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Wednesday, December 24, 2014

The International Federation for Emergency Medicine (IFEM) set up a task force, the Specialty Implementation Committee, which has developed guidelines for creating a specialty organization. The committee wrote the document, published in October, in response to requests for aid in developing a country’s emergency medicine (EM) specialty, and international EM leaders have reviewed the guidelines.


“Worldwide changes in demographics and disease epidemiology make the specialty training of EM increasingly relevant,” the document said. The formation of an EM organization “can establish standards for the education of EM specialists by setting the minimum requirements for the training and certification of its member, and can mandate maintenance of quality through re-certification requirements,” among other duties critical to a specialty organization.


The first step in the guidelines is to create the name of the organization, for which the document provides definitions of association, chapter, and college, among other key words, followed by composing a formal statement with the society’s mission or goals, popularly coined a vision statement. Membership, the document said, is the next early structural consideration, followed by establishing authority figures, like officers, committees, and sections of membership.


Plans for a physical structure must be laid out, too. At the beginning, many organizations depend on volunteers in the form of members and leaders, and as it grows, the organization has to consider hiring paid staff and finding a suitable headquarters space.


The document concludes with listing the benefits of developing an EM specialty organization, which include providing useful education services and effectively advocating with the government and other medical specialties.

Read the entire document:


Tuesday, December 23, 2014

Computed tomography (CT) scans of the brain can help physicians assess damage after a stroke and predict the risk of another stroke occurring, a new study published in Stroke said.


A research team tracked more than 2,000 patients who received CT scans within 24 hours of a transient ischemic attack (TIA) or a non-disabling stroke. Scans revealed that 40 percent of patients had brain damage because of impaired circulation, and about 25 percent of the patients showing this type of damage had another stroke within 90 days.


Other measures to prevent further stroke can include cardiac monitoring or medication to lower blood pressure, treating high cholesterol, and preventing blood clots.


Read the study’s abstract:



Monday, December 22, 2014

Brian J. Secemsky, MD, an internal medicine resident in San Francisco, exhorted medical students and residents to get on Twitter in a column he wrote for KevinMD. His reasons included:

§  Knowledge: “Unlike Facebook or LinkedIn, Twitter allows for you to follow most people online without requiring an invitation or acceptance from fellow users. It takes an easy click to follow professional journals, health policy foundations and/or health care leaders without feeling creepy or fearing rejection from the community.”

§  Networking: “Twitter offers a virtual, often tight-knit community that paves way to directly connect with established members despite geographical and professional distance.”

§  Identity: “Having a venue such as Twitter to display professional accomplishments, engage in discussion over important health issues, and curate high-yield health-related content allows medical students and young physicians a way to develop a reputation for professional commitment and advocacy beyond what is seen at the bedside.”


Read the rest:



Friday, December 19, 2014

A dedicated neurologic ED at Capital Health Regional Medical Center in Trenton, NJ, found average door-to-needle times and outcomes in acute stroke patients were significantly better in the neurologic ED, which is open from 7 a.m. to 6 p.m., compared with the main ED, which is open from 6 p.m. to 7 a.m.


Sixty-seven acute stroke patients received IV tPA in one of the EDs from 2012 to 2014, 35 of whom were evaluated in the neurologic ED. The average door-to-needle time of the patients seen in the neurologic ED was 35 minutes, compared with 83 minutes in the main ED. Discharge NIH Stroke Scale scores were significantly lower, and more patients were discharged home in the neurologic ED group.


Read more about the study:



Thursday, December 18, 2014
By Thomas Cook, MD

Emergency medicine residents meet with their program director for evaluation twice every year. Let’s be honest; no one likes this. Who wants to walk into a meeting with her boss to review what she is not doing right? It creates a lot of anxiety, usually followed by relief and often disappointment, second-guessing, and more anxiety in a business known for incredibly stressful situations.


Our residents are evaluated by faculty and their peers (the other residents) and a few ED nurses. All evaluations are presented to each resident anonymously.


Naturally, residents cringe at any criticism of their performance. They have invested an enormous amount of time and money to get to this point in their lives, and despite easily deflecting insults by patients, they perseverate on even subtle criticism in evaluations, even when lumped into a large collection of comments that praise nearly every element of their being. In short, they are a bit sensitive.


It is interesting to note which group criticizes and compliments the most. Nurses generally tend to be more critical, attendings fairly balanced, and peers tend to heap loving praise on their fellow combatants. That nurses might want to take a shot at the youngsters who arrive knowing nothing and leave with huge salaries is not surprising, but I have found their comments to be insightful, especially in helping me identify specific residents who have problems interacting with staff and patients. Attendings’ evaluations are usually accurate about a resident’s strengths and weaknesses.


Peer evaluation scores, however, are typically 20 to 40 percent better than those by faculty and nurses. Perhaps it is wishful thinking on their part that by being nice to their classmates on evaluations will get them treated likewise. But this comes with a catch. If a resident moves too far from what is considered appropriate behavior, their peers will seemingly come from out of nowhere, band together, and punish him. The effect on the resident is akin to being hit in the head with a sledgehammer. They are broken to bits and often in tears. Welcome to the crab bucket.


When you boil a pot of crabs, the few that manage to grab the rim in an effort to escape are pulled back down by the others. This is sometimes used to describe how members of a disadvantaged group seeking to leave through education and hard work are discouraged by others in their group and even pulled back to “where they belong.” The crab bucket actually has a positive effect on residents, however. They are pulling someone back into the group not to cause failure but to join them in success.


Ask any resident, and they will tell you they universally hate their colleagues for showing up late, not picking their share of charts, and making sloppy turnovers at change of shift. Do any of these enough, and the banter in the residents lounge is how you are becoming “a problem.” It might take a while, but when the tipping point is reached, it creates an evaluation tsunami, and the resident gets pounded.


Fortunately, this problem is easy to fix, and even the most dysfunctional resident can get back into the good graces of his brethren by working on these issues. But just as important, the resident learns that peer relationships are critical to success. Residents only have to fear what their attendings think of them for a mere 1,000 days. Peer impressions last decades, and you will find yourself unhappy at work and regularly changing jobs if you do not play well with others.