SAEM Pulse May-June 2021 by Society for Academic Emergency Medicine

MAY-JUNE 2021 | VOLUME XXXVI NUMBER 3

www.saem.org

SPOTLIGHT PIVOTING THROUGH A PANDEMIC: SAEM PROGRAM COMMITTEE ADAPTS TO THE CHALLENGES OF COVID-19 An Interview with

Daren Beam, MD, MS

SAEM21 Program Committee Chair

THE RAMS GUIDE TO THE SAEM21 VIRTUAL MEETING page 62

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

SAEM STAFF

HIGHLIGHTS

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

Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org Manager, Accounting Hugo Paz Ext. 216, hpaz@saem.org Manager, IT Dan San Buenaventura Ext. 225, DSanBuenaventura@saem.org Specialist, IT Support Simeon Dyankov Ext. 217, sdyankov@saem.org

Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Specialist, Membership Recruitment Berenice Lagrimas Ext. 222, blagrimas@saem.org Membership & Meetings Coordinator Monica Bell, CMP Ext. 202, mbell@saem.org

Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Michelle Aguirre, MPA Ext. 205, maguirre@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 Communications Snizhana Kurylyuk Ext. 201, skurylyuk@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Senior Manager, Development for the SAEM Foundation Julie Wolfe Ext. 230, jwolfe@saem.org

AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Tami Craig Ext. 219, tcraig@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Associate Editor, Pulse RAMS Section Aaron R. Kuzel, DO, MBA aaron.kuzel@louisville.edu

2020–2021 BOARD OF DIRECTORS James F. Holmes, Jr., MD, MPH President University of California Davis Health System

Angela M. Mills, MD Secretary Treasurer Columbia University

Amy H. Kaji, MD, PhD President Elect Harbor-UCLA Medical Center

Ian B.K. Martin, MD, MBA Immediate Past President Medical College of Wisconsin

Christopher R. Carpenter, MD, MSc Washington University in St. Louis School of Medicine Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Michelle D. Lall, MD Emory University Nehal Naik, MD George Washington University

Ava Pierce, MD UT Southwestern Medical Center, Dallas Jody A. Vogel, MD, MSc, MSW Denver Health Medical Center University of Colorado School of Medicine Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

President’s Comments The Future is Bright

Spotlight Pivoting Through a Pandemic: SAEM Program Committee Adapts to the Challenges of COVID-19 – An Interview with Daren Beam, MD, MS

Clerkship Directors in EM Whew, We Made It! Looking Back at the 2021 EM Residency Application Cycle

Climate Change and Health One Climate Disaster Away From Displacement: An Opportunity to Build Climate Resilience

Climate Change and Health A Scourge of Smoke: Wildfires and Emergency Medicine

Climate Change and Health Wildfire Smoke and Children: How Emergency Physicians Can Respond to a Growing Threat to Pediatric Health

Diversity and Inclusion COVID 19: Through the Lenses of Immigrants

Diversity and Inclusion in EM Pandemic Parallels: Unmasking Inequities Then and Now

Ethics in Action Moral Distress: Another Consequence of COVID-19

Geriatric Emergency Medicine “ARMED” and Ready to Start or Revive Your Research Career?

Global Emergency Medicine Emergency Medicine Development in Uganda

Meeting at the Crossroads Wilderness Medicine Through the Lens of Telehealth

The Virtual Presence Altmetrics and Defining the Conversation

Wellness & Resilience Physical and Mental Health During the COVID-19 Pandemic: A Balancing Act

Disclosing Death from Behind a Mask

Sex and Gender in Relation to a Chronic Pain Disorder

Uncontrolled Organ Donation after Cardiac Death

Carrots, Education, and Hopefully Not Too Many Sticks: A Study in Behavior Change

The SAEMF Is Making Bold Investments in Emergency Medicine’s Future

Meet the 2021 SAEMF Grantees

Addressing COVID-19 Vaccine Hesitancy Among Black and Hispanic Communities

From Match to First Promotion: Gender Bias and Clinical Leadership… Top 10 Pearls From the Webinar

Five Tips to Transform Medical Students and Residents into Self-Directed Learners

The RAMS Guide to the SAEM21 Virtual Meeting

Briefs and Bullet Points

SAEM Reports

Academic Announcements

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SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2021 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 James F. Holmes, Jr., MD, MPH UC Davis School of Medicine 2020–2021 SAEM President

The Future is Bright This past year was certainly not what we had hoped or planned for in emergency medicine. COVID-19 unfortunately dominated the past 14 months and nearly all my President’s Comments had something about COVID-19 and its impact on our field. Despite the challenges of the past year, I look back and have nothing but pride in emergency medicine and what we accomplished during the pandemic. You were all heroes.

“Despite the challenges of the past year, I look back and have nothing but pride in emergency medicine and what we accomplished during the pandemic. You were all heroes.”

As I write this issue’s column, a third of the United States population has received at least one dose of a COVID-19 vaccine, and we are vaccinating at a rate over three million doses per day. Many now see the light at the end of this tunnel, and our future is bright. We now embark on a full-fledged virtual annual meeting. Many exciting events are planned, with opportunities for all interests and those at all stages of their careers. As usual, a broad array of cutting-edge emergency care research will be presented, as the SAEM meeting continues being the preeminent meeting for emergency care research. The inaugural Peter Rosen Memorial Keynote Address will describe the rapid growth of pediatric emergency medicine. A host of additional pediatric emergency medicine opportunities await, highlighting the SAEM meeting as the place for academic pediatric emergency medicine physicians. We continue with many of our favorite events — SonoGames®, Sim Wars, Chief Resident Forum, Medical Student Symposium, SAEM Leadership Forum, Junior Faculty Development Forum — but with slight twists on each, due to the virtual flavor.

Likewise, opportunities exist to virtually meet with NIH program officers. This year’s consensus conference is most timely as it creates a research agenda around social emergency medicine and population health. Now an annual event, we will host a second keynote address focused on education outcomes. Our highly successful residency and fellowship fair will be separated from the main meeting and offered May 3-6 and July 26-29. Breaking it off from the annual meeting gives medial students and programs the greatest opportunities to interact. Finally, all of our academies, committees, and interest groups will have their normal meetings, allowing everyone to virtually see and interact with their colleagues who share their interests. As we emerge from this pandemic and embark on our future, I urge everyone to take advantage of the myriad of opportunities SAEM offers at this meeting. It will be a great experience. Finally, it has been my utmost honor to serve as your President this past year. SAEM continues to grow and advance opportunities for our members. I wish to thank the SAEM staff and Board of Directors for the countless hours of assistance to advance our specialty. I am incredibly proud of the work we have done during this most difficult time. Our future will have new challenges, but I am certain our society will face and overcome them. Again, the future is bright and will be exciting to see. ABOUT DR. HOLMES: James F. Holmes, Jr., MD, MPH, is professor and vice chair for research in the department of emergency medicine at UC Davis School of Medicine.

SPOTLIGHT PIVOTING THROUGH A PANDEMIC: SAEM PROGRAM COMMITTEE ADAPTS TO THE CHALLENGES OF COVID-19 An Interview With Daren Beam, MD, MS Daren Beam, MD, MS, is an assistant professor of emergency medicine, department of emergency medicine, Indiana University School of Medicine. Originally an eighth generation North Carolinian, Dr. Beam relocated to Indiana University School of Medicine for his research Fellowship in 2012. Prior to his research fellowship, Dr. Beam attended residency at Carolinas Medical Center (now Atrium Healthcare), in Charlotte, NC and graduated medical school from East Carolina University in Greenville, NC. Initially at Indiana University he focused in developing a large animal model for pulmonary embolism (PE). Now his interest focuses on risk stratification of PE, identifying patients who can be immediately discharged and on the other end of the spectrum, patients who need advance therapy. While at Indiana University he has helped develop an outpatient dedicated venous thromboembolism (VTE) clinic and codirects the PE Response Team for IU-Health. Over the course of the pandemic, he has been a front line provider grateful to serve alongside his colleagues, department, and school. In addition to serving SAEM on the program committee, Dr. Beam has also served on SAEM’s grants and research committees. He has been active in SAEM since prior to medical school, giving his first SAEM presentation at the 2005 SAEM annual meeting in New York City. One of Daren’s favorite professional events is the annual meeting and catching up with colleagues near and far. Outside of work, he enjoys spending time with his family, which includes wife Kristin and sons William (12) and Nicholas (9). In his spare time, he likes doing renovation projects around the house, enjoys music and movies, and recently rediscovered an interest in golf. Daren is looking forward to being able to meet up with friends and family and attend concerts once it is safe to do so.

The COVID-19 pandemic threw the program committee into an unprecedented position of having to cancel an in-person annual meeting and pivot quickly to a virtual event, giving you the unique distinction of being SAEM’s only program committee chair to plan and host an entirely virtual annual meeting… What have been some of the biggest challenges to shifting to an online meeting format? Taking the SAEM annual meeting online has had all the challenges of a producing a busy, live-action television show. It’s like taking an established Broadway play and turning it into a live action movie while trying to keep all the elements of the play. The annual meeting is that one time of year when we get together with colleagues in our own niche areas to exchange ideas. The inspiration we receive at these meetings from our friends and partners is palpable. Preserving this type of environment online, during a pandemic, is something we have worked hard as a program committee to achieve. The SAEM staff and program committee have been amazing. Everyone has adapted rapidly to the challenges of producing our annual meeting in an online format and I believe we will have as close to a live interaction as possible.

What are the clearest benefits and greatest opportunities of attending a virtual meeting vs an in-person meeting? Emergency physicians sacrifice our free time to attend meetings like SAEM’s annual meeting. We still have shifts to work, papers to write, research to complete. Unlike other professions and specialties, we don’t get a “set” time for vacation. The emergency department never closes, which means someone always has to be there working so others of us can attend the annual meeting in person. A virtual meeting gives everyone an opportunity to attend. And because an online

Dr. Beam with Drs. Deborah Dierks and Mark Courtney

Dr. Beam with Drs. Jeffrey Kline and Bo Stubblefield

meeting is more affordable more people get to experience what happens at the SAEM annual meeting — even those who may not have originally had SAEM on their “go to” list of meetings. Our hope is that the convenience and ease of logging on and seeing what we are presenting across the spectrum of emergency medicine will entice and increase the number of people who attend. If you’ve never attended an SAEM annual meeting before, this is the year to try it out!

How have you personally managed stress and maintained work/life balance, particularly during this unprecedented time of COVID-19? What advice would you give to an individual who is struggling? What do you think our specialty as a whole can do to address COVID-19 related stress and improve physician well-being?

What advice would you give an attendee for making the most of the annual meeting in this virtual format? Prepare in advance! Log into the platform early (starting May 5) to familiarize yourself with where things are. Plan out your days, tag sessions, and customize your profile. Reach out to that colleague you usually see in-person every year at annual meeting and schedule a time to talk between sessions. Doing these things will help you get the most out of the meeting. Plus, everyone who logs in early qualifies for a drawing for the chance to win one of several $100 gift cards. So planning ahead is a win-win all the way around!

What are you most looking forward to when we meet again, in person, in New Orleans? There are so many things, but probably what I look forward to the most are the types of interactions that can only occur in person. Like when I get pulled into a session I would not have otherwise gone to or a discussion I would never have thought about having. Or when I’m in a presentation and someone outside of my area of expertise asks a question that’s utterly brilliant, which spurs further discussion, and inspires more ideas. Experiencing and witnessing this sort of spontaneous, in-person interaction and discussion is what I look forward to most.

Speaking of the pandemic, how has COVID-19 affected you, your work, your family, and your colleagues and coworkers? What have been your biggest challenges and greatest lessons learned during this time? One of the greatest lessons I learned during the pandemic was how to let go and not try to control every little detail. It was also a challenge, particularly in the beginning of the pandemic, to look on the bright side of things. But I've learned to have a more positive outlook and approach. Things have a way of working out. I’ve also learned to say yes more to my kids. 20 years from now I want my kids to look back on this year as the year we were able to spend more time with each other. The pandemic has shown me how important family, friends, and colleagues truly are.

I’m not gonna lie, the initial wave of COVID here in Indianapolis was scary. At the beginning of the pandemic I was fearful of and apprehensive about what we might see in the emergency department. What little information we had at the time made me wary as to how we as a specialty and medicine as a whole were going to be able to handle the pandemic. I’m grateful that my department at Indiana University School of Medicine made a concerted effort to check frequently on all the front line providers. Personally, I have tried to not take work home. When I’m “off,” I make sure I dedicate my time and attention to my family. Talking with my wife, and friends, both in and out of medicine, has helped me deal with stress and make sure I take care of myself. I also try to keep things in perspective. So many people, including my family and friends, have been affected in some way or form by the pandemic. I am very thankful that I have had a job to go to, and family, friends and colleagues to depend on, during this last year. My advice for my colleagues who are struggling is to reach out to others. So much negative stigma is placed on physicians who have mental health issues. Our job is tough. I’d be worried if you didn’t feel a little stressed during this pandemic! So take time to invest in yourself. Check on colleagues outside of your core group of friends. Perform a random act of kindness for a coworker.

What are your greatest hopes and biggest fears around the COVID-19 vaccine? Initially my greatest fear around the COVID vaccine was that a large percentage of the population would not get vaccinated; however, as we are now seeing larger numbers of people being vaccinated, I’ve become cautiously optimistic that this will not happen. My family and friends signed up for the vaccine as quickly as they could and most of the patients I treat are doing the same. My hope is that enough people will get vaccinated continued on Page 6

continued from Page 5 before more strains mutate and develop and the efficacy of the vaccine decreases.

What path led you to medicine and specifically to emergency medicine? My path in emergency medicine was pretty straightforward. Prior to medical school I was a research coordinator in the emergency department at Carolinas Medical Center (CMC), now Atrium Healthcare in Charlotte, NC. I was surrounded by some of the most amazing physicians you can imagine. The residents and the attending physicians showed me what the work hard/play hard mentality of emergency medicine is like. During medical school I tried to talk myself out of emergency medicine and see if there was another discipline or specialty that I liked more. The problem was I liked all of the specialties and every path I explored eventually led me back to emergency medicine. I was also lucky to have many phenomenal mentors in emergency medicine who helped shape my journey.

Who or what influenced your decision to choose academics? Even before medical school I had pretty much already decided I wanted to go into academic medicine. I was exposed early

in my medical career to emergency medicine and fortunate to have had a lot of positive mentorship and encouragement to go into academics. I choose academics initially for the research aspect, but over the years I have found enjoyment in other aspects of academics. I find satisfaction in educating the future of our specialty and mentoring medical students, residents, and junior faculty. But more important than why I chose to go into academics is what keeps me in academics: • A strong sense of comradery among my partners, especially now during the pandemic. • Working in an environment that nurtures smart, hardworking residents. • Mentors in and beyond my institution who help me in my research and in maintaining my work/life balance.

Why did you decide to become a researcher? What is your research area(s) of interest and why? I’ve always been interested in trying to figure things out. In college at UNC Chapel Hill, I started off in cancer research and then gravitated toward microbiology, eventually ending up at Emory University working on S. pyogenes. I ended up with a Master’s in biology from the University of North Carolina at Charlotte, working on vibrio vulnificus. I knew I wanted to do more hands-on work clinically, and I was lucky enough during graduate school to have an internship at Carolinas Medical Center. It was there, under the tutelage of Drs. Jeff Kline, Lee

Dr. Beam’s Advice for Making the Most Out of SAEM21

SAEM PULSE | MAY-JUNE 2021

Prepare in advance! Log into the platform early (starting May 5) to familiarize yourself with where things are. Plan out your days and customize your profile. Reach out to that colleague you usually see in-person every year at annual meeting and schedule a time to talk between sessions. Doing these things will help you get the most out of the meeting. Plus, everyone who logs in early qualifies for a drawing for the chance to win one of several $100 gift cards. So planning ahead is a win-win all the way around!

(left) Dr. Beam fishing with son Nicholas. (middle) Dr. Beam hiking with son William. (right) Dr. Beam and his wife Kristin attending a prepandemic wedding

Garvey, and Alan Jones where I saw physicians who were great at taking care of patients and at the same time improving the specialty through research. I knew that I would constantly be interested in my job if I was always trying to improve the specialty and change it for the better in the ways my mentors have. Ever since I started as a research coordinator I have been interested in and have focused a large portion of my career on pulmonary embolism (PE). I’ve worked on both extremes of the disease process from patients who don’t need workups and are safe going home to trying to identify patients at risk of decompensation. One of my most influential memories occurred when I was a research coordinator. I had enrolled a patient, a mother of four and grandmother of eight, into a research trial involving PE. She had recently been placed in rehabilitation following a fractured hip. Like so many other patients with PE, she was “sick” but not critically ill — or so we thought. As I was

speaking with her, she suddenly became unresponsive. Here she was, in one of the best emergency departments in the country, we had the proper diagnosis, she had great docs, but she still died. I remember at that moment thinking how little we knew about pulmonary embolism. I continue to be interested in this disease and I hope one day my work will help people who have it.

If you were not doing what you do, what would you be doing instead? That’s a great question, my wife tells me all the time I enjoy my job to much for it to be “work.” That said, I have a wide range of hobbies I enjoy — from cooking and creating craft cocktails, to playing music. I also really enjoy doing renovation projects around the house. There is a beauty in constructing things and a sense of accomplishment after completing a renovation.

Up Close and Personal Who would play you in the film of your life? Nicholas Cage. I had my better half answer this question for me. I don’t know if she thinks of me as H.I. from “Raising Arizona,” or as “Brad’s Bud” in “Fast Times at Ridgemont High,” but it is what it is. What would that film be called? “50 Plates in the Air” because I tend to juggle a lot of things all at once. Juggling is not easy, and sometimes a plate falls and breaks. Hopefully I learn. What is at the top of your bucket list? To learn how to play the banjo. My wife bought me a banjo a couple of years ago and I am just now trying to learn how to play, which means I am presently VERY bad at playing the banjo. Who would you invite to your dream dinner party? My answer depends on how many people I can invite! I would want a mix of people from different backgrounds. My current list would be singer/songwriter Otis Redding, writer/ cartoonist/songwriter Shel Silverstein, comedian/ musician Steve Martin, master distiller of Kentucky bourbon Parker Beam (no relation), author J.K. Rowling, and actress/comedian Betty White. I think it would be interesting to hear each of their stories, how they view themselves, and what matters most to them. Plus, think about it, music, acting, writing and bourbon, how could that not be awesome? What’s one book you’ve read (fiction or nonfiction) that has had a lasting effect on you? It’s not a book but a collection of poetry from Shel Silverstein called “Where the Sidewalk Ends.” There are poems that inspire, poems that are sarcastic and witty, and others that are just plain silly. Every time I pick it up, it makes me smile. Your “go to” song to sing in the shower or car is… This constantly changes as I have a wide taste in music, but one that I almost always come back to is “Graceland” by Paul Simon. What is one thing people would be surprised to know about you? When I was younger, I was an accomplished singer. In high school I was in a select choir group that ended up singing in Carnegie Hall and on “CBS This Morning.” I’ve sung in numerous weddings and still continue to cantor. I’m hoping to pass some of this love of music on to my boys. 7

CLERKSHIP DIRECTORS IN EM “Our specialty successfully matched 2,826 students almost exactly one year after lockdowns and drastic changes in medical education were instituted.”

Whew, We Made It! Looking Back at the 2021 EM Residency Application Cycle

SAEM PULSE | MAY-JUNE 2021

By Nicole Dubosh, MD, and Sharon Bord, MD, on behalf of the SAEM Clerkship Directors in Emergency Medicine academy

The COVID-19 pandemic has forced all of us to rethink our traditional paradigms for functioning in our academic emergency departments. Its impact on medical students applying to emergency medicine (EM) has been no exception. The pandemic has had an unprecedented effect on every aspect of the EM match process from clinical experiences, away rotations, letters of recommendation, and interviews. Despite this, our specialty successfully matched 2,826 students almost exactly one year after lockdowns and drastic changes in medical education were instituted. As we embark on yet another July, we will begin to see what longlasting effects these changes have had on the way we recruit and train our future emergency physicians. On March 17, 2020 the Association of American Medical Colleges (AAMC)

announced that all medical school clinical rotations were to be paused for a period of time in order to focus on clinical care of COVID-19 patients and to preserve and acquire personal protective equipment for front line staff. Students in their third and fourth years of medical school lost valuable clinical time and medical schools had to scramble to rearrange schedules and find creative alternatives. Because of the uncertainty surrounding the resumption of clinical activities and restrictions on travel impacting away rotations previously expected of our EM-bound students, the major national EM organizations released a consensus statement outlining expectations for students, medical educators, and program directors as they pertained to the 2020-21 EM Match. In summary, the consensus statements stated that away rotations for students with a home EM

program were discouraged, that only one EM faculty electronic Standardized Letter of Evaluation (eSLOE) should be required, that all interviews were to be conducted virtually, and that second look visits were highly discouraged. These recommendations were composed in line with the AAMC guidelines and were designed to ensure equity among students with access to different opportunities. The hope was that they would also relieve anxiety amongst students and educators alike during the challenging medical school and residency application environment. As a result, students were forced to make their specialty choice based on fewer clinical rotations in EM and choose a residency program in many cases without having even set foot in the city or medical center where they chose to match.

“The future is still full of many unknowns, but one thing is for certain: our resilience and ability to adapt will continue and this will in turn help us train the next generation of resilient and bright EM physicians.” EM clerkship directors and other educators had to quickly adapt to this new structure in several ways. Many of us had to shorten our home clinical EM rotations to make up for lost time in the spring. A large amount of didactic teaching was converted to virtual platforms. Some institutions developed purely virtual clerkship experiences for visiting students in an attempt to continue to recruit strong applicants outside their home institutions. Because these virtual-only experiences were nonclinical, programs were faced with ambiguity regarding their utility in assessment and ability to generate letters of recommendation. Other noteworthy challenges also arose along the way. Students were making career choice decisions after significantly less clinical exposure to our specialty compared to prior years. Additionally, advisors struggled with providing applicants with application and interviewing strategies, as there was concern that the tried and true advising of years past was no longer applicable, especially with no match data under the new paradigm. Due to all this brave new world, EM educators made a decision to be proactive. The lack of away rotations in turn led to a lack for EM letters in their files. In order to provide some sort of standardization for this dilemma, the Council of Residency Directors in Emergency Medicine (CORD) and the SAEM Clerkship Directors in Emergency Medicine (CDEM) academy joined to form a task force with the goals of revamping the tried-and-true eSLOE format and create a new letter format, which became known as the “O-SLOE.” The aim of the O-SLOE was to replace the effusive narrative letters from “Offservice” rotations. The O-SLOE gave

faculty members from alternative rotations such as surgery, internal medicine, or ob-gyn a structured format for providing comparative data amongst students they had worked with during the prior academic year. Prior to the application season the O-SLOE was actively promoted on social media sites and educational organizational listservs — both for students and the EM education community — to encourage use by applicants. The interview process also needed to be reworked. Due to an inability to travel, interviews moved to an online format; most programs utilized Zoom-based technology to meet with applicants. While for some the online format allowed for ease of use due to lack of lost time with travel, misplaced luggage, and less financial burden, there are some elements of residency programs that are difficult to convey virtually. Additionally, it was noted by many EM advisors that students who were ranked in the middle or lower third categories on the eSLOE were getting fewer interview offers, while those with a higher ranking were getting a large number of offers and were not cancelling at the same rates as in prior years. Ultimately, on March 19, 2021, at the culmination of a tumultuous year, emergency medicine matched a new class of interns! This year there were 3,734 applicants who applied for a spot in emergency medicine. Of these applicants 2,826 matched into the available 2,840 spots. There were more than 300 applicants who went unmatched — a number significantly higher than in prior years. The reason is likely multifactorial and should be examined when considering the structure for application and interview season in coming years.

Looking back to March 2020, the EM community could not have predicted the trials we would experience in the year ahead. While this application cycle was certainly different, as a community we came together and overcame the challenges that were thrown our way while keeping the best interests of the students and residency programs at the forefront. There were many lessons learned this past year and the changes that were adapted will need to be examined for consideration in the upcoming years. The future is still full of many unknowns, but one thing is for certain: our resilience and ability to adapt will continue and this will in turn help us train the next generation of resilient and bright EM physicians.

ABOUT THE AUTHORS Dr. Dubosh serves as the director of undergraduate medical education at Beth Israel Deaconess Medical Center/Harvard Medical School. She is the 20212022 president of the SAEM Clerkship Directors in Emergency Medicine (CDEM) academy. Dr. Bord is the clerkship director and subinternship director at the Johns Hopkins University School of Medicine where she also serves as cochair of the SLOE committee. She is the 20212022 president-elect of the SAEM Clerkship Directors in Emergency Medicine (CDEM) academy.

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.

CLIMATE CHANGE AND HEALTH

One Climate Disaster Away From Displacement: An Opportunity to Build Climate Resilience

SAEM PULSE | MAY-JUNE 2021

By Anjni Joiner, DO, MPH, and Caitlin Rublee, MD, MPH, on behalf of SAEM’s Climate Change and Health Interest Group

Flooding from storms or sea level rise, droughts and desertification, extreme heat, and wildfires are influencing the movement of people. (Hurricane Katrina, tropical cyclone Yasi and desertification in sub-Saharan Africa are just three examples!) Extreme weather events like these impact resource availability and environmental and social factors that contribute to health and well-being. As emergency physicians, we will not only be responsible for treating patients during extreme weather events but after, as a result of these climate disasters. We will hear patient stories and be challenged to diagnose and treat the resultant injuries and diseases: infections, behavioral health disorders, exacerbations of chronic diseases. Patients will tell us how they had to

leave their home and start a new life for their children. We all will undoubtedly be impacted by these stories and the results of climate disaster, professionally and/or personally, throughout our careers.

A Personal Story

Both my mother and father came from small villages less than an hour apart in Gujarat, India. When I recall my childhood visits to these villages, I remember running around lively streets with my sisters and cousins, waking up early to feed our neighbor’s peacocks, and frequenting the small village shops to buy sweet, hard sugar candies and rubbery multicolored balloons. I returned to my mother’s village a few years ago to find a dramatic transformation into what is now essentially a ghost town. The deserted streets were hot and

dusty and our voices echoed across closed gates of boarded up houses. There were no signs of the running or laughing village children that were such a significant part of my childhood memories. Although the efflux of villagers is no doubt multifactorial, I couldn’t help but think about the impact of increasing temperatures and recurrent drought in an already arid desert region. The northwest state of Gujarat, particularly the district of Kutch, has been pummeled with recurrent droughts, due to a combination of heatwaves and scarce and unpredictable monsoon rainfalls. Inhabitants of this region, along with many other areas of the world are forced to consider a difficult decision — either adapt to the changing landscape or migrate.

Review of Displacement and Human Mobility

Climate migration refers to a voluntary temporary or permanent movement of peoples due to environmental changes in their areas of residence resulting from the sudden or progressive impacts of climate change. This differs from displacement, which is an involuntary movement. Impacts of climate change affecting human mobility can be slow and insidious, such as that which is brought about by drought and sea level rise, or it can be swift and unpredictable, such as from flooding, heat waves, and storms. Reasons for relocation are often due to several factors, including political, economic, and cultural reasons. Thus, primary attribution to climate changes, particularly slow onset changes, can be challenging. There is a complex link among mobility, climate change impacts, and health impacts with climate change affecting mobility directly but also health and subsequent mobility. In response to climate stressors, individuals have four choices: 1.) stay and adapt, 2.) migrate on a long-term basis, 3.) migrate on a cyclical or temporal basis, or 4.) be displaced. Arguably, death is another choice for those left behind.

Who is impacted?

In 2017, an estimated 24 million people were displaced due to sudden-onset climate-related hazards. By 2050, 143 million people in subSaharan Africa, South Asia, and Latin America are projected to be internally displaced due to the effects of climate change. In 2016, the 10 largest disaster events globally were climaterelated. We’ve seen the direct effects of these climate-related disasters such as the medical evacuation of patients in Puerto Rico after Hurricane Maria and increased emergency department visits due to exacerbation of respiratory conditions from wildfires. Other effects have been less obvious, such as an increase in injuries in children left behind in Botswana after parental migration or sexual violence experienced by women and girls. It is often the most vulnerable populations that are victims to these changes, as they lack the resources to adapt locally and are left with no choices other than to seek more viable environments. Disaster after disaster, it is those who have the least who suffer the most. Yet, there is much that can be done to reduce the health harms associated with climate change. Academic emergency medicine physicians and organizations can play a crucial role in creating and sustaining the local and global changes necessary to protect people. continued on Page 12

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Photo credit: Anjni Joiner, DO, MPH

CLIMATE CHANGE

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How does this apply to academic emergency medicine? Direct patient care. Emergency physicians will be responsible for caring for a population of displaced people with various backgrounds, experiences, and languages who seek medical care for emergent and nonemergent causes. Disaster management and planning. Large influxes of people may overwhelm local health care systems. We need to plan ahead by increasing surge capacity to account for mass migration of people after sudden-onset, climaterelated extreme weather events. Local vulnerabilities and preparedness will be key factors to ensure staff and patient safety. Resource allocation and distribution. Identification of patterns of migration should inform resource development and resource allocation including to nearby communities, states, and nations. Expansion of evidence-based research. There is a significant need for high quality research in high-, middle-, and lowincome settings that addresses climate

change and emergency care. Research should guide accurate predictions and allow us to qualify/quantify impacts on the health sector including directly to people, supply chains, emergency medical services, operations, energy, nutrition services, and even educational initiatives that drive action. Climate justice. Vulnerable groups should be prioritized to address the systemic structures that influence adverse health outcomes and displacement. Disproportionate impacts to low- and middle-income countries and small island developing states call for collective global action to reduce greenhouse gas emissions driving future warming. Build climate resilient communities. Emergency physicians have a unique perspective caring for patients impacted by disasters and displacement. We can use our experiences and expertise to lead partnerships with local organizations, public health officials, and policy makers that prepare our communities to address local climate threats. We have a window of opportunity to act now, to prepare our communities and health care systems for the effects of climate change and human mobility. Many communities in the United States

and around the world have already committed to reducing greenhouse gas emissions, investing in public health research focused on advancing health equity, and creating actionable disaster plans. Emergency medicine physicians can lead efforts in promoting climate resilient emergency departments and health care systems. We can choose to adapt to the changing landscape of wherever we call home and protect our families and patients now and for generations to come.

ABOUT THE AUTHORS Dr. Joiner is an assistant professor of emergency medicine at Duke University and has an interest in the impact of climate change on human movement and emergency medical services. Dr. Rublee is an assistant professor of emergency medicine at the Medical College of Wisconsin and chair of the SAEM Climate Change and Health Interest Group.

Key Terminology Refugee: A person who meets the eligibility criteria under the applicable refugee definition, as provided for by international or regional instruments, under UNHCR’s mandate, and/or in national legislation. Asylum Seeker: An individual who is seeking international protection. In countries with individualized procedures, an asylum-seeker is someone whose claim has not yet been finally decided on by the country in which the claim is submitted. Not every asylum-seeker will ultimately be recognized as a refugee, but every refugee was initially an asylum-seeker. Internally Displaced Person (IDP): An individual who has been forced or obliged to flee from their home or place of habitual residence, “…in particular as a result of or in order to avoid the effects of armed conflicts, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized State border” (according to the Guiding Principles on Internal Displacement). Resettlement: The transfer of refugees from the country in which they have sought asylum to another State that has agreed to admit them. The refugees will usually be granted asylum or some other form of long-term resident rights and, in many cases, will have the opportunity to become naturalized citizens. Returnee: A person who was of concern to UNHCR when outside their country of origin and who remains so for a limited period (usually two years) after returning home to their country of origin. It also applies to internally displaced persons who return home to their prior place of residence. Source: United Nations High Commissioner for Refugees (UNHCR)

CLIMATE CHANGE AND HEALTH

Smoky Yosemite Valley — Taken by Zack Wettstein

A Scourge of Smoke: Wildfires and Emergency Medicine

SAEM PULSE | MAY-JUNE 2021

By Zachary S. Wettstein, MD and Jeremy H. Hess, MD, MPH, on behalf of the SAEM Climate Change and Health Interest Group

Wildfires in 2020 burned intensely across the United States, casting particulate matter, toxic gasses, and other noxious compounds into the air that spread from coast to coast. Wildfires have always been a threat to health due to their hazardous smoke, intense heat, and potential to displace whole communities, and are a familiar hazard for emergency medical providers. But wildfires are now darkening our horizons much more often than in the past and wildfire exposure is an increasingly prevalent health risk. Although wildland fires are natural events and important to the functioning of many ecosystems, climate change, drought, and fire suppression over the past century have caused wildfires to spiral out of their historical confines, resulting in more frequent, intense, and larger fires than ever, particularly in the American west.

The fire season has also increased in duration across the country, increasingly dramatically to nearly year-round in some states, such as California. While massive fires blaze mostly in the Western states, the particulate matter and smoke are carried by prevailing winds throughout the Continental U.S., so no region goes unaffected. The Pacific Northwest, where we practice in Seattle, is no exception. For weeks in August and September of 2020, we experienced some of the most intense and sustained waves of smoke seen in the region in recent years. Particulate matter hung in the air, muting the quotidian sounds and casting an eerie orange hue to the sky. On many of these days, Seattle’s air quality, normally quite good, ranked at the bottom ten worldwide. On one shift during this period, emergency medical services brought in a 67-year-old man with a history

of coronary artery disease who had collapsed at home. He was found to be in ventricular tachycardia and, by the time we met, he had been defibrillated and revived. Shortly afterwards he was taken for percutaneous coronary intervention where an occlusion in his right coronary artery was stented open. Another patient we saw was a 32-year-old, otherwise healthy man who was brought to the emergency department after being found down at home following a few days of malaise. His noncontrast head CT sadly showed a large intraparenchymal hemorrhage and significant midline shift. A third critically ill patient we cared for during this week was a 54-yearold woman with chronic obstructive pulmonary disease who despite having taken all her medications at home presented in respiratory distress requiring noninvasive positive pressure ventilation and ICU admission.

“From the standpoint of mental health, the increased stress from smoke exposure, evacuation and displacement, and disruption in routine mental health care can exacerbate underlying anxiety and depression, precipitate new cases of anxiety and depression and increase rates of posttraumatic stress disorder.” It can be challenging to attribute individual events to ambient environmental exposures. Was there any relationship between the smoke exposure and the coronary artery plaque rupture, the intraparenchymal hemorrhage, or the exacerbation of reactive airway disease? For each of these cases, we will never know definitively, however on a population level, evidence is mounting of the range of health conditions caused or exacerbated by wildfire smoke exposure (Table 1).

Respiratory COPD/Asthma Pneumonia Bronchitis Pulmonary embolism Cardiovascular Hypertension Arrhythmia Cardiac arrest Heart failure Neurologic Ischemic stroke Intraparenchymal hemorrhage Dementia Psychiatric Anxiety and panic disorders Depression Post-traumatic stress disorder Table 1: Health Conditions Exacerbated by Wildfire Smoke and Particulate Matter Exposure. While an abundance of the wildfire smoke and health outcomes literature has focused on respiratory conditions,

Sunset behind wildfire smoke.

emerging evidence has demonstrated that wildfire smoke exposure can also exacerbate cardiovascular, neurologic, and psychiatric conditions. The causal pathway for respiratory disease from wildfire smoke is intuitive — inhalation of particulate matter leads to airway inflammation and cell death, exacerbating reactive airway disease and predisposing the airways to infection. This has been borne out in the literature, which reveals significant increases in rates of asthma and COPD exacerbations, as well as bronchitis and pneumonia seen after exposure to wildfire smoke. Cardiovascular effects are perhaps less intuitive, however there are a number of pathways through which particulate matter in smoke has been shown to affect cardiovascular health. The fine particulate matter has been shown to increase sympathetic tone, result in increased systemic inflammation, and

lead to endothelial dysfunction and platelet activation which can increase risk of blood clot formation in both the arterial and venous systems. All together, these can result in clinical outcomes such as dysrhythmias, acute hypertensive episodes, plaque rupture, and emboli formation, with clinical endpoints such as pulmonary embolism, myocardial infarction, heart failure exacerbation, and stroke. In recent years, many studies have found that these cardiovascular outcomes are beyond theoretical and are indeed associated with smoke exposure when examined on a population level. Rates of out-of-hospital cardiac arrest have been found to increase with wildfire smoke exposure in Australia and California. Studies of emergency department usage in California, Washington, and North Carolina have demonstrated a

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relationship between smoke exposure and cardiovascular disease outcomes. Even more, these impacts have been greatest among the most vulnerable patients, including those with chronic disease, African Americans, and those over the age of 65.

From the standpoint of mental health, the increased stress from smoke exposure, evacuation and displacement, and disruption in routine mental health care can exacerbate underlying anxiety and depression, precipitate new cases of anxiety and depression as a result of fire-related losses and rupture of social and place bonds, and increase rates of posttraumatic stress disorder.

Wildfire smoke blanketing the Western US in September 2020.

As these exposures increase, so will the frequency of patients presenting for emergency care as a result of wildfire exposure. What can we do as emergency physicians to help prepare our communities to reduce exposure and, in the event that people are exposed, reduce these health impacts? There are primary, secondary, and tertiary prevention opportunities.

Primary Prevention

Primary prevention includes prevention of the exposure. While emergency medicine providers generally encounter their patients after an exposure has occurred, there are still opportunities to support primary prevention. We can support public health and emergency preparedness organizations in prevention messaging and reinforce the importance of avoiding exposure to the patients we see who are at risk. We can identify patients at increased risk, such as those with underlying chronic diseases like coronary artery disease, stroke, and reactive airway disease, counsel them on preparedness for wildfire smoke waves and ensure they have adequate medication on hand.

Secondary Prevention

Secondary prevention involves reducing the likelihood that disease will emerge once exposure has occurred. Individuals can reduce their exposure by remaining indoors; reducing physical activity during the most intense smoke waves (which reduces respiratory rates and likelihood of outdoor smoke exposure); using indoor air filters; and wearing N95 masks (although the data are limited on their efficacy). Some of these practices and behavior modifications have become more common in the age of COVID and may provide a dual benefit of preventing respiratory viral disease transmission and reducing smoke exposure.

Tertiary Prevention

Tertiary prevention involves reducing the severity of symptoms and disease progression, which is where we typically focus our efforts as emergency providers. We are trained to promote tertiary

“As wildfires are projected to increase in frequency and intensity under climate change, it is essential that we understand the health implications of smoke exposure so we can be prepared to improve the morbidity and mortality of exposure to smoke.” prevention through prompt diagnosis and treatment, but there are ways we can advance our tertiary prevention efforts, by ensuring that services are available even when systems are stressed. Our health systems can prepare by incorporating wildfire smoke events into surge planning in anticipation of an influx of patients to emergency departments and interventional suites. We can also push emergency preparedness for cascading hazards such as the loss of electrical power during periods of extreme heat, drought, and increased wildfire risk, which affects our patients’ ability to avoid wildfire exposure as well as the health care system’s ability to function effectively during these periods. As emergency physicians, we remain on the front lines when these disasters strike. As wildfires are projected to increase in frequency and intensity under climate change, it is essential that we understand the health implications of smoke exposure so we can be prepared to improve the morbidity and mortality of exposure to smoke.

ABOUT THE AUTHORS Dr. Wettstein is a thirdyear emergency medicine resident at the University of Washington. While in medical school at UCSF, he completed a research fellowship with the U.S. Environmental Protection Agency and California Department of Public Health studying the impacts of wildfire smoke on cardiovascular health. Dr. Hess is an associate professor in the departments of emergency medicine, environmental and occupational health sciences, and global health at the University of Washington and the director of the Center for Health and the Global Environment (CHanGE) at the UW School of Public Health.

CLIMATE CHANGE AND HEALTH

Wildfire Smoke and Children: How Emergency Physicians Can Respond to a Growing Threat to Pediatric Health

SAEM PULSE | MAY-JUNE 2021

By Robert Inglis, MD and Hilary Ong, MD, on behalf of the SAEM Climate Change and Health Interest Group

On “Doomsday,” September 9, 2020, the San Francisco Bay Area awoke to a blood-orange sky. Across Northern California, more than 20 wildfires burned, continuously pumping smoke and associated air pollutants such as particulate matter (PM2.5) into the sky. The thick blanket of smoke shaded out the sun and streetlights stayed on through the middle of the day. Residents were warned to stay inside and to keep their doors and windows shut. Schools closed. Outdoor activities came to a screeching halt at a time when indoor activities were already canceled due to the coronavirus pandemic. Many scoured stores and the internet for masks, respirators, and home air

filtration systems, only to find “out of stock” signs. In the following week the Bay Area experienced some of the worst air quality days on record. Bay Area emergency departments saw a spike in respiratory- and asthma-related visits, many of them from pediatric patients. 2020 was the worst wildfire season on record in California. Severe fire seasons are expected to be the new normal in the American West and in other parts of the world. In the past years, there have been unprecedentedly large fires in Australia, the Amazon, Indonesia, Siberia, and sub-Saharan Africa. Fire is a natural process in many ecosystems, but climate change

is causing fires to become more frequent and intense because warmer temperatures lead to drier fuels and decreased relative humidity, both of which favor rapid fire growth. Global average temperature is projected to increase by 1.5 degrees Celsius under the most ambitious decarbonization pathways, with much greater increases projected if emissions do not fall rapidly and technologies for removing carbon from the atmosphere at scale are not invented by the second half of the 21st century. It is therefore almost certain that we face decades to centuries of increased wildfire activity. As a result of these trends, children’s exposure to wildfire smoke is becoming

“Children have smaller airways and higher minute ventilation rates compared to adults, which causes deposition rates of wildfire smoke and particulate matter to be higher, making them more vulnerable to health effects of wildfire smoke and its associated air pollutants.” more widespread, frequent, and severe in the United States and worldwide. As emergency physicians, how can we be better prepared for the upcoming wildfire season, and how can we protect children’s respiratory health from wildfires?

Wildfire smoke

Wildfire smoke has direct and indirect hazardous effects on our health. The major components of wildfire emissions include particulate matter (such as PM2.5, PM10) and toxic gases (such as carbon monoxide, volatile organic compounds). Wildfire smoke can also

react with compounds in the atmosphere to create ozone and secondary organic aerosols. A study by Holm et al. on wildfireassociated air pollution found that the 2018 Camp Fire contributed to spikes in PM2.5 air pollution in San Francisco that reached a maximum of 240 ug/m3, which is almost ten times higher than World Health Organization (WHO) air quality recommendations. These high levels of air pollution lingered at ground level for more than one week after the smoke plume. Thus, the absence of visible smoke may not be sufficient to gauge air pollution

levels. This has significant implications on how we can better provide public health guidance during wildfire-associated poor air quality days. Smoke directly deposits in the airways and lungs to cause oxidative stress and inflammation, leading to respiratory effects. PM2.5 or smaller particles have been the center of focus of many studies and public health policies because they can cross the alveolar-capillary barrier into the circulation, leading to systemic multiorgan effects. continued on Page 20

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Health effects of wildfires on children

Children have smaller airways and higher minute ventilation rates compared to adults, which causes deposition rates of wildfire smoke and particulate matter to be higher, making them more vulnerable to health effects of wildfire smoke and its associated air pollutants. On average, children also spend more time outdoors than adults, increasing their exposure to air pollutants. Children also have periods of rapid growth and, depending on the time frame and duration of their wildfire smoke exposure, there are potential lifelong effects on their growth and the development of their lungs, endocrine, cardiovascular, and neuropsychological systems. Pediatric emergency department visits for asthma are increased with wildfire events. A study by Rady Children’s Hospital in San Diego found an excess of 16 respiratory visits per day

“In the long run, the best way to protect children from wildfire smoke is to mitigate climate change.” associated with Lilac Fire of 2017 when compared to baseline. Young children less than five years of age contributed the most to this excess count. Children who were living downwind of the wildfire were found to be most vulnerable. We on the front lines need to be aware of the acute effects of wildfire on children, which are not limited to increased asthma-related symptoms. The health effects from wildfire smoke exposure can range from relatively minor (such as eye and upper respiratory tract irritation) to more serious (such as asthma exacerbation or pneumonia). Several published studies have suggested that wildfire disasters are associated with increased rates of depressive symptoms and high stress levels. Infants were found to have a change in feeding behaviors as a

manifestation of stress. Special attention should be paid to children with complex medical history and special needs, who may be displaced by wildfire disasters and present with housing instability and the need for medication and home medical supply refills.

A call to action

In the long run, the best way to protect children from wildfire smoke is to mitigate climate change. Physicians have an important role to play in educating the public on the health risks of climate change and advocating for policies that reduce greenhouse gas emissions. With the health care sector responsible for an estimated 8-10% of greenhouse gas emissions in the United States, it is also important for emergency physicians to advocate for energy efficiency improvements and

“Emergency physicians should not only be prepared to care for pediatric patients who present with wildfire-associated acute illnesses but should also play a leadership role in helping our communities mitigate the impacts of wildfire smoke, particularly on the most vulnerable patient populations.” sustainable purchasing decisions in our own institutions. Healthy coexistence with wildfire smoke starts with granular, reliable information about real-time levels of PM2.5 and other wildfire-associated pollutants. As an example, urban areas in San Francisco and the Bay Area are now well served by real-time PM2.5 data from the low-cost sensor network deployed by Purple Air. It would be particularly helpful to have lowcost air quality PM2.5 sensors in schools to monitor both indoor and outdoor air quality. This will enable better informed decision making about school openings and outdoor activities such as recess, physical education classes, or sporting events. The best way to limit exposure to wildfire smoke is to stay inside during periods of hazardous air quality, but indoor air quality varies greatly based on type of building and its HVAC and air filtration systems. Older, less airtight buildings lead to increased smoke exposure, and given that wildfires often occur during periods of hot weather, people living in housing units without air conditioning may have to open windows, despite poor air quality, to maintain tolerable indoor air temperatures. This has the potential to create large socioeconomic disparities in children’s exposure to wildfire smoke. On hazardous air days, it may be necessary to create “clean air spaces” in gyms, community centers, or other public places with air filtration systems so that vulnerable people, including children with respiratory diseases such as asthma, can escape poor air quality in their homes. Outside the home, children spend the majority of their time in school, and improvements in school HVAC and air filtration systems are one of the best ways to reduce children’s exposure to wildfire smoke and reduce disparities in exposure. Depending on the setting, this can either take the form of improved

filtration in central HVAC systems or portable filtration units brought into classrooms. Both approaches have the advantage of also reducing students’ exposure to airborne pathogens, which could reduce missed school days and make it safer to keep schools open during pandemics. When children need to be outdoors during hazardous smoke conditions, masks can help reduce their exposure. Homemade fabric masks are unlikely to be helpful. In fact, there is concern that they could give a false sense of security by filtering out larger particles and letting the smallest PM2.5 particles pass through. Unfortunately, in the United States, there are no certified N95 masks for children, although larger children may be able to wear small adult-sized masks, and filtering facepiece respirators designed for children may be available for purchase from other countries. More research is needed to better understand the real-world effectiveness of masks in protecting children from PM2.5 exposure, and more product development is needed to expand the availability of childsized masks. While preventing the health impacts of wildfire smoke exposure should be the focus of our efforts, it is also important to ensure that our health systems are resilient and able to withstand the increases in patient volume and potential supply chain disruptions created by wildfires. Emergency departments serving children must have disaster and surge planning that enables them to increase staffing and expand their number of patient treatment beds in the event of a severe wildfire smoke event. They may also need to stockpile certain medications, such as steroids and short acting beta agonists, prior to fire season, particularly in places where road closures and other fire-related problems can disrupt supply chains. The National Pediatric Readiness Program

(PedsReady.org) has online resources to improve emergency department readiness to care for critically ill children. We must also be prepared to educate families and patients about the dangers of wildfire smoke exposure. An informational sheet on protecting children from wildfire smoke was put together by the Environmental Protection Agency, the Pediatric Environmental Health Special Units, and the American Academy of Pediatrics and can be included in aftervisit summaries for pediatric patients. Wildfire smoke is a serious threat to children’s health that is almost certain to get worse. Emergency physicians should not only be prepared to care for pediatric patients who present with wildfireassociated acute illnesses but should also play a leadership role in helping our communities mitigate the impacts of wildfire smoke, particularly on the most vulnerable patient populations. With thoughtful planning and preparation, we can ensure that children continue to thrive in our increasingly smoke-filled world.

ABOUT THE AUTHORS r. Inglis is a third-year D emergency medicine resident at University of California, San Francisco. Before medical school, he worked as an environmental journalist and a congressional staffer in Washington, DC. Dr. Ong is a pediatric emergency medicine physician and assistant professor in the department of emergency medicine at the University of California, San Francisco (UCSF). Dr. Ong is also affiliated faculty with the UCSF Center for Climate, Health and Equity.

DIVERSITY AND INCLUSION

COVID 19: Through the Lenses of Immigrants

SAEM PULSE | MAY-JUNE 2021

By Monalisa Muchatuta, MD, MS; Carolina Camacho-Ruiz, MD; and Adedoyin Adesina, MD, on behalf of the SAEM Academy for Diversity & Inclusion in Emergency Medicine

Although the COVID-19 pandemic has affected every stratum of society, its particular impact on the United States immigrant population must not go unacknowledged. In addition to suffering an infection rate higher than that of nonimmigrants, immigrants face additional barriers to the care, information, resources, and support necessary to protect themselves and their families. Immigrants, for example, are disproportionately represented in lines of work that put them at increased risk of infection and usually do not have the luxury of working remotely. Many immigrants are essential workers and remain vulnerable to increased exposure

while unfortunately often underinsured. Impossible dilemmas arise in these circumstances: Do I quit my job to reduce the risk of infecting myself and my multigenerational household or do I stay at my job so I can pay our rent? The pandemic has impacted immigrants’ financial stability, health, and social welfare in countless ways. Many do not have access to resources comparable to their nativeborn counterparts. Undocumented immigrants, for instance, are ineligible for unemployment benefits or federal relief funds while a large proportion may lack established personal network for emergency support.

Immigrants suffer limited access to health information and service in their primary language, making them particularly vulnerable to misinformation without verification from trusted, evidence-based sources. Medical experts in these communities continue to work relentlessly to eliminate dissemination of unreliable information. As immigrants ourselves and practicing physicians who have witnessed these troubling trends, we believe it is important to highlight these issues and share how we perceive that our communities have been affected. At the beginning of the pandemic, calls and messages poured in from

“Immigrants suffer limited access to health information and service in their primary language, making them particularly vulnerable to misinformation without verification from trusted, evidence-based sources.” relatives, friends, and other members of the community about things they’d heard regarding the coronavirus. There were all sorts of worrisome myths being disseminated within my community, which I found myself specially poised to try to dispel. One myth was that COVID-19 didn’t really affect Africans, because African genes and/or the hot climates of Africa were protective. This misconception arose as people attempted to explain why Africa was experiencing low incidences of COVID-19 during the early parts of the pandemic while coronavirus ravaged other countries. These discrepancies can now likely be explained by under-

reporting due to lack of access to testing and effective surveillance methods. Furthermore, COVID-19 infections can mimic other endemic diseases such as malaria or other forms of coronavirus. With testing rates far below other countries due to limited testing capacity, it is not surprising that there were huge gaps between antibody results and reported cases. Many COVID-19 cases had gone unreported and some causes of deaths due to COVID-19 were misdiagnosed. In addition to myths about contracting the disease, I’ve heard people call into question the motives behind the

COVID-19 vaccine. Before the release of the vaccine, misinformation spread that the vaccine was being introduced as a way for the government to infect the population with the coronavirus. Within my community, some of these messages originated from religious leaders. This is particularly troublesome as our religious leaders are meant to be trusted figures in the community. As of January, Africa was seeing a significant increase in cases and deaths since the second wave of the pandemic. This uptick of

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cases is deemed to be due to the more contagious South African variant.

In our emergency department, we witnessed the oppression of the Latinx community firsthand. COVID-positive patients routinely present in critical condition, unaware or unconvinced of the gravity of their circumstances. For Spanish-speaking populations, there is limited health information or statistical data available; the information that is available is often inaccessible to those with limited educational or social resources. Most evidence-supported knowledge is dismissed as a conspiracy or fearmongering. La familia, the family, is a defining characteristic of Latin American culture and the locus from which all activity and growth are spun. Rarely a decision is made without the approval of abuelita (granny). In the throes of this pandemic,

“I am hopeful that post-pandemic life may compel the distillation of American ideals and the restructuring of systems of power that have abandoned our communities at their most vulnerable.” the nature of the virus and the very foundation upon which Latinx culture is built has served to put this community at great risk.

their most vulnerable. As we emerge into a brave new world of our own devising, may we always remember la familia.

On a hopeful note, COVID-19 has forced greater public awareness of the disparities immigrant communities continuously face. I am hopeful that post-pandemic life may compel the distillation of American ideals and the restructuring of systems of power that have abandoned our communities at

The initial stages of mandatory quarantine are where I first noted despair and social disconnect brewing in my community. People were glued to their televisions and struggling to decipher a barrage of information. They were severely isolated, especially young adults and recent immigrants who had

who are spreading misinformation or disinformation. It is our duty to ensure people make informed decisions rooted in evidence. It is imperative to seek to understand the communities we serve — underserved and immigrant alike — to provide better equitable care, which will be the beginning steps to address the health disparities that have long plagued medical communities with distrust and fear from our patients.

ABOUT THE AUTHORS

“Well-informed community and health leaders committed to evidence have large roles in rebuilding trust while showing empathy to address misinformation for the sake of public health.” not yet built family structures or robust support systems. Without such networks in place, stay-at-home orders became challenging, and those with relatives abroad were forced to weather the pandemic alone. In the best of times, mental health often receives little attention in immigrant communities. When compounded with the pandemic, mental health vulnerabilities were exacerbated. New immigrants tend to have limited support, insufficient health care access and cultural barriers that limit them from developing mental health coping skills. As a result, many suffered from unrecognized health issues ranging from depression to panic attacks and major psychotic breaks. Mass vaccination is nearly within reach to help mitigate this crisis, yet health providers must now find empathetic ways to tackle a new challenge:

vaccine hesitancy. I have witnessed Latinx (predominantly Catholic) and African (predominantly of strong faith backgrounds) community members defer this decision to religious leaders because of historical mistrust of medicine in American underserved communities. Just as we began to see hope on the horizon with the release of vaccines distrust has been fueled by religious leaders claiming the vaccines are “antiChrist,” “mark of the devil,” or unethical. All untrue assertions by trusted sources in immigrant communities. Well-informed community and health leaders committed to evidence have large roles in rebuilding trust while showing empathy to address misinformation for the sake of public health.

Duty Calls

As physicians, our voices have to be louder than the megaphones of those

Dr. Adesina is an assistant professor and associate clerkship director of emergency medicine at Baylor College of Medicine. Her professional interest includes cross-cultural communication in medical education and mentoring minorities. Dr. Muchatuta is an assistant clinical professor and director of international minifellowships in emergency medicine at SUNY Downstate Medical Center in Brooklyn NY. She completed a global emergency medicine fellowship at Stanford University. Her professional interests are global emergency system strengthening, health disparity advocacy, and educational advancement of culturally-competent emergency care globally. Dr. Camacho Ruiz is an assistant clinical professor in emergency medicine at Kings County Hospital and SUNY Downstate Medical Center in Brooklyn, NY. She is currently completing a medical simulation fellowship at the H+H Simulation Center. Her professional interests include advocacy as a critical practice of educational leadership and the advancement of equity and intersectionality in medical teaching.

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

DIVERSITY & INCLUSION IN EM

Pandemic Parallels: Unmasking Inequities Then and Now

SAEM PULSE | MAY-JUNE 2021

By Melissa Edwards, DO; Christopher Brown, MD; and Joel Moll, MD on behalf of the SAEM Academy for Diversity & Inclusion in Emergency Medicine

In the early 1980s, physicians took note of a pattern of a rare lung infection in five previously healthy gay men within Los Angeles that would later be identified as Pneumocystis carinii pneumonia, which occurs in immunosuppressed populations such as those with advanced human immunodeficiency virus (HIV) infection— an AIDS-defining illness. Fast forward almost 40 years, and another respiratory illness, eventually labeled SARS-CoV-2 (COVID-19) and originating in Wuhan, China, was at the forefront of international news. Prior to both of these illnesses being named, the stigma and marginalization surrounding HIV and COVID-19 amongst

subpopulations had already been well underway. There are many parallels and intersections between the HIV and COVID-19 pandemics that highlight health inequities seen in medicine, both then and now. Those who have witnessed both epidemics, along with the problematic systemic responses to each, quickly understand the parallels that have adversely affected and continue to affect, so many victims. In both cases, socially charged stigma resulted in fear, violence, division, and isolation for minority populations. HIV/AIDS was initially labeled “Gay-Related-ImmuneDeficiency” (GRID) as it was thought to affect primarily gay men; however,

those utilizing intravenous drugs, Haitians, and hemophiliacs were other affected populations. Labeling led to inappropriately invasive questions, beyond the need to know, regarding personal practices and contraction. During evaluation and diagnosis of what was then a uniformly fatal condition, HIV victims often felt judged and were often ostracized by both society and medicine, which compromised their access to care and often deprived the sick and dying of the comfort of a simple touch. Sadly, many died alone and in shame. Advances in prevention were delayed and awareness strategies put on hold as the public associated the disease with disenfranchised

“There are many parallels and intersections between the HIV and COVID-19 pandemics that highlight health inequities seen in medicine, both then and now.” populations (e.g. racial minorities, gay men, and those with substance use disorders). HIV’s inevitable spread into heterosexual, white, and other majority communities eventually helped shine a light on the illness as an equal opportunity infection that adversely impacted the vulnerable. In much the same way that the LGBTQ+ population faced (and continues to face) ostracization and discrimination due to a homophobic view of HIV/ AIDs, the U.S. Asian community has had to deal with racist violence and discrimination as a consequence of some political leaders labeling COVID-19 as the “China virus.”

Today, Asian American communities are seeing a 150% increase in hate crimes nationally with increases of 1,200% in specific localities such as Orange County, California. This has allowed past biases, discrimination, and hatred toward a racial group to not only resurface but be codified by dangerous and unfounded rhetoric in the place of a robust focus on factual education and containment efforts. Lack of psychosocial support and health care access further highlight disproportionately poor health outcomes faced by marginalized and minority populations during COVID-19. Contributory to these inequities are structural factors within health care, such

as lack of health insurance coverage, delay in seeking care due to historic mistrust of the medical community from past mistreatment, and lack of a primary care physician. In addition to mortality burden of people of color, the LGBTQ+ community has shown to also be adversely affected by the pandemic compared to heterosexual counterparts (J Adolesc Health, Hum Rights Camp). People living with chronic conditions that adversely affect minority communities rely heavily on medical interaction, but

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“If these pandemic parallels teach us one thing, it is that we must not allow scapegoating in medicine now, or ever again.”

D IVERSITY & INCLUSION IN EM

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while physical distancing requirements have led to a boom in telemedicine services, limited internet access has disproportionately affected the most vulnerable, delaying or denying them needed care. Physical distancing requirements to mitigate the COVID-19 pandemic recall visions of AIDS patients isolated and dying alone without family or loved ones by their sides. Because HIV was then seen as a disease that solely affected marginalized groups, support for these patients relied on grassroots movements, unsupported by the public and government so as to not associate with “unacceptable” behavior. COVID-19, once it landed in the western world, spread rapidly and without discrimination. This resulted in a more intense and unified global response to COVID-19 compared to HIV. Labs across the world were focused on better treatments and vaccine development and published data became accessible in near real-time. Although messaging around COVID-19 was harmed by lack of apolitical scientific guidance, the development of therapies and vaccines in such a short time has been a triumph of science. To date, there have been approximately 547,000 deaths in the U.S. due to COVID-19 and approximately 2.76 million deaths worldwide. In comparison, there have been approximately 35 million deaths related to AIDS and AIDS-related illnesses. Racial minorities have borne the brunt of both pandemics. Black and Latinx COVID-19 patients have 1.9 and 2.3 times the mortality, respectively, than white COVID-19 patients. Similarly, when battling the HIV pandemic, inequities continue to dominate. Black and Latinx communities made up 31% of the U.S. population in 2018, but 64% of new HIV diagnoses. Men who have sex with men account for 69% of the new HIV diagnoses, despite the development of pre- and post-exposure medical prophylaxis. As health care workers in the emergency department who are commited to providing patient-centered care to disenfranchised communities and understanding how inequities compromise the health and care of our patients, it is essential that we mitigate

bias and structural stigma in the health care system and society. Emergency medicine has the unique honor and obligation to be the safety net of America. We daily see health inequities and how bias and lack of access, which are more prominent in vulnerable communities, provide higher morbidity and mortality to those communities. Parallels from the HIV and COVID-19 pandemics are strikingly similar and should help us realize how fear and minority status contribute to poor outcomes, especially during a pandemic. Hatred and judgment born and bred during the HIV pandemic remain and have remerged against AsianAmericans out of fear and reinvigorated prejudice. If these pandemic parallels teach us one thing, it is that we must not allow scapegoating in medicine now, or ever again. All Americans deserve equitable and patient-centered health care, and it starts with those of us in the emergency department.

ABOUT THE AUTHORS Dr. Edwards is a PGY1 emergency medicine resident at Virginia Commonwealth University

Dr. Brown is a PGY1 emergency medicine resident at Virginia Commonwealth University

Dr. Moll is residency program director, medical education fellowship director, and associate professor in emergency medicine at Virginia Commonwealth University

ETHICS IN ACTION

Moral Distress: Another Consequence of COVID-19

SAEM PULSE | MAY-JUNE 2021

By Naomi Dreisinger, MD, MS

In March 2020, the world of emergency medicine (EM) changed dramatically. The SARS-CoV2 (COVID-19) pandemic wreaked havoc, causing crowded emergency departments (EDs), anxious patients and staff, and equipment shortages. In the greater New York area, EDs were inundated with patients; concurrently, volumes in pediatric emergency departments (PEDs) began to drop. With shelter-in-place orders, parents were keeping their children home, and the PED was the last place they wanted to go. Our ED experienced these dramatic changes, but as fall moved into winter, the PED seemed to begin to return to the expected volumes. Sunday is a busy day for families, and Sunday nights can be busy in the PED. With sports, social get-togethers, and family outings, injuries happen.

Often treatments are put off until the last minute, making the Sunday overnight shift one of the busier ones in the PED. Walking into the PED for my Sunday overnight shift, I noticed the activity: a 10-year-old with a deformed forearm requiring sedation, an infant with fever, and several patients in the hallway waiting to be seen. The transition was smooth, and within several hours, the PED had leveled out. I sat down to catch up and begin my charting when the phone rang. It was the triage nurse. “Doc, we have a 27-year-old with chest pain. Can you see him?” Chest pain, even in a young adult, can be due to a myriad of concerning pathologies. Since April, our PED had increased our patient age threshold to 30 years, with the understanding that not all patients within this age range would be pediatric appropriate patients. We understood that our adult colleagues were feeling

overwhelmed and wanted to do what we could to help. Yet, the reality is that young adults are not just large children, they are often more complex. The pandemic months introduced me and my pediatric colleagues to management of deep vein thrombosis, greater concern for pulmonary embolism, and a more systematic approach to EKG review to avoid missing that uncommon young patient with cardiac disease. In few months we had diagnosed our share of pericarditis, myocarditis, and even myocardial infarction. This was disconcerting because although we wanted to help, we knew that every step we took beyond the standard pediatric age groups we typically saw, was a potential risk for our patients and ourselves. Early in the fall, we decreased our age threshold to 26 years old. Fall viruses had brought our volume back up and the PED was beginning to get busy.

“Moral distress occurs when one “knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” —Andrew Jameton, 1984 Despite this, whenever the PED emptied out, regardless of what was going on in the rest of the department, patients were sent our way. It really is not that big a deal to manage the young adult subset of patients, but with the bulk of our training in pediatrics, there are many concerns. Each time I took on an older patient I racked my brain to ensure that I expanded my differential to include those adult ailments that could uncommonly present in young adults. UpToDate provided useful information, but was I approaching and treating these patients properly? In the PED, the environment for our patients is of great concern. I needed to make sure that our child-friendly environment persisted despite the presence of all the adult patients. Finally, I often felt as if I had to tuck away the adult patients so that the parents of my pediatric patients would not feel as if adult patients were compromising their children’s care. These factors caused anxiety and distress in my fellow pediatric colleagues and me. We were torn between trying to support our colleagues and doing right by our patients. In 1984, Andrew Jameton coined the term ”moral distress,” defining it as occurring when one knows the right thing to do for a patient but institutional constraints make it impossible to pursue that course of action. The original definition focused on nursing. Nurses felt as if they had limited control and had to complete a task as instructed even in situations where they sensed that it was ethically or morally the wrong course of action. These situations could cause psychological discomfort, which ultimately might lead to job dissatisfaction and early burnout. Over time, it has been recognized that moral distress exists in all aspects and roles within medicine. Obstacles are often put in the way of medical providers that prevent them from completing their tasks. These obstacles may be as straightforward as lack of time, but can include legal considerations, institutional policy, medical power

struggles that inhibit a particular course of action, pressure from a supervisor, and other reasons. Moral distress occurs when the kinds of decisions we have to make about care or the kind of care we are delivering, challenges our fundamental beliefs and commitments as medical professionals. Moral distress is an ethical challenge. As medical doctors, we are committed to doing all we can for the health of our patients. As practiced EM physicians we understand that there are limits and constraints to what can be done in the ED environment, yet our goal is to help, not harm, and to heal whenever possible. Working in an environment that causes moral distress can lead to detachment and loss of empathy. Moral distress may result in an increase in anxiety; physicians who are persistently anxious or stressed have a harder time focusing on the patient, sometimes resulting in cynical care that is not patient centered. Moral distress can be eased through open discussion and debriefing. Working in an environment where there is open communication about concerns as well as the presence of supervisors who can help work through potential problems can mitigate the development of moral distress. Additionally, knowledge of ethics equips the medical provider with a tool kit and steers them towards the fundamental ethical knowledge, skills, and moral courage to practice medicine in a way that is consistent with their professional values. Discussing ethical and moral issues that arise in the daily shift are another way to help physicians recognize that their feelings of discontent are not theirs alone. EM physicians are at risk of being beaten down by the daily challenges we face. How much more so in the face of a pandemic. The COVID-19 pandemic introduced hardships that many ED physicians have never had to face before. Physicians had to confront the fear of contagion: this novel virus could easily spread to the physician, yet for many the fear of spreading it to loved

ones was even greater. Hospitals lacked sufficient personal protective equipment (PPE), which forced physicians to work in potentially unsafe environments. As physicians, we are committed to providing the best possible care to our patients, but COVID-19 undermined the doctor’s ability to comfortably do what we do best: care for and treat our patients. With this unknown viral entity encroaching our patients, our families, and ourselves, we were all ill at ease. Treatment was unknown, inaccessible, and often did not help our patients. We lacked institutional support by way of PPE and equipment, and the structural support of patients’ family members was limited as well. This discomfort led to moral distress for many. We wanted to help, yet when we did, it often felt wrong. Feelings of moral distress can lead doctors to feel alienated and detached. A medical culture of transparency coupled with excellent team dynamics aids in minimizing the negative feelings. The ED is generally a collegial environment. We aim to work together and help one another out. In times of stress this type of environment can be hard to maintain. Holding on to the team dynamic, while openly and honestly communicating our thoughts and concerns with other team members, helps to maintain the collegiality we are used to in the ED. When the nurse called to request my help, I hesitated. I openly explained that although I would like to help, chest pain in this age group would not be an ideal case for me. I scanned the triage board and selected two other patients that I knew I would serve better.

ABOUT THE AUTHORS Dr. Dreisinger is an associate clinical professor, emergency medicine, at Mount Sinai Beth Israel, New York.

GERIATRIC EMERGENCY MEDICINE

“ARMED” and Ready to Start or Revive Your Research Career?

SAEM PULSE | MAY-JUNE 2021

By Ellen D. Sano, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine

Emergency medicine physicians are often referred to as the “front line” in health care. The COVID-19 pandemic highlighted that we also need to be the front line in research. The truth is, in the United States, emergency medicine physicians are the safety net. We are the front door of every public health issue whether it be a new infectious disease, natural or manmade disaster, or illness due to health care disparities associated with age, poverty, racism, misogyny, or violence. We have long held that treatment and disposition of individual patients should be “evidence based.” Beginning in March 2020, I and many of my colleagues were confronted with many critically ill patients, but our search for peer reviewed evidence-based

guidance was fruitless. Prospective observational studies were limited by an immediate pause in funded research programs that relied on in-person, non-clinical research staff. Later retrospective chart reviews were hampered by even the definition of the diagnosis of COVID-19. More than 200 New Yorkers had died and thousands of others infected before the COVID-19 ICD code was available. In the spring of 2020, most institutions offered only admitted patients COVID-19 PCR testing, making access to outcome data skewed and limited. The need to disaster-proof our emergency medicine research seems obvious. This is true whether you are in a large urban setting or a rural

community one. SAEM’s Advanced Research Methodology Evaluation and Design course (ARMED) offers an opportunity to train emergency department (ED) physicians to be researchers and, perhaps more importantly, develop a community of ED researchers that can collaborate and collect data quickly. It was in this environment that I decided to apply for entry into the 2020–2021 ARMED course. I had completed my Master’s in public health 10 years prior and was beginning to revive my research interests in geriatric care when the pandemic began. My department, like many others, had limited CME funding available in this fiscal year. I was fortunate to receive financial support

“SAEM’s Advanced Research Methodology Evaluation and Design Course (ARMED) offers an opportunity to train emergency department (ED) physicians to be researchers and, perhaps more importantly, develop a community of ED researchers that can collaborate and collect data quickly.” from the Academy of Geriatric Emergency Medicine (AGEM) ARMED scholarship. The ARMED course is made up of a series of webinars and three, full-day workshops. The curriculum includes research methodology, statistics, grant writing, manuscript preparation, and information on funding opportunities. It’s a great way to jumpstart your research career and make connections with other researchers in the field of emergency medicine. This year, as with so many other courses, ARMED was held virtually. This proved to be a mixed blessing in that we missed the personal connections; however, it did eliminate associated travel costs and time. The course directors did a good job developing one-on-one virtual mentoring sessions and offering multiple small group workshops. I used my interest in housing instability among older adults and telehealth to develop COVID-19 related AIMS in these areas using retrospective chart review. The statistical and methods seminars

were instrumental in fine-tuning these projects. (I will be presenting abstracts related to both data sets at SAEM21.) AIMS development used for grant applications is a key component of the ARMED course. I used the opportunity to develop AIMS for an application for grant funding. The COVID-19 pandemic hit older adults especially hard. Not only has the mortality rate been highest amongst patients older than 65, but there is mounting evidence that there are both short- and long-term ramifications of COVID -19 infection in older adult cognition and mental health. Community dwelling older adults who were subjected to isolation and quarantine measures may have special needs. I used the ARMED course experts to develop an ED-based prospective study screening for depression, anxiety, and mild cognitive impairment in both COVID-19-recovered and noninfected older adults.

regardless of the stage of one’s career. In many cases, developing a research career after years of clinical practice is perhaps the best way to contribute to our profession. Most clinicians at some point see anecdotal evidence that may contradict “standard of care.” Research training will allow you to develop a testable hypothesis and publish the results to improve the care of all patients. I am hopeful that in future years the ARMED course will have in-person components again to reinforce the virtual connections we have made.

ABOUT THE AUTHOR Dr. Sano is an assistant professor of emergency medicine at the Columbia University College of Physicians and Surgeons.

I would recommend the ARMED course to anyone interested in research

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.”

SAEM PULSE | MAY-JUNE 2021

GLOBAL EMERGENCY MEDICINE

Ugandan emergency medicine residents

Emergency Medicine Development in Uganda By Justine Athieno Odakha, MBChB, MMed EM, and Randall Ellis, MD, MPH, MBA The development of emergency medicine (EM) in Uganda, like any other great achievement, was a result of conviction, hard work, commitment, and sacrifice. Thanks to efforts from the EMS department of the Ministry of Health, health workers convinced about the relevance of the specialty, and development partners across the globe, emergency medicine is now one of the specialties in Uganda with a fast-tracked recognition by the Uganda Medical and Dental Practitioners’ Council and a rapid incorporation into the public health sector of Uganda. In 2017, at the start of the pioneering emergency medicine training program at Mbarara University of Science and Technology (MUST), little was known about this specialty; the role of the emergency physician alongside other specialties was still gray. This caused many health workers to think of emergency medicine as competition to the already existing traditional

“to be accepted and to nurture a good learning environment during the clinical rotations, the pioneering EM class not only studied but also actively engaged in both local and nationwide advocacy for the specialty.” specialties, especially surgery, internal medicine, and anesthesia. Therefore, to be accepted and to nurture a good learning environment during the clinical rotations, the pioneering EM class not only studied but also actively engaged in both local and nationwide advocacy for the specialty. This was done through university-organized grand rounds, conferences within Uganda and East

Africa, engagement of both local and international partners, and direct interaction with health workers within emergency departments. Another hurdle was the lack of wellstructured emergency departments

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Ugandan emergency medicine residents

GLOBAL EM

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that would foster emergency medicine training. All regional referral and national referral hospitals in Uganda were typically organized to have a casualty ward for surgical emergencies and an emergency ward for medical emergencies. Because EM practice strongly hinges on the approach to the undifferentiated patient, this kind of structure presented a major limitation to training. To abate this, during the planning period to establish EM training at Mbarara University, a resuscitation bay was set up. This presented a space where all critically ill patients were seen before disposition. Benchmarking at centers that had state-of-the-art emergency departments was another way we approached this limitation.

“A journey of a thousand miles begins with a single step. Because of the work that was started years ago, the future of EM in Uganda now looks bright.” Early in the training, the pioneering EM residents and faculty spent one week at Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. The interaction with the Tanzanian faculty inspired these pioneers to return home and champion several developments that have changed the department. In 2018, we introduced triage to our ED with a one-way patient flow. This made it possible for all newly arriving patients to go through the EM

team before being sent to their parent specialty, thereby gradually improving the exposure of the EM residents and EM diploma students to a varying ED case mix and case load. An inadequate number of EMtrained faculty was another obstacle. The department depended on visiting faculty at the time the training was launched, and this faculty coverage has been maintained for the last three years by existing partnerships. Numbers

“Since our residency program is a university-based one, faculty members are essential to support both the academic teaching and clinical practice of EM in the ED, thereby displaying the key role of an emergency physician to wary colleagues, and the teaching of EM in the academic department.” are a key factor in establishing a new specialty. Since our residency program is a university-based one, faculty members are essential to support both the academic teaching and clinical practice of EM in the ED, thereby displaying the key role of an emergency physician to wary colleagues, and the teaching of EM in the academic department. We therefore leaned heavily on other academic departments to teach some course units that were not emergency medicinespecific, which availed time to the two EM faculty members to focus on clinical work and EM-specific module delivery. Another challenge was the absence of a unified body of medical workers who understand and want to push for the development of emergency care services in Uganda. At the start of our training, there were a number of small groups of local people and international partners who were enthusiastic about the establishment of an emergency medicine specialty in Uganda. Although everyone was working toward the same goal, many were oblivious to the presence of the others. One of those bodies was the Emergency Medicine Uganda (EMU), a group of health workers who are enthusiastic about the specialty. A meeting among the pioneer class, a faculty member, and the leaders of EMU led to the revamping of the group with a plan to coordinate the work of international partners to improve emergency care services in Uganda. The 2018 African Conference on Emergency Medicine in Rwanda saw the official launch of this national

specialty organization, which was later rebranded as Emergency Care Society of Uganda during the first emergency care conference in Uganda (August 2019). As the philosopher Lao Tzu said, "A journey of a thousand miles begins with a single step". Because of the work that was started years ago, the future of EM in Uganda now looks bright. We have six Ugandan emergency physicians, with eight more graduating at the end of this academic year from the two Master of Medicine residency programs (Mbarara University of Science and Technology and Makerere College of Health Sciences in Kampala). Two cohorts of emergency care practitioners (similar to physician assistants) have also graduated from MUST and are making tremendous contributions to emergency care in their individual hospitals. Mbarara University now has three Ugandan EM faculty members and will soon be launching a new pediatric emergency medicine unit. A training program for emergency medical technicians (EMTs) at Lubaga hospital will improve prehospital care. The EMS department of the Ministry of Health, together with the Emergency Care Society of Uganda and development partners are continuing to champion positive change in the practice, training, and quality improvement of emergency care throughout the country. In addition, one of the recent EM resident graduates has become president of the Emergency Care Society of Uganda, and another Ugandan EM physician has become president of the African Federation of Emergency Medicine.

We acknowledge all the global health partners such as Africa Inland Mission International, Global Emergency Care, SEED Global Health, African Federation of Emergency Medicine, and Malteaser International, who have made it possible for us to reach this stage of our journey. Although the struggle to realize a developed EM system throughout Uganda continues, we are confident that with loyal partners, we shall go far. For God and My Country.

ABOUT THE AUTHORS Dr. Justine Athieno Odakha is an emergency physician in Uganda, currently working as an assistant lecturer in the department of emergency medicine at Mbarara University of Science and Technology. As one of the pioneering EM residency graduates in 2020, she has particular interests in medical education, simulation teaching, resuscitation, and toxicology. Dr. Randall Ellis is a visiting faculty member in the department of emergency medicine at Mbarara University of Science and Technology, a medical educator with Seed Global Health, and member of SAEM. He has been involved in various aspects of emergency care education and development in Uganda since 2018.

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.”

SAEM PULSE | MAY-JUNE 2021

MEETING AT THE CROSSROADS

Wilderness Medicine Through the Lens of Telehealth Meeting at the Crossroads is a column dedicated to bringing members of various SAEM interest groups and academies together to explore the areas where they intersect. In this column, Anisa Heravian, MD, associate director of telehealth for adult emergency medicine at Columbia University Irving Medical Center sits down with Christopher Tedeschi, MD, a fellow of the academy of wilderness medicine and member of SAEM’s Wilderness Medicine Interest Group, to discuss some exciting intersections with telehealth as a tool for delivering care in wilderness medicine. Dr. Heravian: Thank you for meeting with me today. Telehealth has some rich opportunities to interface with patients at remote distances, yet one doesn't think automatically of a "video consultation" when thinking of wilderness medicine care. What do you envision as some of the applications for telehealth in wilderness medicine? Are there any specific areas that you are excited about or where care can be amplified with this technology? Dr. Tedeschi: Wilderness medicine — whether in the mountains or in other resource-limited settings like disasters — offers plenty of opportunities to leverage telemedical care. Providers in remote areas may seek the consultation of experts at clinical hubs, whether from subspecialists, or for assistance interpreting data like ultrasound images or ECGs. With adequate connectivity, patients in remote areas could contact providers directly for assistance with medical concerns or minor trauma, and maybe even spare a difficult in-person response from a search and rescue team or helicopter. Even in more serious situations, I can imagine cases in which a video connection to a patient's cellphone allows for appropriate triage and resource allocation prior to a rescue. Dr. Heravian: Given that wilderness medicine is practiced in a variety of settings, sometimes in places we would consider quite austere, what do you envision some of the challenges in implementing an effective telehealth program in the setting of austere medicine settings? Dr. Tedeschi: Clearly, connectivity can be a problem in areas without broadband access to support video or still images, and as our telemedicine practice becomes more robust (e.g.,

transmitting video of an ultrasound study) even more bandwidth will be required. Nonetheless, even an audio connection or the transmission of still images can be clinically valuable in a variety of settings. In disaster settings, the ability to connect "teleresponders" to front line personnel allows for a far wider variety of expertise than is typically available, and even spare the resources and risk associated with placing additional responders in the field. In the disaster setting, remote mental health care — as long as some continuity of care can be assured — may have particular potential. Challenges related to provider licensure or regulation will continue to be an issue. Expansion of programs that allow recognition of provider licenses across state lines may help, as will provisions that allow loosening of regulations during emergencies. Some practice settings, like ships at sea or even outer space, may be subject to different rules. Dr. Heravian: What are some current projects you are working on and how do you think telehealth could help complement your team's work? Dr. Tedeschi: We're particularly interested in using our expertise to reach resource-limited settings, whether that means an oceangoing vessel, or a disaster team in the field, or a scientific expedition in a remote location. Clearly, leveraging telemedicine plays a key role here, whether it means interfacing with patients directly, or providing expert guidance to physicians, physician assistants, nurse practitioners, paramedics, or first responders in the field. I'm particularly interested in the ethical, legal, and social implications of remote telemedicine — especially in disasters — and hope to continue to engage important questions that arise along those lines. We're also interested

in developing engaging teaching tools for our medical students learning about austere medicine, including the use of telemedicine simulations from remote locations and even virtual reality simulation. Dr. Heravian: Are there any "wish list" ideas or interventions that you'd like telehealth to offer for clinicians practicing in austere conditions that we can focus future research efforts on? Dr. Tedeschi: Point-of-care ultrasound again comes to mind; responders in the field need only to be able to acquire images; they can be interpreted remotely. With improving handheld ultrasound devices, this opens the door to improved diagnosis at remote locations and informs decisions about treatment and evacuation. As wearable technology becomes more advanced and less cumbersome, I can imagine providers in the field transmitting all sorts of biometric data to consultants at clinical hubs, or patients sharing data from their personal devices to aid in their care.

BIOGRAPHIES r. Heravian is a practicing D emergency physician and the associate director of telehealth for adult emergency medicine at Columbia University Irving Medical Center/NewYorkPresbyterian Hospital. r. Tedeschi teaches and writes D about wilderness and disaster medicine. He is an associate professor of emergency medicine at Columbia University and an editorial board member for “Wilderness and Environmental Medicine” journal.

VIRTUAL PRESENCE Altmetrics and Defining the Conversation By Ryan LaFollette, MD, and Ray Fowler, MD, on behalf of the SAEM Virtual Presence Committee

SAEM PULSE | MAY-JUNE 2021

While the halls of academic meetings have changed this year from actual halls to virtual ones, the rate and quality of primary medical literature continues to increase. Staying up to date requires the ability to filter and anticipate the impact of these articles — a task that as become increasingly overwhelming. Yet identifying and prioritizing the quality of this literature and its translation

into meaningful practice change has always been a topic of interest and improvement. Metrics that imply the impact of a journal or article have traditionally come through bibliometrics such as the impact factor. This calculation infers rating by tallying the mean number of citations of that journal within a given time frame. There are a number of

criticisms of this simplified metric: its lack of effective comparison among subject areas, the potential for gaming by manipulative publication behavior, and the fact that it does not account for the societal conversation that medical literature, in particular, is intended to affect. The dynamic nature of dissemination through blogs, social media, and public discussion has an important influence on research today. Given today’s advanced algorithms that allow for broad and rapid indexing, articlelevel metrics (ALM) were created to more accurately trend the real-world impact of researchers, institutions, and journals. These metrics weigh social media (Twitter, Facebook, blogs), policy documents, lay press and scientific references (Mendeley) to create a partitioned impact score. There are

limitations to this, as dissemination does not indicate the quality of peer review or content, however it can more accurately imply its relevance. Academic Emergency Medicine has jumped to the forefront of engaging in online discussion of primary literature through online dissemination and social media. This has occurred since the time Barbic et al. looked at the altmetric scores of pre-2010 papers compared with traditional citation metrics in emergency medicine literature and found a weak correlation. Barbic et al. also discovered that the articles most successful in social media and lay press were those outside of traditional emergency medicine journals. Since that time, innovators such as Ken Milne (thesgem.com), Theresa Chan, and Brent Thoma (canadiem.org) have pushed evidence-based reviews and dissemination into the conversation of emergency medicine and significantly increased the altmetrics of the articles they choose to feature. At the same time, emergency medicine physicians and advocates Megan Ranney and Ali Raja have increased the presence of emergency medicine in the lay press by fostering conversations around how to interpret data quality. Both of these methods are

effective at increasing altmetric scores while also increasing research reach. At a time when scientific discussion is a part of daily public consumption and scientific data is constantly being called into question, altmetrics are needed more than ever to ensure that these conversations contain accurate, relevant data.

ABOUT THE AUTHORS Dr. LaFollette is assistant program director at the University of Cincinnati. He comanages the FOAMed site TamingtheSRU.com, coleads didactics at the SAEM annual meeting and serves as cochair of the SAEM Virtual Presence Committee. Dr. Fowler is professor of emergency medicine and chief of EMS at UT Southwestern and is the James M. Atkins MD Distinguished Professor of EMS at UT Southwestern. Dr. Fowler serves as cochair of the SAEM Virtual Presence Committee.

Useful Ways to Use Altmetrics • Include your altmetrics on your CV and when applying for grants • Comparative altmetrics can be used by institutions and organizations to gauge the impact of content and allot resources to ensure it is seen and engaged with by its intended audience • The annual altmetric Top 100 is a searchable, useful adjunct to reading lists

Five things you can do to help improve your article’s Altmetric score Before promoting your article, create (and subsequently use for various promotional efforts) a short summary of your work. This summary should include your key research outcomes (i.e. we did this study on X and got Y results) as well as links to useful additional resources such as videos. This then allows a wider audience to understand and appreciate your research. 1. If you run a blog, add a post about your article. If you have a contact who runs a blog, ask them to help promote your work. 2. Tweet about your paper – either through any existing accounts that you manage or through any society/institutional accounts. 3. Contact your institutional press office to see if your article is relevant for any publicity opportunities. 4. Talk about your paper at your next conference and personally raise awareness of your research within your own community. 5. Create an account with Mendeley and share your work with thousands of fellow academics. Source: The Wiley Network

SAEM PULSE | MAY-JUNE 2021

WELLNESS & RESILIENCE

Physical and Mental Health During the COVID-19 Pandemic: A Balancing Act By Amanda Michelle Ritchie, MD, BScN, RN and Al’ai Alvarez, MD on behalf of the SAEM Wellness Committee We all know that emergency medicine is a high-stress work environment. In fact, it’s considered a VUCA environment; in other words, an environment filled with volatility, uncertainty, complexity, and ambiguity — all of which can quickly manifest as stress. COVID-19 has made this environment even more challenging. As we pass the one-year mark into the pandemic, already overloaded emergency departments are bracing for ongoing challenges: overcrowding, vicarious trauma, and lack of time, energy, not to mention support to address our own physical and mental health. Physical activity has been shown to boost mental health. The stronger we are physically, the stronger our mental fortitude becomes, which allows us to combat the challenges that wear us down on shift. What’s more, the release of endorphins after a workout provides an emotional boost that can last for days. But many gyms are still closed due to COVID or are operating on limited hours that are largely incompatible with an emergency medicine physician’s shifts. Plus, for many of us who live and work in colder climates, the winter season made it difficult to get outside for a run or walk. So how do we find a way to get in some much-needed physical activity? Home workout apps are a great way to get moving when you’re unable to get outside or to a gym. Most require little to no equipment. Here are a few of the most popular home workout apps at a glance: • Peloton • Aaptiv • Fitbit Coach • Asana Rebel • Adidas Training and Running by Runtastic • Nike Training Club • Zwift Online personal training is another flexible alternative to traditional personal training and can help you get the physical activity you need. Find independent online trainers at Trainerize or check out some of these online coaching/personal trainers:

“Our ability to think outside the box can lead us to creative ways to be physically active.” • Girls Gone Strong • The Big Dawgs • Forge Fitness • Trainiac • Ultimate Performance Fitness • Freeletics The question then becomes, how do you keep yourself motivated to exercise? Is there another way to increase physical activity? One essential aspect of habitforming is accountability. Fortunately, we can look to our partners and friends to keep us accountable for hitting our goals. Secondly, as emergency physicians, creative thinking and problem-solving are part of our skillsets. Our ability to think outside the box can lead us to creative ways to be physically active, such as gardening, landscaping, and home renovation projects. In addition, spending time outdoors walking, hiking or just enjoying nature has the additional benefits of improving blood pressure, boosting mental health, reducing anxiety, controlling depression… and making us happy. Forest bathing or “absorbing the forest atmosphere” requires no exercise at all but has numerous emotional and physical health benefits. Forest bathing simply requires that you “be” in nature, connecting with it through your senses. The scent of pine and earthy soil, the warmth of the sun, the sight of dappled light filtering through trees, the sound of the wind rustling leaves — these ease our stress and worry, help us to relax and think more clearly, and give us peace. Regular doses of “awe” can also do wonders for our mental and emotional health. Awe is that sense of wonder and feeling of smallness you get when you experience something vastly bigger than yourself. You don’t have to travel far to experience awe and it doesn’t require much time. A weekly, 15-minute “awe walk” around your neighborhood, focusing

on the everyday beauty of the world around you, helps take your mind off your worries and anxieties and enhances feelings of joy, gratitude, and compassion. On one recent awe walk with my husband, we saw a herd of eight, whitetailed deer grazing in a meadow and a coyote sunning himself. We would not have encountered these awe-inspiring experiences in a gym or at home. Just as important to physical exercise and spending time outdoors is accepting some things as they are. There will be days when all we want to do is be cooped up inside, “vegging” on the couch, bingewatching Netflix. That is okay, too. One year into the pandemic and I have learned that I don’t necessarily need a gym to stay healthy. What I do need is time for myself doing something that gives me solitude and allows me to selfreflect. Attending to my self-care inspires me to eat healthier, connect with friends and family, and rekindle my relationships. Not surprisingly, it helps me to better care for my patients, and at the end of the day, I think that’s what makes going through this pandemic worth it.

ABOUT THE AUTHORS Dr. Ritchie is an incoming internal medicine/emergency medicine PGY-1 at Louisiana State University Health Sciences Center New Orleans. Dr. Alvarez is a clinical assistant professor of emergency medicine and an assistant residency program director at the Stanford Emergency Medicine Residency Program. @alvarezzzy

SAEM PULSE | MAY-JUNE 2021

Disclosing Death from Behind a Mask By Anita Chary, MD, PhD “I am so sorry to tell you that your mother has died.” I stand six feet away from my patient’s children in the far hallway of the emergency department waiting room, wearing a mask, goggles, and a blue gown as I deliver the news. My patient’s son holds his head in his hands in disbelief; my patient’s daughter begins to wail. I suppress my urge to step forward, reach out, and place my hands on their shoulders. This is a pandemic, and I am a surface, a potential vector for fomites. Death is a part of life, and death is a part of emergency medicine. Physicians who work in the emergency department come to accept that at times, despite all of our efforts, critically ill patients die. Each of us learns to navigate the difficult task of disclosing to our patients’ loved ones that they have passed. As physicians, we do our best to read the situation and choose the right words and the right ways to convey sympathy, but the pandemic has uprooted what I have learned about disclosing tragic news. Before COVID-19, when our patients died in the emergency department — of heart attacks, serious car accidents, gun violence — their family members were often at the bedside, or we would call them to come to the hospital. We would escort them into a family room, designated for these types of conversations, and speak with them face to face about what happened and how their loved one died, with tissues at the ready. Sometimes, when it seemed appropriate, I held family members’ hands, shoulders, or offered them an embrace, and we all grieved together. Now, with rare exception, visitors are not allowed to enter the emergency department while we care for their relatives. Family members are asked to remain masked in the department waiting room as we treat and resuscitate patients. We try to bring family members into the clinical space if their loved one’s death is imminent, and family members are permitted to see a loved one who has died. This already traumatic experience can be even harder to process as visitors of the dead are limited to one, sometimes two at a time, in line with social distancing. Some, in that darkest moment, must face their grief alone.

“As physicians, we do our best to read the situation and choose the right words and the right ways to convey sympathy, but the pandemic has uprooted what I have learned about disclosing tragic news.”

And simultaneously, grief enters the public domain. Now, we no longer have a family room. The small space which used to house a couch and a chair cannot safely accommodate social distancing between a clinician and a patient’s family members. When I tell people their loved one has died in the emergency department, they are in the quietest and least populated section of the waiting room that I can find. I measure my voice so that only the family can hear me, but I do not feel as soft or gentle as I used to when delivering bad news, as I must now be heard from six feet away. As we disclose death, our faces are hidden behind masks and our eyes behind goggles. Where my sympathy used to be tangible, I now wonder if patients’ family members sense my shared devastation. Telling someone that their sibling, parent, or child has died,

with layers of plastic covering my eyes and a respirator muffling the sorrow in my voice, I wonder if the news seems devoid of feeling. These rituals around disclosing death initially seemed cruel but necessary to protect our patients’ loved ones from infection. Hauntingly, now more than one year into the pandemic, they feel like more of the same.

ABOUT THE AUTHORS Dr. Chary is chief resident, Harvard Affiliated Emergency Medicine Residency.

SAEM PULSE | MAY-JUNE 2021

“We now know that women’s pain is treated less aggressively and less promptly in the ED.”

Sex and Gender in Relation to a Chronic Pain Disorder By Barret J. Zimmerman, MD and Alyson J. McGregor, MD, MA, on behalf of the SAEM Sex and Gender in Emergency Medicine Interest Group Pain is one of the most common presenting complaints to the emergency department (ED), and in light of the opioid epidemic, increased attention is being paid to individualized pain treatments based on the underlying causes of pain. One of the most fundamental individualizing factors easily garnered about a patient is their biological sex and current gender identity. Men and women have different physiology, psychology, and socialization affecting the manifestation of pain. One important sex difference involves the role of sex hormones in modulating pain, specifically the protective effect of estrogen on pain, which occurs through upregulating opioid receptors and the release of endogenous opioids. This could help explain why many conditions manifesting predominantly as chronic pain become more prevalent after menopause, less prevalent with pregnancy, and why differences in pain sensitivity between genders become more pronounced after age 12. One such condition, complex regional pain syndrome (CRPS) is at least three times as common in women, predominantly post-menopausal women. Researchers believe the reason females experience higher levels of chronic pain disorders and greater pain sensitivity in general is rooted in the interplay between the immune system and certain sex hormones, including androgens and estrogen. (Ann Ist Super Sanità, J Neurosci Res) Immune system activation appears to have a central role in the pathophysiology of CRPS as well; CRPS is believed to occur because of an inflammatory response after physical trauma which leads to a cascade of nervous system changes. Certain

inflammatory markers are significantly increased in both the acute and chronic phases of the disorder; therefore, it has even been suggested that early identification and treatment with antiinflammatories may be able to prevent this disorder. Although diagnosing CRPS is purely clinical, and some tests correlate, it should be noted that even in a patient with normal inflammatory markers, a diagnosis of CRPS must still be considered. As mentioned, the diagnosis of CRPS is clinical, and the Budapest diagnostic criteria is often used in order to make the diagnosis. This disease of disproportionate pain in an extremity must also be accompanied by a certain number of other signs and symptoms, which may include swelling, changes in nails, skin, hair, or temperature, changes in motor function, and allodynia. It usually occurs in the arms, classically is more distal than proximal, typically occurs after trauma (most often fracture), does not follow an anatomical distribution from a single nerve or spinal segment, and can spread over time. It can be acute or chronic and can persist for years. In addition to an increased likelihood of initially developing CRPS, females are more likely to have symptoms persist beyond one year from the inciting incident. Treatment for CRPS involves patient education, physical therapy, occupational therapy, psychosocial assessment, and pain management with low-risk agents. Treatment failure and expanded options include various other modalities, including interventional approaches. In cases of delayed diagnosis, treatment is less effective.

We now know that women’s pain is treated less aggressively and less promptly in the ED. The authors suspect that this phenomenon is exaggerated in those patients who are returning for the same symptoms regularly, as would be the case in a patient with CRPS. This is despite higher rates of chronic pain conditions and more sensitivity to acute pain among women. CRPS is one of many chronic pain disorders which can be differentiated from one another largely by a careful history and physical examination. Every effort should be made to explore possible diagnoses and explanations of any patient’s pain, bearing in mind the sexually dimorphic physiology of pain and the changes in chronic pain conditions that correlate with fluctuating hormone levels. Clinicians should be familiar with the diagnostic criteria for CRPS, aware of the physiology and epidemiology of this and other similar chronic pain disorders, and be on the lookout for this uncommon disorder.

ABOUT THE AUTHORS Dr. Zimmerman is a PGY-1 in the Brown Emergency Medicine Residency Program

Dr. McGregor is an associate professor of emergency medicine in The Warren Alpert Medical School of Brown University

Uncontrolled Organ Donation after Cardiac Death SAEM PULSE | MAY-JUNE 2021

By Casey Carr, MD, and Torben Becker, MD, PhD

A 55-year-old man collapses while performing land care at home and is found to be in cardiac arrest. He receives advanced cardiac life support in the prehospital setting, and when he does not obtain a spontaneous return of circulation, he is transported to the nearest emergency department. Despite further prolonged attempts at resuscitation, his initial rhythm of ventricular fibrillation devolves into asystole, no cardiac motion is noted on bedside ultrasound, and his end tidal CO2 is consistently less than 10 mm Hg. His time of death is declared. His

driver’s license is obtained in order to contact next of kin — and he is found to have opted in to be an organ donor. Is there a mechanism for this patient to donate his organs? Are there differences in approach in countries outside of the United States? What are the ethical considerations of this approach? The supply for organs for deceased donor transplantation has hit a plateau in the United States despite substantial efforts to increase organ donation rates over the past 10 years. While

organ donation after brain death (DBD) remains the most common form of organ donation, nonstandard forms of donation, such as donation after cardiac death (DCD) have been explored in response to this organ shortage. DCD can be categorized as controlled or uncontrolled. Controlled DCD (cDCD) occurs in the hospitalized setting after planned withdrawal of care. Donation in this setting accounts for less than 10% of all U.S. organ donations. Uncontrolled DCD (uDCD) occurs after unexpected cardiac death, frequently outside of the hospital. While the Institute of Medicine

“The supply for organs for deceased donor transplantation has hit a plateau in the United States despite substantial efforts to increase organ donation rates over the past 10 years. While organ donation after brain death (DBD) remains the most common form of organ donation, nonstandard forms of donation, such as donation after cardiac death (DCD) have been explored in response to this organ shortage.” has recommended uDCD as a promising and ethically acceptable method of transplantation, adoption of this model in the United States remains incredibly rare. France and Spain have the most robust programs of this kind, where uDCD account for a significant number of deceased donor transplants and has been practiced since the 1980s. From 2005-2015, Spain had over 1,000 cases of uDCD transplantations. Both of these countries have specific legislation pertaining to uDCD. These legal texts include revisions related to the criteria for death, limitations to preservation, and requirements for consent. Additionally, national guidelines and protocols have been issued that deal with both the ethical and technical aspects of uDCD. Both Spain and France have an opt out policy regarding organ donation, both controlled and uncontrolled. In these countries, obtaining consent from family is focused on checking for any expressed opposition towards donation. Family consent during uDCD occurs during different points in time, varying between countries and local policy — at times as soon as death is declared or when reperfusion techniques are started. No organ procurement takes place until family provides consent, regardless of where in the uDCD process the conversation occurs. In both France and Spain, there is a strong emphasis on physician involvement in emergency medical services (EMS), which may explain the expansion of these programs in these countries. The procedure of uDCD consists of determination of death, donor referral, donor transfer, organ preservation, and organ procurement. Consent and authorization for organ donation can take place any time during this process,

depending on country and local policy. Current estimates by the Institute of Medicine (IOM) would have uDCD increase organ donation by 22,000 per year in the United States. These estimates were based on the yearly incidence of out-of-hospital cardiac arrest and experience with organ transplantation after uDCD outside the U.S.; however, there are significant ethical concerns. While the majority of Americans would support rapid organ recovery after out-of-hospital cardiac arrest, most would prefer family consent prior to any preservation procedure, and many feel that uDCD would decrease trust in the medical community. One significant ethical challenge is the definition of the irreversibility of cardiac arrest. While outof-hospital cardiac arrest outcomes are poor, there may be a conflict of interest among clinicians declaring death prior to exhausting all advanced cardiac arrest therapies when uDCD is an option. The cessation of advanced cardiac arrest treatment must be entirely independent of consideration of organ donation. Some authors contend that even in the setting of impartial cessation of CPR, the presence of uDCD protocols may create doubt in the impartiality of health care providers on abandoning CPR. Another concern is the performance of preservation techniques after cardiac death but before obtaining family consent. In countries with the most successful programs, chest compressions and mechanical ventilation are continued, even after cardiac arrest is declared irreversible. In addition, some preservation techniques are significantly invasive — from placing pleural tubes to initiating ECMO (extracorporeal membrane oxygenation). Patient’s families may be rightfully concerned that their deceased loved one may be exposed

to these additional procedures before consent is obtained. In populations where community trust in the medical community is low, these concerns would be understandably heightened. Currently, there are no ongoing uDCD programs in the U.S. There have been pilot projects, such as in New York City from 2010 to 2011. While reception by families was positive, there were frequent protocol violations and ultimately no organs were ever recovered. Patients with end organ failure who rely on organ transplantation continue to grow in number, and every year more patients die while waiting. Organ donations have plateaued and uDCD is a potential option for change. Emergency physicians are on the front lines in response to cardiac arrest. Given this pivotal position, emergency physicians need to have an understanding of uDCD protocols and practices and are uniquely positioned to contribute to ongoing research and policy development.

ABOUT THE AUTHORS Dr. Carr is a second-year emergency medicine-critical care medicine fellow at the University of Florida.

r. Becker is an assistant D professor, chief of the division of critical care medicine and the director of prehospital research in the department of emergency medicine at the University of Florida College of Medicine.

INCREASING THE NUMBER OF

SAEM PULSE | MAY-JUNE 2021

X-WAIVERED PROVIDERS

Carrots, Education, and Hopefully Not Too Many Sticks: A Study in Behavior Change By Dana L. Sacco, MD, MSc; Betty Chang, MD; and Bernard P. Chang, MD, PhD Like many emergency departments (EDs) nationwide, we have seen an alarming rise in patients presenting with opioid overdoses, opioid-related complaints, and patients with separate medical complaints but a concurrent opioid use disorder (OUD). The data supporting the use of buprenorphine as a treatment for OUD is mounting, and importantly, so is the data demonstrating that it can be safely initiated from the ED. Yet until recently, buprenorphine treatment in the ED has remained uncommon despite rising numbers of ED patients who would potentially be eligible. Buprenorphine treatment, and more broadly, ED administered mental health interventions, have increasingly been shown to have positive benefit for patients, yet such adoptions require behavioral and practice changes on the part of clinicians and departments nationwide. What are strategies for helping to encourage and motivate clinicians to adapt? Past work in cognitive and organizational psychology has found the science of behavior change (e.g., motivating individuals to adopt new activities or attitudes) to be driven in part by intrinsic (e.g., selfmotivation, attitudinal changes) and extrinsic factors (e.g., external rewards, punishments etc.). These approaches have broad implications for not only patient care (e.g., treatment adherence) but also with regards to behavior change in clinicians. Understanding strategies to influence change and adaptation in clinicians can facilitate operationalizing department-wide changes in practice management, patient care, and culture. Like many EDs across the country, we sought to change our approach to patients with OUD yet encountered numerous challenges, from individual provider hesitation to system-level hurdles in the adoption of new practice guidelines. Our primary questions were: How do we increase the number of X-waivered providers in our ED? And for those with X-waivers, how do we encourage clinicians to administer buprenorphine for eligible patients? In this perspectives piece we share our multi-pronged approach to cultural change and provider education regarding OUD and buprenorphine. Our hope is that in sharing this experience, others may draw generalizable takeaways with regards to motivating faculty across the professional career lifespan on practice adaptation and change. In addressing these challenges (increasing X-waiver providers and ultimately increasing buprenorphine administration), an exploration of the potential causes underlying our behavior may shed light on the issue. Why do so few ED providers prescribe buprenorphine? Several external factors may be responsible. From a regulatory standpoint, a special license called an “X-waiver” is needed to write a prescription for buprenorphine, thus requiring additional training and regulatory processes to complete. Though there were steps taken by the U.S. Department of Health and Human Services at the end of the last administration

X-Waiver Training Coming June 8! Join SAEM on June 8 from noon to 4 p.m. CT for virtual emergency medicine X-waiver training. At the conclusion of the training, participants will be credentialed to apply for their DATA 2000 (X) waiver and prepared to manage opioid use disorder patients. Register today! to reverse this requirement, a change long supported by drug addiction and public health experts, these steps have since been rolled back, leaving clinicians (at the time of this writing) still responsible for obtaining this license. From an administrative standpoint, for our ED, buprenorphine was an acute psychiatric medication historically prescribed by addiction psychiatrists, with the ED pharmacy less familiar and therefore less comfortable with the medication profile in the medical ED setting. Provider-level hesitancy may also be at play. When it comes to patients with OUD, we have historically had few medications in our armamentarium. As ED providers, mental health and particularly substance use complaints have been among the conditions we may be all too happy to refer to a consultant or sub-specialist. Even common opioid-related medications that we encounter in our practice, such as methadone, are not typically prescribed or managed by acute care providers, and many of us have seen firsthand the abuse potential. For some providers buprenorphine may appear to fall into a similar category: a medicine with which providers may have limited experience, treating a population of patients who may have challenges with follow-up and adherence. And what’s more, with more regulatory red tape and additional mandatory training. Why would I prescribe that? Aside from the X-waiver, another potential obstacle to ED providers prescribing buprenorphine is a knowledge gap in terms of its mechanism and administration. Addressing this gap could potentially reduce the hesitancy on the part of providers for prescribing an “opiate.” For example, because buprenorphine is a partial opioid agonist with a ceiling effect, patients don’t become high when they take it orally. And because the preparation suboxone is a combination of buprenorphine plus naloxone, if an industrious user learns how to inject it, the naloxone will become active and will prevent an opioid high as well. Our aim in disseminating information with regards to buprenorphine induction is not to make ED providers addiction

continued on Page 52

“Our goal of increasing both X-waivered providers and buprenorphine prescriptions required a three-pronged approach: education (intrinsic motivation, empowerment), collaboration (interdisciplinary coordination with key stakeholders) and administrative (external reward and recognition).” CARROTS

continued from Page 51 psychiatrists. However, we do not need to be infectious disease specialists to prescribe antibiotics, nor endocrinologists or cardiologists to prescribe a patient with new onset diabetes or hypertension a short prescription of antihypertensives or glycemic agents until they are able to see their primary care doctor. And though we may not always initiate these types of medications, many ED providers are comfortable doing so, provided there is coordination of timely outpatient follow up. Buprenorphine should be the same. Our goal of increasing both X-waivered providers and buprenorphine prescriptions required a three-pronged approach: education (intrinsic motivation, empowerment), collaboration (interdisciplinary coordination with key stakeholders) and administrative (external reward and recognition).

SAEM PULSE | MAY-JUNE 2021

Education

Discussions with our providers on the usage and pharmacokinetics of buprenorphine were carried out at faculty meetings as well as through emails and by a committee we created to address this issue, known as the ED Buprenorphine Task Force. Safe practices for buprenorphine were codified into practice guidelines for our department and posted in clinical areas where providers could easily find and refer to them. Additionally, we created a rotating roster of several X-waivered physicians who were available to help determine patient eligibility, provide education, and ultimately send the prescription if the treating physician had not yet obtained an X-waiver. This physician on-call structure was intended to be a finite resource while our group of providers as a whole obtained

their X-waiver licenses and became more familiar with the prescription of buprenorphine. These physicians served as peer supporters who could guide and encourage colleagues to adopt new treatment strategies in the ED setting.

Collaboration

We assembled a multidisciplinary group to facilitate the prescription of buprenorphine from the ED. This group was composed of ED pharmacists, nurse educators, and our colleagues in the psychiatric ED. We worked together with our pharmacy to prepare for the safe and more frequent usage of buprenorphine in the medical ED. Our psychiatric ED colleagues have been prescribing buprenorphine for a longer time, and we involved them in our rollout of buprenorphine guidelines as well.

Administrative

Complementing our education efforts and peer supporters, we also included external incentives to increase the number of providers with X-waivers. Recent work has described the use of financial incentives to encourage X-waivered participation with positive success. First, with departmental support, we began with a time-sensitive external incentive bonus for providers in the early months of the X-waiver program rollout, then subsequently with a broader mandate for all providers to fulfill X-waiver training by the next academic year. Recognizing the additional administrative and regulatory steps for the training, we hoped that providing some external reward/ recognition would help bolster engagement with our educational program and ultimately increase comfort with buprenorphine management in the ED. From an initial uptake of two providers who were X-waivered prior to our program, we now have over 50 ED faculty with X-waivers. Additionally, prior to the start of our effort we had zero ED-initiated buprenorphine inductions in the ED, and we are now averaging one to two new buprenorphine inductions a week.

The number of X-waivered ED physicians has been reported to be around 7% nationwide (according to data kept by the Substance Abuse and Mental Health Services Administration), and most of these providers are concentrated in urban areas and academic centers. As recently as 2018 up to half of rural counties have been reported to have no X-waivered providers. Strategizing ways to motivate and increase the adoption of such treatment strategies for ED providers should consider leveraging a combination of externally- and internallyguided strategies to encourage new treatment approaches. Ultimately, such multipronged methods may lead to the adoption of dynamic and evidence based clinical practices benefiting the patients we serve.

ABOUT THE AUTHORS Dr. Sacco is a practicing emergency physician at NewYork-Presbyterian/Columbia University Irving Medical Center and is involved with substance use disorder research. Dr. Betty Chang is the medical director at NewYorkPresbyterian/Columbia University Irving Medical Center Adult Emergency Department. She is a practicing emergency physician and leads the departmental ED-Buprenorphine Task Force. Dr. Bernard Chang is a research psychologist and practicing emergency physician. He is currently vice chair of research and associate professor of emergency medicine in the department of emergency medicine at Columbia University.

The SAEMF Is Making Bold Investments in Emergency Medicine’s Future The SAEM Foundation (SAEMF) is the research-supporting arm of the SAEM—bridging the 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. The SAEMF is the largest private foundation for research and research training in EM. Though only established in 2008, our net assets are over $11 million. The foundation funds innovative research in all areas of

Together with SAEM, the SAEMF has awarded over $8 million to more than 400 academicians.

EM with an investment of close to $700,000 in research each year. Our investment during the 2021 grants cycle illustrates our continued commitment to building the pipeline of talented researchers and educators who will become EM’s future leaders. This is only possible through the partnership of the Annual Alliance Donors who generously support our initiatives. Donate now to join the Annual Alliance.

$8M 400 academicians

More From Our Grantees... Watch 2021 SAEMF Grantees share how the grant they received is making a difference then visit www.saemfoundation.org to learn more about the 2021 SAEMF grantees and how their projects will shape emergency medicine’s future. 54

Meet the 2021 SAEMF Grantees

We’re proud to showcase this year’s SAEMF grantees who were selected from a competitive applicant pool after a rigorous NIH-style review. These bright stars demonstrate excellence in pursuit of a career in academic EM research. SAEMF Research Training Grant - $300,000 Taneisha Wilson, MD, ScM

SAEMF/AEUS Research Grant - $10,000 Michael Gottlieb, MD

SAEMF Research Large Project Grant - $150,000 Masashi Okubo, MD, MS

SAEMF/GEMA Research Pilot Grant - $10,000 Julian Hertz, MD

University of Pittsburgh "Resuscitation Culture of EMS Systems for Out-ofhospital Cardiac Arrest”

Duke University "Barriers to Myocardial Infarction Care Among Persons Living with HIV in Tanzania”

SAEMF Education Research Grant - $50,000 Christine Luo, MD, PhD

SAEMF/Simulation Academy Novice Research Grant - $5,000 Julie Gesch, MD

Brown University / Rhode Island Hospital "Emergency Department Focused Assessment and Treatment in a Triage Chair (ED FAST-Chair)”

Oregon Health & Science University "Faculty Development for Academic Emergency Physicians: A Needs Assessment”

SAEMF ARMED Pilot Grant - $25,000 Bennett Lane, MD, MS University of Cincinnati "Identifying Rate and Characteristics of Interhospital Transfers by Air Transport”

SAEMF Education Project Grant - $20,000 Michelle Lee, MDCM

The Hospital for Sick Children "Climbing the Learning Curve in Ocular Point-ofCare-Ultrasound Interpretation”

SAEMF/NIDA Mentor-Facilitated Training Award - $12,000 Betty Chang, MD

NewYork–Presbyterian/Columbia University Irving Medical Center "Tele-Bupe Program”

SAEMF/NIDA Mentor-Facilitated Training Award - $12,000 Jennifer Love, MD

Rush University Medical Center "Automated vs Manual Assessment of B-Lines for Diagnosing Pulmonary Edema with Ultrasound”

The Andrew Levitt Center for Social Emergency Medicine "Improve Emergency Department Ischemic Stroke Care With In Situ Simulation”

SAEMF/AWAEM Research Grant - $5,000 Melissa Parsons, MD

University of Florida "Breaking Through the Glass Ceiling: Networking Best Practices for Women in EM”

SAEMF/ADIEM Research Grant - $2,600 Jessica Bod, MD

Yale University School of Medicine "Bystander Intervention Training for Emergency Medicine Residents”

SAEMF/RAMS Resident Research Grant $5,000 Ai Xin Chen, MD UCLA-Harbor Medical Center "Food Pharmacy Rx”

Elizabeth Scott, MD

UCLA-Harbor Medical Center "Food Pharmacy Rx”

Oregon Health & Science University "Project BEEP”

MTF/SAEMF Toxicology Research Grant - $10,000 Cynthia Santos, MD Rutgers New Jersey Medical School "Genotypes Associated with Dosing and Relapse in Patients with OUD Receiving Buprenorphine”

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

Virginia Polytechnic Institute and State University "Using Best Practice Advisories to Reduce Cancer Patient Admissions from the ED”

EMF/SAEMF Medical Student Research Grants - $5,000 each Kristy Blackwood, BA, Brown University

Eshani Goradia, BA, Stony Brook University

Kendall Burdick, BA, University of Massachusetts

David Helfer, BS, University of Pennsylvania

“Firearm Violence and Safety Training in Undergraduate Medical Education: Evaluation of First Year Clinical Skills Curricular Intervention” “Geographic and Temporal Analysis of Pediatric Trauma Access Disparities in the United States”

“Comparison of the Effects of a Bromelain and Collagenase Based Enzymatic Agent on Inflammation and Eschar Debridement in a Partial Thickness Porcine Model” “Risk Prediction of Acute Coronary Lesions Following Out-of-Hospital Cardiac Arrest”

ADDRESSING COVID-19 VACCINE HESITANCY AMONG BLACK AND HISPANIC COMMUNITIES By Abigail Clarkson-During, MD, and Miya Smith, MD on behalf of SAEM’s Residents and Medical Students COVID-19 vaccines become increasingly available to the general public, but that news is not being met with the same excitement by all people groups. Despite facing higher rates of COVID-19 infection, morbidity, and mortality, a significant portion of Black and Latinx communities harbor skepticism towards the potentially lifesaving vaccination. This vaccination hesitancy is not completely unwarranted. Their mistrust of the medical community is rooted in a history of mistreatment and abuse. As emergency medicine (EM) physicians, it is imperative to understand the factors that contribute to vaccination hesitancy so that we can have constructive conversations that can lead to improved immunization rates.

A Historical Basis for Mistrust

Physicians must acknowledge that throughout American history, medical advancements have often been at the expense of Black and Brown people. In the mid-19th century, Dr. J. Marion Sims, often revered as the “Father of Gynecology”, trialed experimental operations on Black slave women in Alabama without consent or anesthesia. During the Tuskegee Syphilis Study, spearheaded by the United States Public Health Service from 1932 to 1972, 600 poor Black men, thinking they were receiving treatment for “bad blood,” received no treatment at all. 399 of these men had latent syphilis, a contagious venereal disease. Ostensibly for the purpose of tracking the disease’s full progression, researchers provided no effective care as the study’s participants experienced severe health problems, including blindness, mental impairment, and death. The United States Public Health Service also led the Guatemala Sexually Transmitted Disease Studies from 1946 to 1948, during which 5,500 Guatemalan prisoners, soldiers, children, sex workers, and psychiatric patients were purposely infected with syphilis, gonorrhea, or chancroid in order to observe disease progression. More recently, according to the CDC, from 2007 to 2016, black maternal mortality was more than three times that of white maternal mortality. These high rates of racial and ethnic disparities in preventable, pregnancy-related deaths have added to the mistrust, which manifests as disinclination to seek medical care and, in the case of COVID-19, reluctance to get vaccinated.

Health Care Disparities with COVID-19

The COVID-19 pandemic highlights the disparities that Black and Hispanic communities face. A combination of issues have contributed to the ways these communities have been

disproportionately impacted by COVID-19. Lack of access to health care presented another problem during the pandemic, as Black Americans are more likely to be uninsured and therefore less likely to seek care. Barriers to testing, which include lack of availability, inadequate transportation, fear, and misinformation, has also contributed to COVID spread in these communities. Socioeconomic factors are particularly detrimental. For example, a higher percentage of Black Americans and Hispanics are considered essential workers and/or are living in multigenerational homes, making it difficult to effectively self-quarantine, which increases COVID-19 exposures. Systemic racism is another common thread that connects many of these risk factors for exposure. The rates of infection and hospitalization amongst Black and Latinx populations compared to white populations are 1.4 and 1.7 times respectively, according to the CDC (as of February 2, 2021). More notably, the hospitalization rates among Black and Hispanic people are nearly four times that of white people (3.7 and 4.1 times more likely, respectively, as of February 1, 2021) The disparities do not end with contraction of and hospitalization with COVID-19. The rate at which Black Americans have died from COVID-19 is 2.8 times greater than that of white people and equal to Hispanic communities (as of February 1, 2021). Chronic comorbid conditions that disproportionately impact Black Americans (e.g., diabetes, lung disease, obesity, etc.) are associated with worse outcomes in COVID-19. This association likely accounts for the increased ratio of hospitalization-to-death among Black people. Considering this, efforts must be focused on preventing the spread of COVID-19 in all communities, but particularly Black and Latinx communities, which have especially suffered during this pandemic. While traditional efforts like masks and social distancing help reduce transmission, the newly developed COVID-19 vaccines offer invaluable protection for these vulnerable communities and emergency physicians must accept the duty of emphasizing the importance of the vaccine.

Our Role as Emergency Medicine Physicians

In order to effectively encourage vaccination among vulnerable populations, health care providers must be understanding of the reasons behind vaccination hesitancy. As EM physicians, we have the unique ability to treat patients of every demographic and socioeconomic class. Cognizant of these facts during patient interactions, physicians can help by doing the following:

Recognize the historical context. Acknowledge that there are previous injustices that may produce distrust and use that as a framework for your approach. Listen to patient concerns. Allow patients to voice concerns and listen to them thoroughly before attempting to refute any misinformation. This will establish trust and rapport that could improve communication. Encourage personal reading and give an opportunity for questions. Many physicians anecdotally report the prevalence of misinformation about COVID-19 espoused by patients, typically from social media. The information surrounding the disease, even from official sources, was particularly inconsistent and often contradictory early in the pandemic. Mistrust may be difficult to overcome, but by encouraging patients to seek out credible sources to do their own research, you can give them knowledge and agency. It may help to suggest some resources or provide educational pamphlets or discharge instructions in the emergency department. (Resources: Food and Drug Administration, UpToDate, Vaccine Trials) Review FAQs. There are many guides that can help prepare you for conversations about the COVID-19 vaccine. Many resources discuss and provide evidence-based answers to the most frequently asked questions. (Resources: CDC, Chicago COVID-19 Communication Toolkit, Basic Vaccine questions) Discuss your personal reasons for getting the vaccine. Many patients may feel reassured knowing that you and other health care workers support the vaccine. Providing personal reasons for your choice, to your comfort level, could positively influence a patient’s position. Remember that you may not change their mind. Emergency physicians interact with so many patients and have a meaningful impact on their lives. While some people may not be immediately convinced about receiving the vaccine, this

interaction could be the impetus that changes the patient’s mind eventually. Do not be discouraged if it does not yield immediate results.

Conclusion

The clear history of medical mistreatment among Black and Hispanic people plays a role in health care mistrust and vaccine hesitancy. This compounds the already disparate rates of COVID-19 infection, morbidity, and mortality in Black and Latinx communities. By opening conversations about the COVID-19 vaccines, empathizing with fears, debunking myths, and highlighting why prophylaxis is important in Black and Brown communities, we may effectively increase vaccination rates. ABOUT THE AUTHORS: Dr. Clarkson-During is an emergency medicine resident physician at the University of Chicago with interests in global health, health policy, social emergency medicine, and diversity and inclusion. She currently serves on the SAEM Equity and Inclusion Committee, the Chicago Women in EM (ChiWEM) board, and as a community champion for the University of Chicago Graduate Medical Education Office. Dr. Smith is an emergency medicine resident at the University of Chicago with an interest in social emergency medicine, health care disparities, and forensic medicine. She currently serves on the Illinois State Medical Society and the ACEP Forensic Medicine Section. She is an EMRA Health Policy Academy Fellow and a community champion for the University of Chicago Graduate Medical Education Office.

FROM MATCH TO FIRST PROMOTION: GENDER BIAS AND CLINICAL LEADERSHIP… TOP 10 PEARLS FROM THE WEBINAR By Taylor Stavely, MD and Wendy Sun, MD on behalf of SAEM Residents and Medical Students and the SAEM Academy for Women in Academic Emergency Medicine From Match to First Promotion is a collaborative new webinar series from the SAEM Academy for Women in Academic Emergency Medicine (AWAEM) and SAEM Residents and Medical Students (RAMS). The series was created to support professional development during these difficult times which challenge our ability to create organic, mentor-mentee relationships. Even before COVID-19, women in medicine have identified challenges in finding an appropriate and supportive mentor as a barrier to their advancement and promotion. Women in medicine, from the time they enter the academic pipeline as medical students to when they continue their careers as residents and faculty, encounter unique and specific challenges. This series aims to provide a supportive network and educational framework for women to take on these challenges from the time of match to first promotion.

The first installment of the series focused on gender bias and clinical leadership. The panelists included a diverse group of speakers: Drs. Pooja Agrawal, Yale New Haven Health; Jenny Castillo, Columbia University Medical Center; Kat Ogle, George Washington University; Taylor Stavely, Emory University; and Wendy Sun, Yale New Haven Health. Here are the top ten pearls from the webinar: 1. Avoid “queen bee syndrome,” a phenomenon in which women who achieve a significant leadership position or esteemed status begin to reinforce gender stereotypes, treating other women like “worker bees.” 2. Sponsor others with your voice, especially underrepresented minorities in medicine or those who identify as LGBTQIA.

8. As the attending, consider introducing the resident leading the code to the room so that your resident feels supported in your endorsement and the rest of the room knows to go to the resident for decision making. 9. As the attending, stand next to the resident and if direction is needed, speaking quietly in his/her ear so as to maintain his/ her position as the leader in the room. 10. If your competency is being challenged by a colleague or nurse, articulate your thought process to the person who is questioning your decision making so that you can initiate an honest conversation about the patient’s care. 3. The three components of imposter syndrome include a sense of being a fraud, fear of being discovered as a fraud, and difficulty in owning success.

ABOUT THE AUTHORS: Dr. Stavely is an emergency medicine resident at Emory University School of Medicine

4. You have earned your accomplishments; they were not a fluke. Be proud! 5. Do not let fear of failure hold you back from applying for an award, job, or grant. 6. Find a trusted buddy who is attuned to the things you say and who is able to point out when imposter syndrome sets in.

Dr. Sun is an emergency medicine resident at Yale University

7. When leading a resuscitation, set up clear roles and responsibilities beforehand.

FIVE TIPS TO TRANSFORM MEDICAL STUDENTS AND RESIDENTS INTO SELF-DIRECTED LEARNERS By Ryan O’Neill and Allison Beaulieu, MD on behalf of SAEM’s Residents and Medical Students As COVID-19 has moved our didactic sessions out of the classroom and into our homes, more emphasis has been placed on self-study and asynchronous learning. Although we anticipate some form of in-person learning to return, it is likely that a new hybrid model for graduate medical education will exist in the future. Self-directed learning is based on the assumptions that adult learners are self-dependent, intrinsically motivated, and rely on past experiences to build on an existing knowledge base. This guide will give all users the tools needed to become a successful self-directed learner in residency and beyond!

Begin With a Self-Assessment

Where to begin? From managing a cardiac arrest to delivering a baby, emergency medicine physicians are responsible for an incredibly large breadth of knowledge and must be able to perform a diverse range of procedures and skills. It can be daunting to find a launch point for self-study; however, by starting with a self-assessment, you will be able to narrow and refine your focus. • Seek feedback. Regularly seek feedback from your attendings and peers. You can ask for both written and verbal feedback. What do they see as your strengths? What could you improve upon? Do they see any gaps in your knowledge?

"SELF-DIRECTED LEARNING IS BASED ON THE ASSUMPTIONS THAT ADULT LEARNERS ARE SELF-DEPENDENT, INTRINSICALLY MOTIVATED, AND RELY ON PAST EXPERIENCES TO BUILD ON AN EXISTING KNOWLEDGE BASE." • Reflect. Whether you are on shift or attending a conference, take time to reflect and fully understand the problem at hand. What do you need to clarify? What do you already know? How can you build upon this knowledge?

• Self-monitor. Self-monitoring includes your personal judgement of your abilities and awareness of a situation. How did that case go? What went well? What could be improved? What adjustments should you make?

Employ Learning Strategies

• Ask for help. If you begin to feel overwhelmed or have difficulty with this initial step, understand that you do not have to do this alone. This skillset takes time to develop. It is okay to ask for help from faculty or peer mentors to refocus your learning efforts.

Multimodal learning is a form of studying that uses multiple resources in varied formats. These formats could include textbooks, podcasts, videos, and more. This learning strategy not only provides repetition when learning a topic, but also allows you to process the same concepts from different perspectives.

Specific

Attainable

Time-Bound

What action will be performed and by whom?

Is the objective achievable within a given time frame and with the resources available?

When will the objective be achieved? Create a timeframe for when the objectives will be met.

Measurable

Relevant

How will success be measured? Quantify your anticipated results.

Do the objectives align with the instructional method and assessment?

Create Goals and Objectives

After performing a self-evaluation, you can utilize the SMART framework to create a targeted outline to achieve your learning goals and objectives. A goal is a broad, generalized overview of a desired outcome. For example, your goal may be to achieve a higher score on the in-training examination. Objectives are the finer details that outline the process of achieving your desired outcome.

Identify Resources

With your goals in mind, the next step is to identify what types of resources will be used to achieve them. We have access to more educational content than ever before, and it can be easy to get lost in the weeds. This abundance of resources, however, also allows you to pick and choose those that best fit your preferences. Whether you prefer reading textbooks, utilizing question banks, or listening to podcasts, it is essential to evaluate which resources will best help you achieve your goals. SAEM and ALIEM have compiled comprehensive lists of resources. You should also consider utilizing the Social Media Index. This is a comparative index, similar to the impact factor, that has been shown to correlate with quality and can be used to identify reliable FOAM resources. When in doubt, do not forget about the utilizing the human resources in your life. Peers and mentors can oftentimes point you in the right direction when navigating this process. While it could be tempting to try and use every resource you find, there is only so much time in a day, and it is best to choose a few resources that work best for you and stick with them.

At its core, learning is the storage and retrieval of information. There are multiple learning strategies that can be utilized to enhance this process:

Interleaving refers to studying different topics simultaneously. Of all specialties, this learning strategy seems most relevant to emergency medicine. By studying multiple topics at once, both old and new, we are challenged to retrieve disparate bits of information. This challenge enhances our learning and provides an opportunity to draw previously unseen connections between topics. Spaced repetition is the practice of intermittently reviewing previously learned material. Over time, we are more and more likely to forget information we have acquired. By periodically reexposing ourselves to these concepts, we not only prevent this forgetting but also reinforce our understanding of them. Active retrieval challenges us to access the information we have already learned and apply it. This learning strategy can be done through flashcards, quizzes, and patient cases. By pushing ourselves to retrieve and utilize concepts, we strengthen our ability to do so again in the future, ultimately improving our clinical application of what we have learned. Emergency Medicine Cases has a great podcast and article that dive further into this topic.

Evaluate Progress

Congratulations! You have taken the necessary steps to become a reflective, active, self-directed learner. At this stage you will evaluate whether or not you achieved your learning objectives and review what adjustments you can make in the future. Continue to work at this process. You will find the more time you take for self-assessment, creation of SMART goals, review of educational materials, and implementation of learning strategies, the more you will improve. The process of becoming a self-directed learner does not end here: continue to refine your skills in becoming a life-long learner! ABOUT THE AUTHORS: Ryan O’Neill is a fourth-year medical student at The Ohio State University College of Medicine.

Dr. Beaulieu is a first-year medical education fellow and clinical instructor of emergency medicine at The Ohio State University Wexner Medical Center.

SAEM21 VIRTUAL MEETING

THE RAMS GUIDE TO THE SAEM21 VIRTUAL MEETING By Daniel Jourdan, MD, and Vytas Karalius, MD, MPH

SAEM21 is set to kick off in just a couple of weeks. It’s a time to celebrate and learn from emergency medicine’s top researchers and academicians. This year’s annual meeting, while virtual, continues the tradition of highlighting the science, enriching the education, and facilitating the interaction and mentorship that moves our specialty forward! RAMS Education Committee members Daniel Jourdan, MD, Henry Ford emergency medicine/internal medicine residency, and Vytas Karalius MD, MPH, Northwestern University emergency medicine residency, poured over the offerings at SAEM21. As residents and former medical students themselves, and in tune with what would uniquely supplement the knowledge of residents and medical students alike, Drs. Jourdan and Karalius identified several events and sessions that are well-suited to RAMS members. While a few of the sessions overlap, with careful planning, see how many you can attend!

Events and Sessions for Residents and Medical Students Career When to Say Yes and How to Say No: Leveraging Passion in an Academic Career (AWAEM Sponsored) Tuesday 2:00 PM – 6:00 PM Dealing with Disappointment: Picking up the Pieces When Things Go Wrong (didactic) Wednesday, 11:00 AM – 11:20 AM AWAEM/ ADIEM Virtual Networking Extravaganza Wednesday, 11:30 AM – 1:00 PM Speed Mentoring Wednesday, 3:30 PM – 5:20 PM Medical Student Symposium Thursday, 9:00 AM – 4:00 PM

Meet, Greet, and Tweet 1:00 PM – 1:50 PM (didactic) Mentorship Alone Is Not Enough to Reach Your Academic Peak...You Need Coaching, Advising, Mentorship, and Sponsorship! (didactic) Thursday, 3:00 PM – 3:50 PM SAEM Simulation Academy Mentoring Mixer Thursday, 5:00 PM – 6:30 PM Thinking About a Fellowship? What Residents Need to Know: Fellowship Roundtable Discussions (didactic) Friday, 9:00 AM – 9:50 AM Creating a High-Quality Curriculum Vitae and Educator’s Portfolio: An Interactive Workshop Friday, 11:00 AM – 11:50 AM (didactic)

Education Critical Strategies in Simulation Procedural Skills Training for High-Risk/Low-Frequency Procedures (Simulation Academy Sponsored) Tuesday, 9:00 AM – 1:00 PM Take and Bake: Low-Cost Simulation Models and Techniques Taught By the Pros (Simulation Academy Sponsored) Tuesday 2:00 PM – 6:00 PM Short on Time, High on Value: Microteaching Methods to Engage Your Learners While on Shift Wednesday, 11:30 AM – 11:50 (didactic) Resident-Driven Recruitment and Match of Underrepresented Minority Medical Students Wednesday, 1:00 PM – 1:50 PM (didactic) Effects of COVID-19 on Academic Emergency Medicine Medical Education Wednesday, 3:00 PM – 3:50 PM (didactic) Finessing Feedback: How to Create a Culture of Feedback at Your Institution Wednesday, 5:00 PM – 5:20 PM (didactic) Why Antiracism Is Integral to Your Residency Curriculum and How You Can Make It Happen Wednesday, 5:00 PM – 5:50 PM (didactic) Building the Smartest Resident Thursday, 2:00 PM – 2:50 PM (didactic) Beyond a Middle School Science Lesson: The 5E Model for Medical Education in Emergency Medicine Thursday, 3:00 PM – 3:50 PM (didactic) Back to the Drawing Board: A Framework for On-Shift Chalk Talks Thursday, 5:00 PM – 5:20 PM (didactic)

Low Tech, High Yield: Quick Tips for Innovative Bedside Teaching Friday, 11:00 AM – 11:50 AM (didactic)

Research SAEM Grant Writing Workshop (Research Committee Sponsored) Tuesday, 9:00 AM – 6:00 PM Improve Your Educational Research: Medical Education Research Boot Camp Tuesday, 9:00 AM – 1:00 PM Stats and Research for the Rest of Us (Research Committee Sponsored) Tuesday, 2:00 PM – 6:00 PM Manuscript Writing Made Simple: No More Writer’s Block Wednesday, 11:00 AM – 11:50 AM (didactic) Did You Like My Talk? Yes, No, Maybe: Survey Design for Medical Educators Thursday, 11:00 AM – 11:50 AM (didactic) The Basics of Machine Learning and Precision Medicine in Emergency Medicine Thursday, 11:00 AM – 11:50 AM (didactic) Getting Your Work Out There! How to Get Published in Medical Education Thursday, 1:00 PM – 1:50 PM (didactic) Resurrecting the Resident Researcher: Addressing Barriers to Engaging Residents in Emergency Medicine Research Thursday, 4:00 PM – 4:50 PM (didactic) continued on Page 64

RAMS @ SAEM21: THE TRAILER! Log in Early to the SAEM21 Platform and Qualify to Win a $100 Gift Card The annual meeting platform will be open to registered attendees beginning May 5, 2021. Log in early using your SAEM username and password, to explore features and learn your way around: • Set up and customize your user profile • Add sessions to your calendar • Build your schedule • Tag sessions • Schedule meetings and appointments • Select your ribbon • and more! Plus, all registered attendees who log into the platform early will qualify for a drawing for one of several $100 gift cards!

Follow RAMS Twitter!

SAEM residents and medical students, if you’re on Twitter, you’ll want to follow @SAEM_RAMS for exclusive SAEM21 news and information, including recaps of resident and medical student events and education sessions. Spread the word! 64

Early Career Development: Securing Research Support as Junior Faculty Thursday, 5:30 PM – 6:20 PM (didactic)

Wellness Daily Virtual Yoga Every day, 8:00 AM – 9:00 AM Fertility and Childbearing Trends in Female Trainees in Emergency Medicine Wednesday, 5:40 PM – 5:45 PM (didactic) Stop the Nightmare: A Comprehensive Look at Physician Suicide Thursday, 11:00 AM – 11:50 AM (didactic) The Impact of Sleep on In-Training Examination Scores Among Emergency Medicine Residents Thursday, 2:30 PM – 2:36 PM (didactic) Burnout and Post-traumatic Stress Disorder Symptoms Among Emergency Medicine Resident Physicians During the COVID-19 Pandemic 3:06 PM – 3:12 PM (didactic) COVID-Care: Self-care During the COVID-19 Pandemic Thursday, 5:30 PM – 6:20 PM (didactic) Financial Wellness for the Academic Physician Friday, 9:00 AM – 9:20 AM (didactic) #Adulting: Transitioning to Life After Residency Friday, 9:00 AM – 9:50 AM (didactic)

Diversity & Inclusion “The Wise Build Bridges While the Foolish Build Barriers”: Another Lesson from the Black Panther (ADIEM and Simulation Academy Sponsored) (A workshop on techniques for speaking up against bias and stereotypes) Tuesday, 9:00 AM – 1:00 PM AWAEM/ ADIEM Virtual Networking Extravaganza Wednesday, 11:30 AM – 1:00 PM Did That Just Happen?!? How to Respond to Microaggressions in the Emergency Department Wednesday, 1:00 PM – 1:50 PM (didactic) Resident-Driven Recruitment and Match of Underrepresented Minority Medical Students Wednesday, 1:00 PM – 1:50 PM (didactic) Why Antiracism Is Integral to Your Residency Curriculum and How You Can Make It Happen Wednesday, 5:00 PM – 5:50 PM (didactic) ADIEM LGBTQ+ Committee Virtual Cocktail Hour Wednesday, 7:30 PM – 8:30 PM “Otherhood” in Academic Emergency Medicine: How to Engage, Inspire, and Promote Your Nonparent Female Colleagues Thursday, 11:00 AM – 11:50 AM (didactic) Key Concepts in Diversity, Equity, and Inclusion: A Primer for Leaders in Academic Emergency Medicine Friday, 9:00 AM – 9:50 AM (didactic)

Bias in Medical Education Friday, 10:00 AM – 10:50 AM (didactic)

For Fun! Daily Virtual Yoga Everyday, 8:00 AM – 9:00 AM Simulation Academy SimWars Wednesday, 1:00 PM – 5:00 PM RAMS Trivia Night Wednesday, 6:30 PM – 7:30 PM ADIEM LGBTQ+ Committee Virtual Cocktail Hour Wednesday, 7:30 PM – 8:30 PM EMRA and RAMS Cocktails With Chairs Wednesday, 7:30 PM – 8:30 PM SAEM Jeopardy 2021: COVID-19 Edition Thursday, 6:30 PM – 7:20 PM AACEM Reception and Wine Tasting Thursday, 7:00 PM – 8:00 PM SonoGames Friday, 9:00 AM – 1:00 PM

A Special Word of Advice for Medical Students Don’t forget about the Medical Student Symposium on Thursday, from 9 a.m. until 5 p.m. CT. This is an action-packed day full of everything you need to know to prepare for residency: • The Emergency Medicine Match • Residency & Practice Options in EM • Navigating VSAS & Away Rotations • How to Succeed on Your EM Clerkship • Everything You Need to Know About the SLOE • Lessons Learned from a Virtual Match • How to Master the Personal Statement • Taming ERAS • Interviewing 101 • Subspecialty Rotations • IMG, DO, Military, and Couples Match • And even some time for networking! ABOUT THE AUTHORS: Dr. Karalius is a third-year emergency medicine resident at Northwestern University. As a current member of the RAMS Board, he helps lead the SAEM/RAMS Education Committee. Dr. Karalius hopes to pursue a career in medical education following residency. Dr. Jourdan is a first-year resident in emergency medicine/internal medicine at Henry Ford Hospital. He serves as a RAMS Board member-at-large as well as the RAMS Education Committee co-chair.

BRIEFS AND BULLET POINTS SAEM FOUNDATION AACEM Chairs Give Unprecedented Support to EM Research

The SAEMF 2021 Chairs’ Challenge was a tremendous success. This year’s AACEM members generously donated $113,836 in support of more research grants. The Challenge has been the backbone of SAEMF’s vital annual gifts. Chairs can still donate through the end of the year and be included in Chairs’ Challenge recognition. We are grateful to all SAEM members who have supported our mission this year through the Annual Alliance. Make a charitable donation today to join these generous colleagues!

Grant Funding Available for EM Research and Training

The SAEMF is now accepting applications for the following funding mechanisms:

Together We Can Do More! Show your support of research in emergency medicine and help your academy/committee/interest group receive special recognition as a leader in giving. Your gift will help to fund more and larger grants. It’s easy to participate, just make a charitable gift before August 31, 2021 by visiting www.saem. org/donate. If you’ve already donated in 2021, we’re counting that towards the academies, committees, and interest groups to which you belong.

Help us unlock the 2021 SAEM Challenge gift! SAEM will donate $1 for each $1 donated to the SAEMF during the Academy, Committee, and Interest Group Challenge, up to $10,000, for donations received between May 1 and August 31, 2021. Donate today.

• Research Training Grant - $300,000 • Research Large Project Grant • Education Research Grant - $100,000

New Emerging Infectious Disease and Preparedness Grant:

• MTF/SAEMF Toxicology Research

• $100,000/one year

• SAEMF/Clerkship Directors in

• SAEM faculty, graduating fellows, senior residents

$150,000

Grant - $10,000

Emergency Medicine Innovations in Undergraduate Emergency Medicine Education Grant - $5,000

• And many more! To view a full list of grant offerings through the SAEMF, visit What We Fund. All applications are due by 5 p.m. CT on August 1, 2021. For additional information: • View the Grant Submission Tutorial to learn how to submit your proposal. • Check out the SAEM Advanced Research Methodology Evaluation and Design (ARMED) courses. • Take a look at our Grant Writing Resources before you apply. • Check out our 2021 Grantees and their work. • Contact us at foundation@saem.org or visit What We Fund.

• Purpose: To support emergency care research related to emerging infectious disease such as influenza, COVID-19, or other infections (this award is not limited to specific conditions).

SAEM NEWS What Should be the Next Big Research Topic in Emergency Medicine?

Proposals are now being accepted for the 2023 SAEM Consensus Conference, May 16, 2023, in Austin, TX. For more than 20 years, the SAEM Consensus Conference has gathered junior and senior researchers, thought leaders, and other stakeholders in emergency medicine to generate research agendas for the important, unanswered questions

facing emergency care, leading to high-quality, funded research projects of varying scopes from a variety of funding sources. Proposals must be submitted by 5 p.m. CT, September 2, 2021 to consensus@saem.org. For details, guidelines, and a list of previous topics, visit the webpage.

Join SAEM on June 8 from noon to 4 p.m. CT for virtual emergency medicine X waiver training. This newly approved EDspecific training will provide four hours of online education followed by four hours of online directed self-study to be completed within 90 days. At the conclusion of the training, participants will be credentialed to apply for their DATA 2000 (X) waiver and prepared to manage opioid use disorder patients. Register early.

SAEM JOURNALS Academic Emergency Medicine AEM Announces 2021-2022 Resident Editors

Academic Emergency Medicine (AEM) is pleased to announce two residents have been selected to join the AEM editorial board for the 2021Madeline Schwid 2022 term. Madeline Schwid, MD from the Harvard Affiliated Emergency Medicine Residency in Boston and Ian Ferguson, MD from Washington University in St. Louis Ian Ferguson were selected from an extraordinarily competitive pool of applicants. According to Mark B. Mycyk, MD, AEM associate editor and director of the resident-in-training program for AEM, “The specialty of Emergency Medicine is fortunate to have so many curious and enthusiastic residents interested in this program – their talent and energy will serve our journal and our readers well.” During their one year-term on the AEM editorial board, these senior residents will be mentored in all aspects of peer review, editing, and publishing of education research manuscripts to enhance her future career in educational publication and emergency medicine. Their one-year terms begin during the SAEM Virtual Annual Meeting in May 2021. For more information on the resident-in-training editor program, please contact Mark B. Mycyk, MD at mmycyk@cookcountyhhs.org.

Academic Emergency Medicine Announces 2020 Outstanding Peer Reviewers

AEM Education and Training Moves to a New Publication Model Effective with the April 2021 issue of AEM Education and Training (AEM E&T), the journal shifted to a new publication model. Throughout its first four years, AEM E&T has followed a traditional publication workflow where articles have published in the Early View section of the journal website and have subsequently been compiled into sequentially paginated issues on a quarterly basis. Starting in April, the journal adopted a continuous publication workflow, whereby, instead of articles accumulating in Early View, they will populate directly into an issue upon initial publication. Besides the elimination of the Early View section from the website, there will also be some other slight display differences. Upon publication, articles will be assigned an e-Locator ID, which will be a 6-digit alphanumeric code that will serve as a proxy for the article’s pagination. So, instead of articles being identified by a range of pages published in a volume and issue of the journal, they will be identified by the e-Locator ID, which will use the following convention: “e12345.” One benefit that authors will immediately notice is that article records will be searchable in PubMed much sooner than what the journal was previously able to accommodate due to workflow limitations. Since AEM E&T is not yet formally Medline-indexed, article records are provided to PubMed via the journal’s feed to PubMed Central. Previously, articles needed to be held until final issue publication before they could be sent to PubMed Central. For some articles, this resulted in delays of six months or more in article records being searchable on PubMed. This workflow update will reduce the processing time from six months or more to about a week or less. The April issue closed on April 30 and on May 1, the July issue opened and new articles began being deposited there. Subsequent to the closing of the July issue, the December 2021 will open and remain so until the end of the year. In 2022, AEM E&T will increase issue frequency to six times per year with new issues opening at the beginning of odd-numbered months and closing at the conclusion of even-numbered months. We feel that this workflow change introduces a significant benefit to the authors who choose to publish in the journal and bring overall efficiency to the publishing process. We welcome any questions or concerns and these should be directed to Brian Coughlin who serves as the journal’s publisher representative — he can be reached at bcoughli@wiley.com. • Benjamin Friedman, MD, MS

• Sean Stickles, MD

AEM Editor-in-Chief Jeffery A. Kline, MD, has named the following individuals as the AEM Outstanding Peer Reviewers for 2020:

• William Grant, EdD

• Jill Stoltzfus, PhD

• Benton Hunter, MD

• Henry Thode, PhD

• Ula Hwang, MD, MPH

• David Wallace, MD, MPH

• Keith Boniface, MD

• Mahammad Jalili, MD

• Bernard Chang, MD

• Diane Kuhn, MD, PhD

• Brian Driver, MD

• Brandon Maughan, MD

These exceptional peer reviewers are essential to presenting the high-quality academic contributions that fill the pages of AEM each month.

• Alyssa Espinera, MD

• Joseph Pare, MD, MHS

• Ross Fleischman, MD

• Richard Sinert, DO

continued on Page 68

BRIEFS continued from Page 67

Academic Emergency Medicine Education and Training AEM E&T Names 2021-2022 Fellow Editor-in-Training

Academic Emergency Medicine Education and Training (AEM E&T) is pleased to announce that Carolyn Commissaris, MD, medical education Carolyn Commissaris fellow at University of Michigan department of emergency medicine has been selected as the 20212022 AEM E&T Fellow Editor-in-Training. During her one year-term on the AEM E&T editorial board, Dr. Commissaris will be immersed in every aspect of peer review, editing, and publishing of medical research manuscripts to enhance their future career in scientific publication and emergency medicine. In addition to experiencing the duties involved in journal editing, the resident editors will participate in a mentored curriculum to learn about all aspects of publication ethics. Her one-year term begins during the SAEM Virtual Annual Meeting in May 2021. For more information on the AEM E&T fellow editor-in-training program, please contact the director of the program, Esther Chen, MD, at manneporte@gmail.com.

AEM E&T Names Outstanding Peer Reviewers for 2020 Academic Emergency Medicine Education and Training (AEM E&T) Editor-inChief Susan B. Promes, MD, MBA, has named the following individuals as the AEM E&T Outstanding Peer Reviewers for 2020: • Ryan Bodkin, MD • Joshua Davis, MD • Nikhil Goyal, MD • Phillip Harter, MD • Laura Hopson, MD • Jessica Nelson, MD • Ryan Pedigo, MD • Dina Wallin, MD These exceptional peer reviewers are essential to presenting the high-quality

academic contributions that fill the pages of AEM E&T each quarter. The Outstanding Peer Reviewer designation is given annually to peer reviewers who meet specific criteria for excellent performance.

RESIDENTS AND MEDICAL STUDENTS

IN OTHER NEWS ABEM-Certified Physicians Can Now Take MyEMCert Modules

The American Board of Emergency Medicine launched the first three MyEMCert modules on March 31: ✓ Abdominopelvic ✓ Abnormal Vital Signs and Shock ✓ Trauma and Bleeding Three additional modules will be available in summer 2021. ABEM-certified physicians can use the ✓ABEM Reqs tool to learn how MyEMCert affects them, and when they should plan to take modules. Find full details by following the link.

ABEM Elects Two to Its Board of Directors

Congratulations to All Graduating Residents!

With your upcoming graduation, SAEM wants to ensure you stay on track with your career goals! Be sure to log in and update your contact info, renew your membership and participate in our FREE academies and interest groups to connect with peers and discover your niche. Also, as a member, take advantage of registration discounts for SAEM21. Of particular interest to you will be the Junior Faculty Development Forum at SAEM21. This forum is designed with people like you in mind to ensure you have the right tools to take the next steps in your career. Mark your calendar for Tuesday, May 11 and plan to participate in this forum that will provide attendees with the foundation for success in academic emergency medicine! We thank you for your past support and invite your ongoing commitment to SAEM and your continued participation in our community of more than 7,000 emergency medicine academicians. Please renew your membership today to continue to enjoy all of the many benefits of SAEM. Additionally, visit our website and view our SAEM Membership Guide to reacquaint yourself SAEM and everything that’s available to you as a member. If you have any questions, please contact the membership team at membership@saem.org.

The Board of Directors of the American Board of Emergency Medicine (ABEM) has elected two new members: Kim M. Feldhaus, MD, an emergency physician practicing at Boulder Community Health in Boulder, Colorado and Theodore J. Gaeta, DO, MPH, vice chair for academic affairs, program director for the department of emergency medicine, and chief research officer at NewYorkPresbyterian Brooklyn Methodist Hospital Dr. Feldhaus has been an ABEM oral examiner since 2001 and an exam item writer since 2020. Dr. Gaeta has been an ABEM oral examiner since 2002. Drs. Feldhaus and Gaeta will begin their terms on the ABEM Board of Directors in July 2021.

ABEM Announces 2021 Recipients of 30-Year Certificates

ABEM recognizes physicians who, as of December 31, 2020, have marked 30 years of being board certified in emergency medicine with a special certificate. To maintain certification for 30 years, ABEM-certified physicians must participate in a program of continuous professional development and learning in the specialty. Because board certification is a voluntary process, this landmark accomplishment reflects a dedication to the specialty of emergency medicine, a commitment to continuous professional development, and the long-standing provision of compassionate, quality care to all patients. SAEM joins ABEM in saluting these physicians for their dedication to the specialty, their recognition of the value of board certification, and their commitment to caring for acutely ill and injured patients.

Here Are Your 2021-2022 Leaders!

SAEM leaders, L to R: Angela M. Mills, MD; Wendy C. Coates, MD; James F. Holmes, Jr., MD, MPH; Pooja Agrawal, MD, MPH; Christopher R. Carpenter, MD, MSc; Michelle D. Lall, MD; Ava E. Pierce, MD; Ali S. Raja, MD; Jody A. Vogel, MD, MSc, MSW; Jamie Jasti, MD, MS

SAEM Board of Directors

2021–2022 RAMS Board President Wendy Sun, MD, Yale University School of Medicine Secretary-Treasurer Hamza Ijaz, MD, University of Cincinnati Immediate Past President Andrew B. Starnes, MD, MPH, Wake Forest School of Medicine Members-at-Large Greg Adams, DO, Case Western Reserve University (MetroHealth)

Amy Kaji, MD, PhD

President Amy Kaji, MD, PhD, Harbor-UCLA Medical Center President-Elect Angela M. Mills, MD, Columbia University, Vagelos College of Physicians and Surgeons Secretary-Treasurer Wendy C. Coates, MD, Harbor-UCLA Medical Center Immediate Past President James F. Holmes, Jr., MD, MPH, University of California Davis Health System Members-at-Large Pooja Agrawal, MD, MPH, Yale University School of Medicine Christopher R. Carpenter, MD, MSc, Washington University in St. Louis School of Medicine Michelle D. Lall, MD, Emory University Ava E. Pierce, MD, UT Southwestern Medical Center, Dallas Ali S. Raja, MD, Massachusetts General Hospital/Harvard Jody A. Vogel, MD, MSc, MSW, Denver Health Medical Center, University of Colorado School of Medicine Resident Member Jamie Jasti, MD, MS, Medical College of Wisconsin

Michael J. DeFilippo, DO, MICP, NewYork-Presbyterian Hospital Mariame Fofana, MD, Stanford Emergency Medicine Carleigh F. F. Hebbard, PhD, MD, The Ohio State University, Wexner Medical Center

SAEM Committees SAEM Nominating Committee Chair Angela M. Mills, MD SAEM Immediate Past President James F. Holmes, Jr., MD, MPH Elected Members Alexander T. Limkakeng, Jr., MD, MHSc Nancy S. Kwon, MD, MPA Committee/Task Force Representative To be elected by the Board of Directors in 2021-2022 SAEM BOD Representative To be elected by the Board of Directors in 2021-2022 Past President Representative To be elected by the Board of Directors in 2021-2022

RAMS leaders, L to R: Wendy W. Sun, MD; Hamza Ijaz, MD; Andrew Starnes, MD, MPH Nella W. Hendley, MD, MA, Wake Forest School of Medicine Daniel N. Jourdan, MD, Henry Ford Hospital Victoria Zhou, MD, University of Pennsylvania Medical Student Representatives Taylor Daniel, University of Pennsylvania, Perelman School of Medicine Ryan Pappal, Washington University, School of Medicine in St. Louis

2021-2022 Academy Executive Committees AAAEM Executive Committee

President Kain Robbins Immediate Past President Rhea Begeman, RN, BSN, MS President-Elect Amy Jameson, MPhil, MA, MBA Secretary David Christiansen, MBA Treasurer Becky McGowan, MBA Members-at-Large Jennifer Patton Muir, MBA Travis W. Schmitz, PhD, MBA TBD (SAEM President Associate) TBD (AACEM President Associate)

SAEM Bylaws Committee

Nikhil Goyal, MD Bryn E. Mumma, MD, MAS James H. Paxton, MD

continued on Page 70

BRIEFS continued from Page 69

ADIEM Executive Committee President Alden Landry, MD, MPH

President-Elect Edgar Ordonez, MD, MPH Secretary-Treasurer Cassandra Kim Bradby, MD Immediate Past President Jeffrey Druck, MD Members-at-Large Al'ai Alvarez, MD Renee C. Johnson, MD, MPH Jason Rotoli, MD

President Deborah B. Diercks, MD, MSc - UT Southwestern Medical Center, Dallas President-Elect Richard J. Hamilton, MD - Drexel University College of Medicine Secretary-Treasurer Lewis S. Nelson, MD - Rutgers New Jersey Medical School Immediate Past President Peter Sokolove, MD - University of California, San Francisco Members-at-Large Terry Kowalenko, MD - Medical University of South Carolina College of Medicine Ian B.K. Martin, MD, MBA - Medical College of Wisconsin

AWAEM Executive Committee

Development Officer Anika Backster, MD

President Devjani Das, MD

AEUS Executive Committee

President-Elect Valerie Dobiesz, MD, MPH

GEMA Executive Committee

President Scott M. Dresden, MD, MS

Resident Member Jasmyne Patel, MD

President Jennifer A. Newberry, MD, JD President-Elect Sean Kivlehan, MD, MPH Immediate Past President Kelli O'Laughlin, MD, MPH Secretary Stephanie C. Garbern, MD, MPH Treasurer Taylor Wilson Burkholder, MD, MPH Members-at-Large Catalina González Marqués, MD, MPH Erin E. Noste, MD Medical Student/Resident Representative Elinor Marie Shetter Sveum, MD, MSPH Development and Grants Officer Ronak Patel, MD, MPH IT Chair William Weber, MD, MPH Program Committee Liaison Sindhya Rajeev, MD

President-Elect Lauren Cameron Comasco, MD

CDEM Executive Committee

Simulation Executive Committee

President Lindsay Taylor, MD

President-Elect Yiju "Teresa" Liu, MD Treasurer Christopher D Thom, MD Secretary Petra Duran-Gehring, MD Past President Robert David Huang, MD Education Officer K. Meera Muruganadan, MD Research Officer Daniel Theodoro, MD, MSCI

AGEM Executive Committee

Secretary Kathleen Davenport, MD Treasurer Elizabeth M. Goldberg, MD, ScM Immediate Past President Shan Liu, MD Members-at-Large Katherine Hunold Buck, MD Jill M. Huded, MD Mary Mulcare, MD Tim F. Platts-Mills, MD, MSc Resident Representative Anita Chary, MD Medical Student Representative Lily Leitner Berrin

2021-2022 AACEM Executive Committee

Secretary Michelle P. Lin, MD, MPH, MS Treasurer Andrea Fang, MD Immediate Past President Tracy E. Madsen, MD, ScM VP Communications Amy Zeidan, MD VP Corporate Development Neha Raukar, MD, MS VP Education Kathleen Ogle, MD VP Membership Alexandra Mannix, MD

President Nicole Dubosh, MD President-Elect Sharon Bord, MD

Secretary Joseph B. House, MD Treasurer Amy Cutright, MD Past President Julianna J. Jung, MD Members-at-Large Keme Carter, MD Nathan J. Lewis, MD Susana Tsao, DO Audrey Tse, MD

President Nur-Ain Nadir, MD, MHPE President-Elect Ambrose H. Wong, MD, MSEd Treasurer Sara M. Hock, MD Secretary Suzanne Bentley, MD, MPH Immediate Past President Michael James Falk, MD Members-at-Large Tina Chen, MD Michelle Hughes, MD Jane Kim, MD, EdD Neel Naik, MD Glenn Paetow, MD, MACM Jessica M. Ray, PhD

SAEM 2021-2022 Foundation Board of Trustees President Brian J. Zink, MD, University of Michigan Medical School

Roland Clayton Merchant, MD, MPH, ScD, Icahn School of Medicine at Mount Sinai

President-Elect Joseph Adrian Tyndall, MD, MPH, University of Florida Health

Susan B. Promes, MD, MBA, Penn State Health

Secretary-Treasurer Manish N. Shah, MD, MPH, University of Wisconsin, School of Medicine and Public Health

David P. Sklar, MD, Arizona State University J. Scott VanEpps, MD, PhD, University of Michigan SAEM Grants Committee Chair: Nicholas M. Mohr, MD, MS, University of Iowa

Immediate Past President Gregory A. Volturo, MD, University of Massachusetts Medical School

SAEM Finance Committee Chair: Christopher Bennett, MD, MA, Stanford University, Department of Emergency Medicine

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

SAEM President: Amy H. Kaji, MD, PhD, Harbor-UCLA Medical Center

Michelle Blanda, MD, Northeast Ohio Medical University, Western Reserve Hospital, Academic and Community Emergency Specialists

SAEM President-Elect: Angela M. Mills, MD, Columbia University, College of Physicians and Surgeons

Cherri D. Hobgood, MD, Indiana University Robert S. Hockberger, MD, Harbor-UCLA Medical Center James J. McCarthy, MD, Memorial Hermann Health System

SAEM Secretary-Treasurer: Wendy C. Coates, MD, Los Angeles County Harbor-UCLA Medical Center SAEM Immediate Past President: James F. Holmes, Jr., MD, MPH, University of California, Davis

SAEM REPORTS COMMITTEE REPORTS Equity and Inclusion Committee

• Completing the SAEM Scorecard and

presented findings to the SAEM Board of Directors

• In conjunction with ADIEM, hosting

the webinar series “How to Be a Successful EM Applicant” aimed at EM bound applicants as well as providing resources and links for URiM students and applicants

• In conjunction with AWAEM, hosting

the webinar series “From Match to First Promotion” to provide a supportive network and educational framework for women to be equipped with the skills to tackle unique and specific challenges they face from match to first promotion

The Society for Academic Emergency Medicine (SAEM) Equity and Inclusion Committee had a busy and successful first year addressing the objectives set forth by the SAEM Board of Directors. The committee addressed the objectives by splitting into five subcommittees: Data/ Metrics, Education, Needs Assessment, Implicit Bias, and Resources/Products. Highlights of thei accomplishments include:

• Creating and finalizing the SAEM

Statement on Diversity and Inclusion (approved by the SAEM Board of Directors in July 2020)

• Finalizing the Strategic Inclusion &

Diversity Action Plan and presented it to the SAEM Board of Directors for approval

• Creating a leadership-specific

educational program on implicit bias training and key concepts in diversity, equity, and inclusion for SAEM and RAMS board members, academy executive committee members, and committee/interest group chairs and interest group leaders

o Bias in Medical Education, Friday, May 14, from 10–10:50 a.m. CT

o Key Concepts in Diversity, Equity,

and Inclusion: A Primer for Leaders in Academic Emergency Medicine Friday, May 14, 9–9:50 a.m. CT

Grants Committee The simulation community has been extremely active over the past few months:

• Congratulations to the 2021 SAEMF/

Simulation Academy Novice Research Grant recipient Dr. Julie Gesch for her work using in-situ simulation to improve stroke care.

• Devising a governing framework for

member data points and proposed recommendations to the SAEM Board of Directors

• Increasing faculty data collection

of SAEM members by 55%; e.g., nationality, ethnicity, and gender

Simulation Academy

at SAEM21:

and inclusion webinar series and launched the first session: Safe Space for Crucial Conversation: Art as a Catalyst for Anti-Racism

• Identifying additional SAEM

ACADEMY REPORTS

• Sponsoring two didactic presentations

• Creating and implrementing an equity

curating the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) Diversity, Equity, and Inclusion (DEI) Library, in conjunction with ADIEM

This year, SAEM added the new Emerging Infectious Disease and Preparedness Grant to stimulate and support work in this area. The Grants Committee also revised the grant application process to require a onepage mentoring plan for mentored grants. In addition, the committee concluded a five-year Grants Impact Study which reports on the effectiveness of SAEM grant programs, providing data supportive of future funding. The Grants Committee will hold a didactic session on “Pearls and Pitfalls in SAEMF Grant Submissions” during SAEM21. Any inquiries about SAEMF grant programs should be directed to SAEM at foundation@saem.org.

• In conjunction with the CORD The SAEM Foundation provides grants to fund innovative emergency medicine research and education initiatives, and the SAEM Grants Committee recently released requests for applications for the 2021-22 application cycle. Open announcements for SAEM grants include 14 categories for applications.

Simulation Community, the SAEM Simulation academy is excited to offer a simulation consulting service to help troubleshoot simulation education and curricular challenges. To request a consult follow the link.

• Emergency Medicine Resident

Simulation Curriculum for Pediatrics (EM ReSCu Peds), a FREE open-

access eBook containing sixteen cases to address critical pediatric topics for EM residents through simulation has been published and is now available for download.

• For more updates including upcoming events, follow our twitter account @SAEMSimAcademy

Academy for Women in Academic Emergency Medicine

Award Winners

• Risa Moriarity, MD, was awarded a 2021 AWAEM Research Funding Award for her proposal “Effects of Sponsorship, Mentorship, and Networking on Career Outcomes for Men and Women in Academic Emergency Medicine”. • Josie Acuna Schreiber, MD, was awarded a 2021 AWAEM Research Funding Award for her proposal “The Current Status of Gender Disparities in Emergency Ultrasound Fellowship Programs: A Survey Study”. • Jennifer Tsai, MD, MEd, was awarded a 2021 AWAEM Research Funding Award for her proposal “Gender and Race Disparities in Chief Resident Selection”. • Lauren Westafer, DO, MPH, MS, was awarded a 2021 AWAEM Research Funding Award for her proposal “Experience of Transgender Emergency Physicians with Bias Based on Perceived Gender”.

• Kelli Jarrell, MD, won the EMRA Fellow of the Year Award

Recently Published

• Sharon Chekijian MD, MPH, “Healthcare in transition in the Republic of Armenia: the evolution of emergency medical systems and directions forward” • Rebecca Goett MD and Elizabeth Clayborne MD, MA, “Diversity pipelines: The rationale to recruit and support minority physicians”

Promotions

Several AWAEM members were recently promoted in their positions. Please Academic Announcements on page 74 of this issue of SAEM Pulse for details.

In other news…

Simiao Li-Sauerwine, MD MSCR, created a successful Women in EM longitudinal curriculum and mentorship program at the Ohio State University.

ACADEMIC ANNOUNCEMENTS Dr. N. Nounou Taleghani Promoted to Clinical Professor With Stanford EM N. Nounou Taleghani, MD, PhD, has been promoted to clinical professor with Stanford University department of emergency medicine. As director for medical student education for the department, Dr. Taleghani oversees all the department’s medical school courses and served as the inaugural director Dr. N. Nounou Taleghani of the required EMED clerkship. Dr. Taleghani is the assistant dean for academic advising and the director of the Center for Specialty Career Advising for Stanford School of Medicine.

Dr. Raina Merchant is Promoted to Full Professor at UPenn School of Medicine Raina M. Merchant, MD, MSHP, has been appointed to the position of full professor (tenured) at the University of Pennsylvania Perelman School of Medicine, effective July 1, 2021. She is the first African American physician in her department’s history to be promoted to full professor on the tenure Dr. Raina M. Merchant track. Dr. Merchant also serves as the Penn Medicine associate vice president of digital health and is the inaugural director of the Penn Medicine Center for Digital Health.

Dr. Anne Messman Appointed Associate Dean of Graduate Medical Education at Wayne State Anne Messman, MD, associate professor and vice chair of education for the Wayne State University (WSU) School of Medicine’s Department of Emergency Medicine, has been appointed associate dean of graduate medical education. Dr. Messman will also serve as the School of Medicine’s designated Dr. Anne Messman institutional officer, overseeing the Office of Graduate Medical Education and all WSU residency programs. Dr. Messman, who chairs the WSU Women in Medicine and Science group, joined the faculty in 2013. She is the medical education fellowship director for the department of emergency medicine,

Dr. Ali Raja Promoted to Full Professor of EM at Harvard Medical School

Dr. Ali S. Raja

Ali S. Raja, MD, MBA, MPH, has been promoted to professor of emergency medicine at Harvard Medical School. Dr. Raja also serves as the executive vice chair for the department of emergency medicine at Massachusetts General Hospital. He is returning to the SAEM Board of Directors in May 2021.

Dr. Jonathan Slutzman Named Founding Director, Center for the Environment and Health and Medical Director for Environmental Sustainability J onathan E. Slutzman, MD, has been named the founding director of the Center for the Environment and Health and medical director for Environmental Sustainability at Massachusetts General Hospital. In this role, he will lead a team infusing environmental issues into the hospital’s missions of clinical care, education, Dr. Jonathan E. Slutzman research, and community health.

Dr. Manish Sharma Promoted to Associate Professor at Weill Cornell Manish Sharma, MD has been promoted to the rank of associate professor at Weill Cornell Medical College. Dr. Sharma currently serves as chief of emergency medicine at NewYorkPresbyterian (NYP) Queens. Dr. Sharma completed his training in emergency medicine at NYP-Brooklyn Methodist Hospital, where Dr. Manish Sharma he served as chief resident. He subsequently joined the faculty of NYP-Brooklyn Methodist Hospital where he served in several leadership roles including clerkship director and associate quality director. Dr. Sharma joined NYP-Queens in 2008, initially serving as associate residency director and vice chairman prior to becoming chief in 2016.

Dr. Catherin Staton is First EM Faculty at Duke to Receive Tenure Catherine Staton, MD, MS, associate professor of surgery, associate research professor of global health, and associate professor in neurosurgery in the department of surgery, division of emergency medicine at Duke University, was awarded tenure. She is the first Duke emergency medicine Dr. Catherine Staton faculty to achieve this distinction. Dr. Staton has achieved numerous “firsts” for Duke Emergency Medicine, including the first to be awarded an NIH K award, and NIH R21 and NIH R01 award.

Dr. Andrea Wu Promoted to Vice Chair and Director of Clincal Operations at Harbor-UCLA

Dr. Andrea Wu

Andrea Wu, MD, MMM, director of the adult emergency department, co-director of the ED administration fellowship, and health sciences assistant clinical professor, was promoted to vice chair and director of clinical operations in the department of emergency medicine at Harbor-UCLA Medical Center.

Dr. Mark Mycyk is Principal Investigator on $1.5 Million Award from SAMHSA

Dr. Jody Vogel to Join Stanford EM as Vice Chair for Academic Affairs

Mark B. Mycyk, MD, chair of research in the department of emergency medicine at Cook County Health, is the principal investigator on a $1.5 million award from the Substance Abuse and Mental Health Services Administration (1H79TI083122-01) to implement and study the use of acupuncture Dr. Mark B. Mycyk as an opioid-sparing strategy for emergency department patients with pain. The goal of the study is to decrease overall emergency department use and prescriptions of opioids over the next three years. Dr. Mycyk serves on the editorial board of Academic Emergency Medicine journal where he runs the Resident Member of the Editorial Board program.

Jody Vogel, MD, MSc, MSW, will be joining Stanford Emergency Medicine this spring as the new vice chair for academic affairs. Most recently, Dr. Vogel was an assistant professor in emergency medicine at the University of Colorado School of Medicine and an attending physician at the Denver Health Dr. Jody Vogel Medical Center in Denver, Colorado. Dr. Vogel completed residency, and in her final year was a chief resident, at Denver Health Medical Center where she also completed a fellowship in clinical Research. She was chair of the 2018-2019 SAEM Program Committee and is a current member-at-large of the SAEM Board of Directors.

Dr. Timothy Mader Receives National Heart, Lung, and Blood Institute Award

Dr. Martina Caldwell is Inaugural Medical Director of Diversity and Inclusion for Henry Ford Medical

Timothy J. Mader, MD, professor of emergency medicine at Baystate Medical Center/University of Massachusetts Medical School in Springfield, MA has received a National Heart, Lung, and Blood Institute R21 award (R21HL156198) to determine the effect of therapeutic hypothermia/targeted Dr. Timothy J. Mader temperature management after drug overdose out-of-hospital cardiac arrest. Dr. Mader, who was the recipient of the 2005-2006 SAEM Scholarly Sabbatical award, has since secured numerous institutional, foundation, and federal grants.

Martina Caldwell, MD, MS, has been named the inaugural medical director of diversity and inclusion for the Henry Ford Medical Group. Dr. Caldwell is senior staff physician and the director of diversity, equity, and inclusion in the department of emergency medicine. Dr. Martina Caldwell

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 2021 issue. 75

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.

Featured Positions Core Faculty Aventura Hospital and Medical Center Miami, Florida

Core Faculty Toxicology Fellow Brandon Regional Hospital Tampa Bay, Florida

Associate Program Director Osceola Regional Medical Center Kissimmee, Florida

Learn More at Our SAEM 2021 Virtual Booth

844.844.1814 EVPS.com/SAEM21

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

Emergency Medicine Faculty RESEARCH FOCUS

Penn State Health Milton S. Hershey Medical Center is seeking board eligible/certified academic emergency medicine physicians with a clear emphasis and commitment to research and an academic focus for a faculty position in the Emergency Department at Hershey Medical Center, Hershey PA. Located in a safe family-friendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences. We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC. Job Requirements: • Clear emphasis and commitment to research • Academic focus • Graduated from an accredited Emergency Medicine Residency Program • Board Eligible/Certified in Emergency Medicine • Must have or be able to acquire a license to practice in the Commonwealth of Pennsylvania

Benefits: • Competitive salary with Sign-On Bonus • Generous benefits package among highly qualified, friendly colleagues foster networking opportunities • Penn State University Tuition Discount • Malpractice coverage

FOR ADDITIONAL INFORMATION, PLEASE CONTACT:

Heather Pefﬂey, PHR CPRP | Physician Recruiter email: 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.

Baylor College of Medicine (www.bcm.edu) is recognized as one of the nation’s premier academic health science centers and is known for excellence in education, research, healthcare and community service. Located in the heart of the world's largest medical center (Texas Medical Center), Baylor is affiliated with multiple educational, healthcare and research affiliates (Baylor Affiliates). The Henry JN Taub Department of Emergency Medicine at Baylor College of Medicine seeks a Vice Chair of Research to oversee research operations for the department. The responsibilities of this position shall include: 1. Maintain a highly productive research operation with a national and international reputation. 2. Assist the Chair of the Department of Emergency Medicine in developing/recruiting/retaining high potential research faculty. 3. Provide guidance and mentorship to junior faculty members in defining and developing their research projects and directions. 4. Support and expand resident, fellow, graduate student, medical student and undergraduate involvement in research, presentations, and publications. Potential for development of a training grant for resident/fellow research. 5. Compete successfully for external funding in order to maintain a well-rounded research portfolio. 6. Provide oversite, guidance and annual evaluations to research associated faculty members. 7. Have regular meetings with the research manager for financial updates on all research portfolios within the Department. Make recommendations to the Chair for corrective actions needed to keep the research operation viable and solvent. Salary, rank, and tenure status are contingent upon candidate qualifications. The rank and tenure status awarded will be based upon qualifications in alignment with Baylor College of Medicine's promotion and tenure policy. Qualified applicants are expected to have a research record with significant extramural funding and leadership skills to develop a strong multidisciplinary collaborative Emergency Medicine research program and continue to grow current departmental research efforts. In addition to the above responsibilities, other duties may be assigned by the Chair.

Please include a cover letter and current curriculum vitae to your application. This position is open until filled. For more information about the position, please contact Dick Kuo, MD via email [dckuo@bcm.edu]. MINIMUM REQUIREMENTS Education: M.D. degree or equivalent Experience: Research Fellowship not required for application Licensure: Must be currently boarded in Emergency Medicine and eligible for liscensure in state of Texas.

New Fellowship in Medical Toxicology We are excited to announce a new ACGME-accredited fellowship in Medical Toxicology sponsored by the Medical College of Wisconsin and Children’s Wisconsin. • • • • • • •

Located in Milwaukee, WI – high quality of life, lower cost of living. FULLY FUNDED 7 Medical Toxicology faculty, 2 Pharmacy Toxicology faculty all in one department and including national leaders in the field Inpatient and outpatient consultation service to three hospitals Open to graduates of ACGME approved residencies in Emergency Medicine and Pediatrics. Not EM or Peds but interested? Let us know and we can find a way. Be a member of one of the only expanding Departments of Emergency Medicine with a mix of academic and community practice moonlighting opportunities Work with a stable and well-established poison center

Send inquiries to: Mark Kostic, MD Fellowship Director mkostic@mcw.edu

Janice Hinze Fellowship Coordinator jhinze@mcw.edu

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

THANK YOU To our brave and dedicated emergency physicians, nurses, and other medical staff who are on the front lines answering the call to care for the most vulnerable in our society during this time of great need.

SAEM Pulse May-June 2021

Articles inside

Now Hiring

SAEM Reports

Academic Announcements

The RAMS Guide to the SAEM21 Virtual Meeting

Five Tips to Transform Medical Students and Residents into Self-Directed Learners

Addressing COVID-19 Vaccine Hesitancy Among Black and Hispanic Communities

Carrots, Education, and Hopefully Not Too Many Sticks: A Study in Behavior Change

Meet the 2021 SAEMF Grantees

Sex and Gender in Relation to a Chronic Pain Disorder

Uncontrolled Organ Donation after Cardiac Death

From Match to First Promotion: Gender Bias and Clinical Leadership… Top 10 Pearls From the Webinar

Disclosing Death from Behind a Mask