EMRA*Cast

On The Brink of Chief

Hosts:

• Tiffany Proffitt DO, MABS PGY-4 Lakeland Health
• Miguel Reyes MD, PGY-3 and Chief Resident NYU Hackensack

Guests:

• Maddi Massa – Chief at Lakeland in St. Joseph, MI
• Chris Evans - Chief at Doctors in Columbus, OH
• Greg Tanquary - Chief at Doctors in Columbus, OH
• Manavjeet Sidhu PGY - Chief at UCSF-Fresno, CA

Overview:
In this episode, Tiffany and Miguel talk with a panel of newly elected chiefs about their hopes, fears, and plans in their chief year. They share when they knew they wanted to be chief and who influenced that decision. The panel shares the legacies they hope to leave and how they think the chief roll will influence their careers after residency. The episode finishes with some tips for future chiefs and a promise to join EMRACAST for a debrief when this chief year culminates. If you think you might want to be chief, start finding ways to be involved and lead early but be honest with yourself and do it for the right reasons.

References:
EMRA's The Chief Resident Survival Guide

Key Points:

• The Chief role isn’t just for residents hoping for a career in academics and a fellowship spot – it’sabout learning how to lead.
• Be prepared for anything – who knows what will shape your chief year.
• Seek Feedback. Be Humble. Lead by Example.
• And if nothing else… it’s all about the fame and fortune.

Host:  Miguel Reyes, MD PGY-2 Hacken University Medical Center

Guest: Maxwell Thompson, MD

Overview: If you’re interested in ultrasound and want to do a fellowship then this is the podcast for you! We discuss the process of applying, what its like, what to look for in a program.

Key Resources:

• https://eusfellowships.com/
• https://www.emra.org/books/fellowship-guide-book/28-ultrasound/

Key Points:

• Get started ultra sounding early
• US fellowships are 1 year long
• Not ACGME accredited but go through the NRMP match

Dr. Agboola talks with Dr. Tomas Diaz about the complex topic that is diversity and the role it plays in medicine and specifically EM.

Host: Dr. Isaac Agboola MD, MS  PGY-1 YALE 

Guest: Dr. Tomas Diaz MD PGY-4 UCSF @tomasrdiaz

Overview: On this episode, Dr. Agboola and Dr. Diaz discuss the complex topic of diversity and the role that it plays in medicine, highlighting its role in EM. They discuss what programs can do to foster diversity and recruit diverse individuals in the future. They delve into a discussion of how imagery can become expectations and define terms such as minority tax, microaggression, and stereotype threat.  Interspersed throughout this discussion, they open up about their personal experiences as providers of color at their respective training sites.

Key Resources:

• https://issuu.com/sfmedsociety/docs/sf_marin_medicine_sept_2018-issuu (page 25 features Dr. Diaz)
• https://implicit.harvard.edu/implicit/takeatest.html (Harvard implicit bias test)

•  “Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices”  https://www.bmj.com/content/339/bmj.b3450

• “Does Diversity Matter for health?” chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.nber.org/papers/w24787.pdf  

• EMRA diversity and inclusion committee

Key Points:

• Diversity is not just about having colored faces in a space; it is about creating an environment that cultivates and supports diversity.

• Everyone has implicit biases. It is important to be aware of these implicit biases and utilize that information to invoke intrapersonal change.

• Just like allies are useful in overcoming the barriers faced by the LGBTQ community,  allies are also important in overcoming the barriers faced by underrepresented minorities in medicine.

Dr. Kaminsky focuses on practical teaching strategies with Dr. Liu and Dr. Gallegos, covering topics from self-directed learning opportunities, debriefing and brief pearls in the form of digestible teaching moments.

Residents play an important role in medical education to our peers, students, nurses and patients. Internal medicine, surgery and just about every other specialty enjoys the luxury of down-time to reflect on recent presentations or formal didactics, often after rounds. The continuous and often frantic nature of emergency medicine limits our ability to plan for formal teaching. As emergency physicians we are obligated to know the worst of the worst in all medical specialties. But when do we find the time to teach and learn while at work?

Medicine has long embraced the Socratic method of teaching at the bedside -- however there is way more to teaching than “PIMP” questions!

Host: Alex Kaminsky, MD, PGY-2, UCSF - Fresno

Guests: 

Moises Gallegos, MD, MPH, Faculty Attending, Baylor College of Medicine, @moyinscrubs

Jeff Liu, MD, Chief Resident, Baylor College of Medicine

Key Points:

Rule number one: Teaching on-the-fly, while fluid, requires some pre-planning or forethought.

Strategies for teaching on the fly

Courtesy of Dr. Liu and Dr. Gallegos CORD 2019 Hand-out):

1. Focus teaching session into digestible moments. Micro-learning can facilitate teaching in a fast paced environment that may encounter multiple interruptions.
2. Making simple patients sick – the “what if…” game. This is useful when the flow or acuity of patients is low.
3. Debriefing – what just happened and why. This is helpful for highlighting important and critical actions.
4. Setting your learner up for success – using focused directions, pausing for effect, getting a commitment from your learner. By creating a welcoming environment, the learning opportunity solidifies key concepts.
5. Visual pearls around the department – whiteboards, post-it’s, diagrams, etc. These quick ways of highlighting pearls and creating focused learning points can be used to interject teaching into a busy shift that does not allow for dedicated time.
6. Self-directed learning activities/challenges – when you really can’t make the time, facilitate the learner’s practice of searching for answers in evidence-based manners and allow them to be the teacher.

Teaching on the fly isn’t always about creating material “on the fly.” Preparation to develop areas of focus, create a repository of teaching points, and exploring of different teaching styles can facilitate deciding to teach on the spot.

Make a commitment to yourself: Reflective Questions/Thoughts

1. Write down at least one skill to work on that you believe can help you improve on-shift education in your department.
2. What are some topics that you feel comfortable enough with to convey select learning points/pearls if that type of patient encounter were to take place?

Key Resources and Suggested Reading:

• Wolff et al. Not Another Boring Lecture: Engaging Learners with Active Learning Techniques. The J of Em Med. Vol 48, No 1. 2015.

• EMRA Guide: Resident as Educator -- A guidebook by residents for residents. By Guth MD et al.

Dr. Proffitt talks with a panel of Super Doctor Mammas about the art and challenge of mamma docing. The panel openly discusses challenging topics in an attempt to demystify and destigmatize the daily struggles all of us mammas in medicine face throughout medical school, residency and beyond. Listen as we discuss topics such as when to disclose your pregnancy, the lack of firm maternity leave policies in residency, and touch briefly on dealing with miscarriage and infertility during medical training.

Host: Tiffany Proffitt DO, MABS PGY-3 Lakeland Health @ProMammaDoc

Guests:

Meenal Sharkey: Core Faculty at Doctors Hospital Core Faculty @MdSharkattack

Tatiana Moylan: PGY-1 at Yale @tatianamoylan

Mackensie Yore: PGY-2 at UC Fresno

Leah Bauer: PGY-3 at UC Fresno

References:

ACGME Institutional requirements: https://www.acgme.org/Portals/0/PFAssets/InstitutionalRequirements/000InstitutionalRequirements2018.pdf?ver=2018-02-19-132236-600

Greenfield NP. Maternity and medical leave during residency: Time to standardize?. Int J Womens Dermatol. 2015;1(1):55. Published 2015 Feb 20. doi:10.1016/j.ijwd.2014.12.009

Humphries, LS, Lyon, S, Garza, R, et al. Parental leave policies in graduate medical education: A systematic review. American Journal of Surgery. 2017; Oct;214(4):634-639.

Key Points:

• In the era of Times Up Healthcare, I hope concrete ACGME policy change to accommodate moming in medicine is on the docket.
• You need to sit down with your PD and make a concrete policy for your individual pregnancy and maternity leave because there are few well laid out policies in general in GME.
• When planning maternity leave during residency, do not just look at it as the short time frame of delivery to first few months post-partum. Plan it in the context of your entire 3-4 years of residency (depending on the program) and have early discussions with your PD on how to arrange your blocks over those 3-4 years.
• MAMMAS IN MEDICINE: YOU ARE AMAZING!!!! AND YOU ARE NOT ALONE!!!

This episode we talk to Dr. Ordonez about what it’s like to be an academic attending and what it felt like the first year out. Why go into academics, how to best go about obtaining an academic position and other survival tips are all discussed in this podcast!

Host: Miguel Reyes, MD

Guest: Edgar Ordonez, MD

Key Points:

• Find a niche and go with it, that can be your key to success.
• Find a mentor and ask for advice, be honest with them and yourself.
• Stay humble, you won’t always know the answer.
• Transcutaneous before transvenous pacing!

This is the first episode in our Fellowships series. Listen in as Dr. Jessie Werner speaks with our EMRA Fellowship Guide Editor-in-Chief, Dr. Krystle Shafer, about EM fellowships. Why should you do one? Which one is right for you? What should you expect from the application process?

Stay tuned over the next few months as we continue the series and cover the details of specific EM fellowships.

Host: Jessie Werner, MD

Guest: Krystle Shafer, MD

Key Resources:

• EMRA Fellowship Guide: https://www.emra.org/books/fellowship-guide-book/i-title/

Key Points:

• There are a number of different fellowships in Emergency Medicine. Each one has different requirements and sets you up for a unique career.

• When choosing a fellowship, make sure you’re following your passion and have an “end goal” in mind

• Strong applicants will have an proven track record in that specific area of interest

• It’s never too late to apply for a fellowship

EMRA*Cast Host Dr. Jessie Werner talks to Dr. Brian Levine about the EMRA Antibiotic guide and how it can improve your practice.

Host: Jessie Werner, MD

Guest: Brian Levine, MD

Overview: In this episode, Dr. Jessie Werner discusses the EMRA Antibiotic Guide with Editor-In-Chief, Dr. Brian Levine.  Struggle with choosing the right med to treat that pneumonia? That complicated UTI? Find out how this tool can help you select the right antibiotic for just about any infection you encounter in the ED.  

Key Resources:

• https://emra.org/about-emra/publications/bookstore/

Key Points:

• Choosing the right antibiotic is hard! Rely on this guide to provide the most up-to-date recommendations for pretty much any infection you may encounter

• Some new features to the guide:

• Updated antibiograms for local resistance patterns

• Utility of ED tests (urine legionella, CSF, etc)

• Penicillin-allergy algorithm

EMRA*Cast Host Dr. Isaac Agboola speaks with the authors of the EMRA Transgender Care guide to provide residents with helpful advice on the approach to the care of transgender patients in the ED.

Host: Dr. Isaac Agboola, MD, MS  PGY-1 Yale

Guest:  Dr. Julia Paris and Dr. Aiden “Yoshi” Shapiro

Key Resources:

• EMRA Transgender Care Guide

Key Points:

• Best practice is to ask the patient upfront what pronouns they prefer and use those.

• It is important to ask patients what body modifications has the patient taken in order to feel more comfortable with their appearance. Be it surgical, non-surgical or hormonal because that may affect your differential and treatment algorithms.

• Transgender patients are at increased risk for intimate partner, substance abuse and sexually transmitted infections it is very important to take a thorough social history.

• Understand that this is an area where there hasn’t been much formal education as far as most medical schools and residencies are concerned; So be comfortable in your discomfort.

References:  

• https://www.emra.org/books/transgender-care-guide/trans-care-guide-intro/

Dr. Tiffany Proffitt talks with Dr. Richard Bounds about the challenges of starting a residency program.

Podcast Host

Tiffany Proffitt DO, MABS PGY-3 Lakeland Health

Podcast Guest

Dr. Richard Bounds, Emergency Medicine Physician, Program Director for the new Emergency Medicine program at the University of Vermont, Associate Professor Department of Surgery, former Associate Program Director Christiana Care Health System Emergency Medicine Residency, and Co-Director Christiana Care Medical Education Fellowship, @rich_bounds

Short Description of Episode:
Recorded at ACEP 2018 on the Expo floor. A discussion with Dr. Bound on the unique challenges of starting a residency program as well as advice to all the future program directors of the world regarding pitfalls to avoid and opportunities and resources to embrace. Are there questions you want that I didn’t ask? Find Dr. Bounds during his CORD session on dominating the ACGME site visit!

Content of Show Notes:

Dr. Bounds Top 3 for starting an Emergency Medicine residency:

1) Preparation

2) Foster Relationships – KEY TO GET THINGS DONE AND BE AN EFFECTIVE LEADER

3) Anticipate next steps – prepare for possible pitfalls! (see #1)!

Citations for Any Relevant Articles (AMA format please):

@UVM_EM

www.med.uvm.edu/emergencymedicine/education/residency

Leading change. John P. Kotter, 1996, Harvard Business School Press, Boston, MA