Catch 22- residents are here to WORK… … residents are here to LEARN

In a prior blog post I commented on the exploding costs of graduate medical education to $15 billion dollars!  This post highlighted a recent report from the National Academy of Sciences- Graduate Medical Education that Meets the Nation’s Health Needs proposing changes in the model of how GME is funded with a shift toward performance based GME payment.  If we are going to "pay-for-performance" in academic medical centers we need more research on the impact of trainees on cost, quality and other elements of care. THE CATCH 22: Residents are  here to WORK ("cheap labor")-- however  residents Read more [...]

25% Leave Academic Medicine Jobs Annually and other job interview small talk

The winter. For many, it’s a season for sipping eggnog, embarrassing sweaters in public, and forced family interactions. For senior PEM fellows, it’s also a time for dry-cleaning their suits, drafting yet another personal statement, and considering their next life transitions. It’s a familiar cycle, one that they have faced every few years since graduating from college. Despite the extensive experience, it never becomes easy. But this time is different, isn’t it? After fellowship, there are no more long training programs to apply for (right?). This time next year, they will be settled Read more [...]

Guest Blogpost: Dr. Donna Eckardt, MD

While you are immersed in your pediatric emergency medicine fellowship training, have you ever wondered about life outside academia? While the majority of pediatric emergency medical care is delivered in community hospitals and other settings, large academic children’s hospitals dominate the publicity machine. Pediatric Emergency Medicine fellowships graduate 105 fellows a year and 85% of them go on to practice in free-standing pediatric hospitals which are associated with academic centers. They believe that is where they will find fulfillment: they will care for the most complex cases, Read more [...]

Wake Up America! We Are Physicians Not Magicians!

On a cold Midwest winter night, EMS brought a child who complained of itching and rash, which prompted the mother to call 911. The child reached our emergency department at 3 AM and the child was placed in a room. I told myself this is going be a quick case, let me not bother a resident with it. I entered the room, and after greetings and short history, I realized that the patient's rash and itching disappeared without intervention prior to arrival. I explained that it could be a reaction to something, but I wouldn't be able to diagnose it for sure, since I see no rash. The mother was not Read more [...]

Pain in the Pediatric ER: Can we be better?

Do you wish you had more tools to manage pediatric procedural pain in the Emergency Department? What is the evidence behind common practices of pediatric procedural pain management? Join Dr. Stefan Friedrichsdorf and the AAP Learning Center this Wednesday, December 3rd at 11 am (Central Time) for a live webinar exploring the latest tools and evidence surrounding the treatment of pediatric pain. Dr. Friedrichsdorf is medical director of the Department of Pain Medicine, Palliative Care and Integrative Medicine at Children’s Hospitals and Clinics in Minnesota. He lectures extensively nationally Read more [...]

Management Strategies of the Intoxicated Agitated Patient

Last week, we presented three different cases of intoxicated agitated patients and asked you how you might approach these situations. This week, we will discuss the likely inciting agents, show how readers would have approached the cases, and review relevant management strategies. Case 1 involved a 15 year-old who had a seizure at a party after eating some "beans." She was agitated, acidotic, and had a sodium of 109. Ecstasy is the most likely the culprit with hyponatremia resulting from increased free water ingestion, sweating and release of vasopressin in the setting of a pill taken at a party. We Read more [...]

The Intoxicated Agitated Patient

Encountering a patient who may have taken a substance resulting in marked agitation is not an uncommon for the pediatric emergency medicine physician. A working knowledge of potential pitfalls associated with certain drugs of abuse may prove integral in the care of a patient who may deteriorate and code in front of you or one that you may be able to successfully stabilize. In this posting, we will look at three cases and and ask you to think about how you would address them. In a later post we will cover the management of the sympathomimetic toxidrome. In all three cases the urine Read more [...]

A tale of the new and the old in bronchiolitis

I recently participated in a pediatric resident educational conference on bronchiolitis and the recently published AAP Clinical Practice Guideline for bronchiolitis. The room was full of academically rigorous, up to date pediatric residents. When polled about interventions they had heard or seen used for the disease, one reluctant resident piped up, “Well, way back I think they used to use racemic epinephrine.” I may have imagined it, but I feel like he may have lowered his voice a little when saying, “racemic epinephrine” as if to disavow himself from the practice. There may have also Read more [...]