SAEM PULSE September–October 2019 by Society for Academic Emergency Medicine

SEPTEMBER-OCTOBER 2019 | VOLUME XXXIV NUMBER 5

www.saem.org

SPOTLIGHT CALLED TO IMPACT THE LIVES OF SOCIETY'S MOST VULNERABLE AND NEEDY An Interview with

Sheryl Heron, md, mph

NURSING-PHYSICIAN COMMUNICATION page 38

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

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, mschagrin@saem.org Director, Finance & Operations Doug Ray, MSA Ext. 208, dray@saem.org Manager, IT Dan San Buenaventura Ext. 225, DSanBuenaventura@saem.org Accountant Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Marisol Navarro Ext. 205, mnavarro@saem.org Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, sroseen@saem.org Manager, Digital Communications Snizhana Kurylyuk Ext. 201, skurylyuk@saem.org Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, mmcmillian@saem.org Manager, Business Development John Landry, MBA Ext. 204, jlandry@saem.org

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, hbyrdduncan@saem.org Membership Manager George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Meeting Planner Alex Elizabeth Keenan Ext. 218, akeenan@saem.org Membership & Meetings Coordinator Monica Bell Ext. 202, mbell@saem.org AEM Editor in Chief Jeffrey Kline, MD AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD AEMETeditor@saem.org AEM/AEM E&T Manager Stacey Roseen Ext. 207, sroseen@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen tbowen@saem.org Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO sharonatencio@me.com Associate Editor, SAEM BOD D. Mark Courtney, MD Associate Editor, RAMS Shana Zucker, szucker@tulane.edu

2019-2020 BOARD OF DIRECTORS Ian B.K. Martin, MD, MBA President Medical College of Wisconsin

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

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

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

Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center

Michelle D. Lall, MD Emory University Angela M. Mills, MD Columbia University

Stephen C. Dorner, MD, MPH, MSS Brigham and Women's Hospital and Massachusetts General Hospital

Megan L. Ranney, MD, MPH Brown University

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

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

Presidentâ&#x20AC;&#x2122;s Comments The Changing, Sometimes Troubled, Landscape of Residency Training

Spotlight Called to Impact the Lives of Society's Most Vulnerable and Needy

Diversity and Inclusion Departmental Diversity: Whose Responsibility Is It?

Ethics in Action What to do When a Parent Discharges a Child Against Medical Advice

Geriatric Emergency Medicine Essential Steps to Starting a Geriatric-friendly ED

Global Emergency Medicine Taking Emergency Care to the World Stage at the World Health Assembly: A New Resolution on Emergency and Trauma Care

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Health & Wellness Cultivating Compassion: A Primer for Preventing Burnout in Academic Emergency Medicine SGEM: Did You Know? Sex-based Differences in Gout Promotional Toolkit Promoting Your Research Through Social Media Women In Academic EM Ending Harassment in the Emergency Department Introducing Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE)

Recommended Best Practices for Didactic Submissions

Career Guide Planning for an Academic Career: Strategies for Emergency Medicine Residency and Beyond

38 46 50 52

Briefs and Bullet Points Academic Announcements Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. ÂŠ 2019 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 Ian B.K. Martin, MD, MBA Medical College of Wisconsin 2019–2020 SAEM President

The Changing, Sometimes Troubled, Landscape of Residency Training Welcome to the second edition of my President’s Comments. As mentioned before, I hope to use this column to explore with you a number of important, contemporary topics related to medical education, research, and faculty development. If there are particular topics on which you would like me to comment, I welcome suggestions at president@saem.org.

"In these times of need, we have rallied as a Society to help displaced residents find suitable programs at which to complete their training… Gestures such as these should serve as a reminder to all of us of the importance SAEM can play in the lives of those in emergency medicine."

With the recent loss of the Summa Health Emergency Medicine training program, and the dismantling of the Drexel University College of Medicine/Hahnemann University Hospital (“Drexel/Hahnemann”) emergency medicine residency program, I thought it timely to write about the changing, sometimes troubled, landscape of residency training. While the specifics resulting in the dismantling of these two programs are distinct from one another, these closures evidence at least two disturbing trends in residency training: 1) the growing number of emergency medicine residency programs administered by contract management groups (in the Summa Health case); and 2) an increasing number of emergency medicine residency programs housed within a for-profit hospital (in the case of Drexel/Hahnemann). When an emergency medicine training program closes, we all, of course, mourn for the displaced residents. During these turbulent times, the “orphaned” resident is left to contemplate some of the following, and more: • “Will I be able to finish my training in emergency medicine?” • “Will I get first-rate training at another emergency medicine residency program?” • “Will another emergency medicine residency program accept me in transfer?”

• “Where will I end up completing my training?” • “How will I afford a move to a new, distant training site?” • “How will a move to a program far away affect my personal life?” But the dismantling of an emergency medicine training program can mean so much more. Residents lose a place to train, and faculty members potentially lose a place to work. What happens to “orphaned” emergency medicine faculty members? For a whole host of reasons, this question can be much more difficult to answer than the same question about trainees. Some reasons for this additional difficulty include: • Neither hospitals nor medical schools receive federal dollars to employ faculty members; • faculty members are usually more entrenched in their longstanding places of employment and communities of residence; and • with relatively stable faculties in terms of staffing levels, academic departments of emergency medicine are less able to “absorb” displaced faculty members upon closure of training programs.

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SPOTLIGHT CALLED TO IMPACT THE LIVES OF SOCIETY'S MOST VULNERABLE AND NEEDY

SAEM Pulse talks with Sheryl Heron, MD, MPH Dr. Sheryl Heron, MD, MPH, is professor of emergency medicine, vice chair for administrative affairs in the department of emergency medicine, and assistant dean for medical education and student affairs at Emory University School of Medicine. She received her MD at Howard University College of Medicine and completed her emergency medicine residency at King Drew Medical Center. Prior to starting medical school, she received her MPH at Hunter College in New York. Dr. Heron has long been an integral SAEM member and serves on the SAEM Wellness Committee, SAEM's Academy for Diversity & Inclusion in Emergency Medicine (ADIEM), and SAEM's Academy for Women in Academic Emergency Medicine (AWAEM). She is the recipient of many awards, including the American College of Emergency

Physicians National Faculty Teaching Award, the Woman in Medicine Award from the National Medical Association Council on the Concerns of Women Physicians, the Gender Justice Award from the Georgia Commission on Family Violence, and the Outstanding Woman Award at Emory University School of Medicine. Her research interests include diversity and disparities in medicine, intimate partner violence, and wellness and well-being for the healthcare professional. She is co-editor of two textbooks: Diversity & Inclusion in Quality Patient Care and Diversity & Inclusion in Quality Patient Care (2016) 2nd edition; and Your Story/Our Story: A Case-Based Compendium (2019). Dr. Heron was interviewed for this issue by Sharon Atencio, DO, chair of the SAEM Pulse Editorial Advisory Task Force.

Why emergency medicine? Emergency medicine has been my destiny. Called to a profession where we see the juxtaposition of public health each day, the ability to intervene in and impact the lives of our most vulnerable and needy citizens has indeed been a calling. Thanks to my best friend Dr. Patricia Baines, an emergency medicine physician now practicing in Australia for letting me see the light.

Who were some of the mentors and teachers who contributed to your success? Without question, Drs. Vivian Pinn (Howard University College of Medicine and emeritus director NIH Womenâ&#x20AC;&#x2122;s Health), Arthur Kellermann (Emory), Marcus Martin (University of Virginia), Kate Heilpern (Emory), emergency medicine (EM) giants and former chairs at Emory and UV, respectively; Dr. Nadine Kaslow (chief psychologist at Grady and former president of the

The Heron 8 “The Heron philosophy is my internal credo I use to live my life. Everyone needs three things and five communities to support them. When conducting a history with my patients, I incorporate these eight things.” — Sheryl Heron, MD L-R, Drs. Haley, Shayne, Heron, Quest, Ander, Patrice Harris (President of AMA), Hany Atallah. Leaders in medicine at National Medical Foundation.

The three things are 1) something to do that is meaningful,

"Opportunities are out there; one must seize them and

2) someone to love,

believe they can make a difference when you sit at the

3) something to look forward to.

table. That’s the power of leadership." American Psychology Association). And most importantly, Basil and Amy Heron, my parents—who taught me the value of education and excellence.

How does being a self-described “Jamerican” shape your outlook? As an immigrant who arrived to America in 1968, a time of political unrest in the United States, my ability to see through the lens of striving for excellence is and always has been clear. My family assured me I could do anything, be anything — and that I should to contribute to the world because of that foundation. We were surrounded in Jamaica by leaders, teachers, physicians — people who weren’t hampered or afraid of who we are or who we could be. This foundation brings life to others who may not believe or who second guess their right to have access to whatever they may need to be successful.

How did you first become involved with SAEM? What are some of your favorite roles and accomplishments within SAEM? My first poster presentation at SAEM was in 1995, addressing emergency medicine’s response to domestic violence, now referred to as intimate partner violence. The thrill of presenting information that could change our thinking on how to address this public

The five communities are

health problem was eye-opening. My subsequent involvement in the Diversity Interest Group with colleagues such as Drs. Thea James, Kevin Ferguson, Marcus Martin, Lynne Richardson, Lisa Moreno-Walton, and many others too numerous to mention, led to my role as inaugural president of the Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) — by far the most impactful and meaningful role and work I’ve done in SAEM. ADIEM started with 100 members and has grown in size and scope to be representative of the many facets of diversity, including LGBTQ, in addition to partnering with AWAEM and other academies.

What would you say to someone who genuinely believes that the challenges faced by a woman in EM are no different from those of a man? My first question would be how was that conclusion reached? There are countless studies and clear data that speak to the contrary. The need for gender equity is palpable and needed with urgency. We now have more women entering medical school than men, yet the “leaky” pipeline to leadership positions both in

1) Community of Origin (parents, grandparents, aunts, siblings, etc.); 2) Community of Creation (your partner, spouse, and/or co-parent); 3) Community of Work 4) Community of Neighbors 5) Community of Faith

How to “Do You” Without Apology: The Power of the Ps • Know your philosophy, purpose, and passion • Pause to check your pulse, to prioritize, and to recognize the privilege of what you do • Ensure you have partnerships • Route it all through patience/ patients and prayer

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PRESIDENT continued from Page 3 Dismantling of a program can also mean a loss of history. For example, the Drexel/Hahnemann emergency medicine training program is the second oldest in the country — just shy of its 50th year of training residents from across the nation— and one of the “giants” in our field. In the end, closure of this program is not only a loss of training slots; it is sadly also the loss of a beacon in emergency medicine education.

SAEM PULSE | SEPTEMBER-OCTOBER 2019

The “silver lining” in all of this for me has been our specialty’s and SAEM’s response to these recent closures. Chiefly, in these times of need, we have rallied as a Society to help displaced residents find suitable programs at which to complete their training. In addition, in collaboration with the leadership of the Drexel University College of Medicine Department of Emergency Medicine, we lobbied the Accreditation Council for Graduate Medical Education (ACGME) Review Committee (RC) for emergency medicine in support of Drexel/Hahnemann’s efforts to reconstitute the closing program into a new one with a different sponsor. Lastly, with the expectation that these sorts of events will occur more often given the evolving emergency medicine training landscape, the SAEM Board of Directors may incorporate a line item for relief funds to help support displaced emergency medicine residents into the annual operating budget of the Society. Gestures such as these should serve as a reminder to all of us of the importance SAEM (and other emergency medicine associations) can play in the lives of those in emergency medicine.

Once the proverbial “dust” has settled on these recent program closures, I am sure that I will revisit this topic in a coming edition — hopefully sharing some lessons learned. Until next time …

ABOUT DR. MARTIN: Ian B.K. Martin, MD, MBA, is professor and system chair of the Department of Emergency Medicine and professor of medicine at the Medical College of Wisconsin (MCW). He served SAEM previously as president-elect, secretarytreasurer, and an at-large member of the Society’s Board of Directors. Dr. Martin is a founding member and past-president of SAEM’s Global Emergency Medicine Academy (GEMA).

L-R, Drs. Angela Mills, Yvette Calderon, Dara Kass, Jill Baren, Esther Choo, Sheryl Heron at 2018 ELAM.

"…to touch the soul of a person who trusts you enough to share their most sacred thing — their bodies, their concerns — is an incredible gift and a true privilege. It’s sacred, and despite the fatigue, we must dig deep to honor that trust." the community and in academia is telling. Foundationally, we need allies to work together to address the challenges women face in advancing their lives. FemInEM, AWAEM, ELAM (Executive Leadership in Academic Medicine), and AAMC’s MIDWIMS (Mid-Career Women in Medicine and Science) are key national organizations that address the need for gender equity and, more importantly, ensure we have the evidence and the collective will for those who may raise such a question.

You’ve been deeply involved with issues relating to firearm violence for the past 20 years. What do you think needs to happen for our culture to change? It's simple. We need to vote and to have courage. Courage to tackle the behemoths like the NRA (National Rifle Association) and the politicians who aren’t open to exploring the science needed to address gun control. People are senselessly dying in this epidemic of gun violence, not to mention the countless others who are injured. As Spike Lee would say, “Wake up.”

What advice would you give to a student or mentee who wants to become involved in emergency medicine leadership? Find a mentor. Be hungry for opportunities and be involved. Opportunities are out there; seize them and believe you can make a difference when you sit at the table. That’s the power of leadership.

What’s a valuable lesson you’ve learned from your patients? They have taught me much. We are all human and all one needs to do is listen — really listen — to what is being said and perhaps to what is not being said. I keep a book of lessons learned that I carry each day at work and reflect on as I continue to learn from my patients.

What’s a valuable lesson you’ve learned from your trainees? Life is evolving and the struggle is real, no matter where you are on the journey.

When one is weary, trainees remind me they are the future and we need them to continue to care with the greatest intent for our patients and each other.

What do you wish people understood about the work you do? For me, medicine is truly a ministry. It’s all too simple to suture lacerations and address the medical needs of our patients in extremis, but to touch the soul of a person who trusts you enough to share their most sacred thing — their bodies, their concerns — is an incredible gift and a true privilege. It’s sacred, and despite the fatigue, we must dig deep to honor that trust.

Let’s say that by some incredible turn of fate, you suddenly find yourself with a whole day off with no prior commitments. What would you do? Interesting question. I would reflect and give thanks, spend time with my husband Boniface Thomas at the end of the day, and at the beginning of the day I'd "do me" — meditate, take a stroll, enjoy a spa day, breathe …

Dr. Heron and her husband Boniface Thomas, during a birthday celebration in New York.

What’s the last good book you read? The Watch, by Leon Haley Sr.

“Wellness” is a loaded word these days, but what is your interpretation of it? What do you do to have work/life balance? Wellness is “doing you” without apology. For me, this is the power of the “Ps”: Knowing one’s philosophy, purpose, passion; pausing to check one’s pulse; prioritizing and recognizing the privilege of what we do; ensuring we have partnerships —all rooted in patience/ patients and prayer.

L-R, Drs. Judith Tintinalli, Lisa Moreno-Walton, and Sheryl Heron at an ACEP reception.

What do you think is the future of emergency medicine? The place where all will come to obtain immediate access to healthcare and navigation of same, particularly as our population ages.

At the end of your career, how would you like to be remembered? My epitaph would read: “And she lived, and more importantly, she lived, cared, and loved intensely.”

L-R, Dr. Heron’s colleague Philip Shayne, former program director, and residents during Mission trip to Jamaica in 2018.

L-R, Dr. Hany Atallah, former Georgia House Democratic Leader and gubernatorial nominee Stacey Abrams, and Dr. Sheryl Heron.

DIVERSITY AND INCLUSION

Departmental Diversity: Whose Responsibility Is It?

SAEM PULSE | SEPTEMBER-OCTOBER 2019

Marquita N. Hicks, MD, MBA and Ava E. Pierce, MD

Diversity and Inclusion (D&I) is a key factor in academic medicine and patient care. In 2011, Dr. Marc Nivet, executive vice president for institutional advancement at UT Southwestern Medical Center, described diversity 3.0. He stated that “Diversity work must be seen as more than just solving the problem of inadequate representation and alleviating the barriers facing disadvantaged and marginalized populations. Promoting diversity must be tightly coupled with developing a culture of inclusion, one that fully appreciates the differences of perspective. Together, diversity and inclusion can become a powerful tool for leveraging those differences to build innovative, high-performing organizations.”

McKinsey and Company documented how diversity and inclusion impact organizations financially. According to their 2015 Diversity Matters report, companies in the top quartile for racial/ ethnic diversity and gender diversity are three percent and 15 percent, respectively, more likely to have financial returns above their respective national industry medians. This year, the Accreditation Council for Graduate Medical Education (ACGME) common program requirements included the requirement that programs, “in partnership with its Sponsoring Institution, must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows, faculty

members, senior administrative staff members, and other relevant members of its academic community.” (ACGME CPR 1C). Additionally, ACGME also selected its first chief diversity officer, Dr. William A. McDade, “to focus on national initiatives to diversify and include underrepresented groups throughout the medical education continuum with the goal of providing physicians with the knowledge and skills required to serve the American public in humanistic environments where clinician and patient well-being is promoted.”

Who is responsible for ensuring departmental D&I efforts are executed?

Recognizing that enhanced D&I results in increased employee and patient satisfaction, increased organizational revenue, and continued accreditation, many institutions are asking departments to actively address D&I. Who is responsible for ensuring departmental D&I efforts are executed?

This is a question that many emergency medicine departmental leaders are currently addressing. Is it the chair’s responsibility? Chairs set the tone for the department and has the power to insist that the D & I efforts happen. They can direct the appropriate resources and are often in charge of hiring faculty. Is it the responsibility of the vice-chair of clinical affairs? Vice-chairs need to assure culturally competent patient care. Is it the responsibility of the program director? The resident complement is one of the largest groups in the ED. They are the first contact for patients in most cases. Program directors “hire” the residents. Is it the responsibility of a faculty member? Faculty are responsible for training students, residents and fellows who will provide care for our increasingly diverse patient population.

Is it the responsibility of a diversity committee? A diversity committee inclusive of faculty, staff, and trainees volunteering their time would be meeting regularly to address D&I opportunities in the department and develop a plan for implementation. Is it the responsibility of the Deans for Graduate Medical Education? Deans for GME need to assure program compliance with ACGME requirements across all departments. Is it the responsibility of the chief diversity officer? Chief diversity officers need to oversee the organization’s performance in D & I and help to direct resources. Everyone has a role and responsibility in creating a diverse and inclusive environment. For D&I efforts to be successful, everyone must work together to advance the departmental strategic goals. The work is too great to be accomplished by one individual.

ABOUT THE AUTHORS arquita N. Hicks, MD, MBA, M is assistant dean, Student Inclusion and Diversity, and associate professor, Department of Emergency Medicine, at Wake Forest School of Medicine. She is the 20192020 ADIEM president. A va E. Pierce, MD, is an associate professor and the associate chair of Diversity and Inclusion in the Department of Emergency Medicine at the University of Texas Southwestern Medical Center and the director of the Emergency Medicine Research Associate Program. Dr. Pierce is ADIEM's immediate past president.

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in healthcare and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Joining ADIEM is free! Just log into your member profile and click on the "Update (+/–) Academies and Interest Groups" button.

ETHICS IN ACTION

What to do When a Parent Discharges a Child Against Medical Advice SAEM PULSE | SEPTEMBER-OCTOBER 2019

By Andrea Wu, MD, MMM

In most cases, adults are free to make their own decisions as to how they want to treat an illness; however, when a patient is a minor and still legally under the care of parents or guardians, the issue can quickly become complicated and fraught with competing claims. The media is rife with stories of parents whose minor child was removed from them against their will because they withheld medical care for that child and were subsequently charged with endangering his or her life and/or health. Or, even more tragic, parents who were charged with involuntary manslaughter, or some other criminal offense, when their minor child died after they denied him or her lifesaving medical treatment.

State law determines whether denying a child medical care because of religious reasons is considered medical neglect. Most states require parents to provide a reasonable degree of medical care; however, 34 states and the District of Columbia offer legal protection for parents who refuse medical treatment for children on religious grounds. It is important to understand what laws are applicable in your state, as well as your local hospitalâ&#x20AC;&#x2122;s risk management practice. With that in mind, below are some areas of guidance on this challenging situation.

Important Exceptions There are a couple instances for which one ought to consider refusing to allow a parent to take his or her child home against medical advice (AMA):

1) I f there is concern for non-accidental trauma (NAT) in the childâ&#x20AC;&#x2122;s home environment. 2) I f the child is critically ill or has a clearly diagnosed life threatening illness that is treatable In the first case (suspected NAT), it is important to determine whether the patient has ongoing contact with a possible perpetrator and whether or not the patient is safe to be discharged home and with whom. In addition to treating injuries sustained, one must assess the living situation and social interactions of the family. If available at your facility, social workers are excellent resources for gathering collateral information from family members and reporting the cases to Child Protective Services (CPS). You

may need to identify a safe place to discharge a patient or find an alternative family member. If that is unsuccessful, then you may, for safety reasons, need to keep the patient. If keeping the patient occurs against parental wishes, you may need to involve law enforcement and hospital administration. In extreme cases, court involvement may be necessary to intervene on the childâ&#x20AC;&#x2122;s behalf. In the second case (the parents refusing well-established treatment for an emergent condition), there have been several instances of legal precedent supporting the clinicians in continuing medical treatment. Such cases have involved children diagnosed with diseases such as meningitis, sepsis, or diabetic ketoacidosis. Again, given the confrontational nature of this type of situation, it is important to involve hospital administration and risk management. It is often difficult to draw a clear line between refusing care and neglect; however, in the above instances there is legal precedent. Even in states where there are religious exemptions, courts can still intervene and require medical care if they believe a child is in danger of death.

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SAEM PULSE | SEPTEMBER-OCTOBER 2019

ETHICS continued from Page 11

Discussion With Parents/ Caregiver Patients discharged AMA have a high risk of readmission, which may jeopardize their medical care and increase their medical costs. It is important that providers do not become hostile, but rather keep interaction professional and collegial, and continue to care for the patient or arrange the best possible outpatient care. If possible, it is also crucial to learn the reasons the parent/guardian is signing the patient out and try to mitigate the situation. In some populations, religious beliefs may be a reason

"The best legal protection is thorough documentation of the discussion in the medical note." for declining medical care (although these parents frequently do not seek medical care at all.) Common reasons for leaving AMA are dissatisfaction, financial concerns, or childcare needs. Addressing areas of dissatisfaction, such as long wait times, lack of food or drink, or perceived staff rudeness, can help persuade parents. If possible, it may be helpful for the parents to have a discussion with financial registration staff to fully understand the financial implications and learn of possible

financial support programs. Additionally, finding childcare options may be difficult when an unexpected illness occurs, so being empathetic and helping to find alternative childcare support can assist the family in continuing medical care for the child. It is helpful to view leaving AMA as informed refusal of treatment and to explain the diagnosis and prognosis; the likelihood of risks and benefits of leaving the hospital; possible alternatives

"Children discharged against medical advice are at increased risk of readmission and pose medicolegal challenges for the clinician." have shown that this is not true and patients do get reimbursed for ED visits. Another fallacy that clinicians sometimes convey is that the patient/parent must sign the AMA form in order to leave. The AMA form actually offers minimal legal protection and does not actually fully release the hospital or clinician from liability. If the parent is going to leave despite the physicianâ&#x20AC;&#x2122;s best efforts, then provide the best outpatient care possible. This can include providing appropriate prescriptions, coordinating follow-up with the primary care provider or appropriate specialist, and/or having the patient return to the ED at a later time for reevaluation or to continue medical care. Ensure that the parents understand they can return to the ED at any time should they change their minds, or if the child deteriorates.

Documentation If possible, have the parents sign the AMA form. The form should be written at a reading level appropriate to the patient population and in the parents' preferred language. It may also include key points such as risks that might be anticipated from leaving AMA and that the parent assumes responsibility for the decision and therefore releases of the clinicians and hospital from responsibility. to treatment in the hospital; and the risks and benefits of these alternatives. During these discussions it is important to assess if the parent has the mental capacity to make and communicate a choice. The parent needs to be able to articulate a reason for refusing medical care and their understanding of the risks of leaving. Another step which may dissuade the parents from leaving with the child is to involve other family members, the patientâ&#x20AC;&#x2122;s pediatrician, or another clinician for a second opinion. A common bit of misinfomation clinicians sometimes use to try to convince the parent to stay is that the insurance company will not cover an emergency department (ED) visit. Studies

Clinicians are still at risk of legal action even with a signed form. The signed form does not absolve all legal responsibility, only that a discussion of likely adverse outcomes occurred and that the parents understood the consequences. For example, if the patient becomes ill after leaving, and the parents argue that they were given insufficient information about the risks, then the clinician could be held liable. The best legal protection is thorough documentation of the discussion in the medical note. Include objective summaries of the discussions with the parent/guardian: their reasons for leaving; attempts to address the reasons for leaving; whether the patient understood and was able to verbalize the risks of

leaving and had the capacity to make the decision; and if other witnesses (nursing, providers) or other family members were involved. If known, it is also helpful to document the parentâ&#x20AC;&#x2122;s reasoning and plan of care after leaving. It is important to also document any reasonable postdischarge treatment options given to the patient, such as outpatient care coordination, treatments, prescriptions, and return precautions. Showing concern for the patient by involving other family members or colleagues will imply that every attempt was made to help ensure the patient receives the best care.

Summary Children discharged AMA are at increased risk of readmission and pose medicolegal challenges for the clinician. Two important exceptions to letting a patient leave AMA are high suspicion of ongoing NAT without a safe discharge plan and a clearly treatable life-threatening illness. Each state has different laws related to patient neglect and religious exemptions. Parents who want to leave AMA should be offered relevant information regarding the dangers of leaving, and their mental capacity should be assessed through their ability to understand and verbalize these risks. Clinicians should attempt to address reasons for leaving, include other family members or witnesses when possible, and offer treatment alternatives. Although having the parent sign the AMA form is helpful, it does not provide complete legal protection. Careful documentation of the discussion with the parent is critical to protecting oneself in such high-risk situations.

ABOUT THE AUTHOR Dr. Andrea Wu is the medical director for the emergency department at Harbor-UCLA and an assistant professor at the David Geffen School of Medicine at the University of California, Los Angeles.

GERIATRIC EMERGENCY MEDICINE

Essential Steps to Starting a Geriatricfriendly ED

SAEM PULSE | SEPTEMBER-OCTOBER 2019

By Colleen Mcquown, MD, Jill Huded, MD, and Luna Ragsdale, MD, MPH

One out of every four older patients visit an emergency department at least once a year. Unfortunately the prevailing model of complaint-based care in emergency medicine (EM) established over the last 45 years does not conform well for the complex needs of older adults. Geriatric EM leaders realize that atypical presentations of disease, altered physiology of aging, and heightened vulnerability to stress make older patients a unique group. From initial evaluation, to disposition planning, our older population deserves patient-centered care geared to optimize their independence, safety, and quality of life. An ED visit is an opportunity to connect our most vulnerable older patients to these resources and to ensure that atypical presentations of diseases are not missed.

How do I get started? First, what does an ideal geriatric ED look like? • The physical space is created with older patients in mind: lighting, beds, chairs, signage, flooring.

• Patients are screened for geriatric syndromes. • Nurses, providers, and interdisciplinary staff receive specific education on caring for older adults. • Harm is avoided by having protocols in place. • Inpatient and outpatient care is coordinated. • Patients receive proper support to remain independent and safe in their homes through provision of social services. • Families are aware of the plan and are supported in their caregiver roles. • Patients who are unsafe in their homes are transitioned to an appropriate living facility.

Who is already doing this work? The nice part of starting a geriatric ED is that years of work have already been done to identify best practices. The Geriatric Emergency Department Guidelines, published in 2013, were the result of two years of consensus-based work that included representatives from SAEM, ACEP, the American Geriatrics Society, and the Emergency Nurses

Association. Reading through these guidelines will give you a good idea of what can happen when you dream big!

Work creatively with the space and ED staff you already have. Do not feel bad if you do not have a budget to build a new ED. Little changes can be made to your current location to create a friendlier environment for older adults. A geriatric ED is about the care that an older adult receives. Think warm blankets, food, chairs for visitors, dimmable lights, railings, hearing amplifiers, and large print placards. However, if your hospital is planning a renovation, make sure you are at the table with your senior-friendly ED ideas!

Put together your team. Identify geriatric champions. Great ED care for older adults is not a oneperson job; it involves physicians, extenders, nurses, social work, dietetics, engineering, physical therapy, pharmacy, prosthetics, homecare, and administration (having administrative support is key). Champions need time,

protocols need to be enforced, and policies demand authority. Consider partnering with your local quality team, geriatrics service, and medical education programs. Foster future geriatric champions by inviting residents and medical students to participate in quality projects, staff education, and protocol development. Make sure that geriatric EM education is part of your residency and clerkship curriculums.

Any changes to promote agingfriendly ED care count as progress. You do not have to start big. Your initial team could be simply an attending, a resident, and a nurse. Together you might work on a policy to reduce inappropriate Foley catheter placement, create a protocol and educational material, and devise a timeline to roll out the plan. After some time, you might collect additional data and use it to demonstrate to administration that you are improving care and saving money. If administration likes your geriatric ED idea, they might give you a green light to ramp it up. Next might come the addition of an ED pharmacist to help with polypharmacy evaluations; social work or nursing to do caregiver burden evaluations; health techs to conduct gait evaluations, and so on. In addition to providing quantitative data, you might also begin collecting and sharing stories of how your ED impacted the day-to-day functioning of older patients. Get the point?

Taking your geriatric ED to the next level. Now you are ready to take your ED to a whole new level. If you want to screen for vulnerable adults and identify those with increased care needs and geriatric syndromes, you will need screeners. You may want screening for delirium and falls risk for every older patient treated in your ED; if so, your protocol may outline that the bedside nurse complete these. You may want other screens and care tailored to the most vulnerable older seniors. Consider hot-spotting these at-risk older patients through the Identification of Seniors at Risk (ISAR) screen performed by bedside ED nurse

or in triage. The ISAR can trigger more in-depth evaluation for dementia, caregiver burden, polypharmacy, elder abuse, and depression. You may choose to have nurses, social work, or other trained staff do these screens.

Educating screeners, tracking data, and evaluating for effectiveness. Education should be multimodal, touching on the eight domains of geriatric EM as defined by Hogan et al. 1. Atypical presentations of disease 2. Trauma including falls 3. Cognitive and behavioral disorders 4. Emergency intervention modifications 5. Med management/polypharmacy 6. Transitions of care 7. Effect of polymorbidity 8. End of life care You might also consider free informational and educational resources found at geriatric EM websites such as Geri-EM and the Centers for Disease Control and Prevention, and through SAEMâ&#x20AC;&#x2122;s own Academy of Geriatric Emergency Medicine (AGEM). Ensuring you have a way to track your screening and a plan to review the quality of your program are also essential for long term success. Work with your IT department on order sets and consult templates. Work with your quality team to create a dashboard to track your data. This will allow you to have a plan-dostudy-act rapid cycle improvement plan.

Geriatric ED Accreditation

you provide excellent care for older adults? Who can you turn to for advice on making your senior-friendly ED even better? Consider applying for Geriatric ED Accreditation (GEDA). GEDA is based on the SAEM Board-approved Geriatric Emergency Department Guidelines and is run by the American College of Emergency Physicians (ACEP).

ABOUT THE AUTHORS Colleen Mcquown, MD, is an emergency medicine physician at the Louis Stokes Cleveland VA Medical Center and co-director of the geriatric emergency department. J ill Huded, MD, is an acute care geriatrician at the Louis Stokes Cleveland VA Medical Center and co-director of the geriatric emergency department program. She is an assistant professor with Case Western Reserve University School of Medicine. L una Ragsdale, MD, MPH, is the deputy chief of the Durham VA Medical Center emergency department and is the medical director of the geriatric emergency department. She is also clinical associate at the Duke University Medical Center emergency department.

Once you have your geriatric ED started, what can you do to let people know that

About AGEM The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM is free! Just log into your member profile and click on the "Update (+/â&#x20AC;&#x201C;) Academies and Interest Groups" button.

GLOBAL EMERGENCY MEDICINE

Taking Emergency Care to the World Stage at the World Health Assembly: A New Resolution on Emergency and Trauma Care

SAEM PULSE | SEPTEMBER-OCTOBER 2019

By Tsion Firew, MD, MPH

It has been more than 12 years since the World Health Assembly adopted a resolution on emergency care. In the past 12 years, the burden of diseases in most of the world has changed significantly from communicable diseases to noncommunicable diseases. The time to galvanize the agenda on emergency care was past overdue; therefore this year, a resolution on emergency care titled, “Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured” was proposed by the governments of Ethiopia and Eswatini (formerly known as Swaziland). The resolution was co-sponsored by more than 30 countries leading to its adoption at the World Health Assembly in Geneva, Switzerland in May 2019.

The adoption of this resolution at the World Health Assembly sheds light on the importance of emergency care and urges countries to take actions towards strengthening their emergency care systems. The resolution, as a new global mandate, can be used as an advocacy platform to create awareness on the importance of integrating emergency care into ongoing universal health coverage planning processes. It provides the opportunity and challenges countries to strengthen and expand high-quality emergency care to every corner of the world. In the age of social media as an essential tool of communication, it is encouraging to see the director general of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus,

tweet about the importance of emergency care! Time to roll up our sleeves and continue to do what we do every day — advocate for our patients locally and globally! Emergency care saves lives, and we are ready to provide care anytime, anywhere, for anyone…24/7/365.

ABOUT THE AUTHOR Tsion Firew MD, MPH, is an emergency physician and special advisor to the Minister of Health of Ethiopia. She is an assistant professor at Columbia University. @drtsion

World Health Organization Emergency and Trauma Care Publications and Resources • Trauma care checklist • Fatal injury surveillance in mortuaries and hospitals: a manual for practitioners • Strengthening care for the injured: success stories and lessons learned from around the world • Community-based rehabilitation guidelines • Guidelines for trauma quality improvement programs • Guidelines on the provision of manual wheelchairs in less-resourced settings • Mass casualty management systems • Prehospital trauma care systems • Guidelines for essential trauma care

"Emergency care is the

• Guidelines for conducting community surveys on injuries and violence

first point of contact

• Injury surveillance guidelines

with the health system for many people and the delivery of definitive care for many others. WHO is ready to support countries with the evidence and tools to provide high-quality emergency care, as part of its journal towards health for all.” —Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization

About GEMA The Global Emergency Medicine Academy (GEMA) focuses on improvement of the worldwide delivery of emergency medical care. Joining GEMA is free! Just log in to your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

HEALTH & WELLNESS

Cultivating Compassion: A Primer for Preventing Burnout in Academic Emergency Medicine

SAEM PULSE | SEPTEMBER-OCTOBER 2019

By Al’ai Alvarez, MD and Patty de Vries, MS

Physicians in emergency medicine have long suffered from one of the highest rates of burnout in the industry. It is estimated that 48 percent of physicians in emergency medicine suffer from burnout, defined as emotional exhaustion, interpersonal disengagement, and a low sense of personal accomplishment. More work is needed to recognize the drivers for burnout in academic emergency medicine; however, the effects are clear. From a physician perspective, burnout leads to increased turnover and reduced clinical hours, switching specialties, and increased medical errors. One study found that physicians with burnout are more than twice as likely to have self-reported medical errors exclusive of

work hours, fatigue, and even specialty. Burnout has also been correlated with higher levels of depression and suicide. It is estimated that 400 physicians die of suicide every year, the highest among all professions. Burnout is also costly from a healthcare perspective. One study showed that physician turnover and reduction in clinical hours due to burnout are estimated to cost $4.6 billion per year. Another study estimates $500,000 to $1 million to replace one physician due to burnout. Knowing the high cost of burnout to physicians and the healthcare industry, how can we prevent burnout in academic emergency medicine? Several models exist on promoting physician well-being and preventing burnout. The Stanford WellMD Professional

Fulfillment Model uses three domains to address this issue: a culture of wellness, efficiency of practice, and personal resilience. We need all three in order to feel fulfilled in medicine. In addition, cultivating self-compassion can also move physicians from a mindset of fear and self-criticism to one of care and well-being.

A Culture of Wellness

A culture of wellness is defined as “shared values, behaviors, and leadership qualities that prioritize personal and professional growth, community, and compassion for self and others.” This requires much more than simply having a lecture on wellness. Leadership plays a key role in creating a culture of wellness. Emma Seppälä, a Stanford researcher and author of

“The Happiness Track,” describes how “good bosses create more wellness than wellness plans do.” Psychological safety is also key in promoting a wellness culture. Amy Edmondson, Novartis Professor of Leadership and Management at the Harvard Business School, emphasizes the importance of “teaming” and creating psychological safety in healthcare. This is especially true in emergency medicine, where we are positioned by the nature of our work to interface with different aspects of healthcare at an intense pace during highly-stressful, high-stakes decisionmaking for our patients, 24/7/365.

Efficiency of Practice

Efficiency of practice is defined as “workplace systems, processes, and practices that promote safety, quality, effectiveness, positive patient and colleague interactions, and work-life balance.” Developing efficiency of practice requires the highest level of institutional focus. In medicine, examples could include optimizing the electronic health record to work for both patients and also physicians, developing humane shift schedules that are mindful of physician sleep, personal and family time, creating safe avenues to discuss medical errors and litigation stress,

"We need to understand that we are not alone in this suffering, that everyone has bad days and everyone makes mistakes." increasing collaboration amongst different specialties, and learning a common language of professionalism to decrease microaggression and implicit bias. Much work is needed to develop efficiency in our practice. By matching training to the complexity of our work, we can not only practice safer medicine, we can also decrease the cost from waste and improve the chances of experiencing “flow” at work.

Personal Resilience

The third domain in the Stanford WellMD Professional Fulfillment Model is personal resilience, which is defined as “individual skills, behaviors, and attitudes that contribute to physical, emotional, and professional well-being.” Even in a perfect world where there is a culture of wellness in the most efficient medical practice, that alone may not be enough to attain professional fulfillment without also practicing personal resilience. Personal

resilience comes in many forms and is more than just being able to bounce back or weather adversity. As physicians, we develop personal resilience in many ways, including mindfulness and meditation, cultivating the ability to find awe and wonder in our work, practicing gratitude, developing skills in reframing and perspective taking, engaging in the work environment through leadership roles or quality initiatives, and doing research that aims to continuously improve our lives, our patients’ lives and the lives of our colleagues.

Self Compassion

Beyond these three domains, another area of importance is developing selfcompassion. Kristen Neff, associate professor in psychology at the University of Texas at Austin, refers to three continued on Page 20

"By modeling the practice of self-compassion, we may not only find ways to reduce our own risk of burnout, we may also learn to extend compassion to others more effectively."

SAEM PULSE | SEPTEMBER-OCTOBER 2019

HEALTH continued from Page 19

elements required to develop selfcompassion. First is self-kindness as opposed to self-judgment. We have to be kind to ourselves in our practice of medicine. This includes self-forgiveness when we make mistakes. It also includes authenticity, the ability to create boundaries with regards to our ever-accumulating responsibilities, and attentiveness to our physical needs, such as taking those bio-breaks on shift, grabbing a meal, or making sure we have adequate sleep. The second element is the acknowledgement of our common humanity versus an attitude of isolation. We need to understand that we are not alone in this suffering, that everyone has bad days and everyone makes mistakes. Understanding this common humanity is important in developing perspective in our role in the bigger picture. Lastly, we need to practice mindfulness. This isn’t yoga or meditation; it’s simply being present in the moment and recognizing whenever we find ourselves ruminating on a decision we’ve made, a bad outcome, or a medical error. Neff refers to this as a “balanced approach to our negative emotions so that feelings are neither suppressed nor exaggerated.” We need self-compassion in order to overcome the imposter syndrome: the feeling of not being good enough, of not belonging, and of shame. Selfcompassion is simply extending the same kindness to ourselves that we would give to others. One criticism of self-compassion is that it prevents us from taking responsibility for our actions. Quite the contrary, self-compassion “releases us from the self-hatred that prevents us from responding to our life with clarity and balance.” As emergency physicians, we are resilient individuals. We can also be very tough on ourselves. According

to Neff, many people have learned to motivate themselves academically and professionally through fear and self-criticism: the fear of failing, of not being good enough, of not attaining a goal or certain title, rank, or position. While fear can be a powerful and effective motivator, it can also carry a lot of unintended consequences such as anxiety and fear of failure and is not sustainable. In contrast, self-compassion fosters a motivation of care, which cultivates the growth mindset in us, acknowledging that we can learn from our failures. As we learn more about the drivers of burnout in academic emergency medicine, we have an opportunity to recognize the importance of leadership in self-compassion in our profession. By modeling the practice of selfcompassion, we may not only find ways to reduce our own risk of burnout, we may also learn to extend compassion to others more effectively. We may find ourselves to be kinder to our colleagues. We may learn better ways to overcome empathy fatigue for our patients. We may be able to withstand loneliness and isolation that affects our practice in medicine. We may be able to awaken our humanity at work and find true professional fulfillment.

Your Opportunity to Make a Difference! Prevalence studies of burnout have largely been done by small groups or by large, heterogenous groups of physicians. To inform leaders, educators, and researchers within academic emergency medicine on burnout, SAEM is undertaking a comprehensive burnout survey based upon the validated Stanford WellMD survey. With the results of this survey, we hope to track longitudinal burnout and wellness scores, develop interventions to mitigate burnout, and advance the science of physician burnout.

A l’ai Alvarez, MD, is assistant program director, Emergency Medicine, co-chair, Physician Wellness Forum, WellMD, Stanford University @alvarezzzy

The survey launches October 1, 2019 and is only open until October 31, 2019. An email will be sent to all faculty and resident members. Please watch for it and take a few minutes to complete the survey.

P atty de Vries, MS, is associate director of faculty and staff well-being, director of the Stanford LeadWELL Network, ambassador, WellMD, Stanford University @purpurdevries

Your participation is critical in helping SAEM with this next important step in moving the needle on physician wellness.

ABOUT THE AUTHORS

SGEM: DID YOU KNOW?

Sex-based Differences in Gout By Hannah Turner, MD and Lauren Walter, MD, University of Alabama at Birmingham A 70-year-old female with history of hypertension and diabetes presents to the emergency department (ED) for pain and swelling of the right elbow that has slowly developed over the past 4-5 days. She is afebrile, and her other vital signs are within normal limits. On physical exam, the right elbow is swollen and warm, but without erythema. There is limited range of motion in the joint and extreme pain with movement. Gout is a common type of inflammatory arthritis, caused by the bodyâ&#x20AC;&#x2122;s inflammatory response to deposition of monosodium urate crystal in the joints, affecting an estimated 3.9 percent of the U.S. population. Gout is most commonly perceived as a disease that affects primarily males; however, the prevalence of gout in females is increasing, in fact, doubling in recent decades. The classic textbook scenario for a gout presentation is a middle-aged man with sudden onset of podagra, a clinical scenario twice as common in men as compared to women. It has also been shown that men are more likely to have acute onset pain and swelling, with symptom onset peaking within 12 hours. Research has shown however that women who present with acute gout typically do so in a different manner. In the opening scenario, an elderly female presents more indolently, with the affected joint being an upper extremity. Although not â&#x20AC;&#x153;typical,â&#x20AC;? this presentation should also prompt

the clinician to consider gout. Females are more likely to have involvement of the joints of the upper extremities, have poly-articular involvement, and have a less acute, more indolent, presentation. One study showed that while 88.2 percent of men presented with erythema over the joint, only 22.2 percent of women presented with similar erythema. Recognition and diagnosis of gout is essential to ensuring proper therapy and follow-up for patients. Studies have shown that men with gout are more likely to be treated with urate-lowering therapy than women with gout. This is unfortunate because standard urate-lowering therapies like febuxostat and allopurinol have been shown to be both safe and efficacious in women. Gout has a significant impact on the lives of patients; being able to recognize acute gout flares in women in the emergency setting can expedite proper treatment and allow for quicker return to daily activities and increased quality of life. Returning to your patient, you perform a joint arthrocentesis that is significant for 3000 WBCs per mm and needle shaped crystals with negative birefringence. You give her the diagnosis of gout and prescribe NSAIDs, steroids, and colchicine, with recommendations to follow-up with her primary care doctor. The patient sustains a repeat gout flare a few months later, and her primary care doctor decides to initiate urate-lowering therapy.

SGEM "Did You Know?" is a recurring SAEM Pulse submission designed to represent concise facts that demonstrate how patient sex and gender effect emergency care. We welcome submissions. Please send contributions to the co-editors Lauren Walter and Alyson J. McGregor at sgem@lifespan.org.

PROMOTIONAL TOOLKIT

Promoting Your Research Through Social Media

SAEM PULSE | SEPTEMBER-OCTOBER 2019

Promoting your work is challenging. Here are some social media “best practice” recommendations to help you maximize the impact of your research.

5 Pointers for Using Facebook 1. Determine if you will post from your personal account, or create a separate Author Page

Creating an Author Page allows you to create a separate presence, gives you access to analytics that personal profiles do not offer, an unlimited friend count, and the ability to advertise. However, a separate page takes time and resources to maintain and Facebook’s algorithm typically limits the number of newsfeeds your posts show up in to just a fraction of your fan base; so, in order to really get your content noticed, you will need

to establish a large fan base, or support your page with advertising. If you opt not to create a separate page and use your personal page to promote your work, you can manage the privacy settings for each post and allow Facebook users to subscribe to your page, rather than becoming friends.

2. Present Yourself Visually

Facebook gives you the option to add both a profile photo and cover photo – use it! Don’t let your page sit blank. Choose an image of yourself, or one that represents the research you are doing and make sure your brand and personality shine through. This is especially important for your profile photo, as this will be the first photo Facebook users see while searching for you, or pages like yours. One thing to remember is that Facebook makes frequent updates to the sizes and requirements for photos on their

channel. Be sure to monitor your page and update your photos when necessary.

3. Create a Content Schedule

Before you jump in and begin promoting your work, map out a plan for your content, including defining your social voice. Determine how you are going to talk to your fans and what you are going to say to them. Consider posting content about your latest and past research publications with links so fans can read your work. Share other publications you’re reading or using in your research and update readers on upcoming events you’ll be attending. Wherever possible, your posts should contain interesting and engaging images and video interviews. Once you decide on a schedule that is manageable for you, stick to it. Consistency is key. Finally, don’t forget to monitor your page! This includes responding to any

questions or comments left on your page. You should aim to respond within 24 hours.

4. Join Groups

Facebook groups are a great way to engage in discussions with those who have similar interests to yours and with influencers in your particular research community. Being active in these groups will help drive people to your Facebook page. Remember to be genuine and helpful. Although you want to promote your work, you do not want this to appear to be the only reason you’ve joined the group.

5. Consistently Promote, Promote, Promote If you build it, they won’t necessarily come. Make sure you are consistently promoting your page to bring in new fans. Cross promote your Facebook page through any of your other social media accounts, like LinkedIn, or Twitter. Ask your network to promote the page, add a link to your page on your business cards, share it on a blog, or add it to any marketing promotions you are doing to promote your work. Source: The Wiley Network Online

Making Your LinkedIn Profile Work for You How can you harness LinkedIn’s vast audience and successfully showcase and disseminate your published content? By utilizing your strongest promotional tool on LinkedIn: your profile. Did you know that LinkedIn users with complete profiles are 40 times more likely to receive opportunities through LinkedIn? Yet only 51 percent of LinkedIn users have 100 percent completed profiles. Here are seven steps to make your profile a

Good News from Academic Emergency Medicine! –T his year, AEM has achieved a 5-year Impact Factor of 3.389, placing it in the top three of all emergency care journals. –F or the past year, AEM has had an Altmetric Mentions index of 42.2, ranking it as the number two journal in emergency medicine. positive tool in promoting the circulation of your published content:

1. Tell your story

List your occupational experiences, education, awards and achievements. Prior accomplishments may seem small, ancient, or downright irrelevant, until you shift your perspective. LinkedIn users visiting your profile probably don’t know the narrative of your career. A lapse in your profile is a missed demonstration of growth and of ambition. An earlier achievement may not reflect your current work but it will enrich your profile "story." By establishing the scope of your achievements, you grow common interests, expand your circles, and increase access to you and your published content.

2. Frame your profile

Position your most recent accomplishments first. Your publications will default to the bottom of your page; reposition them to the uppermost section of your profile. By doing this you increase the likelihood that a visitor will read them and continue reading.

3. Be public

With LinkedIn’s vast user base, consider the scope of potential users as well as users you’d like to target your work to. Scroll down to the "connections" section and select "customize visibility." Play around with the privacy controls of your account, such as tailoring your activity "broadcasts" and "feeds." Examine how traditional approaches of disseminating your published content (e.g. live networking or print collateral) compare to technology-driven ones. Set attainable goals for your LinkedIn use (such as increase monthly views and numbers of connections), engage with the platform, and measure your success according to your set goals.

4. Highlight your work

When you publish a new paper, add it to the publications section of your profile. Title all publications precisely, list authors in contribution order and add a live link to your articles. If relevant,

continued on Page 24

TOOLKIT continued from Page 23

SAEM PULSE | SEPTEMBER-OCTOBER 2019

consider including the number of citations your article has received, the Altmetrics score, or links to positive press coverage generated by your book or article. By listing your published work you create additional portals to your LinkedIn profile, promoting traffic to your page and circulation of your current and previous published content.

5. Add images, videos, presentations, and documents

LinkedIn allows you to showcase your work through the upload of different types of media. Mix up your visual media with a variety of figures, images, photos, screenshots, video, and presentations. Remember, each time you change your visual content in Professional Portfolio, it displays on the news feed, showcasing your published content to other LinkedIn users.

6. Make it powerful and concise

Avoid verbosity. Cut out unnecessary qualifiers and weak verbs. Capture your accomplishments and other users’ attention with résumé action verbs,

leaving them more compelled, and with more time, to read your published content.

7. Create an ORCID ID

Open Researcher and Contributor ID (ORCID) is an open, non-profit organization that maintains an international registry of unique researcher identifiers and a method of linking research activities to those identifiers. You can include your ORCID ID on your webpage, when you submit publications, apply for grants, and in any research workflow to ensure you get credit for your work. Source: The Wiley Network Online

9 Tips for Tweeting Your Research Twittter has been utilized by all corners of the scholarly community like no other social media platform. In 2019, the social network's audience size is projected to reach 275 million monthly active users worldwide. Here’s how you can make the most of a tweet to promote your research:

1. Don’t be afraid to promote your own work Twitter is not a place to be shy. You are the best advocate for your work, and self-promotion is a proven way to drive research dissemination.

2. Have a clear sense of purpose for why you are on Twitter

It can be easy to get sucked in and waste too much time on Twitter, but the opposite is true, too – you could talk yourself out of using it at all because of the perceived time commitment.

3. If you’re going to tweet about something controversial, plan it out

Depending on your area of research, controversy might be unavoidable, but if you are working on a topic that is controversial or contested, you should plan your engagement around the very real possibility that it will attract backlash online.

4. Tap into your community

Twitter is a very open channel, but its accessibility belies the insular tendencies of the myriad microcommunities that thrive via hashtags like #rstats (statistics), #phdchat (lab life), and #cubing (Rubik’s cube enthusiasts).

Depending on your field of research, these communities can be a major asset in drawing attention to your work.

5. The more you post, the more followers you’ll attract

Some people are better at engaging a large audience on social media than others, but when it comes to building your base, it’s often just a numbers game, so make an effort to tweet regularly.

6. The more followers you have, the broader your audience

Not every researcher wants to connect with the general public, so if your main goal is to simply communicate with your peers, you don’t necessarily need a large Twitter presence. But to reach beyond academia on Twitter, you need to build a (relatively) solid following.

7. Use hashtags, but use them wisely

Don’t just throw any old hashtag onto any old tweet (#science and #biology likely won’t get you very far), but hashtags can be an effective way to tap into an engaged community on Twitter. Other “fast facts” on hashtags that you should know about:

8 More Ways to Help Ensure Your Work Gets Seen, Read, and Cited 1. S earch Engine Optimization (SEO)

• Are your title and abstract clear and searchable? Have you used the most relevant keywords? • Have you looked at off-page SEO strategies, such as link building, to promote your article?

2. Conferences

• Think about simple messages to promote your article at your next conference – whether networking with colleagues, or presenting formally.

3. Publicity

• Is your latest research newsworthy? Have you shared it with your institution's press office? • If sending a press release, wait until the article is published online, refer to the journal in the first paragraph, and link to the final published article on Wiley Online Library.

4. Networking

• Hashtags can increase engagement by 50 percent

• If you run a blog, post about your article. •F ind and engage with blogs in your field. Consider asking if you can guest post • Join academic social networking sites such as Mendeley and Academia.edu

• One or more hashtags can increase retweets by 55 percent

5. The Wider Web

• One or two hashtags can increase engagement by 21 percent more than three or four hashtags • Three or more hashtags can DECREASE engagement by 17 percent

8. Take control of your research group’s updates

University websites aren’t known for their agility, so when a change occurs in your research group or you’ve got a position to fill, get it out into the world fast by posting it on Twitter.

9. Familiarize yourself with your institution’s social media guidelines

Most institutional guidelines for social media use are fairly straightforward, common sense policies, but it’s worth familiarizing yourself with yours, especially if you’re considering a return to Twitter after a long hiatus. If you feel that the current guidelines are overly restrictive or out of date, speak up and get clarification— it’s not unusual for guidelines to be written by those who aren’t all that familiar with the platform. Source: Nature Index Online

• Update your faculty or professional website with an entry about your article. • Register for your unique ORCID ID and add your article details to your profile. • Find a Wikipedia page on a topic related to your article, and add a reference to your paper. • Identify relevant newsletters from your institution or society that may be willing to include a story about or mention of your article • Update your online profiles to include a link to your article

6. Multimedia

• Talk directly to potential readers and create a short video or podcast which conveys the essence of your paper.

7. Email

• Sign up for journal content alerts, so you know when your article is officially published online. • Add a link to your email signature and ask your coauthors to do the same • Send a link to your article to fellow researchers, colleagues, and friends.

8. Article Sharing

• Use Wiley Content Sharing to create a unique sharing link to a full-text, read-only version of your article that’s perfect for using on websites, social media, and Scholarly Collaboration Networks • Use Wiley Article Share to nominate 10 colleagues to receive unlimited free access to your article, or email a link to key colleagues.

WOMEN IN ACADEMIC EM

Ending Harassment in the Emergency Department

SAEM PULSE | SEPTEMBER-OCTOBER 2019

By Jenny Castillo, MD

Over the course of two decades of working in the emergency department (ED), I have experienced frequent and varied forms of bias and discrimination. Patients have gone out of their way to ask me for a blanket, pillow, or food, many times completely bypassing male nurses and physicians. At the disturbing end of the spectrum, I have been asked by more than one patient for another rectal exam because he "enjoyed the first one." These experiences were underscored during my two pregnancies, when it was even more difficult to establish a respectful, meaningful doctorpatient relationship. More than once, upon entering a patient’s room while pregnant, a patient reached out to

touch my belly and/or commented on the size of my gluteus maximus rather than answer my questions about the state of his or her health. In response, I laughed it off or ignored the comments and moved on to my next task. Over the years I've come to see that uninvited and inappropriate comments and actions such as these should not be allowed; instead they should be examined and discussed, especially with our female emergency department residents. We need to help each other build a toolbox of professional responses to tackle this issue. Like many of my female colleagues, I have learned to deal with sexual harassment by accepting it as “part of the job” and something too difficult to change. I am concerned about saying

anything out of fear of appearing weak or hyper-sensitive, so I manage the harassment on my own, in silence. But in truth, I have not pushed aside these comments as well as I’d thought; they have remained with me. And as other female colleagues have begun to share their similar experiences, it has occurred to me that others are feeling perplexed and frustrated about it also. Collectively, we have begun to recognize that there is nothing benign about sexually inappropriate comments. I recently participated in a hospitalsponsored, woman-only leadership seminar. One of the lectures resulted in a group-wide exploration of women in the workplace. The speaker presented statistics pertaining to the number of women CEOs nationally and asked why we thought the number is so small. One

What Constitutes Sexual Harassment, Abuse, or Misconduct?

"It is our duty as women physicians to help our younger colleagues understand this is an issue and to talk about ways we can work to end this behavior." significant reason is cultural stereotypes — no matter the type of working environment, women are first looked at as sexual beings and not as physicians, CEOs, politicians, personal assistants, or factory workers. Because of this cultural norm, women in medicine will inevitably have to deal with people who treat them primarily as sexual beings and not as clinicians. A recent study, entitled “Patients Sexually Harassing Physicians: Report 2018,” by Medscape confirms this theory. The report indicates that 27 percent of physicians, both women and men, have experienced sexual harassment by patients. According to the results, 17 percent of the harassment is described as acting in an overtly sexual manner while seven percent involves a patient having inappropriate physical contact. Of the 3,711 physicians surveyed, 43 percent of emergency medicine physicians reported having been sexually harassed by a patient within the previous three years. Only dermatology experienced higher discrimination, at 46 percent. The most striking finding of the survey is the age range comparison between men and women at when the harassment occurs: 79 percent of women

aged 28-34 had experienced sexual harassment, while only 10 percent of the males in the same age range had. Despite years of studying, practicing, and working alongside our male colleagues, women physicians are still not perceived as the cultural norm. As educated women, we need to recognize that sexual harassment within the ED is widespread. It is our duty as women physicians to help our younger colleagues understand this is an issue and to talk about ways we can work to end this behavior. Also, as the Medscape report states, sexual harassment is a physician issue, not only a female physician issue; therefore, we need both male and female medical professionals to take a hard look at this issue and implement solutions. Our male colleagues should support us when we need to be recused from treating a sexually-abusive patient. We also must empower female physicians to speak up, discuss this issue, and brainstorm methods to establish and maintain a professional clinical setting. We should not require female physicians to handle this additional stress by themselves. A discussion is essential, and action is needed.

•U nwanted sexual text messages/emails • Comments about anatomy/ body parts • Propositions to engage in sexual activity • Being asked repeatedly for a date • Offer of a promotion in exchange for a sexual favor • Threats of punishment for refusal of a sexual favor • Deliberately infringing on body space • Unwanted groping/hugging/ physical contact • Deliberate fondling of self • Grabbing body parts • Rape Source: Patients Sexually Harassing Physicians: Report 2018 – Medscape

Let’s start at the beginning of our careers. ED residency programs must adopt this topic into their curricula, help residents understand that it is a very real issue, and provide tools for change. Once the issue is openly discussed in a supportive environment, all physicians will be empowered to prevent harassment.

ABOUT THE AUTHOR Jenny Castillo, MD, is an assistant professor of emergency medicine for Columbia University Medical Center, New York Presbyterian Hospital, as well as, the director of EM Resident Simulation Education, and an Attending Physician within the Emergency Medicine Department.

About AWAEM The Academy for Women in Academic Emergency Medicine works to works to promote the recruitment, retention, advancement and leadership of women in academic emergency medicine. Joining AWAEM is free! Just log in to your member profile and click on the "Update (+/-) Academies and Interest Groups" button.

SAEM PULSE | SEPTEMBER-OCTOBER 2019

Introducing Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) For the first time, the SAEM has launched an initiative to produce clinical practice guidelines, (known as GRACE, defined in the title). The GRACE initiative will help address the critical need for evidence-based and expert driven recommendations for the clinical care of common chief complaints and syndromes manifested by patients in the emergency department. In contrast to other guidelines, GRACE will address conditions caused by recognized pathophysiological processes but will

likely have even more focus on how conditions are modified or caused by psychosomatic processes. Stated simply, GRACE will address the best practices for the care of the most common chief complaints that can be seen on the tracking board of any emergency department in the country based upon research and expert consensus. These guidelines are designed with de-implementation as a guiding principle, to reasonably reduce wasteful testing, and provide explicit

criteria to reduce foreseeable risk and define sensible and prudent medical care. Where possible, medical care may mean cognitive processes instead of expensive testing. Each GRACE publication will provide measures for healthcare systems to consider as part of quality assurance. The criteria for topics of each guideline include: 1. Complaint or condition that most emergency physicians agree often cause diagnostic dilemma, decisional conflict, and treatment uncertainty.

Members

Academies

Interest Groups

Committees

SAEM BOD

External Groups

Steering Committee

Patient Advisors

Topic Experts

Patient Advisors

Evidence Oversight Panel (GRADE)

Writing Group Dissemination Committee GRACE Publication

2. Complaint or condition that most emergency physicians agree has a high degree of variability in practice between providers. 3. Complaint or condition that most emergency physicians agree evokes “substantial concern” for medical malpractice allegations of negligence in the event of an unexpected adverse outcome. Each publication will follow a set structure, provisionally outlined as follows: 1. Background and statement of need for the condition, including evidence of decisional conflict with associated practice variability. 2. Key questions stated in PICO (Patient, Intervention, Control, Outcome) format.

value/preferences that incorporates a plain language summary decision-aid developed in conjunction with a patient representative. We fully anticipate that GRACE topics will often have sparse direct evidence and will require expert opinion. 5. We anticipate that each GRACE document will contain four components:

a. Table 1 that summarizes answers to questions posed by topic experts and level of evidence

b. A primary flow algorithm that summarizes the clinical approach to the problem

c. Foreseeable risk: A narrative that expresses expert opinions on scenarios that could generate medicolegal allegations of negligence

d. Summary of best practices with corresponding level of evidence, and a checklist of quality measures for practice groups

3. Reproducible and transparent results of evidence search and grading (will include supplements for many details) 4. Evidence grading, using the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology, followed by data synthesis including direction of the recommended action and strength of recommendation based upon evidence quality, balance of desirable/ undesirable outcomes, and patient

Each GRACE product will undergo peer review for anticipated — but not guaranteed — publication in Academic Emergency Medicine journal and formal endorsement from the SAEM Board of

Directors. In addition, other organizations such as the American College of Emergency Physician’s will be provided an opportunity to endorse each GRACE product. The figure above outlines both the workflow and organization of GRACE. Importantly, the Figure above underscores that GRACE will require the input of many SAEM members. Anyone who is interested in serving on the topic expertise panel, the evidence oversight panel (responsible for the work intensive GRADE methodology), or the dissemination committee should contact Stacey Roseen at sroseen@saem.org. Regarding timeline, the first topic will be Management of Patients with Recurrent Low Risk Chest Pain. For this topic, the initial evidence synthesis will occur at the ACEP meeting in Denver in 2019, and the final evidence incorporation at SAEM20, again in Denver in May 2020. We aim for the first GRACE document to be disseminated for public comment ahead of peer review by August 2020. Future topics will be selected with input from SAEM members with the intent to not replicate past or ongoing work from the ACEP Clinical Policy Committee. We welcome your comments about and participation in GRACE!

Recommended Best Practices for Didactic Submissions By Ryan LaFollette, MD and Jean Sun Scofi, MD

Selecting Your Speakers: Who will be presenting? SAEM PULSE | SEPTEMBER-OCTOBER 2019

Think big and collaborate with others.

• Expertise matters. Seek speakers or panelists that are well-respected and reputable experts for your topic. While speakers with national recognition are considered favorably, we also appreciate lesser-known speakers for whom you can clearly demonstrate expertise, experience, or quality. • Diversity matters. If you are proposing multiple speakers or panelists, please include candidates with diverse backgrounds, viewpoints, or experiences. Each speaker that you include should offer a different perspective that enriches your submission.

• Consider multi-institutional or multidisciplinary collaborations. As with abstract submissions, didactic submissions that involve collaborations between multiple institutions or disciplines are considered favorably. The bigger and more creative your scope, the better. • Work with other SAEM members or groups. Submissions that demonstrate thoughtful collaboration across SAEM Academies, Committees, Interest Groups, or individual members are considered favorably. Example: The SAEM Residents and Medical Students (RAMS) Committee collaborates with the SAEM Education

Committee to invite a panel of national EM education experts to debate the merits of traditional versus innovative bedside teaching. The proposed panel is a diverse mix of men and women from different geographic areas with varied academic backgrounds.

Content and Style: What will you present?

Be organized and scientifically rigorous. • Pick an engaging title. Remember that SAEM attendees will be flipping through a massive program spanning four days. What title will make your didactic stand out? • Be focused. Clearly state your objectives and intended audience. What problem(s) or controversies will you tackle? What knowledge gaps will

Two Dates Remain for Didactic “Best Practices” Webinar! The SAEM Program Committee is hosting a webinar designed to share best practices for didactic submissions for SAEM20. The webinar is ideal for SAEM members who want to bring submission ideas for tips and advice are curious about the selection process or want to improve their overall submission quality. During the webinar, the Didactics Subcommittee co-chairs will provide guidance about how to enhance didactic submissions and offer examples of best submissions from previous years. (Note: Only general advice will be offered. The committee will not be reviewing individual written submissions or drafts.) There are two dates remaining: Sept. 3, and Sept. 4 from 3-4 p.m. CT. Interested individuals may sign up here. you address? What insights will your audience gain that they cannot easily acquire elsewhere? • Be organized. Clearly outline the structure and flow of your presentation. Propose a cogent introduction, message, and closing. If you have multiple presenters or panelists, describe what each one will present. If you have a non-traditional format, describe exactly what you propose to do and how this will enrich your presentation. • Consider timing. Demonstrate thoughtful consideration of time constraints. Panels and small groups, are typically more appropriate for a 50-minute format, whereas a single speaker is typically more appropriate for a 20-minute format (with some rare exceptions). • Offer high-quality supporting evidence. Submissions that take an evidencebased approach, have a strong scientific basis, or incorporate critical thinking and analysis are considered favorably.

• Submit a well-developed proposal. Please only submit fully developed ideas. Avoid making vague promises that content “will be developed later upon acceptance.” Submissions that do this implicitly by including descriptions that are only 1-2 sentences long are not considered favorably, even if highquality speaker(s) or collaborations are involved. Example: Title: Decrease Malpractice Risk: What your Charts are Lacking and How to Fix It Objectives: 1) Summarize the analysis of malpractice data from a NYC consortium, compared to benchmarks across a national database; 2) review outcomes of varied strategies to codify gaps in documentation that relate to malpractice claims; 3) develop an ideology of how to close gaps in your personal documentation practices; and 4) propose systems-based solutions to improve documentation across your organization.

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Call for Didactics for SAEM20 The Program Committee of the Society for Academic Emergency Medicine (SAEM) invites proposals for didactic sessions for SAEM20, May 12–15 in Denver. SAEM20 will place a premium on innovative and interactive didactic sessions. Didactic sessions in the areas of pediatric emergency medicine research, teaching, and practice, are highly recommended. Should your didactic proposal be accepted, you will have the opportunity to present your pediatric EM research at the largest forum of its kind for the presentation of original education and research in academic emergency medicine. The submission platform closes October 1. Visit the website for more information.

SAEM PULSE | SEPTEMBER-OCTOBER 2019

DIDACTIC continued from Page 31

Description: The average settlement in emergency room malpractice misdiagnosis cases in 2013 was approximately $362,000. In a recent review of contributing factors resulting in the settlements, 35% of medical malpractice cases could have been avoided by improving documentation. Despite its significance as a major contributing factor in lawsuits, documentation is considered drudgery by many clinicians. Using data gleaned from unique malpractice insurance company sponsored quality improvement initiatives from a large consortium of health systems in the NYC area, we will discuss lessons learned to 1) identify key areas of ED charts where poor documentation was a contributing factor in a malpractice claim, 2) determine if scribes can improve documentation quality while improving patient satisfaction and provider efficiency, and 3) understand the impact of electronic medical record prompts to improve documentation among patients with high-risk chief complaints. Speakers have expertise in patient safety, operations, and

experiential learning.

Example:

Format: How will you present?

For the first half of the presentation, we will use an interactive lecture format to present key information relevant to malpractice risk and documentation (objectives 1 and 2). Will integrate poll everywhere to deliberately engage audience members and use it as a forum for submitting questions to our presentation group. The second half of the presentation will employ small breakout groups facilitated by speakers to help participants develop goals to improve their personal and organizational documentation practices (objectives 3 and 4). Take-aways and goals from the smaller groups will be shared with the entire audience.

Propose effective ways to engage your audience.

• Be interactive. Active audience participation and engagement are strongly encouraged. This can be in the form of audience polls, small groups, breakout sessions, or simply asking your audience questions during your presentation. Clearly describe the interactive components of your didactic(s) in your proposal(s). • Be creative. We welcome all creative or innovative presentation styles. There is no “standard” format for SAEM didactics so long as you adhere to the time limit. • Avoid gimmicks. While creativity is encouraged, please avoid adding an activity just for the sake of having one. All activities and interactions should be clearly linked to your objectives and advance or support your message in a meaningful way. • Include time for questions. Please adjust your content to allow for at least 5 minutes of questions or comments from the audience during or after your didactic(s).

Context: What are you up against?

Stay informed about other work in your focus area. • Look into current “hot topics,” controversies, or novel research in your topic area. This will increase the relevance of your proposal. • Review accepted didactics in your topic area from prior years. This will help you avoid submitting a redundant proposal, and may inspire you to

expand or improve upon past sessions. Sometimes proposals are rejected not because they are poor quality, but because a very similar presentation was already given. Please note that we consider audience feedback from past sessions as part of the selection process for current submissions. You can review the accepted didactics from prior Annual Meetings by clicking on the following links: SAEM17 SAEM18 SAEM19 • Consider collaboration. Is there an Academy, Interest Group or Committee in the content area of your submission? Consider reaching out to collaborate or tailor your didactic to highlight separate areas of content. • The submission pool can vary significantly from year to year. Your didactic submission will be compared to submissions in the same focus area or topic. The number and quality of submissions in each topic can vary widely from year to year. Similarly, some years will have more 20- vs 50-minute slots available in your focus area. Because of this, your submission may be highly competitive in some years and less competitive in others. We encourage you to remain open to revision, resubmission in subsequent years, or submitting to other SAEM speaking venues. You are always welcome to reach out to us for further guidance.

Questions?

If you have questions regarding the submission platform or scheduling, please contact Holly Byrd-Duncan at hbyrdduncan@saem.org or Andrea Ray at aray@saem.org. For all other questions and concerns, please do not hesitate to contact us at didactics@saem.org.

ABOUT THE AUTHORS Ryan LaFollette, MD, University of Cincinnati College of Medicine, co-chair Didactics Subcommittee 2020

Jean Sun Scofi, MD, Yale School of Medicine, co-chair Didactics Subcommittee 2020

How to Write Strong Learning Objectives Learning objectives are statements that follow the session description and describe what the participant is expected to achieve (outcomes) as a result of attending your session. Your didactic description MUST (i.e. it is a requirement) include two to four, approximately one-sentence long, properly written Instructional learning objectives which must be • student-oriented, not instructor-oriented; • stated in behavioral/measurable terms (see examples below), not in abstract terms; and • have a time constraint factor (i.e. the objective should be achieved by the end of the course and not require further study or learning by the student).

Behavioral/Measurable Terms Knowledge/Information list record state define arrange name relate describe tell recall memorize repeat recognize label select reproduce cite identify quote recite select trace update draw point record summarize write Comprehension assess contrast distinguish restate associate demonstrate differentiate explain describe report translate express summarize identify classify discuss restate locate compare discuss review illustrate tell critique estimate reference interpret reiterate compute predict Application apply sketch perform use solve respond practice construct role-play demonstrate conduct execute complete dramatize employ match relate calculate examine operate report translate review treat interpret predict schedule use develop locate Analysis analyze inspect test distinguish categorize critique differentiate catalogue diagnose appraise quantify extrapolate calculate measure theorize experiment relate debate apply criticize diagram infer question appraise separate contract deduce inventory summarize contrast Synthesis develop revise compose plan formulate collect build propose construct create establish prepare design integrate devise organize modify manage arrange specify assemble generalize validate detect Evaluation review rate compare defend score appraise evaluate report on select interpret choose investigate measure support critique justify rank assess decide grade argue determine estimate judge revise recommend test conclude estimate Example: Upon completion of this session, participants should be able to: • Discuss the national statistics of unexpected return visits to the emergency department • Identify the five most common reasons that patients return to the emergency department after discharge • Demonstrate awareness of risk-reduction strategies such as: patient empowerment, teachbacks, shared decision making • Develop a personalized evidence-based strategy for identifying patients that are high-risk for unexpected return visits

SAEM PULSE | SEPTEMBER-OCTOBER 2019

CAREER GUIDE

Planning for an Academic Career: Strategies for Emergency Medicine Residency and Beyond By Jonathan E. Davis, MD Excerpted from the 2019 SAEM Academic Career Guide.

INTRODUCTION

There are many reasons why an emergency physician (EP) may choose an academic career pathway: teaching, intellectual stimulation, a desire to contribute to residency education and the greater body of knowledge of emergency medicine (EM), and many others. Some physicians enter residency with the intent to pursue an academic career, while others decide

to pursue an academic track later during residency, fellowship training, or after years of community practice. This chapter will discuss several key considerations in choosing academics and how to plan your residency training if you may be interested in pursuing an academic career.

in scholarship. Scholarship involves the creation or dissemination of knowledge through teaching, writing, integration, application, or discovery. Residency is the time to lay the initial foundation in each of these areas – a foundation that will grow and mature with opportunities and experience over time.

CHOOSING ACADEMICS

It’s Never Too Late! When, if ever, is it too late to choose academics? The short answer: it is never too late! However, the development and refinement of the essential skill set for success in academics during the course of

Keeping All Doors Open One strategy to ensure that all potential EM career options remain open is to strive to become a “totipotent” EP during the course of residency training, with excellence in both clinical EM and

residency training will prepare you if you decide to pursue academics at any point during your career. Not all academic EPs chose an academic career pathway immediately following training. It is possible to successfully shift from community practice to academics, although making this transition a success may become more challenging with advancing time due the necessity of growth and refinement of the core skill set required for a success on an academic career track.

PLANNING YOUR RESIDENCY TRAINING

Differences in Planning Strategies Based on Program Format The requisite skills for success in academics can be readily achieved during a 3 or 4 year residency. The goal is to begin building one’s academic skill set during residency, regardless of program format. Academic employers want motivated, interested, and highly productive faculty members. Experiences during residency that may further academic skills include dedicated teaching, research or writing projects with sound mentorship, or electives in niche areas of interest, such as ultrasonography, international EM, Emergency Medical Services (EMS), disaster medicine, or critical care. To view a complete list of residency

programs, including location and length, search in the SAEM Residency Directory. A 4 year format may provide additional time for advancing academic skills through added elective time or tracks focusing on areas of interest. Fellowship training following a 3 year format may also provide unique opportunities for academic skill development and refinement within a particular focus area. It may be difficult for a new graduate of a 3 year training program to obtain a firstyear faculty position at a 4 year program. This becomes less of an issue following completion of one year in practice (or a year of fellowship training) for 3 year residency graduates. In addition, the majority of training programs (and hence the preponderance of academic faculty positions) are in the PGY1-3 format (Of 240 total programs, 72% are PGY 1-3 format) based on current information available on the Emergency Medicine Residents’ Association (EMRA) website. Obtaining Academic Skills During Clinical Training With the wide array of skills needed for success in academics, it may seem daunting to obtain any (let alone all) of them during residency training. It is important, however, to remember that exposure takes precedence over mastery during residency. Trying to “do it all” may be counterproductive,

leading to premature burnout and career dissatisfaction. Familiarity with the academic process is paramount. Most academic faculty members have particular areas of interest and expertise, ie their “niche,” where they focus efforts. Gain exposure to many skills, with a focus on particular skills of greatest interest to you. The Importance of Great Mentorship A mentor is “a wise or trusted counselor or teacher,” which in EM might be an upper level resident or a faculty member. A good mentor is one who is willing to share knowledge from prior experiences with leadership, administration, research, and clinical teaching, and who is willing to direct mentees to additional resources for learning. Start first within your residency program. Who are the leaders? Who are the great communicators or teachers? Who are the productive researchers? Who presents nationally and publishes? Who will give useful, constructive feedback for your career journey? Participation in local, regional, or national EM organizations, such as SAEM, RAMS, AAEM, RSA, ACEP, and EMRA, also provide countless opportunities for mentorship through presentations, forums, networking, and collaboration.

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CAREER continued from Page 35

SAEM PULSE | SEPTEMBER-OCTOBER 2019

Chief Residency – Pros & Cons The decision to pursue a chief residency position can be challenging, as the duties and responsibilities will vary from program to program. The “pros” of any chief position are numerous – you will gain valuable administrative experience with residency issues, from remediation and discipline to policy making and quality improvement. You will have opportunities to use and improve teaching, communication, and writing skills. Opportunities for publications or work on projects with faculty members may be available. The chief is viewed as a leader among his or her peers, a resident advocate, and a problem solver.

The “cons” of a chief year include questions of time and “the hassle factor.” The first question to answer is, “Will this be worth my time?” Some chief positions are funded as an additional year after graduation, with the chief functioning as a junior faculty member in addition to performing administrative duties, sometimes combined into an administrative fellowship. Other chief positions are incorporated into the final year of residency, combining the rigors of senior year with additional leadership demands. The senior-as-chief role may create tensions among peers within the same level of training, and may add significant time demands to training, along with requiring strong organizational skills. “The hassle factor” for you as chief is the knowledge that you are often the first person to hear from faculty, residents, program directors, and off-service programs when problems arise. Some view this as troubling, while others view this as invaluable growth experience. Overall, the learning and leadership opportunities offered through participation as a chief resident are vast. A good place to develop the skills and strategies needed to succeed as a chief resident as well as gain mentoring is through the Chief Resident Forum offered each year at the SAEM Annual Meeting. There may be some heartache with all the hard work, but most former chief residents walk away from the experience with great insight into the rewards and rigors of residency

leadership and life in academics. Graduate Degrees – Pros & Cons Obtaining a graduate degree in public health, epidemiology, education, research, business, or law (to name a few) may be advantageous to one’s academic EM career as it creates a focus for future work, whether for teaching, research, funding or writing. You will have expertise in one particular area, have time to pursue your thesis or project(s), and gain invaluable opportunities for lifelong mentorship and collaboration with experts outside of EM. As an expert, you may be called upon to participate in local, state, or national policy making, committees, or teaching. An additional degree is also considered an advantage in the competitive academic job market. The disadvantages of pursuing a graduate degree include time and money. Does the pursuit of the degree require that you leave EM for a significant period of time? Is there adequate protected time to achieve your goals? Will the time away from potential income be repaid through job satisfaction later? Will you be able to use your degree in your EM work? The decision to pursue a graduate degree will ultimately be determined by an individual’s career goals and interests. While not for everyone, those who choose to pursue a graduate degree to complement a career in EM often find they have gained unique skills to enhance career satisfaction in the academic EM world.

LOOKING BEYOND RESIDENCY

Academic Jobs: What are YOU Looking For? What are THEY Looking For? Academic departments want enthusiastic, productive, well rounded faculty members who will contribute to the department’s overall mission. When considering an academic job, focus on the institution’s work environment. Are faculty members using their abilities to the fullest? What career paths are possible at the institution? How much support is there for innovative ideas both within the department and institution? Is startup funding available for new projects? How are the faculty rewarded for their efforts? What is the promotion structure like? What is the turnover rate? What is the mission of the department? What

are your opportunities for ongoing professional development? Comparing the institution’s values with your goals is essential to find a position that is a good fit. Advising and mentoring are essential – ask your trusted mentors for their thoughts and feedback. Conclusions The foundations of success in academics are excellence in both clinical EM and in scholarship. Residency training is the time to pursue these skills, which can be refined with time and experience. The requisite academic skill set includes clinical, teaching, research, writing, administrative, and “people” skills. Focus on skills of particular interest to you while gaining exposure to the entire academic skill set. This approach will prepare you for future success should you choose to pursue an academic career pathway.

ABOUT THE AUTHORS J onathan E. Davis, MD, professor and academic chair, department of emergency medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC J oanne L. Oakes, MD, associate professor of emergency medicine; assistant dean, education programs; distinguished teaching professor, The University of Texas Health Science Center at Houston, Houston, TX.

The Essential Skill Set Residency is the time to acquire the requisite academic skill set, which includes clinical, teaching, research, writing, administrative, and “people” skills. 1. C linical Skills – The most important aspect of emergency practice remains excellence in patient care. Superior clinical skills in history taking, physical examination, risk stratification, use of evidence based medicine, and cohesive, efficient clinical decision making should be acquired and refined during residency training. 2. T eaching Skills – Scholarship involves the creation or dissemination of knowledge. Teaching is one form of dissemination. Clinical (or bedside) teaching skills are learned primarily through the supervision and mentoring of junior residents, interns and medical students. Ask for feedback from mentors, peers, and your students. Many residencies offer a “how to teach” curriculum to upper level residents. Teaching tutorials are available online, and the American College of Emergency Physicians (ACEP) offers a teaching fellowship for EM physicians. Didactic teaching skills are equally crucial for academic success. The adage “practice makes perfect” rings especially true for didactic presentation skills. The more experience and comfort you gain with teaching in small and large groups early in your career will serve you well in the future. 3. R esearch Skills – Discovery through research (whether clinical, educational, or bench) is another essential academic skill. It is most important to be involved with the discovery process. Knowledge of the fundamentals of study design, institutional review board (IRB) processes, data collection/analysis, as well as experience with bringing-it-all-together as a manuscript or abstract are foundational research skills. Whether this involves a single small-scale project or an in-depth experimentation in the laboratory is variable, and remains highly individualized. See SAEM’s Advanced Research Methodology Evaluation and Design (ARMED) course to learn the fundamental knowledge and skills to design a high quality research project. and grant proposal. 4. W riting Skills – Expressing oneself in prose is essential for effective synthesis and dissemination of knowledge. The more experience you can gain with this process during the course of training, the better prepared you will be for future academic success. Writing skills are necessary for abstracts, manuscripts, IRB and grant applications, curriculum development, lectures, policies – in short, everything academics! Writing skills may also be developed and refined by authoring review articles, textbook chapters, or by serving as an editor. SAEM features a Grant Writing Workshop at their Annual Meeting each year. Seek out writing opportunities during residency, and ask for feedback from mentors. 5. A dministrative Skills – An exceptional way to gain administrative experience is to get involved with committee work, whether at the local (residency program and hospital), regional, or national level. In addition, working towards and achieving committee leadership positions is a great way to further refine your organizational, writing, task completion, leadership, speaking, and networking skills. Leadership positions within the residency, such as chief resident duties, also provide additional administrative experience with tasks such as scheduling, budgeting, finances, conflict resolution, counseling, and advocacy. 6. “ People” Skills – Although all of the aforementioned skills are essential for a career in academics, it is difficult (if not impossible) to effectively utilize any of them without effective “people” skills. You must learn to manage, lead, and communicate with others in your different roles, and employ high emotional intelligence in all of your interactions. You must learn to give and receive feedback, work in teams, and develop active listening skills. Mentors are a great resource in this regard – many people skills are learned and refined through role modeling. Seek feedback from faculty members you respect and admire. Take the time to network with other clinicians, educators, and academicians in a variety of settings. This may stimulate ideas or allow for collaboration on future projects.

NURSING-PHYSICIAN COMMUNICATION: THE CORNERSTONE OF COMPREHENSIVE PATIENT CARE By Corlin Jewell, MD “Why don’t you go ask the nurse?” is a question heard a lot during medical school. Sure, “asking the nurse” seems easy, but I remember being very intimidated to do so. What if they thought I was incompetent? What if I slip up and say the wrong thing? What if they ask me something I don’t know the answer to? In my early days of training, thoughts like this held me back from developing essential communication skills as a clinical communicator. Poor communication can topple even the best initiatives and projects and is even more important in the highly technical day-to-day interactions within a bustling emergency department (ED). One of the most critical interactions in the hospital occurs between physicians and nurses and it is one of the most important components of providing reliable and safe care for our patients. Efficient nursing-physician communication has positive effects on all manner of patient outcomes, including patients’ personal satisfaction with the healthcare field. The importance of good nursing-physician communication can be highlighted in the four distinct points outlined below. I have built my early residency career around these four pillars and it has paid very real dividends in my professional relationship with our nursing staff. Remembering why it’s important for us to be good communicators helps us to adapt to a wide variety of workplace situations, including a particularly busy shift or working with difficult people.

Good nursing-physician communication builds an atmosphere of mutual respect.

Let’s face it, you need your nursing colleagues to survive and thrive in the ED. Realistically, they see our patients more than we do, and they are quick to notice things and stave off potential problems BEFORE they become big issues. If they know that you trust their intuition and that they won’t get berated for bringing up their concerns, they will be more likely to come to you with observations and opinions on how to best care for our patients. I can’t begin to tell you how many times I’ve been saved by an astute veteran nurse’s thoughts on what is going on with a difficult case. The more opportunities you have to communicate with nursing, the more they will begin to

"GOOD PHYSICIAN-NURSING COMMUNICATION IS ONE OF THE MOST IMPORTANT, AND MOST OVERLOOKED, SECRETS TO SUCCESS IN EMERGENCY MEDICINE. "

see you as a competent clinician and will trust your decisions implicitly, which can make all the difference in a time-sensitive situation (e.g., a code).

Good nursing-physician communication is good for our patients. If our nurses know what we are thinking, they will understand our treatment priorities and will make sure time-sensitive protocols and procedures happen ON-TIME. They will know what orders to look out for and will be there to ask for things that we may have forgotten to include. They will be able to answer questions from both patient and family members as soon as they are asked, helping to deal with the very common ED patient complaint of “I never knew what was going on.”

Good nursing-physician communication is good for our institutions.

Though our patients always come first, helping our institutions look good should also be one of our concerns. When nurses are onboard with our plans, our patients receive quick, timely care. As previously stated, nurses also understand the plan and what is happening to them/their family members; therefore, they are much more likely to leave satisfied with their visit rather than feeling in the dark due to a treatment team that seemed to contradict one another.

Good nursing-physician communication is good for our personal workflow.

Interruptions have been shown to be a profound barrier to every ED physician’s workflow. If nurses aren’t made aware of what we are thinking, then the only option they have to further patient care is to ask you. This can occur at very inopportune moments and can completely derail your thought process on-shift. This also frees up time for nurses; they don’t have to track you down to ask you questions because you’ve already answered them.

How to Improve On-shift Communication

Outlined below are several strategies for ensuring excellent nursing-physician communication. Obviously, there are times when you are simply too busy to fulfill all, or even some, of these suggestions with every patient encounter; however, this should be the exception rather than the rule. Practice makes perfect and the only way to work on your communication skills is to practice them.

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COMMUNICATION from Page 39

Touch base briefly before and after leaving a patient’s room.

This can be a big ask, but if you can make it happen, this is the easiest way to ensure you are in sync with your nursing team. If they’ve already seen the patient, they can provide insight on what to ask. Comments like “Patient stopped taking their meds because of their depression” or “patient’s port site looks infected” can frame your entire discussion with a potentially otherwise nebulous chief complaint. Touching base after your evaluation allows the nurse to have a basic understanding of what the next steps are and when these can start. Once nurses know you appreciate this preand post-patient contact, they will likely even seek you out to inform you.

Use the emergency medical record to your advantage.

Providing reminders and brief communication within the emergency medical record (EMR) can be a perfect way to update nursing when there is a change in plans and you aren't able to find them to tell them face-to-face. (I also like to set up a “disposition check-list” that lets nursing know what steps still need to occur before the patient will be leaving the ED).

Have their backs!

This goes along with building an atmosphere of mutual respect. If nursing has a poor interaction with an aggressive consulting service, or if a patient or family member is verbally aggressive, you need to stand up for them and address the concern. Let people know that disrespectful behavior towards any member of the ED team will not be tolerated. The ED is a family and the nurses need to know you’ve got their backs (and they will do the same for you... trust me!) Good physician-nursing communication is one of the most important, and most overlooked, secrets to success in emergency medicine. The more time you put into improving this critical skill, the more dividends it will pay. ABOUT THE AUTHOR: Corlin Jewell, MD, is a 2nd year resident at the University of Wisconsin Emergency Medicine Residency Program. He was lucky enough to be selected as one of the chief residents next year and will be helping organize and facilitate the program’s weekly conferences. His interest in emergency medicine is in medical education.

RESEARCH HIGHLIGHTS FROM THE 2019 SAEM WESTERN REGIONAL MEETING Submitted by the SAEM RAMS Research Committee, Chris Counts, MD, chair The 2019 SAEM Western Regional Meeting, hosted by UC Davis School of Medicine, was held March 21-22, 2019 at Embassy Suites by Hilton, Napa Valley, California. This article highlights some of the research presented at the meeting.

Clinical Impact of Reclassification by a High-Sensitivity Cardiac Troponin Assay Presented by Scott Casey, MD, MS PGY-1 University of California, Davis Can you give us a little background on your particular interest in the field? Chest pain is a common complaint in the emergency department, and highsensitivity (hs) cardiac troponin (cTn) testing can improve our diagnosis or Scott Casey, MD, MS exclusion of myocardial infarction (MI). I am part of a research team led by Bryn Mumma, MD, MAS, at the University of California, Davis, whose aim is to understand how this new test affects the way we take care of our patients. I have a special interest in this research because I will soon be starting as an intern at this hospital. Can you briefly summarize the highlights of your research? We compared conventional cTnI and hs-cTnT results in emergency department (ED) patients undergoing cTn testing as part of their ED care. As expected, more hs-cTnT than

conventional cTnI results were “positive.” However, the number of acute MI diagnoses was the same between the two tests, mitigating fears of over-diagnosis of acute MI. Our results also emphasize the importance of effective clinical algorithms and workflows that can manage the increased number of “positive” test results. What are the next steps moving forward for this research; do you plan to build on this? We would like to understand how the hs-cTn test affects ED length of stay and downstream resource utilization. Ideally, the new test could help reduce emergency department overcrowding and reduce hospital costs. What have been the major challenges of this research project? Any advice for future researchers pursuing similar research in this field? Switching to a hs-cTn test can affect multiple hospital departments, and we are trying to provide information on what these individual departments can expect upon switching to hscTn testing. Executing research like this is challenging because we are interested in end points that involve expert opinion from other disciplines such as cardiology, laboratory science, and economics. The collaboration increases the complexity of the project but ultimately gives the results a wider scope. Did you have a mentor when you first started out your research career? What is the key to a successful mentoring relationship? continued on Page 42

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RESEARCH HIGHLIGHTS from Page 41 As a medical student I received excellent research mentoring from Katren Tyler, MD, and Dane Stevenson, MD, MS, at the University of California, Davis. I’ve worked with my current research mentor Bryn Mumma, MD, MAS, both academically and clinically. Each of my mentors had strong commitments to education and allowed me to assume as much responsibility as I wanted on projects. I’ll be very fortunate to have them as teachers when I start my intern year. In completing this project, did you collaborate with anyone from fields or departments different from yours? If so, please comment on how this collaboration impacted your research. Our project involved collaboration among emergency medicine, laboratory medicine, and cardiology. Working collaboratively has increased the scope and rigor of our approach and allowed us to produce results with wider applicability. What have you found most satisfying about incorporating research into your medical career? I’m grateful for the opportunity to work alongside brilliant and dedicated thought leaders in emergency medicine and be a part of an academic process that changes the way we care for patients in the emergency department. The projects that I’ve been involved with over the years have also required

a lot of creative thinking, which is a great way to complement my clinical training.

Syphilis Knowledge Survey in the Emergency Department of University Medical Center New Orleans Presented by Sarah Lawhon MS 3, LSU Health Sciences Center School of Medicine – New Orleans Can you give us a little background on your particular interest in the field? As part of my master’s degree in public health, I did a practice experience with NOLA Knows, an opt-out HIV and Hepatitis Sarah Lawhon C testing program in the emergency department (ED) of University Medical Center (UMC) New Orleans. During my discussions with Dr. Lisa Moreno-Walton, the NOLA Knows Program Director, I learned about the public health burden of syphilis, which prompted me to further research the topic. After learning

about the increasing incidence of syphilis in the United States, particularly New Orleans, I instantly wanted to know more. As a public health student focusing on behavioral and community health sciences, I was interested in evaluating the factors contributing to the high incidence of infection in our community and discovering what could be done to address this problem. Dr. Moreno-Walton suggested conducting a survey study to assess knowledge about syphilis within the ED and its patient population and I immediately jumped at the opportunity. Can you briefly summarize the highlights of your research? The focus of our study was to identify disparities in syphilis knowledge that could then be targeted in future interventions aimed at both decreasing syphilis infection in New Orleans and increasing its diagnosis and treatment in the ED of UMC. We assessed healthcare professionals, patients, and ancillary staff’s knowledge of syphilis symptoms, routes of transmission, risk factors, prevalence, prevention, and treatment. Overall, healthcare professionals had the highest survey scores, followed by ancillary staff, and patients with the lowest scores. Upon further analysis of the data, two questions stood out for having the lowest scores in all three groups. The first question tested the understanding that dysuria is not a symptom of a syphilis infection. The second question tested the fact that men who have sex with men are at an increased risk of contracting syphilis. These, and other low scoring questions, represent topics that need to be addressed by education initiatives. Within the healthcare professionals, nurses and physicians’ assistants scored significantly lower than attendings, residents, and medical students. Our study also identified two major targets for education and awareness programs for patients, school and healthcare professionals, as most patients received their information about syphilis from these sources. Patient demographics, risk factors, and history of STI were also obtained in order to determine possible correlations between these factors and knowledge about syphilis. No significant relationships between these variables were found, although samples sizes for some risk factors were not large enough for significant conclusions to be drawn. What are the next steps moving forward for this research; do you plan to build on this? The next step in the project is to write a manuscript for journal publication. We also plan on sharing the results of the study with UMC administration to recommend a syphilis education program for healthcare professionals, particularly the nurses and PAs, to increase identification and treatment within the ED. The education event would be designed to have a preposttest evaluation to assess effectiveness. This survey data also provides us the information needed to guide future community-based programs in New Orleans aimed at raising awareness of syphilis. What have been the major challenges of this research project? Any advice for future researchers pursuing similar research in this field? The biggest challenge of this project was participant recruitment. The survey was administered via pen and paper, which took a substantial amount of time. Patients were asked to participate in the ED waiting and patient care areas. Since

multiple surveys were handed out at once, you had to be vigilant to keep track of where everyone went and if they were moved in order to retrieve the completed survey. Healthcare professionals and ancillary staff were predominantly surveyed during their shifts, unless there was a staff meeting where many surveys could be administered at once. As a student having just finished my first year of medical school, approaching attendings, residents, and nurses while they were working to ask if they would take time out of their extremely busy days to fill out a questionnaire was at times an intimidating task. I am grateful for these challenges, however, as they were learning experiences that led to personal growth. Additionally, I cannot express how appreciative I am to everyone who participated in the study. My advice to anyone conducting a survey study would be to consider doing so through a secure and confidential digital platform. This would be more convenient for participants and researchers. Did you have a mentor when you first started out your research career? What is the key to a successful mentoring relationship? I have had multiple mentors throughout my research career, which started in college, and in my experience the key to a successful mentoring relationship is open and honest communication. Having someone who is reliably available for advice or to help troubleshoot issues as they arise has been invaluable. As the mentee, it is equally as important to keep your mentor up to date with what is going on with your project and to always be honest and admit to mistakes, even though it may feel uncomfortable. For this project, I was lucky enough to have two mentors: Lisa Moreno-Walton, MD, MS, MSCR, FAAEM; and Kanayo Okeke-Eweni, MBBS, MPH, NOLA Knows clinical coordinator. This was especially important since Dr. Moreno-Walton often works outside the country where she might not have access to internet or phone service. I really appreciated that she designated someone for me to turn to for guidance when she could not be there herself. In completing this project, did you collaborate with anyone from fields or departments different from yours? If so, please comment on how this collaboration impacted your research. In the early phases of the project I did seek the advice and assistance of a couple of professors in the LSU School of Public Health. Having no prior experience in constructing or analyzing a survey study, their input was incredibly helpful. With their guidance I was able to word the survey questions to match the reading level of our patient population, ensuring the questions could easily be understood by patients, healthcare professionals, and ancillary staff alike. They also gave me advice on how to clean the survey data for analysis. What have you found most satisfying about incorporating research into your medical career? For me, the most satisfying aspect of research is its ability to broaden the scope of a physician’s impact beyond the patients we see, or will see, in my case. The translation of knowledge gained from research into interventions capable of reaching entire populations gives us the opportunity to improve health continued on Page 44

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RESEARCH HIGHLIGHTS from Page 43 on a larger scale. At such an early time in my career, I was also happy to be able to integrate the knowledge I have learned during my studies of public health and medicine. In the future, I am excited to see how these degrees will continue to intertwine!

Changes in Patients’ MEWS Scores While in the Emergency Department Predict Mortality, ICU Admission and Length of Stay Presented by Nick Levin, MD PGY-1, University of Utah, Emergency Medicine Can you give us a little background on your particular interest in the field? I’ve long been interested in sepsis and looking for early clinical clues to detection. As far as using clinical Nick Levin, MD calculators, I remember being a medical student and giving a short post-rounds presentation on the data behind qSOFA and SIRS to my internal medicine team and being very interested in the subtle differences in who each score was more or less likely to detect. Can you briefly summarize the highlights of your research? The main highlight of our research is that vital signs and changes in vital signs, specifically in the emergency department, matter to patient outcomes. Along with this, as a proxy for vital sign changes, serial MEWS scores offer easy-toacquire and understandable data points that can potentially help guide clinical decision making and resuscitation. What are the next steps moving forward for this research? Do you plan to build on this? We just finished validating our research against a five-year dataset (previously only one-year) and added in many other covariates to our model. In addition to age, sex, and Charlson Comorbidy Index, we’ve now included whether or not the patient received antibiotics (and how much time before he or she received them), fluids and the volume received, vasopressors, home beta-blocker use, baseline hemoglobin, blood transfused, and whether or not the patient had the flu. We’ve additionally added the outcomes of whether a patient soon after admission escalated in care from floor to ICU or if the patient was initially placed in the observation unit before being upgraded to the floor. With this additional information we hope to investigate and potentially identify patients that might be typically admitted to an inappropriate level of care. Additionally, we are interested in evaluating the role each covariate (antibiotics, fluids, fluid type, vasopressors, etc.) has in vital sign changes and clinical outcomes. Prospectively, we hope to soon integrate a real-time delta MEWS score into our EMR to see if it is a useful tool for monitoring patients in the ED.

What have been the major challenges of this research project? Any advice for future researchers pursuing similar research in this field? The biggest challenge/learning opportunity has been learning to do increasingly advanced coding and statistical analysis. Praise be for the internet and folks who have dedicated time to explaining different statistical approaches in an open-source fashion. I would suggest that folks interested in looking into analyzing large datasets reach out to faculty who have experience with advanced statistical analysis and to also utilize statistical support. Did you have a mentor when you first started out your research career? What is the key to a successful mentoring relationship? I’ve never had someone specifically assigned as a "research mentor"; rather the series of PIs I’ve worked with over the years have effectively functioned as mentors. From doing data collection and database building at the University of New Mexico ED, to qualitive research and grant writing in Uganda for several years and to our work now in Utah, I feel like each PI has offered a different element of mentorship to complement my research career. I feel lucky in that each PI has allowed me to approach the project as a peer, as opposed to a research project where the PI says, “Here’s what I need studied and written." When the PI says “Here’s the data, this is what I think is a good question, what do you think?” it sets up a situation whereby the mentee can grow more and have a less hierarchical relationship with their mentor. For this mentoring relationship to be successful I believe both the mentor and mentee need to possess flexibility, motivation and patience. In completing this project, did you collaborate with anyone from fields or departments different from yours? If so, please comment on how this collaboration impacted your research. We worked closely with some of the critical care and internal medicine faculty at the University of Utah as well as with some of the data scientists. It was very helpful to have the proverbial shoulders to stand-on with internal medicine faculty who have already extensively studied single MEWS scores on the inpatient service. It was also very helpful to have data scientists who know our databases in and out and can do very sophisticated queries in relatively short periods of time. What have you found most satisfying about incorporating research into your medical career? I think as medical students, residents, and faculty we’ve all been trained to be critics of what’s “known” and to always be interested in how to make things better. Adding research to my medical career allows my curious mind to continue to wonder while complementing our day-to-day clinical duties. I find it adds an element of intrigue and reinvigorates me about the complexities and evidence behind our medical practice.

EDUCATION FELLOWSHIP: A SUCCESS STORY An Interview with Nicole Dubosh, MD What advice would you give to someone who is on the fence about doing an education fellowship? A medical education fellowship will provide you with specialized training and an in-depth understanding in all facets of medical education: teaching, curriculum development, assessment, medical education research, administration, and leadership. This fellowship is best suited for those interested in pursuing an academic career in medical education (i.e., holding an educational leadership position such as residency program director, clerkship director, vice chair of education, medical school dean, and other roles that require more than just the ability to teach). While not absolutely necessary to get hired on as dedicated medical education faculty, many chairs these days are seeking applicants with fellowship training for these positions, and at some institutions it is a requirement. What is the cost-benefit of an education fellowship? In terms of cost-benefit, there is much variability in the existing medical education fellowships, including duration (one vs two years), salary, and requirement to pursue an advanced degree such as a Masters of Public Health or a Masterâ&#x20AC;&#x2122;s in Education. Interested candidates should research different fellowships and consider these factors in their decision.

What was the most career-enhancing advantage you gained from the fellowship? The most career-enhancing part of my medical education fellowship was being able to dedicate a full year to learning about all aspects of medical education, but particularly research. Prior to my fellowship, I had little exposure to education research. I was able to immerse myself in courses on research methodology and writing, which has since allowed me to develop my own projects, mentor trainees on medical education studies, collaborate with other medical education researchers across the country on multicenter projects, and obtain grant funding in education research. Who is an educational fellowship best suited for? I would recommend doing an education fellowship if you are considering a true career path in medical education. It is certainly possible to be involved in teaching without a fellowship, and a medical education fellowship is not necessary for those who want a clinical teaching role only. ABOUT NICOLE DUBOSH, MD: Dr. Dubosh is an assistant professor of emergency medicine at Harvard Medical School and the associate clerkship director at Beth Israel Deaconess Medical Center.

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BRIEFS AND BULLET POINTS SAEM News and Information

RAMS Ask-a-Chair Podcasts

SAEM Aligns With EM Representative Groups to Issue Joint Policy Statement Regarding Faculty Protected Time

In July, SAEM and SAEM RAMS, in unified support with several of emergency medicine’s largest representative groups (listed below), agreed on a policy that all emergency medicine core faculty should be allocated protected time. Read the full policy statement. • American College of Emergency Physicians • American Academy of Emergency Medicine (AAEM) • AAEM Resident & Student Association • American Board of Emergency Medicine • American College of Osteopathic Emergency Physicians • American Osteopathic Board of Emergency Medicine • Association of Academic Chairs of Emergency Medicine • Council of Residency Directors in Emergency Medicine • Emergency Medicine Residents’ Association

SAEM’s Expert Consultants Can Help With Teaching, Research, and Other EM Practice Issues

SAEM members possess expertise in teaching, research, and other aspects of academic emergency medicine practice. Through SAEM Consultation Services, these experts from SAEM committees and academies, in consultation with AACEM, are available to assist individuals, departments, and institutions with developing, evaluating, and/or improving various services, including but not limited to new residency and fellowship programs; developing departmental status for emergency medicine divisions; subspecialty expertise (research, ultrasound, etc.); and billing, patient safety, etc. Visit the Consultation Services webpage for more information.

Robert Femia, MD

Andra L. Blomkalns, MD

Robert Shesser, MD

Jeremiah D. Schuur, MD

Accepting Applications and Scholarship Applications: AACEM Chair Development Program

The AACEM Chair Development Program (CDP) is a leadership training initiative designed to enhance the capabilities and effectiveness of new and aspiring academic emergency medicine department chairs through skill development, advising, and mentorship. Applications for the 2020-2021 CDP class, as well as for the following CDP scholarships, will be accepted through September 30. • AACEM/ADIEM Scholarship • AACEM/AWAEM Scholarship • C. Christopher King, MD Memorial Scholarship

SAEM Clinical Image Series Spotlights

More than 120 photos were exhibited in the popular “SAEM Clinical Images” photo competition at SAEM19 in Las Vegas. They are being featured again, throughout the year, on Academic Life in Emergency Medicine’s (ALiEM’s) widereaching blog. See if you can figure out solutions to the cases (listed, to date, below) before you take a peek at the answers! • Facial Swelling in a 2 Year Old • Tea & Toast: A Case of an Abdominal Rash • Corneal Foreign Body • Rash After a Sore Throat and Ibuprofen Use • Another Heart Attack? • Flu-like Symptoms, Oral Ulcers, and Rash • Fishing in Papua New Guinea • Distended Bowels • Rash with Blood Pressure Cuff Inflation

If you could ask an emergency department chair whatever you’d like about what it takes to be and become and EM chair, what would you ask? SAEM RAMS has compiled your most pressing questions and posed them directly to some of the top EM department chairs in the country. They discuss their answers in the SAEM RAMS Ask-a-Chair podcasts. The latest podcasts are below: Robert Femia, MD, professor and chair, Department of Emergency Medicine, NYU Langone Health Andra L. Blomkalns, MD, MBA, professor and chair, Department of Emergency Medicine, Stanford University Robert Shesser, MD, professor and chair, Department of Emergency Medicine, George Washington University Jeremiah D. Schuur, MD, MHS, professor and chair, Department of Emergency Medicine, Warren Alpert Medical School, Brown University

Free Webinar for CME: “The Patient with Recurrent Encephalopathy” Announcing a new, 30-minute, ondemand webinar titled, “ER Doc as Master Diagnostician: The Patient with Recurrent Encephalopathy.” This activity is designated for a maximum of .50 AMA/PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

SAEM Members in the National Spotlight! In Time magazine…

The Dangers of Linking Gun Violence and Mental Illness, co-authored by SAEM board member, Dr. Megan L. Ranney.

On CBS Sunday Morning…

Guns and Public Health: Applying Preventive Medicine to a National Epidemic, featuring SAEM board member, Dr. Megan Ranney and SAEM19 Keynote Speaker Dr. Garen Wintemute.

to address those needs. Pick a day, or several days, anytime between September 1 and September 30 and volunteer in your own community. For this year’s EM Day of Service, your SAEM staff will be volunteering locally at Feed My Starving Children, a non-profit organization that coordinates the packaging and distribution of food to feed the neediest children in developing nations around the world. Last year we packed a total of 9,720 meals that fed 26 children in Haiti for a full year! What will you be doing for EM Day of Service? As soon as you are registered, be sure to use social media to get the word out! Use #emdayofservice to start the buzz! Questions? Email emdayofservice@ emra.org. For more information visit the EM Day of Service webpage.

Educational Content from SAEM19 is Available on SOAR

Vice Chairs, There’s a New SAEM Interest Group Just for You!

page. Check the box next to the Vice Chairs Interest Group and click save. Once selected and saved, go to http://community.saem.org to join in the discussion! Questions? Contact membership@saem.org.

Heads Up! Nominations Open September 30

Mark your calendars for the following open dates and plan to submit your nominations. Watch your inbox and SAEM Social Media for more information. • SAEM Board of Directors Vice chairs advance a wide range of departmental missions through content expertise in broad domains such as education, research, clinical operations, academic affairs, and strategy. The new SAEM Vice Chairs Interest Group provides a forum for these members to collaborate, seek advice, share best practices, and network. If you are an SAEM member who serves as a vice chair and wish to join this interest group, just log in to your SAEM account and click the “Update Academies (+/-) or Interest Groups” button under you r name on the left side of your account

• RAMS (Residents and Medical Students) Board • AACEM Executive Committee • SAEM Academy leadership positions • SAEM Foundation Board of Trustees

EM Day of Service is This Month

During the month of September, join the SAEM staff and your emergency medicine colleagues from around the country in participating in the EM Day of Service, a specialty-driven event where emergency care providers identify community needs and volunteer

SAEM19 educational content is open access and available online at SOAR (SAEM Online Academic Resources). Experience convenient online and mobile viewing of Advanced EM Workshops, didactics, forums, abstracts, and more — 300+ hours of original educational content from SAEM19. Downloadable PDFs and MP3 files provide convenient, on-the-go viewing. Watch presenters’ slides while listening to fully synchronized audio.

SAEM Foundation In the Newest Research Learning Series Podcast Dr. Deborah Diercks Discusses How to Engage Faculty In the newest podcast episode from the SAEM Research Learning Series, Deborah B. Diercks, MD, UT Southwestern Medical Deborah B. Diercks, MD Center, discusses how to engage faculty in research. She provides a definition of engagement, outlines keys to engagement, discusses the need for engagement as a way to obtain buy-in for research, and offers tips for persuading others. The SAEM Research Learning Series provides live, online education on popular emergency medicine research topics.

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SAEM20 Updates Deadline to Submit an Advanced EM Workshop Day Proposal is September 16

Advanced EM Workshop Day takes place on May 12, 2020 and features multiple half- and full-day presentations of novel and/or in-depth academic emergency medicine topics presented by world class physcians. Sessions are geared toward providing attendees with intensive exposure into specialty topics such as research, teaching, clinical innovations, communication, gender and bias topics, and others. The deadline to submit proposals for Advanced EM Workshop Day is September 16, 2019. Visit the website for more information. The 2020 SAEM Annual Meeting is May 12-15, at the Sheraton Denver Downtown Hotel, in Colorado.

Call for Didactic Proposals

The SAEM20 Program Committee invites proposals for innovative didactic sessions that support the mission of SAEM: “To lead the advancement of emergency care through education and research, advocacy, and professional development in academic emergency medicine". Didactic sessions in the areas of pediatric emergency medicine research, teaching, and practice, are highly recommended. Some didactics may have a more focused audience such as trainees, junior faculty, or senior faculty. Successful submissions will require significant interactivity and breadth of content such as: panel discussion; lecture or seminar style; interactive workshop with small group facilitators. Deadline: October 1, 5 p.m. Central Time. The 2020 SAEM Annual Meeting is May 12-15, at the Sheraton Denver Downtown Hotel, in Colorado. For additional submission tips please see our new Recommended Best Practices for Didactics. Please visit the website for more information.

Have a Great Idea for a Pediatric EM Didactic? Submit Your Proposal! The Didactic Subcommittee of the SAEM Program Committee invites your proposals for didactic sessions in the areas of pediatric emergency medicine research, teaching, and practice, for presentation at SAEM20, May 12–15 in Denver. Should your didactic proposal be accepted, you will have the opportunity to present your pediatric EM research at the largest forum of its kind for the presentation of original education and research in academic emergency medicine. Deadline is October 1, 5 p.m. Central Time.

Two Dates Left for Didactic “Best Practices” Webinars

The SAEM Program Committee is hosting a webinar designed to share best practices for didactic submissions for SAEM20. During each webinar, the Didactics Subcommittee co-chairs will provide guidance about how to enhance didactic submissions and offer examples of best submissions from previous years. The webinar will be offered on two remaining dates: Sept. 3, and Sept. 4 from 3-4 p.m. CT. Sign up here. For additional submission tips please see our new Recommended Best Practices for Didactics.

• Expanded session: 50 minutes; generally multiple speakers

Exhibit at SAEM20

Put your products and services in front of EM decision makers, thought leaders, and early adopters... Exhibit with us at SAEM20 in Denver, CO. It’s sure to be well-attended. Visit the SAEM20 Exhibitor Information webpage to learn more.

Association of Academic Chairs of Emergency Medicine Now Accepting Registrations for the 2020 AACEM/AAAEM Annual Retreat

Didactic Formats • Focused session (appropriate for most didactic sessions): 20 minutes in length; one or two speakers; precise, wellhoned presentation format

Conference to Map the Intersection of Emergency Medicine and Telehealth, to be held May 12 at SAEM20 in Denver. The purpose of the consensus conference is to stimulate EM researchers and educators to recognize, investigate, and translate the impact of telehealth on the field of emergency medicine. (Interested in participating in a breakout planning group? Complete the “Contact Us” form on the webpage.)

“Telehealth” is the Focus of SAEM20 Consensus Conference

Registration opens December 1 for the 2020 Consensus Conference, Telehealth and Emergency Medicine: A Consensus

Registrations are now being accepted for the 12th Annual AACEM/AAAEM Annual Retreat, March 15-18, 2020, at the, JW Marriott Desert Springs Resort & Spa in Palm Desert, CA. Chairs and administrators may register online or by phone: (760) 341-2211. For housing, flight, and pricing information, as well as a general agenda, visit the webpage.

Residents & Medical Students

Medical Students: Renew Your RAMS Membership for as Little as $20 When You Sign Up With a Group of 50!

RAMS member benefits and opportunities will bolster your resume, guide you in choosing a specialty, broaden your knowledge, connect you with a network of mentors, and provide resources to give you a leg up in your career. The cost for membership is only $25 per student or $20 if you sign up with an institution of 50 or more medical students. Contact SAEM at membership@saem.org for more details and to join today.

Looking for the Perfect Fellowship? Check out the SAEM-approved fellowships in the Fellowship Directory. All SAEM-approved fellowships have been vetted by experts in administration, disaster medicine, education scholarship, geriatrics, global health, research, and wilderness medicine. They will provide you with the knowledge and skills you need to excel. Under “Fellowship Type,” just click on those marked “SAEM-Approved” to see the list of all programs endorsed by SAEM.

SAEM Regional Meetings It’s Not Too Late to Register for September Regional Meetings South Central Regional Dallas, TX, Sept. 6–7 Register Now!

Great Plains Regional Springfield, IL, Sept. 20–21 Register Now! Midwest Regional Southfield, MI, Sept. 19 Register Now!

SAEM Journals

July–September AEM E&T

AEM 5-Year Impact Factor Climbs Past 3.0!

The editor-in-chief and editorial board of Academic Emergency Medicine (AEM) is pleased to announce that AEM has achieved a 5-year Impact Factor of 3.389, placing it in the top three of all emergency care journals. In addition, for the past year, AEM has had an Altmetric Mentions index of 42.2, ranking it as the number two journal in emergency medicine. The Altmetric score measures the attention an article receives via social media and other media outlets.

Papers on Opioid Use/Misuse, Antibiotic Stewardship, and the Standardized Video Interview are EIC Picks of the Month

For each journal issue, the editors-inchief of Academic Emergency Medicine (AEM) and AEM Education & Training (AEM E&T) journals select one paper they feel is of particular relevance and importance to the specialty of academic emergency medicine. For July through August, AEM EIC Jeffrey Kline, MD, and AEM E&T EIC, Susan Promes, selected the following:

August AEM

Opioid Use and Misuse Three Months After Emergency Department Visit for Acute Pain by first author Raoul Daoust MD, MSc, et Raoul Daoust, MD al. Read Dr. Kline’s commentary, “The Pendulum,” and listen to the podcast, “Hooked on a Feeling…”

July AEM

A Multifaceted Intervention Improves Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings, Kabir Yadav, MDCM by first author Kabir Yadav, MDCM, MS, MSHS, et al. Read Dr. Kline’s commentary, “Real Value,” and listen to the podcast, Please Stop, Prescribing — Antibiotics for Viral Acute Respiratory Infections.

Abbas Husain, MD

The Standardized Video Interview: How Does It Affect the Likelihood to Invite for a Residency Interview? by Abbas Husain, MD, et al. Read Dr. Promes’ commentary.

Journal Podcasts Discuss Pay-for-Performance Programs, Compassion Fatigue, Climate Change, ED Crowding, and More!

Journal podcasts cut down on knowledge translation by providing top-quality audio content, with links to accompanying articles. Here are the latest podcasts, from the July through August issues of Academic Emergency Medicine (AEM) and AEM Education & Training (AEM E&T). Journal podcast are also available on iTunes.

August AEM Podcasts •O pioid Use and Misuse Three Months After Emergency Department Visit for Acute Pain •D o Financial Incentives Change Length-of-stay Performance in Emergency Departments? A Retrospective Study of the Payfor-performance Program in Metro Vancouver

July AEM Podcasts •A Multifaceted Intervention Improves Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings •A Cross-sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Emergency Medicine Physicians in the United States

July–September AEM E&T Podcasts •S cience Policy Training for a New Physician Leader: Description and Framework of a Novel Climate and Health Science Policy Fellowship •E mergency Medicine Resident Efficiency and Emergency Department Crowding

ACADEMIC ANNOUNCEMENTS University of Pennsylvania

Duke University

Jill M. Baren, MD, MBA, a professor of emergency medicine, pediatrics, and medical ethics in the Perelman School of Medicine at the University of Pennsylvania, has been elected president of the American Board of Emergency Medicine (ABEM). She Jill M. Baren, MD, MBA has been a member of the ABEM Board of Directors since July 2012, and was elected to the executive committee in 2016. Dr. Baren, also an attending physician at Children’s Hospital of Philadelphia, has served in many leadership roles at Penn Medicine and in professional organizations nationally, including the Society for Academic Emergency Medicine (SAEM) for which she has served as a past president of the SAEM Board of Directors and of the SAEM Foundation Board of Trustees (presently a member-at-large). Dr. Baren served for many years on the editorial board of Academic Emergency Medicine, and is a long-time, active member of the SAEM Development Committee. In 2017, she received the John Marx Leadership Award, the Society’s most prestigious award, given to a member who has made exceptional contributions to emergency medicine through their leadership.

Charles Gerardo, MD, has been promoted to the rank of professor, the first emergency medicine faculty to attain this rank at Duke University. Dr. Gerardo is the foremost expert in copperhead envenomation, an author of more than 60 peer-reviewed publications and chapters, and a much Charles Gerardo, MD sought-after speaker internationally. He has helped train every graduate from Duke’s emergency medicine residency program and has mentored dozens of trainees and faculty who have become leaders in the specialty.

Baystate Medical Center/University of Massachusetts Medical School-Baystate

NewYork-Presbyterian and Weill Cornell Medicine

Timothy J. Mader, MD, professor of emergency medicine at Baystate Medical Center/University of Massachusetts Medical School in Springfield, MA, has received a National Heart, Lung, and Blood Institute R21 award (R21HL144447) to determine Timothy J. Mader, MD if the effect of therapeutic hypothermia/ targeted temperature management after out-of-hospital cardiac arrest is modified by rhythm classification. Dr. Mader, who was the recipient of the 20052006 SAEM Scholarly Sabbatical award, has since secured numerous institutional, foundation, and federal grants. Daniel F. Leiva, DO, MS, an emergency medicine research fellow at Baystate Medical Center/University of Massachusetts Medical School in Springfield, MA, has been awarded a National Heart, Lung, and Blood Institute T32 Research Training Daniel F. Leiva, DO, MS grant (T32HL120823) to work with Dr. Timothy J. Mader and use data from the Cardiac Arrest Registry to Enhance Survival to derive and validate a simple model, based on readily available patient characteristics and resuscitation process variables independent of patient-specific comorbidities, to predict hospital outcome probabilities for geriatric out-of-hospital cardiac arrest event survivors.

Loma Linda University Tamara Thomas, MD, has been appointed to serve as executive vice president for medical affairs and dean at Loma Linda University School of Medicine. Dr. Thomas has served as the school’s vice dean for academic affairs since 2011. She is a professor of the School of Medicine’s Tamara Thomas, MD Department of Emergency Medicine and the department’s interim chair. Rahul Sharma, MD, an emergency physician-in-chief at NewYork-Presbyterian/ Weill Cornell Medical Center and chair of the department of emergency medicine at Weill Cornell Medicine, has been named a top 25 innovator in the healthcare industry by Modern Healthcare. The inaugural list Tony Rosen, MD recognizes executives who are initiating and leading transformation across the healthcare industry. Dr. Sharma also leads the ED’s telemedicine program, ED Telehealth Express Care, which allows patients with non-lifethreatening conditions to visit virtually with an emergency medicine physician in a private room. Tony Rosen, MD, program director for NewYork-Presbyterian/Weill Cornell Medical Center’s Vulnerable Elder Protection Team (VEPT), and his team, received more than $2 million from the New York State Office of Victim Services to support and expand the VEPT, an innovative, emergency Tony Rosen, MD department-based program that improves care for victims of elder abuse. Dr. Rosen is an assistant professor of emergency medicine at Weill Cornell Medicine an attending emergency physician at NewYork-Presbyterian/ Weill Cornell Medical Center. He is a member of SAEM’s Academy of Geriatric Emergency Medicine (AGEM) and was awarded the 2019 Society of Academic Emergency Medicine (SAEM) Young Investigator Award.

Northwestern University

UT Southwestern Medical Center

Scott Dresden MD, MS, assistant professor of emergency medicine and director of Geriatric Emergency Department Innovations (GEDI) at Northwestern University Feinberg School of Medicine, received an R01 from the Agency for Healthcare Research and Quality for his Scott Dresden MD, MS grant "A Randomized Controlled Trial of Geriatric Emergency Department Innovations (GEDI)." GEDI centers on assessments, referral, and care coordination performed by transitional care nurses in the ED. The primary objective is to evaluate GEDI’s impact on patient centered outcomes using a randomized controlled trial. Dr. Dresden is a member of SAEM’s Academy of Geriatric Emergency Medicine (AGEM).

Larissa Velez, MD, has been selected as the new associate dean for graduate education at UT Southwestern Medical Center where she is also a distinguished teaching professor in the department of emergency medicine and the emergency medicine program director. Dr. Velez is Larissa Velez, MD the inaugural holder of the Michael P. Wainscott, M.D. Professorship in Emergency Medicine.

University of North Carolina Christina Shenvi, MD, PhD, was awarded the National ACEP Junior Faculty Teaching Award and was recently appointed as the director of the UNC Office of Academic Excellence. Dr. Shenvi is fellowship-trained in geriatric emergency medicine and Christina Shenvi, MD, PhD developed the first podcast on geriatric EM topics, called GEMCast. She helped lead the efforts for accreditation of the first geriatric emergency department in the state of North Carolina. Dr. Shenvi is a member of SAEM’s Academy of Geriatric Emergency Medicine (AGEM).

Yale University Arjun Venkatesh MD, MBA, MHS, an assistant professor and director of quality and safety research and strategy in the department of emergency medicine at the Yale University School of Medicine, was selected as the 2019–2020 National Academy of Medicine (NAM) American Arjun Venkatesh MD Board of Emergency Medicine (ABEM) Fellow. The overall purpose of the ABEM Emergency Medicine Fellowship is to provide talented, early-career health science scholars in emergency medicine with the opportunity to experience and participate in evidence-based healthcare or public health studies that improve the care and access to care of patients in domestic and global health care systems. Dr. Venkatesh is also a scientist at the Yale New Haven Hospital-Center for Outcomes Research and Evaluation (CORE).

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to newsletter@saem.org. The next content deadline is October 1, 2019 for the November/December 2019 issue.

NOW HIRING POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES! Accepting ads for our â&#x20AC;&#x153;Now Hiringâ&#x20AC;? section! Deadline for the next issue of SAEM Pulse is October 1. For specs and pricing, visit the SAEM Pulse advertising webpage.

Department of Emergency Medicine University of North Carolina at Chapel Hill, Department of Emergency Medicine is currently recruiting for full-time faculty openings for 2020-2021. Full-time faculty are currently being recruited with expertise in Administration, Research and Ultrasound. Successful applicants will be Board Certified/Board Prepared in Emergency Medicine. UNC Hospitals is a 950-bed Level I Trauma Center. The Emergency Department sees upward of 70,000 high acuity patients per year. Applicants should send a letter of interest and curriculum vitae to: Gail Holzmacher, Business Officer (gholzmac@med.unc.edu), Department of Emergency Medicine, Phone: (919)843-1400. The University is an equal opportunity, affirmative action employer and welcomes all to apply without regard to age, color, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, or sexual orientation. We also encourage protected veterans and individuals with disabilities to apply.

Vice Chair of Research Rutgers Robert Wood Johnson Medical School Department of Emergency Medicine Rutgers is New Jersey’s premiere public research university. With a $1 billion commitment to invest in, support and drive groundbreaking, advanced research, the recent Rutgers and RWJ Barnabas Health integrated academic health system aims to further the university’s reputation as a leader in academic health care and biomedical research. Rutgers currently is ranked among the nation’s top 20 public universities for research and development expenditures. Rutgers Robert Wood Johnson Medical School is first in the state for research and has steadily attracted increased NIH funding and grants in excess of $1 million, as well as substantially expanded its clinical trials with the launch of a new, world-class adult clinical research center. The Department of Emergency Medicine is seeking a Vice Chair of Research at the Associate Professor or Professor level, preferably tenure track. The Department’s goal is to grow its research and scholarly output while building a nationally recognized research program. The Vice Chair will provide leadership and oversight of the research mission for the Department. Successful candidates will have a demonstrated track record of independently funded research, publication in high-impact, peer-reviewed journals, strong mentorship skills and clear evidence of promoting the academic careers of junior faculty. The Vice Chair must demonstrate expertise in leading research in EM and possess the interpersonal skills to engage, inspire and work across disciplines within a large, diverse organization. Robert Wood Johnson Medical School and its principal teaching affiliate, Robert Wood Johnson University Hospital, comprise New Jersey’s premier academic medical center. A 580-bed, Level 1 Trauma Center and New Jersey’s Level 2 Pediatric Trauma Center, Robert Wood Johnson University Hospital has an annual ED census in excess of 90,000 visits. The department has a well-established, three-year Emergency Medicine residency program and an Emergency Ultrasound fellowship. Qualified candidates must be ABEM/ABOEM certified/ eligible. Salary and benefits are competitive and commensurate with experience.

Please send a letter of intent and a curriculum vitae to:

Robert Eisenstein, MD, Chair, Department of Emergency Medicine Rutgers Robert Wood Johnson Medical School 1 Robert Wood Johnson Place, MEB 104, New Brunswick, NJ 08901 Email: Robert.Eisenstein@rutgers.edu Phone: 732-235·8717 · Fax: 732 235-7379 Rutgers, The State University of New Jersey, is an Affirmative Action/ Equal Opportunity Employer, M/F/D/V.

BRIGHAM AND WOMEN'S HEALTHCARE BRIGHAM AND WOMEN'S HEALTHCARE MEDICINE CLINICAL RESEARCHER EMERGENCY EMERGENCY MEDICINE CLINICAL RESEARCHER The Department of Emergency Medicine at Brigham and Women’s HealthCare (BWHC) is seeking emergency medicine physicians interested in clinical research.

The Department of Emergency Medicine at Brigham and Women’s HealthCare

The Department of Emergency Medicine provides unparalleled opportunitiesinterested for collaboration faculty (BWHC) is seeking emergency medicine physicians in with clinical and researchers throughout Brigham Health and Harvard. The appropriate candidate will be eligible for research. academic appointment at Harvard Medical School at the rank of Instructor or Assistant Professor or Associate Professor commensurate with experience, achievement, recognition, and participation in teaching and scholarly activities. The offers unparalleled opportunities for unparalleled professional development, a The Department of position Emergency Medicine provides opportunities competitive salary, and an outstanding comprehensive benefit package. BWHC is intensely committed to forpersonal collaboration withdevelopment faculty and throughout Brigham Health and the and professional of ourresearchers providers.

Harvard. The appropriate candidate will be eligible for academic appointment

Successful candidates must have successfully completed a four year residency training program in at Harvard Medical School at thefollowed rankbyofa Instructor or year Assistant Professor Emergency Medicine, or a three year program fellowship or one in practice, and must beor board prepared or certified in Emergency Medicine. with experience, achievement, recognition, Associate Professor commensurate

and participation in send teaching andCurriculum scholarly The position offers Interested candidates should a letter and Vitaeactivities. to Michael VanRooyen, MD, MPH, Professor and Chair,opportunities Department of Emergency Medicine, Brigham and Women’s Hospital. Please applysalary, by unparalleled for professional development, a competitive confidential email to mdeloge@bwh.harvard.edu. and an outstanding comprehensive benefit package. BWHC is intensely

We are an equal to opportunity employerand and professional all qualified applicants will receive consideration for committed the personal development of our providers. employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, gender identity, sexual pregnancy and pregnancy-related Successful candidates mustorientation, have successfully completed a fourconditions year or any other characteristic protected by law.

residency training program in Emergency Medicine, or a three year program followed by a fellowship or one year in practice, and must be board prepared or certified in Emergency Medicine. Interested candidates should send a letter and Curriculum Vitae to Michael VanRooyen, MD, MPH, Professor and Chair, Department of Emergency Medicine, Brigham and Women’s Hospital. Please apply by confidential email to mdeloge@bwh.harvard.edu. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, gender identity, sexual orientation, pregnancy and pregnancy-related conditions or any other characteristic protected by law.

DEPARTMENT OF EMERGENCY MEDICINE

EMERGENCY MEDICINE FACULTY (ASSOCIATE THROUGH PROFESSOR LEVEL)

The University of Pittsburgh Department of Emergency Medicine invites applications and nominations for the Paul Paris endowed professorship in Emergency Medicine Quality. The successful candidate is expected to advance the knowledge and implementation of quality and safety measures in acute care. A strong record of scholarship with national recognition in fields related to emergency care is required. The successful candidate should mentor junior colleagues, engage in the training mission of the department, and create collaborations throughout the University. Applicants should hold a doctorate and be eligible for full-time appointment at the rank of associate or full professor with tenure. Interested applicants should submit current curriculum vitae with the names and contact information for three references Inquiries can be directed to: Donald M. Yealy, MD Professor and Chair of Emergency Medicine University of Pittsburgh 10028 Forbes Tower 3600 Forbes Ave. Pittsburgh, PA 15213 ART#: 225434_RURWJMS_SAEM.indd PUBLICATION: SAEM Pulse

UPMC and3.5x9.75 The University of Pittsburgh SIZE: are EEO/AA/M/F/Vets/Disabled

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Exciting opportunities at our growing organization • Core Emergency Medicine and PEM Faculty positions • EM Medical Director • EMS Medical Director / EMS Fellowship Director • Vice Chair, Clinical Operations & Strategy Development • Vice Chair, Research Penn State Health, Hershey PA, is expanding our health system. We offer multiple new positions for exceptional physicians eager to join our dynamic team of EM and PEM faculty treating patients at the only Level I Adult and Level I Pediatrics Trauma Center in Central Pennsylvania. What We’re Offering: • Salaries commensurate with qualifications • Sign-on Bonus • Relocation Assistance • Retirement options, Penn State University Tuition Discount, and so much more! What We’re Seeking: • Core Emergency Medicine trained physicians with additional training in any of the following: Toxicology, Ultrasound, Geriatric Medicine, Pediatric Emergency Medicine, Research • Completion of an accredited Emergency Medicine Residency Program and Fellowship for PEM positions • BE/BC by ABEM or ABOEM • Observation experience is a plus

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

FOR MORE INFORMATION PLEASE CONTACT:

Heather Peffley, PHR FASPR at: hpeffley@pennstatehealth.psu.edu Penn State Health is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

Featured Leadership and Faculty Positions Residency Program Director Cartersville Medical Center. Greater Atlanta, GA New EM Residency Program slated to begin July 2020. Contact Barbara Lay at 727.507.3608

Ultrasound Fellowship Director and Clinical Faculty Osceola Regional Medical Center. Kissimmee, FL EM Residency Program affiliated with the University of Central Florida College of Medicine. Contact Shawn Stampfli at 404.663.4770

Core Faculty and PEM Faculty Oak Hill Hospital. Tampa Bay, FL New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Contact Ody Pierre-Louis at 727.507.3621

Research Director and Simulation Director Brandon Regional Hospital. Tampa Bay, FL New EM Residency Program affiliated with the University of South Florida Morsani College of Medicine. Contact Esther Aguilar at 727.519.4851

Clinical Faculty Kendall Regional Medical Center. Miami, FL EM Residency Program affiliated with the Herbert Wertheim College of Medicine at Florida International University. Contact Lisa M. Chamerski at 727.507.2508

Clinical Faculty St. Lucie Medical Center. Port St. Lucie, FL PBCGME affiliated Osteopathic EM Residency Program. Contact Amy Anstett at 954.295.1524

Research Director, Ultrasound Director and Core Faculty Ocala Regional Medical Center. Ocala, FL EM Residency Program affiliated with UCF Health Morsani College of Medicine and HCA GME Consortium. Contact Craig McGovern at 727.437.0846

Academic Emergency Medicine Faculty The BerbeeWalsh Department of Medicine at the University of Wisconsin School of Medicine & Public Health in Madison, Wisconsin, is seeking highly-motivated BC/BE Emergency Medicine Physicians to join a thriving faculty group that provides clinical services in the Emergency Departments of the University of Wisconsin Hospitals and Clinics (University Hospital), UW Health at The American Center (TAC), American Family Childrenâ&#x20AC;&#x2122;s Hospital (AFCH), and other UW Health approved sites. University Hospital is a busy, universitybased referral hospital; one of only two academic medical centers in the state and a Level 1 Trauma and Burn Center for both adult and pediatric patients. EM faculty supervise EM and off-service residents, as well as medical students. Successful candidates will join a faculty of both emergency physicians and pediatric emergency physicians.

Leadership opportunities are available in addition to faculty positions: Pediatric Emergency Medicine and Simulation Robust professional development opportunities exist in all key areas. The position offers a competitive salary, relocation assistance, CME allowance, and a comprehensive benefit package. To inquire, send your CV and cover letter to:

Azita G. Hamedani, MD, MPH, MBA agh@medicine.wisc.edu Chair, BerbeeWalsh Department of Emergency Medicine 800 University Bay Dr. Suite 310, MC 9123 Madison, WI 53705

The University of Wisconsin Hospitals are ranked in the top 20 by U.S. News & World Report Best Hospitals Honor Roll

Madison is home to the University of Wisconsin. As the capital of Wisconsin, Madison boasts of itâ&#x20AC;&#x2122;s natural beauty and outdoor recreation, stimulating cultural scene, distinctive culinary offerings, vibrant shopping, Big Ten sports, a spirit of fun and urban culture mixed with small town charm.

UW Madison is an EEO/AA Employer. Minorities and women are encouraged to apply. Wisconsin caregiver and open records laws apply. A background check will be conducted prior to employment.

EMERGENCY MEDICINE FELLOWSHIP OPPORTUNITIES Continue your academic Emergency Medicine training in Madison, Wisconsin with the BerbeeWalsh Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health

Visit us online at http://emed.wisc.edu

RESEARCH FELLOWSHIP

ACCREDITED EMS FELLOWSHIP

The two-year, Society for Academic Emergency Medicinecertified Research Fellowship seeks emergency medicine residency-trained physicians who wish to develop a career as a clinical or health services researcher.

The one-year, ACGME-accredited EMS fellowship seeks emergency medicine residency-trained physicians interested in advanced training in all aspects of EMS.

Based at a top public university, ranked #9 in EM funding nationwide (NIH 2018), the Research Fellowship leverages extensive Departmental and institutional resources. Faculty members have expertise in the following areas:  Geriatric Emergency Medicine  Emergency Radiology  Infectious Diseases  Informatics In addition, relationships have been established with UW researchers in the following departments:  College of Engineering  School of Nursing  Department of Radiology  Division of Geriatrics

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Fellows will interface with EMS and disaster medicine leaders while engaging with a variety of local EMS systems. Highlights of the EMS fellowship include:  Access to Dane County’s robust EMS network  21 EMS Agencies  28 Fire Departments  30 Law Enforcement Agencies  1,200 EMS Providers  On-scene medical direction and patient care  24/7 Staffed Physician Response Vehicles  Tactical EMS  Physician Staffed Helicopter EMS Opportunities  Research opportunities

Upon graduation, the Fellow will be well prepared for a research career and to obtain a Career Development Award. For more information or to apply, please contact Dr. Manish Shah, Vice Chair of Research and Fellowship Director at mnshah@medicine.wisc.edu. A vibrant state capital & home of the University of Wisconsin—Madison offers the best of all worlds:  Ranked #3 Best Place to Live in the U.S.

by Livability, 2019

 Five area lakes with ample recreation  Within 50 miles of 21 WI state parks  Urban culture mixed small town charm  Distinctive dining & shopping offerings  Big Ten sports & USL soccer team (Pictured) Wisconsin State Capitol downtown Madison

At the completion of the fellowship, the EMS fellow will be fully prepared to lead, providing exceptional medical oversight of pre- and out-of-hospital emergency care systems with advanced competencies in EMS system design, administration, and clinical care. For more information, please contact Dr. Michael Mancera, EMS Fellowship Director at mmancera@medicine.wisc.edu. UW Madison is an EEO/AA Employer. Minorities and women are encouraged to apply. Wisconsin caregiver and open records laws apply. A background check will be conducted prior to employment.

University of California San Francisco Fresno Emergency Medicine Faculty Position The Department of Emergency Medicine at UCSF Fresno in conjunction with Central California Faculty Medical Group is seeking additional core faculty members. Our emergency medicine residency program was founded in 1974, with 42 EM residents in a PGY1-4 format and supported by UCSF and Community Regional Medical Center (CRMC) in Fresno, California. CRMC has 630 beds, averages 115,000 ED visits a year, while being amongst the busiest Level One Trauma Centers in California. We serve as the Base Station for a four-county EMS System and provide medical direction to the National Parks Service. Our faculty group consists of 40 full time residency trained board certified emergency physicians, many with additional fellowship training. Applicants must be board certified in Emergency Medicine (or eligible) and must be able to obtain a California medical license at time of hire. Depending on qualifications, leadership positions exist within the spheres of Ultrasound, EMS, Residency Program Leadership, Research, and Pediatrics. Residents and faculty enjoy a high standard, low cost living. Limitless recreational opportunities and spectacular scenery is all accessible in a community with abundant affordable housing. While there is much to see and do in Fresno, the city is ideally located for convenient getaways to the majestic Sierra (60 minutes away), as well as the scenic Central Coast, just two and one-half hours away. Fresno is the only major city in the country with proximity to three national parks: Sequoia, Kings Canyon and Yosemite. For Inquiries please contact Jim Comes, MD, Chief: jcomes@fresno.ucsf.edu

PLEASE APPLY ONLINE AT: https://aprecruit.ucsf.edu/apply/JPF02012 Visit our websites: www.fresno.ucsf.edu/em UCSF seeks candidates whose experience, teaching, research, or community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an affirmative action/equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, age or protected veteran status.

Pediatric Emergency Medicine Physician

Atrium Health Levine Children’s Emergency Department is hiring additional pediatric emergency medicine subspecialists in the clinician educator role. The Division of Pediatric Emergency Medicine, in the Department of Emergency Medicine, at Atrium Health Carolinas Medical Center and Health Levine Emergency is hiring additional pediatric Atrium HealthAtrium Levine Children’s HospitalChildren’s seeks qualified candidatesDepartment to help us expand pediatric emergency medicalemergency expertise across the system. medicine subspecialists in the clinician educator role. The Division DC. of Pediatric Emergency Levine Children’s Hospital is the largest children’s hospital between Atlanta and Washington,

Medicine, in the Department of Emergency Medicine, at Atrium Health Carolinas Medical Center About our Emergency Dept: and Atrium Health Levine Children’s Hospital seeks qualified candidates to help us expand • Level I trauma center staffed by an inclusive group of pediatric emergency medicineLevine subspecialists and emergency medicine specialists. pediatric emergency medical expertise across the system. Children’s Hospital is the largest • We sponsor a pediatric emergency medicine fellowship program with two fellows per year. children’s hospital between Atlanta and Washington, DC.

• We provide state of the art pediatric emergency medical services to the diverse community of Charlotte using a family centered care model with the help of child life specialists, interpreters, social workers, patient care representatives, and psychiatric care navigators About ourtoEmergency • Our facility is expanding 21 beds in 2020Dept: while designing a brand-new children’s emergency department expected to open in 2024. Candidates with the following training will be considered:

•

Level I trauma center staffed by an inclusive group of pediatric emergency medicine

• Combined Emergency Medicine and Pediatrics residency training and emergency medicine • Emergency Medicinesubspecialists residency AND Pediatric EM fellowship training specialists. • We a pediatric medicine fellowship • Pediatrics residency ANDsponsor Pediatric EM fellowshipemergency training

program with two fellows per year. • We provide state of the art pediatric emergency medical services to the diverse community About the Community: of Charlotte using a family centered care model with the help of child life specialists, • Located in the heart interpreters, of the Southeast, Charlotte is the largest most accessible city between Washington,care DC and Dallas, TX. Due to its midsocial workers, patientand care representatives, and psychiatric navigators Atlantic location, getting to Charlotte is easy from anywhere in the country or the world, hence its nickname “the International Gateway to the • Our facility is expanding to 21 beds in 2020 while designing a brand-new children’s South.”University of Colorado expected to ranks open1st in in 2024. • The population of theemergency metropolitandepartment area is 2.4 million. Charlotte economic strength while maintaining a cost of living below national

Academic and Community Faculty Positions Available

Anschutz average. As the 17thMedical largest cityCampus in the U.S., Charlotte has significant cultural and education resources. The arts are well supported, and the educational system isEmergency progressive, with strong schools in both public and private sectors. Charlotte is 2 hours from the mountains and 3 hours Department of “All Ranks” Candidates with theMedicine following training will be considered: from the east coast.

For more information, please contact: Allison.Beamer@AtriumHealth.org Provider Recruiter, 704.631.1123

• • •

Combined Emergency Medicine and Pediatrics residency training The largest academic health care center in Emergency Medicine residency AND Pediatric EM fellowship training the Rocky Mountain region, Denver has Pediatrics residency AND Pediatric EM fellowship training

Fellowship Opportunities

Administration, Operations & Quality  Palliative Care also been named one of the best places to  ClimateAbout & Health Policy  Research theScience Community: live, play, and raise a family. CU Anschutz  Critical Care/ Anesthesiology  Toxicology leading way in education, research • Located in the heart of the Southeast, Charlotte is the largest is and most the accessible city  Education  Ultrasound University of Colorado between Washington, DC and Dallas, TX. Due to its mid-Atlantic location, getting to and patient care. We provide coverage to Charlotte is easy from anywhere in the country or the world, hence its nickname “the  Emergency Medical Services  Wilderness Medicine Anschutz Medical Campus three hospital based EDs and several of International Emergency Gateway Medicineto the South.” “All Ranks”  Department Global Health 

Academic and Community Faculty Positions Available freestanding EDs.

The population of the metropolitan area is 2.4 million. Charlotte ranks 1st in economic strength while maintaining a cost of living below national average. As the 17th largest city in the U.S., Charlotte has significant cultural and education resources. The academic arts are well The largest health care center in supported, and the educational system is progressive, with strong schools in both public the Rocky Mountain and private sectors. Charlotte is 2 hoursCare from the mountains and 3 hours from theregion, east Denver has  Administration, Operations & Quality  Palliative coast. also been named one of the best places to •

Fellowship Opportunities

Climate & Health Science Policy  Research  Critical Care/ Anesthesiology  Toxicology For more information: please contact: Allison.Beamer@AtriumHealth.org  Education  Ultrasound Provider Recruiter, 704.631.1123  Emergency Medical Services  Wilderness Medicine  Global Health 

live, play, and raise a family. CU Anschutz

is leading the way in education, research and patient care. We provide coverage to three hospital based EDs and several freestanding EDs.

Learn more www.medschool.ucdenver.edu/em email: emed.recruitment@ucdenver.edu

Emergency Medicine & Toxicology Faculty Rutgers Robert Wood Johnson Medical School The Department of Emergency Medicine at Rutgers Robert Wood Johnson Medical School, one of the nation’s leading comprehensive medical schools, is currently recruiting Emergency Physicians and Medical Toxicologists to join our growing academic faculty. Robert Wood Johnson Medical School and its principal teaching affiliate, Robert Wood Johnson University Hospital, comprise New Jersey’s premier academic medical center. A 580bed, Level 1 Trauma Center and New Jersey’s only Level 2 Pediatric Trauma Center, Robert Wood Johnson University Hospital has an annual ED census of greater than 90,000 visits.

Faculty Positions-Emergency Medicine The George Washington University Medical Faculty Associates, an independent nonprofit academic clinical practice group affiliated with The George Washington University, is seeking full-time academic Emergency Medicine physicians. The Department of Emergency Medicine (http://smhs.gwu.edu/emed/) provides staffing for the emergency units of George Washington University Hospital, United Medical Center, the Walter Reed National Military Medical Center, and the Washington DC Veterans Administration Medical Center. The Department’s educational programs include a fouryear residency program and ten fellowship programs. Responsibilities include providing clinical and consultative service; teaching fellows, residents, and medical students; and maintaining an active research program. These non-tenure track appointments will be made at a rank (Instructor/Assistant/Associate/Full Professor) and salary commensurate with experience. Basic Qualifications: Applicants must be ABEM or AOBEM certified, or have completed an ACGME or AOA certified Emergency Medicine residency, and be eligible for licensure in the District of Columbia, at the time of appointment. Application Procedure: Complete the online faculty application at http://www.gwu.jobs/postings/68602 and upload a CV and cover letter. Review of applications will be ongoing beginning August 30, 2019 and will continue until positions are filled. Only complete applications will be considered. Employment offers are contingent on the satisfactory outcome of a standard background screening. Questions about these positions may be directed to Department Chair, Robert Shesser M.D., at rshesser@mfa.gwu.edu. The George Washington University and the George Washington University Medical Faculty Associates are Equal Employment Opportunity/Affirmative Action employers that do not unlawfully discriminate in any of its programs or activities on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity or expression, or on any other basis prohibited by applicable law.

The department has a well-established, threeyear residency program and an Emergency Ultrasound fellowship. The department is seeking physicians who can contribute to our clinical, education and research missions. Qualified candidates must be ABEM/ ABOEM certified/eligible. Salary and benefits are competitive and commensurate with experience. Sub specialty training is desired but not necessary. For consideration, please send a letter of intent and a curriculum vitae to:

Rutgers, The State University of New Jersey, is an Affirmative Action/ Equal Opportunity Employer, M/F/D/V.

BRIGHAM AND WOMEN'S HEALTHCARE BRIGHAM AND WOMEN'S HEALTHCARE MEDICINE CLINICAL RESEARCHER EMERGENCY ACADEMIC EMERGENCY MEDICINE PHYSICIAN, The Department of Emergency Medicine at Brigham and Women’s HealthCare (BWHC) is seeking emergency DIVISION medicine physicians interested in clinical research. OF EMERGENCY ULTRASOUND The Department of Emergency Medicine provides unparalleled for collaboration withHealthCare faculty The Department of Emergency Medicine at opportunities Brigham and Women’s and researchers throughout Brigham Health and Harvard. The appropriate candidate will be eligible for (BWHC)appointment is seeking emergency medicine physicians the department’s academic at Harvard Medical School at the rank of Instructor orfor Assistant Professor or Associate Professor commensurate with experience, achievement, recognition, and participation in teaching Division of Emergency Ultrasound. and scholarly activities. The position offers unparalleled opportunities for professional development, a The Division of Emergency Ultrasoundbenefit at Brigham and Women’s Hospitalto competitive salary, and an outstanding comprehensive package. BWHC is intensely committed the personal and professional development of our providers. oversees point-of-care ultrasound education, credentialing and daily

administrative at Brigham and Women’s Hospital and Brigham and Successful candidates operations must have successfully completed a four year residency training program in Emergency Medicine, or a three year program followedfaculty by a fellowship or one year in practice, must be Women’s Faulkner Hospital. Division co-direct (with facultyandfrom MGH board prepared or certified in Emergency Medicine. and Children’s Hospital) the emergency ultrasound education program for the

Harvard Affiliated Emergency Medicine Interested candidates should send a letter and CurriculumResidency Vitae to Michael(HAEMR). VanRooyen, MD, MPH, Professor and Chair, Department of Emergency Medicine, Brigham and Women’s Hospital. Please apply by The appropriate candidate will be eligible for academic appointment at confidential email to mdeloge@bwh.harvard.edu. Harvard Medical School at the rank of Instructor or Assistant Professor or

We are an equal opportunity employer and all qualified applicants will receive consideration for Associate Professor commensurate with experience, achievement, recognition, employment without regard to race, color, religion, sex, national origin, disability status, protected and participation in teaching and scholarly activities. The position offersor veteran status, gender identity, sexual orientation, pregnancy and pregnancy-related conditions any other characteristic protected byfor law.professional development, a competitive salary, unparalleled opportunities

and an outstanding comprehensive benefit package. BWHC is intensely committed to the personal and professional development of our providers. Successful candidates must have successfully completed a four year residency training program in Emergency Medicine, or a three year program followed by a fellowship or one year in practice, and must be board prepared or certified in Emergency Medicine. Interested candidates should send a letter and Curriculum Vitae to Michael VanRooyen, MD, MPH, Professor and Chair, Department of Emergency Medicine, Brigham and Women’s Hospital. Please apply by confidential email to mdeloge@bwh.harvard.edu. ART#: 225433_RURWJMS_SAEM.indd

We are an equal opportunity employer and all qualified applicants will receive consideration for PUBLICATION: SAEM Pulse employment without regard to race, color, religion, sex, national origin, disability status, protected SIZE: veteran status,3.5x9.75 gender identity, sexual orientation, pregnancy and pregnancy-related conditions or anyD: other characteristic protected by law. mh

WASHINGTON DC – The Department of Emergency Medicine at the George Washington University is offering Fellowship positions beginning July 2020: Disaster & Operational Medicine

International Emergency Medicine

Medical Leadership & Operations

Medical Toxicology

Emergency Ultrasound

Clinical Research

Telemedicine/Digital Health

Health Policy

Extreme Environmental Medicine

Sports Medicine

Medical Education and Simulation

Fellows receive an academic appointment at The George Washington University School of Medicine & Health Sciences and work clinically at a site staffed by the Department. The Department offers Fellows an integrated, interdisciplinary curriculum, focusing on research methodologies and grant writing. Tuition support for an MPH or equivalent degree may be provided, as per the fellowship’s curriculum. Complete descriptions of all programs, application instructions, and Fellowship Director contacts can be found at: https://smhs.gwu.edu/emed/education-training/fellowships

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Congratulations & Happy Anniversary CELEBRATING

10 YEARS OF PROGRESS 61

SEE YOU AT 20 Denver, Colorado May 12-15, 2020 Sheraton Denver Downtown Hotel