Driving the Evolution of EM

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Recently I had the pleasure of attending the EMRA Medical Student Symposium, a collaboration between EMRA and Ohio ACEP. At this student-centric event in Columbus, Ohio, I met the EM residents of tomorrow, all of them eager and anxious. I couldn’t help but remember my own feelings when I was at that stage. I remember the excitement and nervousness that came with the end of third year — those same emotions were palpable among the crowd in Columbus. But these future applicants seem smarter, cooler, and much more prepared than I was. I wonder if I’d even get in if I was applying now?

As I complete my final year of residency, one thing is clear: Over the past 5 years much has changed in the world of health care, residency, and emergency medicine — starting with applicant numbers. According to National Resident Matching Program data, 2,476 applicants vied for a spot in emergency medicine programs in 2016, of which 1,894 matched, representing a 23% increase in the number of applicants since I matched in 2011.1,2 In contrast, during this same time period there has been an increase of only 16% in the number of EM slots available. So as the competitiveness has increased, so too has the number of applicants, which has created an even more competitive match within our specialty.

Outside of the Match, our residency experience has also changed. Duty hour restrictions were implemented in 2011 to help improve patient safety and resident wellness, creating an 80-hour maximum work week with stricter rules for interns. This had downstream effects, which the ACGME is trying to fix this year. Further, education within residency has changed, in many programs going from the traditional PowerPoint presentations to the flipped classroom and more TED-type presentations. Wellness is also finally being addressed by residencies as more and more data shows that burnout has become an ever-increasing problem within emergency medicine.3

From my first year to now, clinical practice and the way we learn also has changed considerably. When I began, the EM blogosphere and podcast worlds were dominated by EM:RAP and EMCrit. Although these are still very popular, hundreds of new podcasts, blogs, and sites dedicated to education have popped up, providing amazing resources. Our ability to individualize our education outside the hospital continues to improve, with our options increasing exponentially every year. Of course, this requires navigating that breadth of information — a job in and of itself.

Every year our practice changes as new studies disprove previous wisdom. For example, tPA was not the standard of care for acute ischemic strokes when I started. Now, tPA administration is standard, with endovascular treatment gaining steam as new data emerges.4 Even our definition of sepsis and its treatment has been turned on its head. Studies such as the ProCESS trial are changing the way we manage these patients, and even the methods we have used for years to identify these patients is now being reevaluated.5

One thing that hasn’t changed is my continued love of emergency medicine; another is EMRA’s dedication to addressing all of the challenges students and residents face. EMRA Match has been revamped, online hangouts with program directors have launched, and there are ample opportunities to get involved while helping make students even more competitive for the application process.

EMRA is committed to providing important educational content, including PressorDex, the EMRA Antibiotic Guide (which will be updated this year), the Fundamentals of Airway Management, and our 2 newest resources, EM
Funda­mentals
and EMS Essentials: A Resident’s Guide to Prehospital Care. EMRA continues to expand its clinical content offerings for members, while advocating for better wellness resources, improvements to duty hour rules, and more. And in this season of change, EMRA has been working with ACOEP’s Resident Chapter as AOA and ACGME EM programs merge into a single path for accreditation.

Emergency medicine continues to grow by leaps and bounds because of the passion each EM physician has for our specialty and patient care. Our specialty will continue to drive change to improve health care through research, education, and legislative initiatives. As I graduate from residency, I am excited about the future, and I know EMRA will continue to be a leader in providing much-needed resources to medical students, residents, and fellows as they navigate their early careers.

References

  1. National Resident Matching Program. Charting Outcomes in the Match, 2011. http://www.nrmp.org/wp-content/uploads/2013/08/chartingoutcomes2011.pdf.
  2. National Resident Matching Program. Advance Data Tables, 2016 Main Residency Match. http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf.
  3. Lefebvre DC. Perspective: Resident physician wellness: a new hope. Acad Med. 2012;87(5):598-602.
  4. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.
  5. Surviving Sepsis Campaign. Surviving Sepsis Campaign Responds to ProCESS Trial. http://www.survivingsepsis.org/SiteCollectionDocuments/SSC-Responds-Process-Trial.pdf.
Ramnik “Ricky” Dhaliwal, MD, JD

Ramnik “Ricky” Dhaliwal, MD, JD

EMRA President, Hennepin County Medical Center, Minneapolis, MN
Ramnik “Ricky” Dhaliwal, MD, JD

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