SAEM PULSE September–October 2017

SEPTEMBER-OCTOBER 2017

VOLUME XXXII NUMBER 5

EDUCATOR SPOTLIGHT

TAKING THE LONG WAY An Interview with Jennifer White, MD

Mission Accomplished!

$10 MILLION Leading the advancement of emergency care through education and research, advocacy, and professional development in academic emergency medicine.

SAEM STAFF

HIGHLIGHTS

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

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

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President’s Comments

Director, Finance & Benefits Doug Ray Ext. 208, dray@saem.org

Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org

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Educator Spotlight

Membership Manager George Greaves Ext. 211, ggreaves@saem.org

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SAEM Foundation $10 Million

Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Operations & Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Manager, Governance & Meetings Monica Bell, CMP Ext. 205, mbell@saem.org IT Database Manager/ Systems Administrator Ahmed Khater Ext. 225, akhater@saem.org IT Support Specialist Jovan Triplett Ext 218, jtriplett@saem.org Director, Communications and Publications Stacey Roseen Ext. 207, sroseen@saem.org Specialist, Digital Communications Nick Olah Ext. 201, nolah@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org

Education Manager Mark Nagasawa, MA Ext. 214, mnagasawa@saem.org

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Assistant, Membership & Education Alex Keenan Ext. 202, akeenan@saem.org

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A Kick-ass Coffee Machine Taking the Long Way

Diversity and Inclusion

Unconscious Bias: How It Impacts Our Professional Lives

Ethics in Action

Refusal and Capacity: The Basics

EM Health and Wellness

AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org

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AEM E&T Editor Susan Promes, MD AEMETeditor@saem.org

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AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org

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AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org

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Graduate Medical Education

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Briefs and Bullet Points

Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com

Take a Minute, Change a Life: Recommendations for EM Professionals

Tech Talk

Emergency Physicians Poised to Lead the Health IT Workforce of the Future

SGEM: Did You Know?

Sex and Gender-based Violence Magnified in the Global EM Landscape Understanding the AAMC Standardized Video Interview

Academic Announcements Now Hiring

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

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

Megan L. Ranney, MD, MPH Brown University

Steven B. Bird, MD President Elect University of Massachusetts Medical School

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

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

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

Angela M. Mills, MD Penn Medicine

Jean Elizabeth Sun, MD Mount Sinai School of Medicine

Andra L. Blomkalns, MD Immediate Past President University of Texas Southwestern at Dallas

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

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

The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. For SAEM Pulse archives visit http://www.saem.org/publications/newsletters Š 2017 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

PRESIDENT’S COMMENTS D. Mark Courtney, MD Northwestern University, Feinberg School of Medicine 2017-2018 SAEM President

A Kick-ass Coffee Machine

"Until we can interact with each other as human beings, and see others in the modern medical machine as unique individuals, we will struggle with treating patients as human beings and unique individuals."

Like some of you, I recently found myself in a faculty meeting where the topic of overall physician engagement within my hospital system was discussed. Senior members of the hospital system presented to the emergency department faculty our engagement score and pledged to do more to improve the collective sense of “engagement” (aka wellness) among all faculty across the entire health care system.

After 20 minutes of graphs and comments, they asked for suggestions of what could be done to improve engagement. Awkward pause. No one said ANYTHING. My chair is chief medical officer of the hospital system and more of a listener than a speaker, so I spoke up and said, “You know what would really improve physician engagement?

A kick-ass coffee machine in the physician lounge!”

The point is, we have devolved so much to “Phone Medicine” that people are defined more by where they work, or what role they play, than who they are as human beings. Until we can interact with each other as human beings, and see others in the modern medical machine as unique individuals, we will struggle with treating patients as human beings and unique individuals.

I told them that my wife, who works as a physician assistant in suburban, non-academic competitor hospitals, visits staff lounges equipped with push button machines that serve lattes and cappuccinos to accompany bagels, oatmeal, and "grab and go" snacks. Our lounge had nothing but a lame TV, some crusty oncologists, and coffee from a syrup concentrate that at best could be described as simply an adequate bolus of caffeine.

After I was done speaking, and made the argument of coffee machine as a bridge to human-human interaction, my other faculty started chiming in on other things we need: Discounted or free parking! Less boarding!

Faster response times for neuro consults!

None of these issues will be resolved soon and none will be resolved without humanhuman trust and collective problem solving across specialties. But guess what? The very next Monday I got an email from someone high up that said, “Send us some specs on this coffee machine you want. We want to move on that right away.”

I went on to state that really this is a vehicle for more human-human interaction among physicians in our hospital. Like many of you, I suspect when you call the reading room to discuss a case with a physician you are met with the response of “RADIOLOGY.” Or when you call an orthopedic resident you get “ORTHO.” I have made it my mission to respond by saying, “Hey my name is Mark Courtney, I am one of the ED attendings. What is your name?”

The coffee machine was part joke/part serious. What we really needed was a venue for physicians to interact with each other as human beings. Perhaps it is sad that a lounge or a coffee machine or free snacks is seen as a solution for gathering people in the same place to allow their humanity to emerge, but it has been done successfully, and even reported in the literature.

About Dr. Courtney: D. Mark Courtney, MD, MSCI, is director of research and an associate professor in the Department of Emergency Medicine at Feinberg School of Medicine, Northwestern University, Chicago. Dr. Courtney is the 2017-2018 president of the Society for Academic Emergency Medicine (SAEM).

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EDUCATOR SPOTLIGHT

TAKING THE LONG WAY “The academic door is never closed, even if you think it is.”

Dr. Jennifer White received her MD from SUNY Downstate School of Medicine and completed residency at St Luke's Hospital University Hospital in Bethlehem, PA. After practicing community emergency medicine for a decade, she decided

SAEM PULSE | SEPTEMBER-OCTOBER 2017

to return to academics and accepted a faculty position at

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the Mayo Clinic Department of Emergency Medicine, where her academic career began. She then sought out specific mentorship and came back to the east coast to Thomas Jefferson University. Her areas of interest include inherited arrhythmia syndromes, sudden cardiac death in the young, and implantable cardiac devices. Her research focuses on sudden unexpected death syndromes. While busy with her career and family—including her four children Emma, Sam, Logan, and Harper—Dr. White also enjoys running, tennis, and travel.

Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force, interviewed Dr. White for this issue.

SAEM Talks With Dr. Jennifer White How has your personal experience with congenital long QT syndrome influenced your decision to pursue academia/teaching?

The person standing next to me at my exercise class thought I had stopped mid-jump to tie my shoes, but I had actually had brief, noprodromal exertional syncope and was subsequently diagnosed with congenital Long QT syndrome (LQTS). I then had sustained torsades de pointes while undergoing pacemaker implant in the electrophysiology lab requiring defibrillation and an upgrade to an ICD. Since this is an autosomal dominant condition, two of my four children also carry the diagnosis. While I was still in the community at the time, I clearly gained a new focus and passion for research.

What has surprised you most about working in academic emergency medicine?

Academic emergency medicine is effectively a second full-time job.

Since I have sat on both sides of the fence I can see the difference. If I had to do it again, I would get formal research training.

What is the number one question you get asked about your work?

How did a girl from Long Island wind up at the Mayo Clinic? Once I decided to go into academics, since I did not have formal research

All in the family... Dr. White and her brother, Dr. Robert Kahoud.

training, I did not have a formal mentor, so I decided to follow my brother, Robert Kahoud. He went from pediatric intensive care fellowship in Seattle to Rochester, Minnesota. I loved practicing medicine under the same roof. Whenever we were on the same pediatric three-way-transfer call we would have to stifle a laugh if one of us said “I defer to Dr. White (or Dr. Kahoud) regarding that matter.”

back to the east coast to get mentorship from Judd Hollander and other great people at Jefferson.

What advice would you give to your younger self just starting out in this specialty?

Tell us about a specific training challenge you encountered and how you dealt with it.

The academic door is never closed, even if you think it is. Nothing is permanent.

Starting out in the community is okay, if you cannot take the traditional academic pathway straight out of residency. It teaches you to be a great clinician and how to handle most things that walk in the door. However, if you ever want to go back into academics, then find an area of interest early. It should be focused, something you are passionate about, and something no one else is doing. Find good mentorship and don’t settle, thus my move

How do you engage learners and keep them motivated?

One word: autonomy. Deflate the water wings and they won’t realize they are swimming on their own. Just don’t let them drown.

Most people don’t think of a language barrier as a New Yorker in Minnesota.

Moving to the Midwest, I did not understand the culture. I didn’t read the “How to Talk Minnesotan” book (there is an actual book). I had to adapt by adopting mindfulness at work and listening for subtle cues. That is where I became the "happy to help" girl.

What behaviors do you try to model for your trainees?

You may not remember the patient in room 8, but they will always remember you. I

"Deflate the water wings and they won’t realize they are swimming on their own. Just don’t let them drown."

call it the 7-11 moment: you are in a 7-11 convenience store getting coffee and a newspaper and life is just fine and the next moment you have metastatic cancer or your kid is killed in a car accident.

Remember that when we give horrific news to patients and their families, they remember exactly what we said, how we said it, and where we were standing.

Give them that moment. They will remember it forever.

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

They actually like paternalism. For example, sometimes we have to take away the burden of a hard decision because we can handle it—putting the elderly mother in the nursing home, or filing the child abuse form against the biological father and not blaming the caregiver son or the mother that has custody. We need to take responsibility for our decisions, and our patients appreciate this.

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

Your trainees want you to be decisive.

No one wants a mentor who cannot make a decision.

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

With autonomy comes accountability. I am still not a huge fan of the “sandwich” approach because this is not a retail store

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Dr. White snorkeling with her mom.

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in that we are dealing with human lives, not "paper or plastic?".

But my residents know that I am invested in them and so I care enough to tell them when they haven’t gotten it quite right.

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"Remember that when we give horrific

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

news to patients and their families

I am a paper girl so I still like the paper versions.

they remember exactly what we said,

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

how we said it, and where we were

I am most interested in making students good doctors. This may mean being uncomfortable in the short term. Once I told a medical student to stop crying at work because it is important to be perceived as emotionally strong (unless the tears are well timed over a patient's death).

standing. Give them that moment.

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

You can't learn to play tennis by watching it on TV or by using the ball machine only. You need real matches with the wind and the sun in your eyes and a left-handed server. Less sim, more bedside instruction, or we won’t be making good doctors.

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

I set expectations from the beginning of the shift. I tell the residents to hit the “enter” button before presenting to me; otherwise, I will make all decisions for them and they will not even know it happened. In order to leave time for fun teaching

They will remember it forever." or mini-journal clubs, I tell them to not ask me any question they can find the answer to themselves (i.e.: How do I order Lyme serology?).

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

This clearly started at SUNY Downstate, where autonomy was a given and we were on our own—it was fantastic. Mike Heller was my program director and his teaching style is much like my own. His expectations were high and we read all of Tintanelli, twice. I think residents need a better fund of knowledge. I got that from both medical school and residency.

Dr. White parasailing with Emma and Sam , two of her four children.

What do you wish other people knew about the work you do?

Don't miss the chance to save a life even if by chance. The ECG may be done for a reason other than syncope but clearly shows pre-excitation, HCM, or a very long QT. These conditions are inherited in an autosomal dominant fashion. If we miss it in our patient, we can miss it in 50% of the family.

How do you balance work and life outside of work?

Work-life balance is a myth. I just live. I get stuff done and enjoy what I am doing in the moment. I exercise hard every day, have great friends, and try not to let people down. It is hard to miss some family events, but I believe what I am doing is important, and that makes it easier.

What led you to become involved with SAEM? SAEM is very research oriented and full of great people doing great things. I look forward to becoming more involved.

“That’s impossible… I’m the healthiest person I know.”

Dr. White Talks about what it was like to be diagnosed at the age of 36 with Long QT Syndrome— a rare, congenital heart condition:

(TOP) Dr. White shares her expertise and wisdom.

(Middle) Dr. White and son Logan after a bike ride.

(BOTTOM) Dr. White at the beach with daughters Emma and Harper.

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Mission Accomplished!

$10 MILLION $10 Million Raised to Fund Future Leaders in EM Research and Education!

SAEM PULSE | SEPTEMBER-OCTOBER 2017

The SAEM Foundation is pleased to announce that it has achieved its goal of raising $10 million to fund promising young researchers and educators in academic emergency medicine. This major investment in the future of emergency care could not have been possible without the support of the Foundation’s many loyal donors and volunteers.

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The SAEM Foundation was created out of a need identified by the SAEM leadership—including the Board of Directors, and many other emergency medicine leaders—that federal and other grant sources were not providing enough support for emergency medicine investigators. This was particularly the case for research training grants which became the focus of the initial “SAEM Research Fund.” SAEM then backed this up in a very significant way by infusing the first large bolus of money into the Research Fund – $1 million out of SAEM operating reserves to make it possible to fund the first grants. SAEM continued to put a significant portion of its operating surplus into its Research Fund, while at the same time soliciting its members for additional funds. Our goal was to get to $6 million and have the Research Fund function like an endowment. The fact that what started as the SAEM Research Fund and then became the SAEM Foundation is now at $10 million was beyond our most ambitious hopes at the time it was started.

Funding provided by the SAEM Foundation (SAEMF) springboards the careers of future leaders in Research and Education. Since its implementation, the SAEM Foundation, in partnership with SAEM, has awarded a total of $6.5 million in grants to national and international universities and medical schools to help fund more than 300 young investigators with their innovative research and education initiatives in the field of emergency medicine.

None of this would be possible without your support.

Gratefully,

Andra Blomkalns, MD, President SAEM Foundation Board of Trustees

"Reaching the goal of $10M for support of Foundation efforts in 10 years has been nothing short of remarkable. Over the years, the Foundation has played a critical role in supporting the development of young researchers and educators in Emergency Medicine. In this era of shrinking budgets for academic medical centers and research funding, support from organizations like the SAEM Foundation are even more critical than in past years. It’s important that we don’t rest on our laurels. We must continue to find ways to expandour support for academic emergency medicine by helping to develop the careers of young investigators and educators in our specialty.”

—William Barsan, MD, SAEM Foundation Development Committee Chair

“The SAEMF provides funding that can jumpstart a career, answer an important clinical question, and support creativity in academic emergency medicine. The innovation that results from activities supported by SAEMF is always interesting, important and relevant. As a long time researcher, I am especially happy to contribute to the development of younger investigators, and look forward to what they will bring to our specialty.”

"The SAEM Foundation plays a significant role in shaping the careers of talented young emergency physicians, their teachers, and their mentors. The Foundation supports the work of these dedicated individuals who want to better understand how to prevent and treat emergency conditions. The bottom line is that this translates into lives saved. " — Jill M. Baren, MD, MBE, FACEP, FAAP SAEM Foundation Founding Member

—Michelle Biros, MD, MS, FACEP SAEM Foundation Founding Member “Sustaining a pipeline of new scientists is fundamental to the success and growth of emergency medicine as a specialty. The SAEM Foundation plays a key role by providing grant support for early career investigators to gain the training and experience needed to progress to a successful scientific career.”

— Robert W. Neumar, MD, PhD SAEM Foundation Founding Member

“The SAEM Foundation has played a critical role in helping to develop researchers in our specialty through funding of promising investigators around the country. There are a number of successful investigators whose careers have been catalyzed by funding support from the Foundation. Ongoing support for the Foundation is critical for the future development of our specialty.”

—William Barsan, MD SAEM Foundation Development Committee Chair

“The SAEM Foundation has jumpstarted the academic careers of many young researchers and educators, which has led to significant advancements in the care of emergency patients and training of emergency physicians.”

—Brian Zink, MD SAEM Foundation Founding Member, SAEM Foundation Development Committee

"The SAEM Foundation helps early-career investigators establish a funding track record and get the pilot data they need to launch follow-up research grants. It’s important for researchers to have access to an organization with a focus on emergency medicine as we have a special role in acute care and prevention research.”

—Deb Houry, MD, MPH SAEM Foundation Founding Member

“As one of the younger academic specialties and scientific disciplines, we in emergency medicine have had to 'elbow our way to the table' in the areas of discovery, innovation, and education. There is no better way to engender enthusiasm in game-changing research and novel educational ideas than to invest in ourselves. We've moved from elbowing our way to the table to setting the table for the next generation, and we are making a positive impact on the lives of millions of ill and injured people in the U.S. and around the world.”

—Katherine L. Heilpern, MD SAEM Foundation Founding Member

“I could not be prouder that SAEM has achieved this goal. The investigators and careers developed as a result of SAEM foundation dollars have helped create the tools and approaches that have saved countless lives.

Next stop…$100 million! Let’s get there.

There is much more that we need to figure out to help our patients live better lives.”

—Judd Hollander, MD SAEM Foundation Founding Member

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Other Foundation News SAEM Committees Raise $19,177 for EM Research and Education Congratulations to SAEM’s 17 committees who came together to raise $19,177 for emergency care researchers and educators through the annual SAEM Foundation Committee Challenge! With a $10,000 matching gift from SAEM, $29,177 will be donated to provide grants to SAEM members, their departments, and emergency medicine specialty.

The competition was close, but in the end the title of 2017 SAEM Committee Champions was earned by the SAEM Bylaws Committee and the SAEM Program Committee. The Bylaws Committee, led by Esther Choo, MD, had 100 percent participation from its members, while the Program Committee, chaired by Danny Pallin, MD, MPH, raised the most money with a contribution of just over $4,000.

The SAEM Foundation is grateful for the support and dedication of our donors. Together, we can improve emergency care for all patients.

SAEM Foundation to Expand Board of Trustees Now that the SAEM Foundation has reached its $10 million goal, we are developing a new strategic plan to further its mission to advance research and education in emergency medicine.

The Foundation will be searching for enthusiastic members dedicated to the academic mission of SAEMF to serve on its Board of Trustees. A call for applications will open this fall.

Please contact the SAEM Foundation headquarters for more information.

Research Learning Series Upcoming Events

SAEM PULSE | SEPTEMBER-OCTOBER 2017

Check out the upcoming complimentary online educational events, hosted by the SAEM Foundation and the SAEM Research Committee. You can also view past events on the SAEM Foundation website.

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How to Be a Good Research Mentor/Mentee Sept. 11, 2017, 2:00 PM EST Speakers: Corita Grudzen, MD, MPH, New York University and Michael Gottlieb, MD, Rush University Medical Center Register here How to Draft a Manuscript Oct. 9, 2017, 3:30 PM EST Speaker: Craig Newgard, MD, MPH, Oregon Health & Sciences University Register here Challenges Getting Started in EM Research Nov. 13, 2017, time TBA Speakers: Gloria Kuhn, DO, PhD; Esther Choo, MD, MPH; and Wendy Coates, MD Register here For questions, please contact foundation@saem.org.

Founding Members of the SAEM Foundation 1998 SAEM Board of Directors Create Research Fund with an initial $1 million investment Scott Syverud Marcus Martin Steven C. Dronen Michelle Biros Rita Cydulka

Debra Perina J. Stephan Stapczynski Irene Tien Daniel DeBehnke

2007 SAEM Board of Directors Officially approve the SAEM Foundation to become a separate entity Debra Houry Glenn C. Hamilton Leon Haley Lance Scott Catherine Marco Robert Schafermeyer Ellen Weber Carey Chisholm Megan Ranney

First SAEM Foundation Development Committee (2008-2009) Brian Zink G. Richard Braen James Hoekstra Heather Prendergast Richard Aghababian

Joseph Adrian Tyndall Griffin Davis Sandra Schneider John A. Marx

Inaugural SAEM Foundation Board of Trustees (2008) Donald Yealy Charles Pollack Frank Zwemer Judd Hollander Jill Baren

Jeff Kline Kate Heilpern Adam Singer Roger Lewis

Senior SAEM Foundation Advisory Council Task Force Robert Neumar

SAEM FOUNDATION MILESTONES 1989 The Society for Academic Emergency Medicine is created and provides limited grant funding through the Emergency Medicine Foundation (EMF) of the American College of Emergency Physicians (ACEP). Grants include the EMF/ SAEM Innovations in Medical Education Grants, the EMF/SAEM Medical Student Research Grants, and the EMS Research Fellowship.

Mid-1990s SAEM begins funding geriatric emergency medicine grants.

1998 Initial Research Fund is created with an investment of $1 million from the SAEM Board of Directors who set a goal of $5 million to support 10 scholarly awards by the year 2004.

2002 SAEM Board of Directors set a target of increasing the annual grant funding to three Research Training Grants, two Institutional Research Training Grants, and two Scholarly Sabbatical Grants by 2006.

2005 Assets of the Research Fund exceed $4 million.

2008 The SAEM Foundation Board of Trustees is established.

2010 The Education Fund was created to award grants for educational research training and educational innovations.

2001 SAEM expands the grants program by increasing the Research Training Grant from a one-year to a two-year grant and establishing the two-year Institutional Research Training Grant. Annual funding for these grants are increased to $75,000 per year and funding for the EMS Research Fellowship Grant is increased to $60,000.

2003 SAEM initiates a formal membership "giving campaign"

2007 SAEM Board of Directors gives official approval of the creation of the SAEM Foundation.

2008-2009 The first SAEM Foundation Development Committee is created and leads the Foundation in its fundraising efforts to the SAEM membership.

2017 SAEM Foundation reaches $10 million goal to fund EM research and education!

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DIVERSITY AND INCLUSION Unconscious Bias: How It Impacts Our Professional Lives

By Bernie Lopez, MD, MS, CPE • Women have a higher rate of missed myocardial infarction.

• Black patients with acute myocardial infarction receive percutaneous coronary intervention at a lower rate than white patients.

• A Latino woman does not receive adequate pain medication because “she is being hysterical.”

• At sign out, a female physician’s opinion is dismissed by her male colleague.

• An older physician evaluates residents as “lazy”.

"Our biases may inadvertently result in involuntary discriminatory practices and can negatively affect the care of our patients SAEM PULSE | SEPTEMBER-OCTOBER 2017

and the function of

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our organizations."

• A residency applicant is scored down during an interview because “He reminds me of someone I don’t like.”

None of these disparities are intentional.

Most emergency physicians are rational, fair-minded, educated human beings who are committed to the highest quality level of work. Yet somehow, these disparities continue. Their causes are complex and occur on both a systemic and an individual level. At the individual level, the causes are rooted in our unconscious biases.

Unconscious bias (sometimes known as implicit bias) are attitudes or stereotypes that are outside of our awareness and affect our understanding, interactions, and decisions. We receive an overwhelming number of stimuli and our brains use biases as shortcuts to simplify and understand our surroundings more quickly. Our individual experiences shape these shortcuts (it is an ongoing and continual dynamic process) and create the unique lenses through which we each view the world.

On an evolutionary basis, bias serves to protect us from harm (e.g., a bias against dangerous-looking figures causes us to run to safety). These automatic responses enable us to make fast decisions; they can also prompt us to jump to unwarranted conclusions. As humans, we harbor unconscious associations—both positive and negative—about other people based on race, ethnicity, gender, age, socioeconomic

class, sexual orientation, and appearance.

These associations influence our feelings and attitudes, especially under demanding circumstances. The emergency department clinical environment and the residency application process are examples of demanding circumstances. Our biases may inadvertently result in involuntary discriminatory practices and can negatively affect the care of our patients and the function of our organizations.

Does unconscious bias affect patient care? A study by Green, et al in 2007 used the Implicit Association Test (IAT) to determine whether physicians showed implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes. The IAT is a tool that measures the strength of automatic associations between concepts (e.g., black people, gay people) and evaluations (e.g., good and bad). It is the most recognized and most commonly used test to measure unconscious bias. Using vignettes on 287 emergency medicine and internal medicine residents at four academic medical centers, the IAT used in the Green, et al, study demonstrated implicit preference for white Americans and implicit stereotypes of black Americans as less cooperative with medical procedures and less cooperative in general. As the physicians’ pro-white implicit bias increased, so did their likelihood of treating white patients—but not black patients—with thrombolysis. The authors concluded that unconscious bias may contribute to racial/ethnic disparities in the use of medical procedures such as thrombolysis for myocardial infarction. While the study is dated (PCI is preferred over thrombolytics), it is the one study linking IAT results to treatment choices. A number of other studies have demonstrated the existence of implicit bias in physicians in race, obesity, gender, and age.

Note that the IAT does not measure prejudice; rather, it simply measures associations that may be linked to biases.

"Unconscious bias (sometimes known as implicit bias) are attitudes or stereotypes that are outside of our awareness and affect our understanding, interactions, and decisions."

Biased?

Who me?

All people harbor beliefs and attitudes about groups

The researchers explain on the site that having an unconscious bias is not the same as being consciously prejudiced or endorsing discrimination.

3. Explore your individual biases and their impact on your interactions and decisions.

Recognize that working with your biases is not easy and comes with uncertainty.

What can we do?

4. Engage with people you consider “others.” Learn and gain experience from them to change your lens.

1. Recognize and accept that you have biases. We all have biases! They help us function and serve to protect us and thus are a necessary component of who we are as humans.

2. Reflect on your biases i.e., develop the capacity to shine the light on yourself.

Research has demonstrated that a bias blind spot is greater in those with higher cognitive ability, so recognize the tendency we have as physicians to “rationally” explain away our biases.

5. Finally, get feedback. Ask someone you trust, “How did I do?”

of people based on their race or ethnicity, gender, body weight, and other traits.

What are your biases? Take the Implicit Association Test (IAT) and find out. The fastmoving test takes about five minutes to complete. Even

ABOUT THE AUTHOR: Bernie Lopez, MD, MS, is professor and executive vice chair in the Department of Emergency Medicine at Thomas Jefferson University where he serves as Associate Provost for Diversity and Inclusion. Dr. Lopez is also a past president of SAEM’s Academy for Diversity and Inclusion in Emergency Medicine (ADIEM)

the most consciously tolerant of us hold biases about certain social groups…

What are yours?

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ETHICS IN ACTION Refusal and Capacity: The Basics

By Jeremy R. Simon, MD, PhD

THE CASE: An 85-year-old man passes out on the street and is brought to the local emergency department. There, the medical record shows that he has a history of coronary artery disease, with stents placed 5 years earlier, but no subsequent recorded cardiac evaluation. The record also documents a history of dementia, although the patient has been able to live on his own with a home health aide present five days a week. Today is one of the aide’s days off.

In the emergency department, the patient says he feels fine and wants to leave. He knows the date and where he is, but he SAEM PULSE | SEPTEMBER-OCTOBER 2017

does not know why he was brought to

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the hospital, despite the preceding events having being explained to him several times. Nonetheless, he insists on leaving.

The emergency physician, however, does not feel comfortable with this and will not allow him to leave. The physician arranges for observation to assure that the patient does not walk out, and admits the patient to the hospital. The next day, the patient’s daughter, whose contact information is not in the record, somehow finds out where her father is and comes to the hospital angry that her father has not been allowed to sign himself out per his wishes.

This case raises the question of who is permitted to sign out against medical advice and, more generally, to refuse care.

Our general rule is that patients can always refuse any care, including admission, but this is not absolute. To understand when the rule doesn’t apply–and why–, we need to first understand why we give patient decisions the weight we do.

"When a patient refuses

When a patient refuses care, we must balance two medical values: 1) acting in the best interest of the patient, and 2) respecting patients’ autonomy. For decades, if not centuries, the well-being of the patient was paramount; thus, the doctor identified the problem and told the patient what to do.

In recent decades, however, the medical profession has given priority to respecting patients’ rights to make their own decisions, even if those decisions would seem harmful.

interest of the patient,

Why do we allow patients to make poor decisions? The value in allowing patients to make decisions about their own lives is that this allows them to live the lives they choose in accordance with the values they hold.

Thus, if one has been a faithful Jehovah’s Witness one’s whole life and believes that God will not permit anyone who has received a blood transfusion into heaven, a refusal to accept even a life-saving transfusion would fit into that person’s deeply held values. Forcing him or her to accept a blood transfusion would be a gross violation of his or her freedom.

However, what of a patient who has no religious or values-based objection to blood transfusions and does not want to die, but believes that what the hospital is transfusing is not blood, but an alien poison from Mars given as part of a secret government experiment? By accepting this person’s refusal of a transfusion, one is, in fact, preventing him from living according to his values, which in this case includes accepting blood products and continuing to live.

Thus, when there is a conflict between helping a patient and respecting her decision, one must ascertain whether acceding to the patient’s decision results in respecting autonomy. This is done by determining whether the patient has capacity to make the decision in question.

care, we must balance two medical values: 1) acting in the best

and 2) respecting patients’ autonomy."

The three primary components of capacity are 1) an ability to understand the relevant information, 2) the ability to reason with that information to reach a practical goal, and 3) the ability to express that decision. If a patient lacks any of these components, she does not have the capacity to make the decision, and someone else, i.e., a surrogate, must make it for her. Local law determines the surrogate but, in general, it is a designated health care agent, or, if there is no designated agent, the patient’s closest family member. Only when there is no one else (or no time to consult the surrogate) is the medical team permitted to decide what to do.

In the case of the patient who refuses the “alien poison” transfusion, the problem appears to occur at the first stage: He is simply unable to receive the relevant information because a delusion interferes.

The patient in the opening case likewise cannot comprehend what is going on, as he cannot recall why he is in the hospital. One suspects that even if he could remember the reason for his being in the hospital, his reasoning abilities might be impaired. For example, he might say “I know I passed out, and yes, I want to live for as long as possible, but I still want to go home,” yet when pressed, it is clear that he has no reason for making this decision; it is just what he “feels” like doing. (The final requirement for capacity—being able to express a decision—is more technical. If a patient cannot communicate, we have no

way of knowing what he wants and would be stuck if we did not have someone else deciding.)

A few important points bear mentioning: First, capacity is both time- and decisionspecific. While some people remain permanently unable to make decisions (e.g., a patient with severe dementia), many patients are only temporarily impaired and when the impairment is removed, they are able to make decisions again.

Likewise, some people have dementia that is severe enough to interfere with their ability to make complex decisions (e.g., whether to undergo a toxic chemotherapy regimen with multiple side effects and limited chance of success), but is not so severe that they cannot consent to having an abscess drained. Third, as this last point should make clear, psychiatric illness does not automatically mean a patient does not possess capacity. A patient may hear voices, but if those voices have no impact on the decision being made, the patient presumably has capacity.

One final point remains, which is perhaps even more important than the technical details discussed up to this point. When a patient refuses care, before you determine whether she has the capacity to refuse that care, consider whether there is any way to make her more comfortable with receiving that care.

Ask yourself these questions: Did you make your concerns and reasoning clear enough to the patient? Is there someone from the patient’s “team” (family, friends, clergy, primary doctor) that could be brought in to help the patient think through the matter? Is the patient’s concern something that can be allayed by, for example, asking a neighbor to feed the patient’s cat? Is the patient just hungry and grumpy because she has been there for 12 hours and no one has even offered her a sandwich?

Removing the conflict between benefit and respect by intervening in any of these ways is better than resolving it through a capacity decision. Even if we are concerned that a patient lacks capacity, removing the conflict is still important, because it is always preferable, and often easier, not to force treatment on a patient.

About the author: Jeremy Simon, MD, PhD is an assistant clinical professor of Clinical Medicine at Columbia and a Scholar-in-Residence at the Center for Bioethics, also at Columbia

"When there is a conflict between helping a patient and respecting her decision, one must ascertain whether acceding to the patient’s decision results in respecting autonomy."

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EM HEALTH AND WELLNESS World Suicide Prevention Day is September 10

Take a Minute, Change a Life: Recommendations for EM Professionals An interview with Debra Houry, MD, MPH In 1999, the Surgeon General had a “call to action” calling suicide a public health crisis.

How do you feel emergency medicine has responded to this call and crisis?

Debra Houry, MD, MPH, is the director of the National Center for Injury Prevention and Control (NCIPC) at CDC. In this role, Dr. Houry leads innovative research and science-based programs to prevent injuries and violence and to reduce their consequences. She joined the CDC in October 2014. She has previously served as vice-chair and associate professor in the Department of Emergency Medicine at Emory University School of Medicine and as associate professor in the Departments of Behavioral Science and Health Education and in Environmental Health SAEM PULSE | SEPTEMBER-OCTOBER 2017

at the Rollins School of Public Health.

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Dr. Houry also served as an attending physician at Emory University Hospital and Grady Memorial Hospital and as the director of Emory Center for Injury Control.

Her prior research has focused on injury and violence prevention in addition to the interface between emergency medicine and public health, and the utility of preventative health interventions and screening for high-risk health behaviors.

She has received several national awards for her work in the field of injury and violence prevention.

Since 1999 and 2015 suicide rates have increased 27 percent. Between 2001 and 2015, rates of nonfatal self-harm behavior (ED data), increased almost 44 percent. This data suggests that much more work is needed across all sectors of society, including health care. Emergency physicians have an important role to play in suicide prevention. Clinically, we are on the frontlines and see patients with ideations or after an attempt that may not be seen by another healthcare provider and we have an opportunity to intervene. In addition, SAEM’s public health interest group and ACEP’s public health committee have held many discussions on this issue and I’ve been happy to see several EM researchers focus on suicide prevention. Dr. Megan Ranney also led a group of us several years ago to develop a research agenda on genderspecific research on this area.

Are there recommendations on how individuals on departments in emergency medicine can make a strong impact on suicide prevention?

CDC recently released a report, Preventing Suicide: A Technical Package of Policy, Programs, and Practices. This report provides evidence-based practices relevant to suicide prevention in the health care setting including, strengthening access and delivery of suicide care, identifying and supporting people at risk, and lessening harms and preventing future risk. Henry Ford Health Care System in Detroit found that health care should focus on suicide prevention and patient safety through a range of policies and practices. Today, these policies and practices are being implemented across the country through an initiative called Zero Suicide. Also mentioned in the technical package, “Emergency

Department Brief Intervention with Follow-up Visits” and follow-up contact approaches such as postcards, letters, and telephone calls intended to increase a sense of connectedness between patients who have attempted suicide and health care providers can be effective. Finally, in February 2016, the Joint Commission issued a Sentinel Event Alert #56—“Detecting and treating suicide ideation in all settings.” This alert provides a range of requirements related to assessment and treatment of suicidal patients for hospitals, ambulatory care, and behavioral health care, including many of the practices related to Zero Suicide.

The Joint Commission indicates that “contracting for safety” should no longer be the practice favoring “safety planning.” Why is that and how can this be incorporated into emergency medicine practice?

Contracting for safety, sometimes called, ‘nosuicide contracts’ are not a recommended practice because there is no evidence that they work and some studies suggest they may even be harmful. Part of the problem is that agreement on what a no-suicide contract is and what it should entail are not clearly defined. At a minimum, experts (Rudd et al, 2006) fear that suggesting the agreement as a ‘contract’ suggests a legal aspect to the intervention that is inappropriate.

Additionally, such agreements may be viewed as a means of confining, restraining, or restricting behavior during a time of struggle and a need for help. A recent study by the National Center for Veterans Studies (Bryan et al., 2017), found that the use of crisis plans versus safety contracts among active duty Army Soldiers attending emergency behavioral health visits, were associated with significantly fewer suicide attempts at 6-month follow-up, faster decline in suicide ideation, and fewer inpatient hospitalization days. So, implementing crisis planning is something that emergency physicians can incorporate into practice.

Take 5 To Save Lives The Take 5 to Save Lives campaign, sponsored by the National Council for Suicide Prevention (NCSP) encourages everyone to take 5 minutes out of their day and complete the five action items below on World Suicide Prevention Day, September 10, 2017.

1. LEARN THE SIGNS Take a few minutes to learn the warning signs of suicide.

Although it may not always be obvious, individuals experiencing an emotional crisis usually exhibit one or more of the warning signs of suicide. Your ability to identify the signs will better prepare you act and could help save a life. Get help immediately if you see or hear any of the following warning signs.

2. DO YOUR PART Everyone has a role in preventing suicide.

What’s yours?

Teachers, parents, students, caregivers, and countless other stakeholders all play a vital role in preventing the tragedy of suicide. Preventing suicide is a collective responsibility. Learn how you can do more to raise awareness and prevent suicide.

Physicians are known to die by suicide at a higher rate than the general population. Has there been progress in preventing physician suicide and what more can be done?

One of my medical school classmates died by suicide during his internship and this always reminds me how anyone can be impacted. The CDC published an article last year on suicide by occupation in 17 states. Suicide rates for healthcare practitioners (which includes physicians) in these 17 states were: 17.4/100,000 overall, 31.6/100,000 for males and 13.3/100,000 for females. In the general population in this same age group in and in the same states in 2012, the corresponding suicide rates were: 18.7/100,000, 29.5/100,000 and 8.0/100,000, respectively, indicating that suicide rates among healthcare practitioners overall and among males were similar to the general population in those states. The largest difference appears among female physicians. Note that the data from 17 states is not nationally representative. We know that rates of suicide, in general, across the population and across most age groups are going up. Several resources exist to help communities and the workplace address suicide.

Several of the prevention strategies and approaches listed in the recently released report, Preventing Suicide: A Technical Package of Policy, Programs, and Practices, are relevant to physicians and medical settings including, creating protective environments (e.g. promoting prosocial organizational policies and culture), promoting connectedness, identifying and supporting people at risk, and lessening harms and preventing future risk.

SAEM has joined with the suicide prevention community around the globe as an official partner in the Take 5 to Save Lives campaign, sponsored by the National Council for Suicide Prevention (NCSP), to raise awareness for World Suicide Prevention Day, September 10.

3. PRACTICE SELF-CARE Make mental wellness a priority in your life.

Research indicates that our mental fitness or wellness is crucial to our overall long-term health, and can even protect us from disease.

Learn some tips for keeping mentally fit. Make it a priority!

4. REACH OUT Help is available and recovery is possible.

If you or someone you know is in emotional distress you must reach out for help. You are not alone. Learn about different help options and how to take that first step in seeking help and care.

5. SPREAD THE WORD Pledge to tell 5 people about Take 5 and WSPD. Let’s get people talking! By sharing the Take 5 campaign with 5 other people we can raise awareness of problem of suicide and equip people with easy tools to help themselves and others. Share the campaign on or before World Suicide Prevention Day, September 10, 2017.

Together we can all make a difference!

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TECH TALK Emergency Physicians Poised to Lead the Health IT Workforce of the Future

By Ted Melnick, MD, MHS Just like emergency medicine, clinical informatics is a relatively new field. In the 1970s, during emergency medicine’s fledgling years, the Information Age was also in its nascency.

“As human-computer interaction becomes a growing part of clinical work, physician competence in clinical informatics will become increasingly SAEM PULSE | SEPTEMBER-OCTOBER 2017

important.”

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Medicine is in the dawn of its Information Age. Coupled with the rapid growth of medical knowledge, physicians will continue to be more reliant on technology in the form of predictive analytics, decision support, precision medicine, and information sharing with patients, etc. As human-computer interaction becomes a growing part of clinical work, physician competence in clinical informatics will become increasingly important.

Over the last decade, the medical community has “gone live” with rapid adoption of electronic health records (EHRs).

As clinicians, our daily clinical frustrations with the EHR are a testament to the growing need to improve health information technology (IT). No two EHR builds are the same. Challenges to health IT are not a single problem but thousands of problems, small and large. Addressing these problems will require a clinical informatics workforce whose knowledge and skill sets span both clinical care and IT.

What is clinical informatics?

Clinical informatics is an interdisciplinary field that aims to: “Transform healthcare by analyzing, designing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician–patient relationship.

“Clinical informaticians use their knowledge of patient care combined with their understanding of informatics concepts, methods, and tools to: • assess information and knowledge needs of healthcare professionals and patients; • characterize, evaluate, and refine clinical processes;

• develop, implement, and refine clinical decision support systems; • lead or participate in the procurement, customization, development, implementation, management, evaluation, and continuous improvement of clinical information systems.”

Board certification in Clinical Informatics is now available to physicians boarded in any ABMS medical specialty. Board certification will prepare trainees to have a seat at the table in the C-suite as Chief Medical Information Officers (CMIO). Currently, there are 29 ACGME-certified fellowship programs (and growing) with a pathway to board certification. At least four of these programs (Regenstrief, UC Irvine, UC San Diego, and Yale) are directed by emergency physicians.

Today, emergency medicine is wellestablished, with over 2,000 new emergency physicians being trained annually. As emergency physicians, we have a deep understanding, appreciation, and knowledge for health care needs at the individual, departmental, and system level. The emergency physician workforce not only provides emergency care to our nation but also is involved in leadership roles throughout the health care continuum.

Emergency physicians are uniquely poised to train and lead the health IT workforce of the future. Indeed, they are already taking leadership roles in clinical informatics across the country. Drs. John Halamka and Adam Landman, for example, are both Chief Information Officers for Harvard-affiliated hospitals. This is just the beginning.

Join us!

ABOUT THE AUTHOR: Ted Melnick, MD, MHS is boardcertified in emergency medicine and clinical informatics.

He is Assistant Professor of emergency medicine and Program Director for the new ACGME-certified clinical informatics fellowship at Yale University School of Medicine. @Ted_Melnick

SGEM: DID YOU KNOW?

Sex and Gender-based Violence Magnified in the Global EM Landscape

By Angela F Jarman, MD Gender-based violence (GBV), which includes physical, sexual, or psychological harm, is a common occurrence both in the United States and across the globe. Both domestic and international estimates suggest that at least one in three women will experience GBV during their lifetime. Significant morbidity is associated with GBV. Acute traumatic injuries in addition to long term sequelae such as chronic pain, disability, and mental health disorders, are common among survivors.1 Internationally, particularly in low and middle-income countries (LMICs) where limited resources exist, the health effects of GBV are exaggerated and include higher rates of infection with HIV, sexually transmitted infections, as well as unwanted pregnancy and obstetric complications.2 The downstream effects of such disability in LMIC cause significant economic and sociocultural losses for patients, particularly those who are young, rural, or poorly educated. Emergency Medicine (EM) physicians are particularly well suited to practice in low resource settings and Global EM opportunities continue to be of increasing interest to learners. EM physicians are uniquely situated to lead efforts to consider sex and gender in acute care, particularly in these high-stakes environments in which unrecognized GBV can lead to dangerous and debilitating consequences for our patients.

ABOUT THE AUTHOR: Dr. Jarman is a Fellow in ‘Sex and Gender in Emergency Medicine’ at the Warren Alpert Medical School of Brown University REFERENCES

1. P hysical and mental health effects of intimate partner violence for men and women. Coker AL, Davis KE, Arias I, Desai S, Sanderson M, Brandt HM, et al. Am J Prev Med. 2002;23(4): 260–268.

2. Intimate partner violence and HIV infection among women: a systematic review and meta-analysis. Li Y, Marshall CM, Rees HC, Nunez A, Ezeanolue EE, Ehiri JE. J Int AIDS Soc. 2014 Feb 13;17:18845.

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

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GRADUATE MEDICAL EDUCATION

Chad Mayer, MD, PhD

Harsh Sule, MD, MPP

Kelly Barringer, MD

Lancelot Beier, MD

Andrew Starnes

Andrew King, MD, FACEP

Understanding the AAMC Standardized Video Interview

SAEM PULSE | SEPTEMBER-OCTOBER 2017

By Chad Mayer, MD, PhD; Harsh Sule, MD, MPP; Kelly Barringer, MD; Lancelot Beier, MD; Andrew Starnes; Andrew King, MD, FACEP

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The Standardized Video Interview (SVI) is a new tool from the American Association of Medical Colleges (AAMC) that is being piloted with emergency medicine (EM) residency applicants during the 2018 application cycle. It is composed of six questions designed to assess an applicant’s knowledge of professional behaviors as well as interpersonal and communication skills.

The interview videos are scored by third-party raters that have undergone extensive inter-rater reliability testing. A composite score is included within each emergency medicine residency applicant’s Electronic Residency Application Service (ERAS) file. Raw videos are made available to residency programs for direct review. For the ERAS 2018 cycle AAMC has required that all applicants to ACGME-accredited EM programs complete the SVI. While those that do not complete will still be eligible to apply, residency programs will be informed that the SVI was not completed.

The SVI is formatted so that applicants can sign in during an assigned window, test their equipment, and then answer six different questions. Applicants have 30 seconds to read each question and then three minutes for each recorded response—3.5 minutes per question cycle. Each answer is scored from 1-5, making the possible composite score range from 6-30. During the 2017 ERAS cycle, some applicants completed the SVI in order to contribute data to the AAMC for interrater reliability testing. Data obtained was not considered a part of their application.

Emergency Medicine applicants participating in this pilot/ research study may be asking themselves, “What does this add to my application?” The best answer may be that the SVI provides applicants a chance to showcase the intangibles about themselves that are neither entered on their application nor reflected by their standardized examination scores. Within their education materials describing the SVI, the AAMC states that the SVI has been shown, based on preliminary data, to not correlate with USMLE Step 1 scores. Thus, the SVI is hopefully accomplishing its overarching goal: measure an aspect of a residency applicant’s worthiness that is not captured by their performance on a standardized examination.

The specialty of emergency medicine continues to gain popularity among graduating medical students, hence competition for a limited number of residency positions continues to increase.

"Identifying strategies to assess an applicant’s intangibles within the pre-interview application is an area that the SVI can make an immediate impact by essentially allowing everyone to have an ‘interview’."

Similarly, the number of applications submitted per applicant has grown, thereby making it challenging for applicants to positively distinguish themselves. Although an imperfect tool, USMLE scores provide a standardized method of evaluating applicants and can help programs perform initial application screenings in a systematic manner. Similarly, the Standardized Letter of Evaluation (SLOE) used in EM helps programs develop a more comprehensive understanding of an applicant’s performance in medical school when compared to free-form letters. Unfortunately, the SLOE is not without its own limitations.1 Reviewers tend to provide overwhelmingly positive reviews regarding their medical students because negative SLOEs may inhibit an applicant’s chance of matching in a residency program, which ultimately reflects poorly on the applicant’s medical school.

Holistic application review involves a flexible, individualized way of assessing an applicant’s capabilities through the balanced consideration regarding experiences, attributes, and academic metrics. When considered collectively, these attributes may define how an individual may perform as a physician. The SVI can provide data that contributes to the holistic review of an applicant, especially pertaining to their professionalism and communication skills. Currently, the only evaluations of an applicant’s professionalism and communication skills are from rotating

through a given emergency department or being invited for an interview - and these are not standardized. Inevitably, many applicants within each application cycle do not have the opportunity to demonstrate their interpersonal skills or professionalism to a program by one of these methods.

The SVI was created by the AAMC out of a desire by program directors to have a way to measure this facet of an applicant prior to interview selection and in a standardized manner, especially given the inability to identify this information via standard application materials. Surveys of program directors confirm that professionalism and interpersonal skills are areas necessitating improved assessment.

Each year programs struggle with how to identify the best-fit or ideal applicants, while applicants struggle with the “safe” number of programs in which they should apply and interview. Consequently, a pool of “stellar“ applicants receives interview offers from multiple programs, while other applicants who may ultimately be a good fit struggle to demonstrate on paper that they are deserving of interviews. The initial determination to offer an interview is often based on objective measures such as grades, or standardized examination scores. However, the ability of these objective data points to predict how a student will function in residency is still up for debate. While some education research has pointed to medical school attended or standardized examination scores2,3 as predictors of future success in residency, there is agreement that no single or few definitive criteria can make this prediction confidently.4 Interestingly, one study, which looked at the multiple-medical interview, a tool used frequently at the medical school admission level and somewhat parallels the SVI in structure, correlated to performance

in the 1st year of medical school, but did not add to traditional measures.5 This raises the question if the SVI will indeed contribute to holistic application review in the 2018 residency application cycle and beyond, as residencies try to recruit the group of residents best fit for their program.

Although there is no clear way to predict how a resident may perform based on previous board scores or where they attended medical school, what factors can be considered to improve a residency program and how can targeting certain applicants feed into those measures?

Diversity is a relatively new target for how to structure a program, and represents one with which academic medical centers have historically struggled,6 particularly in leadership positions. New strategies are emerging to help programs promote diversity at all levels within academic medical centers.7, 8 Identifying strategies to assess an applicant’s intangibles within the pre-interview application is an area that the SVI can make an immediate impact by essentially allowing everyone to have an “interview.” Each program will have the opportunity to view an applicant’s SVI to develop a better understanding of the candidate’s fit within the residency program. Scoring highly on the SVI could be an alternative way to convince program leaders to view one’s SVI and possibly extend an interview offer. Conversely, a low score on the SVI for traditionally stellar applicants could result in fewer interview offers extended, thus improving their perceived monopoly on the desirable interview slots. An SVI score will be provided as part of each emergency medicine residency application. Residency programs will have the opportunity to view the videos; however, this practice will likely be reserved for a few specific applicants

given the significant time burden holistic application review entails.

The AAMC’s plans to formally evaluate the success of the SVI currently remains unclear. Whether it is post-cycle surveys, or a more rigorous statistical analysis of the performance of interns who first match using the SVI, it is clear that we are a long way from understanding whether this tool will be important to future residency cycles.

If successful in some form, its use will likely be expanded to other specialties beyond emergency medicine. What remains clear is the increased need to evaluate residency applicants holistically, rather than placing excessive weight on examination scores and medical schools attended. Hopefully, the SVI will assist traditionally “weaker” applicants secure an increased number of interviews to improve their chance of becoming a successful emergency physician. A robust plan to measure outcomes and assess the impact of the SVI especially in applicants who may have been otherwise passed over is needed to formally assess its value.

REFERENCES 1. Grall KH, Hiller KM, Stoneking LR. Analysis of the Evaluative Components on the Standard Letter of Recommendation (SLOR) in Emergency Medicine. West J Emerg Med. 2014; 15(4): 419-423 2. Harfmann KL, Zirwas MJ. Can performance in medical school predict performance in residency? A compilation and review of correlative studies. J Am Acad Dermatol. 2011 Nov; 65(5): 1010-1022.e2 3. Hayden SR, Hayden M, Gamst A. What characteristics of applicants to emergency medicine residency programs predict future success as an emergency medicine resident? Acad Emerg Med. 2005 Mar; 12(3): 206-210 4. Balentine J, Gaeta T, Spevack T. Evaluating applicants to emergency medicine residency programs. J Emerg Med. 1999 Jan-Feb; 17(1): 131-134 5. Burkhardt JC, Stansfield RB, Vohra T, Losman E, Turner-Lawrence D, Hopson LR. Prognostic Value of the Multiple Mini-Interview for Emergency Medicine Residency Performance. J Emerg Med. 2015 Aug; 49(2): 196-202 6. Bandiera G, Abrahams C, Ruetalo M, Hanson MD, Nickell L, Spadafora S. Identifying and Promoting Best Practices in Residency Application and Selection in a Complex Academic Health Network.

Acad Med. 2015 Dec; 90(12): 1594-1601 7. Auseon AJ, Kolibash AJ, Capers Q. Successful efforts to increase diversity in a cardiology fellowship training program. J Grad Med Educ. 2013 Sep; 5(3): 481-485 8. Lievens F. Diversity in medical school admission: Insights from personnel recruitment and selection. Med Educ. 2015 Jan; 49(1): 11-4

ABOUT THE AUTHORS: Chad Mayer, MD, PhD is an emergency medicine resident at The Ohio State University Wexner Medical Center; Harsh Sule, MD, MPP, is assistant professor and residency program director at Rutgers New Jersey Medical School; Kelly Barringer, MD, is chair of the Clinical Competency Committee and a member of the core clinical faculty at Regions Hospital Emergency Medicine Residency; Lancelot Beier, MD, is an emergency medicine resident atVirginia Commonwealth University; Andrew Starnes is a medical student at the University of Oklahoma School of Community Medicine; Andrew King, MD, FACEP, is assistant professor, medical education fellowship director, and assistant program director at The Ohio State University Wexner Medical Center.

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BRIEFS AND BULLET POINTS SAEM18

Annual Meeting Website Has Launched!

The official website for SAEM18 is now up and running! Bookmark saem.org/ saem18 and be sure to check back often for the most up-to-date information on SAEM’s annual meeting. We can’t wait to see you in Indianapolis!

Call for SAEM18 Workshops and Didactics SAEM is now accepting proposals for workshops and didactics for the 2018 Annual Meeting. The window for workshop submissions is open through Sept. 15, 2017. Didactics will be accepted through Oct. 1, 2017. For full information, including where and how to submit your proposals, visit the Workshop and Didactic webpages on the SAEM18 website.

Attention Exhibitors!

Exhibiting at SAEM’s Annual Meeting places you in direct contact with decisionmakers in emergency medicine. Join us at SAEM18 in Indianapolis to reap the benefits! Please visit our Exhibitor Information webpage to learn why you should add your name to our growing list of 2018 exhibitors and sponsors.

AEM JOURNALS Academic Emergency Medicine Monthly FOAMed Podcast Now Available!

Check out AEM Early Access, a FOAMed podcast collaboration between Academic Emergency Medicine journal and Brown Emergency Medicine. Each month, you’ll find digital open access to an AEM Article in Press, with an author interview podcast and links to curated FOAMed supportive educational materials for EM learners.

The AEM Early Access podcast is also available via iTunes.

AEM Education and Training AEM E&T Podcast Launches Following suit with the AEM Early Access podcast, a similar forum has been set in

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motion for AEM Education and Training.

The inaugural podcast focuses on a contribution from the July-Aug. issue of AEM E&T, entitled, “Emergency Medicine Morbidity and Mortailty Conference and Culture of Safety: The Resident Perspective.” The AEM E&T podcast, a collaboration between the journal and Brown Emergency Medicine, is available via iTunes, along with all AEM Early Access podcasts.

SAEM FOR RESIDENTS

Graduating Residents: NIH Loan Repayment Programs Accepting Applications National Institutes of Health (NIH) online application and documentation deadlines are open! The NIH Loan Repayment Programs (LRPs) are designed to recruit and retain highly qualified health professionals into biomedical or biobehavioral research careers.

Per the NIH, escalating costs of advanced education and training in medicine and clinical specialties are forcing some scientists to abandon their research careers for higher-paying private industry or private practice careers. The LRPs counteract that financial pressure by repaying up to $35,000 annually of a researcher›s qualified educational debt in return for a commitment to engage in NIH mission-relevant research. Learn how you can benefit from LRPs!

SAEM NEWS

Apply Now for Scholarships for the CDP Program Applications are now being accepted for the AACEM Chair Development Program scholarships. The first scholarship, in collaboration with the Academy for Women in Academic Emergency Medicine (AWAEM), supports participation by a raising female academic emergency medicine leader. The second scholarship, in collaboration with the Academy for Diversity & Inclusion in Emergency Medicine (ADIEM), supports a rising leader

who represents the ADIEM mission. Both scholarships cover the full tuition of $3,940 for 2017 CDP and a $2,500 travel stipend.

Applications are due for both scholarships

by October 16, 2017.

For more information, visit the Chair Development Program website.

EM Day of Service: How Will YOU Help?

As part of this year’s annual EM Day of Service, SAEM staff will again be assisting our neighbors, the Maryville Jen School, with preparation and set up for its annual fundraiser: Jammin’ With Jen. The EM Day of Service is a global philanthropic effort driven by the emergency medicine specialty. It provides an opportunity for the EM specialty to give back to its communities by hosting food drives, helping with home repairs for the elderly or disabled, providing health screenings, cleaning up trash along highways or in parks, preparing meals at a local shelter, visiting nursing homes, and countless other ways. What will you do? Pick a day in September, register, and then go do some good. Please share your good dead with us via a post to our Facebook or Twitter pages, #emdayofservice.

Check Out SOAR for SAEM17 Content SOAR (SAEM Online Academic Resources) is the new home for all open access online medical education, including all of the 2017 annual meeting content. SAEM17 was our biggest and one of our best meetings to date—and the content reflects that. Search by topic for 2017 SAEM Annual Meeting presentations, plus other FOAMed educational content.

It’s time to Renew Your Membership SAEM member renewals start in October.

To ensure you continue to receive the many benefits of SAEM membership, simply log in to your SAEM member account and click “pay.” If you have questions or need personal assistance, just call our membership department at (847) 813-9823 or email membership@ saem.org and one of our staff will be happy to assist you. We appreciate your support and look forward to our continued relationship.

There’s an App for That

Terry Kowalenko Elected President of ABEM

The SAEM Community app provides you with all of the features you enjoy on the web version of the SAEM Community Site, but in a mobile format. Sending messages and staying in the loop with current discussions has never been simpler! Available at iTunes and via Google Play.

Terry Kowalenko, MD, has been elected president of the American Board of Emergency Medicine (ABEM). Dr. Kowalenko has been a member of the ABEM Board of Directors since July 2010 and was elected to the ABEM Executive Committee in 2014. Dr. Kowalenko is professor and chair of emergency medicine at the Oakland University William Beaumont School of Medicine and chair of Emergency Medicine at Beaumont Health Royal Oak, Troy, and Grosse Point.

The Academic Emergency Medicine app lets you enjoy the AEM journal on your desktop, tablet or mobile device.

SAEM members should use their member login and password in order to gain access to content on each of these apps.

IN OTHER NEWS Practice Pathways Closing

The practice pathway for Anesthesiology Critical Care Medicine (ACCM) will close in 2018 on the final date of the 2018 ACCM application cycle. The practice pathway for Emergency Medical Services (EMS) will close in 2019 on the final date of the 2019 EMS application cycle. If you have any questions about subspecialty certification, please contact ABEM at subspecialties@abem.org, or 517-332-4800, ext. 387.

Robert Muelleman Elected President-elect of ABEM Robert L. Muelleman, MD, has been elected president-elect of the American Board of Emergency Medicine (ABEM). Dr. Muelleman has been a member of the Board of Directors since July 2011, and was elected to the Executive Committee in 2015. He has served ABEM in a number of capacities, including as an examiner for the Oral Certification Examination since 2005, an item writer for the ConCertTM Examination, and as an ABEM representative to the Residence Review Committee for Emergency Medicine.

Dr. Muelleman is professor and past chair of the Department of Emergency Medicine at the University of Nebraska Medical Center.

ACADEMIC ANNOUNCEMENTS Indiana University School of Medicine

Peter S. Pang, MD

Peter S. Pang, MD, from the Department of Emergency Medicine at Indiana University School of Medicine, was awarded R01 HS025411 “Using Short Stay Units (SSU) Instead of Routine Admission to Improve Patient Centered Health Outcomes for Acute Heart Failure (AHF) Patients” from the Agency for Healthcare Research and Quality (AHRQ).

This 5-year, multi-site, randomized controlled trial will test whether an observation or short stay unit strategy-of-care outperforms inpatient management for lower risk patients with AHF. Other sites include Wayne State University (Phillip D. Levy, MD) and Vanderbilt University Medical Center (Sean P. Collins, MD).

Working together for more than a decade, Drs. Pang, Levy, and Collins form the nucleus of the EMROC (Emergency Medicine Research and Outcomes Consortium) AHF network; a boutique network of proven clinical trial sites. In addition to PCORI FC14-1409-21656 (GUIDED-HF) and NHLBI 1 R34 HL136986-01 (BLUSHED-AHF), this is the third federal award in the last three years being run through the network. EMROC Sean P. Collins, MD has also emerged to become the premier ED based AHF network in the US with EMROC sites leading the way in enrollment for the last several Phase III clinical trials. In recognition of these contributions, EMROC has earned a seat at the table, serving on the leadership of national and international clinical trials, including as steering committee and executive committee members.

Phillip D. Levy, MD

UC Irvine Health

J. Christian (Chris) Fox, MD, has been formally named the new Interim Chair of Emergency Medicine at UC Irvine Health. Dr. Fox previously served as the department's vice chair of academic affairs and was part of the executive leadership team with Dr. Erik Barton. He has served as assistant dean for student affairs in the School of Medicine, is director of ultrasound in medical education and is the department's ultrasound fellowship director. Since joining the faculty in 2001, Dr. Fox has been a national leader in integrating the use of ultrasound in emergency medicine and in medical education.

University of Washington

Susan Stern, MD, has secured departmental status for emergency medicine at the University of Washington (UW) and will become the inaugural chair of emergency medicine at UW effective September 2017. Dr Stern joined the department as professor of medicine and the new head of the Division of Emergency Medicine in 2009. During her eight years as division head, the division has seen unprecedented growth in faculty and educational development, an integrated clinical service, and increased research funding.

Thomas Jefferson University Judd E. Hollander, MD has been appointed enterprise-wide Senior Vice President for Healthcare Delivery Innovation at Thomas Jefferson University. He remains Associate Dean for Strategic Health Initiatives in the Sidney Kimmel Medical College.

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

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

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

Assistant Research Director Washington University Emergency Medicine is seeking an Assistant Research Director to help lead a large, nationally-recognized research group.

Required qualifications: • Experience as a Principal Investigator of prospective, interventional,

and clinical trials (2-3 years) Washington University Emergency Medicine is currently engaged in research projects ranging from industry-sponsored clinical trials to federally-funded grants. The division also runs an Emergency Care Research Core (ECRC) which provides screening and recruitment resources to the university in studies involving acute illness and injury. The ECRC infrastructure includes 10 research coordinators with 24/7 emergency department coverage, 3 information technology specialists, and 1 data/statistical analyst.

The Emergency Medicine Division staffs the Barnes-Jewish Hospital Emergency Department (academic medical center, 90,000 patients/year, Level 1 trauma center) as well as associated community hospitals. The division supports a fully-accredited four-year EM residency with 13 residents per class and multiple fellowship programs.

Recognized as one of the nation's most affordable cities, St. Louis features renowned suburbs with top-ranked schools, abundant outdoor activities and midwest hospitality.

Washington University School of Medicine seeks exceptionally qualified and diverse faculty; women, minorities, protected veterans and disabled candidates are strongly encouraged to apply.

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• Experience with both industry-funded and grant-funded research

studies • Grant writing/review experience • Leadership experience including the ability to train research staff and

oversee study initiation • Board Certified in Emergency Medicine

Learn more at emed.wustl.edu/facultyjobs Interested candidates should send or email a letter of interest and curriculum vitae in confidence to: Brent E. Ruoff, M.D. Associate Professor Chief, Division of Emergency Medicine Washington University School of Medicine CB 8072, 660 S. Euclid Ave. • St. Louis, MO 63110 ruoffb@wustl.edu

WESTERN PENNSYLVANIA

Geriatric Emergency Medicine Fellowship Opportunities

Geriatric Emergency Medicine Fellowship Opportunities

The University of California, Davis School of Medicine, Department ofThe Emergency is pleased announce the opening of a University ofMedicine California, Davis School oftoMedicine, Department of Emergency MedicineEmergency is pleased to announce opening of a available Geriatric Emergency Geriatric MedicinetheFellowship, as a oneMedicine or two Fellowship, available as a one or two year program.

Both one and two year programs year program. Both one and two year programs offer significant offer significant opportunities to develop clinical areas of expertise. The two-year opportunities to develop clinical areas of expertise. The two-year option would include a Masters level degree in research or education. Candidates option would include a Masters levelMedicine degreeand in research or education. must be residency trained in Emergency Candidates must be residency trained in Emergency Medicine and be be board eligible/certified and eligible for licensure in California. board eligible/certified and eligible for licensure in California.

The University of California, Davis, Medical Center, is a 500 bed academic medical

The University of California, Medical Center, isdepartment a 500 visits bed center, Level 1 trauma Center withDavis, more than 80 000 emergency annually. Our residency training program in Emergency Medicine began than more 80 academic medical center, Level 1 trauma Center with more thanemergency two decades ago and has 48 residents.

The department is a state-of-the-art, 000 department visits annually.

Our residency training Geriatric friendly Emergency Department with expanded space and amenities. program in Emergency Medicine began more than two decades ago and has 48to residents. department is Fellowship, a state-of-the-art, Geriatric In addition the GeriatricThe Emergency Medicine the Department of friendly Emergency with expanded amenities.

Emergency Medicine Department currently has clinical Fellowships space availableand in Education, Health

Policy, Research, Ultrasound, Global Ultrasound, Toxicology, and Simulation.

In Interested additioncandidates to the should Geriatric Emergency Medicine submit a letter outlining interests, Fellowship, and curriculum the vitae to:

Department of Emergency Medicine currently has clinical Fellowships Katren Tyler available in MD Education, Health Policy, Research, Ultrasound, Global Professor Toxicology, and Simulation. Interested candidates should Ultrasound, Associate Program Director submit a letter outlining interests, and curriculum vitae to: Geriatric Emergency Medicine Fellowship Director Vice Chair Faculty Development, Wellness and Outreach Katren TylerforMD Department of Emergency Medicine Professor University of California, Davis Associate Program Director krtyler@ucdavis.edu Geriatric Medicine Fellowship Director UC DavisEmergency Dept. of Emergency Medicine 2315 Stockton Blvd., PSSB 2100 Vice Chair for Faculty Development, Wellness and Outreach Sacramento,of CAEmergency 95817 Department Medicine University of California, Davis krtyler@ucdavis.edu

UC Davis Dept. of Emergency Medicine 2315 Stockton Blvd., PSSB 2100, Sacramento, CA 95817

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

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

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

EOE Minority/Female/Vet/Disabled

72714C HRI&E 02/17

ronald o. perelman department of emergency medicine

FELLOWSHIP OPPORTUNITIES ed safety and quality

The Kenneth and JoAnn G. Wellner Fellowship in Emergency Department Safety and Quality aims to prepare graduates to

assume leadership opportunities in quality and safety administration, clinical operations, education, informatics, and research. Educational, administrative, and operational experience are gained through participation in formal didactic learning sessions; teaching and training multiple learner levels in quality and safety activities; and participation in a variety of departmental and organizational initiatives. A number of funded and spontaneous QA/QI research activities provide the opportunity for scholarly and research endeavors, with the support of a dedicated data analyst. Support for advanced degrees tailored to learning and career interests are considered on a case-by-case basis, which may include Masters and Certificate programs in Comparative Effectiveness Research Training, MPH, MPA in Health Policy and Management, Masters of Health Professions Education, or the Biomedical Informatics Master’s Graduate Program. more information: Silas W. Smith, MD, FACEP, FACMT, silas.smith@nyumc.org emergency ultrasound

The Fellowship in Emergency Ultrasound, established in 2012,

aims to prepare graduates to pursue academic or community leadership positions in emergency ultrasound, education and research. This 1- or 2-year postgraduate program focuses on developing educational, administrative and research skills through formal didactics, hands-on experiential scanning shifts, simulation sessions, journal review, image review and participation in division research projects. The Ultrasound Division has five dedicated ultrasound faculty members participating in fellow education and scholarly activities. The Division places particular emphasis on undergraduate medical education (UME) and the fellow has the opportunity to participate in all UME ultrasound curricular innovations and teaching opportunities.

Interested candidates may have the opportunity to pursue an advanced degree in Masters of Health Professions Education (MHPE). more information: Uché Blackstock, MD, RDMS, uche.blackstock@nyumc.org and Kristin Carmody, MD, MHPE, kristin.carmody@nyumc.org

pediatric em

The Fellowship in Pediatric Emergency Medicine was established

in 1987 and is an ACGME accredited, three year program (pediatric trained fellows) or two year program (emergency medicine trained fellows) focusing on education and experience in patient care, research, teaching, and administration. The goal of the fellowship program is to produce physicians who are clinically proficient in the practice of Pediatric Emergency Medicine, especially in the management of the acutely ill and injured child. In addition, fellows are given the opportunity to become skilled teachers, knowledgeable investigators and competent administrators. With the unique resources of Bellevue Hospital Center and NYU Langone Medical Center, we are able to offer a fellowship of the highest caliber. Interested candidates may have the opportunity to pursue advanced degrees in Masters of Health Professions Education or Masters Programs in Clinical Investigation. more information: Michael Mojica, MD, michael.mojica@nyumc.org

medical toxicology

The Fellowship in Medical Toxicology is a NYU Langone

Medical Center based ACGME accredited program at the New York City Poison Control Center. The program has received full certification through the ACGME’s Emergency Medicine Residency Review Committee. The program’s aim is to train physicians in the thoughtful and compassionate care of the poisoned patient. We focus on the clinical and academic aspects of toxicology and pharmacology, in order to prepare our graduates for careers in leadership roles in research, teaching, patient care, and poison control center management. The training period is two years in duration and goals are achieved through clinical and didactic education and academic development. Trainees are expected to participate in the Medical Toxicology Board Certification examination upon completion of the fellowship. more information: Rana Biary, MD, rana.biary@nyumc.org

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DEPARTMENT OF EMERGENCY MEDICINE MASSACHUSETTS GENERAL HOSPITAL A Major Teaching Affiliate of Harvard Medical School

Geriatric Emergency Medicine Fellowship Opportunities

Emergency Medicine Research Fellowship Opportunities The Department of Emergency Medicine at Massachusetts General Hospital

The Department of Emergency Medicine at Massachusetts General Hospital is seeking is seeking for candidates academic faculty positions.

Special consideration candidates academicfor faculty positions.

Special consideration will be given to those academic interests in the following areas:in the following areas: will bewith given to those with academic interests Emergency Ultrasound •-- Emergency Ultrasound Disaster Medicine •- Disaster Medicine Neurological Emergencies -

Vascular Emergencies

• Neurological Emergencies • Vascular Emergencies

Candidates must have a commitment to excellence in clinical care and Candidates must haveappointment a commitment to be excellence in clinical care and teaching; teaching; academic will at Harvard Medical School and is academic appointment will be at Harvard Medical School and is commensurate with commensurate with scholarly achievements. scholarly achievements.

MGH isis the thehome homeof ofthethe 4-year MGH/BWH Harvard Affiliated Emergency MGH 4-year MGH/BWH Harvard Affiliated Emergency Medicine Residency Program. The ED at MGH a high volume, levelhigh 1 trauma and Medicine Residency Program.

TheisED at MGH is ahigh highacuity volume, acuity burn center caring for approximately 112,000 adult and pediatric patients annually. level 1 trauma and burn center caring for approximately 112,000 adult and

The successful candidate will join a faculty of 48 academic emergency physicians in pediatric patients annually. a department with active research and teaching programs as well as fellowship programs in administration, global ofhealth, medicalemergency simulation, The successful candidate willresearch, join a faculty 48 academic ultrasonography, medical education, geriatrics, and wilderness medicine.

physicians in a department with active research and teaching programs

Inquiries should be accompanied by in a curriculum vitae and may submitted email as well as fellowship programs administration, research, globalby health, (Brown.david@mgh.harvard.edu) to:

medical simulation, ultrasonography, medical education, geriatrics, and

wilderness medicine.

David F. M. Brown, MD FACEP MGH Trustees Professor & Chair Inquiries should be accompanied Department of Emergency Medicine by a curriculum Massachusetts General Hospital by email (Brown.david@mgh.harvard.edu) to: Boston, Massachusetts 02114

The UC Davis Department of Emergency Medicine would like to announce the continued availability of two-year Emergency Fellowships.

The The University of California, Davis School of Medicine Medicine, Research Department of Emergency Department General Emergency Research Fellowship with Medicine ismaintains pleased toa announce the openingMedicine of a Geriatric Emergency Medicine theFellowship, area of research dependent on program. the scholar’s addition, the availablefocus as a one or two year Bothinterest. one andIn two year programs Department has opportunities specific designed areasclinical of research including the offer significant to develop areas offellowships expertise. The two-year following: option would include a Masters level degree in research or education. Candidates must be residency trained in Emergency Medicine and

• Cbe ardiovascular Research Fellowship: focused on clinical cardiac and vascular board eligible/certified and eligible for licensure in California. emergencies • Infectious Disease ResearchDavis, Fellowship: diseases medical in the The University of California, Medicalfocused Center, on is ainfectious 500 bed academic emergency setting center, Level 1 trauma Center with more than 80 000 emergency department visits • Eannually. mergency Mental Health Research Fellowship: focused on epidemiology Our residency training program in Emergency Medicine began moreand treatment of mental health emergencies than two decades ago and has 48 residents. The department is a state-of-the-art, • VGeriatric iolence Prevention Research Fellowship: focused on the epidemiology and friendly Emergency Department with expanded space and amenities. prevention of violence • PInediatric Emergency Medicine Research Fellowship: with exposure to addition to the Geriatric Emergency Medicine Fellowship, the Department of multicenter PECARN Emergency research Medicine via currently has clinical Fellowships available in Education, Health Research, Ultrasound, Global translational-science Ultrasound, Toxicology, and Simulation.

• RPolicy, esuscitation Research Fellowship: resuscitation Interestedfellowship candidates should from submit a letter research bridging bench to outlining bedside interests, and curriculum vitae to: • Trauma Research Fellowship: focused on clinical trauma research Tyler MD • UKatren ltrasound/Research Fellowship: combining both ultrasound and research Professor fellowships Associate Program Director • Toxicology/Research Fellowship (3 years): combining both toxicology and Geriatric fellowships Emergency Medicine Fellowship Director research Vice Chair for Faculty Development, Wellness and Outreach

MGH Trustees General Professor & Chair Massachusetts Hospital is an equal opportunity/affirmative action employer.

Department of Emergency Medicine Description and Requirements: of California,ofDavis • EUniversity ligibility: Completion an accredited Emergency Medicine Residency krtyler@ucdavis.edu Program or Pediatric Emergency Medicine Fellowship or PhD in Epidemiology, UC Davis Dept. of Emergency Biostatistics or Public Health Medicine Stockton Blvd., PSSB 2100 • G2315 raduate Coursework tailored to the scholars needs including MPH or MAS Sacramento, CA 95817 degrees if appropriate

Massachusetts General Hospital is an equal opportunity/affirmative action employer.

Contact Information: James F. Holmes, MD, MPH, Professor and Vice Chair for Research Department of Emergency Medicine jfholmes@ucdavis.edu 916-734-1533

vitae and may submitted

David F. M. Brown, MD FACEP Department of Emergency Medicine Massachusetts General Hospital Boston, Massachusetts 02114

2315 Stockton Blvd PSSB 2100 UC Davis Medical Center Sacramento, CA 95817

Academic Emergency Medicine Physicians The University of Chicago's Department of Medicine, Section of Emergency Medicine, is seeking full-time faculty members to serve as Emergency Physicians as we prepare to open a new adult emergency department and establish an adult Level 1 Trauma Center.

Academic rank is dependent on qualifications. Applicants are required to be board certified or board eligible in emergency medicine and to be eligible for Illinois licensure by the start of appointment. Responsibilities will include teaching in the educational programs sponsored by the Section and participation in scholarly activity. We seek candidates looking to develop an academic niche that builds upon our faculty expertise in basic and translational research, health equity and bioethics research, geriatric emergency care, global emergency medicine, medical education, prehospital medicine, aero-medical transport, and ultrasound. We host one of the oldest Emergency Medicine Residency programs in the country and serve as a STEMI receiving hospital, a Comprehensive Stroke Center, a Burn Center, and a Chicago South EMS regional resource hospital. The Adult ED has an annual volume of 65,000 and our Pediatric ED cares for 30,000 patients per year, including 1,000 level 1 trauma patients.

This position provides competitive compensation and an excellent benefits package. Those interested must apply by uploading a cover letter and current CV online at academiccareers.uchicago.edu/applicants/Central?quickFind=55160. Review of applications will continue until all available positions are filled.

The University of Chicago is an Affirmative Action/Equal Opportunity/Disabled/Veterans Employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national or ethnic origin, age, status as an individual with a disability, protected veteran status, genetic information, or other protected classes under the law. For additional information please see the University's Notice of Nondiscrimination at http://www.uchicago.edu/about/non_discrimination_statement/.

Job seekers in need of a reasonable accommodation to complete the application process should call 773-702-0287 or email ACOppAdministrator@uchicago.edu with their request.

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Emergency Medicine Faculty Positions

Advocate Christ Medical Center – Oak Lawn, IL

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Post today or speak to an expert who can help create a customized recruiting solution to get you great candidates.

Advocate Medical Group (AMG) is expanding the Department of Emergency Medicine at Advocate Christ Medical Center and seeks outstanding physicians to join our faculty.

Available positions include Assistant Research Director, Assistant Residency Director, Assistant Simulation Director, and Assistant Medical Student Clerkship Director.

Advocate Christ Medical Center (ACMC) is part of Advocate Health Care, one of the nation’s leading health care networks. A not-for-profit, 749-bed, premier teaching institution with more than 1,500 affiliated physicians, ACMC is one of the major referral hospitals in the Midwest for a number of specialties, including cancer care; cardiovascular services; heart, kidney and lung transplantation; neurosciences; orthopedics; and women’s health. The hospital provides emergency care for more than 110,000 patient visits annually and has one of the busiest Level I trauma centers in Illinois.

ACMC has been named to the Truven Health 100 Top Hospitals® list for four years (2012-2015). ACMC has more than 400 residents, 600 medical students and 800 nursing students trained in accredited programs and a range of specialties each year.

Practice Opportunity Highlights: • Our three-year emergency medicine program matches 13 residents annually and fosters a friendly environment of camaraderie, support, and service.

• ACMC is a tertiary/quaternary care center with emphasis on advanced cardiac and stroke care and is the only Level I Trauma Center serving the south side of Chicago.

• Advocate is committed to growth. Along with an additional 72-bed inpatient tower completed in January 2016, a new 84-bed emergency department has been constructed for 2017.

• Our high acuity emergency department cares for more than 110,000 patients annually, including 38,000 pediatric visits to our dedicated pediatric emergency department.

• Academic appointments are available for qualified applicants through the University of Illinois. Compensation and benefits are highly competitive. Many faculty members and residents live in downtown Chicago and enjoy all that this world-class city has to offer.

Job Requirements: Applicants must be Board Eligible or Board Certified in Emergency Medicine or Pediatric Emergency Medicine and dedicated to education and clinical excellence. Additional interests in research, ultrasound, simulation, and administration are highly valued.

If you are interested, email your CV to Angela Chavez at angela.chavez@advocatehealth.com

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I am a

Boxer I am

Sharon Atencio I am an

Academic Emergency Physician

Supported in part by

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

Watch Sharon's Video!

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SEE YOU IN

Indianapolis, Indiana – May15-18