Introduction to Emergency Medicine

1. 1 Introduction to Emergency Medicine American College of Emergency Physicians This is the second of two slide sets designed to teach medical students about EM. This slide set is designed for first and second year students to help guide them through the application process.This is the second of two slide sets designed to teach medical students about EM. This slide set is designed for first and second year students to help guide them through the application process.

2. A-2 Lecture Objectives Convey an understanding of the field of Emergency Medicine Discuss pros and cons of specialty Describe emergency medicine residency training Introduce EMRA and EM interest groups The purpose of this lecture is to introduce you to the specialty of emergency medicine. I would like you to develop an understanding of what emergency medicine is, what working as an emergency medicine physician is like, and how the emergency department is unique in both its approach to patients and the type of patients we evaluate. I would like also to discuss in general terms the various positive and negative aspects of emergency medicine so that you can better determine if this is the specialty for you. I would like to describe briefly how residency training is accomplished. Finally I would like to describe the Emergency Medicine Residents Association and various Emergency Medicine Interest Groups that are available to you. The purpose of this lecture is to introduce you to the specialty of emergency medicine. I would like you to develop an understanding of what emergency medicine is, what working as an emergency medicine physician is like, and how the emergency department is unique in both its approach to patients and the type of patients we evaluate. I would like also to discuss in general terms the various positive and negative aspects of emergency medicine so that you can better determine if this is the specialty for you. I would like to describe briefly how residency training is accomplished. Finally I would like to describe the Emergency Medicine Residents Association and various Emergency Medicine Interest Groups that are available to you.

3. A-3 History of Emergency Medicine Emergency Departments 1960s: Staffed by physicians of various backgrounds with no EM training American College of Emergency Physicians established 1968 American Board of Emergency Medicine formed 1979, independent specialty 1988 First “resident” 1969; First residency, University of Cincinnati - 1970 Emergency Medicine Residents’ Association formed 1974 Emergency medicine is still a relatively new field within medicine. Historically, emergency departments were staffed by physicians and nurses from various specialties. Often a triage nurse would call the appropriate physician down to care for the patient. In the 1960’s, a few physicians of various specialty backgrounds began to practice only down in the ED. It became obvious that there was a need for a specialty to care for these patients. In 1968, several physicians organized the American College of Emergency Physicians. This group undertook the daunting task of establishing recognition of emergency medicine as a specialty within various US medical establishments. In 1988, the American Board of EM became an independent board without influence of other specialties. Emergency medicine is still a relatively new field within medicine. Historically, emergency departments were staffed by physicians and nurses from various specialties. Often a triage nurse would call the appropriate physician down to care for the patient. In the 1960’s, a few physicians of various specialty backgrounds began to practice only down in the ED. It became obvious that there was a need for a specialty to care for these patients. In 1968, several physicians organized the American College of Emergency Physicians. This group undertook the daunting task of establishing recognition of emergency medicine as a specialty within various US medical establishments. In 1988, the American Board of EM became an independent board without influence of other specialties.

4. A-4 Emergency Medicine Residencies Emergency Medicine Residencies 1983 - 66 1990 - 84 2000 - 122 allopathic; 25 osteopathic 2005 - 134 allopathic; 36 osteopathic Resident Positions in NRMP 1990 - 440 2000 - 971 2005 - 1332 The number of residencies in emergency medicine has steadily grown over the last twenty years. It has stabilized over the last 5 years. The number of resident positions within EM have also grown. The number of residencies in emergency medicine has steadily grown over the last twenty years. It has stabilized over the last 5 years. The number of resident positions within EM have also grown.

5. A-5 Employment Opportunities Urban, suburban, or rural hospitals Teaching: university or community hospitals Traveling (locum tenens) physicians International medicine As an EM physician, there are limitless opportunities to work in the field of medicine. Although it is the best place to work, the ED is not the only venue in which an EM physician can apply his or her skills.As an EM physician, there are limitless opportunities to work in the field of medicine. Although it is the best place to work, the ED is not the only venue in which an EM physician can apply his or her skills.

6. A-6 Subspecialty Certification in Emergency Medicine Pediatric Emergency Medicine Toxicology Sports Medicine Undersea and Hyperbaric Medicine One can move onto various areas of sub-specialty from the specialty of Emergency Medicine. These are the four areas in which we can become board certified through fellowship training. One can move onto various areas of sub-specialty from the specialty of Emergency Medicine. These are the four areas in which we can become board certified through fellowship training.

7. A-7 Areas of Expertise Administration Cardiovascular Emergencies Clinical Forensic Medicine Critical Care Disaster Medicine Geriatric EM International EM Injury Control Medical Education Medical Informatics Neurologic Emergencies Ultrasound Wilderness medicine Beyond the areas of fellowships, there are several areas of expertise within the field of emergency medicine. Many other specialties may consult you about these areas to help manage patients. This can include the care of patients on a helicopter, or at a large gathering such as the Olympics. It might also include the management of multiple injuries at the site of a disaster such as a building collapse. Poisonings and environmental injuries are often managed emergently in the ED. However, the continued resuscitation within the hospital is often better known to us than the physician taking care of the patient. Beyond the areas of fellowships, there are several areas of expertise within the field of emergency medicine. Many other specialties may consult you about these areas to help manage patients. This can include the care of patients on a helicopter, or at a large gathering such as the Olympics. It might also include the management of multiple injuries at the site of a disaster such as a building collapse. Poisonings and environmental injuries are often managed emergently in the ED. However, the continued resuscitation within the hospital is often better known to us than the physician taking care of the patient.

8. A-8 Research Opportunities Broad range of subjects Basic Science Clinical Science Health Policy Broad funding opportunities Availability of mentors Research within EM is not yet well established. However, it is limitless. You can pick almost any area of medicine and research it from the emergency department standpoint. As the specialty grows, there are more and more competent and qualified researchers promoting EM. The number of research projects and clinical trials will continue to grow. Research within EM is not yet well established. However, it is limitless. You can pick almost any area of medicine and research it from the emergency department standpoint. As the specialty grows, there are more and more competent and qualified researchers promoting EM. The number of research projects and clinical trials will continue to grow.

9. A-9 Appeal of Emergency Medicine Unique opportunity to make a difference Life threatening injuries and illnesses Diverse patient population No shift the same as its predecessor First opportunity to make the diagnosis Teacher for staff and patients Emergency / invasive procedures There is no better job than emergency medicine. We see anybody and everybody. We have the chance to make the difference in someone’s health almost every day. We must be prepared to take care of any emergency that arrives at the ED. We work as the detective to determine the cause of the patients’ complaints. Patients are not admitted to us with pyelonephritis; they present with undifferentiated complaints such as back pain and fever. We investigate the complaint through history, physical exam, labs, and imaging. We have to work through a very large differential, with the first opportunity to make the diagnosis. There is no better job than emergency medicine. We see anybody and everybody. We have the chance to make the difference in someone’s health almost every day. We must be prepared to take care of any emergency that arrives at the ED. We work as the detective to determine the cause of the patients’ complaints. Patients are not admitted to us with pyelonephritis; they present with undifferentiated complaints such as back pain and fever. We investigate the complaint through history, physical exam, labs, and imaging. We have to work through a very large differential, with the first opportunity to make the diagnosis.

10. A-10 Appeal of Emergency Medicine Team approach Patient advocacy Open job market Academic opportunities Shift work / set hours Evolving specialty Safety net of healthcare Within EM, we work through a team approach with other specialties to arrive at an appropriate diagnosis and treatment plan for the patient. We must stand firm on what is best for the patient even in the face of consultants seeking to avoid work. We work set hours which allows us to better plan our lives. It allows us more time for our families or interests. We know where our work day ends and our private lives begin. The opportunities within academics are huge. You can work in any setting from a community hospital to a level 1 intercity trauma center. Emergency medicine will continue to grow in the future. There are many avenues that we can improve upon and develop. We will likely continue to serve as the safety net of the US healthcare system for those who have no other access to healthcare for the foreseeable future. Within EM, we work through a team approach with other specialties to arrive at an appropriate diagnosis and treatment plan for the patient. We must stand firm on what is best for the patient even in the face of consultants seeking to avoid work. We work set hours which allows us to better plan our lives. It allows us more time for our families or interests. We know where our work day ends and our private lives begin. The opportunities within academics are huge. You can work in any setting from a community hospital to a level 1 intercity trauma center. Emergency medicine will continue to grow in the future. There are many avenues that we can improve upon and develop. We will likely continue to serve as the safety net of the US healthcare system for those who have no other access to healthcare for the foreseeable future.

11. A-11 Challenges to Emergency Medicine Interaction with difficult, intoxicated, or violent patients or family members Work in a “fishbowl” without 20/20 hindsight Finding follow-up or care for uninsured Limited resources High stress Some patients or their family members are under the influence of drugs or have psychiatric or emotional problems that cause them to be violent or inappropriate. This must be looked upon as a challenge, not a problem. At times, dealing with consultants can be difficult. This is due to the personality of that particular consultant, not the specific specialty. There will be times when other specialists look back at your care and determine that it was inappropriate now that they have much more information. Always do the right thing based on what information you have available. Many patients arrive at the ED without any emergency. Instead they arrive because of convenience for either them or their physician. Although frustrating, it still allows you to practice medicine. Some patients or their family members are under the influence of drugs or have psychiatric or emotional problems that cause them to be violent or inappropriate. This must be looked upon as a challenge, not a problem. At times, dealing with consultants can be difficult. This is due to the personality of that particular consultant, not the specific specialty. There will be times when other specialists look back at your care and determine that it was inappropriate now that they have much more information. Always do the right thing based on what information you have available. Many patients arrive at the ED without any emergency. Instead they arrive because of convenience for either them or their physician. Although frustrating, it still allows you to practice medicine.

12. A-12 The Lifestyle: Two Sides of A Coin Advantages Shift work Rare or no call Part-time employment possible Changing schedule Disadvantages Nights Weekends Holidays Changing schedule Many physicians migrate to EM due to the hours and well defined shifts. However, this must be balanced against the evenings and nights that are part of an EP’s entire career. Many physicians migrate to EM due to the hours and well defined shifts. However, this must be balanced against the evenings and nights that are part of an EP’s entire career.

13. A-13 Number of EM Physicians 4,945 Emergency Departments Need 32,000 - 37,000 ED physicians to staff In 2004, 21,452 ABEM Board certified physicians In 2005, 23, 081 ACEP members Emergency medicine continues to need more board certified physicians to man all of the available Emergency Departments. The estimated number of EM physicians that would be needed to cover all of these departments is between 32 and 37 thousand. However, there are only 16, 149 EM board certified physicians. The employment opportunities in EM are innumerable. They will continue to be so until multiple more EM physicians are trained. Emergency medicine continues to need more board certified physicians to man all of the available Emergency Departments. The estimated number of EM physicians that would be needed to cover all of these departments is between 32 and 37 thousand. However, there are only 16, 149 EM board certified physicians. The employment opportunities in EM are innumerable. They will continue to be so until multiple more EM physicians are trained.

14. A-14 Emergency Medicine Journals Annals of Emergency Medicine Academic Emergency Medicine Journal of Emergency Medicine American Journal of Emergency Medicine Pediatric Emergency Care Emergency medicine has at least five publications that strive to disseminate information about emergency medicine. They help to discuss the various issues facing every EM physician. As well, they present the latest research as well as the latest medical treatment guidelines. Emergency medicine has at least five publications that strive to disseminate information about emergency medicine. They help to discuss the various issues facing every EM physician. As well, they present the latest research as well as the latest medical treatment guidelines.

15. A-15 Emergency Medicine Residents’ Association Represents interests of EM residents and medical students Approximately 5,750 members Publishes EM Resident, a bi-monthly newsletter Publishes Top Clinical Problems for medical students The Emergency Medicine Resident’s Association (EMRA) represents the interests of resident physicians training within emergency medicine. EMRA publishes a bi-monthly newsletter, an annual job catalog, and a medical student handbook. The Emergency Medicine Resident’s Association (EMRA) represents the interests of resident physicians training within emergency medicine. EMRA publishes a bi-monthly newsletter, an annual job catalog, and a medical student handbook.

16. A-16 Emergency Medicine Residents’ Association Publishes antibiotic handbook annually Airway management card Online Medical Student Survival Guide EMRAMatch.org current residency program information for students – updated by residents

17. A-17 EMRA’s Medical Student Committee Represents students with interest in EM Promotes awareness of issues facing EM Organizes annual Medical Student Forum Organizes a Residency Fair Aids in organizing EM interest groups Provides a grass-roots network for students interested in emergency medicine

18. A-18 EM Interest Groups Student run organization “Shadow Shifts” Journal club Suture clinic Radiology lab EKG clinic Lectures on EM topics

19. A-19 Emergency MedicineFirst and Second Year Students Observe in ED Summer research projects with EM staff EM interest group affiliation Be open to any medical specialty

20. A-20 Emergency MedicineThird Year Students See patients in ED on various rotations Obtain EM physician as mentor Start selecting fourth year rotations

21. A-21 Emergency MedicineFourth Year Students Mandatory/Elective EM rotation Consider extramural rotations Community experience Opportunity at a residency program Trauma experience Letters of recommendation

22. A-22 Residency Programs Training programs: (2005) PGY 1-3 (75%) 102 PGY 2-4 (12%) 15 PGY 1-4 (13%) 19 Combined EM Residency Programs Emergency Medicine / Pediatrics Emergency Medicine / Internal Medicine Emergency Medicine / Internal Medicine / Critical Care

23. A-23 Choosing A Specialty Fit your personality Decide between general or specialized field Look at all areas of interest Commit to specialty you choose

24. A-24 Contact ACEP 1125 Executive CircleIrving, TX 75038-2522 800-798-1822 www.acep.org EMRA 1125 Executive Circle Irving, TX 75038-2522 1-972-550-0920 www.emra.org