Joining the Navy to Become a Physician: Nothing Typical About It.

Joining the military and entering a career in medicine are both intensely personal decisions. Individually, becoming a physician or a naval officer requires people to join a profession, represented by the oaths of each group. Both require hard work, demanding schedules, and dedication. Those entering into the Medical Corps will combine these roles. To optimize finding a fulfilling career, students interested in joining the medical corps should identify mentors, which helps them create the career path they want and aids in their self-reflection to discover their motivations and expectations, finally "Semper Gumby." My own path fulfilled my desire to serve and passion for medicine but more importantly afforded me the opportunity to pursue fellowship, gain expertise in academic medicine, and construct a network of mentors, colleagues, and friends around the globe.

Train for the Game: What Is the Learning Environment of Deployed Navy Emergency Medicine Physicians?

OBJECTIVES: Medicine is a practice characterized by ongoing learning, and unique qualities of the operational learning environment (LE) may affect learner needs. When physicians move between differing practice environments learners may encounter situations for which they are unprepared. Using a conceptual framework specific to the LE, we therefore asked the following research question: what is the difference in LE for Navy emergency medicine (EM) physicians who practice in U.S. hospitals but serve an operational environment, and how do these differences shape their learning needs? METHODS: We interviewed Navy EM physicians who recently deployed to explore their perceptions of the deployed LE, how it differed from the LE they practice in stateside, and the perceived effect this difference had on their learning needs. We used the constant comparative method to gather and analyze data until thematic saturation was achieved. RESULTS: We interviewed 12 physicians and identified six interconnected themes consistent with the LE framework in the literature: 1) patient care is central to the learning experience; 2) professional isolation versus connectedness; 3) a sense of meaningful practice engages the learner in the LE; 4) physicians as educators shape the LE; 5) team trust impacts the LE; and 6) the larger military organization impacts the LE. CONCLUSIONS: Our themes span the conceptual framework put forth by previous work and did not find themes outside this framework. These interconnected themes describe the difference in LE between the stateside and deployed setting and impact the learning needs of Navy EM physicians. These results inform strategies to position the deployed medical unit for success.

Defining a Focused Pediatric Emergency Medicine Curriculum for Emergency Medicine Residents: A Case Study at Michigan Medicine.

OBJECTIVES: Emergency medicine (EM) is dedicated to the treatment of urgent and emergent illness requiring physicians to evaluate, treat, and diagnose patients of all ages. EM residency provides the foundation of knowledge enabling trainees to care for any patient. However, specific pediatric curriculum guidance from governing bodies is limited. The literature includes two potential curricula that are cumbersome to implement. Our primary objective was to identify the components of this curricula that were specific to pediatric emergency medicine (PEM). Secondary objectives were to provide a methods framework and to compare the results with the American Board of Emergency Medicine Model of Clinical Practice (EM Model). METHODS: With the modified Delphi technique, iterative rounds of expert panels sought to reach consensus on PEM-specific topics. We utilized the published curricula as the foundation and focused this list using a group of local experts. Predetermined consensus was defined as 80% agreement. RESULTS: The literature-derived list of 190 topics was reviewed by the expert panel. Experts identified 92 PEM-specific topics, and the remaining 98 topics were deemed adequately covered by general EM curricula. All topics reached consensus after three rounds. The final list was sorted in accordance with the EM Model categories. Redundant topics were consolidated resulting in 68 PEM topics. Of these 68 topics, we identified 20 topics (five of which are critical) that were incompletely covered by the EM Model. CONCLUSIONS: Emergency medicine residency programs should focus their PEM curriculum by deliberately assessing their coverage of key PEM topics. The methods of this study can be replicated to yield locally applicable results in other EM programs. Additionally, the next iteration of the EM Model of Clinical Practice should inform their PEM topics from the available curricula in the literature.

Inflammatory markers limitations in the diagnosis of pediatric calcaneal osteomyelitis.

Calcaneal osteomyelitis is an uncommon, but clinically important emergent condition in the differential of the limping child. Early recognition is paramount to prevent complications from delayed diagnosis like formation of periosteal abscesses or growth plate injury. The diagnosis of pediatric osteoarticular infection relies on a combination of clinical exam, imaging and inflammatory markers. Erythrocyte sedation rate (ESR) and C-reactive protein (CRP) have reported sensitivities for osteomyelitis of 94% and 95%, respectively. However, clinicians should be aware that certain clinical factors can decrease the reliability of inflammatory markers in this pediatric condition. Location of infection in small bones like the calcaneus can lead to significantly lower sensitivities than in long bones. Pretreatment with antibiotics prior presentation can also decrease the reliability of ESR and CRP. In this case, we highlight two unique clinical factors that diminish the sensitivity of commonly used inflammatory markers in the diagnosis of pediatric osteomyelitis.

Field Expedient Vasopressors During Aeromedical Evacuation: A Case Series from the Puerto Rico Disaster Response.

IntroductionEmergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico. A critical approach and review of the literature are discussed.Case ReportTwo critically ill patients were managed in an austere environment as a result of the devastation from Hurricane Maria (Yabucoa, Puerto Rico; 2017). They both exhibited signs of respiratory distress, hemodynamic instability, and distributive shock requiring definitive airway management and hemodynamic support prior to aeromedical evacuation.DiscussionThe novel use of field expedient vasopressors prior to induction for rapid sequence intubation was successfully and safely employed in both cases. Both patients had multiple risk factors for peri-induction cardiac arrest given their presenting hemodynamics. Despite their illness severity, both patients were induced, transported, and ultimately admitted to the intensive care unit (ICU) in stable condition following administration of the field expedient vasopressors.Conclusion:Field expedient vasopressors were safely and effectively employed in an austere field environment during a disaster response. This case series contributes to the growing body of literature of safe bolus-dose vasopressor use by emergency physicians to temporize hypotensive patients in resource-constrained situations. HardwickJM, MurnanSD, Morrison-PonceDP, DevlinJJ. Field expedient vasopressors during aeromedical evacuation: a case series from the Puerto Rico disaster response. Prehosp Disaster Med. 2018;33(6):668-672.