I am Dr. Greg Wanner, Emergency Medicine Resident: How I Stay Healthy in EM

How I Stay Healthy logoDr. Wanner (@GregWanner) is an emergency medicine resident from Thomas Jefferson University in Philadelphia. Having been a physician assistant educator in EM for several years prior to his residency, he brings a wealth of experience on how to stay well. Despite this busy schedule, he still finds time to keep fit and spend time with this two daughters. Dr. Wanner is a big supporter of “laughter is the best medicine”. Here’s how he stays healthy in emergency medicine!

 

  • Name: Gregory Wanner, DO, PA-CWannerPhoto
  • Location: Thomas Jefferson University, Philadelphia PA
  • Current job(s): PGY-3 Emergency Medicine Resident, Dad (two daughters, ages 3.5 years and 9 months), Physician Assistant Educator (previously a PA in EM for several years)
  • One word that describes how you stay healthy: Relaxation
  • Primary behavior/activity for destressing: Coffee and naps, not necessarily in that order.

What are the top 3 ways you keep healthy?

  1. Eat well. Both healthy eating and occasionally eating my favorite less-healthy foods, paired with a nice (inexpensive) bottle of wine.
  1. Work/life balance. Admittedly, I’m still working on this one. Having kids as a resident is tough; there are no duty-hour restrictions as a parent. Fortunately my wife is incredible, and dancing around the house with my 3 year-old is always a great way to turn off my work-brain. I’m a horrible dancer, by the way.
  1. Get outside. In the past it was skiing and golf, now it’s more playgrounds and sandcastles. I also enjoy long walks on the beach…

What’s your ideal workout?

Krav Maga. Krav is an Israeli military self-defense system and a wonderful workout. Sparring with a bunch of sweaty guys/gals is a great way to burn calories and relieve stress. I also recommend taking a chlorhexidine shower afterwards.

Do you track your fitness? How?

I weigh myself on a bathroom scale every few weeks, does that count?

How do you prepare for a night shift? How do you recover from one?

Preparation: Over my ten years of night shifts (including nearly two years of full-time nights as a PA), I have come up with some strategies for night shift survival:

  1. Take a pre-shift nap for at least 1-2 hours.
  2. Caffeinate, drink plenty of water, and eat during the shift.
  3. Get charts done early! Falling asleep on the keyboard is uncomfortable…

Recovery: 

  1. Eat before heading to bed in the morning. Eat something small, not too heavy; no chili or deep dish pizza. My usual mini-meal is raisin bread with peanut butter and a hefty swig of orange juice.
  2. Don’t drink too much before going to bed—any desire to sleep will be overpowered by a full bladder.
  3. Dark room and white noise. We have room-darkening curtains, but covering windows with a dark sheet or towels also works, although it is much less fashionable. Turn on some “white noise,” either a smartphone app (with the phone in airplane mode) or a loud fan will help drown out the sounds of sirens or squealing children. We also have a remarkable babysitter who manages to keep kid screams to a minimum.

How do you avoid getting “hangry” (angry due to hunger) on shift?

I typically bring a sandwich, banana, and an energy bar. I often forget to eat any of these items until after my shift. Not recommended.

How do you ensure you are mentally in check?

In most aspects of life I try to use a little bit of humor. At work my goal is to provide nearly every patient with a small therapeutic giggle. At home I try to redirect misbehaving offspring with laughter, rather than getting angry. If unsuccessful, I re-evaluate my own stress levels.

What are the biggest challenges you face in maintaining a longstanding career in EM? How do you address these challenges?

The day-night transitions and constant pace of EM can become difficult over time. A change in scenery is important. I have been working to develop my other interests, including education and disaster medicine, as a way to eventually pull back a bit on clinical time.

Best advice you have received for maintaining health?

“Get enough sleep. Have fun but live within your means. Schedule a colonoscopy and prostate exam in fifteen years.”

Who would you love for us to track down to answer these questions?

Bon Ku
Richard Bounds
Masashi Rotte

 

Author information

Zafrina Poonja

Zafrina Poonja

ALiEM Assistant Editor,
How I Stay Health in EM series
Emergency Medicine Resident
University of Saskatchewan

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Must-Know EM Pharmacotherapy Articles of 2015

Top10There is so much literature to sift through each year, it becomes nearly impossible to stay abreast of it. Here is a quick summary of the 10 must-know Emergency Medicine pharmacotherapy articles from 2015, in my humble opinion.

 

 

 

Top 10 EM Pharmacotherapy Articles of 2015

1. IV Magnesium for Acute Migraine Headache2. Ketamine for Alcohol Withdrawal3. Vancomycin Loading in Obese Patients4. Early Glargine Administration at Start of DKA Treatment5. Reversing Dabigatran with Idarucizumab6. Blood Glucose Response to Rescue Dextrose7. Ketamine vs. Morphine for Analgesia in the ED8. Avoid Opioids for Low Back Pain9. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity10. Therapeutic Tramadol Use Significantly Increases Seizure RiskBonus ArticleFavorite Article of the Year

Does IV magnesium have a role in the management of acute migraine headache in the ED? A new study says yes. [1]

Intervention

  • 35 patients received IV magnesium 1 gm over 15 minutes.
  • 35 patients received IV dexamethasone 8 mg + IV metoclopramide 10 mg over 15 minutes.
  • Each group contained men and women.
  • Initial pain score 8.2 in dexamethasone/metoclopramide group vs. 8.0 in magnesium group.

What They Found

Magnesium sulfate was more effective in decreasing pain severity at 20-min (pain scale 5.2 vs. 7.4) and 1-h (2.3 vs. 6.0) and 2-h (1.3 vs. 2.5) intervals after treatment (p < 0.0001) compared to treatment with dexamethasone/metoclopramide.

Application to Clinical Practice

Two previous studies found mixed results using magnesium (Corbo 2001, Cete 2005). This new study found that IV magnesium may be an additional option. The authors didn’t compare magnesium to more common treatments such as prochlorperazine or metoclopramide 20 mg (+/- ketorolac and diphenhydramine), which may limit its generalizability. However, magnesium’s pain lowering effect was good regardless of comparator group.

Shahrami A, et al. Comparison of therapeutic effects of magnesium sulfate vs. dexamethasone/metoclopramide on alleviating acute migraine headache. J Emerg Med 2015;48(1):69-76. [PMID 25278139]

Originally posted Jan 3, 2015 as University of Maryland (UMEM, @UMEmergencyMed) pearl.

Background

In addition to the down regulation of GABA receptors in chronic ethanol users, there is an upregulation in NMDA receptor subtypes. Although the pathophysiology is much more complex, when ethanol abstinence occurs, there is a shortage of GABA-mediated CNS inhibition and a surplus of glutamate-mediated CNS excitation. If GABA agonists are the mainstay of treatment, why not also target the NMDA receptor? Enter ketamine.

The Data

Only one study exists and was published recently.

  • Retrospective review of 23 adult patients administered ketamine specifically for management of AWS.
  • Mean time to initiation of ketamine from first treatment of AWS, and total duration of therapy were 33.6 and 55.8 hours, respectively.
  • Mean initial infusion dose and median total infusion rate were 0.21 and 0.20 mg/kg/h, respectively.
  • No change in sedation or alcohol withdrawal scores within 6 hours of ketamine initiation.
  • Median change in benzodiazepine requirements at 12 and 24 hours post-ketamine initiation were -40.0 and -13.3 mg, respectively.
  • One documented adverse reaction of oversedation, requiring dose reduction.
  • Authors concluded that ketamine appears to reduce benzodiazepine requirements and is well tolerated at low doses.

Application to Clinical Practice

While the dexmedetomidine studies should not be using reduction in benzodiazepine requirements as an endpoint, it may be acceptable for ketamine since it actually works on the underlying pathophysiology. More studies are needed but it’s good to see we’re starting to look at it.

Wong A, et al. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother 2015;49(1):14-9. [PMID 25325907]

Originally posted May 7, 2015 as UMEM pearl.

Vancomycin guidelines recommend an initial dose of 15-20 mg/kg based on actual body weight (25-30 mg/kg in critically ill patients) (Ryback 2009). The MRSA guidelines further recommend a max dose of 2 gm (Liu 2011).

But, what dose do you give for an obese patient that would require more than 2 gm?

A new study provides some answers to this question. Obese-specific, divided-load dosing achieved trough concentrations of 10 to 20 g/mL for 89% of obese patients within 12 hours of initial dosing and 97% of obese patients within 24 hours of initial dosing.

Application to Clinical Practice

  1. Calculate the total loading dose. At my institution we use actual body weight (the study used IBW).
  2. Divide the total dose to be given every 6 hours until load is complete. We cap each individual dose at 2 gm (the study used 1.5 gm).
  3. Measure a trough level before the third dose.
  4. Change to dosing frequency dictated by renal function once level moves into target range.

Caveats

The study used some more specific dosing calculations based on renal function and percentage above IBW. If patient’s renal function is abnormal, consultation with a pharmacist is recommended.

Denetclaw TH, et al. Performance of a divided-load vancomycin dosing strategy for obese patients. Ann Pharmacother 2015;49(8):861-8. [PMID 2598600]

Originally posted June 6, 2015 as UMEM pearl.

Transitioning Diabetic Ketoacidosis (DKA) patients off an insulin infusion can be challenging. If a long-acting insulin, such as glargine or levemir, is not administered at the correct time to provide extended coverage, patients can revert back into DKA.

Pilot Study

A prospective, randomized, controlled pilot study in 40 patients evaluated administration of glargine within 2 hours of insulin infusion initiation compared to waiting until the anion gap (AG) had closed.

What they did

  • All patients received IV insulin.
  • Experimental: Subcutaneous insulin glargine given within 2 hours of diagnosis.
  • Control: Patients subsequently transitioned to long-acting insulin upon closure of AG.

What they found

Mean time to closure of AG, mean hospital LOS, incidents of hypoglycemia, rates of ICU admission, and ICU LOS were all similar between the groups.

Application to Clinical Practice

Although just a pilot study (using a convenience sample), early glargine administration seemed to be absorbed adequately (based on time to AG closure) and was not associated with increased risk of hypoglycemia. If confirmed in a larger study, this technique could help optimize care of DKA patients in the ED by eliminating the often-mismanaged transition step later on.

Doshi P, et al. Prospective randomized trial of insulin glargine in acute management of diabetic ketoacidosis in the emergency department: a pilot study. Acad Emerg Med 2015;22(6):657-62. [PMID 26013711]

Originally posted July 4, 2015 as UMEM pearl.

The New England Journal of Medicine and Lancet both published studies evaluating idarucizumab for reversal of dabigatran. It is amonoclonal antibody fragment that binds dabigatran with high affinity. Dr. Ryan Radecki summarizes the two articles on his EM Lit of Note blog.

Here are a few take home points from these early studies:

  1. Both studies were funded by Boehringer Ingelheim, who not suprisingly also markets dabigatran. Skepticism is always welcome when the same company makes the drug and the antidote.
  2. The Lancet study was conducted in healthy volunteers, while the NEJM study was conducted in patients needing reversal but lacked a control group.
  3. Idarucizumab seems to reverse laboratory markers of anticoagulation from dabigatran rapidly and completely, including dilute thrombin time and ecarin clotting time. Not all institutions have these assays available.
  4. The dose that seems to ‘work’ the best is 5 gm given IV (two-2.5 gm infusions given no more than 15 minutes apart).
  5. Median investigator-reported time to cessation of bleeding was 11.4 hours in the NEJM study.
  6. 21 of the 90 patients in the NEJM study had ‘serious adverse effects’ including thrombotic events.
  7. The acquisition cost of this medication will most assuredly be high if and when it is FDA-approved in the U.S.

Pollack CV, et al. Idarucizumab for dabigatran reversal. N Engl J Med 2015;373(6):511-20. [PMID 26095746]

Glund S, et al. Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in health male volunteers: a randomised, placebo-controlled, double-blind phase 1 trial. Lancet 2015;386:680-90. [PMID 26088268]

Originally posted July 9, 2015 as UMEM pearl.

How much does the blood glucose concentration increase when dextrose 50% (D50) is administered?

A new study found a median increase of 4 mg/dL (0.2 mmol/L) per gram of D50 administered.

This retrospective study was conducted in critically ill patients who experienced hypoglycemia while receiving an insulin infusion. While it may not directly apply to all Emergency Department patients, an estimation of the expected blood glucose increase from rescue dextrose is helpful. If the blood glucose doesn’t respond as anticipated, it can help us troubleshoot possible issues (eg, line access).

Murthy MS, et al. Blood glucose response to rescue dextrose in hypoglycemic, critically ill patients receiving an insulin infusion. Ann Pharmacother 2015;49(8):892-6. [PMID 25986006]

Originally posted August 1, 2015 as UMEM pearl.

A new prospective, randomized, double-blind trial compared subdissociative ketamine to morphine for acute pain in the ED.

What they did

  • 45 patients received IV ketamine 0.3 mg/kg (mean baseline pain score 8.6)
  • 45 patients received IV morphine 0.1 mg/kg (mean baseline pain score 8.5)
  • Source of pain was abdominal for ~70% in each group
  • Exclusion criteria was pretty standard

What they found

  • Pain score at 30 minutes: 4.1 for ketamine vs. 3.9 for morphine (p = 0.97)
  • No difference in the incidence of rescue fentanyl analgesia at 30 or 60 minutes
  • No serious adverse events occurred in either group
  • Patients in the ketamine group reported increased minor adverse effects at 15 minutes post-drug administration

Application to clinical practice

  1. In an effort to reduce opioid use in the ED, low-dose ketamine may be a reasonable alternative to opioids for acute analgesia.
  2. State nursing regulations govern who can administer IV ketamine in the ED.
  3. What to prescribe on discharge? Lead author Dr. Motov recommends a “pain syndrome targeted” approach with “patient-specific opioid and non-opioid analgesics.”

Motov S, et al. Intravenous subdissociative-dose ketamine versus morphine for analgesia in the emergency department: a randomized controlled trial. Ann Emerg Med 2015;66:222-9. [PMID 25817884]

If there weren’t enough reasons to avoid opioids, here is another: opioids don’t work for low back pain (LBP).

Objective

A well-done, double-blind, randomized controlled trial from JAMA set out to compare functional outcomes and pain at 1 week and 3 months after an ED visit for acute LBP among patients randomized to a 10-day course of (1) naproxen + placebo; (2) naproxen + cyclobenzaprine; or (3) naproxen + oxycodone/acetaminophen.

Intervention

  • Nontraumatic, nonradicular LBP of 2 weeks’ duration or less
  • All patients were given 20 tablets of naproxen, 500 mg, to be taken twice a day.
    • They were randomized to receive either 60 tablets of placebo; cyclobenzaprine, 5 mg; or oxycodone, 5 mg/acetaminophen, 325 mg. Participants were instructed to take 1 or 2 of these tablets every 8 hours, as needed for LBP.
  • Patients received a standardized 10-minute LBP educational session prior to discharge.

Outcome

Neither oxycodone/acetaminophen nor cyclobenzaprine improved pain or functional outcomes at 1 week compared to placebo, and more adverse effects were noted.

Application to Clinical Practice

Among patients with acute, nontraumatic, nonradicular LBP presenting to the ED, avoid adding opioids or cyclobenzaprine to the standard NSAID therapy.

Friedman BW, et al. Naproxen with Cyclobenzaprine, Oxycodone/Aceaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. JAMA 2015;314(15):1572-80. [PMID 26501533]

Not to be outdone by the recent FDA approval of Idarucizumab to reverse dabigatran, a new factor Xa reversal agent is under investigation. “Andexanet binds and sequesters factor Xa inhibitors within the vascular space, thereby restoring the activity of endogenous factor Xa and reducing levels of anticoagulant activity, as assessed by measurement of thrombin generation and anti factor Xa activity, the latter of which is a direct measure of the anticoagulant activity.”

Design

Two parallel randomized, placebo-controlled trials (ANNEXA-A [apixaban] and ANNEXA-R [rivaroxaban]) were conducted in healthy vounteers to evaluate the ability of andexanet to reverse anticoagulation, as measured by the percent change in anti factor Xa activity after administration.

What they Found

Compared to placebo, andexanet significantly reduced anti-factor Xa activity, increased thrombin generation, and decreased unbound drug concentration in both the apixaban and rivaroxaban groups.

Application to Clinical Practice

  1. This drug is not yet FDA approved.
  2. These trials were funded by the maker of andexanet (Portola Pharmaceuticals) and supported by the makers of apixaban and rivaroxaban.
  3. Studies are needed in patients requiring urgent reversal.
  4. The trials looked only at laboratory markers of anticoagulation. We don’t know how fast (or the extent of) the reversal activity is in the clinical setting.

Siegal DM, et al. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med 2015;373(25)2413-25. [PMID 26559317]

Tramadol has a reputation for being a safe, non-opioid alternative to opioids. Nothing could be further from the truth. Several blogs have published about the dangers of tramadol:

But what about seizure risk? Previous studies have been unable to confirm an increased seizure risk with therapeutic doses of tramadol (Seizure Risk Associated with Tramadol Use from EM PharmD blog). However, a new study refutes that premise.
22% of first-seizure patients had recent tramadol use!

  1. Mean total tramadol dose in last 24 hours (reported): 140 mg
  2. Duration of tramadol use less than 10 days: 84.5%
  3. Seizure within 6 hours of tramadol consumption: 74%

This was a retrospecitve study without laboratory confirmation of tramadol intake. Nevertheless, it behooves us not to think of tramadol as a safer alternative to opioids. It is an opioid after all, and it comes with significant adverse effects.
Asadi P, et al. Prevalence of Tramadol Consumption in First Seizure patients; a One-Year Cross-sectional Study. Emerg (Tehran) 2015;3(4):159-61. [PMID 26495407]

Pickard R, et al. Medical expulsive therapy  in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet 2015;386:341-9. [PMID 25998582]

Take Home: Tamsulosin 0.4 mg and nifedipine 30 mg are not effective at decreasing the need for further treatment to achieve stone clearance in 4 weeks for patients with expectantly managed ureteric colic.

It’s not technically a pharmacotherapy article, but this is my favorite article of the year:

Favaloro EJ, et al. Laboratory Testing in the Era of Direct or Non–Vitamin K Antagonist Oral Anticoagulants: A Practical Guide to Measuring Their Activity and Avoiding Diagnostic Errors. Semin Thromb Hemost 2015;41:208–27. [PMID 25703514]

It’s the most comprehensive and practical review of laboratory interpretation for oral anticoagulants I’ve seen. It includes excellent algorithms for how to confirm/exclude various oral anticoagulants based on commonly available labs. An absolute must-read and an outstanding resource to keep in your Dropbox or Google Drive.

Author information

Bryan D. Hayes, PharmD, FAACT

Bryan D. Hayes, PharmD, FAACT

Associate Editor, ALiEM
Creator and Lead Editor, CAPSULES series, ALiEMU
Clinical Associate Professor, EM and Pharmacy Practice

Clinical Pharmacy Specialist, EM and Toxicology
University of Maryland

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PV Card: Adult scaphoid fracture

snuffbox tendernessWhat is the most commonly fractured carpal bone in adults? It’s the scaphoid bone. As a bonus it has the dreaded complication of avascular necrosis. So how good are the physical exam and imaging modalities in diagnosing a fracture? What is the likelihood ratio (LR) that snuffbox tenderness predicts a fracture? Bottom lines: The exam is highly sensitive but poorly specific, such that one can only confidently state that a NON-tender snuffbox and scaphoid tubercle essentially rule out an acute scaphoid fracture. Also negative x-rays for patients with scaphoid tenderness still yield a fracture post-test probability of 25%. This PV card breaks down all the LRs [1].

PV Card: Scaphoid Fracture

Scaphoid Fracture PV

You can download this PV card: [MS Word] [PDF].
See other Paucis Verbis cards.

Reference

  1. Carpenter CR, Pines JM, Schuur JD, Muir M, Calfee RP, Raja AS. Adult scaphoid fracture. Acad Emerg Med. 2014; 21(2): 101-21. PMID: 24673666

 

 

Author information

Sean Kivlehan, MD MPH

Sean Kivlehan, MD MPH

International Emergency Medicine Fellow

Department of Emergency Medicine
Brigham and Women's Hospital

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EBSCO Health/DynaMed Plus EM Residency Wellness Grant winner: Dr. Kory Gebhardt

EBSCO Health/DynaMed Plus EM Residency Wellness Grant

A few months ago, the ALiEM Chief Resident Incubator launched a nation-wide competition to find the best EM residency wellness ideas out there. Today we announce the winner, Dr. Kory Gebhardt and the Northwestern EM residency program. Thanks to the Chief Resident Incubator’s sponsor EBSCO Health/DynaMed Plus for generously underwriting this grant, which focuses on the crucial and often underappreciated aspect of graduate medical education and training — wellness.

 

 

EM Wellness Week

Today marks the ends of EM Wellness Week, but only the beginning for Dr. Gebhardt et al’s year-long, structured wellness curriculum for the Northwestern EM residency program.

EBSCO Health/DynaMed Plus EM Residency Wellness Grant Winning Proposal

A prospective assessment of emergency medicine resident physician wellness

The Project Team

  • Kory Gebhardt, MD (PGY-4, Chief Resident)
  • Carrie Pinchbeck, MD (PGY-3)
  • Logan Weygandt, MD, MPH (PGY-3)
  • Dave Lu, MD, MBE (Faculty Advisor)

Description

In 2015, the Northwestern University EM Wellness Committee was launched and conducted a pilot study to formally measure burnout and other validated markers of wellness among the EM residents. Consistent with other studies from around the country, there were high levels of burnout. The objective of the proposed project is to investigate the impact of specific wellness interventions on NUEM resident burnout and wellness, which includes formal education, small group workshops, and extracurriculum team-building activities. Using a secure platform, the Wellness Committee will periodic measure resident burnout and wellness using validated instruments, such as the Maslach Burnout Inventory, Utrecht Work Engagement Scale, Patient Health Questionnaire-2 depression screen, and the Epworth Sleepiness Scale.

 

Congratulations to the NUEM Wellness Committee for their creative and scholarly approach to addressing wellness in graduate medical education. We look forward to hearing about updates and your findings.

Author information

Michelle Lin, MD

ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco

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Naming contest for ACEP initiative on quality improvement – $250 prize

light bulb cropped - canstockphoto3134429Are you creative? Got a knack for acronyms and catchy names? Want to have bragging rights on naming a major American College of Emergency Physicians (ACEP) initiative? Want to win a $250 prize? Here is your chance. ALiEM has partnered with ACEP to help be the social media wing in their ambitious, grand-scale quality improvement collaborative based on Choosing Wisely recommendations.

What is TCPI and SANS?

The Transforming Clinical Practices Initiative (TCPI) is a national effort funded by the Center for Medicare & Medicaid Innovation (CMMI) to help clinicians achieve large-scale health transformation over the next four years. As a Support and Alignment Network (SAN), ACEP will create a system to help EM clinicians and EDs provide higher value care by working on quality improvement projects alongside EDs across the nation seeking to improve quality, reduce cost, and prepare for alternative payment methods. ACEP is particularly interested in recruiting EDs serving small, rural and medically underserved communities to play an active role in this national movement to learn and deploy novel quality initiatives.


Purpose of Naming Contest

ACEP recently was named as one of 10 Support and Alignment Networks (SAN) — part of the Centers for Medicaid and Medicare Services (CMS) Transforming Clinical Practice Initiative (TCPI). ACEP seeks a name for the collaborative that will encompass the concept of quality improvement and practice transformation in emergency patient care. During the next four years, the ACEP SAN will transform clinical emergency care practice via 3 major initiatives:

  1. Improving clinical outcomes for patients with sepsis
  2. Reducing avoidable testing by supporting clinicians implementing ACEP’s Choosing Wisely recommendations
  3. Reducing avoidable testing and hospitalization for ED patients with low-risk chest pain

Name Criteria

The name should include the following:

  • Features “Emergency Care” or “Emergency Medicine”
  • Features the concept of quality improvement or practice transformation
  • Name must be able to be transformed into an acronym that can be used on public materials and not copyrighted for another health-related project (please check the Copyright Public Catalog)

Award

The winner will receive $250 gift certificate to Amazon.com.

Submission

You must submit your entry by February 6, 2016 (at 11:59 pm EST) through the following Surveymonkey submissions link.

Questions? Contact Nalani Tarrant at ntarrant@acep.org


(c) Can Stock Photo

Author information

Michelle Lin, MD

ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco

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MEdIC Series | The Case of the Awkward Assessors – Expert Review and Curated Commentary

Awkward AssessorsThe Case of the Awkward Assessors outlined a scenario where faculty members are put in a difficult position as they try to provide negative feedback to a medical student working in the ED. What did the ALiEM community think of this case? This month the MEdIC team, led by Brent Thoma (@Brent_Thoma) and Teresa Chan (@TChanMD) hosted a MEdIC series discussion around this issue with insights from the ALiEM community. We are proud to present to you the Curated Community Commentary and our 2 expert opinions. Thank-you to all our participants for contributing to the very rich discussions last week.

This follow-up post includes:

  • Posts by our solicited expert respondents: Dr. Karen Hauer, Associate Dean for Assessment and Professor of Medicine in the School of Medicine at the University of California, San Francisco and Dr. Inna Leybell, Assistant EM Residency Program Director at NYU/Bellevue Medical Centers
  • A summary of insights from the ALiEM community derived from the Twitter and blog discussions
  • Freely downloadable PDF versions of the case and expert responses for use in continuing medical education activities
Expert response 1: Effective feedback delivery: Before, during, and after
Expert response 2: The Art of Feedback
The Case of the Awkward Assessors: Curated from the community

Case and Responses for Download

Click Here (or on the picture below) to download the case and responses as a PDF.

Case 3.04 - Awkward Assessors

Author information

Brent Thoma, MD MA

ALiEM Associate Editor
Emergency Medicine Research Director at the University of Saskatchewan
Editor/Author at CanadiEM.org

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