Faculty Bibliography

Background: African origin have a low risk of developing IPF, while non-Hispanic whites (NHWs) have a higher risk of developing IPF. While multiple gene variants have been associated with IPF, it is likely that many more gene variants have yet to be discovered and gene variants will differ between ethnic populations. The Global IPF Collaborative Network is an international group of pulmonary fibrosis investigators founded at the University of Colorado, committed to working together to gain a deeper understanding of the genetics of pulmonary fibrosis. Our Network is open to international investigators to further understand the genetic etiology of IPF by collecting 10,000 ethnically diverse cases of IPF, by expanding Hispanic, Asian, and African patient populations to identify gene variants related to IPF in populations other than non-Hispanic Whites. Methods: There are currently 38 investigators representing 29 medical institutions (10 U.S. institutions/19 institutions outside of the U.S.) who have collected clinical data and DNA samples from patients with IPF on an ongoing basis. In addition to DNA, study investigators have contributed diagnostic, clinical and survival data for their subjects with IPF. To date, we have collected DNA and clinical data from 4,777 IPF patient samples. 75.7% of our samples are NHW, 6.3% are Hispanic, and 18.1% are Asian; average age is 64.9 years, 68.5% are male, and 66.2% have smoked tobacco. Future/ongoing directions include targeted sequencing to follow up known loci and whole genome sequencing to identify novel IPF associated gene variants. Discussion: The Global IPF Collaborative Network has created a resource that will facilitate identifying gene variants that IPF risk in NHW, Hispanic, and Asian populations

BACKGROUND: Women in medicine continue to experience disparities in earnings, promotion, and leadership roles. There are few guidelines in place defining organization-level factors that promote a supportive workplace environment beneficial to women in emergency medicine. We assembled a working group with the goal of developing specific and feasible recommendations to support women's professional development in both community and academic emergency medicine (EM) settings. METHODS: We formed a working group from the leadership of two EM women's organizations, the Academy of Women in Academic Emergency Medicine (AWAEM) and the American Association of Women Emergency Physicians (AAWEP). Through a literature search and discussion, working group members identified four domains where organizational policies and practices supportive of women were needed: 1) Global approaches to supporting the recruitment, retention, and advancement of women in EM; 2) Recruitment, hiring, and compensation of women emergency physicians; 3) Supporting development and advancement of women in EM; and 4) Physician health and wellness (in the context of pregnancy, childbirth and maternity leave). Within each of these domains, the working group created an initial set of specific recommendations. The working group then recruited a stakeholder group of EM physician leaders across the country, selecting for diversity in practice setting, geographic location, age, race, and gender. Stakeholders were asked to score and provide feedback on each of the recommendations. Specific recommendations were retained by the working group if they achieved high rates of approval from the stakeholder group for importance and perceived feasibility. Those with >80% agreement on importance and >50% agreement on feasibility were retained. Finally, recommendations were posted in an open online forum (blog) and invited public commentary. RESULTS: An initial set of 29 potential recommendations was created by the working group. After stakeholder voting and feedback, 16 final recommendations were retained. Recommendations were refined through qualitative comments from stakeholders and blog respondents. CONCLUSIONS: Using a consensus building process that included male and female stakeholders from both academic and community EM settings, we developed recommendations for organizations to implement to create a workplace environment supportive of women in EM that were perceived as acceptable and feasible. This process may serve as a model for other medical specialties to establish clear, discrete organization-level practices aimed at supporting women physicians

Background: Mid-clerkship feedback (MCF), required by the Liaison Committee on Medical Education, ensures that students receive formative feedback during clerkships. However, reflective metrics are not commonly used in MCF. New York University School of Medicine (NYUSOM) uses an iPad app to collect students' self-assessment data alongside preceptor assessment of student performance during the MCF. Educational Objectives: We introduced the app into our emergency medicine Selective (EM-Sel) and compared its functioning to that of a paper rating form. Methods: Starting in March 2014, all NYUSOM students receive iPads for use in clerkships. NYU developed an app that presents a 6-item form to students [S] to selfrate and then to their preceptors [P] to submit ratings during the MCF process. The items are based on the Reporter-Interpreter-Manager-Educator framework, and Professionalism and Procedural Skills. Upon completion, the app displays a composite view that frames the MCF conversation. This data is stored in our data warehouse. For comparison, we also present the ratings collected on paper forms for the students without iPads. All sessions were conducted by the same two preceptors. Results: From January to November 2014, 72 students engaged in an EM-Sel MCF. The app was used in 26 sessions and the paper form was used in 46 sessions. On review, we had complete PRIMES ratings data from both students and preceptors for 100% (26/26) of the iPad sessions but only 63% (29/46) of the sessions with paper forms. Of the 72 data sets collected, 55 paired ratings were complete (76%); 26 were collected on iPads and 29 were collected on paper. Average [S-P] rating concordance ranged from 56% for Professionalism to 78% for Interpreting. Conclusion: Use of this app resulted in complete documentation of [S-P] ratings for the Em-Sel MCF, which was not seen with the paper form. Storage of complete data allows students and preceptors to reflect on the contents of the MSF sessions at a later date

INTRODUCTION: Board scores are an important aspect of an emergency medicine (EM) residency application. Residency directors use these standardized tests to objectively evaluate an applicant's potential and help decide whether to interview a candidate. While allopathic (MD) students take the United States Medical Licensing Examination (USMLE), osteopathic (DO) students take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX). It is difficult to compare these scores. Previous literature proposed an equation to predict USMLE based on COMLEX. Recent analyses suggested this may no longer be accurate. DO students applying to allopathic programs frequently ask whether they should take USMLE to overcome this potential disadvantage. The objective of the study is to compare the likelihood to match of DO applicants who reported USMLE to those who did not, and to clarify how important program directors consider it is whether or not an osteopathic applicant reported a USMLE score. METHODS: We conducted a review of Electronic Residency Application Service (ERAS) and National Resident Matching Program (NRMP) data for 2010-2011 in conjunction with a survey of EM residency programs. We reviewed the number of allopathic and osteopathic applicants, the number of osteopathic applicants who reported a USMLE score, and the percentage of successful match. We compared the percentage of osteopathic applicants who reported a USMLE score who matched compared to those who did not report USMLE. We also surveyed allopathic EM residency programs to understand how important it is that osteopathic (DO) students take USMLE. RESULTS: There were 1,482 MD students ranked EM programs; 1,277 (86%, 95% CI 84.3-87.9) matched. There were 350 DO students ranked EM programs; 181 (52%, 95% CI 46.4-57.0) matched (difference=34%, 95% CI 29.8-39.0, p<0.0001). There were 208 DO students reported USMLE; 126 (61%, 95% CI 53.6-67.2) matched. 142 did not report USMLE; 55 (39%, 95% CI 30.7-47.3) matched (difference=22%, 95% CI 11.2-32.5, p<0.0001). Survey results: 39% of program directors reported that it is extremely important that osteopathic students take USMLE, 38% stated it is somewhat important, and 22% responded not at all important. CONCLUSION: DO students who reported USMLE were more likely to match. DO students applying to allopathic EM programs should consider taking USMLE to improve their chances of a successful match.

A change in urine color can be distressing for patients and physicians alike. Many of the causes of abnormal urine color are benign effects of medications and foods; however, a change in urine color may be a sign of an underlying pathological condition. The good news is that in many cases the diagnosis can be determined from a thorough history and urinalysis. This article presents many of the conditions physicians may encounter and will help them form a narrow differential diagnosis and treatment plan.

BACKGROUND: Thorough and accurate documentation in the medical record is important, and documentation skills should be an integral component of emergency medicine (EM) residency training. STUDY OBJECTIVE: We sought to study the documentation skills of EM residents as they relate to emergency department (ED) reimbursement. METHODS: This was a retrospective, cross-sectional study. We reviewed all charts of patients presenting to the adult ED during a 2-week period. We compared three groups: patients seen primarily by an EM resident, patients seen primarily by a physician assistant (PA), and patients seen primarily by an attending emergency physician. Outcome measures were the incidence of downcodes and dollars lost to downcodes in all groups. RESULTS: There were 212 patients in the resident group, 683 patients in the PA group, and 437 patients in the attending group. There were 12 downcodes (5.7%, 95% confidence interval [CI] 2.96-9.70) in the resident group, 10 downcodes (1.5%, 95% CI 0.70-2.68) in the PA group, and 17 downcodes (3.9%, 95% CI 2.28-6.14) in the attending group (p = 0.002). The mean dollar lost per patient seen in the resident group was $3.21 (95% CI 1.41-5.00); $0.91 (95% CI 0.33-1.49) in the PA group; and $2.23 (95% CI 1.17-3.28) in the attending group (p = 0.002). CONCLUSION: Charts documented primarily by EM residents were more likely to be downcoded than charts documented primarily by PAs or ED attendings. This downcode rate resulted in a greater loss of revenue in the resident group. We believe this represents an area for improvement in EM residency education.