Case

A 68-year-old female with a past medical history of hypertension, diabetes mellitus, coronary artery disease, peptic ulcer disease, and a remote appendectomy presented to the Emergency Department (ED) with one day of epigastric pain and nausea. The patient denied fever, vomiting, and diarrhea. She also denied chest pain and shortness of breath. On arrival, she was afebrile and had normal vital signs. She was well appearing, and her physical exam was only significant for mild epigastric tenderness to palpation without peritoneal signs. She was evaluated for her abdominal pain with laboratory tests and a computed tomography (CT) scan with IV contrast of the abdomen and pelvis. Laboratory results were significant for an elevated white blood cell count of 15.2 and a lactate of 2. Her CT scan was interpreted by the Radiology service as, “Mild gastric and small bowel mucosal hyperenhancement and wall thickening possibly exaggerated by under distention, however may be seen in the setting of gastroenteritis.” She was discharged home with a diagnosis of gastritis.

The next day, the patient returned with worsening epigastric pain, continued nausea, no bowel movements, and new subjective fevers and chills. Her vital signs were significant for a blood pressure of 179/109 mmHg and her physical exam demonstrated more diffuse abdominal tenderness to palpation, but still most tender in the epigastrium. Since she had an unremarkable CT scan within the past 24 hours, the decision was made to treat her symptomatically with anti-nausea and acid reducing medications and repeat laboratory tests without diagnostic imaging. During this bounce-back visit, she was selected for a point-of-care ultrasound (POCUS) by the rounding ultrasound scanning team. On POCUS, she was noted to have loops of bowel dilated to 2.6 cm with to-and-fro peristalsis (Figure 1). She also had a grossly distended, fluid filled stomach (Figure 2). The POCUS findings were communicated to the treatment team and a CT angiography scan of the abdomen and pelvis was ordered. The scan demonstrated a small bowel obstruction (SBO) described by the Radiology service as, “Distended stomach. Dilated loops of small bowel measuring up to 4 cm with transition point in the left lower quadrant.” Her laboratory test results were significant for an increased white blood cell count of 18.1 and an elevated lactate of 3.2. The General Surgery service was consulted, and the patient was admitted to their service for further management.

Discussion

In the United States, SBO accounts for approximately 2% of ED visits for abdominal pain and nearly 16% of hospital admissions for acute, nontraumatic abdominal pain.^{1, 2} Prompt recognition in the ED is critical, as delays in diagnosis can lead to significant morbidity, including bowel ischemia, necrosis, perforation, and sepsis.³ Point-of-care ultrasound has emerged as a valuable imaging modality for the evaluation of suspected SBO, offering high diagnostic accuracy while avoiding many of the limitations of traditional imaging. A 2023 multicenter meta-analysis including 433 patients reported a pooled sensitivity of 83% (95% CI 71.7%-90.4%) and specificity of 93% (95% CI 55.3%-99.3%) for POCUS in identifying SBO.⁴ These findings exceed the diagnostic performance of abdominal radiography, and several studies suggest that, in the hands of trained operators, POCUS may approach the sensitivity and specificity of CT.¹

While CT remains the gold standard for the evaluation of SBO, providing more comprehensive anatomic details useful for our surgical colleagues, such as identifying transition points and closed loop obstructions as well as assessing for ischemia and strangulation, its limitations include cost, radiation exposure, and time to acquisition.⁵ In a prospective observational study of 125 patients with suspected SBO, the mean time to CT report was 3 hours and 42 minutes, compared to an average of 11 minutes to complete a POCUS exam.² As such, POCUS offers a rapid, radiation-free, low-cost, and highly accurate screening tool for SBO.⁶ Its use has the potential to expedite diagnosis, accelerate patient dispositions, and ultimately improve patient outcomes. Incorporation of POCUS into routine clinical practice for the evaluation of suspected SBO should therefore be strongly encouraged. In relation to our case presented above, the utilization of POCUS helped to guide the care of a patient who may have otherwise not received repeat imaging and the SBO may have been missed.

Case Conclusion

Upon admission, the surgical team placed a nasogastric tube, which had 500 mL of bilious output. The patient was observed overnight and, the following morning, she had very little improvement in symptoms and was not passing flatus. The decision was made to take her to the operating room for an exploratory laparotomy where she was found to have 1-2 feet of threatened appearing bowel with a single associated adhesive band. Bowel was viable appearing and reperfused after lysis of the adhesion. No bowel resection was performed. The patient was discharged 10 days post-operatively in stable and improved condition.

Indications

• Abdominal pain
• Distension
• History of abdominal surgeries
• Obstipation
• Vomiting

Technique

• Examine all four abdominal quadrants in multiple planes, transverse and longitudinal, using a low frequency curvilinear probe.
• Use the lawnmower technique by placing the probe in the right lower quadrant in the transverse orientation, then slide it to the right upper quadrant, and then slide it slightly medially before sliding it inferiorly back to the right lower quadrant. Repeat these steps from the right side to the left side until the entire abdomen has been scanned.
• Apply graded compression as necessary and consider using a high frequency linear probe for patients with lower body mass indices.
• What are you looking for?
  • Low-grade obstruction:
    • Small bowel dilatation >25 mm (87% sensitivity).⁷
    • Abnormal peristalsis – “to-and-fro” motions indicate obstruction, whereas forward flow is normal (82-85% sensitive).⁷
    • Bowel wall edema (sensitivity 76-93% sensitive).⁷
    • “Piano key” sign – visualization of the plicae circulares (also known as the valvulae conniventes or valves of Kerckring) which appear as hyperechoic finger-like projections on a hypoechoic background, resembling the alternating white and black pattern of piano keys.
    • Distended stomach.
  • High-grade obstruction (the above plus):
    • Small bowel wall thickness >3 mm (92.4% sensitive for needing surgery).²
    • Lack of peristalsis.
    • Free fluid surrounding small bowel in a triangular shape.

Pitfalls and Limitations

• User-dependent: Ultrasound fellows achieved specificity of 82%, while ED physicians without formal training had a wider range of specificity (54-84%).⁷
• Bowel gas can interfere with visualization.
• Provides less information than CT scan.
• Difficult to differentiate SBO from ileus, which requires CT scan for diagnosis.

Acknowledgements

We would like to thank Cara Brown, MD FACEP FPD-AEMUS, for her mentorship while preparing this manuscript.

The Increasing Burden of Pediatric Mental Health Emergencies: Research Opportunities for Emergency Physicians

John DeAngelis, MD FACEP
Associate Professor of Academic Emergency Medicine
Assistant Program Director
University of Rochester Medical Center

Julie Endrizzi, MD
Assistant Professor of Emergency Medicine, Lake Erie College of Osteopathic Medicine
Attending Physician, Unity Hospital

Words Matter in Wellness

The profession of Emergency Medicine (EM) is notorious for its ability to upset its practitioners’ sense of balance and wellness in life. Our specialty consistently has burnout rates >50%, and usually tops the charts on burnout by specialty. Early in our EM careers Julie and I both found ourselves burned out after only a few years of practice and began considering exit strategies; but through the use of mindfulness interventions and practices we were reinvigorated and reinvested in the art of Emergency Medicine. We credit the cultivation of mindful practice with saving our careers. So it is with some distress that we see the terms “mindfulness” and “wellness” being used interchangeably with increasing frequency, when they are definitely not synonymous. Mindfulness is a specific and individual contemplative practice, while wellness involves a far broader range of individual, organizational, and system-level conditions and practices. Emphasizing this distinction feels especially vital in a clinical environment where language often guides how problems are defined, who is held responsible for them, and what solutions are ultimately pursued.

In the Emergency Department (ED), this conflation of “mindfulness” and “wellness” is not merely semantic, it has important practical and ethical implications. Mindfulness, as a personal practice of present-moment awareness and nonjudgmental attention, is becoming a popular offering to clinicians as a tool to cope with stress, ethical challenges, and high-acuity workloads.^1,2 Wellness, however, encompasses much more than a single item in an individual’s toolbox of coping strategies; it covers structural issues such as staffing, scheduling, and access to institutional support.^3,4 Maintaining a clear conceptual boundary between mindfulness and wellness is essential to designing interventions that are both compassionate to individuals and implementable at an organizational level. When the boundaries are blurred, wellness initiatives can devolve into asking already overburdened clinicians to “fix” their distress through more self-regulation, rather than addressing the conditions that generate that distress in the first place.

Defining mindfulness

In the literature, mindfulness is described as both a dispositional trait and a trainable practice characterized by present-moment awareness, nonreactivity, and nonjudgmental attention to internal and external experiences.^1,5 Specific interventions to train mindfulness skills include such activities as meditation, STOP think practices, box breathing, and narrative reflection. Longitudinal and cross-sectional work in emergency care shows that higher baseline mindfulness predicts lower depression, anxiety, and social impairment over time, and that mindfulness is associated with reduced burnout among ED personnel.^6,7

Intervention studies demonstrate that mindfulness training reduces stress and burnout among interns and other clinicians, and that even brief, pre-simulation mindfulness sessions can improve state anxiety, cognitive load, and teamwork.^8,9,10,11 Specific components of mindfulness, such as nonreactivity, conscious action, and nonjudgment, correlate with better situational awareness and leadership performance in emergency simulations, reinforcing that mindfulness is a discrete, measurable construct rather than a vague synonym for “feeling well.”^12,13

Defining wellness

Wellness in EM is a broader construct encompassing individual, interpersonal, and organizational factors such as work–life integration, sleep quality, social support, psychological safety, institutional debriefing, professional fulfillment, and system-level policies.¹⁴ Resilience factors like spirituality, perceptions of home life, and institutional procedures interact with burnout and fulfillment to influence outcomes (like intent to leave the profession).^4,15

Consensus and guideline documents emphasize that organizational culture, staffing models, workload, and safety systems exert a dominant influence on physician well-being and on patient safety outcomes (e.g., medical errors, delayed care, documentation problems, etc.).^2,3,16 From this perspective, wellness is not merely an internal psychological state but also a property of the working and learning environment that must be shaped by policy and leadership.^3,10

Key differences and why they matter

At a structural level, mindfulness is an intervention and skill set, whereas wellness is an outcome and system-level multifaceted construction which includes emotional, physical, social, spiritual, and professional aspects.^1,2 Mindfulness-based interventions primarily target psychological processes such as attention regulation and emotional regulation, while wellness initiatives must also address scheduling, boarding, sleep, staffing, safety, leadership, debriefing procedures, and broader organizational and cultural change.^3,4,8

Three major issues arise by using these terms interchangeably. First, it produces a conceptual reductionism: collapsing wellness into mindfulness ignores other protective factors and interventions inherent to wellness that are documented in the literature. Second, it individualizes responsibility by implying that burned-out clinicians simply need to build up their personal resilience through activities like mindfulness training, a concept that diverts attention from structural system-level contributors. Third, it creates measurement and policy confusion: if “wellness” initiatives are limited to mindfulness courses, organizations may overestimate their wellness efforts and fail to track broader outcomes (such as professional fulfillment, resilience, patient safety, and workforce retention).

At the end of the day, if the EM physician has nowhere to see patients due to boarding, no control over their schedule due to understaffing, or feels unsafe because of workplace violence, then adding 15 minutes of meditation before or after shift may simply lead them to be more aware of how unwell their situation has become. In our case, we have found deep fulfillment and meaning in our careers by applying mindfulness in the Emergency Department, yet we remain acutely aware of the work that must be done systemically to improve wellbeing across the field. Thus, we find in this case that words do matter, and understanding why they matter can only help to better implement both wellness and mindfulness within your department.

Nights, Holidays, Weekends

I am no stranger to working on holidays. Dating back to my first job at an ice cube factory, some of the busiest days I worked were holidays. Specifically, the “Ice Cube Holidays” (Memorial Day, The 4th of July, and Labor Day) are typically days where families often enjoy picnics with loved ones in the hot summer sun, and the demand for bagged ice skyrockets. Families count on being able to stop at a convenience store or gas station and being able to pick up a bag of ice to keep their coolers cold during these events. People relied on us to be ready – just as people rely on the emergency department to be ready.

Some holidays are notoriously busy in the emergency department. Thanksgiving has some of the highest rates of visits for laceration complaints from patients that had accidents while cooking a turkey dinner. The 4th of July is infamous for orthopedic injuries secondary to fireworks – so much so that there are public health announcements each year and new episodes of HBO’s “The Pitt” feature an entire season dedicated to the increased volume found on this holiday.

This past New Year’s Eve, I found myself scheduled for a night shift in one of our local emergency departments. While the volume may not have been as high as the preceding night (at least before midnight), every patient I met recounted a story of an emergency that occurred that disrupted their plans and landed them in the hospital. Many were dressed up for parties that they would never attend and instead had to spend the night in the emergency department.

Approximately 5 minutes to midnight, one of our nurses raided the Christmas decorations and found a large silver ball ornament. This was fixed to the examination light in exam room 21 for our own “Buffalo Ball Drop”. 2 minutes to midnight, a page went off to our department phones to meet in room 21. Nurses and attendings had prepared a sparkling grape juice toast, complete with plastic flutes to toast at midnight and ring in the new year. Many of our nurses and staff recounted how they had worked year after year on New Year’s Eve and brought in the new year together, and now I could see why.

As the clock struck midnight, we toasted to the year ahead before returning to our respective stations. We followed up on labs and imaging, called new consults, delivered good and bad news – and through it all we were there for patients in a day when they needed us most.

I will be working many holidays throughout my career in emergency medicine, and if you are reading this, it is likely that you will be too. While working those holidays, it is critical to take a moment – even if it is just 2 minutes in exam room 21 – to reflect on the day and recognize that you are there for your patients on a day when they may need you the most. Happy New Year!

Pitfalls in Pediatric Head Trauma

Introduction:

The prevalence of traumatic presentations in pediatric EDs has been estimated to be around 17.5%.¹ Of the traumatic presentations, fall is a primary mechanism.² In our pediatric patients, this often leads to head injury, which can be classified as a relatively common presentation. Head injury is easy to diagnose by history, but our goal as emergency physicians is to risk stratify these cases for serious intracranial injury. Most trainees are aware of and rely on the PECARN Pediatric Head injury algorithm as a helpful diagnostic tool. This piece aims to focus on some of the potential pitfalls of using such decision tools in the pediatric ED.

Due to physical and cognitive differences, our pediatric patients have unique risks for sustaining head injury. For example, proportionally larger heads change the mechanics of falling and shear stress, and the presence of open skull sutures may change symptomatology.³ This paired with a potential proclivity for falls in young children learning to walk or children involved in sporting activities leads to various situations that need to be considered.

PECARN Pediatric Head Injury tool:

This well-known tool was derived from a prospective cohort study (Kupperman 2009) which examined 42,000 children who visited an ED for head trauma. They studied the children with abnormal findings on head imaging and derived an algorithm based on certain risk factors that were positively associated with clinically significant TBI found on computerized tomography (CT) scan. To validate the tool, the derived algorithm was then retroactively applied to the study cohort by age. Of note, exclusion criteria for the study included age above 18, injury occurrence more than 24 hours prior to ED arrival, suspected non-accidental trauma, and medically complex patients. No cases of clinically important TBI were misclassified as low risk by the tool, showing it to be reliable.

Case 1, from our hospital:

A 4-week-old male with no significant medical history presented after falling 3 feet from his mother’s arms onto concrete without loss of consciousness. The child was subsequently consolable and able to feed. He was noted to have a parieto-occipital hematoma with an otherwise atraumatic and intact neuro exam. In accordance with the PECARN algorithm, providers in the case ordered a CT of the head which revealed a parietal skull fracture and small subarachnoid hemorrhage. The child was transferred to a pediatric trauma center and was eventually discharged at baseline from the hospital after treatment and monitoring.

Case 2, a hypothetical:

A 4-month-old female with no significant medical history presents after a ground-level fall from her sibling’s lap with head strike. The child cried immediately and has since been feeding and behaving as normal. She is awake and alert, has a large boggy frontal hematoma but an otherwise atraumatic and non-focal neurologic exam. In accordance with the PECARN algorithm, the providers in this case do not order a Head CT and discharge the patient home.

Discussion:

In the first case, the PECARN head injury algorithm appropriately caught an abnormal CT. The second case, however, reveals a potential pitfall. While the algorithm does note less than 3 months as a factor to consider CT imaging (Figure 3), this is only in children who have other high-risk features. The child in case two did not have any high-risk features and observation of CT would not be recommended. Here, the Infant Scalp Score is a tool which helps to address this pitfall.

Infant Scalp Score:

The Infant Scalp Score (ISS) is a, perhaps lesser-known, decision tool used to risk-stratify head trauma in asymptomatic infants. It was derived from a prospective cohort study of 608 pediatric ED visits (Greenes and Schutzman, 2001). Infants less than 2 years of age who were found to have skull fracture or ICH were analyzed. Their positive risk factors (e.g. younger age, non-frontal hematoma) were used to derive a screening tool that considers age and scalp hematoma characteristics.⁵ Of note, exclusion criteria included concern for non-accidental trauma, abnormal neuro exam, and abnormal vital signs. The tool was then validated by a follow-up 2010 prospective observational study where, in the case of children with a risk score of 3 or higher, 100% of cases of intracranial injury were discovered.⁶ Additional studies have been done demonstrating increased risk in children younger than 3 months of age with head injury, with greater than 50% having ICH by some analyses.^7,8

Conclusions:

Pediatric head trauma is a relatively common ED presentation. Clinicians are incentivized to identify those patents most likely to have a clinically significant brain injury to avoid morbidity and mortality. Conversely, we aim to be judicious in the use of CT imaging in pediatric patients due to risks associated with radiation exposure. Thus, it is helpful to have well-validated and evidence-based decision tools to aid in care. Trainees should consider the following to avoid diagnostic pitfalls:

• Inclusion/exclusion criteria for the decision tool
• Ensure the tool is applied to the right patient in the right time frame, especially in complex patients (e.g. avoid in the case of hemophilia)
• PECARN may miss cases of asymptomatic TBI in infants, particularly in patients with low-risk mechanisms
• Be familiar with the Infant Scalp Score and its indications for use
• Be cautious in patients younger than 3 months of age with head trauma
• Physician experience/gestalt is built into these decision tools

Leading Beyond the Bedside:

My Experience as NY ACEP’s Inaugural Leadership and Development Fellow

Emergency medicine thrives in moments of urgency and emergency where we routinely make thousands of split-second decisions every shift—but shaping its future requires thoughtful vision, strategic alignment, strong leadership, and patience. This past year, as one of the inaugural NY ACEP Leadership and Development Fellows, I was privileged to step beyond the walls of the ED into the “behind the scenes” where policy is debated, decisions are made, and strategies are defined. I discovered that advocacy is not just about speaking up—it thrives on relationship building, crafting narratives, and leading with purposeful vision.

Over the past year—through NY ACEP—I engaged with leaders who shape policy, tirelessly advocate for our specialty, and continually advance the practice of emergency medicine. This fellowship offered opportunities that were both educational and inspiring, and I am grateful for the chance to contribute to NY ACEP’s mission while growing as a leader.

One of the most impactful experiences was participating in NY ACEP’s Lobby Day in Albany. I joined NY ACEP leadership in meetings with state legislators to advocate for policies critical to emergency medicine and patient care. These conversations underscored the importance of physician voices in shaping legislation and gave me firsthand insight into the complexities of state-level advocacy and politics. Beyond simply learning the issues—such as workplace violence, scope of practice, CMS reimbursement, wrongful death legislation, among others—I observed the strategic thinking that goes into lobbying, how to frame arguments, prioritize agendas, and build coalitions to advance policy. This experience reinforced how essential it is for emergency physicians to engage in the political process to protect access to care and support our workforce.

On the national stage, I attended the ACEP Leadership and Advocacy Conference (LAC) in Washington, D.C., where I participated in lobbying efforts with members of Congress and their staff. Walking the halls of Capitol Hill alongside colleagues from across the country was a powerful reminder of the collective strength of our specialty. I learned how federal policy impacts emergency medicine and gained practical experience in communicating our priorities to lawmakers. While this may sound theoretical in nature, the issues raised affect us undoubtedly on every shift—future changes from this advocacy will enhance and improve our specialty and the work we do day-to-day. These interactions required not only knowledge of the issues but also the ability to adapt messaging to different audiences—a skill that is vital to any leadership role.

Another highlight was participating in NY ACEP’s preparations for ACEP Council. I observed how our chapter evaluates proposed resolutions, determines priorities, and strategizes co-sponsorship. This process provided a window into the governance structure of ACEP and the mechanisms through which policy is shaped within our organization. Understanding how resolutions move from concept to adoption was invaluable and will inform my future involvement in organized medicine.

Throughout the year, I attended multiple NY ACEP committee meetings, which offered a broad view of the chapter’s work beyond advocacy. From education and clinical practice to governance and workforce issues, I saw how diverse committees collaborate to address challenges facing emergency physicians. These experiences highlighted the depth and breadth of NY ACEP’s efforts to support its members and improve patient care across New York State.

Equally important were the relationships I built during this fellowship. I had the privilege of learning from seasoned leaders who generously shared their insights on leadership, advocacy, and career development. These mentors provided guidance that will shape my trajectory for years to come. Networking with peers and national leaders expanded my professional community and opened doors for future collaboration.

A highlight from the national ACEP conference in Salt Lake City included participating in media training sessions designed to prepare physicians for public-facing roles. Learning how to communicate effectively with journalists and the public was a unique and valuable experience—a skill set that complements advocacy and leadership by ensuring our message reaches a broader audience.

This fellowship has been transformative for my professional development. It strengthened my leadership skills, sharpened my strategic thinking, and taught me an approach to navigate complex policy environments. I leave this role with a toolkit of skills—advocacy, communication, coalition-building, and organizational insight—that I can apply to any future job or initiative. Most importantly, it reinforced my commitment to advancing emergency medicine through leadership and advocacy.

I encourage other early-career physicians to seek out similar opportunities. These experiences not only elevate our understanding of our specialty but also empower us to make lasting impacts on the future of emergency care. I thank the NY ACEP executive leadership team for this extraordinary opportunity and look forward to seeing many of you in Lake George in July!

Leading With Purpose: Reflections on Advocacy in Action

This past year I had the unique opportunity to be one of the two inaugural fellows for the NY ACEP leadership and advocacy fellowship. This year has been transformative and has allowed me to grow as a leader. I am currently an Assistant Medical Director at Maimonides Medical Center in Brooklyn, NY. I recently completed a fellowship in Administration & Operations.

I was drawn to this fellowship, which focused on the importance of advocacy within our specialty, to learn more about the impact emergency medicine physicians can have towards policy change. I learned how impactful our voices can be to help guide change that would benefit physicians but more importantly, our patients.

Advocacy is essential in emergency medicine because emergency departments sit at the crossroads of health care, public policy, and social inequity. Emergency physicians and clinicians witness firsthand how systemic barriers—such as lack of insurance, housing instability, structural racism, and limited access to primary care—directly shape patient outcomes long before and long after an emergency visit. Advocacy allows emergency medicine professionals to extend their impact beyond the bedside by addressing these root causes, influencing policies that affect patient safety, access to care, and workforce sustainability. Whether advocating for violence prevention, equitable disaster response, mental health resources, or fair reimbursement and staffing models, emergency clinicians bring credibility, urgency, and lived experience to these conversations. By engaging in advocacy, emergency medicine upholds its core mission: to care for all patients, especially the most vulnerable, and to strengthen the systems that determine health in moments of crisis.

During the fellowship I had the opportunity to attend advocacy day in Albany. I was specifically touched by our advocacy efforts around workplace violence. NYACEP has had a significant impact on raising awareness of this critical issue and through their efforts have brought about change that allows all of us to feel safer coming to work. Through this experience I learned that it is difficult for legislators to understand the challenges physicians may face when on duty. Sharing our firsthand experiences can help encourage legislators to address our concerns.

As part of this fellowship, I had the opportunity to represent New York during the National ACEP council meeting. Attending the national ACEP Council meeting was an inspiring experience that highlighted the collective power of emergency physicians from across the country. Being in a space where clinicians from diverse practice settings came together to debate, refine, and advance policies, reaffirmed the strength of shared advocacy rooted in frontline experience. The passion, thoughtfulness, and commitment to patient-centered care evident in every discussion highlighted how individual voices contribute to meaningful, national-level change. Witnessing resolutions transform into action reinforced my belief that advocacy is not separate from clinical practice but an essential extension of it, and it motivates me to remain actively engaged in shaping the future of emergency medicine.

Working alongside the New York American College of Emergency Physicians (NYACEP) board this year has been a formative experience that deepened my understanding of physician advocacy and organized medicine. Through council meetings, policy discussions, and engagement with state and national leadership, I gained firsthand exposure to how decisions affecting emergency physicians and patients are shaped at the legislative and organizational levels. Participating in debate and voting on resolutions reinforced the importance of representing diverse perspectives across emergency departments throughout New York State, while also highlighting the power of a unified voice in advancing issues such as patient safety, workforce protection, and equitable access to care. This experience strengthened my confidence as an advocate, sharpened my leadership skills, and affirmed the critical role that physician engagement plays in shaping the future of emergency medicine.

The board and executive director of NYACEP truly are an inspiring group of people. They have been excellent mentors to me and my co-fellow. They are passionate about growing and advancing our specialty. They have all helped me grow immensely as a leader over this year and I look forward to continuing to work closely with the NYACEP group. I am thankful for the opportunity to get to meet my amazing co-fellow who has become good friend of mine. I highly recommend this experience to any new graduates with interest in leadership or advocacy. Working alongside the board of NYACEP and attending all of the meetings throughout the year has been nothing short of inspiring and has certainly made me excited about the future of our specialty. I look forward to continuing to be involved with NYACEP in the future.