Academic Career Guide I Chapters 18 Summary

1
Academic Career Guide I (Chapters 1-8 Summary)
2
The History of Academic Emergency Medicine
Milestones

• 1960-70s Emergency Department regarded as a
  pita 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
  (EPs)
• 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
3
The History of Academic Emergency Medicine
Milestones

• 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 EMs first journal, Journal
  of the American College of Emergency Physicians
  (JACEP)

-Summarized from G. Hamilton, SAEM ACG Chapter 1,
2007
4
The History of Academic Emergency Medicine
Milestones

• 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

-Summarized from G. Hamilton, SAEM ACG Chapter 1,
2007
5
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
6
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

-Summarized from LC Patten and F Ankel, SAEM ACG
Chapter 2, 2007
7
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

-Summarized from LC Patten and F Ankel, SAEM ACG
Chapter 2, 2007
8
Choosing AcademicsHow 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
9
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 work
• cons- additional time and financial commitment.
• Fellowship (see also the next section)
• pros- create a precious niche within academic
  emergency medicine
• cons- additional training time and delayed
  workforce entry and financial rewards

-Summarized from J Davis JL Oakes, SAEM ACG
Chapter 3, 2007
10
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 degrees (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
11
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 Masters 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 ICUs despite
  lack of board certification

-Summarized from DS Howes, SAEM ACG Chapter 4,
2007
12
Importance of a Fellowship What are the Choices?

• 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

-Summarized from DS Howes, SAEM ACG Chapter 4,
2007
13
Importance of a Fellowship What are the Choices?

• 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

-Summarized from DS Howes, SAEM ACG Chapter 4,
2007
14
Importance of a Fellowship What are the Choices?

• 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

-Summarized from DS Howes, SAEM ACG Chapter 4,
2007
15
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
16
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
17
Creating a Healthy Career Wellness

• Wellnesswhat does it mean to you? Realize
  this meaning may change during different stages
  in your professional life
• Long-term wellness isnt 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
18
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

-Summarized from F. Nobay, SAEM ACG Chapter 6,
2007
19
Creating a Healthy Career Balancing Personal and
Professional Responsibilities

• Create a long-term vision of your life helps
  ensure that your arent 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.)

-Summarized from F. Nobay, SAEM ACG Chapter 6,
2007
20
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 wont 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

-Summarized from F. Nobay, SAEM ACG Chapter 6,
2007
21
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 youre asked about burnout by more
  than 1-2 peoplestart looking for
  resources/support. Watch out for exacerbation of
  psychiatric illness or substance abuse
• Unique stressors for Women EPs called something
  other than doctordifferent expectations by
  staffbalancing work with motherhood. Try
  finding a mentor, set realistic expectations for
  yourself, and set limits/ say no

-Summarized from F. Nobay, SAEM ACG Chapter 6,
2007
22
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
23
Teaching and Education Academics as a Clinical
Educator

• 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

-Summarized from CS Weaver and AJ Callisto, SAEM
ACG Chapter 7, 2007
24
Teaching and Education Academics as a Clinical
Educator

• 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

-Summarized from CS Weaver and AJ Callisto, SAEM
ACG Chapter 7, 2007
25
Teaching and Education Academics as a Clinical
Educator

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

-Summarized from CS Weaver and AJ Callisto, SAEM
ACG Chapter 7, 2007
26
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
27
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

-Summarized from G Schmitz and C Hobgood, SAEM
ACG Chapter 8, 2007
28
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

-Summarized from G Schmitz and C Hobgood, SAEM
ACG Chapter 8, 2007
29
Author Credit Acad Career Guide IE. Willis
Nottingham MD

• Questions

30
Postresidency Tools of the Trade CD

• 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

• 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