Thursday, December 31, 2009

CDEM unites EM community on LCME accreditation standard ED-15


Over the past few years, I have been increasingly aware of how Emergency Medicine, as a specialty, has been under-appreciated by national accreditation organizations, such as the Liaison Committee on Medical Education (LCME). The LCME essentially accredits all U.S. and Canadian medical schools and is sponsored by the AAMC and AMA. Accreditation standards address all aspects of medical student training and periodically gets revised.

This year, at the national AAMC meeting in Boston, there was a call for public comments on the proposed new ED-15 standard:

Standard ED-15
  • The curriculum of the educational program must prepare students to enter any field of graduate medical education and include content that will prepare students to recognize wellness, determinants of health, opportunities for health promotion, and symptoms and signs of disease; develop differential diagnoses and treatment plans; and assist patients in addressing health-related issues involving all organ systems and spanning the life cycle.
Annotation for ED-15
  • It is expected that the curriculum will be guided by the contemporary content from and clinical experiences associated with, among others, the disciplines and related subspecialties that have traditionally been titled family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, public health, and surgery.
Did you notice the glaring omission of EM and EM-related skills from the wording? Meanwhile, EM is growing increasingly more popular amongst students and is rapidly becoming a required clerkship rotation in medical schools. Also, management of undifferentiated patients and many procedures are taught in the ED setting. Alongside the other specialties mentioned, we should be recognized as a "core" specialty within medical schools.


So, yesterday Dr. Dave Wald (Chair of CDEM) released an official letter on behalf of CDEM to the LCME. The proposed wording changes have the backing of the Alliance of Clinical Education (ACE) and the major EM organizations such as AACEM, AAEM, ACEP, CORD, and SAEM. I just posted it onto the CDEM website. If you'd like to read the well-crafted letter, you can download it here.


In brief, here are CDEM's official wording change recommendations (changes in red):

New Proposed Standard ED-15
  • The curriculum of the educational program must prepare students to enter any field of graduate medical education and include content that will prepare students to recognize wellness, determinants of health, and opportunities for health promotion, to recognize and interpret symptoms and signs of disease; to evaluate undifferentiated patients, to develop differential diagnoses and treatment plans; to acquire decision making skills in acute care situations, to formulate evidence-based management for chronic diseases, and to assist patients in addressing health-related issues involving all organ systems and spanning the life cycle.
New Proposed Annotation for ED-15
  • It is expected that the curriculum will be guided by the contemporary content from and clinical experiences associated with, among others, the disciplines and related subspecialties that have traditionally been titled emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, psychiatry, public health, and surgery.
Hopefully the LCME will take our comments into consideration and amend the new ED-15 standard to accommodate our suggestions. It would go a long way towards validating EM as a specialty, as we continue to grow in presence and importance in medical schools.

Wednesday, December 30, 2009

Trick of the Trade: Hip flexion strength testing


Testing lower extremity strength is a crucial part of the examination in patients with low back pain. In Emergency Departments, however, some patients provide a suboptimal effort because of general fatigue or malingering.

How can you differentiate whether asymmetric hip flexion weakness is from suboptimal effort or true weakness?

Trick of the Trade: Hoover's Test
This test is an example of Newton's 3rd law of motion -- For every action there is an equal and opposite reaction.

A supine patient trying to flex a hip joint should normally push the contralateral heel downwards into the gurney for compensatory assistance. Absent downward pressure from the contralateral heel suggests a lack of effort, mimicking a focal weakness. You can optimize your ability to detect subtle contralateral downward pressure by cradling the patient's heels in your palms during hip flexion testing.

Tuesday, December 29, 2009

Paucis Verbis Card: CNS Infections

CNS brain abscess on CT

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of CNS infections from EM Clinics of North America 2009.

Feel free to download this card and print on a 4'' x 6'' index card.
[
MS Word] [PDF]Other Paucis Verbis cards:
Shock

Reference

Somand D, Meurer W. Central Nervous System Infections. EMCNA 2009; 27: 89-100.

Monday, December 28, 2009

Article review: Failing at feedback in medical education

Most of the medical education literature on feedback is teacher-focused rather than learner-focused. In other words, focus is paid towards teaching faculty how to give feedback which:
  • Is non-judgmental
  • Is non-threatening
  • Is specific
  • Consists of both positive and constructive elements
  • Offers alternatives
However, successful feedback requires not only a skilled feedback giver but also an environment conducive to feedback discussions and a willing feedback receiver. I imagine a feedback session as a discussion between two friends on cell phones. There has to be someone talking, adequate cell phone reception (more than just 1 bar), and someone actively listening. If any of these elements are missing, communication breaks down.

This commentary article in JAMA's annual medical education edition discusses why feedback isn't working as well as it could. Areas that could be improved can be broken down into three areas:

1. The teacher: Learning to give feedback is an essential skill in faculty development. Often teachers are so subtle in their giving of feedback, that the learner doesn't realize that feedback is going on! A neat trick is to preface your feedback comment with: "Here's a little feedback for you..." It is amazing how much more feedback students feel like they are getting.

2. The environment: A crowded Emergency Department is a tough environment to give feedback. Ideally, you should find an area where your comments can be given privately. Don't humiliate the learner. This provides the learner with a safe place to voice their concerns, questions, and thoughts.

3. The learner: The article focuses a lot on this particular topic of improving feedback reception. It is human nature to want to hear positive feedback, and different people respond differently to negative feedback. Some go into denial, and some react with a negative emotion. These preclude the learner from actually gaining any useful feedback from the interaction.

Have you noticed that students who require the MOST amount of improvement are some of the LEAST receptive to constructive feedback? They unfortunately lack self-reflection and insight into how little they know.

In addition to continued faculty development programs to teach how to give feedback, medical schools should also focus on teaching students (1) to recognize feedback, (2) how to practice reflection and self-assessment, and (3) how to incorporate negative feedback without being defensive.

Reference
Bing-You RG, Trowbridge RL. Why medical educators may be failing at feedback. JAMA. 2009 Sep 23;302(12):1330-1.

Wednesday, December 23, 2009

Holiday break (Dec 23-27)


Happy holidays to all.
Stay safe and warm.


New posts will resume December 28th.

Tuesday, December 22, 2009

Paucis Verbis Project: A peripheral brain e-card series


A few days I wrote about my "peripheral brain" note cards that I carry with me on each ED shift. These cards contain brief summaries of updated guidelines, evidence based literature, and clinical pearls. I constantly get requests for a copy of them, but they are fairly outdated now that I'm out of residency.

So starting today, I'm going to start periodically posting new note cards in Word and PDF format that can be printed on any 4x6 inch index card. These will be posted every Friday. Feel free to download, edit, change font or font size, and use. You can add/remove cards as you collect them. Comments are definitely welcome.

Paucis Verbis Project
"Paucis verbis" means "in a few words" in Latin. I'll initially start reviewing new articles from the Emergency Medicine Clinics of North America publication series. This is my favorite review resource in EM. It comes out every 3 months.


My first Paucis Verbis card will be a duo review. The first article is on shock by a super-star friend of mine, Dr. Matt Strehlow (Stanford). The second is first-authored by Dr. Philip Perera (Columbia) on the role of ultrasonography in shock resuscitation.

Download card on shock:

References
Strehlow M. Early Identification of Shock in Critically Ill Patients. Emerg Med Clin N Am. 2010; 28: 57–66.

Phillips P, Mailhot T, Riley D, Mandavia D. The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically lll. Emerg Med Clin N Am. 2010; 28:29-56.

Monday, December 21, 2009

Article Review: Reflection in medical education

Reflection in medical education

A hot topic in medical education is the incorporation of "reflection" into learning and clinical practice. This Medical Teacher article defines reflection broadly as:

"a metacognitive process that occurs before, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future encounters with the situation are informed from previous encounters."

Huh? Quite a wordy definition. I think of reflection as:
  • Thinking about how we think
  • Making sense of a situation so that future actions can be more informed
Reflection requires self-awareness to recognize a situation which may challenge one's beliefs or understanding. There are three types of reflection:

1. Reflection for learning
This type of reflection revolves around a specific experience, such as feeling uncomfortable with a complex medical resuscitation code or learning that you missed a diagnosis. Learners should ask themselves such introspective questions as:
  • Did anything surprise me about the situation?
  • Did I have the information/skills to deal with this situation?
  • Do I need additional information/skills to deal with this same situation in the future?
2. Reflection to develop a therapeutic relationship
This reflective practice is to help finetune your emotional intelligence. Patient-physician and interprofessional relationships are evaluated. Why was a particular patient able to push all your buttons and really frustrate you? Whenever a situation evokes a strong emotion in you, ask yourself:
  • What emotions am I feeling?
  • Why do I feel like this?
  • Are there other situations in my life or my encounters with others when I feel the same?
  • What are the consequences of these emotions for me and for others?
3. Reflection to develop professional practice
Managing Emergency Department cases requires the rapid and complex integration of knowledge, skills, and prior experiences. More experienced clinicians seem to make correct decisions quicker in challenging cases. Why is that? They can draw on their collection of past experiences in similar situations. This is one type of reflection.

Challenges in incorporating reflection in medical education
  • Low motivation for learners: Medical schools are noticing that students having little motivation to document and/or discuss their reflective learning experiences. These exercises are often viewed as additional required assignments, without an in-depth discussion about why they are important. Reflection journals may be viewed as another "hoop to jump through".
  • Exposing deficiencies to evaluators: Your reflection portfolio involves exposing and describing thoughts about your deficits or vulnerabilities. In a private journal, this is a constructive exercise. However, portfolios are increasingly being used in evaluating your performance. This creates an ethical dilemma of how honest you want to be in a non-private document.
My thoughts
Reflection is important in enhancing life-long learning at all levels, but I am not a fan of using it as a summative assessment tool by administrators. If reflection pieces are ever shared, they should be done in a non-judgmental, small-group setting such that everyone has to share something from their portfolios.

You can download the PDF appendix on building a reflection journal from the Medical Teacher website.

Reference
Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach. 2009 Aug;31(8):685-95.

Friday, December 18, 2009

What's in your pocket on an ED shift?


I am always curious about what people carry in their scrubs and lab coat pockets. Often you can identify residents based on what they are carrying or wearing. Stereotypically, I find the following:
  • Long reflex hammer jutting way out of the lab coat pocket - Neurology
  • Plaster smears on their scrub tops and bottoms - Orthopedics
  • Fluffy animal on their stethoscope and/or lab coat - Pediatrics
  • LMP wheel - Obstetrics/Gynecology
  • Small textbook in lab coat pocket - a medical student


What do I carry?
Starting from at the upper left of the photo and moving clockwise:
  • Electronic stethoscope
  • iPhone (I mainly use the visual acuity chart app and calculator)
  • Intake pad to document ED referrals from primary care physicians
  • 3-4 pre-printed Vicodin prescriptions. Because we prescribe these like crazy, I often write a few up just before starting my shift to save time.
  • Small bottle of unused 1% lidocaine
  • Bright LED flaslight
  • LED flashlight holster, which I hook onto my scrub pants
  • Pen - which I quickly lose within 2 hours of my shift
  • My "peripheral brain" on color index cards with various algorithms, literature guidelines, diagrams, and facts to help me teach residents and students on shift. The top card currently displays the acetaminophen metabolism pathway and facts about acetaminophen toxicity.
  • Sanford Guide to antimicrobial therapy
  • Pocket Pharmacopoeia
  • Trauma shears (not shown because I just realized that I'm still wearing them - I just got off shift!)
Question for you:
What do you put in your pockets for an ED shift?

Thursday, December 17, 2009

Hot off the press: Free EMRA Casts


It is mid-December and residency interview season is in full gear. 'Tis the season of black and dark blue suits walking through hospital halls.
  • How have you prepared your interviews?
  • What are the classic types of questions that you'll be ask?
  • What should you do about your Twitter and Facebook accounts?
Dr. Rob Rogers (Maryland), who constantly is coming up with cutting-edge educational projects and of EM-RAP Educator's Edition podcast fame, is starting a new podcast series called "EMRACast". This series uniquely focuses on giving advice to medical students interested in EM.


In this inaugural podcast for EMRACast, Rob talks about how to succeed in residency interviews. He covers the classic pitfalls and pearls, along with a list of common questions, which each applicant should be prepared to answer.

I have been informally polling applicants over the past 3 years while they are touring San Francisco General's Emergency Department. It sounds like this season's questions are pretty mellow. Basically programs want to know if you fit the their mission and if you'll be a fun, hard-working person, whom the nurses and other housestaff would love to have on shift at 3 am. This is known as passing the "night shift test".

Some quirky questions that I've heard about are:
  • If you were on an island, what 3 things would you bring?
  • What song would you like to listen to? I'll play it for you right now.
  • Draw a picture representing yourself on this index card. We'll be posting and re-ordering these cards on rank day. I heard someone wrote "#1" and their name on their card. Pretty quick thinking!
  • What is NOT in your application?

Wednesday, December 16, 2009

Trick of the Trade: Laryngoscope lifting strength


You are about to endotracheally intubate a patient. As you struggle to elevate the laryngoscope more anteriorly, has your left hand ever trembled while trying to see the vocal cords? Before you say, "I think the cords are too anterior, hand me the [insert your favorite backup airway adjunct]", let's focus on some basics.

How can you gain significantly more laryngoscope lift strength? You can do more left arm bicep/tricep exercises, or...

Trick of the Trade
Hold the laryngoscope handle as close to the blade as possible.

Grabbing part of the blade helps to stabilize against the "waggling" of the handle. Furthermore, it is easier to pull exactly along the long-axis of the handle at this grip point. I would avoid holding the laryngoscope handle as shown in the image above. Is the physician intubating or holding a fragile cup of tea?

The most stabilizing larngyoscope grip
which provides maximal lift strength.

For other airway Tricks of the Trade, take a look an older post.

Tuesday, December 15, 2009

Work in progress: Advising EM students using Google Wave

There has been a lot of press about the much-touted Google Wave platform. It will be a major culture-shift in how we communicate electronically. I foresee it replacing traditional email. At a minimum, it is an email, wiki, and real-time collaboration tool all rolled into one. There is also a Playback feature, where you can see how the document was built over time. Often it's hard to follow what happened based on seeing only the most updated version, and it helps to see the evolution. Currently user-access is invite-only, but I have some invites to give out!

I am officially announcing a new "wave" or discussion thread that I am starting, which is open to the public (or at least those with Google Wave accounts). It is called "A career in emergency medicine: Advice from emergency medicine faculty".

This Wave will be a living document where faculty can answer students' questions and post their thoughts about commonly-asked questions about EM. It is so real-time that you can actually see the user typing letter-by-letter, if you catch them at the right moment. As I build the site, you'll see links, graphics, documents, videos, polls, and other cool gadgets.

Here's a screenshot of the initial layout. I may need to break out into several sub-"waves" if the main page gets too long and unwieldy. Each section is editable by the public. Questions/comments can be posted under each chapter within indented boxes. (An example can be seen just under the video.) Click on the image below to see more detail.



If you would like a Google Wave account, please email me at michelle.lin@emergency.ucsf.edu, and I'll give you one of my remaining 19 invitations.

If you have an account already, you can search for and join the Wave by typing "with:public career in emergency medicine" in the home page's New Wave box.

Come and join the fun. I'd love your help. With some help and hard work, I think this virtual EM advising site may really take off.

My prior post on Google Wave and a link to the introductory video from Google.

Monday, December 14, 2009

Article review: Unprofessional online content

Every September, JAMA publishes a special edition on medical education. This September 2009, one particularly caught my eye because of my interest in educational technologies.


As great as Twitter, Facebook, blogs, and other Web 2.0 technologies are in enhancing transparency and real-time collaboration, there are down sides. It can also blur the line separating your professional persona as a physician and your personal life persona. So for me, I avoid posting personal topics.
  • Do I really want a patient to read about my recent vacation?
  • Do I want my boss to be reading about my frustrations of the day?
  • Will any of my online posts reflect poorly on emergency physicians or myself?
For these reasons, I have emptied my Facebook account and no longer post things there. In my brief experimenting with Facebook, I found that I had little control of what was posted about or in response to me. I'm more sure of this move, especially with Facebook's recent announcement of trying to make user content more public.

In this JAMA article, 130 medical school deans (or their representatives) were anonymously surveyed about incidents where students posted unprofessional content online. While only 60% of schools responded (78/130), there were some interesting findings:
  • 60% (47/78) reported incidences of unprofessional posting
  • 52% (22/42) reported use of profanity
  • 48% (19/40) reported frankly discriminatory language
  • 39% (17/44) reported them being intoxicated
  • 38% (16/42) reported sexually suggestive material
  • 13% (6/46) reported patient confidentiality violations
There were 3 instances of student dismal from these infractions.

Bottom line
Web 2.0 technologies are widely available and used by the upcoming generation of learners. It's not just a fad, as one of my tech-averse colleagues thinks. Medical schools need to increase awareness amongst students about how they each leave a "digital footprint". This would fit nicely within the professionalism curriculum.


Reference
Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students.JAMA. 2009 Sep 23;302(12):1309-15.

Friday, December 11, 2009

Who are you? A blog reader census

Well, it is 142 posts later, and I still love writing this blog. To follow one of the cardinal rules in teaching, I would like to get a sense of knowing who my audience is. That way I can tailor some of my posts to the readership. If you have a second, fill out these two polls. Thanks!



Thursday, December 10, 2009

Hot off the press: Apply to join a SAEM Committee

I often get asked the questions:
  • How does one become successful in academics?
  • How can I get to know other EM faculty across the country?
  • How can I make a difference in academics?
I can only answer from my personal experience, and that is:
  • Join a national organization such as SAEM, ACEP, AAEM, CORD, CDEM and become active in committee work.
Dr. Wendy Coates (Harbor-UCLA) first hooked me into the SAEM Undergraduate Medical Education Committee (UMEC) in 2001. I was straight out of residency. From there, I met many people with whom I still collaborate on various education and educational research projects.

Since then this committee has morphed into Clerkship Directors in Emergency Medicine (CDEM), and I was able to help launch this new group purely because I just happened to "be around". For example, as I was just finishing an UMEC meeting at 4 pm, I was randomly invited by Dr. Dave Wald (Temple) and Dr. Dave Manthey (Wake Forest) to join a small informal dinner in 2007. This group eventually became the inaugural CDEM Executive Board in 2008 and I somehow became Vice-Chair. How? Still not exactly sure.

The (in)famous Le Cote Brasserie restaurant in
Boston where the idea of CDEM was first conceived.


Interestingly a lot of my successes happened because I serenditipously was "around" and seated at the table. If I were to write a book, the title would be - Winning by Sitting Down.

A few other examples:
  • From the UMEC, I was asked to join the SAEM Education Research Task Force during 2002-05.
  • From my collaborations with Dr. Jim Olsen (Wright State) on the Education Research TF, I got nominated and was elected to join the SAEM Nomination Committee during 2007-09. I got to meet some bigwig faculty on the SAEM Board of Directors.
  • As the Chair of the UMEC in 2006-08, I was part of an off-shoot ED Overcrowding Task Force, where I met Dr. Brent Asplin (one of the gurus on this topic). Also I had the pleasure of finally working with one of my favorite people Dr. Philip Shayne (Emory) on a paper discussing ED crowding and the impact on education. It got me hooked into educational research assessing how crowding impacts bedside teaching.
  • As an active member of CORD, I met Dr. Mary Jo Wagner (Synergy). At an ACEP meeting a few years ago, she asked me if I was interested in a new column for ACEP News on "Tricks of the Trade". Not sure why she asked me, but I know a great opportunity when it lands in your lap! I have been writing this column for the past 3 years now.
So you can see how things just snowball, just by your being around. I am a poor "schmoozer" and hate blatant networking. So if I can do it, you certainly can become active on the national level. It is truly amazing how many great opportunities are out there - just by occupying a seat at the table.

So, come and take a seat! SAEM just opened its online application, which is due Jan 22, 2010. Faculty and residents are also eligible to apply. Here are the committee choices:


The application is short and sweet. Take a look.

Wednesday, December 9, 2009

Tricks of the Trade: Diagnosing retinal detachment with ultrasound


In a sneak peak of my ACEP News' Tricks of the Trade column, Dr. Patrick Lenaghan, Dr. Ralph Wang, and I will discuss how bedside ultrasonography can significantly improve your ocular exam.

Here is a classic example. A patient presents with acute onset right eye pain and blurry vision. She possibly has a field cut in her vision. Her pupils are a teeny 2 mm in size in the brightly-lit Emergency Department. You are having a hard time getting a good fundoscopic exam to comfortably rule-out a retinal detachment.


Trick of the trade:
Ocular ultrasonography to diagnose retinal detachment

Apply a generous amount of gel on the patient's closed eyelid, such that the probe does not contact the patient's eyelid. Position a linear high-frequency ultrasound probe on the patient's upper eyelid.
  • Vitreous fluid and the lens are anechoic (black).
  • The ciliary bodies and retina are hyperechoic (white).
A retinal detachment appears as a hyperechoic stripe (yellow arrow) adherent to the retina.

Image courtesy of Dr. Patrick Lenaghan.

Important Note:
If the patient may potentially have a globe rupture, ocular ultrasonography is relatively contraindicated. Do not apply any pressure to the patient's orbit.

Tuesday, December 8, 2009

Faculty hero: Ernest Wang (part 2)

Clinical Assistant Professor, NorthShore University HealthSystem
Academic Director, Center for Simulation Technology & Academic Research (CSTAR)
Associate Program Director, University of Chicago EM Residency



Successful faculty often have amazing mentors. Ernie, who were your mentors? What have you learned from them?
I have had a ton of mentorship throughout my career in many aspects of my professional development, each significant in its own way. It's probably easiest to divide by areas of influence, really.

Emergency Medicine
I have to acknowledge Drs. Jeffrey Graff, Jorge del Castillo, and Morris Kharasch - the leadership of our division of EM for providing me with all the support I needed to be successful, both clinically and academically.

Dr. Graff has shown me how a successful group should be managed and imparted the importance of being active in the specialty outside the walls of the ED. As a past president of ABEM, he gave me the opportunity to participate in the organization as an item-writer and starting in 2010, as an oral board examiner. I consider these to be some of the most valuable EM experiences of my career.

Dr. del Castillo has shown me what it takes to navigate hospital administration successfully and how important inter-departmental and administrative relationships are in order to be successful with your own academic activities. Both he and Dr. Graff are selfless and tireless promotors of the sim lab for our benefit.

Dr. Kharasch taught me how to be a doctor and how to be an excellent educator. He believed in me from the beginning. Probably the most influential mentor of anyone in my career. He, along with Pam Aitchison, RN (our Clinical Coordinator for CSTAR) provided Voz with a tremendous amount of support to allow CSTAR to get off the ground in its initial phases and their continued efforts allow us to remain productive. These two have also shown me the extent to which simulation really requires a team effort to be truly successful.

Simulation
Voz obviously is a big influence as we worked together for many years. He shared his vision for sim we with me and from this I observed how he applied that vision, his enthusiasm, his ingenuity, and his tremendous organizational skill set, into transforming himself into a simulation leader nationally within SAEM and the greater simulation community. He and I co-authored my first simulation paper and he gave me several opportunities to participate in sim on a national level that helped me develop the confidence to succeed.

From Jim Gordon, Bill Bond, and Steve McLaughlin, I learned about what it takes to successfully cultivate and grow from a fledgling organization into an influential one. Jim and Bill are tremendous leaders and visionaries and I have admired their ability to shoulder the weight of the simulation agenda over the 6-7 years. Steve brought me on as an instructor in a scenario design work shop at the International Meeting on Simulation in Healthcare and as I tell everyone, much of what I know about scenario design, I learned from him.


Academics
From Mark Adler, Walter Eppich, and Bill McGaghie at Northwestern, I observed first hand the discipline and dedication it takes to design and execute a good research study. They have been tremendously influential in how I think about my own study designs and curricula and I know they are much better now because of what they have taught me.

Drs. Jerrold Leikin and Jim Adams have provided much academic advice as well as opportunity to write chapters for their texts. Dr. Adams impressed upon me the importance of not letting projects stop after the abstract presentation but to see them through to the publication of the work in a journal.

Over the years, Drs. Rita Cydulka and Rebecca Smith-Coggins have played a big part in how I think about academics in the context of my career. They are two examples of extremely successful academicians with tremendous core values and are wonderful people as people as well. Dr. Cydulka gave me my first opportunity as a peer reviewer for AEM and continues to mentor me in a variety of academic venues. Voz also provided me with an opportunity to peer review the AAMC's MedEdPORTAL, which has been a tremendously gratifying activity. I consider the innovative nature and volume of your work inspiring and I look forward to your Tricks of the Trade section in ACEP News every issue. Aw, shucks.


Mentorship
Drs. Wendy Coates and Cherri Hobgood (SAEM Undergraduate Medical Education Committee) were instrumental in helping me get started. And I am sure these individuals don't know this, but I learned how to write a CV by reading Rita Cydulka's, Becky Smith-Coggins', Amal Mattu's, Jerry Hoffman's, and Bob Hockberger's. Every year we hold an annual lectureship entitled the Thomas R. Mulroy Symposium at NorthShore and I have had the honor of introducing these accomplished individuals. So in preparation, I scoured their CVs and in the process, I learned what was important.


Life
And last but not least, my family has given me the ultimate mentorship, support, and inspiration to be successful in my career. My parents and my sister have shown me the value of hard work and unconditional love. My wife, Daria, inspires and supports me every day by giving me the "protected" time at home to be able to work on academic projects and has given me four lovely daughters who give me the motivation to be a good role model. She is also a practicing emergency physician and compared to what she accomplishes with work and the kids, this academic stuff is almost easy. I truly believe that having children has been one of the biggest motivational forces in my life.

Wow, you have proven the point that having multiple mentors is important to move ahead in academics. You've clearly had some wonderful mentors.

We worked on the SAEM Diversity Video together. What behind-the-scenes things do you remember from the project?
And I have you, Michelle, to thank for the creative match that sparked the Emergent Procedures Instructional Collaboration (EPIC) project. I remember in 2007 when you and I first talked about the possibility of the Undergraduate Medical Education Committee (which as since morphed into CDEM) collaborating with the Diversity Interest Group on a diversity video for recruitment. I thought it would be a neat little project.

With your initiative, we were able to line up 3 tremendous interviewees who would represent the interest group well. I remember going into the filming with a very naive understanding of what we needed to produce this video and in retrospect, probably would have been much better prepared and thought it out better. The filming was fairly ad lib as we scouted around the Caribe Royal lobby for a good spot to shoot. Our filming tech was basic by most standards - you brought your camera, tripod, and directional mic. And the conditions were very "suboptimal" (in retrospect) as there were people walking by, carrying tables, hammering in the next lecture hall putting together a stage, and intermittent music was blaring in the background.

Yeah, I totally remembered loud 80's music blaring intermittently, and regretting that we didn't have a quieter space.

I remember after you downloaded the video onto my computer, I thought, "now what do I do with this raw footage?" I had never done any videoediting before and I had just gotten this new Mac computer. So in the airport while I waited for my plane, I opened up iMovie on my Mac (for the first time), started cutting and editing, and found that it was something that I really enjoyed and had a knack for. When I got home, I had to commission my neighbor's kid's friend to show me how to perform post-production sound editing using Final Cut Pro and I watched her do it for several hours a day over two days as she tuned out the music in the background and painstakingly got rid of the "clicks" and "pops" in the rest of the audio track.

Yes, I learned a lot from these early mis-steps. I think the video turned out surprising well though. The magic of video editing! Nice work.




I learned a lot of helpful videoediting techniques by scouring the web and working on the video. The more I learned, the more I got into this as a form of art and expression as well as a method of information delivery. I learned that any videoediting problem you can imagine probably has been addressed by someone (usually under the age of 20) and posted on YouTube.

At about the same time, I was skimming an issue of Academic Emergency Medicine, and found an ad looking for submissions to a new section of the journal entitled "Dynamic Emergency Medicine." The combination of working on the diversity video, the opportunity for publication in AEM, and my interests in simulation, created the perfect storm for me and led to the idea of creating procedural videos for publication. I felt like all the procedural videos that I had seen in other venues were either not well filmed, too long, or too detailed.

I wanted to create videos of procedures that were not necessarily all-encompassing, but conveyed the essence of what someone needed to know to successfully perform a procedure and to successfully avoid the common pitfalls that I had observed over the years in students and residents. I felt that if I could capture those elements in an artistic way, that they may find an audience and if they help a physician successfully perform the procedure or avoid a complication, then feel I will have done a public good. www.emergentprocedures.com

So in summary, you basically served as the impetus for my informal apprenticeship into the world of videomaking. We were very fortunate that the video was well received by the Diversity Interest Group and SAEM. Ironically many have commented to me subsequently that the "spontaneity" and "casual nature" of the diversity video was really effective and part of it's appeal.

Thanks for your time, Ernie, for sharing your experiences and thoughts about your academic life in EM.