Academic Career Guide I (Chapters 1-8 Summary)

Society for Academic Emergency Medicine The History of Academic Emergency Medicine : Milestones u s: Emergency Department regarded as a “pit”…a place to start, end, or be exiled if you were impaired or incompetent u Patient pressures (volumes, expectations), lessons in trauma care from major wars, and recognition of highway injuries spurred the need for better training for Emergency Physicians (EP’s) u Beginning of American College of Emergency Physicians (ACEP) u First Scientific Assembly in Denver, Colorado - Summarized from G. Hamilton, SAEM ACG Chapter 1, 2007

Society for Academic Emergency Medicine The History of Academic Emergency Medicine : Milestones u 1970s: The first residencies: Cincinnati, Penn, USC, Chicago, Louisville u 1972: AMA rejects 1 st proposal for Residency training in emergency medicine u 1973: ACEP creates their own approval process with ACEP Graduate Education Committee u 1972: publication of EM’s first journal, Journal of the American College of Emergency Physicians (JACEP) -Summarized from G. Hamilton, SAEM ACG Chapter 1, 2007

Society for Academic Emergency Medicine The History of Academic Emergency Medicine : Milestones u 1974: formation of Emergency Medicine Residents’ Association (EMRA)…with growing numbers of residents u Society of Teachers of Emergency Medicine (STEM): created through ACEP, a first vital link to American Association of Medical Colleges u 1975: AMA approves a permanent Section of Emergency Medicine and standards for EM residencies -Summarized from G. Hamilton, SAEM ACG Chapter 1, 2007

Society for Academic Emergency Medicine Academics vs. Community Practice? What is Academic Practice? u Keystones: Clinical Practice, Teaching, and Research u ABEM: academician is practitioner who spends 40% of their time outside of clinical duties (writing, teaching, research)…usually with protected time for these pursuits. -tenure track positions often have requirements for research funding, publications, and scholarly work. u Generally associated with a teaching hospital and core faculty at EM residency programs -Summarized from LC Patten and F Ankel, SAEM ACG Chapter 2, 2007

Society for Academic Emergency Medicine Academics vs. Community Practice? Early Paths to Academics u Get involved in research: many academic careers will require work in research, so residents may be well served to learn the fundamentals of research funding, proposals, writing early u Find a mentor: get key advice for academicians who have paved their way before you u Fellowships: academics highly values training beyond the usual EM residency. Possibilities include toxicology, pediatric emergency, sports medicine, ultrasound, pre- hospital care, education, research -Summarized from LC Patten and F Ankel, SAEM ACG Chapter 2, 2007

Society for Academic Emergency Medicine Academics vs. Community Practice? What is Community Practice? u ABEM: community practitioners spend more than 50% of their time on clinical duties u Other duties often include administration or quality improvement u Residents not training in community-hospital based residencies who are considering community practice should do elective rotations at a community hospital to evaluate this practice type first hand u Community practitioners are good resources for residents who wish to explore community practice -Summarized from LC Patten and F Ankel, SAEM ACG Chapter 2, 2007

Society for Academic Emergency Medicine Choosing Academics: How to Plan Your Residency u The foundations of success in academics are excellence in both clinical EM and “scholarly activities” u Success in academics is possible from 3 and 4 year programs (any sticking points resolve after 1 year of practice or fellowship) u Requisite tools for academics to develop: clinical, teaching, research, writing, administrative, and “people” skills u Participation in national organizations (EMRA, ACEP, AAEM, SAEM) provide opportunities for mentorship, networking and collaboration -Summarized from J Davis JL Oakes, SAEM ACG Chapter 3, 2007

Society for Academic Emergency Medicine Choosing Academics: pros/cons of different paths u Chief Resident: pros- valuable experience with administrative duties, policy making, quality improvement, teaching, advocacy cons- depending on format: an additional year before fellowship or entering workforce or additional rigor to senior year u Graduate degrees: pros- creates focus and expertise for future work cons- additional time and financial commitment. u Fellowship: (see also the next section) pros- create a precious niche within academic emergency medicine cons- additional training time and delayed workforce entry and financial rewards -Summarized from J Davis JL Oakes, SAEM ACG Chapter 3, 2007

Society for Academic Emergency Medicine Importance of a Fellowship: Jump Start Your Academic Career u Check Fellowship section of for details u Why? Identify and develop a niche within emergency medicine - Pursue specific interests and skill sets -Mentorship for developing academicians -Some include additional degree’s (MBA, MPH, MS) -ACGME board certification (only available for some types of fellowships: Hyperbaric, Pediatric EM, Sports medicine, Toxicology, Hospice) Why Not? 1-3 year delay in larger salary and likely worse work schedule -Summarized from DS Howes, SAEM ACG Chapter 4, 2007

Society for Academic Emergency Medicine Importance of a Fellowship: What are the Choices? u Medical Education/Faculty Development: work clinical shifts in academic center, while also protected time for didactic teaching, research, often also opportunities for Master’s degree in education u Administration: exposure to operational workings in ED and hospital. May include graduate work towards MBA or MPA degree u Critical Care: currently EM physicians cannot become board certified. However EM physicians can utilize these skills/training in practice and some serve as medical directors of ICU’s despite lack of board certification -Summarized from DS Howes, SAEM ACG Chapter 4, 2007

Society for Academic Emergency Medicine Importance of a Fellowship: What are the Choices? u Emergency Medical Services (EMS): further experience with pre-hospital emergency care and EMS system. Fellows often serve as medical director (or assistant director) for local EMS systems u Hyperbaric Medicine: hyperbaric physiology and diving medicine. Applications include decompression sickness, non-healing wounds, infections, carbon monoxide poisoning, others u International Emergency Medicine: evaluate emergency health needs in countries lacking EMS systems. Often requires international travel and MPH degree -Summarized from DS Howes, SAEM ACG Chapter 4, 2007

Society for Academic Emergency Medicine Importance of a Fellowship: What are the Choices? u Pediatric Emergency Medicine: training taking care of pediatric patients, mainly in ED but also with ICU and subspecialty exposure. Usually incorporates protected research and teaching time u Hospice and Palliative Care: new in 2007, training programs still being developed u Sports Medicine: non-operative management of musculoskeletal sports conditions. Not all programs accept EM physicians -Summarized from DS Howes, SAEM ACG Chapter 4, 2007

Society for Academic Emergency Medicine Importance of a Fellowship: What are the Choices? u Toxicology: biochemistry, pharmacology, and toxic effects of pharmaceutical and environmental compounds. Often includes opportunities to work with poison control centers. u Ultrasound: many applications, including experimental. Also involved in credentialing /teaching others to use EM ultrasound u Others: (see SAEM website) forensics, medical informatics, disaster research and management, geriatrics, neurological and cardiovascular emergencies -Summarized from DS Howes, SAEM ACG Chapter 4, 2007

Society for Academic Emergency Medicine The Academic Skill Set: u More than “I like to teach residents”, though this is important u A Career in academic EM entails deliberate plans aimed at acquiring skills, achieving milestones, and building achievements u Beyond teaching…. -Lecture and Presentation skills: addressing specific learners’ needs, computers skills -Effective communication skills: may be developed by participation in academic tasks in residency -Critical reading and writing skills: essential in teaching, research and admin positions - Summarized from M Dorfsman, SAEM ACG Chapter 5, 2007

Society for Academic Emergency Medicine The Academic Skill Set: Beyond teaching….(continued) -Research: nearly all academic EPs are required to engage in some sort of research -Getting involved in a basic, simple research project early in residency or an academic career provides experience with Institutional Review Boards, statistical methodology, analysis, academic reading/writing, peer reviews, and oral/poster presentations Bottom Line: jump on opportunities to teach, do research, and get administrative experience! - Summarized from M Dorfsman, SAEM ACG Chapter 5, 2007

Society for Academic Emergency Medicine Creating a Healthy Career: Wellness u “Wellness”…what does it mean to you? Realize this meaning may change during different stages in your professional life u Long-term wellness isn’t just the absence of unhealthy feelings or burnout, but it is the active involvement in things that rejuvenate you such as family, friendships, hobbies, spirituality, and exercise -Summarized from F. Nobay, SAEM ACG Chapter 6, 2007

Society for Academic Emergency Medicine Creating a Healthy Career: Wellness u Challenges to Wellness in Emergency Medicine: -Witness tragedy, violence, and illness daily -Shift work (and impact on sleep) -Youth of EM specialty in the hospital hierarchy -Lack of time to rest, socialize, eat optimally during work -Isolation from social support due to geographic and scheduling constraints -Loss of camaraderie resulting from shift work -Briefness of relationships with patients -Difficult interactions with ED staff -Summarized from F. Nobay, SAEM ACG Chapter 6, 2007

Society for Academic Emergency Medicine Creating a Healthy Career: Balancing Personal and Professional Responsibilities u Create a long-term vision of your life: helps ensure that your aren’t overwhelmed by tumult of the moment u Connect to colleagues: get to know co-workers as people, not just other staff. Connection creates intimacy of our experience u Enjoy what you do: at least some of the time. Find humor and laughter in your work u Physical well being: exercise, sleep hygiene and protection, good nutrition and hydration u Keep in touch with family, friends to stay connected with life outside of medicine and find support. Especially with immediate family. Find ways to be present for important life events (birthdays, graduation, etc.) -Summarized from F. Nobay, SAEM ACG Chapter 6, 2007

Society for Academic Emergency Medicine Creating a Healthy Career: Time Management u Make plans: create things to look forward to: anything from lounging in front of TV, to exotic trips u Take time for yourself: 5 minutes? A weekend? You must have ways to refuel the energy it takes to be an EP u Be realistic: You won’t have time to do everything you want to and still get adequate sleep. Avoid over-extending your schedule u Invest in a time management tool: PDA? Home calendar? Choose one method that works for you and your family to interconnect your life -Summarized from F. Nobay, SAEM ACG Chapter 6, 2007

Society for Academic Emergency Medicine Creating a Healthy Career: Avoiding Burnout u “Syndrome of emotional exhaustion, depersonalization and a sense of low personal accomplishment that leads to ineffectiveness at work” u Manifestations: Loss of interest in work, fear, avoidance, anger, loathing, fatigue, irritability, headache, malaise, anxiety, broken relationships, disillusionment u Red Flag: if you’re asked about burnout by more than 1-2 people…start looking for resources/support. Watch out for exacerbation of psychiatric illness or substance abuse u Unique stressors for Women EPs: called something other than “doctor”…different expectations by staff…balancing work with motherhood. Try finding a mentor, set realistic expectations for yourself, and set limits/ say “no” -Summarized from F. Nobay, SAEM ACG Chapter 6, 2007

Society for Academic Emergency Medicine Teaching and Education: Academics as a Clinical Educator u Key topics: -Areas to focus teaching excellence -Identify faculty development opportunities, mentor relationships -How to achieve promotion and tenure in a teaching- based academic career -Summarized from CS Weaver and AJ Callisto, SAEM ACG Chapter 7, 2007

Society for Academic Emergency Medicine Teaching and Education: Academics as a Clinical Educator Areas to focus teaching: -In the ED: great venue for bedside teaching and “learning bites”. Teach to your audience (student? resident? RN? medic?) -Graduate Medical Education: didactics, mentorship, career advice, direct resident supervision -Education Research: peer-reviewed publications, book chapters, grant funding, advancement of medical education and discovery/validation of learning products -Summarized from CS Weaver and AJ Callisto, SAEM ACG Chapter 7, 2007

Society for Academic Emergency Medicine Teaching and Education: Academics as a Clinical Educator Faculty Development: Becoming an Accomplished Teacher - National/local faculty development programs - Advanced Education degrees: credibility in academics, opportunities to collaborate w/ other graduate staff Having a mentor, successful as a clinician-educator is felt to have one of the most positive influences on career development -Summarized from CS Weaver and AJ Callisto, SAEM ACG Chapter 7, 2007

Society for Academic Emergency Medicine Teaching and Education: Academics as a Clinical Educator Promotion and Tenure: what does your institution offer? -dual track? clinical track vs. tenure track?. The key is understanding what your institution’s criteria are, if the overall mission of the institution values clinical teaching (with promotion tracks that reflect this value)…key issues in your job search -documentation: keeping evidence of everything: educational endeavors, teaching evaluations, awards, evidence of quality advising….promotion committees are interest in this evidence of achievement and expertise -Summarized from CS Weaver and AJ Callisto, SAEM ACG Chapter 7, 2007

Society for Academic Emergency Medicine Medical Student Educator Pathway: Teaching within the Curriculum u First Year Students: Basic first aid, fundamentals of EMS systems and triage, ethics of emergency care, introducing the patient interview and physical exam u Second Year Students: emphasizing pathophysiology and pharmacology: shock, drug abuse, toxicology case studies can be integrated into core science material - also a time to tutor/participate in small group learning, skills laboratories, and observational ED rotations -Summarized from G Schmitz and C Hobgood, SAEM ACG Chapter 8, 2007

Society for Academic Emergency Medicine Medical Student Educator Pathway: Teaching within the Curriculum u Third Year Students: ideally dedicated 4-8 week ED rotations with focused core competencies and very basic procedures. Key opportunities for educators to directly supervise student clinical activity and teach u Fourth Year Students: clinical rotation vs. sub-internships. - didactic program emphasizing problem based management - procedural didactics/labs: suturing, splinting, IV access, airway and resuscitation. Focus on recognizing life-threatening conditions - ideally multiple formats: bedside, skills labs, simulation courses -Summarized from G Schmitz and C Hobgood, SAEM ACG Chapter 8, 2007

Society for Academic Emergency Medicine Medical Student Educator Pathway: Student Contact outside the Curriculum u Career Advisor: critical to raise awareness of EM as a career choice and contribute to general welfare of students u Mentoring: take an active role in students’ future and career development, especially key for women and underrepresented minorities in academic medicine u Interest Group Advisor: broad exposure for interested students u Clinical Research: get a student involved in your research! u Journal Club Advisor: teach clinical concepts and critical literature review and evidenced based medicine -Summarized from G Schmitz and C Hobgood, SAEM ACG Chapter 8, 2007

Society for Academic Emergency Medicine Author Credit – Acad Career Guide I: E. Willis Nottingham MD Questions

Society for Academic Emergency Medicine Postresidency Tools of the Trade CD 1) Career Planning – Garmel 2) Careers in Academic EM – Sokolove 3) Private Practice Career Options - Holliman 4) Fellowship/EM Organizations – Coates/Cheng 5) CV – Garmel 6) Interviewing – Garmel 7) Contracts for Emergency Physicians – Franks 8) Salary & Benefits – Hevia 9) Malpractice – Derse/Cheng 10) Clinical Teaching in the ED – Wald 11) Teaching Tips – Ankel 12) Mentoring - Ramundo 13) Negotiation – Ramundo 14) ABEM Certifications – Cheng 15) Patient Satisfaction – Cheng 16) Billing, Coding & Documenting – Cheng/Hall 17) Financial Planning – Hevia 18) Time Management – Promes 19) Balancing Work & Family – Promes & Datner 20) Physician Wellness & Burnout – Conrad /Wadman 21) Professionalism – Fredrick 22) Cases for professionalism & ethics – SAEM 23) Medical Directorship – Proctor 24) Academic Career Guide Chapter 1-8 – Nottingham 25) Academic career Guide Chapter 9-16 – Noeller