2016: Sushil Jain, MD ACEP Directors Academy, Dallas, TX

Thank you to the Class of 2010 for giving me the opportunity to attend ACEP’s ED Direc-tors Academy (EDDA) in Dallas, Texas. This program provided me with invaluable man-agement/operations training and professional development skills that I will utilize through-out my career.

Throughout my education and training, I have strived to maximize the impact I can have for my patients by complementing my clinical training with targeted experiences and education in leadership and operations. The ED Directors Academy was a perfect opportunity for me to build on experiences that I had prior to and during residency. The Directors Academy is a management training course that brings together leaders from across the nation to partici-pate in courses addressing a wide range of topics related to managing an emergency de-partment.

This experience allowed me to not only gain knowledge on specialized topics from experts in the field but also interact and network with innovative and inspiring leaders from across the nation. The coursework included diverse topics such as leadership, operations, emer-gency department flow, patient satisfaction, hospital quality, billing, and many others. All of these provided me with concepts that I could immediately apply to my administrative work as a resident. However, potentially even more valuable than this was the accelerated professional development I obtained by networking with other leaders and learning from their unique experiences within diverse practice environments across the emergency medi-cine landscape. I gained insight into what a career in administration entails, the conflicting and multi-faceted challenges that an administrator faces, and how to balance those respon-sibilities with maintaining clinical expertise while simultaneously preventing the burnout that many administrators experience.

My long-term career goal is to become a leader within an emergency department and hospi-tal while striving to optimize operational systems, maximize efficiency, and eliminate waste in order to provide the highest level of care for my patients. I firmly believe that quality clinical care must be supported by synergistic processes and systems that allow physicians to maximize their effectiveness and enhance the patient experience. The EDDA program was a unique experience that allowed me to continue to learn and grow as a leader in emer-gency medicine and will ultimately be instrumental to my future success.

2017: Hashim Zaidi, MD NAEMSP conference

In January of 2018, I was privileged to be able to attend the “National EMS Medical Directors Course and Practicum” at the National Association of EMS Physicians Conference in San Diego, CA. This could not have been possible without the generous support from the Spirit of 2010 Award from the Northwestern EM Class of 2010 or the Goldberg Charitable Trust Scholarship. At the course I was able to learn about the not only the fundamentals of emergency medical services (EMS) medical direction from experts in the field, but also the challenges facing the field currently and in the near future for those looking to work in prehospital medicine. The course did an excellent job covering a wide variety of topics from budgeting and finances of EMS to medicolegal case studies from recent case law involving prehospital care. Another highlight of the course was the frequent small group sessions going over challenging prehospital cases that brought a wide variety of opinions and insights from across the country. Additionally, and unexpectedly, we were privileged to work with a skills lab with fresh frozen cadavers a and were guided through lateral canthotomies, perimortem C sections, difficult airway management, and resuscitative thoracotomies. This overall course and practicum helped refine not only concrete skills but also offered much in the way of leadership and professional development. The contacts made in this time were also invaluable to pursue a career in EMS and maintain relationships in relatively small community within emergency medicine.

Sincere thanks to the Class of 2010 for their support as well as the NUEM program leadership, chief residents, and program coordinators who helped make this opportunity possible!

Hashim Q. Zaidi MD

2017: Andrew Moore, MD Tuba City, AZ

Thanks to the exceptional generosity of the Class of 2010, I was afforded to the unique opportunity to spend an elective block working in Tuba City, AZ on the Navajo Indian Reservation. My goals in pursuing this rotation were to provide care in a rural emergency medicine department and to provide care to a community that has been systematically marginalized by government policy.

My rotation occurred from March 27th to April 19th . During the rotation I worked 12, 12-hour shifts in the Tuba City Regional Health Care Center (TCRHCC) Emergency Department, a 23 bed ED that sees approximately 47,000 patients per year. TCRHCC provides care for a catchment area of 6000 square miles and is the regional referral center for 75,000 Navajo, Hopi, Southern Piute, and the occasional tourist. The patient population is exceptionally poor, with 66% of the population living below the poverty line. Additionally 33% of patients lack indoor plumbing and 25% have dirt floors in their homes. The ER has a 5% admission rate and 20% transfer rate. The TCRHCC ED is the only ED on the Navajo Reservation that is staffed entirely by board certified emergency medicine physicians. The group of physicians pride themselves on bringing cutting edge emergency care to the people of the Navajo Nation.

The rotation is billed as rural medical elective, but it is also a cultural immersion program. Although I transferred more patients via helicopter in one shift than I have in 4 years of residency, it is the interactions with the patient population that I will cherish most. I have never worked with a more caring, friendly, and appreciative patient population. Routinely patients had bypassed outlying hospitals, driving upwards of 100 miles to receive care at TCRHCC.

In addition to a unique clinical experience, days off on the rotation provided opportunity to explore many Navajo monuments and National Parks. During my off time, I was able to visit multiple National Parks including Arches, Canyonlands, and the Grand Canyon. Additionally, I was able to visit Monument Valley, Navajo National Park designated to protect mesas from private development.

2016: Rachel Haney, MD Roatán, Honduras

Thanks to the Class of 2010’s generous gift I was able to travel to Roatán, Honduras for my 4th year elective. I spent the month teaching local physicians the basics of Point-of-Care Ultrasound (POCUS) at Clínica Esperanza. This clinic, located on Roatán, one of the three Honduran Bay Islands, is resource-limited, with no access to XR, CT or MRI. Ultrasound (US) is the only diagnostic imaging modality available to the physicians in the clinic. Unfortunately US expertise is limited on the island and the physicians are not trained in basic POCUS.

Elizabeth Dearing MD, NUEM ’15 travelled to the clinic in 2015 to lay the ground-work for US education. However, physician turn-over at the clinic is high therefore the group that Dr. Dearing trained had already left by the time I arrived. The current physicians had minimal to no experience using US, including the physician assigned to the OB/GYN patients. An on-going US educational relationship with the clinic is key.

I taught an introductory POCUS lecture and spent 6 hours per day for 3 weeks teaching hands-on US skills at the bedside to two physicians in the clinic. Initially the physicians weren’t sure how to turn on their machines, how to correctly orient the probes or even why they would consider using an US machine. By the end of my time at the clinic, they were successfully identifying intrauterine pregnancies and IUD’s on transvaginal US, checking fetal heart tones, identifying the sex of fetuses, diagnosing biliary colic, renal colic and abdominal aortic aneurysms! We even introduced the bedside diagnosis of pneumonia!

Originally the clinic had 2 small US machines- one point of care unit that was collecting dust and another small but non-portable machine. Shortly before my arrival, the clinic acquired a larger comprehensive machine which a skilled and talented local US tech used one day per week for comprehensive scans. This tech was unfortunately overwhelmed by the volume of scans and unable to complete them in a timely fashion. The introduction of POCUS was fundamental in order to decrease the number of comprehensive scans ordered in order to aid in more rapid diagnosis of time-sensitive conditions.

As a current US fellow, this elective was integral in developing my understanding of teaching US in a resource-limited setting in addition to developing skills in order to teach US novices. This experience also highlighted the importance of a longitudnal continued relationship with the clinic and I plan to return to continue the US education.

Lucky for me, Roatán is also a beautiful Caribbean island therefore downtime was as equally enjoyable. Among many other adventures, I learned to scuba-dive and met a sloth!

Thank you again to the Class of 2010- your generosity will not be forgotten!

2016: Vicky Weston, MD, Ecela Spanish Schools Chile/Argentina

Thank you to the Spirit of 2010 for providing me with the opportunity to attend the Ecela Spanish Schools in South America. The ability to pursue this type of training was a rare experience and provided skills that will be invaluable over my career.

Prior to enrolling in medical school, I had studied Spanish for several years in school, but had not had the opportunity to receive formalized Spanish language instruction since college. Next year, I will be working in a community with a significant Spanish-speaking population – I wanted to make sure that I can easily communicate with my patients.

For my elective experience, I attended courses through the Ecela Spanish schools in Chile and Argentina. This experience provided a cultural and language immersion with training through a well-established, structured Spanish immersion course. The program set-up involved several small group lessons with a focus on grammar and fluency, followed by conversation classes led by an instructor. During the conversation classes, we would focus on the concepts learned in the preceding grammar class. I also took several hours of semi-private lessons with an emphasis on medical vocabulary, history taking, and the physical exam. In addition, we practiced consenting for procedures, describing medical treatments, and answering patient questions. Our instructors also took the time to focus on some important cultural aspects of communication that are unique to Spanish. In addition, we discussed common cultural practices and customs, as well as colloquial or slang terms that patients may commonly use.

One of the benefits of being in an immersion setting is that you are speaking Spanish for the entire day – not just in class. As a consequence, you improve much more rapidly than in a typical class setting. In addition, learning Spanish in two different countries (with vastly different cultures and accents, despite being geographically adjacent) was incredibly useful. I feel that this will help me to better understand and communicate with Spanish speaking patients from different parts of Central or South America.

I learned a great deal through the courses and felt that my fluency improved to a significant degree. Since returning, I have noted a significant improvement in my ability to use Spanish on shift. One patient in particular stands out – she gave me a hug at the end of her visit and told me how grateful and relieved she was that her doctor spoke Spanish. I hope to use the skills I have gained to provide the best possible patient care both next year and throughout my career.

Thank you again to the Class of 2010 for supporting this rare opportunity and incredible learning experience.

2015: Alison Marshall, MD, Cambridge, USA

Thank you to the Spirit Award for providing me with the opportunity to attend the Humanitarian Response Intensive Course (HRIC) hosted by the Harvard Humanitarian Initiative. It’s been a long time dream of mine to attend this two-week workshop and it was made possible by the class of 2010.

HRIC brings humanitarians together from all over the world to learn, collaborate and their field of practice. It focuses on the tenets of humanitarian intervention and the historical context that informed these tenets. Unfortunately, humanitarian response has all too often been initiated without sufficient forethought resulting in further harm instead of relief. As doctors it’s so easy to jump at international opportunities to care for those in need, but HRIC provides a sobering reminder of the pitfalls that follow poorly planned interventions. Medical care is only as sustainable as the system providing it and unsustainable solutions may actually do more harm than good.

This year the workshop hosted 70 students ranging in age from 22 to 65, many of who have been practicing in the humanitarian world for decades. I was particularly struck by participants whose lives were directly shaped by conflict and disaster, forcing them to cut short their formal education in order to enter the humanitarian field. For example, there was a young Syrian at the workshop who had dropped out of university, moved to Lebanon and started working for an NGO to provide safe passage and shelter for Syrian refugees. He was one example of many HRIC participants who dedicate their lives to the humanitarian imperative:

That action should be taken to prevent or alleviate human suffering arising out of disaster or conflict, and that nothing should override this principle.

I was deeply moved by the embodiment of this principle among people who have been afforded lives far less flexible than mine. It was the most diverse and accomplished classroom I have ever been in. HRIC and the colleagues I met there inspired me to be pragmatic without sacrificing my ideals. This is an uncomfortable interplay full of compromise, but one that ultimately allows for evolution of my practice as a physician and a humanitarian.

2015: Liz Dearing, MD, Roatán, Honduras

Thanks to the generosity of the Class of 2010, I was able to spend my fourth-year elective combining my passions of ultrasound education and international medicine in Roatan, Honduras. I worked directly with the Honduran doctors who provide care to over 100 patients daily at Clinica Esperanza – a clinic that provides pediatric, medicine and obstetric care to the island natives.

The clinic had two ultrasound machines for use. However the Honduran physicians are not instructed in ultrasound during their medical education and training so they were not utilizing the machines available. Each day, I would spend 3 hours in the morning and 3 hours in the afternoon teaching ultrasound while caring for patients.

The Honduran doctor in the morning, Dr. Emma Nova, evaluated all of the obstetric patients. When I arrived she told me the ultrasound wasn’t working because the screen was too dark. I increased the gain and the image improved and she was amazed! When I arrived she did not use the ultrasound in her evaluation of the pregnant patients. Instead she measured uterus size with a tape measure and used a Doppler to assess fetal heart rate. Dr. Nova was a fast learner and when I left she was using the ultrasound to assess fetal heart rate and also to date pregnancies in each trimester. The best part of this was seeing the joy in each mom ‘s face when they saw their babies for the first time!

Dr. Jayleen Coleman was the afternoon Honduran physician. She saw general medical patients and was excited about all aspects of bedside ultrasound. We used the ultrasound to evaluate gallbladder, kidneys, aorta, heart, lungs, DVT – basically anything and everything we could! Because of the broad range of applications, Dr. Jayleen was not independent with any one ultrasound exam. But I know that with more practice she will be able to incorporate point-of-care ultrasound and improve care for her patients at Clinica Esperanza.

While in Roatan, I also hired a local woman, Karina, for individual Spanish lessons. I spent 2 hours a day with her in her home. It was such a pleasure getting to know Karina, her nine-year-old daughter Alice and her dog Molly. It was an experience I will never forget!

2014: Charles Pearce, MD, San Francisco, USA

Thanks to the generosity of the class of 2010, I was afforded the chance to participate in Kaiser Permanate's elective in mass gather medicine during America's Cup. The elective took place during the latter part of the summer of 2013 and involved a fascinating combination of policy discussion, large scale medical operations, and daily shifts in a makeshift emergency room. The fact that the provision of care was no different than any emergency department was itself remarkable; the coordination and planning required in this undertaking was laid out in a series of lectures and meetings with city and hospital administrators as well as regional disaster experts.

I walked into this elective wanting to expand my breadth and depth of both experience and knowledge in the field of mass gathering medicine. I walked out with an expansive appreciation for a burgeoning academic field, spurring on an interest in arenas of remote medicine, telemedicine, international medical ethics and operations. Most of the faculty mentors/instructors have ongoing involvement in disaster medical response teams and USAR and through them, I too have been moving in that direction through regional and state fire and rescue training and service.

2014: Lauren Gallagher, MD, Dublin, Ireland

Thanks to the Spirit of 2010 award, I was able to spend my elective in Ireland, getting to know the healthcare system as well as the ins and outs of emergency care. I spent my time with Dr. Andy Neill, an avid proponent of #FOAMed (Free open access medical education) and emergency physician at the Mater Misericordiae University Hospital in Dublin.

During my clinical time there, I realized that there are as many similarities as there are differences in the way we practice. Many of the similarities lie in the shared frustrations of EP's everywhere, though we have much more litigation concerns here in the US than they do in Ireland. The differences are many. One of the most striking differences is the structure of staff there. Very few doctors seek out EM as their specialty. Their equivalents of attendings play a much more administrative, hands-off role and do few clinical shifts, if any. Most of the resident staff in the ED at a given time are rotating residents from other specialties who spend as much as six months at a time there.

Another observation was that of the lack of a regulated trauma system (though it is something they are working towards). Right now traumas can go to any ED and most rely on a general surgeon taking home call overnight to respond to emergencies. Luckily traffic is tight in Dublin, so they don't see a lot of high speed MVCs.

Lastly, I was able to learn a lot from Andy about the FOAMed movement. Andy's blog "Emergency Medicine Ireland" contains tips, tricks and pearls for EM physicians everywhere. We reviewed podcasts and spoke a lot about emergency medicine education and where it is headed. Exciting things are in store and I was glad to be a part of it. Thank you, 2010!

2013: Krista Brucker MD, Roatan, Honduras

For my elective I spent a month at Clinica Esperanza on the Island of Roatan just off the north coast of Honduras. I had a mixed role in the clinic where I spent many of my mornings providing basic primary care, peds and OB consults to some of the 80 patients the clinic sees each morning. The clinic is the primary healthcare provider for over 10,000 island families treating everything from hypertension and diabetes to snake bites and scuba diving injuries.

In the afternoon, I spent time helping the administrative staff of the clinic complete a formal evaluation of the visiting medical student experience. I was responsible for talking to the permanent clinic staff, the visiting medical students as well as community members and small business owners to help assess the status of the current rotation and provide suggestions about how it might be improved. Through this collaborative effort we were able to provide the clinic with many suggestions that will hopefully both improve the visiting medical students' experience and also begin a more thorough discussion of how to best utilize visiting medical professionals and students for the benefit of the clinic and the larger community.