Academic Career Guide I (Chapters 1-8 Summary). Society for Academic Emergency Medicine The History...

Academic Career Guide I (Chapters 1-8 Summary)

Society for Academic Emergency Medicine

The History of Academic Emergency Medicine : Milestones

1960-70s: Emergency Department regarded as a “pit”…a place to start, end, or be exiled if you were impaired or incompetent

Patient pressures (volumes, expectations), lessons in trauma care from major wars, and recognition of highway injuries spurred the need for better training for Emergency Physicians (EP’s)

1968- Beginning of American College of Emergency Physicians (ACEP)

1969- First Scientific Assembly in Denver, Colorado

-Summarized from G. Hamilton, SAEM ACG Chapter 1, 2007



1970s: The first residencies: Cincinnati, Penn, USC, Chicago, Louisville

1972: AMA rejects 1st proposal for Residency training in emergency medicine

1973: ACEP creates their own approval process with ACEP Graduate Education Committee

1972: publication of EM’s first journal, Journal of the American College of Emergency Physicians (JACEP)




1974: formation of Emergency Medicine Residents’ Association (EMRA)…with growing numbers of residents

Society of Teachers of Emergency Medicine (STEM): created through ACEP, a first vital link to American Association of Medical Colleges

1975: AMA approves a permanent Section of Emergency Medicine and standards for EM residencies



Academics vs. Community Practice?What is Academic Practice?

Keystones: Clinical Practice, Teaching, and Research

ABEM: academician is practitioner who spends 40% of their time outside of clinical duties (writing, teaching, research)…usually with protected time for these pursuits.

-tenure track positions often have requirements for research funding, publications, and scholarly work.

Generally associated with a teaching hospital and core faculty at EM residency programs

-Summarized from LC Patten and F Ankel, SAEM ACG Chapter 2, 2007


Academics vs. Community Practice?Early Paths to Academics

Get involved in research: many academic careers will require work in research, so residents may be well served to learn the fundamentals of research funding, proposals, writing early

Find a mentor: get key advice for academicians who have paved their way before you

Fellowships: academics highly values training beyond the usual EM residency. Possibilities include toxicology, pediatric emergency, sports medicine, ultrasound, pre-hospital care, education, research



Academics vs. Community Practice?What is Community Practice?

ABEM: community practitioners spend more than 50% of their time on clinical duties

Other duties often include administration or quality improvement

Residents not training in community-hospital based residencies who are considering community practice should do elective rotations at a community hospital to evaluate this practice type first hand

Community practitioners are good resources for residents who wish to explore community practice



Choosing Academics:How to Plan Your Residency

The foundations of success in academics are excellence in both clinical EM and “scholarly activities”

Success in academics is possible from 3 and 4 year programs (any sticking points resolve after 1 year of practice or fellowship)

Requisite tools for academics to develop: clinical, teaching, research, writing, administrative, and “people” skills

Participation in national organizations (EMRA, ACEP, AAEM, SAEM) provide opportunities for mentorship, networking and collaboration

-Summarized from J Davis JL Oakes, SAEM ACG Chapter 3, 2007


Choosing Academics: pros/cons of different paths

Chief Resident: pros- valuable experience with administrative duties, policy making,

quality improvement, teaching, advocacy cons- depending on format: an additional year before fellowship or

entering workforce or additional rigor to senior year Graduate degrees:

pros- creates focus and expertise for future workcons- additional time and financial commitment.

Fellowship: (see also the next section)pros- create a precious niche within academic emergency medicinecons- additional training time and delayed workforce entry and

financial rewards

-Summarized from J Davis JL Oakes, SAEM ACG Chapter 3, 2007


Importance of a Fellowship: Jump Start Your Academic Career

Check Fellowship section of www.saem.org for details Why? Identify and develop a niche within emergency

medicine-Pursue specific interests and skill sets-Mentorship for developing academicians-Some include additional degree’s (MBA, MPH, MS)-ACGME board certification (only available for some

types of fellowships: Hyperbaric, Pediatric EM, Sports medicine, Toxicology, Hospice)

Why Not? 1-3 year delay in larger salary and likely worse work schedule

-Summarized from DS Howes, SAEM ACG Chapter 4, 2007


Importance of a Fellowship: What are the Choices?

Medical Education/Faculty Development: work clinical shifts in academic center, while also protected time for didactic teaching, research, often also opportunities for Master’s degree in education

Administration: exposure to operational workings in ED and hospital. May include graduate work towards MBA or MPA degree

Critical Care: currently EM physicians cannot become board certified. However EM physicians can utilize these skills/training in practice and some serve as medical directors of ICU’s despite lack of board certification




Emergency Medical Services (EMS): further experience with pre-hospital emergency care and EMS system. Fellows often serve as medical director (or assistant director) for local EMS systems

Hyperbaric Medicine: hyperbaric physiology and diving medicine. Applications include decompression sickness, non-healing wounds, infections, carbon monoxide poisoning, others

International Emergency Medicine: evaluate emergency health needs in countries lacking EMS systems. Often requires international travel and MPH degree




Pediatric Emergency Medicine: training taking care of pediatric patients, mainly in ED but also with ICU and subspecialty exposure. Usually incorporates protected research and teaching time

Hospice and Palliative Care: new in 2007, training programs still being developed

Sports Medicine: non-operative management of musculoskeletal sports conditions. Not all programs accept EM physicians




Toxicology: biochemistry, pharmacology, and toxic effects of pharmaceutical and environmental compounds. Often includes opportunities to work with poison control centers.

Ultrasound: many applications, including experimental. Also involved in credentialing /teaching others to use EM ultrasound

Others: (see SAEM website) forensics, medical informatics, disaster research and management, geriatrics, neurological and cardiovascular emergencies



The Academic Skill Set: More than “I like to teach residents”, though this is important A Career in academic EM entails deliberate plans aimed at

acquiring skills, achieving milestones, and building achievements

Beyond teaching….-Lecture and Presentation skills: addressing specific learners’

needs, computers skills-Effective communication skills: may be developed by

participation in academic tasks in residency-Critical reading and writing skills: essential in teaching,

research and admin positions

- Summarized from M Dorfsman, SAEM ACG Chapter 5, 2007


The Academic Skill Set:Beyond teaching….(continued)

-Research: nearly all academic EPs are required to engage in some sort of research

-Getting involved in a basic, simple research project early in residency or an academic career provides experience with Institutional Review Boards, statistical methodology, analysis, academic reading/writing, peer reviews, and oral/poster presentations

Bottom Line: jump on opportunities to teach, do research, and get administrative experience!

- Summarized from M Dorfsman, SAEM ACG Chapter 5, 2007


Creating a Healthy Career: Wellness

“Wellness”…what does it mean to you? Realize this meaning may change during different stages in your professional life

Long-term wellness isn’t just the absence of unhealthy feelings or burnout, but it is the active involvement in things that rejuvenate you such as family, friendships, hobbies, spirituality, and exercise

-Summarized from F. Nobay, SAEM ACG Chapter 6, 2007


Creating a Healthy Career: Wellness

Challenges to Wellness in Emergency Medicine:-Witness tragedy, violence, and illness daily-Shift work (and impact on sleep)-Youth of EM specialty in the hospital hierarchy-Lack of time to rest, socialize, eat optimally during work-Isolation from social support due to geographic and

scheduling constraints-Loss of camaraderie resulting from shift work-Briefness of relationships with patients-Difficult interactions with ED staff



Creating a Healthy Career: Balancing Personal and Professional Responsibilities

Create a long-term vision of your life: helps ensure that your aren’t overwhelmed by tumult of the moment

Connect to colleagues: get to know co-workers as people, not just other staff. Connection creates intimacy of our experience

Enjoy what you do: at least some of the time. Find humor and laughter in your work

Physical well being: exercise, sleep hygiene and protection, good nutrition and hydration

Keep in touch with family, friends to stay connected with life outside of medicine and find support. Especially with immediate family. Find ways to be present for important life events (birthdays, graduation, etc.)



Creating a Healthy Career: Time Management

Make plans: create things to look forward to: anything from lounging in front of TV, to exotic trips

Take time for yourself: 5 minutes? A weekend? You must have ways to refuel the energy it takes to be an EP

Be realistic: You won’t have time to do everything you want to and still get adequate sleep. Avoid over-extending your schedule

Invest in a time management tool: PDA? Home calendar? Choose one method that works for you and your family to interconnect your life



Creating a Healthy Career: Avoiding Burnout

“Syndrome of emotional exhaustion, depersonalization and a sense of low personal accomplishment that leads to ineffectiveness at work”

Manifestations: Loss of interest in work, fear, avoidance, anger, loathing, fatigue, irritability, headache, malaise, anxiety, broken relationships, disillusionment

Red Flag: if you’re asked about burnout by more than 1-2 people…start looking for resources/support. Watch out for exacerbation of psychiatric illness or substance abuse

Unique stressors for Women EPs: called something other than “doctor”…different expectations by staff…balancing work with motherhood. Try finding a mentor, set realistic expectations for yourself, and set limits/ say “no”



Teaching and Education: Academics as a Clinical Educator

Key topics: -Areas to focus teaching excellence

-Identify faculty development opportunities, mentor relationships

-How to achieve promotion and tenure in a teaching-based academic career

-Summarized from CS Weaver and AJ Callisto, SAEM ACG Chapter 7, 2007



Areas to focus teaching:

-In the ED: great venue for bedside teaching and “learning bites”. Teach to your audience (student? resident? RN? medic?)

-Graduate Medical Education: didactics, mentorship, career advice, direct resident supervision

-Education Research: peer-reviewed publications, book chapters, grant funding, advancement of medical education and discovery/validation of learning products




Faculty Development: Becoming an Accomplished Teacher

- National/local faculty development programs

- Advanced Education degrees: credibility in academics, opportunities to collaborate w/ other graduate staff

Having a mentor, successful as a clinician-educator is felt to have one of the most positive influences on career development




Promotion and Tenure: what does your institution offer?-dual track? clinical track vs. tenure track?. The key is

understanding what your institution’s criteria are, if the overall mission of the institution values clinical teaching (with promotion tracks that reflect this value)…key issues in your job search

-documentation: keeping evidence of everything: educational endeavors, teaching evaluations, awards, evidence of quality advising….promotion committees are interest in this evidence of achievement and expertise



Medical Student Educator Pathway: Teaching within the Curriculum

First Year Students: Basic first aid, fundamentals of EMS systems and triage, ethics of emergency care, introducing the patient interview and physical exam

Second Year Students: emphasizing pathophysiology and pharmacology: shock, drug abuse, toxicology case studies can be integrated into core science material

- also a time to tutor/participate in small group learning, skills laboratories, and observational ED rotations

-Summarized from G Schmitz and C Hobgood, SAEM ACG Chapter 8, 2007


Medical Student Educator Pathway: Teaching within the Curriculum

Third Year Students: ideally dedicated 4-8 week ED rotations with focused core competencies and very basic procedures. Key opportunities for educators to directly supervise student clinical activity and teach

Fourth Year Students: clinical rotation vs. sub-internships.- didactic program emphasizing problem based management- procedural didactics/labs: suturing, splinting, IV access, airway and resuscitation. Focus on recognizing life-threatening conditions- ideally multiple formats: bedside, skills labs, simulation courses



Medical Student Educator Pathway: Student Contact outside the Curriculum

Career Advisor: critical to raise awareness of EM as a career choice and contribute to general welfare of students

Mentoring: take an active role in students’ future and career development, especially key for women and underrepresented minorities in academic medicine

Interest Group Advisor: broad exposure for interested students

Clinical Research: get a student involved in your research! Journal Club Advisor: teach clinical concepts and critical

literature review and evidenced based medicine



Author Credit – Acad Career Guide I:E. Willis Nottingham MD

Questions


Postresidency Tools of the Trade CD

1) Career Planning – Garmel

2) Careers in Academic EM – Sokolove

3) Private Practice Career Options - Holliman

4) Fellowship/EM Organizations – Coates/Cheng

5) CV – Garmel

6) Interviewing – Garmel

7) Contracts for Emergency Physicians – Franks

8) Salary & Benefits – Hevia

9) Malpractice – Derse/Cheng

10) Clinical Teaching in the ED – Wald

11) Teaching Tips – Ankel

12) Mentoring - Ramundo

13) Negotiation – Ramundo

14) ABEM Certifications – Cheng

15) Patient Satisfaction – Cheng

16) Billing, Coding & Documenting – Cheng/Hall

17) Financial Planning – Hevia

18) Time Management – Promes

19) Balancing Work & Family – Promes & Datner

20) Physician Wellness & Burnout – Conrad /Wadman

21) Professionalism – Fredrick

22) Cases for professionalism & ethics – SAEM

23) Medical Directorship – Proctor

24) Academic Career Guide Chapter 1-8 – Nottingham

25) Academic career Guide Chapter 9-16 – Noeller

Academic Career Guide I (Chapters 1-8 Summary). Society for Academic Emergency Medicine The History...

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