SAEM Pulse November-December 2021

NOVEMBER-DECEMBER 2021 | VOLUME XXXVI NUMBER 6

www.saem.org

SPOTLIGHT A CHAMPION FOR PHYSICIAN WELL-BEING AND GENDER EQUITY An Interview with

Michelle D. Lall, MD, MHS

DON’T HESITATE, INNOVATE! A MACGYVER SOLUTION TO A COMMON PROBLEM page 14

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

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

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

Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Specialist, Membership Recruitment Berenice Lagrimas Ext. 222, blagrimas@saem.org Planner, Meetings Margaret Rivera Ext. 218, mrivera@saem.org Senior Membership & Meetings Coordinator Monica Bell, CMP Ext. 202, mbell@saem.org

HIGHLIGHTS 3

President’s Comments Stop the Stigma EM: A Call to Action and Commitment to Change

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Sex & Gender in EM Sex and Gender Differences in COVID-19

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Spotlight A Champion for Physician Well-Being and Gender Equity – An Interview with Michelle D. Lall, MD, MHS

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Social EM Hoops for Health: EM Residents Respond to Public Recreation Closures During COVID

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Clerkship Corner How COVID Changed Our Medical Education

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Virtual Realities Success at Every Level: How to Ace Virtual Recruitment Season

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Clubhouse and Twitter Spaces: Medical Education and Networking Through a Pandemic

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Wellness A Picture of a Smiling Face: Humanizing Front Line Workers During the Pandemic

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Searching for Healing and Understanding in a Time of Anti-Asian Violence

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Addressing the COVID-19 INFODEMIC

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SAEM’s Medical Student Ambassador Program: A One-of-a-Kind Opportunity

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Critical Care Medical Right to Repair: A Primer for Emergency Physicians

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The Cutting Edge Don’t Hesitate, Innovate! A MacGyver Solution to a Common Problem

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Diversity, Equity & Inclusion Trans Patients, Trans Selves

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EM Education “Resident, Know Thyself:” The Challenge of Assessing Self-awareness and Well-being in Milestone 2.0

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Climate Change: A Guide for Optimizing the Learning Environment

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Teaching and Learning on the Job: Maximize Your Efficiency Using Learning Theories

Associate Editor, Pulse RAMS Section Aaron R. Kuzel, DO, MBA aaron.kuzel@louisville.edu

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Geriatric EM Transformation of the Digital Health Care Landscape — Older Adults Included

2021–2022 BOARD OF DIRECTORS

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Global EM 10 Years Later: The Effect of Egypt’s Revolution on Emergency Response Systems

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

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

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The Formation of the First Student-Led EM Interest Group in Uganda

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

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

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Health Policy Highlight The Dr. Lorna Breen Health Care Provider Protection Act

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EM Research 5 Questions Research-Bound EM Medical Students Should Ask Attendings: An Interview With Dr. James Paxton

Director, Governance Snizhana Kurylyuk Ext. 201, skurylyuk@saem.org Manager, Governance Michelle Aguirre, MPA Ext. 205, maguirre@saem.org Director, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Journals and Communications Tami Craig Ext. 219, tcraig@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Senior Manager, Development for the SAEM Foundation Julie Wolfe Ext. 230, jwolfe@saem.org

AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Tami Craig Ext. 219, tcraig@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org

Pooja Agrawal, MD, MPH Yale University School of Medicine

Ava Pierce, MD UT Southwestern Medical Center, Dallas

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

Ali S. Raja, MD Massachusetts General Hospital/Harvard

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

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

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

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SAEMF Grantees Make a Difference in the Understanding of COVID-19

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Your Gift to SAEMF Has Tangible Impact

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SAEMF Announces Challenge Winners

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Briefs and Bullet Points

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Academic Announcements

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Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2021 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

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

Stop the Stigma EM: A Call to Action and Commitment to Change

“Together, we can lift the toxic stigma of shame, isolation, silence, and loneliness that result from misguided perceptions, beliefs, and policies regarding mental illness.”

Stop the Stigma EM: A Toolkit for Individuals, Educators & Institutions

SAEM officially launched the “Stop the Stigma EM” campaign in early September and brought together a coalition of emergency medicine (EM) organizations to form an EM Mental Health Collaborative to increase awareness, advocacy, and policy action to breaking down the barriers to mental health care in emergency medicine.

The fact is that most people can be successfully treated for their mental illness, but only a minority of adults in the U.S. who need services and treatment get the help they need. And, the annual National Physician Suicide Awareness Day, with the goal of taking steps to mitigate the unacceptably high proportion of physicians who die by suicide or are crippled by mental illness, occurred on September 17, 2021.

Together, we can lift the toxic stigma of shame, isolation, silence, and loneliness that result from misguided perceptions, beliefs, and policies regarding mental illness. We know that 400 physicians die by suicide every year, and more than half of physicians know a physician who has considered, attempted, or died by suicide. Simply being a physician as one’s profession is one of the greatest risk factors and predictors for suicide attempts and successful completion of suicide. And, emergency physicians are among the medical specialties at highest risk for suicide and also have higher rates of career burnout (upwards of 65% of emergency physicians report burnout) and posttraumatic stress disorder (PTSD).

Unfortunately, burnout has consequences for patients, patient safety, and patient outcomes, as well, as it is associated with increases in medical errors.

The importance of mental health has taken on even more criticality for our specialty as COVID-19 has impacted the

mental health of EM physicians across the world. Since the pandemic, 90% of EM physicians say that they are under more stress, and 72% report professional burnout. Yet, a national poll released on October 26, 2020 indicated that 45% of the nation’s emergency physicians do not feel comfortable seeking mental health treatment, and 57% stated that they would be concerned about losing their medical licenses or face career setbacks by doing so. Licensing boards throughout the country require disclosure by physicians of current or past mental health care, and hospitals often require disclosure for credentialing. The fact is that mental illness is handled quite differently than medical illness by hospital and licensing entities.

It is therefore no surprise that many of us personally know the stigma to be a reality.

We know that we or one of our colleagues have declined mental help because of fears that we will be thought of as “less than” or weak for seeking help. Objectively, 27% of emergency physicians have avoided seeking mental health treatment for fear of professional consequences. Yet, it takes courage to admit vulnerability and allow for health and well-being to be reestablished for the individual and our community. The Stop the Stigma EM campaign is aimed towards doing just that. It is our call to action for policy makers, EM department chairs, residency program directors, individuals and organizations to commit to its objectives.

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

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SPOTLIGHT A CHAMPION FOR PHYSICIAN WELL-BEING AND GENDER EQUITY An Interview With Michelle D. Lall, MD, MHS Dr. Michelle D. Lall, a board-certified emergency medicine physician, is an associate professor at Emory University, where she has maintained a faculty position since 2013 and served for seven years as associate residency director.

She is currently the inaugural director of well-being, equity, diversity, and inclusion for the Emory department of emergency medicine and the fellowship director for medical education in the department of emergency medicine.

Prior to returning to Emory, Dr. Lall was an assistant professor at Wayne State University, assistant residency director for the Sinai-Grace/Wayne State University emergency medicine residency program, and medical student clerkship site director at Sinai-Grace/Wayne State University.

Dr. Lall is actively involved in the teaching and supervision of medical students and residents. Her primary interests are physician well-being and the negative impact of gender bias on equity and inclusion in medicine. Dr. Lall is active in investigating gender differences in burnout among physicians. She has presented didactics on physician wellbeing and gender bias in medicine at multiple signature regional and national annual meetings of medical educators.

Dr. Lall is part of a national emergency medicine work group focused on exploring and addressing gender and racial bias and disparities in academic emergency medicine.

Dr. Lall and family: L-R, husband Tom and children Graham (9), Carmen (11), Kai (7), and Dr. Lall

Dr. Lall is a member-at-large of the SAEM Board of Directors and a past president of SAEM’s Academy for Women in Academic Emergency Medicine (ADIEM). Her other professional memberships include the American Association of Women Emergency Physicians, Georgia College of Emergency Physicians, and American College of Emergency Physicians, where she is a fellow. She is also a member of the Delta Omega Honor Society.

Dr. Lall is a recipient of the Momentum Award from the Academy for Women in Academic Emergency Medicine (AWAEM), which recognizes extraordinary efforts that further the mission and values of AWAEM. While at SinaiGrace/Wayne State University, Dr. Lall was a two-time "Faculty Teacher of the Year" award winner; she is a two time recipient of Emory's “Faculty Advocate of the Year” award. In 2020, Dr. Lall was named one of the Emergency Medicine Residents’ Association (EMRA’s) 25 Under 45 Influencers in emergency medicine whose contributions embody the spirit of the specialty.

Dr. Lall and husband Tom at home

Dr. Lall is a graduate of Wayne State University School of Medicine in Detroit. She completed her residency training at Emory University where she served as chief resident.

“Clinicians should never feel shame or guilt in seeking the care that they need.”

Why did you choose the emergency medicine specialty? When and why did you choose to work in academics? What has surprised you most about working in academic emergency medicine?

Dr. Lall's daughter, Carmen, with the family pets

There are many reasons that I chose EM as a specialty. First, I have always been drawn to situations that require urgency and leadership. When I was eight years old, I wanted to be a 911 dispatcher so that I could help people when they needed it most, and I would say that was when my love of EM began. However, I have always loved school and wanted to be a teacher as well.

I enjoy the comradery and continuous learning that is part of formal education. As I matriculated, I realized that academic EM would be the perfect fit for me. I knew during medical school that I would stay in academics and that was further solidified during my residency. My passion for working with learners of all levels and innovating in EM has anchored me in academics.

The specialty’s drive to be a leader in all of academic medicine across all specialties has been a pleasant surprise.

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Dr. Lall’s cats, Mocci and Pistachio

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What do you find most challenging about the work you do? Conversely, what do you find most rewarding about the work you do?

Seeing tragedy and death on a regular basis is arduous. There are those cases that haunt you, and after a difficult case, it can be challenging to bounce back and take care of the next patient waiting for you.

There are many things that I find rewarding about EM including the breadth and diversity of the medicine. Moreover, the opportunity to practice with and privilege of educating learners, patients and their families remains paramount to my enjoyment of the field. Additionally, EM leads the field of medicine in so many arenas that it is a privilege to be part of that group.

If you weren’t doing what you do, what would you be doing instead?

My sister, also an EM physician, and I always said we would open a hut on a beach and sell trinkets. But realistically if I wasn’t in medicine, I would probably be working as a teacher, as education would remain central to my personal happiness.

Stigma is a leading barrier to mental health care for emergency physicians. Many fear that treatment for mental illness could jeopardize their careers or their licenses to practice. What would you say are the key challenges to addressing this stigma?

As medical professionals, we need to accept and recognize that mental illness is like any other systemic illness. Clinicians are not required to disclose other types of acute or chronic illness to licensing boards so why should mental illness be any different? Next steps include continuing national efforts like the “Stop the Stigma in EM” campaign and advocating for the removal of mental health questions from state licensing organizations.

SAEM PULSE | NOVEMBER-DECEMBER 2021

What advice would you give EM physicians who are struggling emotionally, physically, and/or mentally, but are too afraid to seek help?

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You are not alone, and it is okay to not be okay. The work we do is incredibly challenging (emotionally, physically, mentally) and the COVID-19 pandemic has been no exception. We have all heard about compassion fatigue and burnout, but it remains paramount to recognize that if you feel like you have lost your resilience and lost yourself that maybe you are experiencing something more like depression, anxiety, or PTSD. Clinicians should never feel shame or guilt in seeking the care that they need. I’m sure that with many other medical conditions individuals wouldn’t feel shame or guilt in accessing care.

What can be done to create a sense of safety for EM physicians and medical trainees that would encourage them to ask for help or self-report when they’re struggling with their mental health?

Culture change takes time, and the removal of stigma around accessing services for mental health will likely take longer than

Dr. Lall and daughter Carmen in the north Georgia mountains (top) and at the Great Sand Dunes (bottom)

expected. As a specialty I think we must continue dialogue relative to the losses we have suffered with emergency physician suicide and those that have left the field because of burnout. Perhaps if more of us are willing to share our stories, over time we can erase the stigma. Additionally, every institution needs to be cognizant that the mental health and well-being of health care staff is currently at an all-time low.

Our system is broken, and we must work actively from the highest levels of leadership to remedy the situation.

EM culture has traditionally valued self-sacrifice above self-care… What steps can be taken to begin to change this culture?

Across all specialties the culture of medicine has traditionally valued self-sacrifice over self-care. However, we are slowly seeing change with younger physicians that have different expectations about their work-life integration. In EM, we have studied our own wellness and recognize that appropriate boundaries to protect time for oneself and one’s loved ones is critical for maintaining a healthy and fulfilling professional and

personal life. Change can begin with small steps. Disconnect from your email. An email you receive at 8 p.m. can wait until the following morning. Recognizing that we have irregular working hours, consider putting a footer on your email encouraging others to read and return your message during their regular working hours. If an individual has a day completely free of work-related responsibilities, that time should be prioritized for personal use.

How do you personally manage stress and maintain work/life balance, particularly during this unprecedented time of COVID? What do you think the EM specialty can do to address COVID-related stress and improve physician well-being?

I manage stress with pretty much any activity that will let my mind shut down and go on auto pilot. I enjoy regular exercise including running, swimming, biking, and strength training. I love to read and listen to audiobooks. I newfound hobby during the pandemic was to assemble puzzles. Additionally, I love to spend time with my family. Making family time a protected and prioritized time on my schedule is paramount to my wellness.

As a specialty, I think we need to recognize that variable shift times and the multitude of nonclinical work can be challenging and that we all need recovery time from the demands of our profession.

COVID has exacerbated many of our regular personal and professional stressors. As a specialty, it is imperative to encourage each another to take time to decompress and reflect on how challenging COVID has been. We have been and remain the front line of this pandemic. It has been exhausting. I have heard myself and others say, “I don’t have any more resilience” or “I am so exhausted from all of this, and I don’t have the energy to do anything else.” These are cries for help. We need to empower EM physicians to take the time they need to reflect and recover. We have been in the morass of this for a year and a half and must recognize that it may take a year and half or more to recover. Remember to prioritize yourself, your family/friends, and things that bring you joy.

Race and gender inequalities, even when openly acknowledged, are challenging and emotional topics for many. How would you suggest people learn more about these subjects and engage in meaningful dialogues to bring about change? What do you see as the biggest obstacles to achieving substantial diversity in the EM workforce?

Racial and gender inequity exists in all fields of medicine and emergency medicine is no exception. To move the needle forward and advance work in this arena, the first step is education and recognition by leaders that there is room to grow.

Programs that educate on bias in hiring practices, implicit bias, the effects of bias, and mistreatment in the workplace are a great first step. If we want to increase the number of women and those individuals underrepresented in emergency medicine, we need to start earlier in the trajectory of students. We need to be diligent to increase pipeline and mentoring programs from a young age, even as early as middle school. If we only target and engage those who have matriculated into medical school, we will have already placed ourselves behind the proverbial eight ball.

“If we want to increase the number of women and those individuals underrepresented in emergency medicine, we need to start earlier in the trajectory of students.”

Up Close and Personal Who would play you in the movie of your life and what would that movie be called?

1980’s Sigourney Weaver and the title would be ‘Insanity Reigns’ Name three people, living or deceased, whom you would invite to your dream dinner party.

Ruth Bader Ginsburg, Marie Curie, Freddie Mercury What's the one thing about you few people know?

I was a collegiate volleyball player and for a time held the all-time assists record for Johns Hopkins.

What is your guiltiest pleasure (book, movie, music, show, food, etc.)?

Binge watching TV series that everybody else watched years ago. I’m a bit behind the times.

What is your most prized possession?

To be honest I don’t prize possessions as much as experiences.

You have a full day off… what do you spend it doing?

Ideally, I would spend it sleeping in, getting in a workout, going for a massage, spending some time watching TV or reading and then spending the evening with my family. How do I realistically spend a day off, usually catching up on life things and household things but then also trying to squeeze in one or two of the aforementioned activities.

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SAEM PULSE | NOVEMBER-DECEMBER 2021

CLERKSHIP CORNER

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How COVID Changed Our Medical Education

By Nathan Lewis, MD and J. Scott Wieters, MD on behalf of the SAEM Clerkship Directors in Emergency Medicine The SAEM Clerkship Directors in Emergency Medicine (CDEM) academy strives not only to provide the best educational tools and resources for students, but also to understand their experiences. Recently on EM Stud, the official student podcast for CDEM, Drs. Nathan Lewis and J. Scott Weiters, cohosts of the podcast, invited medical students from across the country to share how the COVID-19 pandemic impacted their medical education. A partial transcription of the episode, originally recorded in April 2021, follows. Listen to the full podcast at www.emstud.com, on Apple Podcasts, Google Podcasts, Spotify, or SoundCloud. EM Stud covers a range of topics including how to excel on clerkships, EM subspecialties, residency application and interviewing tips, and much more.

Dr. Wieters: Nate, this was a year that none of us have ever seen in medical education. We didn’t have this when we were medical students, but we’ve got some students today that have experienced and walked the walk in what it looks like to be educated during a pandemic.

Dr. Lewis: Yeah, Scott…As you know, we’ve gone back and forth a lot about just all the changes related to the residency application process, interviews, going through the match statistics. But we really haven’t been able to get the student perspective yet. And so today, we have with us eight students to tell us

about how COVID has impacted their medical education and their medical education experience over the past year.

Dr. Wieters: We’ve got a really good representation, a lot of different years, a lot of different schools, and so, we’re very interested to learn how medical school looked during a pandemic. Nate, what’s on your mind? What are you interested in getting to know from these folks?

Dr. Lewis: I’m curious to hear from our students just exactly how things are going. I mean, obviously it’s been a very long year, a lot of changes, but how are things going now? Are things roughly back to normal?

Kayla Nussbaum: I would say at Dell for our nonclinical students, things are not back to normal. Most lessons are still over Zoom or online and asynchronous.

But our clinical students are back in the hospital, back on rotations as scheduled. and things feel pretty normal in the hospital.

Callie Adams: At Texas Tech, I think that our school did a pretty good job trying to keep things as normalized as they could from the beginning, but they are starting to get back to our new normal. I don’t think there will ever be anything that continued on Page 10

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CLERKSHIP CORNER

SAEM PULSE | NOVEMBER-DECEMBER 2021

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goes back to quite like it was. For right now our OSCEs (Objective Structured Clinical Examination), and things like that, are still virtual but for our next rotation, which is the last one of third year, we will be back in person and finals week will be back in person. So we are moving towards that direction.

The first and second years still have a pretty heavy virtual component, but that was already something that was built into our first and second year curriculum where you could have that flexibility to stream and do things online. It was really just the testing that changed quite a bit.

Angela Nguyen: At UIW (University of Incarnate Word), I would say things

are going well. I wouldn’t say things are back to normal. At the start of the quarantine we moved to an online platform. There was trial and error in trying to figure out how to make a flipped classroom curriculum work on that type of platform, but now, over a year later, we are more of a hybrid platform. All of our lecture classes, like large groups and small group discussions, are still online, but we do come in once or twice a week for our clinical skills and our anatomy labs.

Dr. Wieters: I remember this well…

We were skiing for spring break with our kids in Colorado and the day after we left to return home, the slopes shut down. We were driving back wondering what it would be like when we got home. Everything was shut down so we immediately bought tons of toilet paper and rice… we were those people.

But when did you first start to feel the impact of COVID on your medical training?

Colton Junod: Here at Indiana we started to really notice it in the middle of March. I was ending my second year, so that was our dedicated month to study for Step 1. All of my classmates were at school together and we got the notification that all of our testing centers had closed and our Steps were postponed. We were nine days before our exams. So that’s when we first felt like it affected our education.

Just around that time IU also pulled all students from clinicals. So, all the third- and fourth-years were taken off of clerkships. And then, of course, the firstyears went online for school as well. So that was really the first time we noticed it, and then of course we continued to feel it over the summer and when

our third year start date was delayed. It was supposed to start at the beginning of May and it ended up starting at the end of June. So our clerkships ended up being shortened to three weeks and six weeks instead of the normal four and eight weeks. That was also one of the first things we felt really in our education.

Angela Nguyen: I think I definitely felt it since the very beginning of quarantine as well. It was really hard not only to find the motivation, but also to focus — to sit down and study with everything else going on in the world. And I think a big part of that also is that all the things I used to do to help refresh and keep myself motivated between study sessions — hanging out with my friends, getting $7 coffees at coffee shops, and normal med school experiences like clinical experiences and actually being able to do clinical skills classes in person, using my hands, stuff like that—were all taken out of the equation. So it did take quite a bit of time and adjustment just trying to get back into the groove of doing med school again.

Juliana Castrillon: We felt the impact pretty early on. I’d say it was late February and we were just about to leave for spring break. We had in our sister hospital what I think was the second patient in New York City to be identified

as COVID positive. At that point, we didn’t know that much about COVID and what the implications were. I think we were expecting it to all blow over pretty quickly. Although it felt like a scary unknown, we still didn’t think it would last this long. It's a year later and we're still feeling the impact of COVID in our hospital and in our medical school. When we left for spring break, we all thought we would be back in person in maybe a few weeks or a month, and I think a few days before we were meant to come back to campus we found out it would likely be for the entire semester that we would be virtual. I think the administration did a great job shifting us to fully virtual education. As several people have mentioned, we did have a lot of online lectures that could be viewed from home.

But given that we were in our first year I think there are a lot of hands-on things that are difficult to do virtually; a lot of clinical skills that are really helpful to do in person and get feedback about in real time. I think that was the hardest part of the transition — not having the in-person components.

To hear the rest of this episode, visit www.emstud.com, or listen on Apple Podcasts, Google Podcasts, Spotify, or SoundCloud.

ABOUT THE AUTHORS Dr. Lewis is an associate professor and attending physician in the department of emergency medicine at Virginia Commonwealth University (formerly Medical College of Virginia) in Richmond, VA. He is also the clerkship director, which is awesome, because he gets to spend a lot of time with some of the best and brightest medical students anywhere in the country. Their enthusiasm and intellectual curiosity is energizing and one of the main driving forces behind developing this blog/ podcast. @ERDrN8 Dr. Wieters is the director of undergraduate medical education for The Scott & White EM Residency Program.

His favorite part of his job is working along side students as course director for the Texas A&M College of Medicine EM Clerkship.

He has been awarded multiple teaching awards, yet is most proud of “meeting expectations” as a trophy husband to his wife, THE Dr. Wieters.

He’s a proud parent of four children who are all “exceeding expectations”. His kids all agree he “needs improvement” in his role as a youth sports coach. @EMedCoach

Podcast Panelists Class of 2021 - Lauren Bayliss, University of Texas Rio Grande Valley School of Medicine

Class of 2022 -C allie Adams, Texas Tech University Health Sciences Center School of Medicine

Class of 2023 - Juliana Castrillon, Columbia University Vagelos College of Physicians and Surgeons

- Kayla Nussbaum, University of Texas at Austin Dell Medical School

-D an Hubbard, Texas College of Osteopathic Medicine

- Angela Nguyen, University of Incarnate Word School of Osteopathic Medicine

- Billy Shank, Texas A&M College of Medicine

-C olton Junod, Indiana University School of Medicine

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

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CRITICAL CARE

Medical Right to Repair: A Primer for Emergency Physicians SAEM PULSE | NOVEMBER-DECEMBER 2021

By Helena Halasz MD; Shuhan He MD; and Jarone Lee MD on behalf of the SAEM Critical Care Interest Group

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If you have ever ordered a McFlurry® at McDonald’s only to be told that the ice cream machines are down, you may be surprised to learn that the reason behind it is the same reason why hospitals during COVID-19 were often left without working equipment.

In the manufacturing industry, it is common practice for companies to sell their products with an exclusive right to perform all necessary repairs going forward. This, along with strict intellectual property-related restrictions, serves as a reliable source of ongoing revenue for manufacturers. However, limitations on consumers’ ability to use third-party repair companies has come under scrutiny in recent years, and the

“Right to Repair legislation could move health care in the United States in a more affordable, sustainable direction.”

“Right to Repair” movement, which petitions for access to information and tools, has gained significant traction.

The problem exists worldwide, across industries ranging from automotive to farming to electronics. In 2012, the state of Massachusetts passed the

country’s first Motor Vehicle Owners’ Right to Repair Act; since then, several other states have followed suit. In March 2020, the European Commission announced plans to instate new right to repair rules that would cover mobile phones, tablets, and laptops.

“Our equipment is like our stethoscopes: we must take care of our tools to be able to take care of our patients. This not only means repairing them when they’re broken, but also ensuring that we can prevent unintended consequences of repair limitations.”

But what happens when the restricted device in question isn’t a cellphone, but rather a decommissioned ventilator that could potentially save a patient's life? During the COVID-19 pandemic, this became a very relevant question.

Hospitals across the world reported a lack of sufficient medical equipment, with shortages of ventilators, decontamination equipment, hemodialysis machines, and personal protective equipment. As cases surged worldwide, health care institutions were faced with unrelenting demand for repair and maintenance related to high use, secondary to increased patient volumes, acuity, and turnover. Due to limitations, these repairs could only be performed by authorized service staff. In many cases, hospitals’ own biomedical engineers, who had the technical knowledge required, lacked both the vital information and permission to attempt repair of essential equipment.

information and resources to biomedical technicians during our fight against COVID-19. Additionally, despite supply chain constraints, several medical device companies ramped up production to try to meet the needs of front-line health care workers.

In August 2020, Oregon Senator Ron Wyden introduced the Critical Medical Infrastructure Right-to-Repair Act of 2020, which aimed to compel manufacturers to provide, on fair and reasonable terms, access to the tools and information that would make it possible for hospitals to take matters into their own hands. Even without legislation mandating them to, many medical device companies provided crucial

These unprecedented times during COVID-19 demonstrated how important collaborations between medical device companies, hospitals and clinicians really are. Our equipment is like our stethoscopes: we must take care of our tools to be able to take care of our patients. This not only means repairing them when they’re broken, but also ensuring that we can prevent unintended consequences of repair limitations. By

On July 9, 2021, President Biden signed an executive order that urges the Federal Trade Commission (FTC) to establish right to repair regulations.

These policies would force manufacturers to give individuals and independent repair shops access to special tools, parts, and diagnostic software, as well as to grant the freedom to service their own products. This federal legislation would remove barriers to maintenance of live-saving devices in a timely fashion.

Furthermore, reports predict that Right to Repair legislation could move health care in the United States in a more affordable, sustainable direction.

working together, these issues can be resolved, but it is crucial to keep the momentum going.

ABOUT THE AUTHORS r. Halasz is a recent graduate D of Semmelweis University (Budapest, Hungary) and an aspiring emergency medicine physician, with a special interest in social emergency medicine and bedside ultrasonography. @halaszhelenamd Dr. He is an emergency medicine physician and faculty member of Harvard Medical School and in the Lab of Computer Science at Massachusetts General Hospital. @shuhanhemd Dr. Lee is an associate professor at Harvard Medical School, director of the Blake 12 ICU at Massachusetts General Hospital, and a member of the SAEM Critical Care Interest Group.

As a medical officer in the National Disaster Medical System, he deploys in response to disasters and other major events. @JaroneLeeMD

Join the SAEM Critical Care Interest Group If you are an SAEM member and are interested in adding the Critical Care Interest Group (CCIG) to your membership, simply log in to your SAEM profile and join today for free. SAEM members who are already part of the CCIG can find more information and resources by visiting the SAEM CCIG Community Site.

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SAEM PULSE | NOVEMBER-DECEMBER 2021

THE CUTTING EDGE

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Don’t Hesitate, Innovate! A MacGyver Solution to a Common Problem

By Ali Dakka, MD and James Bishop, MD Attempting to remove a ring that is stuck on your patient's swollen finger can be a frustrating experience. You try lubricating it. You try using soap and water. You try wiggling it around and pulling with force. However, nothing seems to work.

Now, you must decide whether it is time to invoke the last resort: cutting the patient’s precious ring off with a ring cutter. Time is of the essence in the emergency department (ED), and you have other patients waiting to be seen, not to mention any codes that may come in. How do you solve this dilemma? You think like MacGyver!

Recently, my attending and I were in this situation. We had a patient who presented with significant finger swelling following a fall and distal radius fracture.

After performing a hematoma block and reducing the fracture, we tried to remove her ring with lubricant and then with soap and water. Both attempts failed. We informed the patient that we might have to cut her ring off.

As we were losing hope looking around the room for something we could use, a MacGyver-like idea came to us. We found a supply of patient wristbands and wondered if they could be used to help us slide the ring off. Inspired by furniture sliders, which work by reducing friction between two items, we carefully slipped a wristband between the finger and the ring. Once in place, the wristband functioned as a smooth interface between the finger and the stuck ring.

After some pulling and careful rotation of the ring, the ring came off!

As emergency medicine physicians, we are often challenged to solve our patients’ problems using only the basic tools at our disposal. Through innovation and improvisation, we were able to achieve a successful ring removal for our patient. Fortunately, patient wristbands are typically readily available, so this ring removal technique could easily be applied in the ED setting. Multiple wristbands may be used, but one was sufficient in our case. Watch the video associated with this article to see our technique in action.

When in doubt, think like MacGyver!

ABOUT THE AUTHORS Dr. Dakka is a first-year emergency medicine resident at the Ascension Providence Emergency Medicine residency in Southfield, MI, and a clinical instructor for the Michigan State University College of Human Medicine. He graduated from the Wayne State University School of Medicine in 2021 and the University of Michigan-Ann Arbor in 2017 with a major in cellular and molecular biology.

Dr. Bishop is the associate program director for the Ascension Providence Emergency Medicine residency, Southfield, MI and an assistant professor of emergency medicine for Michigan State College of Human Medicine and College of Osteopathic Medicine. He has over 20 years of experience and is a partner with Independent Emergency Physicians. He is a graduate of Wayne State University School of Medicine and the University of Michigan-Ann Arbor.

“As emergency medicine physicians, we are often challenged to solve our patients’ problems using only the basic tools at our disposal.”

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SAEM PULSE | NOVEMBER-DECEMBER 2021

DIVERSITY, EQUITY & INCLUSION

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Trans Patients, Trans Selves

By Lachlan Driver, MD Treating a queer patient hits a little bit differently when we’re also a queer health care provider. For better or worse we see a little bit of ourselves, our experiences, and the challenges we’ve faced in life in those same patients. I recently had an experience where I was seeing a “John Smith, male, 20s” for chief concern of “sore throat.” As I entered the room, fully expecting a bread-and-butter viral versus streptococcus pharyngitis patient, my clinical brain paused because as I was walking in and saying my usual greeting, “Hello Mr. Smith…” I saw in front of me a transgender woman.

Even as a trans individual, I would be lying if I said walking in and immediately misgendering my patient did not phase me, although it is not uncommon for the electronic health record and a patient’s identity, name, or other aspects relating to their sense of self to be incongruous.

In the few seconds that followed I realized that I needed to kick into gear my many years of internal preparation for this moment. I immediately introduced myself, though probably somewhat overzealously, “Hello I’m Dr. Driver! I use he/him or they/ them pronouns, I will be taking care of you today. What name and pronouns do you use?” As she introduced herself, I could see a sigh of relief. She would not be questioned as to why she does not look like the picture painted in her chart; she would be understood.

To save everyone the suspense — I never found the root cause of her sore throat, although we used shared decision making and tested for strep pharyngitis, mononucleosis, COVID-19, and gonorrhea/chlamydia, as she frequently has oral receptive sex with partners who have penises.

However, what I was able to do as her doctor was take two minutes to call registration and make sure that her true gender and her name in the chart are listed correctly. I was able to update my patient that it is now officially changed in

“Focusing on these seemingly small things allows me to cope with the monumental feeling of otherness as a queer provider and consider my own experiences.” our system, so no one would be walking in calling her by the wrong name and/or gender, and subsequently being awkward and confused about why the chart says one thing and the patient another.

Although I cannot explain the pharyngitis, somehow what I was able to do for her seemed more significant, both for my sense of well-being as a queer provider and for the patient. Focusing on these seemingly small things allows me to cope with the monumental feeling of otherness as a queer provider and consider my own experiences.

I came away from this early interaction entirely humbled — we all make mistakes, but being an ally to queer and transgender patients, to be that supportive, is more complicated than simply wearing a rainbow pin; we wear the pin as a sign that we are willing to listen, to go that extra mile, to support our patients regardless of their gender or sexual identity.

So many times, as physicians, queer or otherwise, we feel helpless in the larger system, as we try to advocate for our patients and do what we can for whom we can when we can. And many times, small interactions, such as this one, can change an LGBTQ+ patient’s experience in a big way, whether it’s medical or social. I have been asked more times than I can recount on how to support the transgender patient, although gender is a spectrum and the needs of, for instance, a nonbinary person who is just in the process of coming out are vastly different than a transgender man who has been on testosterone for years.

Often cisgender people do not realize that it is not usually a one-off interaction that is toxic or hurtful, it’s the day-afterday coping with the onslaught of the “ma’ams,” “sirs,” or “what does your wife do?” It sometimes feels like waves hitting against a rock, a single wave does nothing, but given time the rock wears down and wears away. Sometimes as physicians the best we think we can do is not worsen that already substantial mental load, but the reality is that we can often do more. We can advocate to adjust our patient’s name in the electronic health record. We can stand up to coworkers who make inappropriate jokes. We can feel empowered to correct people who use incorrect pronouns. We can normalize gender diversity and allow gender diverse physicians to thrive and treat gender diverse patients. Finally, we can amplify the voices of those who have been marginalized without speaking for them.

These seemingly small things may allow us to heal the patient even if we cannot treat the disease.

ABOUT THE AUTHOR r. Driver is an emergency D medicine resident in the Harvard Affiliated Emergency Medicine Residency (HAEMR) program at Mass General Brigham, as well as a member of the LGBTQ Advisory Committee at Harvard Medical School.

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

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EM EDUCATION

“Resident, Know Thyself:” The Challenge of Assessing Self-awareness and Well-being in Milestone 2.0

SAEM PULSE | NOVEMBER-DECEMBER 2021

By Carolyn Commissaris, MD, and Esther H. Chen, MD, on behalf of the SAEM Education Committee

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The new milestones for assessing emergency medicine (EM) residents went into effect in July 2021 just as we were getting used to the old ones.

Notably, there is a new milestone, PROF3: Self-awareness and Well-being, with anchors ranging from Level 1: “recognizes, with assistance, the status of one’s personal and professional well-being” to Level 5: “coaches others when their emotional responses or level of knowledge/skills fail to meet professional expectations.”

The introduction of this milestone is timely, as provider well-being has been a central topic of discussion by national organizations for several years. In the last year, 72% of EM providers reported more professional burnout than in the prepandemic period, but nearly 50% were hesitant to seek mental health

treatment due to workplace stigma.

This startling data led several EM organizations to form the EM Mental Health Collaborative to promote the “Stop the Stigma EM” campaign and attempt to break down barriers to mental health care for EM providers.

factors affect well-being, and the tools and resources (personal, programmatic, and institutional) available to improve and maintain their well-being.

Within this broader context, the motivation to improve resident wellbeing is laudable, but framing it as an assessment has the potential for negatively impacting resident well-being and discouraging open conversation about burnout and mental health.

Furthermore, it’s important to remember that the PROF3 subcompetency is not intended to evaluate a resident’s well-being. Rather, its intent is to ensure that each resident has the fundamental knowledge of factors that affect wellbeing, the mechanisms by which those

In framing well-being as an assessed skill, we are concerned that this may create additional barriers to open discussion with residents struggling with burnout, mental health, and wellbeing. Although milestones are not grades, our high-achieving learners may perceive them as such. A resident who fears receiving a “bad grade in wellness” may be more reluctant to disclose mental health challenges they may be facing with program leaders or faculty mentors and less likely to receive the support they need. Moreover, we

Potential Pitfalls Performative Wellness

“The motivation to improve resident well-being is laudable, but framing it as an assessment has the potential for negatively impacting resident well-being and discouraging open conversation about burnout and mental health.” should consider how this assessment may encourage “performative wellness,” where the public display of a resident’s well-being is as carefully curated as their Instagram account, highlighting the positives but hiding struggles into an unseen and undiscussed space.

Limitation of Fixed Anchors Unlike clinical skills which follow a logical progression of skills, the PROF3 rating scale for self-awareness and wellbeing is more complex and may not be as easily measured in a rating scale with fixed anchors. Our residents are highfunctioning individuals who may be perceived as functioning at the “Level 5,” because they are able to coach their peers toward maintaining wellbeing, and yet lack the insight to recognize their own need for help (Level 1).

A Minefield of Bias

for coaching, direct observation, or simulations. Programs typically bear the cost of this additional support. How might a program approach supporting a resident who is consistently not meeting expectations in the PROF3 milestone?

Who will bear the cost of mental health interventions? Will individuals who receive a letter of concern be required to seek mental health care? What are the consequences for programs who do not address or provide support for struggling residents? Conversely, as students evaluate programs and institutions with varying levels of mental health resources and support, what might be the impact on resident recruitment?

Practical Approach to the PROF3 Milestone: Dos and Don’ts

There is increasing evidence of bias in assessment in medical education. We caution program leaders and faculty to consider how this milestone may be biased toward or against individuals who talk about their feelings too much or introverted individuals who do not.

Additionally, the degree to which learners may want to disclose, discuss, or demonstrate their own personal wellbeing also depends highly on varying cultural expectations and values. It’s critical for programs and residents to understand that residents are not being assessed on their disclosure or management of mental health conditions, but rather their knowledge of factors that affect well-being and the resources they have available to them to maintain wellbeing.

Prepare Your Program

Undefined Accountability and Consequences

Evaluate Your Data Sources

Programs are responsible for supporting residents who are not meeting expectations on their milestones. For example, those falling behind in clinical skills may require a remediation strategy that includes additional faculty time

• Do have your Clinical Competency Committee faculty review the Milestone 2.0 supplemental guide for how to assess this milestone.

• Do ensure that your residents, faculty, and program leadership understand existing programmatic, institutional, and local mental health resources available to residents.

• Do reflect on existing program and institutional resources to support mental health and well-being and advocate for additional resources from the department or institution.

• Do collaborate with other residencies and specialties on their approach to and experience with the well-being milestone, as this is not unique to EM. • Do use self-assessment and personal goal setting around well-being as a primary source for milestone progression data.

• Do use smaller advising group discussions or direct observations of resident wellbeing. During the semi-

annual meeting discussion, discuss well-being in an open and supportive way.

• Do internally evaluate programmatic milestone progress for signals of bias in assessment.

• Don’t add this milestone to shift-based assessments based on brief clinical encounters.

Stop the Stigma

• Do encourage open discussion of resident well-being in a judgement-free space.

• Don’t invoke milestone performance in conversations where residents disclose burnout or other mental health conditions.

• Don’t provide metrics on this milestone without providing any additional context.

• Don’t provide class averages or other aggregate data for this milestone.

• Don’t comment on the presence or treatment of specific mental health disorders in documentation of PROF3 milestone progress.

ABOUT THE AUTHORS Dr. Commissaris is a medical education fellow and assistant residency program director at the University of Michigan in Ann Arbor, Michigan. She is the 2020-2021 fellow editor-in-training for Academic Emergency Medicine Education & Training journal. r. Chen is a professor of D emergency medicine and associate residency director at the University of California, San Francisco. She is also the director of graduate medical education at San Francisco General Hospital.

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SAEM PULSE | NOVEMBER-DECEMBER 2021

“An understanding of the key concepts of the learning climate can be the difference that cements a lifesaving learning point.”

Climate Change: A Guide for Optimizing the Learning Environment

By David Diaz, MD; Ryan, MD; Andrew Kendle, MD; Allison Beaulieu, MD, on behalf of the SAEM Education Committee Learning climate is broadly defined as the tone, mood, and standards of the teaching environment. Components of the learning climate include both the physical and the emotional environment, as well as the interactions between the instructor, learner, and content. These interactions occur within a specific context such as bedside teaching, on shift lessons, or more formal lectures. It is vital to actively shape this climate both prior to and during learning encounters, as the controlled chaos of the emergency department can present a challenging, but highly valuable, setting to teach and learn. An understanding of the key concepts of the learning climate can be the difference that cements a lifesaving learning point. The four key concepts to be covered in this article are respect, learner involvement, stimulation, and understanding limitations.

Respect

Simple steps can be critical in setting up a respectful learning climate. The first step is to “meet the learner.” Is this a firstyear medical student on his or her first day or an off-service medicine resident interested in critical care? How do your learners refer to themselves, from name to pronouns? What does the learner hope to get out of the session? These questions will help tailor the teaching to the learner’s level and establish a secure environment. Another vital strategy is the creation of a safety statement such as, “we are all here to learn today and there are no silly questions or penalties for not knowing an answer.” Setting this expectation will ensure that learners feel comfortable sharing what they do and do not know. This is especially important in environments with multiple learners who may be reticent to answer for fear of being wrong in front of peers.

It is imperative for educators to understand implicit bias and how to

address microaggressions. Implicit bias is defined as the attitudes or stereotypes we hold without having conscious knowledge of them. To assess your own biases, you can take a variety of Implicit Association Tests.

• Ask clarifying questions to help you understand the intentions.

of various stages rotating through the emergency department. Start with the broadest questions for your novice learners and to fill in gaps, probe your senior learners using prior experience and evidence-based medicine. You can also use different questioning techniques to provide some variation to the learning.

One example is “what if” questions, which allows you to change a clinical scenario to address various teaching points.

Another technique is “round robin,” where each learner answers one question before moving to the next learner.

When correcting incorrect answers, be respectful and constructive. Lastly, be an active listener, and encourage learners to participate in the safe environment you have created.

• Carefully listen.

Stimulation

A microaggression is defined as a statement, action, or incident resulting in the discrimination against members of a marginalized group. An example would be a Black medical student during a clerkship rotation being asked by staff to show identification. To address microaggressions, you can utilize the A.C.T.I.O.N mnemonic developed by Cheung, Ganote, and Souza:

• Tell others what you observed as a micro aggression in a factual manner.

• Impact exploration: Ask for, or state, the potential impact of such a statement or action on others without putting the target of the microaggression on the spot.

• Own your own thoughts and feelings around the microaggression’s impact using first-person language.

• Next steps – request appropriate action be taken and check in with the target of the microaggression.

Learner Involvement

Learner involvement is how we encourage learners to actively participate in their own education. One way to obtain early buy-in from learners is to elicit their goals, which encourages learners to take an active role in their educational experiences. This also shows that you value their input and helps build a mutual point to work towards that is personally important to the learner. Another point to consider is that there are learners

Stimulation is how we design our environment to better engage learners.

In the clinical setting, teaching occurs most commonly at the bedside and in the charting area where you can think about varying your presentation style to keep learners interested. A great way to do this is utilizing some of the following techniques to emphasize various points: • White board teaching. The combined visual and verbal format of this technique can be helpful for learners to organize new information.

• Post-it notes. A high yield learning point or clinical pearl can be summarized on a Post-it note, helping emphasize the importance of the concept. It can then be posted in another location where the learner will continue to be exposed to it, thus further reinforcing the point.

• Note cards. Like Post-it notes, note cards can provide a slightly more in-

continued on Page 22

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With constant interruptions, it can be difficult to fit in a teaching session.

Acknowledge to your learners that “there will be interruptions, but hopefully the next strategies we discuss will give you some new tools to provide the best learning environment while in the emergency department.”

Conclusion

“Learner involvement is how we encourage learners to actively participate in their own education.”

EM EDUCATION

continued from Page 21

SAEM PULSE | NOVEMBER-DECEMBER 2021

depth review of a topic, providing an easy format for learners to quickly review a concept.

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• Practice board/shelf questions. Many question banks have a search function that allows you to find questions relevant to your teaching points. This will not only help your learners work toward a better test score, but also give you an idea of what helpful topics you can focus on.

Lastly, show enthusiasm for whatever topic you’re teaching, explicitly stating why you are interested in the topic and why it is important. An uninterested and unenthusiastic teacher oftentimes results in a similar-minded learner.

Limitations

Address the limitations of the learner, yourself, and those factors intrinsic to the emergency department. New learners may feel uncomfortable in an environment they have never worked in.

For example, figuring out the charting system, determining where patient

rooms are, and even placing orders can be daunting to novice learners.

You can acknowledge these limitations early on with a reassuring statement such as “I know this is your first day in the emergency department and I don’t expect you to have all the answers, but I do expect you to be engaged and learn something new.” This may also be the learner’s first time being exposed to certain medical problems, diagnoses, and management strategies, which can turn presentations into stressful situations. Instead of getting upset at a learner for not knowing something, try to ease his or her fears and normalize the situation. This could be a phrase to set the tone of a conversation such as “when I was an intern, I struggled with this. Let’s take time to discuss it.”

It’s also important to consider your own limitations. To create a safe learning climate, be transparent about your own limitations and admit to your own errors.

Ask your learners for feedback to see what you can improve on and how you can make the learning environment even better.

Another limitation to consider in the emergency department is timing.

Our goal as educators is to improve patient care through medical education.

The emergency department can be a challenging environment for optimal learning due to constant interruptions and its intrinsic unpredictable nature.

As teaching often occurs on the fly, consider using the above techniques to focus your efforts on learners at various stages of training. Recognize your own implicit biases and know how to identify and address microaggressions.

The safer the learning environment, the more likely learners will feel comfortable asking questions and retaining knowledge. Taking the step to set up a positive learning climate will have a positive impact on your learners.

ABOUT THE AUTHORS Dr. Diaz is a PGY3 emergency medicine resident at The Ohio State Wexner Medical Center.

Dr. O’Neill is a PGY1 emergency medicine resident at The Ohio State Wexner Medical Center.

Dr. Kendle is a PGY3 emergency medicine resident at The Ohio State Wexner Medical Center.

Dr. Beaulieu is a medical education fellow and interim assistant program director for the combined emergency medicine and internal medicine residency program at The Ohio State Wexner Medical Center.

Teaching and Learning on the Job: Maximize Your Efficiency Using Learning Theories

By Shaila Quazi, DO Shifts can get busy and an additional hurdle is blocking time to read and learn outside of work while juggling other responsibilities. One way to gain back some time is to maximize learning while on the job. Here’s a method I use with myself, my residents, and my students.

1. Plan. Give everyone a sheet of paper to write down three things they learned throughout the shift.

2. Discuss. Sometime during the shift, discuss what folks have written down on their papers. Items can include dosages of meds or other pearls learned from utilizing references through self-directed learning or from information learned directly from faculty, staff, or any other emergency department team member.

3. Save. Each learner takes a picture of his or her list and saves it (in a separate album, typically) to review again later.

Applied Theories

Critical reflection. Recognizing and identifying when new knowledge is gained is reflection in action. Later during discussion, reflection-on-action occurs. This allows us to process the information in a way that leads to better understanding and retention.

Elaboration. Elaboration is a strategy (under cognitivism) to process information. It involves writing and/or discussion. Elaboration occurs two times in this activity. Learners paraphrase what they learned from websites, phones,

online textbooks, etc. when they write down the pearls, thus processing the information the first time. Then, by explaining it in discussion later, elaboration recurs.

Spaced repetition. If new information is not reviewed within three days of acquisition, more than 40% is lost. By saving the pearls on our phones, we can review it again later, to minimize learning loss.

Social learning. Group learning can be very effective since the positive emotions and feedback from the group will also be tied into the information being processed.

We also learn from multiple sources, rather than just a faculty member.

Other applied theories include humanism and constructivism.

Additional Reading • Overview of current learning theories for medical educators • Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83 • Applying the science of learning to medical education • Applying Cognitive Learning Strategies to Enhance Learning and Retention in Clinical Teaching Settings • Becoming a Critically Reflective Teacher

Sometimes, we turn it into a game and if multiple people have the same pearls, we say “jinx” and it doesn’t count for points. Sometimes we write the pearls on a marker board and draw pictures or come up with mnemonic devices to help remember the information. Use your own creativity to amplify the learning and make it useful in your own setting.

ABOUT THE AUTHOR Dr. Quazi is a practicing emergency medicine physician at Tower Health in Reading, PA. As a previous art major, she enjoys the creative aspect of her current job as the director of the simulation program. She also serves as director of faculty development and cochair of the faculty development committee for the seven-hospital health system. She loves teaching and is presently pursuing a Master’s in Education of Health Professions through Johns Hopkins University.

Additionally, she is an instructor for a clinical skills course at Drexel University for second year medical students. She will serve as course director for the Reading campus in the upcoming academic year. She is most proud of being a mom to two super kids.

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Your gift today is an investment in emergency medicine’s future.

During the 2021-22 Grants cycle, the SAEMF awarded close to $700,000 to fund 23 of the most promising researchers and educators in emergency medicine.

Meet our researchers, hear more about their work at www.saemfoundation.org

Donate before December 31 to help shape the careers of tomorrow’s academic emergency medicine leaders

SAEM PULSE | NOVEMBER-DECEMBER 2021

Your gift will make a difference ...

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$100

$250

$500

$1,000

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

Provides a fellow with 2.5 hours of dedicated training time

Brings together medical students for an Emergency Medicine Interest Group

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

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ways to support research and education this holiday season

• Donate a recurring gift to easily support SAEMF year-round

• Consider a Legacy gift when you review your estate plans

• Contribute your Grand Rounds Honoraria

• Honor someone special through a tribute gift

• Shop with AmazonSmile • Talk to your advisor about options to gift appreciated securities

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

That’s normal.

I’m struggling too.

I need to tell you…

I’m struggling.

If you’re struggling, tell someone.

Don’t struggle alone. #StopTheStigmaEM

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GERIATRIC EM

Transformation of the Digital Health Care Landscape — Older Adults Included SAEM PULSE | NOVEMBER-DECEMBER 2021

By Mary Mulcare, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine

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Virtual care has evolved dramatically over the last 18 months. Prior to March 2020, in the academic world, we were slowly trying to roll out different ways in which telemedicine might expedite care for people, particularly those with low acuity concerns. There were a lot of false starts and timid steps in line with regulatory constraints. Telehealth at large was then given — and passed — an unprompted stress test. Content and thought leaders in the virtual care world were given an opportunity to be creative and implement new technology, points of accessibility, and pathways, with end-users ready to trial it. The beauty of the evolution is that almost everyone involved (I’d like was doing it with the same goal in mind: to improve access

“The older adult population stands to benefit significantly from this new digital age of health care.” and outcomes. This was especially true at the start of the pandemic when the fragility of our in-person health care system was unabashedly exposed. We simply needed to get physicians and patients connected to provide care.

We had a rapid feedback cycle with the surge of participating patients

and providers, which with modified regulatory boundaries, allowed for the iterative process to move much faster than historically happens in health care.

Much of this drive was led by academic institutions, especially those that already had built the infrastructure for telehealth programs, providers who were able to quickly adapt, and a trusted brand

which patients sought at a time of much consternation and fear.

Now we are at a place of trying to understand what will stick and how to find that appropriate balance among all the players and interests at hand, while maintaining the common goal of improving health outcomes and containing health care costs that are not sustainable.

The older adult population stands to benefit significantly from this new digital age of health care. Skilled nursing facilities and nursing homes have been adopting telehealth mechanisms for years, trying to keep their patients in the current facility rather than bouncing back to the hospital.

However, there are mixed perceptions about how well community dwelling older adults will function with this medium and whether they “like” it. As the digital health care industry grows, community-dwelling older adult populations should not be overlooked based on assumptions as to how this population best receives care.

Those of us practicing telemedicine have seen community-dwelling older adults able to navigate various platforms.

Not only that, but the virtual environment has also facilitated care in the following ways: • The ability to do a visit from home that does not require complex transportation, coupled with remote monitoring options, has been a very welcomed change for many.

• Providers have been offered a window into people’s homes to do the first (potentially) legitimate medication reconciliation in years, as the patient has been able to display their medication bottles in real time.

• Other members of the medical team have been able to expand the scope of home safety evaluations through this virtual medium.

• Older adults can turn up the volume on their devices to be able to hear a soft-spoken physician with minimal background noise.

• Older adults have benefited from being able to have additional care givers present for medical visits for enhanced communication going forward.

In the fast-paced world of digital health and innovation, we should strive to provide enhanced, convenient, and timely care to our older adults.

ABOUT THE AUTHOR Dr. Mulcare is fellowship trained in geriatric emergency medicine and is the clinical assistant professor of emergency medicine at Weill Cornell, New York. She has held several educational leadership roles at NYP/Weill Cornell and is currently chief medical officer for Summus Global, Inc, the leading digital platform for specialty care.

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

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SAEM PULSE | NOVEMBER-DECEMBER 2021

GLOBAL EM

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10 Years Later: The Effect of Egypt’s Revolution on Emergency Response Systems

By Kirlos N. Haroun, MD; William Weber, MD, MPH; and Gamal Eldin Abbas Khalifa, MB, ChB, MSc EM, EMDM, on behalf of the SAEM Global Emergency Medicine Academy Dr. Gamal Khalifa served as one of the first emergency physicians in Egypt and helped form the Egyptian Resuscitation Council (EgRC). Ten years Dr. Gamal Khalifa after the Egyptian Revolution and Arab Spring, he sat down for an interview to discuss the history and future of emergency medicine in Egypt.

“When the revolution happened, there was a significant amount of distrust between the revolutionaries and the government. Many citizens felt that if they stepped into an ambulance from a site of protest, they would be taken to jail rather than to a hospital,” Dr. Gamal Khalifa remarked, recounting the Egyptian Revolution of 2011.

“The ambulances absolutely were able to do good work by transporting sick and injured patients to local hospitals, but the rumors that spread deeply affected the people. Many people, especially near Tahrir Square, stayed far away from the emergency medical systems support teams, which limited our ability to help our people through the trauma of the revolution.”

What was the state of emergency medicine (EM) prior to the revolution?

“Emergency medicine began as a specialty in Egypt in 1979. A team of health care professionals at Alexandria University, including Professor Abdel Magid, saw an incredible need for primary emergency physicians. The initial training class, known as a Master’s degree, had only two people. The second class had three people, one of whom was me. At that time, no one knew what emergency medicine was. You had a poor salary and no privileges in most hospitals, so people stayed away from the field. However, against my family and friends’ advice, I committed to EM. “My peers and I formed the Egyptian Resuscitation Council (EgRC) in 2001.

Our goal was to create a recognized

system that could provide training on resuscitation, trauma, and disaster medicine. With the Egyptian Ministry of Health, we helped to formalize structured EM training programs across the country.

To this day we teach the Advanced Life Support European Trauma Course, and the Pediatric Life Support and Neonatal Resuscitation Programs in universities and major hospitals across the country.

We also helped develop an emergency medical services infrastructure to better distribute sick patients between the country’s public hospitals; a system that we discovered a decade later had its flaws.”

What was your personal experience of the Egyptian Revolution?

“In 2011, I was employed in Abu Dhabi.

By chance, on January 25 — the day the revolution began — I was at Cairo University leading a European Trauma Course to emergency fellows. When the revolution started, I was ecstatic but also afraid for my physician-colleagues.

I quickly went to my home city of Alexandria, in all honesty, to take part in the protests. I did not work directly as a medical officer during the revolution, but I was in close communication with physicians throughout.”

How well were Egypt’s hospitals prepared for the stressors of the revolution?

“Much of the response was improvised.

Despite our efforts, the public system was not fully trained for disasters. We lacked adequate structural plans and field training.

“Much of the response was led by churches and mosques. One church that I remember specifically was a Catholic Church in Cairo whose leader was both a priest and a doctor. They helped many people by creating a field hospital in one of the squares. The hospital depended on volunteers as well as donations for medications and equipment, so you can imagine they were continually strained.

“We had limited numbers of welltrained paramedics and emergency

medicine technicians as well as upto-date prehospital equipment. EMS staff were overwhelmed and under resourced, but alongside our religious institutions they helped many people.

Since then, we have greatly expanded our training of college graduates to transition into support careers in EM and have commissioned a new fleet of ambulances.

What do you feel were the biggest challenges and successes that the emergency physicians had to face?

“Emergency physicians, and physicians throughout, sought to maintain trustworthy communication between themselves and the public. The physicians’ presence as respected authorities in our society was one of the most valuable roles they held — maybe even more so than their medical training. We emphasized to the public that hospitals were there to help — a message that was vital amidst the widespread distrust of institutions affiliated with Egypt's government.

“Beyond this, an enormous point of organic growth was the improved communication between EMS teams.

Emergency physicians quickly became regional leaders across Egypt. The EgRC continues to train regional physician groups specifically around local response systems that have shared approaches to traumatic and medical resuscitations as well as larger-scaled disaster preparedness.

“Finally, a success story from the revolution was the great level of teamwork that arose between emergency physicians and other physicians.

Splinting broken bones and stitching closed wounds was a task many of us could do together. Physicians also built relationships as they coordinated between major cities to send and receive vital resources and personnel.”

continued on Page 30

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GLOBAL EM

continued from Page 29

SAEM PULSE | NOVEMBER-DECEMBER 2021

What is the current state of emergency medicine in Egypt?

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“Only 20 to 25 hospitals across Egypt have an emergency physician — mostly concentrated in universities. When there is no EM physician present in a department, we consistently see chaos. That being said, common public knowledge of the field of EM is continuing to increase in Egypt, which is leading to more applicants for emergency medicine fellowships after medical school.

“Our most pressing problem is brain drain. We train emergency physicians and then they leave. Physicians leave Egypt because of two core issues: lack of income and poor career progression in Egypt. Training for years understandably leads people to seek

“Go and teach in one new location — sharing your time and knowledge — and I promise it will only bear the fruit of more and more opportunities.” out good careers. Our graduates often find better opportunities outside of Egypt.”

Where do you see the future of EM in Egypt going?

“Legislation towards better pay and physician support in Egypt can be slow. The EgRC trains emergency physicians according to rigorous international guidelines and fighting to retain them while also developing a pool of nonphysician providers.

Currently, we use the World Health Organization’s (WHO’s) Basic Emergency Care Course to train nonphysician emergency medicine providers. Bringing this course to Egypt will help mitigate effects of the physician gap.

“Overall, the EgRC is very well connected, with over 800 members across Egypt and we would be happy to invite others for exchange training programs, research around disaster

preparedness, or clinical rotations.

We invite educators and researchers to come teach and learn alongside us.

Notably, the EgRC expanded our training around ultrasound and critical care.

People in these fields can feel free to reach out to me.”

What are you currently doing within the field of emergency medicine?

“I am currently retired; however, my career has always been centered on training and publishing alongside my international partners. I have always and will continue to teach trauma and nontrauma-based courses to physicians from different specialties and affiliations in Egypt and across the Middle East, Europe, and Asia.

“My work with the EgRC has expanded my scope like a chain reaction. An

impor-tant lesson I have learned throughout is to work under the umbrella of international organizations.

For example, creating collaborative affiliation agreements with the European Resuscitation Council and WHO has helped me develop and implement resuscitation guidelines in Egypt and many other countries.

“Beyond training, I participate in writing and publishing extensively on the European resuscitation guidelines, prehospital and hospital disaster planning, as well as simulation in these topics. I am always interested in collaborations if readers share my research interests! One final message I will impart is this: go and teach in one new location — sharing your time and knowledge — and I promise it will only bear the fruit of more and more opportunities.”

ABOUT THE AUTHORS r. Haroun is an emergency D medicine resident at the University of Chicago. He is interested in medical education and social emergency medicine with a goal of pursuing wellness and health for both learners and community members.

Dr. Weber is an international emergency medicine fellow at the University of Chicago focusing on the health of individuals in carceral settings. He serves on the executive board of SAEM’s Global Emergency Medicine Academy, the Public Health and Injury Prevention Committee of ACEP, and as national medical director for the Medical Justice Alliance.

About GEMA The Global Emergency Medicine Academy (GEMA) focuses on improvement of the worldwide delivery of emergency medical care.

Joining GEMA is free! Just log in to your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

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MUST EM residents running a BLS practical session organized by MUST-EMIG on campus for EM-bound students.

The Formation of the First StudentLed EM Interest Group in Uganda

SAEM PULSE | NOVEMBER-DECEMBER 2021

By Jonathan Kajjimu and Randall Ellis, MD, MPH, MBA

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Emergency medicine (EM) is a new specialty in Uganda. Graduation of the first class of EM residents occurred only in 2020. The Ugandan Ministry of Health and many collaborating organizations are working to develop and improve emergency care for all 47 million citizens.

Until recently, EM was not an option for students, but that has changed. This is an overview of the first EM interest group (EMIG) in the country.

It was on social media that I found a poster of the inaugural Emergency Care Conference in Uganda to occur August 2019 and decided to attend.

My objective was to learn more about reading electrocardiograms (ECGs).

I attended the ECG workshop and met an amazing facilitator, Dr. Mary Ellen Lyon, who later became my first formal mentor. Dr. Lyon motivated me to start an emergency medicine interest group (EMIG) as a way of sharing resources with other students who were passionate about EM. I was matched with my mentor, Dr. Lyon, by Dr. Christine Ngaruiya, who spoke at

the conference about mentorship with female students in Kenya.

Around this time, another EM physician, Dr. Mardi Steere, shared a link to a virtual EM conference organized by Don’t Forget the Bubbles (DFTB). I attended this DFTB event in August 2020 and met Dr. Andrew Tagg, who would become key to the successful foundation of our EMIG. In late September 2020 I connected with a Nigerian colleague on Twitter who had started a national EMIG in her country.

She encouraged me to start an EMIG at Mbarara University of Science & Technology (MUST), a public university in Uganda.

Finally, through the guidance of Drs. Lyons and Tagg, the help of faculty advisor Dr. Justine Athieno Odakha, and online support and resources from the Emergency Medicine Residents Association (EMRA), our EMIG was finally established. The Mbarara University of Science and Technology Emergency Medicine Interest Group (MUST-EMIG) officially started on

December 9, 2020. Our student group was originally founded for medical students, but in a quest to include other members of the emergency care team, we decided to invite interested nursing students to be members as well.

Currently medical students make up most of the group membership.

The goals of MUST-EMIG include providing opportunities for students to learn key aspects of the EM knowledge base and participate in resuscitation simulations. The EMIG also facilitates close communication between students and the department of emergency medicine at MUST and introduces the specialty of EM to MUST students and faculty. During a recent survey of over 100 registered group members, most students believed that the EMIG could aid in pursuing a career in EM. Our EMIG is serving as a model to other student organizations at MUST and throughout Uganda.

We have successfully held online lecture webinars and journal clubs, attended EM conferences and courses, organized EM skills simulations, and sent some EMIG students for training and certification in life support courses.

I have been invited to engage with other stakeholders and organizations on behalf of MUST EM-bound students. One of our students was recently selected as the first Ugandan to join the fourth cohort of the American College of Emergency Physicians/EMRA Global Emergency Medicine Student Leadership Program.

We are grateful for the support we have received from organizations such as DFTB, Emergency Care Courses Uganda, EMRA, Emergency Care Society of Uganda, Seed Global Health, and others.

Some challenges we encountered included lack of stable internet access for all students to attend our online activities, lack of proper presentation and communication tools, and the inability to fund all interested students to attend and achieve certification in life support courses. Of course, university closures due to the COVID-19 pandemic also hampered some of our plans.

We hope that in the future our student group will continue to supplement our medical education until we have a well-established EM curriculum in Uganda. At present we are discussing the development of a toxicology module for EM-bound students at MUST in partnership with Yale University. Also, to contribute to the scientific evidence concerning the benefit of EMIGs, we intend to have standardized objective self-assessments of all students’ preand post-group activities. Lastly, we hope our EMIG will someday be open to all interested medical students in the country.

We are pleased to have inspired fellow students to initiate their own interest groups. MUST students are founding interest groups for internal medicine, pathology, and rehabilitation medicine. Our colleagues at Gulu University in northern Uganda are in the final stages of initiating their EMIG. Also, in most of our online sessions, students from 2-3 other universities join us, which proves that medical

The first student leadership team (executive committee) of MUST-EMIG.

MUST EM residents running a BLS practical session organized by MUST-EMIG on campus for EM-bound students.

students in Uganda are eager to learn more about EM. In conclusion, we encourage medical students to attend conferences of disciplines they are passionate about.

Through such conferences, innumerable networking opportunities can arise. We also call upon conference organizers to consider making conference attendance free or sponsored for global medical and nursing students. Our EMIG would not exist without student attendance. It has been by standing on the shoulders of EM giants whom we met in conferences that we have been able to see further. We pay our significant respect to all of champions of Global Emergency Medicine, past and present. EM has a bright future in Uganda because of global collaboration.

ABOUT THE AUTHORS Jonathan Kajjimu is a fourthyear medical student and the founding president of the MUST (Mbarara University of Science and Technology) Emergency Medicine Interest Group, in Mbarara, Uganda.

Dr. Randall Ellis, MD, MPH, MBA, is director of emergency medicine programs and physician educator with Mbarara University of Science and Technology; educator, Seed Global Health.

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HEALTH POLICY HIGHLIGHT

SAEM PULSE | NOVEMBER-DECEMBER 2021

The Dr. Lorna Breen Health Care Provider Protection Act

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By Kyle Stucker, MD Dr. Breen was unable to get out of her chair on April 9, 2020. On the front lines of the spring COVID-19 surge in New York City, she was exhausted. Since childhood, her purpose and goal had been to serve as a physician in New York City. Now she had accomplished that goal and loved fulfilling her lifelong dream. Dr. Breen was also an active member of her church, the aunt to eight nieces and nephews, a salsa dancer, and even the driver of a convertible.

Although she enjoyed a strong support group and professional success, she still harbored concern about the

professional and social consequences of seeking help. On April 26, 2020, she died by suicide.

Dr. Breen’s tragedy is unfortunately not unique. Approximately 400 physicians die by suicide each year, at a rate twice that of the general population. A 2020 article in JAMA Psychiatry opined that the likely explanation, though physicians have advanced professional knowledge and access to many socioeconomic resources, was due to the “deep shame and inadequacy” often felt by our colleagues. Similarly, a 2018 Occupational Medicine study targeting

physicians currently seeking mental health treatment found that nearly 50% of respondents believed their diagnosis could have been recognized earlier.

Almost half of respondents denied their mental health issue, were embarrassed, or simply felt they needed greater mental health literacy to identify their mental health problem sooner.

Dr. Breen was an emergency physician, and her struggles are experienced by others in our specialty.

In 2019, the Western Journal of Emergency Medicine published a systematic review finding that EM is one of the most “burned out” specialties.

It starts early, with between 65-74% of residents meeting criteria for burnout. The authors estimated that, in 2018, as many as 6,000 emergency physicians had contemplated suicide — and up to 400 may have attempted it.

Introduced into the U.S. Senate in March 2021, the Dr. Lorna Breen Health Care Provider Protection Act’s stated goal is “to address behavioral health and wellbeing among health care professionals.”

With a budget of $10 million per year, the Secretary of Health and Human Services (HHS) will award grants “related to improving mental health and resiliency among health care professionals.” HHS will also be tasked with “identifying and disseminating evidence-based practices” to achieve the same goal. Additionally, HHS will be responsible for training health care professionals “in appropriate strategies to promote their mental health.”

Priority is given to health care entities, and especially those who provide care in health professional shortage areas or rural areas. After four years of awarding grants and developing new training programs, the secretary of HHS will report the results of the program to congress.

There are, of course, potential pros and cons of any legislation. Senator Kaine (D-VA), the main sponsor of the bill, certainly believes it will be a positive force in the industry: “It’s so important… to pass this bipartisan legislation so we can meaningfully change how our health care industry approaches mental health and set up a more reliable infrastructure and culture for health professionals…”

By awarding grants there will be extra incentive to hospitals and other organizations to focus on the wellness of their physicians, and, with extra incentive, it is more likely that money, instead of lip service, will be paid to address these issues. However, a potential concern is that federal action removes responsibility from many stakeholders and, as many would argue, from the organizations that often create the stressors leading to burnout. Some may say that the problem would be addressed more effectively if the primary agents of change were physician advocacy groups and employers looking to create better employees. The probable inefficiency of money distribution by nonmedical personnel isolated from the problem may be indicated by the Congressional

Budget Office’s estimate for a cost of $103 million to award an estimated $29 million of grant money.

The Dr. Breen Act (S. 610 and HR 1667) has bipartisan support and will next move to the House. If you would like to contact your legislator, visit https://www. house.gov/representatives/find-yourrepresentative.

For additional ways you can help break down barriers to mental health care in emergency medicine, visit "Stop the Stigma EM": A Toolkit for Individuals, Educators & Institutions.

ABOUT THE AUTHOR Kyle Stucker, MD is a PGY-1 at the University of Louisville.

From Franklin, Indiana, he completed his undergraduate education at Wabash College and his medical education at the Indiana University School of Medicine.

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EM RESEARCH

5 Questions Research-Bound EM Medical Students Should Ask Attendings: An Interview With Dr. James Paxton

SAEM PULSE | NOVEMBER-DECEMBER 2021

By Maurice Dick on behalf of the RAMS Research Committee

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James H. Paxton, MD, MBA, is the director of clinical research at Detroit Receiving Hospital (DRH) and an associate professor in the department of emergency medicine at Wayne State University (WSU) School of Medicine, Detroit, Michigan. He is currently chair of the SAEM Research Committee James H. Paxton and a member of the SAEM By-Laws Committee. He served as chair of the WSU Institutional Review Board from 2015 to 2020.

Dr. Paxton received his Bachelor of Arts in English and biology from Case Western Reserve University, where he graduated magna cum laude in June 1998. He graduated from the University of Cincinnati (UC) College of Medicine in 2004 and earned his master’s degree in business administration from UC College of Business in 2005. He completed residency in emergency medicine at Henry Ford Hospital, Detroit, Michigan, in 2011.

Dr. Paxton has served as principal investigator for dozens of clinical trials and studies, including both federally funded and industry-funded protocols. He is a prolific author, recently editing new books on emergent vascular access and resident research. His clinical research interests are varied, including

prehospital stroke, cardiac arrest, emergent vascular access, medical errors, and medical devices. He is currently working on a multicenter prehospital study evaluating a device for the detection of large vessel occlusion stroke.

1. Why did you pursue a career in research?

During the summer of 2001, I took a job working in the basic science lab of Dr. Per-Olof Hasselgren at the University of Cincinnati (UC). While most of my friends were enjoying their down time between lectures, I was learning about ELISAs and luciferase assays. For the most part, my role consisted of the most mundane lab-related activities that one could imagine: preparing gels, pipetting samples, and so on. I didn’t know it at the time, but the most valuable lessons that I was learning that summer had nothing to do with Western blots. I became inspired by the people working alongside me in the lab. I worked with surgical residents who would show up to the lab having not slept the night before. Keep in mind that these were surgical residents before work hour restrictions were commonplace! But they remained motivated despite incomprehensible fatigue and innumerable setbacks. I didn’t understand half of the basic science behind what we were doing at that stage in my career, but something about the search for “truth in the universe” really connected with me. As a neophyte, I was in awe of these people who put aside their own needs for sleep, food, and sanity, in search of something

“Research is an extension of the innate human need to understand the world around us. Successful medical researchers always begin their journey with deep introspection about the clinical questions that inspire their curiosity.” thus far undiscovered. Their drive to learn — to know — was fascinating to me.

Dr. Hasselgren is a brilliant endocrine surgeon and has been a prolific author for nearly half a century, but it was a chance conversation with him in the hallway outside of the lab that helped to formulate my lifelong attitude towards clinical research. On this day, Dr. Hasselgren was waxing philosophic about the role of research in a physician’s career. He explained to me that a successful career in medicine, “is like a three-legged stool.

Truly successful physicians must cultivate lifelong education in three areas: the treatment of patients, the education of learners, and the generation of original knowledge. Each of these ‘legs’ supports the development of the physician; if one of these supports is lacking, the entire enterprise collapses.”

I still think of my medical career in these terms, 20 years later. My research career, which literally began that summer two decades ago, is predicated upon an awareness that clinical care, education, and research are all equally important endeavors that must be recognized and cultivated. My career in research began that summer and continues to be influenced by this casual discussion with one of my earliest research mentors.

2. How do you develop research ideas and carry them forward?

Research is an extension of the innate human need to understand the world around us. Successful medical researchers always begin their journey with deep introspection about the clinical questions that inspire their curiosity.

Albert Einstein once said, “I have no special talents. I am only passionately curious.” In my opinion, passion and curiosity are the two most essential components of a successful research career. Young researchers should spend a lot of time early in their career contemplating what they are passionate about. Research is hard work. The real world must be managed to permit successful execution of a research protocol. Unfortunately, this awareness

of one’s own motivations is not always a focus for junior investigators, who may be tempted to select a research topic simply because it is currently popular or ripe for funding. In my opinion, researchers are better off never being funded if they can wake up every morning excited to pursue their own research objectives. Life is too short to spend it pursuing someone else’s research goals.

3. What is your greatest research accomplishment, thus far?

This is a difficult question. I have been principal investigator in a wide variety of clinical trials and observational studies.

In the research world, a lot of attention is paid to large-budget, multicenter studies, especially those with federal funding.

But I think that success should be viewed through the lens of local context and available resources. I think that my greatest research accomplishments have been completing smaller, unfunded, or privately funded studies. Getting a study off the ground with little or no funding is a true test of the research team’s ingenuity, resourcefulness, and commitment to the project.

4. What three factors were most influential in your greatest research accomplishment?

It is hard to identify only three factors, but I will try. The most important factor to research success is finding the right coinvestigators. I have been blessed with an inimitable crew of dedicated research assistants and research technicians at Wayne State University over the last decade. As I have stated before, I believe that passion and curiosity are the keys to success in research. This is true for all members of the research team. You cannot teach these qualities; you can only find and leverage them. A second factor contributing to research success is departmental support for research. Research funding, protected time, and recognition of the importance of research are not always available to junior researchers. Clinical duties can easily overwhelm even the most talented research minds. A third factor is

adequate support services. Assistance with grant writing, data collection, and data analysis is often lacking in smaller departments, even those that recognize the importance of research. This can create an insurmountable volume of work for the investigator, even if she or he has the necessary training to complete these tasks. Unfortunately, investigators must often rely on others to provide these critical resources. This underscores the importance of identifying and accessing the resources available in one’s local research environment to maximize one’s research potential.

5. Looking back, what would you tell yourself as a medical student with regards to becoming a researcher?

I would suggest that the younger me cultivate productive research relationships. Research is very much a team sport. The principal investigator of a clinical study may be the coach, but she or he cannot play the game alone.

The ability to form and maintain strong interpersonal relationships is essential to research success. I worked as a bartender in college, and this experience has contributed far more to my success than any formal research training that I have received. Understanding human nature is just as important to a principal investigator or director of clinical research as understanding the science involved in a study.

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

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SEX & GENDER IN EM Sex and Gender Differences in COVID-19

By Lily Gordon on behalf of the SAEM Sex & Gender in Emergency Medicine Interest Group

Case Overview

This case study follows the clinical courses of two individuals suffering from COVID-19 with the goal of understanding how sex and gender impact clinical presentation and outcomes. Each case is composite narrative based on the known patterns of risk factors, clinical presentation, and disease course in cisgender men and women.

Patient Information

Patient Information

Chief Complaint

Chief Complaint

Name: Elijah Cooper Age: 55 Sex: Male Occupation: Real estate agent Confusion with associated cough and fever

History of Present Illness

Elijah noticed that he was starting to feel fatigued about seven days ago. He went to sleep and woke up the next morning with a low-grade fever. Over the next four days he developed a dry cough and his fever persisted, hovering between 100-101 degrees. This morning his wife noticed he seemed confused and took him to the ED.

Past Medical and Social History

SAEM PULSE | NOVEMBER-DECEMBER 2021

Elijah has a past medical history of diabetes and hypertension. He is a current smoker with a 20 pack a year history. He doesn’t drink alcohol.

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Diagnosis

Elijah receives a positive result on a SARs-COV-2 RT- PCR test.

Work-Up and Clinical Course

Elijah’s pulse oximeter reads 88%. His CXR shows bilateral ground-glass opacities in the lower lung lobes. Elijah is started on supplemental oxygen via nasal canula and dexamethasone in the ED. He is quickly admitted to the ICU where he is also given a single dose of Tocilizumab. Over the next 12 hours Elijah develops hypercapnia and the decision to intubate is made on day one of his hospitalization. Elijah is extubated on day 10 of his hospitalization and eventually discharged on day 15.

Name: Olivia James Age: 39 Sex: Female Occupation: Elementary school teacher Dyspnea and fatigue

History of Present Illness

Olivia noticed her food tasted odd about 8 days ago. She went into work that day, and by the end of the day had a throbbing headache and muscle pains. Olivia was concerned and got a rapid COVID test that evening and tested positive. She spent the next five days in quarantine, but her symptoms did not subside. Yesterday she started to feel as though she couldn't quite catch her breath while going upstairs and decided to come into the emergency department today.

Past Medical and Social History

Olivia does not have any active medical conditions. She is overweight with a BMI of 30. She does not smoke and has 1-2 drinks of alcohol on the weekend with friends.

Diagnosis

Olivia receives a positive result on a SARsCOV2 RT-PCR test.

Work-Up and Clinical Course

Olivia’s CXR shows consolidation in the peripheries of the lower lungs bilaterally. She had an SaO2 of 94%. She is put on a high flow nasal canula and started on oral dexamethasone. She is admitted to the hospital and spends three days on supplemental oxygen before being discharged.

Discussion

As of August 2021, the Centers for Disease Control has documented over 30 million cases of COVID-19 in the United States with 52% of cases attributed to women. Despite the slightly higher rates of infection among women, men account for 54.8% of COVID-19 related deaths and 60.6% of ICU admissions. Few countries are reporting gender or sex disaggregated data, but preliminary reports suggest that this trend is reflected on a global scale.

Studies have documented significant differences in the initial presentation of COVID-19 in cisgender men and women.

For example, cisgender women are much more likely to present with anosmia, dysgeusia, and headache. Additionally, on initial presentation, men generally had more severe disease based on respiratory parameters and laboratory parameters.

The disparities in outcomes and presentations between men and women are likely due to a combination of sex-specific biological as well as gender-related social differences. Sexbased differences in immunological and inflammatory responses have long been recognized in the scientific literature. Sex hormones play a role in both the adaptive and innate immune responses, with testosterone having an overall immunosuppressive effect while estrogen has an upegulating effect on the immune system. As a result, cisgender women generally have faster rates of viral clearance and disease resolution as compared with cisgender males.

Previous research has also shown that females display higher rates of adaptive immune response, which results in higher levels of antibody production and longer immune memory. Persistence of higher antibody levels in cisgender women as compared with men has been observed in cases of COVID-19, which may have implications for sex-dependent vaccine efficacy in the future. With regards to inflammatory responses, studies have identified a link between high levels of inflammatory cytokines, such as Il-6 and TNF-alpha, and the acute phase reactant C-Reactive Protein with more severe SARS-CoV-2 disease and death. Males

“Cisgender women generally have faster rates of viral clearance and disease resolution as compared with cisgender males.” with COVID-19 show higher levels of CRP, Il-6, and TNF-alpha levels independent of comorbidities such as diabetes, hypertension, and smoking history.

Among women, pregnant individuals are of particular concern for high-risk COVID-19 and complications. Although preliminary data does suggest higher rates of infection among pregnant compared with nonpregnant cisgender women, it is unclear whether this finding reflects a true difference in infection rates or a difference in testing rates as a result of pregnant women’s increased contact with the health care system. Overall, current data suggest that pregnant women have slightly higher rates of ICU admission and mechanical ventilation, but there is no significant difference in the mortality rate based on pregnancy status.

Biological sex is not the only contributor to the differential outcomes observed between men and women. Gender roles and expectations have major impacts on exposure to risk factors for both men and women. Observational studies have consistently demonstrated that cisgender women have higher rates of health care seeking behavior for physical and mental health concerns.

Additionally, women are much more likely to work in health care or other first-line jobs such as grocery stores and childcare, thus increasing their potential for viral exposure. Furthermore, cisgender men have higher rates of smoking, diabetes, and hypertension, which likely contribute to an overall increased modifiable burden of COVID-19 in men.

Although cisgender individuals make up most of the population, transgender and gender nonconforming individuals are at particularly high risk for severe COVID-19 due to specific social determinants of health that impact this

population. Approximately 1-2% of people identify as either transgender or gender nonconforming. There is a dearth of data on the impact of COVID-19 on transgender and gender nonconforming individuals. Nevertheless, transgender individuals are much more likely to live below the poverty line and to be uninsured, both of which are associated with more severe COVID-19. Additionally, transgender and gender non-conforming people experience high rates of discrimination in health care settings, making them less likely to seek medical care.

Throughout the coronavirus pandemic, sex and gender have impacted the health outcomes for individuals on a global scale. We have yet to fully understand the nuances of these impacts, particularly with regards to pregnancy and the interplay of gender and healthcare access.

Further research on the differences in COVID presentation, as well as its clinical progression, focusing on the intersection of sex, gender, and COVID-19 outcomes is greatly needed to fully understand the underpinnings of the existing disparities.

Furthermore, such research could allow for the development of clinical algorithms that stress differential triaging of men based on their higher degree of risk as well as tailored interventions based on sex-based biological differences.

ABOUT THE AUTHOR L ily Gordon is a medical student at Warren Alpert Medical School, Brown University, and a research assistant at the Brown University School of Public Health.

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

Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side.

Select the box next to the academy you wish to join. Click “save.”

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SAEM PULSE | NOVEMBER-DECEMBER 2021

SOCIAL EM

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Hoops for Health: EM Residents Respond to Public Recreation Closures During COVID

By Michael Okoronkwo, MD It was the 10th and final stop on a hot summer afternoon U-Haul drive delivering basketball hoops and balls to local New Orleans families. Tomi, sweat drenched as he reclined in the passenger seat, and I, lamented at the exhaustion of our days’ work. We had already driven 55 miles across the city to the homes of nine families. Though our service was with grace, by this time we were tired and prepared to simply

drop off and go as the family emerged from the house. Admittedly, our grace was now guilty of greed.

“When times get tough, my sons will recall the memory of today.” Anne, the foster mother of two brothers, uttered this sentiment to us as her sons excitedly ran off dribbling the basketballs.

These words invigorated the return of our grace to recapture the selfless purpose which inspired Tomi and me

to establish Drive and Dish. With the assistance of Oluwatomi Akingbola, a University of Pennsylvania emergency medicine resident, I created the Drive and Dish initiative as a response to public recreation closures caused by the COVID-19 pandemic. Such closures, I felt, threatened the health and safety of community youth, as recreation had always been a mental and physical safety net for me as a child. It oriented me into my goal of collegiate athletics.

Drive and Dish in the News • Frontline workers give basketball goals to New Orleans kids • Drive and Dish Foundation • Local doctors donate basketball hoops to families to help with COVID-19 isolation • LSU Health New Orleans Resident Physicians Donate Basketballs, Goals to NOLA Youth During COVID-19 Pandemic Its foundation inspired my purpose to become an emergency medicine doctor.

Drive and Dish raised over $5k to donate home basketball hoops and balls to 50 New Orleans area families with children. Donations were supported by community members which included New Orleans Mayor Latoya Cantrell and emergency medicine physicians.

As I now reflect on the Drive and Dish experience, I uplift the vision of social emergency medicine. Advocates of social emergency medicine consider the interaction between patient and social structure to improve health outcomes.

2015 New Orleans crime data illustrates deadly adolescent outcomes attributable to community gun violence. Data suggest juvenile park access and recreation protects behavioral and physical health and reduces risk to violent exposures.

A 2015-2017 study involving at risk 12–17-year-old children in Miami, points to violence risk reduction and mental health resilience from park recreational activity.

Treating patients in the busy urban emergency department of a level one trauma center teaches me more than what I put into it. Therefore, purpose for my service outlasts my fatigue from it, with an unrelenting inspiration to explore the interaction of patient context and social dynamic with the emergency department experience. Drive and Dish, supported by the Louisiana State University Health Sciences Center emergency medicine department staff, which consists of city and state health

“Advocates of social emergency medicine consider the interaction between patient and social structure to improve health outcomes.” officials, answered the call of social emergency medicine, but also leaves a message for us to answer its call again.

With each drop off, Drive and Dish volunteers engaged with children encouraging resilience and wellness during the pandemic. I refined my appreciation of the social determinants of health and will continue ongoing efforts to advance social emergency medicine.

Drive and Dish provided more than recreation for children; it promoted their wellness and protected access to their dreams, as recreation did for me. The impact of social emergency medicine sustains and will be there for Anne’s sons

to reflect upon the day they met Tomi and me. This foresight should encourage all to mobilize the vision of social emergency medicine.

ABOUT THE AUTHOR Dr. Okoronkwo is an emergency medicine resident physician at Louisiana State University Health Sciences Center.

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Success at Every Level: How to Ace Virtual Recruitment Season

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By Lauren Willoughby, MD; Esther H. Chen, MD; and Allison Beaulieu, MD on behalf of the SAEM Education Committee Although graduate medical education has been affected by the COVID-19 pandemic in several ways, perhaps its most significant impact has been on the residency recruitment process.

As we look forward to another year of virtual recruitment, here are some virtual recruitment activities and processes that made last year’s recruitment season a big success.

Medical Student Perspective Get in the Know

Create a professional social media account and follow the Twitter accounts of the programs in which

you are interested. Programs will post information on upcoming virtual recruitment sessions as well as program highlights such as wellness events and residency accomplishments. Virtual recruitment sessions are open to all applicants. Sessions may be through a residency fair or specific to one program. Some programs require you to sign up ahead of time. Programspecific sessions typically have themes like ultrasound, EMS, or diversity, equity, and inclusion.

At these sessions you will be able to meet different residents and faculty that you may not encounter on your

interview day. These sessions allow you to spend more time learning about a specific program and the culture of that program; however, beware of Zoom fatigue and do not overextend yourself during recruitment season by attending every session for every program. Pick and choose wisely, and pace yourself to ensure a successful virtual recruitment season.

Prep for the Pre-interview Dinner

Follow these five tips to showcase who you are in the virtual arena and ensure a successful recruitment dinner.

1. Be enthusiastic. It can be difficult to engage with new people on a virtual platform. As we continue to adapt to a virtual world, it is more important than ever to be fully present and give your undivided attention to the activities planned by the residency program. Phones should be silenced, and you should not have a second browser up for checking emails or surfing the web.

your genuine enthusiasm. If not already occurring at your program, suggest hosting specific sessions highlighting each of these subspecialties.

Update Departmental and Residency Websites

While having a professionally designed website is unnecessary, displaying an outdated website may distract students from your program’s merits. Your website should highlight the features of your program that make it exceptional (e.g., location, patient diversity, mission, commitment to underserved, research).

Students scroll through many program websites, so consider how to showcase the distinguishing features of your program.

2. Be on time. Residents are taking time out of their busy schedules to meet with you, so be respectful and show up on time. Do not call into a pre-interview dinner from your mobile phone or from a restaurant.

Plan ahead and let a residency representative know if you are unable to be there on time.

3. Dress for success. Treat the preinterview dinner as you would treat a regular interview day and dress professionally.

4. Come prepared. No one likes awkward silence. Be ready to discuss your interests and hobbies. In addition, have a set of questions ready to ask the residents, such as what do they do with their time off and what is the culture of the program?

5. Take notes. After the session is over, take time to note the important topics mentioned, such as resident scheduling, wellness events, and mentorship opportunities. This will help you craft your rank list at the end of interview season.

Understand Post-Interview Communication

Many programs have a policy on postinterview communication and prefer no contact until Match Day. Other programs will accept communication, especially if you have a specific question about the program. For more information, check out the NRMP Match Communication Code of Conduct and be sure to keep track of each program’s preferred contact methods.

Resident Perspective Showcase Interests

Do you have a particular interest or niche within emergency medicine such as wilderness medicine, ultrasound, or research? Share your passions with applicants during the pre-interview social events. Applicants often enjoy discussing shared interests and will notice

opportunities to interact directly with residents and faculty to gain firsthand knowledge about the community. For programs, this challenge can be mitigated by establishing a virtual presence that showcases the distinguishing features of the program.

Increase Social Media Presence

Create a Memorable Preinterview Social Event

Many pre-interview social events occur on virtual platforms such as Zoom.

Creating an engaging environment will leave prospective applicants with a positive and memorable impression.

The Ohio State University utilizes BINGO cards. The BINGO squares highlight key aspects of the program to be emphasized and encourage applicants to ask questions. If desired, prizes can include gift cards or a “recruitment box” with “swag” that is unique to the program (e.g. coffee mug, sticker, etc). Incorporating a game into your social event can keep applicants engaged, create a relaxed atmosphere, and provide content for the conversation.

Display the Culture of the Program

One of the biggest downfalls of virtual recruitment is the inability for applicants to visit the hospitals and cities where programs are located. While impossible to replicate an actual visit, a short video including a brief tour of the department as well as key features and activities in the city can give applicants a sense of the work environment as well as what life outside the hospital looks like.

Increase activity on traditional or program-sponsored social media outlets by posting learning points, celebrations, and great saves and by participating in online social communities through national organizations.

Increase Outreach: Participate in Structured Online Activities

Virtual emergency medicine clerkships.

This may be particularly helpful for newer programs that are not as well known within the emergency medicine academic community.

Webinars and information sessions.

Many professional organizations (e.g., SAEM RAMS, EMRA) provide opportunities for students to chat with program representatives.

Interest groups and “second look” events. Showcase the different people in your program (e.g., first generation to college, underrepresented in medicine, women in medicine) and encourage participation by asking residents to help publicize these events at their former medical school’s EM interest group meetings.

Maximize Interpersonal Interactions and Minimize Downtime

Consider zoom fatigue. While it may be easier to move the entire in-person interview day to a virtual format, this may

Program Perspective Virtual recruitment and restrictions on in-person clinical clerkships limit student

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result in a very long day with periods of down time. Consider maximizing time for interpersonal interactions with program leadership, faculty, and residents while minimizing time in passive listening or in a waiting room.

Utilize Zoom breakout rooms. There are many ways to use Zoom effectively.

Some programs set up a main room for students to congregate, have interviewers stay in their own breakout rooms, and rotate students into those interviewer rooms. Others find it easier to have the students stay in their own breakout rooms and rotate interviewers into the student rooms. The advantage of using breakout rooms rather than setting up separate Zoom links for each interview is that the interview coordinator can send out a five-

minute warning to all the breakout rooms simultaneously and try to keep everyone on-time.

Prepare a back-up plan. Virtual interviews depend on reliable internet connections, which can go down at any time during the interview.

Make sure that the applicant and the interviewer know the back-up plan and have phone numbers available in case the Zoom application goes down.

Practice with all new interviewers or recommend that they use a residency office space for the interview so that the interview coordinator can help troubleshoot any problems.

Schedule informal social time. This critical part of the virtual interview day is a great opportunity for applicants to meet your residents in small groups.

Try to keep the groups small (4-6 people) to facilitate open discussion with the residents.

ABOUT THE AUTHORS r. Willoughby is an D emergency medicine chief resident at the Ohio State University. @laurwilloughby

r. Chen is a professor of D emergency medicine and associate residency director at the University of California, San Francisco. She is also the director of graduate medical education at San Francisco General Hospital.

Dr. Beaulieu is a second-year medical education fellow and interim assistant program director at the Ohio State University. @BeaulieuMD

Clubhouse and Twitter Spaces: Medical Education and Networking Through a Pandemic

By Steven T. Haywood, MD and Rodrigo G. Gerardo, MD, on behalf of the SAEM Virtual Presence Committee Historically, opportunities for networking and education for physicians and other medical professionals/trainees have largely been through in-person society meetings, continuing medical education (CME) events, and other professional gatherings. Over the last 10-15 years, social media has become a growing source for networking and medical education. A gradual transition towards digital meetings and education has been predicted for many years. With the onset of the COVID-19 pandemic in the spring of 2020, most major medical conferences have either been canceled or held

virtually. While a virtual conference has similar didactic offerings, the networking aspect is largely lost. A virtual wine and cheese event over Zoom is undoubtedly much different than casually strolling around a room meeting colleagues in person. While social media has been shown to overlap with medical education conferences, it now may be the answer to filling the void left by their cancellations.

Traditional social media platforms such as Twitter, Facebook, Instagram, and even TikTok have played a larger role in filling this networking void left by canceled and virtual conferences. However, many

have felt that these platforms still lack a similar personal connection often made at conferences. This is likely because these platforms lack live interactive features where multiple users can hold a conversation in real time.

In the networking vacuum created by the pandemic, Clubhouse and Twitter Spaces have emerged as excellent platforms for meeting other medical professionals.

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Clubhouse

“In the networking vacuum created by the pandemic, Clubhouse and Twitter Spaces have emerged as excellent platforms for meeting other medical professionals.”

Clubhouse is an audio-based social networking mobile application launched in March 2020 in the early months of the COVID-19 pandemic. Clubhouse had over 10.1 million users as of February 2021, highlighting its vast reach and potential impact. Clubhouse users expanded with the addition of an Android compatible version in the Summer of 2021.

to join in on the discussion. The creator of each room can moderate who is on the stage. The creator can also promote other stage members to moderator.

Clubhouse allows users to create and join “rooms.” Each room has a title and topic. Inside of the room, users can just listen from the audience, or they can “raise their hand” and come to the stage

Users can also create and join “clubs” focused on specific topics or themes.

Several emergency medicine and critical care education clubs have been created such as “Emergency Medicine ED,”

“CriticalCareNow,” and “EMCrit.”

Twitter Spaces

Building on the success of Clubhouse, in November 2020 Twitter launched Twitter Spaces. Twitter spaces allows for voice-based discussions like Clubhouse. Users can join with their Twitter profile. Currently, Twitter spaces limits each space to one host and up to

“Medical education Clubhouse rooms and Twitter Spaces are being led by some of the top educators and researchers in emergency medicine.” two cohosts. The number of speakers is limited to 13.

Medical Education

Medical education Clubhouse rooms and Twitter Spaces are being led by some of the top educators and researchers in emergency medicine, such as Haney Mallemat, MD, Esther Choo, MD, MPH, Jeremy Faust, MD, MS, and Scott Weingart, MD. They are providing live lectures covering the latest publications and evidence that lead to best practices. Physicians have access to these educators to ask questions and interact on a level that is not possible at live conferences while other listeners also benefit from hearing the responses and information that is shared In addition to focused emergency medicine topics, interspecialty education is occurring in ways that have rarely been achieved at live conferences.

Surgeons have discussed best practices and techniques to help an emergency medicine physician complete a surgical airway. Cardiologists have offered pearls for discovering subtle signs in an ECG that may change management.

This emergency physician was able to provide tips to an inpatient physician who was placing an esophageal balloon tamponade device for the first time.

In addition to the interspecialty discussion, discussions among health care professionals and trainees from various continents can open eyes to the global practice of medicine in a way that live conferences never will.

These multidisciplinary discussions have led to real change in the practice of medicine. For example, a pediatric

surgeon at Cincinnati Children’s Hospital Medical Center (CCHMC) hosted a Clubhouse room on pediatric abdominal trauma with the intention of discussing how to perform a splenectomy in the setting of trauma. The conversation was joined by an interventional radiologist from UCLA Harbor. She presented the utilization of a hybrid operating room and collaboration between interventional radiology (IR) and surgery for the management of solid organ injury in trauma. Instead of performing a splenectomy, she discussed intraoperative endovascular embolization to spare any functional spleen, especially in the pediatric patient.

This novel approach was then discussed at multidisciplinary meetings at CCHMC between IR and surgery, with the intention of implementing a hybrid operating room for pediatric trauma.

Limitations

The possibility for visibility and education that social media provides to physicians is tremendous, but this seemingly limitless potential can also be seen as a doubleedged sword. Social media has long been a source of medical misinformation.

Social media applications provide users with the ease of sharing medical claims whether they are founded in scientific literature or not. Users can curate their

following, adding or deleting other users whose beliefs align or don’t align with their own. This leads to an “echo chamber” or “information silo” in which similar users can spread false medical claims amongst each other with little contradiction or debate.

ABOUT THE AUTHORS Dr. Haywood is assistant professor of emergency medicine, clerkship director, and core faculty at Summa Health. Dr. Haywood is the chair of the SAEM Virtual Presence Committee. He has a passion for online education contributing and editing multiple FOAM sites and is senior editor of CriticalCareNow.com.

Dr. Gerardo is a general surgery resident at Wright State University and currently doing dedicated research at Cincinnati Children’s Hospital Medical Center with the department of pediatric general and thoracic surgery. Dr. Gerardo has an interest in digital surgical education and hosts the Stay Current in Pediatric Surgery podcast.

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WELLNESS

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A Picture of a Smiling Face: Humanizing Front Line Workers During the Pandemic

By Mia Karamatsu, MD; Al’ai Alvarez, MD; Anya Waterstone, MD; Danielle McTaggart; and Nancy Ewen Wang, MD on behalf of the SAEM Wellness Committee As we enter the second year of the COVID-19 pandemic, wearing masks and personal protective equipment (PPE) has become second nature to all of us. While the masks, gowns, and goggles serve to protect us, they also make patient interactions less personal and somewhat disconnected.

At Stanford Emergency Medicine (EM), we implemented an intervention

focused on humanizing the experience between front line workers and our patients. We wanted to explore the effects of wearing a “smiling” selfportrait on staff well-being and patientstaff interactions.

The project originated from Mary Beth Heffernan’s Personal Protective Equipment (PPE) Portrait Project. During the Ebola crisis in Africa in 2014, Mary

Beth Heffernan recognized the value of seeing the face of health care providers and called her project “PPE Portraits.”

Health care workers, donned in PPE from head to toe, wore large portraits of their smiling faces while caring for their patients. This provided a human connection and improved the patient (and provider) experience. Based on Mary Beth Heffernan’s work, Dr. Cati Brown-Johnson used PPE Portraits at

“This project really made a difference in building a meaningful patient-physician relationship, for them to see the person behind the mask.” a Stanford COVID drive-through testing site for a one-week pilot project, which produced similar results. Since the start of the pandemic, the PPE Portraits project has been implemented across 25 institutions.

Photos of health care worker faces with a “smile they wish their patients could see” were made into 3” x 4.5” reusable, laminated PPE portrait badges. This low-cost intervention immediately caught the eyes of everyone we worked with within the emergency department (ED).

One front line worker shared, “Children would smile and point at my picture or tell me they liked my portrait. Families would comment positively as well.”

This allowed front line workers a much-needed connection with their patients during the time of fear, loss, and isolation. Our portraits, worn at “heartlevel,” became a conversation piece; “I like your smile!” and “Oh, that’s what you look like!” It was clear that patients enjoyed seeing the now-missed faces of physicians and staff, “Babies loved looking at my badge. Parents gave overwhelmingly positive feedback about how nice it is to see what my face looks like under my mask and goggles.”

This was equally important for Stanford EM residents, many of whom volunteered to work in the COVID ICU in addition to their clinical shifts in the ED. Dr. Wil Gibb,

a PGY-3 EM resident, shared, “My badge helped me feel more connected with patients in this extremely stressful time.

Even though my often-worried face was covered in PPE, it was nice to know my patients could always see my smile.”

Dr. Christine Scullywest, a PGY4, added, “My portrait showed them the face behind the PPE and helped to develop trust between patient and physician.”

Chief Resident Dr. Sarabeth Maciey also shared, “This project really made

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a difference in building a meaningful patient-physician relationship, for them to see the person behind the mask. This intervention is making a positive impact on our patients and staff. Being able to see our entire face in pictures ease patients’ fears of health care workers, while also allowing us to maintain safety.”

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Shortly after our pediatric ED piloted this intervention, faculty, residents, nurses, and other staff members from our adult ED started reaching out to participate. We knew we joined in an effort that is bigger than us; a project that allows our colleagues to remind both our patients and each other that we stand in solidarity and that our welcoming smiles carry our commitment to see them beyond their disease processes.

“It helps me connect better with others, both staff and patients. It brings a smile to my face when I see others with their portrait, and it’s an easy way to give a heartfelt compliment!”

As staffing naturally changed during the demands of the pandemic, this project also allowed us to meet new members of our ED in a better light: “Some coworkers started in our ED after masking guidelines were in place, and I never knew what they looked like!”

The portraits serve as a reminder that behind the mask, beyond the tasks and to-do lists on patient care and our daily work, there are human beings needing connection with each other.

The toll of the pandemic goes beyond just the death and trauma that we see as front-line workers. We carry these traumas at home and with us at work.

The PPE Portrait Project allows us to be seen again. One staff member shared that the PPE portraits “made me feel that I'm not hidden from my families anymore. Our work matters, and who we are matters.”

We have made more than 150 PPE portraits in total. The beauty of this project is that it is a simple, cost-effective way to for front-line workers to make a human connection. As we continue to care for those who are suffering during this pandemic, it is comforting to know that even with the simplest gesture of showing a friendly smile, we can extend compassion and help our patients and each other heal.

Acknowledgments: We would like to extend our gratitude to Mary Beth Heffernan for allowing us to use PPE Portraits in the Stanford ED. We also would like to thank Dr. Cati BrownJohnson; Dr. Bernard Dannenberg; Paige Parsons; Michelle Lin, RN; Lindsay Post, RN; and the Stanford ED staff for their support.

ABOUT THE AUTHORS Dr. Karamatsu is a clinical assistant professor in pediatric emergency medicine at Stanford Emergency Medicine.

Dr. Alvarez is director of wellbeing, Stanford Emergency Medicine, @alvarezzzy

Dr. Waterstone is a PGY-4 emergency medicine resident, Stanford Emergency Medicine

Danielle McTaggart is a child life specialist in Lucile Packard Children’s Hospital, Stanford Pediatric Emergency Department Dr. Ewen Wang is professor and associate director, pediatric emergency medicine, Stanford Emergency Medicine

“It helps me connect better with others, both staff and patients.

It brings a smile to my face when I see others with their portrait, and it’s an easy way to give a heartfelt compliment!”

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Searching for Healing and Understanding in a Time of AntiAsian Violence

By Kevin Hon, DO on behalf of the SAEM Wellness Committee On Feb 16, 2021, a 52-year-old Asian woman presented to our emergency department (ED) with a laceration to her forehead. She’d been violently lifted off the ground and thrown at a metal news rack and was now in our emergency department being treated by our residents. . She was treated by my coresidents without a second thought. Even on her worst day, she insisted that we accept her Chinese New Year red money packet to thank us for treating her.

As my PGY-1 year progressed, attacks like these became more frequent and, as an Asian-American doctor, painfully more personal. An elderly Korean lady presented to our emergency department (ED) after being harassed by a group of teenagers and pushed onto a parked van. A man presented to the ED with a subdural hematoma after being assaulted in the face and found in a ditch. Was he targeted for being Asian? Not long after an elderly Filipino woman suffered

severe injuries following an unprovoked attack in Manhattan while walking to church, I treated a patient of similar demographics who sustained facial trauma from a fall while walking home from church. Was she also a victim?

My heart sank when I heard about the six Asian women who were killed on March 16, 2021, in the Atlanta spa shootings. I thought of our residents, faculty, and nurses — the people I see every day, many of them of

“The most fruitful reward of the forum was the opportunity for our nonAsian residents to hear from us and gain understanding about our fears and how we had been affected by the uptick in violence against Asians.

That simple action of allyship allowed us as residents to heal together and contributed to lessening our burnout and enhancing our well-being.”

Asian descent. Was it safe for them to commute home? Hospitals across the country came out in force for “White Coats for Black Lives” only a year prior, but where was the outcry now? Hate crimes against Asians were on the rise, yet we seemed invisible. Our hospitals and administration remained silent. I felt helpless and alienated in my own community and wondered how our other Asian residents felt and whether my nonAsian fellow residents were even aware.

In my despair, I drafted a statement to bring awareness to Anti-Asian violence in my community. With the support of my fellow residents and attendings, the statement reached our program director’s desk and then the graduate medical education department and eventually our hospital’s chief medical officer.

From there, our hospital organized a moment of silence for the Atlanta victims.

Residents and faculty spoke out about their experiences of Asian violence. Soon, other hospitals within our system held similar events at their campuses.

Yet none of these events, while all positive, really confronted how lost we Asian residents were feeling. To address this, our faculty held an open forum/ wellness discussion. For our Asian residents who are female and therefore (given the trend) the most likely to become potential victims of assault, this was a platform to express their fears and discuss safeguards. However, the most fruitful reward of the forum was the opportunity for our non-Asian residents to hear from us and gain understanding about our fears and how we had been affected by the uptick in violence against Asians. That simple action of allyship allowed us as residents to heal together and contributed to lessening our burnout and enhancing our well-being.

An important reminder: While we have a strong Asian representation here in our residency, Asian residents elsewhere

may be feeling alienated on the job and among their colleagues. Let’s remember that in times of collective social crisis, our personal wellness can benefit from a little help from above and from each other.

Even if you’re the only Asian resident in your program, you can make a difference.

A simple statement can go a long way toward helping others learn more about each other and supporting each other through difficult times.

The author would personally like to thank Drs. Anika Nichlany, Saumil Parikh, and Cynthia Pan for their support during these difficult times and for making it possible to address these issues.

ABOUT THE AUTHOR Dr. Hon is a PGY-1 at NewYork-Presbyterian, Queens. He received his medical degree from Western University of Health Sciences College of Osteopathic Medicine and his undergraduate degree from the University of California San Diego

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Addressing the COVID-19 INFODEMIC

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By Michael A. Gisondi, MD Dr. Vivek Murthy, the U.S. Surgeon General, recently described health misinformation and disinformation as a public health crisis. His comments were made in response to the COVID-19 pandemic and the staggering number of unvaccinated Americans to date.

Vaccine hesitancy is fueled in large part by online misinformation and disinformation about vaccine safety and side effects, most notably on social media platforms. Misinformation greatly affects vaccination rates across the country, but especially among certain populations and states. Social media

companies actively seek to remove clearly false or misleading information about COVID-19 from their platforms, and they pair warnings with sound science and public health messaging.

However, this reliable health information about the COVID-19 vaccine is drowned out by the overwhelming and growing amount of misinformation online, leading to an infodemic.

An “infodemic” is defined by the World Health Organization as “too much information, including false or misleading information in digital and physical environments during a disease outbreak. It causes confusion and risktaking behaviors that can harm health.”

The deluge of information during an infodemic leads to widespread mistrust of health authorities, undermining

“Vaccine hesitancy is fueled in large part by online misinformation and disinformation about vaccine safety and side effects, most notably on social media platforms.” medicine. The conference goal was to identify new best practices for social media companies to combat COVID-19 misinformation on their platforms.

Over 500 participants from 71 countries listened to speakers from Pfizer, the World Health Organization, the Council on Foreign Relations, and the Hastings Center (among others) discuss vaccine hesitancy, confidence, equity, and ethics. Representatives from Google, Facebook, and Twitter and online physician influencers discussed current efforts to communicate accurate COVID-19 vaccine information online.

Invited participants also included politicians and religious leaders who discussed the types of messaging needed to best communicate health information to their unique constituencies.

public health efforts and fueling outbreaks. The COVID-19 Infodemic started early in the pandemic and has evolved to include widespread misinformation about transmission and disinformation about the vaccine. This has led to significant challenges for physicians trying to educate patients about vaccine safety and slower than expected vaccination rates. Specific, targeted messaging by public health officials and deliberate actions by social media platforms are required to combat this infodemic.

INFODEMIC featured 10 presentations/ panel discussions that are now freely accessible to the public. Video recordings of each session are available on the Stanford Emergency Medicine YouTube channel and audio recordings are available as podcast episodes through the Academic Life in Emergency Medicine podcast. These individual recordings and the full conference recording are also available on the INFODEMIC website.

The Journal of Medical Internet Research is sponsoring a special theme issue in conjunction with INFODEMIC, with a call for papers on “Social Media, Ethics, and COVID-19 Misinformation.”

The guest editors for the issue are all emergency physicians: Drs. Mike Gisondi, Matt Strehlow, Ali Raja, Mike Gottlieb, Lauren Westafer, and Jeremy Faust.

Researchers are encouraged to submit their manuscripts ahead of the December 31 deadline.

ABOUT THE AUTHOR Dr. Gisondi is the inaugural vice chair of education in the department of emergency medicine at Stanford University. He is the principal and founder of The Precision Education and Assessment Research Lab (The PEARL), codirector of the Scholarly Concentration in Medical Education at Stanford School of Medicine, and the recipient of the 2021 Hal Jayne Excellence in Education Award from SAEM

On August 26, 2021, the Department of Emergency Medicine at Stanford University partnered with the Stanford Ethics, Society, and Technology Hub to sponsor “INFODEMIC: A Stanford Conference on Social Media and COVID-19 Misinformation.” INFODEMIC virtually convened experts from around the world and a broad cross section of disciplines, including social media, cyber policy, ethics, public health, and

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SAEM’s Medical Student Ambassador Program: A One-of-a-Kind Opportunity

SAEM PULSE | NOVEMBER-DECEMBER 2021

Each year, medical students from across the country can partake in and contribute to the SAEM Annual Meeting via the Medical Student Ambassador (MSA) Program. Operating within SAEM’s Program Committee, MSAs play an integral role in the smooth execution of the annual meeting.

Students can apply for the program beginning December 1, 2021 by visiting the Medical Student Ambassador webpage.

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During the meeting, MSAs help coordinate and facilitate a variety of events — didactics, poster sessions, oral presentations, etc. — in addition to promoting the meeting on social media platforms. Additionally, MSAs enjoy the benefits of MSA-only educational sessions and one-on-one mentorship with select faculty from around the country. Throughout the meeting, MSAs are actively involved in the coordination of every part of the conference. Thus, the program offers an unparalleled opportunity to learn about academic emergency medicine and become immersed into the community.

A Chance to Develop Skills

Comfort Orebayo is a fourth-year medical student at Kansas City University. Born in Lagos Nigeria, she’s currently serving as an executive Comfort Orebayo board member on the Council of Osteopathic Student Government Presidents (COSGP), a

student director on the board of the American Osteopathic Foundation as well as the program subcommittee cochair for the Student National Medical Association (SNMA) Health Policy and Legislative Affairs Committee. She will be applying to emergency medicine residency programs this fall.

“Since developing a passion for medical education while in medical school, I had been trying to figure out ways to become more involved with SAEM. I remember discovering the MSA program days after the 2019 application deadline. At the time I didn't know anything about the program, but it seemed like an amazing opportunity to connect with potential mentors and other EM-bound students. Disappointed I’d missed the deadline, I bookmarked the page knowing that one day, I would be part of what seemed like an awesome way to get involved with academic emergency medicine. So imagine my excitement getting the email that I’d been selected as an MSA for SAEM21. A month later, when Dr. Alex Huh offered me a position as a lead in the program, I was shocked and overjoyed at the opportunity to not only serve SAEM but also my fellow students.

“Being a lead MSA was a truly rewarding opportunity that I’ll forever cherish both on a personal and professional level. As a lead MSA I had the opportunity to develop my public speaking, presentation, collaboration, and networking skills. Alongside the other leads, I was able to plan social

media blasts for SAEM21 as well as friendly competitions and social events in order to foster community, teamwork and comradery amongst the MSAs. “One of my favorite aspects of being an MSA was the chance to attend the MSA “lunch and learns” and the medical student symposium, which equipped me with tools that I use daily as an auditioning fourth-year medical student and EM-bound applicant. I also enjoyed being virtually behind the scenes on some of the innovation and lightning oral sessions at SAEM21, as it gave me an opportunity to learn about the cuttingedge research, tech, procedures, and practices in medical education.”

An Opportunity to Learn From Mentors

Taylor Daniel is a fourth-year medical student at the University of Pennsylvania and will be applying to emergency medicine residency Taylor Daniel programs this fall. She currently serves as a medical student representative on the RAMS Board and as a RAMS Board Liaison to the SAEM Education Committee.

Taylor completed a bachelor’s degree in molecular biology at the University of Pennsylvania.

“I discovered the MSA Program during my third year of medical school.

Newly set on pursuing a career in emergency medicine, I had just begun

to familiarize myself with the SAEM community when I stumbled upon the MSA application. I figured it would be an excellent way to throw myself into the world of emergency medicine, meet like-minded peers and mentors at all stages of training, and make my own contribution. The application was straightforward, and within a couple of months I was thrilled to join the ranks of SAEM21 MSAs. “Before the meeting, our program directors facilitated introductions, took our requests to attend specific SAEM21 sessions, and assigned each of us a faculty mentor. In addition, we attended an initial virtual training session and a second one the day before the start of SAEM21 to reiterate and clarify our responsibilities.

“During the meeting, I was tasked with logging into my assigned sessions early to ensure speaker and facilitator attendance, monitoring the chat for questions and comments, generating discussion by posting questions for presenters, and providing feedback at daily program committee meetings.

During MSA-specific sessions with program directors, residents, and EM faculty, I found it valuable to have the opportunity to ask questions and learn from those further along in their careers. Everyone I encountered was approachable, helpful, and enthusiastic about passing wisdom onto eager medical students.

“The sessions were engaging, and my involvement felt meaningful and appreciated. Above all, the opportunity to get to know the people of the EM community stands out as the greatest benefit from my time as an MSA.”

Programming Just for Medical Students

Dr. Victoria Zhou was a medical student at the University of Rochester when she served in-person as a medical student ambassador at SAEM18. She is Victoria Zhou presently a thirdyear resident at the University of Pennsylvania, Perelman School of

Medicine. Dr. Zhou is a member at large of the SAEM RAMS Board.

“Attending SAEM18 in-person as an MSA was one of my first exposures to the world of academic emergency medicine. The experience of being surrounded by a diverse group of students, residents, and faculty from all around the country (and world) was very inspiring.

“There was lots of programming aimed specifically at medical students plus a residency fair where I got to chat with program leaders one-on-one. We also had multiple MSA sessions that provided an overview of the residency application process and tips and tricks.

“One of our responsibilities was to help run a variety of plenary, didactic, and research presentation sessions. I was able to listen to leaders in emergency medicine talk about their areas of expertise, which always sparked lively discussions afterwards with their audience. The level of engagement of all those attending SAEM was remarkable.”

Become a Medical Student Ambassador!

Each year, the SAEM Program Committee looks for enthusiastic and responsible medical students from around the country to work directly with SAEM leadership to assist in the planning, coordination, and execution of SAEM’s Annual Meeting. This group of medical students serves as the primary volunteer force at the SAEM Annual Meeting. Applications open December 1, 2021. For details regarding benefits and obligations (and a new diversity and inclusion scholarship!), visit the Medical Student Ambassador webpage.

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SAEMF Grantees Make a Difference in the Understanding of COVID-19 Last year, as we began to navigate the pandemic and its impact on emergency medicine, the Society for Academic Emergency Medicine Foundation (SAEMF) awarded two important grants to aid in the understanding of COVID-19. The first $25,000 grant was awarded to Bernard Chang, MD, PhD from Columbia University Bernard P. Chang, MD, PhD, for his study “The Recipient of the 2020-21 Psychological Effects SAEMF COVID-19 Research of COVID-19 Amongst Grant - $25,000 Emergency Providers.”

Here’s a bit of background about his meaningful study and its goals: The emergency department is the gateway to the health care system, and the safety net for our society.

This is not our first pandemic or disaster, and previous work has established that front line health care workers (HCWs), such as emergency physicians and nurses, are vulnerable to the development of adverse behavioral and psychological sequelae, which may persist long after the disaster. This SAEMF-funded study will look at the longterm development of psychological distress amongst emergency staff following the COVID-19 pandemic. The results will inform our understanding of psychological stress among front line providers following COVID-19 and ideally lead to the development of interventions aimed at protecting the mental and physical well-being of our critical front line, as we navigate this and future public health crises.

Now over halfway through the completion of his project, Dr. Chang has found striking results: “In our study we successfully enrolled 244 participants to date (target n=250; 98% enrollment target), with enrollments across four hospital sites in the New York Metropolitan area. Our preliminary findings identified that

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approximately 60% of health care providers endorsed some anxiety and/or depressive symptoms in the wake of the early phase of the COVID-19 pandemic during March and April, with those working in areas of high acuity, most vulnerable to development of anxiety and/or depressive symptoms.

“In our study we also had participants wear accelerometer devices (e.g., Fitbit watches) capturing sleep and resting heart rate, in addition to daily home blood pressure readings with a Bluetooth enabled monitoring device. Physiologically, sleep was disrupted in providers, with clinicians sleeping on average 6.12 hours a day compared to 6.45 hours prior to the pandemic (based on another existing dataset of cardiovascular data we have among emergency department providers that we have conducted here at Columbia).

“Finally, resting blood pressure and heart rate was within normal limits among our sample; however, interestingly, post-shift resting heart rate and blood pressure was increased by 20% and 8% respectively, over a period of 12 hours after shift completion, suggesting some prolonged ‘stress response’ in the wake of shifts.

“Thanks to this generous SAEMF grant, we were able to use this pilot work to submit an R01 grant to National Institutes of Health (NIH) that was favorably reviewed and received a fundable score after study section review. If this five-year longitudinal study (R01) from (HL HL157341) is ultimately funded by the NIH, this will be among the largest prospective longitudinal studies on front line provider psychological and cardiovascular health in the wake of the COVID-19 pandemic. Thank you again to the individual and institutional donors of SAEMF. We are so grateful for your support!”

The second SAEMF COVID-19 grant of $25,000 was awarded to Evan Bradley, MD, PhD, and the University of Massachusetts Medical School, for "Nasopharyngeal Microbiome and Clinical Outcomes in Patients with COVID-19.” Dr. Bradley’s research focused on the effects of SARS-nCOV2 on the nasopharyngeal microbiome.

He hypothesized that there may be reliable features of the nasopharyngeal microbiome that are associated with COVID-19 that may aid in the diagnosis of infection, even if standard testing is negative. The community

of microorganisms that inhabit the human nasopharynx, known as the nasopharyngeal microbiome, is known to interact with respiratory viruses and influence how the host initially responds to infection and potentially influence disease course.

How it interacts with SARS-nCOV2, the virus that causes COVID-19, may have important effects on the Evan Bradley, MD, PhD, virus’ ability to establish Recipient of the 2020-21 a productive infection SAEMF COVID-19 Research and host’s response to Grant - $25,000 the virus. Through this SAEMF-funded study, Dr. Bradley performed a prospective cohort study of patients presenting to the UMass Memorial Emergency Department under investigation for COVID-19. They performed microbiome analysis on nasopharyngeal swabs to determine the effect SARS-nCOV2 has on the nasopharyngeal microbiome, and if there are microbiome factors associated with a benign or severe clinical course.

Dr. Bradley recently shared the following update with us: “Since beginning our study of the microbiome among COVID-19 patients, we have enrolled 156 patients in the emergency department being tested for, or already diagnosed with, COVID-19. We collected swabs and information about their clinicals course with a special emphasis on need for respiratory support and symptom duration. Utilizing high-throughput DNA sequencing of these swabs, we identified bacterial species and microbial metabolic pathways present in the oropharynx. Using a machine-learning based random forest classification model, we identified clinical factors, bacterial species, and metabolic pathways that were associated with the need for respiratory support and the development of persistent COVID-19 symptoms.

“We found that microbiome factors were the most important predictors in our models for both the need for respiratory support and the development of persistent COVID-19 symptoms, showing greater importance in our models than known risk factors for severe COVID-19 such as body mass index and high blood pressure.

Unexpectedly, it was an increased abundance of certain commensal organisms and metabolic pathways associated with bacterial products synthesis which appeared to be protective against the need for respiratory support.

This suggests that bacteria within the oropharyngeal microbiome may play a protective role against severe COVID-19, as opposed to representing a source of opportunistic pathogens.

“Several bacterial species found to be predictive of persistent COVID-19 symptoms had been previously described as being associated with chronic fatigue syndrome (CFS), suggesting a possible link between CFS and long-COVID. This finding is particularly relevant now as a significant number of COVID-19 patients who recover have persistent and debilitating symptoms, even if they were fully vaccinated against COVID-19 and did not develop disease severe enough to require hospitalization. We are currently preparing two manuscripts to publish our findings and are actively planning larger follow-up studies to investigate the interplay between the immune system and the oropharyngeal microbiome to understand the mechanisms behind our results.”

These are just two reports about the meaningful progress being made in vital areas of research that will benefit emergency medicine providers and patients in the future.

Visit SAEMF’s Donor Impact section for more Researcher Highlights. We are grateful to all those who contributed to make these projects possible and look forward to updating you about the work of other SAEMF grantees in 2022.

Learn more about Dr. Bradley's research in this article published in the October 2021 JCI Insight: Inflammation-type dysbiosis of the oral microbiome associates with the duration of COVID-19 symptoms and long COVID.

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Your Gift to SAEMF Has Tangible Impact For the 2021-22 Grants cycle, the Society for Academic Emergency Medicine Foundation (SAEMF) awarded close to $700,000 to fund 23 of the most promising researchers and educators in emergency medicine thanks to the generosity of hundreds of SAEM member donors.

SAEMF funding is vital to trainees as they navigate the early stages of their academic careers. We are honored to help launch their careers as they begin to publish papers, find meaningful peer and mentor connections, and participate in SAEM/F activities that lend to showcasing themselves and their work to the emergency medicine community.

Our grantees are making a true impact on emergency medicine. For every $1 donated to SAEMF, $3 is generated in subsequent funding. We recently visited with Jestin Carlson MD, MS, MHA, director of resident research, Saint Vincent Hospital and National Director of Clinical Education, U.S. Acute Care Solutions, who shared his sentiments about the impact an SAEMF grant has had on his work: “I received the SAEMF Education Research Grant in 2014-15 for my research ‘Comparison of Visual Centers of Attention between Experienced and Novice Providers during a Simulated Cardiac Arrest.’ This grant positively

impacted my career by launching this line of work. It has led to over $500,000 in additional funds in this area. Through this project, we have increased the understanding about how teams interact during critical events. The SAEMF helped my career in ways I am still realizing, and I am so appreciative of SAEM/F and their donors for support of this work.”

Hear more from Jestin, then visit SAEMF’s donor impact section of our website for more information about the impact of a gift.

You can help us do even more to shape the careers of tomorrow’s academic emergency medicine leaders like Jestin when you make a gift by December 31, 2021.

“I received the SAEMF Education Research Grant in 2014-15 for my research ‘Comparison of Visual Centers of Attention between Experienced and Novice Providers during a Simulated Cardiac Arrest.’ This grant positively impacted my career by launching this line of work. It has led to over $500,000 in additional funds in this area.

Through this project, we have increased the understanding about how teams interact during critical events. The SAEMF helped my career in ways I am still realizing, and I am so appreciative of SAEM/F and their donors for support of this work.”

Your gift will make a difference ...

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$100

$250

$500

$1,000

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

Provides a fellow with 2.5 hours of dedicated training time

Brings together medical students for an Emergency Medicine Interest Group

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

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ways to support research and education this holiday season

1

2

Donate a recurring gift to easily support SAEMF year-round

3

Shop with AmazonSmile

4 Consider a Legacy gift when you review your estate plans

Contribute your Grand Rounds Honoraria

5

6 Honor someone special through a tribute gift

Talk to your advisor about options to gift appreciated securities

Whichever way you choose to donate, your generosity will make a difference in your specialty’s future and in the lives of millions of patients who will benefit from future advances in emergency care and well-trained emergency medicine physicians — made possible through today’s SAEMF researchers and educators.

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

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BRIEFS AND BULLET POINTS SAEM FEATURED NEWS Call for Nominations: 2022-2023 Leadership Positions

Nominations are now being accepted for leadership positions for SAEM, RAMS, AACEM, SAEM academies, and the SAEM Foundation. Leadership positions should be filled by committed individuals who have a wide range of perspectives and possess the relevant skills and experience to effectively lead. If you, or someone you know, fit that description we invite you to submit a nomination in one or more of the categories listed on the nominations webpage. Deadline for nominations is November 12, 2021.

Everyone has a role to play in breaking down barriers to mental health care in EM. Click the link below for resources and to see how you can and help: Stop the Stigma EM: A Toolkit for Individuals, Educators & Institutions

SAEM, EM Physician Organizations Issue Joint Statement Regarding Mental Health Care Stigma in EM In response to COVID’s growing toll on the mental health and well-being of EM physicians and the hesitancy to seek mental health treatment due to stigma in

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Program Registration Opens Dec. 1 for the 2022 Residency & Fellowship Fair

Residency and fellowship directors… showcase your institution's programs at the 2022 Residency & Fellowship Fair, to be held from 3–5 p.m. CT, Thursday, May 12, in New Orleans. Meet in-person with hundreds of medical students and residents from across the country who are looking to find their perfect residency or fellowship. Program registration opens December 1. Save the date and make plans to register for this popular event.

the workplace, a coalition of emergency medicine organizations, led by SAEM, has formed an EM Mental Health Collaborative to stimulate education, awareness, advocacy, and policy action related to breaking down barriers to mental health care in EM. Read the full joint statement and call to action here.

well as payer and regulatory segments of the health care system. This is an assessment put forward in a commentary article titled Emergency Department Crowding: The Canary in the Health Care System, published in New England Journal of Medicine Catalyst. The article was coauthored by members of the AACEM.

Accepting Nominations for 2022 Awards

SAEM Clinical Image Series

SAEM and RAMS invite you to nominate your exceptional colleagues for one of several SAEM awards (including the new Fellowship Award in Toxicology and Young Educator Award) and RAMS awards. These awards recognize outstanding individuals for their contributions to academic emergency medicine. National award recognition is an excellent boost to your CV and for potential promotion. Nominate yourself or a colleague

by December 9, 2021, to be considered for this year’s awards.

AACEM Leaders Publish Paper Urging Action to Address Emergency Department Crowding

ED crowding and resultant delays in patient care have been incontrovertibly shown to lead to patient harm. ED crowding is a problem largely caused by overall hospital crowding and thus cannot be solved by a single department but through ongoing commitment by institutional leaders as

Take a look at the latest installments in the SAEM Clinical Image Series — a collaboration between the Society for Academic Emergency Medicine (SAEM) and Academic Life in Emergency Medicine (ALiEM). Check out the images, read the case notes, and see if you can figure out the diagnosis before you reveal the answer.

• Silver Scales • Traumatic Swollen Eye • Pediatric Penis Swelling • Pulseless and Painful Blue Leg • Sudden Onset of Facial Petechiae in Kindergartener • Facial Edema

Now on Video!

• FDC: Emotional Intelligence: A Vital Trait for Effective Leaders • Acute Agitation Associated with Schizophrenia and Bipolar Disorders: What Can Be Improved?

• ADIEM Presents: Pathways to Professor

• From Match to Promotion Webinar Series: Contract Negotiation-Securing your First Job like a Pro • Surviving Medical Training During the Pandemic: Being Well and Staying Well • So, You Want to Be a Clinical/Academic Leader... Pearls and Pitfalls to Consider in Successfully Navigating a Career • Secrets to a Successful Academic Career – Think Tripod

Dr. Michelle Lin

Introducing Three New Publications From SAEM

The Reason for Research A career with a focus on academic research in emergency medicine (EM) is a rigorous but thrilling professional path, providing intellectual stimulation, variety, autonomy, and the potential to impact many areas of acute care, including hospital operations. “The Reason for Research” is a comprehensive guide for medical students, residents, and junior faculty who may be interested in pursuing an academic career in emergency medicine research. It provides an overview of a career in EM research, including career planning tips, information on required education and training, and advice and inspiration from some of the top researchers in emergency medicine.

Fellowship Program Guide The Fellowship Program Guide is a comprehensive, online tool that offers advice and resources for creating and leading emergency medicine fellowship programs from the ground up. It includes detailed chapters on problem identification, general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation and feedback.

Health Policy Roadmap Physician involvement in local, state, and federal legislation is essential to advocating for and protecting the patients emergency physicians serve. The involvement of emergency physicians in health policy is vital to upholding the standard of care and seeking justice for all individuals in need of medical assistance. The SAEM RAMS Health Policy Roadmap is a definitive, stepby-step guide on how to succeed in health policy at every training level.

SAEM JOURNALS

Dr. Kamna Balhara

Dr. Jody Vogel

amna Balhara, MD, MA, K is an assistant professor in the department of emergency medicine and assistant program director of the Johns Hopkins Emergency Medicine Residency Program.

Dr. Elizabeth Schoenfeld

AEM E&T Journal Seeks a Social Media Editor

The AEM Education and Training (AEM E&T) editorial board is searching for a volunteer social media editor to help grow the journal’s social media presence. The position offers important professional benefits that will enrich your CV, enhance your influence, and broaden your network.

The social media editor will be an integral part of the AEM E&T editorial board by shaping the messaging and expanding the reach of the journal. Applications are due by December 1, 2021. For details, visit the webpage.

REGIONAL MEETINGS

Jody Vogel, MD, MSc, MSW, is vice chair of academic affairs and associate professor in the department of emergency medicine, at Stanford University.

Makini ChisholmStraker, MD, is an associate professor of emergency medicine in the department of emergency medicine and core faculty in Dr. Makini Chisholm-Straker the Institute for Health Equity Research, Icahn School of Medicine, Mount Sinai.

Elizabeth Schoenfeld, MD, is an assistant professor in the department of emergency medicine at the University of Massachusetts Medical School–Baystate Medical.

Paul Musey, MD, is an assistant professor of emergency medicine at Indiana University School of Medicine.

Dr. Paul Musey

Peter Jenkins, MD, is an assistant professor of surgery at Indiana University School fo Medicine.

Academic Emergency Medicine Names 7 to Editorial Board

The editor-in-chief and senior editorial board of Academic Emergency Medicine (AEM) is proud to announce the addition to the AEM editorial board of the following new members:

ichelle Lin, MD, MPH, M MS, is an associate professor of population health science and policy and associate professor of emergency medicine, Icahn School of Medicine at Mount Sinai.

Dates Announced for Western Regional Meeting

The SAEM Western Regional Meeting will be held April 1-2, 2022 at Stanford University. This meeting is the primary forum for presenting original emergency medicine research in the western region. Abstract submission window for the Western Regional Meeting opens November 1. Note this is a 100 percent in-person event.

ACADEMY REPORTS Simulation Academy The SAEM Simulation Academy community has been extremely active over the past few months.

• We launched a new website!

• In conjunction with the CORD Simulation Community, are offering a simulation consulting service to help troubleshoot simulation education and curricular challenges. (To request a consult, email simconsults@saem.org) • The Simulation Academy Executive Board is expanding! Open for election this year are four new positions: Fellow, Vice Chair of Education, Vice Chair of Communications, and Social Media.

For more updates including upcoming events, follow the Simulation Academy twitter account @SAEMSimAcademy

Dr. Peter Jenkins

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A One-of-a-Kind Opportunity Just for Medical Students!

SAEM is recruiting 70 energetic, self-starting, responsible, and enthusiastic medical students to work directly with the SAEM Program Committee to assist in the planning, coordination, and execution of SAEM22 in New Orleans, LA, May 10–13, 2022.

7 Benefits of Being an SAEM20 Medical Student Ambassador 1. Waiver of your SAEM22 registration fee (a savings of $175!)

2. Free registration to the Medical Student Symposium (valued at $125) 3. Exposure to current education and research in EM through participation in didactics, poster sessions, lectures, and other educational activities 4. Pairing and scheduled one-on-one meetings with an academic EM mentor (a faculty advisor from the SAEM22 Program Committee) 5. Opportunities to form relationships with faculty members, residents, and medical students from EM programs around the country 6. A personal letter from the program committee chair, sent to your dean of student affairs, acknowledging your contributions 7. Your very own SAEM-branded athletic jacket! (All the cool kids are wearing them!)

Requirements and Expectations of Medical Student Ambassadors • Attend

the orientation and property tour on Monday, May 9, 2022, at 5 p.m.

• Fulfill

your role through the entirety of the annual meeting, ending on Friday, May 13, 2022, at 6 p.m.

• Attend

daily program committee meetings, arriving promptly each morning

• Complete

all assigned responsibilities (approximately six hours daily)

• Attend

research and didactic sessions

• Tweet

educational pearls from research and didactic sessions

• Encourage

participants to complete online

evaluations • Assist

with audiovisual needs

• Facilitate

transitions between lectures

• Be

responsive and flexible to the needs of the program committee

How to Apply Medical students who are interested in serving as a Medical Student Ambassador for SAEM22 should complete the application form

by January 11, 2022. MSAs will be selected and notified by February 7, 2022. Questions?

Contact Holly Byrd-Duncan at hbyrdduncan@ saem.org or education@saem.org.

Please note: Travel and hotel expenses are the responsibility of the individual MSAs; however, SAEM will provide contact information for all MSAs to help facilitate the sharing and consolidation of these expenses.

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ACADEMIC ANNOUNCEMENTS Dr. Shayne Gue Appointed Director of Education Dr. Alicia Genisca Receives Inaugural Brown at University of Central Florida URM Award Shayne Gue, MD, was recently appointed director of education for the University of Central Florida College of Medicine/ HCA GME Consortium EM Residency Program of Greater Orlando. Dr. Gue is participating in the 2021 ACEP/CORD teaching fellowship and currently pursuing Dr. Shayne Gue a Master's in medical education from Lake Erie College of Osteopathic Medicine. He has been recognized as the 2020 Faculty Member of the Year for the AdventHealth GME as well as the winner of the 2021 ACEP TF Microteaching Award.

Dr. David H. Jang Awarded an NIH High Priority, Short-Term Project David H. Jang, MD, MSc, an assistant professor of emergency medicine and medical toxicology at the University of Pennsylvania Perelman School of Medicine, was recently awarded an NHLBI R56 for his project entitled, “The use of blood cells as a biomarker in a porcine model of CO Dr. David H. Jang poisoning with evaluation of an engineered succinate-prodrug.” His project will specifically investigate the use of noninvasive optical measures of cerebral COHb and Complex IV redox states in a swine model of carbon monoxide poisoning as a surrogate measure of mitochondrial tissue function. This project is in collaboration with Drs. Todd Kilbaugh (CHOP), John Greenwood (Penn), Matthew Kelly (UAB), and Wesley Baker (Penn/CHOP).

Dr. David Brown Named President of Massachusetts General Hospital and Executive VP at Mass General Brigham David F. M. Brown, MD, was named president of Massachusetts General Hospital (MGH) and executive vice president at Mass General Brigham effective September 8. Dr. Brown currently serves as chair of the department of emergency medicine at MGH, interim Dr. David F. M. Brown president of Cooley Dickinson Health Care and the MGH Trustees Professor of Emergency Medicine at Harvard Medical School. He has been recognized with multiple awards and currently also serves as the chair of the Executive Committee on Teaching and Education and as the academic head of the Harvard Affiliated Emergency Medicine Residency at Mass General Brigham.

Alicia E. Genisca, MD, assistant professor of emergency medicine and assistant professor of pediatrics at Brown Emergency Medicine, received an inaugural Brown Physicians Incorporated Minority Faculty Career Development Awards for her project, “Pediatric Emergency Medicine Education.”

Dr. Alicia E. Genisca This award supports junior faculty from underrepresented minorities in medicine who are committed to the pursuit of a career in academic medicine.

Dr. Taneisha Wilson Receives Inaugural Brown URM Award Taneisha Wilson, MD, ScM, assistant professor of emergency medicine and director of diversity initiatives for Brown Emergency Medicine, was the recipient of an inaugural Brown Physicians Incorporated Minority Faculty Career Dr. Taneisha Wilson Development Awards for her project, “Focused Assessment for Sickle Cell Crisis in a Triage Chair.” This award supports junior faculty from underrepresented minorities in medicine who are committed to the pursuit of a career in academic medicine.

Make emergency medicine your cause this Giving Tuesday Nov 30, 2021

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NOW HIRING POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES! Accepting ads for our “Now Hiring” section!

Deadline for the next issue of SAEM Pulse is December 1.

For specs and pricing, visit the SAEM Pulse advertising webpage.

Clinical Research Fellowship This two-year Fellowship gives the fellow an opportunity to obtain a Master’s Degree in clinical research techniques and join our highly productive clinical research program.

The fellow will benefit from 24/7 research associate coverage of our EDs and a CTSA with extensive resources.

Previous graduates of this program now hold leadership positions in a variety of regional institutions.

Fellows will work clinical shifts in our high volume EDs in the Bronx, NY with our emergency medicine residents. The Montefiore EDs see 250,000 patients annually. The PGY1-4 residency program is one of the oldest and largest in the nation. Montefiore is the primary affiliate for the Albert Einstein College of Medicine.

Applicants must have completed an emergency medicine residency prior to starting the fellowship.

Interested applicants should send inquiries to Recruiting Manager, John C. Pinto at jpinto@montefiore.com or 718.920.2937.

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Montefiore (https://www.montefiore.org) is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.

Envision Physician Services Services is currently featuring a number of emergency medicine leadership and staff positions at highly desirable academic facilities across the nation.

Physicians Choose Envision Because…

Working with us means having access to tools and resources that enable our teammates to focus on patient care while enjoying an exceptional quality of practice.

Featured Positions Assistant Residency Director Aventura Hospital and Medical Center Miami, FL

Ultrasound Director TriStar Skyline Medical Center Nashville, TN

Simulation Director Osceola Regional Medical Center Kissimmee, FL

Ready to learn more?

Contact our experienced recruiters today!

844.982.4855 EVPS.com/SAEM

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Penn State Health Emergency Medicine About Us: Penn State Health is a multi-hospital health system serving patients and communities across 29 counties in central Pennsylvania.

The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Children’s Hospital, and Penn State Cancer Institute based in Hershey, PA; Penn State Health Holy Spirit Medical Center in Camp Hill, PA; Penn State Health St. Joseph Medical Center in Reading, PA; and more than 2,300 physicians and direct care providers at more than 125 medical office locations. Additionally, the system jointly operates various health care providers, including Penn State JOIN OUR TEAM Health Rehabilitation Hospital, Hershey Outpatient Surgery Center, Hershey Endoscopy Center, Horizon Home Healthcare and Pennsylvania Psychiatric Institute.

EMERGENCY MEDICINE OPPORTUNITIES In December 2017, Penn State Health partnered with Highmark Health to facilitate creation of a value-based, AVAILABLE community care network in the region. Penn State Health shares an integrated strategic plan and operations with Penn State College of Medicine, the university’s medical school.

We foster a collaborative environment rich with diversity, share a passion for patient care, and have a space for those who share our spark of innovative research interests. Our health system is expanding and we have opportunities in both an academic hospital as well community hospital settings.

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

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

hpeffley@pennstatehealth.psu.edu

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

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NEW CAREER OPPORTUNITIES IN ACADEMIC MEDICINE

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

Join our team

teamhealth.com/join or call 877.650.1218

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Emergency Medicine Residency Program Director Penn State Health Milton S. Hershey Medical Center is seeking an Emergency Medicine Residency Program Director to join our exceptional academic team located in Hershey, PA. This is an excellent opportunity to join an outstanding academic program with a national reputation and inpact the lives of our future Emergency Medicine physicians.

What We’re Offering: • Competitive salary and benefits • Sign-On Bonus • Relocation Assistance • Leadership for Emergency Medicine Residency Program • Comprehensive benefit and retirement options

FOR MORE INFORMATION PLEASE CONTACT:

Heather Peffley, PHR CPRP Physician Recruiter Penn State Health

Email: hpeffley@pennstatehealth.psu.edu Website: careers.pennstatehealth.org

What We’re Seeking: • MD, DO, or foreign equivalent • BC/BE by ABEM or ABOEM • Leadership experience • Outstanding patient care qualities • Ability to work collaboratively within a diverse academic and clinical environment

What the Area Offers: Located in a safe family-friendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences. We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC.

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

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The University of California, Davis, School of Medicine, Department of Emergency Medicine is conducting a faculty search for emergency medicine physicians as Assistant/Associate/ Professors in either a (HSCP) clinician/educator or (Clin X) clinician/researcher track.

Requirements include M.D. degree or equivalent, Board Certification or eligibility in Emergency Medicine, valid CA Medical License or eligibility for licensure, experience teaching medical students, residents, and fellows, the ability to work cooperatively and collegially within a diverse environment, and the ability to adhere to policies and procedures. Fellowship training with at least one year of post-training clinical experience is desired. We especially welcome applicants whose research, teaching, and community outreach demonstrably attest to their commitment to inclusion of under-represented and/or non-majority individuals into their respective area of specialization within their discipline.

The Emergency Department provides comprehensive emergency services to a large local urban and referral population as a Level One Trauma Center, paramedic base station, and training center. The fully accredited residency training program in Emergency Medicine at UC Davis Medical Center began over three decades ago and currently has 60 residents. All faculty members are required to provide both bedside and didactic teaching to residents, medical students, and others rotating through the Emergency Department. The successful candidate will show a commitment to educating and mentoring a diverse student body to expand opportunities and enhance personal growth, retention, and academic success.

For full consideration, please consult the link below for apply by dates. This recruitment will be open until filled through June 30, 2022. To apply please upload the following: letter of interest, curriculum vitae, and a statement of contributions to diversity to: https://recruit.ucdavis.edu/apply/JPF04321. All files should be in PDF format.

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 patients with Hepatitis B, HIV, other infectious diseases, and also patients who may inflict physical harm.

UC Davis commits to inclusion excellence by advancing equity, diversity and inclusion in all that we do. We are an Affirmative Action/Equal Opportunity employer, and particularly encourage applications from members of historically underrepresented racial/ethnic groups, women, individuals with disabilities, veterans, LGBTQ community members, and others who demonstrate the ability to help us achieve our vision of a diverse and inclusive community.

Under Federal law, the University of California may employ only individuals who are legally able to work in the United States as established by providing documents as specified in the Immigration Reform and Control Act of 1986. Certain UCD positions funded by federal contracts or sub-contracts require the selected candidate to pass an E-Verify check. More information is available at http://www.uscis.gov/e-verify.

UC Davis is a smoke & tobacco-free campus (http://breathefree.ucdavis.edu/). If you need accommodation due to a disability, please contact the recruiting department. For additional information: Erik Laurin, M.D., Professor and Search Committee Chair, (eglaurin@ucdavis.edu) UC Davis Department of Emergency Medicine 2315 Stockton Boulevard, PSSB 2100, Sacramento, CA 95817 The University of California is an affirmative action/equal opportunity employer.

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RESEARCH FACULTY – EMERGENCY MEDICINE University of California San Francisco The University of California, San Francisco (UCSF) Department of Emergency Medicine is recruiting a Basic, Clinical or Health Services Researcher with a track record of successful research activities, as demonstrated by peer-review publications and funding.

Candidates should hold a medical degree (MD/DO), doctorate degree (PhD), or both. Physician candidates should be board certified or eligible in Emergency Medicine. The successful candidate will demonstrate outstanding and original research, a track record of funding, and a collaborative spirit. Successful candidates must be willing to contribute to the department’s strategic plan in the area of diversity, equity and inclusion. Academic rank and series will be commensurate with qualifications.

The Department of Emergency Medicine provides comprehensive emergency services to a large local and referral population at multiple academic hospitals across the San Francisco Bay Area, including UCSF Hellen Diller Medical Center, Zuckerberg San Francisco General Hospital, and the UCSF Benioff Children’s Hospitals in San Francsico and Oakland. The Department of Emergency Medicine directs a fully accredited 4-year Emergency Medicine residency program, multiple ACGME and non-ACGME fellowship programs, and nearly 20 courses in the School of Medicine.

Research is a major departmental priority, with about 70 ongoing studies and more than 100 peer-reviewed publications every year across a wide range of research domains. The department participates in multiple national clinical research networks and has strong research collaborations with other UCSF departments and institutes. There are opportunities for leadership and growth within the Department and UCSF School of Medicine.

UCSF is one of the nation’s top five medical schools, and demonstrates excellence in basic science and clinical research, global health sciences, policy, advocacy, and medical education scholarship. The San Francisco Bay Area is well-known for its great food, mild climate, beautiful scenery, vibrant cultural environment and its outdoor recreational activities.

Please apply online at https://aprecruit.ucsf.edu/JPF03641 UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an Equal Opportunity/ Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. For additional information, please visit our website at http://emergency.ucsf.edu/

UMass Emergency Medicine Fellowships

Seven robust fellowship training opportunities are available in a premiere academic setting www.umassmed.edu/emed/fellowship Contact: Jean Baril at 505-421-1750 Email: Jean.Baril@umassmed.edu

Health Equity Fellowship

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JOB OPPORTUNITY ABEM

Director of Research

The Director of Research will build a new research unit within ABEM and will identify research opportunities in ABEM’s data-rich environment that will inform ABEM’s certification efforts and advance the specialty.

Contact us

View the full job description and apply

Learn about ABEM

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