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Delayed Bleeding: The Silent Risk for Seniors

Robert D. Glatter, MD; Richard D. Shih, MD; Christina L. Shenvi, MD, PhD, MBA

Authors and Disclosures

Disclosure: Robert D. Glatter, MD, has disclosed no relevant financial relationships. 

Disclosure: Richard D. Shih, MD, has disclosed the following relevant financial relationships:   Received research grant from: The Florida Medical Malpractice Joint Underwriting Association Grant for Safety of Health Care Services (Grant RFA #2022-01: The Geriatric Emergency Department Fall Injury Prevention [The GREAT FALL]. Principal Investigator: Shih RD; 07/01/2022 to 06/30/2025)

Disclosure: Christina L. Shenvi, MD, PhD, MBA, has disclosed the following relevant financial relationships:  Serve(d) as a consultant for: American College of Emergency Physicians; Institute for Healthcare Improvement  Serve(d) as a speaker or a member of a speakers bureau for: AstraZeneca; CurvaFix (spoke to their staff about geriatric falls)

This discussion was recorded on August 2, 2024. This transcript has been edited for clarity. 

Robert D. Glatter, MD: Hi. I'm Robert Glatter, medical advisor for Medscape Emergency Medicine. Today, we'll be discussing the results of a new study published in The Journal of Emergency Medicine , looking at the incidence of delayed intracranial hemorrhage among older patients taking preinjury anticoagulants who present to the emergency department (ED) with blunt head trauma .

Joining me today is the lead author of the study, Dr Richard Shih, professor of emergency medicine at Florida Atlantic University. Also joining me is Dr Christina Shenvi, associate professor of emergency medicine at the University of North Carolina (UNC) Chapel Hill, with fellowship training in geriatric emergency medicine. 

Welcome to both of you.

Richard D. Shih, MD: Thanks, Rob. 

Christina L. Shenvi, MD, PhD, MBA: Thanks. Pleasure to be here. 

ICH Study Methodology

Glatter: It's a pleasure to have you. Rich, this is a great study and targeted toward a population we see daily in the emergency department. I want you to describe your methodology, patient selection, and how you went about organizing your study to look at this important finding of delayed intracranial hemorrhage, especially in those on anticoagulants.

Shih: This all started for our research team when we first read the 2012 Annals of Emergency Medicine paper . The first author was Vincenzo Menditto, and he looked at a group of patients that had minor head injury , were anticoagulated, and had negative initial head CTs. 

There were about 100 patients, of which about 10 of them did not consent, but they hospitalized all these patients. These were anticoagulated, negative-first head CTs. They hospitalized the patients and then did a routine second CT at about 24 hours. They also followed them for a week, and it turned out a little over 7% of them had delayed head CT. 

We were wondering how many delayed intracranial hemorrhages we had missed because current practice for us was that, if patients had a good physical exam, their head CT was normal, and everything looked good, we would send them home.

Because of that, a number of people across the country wanted to verify those findings from the Menditto study. We tried to design a good study to answer that question. We happen to have a very large geriatric population in Florida, and our ED census is very high for age over 65, at nearly 60%. 

There are two Level I trauma centers in Palm Beach County. We included a second multicenter hospital, and we prospectively enrolled patients. We know the current state of practice is not to routinely do second CTs, so we followed these patients over time and followed their medical records to try to identify delayed bleeding. That's how we set up our methodology.

Is It Safe to Discharge Patients With Trauma After 24 Hours?

Glatter: For the bulk of these patients with negative head CTs, it's been my practice that when they're stable and they look fine and there's no other apparent, distracting painful trauma, injuries and so forth, they're safe to discharge. 

The secondary outcome in your study is interesting: the need for neurosurgical intervention in terms of those with delayed intracranial hemorrhage.

Shih: I do believe that it's certainly not the problem that Menditto described, which is 7%. There are two other prospective studies that have looked at this issue with delayed bleeding on anticoagulants . Both of these also showed a relatively low rate of delayed bleeding , which is between like 0.2% and 1.0%. In our study, it was 0.4%. 

The difference in the studies is that Menditto and colleagues routinely did 24-hour head CTs. They admitted everybody. For these other studies, routine head CT was not part of it. My bet is that there is a rate of delayed bleeding somewhere in between that seen in the Menditto study and that in all the other studies.

However, talking about significant intracranial hemorrhage, ones that perhaps need neurosurgery, I believe most of them are not significant. There's some number that do occur, but the vast majority of those probably don't need neurosurgery. We had 14 delayed bleeds out of 6000 patients with head trauma. One of them ended up requiring neurosurgery, so the answer is not zero, but I don't think it's 7% either. 

Glatter: Dr Shenvi, I want to bring you into the conversation to talk about your experience at UNC, and how you run things in terms of older patients with blunt head trauma on preinjury anticoagulants.

Shenvi: Thanks, Rob. I remember when this paper came out showing this 7% rate of delayed bleeding and the question was, "Should we be admitting all these people?" Partly just from an overwhelming need for capacity that that would bring, it just wasn't practical to say, "We're going to admit every patient with a negative head CT to the hospital and rescan them." That would be hundreds or thousands of patients each year in any given facility. 

The other thing is that delayed bleeds don't always happen just in the first 24 hours. It's not even a matter of bringing patients into observation for 24 hours, watching them, and rescanning them if they have symptoms. It can occur several days out. That never, in almost any institution that I know of, became standard practice. 

The way that it did change my care was to give good return precautions to patients, to make sure they have somebody with them to say, "Hey, sometimes you can have bleeding several days out after a fall, even though your CT scan here today looks perfect," and to alert them that if they start having severe headaches, vomiting, or other symptoms of intracranial hemorrhage, that they should come back. 

I don't think it ever became standard practice, and for good reason, because that was one study. The subsequent studies that Richard mentioned, pretty quickly on the heels of that initial one, showed a much lower rate of delayed ICH with the caveats that the methodology was different. 

Shift in Anticoagulants

Shenvi: One other big change from that original study, and now to Richard's study, is the shift in anticoagulants. Back in the initial study you mentioned, it was all warfarin . We know from other studies looking at warfarin vs the direct oral anticoagulants (DOACs) that DOACs have lower rates of ICH after a head injury, lower rates of need for neurosurgical intervention, and lower rates of discharge to a skilled nursing facility after an intracranial hemorrhage.

Across the board, we know that the DOACs tend to do better. It's difficult to compare newer studies because it's a different medication. It did inform my practice to have an awareness of delayed intracranial hemorrhage so that I warn patients more proactively. 

Glatter: I haven't seen a patient on warfarin in years. I don't know if either of you have, but it's all DOACs now unless there's some other reason. That shift is quite apparent.

Shih: The problem with looking at delayed bleeding for DOACs vs warfarin is the numbers were so low. I think we had 13 people, and seven were in the no-anticoagulant group. The numbers are even lower, so it's hard to say. 

I just wanted to comment on something that Dr Shenvi said, and I pretty much agree with everything that she said. Anticoagulants and warfarin, and that Menditto study, have a carryover effect. People group DOACs with warfarin similarly. When a patient is brought in, the first thing they talk about with head trauma is, "Oh, they're on an anticoagulant" or "They're not on an anticoagulant." It's so ingrained.

I believe that in emergency medicine, we're pressed for space and time and we're not as affected by that 24-hour observation. Maybe many of our surgeons will automatically admit those patients. 

I haven't seen a guideline from the United States, but there are two international guidelines. One is from Austria from 2019, and one is from Scandinavia . Both recommended 24-hour observation if you're on an anticoagulant.

There is a bit of controversy left over with that. Hopefully, as more and more of information, like in our study, comes out, people will be a little bit more clear about it. I don't think there's a need to routinely admit them. 

I do want to mention that the Menditto study had such a massive impact on everybody. They pointed out one subgroup (and it's such a small number of patients). They had seven cases of delayed bleeding; four or five of them were within that 24 hours, and a couple were diagnosed later over the next couple days.

Of those seven people, four of them had international normalized ratios (INRs) greater than 3. Of those four patients, I've heard people talk about this and recommend, "Okay, that's the subgroup I would admit." There's a toss-up with what to do with DOAC because it's very hard to tell whether there's an issue, whether there are problems with their dosing, and whatever. 

We actually recently looked at that. We have a much larger sample than four: close to 300 patients who were on warfarin. We looked at patients who had INRs below 3 and above 3, and we didn't show a difference. We still don't believe that warfarin is a big issue with delayed bleeding.

Should We Be Asking: 'Are They on Blood Thinners?'

Shenvi: One of the interesting trends related to warfarin and the DOACs vs no anticoagulant is that as you mentioned, Dr Shih, the first question out of people's mouths or the first piece of information emergency medical services gives you when they come in with a patient who's had a head injury is, "Are they on blood thinners or not?"

Yet, the paradigm is shifting to say it's not actually the blood thinners themselves that are giving older patients the higher risk for bleeding; it's age and other comorbidities.

Certainly, if you're on an anticoagulant and you start to bleed, your prognosis is much worse because the bleeding doesn't stop. In terms of who has a bleeding event, there's much less impact of anticoagulation than we used to think. That, in part, may be due to the change from warfarin to other medications.

Some of the experts I've talked to who have done the research on this have said, "Well, actually, warfarin was more of a marker for being much older and more frail, because it was primarily prescribed to older patients who have significant heart disease, atrial fibrillation , and so on." It was more a marker for somebody who is at risk for an intracranial hemorrhage. There are many changes that have happened in the past 10 years with medications and also our understanding. 

Challenges in Patient Follow-up

Glatter: That's a great point. One thing, Rich, I want to ask you about is in terms of your proxy outcome assessment. When you use that at 14 and 60 days with telephone follow-up and then chart review at 60 and 90 days (because, obviously, everyone can't get another head CT or it's difficult to follow patients up), did you find that worked out well in your prospective cohort study, in terms of using that as a proxy, so to speak? 

Shih: I would say to a certain extent. Unfortunately, we don't have access to the patients to come back to follow up all of them, and there was obviously a large number of patients in our study. 

The next best thing was that we had dedicated research assistants calling all of the patients at 14 days and 60 days. I've certainly read research studies where, when they call them, they get 80%-90% follow-up, but we did not achieve that.

I don't know if people are more inundated with spam phone calls now, or the older people are just afraid of picking up their phone sometimes with all the scams and so forth. I totally understand, but in all honesty, we only had about a 30%-35% follow-up using that follow-up pathway. 

Then the proxy pathway was to look at their charts at 60 and 90 days. Also, we looked at the Florida death registry, which is pretty good, and then finally, we had both Level I trauma centers in the county that we were in participating. It's standard practice that if you have an intracranial hemorrhage at a non–Level I trauma center, you would be transferred to a Level I trauma center. That's the protocol. I know that's not followed 100% of the time, but that's part of the proxy follow-up. You could criticize the study for not having closer to 90% actual contact, but that's the best we could do. 

Glatter: I think that's admirable. Using that paradigm of what you described certainly allows the reader to understand the difficulty in assessing patients that don't get follow-up head CT, and hardly anyone does that, as we know.

To your point of having both Level I trauma centers in the county, that makes it pretty secure. If we're going to do a study encompassing a similar type of regional aspect, it would be similar.

Shenvi: I think your proxies, to your credit, were as good as you can get. You can never get a 100% follow-up, but you really looked at all the different avenues by which patients might present, either in the death registry or a Level I center. Well done on that aspect. 

Determining When to Admit Patients for Observation

Glatter: In terms of admissions: You admit a patient, then you hear back that this patient should not have been admitted because they had a negative head CT, but you put them in anyway in the sense of delayed bleeding happening or not happening.

It's interesting. Maybe the insurers will start looking at this in some capacity, based on your study, that because it's so infrequent that you see delayed bleeding, that admitting someone for any reason whatsoever would be declined. Do you see that being an issue? In other words, [do you see] this leading to a pattern in terms of the payers?

Shih: Certainly, you could interpret it that way, and that would be unfortunate. The [incidence of] delayed bleeding is definitely not zero. That's the first thing. 

The second thing is that when you're dealing with an older population, having some sense that they're not doing well is an important contributor to trying to fully assess what's going on — whether or not they have a bleed or whether they're at risk for falling again and then hitting their head and causing a second bleed, and making sure they can do the activities of daily life. There really should be some room for a physician to say, "They just got here, and we don't know him that well. There's something that bothers me about this person" and have the ability to watch them for at least another 24 hours. That's how I feel. 

Shenvi: In my location, it would be difficult to try to admit somebody purely for observation for delayed bleeding. I think we would get a lot of pushback on that. The reasons I might admit a patient after a fall with a negative head CT, though, are all the things that, Rob, you alluded to earlier — which are, what made them fall in the first place and were they unable to get up? 

I had this happen just this week. A patient who fell couldn't get off the ground for 12 hours, and so now she's dehydrated and delirious with slight rhabdomyolysis . Then you're admitting them either for the sequelae of the fall that are not related to the intracranial hemorrhage, or the fact that they are so debilitated and deconditioned that they cannot take care of themselves. They need physical therapy. Often, we will have physical and occupational therapists come see them in the ED during business hours and help make an assessment of whether they are safe to go home or whether they fall again. That can give more evidence for the need for admission.

Glatter: To bring artificial intelligence into this discussion, algorithms that are out there that say, "Push a button and the patient's safe for discharge." Well, this argues for a clinical gestalt and a human being to make an assessment because you can use these predictive models, which are coming and they're going to be here soon, and they already are in some sense. Again, we have to use clinical human judgment. 

Shih: I agree. 

Advice for Primary Care Physicians

Glatter: What return precautions do you discuss with patients who've had blunt head trauma that maybe had a head CT, or even didn't? What are the main things we're looking for?

Shenvi: What I usually tell people is if you start to have a worse headache , nausea or vomiting, any weakness in one area of your body, or vision changes, and if there's a family member or friend there, I'll say, "If you notice that they're acting differently or seem confused, come back."

Shih: I agree with what she said, and I'm also going to add one thing. The most important part is they are trying to prevent a subsequent fall. We know that when they've fallen and they present to the ED, they're at even higher risk for falling and reinjuring themselves, and that's a population that's already at risk.

One of the secondary studies that we published out of this project was looking at follow-up with their primary care physicians, and there were two things that we wanted to address. The first was, how often did they do it? Then, when they did do it, did their primary care physicians try to address and prevent subsequent falls?

Both the answers are actually bad. Amazingly, just over like 60% followed up. 

In some of our subsequent research, because we're in the midst of a randomized, controlled trial where we do a home visit, when we initially see these individuals that have fallen, they'll schedule a home visit for us. Then a week or two later, when we schedule the home visit, many of them cancel because they think, Oh, that was a one-off and it's not going to happen again . Part of the problem is the patients, because many of them believe that they just slipped and fell and it's not going to happen again, or they're not prone to it.

The second issue was when patients did go to a primary care physician, we have found that some primary care physicians believe that falling and injuring themselves is just part of the normal aging process. A percentage of them don't go over assessment for fall risk or even initiate fall prevention treatments or programs. 

I try to take that time to tell them that this is very common in their age group, and believe it or not, a fall from standing is the way people really injure themselves, and there may be ways to prevent subsequent falls and injuries. 

Glatter: Absolutely. Do you find that their medications are a contributor in some sense? Say they're antihypertensive, have issues of orthostasis, or a new medication was added in the last week. 

Shenvi: It's all of the above. Sometimes it's one thing, like they just started tamsulosin for their kidney stone, they stood up, they felt lightheaded, and they fell. Usually, it's multifactorial with some changes in their gait, vision, balance, reflex time, and strength, plus the medications or the need for assistive devices. Maybe they can't take care of their home as well as they used to and there are things on the floor. It's really all of the above.

'Harder to Unlearn Something Than to Learn It'

Glatter: Would either of you like to add any additional points to the discussion or add a few pearls? 

Shenvi: This just highlights the challenge of how it's harder to unlearn something than to learn it, where one study that maybe wasn't quite looking at what we needed to, or practice and prescribing patterns have changed, so it's no longer really relevant. 

The things that we learned from that, or the fears that we instilled in our minds of, Uh oh, they could go home and have delayed bleeding , are much harder to unlearn, and it takes more studies to unlearn that idea than it did to actually put it into place. 

I'm glad that your team has done this much larger, prospective study and hopefully will reduce the concern about this entity. 

Shih: I appreciate that segue. It is amazing that, for paramedics and medical students, the first thing out of their mouth is, "Are they on an anticoagulant?"

In terms of the risk of developing an intracranial hemorrhage, I think it's much less than the weight we've put on it before. However, I believe if they have a bleed, the bleeds are worse. It's kind of a double-edged sword. It's still an important factor, but it doesn't come with the Oh my gosh, they're on an anticoagulant that everybody thinks about.

Number-One Cause of Traumatic Injury Is a Fall from Standing

Glatter: These are obviously ground-level falls in most patients and not motor vehicle crashes. That's an important part in the population that you looked at that should be mentioned clearly. 

Shih: It's astonishing. I've been a program director for over 20 years, and geriatrics is not well taught in the curriculum. It's astonishing for many of our trainees and emergency physicians in general that the number-one cause for traumatic injury is a fall from standing.

Certainly, we get patients coming in the trauma center like a 95-year-old person who's on a ladder putting up his Christmas lights. I'm like, oh my God. 

For the vast majority, it's closer to 90%, but in our study, for the patients we looked at, it was 80% that fall from standing. That's the mechanism that causes these bleeds and these major injuries. 

Shenvi: That's reflective of what we see, so it's good that that's what you looked at also. 

Glatter: Absolutely. Well, thank you both. This has been a very informative discussion. I appreciate your time, and our readers will certainly benefit from your knowledge and expertise. Thank you again. 

Robert D. Glatter, MD, is an assistant professor of emergency medicine at Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. He is a medical advisor for Medscape and hosts the  Hot Topics in EM  series . 

Richard D. Shih, MD , is a professor of emergency Medicine at the Charles E. Schmidt College of Medicine at Florida Atlantic University. His current grant funding and area of research interest involves geriatric emergency department patients with head injury and fall-related injury. He has received a number of teaching awards including the American College of Emergency Physicians National Faculty Teaching Award and the American Academy of Emergency Medicine Educator of The Year Award. 

Christina L. Shenvi, MD, PhD, MBA , is an associate professor of emergency medicine at the University of North Carolina at Chapel Hill. She is fellowship-trained in geriatric emergency medicine; has launched a geriatric emergency medicine podcast, GEMCAST; and has served on the board of governors for the American College of Emergency Physicians Geriatric Emergency Department Accreditation Program.

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Updated on 2024/07/28

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Research theme： Research of thromboembolism and cardiotoxicity related to cancer therapy.

Keyword： IMiDs-induced thromboembolism, anthracycline-induced cardiotoxicity

Research period： 2017.4 - 2025.3

Thrombospondin-1 is an endogenous substrate of cereblon responsible for immunomodulatory drug–induced thromboembolism Reviewed International journal

8 ( 3 )   785 - 796   2024.2

　 More details

Language： English   Publishing type： Research paper (scientific journal)  

Immunomodulatory drugs (IMiDs) are key drugs for treating multiple myeloma and myelodysplastic syndrome with chromosome 5q deletion. IMiDs exert their pleiotropic effects through the interaction between cell-specific substrates and cereblon, a substrate receptor of the E3 ubiquitin ligase complex. Thus, identification of cell-specific substrates is important for understanding the effects of IMiDs. IMiDs increase the risk of thromboembolism, which sometimes results in fatal clinical outcomes. In this study, we sought to clarify the molecular mechanisms underlying IMiDs-induced thrombosis. We investigated cereblon substrates in human megakaryocytes using liquid chromatography–mass spectrometry and found that thrombospondin-1 (THBS-1), which is an inhibitor of a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13, functions as an endogenous substrate in human megakaryocytes. IMiDs inhibited the proteasomal degradation of THBS-1 by impairing the recruitment of cereblon to THBS-1, leading to aberrant accumulation of THBS-1. We observed a significant increase in THBS-1 in peripheral blood mononuclear cells as well as larger von Willebrand factor multimers in the plasma of patients with myeloma, who were treated with IMiDs. These results collectively suggest that THBS-1 represents an endogenous substrate of cereblon. This pairing is disrupted by IMiDs, and the aberrant accumulation of THBS-1 plays an important role in the pathogenesis of IMiDs-induced thromboembolism.

DOI： 10.1182/bloodadvances.2023010080.

TET2 Clonal Hematopoiesis is Associated with Anthracycline-Induced Cardiotoxicity in Patients with Lymphoma Reviewed International journal

Kiwamu Hatakeyama, Michinari Hieda, Yuichiro Semba, Shohei Moriyama, Yuqing Wang, Takahiro Maeda, Koji Kato, Toshihiro Miyamoto, Koichi Akashi, Yoshikane Kikushige

4 ( 1 )   141 - 143   2022.3

DOI： 10.1016/j.jaccao.2022.01.098

Repository Public URL： https://hdl.handle.net/2324/6789521

Emphysematous pyelonephritis with ST elevation accompanied by reciprocal changes mimicking acute coronary syndrome Reviewed International journal

Kiwamu Hatakeyama, Yuji Shono, Takuma Hashimoto, Taiki Sakamoto, Masaaki Nishihara, Takeshi Iyonaga, Soichi Mizuguchi, takafumi sakamoto, Jun Maki, Tomohiko Akahoshi

American Journal of Emergency Medicine   70   208.e5 - 208.e7   2023.8

COVID-19重症肺炎を合併した妊婦に対して腹臥位療法を行った１例

畠山　究、徳田　賢太郎、安藤　太一、高橋　慶多、十時　崇彰、彌永　武史、西原　正章、生野　雄二、牧　盾、赤星　朋比古

第49回日本集中治療医学会学術集会  2022.3 

Event date： 2022.3

Language： Japanese   Presentation type： Oral presentation (general)  

Venue： 仙台   Country： Japan  

【背景】 COVID-19第５波の波及に伴い、妊婦においてもCOVID-19肺炎を合併する症例が散見されるようになり、その一部は人工呼吸を含む集中治療を必要としている。 【症例】38歳女性、妊娠27週。SARS-CoV-2家庭内感染によりCOVID-19に罹患した。発症7日目、酸素化障害のため入院し、高流量酸素療法を実施した。発症11日目、酸素化悪化のため集中治療室で人工呼吸管理を開始した。ICU入室時より、助産師・産科医による胎児心拍モニタリングを毎日実施し、胎児の健常性を確認した。また酸素化増悪時のVV-ECMO導入条件、帝王切開による妊娠帰結のタイミング、出生後の新生児の収容病棟について、産科・新生児科・感染制御部門・手術部門と打ち合わせを行った。胎児への酸素供給を考慮し、非妊婦の場合よりも高い動脈血酸素飽和度を維持するように呼吸管理を行った。当初、腹臥位療法の実施はためらわれ頭高位・側臥位での管理を行ったが、次第に酸素化が悪化したため、ICU入室3日目より筋弛緩併用深鎮静下に腹臥位療法を開始し、入室9日目まで継続した。腹臥位療法中は腹部の除圧ができるよう極軽度半身を浮かした状態を保持し、超音波診断装置による胎児観察も可能となるよう工夫した。次第に呼吸状態の改善を認め、入室11日目に人工呼吸器を離脱した。入室18日目（妊娠30週）、胎児の発育に問題ない状態でICUを退室した。 【結語】COVID-19肺炎による重症呼吸不全の呼吸管理として、腹臥位療法は標準的手法となっており、妊婦においても、その安全性や有効性に関する報告が増えている。本症例においても、増大した子宮・発育した胎児への圧迫が最小限となるよう配慮した上での、腹臥位療法の実施が有効であった。また、母体の救命を第一に考えながらも、可能な限り胎児の救命も目指す必要があり、関連する診療科・多職種での連携が重要であった。

TET2 Clonal Hematopoiesis Represents a Strong Risk Factor for Anthracycline-Induced Cardiotoxicity in Lymphoma Patients

2022.3 

Language： English   Presentation type： Oral presentation (general)  

Country： Japan  

新日本先進医療研究財団の研究助成金 固形腫瘍における、TET2クローナル造血とがん療関連心機能障害の関連解析

Grant type： Donation

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Emergency medicine residency pathways for MD/PhD trainees: A national cross-sectional study of physician-scientist training programs

Affiliations.

• 1 Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA.
• 2 Department of Emergency Medicine Washington University School of Medicine St. Louis Missouri USA.
• 3 Society for Academic Emergency Medicine Des Plaines Illinois USA.
• 4 Departments of Emergency Medicine, Anesthesia Critical Care, and Epidemiology University of Iowa Carver College of Medicine Iowa City Iowa USA.
• PMID: 38525369
• PMCID: PMC10955610
• DOI: 10.1002/aet2.10960

Background: Combined clinical and research training is common in residency programs outside emergency medicine (EM), and these pathways are particularly valuable for combined MD/PhD graduates planning to pursue a career as a physician-scientist. However, EM departments may not know what resources to provide these trainees during residency to create research-focused, productive, future faculty, and trainees may not know which programs support their goal of becoming a physician-scientist in EM. The objective of this study was to describe research training and resources available to MD/PhD graduates in EM residency training with a focus on dedicated research pathways.

Methods: This study was a cross-sectional inventory conducted through an electronic survey of EM residency program directors. We sought to identify dedicated MD/PhD research training pathways, with a focus on both resources and training priorities. Descriptive statistics were used to summarize survey responses.

Results: We collected 192 survey responses (69.6% response rate). Among respondents, 41 programs (21.4%) offered a research pathway/track, 52 (27.4%) offered a research fellowship, 22 (11.5%) offered both a residency research pathway/track and a research fellowship, and two (1.0%) offered a dedicated EM physician-scientist training pathway. Most programs considered research a priority and were enthusiastic about interviewing applicants planning a research career, but recruitment of physician-scientist applicants was not generally prioritized.

Conclusions: Some EM residency programs offer combined clinical and mentored research training for prospective physician-scientists, and nearly all residency programs considered research important. Future work will focus on improving the EM physician-scientist pipeline by optimizing pathways available to trainees during residency and fellowship.

Keywords: clinician‐researcher; clinician‐scientist; dual degree; emergency medicine; internship and residency; physician‐scientist; research; workforce.

© 2024 The Authors. AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.

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Conflict of interest statement

The authors declare no conflicts of interest.

Prioritization of research and research‐focused…

Prioritization of research and research‐focused residents by EM residency programs. *For this question,…

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Chairman, department of emergency medicine, chief, emergency medicine, tampa general hospital, research director, division of emergency medicine, medical director, transitions of care, department of emergency medicine, associate professor, morsani college of medicine, affiliate faculty, anthropology, contact info.

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• MD , Medicine, University of South Florida, 2008
• MA , Anthropology, University of Michigan, 2004
• BA , Anthropology, University of South Florida, 2000
• PhD , Anthropology, University of South Florida, 2023

Jason W. Wilson, MD, PhD, CPE, FACEP is the founding Chariman of the Department of Emergency Medicine at the Morsani College of Medicine, University of South Florida. He also serves as the Chief of Emergency Medicine at Tampa General Hospital. He is an Associate Professor in the Morsani College of Medicine. He also holds a PhD in Anthropology and has an affiliated faculty appointment with the Department of Anthropology at the University of South Florida. Dr. Wilson serves as the Medical Director for Transitions of Care as well as the the Research Director for Emergency Medicine.

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"integration of social science into clinical pathways, assemblages and entanglements of clinical pathway, utilization of medical anthropologists in clinical space, patient centered pathway development, new care strategies"

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• clinical emergency medicine, critical medical anthropology
• http://tampaerdoc.com
• biocultural/medical anthropology/social determinants of healthcare, HIV/HCV, transitions of care pathways, anticoagulation/VTE/afib management, health services research/hospital operations, anthropology, emergency medicine clinical trials, acute care research, medical education, sports medicine

Awards/Honors

• Covid Public Service Commendation (City of Tampa - 2021)
• 40 Under 40 (Tampa Bay Business Journal - 2013)
• Top Doctor (Tampa Bay Magazine - 2023)

Memberships

• Member (Society for Applied Anthropology, 2015 - Present)
• Member (Society for Academic Emergency Medicine, 2012 - Present)
• Fellow (American College of Emergency Physicians, 2007 - Present)
• Member (American Anthropological Association, 2000 - Present)
• Member (Association of Academic Chairs of Emergency Medicine (AACEM), 2022 - Present)

Recent Publications

• Bischof Jason J, Elsaid MI Bridges JFP Rosko AE Presley CJ Abar B Adler D Bastani A Baugh CW Bernstein SL Coyne CJ Durham DD Grudzen CR Henning DJ Hudson MF Klotz A Lyman G H Madsen TE Reyes-Gibby CC Rico J Ryan RJ Shapiro N Swor R Thomas CR Venkat A Wilson JW Yeung SCJ Yilmaz S Caterino JM, . Characterization of Older Adults with Cancer Seeking Acute Emergency Department Care: A Prospective Observational Study. Journal of Geriatric Oncology. . 22: S1879-4068, 2022.
• Wilson JW and Baer R, . Clinically Applied Anthropology 2.0: Improving the Patient Experience Through Education and Integration of Medical Anthropology into the Clinical Space. Lexington books. Rowman and Littlefield Publishing Group. . , 2022.
• Henderson HH Wilson JW McCoy B, . Applied Medical Anthropology and Structurally Informed Emergency Care in the Evolving Context of COVID-19 Human Organization . 80(4) : 263-371, 2021.
• Villalona S, Castañeda H, Wilson JW, Romero-Daza N, Yanez Yuncosa M, Jeannot C. Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care. Hispanic health care international : the official journal of the National Association of Hispanic Nurses . : 15404153211067685, 2021.
• Connors JM, Brooks MM, Sciurba FC, Krishnan JA, Bledsoe JR, Kindzelski A, Baucom AL, Kirwan BA, Eng H, Martin D, Zaharris E, Everett B, Castro L, Shapiro NL, Lin JY, Hou PC, Pepine CJ, Handberg E, Haight DO, Wilson JW, Majercik S, Fu Z, Zhong Y, Venugopal V, Beach S, Wisniewski S, Ridker PM. Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial. JAMA . , 2021.
• Faryar KA, Henderson H, Wilson JW, Hansoti B, May LS, Schechter-Perkins EM, Waxman MJ, Rothman RE, Haukoos JS, Lyons MS. COVID-19 and beyond: Lessons learned from emergency department HIV screening for population-based screening in healthcare settings. Journal of the American College of Emergency Physicians open . 2(3) : e12468, 2021.
• Decker SJ, Goldstein TA, Ford JM, Teng MN, Pugliese RS, Berry GJ, Pettengill M, Silbert S, Hazelton TR, Wilson JW, Shine K, Wang ZX, Hutchinson M, Castagnaro J, Bloom OE, Breining DA, Goldsmith BM, Sinnott JT, O''Donnell DG, Crawford JM, Lockwood CJ, Kim K. 3D Printed Alternative to the Standard Synthetic Flocked Nasopharyngeal Swabs Used for COVID-19 testing. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America . , 2020.
• Villalona S, Boxtha C, Webb WA, Cervantes C, Wilson JW. "If at Least the Patient Could Not Be Forgotten About": Communication in the Emergency Department as a Predictor of Patient Satisfaction. Journal of patient experience . 7(6) : 1015-1021, 2020.
• Villalona S, Cervantes C, Boxtha C, Webb WA, Wilson JW. "I Felt Invisible Most of the Time": Communication and satisfaction among patients treated in emergency department hallway beds. The American journal of emergency medicine . 38(12) : 2742-2744, 2020.
• Baugh CW, Levine M, Cornutt D, Wilson JW, Kwun R, Mahan CE, Pollack CV, Marcolini EG, Milling TJ, Peacock WF, Rosovsky RP, Wu F, Sarode R, Spyropoulos AC, Villines TC, Woods TD, McManus J, Williams J. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Annals of emergency medicine . 76(4) : 470-485, 2020.
• Villalona S, Jeannot C, Yanez Yuncosa M, Webb WA, Boxtha C, Wilson JW. Minimizing Variability in Interpretation Modality Among Spanish-Speaking Patients With Limited English Proficiency. Hispanic health care international : the official journal of the National Association of Hispanic Nurses . 18(1) : 32-39, 2020.
• Wilson JW, Gillen JP, Maute T. Patient Safety during Rapid Sequence Intubation When Using Succinylcholine Instead of Nondepolarizing Paralytic Agents: Should We Change a Common Rapid Sequence Intubation Pathway? Journal of emergencies, trauma, and shock . 13(4) : 264-268, 2020.
• Wilson J, Sanmugalingham G, Ozoya O, Pierce L, Hundley K, Palakurty SH. Acute HIV Infection in a Patient with Repeat HIV Antibody/Antigen Negative Results Presenting at an Urban Emergency Department: A Case Report. The Journal of emergency medicine . 57(4) : e113-e116, 2019.
• Christopher W, Baugh MD MBAa∗''Correspondence information about the author MD MBA Christopher W, BaughEmail the author MD MBA Christopher W, Baughlink Michael Levine MDb David Cornutt MDc Jason W, Wilson MD MAd Richard Kwun MD MBAe Charles E, Mahan PharmD PhCf Charles V, Pollack Jr, MD MAg Evie G, Marcolini MDh Truman J, Milling Jr, MDi W, Frank Peacock MDj Rachel P, Rosovsky MD MPHk Fred Wu MHS PA-Cl Ravi Sarode MDm Alex C, Spyropoulos MDn Todd C, Villines MDo Timothy D, Woods MDp John McManus MD MBAq James Williams DO MSr∗''Correspondence information about the author DO MS James William. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel Annals of Emergency Medicine . : https://www.annemergmed.com/article/S0196-0644(19)31181-3/fulltext, 2019.
• Caterino JM, Adler D, Durham DD, Yeung SJ, Hudson MF, Bastani A, Bernstein SL, Baugh CW, Coyne CJ, Grudzen CR, Henning DJ, Klotz A, Madsen TE, Pallin DJ, Reyes-Gibby CC, Rico JF, Ryan RJ, Shapiro NI, Swor R, Venkat A, Wilson J, Thomas CR, Bischof JJ, Lyman GH. Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments. JAMA network open . 2(3) : e190979, 2019.
• Wilson JW, Baer RD, Villalona S. Patient Shadowing: A Useful Research Method, Teaching Tool, and Approach to Student Professional Development for Premedical Undergraduates. Academic medicine : journal of the Association of American Medical Colleges . 94(11) : 1722-1727, 2019.
• Adler D, Abar B, Durham DD, Bastani A, Bernstein SL, Baugh CW, Bischof JJ, Coyne CJ, Grudzen CR, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Pallin DJ, Reyes-Gibby CC, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SJ, Caterino JM. Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients With Active Cancer. The Journal of emergency medicine . , 2019.
• Baugh CW Clark CL Wilson JW Stiell IG Kocheril AG Luck KK Pollack CV Jr Roumpf SK Tomassoni GE Williams JM Patel BB Wu F and Pines JM, . Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel. Academic Emergency Medicine . 25(9) : 1065-1075, 2019.
• Adler D Abar B Durham DD Bastrani A Bernstein SL Baugh CW Bischof JJ Coyne CJ Grudzen CR Henning DJ Hudson MF Klotz Lyman GH Madsen TE Pallin DJ Reyes-Gibby CC Rico JF Ryan RJ Shapiro NI Swor R Thomas CR Venkat A Wilson J Yeung S-CJ Caterino J. Validation of the Emergency Severity Index (Version 4) for the Triage of Adult Emergency Department Patients with Active Cancer Journal of Emergency Medicine . 57(3) : 354-361, 2019.
• Baugh CW, Clark CL, Wilson JW, Stiell IG, Kocheril AG, Luck KK, Myers TD, Pollack CV, Roumpf SK, Tomassoni GF, Williams JM, Patel BB, Wu F, Pines JM. Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine . 25(9) : 1065-1075, 2018.
• Mirarchi FL, Cooney TE, Venkat A, Wang D, Pope TM, Fant AL, Terman SA, Klauer KM, Williams-Murphy M, Gisondi MA, Clemency B, Doshi AA, Siegel M, Kraemer MS, Aberger K, Harman S, Ahuja N, Carlson JN, Milliron ML, Hart KK, Gilbertson CD, Wilson JW, Mueller L, Brown L, Gordon BD. TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care. Journal of patient safety . 13(2) : 51-61, 2017.
• Payor A, Jois P, Wilson J, Kedar R, Nallamshetty L, Grubb S, Sullivan C, Fowler T. Efficacy of Noncontrast Computed Tomography of the Abdomen and Pelvis for Evaluating Nontraumatic Acute Abdominal Pain in the Emergency Department. The Journal of emergency medicine . : doi:10.1016/j.jemermed.2015.06.062, 2015.
• , Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol-based care for early septic shock. The New England journal of medicine . 370(18) : 1683-93, 2014.
• Bihorac A, Chawla LS, Shaw AD, Al-Khafaji A, Davison DL, Demuth GE, Fitzgerald R, Gong MN, Graham DD, Gunnerson K, Heung M, Jortani S, Kleerup E, Koyner JL, Krell K, Letourneau J, Lissauer M, Miner J, Nguyen HB, Ortega LM, Self WH, Sellman R, Shi J, Straseski J, Szalados JE, Wilber ST, Walker MG, Wilson J, Wunderink R, Zimmerman J, Kellum JA. Validation of cell-cycle arrest biomarkers for acute kidney injury using clinical adjudication. American journal of respiratory and critical care medicine . 189(8) : 932-9, 2014.
• Schocken DM, Runyan A, Willieme A, Wilson J. Medical hierarchy and medical garb. The virtual mentor : VM . 15(6) : 538-43, 2013.
• Zeidan A, Salhi BA, Backster A, Shelton E, Valente A, Safdar B, Wong AH, Della Porta A, Lee S, Schneberk T, Wilson JW, Westgard BC, Samuels-Kalow, ME. A Structural Competency Framework for Emergency Medicine Research: Results from a Scoping Review & Consensus Conference Western Journal of Emergency Medicine . , 2022.
• Sher T., Shah J., Holbrook E. A., Thomas, A., Wilson, J Electric Scooter Injuries in Tampa, Florida, are Associated with High Rates of Head Injury, Hospital Admission, and Emergency Medical Service Transport and Low Rates of Helmet Use Cureus . 15(5) , 2023.
• Papa L, Cienki JJ, Wilson JW, Axline V, Coyle EA, Earwood RC, Thundiyil JG, Ladde JG. Sex Differences in Neurological Emergencies Presenting to Multiple Urban Level 1 Trauma Centers Neurotrauma Rep . 4: 605-612, 2023.
• Webb, PB; Jiminez, J; Elder, A; Ortega Cotte, A; Ravinchandran, A; Holbrook, EA; Baer, RD; Wilson, JW Exploring Lived Experiences of Gun Shot Wound Survivors: A Key to Ethnographically Informed Public Health Interventions for Curbing Firearm Violence. Injury . , 2023.
• Rico, JF, Caterino, JM, Stephens, J, Pallin, DJ, Gruzen, CR, McNaughton, C, Marcelin, I, Abar, B, Adler, D, Bastani, A, Bernstein, SL, Bischof, JJ, Coyne, CJ, Henning, DJ, Hudson, MF, Klotz, AD, Lyman, GH, Madsen, TE, Reyes, CC, Ryan, RJ, Shapiro, NI Variables Affecting Admission Rates Among Cancer Patients Presenting to Emergency Departments: A CONCERN Group Study Journal of Emergency Cancer Care . 2(7) , 2023.

Emergency Medicine

Philip Mudd, MD, PhD

Assistant Professor, Emergency Medicine

• Email: pmudd@ nospam. wustl.edu
• B.S., Biochemistry, Summa cum Laude, University of Oklahoma, Norman, OK. 2006
• Ph.D, Cellular and Molecular Biology, University of Wisconsin-Madison, Madison, WI. 2011
• M.D., University of Wisconsin School of Medicine and Public Health, Madison, WI. 2013

Dr. Mudd’s Lab

• Residency, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH. 2017

Licensure and Board Certification

• Missouri Medical License
• Board Certified in Emergency Medicine
• The Golden Apple Teaching Award, Washington University Emergency Medicine Residency, 2019
• Society for Academic Emergency Medicine Medical Student Award, 2013
• American Society of Clinical Pathologists Award for Academic Excellence and Achievement, 2008
• Medical Scientist Training Program Fellowship – University of Wisconsin-Madison, 2006
• Barr M. Goldwater Scholar, 2005” to “Barry M. Goldwater Scholarship, 2005
• Sir Alexander Fleming Scholar – Oklahoma Medical Research Foundation, 2002

Recent Publications

• Turner JS, Lei T, Schmitz AJ, Day A, Choreño-Parra JA, …, Cruz-Lagunas A, House SL, Zúñiga J, Ellebedy AH, Mudd PA .  2020.  Impaired Cellular Immune Responses During the First Week of Severe Acute Influenza Infection.  J Infect Dis .  222(7):1235-1244.
• Mudd PA , Crawford JC, Turner JS, Souquette A, Reynolds D, …, Presti RM, OHalloran JA, Powderly WG, Thomas PG, Ellebedy AH.  2020.  Distinct inflammatory profiles distinguish COVID-19 from influenza with limited contributions from cytokine storm.  Sci Adv .  In press.
• Mudd PA , Hooker EA, Stolz U, Hart KW, Bernstein JA, Moellman JJ.  2020.  Emergency department evaluation of patients with angiotension converting enzyme inhibitor associated angioedema.  Am J Emerg Med .  2020 Jan 7:S0735-6757(19)30881-2.
• Carpenter CR, Mudd PA , West CP, Wilber E, Wilber ST.  2020.  Diagnosing COVID-19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases.  Acad Emerg Med . 2020 Jun 16:10.1111/acem.14048.
• Madsen A, Dai YN, McMahon M, Schmitz AJ, Turner JS, …, Mudd PA , Simon V, Cox RJ, Fremont DH, Krammer F, Ellebedy AH.  2020.  Human Antibodies Targeting Influenza B Virus Neuraminidase Active Site Are Broadly Protective.  Immunity .  2020 Oct 13;53(4):852-863.e7.
• Stadlbauer D, Zhu X, McMahon M, Turner JS, Wohlbold TJ, …, Nachbagauer R, Mudd PA , Wilson IA, Ellebedy AH, Krammer F.  2019.  Broadly protective human antibodies that target the active site of influenza virus neuraminidase.  Science .  366(6464):499-504.

Selected Publications

• Mudd PA , Martins MA, Ericsen AJ, Tully DC, Power KA, …, Piatak M, Haase AT, Lifson JD, Allen TM, Watkins DI.  2012.  Vaccine-induced CD8 + T cells control AIDS virus replication.  Nature .  491(7422):129-133.
• Mudd PA , Ericsen AJ, Burwitz BJ, Wilson NA, O’Connor DH, Hughes AL, Watkins DI.  2012.  Escape from CD8 + T cell responses in Mamu-B*00801 + macaques differentiates progressors from elite controllers.  J Immunol .  188(7):3364-3370.
• Mudd PA , Ericsen AJ, Price AA, Wilson NA, Reimann KA, Watkins DI.  2011.  Reduction of CD4 + T cells in vivo does not affect virus load in macaque elite controllers.  J Virol .  85(14):7454-7459.
• Mudd PA , Ericsen AJ, Walsh AD, León EJ, Wilson NA, Maness NJ, Friedrich TC, Watkins DI.  2011.  CD8+ T cell escape mutations in simian immunodeficiency virus SIVmac239 cause fitness defects in vivo , and many revert after transmission.  J Virol .  85(23):12804-12810.

View a complete list of Dr. Mudd’s published work »

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Emergency medicine residency pathways for MD / PhD trainees: A national cross‐sectional study of physician‐scientist training programs

Karen cyndari.

1 Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City Iowa, USA

Libby White

Philip a. mudd.

2 Department of Emergency Medicine, Washington University School of Medicine, St. Louis Missouri, USA

J. Priyanka Vakkalanka

Sydney krispin, kelli wallace, megan schagrin.

3 Society for Academic Emergency Medicine, Des Plaines Illinois, USA

Nicholas Mohr

4 Departments of Emergency Medicine, Anesthesia Critical Care, and Epidemiology, University of Iowa Carver College of Medicine, Iowa City Iowa, USA

Associated Data

Combined clinical and research training is common in residency programs outside emergency medicine (EM), and these pathways are particularly valuable for combined MD/PhD graduates planning to pursue a career as a physician‐scientist. However, EM departments may not know what resources to provide these trainees during residency to create research‐focused, productive, future faculty, and trainees may not know which programs support their goal of becoming a physician‐scientist in EM. The objective of this study was to describe research training and resources available to MD/PhD graduates in EM residency training with a focus on dedicated research pathways.

This study was a cross‐sectional inventory conducted through an electronic survey of EM residency program directors. We sought to identify dedicated MD/PhD research training pathways, with a focus on both resources and training priorities. Descriptive statistics were used to summarize survey responses.

We collected 192 survey responses (69.6% response rate). Among respondents, 41 programs (21.4%) offered a research pathway/track, 52 (27.4%) offered a research fellowship, 22 (11.5%) offered both a residency research pathway/track and a research fellowship, and two (1.0%) offered a dedicated EM physician‐scientist training pathway. Most programs considered research a priority and were enthusiastic about interviewing applicants planning a research career, but recruitment of physician‐scientist applicants was not generally prioritized.

Conclusions

Some EM residency programs offer combined clinical and mentored research training for prospective physician‐scientists, and nearly all residency programs considered research important. Future work will focus on improving the EM physician‐scientist pipeline by optimizing pathways available to trainees during residency and fellowship.

INTRODUCTION

Emergency medicine (EM) was officially recognized as a clinical specialty in 1979, 1 and currently it has the lowest proportion of physician‐scientists and National Institutes of Health (NIH)‐funded researchers of any clinical specialty. 2 EM also ranked last in NIH‐funded Career Development Awards—an important metric for a robust physician‐scientist pipeline. 3 In 2021, a task force of the Academy of Academic Chairs in Emergency Medicine (AACEM), Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), and American Academy of Emergency Medicine (AAEM) published the Emergency Medicine 2030 Research Strategic Goals, focused principally on enhancing the pipeline of physician‐scientists in the specialty of EM. The task force recommended national, institutional, and individual strategies to increase EM research, and seven of these strategies focused on recruiting research‐interested students into EM and developing improved research training pathways within the specialty. 2

Among all physicians who received their first NIH‐funded R01 award in 2020, 38% were graduates of combined MD/PhD programs and many were also graduates of NIH‐funded T32 Medical Scientist Training Programs (MSTP). 4 This combined‐degree pathway has been a valuable source of clinician‐researchers, and many specialties outside of EM have developed dedicated research‐focused residency pathways to enhance the transition of these graduates into faculty positions as physician‐scientists. 4 , 5 These pathways, often called physician‐scientist training pathways (PSTP), typically combine longitudinal research training and mentorship with residency and fellowship clinical training, and in some cases these pathways alter clinical training requirements. 4 , 5

According to the annual Association of American Medical Colleges (AAMC) report, MD/PhD graduates represented 3.4% of all residents in 2017. 6 Of all MD/PhD graduates, only 1.1% were EM residents in 2017, and this decreased to 0.8% in 2019. 7 Child neurology, radiation oncology, pathology, vascular surgery, and interventional radiology had the highest representation of MD/PhD graduates, while EM and family medicine had the lowest. While EM may be underrepresented in physician‐scientists, a similar pattern has been observed in orthopedics, 8 general surgery, 9 and anesthesia. 10 According to predictions, the current number of MD/PhD graduates is insufficient to maintain current levels of physician‐scientists in the workforce. 11

Even among EM‐trained MD/PhD graduates, many do not pursue a career as a physician‐scientist, with nearly half of MD/PhD graduates in EM pursuing nonacademic careers. 12 Only 19% of EM MD/PhD graduates dedicate most of their professional effort to biomedical research compared with over 50% in internal medicine, neurology, pediatric neurology, and pediatrics. 11 Based on these data, MD/PhD graduates planning to pursue a research career are choosing specialties outside EM, and this may represent an underdeveloped pathway for recruiting physician‐scientists into the specialty of EM. Scholarly tracks during EM residency training have been developed and are successful at many institutions to develop academic careers, 13 but these tracks have not increased recruitment of MD/PhD residents into EM. 6 , 7 Identifying EM pathways for MD/PhD graduates to successfully transition into independent researchers is important to guide program directors on how to develop these pathways, and also to guide applicants on how identify promising training options. 14 , 15 Additional strategies to improve pathways for research‐committed medical school graduates could be a valuable approach to increasing funded EM physician‐scientists.

To better understand dedicated training opportunities for MD/PhD graduates within EM residencies, we conducted a cross‐sectional inventory of dedicated residency research career training in EM. The objective of this study was to describe research training in EM residency programs, with a focus on formal research tracks and support for graduates of MD/PhD programs. We also sought to understand how prior research training and credentials were used in residency recruiting and research training support.

We conducted a cross‐sectional electronic survey of EM residency program directors between June 2022 and July 2023. Our survey was delivered electronically by email to program directors, research directors, and program coordinators in sequential preference, and we followed up individually by email and telephone to encourage participation. Data were collected using the Research Electronic Data Capture (REDCap) tool (Vanderbilt University). This study was determined by our local institutional review board not to constitute human subjects research, and our results are reported consistent with the Consensus‐Based Checklist for Reporting of Survey Studies (CROSS). 16 Residency programs identified in this article separately gave their permission to be identified.

Survey development

A steering committee of four experts in residency research training developed our 11‐question tool to inventory both program‐specific resources and institutional research resources available to EM residents. Questions also sought to characterize perceptions related to training MD/PhD graduates. This tool included both dichotomous questions about resource availability and Likert‐style responses about priorities, and it was intentionally designed to focus on MD/PhD graduates rather than characterizing all research resources available to EM residents. We used the model of PSTP programs in other specialties as an exemplar of the resources we were trying to capture, but we maintained a broad perspective to capture creative approaches. The draft survey was shared with other experts in the field and refined based on feedback, and it was reviewed and approved by both the SAEM Research Committee and the SAEM Board of Directors. The survey is included in Figure  S1 .

Study population

We used the SAEM Residency Program Director email list and the Emergency Medicine Residents’ Association (EMRA) Match Database to identify EM residency program directors to receive the survey starting in June 2022. We excluded any program that lost accreditation during the data collection period. We verified contact information using the SAEM Residency Directory, official program website, and social media accounts. We contacted programs up to four times by a combination of email and telephone to maximize response over the course of the study period. For programs that submitted multiple surveys, only the most recent survey was included in the analysis.

Definitions

For the purposes of our survey, we used the following definitions, which were also provided to survey respondents:

Research‐focused residency pathway/track

This is defined as a pathway or track within residency for trainees dedicated to a career as a physician‐scientist. This type of pathway/track is different than a research curriculum or research requirement in which all residents participate, as the goal is to prepare a resident for a long‐term research career. In many cases, this type of program has its own website, specific goals and objectives, and an annotation on the graduation certificate. Residents who engage in this pathway/track may have different training activities and responsibilities than other residents. Applicants may seek admission to this track either before residency matriculation or after starting residency, and it may be open either only to applicants with a prior PhD or to a broader range of applicants. It may or may not extend the residency duration beyond the standard number of clinical training years in the categorical residency program.

Research fellowship

This is defined as a dedicated research training/mentorship program that is started after residency graduation (i.e., not completed during a residency program). We did not differentiate between SAEM‐approved research fellowships and other research fellowships.

This is defined as a combined residency/fellowship/postdoctoral research training pathway or program that is typically available to graduates of an MD/PhD program or MSTP. PSTP programs combine concurrent clinical and research training, and typically incoming residents have a formal commitment to clinical or research fellowship training as part of the pathway. These programs merge traditional residency training with mentored research training and extend beyond the standard number of clinical training years in the categorical residency program. Although many PSTP programs are funded by federal training grants, the source of program funding was not collected for the purposes of this study.

Data analysis

We tabulated the responses to survey questions and reported the results descriptively. To assess nonresponse bias, we compared characteristics of responding and nonresponding programs using data publicly available on the EMRA Match Database and/or institutional websites. Differences were calculated as Cohen d or h statistics to assess meaningful differences of a standardized mean difference in proportions (categorical variables) and means (continuous variables), and we considered differences of greater than 0.1 to be meaningful. Statistical analysis was performed in SAS 9.4.

Of 276 accredited EM residency programs invited to participate, 192 surveys were completed (69.6% response rate; Table  1 ). Among respondents, 146 (76.0%) were 3‐year residency programs, 94 (48.9%) had an MD/PhD or MSTP program at the affiliated medical school, and 39 (20.0%) had principal investigators with current NIH research funding in the department of EM as of 2022. 18 Responding programs were more likely to be 4‐year residency programs, located in an urban area, affiliated with a university, and have current NIH funding. Residency programs at institutions with MD/PhD or MSTP programs were also more likely to respond (Table  S1 ).

Descriptive statistics of survey respondents.

Note: Data are reported as n (%) or mean (±SD).

Abbreviations: AAMC, Association of American Medical Colleges; FY, fiscal year; MSTP, medical scientist training program; N/A, not applicable; NIH, National Institutes of Health; PGY, postgraduate year; PSTP, physician‐scientist training pathway.

Program descriptions

A total of 41 (21.0%) programs offered a research‐focused pathway/track during residency. Of these programs, 25% admitted residents to the pathway/track before or at the start of residency matriculation. Three (7.3%) of the 41 programs included training beyond the categorical residency to complete the research pathway/track. Two programs were self‐classified as EM PSTP, and one of these programs extended research training beyond the categorical residency.

Fifty‐two of the 192 (27.1%) responding residency programs offered a research fellowship. Within the past 5 years, 10 of the 52 fellowship programs (19.2%) recruited fellows with prior PhD training. Twenty‐two (11.5%) responding institutions offered both a research‐focused pathway/track and a research fellowship (Table  2 ). Two programs offered a research‐focused pathway with the structure of an EM PSTP: Northwestern University and the University of Iowa. Two additional institutions noted specific pathways available that may also be EM PSTP‐equivalent: Yale New Haven Medical Center offers the Yale Emergency Scholars program, a 4 + 1 pathway where residents have integrated research years during postgraduate year (PGY)‐3 and PGY‐4, and nearly all obtain a master of health sciences at the end of PGY‐5; and Johns Hopkins University offers 50% academic time in the PGY‐4 year for an integrated research fellowship.

Survey responses regarding research pathway/track, fellowship, PSTP, and MSTP existence at each institution.

Note: Data are reported as n (%).

Abbreviations: MSTP, medical scientist training program; PSTP, physician‐scientist training pathway.

Institutional resources and recruitment of trainees with prior PhD training

Eighty‐eight programs (45.8%) reported that they had an MSTP or MD/PhD program at their affiliated medical school (Table  2 ). Of those that reported “no” or “don't know” to this prompt, an additional 18 institutions were listed as having active MD/PhD programs by the AAMC, making the total count 112 (58.3%). 17 Twenty‐five (13.0%) programs offered a PSTP (nearly all in a specialty other than EM) at their institution (Table  2 ); of those, only two (8.0%) offered an EM‐specific PSTP. Within the past 5 years, 64 programs (33.5%) had matriculated between one and three residents with prior PhD training, and six programs (3.1%) had at least four current residents with prior PhD training. Among programs that had graduated residents with prior PhD training, 37 (52.1%) responded that these residents had gone on to continue a research career after graduation (Table  2 ).

Most responding EM residency programs (172/192, 89.6%) reported that they approved elective time to be used for research activities, and 158/192 (82.3%) assist in identifying a career research mentor. A total of 63/192 (32.8%) offered scheduling flexibility to work with an existing research group on campus. Twenty‐eight percent of programs reported they would provide all three: approve elective time for research, help identify a research mentor, and offer scheduling flexibility to work with a research group. Nineteen programs entered free‐text answers regarding additional resources offered to residents (Table  3 ), most of which (12/19) focused on funding and/or sponsorship.

Resources offered to research‐interested residents.

Attitudes toward research and physician‐scientist applicants

Most respondents agreed or strongly agreed that their EM department felt research was important ( n  = 164/190, 86.3%; Figure  1 ) and that they were excited to interview residents with a passion for research ( n  = 137/191, 71.7%). Over half of the EM residency programs agreed they were a “great fit” for research‐interested residents ( n  = 106/190, 55.8%). Of these 106 EM residency programs, 33 (31.1%) offered a research‐focused residency track, 43 (40.6%) offered a research fellowship, 18 (17.0%) offered both a research track and fellowship, and two (1.9%) offered an EM PSTP.

Prioritization of research and research‐focused residents by EM residency programs. *For this question, “strongly agree” was further defined as “I would strongly prioritize these applicants over other applicants.” “Strongly disagree” was further defined as “I would consider these applicants just like any other applicant.”

Twenty percent ( n  = 37/189) agreed or strongly agreed that they would prioritize recruitment of physician‐scientists. Among these 37 EM residency programs, 14 (37.8%) offered research‐focused residency tracks, 17 (45.9%) offered research fellowship opportunities, nine (24.3%) offered both a research‐focused residency track and research fellowship, and two (2.7%) offered an EM‐specific PSTP. Twenty‐two EM residency programs (Table  3 ) had either (1) both a research track and a research fellowship or (2) an EM‐specific PSTP.

In our inventory of EM residency programs, we found that a number of institutions have developed focused tracks and fellowship programs intended to provide career‐level research training and mentorship, but these focused training opportunities represented a minority of EM residency training programs. Few programs specifically recruited MD/PhD graduates, and many programs who have trained MD/PhD residents have residency graduates no longer participating in research. Despite the limited availability of these dedicated research programs, program directors are generally supportive of research training and careers. Overall, our findings suggest that EM training programs have opportunities to develop additional pathways to recruit, retain, and develop physician‐scientists from the cadre of MD/PhD graduates. Maintaining credible EM‐focused career pathways for physician‐scientists remains a critical goal to achieving targets for EM research growth and expansion, 2 and the lack of these supportive transition programs may encourage MD/PhD graduates to pursue training in other specialties. For example, according to the Blue Ridge Institute for Medical Research (BRIMR) Rankings of NIH funding in 2022, 41 EM departments across the United States were receiving an approximate total of $101M in funding, compared to $5.175B for internal medicine, $1.142B for pediatrics, $1.151B for psychiatry, $786M for pathology, and $1.001B for neurology. 18 These specialties corresponded to the top 5 specialties for MD/PhD graduates by number of active residents, whereas EM ranked No. 14 in the same year. 7

PSTP pathways are a growing option for MD/PhD graduates across specialties, and applicants strongly value the structured time and mentorship that PSTP pathways provide. 5 , 19 Outreach to research‐oriented medical students and development of PSTP pathways was recently recommended by a task force of the Anesthesia Research Council as a strategy to increase research productivity in anesthesiology—based mainly on the success of similar initiatives in internal medicine, surgery, pathology, and psychiatry. 3 Diverse PSTP programs in the U.S. are being structured to serve as a bridge between MD/PhD training and career independence, and these programs offer benefits to both trainees and research funding organizations. 20

EM presents a unique opportunity for developing competitive PSTP pathways that transition into successful research careers because of the feasibility of combining the EM clinical schedule with dedicated research time, the diversity of federal funding sources that apply to acute care medicine research, and parity in salary and work‐hours factors with other clinical specialties. Shift work can facilitate laboratory work by increasing availability of days and evenings, enabling longitudinal experiments, and continuing high‐level research during residency. Further, the available infrastructure in institutional PSTP programs can be applied in EM, and protecting time for research fellows and clinical faculty to expand research training remains possible in many institutions. Formal alignment with MD/PhD programs and institutional PSTP programs would provide a scientific community, diverse mentorship, institutional research culture, and complementary funding pathways that can accelerate training opportunities in EM‐focused funded research programs. Expanding formal PSTP programs in EM and expanding mentorship opportunities for EM faculty to students in MD/PhD programs could serve as a substantial recruiting tool to help bring some of the best future physician‐scientists into EM after medical school graduation.

Our survey results show that a minority of EM residency programs offer a research track during residency or a research fellowship after residency, and formal PSTP in EM is rare. A comparative experience to PSTP could be defined as a research track followed by a research fellowship, for a 3‐ to 6‐year experience with dedicated mentored research time. Using this metric, we identified 22 EM residency programs listed in Table  4 that may be ideal for the physician‐scientist applicant. Of these 22 programs, two offer official PSTP tracks in EM, while an additional 16 are located at universities with PSTPs in other specialties. These institutions may have an opportunity to expand PSTP options in EM, as the necessary infrastructure and organizational framework may already be available. If utilizing preexisting PSTP infrastructure were not feasible, residency programs could consider matriculating applicants into a combined research track and research fellowship by recruiting highly qualified trainees, similar to established PSTP recruitment practices in other specialties. 21 This structure can enable longitudinal mentorship, a larger mentored project, integration into an existing research group, and some general EM research training, but such a commitment requires resources and faculty champions (in many cases, both within and outside EM).

Programs with research focused tracks, research fellowships, and PSTP.

Abbreviation: PSTP, physician scientist training pathway.

So where do we go from here? Even though only 22 programs currently have a structure for dedicated EM physician‐scientist training, program directors were overall supportive of research training and many had established procedures to help research‐interested residents achieve their professional goals. We identified 106 EM residency programs at institutions with combined MD/PhD training programs. EM departments seeking to expand or accelerate their research programs may wish to connect with this community of home‐grown MD/PhD trainees or likewise may consider recruiting graduates of these programs. We also identified 25 total EM programs at institutions with PSTP pathways outside EM, suggesting that infrastructure exists to bolster integrated EM research and residency training using models from other disciplines. The AAMC has listed six non‐EM specialties that sponsor PTSP pathways, 22 and the structure provided by these programs can be adapted to EM training paradigms for research‐interested EM applicants. PSTP programs also offer intellectual community and shared career goals, which provide important support for trainees. Developing such research‐focused training pathways requires independent research‐oriented faculty, so such pathways may not be feasible in all institutions.

Developing these pathways will take work and monetary investment. Research career training requires strong mentors and dedicated resources. In 2020, fewer than 100 faculty in EM were principal investigators for NIH grants, and fewer than ten K12 or T32 institutional training awards were active in departments of EM. 2 While only 41 EM departments had NIH funding in 2022, this has increased by 20% over the past decade. 23 Research funding from EM foundations has been robust over the past 20 years, and these awards have been leveraged effectively into future federal research funding. 24 Continued focus in this area, especially in aligning combined MD/PhD research training pathways in institutions with successful federally funded research programs, will be critical to realizing the 2030 EM research strategic goals. 2

LIMITATIONS

Our study has several limitations. First, our response rate of nearly 70%, while strong for an electronic survey, may have missed nonresponding programs with resources to support physician‐scientist career development. Many of the programs that did not respond were community‐based residency programs. Second, we collected data and opinions from only one respondent at each site. While we tried to identify the person best informed to provide accurate data and perceptions, there may have been some misclassification if the information or opinions held by that person were not internally consistent with others in the institution. Finally, we focused our data collection on dedicated physician‐scientist training for graduates of MD/PhD programs. This pathway is clearly not the only (or even the dominant) pathway into a career as an EM physician‐scientist, but we focused on this pathway as a roadmap for successful training that other specialties have used to grow their physician‐scientist workforce and that could be applied in EM.

CONCLUSIONS

In our cross‐sectional survey of U.S. emergency medicine residency programs, we identified 22 programs with both a research track and a research fellowship focused on providing career‐level mentored research training to residents interested in pursuing a career as a physician‐scientist, and we identified two dedicated physician‐scientist training pathways residency pathways in emergency medicine. Program directors were largely enthusiastic about training physician‐scientists. Growing research activity in emergency medicine remains a strategic priority, so identifying techniques to recruit and retain research‐interested medical students into emergency medicine is critical.

AUTHOR CONTRIBUTIONS

Study concept and design (Karen Cyndari, Philip A. Mudd, Nicholas Mohr), acquisition of the data (Karen Cyndari, Libby White, Philip A. Mudd, Nicholas Mohr), analysis and interpretation of the data (Libby White, Karen Cyndari, Nicholas Mohr, J. Priyanka Vakkalanka), drafting of the manuscript (Libby White, Karen Cyndari, J. Priyanka Vakkalanka, Nicholas Mohr, Sydney Krispin), critical revision of the manuscript for important intellectual content (Karen Cyndari, Libby White, Philip A. Mudd, J. Priyanka Vakkalanka, Sydney Krispin, Kelli Wallace, Megan Schagrin, Nicholas Mohr), and statistical expertise (J. Priyanka Vakkalanka).

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Supporting information

Acknowledgments.

The authors acknowledge Melissa McMillian, CAE, CNP, for her assistance with distributing the survey and James Paxton, MD, MBA, Chair of the SAEM research committee, for his guidance. The authors further acknowledge the participation from residency programs nationwide to compile these data.

Cyndari K, White L, Mudd PA, et al. Emergency medicine residency pathways for MD/PhD trainees: A national cross‐sectional study of physician‐scientist training programs . AEM Educ Train . 2024; 8 :e10960. doi: 10.1002/aet2.10960 [ CrossRef ] [ Google Scholar ]

Karen Cyndari and Libby White contributed equally to this work.

Supervising Editor: Esther Chen

Presented at the American Physician Scientists Association Midwest Regional Meeting, St. Louis, MO, October 2023.

The findings detailed within this document are those of the authors only and do not represent the official view of the Society for Academic Emergency Medicine.

Rittik Chaudhuri , MD , PhD

Emergency medicine.

• Johns Hopkins School of Medicine

14 Insurances Accepted

Rittik Chaudhuri is part of the Department of Emergency Medicine's Tactical Medicine Fellowship Program under the direction of program director Nelson Tang.

Dr. Chaudhuri received his Ph.D. in Biochemistry from the University of Cambridge in 2010 and his medical degree from the Washington University School of Medicine in 2014. He then joined the Harvard-affiliated emergency medicine residency at Massachusetts General Hospital and Brigham and Women’s Hospital from which he graduated.

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MD-PhD Degree Programs by State

New section.

Combined MD-PhD degree programs provide students the opportunity to earn both the MD and the PhD in areas pertinent to medicine.

Combined MD-PhD degree programs provide students the opportunity to earn both the MD and the PhD in areas pertinent to medicine. Below is a list of schools offering a combined MD-PhD degree, with links to their web sites. Please contact the institutions directly for curriculum information and admission requirements. School administrators may contact [email protected]  with any omissions or corrections to this listing.

University of Alabama School of Medicine Birmingham, Ala.

University of South Alabama College of Medicine Mobile, Ala.

University of Arizona College of Medicine Tucson, Ariz.

University of Arizona College of Medicine - Phoenix Phoenix, Ariz.

University of Arkansas College of Medicine Little Rock, Ark.

Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, Calif.

Loma Linda University School of Medicine  Loma Linda, Calif.

Stanford University School of Medicine Stanford, Calif.

University of California, Davis School of Medicine Davis, Calif.

University of California, Irvine School of Medicine Irvine, Calif.

University of California, Los Angeles School of Medicine Los Angeles, Calif.

University of California, San Diego School of Medicine La Jolla, Calif.

University of California, San Francisco School of Medicine San Francisco, Calif.

Keck School of Medicine of the University of Southern California Los Angeles, Calif.

University of Colorado Health Sciences Center Denver, Colo.

Connecticut

University of Connecticut School of Medicine Farmington, Conn.

Yale University School of Medicine New Haven, Conn.

District of Columbia

Georgetown University School of Medicine Washington, D.C.

Howard University College of Medicine Washington, D.C.

University of Florida College of Medicine Gainesville, Fla.

University of Miami Miller School of Medicine Miami, Fla.

University of South Florida College of Medicine Tampa, Fla.

Emory University School of Medicine Atlanta, Ga.

Morehouse School of Medicine Atlanta, Ga.

Medical College of Georgia at Augusta University Augusta, Ga.

Loyola University of Chicago - Stritch School of Medicine Maywood, Ill.

Northwestern University Medical School  Chicago, Ill.

Rosalind Franklin University of Medicine and Science - Chicago Medical School North Chicago, Ill.

University of Chicago Pritzker School of Medicine (MTSP) Chicago, Ill.

University of Chicago Pritzker School of Medicine (MD/PhD) Chicago, Ill.

University of Illinois at Chicago College of Medicine Chicago, Ill.

University of Illinois at Urbana-Champaign Carle Illinois College of Medicine Urbana, Ill.

Indiana University School of Medicine Indianapolis, Ind.

University of Iowa College of Medicine Iowa City, Iowa

University of Kansas School of Medicine Kansas City, Kan.

University of Kentucky College of Medicine Lexington, Ky.

University of Louisville School of Medicine Louisville, Ky.

Louisiana State University, New Orleans School of Medicine New Orleans, La.

Louisiana State University, Shreveport School of Medicine Shreveport, La.

Tulane University School of Medicine New Orleans, La.

Johns Hopkins University School of Medicine Baltimore, Md.

National Institutes of Health Intramural MD-PhD Partnership Bethesda, Md.

Uniformed Services University of the Health Sciences Bethesda, Md.

University of Maryland at Baltimore School of Medicine Baltimore, Md.

Massachusetts

Boston University School of Medicine Boston, Mass.

Harvard Medical School Boston, Mass.

Tufts University School of Medicine Boston, Mass.

University of Massachusetts Medical School Worcester, Mass.

Michigan State University College of Human Medicine East Lansing, Mich.

University of Michigan Medical School Ann Arbor, Mich.

Wayne State University School of Medicine Detroit, Mich.

Mayo Medical School Rochester, Minn.

University of Minnesota Medical School Minneapolis, Minn.

Mississippi

University of Mississippi School of Medicine Jackson, Miss.

Saint Louis University School of Medicine St. Louis, Mo.

University of Missouri - Columbia School of Medicine Columbia, Mo.

University of Missouri - Kansas City School of Medicine Kansas City, Mo.

Washington University School of Medicine St. Louis, Mo.

Creighton University School of Medicine Omaha, Neb.

University of Nebraska College of Medicine Omaha, Neb.

University of Nevada School of Medicine Reno, Nev.

New Hampshire

Geisel School of Medicine at Dartmouth Hanover, N.H.

Rutgers - New Jersey Medical School Newark, N.J.

Rutgers - Robert Wood Johnson Medical School Piscataway, N.J.

University of New Mexico School of Medicine Albuquerque, N.M.

Albany Medical College Albany, N.Y.

Albert Einstein College of Medicine of Yeshiva University Bronx, N.Y.

Columbia University College of Physicians and Surgeons New York, N.Y.

Hofstra North Shore - LIJ School of Medicine Hempstead, N.Y.

Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD/PhD Program New York, N.Y.

Mount Sinai School of Medicine New York, N.Y.

New York Medical College Valhalla, N.Y.

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Rhode Island

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South Dakota

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Meharry Medical College School of Medicine Nashville, Tenn.

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Vanderbilt University School of Medicine Nashville, Tenn.

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McGovern Medical School at UTHealth/MD Anderson Cancer Center/University of Puerto Rico Tri-Institutional Program Houston, Texas

Texas A&M University Health Sciences Center College of Medicine College Station, Texas

Texas Tech University School of Medicine Lubbock, Texas

University of Texas Medical Branch at Galveston Galveston, Texas

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Medical College of Wisconsin Milwaukee, Wisc.

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McGill University Faculty of Medicine Montreal, Quebec

McMaster University of Faculty of Health Sciences Hamilton, Ontario

Memorial University of Newfoundland Faculty of Medicine St. John's, Newfoundland and Labrador

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Universite Laval Faculte de Medecine Quebec, Quebec

University of Alberta Faculty of Medicine and Dentistry Edmonton, Alberta

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University of Manitoba Faculty of Medicine Winnipeg, Manitoba

University of Saskatchewan College of Medicine Saskatoon, Saskatchewan

University of Toronto Faculty of Medicine Toronto, Ontario

University of Western Ontario London, Ontario

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Bernard P. Chang, MD, PhD

Locations and Appointments

Cuimc/presbyterian hospital and vanderbilt clinic, about bernard p. chang, md, phd.

Dr. Bernard P. Chang is the Associate Dean of Faculty Health and Research Career Development at the Vagelos College of Physicians and Surgeons at Columbia University, where he holds the Tushar Shah and Sarah Zion Endowed Associate Professorship in Emergency Medicine. He also serves as Vice Chair of Research in the Department of Emergency Medicine at Columbia University.

Dr. Chang has been recognized with numerous awards including the Lamport Prize, the American College of Emergency Physician-Established Investigator Award (New York), and the Young Investigator Award from the Society for Academic Emergency Medicine. He is an elected fellow to the Academy of Behavioral Medicine and New York Academy of Medicine and served as a board member of the Alumni Board of Governors at Stanford University Medical Center, and Board of Directors at the American College of Physicians (New York Chapter).

Dr. Chang received his PhD from Harvard in psychology, his MD from Stanford and completed his Emergency Medicine residency training at Harvard Medical School (Massachusetts General Hospital and Brigham and Women's Hospital). Prior to his medical training, he served as a sailboat captain doing yacht deliveries internationally.

Board Certifications

• Emergency Medicine

Languages Spoken

• Internship: Harvard Medical School/ Beth Israel Deaconess Medical Center
• Medical School: Stanford University School of Medicine
• Residency: Harvard Medical School/ Beth Israel Deaconess Medical Center
• Internship: Brigham and Women's/Massachusetts General Hospital - Harvard Affiliated Emergency Medicine Residency
• Residency: Brigham and Women's/Massachusetts General Hospital - Harvard Affiliated Emergency Medicine Residency

Leadership, Titles & Positions

• Associate Dean of Faculty Health and Research Career Development
• Tushar Shah and Sara Zion Associate Professor of Emergency Medicine
• Vice Chair of Research, Department of Emergency Medicine

Hospital Affiliations

• NewYork-Presbyterian / Columbia University Irving Medical Center
• NewYork-Presbyterian Allen Hospital

Awards & Honors

• Lamport Prize
• The American College of Emergency Physician-Established Investigator Award, New York
• The Young Investigator Award from the Society for Academic Emergency Medicine.

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Jared Conley, MD, PhD, MPH

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Contact Information

Boston, MA Phone: 617-724-4100

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About Jared Conley, MD, PhD, MPH

Dr. Jared Conley is an Assistant Professor at Harvard Medical School and emergency physician at Mass General Hospital. He serves as the Associate Director of the Healthcare Transformation Lab, where he leads a team of clinicians and engineers to enhance the quality and affordability of healthcare through technology and innovation. He additionally serves as a Physician Advisor for MGH's Home Hospital program. His work explores opportunities to enhance healthcare delivery at home—and the enabling opportunity for digital health to improve the quality, safety, cost, and scale of such care. His work has been featured in various medical journals, including NEJM Catalyst and JAMA Internal Medicine, as well as new outlets such as Reuters and Medscape. His most recent article on technology-enabled hospital at home was named one of the top articles of 2022 by NEJM Catalyst. He completed a joint MD/PhD program at Case Western School of Medicine, as well as received an MPH from The Dartmouth Institute. His clinical training was obtained at Harvard (MGH/BWH) and he completed a fellowship in healthcare innovation at Stanford.

Clinical Interests:

• Digital Health
• Emergency medicine
• Health care delivery innovation
• Health care policy
• Hospital at Home
• Remote patient monitoring
• Telemedicine
• Adult & Pediatrics

Mass General Emergency Medicine 55 Fruit St. Boston , MA   02115 Phone: 617-724-4100

Medical Education

• MDPhD, Case Western Reserve University School of Medicine
• Residency, Harvard Affiliated Emergency Medicine Residency Program -- MGH/BWH

American Board Certifications

• Emergency Medicine, American Board of Emergency Medicine

Accepted Insurance Plans

• Beech Street
• Blue Cross Blue Shield
• Blue Cross Blue Shield Medicare
• Commonwealth Care Alliance
• Fallon Health
• Harvard Pilgrim Health Care
• Maine Community Health Options
• Mass General Brigham Health Plan
• Medicaid CT
• Medicaid ME
• Medicaid NH
• Medicaid RI
• Medicaid VT
• Medicare ACO
• Railroad Medicare
• Senior Whole Health
• Tufts Health Plan
• United Health Care
• WellSense NH

Note: This provider may accept more insurance plans than shown; please call the practice to find out if your plan is accepted.

Publications

https://www.ncbi.nlm.nih.gov/pubmed?term=Jared%20Conley%5BAuthor%20-%20Full%5D

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A Top Hospital in America

Mass General is recognized as a top hospital on the U.S. News Best Hospitals Honor Roll for 2024-2025.

Related News and Articles

• Apr | 12 | 2023

Research Spotlight: Hospital at Home and The Next Frontier of Remote Patient Monitoring

How can remote patient monitoring be better employed to enable the expansion of the hospital-at-home (HaH) model to benefit more patients seeking to heal in the comfort of their homes?

• Press Release
• Feb | 16 | 2022

For successful hospital-at-home programs, crucial technologies are within reach

A new article in NEJM Catalyst Innovations in Care Delivery highlights MGB’s experience in developing and employing key technologies to better enable and enhance acute hospital care at home.

• Aug | 31 | 2020

Massachusetts General Hospital launches digital health solution with American Heart Association

Massachusetts General Hospital (MGH) is announcing the launch of a new digital health application for frontline healthcare workers today.