The number of applications to individual emergency medicine (EM) residency programs has markedly increased over the past decade.1-3 As a result, residency programs have difficulty reviewing applications holistically and struggle to identify applicants who are truly interested in their program. These challenges were exacerbated by the COVID-19 pandemic: programs received more applications; and away-rotation restrictions limited EM applicants’ ability to express, and programs to identify, interest in a residency program or geographic region.2 Additionally, the Association of American Medical Colleges reported a concern for maldistribution of interview offers to the highest tier applicants, leaving other well-qualified students with a paucity of interviews – a trend that would threaten the success of the Match for all stakeholders.4
While simulation plays a prominent role in healthcare education at every level,1 the ability to perform traditional, in-person simulation has been practically eliminated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV), or COVID-19, pandemic. Simultaneously, COVID-19-related education has become vital, as providers work to expand their knowledge base and learn new skills. Were it not for social distancing, simulation would play a major role in addressing the pandemic’s challenges. Simulation-based education could help providers optimize patient care while minimizing viral aerosolization. Simulation could even teach strategies for coping with the emotional consequences of working during a pandemic.
Communication is complex in that what we say is not always what is heard. Communication that is intended to help can sometimes result in doing harm. The COVID-19 pandemic is a public health emergency. While we rapidly learn of the scientific and healthcare aspects of this disease, there is an opportunity to better understand the consequences of well-intentioned communication by experts.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that was first detected in China, was declared a public health emergency of international concern on January 30, 2020. By March 11, 2020, the World Health Organization (WHO) characterized it as a global pandemic. The United States reported its first cases of coronavirus disease 2019 (COVID-19), the illness caused by SARS-CoV-2, on January 20, 2020. As of September 2, 2020, there have been over 6.26 million confirmed cases of COVID-19 in the United States with over 13,000 confirmed cases in the city of Detroit, Michigan.1 SARS-CoV-2 is a highly transmissible virus. The disease it causes, COVID-19, is a predominantly respiratory illness with varying symptom severity contributing to the potential for significant critical illness.
While current research efforts focus primarily on identifying patient level interventions that mitigate the direct impact of COVID-19, it is important to consider the collateral effects of COVID-19 on antimicrobial resistance. Early reports suggest high rates of antibiotic utilization in COVID-19 patients despite their lack of direct activity against viral pathogens. The ongoing pandemic is exacerbating known barriers to optimal antibiotic stewardship in the ED, representing an additional direct threat to patient safety and public health. There is an urgent need for research analyzing overall and COVID-19 specific antibiotic prescribing trends in the ED. Optimizing ED stewardship during COVID-19 will likely require a combination of traditional stewardship approaches (e.g. academic detailing, provider education, care pathways) and effective implementation of host response biomarkers and rapid COVID-19 diagnostics. Antibiotic stewardship interventions with demonstrated efficacy in mitigating the impact of COVID-19 on ED prescribing should be widely disseminated and inform the ongoing pandemic response.
The Sandy Hook Elementary School mass shooting on December 14, 2012, killed 26 people including 20 young children ages six to seven. The Sandy Hook shooter fired 154 bullets in less than four minutes, or about 38 bullets per minute from a semiautomatic rifle.
When the bullet leaves a Bushmaster rifle, it travels over 2000 feet per second. This velocity gives this bullet its devastating wounding potential. As this rifle bullet penetrates a human body, the energy of the bullet tears and shreds through tissue and bone, resulting in fractures, ruptured livers, and swollen brains, leading to hemorrhage, shock, and death. As an emergency physician, I have cared for hundreds of patients injured by bullets. I have had to tell parents that their teenager has died. Even those who survive are forever maimed and suffering. As a physician, I am interested in better understanding this pathogen of gun violence: the bullet and the guns that carry them.1
Firearm-related deaths and injuries are a serious public health problem in California and the United States. The rate of firearm-related deaths is many times higher in the US than other democratic, industrialized nations, yet many of the deaths and injuries are preventable. The California American College of Emergency Physicians Firearm Injury Prevention Policy was approved and adopted in 2013 as an evidence-based, apolitical statement to promote harm reduction. It recognizes and frames firearm injuries as a public health epidemic requiring allocation of robust resources, including increased governmental funding of high-quality research and the development of a national database system. The policy further calls for relevant legislation to be informed by best evidence and expert consensus, and advocates for legislation regarding the following: mandatory universal background checks; mandatory reporting of firearm loss/theft; restrictions against law-enforcement or military-style assault weapons and high capacity magazines; child-protective safety and storage systems; and prohibitions for high-risk individuals. It also strongly defends the right of physicians to screen and counsel patients about firearm-related risk factors and safety. Based upon best-available evidenced, the policy was recently updated to include extreme risk protection orders, which are also known as gun violence restraining orders.
Encouragingly, many governments, financial institutions, and businesses are setting targets to reach net-zero emissions, including targets for 2030. The cost of renewable energy is dropping rapidly. Many countries are aiming to protect at least 30% of the world’s land and oceans by 2030.11
Increasingly, the lay and academic press has blurred the titles and roles of those who deliver various aspects of healthcare. This development confuses patients and fails to acknowledge the substantial differences in training and clinical experience.1
Therefore, beginning with the next issue, the Western Journal of Emergency Medicine will no longer publish the term “provider” in reference to physicians except as required to reference specific laws or formal program names. The decision to formally and publicly expunge a term from our written language should not be – and was not –taken lightly. Yet the evidence overwhelmingly supports the scientific and professional obligation of the Journal to accurately and respectfully refer to healthcare professionals of all degree types and roles. As we strive to phase out use of this term, we encourage other journals to do the same.
Social identity-based discrimination from patients against healthcare providers is a prevalent and well- documented phenomenon. Numerous studies and essays detail clinicians’ experiences of slurs, harassment, and violence from patients based on racial identity. In this essay, we advance arguments about how emergency departments (ED) should respond to interpersonal racism from patients. We use an anthropological definition of race as a socially constructed way of categorizing humans based on perceived physical traits, such as skin and hair color.9 However, race does not have an inherent biological or genetic basis: there is greater physical and genetic variation within racial groups than between them, and racial categories vary across societies. Rather, race is assigned in ways that afford privilege, wealth, and power to some, while disadvantaging others.
Angiotensin-converting enzyme 2 (ACE2) and its role in viral transmission and associated morbidity has also been a topic of recent COVID-19 associated discussion. ACE2 receptors on pulmonary endothelium serve as a main entry point for coronavirus.
In the current age of ubiquitous Internet connectivity and the ability to share anything on social media at a moment’s notice, it is critical that physicians be aware of laws enacted to protect our safety and integrity as practicing clinicians in the 21st century.
In recent months, the University of California has gained significant attention for taking a strong stance in support of open access publishing of UC research as it negotiates new agreements with major journal publishers.
Until 2019, the Emergency Medicine ACGME (Accreditation Council for Graduate Medical Education) program requirements stated that institutions were required to provide protected non-clinical time for core faculty. Specifically, core faculty could not be required to generate clinical or other income to support that protection. These core faculty could not average more than 28 clinical hours per week, or 1344 clinical hours per year. In the new proposed program requirements, the requirement to ensure this non-clinical time has been removed.
The true intent of the ACGME Milestones is to represent the developmental trajectory of a resident over time. The variability in faculty ratings, which may initially seem frustrating, are instead intentionally important to the process of monitoring development in our trainees. There is no perfect assessment tool and there will be variability in assessments. And that’s okay.
This paper provides an overview of the importance of grant funding within medical education, followed by a stepwise discussion of strategies for creating a successful grant application for medical education-based proposals.
Like the fable of the blind men and the elephant, each of whom, feeling a different part of the elephant, described it in very different ways, clinical reasoning is a vast, complex construct that is described and used in different ways by different people
Healthcare organizes doctors and patients into a system where that relationship can be financially exploited and as much money extracted as often as possible by hospitals, clinics, health insurers, the pharmaceutical industry, and medical device manufacturers.
In this issue of WestJEM, Smith and colleagues present a prospective observational evaluation of anticoagulation prescribing practices in non-valvular AF. Patients presenting to one of seven Northern California EDs with AF at high risk for stroke were eligible unless admitted, not part of Kaiser Permanente of Northern California (KPNC), or already prescribed anticoagulation