SAEM Pulse November-December 2023 by Society for Academic Emergency Medicine

NOVEMBER-DECEMBER 2023 | VOLUME XXXVIII NUMBER 6

www.saem.org

SPOTLIGHT A JOURNEY INTO RESEARCH AND RURAL HEALTH An interview with

Nicholas Mohr, MD, MS

Office of Emergency Care Research

Demystifying the NIH Peer Review Process: Insights from Study Section Evaluations page 28

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 mschagrin@saem.org

Sr. Director, Foundation and Business Development Melissa McMillian, CAE, CNP mmcmillian@saem.org Sr. Manager, Development for the SAEM Foundation Julie Wolfe, jwolfe@saem.org Manager, Educational Course Development Kayla Belec Roseen, kroseen@saem.org Manager, Exhibits and Sponsorships Bill Schmitt, wschmitt@saem.org

Director, Finance & Operations Doug Ray, MSA, dray@saem.org Manager, Accounting Edwina Zaccardo, ezaccardo@saem.org Director, IT Anthony "Tony" Macalindong, amacalindong@saem.org IT AMS Database Specialist Dometrise "Dom" Hairston, dhairston@saem.org Specialist, IT Support Dawud Lawson, dlawson@saem.org Director, Governance Erin Campo, ecampo@saem.org Manager, Governance Juana Vazquez, jvazquez@saem.org Director, Communications & Publications Laura Giblin, lgiblin@saem.org Sr. Manager, Communications & Publications Stacey Roseen, sroseen@saem.org Manager, Digital Marketing & Communications, Alison “Ali” Mistretta amistretta@saem.org Specialist, Web and Digital Content Alex Gorny, agorny@saem.org

Director, Membership & Meetings Holly Byrd-Duncan, MBA, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves, ggreaves@saem.org Sr. Manager, Education Andrea Ray, aray@saem.org Sr. Coordinator, Membership & Meetings Monica Bell, CMP, mbell@saem.org Specialist, Membership Recruitment Krystle Ansay, kansay@saem.org Meeting Planner Kar Corlew, kcorlew@saem.org AEM Editor in Chief Jeffrey Kline, MD, AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD, AEMETeditor@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen, tbowen@saem.org aem@saem.org, aemet@saem.org

HIGHLIGHTS 3

President’s Comments End of the Year Update: Progress and Partnerships

Sex & Gender Gender Disparities in Homelessness: Implications for Health Outcomes

SAEM Board Corner SAEM board liaisons provide a roundup of what's happening in the Society's many active groups.

Wellness Perspective Prescription for the Soul: Lessons from a Sabbatical in the Himalayan Foothills

Spotlight A Journey into Research and Rural Health – A Conversation with Dr. Nicholas Mohr

Identity, Belonging, and Mentorship: Keys to Navigating the Isolation of EM Residency

Cardiovascular Cases Bendopnea: The Heart's Subtle Message in a Simple Bend

Wilderness Medicine Navigating Toxic Flora: A Guide to Common Cardiac Glycoside Plants in North America

Clinical Practice The Escalating Crisis: Hospital Capacity and the Vital Role of the ED Medical Officer of the Day

Summer of the Shark: Managing Shark Bites in the ED

Residents & Medical Students RAMS Declassified Workforce Survival Guide

The Legacy Society: Donors Sustaining EM Research Well Into the Future

Briefs & Bullet Points Important news, information, and upoming deadlines from SAEM.

SAEM24 Updates

SAEM Reports News from SAEM's committees, academies, and interest groups.

Academic Announcements Appointments, promotions, awards, and other good news about your EM peers and colleagues!

Now Hiring

Diversity, Equity, Inclusion Tokenism: The Result of Diversity Without Equity and Inclusion

Education Your Story, Your Success: Crafting a Curriculum Vitae With You at the Center

Ethics in Action Balancing Acts: Prioritizing Patients in Inter-Service Agreements

Faculty Focus Balancing Personal Well-being and Professional Accountability: Challenges for a New Residency Program

Geriatric EM Addressing Substance Use in Geriatric EM: A Novel Rotation Approach

NIH Office of Emergency Care Research Demystifying the NIH Peer Review Process: Insights from Study Section Evaluations

Resident Wellness The GROW Initiative: An Innovative Approach to Resident Growth and Wellness

We’re innovating with a new phone system! For the most up-to-date information, visit the “Contact Us” page starting November 7.

2023–2024 BOARD OF DIRECTORS Wendy C. Coates, MD President UCLA Department of Emergency Medicine David Geffen School of Medicine at UCLA Ali S. Raja, MD, DBA, MPH President Elect Massachusetts General Hospital/Harvard Members-at-Large Pooja Agrawal, MD, MPH Yale University School of Medicine Jeffrey Druck, MD The University of Utah School of Medicine Julianna J. Jung, MD Johns Hopkins University School of Medicine Nicholas M. Mohr, MD, MS University of Iowa

Michelle D. Lall, MD, MHS Secretary Treasurer Emory University Angela M. Mills, MD Immediate Past President Columbia University Vagelos

Ava E. Pierce, MD UT Southwestern Medical Center, Dallas Jody A. Vogel, MD, MSc, MSW Stanford University Department of Emergency Medicine Resident Member Michael DeFilippo, DO, MICP NewYork-Presbyterian - Columbia & Cornell

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. © 2023 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 Wendy Coates, MD UCLA Department of Emergency Medicine David Geffen School of Medicine at UCLA 2023-2024 President, SAEM

End of the Year Update: Progress and Partnerships

“In the spirit of service, the SAEM Board, along with the entire SAEM staff, participated in an "EM Day of Service" event on behalf of all our members.”

As the year draws to a close, the rush of the holiday season is upon us, filled with festive gatherings, holiday preparations, and tying up the loose ends of the year (including SAEM abstracts!). Amidst the flurry of activity, your SAEM leadership has been hard at work on your behalf. As the clock ticks toward 2024, here’s a recap of the strides made by SAEM and initiatives undertaken by your BOD these past few months: In September, the SAEM Board of Directors gathered at SAEM Headquarters for an intensive two-day meeting. Among our many agenda items was the review of the fantastic suggestions made by our members during the August strategic planning session. These ideas are missiondriven, focusing on how to propel SAEM forward in the areas of medical education, professional development, research, and workforce development. You'll see many of your suggestions becoming committee objectives in the upcoming year, while others will be put into action by the dedicated SAEM staff and Board of Directors. We reviewed the many project proposals submitted by our academies, committees, and interest groups. What a creative bunch! Their ideas are bound to make a real difference! We're incredibly fortunate to have such committed and knowledgeable volunteers who are shaping the future of SAEM to best serve all our members. In the spirit of service, the SAEM Board, along with the entire SAEM staff, participated in an "EM Day of Service" event on behalf of all our members. We donned hairnets and assembled nutritionally balanced "Manna Packs®," which will be sent to hungry children worldwide, using various modes of transportation, from trains and horse carts to parachutes and kayaks. We also had the pleasure of hosting the ARMED MedEd cohort at SAEM headquarters. They joined us for a

two-day intensive writing workshop, dedicated to advancing their ongoing grant project development. Alongside our faculty volunteers, we were joined by representatives from the American Medical Association (AMA) Grants program and the Accreditation Council on Graduate Medical Education (ACGME), both based in Chicago. They were genuinely impressed by the participants and the structure of the course, expressing interest in future collaborations. I'm delighted to share news of a recent meeting with the leadership of the NIH National Institute of Mental Health (NIMH) to explore our mutual research interests and discover the resources NIMH can offer to emergency care researchers. Currently, we're in the process of exploring strategies for potential collaboration. October was a significant month, marked by the #StoptheStigmaEM Month campaign, an initiative to raise awareness about the importance of mental health and wellness among emergency medicine physicians. Led by the SAEM Wellness Committee, this EM-wide campaign is a crucial annual step toward reshaping mental health in emergency medicine. Even though the month has passed, I encourage you to reach out to your colleagues, trainees, and medical students. Take a moment to check in on how they're doing, share helpful resources, start the conversation — especially as the holiday season approaches. Wishing you all the best for a joyous and healthy holiday season and a fantastic New Year!

ABOUT DR. COATES: Wendy Coates, MD, is professor of emergency medicine at David Geffen School of Medicine at UCLA and senior faculty/ education specialist at UCLA Department of Emergency Medicine

SAEM BOARD CORNER leading 35 didactics at SAEM23, creating 11 Pulse articles, and publishing five journal articles on topics related to diversity, equity and inclusion.

Clinical Researchers' United Exchange (CRUX) Interest Group Chairs: Naomi Alanis, MBA and Huma Siddiqui, MD

Overview

Jody Vogel, MD, MSc, MSW

Member-at-Large, SAEM BOD Vice Chair for Academic Affairs, Stanford Emergency Medicine Associate Professor of Emergency Medicine, Stanford University School of Medicine vogelj@stanford.edu Dr. Vogel is the SAEM Board Liaison for the following SAEM groups:

Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) President: Cassandra Bradby, MD

Overview

SAEM BOARD CORNER

The Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) is committed to promoting diversity and inclusion in the emergency medicine professional workforce at all levels and the culturally competent delivery of emergency medical services; eliminating healthcare disparities through research, education, and mentorship; enhancing the retention and promotion of those historically under-represented in medicine (URiM); and creating an inclusive environment for the training of emergency medicine providers.

Updates/Status

• Actively focusing on the recruitment

and retention of students to academic emergency medicine who are URiM through the development of our first pathway program called LEAP; the Leadership, Engagement and Academic Pathway Program.

• Continuing scholarly work which, in

the past year, included successfully

The Clinical Researchers' United Exchange (CRUX) Interest Group is a robust platform that enables Research Coordinators and other Clinical Research Professionals to connect and exchange knowledge within the SAEM community. The primary objective of CRUX is to gain insights into the best practices and research strategies employed by various institutions nationwide. Additionally, CRUX endeavors to identify alternative approaches to overcome the challenging barriers encountered during research in the Emergency Department.

Updates/Status

• Conducting interviews with Research Coordinators and Clinical Research Professionals to highlight effective research strategies employed by various institutions nationwide.

• Actively focusing on the recruitment

of Research Coordinators and other Clinical Research Professionals to CRUX.

• Monthly meeting to engage CRUX

members, providing a supportive community to review current research topics, share resources, and afford networking opportunities.

Ethics Committee Chair: Jolion McGreevy, MD, MBE, MPH

Overview

The Ethics Committee focuses on ethical aspects of academic emergency medicine and reviews SAEM’s Conflict of Interest Policy annually and ensures the professional standing and integrity of the Society by monitoring the relevant policies of other societies and evaluating recommendations from health care experts, ethicists, and other resources.

Updates/Status

Hosting didactics and authoring Pulse articles on pertinent ethics topics in academic emergency medicine. Authoring publications on relevant ethics topics, including Emergency Readiness: Beyond Crisis Standards of Care, Data Privacy, and Moral Distress and Injury in Academic Emergency Medicine. Providing consultation to the SAEM Board and Program Committee regarding key, emerging ethics-related issues that may be developed into future educational endeavors and products for Society members.

Fellowship Approval Committee Chair: Martin Reznek, MD, MBA

Overview

SAEM recognizes there are many valuable non-ACGME approved, post-graduate training opportunities for emergency medicine residency graduates. To promote standardization and excellence in training for fellows in these programs, SAEM has used content experts within the Fellowship Approval Committee to develop guidelines for fellowship training programs that address milestones in curricular elements, faculty support recommendations, and career development opportunities. The Fellowship Approval Committee carefully considers and thoroughly reviews both institutional and fellowship program applications for SAEM approval.

Updates/Status

• This SAEM year (May 2023-present), the SAEM Fellowship Approval Committee has reviewed and approved fourteen new programs and six renewals, with an additional nineteen renewals and one new program currently under review.

• Presently, there are 104 fellowships approved by the SAEM Fellowship Approval Committee.

• The Fellowship Approval Committee

is convening a smaller working group to conduct a deep dive on a potential pathway to develop guidelines and review less prevalent fellowship types. The intent of this project is to balance SAEM support for educational

• Meeting quarterly to review current

topics, research opportunities, and proposals for collaboration.

Quality and Patient Safety Interest Group

identified representatives to facilitate two-way communication of events and meetings. It launched this summer and should be an excellent resource for EMIGs and programs nationwide!

Chairs: J ared Anderson, MD and Jonathan Sonis, MD, MHCM

Academy of Administrators in Academic Emergency Medicine (AAAEM)

Overview

Chair: David Christiansen, MBA

The Quality and Patient Safety Interest Group promotes patient safety and the development of skills and a knowledge base for faculty engaged in medical quality management through discussion and collaboration among members, SAEM/RAMS committees, academies, and other interest groups through education and projects within and outside the interest group.

Updates/Status

• Submitting collaborative didactics

on behalf of the Quality and Patient Safety Interest Group regarding high-yield core quality topics. One example is a didactic submission on the practical and ethical implications of Emergency Medical Treatment and Labor Act (EMTALA).

• Creating Pulse articles on “hot topics

in Emergency Department Quality and Safety”, such as workplace violence prevention.

Trauma Interest Group Chair: Mike Jones, MD

Overview

The mission of the Trauma Interest Group is to promote the development of a skills and knowledge base for faculty engaged in trauma management, support research and education as scholarly activity within academic promotion and tenure criteria, and to provide the ability for academic professionals involved in trauma quality management an opportunity and forum for networking.

Updates/Status

• Developing research projects and

initiatives on trauma related topics, including recording resuscitation management, utilization of ultrasound in trauma evaluations (specifically transesophageal echocardiography), and regional anesthesia.

• Hosting well-attended didactics, such

as a recent session on the “Literaturebased Debate Over the Most Recent Trauma Guidelines”.

SAEM BOARD CORNER

innovation in our specialty and the development of fledgling fellowship types while ensuring responsible Society resource utilization.

Overview

Ali Raja, MD

President-Elect, SAEM BOD Professor, Harvard Medical School Deputy Chair, Massachusetts General Hospital, Department of Emergency Medicine araja@mgh.harvard.edu Dr. Raja is the SAEM Board Liaison for the following SAEM groups:

Residents and Medical Students (RAMS) Chair: Daniel Jourdan, MD, NRP

Overview

The mission of RAMS is to advance the future of emergency medicine by developing residents and medical students into academic leaders. RAMS is considered the premier organization for early-career residents and medical students interested in academic emergency medicine. RAMS members author cutting-edge research, podcasts, and publications, RAMS provides essential content for medical education, mentorship, and career development.

Updates/Status

The RAMS Board has been exceptionally busy, focusing on representation on several national groups, advocacy regarding issues that affect their members, member engagement with a number of active task forces, a series of wonderful webinars, and the Regional Ambassador Program.

This newest RAMS initiative is designed to develop a robust regional representation structure such that individual programs and EMIGs have

The Academy of Administrators in Academic Emergency Medicine (AAAEM) is a professional association for individuals managing the administrative and business functions of an academic department or division of emergency medicine. These academic units typically engage in activities related to patient care, education, and research missions, including the primary administration of an emergency medicine residency program. AAAEM’s vision is to be the leading experts and innovators in the evolution of academic emergency medicine administration.

Updates/Status

AAAEM has had a fantastic year. Its members and collaborators published 12 papers using benchmarking data and other survey findings, and they presented two didactics at SAEM23. The academy also added internal infrastructure, with committee charters and a strategic plan for growth to harness new member engagement and enthusiasm. Their newest AAAEM initiative is the Member Insider Program (MIP), a yearlong mentorship program that pairs new or junior administrators with experienced AAAEM members to support their career and professional development. AAAEM is also continuing to improve their new member onboarding process and to encourage new member and continuing member participation in committees and AAAEM events.

Sex and Gender in Emergency Medicine Chairs: R ebecca Barron, MD and Ynhi Thomas, MD

Overview

The mission of the Sex and Gender in Emergency Medicine (SGEM) Interest Group is to raise consciousness within the field of emergency medicine on the continued on Page 6

Overview

continued from Page 5 importance that 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.

Updates/Status

This past year has been a busy one for SGEM! They gathered pertinent data regarding the health equity fellowships and their members' research/advocacy/ education interests. They also developed several didactics for SAEM23 while their Education and Research subcommittees continued to work on projects to raise consciousness on the importance patient sex and gender have on the delivery of emergency care.

Tactical and Law Enforcement Interest Group Chair: Jeremy Ackerman, MD, PhD

Designed for those in the field or eager to learn, SAEM's newest interest group equips emergency physicians with accurate, up-to-date knowledge in tactical and law enforcement medicine. A primary objective of the group is to encourage the publication and presentation of educational and research topics relevant to the fields of tactical and law enforcement medicine. Additional aims are to foster engagement among SAEM's 8,500 EM physicians, expand resources, build community connections, and cultivate collaboration with relevant organizations.

Updates/Status

As our newest interest group, TLEIG is just getting started, and will have updates in my next Board Corner!

Telehealth Interest Group

Overview

The mission of the Telehealth Interest Group is to foster online information exchange and discussion amongst Interest Group members by enhancing the online presence and discussion board topics of conversation. It also aims to explore potential opportunities for collaboration with other Interest Groups as they relate to Telehealth with joint conferences, meetings, and lectures.

Updates/Status

The TIG has been meeting regularly and arranging for speakers from academic medical centers across the country with robust telehealth programs to present to them in order to grow their members’ expertise. They are also working to create a standardized EM-Telehealth resident curriculum and have made significant progress this year!

Chairs: Lulu Wang, MD and Shruti Chandra, MD, MEHP

Join an Academy and/or Interest Group!

SAEM BOARD CORNER

Log into SAEM.org

Click “My Participation” in the upper navigation bar

Under “My Participation” click the “Update (+/-) Academies or Interest Groups”.

It's Free to Join!

SAEM BOARD CORNER

You can’t pour from an empty cup. Take care of yourself first. #StopTheStigmaEM

SPOTLIGHT

A JOURNEY INTO RESEARCH AND RURAL HEALTH An Interview With Dr. Nicholas Mohr Nicholas Mohr, MD, MS, is a professor of emergency medicine (EM), anesthesia critical care, and epidemiology and the vice chair for research at the University of Iowa Carver College of Medicine. Dr. Mohr is currently the director of the EM-Anesthesia Critical Care Fellowship Program, the director of the EM Physician-Scientist Training Pathway (PSTP) in the EM Residency Program, and he teaches in the epidemiology graduate program in the University of Iowa College of Public Health. Dr. Mohr’s research focuses on systems of care and innovative methods of health care delivery, and he directs the Rural Telehealth Research Center—a federally funded center charged with understanding the role of telehealth at improving the health of people who live in rural communities. He has current or recent research funding from the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality (AHRQ), the Veterans Health Administration (VHA), and the Health Resources and Services Administration (HRSA). Dr. Mohr graduated with his BS in mechanical engineering from Iowa State University and earned his medical degree from the University of Iowa. He completed his residency in emergency medicine at Indiana University and his fellowship in critical care medicine at Washington University in St. Louis. Dr. Mohr currently serves on the SAEM Board of Directors, and he has previously held roles on the SAEM Grants Committee, SAEM Program Committee, SAEM Research Committee, and the SAEM Foundation. He represents SAEM on the AAMC Training Opportunities for Physician-Scientists Committee and the Surviving Sepsis Campaign. Dr. Mohr has won numerous teaching and research awards, including the SAEM Mid-Career Investigator Award, the Leonard Tow Humanism in Medicine Award, and the University of Iowa Distinguished Alumnus Award.

Dr. Mohr and his family

The University of Iowa Department of Emergency Medicine Research Division.

Congratulations on your election to the SAEM Board of Directors. What do you personally hope to accomplish during your tenure? I am excited to serve SAEM on the Board of Directors because the Society has been so important for me. As I grew up in SAEM, much of my energy was focused on research-related service. One of the things that has been fun for me on the board so far has been getting more involved in the breadth of activities and interests within the Society and working with more of our members in non-research aspects of our mission—education, operations, career development, and many other areas. One of my specific interests is improving and diversifying research training pathways in emergency medicine, but I think the strength of SAEM comes from having such a passionate group of people who have such diverse academic interests.

You have played many roles/served in many ways with SAEM over the years… Which experiences have been your favorites and why? When I first joined the SAEM Grants Committee, I found this incredibly passionate and hardworking group of people who wanted to see young researchers and educators succeed. That group knows that being awarded an SAEM grant changes the trajectory of a career and they are really living into SAEM’s mission. Over time, the most fun part for me was seeing people who had received SAEM grants in the past going on to find success as federally funded researchers and educational leaders—some even came back as mentors for future applicants! I continue to be involved in the EMF/SAEMF Grantee Workshop. Working with our grantees makes it easy to be optimistic about the future of academic emergency medicine.

How has being involved with SAEM benefitted you professionally? It’s all about the people. The most valuable part of SAEM, for me, are the mentors and friends I’ve found through the Society. Emergency medicine is an inviting group of people and it’s a place where people want to help one another. Many of the people who have become some of my closest career mentors are people I’ve met through SAEM. We talk a lot in emergency medicine about drivers of career satisfaction, and for me one of the biggest drivers is continuing to work with inspiring role models around the country who I met through SAEM.

Please tell us why you decided to become a researcher and how you first became involved with research. When I started my critical care fellowship, it was a different time. Emergency medicine residency graduates had no critical care board certification pathways available, so many of us found fellowship training in places that had not had emergency medicine-trained fellows before. During fellowship, I saw how much we knew about the physiology and management of critical illness, but most of our best data were from clinical trials that enrolled participants after they had been in the ICU for a few days. The original early goal-directed sepsis trial (Rivers E, et al. New Engl J Med 2001;345:1368-77) was still pretty new at that time, and one of the most novel parts of that trial was that participants were enrolled and treated in the emergency department. There were a lot of important questions that couldn’t be answered in ICU-based trials only, so I had a notion that we still had a lot to learn. We still do.

What research topics get you fired up and why? My research interests have evolved over time. Early on, I thought I was going to conduct clinical trials focused on the physiology of critical illness. It became clearer to me, though, that a real barrier to better outcomes was actually delivering timely highquality emergency care when and where it mattered. Where people live still dictates their access to care and outcomes, and this is especially true in critical illness, because critical care is so highly centralized. Only half of U.S. hospitals have an ICU and only a portion of those ICUs are equipped to care for the sickest patients. Dissemination and implementation science has shown us that a disjointed system of acute care makes delivery of timely care hard in several diseases, and these disjointed systems can lead to geographic disparities. More recently, developments in telehealth, machine learning, and computational power are driving innovation. It’s an exciting time, because these tools allow us to reimagine what emergency care ought to look like without the historical constraints of a single doctor relying on the lessons from residency alone.

What advice would you give to a new resident who is conducting research for the first time? You must be curious and persistent to be successful in continued on Page 10

continued from Page 9 research; however, if you’ve found a question that is intensely interesting, everything else you can learn through good mentorship. Having good mentors and collaborators will make you better and challenge you to think differently, which is key to innovation.

What inspired your academic interest in rural health and novel methods of care delivery, especially as it impacts survival from early critical illness?

SAEM PULSE | NOVEMBER-DECEMBER 2023

Shortly after I started my first faculty job, I went to a holiday gathering at my grandparents’ farm in rural Iowa. While I was there, one of my family members asked me when the things I was studying would be used in the small-town hospital near where he lived. That question was a real eye-opener for me because when I was driving back home, I drove past dozens of small rural hospitals, and many of them treat early critical illness every day. We have about 1,800 rural hospitals in the U.S., compared to only about 220 academic medical centers. Rural hospitals are responsible for about 12% of all U.S. hospital admissions, compared to about 20% in academic centers. Almost all the research and clinical guideline development happens in our largest and most capable centers, and systems of care have increasingly focused on identifying patients who need to be in tertiary care centers and getting them there quickly. But for many patients, the earliest local care they receive, along with decisions and timeliness of interhospital transfer, still affect their outcomes. The people early in the chain of care have an outsized influence on care pathways and outcomes.

One interesting by-product of our focus on centralizing care in tertiary centers is that more patients need services that are only available in big hospitals. That’s a problem if it leads to system over-capacity. Many of our academic medical centers are busting at the seams, which drives the boarding that has become so rampant in our academic emergency departments. Developing effective strategies to deliver technology-enabled evidence-based regionalized care outside academic medical centers could improve local care and outcomes, while at the same time partially decompressing hospitals burdened by the pressures of centralization. That type of acute care system, however, looks very different than the way we imagine such a system today.

I’m sure you’ve had many experiences in your career that have shaped you as a physician and person. Are there any that stand out and, if so, why? One of the things I’ve really learned in doing this work is that our perspective matters a lot, and we don’t always understand the world as well as we think we do. When I was doing my critical care fellowship, there was a small singlecovered emergency department where I sometimes did some moonlighting on the weekends. One weekend, I cared for a woman with septic shock, and I transferred her to the academic medical center where I was training in the ICU. The next morning, I came in to work, and that woman was on my service in the medical ICU. When we started rounding outside her room, the resident started presenting the story of how this woman was seen in a little hospital where the “ER doctor” didn’t know what was wrong with her and told the team about

Dr. Mohr with a mentor at a site visit at the Centers for Disease Control and Prevention (CDC).

Dr. Mohr meeting with his research leadership team.

all the ways that her care had been terrible. The resident didn’t realize that I had been that “ER doctor,” and many of the things she said weren’t quite true. That was the point when I realized that it’s hard in medicine to have someone else’s perspective, and that perspective matters a lot. We all have heard stories about the things that happen in an “outside hospital,” and some of us may have even told some of these stories. I’ve tried to remain curious and humble in trying to understand why things happen the way they do, and I still don’t always get it right. Genuine curiosity can go a long way in trying to understand someone else’s practice, community, or perspective, but reaching understanding is still the only way to make sustainable change.

In the coming years, what will emergency medicine physicians need to become experts at? In my opinion, a significant differentiator in emergency medicine training remains the skill of rapidly treating undifferentiated critical illness. This skill remains a core component of our practice and our identity, and it is probably even more important as the rest of medicine is becoming more specialized. There has been a lot of discussion about the evolving role of the emergency physician and the roles that emergency physicians might play outside the emergency department in the future. The skill of rapidly treating undifferentiated critical illness, however, is a role our patients and colleagues rely upon, and it’s a skill I don’t think we ever want to lose.

Up Close and Personal When you were a child, what did you aspire to be when you grew up? When I was young, I really wanted to be a firefighter. I used to run around the neighborhood in my snow pants and snow boots with my wagon and garden hose just waiting to find a fire to put out. I probably mostly used that as an excuse to tell my brothers what to do.

Dr. Mohr with his brother and son on RAGBRAI, the longest and largest recreational bike ride in the world.

What would most people be surprised to learn about you? When I was in college, I was part of a team to build a solar-powered electric car, and we raced our solar car from Chicago to Los Angeles. We borrowed the football team’s semi-truck, and two friends and I learned how to drive it to carry our equipment along the route. A bunch of engineering students spending two weeks in the football team’s trailer was a clash of worlds.

Dr. Mohr and his wife, skiing.

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

What do you think are the most urgent issues facing emergency medicine in the U.S. today? What steps do you hope to take toward addressing these issues during your tenure on the BOD?

Playing with my kids. During the pandemic, my kids and I learned to sail, so we like doing that together in the summer. Sailing in Iowa makes you really good, because there’s a lot of tacking and jibing.

I think one of the most urgent issues in our specialty is that of continued growth in emergency medicine research. In 2022, a group of emergency medicine leaders published a report entitled “Emergency medicine research: 2030 strategic goals” (Neumar RW, et al. Acad Emerg Med 2022;29(2):241-51). In that article, the task force showed that emergency medicine was ranked in last place among all specialties in NIH-funded researchers and projects, and it additionally showed that growth in funded research in our specialty had slowed. The reasons identified were multifactorial, but that pattern is a real problem for the future of innovation in emergency care. The report highlighted opportunities to strengthen the emergency medicine research pipeline through expanding combined residency-research training pathways, improving pathways to recruit MD/PhD graduates into the specialty of emergency medicine, and facilitating the transition from federal mentored career development awards to career-level research project funding. The reason I think that emergency care research is so important is because I believe that the best solutions to our biggest challenges in emergency medicine come through innovation. We want people in our specialty thinking about how we can have a bigger impact on our patient’s outcomes, how we can organize care to make our jobs more fulfilling, and inventing the tools that we can use to reimagine emergency care. Our predecessors laid the groundwork to build a cadre of professional researchers in our specialty, and continuing to strengthen that capacity is critical to our future.

What is your guilty pleasure? I love audio books. Sometimes if I’m late on my way home from work, it’s because I’m at a really good place in my book and I had to take “the long way” home.

Who would you invite to your dream dinner party? American author and financial journalist Michael Lewis; triple Pulitzer Prize-winning American author, reporter, and columnist Thomas Friedman; American author, journalist, and professor. Walter Isaacson; and Pulitzer Prize-winning American biographer and presidential historian, Doris Kearns Goodwin. Each of them have a gift for seeing in stories a larger narrative about the course of humanity. Like storytellers in all of human history, they have worked to define our modern virtues.

CARDIOVASCULAR CASES

Bendopnea: The Heart's Subtle Message in a Simple Bend SAEM PULSE | NOVEMBER-DECEMBER 2023

By Mounir Contreras Cejin, MD and Jackie Nguyen, MD

Congestive heart failure is a prevalent condition in the emergency department (ED), affecting approximately 6.2 million Americans. Among patients over 65 years old, heart failure accounts for 20% of hospitalizations. Currently, breathlessness is categorized based on activity, with clinicians relying on symptomatology established by the Framingham Heart Study, including dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. However, there exists a seemingly inconspicuous yet remarkably telling phenomenon: bendopnea. Bendopnea, also known as "flexo-dyspnea," refers to shortness of breath elicited by bending forward at the waist, akin to tying one's shoes or putting on socks.

“the presence of bendopnea has been linked to identifying advanced heart failure patients and increased mortality.” As a provocative test, bendopnea is quick and easy to perform. If a patient develops shortness of breath within 30 seconds of bending forward, they exhibit bendopnea. This symptom was first described in 2014 by a group of dedicated advanced heart failure specialists who noticed patients experiencing shortness of breath while performing simple tasks

like donning shoes or socks. In a prospective study of 102 subjects with systolic heart failure referred for right-heart catheterization, bendopnea was found in about 30% of patients. Subsequent studies have confirmed its prevalence in heart failure patients (ranging from 18% to 49%) and its association with other symptoms such as dyspnea, orthopnea, paroxysmal

“Bendopnea, although a relatively recent addition to the clinician's toolkit, plays a significant role and should be actively sought during patient evaluations.” nocturnal dyspnea, and abdominal fullness. Moreover, the presence of bendopnea has been linked to identifying advanced heart failure patients and increased mortality. The pathophysiology of bendopnea involves increased ventricular filling pressures, particularly in the setting of low cardiac index (≤2.2/min/m2). This is essential to understand as heart failure patients already have increased filling pressures in the setting of low cardiac indices. The bending motion, while sitting, increases intrathoracic pressures, exacerbating left ventricular filling pressures and triggering shortness of breath. To enhance diagnostic accuracy, skilled emergency physicians must rely on a comprehensive approach, incorporating patient history, physical examination, and ancillary tests evaluating patients with heart failure. However, recognizing the limitations of each component is crucial. While biochemical markers like B-type natriuretic peptide (BNP) are valuable in suspected heart failure cases, they have limitations in established diagnoses, which account for 80% of heart failurerelated hospitalizations. For patients already diagnosed, BNP concentrations falling within the intermediate range (100400 pg/mL) create a diagnostic “gray zone.” Moreover, chest X-ray findings can be delayed by up to 12 hours from symptom onset and persist for days after clinical improvement. Notably, a study in the Annals of Emergency Medicine revealed that in up to 20% of admitted patients diagnosed with acute decompensated heart failure, ED chest X-rays failed to indicate signs of congestion, underscoring the test's limitations. Additionally, clinicians should be aware that certain expected physical signs, such as peripheral edema, are often absent in young patients with elevated filling pressures. Instead, these patients might complain of symptoms like abdominal

discomfort, anorexia, and early satiety, all associated with heightened rightsided filling pressures. While assessing for peripheral edema is standard in suspected decompensated heart failure cases, it's essential to consider that this symptom indicates extravascular volume rather than intravascular volume. Thus, it could result from various pathologies, such as lymphedema or the use of medications like amlodipine. As long as our objective remains the identification and treatment of heart failure, the clinical evaluation will retain its pivotal role in managing both the diagnosis and the patient. Frequently, our reliance on physical findings serves as a fundamental measure to assess the extent of decompensation, gauge the therapeutic response, and monitor the improvement of symptoms. It is crucial to note the limitations of bendopnea. While it is a non-diagnostic symptom and has been observed in patients with pulmonary disease and morbid obesity, these factors do not diminish its utility in evaluating patients arriving at the emergency department with suspected congestive heart failure. Much like how orthopnea and edema remain relevant classic signs of heart failure in obese patients, bendopnea, despite its non-specific nature, still holds valuable diagnostic potential when assessing individuals for heart failure symptoms. Recognition of bendopnea can be invaluable, especially for clinicians less proficient in measuring jugular venous pressures. It offers an alternative means to assess volume status and aids in determining the presence of "wet" conditions, characterized by signs and symptoms indicative of elevated ventricular filling pressures. Bendopnea, although a relatively recent addition to the clinician's toolkit, plays a significant role and should be actively sought during patient evaluations. Patients might not spontaneously mention bendopnea

Learn More • Characterization of a Novel Symptom of Advanced Heart Failure: Bendopnea. • The Role of the Clinical Examination in Patients With Heart Failure • Observation is Never Obsolete • Prevalence of Negative Chest Radiography Results in the Emergency Department Patient With Decompensated Heart Failure • Clinical Significance of Bendopnea in Heart Failure: Systematic Review and Meta-analysis • CDEM Congestive Heart Failure M4 Curriculum

as a symptom, making it crucial for clinicians to inquire about it directly. This thoughtful assessment is indispensable, because the first step in making way for improvement is, of course, getting a good diagnosis.

ABOUT THE AUTHORS Dr. Contreras Cejin is a secondyear emergency medicine resident at the University of Texas Southwestern, in Dallas, Texas. He completed his medical degree at Ross University School of Medicine in 2022. His interests include medical toxicology and cardiovascular emergencies. @MounirContreras Dr. Nguyen is a second-year emergency medicine resident at the University of Texas Southwestern, in Dallas, Texas. She completed her medical degree at Nova Southwestern University in 2022. Her interests include medical education.

CLINICAL PRACTICE

SAEM PULSE | NOVEMBER-DECEMBER 2023

The Escalating Crisis: Hospital Capacity and the Vital Role of the ED Medical Officer of the Day

By Maulik Lathiya, MBBS; Susan Cullinan, MD; and Matthew Olmstead, DO As health care systems around the globe grapple with the modern challenges posed by pandemics, growing populations, and the natural progression of illnesses, the importance of health care infrastructure and capacity planning has never been more apparent. This significance is particularly evident in the United States, where issues related to hospital and emergency department (ED) capacity underscore the need for preparedness and adaptability. While large urban centers have long grappled with overcrowding and capacity constraints,

these challenges are now spilling over into smaller regional hubs and critical access community medical centers.

From Urban Centers to Regional Hubs: A Cascading Challenge

Historically, large urban health care facilities prepared for periodic surges in patient counts, utilizing their infrastructural resources, human capital, and experience to manage these occasional influxes, albeit imperfectly. Conversely, regional hubs and smaller community medical centers experienced

steadier patient flows. However, the evolving health care landscape has thrust these smaller settings into challenges previously limited to larger counterparts. Struggling with limited resources and bandwidth, they now face overwhelming demands beyond their traditional capacity.

Emergency Department Boarding: A Manifestation of the Crisis

One alarming manifestation of this crisis is ED boarding. When smaller centers experience a sudden surge in patient

“As health care systems around the globe grapple with the modern challenges posed by pandemics, growing populations, and the natural progression of illnesses, the importance of health care infrastructure and capacity planning has never been more apparent.” numbers, they must admit these patients, leading to prolonged stays in the ED due to limited resources. This congestion not only jeopardizes patient safety but also raises the risk of deteriorating conditions, especially when specialized care is scarce.

The Cumbersome Burden of Transfers

Complicating matters is the need to transfer these patients to larger and better equipped centers, diverting already stretched-thin ED providers. This process consumes valuable time, hindering direct patient care. Additionally, logistical challenges in transfers further endanger patient safety and well-being.

Introducing the ED MOD Role: A Timely Response Recognizing these challenges and the imminent need for a solution, the role of the Emergency Department Medical Officer of the Day (ED MOD) has been introduced. The ED MOD serves as a dedicated ED physician who brings

expertise specifically tailored to the unique dynamics of smaller sites. Their primary focus is supporting health care providers in strained settings, guiding decision-making processes, optimizing patient flow, and providing strategic insights. The ED MOD also facilitates efficient communication and coordination for patient transfers, reducing the burdens on ED providers and ensuring uncompromised patient safety.

Looking Forward: The Imperative for Adaptation

The introduction of the ED MOD role underscores the evolving health care landscape and the need for adaptability. As challenges expand beyond urban centers, innovative solutions like the ED MOD become essential. However, this is just a step in the journey. Broader systemic changes, from infrastructure investments to policy revisions, are crucial to enabling all health care facilities, regardless of size, to effectively serve their communities without compromising quality or safety.

In summary, the challenges of hospital and ED capacity are pressing and widespread, extending beyond urban health care centers. However, within challenges lie opportunities. The ED MOD role, while a response to the current crisis, symbolizes adaptability and innovation in a continuously evolving health care landscape.

ABOUT THE AUTHORS Dr. Lathiya is a research fellow in the Department of Emergency Medicine at Mayo Clinic Health System, Eau Claire, WI. He is an international graduate medical student, a U.S. emergency medicine residency applicant, and a member of the SAEM Program Committee and SAEM Wellness Committee. Lathiya.Maulik@mayo.edu Dr. Cullinan is an assistant professor in the Mayo Clinic College of Medicine and Science, serving as the chair in emergency medicine for Mayo Clinic Health System. She is a member of International Quality, and the Mayo Clinic Ambulance Board. She also serves as a diplomat of the American Board of Emergency Medicine. Dr. Olmstead serves as a consultant in emergency medicine for Mayo Clinic Health System in Eau Claire, WI. He is the medical director in the emergency medicine department for Mayo Clinic Health System in Eau Claire and holds the role of chair of hospital practice for Mayo Clinic Health System.

DIVERSITY, EQUITY, INCLUSION

SAEM PULSE | NOVEMBER-DECEMBER 2023

Tokenism: The Result of Diversity Without Equity and Inclusion

By Felissa Hong and Ryan Tsuchida, MD, on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine Imagine being a person of color (POC) recruited into a leadership role but denied the power, resources, and authority to lead — always visible, seldom heard. This is tokenism. POCs and underrepresented minorities (URMs) are often recruited to become the “face” of diversifying organizations, but they are not always given the necessary support or authority to make meaningful changes. Instead, the White majority maintains power. Tokenized leaders are valued primarily for their contributions to diversity, equity, and inclusion (DEI) efforts.

Tokenism, a term popularized during the civil rights movements in the 1960s by Martin Luther King Jr. and Malcolm X, refers to the practice of making superficial gestures, like recruiting someone from an underrepresented group, to create an appearance of gender or racial equality in the workforce. Despite the passage of 60 years, tokenism persists today, albeit in different forms. It is one of several forms of discrimination that negatively impact minority and marginalized groups. This article aims to provide examples of racial tokenism and the associated risks faced by tokens in the field of medicine.

Tokenism can be quantified as the experience of being a numerical minority in a relatively homogenous environment. The risk of tokenism increases as one’s relative proportion diminishes. According to one theory, tokenism occurs when group representation falls below 15%. In medicine, it often manifests at the intersection of race and gender, such as a token Hispanic female surgeon surrounded by predominantly white male colleagues. To experience tokenism, two key elements are required. First, an individual of minority status becomes

“POCs and underrepresented minorities (URMs) are often recruited to become the "face" of diversifying organizations, but they are not always given the necessary support or authority to make meaningful changes.” a symbol of diversity. Second, minority members face exploitation and challenges relative to majority members within shared spaces. For instance, URM students in medical schools are frequently highlighted in outward-facing communications and tasked with DEI efforts. In institutions lacking proper support, these students may feel like tokens, struggling to meet general medical school expectations while grappling with the heightened visibility, being rendered a diversity placeholder, and the burden of the minority tax. Consequently, tokens in medicine suffer significant and lasting harms, leading to burnout. Tokens face heightened scrutiny and increased visibility, which amplifies their risk of workplace discrimination and unnecessary performance pressures. Studies have shown that URM physicians receive significantly lower patient satisfaction scores compared to their White colleagues, highlighting how tokens face implicit biases from patients and negative financial implications. To overcome racial challenges and validate their place within medicine, tokens may also feel compelled to overperform, particularly URM physicians in medical subspecialties, who have been described as ultra-achievers. Balancing discrimination and high-performance pressures can be overwhelming for tokens. Frequently the “firsts” and “onlys” within an environment, URM physicians are often trailblazers and tokens. But while trailblazers have the power to disrupt the status quo, tokens lack the agency. They are valued more as diversity placeholders than change agents and are more likely to face negative consequences when advocating for change. The fear of jeopardizing one’s career often discourages tokens from taking risks.

In a series focused on race-based medicine, one narrative sheds light on the challenges of attempting to drive change as a token black resident trainee. Dr. Parrisha Roane describes a sense of defeat after receiving reprimand for advocating for her black patient. She concludes, “Although being the dissenting voice is important, I may not always have the strength to speak for those who cannot.” Naturally, the fear of jeopardizing one’s career may deter individuals from taking risks. Tokens are frequently tasked with leading DEI discussions, putting the burden of dispelling harmful myths and clarifying cultural stereotypes on them — a term known as minority tax and defined as the burden of time and resources placed on minority persons to represent and advocate for their communities. This added responsibility leads to fatigue, stress, and a sense of isolation. To address tokenism, it is crucial to establish shared language through effective DEI training, increase awareness of tokenizing practices, and prioritize education on its implications.

Avoiding and Mitigating Tokenism The Significance of Nomenclature

Recognizing the importance of nomenclature is vital in effective Diversity, Equity, and Inclusion (DEI) training. Clear communication through a shared language is fundamental. Identifying a problem is the initial step towards understanding and resolving it. The vocabulary related to DEI is continually evolving as more experiences are analyzed and understood. It is imperative to focus on tokenizing practices and prioritize comprehensive education regarding its terminology and implications. By enhancing awareness of these terms, we can deepen our

understanding of the challenges at hand and work towards more meaningful solutions.

A Hand Up, Not a Hand-Out

Diversification requires bidirectional change. Equity cannot be achieved solely through supportive programming; it demands fundamental incorporation of DEI principles. Creating a culture that prioritizes DEI is essential for sincerely welcoming diversity, inclusion, and belonging. Institutional DEI education can help self-identify and prevent unrecognized workplace discrimination. Deliberate inclusivity, along with targeted policies and programs, ensures URM trainees and faculty achieve equitable success.

Creating Safe and Brave Spaces

Creating safe and brave spaces is vital. Vulnerability from all levels of leadership promotes honesty, enabling minorities to voice their concerns without fear of retribution. Affinity group peer support and quality URM faculty mentorship empower tokens, providing resources for navigating stressful environments and validating lived experiences.

Belonging is Essential

A strong commitment and feeling valued by peers are crucial factors in fostering an inclusive environment. Daily reminders of one’s racial identity, being seen merely as a diversity symbol, and the pressures of performance can make anyone feel like an outsider. Research emphasizes the significant advantages of affinity group peer support, where individuals can share resources for navigating stressful situations and validate one another’s lived experiences. Additionally, high-quality mentorship from underrepresented minority (URM) faculty, with a menteefocus approach, has been proposed as continued on Page 19

SAEM PULSE | NOVEMBER-DECEMBER 2023

DEI PERSPECTIVE

continued from Page 17 an effective way to support and empower URM physicians and trainees, providing them with the necessary guidance and encouragement in their professional journeys. Tokenism perpetuates discrimination in higher education, making diversity efforts seem insincere and hindering progress. True diversity within medicine offers numerous benefits, but without equity, inclusion, and belonging, it leads to disproportionate outcomes for marginalized colleagues. Acknowledging these struggles fosters better solutions, reducing isolation. Overcoming tokenism is a crucial step toward prioritizing DEI and fostering genuine change.

ABOUT THE AUTHORS Felissa Hong is a fourthyear medical student at the University of Wisconsin, School of Medicine and Public Health (UW-SMPH). She has served as a leader in multiple multicultural organizations including UWSMPH’s Medical Students for Minority Concern and as a member of the board of directors for Wisconsin Microfinance. Dr. Tsuchida is an assistant professor at the University of Wisconsin, School of Medicine and Public Health. He is the interim assistant dean for multicultural affairs for health professions learners at UWSMPH, leads his department’s equity, diversity, and inclusion committee, and chairs the ADIEM Membership Committee. @rtsuchida

“To address tokenism, it is crucial to establish shared language through effective DEI training, increase awareness of tokenizing practices, and prioritize education on its implications.”

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the goal of diversifying the physician workforce at all levels, eliminating disparities in health care and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”

EDUCATION

SAEM PULSE | NOVEMBER-DECEMBER 2023

Your Story, Your Success: Crafting a Curriculum Vitae With You at the Center

By Rowan Kelner, MD; Lauren Willoughby, MD; Krystin Miller, MD; and Allison Beaulieu MD, MAEd on behalf of the SAEM Education Committee Welcome to our guide on crafting the perfect CV, where the focus is firmly on you and your journey. A curriculum vitae (CV) is your way to document your academic history, highlighting your strengths and effectively documenting your achievements throughout your career. In this article, we will explore expert tips and strategies to help you create a standout CV that reflects your individuality and strengths. We recommend using the AAMC template as a guide to maintain a consistent and organized structure for your CV. From formatting essentials to personalized narrative techniques, we'll delve into

the key elements that make your CV not just a piece of paper, but a powerful representation of your professional story.

and descriptions, reorganize your CV using a table format. After editing, employ the "hide all borders function" to present a clean, polished CV without visible table lines.

Top 10 CV Tips 1.

Use a consistent format: Utilize sans-serif fonts, with 12-18 pt for your name, 12-14 pt for headings, and 10-12 pt for text. Ensure uniformity in font, letter size, style, alignment of section headers, and verb tenses. Include page numbers on every page.

Embrace tables: If you're struggling to align dates, titles,

Feature your name on every page: Employers sift through a large volume of CVs.To keep your name prominently visible, include it in the header on each page. On the first page, provide your name, title/ position(s), institution, email, and phone number. For subsequent pages, use your name only in the header.

Order items in reverse chronologically: List your experiences in reverse chronological order to showcase the progression and status of your education and career effectively.

Craft your narrative: Emphasize what's crucial for both you and the job you're applying for. Tailor your CV to highlight experiences relevant to the position, placing pertinent sections near the top to demonstrate your qualifications immediately.

Keep it current: Focus on activities from medical school and residency that are relevant. Remove outdated and unrelated activities from high school and college.

Define your title and use action verbs: Clearly specify your titles, roles, and responsibilities. Utilize specific, action-oriented verbs; the Wake Forest/EMRA guide offers a list of appropriate CV verbs.

Regularly update your CV: Maintain a list of leadership roles, accomplishments, lectures, and relevant activities to use when updating your CV. Establish a schedule for updates (e.g., weekly, monthly, quarterly) and save previous versions on your desktop for future reference.

Submit your CV in PDF format: Save your CV as a PDF and thoroughly review for formatting errors, such as page breaks, font type/size, and coloring. This ensures consistent formatting each time it is opened by a potential employer.

10. Proofread meticulously: Before submission, carefully check for grammatical errors and spelling mistakes. Additionally, ask colleagues, mentors, or peers to review your CV, as it's easy to overlook your own errors.

In conclusion, crafting an exceptional CV is not just a formality; it's your narrative, your journey, and your gateway to opportunities. By adhering to the guidelines and personalized strategies shared in this article, you can create a CV that truly reflects you — your skills, your experiences, and your aspirations. Remember, your CV is more than a document; it's a powerful tool that showcases your unique strengths and qualifications. So, take the time to refine it, update it regularly, and let it be a testament to your professional journey. By putting yourself at the center of your CV, you're not just applying for a job; you're telling your story, and in doing so, you're positioning yourself for the success you deserve.

“A curriculum vitae (CV) is your way to document your academic history, highlighting your strengths and effectively documenting your achievements throughout your career.”

ABOUT THE AUTHORS Dr. Kelner is a medical education fellow at the University of Utah.

Dr. Willoughby is an assistant professor of emergency medicine at the Medical College of Wisconsin.

Dr. Miller is an assistant professor of emergency medicine, assistant residency program director, and lead physician for off-service residents and fellows at The Ohio State University. Dr. Beaulieu is an assistant professor of emergency medicine, assistant residency program director, and medical education fellowship director at the University of Utah.

ETHICS IN ACTION

Balancing Acts: Prioritizing Patients in Inter-Service Agreements By Gerald Maloney, DO

SAEM PULSE | NOVEMBER-DECEMBER 2023

The Case

You are caring for a 73-year-old female patient, brought in by EMS as a trauma case. She is undergoing thrice-weekly hemodialysis and has a prolonged history of atrial fibrillation treated with warfarin. According to EMS, she fell during a transfer from her hemodialysis chair, resulting in an evident deformity, significant swelling, and ecchymosis in her right thigh. The trauma service in the emergency department evaluated her, diagnosing a right femur fracture as her sole injury. In adherence to a recent agreement with orthopedic surgery, the patient, although having an isolated orthopedic injury, should be admitted to orthopedics. However, her situation

is complicated by multiple medical problems and the necessity for continued hemodialysis, as the fall transpired while she was attempting to access her dialysis chair. Her international normalized ratio (INR) stands at 3.4. The medical service declines admission, asserting that her case pertains solely to orthopedics, offering consultation instead. The orthopedic team, hesitant about assuming primary responsibility, delays surgical intervention pending clarification on the admitting service dilemma. Meanwhile, the patient's leg experiences ongoing swelling, and her pain intensifies.

The Discussion

Professional ethics, a subset of general ethical principles, play a pivotal role in guiding behavior across multiple fields.

These principles encompass fulfilling all duties towards customers, constituents, or patients, ensuring high-quality work, fair and legal billing, and maintaining professional interactions. Integrating basic biomedical principles, particularly autonomy and beneficence (acting in the patient's best interest), into professional ethics is imperative. Within the realm of professionalism in health care, one crucial aspect lies in the interactions between different medical services within a facility. While individual health care facilities can establish agreements dictating the responsibilities of each service, a fundamental tenet of professional ethics is to ensure that these agreements are not only fair but also appropriate to the unique circumstances at hand. This involves a delicate balance, where the best

“While individual health care facilities can establish agreements dictating the responsibilities of each service, a fundamental tenet of professional ethics is to ensure that these agreements are not only fair but also appropriate to the unique circumstances at hand.” interests of the patient should, at times, supersede pre-existing agreements. When services within a health care facility perceive a disparity in the distribution of workload, it often leads to feelings of resentment. Such sentiments can, in turn, foster unprofessional behavior among these services, creating a discordant environment. In this specific case, the orthopedic service was perceived as disproportionately burdening other services with aspects of patient care. This perception, coupled with the patient's complex situation — an isolated orthopedic injury alongside multiple medical comorbidities — resulted in a challenging conundrum. In health care ethics, the principle of beneficence plays a pivotal role, guiding professionals to act in the best interest of the patient. Agreements between services, dictating their respective responsibilities, should prioritize the patient's well-being over individual service concerns. At the core of all professional ethics lies an unwavering obligation to the patient. In the case discussed, the flaw in the interservice agreement became apparent as it failed to consider vital aspects beyond the nature of the injury, thus neglecting the comprehensive clinical obligation to the patient. This oversight resulted in a deviation from the highest standards of professional ethics, highlighting the importance of consistently prioritizing the patient's welfare in health care decisions.

agreeing to admit the patient or transferring her to the trauma service under critical care-trained physicians. An alternative approach is the "my mother" test, imagining the patient as one's own family member. While somewhat paternalistic, this method aids in determining the service best suited to manage the patient's overall condition. It ensures decisions prioritize the patient's best interests over provider convenience or preferences.

The Conclusion

In this case, after hours of deadlock, the chief medical officer intervened. The patient was eventually admitted to the Medical Intensive Care Unit, under a medicine service, facing a complex postoperative course involving respiratory failure and volume overload, necessitating multiple intermittent hemodialysis sessions.

ABOUT THE AUTHOR Dr. Maloney is an associate professor of medicine, Case Western Reserve University, Cleveland, Ohio and medical director, emergency department, Louis Stokes Cleveland VA Medical Center.

A more ethical approach involves a collaborative discussion between trauma, orthopedic, and medical services to assess the patient's overall needs. Decisions on the admitting service should consider not only her injury but also her likely clinical course and postoperative requirements. Such parameters could lead to a resolution, such as medicine

FACULTY FOCUS

Balancing Personal Well-being and Professional Accountability: Challenges for a New Residency Program

SAEM PULSE | NOVEMBER-DECEMBER 2023

By Daniel Frank, MD, on behalf of the SAEM Faculty Development Committee

When we embarked on the journey to establish a new residency program, we faced numerous challenges. Recognizing the suitability of our high-volume, community-based university hospital for training emergency medicine residents, we also acknowledged the daunting road ahead. We authored the initial ACGME application, recruited faculty, and collaborated with leadership to allocate protected time for them. We developed a comprehensive program-specific policy manual, defined goals and objectives for each rotation, established agreements with other rotation sites, and created dedicated block and shift schedules. A detailed longitudinal curriculum was developed, and an annual spending budget for the program was established in consultation with our executive suite. We launched a program website and social media channels and initiated our first recruitment season. Finally, in July 2019, we welcomed our inaugural class of residents.

pose significant challenges. While the program leadership and core faculty had experience working with and educating residents, many clinical faculty, nurses, and administrators had not interacted with residents in years, if ever. Adjusting standard workflows, such as attendings receiving case presentations from residents, or nurses consulting residents first for patient-care questions, required adaptation. Over time, the residents were welcomed into the department and organically became integral to dayto-day operations.

Early on, we recognized that integrating residents into the departmental and hospital culture would

As the program matured, the residents’ clinical skills and medical knowledge grew. Team dynamics and

“Programs must create a supportive learning environment, but residents must fulfill their job responsibilities consistently, on and off duty, to succeed as future attendings.” camaraderie with faculty, nurses, and administrators also evolved. However, it's not uncommon for residency programs, especially new ones, to face challenges. Our early residency classes lacked chief or senior residents to set examples or offer guidance. Although there were plenty of faculty available for coaching and mentoring, our initial residents had to learn time management and administrative skills on their own. This was compounded by the demands of a specialty known for its intense workload, rapid task changes, and disruptions in sleep patterns. Consequently, there were occasional issues with meeting deadlines, communication, and overall performance.

“the long-term success of residents depends on us setting clear expectations and holding them accountable for the numerous responsibilities that enable them to attain these professional objectives.” As leaders of the program, we dedicated significant time to reflecting on how to mitigate these shortcomings and elevate our residents’ performance and future success. Our conversations always circled back to the theme of accountability. To illustrate, I consider how attending physicians typically handle sudden duty callouts. An on-call doctor might be assigned to cover the shift, or those already on duty could be tasked with adjusting their workflow to accommodate the absence of a team member for the day. These are tangible consequences that directly affect our colleagues. We acknowledge and weigh these consequences carefully before making a duty callout decision. Now, consider a similar scenario in a new residency program (without a full cohort), where some residents may be off-service or on vacation, and duty-hour regulations must be observed. In such a situation, there might not be enough residents, and an open resident shift could remain uncovered, resulting in a lack of tangible consequences. As program leaders, we quickly grasped the importance of ensuring that residents comprehend and value the consequences. Compared to residency, life as an attending presents more challenges. Attendings are responsible for managing more patients, documentation, communication, and decision-making. Attendings are accountable for various non-clinical obligations such as email correspondence, attending faculty meetings, completing CME requirements, and maintaining board certification, and lapses may jeopardize financial incentives. This raised a critical question: are we fostering a culture of accountability to support residents’ success as future attendings? To facilitate their professional development, we established clear expectations, monitored progress, and held residents accountable. Independent practice readiness demands substantial effort from trainees. It necessitates studying outside of on-duty hours, attending didactics, engaging in scholarly activities and

quality improvement projects, preparing for exams, and accumulating extensive clinical hours. Residents must balance this with self-care and personal life while understanding that personal wellness priorities do not excuse professional accountability. Programs must create a supportive learning environment, but residents must fulfill their job responsibilities consistently, on and off duty, to succeed as future attendings. It is crucial to recognize that taking time off from work and prioritizing personal wellness are essential components of resident success. We all require adequate rest, exercise, engagement in hobbies, quality time with family and friends, attendance at significant life events, and handling personal errands. Nevertheless, we must also acknowledge the interconnection between work-related accomplishments and the well-being of both residents and the program. The aspects of their work that bring residents satisfaction and a sense of achievement are just as vital to their well-being as activities outside the hospital. Trainees must have the opportunity to pursue and achieve their professional aspirations, gain control and autonomy in their practice and decision-making, build confidence and increasing mastery, and foster positive collegial relationships. While programs are responsible for creating a supportive learning and working environment, the long-term success of residents depends on us setting clear expectations and holding them accountable for the numerous responsibilities that enable them to attain these professional objectives. In hindsight, striking the right balance between personal well-being and professional accountability emerged as one of our most significant challenges. We worked diligently to orient our new residents into their roles as physicians, develop a strong didactic- and simulationbased curriculum, teach and hone procedural skills, and organize meaningful off-service rotations. We consistently reinforced their responsibilities, including weekly study assignments, Step 3 exams, and in-training exam preparations. Additionally, we placed a high priority on

fostering team spirit and social cohesion, organizing various team-building and social events. These efforts aimed to integrate them into the cultural fabric of the department and the hospital, ensuring they felt supported as trailblazers of our new program. However, it took us some time to fully appreciate that, as leaders, we needed to be deliberate and establish clear expectations. This realization was crucial for residents to truly grasp the long and short-term consequences for their professional development. With the time and reinforcement of our expectations, we have reached a point where residents have assumed greater ownership for their personal and programmatic success. Instances of missed deadlines have become rare; exam performance has improved; scholarly productivity has increased; all our graduates have secured meaningful employment; and more residents are pursuing advanced fellowship training. Residents are increasingly supportive and socially engaged with one another, while also holding one another accountable for their individual responsibilities. By setting and monitoring of expectations, we have developed a cultural understanding that our residents’ well-being is contingent not only on their professional achievements but also on the time and activities they engage in outside of work. We hope other programs recognize the value of this cultural equilibrium, particularly amid the escalating discussions around wellness and self-care in the medical field.

ABOUT THE AUTHOR Dr. Frank is the founding program director of the Emergency Medicine Residency Program at South Shore University Hospital/ Northwell Health. He completed his EM residency training at Stony Brook University in 2012 and Critical Care Fellowship at North Shore University Hospital in 2014. Dr. Frank is a member of the SAEM Faculty Development Committee.

GERIATRIC EM

Addressing Substance Use in Geriatric EM: A Novel Rotation Approach SAEM PULSE | NOVEMBER-DECEMBER 2023

By Kira Gossack-Keenan, MD, on behalf of the SAEM Academy of Geriatric Emergency Medicine

Substance use among older adults presents a unique intersection of two highly vulnerable patient populations. This clinical presentation is often understudied and frequently overlooked, despite its significant association with major geriatric syndromes. Older adults, due to altered metabolism and distribution, are more sensitive to the adverse effects of alcohol, leading to elevated alcohol levels when consuming similar amounts as younger adults. These effects include hypertension, arrhythmias, myocardial infarction, cerebrovascular accidents, osteoporosis, liver disease, and falls. Heavy alcohol use is associated with functional and cognitive decline, which

“older adults may not readily disclose their substance use, and symptoms related to usage are frequently misattributed to dementia or depression.” contributes to complex emergency department (ED) presentations and is also linked to higher rates of falls and delirium. Remarkably, one-third of older patients diagnosed with alcohol use disorder only receive this diagnosis in their later years. Notably, older adults may not readily disclose their substance use, and symptoms related to usage are

frequently misattributed to dementia or depression. This underexplored domain offers significant potential for improving geriatric ED care. To bridge this educational and care gap, a novel one-month elective rotation in geriatric addiction medicine was developed by a geriatric emergency medicine fellow. This rotation

“This rotation emphasizes qualitative social factors affecting substance use among older adults, a unique aspect that emergency medicine physicians encounter firsthand.” addressed learning needs related to the intersectionality of substance use in older adults, including interactions with polypharmacy, frailty, and social support networks. The clinical setting encompassed ED consults, longterm behavioral support rounds, and community practice clinics. Supervised by a physician specializing in geriatric addictions, the rotation also involved input from interprofessional teams, including nursing, social work, and behavioral support specialists. Specific competencies were established to guide future educational opportunities for trainees. The goals of the rotation were as follows: • Increase clinical exposure to older adults with substance use disorders • Observe and engage in a variety of clinical settings (unstable housing, community living, long-term care, addiction clinics) • Develop familiarity with screening, assessment, resources, and treatment options (particularly those pertinent to ED care) • Enhance awareness of and sensitivity to the intersectionality of substance use in older adults: considering interactions with cognitive impairment, polypharmacy, frailty, and social support networks, and developing strategies to address these issues in the ED Informal feedback on this rotation was quite positive. This rotation emphasizes qualitative social factors affecting substance use among older adults, a unique aspect that emergency medicine physicians encounter firsthand. Medical educators are encouraged to incorporate training in this area within their programs, especially for geriatric emergency

medicine fellows. (For those interested in implementing a similar initiative, you can contact the author at kira. gossackkeenan@vch.ca.) In summary, it is crucial to recognize that substance use can significantly impact the clinical presentation of complex older adults in the ED. Patients should be routinely screened, and if positive, educated about potential medical consequences. Red flags that should prompt clinicians to screen include frequent ED visits, gastrointestinal issues, unexpected delirium during hospitalization, malnutrition, poorly controlled hypertension, and irritability/ mood changes. Ideally, a multidisciplinary approach should be employed. One suitable screening tool specifically

designed for older adults is the “Senior Alcohol Misuse Indicator and the Comorbidity Alcohol Risk Evaluation Tool,” which is age-appropriate and accounts for potential cognitive decline.

ABOUT THE AUTHOR Dr. Gossack-Keenan is an emergency physician affiliated with the University of British Columbia in Vancouver, British Columbia, Canada. She recently completed a clinical fellowship in geriatric emergency medicine and her other interests include medical education and palliative care. She can be reached at kira.gossackkeenan@vch.ca.

“it is crucial to recognize that substance use can significantly impact the clinical presentation of complex older adults in the ED.”

Red flags that should prompt screening for substance misuse: • frequent ED visits

• gastrointestinal issues • malnutrition • irritability/mood changes

• unexpected delirium during hospitalization • poorly controlled hypertension

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.”

Office of Emergency Care Research

NIH OFFICE OF EMERGENCY

Demystifying the NIH Peer Review Process: Insights from Study Section Evaluations By Jeremy Brown, MD In our previous column, we delved into the intricate process of NIH peer review, a pivotal axis around which the entire NIH revolves. Peer review stands as the paramount criterion, often the sole measure, guiding nearly all funding decisions. But what exactly unfolds when your peers scrutinize your work? As a quick recap, the NIH operates through the Center for Scientific Review (CSR), which oversees approximately 250 study sections. CSR staff, possessing subject expertise, appoint members, primarily from academia, for a limited tenure on each section.

These members, predominantly drawn from past NIH recipients (though not exclusively so), can voluntarily participate in the NIH peer review process. The Center for Scientific Review also administers the Early Career Reviewer Program, pairing assistant professors with experienced reviewers in study sections. This initiative stands as an invaluable opportunity for budding faculty to hone their grant proposal skills, a resource I strongly advocate leveraging. Sometimes, each institute appoints its own study section, but the process is essentially identical to a study section run by the CSR.

Typically, each study section, helmed by a chair and comprising 10-25 members, designates two or three primary reviewers. Their duty involves meticulous evaluation of the assigned proposals, commencing with the assignment of preliminary scores. Prior to detailed discussions, the chair identifies proposals that received exceptionally low preliminary scores and categorizes them as "Not Discussed," indicating they are initially considered lacking in merit for detailed evaluation. Approximately half of the proposals reviewed often fall into this category. Any section member retains the prerogative to challenge

CARE RESEARCH Office of Emergency Care Research

“The primary reviewers provide succinct verbal assessments of grant strengths and weaknesses. Subsequently, all section members who have reviewed the proposals, albeit not as comprehensively as the primary reviewers, engage in earnest debates about the scientific merits, supporting data, and the approach of the Principal Investigator (PI) and their team.” this classification and bring a proposal labeled as "Not Discussed" back for comprehensive consideration. The primary reviewers provide succinct verbal assessments of grant strengths and weaknesses. Subsequently, all section members who have reviewed the proposals, albeit not as comprehensively as the primary reviewers, engage in earnest debates about the scientific merits, supporting data, and the approach of the Principal Investigator (PI) and their team. Statistical experts within the section scrutinize the data analysis segment closely. It's crucial to note that NIH program and review staff remain uninvolved during these dynamic

discussions, although the review officer is available for procedural inquiries.

ABOUT THE AUTHOR

Study sections may allow the PI to address specific concerns via phone if needed. Post-discussion, the chair encapsulates the discussion. Primary reviewers then assign final scores, followed by other members submitting their scores. These study sections convene over one or two days, evaluating anywhere from a handful to over 20 proposals. Within days post-meeting, each primary reviewer submits comprehensive written reviews for every proposal, even those not discussed. These reviews coalesce into a Summary Statement, our topic for the next column.

Dr. Brown is the director of the Office of Emergency Care Research (OECR) where he leads efforts to coordinate emergency care research funding opportunities across NIH. Additionally, Jeremy is the primary contact for the NINDS Exploratory and Efficacy FOAs and serves as NIH's representative in government-wide efforts to improve emergency care throughout the country. He is also the medical officer for the SIREN emergency care research network which is supported by both NINDS and NHLBI. Jeremy.brown@nih.gov

SAEM PULSE | NOVEMBER-DECEMBER 2023

RESIDENT WELLNESS

The GROW Initiative: An Innovative Approach to Resident Growth and Wellness By Alexander Close, MD; Kimberly Sycks, MD; Ellie Ganz, MD; Matthew Barraza, MD, MS; and Simiao Li-Sauerwine, MD, MSCR As physicians, we recognize that our overall well-being enhances our capacity to provide patient care. Yet, improving resident wellness remains a challenge. In an era where the practice of medicine faces a mental health crisis, the demands of residency remain significantly emotionally draining. We experience pressure to sacrifice personal time, such as date nights, Saturday brunches, sleep, exercise, and family moments, in favor of our patients and careers. In a system where residents endure long hours in

stressful environments round the clock, the question arises: How can we foster a sense of community and establish psychological safety? The Ohio State University Emergency Medicine Residency Program has developed an extensive well-being initiative known as GROW (Gearing Residents for Overall Well-being). This program comprises a comprehensive well-being curriculum, monthly activities involving residents’ loved ones, designated time off for residents to socialize outside of the department,

and the introduction of a professional development grants initiative. As resident leads, known as the G-force, we have played a pivotal role in shaping the program and organizing many of these events for our fellow residents. By incorporating our input, GROW has been tailored to meet the specific needs of residents, ensuring optimal engagement and community development. While GROW receives support from the OSU EM Sam Kiehl III Resident Well-being Endowment, we are eager

“Each residency class is granted an evening to spend with classmates in an activity of their choice. This dedicated time fosters strong bonds among class members, and each class values the opportunity to cover for others when it’s their turn to have the night off.” to share aspects of our program that can be readily implemented in other residency programs.

Fostering Relationships & Building Strong Communities

Residents themselves recommend and organize most of the wellness events, ensuring alignment with current interests. At the start of each year, all residents are assigned to one of seven “Houses,” each comprising an equal number of residents from classes and faculty advisors. This arrangement is intended to establish a small, consistent, and long-term cohort where residents can forge relationships and offer mutual support. Each house participates in educational activities during weekly didactic sessions and plans an annual, all-residency event. These events are open to all residents not on shift, and advance requests for time off are accommodated. The day and time of these events vary to cater to as many participants as possible. We have taken care to curate a diverse array of events to cater to various interests, welcoming both residents and their loved ones, as well as faculty members. Previous activities have included paintball, boating, professional sports outings, go-kart racing, apple picking, and exploring Ohio’s forests for foraging. Residents have expressed their enjoyment, with comments such as, “I have gone paintballing several times, but attending this event with my fellow residents and faculty members was a great experience,” and, “My wife and daughter joined us for boat day this year, providing a wonderful opportunity to spend time with my family and friends.” GROW-sponsored all-residency events have introduced participants to novel experiences they might not have otherwise tried. For instance, none of us had taken a foraging class before, and likely wouldn’t have if residents hadn’t organized it. During this event, we hiked in a local park with an expert forager

and professional chef as our guide. We identified various plants and spices, which were later used in the dishes we prepared together. A select few events are protected each year to ensure that all residents can attend, notably our annual fall retreat—a 24-hour period free from clinical duties, dedicated exclusively to fostering community. This year, we started the day at a nearby park, engaging in activities such as hiking, dodgeball, and crafts, all expertly led by members of the G-force. The morning was followed by a lively talent show featuring musical performances, spoken word poetry, a medical spelling bee that put faculty members to the test, and impressive displays of strength. The talent show not only showcased the diverse talents and personalities of our residents but also elicited abundant laughter. The day culminated in a community dinner, where residents’ loved ones were warmly welcomed to join us, creating a sense of inclusivity, and strengthening our residency community.

Beyond Clinical Duties Toward Work-Life Balance

Another cherished aspect of our program is our quarterly protected class nights off. Each residency class is granted an evening to spend with classmates in an activity of their choice. This dedicated time fosters strong bonds among class members, and each class values the opportunity to cover for others when it’s their turn to have the night off. Additionally, the residency ensures protected time for attending key events such as the SAEM and ACEP annual meetings during our first and third years, respectively. Thanks to the efforts of the G-force, the second-year class now benefits from two days of protected time for an exclusive spring retreat. Last year, the class rented a spacious cabin in a nearby state park, where they enjoyed activities like hiking

and relaxing in the hot tub, providing a valuable opportunity for decompression and camaraderie.

Professional Development and Personal Growth

Professional development and engagement are pivotal for career satisfaction in emergency medicine (EM). To facilitate this, the residency has established a Professional Development Grants Program. Through this initiative, residents can explore various interests within the field of emergency medicine. Many residents in our program seek funding from these grants to pursue certifications in wilderness medicine, present at conferences, attend cadaver or difficult airway courses, and acquire additional subspecialty training or certifications. This program significantly enhances our capabilities and expertise in the field. To enhance professional development, we introduced a monthly GROW curriculum, featuring small group breakouts customized for each class year. These dedicated sessions occur once a month during didactic sessions and cover a range of topics, including stress management, work-life balance, financial well-being, and career planning. In a recent session, the third-year class focused on job and fellowship applications, as well as contract negotiation strategies. Meanwhile, the first-year class delved into discussions about imposter syndrome and effective methods to overcome it. These tailored discussions provide valuable guidance and support for residents at different stages of their training.

A Blueprint for Mental Health Support in Residency

Our residency program has implemented initiatives that foster psychological safety and cultivate a culture of well-being.

continued on Page 33

SAEM PULSE | NOVEMBER-DECEMBER 2023

“To enhance professional development, we introduced a monthly GROW curriculum, featuring small group breakouts customized for each class year. These dedicated sessions occur once a month during didactic sessions and cover a range of topics, including stress management, work-life balance, financial well-being, and career planning.” RESIDENT WELLNESS

continued from Page 31

One significant step is the introduction of debrief huddles following the care of critically ill patients. These huddles embrace a no-blame approach, focusing on constructive discussions about what could have been done better. We have also instituted a jeopardy system that prioritizes residents' well-being by eliminating penalties and the need for detailed explanations when calling off work. We firmly believe that individuals should not have to justify their inability to work when they feel unable to do so. Additionally, our program leadership actively advocates for residents taking parental leave. We have a published policy in place to support resident parents, including accommodations such as no night shifts during the first and third trimesters to mitigate pregnancy complications and provisions for postleave lactation support. Residents are encouraged to voice their concerns through various channels, including dedicated times at conferences, our Resident Advisory Board, or by reaching out to our chiefs. These initiatives underscore our commitment to creating a supportive and inclusive environment for all residents.

A Compassionate and Understanding Learning Environment

To align with our goal of creating a safe learning environment, we approach our educational sessions with a growth mindset framework. During orientation, all interns participate in a procedural competency curriculum focusing on the most common and high-risk emergency medicine procedures. Residents are granted multiple attempts to competently perform these procedures safely, without facing penalties for mistakes or initial failures.

We have transitioned from conventional morbidity and mortality conferences to "case-based error reduction" sessions, which highlight areas for improvement within our systems. The focus is on understanding the factors that influence intelligent and compassionate individuals to make decisions “at the moment.” The philosophy guiding these sessions is one of continual learning and improvement, promoting a culture of ongoing development and understanding. Our residency program is dedicated to supporting the mental health and wellbeing of all residents, acknowledging that at some point, everyone may require such assistance. We have established various avenues for residents to access counseling and mental health resources. During intern orientation, residents are introduced to our Employee Assistance Program Counselors, with the option to opt-out, providing insights into the available resources encompassing therapy, financial guidance, and legal assistance. Residents are explicitly encouraged to reach out to any faculty member for support if they feel comfortable, including our designated faculty coaches who act as advocates. This open and supportive approach ensures that residents have multiple avenues to seek help, fostering a compassionate and understanding environment within our program.

Fostering the Growth of Wellrounded Physicians

Psychological safety and environmental supports are essential components of residency training, fundamental for the well-being of trainees. We hope that highlighting the programs at OSU EM will inspire ideas for implementation and broader support across all emergency medicine programs. Through these initiatives, we have offered residents numerous avenues to enhance their personal well-being, foster connections, and pursue extracurricular development.

Our hope is to facilitate the growth of well-rounded individuals not only during their residency training but also in their roles as exceptional physicians.

ABOUT THE AUTHORS Dr. Close is a second-year emergency medicine resident at The Ohio State University Wexner Medical Center. alexander.close@osumc.edu Dr. Sycks is a third-year emergency medicine resident at The Ohio State University Medical Center, where she also earned her medical degree. Dr. Sycks is the senior resident GROW/wellness liaison for the residency, serving on the committee three years. Dr. Ganz is currently completing an emergency edicine residency at The Ohio State University. @ellie_ganz, ganz05@osumc.edu

Dr. Barraza is a combined emergency/internal medicine resident and plans to pursue pulmonary and critical care fellowship.

Dr. Li-Sauerwine is an associate professor of emergency medicine, associate residency program director, and medical education fellowship director at The Ohio State University where she is also director of the Kiehl Resident Well-Being Endowment. She is the 2023-2024 Chair of the Council of Residency Directors in Emergency Medicine (CORD) Wellbeing Committee. @theSimiao

SEX & GENDER

Gender Disparities in Homelessness: Implications for Health Outcomes SAEM PULSE | NOVEMBER-DECEMBER 2023

By Christine Shaw, MD, on behalf of the SAEM Sex & Gender in Emergency Medicine Interest Group

Unstable housing is well-documented to be associated with poorer health outcomes and increased utilization of emergency medical resources. Homelessness and housing insecurity, however, are complex issues overlapping with mental and social determinants of health, as well as comorbid medical conditions. Recent literature delves into specific sex and gender differences in homelessness. Presently, homelessness predominantly affects men, with a 2:1 ratio on average. Some studies suggest this might be linked, in part, to disproportionate access to resources for women, including shelter, due to a bias towards assisting “vulnerable populations,” such as women with children and

victims of domestic violence. However, research focusing on sheltered persons experiencing homelessness (PEH) (residing in shelters) versus unsheltered PEH (living on the streets, outdoors, or other unsuitable places) indicates equal proportions of men and women living unsheltered. Risk factors associated with homelessness vary between women and men. Incarceration is a major risk factor for both genders, but proportionally, women face a higher risk of homelessness post-incarceration, even though a higher percentage of homeless individuals who are former prisoners are men (80%) compared to women (67%). Women experiencing homelessness report a lower rate of

substance misuse than men, but a higher incidence of mental illness, particularly depression. Women are also more likely to have been in the foster care system as children or adolescents. Unsheltered females have different risk factors; they are more likely to have not completed high school, have a history of incarceration (five times more likely), experience prolonged homelessness, and report substance misuse. Conversely, unsheltered men, particularly military veterans, face a higher risk of being unsheltered. In a prior study, the majority of women had been in military entitlement-based housing before becoming homeless. These gender-specific risk factors could serve as crucial indicators, especially for

“Family alienation, prejudice, and acts of violence significantly contribute to the high incidence of homelessness among transgender and LGBTQ-identified youth.” women at risk of housing insecurity and homelessness. These differences in risk factors might contribute to sex and gender disparities in health outcomes. Particularly striking is the ten-fold increase in mortality among young homeless women compared to men. While in the general population, females have a lower mortality rate than males, even at lower socioeconomic levels, this trend reverses dramatically in the young homeless population. The exact cause remains unidentified, but it might be related to higher rates of victimization and assault among homeless women, especially sexual assault, leading to increased medical presentations for physical and somatic pain. There is a strong correlation between assault, emotional distress, and reported pain levels. Furthermore, while existing literature often views homelessness through a binary gender lens, gender is not binary. Homelessness is a critical issue for transgender people; depending on the source, 1 in 5 to 1 in 3 transgender individuals have experienced homelessness at some point. Transgender individuals are also

more likely than cisgender persons to be unsheltered homeless. Family alienation, prejudice, and acts of violence significantly contribute to the high incidence of homelessness among transgender and LGBTQ-identified youth. Unfortunately, social service agencies and homeless shelters dedicated to assisting this demographic frequently lack culturally sensitive and suitable support for transgender individuals experiencing homelessness. Instances of denying shelter based on gender identity, placing them in gender-specific spaces incongruent with their identity, and neglecting to address concurrent challenges confronting transgender homeless adults and youth are prevalent. From an emergency medicine perspective, individuals experiencing unstable housing disproportionately use emergency department (ED) resources compared to the general public. Despite the male predominance of homelessness, there doesn’t seem to be a gender discrepancy among patients experiencing homelessness who access the ED; women comprise roughly half of ED visits from this cohort. Assessments and interventions addressing homelessness in

the community and acute care settings, including the ED, should consider and incorporate gender-specific differences in risk factors and experiences. This should include a focus on mental illnesses, especially depression and PTSD, screening for interpersonal violence and assault, and early intervention for those at risk, such as recently incarcerated individuals and those on subsidized housing. Involving social work early and frequently can provide crucial support to those facing unstable housing. Encouraging future ED-based research that specifically considers gender differences is vital to understanding the impact of the ED and emergency clinicians on homeless and housinginsecure patient populations.

ABOUT THE AUTHOR Dr. Shaw is an instructor and Social Emergency Medicine and Population Health/Global Health fellow in the department of emergency medicine at University of Alabama Birmingham

WELLNESS PERSPECTIVE

Prescription for the Soul: Lessons from a Sabbatical in the Himalayan Foothills

SAEM PULSE | NOVEMBER-DECEMBER 2023

By Al’ai Alvarez, MD, on behalf of the SAEM Wellness Committee

In January 2023, I submitted my request for a sabbatical. With my work on physician well-being and professional fulfillment, I considered several options: creating wellness retreats, experiencing austere clinical environments, or researching highperformance teams. Because of my professional interest in self-compassion, I recognized the importance of mindfulness and self-awareness. Having trained in a busy county hospital in the Bronx, I had no exposure to mindfulness and meditation as a means of self-care, so I decided to dive deeper into creating a solid foundation for meditation, which is one way to establish a mindfulness habit. I wanted to learn from experts with formalized daily practice to see how much more I could improve on the practice of selfcompassion.

I chose Dharamsala because it is where His Holiness the Dalai Lama (HHDL) currently resides. Despite my non-religious perspective, I hoped that my proximity to the key leader in Buddhism would give me an opportunity to meet him. I selected Tushita Meditation Center for a 10-day onsite meditation training. A month before the start of my sabbatical, it was announced that HHDL would be giving a 2-day teaching event, coinciding fortuitously with the beginning of our meditation retreat. I attended Buddhism classes taught by Geshes (the Tibetan academic degree for Buddhist monks and nuns, equivalent to attaining a PhD in Buddhism, and earned over a period of about 20 years).I also experienced Tibetan medicine and met several physicians.

As I delved deeper into the classes and the retreat, I noticed students approaching the monks, asking them questions about life and everyday struggles, and seeking advice. Watching them navigate tough questions led me to ask as many monks and Geshes as possible about vicarious trauma. Given that they hear about people’s challenges, including depression and even suicidality, I was curious to know if Tibetan monks receive any formal teaching on preventing burnout. Soon enough, I began hearing similar themes in their responses: no standardized texts or teachings on avoiding burnout, nor is it common for them to experience this. Each monk emphasized the notion of self-care, of practicing compassion with wisdom, and how the two must go hand-in-hand.

The Tibetan monks were generous with their time, each one using various practical analogies: one about smartphones and how versatile they are these days, yet we must take time to recharge them, or the battery runs out, rendering the phone useless. Another analogy was on the common Tibetan tradition of serving tea to guests and how, despite our best intentions, we must ensure our pot is full to be able to serve tea. Each monk reinforced the idea that for us to be effective, we must also take time to recharge. Satisfied with the responses, it was clear that the intention is to be proactive, in part, to develop preventative mechanisms to overcome the constant challenges we face as physicians. Later, I refined my question to, “How might we support physicians suffering from burnout due to caring for others’ suffering?” He added that even though we want to care for everyone, there is no way to realistically achieve this. I shared with him that on this trip alone, I had met several physicians, including emergency physicians, who had quit medicine or transitioned into other roles. He reiterated the idea that sometimes this may be the best course, but if we don’t strive to reach our human potential, whatever new role we pivot to, we will not find peace or fulfillment. So, whether we decide to persevere or change paths, he emphasized that doctors have a great responsibility and potential, and it’s essential to practice wisdom with compassion. Rinpoche’s response reminded me that self-compassion requires understanding our shared common humanity. As doctors, we have chosen a challenging path, and while many of our challenges may be unique to physicians, at the core everyone simply wants to be happy and free from suffering. While the system and the institution should focus on creating a culture of wellness and improving efficiency in our practice, we also have a role to play. This role includes setting aside time to recharge. In my time in Dharamsala, I appreciated the intentionality of having time away from work for my own personal and professional development. Wanting to be away from work did not mean I did not love my job—quite the contrary. Through my experience, I’ve come to appreciate how time off

“Each monk emphasized the notion of selfcare, of practicing compassion with wisdom, and how the two must go hand-in-hand.” recharges me and offers me the space to be more creative, productive, and better able to navigate the daily challenges we face as academic emergency physicians. The logistical challenges of taking a sabbatical cannot be understated. It requires thoughtful planning. I submitted my request more than six months ahead of my scheduled break. Departments may offer the option for physicians to add one to two extra shifts in the months leading up to their sabbatical to help defray the time commitment. Even better, some departments, including those outside academia, provide partial or complete paid leave for professional development. During my sabbatical, setting work boundaries was critical. Because the meditation retreat I signed up for required us to relinquish our phones and computers and practice silence for the duration of the program, it was easier for me to disconnect. Over the years, I’ve developed “out of office” messages that convey what I’m doing while away and alert everyone that I will only be responding to emails upon my return. As emergency physicians, we’re accustomed to life-and-death

situations, so almost all correspondence by email can wait; either that, or other solutions will emerge. I had to learn to let go of always having the answer or constantly feeling the need to respond. I also scheduled to take my vacation prior to the start of my sabbatical to help me fully unwind from work and allow me to focus on my sabbatical once it began. I’m grateful for my institution’s support during my sabbatical. I also appreciate Dara Bramson, a cultural anthropology PhD candidate at Tulane, who assisted me in my journey in Dharamsala. I wish I had taken a sabbatical sooner and look forward to my next break. In the meantime, I’m glad to be back in our ED.

ABOUT THE AUTHOR Al’ai Alvarez, MD, is director of well-being at Stanford Emergency Medicine and chair of the SAEM Wellness Committee. @alvarezzzy

WELLNESS PERSPECTIVE

Identity, Belonging, and Mentorship: Keys to Navigating the Isolation of EM Residency By Talya M. Jeffrey, DO, MPH; P. Logan Weygandt, MD, MPH; Vytas Karalius, MD, MPH, MA; and Christine Stehman, MD on behalf of the SAEM Wellness Committee SAEM PULSE | NOVEMBER-DECEMBER 2023

A Personal Experience

They say the road to success is a lonely one few are willing to endure. As a first-generation college graduate, middle-class white female, and now a second-year emergency medicine resident, I, too, have navigated this challenging journey. The road leading to my current position has tough, marked by both ups and downs. It has been a long road; few have accompanied me on this arduous journey; at times, I’m even surprised I have. However, the sense of isolation I experienced during my residency was unexpected. The fresh new energy of being an intern, the excitement of finally being called “Doctor,” quickly waned

under the isolation of the resident physician experience. During my intern year, I felt like the new kid on the block – awkward, naïve, and often scared. The relentless firehose of clinical knowledge in the fast-paced, high-pressure environment threatened to push me off the little perch of safety and left little energy to connect with my colleagues. My own harsh heavy-handed self-judgments made matters worse. I constantly doubted my abilities and worried that I took too much time, didn’t know enough, slowed down the workflow, didn’t carry a sufficient patient burden. My harsh self-criticism made my perch smaller and smaller until it took all

my energy just to remain standing on a single toe. It was exhausting and I couldn’t wait to leave work one the clock hit the tenth hour. Off-service rotations were better. I bonded with colleagues over the shared experience of challenging patient cases and long work hours. The attendings in these rotations had more time for teaching and It felt like we truly were in the trenches together. I felt more connected to my off-service residents than to my own EM colleagues. I began questioning whether it was the nature of residency itself or the specific structure of emergency medicine training that was so lonely and isolating.

Reflecting on my struggles, I realized that my fear of vulnerability was what kept me from connecting with my coresidents and seniors. I wondered if residency was as hard for them as it was for me. What would they think of me if they knew I was emotionally struggling? I was never brave enough to ask. My feelings of not belonging, stemming from my background as a white middle-class female from a ranch in rural New Mexico, made me feel “different” and intensified my isolation. Despite my achievements in medical school and board exams, I struggled to convince myself that I deserved to be here. By the end of my intern year, my spirit hit an all-time low. As a newly minted, second year resident, I have found the courage to be vulnerable. I talk openly to the new interns, both on and off-service, discussing the challenges of residency. My hope is that by sharing stories and normalizing my experiences, I can empower others to do the same, fostering stronger connections among us. I am hopeful this open dialogue can transform the isolating and lonely experience of emergency medicine training. My experience is not unique or uncommon. Emergency medicine residencies are often structured in a manner that fosters isolation. The demanding nature of shift schedules and rotations make it challenging to maintain consistent contact with coresidents, mentors, and loved ones. Residents in off-service rotations may spend months without regular interactions with their classmates and colleagues. Even when residents are physically present in the same location, the hierarchical structure of emergency medicine teams limits interactions among members of the same cohort. Additionally, the culture of emergency medicine discourages physicians from sharing their insecurities and mental health challenges, despite the prevalence of these issues in the field. The sense of isolation is further compounded by intersectionality, where physicians share multiple minority identities. Whether it's being underrepresented in medicine, identifying as LGBTQIA+, coming from a disadvantaged background, or being a female and a first-generation college student from a rural upbringing, these shared identities can magnify feelings of

isolation. When residents lack peers who share their identities, feelings of isolation can compound and further push those residents to the margins. Fortunately, there are steps that individuals, programs, and departments can take to overcome this isolation and create a sense of belonging.

Intern Orientation

Intern orientation plays a pivotal role in professional identity formation, providing an early opportunity for residents to discuss their unique identities, vulnerabilities, and imposter syndrome experiences. Normalizing these conversations and creating space for them, can flatten hierarchies and help residents establish a sense of belonging as they as they begin their career journeys.

Affinity Groups

Affinity groups are an excellent way to unite individuals with shared identities. These groups promote cohesion, pride in one's uniqueness, and provide space for personal and professional identity development. Affinity groups often lead to mentorship relationships, offering guidance and support to those who need it. Because of the size of many EM residencies, these affinity groups may need to extend across specialty or institutional boundaries to be effective.

Mentors and Mentorship Programs

Mentorship programs that focus on shared identities can strengthen the sense of belonging. Even if a resident belongs to a minority group with few representatives in their program, mentors can employ strategies to enhance their mentees' sense of belonging. Mentors who avoid discussing identityaware topics, inadvertently erase the mentees' identities and push them further to the margins. Conversely, mentors who engage in identity-aware conversations contribute significantly to fostering inclusion and a sense of belonging.

Retreats

Retreats are an excellent way to bring residents together; however, simply placing residents in the same physical space does not guarantee increased connection or belonging. Programming should focus on shared professional identity formation, encourage vulnerability, and provide time and space

for reflection. While these retreats should be enjoyable, it's important to avoid activities that cater only to the majority, ensuring that every resident feels included. In conclusion, emergency medicine residency can be a lonely and isolating experience, especially for those with unique and intersecting identities. However, purposeful programming can overcome these challenges. By working together, we can enhance belonging and alleviate isolation for our diverse residents.

ABOUT THE AUTHORS Dr. Jeffrey is a second-year emergency medicine resident at the University of Illinois College of Medicine, Peoria. She obtained her Doctor of Osteopathic Medicine and Master in Public Health from Pacific Northwest University College of Medicine and Columbia University Mailman School of Public Health. talya.jeffrey@gmail.com Dr. Weygandt is an assistant professor at Johns Hopkins Emergency Medicine. He obtained his medical degree and Master in Public Health from Johns Hopkins University School of Medicine and Bloomberg School of Public Health. He attended residency at Northwestern University Emergency Medicine. loganweygandt@gmail.com Dr. Karalius is an interim assistant program director and medical education scholarship fellow at Stanford University. He obtained his medical degree from Mayo Clinic School of Medicine and attended residency at Northwestern University Emergency Medicine. karalius@stanford.edu Dr. Stehman is a visiting clinical associate professor at the University of Illinois College of Medicine Peoria in the emergency medicine residency. She obtained her medical degree from Northwestern University's Feinberg School of Medicine. She attended the Cook County Emergency Medicine residency after a military transitional internship. crstehman@gmail.com

WILDERNESS MEDICINE

Navigating Toxic Flora: A Guide to Common Cardiac Glycoside Plants in North America

SAEM PULSE | NOVEMBER-DECEMBER 2023

By Kailee Pollock and Kevin Watkins on behalf of the SAEM Wilderness Medicine Interest Group

The toxic plant classification systems have been debated for years. A recent effective system, outlined by James H. Diaz in his study "Poisoning by Herbs and Plants: Rapid Toxidromic Classification and Diagnosis," offers valuable insights. Diaz's classification, beneficial for frontline providers, includes four primary toxic plant categories: cardiotoxic, neurotoxic, cytotoxic, and GI/hepatotoxic plants. Among these, cardiotoxic plants, like foxglove, are widely known. They can be divided into three main groups: cardiac glycosides, sodium channel activators, and sodium/calcium channel blockers. This article will focus on cardiac glycosides. Nature boasts over 200 cardiac glycosides, present in both plants and animals. Structurally, they consist of a steroid backbone, lactone ring, and sugar moiety. These toxins

predominantly bind to Na/K ATPase enzymes in cardiac myocytes, skeletal muscle, and baroreceptors, leading to a digoxin toxidrome. Inhibiting this enzyme elevates intracellular sodium and calcium, increasing automaticity. While cardiac effects are their hallmark, these plants can also impact the GI system, with symptom onset and duration varying among different plant species but are not well-known for some plant species. In cases of acute toxic ingestion of cardiac glycosides, the initial gastrointestinal distress is followed by cardiac toxicity, characterized by heightened vagal tone on the sinoatrial (SA) or atrioventricular (AV) node, leading to bradycardias or AV blocks, notably in younger patients with naturally higher baseline vagal tone levels. Additionally, these toxins increase atrial and ventricular automaticity, potentially causing abnormal heart rhythms like

atrial or ventricular tachycardias. While bidirectional ventricular tachycardia is often considered indicative of cardiac glycoside toxicity, similar patterns can also result from other plant toxins. These conduction affects are the most common cause of death. The ECG may display nonspecific ST and T wave changes, and patients might experience visual disturbances, altered mental status, and weakness during acute toxicity, although these symptoms are more commonly associated with chronic digoxin exposure rather than acute ingestion. Due to their impact on the Na/K ATPase enzyme, cardiac glycosides can cause hyperkalemia that produce typical changes on ECG. The degree of hyperkalemia aids in prognosis prediction. Comprehensive electrolyte panels, including renal function studies, should be obtained. Elevated digoxin serum assays confirm exposure, but levels don't correspond with illness severity.

“Nature boasts over 200 cardiac glycosides, present in both plants and animals. Structurally, they consist of a steroid backbone, lactone ring, and sugar moiety.” Treatment centers on supportive care, involving IV fluids, anti-emetics, and GI decontamination. Managing hyperkalemia is crucial; however, calcium use is debated due to the theoretical risk of stone heart syndrome, though recent studies challenge this notion. Pacing or antiarrhythmic agents may be necessary, but atropine usage should be restricted to life-threatening bradycardias, as it can exacerbate tachyarrhythmias that may be harder to treat. Lidocaine is the preferred antiarrhythmic due to contraindications with amiodarone, beta blockers, and calcium channel blockers, which can elevate cardiac glycoside levels. Electrical cardioversion must be approached cautiously due to potential complications; it's suitable for resistant cases only. Dialysis isn't effective due to high albumin binding and broad distribution. Some cardiac glycosides undergo enterohepatic circulation can be eliminated with cholestyramine. The mainstay of treatment of patients with significant illness is digoxin-specific Fab antibody fragments are the mainstay treatment, with high doses (10-20 vials) potentially required.

Foxglove (Digitalis purpurea) is a common cardiac glycoside-containing plant frequently featured in emergency medicine boards. Widely found across North America, it stands out with vibrant clusters of trumpet-shaped flowers. Foragers sometimes misidentify it, confusing it with borage, dandelion leaves, or comfrey. Notably, foxglove's bitter-tasting flowers are not commonly ingested; instead, leaves are often mistaken and consumed,

especially since the plant does not bloom in its initial year. The cardiac glycoside in foxglove is digitoxin, present throughout the entire plant, making it crucial to recognize and differentiate from similarlooking vegetation.

Common oleander (Nerium oleander) and yellow oleander (Thevetia peruviana) are primarily found in the southern United States. Common oleander, in particular, is notorious for causing a significant number of toxic cardiac glycoside ingestions globally. It contains oleandrin and neriine, potent cardiac glycosides. Yellow oleander, on the other hand, primarily contains thevetin A, thevetin B, and thevetoxin. These toxic compounds are present throughout the plants but are especially concentrated in the seeds; even the ingestion of a few seeds can lead to severe toxicity.

Lily-of-the-valley (Convallaria majalis) is prevalent in shaded areas across most of North America. The plant contains convallotoxin as its primary toxin. Accidental ingestion often occurs when

it's mistaken for ramps, due to their similar leaf appearance, although lily-ofthe-valley leaves typically swirl. While the plant's small, bell-shaped white flowers are distinctive, they aren't present yearround and aren't found on every plant. Typically, morbidity and mortality resulting from lily-of-the-valley ingestion are low, unless consumed in large quantities.

Squill (Urginea marítima) contains several types of cardiac glycosides, including scillaren A, which belong to the bufadienolide glycoside family. This plant is characterized by its dark-red, bulbous appearance and is occasionally mistaken for wild onions or ramps. Squill predominantly thrives in the southwestern region of the United States.

The Suicide Tree, also known as pongpong seeds (Cerbera odollam), is typically found along shorelines and forests near the Pacific Ocean. This green, bushy tree features white flowers with a yellow

continued on Page 42

“In cases of acute toxic ingestion of cardiac glycosides, the initial gastrointestinal distress is followed by cardiac toxicity, characterized by heightened vagal tone on the sinoatrial (SA) or atrioventricular (AV) node, leading to bradycardias or AV blocks, notably in younger patients with naturally higher baseline vagal tone levels.” WILDERNESS MEDICINE

continued from Page 41

SAEM PULSE | NOVEMBER-DECEMBER 2023

center and produces red, round, and smooth fruit resembling an apple. The seeds contain toxic substances such as cerebin, neriifolin, and cerebroside, concentrated in the kernel core. Due to the plant's potent cardiac glycosides, it has tragically been used for suicidal purposes. Its close relative, the Sea Mango (Cerbera manghas), resembles a small mango but is not commonly found in the Uninted States. Nonetheless, U.S. poison control centers have been involved in managing cases where individuals acquired these seeds online.

Star of Bethlehem (Ornithogalum umbellatum) contains toxic cardiac glycosides known as convallotoxin within its bulbs. The plant exhibits a stem bearing white flowers, arranged in star-shaped clusters, each attached to its stalk with distinctive green lines underneath. Every part of the plant, especially the leaves and bulbs, contains toxins. The leaves, in particular,

might be confused with garlic. Star of Bethlehem typically proliferates as an invasive weed in fields and roadsides. Despite some claims suggesting their edibility, the bulbs are not safe for human consumption due to their poisonous nature.

Milkweed (Asclepias syriaca) is a common perennial herb that thrives across the United States. Characterized by linear, alternating leaves, these plants produce flowers ranging in color from green-white to yellow-red, and they contain milky sap. Milkweed contains cardenolides, a type of digitoxin-equivalent cardiac glycosides, specifically, asclepin and calotropin. The highest concentration of these toxins is found in the latex fluid, stems, leaves, and roots of the plant. While there have been reports suggesting possible edibility with specific cooking methods, this has not been thoroughly studied.

ABOUT THE AUTHORS

Hemp Dogbane (Apocynum cannabinum) is a perennial plant characterized by smooth-edged leaves that are hairy on the lower part of the tree. Its upright flowers are off-white and mature into pods covered in silkywhite hairs. Its close relative, Dogbane (Apocynum androsaemifolium), features drooping, clustered flowers that are white, bell-shaped, and adorned with pink stripes. Both species are native to nearly all of North America and were historically utilized as cardiac stimulants. The primary toxin found in these plants is cymarin. Remarkably, the trees remain poisonous even when dried, and their toxic sap is present in broken stems or leaves, with the most potent part residing in the root. Lethal effects from ingestion may manifest 6-12 hours after exposure.

Kailee Pollock is a licensed clinical pharmacist and a second-year medical student at Ohio University Heritage College of Osteopathic Medicine. She serves as president of the local chapter’s EM Club, as well as the representative as the Wilderness Medicine Chair. Dr. Watkins is an assistant professor of emergency medicine at Northeast Ohio Medical University and core faculty at the Cleveland Clinic Akron emergency medicine residency program, where he serves as division head of wilderness medicine. He enjoys teaching with the track and elective as well as the local Wilderness Life Support for the Medical Professional (WLS:MP) program and Cuyahoga Valley Wilderness Medicine Conference. He is a member of the SAEM Wilderness Medicine Interest Group. @kwat2122

WILDERNESS MEDICINE

Summer of the Shark: Managing Shark Bites in the ED By Caroline Ferazani, Nadia Baranchuk, MD, and Sanjey Gupta, MD, on behalf of the SAEM Wilderness Medicine Interest Group The term “shark bite” often evokes images of severe soft tissue loss or limb amputation, but in reality, shark bites result in a broad spectrum of soft tissue injuries. These incidents are infrequent, with the United States being a global leader in unprovoked bites, recording 41 cases in 2022. Among these, New York City and Long Island, NY, witnessed 14 bites since the beginning of the year. Our coastal Long Island Emergency Department successfully treated three of these victims. Managing shark bites necessitates a nuanced understanding of soft tissue damage, vascular or nerve injury, and infectious risks. This complex interplay underscores the importance of

a comprehensive approach to wound management for these rare animal bites.

Clinical Presentations in Our ED Patient 1: A 49-year-old man swimming in the Atlantic Ocean suffered multiple jagged lacerations on his right hand, ranging from 1-3 cm. EMS applied a pressure dressing before arrival. The hand had no sensorimotor or vascular issues, except for a retained tooth near the fourth metacarpal. The patient underwent foreign body removal, washout, and wound repair in the operating room. Patient 2: A 47-year-old woman swimming in the Atlantic Ocean

sustained multiple puncture and jagged lacerations on her left upper thigh and groin. These wounds, deep to subcutaneous tissue, were accompanied by an underlying hematoma. Despite superficial abrasions on her left hand from prying the shark away, her distal extremity remained neurovascularly intact. X-rays of the hand, pelvis, and femur were normal. Local wound care was administered, and the patient received doxycycline and Augmentin, along with wound care instructions upon discharge. continued on Page 45

SAEM PULSE | NOVEMBER-DECEMBER 2023

“Shark bites can exhibit a massive bite force, estimated to max at 18 tons/sq inch in some species. These bite forces can lead to massive tissue loss, limb amputation, significant crush injuries, nerve, or vascular injuries.” WILDERNESS MEDICINE

continued from Page 43

Patient 3: A 33-year-old male lifeguard bitten on the right chest and hand during training drills. The chest had three superficial 1cm puncture wounds, and the palm had a 2 cm laceration. Both areas were neurovascularly intact. The hand laceration was loosely approximated, and the patient was discharged with doxycycline.

Categories of Shark Attacks and Wound Descriptions Shark attacks categorize into three types: “hit and run,” where the shark bites once and does not return; “bump and bite,” where the shark bumps the victim before returning to bite; and “sneak attack,” where the shark bites without warning and returns for further attacks. The last two, while rarer, result in severe bites and fatalities.

Shark jaws contain multiple rows of serrated triangular teeth that are continuously shed and replaced. Shark bites typically have crescent-shaped or parallel cuts caused by teeth raking on the victim’s skin. Shark bites can exhibit a massive bite force, estimated to max at 18 tons/sq inch in some species. These bite forces can lead to massive tissue loss, limb amputation, significant crush injuries, nerve, or vascular injuries. Fortunately, most bites result in lacerations or puncture wounds that are not deep and do not cause vascular, nerve, or bony injury. Shark encounters can cause significant skin abrasions even without a bite due to their abrasive, toothlike dentricles that are very abrasive when applied to human skin.

Injury Epidemiology and Injury Scoring The likelihood of a shark bite in the United States is less than one in 11.1

million. Shark-related injury (SRI) death rates range from 6.6% to 38%. Most SRIs are minor lacerations or superficial wounds on the lower extremities. The Shark-Induced Trauma (SIT) Scale, established in 2010, provides a standardized language for describing SRI severity, considering factors such as blood pressure, injury depth, extremity function loss, treatment, and patient survival.

Treatment and Management Considerations

Shark attacks become lethal due to massive tissue damage or blood loss. Pre-hospital treatment involves resuscitative measures, direct pressure, tourniquet, or vascular compression, based on SRI severity. Wounds should be evaluated for size, depth, degree of devitalized tissue, neurologic and vascular damage, bony injury, other soft tissue injury, compartment syndrome, and foreign bodies. Imaging studies like x-ray, CT, or ultrasound, are useful in the detection of retained foreign bodies. A CT angiogram can be useful in suspected vascular injury in the absence of hard signs of arterial injury. Extensive wounds with underlying injury will require resuscitation, infectious prophylaxis, specialty consultation for inpatient management, and admission or transfer to a center capable of taking care of all aspect of the injury. Minor wounds, injury, and lacerations without significant trauma to underlying tissue can safely be managed and discharged from the ED. The wounds should be irrigated copiously and debrided of necrotic or de-vascularized tissue. The decision for a primary wound closure should be based on extent of injury, location, infectious risk, patient heath status, cosmesis, functional outcomes, and availability of appropriate follow up.

Infection causes morbidity or delayed mortality. Prophylactic antibiotics should be considered in all SRIs. A combination of exposure to bacteria in the marine environment and mouth flora coupled with soft tissue injury increases the risk of wound infection. A consensus regarding antibiotic choice does not exist due to the variation in shark type and mouth flora. Antibiotics should cover Vibrio species, gram negative bacteria, Staph. and Strep. species, and Pseudomonas species. Recommendations include a fluoroquinolone or the combination of doxycycline and a third generation cephalosporin, and coverage for Staph and Strep with cephalexin, amoxicillinclavulanate, or clindamycin. Consider intravenous antibiotics for more severe or contaminated wounds.

Conclusion

With climate change and shifting shark migration patterns, we anticipate an increase in SRIs in new locations. Preparedness and education are vital to successfully managing these rare trauma cases in emergency departments.

ABOUT THE AUTHORS Caroline Ferazani is a current sophomore at the University of Notre Dame studying psychology and prehealth. She participated in the Summer Scholars Program in the emergency department of South Shore University Hospital, Bay Shore, New York, in the summer of 2023, where she volunteered and engaged in clinical research. cferazani19@gmail.com Dr. Baranchuk is an emergency physician and the director of ultrasound at South Shore University Hospital, Bay Shore, New York. She is also an assistant professor of emergency medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York. nbaranchuk@northwell.edu Dr. Gupta is the chair of emergency medicine at South Shore University Hospital, Bay Shore, New York. He is a fellow in the Academy of Wilderness Medicine and a professor of emergency medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York.

RESIDENTS & MEDICAL STUDENTS

RAMS Declassified Workforce Survival Guide

SAEM PULSE | NOVEMBER-DECEMBER 2023

By Stephanie Balint; Laura Barrera, MD; Mitchell Blenden, MD; Lauren Diercks; Carleigh Hebbard, MD, PhD; and Hamza Ijaz, MD, on behalf of the RAMS Workforce Taskforce

Welcome to the RAMS Declassified Workforce Survival Guide. Our goal is to demystify workforce articles so residents and students can understand the current state of the emergency medicine (EM) workforce. We will discuss five prominent workforce articles with summaries, limitations, and implications for RAMS.

The Emergency Medicine Physician Workforce: Projections for 2030 Read the full article here.

Summary: In this study conducted by a multi-organizational task force, the aim was to assess the future supply and demand for emergency physicians (EPs). Researchers used various sources of existing data and employed mathematical modeling techniques

to project potential trends. The study investigated whether current patterns would lead to a shortage or surplus of residency-trained, board-certified EPs, as well as other physicians, nurse practitioners (NPs), and physician assistants (PAs). The findings indicated a projected 2% annual growth in graduate medical education, a 3% annual attrition rate for EPs, and an expected increase in NP/ PA encounters from 15% to 20% by 2030. Additionally, the study projected a rise in emergency department (ED) patient visits from 11% in 2018 to 15% in 2030. As a result, the research team estimated a surplus of 7,845 physicians in the year 2030. Limitations: The study's limitations include its reliance on data collected

until 2018, which means it does not factor in the impact of the COVID-19 pandemic and the subsequent rise in attrition rates for emergency physicians (EPs), nurse practitioners (NPs), and physician assistants (PAs). Additionally, the research does not account for variability in the number of shifts worked, non-clinical roles (such as those in academic settings), and the disparities between urban and rural practice settings. Furthermore, the attrition rate calculation using the American Board of Emergency Medicine (ABEM) board certification may not accurately reflect EP attrition due to the certification's ten-year renewal cycle. Implications for RAMS: Our future in the medical field is not predetermined; it remains fluid and adaptable. Workforce

“Workforce projections, as the term suggests, are mere predictions based on existing data and trends. They provide valuable insights, but they are not definitive outcomes.” projections, as the term suggests, are mere predictions based on existing data and trends. They provide valuable insights, but they are not definitive outcomes.

The 2013 to 2019 Emergency Medicine Workforce: Clinician Entry and Attrition Across the US Geography Read the article study here.

Summary: In this cross-sectional analysis utilizing CMS Provider Utilization and Payment Data, a significant trend emerges in the health care workforce. The proportion of emergency physicians (EPs) is decreasing, while the presence of advanced practice providers (APPs) is on the rise. Notably, the number of physicians entering the workforce peaked in 2016 and has since declined. A key finding of the study revealed that the annual attrition rate ranged from 3-5%, contrasting with the previously assumed rate of 3%. This attrition rate was calculated using Medicare claims data, specifically focusing on clinicians with at least 50 reimbursements. Particularly in rural areas, a higher number of EPs are leaving the workforce compared to those entering. This results in rural regions having more APPs and non-EPs than EPs providing emergency care. The study also underscored disparities in EP supply optimization. For instance, rural states like Montana and South Dakota, which initially had low emergency medicine (EM) physician density, experienced an increase in EPs during the study period. In contrast, Rhode Island, with a high density of EM clinicians in 2013, continued to see growth in EP numbers. Limitations: One notable limitation of the study is related to the data source. The study utilized Public Use Files, which captured Advanced Practice Provider (APP) services without attending physician supervision. Consequently,

the recorded APP growth is likely an underestimate. Implications for RAMS: A key implication of this study is its role in identifying regions where there is a pressing need for more emergency physicians (EPs). This insight is invaluable for RAMS as it delineates areas offering significant job opportunities for graduating residents.

Analysis of Trends in Nurse Practitioner Billing for Emergency Medical Services: 2015-2018 Read article here.

Summary: In their study, Veneema et al., analyzed billing patterns in emergency department NP practice using Current Procedural Terminology (CPT) codes. The research was grounded in the initial assumption that NPs were integrated into EDs to streamline patient flow by handling less complex cases, and increase access to health care, especially in underserved areas. The study focused on categorizing billing patterns based on the severity of cases, distinguishing between rural and urban settings, and understanding variations in state-specific practice regulations. The research revealed the highest increase in number of billing clinicians was among nurse practitioners, with a substantial 27.2% rise, compared to a modest 4.5% increase observed among emergency physicians. Notably, there was a 37.1% surge in the number of NPs in rural areas. Interestingly, while there was a decline in NPs billing for low acuity codes, there was a corresponding increase in handling moderately complex and high acuity cases. Additionally, the study identified a positive correlation between CPT code 99285 (indicative of life-threatening situations) and reduced and restricted practice. Limitations: The limitations highlighted reveal challenges related to using Current Procedural Terminology (CPT)

codes. These limitations include interrater reliability issues, where different interpretations of CPT codes can lead to discrepancies in categorizing medical procedures. Moreover, CPT codes may not fully represent the extent of an attending physician's involvement in patient care, as the final chart sign-off might not reflect the complete picture. Additionally, there's a potential for subjectivity in coding higher acuity cases, with physicians possibly categorizing them as lower-level codes. Despite these limitations, a discernible trend emerges, indicating increased acuity in cases handled by NPs in EDs, although the true extent of this trend might be more pronounced than what the billing codes suggest. Implications for RAMS: It is important for residents and medical students to to have a comprehensive understanding of Advanced Practice Providers' (APPs) scope of practice at the state level.

Membership in the Council of Teaching Hospitals and Health Systems Among Emergency Medicine Residency Program– Sponsoring Institutions, 20012020 Read article here.

Summary: This study examines the rapid growth of emergency medicine (EM) residencies, particularly those affiliated with for-profit hospitals, from 2001 to 2020. Focusing on Council of Teaching Hospitals and Health Systems (COTH), which restricts membership to certain teaching hospitals, the research reveals a threefold increase in residencies not associated with COTH. COTH-affiliated institutions were noted for higher total visit volumes, frequent trauma and burn center designations, and a tendency to be Percutaneous Coronary Intervention (PCI) and stroke centers, although not statistically significant.

continued on Page 49

SAEM PULSE | NOVEMBER-DECEMBER 2023

E E C D R I O GU F K L R A O V I W RV SU

STUDENTS

continued from Page 47 Limitations: Two notable limitations of this study should be acknowledged. Firstly, the research relied on SAEM data due to the unavailability of corresponding ACGME data for the matched years, potentially influencing the study's comprehensiveness. Secondly, the utilization of COTH membership status as a method to delineate program disparities might have inherent limitations. Implications for RAMS: The rise in emergency medicine (EM) residency programs not affiliated with COTH raises concerns for RAMS. These developments might impact the educational environment for residents. Additionally, there are apprehensions about these programs' capacity to meet the stringent requirements set by the Accreditation Council for Graduate Medical Education (ACGME).

United States 2020 Emergency Medicine Resident Workforce Analysis Read article here.

Summary: This study aimed to characterize the emergency medicine (EM) resident physician workforce and explore trends in EM residency training programs using ACGME data from 20132020. The research revealed a significant increase in EM residents and a rapid proliferation of EM residency programs, attributed to the merger of ACGME and AOA accreditation systems and the establishment of new programs. Notably, this growth was skewed toward urban areas, which saw saw a much faster increase in EM residents and programs compared to rural areas, despite rural regions needing more EPs. This disparity is worsening the shortage of EPs in rural areas, creating a significant gap in emergency medical care between urban and rural regions, creating what the authors term an "emergency medicine desert." The study indicates a potential future scarcity of EPs in rural areas, potentially leading to an uptick in non-physician practitioners. Proposed solutions include leveraging telehealth services and enhancing exposure to rural health care settings during medical school and residency programs. Implications for RAMS: The rise in urban EM residency programs,

contrasted with limited growth in rural ones, holds significance for RAMS. Residents often practice in settings similar to where they were trained. Given the urban focus, this trend will likely create a high demand for practitioners in rural areas.

ABOUT THE AUTHORS Dr. Blenden is a fourth-year emergency medicine resident at Northwestern University in Chicago. He serves on several SAEM committees and is the sectary-treasurer of SAEMRAMS. Stephanie Balint is a third-year medical student at Quinnipiac University. She is the RAMS Medical Student Representative and RAMS liaison to the SAEM Workforce Committee. Lauren Diercks is a fourthyear medical student at UT Southwestern in Dallas, Texas. She is a member of the RAMS Board and the SAEM Membership Committee. Dr. Barrera is a third-year emergency medicine resident at Virginia Commonwealth University in Richmond, Virginia and an active-duty military member in the United States Air Force since 2008 working as a Flight Surgeon. She is a member-at-large on the SAEM RAMS Board and is a liaison to the SAEM Workforce Committee. Dr. Hebbard is a toxicology fellow at Washington University in Saint Louis. She is a member of the SAEM Workforce Committee and was a memberat-large on the 2022-2023 SAEM-RAMS Board. Dr. Ijaz is completing an administrative fellowship in health ccare leadership and management at Weill Cornell. He is also obtaining an executive MBA and MS in Healthcare Leadership through Cornell. Dr. Ijaz has served and led on numerous SAEM committees and is a past president of SAEM-RAMS.

2023 EMF-SAEMF Medical Student Research Grantees The Emergency Medicine Foundation (EMF) and Society for Academic Emergency Medicine Foundation (SAEMF) jointly award stipends to encourage medical students (our future emergency medicine researchers and educators) to engage in and to be exposed to emergency medicine research. We applaud this year’s cohort of grantees and wish them all the best as they move forward with their research training:

Jonathan Duldner, BS

Emily Larson, BS

University of Toledo College of Medicine for “Novel Approaches to Prevent Brain Injury after Sudden Cardiac Arrest”

Johns Hopkins University School of Medicine for “Prehospital Presentation and Outcomes for Acute Aortic Dissection”

Alice Y. Lu, MSL

Gabrielle Ramirez

University of California, San Francisco for “Efficacy of Connecting ED Patients to Intimate Partner Violence Resources Using Tailored Referrals”

Weill Cornell Medical College for “The impact of a mobile integrated health program on patient experience for those living with heart failure: a qualitative study of patients and care givers participating in the MIGHTy Heart trial”

For more information or to apply for a 2024 EMF-SAEMF Medical Student Research Grant please visit our website. Your gift of any amount today will support more future leaders like these grantees.

A Special Thanks to SAEMF's 2023 Annual Alliance Donors E

DONOR GUID

SAEMF extends its gratitude to the hundreds of SAEM members who have helped to build the pipeline of future EM researchers through an Annual Alliance donation to support SAEMF this year.

Donate Today! 50

Congratulations to the 2023 Emergency Medicine Interest Group (EMIG) Grantees SAEMF recognizes the valuable role of emergency medicine medical student interest groups (EMIGs), and awards $500 grants to support these groups' educational activities. EMIG grant goals are to: • Promote growth of emergency medicine education at the medical student level • Identify new educational methodologies advancing undergraduate education in emergency medicine • Support educational endeavors of an EMIG You can learn more about EMIG grants or apply for a 2024 EMIG Grant (2024 applications are due by 5 pm C.T. on Tuesday, January 31). Your charitable gift of $500 will help to make one EMIG possible — donate today! We applaud the following 2023 grantees for being awarded these important educational grants for their programs:

Alyssa Altheimer and Sara Lin

Natalie Baker and Liz Roux

Vanderbilt, “Housing is Healthcare: A Lunch and Learn Series on the Intersection between Emergency Medicine and Homelessness”

Harvard Medical School, “Wilderness Emergency Medicine Bootcamp: Targeted procedural and simulation skills for the developing physician”

David Dorfman

Melissa Ebeling

Ryan Leone

Warren Alpert Medical School, Brown University, “Rhode Island Soundwave Symposium”

University of Alabama at Birmingham, “Beyond Band-Aids: Bringing “Stop the Bleed” Skills into Undergraduate Medical School Education”

Columbia University, “First Responder ‘Escape Room’ Competition”

RAMS Donors Are AMAZING! SAEMF is excited to share some great news. Year after year, SAEM’s Board of Directors, SAEMF’s Board of Trustees, and our staff strive to have 100% of their members donate to make more emergency medicine research possible. Donors often mention that this is so important for them to learn as they consider their own giving. This year, the RAMS Board of Directors joined that group of 100% participation! What’s more, in a show of solidarity, SAEM's President, Ali Raja, MD, DBA, MPH, decided to match donations from RAMS members, honoring their role as future emergency medicine leaders and researchers. RAMS members, this match is not yet complete. Donate a gift of any amount today to help us fully unlock Ali’s generous match! saem.org/donate The RAMS Board, a small but dedicated group of residents and medical students, has already contributed $1,120, thanks to their gifts and Ali's match. This could fund two Emergency Medicine Interest Group Grants or partially support an SAEMF RAMS Grant! Please add your name to the RAMS donor list today to help SAEMF fund more of tomorrow’s emergency medicine researchers.

BRIEFS & BULLET POINTS SAEM’s Remarkable Journey Continues, Thanks to YOU!

In partnership with SAEM’s committees, academies, and AACEM, SAEM now offers specialized guidance to academic departments of emergency medicine in two crucial areas:

SAEM members, your outstanding efforts continue to shine! The SAEM24 program committee is thrilled to announce that we have once again broken all records for workshop and didactic submissions. But there’s more exciting news! Our governance team has received a record number of applications for the 2024-2025 committee cycle, reflecting an astounding 110% increase in just five years. Your dedication, engagement, and active participation are the driving force behind SAEM’s success, and we are immensely grateful for your contributions. Continue with us on this exciting journey:

SAEM Research Consult Service— Federal Funding supports departments in fostering sustainable federally funded research programs or revitalizing past initiatives. With the support of AACEM's experts, we assist departments at every stage of their research endeavors. Our team focuses on providing comprehensive assistance to NIH-funded Principal Investigators and identifying diverse federal funding sources.

1. Renew your SAEM membership

Visit our website to learn more.

2. N ominate yourself or a colleague for a leadership role

Nominate Yourself or a Colleague for a 2024-25 Leadership Role!

3. J oin us at SAEM24, May 14-17 in Phoenix

SAEM NEWS & INFO SAEM Extends a Heartfelt Welcome to Our Newest Members!

Your presence strengthens our shared mission of advancing emergency care and academic EM excellence. We urge you to dive into the wealth of resources available and embrace opportunities to connect and collaborate with some of the brightest minds in the field. 2023 Administrator Members 2023 Associate Members 2023 Faculty Members 2023 Fellow Members 2023 Medical Student Members 2023 Resident Members

SAEM Launches Research Consultations

SAEM Research Consultation Service— General provides support to academic departments seeking assistance with non-federal funding sources, such as industry and foundation-sponsored programs. Areas of expertise include designing post-doctoral initiatives, establishing resident-focused scholarship programs, and integrating scholarly pursuits into faculty development.

SAEM invites your nominations for diverse elected leadership positions. In addition to gaining valuable leadership experience and enhancing your professional growth, your involvement gives you a seat at the table when it comes to making decisions that shape the future of EM health care and influence education, research, and patient care. Join the ranks of decisionmakers who drive impactful change and make a truly meaningful difference. Nominate yourself or a colleague by November 10, 2023.

Apply by November 16 for an Extramural Loan Repayment Program Award! The NIH Loan Repayment Programs (LRPs), mandated by Congress, incentivize highly qualified health professionals to pursue biomedical or biobehavioral research careers. Rising education costs drive some scientists to higher-payingprivate sectors, but LRPs ease this burden by repaying up to $50,000 annually of eligible educational

debt in exchange for NIH research commitment. These programs support early-career investigators, investing in the future of healthcare discovery. While structured around research areas, extramural LRPs (for non-NIH-employed researchers) don’t fund specific projects but reward an applicant’s potential to nurture research careers. The application period closesNovember 16. Visit the NIH LRP website for details.

Celebrate Excellence: Submit Award Nominations by December 9!

Join us in recognizing outstanding contributions in academic emergency medicine research, education, and leadership! We invite you to nominate a colleague, mentor, or yourself for an SAEM or RAMS award by December 9, 2023. These prestigious awards showcase the remarkable achievements within our field. Be part of this celebration of excellence in our community and explore the award categories and the nomination process today!

EDUCATIONAL COURSES Elevate Your Medical Education Research with ARMED MedEd

The Advanced Research Methodology Evaluation and Design: Medical Education (ARMED MedEd) course is designed for individuals with a basic understanding of the field, offering opportunities to develop advanced research and writing abilities, connect with experienced mentors from SAEM, and expand your professional network. Discover the confidence to excel in medical education research and benefit from an inclusive and supportive community. Scholarships are available. Apply today! Opening November 30 Emerging Leader Development Program (eLEAD) SAEM Master Educator

WEBINARS & PODCASTS Put These Webinars on Your MustWatch List!

SAEM offers live and recorded webinars

covering a variety of emergency medicine topics, providing an excellent opportunity to stay current and learn from your colleagues. These webinars are free for SAEM members, and recordings are accessible after each event. Check out what's coming up: The Roads We Travel: Exploring EM Career Pathways, Nov. 9 Emergency Medicine Workforce Analysis: A Guide for EM Advisors, Nov. 15

MedEd Sound Bite Gives Tips on Building On-Shift EM Teaching Toolkit In the new and concluding episode of the MedEd Sound Bites series, Drs. Julie Tondt, Dina Wallin, and Ryan Pedigo are joined by special guest Dr. Leonardo Aliaga. Together, they take a deep dive into the art of building effective medical education toolkits tailored for on-shift teaching in the emergency department. Tune in for some sound, bite-sized wisdom you can use on your next shift! Explore all five episodes on our website and elevate your ED teaching skills!

SAEM JOURNALS Call for Papers: AEM Special Issue on Errors in Emergency Care Academic Emergency Medicine (AEM), the flagship journal of the Society for Academic Emergency Medicine will publish a special issue dedicated to the science of errors in emergency care. This special issue will publish original reports that focus on all aspects of errors relevant to emergency care, ranging from the definition of errors, cognitive processing, diagnostic hypothesis generation, treatment, and communication with patients and other providers. We hope to focus particularly on diagnostic error. A team of three specially designated editors will be looking for work that elucidates the why behind errors and how to prevent them, but also for data that illuminate groupbased inequities in errors. At the time of upload, authors can choose desire to submit to the “Special Issue on Errors” through https://mc.manuscriptcentral. com/aemj. The deadline for submission is January 15, with plans to publish Spring 2024. Please email any questions to Jeffrey A. Kline, AEM Editor-In-Chief, at jkline@wayne.edu.

SAEM FOUNDATION

But, why wait until November 29? Donate now to help make more possible through EM research and education.

Accepting Applications for NIDA Mentor-Facilitated Training Award

Residents, fellows, and junior faculty, apply by Thursday, November 30, 2023 for the $12,000 NIDA Mentor-Facilitated Training Award, sponsored by SAEMF. This is a key component of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) Dissemination Initiative and will support the development of expertise in substance use disorder (SUD) treatment research, especially opioid use disorder, through completion of a mentor-supervised project focused on adoption and/or dissemination of SUD treatment research and the publication of results. Share this information with your colleagues and trainees! Learn more.

GivingTuesday 2023: Everyone Has Something to Give

GivingTuesday is a global generosity movement unleashing the power of radical generosity. GivingTuesday was created in 2012 as a simple idea: a day that encourages people to do good. Since then, it has grown into a year-round global movement that inspires hundreds of millions of people to give, collaborate, and celebrate generosity. Everyone can give something on GivingTuesday: • Host a small social gathering and donate proceeds to SAEMF • Donate your time to an organization in your community • Visit your local schools to talk about what you do when you become an academic EM

• Download the “SAEMF Unselfie” graphic, print, personalize, and post to invite others to join you in supporting the best ED care through research and education. • Share your donor story on social.

Thank you, Legacy Society Donors!

SAEMF extends deep gratitude to our Legacy Society Donors whose decisions to generously champion the ongoing advancement of emergency medicine is nothing short of inspiring. Their legacy gifts play a vital role in advancing future research in the field of emergency medicine. Curious to learn more about this impactful initiative? The September/ October issue of SAEM Pulse has all the details. Thinking about contributing to the future landscape of emergency medicine research and education? You’ll find this brief and informative video on bequests to be a useful resource.

JUST FOR RAMS Follow Us on Instagram!

Have you heard the news? SAEM has joined the Instagram community! Follow us @SAEMOnline to stay updated on all things SAEM, with a special focus on our residents and medical students. Don’t miss out! Tap that «Follow» button today and be part of our Instagram family. Thank you for your continued support!

Dr. Chris Fox Featured in New RAMS Ask a Chair Podcast

Hosted by Hamza Ijaz, MD, MPH, the latest episode of the RAMS Ask a Chair podcast features a compelling conversation with Chris Fox, MD, department Dr. Chris Fox chair, UC Irvine School of Medicine. This insightful interview explores Dr. Fox’s career trajectory. Discover what steered him towards emergency medicine, explore the pivotal factors that helped him carve his career niche, and much more! For a front-row seat to this enriching conversation and to stay connected with the ongoing discourse, simply navigate to the RAMS Ask a Chair webpage!

REGIONAL MEETINGS Midwest Highlights and Takeaways from the Midwest Regional Meeting

The Midwest Regional SAEM Conference, hosted by the Michigan State University Department of Emergency Medicine, took place on September 24, 2023 at the L.V. Eberhard Center in Grand Rapids, Michigan. This full-day event brought together students, clinicians, and researchers from across the Midwest, featuring a total of 48 research projects. These enlightening abstracts were published in the MSU Medical Student Research Journal in October. Among the notable achievements, Abbi Behmlander and colleagues from MSU won the Best Poster Presentation award. Additionally, two awards were presented for the Best Clinical Research Presentation. The first went to Reid Mitchell, Adam Anderson, Lauren Wolf, Lisa Dumkov, and Stephanie Coallier from Trinity Health Grand Rapids for their research study, "Full Dose Challenge of Moderate, Severe, and Unknown Beta-Lactam Allergies in the Emergency Department." The second was given to Amanda Missel, Stephen Dowker, Daniel Rizk, Noor Majhail, Madison Downey, Christine Brent, David Berger, Robert Swor, and James Cooke from the University of Michigan Medical School, Corewell East William Beaumont University Hospital, and Oakland University William Beaumont School of Medicine for their study titled "Early Intranasal Medication Administration in Out-of-Hospital Cardiac Arrest: Two Randomized Simulation Trials." This year’s conference theme, "Advances in Prehospital Emergency Care," was explored in depth. The event featured an insightful series of breakout sessions on topics such as prehospital stroke care by Adam Oostema, MD, and cardiac resuscitation by Josh Reynolds, MD. Additionally, a panel discussion on prehospital behavioral emergencies, led by Lindsey Rauch MD, EMS director, featured the Homeless Outreach Team and the Grand Rapids Police Department Mental Health Co-response Team. Notably, the Mental Health Co-response Team, operational since July 2022, has responded to over 1,000 calls, diverting more than 200 individuals from jail, ambulances, and emergency departments, effectively connecting them with necessary services. Dr. Daniel Jourdan finished the morning didactics by speaking to residents and medical students (RAMS) on how to level up their career with SAEM RAMS. The keynote speaker, Jeffrey P. Druck, a member of the SAEM Board of Directors, emphasized the advantages of early SAEM involvement for faculty and residents. He highlighted opportunities such as participation in SAEM committees, involvement in organizing SAEM's Annual Meeting, direct collaboration with academic emergency medicine leaders, and advocacy for fellow residents. The conference concluded with a Michigan beer and cheese networking session, where the research award winners were announced. Dr. Rebecca Barron was also present to address queries about the Academy for Women in Academic Emergency Medicine (AWAEM).

SAEM24 UPDATES Now Accepting Submissions Abstracts

SAEM Annual Meeting abstracts reflect the daily interaction of the emergency department with the most vulnerable persons in society and cover a relevant mix of topics that encompass a day in the emergency department. These abstracts represent the work of thousands of researchers and educators who have created new knowledge and thinking about emergency care that adds valuable confirmation of previous work, presents evidence that might change the practice of EM for the better, and elevates the outcomes and experiences of every patient who seeks emergency medical care. Collectively they reflect a global experience of emergency care that together tell the story of important challenges and the need for more knowledge. Each year accepted abstracts are published in a special supplement of Academic Emergency Medicine journal. From among the more than 1,000 submissions, a select few will be chosen as the best of the best, to be presented during a special plenary session. Platform closes January 3, 2024. Learn more.

Innovations

A One-of-a-Kind Opportunity for Medical Students! SAEM is recruiting 50 energetic, self-starting, responsible, and enthusiastic medical students for the SAEM24 Medical Student Ambassador (MSA) program. Selected MSAs will work directly with the SAEM Program Committee to assist in the planning, coordination, and execution of 2024 SAEM Annual Meeting in Phoenix, Ariz., May 14-17, 2024.

Innovations is a forum for members to present novel ideas and approaches in undergraduate and graduate medical education as well as advances in other nonclinical areas such as faculty development and operations. Platform closes: January 11, 2024. Learn more.

7 Benefits of Being a Medical Student Ambassador

IGNITE!

2. Free registration to the Medical Student Symposium

IGNITE! is a highly energetic, captivating, fast-paced, and engaging speaking competition. Each IGNITE talk is five minutes in length with 20 automatically advancing slides. A panel of judges selects a “Best of IGNITE!” winner from each IGNITE session. An “Audience Choice Award” is also given at each session based on audience polling. Because there are no limitations on submission topics, you will be exposed to all sorts of interesting issues in EM. Speakers are selected from all levels of training from all parts of the country. Platform closes January 11, 2024. Learn more.

Clinical Images

The popular SAEM Clinical Images Exhibit, held each year at the SAEM annual meeting, features high definition, image-based, educational case submissions relevant to the practice of emergency medicine. Accepted submissions are selected based on their educational merit, relevance to emergency medicine, image quality, the case history, and appropriateness for public display. Images that are selected for display and have patient consent will also be featured in the Academic Life in Emergency Medicine’s (ALIEM) widereaching blog, SAEM Clinical Images Series. Platform closes January 11, 2024. Learn more.

SAEM24 Registration Opens December 1 The SAEM Annual Meeting offers something for everyone from seasoned faculty to medical students just starting their careers. Featuring cuttingedge research from the best minds in academic EM, expert educational content from world-class faculty, workshops that strengthen knowledge and skills in specific topic areas, energetic experiential learning competitions, and expansive networking events and career development opportunities to take your career to the next level. Plan now to join us in Phoenix, AZ, May 14-17, for SAEM24. Registration opens December 1! Early bird deadline is March 14. Visit the SAEM24 website to stay up to date on all the latest news and information.

1. Waiver of your SAEM24 registration fee

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 SAEM24 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!)

How to Apply Medical students who are interested in serving as a Medical Student Ambassador for SAEM24 should complete the application by January 11, 2024. Questions? Contact Holly Byrd-Duncan at hbyrdduncan@saem.org or education@saem.org.

SAEM REPORTS COMMITTEES Bylaws Committee Join the Bylaws Committee and Impact Positive Change Through Your Leadership! Bylaws Committee member, Ronny Otero, MD, MSHA, interviews the other two members of the committee: James H. Paxton, MD, MBA (committee chair), and Angela Lumba-Brown, MD, about what it’s like to serve as members of the SAEM Bylaws Committee.

Membership RAMS EMIG Survey Reveals Insights into Med Student Engagement

A survey was conducted during the 2022-2023 academic year to assess the status of Emergency Medicine Interest Groups (EMIGs) and explore strategies RAMS can undertake to enhance their effectiveness. The objective was to facilitate the growth of EMIGs by understanding the challenges and aspirations of medical students involved in emergency medicine. Twenty-eight distinct EMIGs participated in the survey, providing valuable data. The majority of EMIGs undergo leadership transitions in the spring, with nearly half boasting memberships exceeding 50 individuals and holding monthly meetings. Notably, 82% of EMIGs sought assistance from the Society for Academic Emergency Medicine (SAEM) for specialized workshops related to airway management and suturing techniques. Additionally, 79% expressed interest in events showcasing career opportunities in emergency medicine, while 71% sought guidance on developing simulation activities. The survey highlighted the varied utilization of SAEM resources by EMIG students, including regional meetings (10%), curriculum (13%), roadmaps (13%), and webinars (20%). Moreover, 10% applied for SAEM grants, and 13% received prestigious SAEM awards.

EMIGs’ Expectations from RAMS EMIGs articulated several expectations from RAMS. They emphasized the need for networking and mentorship opportunities, a sense of community, and insights into the operational aspects of other EMIGs’ meetings, events, and workshops. Students also sought structured guidance for organizing EMIG events, including updates on grant and award application timelines. Furthermore, there was a strong desire for lectures by well-known SAEM physicians and resources to enhance clinical skills.

RAMS Initiatives RAMS initiated the Regional Ambassadors Program, comprising two RAMS Board members representing each of the seven regions. These ambassadors act as liaisons, providing EMIGs with necessary resources and support. RAMS also established a “Speaker Bank” comprising SAEM experts available for virtual or in-person presentations to EMIGs in their respective regions. Additionally, RAMS plans to conduct an EMIG officer transition webinar in April and publish an EMIG Guide. This guide will offer structured guidance to EMIG leadership, encompassing clinical topics, social event ideas, and leadership fundamentals.

Conclusion The survey results underscored the vitality of EMIGs in academic settings, emphasizing their frequent meetings and substantial memberships. While EMIGs demonstrated innovative event ideas to engage students with emergency medicine, they faced challenges related to support, funding, and access to expert speakers. RAMS, through its Regional Ambassador Program and comprehensive EMIG Guide, aims to bridge these gaps, ensuring EMIGs have the necessary resources and support to thrive. Submitted by Lauren Diercks is a fourth-year medical student at UT Southwestern in Dallas, Texas. She is a member of the RAMS Board and the SAEM Membership Committee.

Bylaws Dr. Peter C. Hou Assumes New Role on SAEM Bylaws Committee

Dr. Peter C. Hou, associate chief of academic affairs, Division of Emergency Critical Care, Mass General Brigham, has a new role on the SAEM Bylaws Committee for the 2023-2024 term. With a distinguished background as the former Program Director of the Brigham and Women’s Hospital Emergency Medicine and Dr. Peter C. Hou Critical Care Medicine Fellowship, and as an Assistant Professor of Emergency Medicine at Harvard Medical School, Dr. Hou brings significant expertise to the committee. An SAEM member since 2009, he has actively contributed to various committees and interest groups, including serving as a founding member and former chair of the SAEM Critical Care Interest Group.

ACADEMIES Academy of Administrators in Academic Emergency Medicine AAAEM Launches FY23 Benchmark Surveys

The Academy of Administrators in Academic Emergency Medicine (AAAEM) Benchmark Committee has initiated data collection for its annual benchmark surveys. These surveys are crucial for assessing academic emergency medicine departments’ clinical, education, and research missions. The data submission deadline for FY23 (July 2022 – June 2023) is December 15, 2023. For inquiries or assistance submitting your organization’s data, reach out to Alyssa Tyransky at alyssa.tyransky@osumc.edu. AAAEM will unveil some of the results of the FY23 data collection at the AAAEM booth during SAEM24, so plan to stop by and learn more about the surveys and AAAEM’s initiatives.

Academy for Diversity and Inclusion in Emergency Medicine New Mentorship Program: A Supportive Space for LGBTQIA+ Individuals

The LGBTQIA+ Mentorship Program from the SAEM Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) is helmed by dedicated EM faculty and offers a stress-free

environment where EM residents and medical students can find essential support, guidance, and camaraderie. Faculty members, residents, and students from diverse institutions comprise Mentorship Families that gather regularly via Zoom to facilitate open discussions and mutual assistance. The program provides a safe haven for LGBTQIA+ individuals, fostering meaningful connections, empowering career growth, and ensuring confidentiality. If you are seeking a compassionate community and mentorship tailored to your needs, ADIEM invites you to complete our form.

SAEM Introduces New Tactical and Law Enforcement Interest Group Designed for those in the field or eager to learn, SAEM’s newest interest group equips emergency physicians with accurate, upto-date knowledge in tactical and law enforcement medicine. A primary objective of the group is to encourage the publication and presentation of educational and research topics relevant to the fields of tactical and law enforcement medicine. Additional aims are to foster engagement among SAEM’s 8,500 EM physicians, expand resources, build community connections, and cultivate collaboration with relevant organizations. To join, log into your SAEM account and click “Update Academies and Interest Groups.”

INTEREST GROUPS Informatics and Data Science Updates and Achievements

The SAEM Informatics and Data Science Interest Group is excited to announce the successful outcomes of their collaborative endeavors. These efforts have led to the submission of one manuscript, two presentations based on a national ED patient portal usage study, an SAEM workshop focusing on large

language models, and an SAEM didactic session on careers in informatics. Additionally, members of the organization, including faculty, residents, and students contributed to an informatics curriculum hosted by EMRA. This curriculum is designed to spark interest in the subspecialty among emergency medicine trainees. Finally, the organization is delighted to share its involvement in various Society-level initiatives to explore the optimal integration of informatics and data science as fundamental components of SAEM’s research agenda in the coming years.

AFFILIATES Association of Academic Chairs of Emergency Medicine Dr. Susan Promes Assumes Role as AACEM Member-at-Large

Dr. Susan Promes, MD, MBA, professor, and chair of the Department of Emergency Medicine at Penn State University Milton S. Hershey Medical Center, has been elected as a member-at-large on the executive committee of the Association of Academic Chairs of Emergency Medicine (AACEM), Dr. Susan Promes succeeding Rawle “Tony” Seupaul, MD, who was promoted to the position of executive vice president and chief executive physician for the Carilion Clinic Health System. Dr. Promes assumed office immediately after her election, filling the vacancy created by Dr. Seupaul’s promotion. Alongside her new AACEM role, Dr. Promes also serves as the editor-in-chief of Academic Emergency Medicine Education and Training (AEM E&T) and is a member-at-large of the SAEM Foundation. Thank you to Dr. Seupaul for his time served on the AACEM executive committee. We extend our best wishes to both Drs. Promes and Seupaul in their new professional endeavors.

SAEM CONSULTATION SERVICES New Consultations to Support Research & Operations 57

ACADEMIC ANNOUNCEMENTS UC Davis Celebrates Promotion of Women Faculty to Professor Kelly Owen, MD, and Bryn Mumma, MD, MAS, have been promoted to the rank of professor in the UC Davis Department of Emergency Medicine and Women in Medicine and Dr. Kelly Owen Dr. Bryn Mumma Health Sciences (WIMHS) Program. Their promotions bring the total number of women professors in the department of emergency medicine to 11, comprising nearly half of the faculty at this rank. The WIMHS Program recently celebrated over 300 women achieving professor rank in the UC Davis School of Medicine.

Indiana University School of Medicine Announces Retirement of Dr. Robert Robinson Robert Robinson, MD, assistant professor of clinical emergency medicine retired in September. The Indiana University School of Medicine is extremely appreciative of his years of service at IU Health Jay Hospital and dedication to patients and community. Dr. Robinson has been an emergency Dr. Robert Robinson medicine physician role model and devoted to compassionate patient care. Congratulations and enjoy your retirement!

UMass Chan-Baystate Researchers Receive Two Grants

Dr. Elizabeth Schoenfeld

Dr. William Soares

Dr. Lauren Westafer

Dr. Natalie Strokes

Researchers led by Elizabeth Schoenfeld, MD, MS, from UMass Chan-Baystate recently received two grants. The first is a $200,000 grant from the RIZE Foundation of Massachusetts entitled, “Safer Smokes – A project to engage stimulant-users in harm reduction in the emergency department and mitigate the harms of opioidstimulant contamination.” This two-year award supports a collaboration with community organizations to develop and implement trainings around harm reduction in the emergency department and the distribution of harm reduction supplies tailored to marginalized drug-using populations. The second is a $720,000 R34 grant from NIDA entitled, “Conversations can save lives: TALKing About Buprenorphine

& methadone for Opioid Use Treatment Initiation (TALK ABOUT IT).” This three-year award supports refinement and pilot testing of a shared decision-making intervention to help emergency department (ED) patients decide between starting methadone and suboxone during or after an ED visit related to opioid use. This project comes out of a previous large project during which the research team interviewed dozens of ED clinicians and patients with lived experience to create a decision aid to be used in the setting of ED care. Other SAEM members on these projects include William Soares, MD, MS; Lauren Westafer, DO, MPH, MS; and Natalie Strokes, MD.

UC Davis and Johns Hopkins Researchers Awarded U01 Award From the CDC Daniel Nishijima, MD, MAS and Beth Slomine, PhD, ABPP are co-principal investigators (PIs) on a recently awarded a five-year, $2.75 million, Centers for Disease Dr. Daniel Nishijima Dr. Beth Slomine Control and Prevention U01 award to develop a clinical prediction tool to predict mental health sequelae after mild traumatic brain injury in adolescents in the emergency department (Screening Emotions in Adolescents Receiving Care at the Hospital for mTBI [SEARCH-mTBI study]). This tool will provide evidence for clinical decision-making, helping to reduce uncertainty amongst clinicians and decrease health disparities. Nathan Kuppermann, MD, MPH, UC Davis and Stacy Suskauer MD, Johns Hopkins, are senior investigators for the study and Dr. Tiffani Johnson, UC Davis, will serve as the disparities lead. The study will include Children’s Hospital of Philadelphia (Site PIs: Daniel Corwin, MD, MSCE and Kristy Arbogast, PhD), Hasbro Children’s (Mark Zonfrillo, MD), Children’s Wisconsin (Danny Thomas, MD, MPH), and Texas Children’s (Andrea Cruz, MD, MPH), with the University of Utah serving as the Data Coordinating Center (Charlie Casper, PhD).

Dr. Hassan Mohamed Appointed Director of Quality and Patient Safety, Columbia University Department of EM Hassan Mohamed, MD has been appointed director of quality and patient safety at the Columbia University Department of Emergency Medicine. He has served as the assistant director of quality and patient safety since 2019, contributing to various quality initiatives and operational Dr. Hassan Mohamed improvements. His leadership role encompasses stroke, STEMI, and sepsis processes for the department.

Dr. Michelle Lall Named Inaugural Vice Chair of Diversity, Equity and Inclusion at Emory EM Michelle Lall, MD, MHS, has been announced as the inaugural vice chair of diversity, equity, and inclusion at Emory Emergency Medicine. Dr. Lall joined the Emory faculty in 2013 after completing her residency training at Emory Emergency Medicine (EM) in 2008. She was an Dr. Michelle Lall associate residency director for seven years and the inaugural director of wellness, equity, diversity, and inclusion for the department of emergency medicine. Dr. Lall’s primary interests are physician wellbeing and the negative impact of gender bias on equity and inclusion in medicine. She is a member at large on the SAEM Board of Directors.

Dr. David Kessler Promoted to Professor of Pediatrics (in Emergency Medicine) at Columbia University David Kessler, MD, MSc, has been promoted to the rank of professor of pediatrics (in emergency medicine) at Columbia University Vagelos College of Physicians & Surgeons. Dr. Kessler has served as the Vice Chair of Innovation & Strategic Initiatives for the Columbia Dr. David Kessler University Department of Emergency Medicine since 2019. He is an executive founding member and research chair of the International Network for Simulation-based Pediatric Innovation, Research, & Education (INSPIRE).

Dr. John Riggins Appointed DEI Chair and Assistant Medical Director of the Columbia University Department of EM, NYP Allen ED John Riggins, MD, MHA, has been appointed as the assistant medical director of the NewYork-Presbyterian Allen Hospital Emergency Department and chair of the Columbia University Department of Emergency Medicine DEI Committee. Dr. Riggins was the inaugural Dr. Lorna M. Dr. John Riggins Breen Fellow in Healthcare Administration at Columbia University and received his Master of Health Administration from the Columbia University Mailman School of Public Health.

Dr. Matthew Stehlow Promoted to Full Professor and Executive Vice Chair, Stanford Department of EM Matthew Strehlow, MD has been promoted to full professor and executive vice chair for Stanford University’s Department of Emergency Medicine Dr. Strehlow received his doctorate from the University of Washington and completed his emergency medicine residency and Dr. Matthew Strehlow global emergency medicine fellowship at Stanford. He also serves as director of Stanford Emergency Medicine International and previously served as vice chair of strategy for the department. Dr. Strehlow co-chaired the 2023 SAEM Consensus Conference on precision emergency medicine.

Dr. Dylan Cooper Named Chief of the Division Drs. Krzyzaniak and Urdaneta Named Associate of Simulation, Indiana University School of Vice Chairs, Stanford Department of EM Medicine, Department of EM Sara Krzyzaniak, MD and Alfredo Urdaneta, MD, have both been named associate vice chair of Stanford University’s Department of Emergency Medicine. Dr. Sara Krzyzaniak Dr. Alfredo Urdaneta Dr. Krzyzaniak, director of Stanford’s emergency medicine residency program and an associate professor of emergency medicine, completed medical school at Northwestern University Feinberg School of Medicine and emergency medicine residency at Denver Health Medical Center. Dr. Urdaneta, an associate professor of emergency medicine, is a graduate of Columbia University College of Physicians and Surgeons, and completed his emergency medicine residency at UCSF Fresno, and a fellowship in critical care medicine at University of Washington Medical Center. He serves as medical director for Stanford’s Life Flight program and was recently promoted to colonel in the Army Reserves.

Dylan Cooper, MD, professor of clinical emergency medicine has been appointed the chief of the division of simulation at Indiana University School of Medicine, Department of Emergency Medicine. He has been with the department since his residency, joining the faculty in 2005. Dr. Dr. Dylan Cooper Cooper has proven to be an incredible educator with a passion for teaching, demonstrated by receiving awards such as the Trustee Teaching Award, Scholar Educator Award, and an impact award for significant contributions to simulation education. In 2013, he was appointed director of the Simulation Center at Fairbanks Hall, one of the largest simulation centers in the country.

Academic Announcements continued on Page 60

ACADEMIC ANNOUNCEMENTS continued from Page 59

Dr. Ambrose Wong to Receive PCORI Funding for Project Ambrose Wong, MD, MSEd, MHS, a physician-scientist in the department of emergency medicine at Yale School of Medicine, was approved for funding from PCORI (Patient-Centered Outcomes Research Institute) for his project “Peer Support Enhanced Behavioral Crisis Dr. Ambrose Wong Response Teams in the Emergency Department.” The project will compare the use of peer support services embedded within a structured clinical response team to patients experiencing behavioral crises in the ED to current standard of care, allowing a major step forward for community engagement and patient centered care for mental health crisis. Dr. Wong is also Research Director and Fellowship Director at the Yale Center for Medical Simulation.

Dr. David Jang, U Penn School of Medicine, Receives $3.5 Million NHLBI R01 Award David H. Jang, MD, MSc, was recently awarded an R01 (R01HL166592) from the National Heart, Lung, and Blood Institute (NHLBI) for $3.5 million. Dr. Jang’s project, “The Use of Blood Cells and Optical Cerebral Complex IV Redox States in a Porcine Model of CO Poisoning with Dr. David H. Jang Evaluation of Mitochondrial Therapy,” is a five-year project to develop improved biomarker and therapy for carbon monoxide (CO) poisoning. Dr. Jang is an assistant professor of emergency medicine and medical toxicology at the University of Pennsylvania School of Medicine.

Dr. Shameeke Taylor, Icahn School of Medicine, Named Career Development Award Scholar Shameeke Taylor, MD, was selected as a Bristol Myers Squibb Foundation Robert A. Winn Diversity in Clinical Trials: Career Development Award Scholar. This twoyear award focuses on strengthening partnerships between clinical investigators and communities and increasing the Dr. Shameeke Taylor diversity of patients enrolled in clinical trials. The award will support his development as a clinical investigator with an interest in advancing health equity through research and mentoring. He will receive training in investigator-initiated and industry-sponsored clinical trials, in community outreach and engagement and serve as a research mentor for medical students. Dr. Taylor is assistant professor of emergency medicine, Icahn School of Medicine at Mount Sinai, and an emergency medicine attending physician at Mount Sinai Morningside and West.

Drs. Jeffrey Glassberg and Abdullah Kutlar Receive Grant From NHLBI for Sickle Cell Disease Project Jeffrey Glassberg, MD, Icahn School of Medicine at Mount Sinai, and Abdullah Kutlar, MD, Medical College of Georgia, were awarded a grant in excess of $12 Dr. Jeffrey Glassberg Dr. Abdullah Kutlar million grant from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH) for their project, "REAL Answers" (Registry Expansion Analyses to Learn). REAL Answers is a consortium study involving eight clinical Sickle Cell Disease centers across the United States that will enroll patients in a target trial emulation. Target trial emulation is a high efficiency, observational study design that will allow investigators to gain knowledge equivalent to dozens of randomized trials within a span of five years. The study will enroll over 1,000 patients and explore genetic predictors of response to medication so that clinicians can provide more personalized treatment plans based on each patient's unique characteristics.

Dr. Christopher Hahn Promoted to Associate Professor, Icahn School of Medicine, Mount Sinai Christopher Hahn, MD, associate program director of the Mount Sinai Morningside and West Emergency Medicine residency program, was promoted to associate professor, Icahn School of Medicine at Mount Sinai. Dr. Hahn is an emergency medicine attending physician at Mount Dr. Christopher Hahn Sinai Morningside and Mount Sinai West Hospital Emergency Departments. He is nationally known for his innovative medical education presentations, for which he uses his skills as a hip-hop artist to stimulate audience engagement. His education focus is EKG interpretation and STEMI diagnosis.

SAEM Members Selected to the National Academy of Medicine Several SAEM members are among the newly elected members of the prestigious and influential National Academy of Medicine (NAM). Election to the Academy is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service. Congratulations to all the physicians elected to NAM.

IN MEMORIAM Ann Harwood-Nuss, MD

Dr. Ann Harwood-Nuss

Ann Harwood-Nuss, MD, a distinguished academic physician and dedicated community volunteer whose commitment helped guide the University of Florida College of Medicine - Jacksonville and the field of emergency medicine for more than three decades, died in Jacksonville, Florida. Over the course of twenty-five years at the University of Florida, Dr. Harwood-Nuss served as division chief, emergency medicine, director of graduate medical education and associate dean for educational affairs. She was the editor in chief for three editions of the highly regarded J.B. Lippincott's Clinical Practice of Emergency Medicine textbook. She retired in 2011 and was appointed Emeritus Professor of Emergency Medicine at the University of Florida. She was well honored for her work, receiving the University of Florida Medallion, the Emergency Medicine Lifetime Achievement Award. She was 75 years old.

E. Brooke Lerner, PhD E. Brooke Lerner, PhD, passed away in October, after a courageous battle with cancer. She began her career in Western New York as an EMT and paramedic. Following a notable research career at the University of Rochester and the Medical College of Wisconsin she became a distinguished professor and vice chair of research at the University at Buffalo's Department of Emergency Medicine. Dr. Lerner authored over 140 peer-reviewed publications and led crucial research projects and secured numerous federally funded grants to support her work, which included serving as principal investigator on a PECARN project to improve prehospital care for children. She played a pivotal role in shaping national guidelines for mass casualty triage and trauma field triage. Dr. Lerner was dedicated to mentoring young researchers, contributing Dr. E. Brooke Lerner significantly to the next generation of EMS scholars. Her remarkable contributions were acknowledged with prestigious awards, including the 2013 Keith Neely award from the National Association of EMS Physicians. Despite her diagnosis, she collaborated with organizations like the National Association of EMS Physicians (NAEMSP) and the GMR Foundation for Research and Education to establish the E. Brooke Lerner Research Fund, supporting budding EMS researchers. Dr. Lerner's legacy continues to inspire, leaving an indelible mark on the field. She was 52 years old.

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is December 1, 2023 for the January-February 2024 issue. 61

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.

Academic Emergency Medicine positions on the beautiful Gulf Coast Faculty Positions, Emergency Medicine The George Washington University Medical Faculty Associates, an independent nonprofit academic clinical practice group affiliated with The George Washington University, is seeking full-time academic Emergency Medicine physicians. The Department of Emergency Medicine provides staffing for the emergency units of George Washington University Hospital, the United Medical Center, the Walter Reed National Military Medical Center, and the Washington DC Veterans Administration Medical Center. The Department’s educational programs include a four-year residency and ten fellowship programs. Responsibilities include providing clinical and consultative service; teaching fellows, residents, and medical students; and maintaining an active research program. These non-tenure track appointments will be made at a rank (instructor/assistant/associate/full professor) and salary commensurate with experience. Basic Qualifications: Applicants must be American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certified or have completed a residency certified by the Accreditation Council for Graduate Medical Education or American Osteopathic Association, and be eligible for licensure in the District of Columbia, at the time of appointment. Application Procedure: Complete the online faculty application at http://www.gwu.jobs/postings/105537 and upload a CV and cover letter. Review of applications will begin October 27, 2023, and will continue until positions are filled. Only complete applications will be considered. Employment offers are contingent on the satisfactory outcome of a standard background screening.

The George Washington University and the George Washington University Medical Faculty Associates are Equal Employment Opportunity/Affirmative Action employers that do not unlawfully discriminate in any of its programs or activities on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity or expression, or on any other basis prohibited by applicable law.



The University of South Alabama (Mobile, AL) has an EM residency and expanding EM academic programs at our two hospitals (Level I USA Health University Hospital, Children’s & Women’s Hospital), and a new Freestanding ED. • Must be EM or PEDS ED trained and board eligible/certified • Fellowship or equivalent experience in US, PEM, EMS, simulation, education/admin or research is a plus • Opportunities to lead, initiate or contribute to new programs and services Applicants are invited to submit CV and letter of interest to: Edward A. Panacek, MD, MPH, Chair of Emergency Medicine, USA College of Medicine, at eapanacek@health.southalabama.edu Further info: careers.usahealthsystem.com/jobs/6955?lang=en-us

JOIN OUR TEAM

EMERGENCY MEDICINE OPPORTUNITIES AVAILABLE

Penn State Health Emergency Medicine About Us: Penn State Health is a multi-hospital health system serving patients and communities across central Pennsylvania. We are the only medical facility in Pennsylvania to be accredited as a Level I pediatric trauma center and Level I adult trauma center. The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Health Children’s Hospital and Penn State Cancer Institute based in Hershey, Pa.; Penn State Health Hampden Medical Center in Enola, Pa.; Penn State Health Holy Spirit Medical Center in Camp Hill, Pa.; Penn State Health Lancaster Medical Center in Lancaster, Pa.; Penn State Health St. Joseph Medical Center in Reading, Pa.; Pennsylvania Psychiatric Institute, a specialty provider of inpatient and outpatient behavioral health services, in Harrisburg, Pa.; and 2,450+ physicians and direct care providers at 225 outpatient practices. Additionally, the system jointly operates various healthcare providers, including Penn State Health Rehabilitation Hospital, Hershey Outpatient Surgery Center and Hershey Endoscopy Center. We foster a collaborative environment rich with diversity, share a passion for patient care, and have a space for those who share our spark of innovative research interests. Our health system is expanding and we have opportunities in both academic hospital as well community hospital settings.

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

FOR MORE INFORMATION PLEASE CONTACT:

Heather Peffley, PHR CPRP - Penn State Health Lead 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.

Join a Collegial Team Committed to Supporting You ■

Physician-led group on the local, regional and national levels

■

Professional development, mentoring and leadership opportunities

■

Robust support for clinician wellness

■

Flexible, equitable scheduling that supports work-life balance

■

Full-time, part-time, per diem and ENVOY Ambassador Team options

We’re currently featuring academic leadership and staff positions at highly desirable hospitals across the nation.

RESIDENCY PROGRAM DIRECTOR

PEDIATRIC SITE MEDICAL DIRECTOR

Centerpoint Medical Center

Medical City Dallas

Kansas City, MO

Dallas, TX

RESIDENCY PROGRAM DIRECTOR

RESEARCH DIRECTOR

HCA Florida Lawnwood Hospital

Morristown Medical Center

Fort Pierce, FL

Morristown, NJ

EMS PHYSICIAN

Trinity Health Ann Arbor Hospital

TriStar Skyline Medical Center

Ann Arbor, MI

Nashville, TN

CORE FACULTY OPPORTUNITIES

ULTRASOUND PHYSICIAN

HCA Florida Lawnwood Hospital

TriStar Skyline Medical Center

Fort Pierce, FL

Nashville, TN

Reach out to our experienced recruiters today to learn more about these featured opportunities.

844.945.1008 Envision.Health/AcademicEM

Northwestern Medicine Seeking Emergency Physicians For Huntley, McHenry and Woodstock Hospitals Northwestern Medicine is recruiting qualified Board Certified/Board Eligible Emergency Physicians to join our community practice group staffing the Emergency Departments of Huntley, McHenry and Woodstock Hospitals. Located in the beautiful northwest suburbs of Chicago, approximately 1 hour Northwest of downtown Chicago, Physicians will have the opportunity to practice clinically in an innovative care space with advanced resources and technology as part of an integrated academic health system. In conjunction with clinical practice responsibilities, the physician will be responsible for providing supervision and instruction to all advanced practice providers while contributing to the Patients First mission at Northwestern Medicine. Required qualifications of prospective candidates include, but are not limited to: • Active Illinois Medical Licensure and DEA • Board certified/eligible in Emergency Medicine • Graduate of fully accredited medical school and successful completion of residency in Emergency Medicine Employment at NM includes a competitive compensation structure, robust retirement/benefits packages, and liability coverage for practicing providers. Application Process: Please email all CVs to Lisa Nono at: EMFacultyRecruitment@nm.org For more information about the Northwest Region hospitals, please visit: https://www.nm.org/locations

EMERGENCY MEDICINE TOXICOLOGY FACULTY University of California, San Francisco

The UCSF Department of Emergency Medicine, is seeking a full-time Assistant or Associate Professor in Medical Toxicology. This position requires strong clinical skills in emergency medicine or pediatric emergency medicine, a commitment to education and training, contributions to diversity and equity, and proficiency in clinical research. The department provides emergency services at academic hospitals across the San Francisco Bay Area, including UCSF Hellen Diller Medical Center and Zuckerberg San Francisco General Hospital. The San Francisco division of the California Poison Control Center, handling 65,000 exposure calls yearly, is based at ZSFG. Faculty offer bedside consultation services and mentorship at various campuses. UCSF serves as the primary teaching site for a 4-year Emergency Medicine residency program and offers fellowships in multiple specialties. Candidates must be board-certified or eligible in emergency medicine or pediatric emergency medicine and medical toxicology. UCSF, one of the top five medical schools in the nation, emphasizes excellence in research, global health, policy, and medical education scholarship. The San Francisco Bay Area offers a vibrant cultural environment, outdoor activities, and a mild climate. PLEASE APPLY ONLINE AT https://aprecruit.ucsf.edu/apply/JPF04708 UCSF values candidates with diverse backgrounds, teaching expertise, research experience, and community engagement. The university is an Equal Opportunity/Affirmative Action Employer, promoting diversity and excellence. All qualified applicants will be considered without regard to race, color, religion, gender, sexual orientation, national origin, disability, age, or veteran status. For more details, visit http://emergency.ucsf.edu/ or contact 628-206-5753.

Check companies advertising jobs on SAEM’s EM Job Link against your LinkedIn contacts. Leverage professional connections for more information about the company or request a referral.

See You in Phoenix, Arizona

May 14-17, 2024 | Sheraton Phoenix Downtown