SAEM PULSE May–June 2017

MAY-JUNE 2017

VOLUME XXXII NUMBER 3

EDUCATOR SPOTLIGHT

IMPROVING HEALTH THROUGH LEARNING An interview with Sally Santen, MD, PhD

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

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

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Membership Manager George Greaves Ext. 211, ggreaves@saem.org Education Manager Mark Nagasawa, MA Ext. 214, mnagasawa@saem.org Assistant, Membership & Education Alex Keenan Ext. 202, akeenan@saem.org Meeting Planner Maryanne Greketis, CMP Ext. 209, mgreketis@saem.org

Director, Finance & Benefits Doug Ray Ext. 208, dray@saem.org Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Operations & Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Manager, Governance & Meetings Monica Bell, CMP Ext. 205 mbell@saem.org IT Support Specialist Jovan Triplett Ext 218 jtriplett@saem.org

AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Editorial Coordinator Taylor Bowen tbowen@saem.org

Director, Communications and Publications Stacey Roseen Ext. 207, sroseen@saem.org Specialist, Digital Communications Nick Olah Ext. 201 nolah@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio sharon.atencio@rvu.edu

3

President’s Comments

4

Educator Spotlight

A Year in Review

Improving Health Through Learning

8 11

SAEM17 Know Before You Go

13

SGEM: Did You Know?

14

SAEM17 The Resident-Student Guide Sex, Pain, and Gender: A Beginner’s Mind

Diversity and Inclusion

Striving for Equity: Women and Minorities in Emergency Medicine

16

Ethics in Action

17

Graduate Medical Education

20 23 24 25 27

Treating–Not Judging–Substance Abusing Patients Decoding Physician Wellness

The Resident-Student Side Medical Students for Haiti’s Mission of Emergency Medical Education

Academic Emergency Medicine

Reflections on my Year as a Resident Editor on the Board of AEM

Social Media in Academic EM

Learning From Excellence vs. Focusing on Mistakes

Briefs and Bullet Points Academic Announcements

2016-2017 BOARD OF DIRECTORS Andra L. Blomkalns, MD President University of Texas Southwestern at Dallas

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

D. Mark Courtney, MD President-Elect Northwestern University Feinberg School of Medicine

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

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

Ian B.K. Martin, MD, MBA West Virginia University School of Medicine

Riley P. Grosso, MD University of Cincinnati College of Medicine

Steven B. Bird, MD Secretary/Treasurer University of Massachusetts Medical School Deborah B. Diercks, MD, MSc Immediate Past President University of Texas Southwestern at Dallas

Ali S. Raja, MD, MBA, MPH Massachusetts General Hospital

Angela M. Mills, MD Perelman School of Medicine, University of Pennsylvania

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine, 1111 East Touhy avenue, Suite 540, Des Plaines, IL 60018.

The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. For SAEM Pulse archives visit http://www.saem.org/publications/newsletters © 2017 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 Andra Blomkalns, MD University of Texas Southwestern Medical Center at Dallas SAEM President 2016-2017

A Year in Review

"It has been an honor and privilege to serve all of you."

What a year! I cannot believe that it has been nearly a year since SAEM16—our annual meeting in New Orleans. A lot has happened for the Society for Academic Emergency Medicine in this short year.

time and year-round networking and collaboration. Take a look…click around!

I have been looking forward to something like this for SAEM for over 10 years and it is finally here!

May started off with sudden and full court press involvement within the Association of American Medical Colleges (AAMC) Standardized Video Interview (SVI) pilot program. SAEM and the Association of Academic Chairs of Emergency Medicine (AACEM) were central in convincing the AAMC that the effort needed to start as a voluntary research pilot instead of a full operational launch in May 2016. The intent of establishing a voluntary pilot program was to work through the process, get student feedback, establish and begin validation of a grading rubric, establish stakeholder understanding and buy-in. This residency application year, the SVI program will expand to include all emergency medicine applicants while continuing to improve the system and follow outcomes. I hope this productive relationship with the AAMC continues into the future.

The New Year also brought the launch of SAEM’s new companion journal, Academic Emergency Medicine Education and Training (AEM E&T), with Editor Susan Promes. AEM E&T is a quarterly, peerreviewed journal dedicated to publishing information relevant to education and training in emergency medicine, including original education research contributions, case reports, education case conferences, book media review, and personal features such as narratives, art, and photographs.

In September 2016, the SAEM office moved to a new location at 1111 East Touhy Ave., Ste. 540 in Des Plaines, Illinois. SAEM can now host small meetings and courses. This year the AACEM Chair Development Program conducted their January session in that location. The staff has an office where they can easily collaborate and thrive.

On a more somber note, January was also when the academic emergency medicine community learned of the failed negotiations for the academic emergency department and residency training program at Summa Health. After an unsuccessful appeal, ACGME rendered a withdraw of accreditation decision effective July 1, 2017 for the emergency medicine program and a probation decision for the Summa sponsoring institution. SAEM and AACEM assisted in finding new homes for the existing residents. SAEM has also committed to undergo an advising program for emergency medicine faculty in Akron, OH with the potential of submitting a successful application for a new ACGME approved residency in 2-3 years.

In January, SAEM revealed a new information technology platform: new website, a microsite for each of the academies, directories for residencies, medical student clerkships, and fellowships.

Included in this project are a bolstered social media presence (SAEM Facebook and SAEM Twitter @SAEMonline) Online communities for interest groups, committees, and academies foster real

It has been an honor and privilege to serve all of you and I want to publicly thank the exceptional SAEM Board of Directors and excellent SAEM staff. The Program Committee for SAEM17 has been hard at work all year to furnish a program I am sure will not disappoint! If you have not already, please register, and be sure to download the SAEM17 mobile app. I look forward to seeing all of you in Orlando!

3

EDUCATOR SPOTLIGHT

IMPROVING HEALTH THROUGH LEARNING

SAEM PULSE | MAY-JUNE 2017

… it is not about my teaching, but instead about the trainees’ learning.

4

Sally Santen, MD, PhD, is Assistant Dean for Educational Research and Quality Improvement at the University of Michigan Medical School and Associate Chair of Education in the Department of Emergency Medicine.

She also is a Professor of Emergency Medicine and Learning Health Sciences. She earned her MD from the George Washington University School of Medicine and completed a residency in emergency medicine at the George Washington/Georgetown hospitals. She received her Ph.D from the Vanderbilt Peabody School of Education.

Dr. Santen’s primary work is in the medical school, where she leads curriculum development, student assessment, and evaluation. She, and Associate Dean for Medical Student Education Rajesh S. Mangrulkar, MD, were awarded a five-year $1.1M grant from the American Medical Association for an initiative to transform the curriculum into a program that will graduate physician leaders who help drive change in patient care, health care delivery, and science. Dr. Santen is recognized in emergency medicine for her teaching and educational research. Her areas of research include assessment, evaluation, burnout, resiliency, and entrustment.

In 2016, Dr. Santen was recognized for outstanding contributions to emergency medicine through the teaching of others and the improvement of pedagogy with the Hal Jayne Excellence in Education Award from the Society for Academic Emergency Medicine.

Sharon Atencio, chair of the SAEM Pulse Editorial Advisory Task Force interviewed Dr. Santen for this issue’s Educator Spotlight—an ongoing series of interviews featuring educators in academic emergency medicine.

SAEM Talks with Sally Santen, MD, PhD Please tell us about how you first became an educator. Did you always know you would teach?

In college I was not sure if I would be a teacher or doctor. I dropped out for a year and worked as an EMT and found that medicine— and specifically emergency medicine—was the right field. I always maintained my interest in teaching.

Do you have a teaching mission statement, and if so, what is it?

My vision is to improve health through learning. We need to be learner centered. In other words, it is not about my teaching, but instead about the trainees’ learning. We achieve this objective by using the best evidence to help trainees learn effectively.

Further, we have a responsibility to determine the effectiveness of our teaching and learning and, when successful, to disseminate those findings.

Who are some of the teachers you’ve had in the past who have influenced how you train your students today?

Jim Scott was a faculty member when I was a student and resident at George Washington. As an EM doc he knew everything, but more than that, he knew how to share his knowledge. We

Dr. Santen with emergency medicine-bound students, Match Day 2017.

all wanted to be like him. Dr Yolanda Haywood, also at George Washington, demonstrated a compassion for patients regardless of their social situation and reminded us about the learning in every patient. When I was working on my education Ph.D, there were several Ph.D educators who also challenged me to think deeply.

Tell us about your curriculum initiative focused on teaching students to be leaders as well as physicians.

One facet of the University of Michigan Medical School curriculum is focusing on leadership and teamwork. Leading through effective contribution to teams is a responsibility for all providers. This is not Leadership with a big “L” of dominance and hierarchy, but it is leadership with a little “l” in which focus on getting the best from the team is key. Examples include when the medical student speaks up when there is a potential error, works with the patient and social workers to identify barriers, and contributes to the team.

In other words, leadership, engaged

followership, and teamwork opportunities are everywhere.

How do you engage learners and keep them motivated?

It is important to know where learners are coming from, what they care about, what motivates them—and then to support that learning. One of the more important methods is entrustment, which is giving the appropriate level of responsibility to the trainees to care for patients.

Tell us about a specific training challenge you encountered (Language barrier? Lack of resources?) and how you dealt with it.

Sharing feedback about performance is key to improvement of trainees. I was once working with a senior resident who was disrespectful with patients and families.

When I provided feedback that he should be “nice to patients,” I believe he may have rolled his eyes at my comment and completely disregarded what I had observed in his patient interactions. I still struggle with what I could have done better to help him understand. In the end,

"This is not Leadership with a big “L” of dominance and hierarchy, but it is leadership with a little “l” in which focus on getting the best from the team is key."

for each of us, we have credible sources of feedback we will believe when they give us feedback that is not consistent with our views of ourselves. For him I was not a credible source; he did not value my feedback. For this resident, I worked to identify someone he trusted in order to provide the feedback and the consequences of poor communication.

What behaviors do you try to model for your trainees?

I care about our patients. I am struck by how different people’s lives can be from our own.

What’s a valuable lesson you’ve learned from your patients?

Listen for the subtext. What is the real reason they came to the ED?

What’s a valuable lesson you’ve learned from your trainees?

It is important to always keep learning.

As I observe residents communicate with patients and manage the team, I learn different approaches to teamwork and communication. It’s also reinvigorating to see our jobs through their eyes.

How do you help your trainees learn to deal with mistakes?

It is important to talk through mistakes.

While the single mistake is not likely to be repeated, identifying the root cause of how the mistake was made will help

5

Dr. Santen, with friends and her mom, at the 2017 Womens' March.

prevent further errors. It is helpful to review potential cognitive biases and system-based issues and the roles these may have played in the outcome. This is not meant to minimize personal responsibility, but should allow people to see their own performance in the larger system context.

of teaching in medicine. It was for this reason that I returned to school to get my Ph.D; I wanted to learn more about education.

This provided me a strong foundation in education as well as in research. For junior educators, a master’s in health professions education may provide this foundation.

What advice would you give to a resident who would like to go into teaching?

"While the single mistake is not likely to be repeated, identifying the root cause of how the mistake was made SAEM PULSE | MAY-JUNE 2017

will help prevent further errors."

6

Teach every day, try new methods of teaching, watch other teach so you can learn what works and does not. We know that self-assessment is not accurate; therefore, most importantly, get feedback on your performance from trainees and other educators.

Tell us about a particularly satisfying moment you had while training a student.

I routinely read ICE Blog (International Clinician Educators Blog) and Barb Oakley’s Learning How to Learn.

I have a pair of first-year students who come and work when I am working in the ED. It is part of a clinical reasoning elective that I direct. These students are so excited about everything because they have only learned from books. They remind us how much we need to know. In addition, they often go into the social context of patients and remind us how illness affects patients’ lives.

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

What do you think is the future of emergency medicine education?

When I was a junior faculty member at Vanderbilt, I was concerned about the “see one, do one, teach one” paradigm

While technology is a major source of change, it still comes back to the interpersonal connection. I have watched education

What do you think about FOAMed in general? Do you have any particular favorites?

"While technology is a major source of change, it still comes back to the interpersonal connection." theory come into emergency medicine over the past years and it is making our learning stronger. Further, some of the education researchers in EM are adding to our understanding of learning. I think this process will continue.

What qualities do you think are most important in a resident? In a faculty member?

In my last position, one of my objectives was to figure what makes a good physician and measure it. There are two qualities: excellence in communication with patients, team, and family; and the ability to appropriately seek and learn new knowledge. It is also helpful to find an area that you feel passionate about because this helps maintain some of the excitement that many of us felt when we entered medicine.

What are some ideas you’ve successfully employed in your teaching?

It is important to entrust the residents and let them have as much autonomy as they can handle. I try to do this by having the resident sit in the attending chair at the ED desk (I take the resident desk). That way the resident can have responsibility and run the ED. I back them up by silently observing their care to ensure safety while entrusting autonomy.

What do you do to manage stress, achieve work-life balance, and contribute to your overall health and well-being?

As ED physicians, many of us do not focus on this aspect of our lives. It is important to recognize how much resiliency you

Dr. Santen receives the Hal Jayne Excellence in Education Award from the Society for Academic Emergency Medicine at SAEM16 in New Orleans.

have and when it is low, pay attention and work to increase your resiliency through, sleep, rest, chocolate, fun, and friends.

At the end of your career, how would you like to be remembered?

I would like to be remembered as developing others as educators.

One of my skills is the ability to catalyze others in the education field—to help others pursue evidence-based learning and education research. I also hope that I have contributed to helping people learn both in practice and through research.

7

17

KNOW BEFORE YOU GO

Staying and Playing in Orlando The Hyatt Orlando Host Hotel

E-Concierge service. Log in with your last name and Hyatt confirmation number.

Business Services

ANNUAL MEETING

Location

8

The Hyatt Regency Orlando Host Hotel, is located at 9801 International Drive in Orlando, is the site for SAEM’s educational sessions and most of its events and activities. This handy map will help guide you as you make your way around the Host Hotel.

Concierge Personalize your stay at the Hyatt Orlando—from scheduling transportation and making dinner reservations to requesting extra pillows—with the Hyatt

The Executive Business Center at the Hyatt Regency Orlando offers work stations with computers equipped with copy and fax services 24 hours a day, plus on-site graphic design and sameday printing; package receiving and outbound shipping services; binding, scanning, faxing, photocopying; business supplies and office equipment rentals; and more. Phone (407) 345-446, Fax (407) 351-917, or e-mail.

Parking and Airport Shuttle The Hyatt Regency Orlando offers selfparking and valet parking. The Hyatt is located at stop number 21 for the I-Ride Trolley, which operates daily from 8 am–10:30 pm and provides transportation to hundreds of shopping, dining, and entertainment destinations within the International Drive resort area. Call (866) 243-7483.

Shuttle transportation for the Hyatt Regency Orlando is provided by Mears Transportation. Shuttle reservations for

the parks must be made at least 2 hours prior to desired departure time. Shuttle reservations for the Orlando International Airport must be made 24 hours in advance. Shuttle pick-up is from the International Tower Front Drive. Shuttle vouchers and theme park tickets can be purchased at the Concierge Desk located in the Regency Lobby.

Deals for SAEM17 Attendees Arrive early or extend your stay to enjoy the many exciting attractions Orlando has to offer. Please see below for special SAEM17 discount pricing. Please note: Tickets may be subject to service charge and offers may change without notice.

Dining Specials Show your annual meeting badge and save at participating Orlando area restaurants between May 15-19 to take advantage of a great dining offers.

Download the Orlando dining map.

Attraction Specials • SeaWorld Orlando • Universal Orlando Resort • Walt Disney World Resort

ANNUAL MEETING

Getting the Most Out of SAEM17 Registration

Online Tools

The annual meeting registration area is located on the Convention Level at the Hyatt. Registration hours are:

SAEM17 is all-digital! No more printed program to carry around or misplace. We’ve provided online planning tools and resources to help you achieve a dynamic, individualized experience that meets all your learning needs.

• Monday, 3 pm−6 pm • Tuesday, 7 am−5 pm • Wednesday, 7 am-7 pm • Thursday, 7 am-5 pm • Friday, 7 am-4 pm Please note that annual meeting participants (members, nonmembers, partners, children, guests) must register and wear badges for admission to sessions, exhibit hall, and most events.

If you have preregistered you will receive a barcoded email confirmation. Please save this to your mobile device or print it out to scan it at our convenient, self-serve express kiosks, located on the convention level near the SAEM17 registration desk. Forget your confirmation? No problem! Just touch “Use Lookup” on the screen and search for your name. Hit print and your badge and any applicable tickets will print out. Badge holders and lanyards will be available at the kiosks.

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

Program Planner The SAEM17 Online Program Planner provides pre-meeting access to the SAEM17 program. Log in using your SAEM user name and password and browse through the full list of pre-meeting workshops, educational sessions, meetings, social events, and more. Search among 35 different topic areas, or use one of the many other filters to help you narrow the view. Review abstracts, learning objectives, and speakers for educational sessions. Find links to travel information and local dining and activities. Scope out the exhibit hall with the online floor plan and create your must-see list of exhibitors.

As you browse, customize your schedule by adding items to your favorites list. Create your individualized program before you arrive you. Save it and/or print it out as your personalized daily itinerary. Use it at the annual meeting to remind you what not to miss and where to go next. Then install the SAEM17 mobile app (see below), log in using your SAEM credentials, and voila! Your schedule is synced from the online program planner.

9

Thursday, May 18 Exhibit Hall Open 7 am-1pm Networking Breakfast in Exhibit Hall 7-8 am Walking Lunch in Exhibit Hall 11:30 am-1 pm

Additional Information News and Updates SAEM news and updates will be announced via a nightly annual meeting e-newsletter and via SAEM Social Media. Make sure to follow us on SAEM Facebook and Twitter @SAEMOnline (#SAEM17) during the annual meeting for up-to-date meeting announcements and to share your insights with other meeting attendees.

Wireless Internet Access As a service to annual meeting registrants, SAEM will provide free wireless Internet access, sponsored by CEP America, in designated areas of the Hyatt Orlando Host Hotel during SAEM17. User name: SAEM17; Password: CEPcareers.

SAEM17 Mobile App Navigate SAEM17 like a pro by downloading the mobile app to your smartphone or tablet. It’s easy! Just search The App Store or Google Play for “SAEM 2017," then sign in with your SAEM user name and password to launch the app. The app can be synced to your SAEM17 Program Planner and offers all the same functionality in a simple, easy-to-use mobile version: • View agenda and explore sessions • Build your personal schedule • Claim CME • Access exhibitor and sponsor information • View maps of the Expo floor • Provide valuable feedback • Keep notes

Lactation Room A comfortable lactation room will be provided for nursing mothers in Bayhill 33, Lobby Level from 7 am-5 pm, Wednesday May 17-Friday, May 19.

SAEM17 Online Education All educational content from SAEM17 will be open access and available online at the SAEM Education Library within two weeks after the close of the annual meeting. Experience convenient online and mobile viewing of pre-meeting workshops, didactics, forums, abstracts—more than 200 hours of original educational content from SAEM17. Downloadable PDFs and MP3 files provide on–the-go viewing at a time that’s convenient to your busy schedule. Just log in with your SAEM ID and password to enjoy the content.

ANNUAL MEETING

Exhibit Hall

10

Visit with more than nearly 60 exhibitors who will be on hand to showcase their latest products and services. Use the SAEM17 Online Program Planner to scope out the exhibit hall with the online floor plan and create your must-see list of exhibitors.

Don’t forget to stop by SAEM Booth #112 to pick up a free SAEM17 tee shirt and have a professional headshot taken.

Exhibit hall hours and events are below.

Tuesday, May 16 Rum Runner Exhibit Hall Reception 5-6 pm

Wednesday, May 17 Exhibit Hall Open 11:30 am-4 pm Networking Breakfast in Exhibit Hall 7-9 am Walking Lunch in Exhibit Hall 11:30 am-1 pm Power Break in Exhibit Hall 2:30-3 pm

Yoga and Meditation Class We’re bringing mindfulness to the annual meeting! Relax and renew your mind, body, and spirit in our hour-long, complimentary yoga classes.

• Wednesday, May 17, 7:30-8:30 am, Regency Ballroom U • Thursday, May 18, 7-8 am, Windermere Ballroom Y

Need Assistance?

SAEM’s Medical Student Ambassadors will be stationed throughout the Hyatt Host Hotel to help. They will be wearing SAEM-branded polo shirts, so they’ll be easy to spot. Additionally, SAEM staff will be at the registration desk during registration hours and at SAEM Booth #112 during exhibit hours.

New to SAEM or the Annual Meeting?

Is this your first time attending the annual meeting, or are you a new member of SAEM? If so, please stop by our SAEM Booth #112 in the exhibit hall during exhibit hours and introduce yourself, pick up a free SAEM17 tee shirt, have a professional headshot taken, and let us tell you about SAEM’s programs and services and how to get the most from the annual meeting.

By Ryan LaFollette, MD In just a couple of weeks SAEM17 will convene. It’s a time we look forward to all year long— an opportunity to come together to celebrate and learn from emergency medicine’s top researchers and academicians. This year’s annual meeting, May16-19 at the Hyatt Regency in Orlando, has been crafted by the SAEM Annual Meeting Program Committee to highlight the science, feed the education, and facilitate the interaction and mentorship that moves the specialty forward. Each year we set aside a page in this publication to curate a list of several sessions and events that we believe will be of special interest to residents and/or medical students. Take a look and mark your calendars!

"It’s a time we look forward to all year long—an opportunity to come together to celebrate and learn

Tuesday, May 16: A Great Beginning Start your time at SAEM17 on the right foot by attending a pre-meeting workshop.

Choose from several unique sessions, each designed with the practicing emergency medicine provider in mind, such as Medical Education Boot Camp with Dr. Sally Santen from 8 am-5 pm in Plaza International Ballroom E.

from emergency Wednesday, May 17: The Official Kickoff medicine’s top New to this year’s meeting is the Chair researchers and academicians."

Fair, from 7-9 am in Windermere Ballroom Y. Academic emergency medicine chairs from across the country will be available to advise, discuss careers, and give perspective to graduates and young faculty in emergency medicine. Attend this inaugural event for valuable face-toface time with some of the most notable department chairs in the specialty of academic emergency medicine.

The annual meeting will officially kick off at 9:30 am with a keynote speech by one of the most well-respected leaders of Academic Emergency Medicine—Judd Hollander, MD, who will present “The Future of Emergency Medicine: What You (and Hopefully I) May Be Doing in 35 Years.”

Immediately following the keynote address

ANNUAL MEETING

17

THE RESIDENT-STUDENT GUIDE TO SAEM17 will be the presentation of the plenary abstracts, which have been hand selected to highlight the cutting edge research and education topics of the year. Both events will be held in Plaza International Ballroom G and H. For the future providers of emergency medicine, SAEM17 offers sessions specifically to help young academicians find their way into and through a career in emergency medicine. The new Speed Mentoring session, from 3-5 pm in Windermere Ballroom Y, will let you connect one-on-one with more than 60 senior academic faculty for 10 minutes of focused mentoring, networking, and idea sharing.

Thursday, May 18: A Packed Day The conference continues in full swing on Thursday, May 18. with the return of favorites such as IGNITE, ePosters (with new and improved formatting), and lightening oral sessions. In addition to these old favorites, there are plenty of new sessions to check out (details below).

In the new SAEM National Grand Rounds didactics on Thursday, May 18, some of the top names in the emergency medicine specialty will address topics of current research and interest to academic emergency medicine. Part 1, from 8-9:20 am, is brought to you by the SAEM Research Committee, and will highlight high quality research and high impact research results from established and federally funded senior investigators from disparate scholarly domains.

Part 2, from 9:30-10:50 am is a question and answer session with the senior investigators who will address inquiries related to their research results and research methods. Attendees will be able to ask questions about grants and other means of support. The session will be a moderated panel featuring senior investigators in emergency medicine. Parts 1 and 2 will be held in the Plaza International Ballroom K. The Resident Academic Leadership Forum (RALF), from 8 am-3 pm, in Orlando

11

Ballrooms L, M, N, will target specific development skills for residents and unique challenges of chief residents. RALF is designed for current emergency medicine residents, chief residents, and future leaders in emergency medicine, to engage with senior leaders in our field; create a roadmap to leadership in emergency medicine; develop leadership, wellness, time management, and communication skills; and overcome challenges facing resident leaders. RALF will feature focused and dynamic didactic presentations, interactive sessions, panel discussions, and networking sessions with fellow resident leaders as well as established senior leaders in emergency medicine administration, education, and research.

The Junior Faculty Development Forum, from 8 am-2 pm in Plaza International Ballroom J, is designed for junior faculty to engage with senior leaders in our field to develop the strategies for promotion, productivity, and academic advancement that will enable them to become the next generation of leaders in academic emergency medicine.

The forum will feature focused didactic presentations from leaders in emergency medicine administration, education, and research, as well as a Q & A panel of current and former department chairs.

The Medical Student Symposium (MSS), from 8 am-3 pm in Plaza International Ballroom E, will provide an overview of emergency medicine and discuss the process of applying for an emergency medicine residency position. There will be specific discussions about clerkships, away rotations, personal statements, the match process, and interviews. The SAEM Residency and Fellowship Fair, which showcases many of the academic emergency medicine programs in the country, will immediately follow the MSS and is part of the registration fee for this session.

Outside of the educational sessions, there are plenty of social events to keep you entertained and having fun… starting with the SAEM17 Opening Ceremony from 5-7 pm in the Regency Rotunda. This year’s kickoff event will have a “Game Night” theme with interactive hoops, electronic horse races, a supersized Operation Game, a Big piano dance mat (like in the movie), plus funny photo booths, and lots of good (and free) food!

And So Much More!

The Residency and Fellowship Fair, from 3-5 pm in the Windermere Ballroom W and X, is the where you can get face-to-face time with program and fellowship directors from around the country and start to figure out which programs might be a good fit for your future education. Meet with current residents and fellows, ask questions, seek application and interview advice... all in one place.

Friday, May 19: Let the Games Begin!

A new and expanded SonoGames®, from 8 am until noon in the Windermere Ballroom W, X, Y and Z, is the highlight of Friday, May 19. Twice the number of teams and double the space means you can expect a whole new level of excitement with this year’s competition.

Always a conference favorite, SAEM Dodgeball, 5:30-7:30 pm in Plaza International Ballroom G and H, is back for another year of competition—but in an even bigger and better way.

The main ballroom with be converted into a stadium of double elimination showdowns where 14 residency teams will battle each other, the SAEM Board of Directors, and the Medical Student Ambassadors to declare dodgeball dominance. Come grab some food, a cold beverage, and enjoy the competition!

After the games, let loose with your peers and unleash your inner fiesta at the Resident and Medical Student “Yard Party,” from 8-11 pm at Señor Frogs. This always-fun event is FREE for residents and medical students. Roundtrip transportation is available. Drink tickets will be distributed at the door.

ANNUAL MEETING

See you in Orlando!

12

We hope you’ll be joining us in Orlando this year, but if for some reason you have to miss out, stay tuned for a recap of each day’s highlights with our nightly e-blast updates. And while you’re on these pages of SAEM Pulse, be sure to review the Know Before You Go section, starting on page 8, for an overview of information to help your time at SAEM17 run smoothly.

ABOUT THE AUTHOR: Ryan LaFollette, MD is an Assistant Professor at the University of Cincinnati and the Social Events Subcommittee Chair of the SAEM17 Program Committee

SGEM: DID YOU KNOW?

Sex, Pain, and Gender: A Beginner’s Mind

By Bruce Becker MD, MPH, FACEP, Professor of Emergency Medicine, Brown University, Alpert Medical School Pain is a major component of most chief complaints seen in the emergency department (ED). Sex and gender have a significant influence on the patient’s perception and expression of pain, and the clinician’s recognition, diagnosis, and treatment of that pain. The sensation of pain results from the stimulation of hard-wired sensory receptors, but the communication of pain is a behavior. Every cell has sex chromosomes and may produce sex hormones that can influence nerve function and modulate nociceptors (pain receptors) by producing endogenous analgesics and by varying the concentration and activity of cell surface receptors on neurons. In women, hormonal control of nociception changes with the menstrual cycle.

Patients’ pain behaviors are a reflection of their personal, familial, and cultural histories and expectations, which are also impacted by their sex and gender. Patients use spoken and body language to represent the degree of their discomfort. Just as the patient has nociceptors that perceive pain, Emergency Medicine Providers (EMP’s) have receptors to perceive their patient’s pain: vision to see tears and grimacing, ears to hear crying, and moaning, and fingers to elicit tenderness.

EMP’s who undertreat their patients’ pain either cannot perceive that pain (afferent deficit) or cannot respond appropriately (efferent deficit). These deficits are influenced by the sex and gender of the patient and of the provider. Inadequate treatment of acute pain subsequently leads to patients requiring increased medication and to the development of chronic pain syndromes, anxiety, post traumatic stress disorder (PTSD), and depression. There is a vicious cycling that repeatedly rolls through the ED creating a challenging relationship between provider and patient. There is amplification: Patients speak about their pain in a louder voice, leading clinicians to turn down the volume. Consequently, other words in the medical conversation are misheard, leading to misdiagnosis and medical errors.

Currently, we have a very limited understanding of the influence of sex and gender on pain, and the way that the sex and gender of patients and providers influences diagnosis, treatment, and outcome. We need pain-related sex- and gender-specific scientific research, assessment tools, and medical education. We, as emergency medicine physicians must embrace a “beginner's mind,” abandoning our myths and beliefs, maintaining self-awareness, and approaching each patient who is in pain with the intention of relieving their suffering.

Please send contributions for this column to coeditors Lauren Walter and Alyson J. Mcgregor at sgem@lifespan.org. If you are an SAEM member and are interested in adding the Sex and Gender in Emergaency Medicine Interest Group (SGEM IG) to your membership, simply sign in to your profile and join today. SAEM members who are already part of the SGEM IG can find more information and resources by visiting the SGEM IG Community Site.

13

DIVERSITY AND INCLUSION

Iris Reyes, MD

Ava Pierce, MD

Alden Landry, MD, MPH

Striving for Equity: Women and Minorities in Emergency Medicine

By Iris Reyes, MD, Ava Pierce, MD, and Alden Landry, MD, MPH

SAEM PULSE | MAY-JUNE 2017

Despite decades of calls demanding increased representation of women and underrepresented minorities in the health care workforce, the numbers remain woefully suboptimal. The need to accomplish equity in representation both in practice, academia, and in leadership positions for women and racial/ ethnic minorities is one of the most glaring of our shared concerns. The 2013-14 AAMC report entitled “The State of Women in Academic Medicine” highlighted the significant underrepresentation of women in academic faculty rosters. The 2014 AAMC faculty roster revealed that women comprised 38% of associate professors and 21% of full professors despite outnumbering men at 56% at the Instructor [AL1] level in academic medicine. Women comprise 38% of all trainees in emergency medicine with the same percentage comprising the female full time faculty in the specialty.

14

The term underrepresented in medicine (URM) as defined by the Association of American Medical Colleges[AL2] (AAMC), identifies those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population. Historically, African Americans, Native Americans and Latinos have fallen into this definition. These racial/ethnic groups comprise 30% of the total US population, yet only 6% of all practicing physicians and 9% of emergency physicians self-identified as URMs. The percentages are unlikely to improve as URMs account for 15% of the medical student population and 14% of residents in emergency medicine training programs. Diving deeper, in the

recent report, Altering the Course: Black Males in Medicine, the AAMC noted that fewer black males applied to medical school in 2014 than in 1978.

The AAMC Faculty Engagement Survey of 2011-14 proposed improvements to the workforce climate that would certainly benefit members of each of our academies. These include the provision of: • An equitable and diverse workforce with an environment that retains female and racial/ethnic minority faculty and insists on their inclusion at all levels and roles. Numerous studies have revealed the significant value of diverse perspectives when addressing challenges both at the bedside and at the institutional level.

• Clear expectations about their role and the path to advancement. Women and URM’s are subject to implicit bias and microaggressions that can curtail the progression of their academic careers. The recent JAMA article by Dayal, Comparison of Male vs Female Resident Milestone Evaluations

by Faculty During Emergency Medicine Residency Training, speaks to the significant challenges and potentially career derailing challenges faced by our female trainees. It goes without saying the many URM’s have historically been victims to these microaggressions, and implicit biases, in addition to outright racist behaviors, as they pursue their training and progress through their medical careers.

"The “leaky pipeline” that plagues our profession starting as early as the undergraduate level and progresses through our academic careers, is unlikely to improve without a focused and concerted effort by those of us who have been successful with the strong advocacy of departmental and institutional leaders."

• Access to opportunities for professional advancement through faculty development programs and access to mentors. Participation in leadership and research training programs both within their institutions and in programs sponsored by national organizations is essential in providing a potential solution to the lack of equity in academic medicine by women and URM physicians.

The factors that led to our present day inequitable emergency medicine workforce are complex. The “leaky pipeline” that plagues our profession starting as early as the undergraduate level and progresses through our academic careers, is unlikely to improve without a focused and concerted effort by those of us who have been successful with the strong advocacy of departmental and institutional leaders. The egress of the talented women and URM physicians from academic medicine despite having successfully achieved the level of instructors must be curbed. URM and women physicians must have a seat at the table with others in leadership positions to voice our concerns, and to provide our unique perspectives and solutions on the issues that affect us, our colleagues and, most importantly, our patients.

ABOUT THE AUTHORS: Iris Reyes, MD, is a professor of clinical emergency medicine at the Perelman School of Medicine at the University of Pennsylvania. Ava Pierce, MD, is an associate professor of emergency medicine at the University of Texas Southwestern Medical Center. Alden Landry, MD, MPH, is an assistant professor of emergency medicine at Beth Israel Deaconess Medical Center.

The Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) will be joining the Academy for Women in Academic Emergency Medicine (AWAEM) for AWAEM's annual luncheon to be held at SAEM17 in Orlando. The joint luncheon is an opportunity for the members of each academy, along with luncheon attendees, to begin a dialogue addressing shared experiences and concerns about our careers in Academic Emergency Medicine.

15

ETHICS IN ACTION Treating–Not Judging– Substance Abusing Patients

By Naomi Dreisinger, MD, MS, FAAP Emergency medicine (EM) is a complex field for which providers must have the ability to evaluate and treat many different types of patients and their illnesses. Inner-city emergency departments (EDs) are often swamped with patients who have drug- and alcohol-related addiction problems. Each night ED physicians are inundated with patients who are intoxicated.

They are often undomiciled, unkempt, and a challenge to care for. Their complaints often seem meaningless. It is difficult for physicians to avoid falling into the trap of bias.

It is your third overnight shift in a row working in the downtown city hospital.

Glancing at the screen you note that the next patient assigned to you is one of the emergency department’s (ED’s) “frequent fliers.” The patient is a 56-year-old man with chronic alcoholism, complaining of foot pain. You roll your eyes—not again. Each night it feels as if the bulk of the patients you see in the ED are drunks. This is not

SAEM PULSE | MAY-JUNE 2017

what emergency medicine is meant to be.

16

The Surgeon General recently released a report with a focus on alcohol, drugs, and health. In it, substance misuse is defined as use of any substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them. Severe and chronic substance use disorders are commonly referred to as addictions.

Addiction disorders have become rampant in many cities and small towns around the United States—so much so that as ED physicians we have become accustomed to treating patients afflicted with substance addiction disorders, yet few of us are able to view this condition as a medical condition; instead, we treat their medical complaints, perhaps provide them with a blanket, and usher them out of the ED as rapidly as possible. The Surgeon General has asked physicians to begin to change this viewpoint and view the patients seen in the ED who have substance addiction as having a medical illness, with the goal of helping these patients begin the process towards healing.

Unfortunately, the tendency is for physicians to view substance addiction disorders as character deficits rather than true medical illnesses. Why is it so hard for doctors to accept addiction as a medical illness? Further exploration suggests that it may be because we are far from immune to substance addiction disorder ourselves.

In fact, the rates of physician addiction are at an all time high with EM doctors being

at the forefront. As EM doctors, our world is one of high stress, many leave the ED at the end of a shift and turn to substance to relieve the stress of the day. This routine can quickly spiral out of control. Recognition of substances abuse as a medical illness allows physicians to admit their addictions and gain access to treatment without fear and with limited risk of stigma.

There are few other medical conditions that are surrounded by as much shame and misunderstanding as substance use disorders. Our society treats addiction and misuse of alcohol and drugs as a symptom of moral weakness or as a willful rejection of societal norms. Our health care system has not given the same level of attention to substance use disorders as it has to other health concerns that affect similar numbers of people. Substance use disorder treatment in the United States remains separate from the rest of health care and serves only a fraction of those in need of treatment. As many as 18% of patients seen in the ED have substance abuse issues, yet these patients are often avoided and forgotten.

Recent research on alcohol and drug use, including addiction, has led to an increase of knowledge and to one clear conclusion: addiction to alcohol or drugs is a chronic but treatable brain disease that requires medical intervention, not moral judgment. More than 40% of people with substance use disorder have a mental health comorbidity, yet fewer than half of them receive treatment. Effective prevention programs and policies exist. The ED is a hectic and busy place, yet it is the perfect place to begin to recognize these patients as in need of help and services. An extra referral or phone call is often all that is needed to help steer these patients in the right direction.

ABOUT THE AUTHOR: Naomi Dreisinger, MD, MS, FAAP is the director of the Pediatric Emergency Department at Mount Sinai Beth Israel and Mount Sinai Hospital.

GRADUATE MEDICAL EDUCATION

David K. Barnes, MD, FACEP

Nicholas Hartman, MD

Katren R. Tyler, MD

Decoding Physician Wellness

By David K. Barnes, MD, FACEP, Nicholas Hartman, MD, and Katren R. Tyler, MD This might be the understatement of the year, but residency training is difficult. Those who have completed emergency medicine training undoubtedly recall periods of sleep deprivation, emotional depletion, and lack of time and opportunity to pursue outside passions and interests. Post-graduate training stresses relationships and complicates child bearing and rearing, and requires separation from family and friends, debt accumulation, and acclamation to demanding schedules. No wonder trainees feel helpless.1 The emergency medicine and broader graduate medical education (GME) communities now appreciate the human consequences that the training environment and clinical practice have on physician wellness.2 The World Health Organization defines wellness as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” An evolving concept, wellness is often used interchangeably with the term “well-being”. While several models of wellness exist, each contains a common set of eight dimensions determined to be essential—characteristics, identities, and behaviors that contribute to one’s complete health.

Fortunately, a growing wellness effort now exists within the medical community and aims to improve the mental health and professional satisfaction among residents and practicing physicians.3,4 Of all the elements contained within physician wellness, burnout usually dominates the conversation. Burnout—defined as a syndrome of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment—has been a topic of discussion in the medical community since its description

by Maslach in the 1980s.5 Physician trainees have consistently been found to possess higher rates of burnout and lower rates of wellness than the general population.6

Unfortunately, physician burnout is on the rise. The AMA and Mayo Clinic surveyed 6,880 physicians across all specialties to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population.”

They reported that rates of burnout and professional dissatisfaction rose for every specialty studied from 2011 to 2014. Unsurprisingly, emergency physicians reported the highest rate of burnout in both study periods. Even worse, emergency medicine was the only specialty to exceed a 70% burnout rate.7 Emergency medicine may be unique with its combination of shift work, patient mix, chaotic work environment, and high volume/high acuity, but the circumstances that conspire to cause and contribute to burnout affect all physicians: long work hours, chronic fatigue, difficult patients, administrative barriers to care, loss of autonomy, human suffering, to name just a few.

"It has become increasingly clear that helping residents improve their own well-being and mitigating the circumstances that lead to burnout will be essential in the coming years."

17

SAEM PULSE | MAY-JUNE 2017

18

Higher rates of burnout and decreased physician well-being carry consequences not just for the health of the individual physician but also for the safety of patients and the quality of care they receive.8 The death of Libby Zion in a New York hospital in 1984, attributed by members of the Bell Commission to cognitive errors made by unsupervised residents who were sleep deprived, incidentally led to the first wellness revolution in GME. The Accreditation Council for Graduate Medical Education (ACGME) implemented the first duty hour restrictions in 2003 with an update to the Common Program Requirements (CPRs), the accreditation framework to which all residency programs must adhere. In addition to mandating a minimum number of days off each month, residents’ weekly work hours and continuous duty hours were limited. This was the first attempt to forcibly restrict the GME clinical work environment specifically to protect patients by simultaneously protecting residents’ wellbeing.

"The emergency medicine and broader graduate medical education communities now appreciate the human consequences that the training environment and clinical practice have on physician wellness."

While burnout prevention is an important component of wellness—and indeed might be the most obvious concern for many physicians—it’s part of the larger wellness paradigm, and efforts to move beyond merely prevention of burnout toward the broader goal of personal wellness and happiness across the entire wellness spectrum are underway.9 The ACGME recently revised the CPRs that will become effective in July 2017. “Well-Being” is now included as a core requirement, while “Alertness

Management and Fatigue Mitigation” has been modified and expanded from previous CPR iterations. By recognizing that physician mental, emotional, psychological, and physical wellness are integral to the maintenance of a resilient, capable, healthy, and sustainable workforce, the ACGME has elevated resident well-being to the level of a programmatic requirement.10 Owing to the growing emphasis on resident duty hours, fatigue management is one of the most highly regulated aspects of wellness from the ACGME

EMOTIONAL—How one feels, deals with stress, and processes their environment SOCIAL—Creating and maintaining relationships and staying active in the community FINANCIAL—Living within one’s financial means and planning for future financial health INTELLECTUAL—Staying curious, engaged, continually learning, and open to new ideas ENVIRONMENTAL—Taking care of one’s local surroundings and the global environment SPIRITUAL—Understanding beliefs, values, & ethics by which to live and find purpose PHYSICAL—Staying active and maintaining a healthy body OCCUPATIONAL—Personal satisfaction and enrichment in one’s life through work perspective. Programs are required to provide education about fatigue related to long, continuous duty hours. In addition to providing education about recognizing one’s own limits in the face of fatigue, programs and sponsoring institutions must provide resources for residents too fatigued to care for patients safely (e.g. nap rooms) or to travel home without jeopardizing themselves or others (e.g. taxi vouchers). In an important cultural about-face, programs and sponsoring institutions must commit to not retaliating when residents recuse themselves because of fatigue. Indeed, it is courageous and altruistic to self-report when patients’ lives and team member trust are on the line. These changes will challenge trainees and educators to find a balance between professionalism and development toward independent practice on the one hand, and personal self-care and patent safety and the other.

Individual programs are now grappling with how to comply with ACGME requirements and also how to facilitate well-being among their trainees proactively.

In recent years, wellbeing, burnout, and more seriously psychiatric illnesses such as depression have emerged as issues that residency programs should address in their curricula. Evidence is sparse, but academic interest in physician burnout has surged over the last 5-10 years with 183 published articles relating to ‘burnout in

physicians’ in 2016. There were three such articles in 1981.

What is less clear is how effective program level interventions can improve resident well-being. Systems-level interventions that protect work-life balance (e.g. shift duration limits, duty hours, protected overlap between shifts, scribes, asynchronous learning elements) may be more effective at enhancing resident wellness since these are components over which residents normally have little control.3,4,11 Many wellness projects essentially become an exercise in shining light on the issues of well-being and burnout, allowing residents to think about their own wellness strategies. Didactic components may be the least effective intervention: a bad or boring didactic presentation likely harms efforts to improve well-being by making it seem like another administrative task to endure.

Within the EM residency program at UC Davis, individual well-being activities have included didactic, non-didactic, and non-academic exercises incorporated into the required weekly conference schedule and separately as part of resident retreats.

Non-didactic interventions have included small group discussions and have been well-received, although application, feasibility, and efficacy beyond a single program is difficult to demonstrate. Topics covered have included sleep hygiene,

comprehensive wellbeing strategies, burnout, and recognition of the impaired physician. Not surprisingly, non-academic components have been the most fun—for residents and faculty—and highest rated: group yoga, running, walking, cycling, guided bird watching, rafting, self-defense classes, and touring art museums.

Retreats, like white water rafting, rock climbing, and snow skiing, tend to be more extravagant, costly, and logistically challenging but have been ranked highly by residents.

It has become increasingly clear that helping residents improve their own wellbeing and mitigating the circumstances that lead to burnout will be essential in the coming years. Regulatory efforts are now underway, and will almost certainly continue, to change the training culture towards one that encourages and facilitates well-being. At the moment, residency program leaders are left to contemplate additional ways to ensure their residents have resources and opportunities to engage in beneficial habits, lead healthy lifestyles, and strive for positive mindsets. Recent experience shows that structural interventions to improve the work environment are likely more effective than curricular add-ons and wellness instruction.

More study and experimentation is needed to determine best practices in wellness promotion among resident physicians.

REFERENCES

1. D yrbye LN, et.al. Academic Medicine. 2014;89(3):443-451.

2. D yrbye L, et.al. Medical Education. 2016;50(1):132-149.

3. West CP, et.al. Lancet. 2016;388(10057):2272-2281.

4. E pstein RM, et.al. Lancet. 2016;388(10057):2216-2217.

5. S chaufeli WB, et.al. Psychology & Health. 2001;16(5):565-582.

6. R aj KS. Journal ofGgraduate Mmedical Education.

2016;8(5):674-684.

7. S hanafelt TD, et.al. Mayo Clinic Proceedings.

2015;90(12):1600-1613.

8. Wallace JE, et.al. Lancet. 2009;374(9702):1714-1721.

9. E ckleberry-Hunt J, et.al. Journal of Graduate Medical Education. 2009;1(2):225-230.

10. C ommon Program Requirements (Section VI) with Background and Intent. 2017; http://www.acgme.org/Portals/0/PFAssets/ ProgramRequirements/CPRs_Section VI_with-Backgroundand-Intent_2017-01.pdf.

11. S hanafelt TD, et.al. Mayo Clinic proceedings. 2017;92(1):129-146.

ABOUT THE AUTHORS: David K. Barnes, MD, FACEP, is associate professor and residency program director at UC Davis School of Medicin/UC Davis Health System, Sacramento, CA. Nicholas Hartman, MD, is assistant professor and assistant program director at Wake Forest University Baptist Medical Center, Winston-Salem, NC. Katren R. Tyler, MD, is associate professor and associate program director at UC Davis School of Medicine/UC Davis Health System, Sacramento, CA. Submitted on behalf of the SAEM Graduate Medical Education Committee.

19

THE RESIDENT-STUDENT SIDE Near-Peer Educators to Country Wide Changers:

Medical Students for Haiti’s Mission of Emergency Medical Education

By Isaiah Levy, BS and Randy Sorge, MD

Isaiah Levy, BS

SAEM PULSE | MAY-JUNE 2017

Randy Sorge, MD

20

We start our day at 6:30 a.m. Twelve of us cram into a small van and wedge between bulky, over-sized duffels stuffed with teaching supplies. It's only March, but the sun's rays are strong and the van warms quickly.

As we traverse the mountainous roads of Port-au-Prince, Haiti, our driver swerves sharply, carefully avoiding the innumerable potholes. We pull out onto the main road and hit heavy traffic. The city is bustling with colorfully painted, open-air taxis known as “Tap Taps” which, like our van, are similarly overcrowded. Our commute takes nearly 45 minutes to travel a mere three miles to our destination: Université Quisqueya—a well-respected medical school built into the hillside with a beautiful view of the city. Upon arrival, we unload our equipment and shuffle into a large lecture hall where we are greeted by a huge group of Haitian medical students.

We were only expecting 70 students this year, but almost 90 have arrived. Refusing to turn anyone away, a pair of us breaks off to register the new students while the rest of us set up for today's first lesson: Basic Life Support (BLS) CPR. We are Medical Students for Haiti (MS4H), a student-run organization at the Icahn School of Medicine at Mount Sinai. Our mission is primarily medical education: We train Haitian medical students to become emergency first responders utilizing a nearpeer teaching model. MS4H was founded in response to the 2010 earthquake that devastated Port-au-Prince. This disaster only added strain to a healthcare system already facing significant challenges. Port-auPrince suffered from infrastructural damage, population displacement, and a fractured healthcare system1. Seven years later, the emergency response system in Port-auPrince is almost non-existent and transport of the sick and injured is a responsibility that often falls on friends and family who have little to no medical training whatsoever.

Similar to medical schools in the United States, the first years of the Haitian medical

curriculum primarily focus on basic sciences, leaving a gap in practical medical knowledge that could otherwise prove useful in an emergency setting. This is problematic for junior Haitian medical students who may find that they are the most qualified providers in their community but lack the essential skills to help. Our mission is to fill this curricular gap by teaching first responder skills to our counterparts in Haiti. With the assistance of faculty and residents from the Department of Emergency Medicine at Mount Sinai, we developed a novel curriculum that incorporates aspects of both emergency medicine and wilderness medicine with special emphasis on providing practical, prehospital care in a low resource setting.

Our course runs Monday to Friday and consists of both didactics and small group activities. The first day is composed of BLS CPR and AED training. Throughout the week our lectures cover the principals of becoming a first responder, how to evaluate and treat patients with head and neck injuries, and how to manage bleeding wounds and musculoskeletal injuries. After each lecture, we break up into groups and practice the corresponding skills: performing a primary and secondary survey, assessing for a cervical spine injury, moving patients, bandaging wounds, tying tourniquets and splinting extremities. We teach the students to use everyday objects to provide basic medical care: tourniquets are made with stripes of cloth and ballpoint pens, cervical spinal immobilization is achieved with backpacks and empty water bottle, and pressure dressings are fashioned from belts and handkerchiefs. The students are fierce competitors and among groups they race to stabilize their patients and transport them expeditiously. On the final day, we create a full-scale mass casualty simulation. With the use of make-up, costumes, and props, members of MS4H are transformed into victims of an industrial explosion. The Haitian students assess for scene safety, designate

a staging area, and prioritize patients using the principles of START triage. This simulation is not only fun, it also allows the students to tie together the skills they have learned throughout the course and demonstrates the importance of communication and teamwork in a disaster setting.

In order to establish a sustainable system of education, we conduct an instructor’s course in the afternoon for students who wish to advance their skill set further. In these sessions, we utilize case-based learning and teach-back methodology.

The emphasis of the instructor’s course is shifted away from the “how to” and towards the “why and why not.” This course culminates with the newly certified instructors teaching a naive group of their peers BLS CPR. Upon completion, these new instructors will be qualified to teach BLS CPR and the first responder skills independently. To assess the students’ knowledge retention, we administer both a pre- and post-test examination. In 2016, we compared the average final exam grades of the MS4H-taught students (n = 39, 90 ±11), to those of the Haitian instructor-taught students (n=12, 87.6 ±10) and found no significant differences (p=0.53)2. These data support the position that cross-cultural, near-peer teaching is not only feasible, it is also effective3.

Throughout the year we encourage the Haitian instructors to conduct CPR and first responder courses in their community.

In the past year, a small group of highly motivated instructors from Université Quisqueya have begun teaching CPR to adolescents (ages 12-18) in schools throughout Port-au-Prince. In total, the instructors have taught more than 500 additional students! Granted, the CPR course that the instructors teach has been abbreviated to a half-day and is understandably simplified to be ageappropriate. However, despite these

(Top left) Student reviewing and practicing BLS CPR and AED training. (Top right) Haiti countryside.

(Bottom) Students with certificates of completion.

modifications, this initiative is remarkable and demonstrates the instructors’ sense of social responsibility and ownership of the material. We fully support the instructors’ initiatives of teaching CPR to adolescents, which is consistent with recommendation of the American Heart Association that encourages CPR training as early as age nine4. The hope is that by conducting these classes annually with graduated complexity, this program can certify students by the time they graduate high school, and thereby significantly increasing the first responder capacity in Haiti.

In order to better address the needs of our students, we collect annual feedback surveys as a way to continually improve our curriculum. Based on last year’s feedback and because pre-eclampsia is extremely prevalent in Haiti, we added material on OB/GYN emergencies and seizure management. Additionally, as a way to enhance retention, we published a course manual complete with lecture summaries, homework assignments, and discussion questions. Innovations for next year will include a lecture on environmental emergencies and near drowning, and

21

MS4H student leaders from Mount Sinai and Université Quisqueya.

"While we saw many of the medical challenges so often highlighted in Haiti (shortages of equipment, medications, and staff), we also saw resourcefulness,

SAEM PULSE | MAY-JUNE 2017

resilience, and selflessness."

22

we plan to produce our own CPR training video in Creole. In addition to our first responder course, MS4H has created an observership rotation in the Department of Emergency Medicine at Mount Sinai Hospital. This rotation is available to Haitian medical students entering their senior year who wish to gain more clinical exposure in the United States health care system.

During the month-long rotation, students work clinically in the Emergency Department alongside senior residents, aeceive one-on-one teaching from faculty, and participate in simulation labs with the Mount Sinai medical students. Rotators gain experience in point-of-care ultrasound, intubation, and central line placement. In addition, they benefit from personalized mentorship and receive a letter of recommendation.

Since the organization was created, MS4H has trained nearly 200 Haitian medical students and an additional 30 instructors; however, one would be mistaken to think that the educational initiative is unidirectional. In fact, one could argue that we learn more from the Haitian students than they do from us. Between lectures, over lunch, and in the hallways of the University Quisqueya, they teach us about their country, their culture, and the challenges they face as they begin their

medical careers. During the week, the Haitian students take us on a tour of a public hospital where they perform clinical rotations during their final years. They share stories about the patients they have compassionately cared for—some who were successfully treated and others that were beyond saving. While we saw many of the medical challenges so often highlighted in Haiti (shortages of equipment, medications, and staff), we also saw resourcefulness, resilience, and selflessness. It is clear that the students possess an insight, maturity, and a sense of responsibility that is well beyond what one would expect from someone in their early twenties. Our experience as a part of MS4H has profoundly affected our vision of health care and helped define the kind of physicians we hope to become. It would be an understatement to call the relationship between the students of MS4H and Université Quisqueya a friendship.

We are bonded by a common goal, a shared vision, and our love for Haiti.

REFERENCES

1. C . Ozden, M. Schiff (Eds.) International Migration, Remittances and the Brain Drain. Palgrave MacMillan, New York; 2005, WHO country profile: Haiti. Geneva: The World Health Organization.

2. M urphy, James et al. Near-peer teaching for sustainable capacity building of basic life support training in Haiti: Feasibility of a training the trainers model. Ann Glob Health. 2016 MayJun;82(3) 485-486.

3. P ean, CA et al. Near-peer emergency medicine for medical students in Port-au-Prince, Haiti: an example of rethinking global health interventions in developing countries. Ann Glob Health.

2015 Mar-Apr;81(2):276-82.

4. American Heart Association: "Course FAQs" cpr.heart.org. 2017.

ABOUT THE AUTHORS: Randy Sorge, MD, is a PGY-3 Emergency Medicine resident at Mount Sinai Hospital in New York City. For three years, he has served as the resident advisor for MS4H. Isaiah Levy, BS, is a second year medical student at Icahn School of Medicine in New York City. He is member of the MS4H leadership, serves on the steering committee for Mount Sinai’s studentrun free clinic, mentors first generation college students, and conducts research on access to medical technologies in resource-limited populations.

ACADEMIC EMERGENCY MEDICINE Reflections On My Year as a Resident Editor On the Board of AEM

By Vanessa Franco, MD, PhD, Resident Editor, AEM As a last stitch is delicately placed into a complicated wound repair, the overhead lights bounce across the bright blue luster of freshly placed nylon. The sutures glisten in a neat row, giving the illusion of a simple closure. Meanwhile, a complex array of deep sutures underneath supports the framework, structure, and integrity of the repair. Even though these deep, meticulously placed sutures are essential for the quality, longevity, and elegance of healing, they will remain hidden beneath the surface, seen only by the person who placed them.

"Like placing deep sutures into a wound, editorial review is painstaking work, which ensures that a solid foundation lies beneath a final product."

This analogy parallels the value, diligence, and anonymity inherent in editorial and peer review. Like placing deep sutures into a wound, editorial review is painstaking work, which ensures that a solid foundation lies beneath a final product. I am grateful to have spent the last year as a resident editor on the board of Academic Emergency Medicine (AEM) critically reviewing papers under the guidance of experts in the sometimes overlooked, largely undercompensated, and yet critical skill of editorial review. I have seen how the future direction of academic emergency medicine is influenced discreetly by thoughtful reviews, which ensure that only the most interesting and rigorously performed work is published.

In addition to vetting submitted manuscripts, editors and reviewers must also ensure that publications are comprehensible to front line emergency physicians. If literature is to be adopted into current practice, it must be communicated elegantly, much like the aesthetic appeal of neatly placed superficial sutures exudes confidence in the repair beneath them. As no two wounds are identical, each submission presents unique challenges for reviewers.

Just as gaining a patient’s cooperation is useful in ensuring lasting outcomes of wound repair, I have learned that carefully placed encouragement woven throughout critical feedback inspires researchers to

continue pursuing their endeavors. While no two physicians encourage a patient in the same way, my experiences reflecting on real ethical publication dilemmas has helped me to accept that there is sometimes no clear answer. A trusted effort to be judicious and fair is a ubiquitous responsibility that reviewers and editors must take seriously.

In a world where “fake news” seems omnipresent, the task of high quality and ethically sound editorial review has never seemed more essential. Each one of us has the unique opportunity to influence the direction and merit of our field’s advancements by providing rigorous and thoughtful review, despite the often under-appreciated nature of this duty. Just as cutting edge papers will continuously be supplanted by newer work, superficial sutures will lose their luster and be removed. If all layers of a repair are performed optimally, the skin will heal smoothly and grow stronger. Similarly, if a deep lattice of rigorous review lies beneath each publication, the forward progress of academic emergency medicine will continue to thrive.

ABOUT THE AUTHOR: Vanessa Franco, MD, PhD, earned her medical degree and PhD in Neuroscience from the Universtiy of Pittsburgh where she completed a post-doctoral research fellowship in the Department of Emergency Medicine. She is chief resident in emergency medicine at the University of California, Los Angeles. Dr. Franco was AEM’s first resident editor.

Read all about the AEM Resident Editor program, and AEM’s resident editor selections for 2017-2018, in the Briefs and Bullet Points section, on page 24 of this issue of SAEM Pulse.

23

SOCIAL MEDIA IN ACADEMIC EM Learning From Excellence vs.

Focusing on Mistakes

By Catherine D. Parker, MD They go by many names: Quality Improvement Groups, Patient Safety Networks, Morbidity and Mortality Conferences, etc.

Regardless of what they are called, the purpose of these teams/committees/groups of individuals is to review the mistakes of medical peers that have occurred during the care of patients.

On the surface, this seems like a logical way to identify areas in need of improvement, prevent future missteps, and improve clinical skills, but this focus on the negative has a downside: It has helped to create a medical culture that is motivated by fear and avoidance.

"Focusing solely on mistakes in medicine is like trying to understand sharks by only studying

SAEM PULSE | MAY-JUNE 2017

shark attacks"

24

Dr. Adrian Plunkett, in a presentation he gave at SMACC (Social Media and Critical Care), disputes this notion of negative reinforcement and challenges those of us in medicine to instead “learn from excellence.” In building a medical culture that only acknowledges errors in judgement, Dr. Plunkett contends that we miss out on learning from the positive examples that are all around us.

"The focus of appreciative inquiry is on what is done well, so that others can learn

Learning From Excellence Resources Resources for setting up and maintaining an excellence reporting program.

• Quick start up guide • Top 10 tips • How to get started To address this matter, Dr. Plunkett and a team of health care professionals created a reporting system titled “appreciative inquiry,” which is designed to recognize what is “done well” by clinicians and medical staff.

Appreciative inquiry allows any individual to recognize another individual for the excellent work they do. The focus of appreciative inquiry is on what is done well, so that others can learn from an example of excellence.

Dr. Plunkett’s team found that this type of system had a snowball effect on the medical community within their hospital. Not only did those who were recognized for their good work continue to provide excellent care, but an entire intensive care unit saw an improved antibiotic practice pattern.

Even when we strive to do our best, mistakes sometimes happen. When we focus solely on those mistakes, we miss out on the opportunity to learn from our mistakes and become better physicians. As Dr. Plunkett said, “Focusing solely on mistakes in medicine is like trying to understand sharks by only studying shark attacks.”

To learn more about starting an excellence reporting (i.e. appreciative inquiry) system, at your institution, please visit Dr. Plunkett’s website.

from an example of excellence."

ABOUT THE AUTHOR: Catherine D. Parker, MD, is chief resident, R3, in the Department of Emergency Medicine at the University of Missouri.

BRIEFS AND BULLET POINTS SAEM NEWS Election Results The Board of Directors of the Society for Academic Emergency Medicine is pleased to announce the winners of recent elections to SAEM leadership positions. Congratulations to the individuals whose names are highlighted in red who join their esteemed colleagues in the following categories:

2017-2018 SAEM BOARD OF DIRECTORS President D. Mark Courtney, MD, Northwestern University Feinberg School of Medicine

Resident Member Jean Elizabeth Sun, MD, Mount Sinai School of Medicine

NOMINATING COMMITTEE Chair Steve Bird, MD

SAEM Immediate Past President Andra Blomkalns, MD Elected Members Martin Reznek, MD, MBA Gillian Beauchamp, MD Committee/Task Force Representative To be elected by the Board of Directors in 2017-2018 Past President Representative To be elected by the Board of Directors in 2017-2018

BYLAWS COMMITTEE Steven B. Bird, MD

Ian B.K. Martin, MD, MBA

President-Elect Steven B. Bird, MD, University of Massachusetts Medical School Secretary-Treasurer Ian B.K. Martin, MD, MBA, West Virginia University School of Medicine Immediate Past President Andra L. Blomkalns, MD, University of Texas Southwestern at Dallas Members-at-Large James F. Holmes, Jr., MD, MPH, University of California Davis Health System Amy H. Kaji, MD, PhD, Harbor-UCLA Medical Center Ali S. Raja, MD, MBA, MPH, Massachusetts General Hospital Richard E. Wolfe, MD, Beth Israel Deaconess Medical Center/Harvard Medical School Angela M. Mills, MD, Penn Medicine Megan L. Ranney, MD, MPH, Brown University

Chair Esther Choo, MD, MPH Members Doug Char, MD Jason Hoppe, DO

SAEM ACADEMIES

SAEM REGIONAL MEETINGS

Congratulations to the winners of the SAEM academy elections. Links to each academy’s full 2017-18 executive committee are below. The new executive committees will assume their posts at SAEM17.

• Academy of Administrators in Academic Emergency Medicine (AAAEM) • Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) • Academy of Emergency Ultrasound (AEUS) • Academy of Geriatric Emergency Medicine (AGEM)

• Clerkship Directors in Emergency Medicine (CDEM) • Global Emergency Medicine Academy (GEMA) Megan L. Ranney, MD, MPH

Research, education, and the sharing of ideas are paramount to SAEM’s mission and vision. With that in mind, SAEM is pleased to introduce Academy Open Access Education Resources. These teaching and learning materials are now hosted on SAEM’s website and are freely available for any SAEM member to use, whether a researcher, educator, or student. This library of free virtual education will continue to populate over time, eventually resulting in full courses, course modules, syllabi, lectures, simulations, research articles, quizzes, lab and classroom activities, pedagogical materials, games, and many other resources, available as PDFs, Blogs, podcasts, and other document, video, and audio form. SAEM invites you to explore and bookmark the new webpage and check back again following SAEM17, for new and updated content.

2017-2018 Academy Executive Committees

• Academy for Women in Academic Emergency Medicine (AWAEM)

Angela M. Mills, MD

Academy Open Access Education Resources

• Simulation Academy of the Society for Academic Emergency Medicine (SIM)

2017 New England Regional Meeting

The 21st Annual SAEM New England Regional Meeting, hosted by Maine Medical Center/Tufts University School of Medicine, took place on March 29, 2017 in Worcester, MA. Attendance reached 334 and a total of 111 abstracts were presented from among the 323 abstracts that were considered.

SAEM’s Director of Finance, Doug Ray, attended the meeting and offered a welcome from SAEM and organizational

25

updates. In addition, it was our privilege to have Dr. Steve Bird, Professor of Emergency Medicine, Vice Chair of Education and Residency Program Director at the University of Massachusetts Medical School and SAEM President-Elect, give the keynote lecture. Dr. Bird’s talk, “Physician Vitality and Wellness: Achieving Joy in the Practice of Medicine,” focused on the importance of caring for ourselves and preventing burnout to ensure we are prepared to care for our patients.

One exemplary resident from each of the New England emergency medicine programs gave a plenary oral presentation; 49 lightning oral and 53 poster presentations were also provided.

Representatives from AWAEM led a breakout session during lunch. Drs. Tara Overbeeke and Kendra Parekh from Vanderbilt University began the session with a talk on “How to Implement a WAM! Group at your Institution.” This was followed by a mentoring session led by Dr. Tricia Smith from the University of Connecticut.

The entire breakout was coordinated and moderated by Dr. Basmah Safdar from Yale University and Dr. Neha Raukar from Brown University.

SAEM JOURNALS Academic Emergency Medicine (AEM) AEM Announces Resident Editors for 2017-2018 Academic Emergency Medicine (AEM) is pleased to announce two residents have been selected to join the AEM editorial board for the 2017-2018 term. Geoffrey Hays, MD from Indiana University and Andrew Moore, MD from Northwestern University were selected from our largest and most competitive application pool ever.

Geoffrey Hays, MD

According to Mark B. Mycyk, MD, AEM associate editor and coordinator of the resident-in-training program, “The decision this year was not easy—our specialty is lucky to have so many talented and enthusiastic residents interested in this program. If we had the capacity, we would have offered each of our finalists a position on the board.”

During their one year-term on the AEM editorial board, these senior residents will be immersed in every aspect of peer review, editing, and publishing of medical research manuscripts 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.

Andrew Moore, MD

Geoffrey Hays will be entering the final year of a combined 5-year emergency medicine-pediatrics residency program at Indiana University. He hopes his future career involves pediatric critical care.

“The drive for self-improvement, in the context of the inherent murkiness of medicine, has manifested itself in the scholarly journal. To be our best at the bedside we must start from sound knowledge. AEM is a journal focused on proper method, rigorous peer-review, and high-quality research. Participation in that

26

process as a reviewer will only help bolster my efforts to expand the EM knowledge base,” said Hays.

Andrew Moore, who will be entering his final year of a 4-year emergency medicine residency at Northwestern, said “I am excited by the opportunity to gain experience and mentoring in academic publishing and to participate in the peer review process. Sitting on the editorial board will provide an immense educational opportunity that will complement my capabilities and give me valuable experience in the peer review process of a leading medical journal.

I believe this will greatly impact my future career in academic emergency medicine.” Andrew’s plans include a research fellowship after residency.

Their one-year term begins during SAEM17 in Orlando. Next year, we hope to expand this program to the AEM Education and Training journal. For more information on the resident-in-training editor program, please contact Mark B. Mycyk, MD at mmycyk@ cookcountyhhs.org.

IN OTHER NEWS

2017-2018 AACEM Leaders to Take Office in May The 2017-2018 executive committee of the Association of Academic Chairs of Emergency Medicine (AACEM) will take office at the SAEM annual meeting in Orlando in May 2017. Elections for 2017-2018 closed in early March 2017. The AACEM mission is to enhance and support academic departments of emergency medicine as they improve healthcare through high-quality education and research.

ADVERTISE YOUR JOB OPENING! SAEM has two opportunities available for the posting of fellowship and academic positions:

SAEM Pulse EM Job Link

ACADEMIC ANNOUNCEMENTS Temple University David Wald, DO, professor of emergency medicine at the Lewis Katz School of Medicine at Temple University, has been awarded the Lindback Award for Teaching Excellence and Originality. This is Temple University’s most distinguished teaching award. Dr. Wald is recognized for developing creative and effective active learning sessions that have been incorporated throughout the curriculum and serve as the model for future changes. Dr. Wald serves a mentor to both clinical and basic science educators, and has extensively published his educational innovations.

Johns Hopkins University Linda Regan, MD, associate professor of emergency medicine, has been appointed the first vice chair of education for the Department of Emergency Medicine at the Johns Hopkins University School of Medicine. In her new role, Regan will oversee all of the department’s education programs and faculty development related to education. She will also maintain her current role as the program director of the Emergency Medicine Residency Program. Regan joined the Department of Emergency Medicine faculty in 2007.

She is a nationally recognized education leader in the field of emergency medicine and has been the recipient of a number of awards, including the American College of Emergency Physicians Emergency Medicine Faculty Teaching Award and the 2016 Emergency Medicine Residents’ Association Residency Director of the Year Award.

CHAIR OF EMERGENCY MEDICINE Baylor College of Medicine seeks to recruit a dynamic leader for the inaugural Chair of Emergency Medicine in the newly created Department of Emergency Medicine. This individual will be recognized for excellent leadership in patient care, education, and research on a scale that merits national preeminence.

With several clinical sites including Ben Taub Hospital’s ACS verified Level I Trauma center with 95,000 visits; the flagship Baylor St. Luke’s Medical Center with 35,000 visits (a Catholic Health Initiatives joint venture), and the Michael E. DeBakey VA Medical Center, the Chair will have a unique opportunity to transform Emergency Medicine from a Division within the Department of Medicine into a regionalized, community emergency medicine service.

Significant vision, communication and collaboration skills, accompanied by an entrepreneurial spirit and strong business acumen, are required to effectively lead the combined clinical, research, and educational enterprise. The successful candidate will possess significant experience expanding a prominent Emergency Medicine Division/Department within a competitive marketplace.

This individual must have the collaboration skills to support faculty in their academic, teaching and clinical endeavors, as well as cultivating their relationship with private practice physicians.

Baylor College of Medicine (BCM): The only private medical school in the greater Southwest, BCM is an internationally renowned medical and research institution that attracts students from around the world. BCM consistently ranks among the top of the nation’s 147 medical schools for research and primary care.

Please submit nominations and/or curriculum vitae to the search consultant: Jannah Hodges, Managing Partner, Hodges Partners 2911 Turtle Creek Blvd., Suite 300, Dallas, TX 75219 Phone: 214.902.7901 E-mail: jannah@hodgespartners.com

SEE YOU IN

Indiana University

Peter S. Pang, MD

Frances Russell, MD

Peter S. Pang MD, and Frances Russell, MD, from the Department of Emergency Medicine at Indiana University School of Medicine, were awarded R34HL136968 for B-lines Lung Ultrasound Guided ED Management of Acute Heart Failure (BLUSHED-AHF). This multi-site, randomized, controlled pilot trial will test whether a lung-ultrasound (LUS) guided strategy better decongests patients vs. usual care. The design of this study is to generate the necessary and sufficient data for a larger, more definitive study. Other BLUSHED-AHF sites include Wayne State (Phillip Levy, MD and Rob Ehrman, MD) and Vanderbilt University (Sean Collins, MD and Robinson Ferre, MD). Vicki Noble, MD, at Case Western Reserve University will run the Core Lab. Christopher O’Connor, MD, at INOVA will be the study chair.

Indianapolis, Indiana – May15-18 27

WESTERN PENNSYLVANIA

EMERGENCY MEDICINE UPMC and University of Pittsburgh UPMC has a long history of emergency medicine excellence, with a deep and diverse EM faculty also a part of the University of Pittsburgh. We are internationally recognized for superiority in research, teaching and clinical care. With a large integrated insurance division and over 20 hospitals in Western Pennsylvania and growing, UPMC is one of the nation’s leading health care systems. We do what others dream — cutting edge emergency care inside a thriving top-tier academic health system.

We can match opportunities with growth in pure clinical or mixed careers with teaching, research, and administration/ leadership in all settings — urban, suburban and rural, with both community and teaching hospitals. Our outstanding compensation and benefits package includes malpractice without the need for tail coverage, an employer-funded retirement plan, generous CME allowance and more.

To discuss joining our large and successful physician group, email emcareers@upmc.edu or call 412-432-7400.

EOE Minority/Female/Vet/Disabled

28

72714C HRI&E 02/17

DEPARTMENT OF EMERGENCY MEDICINE Yale School of Medicine

Seeking qualified applicants for the Yale Drug Abuse, Addiction and HIV Research Scholars (DAHRS) program, a three year post-doctoral program preparing investigators for careers focusing on drug abuse, addiction and HIV in general medical settings.

Scholars earn the Master in Health Sciences research degree that combines vigorous research methodology, statistics and design didactics in small group sessions and seminars covering topics related to drug abuse, addiction and HIV, leadership, grant writing and responsible conduct of research. Candidates complete mentored research project(s), multiple manuscripts, and apply for independent funding.

Additional information and application instructions: http://medicine.yale.edu/dahrs Applicants may also contact Gail D’Onofrio, MD, MS dahrs@yale.edu Yale is an Equal Opportunity/Affirmative Action Employer

I am a

DJ

I am

Joffre Johnson I am an

Academic Emergency Physician

Supported in part by

The purpose of the “I am SAEM” campaign is to emphasize the importance of stress management, to improve provider well-being, and to promote academic emergency medicine as a career path. If you or someone you know has a unique or noteworthy outside interest or activity that helps you achieve work-life balance, please share your story with us! Read Joffre’s full story at "I am SAEM".

Watch Joffre's Video!

29

The University of California, Davis School of Medicine, Department of Emergency Medicine is conducting a faculty search for an Emergency Medicine physician to serve as Vice Chair for Clinical Operations. For the qualified individual, there are substantial opportunities for leadership and growth within the Department and the School of Medicine. Candidates must be residency trained in Emergency Medicine with board certification and be eligible for licensure in California.

Prior leadership positions including those involving clinical operations, patient safety and quality of care are desired. Candidates are expected to enter at the Associate or Professor level, commensurate with experience and credentials.

The University of California, Davis, Medical Center, one of the nation’s “Top 50 Hospitals,� is a 613 bed academic medical center with approximately 80,000 emergency department visits annually, including approximately 17,000 pediatric visits. The emergency services facility opened in 2010 and is state-of-the-art. Our program provides comprehensive emergency services to a large local urban and referral population as a level 1 trauma center, paramedic base station and training center. The department also serves as the primary teaching site for a fully accredited EM residency program and eight different EM fellowship programs. Our residency training program began more than twenty years ago and currently has 42 residents. The Department has a separate area for the care of children and is one of the leading centers in the Pediatric Emergency Care Applied Research Network (PECARN).

Salary and benefits are competitive and commensurate with training and experience. Sacramento is located near the northern end of California's Central Valley, close to Lake Tahoe, San Francisco, and the "wine country" of the Napa and Sonoma Valleys. Sports enthusiasts will find Sacramento's climate and opportunities ideal.

For consideration, a letter outlining interests and experience along with curriculum vitae should be sent to https://recruit.ucdavis.edu/apply/JPF01544.

Contact info: Erik Laurin, MD, Professor and Search Committee Chair (eglaurin@ucdavis.edu), UC Davis Department of Emergency Medicine 2315 Stockton Blvd., PSSB 2100, Sacramento, CA 95817.

For full consideration, applications must be received by August 30, 2017. The position will remain open until filled, through June 30, 2018. The University of California, Davis, is an affirmative action/equal opportunity employer with a strong institutional commitment to the achievement of diversity among its faculty and staff.

This position may, at times, require the incumbent to work with or be in areas where hazardous materials and/or infectious diseases are present. Specific hazards of the position may include, but are not limited to, treating Hepatitis B patients, HIV patients, other infectious diseases, and also patients who may inflict physical harm.

30

Academic Emergency Medicine

At the Medical College of Wisconsin in Milwaukee

Academic Emergency Medicine

The Academic Department of Emergency Medicine is one of the oldest Departments in the United States. Our residency program was established in 1978, and recently expanded to ten residents per year At the Medical College of Wisconsin in Milwaukee with strong hospital affiliate support, including the VA Medical Center.

We are interested in recruiting new faculty to our Department.

The Academic Department of Emergency Medicine is one of the oldest Departments in the Our ED at Froedtert Hospital, our primary affiliate, recently completed United States. Our residency program was established in 1978, and recently expanded to ten an expansion and we are increasing our daily physician coverage hours. We are recruiting for two faculty candidates to complete our residents per year with strong hospital affiliate support, including the VA Medical Center. coverage at this primary academic site. In addition, the Froedtert We are interested in recruiting new faculty to our Department.

Health System recently opened a free-standing ED at the Moorland Reserve Health Center in July, 2016. Our faculty is responsible for Our ED at Froedtert Hospital, our primary affiliate, recently completed an expansion and we are staffing this ED. Faculty members have the opportunity to work at one or both of these sites. increasing our daily physician coverage hours. We are recruiting for two faculty candidates to The Department of Emergency Medicine at MCW is nationally and complete our coverage at this primary academic site. In addition, the Froedtert Health System internationally recognized in academic areas including EMS and recently opened a free‐standing ED at the Moorland Reserve Health Center in July, 2016. Our Disaster Medicine, Toxicology, Injury Prevention and Control, Cardiac faculty is responsible for staffing this ED. Faculty members have the opportunity to work at one Resuscitation, Global Health, Ultrasound, Medical Education, and ED or both of these sites.

Process Improvement. The Department is ranked in the top 20 NIH funded departments of emergency medicine.

The Department of Emergency Medicine at MCW is nationally and internationally recognized in Interested applicants should submit a curriculum vitae and letter academic areas including EMS and Disaster Medicine, Toxicology, Injury Prevention and of interest to Dr. Stephen Hargarten, Department Chairman at Control, Cardiac Resuscitation, Global Health, Ultrasound, Medical Education, and ED Process hargart@mcw.edu.

Improvement. The Department is ranked in the top 20 NIH funded departments of emergency medicine.

Director of Quality Improvement The Emergency Services Institute at Cleveland Clinic is currently seeking a Director of Quality Improvement to oversee quality assurance/ improvement at 15 emergency departments with over 550,000 annual visits.

Qualified candidates will be board certified in Emergency Medicine.

Fellowship training in Patient & Safety Quality and/or a Master’s Degree in Business Administration, Public Health, Quality, or Healthcare Administration and 3-5 years of quality improvement experience in a large health system is preferred. Responsibilities will include peer review, quality metrics, and accreditation across the enterprise.

The Emergency Services Institute (ESI) at Cleveland Clinic is made up of 15 full service Emergency Departments which includes our Main Campus, 8 Regional Hospitals, 2 pediatric emergency departments, 3 free standings, and our hospital in Weston, Florida. This dynamic opportunity offers an extremely competitive salary enhanced by an attractive benefits package and a collegial work environment.

Interested candidates should submit an application online by going to

www.clevelandclinic.org/careers

and search under Physician Opportunities We are proud to be an equal opportunity employer.

Smoke-free/ drug-free environment.

Interested applicants should submit a curriculum vitae and letter of interest to Dr. Stephen Hargarten, Department Chairman at hargart@mcw.edu.

Department of Emergency Medicine Yale University School of Medicine

Advancing the Science and Practice of Emergency Medicine

Director of Quality Improvement

The Department of Emergency Medicine at the Yale University School of Medicine has a total of 4 clinical sites: Adult Emergency Services at York Street Campus; Shoreline Medical Center; Saint Raphael’s Campus; and the West Haven VA Emergency Department with a combined ED volume of 195,000 visits per year. We are seeking faculty at all levels with interests in clinical care, education or research to enhance our existing strengths. Interest and/or experience in observation medicine is a plus.

The successful candidate may be a full time clinician committed to excellence in patient care and emergency medicine education or one that would want to join the academic faculty promoting scholarship to enhance the field of emergency medicine. We offer an The Emergency Services Institute at Cleveland Clinic is extensive faculty development program for junior and more senior faculty. We have a well-established track record of interdisciplinary currently seeking a Director of Quality Improvement to collaboration with other renowned faculty, obtaining federal and private foundation funding, and a mature research infrastructure oversee quality assurance/ improvement at 15 emergency supported by a faculty Research Director, a staff of research associates and administrative assistants.

departments with over 550,000 annual visits. Qualified candi-

dates will bemedicine. board certified in Emergency Medicine.

Fellowship Eligible candidates must be residency-trained and board-certified/-prepared in emergency Rank, protected time and salary training in Patient & Safety Quality and/or a Master’s Dewill be commensurate with education, training and experience.

gree in Business Administration, Public Health, Quality, or Health-

Yale University is a world-class institution providing a wide array of benefits and research opportunities. care Administration and 3-5 years of quality improvement

The Em made u cludes gency d Florida. salary e work en

experience in a large health system is preferred. Responsibilities

Interest applica

the enterprise.

ww

To apply, please forward your CV and cover letter to Gail D’Onofrio, MD, MS Chair, via email: jamie.petrone@yale.edu, or mail: will include peer review, quality metrics, and accreditation across Yale University School of Medicine, Department of Emergency Medicine, 464 Congress Ave, P.O. Box 208062, New Haven, CT 06519-1315.

Yale University is an affirmative action, equal opportunity employer. Women and groups are encouraged Wemembers are proudoftominority be an equal opportunity employer. to apply.

Smoke-free/ drug-free environment.

and sea

31

Yale University School of Medicine Department of Emergency Medicine Fellowship Programs For specific information including deadlines and requirements, visit: http://medicine.yale.edu/emergencymed/ The Research fellowship is a 2-3 year program focused on training clinician scholars as independent researchers in Emergency Medicine. Scholars will earn a Master of Health Sciences degree from Yale combining clinical experience with extensive training in research methods, statistics and research design.

With the guidance of research content experts and professional coach mentors, the scholar will develop a research program, complete a publishable project and submit a grant application prior to completion of the program. The program is credentialed by the Society for Academic Emergency Medicine. For further information, contact Steven L. Bernstein, MD, steven.bernstein@yale.edu.

The fellowship in Emergency Ultrasound is a 1 or 2 year program that will prepare graduates to lead an academic/community emergency ultrasound program. The 2-year option includes a Master of Health Sciences with a focus on emergency ultrasound research. This fellowship satisfies recommendations of all major societies for the interpretation of emergency ultrasound, and will include exposure to aspects of program development, quality assurance, properties of coding and billing, and research. The program consists of structured time in the ED performing bedside examinations, examination QA and review, research into new applications, and education in the academic/ community arenas. We have a particular focus on emergency echo and utilize state of the art equipment, as well as wireless image review. Information about our Section can be found at http://medicine.yale.edu/emergencymed/ultrasound/ For further information, contact Chris Moore, MD, RDMS, RDCS, chris.moore@yale.edu, or apply online at www.eusfellowships.com.

The fellowship in EMS is a 1-year program that provides training in all aspects of EMS, including academics, administration, medical oversight, research, teaching, and clinical components. The ACGME-accredited program focuses on operational EMS, with the fellow actively participating in the system’s physician response team, and all fellows offered training to the Firefighter I or II level. A 1-year MPH program is available for fellows choosing additional research training. The fellowship graduate will be prepared for a career in academic EMS and/or medical direction of a local or regional EMS system, and for the new ABEM subspecialty examination.

For further information, contact David Cone, MD, david.cone@yale.edu.

The Administration fellowship is a new 2-year program that will prepare graduates to assume administrative leadership positions in private or academic practice. By having an active clinical practice in our department, the fellow will acquire experience in all facets of emergency department clinical operations. Fellows will complete the Executive MBA program at the Yale School of Management and a clinical Emergency Medicine Administrative Fellowship. In addition, the candidate will play a leadership role on one or more projects from the offices of the Chair and Vice Chair for Clinical Operations. For further information, contact Andrew Ulrich, MD, andrew.ulrich@yale.edu.

The Global Health and International Emergency Medicine fellowship is a 2-year program offered by Yale in partnership with the London School of Hygiene & Tropical Medicine (LSHTM). Fellows will develop a strong foundation in global public health, tropical medicine, humanitarian assistance and research. They will receive an MSc from LSHTM, a diploma in Tropical Medicine (DTM&H) and complete the Health Emergencies in Large Populations (HELP) course offered by the ICRC in Geneva. In addition, fellows spend 6 months in the field working with on-going Yale global health projects or on an independent project they develop. For further information, contact the fellowship director, Hani Mowafi, MD, MPH, hani.mowafi@yale.edu.

NIDA K12: Partnering with Yale’s Clinical and Translational Sciences (CTSA), Robert Wood Johnson Foundation Clinical Scholars Program, the Center for Interdisciplinary Research on AIDS (CIRA) and the VA Connecticut Healthcare we are offering the Yale Drug Abuse, HIV and Addiction Scholars K12 Research Career Development Program. The DAHRS K12 Scholars Program provides an outstanding 2-3 year research training experience that offers a Master of Health Science, a mentored research program as well as career and leadership development activities. For further information, contact Gail D’Onofrio, MD, MS, gail.donofrio@yale.edu.

The Wilderness Medicine fellowship is a 1-year program that provides the core content of medical knowledge and skills in being able to plan for and to provide care in an environment that is limited by resources and geographically separated from definitive medical care in all types of weather and evacuation situations. The fellow will be supported to obtain the Diploma in Mountain Medicine and other Wilderness Medical education. The fellow will become a leader and national educator in the growing specialty of wilderness medicine. For further information, contact David Della-Giustina, MD, FAWM, david.della-giustina@yale.edu.

The Medical Simulation fellowship is a 1-year program that provides training in all aspects of simulation education, including high fidelity mannequin simulation with computer program training, acquisition of debriefing skills and procedural simulation. The fellow will participate in all educational programs for medical students, residents and faculty at the new Yale Center for Medical Simulation (opened the winter of 2014-15). The fellow will receive training in research methodology through the Research Division of the Department of Emergency Medicine and participate in the medical education fellowship through Yale Medical School. The fellow will attend a one week Comprehensive Instructor Workshop at the Institute for Medical Simulation in Boston. The fellow will also have the opportunity to participate in an international exchange through the Yale-China Association Xiangya School of Medicine. For further information, contact Leigh Evans, MD, leigh.evans@yale.edu.

The Clinical Informatics fellowship is a 2-year program that provides ACGME-approved training in all aspects of clinical informatics. The program is administered through the Yale Department of Emergency Medicine. In the first year, the fellow will rotate between the Yale-New Haven Health and Veterans Affairs. Major blocks will be devoted to electronic health records, clinical decision support, databases and data analysis, and quality and safety. Experiential learning will be combined with didactic classes and conferences. The second year is dedicated to advanced learning and project leadership. The fellow will attend the American Medical Informatics Association annual meeting. The program prepares fellows for Clinical Informatics Board examination. For further information, contact Cynthia Brandt, MD, PhD, cynthia.brandt@yale.edu or Richard Shiffman, MD, richard.shiffman@yale.edu.

All require the applicant to be BP/BC emergency physicians and offer an appointment as an Instructor to the faculty of the Department of Emergency Medicine at Yale University School of Medicine. Applications are available at the Yale Emergency Medicine web page http://medicine. yale.edu/emergencymed/ and are due by November 15, 2017 with the exception of the Wilderness Fellowship, which are due by October 15, 2017.

Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women, persons with disabilities, protected veterans, and members of minority groups are encouraged to apply.

32

May 16-19 • Hyatt Regency • Orlando