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  July 2013

From the President

Rick Robinson, MD, FACEP

rick_robinson

Welcome to another edition of EMphasis - the official publication of the Texas College of Emergency Physicians.  There has been considerable activity within TCEP, Texas Emergency Medicine, and both state and national government and legislative bodies in the two months since our last edition.  Dr. Fite provides a more detailed report of the 83rd Texas Legislative session below.  I would like to point out that in general Emergency Medicine fared well during the recent legislative session.  Retention of tort reform and its practical protections for both patients and providers, increases to Graduate Medical Education funding, and increased penalties associated with assault of emergency services personnel are but a few highlights of the legislative session that will positively impact the delivery of quality emergency medical services to the citizens of Texas.  Many members of TCEP actively participated in the success of these legislative actions.  Mignon McGarry and her team were once again instrumental to TCEP advocacy efforts by assuring we kept our fingers on the pulse of the legislative issues and processes during the recent session.

Speaking of effective advocacy...TCEP was well represented in DC during the ACEP Leadership and Advocacy Conference (LAC) May 19-22.  Not only is LAC an outstanding educational conference but it is also fertile ground in terms of advocacy training opportunities for TCEP and national Emergency Medicine leadership.  During LAC we have direct contact with our representatives in the US House and Senate.  This allows our more experienced TCEP members to further mentor the next generation of state and national leaders through introduction and discussion of the most important health care issues of our time.  As we look toward the full implementation of the Affordable Care Act perhaps no time in the history of Emergency Medicine have we been challenged and encouraged to lead the House of Medicine to look to the future of a health care delivery system that both eliminates gaps and ensures access.  It is comforting to know that TCEP members are fully engaged in this process.

On the clinical front many TCEP members worked to provide care and alleviate suffering in the aftermath of recent mass casualty incidents.  The industrial explosion in West, Texas and the several tornadoes that destroyed communities across North Central Texas brought the prehospital and emergency medical communities together to provide much needed and appreciated care to those injured in the wake of these disasters.  TCEP commends all who continue to be the front line heroes when our communities need you the most.

Scientific Assembly...or ACEP13 as it is called this year...is a few months away.  This year we once again meet in Seattle.  TCEP will have seventeen Councillors and twenty Alternate Councillors participating in ACEP Council this year.  TCEP is the third largest Chapter in ACEP and we always bring a full house to the Council floor to ensure that issues affecting our specialty and state are heard and debated with the best interests of our members and patients in mind.  Those of you contemplating Council resolutions are encouraged to submit to ACEP before the regular deadline of July 15.  Those considering TCEP support of your resolution should have ensured their delivery to TCEP headquarters
texacep@gmail.com by June 1 in order to allow the Board to review and respond prior to June 15.

The next meeting of the TCEP Board will be held July 25-26 at ACEP headquarters in the DFW area.  We will review committee activities for the prior quarter and conduct our annual strategic planning meeting at that time.  TCEP Board meetings are open to all members so join us if your schedules permit.  Those of you that are unable to attend can rest assured that the Board and Committees will use EMphasis as a vehicle to keep you posted regarding the status of the projects adopted for action during the coming year.

To reiterate a point from the May EMphasis, I want to take a moment to once again encourage all TCEP members to contribute to the EMRA Legacy Initiative.  This is the most important documentary on Emergency Medicine ever produced.  It chronicles the history of our specialty through timeless images and recollections of the founders of the one indispensible medical service of the last half century.  Pledging is easy and can be accessed through the TCEP website home page.  Thanks to all of you that have contributed to date.  I encourage those that have yet to contribute to visit the TCEP website today and support this outstanding project.

It is a source of personal pride to recognize another in a list of achievements by one of TCEP's favorite sons Bobby Greenberg, MD FACEP.  Dr. Greenberg is a TCEP Past President and continues to remain active in TCEP and ACEP projects.  He is a well respected member of the Scott and White faculty where he continues to train the next generation of Emergency Physicians.  He is also active within the Texas EMS community and the Texas Medical Association House of Delegates.  Dr. Greenberg was recently awarded an Academic Excellence Achievement Award by the TMA at its Annual Meeting in May.  This is a prestigious award that is well deserved.  Congratulations Dr. Greenberg.

In closing I want to recognize what surely represents a loss for Texas.  Brent King, MD FACEP is stepping down as Chairman of Emergency Medicine at the University of Texas at Houston.  Dr. King is one of the most important figures in Academic Emergency Medicine.  He is well known nationally and internationally as a leader in both clinical and administrative circles.  His vision and leadership have been responsible for placing at least 150 Emergency Medicine Residency Trained and Board Eligible/Certified Emergency Physicians into the workforce since I first met him as an intern in that program in 2000.  Most of the graduates of that program remain in Texas serving the citizens of their communities.  A number of those graduates are now training the new faces of Emergency Medicine.  I was honored to be asked to speak to those in attendance at the recent 20th anniversary reception of the UT-Houston Emergency Medicine Program.  As I prepared my address two things came to mind that best describe that program.  These are family and leadership.  Dr. King created and maintains an environment that feels like family.  In true family fashion over the years he also mentored many people that went on to positions of leadership within their groups, their hospitals, their professional societies, and - most important - their communities. Many of them are active in TCEP and ACEP as well as County Medical Societies and the TMA.  The true breadth and depth of Dr. King's legacy may not be fully realized until he has been gone from Texas for a while.  In the meantime I wish him the very best in his new position as Chief Medical Officer at AI DuPont Children's Hospital in Wilmington, Delaware.  Vaya con dios amigo.

Wishing you all the very best until we meet again on the pages of EMphasis.


Rick Robinson, MD, FACEP
President
Texas College of Emergency Physicians

In This Issue:
2013-2014 Board of Directors
Government Relations Committee Report
Senate Bill No. 1191 - Relating to Care Provided to a Sexual Assault Survivor in an Emergency Department in Texas
News From the Practice Enhancement Committee
Laceration Review
Long Live Texas!
EMRA Update
Medical Student Committee Recap of the 2012-2013 Academic Year
Importance of Regionalization of Mentorship
Welcome New TCEP Members
Calendar of Events



2013-2014 TCEP Board of Directors

>>>View their information here>>>

PRESIDENT
Rick Robinson, MD, FACEPboard_bandera_shirt

PRESIDENT ELECT
Bruce Moskow, MD, FACEP

TREASURER
Angela Siler Fisher, MD, FACEP

SECRETARY
Shkelzen Hoxhaj, MD, FACEP

IMMEDIATE PAST PRESIDENT
Dan Peckenpaugh, MD, FACEP

BOARD OF DIRECTORS
Shannon Bagwell, MD, FACEP
Carrie de Moor, MD, FACEP
Heidi Knowles, MD, FACEP
Heather Owen, MD, FACEP
Michael Pandya
Patty Short, MD, FACEP
Tim Taylor, MD, FACEP
Christine Tracy, DO
Gerad Troutman, MD

CHAPTER OFFICE
Jim Coles, CAE
Executive Director

Nancy Davis
Executive Assistant
2525 Wallingwood Bldg 13A
Austin, Texas 78746
OFFICE: 800/TEX-ACEP
FAX: 512/329-8943
texacep@gmail.com

NATIONAL ACEP
PO BOX 619911
Dallas, TX 75261-9911
OFFICE: 800/798-1822
FAX: 972/580-2816


Government Relations Committee Report

Diana Fite, MD, FACEP
Chair, Government Relations Committee

Yay!! The Legislative session is over for another two years!! Why would I think this is good news when there were bills that we support that did not get passed yet? Because virtually anything can happen during a legislative session and there may be bills that we do not like that can be passed or amendments added to bills at the last minute that we do not like that can pass.  With 5000 to 6000 bills filed per session, even with computers watching for key words in the bills, things can be missed.  And much work goes on in between sessions.  Bills that did not go through are re-worked and coalitions for support are formed, or sometimes the same end-points can be achieved in other manners, such as rule changing through state departments.

For this report, I am going to give you some of the highlights that our lobbyist thinks are important and also that the TMA (Texas Medical Association) lobbyist team thinks are important about this last session.  In future reports, I will go into more detail about some individual bills that I think affect us directly as physicians in general and most importantly, as emergency physicians.

We were pleased that two bills filed to repeal the driver responsibility program (HB 104 and HB 790) did not pass.  They would have taken away much of the funding for the trauma fund.

HB 2426/SB 1754 did not pass.  These bills had to do with allowing multiple organizations to standardize training and certifying of EMT's and paramedics other than the currently utilized Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the National Registry of EMT's (NREMT).  This would have created multiple standards in Texas while most of the United States and the U.S. military adhere to the existing single national standard.  We were opposed to these bills.

There were several vaccine-related bills that passed that the TMA was in strong support of but that do not affect us directly.  A bill that the TMA supported regarding efficiency of the state immunization registry (physicians would "opt-out" rather than "opt-in") did not pass.

As you would expect, a lot of legislation regarding Medicaid was filed, but most did not pass.  We do not yet have any change in Medicaid paying 40% less for emergency department services that they deem to be diagnosed as non-emergency conditions, a rule that has been on the books for years but was only implemented in the past two years.  At least funding for the Medicare deductible for patients who are covered by Medicaid was reinstituted. 

Unfortunately, one of our TCEP priority bills, HB 245, regarding allowing emergency physicians to initiate a psychiatric hold for up to 24 hours in the ED rather than having to wait for a warrant from the judge or justice of peace, did not pass.  Neither did an alternate bill, SB 937, which provided for a hold up to 4 hours.  However, we did form some important coalitions this time around and also found where some opposition cropped up (rural facilities) that will be worked with during the interim before trying again next session.

The TMA worked with Senator Jane Nelson on SB 406 regarding scope of practice issues and were pleased to have this bill pass.  The bill was a negotiation between physicians and nurse practitioners and physician assistants to allow the NP's (now called APRN's which stands for advanced practice registered nurses) and PA's to prescribe or order drugs, including certain controlled substances, and devices, but under a physician's supervision, in hospital and hospice settings. 

SB 1193 introduced by Senator Donna Campbell, who works as an emergency physician, along with HB 2348 by Representative John Zerwas, an anesthesiologist, involved removing confidentiality of complaints to the Texas Medical Board, under the premise that we should be able to confront our accusers, as in court, and not have confidential complaints made against us.  These bills did not pass.  TCEP did not actually take a stand on these bills one way or the other because there was significant division of opinion among members.  Some felt that this would hurt our tort reform and more cases would go to the courtroom than work through the TMB, while other TCEP members supported this concept of removing confidentiality of complaints.

HB 1376 required hospital-owned freestanding emergency departments (FSEDs) that bill patients at emergency department rates to advertise as emergency departments and post a conspicuous notice that they bill rates like a hospital emergency department so that patients do not think they are in an urgent care facility or that they will be billed less because the facility is not part of a hospital.  We saw no reason to oppose this bill and it did pass.  SB 413 involved reversing the prohibition of FSEDs from providing nonemergency care (such as Botox injections or routine flu shots).  It did not pass. 

SB 822 involved prohibition of silent PPO's, which meant stopping the practice of  PPO networks  selling, leasing, or sharing other PPO agreements that a physician may have made at some point in time for a more discounted rate under certain circumstances would now be available in multiple circumstances not agreed upon by the physician.  This bill did pass. 

SB 830 allowed telemedicine to replace having an on-site or on-call physician respond at level IV trauma centers in counties of 50,000 or less.  TCEP opposed this legislation and it did not pass. 

HB 1803 passed and will allow the TMB to issue our DPS certifications every 2 years instead of annually, along with our medical license renewals.  This will circumvent the backlog DPS has been having which delayed many physicians from getting their DPS certificate renewals on time and caused some physicians to actually not be able to work in the emergency department until their renewal came through.  

SB 1, which was the budget bill, nearly restored the GME (graduate medical education) funding which was lost last session.  Funding for mental health and women’s health care was also nearly restored, as was funding for medical school loan repayment programs.

We did not get to weigh in on SB 1191, which requires emergency departments to comply with minimum standards for emergency services provided to sexual assault victims, meaning we will resume the care that we provided in the past by having the forensic evidence kits available and performing the exams, or providing for a sexual assault nurse exam (SANE), in every department, rather than transferring the victims to a facility specifically set up to provide SANE care.  This bill passed and will go into effect September 1, 2013.  We will have more information on this for our members soon.

Probably the best news from this session is that this marked the tenth anniversary of liability reform and the tort laws still stand untouched at this time.  TCEP will remain vigilant in protecting and preserving our tort laws.

As we always remind our TCEP members, we would appreciate you working one shift per year to give to EMPACT (the political action committee for the Texas College of Emergency Physicians).  And larger donations are appreciated, of course.  We need to fund EMPACT so that we can give donations to legislators, particularly those in positions of importance to our issues or who have helped us out with our bills or with support of our agenda.  Our reports emphasize the importance of having a strong voice when it comes to legislation that affects us so directly.  We have to help legislators get elected who understand our issues and help us advocate for our patients.  EMPACT needs money to accomplish this. Please send your check to TCEP or call 1-800-TEX-ACEP with your credit card information.  You can donate with credit card deductions monthly or quarterly if that is helpful.  And you have to renew your donation on a yearly basis.  Please call me (713-301-3564) or e-mail me (
dianafite@mail.com) or call our executive director, Jim Coles (1-800-TEX-ACEP) or e-mail him (texacep@gmail.com), if you wish to discuss any of the information in this report.


simon


Senate Bill No. 1191 - Relating to Care Provided to a Sexual Assault Survivor in an Emergency Department in Texas

Bruce Moskow, MD, JD, FACEP

The 83rd Texas Legislature passed Senate Bill 1191, which has several provisions that affect the care of sexual assault survivors in emergency departments in the State of Texas.  It is effective September 1, 2013.  There are several provisions that may affect TCEP members and this article is intended to briefly review those sections.

Section 1.  Subsection (a) suggests that any emergency department in the State of Texas would need to provide a plan for approval to the Department of State Health Services, at their request, providing services to sexual assault survivors.  This is a change from the current law, which is that regional centers, with SANE nurses, are to provide forensic exams.  It is more of a reversion to the old way of treating assault victims, which is that they could be treated at the institution at which they arrive.  

Section 2 of this Act provides that the survivor can either be transferred to a regional center or the care must be available at every emergency department in Texas.  If the patient is to be transferred there are a number of requirements for stabilization, privacy, and antibiotic prophylaxis.

Section 2 (b-1) adds a new wrinkle that may affect emergency physicians in Texas.  It states a person may not perform a forensics examination on a sexual assault survivor unless the person has the basic training described by Section 323.0045 or the equivalent education and training.  Section 323.0045 indicates that any person who is going to do a forensics examination must have at least basic forensic evidence or collection training or the equivalent education.  It goes on to say that a person that completes a continuing medical or nursing education course in forensic evidence collection that is approved or recognized by the appropriate licensing board is considered to have basic sexual assault forensic evidence training for purposes of this chapter.

This is the section that may give TCEP members the most problems.  It is unclear if the basic physician education is going to be considered as appropriate, or whether there will be an additional level needed to prove the basic forensic training.  The section also indicates that CME would be appropriate, but that CME would have to be approved by the "appropriate licensing board".  To date the Texas Medical Board has not put out any guidelines in this area.  Therefore it is somewhat unclear as to whether being a physician in the Emergency Department is enough, whether Board certification is enough, or whether additional CME is going to be required. 

The Texas College of Emergency Physicians is pursing inquires with the Texas Medical Board about licensing for CME and with the Department of State Health Services as to any additional requirements that they will be imposing.  Also as of this time, the Texas College of Emergency Physicians is investigating co-sponsoring CME training, which we expect will be in compliance with the statute, and for which TCEP members will be able to get a significant discount as current members. 

More to follow in next month's EMphasis as the rules and CME requirements become clearer. 

esp-display_ad-may_2013

News From the Practice Enhancement Committee

Rob Dickson, MD, FACEP
Chair Practice Enhancement Committee

Practice Enhancement Committee: Summer 2013 update
Greetings to all of our EP colleagues! As we enter the most revered summer misery season (Hurry labor day!) I want to take this opportunity to update you on some of the goings on at your college.
The legislative session is just finished and there was a lot of activity that concerns EP practices. I will not bore you with my recantation of the highlights but instead encourage you to follow Dr. Fite's updates or the TMA website for a synopsis.

http://www.texmed.org/legislature/

I have just returned from the PSR leadership conference in Washington DC. Dr. Vidor Friedman, ACEP board member from Florida updated attendees on the recently published Rand report on the role of EP's in our rapidly evolving health care system. As leaders in the specialty I encourage everyone to take a look at this paper. As Dr. Friedman stated so well at the conference, "It confirms to the American public what EP's have known all along"!
Here are the 4 main take home points:

  • The ED is an important source of admissions in the US hospital system
  • ED's are being utilized more due the complex nature of workups required in patients with worrisome symptoms
  • The main reason patients with non- urgent complaints attend the ED is a lack of timely primary care options elsewhere
  • ED's may be playing a role in preventing hospital admissions

I have included a link below and encourage everyone to give it a look and please repeat its findings to anyone who will listen! As leaders in our health care system we need to be advocates for not only our patients but for our specialty's role in shaping what the new system will look like.

TCEP Introduction
As part of an effort here at your college to keep members informed on issues that affect their practices, we encourage members to become involved and share their expertise with others in the college. I have the pleasure to introduce one of these members in this issue of the Emphasis. Dr. Zachary Goldman is a practicing EP with Questcare partners in the Dallas area. Dr. Goldman's administrative interests are  billing and coding.  He's done a review on billing and coding of lacerations for this issue of the Emphasis and we welcome his contributions to the practice enhancement committee.

Thanks to all for your participation in TCEP and please send me any suggestions or submissions for upcoming issues of the Emphasis.

rdickson@lemamd.com

http://www.rand.org/pubs/research_reports/RR280.htmld.


tmltmay2013

Laceration Review

My name is Zachary Goldman and I am an Emergency Physician and Director of Billing and Documentation for Questcare Partners, a Democratic group based in Dallas, Texas.  I practice in Lewisville and Flower Mound, Texas.  After completing residency a few years ago, I felt as though my training was excellent when it came to diagnosis and treatment of the Emergency Medicine patient, but was lacking when it came to quality documentation. To that end, I have focused my attention on becoming more proficient in Emergency Medicine documentation by attending many conferences (including ACEP) and working with leaders in the field of EM documentation.  With the help of TCEP, I am hoping to sit on various ACEP Committees on the leading edge of documentation.  My goal is to provide physicians with concrete and tangible information to help improve documentation and reimbursement in the Emergency Department.

I want to focus this article on lacerations. This common procedure performed many times a year can influence billing and reimbursement greatly when properly documented. The three key components for laceration repair documentation are length, location, and complexity. 

Length

Providers are historically poor at estimating length of laceration so my first recommendation is to actually measure the length of the laceration to increase RVU production. The usual break down is greater than 2.5cm and then again greater the 7.5cm (see table below).

***RVUs below might not correspond to your specific practice but the general increase is consistent***

Laceration Type RVUs
Simple ≤ 2.5

2.32

Simple 2.6-7.5
2.72
Simple 7.6-12.5
3.48
Inter ≤ 2.5 2.94
Inter 2.6-7.5 3.62
Inter 7.6-12.5
4.54
Complex 1.1-2.5 5.56
Complex 2.6-7.5
6.63

Location
The second important point is location, location, location.  There are significant RVU differences if you are talking about the forehead vs. the lip vs. ear vs. extremity, etc.  Instead of just stating laceration to the head make sure to list the specific anatomic location as this can increase the RVUs for that procedure. 

RVU impact on location of laceration repair:

****RVUS below might not correspond to your specific practice but the general increase is consistent***

13 cm scalp laceration about 3.12 RVUs
13 cm facial laceration about 4.18 RVUs…33% increase

Complexity

Finally, the complexity of the repair greatly impacts the RVU value.  The key to this is simply document what you do.  Even a simple repair that needs extensive decontamination will increase the complexity.  See the key points below that differentiate laceration complexity.  The key to all of this is to document what you do to receive the correct compensation for the work performed.

Clarification on the distinction of laceration repair:

  •     Simple
    • Single layer, no particulate, no contamination
  •     Intermediate
    • Two layers, or single layer with particulate and/or contamination
  •     Complex
    • Two layers with particulate and or contamination or MDs documentation of what made the repair complex:  wound edge revision, undermining, removal of necrotic tissue or macerated wound edges, extension for exploration

These are the key words and phrases the coders look for in determining the complexity of the laceration.  Please review the table above with laceration lengths and also see RVU differences associated with complexity.


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Long Live Texas!

Gerad Troutman, MD
TCEP Young Physician Board Member
University Medical Center, Lubbock, TX

We all know that Texas is a GREAT place to practice medicine, but there are many opportunities for improvements and many precious situations to protect.  TCEP strives to keep the Emergency Medicine physician voices of Texas heard, and the Texas Medical Association helps magnify that voice to our citizens and lawmakers.  With near 50,000 members, the TMA is one of the most well organized, well respected medical associations in our country and has advocated for physicians and our patients on many important matters including tort reform, reimbursement, and access to care.  Effective organizations require stellar leadership; developing a pipeline of leaders has become a goal of many organizations including TCEP and the TMA.

TCEP has had an excellent track record with our Leadership and Advocacy Fellowship and has seen other states model after our program.  Many of our board members are past fellows (yours truly included), and many have gone on to become committee members/chairs at the national level and have promoted to leadership positions within their practices.  The TMA has its own program called the TMA Leadership College (TMALC), now recruiting for its fourth class.

I was fortunate to serve in the TMALC this past year.  This program was excellent; filled not only with real world leadership didactic learning opportunities, but also with opportunities to interact with current and past TMA leaders.  I met classmates from varied specialties throughout the state creating a foundation for networking.  I had the opportunity to visit multiple committees and councils and gained an appreciation and understanding of the inner workings of the organization.  Our classes were filled with interactive skill sessions on topics including conflict resolution, building effective teams, and media training.  This program has proven to be immensely useful for not only my professional practice, but also for future leadership opportunities in organized medicine.

TCEP has a voice, but that voice is magnified when echoed with the TMA.  We need more Emergency Medicine physicians involved with our state organizations so that we are always heard loud and clear.  Please consider joining the TMA if you are not already a member, and please consider applying for the TMALC if you are a young physician and have interest in leadership roles in organized medicine.  More information including application can be found at this website: http://www.texmed.org/leadership/

Gerad Troutman, MD

gerad.troutman@umchealthsystem.com

EMRA Updates

Ije Akunyili, MD, MPA


Vice-Speaker of the Council
Emergency Medicine Residents' Association (EMRA)

Medical Center Emergency Physicians, Houston TX
Baylor College of Medicine



It was a great pleasure to meet so many of our Texas members at the EMRA SAEM meeting in Atlanta Georgia.  Our EMRA representative council meeting was productive with passionate debates from our program representatives.  We discussed resolutions ranging from GME funding for graduate education to the use of the term "doctor" by non-physicians in the emergency department and streamlining paramedic license requirements for emergency medicine residents. 

EMRA was also proud to co-sponsor the TCEP Annual meeting in Frisco, TX.  The medical student track brought together over one hundred medical students from Texas and surrounding states for a highly enriching meeting.  EMRA values its partnerships with TCEP and Texas remains a strategic ally in our regional meeting efforts.

Advocacy is important to EMRA. Most of us chose Emergency Medicine for our unique mandate to take care of any patient that comes through our departments' doors. To fulfill this unique role we need to continue our strong advocacy efforts. This year alone, EMRA donated fifty thousand dollars to the Emergency Medicine Action Fund (EMAF) to support its wide reaching advocacy efforts.

EMRA's commitment to education is unrelenting. We have also donated fifty thousand dollars to the Emergency Medicine Fund (EMF).  EMF's funds go directly towards sponsoring original research by emergency medicine residents and faculty. We continue to fund travel scholarships to our conferences and provide a yearly sponsorship for ten EMRA members to the Emergency Department Director's Academy (EDDA).

I want to use this opportunity to welcome all our new TCEP and EMRA resident members especially those who may be joining a Texas residency program from out of state.  Take advantage of all the benefits of your TCEP and EMRA memberships.  As always, contact me with any questions or feedback you may have.  Our goal is to remain an organization that is attentive and responsive to the needs of all of our members.

Medical Student Committee Recap of the 2012-2013 Academic Year

Daryn Donathan, MSII
Chair, Medical Student Committee  

This has been a very busy year for the TCEP Medical Student Committee (MSC).  Being the first full academic year of the committee's existence, my Co-Chair Michael Yip, UTMB MSIII, and I had the challenge of developing and solidifying committee goals to best reflect the needs of Texas medical students pursuing Emergency Medicine.  As the academic year (and our tenure as Chairs) come to a close, I am proud to share some of our accomplishments this year.

We were able to establish representation on the committee from each of the nine Texas medical schools through the Liaison and At-Large positions.  This was the most fundamental objective of the MSC, as developing opportunities/resources for medical students is an obsolete notion without an established avenue for dissemination.  We conducted monthly conference calls during which all members were updated on current projects and opportunities were presented for members to work on new projects.  Liaisons were also able to provide updates from their respective Emergency Medicine Interest Group (EMIG), allowing them to share accomplishments and be exposed to new ideas and opportunities for their EMIG.  Additionally, each medical school was given the opportunity to publish an EMphasis article in which they could publicly share their accomplishments.  Effectively, all nine EMIGs in the state collaborated monthly to optimize the experiences of their respective students.   

The Medical Student Leadership Initiative (MSLI) was another unprecedented accomplishment for the MSC this year.  The MSLI was designed to introduce the benefits of being involved in organized Emergency Medicine.  The meeting consists of a short PowerPoint presentation explaining the different organizations (the so-called "Alphabet Soup" of organized EM) and benefits of membership, followed by a panel of local EM physician leaders who field questions regarding EM.  In its first year (2011-2012) the MSLI was limited to the Houston-Galveston area (BCM, UT-H, and UTMB).  This year the MSC piloted the expansion of the program to all medical schools in Texas.  We were able to achieve this at 6 of 9 schools.  Informal feedback from students has been overwhelmingly positive.  The most popular portion of the MSLI has been the expert panel which consisted of various local and state physician leaders from different areas of expertise, including academic and community physicians.  Additionally, we were fortunate enough to have at least one TCEP Board of Director member at all but one of the panels.  We have created a short survey through which students can provide objective and subjective feedback regarding their respective MSLI.  Students may access the survey here. If you haven't yet, please take a few minutes to complete it so the MSC can continue to improve the MSLI in the future.   

The Medical Student Track at the 2013 TCEP Annual Meeting was another great success.  The day included engaging lectures from state and national leaders, including Dr. Angela Fisher, Dr. Todd Berger, and Dr. Angela Gardner.  Towards late morning, students were given the opportunity to walk around the Residency Fair and visit representatives from each of the current civilian EM residencies in Texas.  The day ended with two panels, one of which was tailored to applying and matching to residencies, while the other served to answer more general questions regarding Emergency Medicine as a specialty.  A survey has also been created for the Medical Student Track, which can be accessed by students at Medical Student Track Survey. Please take a minute to provide feedback so the MSC may continue to improve the medical student experience at the TCEP Annual Meeting.

I would like to thank our faculty advisors, Dr. Angela Fisher and Dr. Gerad Troutman, for their guidance and support, as well as the TCEP Board of Directors for approving and supporting the committee's projects during the past year.  I would also like to thank each of the MSC Liaison and At-Large members.  It was through your efforts and hard work that the MSC was able to achieve continued success this year. 

Lastly, I would like to formally introduce the new MSC Executive Leadership: Co-Chairs Ronnie Ren, BCM MSII, and Archana Shah, TTUHSC-Lubbock MSII; Secretary-Editor  Miles Raizada TTUHSC-Lubbock MSIII.  We are confident they will continue to develop and improve the MSC during the next year and we look forward to see it grow. 

Importance of Regionalization of Mentorship

Sara Andrabi, MS IV, Baylor College of Medicine
Medical Student Leadership Initiative Director & At-Large Member TCEP Medical Student Committee 



Angela Siler Fisher, MD, FACEP
Associate Chief for Operations & Public Affairs, Baylor College of Medicine
Medical Director Ben Taub General Hospital Emergency Department

resized__125x187_saraTCEP has experienced unprecedented growth and participation, now surpassing the 1800 membership mark with greater than 1100 active members coupled with candidate resident and medical student members. As the third largest state chapter, we are excited to increase our representation of Texas Emergency Physicians in the American College of Emergency Physicians council with the expansion to 17 counselors in October 2013.

resized__135x160_Fisher2_picWe credit our EM Futures program as the main reason for our marked membership growth and engagement of young leaders. This nationally recognized innovative program focuses on recruiting and engaging members across the EM career spectrum. This has helped fulfill goals such as increasing the visibility and publicity of emergency medicine as a specialty, opportunities for networking, leadership development, and mentorship all the while increasing membership participation. The implementation and continued commitment to the EM Futures program is critical to membership growth and emphasizes the importance of regionalization of mentorship.

The mentorship program is the backbone of the EM Futures program. This program provides for opportunities to gain advice, shadowing, networking opportunities and mentorship for medical students, residents, and young physicians who are members of TCEP. Although there are proper channels for setting up elective rotations, having a mentor advocate in a program of interest ensures additional support and resources. The database is organized by region according to the Texas Emergency Medicine Task Force regions and simultaneously serves as a source of speakers for TCEP Residency Visits and Medical Student Leadership Initiative meetings. This helps connect individuals regionally and develop a group of people that function as a resource for medical student and resident activities. It will formalize TCEP's strong history of nurturing its members to their full potentials and creating a culture of leadership and advocacy development.

More information and starter kits pertaining to implementing these programs in your region is available at www.ACEP.org/ChapterMarketing

Welcome New TCEP Members

Joseph Jenkins, MD
Brian Kendall
William Frank Peacock, MD, FACEP
Franklin Rivers, Jr, MD, FACEP
Anita Rohra, MD
Angela Ruth Rountree, MD, FACEP
Timothy Ruttan, MD
Navdeep Singh Sekhon, MD
Tim Vu, MD, FACEP
Alec Weir
Radosveta Wells, MD

Calendar of Events

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Texas College of Emergency Physicians
2525 Wallingwood Drive, Bldg. 13A | Austin, Texas 78746
Phone: 512.306.0605 | Toll Free: 800.839.2237 | Fax: 512.329.8943
texacep@gmail.com

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