EMRA*Cast

This topic never gets old! Whether you realize it or not, geriatrics is probably a large part of your practice, especially when it comes to high-complexity, high-acuity emergency medicine. Dr. Lauren Southerland will teach us what we can do to better care for older adults. We’ll also discuss how to get involved at the national level and how to pursue a career in geriatric EM if you want to go a step further.

Patients who are homeless visit the emergency department more often than the general population, yet emergency physicians get minimal formal education about homelessness and the impact of housing on health. In this episode, we talk with three physicians about how we can best support our patients struggling with housing issues.

Host:  Kate Joyce, MD, MPH

Guests:

• Richard Bryce, DO; Chief Medical Officer, Community Health and Social Services Center; faculty advisor for Street Medicine Detroit and Detroit Street Care; faculty at Michigan State University, Wayne State University and Henry Ford Hospital
• Ryan McCormack, MD, MS, FACEP; Assistant Professor, Emergency Medicine and Addiction Medicine, Bellevue Hospital, NYU School of Medicine
• Katherine Chen, MD; National Clinician Scholars Program, Internal Medicine/UCLA

In medicine, one thing you cannot avoid is giving presentations. It is both exciting and nerve-wracking to present to colleagues, attendings, and friends. Yet some doctors are extremely talented at holding captive audiences. Host Dr. Ranjita Raghavan chats with the incomparable Dr. Anand Swaminathan (aka Swami) to give us the scoop on how to make an excellent, engaging lecture in person and on Zoom.

So you've got a handle on the medicine, but have you got a handle on your personal finances? Take a deep dive into financial education and learn about the most common mistakes, questions, and fears young physicians encounter with physicians/personal finance gurus Sotirios Keros and Dalton Haslam.

OverviewNew to emergency medicine residency and trying to take that first step toward building your knowledge base? Maybe you're trying to optimize your study strategy? Look no further! The great thing about EM is that we LOVE medical education. Today we take a look at a variety of educational resources to help build a solid foundation of your medical/clinical knowledge.

Key PointsTopics we cover include:

1. EM gear to bring to shift
2. Podcasts to listen to on the way to shift
3. The most valuable on-shift mobile apps
4. Pocket guides for every clinician
5. Textbooks that won't collect dust
6. Question banks that will be the work-horse of your study plan
7. The best way to keep up with current medical literature
8. How to solidify your knowledge

Resources and References

• Best EM Podcasts: https://www.emra.org/emresident/article/best-podcasts-for-the-student-em-nerd/
• Textbook suggestions by Scott Weingart: https://emcrit.org/recommended-reading/
• EMRA's on-shift guides: https://www.emra.org/apps  https://www.emra.org/amazon  https://www.emra.org/about-emra/publications/bookstore/

OverviewIn this episode originally released in 2019, Drs. RJ Sontag and Andrew Meltzer interview fellow emergency physician Rep. Raul Ruiz, D-CA, to explore how medical students, residents, and recent grads can become advocates for their patients and their profession outside the emergency department. As EMRA's 2019 Congressional Health Policy Fellow, Dr. Sontag worked with Dr. Ruiz on Capitol Hill to turn medical and policy research into legislative solutions on a wide range of topics, from firearm violence prevention to surprise billing to youth nicotine use.

HostsRJ Sontag, MDPresident, EMRA Residency: UT Health San Antonio Medical school: Wright State University EM Resident Articles Twitter: @RJSontagMD

Andrew Meltzer, MD, MS Associate Professor of Emergency Medicine, George Washington University Director, Urgent Matters Fellowship: Clinical Research, University of Maryland Shock Trauma Center Residency: University of Maryland Shock Trauma Center Medical School: SUNY Downstate School of Medicine Twitter: @ACMeltzer

Guest Raul Ruiz, MD, MPH, MPP United States Congressman (CA-36) Fellowship: International Emergency Medicine, Brigham and Women’s Hospital Residency: University of Pittsburgh Medical School: Harvard University Twitter: @CongressmanRuiz

Key Points

• Being an emergency physician provides a unique perspective on governing
• Our understanding of the needs of underserved and underinsured populations can influence policy decisions
• Patient health involves more than just the care we provide in the emergency department
• Social determinants of health, drug pricing, insurance status, and many other factors affect our patients’ health
• To truly improve our patients' health, students, residents, and young physicians must learn the language of advocacy by getting involved at every level of policy creation: from hospital administration to local, state, and federal government
• Emergency physicians are better equipped than other specialties to advocate for our patients and our profession because of our experience standing up for our patients to guarantee they get the care they need every single shift
• Government can play a role in incentivizing technology and alternative payment models to improve health care access and affordability

References

• Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
• Biography, Congressman Raul Ruiz, MD
• EMRA Advocacy Handbook
• EMRA Congressional Health Policy Fellowship
• Urgent Matters

The emergency medicine job market has been tight this year, there's no doubt. COVID has caused some groups and hospitals to cut back or even lay off EM physicians. So what's a resident or fellow to do? In this episode, host Kate Joyce, MD, MPH, gets a few perspectives on the job landscape from Washington Post reporter Ben Guarino, US Acute Care Solutions chief clinical recruiting officer Travis Ulmer, MD, FACEP, and NYU/Bellevue chief resident Michelle Romeo, MD. Learn some tips on navigating the job market this year and in the years to come.

• COVID has added stress to the EM job market, making finding jobs more difficult.
• Applicants are encouraged to apply broadly in terms of setting and geography.
• Recruiters can be especially helpful in the job hunt.
• Talk to your attendings to learn their experience and to find networking opportunities.
• Collaborating with fellow residents can help everyone find work.
• Reaching out to departments directly may reveal jobs not posted on hospital websites.
• Your first job does not have to be your last job.

Host: Dr. Isaac Agboola, MD, MS

Guest: Dr. Sheryl Heron, MD, MDP, FACEP Assistant Dean of Medical Education and Student Affairs at Emory University School of Medicine  Vice Chair of Administrative Affairs Professor of Emergency Medicine

OverviewDrs. Agboola and Heron discuss the intricacies of cognitive bias and cultural competency and the role it plays in the emergency department. They discuss ways that individuals and residency programs alike can ensure they are rendering more culturally competent care - and model that for medical trainees. Additionally, they spend time addressing communities at risk for such biases such as undomiciled populations, individuals from lower socioeconomic status, and racial minorities.

Key Resources

• EMRA Diversity and Inclusion Committee 
• Implicit Bias: What Can We Do?
• Implicit Bias and ED Overcrowding

Key Points

• Cognitive bias, microaggressions and cultural humility should compel us to think more deeply on how we can deconstruct the "-isms".

• It is important to create and nurture an environment that allows for open dialogue in a safe space. 

• As a health care provider there are critical steps that need to be taken: 

• • Appreciate and understand that we are all different - diversity is a good thing!

• • Be prepared to "call the card" if you experience a discriminatory comment/action. It is important to address it. Do not ignore it. 

• Eliminating bias is not an individual effort; it is institutionally and systemically driven.

• Patient populations with common negative biases include those with cardiovascular disease, high utilizers/low socioeconomic status, and the incarcerated.
• There is a large amount of research that demonstrates disparities and inequities in care but more work is still left to be done.

References

• Martin ML, Heron SL, Moreno-Walton L, Strickland M. Diversity and Inclusion in Quality Patient Care: Your Story/Our Story: a Case-Based Compendium. Cham: Springer; 2019

• Dehon E, Weiss N, Jones J, Faulconer W, Hinton E, Sterling S. A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making. Academic Emergency Medicine. 2017;24(8):895-904. doi:10.1111/acem.13214.

• ACEP Implicit Bias and Cultural Sensitivity Paper

Let's discuss a few hot topics: How do rising temperatures affect emergency medicine and the health of your patients? In this episode we sit down with Dr. Caitlin Rublee to discuss bugs, drugs, plants, and people. We connect the dots to show how climate change relates to social emergency medicine and what we can do as leaders to engage in health policy and take action to protect our patients!

Key Points

1. Climate change affects bugs, drugs, plants, and people! Rising temperatures mean increased vector-borne/zoonotic infections,  decreased efficacy of medications and patient access to medications, as well as increased potency of plant-borne illness and decreased biodiversity. Most important, it means poor health outcomes for our patients.
2. Addressing health care equity is crucial when it comes to climate change. Vulnerable populations are disproportionately affected, and social determinants of health are front and center. 
   • Start a conversation about climate change in your program or medical school
   • Incorporate health policy education into your curriculum, research, or QI projects
   • Seek multi-disciplinary collaborators
   • Get involved with organizations within your hospital or on the national stage
3. COVID-19 has exposed our fragile health care system. There are many steps we can take to build climate-smart, climate-resilient health systems to prepare for when disaster strikes. You can:
4. You can talk about climate change with your patients! For example, for your patients with asthma, discuss risks stemming from pollen and air pollution. For your patients who work outside, talk about heat index and cooling measures. 
5. You are a leader: what can you do to inspire and engage? Channel the fierce urgency of now into action! 

Guest: Jess Mason, MD, FACEP, director of the Medical Education Fellowship at UCSF-Fresno and deputy editor of EM:RAP, EM:RAP HD videos, and creator of EM:RAP’s C3

Hosts: Ranjita Raghavan, MD, of The Mount Sinai Hospital EM Residency, and Shreyans Sanghvi, DO, of Northwell Zucker School of Medicine (North Shore/LIJ) 

OverviewEmergency medicine offers an exciting yet staggering number of career paths. In this episode, we explore what it takes to find your niche in the specialty. Get the inside track from Jessica Mason, MD, FACEP, who knew early on what motivates her and has established herself as a leader in FOAMed.

Key Points

• If you are looking for inspiration for what niche to pursue, ask yourself, "What bothers you?" The answer to this question usually will lead to something you are passionate about.
• You do not need to be at a residency that directly fits your passions; you can find mentors and pursue opportunities anywhere you go. You just need to reach out to people; they will generally be willing to help.
• When reaching out to someone, do NOT ask "What should I do?" Instead, come with an idea or plan; this is more helpful and shows you are motivated and inspired, and people will find it easier to help you execute your ideas.
• "Everything is already taken" – except it's not. There is always room for another voice, a different perspective, or a fresh approach. Just because it's been done before does not mean there is no room for you.
• Everyone is always hiring. Remember this; every interaction is a connection, and you never know when an opportunity will pop up suddenly, so reach out to people and places you are interested in.
• Whatever you do, 10% of people are not going to like it – and that is good; it means you made an impression. The most inspiring people usually have strong opinions.
• Say yes to opportunities and be willing to take a leap of faith.