM Equity and Inclusion Committee, ADIEM, AWAEM, and beyond are voicing this need and their continuing strong commitment at their own institutions and among national organizations. As stated above, “diversity, equity, and inclusion are everyone’s responsibility” and research in this area is just one way to take responsibility, make data transparent, and promote positive change.

ABOUT THE AUTHORS Dr. Lumba-Brown is an associate vice chair and associate professor of emergency medicine at Stanford University School of Medicine. She is a member of the SAEM Bylaws Committee and AWAEM Research Committee. She also sits on the Centers for Disease Control and Prevention’s Board of Scientific Counselors. Her research examines of sex-based differences, disparities in care, and subtype classification of traumatic brain injury. Dr. Fernandez is a resident physician PGY-2 at Northwell Northshore-LIJ in NYC, NY and oversees the Diversity, Equity, and Inclusion Resident Subgroup committee. Dr. Fernandez completed his undergraduate career in the city of Boston and attended medical school at New York Medical College. He is passionate about DEI, mentorship, teaching, and patient care. Dr. Kwon is the vice chair of emergency medicine at Long Island Jewish Medical Center which is part of Northwell Health. She has been an active member of SAEM as part of the Faculty Development, Research, and Equity and Inclusion committees, and is presently a member of the SAEM Nominating Committee. Her areas of interest and research include faculty development and mentorship, diversity, equity and inclusion, and the implementation of programs to support vulnerable patient populations.

EDUCATION

On-Shift Leadership: Teaching Beyond the “Hidden Curriculum”

SAEM PULSE | MAY-JUNE 2022

By Michael Zdradzinski, MD; Stephen Sanders, MD; Caroline Molins, MD; and Nicole Prendergast, MD, on behalf of the SAEM Education Committee

As emergency physicians, we play many roles on-shift. We care for patients; we educate patients, families, nurses, and learners; and we assist with departmental flow and coordinate with specialists. Central to all these activities, however, is leadership. An effective emergency physician is a leader for the department, orchestrating its ebbs and flows, and navigating difficult interpersonal situations. Despite the importance of leadership to physicians’ clinical success, it is seldom given time in packed residency conference curricula; therefore, it tends to exist as part of the “hidden curriculum” of residency training.

“An effective emergency physician is a leader for the department, orchestrating its ebbs and flows, and navigating difficult interpersonal situations.” Working in the emergency department (ED) throughout the COVID-19 pandemic has underscored the importance of specific aspects of leadership. With prolonged wait times, high volumes, and staffing challenges,

the pandemic has highlighted the need for physicians to demonstrate empathy, professionalism, and effective communication skills. Given this need, we suggest that residencies develop a curriculum to discuss on-shift

“Beyond highlighting important characteristics of good leaders, like clinical competence, confidence in oneself, and the ability to make critical decisions quickly, a curriculum can help trainees to envision themselves as leaders and to understand that others view them as leaders.”

leadership skills. Such a curriculum can facilitate resident development in many ways. Beyond highlighting important characteristics of good leaders, like clinical competence, confidence in oneself, and the ability to make critical decisions quickly, a curriculum can help trainees to envision themselves as leaders and to understand that others view them as leaders. The literature identifies several themes that contribute to high-quality clinical leadership: team management, vision, communication skills, and personal attributes. Leadership topics can also be conceptualized in either a team-based model (i.e., resuscitation management) or a more individualized model (such as managing a difficult patient interaction with nursing staff). To teach these important concepts, we suggest a yearly workshop or integrated longitudinal curriculum tailored to each residency class.

For Interns

For interns, resuscitation leadership provides a good introduction to the broader concepts, as this topic is often of interest while they begin to care for critically ill patients. The discussion should include best practices, including closedloop communication, clear assignment of responsibilities, soliciting feedback from staff, and debriefing. Simulation or case-based learning can also be applied

to encourage practice of these key skills. The session can progress to a review of common leadership styles and their relative benefits and drawbacks. Through group discussion, learners should be encouraged to anticipate challenges they may encounter as they progress into more supervisory roles.

For PGY-2 and PGY-3 Residents

For the middle resident workshop, we suggest delving further into different leadership styles (such directive, empowering, transformational, transactional, laissez-faire), and encouraging residents to identify the strengths and weaknesses of each. These learners can be asked to reflect on their developing leadership styles, discuss challenges they have faced, and identify areas for improvement as they progress in seniority.

For Senior Residents

The graduating senior resident workshop can provide an opportunity for the learners to reflect on their leadership journey throughout training, anticipate new challenges as early attendings, plan for potential administrative leadership opportunities, and consider the need for ongoing self-assessment and growth as attendings. When we implemented a similar workshop series, the residents expressed appreciation for the curriculum, noting that they have become more deliberate

“For interns, resuscitation leadership provides a good introduction to the broader concepts, as this topic is often of interest while they begin to care for critically ill patients.”

in developing their leadership styles. If you are interested in developing such a curriculum, the graphic lists some resources available to assist. On-shift leadership is a crucial topic for residents to learn. Beyond the immediate need for these skills in the pandemic environment, emergency physicians who have trained in these techniques will be better equipped to lead both their departments and communities.

ABOUT THE AUTHORS Dr. Zdradzinski, is an assistant professor in the Department of Emergency Medicine at the Emory University School of Medicine. He serves as the director of postgraduate education and is the assistant director of the Medical Education Fellowship for the department. Dr. Sanders is an assistant professor in the Department of Emergency Medicine at Emory University School of Medicine.

Dr. Prendergast is a PGY-4 and chief resident in the Department of Emergency Medicine at Stanford University

Dr. Molins is an assistant professor in the Department of Emergency Medicine at Loma Linda School of Medicine and clinical assistant professor at University of Central Florida College of Medicine and Florida State University School of Medicine.

Increased Mental Workload for Academic Women Physicians Since the Pandemic Era

SAEM PULSE | MAY-JUNE 2022

By Erin L. Simon, DO; Ashley I. Heaney, MD; Rebecca A. Merrill, MD; and Sarah Greenberger, MD, on behalf of the SAEM Education Committee

We are all anxiously awaiting the day when the COVID-19 pandemic is a distant memory and life seems more “normal.” There have been many changes that have occurred during the past two years because of COVID-19. Some changes have simplified our lives, and some have complicated them. Many of us have noticed an increased mental workload despite the many virtual options we have been given for activities, tasks, and meetings that were previously conducted in person. As we evolve to our new “normal,” we are evaluating the efficiency of how things were done pre-pandemic versus how they are done now. Academic

women physician activities may include working clinical shifts, administrative emails and paperwork, faculty and department meetings, preparation for clinical teaching and resident didactics, hospital committees, office hours, national committee responsibilities, and scholarly activity, to name a few. Personal activities may include parenting, time with family, spiritual wellness, and personal wellness such as exercise and hobbies. As we transition back and forth between virtual and in person duties, are the changes we have seen over the past two years lightening our load or increasing it? Virtual events eliminate

travel expenses and commute times and allow for breaks to do other tasks at home such as laundry, cooking, and childcare. Some of the lines between work-life balance blurred, with no clear “time off.” When our boundaries become blurred between work life and home life, we may not be devoting our full attention to either task. Many women find it challenging to take on administrative duties while at home, especially when young children are in the picture. The COVID-19 pandemic exacerbated this by disrupting normal school routines and childcare support. There is an innate desire for children to want to be near their parents when

“There is an innate desire for children to want to be near their parents when they are in the home, and parents may feel the pull to meet those needs while simultaneously juggling work duties previously accomplished outside of the home.” they are in the home, and parents may feel the pull to meet those needs while simultaneously juggling work duties previously accomplished outside of the home. As women academic emergency medicine physicians, the changes from the COVID-19 pandemic aren’t limited to our personal lives. Professionally, we have found recruiting and interviewing for our residency programs to be challenging in the virtual era. Hosting virtual events, interviews and reading thousands of applications all without having face to face time with most candidates creates gaps in this experience. Developing COVID friendly events, such as resident conferences, graduations, intern welcome events and team building, has been difficult and time intensive. Budgets for live events have been cut or removed at many institutions, leaving few options for social wellness within residency programs. Faculty become fatigued on virtual meetings, courses, retreats, and networking and find themselves working in isolation instead of as a cohesive team. This makes it difficult to build and maintain meaningful connections with coworkers. As we pivot between virtual and inperson worlds, how do we maintain our physical and mental wellness? Wellness is something that must be actively pursued and with COVID-19, our ability to actively pursue wellness was challenged. Gyms and restaurants were closed, time with friends and family was limited, and travel was restricted. Without a clear delineation between work life and personal time, defining intentional time for wellness became imperative. Multitasking is a strength of women academic emergency medicine physicians, but for many, this became a detriment when boundaries blurred. Multitasking led to feelings of inadequacy. We found ourselves making dinner and homeschooling children all while attending meetings, responding to emails,

completing charts, and developing innovative virtual residency education. Initially, there was a sense of being able to maintain previous productivity; however, we learned many things were being done mediocrely and nothing greatly. To optimize performance we needed to learn how to incorporate selective multitasking and define time separately for work and personal lives. We found a threefold approach to delineate our work and personal time. First, we became more selective in the tasks we said “yes” to. For every opportunity given, you must consider the time you must sacrifice to meet that goal. It is also important to examine if that opportunity aligns with your professional ambitions. Acknowledging the opportunity and determining if it is best suited for you or someone else is an important aspect of work-life balance. Instead of simply saying “no,” you can assist colleagues interested in building their leadership skills by offering them the role. If you are interested in the opportunity and it conflicts with your personal life schedule, it is reasonable to state your interest and to suggest a time that enables your attendance. Secondly, we found outsourcing tasks that took time away from our professional and personal lives helped us to maintain productivity. Tasks such as grocery shopping could be expedited with grocery pick up or delivery. Hiring someone to help with maintaining the home was also helpful. As women we often feel the pressure to do it all, but outsourcing a few simple tasks can lighten your load. Thirdly, schedule time for yourself. Put it on the calendar and give yourself uninterrupted time for an activity that allows you to have a mental break. Read a book, exercise, or choose your preferred wellness activity. Protecting time for yourself and making it uninterrupted from screen time and personal duties will prepare you to tackle other responsibilities.

We look forward to brighter days ahead as COVID cases decline, vaccination rates climb, and life slowly edges back towards normal. However, we expect virtual meetings and events aren’t going away entirely and some postpandemic changes are likely here to stay. The next step is to figure out which elements of our new normal should be preserved. These elements should provide equity for women physicians while promoting productivity and wellness.

ABOUT THE AUTHORS Dr. Merrill is an assistant professor of emergency medicine and the M3 clinical experiential director in emergency medicine for Northeast Ohio Medical University. She is the program director for the emergency medicine residency at Cleveland Clinic Akron General. Dr. Heaney is an attending physician in the Department of Emergency Medicine at Cleveland Clinic Akron General. She currently serves as assistant clerkship director for the emergency medicine clerkship and associate program director for Cleveland Clinic Akron General’s Emergency Medicine Residency. Dr. Simon is an associate professor at the Northeast Ohio Medical University and the Emergency Medicine research director for Cleveland Clinic Akron General. Dr. Greenberger is an associate professor and associate residency program director in the Department of Emergency Medicine at the University of Arkansas for Medical Sciences.

RESEARCH

Congratulations on Your R01! A Q&A With First-Time Recipient Dr. Bory Kea

SAEM PULSE | MAY-JUNE 2022

By Joshua Lupton, MD, on behalf of the SAEM Research Committee

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Bory Kea, MD, MR, is an associate professor in the Department of Emergency Medicine at Oregon Health & Science Bory Kea University. Here first RO1 is for her project, “Optimizing Stroke Prophylaxis of Acute Atrial Fibrillation with an Electronic Clinical Decision Support Tool: A SteppedWedge Cluster Randomized Trial Design.”

Congratulations on your first R01, “Optimizing Stroke Prophylaxis of Acute Atrial Fibrillation with an Electronic Clinical Decision Support Tool: A Stepped-Wedge Cluster Randomized Trial Design.” Can you give a summary of your project? Thank you! Although atrial fibrillation (AF) is commonly diagnosed and treated in the emergency department (ED), oral anticoagulation is significantly underprescribed even though it can reduce stroke risk. Under prescribing has been attributed to a lack of empowerment and deferral of prescribing to longitudinal care clinicians; however, patients often do not follow up, resulting

in missed opportunities to provide guideline-recommended care. My R01 focuses on this missed opportunity to change the trajectory of care in the ED for patients with atrial fibrillation with appropriate early prescribing of oral anticoagulants and thereby improve clinical outcomes. The study is a convergent parallel quantitativequalitative study consisting of three components: 1.) Implement a clinical decision support tool in a multi-centered stepped-wedge cluster randomized trial; 2.) Identify clinician facilitators and barriers to excellent AF care and refine clinical decision support tool for different

“I hope this research will allow me to learn how the unique environments of each hospital setting interact with the clinical decision support tool and evaluate the level of engagement needed to change clinical behavior.” settings using qualitative approaches; and 3.) Explore patient satisfaction with the tool for future scalability and generalizability. What findings are you hoping for from your R01? I hope this research will allow me to learn how the unique environments of each hospital setting interact with the clinical decision support tool and evaluate the level of engagement needed to change clinical behavior. The quantitative information will provide information on the impact of the clinical decision support tool. The qualitative aspect will provide us with information on how to refine and implement the tool to change clinical behavior. What prior grants did you receive before your R01 award? How did these impact your success in obtaining an R01? Before my R01, I received an NHLBI K08 Mentored Career Development Award, NHLBI K12 Institutional Mentored Career Development Award, OHSU Tartar Trust, OHSU Jerris Hedges Research Award, UCSF CTSI Resident Research Grant, and Stanford Medical Scholars Grant, which was my first grant. Although I have not pursued bench research since then, that first grant allowed the exploration of an intensive research experience and led to a desire for a career as a physician-scientist. I have received other smaller grants along the way, which were steppingstones to the larger ones, providing support for projects or developing a grant proposal.

These included the OHSU BioInnovation Program grant and OHSU Faculty Development Grant. How did you develop an interest in research? While I was an undergraduate student, I had the opportunity to visit NIH for a weeklong exposure to NIH research, which turned into a summer research experience at NHGRI. These initial experiences where physicians researched the clinical needs of their patients were highly inspiring and motivating to follow a similar physician-scientist career path. What piece of advice would you give a medical student or resident interested in pursuing a career as a physician-scientist? Find a topic that you are passionate about or one that causes confusion or triggers questions, as those questions can lead to research ideas and proposals. It is okay to change topics. I started with fish scales that detected toxins in a lab as an undergrad, worked on mice with pulmonary atresia, in vitro fertilization research on embryos, using microarrays for dermatomyositis, to guidelines for chest x-rays in trauma, opioid prescribing in emergency medicine, and now to atrial fibrillation (and other stuff in between)! As you have yet to be exposed to the multitude of topics out there, it may take time to determine what may interest you or the ideal environment to launch your research idea (topic, mentors, data, lab, etc…)! Find mentors of different types that can help you achieve your goals, as well as sponsors that can help move you into places that you wouldn’t normally be

Know Someone We Should Highlight? This article is the first in a new SAEM Research Committee Q & A series that highlights and celebrates SAEM members who have received their first R01 or equivalent funding. If you or a colleague you know, are someone who should be highlighted, please let us know by sending us an email at grants@saem.org

at. Also stay in contact with friends from medical school or other walks of life — a wide network can come in handy! Peer mentors are also extremely important. Who are some of the mentors you look to who have made a positive impact on your career? Rob Rodriguez (UCSF-ZGH), Ben Sun (formerly OHSU, now UPenn), Leslie Biesecker (NGHRI), Mohamud Daya (OHSU). Peer mentors: Anna Marie Chang (Jefferson), Hemal Kanzaria (UCSF) What has been the most challenging aspect of your work as a physician-scientist? Trying to do it all, including being a parent, spouse, teacher, physician, researcher. One of my mentors told me that for every three things you try to do, you can only do two of them well. It’s not necessarily about work-life balance, it’s about compromise. At some point, you won’t be great at all things, but there are times when it’s more important to be great at one or two of those things and let someone else pick up the slack. How has SAEM impacted your path to an R01? I have networked tremendously through SAEM and have served on the research committee and grants committee. By evaluating other projects and grants, I glean on how I can improve my own studies and grants. Learn more about the NIH Research Project Grant (R01) program: https:// grants.nih.gov/grants/funding/r01.htm

ABOUT THE AUTHOR Dr. Lupton is a Research Fellow in the Department of Emergency Medicine at Oregon Health & Science University and a member of the SAEM Research Committee. Dr. Lupton is the recipient of the 2022 SAEMF Research Training Grant.

Demystifying the Institutional Review Board

SAEM PULSE | MAY-JUNE 2022

By Adrienne Malik, MD; James Paxton, MD, MBA; and Mark Mycyk, MD on behalf of the SAEM Research Committee

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From the outside, it may appear that the Institutional Review Board (IRB) is a group of maleficent specters intent upon derailing the well-intentioned efforts of researchers who are simply in pursuit of undiscovered truths needed to improve the practice of medicine. But those on the inside understand that the IRB exists to protect human subjects from abuses that may be completely incomprehensible to most researchers. As members of the IRB Illuminati, we bring you information from “behind the curtain,” to help you better understand the process, its invaluable function, and some tips on how to tailor your submissions to make them more acceptable to your IRB colleagues. We promise, we are on your side.

Why do we need an IRB?

All institutions engaged in research are required to have an IRB and they all function similarly. The purpose of the IRB is to assure that, both in advance and by periodic review, appropriate steps are taken to protect the rights and welfare of human subjects participating in research. The over-arching focus of this group is on the risk-to-benefit ratio for subjects engaged in research.

Regulation from the IRB is needed to prevent citizens from engaging in clinical research that poses an unacceptable risk to their health without adequate benefit to themselves and society. IRBs exist because in the past some very questionable (and at times abhorrent) methods have been employed in the name of research, at the very real and unethical expense of study subjects (e.g., The Tuskegee Study). In short, the IRB exists for the benefit and protection of potential study subjects.

Who are the members of the IRB?

United States Food and Drug Administration regulations [21 CFR 56.107(a)] require that the IRB must have a "diversity of members, including consideration of race, gender, cultural backgrounds and sensitivity to such issues as community attitudes." Consequently, membership in the IRB includes a mix of community members as well as research scientists and other individuals with insight into the research process. In general, IRBs cannot decide on research protocols without adequate representation by “laypersons” from the community. It is important to remember

that IRB members are volunteers, with a wide range of backgrounds, including physicians, nurses, pharmacists, lawyers, business leaders, and other members of the community. By law, IRBs must contain at least one non-scientist and one individual not associated with your institution to act as unbiased stakeholders on the behalf of study subjects.

What are the types of IRB submissions?

Submissions to the IRB can be categorized as “exempt” (not requiring IRB oversight), “expedited” (not requiring full committee review) or requiring “full board” review. Although the IRB may offer decision tools to help researchers assess the distinction between these types of submissions, the final determination remains up to the IRB. Expedited submissions are generally low-risk protocols that may be reviewed by a single appointed IRB member, rather than the full IRB. Once an expedited or full-board protocol has been approved, the study team may submit an “amendment” (aka “modification”) to change any aspect of the study, or a “continuation” to

“The purpose of the Institutional Review Board is to assure that, both in advance and by periodic review, appropriate steps are taken to protect the rights and welfare of human subjects participating in research.” keep the study open beyond the initial approval period (typically 6-12 months). When “unexpected problem” reports are submitted for adverse events that occurred during an ongoing study, the IRB will determine whether the problem represents an isolated incident, a protocol deviation, or something serious enough to require stopping the study altogether.

What really goes on during IRB meetings?

Committees meet regularly to discuss full-board research proposals. The IRB chair will assign a primary (and possibly a secondary) reviewer for each proposed research protocol, and your proposal’s primary reviewer will be that board member who is most familiar with your protocol and will facilitate discussion with other members. Each member of the IRB is eligible to vote for or against a study’s approval, but they are required to recuse themselves if they have a conflict of interest. These discussions can get quite in depth if there is an aspect of a study that is concerning to any one of the IRB members, not just the primary reviewer. Committees must have a quorum (i.e., minimum number) of members present to conduct business, and this quorum usually specifies how many scientists, nonscientists, and community members must be present.

Why does it take so long for them to get back to me?

Most IRBs require submission for evaluation 2-3 weeks in advance of the committee’s meeting date, so that members will have enough time to fully review the proposal. Even if the IRB determination is favorable, it may be 1-2 weeks before a formal letter can be issued to the investigator to communicate their determination. It is helpful for investigators to consider these delays when submitting initial or amendment proposals. Occasionally, approval of a project will be contingent upon a change in the protocol, informed consent form, or other aspect of your study. If this is the case, the IRB will need to confirm that these changes have been implemented prior to giving your study a green light to

enroll. A requested change will require additional review by the IRB at their next scheduled meeting.

What is the IRB really looking at in my project submissions?

Although the “scientific merit” of the study is considered, the IRB’s primary purpose is to protect human subjects. Although scientist members of the committee will offer their interpretation of the value of the data to be collected, many members of the committee are not scientists or researchers. If the risk of participation in a study is low, a wellwritten and complete submission has a high likelihood of approval. If the risk associated with participation is high, the study team will need to provide adequate justification for subject enrollment before the IRB can approve the study. Thus, the primary focus of most IRBs is on the risk-to-benefit ratio for participants, so this aspect of the study should be clearly described in the IRB submission. Before submitting a proposal to the IRB, researchers should consider whether their protocol, informed consent form (ICF), and all other documents are free of cumbersome medical jargon and easily interpretable to nonscientists and patients with limited research training or formal education. It is helpful to bear in mind that while many members of your IRB are physicians or scientists, they may have an area of expertise that is far removed from the scope of your research. Simple explanations and clear, concise language in your protocol will benefit you in your IRB review. Additionally, make sure to include known or anticipated adverse effects of investigational drugs or procedures, and your plan to mitigate the risks to your subjects. A study’s ICF is subject to significant scrutiny by the IRB. Many submissions are held up due to the consent form being viewed as confusing, unclear, or manipulative by nonmedical members of the IRB. Aim to write an ICF that can be understood by someone with a 6th grade reading level and avoid the use of coercive language.

What other tips do you have for IRB submissions?

Investigators should ensure that they have adequately described their plan for data handling and patient safety monitoring during the study, as these represent other areas of potential risk to subjects that will be closely examined during the IRB review. If you plan to compensate your subjects for participation, make the compensation commensurate with what you are asking them to do. Lastly, your institutional IRB is very willing to assist you with your proposal or answer any questions you might have. We understand navigating the submission and review process is not always intuitive. Communication from you or your research team is both welcomed and encouraged. We hope you found this little foray into the enigmatic world of the IRB to be helpful. We look forward to reviewing your next proposal!

ABOUT THE AUTHORS r. Malik is an assistant D professor of emergency medicine at the University of Kansas Medical Center in Kansas City, KS. She has been a member of the Kansas University Institutional Review Board since 2020. Dr. Paxton is associate professor of emergency medicine and director of clinical research at Detroit Receiving Hospital/ Wayne State University (WSU) School of Medicine (Detroit, MI). He is a long-time member of the WSU Institutional Review Board, including recent chair of the MP2 IRB Committee (2015-2020). Dr. Mycyk is chair of research in the Department of Emergency Medicine and serves as vice chair of the Institutional Review Board at Cook County Health.

Emergency Medicine Network is Forging Ahead: An Interview With Dr. Carlos Camargo

SAEM PULSE | MAY-JUNE 2022

By Maurice Dick on behalf of the SAEM Research Committee

Dr. Carlos Camargo is a professor of emergency medicine, medicine and epidemiology at Harvard University, and the Conn Carlos Camargo Chair in Emergency Medicine at MGH. He founded and leads the Emergency Medicine Network (EMNet). Dr. Camargo’s research also focuses on nutrition and respiratory/allergy disorders, both in large cohort studies (e.g., the Nurses’ Health Studies) and in large randomized controlled trials; the health effects of vitamin D are a major focus. He has more than 1,100 publications with an H-index of 145. Dr Camargo is past president of the American College of Epidemiology, and has worked on several U.S. guidelines, including those on diet, asthma, and food allergy. In 2016, he received the ACEP Award for Outstanding Contribution to Research. Another important focus for Dr. Camargo is research training and mentorship; he was honored by Harvard with the Barger Excellence in Mentoring Award (2011) and by MGH with the Potts Faculty Mentoring Award (2019).

“A major factor that contributed to EMNet’s early growth and success was our open invitation to any highly motivated, detailoriented EM researcher to join us.” Can you expound on some of the challenges, gaps and or deficiencies that you encountered prior to the establishment of EMNet? At that 1996 SAEM meeting, multiple investigators expressed frustration about doing single center studies with small sample sizes, low statistical power, and potentially limited generalizability. Moreover, recruitment at only one center typically required months (sometimes years), which extended far beyond the traditional fall burst in asthma exacerbations. The long duration of these studies did not match the mindset of many emergency physicians, who typically favor shorter, simple, intense experiences — and then done! In response to this, we agreed to 24/7 enrollment of all emergency department (ED) patients with asthma exacerbations during a two-week period that fall.

Ultimately, 12 sites enrolled greater than 80% of truly consecutive patients and we collectively enrolled more than 500 patients in a few weeks. Moreover, we were able to contact more than 80% of these patients at two-week follow-up! EMNet has experienced exponential growth since inception (1996), including but not limited to, 24/7 medical centers and three distinctive programs (MARC, HSR, Social EM). What are some major factors that contributed to EMNet’s growth and success? After that initial success, we quickly grew to 77 sites and then just kept growing as we expanded our focus to other respiratory/allergy emergencies (e.g., COPD, anaphylaxis, acute respiratory infections) and developed HSR research on the heterogeneity of EDs, both in the U.S. and internationally. Major HSR studies have focused on the emergency

medicine (EM) workforce and patient safety issues. We also undertook novel studies on more psychosocial aspects of emergency care, including suicide prevention. A major factor that contributed to EMNet’s early growth and success was our open invitation to any highly motivated, detail-oriented EM researcher to join us. We typically develop simple protocols, for short duration studies (involving many sites), and emphasize the importance of disseminating our findings through national meetings and manuscript publications. To date, EMNet investigators have published over 850 manuscripts, with more than 800 named authors from more than 175 participating sites. How has EMNet adjusted over the years, with reference to products, processes, and procedures, to medical, social, and technological trends and advancements? The biggest change over the past 25 years involves funding. Initial studies were largely unfunded, with sites volunteering to participate for these intensive two-plus week studies. Alas, those days are long gone. Moreover, as we have grown to rely largely on NIH funding, we have had to focus on longer (e.g., five-year) studies with fewer sites and more challenging protocols. We still work on a variety of study designs (from short surveys to randomized controlled trials) but the large federally funded studies have pushed the EMNet Coordinating Center from 10-20 staff to its current 50+ staff. Without all these hard-working people, under the leadership of Ashley Sullivan, MPH, MS, we could not do all that we do. Another important change has been technological. We started EMNet in the 1990s when email/internet was being

introduced to academia, and we could not have advanced as we did without that technology. Over the past decade, we have turned over most of our data management to REDCap and similar programs, which have greatly improved the efficiency of our research operations. Describe a significant challenge EMNet may have experienced and how was this challenge addressed? The biggest challenge for EMNet has been the lack of dedicated infrastructure support for the network. Our annual budget (now $7.2 million) is entirely funded by individual research project grants, especially NIH R01 grants. EMNet funding started with an administrative supplement to my K award in 1996, which has been followed by multiple grants from NHLBI, NIAAD, AHRQ, CDC, and other federal sponsors; federal funding accounts for greater than 90% of our support. It has not been easy, but we’ve been able to secure continuous funding for 25 years and, as much as possible, to share these funds across the network. Can you highlight at least two major accomplishments of EMNet? The two main accomplishments of EMNet are its scientific publications and its mentorship of EM researchers. With regard to publications, the MARC program has shined a light on the importance of ED visits for asthma exacerbations and anaphylaxis and this has led to changes in NIH guidelines; the HSR program — partly through our annual survey of all U.S. EDs, called the National ED Inventory (NEDI)-USA — has emphasized the heterogeneity of U.S. EDs and its workforce and, thereby, influenced EM health policy; and the

Social EM program has done important work on ED-based suicide prevention and the role of ED-based screening for adverse social determinants of health. Regarding EM research mentoring, EMNet studies have provided practical, “on-the-job” research training for hundreds and hundreds of EM faculty, post-docs, EM residents, and students, across the U.S. and worldwide. With collaborators at most academic EM programs, this mentorship and, ultimately, our shared learning is probably EMNet’s biggest contribution to EM. Where do you see EMNet in the future? We will continue to work on our three programs (MARC, HSR, Social EM), along with one-off projects on specific issues of interest. For example, we recently finished a scientific review of SAEM Annual Meeting abstracts over the past 30 years. I attended my first SAEM Annual Meeting in 1994 and the improvements since then have been remarkable! We set out to formally study this and confirmed my anecdotal impressions. It gives me great personal satisfaction to know that EMNet played a small but important role in this remarkable scientific progression.

ABOUT THE AUTHOR Maurice Dick is a third-year medical student at Saint James School of Medicine and a 2021 SAEM Medical Student Ambassador. His aspiration is to become an emergency medicine physician devoted to underserved communities. His major interests in emergency medicine include critical care, pointof-care ultrasound, and simulation education.

About EMNet The Emergency Medicine Network (EMNet) was founded in May 1996 by a dozen SAEM members with a research interest in asthma. At the initial meeting, Dr Carlos Camargo, Massachusetts General Hospital (MGH), Harvard, was chosen to lead this voluntary, unfunded, multicenter initiative. The group launched its first asthma study in the fall of 1996. The network was originally known as the Multicenter Airway Research Collaboration (MARC) but it was quickly apparent that most problems of emergency department (ED) patients with asthma involved: a.) health care delivery/policy issues and b.) psychosocial issues. The collaboration was renamed EMNet, and it now includes three emergency medicine (EM) research programs: MARC, Health Services Research (HSR) in emergency care, and Social EM. EMNet is a research division in the MGH Department of Emergency Medicine; the EMNet Coordinating Center includes approximately 50 EM faculty, post-docs, analysts, clinical research coordinators, research assistants and administrators.

ETHICS IN ACTION

End-of-Life Care: Implementation of POLST and MOLST Forms By Trudi Cloyd MD, MSc

SAEM PULSE | MAY-JUNE 2022

The Case

A 63-year-old female patient with a history of stage IIIC2 endometrial cancer presents from subacute rehab with hypotension and altered mental status; she is minimally responsive to pain. On review of her medical record, you see that she was discharged from the hospital four days ago after a month-long admission initially for malignant stricture of duodenum now stented. Hospital course was complicated by septic shock due to large gastric perforation. Prior hospital documentation was full code, but the rehab facility provides medical orders for life-sustaining treatment (MOLST) paperwork documenting do not resuscitate/do not intubate (DNR/ DNI) and limited medical interventions.

The document is signed by the patient, facility nurse practitioner, and social worker the day after discharge from the hospital. The patient’s son, who is not officially health care proxy, is bedside, but has been unable to visit the facility due to COVID-19 restrictions. He had no knowledge of the updated goals of care status. Advance care planning can help patients and their families discuss and document their individual wishes for end-of-life care to health care providers, should patients be unable to express their wishes at that time. There are many formats for documenting these wishes, including physician orders for life-sustaining treatment (POLST), MOLST and medical orders for scope

treatment (MOST) forms, do not attempt resuscitation (DNAR) orders, living wills, and durable powers of attorney for health care. Unfortunately, care of the acutely ill or dying patient in the emergency department is often initiated with limited information, including understanding of end-of-life wishes. In the early 1990s, health care professionals in emergency medicine, long-term care, and ethics convened a task force to address the need for a standardized portable medical order that could guide the medical team in the acute presentation of the decompensating patient. Advance directives or living wills were rarely available in a timely manner to guide decisions, and DNR/DNI orders failed

“the presence of a POLST form does not obviate the need to confirm end-of-life preferences in patients with decision-making capacity.” to address the nuanced medical choices available during resuscitation. In addition, DNR and DNI orders were restricted to a specific hospital admission and rarely follow the patient on discharge. The POLST was developed as an alternative to DNR/DNI and advance director as it was designed to help patients provide nuance and clarity on their treatment wishes in the period before imminent death. POLST documents may also be referred to as MOST and MOLST, but all share the same core elements in form and design. They address such elements as IV fluids, antibiotics, artificial nutrition, and comfort measures as well as cardiopulmonary resuscitation (CPR) and intubation — and record the patient’s wishes regarding many of these issues. By allowing a nuanced selection of medical interventions, patients and their authorized surrogates can translate goals and wishes into orders that are specific to most medical encounters. This contrasts with DNR/DNI documents, which are much more limited in their scope and address only avoidance of resuscitation or intubation. Physicians, and in some states physician assistants and nurse practitioners, can complete these forms after discussing goals of care with patients or their surrogates. In the case of the latter, the surrogate should be encouraged to make end-of-life care choices that are based on the patient’s preferences, values, and goals rather than the surrogate’s own preferences. The POLST orders are transferrable across health care settings and should be followed by emergency personnel, physicians, long-term care staff, nursing homes, and other health care providers. Although POLST forms are ideally completed when patients can still express their wishes, they only become necessary to refer to once patients can no longer talk for themselves. Therefore, the presence of a POLST form does not obviate the need to confirm end-of-life preferences in patients with decisionmaking capacity, as patients may express changes to their previously expressed wishes. In such circumstances, a

broader discussion is encouraged to review prognosis and goals of care. These discussions should include family as much as possible and appropriate to avoid future misunderstandings. In the absence of a patient with decisionmaking capacity, as in this particular case, the medical team should rely on the POLST documentation to guide care. Only in exceptional circumstances, for instance if the team does not believe the patient understood what was being signed, should documented POLST orders be adjusted, and in such a case it is recommended to include your hospital ethics service and/or risk management. POLST, or one of its variants, is recognized in all 50 states and Washington, D.C. (www.polst.org), but they vary in their applicability and are not universally established as standard of care. However, the development of national and cloud-based POLST registries will likely further increase adoption and ease of access for emergency personnel and health care professionals enabling more timely and consistent recognition of patient preferences for end-of-life care. As physicians and health care professionals, we uphold the ethical principle of respect for patient autonomy as well the legal principle of patient self-determination. While initial advance directives and DNR/DNI orders attempted to empower patients to make informed decisions on their end-of-life care, the

information was limited or often not easily accessible to medical providers. The POLST form provides specific information on frequent medical interventions that can be more easily implemented across a variety of scenarios. It is the hope that with increased implementation and cloud-accessibility, health care providers can consistently honor these wishes, improving quality of life by ensuring care is provided in accordance with patients’ wishes.

Case Conclusion

The hospital ethics team was consulted after the patient’s son expressed concern that the new MOLST was not consistent with his mother’s wishes. Palliative care meetings with the family and patient during the previous admission documented plans for aggressive cancer treatment and full code status. The medical team elected to escalate care to antibiotics and peripheral vasopressors but not pursue intubation. Ultimately, the patient expired two days later.

ABOUT THE AUTHOR Dr. Cloyd is an assistant professor in emergency medicine at Columbia University and assistant residency program director at New York-Presbyterian emergency medicine program

GERIATRIC EM

When Is It too Late? Lifestyle Medicine for Older Adults By Mary Mulcare, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine

SAEM PULSE | MAY-JUNE 2022

The “wellness” conundrum poses a challenge to health care; what makes one person well is very different from that which makes the next person feel equally well. Most approaches to wellness to date have been a series of point solutions that are narrow in their scope. The evidence behind these solutions is lacking and the adherence to these programs varies dramatically. What is the right (or potentially right) answer?

Lifestyle Medicine (LM) is changing the wellness landscape. The American College of Lifestyle Medicine has defined LM as “the use of evidencebased lifestyle therapeutic intervention – including a whole-food, plantpredominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection—as a primary modality, delivered by clinicians trained and

“A skilled lifestyle medicine provider assesses the patient’s current state and meets them there, creating simple, feasible goals to move the patient towards a healthier state.” certified in this specialty, to prevent, treat and often reverse chronic disease.” In a more distilled format, this translates to replacing unhealthy behaviors with positive ones in these six areas.

assesses the patient’s current state and meets them there, creating simple, feasible goals to move the patient towards a healthier state. The goal is nonpharmacologic intervention.

As I was discussing this concept with some colleagues, the question arose: when is it too late to bring lifestyle medicine into one’s life? At what age? As someone trained in geriatrics, that seemed like a ridiculous question. It is never too late! A skilled LM provider

Let’s briefly unpack the six pillars further as we think about the older patient cohort:

1. Nutrition

Plant-based diets have antiinflammatory effects, reduce cardiovascular disease, and impact the

onset of many common malignancies. For patients suffering from constipation, nutritional changes can provide the motility enhancement needed.

2. Exercise

Moderate exercise in one’s routine likewise reduces cardiovascular disease, obesity, and diabetes, among other things. For our older adults, it allows them to maintain independent living for longer, work on balance, and provides strength to be functional with activities of daily living (ADLs).

3.Sleep

Understanding healthy sleeping habits may prevent insomnia or changes in sleep-wake cycles experienced by many older adults, as well as allow them to reduce the deleterious sleep aids often trialed.

4. Stress management

Stress is one component of emotional resilience, a life-long skill that allows

people to return to their “pre-event” status after an acute issue.

5. Avoiding risky substances

Alcohol can be especially dangerous in older adults as their metabolism changes. Older adults are more likely to fall, lead to devastating consequences, and suffer from unrecognized alcohol withdrawal upon losing access to drinks in acute scenarios compounding life-threatening situations.

6. Social connectedness

Older adults who stay connected with their community have increased longevity and better brain health. Social constructs facilitate the goals in all the above categories. We can incorporate an introductory discussion to Lifestyle Medicine with our care in an emergency department. We are often left with unrevealing workups. What if instead of trying to explain to the patient why it is a good thing you

don’t have an explicit answer for their pain, you spend a few minutes outlining some of the positive changes they might make in one of these six pillars that may prevent them from having similar trips to the emergency department in the future? Education and awareness is key to the Lifestyle Medicine mission. Take a few minutes to explore the American College of Lifestyle Medicine.

ABOUT THE AUTHOR Dr. Mulcare is clinical assistant professor of emergency medicine at Cornell University and chief medical officer for Summus Global. She brings deep medical experience and a commitment to patient and physician education, particularly that related to older adults, to her current positions.

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

GLOBAL EM

Strengthen Global Toxicology: An Antidote to Disparities in Global and Country-Level Toxicology Systems

SAEM PULSE | MAY-JUNE 2022

By Jonathan Meadows, MD, and William Weber, MD, on behalf of the SAEM Global Emergency Medicine Academy

Over the past two years, the SARSCoV-2 COVID-19 pandemic has unearthed new and exacerbated existing challenges in treating toxicological conditions. One major example is misinformation driven treatments, such as taking hydroxychloroquine (HCQ) or sodium hydroxide (bleach) to neutralize SARSCoV-2, which has prompted responses such as the following Twitter post from the Food and Drug Administration: “You are not a horse. You are not a cow. Seriously, y’all, Stop it.” – Twitter post, 8/21/2021, US Food and Drug Administration.

This article presents the current state of global toxicology within the crucible of the COVID-19 pandemic, as well as progress towards all countries having emergency health systems to manage toxic exposures. These health care system components include but are not limited to the following: support for individual exposures at the health care facility level, systems for monitoring & addressing significant exposure incidences, and preventive approaches to future toxic exposures. This article will also discuss aspects of systems for toxicologic management in the context of COVID-19 including individual

exposures, monitoring systems for significant exposure incidences, and preventive approaches to future toxic exposures. The global burden of toxicological disease can be approximated from injury data from the World Health Organization (WHO). Since 2014, 10% of deaths have been due to self-inflicted harm, which includes poisoning. Updated data regarding poisoning within the context of COVID is published by stakeholder organizations, such as the WHO and poison center data registries, such as the Toxicology Investigators Consortium (ToxIC)

registry. Providing real time aggregated and disaggregated data regarding acute and chronic poisoning can be challenging amongst the stakeholders and the COVID-19 pandemic’s impact on trends is being elucidated currently. Articulating and addressing the asymmetric burden of poisoning in low-middle income countries can also be additional disaggregated data points. Efforts to meet this global burden of disease are ongoing and are continuations of historical efforts. In the US, one of the first poison information systems ever started was in the 1930’s by registered pharmacist Louis Gdalman at St Luke’s hospital in Chicago, IL. Throughout the 1940s and 1950s, efforts to increase public awareness were undertaken, such as the American Academy of Pediatrics’ national efforts to reduce child poisoning. At the global level, the first poison information centers were started in the Netherlands in 1949. The US poison center at Presbyterian-St Luke’s Hospital was formally recognized in 1953. Afterwards, poison control centers spread throughout the US. Today, poison control center development serves as additional opportunities for growth. Only 47% of countries have one or more poison control centers (Image 1). These centers may be concentrated in high-resource areas, given that the WHO has documented severe all-type medical staff shortages in low- and middle-income countries, leading to the low likelihood of am accessible trained medical toxicologist for intervention & consultation. The WHO has guides to establish centers, such as the 2021 publication “Guidelines for establishing a poison centre.” Thus, a need to address the global burden of toxicological disease is clear and can be undertaken with global cooperation amongst poison control centers, and toxicology societies, potentially under the coordination with the WHO and/or International Committee of the Red Cross (ICRC). These societies include the International Union of Toxicology or regional toxicology societies, such as MENATOX (Middle East and North Africa Clinical Toxicology Association), AACT (American Academy of Clinical Toxicology), and ACMT (American College of Medical Toxicology). Thus, galvanizing toxicological management capacity can include the key following actions:

Image 1. Poison control centers by geography

““You are not a horse. You are not a cow. Seriously, y’all, Stop it.” – Twitter post, 8/21/2021, US Food and Drug Administration.” • Building poison control centers. • Improving surveillance reporting systems (pharmacovigilance). • Expanding acute care systems, such as updating physical and technological structures. • Crafting strong administrative policies. • Establishing training programs in toxicology. • Improving mandatory reportable disease policies & systems. • Strengthening the interlocking emergency medical systems (EMS)emergency department (ED)-intensive care unit (ICU) care systems. • Additional steps & actions are noted by organizations, such as the WHO. Recent effort by the WHO and the ICRC to standardize basic emergency care incorporates toxidromes (toxicological clinical presentations and features along with their antidotes) appropriately under the “Altered Mental Status” section. This Basic

Emergency Care (BEC) course is used to teach emergency medical response & medical stabilization skills in resource poor settings. In the same direction, strengthening EM academic programs globally have been ongoing. Academic centers can capture toxic ingestion cases and sequala related to the COVID pandemic (such as bleach ingestions, ivermectin paste use, or high dose HCQ ingestions as dangerous treatment alternatives) and expand the number of local toxicologists (in an effort to forward the “decolonization movement” in global health). Professional society educational programs, such as ACMT’s Global Educational Toxicology Uniting Project (GETUP), also provide outreach training to advance toxicology knowledge and capacity. Future advancements of capacity for toxicological services include the use of telemedicine, which has been adopted by many toxicology fellowship training continued on Page 46

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programs and academic centers with toxicology services. The incorporation of the internet as a surveillance tool for word searches can be used to add additional information for incidence response. Other novel technologies are being applied in the forefront of toxidrome management, such as social media and wearable devices.

Current events of large scale toxicological threats, such as the Russian military occupation of the Zaporizhzhia nuclear power plant in southeastern Ukraine or the ammonium nitrate 2020 Beirut explosion, articulate the need for toxicological disaster preparedness and HAZMAT responses. Medical implications of such disasters require specialized training and response, such as participation in Advanced Hazmat Life Support (AHLS) courses along with domestic and international training events. Knowledge in these areas were critical for responses to previous nuclear & radiological incidences, like Chernobyl and Fukushima. Organizations, such as Organization for the Prohibition of Chemical Weapons, monitor chemical weapon use globally and utilize toxicological principles to combat the use of banned weapons, such as nerve agents. Linkages to climate change and environmental toxicology can be monitored and addressed with global toxicology through these aforementioned efforts, such as hydrocarbon exposures, air pollution, persistent water organics, and organophosphate pesticide use on farms that face water precipitation changes.

Finally, advocacy is critical to preventing poisoning and building capacity for toxicological clinical response in the US and globally. Academic institutions, such as Karolinska Institutet in Sweden, are teaching courses that link global toxicology to the United Nations (UN) Sustainable Development Goals (SDG), international legislations and policies for chemical safety. Chemical safety policy also encompasses US and European post-marketing drug reporting in research studies as well as adverse drug event reporting are required. European Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) legislation requires companies to adhere to higher industry standards, testing guidelines, and regulatory processes that protect human health and the environment. Furthermore, advocacy is needed to earmark public funds for poison control centers, toxicology surveillance systems. This places global toxicology not only in the sphere of global health governance, and other initiatives like global addiction medicine & pharmacosurveillance, but also broader global efforts, such as the aforementioned WHA declaration, and tropical medicine’s One Health initiative. This connects toxicology to tropical medicine as function of emerging diseases and neglected tropical diseases (NTDs) within the overlaps of veterinary and human use of chemicals, such as organophosphate pesticide, snakebites, insect bites (and their sequelae), and antibiotics. Addressing toxicological diseases through emergency care systems to meet the UN SDG, ensuring timely of acutely ill toxicological patient, can be achieved with realization of the

aforementioned points of expanding poison control centers, academic toxicology training centers, toxicology training programs, disaster response efforts, and advocacy efforts. Global toxicology advocates not only can strengthen the health care systems, but can advocate directly to the public to prevent poisoning through public health communication messaging in times of pandemics, such as through Health Alert Networks towards health care providers and news articles to the lay public to prevent exposures, such as pediatric sodium azide COVID test kit exposure.

ABOUT THE AUTHORS Dr. Meadows is an EM resident at Franciscan Health Olympia Fields applying for toxicology fellowships. His professional experiences range from disaster response, WASH development, food borne disease outbreak investigation, disaster preparedness, to correction medicine in global health. He’s served on EMRA leadership and is completing the ACEP EMBRS course. Dr. Weber practices at Beth Israel Deaconess Medical Center. He helped found the Medical Justice Alliance to advocate for the health of individuals in carceral settings. On the side, he helps lead ACEP's Public Health and Injury Prevention Committee and developed Chart Decoder, an app to help patients understand their medical records.

Emergency Medicine: A Venezuelan Perspective An interview with Dr. Carmen Sofia Rosales by Atillio Atencio, MD and William Weber, MD, on behalf of the SAEM Global Emergency Medicine Academy For the last decade Venezuela has been battling political unrest and a failing economy. In a mere eight years the country's gross Carmen Sofia Rosales domestic product (GDP)) has dropped by over two-thirds. More than 75% of Venezuela’s 28 million residents live in extreme poverty, with annual inflation rates ranging from 2,000% in 2021 to 60,000% in 2017. Dr. Carmen Sofia Rosales is a pediatric emergency physician and professor at Instituto Autónomo Hospital Universitario de Los Andes (IAHULA) in Merida, Venezuela. She sat down for an interview to discuss her experiences and the challenges

faced while practicing medicine in a country battling economic crisis amidst a global pandemic. While there are universal similarities seen in all emergency departments, Dr. Rosales provides a unique insight into the training and resources available in Venezuela.

year residents rotate through our Unidad de Cuidados Especiales Pediátricos — essentially an ICU set up in the ED. Third-year residents oversee triaging and managing all patients. Our internal medicine colleagues cover the adult ED with a similar set-up.

What does emergency medicine training look like in Venezuela? There is no formal emergency residency in Venezuela, so training varies depending on the institution where you practice. Here at IAHULA, our emergency department (ED) is run by residents who spend an average of two months out of the year with us.

Are there resources available for physicians seeking emergency medicine specific training? The short answer is no, not outside what is taught during medical school and residency. We have few resources with regards to supplies and technology. With that said, we have an excellent university that has trained some remarkable physicians.

On the pediatric side, first-year residents see less acute patients and staff them with attendings. Second-

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The best training asset our hospital offers is our patient population. Our residents are exposed to the sickest of the sick who, in general, are extremely under resourced with minimal health literacy.

Can you describe the emergency medicine culture in your hospital? I do not think we have a culture of our own as emergency physicians, but we are all bonded by the limiting circumstances in which we practice medicine. Our patients are the priority of all physicians remaining here at IAHULA. I am also proud to say that we have seen a rise in women physicians in the ED, which was not always the case. What do you mean by “physicians remaining here at IAHULA?” In the last 6-8 years we’ve seen an exodus of Venezuelans from our country due to economic and political instability. This is especially true of our new physicians who understandably would prefer practicing in more stable conditions. We are short on nursing staff for similar reasons.

“It has been many years since our hospital has been able to reliably count on things like routine antibiotics or imaging.” How has the current political and economic situation affected your ability to practice medicine in Venezuela? This is a question too complicated to answer in just one interview. The easy answer is that the current political environment limits access to diagnostic and therapeutic tools. We have been forced to make do with what there is and not with what there should be; with what patients or relatives can buy, as the hospital does not supply them. This leads to many ethical conflicts. Medicine isn’t the same as it used to be 15-20 years prior. Are you aware of any United States policies affecting Venezuelan health care? I am not aware of a policy affecting our health care but I do see the influence of American business. Within the last year our country’s economy has transitioned to the U.S. dollar. Purchases ranging

from groceries to antibiotics are made through Zelle transactions on our phones. I doubt this is sustainable, but it has allowed for a new market of goods, including medicines, that we have not seen available for years. What are the biggest challenges you face as EM physicians in Venezuela? Not having enough resources to effectively diagnose or treat. It has been many years since our hospital has been able to reliably count on things like routine antibiotics or imaging. For example, we have not had a working CT machine for the last 10 years. Even our ultrasound and X-rays are hit-or-miss. We’ve started to rely on local private clinics where we send our patients for imaging. Patients must buy an ambulance ride to the clinic, purchase a CT scan, then pay for the ride back to the hospital. All together, they can end

“The lack of resources poses a threat for the longevity of emergency medicine in Venezuela, and our patients will be left with either seeking health care in other countries or not receiving medical care at all.” up spending $300 (USD) — an amount that takes an average family weeks to get together. Patients must often provide the medications for us to administer because our hospital pharmacy is rarely stocked with what we need. Even basic supplies such as sheets or pillowcases often must be brought by a patient’s family; this leads to some colorful rounds. Patients have turned to private pharmacies, the black market, or friends and family in other countries to send supplies. Resources available depend on the day and we’ve learned to ration what we have. It's a dysfunctional system that has led to more problems than I care to admit. Any specific examples that come to mind? Just last week we had a five-yearold present after falling off his father’s motorcycle. We sent him out for imaging, and he decompensated on the way to the CT clinic. The child was rushed back to the ED and immediately treated for a presumptive intracranial bleed. I can’t help but imagine how much safer he would have been if we had CT imaging capabilities here in our ED. How has COVID affected IAHULA policies and the way physicians in the ED practice medicine? COVID has exacerbated nearly every problem in our ED and hospital. For example, there weren’t enough critical care beds even before the pandemic, but now we have taken half of the pediatric and adult EDs and converted

them into COVID units. Another struggle has been managing our ventilators. We have five ventilators to share with the entire hospital. One is solely for the use of pediatric patients and three are set aside for adults; the other one is shared based on need. Fortunately, we’ve only had two COVID related intubations on the pediatric side since the onset of the pandemic; however, I’ve heard from my adult critical care colleagues that they have not been as lucky. It’s rare that we have a free ventilator, so we’ve become good at triaging its use for only our very sick patients. Where do you see emergency medicine in Venezuela progressing in the next 10 years? Without changes in national health policies there will be more patients who will not have adequate management of their diseases. We have a deteriorating health care infrastructure, and our newly trained physicians are leaving the country. The lack of resources poses a threat for the longevity of emergency medicine in Venezuela, and our patients will be left with either seeking health care in other countries or not receiving medical care at all. What do you think that other clinicians could learn from Venezuelan emergency physicians? Our scarcity has forged us to be experts at diagnosing patients by means of clinical presentation, history, and physical exam rather than relying on imaging or more involved studies. I believe we

“We have been forced to make do with what there is and not with what there should be.”

could teach a course on using this clinical expertise to manage patients. We also see a myriad of tropical diseases including dengue, yellow fever, and parasitic illnesses. What are ways that emergency physicians from other countries could get involved with the work you are doing and support the emergency medicine infrastructure at IAHULA? We are currently lacking therapeutic and diagnostic resources and we’d welcome any assistance procuring these. We also would love to establish relationships with EM residency programs internationally. We base our management on American Medical Association guidelines, more so than other European guidelines, and would like to continue practicing up-todate, evidence-based medicine.

ABOUT THE AUTHORS Dr. Atencio is an emergency medicine resident at the University of Chicago. He is interested in global emergency medicine, medical education, and LHS+ equitable healthcare. Atilioeatencio@gmail.com Dr. Weber practices at Beth Israel Deaconess Medical Center. He helped found the Medical Justice Alliance to advocate for the health of individuals in carceral settings. On the side, he helps lead ACEP's Public Health and Injury Prevention Committee and developed Chart Decoder, an app to help patients understand their medical records.

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

HEALTH POLICY

The Blurred Lines Between Employee, Government Contractor, and Private Citizen Revealed in Recent SCOTUS Decision SAEM PULSE | MAY-JUNE 2022

By Kyle Stucker, MD

50 50

In our endeavor to treat and care for our friends and neighbors, do we give up more than just our time? Do we risk our rights in addition to our health? How much control should we have when our decisions can impact the lives and wellbeing of others? On November 4, 2021, the Centers for Medicare and Medicaid Services (CMS), released an emergency requirement for COVID vaccination of staff at health care facilities which

receive funding or reimbursement from the Medicare/Medicaid programs. This distinction includes a litany of programs for entities from emergency departments to hospices. The deadline for a second vaccine dose was initially January 4, 2022, putting an estimated 10 million CMS-associated employees on the clock. Missouri, Louisiana, and others quickly filed suit, setting up an impending legal discussion over the possibly unique roles, responsibilities, and rights of healthcare providers in our society.

The peer reviewed data relevant to this debate is interesting, but limited, likely due to the novelty of the COVID-19 pandemic and its associated issues: A 2021 systematic review and metaanalysis from Ponsford et al published in Frontier Immunology examined the differences between outcomes of community-acquired and nosocomial COVID. The study examined 8,251 admissions across 8 countries during the first wave, comprising

“In our endeavor to treat and care for our friends and neighbors, do we give up more than just our time? Do we risk our rights in addition to our health? How much control should we have when our decisions can impact the lives and well-being of others?” 1513 probable or definite nosocomial COVID-19. Across all studies, the risk of mortality was 1.3 times greater in patients with nosocomial infection compared to community-acquired. Gómez-Ochoa et al examined the prevalence, risk factors, clinical characteristics, and outcomes of COVID-19 affected health-care workers in their 2021 American Journal of Epidemiology meta-analysis. At that time, COVID prevalence was around 11%. Severe clinical complications developed in about 5% of the COVID-19-positive HCWs, and almost 0.5% died. Biswas et al conducted a Journal of Community Health systematic review exploring hesitancy in 76,471 participants. About 22.5% of healthcare workers were hesitant, and mostly expressed concerns about vaccine safety and efficacy as their reasoning. On January 13, 2022, this question was considered by the U.S. Supreme Court, which rendered a 5-4 decision in favor of issuing a stay of the injunctions blocking the CMS mandate. Justices Roberts, Breyer, Kagan, Sotomayor, and Kavanaugh composed the coalition ruling in favor. They begin their argument by stating that “Medicare and Medicaid are administered by the Secretary of HHS, who has general authority to promulgate regulations ‘as may be necessary to the efficient administration of the functions with which [he] is charged.’” One of the functions granted to the Secretary by the Congress is “to ensure that the healthcare providers who care for Medicare and Medicaid patients protect their patients’ health and safety.” The Secretary is authorized to “promulgate, as a condition of a facility’s participation in the programs, such ‘requirements as [he] finds necessary in the interest of the health and safety of individuals who are furnished services in the institution.’” The Justices further argue that the Secretary has given many long “lists of detailed conditions,”

including requirements for “immunization” and “that certain providers maintain and enforce an ‘infection prevention and control program.’” Since the unvaccinated staff “pose a serious threat to the health and safety of patients,” requiring providers receive the vaccine “is consistent with the fundamental principle of the medical profession: first, do no harm.” Justice Thomas was joined in dissent by Justices Alito, Gorsuch, and ConeyBarrett. Justice Thomas focuses his argument on the lack of Congressional authority granted to CMS by Congress to enact such a sweeping “omnibus rule [that] compels millions of healthcare workers to undergo an unwanted medical procedure that ‘cannot be removed at the end of the shift.’” He mentions the same authorizations quoted by the affirming justices, but notes that they are intended to allow CMS to “carry out the administration of the insurance programs” under the Medicare Act, and that the clause directing providers to “maintain and enforce an ‘infection prevention and control program’” is directed only at long-term nursing facilities. One of the consistent presumptions made by the Court in past rulings is that “Congress does not hide ‘fundamental details of a regulatory scheme in vague or ancillary provisions.’” He continues, saying that it is precedent to “expect Congress to

speak clearly when authorizing an agency to exercise powers of vast economic and political significance.” Yet in this case, Thomas claims, the entire argument by the government is a proposition “to find virtually unlimited vaccination power, over millions of healthcare workers” buried in these very same vague and ancillary provisions. “Had Congress wanted to grant CMS power to impose a vaccine mandate… it would have...” The Court’s ultimate decision ended the block on the federal government’s order. Now, most health care workers throughout the nation have until the end of February to comply with the mandate. If you would like to read the text of the Court’s decision, you can find it here: If you would like to share your opinion with your representative, visit www. house.gov/representatives/find-yourrepresentative.

ABOUT THE AUTHOR Dr. Stucker is a PGY-1 at the University of Louisville School of Medicine

OBSERVATION CARE

Psychiatric Observation: Driving Improvement and Capturing Opportunity

SAEM PULSE | MAY-JUNE 2022

By Megan R. Hunt, MD and Aaryn Kelli Hammond, MD

Given the mental health crisis in America, patients frequently present to emergency departments in need of evaluation and care and there is a subsequent responsibility on emergency departments to find the appropriate disposition for these patients. These dispositions are often complex and for many patients many hours of care are necessary to identify appropriate inpatient or intensive outpatient psychiatric care. Psychiatric observation protocols provide the opportunity to capture reimbursement for our work and define areas of improvement in the care of these patients. How can closer examination of this care capture the impact of upstream factors such as community resource availability as well as downstream factors like a lack of a transportation for transfer to inpatient facilities? Closer examination of psychiatric observation care will identify the opportunities to request the right resources to improve provider and patient experience. This article would focus on the utility of utilizing and examining observation protocols for extended care of psychiatric patients pending complete psychiatric evaluation and safe disposition.

No one working in an emergency department (ED) can deny the impact of our nation’s mental health crisis on workplace violence, physician and staff experience, and patient care quality. Patients present to our EDs desperate for mental health evaluation and care due to the continued lack of community, outpatient, and inpatient resources that has been a problem for years. The COVID-19 pandemic has only accelerated this trend. Regulatory bodies, including The Joint Commission, continue to note the increasing impact of psychiatric boarding on our ability to provide emergency care while simultaneously requiring our teams to expand services to this population with no additional resources. Thus, we find ourselves drifting farther downstream, right alongside our patients, on the waves of an upstream crisis with little hope of anyone building a dam. While we await the necessary aid, we have found that the use of observation in our patients suffering from acute exacerbation of mental illness has allowed us to recoup necessary reimbursement, improve patient care, and decrease length of stay.

At Wake Forest, we deployed a protocol for the use of observation status for patients presenting with psychiatric complaints in March of 2019. We employed a conservative threshold, which allowed for the use of observation for patients with undetermined disposition. This protocol resulted in partial compensation for resources, including provider, nursing, and care coordination services, required to manage patients who were not immediately appropriate for discharge or admission to an inpatient unit. While this did not address patients definitively in need of inpatient psychiatric care and still awaiting inpatient bed availability, it was a useful first step in gaining appropriate compensation for the care of this rapidly growing population. Later that same year, the AMA CPT committee provided guidance that observation codes were appropriate for use in boarding patients with acute psychiatric illness. After a process of establishing institutional buy-in, we transitioned to an expanded criteria for psychiatric observation in October of 2019 that included those patients meeting inpatient criteria as well, but who remained in the ED, receiving

“We find ourselves drifting farther downstream, right alongside our patients, on the waves of an upstream crisis with little hope of anyone building a dam.” active management, for a prolonged period of boarding. At that time, we also disseminated this observation protocol to our network of community hospitals and EDs that were providing psychiatric care via telemedicine from the academic psychiatry group. While some feared that formally placing patients in observation would increase the hours and cost of ED care by providing a different, if temporary, disposition, our experience in both community and academic settings demonstrated no significant impact on length of stay and did result in reimbursement for previously uncompensated days of care. We invite those not already providing and billing observation care for this population to leverage our experience and begin the work to seek appropriate reimbursement for the care that you are already delivering. In addition to financial resource generation, we have also observed improvements in the care of our patients suffering from acute exacerbations of mental illness. With the institution of regular rounding and review of placement efforts, we have been able to decrease problems often associated with long stays in the ED. With comprehensive observation care, we can avoid the development of emergent conditions from unmanaged chronic diseases including diabetes and hypertension, the progression of coexistent acute infection, and development of dangerous withdrawal syndromes. Additionally, with the routine psychiatry reevaluation (either in person or via virtual consultation) and improved care coordination included in these protocols, observation care can reduce overall need for admission in patients presenting primarily with medication non-compliance or need for minor medication adjustment. With nursing and ancillary staff shortages projected to extend into the future, any measure that could reduce the need for admission and reduce length of stay will likely reap

dividends. As our psychiatry and other inpatient colleagues suffer from the same decrease in staffed spaces to provide care, we should capitalize on the opportunity to collaborate with them in the ED space to advance and improve patient care. As ED teams, we excel in offering the right care, to the right patients, in the spaces available to us. We have shown with chest pain and TIA protocols, that ED observation protocols can decrease hospital length of stay and admission rates. We believe that we can demonstrate similar gains in the care of patients with mental health complaints. While our goal was not to take on additional days of care for these patients, due to decreased inpatient capacity throughout our region, we have been required to do so to make the most of a difficult situation. Instead, we advocate for stronger partnership with psychiatric resources within our departments via in person or telemedicine services to enhance patient care with greater efficiency and efficacy within our walls. We are confident that this work will reduce the footprint currently consumed by our psychiatric observation population and reduce their inpatient length of stay following an ED observation when required. Moreover, it has become apparent that managing the current mental health crisis takes a toll on clinical staff. Workplace violence has increased across the health care spectrum and the management of patients with acute psychiatric illness can present safety concerns. While some sites are fortunate enough to have a space separate from the ED to room this subset of ED patients, many facilities do not have that luxury. Observation care allows us to play an active role in the care of patients boarding in the emergency department or with prolonged dispositions. As a result, we maintain better situational awareness of patient care needs to prevent under treatment, overstimulation, and rising patient frustration as stays extend. Our hope

is that these efforts can both improve patient care and, perhaps even more importantly, reduce workplace violence. Emergency department care of patients with acute exacerbations of mental illness is fraught with many barriers. Psychiatric observation is one route by which we can improve care. In its current iteration, we can gain modest financial benefit while ensuring quality patient care and, when appropriate, decrease the need for inpatient admission. We are the experts in offering care to every patient and every disease process under the sun and the use of observation for patients with psychiatric complaints allows us to do just that, while also working to reduce workplace violence. Furthermore, this work will allow our teams to engage in their why, providing patient care for those acutely in need.

ABOUT THE AUTHORS 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. She is passionate about reducing health care disparities and improving health equity through the optimization of clinical operations. 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. She is committed to improving care for patients suffering with acute psychiatric illness. Photo headshots are courtesy Atrium Health–Wake Forest Baptist Creative Photography Services.

SEX & GENDER

The Female Athlete Triad Examined Under the New Lens of Sex and Gender Evidence

SAEM PULSE | MAY-JUNE 2022

By Yael Sarig and Mehrnoosh Samaei, MD, MPH on behalf of the SAEM Sex & Gender Interest Group

The female athlete triad is a condition afflicting female athletes with low energy availability, which may be the result of over training, under eating, or both. The “triad” is so defined because it involves three key components: menstrual cycle irregularity or absence, low bone mineral density, and energy deficiency. Athletes need not display all three components of the triad to be diagnosed with it and suffer the health consequences. The female athlete triad may impact anyone who is biologically female, and able to menstruate, regardless of gender identity. However, the female athlete triad’s prevalence is certainly influenced by sociocultural stigma and pressures acting against women.

The Triad Components

Menstrual Cycle Irregularities Amenorrhea exists on a spectrum, ranging from oligomenorrhea, to

anovulation, to luteal-phase defect, to complete amenorrhea. Discourse about the fertility-related consequences of menstrual irregularity has long dominated conversations about the female athlete triad; however, the impacts of amenorrhea, and of the female athlete triad more broadly, go far beyond infertility. A commonly occurring form of amenorrhea in individuals in an energy deficit is functional hypothalamic amenorrhea (FHA). FHA, which is characterized by low levels of estrogen, leads to higher rates of premature cardiovascular disease, decreased immune function, and decreased skeletal health, osteopenia and osteoporosis. Moreover, women with FHA have higher depression scores, more anxiety, and more difficulty coping with daily stress; they tend to describe feeling more insecure, and

feeling lack of control; they have far higher incidences of binge-eating disorder. Additionally, FHA strongly correlates with perfectionist attitudes, which correspond to the unique social pressures that act on women athletes. These athletes often feel a greater need to prove they deserve to share the stage with their male counterparts due to gender stigma. Finally, the social stigma against menstruation that is prevalent in numerous cultures, which is internalized in women athletes, discourages the reporting of missing menstrual cycles. For instance, it was seen as a massive break in standards of conduct when Chinese swimmer Fu Yuanhui spoke about the impact her period had on her performance in her 4x100 meter relay. Even in her admission that she felt she had not swum well because of physical pain from her period, she was quick to

“The female athlete triad is a condition afflicting female athletes with low energy availability, which may be the result of over training, under eating, or both.” note that her period should not be used as an excuse: “I feel I didn’t swim well today…My period came last night and I’m really tired now. But this isn’t an excuse, I still didn’t swim as well as I should have.” Moreover, women athletes may be socialized to view their menstrual cycle as a distraction from or a hinderance to sports performance, and thus may not be concerned with losing it. Energy Deficiency Low energy availability is particularly worrisome in the context of women athletes since women face intense social pressure to remain thin. Energy deficiency may be caused by eating disorders, which occur far more frequently among women than among men. Women athletes specifically are 5 to 10 times more likely to have eating disorders than male athletes. Women who participate in lean-body sports are at a particularly high risk for the Triad, demonstrating that ideas of body image and worth correlating with body size—ideas that act pervasively against women—influence the incidence of the Triad. Low Bone Mineral Density Bone mineral density may be the most clinically concerning element of the Triad. Bone mineral density is lower in amenorrheic athletes than in eumenorrheic athletes, and a review article by Khan et al found that in female athletes, the prevalence of osteopenia ranged from 22% to 50%, and the prevalence of osteoporosis ranged from 0% to 13%, compared to 12.2% and 2.3% respectively expected in a normal population distribution. Yet even in light of this evidence, oral contraceptive pills remain among the most commonlyprescribed treatments for the Triad. OCPs restore menstruation, but fail to treat low bone mineral density, and do not actually

fix the energy imbalance that the athlete is experiencing. The prescription of OCP to treat the Triad also goes against the guidelines for the treatment of the condition as established by the American Academy of Family Physicians (AAFP). In addition to gender stigma that acts against women and women athletes, limited education contributes to the lack of effective and evidence-based treatment and intervention for the triad. Female athletes, coaching staff, and health staff alike have been shown to underestimate the severity of the Triad. To properly treat the Triad, the knowledge gap regarding the Triad’s prevalence, presentations, and severity must be rectified. Proven, effective measures like weight gain and reduced exercise should become the standard treatment for the Triad. However, treatment of the Triad must extend beyond the mitigation of physiological symptoms. It is necessary to also address

the culturally-held beliefs about women which discourage women athletes from seeking treatment for the Triad or from recognizing the consequences beyond infertility that the Triad may have, and which prevent coaches from holding open and honest conversations about menstrual health with their athletes.

ABOUT THE AUTHORS Yael Sarig, is an AB medical anthropology candidate at Brown University.

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

About SGEM The Sex and Gender in Emergency Medicine (SGEM) Interest Group works to raise consciousness within the field of emergency medicine on the importance patient sex and gender have on the delivery of emergency care and to assist in the integration of sex and gender concepts into emergency medicine education and research. Joining SGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

WELLNESS

Work-Life Balance: Why It Doesn’t Work and How to Design a Life With Harmony

SAEM PULSE | MAY-JUNE 2022

By Jennifer Kanapicki Comer, MD and Al’ai Alvarez, MD, on behalf of the SAEM Wellness Committee

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At times our lives can feel like a gnarled tree with twisted branches — some that flourish and others that break. When life feels like this, people who are close to us say we need a better work-life balance. But work-life balance doesn’t work. Instead, we offer you another perspective: focus on designing the life you want based on your values and priorities.

Debunking the Work-Life Balance Myth

We are all on this elusive quest to balance our work commitments and personal life. Despite our best efforts, we often fail, which can be a source of burnout. Think of work-life

balance as a scale. When your focus is weighted on one side of the scale, the other side suffers. This imbalance is uncomfortable, unsettling, and frustrating. Work-life balance implies a tradeoff. Who wants to have to choose between work and life all the time? What if, instead, we strive for work-life harmony. The definition of harmony is a pleasing arrangement or combination of parts. It leads to tranquility and congruence. Living with work-life harmony puts you at the center. You are the trunk and roots of the tree. It’s about where you want to invest your time based on your priorities. It’s also about understanding how you fit in your institution’s mission, vision, and

values. Alignment of your values with your institution’s values are critical for professional fulfillment. Harmony comes from living a life that aligns your set of values with your environment. This helps us with our priorities and goals. Work-life balance is about the what, when, and how. Work-life harmony is about the why.

Designing the Life You Want

Designing your Life, by Bill Burnett and Dave Evans, suggests expanding our view of life to three specific gauges: love, play, and health. We can understand which areas require more attention by thinking of work, love, play, and health as gauges.

“The definition of harmony is a pleasing arrangement or combination of parts. It leads to tranquility and congruence.” In his book, The Productivity Project, Chris Baily writes about “hotspots,” which is what makes up your life portfolio. Baily points out that every task, commitment, or project can fit into a hotspot and that 90% of people have the same seven hotspots: mind, body, emotions, finances, career, fun, and relationships. Write down the seven hot spots and what they mean to you. Maybe under mind, remind yourself of that longing to take up a new hobby. Under body, you may mention exercise as something important to your well-being. Think about what you value in your career and your own career vision. By doing this exercise, you write your personal mission, vision, and values and design the life you want. What is clear in both books is that there is a benefit to introspection around how we fill our tanks. The more specific we are and more intentional we are about doing this, the better we can be at finding worklife harmony. What follows are some tools to set you up for success.

Calendaring

Most people have a to-do list. The Kruse research team showed that 41% of items on a to-do list never get done. Unfinished goals are stressful; they swim around in your head and divert your attention from the task at hand. Highly successful time managers don’t have to-do lists but very well-prioritized calendar tasks. For example, if you need to do a literature search for your next research project, put on your calendar “Literature search,” Tuesday, 9-11 am. By providing a definite date and time entry on your calendar for accomplishing this task, it becomes less nebulous.

To-do Lists Are Where Ideas Go to Die Pick a night of the week to calendar the week ahead of you. Review your hotspots and remind yourself of your personal mission, vision, and values, and use your calendar to reflect these

values. That Wednesday, 8 p.m. “Date with my partner,” is just as important as that Wednesday 9 a.m. “Methods Writing Session.”

Creating a “Not to Do” List

The Pareto principle tells us that 20% of our actions account for 80% of the results. Consider that 80% of your actions aren’t producing results. What can you automate, outsource, or eliminate? Check to make sure all your bills are on autopay and use apps like Instacart to save hours spent at the store grocery shopping. Lastly, what committees are you on or roles do you hold that aren’t in line with your personal mission, vision, and values? Pivot your focus on those that have better alignment.

Say No

It’s often challenging for us to say no, but remember that every yes is a no to something else. In this virtual world, it’s so easy to get asked to jump on that last-minute Zoom call or be tempted

“Work-life balance is about the what, when, and how. Work-life harmony is about the why.”

to check Slack many times during the day. Remember: you calendared your week based on your personal mission statement when you had the 30,000-foot view of your week. Don’t get deterred by “got-a-minute?” meetings. Practice selfcompassion and stick with your original plan based on your life’s priorities. Finding balance in our life sometimes feels impossible, so let’s design a life that aligns work with our own personal mission, vision, and values. Only then can we truly embrace work-life harmony.

ABOUT THE AUTHORS Dr. Comer is associate program director at Stanford Emergency Medicine Residency. @kanapicki

Dr. Alvarez, is the director of well-being at Stanford Emergency Medicine. @alvarezzzy

Prioritizing Sleep for High-Performance Teams in the Emergency Department

SAEM PULSE | MAY-JUNE 2022

By Amanda J. Deutsch, MD, and Al’ai Alvarez, MD, on behalf of the SAEM Wellness Committee

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Like our mobile phones and other handheld devices, our energy depletes over time and needs to be recharged. Likewise, when it comes to our energy at work, we are recharged and our performance is optimized by a few critical things: food, exercise, and rest — especially a good night’s sleep. Not only is lack of sleep not good for your long-term health, in the short term, it can impact performance and put you at risk for mistakes and accidents. The long-term effects of sleep impairment are astounding. Briefly, lack of sleep shortens our lives. Adults who sleep fewer than six hours a night have a 200% increased likelihood of a heart attack or stroke in their lifetime and a 40% increased risk of developing cancer. Short sleep time leads to a 45% increase in developing coronary heart disease. In one study, restricted sleep for one week (<6 hr) caused an

individual’s cells to be insulin resistant, and in another, sleep-deprived mice showed a 200% increase in speed and size of cancer growth. If that is not enough, sleeping less impacts our DNA by physically damaging telomeres. While long-term complications of sleep disruptions are well established, it is essential to consider the impact of impairment in sleep on our performance. Emergency physicians are not unlike elite athletes and other highperformance teams — the moment we step into the emergency department, we are on the go and performing at a high level until we leave. EKGs are handed to us to gauge whether to quickly activate the Cath lab. We are constantly assessing the board for patients who need expedited rooming and acute interventions, serially taskswitching our focus on various highpriority decisions, all while taking time to

convey treatment plans to patients and families in a compassionate manner. Imagine going through medical school with people telling you, “You need to go home and get some sleep to better learn the skills you’re being taught.” Studies have shown the importance of sleep on motor skills to the extent that the International Olympic Committee released a consensus statement highlighting the need for sleep across all sports and genders. Performance, specifically with elite athletes, has been studied to see what happens when athletes get fewer than eight hours of sleep. In his book, Why We Sleep, Matthew Walker shared statistics of Golden State Warrior Andre Iguodala’s performance based on his sleep habits. When he had more than eight hours of sleep, he had a 12% increase in minutes played, 29% increase in points per minute, 2% increase in three-point

“Microsleep, while lasting only seconds in duration, creates a momentary lapse in concentration whereby no form of perception gets through to your brain, and no motor responses make it out.” percentage, and 9% increase in freethrow percentage. However, when he slept less than eight hours, he had a 37% increase in turnovers and a 45% increase in fouls committed. Think about your last shift and imagine how sleep might have impacted your performance. If you’d had at least eight hours of sleep, would you have seen more patients per hour? Written more notes? Done one extra procedure? Increased your efficiency of discharges? Or, if you’d been sleep-deprived, would you have been more likely to order unnecessary imaging or consultations? Would you have been more dismissive and/or abrupt with your colleagues, patients, and families? Even slight sleep impairment has significant effects on concentration. For example, sleep impairment can lead to fatigue-related driving collisions. This is often due to a phenomenon called microsleep. Microsleep, while lasting only seconds in duration, creates a momentary lapse in concentration whereby no form of perception gets through to your brain, and no motor responses make it out. These microsleeps are often more dangerous than drunk driving, as there is a delayed response instead of the inability to respond. Fortunately, microsleeps occur in those chronically sleep-restricted. But what counts as “chronically sleeprestricted?” Chronically sleep-restricted is defined as getting less than seven hours of sleep on a routine basis. Many of us likely fall into this category; some of our wearable devices collect biometric data that can confirm this. When we find ourselves exhausted after a shift, how many of us pause to check our fitness for driving home? One of my mentors, Dr. Rebecca Smith-Coggins, studied the change in psychomotor performance in emergency physicians and nurses, highlighting that even a short nap improved IV insertions, exhibited less dangerous driving, and displayed fewer behavioral signs of

sleepiness during driving simulation. Another study found that night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire. The effects of microsleep have also been studied in controlled environments. David Dinges studied the impact of getting different doses of sleep deprivation. One set of subjects stayed up for 24 hours and then measured response times for clicking a button to visual stimuli. Those who lacked sleep showed a 400% increase in missed responses compared to those that slept for eight hours a night. Strikingly, they also found that restricting subjects to no more than six hours of sleep a night for 10 days in a row resulted in the same underperformance as those who pulled all-nighters. Even missing a few hours of sleep drastically impacts our ability to focus and perform when going about our regular activities, especially during our shifts. Sleep is vital for performing well and for our long-term health, yet working the night shift is part of our job. Let us endeavor to minimize sleep cycle disruptions. Switching into shifts that

counter the circadian rhythm (e.g., afternoon shift followed by morning shift or quick turnarounds from overnight to morning shifts) has detrimental effects. As a department, we can explore ways to minimize disruptions to the circadian rhythm by creating scheduling logic that promotes forward progression from morning to afternoon to night shifts. We can develop nocturnist teams and recognize them for their work. How else might we prioritize sleep cycles to minimize circadian rhythm disruptions?

ABOUT THE AUTHORS Dr. Deutsch is an EM Physician Wellness Fellow at Stanford Emergency Medicine. @amandajdeutsch

Dr. Alvarez, is the director of well-being at Stanford Emergency Medicine. @alvarezzzy

SAEM PULSE | MAY-JUNE 2022

EM Wellness Initiatives: Oregon Health & Science University

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The RAMS Wellness Committee, in conjunction with the SAEM Wellness Committee, will be highlighting wellness initiatives from emergency medicine (EM) programs around the country in a recurring wellness section of SAEM Pulse. Our hope is that this section will share ideas on EM-led wellness initiatives and continue emphasizing the importance of these activities for residents and medical students. For this issue, we talked to Ethan Kimball, DO, First Tuesday lead team member; Cam Upchurch, MD, chief resident; Ryanne Mayersak, MD, associate program director and director for resident wellness; and David Jones, MD, program director in the Department of Emergency Medicine at Oregon Health & Science University (OHSU). What is a unique wellness initiative that your program has for its residents? Or what wellness initiative at your program are you most proud of? Our residency provides many avenues to maintain wellness and an overall work-life balance. We call one of our best events “First Tuesday,” which

provides four hours of protected time on the first Tuesday evening of every month. This resident led initiative focuses on wellness, education, interests, and meeting the needs of our residents. The topics for First Tuesday span landmark journal article reviews, complex cases managed in our emergency department, intriguing guest speakers, as well as fun bonding/ wellness activities. Prior to COVID, we would meet in person at a local venue for food, socializing, and the scheduled event. Since COVID began, we the event has largely been virtual with a few outdoor, in-person events when it has been deemed safe. Some of our recent in-person events have included renting boats on the Willamette River and Journal club in the park. With the emergence of the Delta variant, we returned to our virtual format but have maintained wellness through games such as trivia. What aspect of resident life at your program do you think has the biggest positive impact on residents? Portland as a city offers many fun activities to allow for an appropriate

work-life balance. Our city has many restaurants, bars, theaters, and sporting venues and attracts national musicians, comedians, and other performers. Additionally, Portland has invested in its parks and natural forests. This investment offers miles of local hikes and a plethora of picnic areas in addition to many public basketball and tennis courts, soccer fields, and more. Portland is ideally located so that a day trip to the coast for a beach day or to Mt. Hood for year-round snow sports is possible. On-campus, OHSU has a student center with a basketball court, gym, and swimming pool that all residents have access to. Most importantly, our scheduling allows our residents to take advantage of these local treasures. Our emergency department uses seven-, eight-, and nine-hour shifts, allowing for time before or after a shift to enjoy all the above. What diversity and inclusion wellness initiatives does your program have? As aforementioned, First Tuesday is protected time that covers a wide scope of topics for our residents, faculty, and staff. After our country

“After our country witnessed the death of George Floyd and racial tensions were at their peak, we wanted to have an open, reflective, and nonconfrontational discussion about race and its impact on our society and in health care.” What aspect of wellness do you think the emergency medicine community should focus on more? Wellness is an essential aspect of every person’s life and work-life balance. We know that emergency medicine, and residency in general, is demanding, exhausting, and sometimes feels as if we are just hanging on by a thread. During the past two years, COVID has caused many additional stressors to our lives both inside and outside of work; it is of great importance that we acknowledge these stressors and do our best to combat them. The term “wellness” has emerged as an antidote to stress, fatigue, and burnout. It is critical that we understand what wellness means to each individual and that it is different for each person. Although having the occasional fun social activity is great for relaxation, team building, and developing a sense of community, it is important that we treat these underlying stressors like the chronic problem they are. witnessed the death of George Floyd and racial tensions were at their peak, we wanted to have an open, reflective, and nonconfrontational discussion about race and its impact on our society and in health care. To accomplish this, we held a book club and selected “So You Want to Talk About Race” by Ijeoma Oluo. This event was open to students, residents, faculty, nursing, and other emergency department staff, and sparked a helpful dialogue within our community. This past year we used this time to discuss

transgender care in the emergency department, with many speakers from the transgender community, so that we could reflect on their perspectives of emergency care. Having this protected time available for a broad range of topics has allowed us to tailor not only to the needs of our residents but the needs of our community. Through these and other discussions, we seek to continue to promote a diversity of thoughts, ideas, and social interactions.

Does your program have ideas or plans for future wellness initiatives? We plan to have in-person participation for our First Tuesday events, as well as for some elements of our weekly didactic sessions. Didactics will be dedicated toward wellness and jobs for which we’ll have talks about healthy careers, sleep, and finances, among other things. Our program also has monthly “Leadership Lunches” where residents and faculty get together after our educational conference to promote community and conversation over good food.

“I have found that organized wellness activities have been incredibly enjoyable and irreplaceable for establishing a sense of community and belonging; however, it’s my daily and weekly routines that allow me to maintain a well-balanced mindset and start each shift with a sense of enjoyment and excitement. I urge our community to remember that wellness is not a single event but rather multiple daily decisions that develop a well-balanced lifestyle.” —Ethan Kimball, DO, PGY-2 61

Announcing the 2022 SAEMF Research and Education Grantees The SAEMF is the research-supporting arm of the SAEM — bridging the research funding gap in emergency medicine (EM), advancing the science and innovation at the heart of the specialty, and building the pipeline of talented EM research leaders for the future. We are the largest private foundation for research and research training in EM. Though only established in 2008, our net assets are over $12 million. We fund innovative research in all areas of EM with an investment of close to $800,000 in research each year.

We are thrilled to announce that the SAEM Foundation (SAEMF) Board of Trustees recently approved investing close to $850,000 – the highest one-year grants investment in SAEMF’s history – to fund the work of 21 of the most promising researchers and educators in academic emergency medicine. Join us in celebrating this year’s grantees. We are certain these grantees will go on to do big things thanks to their SAEMF funding which is only possible through the partnership of the Annual Alliance Donors.

Celebrating the 2022 SAEMF Research and Education Grantees Joshua Lupton, MD, MPH, MPhil Oregon Health & Science University

SAEMF Research Training Grant - $300,000

“Determining the Ideal Timing and Route for Antiarrhythmics during Cardiac Arrest”

Margaret E. Samuels-Kalow, MD, MPhil, MSHP Massachusetts General Hospital

SAEMF Research Large Project Grant - $150,000

“Missed Opportunities + New Strategies: Addressing Adverse SDoH in the ED”

Arjun Venkatesh, MD, MBA, MHS Yale University

SAEMF Emerging Infectious Disease and Preparedness Grant - $100,000

“Impact of Acute Care System Capacity and Utilization on Mortality During COVID-19”

Alexandra Weissman, MD, MS, MPH University of Pittsburgh

SAEMF Emerging Infectious Disease and Preparedness Grant - $100,000

“Precision Methods of Bacterial Infection Recognition in the Acute Care Setting”

Martin Casey, MD, MPH

University of North Carolina at Chapel Hill School of Medicine

SAEMF ARMED Pilot Grant - $25,000

“Albuterol Use In Patients with Heart Failure and Obstructive Pulmonary Disease”

Cameron Gettel, MD, MHS Yale University

GEMSSTAR for Emergency Medicine Supplemental Funding Program $25,000

“Development and Validation of the Patient Reported Outcome Measure for Older Adult Care Transitions in the ED Tool”

Holly Caretta-Weyer, MD, MHPE Stanford University School of Medicine

SAEMF Education Project Grant - $20,000

“Current Values, Processes, and Outcomes in Emergency Medicine Residency Selection”

Lauren Ann Selame, MD

Brigham & Women’s Hospital/Harvard Medical School

SAEMF Education Project Grant - $20,000

“Tele-Ultrasound Instruction in the Performance of Sonography”

Corey Hazekamp, MD, MS Lincoln Medical and Mental Health Center

SAEMF NIDA Mentor-Facilitated Training Award - $12,000

“Shifting Tides: Changing the Paradigm of Treating Opioid Use Disorder by Updating Resident Education”

Aaron Krumheuer, MD University of Michigan

SAEMF NIDA Mentor-Facilitated Training Award - $12,000

“After the X-Waiver: Implementation of an Abbreviated Curriculum on Medication for Opioid Use Disorder (MOUD) for Emergency Medicine Residents”

More from our grantees... Watch 2022 grantees share how the grant they received is making a difference Visit saemfoundation.org to learn more about the 2022 grantees and how their projects will shape emergency medicine’s future. 63

Kevin Baumgartner, MD

Washington University in St. Louis School of Medicine

MTF/SAEMF Toxicology Research Grant - $10,000

“Evaluation of the Human Immune Response to North American Crotalid Envenomation”

Rebecca Theophanous, MD Duke University

SAEMF/AEUS Research Grant - $10,000

“A POCUS Implementation Intervention for ED providers in the Durham VAHCS”

Torben Becker, MD, PhD University of Florida

SAEMF/GEMA Research Grant - $10,000

“Increasing Access to Pre-Emergency Care and Treatment in Ghana”

Eric Boccio, MD Baystate Medical Center

SAEM/Simulation Academy Novice Research Grant - $5,000

“Patient Monitor Positioning and Provider Recognition of Desaturation Events During Intubation”

Nicole Battaglioli, MD

Emory University School of Medicine

SAEMF/AWAEM Research Grant - $5,000

“Investigation of Support Solutions for Women in Academic Medicine”

Jennifer L. Carey, MD

University of Massachusetts Medical School

SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education Grant - $5,000 “Healthy Equity Education: Hands-on Training for EM Clerkship Students through Simulation”

David Yang, MD, MHS Yale University School of Medicine

SAEMF/ADIEM Research Grant - $4,000

“Anti-Asian Discrimination and Burnout on Asian American Medical Students”

Katie Lebold, MD, PhD

Board of Trustees of the Leland Stanford Junior University

SAEMF/RAMS Resident Research Grant - $5,000

“ED-Based Prognostication of ARDS Onset and Severity”

Gregory Peters, MD

Massachusetts General Hospital

SAEMF/RAMS Resident Research Grant - $5,000

“Factors Associated with Potentially Unnecessary Pediatric Transfers for Asthma from the Emergency Department”

Andrew Monick, BBA Thomas Jefferson University

SAEMF/RAMS Medical Student Research Grant - $2,500

“Unhewn Student Experience – Cognitive Heuristics in Emergency Clinical Knowledge”

John Vaile, BS, BA Thomas Jefferson University

SAEMF/RAMS Medical Student Research Grant - $2,500

“Characterization of Medical Student Burnout Using Remote Physiologic Monitoring”

EMF/SAEMF Medical Student Research Grantees - $5,000 To be announced, Summer 2022

Emergency Medicine Interest Group Grantees - $500 To be announced, Summer 2022

A Special Thanks to Our Donors Thank you to the Annual Alliance Donors that have supported these researchers and educators so they can shape our specialty tomorrow. We could not make this impact without you! Donate now to join the Annual Alliance.

Join Me In Making More Research and Education Possible

“Federal funding is decreasing for all areas of research. Emergency medicine has always disproportionately had inadequate support. When I donate to an organization, its mission and principles are of vital importance – and, SAEMF checks both of those boxes. We need organizations like SAEMF to support our specialty's research and train the next generation of researchers and educators.”

Join the Annual Alliance today! saem.org/donate

Amy Kaji, MD, PhD

Harbor-UCLA Medical Center SUSTAINING DONOR OF THE ANNUAL ALLIANCE

SAEM Foundation is a public charity exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code. Contributions to SAEM Foundation may be tax-deductible to the fullest extent permitted by law. Please check with a tax advisor regarding the deductibility of your gift.

Behind the Scenes: Piloting an SAEM Resident Reviewer Program to Foster the Next Generation of Emergency Medicine Researchers By Stefanie Sebok-Syer, PhD; Caroline Freiermuth, MD, MHS; Nicholas Mohr, MD; and Bryn Mumma, MD, MAS, on behalf of the SAEM Grants Committee It’s August 1st and you successfully submitted a grant to the SAEM Foundation. Behind the scenes, the SAEM Grants Committee is working hard to review your science and score your proposal, with scores being sent in to the Foundation for final determinations regarding funding. This crucial aspect of work performed every year by the SAEM Grants Committee likely comes as no surprise to the broader SAEM community. This past year our review process looked a little different, with broadened participation from our resident community. Led by Dr. Caroline Freiermuth, the SAEM Grants Committee piloted a new initiative called the Resident Reviewer Program, specifically designed to provide a mentored learning experience to residents with a proven research trajectory, focused on critically appraising grants. RESIDENT REVIEWERS

During their experience, residents met with their assigned mentors, could ask questions, comprehend the scoring system, gain confidence in reviewing grants, and learn about how to submit competitive grants in the future. In Summer 2021, the Grants Committee invited residents to apply through RAMS and SAEM’s networking channels. We received numerous applications, and a sub-committee selected six highly qualified residents for the first Resident Reviewer class. Participating residents were paired with established SAEM research faculty who are members of the SAEM Grants Committee to collaboratively review assigned grants and participate in the grant review meeting. Resident reviewers served as adjunct members of the committee. After participating in the resident reviewer MENTORS

Agatha Brzezinski, MD, University of California, Los Angeles

Stephanie Eucker, MD, PhD, Duke University School of Medicine

Karen Cyndari, MD, PhD, University of Iowa Hospitals and Clinics

Colin F. Greineder, MD, PhD, University of Michigan

James Ford, MD, University of California, Davis

David Adler, MD, MPH, University of Rochester School of Medicine and Dentistry

Katie Lebold, MD, PhD, Stanford University

Joseph Miller, MD, Henry Ford Hospital

Agatha Offorjebe, MD, Los Angeles County/University of Southern California

Kori Zachrison, MD, MSc, Massachusetts General Hospital

Christopher Zalesky, MD, University of Cincinnati College of Medicine

Stefanie Sebok-Syer, PhD, Stanford University

Table 1. Inaugural resident reviewers and their paired mentors.

“There were a multitude of interested residents who applied for the program and many eager faculty stepped up to serve as mentors. The many hours of preparation that went into the program were evident by the thorough overviews of grants presented by residents and their ability to answer questions posed by other members of the committee. I have no doubt that the residents who participated in this program will go on to submit high-quality grants and become the next generation of successful researchers.” - Caroline Freiermuth, MD, MHS, Resident Reviewer Program Chair

“This program is hugely valuable and should be offered to future residents! I feel like I have a much better grasp of the grant writing/review process, which will prove invaluable for my future grant proposals.” - James Ford, MD, Resident Reviewer

orientation and completing the same confidentiality training as full members of the committee, resident reviewers were assigned to the same grants and study sections as their mentors (Table 1). Mentors provided individualized training and support throughout the entire grant review process. Residents reviewed grants with their mentors and agreed on grant scores together, to maximize both the resident experience and the integrity of the formal review process. These mentor/resident reviewer meetings were a valuable time for residents to learn about the criteria-based scoring process, the role of independence in peer-review, and key aspects of review decisions. As with all SAEM grant peer-review, the Resident Reviewer Program was explicitly designed to adhere to our rigorous confidentiality and conflicts of interest provisions. In this way, the SAEM Grants Committee ensured that both applicants, their privileged materials, and the integrity of the review process were protected. Mentors reminded residents of these principles during their meetings as well. During each study section’s grant review meeting, residents actively participated in discussion of grants they reviewed. As

adjunct members of the Grants Committee, residents did not officially enter scores for applications. After the study section grant review meeting, the mentor and resident met one final time to discuss the process of adjusting comments and scores before finalizing the grant review. Mentors also debriefed the process with their resident and solicited feedback that could inform future iterations of the program. At the end of the resident reviewer experience, a survey collected information about the program from residents and mentors. All residents felt confident that they understood the grant review process; all residents strongly agreed that this experience benefitted their overall research career and would recommend the program to other residents in the future. Additionally, all mentors recognized the critical importance of the program and were willing to serve as mentors again. The SAEM Grants Committee would like to thank the Annual Alliance donors for their role in making programs like this one possible. If you are interested in fostering the next generation of emergency medicine researchers, please consider showing your support with a tax-deductible gift today.

“This was time consuming, but I think it was well worth it. Happy to mentor again. It gave my mentee insight as to the level and expectations of grantsmanship. We used our review time as teachable moments (e.g., include a detailed data analysis section). It also gives residents and fellows an opportunity to network, and potentially collaborate, with SAEM/F researchers.” - Stefanie Sebok-Syer, PhD, Resident Reviewer Program Mentor

Resident Reviewer Perspective (RRP) Hear about RRP's value from Agatha Offorjebe, MD, LAC/USC, 2021 RRP participant Apply by May 25, 2022 to become a 2022 SAEM Grants Committee Resident Reviewer

BRIEFS AND BULLET POINTS SAEM NEWS SAEM Releases New Position Statements

SAEM understands the value of words and the power they hold to enact improvement and bring about change. To that end, we encourage your review of these recently-released, SAEM Boardapproved statements which reflect our Society’s commitment to addressing issues at the forefront of our specialty: • Position Statement on Sexual Harassment and Sexual Misconduct • Consensus Statement for the Emergency Medicine 2022-2023 Residency Application Cycle Regarding Emergency Medicine Away Rotations • Joint Statement on the Protection of Health Care Workers and Health Care Facilities in Ukraine • Joint Statement on the 2022 Emergency Medicine Residency Match

Accepting Proposals on “Creating and Sustaining Diverse Federally Funded Physician Scientists”

AEM E&T Names 2022-2023 Fellow Editors-in-Training

Dr. Mallory Davis

Dr. Chris Nash

Academic Emergency Medicine Education and Training (AEM E&T) is pleased to announce that Mallory Davis, MD, MPH, University of Michigan, and Chris Nash, MD, Massachusetts General Hospital have been selected as the 20222023 AEM E&T Fellow Editor-in-Training. The fellow appointment to the Editorial Board of Academic Emergency Medicine Education and Training (AEM E&T) is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts.

SAEM JOURNALS

AEM Announces 2021 Outstanding Peer Reviewers

Dr. Girgis Fahmy

Dr. Robert Stephens

• • • •

Justin Kaplan, MD Paul Musey Jr., MD Joseph Pare, MD Jill Stoltzfus, PhD

AEM Education and Training Names Outstanding Peer Reviewers for 2021 Academic Emergency Medicine Education and Training (AEM E&T) Editor-in-Chief Susan B. Promes, MD, MBA, has named the following individuals as the AEM E&T Outstanding Peer Reviewers for 2021. • • • • • • • • •

Matthew Ball, MD Ryan Bodkin, MD Joshua Davis, MD Nikhil Goyal, MD Nicholas Hartman, MD Anne Messman, MD Ryan Pedigo, MD, MHPE Antonia Quinn, DO Benjamin Schnapp, MD, MEd

SAEM FOUNDATION

Proposals on the topic of “Creating and Sustaining Diverse Federally Funded Physician Scientists” are being accepted for the 2024 SAEM Consensus Conference, May 14, 2024, in Phoenix, AZ. The primary purpose of the SAEM Consensus Conference is to gather junior and senior researchers, thought leaders, and other stakeholders in emergency medicine to generate research agendas for the important, unanswered questions facing potential physician scientists in emergency medicine seeking federal funding. Submit proposals by 5 p.m. CT, September 2, 2022 to consensus@saem.org.

AEM Announces 2022-2023 Resident Editors

Girgis Fahmy, Emory University, and Robert Stephens, Washington University in St. Louis, have been selected to join the editorial board of Academic Emergency Medicine (AEM) for the upcoming year. “I feel confident about the future of science and medical journals because so many talented residents continue to show interest in this program. Their perspective and energy will serve our journal and readers well,” said Mark B. Mycyk, MD, AEM associate editor and director of the resident editor program for AEM. During their one year-term, these senior residents will be immersed in every aspect of peer review, editing, and publishing of medical research manuscripts.

Academic Emergency Medicine (AEM) Editor-in-Chief Jeffery A. Kline, MD, has named the following individuals as the AEM Outstanding Peer Reviewers for 2021. These exceptional peer reviewers are essential to presenting the highquality academic contributions that fill the pages of AEM each month. • Bernard Chang, MD, PhD • Brian Driver, MD

May 1 Kicks Off SAEMF’s Annual Challenge

Show your support of research in emergency medicine and help your group climb its way to the top of the leaderboards when you make a taxdeductible donation of any amount before September 1, 2022. Your gift will help to fund more and larger grants like those you’ve read about in this issue of SAEM Pulse. It’s easy to participate, just make a charitable gift before September 1, 2022 by visiting www.saem.org/donate. (If you’ve already donated in 2022, we’re counting that towards the totals for the academies, committees, and interest groups to which you belong!)

Donate Today! Help Us Unlock the 2022 SAEM Challenge Gift!

SAEM will donate $1 for each $1 donated to the SAEMF during the Academy / Committee / Interest Group Challenge, up to $10,000, for donations received between May 1 and September 1, 2022. Donate today.

SAEMF Grant Applications Now Open Every year, SAEM Foundation (SAEMF) awards over $800,000 to SAEM members to enhance their career development and to study the most critical challenges in EM. Take a look at some the funding opportunities available this cycle and submit your application by 5 p.m. CT August 1, 2022. Funding Opportunities • Research Training Grant (RTG) $300,000 • Research Large Project Grant (LPG) $150,000 • Education Research Training Grant (ERG) - $100,000 • SAEMF Emerging Infectious Disease and Preparedness Grant - Up to $100,000 • SAEMF Toxicology Research Grant $20,000 • SAEMF/Clerkship Directors in Emergency Medicine (CDEM) Innovations in Undergraduate Emergency Medicine Education Grant - $5,000 • And many more! To view a full listing of grant offerings through the SAEMF, visit the SAEMF website under What We Fund. For additional information • View the Grant Submission Tutorial to learn how to submit your proposal. • Take a look at our Grant Writing Resources before you apply. • Check out our 2022 Grantees and their work. • Checkout the Donor Guide for information about prior grantees and the SAEMF’s mission. • Contact us at foundation@saem.org or visit What We Fund.

New This Year! Pilot Training Grant

The SAEMF Board of Trustees and Grants Committee are pleased to introduce a new Advanced Research Methodology Evaluation and Design in Medical Education (ARMED MedEd) Pilot Training Grant of $25,000.

Your Giving Has Impact

supported our mission this year through the Annual Alliance. Make a charitable donation today to join these colleagues or email Julie Wolfe for details.

ward close to $2M over the A last 3 years in research and education grants to build the pipeline of future leaders. Introduce new grants like the $100,000 Emerging Infectious Disease and Preparedness Grant to encourage more research in these critical areas. Partner with the SAEM Advanced Research Methodology Evaluation and Design (ARMED) courses to offer dedicated funding for graduates of the traditional research and medical education research courses.

The 2022 Chairs’ Challenge Results Are In!

The 2022 Chairs’ Challenge was a tremendous success. This year’s AACEM member donors generously donated $133,587 in support of SAEMF’s work and to make more research and education grants possible. The annual Chairs’ Challenge has been the backbone of SAEMF’s vital annual gifts since 2018. We are grateful to AACEM’s Chairs and to all of the SAEM members who have

INTEREST GROUP REPORTS Evidence Based Healthcare & Implementation Guest Speaker Series Announced

In March SAEM’s Evidence Based Healthcare & Implementation Interest Group kicked off a new guest speaker series by welcoming Dr. Jestin Carlson from the Annals of Emergency Medicine Systematic Review Snapshot Series, who explained the ins and outs of publishing a Systematic Review Snapshot, what to expect, and how to get involved. Watch and learn!

REGIONAL MEETINGS Western Regional “Innovation and Inclusion” Event Draws 220 to Stanford

The SAEM Western Regional Meeting (WSAEM), “Innovation and Inclusion,” held April 1-2 drew more than 220 registrants to Stanford University for the first in-person western regional meeting since before the pandemic. WSAEM included special tracks for education, residency, medical students and research, and also featured a special two-hour workshop for health

care innovators and entrepreneurs. Keynote speakers addressed diversity, equity, and inclusion challenges in health care; precision emergency medicine; and precision education. Attendees presented more than 80 abstracts and five teams participated in the SIMulation team competition with Stanford Emergency Medicine and St. Joseph’s Medical Center taking home top honors. The event was hosted by the Stanford University Department of Emergency Medicine.

Seeking funding for a wellnessfocused project?

Check out our Notice of Special Interest (NOSI) which is intended to develop the science of physician wellness in EM and to contribute to building the career of researchers focused on physician wellness.

Here Are Your 2022-2023 Leaders!

SAEM leaders, L to R: Wendy C. Coates, MD; Ali S. Raja, MD, MBA, MPH; Amy H. Kaji, MD, PhD; Jeffrey P. Druck, MD; Julianna J. Jung, MD; Pooja Agrawal, MD, MPH; Michelle D. Lall, MD, MHS; Ava E. Pierce, MD; Jody A. Vogel, MD, MSc, MSW; Wendy W. Sun, MD

SAEM Board of Directors

Immediate Past President Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center Members-at-Large Jeffrey P. Druck, MD University of Colorado School of Medicine Julianna J. Jung, MD Johns Hopkins University School of Medicine Pooja Agrawal, MD, MPH Yale University School of Medicine Michelle D. Lall, MD Emory University

Angela M. Mills, MD

President Angela M. Mills, MD Columbia University, Vagelos College of Physicians and Surgeons President-Elect Wendy C. Coates, MD Los Angeles County Harbor-UCLA Medical Center Secretary-Treasurer Ali S. Raja, MD, MBA, MPH Massachusetts General Hospital/ Harvard Medical School

Prasanthi (Prasha) Govindarajan, MD, MAS Stanford University Department of Emergency Medicine Nancy S. Kwon, MD, MPA Long Island Jewish Medical Center

SAEM Bylaws Committee

Bryn E. Mumma, MD, MAS (Chair) University of California, Davis, School of Medicine Angela Lumba-Brown, MD Stanford University Department of Emergency Medicine

Ava E. Pierce, MD UT Southwestern Medical Center, Dallas

James H. Paxton, MD, MBA Wayne State University/ Detroit Medical Center

Jody A. Vogel, MD, MSc, MSW Stanford University Department of Emergency Medicine

AACEM Executive Committee

Resident Member Wendy W. Sun, MD, Yale University School of Medicine

SAEM Committees SAEM Nominating Committee

President Richard J. Hamilton, MD, MBA Drexel University College of Medicine President-Elect Lewis S. Nelson, MD Rutgers New Jersey Medical School

Wendy C. Coates, MD (Chair, SAEM President-Elect) Los Angeles County Harbor-UCLA Medical Center

Secretary-Treasurer Jane Brice, MD, MPH University of North Carolina at Chapel Hill School of Medicine

Amy H. Kaji, MD, PhD (SAEM Immediate Past President) Harbor-UCLA Medical enter

Immediate Past President Deborah B. Diercks, MD, MSc UT Southwestern Medical Center, Dallas

Members-at-Large: Ian B.K. Martin, MD, MBA Medical College of Wisconsin

Members-at-Large Steven L. Bernstein, MD Geisel School of Medicine at Dartmouth

Rawle "Tony" Seupaul, MD University of Arkansas for Medical Sciences College of Medicine

Michelle Blanda, MD Northeast Ohio Medical University/ Western Reserve Hospital

SAEM Foundation Board of Trustees

Cherri Hobgood, MD Indiana University

President Joseph Adrian Tyndall, MD, MPH Morehouse School of Medicine President-Elect Manish N. Shah, MD, MPH University of Wisconsin School of Medicine and Public Health Secretary-Treasurer Robert S. Hockberger, MD Los Angeles County-Harbor UCLA Medical Center Immediate Past President Brian J. Zink, MD University of Michigan

James J. McCarthy, MD Memorial Hermann Health System Zachary F. Meisel, MD, MPH, MSc University of Pennsylvania, School of Medicine Susan B. Promes, MD, MBA Penn State Health Niels K. Rathlev, MD University of Massachusetts - Baystate J. Scott VanEpps, MD, PhD University of Michigan Richard E. Wolfe, MD Beth Israel Deaconess Medical Center

RAMS Board

SAEM Grants Committee Chair Bryn Mumma, MD, MAS University of California, Davis, School of Medicine SAEM Finance Committee Chair Christopher Bennett, MD, MA Stanford University Department of Emergency Medicine SAEM President Angela M. Mills, MD Columbia University, Vagelos College of Physicians and Surgeons SAEM President-Elect Wendy C. Coates, MD Los Angeles County Harbor-UCLA Medical Center SAEM Secretary-Treasurer Ali S. Raja, MD Massachusetts General Hospital/ Harvard Medical School SAEM Immediate Past President Amy H. Kaji, MD, PhD Harbor-UCLA Medical Center

Lauren Diercks UT Southwestern Medical Center, Dallas Members-at-Large Daniel Jose Artiga UCLA David Geffen School of Medicine

Hamza Ijaz, MD

Victoria Lynn Zhou, MD

Wendy Sun, MD

President Hamza Ijaz, MD University of Cincinnati College of Medicine Secretary-Treasurer Victoria Lynn Zhou, MD Penn Medicine-Department of Emergency Medicine Immediate Past President Wendy W. Sun, MD Yale University School of Medicine

Taylor Brown, MD Beth Israel Deaconess Medical Center/Harvard Medical School Taylor Daniel Penn Medicine-Department of Emergency Medicine Michael J. DeFilippo, DO, MICP New York Presbyterian Hospital Carleigh F. F. Hebbard, PhD, MD The Ohio State University Wexner Medical Center Daniel N. Jourdan, MD Henry Ford Hospital Ryan D. Pappal, BS, NRP Washington University School of Medicine in St. Louis

Medical Student Representatives Stephanie Balint Quinnipiac University

Academy Leadership Turn to these pages in the next issue of SAEM Pulse for the full slate of 2022-2023 leadership for SAEM’s Academies! 71

ACADEMIC ANNOUNCEMENTS Dr. Jessica Smith Named Designated Institutional Official/Associate CMO Jessica Smith, MD, has assumed the position of designated institutional official (DIO)/associate CMO for Lifespan and the Warren Alpert Medical School. Dr. Smith will oversee the Graduate Medical Education (GME) office and be responsible for Dr. Jessica Smith compliance with the ACGME requirements for residents and fellows. She will also coordinate with colleagues at WAMS around the medical student experiences at Lifespan and engage in the transitions between undergraduate medical education and GME. Dr. Smith brings more than a decade of GME experience to the role. She completed her emergency medicine training at Boston Medical Center and started her academic career at Rhode Island Hospital and The Miriam Hospital in 2006. She was curriculum director and residency program assistant director, ultimately rising through the ranks to become residency program director for the department of emergency medicine in 2013. A dedicated educator, Dr. Smith became a professor, clinician educator, in July 2021. She has numerous abstracts and peer-reviewed publications, and has been invited to present locally, regionally, and nationally on many topics, but with a specific focus on medical education. She has also been an investigator or sub-investigator on nine grants. Dr. Smith is a graduate of SAEM’s Chair Development Program, a CORD Distinguished Educator, a Fellow of the American College of Emergency Physicians, and has served in multiple national leadership positions in ACEP, CORD, and SAEM.

Dr. Lisa Moreno-Walton Appointed Associate Dean for Diversity Lisa Moreno-Walton, MD, will become associate dean for Diversity at the Brody School of Medicine, East Carolina University, North Carolina, effective May 21, 2022. Dr. Walton is currently professor of emergency medicine, director of research, Dr. Lisa Moreno-Walton and director of diversity for the Section of Emergency Medicine at Louisiana State University Health New Orleans School of Medicine. She also serves as the first female president of the American Academy of Emergency Medicine (AAEM). Dr. Moreno-Walton is a graduate of SAEM’s Chair Development Program and is the founder of SAEM’s Academy for Diversity and Inclusion in Emergency Medicine (ADIEM), for which she served

previously as president. Her multiple awards include the SAEM Marcus L. Martin Leadership in Diversity and Inclusion Award, ADIEM Outstanding Academician Award, Alpha Omega Alpha Medical Professionalism Award, and Council of Residency Directors in Emergency Medicine Distinguished Educator Award. The recipient of many research grants, Dr. Moreno has given more than 500 academic presentations and authored or coauthored more than 45 publications, She is the author of the textbook, “Diversity and Inclusion in Quality Patient Care.”

Dr. Mary Patterson Named EM Department Chair Mary Patterson, MD, MEd, has been named chair of the Department of Emergency Medicine at the University of Florida College of Medicine. Patterson first Dr. Mary Patterson joined the College of Medicine faculty in 2018 as associate dean of experiential learning and the Lou Oberndorf Professor of Healthcare Technology. She was instrumental in helping to establish the nationally recognized UF Center for Experiential Learning and Simulation.

Dr. Brenna Farmer Appointed Vice Chief of Clinical Services Brenna Farmer, MD, MBA, MS, is the new vice chief of clinical services for the Department of Emergency Medicine at NewYork-Presbyterian (NYP) Brooklyn Methodist Hospital. She will be working Dr. Brenna Farmer alongside leadership on clinical services, including quality and patient safety, as Brooklyn Methodist Hospital integrates into the NYP enterprise. Dr. Farmer served previously as site director at NYP/Lower Manhattan Hospital Emergency Department and vice chair of quality and patient safety in the Department of Emergency Medicine at Weill Cornell Medicine (WCM). Dr. Farmer, a nationally recognized medical toxicology expert and frequent keynote speaker on quality improvement, patient safety, and medication safety, joined WCM in 2009 and served the Department of Emergency Medicine in several senior leadership roles during her tenure. She played an instrumental role in leading the department’s response to the COVID-19 pandemic. As a result, in 2021, she was named Physician of the Year at NYP/Lower Manhattan Hospital in honor of her extraordinary leadership, teamwork and collaboration.

Safdar Appointed Vice Chair of Faculty Affairs & Development Basmah Safdar, MD, MSc, has accepted the newly created position of vice chair of faculty affairs & development, for the Department of Emergency Medicine at the Yale School of Medicine. In this role, Dr. Safdar will help lead the department’s Dr. Basmah Safdar faculty affairs, promotions, and appointments processes. In addition, she will oversee faculty mentoring, development, and retention programs. She currently directs the faculty development program for the department and is uniquely qualified for her new role. Dr. Safdar is nationally renowned for her work striving for equity in the health care workforce. After serving as president of SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM), Dr. Safdar led the Society of Academic Emergency Medicine Equity Taskforce, first documenting gender and race disparities in faculty salary and advancement, and then reporting on best practices and innovations to address them. For her excellence in mentorship and leadership, Dr. Safdar has received several awards, including the AWAEM Mid-Career Faculty Award, AWAEM Momentum Leadership Award, and Outstanding Mentor Award by Yale Women’s Housestaff Organization. She is also an accomplished investigator with expertise in translational research and clinical trials, and an internationally recognized scholar in sex and gender-specific research focusing on endothelial function and microvascular health. Dr. Safdar has published 100+ peer-reviewed publications.

See You in New Orleans

MAY 10-13 Sheraton New Orleans Hotel

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is June 1, 2021 for the July/August 2022 issue. 73

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

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

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

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

EMERGENCY MEDICINE PHYSICIANS CHOOSE ENVISION BECAUSE… We have strong partnerships with diverse practices across the nation, enabling you to choose the environment in which you practice and the area where you want to live. Our national network of partner facilities also provides flexible scheduling options, so you can choose from full-time, part-time, per diem and ENVOY Ambassador Team opportunities.

Featured Position EM RESIDENCY PROGRAM DIRECTOR Lawnwood Regional Medical Center & Heart Institute Ft. Pierce, Florida

Visit Us at SAEM22 at Booth #213 Speak with our clinical leadership and experienced recruiters and find out how you can advance your career with Envision Physician Services.

Ready to learn more? Contact our experienced recruiters today! 847.908.9524 EVPS.com/SAEM

Department of Emergency Medicine Vice Chair of Research, Endowed Chair The University of Florida Department of Emergency Medicine (DEM) in Gainesville, FL seeks a dynamic and accomplished physician-scientist with a national reputation to continue the DEM's growth and trajectory as a leader in emergency medicine research. The Department of Emergency Medicine receives funding from the Department of Defense, the National Institutes of Health, and multiple industry partners. The DEM research mission is supported by the University of Florida Clinical and Translational Science Institute, which provides training opportunities including KL2 fellowships and K award preparation. The Vice Chair of Research will hold work closely with the Chair to develop priorities and milestones for the research mission. The successful candidate will have a track record of securing investigatorinitiated funding and will have experience mentoring faculty on training grants. S/he will work with the Vice Chair of Faculty Development to create scholarship opportunities for academic faculty that align with department and COM priorities.

Department of Emergency Medicine Executive Vice Chair of Clinical Affairs and Systems Integration The Department of Emergency Medicine (DEM) in Gainesville, FL is seeking an Executive Vice Chair (EVC) of Clinical Affairs and Systems Integration. With the Chair of Emergency Medicine, the EVC will help to craft the strategic, clinical, and operational priorities and act as a key liaison with internal and external partners. The EVC will provide executive oversight of the core clinical mission and oversee the development, implementation, and sustainment of DEM clinical positions, priorities, and programs. The EVC of Clinical Affairs and Systems Integration will work closely with the DEM Chair and the DEM Executive Vice Chair of Academic Affairs to ensure alignment of clinical and academic missions. Additionally, the EVC will serve as the Associate Chief of Emergency Services, guiding the expansion and delivery of emergency care throughout the UF Health system. The successful candidate will have demonstrated experience leading clinical operations in emergency medicine and will have a strong vision to guide new initiatives.

The UF academic health center is home to a world-class academic health system that has served Florida for more than 50 years. The academic hospital that serves as a Level One Trauma Center, Chest Pain Center and Stroke Center; a comprehensive children’s hospital; a cancer hospital; and multiple ambulatory care centers. The University of Florida Department of Emergency Medicine in Gainesville provides high quality clinical emergency care in four clinical sites, the UF Health Shands Adult ED, UF Health Shands Pediatric ED, and two freestanding UF Health Shands Emergency Centers (Springhill and Kanapaha).

For more information please contact Amy Smith, amysmith@ufl.edu or Rosemarie Fernandez, fernandez.r@ufl.edu .

NEW CAREER OPPORTUNITIES IN ACADEMIC MEDICINE

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

Join our team

teamhealth.com/join or call 877.650.1218

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

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

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

hpeffley@pennstatehealth.psu.edu

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

Become an Accredited Geriatric Emergency Department Today

Learn more at

acep.org/geda

Apply for ACEP’s geriatric ED accreditation program and validate your hospital’s commitment to: • Providing a more positive and sensitive physical environment • Adopting standardized approaches to geriatric care • Ensuring optimal transitions of care • Supporting geriatric-focused quality improvement

1703_0619

Geriatric EDs promote best clinical practices for older adults and have the potential to improve health outcomes, coordinate care more effectively, and reduce cost of care.

See You in Austin, Texas

May 16-19, 2023 | JW Marriott Austin

SAEM Pulse May-June 2022

Articles inside

Now Hiring

SAEMF Grant Applications Now Open

Announcing the 2022 SAEMF Research and Education Grantees

Briefs and Bullet Points

EM Wellness Initiatives: Oregon Health & Science University

Prioritizing Sleep for High-Performance Teams in the Emergency Department

Emergency Medicine: A Venezuelan Perspective

Emergency Medicine Network is Forging Ahead

Demystifying the Institutional Review Board

21 Know Before You Go

Increased Mental Workload for Academic Women Physicians Since the Pandemic Era

Diversity, Equity, and Inclusion in EM Research: A Call to Action

President’s Comments United in Facing the Major Issues That Face Us

Diversity & Inclusion Can You Tell I’m Pregnant?

One Step at a Time