SAEM Pulse September-October 2020

SEPTEMBER-OCTOBER 2020 | VOLUME XXXV NUMBER 5

www.saem.org

SPECIAL ISSUE: RACISM AS A PUBLIC HEALTH CRISIS

SPOTLIGHT BUILDING A CULTURE OF INCLUSION AND EQUITY THROUGH ADVOCACY, RESEARCH, AND EDUCATION An Interview with

Ava E. Pierce, MD

EXPLORING ACADEMICS: HOW MEDICAL STUDENTS & RESIDENTS CAN GET INVOLVED IN ACADEMIC EMERGENCY MEDICINE page 56

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 Manager, Accounting Hugo Paz Ext. 216, hpaz@saem.org Director, Governance Kat Nagasawa, MBA Ext. 206, knagasawa@saem.org Coordinator, Governance Michelle Aguirre, MPA Ext. 205, maguirre@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 Sr. Manager, Membership George Greaves Ext. 211, ggreaves@saem.org Education Manager Andrea Ray Ext. 214, aray@saem.org Membership & Meetings Coordinator Monica Bell, CMP Ext. 202, mbell@saem.org Meeting Assistant Maja Keska Ext. 218, mkeska@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

2020–2021 BOARD OF DIRECTORS James F. Holmes, Jr., MD, MPH President University of California Davis Health System

Angela M. Mills, MD Secretary Treasurer Columbia University

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

Ian B.K. Martin, MD, MBA Immediate Past President Medical College of Wisconsin

Christopher R. Carpenter, MD, MSc Washington University in St. Louis School of Medicine Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Michelle D. Lall, MD Emory University Nehal Naik, MD George Washington University

Ava Pierce, MD UT Southwestern Medical Center, Dallas Jody A. Vogel, MD, MSc, MSW Denver Health Medical Center University of Colorado School of Medicine Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

3

President’s Comments To Resolving Inequalities in Our Health System

4

Spotlight Building a Culture of Inclusion and Equity Through Advocacy, Research, and Education An Interview With Ava E. Pierce, MD

8-41 8

Racism as a Public Health Crisis SAEM on Equity, Diversity, and Inclusion: Transforming Words Into Action

42

COVID-19

The Unintended Consequences of COVID-19 Lockdowns

45

Education and Training Zooming in on Virtual Interview Day Strategies

47

Education and Training Zooming in on Virtual Residency Recruitment: A Program’s Guide

49

Administrative Fellowship Member Profile: Dr. Maureen (Mo) Canellas, Administrative Fellow

50

Ethics in Action Everyone’s Entitled to an Opinion, But…

52

Research In Academic EM From K to Baby R to Big R: Should I Apply for an R03/R21?

12

Humanizing Patients and Physicians Through Storytelling

14

Racism in Academic EM: Finding a Way Forward

by Embracing Policies That Benefit Black Physician Recruitment and Retention

16

Health and Social Justice in a Changing Climate

19

AWAEM and Anti-Racism: A Conversation Starter

20

The COVID-19 Pandemic is Worsening Health Disparities. Emergency Physicians Can Help

22

COVID-19’s Disproportionate Impact on the “Latinx” Community

56

Exploring Academics: How Medical Students and Residents Can Get Involved in Academic EM

24

Developing a Diverse EM Faculty by Thinking Strategically About the Pipeline That Leads From Student to Clinician

60

Strategies for Addressing and Mitigating the Lack of Diversity in Emergency Medicine

26

Working Toward Equity in Flyover Country: A Tulsa ED Physician’s Perspective

62

Personal Perspectives on Diversity, Equality, and Inclusion

64

Virtual Interviewing Tips and Tricks

28 30

COVID-19 Through the Eyes of Your Latino Patients Reducing Bias with Agitated Patients in the Emergency Department

32

How Social Identity Impacts Clinical Leadership in Emergency Medicine

34

50 Terms to Engage in Racial Equity and Justice

38

COVID-19 Reveals an Unsurprising Harsh Reality: Health Care is Not Immune to Racial Injustice

40

Are We Really Prepared to Be Anti-Racists?

66

Briefs and Bullet Points

70

Academic Announcements

72

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. © 2020 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 James F. Holmes, Jr., MD, MPH UC Davis School of Medicine 2020–2021 SAEM President

To Resolving Inequalities in Our Health System

“SAEM has been and continues to be deeply committed to diversity and inclusion. We have historically had a diverse board of directors and our current staff is incredibly diverse. Despite this, there is still plenty of work to do.”

Recent events (e.g. the tragic deaths of Breonna Taylor and George Floyd) have again spotlighted the existing racial inequalities in the United States while the COVID-19 pandemic has exposed our continuing struggle with health inequalities. Systemic racism not only places specific individuals at a disadvantage, it frequently allows others an undeserved advantage. The effects of systemic racism are readily seen in emergency departments. Perhaps no group witnesses the impact of racial inequalities in health more than emergency providers, especially those providing care in many of our urban hospitals where underserved patients often predominate.

embrace the existing cultural and other differences of its membership and of the patients we serve. SAEM supports and promotes the development of education, research, and services that assist emergency departments to improve the lives and health of all, and to eliminate health inequities and opportunity disparities; SAEM actively works to eradicate bias both in health care, as well as in society, around age, race, gender, gender identity, gender expression, sexual orientation, ethnicity, creed, religion, national origin, veteran or military status, immigration status, disability, or any other factor or demographic that contributes to or results in inequitable health care.”

SAEM has been and continues to be deeply committed to diversity and inclusion. We have historically had a diverse board of directors and our current staff is incredibly diverse. Despite this, there is still plenty of work to do.

We provide care to people from a wide array of backgrounds and perspectives.

Our goal should be the same — to be inclusive of all. It is time to address and solve health inequalities. It is our shared responsibility to oppose racism and the associated inequalities, and we should openly identify and reject racism and other forms of intolerance. Through education, leadership, and research, SAEM seeks to prevent inequalities from all causes. As SAEM president, I pledge to further our commitment to diversity and inclusion.

In this issue of SAEM Pulse is an article that outlines SAEM’s prior and ongoing diversity and inclusion activities. Please look at the actions SAEM is taking. All are welcome to join us in our endeavors.

On July 22, SAEM released an updated version of our "Statement on Diversity and Inclusion." My thanks to the members of the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) for their assistance with revising our prior statement. In this statement, we reiterate our prior commitment to all aspects of diversity and inclusion in our members and employees. In our update, we expand on our commitment to diversity and inclusion to reach our patients and society. I encourage everyone to read the statement in its entirety. An excerpt of the revision is here: “SAEM expects its members and employees to respect, support, and

ABOUT DR. HOLMES: James F. Holmes, Jr., MD, MPH, is professor and vice chair for research in the department of emergency medicine at UC Davis School of Medicine.

3

SPOTLIGHT BUILDING A CULTURE OF INCLUSION AND EQUITY THROUGH ADVOCACY, RESEARCH, AND EDUCATION An Interview With Ava E. Pierce, MD

SAEM PULSE | SEPTEMBER-OCTOBER 2020

Ava E. Pierce, MD, is an associate professor in the department of emergency medicine at UT Southwestern Medical Center, the associate chair of diversity and inclusion for the department of emergency medicine, the director of the Emergency Medicine Research Associate Program, and co-director of the Joint Admission Medical Program (JAMP) at UT Southwestern. Dr. Pierce also works clinically at Parkland Health and Hospital Systems. She obtained her medical degree from Louisiana State University School of Medicine at Shreveport and completed an emergency medicine residency at Emory University School of Medicine. Dr. Pierce completed the Medical Education Research Certificate (MERC) Program and the AAMC Healthcare Executive Diversity and Inclusion Certificate Program and is committed to making innovative changes that will enhance diversity and inclusion and improve excellence in health care, thus strengthening a diverse workforce that will provide culturally competent quality medical care to all. She serves as a member of the UT Southwestern Medical Center’s medical school admissions committee and is a faculty liaison for Housestaff Emerging Academy of Leaders (HEAL), which focuses on professional development and mentoring for residents and fellows from under-represented groups. Her research interests include medical education, diversity and inclusion, and cardiac resuscitation.

4

Dr. Pierce has built a steadfast academic career with involvement in numerous capacities at SAEM. She has been actively involved in the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) since it was founded and has served as ADIEM’s development officer and president. She was awarded ADIEM’s Outstanding Academician Award in recognition of her impact on the academic success of students and residents from underrepresented minority groups. She has also served on SAEM’s Membership Committee, Ethics Committee, and Diversity and Inclusion Task Force. Most recently she was elected as a 2020–2021 memberat large of the SAEM Board of Directors.

She is a member of the National Medical Association, the AAMC Group on Diversity and Inclusion, and a fellow of the American College of Emergency Physicians.

Dr. Pierce was interviewed for this article

by Dr. Sharon Atencio, chair of the SAEM Pulse Editorial Advisory Task Force.

2019–2020 ADIEM president Marquita Hicks, MD honors Ava Pierce, MD, 2018–2019 ADIEM president at SAEM19 in Las Vegas.

“No matter how many changes happen in the future... EM physicians will always be the ones who show up to take care of those who need help the most....we are the physicians who will change the face of medicine.”

What initially drew you to emergency medicine? To academics?

During medical school, I was interested in many specialties. I was initially drawn to emergency medicine because I enjoy taking care of undifferentiated patients.

I enjoyed taking care of all patients from neonates to older adults, trauma patients, cardiac patients, and respiratory patients.

In emergency medicine I get to take care of patients at some of the most difficult times in their lives. I have the honor of being the advocate for patients who may not be able to advocate for themselves.

I have always loved educating others.

Both of my parents were educators and helping others to learn was a large part of my childhood. This love for teaching drew me to academics. During residency I had several mentors who made such a great

impact on me and I hope that I can help others as they did me.

My career in emergency medicine has helped me to develop greater humility, resilience, and empathy. The medical students and residents I work with teach me something every day. I feel blessed as an academic physician to be just a small part of helping to educate the next generation of emergency medicine physicians.

Who are some mentors who were influential on your career?

I have been fortunate to have had many mentors during my career. During my emergency medicine residency at Emory, my mentors included Sheryl Heron, MD, MPH; Arthur L. Kellermann, MD, MPH; Philip Shayne, MD; and Leon Haley,

MD. In 2014, I completed the AAMC Healthcare Executive Diversity and Inclusion Certificate Program and gained Marc Nivet, EdD, MBA; Leon McDougle, MD, MPH; and Bernard Lopez, MD, MS, as mentors. As a member of SAEM’s ADIEM, Lisa Moreno, MD, MS, and Marcus Martin, MD, joined my growing list of mentors. At UTSW, I have gained not only mentorship but also sponsorship from the late Michael Wainscott, MD, previous UTSW program director; Deborah Diercks, MD, MSc, the chair for the department of EM; Mark Courtney, MD, executive vice chair of academic affairs; Ahamed Idris, MD, director of the research division; and Larissa Velez, MD, associate dean for graduate medical continued on Page 6

5

continued from Page 5 education and emergency medicine vice chair of education. I have also received support and guidance from Byron Cryer, MD, in the Office of Faculty Diversity and Development.

How did you first become involved with SAEM? I first became involved with SAEM as an EM resident at Emory. I completed a research project with Arthur L. Kellermann, MD, MPH, and presented the poster at SAEM. This interest continued as I became an attending physician and became active in ADIEM.

Congratulations on your election to the SAEM Board of Directors. What would you like to accomplish during this year?

SAEM has contributed tremendously to my professional development and being on the SAEM board is affording me the opportunity to help promote the development of other academic emergency medicine faculty through SAEM. My goal as a board member is to work with SAEM to make innovative changes and enact creative solutions that advance the mission and vision of the society. I bring the perspective of a former SAEM academy leader with the big picture of where academic emergency medicine has been and is going. I would like to enlist the help of each academy to increase SAEM membership so that the majority of academicians can benefit from the education and research resources that SAEM offers.

I would like to help SAEM implement programs that increase the pipeline of academic EM physicians and build a culture of inclusion and equity, which will ultimately improve the delivery of emergency care for all patients. I will work to 1.) increase the number of SAEM grants to help support the development and retention of junior faculty, 2.) help to design programs to increase mentorship opportunities for medical students, residents, fellows, and junior faculty, and 3.) assist in the implementation of programs that promote physician wellness and mitigate burnout. I am excited about the vision that SAEM has for academic medicine and am honored to have the opportunity to serve the organization that has been so influential in my professional growth.

6

Taking a moment to thank SAEM leaders who attended the 2019 SAEM South Central Regional Meeting—Increasing Diversity, Inclusion, and Equity in EM: Value of Research, Networking, and Faculty Development. The meeting was hosted by the department of emergency medicine at the University of Texas Southwestern Medical Center (UTSW) in Dallas, TX, September 6-7, 2019. Left to Right: Deborah Diercks, MD, MSc, 2015–2016 SAEM president and chair of the department of emergency medicine, UTSW; meeting keynote speaker Ian B.K. Martin, MD, MBA, 2019–2020 SAEM president, and chair of the department of emergency medicine, Medical College of Wisconsin; and Ava Pierce, MD, 2018–2019 ADIEM president and associate chair of diversity and inclusion, department of emergency medicine, UTSW

“Talking about race, racism, and gender equalities can be uncomfortable and bring about conflict, but it is necessary.”

Race and gender inequalities, even when openly acknowledged, are challenging and emotional topics for many. How would you suggest people learn more about these subjects and engage in meaningful dialogues to bring about change?

Talking about race, racism, and gender equalities can be uncomfortable and bring about conflict, but it is necessary.

I feel that acknowledgement, education, and advocacy are the keys to bringing about change. Data from the CDC shows that Black women are three to four times more likely to die of pregnancy-related causes than White women and the average life expectancy for Blacks is four years lower than the remainder of the U.S. population.

We need to identify what implicit biases we have and then work to deconstruct those biases and learn to respond to microaggressions and overt discrimination. It will take systematic change to create equality.

What is the biggest obstacle to achieving substantial diversity in our workforce?

Rather than discuss the obstacles, I would like to talk about some solutions.

I think that the things that will help improve diversity in the workforce include increasing the pipeline of individuals interested in emergency medicine and improving the culture that exists once diverse individuals are recruited. There needs to be culture change in academic institutions so that the environment is inclusive and women and URM physicians can thrive, not just survive.

What do you wish the rest of the world knew about the challenges of being a black woman in medicine?

When I spend time discussing the work environment with female faculty, many discuss that they have been harassed. But as a black woman, I have to experience the added complexity of intersectionality where both gender and race contribute to discrimination.

Dr. Pierce enjoying a girls day out with family and friends. L–R: Dr. Pierce’s daughter Angelica Bell, Dr. Pierce, Dr. Pierce’s longtime friends Sharalyn Fontenot, Sherrette Shaw-Fontenot, MD, and Stephanie Meinel Phoenix.

How has COVID-19 affected you and your practice?

I practice clinically in Dallas, Texas. As the number of patients presenting to the ED with symptoms of COVID-19 increased, our ED visits for other serious illnesses declined, although our numbers of cardiac arrest patients increased. I have seen racial and ethnic minority groups in my practice be disproportionately affected by COVID-19, due in large part to inequities in social determinants of health.

Aside from the pandemic, what do you think are the most pressing issues in emergency medicine today?

One thing that I would like to highlight is that structural racism is a public health emergency. Racism is a driving force of the social determinants of health. Injustices caused by racism must be addressed so that everyone can achieve health equity.

Looking back, what advice would you give to your younger self?

I would tell myself and any young faculty starting a career in emergency medicine: Be true to yourself. Follow your passions and be bold about the choices that you are making, because your work can and will make a difference.

If you found yourself with an unexpected day off, free from any responsibilities, how would you spend it?

If I found myself with an unexpected day off, I would spend it relaxing with family and friends.

What do you see as the future of emergency medicine?

Emergency medicine has and always will be the safety net for all patients. No matter how many changes happen in the future, including artificial intelligence and other advances, EM physicians will always be the ones who show up to take care of those who need help the most. As evidenced by how we responded to the COVID-19 pandemic, we are the physicians who will change the face of medicine.

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

At the end of my career, I would like to be remembered for helping to diversify the health care workforce and working to eliminate health disparities through advocacy, research, and education.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

— Dr. Martin Luther King Jr., in a speech to the Medical Committee for Human Rights, 1966 “When you see something that is not right, not fair, not just, you have to speak up. You have to say something; you have to do something.”

— John Lewis, American statesman and civil-rights leader 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.

— Mark Nivet, EdD, MBA, executive vice president for Institutional Advancement, University of Texas Southwestern Medical Center

7

SAEM on Equity, Diversity, and Inclusion: Transforming Words Into Action

RACISM AS A PUBLIC HEALTH CRISIS

Words are important. They can incite anger or evoke passion.

They can bring people together or tear them apart. They can uphold the truth or promote a lie. At SAEM we understand the value of words and the power they hold to enact improvement and bring about change.

8

The Society for Academic Emergency Medicine, in July 2020, released a revised “Statement on Diversity and Inclusion” which commits to the goal of promoting equity, diversity, and inclusion in all aspects of emergency medicine and respecting, supporting, and embracing the cultural uniqueness of our members and the patients we serve. This followed on the heels of a statement released this past May by SAEM and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) in response to the death of George Floyd.

At SAEM we believe strongly in the statements we support, and we stand by them. But we also believe that when it comes to amplifying the voices of the underrepresented, eradicating disparities, and attaining equity and inclusion, actions speak even louder. To that end, SAEM strives to walk the talk. We’re proud of all we’ve done to promote diversity, equity, and inclusion at SAEM — as an SAEM member, you should be too! But we know there’s much work to be done. We invite you to take a look at some of our ongoing and future diversity and inclusion initiatives and activities and consider joining us in being change agents for good. The sidebar at the end of this article tells you how.

RACISM AS A PUBLIC HEALTH CRISIS

Ongoing and Future SAEM Diversity and Inclusion Initiatives SAEM Supported Statements

• SAEM Statement on Diversity and Inclusion • SAEM and ADIEM Statement on the Death of George Floyd • SAEM Statement on the Department of Health and Human Services (DHHS) Definition of Sex and Gender • AACEM Statement on Systemic Racism • Equity in Crisis Standards of Care Statement

Webinars

• From Katrina to COVID-19: Emergency Care for the Underserved During Times of Crisis • Finding a Home Away From Home: Challenges of the Match faced by URM Applicants and Those Without an Affiliate EM Program • Diversity in Medicine Residency Meet-n-Greet • Virtual Mentoring Hour: Teaching Anti-Racism Through Simulation • Academy for Diversity and Inclusion in Academic Emergency Medicine Webinar Series “How to Be a Successful EM Applicant” • Coming! Gender Considerations for EM Research Careers

Education

• SOAR: SAEM Online Academic Resources

– Diversity – Sex and gender – Social EM – Geriatrics and pediatrics – Coming! Racial and health disparities

Annual Meeting

• Special issue of Academic Emergency Medicine (AEM): “Influence of Gender on the Profession of Emergency Medicine” • Special issue of SAEM Pulse dedicated to “Racism as a Public Health Crisis” • Coming! AEM special issue on “Scientific Inquiry into the Inequities of Emergency Care” • Seventeen of the last 28 SAEM Pulse covers/Spotlight interviews have featured a woman, a person of color, or a member of the LGBTQ community.

• SAEM Pulse has recurring columns related to sex- and gender-based differences, diversity and inclusion, and women in academic emergency medicine.

• SAEM Pulse standard operating procedure: every article to include at least one image representing a diverse population

Other Resources • ADIEM Diversity, Equity, and Inclusion (DEI) Library • ADIEM COVID-19 Resources • Advisory Council on Equity, Diversity and Inclusion Team (ACED-IT) • LGBTQ Mentoring Program • AWAEM Toolkit: A Roadmap for Creating Women’s Groups

• AWAEM/ADIEM annual networking/mentoring luncheon • Lactation room for nursing mothers • Credit for in-room childcare • Coming! A new SAEM annual meeting abstract submission category: Racial & Health Disparities

Research • SAEM21 Consensus Conference—From Bedside to Policy: Advancing Social Emergency Medicine and Population Health through Research, Collaboration, and Education • SAEM14 Consensus Conference —Gender-Specifc Research in Emergency Care

Publications SAEM publications have long been front and center when it comes to publishing research and information that advances diversity, inclusion, and health equity and addresses implicit bias and racial, ethnic, and gender health disparities. continued on Page 10

9

RACE AS A PUBLIC HEALTH CRISIS

continued from Page 9

Association of Academic Chairs of Emergency Medicine • AACEM/AWAEM Chair Development Program Scholarship • AACEM/ADIEM Chair Development Program Scholarship

Grants, Awards, and Scholarships SAEM Foundation • SAEM Foundation/ADIEM Research Grant • SAEM Foundation/Academy for Women in Academic Emergency Medicine Research Grant Society for Academic Emergency Medicine • Advancement of Women in Academic Emergency Medicine Award

Academy of Women in Academic Emergency Medicine (AWAEM) • AWAEM Outstanding Department Award • AWAEM Early Career Research Award • AWAEM Mid-Career Faculty Award • AWAEM/RAMS Medical Student and Resident Award • AWAEM Early Career Educator Award

• Marcus L. Martin Leadership in Diversity and Inclusion Award

• AWAEM Administrator Award

• Medical Student Ambassador Diversity and Inclusion Scholarship

• AWAEM/GEMA Global Travel Grant

• AWAEM “Catalyst” Award

• AWAEM Resident Award and Travel Grant • AWAEM Junior Faculty Development Forum (JFDF) Scholarship • AWAEM SAEM Leadership Forum (SAEMLF) Scholarship • AWAEM Pre-Day Workshop Scholarship Academy for Diversity and Inclusion in Academic Emergency Medicine (ADIEM) • Visionary Educator Award • Outstanding Academician Award • Outstanding Future Academician Award Clerkship Directors in Emergency Medicine • CDEM Visiting Elective Scholarship Programs for Underrpresented Minorities SAEM Leadership • SAEM staff: 94 percent diversity (women, ethnic and racial minorities) • SAEM Board of Directors: 73 percent diversity (women, ethnic and racial minorities)

RACISM AS A PUBLIC HEALTH CRISIS

• Implicit bias training was required of and completed by all SAEM board members and staff

10

Other • SAEM added demographic data fields to member profiles to track progress on diversity efforts through a formal scorecard to the Board of Directors • SAEM launched the Equity and Inclusion Committee and a Research Equity Task Force

RACISM AS A PUBLIC HEALTH CRISIS

Join Us In the Important Work of Promoting Inclusion and Eliminating Inequity One of the most effective ways to create change is by coming together toward a common vision, for a common cause. Participating on one or more of SAEM’s committees, academies, and/or interest groups not only furthers your professional development, it also gives you opportunities to help SAEM work toward the important goal of developing education, research, and services that assist emergency departments to improve the lives and health of all and eradicating inequities, opportunity disparities, and bias in health care.

We encourage you to considering joining the following diversity-focused groups or any SAEM committee, RAMS committee, academy, or interest group. SAEM Committee sign up and RAMS committee sign up is now until August 31. Academies and interest groups are free to join any time!

Together we can do so much.

• NEW! Equity and Inclusion Committee • Academy for Diversity & Inclusion in Academic Emergency Medicine • Academy for Women in Academic Emergency Medicine • Sex and Gender in Emergency Medicine (SGEM) IG • Social Emergency Medicine and Population Health IG 11

Humanizing Patients and Physicians Through Storytelling

By Eniola Gros, MS4 and Al’ai Alvarez, MD, APD on behalf of the Academy for Diversity and Inclusion in Emergency Medicine

RACISM AS A PUBLIC HEALTH CRISIS

The Story…

12

In one of the most racially segregated cities in America, I sat in the clinic conference room going over flashcards for my next shelf exam. It was hot and I couldn't hear myself think over the loud blower fan in the corner. Had I arrived at five o’clock that morning, I would have seen a line of patients waiting anxiously outside, hoping that their spot in line would allow them to be seen by a doctor. There were babies crying in the stuffy waiting room, mothers and fathers taking advantage of their only opportunity that week to charge their phones, and patients randomly checking boxes on their triage forms because they don’t know how to read the questionnaires.

Saint Louis is one of the many cities in this country that still experiences the wrath of de jure segregation. In 1916, the City of Saint Louis established a racial segregation ordinance mandating 75 percent of residents within any given

“We are people responding to a calling.

All of us can be part of the effort. We are brothers and sisters in medicine.” neighborhood be of the same race.

Given the already segregated parks, hospitals, and universities, the city needed to find a suitable dividing line to establish this law. That dividing line is Delmar Boulevard. Despite deeming this ordinance unconstitutional in the late 1940s, its effects remain today. Just by crossing the “Delmar Divide” traveling north-bound, your life expectancy decreases by six years and your overall health rating (rated from low to highrisk), as determined by demographics, socioeconomic status and access to quality health care, increases four-fold.

The free student-run clinic at my school serves more than 2,000 patients that fall into this bracket. We serve single mothers and patients who are either without a home or with prior convictions — all working-class citizens without health insurance.

As I listened to the preclinical student’s patient presentation, I wasn’t surprised that it was different from my history and physical exam findings.

Before I saw the patient, my junior student informed me that “the patient is a poor historian.” Hearing a commotion on the other side of the door, I opened

RACISM AS A PUBLIC HEALTH CRISIS

it to find three kids running around the room while our patient rested on the examination table. An immediate sense of relief came across her face when she saw me. Ms. Smith was her name.

During the brief history, I asked her how long she’d had diabetes. She replied, “What’s that? I don’t have diabetes, I have high sugar.” She shared how she splits her metformin (“the thick white pill”) in half in order to save money on the prescription. She'd taken two different buses with her children to get here. She shops for groceries at a local gas station, because it’s within walking distance and more importantly, “why would anyone spend $4 on fresh produce when you can buy a 20-pack of Twinkies® that won’t expire in five days?”

It took me about an hour to explain to Ms. Smith her treatment plan, establish follow-up, organize her bus routes, and find the cheapest location for her medications. I offered her GoodRx coupons to help defray the cost of treatments. As she left, my patient turned around and said “whatever you gotta do to finish school…do it. We need you.” She needed me not only to manage her health but also to keep her human. In our talk, I wasn’t worried about my student loans, upcoming shelf exam, or clerkship grades — I was focused on being a physician for my patient. Ms. Smith helped me remember why I joined this profession in the first place and because of this, I realized I needed her, too.

As future physicians who volunteer in the community, we get to put our short white coats on, “play doctor” for a couple of hours, and drive home to our air-conditioned downtown lofts, feeling good about the service we provided for the day. We rarely take the time to think about how our patients get home (if they even have a home) or where their next meal will come from. Some of us get annoyed with our patients’ poor medication compliance, tardiness, or appointment no-shows.

COVID19 restrictions continue to affect the recruitment of students for residency and the job market, especially underrepresented in medicine (UiM) applicants. We have an opportunity to reflect on how we can humanize our future colleagues in medicine. We can look beyond the metrics and also honor their distance traveled and the many other intangible qualities not easily reflected in traditional applications without

doing a holistic review. This is how we advance diversity. This is how we break structural racism and design for better equity. This is how we pave the way for increased representation — for us and for our patients.

As Dr. Vivek Murthy, the 19th Surgeon General of the United States, said, "We are people responding to a calling. All of us can be part of the effort. We are brothers and sisters in medicine."

ABOUT THE AUTHORS Eniola Gros is a medical student (MS4) at Saint Louis University School of Medicine. @Eniola_Gros

r. Alvarez is assistant D residency program director at Stanford Emergency Medicine.

He is the 2020 recipient of ADIEM’s Outstanding Academician Award in recognition of his scholarly contributions addressing health disparities. @alvarezzy

13

Racism in Academic EM: Finding a Way Forward by Embracing Policies That Benefit Black Physician Recruitment and Retention

RACISM AS A PUBLIC HEALTH CRISIS

By Taneisha Wilson, MD, ScM and Elizabeth Goldberg, MD, ScM

14

After weeks of serving on the front line for COVID-19 and witnessing how Black Americans are disproportionately affected by the disease, the latest videos documenting police violence against Black Americans are too much to bear. We know that Black Americans have been subject to generations of racist policies — housing discrimination, educational segregation, disproportionate imprisonment — that have led to poor health. We also know that academic medicine is not devoid of racism. Under the hashtag #BlackintheIvory, academics have been sharing personal experiences from their professional lives that expose a system that needs repair.

For us it starts with making sure medicine attracts the very people harmed by racist policies — Black Americans— so our patients can

be cared for by one of their own and equitable policies can emerge that are informed by physicians who share experiences with our patients.

Unfortunately, although 14 percent of Americans are Black, Blacks make up only four percent of physicians.

In addition, the cost of the medical admission test and medical school applications can run upward of $10,000 — an amount which is prohibitive to many families due to a lack of generational wealth from decades of discriminatory policies.

Three Ways We Can Change This Legacy

Empirical research also shows that implicit bias is pervasive in letters of recommendation, where Blacks are more likely to be described as “competent” compared to their white peers who are “stand-out.” In addition, membership in Alpha Omega Alpha, the honor medical society, is more likely to be bestowed upon whites even when controlled for test performance, and we’re going in the wrong direction.

Sadly, there were more Blacks in Alpha Omega Alpha in 1985 (1.4 percent) than there were in 2015 (0.7 percent). White physician mentors, educators, and

1. Barriers to recruiting Black physicians should be lifted.

Meaningful change cannot occur without incorporating the voices of Black Americans in medicine; unfortunately, current structures make the pursuit of medicine all but impossible for most Black adults. To apply to medical school, you must first be admitted to college — a tremendous feat considering that most African Americans attend low-income underperforming public schools.

RACISM AS A PUBLIC HEALTH CRISIS

“Meaningful change cannot occur without incorporating the voices of Black Americans in medicine; unfortunately, current structures make the pursuit of medicine all but impossible for most Black adults.” colleagues should combat their own racial bias and racism in order to better teach and support trainees.

2. Hospital and practice leaders must speak out against racism.

Leaders cannot be silent when women and men are protesting in the streets about racism or when one of their own faces discrimination. Although most leaders are white (people of color make up only 12 percent of boards of directors) everyone can be an ally.

Policies that ensure diverse boards, such as quotas and public reporting of board diversity, are desperately needed.

Statements about racism and the value of Black lives must be followed with concrete steps to recruit and retain more Black medical students, residents, and attendings. Residency programs can offer paid visiting clerkship programs or “second look” visits, whereby Black medical students can evaluate desirable hospitals at little to no cost to them.

Additionally, Black faculty who “do the work” should be compensated for their

time spent leading inclusion efforts. This can be done by recognizing their efforts as part of academic promotion criteria and offering buy-downs of clinical time or stipends.

3. Create checks and balances to reveal bias.

Data must be routinely collected and analyzed to ensure equity in hiring, salary, benefits, and promotion.

Measures such as representation in number of invited lecturers, stipend payment faculty, faculty recommended for promotion, medical students interviewed and matriculated into residencies — all need to be tracked, scrutinized, and improved upon.

To be sure, fixing racial bias in health care alone will not end violent policing and create equitable societies, but as physicians, we can be community leaders in ushering in change. It must start with “cleaning our own house first.” When we embrace policies that benefit Black physician recruitment and retention we also improve care for our

diverse patients. This year, 2020, can go down as the year that we continued our legacy of disregard, ambivalence, and inaction toward Black Americans in medicine or it can be the year in which we righted our wrongs and showed the world we can find an equitable way forward — one that benefits us and our patients.

ABOUT THE AUTHORS Dr. Wilson is an assistant professor of emergency medicine at Brown University.

Dr. Goldberg is an associate professor of emergency medicine and health services at Brown University.

15

Health and Social Justice in a Changing Climate

RACISM AS A PUBLIC HEALTH CRISIS

By Hanna Linstadt MD, Rachel Dahl MS, and Caitlin Rublee MD, MPH, on behalf of the SAEM Climate Change and Health Interest Group

16

Our knowledge and understanding of history inform our actions in the present. The teachings and foundation of medical education build critical thinking skills that apply to clinical practice. In emergency medicine, atypical disease presentations influence future management plans and an ever-expanding differential diagnosis.

The most up-to-date literature informs evidence-based practices that define high quality, timely emergency care year after year.

One of the challenges of COVID-19 has been the on-the-go learning and development of evidence; yet, even in a global pandemic, we can look to history to inspire and lend key lessons on public health and social justice.

The Pandemic of 1918, or the Spanish Flu, transformed public health in the United States (U.S.). It claimed the lives of approximately 675,000 Americans and decreased the average life expectancy in the U.S. by 12 years. The similarities to COVID-19 include strain on health care systems,

“Effects of climate change exacerbate existing social and environmental conditions, thereby increasing exposure of at-risk populations to conditions that contribute to adverse health outcomes.” ill practitioners, rapid spread, altered medical education, specific populations at increased risk, limited gatherings, misinformation, masks and restrictions.

Following the Pandemic of 1918, public health, evidence-based medicine, and health care systems developed with a new-found purpose. There was a renewed interest in science and data to inform prevention and treatment, and groundbreaking achievements in modern medicine were accomplished.

Population-level surveys were created and implemented, governments created

health plans, vaccines were created, and laboratories formed networks to test for diseases. Out of a devastating pandemic came an era of modern medicine which set the foundation for scientific, evidence-based medical discovery and practice.

As medical education and research matured, so did recognition of the social and environmental determinants of health. Specifically, a new threat to health was identified: environmental injustice. Environmental justice is “the fair treatment and meaningful

involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.” The environmental justice movement had its roots in the 1960s and 1970s civil rights and environmental movements and gained significant momentum following the dumping of polychlorinated biphenyl-contaminated soil in a North Carolina county with a high proportion of Black residents.

Shortly after, in 1983, a study was released that found that three out of four hazardous waste landfills were located in predominantly Black communities and impoverished communities. Four years later, another study noted that “although the socioeconomic status of residents appeared to play an important role in the location of hazardous waste sites, the residents’ race was the most significant factor among the variables analyzed.” Despite this knowledge of injustice, resources to prevent further injustice, and even the establishment of the U.S. Environmental Protection Agency (EPA) Office of Environmental Justice, we have not cured the environmental factors that harm health.

Effects of climate change exacerbate existing social and environmental conditions, thereby increasing exposure of at-risk populations to conditions that contribute to adverse health outcomes. There is a vicious cycle in which “initial inequality causes the disadvantaged groups to suffer disproportionately from the adverse effects of climate change, resulting in greater subsequent inequality.” There are numerous examples of the unequal effects of climate change on the health of the Black population, including, but not limited to, the following: increased mortality associated with elevated temperatures, worse health disparities during and following extreme weather events, increased pediatric emergency department visits for asthma exacerbations, and an increase in preterm births associated with air pollution.

These adverse health impacts offer an opportunity for change. As history

has demonstrated, laws have resulted in drastic improvements in health for adults and children: • Environmental Laws and Executive Orders • Clean Air Act 1970 Clean Water Act 1972 • The Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA or Superfund) 1980 • Marine Protection, Research, and Sanctuaries Act 1988 • Pollution Prevention Act 1990 • Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations 1994 • Energy Policy Act 1995 Source: Environmental Protection Agency (EPA) Now in 2020, we see two seemingly different historical events — a pandemic and a movement toward social justice (which is inextricably tied to environmental justice) — combine to present an opportunity for change. It is a time to establish a new standard of operation and equity in our health care systems and emergency departments as we promote institutional research, evidence-based practices, and education. We can work towards social justice by choosing climate action, thereby advancing health equity. Here is how we can start: • Reduce greenhouse gas emissions on an individual, community, and national scale. We can start in our own hospitals, as the U.S. health care system alone contributes an astounding 10 percent of greenhouse gas emissions.

• Better recognize and treat climatesensitive conditions while helping patients recognize the effects of pollution on their disease. Improve climate-sensitive disease surveillance and treatment and develop early warning systems from the emergency department.

• Build resilience in hospitals against supply chain disruptions and

infrastructure failures from extreme weather events so our facilities can remain open during times of greatest need.

By mitigating and adapting to a warming world, we can help protect global populations whose health and well-being have been disproportionately affected by climate change over the past century. Just as the pandemic of 1918 changed the face and practice of medicine, we can emerge from this pandemic with a new goal of health care: to pursue public health through social and environmental justice. By learning from the past, we can choose a healthier and more just future.

RACISM AS A PUBLIC HEALTH CRISIS

“We can work towards social justice by choosing climate action, thereby advancing health equity.”

Even doctors can be historians. It will allow us to create key opportunities to improve practices, people, and our planet. According to Sir Geoffrey Vickers (1958), public health is “successive re-definings of the unacceptable.” We in academic emergency medicine can keep redefining.

ABOUT THE AUTHORS r. Linstadt is an instructor/ D fellow in emergency medicine and the Living Closer Foundation Fellow in Climate Change and Health Science Policy at the University of Colorado department of emergency medicine. s. Dahl is a third-year M medical student at the University of Iowa Carver College of Medicine and concurrently pursuing an MPH through the online/n campus public health program at the University of California Berkeley. r. Rublee is an assistant D professor of emergency medicine at the Medical College of Wisconsin and the current chair of the SAEM Climate Change and Health Interest Group. @CaitlinRublee

17

18

RACISM AS A PUBLIC HEALTH CRISIS

By Kat Ogle MD and Katja Goldflam MD on behalf of the Academy of Women in Academic Emergency Medicine Recent news and social media have highlighted innumerable examples of White people asking Black friends and colleagues to help them understand their experiences of being marginalized.

White folks are asking people of color to teach them what they should be doing to eliminate racism and how they can help. White people are asking for acknowledgement and validation for demonstrating that we are simply trying. We personally recognize these sentiments and acknowledge how much we still have to learn about being anti-racist colleagues and becoming advocates and allies in the elimination of racism from our own little sphere of emergency medicine. We understand how tempting it is to turn to our colleagues of color for solutions.

The efforts of academic institutions to enhance diversity and inclusion are well-intentioned, but they often fall short. Some strategies are superficial, even performative. Expecting physicians of color to assume leadership positions that champion diversity and inclusion, often without proper compensation or acknowledgement of their time, may distract from their chosen career trajectories. These assumptions and expectations are inappropriate, unfair, and create undo stress and strain on our colleagues of color. Research acknowledges that intersectionality negatively impacts the careers of academic women of color to a disproportionate degree. Add to that the detrimental effects of microaggressions and implicit biases on personal confidence and opportunities for professional growth and development, and the disproportionate burden on our colleagues of color is further intensified.

As academic emergency physicians, we function on a foundation of evidence-based medicine, algorithms

“To move forward as women in academic emergency medicine taking a stand against racism, we must invest in our mission to take personal responsibility for educating ourselves, finding our own resources, in spite of the unease and discomfort we may feel.” and action. On the precipice of our own personal antiracist journey, we too are intimidated and unsure where to start, but we signed on to this career with a commitment to lifelong learning. The systemic problem we are now working to treat is racism. Our self-directed lessons must therefore focus on recognizing racist policies, procedures, actions, and interactions which negatively impact our peers, colleagues, students, and friends.

So, what can a couple of cisgender White women do? We are the ones that have the most to learn. We need to revisit decisions we have made, examine interactions we have had, and reevaluate policies we have supported.

We need to reflect on the times we sat quietly as bystanders when one or more of our own — particularly women of color — experienced microaggressions, overt racist behavior, or limited professional opportunities. We need to commit to standing by our colleagues when we see racial inequity. To move forward as women in academic emergency medicine taking a stand against racism, we must invest in our mission to take personal responsibility for educating ourselves, finding our own resources, in spite of the unease and discomfort we may feel.

RACISM AS A PUBLIC HEALTH CRISIS

AWAEM and Anti-Racism: A Conversation Starter

We realize we have more questions than answers, but we hope you will join us in considering the ways in which we, as members of SAEM, and women in academic emergency medicine in particular, can be part of building a better, anti-racist infrastructure. We look forward to each of you participating in this discussion and working to develop creative and sustainable solutions.

ABOUT THE AUTHORS Dr. Ogle is an assistant professor and ultrasound fellowship director at the George Washington University Department of Emergency Medicine. She is engaged in undergraduate medical education, graduate medical education, and faculty development. Dr. Ogle is the vice president of education for SAEM’s Academy of Women in Academic Emergency Medicine (AWAEM). @drkittykat Dr. Goldflam is an assistant professor and associate residency director in the department of emergency medicine at Yale University.

She is interested in education and wilderness medicine.

About AWAEM The Academy for Women in Academic Emergency Medicine 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.

Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

19

The COVID-19 Pandemic is Worsening Health Disparities.

Emergency Physicians Can Help

RACISM AS A PUBLIC HEALTH CRISIS

By William E. Baker MD, David A. Kim MD, PhD, and Leon D. Sanchez MD, MPH on behalf of the SAEM ED Administration and Clinical Operations Committee

20

Though COVID-19 was initially described as a “great equalizer” to which rich and poor, young and old alike were susceptible, the pandemic’s impact on our society has been anything but uniform. COVID-19 mortality is markedly higher in regions with more poverty, crowding, and racial segregation. In Chicago, Black residents account for 30 percent of the population, but 70 percent of COVID-19 deaths. Nationwide, only six percent of white patients who died from COVID-19 were younger than 60, compared to 25 percent among Latinos. Even among front-line providers, risk of COVID-19 is greater among minorities.

Though medical comorbidities are more prevalent among minority and low-income patients and are risk factors for severe COVID-19, comorbidities alone do not explain the stark disparities in cases and deaths by race and socioeconomic status. Lower income

“Though COVID-19 was initially described as a “great equalizer” to which rich and poor, young and old alike were susceptible, the pandemic’s impact on our society has been anything but uniform.” and minority patients make up a disproportionate part of the “essential workforce,” with few opportunities for social distancing or remote work.

When patients fall ill with COVID-19 and seek care, minority and low-income patients are more likely to receive care in overburdened and under-resourced public and/or safety-net hospitals. At

the height of the outbreak in New York City, COVID-19 mortality was as much as three times higher in the understaffed and overwhelmed public system (which received a preponderance of lowincome patients), compared to wellstaffed private hospitals, which received vanishingly few transfers from the overwhelmed public system.

RACISM AS A PUBLIC HEALTH CRISIS

COVID-19 Disparities and the Emergency Department

Emergency departments (EDs) are the safety net of our health care system.

Only 31 percent of 139 million annual ED visits are paid by private insurance, and many “safety net” hospitals serve primarily minority and low-income patient populations. In Boston, where less than one percent of the population is homeless, homeless patients comprised 16.4 percent of one safety net hospital’s COVID-19 census.

Emergency departments have experience handling unpredictable and variable volumes of patients, but our mechanisms for expanding capacity to meet demand can themselves exacerbate disparities. ED patients insured by Medicaid are substantially more likely than comparable privately insured patients to be assigned to temporary hallway beds when dedicated rooms are unavailable (hallway care being associated with adverse outcomes and lower patient satisfaction compared to standard ED bed care). Infection control concerns during the pandemic have curtailed the use of these provisional and inferior care spaces, but the temptation to reinstate them will inevitably recur. EDs concerned with equity would do well to eliminate hallway spaces permanently, or at the very least audit their use to

avoid compounding the disadvantage of their most vulnerable patients.

American health disparities did not arise with the COVID-19 pandemic.

Structural racism and economic inequality have deep roots, and cannot be solved in the ED. Yet emergency physicians, with unique experience caring for our society’s most vulnerable patients, have an important role to play not only in diagnosing and treating COVID-19 but in mitigating the disparities the pandemic has exposed.

Beyond ensuring that low-income and minority patients receive equal triage and treatment, EPs can screen patients for unmet social needs and work to ensure safe dispositions for homeless and other vulnerable patients. EPs must be especially attentive to undiagnosed domestic violence, which has surged as the pandemic has forced people to spend more time at home. EDs with greater capacity and resources can lobby hospital administrators to accept appropriate and timely transfers of COVID-19 patients from overwhelmed regions and hospitals. Additionally, EDs should collect detailed data on outcomes by income and race/ethnicity, so as to measure their performance in reducing disparities and disseminate successful practices.

When the World Health Organization (WHO) first declared the global outbreak

of COVID-19 a “pandemic” in March, the obvious connotation was of a uniform and ubiquitous threat. As EPs now prepare for a second wave of COVID-19 in the fall, or continue to fight the first one, we harbor no such illusions. EPs are uniquely positioned to advocate for the patients and communities that continue to bear the brunt of the pandemic’s worst effects.

ABOUT THE AUTHORS Dr. Kim is an assistant professor of emergency medicine at Stanford University.

Dr. Baker is clinical associate professor and senior vice chair of emergency medicine, Boston University School of Medicine, Boston Medical Center.

Dr. Sanchez is vice chair for emergency department operations at Beth Israel Deaconess Medical Center and associate professor of emergency medicine at Harvard Medical School.

21

COVID-19’s Disproportionate Impact on the “Latinx” Community

RACISM AS A PUBLIC HEALTH CRISIS

By Joseph Graterol, MD

22

Two experiences have exemplified my work as an emergency physician lately.

The first is having a 60-year-old male come into the emergency department (ED) gasping for air after being recently diagnosed with COVID-19. He had saturations of 60 percent and despite my best noninvasive ventilation efforts, he seemed at ease after I told him that he would need to be intubated. The second was a 30-year-old male, also COVID-19 positive, who was stable without an oxygen requirement. He related to me how he felt fortunate that he had SARS-CoV-2 and not coronavirus and was surprised when I explained to him that these terms in fact identified the same virus.

What relates these two separate visits, other than their diagnoses, was that both patients are members of our Latinx community in the Bay Area, a community that has been disproportionately ravaged by this pandemic.

Being Latino myself, and speaking native Spanish, it is one of my favorite

“Latinos account for 34 percent of the cases of COVID-19 nationwide, while only representing 18 percent of the U.S. population.” parts of the job to speak with my Latinx patients in their language while caring for them in the ED. Unfortunately, as with many things during this pandemic, this joy has been turned on its head because of how much harder our Latinx community has been afflicted. We in San Francisco have been overall very fortunate to not have had the waves of COVID deaths that other localities have experienced across the country.

But what we have seen is the severe ethnic/racial disparities exacerbated by the pandemic.

Per data from the Centers for Disease Control and Prevention (CDC), Latinos account for 34 percent of the cases of COVID-19 nationwide,

while only representing 18 percent of the U.S. population. In California, the data is even more stark with Latinx individuals accounting for greater than 56 percent of cases and 45.9 percent of deaths while only representing 39 percent of the population. Within my own community of San Francisco, this disparity is corroborated by a recent University of California, San Francisco (UCSF) study which found that 95.1 percent of those testing positive for COVID-19 self-identified as Latinx while only representing 40 percent of those tested — an almost unimaginable proportion.

This data, however, is likely not that surprising if you have been working

RACISM AS A PUBLIC HEALTH CRISIS

in the ED lately. One would almost be excused for making a test-taking word-association equating COVID-19 to Latinx patients akin to how we were trained to associate sarcoidosis and black female patients for tests like the United States Medical Licensing Examination (USMLE). These associations, although most often not rooted in physiologic bases, do highlight the question of why such disparities in illness prevalence exist across races.

The likely causes for this current disparity in pandemic incidence have been well described. Communal living and multigenerational households — staples of the social structure of Latinx communities — lead to increased rates of disease transmission. Furthermore, Latinos are more likely to work in essential jobs and live at or near poverty levels, making losing their employment untenable.

Latinx patients are also more likely to have associated comorbidities such as uncontrolled hypertension and diabetes, exacerbated by their decreased access to the health care system.

Some of this disparity in access can be explained because of a fear of the medical establishment and associated authorities. This fear was shown in a recent study performed in our own hospital which found that a significant

number of our undocumented Latinx patients feared going to the hospital because of fear of discovery and reporting of their immigration status.

Finally, as my second patient illustrates, our education of these patients regarding issues of health literacy can be lacking.

Many of these explanations bring to light the fact that our health care system and society have set communities of color up for failure. Recent events of racial injustice and police brutality have brought the term structural racism to the forefront. As we should continue to push toward a more just police and criminal justice system, we must also remember that structural racism is well embedded within our ranks in medicine.

What can we do?

As emergency room providers, we should ensure that our patients understand our instructions by providing discharge instructions in Spanish and using interpreters. We should also advocate to have an increased number of contact tracers/public health workers who better represent the communities they are surveilling, meaning increasing the proportion of bilingual staff who may be better able to get the educational message across while decreasing any perceived threat from authorities. Additionally, in order

to better target our resources we need to continue to advocate for data that is disaggregated by race and ethnicity both at the national and state levels, but also within our own communities and hospitals. Furthermore, we need to continue to push for a workforce at all levels of health care delivery that is more representative of the racial diversity in our communities.

It has been proven that COVID-19 is not the great equalizer as it was initially thought to be, but in fact an exacerbator of racial/ethnic disparities. Let’s not make it worse as emergency physicians by sitting back and not responding to this public health crisis.

REFERENCES •C DC COVID Data tracker • F ear of discovery among Latino immigrants presenting to the emergency department • S ARS-CoV-2 Community Transmission During Shelter-in-Place in San Francisco

ABOUT THE AUTHOR r. Graterol is a clinical D instructor in the department of emergency medicine at Zuckerberg San Francisco General Hospital and Trauma Center with interests in health care equity and Latinx population health.

23

Developing a Diverse EM Faculty by Thinking Strategically About the Pipeline That Leads From Student to Clinician

RACISM AS A PUBLIC HEALTH CRISIS

By Nancy Wood MPA, MS and Beau Abar PhD on behalf of the SAEM Grants Committee

24

Undergraduate emergency medicine (EM) research enroller programs have served as a pipeline to support students considering a career in medicine, engaging them in research and, in many cases, instilling a passion for EM. Many end up in EM residencies and become our colleagues in emergency departments across the country.

Recently, the societal unrest following George Floyd’s death and the resulting attention to the Black Lives Matter movement has prompted us to reflect on and intensify our division’s efforts to diversify the population of student enrollers working in our emergency department (ED).

Several years ago, we began considering changing the model of our ED Research Associate (EDRA) program to include classes for credit prior to hiring students into paid positions. In the past, we hired undergraduates into parttime positions and trained them

“the vision of the class model held by program leadership was to provide underrepresented students of color with experiences that would help them compete with students experiencing privilege.” after hiring. The proposed new model, instead, first required students to take a new four-credit public health class providing all of the initial training and field experience to prepare a student to work in ED research. Enrollment in the class was capped at 16 students per semester, with applications required for admittance. Successful completion of the class became a prerequisite

to being hired into a parttime EDRA position.

There was initial hesitation about this idea, with team members arguing that under this system only the students who were financially stable could give up paid employment to work in the ED “for free,” as the class involved committing to time spent working in the ED as well as classroom instruction. There was

RACISM AS A PUBLIC HEALTH CRISIS

concern that this innovation, as initially planned, would result in the program becoming even less representative of our student and patient populations during a time when we were actively trying to diversify and make the enrollers more representative of our populations’ racial, ethnic, and socioeconomic diversity.

In the end, we agreed to a trial of this change in program structure. While there would be more students than paid positions open, it was acknowledged that the class would broaden the number of students receiving invaluable experiences with direct patient interactions that would prepare them for medical school and beyond.

An important lesson learned in interviewing students for EDRA positions was that students who came with a long resume of clinical experience (including shadowing) and fantastic prior research experiences were more likely to be White and/or raised in a wealthy suburban family. They were hired because they arrived with more qualifications and were perceived as more ready for ED enrollment. As a result, the vision of the class model held by program leadership was to provide underrepresented students of color with experiences that would help them compete with students experiencing privilege. Not surprisingly, it didn’t happen overnight.

The University of Rochester student body is about 46 percent White, but we found our course applicants did not represent the 54 percent of nonWhite students. Much to our dismay, we didn’t have an “if we build it, they will come” situation. Over time, we partnered with first generation student outreach groups, student organizations that supported students of color, and the campus group that supported students of color seeking internship experiences. We learned that many of the students we sought were unable to take an extra class and still work enough to pay expenses, so we modified the class so that it would not be considered “extra.” We enhanced our writing assignments so that students could use the EDRA internship to satisfy undergraduate writing requirements and eliminate a class taken solely for this requirement.

We reached out and, most importantly, tried to listen. As a result, our recent EDRA internship classes have been substantially more racially and ethnically diverse than in previous semesters, and this is an accomplishment we’re very proud of.

Our vision is that by playing a small part in increasing the number of underrepresented students who apply to medical school, who have

competitive experience on their resumes and compelling stories about patients in the ED to talk about in interviews, and who go on to EM residencies based on a passion sparked as an undergraduate, our EM faculty will eventually look a bit more like the patients they serve.

We encourage everyone to think strategically about the pipeline that leads from student to clinician as a way to make meaningful changes that can grow over time.

ABOUT THE AUTHORS Nancy Wood is a faculty member in Emergency Medicine at the University of Rochester Medical Center (URMC) and the administrative director of the University of Rochester Emergency Department Research Associates program.

She also serves as the primary instructor of the above discussed EDRA internship class.

Dr. Abar is an associate professor of Emergency Medicine, Psychiatry, and Public Health Sciences and is the faculty director of the EDRA program at URMC.

25

Working Toward Equity in Flyover Country: A Tulsa ED Physician’s Perspective

RACISM AS A PUBLIC HEALTH CRISIS

By Joshua Gentges, DO

26

Tulsa is a beautiful city. From our wonderful art deco architecture to the Gathering Place, a hundred-acre playground called “the best new attraction in the nation” by USA Today, the city is the jewel of Green Country, a region packed with swift rivers, placid lakes, and green rolling hills. It is my home, and I love it with all my heart. When we truly love someone or something, we must be able to see it clearly, blemishes and all. The nation now knows Tulsa much better than ever before, as the protests over the damnable murder of George Floyd and the first rally of President Trump’s 2020 campaign cast a harsh light over our shameful history. The Tulsa race massacre of 1921 is a stain that remains uncleansed, partially because we only began teaching about it in schools here, on a limited and trial basis, in 2018.

Let that sink in…Tulsa high school students know more about the worst

“Vigilance and a continued commitment to reducing social, economic, and health inequities are necessary to help our city to become a place where all are treated fairly and given the opportunity to live healthily, happily, and without fear that they will be disadvantaged because of the color of their skin.” racial violence incident ever seen in our country from HBO’s Watchmen than they’ve learned in history.

1921 is a long time ago, surely we’ve become an antiracist, equitable place to live? I would like to cheerlead for

my city, to say that we are better, but I cannot; systemic forces continue to generate large health disparities in the city that disproportionately affect Black Tulsans. These disparities are indisputable; from infant mortality to life

RACISM AS A PUBLIC HEALTH CRISIS

expectancy and everything in between Tulsans are more likely to sicken and die needlessly if they are Black. The reasons are systemic: Black Tulsans are concentrated in parts of the city without many doctor’s offices, without many walkable neighborhoods, and without much investment. Food deserts (areas of the city with no access to fresh food) affect thousands of Tulsans, most notably in north Tulsa, where there are no grocery stores. Redlining (designating neighborhoods as bad credit risks) and exclusionary zoning reduced investment and opportunity for Black Tulsans throughout the 20th century, and the effects continue today — Black Tulsans are denied mortgages at a rate 2.4 times that of whites. The lack of investment in black neighborhoods worsens the economic prospects for those that live there, contributing to poverty and exacerbating health inequities.

Not all is doom and gloom. Tulsa’s leadership is focused on reducing health inequities, led by Mayor G.T. Bynum and

the director of the Tulsa County Health Department, Bruce Dart. New medical clinics in north Tulsa in partnership with the Oklahoma University School of Community Medicine are improving access to health care for vulnerable populations, although significant disparities in emergency department use continue and indicate that we are not yet close to equitable access to primary care.

The Tulsa Economic Development Corporation is building a $5 million grocery store in north Tulsa — an important project that will provide better access to fresh food for the 42,000 Tulsans in that area who live a mile or more away from any grocery store. In the meantime, R&G Grocers brings groceries to the people, with an innovative mobile grocery store built into a semi-trailer truck that serves food deserts across the city. The city is also focusing on improving economic and living conditions in disadvantaged neighborhoods, including community development projects, better access to

transportation, and partnerships with non-profit organizations and schools.

Challenges remain, and the road is long, with one of the biggest risks being complacency. Vigilance and a continued commitment to reducing social, economic, and health inequities are necessary to help our city to become a place where all are treated fairly and given the opportunity to live healthily, happily, and without fear that they will be disadvantaged because of the color of their skin.

ABOUT THE AUTHOR Dr. Gentges is an associate professor and the research director for Oklahoma University’s department of emergency medicine. In his spare time Josh is finishing his MPH and yelling at people who spread COVID-19 disinformation on Twitter. @jgentgesdo

27

COVID-19 Through the Eyes of Your Latino Patients RACISM AS A PUBLIC HEALTH CRISIS

By Camila A. CalderĂłn, MD

28

Familia. In the Latino culture it is the absolute core of everything and anything we do. It is who we are.

As Latinos in the United States, our households are often little versions of our countries — multiple generations gather around the table enjoying a taste of home while the sound of salsa music is drowned out by loud Spanglish and laughter. The custom of greeting each other with a hug and a kiss is something that has very much remained a part of our culture as we have assimilated into this country.

As both a Latina and an emergency physician I visualize my 87-year-old abuelita being covered in COVID kisses every time she is greeted by my family.

And each time my 92-year-old abuelito

enjoys his empanadas I envision COVID-filled droplets spraying with each bite. It is terrifying! What is equally alarming to me is the thought of how lonely my abuelos have been these past five months in social isolation, visiting with family only when they drop off groceries and from the safe distance of the driveway.

The COVID pandemic has been hard on everyone, but there is clear data from the Texas Department of State Health Services that show it has especially impacted the Latino community, in terms of fatalities. Moreover, Hispanics are more concerned than Americans overall about the threat the COVID-19 outbreak poses to the health of the U.S. population and their personal health, wealth, and well-being.

Language barriers, the socioeconomic impact of not being able to work from home, the fear of seeking medical care due to being undocumented and our (literally physically) tight-knit culture have all contributed to alarming rates of COVID infections and hospitalizations in Latino communities across the country. I have shared in the frustration of the COVID non-believers, but I do not believe this group comprises most Latinos; rather, I believe they simply do not understand.

While I plead with all my patients to wear masks and to practice social distancing, I have found that I have had to approach my Latino patients differently. Fortunately, and foremost, as their Spanish-speaking Latina physician, I already have a connection with them

RACISM AS A PUBLIC HEALTH CRISIS

“Language barriers, the socioeconomic impact of not being able to work from home, the fear of seeking medical care due to being undocumented and our (literally physically) tight-knit culture have all contributed to alarming rates of COVID infections and hospitalizations in Latino communities across the country.” they may not have with a physician that does not share their background. I listen to their thoughts and concerns about the virus, wearing masks, and what they have heard on the news. Then, I educate them, empathize with them, and acknowledge their frustrations. I share with them my family’s ways of coping and I appeal to them as the granddaughter of Latino grandparents who are the cornerstone of our family and must be protected.

Some of my patients have no choice — they are undocumented, they are essential workers, they live with six other people in a one-bedroom apartment, and they do not speak English. For them, I pray extra hard, and while prayer (another pillar of the Latino community) is important, it is not enough. We must

educate other health care workers on the disparities the Latino community faces against COVID. We must continue to educate ourselves on health policy and reform, and we must speak out against the unjust societal norms we have tolerated for far too long.

Providing better care to your Latino patients can be achieved with simple steps: First, ensure you have an interpreter when interviewing your patient. This allows them to feel comfortable and provides quality care and education.

Second, take the extra time to ask about your Latino patient’s family dynamics— who lives with them, how often do they visit others, what kind of work they do.

Third, discern what they understand and don’t understand about COVID, the importance of wearing masks, and the purpose of social distancing.

Finally, use all the information you have gathered to provide tailored education to your patient and provide suggestions and instructions that are feasible to their unique situation.

ABOUT THE AUTHOR Dr. Calderón is an Ecuadorian immigrant, second-year emergency medicine resident, and an advocate for patients underrepresented in medicine, specifically refugee and Latino patient populations.

29

Reducing Bias with Agitated Patients in the Emergency Department

By Anita Chary MD, PhD, Farah Dadabhoy MD, MSc, Melanie Molina MD, Emily Cleveland, MD, MPH The Harvard Affiliated Emergency Medicine Residency began a longitudinal health equity curriculum in 2019 to address racism and social identitybased discrimination in emergency medicine. Part of the curriculum involved a review of cases in which a patient’s social identity influenced their care.

Residents and social workers submitted a series of cases specifically regarding the management of agitated patients.

In each case, we observed how the patient’s race influenced staff members’ perceptions of threat, their threshold for involving security officers, and their willingness to engage in verbal deescalation. We present the selected cases below and then offer an algorithm we developed to promote assessment for bias when de-escalating agitated patients.

Case 1.

A Black man in his 20s presented to the emergency department (ED) voluntarily for suicidal ideation without a plan. He was accompanied by family members. Shortly after his arrival, four security guards were posted outside of his room. They informed him that he could not leave until he was evaluated.

Despite having no history of self-harm, the patient’s care team — almost all of whom were white — determined that the patient met criteria for an involuntary hold, would have to have his belongings searched, and needed to change into scrubs per hospital policy. On hearing this news, the patient became upset and started to pace in his room, distraught about potentially being held against his will.

One of the clinicians, concerned that the presence of security was aggravating the situation, had a closer conversation with the patient and learned that he had a history of childhood trauma. He worked two jobs, had private health insurance, and stated he was doing all he could to get his life on track. The clinician requested to defer the belonging search and re-contacted psychiatry for an expedited evaluation. Psychiatry deemed the patient safe for discharge with outpatient support.

Case 2.

A middle-aged White man presented to the ED voluntarily with suicidal ideation with a plan. He arrived alone, pacing around his room, speaking loudly, and responding to internal stimuli.

/ZBO:hGE¡ GGhC:X:jO\Z¡OZ¡jNG¡ YGgMGZCs¡ Gd:gjYGZj %URXJKW WR \RXU E\ +$(05 6RFLDO (PHUJHQF\ 0HGLFLQH Brought to you by: HAEMR Social Emergency Medicine

" /"

,V WKHUH DQ LPPHGLDWH PLQV VHFRQGV WKUHDW WR SK\VLFDO VDIHW\"

3HUIRUP ELDV FKHFN

RACISM AS A PUBLIC HEALTH CRISIS

:KDW LV WKH SHUFHLYHG WKUHDW WR VDIHW\"

30

#%

; 1

3UR 7LSV WR (QJDJH WKH $JLWDWHG 3DWLHQW

&RQVLGHU SK\VLFDO FKHPLFDO UHVWUDLQWV

$./ ) '*. '4 /* 2# / /# + /$ )/ $. . 4$)" Â?

-*1$ 1 - ' ) )*)›1 - ' &)*2' " ( )/ *! 2# / /# + /$ )/ $. *((0)$ /$)"

&RQVLGHU ,V WKH SDWLHQW \HOOLQJ" ,V WKH SDWLHQW SDFLQJ" ,V WKH SDWLHQW GHI\LQJ LQVWUXFWLRQV"

' 3‡ ( $)/ $) )*)› *)!-*)/ /$*) ' * 4 +*./0- ‰ +' 4*0- # ) . $) !-*)/ *! 4*0- * 4‰ $)$($5 " ./0-$)"‡ + $)"‡ !$ " /$)"

./ '$.# ¢. ! ÂŁ *) *) *) *((0)$ /$*) › /-4 )*/ /* *1 -2# '( /# + /$ )/ 2$/# (0'/$+' +-*1$ -. . *) $. ‡ .$(+' ' )"0 " Ä?

,GHQWLI\ VSHFLILF FRPSRQHQWV GULYLQJ SHUFHSWLRQV RI WKUHDW +RZ DUH UDFH JHQGHU VRFLDO LGHQWLW\ GULYLQJ SHUFHSWLRQV RI WKUHDW"

&RQVLGHU \RXU RZQ DQG \RXU WHDPĂ‹V ELDVHV ERWK XQFRQVFLRXV DQG VWDWHG

(QJDJH DWWHQGLQJ VHQLRU

'R , IHHO VXSSRUWHG"

&RQVLGHU ZKHWKHU VHFXULW\ SUHVHQFH LV QHHGHG ZRXOG WKH\ KHOS RU DUH WKH\ H[DFHUEDWLQJ WKH SDWLHQWĂ‹V DJLWDWLRQ"

5HTXHVW DOO QRQ HVVHQWLDO SHUVRQQHO OHDYH WKH URRP

,%6:%6( )1)6+)2'= 1)(-'-2)

'$ / ! '$)".‡ "- /* $. " * )*/ # '' )" '0.$*).‡ # ''0 $) /$*).‡ ! -. › &)*2' " /# $- �- '$/4�

4 *2) /# ' 2 ) . / ' - '$($/. “ 0) -./ ) $/. *)!0.$)" 2# ) -0' . # )" ‡ 0/††† › ' ( /# )./$/0/$*)¨+*'$ 4 ¢ *)’/ + -.*) '$5 £

!! - #*$ . Â? /$ )/. ! ' (+*2 - $! /# 4 # 1 .*( #*$ $) ( // -.

)3$*'4/$ Š - /# - Š 2 / - Š !** Š + - /#$)" 3 - $. . %HETXIH JVSQ XLI %QIVMGER %WWSGMEXMSR JSV )QIVKIRG] 4W]GLMEXV] (I IWGEPEXMSR ;SVOKVSYT

RACISM AS A PUBLIC HEALTH CRISIS

He disclosed to his care team — all of whom were white — that he had a criminal history. Security was not called. The care team allowed the patient to remain in his street clothes.

His belongings were searched after evaluation by psychiatry outside the room within his view and were subsequently returned to him. His bag contained his belt, a laptop, a power cord, two cell phones, a bag of shaving razors, and all of his psychiatric medications. His belongings remained with him in his room for two days until transfer to an inpatient psychiatric facility.

Case 3.

A Black man in his 20s was wheeled into the ED with a stab wound to his chest. Per protocol, a “Code Trauma” page summoned a large multidisciplinary team to his bedside.

The patient was transferred to a stretcher and hooked up to a monitor, which revealed normal oxygen saturation and hemodynamics. A senior clinician who arrived shortly thereafter loudly reprimanded the team for not removing the patient’s pants to facilitate full exposure. As multiple staff members attempted to do so, the patient became upset, asking the crowd why they needed to examine his lower body since he had not reported any injuries there. With the exception of two junior residents, the entire care team was white. As staff members continued to try to undress the patient, he became increasingly agitated and attempted to get off of the stretcher.

“If you don’t want our help, you should just leave,” the senior clinician told the patient. “Why did you even bother coming here anyway?” A senior emergency medicine resident intervened,

requesting everyone except the patient’s nurse step outside of the room. The resident privately communicated the importance of the exam to the patient, who subsequently agreed to be examined underneath a sheet.

Case 4.

A middle-aged white man presented to the ED with knee pain. A female resident of color evaluated the patient and noticed that he had tattoos of swastikas and spiked rings. During the evaluation, the patient made hateful comments about non-white people, which grew louder after the resident left the room.

While the resident felt personally threatened, the rest of the care team, including the attending, was white; the resident felt unsure about requesting security assistance and ultimately did not involve them.

Why was security called for the first patient, but not the second? Whose sense of safety was security protecting, the patient’s or staff members’? How do the care team members’ own social identities and clinical positions affect their ability to de-escalate conflict, raise concern about bias, or involve security?

Our working group discussed these questions and developed the following algorithm for situations in which there is not an immediate threat to patient or provider safety. We recommend brief internal assessments of one’s own perceived threat to safety, recognition of how social identities may be driving perceptions of threat, and consideration of whether a clinician feels supported in raising concerns about bias to the rest of the care team. Additionally, the algorithm features strategies to facilitate verbal de-escalation adapted from a consensus statement from the American

Association for Emergency Psychiatry De-escalation Workgroup (2012).

We recognize that clinicians in our specialty face an unacceptably high rate of physical and verbal assault from patients, and that care team members who spend more time at the bedside, such as nurses, bear a disproportionate burden of safety risks. We hope this algorithm helps ED clinicians provide more equitable care while maintaining a safe environment for all patients and providers.

ABOUT THE AUTHORS Dr. Chary is a resident physician (PGY-4) at the Harvard Affiliated Emergency Medicine Residency.

Dr. Dadabhoy is a resident physician (PGY-4) at the Harvard Affiliated Emergency Medicine Residency.

Dr. Molina is a resident physician (PGY-4) at the Harvard Affiliated Emergency Medicine Residency.

Dr. Cleveland is faculty in the department of emergency medicine at Boston Medical Center.

31

How Social Identity Impacts Clinical Leadership in Emergency Medicine

RACISM AS A PUBLIC HEALTH CRISIS

By Anita Chary MD, PhD and Melanie Molina MD

32

As emergency physicians, we are leaders. We lead traumas, codes, and the resuscitation of the critically ill; however, we often receive differential recognition of our leadership based on our social identities.

In the United States, the societal vision of a doctor remains White and male, and this has been reflected in the demographic composition of emergency medicine physicians. As two female resident physicians of color, we have noticed the ways in which social identity has impacted perceptions of leadership, both for us and for our colleagues. We have witnessed Black physicians being mistaken for non-clinicians such as transportation staff or patient sitters.

We have experienced senior female residents being silenced during traumas in favor of male junior residents. We have had patients refuse the care of our Black and Brown colleagues.

In light of these realities, we held a panel with a few of our experienced mentors to discuss how social identity impacts clinical leadership in emergency medicine. Here are some excerpts from our conversation.

How do your social identities influence your clinical leadership style?

Dr. Adaira Landry: I have various social identities. I think the leading one for me is being a Black person. That’s number one, two, and three. When I walk into a room, I am being observed as a Black person before I am being observed as a woman. I think that has carried over into my experience as a physician as well.

I have been in the room with women

who are not of color. I have seen them questioned less about their credentials compared to me and doubted less as to who’s going to be doing the procedure.

I’m also aware of when I want to bring in a different identifier, such as being a mother. There are some situations where that is the part of me that I’m bringing forward. Sometimes it’s being a woman.

It can transition a bit depending on the topic at hand or the situation at hand.

Dr. Dan Egan: I’m a White man and coming from my space as a gay man, it’s not as obvious as it is for my colleagues who talk about walking into the room and immediately being identified as Black. I haven’t had the same experiences of not being trusted that I’m a doctor; however,

every single job that I’ve had, I’ve been called the name of the other gay doctor, who at one hospital, was Asian. I’ve been called “faggot” by patients. I’ve been told by male patients, “You can’t do my rectal exam.” Over time, you have to develop a way that you’re going to respond. That intrinsic anger needs to translate into a professional response.

How do you approach the situation when your clinical abilities are questioned — whether by patients or other colleagues in the emergency department (ED)?

Dr. Adaira Landry: That’s happened with me and residents in this program

About the Panelists Adaira Landry, MD, MEd, is the assistant residency director of the renowned Harvard Affiliated Emergency Medicine Residency, assistant professor of emergency medicine at Brigham and Women’s Hospital, ultrasound fellowship director for the department of emergency medicine at Brigham and Women’s Hospital, and advisor and associate director of the Walter Bradford Cannon Society at Harvard Medical School.

Alden M. Landry, MD, MPH, is an assistant professor of emergency medicine at Beth Israel Deaconess Medical Center, assistant dean for the Office for Diversity Inclusion and Community Partnership, associate director and advisor for the William B. Castle Society, and director of health equity education at Harvard Medical School. He also serves as senior faculty at the Disparities Solutions Center at Massachusetts General Hospital and is the founder and codirector of the nonprofit organization Motivating Pathways.

Dan Egan, MD, is the program director of the Harvard Affiliated Emergency Medicine Residency. He is the former vice chair of education for emergency medicine at Columbia University and the former program director for Mount Sinai St. Luke’s and Mount Sinai Roosevelt in New York City.

when we’ve gone into rooms together.

You want to think the best of everyone.

A Black male resident and I went into a room once, and the patient literally asked both of us, “Where did you go to medical school? Undergrad? What year are you in training?” It is hard to not respond with frustration, but I don’t. We lead by being professional. We lead by going high and not low. We lead by just taking care of the patient. We lead by holding people accountable for social injustice. And that is our goal.

Dr. Alden Landry: Recently, in a trauma activation, I was letting my residents go about their set up when the trauma attending looked at me and said, “Hey, ortho, we should probably have you wait outside. We want to minimize the people in the room.” I looked around to try to find where that orthopedics resident was and then we just looked at each other and the trauma attending realized I was not the ortho resident. Ultimately, he apologized. It was a good learning opportunity to recognize who’s in the room. The appropriate way to talk with others in the resuscitation is to introduce yourself, then ask for clarification if you don’t know who the person is. This time I was considered a physician. But many times, I’m perceived as the person that’s getting the patient a bedpan or the person who’s going to be taking them to x-ray…not the physician. I still struggle with this. It’s interesting now how my residents, when I walk into the room of a patient I’m assessing, will always introduce me, “This is Dr. Landry. He is my boss. He is my attending.” They are aware and make that effort.

Who were your role models in clinical leadership?

Dr. Adaira Landry: The interesting thing about being in emergency medicine is that when I was a junior resident, there were no senior Black women in my department. My mentor at the time, Uché Blackstock, was a junior faculty member. In our department here, I am the only Black female faculty member.

For our residents, it’s tough, because you don’t have exposure to senior level Black women who are department faculty.

The absence of that is a disadvantage

because when it comes to leadership styles, you learn from those who are above you; those who have experience, who can teach you about all sorts of perspectives because of their experience.

It’s tough when you are a resident and you don’t have someone incredibly experienced to teach you, compared to, say, our White male residents who have multiple faculty members with various styles from which they can learn.

Are there aspects of yourselves that you have had to change or modulate in order to succeed in clinical leadership roles?

Dr. Alden Landry: Part of what you’re getting at, I think, is “code switching,” when you go into a clinical space and talk differently, use a different tone, and measure yourself a bit more before you make a statement. It’s interesting how much I recognize now that I do this, even in how I reply to an email. If I write a strongly worded email, if I raise my voice, it is assumed that I am the angry Black man. What I’ve actually started to do now is try and do less code switching and curtailing of my true emotions and more challenging people for making those assumptions, calling me angry, and saying I’m yelling. I explain to them that they are interpreting me in those spaces when I’m actually not angry and I explain to them how that is detrimental to those spaces. My emotions matter. My feelings about a situation matter.

Dr. Adaira Landry: This is the downfall of academics and the professional workplace in general. I really hate that I often feel tempted to hide the most honest part of myself. Like Alden, I do it as well. I’m definitely a more casual and informal person around my family than in the professional setting. When it comes to advocacy, that’s where I feel like most of us walk on eggshells as far as calling out something that is unfairly being done to us or a situation that is obviously unfair.

We have to frame it in a way that, like Alden said, is friendly, softened, muted, more commercialized, and less raw. It’s really sad that for us to speak the truth we have to package it up and wrap it in a bow. It shouldn’t really be on the victim to make sure their speech is palatable to

How do you work to support trainees with marginalized identities in clinical leadership situations?

RACISM AS A PUBLIC HEALTH CRISIS

“We lead by being professional. We lead by going high and not low. We lead by just taking care of the patient. We lead by holding people accountable for social injustice. And that is our goal.”

the audience that’s about to hear it. I do think that people of color—Black people specifically in this country—have a very narrow window of allowable emotion which applies only to being angry but also to being excitedly happy. When my brother was in elementary school he was jumping on a table because he was happy and got a note that his teacher was fearful of him. That’s how we can be perceived when our emotions go out of the expected range. It’s really challenging and quite disappointing.

Dr. Dan Egan: It’s important to be that person who doesn’t allow things to take place that make you fearful and/ or uncomfortable, but what’s found to be even more effective is bystander intervention. All of us should be committed to speaking up when we see inequity. In my life growing up as a gay person, I constantly had a fear of someone finding out. My whole life going to Catholic school I was always scared that someone else was going to judge me, exclude me from situations, or not want me to be there because of who I was. And that has translated 100 percent into clinical leadership, especially in cases of resuscitations. I’m concerned about others being excluded and losing focus on the patients. I think about times I was scared to go to a doctor because I was scared to tell them I was gay. I remember at times mapping out if I had to go to the hospital, where I would go so that no one would ever find out. I think it’s important to make sure that we’re paying attention to the human that’s in there, that everyone on the team feels valued and included, that we know their names. All of those things come from a place where that wasn’t always the case for me.

ABOUT THE AUTHORS Dr. Chary is the Chief Resident of Harvard Affiliated Emergency Medicine Residency and coleader of the residency’s Social Emergency Medicine Interest Academy.

Dr. Molina is a resident physician (PGY-4) at Harvard Affiliated Emergency Medicine Residency and coleader of the residency’s Social Emergency Medicine Interest Academy.

33

Let 's talk about race...

50 Terms to Engage in Racial Equity and Justice

By Edgardo Ordoñez MD, MPH, Chloé Woodington MD, MPH, Michelle Suh MD, and Moises Gallegos, MD, MPH, on behalf of the Academy for Diversity & Inclusion in Emergency Medicine

RACISM AS A PUBLIC HEALTH CRISIS

In having discussions about race and racism, we must start by educating ourselves. Below is a list of terms with definitions that can help us develop a common language, enhance the quality of our dialogue, and allow us to engage in supportive movements towards dismantling racism. As academic emergency physicians, we have a dual responsibility in providing quality patient care and fighting for justice through curricular reform, bedside teaching, and community engagement and activism through a racial and social justice lens. We understand that words on this list may have different meanings based on individual identities and lived experiences. This list is not all-inclusive and represents current usage, as terms are constantly evolving. We welcome your feedback and suggestions.

34

Affinity (Caucus) Group: A group formed around a shared identity (e.g., gender, race, sexual identity, etc.) to allow for a safe space where participants can share and discuss experiences or work toward common goals Accomplice: Someone who commits to dismantling the structures that oppress certain groups by putting allyship into action Ally: Someone who makes the commitment and effort to recognize their privilege (based on gender, race, sexual identity, etc.) and work in solidarity with oppressed groups in the struggle for justice Anti-racism: Includes an active process of identifying and eliminating racism by opposing and challenging attitudes, policies, and behaviors through structural change

Bigotry: Intolerant devotion to one’s prejudices and beliefs that denigrates other groups, including ethnic and racial groups BIPOC: An acronym that stands for Black, Indigenous, and People of Color; more inclusive than the commonly used term “people of color,” and centers on the unique experiences of Black and Indigenous people Code-Switching: Linguistically refers to when an individual alternates between or intermixes the use of two or more languages, dialects, or language varieties depending on social context or conversational setting; can also mean a modification of one’s appearance, expressions, or behavior to adapt to sociocultural norms Colonialism/Colonization: The theory and act of assuming control of someone else’s territory through dispossession and subjugation of native people; colonialism is the practice, while colonization is the process

intersectionality

colorism

Colorism: A form of discrimination, typically within racial groups, in which there is a prejudicial and preferential treatment based solely on one’s color and skin tone; preferential treatment is generally towards those with a lighter skin tone, whereas there is a marginalization of those with darker skin tones Critical Race Theory: A theoretical framework that analyzes the relationship between race, racism, and power; seeks to understand, interrogate, and find solutions to racial inequality and structural racism that emerge from racist ideologies, systems, and institutions that maintain white supremacy Cultural Competence: The integration and transformation of knowledge about cultural belief systems, practices, and attitudes that are different from one’s own; allows for the ability to communicate, interact, and understand people across cultures effectively Cultural Appropriation: Adoption of cultural elements for personal interest and can include symbols, fashion, art, language, and customs; often done without understanding, acknowledging, or respecting its value to the original culture Cultural Humility: An ongoing process of self-exploration and self-reflection whereby one not only learns about, but also acknowledges, limits in understanding other cultures due to one’s assumptions, biases, and values Discrimination: The unjust, prejudiced, or unequal treatment of members of various groups based on gender, race, sexual identity, etc.

Diversity: Unique and individual differences within the dimensions of gender, race, sexual identity, etc.; also involves different ideas, perspectives, and values

RACISM AS A PUBLIC HEALTH CRISIS

code switching

Empowerment: A multi-dimensional social process that helps people gain control over their own lives; fosters power in people (that is, the capacity to implement), for use in their own lives, their communities, and in their society, by acting on issues that they define as important Ethnicity: Recognizes differences between people mostly based on language and shared culture; encompasses everything from language, to nationality, culture, and religion, it can enable people to take on several identities Equality: Ensuring that every individual has an equal opportunity to make the most of their lives and talents; recognizes that historically certain groups of people with “nonmajority” characteristics such as gender, race, sexual identity, etc. have experienced discrimination Equity: In the general sense, to be fair and impartial; may be used to refer to the pursuit of justice and fairness for all people Implicit Bias: Refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner; these biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control Inequality: The state of not being equal, especially in status, rights, and opportunities Inequity: Refers to unfair and avoidable differences arising from poor governance, corruption, or cultural exclusion

continued on Page 36

35

racialization

white fragility

LET'S TALK ABOUT RACE

continued from Page 35

RACISM AS A PUBLIC HEALTH CRISIS

Inclusion: The achievement of an environment in which all individuals are treated fairly and respectfully, have equal access to opportunities and resources, and can contribute fully

36

microaggression

Marginalization: The treatment of groups and communities as secondary, inferior, or abnormal compared to the group with power Microaggression: Brief and commonplace slights, insults, and indignities that appear innocuous but demean a person’s identity or convey a discriminatory attitude or belief

Individual Racism: Assumptions, beliefs, or behaviors as a form of racial discrimination that stems from conscious, and unconscious, personal prejudice; connected to and reinforced by systemic racism

Minoritization: the subordination of a person or people; the term “minority� no longer refers just to a smaller group within a populace but may also imply lesser value or importance

Injustice: The absence of justice; a violation of the rights of others

Oppression: Systematic subjugation of a group for the social, economic, and political benefit of the more powerful group; a result of power and prejudice

Institutional/Structural/Systemic Racism: Policies and practices of organizations that have a disproportionately negative effect on racially marginalized groups in terms of access, resources, and outcomes; this can occur without intentionality or awareness Internalized Racism: When an oppressed racial group develops and participates in the attitudes, behaviors, structures, and ideologies that support racism Intersectionality: A framework describing how people experience discrimination, disadvantage, and privilege differently depending on their overlapping identities (e.g., race and gender, race and sexual orientation)

Prejudice: A preconceived unfavorable belief or judgment about a person or group that is not based on actual experience Privilege: Unearned, and often unrecognized, advantage given to individuals solely based on their membership in a dominant group Race: A social construct without a biological basis for which definitions have shifted over time in response to interests of groups in power Racial Disparities: In a general sense, differences among racial groups; possibly as a result of racism and discrimination

responsibility in providing quality patient care and fighting for justice through curricular reform, bedside teaching, and community engagement and activism through a racial and social justice lens.”

Racial Equity: A state of being where race does not predict future outcomes and all groups benefit from a just and equitable system

White Fragility: Discomfort with issues of racial inequality and injustice that results in white individuals showing outward defensive actions and emotions and choosing to avoid the situation

Racial Justice: Systematic and active implementation of policies to both prevent racial inequity and promote fair treatment and opportunity for all racial groups

White Privilege: The occurrence of advantages, entitlements, and benefits given to a person solely for being white creating institutional and cultural preference that the individual is often unaware of

Racialization: The application of a racial meaning to a previously racially unclassified relationship, social practice, or group and on that basis subjected to differential and/or unequal treatment Racism: Race prejudice + institutional power. A belief that a particular race group is inherently superior and involves having the power to carry out systematic discrimination through institutional policies and practices and by shaping the cultural beliefs and values that support those racist policies and practices Social Justice: A broad concept espousing the belief that everyone deserves equal economic, political, and social rights and opportunities, and calling for just and fair relationships between all individuals and society Solidarity: The coming together of individuals with a shared identity, lived experience, or political commitment often in efforts to combat adversity

RACISM AS A PUBLIC HEALTH CRISIS

“As academic emergency physicians, we have a dual

White Supremacy: A historical system of oppression of BIPOC under the belief that the white race should be dominant in society Xenophobia: A fear or hatred of ideas, items, or individuals considered foreign or strange

ABOUT THE AUTHORS Dr. Ordoñez is an assistant professor of emergency and internal medicine and assistant program director of the Baylor College of Medicine Emergency Medicine Residency. @TheEMIMdoc

Dr. Woodington is a PGY-3 and chief resident at the Baylor College of Medicine Emergency Medicine Residency. @theCHosen_mvp

Stereotype: A fixed and overgeneralized belief about a group or class of people that can result in prejudice Stereotype Threat: A psychological threat to performance that arises when one is in a situation or performing a task for which a negative stereotype about one’s group exists Structural Competency: The trained ability of health professionals to recognize the impact of social factors on the health of individuals, populations, and systems Tone Policing: A diversionary tactic to draw attention to the tone of a statement being made by an individual from a marginalized group, rather than the meaning of the words, to discredit the argument as an overreaction or as irrational

Dr. Suh is a PGY-1 resident at the Baylor College of Medicine Emergency Medicine Residency. @msuh25

Dr. Gallegos is a clinical assistant professor of emergency medicine and clerkship director at the Stanford University School of Medicine. @moyinscrubs

37

COVID-19 Reveals an Unsurprising Harsh Reality: Health Care is Not Immune to Racial Injustice

RACISM AS A PUBLIC HEALTH CRISIS

By Vineet Kumar Sharma, MD, MS and Devjani Das, MD

38

The United States has been severely hit

by COVID-19, more so than any other nation, accounting for approximately one-third of all global confirmed cases.

In the initial stages, New York City became the global epicenter of the pandemic. Amidst the devastation that wrecked New York City’s health system is a harsh reality: racial minorities are being disproportionately impacted.

As of June 12, 2020, age-adjusted hospitalization rates for non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons were nearly five times that of non-Hispanic white persons. Hispanic or Latin persons have a rate approximately four times that of non-Hispanic white persons. Ageadjusted mortality rates per 100,000 people are just as appalling: as of June 10, 2020 African American had 92 deaths and Hispanic/Latin individuals had 74 deaths compared to 45 deaths reported for Caucasian Americans.

While these statistics are damning, health disparities seen in minorities are

not new and have been highlighted further during the COVID-19 pandemic.

Health disparities, as defined by Health People 2020, adversely affect groups who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, gender identity, sexual orientation or other characteristics historically linked to discrimination or exclusion. Social determinants of health (SDoH), which include racial inequalities, account for anywhere from 40-80 percent of all health outcomes, compared to traditional clinical care, which comprises approximately 20 percent. Despite this, the United States is the only developed country that spends more on health care than on social services. Given this, it should be of no surprise that Black and Hispanic Americans, along with American Indians, have higher infant mortality rates and that premature deaths from stroke and heart disease are highest among Black Americans.

Additionally, chronic diseases, such as

asthma, diabetes, hypertension, obesity and preterm births are more prominent in minorities. (Amer Jour of Pub Health, CDC Health Disparities and Inequalities Report U.S. 2013, 2013 National Healthcare Disparities Report) There is no singular cause for racial inequalities seen in health care, but a contributing factor is implicit racial biases amongst health care providers towards people of color and/or specific ethnic backgrounds. Implicit biases may be universal amongst all individuals and subtle, but they do hinder any chance in developing a trusting patient-provider relationship, which is vital, particularly in the emergency setting. As the safety net of society, emergency departments (ED) serve as an interface between medicine and society. Our patients come to us when they have nowhere else to go, and as emergency providers we are often defined more by our ability to be their advocates than by the procedures we perform. However, the high volume and fast-paced nature of emergency

The impact of racial/ethnic biases extends well beyond simply patient outcomes. Since implicit biases often exist outside of conscious, they are difficult to acknowledge and control — a fact that likely has allowed health disparities to persist in various sectors of health care (e.g. diversity and promotion of underrepresented minorities and lack of emphasis in medical education and training).

A study by Fang et al. demonstrated that minority faculty in academic medicine are less likely to be on tenure track or to received NIH awards, and thus less likely to be promoted compared to their white counterparts, despite the fact that their representation has steadily increased over time.

Additionally, the concept of racial inequalities in medical school curricula has been dominated by biological perspective rather than focusing on alternative approaches such as the sociopolitical aspect. The combination of these issues perpetuates the vicious cycle of racial disparities within health care and has a domino effect on medical education and training, as attending physicians, nurses, and senior colleagues play the largest role in the learning process, more so than textbooks or simulations. Take for example an attending physician who

RACISM AS A PUBLIC HEALTH CRISIS

medicine usually affords us only one chance to make a positive impression on our patients, and this interaction is paramount for us to address their needs and provide the best care. When we unknowingly fail and let our prejudices enter the equation, it is the patient who suffers. If a provider believes that their Black and/or Hispanic patients are less intelligent, more likely to engage in risky health behaviors, or unlikely to accept responsibility for their own health, and thus less able to adhere to treatment recommendations, it impacts the providers’ decision in doing a more or less thorough diagnostic workup.

For example, they may potentially spend less time explaining diagnoses and treatment with certain minority patients. Furthermore, a dominant or condescending tone decreases the likelihood a patient will feel heard and valued. Likewise, failing to provide an interpreter when needed, or offering limited empathy and positive emotions, causes people of color to become less trusting of the health care system, compounding the disparity.

has the power to impact a student's or resident’s grade/evaluation and, more importantly, oversees all his or her decisions, thus shaping his or her understanding of “appropriate” medicine. If there continues to be a lack of minorities represented and/ or promoted to leadership positions within academic medicine, it will worsen the growing concern of being able to adequately provide culturally competent care and training to our medical students and residents in an increasingly diverse patient population.

Furthermore, without increased minority faculty, it will be nearly impossible to provide unbiased bedside teaching and uncover specific implicit biases that may already exist within students or residents. A systematic review done in 2015 highlighted this fact when it demonstrated that although health profession students may have similar levels of racial/ethnic bias to those of practicing providers, it has less of an impact on health outcomes. This suggests that implicit bias becomes more pronounced as professionals progress through their training and career, likely from following in the footsteps of their peers and colleagues.

The United States is currently in the midst of two pressing issues: the COVID-19 pandemic, and social injustice highlighted by the recent murders of George Floyd, Breonna Taylor, and Ahmaud Arbery. Although these issues are being addressed individually, they both are an endemic that highlights racial inequalities that are a daily reality plaguing the patients and communities that we have served for decades. At its root, emergency medicine is a specialty born of the societal need to provide

equal care for all patients, regardless of their socioeconomic or racial status; therefore, we must unify as a specialty to address these racial inequalities within the medical profession. At Columbia University Medical Center Department of Emergency Medicine, members of the Social EM group are actively working on initiatives to reduce health disparities and advance anti-racism efforts.

Through a multi-faceted approach, we hope to promote health equity by creating pipeline programs that increase diversity within health professions, collaborate with public health colleagues on initiatives that lead to policy change and research opportunities, and formalize a social medicine curriculum that places greater emphasis on better recognizing and understanding SDoH, including racial inequalities which can be incorporated into medical education and training. We hope that such an approach may be adapted by other institutions in the near future to help address these pressing issues.

ABOUT THE AUTHORS Dr. Vineet Kumar Sharma is an emergency medicine resident (PGY-4) at New York-Presbyterian, University Hospital of Columbia and Cornell. r. Das is director, D Undergraduate Point-of-Care Ultrasound Medical Education and assistant professor of emergency medicine, Columbia University Vagelos College of Physicians & Surgeons.

39

Are We Really Prepared to Be Anti-Racists?

RACISM AS A PUBLIC HEALTH CRISIS

By Maame Yaa A. B. Yiadom, MD, MPH, MSCI, Italo M. Brown, MD, and Christopher L. Bennett, MD, MA on behalf of the SAEM Equity and Inclusion Committee

40

On June 10, 2020, various emergency medicine groups participated in the Science, Technology, Engineering and Mathematics (STEM) Shut Down (#ShutDownAcademia). Academic meetings, conferences, and calls were canceled as a pause in our consciousness intended to advance our understanding and educate ourselves on 1.) the persistence of racism, 2.) sources of inequality, and 3.) remedies for ineffective government and organizational responses. From our reflection we find being a “nonracist” is a response that is good, but not good enough. A challenge in our current society is that there are too few “anti-racist.” This applies to many of the other “isms” (sexism, antisemitism, homophobism, xenophobism, etc.) that we struggle with in our diverse country.

The reality is that being an anti-racist is tough, and at times risky. It means speaking up when we see people treated differently, in ways that are unfair and negatively affect their life

“Medicine is a conservative community where we tend to be risk averse, yet our world and local communities will not improve until those of us with influence lead by example.” opportunities and outcomes. It calls us to say something when people are excluded because it is uncomfortable to include them. It compels us to step back and listen to the details from all sides of any conflict knowing there is bias in how conflict is framed and reported. It encourages us to be uneasy until we address situations where people are disciplined unjustly

with evidence that bends the truth, exaggerates significance, or uses fabricated information.

We see egregious examples of racism in the news which are easy to call out as there are elements of clear ill-will and expressions of dehumanizing fear. At the heart of these issues is conscious and unconscious biases that present themselves in less blatant

RACISM AS A PUBLIC HEALTH CRISIS

ways in everyday life. These biases are gentle pressures that push subgroups of people to the periphery. It is easier and politically safe to not participate yet avoid speaking up. Slinking away when we bear witness to an “incident” should unsettle us. Simply saying “I would have never done something like that” while doing our best to “avoid getting involved” perpetuates problems.

Medicine is a conservative community where we tend to be risk averse, yet our world and local communities will not improve until those of us with influence lead by example. We should not only acknowledge the density of evidence on systemic racism and resultant differences in outcomes, we should translate the assessment into a treatment plan with required action. As physicians, we are fortunate to have a significant, albeit often underutilized, influence on society. Protesting is one of many powerful means of leading change. Diplomacy in conflict, elevating awareness, kindly coaching misguided colleagues, being open to seeing and validating the experience of others, educating the patients and communities we serve, and holding ourselves collectively accountable to standards

of equity are more strongly suited ways for us to exercise anti-racism in our privileged positions as health care providers.

Frankly, being an anti-racist is a bigger call to action than many of us are likely prepared to immediately assume for our patients or one another…but it is critical. It involves being unsafe and uncomfortable at times. It requires us to admit we have not fully seen or processed everything happening around us, while committing to the process of correcting our lenses. It urges us to challenge systems and communities in addition to monitoring our personal behavior and biases. Paraphrasing the words of actor Will Smith, “racism and corruption aren’t getting worse, they are just being filmed.” Inaction erases the film, and silence makes us complicit in harm done. We all took an oath to do no harm in our practice and identities as health care providers. Let’s extend it to this chronic, yet now “seen” public health and social justice crisis. To fully embrace anti-racism, our specialty must be willing to admit that 1.) the problem exists, 2.) it affects our practice culture, colleagues, and patients, and 3.) each of us plays a role in the solution.

ABOUT THE AUTHORS Dr. Yiadom is an associate professor of emergency medicine at Stanford University and director of the Emergency Care Health Services Research Data Coordinating Center. She conducts research evaluating and addressing inequities in clinical outcomes among patients with emergency care conditions.

Dr. Brown is an assistant professor of emergency medicine at Stanford University School of Medicine.

His academic interests include health equity, social justice, and barbershop-based health interventions focused on improving health outcomes for Black men and boys.

Dr. Bennett is an assistant professor of emergency medicine. His academic pursuits include exploring change in gender, race, and ethnicity representation among residents and faculty.

41

COVID-19

The Unintended Consequences of COVID-19 Lockdowns

COVID-19

By William Weber MD, MPH on behalf of the SAEM Global Emergency Medicine Academy

42

In order to curtail the spread of the COVID-19 pandemic by limiting population intermixing, numerous countries have enacted lockdown measures such as curfews, quarantines, or shelter-in-place orders. While these measures have limited human interactions, their implementation can disrupt other systems meant to safeguard population health, leading to increases in childhood mortality, communicable disease, and domestic violence. Emergency physicians should be aware of the potential collateral damage of COVID-19 lockdowns as they care for patients.

Pediatric Vaccination Pediatric vaccination delivery has dropped substantially around the world,

“While lockdowns can lower overall deaths from COVID-19, their effect could be dwarfed by a corresponding rise in vaccinepreventable deaths.� putting a large number of children at risk of disease. A June 2020 World Health Organization (WHO) survey of health leaders reported disruptions or suspensions of around 70 percent of outreach vaccination efforts (e.g., mass vaccination at a refugee camp) and 44 percent of fixed-post vaccination efforts (e.g., established clinics). Travel restrictions were cited as a cause in 40

percent of cases. The effects of vaccine disruption on mortality are significant.

A Lancet article estimated that a sixmonth pause of current immunization programs in Africa would lead to around 700,000 vaccine-preventable deaths in children, which is nearly equivalent to the total worldwide deaths from COVID-19 through August 2020. Their models of Africa estimate that for

COVID-19

every COVID-19 death attributable to vaccination clinic visits, 84 deaths in children could be prevented by those vaccinations. While lockdowns can lower overall deaths from COVID-19, their effect could be dwarfed by a corresponding rise in vaccinepreventable deaths.

Other Communicable Diseases Lockdowns could also lead to a resurgence of infectious diseases, especially in low- and middleincome countries. Malaria, Human Immunodeficiency Virus (HIV), and tuberculosis all require consistent interventions to limit their effects.

Lockdowns can prevent patients from accessing clinics, screening, and treatment. Large-scale interventions like mosquito-net distribution become extremely time consuming if people cannot come to a centralized location.

According to WHO data, the current sum of deaths related to these diseases is around 2.5 million annually. A Lancet article estimates that care disruptions

from COVID-19 could increase deaths related to HIV up to 10 percent, tuberculosis up to 20 percent, and malaria up to 36 percent over the next five years in settings with high disease burden. Lockdowns could contribute to a significant increase in mortality from other communicable diseases in developing countries.

Domestic Violence Lockdowns restrict people’s ability to leave home, potentially preventing survivors of domestic violence from avoiding dangerous situations. The United Nations reports significant increases in emergency calls related to domestic violence around the world.

These episodes of domestic violence have disproportionately affected women, with rates of femicide climbing in multiple countries. Lockdowns can limit the opportunities of people to escape abuse at home, replacing exposure to virus with exposure to violence.

Lockdowns are not a one-size-fits-all approach to COVID-19 and can have unintended consequences, especially in

areas with limited health infrastructure.

Emergency physicians around the world should consider ways to mitigate unintended effects of lockdowns within their practice such as screening patients for domestic violence or refilling chronic HIV medications if patients cannot access clinics. From a policy standpoint, careful thought should be given to weighing the risks and benefits of lockdowns in the local environment, lest well-intended policies leave people at greater risk.

ABOUT THE AUTHOR Dr. Weber is an international emergency medicine fellow at the University of Chicago focusing on immigrant/ refugee health. He has worked in Zambia, Ecuador, and South Africa, and serves on the Public Health and Injury Prevention Committee of ACEP. Dr. Weber is a member of the SAEM Global Emergency Medicine Academy.

43

SAEM PULSE | SEPTEMBER-OCTOBER 2020

EDUCATION AND TRAINING

44

Zooming in on Virtual Interview Day Strategies

By Jessica Nelson MD, Sarah Greenberger MD, and Alina Tsyrulnik MD on behalf of the SAEM Education Committee The COVID-19 pandemic has posed multiple challenges for residency programs, not the least of which is the Association of American Medical Colleges’ recommendation that all residency interviews be conducted remotely. Because the traditional recruitment season is exceedingly complex, careful planning is essential for a successful transition to a virtual interview experience. The following considerations and strategies may be useful to residency and fellowship programs as they seek to adapt.

Preseason Planning and Interviews

First, programs need to decide which virtual platform will be universally used by the residency for recruitment. Possible platforms include Zoom, Skype, Microsoft Teams, GoTo Meeting, and Webex.

Scheduling programs, like Thalamus, now offer virtual interviews too. Institutional contracts should be considered, as well as cost, ease of use, security, and accessibility across operating systems and devices. Within the platform, the program should choose whether to have a combined virtual space with breakout rooms or independent meetings with separate links for each interview and group session.

All interviewers should have access to a video-ready device and an optimal internet connection. Programs should prepare interviewers by discussing virtual interview etiquette, including platform familiarity, mandated review of application materials in advance, appropriate attire, professional background, minimized backlight, and need to look at the camera (to simulate eye contact) instead of at the screen or their own images.

Furthermore, interviews should occur free of distractions: other computer programs should be closed, audio notifications should be muted, and background noise should be avoided. Structured interviews with standardized questions or instructions to address predetermined competencies (e.g., empathy, teamwork) ensure that interviewers glean adequate information without duplication.

“Structured interviews with standardized questions or instructions to address predetermined competencies (e.g., empathy, teamwork) ensure that interviewers glean adequate information without duplication.”

Applicants should be encouraged to be “IT-ready” for the interview day by downloading and testing in advance all of the platforms that will be needed/ used. A backup plan should be communicated (e.g., FaceTime, Google Hangouts, phone) in case of technical failures, and a dedicated staff member should be ready to serve as technical support.

Interviews may be exclusively virtual, with both interviewers and applicants at remote sites, or a hybrid model may be utilized with applicants participating remotely but interviewers together in one location. Programs may have applicants view introductions or video tours in a group setting (similar to a traditional interview day), or the residency may house this information at a website that can be reviewed by applicants on their own time. The latter option, combined with multiple interview time slots, may ameliorate time zone difficulties.

Shorter interviews are generally preferable with a virtual format, but programs should consider scheduling time buffers between interviews to troubleshoot technical difficulties, transfer applicants between rooms, and allow interviewers to record thoughts or score candidates. When breakout rooms are utilized, two-minute warnings before interviews conclude will prevent an abrupt end to conversations. Resident interviews, which tend to be less formal, can help replace casual conversations

that applicants would normally have on tours or over meals.

After interviews, programs should follow up to identify technical issues and obtain feedback for improvement.

A protocol should be established for applicants who request repeat interview days due to technical difficulties.

Programs should also consider the potential for unconscious bias and avoid inadvertently penalizing applicants from disadvantaged backgrounds who may have poor internet connections, reduced audiovisual quality, or less professional interview environments.

Virtual Tours

Finding a reasonable substitute for the interview-day tour is one of the greatest difficulties in recruiting on a virtual platform. As many programs are not allowing visiting students to do sub-internship rotations this year, the virtual tour is an especially important opportunity for applicants to familiarize themselves with both the institution and its surroundings. Virtual tours can range widely in content, but typically include highlights of the institution’s location, the emergency department, the residents’ lounge, and educational spaces like the simulation center. Slide presentations, which can be easily shared via many of the online platforms, provide consistency between interview days and require relatively minimal up-front continued on Page 46

45

“Programs should also consider the potential for unconscious bias and avoid inadvertently penalizing applicants from disadvantaged backgrounds who may have poor internet connections, reduced audiovisual quality, or less professional interview environments.”

EDUCATION AND TRAINING

continued from Page 45

SAEM PULSE | SEPTEMBER-OCTOBER 2020

resources. A formal video, filmed with the help of the institution’s information technology department or public relations specialists, requires more time and resources but also shows the most polished version of a program. Portions of a formal video may be shared among multiple programs, although ideally the video will also focus on areas specific to the emergency medicine residency. Either a full or condensed version of the video can be posted to the program’s web site and should be sent to applicants via a link in any postinterview correspondence.

46

For a more personable option, a resident-led tour can be either prerecorded or conducted live. If prerecorded, residents can provide insight into some of the nearby neighborhoods or points of interest in addition to showing areas within the hospital. Live tours of the institution pose multiple challenges. Internet and phone signals are likely to vary throughout the hospital, risking frozen screens, poor audio, and dropped connections. Live tours also pose a high risk of compromising patient privacy. Tours must avoid images of patients and their protected health information. With a live tour there is no chance to edit out information that may be visible on screens or on desks, or patients and families moving through the hospital. The variability of tours and the inability of an applicant to “save” a tour to reexamine at a future time, when making ranking decisions, also make live tours a less desirable option. If there is a strong desire to make the tour more interactive, then consider combining a slide presentation or prerecorded video with a resident question and answer session regarding the program’s location and workspaces.

Interview-Related Social Events

Social gatherings that happen the evening before or after the interview day, as well as during the interview day itself (often over breakfast or lunch), are critical to the interview experience.

Many applicants feel that these social interactions help shape their attitudes and opinions toward the program and whether they feel like they will ultimately fit in with a particular group. While an imperfect substitute, applicants should be given an opportunity to talk with residents more casually via a chosen online platform.

Virtual meeting platforms differ from in-person social gatherings in their inability to facilitate “small group small-talk”; therefore, scheduling multiple, smaller social sessions is key. Applicants can start in a large group but then utilize breakout rooms in which 1-2 residents are matched with 2-3 applicants at a time. In these breakout rooms, everyone can unmute and have a discussion. Another option is to use interest-specific breakout rooms. Residents pick a topic that they feel comfortable discussing and have small-group discussions that last for a set, short timeframe. Examples of these types of breakout topics include local recreational activities, relocating with a family, finding housing, and diversity and inclusion programs. All attendees should be encouraged to have their video cameras on and in “gallery view” in order to see all the participants. If more than five participants are gathering, the chat box and “raise your hand” features available on many platforms can be utilized to prevent people from being interrupted or talking over one another. Overall, the number of residents involved in each virtual social event will likely be smaller than for in-person gatherings.

Residents may need to be specifically invited to participate in these sessions

in order to facilitate an appropriate group size, level of diversity, and relaxed atmosphere.

Second Look

During any interview season, there exists the controversial “second look.”

Applicants may fear that if they do not pay an in-person visit to the program after their virtual interview, then the rank committee may underestimate their interest. Programs should address this matter openly and honestly during the general introduction or in the concluding remarks by the program director. Although “second look” visits do not have to be strictly forbidden, the residency leadership should not encourage and should make clear that they do not expect any in-person visits during the current interview season.

ABOUT THE AUTHORS r. Nelson practices D emergency medicine and critical care at Washington University School of Medicine where she is an assistant professor and an associate program director for the Anesthesiology Critical Care Fellowship.

Dr. Greenberger is an associate professor and the residency program director in the department of emergency medicine at the University of Arkansas for Medical Sciences.

Dr. Tsyrulnik is an assistant professor and an associate program director for the department of emergency medicine residency at Yale University School of Medicine.

Zooming in on Virtual Residency Recruitment: A Program’s Guide

By Kimberly Bambach, MD and Andrew King, MD on behalf of the SAEM Education Committee The current pandemic has disrupted medical education in numerous ways, including residency recruitment. As we continue our fight against COVID-19, social distancing and travel restrictions are necessary to keep medical students safe. SAEM, ACEP, CORD, ACOEP, and AAEM released a consensus statement that all residency interviews will be conducted virtually during the 202021 residency application season. This presents unique challenges: how do programs and applicants find a mutual “fit” in this virtual landscape? Providing virtual opportunities to explore emergency medicine (EM) programs is critical to supporting applicants who cannot participate in away rotations or interview face-to-face to gain first-hand knowledge of EM programs. The following suggestions will help programs create an engaging virtual recruitment experience despite the distance.

Reflect on your Program’s Identity

Applicants rely on your program’s online presence to gain insight into the educational opportunities and culture of your program. The first step in cultivating your online presence is to reflect on your program’s mission and values. What are you most proud of? Why do residents choose to train at your program?

Reflecting on and establishing your program’s “brand” enables you to have a clear vision of what you wish to convey to applicants.

Include Residents on your Recruitment Team

Applicants are eager to hear from current residents, and residents are eager to meet their future peers! Consider forming a recruitment committee and give residents the opportunity to hold leadership roles. Encourage residents

to bring their creative ideas to engage with applicants and spotlight the program. Residents and applicants can interact through casual virtual hangout sessions, small-group breakout rooms on interview day, or interactive games.

Inviting applicants to virtual didactics or journal club will also help them sample resident life. If an applicant shares an interest with a resident at your program, consider pairing them so applicants can ask questions and form personal connections.

Update your Program’s Website Your website is the official source of information on your residency where applicants will glean basic information on the curriculum, didactics, research opportunities, and subspecialty niches.

The website should be easy to navigate

continued on Page 48

47

EDUCATION AND TRAINING

continued from Page 47

and core program information readily accessible. Consider including letters from program leadership, bios on faculty and residents, blog-style entries on the latest program developments, a map of where program alumni currently practice, and information on the surrounding community. Ensure that supplemental program materials, such as brochures, are updated as well.

Get Social Despite the Distance

Tech-savvy applicants are eager to connect with programs via social media. Social media provides an informal platform to give applicants a sense of the culture that they will be missing on the interview trail. Create a residency Twitter account to send brief “tweets” that highlight the people and opportunities that define your residency.

Send tweets to celebrate and promote resident accomplishments, share program news and didactic pearls, answer applicant questions, and display photos of residency social events. This is also a way to engage in advocacy and the current national conversations in emergency medicine. Creating an Instagram account is another way to connect through the sharing of photos.

Posting at least once a week helps to maintain a connection with your followers.

SAEM PULSE | SEPTEMBER-OCTOBER 2020

Create a Virtual Tour

48

For those applicants who are unable to tour the clinical space in person, creating a virtual tour allows them to visualize what it is like to be a resident in your emergency department. Simply film a walk-through of the department highlighting important clinical spaces (trauma bays, critical care bays, etc.).

Additional training sites or rotations may also be included. Add personality to the virtual tour by including narration or commentary from current residents.

Optimize Interview Day Logistics

As emergency physicians, we are well-equipped to anticipate potential setbacks. There are several steps you can take to ensure that interview day runs smoothly: • When an applicant is selected for an interview, provide clear expectations

“Unconscious bias training for interviewers is more important now than ever, as virtual interviews may potentially introduce novel biases to resident selection.” for interview day, including an itinerary that includes video conference IDs and links.

• Provide applicants with information about the video conferencing platform so that they can make any necessary installations ahead of time.

• Anticipate that technological malfunctions will inevitably occur.

Ensuring that faculty are familiar with the platform and conducting a test call prior to interviews may identify issues.

Providing applicants with a back-up, such as a phone number to call if the video call is disconnected, will help set applicants at ease.

Beware of Potential Biases

Unconscious bias training for interviewers is more important now than ever, as virtual interviews may potentially introduce novel biases to resident selection. During video interviews, the interviewer may notice details of the interviewee’s environment that convey personal information, such as the applicant’s religion or socioeconomic status. Distractions or disruptions due to technological malfunctions or unexpected events may occur. Consider the potential for conscious and unconscious biases in these scenarios.

It is our hope that these tips will spark creativity and help programs and applicants forge real connections during this "virtual" application season.

This is a stressful and unprecedented time for programs and applicants, and acknowledging this fact is important.

COVID-19 will not stand in the way of our mission to train exceptional emergency physicians and recruit our future colleagues.

Additional Resources

•V irtual Residency Recruitment in the Time of COVID •Z ooming In Versus Flying Out: Virtual Residency Interviews in the Era of COVID-19 •T welve Tips for Tweeting as a Residency Program

ABOUT THE AUTHORS Dr. Kimberly Bambach is chief resident in the Department of Emergency Medicine at The Ohio State University Wexner Medical Center.

A ndrew King, MD is an associate professor, associate residency program director, and medical education fellowship director, Department of Emergency Medicine, The Ohio State University Wexner Medical Center.

ADMINISTRATIVE FELLOWSHIP Member Profile: Maureen (Mo) Canellas, MD, Administrative Fellow What was your fellowship experience like?

My time at UMass has been invaluable. Last year, I was immediately welcomed as a member of the leadership team and taught about the goals and trajectory of the department. Suddenly, I was privy to the how, when, and why of department changes. The most unique experience has been the debrief meetings with my fellowship director after team meetings. We discuss what I would have changed or done differently, what politics may be at play, and what values were aligned or misaligned between parties. Being able to have that time for reflection on my leadership style and management has been a unique experience that I did not know I would have during fellowship.

What advice would you give to someone who is on the fence about doing a fellowship?

I would advise anyone who is considering this fellowship to reach out to their medical director or operations team to discuss their interest. They have invaluable insight and can help advise you through your decision process.

Overall, administration fellowships can be quite flexible and personalized toward your interests in administration and leadership. The one or two years of extra training will allow you to hone your administrative skills beyond what you would be able to going straight into an attending job. In addition, many administrative fellowships offer protected time and subsidized tuition for a graduate degree (e.g., MBA, MHA, MPH). These opportunities are invaluable and can help set you apart from other candidates for leadership positions.

What was the most career-enhancing, or eyeopening thing, you gained from the fellowship?

Maureen (Mo) Canellas, MD, University of Massachusetts Medical School, Administrative Fellowship

Search for SAEM-approved fellowships in the Fellowship Directory to find programs that meet the highest standards of training in your subspecialty.

View the criteria for SAEM-approval of fellowship programs at www.saem.org/fellowship.

I capped off my first year of fellowship with the coronavirus pandemic. It has been inspiring to watch the administration team work tirelessly to manage all the needed changes in the department. Even through the pandemic, the administration team ensured my learning and fellowship experience continued at full speed. From learning about staff redeployment and the creation of unique care spaces to implementing my own intubation protocol, these first-hand experiences of leading in ambiguity have been vital to my development as a leader and manager.

What are your career plans after fellowship?

I plan to stay in academic emergency medicine, hopefully as part of a clinical operations and administration team.

Outside of clinical work, I plan to continue researching national visit and metric trends through my involvement with the Emergency Department Benchmarking Alliance. I hope to utilize national research insights to improve patient care and experience in my own emergency department as well as improve and inform the national practice of emergency medicine.

49

ETHICS IN ACTION

Everyone’s Entitled to an Opinion, But…

By Gerald Maloney, DO

SAEM PULSE | SEPTEMBER-OCTOBER 2020

The Case

50

It’s been the talk of the department.

One of the chief residents — soonto-be new faculty member — has made several posts on his blog endorsing controversial theories about the coronavirus pandemic, including comments that minimize the severity of the illness and the need for social distancing and use of masks. While he has not identified his employer, he does identify himself as a physician. His posts have received several thousand views.

When confronted, he states that he has a right to his opinions on this topic and a First Amendment right to make the posts. His statements contradict the hospital’s public health messaging regarding coronavirus. Should he be permitted to continue making and posting his controversial statements?

It is not unusual for a conflict between personal beliefs and professional obligations to arise in clinical practice.

Physicians have a wide array of personal beliefs on a variety of topics within and

“Our duty is to focus on what is best for the patient in front of us, even if it does not comport to our personal beliefs.” outside of medicine and are no more likely to universally agree with each other on all topics than any other segment of the population. Even within the realm of medical care, there is wide divergence of opinion on the evidence supporting various interventions — the ongoing debates over thrombolysis for acute stroke being one obvious example.

Respect for the rights of individuals to have their own opinions has been a tenet of civil rights in our society.

This falls in with a broad definition of autonomy as an ethical principle; however, it is also a tenet of professional ethics that outside considerations (such as a personal belief on an issue) should not affect the delivery of medical

care. We frequently deliver care to patients with whom we may disagree.

We deliver care to physically or verbally abusive patients, criminals, and enemy combatants. We deliver care to patients who wear hats or have tattoos endorsing political beliefs that are the opposite of ours and are expected to do so in an entirely nonjudgmental fashion.

While there are cases in which these conflicts come out into the open (a previously discussed case in this column being the physician who has a strong moral opposition to birth control refusing to prescribe emergency contraception), even then, the physician is expected to find a way to ensure the patient stills receives the care he or she requires. Our

“even if the physician holds a differing opinion (for example, that wearing masks in public or social distancing is unnecessary), if the best available evidence and the preponderance of medical opinion contradicts this opinion, he needs to err on the side of doing the least harm for his patient.” duty is to focus on what is best for the patient, even if it does not comport to our personal beliefs.

Given this, the aforementioned scenario raises two pressing questions: 1.) Given that what the physician is endorsing is not what is supported or recommended by the best available evidence and the opinions of the rest of the medical community, is he behaving unethically by espousing beliefs in his role as a physician that may endanger the health of patients? 2.) Because he is making these posts on his own blog, during non-work time, and identifying himself only as a physician and not speaking for his employer, can the hospital ask him to desist from exercising what he believes is his right to free speech?

While there are disputes about what may be the best approach or best treatment for a given condition, the physician has an obligation, when making recommendations to his patient, to do no harm and make recommendations that he reasonably foresees as being in the best interest of the patient’s health and well-being (beneficence and nonmaleficence). Thus, even if the physician holds a differing opinion (for example, that wearing masks in public

or social distancing is unnecessary), if the best available evidence and the preponderance of medical opinion contradicts this opinion, he needs to err on the side of doing the least harm for his patient. Even though a blog post or tweet may not be targeted to an individual patient the way a face-to-face encounter would be, it would still be reasonably expected that a person viewing that post might feel he or she is receiving expert medical advice on the topic. The recent sanctioning of two physicians who posted a video that directly contradicted recommendations from multiple professional and public health agencies underscores the obligation of physicians to be responsible in making recommendations — even if posted on their own blog and on their own time.

The right to free speech certainly exists with few limitations (namely those done to incite a disturbance or that create a safety risk); however, employers have a right to impose their own restrictions as to what their employees can and cannot say publicly. Even if an employee does not identify himself as speaking in an official capacity on behalf of the hospital, any public statement he makes — because it can be easily found and potentially linked to the employer — is subject to

the employer’s code of conduct and the consequences of breaking that code.

Thus, although an individual is entitled to exercise his right to free speech, if an employer deems that speech harmful to the organization, the employer may opt to exercise the right to terminate employment.

The Conclusion

Absent any medically compelling information that supports his position, the physician, ethically, should not be making public recommendations that may result in harm to his patient (or the public in general). The hospital does have the right to ask him to desist in his blog posts or risk losing his job — even if he does not identify himself as their agent — since the information he is posting can be readily discovered and potentially linked to his employer.

ABOUT THE AUTHORS Gerald Maloney, DO, associate professor of emergency medicine, Case Western Reserve University and associate medical director, Louis Stokes Cleveland VA Medical Center.

51

RESEARCH IN ACADEMIC EM

From K to Baby R to Big R: Should I Apply for an R03/R21?

SAEM PULSE | SEPTEMBER-OCTOBER 2020

By David H. Jang, MD, MSc, on behalf of the SAEM Research Committee

52

For any young investigator with an interest in research, one of the primary goals is to land a career development award (CDA) which provides the time, training, preliminary data, and time (did I say time twice?) to transition to an independent investigator. There are various CDAs available that include but are not limited to the National Institutes of Health (NIH) K awards (K08 and K23 being the most common), foundation CDAs such as the SAEM Foundation Research Training Grant (which provides $150,000 per year for two years), the Harold Amos Medical Faculty Development Program, and others.

While they differ in small ways, many of these CDAs provide substantial salary support with a modest research budget to allow awardees to competitively compete for independent funding.

I will discuss other funding opportunities within the context of an NIH K award (or CDA equivalent). K awards provide anywhere from 3–5

years of 75 percent protected time with a modest research budget ($25,000– $50,000 per year depending on the institute). Based on my own experience being about halfway done with my K award (K08HL136858), the reality of applying for an R01 is starting to sink in. My K currently provides $25,000 per year for research supplies. At first glance that seems like a lot for a young investigator, but I quickly realized early on that I needed more money! Science is not cheap. I am quite fortunate in that I have an amazing mentor (Dr. Todd Kilbaugh at the Children’s Hospital of Philadelphia) and a lab with robust staffing. I didn’t have to worry about hiring my own technician or preparing or buying common reagents, but there were project-specific equipment and supplies I needed to be successful — and that was going to require more money than what my CDA provided.

I don’t think I’m the only young investigator in this situation, so I wanted

to share my own experiences with some common funding mechanism available within the NIH system that those on CDAs may want to consider leveraging to bolster both their war chest and street credit to land that first R01. This is by no means exhaustive and there are certainly many equivalent funding mechanisms designed to do the same thing (i.e., SAEM Foundation grants). The question about R03 and R21 grants comes up a lot among many investigators at our stage, so this article is meant to provide some context about whether a junior investigator might want to apply for one. For context, I am a little more than halfway through my K08, which is focused on the intersection of mitochondrial function, therapeutics, and critical care illnesses (mostly toxicology, since I am a toxicologist). Before moving further, it is worth noting a CDA is not a requisite for these grant opportunities nor are they needed to apply and obtain an R01. With that out of the way:

The R21

An R21 is often referred to as a “highrisk, high reward” grant. It supports two years and a total of $275,000 in direct costs. Clearly a good chunk of change, it is often used to generate data for an R01.

While a two-year grant seems “easier” to get, NIH data clearly shows these are as difficult, if not more difficult, to obtain than an R01. At least half of those obtaining an R21 are established investigators.

Because of this, many mentors advise younger investigators to “just go for the R01” because: a.) R21s are not renewable, b.) they can be as competitive as R01s, and c.) the time to write up an R01 may not be substantially different from an R21. In my own experience, my early K work was focused on treatment of mitochondrial dysfunction with a succinate prodrug (NV118) using in vitro poisoning models. We saw some very exciting results, so I pitched an R21 to explore the use of this drug in a murine model of poisoning that was well-received (R21ES031243). I proposed a straightforward two aim project and did not suck up too much time to prepare. While one does not get any special consideration for being an early-stage investigator (ESI) with this mechanism, there were a few comments from reviewers that noted this R21 would help me apply for an R01,

“As with all grants, perhaps the most important thing to do is to talk to the program officer (PO).” which is nice for study section members to recognize. I also applied for this R21 with my mentor (Todd Kilbaugh) as a coinvestigator (Co-I) and did not ever refer to him as a “mentor” in the application.

I discussed his role as a Co-I and what skills he would bring to the project, which I think is important for those who want to involve their mentor as a Co-I. As a general rule for those on a CDA, this is an important time to establish your area of expertise. It must be clear that it is different from your mentor’s area of expertise, especially if you intend to apply for future funding with said person. At the time of the application, we did not even have a paper together, so do not let that be a barrier if you are early in your CDA with your mentor.

Whether you have a CDA or not, I do think there are a few caveats for those interested in this funding mechanism.

For a young investigator who is looking for funding to support time, the R21 is

not the way to go. Without killing all your budget on salary, one will probably ask for a 10–15 percent effort which is small in terms of “shift buy down.” It is way more fruitful to go for that CDA. Another myth about an R21: while the grant instructions state that preliminary data is not required, the data show that most funded R21s include some form of preliminary data.

Having served on a study section that reviewed R21s, I personally “buy into it more” if there is some form of preliminary data. Obviously, the definition of what constitutes preliminary data is in the eye of the beholder. As with all grants, perhaps the most important thing to do is to talk to the program officer (PO). I discussed my research idea early in the process and was in close contact after my first submission and resubmission (without being the clingy type) which I think helped tremendously. The last point continued on Page 54

53

RESEARCH

SAEM PULSE | SEPTEMBER-OCTOBER 2020

continued from Page 53

54

is that not all NIH Institute and Centers (ICs) offer the R21 mechanism. Again, reach out to the PO so you don’t waste time crafting an application that can’t even go to the appropriate IC. My K’s home IC (NHLBI) did not offer the R21 so I reached out to another IC (NIEHS) where my toxicology work also fits in.

For those within the NIH system, going though different ICs is a good way to expand your work and portfolio to remain agile in terms of future funding.

The R03

An R03 is a much smaller grant than an R21, offering $50,000 per year for two years for a total of $100,000 in direct costs so it is for a very focused project that can be completed in two years. Again, this is also a popular funding mechanism that I have known many to apply for. The same advice applies: a CDA should be the primary mechanism to garner salary support, as an R03 is not an effective way to obtain salary support. If one is early

“the primary purpose of any CDA is to obtain the skills, papers, and data to submit a competitive R01.” in their career with some support (institutional KL2 or K12 for example), then an R03 may be a consideration.

Some ICs will use the R03 mechanism for other purposes, such as a mini career development award (NIA GEMSSTAR to promote aging-related research) or in my case to bolster funding for K awardees. Many ICs use the R03 mechanism specifically made available to only K awardees in their last two years or within two years of finishing their K awards.

It is probably not shocking to know that with the fierce competition for research dollars, the conversion from K award to R01 (while improved with having a K award) is far from a slam dunk. With this recognition, this

specific R03 is used to better support K awardees with more funding, make one more competitive for an R01 submission, provide more experience with grant writing, etc. This K-specific R03 is similar to a normal R03 except that one is required to also submit a K progress report and explain how the R03 will be used. Reviewers will look for productivity on the K award (publications, data, and career advancement) and specifically how the R03 will help the K awardee obtain an R01. In my case, I pitched developing a large animal model of poisoning to study alteration in mitochondrial function to set-up work for my future R01 submission. I specifically described how the K has led to the R03 application, what I envision the R03 to do to help

with my upcoming R01 submission and what data/papers I anticipate with the proposal (R03HL154232). Part of the grantsmanship for this mechanism is to show how this work will expand your expertise and exactly how this will benefit your R01 application. At least based on my experience with reviewer comments, they clearly know where we are in our stage of career and I felt they were looking for reasons to score the application well. The obvious metric for K awardees and this R03 is to convert to an R01, so the more you can make your case how this will happen and that funding the R03 is critical for this, the more likely you will be get this. I also think another valuable feature in general is the summary statement. The comments from this R03 is useful to anticipate issues that may crop up for the R01 submission since in most instances one will probably submit their R01 to the same IC that is funding their K (study section may differ though).

The Timeline It is worth mentioning that from the time of submission to funding can be

close to a year and well over a year with resubmission. This is important to consider in your overall timeline. For the R21, my first submission was in February 2019 and while close to the pay line, it was not funded. I found this out over that summer and resubmitted in the fall cycle of the same year with the resubmission being recently funded… so overall the timeline was about 1.5 years! The R03 was submitted around November 2019 (slightly different submission cycle) and while funded on the first cycle (July 2020) we are still talking 9–10 months.

In conclusion, the primary purpose of any CDA is to obtain the skills, papers, and data to submit a competitive R01.

Even though many ICs offer “bonus points” for being an ESI, competition is still tough, so anything you can do to increase productivity and data is an asset. Depending on where you are in your development, consider applying for a smaller R (R03 or R21) if you find it fits within the greater plan for an R01 as opposed to “applying for the sake of applying.” Finally, I want to put in a plug for the SAEM grant writing workshop, which is taught by outstanding and

successful EM researchers and is an awesome resource for young researchers to learn the skills needed to craft a competitive grant. SAEM is fully dedicated to the growth of the research pipeline for our specialty and offers a variety of grants for investigators in different stages of their careers to further this critical mission.

If there are any ideas or requests for future articles related to research (e.g. mentorship, ways for medical students or residents to get involved, etc. please let us know. The SAEM Research Committee has a vested interest in promoting the research aspect of SAEM to everyone in any stage of their training.

ABOUT THE AUTHOR r. David H. Jang is an assistant D professor in the Department of Emergency Medicine and Division of Medical Toxicology at the University of Pennsylvania Perelman School of Medicine.

He is a member of the SAEM Research Committee.

55

EXPLORING ACADEMICS: HOW MEDICAL STUDENTS AND RESIDENTS CAN GET INVOLVED IN ACADEMIC EM

By Max Griffith MD, Kathryn Wiesendanger, Rachel Dahl MS, and Hamza Ijaz, MD on behalf of the SAEM/RAMS Faculty Development Committee Academic medicine plays a vital role in scientific advancement through innovative research, development of medical breakthroughs, and dissemination of knowledge.

Over time, the concept of academic medicine has evolved to encompass much more, including opportunities for mentorship, teaching, administrative roles, and collaboration.

In part because of this variety, academic medical professionals have reported less burnout and better career satisfaction when compared to their nonacademic colleagues.

While the majority of medical education focuses on mastering the basic sciences, recognizing pathologies, and developing clinical skills, it may benefit students and residents to explore some of the non-clinical aspects of medicine. Because these may or may not be built into medical school or residency curriculum, getting involved with academics requires some initiative. Early exploration can help develop a professional niche and guide your approach when applying to residency, and eventually, your career as an attending.

56

"A STRONG MENTOR WILL HELP A STUDENT DEVELOP AND HONE INTERESTS THAT GUIDE CAREER DIRECTION, AS WELL AS SHARE OPPORTUNITIES FOR PROJECTS, CONFERENCES, AND NETWORKING."

Testing the Waters: Academic Medicine for Medical Students

Among the challenges medical students face when deciding on a potential future in academic emergency medicine (EM) is a lack of significant exposure to what constitutes “academic” EM. New medical students may not have a clear understanding of what academic medicine entails, or how some EM residency programs with a more academic focus may have different expectations from applicants. There are a variety of resources in medical school to help students gain a better understanding of careers in academics and to develop a competitive application for residency.

Seeking early opportunities to participate in academic projects in medical school, such as research, teaching, or committee work, allows for exploration of EM or other specialties of interest prior to advanced clerkships. It also helps build skills in leadership, teaching, and writing, and provides the opportunity to identify mentors.

Mentors can be critically important assets for medical students, starting with sharing their own experiences working in academic EM and its unique features. A strong mentor will help a student develop and hone interests that guide career direction, as well as share opportunities for projects, conferences, and networking. Mentors can offer constructive criticism for improving one’s CV and guidance for standing out in increasingly competitive application cycles. They can be helpful resources in understanding which programs place

more emphasis on academics and have a higher percentage of graduates who go on to become fellows and/or faculty at university hospitals.

SAEM’s Medical Student Ambassador program offers an excellent opportunity for medical students looking to explore academic EM. The student ambassadors serve as liaisons during the SAEM Annual Meeting and are paired up with faculty mentors. Not only does this look great on a CV, but it also allows students the opportunity to learn about national issues facing EM. Building a well-balanced resume in medical school, with exposure to leadership, research, and/or teaching activities, helps residency applicants stand out in the application pool and provides interesting fodder for conversations during interviews.

However, the COVID-19 pandemic presents new challenges for rising fourth years. They face having fewer opportunities to stand out from the crowd, with the delay of Step 2 CS, a lack of away rotations, the removal of medical students from EM clerkships, and the resultant lack of SLOEs. Yet for all the setbacks COVID-19 has caused in medical education and patient care, the pandemic has created new opportunities for student leaders and researchers to step up, whether developing creative ways to virtually deliver a curriculum, deploying medical students to assist hospital staff in ancillary roles, or directly contributing to research efforts. continued on Page 58

57

EXPLORING ACADEMICS from Page 57 The most critical component in the process of determining residency and career interest is initiative by the medical student. Medical students should be encouraged by faculty early on to seek out resources and mentors relevant to their interests. However, even if they lack that support, students should be proactive in getting involved with activities that demonstrate their interest in academic EM. This may include, but is not limited to, becoming active members of national professional organizations; participating in committee work in these organizations or at their own schools; participating in publishing and presenting research; attending academic conferences; and tutoring or facilitating small group discussions.

Taking the Plunge: Academics During Residency

Most will agree that residency is first and foremost an opportunity for trainees to develop and hone clinical skills.

For residents interested in academic careers, it is also important to carve out time for teaching, research, and leadership opportunities during training. Medical school graduates already involved in medical education can build on these experiences in residency, while those who are relatively new to academic medicine can start to explore projects that complement their clinical training.

58

While accomplished graduates from any residency program can land a job in academics, different residencies may emphasize academics to varying degrees. Residency applicants may want to consider how much funding is available to support research and travel to conferences; whether there are faculty mentors with experience publishing research and a track record of involving residents as authors; and whether the career exploration afforded by a four year program is worth the extra time in training. Residencies are increasingly offering career development tracks in areas such as ultrasound, research, or global health, which may also be valuable for residents trying to develop a niche. Some residencies have scholarly requirements for graduation, such as presenting at a national conference or publishing in a peerreviewed journal. Some may view this as just another obstacle to graduation, but it might also indicate that the residency views academics as a priority.

Residents looking to become involved with academic medicine have many options. Signing up to give lectures or lead procedure labs for a medical student clerkship can help develop teaching and presentation skills. One way to get involved with research is simply to reach out and ask faculty mentors directly — whether to answer some burning question you’ve already identified or simply to inquire about ongoing projects. There are many leadership opportunities for residents at the departmental, institutional, and national level and likely no shortage of committees in need of residency

"HAVING A PROJECT TO FOCUS ON OUTSIDE OF EVERYDAY

ABOUT THE AUTHORS: Dr. Griffith is a third-year resident at the University of Michigan with an interest in Medical Education and Med Ed research.

PATIENT CARE, AND THE SENSE OF ACHIEVEMENT IN SEEING THAT PROJECT TO COMPLETION, CAN PROVIDE A WELCOME CREATIVE OUTLET DURING RESIDENCY." representation at residency meetings. SAEM and other national emergency medicine organizations also have multiple resident committees with annual application cycles for those looking to get involved. SAEM-RAMS is always looking to increase its membership by recruiting interested medical students and residents to collaborate with. (Join a 2021-2022 RAMS Committee!)

Not only do these opportunities look great on a resume, the right opportunity can pay dividends. Teaching or committee work are often valuable sources for future scholarship. That new lecture series or simulation session you facilitated for medical students can become a research project, innovation report, or poster presentation. Getting involved is also a networking opportunity to meet peers and mentors with similar interests.

Letting it Soak In

The main question for students and residents may not be “am I interested in academic medicine?” but rather “do I have time?”

Given the demands of training, dedicating extra time and energy to academics is a big ask. Yet just as faculty involved with academics report decreased rates of burnout, many residents consider extracurricular projects as a source of energy, not a drain. Having a project to focus on outside of everyday patient care, and the sense of achievement in seeing that project to completion, can provide a welcome creative outlet during residency. Not every trainee will love their experiences with academics. The incremental process of research, the challenges of managing learners as a teacher, and the extra responsibility of administrative roles are not for everyone. If after dabbling in academics, a medical graduate enters the workforce with a firm conviction that they want to focus only on clinical medicine, previous experience with academics will make them more confident in that decision. However, by exploring and branching out early in training, many will find a path to a more fulfilling and varied career, with the opportunity to improve medicine for the next generation of doctors and patients.

athryn Wiesendanger is a third-year medical K student at the Royal College of Surgeons in Dublin, Ireland and aspiring emergency medicine physician. A gun violence survivor and contributor to the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM), Kathryn is passionate about gun violence research and injury prevention. achel Dahl is a third-year medical student at R University of Iowa Carver College of Medicine and concurrently pursuing an MPH through the University of California Berkeley. Rachel plans to pursue a career in either emergency medicine or neurocritical care, with additional interests in community and global health.

Dr. Ijaz is a second-year resident at the University of Cincinnati. He is interested in medical education and emergency department operations and administration.

Join a RAMS Committee!

RAMS is looking for committee members to help chart the course for the future of academic emergency medicine by developing educational, professional, and career solutions that address the needs of SAEM residents and medical students. If you are interested in championing the next generation of emergency medicine academicians and leaders, please review the RAMS committee descriptions and consider signing up for a 2020-2021 RAMS Committee.

59

STRATEGIES FOR ADDRESSING AND MITIGATING THE LACK OF DIVERSITY IN EMERGENCY MEDICINE

By Reuben William Horace, II MPH Emergency medicine (EM) has experienced incredible growth over the past decade; unfortunately, growth in the number of EM physicians from underrepresented minority (URM) backgrounds remains stagnant. Increasing the number of underrepresented minorities in graduate medical education, particularly in emergency medicine, is a priority that continues to be actively supported and advocated by numerous medical professional societies such as the Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), Council of Emergency Residency Program Directors (CORD), and National Medical Association (NMA). With this understanding of the lack of underrepresented minorities in emergency medicine, graduate medical education institutions have incorporated diversity and inclusion committees as part of

60

their effort to not only attract these minority groups, but to also bridge the gap in emergency medicine.

Embracing diversity and inclusion in the workplace and professional societies has the potential to improve patient care and outcomes. Some of our country’s emergency departments regularly serve these minority patients and the trend will continue to rise as our population becomes more and more diverse. As a result, a diverse workforce in EM is more representative of the larger population, and diverse providers can bring their unique experiences and understanding of patient backgrounds, leading to increased cultural sensitivity and improved care for the diverse emergency department (ED) patient population.

Furthermore, studies have shown that patients gravitate more to physicians similar to themselves, and that when patients

"A DIVERSE WORKFORCE IN EM IS MORE REPRESENTATIVE OF THE LARGER POPULATION, AND DIVERSE PROVIDERS CAN BRING THEIR UNIQUE EXPERIENCES AND UNDERSTANDING OF PATIENT BACKGROUNDS, LEADING TO INCREASED CULTURAL SENSITIVITY AND IMPROVED CARE FOR THE DIVERSE EMERGENCY DEPARTMENT (ED) PATIENT POPULATION. FURTHERMORE, STUDIES HAVE SHOWN THAT PATIENTS GRAVITATE MORE TO PHYSICIANS SIMILAR TO THEMSELVES, AND THAT WHEN PATIENTS HAVE DEMOGRAPHIC CONCORDANCE THEY ARE MORE SATISFIED, HAVE MORE TRUST IN THE PHYSICIAN, AND GREATER COMPLIANCE TO TREATMENT." have demographic concordance they are more satisfied, have more trust in the physician, and greater compliance to treatment. As a whole, EM has the opportunity to serve these diverse populations by attracting and increasing their minority applicant pool.

Recruitment Strategies

Based on identified barriers and the need for more underrepresented EM applicants in emergency medicine, recommendations encompass seven main areas: 1. Maximizing the URM applicant’s exposure to faculty that are themselves underrepresented in emergency medicine that share similar clinical or research interest 2. Improving the communication between highly ranked underrepresented in emergency medicine applicants and key program faculty 3. Improving outreach to underrepresented minorities interested in EM by recruiting and attending yearly Student National Medical Association (SNMA) conferences 4. Improving the residency curriculum surrounding community emergency medicine and cultural competence. (Each residency serves a different population and having residents who look like the population they serve will only strengthen patient physician relationship which can lead to better patient outcomes.)

5. Utilizing social media platforms such as Twitter and Instagram to showcase program highlights and hold open forums where underrepresented minority applicants can speak with other minority residents and key faculty within the residency programs 6. Being open to mentor and encourage underrepresented minorities to pursue careers in EM. This can include formal

mentoring at your current institution or engagement with national student originations such as Student National Medical Association (SNMA) and National Hispanic Medical Association (NHMA) On a personal note, many highly qualified URM candidates may not be considered “high priority” due to arbitrary cutoffs based on COMLEX Level 1 or USMLE Step 1 scores. I argue that institutions will still get highly regarded candidates if selection criteria are broadened to not solely focus on just board scores, but instead more tangible and meaningful criteria such as research experience, standardized letter of evaluation, long term leadership roles, and other meaningful life experiences that will enrich the institution's environment.

It is crucial, now more than ever, that emergency medicine programs recruit URM applicants to their programs to help serve the needs of a diverse and ever-growing population.

The importance of recruiting URM candidates cannot be underestimated in the emergency medicine setting and through these efforts, we can facilitate a richer emergency department environment. These recommendations should be used to help equip emergency medicine programs with the knowledge to achieve the ultimate goal of increasing diversity at their institutions, attracting high quality faculty, and increasing the work force of unrepresented physicians in emergency medicine.

ABOUT THE AUTHOR: Reuben Horace is a third-year medical student at New York Institute of Technology. Among his interests are topics surrounding research in cardiovascular emergencies and diversity and inclusion.

61

PERSONAL PERSPECTIVES ON DIVERSITY, EQUALITY, AND INCLUSION “Racism is a public health crisis and we need to work together to address it.”

Dr. Alam graduated from Howard University College of Medicine and aspires to become an emergency medicine physician and to bring healing, address inequities, and reduce disparities in underserved communities.

“I recently graduated from Howard University College of Medicine and took the opportunity Mustafa Alam, MD of doing academic research in Mount Sinai Hospital in New York City. As 2020 progressed, the city would also become the center of the worldwide pandemic of COVID-19.

“Many people can share personal stories of how COVID-19 has impacted their lives. It has been a challenging period for many hospitals, communities, and individuals. It is still a battle being fought. One result we have seen is the disproportionate number of patients that were infected and the mortality from this virus towards people of color.

62

“In the midst of this worldwide pandemic of COVID-19, the world also witnessed the tragic murders of Ahmaud Arbery, Breonna Taylor, and George Floyd. The videos of their deaths are haunting; watching lives taken so unjustly was jarring to see. In many cities protests and marches demanded justice for these individuals. The images and events reminded people of the public health crisis which has affected our nation for many years: Racism.

“If we anatomically look at racism, it seems to be ingrained in different aspects of our society. It is seen in the health disparities we may come across with the medical care of our patients. It is seen in the socioeconomic disparities of the population in the communities we serve. It is felt when we see injustice from our legal system and/or law enforcement officials in the treatment of people of color.

“Emergency medicine is a specialty that can address this health crisis in a unique way. I was happy to see emergency medicine physicians taking the lead in addressing this issue.

For myself, emergency medicine, is my chosen medical specialty. I want to become an emergency medicine physician and practice in underserved communities. As the first doctor in my family and a person of color, I also have been a victim of racism. Racism causes a pain you would not wish upon any other human being. It wounds and hurts with each infliction.

When I think about racism, I want to do my best to address it and to end it. Many underserved communities have families and individuals who have been victims of racism or of systemic racism within their communities.

I would love to advocate for emergency medicine residency programs to make this year's class of residents the most diverse class ever. If you come across a person of color that has faced setbacks, please give that applicant a chance. That opportunity will offer an inspirational story for that doctor to share with their families, mentors, and communities — communities that see someone who looks just like them and would be pleased to have a doctor of color serving them. More importantly, it will give these doctors the opportunity to provide hope, relief, and healing to communities with an urgent need.

“It is an emergency that people of color are facing injustice and racism. It is an emergency that we cannot ignore. Racism is rampant. We need to have an effective curriculum that addresses diversity issues in programs and hospitals; for example, simulation exercises that address conditions a patient from an underserved community encounters or how to approach a patient that is a victim of racism.

“Racism is a public health crisis, and we need to start now to address it. If we work hard to make changes and face this crisis together, with time we shall overcome it. It starts by changing ourselves and how we feel about each other. If we work together toward this cause, I envision a time where we will embrace our differences, when the values of equality, justice, and love will reign, and where a world will heal from the wounds and suffering caused by years of racism.

“We can start now, with our residency programs and ensure that the next generation of residents will be leaders in their communities in battling this public health crisis. May this specialty continue to inspire everyone to make a difference and to be in the front lines no matter which crisis comes through the ED.”

“Racism is a public health crisis… When will enough be enough?”

M. Aaron Vrolijk

M. Aaron Vrolijk is a fourth-year medical student at the University of Colorado Anschutz applying to emergency medicine. His recent projects include curriculum aiming to reduce bias in medicine, interventions to improve communication with LGBTQ+ patients, and investigating the unique added stressors minoritized medical students face.

“There are two patients from my emergency medicine acting internship this year who keep recurring in my thoughts. Both are Black men. The first patient was a young man who came in after cutting his hand on glass while working a temporary job. As I sutured his hand, he thanked me profusely and apologized when I nicked a vessel causing his hand to bleed. I kept reassuring him that he was okay, he did nothing wrong, I had made the mistake, and I was there to take care of him. I wanted him to see that he deserved

to be treated like this in all parts of his life and that it was not his fault that we live in a racist system. Throughout his visit he was telling medical personnel that “all lives matter.” When he told me this, it broke my heart. I was worried he didn’t see that his life was as important as everyone else’s. Not knowing how to respond, I said, “I went to the vigil for Elijah McClain.”

My patient lowered his head and described the Elijah he remembered and how they knew one another.

“I saw the second patient, a Black man in his 30’s, on the last shift of my rotation. He was there for excruciating back pain and possible cauda equina following a laminectomy at another hospital. Neurosurgery was consulted after an MRI confirmed nerve impingement. Despite his pain, he was hesitant to get more pain medication. He tearfully told me that he had gone to several emergency departments before surgery with back pain.

At one he had been labeled “pain medication-seeking” in his chart. Finally, he found someone who offered him a treatment— surgery—in another city. He started crying, telling me that I didn’t need to talk to him or to listen... but I did. He felt cared for, heard, and like his health problems were being addressed at our hospital for one of the first times.

“As a future emergency physician (fingers crossed for this match season), I am realizing the enormous responsibility we wield beyond direct lifesaving measures. We can change a patient’s life with a keystroke by marking them as a “poor historian” or “pain med seeking” (both characterizations I have only seen attributed to Black patients). We are part of a system that inappropriately dosed Elijah McClain with ketamine. But this health crisis is the result of a racist system that results from racism in medical training, housing inequality, K-12 education disparities, the prison industrial complex, and many others.

The list feels endless. The publications detailing the racist underpinnings of America are well documented. How many books and studies need to be published solidly demonstrating America’s racist system? How many more studies do we need on health outcomes and treatments that differ based on a patient’s reported race? When will it be enough for medical schools to hire a professional to remove the numerous ways medicine continues to use race as a risk factor instead of the socioeconomic inequalities that have been perpetuated due to racism?

“I think about how much these interactions continue to affect me as a white man and can’t imagine how they affect my Black colleagues and friends. Medical school and residency are hard enough without seeing the effects of discrimination evident in patients or their own experiences with racism while navigating already difficult rotations. The numerous documented extra challenges minoritized medical students, residents, and faculty face make me think an instrumental step in dismantling racism (and, thus, the subsequent health crisis) is aggressively refiguring medicine to support minoritized members regardless of their health profession. The emergency department—with its interdisciplinary team, diverse patient population, commitment to medical training, and influence on patient care—is a fertile place to restructure patient care, support minoritized medical personnel, and remove racial underpinnings in medical education. Individually, we must make a decision to be open to listening, changing, and declaring that we’re tired of lives being stunted and lost based on the color of a person's skin.”

63

VIRTUAL INTERVIEWING TIPS AND TRICKS

By Cassandra Mackey MD and Christine Kulstad MD COVID-19 has led to a change in the practice of medicine and medical education. One area where the impact of COVID has been felt profoundly is in the area residency and fellowship application. In the past this would be accomplished with in-person interviews and meetings. These face-to-face opportunities were the best way for both the department and the applicant to find their perfect fit. COVID has changed all of that. To avoid spread of disease, there is a focus on minimizing in-person contact. Restrictions have been placed on the number of people who gather in groups and how far apart they must stand when gathering. The AAMC now recommends virtual interviews and meetings for all fellowship and residency applicants.

Our goal in creating this piece is to provide guidelines for virtual interviewing and advice on how to put your best foot forward during virtual interviews. Virtual interviews are certainly a change from traditional interviews, but they have been used successfully in the past for residency and fellowship positions (as noted by Vadi et al 2016, Jones et al 2020, and Healy et al 2017.) There are many ways to optimize your success; we encourage you to invest in the time to determine which ways work best for you.

Preparation

Before interview day, download the residency program’s application. If the program application is one you have used before, ensure that your display name is a professional version of your actual name. To ensure the program’s technology/application works with your computer, run

64

through a mock interview. Focus on the functionality of your camera. If your computer’s camera is low quality, consider using an external webcam. Evaluate the performance of your speakers and sound system and consider using headphones for better sound quality and to prevent feedback or echoing.

Record and play back the mock interview, paying close attention to your unconscious habits (e.g. adjusting your glasses, playing with your hair, stroking your beard/mustache, chewing on your nails etc.) as these can be distractions. Note these habits and make a conscious effort to avoid them in the future. Having a friend or mentor watch the interview will give you additional perspective on areas for improvement.

Spend some time before your first interview learning how to optimize your internet connection and image quality. Explore the options that are available on the application you will be using. Close other programs on your computer that might make the application run slower. Turn off other devices that use the Internet or at least temporarily turn off their WiFi connection. Find a place with a strong WiFi signal, close to the router, to maximize internet connection or, if possible, consider using a wired connection. All of these steps should help avoid a frozen video or lost audio signal.

Just as you would prepare for any other interview, develop answers to questions you think will be asked. Explore the program’s website and watch their promotional videos to become familiar with the institution. Develop a list of questions.

Figure 1 QUESTIONS

ASK…

Who has ownership of patients?

Residents and Faculty

Who do you present to on shift? As an intern? As an upper level?

Residents and Faculty

Availability of fellowships?

Residents and Faculty

Do residents feel ready for independent practice at the time of graduation?

Faculty

What would you change about the program?

Residents and Faculty

What is the culture of mentorship? How do residents go about finding a mentor?

Residents and Faculty

What unites residents?

Residents

How do residents and faculty get along with ancillary staff? Consulting Services?

Faculty and Residents

How often do residents hang out with colleagues or coworkers outside of shift?

Faculty and Residents

Remote interviewing can make it difficult to get a general “feel” for a place, so ask questions that might help bridge this gap. For example, ask about mentoring, activities residents do together for fun, or how comfortable residents feel about contacting their attendings during non-work hours. (See Figure 1 for other example questions.) If the option is offered, consider contacting residents after the interview to try to replace the social interactions missing from virtual interviews.

Environment

Make sure you have a neutral, light-colored background without a direct light source behind you, which can cause an unflattering shadowing or make it difficult for the interviewer to see your face. A warm light source positioned just off to the side but shining on your face is generally the most flattering. A neutral background will bring you to the foreground. Try to avoid images or artwork in the background; although potentially a key to your personality, they can be a distraction.

Barking pets and active children, adorable as they may be, are also distractions to try to avoid during your interview. Consider having someone keep an eye on the pets and children from a different room that’s not within earshot of the room in which you are doing your interview. If your institution allows, an empty classroom or office on campus may provide the quiet environment you need.

Appearance

Just as with an in-person interview, dress for success. If you would wear a suit and tie or formal dress to an in-person interview, wear the same thing during the virtual interview.

Groom your hair, beard, etc., just as you would for an in-person interview. Although what you are wearing on the bottom may not be shown on video, dressing professionally is an unconscious reminder to you that this is an interview to be taken seriously. In addition, there have been many examples of virtual meetings where participants did not realize how much of themselves was visible on screen!

Look directly at the camera when you are speaking and not at the screen (watch your recorded practice interview to see how both options come across). Just as meeting someone’s eyes during an in-person interview exudes confidence, so does

keeping your eyes fixed on the camera. Looking at (and seeing yourself on) the screen may also distract you from what you are saying or make you feel self-conscious. It can also be helpful to look at the interviewer when they are speaking to pick up on their non-verbal clues.

It’s harder to project your personality through a virtual interview and easier to come across as low energy, which can be interpreted as uninterested. If you decide to sit during the interview, make sure you are sitting upright in a chair and not lounging on a sofa or bed. Consider arranging your laptop on an elevated surface so that you are standing during the interview.

Practice with both options before the actual interview and watch the recorded interview to decide which option shows off your personality the best without creating distractions.

Keep your phone away from the computer during the interview and remove anything that lights up or makes noise that could possibly distract you from the conversation. Just before the interview starts, make sure you turn off all alerts and pop-up windows on your computer. (It is especially obvious during a one-on-one interview when someone is distracted.)

Closing Remarks

We hope that by applying these tips you will be prepared for a successful and worry-free virtual interview day. (And if you start to feel stressed about the changes, consider the time and money you're saving — more than $3,000!.

ABOUT THE AUTHORS: Dr. Mackey is an assistant professor in the department of emergency medicine at the University of Massachusetts Medical School and a former medical education fellow at the University of Texas Southwestern Medical Center @casscln.

Dr. Kulstad is the clerkship co-director and an associate professor in the department of emergency medicine at the University of Texas Southwestern

65

BRIEFS AND BULLET POINTS SAEM NEWS

SAEM and ADIEM Launch Diversity, Equity, and Inclusion Library Committee Sign-Ups Are Now Open!

One of the most valuable benefits of membership in the Society for Academic Emergency Medicine (SAEM) is the opportunity to participate on one or more SAEM and RAMS committees.

Serving on a committee furthers your professional development by providing leadership experience, expanding your professional network, and strengthening your ties within the specialty. What’s more, committee members are directly involved in identifying new opportunities, guiding projects, and offering their expertise...so you will have a direct hand in helping us achieve the Society’s goals.

Review the committee descriptions and sign up for those that best match your interests and expertise.

Virtual Consensus Conference on Telehealth and Emergency Medicine Register for the 2020 SAEM Consensus Conference — Telehealth and Emergency Medicine: A Consensus Conference to Map the Intersection of Emergency Medicine and Telehealth, to be held virtually on September 22 and 24, from 11 a.m. until 4 p.m. CT. The conference is designed to stimulate emergency medicine (EM) researchers and educators to recognize, investigate, and translate the impact of telehealth on the field of emergency medicine for the purpose of designing a research agenda.

The conference will be led by nationally recognized presenters and keynote speakers.

66

SAEM and the Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) are proud to bring you the Diversity, Equity, and Inclusion (DEI) Library. This online resource is a tool for emergency physicians to learn more about achieving health equity and eliminating health disparities. The DEI Library is organized by media type and categorized in seven subject areas.

We’ve Elevated SOAR to Even Greater Heights!

After months in the making, SAEM and the SAEM Virtual Presence Committee are excited to unveil the newest version of SOAR: SAEM Online Academic Resources. SOAR now features three years of annual meeting content (including new content from the SAEM20 Virtual Annual Meeting!) and more accessibility than ever before. Plus, an enhanced, easy-to-navigate layout allows you to view online education resources by topic or view videos from the SAEM YouTube Channel for additional features that let you easily sort, save, and share your favorite content!

A Webinar Series From ADIEM: “How to Be a Successful EM Applicant” The new, eight-session series from SAEM’s Academy for Diversity & Inclusion in Emergency Medicine (ADIEM), takes participants through the steps of and offers helpful advice on How to Be a Successful EM Applicant. Follow the links below or visit the series webpage to register and for the most up-to-date information.

Now on video!

• Fundamentals of the EM Application Process • Making Your ERAS Program List Coming soon!

• How to Ace Your EM Rotation Sept. 9, 7–8 p.m. CT

•S pecial Considerations Sept. 14, 6–7 p.m. CT •C linical Scenarios Sept. 21, 6–7:30 p.m. CT •T he Interview Sept. 30, 7–8:30 p.m. CT •E valuating Which Program is Right for You Oct. 13, 7–8 p.m. CT •M entorship and Person Advocacy Oct. 15, 6–7 p.m. CT

Midwest Regional Meeting to Be Held Virtually, Sept. 23

Register for the Midwest Regional Meeting, “Emergency Medicine Inspires Innovation” to be held virtually from Cleveland, Ohio on September 23, 2020.

For registration link, agenda, and a roster of speakers, visit the event webpage.

Dr. Maureen Canellas is a Fellowship Approval Committee “Success Story”

Maureen (Mo) Canellas, MD is next up in a series of fellowship Success Stories sponsored by SAEM’s Fellowship Approval Committee.

Maureen (Mo) Canellas If you’re interested in becoming an administration fellow, check out the advice from Dr. Canellas, an administration fellow at the University of Massachusetts Medical School, who shares insights and advice from her own experience, including the most careerenhancing thing she gained.

SAEM Signs Joint Statement in Support of the Mental Health of EM Physicians

A joint statement signed by SAEM, academic and psychiatry experts, and other emergency medicine and medical organizations, outlines steps to support the mental health of emergency physicians and other health professionals currently risking their lives to treat patients during the COVID-19 pandemic. “Optimal physical and mental health of physicians and other medical clinicians is conducive to the optimal health and safety of patients,” the joint statement reads. The statement asserts that credentialing entities should refrain

both from discouraging physicians from seeking professional help and from dissuading physicians from joining peer support groups and that there should be no reprisals for a physician who engages in such therapeutic endeavors. Read the full statement.

critical content in 15 minutes flat. In the first installment, Fast-15 on Finances in the Era of COVID-19: Critical Content in 15 Minutes Flat!, leading financial entrepreneurs in the medical community provide their expertise for navigating finances in the era of COVID-19.

CDEM M4 Curriculum Site Has Been Updated!

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

The Clerkship Directors in Emergency Medicine (CDEM) M4 curriculum site has updated versions for all 50 M4 chapters. In addition, all of the online chapters (including the M3 curriculum and pediatric EM curriculum) have a new, reader-friendly format that allows for easy viewing on mobile devices. The original CDEM curriculum was crafted with an audience for M4 students. It was meant to capture the most common conditions a fourth-year student would encounter while rotating in the emergency department.

SAEM Consultation Services Can Help With Teaching, Research, and Other EM Practice Issues

SAEM members possess expertise in teaching, research and other aspects of academic emergency medicine (EM) practice. Through SAEM Consultation Services, these experts from SAEM committees and academies, in consultation with Association of Academic Chairs of Emergency Medicine (AACEM), are available to assist individuals, departments, and institutions with developing, evaluating, and/or improving various services, including new residency and fellowship programs; developing departmental status for EM divisions; subspecialty expertise (research, ultrasound, etc.); and billing, patient safety, etc. For more information, visit the SAEM Consultation Services webpage.

SAEM committee and academy members possess expertise in teaching, research and other aspects of academic emergency medicine (EM) practice. Through SAEM Consultation Services, these experts, in consultation with Association of Academic Chairs of Emergency Medicine (AACEM), are available to assist individuals, departments, and institutions with developing, evaluating, and/or improving various services; developing departmental status for EM divisions; subspecialty expertise (research, ultrasound, etc.); and billing, patient safety, etc.

Mark Your Calendars!

Sep 15 Advanced EM Workshop submissions Close Sep 28 Nominations Open Oct 1 Didactic submissions close Oct 5 Committee sign up closes Nov 1 Abstracts submissions open Nov 1 Innovations/IGNITE! submissions open Nov 16 Nominations close

SAEM FOUNDATION Research Learning Series Offers Valuable, Online Research Content!

First “Fast-15” Installment Covers Finances in the Era of COVID-19

Hosted by the SAEM Industry Advisory Council in collaboration with SAEM RAMS, “Fast 15” is designed to give you

SAEM’s Research Learning Series (RLS) features valuable education on popular emergency medicine research topics delivered by experts in the field of emergency research. Sign up for the these high-yield, interactive educational events for free, or view previous podcasts and lectures, housed online at the RLS webpage.

Join EM Influencers in Donating to the SAEMF! Some of emergency medicine’s greatest influencers give to the SAEM Foundation… Learn why they give and how you can join them in supporting promising emergency medicine academicians.

SAEM JOURNALS Call for Papers: AEM Special Issue on Scientific Inquiry Into the Inequities of Emergency Care

To address a pervasive and wide knowledge gap about the science of inequities in emergency care, Academic Emergency Medicine (AEM) will publish a special issue in the fall of 2021.

A primary focus of this issue will be on the impact of race and ethnicity inequity, with a preference toward original-based research that addresses patient-centered topics as well as inequities that affect clinicians of color in their professional roles. Priority will be given to papers with intervention-based, original data.

All papers will undergo peer review. For details follow the link.

Listen to the Latest Podcasts from SAEM Journals!

Each issue, Academic Emergency Medicine (AEM) journal and AEM Education and Training (AEM E&T) journal releases podcasts highlighting papers selected by their respective editors-in-chief as especially significant and relevant. Journal podcasts are also available on iTunes. The latest podcasts, from the July and August issues of AEM and AEM E&T are below: • Dr. Christopher Carpenter discusses Diagnosing COVID-19 in the Emergency Department • Dr. Frank Peacock discusses HighSensitivity Troponin I Testing • Dr. Mark Ebell discusses Accuracy of Signs and Symptoms for Diagnosis of CAP • Dr. Elizabeth Schoenfeld discusses Shared Decision Making

continued on Page 68

67

BRIEFS continued from Page 67 • Dr. Sarah Greenberger discusses Impact of Changes to the ACGME Common Program Requirements • Dr. Michael Gottlieb discusses tips on Rethinking Residency Conferences in the Era of COVID-19

Check Out AEM, AEM E&T Online COVID-19 Collections

To facilitate the rapid dissemination of COVID-19 findings, Academic Emergency Medicine and AEM Education and Training have made the latest COVID-19 research available in online collections of accepted, citable articles. These collections are being updated constantly, so be sure to check frequently for the latest COVID-19 research from SAEM journals: AEM Online COVID-19 Collection AEM E&T Online COVID-19 Collection

July AEM E&T EIC Pick: Front Line Perspectives on COVID-19 AEM Education and Training (AEM E&T) Interim Editor-in-Chief Wendy Coates, MD, selected a series of articles written in the first weeks of the declaration of the COVID-19 pandemic in the U.S. as her July issue “picks.” Introduced by an editorial, The 2020 COVID-19 Pandemic: Front Line Perspectives Through Different Lenses, the “perspectives” series reveals the motivations, inner fears, and insights across the spectrum of academic emergency medicine physicians, Dr. Coats shares her thoughts and observations regarding the selection of these papers in a commentary, The 2020 COVID-19 Pandemic: Front Line Perspectives Through Different Lenses.

SAEM RAMS COVID-19: The Basics for Medical Students and New Interns

The Latest AEM EIC Pick of the Month Commentaries...

For each issue of Academic Emergency Medicine journal, editor-in-chief Dr. Jeffrey Kline selects one paper as having particular importance to the experience of patients during times of emergency.

He shares his thoughts and observations regarding these selected studies in a regular “EIC Pick of the Month” commentary. Dr. Kline’s July and August commentaries are below: • All The Crap We’ve Learned • Diabolical Despot Defies Diagnosis

68

A new podcast from RAMS, COVID-19: The Basics for Medical Students and New Interns, outlines basic, need-toknow information on COVID-19 for medical students and new interns. Topics include epidemiology of the disease, its varied clinical presentation, testing, and available treatments. Interviewed are Dr. Larrisa May, a professor of emergency medicine at University of CaliforniaDavis where she focuses on infectious disease and antibiotic stewardship, and Dr. Jennifer Stahl, an assistant professor of emergency medicine and critical care at East Carolina University who has treated COVID-19 patients in both the emergency department and in ICUs.

SAEM ANNUAL MEETING Submission Platform for SAEM21 Didactics is Now Open

Didactic submissions are now being accepted for SAEM21. For submission guidelines, tips, best practices, and examples of previously accepted submissions visit the SAEM21 didactics webpage. Please note that the SAEM

Program Committee is especially seeking proposals for didactic sessions in the areas of pediatric emergency medicine research, teaching, and practice. Submit now.

Now Accepting Advanced EM Workshop Day Submissions

SAEM21 Advanced EM Workshop Day submissions now being accepted.

Authors are invited to submit original emergency medicine research of novel or in-depth topics related to academic emergency medicine in the following categories: Clinical Innovations, Communication, Gender and Bias, Research, Teaching, and Other. See “How to Get Attendees to Flock to Your Workshop” for tips and guidelines on writing your workshop submission description. Submit now.

SAEM20 Clinical Image Series:

The SAEM Clinical Image Series is a collaborative series with ALiEM (Academic Life in Emergency Medicine) and features participants in the SAEM Annual Meeting Clinical Images Exhibit.

Check out the images, read the case notes, and see if you can figure out the diagnosis before you reveal the answer.

The first three clinical Images from the SAEM20 virtual meeting are posted below; all images will be highlighted throughout the coming year in SAEM Weekly at the ALiEM website.

•T he Cocaine Gut •S evere Cutaneous Lesions in an Immunocompromised Host •F ound Down with Altered Mental Status

Visit the SAEM20 Virtual ePoster Gallery!

As part of the effort to provide SAEM members with SAEM20 Virtual Meeting content, the presenting authors of accepted ePoster abstracts have uploaded their content, including recorded presentations of their case studies, for online viewing convenience.

These digital posters are now available in the SAEM20 Virtual ePoster Gallery!

More Than 7,000 Register for SAEM/RAMS Virtual Residency & Fellowship Fair!

The SAEM/RAMS Residency & Fellowship Fair is an important event in the annual EM application cycle, giving institutions the opportunity to showcase their residency and fellowship programs to medical students and emergency medicine residents looking to find their perfect residency or fellowship. So when the in-person SAEM/RAMS Residency & Fellowship Fair was canceled this past May due to COVID-19, SAEM pivoted quickly to provide a free virtual event. Residents and medical students were able to register for as many sessions as their time allowed, and most took full advantage of the opportunity. Thanks to the convenient, virtual format many were able to fit several of the 50-minute sessions into their schedules throughout the July 27-30 event. Likewise, 104 institutions signed up for the event, with several registering for more than one slot. They used their allotted time in ways that best reflected their institutions and programs — from formal presentations and PowerPoints by program directors to informal video tours and Q & A time with the program’s residents. The response from the 6,000 + residents and medical students in attendance was overwhelmingly positive and grateful:

“…the residency and fellowship fair has been awesome! There are SO many cool programs!”

“These @SAEMOnline residency fairs are giving me life right now.”

“So thankful for SAEM and their virtual residency fair. I’m learning so much about all these wonderful residency programs.”

69

ACADEMIC ANNOUNCEMENTS University of Washington’s Dr. Kelli O’Laughlin Receives Grant for COVID Research Kelli O’Laughlin, MD, MPH, assistant professor of emergency medicine and global health at the University of Washington and president of SAEM’s Global Emergency Medicine Academy (GEMA) for SAEM, has received a grant from Elrha/R2HC to implement and evaluate an Interactive Kelli O’Laughlin Voice Response (IVR) telephone-based COVID-19 symptom and exposure surveillance survey among refugees in Uganda. The team will validate a prediction model with COVID-19 testing, assess knowledge and perceptions of risk and explore barriers and facilitators to risk mitigation strategy adoption among refugees living in Uganda. Funders: UK Government Department for International Development, Wellcome Trust, UK National Institute for Health Research.

Dr. Sheryl Heron Appointed to Leadership Position in Diversity, Equity, and Inclusion at Emory University Sheryl Heron, MD, MPH has been appointed to the role of associate dean for community engagement, equity and inclusion at Emory University. Dr. Heron is a professor of emergency medicine in the school of medicine. She is an editor of two textbooks addressing diversity and inclusion Sheryl Heron in quality patient care and is the recipient of numerous awards including the American College of Emergency Physician's 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 in the School of Medicine and the inaugural Excellence in Diversity and Inclusion award in the SOM. Her research interests include equity and inclusion in medicine, violence prevention, and wellness and well-being for the health care profession. Dr. Heron serves on the SAEM Wellness Committee and is a member of SAEM’s Academy for Diversity & Inclusion in Emergency Medicine and Academy for Women in Academic Emergency Medicine.

Dr. Kenton Anderson Promoted to Clinical Associate Professor of EM at Stanford

Kenton Anderson

enton Anderson, MD has been promoted K to clinical associate professor of emergency medicine at Stanford University School of Medicine. Director of the Stanford Emergency Ultrasound Fellowship and director of emergency medicine ultrasound research, Dr. Anderson also served as a research officer for the SAEM Academy of Emergency Ultrasound.

Stanford Professor Dr. Samuel Yang is Awarded $3.8 Million from NIH to Develop Sepsis Test Samuel Yang, MD, associate professor of emergency medicine at Stanford department of emergency medicine has been awarded a $3.8 million R01 grant from the National Institutes of Health as principal investigator (PI). His study, “Changing Cultures in Sepsis,” aims to develop an amplificationSamuel Yang free, microfluidic system for broad pathogen detection, identification, and antimicrobial susceptibility testing directly from whole blood in a short timeframe. This will be Dr. Yang’s second R01 grant as PI. This work will be in collaboration with Dr. Pak Kin Wong, PhD in the Dept of Biomedical Engineering at Penn State University.

Dr. Sebok-Syer Receives Grant From Edward J. Stemmler, MD, Medical Education Research Fund Stefanie Sebok-Syer, PhD, Stanford department of emergency medicine instructor, has received a two-year grant from the Edward J. Stemmler, MD, Medical Education Research Fund for a groundbreaking new project, “Conceptualizing and Assessing Interdependent Performance in Collaborative Stefanie Sebok-Syer Clinical Environments,” in partnership with Lorelei Lingard, PhD, professor in the department of medicine, Western University. Dr. Sebok-Syer is also a co-founder of Stanford’s Precision Education and Assessment Research Lab.

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, 2020 for the November/December 2020 issue.

70

Dr. Sarah Williams Completes Master of Health Professions Education Program at UIC Sarah R. Williams, MD, clinical professor of emergency medicine with the Stanford department of emergency medicine, has completed the Master of Health Professions Education (MHPE) at the University of Illinois, Chicago. MHPE is an educational leadership program for health professionals. Dr. Williams, Sarah R. Williams previously program director for the emergency medicine residency program, has been on faculty at Stanford since 2000. She was founding director of the emergency medicine ultrasound program at Stanford and co-runs the multidisciplinary Stanford clinical teaching program. Her current focus is building a novel coaching program and serving as specialty career advisor at Stanford School of Medicine.

Dr. Sara Krzyzaniak Named Director of Stanford Emergency Medicine Residency

Sara Krzyzaniak

Sara Krzyzaniak, MD, has been named director of the Stanford University emergency medicine residency program.

Prior to Stanford, Dr. Krzyzaniak served as associate program director for the University of Illinois College of Medicine at Peoria emergency medicine residency. As part of her international work, Dr. Krzyzaniak

helped develop a curriculum to improve care for acutely injured and ill children in regional hospitals in southern Vietnam. Her recent scholarly work focuses on gender issues in medicine, remediation of struggling learners, and medical education. Dr. Krzyzaniak is chief operating officer of the Academic Life in Emergency Medicine: Faculty Incubator.

Dr. Alex Manini is Awarded an RO1 Grant to Study Fentalog Overdoses Alex Manini, MD, MS, professor of emergency medicine at the Icahn School of Medicine in New York, has been awarded a five-year R01 grant from the National Institutes of Health (NIH/NIDA). The project, entitled "Predicting Medical Consequences of Novel Fentanyl Analog Overdose Using the Toxicology Alex Manini Investigators Consortium (ToxIC)" will utilize high volume geographically diverse ToxIC sites over the next 5 years to evaluate risk factors, treatment needs, and regional trends for fentalog overdoses. The project involves collaboration between his institution and the ToxIC national hospital network. Dr. Manini is also an attending physician in the emergency department at Elmhurst Hospital Center in Queens, New York and a clinician-scientist with a research focus on the emergency medical and cardiovascular consequences of drug overdose.

71

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

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

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

Vice Chair for Clinical Operations Department of Emergency Medicine The Department of Emergency Medicine at the Medical College of Wisconsin (MCW) seeks a visionary and highly-motivated board-certified Clinician Leader to join the Department as an Associate or Full Professor for the position of Vice Chair for Clinical Operations.

The Vice Chair will report directly to the System Chair of the Department of Emergency Medicine and be responsible for the development and implementation of strategic plans for the patient care mission of the Department in conjunction with Department Chair. The successful Vice Chair for Clinical Operations shall provide oversight, direction, and leadership for the clinical operations of all practices staffed by the Medical College of Wisconsin Department of Emergency Medicine.

Our Department maintains a thriving clinical practice including: Froedtert and MCW (F&MCW) Froedtert Hospital Emergency Department (level 1 adult trauma center); Children’s Wisconsin (level 1 pediatric trauma center); Clement J. Zablocki Veterans Affairs Medical Center Emergency Department; F&MCW Froedtert Moorland Reserve Health Center (free-standing) Emergency Department; F&MCW Froedtert Menomonee Falls Emergency Department; and a series of soon-toopen, community-based, neighborhood hospital Emergency Departments. Across this myriad of clinical practices, our faculty, fellows, residents, and advanced practice providers (APPs) care for more than 200,000 patient visits each year.

Our Department is home to a competitive training program of 36 residents, which attracts top-notch housestaff from medical schools across the nation. Many of our faculty members, fellows, residents, APPs, and staff are engaged in a host of extramurally-funded, cutting-edge, investigative research.

Inquiry in the areas of cardiac arrest and resuscitation, injury, EMS, and others have garnered MCW a reputation as an Emergency Medicine research powerhouse.

Successful candidates should be residency-trained and board-certified in Emergency Medicine by the ABEM. Desired qualities and skills include prior management and leadership experience at Service Chief or Medical Director level in an academic medical center. The candidate should have successful demonstration of operational improvements and innovations in clinical operations. The candidate should have documented academic accomplishments to be appointed at the Associate Professor or Professor level, with or without tenure, at the Medical College of Wisconsin.

 Please submit a CV, letter of interest, and a list of references to: Ian B.K. Martin, M.D., M.B.A., FACEP, FAAEM Professor with Tenure and System Chairman, Department of Emergency Medicine, Professor, Department of Medicine The Medical College of Wisconsin Medical School at imartin@mcw.edu.

The Medical College of Wisconsin is an equal employment opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.

72

Department of Emergency Medicine Northwestern University Feinberg School of Medicine Department of Emergency Medicine is currently recruiting for several different fellowship positions for 2021-2022 Visit us online at: https://www.feinberg.northwestern.edu/sites/emergencymed/

Clinical Operations & Administration Fellowship The two-year Admin Fellowship seeks emergency medicine residency trained physicians who wish to develop a career as operational and administrative leaders within EM. Fellows will work closely with departmental, hospital, and health system leaders as part of an immersive experience that provides practical skills in all aspects of clinical operations. Fellows will complete the MBA program at the prestigious Kellogg School of Management as part of their fellowship. The fellow will assume a leadership role within the operations team and participate in several projects supporting clinical operations.

Research Fellowship The two-year, SAEM-approved Research Fellowship seeks emergency medicine residency trained physicians who wish to become independent investigators and academic leaders with expertise in health services research.

Each trainee will have an individualized career development plan for the two years of fellowship and beyond. The training tasks of the program include research training leading to a Masters of Science in Health Services Research or equivalent and mentored research projects guided by methodologic and content experts.

Fellows will work closely with established EM investigators to develop their own research program, complete publishable projects, and submit a grant application during fellowship.

Medical Education Scholarship Fellowship The two-year, SAEM-approved Emergency Medicine Education Scholarship Fellowship provides comprehensive formal training in medical education scholarship and ample experiential opportunities to assimilate practical skills necessary for effective medical education leadership and administration.

Program graduates will be thought leaders in the field of medical education. Meet our current Medical Education Fellow by visiting the website here.

Follow Us:

For more information please contact:

Chelsea Harrison chelsea.harrison@northwestern.edu

73

Exciting opportunities at our growing organization • • • •

Emergency Medicine Faculty Positions Pediatric Emergency Medicine Faculty Positions Vice Chair, Clinical Operations 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 Pediatric 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: • Emergency Medicine trained physicians with additional training in any of the following: Toxicology, Ultrasound, Geriatric Medicine, Pediatric Emergency Medicine, Research • Completion of an accredited Residency Program.

• BE/BC by ABEM or ABOEM

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 family-friendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences.

We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC.

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.

74

THANK YOU for the remarkable work and sacrifices you are making during the COVID-19 pandemic.

You refused to indulge fear as you put the needs of others before your own.

Join our team

teamhealth.com/join or call 877.650.1218

75

Innovation - does joining a team that is re-imagining acute care delivery inspire and excite you? Impact - do you want to shape the future of healthcare? The Department of Emergency Medicine at The Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA continues to expand its faculty complement. Our team is revolutionizing the way emergency care is taught to our students, residents and faculty and how care is provided to patients. We have pioneered emergency telemedicine and design thinking in EM. We have nimbly integrated our diverse faculty and forward-looking enterprise to impact population health, emergency medical services, access to care, patient flow and clinical research. We are interested in emergency physicians that wish to be a part of a department that will contribute to the ongoing transformation of acute unscheduled care.

We have an extensive and robust clinical footprint, with the opportunity to practice across the acute care spectrum. We provide faculty and resident coverage at two emergency departments – TJUH (center city campus), a 700-bed academic quaternary-care, Level 1 trauma center that treats 73,000 patients annually, and the Methodist Hospital Division of TJUH, a 140-bed community hospital that treats 34,000 patients annually. Faculty also provide coverage at seven urgent care centers run by the department as well as the clinical decision unit (CDU) at Thomas Jefferson University Hospital and have the opportunity to provide on-demand direct-to-consumer through our Telehealth Program. Faculty will be responsible for patient care and bedside teaching of students and residents and will have the opportunity to develop their academic focus. Additional information on the department can be found at: http://www.jefferson.edu/university/jmc/departments/emergency_medicine.html We seek the following: Director of Emergency Medical Services The Director of EMS will be the forward-facing leader for prehospital care. This person will have a multifaceted mission with core responsibilities in EMS education, EMS outreach and EMS research. Additionally, they will work collaboratively with JeffSTAT (the ground and air-based program that moves patients across our 14-hospital enterprise). In doing so, there is opportunity for medical command and education at the JeffSTAT training center. This person will also represent Jefferson EMS locally, regionally and nationally while concurrently building relationships and bolstering Jefferson’s presence in these domains.

With Jefferson’s focus on innovation and care transformation in mind, specific touch points are working in partnerships with JeffSTAT and the city of Philadelphia to re-imagine prehospital care and safe inter-facility patient movement.

Clinical Faculty Clinical faculty provide patient care and bedside teaching of students and residents in the ED, clinical decision unit and urgent care. Additionally, clinical faculty have opportunities to become involved in administration, clinical operations, undergraduate and graduate medical education.

The Sidney Kimmel Medical College at Thomas Jefferson University values a diverse and inclusive community as it allows us to achieve our missions in patient care, education, and research and best allows us to serve the healthcare needs of the public. Thomas Jefferson University and Hospitals is an Equal Opportunity Employer. Jefferson values a diverse and inclusive community diversity and encourages applications from women, those underrepresented in medicine, Lesbian, Gay, Bisexual and Transgender (LGBT) individuals, disabled individuals, and veterans. Interested candidates are invited to send their curriculum vitae to: Bernard L. Lopez, MD, MS, CPE, FACEP, FAAEM Executive Vice Chair, Department of Emergency Medicine Bernard.lopez@jefferson.edu

76

VICECHAIR CHAIR OF OF RESEARCH VICE RESEARCH The Department of Emergency Medicine at Weill Cornell Medicine and NewYork- Presbyterian is seeking a dynamic The Department of Emergency Medicine at Weill Cornell Medicine and NewYork- Presbyterian is seeking a dynamic and visionary inaugural Vice Chair of Research for this rapidly growing department. The Vice Chair of Research will and visionary inaugural Vice Chair of Research for this rapidly growing department. The Vice Chair of Research will report directly to the Department Chair and will serve as a key member of the department’s leadership team. The reportindividual directly to the Department Chair will serve as a key member of mission the department’s leadership team. will provide leadership andand strategic oversight of the research for the Department, and its The individual will provide leadership and strategic oversight of the research mission for the Department, academic affiliates, including NewYork-Presbyterian Queens and NewYork-Presbyterian Brooklyn Methodistand its academic affiliates, including NewYork-Presbyterian Queens andand NewYork-Presbyterian Brooklyn Hospitals.

The current research portfolio totals several million dollars is expected to grow significantly overMethodist the next The few years.

Theresearch Vice Chairportfolio must be highly and entrepreneurial with demonstrated expertise in leading Hospitals. current totalsmotivated several million dollars and is expected to grow significantly over the research inclusion, equity, and collaboration are fundamental of the Department andleading next few years.initiatives.

The ViceDiversity, Chair must be highly motivated and entrepreneurial withprinciples demonstrated expertise in the initiatives.

Vice Chair ofDiversity, Research inclusion, will help toequity, promoteand these principles in are this fundamental leadership role.principles of the Department and research collaboration the Vice Research help to promote these in this leadership TheChair Vice of Chair will bewill an accomplished clinical andprinciples translational researcher with role. an MD or PhD in Emergency Medicine, Epidemiology, Global Health, Healthcare Delivery Science and Innovation, Health Services Research,

The Vice Chair will be or ana accomplished clinical andwill translational an MD or PhDenterprise, in Emergency Population Health, related field. This individual be skilled at researcher managing in with a complex academic Medicine, Epidemiology, Global Health, Healthcare Delivery Science and Innovation, Health Services have a strong vision for growth and focus on high impact research. He or she will have an outstanding recordResearch, of Population Health, or a related field.funding This individual willdevelopment, be skilled atand managing inresearch a complex academic enterprise, innovations, success in extramural and program publishing results in high impact have ajournals. strong vision for growth and focus onattained high impact research.

Heofor she willProfessor have anoroutstanding of The incoming Vice Chair will have the academic rank Associate Full Professorrecord at his/her institution. innovations, success in extramural funding and program development, and publishing research results in high impact journals. The incoming Vice Chair will have attained the academic rank of Associate Professor or Full Professor at This is an exciting opportunity for a dynamic and entrepreneurial leader who would like to have a broad national his/her institution. impact. The faculty in the department, and its affiliates, collaborate with local and national partners in cutting-edge scientific research funded by federal agencies, industry, and foundations. The Vice Chair will have full support of This isdepartmental, an exciting opportunity for a dynamic and entrepreneurial leader who would like to have a broad national hospital and Medical College leadership. Significant resources, including data and statistical and impact.

The faculty in the its affiliates, collaborate with local and national partners in cutting-edge analytical support, willdepartment, be allocated toand expand and diversify the department’s research portfolio.

scientific research funded by federal agencies, industry, and foundations. The Vice Chair will have full support of The Department hasand a highly dedicated faculty, comprisingSignificant of over 100 junior, mid-career, and senior with and departmental, hospital Medical College leadership. resources, including data members and statistical a diverse mix of clinical, research and educational interests.

The Department is a high volume, high acuity regional analytical support, will be allocated to expand and diversify the department’s research portfolio. trauma, burn and stroke center caring for more than 90,000 adult and pediatric patients. Clinical faculty also have

the opportunity work dedicated at our Newfaculty, York Presbyterian-Lower Manhattan Hospital ED campus, which members is a busy with The Department has atohighly comprising of over 100 junior, mid-career, and senior community hospital seeing 45,000 annual visits.

Total annual ED visits across both campuses and affiliates are more a diverse mix of clinical, research and educational interests. The Department is a high volume, high acuity regional than 375,000, which presents an ideal opportunity for research expansion and integration with innovative clinical trauma, burn and stroke center caring for more than 90,000 adult and pediatric patients. Clinical faculty also have efforts currently underway. the opportunity to work at our New York Presbyterian-Lower Manhattan Hospital ED campus, which is a busy community hospital seeing 45,000 annualisvisits.

Totalofannual ED visits across both campuses and Telemedicine, affiliates are more The Department’s research portfolio comprised programs in COVID-19 Pandemic Research, Medical Toxicology, Geriatric Medicine,for Wilderness Global Medicine, Simulation,clinical than 375,000, which presents anEmergency ideal opportunity researchMedicine, expansion andEmergency integration with innovative Ultrasound.

In addition, we offer fellowships in Geriatric Emergency Medicine, Healthcare Leadership and effortsand currently underway.

Management, Medical Education, Medical Simulation, Pediatric Emergency Medicine, as well as PA and NP residencies in Emergency Medicine. is comprised of programs in COVID-19 Pandemic Research, Telemedicine, The Department’s research portfolio

Medical Toxicology, Geriatric Emergency Medicine, Wilderness Medicine, Global Emergency Medicine, Simulation, For more information and/or to express interest please send a Curriculum Vitae and Cover Letter to: and Ultrasound. In addition, we offer fellowships in Geriatric Emergency Medicine, Healthcare Leadership and Management, Medical Education, Medical Simulation, Pediatric Emergency Medicine, as well as PA and NP Rahul Sharma, MD, MBA, FACEP Professor and Chair residencies in Emergency Medicine.

Department of Emergency Medicine, 525 E 68th Street, Box 179 New York, NY 10065 For more information and/or to express interest please send a Curriculum Vitae and Cover Letter to: (212) 746-0780 ras2022@med.cornell.edu Rahul Sharma, MD, MBA, FACEP

Professor and Chair

Weill Cornell Medicine/NewYork-Presbyterian are employers and educators recognized for valuing AA/EEO, th Street, Box 179 Department of Emergency Medicine, 525with E 68 Protected Veterans, and Individuals Disabilities.

New York, NY 10065 (212) 746-0780 ras2022@med.cornell.edu

Weill Cornell Medicine/NewYork-Presbyterian are employers and educators recognized for valuing AA/EEO, Protected Veterans, and Individuals with Disabilities.

77

The University of California, Davis School of Medicine, Department of Emergency

applications the 2021-2022 academic year forMedicine our TheMedicine Universitywelcomes of California, Davis Schoolfor of Medicine, Department of Emergency welcomes Researchfor in the Emergency Medicine Fellowship. applications 2021-2022 academic year for our Research in Emergency Medicine Fellowship.

WASHINGTON DC – The Department of Emergency Medicine at the George Washington University is offering Fellowship positions beginning July 2021:

The two-year, SAEM approved, UC Davis Research Fellowship combines

medicine research training with graduate level training for Thehands-on two-year, emergency SAEM approved, UC Davis Research Fellowship combines hands-on emergency medicine eithertraining a Masters Advanced Public of Health degree.

Theor Masters of research withofgraduate levelStudies trainingorforMasters either aof Masters Advanced Studies Department has consistently ranked the top 10 in NIH funding and several Public Health degree.

The Department hasinconsistently ranked in the top 10has in NIH funding and has NIH-funded mentors with variousemergency emergencycare care research several NIH-funded mentors withexpertise expertiseacross across various research topics. The topics. The is a founding member of PECARN and continues be are a a leader in Department is aDepartment founding member of PECARN and continues to be a leading site.toWe leading site.

We are leader will in multicenter The fellow will have access care research multicenter research.

Thea fellow have accessresearch. to participation in various emergency to participation in various emergency care research networks including PECARN, networks including PECARN, SIREN, PETAL, and StrokeNet. SIREN, PETAL, and StrokeNet.

UC Davis andDepartment the Department of Emergency Medicine are committed to nurture UC Davis and the of Emergency Medicine are committed to nurture merit, talent, and merit, talent, and achievement and support diversity and equal opportunity in achievement and support diversity and equal opportunity in all endeavors, including research and all endeavors, including research and creative activity. These commitments are creative activity. These commitments are based on the knowledge that excellence is derived from based on the knowledge that excellence is derived from engaging the richness engaging the richness of including multiple cultures includinggender race, ethnicity, sexual orientation, of multiple cultures race, ethnicity, identity, gender sexual identity, orientation, disabilities, national origin, and and religion, among otherother diversities.

The full and impact of our disabilities, national origin, religion, among diversities.

Thepotential full potential scholarship, teaching and learning, innovation, caninnovation, only be realized an environment and impact of our scholarship, teaching and andservice learning, and in service where equity, and inclusion are core principles. candiversity, only be realized in an environment where diversity, equity, and inclusion are

Clinical Research

Operations Research

Disaster & Operational Medicine

Simulation in Medical Education

Emergency Ultrasound

Sports Medicine

Health Policy

Telemedicine/Digital Health

International Emergency Medicine

Ultrasound for Family Medicine

Medical Leadership & Operations

Wilderness Medicine

Medical Toxicology

Wilderness & Telemedicine Combined Fellowship

core principles.

TheThe UC Davis Medical Center,Center, is a 625-bed academicacademic medical center, Level 1 trauma with more UC Davis Medical is a 625-bed medical center, Levelcenter 1 thantrauma 80,000center emergency visits annually.

In addition to thevisits Research Fellowship, the with department more than 80,000 emergency department annually.

In Department Medicine also hasthe clinical fellowships in Critical Care, addition of to Emergency the Research Fellowship, Department of available Emergency Medicine Education/Simulation, Emergency Airway Management, Medicine Services (ACGME), Health also has clinical fellowships available in Critical Emergency Care, Education/Simulation, Emergency AirwayGlobal Management, Emergency Medicine Services (ACGME), Health Most of our Policy, Global Health, Ultrasound, Geriatrics, Toxicology (ACGME), and Ultrasound.

Policy, Global Health, Global Ultrasound, Toxicology and non-ACGME fellowships offer a two-year option Geriatrics, that includes a master’s(ACGME), level degree.

Ultrasound. Most of our non-ACGME fellowships offer a two-year option that

includes a master’sshould level degree.

Interested candidates submit their curriculum vitae, the names of two referees, and a personal Interested candidates submit curriculum vitae,medicine the names of two statement (250-500 words)should describing your their interest in emergency research to: referees, andMD, a personal statement (250-500 Medicine, words) describing your interest Medicine, Daniel Nishijima, MAS, Professor of Emergency Department of Emergency in emergency medicine to: Daniel Nishijima, MD, MAS, Professor University of California, Davis. research dnishijima@ucdavis.edu of Emergency Medicine, Department of Emergency Medicine, University of California, Davis. dnishijima@ucdavis.edu

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

Emergency Medicine, Injury Prevention Center Faculty MD-MPH or PhD, Senior Scientist The Department of Emergency Medicine (EM) at the Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) seeks an academic faculty member, for our Injury Prevention Center (IPC). Applicants can be at the Assistant, Associate or Professor level, with IPC leadership opportunity for applicants with significant experience.

BMC is a level-one trauma center with an annual census of over 130,000, serving as Boston’s major safety net hospital. The Department of Emergency Medicine is an independent academic department within BUSM and BMC. The BMC ED is the medical control hub and academic base for Boston EMS. We seek candidates with a demonstrated record of injury prevention research to join and assume leadership roles in the IPC. The BMC IPC, founded in 2000, is an ED-based research, education, and advocacy collaborative with focus on opioid harm reduction interventions, violence intervention advocacy, traffic fatalities, youth concussion/brain injury, and older adult falls epidemiology and intervention. IPC personnel include PhD researchers and EM clinicians who collaborate closely with the BUSM Departments of Surgery, Pediatrics, Neurology, and Geriatrics, the Boston University School of Public Health, the Massachusetts Department of Public Health, and other regional and national injury research centers.

Successful candidates will have a MD, PhD, or equivalent degree, and will demonstrate a commitment to the training of EM residents and students and mentoring of junior faculty. Candidates may have expertise in one or more of the current IPC focus areas or in other areas of injury prevention. Preference will be given to applicants with a proven track record in injury prevention research and grant funding. The position comes with competitive salary commensurate with experience, an excellent benefits package, and a faculty appointment.

BMC/BUSM is an equal opportunity/affirmative employer. The BMC Department of Emergency Medicine is exceptionally committed to diversity and inclusion within our faculty and residents and welcomes applicants from diverse backgrounds.

For further information, contact: Jonathan Olshaker, MD Professor and Chair Department of Emergency Medicine Boston University School of Medicine Chief, Department of Emergency Medicine Boston Medical Center BCD Building, 1st Floor Boston, MA 02118 Email: olshaker@bu.edu

78

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

The University of California, Davis School of Medicine, Department of Emergency applications for the 2021-2022Department academic year for our Geriatric TheMedicine Universitywelcomes of California, Davis School of Medicine, of Emergency Medicine welcomes Emergency Medicine Fellowship. applications for the 2021-2022 academic year for our Research in Emergency Medicine Fellowship.

Care of the acutely ill older adult has components of clinical care, health systems design, interdisciplinary collaborations, and educational development; geriatric

The two-year, SAEM approved, UC Davis Research Fellowship combines hands-on emergency medicine emergency medicine is the most patient centered field in emergency medicine. research training withtograduate level for either Advanced Studies or Masters of Building systems better care for training older adults is one a ofMasters the mostofimportant outcomes Public Health degree.

The Department has consistently ranked in the top 10 in NIH funding and has of training in geriatric emergency medicine.

Geriatric Emergency Medicine fellows several NIH-funded mentors with expertise care research The will split their time between clinical workacross in the various ED, andemergency gaining expertise caring topics. for older ED is patients.

A research or quality improvement is included in a leader in Department a founding memberproject of PECARN and continues to beproject a leading site. We are the fellowship.

Travel national and geriatrics conferences is care research multicenter research.

Thetofellow will emergency have accessmedicine to participation in various emergency supported.

As aPECARN, health system, UC Davis expanding the clinical care offered to networks including SIREN, PETAL, andisStrokeNet. older patients in the health system and the community through the UC Davis Aging Initiative.

UC Davis and the Department of Emergency Medicine are committed to nurture merit, talent, and UC Davis and andsupport the Department of Emergency Medicine areendeavors, committedincluding to nurture achievement diversity and equal opportunity in all research and merit, talent, and achievement and support diversity and equal opportunity in all creative activity. These commitments are based on the knowledge that excellence is derived from endeavors, including research and creative activity. These commitments are based engaging richness that of multiple cultures including ethnicity, sexual orientation, on thethe knowledge excellence is derived fromrace, engaging the gender richnessidentity, of multiple disabilities, religion,gender amongidentity, other diversities.

The full potential and impact of our cultures national includingorigin, race,and ethnicity, sexual orientation, disabilities, scholarship, teaching learning, innovation, and service be realized in an environment national origin, andand religion, among other diversities.

Thecan fullonly potential and impact of our diversity, scholarship, teaching and learning, innovation, and service can only be realized in where equity, and inclusion are core principles. an environment where diversity, equity, and inclusion are core principles.

University of California, Medical Center, is a 625-bed medical TheThe UC Davis Medical Center, is Davis, a 625-bed academic medical center, academic Level 1 trauma center with more 1 trauma center with more than 80,000 emergency visits thancenter, 80,000Level emergency department visits annually.

In addition to the department Research Fellowship, the annually.

In addition to Geriatric Emergency Medicine, the Department of Emergency Department of Emergency Medicine also has clinical fellowships available in Critical Care, Medicine also has clinical Fellowships available in Critical Care, Education/Simulation, Education/Simulation, Emergency Airway Management, Emergency Medicine Services (ACGME), Health Emergency Airway Management, Emergency Medicine Services (ACGME), Health Policy, Global Health, Global Ultrasound, Geriatrics, Toxicology (ACGME), and Ultrasound. Most of our Policy, Global Health, Global Ultrasound, Research, Toxicology (ACGME), and non-ACGME fellowships offer a two-yearfellowships option thatoffer includes a master’s Ultrasound.

Most of our non-ACGME a two-year optionlevel thatdegree. includes a master’s level degree. Please see our departmental fellowship website for further

Interested submit their submit curriculum the names of the twonames referees, details. candidates Interested should candidates should theirvitae, curriculum vitae, of and a personal two referees, andwords) a personal statement describing yourresearch interest to: in statement (250-500 describing your (250-500 interest inwords) emergency medicine geriatric emergency medicine to: Geriatrics KatrenMedicine, Tyler MD Clinical Professor, Senior Medicine, Daniel Nishijima, MD, MAS, Professor of Emergency Department of Emergency Emergency Care Unit Physician Champion, Vice Chair for Faculty Development, University of California, Davis. dnishijima@ucdavis.edu Wellness and Outreach Department of Emergency Medicine University of California, Davis. krtyler@ucdavis.edu

The University of California, Davis is an Equal Opportunity / Affirmative Action Employer.

TheDepartment Department of Emergency MedicineGeneral at Massachusetts The of Emergency Medicine at Massachusetts Hospital is seeking candidates academic is faculty positions.

Candidates must have a commitment to General for Hospital seeking candidates for academic faculty excellence in clinical care and teaching; academic appointment will be at Harvard positions. have a commitment to excellence Medical SchoolCandidates at the instructor,must assistant professor or associate professor level. in clinical care and teaching; academic appointment will be at

MGH is the home of the 4-year MGH/BWH Harvard Affiliated Emergency Medicine HarvardProgram.

Medical atisthe instructor, Residency TheSchool ED at MGH a high volume, highassistant acuity level 1professor trauma and burn center caringprofessor for approximately 112,000 adult and pediatric patients annually. or associate level.

The successful will the join a4-year faculty ofMGH/BWH 50 academic emergency in MGH is thecandidate home of Harvardphysicians Affiliated a department with active research and teaching programs as well as fellowship Emergency Medicine Residency Program.

The ED atmedical MGH programs in administration, research, medical simulation, ultrasonography, education, wilderness medicine,level and disaster medicine. is a highgeriatrics, volume, high acuity 1 trauma and burn center

caring should for approximately adult pediatric Inquiries be accompanied by112,000 a curriculum vitae and and may submitted patients by email (Brown.david@mgh.harvard.edu) to: annually.

David M. Brown, MD candidate FACEP The F.successful will join a faculty of 50 academic MGH Trustees Professor & Chair emergency physicians in a department with active research Department of Emergency Medicine Founders 110 and teaching programs as well as fellowship programs in Massachusetts General Hospital administration, research, medical simulation, ultrasonography, Boston, Massachusetts 02114

medical education, geriatrics, wilderness medicine, and disaster medicine.

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

Inquiries should be accompanied by a curriculum vitae and may submitted by email (Brown.david@mgh.harvard.edu) to: David F. M. Brown, MD FACEP MGH Trustees Professor & Chair Department of Emergency Medicine Founders 110 Massachusetts General Hospital Boston, Massachusetts 02114 Massachusetts General Hospital is an equal opportunity/ affirmative action employer.

EXCITING ACADEMIC FELLOWSHIP OPPORTUNITY Health Inequities Fellowship in Emergency Medicine (DIEM) at University of EXCITING ACADEMIC FELLOWSHIP OPPORTUNITY EXCITING ACADEMIC FELLOWSHIP OPPORTUNITY Massachusetts-Baystate Medical Center Health Medicine(DIEM) (DIEM)atatUniversity University HealthInequities InequitiesFellowship Fellowship in in Emergency Emergency Medicine of of Trainees will: Massachusetts-Baystate Medical Center Center Massachusetts-Baystate Medical Trainees will: Trainees will: • Develop an understanding of the gaps in racial, ethnic, and sexual and gender minority inanemergency medicine Developan understanding the gaps gaps in racial, minority • • research Develop understanding ofof the racial, ethnic, ethnic, and andsexual sexualand andgender gender minority • Recognize to become active leaders in diversity and inclusion locally and researchinways inemergency emergency medicine research medicine Recognizeways waystotobecome become active active leaders leaders in • • nationally Recognize in diversity diversity and andinclusion inclusionlocally locallyand and nationally • Develop competency in instruction of medical students, residents, and faculty in the area nationally Develop competency instruction of medical medical students, residents, and in in thethe area racial, competency ethnic, and sexual and gender minority patients in emergency medicine • • of Develop inininstruction of students, residents, andfaculty faculty area of racial, ethnic, and sexual and gender minority patients in emergency medicine • Earn an advanced degree specialized certificate training the University of of racial, ethnic, and sexualorand gender minority patients infrom emergency medicine Earn advanced degree orspecialized specialized certificate training of of Medical School that will advance their skillsfrom • • Massachusetts Earn anan advanced degree or certificate training fromthe theUniversity University Massachusetts Medical School that will advance their skills Massachusetts Medical School that will advance their skills Application Requirements Application Requirements Application Requirements • Applicants must be graduating or have graduated from an accredited emergency • Applicants must be graduating or have graduated from an accredited emergency medicine residency • Applicants must be graduating or have graduated from an accredited emergency medicine residency • • Provide a letter three letters lettersofofrecommendation recommendation(including (including medicine residency Provide a letterofofinterest, interest,current current CV CV and and three a a from the residency director) • letter Provide a letter of interest, current CV and three letters of recommendation (including a letter from the residency director) letter from the residency director) Please Pleasesend sendApplication Application to: to: vanna.albert@baystatehealth.org vanna.albert@baystatehealth.org Please send Application to: vanna.albert@baystatehealth.org

79

Emergency Medicine, Injury Prevention Center Academic Faculty Position The Department of Emergency Medicine at the Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) seeks an academic faculty member for our Injury Prevention Center (IPC). Applicants can be at the Assistant, Associate or Professor level, with IPC leadership opportunity for applicants with significant experience.

BMC is a level-one trauma center with an annual census of over 130,000 ED visits, and serves as Boston’s major safety net hospital. The Department of Emergency Medicine is an independent academic department within BUSM and BMC. The department is home to Boston’s first EM residency, a nationally recognized PGY1-4 residency program as well as an ultrasound and EMS fellowship. The BMC ED is the medical control hub and academic base for Boston EMS. The BMC IPC, founded in 2010 is an ED based research, education and advocacy collaborative with a focus on opioid harm reduction interventions, violence intervention advocacy, traffic fatalities, youth concussive/brain injury, firearm injury, and older adult falls reduction research and interventions. IPC personnel include PhD researchers and EM physician scientists who collaborate closely with the Department of Surgery, Pediatrics and Geriatrics. We seek candidates with a demonstrated record of injury prevention research to join and assume leadership roles in the IPC. Successful candidates will be ABEM board certified/eligible and demonstrate a commitment to the training of EM residents and students, and mentoring of junior faculty. Candidates may have expertise in one or more of the current IPC focus areas or in other areas of injury prevention. Preference will be given to applicants with a proven track record in injury prevention research and grant funding. The position comes with competitive salary and title commensurate with experience, an excellent benefits package and a faculty appointment in the BUSM. BMC/BUSM is an equal opportunity/affirmative employer. The BMC Department of Emergency Medicine is exceptionally committed to diversity and inclusion within our faculty and residents, and welcomes applicants from diverse backgrounds.

For further information, contact: Jonathan Olshaker, MD Professor and Chair Department of Emergency Medicine Boston University School of Medicine Chief, Department of Emergency Medicine Boston Medical Center BCD Building, 1st Floor Boston, MA 02118 Email: olshaker@bu.edu

EM Jobs Now on SAEM Facebook Does your institution have an open position it’s looking to fill? Contact John Landry at 847-257-7224 or jlandry@saem.org to add your name to the career widget on our SAEM Facebook page. Job seekers: Click on “Careers” on the left-hand menu of SAEM’s Facebook page to view recently posted jobs in academic emergency medicine.

Free CV Critique Did you know that EM Job Link offers a free CV critique service to job seekers? As a job seeker, you have the option to request a CV evaluation from a writing expert. You can participate in this feature through the CV Management section of your account. Within 48 hours of opt-in, you will receive an evaluation outlining your strengths, weaknesses and suggestions to ensure you have the best chance of landing an interview.

Job Alert!

Are you looking for a job in academic emergency medicine? Create a personal job alert on EM Job Link so that new jobs matching your search criteria will be emailed directly to you. Make sure the perfect opportunity doesn’t pass you by. Sign up for job alerts today on EM Job Link by clicking on Job Seekers and then selecting Job Alerts. You will be notified as soon as the job you’re looking for is posted.

80

UCONN INTERNATIONAL DISASTER MEDICINE FELLOWSHIP Applications being accepted for July 2021!

This is a one or two-year (with MPH) SAEM approved fellowship for emergency medicine residency trained physicians. The fellowship uses milestone type progression to build austere medical skills, deployment readiness and personal resiliency. The program focuses on experiential learning, inoculation with various increasingly complex situations and deployments. Throughout the program the fellow will work clinically as an attending in the Emergency Department at UConn Health in Farmington, CT.

Qualified and interested candidates should contact James Gorman Jr. at 860-679-3486 or gorman@uchc.edu.

Vice Chair of System Integration: The Albany Med Health System is currently conducting a search for a Vice Chair of System Integration, a new position for our network. The candidate will oversee and coordinate emergency and urgent care services, operations, and EM Residency training for affiliate institutions within our system. The Regional Medical Directors will report to the Vice Chair of System Integration as part of an innovative, mission-driven system that provides cutting-edge and standardized, patient-centric care.

Our health system serves a community of nearly three million people and consists of three hospitals, fifteen urgent care centers, and over 14,000 employees. Continued growth and expansion are expected for the system.

Albany Medical Center is the hub of the hospital and urgent care network, comprised of the medical college and hospital. Founded in 1837, Albany Medical College is one of the nation's oldest medical schools. Albany Med is the region’s only Level 1 Trauma Center and is often the busiest trauma center in the state of New York. It is the referral center for 25 counties across Eastern New York State and Western New England Albany Med’s Emergency Medicine faculty have diverse interests with members fellowship trained in toxicology, clinical research, critical care medicine, pediatric emergency medicine, emergency medical services, ultrasound, and sports medicine.

Annually, the Albany Med Health System has over 150,000 emergency visits and more than 240,000 urgent care visits. Approximately 45% of emergency visits and 33% of urgent care visits are made to our affiliate hospitals, Columbia Memorial Hospital and Saratoga Hospital, and their urgent care sites.

The Vice Chair of System Integration will be responsible for developing state-of-the-art clinical care delivery as well as operational integration within the health system, initially focusing on our northern-based partner, the 171-bed Saratoga Hospital. This leader will also work to create and enhance Emergency Medicine training in our regional sites. The Vice Chair of System Integration will collaborate with and report to the Chair of Emergency Medicine to further the growth and expansion of emergency medical care within our network and the region.

The Vice Chair of System Integration will possess superior interpersonal skills with significant experience as a physician leader in order to execute this highly visible and strategic role. The ability to work collaboratively among the regional leaders is a must. Qualified applicants should hold an active MD/DO and be current in Emergency Medicine board certification. The applicant must be qualified for a faculty appointment within Albany Medical College’s Department of Emergency Medicine at the Associate or Professorial level.

Albany Medical Center is located in the capital of New York State, and with its affiliates, spans from the upper Hudson Valley to the foothills of the Adirondack Mountains.

This region of New York State offers larger city venues but with a small-town feel. It is home to many museums, music venues, theatres, beautiful architecture, thoroughbred horse racing, and restaurants, pubs and cafes. It also has easy access to the metropolitan areas of New York City, Boston, and Montreal. The region is a culturally and environmentally diverse area with an affordable cost of living, safe communities, excellent schools, and close proximity to the Adirondack, Berkshire, and Catskill Mountains, offering outdoor activities such as skiing, hiking, kayaking and climbing.

This is an extraordinary opportunity for a visionary physician executive to advance clinical care among the system’s emergency departments and urgent care centers.

Interested candidates should send a letter of interest and curriculum vitae to: Denis R. Pauzé MD, Chair Department of Emergency Medicine 43 New Scotland Avenue. MC-139 Albany, New York 12208 Email: Pauzed1@amc.edu Phone: 518-262-3773

81

THANK YOU To our brave and dedicated emergency physicians, nurses, and other medical staff who are on the front lines answering the call to care for the most vulnerable in our society during this time of great need.