Academic Emergency Medicine Departments Research Articles

Effect of serial night shifts on the cognitive, psychomotor, and moral performance of residents in the department of Emergency Medicine.

The objective was to study the effect of serial night shifts on the cognitive, psychomotor, and moral performance of emergency medicine residents of an academic Emergency Medicine Department. This prospective case-crossover study compared emergency medicine residents' sleep time, subjective sleepiness, cognitive function, moral judgment, and psychomotor skills after 5 consecutive days versus night shifts using sleep diaries, activity monitors, and multiple performance tests. Paired t-tests and Wilcoxon signed-rank tests were used to analyze data based on normality. Correlation analysis was done using Spearman's correlation test. Subgroup analysis was also performed to find any difference based on gender and year of residency. Twenty-seven emergency medicine residents participated (13 males, 48.1%). The distribution across residency years was as follows: 44.4% in their first year, 25.9% in their second year, and 29.6% in their third year. Following five consecutive night shifts, total sleep duration decreased significantly from 338.1 ± 67.8 to 307.4 ± 71.0 min (p < 0.001), while subjective sleepiness scores increased from 9.6 ± 3.3 to 13.6 ± 4.6. Psychomotor performance and reaction times did not significantly differ between night and day shifts. However, working memory declined, assessed by self-paced three-back test scores (median [IQR] 517.1 [471.9-546.7] vs. 457.6 [334.4-508.8]; p = 0.034) and interference test scores (445.5 ± 59.9 vs. 407.2 ± 56.8; p < 0.001), along with moral judgment (median [IQR] 19 [18-28] vs. 15 [11-21]; p = 0.010) after serial night shifts. No correlations existed between performance measures nor differences based on gender or residency year. Residents sleep less following night versus day shifts, reporting the highest sleepiness levels after 5 consecutive nights. Despite this, psychomotor performance and reaction times did not significantly differ. However, considerable reductions occurred in moral judgment, working memory, and interference test performance after serial night shifts.

Bed-up-head-elevated Position versus Supine Sniffing Position in Patients Undergoing Rapid Sequence Intubation Using Direct Laryngoscopy in the Emergency Department – A Randomized Controlled Trial

Introduction: The objective of this study is to compare bed-up-head-elevated (BUHE) position with supine sniffing position (SSP) in patients undergoing rapid sequence intubation (RSI) using direct laryngoscopy in the emergency department (ED). Methods: This single-center randomized controlled superiority trial was carried out from September 2021 to December 2022 in an academic emergency medicine department. The patients undergoing RSI in ED were grouped into two arms, namely BUHE position and SSP. The primary outcome was the time taken for endotracheal intubation. The secondary outcomes were the first-pass success rates and postintubation complications. Results: A total of 136 patients were enrolled in the study. Time for intubation in the BUHE group was no different from SSP (32.09 s [interquartile range (IQR): 23.30–42.68] vs. 33.40 [IQR: 27.53–45.90], P = 0.17). There was a modest reduction in intubation time when performed by trained experts (22.5 s [IQR: 17.7–25.3] versus 30.3 s [IQR: 21.3–33.2], P = 0.04). The first-attempt success rate in the BUHE position was also similar to the SSP position ([91.18% vs. 90.91%] P = 0.958). Postintubation complications were lesser in BUHE compared to the SSP group ([7.4% vs. 19.7%] P = 0.04). Conclusions: In our study, BUHE position did not improve time to intubation and first-pass success rate in ED patients compared to SSP. A modest decrease in intubation time was noted while experts used the BUHE position. The postintubation complications were slightly lesser in the BUHE group.

Clinical duties and compensation for U.S. emergency medicine fellows at academic centers: A descriptive, cross-sectional survey.

Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little is known about the clinical hours worked and financial compensation received by fellows during training. We sought to describe the clinical duties and financial compensation of EM fellows at U.S. academic centers. This cross-sectional study surveyed U.S. academic EM department administrators who were members of the Society for Academic Emergency Medicine's Academy of Administrators in Academic Emergency Medicine (AAAEM) regarding their fellowship programs and fellows. We electronically distributed the validated survey instrument to 73 member sites between October 2022 and January 2023. Survey domains included fellow and fellowship demographics, base and total annual clinical hours, and base and total annual compensation. We calculated descriptive statistics and compared fellows by accreditation (Accreditation Council for Graduate Medical Education [ACGME] or non-ACGME) using chi-square and Wilcoxon rank-sum testing. We conducted a secondary analysis of base and total salary by gender and accreditation using Wilcoxon rank-sum testing. We received 38 institutional responses (response rate 52%), which represented 217 individual fellows. Nearly three-fourths (n = 158, 72.8%) of fellows enrolled in non-ACGME fellowships, worked 33% more base hours annually than ACGME fellows (median 571 h vs. 768 h, p < 0.001), and received base compensation 20% higher than ACGME fellows ($88,540 vs. $70,777, p < 0.001). Accounting for additional compensation, the median total annual compensation for non-ACGME fellows remained 11% higher than ACGME fellows ($105,000 vs. $93,853, p = 0.004). We observed no significant differences salary when stratified by gender. Most EM fellows at U.S. academic institutions enrolled in non-ACGME fellowships with significantly higher base hours and financial compensation than ACGME fellowships. These results represent the first description of the clinical hours and financial compensation of academic EM fellows and should be considered in ongoing benchmarking efforts by AAAEM.

Identifying the prevalence and characteristics of diversity, equity, and inclusion leaders in academic emergency medicine.

Our study aims to better understand and describe the current state of diversity, equity, and inclusion (DEI) leadership in emergency medicine (EM) by identifying the prevalence of department DEI leadership positions, their demographics, and their job duty characteristics. We disseminated an electronic survey from April to July 2022 to Society for Academic Emergency Medicine (SAEM) Association of Academic Chairs of Emergency Medicine, Academy for Diversity and Inclusion in Emergency Medicine, and the Equity and Inclusion Committee to identify department DEI leads. From July to August 2022, a 45-question survey was sent to all identified DEI leaders on individual characteristics, DEI experience, and DEI lead job description. We received a response from 79 out of 120 academic EM departments identified (65.8%). Of the responding institutions, 59 (74.7%) reported a DEI leader. A total of 74.6% of these DEI leaders responded at least partially to our survey and 57.6% responded in full. The most common titles were vice/associate chair of DEI (34.4%), director of DEI (28.1%), and DEI committee chair (18.8%). Most respondents (84.4%) were the inaugural DEI lead in their department and 84.4% of respondents did not have a formal DEI role in their department previously. On average, respondents have had their DEI title for 2 years (range 0-7 years) with an average of 7 years (range 0-30 years) of experience performing DEI work. Many (63.4%) do not receive any funded effort for their DEI roles. Most DEI leads were not tenure track (72.2%) and most commonly at the rank of assistant professor (47.2%) followed by associate professor (33.3%), full professor (16.7%), and instructor (2.8%). This is the first known study to assess the characteristics of DEI department leaders in EM. EM DEI leadership positions are new, common, and led by diverse personal identities and are often not funded. Future directions could gain qualitative insight into this workforce to guide best practices in EM DEI leadership.

Boarding in US Academic Emergency Departments During the COVID-19 Pandemic.

The first 2 years of the COVID-19 pandemic brought substantial and dynamic changes to emergency department volumes and throughput. The objective of this study was to describe changes in ED boarding among US academic EDs across the duration of the COVID-19 pandemic. We conducted a retrospective analysis of monthly data collected from a convenience sample of academic departments of emergency medicine. The study period was from January 2019 to December 2021. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. We used multivariable linear panel regression models with fixed effects for individual EDs to estimate adjusted means for 3-month quarters. Of the 73 academic departments of emergency medicine contacted, 34 (46.6%) participated, comprising 43 individual EDs in 25 states. The adjusted mean total boarding hours per month significantly decreased during the second quarter of 2020 (4,449 hours; 95% confidence interval [CI] 3,189 to 5,710) compared to the first quarter of 2019 (8,521 hours; 95% CI 7,845 to 9,197). Beginning in the second quarter of 2021, total boarding hours significantly increased beyond pre-pandemic levels, peaking during the fourth quarter of 2021 (12,127 hours; 95% CI 10,925 to 13,328). A sustained and considerable increase in boarding observed in selected US academic EDs during later phases of the COVID-19 pandemic may reflect ongoing stresses to the health care system, with potential consequences for patient outcomes as well as clinician well-being.

Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision

BACKGROUND CONTEXTFive out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness. PURPOSETo test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors. STUDY DESIGN/SETTINGA cohort study, single-center academic hospital. PATIENT SAMPLESA total of 97 men and women (age 18–65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization. PRIMARY OUTCOME MEASURENeck disability at 12-months. METHODSParticipants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%–8%), (2) Mild (10%–28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age. RESULTSSignificant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months. CONCLUSIONSHigher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma. Trial RegistrationClinicalTrials.gov Identifier: NCT02157038.

Assessing awareness and attitude of Egyptian medical students towards emergency medicine as a specialty and career choice: A single-institutional study.

Emergency medicine (EM) was formally recognized as a specialty in Egypt in 2002. Many institutions of higher education do not yet have an operational academic department of emergency medicine. This study attempts to quantify the awareness and attitude of Ain Shams University medical students towards emergency medicine as both a specialty and a career. A paper-based survey was delivered to undergraduate medical students at the Faculty of Medicine, Ain Shams University in Cairo, Egypt between December 2021 and April 2022. The survey was designed to assess awareness towards the scope of practice of emergency physicians as well as general attitude toward emergency medicine as a specialty and career choice. A total of 391 students and interns/house officers participated in this study. 53.2% of participants were females and the mean age was 21.65 ± 2.25 years. Only 30 participants (7.7%) were classified as having "Excellent knowledge" of emergency medicine, 92 (23.5%) as "Good knowledge", 158 "40.4%" as "Fair knowledge" and 111 (28.4%) as "Poor knowledge". The difference in scores between academic years was not statistically significant (p=0.239). 91.8% of respondents favored the creation of student interest groups in EM and 40% of respondents found it difficult to reach information regarding EM. Our study demonstrates a lack of awareness and knowledge towards emergency medicine as a specialty across all academic years at our institution. Formal recognition of EM as a specialty doesn't guarantee widespread knowledge among medical students, particularly at institutions without academic EM departments.

Endowed Faculty Positions in Academic Emergency Medicine: 2021

BackgroundIn 2004, 2009, and 2014, we examined the number of endowed faculty positions in academic departments of emergency medicine (ADEMs). ObjectiveWe sought to survey ADEMs regarding the current number of endowed faculty positions and compare the results over time. MethodsA survey was emailed to the chairs of all ADEMs belonging to the Association of Academic Chairs of Emergency Medicine or identified by the Association of American Medical Colleges. We requested the following information: number of endowed chairs and professorship positions; the amount required to fund; the amount allowed to be spent annually; the date established; and the names of the positions. ResultsOne hundred chairs responded out of a total of 109 ADEMs, for a response rate of 92%. Thirty-eight ADEMs (38%) reported having a total of 55 endowed chair positions. Twenty-six ADEMs (26%) reported having a total of 37 endowed professorships. The most common amount required to fund an endowed chair was $2 million to $2.5 million, and $1 million for an endowed professorship. The majority of ADEMs were allowed to spend 4–5% of the value of the endowment annually. ConclusionsForty-six individual ADEMs (46%) reported having at least one endowed faculty position compared with only 30 in 2014 and only 19 in 2009. The total number of endowed faculty positions in ADEMs was 92 in the current study compared with 53 in 2014, 25 in 2009, and only 9 in 2004.

Building a RAFFT: Impact of a professional development program for women faculty and residents in emergency medicine.

BackgroundWomen comprise 28% of faculty in academic departments of emergency medicine (EM) and 11% of academic chairs. Professional development programs for women are key to career success and to prevent pipeline attrition. Within emergency medicine, there is a paucity of outcomes‐level data for such programs.ObjectivesWe aim to measure the impact of a novel structured professional development curriculum and mentorship group (Resident and Faculty Female Tribe, or RAFFT) within an academic department of EM.MethodsThis prospective single‐center curriculum implementation and evaluation was conducted in the academic year 2020–2021. A planning group identified potential curricular topics using an iterative Delphi process. We developed a 10‐session longitudinal curriculum; a postcurriculum survey was conducted to assess the perceived benefit of the program in four domains.ResultsA total of 76% of 51 eligible women attended at least one session; for this project we analyzed the 24 participants (47%) who attended at least one session and completed both the pre‐ and the postsurvey. The majority of participants reported a positive benefit, which aligned with their expectations in the following areas: professional development (79.2%), job satisfaction (83.3%), professional well‐being (70.8%), and personal well‐being (79.2%). Resident physicians more often reported less benefit than expected compared to fellow/faculty physicians. Median perceived impact on career choice and trajectory was positive for all respondents.ConclusionsSuccess of this professional development program was measured through a perceived benefit aligning with participant expectations, a positive impact on career choice and career trajectory for participants in each career stage, and a high level of engagement in this voluntary program. Recommendations for the successful implementation of professional development programs include early engagement of stakeholders, the application of data from a program‐specific needs assessment, early dissemination of session dates to allow for protected time off, and structured discussions with appropriate identification of presession resources.

Chronotype, Shift Work, and Sleep Problems Among Emergency Medicine Clinicians

Introduction: Extensive research has demonstrated that shift work can be detrimental to sleep. Chronotype, the preference for time of day to sleep or be active, can influence how we function at different times of day and how shift work impacts us. This study was designed to assess the chronotype of emergency physicians (EPs) and emergency advanced practice providers (EAPPs) and examine how chronotype was related to sleep problems and shifts worked over a three-month period. Methods: A survey assessing chronotype and sleep quality was sent to 225 EPs and EAPPs in a single, large academic Department of Emergency Medicine. An archival database indicated the shifts worked during the prior three months and the percentages of day, evening, and night shifts for each practitioner were calculated. Results: 127 people completed the survey (56.4%). Of the three chronotypes (morning, intermediate, evening), most EM clinicians were categorized as intermediate chronotype (56/127, 44.1%), followed by morning type (39/127, 30.7%) and then evening type (32/127, 25.2%). Those with an evening chronotype were more likely to report daytime dysfunction (a lack of enthusiasm and propensity to fall asleep during activities) (p < 0.01) and worked a greater percentage of night shifts than other chronotypes (p < 0.05). Interestingly, the effect of evening chronotype on daytime dysfunction was no longer significant when controlled for the relatively greater percentage of night shifts worked, suggesting that the observed dysfunction was more likely an artifact of the night shifts worked, rather than purely chronotype driven. Conclusion: This is the first study of a large cohort of EM practitioners investigating chronotype and its influence on shift preference and sleep quality. In this pilot investigation, most of the surveyed clinicians were categorized as an intermediate chronotype. Working night shifts was associated more closely with daytime dysfunction than was chronotype, strengthening the latent literature that working night shift carries with it significant challenges to the EM clinician. Future research should evaluate the relationship between chronotype malalignment to practitioner burnout and well-being.

Meeting expectations: An exploration of academic emergency medicine faculty experiences and preferences in the virtual meeting environment by age, gender and parental status.

During the COVID-19 pandemic, virtual meetings became the norm in academic emergency medicine (EM) departments. This study explores the experiences of academic EM faculty within this environment. In 2021, authors surveyed a cross-sectional convenience sample of EM faculty using a mixed-methods approach to explore perceptions of the virtual meeting environment. Authors reported data on a five-point Likert scale, summarized as percentages, and calculated differences using Pearson's chi-squared test, where p<0.05 was significant. Free text responses were analyzed qualitatively. Two-hundred-fifty-nine responses were collected, (female [55.6%], ≤40years old, [39.8%]) of which 33.2% had children ≤7years old. Most respondents felt the total number of virtual meetings had increased and were more likely to happen outside of regular business hours compared to in-person meetings. Most faculty preferred meetings during regular hours and liked the virtual format overall. Younger faculty respondents were more polarized in their preferences of timing of meetings and reported more pressure to accept meetings outside of regular hours. Female respondents with young children were more likely to dislike meetings outside regular hours and to have declined them. Women faculty, younger faculty, and women faculty with young children were significantly more likely to agree that women had been "more impacted by the new virtual work environment." Qualitative themes highlighting the flexibility provided by the virtual work environment and decreased commuting time, though many felt communication was limited in virtual meetings. Academic EM faculty mostly preferred keeping meetings during regular business hours and in a virtual format. Experiences varied by age but not by gender overall. Women with young children reported greater challenges than women without. Men did not differ by parental status. The virtual format provided increased flexibility but limited communication and engagement. Academic EM departments may use this data to inform future meeting practices.

384 Endowed Faculty Positions in Academic Emergency Medicine: 2021

In 2004, 2009, and 2014, we examined the number of endowed faculty positions in academic departments of emergency medicine (ADEMs). Our objective was to survey ADEMs regarding the current number of endowed faculty positions and compare the results over time.

132 Faculty Procedural Skills in Academic Emergency Medicine: A Multisite Survey

Emergency physicians must be competent to perform numerous procedures. It is unclear if clinical practice alone is sufficient to maintain procedural skills, particularly for academic faculty who supervise trainees. Formal assessment of procedural skills beyond training is uncommon. There is a paucity of literature on faculty skills attrition or their preferences for skills maintenance. The faculty procedural skills (FPS) survey sought to determine faculty attitudes, beliefs and experience with procedures to inform programming aimed at skills maintenance. This was a multisite, cross-sectional study of emergency medicine (EM) and pediatric EM (PEM) physician faculty at five large US academic EM departments. Subjects were board certified or board eligible in EM or PEM and provided both clinical care and supervision of trainees. Subjects completed the FPS survey online which consisted of three sections: (1) respondent characteristics and experience performing and supervising EM procedures; (2) degree of confidence performing critical procedures; and (3) attitudes about skills attrition and learning preferences. Internal consistency of each survey section was calculated using Cronbach’s alpha. Items related to beliefs and attitudes were graded on a 5-point scale (strongly disagree to strongly agree), with higher values representing greater agreement. Response agreement (with 95% confidence interval [CI]) was calculated by combining “strongly disagree” with “disagree” and “strongly agree” with “agree” responses. A total of 186 faculty completed the survey (44% response rate). Scale reliability was good (Cronbach’s alpha performance = 0.82; supervision = 0.86; confidence = 0.85). All respondents agreed that ongoing procedural skills training is important for the clinical practice of EM. The majority of respondents agreed: that faculty should have opportunities to retrain for uncommon procedures (98%, 95% CI: ±2%); that skills attrition is a concerning problem (91%, 95% CI: ± 4.1%); that skills attrition is a patient safety issue (89%, 95% CI: ± 4.5%); that attrition was more likely in academic settings (93%, 95% CI: ± 3.7%); that faculty should be required to demonstrate procedural competence (83%, 95% CI: ± 5.4%). The majority of respondents (73%, 95% CI: ± 6.4%) personally experienced procedural skill attrition and a similar number (68%, 95% CI: ± 6.7%) observed it in peers. The most preferred method for skills maintenance was simulation (83%, 95% CI: ± 5.4%). The most preferred learning environment was in groups with peers (89%, 95% CI: ± 4.5%). A majority of faculty reported skills attrition, both personally and observed in peers. Respondents also overwhelmingly agreed they should be competent to perform procedures for which they are credentialed. These findings raise questions about the need for technical skill competency assessments for continued clinical practice. Faculty preferred simulation-based learning and peer environments for skills maintenance. Further study is needed to determine the attitudes, beliefs, and experiences of non-academic emergency physicians with procedural skills attrition.

Maintaining procedural skills for academic emergency medicine faculty: A needs assessment.

Emergency physicians require competence performing critical and routine procedures. The clinical practice of emergency medicine (EM) alone may be insufficient for the acquisition and maintenance of skills. Prior studies suggest the presence of trainees in academic settings and/or the low frequency of procedures increase the risk of skills attrition among faculty. We sought to develop a valid needs assessment survey to inform a faculty procedural skills (FPS) maintenance curriculum. A Web-based FPS survey was designed to assess experiences performing procedures, self-reported confidence with procedures, and learning preferences for skills maintenance. The survey was administered at a large academic department of EM. Responses were analyzed to determine survey construct validity, faculty attitudes about procedural attrition, and preferred learning methods. Among EM faculty, confidence was significantly higher for common versus uncommon procedures (p<0.001). EM faculty respondents reported significantly greater confidence than pediatric EM (PEM) faculty for both common adult procedures (EM mean=3.7 [±0.3], PEM=3.0 [±0.4], p<0.001), and uncommon adult procedures (EM=2.7 [±0.4], PEM=2.1 [±0.5], p<0.001). PEM faculty reported significantly greater confidence with pediatric procedures than EM faculty (PEM mean[±SD] =3.5 [±0.8], EM=2.2 [±0.8], p<0.001). Nearly all faculty (93% [52/56]) agreed that procedural attrition is a concerning problem, and 80% (44/56) had personally experienced it. The most preferred learning methods were task trainers and simulation. Faculty preferred learning environments with faculty peers (91%) over mixed groups with trainees (50%). Significant differences in procedural skills confidence between common and uncommon procedures, and between EM and PEM faculty, indicate that the FPS survey displayed appropriate construct validity. The finding that skills attrition is prevalent among EM and PEM faculty highlights the need for skill maintenance programming, preferably in peer groups employing task trainers and simulation.

Assessment of the Preparedness and Planning of Academic Emergency Departments in India During the COVID-19 Pandemic: A Multicentric Survey.

Emergency medicine being a young specialty in India, we aimed to assess the level of disaster preparedness and planning strategies among various academic emergency departments (EDs) across India during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional multicentric survey was developed and disseminated online to various academic EDs in India and followed up over a period of 8 wk. All results were analyzed using descriptive statistics. Twenty-eight academic emergency medicine departments responded to the study. Compared with pre-COVID period, COVID-19 pandemic has led to 90% of centers developing separate triage system with dedicated care areas for COVID suspected/infected in 78.6% centers with nearly 70% using separate transportation pathways. Strategizing and executing the Institutional COVID-19 treatment protocol in 80% institutes were done by emergency physicians. Training exercises for airway management and personal protective equipment (PPE) use were seen in 93% and 80% centers, respectively. Marked variation in recommended PPE use was observed across EDs in India. Our study highlights the high variance in the level of preparedness response among various EDs across India during the pandemic. Preparedness for different EDs across India needs to be individually assessed and planned according to the needs and resources available.

Tenure Trends in Academic Emergency Medicine Departments in U.S. Medical Schools.

The objective was to assess the long-term trends in tenure status stratified by sex and underrepresented in medicine (URM) status among emergency medicine (EM) department faculty in U.S. medical schools. This study used the Association of American Medical Colleges Faculty Roster to study trends in tenure status of full-time faculty from 1989 to 2018. The numbers and proportions of faculty by tenure status were studied over the years and compared across sex and URM minority status. Two-independent-sample t-test and simple linear regression were used for statistical comparisons. The number of EM faculty increased from 177 in 1989 to 5,237 in 2018, with the majority of increase in nontenured (from 120 to 4,485) rather than tenured (from 24 to 198) or tenure track (from 28 to 548) faculty. The proportions of tenure-line faculty increased briefly from 1989 (29.4%) to 1994 (32.5%) and decreased since to 14.2% in 2018. The decreases were greater among men (from 34.5% to 14.9%) or non-URM (from 32.7% to 14.1%) than women (from 24.8% to 13.1%) or URM (from 30.2% to 15.3%). Compared to other academic departments, EM departments had the second lowest proportion of tenure-line faculty in 2018. Emergency medicine faculty size increased rapidly in the past 30years, with the vast majority of growth in nontenured faculty, regardless of sex or URM status. This highlights the need to review career development and academic promotions for EM particularly among nontenured faculty.

An analysis of 1344 consecutive acute intoxication cases admitted to an academic emergency medicine department in Turkey.

OBJECTIVE:One of the major causes of emergency department (ED) visits is acute poisoning. Acute intoxications occur soon after either single or multiple exposures to toxic substances, and they started to be a more serious problem in developing countries. The objective of this study was to investigate the local patterns of acute intoxications, as well as clinical and sociodemographic characteristics of patients with acute poisoning, admitted to our hospital’s ED.METHODS:This single-center, retrospective study was conducted using medical records of consecutive patients admitted to the ED between January 2016 and December 2017.RESULTS:A total of 1344 patients were included in the statistical analysis. Of these, 673 (50.1%) were female. Mean (±SD) age was 32.2 (±12.0), ranging between 17 and 84 years. The highest number of poisoning cases was observed in summer, especially in July (10.0%) and August (11.8%), whereas lowest number of admissions related to poisoning occurred during winter in November (5.1%) and December (5.2%). Among admitted cases, many were suicide attempts (55.7%) followed by non-intentional (accidental) ingestion of non-pharmaceutical (n=553, 41.2%) and pharmaceutical agents (n=42, 3.1%). Single agents were the most common cause of acute intoxications (63.2%) rather than multidrug intoxications. Most frequently observed causes of poisonings were recreational substances (30.0%) and agents exposed by inhalation (13.2%). INR, lactate, and pH levels at admission were significant predictors of 7-day mortality without a significant paired difference between each other. The AUCs for each were 0.89 (SE 0.04; p<0.0001), 0.84 (SE 0.10; p=0.0007), and 0.79 (SE 0.11; p=0.0102), respectively.CONCLUSION:We conclude that recreational substances and medicinal drug intoxications were the leading cause of acute poisonings in our region, occurring mostly during the summer.

Pandemic influenza and major disease outbreak preparedness in US emergency departments: A survey of medical directors and department chairs.

To quantify the readiness of individual academic emergency departments (EDs) in the United States for an outbreak of pandemic influenza. Methods, design, and setting: Cross-sectional assessment of influenza pandemic preparedness level of EDs in the United States via survey of medical directors and department chairs from the 135 academic emergency medicine departments in the United States. Preparedness assessed using a novel score of 15 critical preparedness indicators. Data analysis consisted of summary statistics, χ2, and ANOVA. ED medical directors and department chairs. One hundred and thirty academic emergency medicine departments contacted; 66 (50.4 percent) responded. Approximately half (56.0 percent) stated their ED had a written plan for pandemic influenza response. Mean preparedness score was 7.2 (SD = 4.0) out of 15 (48.0 percent); only one program (1.5 percent) achieved a perfect score. Respondents from programs with larger EDs (=30 beds) were more likely to have a higher preparedness score (p < 0.035), an ED pandemic preparedness plan (p = 0.004) and a hospital pandemic preparedness plan (p = 0.007). Respondents from programs with larger EDs were more likely to feel that their ED was prepared for a pandemic or other major disease outbreak (p = 0.01). Only one-third (34.0 percent) felt their ED was prepared for a major disease outbreak, and only 27 percent felt their hospital was prepared to respond to a major disease outbreak. Significant deficits in preparedness for pandemic influenza and other disease outbreaks exist in US EDs, relative to HHS guidelines, which appear to be related in part to ED size. Further study should be undertaken to determine the barriers to appropriate pandemic preparedness, as well as to develop and validate preparedness metrics.

MP22: Guiding practice transition with a faculty mentorship program

Innovation Concept: Transition to independent practice is challenging and early career physicians are more prone to burnout and error. Despite recommendations for formal mentorship to support physicians, only 43.6% of US academic Emergency Medicine departments have such programs. We describe an innovative mentorship program designed to support these early career physicians and enhance quality of care, career longevity, and wellness. We operationalized mentorship in which experienced, highly regarded, empathic mentors guide mentees in their personal and professional development. Methods: In this program two Emergency Physician mentors were teamed with each newly hired Emergency Physician. Mentees could request their own mentors, and teams were matched on the basis of shared personal and academic interests. Mentors received academic funding and training on good mentorship practice, roles and responsibilities, and feedback. Teams had to meet formally at least twice a year, with additional contact as needed. While mentees set the meeting agenda, teams were also encouraged to address four main areas. These areas were identified from a targeted needs assessment and literature review. They include: 1) clinical process and care, 2) departmental structure and culture, 3) teaching and scholarship, and 4) physician wellness. After meetings, mentees summarized and submitted the topics discussed and reflected on action plans. An oversight committee supported the program. Curriculum, Tool or Material: All nine (9) newly hired physicians joined the program in Fall 2018. As of December 2018, six (6) teams have had formal meetings. They discussed the following areas: clinical processes and care (50%), departmental structure and culture (100%), teaching and scholarship (67%), and physician wellness (100%). Other areas discussed include: academic career, financial planning, and networking. Teams spent 20-60% of the time formulating steps to achieve mentee career goals. They spent 40-60% of the time discussing skills and resources needed. End of year program evaluation will include outcomes such as satisfaction, value, effectiveness, projects, promotions, and awards. The results will shape future program design. Conclusion: We implemented a mentorship program for newly hired Emergency Physicians. As mentorship is integral to successful transition to independent practice, this program model could be highly beneficial to other academic Emergency Medicine departments.

LO44: Simulation in the continuing professional development of Canadian academic emergency physicians: a national survey

Introduction: Capitalizing on the success of Simulation-Based Education (SBE) in residency-training programs, simulation has been gradually integrated into Continued Professional Development (CPD) programs for Emergency Physicians (EPs) in Canada. This study sought to characterize how Canadian academic emergency medicine (EM) departments have implemented SBE for CPD. Methods: We conducted two national surveys: 1) the National Faculty Simulation Status Assessment Survey, administered by telephone to the simulation directors (or equivalent) at 20 Canadian academic EM sites and 2) the Faculty Simulation Needs Assessment Survey administered online to all full-time EPs across 9 Canadian academic EM sites. Results: The response rates for the National Status and Needs Assessment Surveys were 100% (20/20), and 40% (252/635), respectively. The majority (60%) of Canadian academic EM sites reported utilizing SBE for CPD, though only 30% reported dedicated funding support. EPs reported participating in a median of 3 hours per year of SBE (IQR 1-6 hours). Reported incentivization offered in the form of continued medical education credits varied between simulation directors (67%) and EPs (44%). Simulation directors identified several significant barriers to SBE including a lack of faculty time, fear of peer judgment, and faculty inexperience. In contrast, EP-identified barriers included time commitments outside of shift, lack of opportunities, and lack of departmental. The three most common topics of interest for SBE by EPs were performance of rare procedures, pediatric resuscitation, and neonatal resuscitation. Interprofessional involvement in SBE CPD was valued by both simulation directors and EPs, with most EPs (79%) indicating it is useful. Conclusion: Most Canadian EPs and simulation directors recognize the value of SBE for CPD, yet it is only utilized, infrequently, by 67% of Canadian academic EM departments for this purpose. This may be explained, in part, by poor incentivization for participation. Simulation directors and EPs noted different barriers to SBE implementation for CPD suggesting the need for dialogue to improve utilization. As SBE for CPD is incorporated more frequently, and at more sites, content should be guided by local needs assessments with an emphasis on interprofessional participation.