Online Publications

Scholarly Journals--Published

  • Hopson L, Edens M, Goodrich M, Kiemeney M, Werley E, Kellogg A, Franzen D. Calming Troubled Waters: A Narrative Review of Challenges and Potential Solutions in the Residency Interview Offer Process. West J Emerg Med. 2020;22:1-6. The rising numbers of residency applications along with fears of a constrained graduate medical education environment have created pressures on residency applicants. Anecdotal evidence suggests substantial challenges with the process of offering residency interviews. This narrative review is designed to identify and propose solutions for the current problems in the process of offering residency interviews. We used PubMed and web browser searches to identify relevant studies and reports. Materials were assessed for relevance to the current process of distributing residency interviews. There is limited relevant literature and the quality is poor overall. We were able to identify several key problem areas including uncertain timing of interview offers; disruption caused by the timing of interview offers; imbalance of interview offers and available positions; and a lack of clarity around waitlist and rejection status. In addition, the couples match and need for coordination of interviews creates a special case. Many of the problems related to residency interview offers are amenable to program-level interventions, which may serve as best practices for residency programs, focusing on clear communication of processes as well as attention to factors such as offer-timing and numbers. We provide potential strategies for programs as well as a call for additional research to better understand the problem and solutions. (12/2020)
  • Pelletier-Bui A, Franzen D, Smith L, Hopson L, Lutfy-Clayton L, Parekh K, Olaf M, Morrissey T, Gordon D, McDonough E, Schnapp BH, Edens MA, Kiemeney M. COVID-19: A Driver for Disruptive Innovation of the Emergency Medicine Residency Application Process. West J Emerg Med. 2020;21:1105-1113. The coronavirus disease (COVID-19) pandemic has had a significant impact on undergraduate medical education with limitation of patient care activities and disruption to medical licensing examinations. In an effort to promote both safety and equity, the emergency medicine (EM) community has recommended no away rotations for EM applicants and entirely virtual interviews during this year's residency application cycle. These changes affect the components of the EM residency application most highly regarded by program directors - Standardized Letters of Evaluation from EM rotations, board scores, and interactions during the interview. The Council of Residency Directors in Emergency Medicine Application Process Improvement Committee suggests solutions not only for the upcoming year but also to address longstanding difficulties within the process, encouraging residency programs to leverage these challenges as an opportunity for disruptive innovation. (08/2020)
  • Kiemeney M, Franzen D. Availability of  Emergency Medicine Away Rotations. Academic Emergency Medicine Education and Training. 2020;5(2):e10487. eCollection 2021 April Objectives: Residency directors in emergency medicine (EM) have been placing increased value on the Standardized Letter of Evaluation to evaluate the escalating numbers of residency applications received each year. This has placed added significance on EM away rotations (ARs). We sought to determine the overall availability of ARs in EM. Methods: We surveyed clerkships sites at the end of 2018-2019 application season. The survey requested data about maximum rotation spots available, actual number of students that rotated, and data about application processing and rotation offer decision making. Results: We received 190 responses, of which 129 (49% of 262 clerkship sites surveyed) provided data regarding available positions and student rotators. A total of 3,472 ARs were completed at the responding sites. The average capacity ratio (CR; maximum available AR spots divided by AR completed by students) for responding sites was 1.57. AR availability varied by time and geography. Most AR positions were filled during peak season (CR = 1.22); however, many went unfilled outside of this time frame (CR = 2.41). Geographic data showed some locations had significant unfilled AR availability. Conclusions: Our survey data show that there are at least 1.5 AR positions per applicant. Students can be reasonably expected to complete one AR and, in select cases, a second. CR during peak season indicates nearly saturated AR positions. Flexibility of rotation timing and tools to link open AR positions with students needing to complete a rotation will help optimize filling available AR positions. Continued effort in application advising from home clerkships and processes to ensure equitable distribution of AR positions among students will help ensure interested students obtain a position. (07/2020)
  • Fierro L, Kuntz HM, Guptill M, Reibling E, Kiemeney M, Smith DD, Young TP. Video review with sports performance software improves trainee endotracheal intubation time, posture and confidence. Educ Health. 2020 Jan-Apr;33(1):26-27. (01/2020)
  • March JA, Kiemeney MJ, De Guzman J, Ferguson JD. Retention of cricothyrotomy skills by paramedics using a wire guided technique. American Journal of Emergency Medicine. 2018;37:407-410.  Introduction: Cricothyrotomy may be necessary for airway management when a patient's airway cannot be maintained through standard techniques such as oral airway placement, blind insertion airway device, or endotracheal intubation. Wire-guided cricothyrotomy is one of many techniques used to perform a cricothyrotomy. Although there is some controversy over which cricothyrotomy technique is superior, there is no published data regarding long term retention rates. The purpose of this study is to determine whether ground based paramedics can be taught and are able to retain the skills necessary to successfully perform a wire-guided cricothyrotomy. Methods: This retrospective study was performed in a suburban county with a population of 160,000 with 23,000 EMS calls per year. Participants were ground-based paramedics who were taught wire-guided cricothyrotomy as part of a standardized paramedic educational update program. After viewing an instructional video, the paramedics were shown each the steps of the procedure on a simulation model, using a low fidelity task trainer previously developed to train emergency medicine residents. Using a 16 step procedural checklist, participants were allowed open-ended practice using the task trainer. Critical steps in the checklist were marked in bold lettering indicating automatic failure. Each paramedic was then individually supervised performing a minimum of 5 successful simulations. Retention was assessed using the same 16 step checklist 6 to 12 weeks following the initial training. Results: A total of 55 paramedics completed both the initial training and reassessment during the time period studied. During the initial training phase 100% (55 of 55) of the paramedics were successful in performing all 16 steps of the wire-guided cricothyrotomy. During the retention phase, 87.3% (48 of 55) of paramedics retained the skills necessary to successfully perform the wire-guided cricothyrotomy. On the 16 step checklist, most steps were performed successfully by all the paramedics or missed by only 1 of the 55 paramedics. The step involving removal of the needle prior to advancing the airway device over the guide wire was missed by 34.5% (19 of 55) of the participants. This was not an automatic failure since most participants immediately self-corrected and completed the procedure successfully. Conclusion: Paramedics can be taught and can retain the skills necessary to successfully perform a wire-guided cricothyrotomy on a simulator. Future research is necessary to determine if paramedics can successfully transfer these skills to real patients. (03/2019)
  • Li RM, Kiemeney M. Infections of the Neck. Emerg Med Clin North Am. 2019;37:95-107. Infection of the neck is a relatively common emergency department complaint. If not diagnosed and managed promptly, it may quickly progress to a life-threatening infection. These infections can result in true airway emergencies that may require fiberoptic or surgical airways. This article covers common, as well as rare but emergent, presentations and uses an evidence-based approach to discuss diagnostic and treatment modalities. (02/2019)
  • Young TP, Schaefer M, Kuntz HM, Estes M, Kiemeney M, Wolk BJ, Guptill M. Yogaman: an inexpensive, anatomically detailed chest tube placement trainer. West J Emerg Med. 2019;20:117-121. Introduction: Opportunities for chest tube placement in emergency medicine training programs have decreased, making competence development and maintenance with live patients problematic. Available trainers are expensive and may require costly maintenance. Methods: We constructed an anatomically-detailed model using a Halloween skeleton thorax, dress form torso, and yoga mat. Participants in a trial session completed a survey regarding either their comfort with chest tube placement before and after the session or the realism of Yogaman vs. cadaver lab, depending on whether they had placed <10 or 10 or more chest tubes in live patients. Results: Inexperienced providers reported an improvement in comfort after working with Yogaman, (comfort before 47 millimeters [mm] [interquartile ratio {IQR}, 20-53 mm]; comfort after 75 mm [IQR, 39-80 mm], p=0.01). Experienced providers rated realism of Yogaman and cadaver lab similarly (Yogaman 79 mm [IQR, 74-83 mm]; cadaver lab 78 mm [IQR, 76-89 mm], p=0.67). All evaluators either agreed or strongly agreed that Yogaman was useful for teaching chest tube placement in a residency program. Conclusion: Our chest tube trainer allowed for landmark identification, tissue dissection, pleura puncture, lung palpation, and tube securing. It improved comfort of inexperienced providers and was rated similarly to cadaver lab in realism by experienced providers. It is easily reusable and, at $198, costs a fraction of the price of available commercial trainers. (01/2019)
  • Hopkins, E, Green SM, Kiemeney M, Haukoos JS. A two-center validation of “patient does not follow commands” and three other simplified measures to replace the glasgow coma scale for field trauma triage. Annals of Emergency Medicine. 2018;72:259-269. Study objective: Out-of-hospital personnel worldwide calculate the 13-point Glasgow Coma Scale (GCS) score as a routine part of field trauma triage. We wish to independently validate a simpler binary assessment to replace the GCS for this task. Methods: We analyzed trauma center registries from Loma Linda University Health (2003 to 2015) and Denver Health Medical Center (2009 to 2015) to compare the binary assessment "patient does not follow commands" (ie, GCS motor score <6) with GCS score less than or equal to 13 for the prediction of 5 trauma outcomes: emergency intubation, clinically significant brain injury, need for neurosurgical intervention, Injury Severity Score greater than 15, and mortality. As a secondary analysis, we similarly evaluated 3 other measures simpler than the GCS: GCS motor score less than 5, Simplified Motor Score, and the "alert, voice, pain, unresponsive" scale. Results: In this analysis of 47,973 trauma patients, we found that the binary assessment "patient does not follow commands" was essentially identical to GCS score less than or equal to 13 for the prediction of all 5 trauma outcomes, with slightly superior positive likelihood ratios (eg, those for mortality 2.37 versus 2.13) offsetting slightly inferior negative ones (eg, those for mortality 0.25 versus 0.24) and its graphic depiction of sensitivity versus specificity superimposing the GCS prediction curve. We found similar results for the 3 other simplified measures. Conclusion: In this 2-center external validation, we confirmed that a simple binary assessment-"patient does not follow commands"-could effectively replace the more complicated GCS for field trauma triage. (09/2018)
  • Young TP, Kuntz HM, Alice B, Roper J, Kiemeney M. An inexpensive esophageal balloon tamponade trainer. Journal of Emergency Medicine. 2017;53:726-729. Background: Emergency medicine practitioners must be able to perform rare, life-saving procedures. One such example is esophageal balloon tamponade, which is complex, fraught with complications, and difficult to demonstrate and practice. Discussion: We constructed a simple, inexpensive model esophagus and stomach that we attached to a mannequin, allowing emergency medicine residents to visualize and practice esophageal balloon tamponade device placement. Conclusion: Our esophageal balloon tamponade model was easy to construct and allowed demonstration, conceptual visualization, and simulated performance of the procedure. (11/2017)
  • Davis AJ, Fierro L, Guptill M, Kiemeney M, Brown L, Smith DD, Young TP. Practical Application of Educational Theory for Learning Technical Skills in Emergency Medicine. Annals of Emergency Medicine. 2017; 70:402-405 (09/2017)
  • Lee C, Walters E, Borger R, Clem K, Fenati G, Kiemeney M, et al. (2016). The San Bernardino, California, Terror Attack: Two Emergency Departments’ Response. Western Journal of Emergency Medicine. 2016; 17:1-7. On December 2, 2015, a terror attack in the city of San Bernardino, California killed 14 Americans and injured 22 in the deadliest attack on U.S. soil since September 11, 2001. Although emergency personnel and law enforcement officials frequently deal with multi-casualty incidents (MCIs), what occurred that day required an unprecedented response. Most of the severely injured victims were transported to either Loma Linda University Medical Center (LLUMC) or Arrowhead Regional Medical Center (ARMC). These two hospitals operate two designated trauma centers in the region and played crucial roles during the massive response that followed this attack. In an effort to shed a light on our response to others, we provide an account of how these two teaching hospitals prepared for and coordinated the medical care of these victims. In general, both centers were able to quickly mobilize large number of staff and resources. Prior disaster drills proved to be invaluable. Both centers witnessed excellent teamwork and coordination involving first responders, law enforcement, administration, and medical personnel from multiple specialty services. Those of us working that day felt safe and protected. Although we did identify areas we could have improved upon, including patchy communication and crowd-control, they were minor in nature and did not affect patient care. MCIs pose major challenges to emergency departments and trauma centers across the country. Responding to such incidents requires an ever-evolving approach as no two incidents will present exactly alike. It is our hope that this article will foster discussion and lead to improvements in management of future MCIs. (01/2016)


  • Moussavi K, Wolk B, Hauschild C, Yomtoubian C, Kiemeney M. Use of pharmacy residents to promote pharmacist involvement with ACLS. Crit Care Med 2018;47(1):632. (2018)
  • Kiemeney M, Matthews S, Dudas R, Mainville D, Wickes J, Smith D, Young TP, Phan T, Daniel-Underwood L. Small-group shift for assessment of entrustable professional activities in an EM clerkship. Western Journal of Emergency Medicine. 2017; 18(supplement):S65-S66. (2017)