Representative's Handbook - October 26, 2021 Virtual Meeting
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Representative’s Handbook
October 26, 2021
Virtual Meeting
EmergencyM
edicineR
esidents’A
ssociation
RepresentativeHandbook
TableofContents 
October 17, 2021 Dear EMRA Program Representatives, Welcome to EMRA at ACEP21! We are excited to see and hear from you all again, although we wish it was in person. We are hoping that you are all staying safe, and we sincerely thank you for your continued commitment to make EMRA the best organization it can be! This past year, emergency physicians and residents have faced many challenges: the continued stress of COVID, vaccine rollouts, workforce concerns, nursing shortages, and more. Through it all, EMRA members have continually shown how resilient we all are and has shown why emergency medicine is the best specialty. Over the past year, EMRA has continued to advocate for our medical students and residents. When the ACEP Workforce Report showed concerning trends in the job market, our president RJ Sontag was quick to ensure that the voice of young physicians was heard in this important conversation about our future. EMRA was quick to join the ACEP Taskforce to help brainstorm different solutions to workforce issues. We then held our own EMRA town hall to hear directly from residents around the country. Based on that conversation and our Policy Compendium, EMRA continues to advocate for our residents’ best interests. ACEP now has multiple different task forces creating actionable solutions to many different workforce issues, and you can bet that we have resident leaders sitting on all of these committees. While the wheelhouse of the speaker and vice speaker centers mainly around EMRA policy, EMRA has had so many other amazing accomplishments this year including big wins at our Leadership and Advocacy Conference in Washington, DC; amazing new EMRA/MobilEM guides regarding pain management, trauma, urgent care, PEM, and ECGs; and amazing virtual programming from all of our EMRA committees. I encourage you all to read the other updates below from our amazing EMRA leaders. During our Representative Council meeting, you will hear updates from our leadership and liaisons at ACEP, ABEM, and CORD. We will also elect new board members and are pleased to present one new resolution for consideration. Resolutions are written by EMRA members and are the foundation of our organization, the advocacy priorities of EMRA and its Board of Directors, and the guides toward the future of our specialty. As your Council officers, we extend our gratitude to the fellows, residents, and medical students that authored these resolutions. One of EMRA’s greatest strengths is our highly engaged Representative Council.
Throughout this conference, take time to enjoy the rest of the programming offered. EMRA committees have been working hard to produce extraordinary virtual sessions and activities, all of which are free to members! Each of you, by taking on the responsibility of serving as a Program Representative, provides a leadership service that advances our advocacy efforts and challenges EMRA to continue to grow and strengthen our member benefits and the work we do on behalf of our specialty and patients. Thank you for everything you do, for your patients and for our specialty. Sincerely, Tracy and Ashley Tracy Marko, MD, PhD Speaker of the Council Ashley Tarchione, MD Vice Speaker of the Council
Emergency Medicine Residents’ Association
EMRA Representative Council and Business Meeting
October 26, 2021 10:00am – 3:30pm ET
Virtual Meeting
Credentialing begins – 9:00am EST
PROGRAMING:
10:03am Recognizing EMRA 25 Under 45 Recipients
10:05am Welcome Message
Tracy Marko, MD, PhD, MS
EMRA Speaker of the Council
10:10am Liaison Q&A
ACEP - American College of Emergency Physicians
Alison Haddock, MD, FACEP
Vice President
Former EMRA Board Member
10:25am Liaison Q&A
ABEM – American Board of Emergency Medicine
Marianne Gausche-Hill, MD, FACEP
President
10:40am Liaison Q&A
CORD – Council of Emergency Medicine Residency Directors
Boyd (Bo) Burns, DO, FACEP
Board of Directors
Call to Order – 11:00am
11:00am Information on proceedings
Tracy Marko, MD, PhD, MS
EMRA Speaker of the Council
11:10am Moment of Silence
A time to honor EMRA members lost in the past year
11:15am President's’ Address: State of the Association
RJ Sontag, MD
EMRA President
11:25am Parliamentary Review
Sophia Spadafore, MD
EMRA Representative to the AMA
11:30am Voting Overview
Ashley Tarchione, MD
EMRA Vice Speaker of the Council
11:40am Quorum Report
11:45am Elections
Order of Elections:
• President-Elect
• Vice-Speaker of the Council
• Secretary-Editor
• Member at Large
• Director of Education
1:00pm Approval of Minutes from CORD21 Meeting
April 12, 2021 - Virtual Meeting
1:05pm Reports and Resolutions
Reference Committee Report
3:00pm Announcements and Adjourn
EMERGENCY MEDICINE RESIDENTS’ ASSOCIATION
Representative Council Meeting Minutes
April 12, 2021
Virtual Meeting
COUNCIL OFFICERS: Tracy Marko, MD, PhD, MS, Ashley Tarchione, MD
BOARD OF DIRECTORS Hannah Hughes, MD, MBA; RJ Sontag, MD; Priyanka
Lauber, DO; Deena Khamees, MD; Angela Cai, MD, MBA; Breanne Jaqua, DO, MPH;
Sophia Spadafore, MD; Chiamara Anokwute, Maggie Moran, Nicholas Cozzi, Nick
Salerno, Yev Maksimenko
PARLIAMENTARIAN: Sophia Spadafore, MD
TELLERS AND CREDENTIAL CHAIR: None present as the meeting was in a virtual
setting
SERGEANT-AT-ARMS: None present as the meeting was in a virtual setting
REFERENCE COMMITTEE: Michaela Banks, MD
GUESTS: Boyd Burns, DO; Mary Nan S. Mallory, MD, MBA; Mark S. Rosenberg, DO,
MBA, FACEP; Suzannah ACEP/PEER
STAFF: Cathey Wise, CAE; Todd Downing; Valerie Hunt; Alyssa Ceniza, Heather Deja
PROGRAMS:
Albert Einstein Medical Center Philadelphia, AMITA Health Resurrection Medical
Center, Ascension St. John Hospital, Aventura Hospital and Medical Center, Beaumont
Health, Boston University Medical Center, Brandon Regional Hospital Emergency Med,
Brown University, CMU, Cooper University Hospital, Denver Health, Desert Regional
Medical Center, Eastern Virginia Medical School, Emory University, EMRA Medical
Student Council, FSU Emergency Medicine, Geisinger Medical Center, George
Washington University, Georgetown University Hospital/MedStar Washington Hospital
Center, Harvard affiliated emergency medicine residency at MGH/BWH, Hennepin
County Medical Center, Hofstra SOM/Northwell-LIJ, Icahn School of Medicine at Mount Sinai, Kaiser Permananete San Diego Emergency Medicine Program, Kent hospital in Warwick RI, Kings County/SUNY Downstate EM residency, Loma Linda University, Medical College of Georgia, Midwestern University, Prisma Greenville Health System, Regions (Healthpartners institute), Riverside Regional Medical Center, Rush University Medical Center, Rutgers New Jersey Medical School, SAUSHEC Brooke Army Medical Center, Sparrow Hospital/MSU Emergency Medicine Residency Program, Spectrum Health/Michigan State University, St. Joseph's University Medical Center, Paterson NJ, The MetroHealth System/ Case Western Reserve University, UC Davis, UC San Diego, UCF HCA Osceola Regional, UCF Ocala, UCLA Ronald Reagan | Olive View Emergency Medicine Residency Program, UConn Emergency Medicine, UCSF, University hospital columbia Missouri, University of Chicago Emergency Medicine, University of Florida - Jacksonville, University of Louisville, University of Maryland Medical Center, University of Miami/Jackson Memorial Hospital, University of Nebraska Medical Center, University of Oklahoma Department of Emergency Medicine, University of Pittsburgh Medical Center, University of Texas at Austin Dell Emergency Medicine Residency, University of Wisconsin, UPMC Pinnacle, UT Southwestern Emergency Medicine, VCU, Washington University St Louis, WellSpan York Hospital, Wellstar Kennestone-Emergency Medicine, Wyckoff Heights Medical Center, Dr. Marko called the meeting to order at 11:00am EST. She thanked the program representatives for their dedication to their programs and to EMRA. Dr. Marko provided opening remarks to the Council. She introduced the liaisons to provide updates. Dr. Rosenberg, President-Elect of the American College of Emergency Physicians (ACEP), participated in a moderated Q&A with Dr. Marko. Dr. Mallory, President of American Board of Emergency Medicine (ABEM) participated in a moderated Q&A with Dr. Marko. Dr. Burns, Council of Emergency Medicine Residency Directors (CORD) Board of Directors, participated in a moderated Q&A with Dr. Marko. Dr. Marko led a moment of silence for our colleagues who we have lost since our last meeting. Dr. RJ Sontag provided the President’s Address to the Council. Dr. Spadafore presented an overview of the use of parliamentary procedure and its importance in the deliberations of the Council. Dr. Marko introduced the electronic voting system. Dr. Marko stated that a quorum is present.
A motion was made to approve the minutes from the EMRA Representative Council Meeting held on October 26, 2020 virtual meeting at the ACEP Academic Assembly. The motion was seconded and adopted by a voice vote of the Council. Student Doctor Chiamara Anokwute was elected by the Medical Student Council into the position of EMRA Board of Directors. This was voted on as a voting position was elected successfully into the position. Suzannah Alexander announced updates to PEER. Dr. Marko presented the sunset committee report. It was voted on and it was retired. Dr. Marko introduced the reference committee and the Reference Committee’s proposal for the Consent Agenda. She informed the Council the recommendations was TO ADOPT AS AMENDED: S’21-01: Unconscious Bias and Cultural Sensitivity Education S’21-03 Accountable Organizations to Resident and Fellow Trainees S’21-04 Voting for Hospitalized Patients with the Capacity to Vote S’21-06: Increasing Evidence Based Domestic Violence Screening in the Emergency Department S’21-07 Equal Consideration for Osteopathic Med Students S’21-08: Residency Application Process Improvement S’21-09: Single Payer Healthcare System for All S’21-10 Supporting Voter Registration Efforts in the Emergency Department Dr. Marko then called for any extractions and received motions to extract the following resolutions: S’21-01: Unconscious Bias and Cultural Sensitivity Education S’21-05 Equity in the Standardized Letter of Evaluation by International Students S’21-08: Residency Application Process Improvement S’21-09: Single Payer Healthcare System for All There was a motion to accept the Consent Agenda, which was seconded and passed by an electronic vote. The following resolutions were adopted as amended: S’21-03 Accountable Organizations to Resident and Fellow Trainees S’21-04 Voting for Hospitalized Patients with the Capacity to Vote
S’21-06: Increasing Evidence Based Domestic Violence Screening in the Emergency Department S’21-07 Equal Consideration for Osteopathic Med Students S’21-10 Supporting Voter Registration Efforts in the Emergency Department Dr. Marko introduced resolution S’21-1: Unconscious Bias and Cultural Sensitivity Education. After discussion, there was a motion TO ADOPT the Amended Resolution, seconded, and passed via the electronic voting system. Dr. Marko introduced resolution S’21-8 (Residency Application Process Improvement). After discussion, there was a motion TO ADOPT the amended resolution, seconded, and passed via the electronic voting system. Dr. Marko introduced resolution S’21-5: Equity in the Standardized Letter of Evaluation by International Students. After discussion, there was a motion TO ADOPT the Amended Resolution, seconded, and passed via the electronic voting system. Dr. Marko introduced resolution S’21-9: Single Payer Healthcare System for All. After discussion, there was a motion TO ADOPT the amended resolution, seconded, and passed via the electronic voting system. Adjourned at 2:40pm
PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE ACEP21 VIRTUAL REPRESENTATIVE COUNCIL MEETING.
RESOLUTIONS ARE NOT OFFICIAL UNTIL ADOPTED BY THE REPRESENTATIVE COUNCIL AND THE BOARD OF
DIRECTORS (AS APPLICABLE).
1 EMERGENCY MEDICINE RESIDENTS’ ASSOCIATION
2
3 Healthcare Equity and Addiction Treatment for Incarcerated Patients
4
5 Authors: Jessica Adkins, MD and Alexander Ulintz, MD
6 on behalf of the Social Emergency Medicine Committee
7
8 WHEREAS, In 2020, 2.1 million people were incarcerated in the United States1, each of them
9 protected under the Eighth Amendment's prohibition against cruel and unusual punishment,
10 which requires the government to provide them with adequate health care as demonstrated by
11 the Supreme Court’s decision in Brown vs. Plata2, 3; and
12
13 WHEREAS, An estimated 65% of incarcerated people in the U.S. had an active substance use
14 disorder, according to the National Institute on Drug Abuse4, yet multiple studies have shown
15 those with opioid use disorder have disproportionately low rates of buprenorphine treatment for
16 their addiction compared to non-incarcerated people5, 6; and
17
18 WHEREAS, The opioid overdose crisis is a greater threat than ever, with 93,000 deaths in the
19 U.S. in 2020 representing the largest death toll from overdose ever recorded in a 12-month
20 period (75% of which were opioid-related)7; and
21
22 WHEREAS, Multiple studies have indicated an increased risk of opioid overdose death (OOD)
23 soon after release from prison, including a 2018 North Carolina study that found a 40-fold
24 increased risk of OOD in the first two weeks after release compared to the general state
25 population’s risk of OOD8, and a 2010 meta-analysis that found a three- to eight-fold increased
26 risk of drug-related death in the first two weeks after release when compared to the following 9
27 weeks9; and
28
29 WHEREAS, EMRA has preexisting policy upholding that “EMRA supports evidence-based
30 policy reforms of the criminal justice system that contribute to individual and public health”
31 (EMRA Policy IV.-III.) and that “EMRA: ...Should support adoption of proven strategies in opioid
32 harm reduction including enhanced public distribution of naloxone…” (EMRA Policy IV.-XI.);
33 therefore, be it
34
35PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE ACEP21 VIRTUAL REPRESENTATIVE COUNCIL MEETING.
RESOLUTIONS ARE NOT OFFICIAL UNTIL ADOPTED BY THE REPRESENTATIVE COUNCIL AND THE BOARD OF
DIRECTORS (AS APPLICABLE).
36 RESOLVED that EMRA Policy Section IV: III. Emergency Medicine to Support Evidence-Based
37 Policy Reforms of the Criminal Justice System be amended to:
38
39 III. Emergency Medicine to Support Evidence-Based Policy Reforms of the
40 Criminal Justice System and Equitable Health Care for Incarcerated
41 Patients
42 EMRA supports evidence-based policy reforms of the criminal justice system that
43 contribute to individual and public health.
44
45 EMRA recognizes that incarcerated people form a vulnerable patient population
46 with higher rates of chronic medical conditions including substance use
47 disorders. As front-line practitioners in caring for patients who present while
48 under the custody of law enforcement, EMRA:
49 1. supports required screening of people under custody of law enforcement
50 to identify medical conditions including substance use disorders, and prompt
51 treatment of these conditions.
52 2. upholds that addiction treatment including buprenorphine, counseling,
53 and other evidence-based treatment must be provided to incarcerated people
54 who are prescribed such treatment and give consent for treatment.
55 3. advocates for rehabilitation initiatives that support the comprehensive
56 medical needs of patients upon release from incarceration. These needs include
57 addiction treatment such as buprenorphine and naloxone to reduce the risk of
58 relapse, reincarceration, and overdose death.
59
60 References:
61 1. Kang-Brown J, Montagnet C, Heiss J. People in Jail and Prison in 2020. New York: Vera
62 Institute of Justice. https://www.vera.org/publications/people-in-jail-and-prison-in-spring-
63 2021 Published June 2021. Accessed August 28, 2021.
64 2. Eber GB. Using the constitution to improve prisoner health. Am J Public Health.
65 2009;99(9):1541-1542. doi:10.2105/AJPH.2009.168112
66 3. Kennedy A. Brown v. Plata. Legal Information Institute.
67 https://www.law.cornell.edu/supct/html/09-1233.ZO.html Published May 23, 2011.
68 Accessed September 10, 2021.
69 4. NIDA. Criminal Justice DrugFacts.
70 https://www.drugabuse.gov/publications/drugfacts/criminal-justice Published June 1,
71 2020. Accessed September 3, 2021.
72 5. Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and
73 buprenorphine prescribing and referral practices in US prison systems: results from a
74 nationwide survey. Drug Alcohol Depend. 2009 Nov 1;105(1-2):83-8. doi:
75 10.1016/j.drugalcdep.2009.06.015.
76 6. Mancher M, Leshner AI, eds. Medications for Opioid Use Disorder in Various Treatment
77 Settings. In: Medications for Opioid Use Disorder Save Lives. Washington (DC): National
78 Academies Press (US); 2019. https://www.ncbi.nlm.nih.gov/books/NBK541385/
79 Accessed September 1, 2021.PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE ACEP21 VIRTUAL REPRESENTATIVE COUNCIL MEETING.
RESOLUTIONS ARE NOT OFFICIAL UNTIL ADOPTED BY THE REPRESENTATIVE COUNCIL AND THE BOARD OF
DIRECTORS (AS APPLICABLE).
80 7. Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National
81 Center for Health Statistics. 2021.
82 8. Shabbar I. Ranapurwala, Meghan E. Shanahan, Apostolos A. Alexandridis, et al. 2018:
83 Opioid Overdose Mortality Among Former North Carolina Inmates: 2000–2015.
84 American Journal of Public Health 108, 1207-1213,
85 https://doi.org/10.2105/AJPH.2018.304514
86 9. Merrall EL, Kariminia A, Binswanger IA, et al. Meta-analysis of drug-related deaths soon
87 after release from prison. Addiction. 2010;105(9):1545-1554. doi:10.1111/j.1360-
88 0443.2010.02990.x
89
90 EMRA Policy:
91 1. Section IV: Public Health, III. Emergency Medicine to Support Evidence-Based Policy
92 Reforms of the Criminal Justice System (https://www.emra.org/globalassets/emra/about-
93 emra/governing-docs/policycompendium.pdf)
94 2. Section IV: Public Health, XI. Opioid Harm Reduction
95 (https://www.emra.org/globalassets/emra/about-emra/governing-
96 docs/policycompendium.pdf)
97
98 Financial Note: NoneEMRA 2021 Board Candidates ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------
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EMERGENCY MEDICINE RESIDENTS’ ASSOCIATION
EMRA BOARD REPORTS
EMRA Representative Council and Business Meeting
October 26, 2021
Virtual MeetingEMRA President RJ Sontag, MD Mid-Ohio Emergency Services
EMRA President-Elect
Angela G. Cai, MD, MBA
Hello EMRA!
This is an annual update from your President-Elect. For those of you who don’t know me, I am a
fresh residency graduate of Kings County/SUNY Downstate in Brooklyn, an Innovation Fellow at
USACS based out of DC and working clinically in Maryland, and a new mom. This is my 3rd
year on the board (previously Director of Health Policy), and I still love it!
EMRA does so much (see Dr. Sontag’s President End of Year Report for a snapshot). Here, I
would like to highlight some priorities I intend to carry forward as I become your President.
Shaping the Workforce of the Future
● With the tough market last year, EMRA offered to our nationwide network to make
personal connections for anyone still looking for jobs late in the season. Things are
looking up this year, but we intend to remain a connecting resource for all job-seeking
EM residents.
● EMRA is updating our career transition resources, so that you are empowered to identify
your career path, negotiate your contract, and make an informed decision about how
ownership and employment models impact your career.
● Since EMRA co-sponsored the ACEP Workforce Study, we have secured a trainee voice
at the subsequent multi-organizational workgroups tackling the specific solution
proposals.
Ensuring Organizational Sustainability
● EMRA has a mostly new all-star staff including our Interim Executive Director, Bob
Ramsey. We are in the process of recruiting the next Executive Director.
● EMRA needs to prioritize our resources (including our small but mighty staff) according
to your greatest needs in light of EMRA’s tremendous growth in members, dollars, and
programs. We will accomplish this through our triennial strategic planning next year
where we will examine the core components of our broad educational, leadership
development, and advocacy missions.
The fundamental reason why EMRA exists and why I am here is to promote your wellbeing. In
my mind, we get there by advocating for your professional fulfillment, fair treatment, and
connecting with each other in the process. I look forward to meeting and continuing to represent
you over the next year. Reach out anytime.
Yours truly,
Angela G. Cai
EMRA President-Elect
presidentelect@emra.org | 704-779-1908EMRA Immediate Past President
Hannah Hughes, MD, MBA
University of Cincinnati
EMRA’s end-of-year financials are notable for the following:
● Total assets of $6.41M, up 30% compared to end of FY20, with a total member equity of
$5.48M
● Total revenue of $2.75M, higher than budgeted due to product sales but 9% lower than
end of FY20 predominantly due to job market consolidation and decreased advertising
● Total direct expenses of $2.26M, lower than budgeted due to labor and 28% lower than
end of FY20 predominantly due to savings from lack of travel
● For FY21, the contribution to member equity was $1.57M, as compared to $70K the year
prior, which will allow EMRA to continue to reinvest into its members and the future of
emergency medicine
In summary, EMRA remains financially strong allowing it to serve its mission - Best doctor. Best
leader. Best speciality!
Hannah R. Hughes, MD, MBA
Immediate Past President | EMRA
Chair | EMRA Finance Committee
---
EMRA Secretary / Editor-in-Chief EM Resident
Priyanka Lauber, DO
Lehigh Valley Hospital
Hello Representative Council,
Thank you for being involved!
Here are some of the updates from your Editor-in-Chief of EM Resident, Secretary, and one of
the EMRA Board of Directors.
EM Resident has had another record-breaking year with increased online and print
engagement. Our print magazine is distributed to over 18,000 members and we have helped
publish more than 300 authors. Our online presence has climbed to roughly 85,000 visits per
month.
We are grateful and thankful to continue maintaining a strong editorial team that includes
dedicated residents, fellows, and faculty editors who are content experts in various Emergency
Medicine subjects including cardiology, critical care, toxicology, pediatric EM, ultrasound, EMS,
and social EM.
EM Resident continues to also provide a platform for the series “Heart of EM” - a section where
residents and medical students have a national platform to share their experiences and
thoughts. This has been extremely well received, especially in the times of COVID. Authors can
submit their names or request to remain anonymous.Over the past year, EM Resident has addressed a multitude of topics including workforce shortage, health policy, and various educational topics to advance our collective Emergency Medicine knowledge. We are a true platform for advocacy for EMRA and for residents. So far this year, we have advocated for residents and medical students during times of COVID PPEs and contract negotiations. We continue to work to protect the terms “resident” and “fellow”, opposing the expansion of GME funding to NP and PAs training programs, and much more. EMRA continues to support Board members, like myself, to become involved and represent our organization on state and national panels. These national panels are essential for advising and encouraging residents and medical students to become the best leaders and doctors they can be while maintaining Emergency Medicine to be the best specialty it can be. Finally, EM Resident continues to be a thriving publication for residents, medical students, and faculty by residents! We are grateful to currently be experiencing a record number of article submissions. We continue to maintain a personalized, individual interaction with every author thanks to our wonderful editorial team. Thankful for EMRA and our editorial team that continues to make EM Resident as successful as it can be. -- Priyanka Lauber, DO --- EMRA Resident Representative to ACEP Nicholas Cozzi, MD, MBA FDNY/Northwell Health Dear 2021 EMRA Representative Council, It has been an honor and privilege to represent the nearly nineteen thousand emergency medicine physicians-in-training to ACEP’s Board of Directors. Each day I have committed myself to being intentional in building relationships based on mutual respect, buy-in, and common mission. This year represented my first year as Resident Representative to ACEP. Through it all I have strived to remain true to representing you each day. Our first initiative was working towards furthering EM as BEST LEADER and BEST SPECIALITY. We developed and cultivated meaningful relationships with ACEP Committees and Sections by nominating EMRA representatives to each Committee and Section. This serves to create opportunities for networking and learning, all while fostering opportunities for our members to develop skills and career development within emergency medicine. In total, we have successfully nominated representatives to eighty-seven percent of ACEP Committees and Sections with fifty-five percent of our representatives being female. As we forge new paths in diversity, equity, and inclusion, we are proud to nominate members who will help us realize a more representative membership. Moreover, we were intentional in our nominations with ensuring a warm-handoff and continuity between EMRA Committees and ACEP Committees and Sections. We have much more work to do in this regard but this serves as an important first step.
This year powered innovation and a realization of the challenges and opportunities within the evolving emergency medicine workforce discussion. As the Resident Representative to EMRA, I remain committed to intentional involvement and representing you each day in my conversations with ACEP Board Members and in Board Meetings. I am often reminded and remain cognizant of how our decision impacts physician trainees and those within medical school. One shining example I try to be mindful of is how our decisions impact the resident physician working at 3AM taking care of patients. The year brought upon new ACEP Task Forces which include: Telehealth, Adverse Impact of Health-Insurer Reimbursement, and ED Accreditation. Each of these Task Forces include EMRA representation as we embark on shaping the future of our speciality. Additionally, we successfully nominated a member to the Emergency Care Quality Measures Consortium (ECQMC). These are meaningful opportunities for our members to build, create, and lead at the national level. Thank you to those who have answered the call to serve. We are proud and thankful for you. There is much work ahead and we need your voice, your passion, and your ideas. I would love to meet you and get your insight as I work to continue representing our membership to the American College of Emergency Physicians. Nicholas P. Cozzi, MD MBA PGY-4, Emergency Medical Services FDNY/ Northwell Health nicholaspcozzi@gmail.com | 773-573-0556 --- EMRA Director of Education Deena Khamees, MD McGovern Medical School at UT Health Science Center at Houston It is such a pleasure to address the Representative Council; thank you for all the care and effort you show our EM community! Here on the Education side of EMRA, we’ve been busy this past year, too. The oldies but goodies, our EMRA Guides, have been a huge achievement this year. We updated handy pocket guides such as our Airway Card, Adult Infusion Card, and Ventilator Cards. These couldn’t be more timely with the volumes of COVID-related respiratory failure we’re unfortunately seeing nationwide. We’ve also introduced a brand-new card, the ECG Interpretation Card. For those demanding more than a card - we hear you! We’ve teamed up with fan-favorite Dr. Amal Mattu and colleagues Drs. Berberian and Brady to bring you the Emergency ECGs Kindle book with over 100 cases and 400 annotated images to sharpen those rhythm reading skills. We’ve updated EM Fundamentals (2nd ed), Basics of EM (4th ed), and Basics of EM: Peds (3rd ed) and if that weren’t enough, rolled out two additional new guides - the PEM Fundamentals Guide and the Urgent Care Guide. I particularly love the Urgent Care Guide for helping with that critical question, “When do I transfer to a higher level of care?” Don’t let the name fool you; this guide is the
new best friend of every new residency grad and those working critical access hospitals where a consult may mean a transfer. We continue to ride the soundwaves via EMRA*Cast with 2 new podcasts every month, reaching 110,000 downloads! The episodes cover an incredible range of topics with one thing in common - it matters to EM residents and medical students. If you haven’t yet, check it out; I guarantee you find something interesting. EMRA*Cast recruits a new cohort of podcast hosts (our “Casters”) every two years; be on the lookout next year for your chance, or an interested co-resident! COVID introduced us to our first ever virtual EMRA 20 in 6 Competition at ACEP 2020 and virtual Quiz Show at CORD 2021! This was an exciting and nerve-wracking time for all of us - we wanted to be true to the programming we all love but also lean in and embrace our virtual platform. Congratulations to 20 in 6 2020 Winner Dr. Sarah Carpenter for “Those Who Show Up” - you definitely showed up and we loved it! Tune in to this year’s competition on Wednesday, October 27 at 2:30pm eastern. Speaking of those who showed up - special thanks to the Education Committee leadership for the incredible masterminding of virtual Quiz Show, our annual pub-style medical and pop culture-based trivia show, and the amazing resident teams who competed. And last, but not least, two VIP Guests we’re bringing to this ACEP - two new Telehealth videos (created after you made it a priority) explaining the how-to’s and how-not-to’s of telemedicine, because we’re watching out for your educational future and know you are, too. Deena Khamees, MD --- EMRA Director of Health Policy Maggie Moran, MD Brooke Army Medical Center To the Representative Council, Thank you for your continued involvement and investment in what keeps EMRA great, our membership! Please allow me to update you on my role and progress over the last year. The Federal Government Affairs (FGA) Committee monitors and analyzes legislative and regulatory priorities of Congress and prepares ACEP to promote its own regulatory and legislative priorities. The National Emergency Medicine Political Action Committee (NEMPAC) is a “voluntary, nonprofit, unincorporated association operating as a separate segregated fund of ACEP.” EMRA’s Director of Health Policy sits at these tables and advocates for trainees from medical school through fellowship. In my opinion, our biggest win of the year was the passing of ACEP-developed Dr. Lorna Breen Health Care Provider Protection Act through the Senate. EMRA relies on the Representative Council to provide direction for our advocacy priorities. EMRA’s Director of Health Policy is also responsible for planning and executing the Heath Policy Primer each year at the Leadership and Advocacy Conference. This Primer helps to
make policy and advocacy approachable to trainees, who bring the drive to get involved and the thirst for information on how. Planning has already started for programming the Health Policy Primer 2021. EMRA’s policy and advocacy direction rely on members, like you! Trainees who have passion for bettering the landscape of medicine and the understanding that we have the power to shape that landscape, even now! Thank you for your time and your continued involvement. I can be contacted at healthpolicydir@emra.org at any time. Yours, Maggie Moran, MD --- EMRA Director of Leadership Development Yevgenly Maksimenko, MD, MA, DiMM, FAWM, NRP.LP, FP-C EMS and Disaster Medicine Fellow San Antonio Uniformed Services Health Education Consortium Dear 2021 EMRA Representative Council, Welcome to ACEP 2021 and thank you for all you do. My name is Yev and I hold the newly created EMRA Board of Directors position, Director of Leadership Development. I wanted to update you about the new position and what the EMRA committees are up to! Director of Leadership Development In 2020, the EMRA board had decided to reorganize the structure and responsibilities of certain board members. With this in mind, the position of Director of Leadership Development came to replace the Director of Membership. Along with this change, the responsibilities for EMRA Committees and Leadership Academy were transferred from the EMRA President-elect to the Director of Leadership Development, and the membership duties went to the President-elect. The goal of this reorganization was to create a dedicated position to support our committees, which are one of the biggest and most productive aspects of the EMRA. Furthermore, it allowed our president-elect to focus on supporting members and growing our membership, especially in the difficult times of COVID-19. I have been humbled to be voted in as the first Director of Leadership and hope to build this into a sustainable and effective position for years to come. EMRA Committees Update Our committees have been as strong as ever. With the new leadership class of 2021-2022, we now have over a 100 leaders in positions of chair, chair-elect, vice chair and assistant vice chair. Adapting to the ongoing pandemic, EMRA committees have produced too-many-to-count high quality webinars, mentoring sessions, EM Resident articles and interactive events throughout the year. Furthermore, the virtual attendance and member involvement at ACEP 20 and CORD 21 have never been higher, showing that the combination of virtual and in-person programming may be the wave of the future. While we hope to be able to host all of our programming in person one day, due to the ongoing health risk to our members EMRA pivoted to hybrid programming at ACEP this year, hosting the majority of its programming virtually, with only the
EMRA MedWAR taking place in person. At the EMRA board of directors, we are committed to our committees and are looking forward to continuing their growth. Leadership Development and Committee Leader Selection Updates With the creation of the Director of Leadership Development position, one of the identified goals was to add a component of leadership growth to the EMRA leader position. We were able to accomplish this by introducing the Leadership Development series, which are interactive sessions focused on concepts of leadership that directly benefit EMRA leaders. The first session at CORD 21, led by the ACEP President-elect, Dr. Gillian Schmitz, was incredibly valuable and well-received. The second session will be hosted by Dr. Aisha Terry will take place shortly before ACEP 21. We hope to continue these sessions on a bi- or tri-annual basis. We also aimed to improve on the committee leader selection process, by identifying biases and removing systemic barriers in the process to make it as equitable and holistic as it can be. We look forward to releasing the updated committee leader application at ACEP 21. EMRA/ACEP Leadership Academy Update Our leadership academy entered its 4th year and continues to be one of the premier leadership courses available to EM residents and EM-bound medical students. Our leadership team has done an incredible job to select over 75 students from a competitive group of applicants, and continues to innovate and improve the curriculum to bring the best leaders in Emergency Medicine to the course participants. We look forward to selecting the next class starting at CORD 22. Parting Thoughts Thank you for making it through this long update. I want to again thank you for your dedication to emergency medicine, representing your residency, and EMRA. With your help we can continue to advocate for the residents’ voice and provide opportunities to develop the future leaders of emergency medicine. Very respectfully, Yev Maksimenko, MD, MA, DiMM, FAWM, NRP/LP, FP-C Capt., USAF, MC Director of Leadership Development --- EMRA Ex-Officio Member Breanne Jaqua, DO, MPH Mercy St. Vincent Medical Center Dear RepCo, It has been a pleasure serving with the EMRA Board of Directors and I thank you for the opportunity to provide a brief update. EMRA has been a fierce advocate for parental leave policies for medical students, residents, and fellows, as noted in the following excerpt from the EMRA Policy Compendium V.VI. Family and Medical Leave Policy:
“EMRA believes that access to maternity/paternity leave should be equal for men and women
with newly born or adopted children. EMRA further believes that individuals taking maternity and
paternity leave should be paid for the totality of these leaves. EMRA should work with local,
state, and federal policymakers to advocate for paid parental leave for physicians,
physicians-in-training, and all persons.”
The ACGME recently had an open public comment period for proposed changes to the
Institutional Requirements. If these proposed changes are approved for adoption, it would codify
a minimum of 6 weeks of paid medical/parental/caregiver leave of absence for trainees in
ACGME accredited programs. EMRA provided public comment in support for this language in
alignment with EMRA’s policy compendium.
In July 2021 my term as the Resident Representative with the ACGME’s Emergency Medicine
Review Committee expired. I will continue to serve the EMRA Board of Directors as an
Ex-Officio member through Fall of 2022. [The above comments are provided for EMRA
members for general reference only. Please note that I am not a spokesperson for the ACGME,
and this report does not constitute in any way an official or unofficial statement from the
ACGME.]
Respectfully submitted,
Breanne Jaqua, DO, MPH
Ex-Officio Member of the EMRA Board of Directors
jaqua.emra@gmail.com
---
EMRA Representative to the AMA
Sophia Spadafore, MD
Mount Sinai School of Medicine - New York
Dear Representative Council,
What a year it has been! Although policy meetings have been virtual there has not been a
decrease in the amount of hot topics discussed.
Here is a summary of important policy passed at the June AMA-RFS meeting:
● Guidelines for the new AMA health equity plan which seeks to prevent and address
systematic racism, biases, and microaggressions
● Support of global vaccine dissemination and a temporary waiver of the Trade Related
Aspects of Intellectual Property agreement, which allows easier global manufacturing
● Setting standards for vaccine mandates
● Call to Congress to provide PPE to tribal communities in concordance with trust and
treaty laws and to advocate for better fitting PPE, as current designs are more likely to
cause pressure ulcers and inadequate protection amongst varying body types
● Identification of broadband internet access as a social health determinant and
advocacy for universal broadband access to further improve access to Telehealth and
remove health barriers
● Urge collaboration with the Department of Health and Human Services on
information-blocking regulations (the regulations that make our notes immediatelyavailable to patients) and advocate to prevent the release of such information if this
may cause distress to the patient
● Establishing a set of operating principals for Urgent Care Centers to follow
● Advocacy for and endorsement of medical treatment for opioid use disorder at
correctional facilities
● Opposition of to the use of sedative/hypnotic and dissociative agents for solely law
enforcement purposes
In addition to this exciting policy, we had the most representation of EM residents and fellows of
any AMA-RFS meeting in recent history. We also have had 3 EM trainees on the RFS governing
council (including myself as I was elected Speaker in June!)
The ACEP workforce report was widely discussed in our specialty, but I ensured it was also
discussed within the house of medicine and the AMA is acutely aware of what is going on. I
have worked with the EM Section Council within the AMA to ensure these conversations
continue. Some concrete steps have been taken, such as ACEP joining the AMA Scope of
Practice partnership and the AMA committing funds to research the effect of private equity on
GME.
Lastly, I have served as your parliamentarian and helped lead the Health Policy Academy
fellows throughout the year. We have a new ambitious plan for representing EMRA at ACEP
Council, if anyone is interested in knowing more please let me know!
All the best,
Sophia
---
EMRA Medical Student Council Chair
Chiamara Anokwute
Indiana University School of Medicine
Hello EMRA family!
It has been an honor to serve as your 2021-2022 Medical Student Council Chair. My role
involves serving as the medical student voice on the EMRA Board of Directors and presiding
over the workings of the EMRA MSC.
The MSC has a very strong history of collaboration with residents and EMRA Committees. We
also serve as the pipeline for future resident leaders in EMRA. If you have any collaboration
ideas or questions about medical student involvement in EMRA, please do not hesitate to
contact me via the information below. On behalf of the MSC, we are always grateful to find ways
to advocate on behalf of EMRA’s members.
This year’s MSC has been hard at work since March, advocating for EM bound medical
students everywhere in the midst of the pandemic. We have worked hard to improve existing
programs and create new projects to increase the value of EMRA membership for existing and
potential student members. Some highlights from this group over the past few months
Include:• Organized and hosted the virtual Spring and Fall Medical Student Forums (MSF).
These forums included sessions with program directors from across the country as well
as specific advising sessions tailored to each step of an EM-bound student’s career.
• Brought EMRA medical student members the well sought after Residency Fair in an all
virtual format that included over 200+ EM residency programs.
• Collaborated with CORD/CDEM Faculty to develop a targeted Hangout session
addressing “EM Away Rotations & SLOEs in 2021-2022: Let’s Talk About the New
Consensus Statement!”
• Continued to develop our regional representative system that maintains contact with all
EMIGs from across the country and also internationally.
• Continue to recognize EMIGs doing extraordinary work at different schools across the
country by awarding the EMIG of the Year Award.
• Served as key liaisons for all existing EMRA Committees.
• Provided student specific input on the All EM Organizations “Consensus Statement on
the 2021-2022 Residency Application Process for US Medical Students Planning
Careers in Emergency Medicine in the Main Residency Match” which helped to guide the
2021-2022 application cycle for all EM bound students.
• Provided student specific input on the CDEM/CORD “Recommendations on
Program-Sponsored Events During the 2021-2022 Interview Season” which will help
guide the 2021-2022 interview season for all EM bound students.
• Provided student specific input during ACEP’s Strategic Planning Sessions.
The MSC is grateful for all of your support for EMRA’s medical student members. The EMRA
family continues to show its support for its medical student members, particularly during the
second application cycle that has been upturned by the COVID-19 pandemic. EMRA continues
to be committed to the development of future leaders within emergency medicine starting when
they are medical students. Please reach out to us at any point in the future as we would love to
find ways to advocate on behalf of all of our members.
Respectfully,
-- Chiamara Anokwute
EMRA Medical Student Council ChairParliamentary Procedure at a Glance
(Based on The Standard Code of Parliamentary Procedure by Alice Sturgis)
Principal Motions (Listed in Order of Precedence)
TO DO THIS YOU SAY THIS May You Must You Be Is The Motion What Vote is
Interrupt Seconded? Debatable? Required?
Speaker?
*Adjourn the meeting "I move the meeting be NO YES YES MAJORITY
adjourned" (RESTRICTED)
*Recess the meeting "I move that the NO YES YES** MAJORITY
meeting be recessed
until..."
Complain about noise, "I rise to the question of YES NO NO NONE
room temperature, etc. personal privilege"
Postpone temporarily "I move that this motion NO YES NO MAJORITY
(Table) be tabled" (REQUIRES
TWO-THIRDS
IF IT WOULD
SUPPRESS)
End debate "I move to vote NO YES NO TWO-THIRDS
immediately"
*Limit debate "I move that each NO YES YES** TWO-THIRDS
speaker be limited to a
total of two minutes per
discussion"
*Postpone consideration "I move to postpone this NO YES YES** MAJORITY
of an item to a certain item until 2:00pm..."
time
*Have something "I move this matter be NO YES YES** MAJORITY
referred to committee referred to…"
*Amend a motion "I move to amend this NO YES YES MAJORITY
motion by…"
*Introduce business (the "I move that..." NO YES YES MAJORITY
Main Motion)
*Amend a previous "I move to amend the NO YES YES MAJORITY
action motion that was
adopted..."
Ratify action taken in "I move to ratify the NO YES YES MAJORITY
absence of a quorum or action taken by
in an emergency the Council..."
Reconsider "I move to reconsider..." YES YES YES** MAJORITY
Rescind (a main motion) "I move to rescind the NO YES YES MAJORITY
motion..."
Resume consideration of "I move to resume NO YES NO MAJORITY
a tabled item consideration of...?
*Amendable
**Debatable if no Other Motion is PendingParliamentary Procedure at a Glance
(Based on The Standard Code of Parliamentary Procedure by Alice Sturgis)
Incidental Motions
TO DO THIS YOU SAY THIS May You Must You Be Is The Motion What Vote is
Interrupt Seconded? Debatable? Required?
Speaker?
Vote on a ruling by the "I appeal the Chair’s YES YES YES MAJORITY
Chair decision"
Consider something out "I move to suspend the NO YES NO TWO-THIRDS
of its scheduled order rules and consider…"
To discuss an issue "I move that we NO YES NO MAJORITY
without restrictions of consider informally…"
parliamentary rules
To call attention to a "I rise to a point of YES NO NO NONE
violation of the rules or order"
error in procedure, and to
secure a ruling on the
question raised
To ask a question "I rise to a YES NO NO NONE
relating to procedure parliamentary inquiry"
To allow the maker of a "I move to withdraw my YES NO NO NONE
motion to remove the motion"
motion from
consideration
To separate a multi-part "I move division of the NO NO NO NONE
question into individual question"
questions for the purpose
of voting
To verify an indecisive "I move to divide the YES NO NO NONE
voice or hand vote by Assembly"
requiring voters to rise
and be counted
*Amendable
**Debatable if no Other Motion is PendingTHE CHIEF PURPOSES OF MOTIONS
PURPOSE MOTION
Present an idea for consideration and Main motion
action Resolution
Consider informally
Improve a pending motion Amend
Division of question
Regulate or cut off debate Limit or extend debate
Close debate
Delay a decision Refer to committee
Postpone to a certain time
Postpone temporarily
Recess
Adjourn
Suppress a proposal Table
Withdraw a motion
Meet an emergency Question of privilege
Suspend rules
Gain information on a pending motion Parliamentary inquiry
Request for information
Request to ask member a question
Question of privilege
Question the decision of the presiding Point of order
officer Appeal from decision of chair
Enforce rights and privileges
Division of assembly
Division of question
Parliamentary inquiry
Point of order
Appeal from decision of chair
Consider a question again Resume consideration
Reconsider
Rescind
Renew a motion
Amend a previous action
Ratify
Change an action already taken Reconsider
Rescind
Amend a previous action
Terminate a meeting Adjourn
Recess
(From The Standard Code of Parliamentary Procedure by Alice Sturgis)Parliamentary Strategy
(From The Standard Code of Parliamentary Procedure by Alice Sturgis)
TO SUPPORT A MOTION TO OPPOSE A MOTION
1. Second it promptly and enthusiastically. 1. Speak against it as soon as possible.
Raise questions; try to put proponents on
2. Speak in favor of it as soon as possible. the defensive.
3. Do your homework; know your facts; have 2. Move to amend the motion so as to
handouts, charts, overhead projector slides, eliminate objectionable aspects.
etc., if appropriate.
3. Move to amend the motion to adversely
4. Move to amend motion, if necessary, to encumber it.
make it more acceptable to opponents.
4. Draft a more acceptable version and
5. Vote against motion to table or to offer as amendment by substitution.
postpone, unless delay will strengthen your
position. 5. Move to postpone to a subsequent
meeting.
6. Move to recess or postpone, if you need
time to marshal facts or work behind the 6. Move to refer to committee.
scenes.
7. Move to table.
7. If defeat seems likely, move to refer to
committee, if that would improve chances. 8. Move to recess, if you need time to
round up votes or obtain more facts.
8. If defeat seems likely, move to divide
question, if appropriate, to gain at least a 9. Question the presence of a quorum, if
partial victory. appropriate.
9. Have available a copy of the 10. Move to adjourn.
organization's standing rules, its bylaws, and
The Standard Code of Parliamentary 11. On a voice vote, vote emphatically.
Procedure, in case of a procedural dispute.
12. If the motion is adopted, move to
10. If motion is defeated, move to reconsider, if you might win a subsequent
reconsider, if circumstances warrant it. vote.
11. If motion is defeated, consider 13. If the motion is adopted, consider trying
reintroducing it at a subsequent meeting. to rescind it at a subsequent meeting.
14. Have available a copy of the
organization's standing rules, its bylaws,
and The Standard Code of Parliamentary
Procedure, in case of a procedural dispute.You can also read
