Academic Life in Emergency Medicine

Dr. Sara Krzyzaniak (Host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Abra Fant (Northwestern PD) to reflect on the 2024 Match, after last year's shockingly high number (554) of unfilled positions in the match. We discuss our updated table of match metrics and help provide some context, especially as we look to the future.

https://www.ALiEM.com/em-match-advice-43-program-directors-reflect-2024-match/

Dr. Sara Krzyzaniak (Host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Aaron Kraut (University of Wisconsin PD) in this insightful, rapid-fire, practical episode through the lens of residency program directors.

• What does the ERAS data show so far?
• Have there been any surprises or changes during interview season?
• Has the program signaling option been working?
• What should students think about in the post-interview stage?

Audio engineer: Kellen Vu

EM Match Advice Series: https://www.aliem.com/em-match-advice-series/

Dr. Sara Krzyzaniak (Host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Alexis Pelletier-Bui (Cooper University Hospital Associate PD) and Dr. Elizabeth Werley (Penn State Hershey PD). Both serve as key representatives on behalf of the EM specialty on the AAMC ERAS Supplemental Application Working Group.

We discuss the changes made, why they were done, and potential sticking points for medical students while completing the application. We also do a deeper dive on "program signaling". What is it, how many programs can EM applicants list, and nuanced decisions to consider.

Audio engineer: Kellen Vu

Dr. Sara Krzyzaniak (Host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by the Dr. Abra Fant (Northwestern PD) and Dr. Richard Church (University of Massachusetts PD) to debrief each other and you with what went down with the unprecedented results from 2023 EM Match. There were 132 programs with a total of 554 (18.4%) positions that went unfilled. Contrast that to our usual unfilled rates of 0-30 positions in 2015-2021.

We review "The Slide" with all the numbers from the National Resident Matching Program (NRMP) from the past few years. We propose reasons why there were so many unfilled positions in 2023. What does this mean for the upcoming 2024 Match?

Show notes and tables at: https://www.ALiEM.com/em-match-advice-40-program-directors-reflect-2023-match/

Audio engineer: Kellen Vu

Dr. Sara Krzyzaniak (Host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by the always-wise Dr. Matt Pirotte (Vanderbilt University PD) to answer questions that YOU, the students, submitted to us regarding interview season. We tackle questions involving the nuances around:

• Preference signaling 
• Writing letters or emails of interest
• Meaningfully connecting with busy program directors

Also we answer the perennial question of "Really, how important IS the interview in my overall application?"

Audio engineer: Kellen Vu

Speakers:

• Arianna Campbell, PA-C (Marshall Medical Center)
• Aimee Moulin, MD FACEP (Professor of Emergency Medicine at University of California Davis, Chief of the Division of Addiction Medicine)

Host: Jason Woods, MD (Assistant Professor of Pediatrics - Emergency Medicine, University of Colorado)

Audio engineer: Kellen Vu (Stanford University)

In this episode of EM Match Advice, our new host, Dr. Sara Krzyzaniak (Stanford University), already has her finger on the pulse on the 2022-23 EM residency application season. Hot off the presses, the Council of EM Residency Directors just released its Standardized Letter of Evaluation (SLOE). We are honored to have CDEM president, Dr. Sharon Bord (Johns Hopkins University) and Dr. Doug Franzen (University of Washington), walk us through the document and the behind-the-scenes thought processes. Co-host: Dr. Michelle Lin (UCSF); sound Engineer: Kellen Vu

https://www.ALiEM.com/em-match-advice-38-our-2-cents-sloe-standardized-letter-of-evaluation

Guest: Edward Jauch MD, MS (Chief of System Research, Mission Health System, Asheville, NC)

Host: Jason Woods MD

References:

1. Jauch EC, Cucchiara B, Adeoye O, Meurer W, Brice J, Chan YY, Gentile N, Hazinski MF. Part 11: adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S818-28. doi: 10.1161/CIRCULATIONAHA.110.971044. Erratum in: Circulation. 2011 Oct 11;124(15):e404. PMID: 20956227.
2. Dall TM, Storm MV, Chakrabarti R, Drogan O, Keran CM, Donofrio PD, Henderson VW, Kaminski HJ, Stevens JC, Vidic TR. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2013 Jul 30;81(5):470-8. doi: 10.1212/WNL.0b013e318294b1cf. Epub 2013 Apr 17. PMID: 23596071; PMCID: PMC3776531.
3. Kronick SL, Kurz MC, Lin S, Edelson DP, Berg RA, Billi JE, Cabanas JG, Cone DC, Diercks DB, Foster JJ, Meeks RA, Travers AH, Welsford M. Part 4: Systems of Care and Continuous Quality Improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S397-413. doi: 10.1161/CIR.0000000000000258. PMID: 26472992.
4. Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, Khalessi AA, Bushnell C, Barsan WG, Panagos P, Alberts MJ, Tiner AC, Schwamm LH, Jauch EC. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update. Stroke. 2019 Jul;50(7):e187-e210. doi: 10.1161/STR.0000000000000173. Epub 2019 May 20. Erratum in: Stroke. 2020 Apr;51(4):e70. PMID: 31104615.

This episode is a rapid fire review of litigation issues surrounding the provision of (or lack of provision of) tPA for stroke.

Guests: Latha Ganti, MD, MS, MBA Professor of Emergency Medicine & Neurology ,University of Central Florida College of Medicine

Joshua N. Goldstein MD, PhD Professor of Emergency Medicine, Harvard Medical School

Host: Jason Woods MD

References:

1. Chernyshev OY, Martin-Schild S, Albright KC, Barreto A, Misra V, Acosta I, Grotta JC, Savitz SI. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology. 2010 Apr 27;74(17):1340-5. doi: 10.1212/WNL.0b013e3181dad5a6. Epub 2010 Mar 24. PMID: 20335564; PMCID: PMC2875935.
2. Gebel JM, Sila CA, Sloan MA, Granger CB, Mahaffey KW, Weisenberger J, Green CL, White HD, Gore JM, Weaver WD, Califf RM, Topol EJ. Thrombolysis-related intracranial hemorrhage: a radiographic analysis of 244 cases from the GUSTO-1 trial with clinical correlation. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. Stroke. 1998 Mar;29(3):563-9. doi: 10.1161/01.str.29.3.563. PMID: 9506593.
3. Kass J et al. CONTINUUM (MINNEAP MINN) 2020;26(2, CEREBROvascular disease): 499-505

Guest: Adam Oostema, MD MS FACEP (Associate Professor of EM, Michigan State University College of Human Medicine)

Host: Jason Woods MD

Select References:

• National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7. doi: 10.1056/NEJM199512143332401. PMID: 7477192.
• Saver JL, Gornbein J, Starkman S. Graphic reanalysis of the two NINDS-tPA trials confirms substantial treatment benefit. Stroke. 2010 Oct;41(10):2381-90. doi: 10.1161/STROKEAHA.110.583807. Epub 2010 Sep 9. PMID: 20829518; PMCID: PMC2949055.
• Kwiatkowski TG et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. N Engl J Med. 1999 Jun 10;340(23):1781-7. doi: 10.1056/NEJM199906103402302. PMID: 10362821.
• Ingall TJ et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke. 2004 Oct;35(10):2418-24. doi: 10.1161/01.STR.0000140891.70547.56. Epub 2004 Sep 2. PMID: 15345796.
• Emberson J et al. Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266.
• Hacke W et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656. PMID: 18815396.
• Alper BS et al. Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances. BMJ Evid Based Med. 2020 Oct;25(5):168-171. doi: 10.1136/bmjebm-2020-111386. Epub 2020 May 19. PMID: 32430395; PMCID: PMC7548536.
• Powers WJ et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30. Erratum in: Stroke. 2019 Dec;50(12):e440-e441. PMID: 31662037.