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.

Social Medicine in the Emergency Department: Not all conditions can be treated with medicines

social medicine emergency department homeless

On the day we met Jane, a woman in her 70’s with diabetes and mobility impairment, she was visiting an Emergency Department (ED) for the 50th time in the past year. Jane was experiencing homelessness and spent much of her day riding public transportation in her wheelchair. Bystanders, often concerned for her health after noticing she had an episode of incontinence, would call 911 after which Jane would be brought to the nearest ED.

On the day Jane came to our ED, our multidisciplinary ED-based Social Medicine team was asked to help in her care. She was very thin, her clothes were wet from rain, and her belongings were falling from the plastic bags draped on the back of her wheelchair.  Our team sat with Jane to understand what type of help that she wanted — she was hungry, she hadn’t had stable access to food for months, and her bottom was painful as she had developed wounds from spending hours sitting in soiled clothes. That day, our team provided her with a sandwich and hot coffee, brought her a set of clean, dry clothes, and built enough rapport with her to interest her in moving indoors to a nearby respite center. Over the ensuing months, Jane gained back her strength, she established care with a primary care physician and improved her diabetes control, her wounds healed, and she built a relationship with a case manager who helped her to move into long-term housing. And, as a secondary outcome, her use of acute care services dropped substantially – she had less than 5 ED visits and no hospitalizations in the following year.  Caring for Jane and watching what happened next was a lesson for all of us about the impact of addressing medical and social needs together.

What is an ED Social Medicine team?

We formed the ED Social Medicine team in 2017 to support ED clinicians and help better meet the complex medical, behavioral health, and social needs of ED patients. A brief description of our work was recently published in JAMA [1], which provides one potential roadmap to medical and social care integration in the ED. A few core components of this work include:

  1. Asking patients about their self-identified social needs – Meeting a patient’s psychosocial needs allows them to better engage with medical care.
  2. Supporting ED clinicians in the care of patients with complex behavioral health and social needs – The ED and acute care system cannot function optimally in a silo. The Social Medicine team is multi-disciplinary and includes hospital-based social workers, nurses, pharmacists, care coordinators, AND strong partnerships with ambulatory health care clinicians and community-based organizations essential to the safe discharge and successful care of ED patients with complex social needs.
  3. Considering how to best promote the individual patient’s health and independence while preserving access to acute care for all patients – Medical, social, and behavioral health resources in the community are often more robust than we might realize; clinicians and patients both win by better understanding the landscape of care and resources available in the community. Leveraging available community resources also allows the ED and inpatient hospital to be preserved for patients with the most emergent medical conditions.

Integrating the medical, behavioral, and social care for your patient

Treatment of medical conditions without consideration of underlying social needs will be less effective, more costly, and may lead to moral distress for both patients and providers. We all want to feel that we are treating the patient so that they will do as well as possible in their life outside the hospital — to address not just the immediate medical issue, but the things that are fundamental challenges in their lives.

For instance, when we are treating a patient in the ED with diabetes, homelessness, and social isolation, prescribing medication to treat hyperglycemia may be the most straightforward solution, but it is unlikely to be maximally effective without ensuring the patient can do the following:

  • Afford the medication
  • Get to the pharmacy
  • Read the label and administer the medication
  • Access affordable food
  • Obtain transportation to follow up medical appointments
  • Find a stable place to live
  • Connect with social support in their community

These can seem daunting, and it may not be possible to improve all of these issues during the ED visit, but there are effective interventions to try to help patients experiencing complex social needs. As related to the example above:

  • Arrange a conversation with a social worker to assess and address the patient’s social needs
  • Dispense discharge medications directly from the ED
  • Ask the pharmacist to consider how to make dosing easier such as a medi-set or special labeling for patients who speak a primary language other than English, or have visual impairment or low literacy
  • Facilitate the next check up in primary care or other medical care by making an appointment or providing a warm handoff
  • Provide printed information about social and community resources such as meal kitchens, food pantries, housing programs and community groups (such as support groups, faith communities and cultural organizations)

No matter what the problem, a first step is always to ask the patient what support they need in order to be successful.

Call to action for social medicine

  1. Partner up: We encourage you to understand the underlying social needs of your patients and work with partners, such as your ED social workers and community social services, to help meet those needs. The ED visit can be an opportunity to go beyond healthcare, and help our patients realize optimal health.
  2. Ask the patient: At the frontline, we recommend asking your patients about their primary concerns and social needs, and doing what you can to help.
  3. Form a team: If you want to go a step further, form a team and develop partnerships with staff in your ED (e.g., social workers) and outside your health setting (e.g., community based organizations) to understand a system problem (e.g., access to medications, food or emergency housing) more deeply. Talk to your patients to get their input and recommendations. Then, use quality improvement techniques to improve the care of that problem in service to your patients.
  4. Look upstream: If you want to work upstream of direct care, join or form a group to understand a problem at the community level and advocate for increased social services available to your organization and community.

More resources

If you want to learn more or get more involved in the Social Emergency Medicine space:



  1. Chase J, Bilinski J, Kanzaria HK. Caring for Emergency Department Patients With Complex Medical, Behavioral Health, and Social Needs. JAMA. 2020;324(24):2550-2551. doi:10.1001/jama.2020.17017

Photo by Ev on Unsplash

Beyond the Abstract | Resident Motivations and Experiences in Listening to Educational Podcasts

Podcasts are all the rage these days, and it is not surprising that some residents spend more time with podcasts than any other educational resource.​1–3​ But why? And how do podcasts fit with other forms of learning, like lectures, textbooks, and clinical teaching?

In our recent article published in Academic Medicine, we explored these questions. Using qualitative interviews and analysis, we identified 3 overarching themes that shed light on residents’ podcast listening behaviors and the tensions with which listeners wrestled.​4​


Beyond the Abstract: A Return to Work Policy for New Resident Parents

More women than men entered medical school in the United States for the first time in 2017. Will this generation also set new trends in parenting during their training? One study suggests that 40% of female residents plan to have a child while in residency.1

Can our graduate medical education system withstand even a modest increase in the number of resident parents? Can your hospital?


By |2019-04-18T15:05:11-07:00Mar 19, 2019|Beyond the Abstract, Wellness|

Beyond the Abstract | Shared Decision-Making in the ED: 3 Factors That Matter

shared decision-makingShared decision-making seems to be more popular than Snapchat these days. Everyone in emergency medicine is talking about it… but who is actually doing it properly? In our recent concepts piece published in Annals of Emergency Medicine, we describe 3 key factors that must be present for shared decision-making (SDM) to be appropriate in the emergency department (ED).


By |2019-04-18T15:03:19-07:00May 31, 2017|Beyond the Abstract|

Beyond the Abstract: Patient video testimonials improve physician interpretation of advance directives and POLST

advance directives and POLST with videoOver 1,300 physicians across the U.S. were asked to interpret patient preferences for end-of-life care in theoretical cases. Physicians rarely reached consensus about patient preferences when they were given only living wills and POLST documents to interpret. The addition of a patient video testimonial helped physicians make better care decisions that reflected their patients’ wishes. Will video become the new national standard for advance care planning?


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