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Didactics 2014

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2014 Annual Meeting Didactics


WEDNESDAY, MAY 14, 2014


DS001: Maximize Your Career Potential: Strategies to Increase Your Academic Productivity

Wednesday, May 14 - 8:00 am - 9:00 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to:
1. Identify strategies from the session that will increase their scholarly productivity,
2. List 3 strategies that will increase their potential for career advancement.

Description: Staying productive in research or other scholarly work is challenging for EM physicians, who often have many other personal and professional responsibilities competing for their time. However, career advancement in academic emergency medicine depends on scholarly productivity. Maintaining a successful publishing track record while balancing clinical shifts, educational responsibilities, and personal priorities requires planning and strategizing. We have many leaders in academic emergency medicine who have consistently maintained their productivity throughout their careers. In this session, junior and senior EM researchers will learn strategies from those who have been successful in our field. The session will be a 50-minute panel presentation with three panelists. There will be a brief introduction as well as a period for questions at the end. Each panelist will have 10 minutes to discuss strategies they use for maintaining their academic productivity. Examples of strategies may include building a supportive writing team, increasing productivity through collaboration with colleagues with similar interests, and building regular writing days into your clinical schedule.

Tracy Madsen. Alpert Medical School of Brown University, Providence, RI - Submitter

Esther Choo. Alpert Medical School of Brown University, Providence, RI - Presenter

David C. Cone. Yale School of Medicine, CT - Presenter

Lalena Yarris. Oregon Health and Science University, Portland, OR – Presenter



DS002: Emergency Department Discharges: Education-based Solutions to Address a Significant Patient Safety Issue

Wednesday, May 14 - 8:00 am - 9:00 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Describe the major threats to safety surrounding patient discharge processes in the emergency department. 2. Describe a training intervention that targets emergency department patient discharge processes. 3. List several mechanisms for evaluating the impact of a discharge-related training intervention.

Description: The process of discharging a patient from the emergency department presents a significant threat to patient safety due to patient-, hospital-, and practitioner-related factors. While this issue exists in other areas of health care, the dynamic, time-pressured, highly variable environment of the emergency department presents additional challenges and inhibits safety mechanisms demonstrated to be effective in other settings. Faculty will begin this session with a short interactive discussion to engage the audience. Faculty will query attendees about discharge practices and practitioner education in their institutions. Session leaders will present an overview of the discharge process literature, focusing on emergency medicine. They will specifically highlight patient-, environment-, and practitioner-related factors that are potential targets for discharge-related interventions. Faculty will present an educational intervention that targets all three (practitioner, patient, and environment) barriers to effective discharges. They will draw from both the communication and patient safety literature to support their approach and will present a mechanism to evaluate training effectiveness. They will end with a facilitated, interactive discussion focused on how to further this line of inquiry and create an educational agenda around discharge processes.

Fiona Gallahue. University of Washington, Seattle, WA – Submitter, Presenter

Amy E. Betz. University of Washington, WA - Presenter

H. Gene Hern. Alameda Health System - Highland, CA - Presenter



DS003: Fulfilling the Resident Scholarly Project Requirement: Solutions from Both Program and Research Directors

Wednesday, May 14 - 8:00 am - 9:00 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Define the resident scholarly activity requirement 2. Identify feasible resident research and academic projects. 2. Understand how departmental research infrastructures can be adapted to complete resident research and scholarly activities. 3. Increase their knowledge of how to overcome challenges assisting residents and faculty mentors in executing high-quality resident research and scholarly projects.

Description: Resident research and scholarly activity represent both a challenge and an opportunity for departments or divisions of emergency medicine. An important objective of emergency medicine residency programs is to educate residents on the mechanics of clinical research and other forms of scholarly activity. Participation in research and scholarly activity may inspire residents to pursue an academic career. However, meeting the scholarly activity requirement can be difficult for both residents and faculty. Residents may perceive the scholarly activity requirement as a burden with resultant output of little academic value. Faculty mentors may be diverted from working on their long-term career goals for which department resources are allocated. As a result, academic departments of emergency medicine may struggle to identify feasible projects, mentors and resources for resident research and scholarly activity.
Dr. Garmel will introduce the session by providing an overview of the resident scholarly requirement and how feasible projects can be identified, focusing on early mentorship of residents and pairing residents with faculty who share the resident’s career interest. Dr. Venkat will discuss how academic departments of emergency medicine can identify resources for resident research and scholarly activity, including how to adapt existing research infrastructures for this purpose. Dr. Baumann will conclude the course by outlining her department’s hybrid model of non-research and research scholarly activities. She will also provide examples of successful scholarly projects from residents who pursued community and academic careers and will discuss how to improve faculty and resident motivation.

Arvind Venkat. West Penn Allegheny Health System, Pittsburgh, PA - Submitter, Presenter

Brigitte M. Baumann. Cooper Medical School of Rowan University, NJ - Presenter

Gus M. Garmel. Stanford University School of Medicine, Kaiser Permanente, CA – Presenter

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DS004: "Teaching 101" for Young Educators

Wednesday, May 14 - 8:00 am - 9:00 am

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Establish a safe learning climate that promotes enthusiasm for learning and acknowledges a learner’s limitations. 2. Learn to control a teaching session utilizing their particular leadership/teaching style. 3. Learn to communicate clear expectations to help promote knowledge acquisition. 4. Learn how to teach content so that learners understand and retain the material in a more meaningful way.

Description: Educators are continuously charged to develop innovative approaches to enhance student learning. In fact, the ability to effectively educate others is one of the distinguishing features of an outstanding physician. Yet, many do so without any formal training or direction, making learning a trial-and-error process. Currently, the demand for highly skilled medical educators is ever increasing. As such, all educators must have a framework for teaching to ensure learners are learning and retaining what is taught to them. This workshop will address 4 aspects of teaching: learning climate, control of session, communication of goals, and promotion of understanding and retention. This workshop will provide skills to improve the interaction between the educator, the learner and the content being taught.

Nestor Rodriguez. University of Wisconsin, Madison, WI - Submitter, Presenter

Megan Cloutier. Emory University, GA - Presenter

Mary Westergaard. University of Wisconsin, WI – Presenter

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DS005: Early Care of Septic Shock: New Data and How Does it Fit?

Wednesday, May 14 - 8:00 am - 9:00 am

 Location: Dallas Ballroom D1

Objectives: At the completion of this session, participants should be able to: 1.Describe the most recent study goals, design, and observed outcomes. 2. List two strengths and two weaknesses of the recent study and results. 3. Identify at least one contrast and one common theme between all ED-based septic shock research studies. 4. Name at least two approaches to improving early septic shock care.

Description: A recently completed NIH-funded multi-site, ED-based RCT of early septic shock care released results. These data, along with those available over the past decade, bring into focus the key role of emergency care in improving outcomes of patients with septic shock. In this session, experts will review the current data and design, including limits; elicit expert opinion on the current evidence and the impact on care and on future research; and discuss the policy implications of the current knowledge base.

Donald M. Yealy. University of Pittsburgh, Pittsburgh, PA - Submitter, Presenter

Emanuel P. Rivers. Henry Ford Hospital, MI - Presenter

Stephen Trzeciak. Cooper Hospital/University Medical Center, Camden, NJ - Presenter

Alan Jones. University of Mississippi Medical Center, Jackson, MS - Presenter



DS006: Can We Improve Outcomes in Acute Heart Failure? 2014 Update on Acute Heart Failure Research

Wednesday, May 14 - 8:00 am - 9:00 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Understand the epidemiology of AHF related to the ED. 2. Describe both current and emerging biomarkers and therapies. 3. Describe potential alternative strategies to hospitalization. 4. Understand the role of the ED regarding national quality metrics. 5. Describe key unanswered research questions.

Description: This state-of-the-art session will focus on the pivotal role of emergency medicine in acute heart failure (AHF). The role of the ED regarding HF quality measures will also be discussed. New and emerging biomarkers, updates on emerging therapies along with novel strategies to reduce morbidity and mortality will also be presented. Key future hypotheses to advance the field will be discussed and debated.

Peter Pang. Northwestern University FSM, Chicago - Submitter, Presenter

Phillip Levy. Wayne State University, MI - Presenter

Sean Collins. Vanderbilt University, Nashville - Presenter

Gregory J. Fermann. University of Cincinnati, OH – Presenter



DS007: Stroke on the Fringes: Update on Management of Wake-Up Stroke, Rapidly Improving/Minor Strokes, and Thrombolysis in the Setting of Oral Anti-Coagulants

Wednesday, May 14 - 8:00 am - 9:00 am

Location: Dallas Ballroom D3

Objectives: Upon completion of this course, participants should be able to: 1. Define wake-up stroke, and summarize the present understanding of the pathophysiology of wake-up stroke 2. Define who may benefit from thrombolysis after wake-up stroke. 3. Define rapidly improving/minor stroke and summarize the present outcomes. 4. Describe the future direction of research for management of rapidly improving/minor stroke. 5. Summarize the different types of anticoagulants that the patients with acute ischemic stroke (AIS) may be on and their implication in the setting of thrombolysis.

Description: Intravenous thrombolytic therapy continues to be the only FDA-approved acute treatment available for patients with AIS. The goal of this session is to discuss three stroke syndromes that blur the indication for thrombolysis: 1) Wake-up Stroke, 2) Rapidly improving/minor strokes, and 3) Patients with AIS in the setting of oral anti-coagulants. “Wake-up Stroke” refers to patients who were normal when they went to bed, and subsequently awaken with findings of acute stroke. These patients have traditionally been challenging in terms of their eligibility, because of an undefined time of onset. New research suggests that the time of awakening may be considered the onset time of the stroke. The goal of this session will be to discuss wake-up stroke management, what the research indicates, and where the cutting-edge research is headed. Rapidly improving/minor strokes are defined as NIHSS < 5 or rapidly improving symptoms. Because these patients were initially excluded from the NINDS-tPA trial, information regarding efficacy and safety in these groups was limited. However, multiple studies have suggested poor outcomes for these patients. The goal of this session will be discuss the findings leading to the debate on optimal treatment in this setting, and current definitions and future research that may be able to answer this question. Patients with AIS in the setting of anticoagulation, especially with the new generation of anticoagulants, present another challenge to the bedside clinician in deciding on thrombolysis. The goal of this session will be to address the newer generation anticoagulants and the approach to management of these patients.

Pratik Doshi. University of Texas Health Science Center, Houston, Houston, TX - Submitter

Peter Panagos. Washington University, St Louis, MO - Presenter

Joshua Goldstein. Harvard Medical School, Boston, MA - Presenter

Laura Heitsch. Washington University, MO - Presenter

Edward Jauch. Medical University of South Carolina, Charleston, SC – Presenter



DS008: National Institutes of Health (NIH) Research Training Programs or How to Jumpstart a Research Career!

Wednesday, May 14 - 8:00 am - 9:00 am

Location: Houston Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Describe the organization of NIH and understand that many institutes support extramural research training programs. 2. Understand how NIH postdoctoral training mechanisms, fellowships, and early-career faculty awards help build independent research careers. 3. Describe opportunities for training on the NIH campus (NIH intramural training programs). 4. Recognize that a loan repayment program exists for some clinicians who pursue NIH research training.

Description: One of National Institutes of Health’s (NIH’s) critical missions is to ensure that there are scientists to meet this country’s biomedical research needs in the future. The goal of this session is to provide an overview of NIH and its training programs with emphasis on programs available to clinicians wishing to pursue scientific careers. Topics will include institutional postdoctoral training programs (T32 grants), as well as fellowship programs (F grants), and early career development awards (K grants). Training programs in the NIH intramural labs will also be discussed as well as NIH loan repayment programs that support scientists who study specific areas. And finally, the conversation will cover NIH online resources and personnel who are available to provide additional information as you start to investigate a research training program.

Jane D. Scott. NHLBI, NIH, Bethesda, MD - Submitter, Presenter



DS009: Not Another Boring Lecture!

Wednesday, May 14 - 8:00 am - 10:00 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. Recognize examples of less effective instruction. 2. Demonstrate a basic understanding of modern learning theories and their role in instructional design. 3. Employ new teaching tools effective for their environment.

Description: This session will challenge participants to branch out of their comfort zone by demonstrating and encouraging the use of modern instruction. Learners only retain 10-30% of what they hear in standard lectures, often because little attention is paid to learning theories and principles of instructional design that promote improved attention and knowledge retention. During the session, participants will participate in several methods of interactive teaching that demonstrate dynamic opportunities for the teacher to engage the learner. These will include cooperative learning, modified team-based learning, and computer-assisted learning. At the completion of the session, participants will be able to incorporate new teaching methods into their practice.

Meg Wolff. University of Michigan, MI - Submitter, Presenter

Amish Aghera. Maimonides Medical Center, Albert Einstein College, NY - Presenter

Steve Cico. Northwestern University Feinberg School of Medicine, Chicago, IL - Presenter

Sally Santen. University of Michigan, Ann Arbor, MI – Presenter



DS010: Emergency Medicine Websites: A Review, the Future and a “How-To” Guide

Wednesday, May 14 - 8:00 am - 10:00 am

Location: Seminar Theater

Objectives: At the completion of this session, participants should be able to: 1. Describe emergency medicine topic-specific public websites and resources. 2. Discuss goals and barriers to creating a website, blog, video/audiocast, or a social media feed. 3. Review goals, development and traffic details of redpod.org. 4. Provide a step-by-step guide for how to contribute to or create a web space with a limited budget.

Description: The volume of emergency medicine material available on the web has changed how we practice and how we teach. Individuals, residency programs and nonprofits are contributing greatly to this nexus of information. Join us for a review of how our community is contributing. We will summarize our own experiences with creating, composing, and sharing key concepts online for self-motivated learners (www.redpod.org). We will analyze the limitations and challenges we have faced, and how we have worked together as a multidisciplinary team to create a locally well-utilized website oriented toward the interests of our followers. For individuals interested in contributing to or creating their own website, blog, video/audiocast, or social media feed, we will discuss the key first steps to launching such a venture with a limited budget.

Oli Francis. University of Connecticut, CT - Submitter, Presenter

Lalaynya Dobrowolsky. Hartford Hospital, CT - Presenter

Gabrielle Jacknin. Memorial Hospital - University of Colorado Health, CO – Presenter

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DS011: Taking Your Academic Writing Skills to the Next Level: Tips from the Experts

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to use tools they have learned to improve their academic writing skills by more effectively communicating the outcomes of EM research to the research community, the media, and the public.

Description: Scholarly writing is a skill that is essential for EM researchers to master in order to effectively communicate the results of their work. Without high-quality academic writing, research in our field cannot be translated into recommendations for clinical practice or public policy changes, and the lay public will not learn about studies that may affect their health. In addition, career advancement in academic EM depends on physicians’ abilities to write and publish in a variety of formats. Furthermore, many EM physicians have never received any formal training in academic writing. The session will be a 50-minute panel presentation with three panelists. There will be a brief introduction and a brief period for questions at the end. Each panelist will focus on a specific area of academic writing and will have 12 minutes to communicate practical tools to help improve the quality of writing by EM researchers and clinicians. The three areas of focus will be research manuscripts, clinically oriented review articles in EM publications, and pieces written to communicate EM research to the media and/or lay public.

Tracy Madsen. Alpert Medical School of Brown University, Providence, RI – Submitter, Presenter

Deb Houry. Emory University School of Medicine, Atlanta, GA - Presenter

Kevin Klauer. Emergency Medicine Physicians, Canton, OH - Presenter

Christopher Carpenter. Washington University School of Medicine, St. Louis, MO – Presenter

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DS012: Diagnosing Dizziness – A Fresh Approach

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Understand the basis for and the intrinsic limitations of the traditional “symptom quality” diagnostic approach to dizziness. 2. Describe a new approach for the diagnosis of acutely dizzy patients based on symptom “timing and triggers.” 3. Apply targeted bedside eye examination tests to help reduce misdiagnosis of posterior circulation stroke. 4. List the limitations of brain imaging (both CT and MRI) in diagnosing dizzy patients.

Description: Two nationally known experts on neurological emergencies who have published cutting-edge research on the diagnosis of acutely dizzy patients in the emergency department (ED) will present a new diagnostic paradigm. This is not simply a discussion about how to diagnose the dizzy patient, but rather a critical review of up-to-date research that suggests the very foundation upon which we diagnose dizzy patients is faulty. Importantly, this is not just a session for trainees: even the most experienced clinician will be able to learn and implement this new diagnostic paradigm that has the potential to change practice and improve care. The moderator is Josh Goldstein. Jonathan A. Edlow will review the original study upon which the “symptom quality” diagnostic paradigm was based and recent research that undercuts the basic premises of the symptom quality approach. Dr. Edlow will present data that suggests that a new diagnostic paradigm based on dizziness “timing and triggers” and a bedside oculomotor exam is far more consistent with our current evidence base. David Newman-Toker will focus on solutions. Imaging can be misleading. CT is rarely the best test for a dizzy patient, and even MRI can miss up to 12% of posterior circulation strokes in the first 48 hours. Current evidence suggests that we can make more precise diagnoses using a targeted bedside exam, and ongoing research using video-goggles opens the possibility that soon, we may be able to automate the bedside oculomotor exam and have an “EKG of the eyes.”

Jonathan Edlow. Beth Israel Deaconess Medical Center, Boston, MA - Submitter

David Newman Toker. Johns Hopkins Medical School, Baltimore, MD - Presenter

Josh Goldstein. Massachusetts General Hospital, MA – Presenter



DS013: Community Paramedicine: A Novel Strategy to Decrease ED Crowding and Costs

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Describe the proportion of 911 dispatches and ambulance transports for non-emergent complaints, and the costs associated with this use of the EMS system. 2. Describe the goals, practices, and outcomes of existing community paramedicine programs. 3. Understand the effects of a community paramedicine program on ED crowding and ambulance diversion. 4. Explain the major research methodologies available for outcomes-based and cost-efficacy evaluation of community paramedicine programs.

Description: Many patients that access the EMS system and are transported to emergency departments could be managed at home or in lower-acuity settings. The Affordable Care Act creates opportunities for health care services research focusing on alternate prehospital delivery models that may be more efficient and effective for patients needing unscheduled but non-emergent care. While legislative or regulatory relief would be required in most states before implementation, one such model, community paramedicine, would expand paramedic scope of practice to include management and referral of appropriate patients without transport, or transport of patients to destinations other than emergency departments. If broadly implemented, community paramedicine could markedly decrease ED crowding. In addition, the model could create new career pathways for emergency physicians. Many have voiced concerns regarding paramedics’ ability to determine emergent vs. non-emergent patient presentations, and the ability of EMS systems to create, evaluate, and administer such programs safely and effectively. This didactic session uses brief presentations and a panel discussion by EMS leaders to explore data supporting development of community paramedicine, as well as current examples of existing projects. Additionally, it details select methodologies for program design and evaluation that may be successfully applied to this new field.

Shira Schlesinger. University of California, Irvine, Orange, CA - Submitter, Presenter

Mike Wilcox. St. Paul, MN - Presenter

Jeff Beeson. MedStar Mobile Healthcare, Dallas, TX - Presenter

Kristi L. Koenig. Center for Disaster Medical Sciences, University of California, Irvine, CA – Presenter



DS014: Establishing Your Niche: The First Five Years

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Establish a timeline of activities for the first five years of their career and develop a professional mission statement. 2. Identify the importance of mentoring relationships and their role in establishing such relationships. 3. Define the importance of establishing a career focus niche, and how to nurture required skills. 4. Describe the fine balance between universal faculty obligations and individual career development. 5. List general faculty development opportunities common across all departmental faculty.

Description: Entry-level and junior faculty members frequently encounter a perplexing workplace that may not overtly provide the guidance or tools to chart an organized faculty development and professional career pathway. There are many conflicting demands on newly hired faculty, and a reluctance to say “no” may further compromise career goals. Establishing a timeline for the first five years and developing a professional mission statement are extremely important tasks for junior faculty. Developing short-term and long-term SMART career goals is also of utmost importance. These topics and others will be discussed.

Carey Chisholm. Indiana University School of Medicine, Indiana University Indianapolis, IN - Submitter, Presenter

John Ma. Oregon Health and Science University, Portland, OR – Presenter



DS015: Mentorship in Emergency Medicine: From Near-Peers to Tiers

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Dallas Ballroom D1

Objectives: At the completion of this session, participants should be able to: 1. Describe the mentoring models that exist for medical students and residents. 2. List several benefits specific to residents in these mentorship relationships. 3. Describe the limitations to assigning mentors to mentees. 4. Describe the role of gender in mentorship.

Description: Mentorship is defined as a reciprocal relationship in a work environment between an advanced career incumbent (mentor) and a beginner (mentee) intended to promote professional development and career advancement. Despite the well-known benefits of mentorship, only 40% of medical students have identified a mentor. Additionally, formal mentoring programs for medical students and residents are lacking in most countries. That said, one of the barriers to the mentorship relationship, “finding a suitable mentor,” can be solved by starting a mentorship program. This session will feature two speakers and a panel of residents and students who have participated in mentorship programs. Two types of group-mentoring models, both involving students, residents and faculty, will be presented to participants. The structure of the mentorship relationships in both programs includes residents as mentors to students, providing unique benefits to all involved in the mentorship programs. Successes and failures in mentorship will be discussed. Pros and cons of group mentoring, gender-specific mentoring, and assigned mentoring will also be discussed.

Sarah Ronan-Bentle. University of Cincinnati, Cincinnati, OH - Submitter, Presenter

Nicholas Kman. The Ohio State University Dept. of Emergency Medicine, OH – Presenter



DS016: Exploring Traditional and Nontraditional Training Opportunities in Emergency Health Services Research

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. List the various graduate and post-doctoral training opportunities available in health services research. 2. Describe how a research training program is structured. 3. Describe how to locate and secure a fellowship with a tailored research experience, including working with program directors and department chairs. 4. Define the importance of mentorship, how to find a mentor, and how to build a mentorship team.

Course Description:

The complexity and costliness of US health care necessitates a cadre of trained researchers with the expertise to answer timely questions regarding the delivery and financing of the health care system.  Health services research (HSR) is a growing field that studies how social factors, financing systems, organizational structures and processes, and health behaviors affect access to health services, health outcomes, and the quality and cost of health care. Over the past decade, there has been an increase in training opportunities for HSR available to physicians. These programs include AHRQ-funded institutional training grants (T32), NIH-funded institutional grants for emergency research (K12), and the Robert Wood Johnson Clinical Scholars Program. Our goal is to provide participants with an overview of the types of traditional and nontraditional training opportunities in health services research and discuss how participants can obtain a tailored post-doctoral training experience that will lay the foundation for success in a career in health services research.  Topics to be covered will include the features of formal training programs, including, but not limited to, length, clinical work expectations, salary and service obligations, and publications and grants typical during and after a research fellowship. Emphasis will be placed on what to look for in a mentor and how to build a mentorship team.  In addition, we will discuss how to work with your department chair and mentors to create an individualized post-graduate training experience outside of a formal health services research fellowship. 

Amber Sabbatini. University of Michigan, Ann Arbor, MI - Submitter, Presenter

Esther Choo. Warren Alpert Medical School of Brown University, Providence, RI - Presenter

Brian Zink. Warren Alpert Medical School of Brown University, Providence, RI - Presenter



DS017: Where is the Evidence IV: The ABCs of Pediatric Respiratory Infections

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Dallas Ballroom D3

Objectives: At the completion of this session, participants should be able to: 1. Accurately stratify severity of illness in the ED for each respiratory illness in order to appropriately institute therapy. 2. Develop evidence-based ED treatment strategies for each of these common pediatric respiratory infections.

Description: Children with respiratory diseases frequently present to emergency departments. Asthma, bronchiolitis, and croup all pose unique challenges and clinical dilemmas for the emergency physician. Acute asthma requires intensive therapy and assessments, which can lead to prolonged ED length of stay and high admission rates. Bronchiolitis remains among the most difficult clinical entities to manage in the ED setting, owing to lack of efficacious therapies and the highly changeable nature of respiratory distress and hypoxemia. Croup, on the other hand, has known therapies that are effective, yet recognition of correct application of treatment in the ED setting is not always the rule. Treatment dilemmas remain for each of these commonly encountered respiratory infections. Accumulated evidence, including recent trials, has advanced our knowledge of asthma, bronchiolitis, and croup, and has permitted evidence-based approaches to their treatment in the ED. In this session, the up-to-date evidence for ED management of acute asthma, bronchiolitis, and croup will be presented, including synthesis of current literature for each condition. We will review the latest evidence-based approach and treatment for each respiratory illness, and discuss upcoming research and potential future ED interventions.

Rakesh Mistry. Children’s Hospital Colorado, Denver, CO - Submitter, Presenter

Richard Ruddy. Cincinnati Children's Hospital, OH - Presenter

Todd A. Florin. Cincinnati Children's Hospital Medical Center, OH – Presenter



DS018: Making the Leap to Research Independence: NIH Career Development Awards

Wednesday, May 14 - 9:00 am - 10:00 am

Location: Houston Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Describe the objectives of NIH individual career development awards. 2. Understand the differences between institutional (K12, KL2) awards and individual awards (K08/K23 award). 3. Understand how the awards help young faculty develop areas of research expertise 4. Identify why K awards are critical in developing research independence.

Description: The goal of the session will be to provide an overview of NIH Institutional Career Development Awards (K12, KL2) as well as the individual career development awards (K08, K23). The panel includes current and former K- awardees who are emergency medicine faculty. Investigators will discuss their experiences in applying for the K awards, the benefits of the award, and will comment on how the award helped them in their research careers. Panelists will include: former K08 awardee Lance Becker, MD, former K23 awardee Sean Collins, MD, MS and Jeffrey Glassberg, MD, MA, who is a recent K23 recipient.

Jane D. Scott. NHLBI, NIH, Bethesda, MD - Submitter, Presenter

Lance B. Becker. University of Pennsylvania Health System, Center for Resuscitation Science, PA - Presenter

Jeffrey A. Glassberg. Mount Sinai, New York, NY – Presenter



DS019: Innovations for Preventing Hospital Admissions and Readmissions

Wednesday, May 14 - 10:30 am - 11:30 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Discuss evidence-based alternatives to hospitalization from the ED focusing on clinical prediction rules and other criteria to guide decisions. 2) Explain novel strategies such as Hospital at Home and transitional care to reduce admissions. 3) Describe options for patients with uncertain follow-up.

Description: Emergency department utilization is increasing as the population ages, and a disproportionate number of older patients who present to emergency departments are admitted to the hospital. The reasons for this are varied, and include provider discomfort with discharge planning, insufficient coordination with outpatient providers, and perceived lack of support or resources at home. Hospital admission, particularly for older patients, is fraught with complications such as hospital-acquired infections, exacerbations of delirium, and falls, all of which are associated with significant morbidity and financial burden. Avoiding hospital admission and readmission is an attractive goal, as it may reduce these complications and lead to safer, more effective, and better-quality patient care. In this session, we will examine evidence-based alternatives to hospitalization from the ED, focusing on clinical prediction rules to guide decision-making, alternative strategies such as Hospital at Home, improving transitions in care to prevent unnecessary readmissions, and exploring options for patients with uncertain follow-up.

Marian Betz. University of Colorado School of Medicine, Aurora, CO - Submitter

Mary Tanski. Oregon Health and Science University, Portland, OR - Presenter

Jesse Pines. George Washington University School of Medicine, Washington, DC – Presenter



DS020: Developing an Effective Curriculum for Incorporating Ultrasound Education into the Gross Anatomy Course in Medical School

Wednesday, May 14 - 10:30 am - 11:30 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Discuss key components for developing a comprehensive ultrasound curriculum in gross anatomy. 2. Develop a systematic approach for incorporating basic and advanced ultrasound imaging applications into the gross anatomy course. 3. Describe effective methods of evaluating learner competencies. 4. Discuss challenges associated with program implementation. 5. Recognize the importance of collaboration with the gross anatomy instructor to accomplish the educational objectives.

Description: This course will provide participants with the necessary tools to develop effective ways of implementing a curriculum for incorporating ultrasound education into the medical school gross anatomy course.

The course content will include examples of curriculum documents used at the Wayne State University School of Medicine since 2006, and tips on developing more effective teaching methods using ultrasound to enhance the medical student’s understanding of gross anatomy. The course will also focus on developing appropriate and practical objectives for implementing a curriculum for teaching gross anatomy. Unique aspects of course implementation will also be discussed, including recruiting enough qualified instructors and how to develop student interest in ultrasound very early in the preclinical years. Participants will also learn about effective ways of evaluating medical student competencies in ultrasound image acquisition and interpretation, and how to partner with the gross anatomy professor to facilitate course implementation.

David Amponsah. Henry Ford Hospital, Detroit, MI - Submitter, Presenter

Mark Ireland. Wayne State University School of Medicine, Detroit, MI - Presenter

Julian Suszanski. Henry Ford Hospital, Detroit, MI - Presenter

Gregory Hays. Henry Ford Hospital, Detroit, MI - Presenter

Sudhir Baliga. Henry Ford Hospital, Detroit, MI – Presenter



DS021: Super Utilizers: Patient-Centered Care

Wednesday, May 14 - 10:30 am - 11:30 am

Location: Dallas Ballroom A3

Objectives: On completion of this session, participants should be able to: 1. Describe the utility of a patient-centered care committee for ED super utilizers. 2. Recognize the resources in their community to aid in the care of the super utilizer. 3. Explore the implications of super utilizers on the hospital. 4. Review ways to access community outreach and resources.

Description: The emergency department (ED) is packed, trauma patients are coming in by air and ground, and here comes James, stumbling in, for his third visit today. Call it what you may: “super utilizer,” “uber-user,” “population management,” or “complex case management,” EDs often serve as the super utilizer’s primary source for health care. This is an untenable situation: health care systems are attempting to improve quality of care, reduce costs, and provide EMTALA-mandated care while many other resources are still fragmented or inaccessible. The speaker will discuss the “complex case super utilizer” committee and its mission in a Level 1 urban-based trauma hospital. The speaker will review the resources and community outreach that have come together to champion this population and will review the steps to reduce use of the ED, decrease unnecessary admissions, support patients through community resources, and improve patient outcomes. The speaker will present several case-based experiences discussing complex case management with patient-centered plans for patients with chronic illnesses and will discuss how the super utilizers have acclimated to a community-based health care system. Finally, the speaker will describe the key components to assessing eligibility for enrollment services through federal, state, and community resources.

Ashlee Melendez. University of Louisville, Louisville, KY - Submitter, Presenter

Kirsten Rounds. Alpert Medical School of Brown University, Providence, RI - Presenter

Kenneth A. Marx. University of Florida, Gainesville, FL – Presenter



DS022: Improve Your Teaching by Debunking Education Myths: Evidence-based Teaching Workshop Using Articles That Will Change Your Teaching Practice

Wednesday, May 14 - 10:30 am - 11:30 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Explain several limitations associated with traditional teaching. 2. Discuss evidence for optimizing educational techniques from the teaching and learning literature. 3. Apply the evidence to develop strategies to change and improve their teaching practice.

Description: RATIONALE: In the same way that clinicians apply evidence-based changes to their practice, medical educators should use evidence-based conclusions from pedagogical literature and incorporate it into their teaching practice. CONTENT: This workshop will help participants translate evidence from some landmark education articles: 1) urban legends of learning styles; 2) multi-tasking and applications to teaching; 3) learning retention; and 4) technology and learning. Each year, this highly rated session incorporates the most recent literature to inspire changes in teaching practice. The evidence will be briefly presented; the participants will then divide up into small groups to plan learning or assessment exercises based on their own settings. The workshop will be highly interactive, requiring participants both to use the evidence and to apply it to their teaching, learning and assessment practices. The workshop will incorporate large- and small-group exercises to understand the concepts and to develop ways to improve each participant’s teaching skills. The participants will gain a better understanding of the available evidence for effective teaching and assessment, take home strategies for improving their teaching, and develop a plan for incorporating the evidence into their teaching practice.

Sally Santen. University of Michigan, Ann Arbor, MI - Submitter, Presenter

Susan E. Farrell. Partners Healthcare International, Harvard Medical School, Boston, MA - Presenter

Robin Hemphill. Veterans Association, Ann Arbor, MI - Presenter

Laura R. Hopson. University of Michigan, Ann Arbor, MI – Presenter



DS023: Bringing Sports Medicine to the Emergency Physician

Wednesday, May 14 - 10:30 am - 11:30 am

Location: Dallas Ballroom D3

Objectives: At the completion of this session, participants should be able to: 1. Recognize the growing demand for emergency care of athletic injuries and identify the unique challenges and opportunities involved in providing this care. 2. Understand the role of the emergency physician in advancing care through research and resident education in sports medicine. 3. Identify areas of scholarly concentration for the non-fellowship-trained emergency physician with an interest in sports medicine.

Description: While increasing numbers of emergency physicians are pursuing fellowship training in sports medicine, many more are staffing mass participation events, covering athletic sidelines, and facing sports medicine challenges in the emergency department. Management of sports-related concussion, injury prevention in youth sports, and sudden cardiac arrest in athletes are hot topics in the sports medicine community with particular relevance to emergency medicine. This session will highlight controversial clinical issues surrounding care of the athlete, opportunities for research and resident education, and recommendations for the emergency physician desiring greater involvement in sports medicine. Each speaker practices academic emergency medicine, clinical sports medicine, or team medicine in settings encompassing high school, college, and professional sports. Jeffrey Feden, MD, will provide a brief overview of controversies in sports medicine and their importance to the emergency physician (10 minutes). Moira Davenport, MD, associate EM residency director at Allegheny General Hospital and team physician for the Pittsburgh Pirates baseball team, will highlight opportunities for advancing concussion care through research and peer education (15 minutes). Anna Waterbrook, MD, associate fellowship director and team physician at the University of Arizona, will discuss methods to enhance EM resident education in orthopedics and sports medicine (10 minutes). The program will conclude with a collective review of practical considerations for the emergency physician interested in developing professionally in this growing field (10 minutes). A brief question-and-answer session will follow (5 minutes).

Jeffrey Feden. Alpert Medical School of Brown University, Providence, RI – Submitter, Presenter

Anna Waterbrook. University of Arizona, Tucson, AZ - Presenter

Moira Davenport. Allegheny General Hospital, Pittsburgh, PA – Presenter



DS024: Funding for EM Research Fellowships: NIH Post-Doc Institutional Training Grants (T32)

Wednesday, May 14 - 10:30 am - 11:30 am

Location: Houston Ballroom B                                                                                                                   

Objectives: At the completion of this session, participants should be able to: 1. Understand that NIH T32 training is a fundamental building block in developing research careers. 2. Describe how the NIH T32 postdoctoral training grants can be aligned in conjunction with EM fellowship programs. 3. Describe the attributes of successful T32 programs, and be better prepared to write a T32 grant application.

Description: The National Institutes of Health have a long history of funding Institutional Training Programs (T32 grants) that provide pre- and postdoctoral research training. T32 postdoctoral programs are frequently aligned with clinical fellowship programs and provide postdoctoral trainee stipends, tuition, travel, and training-related expenses. Most importantly, the stipends provide 90% protected time to pursue research. T32 training generally takes two or three years and is the foundation of a research career. Those who complete the training often go on to obtain NIH research career development awards (K awards) and NIH research funding (R01 grants). Currently there are more than 1,400 T32 programs funded nationwide. These are highly competitive five-year training grants. To date, emergency medicine has had very limited success in translating these fellowship guidelines into the T32 mechanism. Several years ago, the SAEM Fellowship Task Force established guidance for clinical and health services research EM fellowships. The Task Force recommendations addressed training length, protected time, courses, ethics, grant writing, publications, mentoring and metrics. The Fellowship criteria are clear, specific, and challenging, and the final result is that EM research fellowship requirements are now comparable to many T32 postdoctoral research training programs. The purpose of this session is to provide an overview of NIH T32 programs, explore how these training grants might benefit EM research fellowships, and discuss ways to maximize application success. Discussion will include program structure, leadership, mentoring, coursework and metrics of program success.

Jane D. Scott. NHLBI, NIH, Bethesda, MD - Submitter

Judd Hollander. University of Pennsylvania, Philadelphia, PA - Presenter

Cynthia D. Morris. Oregon Health & Science University, Portland, OR - Presenter

Douglas B. Sawyer. Vanderbilt K12 Program in Emergency Medicine, Nashville, TN - Presenter

Lynne D. Richardson. Icahn School of Medicine at Mount Sinai, New York, NY – Presenter



DS025: Home Treatment with Target-specific Anticoagulants (TSAs) for Patients with Venous Thromboembolism (VTE) Diagnosed in the Emergency Department

Wednesday, May 14 - 10:30 am - 12:30 pm

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. Describe how to initiate an outpatient treatment protocol for venous thromboembolism using TSAs in the emergency department. 2. Explain the barriers to and patient- and hospital-oriented implications of initiating this protocol.

Description: This session seeks to generalize a standard care protocol of home treatment for low-risk patients with VTE, including PE, with TSA agents. The workshop comprises three sessions: lecture, breakouts and summary. The lecture session will present the protocol and outcomes from one year of enrollment, and will cover three topics: Clinical and Operational, Economic, and Academic Advancement. 1) Clinical and operational topics: i. Risk stratification to select low-risk patients; ii. Pharmacology, access and adherence to NOAC therapy; iii. The mechanism for follow-up, including an EM-run clinic, what needs to be monitored and when; iv. Via Skype, live testimonial of opinions and preferences from VTE patients from our clinic, comparing this experience to “Coumadin clinic”; v. Operationalizing the protocol; and vi. Pitfalls and Setbacks. 2) Economics: i. Case-control cost data comparing our patients to matched controls treated with warfarin; ii. Economic value of this approach to patients and hospitals with under four hypothetical payer assumptions: Patient self-pay, Medicare, Medicaid, or private health insurance. 3) Academic advancement: i. Funding opportunities from industry, PCORI and CMS; ii. This model as a platform to train research fellows in the policy and science of expanded home treatment in emergency care. Participants will then break into small-group sessions (15-20/group) to discuss the approaches, barriers and questions from their perspectives, including issues unique to their institutions. Expected concerns include reversal protocols. In the summary session, all participants will review the themes of the breakout sessions and, as needed, ask questions of the organizers and the patient participant.

Jeffrey Kline. Indiana University School of Medicine, Indianapolis, IN - Submitter, Presenter

Daren M. Beam. Indiana University School of Medicine, Indianapolis, IN - Presenter

Zachary P. Kahler. Indiana University School of Medicine, Indianapolis, IN – Presenter



DS026: Leading Through Change: Becoming a Change Agent

Wednesday, May 14 - 10:30 am - 12:30 pm

Location: Dallas Ballroom B

Objectives: At the conclusion of this session, participants should be able to: 1. Identify the typical obstacles to promoting change within an organization. 2. List practical tools of change leadership that attendees can start exercising immediately. 3. Discuss techniques to manage individuals and create a culture of change.

Description: This session will provide participants with practical tools and advice by which to 1) establish “buy-in” with change, 2) understand the culture of a true learning organization, 3) uncover opportunities for successful interactions and positive change, 4) interact with and learn from SAEM leaders in a small-group setting. In the initial brief introduction, Drs. Blomkalns and Clyne will describe the obstacles met when leading change in an organization and identify key skills typical of successful change agents. The short introduction will be followed by facilitated roundtable discussions with SAEM leaders at individual tables. Roundtable participants in the past have included Alan Jones, Deb Houry, Brian Gibler, James Hoekstra, Cherri Hobgood, Kate Heilpern, Deb Diercks, Arthur Pancioli, Robert Hockberger and Brian Zink. An updated list for the 2014 meeting will be posted at registration.

Andra Blomkalns. University of Cincinnati, Cincinnati, OH - Submitter, Presenter

Brian Clyne. Alpert Medical School of Brown University, Providence, RI – Presenter



DS027: Principles of Medical Photography and the Use of Clinical Images in Medical Education

Wednesday, May 14 - 10:30 am - 12:30 pm

Location: Dallas Ballroom D1

Objectives: At the conclusion of this session, participants should be able to: 1. List the appropriate equipment needed for medical photography. 2. Describe proper photographic techniques for maximum image quality. 3. Review the use of medical imaging in teaching and clinical applications. 4. Practice utilizing newly learned photographic techniques.

Description: Medical photography is a powerful tool that can establish permanence of clinical teaching opportunities. In order to maximize the sharing experience and opportunities for learning from clinical photographs, the educator should strive to obtain medical images of the highest possible quality. This session consists of a series of short lectures addressing a) the essential equipment needed to produce excellent clinical images, b) the fundamentals of medical photography, including explanations of exposure, lighting, establishment of view, reproduction ratios, and management of distortion, c) the use of clinical images to augment teaching, and d) clinical applications of medical photography. Following the lecture segment, the faculty will teach a hands-on workshop so that participants can practice newly learned techniques. During the workshop, the faculty will use digital SLR cameras and projection equipment to demonstrate how proper technique generates high-quality images, as well as how improper technique may result in poorer-quality images. Participants are encouraged to bring their own personal digital SLR cameras, but cameras will be provided during the workshop for participants’ use.

R. Jason Thurman. Vanderbilt University, Nashville, TN - Submitter, Presenter

Suzanne Dooley-Hash. University of Michigan, Ann Arbor, MI - Presenter

Kevin Knoop. Naval Medical Center, Portsmouth, VA - Presenter

Lawrence Stack. Vanderbilt University, Nashville, TN – Presenter



DS028: Beyond Google: Information Mastery at the Point of Care in the Era of Evidence Syntheses: an E-classroom Experience

Wednesday, May 14 - 10:30 am - 12:30 pm

Location: Seminar Theater

Objectives: At the completion of this session, participants should be able to: 1. Harness the power of unique search engines designed to deliver concise and user-friendly evidence syntheses at the point of care. 2. Navigate and practice using such resources for purposes of emergency medicine decision-making.

Description: Single studies are rarely (if ever) the source of truth for what works in emergency medicine. The Institute of Medicine has made clear in its 2011 report that decision-making by clinicians and their patients should be informed by systematic reviews. Specifically, systematic reviews and high-quality clinical practice guidelines based upon them need to synthesize the totality of relevant clinical research, while mitigating the risks of bias in study design and execution - but where to find that research? Suitable electronic resources are often readily available to clinicians within their institution, as are sophisticated search engines that can facilitate timely access. However, knowledge and effective use of these resources are often limited. Using the unique e-classroom facility available at the SAEM conference hotel, participants will engage in a hands-on and practical problem-solving workshop that will highlight cutting-edge evidence-based search engines, e.g. the Trip database, MacPLUS Federated Search, and National Guidelines Clearinghouse. It will showcase online resources that serve as repositories for high-quality evidence syntheses. Specifically, participants will work from purposely designed clinical cases that highlight knowledge gaps and provide context for learning to use such resources. The session format will promote team learning and interactivity, while faculty will provide guidance and information on the online resources that will be explored. Participants will work from a single home-base webpage with links to high-impact resources that they will navigate to inform the management of critical problems in emergency care.

Eddy Lang. University of Calgary, Calgary, AB, Canada - Submitter

Peter Wyer. Columbia University, New York, NY - Presenter

Michael Brown. Michigan State University, Grand Rapids, MI - Presenter

Rawle Seupaul. University of Arkansas for Medical Sciences, Little Rock, AR – Presenter



DS029: Building a Geriatric Emergency Department Risk Stratification Toolbox: Evidence-Based Screening for Cognitive Impairment, Risk of Falls, and Functional Decline

Wednesday, May 14 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Understand the research methods and quality assessment of diagnostic or prognostic systematic reviews in geriatric emergency medicine. 2. Use systematic review methodology to find and incorporate valid, reliable emergency department appropriate instruments to screen older adult patient populations for dementia, delirium, fall-risk, and antecedent functional decline. 3. Develop strategies to overcome common barriers to widespread geriatric syndrome screening for these four conditions in the contemporary emergency department.

Christopher Carpenter. Washington University, St. Louis, MO - Submitter, Presenter

Timothy Platts-Mills. University of North Carolina at Chapel Hill, Chapel Hill, NC – Presenter



DS030: Development of Workplace-based Assessment Tools in the Emergency Department

Wednesday, May 14 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Understand the processes for developing workplace-based assessment tools. 2. Describe the concepts of reliability and validity of workplace-based assessment. 3. Identify potential difficulties with implementation of workplace-based assessments with respect to the ACGME EM milestones.

Description: Governing bodies in medical education, including the ACGME, are promoting the use of workplace-based evaluations to assess both competency and developmental milestones. Development of these tools is complicated by variations within ED workplaces. Knowledge of the concepts of workplace-based assessment and understanding of the variables to be assessed are the keys to successful evaluation development. This workshop will present a step-by-step method for developing a workplace-based assessment of trainees to meet these requirements, while taking into account specific training environmental factors. The concepts of validity and reliability of assessment tools will be presented and evaluated. Factors that influence these two concepts during tool development will be presented and discussed. Potential implementation difficulties when utilizing workplace-based direct assessments of the ACGME EM milestones will be considered. After the workshop, participants should have an understanding of the requirements for effective workplace-based assessment tools and an understanding of how to develop these tools for their own programs.

Thomas K. Swoboda. LSU Health Sciences Center, Shreveport, LA - Submitter, Presenter

Susan Promes. UCSF School of Medicine, San Francisco, CA - Presenter

Sally Santen. University of Michigan School of Medicine, Ann Arbor, MI – Presenter

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DS031: Ethical Issues in the Management of Potential Organ Donors in the Emergency Department

Wednesday, May 14 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Describe the organ donor management protocols in the emergency department. 2. Review ethical concerns in the areas of donor identification, referral and treatment associated with current methods of organ procurement. 3. Describe how ethical tensions in the management of potential organ donors can be overcome in the emergency department.

Description: Transplantation is a beneficial medical intervention for patients whose lives are threatened by organ failure. In the United States, the primary source of organ donation is patients who have been declared dead by either neurologic or cardiac criteria. The emergency department serves as a common point of entry for the presentation of individuals who are most likely to transition from being salvageable to being a potential organ donor. As a result, emergency physicians play a critical role in the identification, referral and treatment of patients who are potential organ donors. This course will provide an overview of how organ donor management can raise ethical concerns for emergency physicians and how these tensions can be resolved. Dr. Venkat will introduce the session by providing an overview of the current protocols for organ donation under neurologic and cardiac criteria and the role that emergency physicians play in their execution. Dr. Schears will discuss how these protocols can present ethical dilemmas for emergency physicians, with particular focus on the perceived transition of physician obligations from patient treatment to donor management. Dr. Michael will highlight the difficulties posed by the need for early patient referral to local organ procurement organizations and the logistical challenges of managing an organ donor in the emergency department under the current constraints of law and practice. Drs. Michael and Venkat will conclude the session by presenting a point-counterpoint analysis of how emergency physicians can resolve potential ethical dilemmas during identification, referral and treatment of organ donors in the emergency department.

Arvind Venkat. Allegheny Health Network, Pittsburgh, PA - Submitter, Presenter

Raquel Schears. Mayo Clinic, Rochester, MN - Presenter

Jeremy Simon. Columbia University, New York, NY – Presenter

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DS032: Is the Patient Safe? Assessing Procedural Competence

Wednesday, May 14 - 11:30 am - 12:30 pm

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Discuss the needs, benefits, and limitations of assessment of procedural competency. 2. Discuss the educational rationale behind assessment of skills. 3. Identify methods that optimize use of available resources to perform procedural assessment on trainees. 4. Develop a plan to implement an assessment of procedural skills in a variety of scenarios.

Description: Procedural skills involve a complex combination of cognitive and technical skills. The ACGME milestones and, potentially, conditions for maintenance of certification are increasingly requiring that learners and practitioners be formally assessed for procedural competency. In addition, assessment also provides an opportunity for feedback to enhance skill development. Both of these goals require use of effective and valid tools. This session will review the evidence supporting the use of various assessment modalities, including self-assessment, direct observation, use of non-physician evaluators, and simulation. It will also review available assessment tools such as the OSATS instrument. The session will cover issues related to determining the validity of an assessment and developing a toolbox. Through the use of case examples and small-group activities, participants will practice use of common assessment instruments and strategies for their implementation. Due to the interactive nature of the small-group sessions, additional facilitators will be employed for these sections of the workshop, including: Alyssa Bryant, MD; Jared Novack, MD; Cemal Sozener, MD; and Nikhil Theyyuni, MD.

Samantha Hauff. Unviersity of Michigan, Ann Arbor, MI - Submitter

Laura R. Hopson. University of Michigan, Ann Arbor, MI - Presenter

Douglas Ander. Emory University, Atlanta, GA - Presenter

Ernest Wang. NorthShore University Health System, Evanston, IL – Presenter



DS033: You took what??? Toxicologic Public Health Outbreaks: Lessons from Synthetic Cannabinoid, Bath Salt, and Acetyl Fentanyl Experiences of 2013

Wednesday, May 14 - 11:30 am - 12:30 pm

Location: Dallas Ballroom D3

Objectives: At the completion of this session, participants should be able to: 1. List resources available to ED providers concerned about an outbreak related to a new drug of abuse. 2. Describe the steps in identification of a new drug of abuse. 3. Identify the process of a public health response to an emerging toxicologic epidemic.

Description: Designer drugs of abuse (DOAs) and “legal” drug alternatives have become a significant public health issue over the past decade. Due to the nature of these agents, the initial presentation of cases is most often to EMS and emergency departments (EDs). ED providers are on the front lines when a community is confronted by a novel DOA. As such, we are placed in the difficult position of being expected to care for these cases while simultaneously assisting with efforts to identify the causative agent. 
How can EM physicians address this complicated public health problem? Emergency physicians need to be aware of their role in case identification, be familiar with the public health resources available, and understand how to collaborate with public health officials and law enforcement to best control the epidemic.

 
This session will bring together experts in emergency medicine, medical toxicology and public health. There will be two brief presentations discussing the novel DOA outbreaks in 2013: synthetic cannabinoids (SC), bath salts, and acetyl fentanyl. Dr. Andrew Monte will discuss the SC outbreak in Colorado and how local hospitals, law enforcement, the department of public health, and the CDC collaborated to identify the causative agent and minimize patient exposure. Dr. Edward Boyer will discuss the outbreaks of acetyl fentanyl in Rhode Island and bath salts in Boston, with emphasis on rapid identification by emergency physicians and forensic toxicologic investigation. Dr. Alvin Bronstein will supplement the panel with informal discussion of the National Poison Database System, public health resources, and the roles of the EM physician and toxicologist in surveillance. A discussion about the identification of the causative agents, how to facilitate cooperation between partners with different objectives and different time constraints, and what resources are available for EM physicians during an outbreak will follow. We will close with a panel question-and-answer session led by the moderator, with opportunities for audience participation.

Andrew Monte. University of Colorado, Aurora, CO - Submitter, Presenter

Alvin C. Bronstein. Rocky Mountain Poison & Drug Center, Denver, CO - Presenter

Edward Wright Boyer. University of Massachusetts School of Medicine, Worcester, MA - Presenter

Jason Hoppe. University of Colorado, Aurora, CO – Presenter



The Office of Emergency Care Research at NIH/Research and Career Development
Jeremy Brown, MD, Director, Office of Emergency Care Research

Wednesday, May 14 - 11:30 am - 12:30 pm

Location: Houston Ballroom B (Conf. Center - 3rd Floor)



The National Institutes of Health Office of Emergency Care Research (OECR) was created in 2012 in response to the collaborative efforts of the NIH, the Society for Academic Emergency Medicine, the American College of Emergency Physicians, and other stakeholders in the specialty of emergency medicine to develop a coordinated, trans-NIH approach to improving the nation’s emergency care system, in order to achieve greater efficiency, realize scientific opportunities and enable the rigorous training of new investigators, leading to significant, long-term benefits for patient outcomes and advances in the field of emergency care. This session will describe the work of the office and its goals, and outline a detailed portfolio analysis of NIH support for emergency medicine research.  The presentation will also describe opportunities for research support at NIH. 
One of NIH’s critical missions is to ensure that there are scientists to meet this country’s biomedical research needs in the future.  This session aims to provide an overview of OECR and how it interacts with other NIH institutes to develop research support and training opportunities for those wishing to pursue careers in emergency care research.  Topics will include research proposals as well as early career development awards (K grants). 
The intended audience for this session is faculty with an interest in developing research ideas that require NIH support, as well as residents, medical students, and others who want to understand the mechanism of NIH support for mentored research.



THURSDAY, MAY 15, 2014

DS034: Perception and Metacognition - Thinking About How You Think

Thursday, May 15 - 8:00 am - 9:00 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Describe how perception and cognition affect clinical decision-making. 1. Describe the use of specific cognitive forcing strategies to improve clinical decision-making.

Description: Both perception and cognition are neglected aspects of medical education and training. Yet both of these complex processes are critical to medical decision-making and providing high-quality medical care. In this session we will demonstrate (using examples from disparate fields such as film animation, basketball, various medical specialties, and interactive videos) limits to perception and how such limits affect medical decision-making. In the second half of the session, we will introduce and discuss metacognition – that is, thinking about how we think. Through the use of examples (from disparate fields such as competitive chess and trauma radiology), the audience will be introduced to the limitations of specific cognitive forcing strategies to assist clinicians in improving their medical decision-making.

Steve Bird. University of Massachusetts Medical School, Worcester, MA - Submitter, Presenter

Kavita Babu. University of Massachusetts Medical School, Worcester, MA - Presenter



DS035: Care of the Critically Ill, Morbidly Obese Patient

Thursday, May 15 - 8:00 am - 9:00 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. List key physiologic changes in the cardiovascular, respiratory and gastrointestinal systems of morbidly obese patients. 2. Recognize important differences in medication pharmacokinetics and pharmacodynamics in the morbidly obese patient. 3. Describe effective resuscitation interventions unique to the obese patient. 4. List relevant complications in obese patients presenting with traumatic injuries or burns.

Description: Obesity and morbid obesity are growing in prevalence in the North American population at an astounding rate. Estimates place 24.1% of Canadian adults and 35.9% of American adults as obese, and approximately 3% as morbidly obese. This patient population has important baseline physiologic changes to their cardiovascular, respiratory, and gastrointestinal systems that can have profound ramifications for clinical management. In addition, drug pharmacokinetics and pharmacodynamics can be dramatically altered in these patients for a multitude of reasons. In a lecture format, this presentation will provide important insight for clinicians into these physiologic and pharmacologic changes in the obese patient. Key learning points and techniques for patient resuscitation and management that have come from the recent anesthesia and critical care literature will be highlighted in a didactic and case-based format. Specifically, airway techniques, fluid resuscitation and pharmacologic principles unique to the obese patient will be highlighted. Clinicians will be guided through some of the finer points of management of the critically ill, morbidly obese patient, as well as areas of particular concern such as trauma and burn patients.

David Barbic. Sunnybrook Health Sciences Centre, Toronto, ON, Canada - Submitter, Presenter

Andra L. Blomkalns. University of Cincinnati, Cincinnati, OH – Presenter



DS036: The Impact of Civil Rights Law on Diversity and Disparity in the Emergency Department

Thursday, May 15 - 8:00 am - 9:00 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Define Title VI of the Civil Rights Act. 2. Discuss possible discriminatory actions under Title VI. 3. Describe how OCR can address disparities resulting from bias. 4. Partner with interdisciplinary teams when Title VI compliance issues arise. 5. Strengthen physician advocacy to raise awareness of health care disparities caused by discrimination/bias, in alignment with SAEM’s mission to “lead the advancement of emergency care through education and advocacy in academic emergency medicine.”

Description: While medical school students and residents are typically exposed to cutting-edge treatments and technologies, they are rarely made aware of federal civil rights laws that impact the institutions where they practice. To address this critical deficiency, the U.S. Department of Health & Human Services, Office for Civil Rights (OCR), collaborated with Stanford University School of Medicine and the National Consortium for Multicultural Education for Health Professionals (Consortium) in developing a curriculum focused on providing an educational framework for medical/health professionals to better understand and appreciate racial/national origin bias/discrimination. The curriculum has been most recently augmented and presented at the Emory University School of Medicine and the University of Colorado School of Medicine.

By introducing participants to potential racial/national origin bias/discrimination, the curriculum seeks to empower them to address these issues throughout their careers. After attending this session, participants should also be inspired to learn more about providing health care that reduces disparities and advances advocacy and communication across interdisciplinary groups.

Jason Liebzeit. Emory University, Atlanta, GA - Submitter, Presenter

Sheryl Heron. Emory University, Atlanta, GA - Presenter

Andrea Oliver. Office of Civil Rights, US Department of HHS, Denver, CO - Presenter

Jeffrey Druck. University of Colorado, Aurora, CO – Presenter



DS037: Ultrasound in Resource-limited Settings: Discussion of Use, Benefits, Research and Sustainable Program Design

Thursday, May 15 - 8:00 am - 9:00 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Describe the unique uses of ultrasound and findings of disease processes common in the developing world. 2. Understand trends and future directions in research involving ultrasound in the developing world. 3. List some of the unique challenges and key components for success in development of an ultrasound training program in limited-resource settings.

Description: Over the last few decades, emergency department ultrasound (US) has proven its tremendous clinical utility, making it the standard of care in emergency departments across the developed world. As the field of global emergency medicine continues to push further into resource-limited settings to meet the needs of an increasing unaddressed burden of acute disease, ultrasound is again proving to be of immense value. Standard emergency department US exams, such as the FAST exam, that have proven their utility in the developed world continue to show similar, if not increased, clinical utility in the resource-limited setting, with its limited access to advanced diagnostic imaging such as CT scanning. Given that the majority of the world’s population is low-income and resides in resource-poor locations, and that US is a relatively inexpensive technology that is becoming increasingly durable and portable, without the risks of ionizing radiation, there is a selective pressure to expand ultrasound training in the developing world, in addition to the variety of clinical indications for US globally. In this didactic, four experts with unique experience in global health and diagnostic ultrasound will discuss these novel training programs and uses of US, along with the research that has, and could, stem from these unique investigations. We will also discuss how the use of US in conjunction with local epidemiologic data can provide fertile areas of novel clinical applications and research. Lastly, we will describe tips for and traits of a sustainable US program in the resource-limited setting, including options for monitoring and evaluation.

Kristin Carmody. New York University School of Medicine, New York, NY - Submitter

Sachita Shah. University of Washington School of Medicine, Seattle, WA - Presenter

Stephen Dunlop. Hennepin County Medical Center, Minneapolis, MN - Presenter

Trish Henwood. Brigham and Women's Hospital, Harvard University, Boston, MA - Presenter

Adam C. Levine. Alpert Medical School of Brown University, Providence, RI – Presenter



DS038: "Shark Tank": Real-world Research Proposal Development

Thursday, May 15 - 8:00 am - 10:00 am

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to:1. Identify 5 critical elements and 4 basic structural components of a successful study proposal. 2. Describe, and avoid, 4 key mistakes made by junior researchers in study design and proposal. 3. Understand how to maximize the success of their own study proposals.

Description: A perennial issue for junior EM investigators is lack of guidance in, and experience with, the development and funding of initial small-scale study proposals. Many senior investigators believe that creating and getting funding for a research proposal is similar to the entrepreneurial process of developing and funding a business proposal. Drawing on the innovative and humorous format of the popular “Shark Tank” television show, this didactic’s panel of senior emergency medicine researchers will provide real-time guidance on this model of proposal development. The didactic will begin with a brief presentation on the 5 critical elements of a grant proposal. We will introduce the 4 basic structural components of a successful proposal: the concept (the unmet need); the plan (how they are going to solve it); the outcome (what the metric of success is); and the credentials (why we should “invest” in them). We will then offer junior researchers the chance to present their study ideas to our “Shark Tank” panel. (Proposals will be solicited in advance from the SAEM Research Fellowship Committee listserv; we will also save space for impromptu presentations from audience members.) Each proposal will be presented using a standard format. It will then be critiqued by panelists. For the most successful proposals, we will offer a true “investment” in the form of distance mentorship by panel members, as well as the opportunity to obtain priority review with Academic Emergency Medicine and/or Annals of Emergency Medicine.

Megan Ranney. Alpert Medical School of Brown University, Providence, RI - Submitter, Presenter

Judd Hollander. University of Pennsylvania, Philadelphia, PA - Presenter

Jeff Kline. Indiana University, Indianapolis, IN - Presenter

David Cone. Yale School of Medicine, New Haven, CT - Presenter

Debra Houry. Emory University, Atlanta, GA - Presenter

Donald M. Yealy. University of Pittsburgh, Pittsburgh, PA – Presenter



DS039: Rescuing the Learner Struggling with Clinical Reasoning: Can We Do It? How Do We Do It?

Thursday, May 15 - 8:00 am - 10:00 am

Location: Dallas Ballroom D1

Objectives: At the completion of this session, participants should be able to: 1. Diagnose and assess undergraduate and graduate medical education learners struggling with clinical reasoning skills. 2. Develop educational plans and remediation strategies using a framework to assist learners struggling with clinical reasoning. 3. Develop a list of best practices and possible tools for the identification, assessment, and remediation of learners struggling with clinical reasoning.

Description: The acquisition of clinical reasoning skills by physicians is central to undergraduate and graduate medical education, but how these skills are acquired, assessed and remediated in struggling learners represents an important challenge to medical educators. This workshop will introduce a framework to identify, assess, diagnose and remediate learners struggling with clinical reasoning difficulties. Presenters will address the difficulties for educators in identifying such learners and will provide a framework that both diagnoses the learner and suggests remediation strategies to pursue. The workshop will illustrate how the presenters have diagnosed and remediated these kinds of learners using the suggested framework and actual learner cases. Participants are asked to bring their own cases and any strategies for diagnosing or remediating them for discussion at the workshop. The session will conclude by compiling best practices of methods for the diagnosis and assessment of learners struggling with clinical reasoning as well as remediation strategies for medical educators seeking to assist them.

Todd Guth. University of Colorado, Anschutz Medical Campus, Aurora, CO - Submitter, Presenter

David Gordon. Duke University, Chapel Hill, NC - Presenter

Joshua Wallenstein. Emory University, Atlanta, GA – Presenter



DS040: Evidence-based Operations: Using Discrete-event Simulation to Enhance ED Operations Research

Thursday, May 15 - 9:00 am - 10:00 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Describe discrete event simulation (DES) and contrast its strengths and limitations with other methodological approaches. 2. Discuss how the use of DES can enhance the efficiency and performance of modern emergency-care systems. 3. Describe the steps necessary to build an effective and valid DES model of an emergency-care environment.

Description: Discrete event simulation (DES) is a well-established methodological approach to analyzing inefficiencies in operational practices, but to date DES has been infrequently applied to emergency care. DES is a means of modeling and visualizing ED processes and offers novel means to address difficult “what if” questions, such as: A) What is the most effective strategy to meet the latest core measure? B) What are the effects of two different strategies on patient waiting time? and C) If staffing resources are limited, where would we most effectively use those resources? Other statistical methods, such as regression modeling and queuing theory, cannot handle the complexities of highly variable patient flow experienced in the ED. DES offers significant advantages for ED operations research in its ability to evaluate alternative operational strategies and their effect on ED patient flow, prior to potentially expensive and hazardous process implementations. A team of emergency physicians with expertise in operations research and computer science will discuss how to effectively work with a modeler, necessary steps and common pitfalls in building robust models, and how to effectively use DES to enhance patient flow in your ED. Presenters will review prior research applying DES to ED environments, promising research opportunities using DES, and how to critically review reports of DES in the literature. Finally, presenters will describe first steps in developing such an enterprise, identifying partners within and beyond their home institutions.

Eric Goldlust. Alpert Medical School of Brown University/UEMF, Providence, RI - Submitter, Presenter

Nathan Hoot. University of Texas Health Science Center, Houston, TX - Presenter

Michael Ward. Vanderbilt University, Nashville, TN – Presenter



DS041: Teaching in the Wild: How to Teach and Assess Students and Residents in the Out-of-Hospital Setting

Thursday, May 15 - 9:00 am - 10:00 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to:1. Design and implement simulation and standardized patient-based educational programs for the out-of-hospital setting. 2. Develop and utilize assessment tools to evaluate individual skills and effective teamwork, with particular focus on assessment related to the ACGME’s Milestones project.

Description: This course will provide instruction on the development of educational programs for the purpose of teaching skills for the care of patients in resource-limited, austere, or out-of-hospital environments. The course will present the framework for scenario design utilizing standardized patients and high-fidelity manikins in the in-situ or simulation lab environment. Also, methods for didactic design for the “outside” locations will be presented. Additionally, this course will provide instruction on methods to teach individual skills, improvisational procedural skills, and teamwork training for resource-limited settings. The development and utilization of assessment tools will be discussed, with particular focus on incorporating EM-Milestones-focused assessment of cognitive and behavioral performance standards and procedural skills competencies into the traditional critical action checklists, behavioral ratings, and algorithm compliance ratings. Further, this course will delineate how scenario-based teaching can be used as a platform to instruct residents on educational theory and how to hone bedside teaching skills. Lastly, this course will discuss modified debriefing techniques and the utilization of portable technology for teaching and debriefing in the out-of-hospital setting.

Sanjey Gupta. New York Hospital Queens, Flushing, NY - Submitter, Presenter

Henderson D. McGinnis. Wake Forest Baptist Health, Winston-Salem, NC - Presenter

N. Stuart Harris. Massachusetts General Hospital, Boston, MA – Presenter



DS042: A CLER Plan: Implementing a Patient Safety Council for Residents and Fellows

Thursday, May 15 - 9:00 am - 10:00 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Describe CLER objectives. 2. Implement a resident- and fellow-driven Patient Safety Council to demonstrate trainee involvement in patient safety and quality improvement.

Description: In response to the Clinical Learning Environment Review program established by the ACGME, residencies and institutions will need to demonstrate their trainees’ engagement in patient safety and quality improvement. To accomplish these goals, the graduate medical office at Indiana University looked internally to the leaders of patient safety in resident education, the Emergency Medicine Residency Program. We established a Patient Safety Council, comprised of residents, fellows, faculty mentors, and hospital leaders, that is trainee-directed and driven. This group was based on the existing Emergency Medicine Committee established 9 years ago, still thriving today. In the first half of the session, we will briefly summarize the new GME landscape as a result of the ACGME 2011 updates, including the CLER initiative. We will then share the planning that successfully launched the Patient Safety Council, and how we maintain ownership by the residents while guiding the direction of the Council’s objectives through faculty advisors. We will also share current projects and long-term goals of the Council, and demonstrate how this Council has assisted our program in meeting the CLER objectives. The last half of the session will involve small-group discussion on QIPS activities ongoing at participants’ institutions, using guided question worksheet and scenarios to guide the table discussions and increase the potential for take-home learning, as well as brainstorming for potential resident projects and council objectives. Best practice sharing, responses to scenarios, and Q & A will be interactive and participatory.

Marie Vrablik. Indiana University, Indianapolis, IN - Submitter, Presenter

Carey Chisholm. Indiana University, Indianapolis, IN – Presenter



DS043: Catapulting to the Pinnacle of Best Evidence: Conducting a Systematic Review and Meta-Analysis to Jumpstart your Research Career

Thursday, May 15 - 9:00 am - 10:00 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. List the resources and mentorship team necessary to conduct a systematic review. 2. Select a research question and work with a medical librarian to design a database query. 3. Perform independent review, analyze results using statistical concepts of pooling and heterogeneity, and submit a manuscript report of the systematic review/meta-analysis. 4. Discuss the role of the systematic review in advancing a professional research career.

Description: Systematic reviews and meta-analyses have exploded in the medical literature since 2000, with almost 10,000 systematic reviews being published in the last 4 years alone. This specialized formal technique affords the reader a comprehensive answer to a clinical question, but conducting the review correctly requires specialized training and mentorship. This session will be led by two experts in systematic review methodology, and will focus on how to conduct and publish a first systematic review. At the end of the session, participants will be able to demonstrate how to build a team of collaborators, work with a medical librarian to formulate a rigorous database search, perform independent review, analyze results using statistical concepts of pooling and heterogeneity, and submit a manuscript developed using the guidelines of the PRISMA statement. Participants will be exposed to examples of both diagnostic and therapeutic reviews and should expect to be able to conduct a systematic review/meta-analysis with mentorship at the conclusion of this session. Presenters will use examples from their own experience in conducting systematic reviews/meta-analyses to highlight the strengths and pitfalls of these methods, and speakers will discuss the use of a systematic review and meta-analysis in advancing a professional research career.

Nicholas M. Mohr. University of Iowa Carver College of Medicine, Iowa City, IA - Submitter, Presenter

Christopher Carpenter. Washington University School of Medicine, St. Louis, MO - Presenter

Abel Wakai. Beaumont Hospital, Dublin, and Royal College of Surgeons in Ireland, Dublin, Ireland – Presenter

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DS044: Demystifying the American Board of Emergency Medicine's Maintenance of Certification Program

Thursday, May 15 - 10:30 am - 11:30 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Describe the components of the ABEM MOC program and how and when to complete them. 2. Analyze the evidence supporting the elements of the MOC program. 3. Be capable of designing a research project to evaluate if the MOC program can improve physician knowledge and improve patient and system outcomes.

Description: Select members of the ABEM Board of Directors will provide a brief history and rationale for the ABMS MOC program. They will then describe the current ABEM MOC requirements. This will be followed by a presentation of current evidence that supports MOC as it pertains to physician knowledge and improved patient and/or system outcomes. Finally, there will be an interactive discussion with the audience on strategies for developing research pertaining to MOC.

Terry Kowalenko. Beaumont Health System, Royal Oak, MI - Submitter, Presenter

Michael Carius. Norwalk Hospital, Norwalk, CT - Presenter

James H. Jones. Indiana University, Indianapolis, IN – Presenter



DS045: Generating Scholarship through Industry Partnerships

Thursday, May 15 - 10:30 am - 11:30 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. List ways to creatively partner with industry to accomplish academic goals. 2. Identify components of workflow for an industry-funded project. 3. Describe legal and ethical potential conflicts in partnering with industry. 4. Understand precepts to ensure industry partnerships result in legitimate scholarship.

Description: Emergency medicine researchers face many challenges when conducting research. Industry-funded research can be a means to accomplish research objectives. Such endeavors can be valuable components of academic EM research missions, but they also present unique challenges. These include approaches to access such funds, limitations on types of studies conducted, financial or legal implications of conducting such research, and issues related to academic freedom,such as publication rights, data ownership, patents and copyright. The purpose of this didactic is to discuss how to find and leverage industry relationships to accomplish academic goals, how to ensure such efforts result in legitimate scholarship, and how to manage such relationships to maintain integrity. In this session, a panel of researchers with experience working with industry will describe the general workflow of an industry-funded project, provide examples of successful investigator-initiated proposals, demonstrate how industry-initiated studies can lead to scholarship, explain how to navigate legal hurdles during the contracting process, and advise on how to maintain academic integrity during such research. Short presentations on each of these topics will alternate with panel input and discussion. Novice researchers and seasoned veterans alike should benefit from these presentations and discussion.

Alexander Limkakeng. Duke University, Durham, NC - Submitter, Presenter

Daniel J. Pallin. Brigham and Women's Hospital, Boston, MA - Presenter

Judd Hollander. University of Pennsylvania, Philadelphia, PA – Presenter



DS046: Research Methods for Studying Social Determinants of Health in Emergency Medicine

Thursday, May 15 - 10:30 am - 11:30 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Describe social determinants of health and their impact on emergency care. 2. Identify research modalities that can be used to study the social determinants of health impacts in emergency medicine. 3. Develop a research agenda that focuses on identifying the roots of disparities in emergency care.

Description: Healthy People 2020 has selected social determinants as a Leading Health Indicator in an effort to recognize that an individual or population’s environment plays a crucial role in influencing health outcomes. Additionally, policy makers, clinicians, and researchers have begun to analyze with a renewed focus the root causes of diseases in Americans. As the emergency department often provides the safety net for our health care system, emergency physicians have unique insight into the social causes of disease and are frequently afforded opportunities to study and monitor these effects. Health services and social science researchers have played an integral part in demonstrating the role of social determinants on health care utilization and access. With the implementation of the Patient Protection and Affordable Care Act (PPACA), emergency care researchers are leading the way in determining its impact on access to care. This didactic will enhance participants’ understanding of the social determinants of health, such as education, poverty, neighborhood environment, and race/ethnicity as they relate to emergency medicine, and how to scientifically study this area with appropriate methods, thereby exposing the root drivers of America’s health disparities. Panelists include leaders in health services research who will explain how their work highlights the impact that social determinants have on emergency medicine. The session will end with an audience-directed question-and-answer period.

Enesha Cobb. University of Michigan, Ann Arbor, MI - Submitter

Manya Newton. University of Michigan, Ann Arbor, MI - Presenter

Robert A. Lowe. Oregon Health and Science University, Portland, OR - Presenter

Lynne D. Richardson. Icahn School of Medicine at Mount Sinai, New York, NY – Presenter



DS047: How to Build a Career in Academic Wilderness Medicine

Thursday, May 15 - 10:30 am - 11:30 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Give a detailed description of steps needed to develop a robust and productive career as an academic emergency physician specializing in wilderness medicine. 2. Describe how the skill set of wilderness medicine can benefit other emergency medicine subspecialties (disaster, international, and ultrasound). 3. Recognize and avoid hazards to a productive research and teaching career.

Description: This workshop will give practical, concrete instruction on how to create a productive career as an academic emergency physician who specializes in wilderness medicine. It will be taught as a workshop by the leading faculty of nationally known wilderness medicine fellowship programs. We will describe detailed measures required to advance individual careers and the specialty of wilderness medicine within academic EM. Our “how-to” format will have three primary foci: 1) Developing clinical care skills; 2) Understanding strategies for successful teaching; and 3) Safeguarding a productive and rewarding research and teaching career. Our goal is to provide participants with practical knowledge so that they may develop an individualized road map to succeed in their careers. We will highlight how to build productive relationships within emergency medicine (with disaster, international, and ultrasound expertise) as well as with other specialties and experts.

N. Stuart Harris. Massachusetts General Hospital, Boston, MA - Submitter, Presenter

Tracy Cushing. Denver General Hospital, University of Colorado, Denver, CO – Presenter



DS048: Across Genders and Generations: Effective Feedback and Communication in Emergency Medicine

Thursday, May 15 - 10:30 am - 11:30 am

Location: Dallas Ballroom B

Objectives: At the conclusion of this session, participants should be able to: 1. Understand the importance of effective feedback on patient care and career satisfaction. 2. Identify gender and generational differences in feedback and conflict resolution. 3. Use provided strategies to overcome gender and generational barriers to effective communication and feedback. 4. Acknowledge that individuals equipped to recognize, appreciate and manage these differences will have an advantage in the modern workplace.

Description: Have you ever been reluctant to approach an older male physician with a patient care question because you just heard him swear at the EMR? Have you felt like you were walking a tightrope by giving feedback to a young female resident because you were worried that she may become visibly upset? Been approached by a medical student who is afraid to voice his or her response to an offensive comment made by another attending? Feedback and effective team communication are vital for reduction of medical errors, staff morale, patient satisfaction and professional development. Both can be challenging, especially given the potential misunderstandings surrounding gender and generational stereotypes and differences. This session will highlight a handful of common gender and generational differences, as well as personality traits that may affect effective team communication and feedback. The session will also provide the learner with tools to effectively identify and manage these gaps. The session will be a 50-minute moderated, case-based session that will discuss multiple scenarios in which there is a gender, generational, or personality mismatch between the evaluator’s and evaluatee’s perceptions and expectations. An expert panel consisting of gender, generation and feedback specialists will then elucidate the roots of these mismatches and provide concrete tips to help bridge differences and identify shared desired outcomes. Cases will then be “rerun” to model reframing and wording.

Tracy Madsen. Alpert Medical School of Brown University, Providence, RI - Submitter

Tracy G. Sanson. University of South Florida College of Medicine, Tampa, FL - Presenter

James G. Adams. Northwestern University Feinberg School of Medicine, Chicago, IL - Presenter

Jeannette Wolfe. Tufts University School of Medicine/Baystate, Springfield, MA – Presenter

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DS049: Achieving your Milestones Through Simulation

Thursday, May 15 - 10:30 am - 11:30 am

Location: Dallas Ballroom D1

Objectives: At the completion of this session, participants should be able to: 1. Describe a method of creating milestone-based simulation scenarios from existing scenarios 2. Describe the process for implementing a simulation-based assessment. a3. Determine the resources required for implementation at their particular institution.

Description: With the implementation of the Next Accreditation System this academic year, residency leadership is confronted with a challenge and an opportunity to drastically alter how residents are assessed. Specifically, all residents must be assessed using criterion-referenced milestones twice annually. Simulation is now widely used for education and formative feedback in emergency medicine residency programs, but there has been no prior experience with simulation for milestone-specific assessment. A group of simulation experts nationwide has endeavored to design, validate, and pilot scenarios and assessment tools to fill this gap. This session will begin with a presentation of a tool to convert existing simulation scenarios into robust milestone-linked assessment tools. Panelists will then discuss their experiences in implementing large-scale milestone assessments in their residency programs, with a focus on resource needs, faculty and resident buy-in, and logistical considerations.

Jeffrey Siegelman. Emory University, Atlanta, GA - Submitter

Eric A. Brown. Palmetto Health - USC School of Medicine Simulation Center, Columbia, SC - Presenter

Daniel G. Miller. University of Iowa, Iowa City, IA - Presenter

Danielle Hart. Hennepin County Medical Center, Minneapolis, MN - Presenter

Michael Beeson. Northeast Ohio Medical University, Akron, OH – Presenter



DS050: Advancing Your Career as an Educator

Thursday, May 15 - 10:30 am - 11:30 am

Location: Dallas Ballroom D2

Objectives: At the conclusion of this session, participants should be able to: 1. Describe two potential ways to turn their own educational activities into scholarship. 2. Describe how to increase research productivity through teams. 3. Identify which educational opportunities are the most high-yield for strengthening one's CV.

Description: Many medical educators spend the majority of their time on clinical education, often at the expense of other activities that would help them build a portfolio for promotion and/or advancement within their institution. The list of areas encouraged for promotion includes: clinical and didactic teaching, curriculum/assessment/evaluation development, leadership, mentorship, scholarly teaching, research/scholarship, service, awards and honors. How are educators to address these missions while continuing to excel in teaching? In this session, we will investigate how increasing productivity in these other areas will lead to successful career advancement and promotion. This workshop will be presented by the CORD Academy for Scholarship in Education in Emergency Medicine, whose members have been selected as national top-tier faculty in the areas of education scholarship, education leadership, teaching and evaluation, and enduring educational materials. The session will be highly interactive, requiring participants to call upon their own context, responsibilities and priorities. First, two academy members will deliver a short didactic presentation and introduce a large-group discussion. Anticipated topics will include turning an education into scholarship and other high-visibility projects, how to increase research productivity through teams, thinking about one’s teaching portfolio, and time management. Participants will then engage in facilitated small-group discussions with an Academy member to allow individualized mentoring, in order to plan individual increased productivity. Finally, each group will report out important lessons learned for the benefit of the large audience.

Nicole DeIorio. Oregon Health and Science University, Portland, OR - Submitter

Michael T. Fitch. Wake Forest School of Medicine, Winston-Salem, NC - Presenter

Sally Santen. University of Michigan, Ann Arbor, MI – Presenter



DS051: Medication Management: A Niche in Patient Safety for Emergency Physicians

Thursday, May 15 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A1

Objectives: At the end of this session, participants should be able to: 1. Define medication management (MM) and related terms. 2. Discuss knowledge gaps in MM in the academic medical center and ED and potential research needed to address these limitations. 3. Describe medication safety curricular needs for faculty, residents, nurses, and pharmacists, with a focus on how medication safety can be used to support faculty development in assessing and implementing important patient safety and quality concepts required by ACGME’s CLER program. 4. Identify opportunities to focus on ED MM as a career niche.

Description: Emergency physicians (EPs) are increasingly stakeholders in the process of safe and effective medication use (i.e., medication management, or MM) due to the expanding spectrum of medications used in the ED, drug shortages, use of high-alert medications (HAMs), and care of populations with high-risk co-morbid conditions. There are important means by which EPs can enhance the quality, safety, and efficiency of patient care while building a career in academic EM.

This session will be divided into three parts:
The first part will introduce the principles of MM, and describe how to advance a curriculum on medication safety specific to EM. Standard and innovative techniques should teach residents, faculty, nurses, and pharmacists about safe and appropriate use of HAMs, integration of new medications into clinical practice, drug shortages, conservative prescribing, and the epidemiology and management of adverse drug events (ADEs) and medication errors (MEs). This approach can be integrated into the training curriculum to highlight relevant tools, such as event reporting, root cause analysis, and team training, allowing a residency to meet the ACGME requirements to demonstrate proficiency in patient safety and quality improvement during CLER assessments.

The second part will describe the importance of active involvement in relevant medical center and departmental safety and quality efforts. This includes committee work, development of guidance for high-risk/uncommonly used medications, assessment and prevention of ADEs and MEs, and enhancing computerized order entry. We will also discuss how to incorporate a collaborative, multidisciplinary institutional and departmental focus on safety rounds, and explore opportunities for clinical pharmacists and mid-level providers to impact quality and safe medication use.

The last part will discuss the role of involvement outside of the medical center with local, state, and national groups that focus on quality and safety. This will include how developing a focus on MM can lead to academic success, satisfaction, and promotion.

Brenna Farmer. Weill-Cornell Medical College, New York, NY - Submitter, Presenter, Jeanmarie Perrone. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA – Presenter, Lewis Nelson. New York University School of Medicine, New York, NY – Presenter



DS052: Research Associates Programs: Making Them Better.

Thursday, May 15 - 11:30 am - 12:30 pm

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1.Understand the broader value of an EM research associates program (EMRAP) to support EM research activities. 2.Describe ways to address new/increased IRB requirements that impact RA programs. 3. Explain successful strategies for expanding the scope and effectiveness of EMRAPs. 4. List multiple best practices to incorporate into EMRAPs.

Description: Performing underfunded research in the emergency department is a challenge. Many emergency departments have developed research or academic associates (RA) programs, usually with undergraduate or recent postgraduate students as unpaid research assistants in the ED. The number of RA programs has grown substantially in the past 10 years. However, most existing RA programs are relatively small, many are struggling, and few take advantage of their full potential to support research activities. In this session, speakers with extensive experience in developing and running these programs will describe their best practices, insights and suggestions to creatively broaden the range of research activities in a program while also avoiding some of the pitfalls that may occur. Topics to be covered will include: meeting new IRB requirements that impact RA programs; negotiating sufficient support from your department; running the program with a positive financial balance sheet; structuring the program to minimize administrative demands on the faculty and staff; creative approaches to providing educational sessions; roles in assisting with industry-sponsored clinical trials; legal regulation pitfalls to avoid; and expanded RA roles beyond subject screening in the ED.

Edward Panacek. UC Davis, Sacramento, CA - Submitter

Judd Hollander. University of Pennsylvania, Philadelphia, PA - Presenter

Keith Bradley. St. Vincent's Hospital, Bridgeport, CT – Presenter



DS053: Point-of-Care Ultrasound for Pediatric Global Health: A 21st-Century Technology for Meeting the United Nations Millennium Development Goals for Decreasing Global Under-5 Mortality

Thursday, May 15 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Review the U.N. Millennium Development Goals for 2015. 2. Define how point-of-care ultrasound can help manage the leading causes of mortality and morbidity in children worldwide. 3. Discuss future directions for point-of-care ultrasound in global health.

Description: Pneumonia and diarrhea are the leading killers of the world's children under 5 years of age and are targets for the U.N. Millennium Development Goals for 2015. The World Health Organization estimates that over two-thirds of the world's population lacks access to any diagnostic imaging technologies, especially in developing countries in places such as sub-Saharan Africa and South Asia. Point-of-care ultrasound is a feasible and sustainable solution in addressing this worldwide disparity. This didactic will focus on point-of-care ultrasound applications that can be applied to the leading causes of mortality and morbidity in children worldwide. By addressing methods to overcoming barriers in settings that lack ultrasound-trained health care professionals as well as presenting technologies such as telemedicine and tele-ultrasound, workshop participants should be equipped with the knowledge and resources necessary to promote ultrasound in pediatric global health. Topics discussed will include: 1. Point-of-care Ultrasound: A Solution for the U.N. Millennium Development Goals. 2. Lung Ultrasound for Pneumonia and Acute Respiratory Illnesses. 3. Hemodynamic Assessment for Diarrhea and Sepsis: Cardiac and Inferior Vena Cava Ultrasound. 4. Ultrasound Assessment of Musculoskeletal Trauma: Extended Focused Assessment with Sonography in Trauma (eFAST) and MSK Ultrasound.

Kristin Carmody. New York University School of Medicine, New York, NY - Submitter

Joni Rabiner. Albert Einstein College of Medicine, Bronx, NY - Presenter

Lorraine Ng. Columbia University School of Medicine, New York, NY - Presenter

James Tsung. Mount Sinai School of Medicine, New York, NY – Presenter



DS054: Enhancing Emergency Medicine Training in Medical Schools and Developing Baseline Metrics for Milestones through Clinical Capstones

Thursday, May 15 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Recognize the value of medical school capstone courses as foundations for the ACGME Milestones while further expanding emergency medicine’s role in undergraduate medical education. 2. Articulate the key goals and objectives of a capstone course. 3. Provide examples of learner-centered approaches to enhance the effectiveness of capstone courses.

Description: There is no quantitative difference in the knowledge or skills of physicians-in-training on the last day of medical school and the first day of residency, yet their degree of responsibility is markedly different. Residents serve as problem-solvers and first responders for many emergencies that occur throughout the hospital, yet there is little guarantee trainees have adequate experience in dealing with common emergencies. Clinical capstones serve as an opportunity to address this gap in experience by reviewing high-yield clinical concepts that underlie emergencies commonly experienced by residents. While capstone courses demonstrate the practical application of emergency-medicine training outside the ED, they are also important opportunities to ensure learners are prepared to enter residency at Level 1 of the Milestones described in the Next Accreditation System by the ACGME. Capstone courses ideally serve as a multi-purpose tool to: 1) allow students to synthesize and apply major themes and learning points from their medical training; 2) offer an opportunity to remediate and address deficiencies; 3) provide an assessment of the learners’ readiness for residency; and 4) offer an evaluation of the overall medical school curriculum. Our workshop will introduce the concept of and evidence for clinical capstones while emphasizing resource creation and sharing among participants. We will describe curricular content around topics such as shock and resident wellness, along with innovative teaching modalities, including high- and low-fidelity simulation, case-based learning, and role-playing. Group discussions will highlight opportunities and challenges that are experienced in the design and implementation of capstones currently offered at several institutions.

Matthew Stull. University of Cincinnati College of Medicine, Cincinnati, OH – Submitter, Presenter

Susan M. Dunmire. University of Pittsburgh School of Medicine, Pittsburgh, PA - Presenter

Sarah Ronan-Bentle. University of Cincinnati College of Medicine, Cincinnati, OH – Presenter



DS055: Teaching Emergency Medicine Residents to Choose Wisely: Incorporating Cost-Conscious Practices into Training

Thursday, May 15 - 11:30 am - 12:30 pm

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Describe methods by which cost-conscious educational initiatives have been incorporated into medical training. 2. Describe barriers and potential solutions to incorporating cost-effectiveness education into resident training. 3. Identify emergency medicine practices for which adoption of more evidence-based cost-effective approaches would have greatest impact. 4. Describe how to assess knowledge retention and impact on clinical practice.

Description: As ED visits increase and account for a growing share of hospital admissions, strategies to contain emergency medical costs are increasingly important. Recent studies have shown that increased blood testing, IV medications, and radiography contribute to increased length of stay and ED crowding, which can be associated with adverse outcomes and higher rates of errors. Additionally, variation in hospital admission from the ED has been documented among emergency physicians. Incorporating evidence-based cost-conscious practices into residency training is important because of its potential to shape future practice patterns. The purpose of this didactic session is to help attendees understand how to incorporate education regarding cost-conscious care into their training programs. We will introduce examples of existing educational initiatives that have addressed this subject in emergency medicine and other specialties. We will examine barriers to implementation and potential solutions that address how these might be overcome. Finally, we will discuss assessment methods to evaluate the effectiveness of these educational initiatives. Dr. Schuur will moderate the session and give a brief overview of the imperative for cost-conscious care. Dr. Shah will discuss the Teaching Value Project and efforts to educate health care providers on costs across various medical specialties. Dr. Lin will discuss how to adapt evidence-based cost-conscious education to emergency medicine training, using the example of a curriculum that she introduced as a senior resident. There will be 10 minutes for questions.

Michelle Lin. Brigham and Women's Hospital, Boston, MA - Submitter, Presenter

Neel Shah. Beth Israel Deaconess Medical Center, Boston, MA - Presenter

Jeremiah Schuur. Brigham and Women's Hospital, Boston, MA – Presenter



DS056: Defining and Assessing Team Leadership in Emergency Medicine

Thursday, May 15 - 11:30 am - 12:30 pm

Location: Dallas Ballroom D1

Objectives: At the completion of this session, participants should be able to: 1. Describe the current status of team leadership assessment in emergency health care teams. 2. Understand how team science can be applied to leadership assessment in emergency health care teams. 3. Discuss the assessment of team leadership in terms of the current Accreditation Council for Graduate Medical Education (ACGME) milestones. 4. Identify where opportunities for team leadership assessment research might exist.

Description: Team leadership is critical to the effective performance of health care teams, especially those that function in highly variable, dynamic situations. Undergraduate and graduate medical educators recognize the need to assess leadership competency. However, while team leadership skills are represented within the current ACGME Milestones for Emergency Medicine, scientifically grounded mechanisms for assessment have not been clearly delineated. Faculty will begin this session by presenting the results of a comprehensive systematic review to highlight current practices in health care team leadership assessment. They will note gaps in knowledge and evidence, pointing out where research is needed to better define best practices. Faculty will examine the current ACGME Milestones and identify areas where leadership skills are combined with other components of trainee assessment. This will then be discussed from a measurement and assessment science perspective. Faculty will describe a leadership model and assessment framework that support the assessment of team leadership in health care teams, highlighting the potential for future research.

Rosemarie Fernandez. University of Washington, Seattle, WA - Submitter, Presenter

Elizabeth D. Rosenman. University of Washington, Seattle, WA - Presenter

Jeremy B. Branzetti. University of Washington, Seattle, WA – Presenter



DS057: The Value of Non-Accredited Fellowships for the Modern Academic Emergency Physician

Thursday, May 15 - 1:30 pm - 2:30 pm

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Identify the short-term pros and cons of pursuing non-accredited fellowship training. 2. Describe the impact of fellowship training on academic job prospects and future career goals. 3. Evaluate the various offerings included in non-accredited fellowship training and their impact upon fellow wellness and job satisfaction during fellowship and afterwards.

Description: Of the 31 fellowship opportunities listed in the SAEM catalog, only seven potentially result in board certification (Sports Medicine, Hyperbaric Medicine, Toxicology, Pediatric Emergency Medicine, Critical Care, Palliative Care, and EMS). The rest of the available experiences vary greatly in the length and breadth of training, protected time, salary, work hours, research support, and future opportunities for career development. Weighing the benefits of these offerings against the opportunity cost of reduced salary during training is daunting for the graduating or recently graduated resident. Each member of the panel has graduated from a non-accredited fellowship and is at a different stage in their career (immediate, two, three, and six years post fellowship) and will discuss their motivations in selecting training, the pros/cons of their decision, and how that decision has affected their academic career. Specific emphasis will be placed upon evaluating potential non-accredited fellowships and their offerings (i.e. salary, curricula, lengths of training, locations of training, off-service experiences, protected time, on-call requirements, shift obligations, work hours, benefits, advanced degree programs, research support).

Michael Kurz. Virginia Commonwealth University, Richmond, VA - Submitter, Presenter

Lauren Southerland. Ohio State University, Columbus, OH - Presenter

Deborah Kleiman. University of IL at Chicago, Chicago, IL - Presenter

Teresa Camp-Rogers. University of Texas at Houston, Houston,TX – Presenter



DS058: How (and Why) to Peer-Review a Manuscript

Thursday, May 15 - 1:30 pm - 2:30 pm

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Describe the role of peer review in the advancement of the scientific literature. 2. List four key components of a high-quality peer review. 3. Specify two ways in which performing peer review can contribute to professional development.

Description: Academic emergency physicians with scholarship experience and expertise are well-positioned to serve as peer reviewers for scientific journals. High-quality peer reviews help ensure the quality of the research that guides the clinical practice of emergency care, and can contribute to the professional development of the reviewer. This session will briefly review how peer review contributes to the advancement of the scientific literature, but will primarily focus on how to perform a useful peer review, using the Academic Emergency Medicine peer-review template as a guide. The attendee should leave the session with sufficient information to begin conducting peer reviews with minimal mentoring.

David Cone. Yale School of Medicine, New Haven, CT - Submitter, Presenter

Brian Hiestand. Wake Forest University School of Medicine, Winston-Salem, NC - Presenter



DS059: The Why, the What and the How of Developing “Physician as Educator” Programs for Medical Students and Residents

Thursday, May 15 - 1:30 pm - 2:30 pm

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Recognize the importance of the development of “physician as educator” programs for residents and students. 2. Identify the key modules to include in the development of a “physician as educator” curriculum. 3. Recognize the importance of providing opportunities for learners to practice their clinical teaching skills and receive feedback from experienced educators. 4. Discuss examples of successful “physician as educator” programs.

Description: The role of a physician as teacher is almost as important as his or her role as healer. The LCME and the ACGME require medical schools and residency programs to provide opportunities for both residents and medical students to develop themselves as educators. This interactive session seeks to discuss a rationale and impetus for developing “medical student as educator” and “resident as educator” programs, a suggested curriculum for topics that may provide the initial structure for these programs, and the logistical challenges in implementing such programs. In particular, medical educators must not only create a curriculum of topics, but also provide the supportive environment in which learners can successfully practice their teaching skills. Ideally, these experiences should be supervised by an experienced educator who provides meaningful feedback to the learner about their teaching. Presenters will solicit participants for their experiences with instituting “physician as educator” programs, highlight the successes and hurdles of developing these curricula at their institutions, and create a list of best practices among presenters and audience participants.

Todd Guth. University of Colorado, Anschutz Medical Campus, Aurora, CO - Submitter, Presenter

Sneha H. Shah. University of Massachusetts Medical School, Worcester, MA - Presenter

Michael Epter. University of Nevada, Las Vegas, NV - Presenter



DS060: The Affordable Care Act and Emergency Care: The Impact of ACOs and Other Shared-risk Models on the Quality, Cost, and Practice of Emergency Medicine

Thursday, May 15 - 1:30 pm - 3:30 pm

Location: Dallas Ballroom B

Objectives: At the completion of the session, participants should be able to: 1. Understand the impact of shared-risk models on the delivery of emergency care. 1. Define shared-risk models, accountable care organizations, and payment reform. 2. Conceptualize how quality and cost should be measured in emergency care. 3. Explore the implications of shared-risk models on the practice of emergency medicine.

Description: Shared-risk models are designed to distribute the risk of costs among several participants in an enterprise. The passage of the Patient Protection and Affordable Care Act has accelerated the development of accountable care organizations (ACOs), which involve risk-sharing between payers and providers in an effort to create financial incentives for high-value care. In particular, reimbursement for health services is evolving to pay for the quality of care instead of the quantity. This session will include a discussion of several aspects of health reform’s impact on the delivery of emergency care. We will first begin with an overview of shared-risk models, and ACOs in particular. We will then consider the role of emergency medicine in ACO quality measurement, specifically the effect of emergency care on current and potential ACO measures, and on balancing the need for targeted ED measures with ACO population measures. Next, we will focus on payment reform. The transition to ACOs and non-fee-for-service-based methods of payment will require a better understanding of both the cost of emergency care and the role the ED plays in reducing both ED and downstream health care expenditures. We will focus on the financing of emergency care, potential strategies for the reduction of costs associated with emergency care, and the unique role of the ED within global payment systems. Lastly, we will conclude by examining the impact of shared-risk models on the practice of emergency medicine. Specifically, we will address how these changes in health care delivery are relevant to emergency providers and researchers and discuss strategies for being proactive and not reactive to policy mandates that are likely forthcoming.

Keith Kocher. University of Michigan, Ann Arbor, MI - Submitter

Karin V. Rhodes. University of Pennsylvania, Philadelphia, PA - Presenter

David Nilasena. Centers for Medicare and Medicaid Services, Dallas, TX - Presenter

Adam Sharp. Kaiser Permanente Southern California, Pasadena, CA - Presenter

Timothy A. Peterson. University of Michigan, Ann Arbor, MI - Presenter

Arjun Venkatesh. RWJF Clinical Scholars Program/Yale School of Medicine, New Haven, CT - Presenter

Brent Asplin. Catholic Health Partners, Cincinnati, OH - Presenter

Peter Smulowitz. Beth Israel Deaconess Medical Center, Boston, MA – Presenter



DS061: PCORI Made Easy: An Insider's Guide to the Patient-Centered Outcomes Research Institute

Thursday, May 15 - 1:30 pm - 3:30 pm

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Define the mission and scope of PCORI. 2. Describe how an emergency care researcher can conduct patient-centered outcomes research. 3. Use PCORI methods and standards to win PCORI grants.

Description: The Patient-Centered Outcomes Research Institute (PCORI), a public research entity created by the Affordable Care Act, is a major source of funding now and for the foreseeable future for patient-oriented comparative effectiveness research. It has unique relevance for emergency care and emergency care research. Over $500 million in grants are expected to be distributed annually. Those who are interested in learning about PCORI opportunities must first understand the unique approach PCORI takes to funding and developing projects in this arena. This panel discussion will be an insider’s guide to the PCORI enterprise, featuring members of the grants review committee, an emergency medicine PCORI principal investigator, and patient advisors who have participated in the essential patient role in developing and executing PCORI projects. It will be moderated by an emergency physician who currently holds a contract to work with PCORI to enhance dissemination of PCOR standards. In accordance with PCORI's mission, it is essential for this didactic to include the perspectives of not just current investigators, but also reviewers and patients themselves. Zachary Meisel (moderator) will introduce the session with a “primer on PCORI methods and standards.” Erik P. Hess will speak on the “Nuts and Bolts of a Successful PCORI Grant.” Michel Demers and Annie LeBlanc will speak on the process of contributing patient and caregiver voices to PCORI research projects. Judd E. Hollander will compare and contrast the approaches to grant writing between PCORI and other funding sources. Deborah B. Diercks will speak on “What Really Goes on at PCORI Grants Review Sessions.”

Zachary Meisel. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA - Submitter

Erik P. Hess. Mayo Clinic, Rochester, MN - Presenter

Judd Hollander. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA - Presenter

Deborah Diercks. University of California at Davis, Sacramento, CA - Presenter

Michel Demers. Mayo Clinic, Rochester, MN - Presenter

Annie LeBlanc. Mayo Clinic, Rochester, MN – Presenter



DS062: Talking Your Way to a More Satisfied and Compliant Patient: How Can the Literature Help Us Refine Our Communication Skills?

Thursday, May 15 - 2:30 pm - 3:30 pm

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Discuss the barriers to effective communication that an ED provider can experience. 2. Explain key communication strategies that can enhance the patient-provider encounter. 3. Classify high-risk communication times and discuss strategies to maximize the chance of a good outcome. 4. Examine the available literature on ED provider communication and its effect on patient satisfaction and compliance.

Description: In an era of ED crowding, throughput measurements, and patient satisfaction scores, the conflict for providers between providing efficient, cost-effective care and still having satisfied patients has continued to grow. Provider time with the patient is short, and this session will focus on how to make the most of it. Providers at any level can take something away from this session. This didactic will cover the current state of the patient experience as documented in the literature. How much time do we spend with our patients? Do you know what patients expect when they come to see you? Is spending more time with the patient the only way to make them happy? What are the most important parts of a patient encounter, and how are we doing with them? Can you maximize them to help patients take better care of themselves when they leave? Are there high-yield communication times that should have focused training? The speakers will explore the literature available on these topics and discuss challenges, barriers for residents, and solutions for having a more effective patient encounter and a more satisfied patient.

Linda Regan. Johns Hopkins Medical Institutions, Baltimore, MD - Submitter, Presenter

Tina M. Latimer. Emergency Medicine Associates, P.A., P.C., Germantown, MD – Presenter



DS063: Predatory Journals: The Landscape of Peer-Reviewed Publication in the Open-Access Era

Thursday, May 15 - 2:30 pm - 3:30 pm

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Analyze the relative advantages and disadvantages of open-access publication. 2. Describe the definition of a predatory journal. 3. Take 3 steps to avoid being taken advantage of by predatory journals.

Description: Open-access journals have widely proliferated in the past several years. Originally, these journals were heralded as transforming the field of academic publishing, bringing scientific advances to a wide global audience. However, this publication model is facing new funding models, including “pay to publish,” in which revenue to support the journal comes from publication fees charged to authors, rather than from advertising, subscription fees, or society dues. A subset of open-access journals, the so-called “predatory journals,” exists only to make money from publication fees. They often have similar names as high-level academic journals, and solicit manuscripts through spam e-mail without disclosure of their fees. As discussed in a recent editorial in Annals of Emergency Medicine, these predatory journals are threatening the legitimacy of scientific publishing. How are academic societies and researchers to approach the open vs. classical publishing dilemma? Dr. David Cone will begin by discussing the state of open-access publishing in today’s academic landscape. He will provide his perspective on the market impact of open-access publishing, and will discuss publication strategies for researchers at various career stages. Jeffrey Beall, manager of “Beall’s List,” a frequently updated list of predatory journals, has presented his work internationally and is considered a world expert on the issue. He will discuss the impetus for establishing his list, review the methods used for determining which are journals are “predatory” and which are “legitimate,” and specify how to avoid becoming prey for these academically dishonest companies.

Andrew Monte. University of Colorado, Aurora, CO - Submitter, Presenter

David Cone. Yale School of Medicine, New Haven, CT - Presenter

Jeffrey Beall. University of Colorado Denver, Denver, CO – Presenter

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DS064: Policy Change 102: Public Scholarship for Emergency Physicians

Thursday, May 15 - 2:30 pm - 3:30 pm

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1.Define public scholarship and its role in emergency medicine. 2. Articulate how to get involved with the primary current formats for public scholarship: online op-eds, Twitter, and the blogosphere. 3. Design a plan for personal involvement in public scholarship, including a way to receive academic credit for one’s efforts.

Description: In “Policy Change 101,” we discussed the basics of health care policy and how emergency physicians can incorporate advocacy into their academic work. This year we will expand our discussion to focus on public scholarship, which will give our participants the skill sets needed to make their advocacy ideas a reality. Public opinion is increasingly shaped by non-traditional sources, such as online news magazines, blogs, and social networking sites (including Facebook and Twitter). Active involvement in these media through “public scholarship” therefore has the potential to have a huge impact on medical care, public health, and health care policy. Although many emergency physicians participate in online medical education discussions (“FOAMed”), fewer are actively involved in public scholarship. In this didactic, three emergency physicians who are actively involved in this novel form of scholarship will discuss ways that our specialty can contribute to the public discussion of critical health issues. We will begin with a discussion of the concept of public scholarship. We will then discuss the relative advantages and disadvantages of blogs (Radecki), Twitter (Ranney), and online Op-Eds (Houry) for disseminating research, influencing public opinion, and creating community dialogues. For each form of scholarship, we will provide an overview of the process for getting started in each medium; potential pitfalls; and ways to maximize one’s time spent. We will close with a question-and-answer panel discussion session. Throughout the session, we will live-tweet our discussion using the #SAEM14 hashtag, to increase wider EM community involvement in the discussion.

Lauren Hudak. Emory University School of Medicine, Atlanta, GA - Submitter

Megan Ranney. Alpert Medical School of Brown University, Providence, RI - Presenter

Debra Houry. Emory University School of Medicine, Atlanta, GA - Presenter

Ryan P. Radecki. Texas Health Science Center at Houston, Houston, TX – Presenter



DS065: Coping with Rejection in Research: Resiliency Strategies to Effectively Move Forward After a Setback

Thursday, May 15 - 4:00 pm - 5:00 pm

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Understand that rejection is a part of doing research. 2. Describe specific practical techniques for addressing reviewer comments and revising grant applications/manuscripts to maximize success. 3. Identify and adopt strategies to overcome psychological effects of academic rejection.

Description: All researchers face rejection at some point in their careers. One measure of a successful researcher is how he or she responds to these rejections. Moving forward after a rejection requires both psychological fortitude and a practical plan. The purpose of this didactic is to discuss ways to cope with rejection and specific practical techniques for moving a project forward after a setback. The discussion will focus on two main topics: 1) Practical aspects of moving a project forward after a rejection. Panelists will discuss how they have gone on to success after a grant or a manuscript was rejected, using specific examples from their careers. The discussion on grants will include: performing preliminary studies, revising a grant application in response to reviews, bringing on collaborators, and targeting a re-application to the goals of the funding agency. The discussion on manuscript preparation will describe how to read reviews constructively, incorporate comments (or not), write with reviewers in mind, and target a re-submission to the most appropriate journal. 2) Psychological aspects of coping with rejection. While the rejection of a grant or manuscript may reflect institutional priorities, finances, or other external factors, it is easy to view a rejection as a personal comment on one’s intelligence or promise as a researcher. Researchers may be tempted to abandon valuable projects rather than face the criticism of reviewers and the feeling of having “wasted time” on work that was not funded or accepted. This discussion will address ways to cope with these feelings, when to seek advice, and steps for moving forward.

Christopher Kabrhel. Massachusetts General Hospital, Harvard University, Boston, MA - Submitter, Presenter

Jeffrey Kline. Indiana University, Indianapolis, IN - Presenter

Mark Courtney. Northwestern University Hospital, Chicago, IL - Presenter

Judd Hollander. University of Pennsylvania, Philadelphia, PA – Presenter



DS066: Training Pathways for Educators: A Panel Discussion

Thursday, May 15 - 4:00 pm - 5:00 pm

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Compare the four pathways to obtaining formal training in health professions education. 2. Assess the utility of the various educational formats presented in relation to participants’ individual career goals. 3. Describe strategies for obtaining funding and protected time in order to complete a formal education program.

Description: While education is a core mission of all medical disciplines and is carried out on a daily basis both at the bedside and in the classroom, there has historically been a lack of emphasis on “teaching the teachers.” This panel will serve to highlight the options available to emergency physicians seeking formal training in leadership, educational theories and modalities, curriculum development and assessment, and education research. The panel will be comprised of EM physicians who are currently participating in or have recently completed the following education programs: Fellowship in Medical Education, Master’s in Healthcare Professions Education (MHPE), SAEM Education Fellowship Grant, and ACEP Teaching Fellowship. These members will speak about their career paths, the resources they used to attend formal education programs, as well as their personal experiences with these programs and how they relate to their academic goals and achievements.

Jo Anna Leuck. Carolinas Medical Center, Charlotte, NC - Submitter, Presenter

Sean M. Fox. Carolinas Medical Center, Charlotte, NC - Presenter

Samuel Clarke. UC Davis, Sacramento, CA - Presenter

Sorabh Khandelwal. The Ohio State University, Columbus, OH - Presenter



DS067: From Twitter to Tenure: Use of Social Media to Advance Your Academic Career

Thursday, May 15 - 4:00 pm - 5:00 pm

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Describe how social media can fulfill academic responsibilities and relate to their institution’s promotion/tenure requirements. 2. List ways social media can lead to career advancement opportunities, including program, institutional, local, and national levels. 3. Explain opportunities for social media-related research and collaboration.

Description: Social media has grown in popularity and has become an engaging tool for educators, trainees, and researchers; however, many participants are concerned that their academic activities on blogs, Twitter and podcasts may not earn the same regard and appreciation from promotion committees as traditional forms of scholarship. The panelists will discuss how their work in social media has advanced their academic careers, in part by leading to traditional measures of accomplishment such as committee positions, speaking opportunities and publications. Presenters will also discuss how advancement is possible thanks to the increasing adoption of modern, progressive definitions of influence and audience.

Jason Nomura. Christiana Care Health System, Newark, DE - Submitter, Presenter

Michelle Lin. University of California San Francisco, San Francisco, CA - Presenter

Nicholas Genes. Icahn School of Medicine at Mount Sinai, New York, NY - Presenter

Robert R. Cooney. Conemaugh Memorial Medical Center, Johnstown, PA – Presenter


FRIDAY, MAY 16, 2014

DS068: A Cadaver-Based Curriculum for Ultrasound-Guided Applications and Procedures: A Promising Alternative in Emergency Ultrasound Education

Friday, May 16 - 8:00 am - 9:00 am

Location: San Antonio Ballroom A

Objectives: At the completion of this session, participants should be able to: 1. Define what is required to successfully incorporate a cadaver-based educational curriculum at any level of medical education. 2. Present an effective, safe method by which trainees can practice procedures and detect pathologic findings. 3. Examine how this curriculum can bolster research that addresses improvement in student learning, comprehension of anatomical structures and pathology, retention of information, and clinical performance.

Description: As point-of-care ultrasound (POC US) continues to expand within our practice, the need for an effective educational model that trains residents to become competent in POC US grows as well. The current POC US training method (live model scanning) is limited due to the lack of abnormal or pathologic findings found during scan sessions. Additionally, invasive procedures cannot be performed on live models, and cannot be repeated on patients. Thus, educational curriculums that highlight pathologic findings and allow for safe procedural practice can be very useful for trainees. During this course, participants will learn how to successfully incorporate a cadaver-based educational model. Sample US cadaver-based curriculums with lectures on lab experiences; saline injection into the abdominal cavity, thorax, veins, and joints; creation of bony fractures, MSK injuries, and foreign bodies; US-guided endotracheal intubations; cricothyrotomy; and major organs and soft tissues will be presented. Participants should learn how to start the process of creating a curriculum, how to collaborate with the medical school and the lab, and how to obtain material. Participants should also be able to answer three basic questions regarding areas of research that result from this type of teaching: 1) How this curriculum is more beneficial to the learner than the regular US teaching or anatomy course; 2) Ways to test whether this type of learning improves comprehension and retention of material; and 3) Ways to test improvement of technical/procedural skill. A cadaver will be provided for the didactic session (by UT-Southwestern) to showcase how US-guided applications and procedures are performed on a cadaver.

Kristin Carmody. New York University School of Medicine, New York, NY - Submitter

Tarina Kang. LAC + USC Medical Center, Los Angeles, CA - Presenter

Laleh Gharahbaghian. Stanford University, Stanford, CA - Presenter

Matthew Dawson. University of Kentucky, Lexington, KY - Presenter

Dina Seif. LAC + USC Medical Center, Los Angeles, CA – Presenter



DS069: Mechanical Treatment of Stroke: Update on Recent Clinical Trials and Future Directions. Putting Clinical Trials in Perspective: Pro-Con Debate

Friday, May 16 - 8:00 am - 9:00 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. Define the available endovascular treatment modalities for acute ischemic stroke and the patient population that is hypothesized to benefit from these modalities.  2. Summarize the findings of recent clinical trials and describe the limitations in terms of application of these treatments. 3. Compare and contrast the opposing positions on the future of mechanical treatment in acute ischemic stroke.

Description: Systemic thrombolytic therapy continues to be the only FDA-approved treatment available for patients with acute ischemic stroke. While its use has increased over the past decade, less than 10% of eligible patients receive this therapy. The main limitation to the use of thrombolysis continues to be the narrow time-window for treatment. As a result, there has been significant focus on endovascular treatment of stroke with the hope of improving outcomes while allowing for a longer time-window. There have been multiple recent trials (such as the Synthesis, IMS III, and Rescue trials) evaluating the effectiveness of these modalities on outcome. So far, the results are far from conclusive. At the same time, endovascular treatment has become increasingly more common in the clinical setting. This raises the debate about whether patients are being managed in an appropriate and evidence-based manner. This presentation will review the findings of these trials and discuss future directions of research, focusing on whether we should continue utilizing these technologies and search for the optimal application versus whether we should shift away from the mechanical treatments.

Pratik Doshi. University of Texas Health Science Center, Houston, Houston, TX - Submitter, Presenter

Bill Barsan. University of Michigan, Ann Arbor, MI - Presenter

William Meurer. University of Michigan, Ann Arbor, MI - Presenter

Art Pancioli. University of Cincinnati, Cincinnati, OH – Presenter



DS070: Learner-Centered Feedback: Time To Change the Conversation

Friday, May 16 - 8:00 am - 9:00 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Examine the feedback literature to understand better the change of focus from teacher to learner. 2. Outline steps required to provide effective feedback within the new conceptual framework. 3. Implement strategies to improve learner receptiveness to feedback regarding their clinical teaching practice.

Description: While educators view providing feedback as a crucial step towards improving learner performance, the emphasis is shifting from delivering effective feedback to impacting personal factors that affect learner responsiveness to feedback. In fact, many experts now view learner responsiveness to feedback as one of the most important aspects of the feedback encounter. This session will build on previous sessions focused on feedback presented at the SAEM Annual Meeting. We will draw upon seminal articles in the feedback literature to both enable the participant to understand the psychological impact of feedback from the receiver’s perspective, and empower participants to employ practical strategies to successfully engage the learner in accepting feedback. This workshop will focus on several resident issues, such as poor self-confidence, overconfidence, poor self-assessment, lack of motivation, and fear. The session will utilize a combination of short didactic presentations intermixed with small-group activities. The workshop will utilize large- and small-group exercises to allow the participant to understand key concepts surrounding the area of feedback responsiveness and identify strategies to successfully address these issues. Facilitators will include David Manthey, MD; Robin Hemphill, MD, MPH; Josh Kornegay, MD; and Thomas Terndrup, MD.

Sorabh Khandelwal. The Ohio State University, Columbus, OH - Submitter, Presenter

Marcia Perry. University of Michigan, Ann Arbor, MI - Presenter

Lalena Yarris. Oregon Health & Science University, Portland, OR - Presenter

Sally Santen. University of Michigan, Ann Arbor, MI – Presenter

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DOWNLOAD HANDOUT 3 (.doc)
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DS071: Redesigning Emergency Care Delivery to Optimize Patient Care and Grow the Academic Mission

Friday, May 16 - 8:00 am - 9:00 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Understand how modern process improvement tools can fundamentally redesign emergency care. 2. Understand the importance of analytics. 3. Integrate educational and research needs of an academic department into the care redesign process.

Description: The process of delivering emergency care has remained unchanged for many decades, yet the practice of emergency medicine has changed dramatically. As most emergency departments are redesigning care delivery models to meet the needs of patients by focusing on the patient experience and efficiency, academic departments often struggle to balance the drive for efficiency with the need to maintain or grow opportunities for education and research. By taking a data-driven, patient-centered approach to care redesign, utilizing tools from modern process-improvement methodologies, academic emergency departments can redesign care to be efficient and patient-centered while enhancing the academic mission. This session will include experts in ED operations, process improvement, quality, safety and education. Dr. Zane will moderate the session, which will begin with a joint lecture addressing the application of process-improvement methodology to care redesign and emergency medicine, developing performance excellence metrics in a meaningful actionable format while recognizing the unique needs and mission of an academic ED. There will be a question-and-answer session with audience participation after the discussion.

Richard Zane. University of Colorado School of Medicine, Aurora, CO - Submitter, Presenter

Derek Birznieks. University of Colorado Hospital, Aurora, CO - Presenter

Erik Barton. University of Utah, Salt Lake City, UT - Presenter

Ali Raja. Harvard Medical School / Brigham and Women's Hospital, Boston, MA - Presenter

Jennifer L. Wiler. University of Colorado School of Medicine, Aurora, CO - Presenter



DS072: Diagnostic Imaging and Radiation Exposure: How Much is Too Much?

Friday, May 16 - 8:00 am - 9:00 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1.Discuss the radiation dosing associated with various imaging modalities commonly ordered in the emergency department and the implications for different patient populations. 2. Identify strategies to minimize unnecessary use of medical imaging, including the use of electronic clinical decision support and alternatives to modalities that confer radiation. 3. Describe strategies to minimize radiation dosing that can be discussed with participants’ radiology departments.

Description: The United States health care system has seen a rise in the use of diagnostic imaging, without commensurate improvement in patient-centered outcomes. Emergency departments (EDs) are responsible for a large percentage of this growth. In many instances, modalities that use radiation, such as CT scans, are the optimal diagnostic modality in the ED; however, at times these examinations are unnecessary, and there can be significant drawbacks. Recently, the cancer risk associated with diagnostic radiation has been rigorously studied and publicized in the media. Consequently, physicians should be knowledgeable about the current understanding of the risks associated with medical radiation, and the up-to-date strategies involved in minimizing the unnecessary use of this modality, as well as techniques available to minimize radiation dosing. This didactic will review the current knowledge regarding diagnostic imaging and radiation, critically discuss how to incorporate this knowledge into emergency medicine practice, and discuss state-of-the-art research examining methods to decrease the unnecessary use of medical imaging.

Jennifer Marin. University of Pittsburgh School of Medicine, Pittsburgh, PA - Submitter, Presenter

Kimberly Applegate. Emory University School of Medicine, Atlanta, GA - Presenter

Angela Mills. University of Pennsylvania School of Medicine, Philadelphia, PA - Presenter



DS073: Emergency Ultrasound for Airway Management

Friday, May 16 - 9:00 am - 10:00 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Describe the appearance of essential airway structures on ultrasound. 2. Understand the technical approach to performing airway ultrasound. 3. Understand the indications for airway ultrasound. 4. Describe ultrasound findings correlating with: prediction of difficult intubation, assessment of correct tube size, confirmation of tube placement, safe postprandial stomach size, landmarks for surgical airways and airway nerve blocks. 4. Discuss future directions in airway ultrasound.

Description: Ensuring a patent airway during resuscitation of an emergency patient remains one of the most critical procedures for emergency physicians. Despite extensive training and an armamentarium of devices for airway management, there is ongoing morbidity and mortality from airway complications. Challenges remain in predicting difficult intubations and correct endotracheal tube size, limiting aspiration, confirming correct tube position and establishing last-resort surgical airways. Bedside ultrasound of the airway is emerging as a powerful new tool in emergency airway assessment and management. Despite an emerging body of literature, most emergency physicians remain unfamiliar with the powerful applications of bedside ultrasound in airway management. Our session will begin with an orientation to the sonographic appearance of important airway structures. We then provide an up-to-date literature summary and practical “how-to” approach for emerging bedside ultrasound applications for airway management, including: prediction of difficult intubation and appropriate endotracheal tube size, evaluation of stomach contents, confirmation of correct endotracheal tube placement, and ultrasound guidance for both surgical airway procedures and upper-airway nerve blocks (for awake intubation). This didactic will provide images and videos from actual clinical experiences to illustrate these techniques and findings. We will describe our novel approach to airway ultrasound simulation and how to develop a simple and inexpensive airway ultrasound phantom model. There will also be a discussion on future research directions as we share our experience in designing and implementing research protocols in this exciting new area.

Kristin Carmody. New York University School of Medicine, New York, NY - Submitter

Mark O. Tessaro. Maimonides Medical Center, Brooklyn, NY - Presenter

Eric H. Chou. Maimonides Medical Center, Brooklyn, NY – Presenter



DS074: Incentives to Participate in Clinical Trials: Practical and Ethical Considerations

Friday, May 16 - 9:00 am - 10:00 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, the participants should be able to: 1. Discuss incentives commonly used to recruit subjects into clinical trials and retain them for follow-up. 2. Understand the ethical issues surrounding the nature, scope, and amount of these incentives.

Description: The success of clinical trials depends on the recruitment and retention of sufficient numbers of subjects. Providing token compensation in the form of cash, gift cards, or vouchers is a common strategy used for recruitment and retention. The challenge is to design a program where the incentives are sufficiently large and salient to attract potential subjects, but not large enough to be considered coercive. Investigators must decide on the size of incentives, their timing, and whether to vary the incentive based on the effort required or inconvenience to the subject. In addition, incentives must be sensitive to the constraints of grant budgets. The presenters of this program will review the current status of incentives used in clinical trials of emergency department-based interventions. The first speaker, Dr. Bernstein, is an experienced investigator who has conducted multiple clinical trials in the ED. He will survey the current literature to review the types of incentives used in published EM trials, along with practical pointers from his own work. Dr. Feldman, a member of the Institutional Review Board at Boston Medical Center, will discuss ethical considerations regarding clinical trial incentives, with a focus on how IRBs determine whether incentives are coercive, and whether they can be scaled to subjects’ socioeconomic status. Examples from completed trials will be discussed.

Steven L. Bernstein. Yale School of Medicine, New Haven, CT - Submitter, Presenter

James Feldman. Boston University School of Medicine, Boston, MA – Presenter

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DS075: Developing a Curriculum in Advocacy for Emergency Medicine

Friday, May 16 - 9:00 am - 10:00 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Define advocacy as it pertains to medical professionalism in EM. 2. Understand and apply basic principles of advocacy curriculum development in emergency medicine residency programs.

Description: Emergency physicians hold the unique position of caring for patients of all ages and all walks of life, often when they are at their most vulnerable. On the front lines of medicine, emergency physicians have both a ground-level and a bird’s-eye view of the individual patient and the community at large as they are affected by social determinants of health, such as socioeconomic status, education, employment, and mobility. This makes academic emergency departments well positioned to train future emergency physicians in how to navigate the complex landscape of health care for the betterment of the profession, patients, and society at large. Given the rapid changes in the health care environment and the likelihood that emergency physicians will need to be prepared to care for a greater proportion of vulnerable patients during this delicate transition, it has never been more imperative for trainees and their faculty educators and mentors to be comfortable with community engagement, resources, and health policy. The advancement and dissemination of this knowledge should be embraced in the academic setting. This didactic session will introduce the principles of patient-centered advocacy in the emergency department, with a shift in focus beyond individual patients to inclusion of communities and policies as defined in the ecologic model of public health. Participants will learn how to define advocacy in our unique setting, and will learn introductory principles of curriculum development from experienced leaders in advocacy education.

Jennifer Walthall. Indiana University, Indianapolis, IN - Submitter

Peter Sokolove. University of California, San Francisco, CA - Presenter

Sean Thompson. Indiana University, Indianapolis, IN - Presenter

Adam Sharp. Los Angeles Medical Center, Los Angeles, CA – Presenter



DS076: Opioid Prescribing from Our EDs: Where Do We Go from Here?

Friday, May 16 - 9:00 am - 10:00 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. List several of the ED prescribing guidelines that are currently available and the benefits and limitations of each. 2. Describe medications and medication combinations that constitute high-risk ED prescribing. 3. Highlight the research on opioid analgesic safety and existing gaps in outcome-based research related to ED prescribing.

Description: Prescription opioid misuse is responsible for more than 350,000 visits to our EDs annually, and has caused so many deaths that the CDC has proclaimed it to be an epidemic. There is no doubt that our EDs have been and continue to be an important source of prescription opioids that are used nonmedically. ED providers have been placed in the difficult position of being expected to aggressively identify and treat pain while safely prescribing pain medications in an environment of limited time and resources, to a population that is likely at high risk of nonmedical opioid use. To address this complicated situation, emergency physicians need to be aware of the role ED prescribing plays in the current epidemic, and the guidance that is available to help in decision-making. This session will bring together experts in opioid safety, medical toxicology and ED prescribing. The session will be moderated by Dr. Lewis Nelson, an editor of Goldfrank's Toxicologic Emergencies. There will be two presentations (Drs. Hoppe and Perrone) of 15 minutes each: 1) A review of baseline ED prescribing data, opioid prescribing rates, and available ED pain management guidelines and how they are accessed and utilized, and 2) A discussion of recent changes in drug labeling, REMS programs, and high-risk features. Both speakers will include a description of the available outcomes data on ED opioid prescribing and research gaps. This will be followed by a brief question-and-answer session.

Jason Hoppe. University of Colorado, Aurora, CO - Submitter, Presenter

Jeanmarie Perrone. University of Pennsylvania, Philadelphia, PA - Presenter

Lewis Nelson. New York University School of Medicine, New York, NY – Presenter



DS077: Respecting Pulmonary Embolism: Treating the Spectrum of Disease from Outpatient Management to Systemic Thrombolytics

Friday, May 16 - 9:00 am - 10:00 am

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Discuss the importance of pulmonary embolism risk stratification in the emergency department. 2. Describe the general patient characteristics currently understood to be safe for short-term observation and outpatient management vs. those deserving consideration for advanced therapies. 3. Identify the variations and challenges in managing pulmonary embolism. 4. Describe future research directions in treatment of pulmonary embolism.

Description: Pulmonary Embolism (PE) is a potentially life-threatening diagnosis often made in the emergency department (ED). However, the size and location of a PE, as well as numerous patient factors, make treating the spectrum of PE challenging. In recent years, research efforts have focused on risk-stratifying PE in order to identify both those who might be safe for outpatient management and those who would benefit from either systemic or catheter-directed thrombolytics. In practice there is significant variation in care, and for emergency medicine providers, recognizing the need for risk stratification and individualized treatment options is important in order to prevent short-term mortality and long-term morbidity from PE. Emergency physicians are uniquely positioned to impact the treatment of patients diagnosed with PE. As pressure builds to send more patients home from the ED, observation or clinical-decision units may be well-suited to arrange safe discharge of patients with small, low-risk PEs. This session will involve discussion of current treatment controversies for PE and present important knowledge gaps requiring further study.

Kelly N. Sawyer. William Beaumont Hospital, Royal Oak, MI - Submitter, Presenter

Pawan Suri. Virginia Commonwealth University, Richmond, VA - Presenter

Jeffrey Kline. Indiana University, Indianapolis, IN – Presenter



DS078: Ethical Dilemmas in International Emergency Medicine

Friday, May 16 - 9:00 am - 10:00 am

Location: Dallas Ballroom D1

Objectives: At the completion of this session, participants should be able to: 1. Identify common ethical dilemmas in international emergency medicine. 2. Describe the ethical concepts applicable to international emergency medicine. 3. Discuss different approaches to ethical dilemmas. 4. Develop a practical solution for real-life ethical challenges commonly encountered in international emergency medicine.

Description: How should emergency physicians approach ethical dilemmas when working globally? Short-term relief work is more popular than ever before. Medical mission trips and electives have become an integral part of medical school and residency curricula. Global health/international emergency medicine fellowships are becoming increasingly popular. Many practicing physicians volunteer for relief work, take time off from work, use their vacation time or become involved with NGOs to provide hands-on care in resource-limited environments. Despite good will and humanitarian idealism, ethical problems are routinely encountered. They affect not only the relief worker (cultural competency, safety, credentialing), but also local health care workers (cooperation with outside personnel), the affected patients (appropriate qualifications, consent, language barriers), their families and the community at large (effects on local health care infrastructure). This didactic session will start with a short overview of common ethical dilemmas, and will engage a panel of speakers with unique qualifications and backgrounds to discuss real-life ethical scenarios. Through this discussion, the speakers will engage the audience and will develop practical strategies to appropriately manage such ethical dilemmas in international emergency medicine.

Torben Becker. University of Michigan, Ann Arbor, MI - Submitter, Presenter

Ian B.K. Martin. University of North Carolina at Chapel Hill, Chapel Hill, NC - Presenter

Edward Otten. University of Cincinnati, Cincinnati, OH – Presenter



DS079: Update on Emergency Department Evaluation and Management of Pediatric Concussion

Friday, May 16 - 9:00 am - 10:00 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Describe the principles of diagnosis and management of pediatric concussion. 2. Understand the role that emergency medicine physicians can play in initiating cognitive and physical rest, and recommending appropriate follow-up.

Description: Concussion is a disruption in normal brain function caused by the impact of biomechanical forces on the head or the body. Approximately 100,000-140,000 children and adolescents present to the emergency department for concussion each year in the United States. Immediate recognition of concussion and prompt initiation of treatment in the form of complete cognitive and physical rest is essential to promote recovery, and to prevent prolonged physical, cognitive, and emotional symptoms. While emergency departments frequently serve as the initial point of entry for the care of pediatric concussion patients, providers may not have adequate training or tools necessary to provide standardized and evidence-based care. For this didactic session, the presenters will discuss the diagnosis, management, and after-care of concussion. A growing body of basic and clinical research has provided the evidence for standardized evaluation of concussion and prompt treatment with physical and cognitive rest. General awareness of concussion and a growing number of state laws requiring medical clearance before return to activity have resulted in a significant increase in concussion-related visits in a variety of clinical settings, including the emergency department. The presenters will provide updates on the science, policy, and evidenced-based best practices for pediatric concussion that emergency physicians can readily implement in their everyday practice. Following the formal didactic presentation, there will be allotted time for questions and discussion.

Mark Zonfrillo. Children's Hospital of Philadelphia, Philadelphia, PA - Submitter, Presenter

Matthew Eisenberg. Boston Children's Hospital, Boston, MA – Presenter



DS080: Federal Funding Streams for Global Health Research

Friday, May 16 - 10:30 am - 11:30 am

Location: Dallas Ballroom A1

Objectives: At the completion of the session, the participant should be able to: 1. Understand the various federal funding opportunities available to support emergency physicians conducting international research. 2. Understand Fulbright and Fogarty program support of US physicians working and conducting research abroad. 3. Understand the application and review process for various federal funding opportunities that support global health research. 4. Understand the qualifications of successful grant proposals and applicants seeking funding to support global health research.

Description: Funding for global health has grown significantly over the past two decades. In 1990, an estimated US$5.6 billion was spent on development assistance for global health; this amount had grown to approximately US$27.7 billion as of 2011. While most funding has been earmarked for program development and implementation, there has also been a steady growth in research funding. However, much of this research funding has been directed towards specific disease processes, and little has been focused on emergency care research. Funding for emergency care research in the global health context is challenging, as few grants are overtly geared towards emergency care research. The 2013 AEM Consensus Conference on Global Health Research Agendas led to the creation of goals to strengthen global emergency care research funding. These included quantifying the funding opportunities for global health and emergency care research, improving understanding of current research priorities, and identifying barriers to current research funding. In this session, three academic emergency physicians will discuss their perspectives, experience and insight regarding federal funding streams for global health. First, Dr. Jeremy Brown, director of the Office of Emergency Care Research (OECR), will present an overview of federal funding opportunities. The OECR is housed within the National Institute of General Medical Sciences and is tasked with coordinating and fostering basic, clinical and translational research and research training for the emergency setting. The second panelist, Dr. Robert Hoffman, is a former reviewer of Fulbright applications and will review the awards, the application process, and the characteristics of successful applications and applicants. The third panelist, Dr. Adam Levine, has successfully secured a K-award from the Fogarty International Center and will review the pearls and pitfalls of a successful NIH application. Time will be allocated at the end of the session for audience questions.

Bhakti Hansoti. Johns Hopkins University, Baltimore, MD - Submitter

Robert Hoffman. Mount Sinai School of Medicine, New York, NY - Presenter

Jeremy Brown. NIH, Bethesda, MD - Presenter

Adam C. Levine. Alpert Medical School of Brown University, Providence, RI – Presenter



DS081: Gun Injury: Reframing the Public Health Debate

Friday, May 16 - 10:30 am - 11:30 am

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Apply the public health model to firearm injury prevention. 2. Describe three ways to influence public opinion and policy about gun-related injuries. 3. Develop three strategies to apply in their own communities for prevention of firearm-related injuries.

Description: As emergency physicians struggle with the mounting medical problem of gun violence and its aftermath, we are increasingly called to step outside of the ED and take a role in the forum of public debate and policy development. Some emergency physicians (EPs) embrace this role, others shun it, but the fact is that in many settings we are viewed by our communities as experts. In this session, EPs who have looked at gun injury in a larger context will share their research and experience in advocacy. Topics will include advocating for a coordinated public health approach to gun violence; how EPs can influence legislation and how legislation can influence gun violence; and how to navigate the politics of public health advocacy in such a fraught realm as firearms.

Harrison Alter. Alameda Health System - Highland Hospital, Oakland, CA - Submitter

Eric Fleegler. Boston Children's Hospital, Boston, MA - Presenter

Megan Ranney. Warren Alpert Medical School of Brown University, Providence, RI - Presenter

Jason Wilson. University of South Florida, Tampa, FL – Presenter



DS082: Building from Experience: Creating Sustainable Bridges between Emergency Medicine Researchers and Invested Public Health Agencies

Friday, May 16 - 10:30 am - 11:30 am

Location: Dallas Ballroom D1

Objectives: At conclusion of this session participants should be able to: 1. Identify key public health issues at the forefront of emergency medicine. 2. Describe the role of public health agencies in promoting health. 3. Formulate an agenda for advancing key partnerships between EM and public health.

Description: The ED is called upon to advance public health programs and new research initiatives. EM-public health shared areas of expertise have resulted in a variety of partnerships, with funding from key agencies including CDC, HHS, and state health departments. This didactic will showcase successful cutting-edge innovations between EM investigators and public health. Recognizing the ever-changing funding environment, it is essential that academic emergency physicians make connections to respond to continued needs at the EM-public health interface. This is a two-part session. Part 1: Three invited panelists will deliver 8-minute presentations from distinct areas describing development and outcomes associated with one EM-public health collaboration, focusing on lessons learned and evolving opportunities. Examples will include: an ED-based network for infectious disease surveillance; a multi-center program to translate priorities into community-based injury research to the ED; and the role of EM in preparedness capability. Part 2: The organizers will present a proposed web-based platform for creating permanent bridges to optimize opportunities for sustaining and growing EM-public health partnerships. A moderated discussion will be directed towards developing consensus-based recommendations for this platform. Notes: The platform content and format will be based on advanced literature review and snowball sampling for the three areas highlighted at the session and will serve as a prototype for shared EM-public health partnerships, with the platform to be launched and sustained by the SAEM Public Health Interest Group. Consensus-building will begin at the annual meeting and with the completion of post-meeting surveys.

Larissa May. The George Washington University, Washington, DC - Submitter

Richard Rothman. Johns Hopkins University, Baltimore, MD - Presenter

Gregory Moran. University of California Los Angeles, Los Angeles, CA - Presenter

Deb Houry. Emory University, Atlanta, GA - Presenter

Kristi L. Koenig. UC Irvine, Center for Disaster Medical Sciences, CA - Presenter

David Sugerman. Centers for Disease Control and Prevention, Atlanta, GA – Presenter



DS083: Current Controversies in Post-Cardiac Arrest Care

Friday, May 16 - 10:30 am - 11:30 am

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Compare and contrast emerging non-invasive monitoring available for use during resuscitation. 2. Discuss the evidence for steroids, neuromuscular blockade, emergent coronary intervention, and mechanical support in the peri-arrest period. 3. Understand the ongoing gaps in post-arrest treatment practices. 4. Describe future research directions within cardiac resuscitation, including temperature management in the post-arrest period.

Description: Cardiac resuscitation research continues to surge, as researchers strive to identify factors associated with “good” outcomes after cardiac arrest. Yet many questions remain regarding applying temperature management, monitoring the quality of resuscitation, using medication adjuncts during resuscitation, and augmenting cardiac output with mechanical support in the peri-arrest period. These are just a few examples of current controversies in post-cardiac arrest care. Ongoing concerns regarding emergent coronary intervention in patients who have uncertain neurologic status limit the availability of this resource to many patients. The fact that patients who suffer cardiac arrest have a high likelihood of acute coronary occlusion may suggest we revisit the usefulness of systemic thrombolytics in patients unable to go to the catheterization laboratory. This session will discuss the most recent cutting-edge controversies in post-arrest care and suggest areas in need of attention for the 2015 guidelines.

Kelly N. Sawyer. William Beaumont Hospital, Royal Oak, MI - Submitter, Presenter

Michael Kurz. Virginia Commonwealth University, Richmond, VA - Presenter

Teresa Camp-Rogers. UT Health Science Center at Houston, Houston, TX – Presenter



DS084: Important Applications for Point-of-Care Ultrasound in Pediatric Emergency Medicine

Friday, May 16 - 10:30 am - 12:30 pm

Location: Dallas Ballroom C

Objectives: At the conclusion of this session participants should be able to: 1. Illustrate how POCUS can assist with the management of pediatric emergency medicine patients. 2. Understand how to develop proficiency in the ultrasound techniques for common pediatric conditions. 3. Become familiar with the evidence surrounding POCUS for each of the indications and procedures discussed.

Description: Point-of-care ultrasound (POCUS) is rapidly expanding into the field of pediatric emergency medicine. Recent advances in pediatric ultrasound include applications that aid in the evaluation and management of common pediatric clinical conditions and in the guidance of invasive procedures. In this session, we will discuss novel POCUS applications in the management of common pediatric complaints encountered by emergency providers. Specifically, the application of POCUS in the management of the febrile infant, pediatric abdominal pain, musculoskeletal injuries, and respiratory distress will be presented. In addition, the session will include a demonstration of ultrasound techniques, a discussion of common pearls and pitfalls, and a review of the most up-to-date evidence-based approaches for each POCUS application. At the end of this session, participants should be equipped with the knowledge to integrate POCUS into clinical decision-making and the management of pediatric patients.

Kristin Carmody. New York University School of Medicine, New York, NY - Submitter

James Tsung. Mount Sinai School of Medicine, New York, NY - Presenter

Lorraine Ng. Columbia University School of Medicine, New York, NY - Presenter

Jennifer Marin. Children’s Hospital of Pittsburgh, Pittsburgh, PA – Presenter



DS085: After Words … Managing the Aftermath of Adverse Events

Friday, May 16 - 10:30 am - 12:30 pm

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. List the advantages of a proactive, comprehensive approach to crises. 2. Describe innovative ways to reconcile demands for accountability with requirements for learning and considerations of compassion and justice. 3. Describe a comprehensive approach to organizational learning about hazards in care.

Description: You’ve just heard that a pregnant woman discharged from your ED after a low-impact auto accident delivered a stillborn secondary to an abruption some hours after discharge. The EMR notes good fetal heart tones and fetal movements, but an addendum notes FHT of 190, which you failed to see. Or… you’ve just heard that an elderly patient you treated for an eyebrow laceration returned with endophthalmitis, leading to enucleation due to unrecognized rupture of the globe. The chart is missing visual acuity. In both these cases, state agencies are pressing for investigation and punishment. Now what? The emergency department is a high-risk environment for adverse outcomes – some inevitable, and some preventable. This interactive panel discussion will provide examples of how such tragedies can be better managed, to support the patients and families (first victims), the caregivers involved (second victims), and to help the care-delivery organization improve (third victims). Panelists will use case examples from their own work in four important activities: (1) explanation and apology to the patient and family, along with medical, social and economic assistance as needed; (2) support for the “second victim,” the medical staff involved in the error; (3) a technically sophisticated analysis, looking for hazards in the system of care that were revealed in the accident; and (4) a means for balancing calls for greater transparency and external accountability with the psychological safety needed for learning and justice.

Robert L. Wears. University of Florida, Jacksonville, FL/ Imperial College London, London, UK - Submitter, Presenter

Rollin (Terry) J. Fairbanks. Medstar Health, Georgetown University, Washington, DC - Presenter

Rob Robson. Healthcare System Safety and Accountability, Inc., ON, Canada - Presenter

Thomas H. Gallagher. University of Washington School of Medicine, Seattle, ßWA – Presenter



DS086: The Top Global Emergency Medicine Articles of 2013: Highlights from the Global Emergency Medicine Literature Review

Friday, May 16 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A1

Objectives: At the end of this session, participants should: 1.Become familiar with the most recent high-quality global emergency medicine research being conducted around the world. 2.Improve their understanding of evidence-based practices and the current standard of care in global emergency medicine. 3. Be better-prepared to conduct their own ethical and high-quality global emergency medicine research, having learned from the experience of recent investigators.

Torben Becker. University of Michigan, Ann Arbor, MI - Submitter, Presenter

Adam C. Levine. Alpert Medical School of Brown University, Providence, RI – Presenter



DS087: Top 10 Tips for Getting Started in Research

Friday, May 16 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Define an achievable research question. 2. Identify 2-3 potential mentors to help them achieve their research goals. 3. Outline a timeline and next steps to initiate their research project.

Description: As mentors and researchers, we often hear the question, “How do I get started in research?” In this didactic, we will provide the answer for those who have enthusiasm but minimal prior research experience. The speakers, experienced research mentors, will discuss the key elements necessary for success in: defining your overall goals for research; finding an appropriate mentor or mentor team; defining a focused research question; creating a realistic research timeline; navigating the IRB and other research preparatory tasks; pursuing opportunities to publish and present; developing specific research skills; and planning long-term trajectories for research. After a brief discussion by the speakers, each topic will then be discussed in a small-group format facilitated by experienced research faculty.

Megan Ranney. Alpert Medical School of Brown University, Providence, RI - Submitter, Presenter

Brendan G. Carr. University of Pennsylvania, Philadelphia, PA - Presenter

Esther Choo. Alpert Medical School of Brown University, Providence, RI – Presenter



DS088: Congratulations! You are the Research Director! Now What?

Friday, May 16 - 11:30 am - 12:30 pm

Location: Dallas Ballroom A3

Objectives: At the completion of this session, participants should be able to: 1. Describe the role of research director in a variety of institutional settings. 2. Compare and contrast the various descriptions of the research director. 3. List obstacles they may face while developing/maintaining a research program at their own institution.

Description: While the title of “director of clinical research” is commonly seen in emergency medicine programs, the role and job description vary based upon the clinical and academic setting, resources, and institutional culture, and success in this role is dependent on these various factors. Some research directors primarily mentor resident scholarly activity, while others manage faculty. Often, a young faculty member is thrust into this role based upon early research successes. Others may inherit the role based upon a department’s needs and staffing. Lastly, some may develop into the role and have had the chance to be groomed for success. This session is intended to provide attendees with information that will help them to decide on pursuing the role of research director, and, when in the role, be successful. During this session, a panel composed of current research directors will address the following topics: 1. Description of their current setting and main roles. 2. Major challenges in their role. 3. Top 5 tips for success. After each topic presentation, there will be 3-4 minutes for questions and answers from the audience. After the conclusion of all topics, the remaining time will be used for lessons learned and/or questions. The panelists will come from the following settings: 1.A university ED with a well-established EM research program with significant extramural funding. 2. A university ED with a mid-level clinical research program. 3. A university ED with a brand-new research program. 4. A community hospital ED with a medical school affiliation.

Preeti Dalawari. Saint Louis University School of Medicine, Saint Louis, MO - Submitter, Presenter

Bernard Lopez. Thomas Jefferson Medical College, Philadelphia, PA - Presenter

Judd Hollander. University of Pennsylvania, Philadelphia, PA - Presenter

Tania D. Strout. Maine Medical Center, ME – Presenter



DS089: Getting Your Qualitative Emergency Medicine Research Published

Friday, May 16 - 11:30 am - 12:30 pm

Location: Dallas Ballroom D1

Objectives: At the completion of this session, participants should be able to: 1. Select appropriate and efficient analysis techniques for qualitative data. 2. Be familiar with frequent journal reviewer concerns regarding qualitative manuscripts and strategies to address these.3. Be familiar with several alternate dissemination techniques for qualitative research.

Description: Qualitative research seeks to develop concepts to better understand complex social phenomena in natural settings. Qualitative study designs commonly use in-depth interviews, focus groups, and field observation. Qualitative methods are particularly relevant in emergency medicine, where research questions often have little existing research background and outcomes are difficult to measure. Yet investigators face considerable challenges publishing such research. This session will enhance participants’ capacity to appropriately design, analyze and disseminate qualitative research. Session faculty are emergency physician researchers with experience in qualitative methods and will use their projects to highlight concepts. Dr. Grudzen will discuss how to build an analytic team when coding transcripts from semi-structured interviews and focus groups, and how to effectively publish results in the peer-review literature. She will use examples from her work regarding palliative care. Dr. Rhodes will discuss use of a tentative thematic framework to conduct content analyses with qualitative data and selectively code for broad themes, and will provide examples of published qualitative methods sections. She will use examples from work on ED provider-patient communication around psychosocial issues and access to care. Dr. Schuur will discuss how he used interviews and focus groups to identify successful infection-prevention strategies in EDs. He will discuss how to prepare a qualitative manuscript for peer review and will review frequent journal reviewer concerns regarding qualitative manuscripts, offering tips to avoid and answer these. A question-and-answer session will follow.

Jeremiah Schuur. Brigham and Women's Hospital, Boston, MA - Submitter, Presenter

Corita Grudzen. Icahn School of Medicine at Mount Sinai, New York, NY - Presenter

Karin Rhodes. University of Pennsylvania, Philadelphia, PA – Presenter



DS090: Recent Advances in Evaluation and Management of the Febrile Young Infant: Viral Infections and Biosignatures

Friday, May 16 - 11:30 am - 12:30 pm

Location: Dallas Ballroom D2

Objectives: At the completion of this session, participants should be able to: 1. Explain the role of enterovirus testing in the febrile young infant. 2. Describe the epidemiology of neonatal herpes simplex virus infection and when to test and initiate acyclovir therapy. 3. Describe the role of immune responses in pathogen identification. 4. Understand rudiments of microarray analysis for disease detection in clinical settings.

Description: The febrile young infant aged 0-60 days is commonly encountered in the emergency department. These infants are at high risk for serious bacterial infection and often undergo a full sepsis evaluation. Enterovirus is a common pathogen that causes febrile illness in young infants. Despite availability of rapid enterovirus PCR testing, there is wide variability in enterovirus testing in febrile infants, even with recent studies demonstrating benefits of routine testing. Neonatal herpes simplex virus (HSV) is a life-threatening infection that is difficult to diagnose clinically, and therefore controversy exists as to which neonates should be tested and empirically treated. Importantly, novel diagnostic methods including biosignatures (RNA expression analysis) are being investigated to improve identification of fever-inducing pathogens. In this session, the most recent advances in the management of the febrile young infant will be presented. The presenters will discuss the epidemiology of enterovirus and neonatal HSV infections, and will review the evidence-based approach to viral testing in the febrile young infant, including an upcoming multicenter study. Additionally, novel approaches to diagnosis, including transcriptional biosignatures, will be discussed. Following a brief introduction to novel diagnostic techniques currently being used in the evaluation of a young febrile infant, a more detailed description of one of the more promising technologies will be presented. RNA expression analysis is the study of the host response to the presence of a pathogen. Analysis of unique host response patterns can potentially lead to identification of fever etiology, thus obviating the reliance on sub-optimal reference standards, including cultures.

Paul L. Aronson. Yale School of Medicine, New Haven, CT - Submitter, Presenter

Prashant Mahajan. Children's Hospital of Michigan, Detroit, MI – Presenter


DS097: Controversies in Emergency Ultrasound II: The Debate Rages On

Friday, May 16 - 10:30  - 11:30 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Describe cutting-edge and controversial issues in emergency ultrasound today. 2. Discuss current evidence in support of and against ultrasound use. 3. List areas for future research.

Description: This session will feature a debate-style format, with discussants utilizing an evidence-based approach to discuss two controversial topics in emergency ultrasound. Session will be evidence-based, drawing on pertinent literature to support viewpoints.

Christopher Raio. North Shore University Hospital, Manhasset, NY - Submitter

Andrew Liteplo. Massachusetts General Hospital, Boston, MA - Presenter

Michael P. Mallin. University of Utah, Salt Lake City, UT - Presenter

Jason T. Nomura. Christiana Healthcare System, Newark, DE – Presenter





SATURDAY, MAY 17, 2014

DS091: Delivering Public Health through EMS

Saturday, May 17 - 8:00 am - 9:00 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Describe the financial and legal barriers impeding prior EMS involvement in public health. 2. Describe existing best practices of EMS-based public health activities. 3. Describe the existing opportunities to expand the role of EMS in public health.

Description: Emergency medical services (EMS) systems predominantly focus on transportation. However, EMS agencies frequently interact with our most vulnerable patients, both before and after acute injuries or illness. There are many instances when EMS might be well positioned to smooth the transition of care or perform public health outreach to disadvantaged or vulnerable populations. The EMS community has been interested for a long time in moving beyond basic transportation services toward becoming a more flexible, patient-centered, clinically integrated mobile health service, working with partners in the medical and public health communities to support population health. However, few innovations have been put into general practice, largely because of legal constraints and financial incentives that favor the status quo. Given macro trends in health care policy toward greater coordination of care and population health management, there may be new opportunities available for EMS (out-of-hospital care) systems to expand their role beyond emergency care delivery into such public health areas as fall and injury prevention, personal preparedness, public vaccination programs and more. This session will feature three leaders in the EMS community who will update us on the latest public health innovations in the practice of EMS.

Kevin Munjal. Mount Sinai Medical Center, New York, NY - Submitter, Presenter

David Sugerman. Centers for Disease Control and Prevention, Atlanta, GA - Presenter

Thomas Judge. LifeFlight of Maine, Bangor, ME – Presenter



DS092: Do-it-yourself Simulation: Cutting-edge Simulation on a Shoe-String Budget

Saturday, May 17 - 8:00 am - 9:00 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. Discuss the costs associated with establishing simulation in a resident curriculum. 2. Describe the literature on DIY simulation and demonstrate a variety of models: vascular access, soft-tissue infection, pericardiocentesis, among others. 3. Take home various “recipes” for simulators so they may try them on their own.

Description: There are many different medical simulators commercially available; however, they come at a significant cost. Most educators have limited budgets and relatively high operating costs. The goal of this didactic is to discuss the costs associated with simulation, from a basic to an advanced level, and to give educators the resources to make quality low-cost simulators for physician education.

Kristin Carmody. New York University School of Medicine, New York, NY - Submitter

William Bond. Lehigh Valley Health Network, Allentown, PA - Presenter

Nova Panebianco. University of Pennsylvania School of Medicine, Philadelphia, PA - Presenter

Daniela E. Morato. University of Pittsburgh School of Medicine, Pittsburgh, PA – Presenter



DS093: How to Effectively Supervise and Teach Residents: Entrustment and Autonomy

Saturday, May 17 - 8:00 am - 9:00 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Describe the factors affecting autonomy. 2. Be prepared to navigate the barriers to entrustment. 3. Appropriately facilitate resident autonomy and grant trainee-suitable entrustment of patient care to enhance resident education.

Description: The goal of residency is to train residents to manage patients independently but also safely as they learn. The role of the attending varies between supervision and allowing autonomy. This concept has been termed entrustment. Entrustment is essential for implementation of the milestones. As residents progress along the milestones, the role of the supervising physician is to grant incremental responsibilities of patient care to residents, with concurrent reduction in clinical oversight. This entrustment of professional activities to each resident varies based on multiple elements, including attending factors (characteristics, experience, confidence), resident factors (proficiency, level of training, characteristics), patient factors (severity of illness, complexity) and environment (volume, service expectations). In this session, we will discuss use our understanding of how leveraging entrustment can create an effective learning environment. We will explore resident perceptions of autonomy, the learning environment, and strategies for faculty to enhance resident learning within this framework. This workshop was presented at SAEM in 2013 to very good reviews. We have incorporated feedback received from that session into the design of this didactic. Additional small-group facilitators include Felix Ankel, MD; Emily Mills, MD; and Josh Glazer, MD.

Margaret Wolff. University of Michigan, Ann Arbor, MI - Submitter, Presenter

Ben Bassin. University of Michigan, Ann Arbor, MI - Presenter

Sally Santen. University of Michigan, Ann Arbor, MI - Presenter

Sheryl Heron. Emory University, Atlanta, GA – Presenter



DS094: Law, Ethics, and Truth: Caring for LGBT Patients in the ED. Introduction to a Module from a Novel Curriculum on LGBT Health in Emergency Medicine

Saturday, May 17 - 8:00 am - 10:00 am

Location: Dallas Ballroom D3

Objectives: At the end of this session, participants should be able to: 1. Locate the new resource curriculum on LGBT health. 2. Discuss challenges, resources, and future needs regarding legal and ethical concerns for LGBT patients. 3. Describe components of federal and state laws that impact LGBT patient care, access to care, advanced directives, and visitation. 4. Identify biases that serve as barriers to effective communication and can adversely affect care of LGBT patients.

Description: Original research presented last year at SAEM on behalf of ADIEM demonstrated a need for and desire on the part of program directors for LGBT health care-related residency education. The LGBT subcommittee of ADIEM has developed a module-based curriculum for use by EM residency programs. After a brief introduction and overview of the curriculum components, an individual module that focuses on the legal and ethical challenges in the physician-patient relationship for LGBT patients will be explored. Participants in this session will be divided into small groups to consider case-based scenarios that will facilitate discussion between EM physicians and their patients. Specifically, the dilemmas, management, and resources available to successfully navigate these legal and ethical challenges in the physician-patient interaction will be examined. At the conclusion of the session, we will bring the groups back together for a debriefing to summarize challenges, solutions, and future needs.

Joel Moll. University of Michigan, Ann Arbor, MI - Submitter, Presenter

Ellen Slaven. Louisiana State University, New Orleans, LA - Presenter

Thea James. Boston University, Boston, MA - Presenter

Paul Krieger. Beth Israel, New York, NY – Presenter

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DS095: Emergency Informatics Research: Interesting, Approachable Projects for the Resident or the Career Scientist

Saturday, May 17 - 9:00 am - 10:00 am

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. Describe the current status of emergency informatics research. 2. Discuss the design of several informatics research projects that could be performed by non-technical researchers.

Description: Clinical Informatics is a new official subspecialty available to emergency medicine diplomates and is an exciting area of medicine experiencing rapid change. We are seeing government mandates for electronic health records in most of the developed world. Patients expect their records to be complete and accessible. Physicians expect the systems to be usable for decision support and to be helpful and timely. The transformation of health information into electronic formats (EHR) is outpacing the research in the field. Many informatics researchers focus on technical aspects; however, we will focus on areas that do not require significant technical knowledge. This research is achievable by any emergency physicians or residents. More must be done to assure that changes being made truly help promote safe and effective patient care. We will focus on several key areas of informatics research that directly relate to emergency medicine: workflow analysis, EHR usability, alerting/clinical decision support, and pre-hospital informatics. This session will consist of (1) four panel members presenting short literature reviews of existing areas of emergency informatics research, together with future directions, followed by (2) a panel discussion regarding the generation of research ideas and suggestions for study design, accompanied by practical suggestions.

Jeffrey Nielson. Summa Akron City Hospital/NEOMED, Akron, OH - Submitter

Jason Shapiro. Icahn School of Medicine at Mount Sinai, New York, NY - Presenter

Adam Landman. Brigham and Women's Hospital, Boston, MA - Presenter

Nicholas Genes. Icahn School of Medicine at Mount Sinai, New York, NY – Presenter



DS096: Bringing Patient Safety Into Your Program

Saturday, May 17 - 9:00 am - 10:00 am

Location: Dallas Ballroom A2

Objectives: At the completion of this session, participants should be able to: 1. Describe the Just Culture and its application to improving patient safety within a residency. 2. Apply important concepts about patient safety to improve ED culture and enhance resident participation in safety practices.

Description: RATIONALE: Patient safety is increasingly important, but residents and students may not understand the role they can play in delivering safe care and improving the environment of care. CONTENT: This workshop should help participants translate the evidence related to safety culture into (1) methods to enhance and engage resident participation in patient safety; (2) methods to improve success in meeting core competencies related to patient safety. FORMAT: The Just Culture will be briefly presented; then, in small groups, the participants will plan learning or assessment exercises for their own setting. The workshop will be highly interactive, requiring participants to both understand patient safety concepts and apply them to their teaching, learning and assessment practices. The workshop will incorporate large- and small-group exercises to understand the concepts and develop ways to improve each participant’s ability to incorporate key concepts of culture and safety into ED practice. INTENDED OUTCOMES: Participants should be able to understand the Just Culture and its application to patient safety, and incorporate the important concepts about patient safety into teaching practice and the ED clinical setting.

Robin Hemphill. Veterans Health Affairs, Washington, DC - Submitter, Presenter

Benjamin Bassin. University of Michigan, Ann Arbor, MI - Presenter

Felix Karl Ankel. HealthPartners, Saint Paul, MN - Presenter

Sally A. Santen. University of Michigan, Ann Arbor, MI – Presenter



DS098: Getting the Right Treatment to the Right Patient: Phenotyping in the Era of Personalized Emergency Care

Saturday, May 17 - 9:00 AM - 10:00 AM

Location: Dallas Ballroom B

Objectives: At the completion of this session, participants should be able to: 1. Describe three common approaches to genomics, metabolomics, and proteomics research studies. 2. Identify areas of emergency medicine that are currently or soon will be the subject of this area of research. 3. Articulate potential clinical applications of -omics.

Description: The -omics revolution promises improved care through genome-specific diagnostics and personalized treatments. These methods include genomics (genome-wide association studies, gene expression analysis, whole transcriptome sequencing), proteomics, and metabolomics. These methods are increasingly being applied to acute care conditions for identification of specific conditions requiring time-sensitive treatments, treatment selection and prognosis. Further, they represent a new paradigm in the development of standard laboratory-based diagnostics and treatments. NIH leaders have identified -omics research as one of the natural fits for emergency medicine research within the federal research mission. In this didactic, Ephraim Tsallick will provide a broad overview of these methods and how they work. He will provide a brief description of his own work with infectious disease diagnostics. Andrew Monte will then describe the applications, and limitations, of -omics in personalized medicine, using his own genomic and metabolomic work with opioids and altitude-induced hypoxia as examples. Finally, Charles Cairns will outline an agenda for how these methods will fit in the future of EM care.

Alexander Limkakeng. Duke University, Durham, NC - Submitter

Ephraim L. Tsalik. Durham VA Medical Center, Durham, NC - Presenter

Andrew Monte. University of Colorado Denver, Denver, CO - Presenter

Charles Cairns. University of North Carolina at Chapel Hill, Chapel Hill NC – Presenter



DS099: So You Want to Start a (Non-ACGME)-accredited Fellowship?

Saturday, May 17 - 10:00 am - 11:00 am

Location: Dallas Ballroom A1

Objectives: At the completion of this session, participants should be able to: 1. Illustrate those aspects of a department and institution that make it an appropriate host for a fellowship. 2. Describe how to construct a fellowship curriculum incorporating Milestones and clearly defined objectives. 3. Identify commonly encountered obstacles and pitfalls in starting a non-ACGME-accredited fellowship.

Description: This didactic will be a panel discussion focused on giving the audience the fundamental constructs for developing an excellent (non-ACGME-accredited) fellowship. Emergency medicine residency graduates have multiple fellowship opportunities available to them, only the minority of which are ACGME-accredited. Ensuring that fellowships are optimally designed and executed benefits both the fellows and the departments hosting the fellowships. Remarkably, however, for non-ACGME fellowships, there is little to no standardization or clarity regarding what the learner should expect for his or her investment of time and energy. What defines a non-ACGME-approved fellowship? How does a department determine if it is ready to start a fellowship in an area of expertise? What are possible funding sources? What educational opportunities should be made available to the fellows? How do we ensure a rich educational environment without ACGME guidelines and credentialing? Is there a role for Milestones and clear learning objectives even without ACGME oversight, and how would this be created? What resources should be made available to the fellowship director by the department? A panel of experienced directors of fellowships including administration, global health, and geriatric emergency medicine will discuss these topics as they describe how they started and run their renowned fellowships.

Kevin Biese. University of North Carolina at Chapel Hill, Chapel Hill, NC - Submitter, Presenter

Ian B.K. Martin. University of North Carolina at Chapel Hill, Chapel Hill, NC - Presenter

Charles Reese. Christiana Care Health System, Newark, DE - Presenter

Michael Stern. New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY – Presenter



DS100: What Millennials Want: Reshaping Your Residency for a New Generation of Learners in the NAS

Saturday, May 17 - 10:00 am - 11:00 am

Location: Dallas Ballroom A2

Objectives: At the end of the session the participant should be able to: 1. Describe the positive and negative attributes and generational values of the Millennial generation, as well as how these values and attributes impact the success of residency programs. 2. Discuss why professionalism and communication issues arise frequently with Millennials and bring back specific ideas to develop behavioral expectations. 3. Implement curriculum changes that increase success of the learner without changing the underlying content, including interprofessional simulation, role-playing, and the formal use of social media.

Description: This session will focus on using knowledge of Millennial generation attributes and value systems to further refine multiple aspects of residency program management, including recruitment, orientation, didactic curriculum, and integration of non-traditional educational methods. The session will begin with a detailed introduction to Millennial attributes, both positive and negative, focusing on how these values impact their education, in both the clinical and the nonclinical realm. This will be followed by a review of specific methods of incorporating Millennial ideals into the residency, beginning with more effective recruitment strategies. The session will conclude with a discussion of perceived differences in professionalism and communication skills and how to develop expectations that will be met by younger generations via expectation development, use of reflection, and leadership development.

Hollynn Larrabee. West Virginia University, Morgantown, WV - Submitter, Presenter

Megan Fix. University of Utah, Salt Lake City, UT – Presenter



DS101: Taking Advantage of the Teachable Moment: A Workshop for Efficient, Learner-Centered Clinical Teaching

Saturday, May 17 - 10:00 am - 12:00 pm

Location: Dallas Ballroom C

Objectives: At the completion of this session, participants should be able to: 1. Discuss barriers to effective clinical teaching. 2. Identify characteristics of ideal clinical teachers. 3. Describe principles of learner-centered education. 4. Practice a variety of evidence-based teaching models in small groups. 5. Incorporate learner-centered teaching techniques into clinical practice.

Description: When working in a chaotic emergency department with competing priorities, clinical teaching may be sacrificed for the sake of patient flow and throughput. An organized, efficient approach to clinical teaching based upon constructivist educational theory helps focus the teaching on what the learner needs at that moment, incorporates regular feedback, keeps the department on track, and prevents over-teaching.

In this interactive workshop, participants will be engaged in a discussion about barriers to teaching in the emergency department, learn about characteristics of teachers appreciated by learners, explore basic principles of learner-centered education, practice a number of teaching models such as OMP, SNAPPS, ED STAT! and ultimately should be able to take these skills and apply them to their interactions with learners in the clinical setting. Videos illustrating examples of effective and ineffective teaching encounters will serve as an adjunct to the discussion.

At the end of this workshop, participants should be prepared to seize the teachable moment and provide timely and learner-centered clinical educational encounters.

Sneha Shah. University of Massachusetts, Worcester, MA, Submitter, Presenter

Todd Guth. University of Colorado, Aurora, CO - Presenter

Michael Epter. Maricopa Medical Center, Phoenix, AZ - Presenter

Elise Lovell. Advocate Christ Medical Center, Oak Lawn, IL – Presenter



DS102: Watch a Doctor Get Sued: A Live Medicolegal Simulation

Saturday, May 17 - 10:00 am - 12:00 pm

Location: Dallas Ballroom B

Objectives: At the conclusion of this session, participants should be able to: 1. Vicariously experience the stress of a physician being sued and deposed. 2. Witness an example of a newcomer being deposed. 3. Witness an example of an expert being deposed. 4. Participate in a question-and-answer period with practicing attorneys during the debriefing of the simulations. 5. Walk away from this simulation feeling a little bit more prepared for the potential of being deposed.

Description: Being sued is probably one of the most stressful life events that an emergency physician can experience, and the probability is high that the physician will be sued during her career. This live simulation demonstration will allow the audience to vicariously experience a realistic medical malpractice deposition with practicing attorneys. Examples will include depositions of a chief resident a long-tenured department chair. Both will be debriefed by the attorneys, with time for audience questions and answers. What to look out for, how to react, and what’s important will be highlighted by the attorneys and will be contrasted with emergency physician perceptions of the same.

Michael D. Smith. MetroHealth Medical Center, Cleveland, OH - Submitter, Presenter

Adam Davis. Reminger Attorneys at Law, Cleveland, OH - Presenter

Charles Emerman. Case Western Reserve University, Cleveland, OH - Presenter

Marilena Disilvio. Reminger Attorneys at Law, Cleveland, OH - Presenter

Bryan E. Baskin. MHMC, OH - Presenter