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Introduction to Emergency Medicine

Introduction to Emergency Medicine . American College of Emergency Physicians. 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.

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Introduction to Emergency Medicine

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  1. Introduction to Emergency Medicine American College of Emergency Physicians

  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

  3. History of Emergency Medicine • Emergency Departments • Staffed by physicians of various backgrounds • No specialty training • American College of Emergency Physicians • Established 1968 • American Board of Emergency Medicine • Formed 1979 • Independent specialty 1988

  4. Emergency Medicine Residency • First “resident” - 1969 • First residencies - 1970 • University of Cincinnati • Emergency Medicine Residents’ Association - 1974

  5. Emergency Medicine Residency • Emergency Medicine Residencies • 1983 - 66 programs • 1990 - 84 programs • 2000 - 122 allopathic programs; 25 AOA programs • Resident Positions in NRMP • 1990 - 440 positions • 2000 - 971 positions

  6. Specialty Selection Top Ten Leading Causes of Death in the U.S. • Heart Disease: 726,974 • Cancer: 539,577 • Stroke: 159,791 • Chronic Obstructive Pulmonary Disease: 109,029 • Accidents: 95,644 • Pneumonia/Influenza: 86,449 • Diabetes: 62,636 • Suicide: 30,535 • Nephritis, Nephrotic Syndrome, and Nephrosis 25,331 • Chronic Liver Disease and Cirrhosis: 25,175

  7. Patient Encounters • Motor vehicle versus pedestrian accident • Acute myocardial infarction • 24 yo with GSW to chest • 66 yo with CPR in progress

  8. What’s Your Diagnosis ?

  9. Patient Encounters • 5 yo with Asthma • 75 yo with Emphysema • 45 yo alcoholic vomiting blood • 3 week old with fever of 104 • 37 week pregnant female with vaginal bleeding

  10. What’s Your Diagnosis ?

  11. Patient Encounters • 25 yo with a rash • Spousal abuse • Homeless patient with no other physician • Back pain for 3 months • Migraine headache

  12. Employment Opportunities • Urban, rural, or suburban hospitals • Teaching or community hospitals • Traveling (Locum tenens) physicians • International opportunities • Third world opportunities • Cruise ship

  13. Appeal of Emergency Medicine • Make an immediate difference • Life threatening injuries and illnesses • Undifferentiated patient population • Challenge of “anything” coming in • Emergency / invasive procedures • Safety net of healthcare

  14. Appeal of Emergency Medicine • Team approach • Patient advocacy • Open job market • Academic opportunities • Shift work / set hours • Evolving specialty

  15. Downside to Emergency Medicine • Interaction with difficult, intoxicated, or violent patients • Finding follow-up or care for uninsured • Work in a “fishbowl” without 20/20 hindsight • Working as a patient advocate

  16. The Lifestyle:Two Sides of A Coin • Well defined shifts • Usually not on call • Part time employment possible • Evenings and nights • Weekends • Holidays

  17. Subspecialties in Emergency Medicine • Pediatric Emergency Medicine • Toxicology • Emergency Medical Services • Sports Medicine

  18. Areas of Expertise • Toxicology • Emergency medical services • Mass gatherings • Disaster management • Wilderness medicine

  19. Upcoming Areas of Emergency Medicine • Hyperbaric medicine • Observation units • ED ultrasound • International emergency medicine

  20. Research Opportunities • Broad range of subjects • Limited amount of work published in our relatively new field • Limited number of research mentors • Limited number of clinical trials

  21. Number of EM Physicians • 4,945 Emergency Departments • Need 32,000 - 37,000 ED physicians to staff • In 2000, 20,164 ACEP members • In 2000, 16,149 EM Board certified physicians

  22. Emergency Medicine Organizations • American College of Emergency Physicians • Society for Academic Emergency Medicine • American Academy of Emergency Medicine • Emergency Medicine Residents’ Association

  23. Emergency Medicine Journals • Annals of Emergency Medicine • Academic Emergency Medicine • Journal of Emergency Medicine • American Journal of Emergency Medicine • Pediatric Emergency Care

  24. Emergency Medicine Residents’ Association • Represents interests of EM residents and medical students • Publishes EM Resident, a bi-monthly newsletter • Publishes annual job catalog • Publishes handbook for medical students

  25. Emergency Medicine Residents’ Association • Publishes • Antibiotic handbook annually • Airway management card • Approximately 4,484 members

  26. EMRA’s Medical Student Affiliate • 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

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

  28. 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

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

  30. Emergency MedicineFourth Year Students • Mandatory/Elective EM rotation • Consider extramural rotations • Community experience • Opportunity at a residency program • SAEM maintains list of extramural EM rotations • Letters of recommendation

  31. Residency Programs • As of 2000: • 122 allopathic programs; 25 AOA programs • 1063 starting positions • 971 resident positions in NRMP • Training programs: • PGY 1-3 (72%) • PGY 2-4 (15%) • PGY 1-4 (12%)

  32. Combined EM Residency Programs • Emergency Medicine / Pediatrics • Emergency Medicine / Internal Medicine • Emergency Medicine / Internal Medicine / Critical Care

  33. Choosing A Specialty • Fit your personality • Decide between general or specialized field • Look at all areas of interest • Ignore gossip and commentary from outside the specialty you are investigating • Commit to specialty you choose

  34. American College ofEmergency Physicians Member Services Department PO Box 619911 Dallas, TX 75261-9911 1-800-798-1822 Touch 5 www.acep.org

  35. Emergency MedicineResidents’ Association 1125 Executive Circle Irving, TX 75038-2522 1-972-550-0920 www.emra.org

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