About Al'ai Alvarez, MD

Assistant Residency Program Director
Clinical Assistant Professor
Department of Emergency Medicine
Stanford University School of Medicine

Reading from the Silver Linings Playbook: The ALiEM Connect Project

ALiEM Connect graduation

It feels like yesterday that we were sheltered-in-place, staring at our computers, wondering, “So now what?” 

As COVID-19 paused all in-person educational sessions, the early morning residency conference we used to begrudgingly join quickly became something that we profoundly missed. While we can now be “present” while wearing sweatpants and a button-down shirt, we miss the human connection. Many of us would gladly even suffer through traffic just to be a part of this morning conference tradition.

As educators and innovators, we know what a disruptive force the COVID-19 pandemic has been to the medical community. It has strained our medical and healthcare systems and has irrevocably altered our day-to-day lives. Without a doubt, the pandemic also changed how we delivered educational content to our learners over the past year.

Scholars have written about how likely this pandemic will likely precipitate the much-needed digital transformation of healthcare and health professions education that many of us have expected and hoped for. But while some of these innovations are born out of necessity, they may also inadvertently isolate us from the experiential aspects of education and human interaction that provide meaning to our work. For the ALiEM team, we cherish the opportunity to be part of some of these significant innovative and positive “disruptions,” further aligning our goal of creating an impactful and fulfilling academic life in emergency medicine. 

The Backstory

As a remote team working across continents, the ALiEM team has thrived on digital connection for over a decade. With excellent collaborators and volunteers representing different parts of the world, our daily operations require us to stay connected and work asynchronously to achieve our goals and deliverables. When the lockdowns hit, we leveraged its impact on physical distancing and leaned into connecting with each other even more! They say “chance favors the prepared mind,” and there we were, already on Slack and yearning for the opportunity to harness the power of teamwork using our shared passions, individual creative strengths, and enthusiastic and supportive emojis. There were moments of creating, moments of celebration, and moments of simply being with each other – often through an evening #WifiAndWine.

By the Ides of March 2020, an auspicious time indeed, we knew we were at a turning point. Our friends and work families had been working on the front lines combating the pandemic locally, gathering PPE, and studying the effects of a virus we knew next to nothing about. New information was coming in daily, and the signal-to-noise ratio was low. In some ways, to escape the disruptions going on all around us, we banded together to focus our unique energies toward creating something as novel as the virus itself in the realm of free open-access medical education.

At a time where everyone was feeling alone, we asked ourselves how we could support the joy of learning from and with each other? In truly whirlwind fashion, the first ALiEM Connect conference went from idea to execution in less than 2 weeks, a record-breaking time even for ALiEM. Thank especially to the American Board of Emergency Medicine for sponsoring these events.

We recently made it to the semi-finals at the CORD/ACEP Innovator of the Year competition, where we shared the below video capturing the fun, collaboration, and innovative outcome of our efforts. Oh, and the familiar ratatat of Slack.

Making this a Multiple Win

The secret sauce of the ALiEM team is that we have a diverse group of people, each of whom brings their own perspective and that we are able to share with one another liberally. Dr. Michelle Lin encouraged an environment that is psychologically safe and supportive since the inception of the ALiEM enterprise. It is out of this space that our diverse team was able to successfully bring a massively successful project to fruition amid a global pandemic. What started as a small brainstorming session blossomed into ALiEM Connect – 3 distinct remote conferences featuring nationally-recognized educators and thought leaders enjoyed by residents across the country.

It’s difficult to express as a linear narrative, but looking back, it seems as though our team divided into unique roles without a second thought. Just like a production company, we had the front and back of the house. Those in the front made sure to help get people in the seats to watch; stage managers and coordinators ensured that every part of each of the ALiEM Connect experiences was phenomenally smooth. We had talented individuals who acted as hosts and speakers to ensure that each of these experiences was top-notch and engaging. In the back, Drs. Mary Haas, Yusuf Yilmaz, and Teresa Chan sprung quickly into action to create a program evaluation strategy for our ALiEM Connect program, including a formal institutional review board exemption! All the while, testing and vetting platforms and methods to distribute the material were ongoing. We built upon each technological skill, learned new platforms, and trialed different features. We had barely decided on an open, free, and accessible platform (which was, in fact, no individual platform but an amalgamation of many!) before sending out the invites.

But the fun didn’t stop there! We’re the “academic” life in emergency medicine! How could we not also share our results with the traditional academic community? Within days of finishing our first ALiEM Connect experience, our program evaluation team generated the scaffolding of a manuscript to put together our thoughts and analyze the evaluation data collected. We harnessed the power of metrics from social media platforms (YouTube, Slack, Twitter), website analytics, and end-user experiences. Harnessing all of these analytics and communicating the right message with our academic medicine community was important to inform and help others to replicate similar approaches to their residents. Our team used ready to use metrics which came from YouTube analytics. But we did not stop there as we needed more reports of how the residents and programs interacted during the Connect events in the backchannel, Slack. We developed Python supported software to export and analyze all the messages happening in separate channels. We developed a “Emoji Cloud” to see how the reactions happened, and closely analyzed the messages during the event.

Given the true novelty of the experience, we figured we might as well shoot for the moon, as they say, by submitting our innovation description paper to Academic Medicine. After all, even if they didn’t accept it, we might get some constructive reviews, to say the least. As innovators, we are comfortable with the possibility of failure. We understand the value of the saying, “You miss 100% of the shots you don’t take,” and were prepared to accept “no” as an answer. With that, we took a calculated risk, making use of the same collaborative strategy to craft a manuscript, and clicked submit.

…And we’re glad we took that shot! We are excited to share that what we sent was indeed accepted and express our gratitude for the chance to share our low-cost approach to a large-scale, nationwide residency conference! You may read the Published Ahead-of-Print version of our paper.

Moral of the story…

You might be asking yourself, “What’s the moral of the story here? Of course, with enough academics and experts, yeah, you got a paper published. Cool…” But the papers aren’t the point. In fact, during the COVID-19 pandemic, more papers have been published than ever before – more research is being done, and our whole field is changing. The point is… this is how we got to ENJOY the academic life during a pandemic! We made lemonade (and several other desserts!) out of the lemons we were handed. New knowledge comes from thinking big and trying new things. Turns out, sometimes you also have to write about those experiences and share them with others.

As emergency physicians, we know we’re good in a crisis. But this experience reminded us that by surrounding ourselves with amazing people, we could get a surprising amount of work done (at record speed) and have a fantastically memorable time along the way. The moral of this story is that when you bring great people together and give them a chance to get to know each other, magic happens. ALiEM Connect happens. And we impact more people than we can possibly meet at the touch of our keyboards. We are so grateful for the chance to work alongside all the wonderful people at each of our institutions every day. Still, also, we are indebted to those who are our digital family. Thank you to all of you who make initiatives like ALiEM Connect possible. Academic life in emergency medicine is all about bringing a great team together.

So is the ALiEM team.

ALiEM Stands in Solidarity with Our Asian American and Pacific Islander (AAPI) Community

We at ALiEM wholeheartedly condemn the xenophobia, intolerance, and hate crimes directed towards Asians and the Asian American and Pacific Islander (AAPI) communities. Recent events spurred by the COVID-19 pandemic are hurtful, “othering,” and simply unacceptable.

Anti-Asian hate crimes across the country since the onset of the COVID-19 pandemic have increased 833% in 2020, compared to 2019, in cities across the United States [1]. This heart-breaking trend of violent assaults against individuals in the AAPI community is misguided and counter to the healing and building that our country direly needs as a result of the global pandemic.

Last week’s shootings in the Atlanta area that claimed the lives of eight people, including six Asian women, have had devastating effects on the AAPI community. For some, it has sparked recollections of previous incidences of bias they themselves have experienced. For others, it has been a call to action, on how to be better advocates and allies for all people of color.

We stand in solidarity with our AAPI communities and allies. These hate crimes continue to highlight the ongoing and longstanding structural anti-Asian and anti-immigrant racism in our country. Each of us has the capacity to show kindness, compassion, and respect for one another. Each of us has the capacity to stand up for those tormented and racialized. Let us work together to overcome the hate and bigotry that plague our nation.

 

What can you do to be an ally?

 

References

  1. VOA News: Hate Crimes Targeting Asian Americans Spiked by 150% in Major US Cities

AAPI solidarity statement

By |2021-03-28T10:19:46-07:00Mar 26, 2021|Life, Public Health|

Silence is not an option: Addressing structural racism in medical education

racismThe year 2020 has been a year of upheaval. The COVID pandemic revealed disparities in healthcare and its effects on marginalized groups such as the Black community. The pervasive effects of structural racism affect all of us, including in medical education. We cannot and must not remain silent. As we honor Juneteenth, #BlackLivesMatter, and #WhiteCoatsforBlackLives, let us reflect on ways we can address racial injustice in our direct environment.

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By |2020-06-19T08:37:15-07:00Jun 19, 2020|Academic, Emergency Medicine, Life|

Trick of the Trade: Angiocatheter for manual aspiration of priapism

needle position for priapism

A 25-year-old man presents with 6 hours of penile pain and swelling after recreational penile injection of Trimix (alprostadil, papaverine, and phentolamine). He denies any history of sickle cell disease or penile trauma. On exam, he is in moderate discomfort and has a tumescent penis with a soft glans. You suspect the patient is suffering from ischemic, low-flow priapism. Manual compression and ice application have been attempted with no significant improvement in the patient’s clinical status.

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By |2020-05-13T11:19:13-07:00Jun 10, 2020|Genitourinary, Tricks of the Trade|

All-EM Residency Graduation Extravaganza: Save the Date

all-EM residency graduation emergency medicine speakers

We invite all of you to join the first-ever all-EM residency graduation event to celebrate the #EMClassof2020 who are embarking on their professional careers in an especially tumultuous time in history. Although this online event cannot replace the experience of an in-person departmental event, we hope that we can all take a collective pause to realize how connected we are in EM and even find some joy in these dark times. As a testament to this momentous “leveling-up” event, world-class speakers, Dr. Esther Choo, Dr. Mel Herbert, and Dr. Amal Mattu will headline a series of well-wishes and inspirational words. We have pulled out all the stops and spared no expense to honor YOU, the future of EM!

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By |2020-06-08T16:15:47-07:00Jun 5, 2020|Academic, Social Media & Tech|

Trick of the Trade: Sodium Bicarbonate for Acute Symptomatic Hyponatremia

sodium bicarbonate

A 25-year-old woman is brought into the emergency department by friends due to “acting weird.” She was at a rave and is reported to have consumed alcohol, marijuana, and ecstasy. On exam, she is afebrile, tachycardic, normotensive, and breathing comfortably on room air. She is lethargic, mumbling incomprehensibly, and does not follow commands. Her glucose is 115 mg/dL, her pregnancy test is negative, her EKG reveals sinus tachycardia, her ethanol level is 30 mg/dL, and a stat CT head is negative. Her chemistry panel reveals a sodium level of 114 mEq/L. You order a 100 mL 3% sodium chloride bolus, but it may take 30 minutes to arrive from the central pharmacy. At this point, the nurse informs you that the patient is seizing.

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By |2020-05-11T06:50:15-07:00Jun 3, 2020|Tox & Medications, Tricks of the Trade|

ALiEM Statement Against Racism

ALiEM Statement Against Racism

Illustration by Dr. Moises Gallegos

Academic Life in Emergency Medicine (ALiEM) stands in solidarity with emergency physicians and learners in denouncing the structural racism and acts of violence that disproportionately affect persons of color. ALiEM denounces the senseless death of George Floyd which adds to the ever-rising numbers of deaths among Black men and women. The dissemination of the now-viral video documenting Mr. Floyd’s last desperate moments has brought a renewed public awareness to a disease that has for far too long afflicted this nation. We see the injustice and disparities in healthcare that are made even more visible during the COVID-19 pandemic. ALiEM is committed to taking action against racism and discrimination and joins the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), and the American Academy of Emergency Medicine (AAEM) in urging frontline healthcare providers, educators, and leaders to promote a safe, equitable, and inclusive learning and patient care environment in emergency medicine. We support diversity in free and open access to medical education and uphold efforts to embrace our common humanity.

By |2020-06-01T16:43:29-07:00Jun 2, 2020|Public Health|
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