**A newsletter for medical students pursuing a career in Emergency Medicine**

May 2020

We are thrilled that you are interested in the exciting field of Emergency Medicine (EM)! We are beyond excited to launch the inaugural issue of Academic Life in Emergency Medicine’s (ALiEM) EM Bound. This free monthly newsletter for EM-bound medical students serves as a resource and guide on their journey to the residency match and beyond.

TOP NEWS

Reminder: Bridge to EM is an 8-week guide to provide structured preparation in the weeks leading up to July 1st when you will enter the hospital as an EM intern. On this date, members of your team will look to you for guidance in the management of patients. We want to equip you with the tools to help build your medical knowledge foundation so you can start your first day with confidence. All of these resources are free for students (assuming an EMRA membership), and they have all been vetted to ensure up-to-date information. These resources are well-made, practical for real life, and high yield.

During April 24-June 30, 2020, EM:RAP has made the relevant Bridge to EM C3 episodes open access for even non-EMRA members.

Ways to close the distance while keeping 6 feet away

In the era of COVID and physical distancing, wellness often easily takes the back burner as we are attending to our school work, family, and community needs. Physical distancing can take a toll on your emotional status, and left untended, can lead to burnout and challenge our wellbeing. Here are some top tips on how to maintain and preserve your own wellness and close the social distance while staying 6 feet away!

Top Tips:

Create some “me time”: In a time when you are in clinical rotations, or working in the hospital, we are pulled to serve others. The best way to stay focused at work is to take some time for yourself. Put it in your calendar! Remember: “If it’s not documented, it didn’t happen.” Color code your “me time,” so you can look at your week’s schedule and objectively see how much you’ve done for yourself.
Stay active: Exercise can serve as a way to relieve stress and anxiety during this pandemic. Having an accountability partner to workout with is a great way to start. Youtube and various online apps are available for group online classes to help you be at the gym while in the comfort of your own living room! Create a habit of daily or weekly practice to minimize the guilt of not able to exercise.
Schedule a date: Regular meetups with family/friends online can bring a world that feels far apart to your fingertips. Consider a coffee talk, wine night, or even cooking a meal “together.” Scheduling quality time can help prevent feelings of isolation. Again, “If it’s not documented, it didn’t happen.”
Happy hour online: Plan regular meetups online with friends or family on a regular basis (i.e., Friday at 5 pm every week). This can help you look forward to a social activity and break up the monotony of social isolation. Creating a themed event or meeting with your favorite drink can help add excitement while you share each other’s company.
Parallel play: Popular among toddlers, parallel play also works well in the era of social distancing. Consider keeping a friend online while you both work independently on projects. It can make you feel like you are side-by-side despite the distance. You can see each other and check in on each other’s progress for accountability and to promote productivity!
Screen sharing: This is a great way to watch TV shows or movies together, play online games, and interact with friends and colleagues. You can even play board games together with friends! Activities that were previously for leisure or decompress can be repurposed during social distancing practices to stay connected.
Meet outdoors: While we are required to maintain physical distance, being outside is a great way to talk and catch up while still maintaining safety. Google the words, “forest bathing,” and see the benefits.
Virtual book club: With extra time on your hands, why not pick up a book? Creating a virtual book club with friends, family, or colleagues, can help give you the motivation to read that book that has been on your to-do list!
Retail therapy: Shopping online, alone, or with a friend, can help you to get the necessities you need without going to the store and risking exposure. Although it can be fun and relaxing, remember to be mindful of your budget!
Stay neighborly: If your neighborhood has a Facebook group, or online website, request to join. You can share pictures and activities (i.e., Start a sidewalk chalk drawing contest with different themes, put flowers or clovers in your windows for kids to point to on their walks, etc).
Jam out online: Music can help close the distance and share in a common experience. Grab an instrument and plan a jam session with your friends. You can do this on Zoom (Here’s an example from Italy) or even with your neighbors (Here’s another example from our trendsetters in Italy).
Volunteer! Several medical students have channeled their energy into their community. #PPEdrive has been successful. Consider #MealsOnWheels. There are lots of creative and innovative ways to still serve while you aren’t able to practice clinically.

What other ways have you done to maintain your wellness during the COVID-19 physical distancing?

Spotlight

Social EM:Updates in COVID-19 and Health Disparity

EM is uniquely positioned to see the impact of social determinants of health on a daily basis, let alone during a pandemic. Many challenges faced by medical and public health efforts in response to the rapid spread of COVID-19 were a result of long-standing inequity in healthcare systems. COVID-19 has confirmed that many communities composed of racial/ethnic minorities and the unhoused/homeless in the US experience health and socioeconomic disparities.

Reasons for the higher incidence of COVID-19 among racial and ethnic communities are multifactorial but include a higher prevalence of underlying chronic disease as well as barriers in access to care including cost and health literacy. Additionally, members of these communities may not be able to fully adhere to social distancing policy. These individuals comprise a large number of “essential” employees from sectors such as public works, the food industry, and custodial services which prevent their working from home. Furthermore, these communities often rely on multi-family living accommodations and shared spaces. For more information: COVID-19 in Racial and Ethnic Minority Groups and Failing Another National Stress Test on Health Disparities.

If you are interested in learning more about how social context influences the health of patients and the care provided in the Emergency Department, check out the following resources on Social EM.

ACEP Section page on the growing field of Social Emergency Medicine
Social Empact
EMRA Social EM & EMRA Social EM Fellowship Guide
The Andrew Levitt Center for Social Emergency Medicine

COVID-19 UPDATES

Clinical Pearls

A mantra to remember is: “There are no emergencies in pandemics.” You must protect yourself and your team when approaching potential COVID-19 positive patients.
Donning and doffing are crucial for protection against contamination and infection. Ensure good hand hygiene and that you are complying with institutional PPE guidelines.
Flatten the curve: While on shift, make sure you’re handwashing and avoiding touching your face is key to preventing spread! Crucial practices include social distancing of ≥ 6 feet, limiting travel to high-risk areas, and avoiding sick individuals.

Additional Vetted Resources

EmDocs: PPE: Donning and Doffing PPE Pearls for COVID-19
CDC:
- Using PPE
- Donning/Doffing PPE Video: PPE Donning; Doffing PPE

CLERKSHIP LIFE & RESIDENCY APPLICATION SEASON

While COVID-19 has cast uncertainty on when clinical rotations will resume and whether away rotations will even occur, let us all proceed with a sense of hope and optimism that you will be a fantastic EM sub-I this summer or fall. So what is one to do in the meantime, you ask?

Great question. COVID-19 or not, coming into your sub-I with a strong grasp of the differential diagnosis and approach to common presentations, familiarity with critical care management, and a basic foundation in ECG interpretation will help you shine. There are numerous high-quality online resources out there, but here are some to help you take advantage of your current virtual life.

Differential Diagnosis and Critical Care

CDEM M4 Curriculum: With recent updates, you can learn about the approach to common chief complaints and specific disease conditions.
First10EM: Dr. Morgenstern shares his clear and organized approach to critical care scenarios. Be sure to check out the modules on a general approach to resuscitation, undifferentiated hypotension, and respiratory distress.
Ddxof: A compilation of algorithms for common presenting problems and diseases. Use the search feature to find chief complaints. Also available as an app.
EM Basic: With over 90 episodes, this podcast series covers a wide range of topics. Go to the initial episodes to start with the basics.
EM:RAP: Another popular podcast that is free to medical students through an EMRA membership. Their C3 series covers the basics for common complaints. They also have a video series that parallels this C3 series and covers additional topics like ECGs, ultrasound, and procedures.

ECG Interpretation

ECG Wave Maven: A large repository of ECGs encased in clinical scenarios that also offers the ability to self-assess your interpretation skills
Life in the Fast Lane: Offers a basic introduction to ECG interpretation, an excellent library of examples with explanations, and quizzes.
Strong Medicine: Dr. Strong has developed a wide and rich range of medical education YouTube videos. Among them is a series on ECG interpretation. Start with the basics or jump into the challenging world of arrhythmias.
Dr. Smith’s ECG Blog: For those itching for more, this site can help you jump into more advanced ECG readings as well as ensure you have a hold on the basics!
ECGWeekly: Run by the ECG Guru, Dr. Mattu, this resource is jammed packed with common ECG, as well as tips and tricks to teach the nuances of subtle presentations. Although not free, learning from the master of EM Cardiovascular disease is worth it!

EXPAND YOUR SOCIAL MEDIA HORIZONS

Twitter has become an incredible venue to grow your network, medical knowledge, and presence on a national and international forum. At your fingertips are smart clinicians filtering the literature for landmark findings and sharing these with you! Building your social-media presence early will prepare you for residency, because it is impossible to stay current with the literature by yourself on a sustainable basis.

Three suggested Twitter accounts to follow today:

To help you get started with building your personal learning network, here are some Twitter hashtags to peruse:

You can engage with us at @ALiEMteam. We’d love to hear how you are doing!

IF I KNEW THEN WHAT I KNOW KNOW

A RESIDENT’S PERSPECTIVE

Thoughts on COVID-19 for Medical Students
JJ Hoff, PGY-2 (rising Chief Resident)
Duke University Hospital Emergency Medicine
@jjhoff33

As a current 2nd-year EM resident attempting to navigate through the COVID-19 pandemic, it’s hard to fathom the emotions I would feel if I were to flashback to being a medical student during this time. With the immense amount of uncertainty surrounding when and how both classroom time and rotations will return to “normal” again for you, it must be difficult to see the way forward as you isolate at home and socially distance yourself from both your friends and us as your colleagues in the hospital.

To those MS4s who graduated early to start your critically important work ahead of schedule, we salute your bravery and the immense help you will provide! To the other MS4s who will be unfortunately unable to celebrate a monumental achievement and enjoy graduation day with their peers, we sympathize with you and cannot wait to start working with you shortly. Although I’m still a resident, here are a few brief thoughts on things you can do during this bizarre time as a student interested in a future in EM.

First and foremost, please continue to be an advocate as a trusted member of the healthcare community. We are seeing firsthand the positive effects of social distancing and societal changes being made on our ability to handle surge capacity in the hospital. Use your knowledge and spread it to others to continue “flattening the curve.” Also continue to broaden your knowledge base surrounding COVID-19. Our best guess is that we will continue to see this disease in our hospitals for months, so when you are back working with us you are likely to encounter patients that have either tested positive or still need to have COVID-19 considered as part of the differential diagnosis. The reality is that we are all learning new things every day in both diagnosing and treating COVID-19, so you will be a tremendous resource with the ability to comb through a myriad of online resources and journal articles to help care for our patients.

We are still continuing to see our usual amalgamation of patient presentations in the ED. Use this time now to nail down your workups and differentials for common chief complaints such as chest pain, abdominal pain, and altered mental status. The inherent nature of our profession is that we will always be needed for these “bread and butter” patients; appendicitis and acute coronary syndrome do not seem to care that there is a global pandemic going on!

Bottom line:

Stay informed and stay ready! It has been very eerie in the ED without our medical students around, and we cannot wait to have you back.
Stay safe at home and know that our patients will be here for you when you return!