It is not very often that the ERAS application process for residency positions changes from year to year. In 2018, there is going to be a new component added – the Standardized Video Interview (SVI) launched by the Association of American Medical Colleges (AAMC). All EM applicants in the 2018 application season are required to complete this interview during June 6 – July 31, 2017. Because it is such a new process, we invited key various stakeholders to the virtual table. The discussion was hosted by Drs. Michael Gisondi (Stanford) and Michelle Lin (UCSF/ALiEM).
“We do make a difference, but not just in the setting of resuscitating critically ill or injured people, but in putting people on the pathway to health. We often get cheated out of the ending of the movie. We don’t see the romantic side of what we’ve helped facilitate. We certainly don’t get credit for it.” – Dr. Richard Cantor
There are lots of reasons why Emergency Medicine (EM) has one of the highest burnout rates compared to other medical specialties.1,2 We have long and erratic hours, difficult patients, and an increasing number of bureaucratic tasks such as clicking boxes in an electronic medical records system or ensuring high patient-satisfaction survey responses.2 These stresses are not unique to EM, but our high-volume and high-acuity patient loads do amplify those stresses compared to other fields.
When I got back home from taking [my board exams], having all these [negative] feelings swirling through my head, I remember driving up and seeing my wife and baby sitting on the porch and suddenly being like, “Isn’t this what life is all about? Is it really about studying for an exam? Is it really about pushing yourself to get triple-boarded or do this or that within medicine? I mean, isn’t THIS what it’s about? Having a wife and a child, a family to call your own, aren’t these the things that are most important that we should value?” After that point, after seeing them on the porch and over the next couple weeks, things really started to change for me.
— Haney Mallemat, MD
“One of the residents that I was working with was yelled at once by somebody else because he had cried while giving a family bad news. I think everyone knows when you’re giving them bad news; it’s not like a big secret. You maintaining a great deal of composure doesn’t change that fact. I think that we’re allowed to be human. If we force ourselves not to be human or have any degree of human emotion, that’s obviously not putting us on the path to wellness and certainly if we force other people not to be human that’s not putting either them or us on the path to wellness.”
—Ilene A. Claudius, MD
Breaking bad news to patients and families is a fact of life for an emergency physician. More than 300,000 patients die in emergency departments each year from either traumatic or nontraumatic cardiopulmonary arrest, and an even greater number are diagnosed with a new life-threatening or life-altering illness, such as cancer, stroke, or traumatic brain injury.1 We stand at the front lines for these patients and families when they are first confronted with death or their own mortality. It is up to us at these moments, not their specialists or family physicians, to comfort and support them in a time of need. While intensely fulfilling at times, this type of demanding emotional support can also be incredibly draining in an environment that never sleeps and never stops moving.
“It’s rarely the patients that hurt me. It’s my colleagues in the hospital.”
“[Interprofessional conflict] is so underappreciated as a source of stress and misery in our job. And so often in the hospital, horrible behavior is swept underneath the rug because a) there is no pathway to address this stuff and b) it’s almost seen as de rigor for certain services to act this way. “Oh it’s the surgical service, what do you expect, that’s just the way they are.” That is what ruins me … I think that is the biggest threat to wellness in my world.”
–Scott Weingart, MD
Case: A 78 year-old female with a past medical history of asthma and hypothyroidism presents with a three day history of sore throat and a two day history of a “lump” along the right side of her neck. The “lump” has now progressed to involve both sides of her anterior neck and is accompanied with erythema, tenderness to palpation, and swelling. In addition, the patient has developed a hoarse voice and odynophagia. The patient’s primary care physician referred her to an ENT specialist, who then referred the patient to the ED for urgent imaging due to the concern for a deep space neck infection. Triage vitals are remarkable for a heart rate of 118 beats per minute. She is otherwise normotensive and afebrile. On physical exam, slight crepitation in noted on the floor of the patient’s mouth. Of note, the patient also informs you of her penicillin allergy. Which of the following is the biggest risk factor for this particular disease process?
Podcasts: Pearls on Networking, Early Academic Career, and Part Time Academics in the AWAEM Professional Development Series
For those early in their academic medical career, it can be challenging to find solid, trustworthy advice on how to navigate the perils of academia. Fortunately, The Academy for Women in Academic Emergency Medicine (AWAEM) has published a series of video-based Peer Reviewed Lectures (PeRLs) in the Academic Emergency Medicine journal. Thanks to the journal, we were given permission to repurpose some of of the videos into podcast form. Take a listen to these short, abridged, high-yield podcasts for those pursuing an academic career.