Emergency Medicine Commons^™

From Learners To Leaders: A Peer-Led Simulation Program For Anesthesia Procedural Skills Training In Medical Students, Noah S. Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, Dr. John D. Mitchell Md

Medical Student Research Symposium

Title: From Learners to Leaders: A Peer-Led Simulation Program for Anesthesia Procedural Skills Training in Medical Students

Authors: Noah Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, John D. Mitchell, M.D.

Background: Procedural skill competency is vital in medical education, but limited faculty availability poses challenges. We implemented a peer-led simulation program teaching peripheral IV insertion (PIV) and endotracheal intubation, with a focus on student leadership.

Methods: Sixteen peer educators, trained by attendings, conducted monthly workshops from July-October 2025. Students practiced at PIV and intubation stations, assessed via validated rubrics (17 items for PIV, 21 for intubation; 5-point scale). …

Inflammatory Markers In The Emergency Department And Ptsd Symptoms In The Aurora Study: A Longitudinal Cohort Study, Kristen Nishimi, Sarah Linnstaedt, Thomas Neylan, Lauren Mckibben, Liz Marie Albertorio-Sáez, Ying Zhao, Stacey House, Francesca Beaudoin, Xinming An, Jennifer Stevens, Gari Clifford, Tanja Jovanovic, Laura Germine, Scott Rauch, John Haran, Alan Storrow, Paul Musey, Phyllis Hendry, Sophia Sheikh, Brittany Punches, Robert Swor, Jose Pascual, Mark Seamon, Elizabeth M Datner, Claire Pearson, David Peak, Roland Merchant, Robert Domeier, Niels Rathlev, Brian O'Neil, Paulina Sergot, Leon Sanchez, Steven Bruce, Steven Harte, Ronald Kessler, Karestan Koenen, Kerry Ressler, Samuel Mclean, Aoife O'Donovan

Department of Emergency Medicine Faculty Papers

BACKGROUND: Systemic inflammation is hypothesized to contribute to post-traumatic stress disorder (PTSD) vulnerability. Few studies have examined inflammation shortly after trauma as a predictor of later PTSD symptoms. We examined whether inflammation from the emergency department (ED) post-trauma is associated with PTSD symptom severity over the following 6 months.

METHODS: Our sample included 742 AURORA participants, a longitudinal cohort of patients in 29 EDs across the United States after a traumatic stressor, followed up to 6 months. Plasma cytokines were assessed from a study blood draw in the ED: an inflammatory index (standardized sum of generally pro-inflammatory markers interleukin [IL]-6, …

From Clinical Observation To Scholarly Question Academic Curiosity As A Professional Virtue In Emergency Medicine Introducing The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (Moccs) Model, James Espinosa, Alan A. Lucerna

Rowan-Virtua Research Day

Emergency Medicine generates continuous clinical observations, yet many potentially meaningful insights never progress beyond informal reflection. This poster reframes every day shift observations as the ecological foundation of scholarly inquiry. Conceptual Framework: We propose a simple, repeatable process to lower the activation energy for academic engagement The Mindful Observation → Curious Inquiry → Clinical Structuring → Scholarly Sharing (MOCCS) Model. This model centers disciplined noticing as a professional virtue. By naming and normalizing the “hmmm” and “huh?” moments, this approach validates frontline clinical wisdom, democratizes scholarly participation, and restores intellectual joy within high-stress clinical environments. Conclusion: Curiosity is not hierarchical. …

The Neurobiology Of Interruptions In Emergency Medicine: The Case For Informed Interruption Management In Support Of Cognitive Stability In High-Reliability Clinical Environments, James Espinosa, Henry Schuitema, Alan Lucerna

Rowan-Virtua Research Day

Background: Interruptions are ubiquitous in Emergency Departments (EDs) and have been associated with task delay, multitasking, and increased error risk. While operational and human-factors impacts are well described, the underlying neurocognitive mechanisms remain underexplored. Not all interruptions are avoidable.  However,  interruptions in emergency medicine represent neurocognitive destabilization events that can degrade task representation and increase vulnerability to error during task resumption. Recognizing the neural mechanisms underlying interruptions reframes their management as a systems-level patient safety priority. The aim is not elimination of clinically necessary communication, but thoughtful reduction, prioritization, and design that protects cognitive stability.

Objective: To synthesize cognitive neuroscience …

Protecting The Protectors: Supporting Emergency Department Security Officer Wellness: A Brief Conceptual Review And Research Agenda, James A. Espinosa Md, Paul Sarnese, Alan Lucerna

Rowan-Virtua Research Day

Background: Workplace violence in emergency departments (EDs) has been widely studied, yet the occupational wellness of ED security officers has received comparatively limited focused attention in emergency medicine literature.

Objective: To conceptually examine the role of ED security personnel within the emergency care environment and outline a research agenda addressing their wellness.

Discussion: Security officers frequently respond to behavioral crises, assist with restraint events, and help maintain safety for patients, visitors, and staff. These duties include vigilance between events, sudden physical exertion, and exposure to aggression. ED security work often follows a recognizable rhythm: baseline vigilance, rapid escalation response, physical …

Wildfires And Emergency Department Respiratory Surge: Brief Review, Systems Forecasting Implications And Recommendations For Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Wildfire smoke produces abrupt increases in PM2.5 and Air Quality Index (AQI) levels. Event-based and multi-season studies demonstrate short-term increases in asthma-related Emergency Department (ED) visits, with additional evidence supporting increased utilization for broader respiratory disease and chronic lower respiratory disease (including COPD) (Reid et al., 2016; Liu et al., 2015; Stowell et al., 2025; CDC, 2023).

Objective: To synthesize current evidence linking wildfire smoke to ED respiratory surge and to propose a systems forecasting model that translates environmental signals into structured operational stabilization within a complex adaptive system (CAS).

Methods (Review & Model Development): Narrative synthesis of event-based …

Soundscapes (Ambient Sound, Noise, Music And Other Background Sound) In The Emergency Department: An Under-Theorized Environmental Modifier In A Complex Adaptive System, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background:

Music and ambient sound (including noise and other sounds) are frequently present in emergency departments (EDs), yet their role as environmental modifiers remains under-theorized. Existing literature largely examines background music, for example,  in procedural or perioperative contexts, with limited attention to open, high-density, multi-agent acute care systems.

Objective:

To conceptualize auditory input as a dynamic environmental variable within the ED viewed as a Complex Adaptive System (CAS), integrating neurobiological mechanisms with systems-level implications.

Methods/Conceptual Approach: Narrative conceptual synthesis integrating neurobiology of auditory processing, affective neuroscience, cognitive load theory, and complexity science.

Results:

Conceptual Insights: Auditory stimuli engage distributed neural …

Identifying And Generalizing Best Attending Teaching Practices: A Proposal For The Use Of Appreciative Inquiry To Enhance Emergency Medicine Residency Teaching Practices, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Teaching in the Emergency Department (ED) occurs within a complex adaptive system characterized by time pressure, interruptions, and high cognitive load. Studying what works well in clinical teaching , even in such a challenging  environment for  teaching, may reveal reproducible patterns that strengthen educational culture, enhance resident learning, and accelerate the development of teaching expertise. In complex clinical environments, excellence is often present but under-recognized; An approach called Appreciative Inquiry provides a structured method for making it visible.

Conceptual Framework

Appreciative Inquiry (AI) offers an alternative approach by systematically studying successful practices rather than failures. AI explores how and …

Conceptualizing The Transition From Stable Operations To Turbulent States : Reframing Emergency Department Operations. Learning From Fluid Dynamics And Complexity Science, James Espinosa, David Ho, Alan Lucerna

Rowan-Virtua Research Day

Background: Emergency departments are frequently described using the language of patient flow, implying  smooth and predictable movement of patients through a system versus known obstructions to flow.  Clinicians, however, often observe abrupt shifts in operational stability.

Objective: To explore whether concepts from fluid dynamics and complexity science offer a useful framework for understanding these transitions.

Methods: Conceptual synthesis drawing on emergency medicine operations research, human factors, systems science, and fluid mechanics.

Results (Conceptual): Emergency departments exhibit behaviors analogous to systems approaching turbulence, including sensitivity to perturbation, amplification of delays, and nonlinear responses.

Conclusion: Viewing ED operations through the lens of …

A Systems Perspective On Workstation Ergonomic Principles And Their Application In Emergency Care Environments, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background: Workstation ergonomic principles are commonly included in mandatory healthcare training programs. These recommendations—monitor height relative to eye level, neutral arm positioning, and adjustable seating—derive largely from occupational ergonomics literature designed to reduce musculoskeletal strain and improve comfort during computer work. Emergency Departments (EDs), however, represent dynamic environments with shared workstations and workflow interruptions that may influence the implementation of these recommendations.

Objective: To summarize the evidence supporting commonly taught workstation ergonomic principles and frame them within a systems perspective of ED work environments.

Methods: Narrative review of occupational ergonomics guidelines, ergonomic intervention studies, and human factors literature relevant to …

The Ed Is Inherently Interleaved: The Learning Theory Case For Hybrid Resident Conference Curriculum Design In Emergency Medicine: Block For Onboarding And For Specialized Topics With Predominant Interleaving For Intermediate And Advanced Residents, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Emergency medicine (EM) training occurs within a clinical environment characterized by rapid context switching, diagnostic uncertainty, and frequent transitions between unrelated clinical problems. Didactic curricula that rely only on block-based topic organization may not fully reflect the cognitive demands of real emergency department practice.

Objective

To propose a developmentally adaptive hybrid model of EM curricular design that integrates early block learning during the onboarding phase of new residents, progressing to a general approach of interleaved learning. Specialized topics,  can be introduced using block learning at any time during the residency years.

Methods / Conceptual Approach

This conceptual educational model …

Reframing Emergency Medicine (And Healthcare) Wellness Measures: The Case For Adding Measures Of Physiological Sustainability, Exercise, Restoration, And Meaning, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Background

Physician wellness measurement in Emergency Medicine (EM) in particular and in healthcare in general has largely focused on identifying distress states such as emotional exhaustion and depersonalization. Instruments such as the Maslach Burnout Inventory and related derivative surveys have been well-validated and  have played a central role in identifying the scope of burnout across healthcare systems.

Conceptual Framing

While current measures of distress are essential, they may not fully characterize the spectrum of clinician health. In many fields outside healthcare—including occupational health, resilience research, and positive psychology—assessment of well-being includes behaviors and experiences associated with sustained health, such as …

Reframing The Ed–Hospitalist Admission As A Clinical Handoff: The Ed To Hospital Admission As A Cross-System Handoff In A Complex Adaptive Clinical Environment. The Case For Systems Approaches To Enhance Safe And Effective Transitions Across A True System Interface, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Background

Transitions from the Emergency Department (ED) to hospital medicine represent a high-stakes clinical handoff across systems. While often experienced as challenging, these interactions are better understood as occurring between services operating under different cognitive loads, operational priorities, and time horizons. Reframing the ED–hospitalist admission as a structured handoff aligns this process with broader patient safety efforts.

Objective

To characterize the ED–hospitalist admission as a cross-system clinical handoff and to identify practical strategies that enhance safety, clarity, and alignment during this transition.

Methods

Conceptual analysis informed by clinical experience, systems theory, and teaching observations. Key domains of potential misalignment were …

Mental Health Vs Substance Misuse: Predicting Restraint Use In The Emergency Department, Chloe Lafosse Bs, Michael Witt Md, Mph

Rowan-Virtua Research Day

Introduction: Violence in the emergency department affects approximately 30% of hospital staff every 6 months. Presenting complaints may contribute to violence risk, particularly in those with mental health or substance misuse issue where there are heightened risks of cognitive impairment and involuntary holds.

Methods: We conducted a systematic review of literature published between 1957-2025 using multiple databases, identifying studies that observed physical restraint use on adult emergency department patients. All relevant data was recorded and imputed into SPSS for a chi-square test.

Results: Thirteen studies (2019-2025) met inclusion criteria, with sample sizes ranging from 58 to 1,035,522 participants. All studies …

Myxedema Coma: Recognizing A Silent But Potentially Fatal Emergency, Aashna Chaudhry, Robin Lahr, James Espinosa, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Myxedema coma is an endocrinologic emergency that requires prompt recognition and treatment. It is described as severe hypothyroidism characterized by life-threatening slowing of metabolic processes, often occurring in the setting of precipitating factors such as trauma, infection, medications, or cold exposure. This case report presents a clinical case in which early suspicion of myxedema coma in an elderly female patient led to prompt treatment and life-saving measures.

Reducing Pharmacy Callbacks And Improving Workflow Efficiency In The Emergency Department: A Quality Improvement Initiative, Philip .. Carhart, Hannah Culleny, Alexis Schuitema, James Espinosa, Robin Lahr, Sergey Medlenov, Gabriel Meister, Alan Lucerna

Rowan-Virtua Research Day

A simple educational intervention combined with structured provider feedback reduced ED pharmacy callbacks by 86%. While individual call duration remained unchanged, the reduction translated into nearly eight hours of provider time saved annually. This study highlights the impact of targeted quality improvement efforts on: • Workflow efficiency • Interprofessional communication • Patient care reliability. Small systems interventions can produce disproportionate operational benefits.

Shopping Cart–Related Injuries In Children: Brief Clinical Review And Public Health Implications, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Shopping cart–related injuries represent a common yet underrecognized mechanism of pediatric trauma. National estimates suggest approximately 24,000 children annually are treated in U.S. emergency departments for shopping cart–related injuries, with falls accounting for the majority of cases. Younger children, particularly those under 5 years of age, are disproportionately affected, and head and facial injuries predominate.

Objective:

To provide a concise clinical and public health review of shopping cart–related pediatric injuries, with emphasis on epidemiology, injury patterns, and opportunities for prevention within emergency department practice.

Methods

Narrative review of national injury surveillance data, prior epidemiologic studies, and consumer safety guidance addressing …

Hydration During Emergency Medicine Shifts: An Overlooked Component Of Cognitive Performance, Well-Being, And Systems Design To Fail To Plan For Shift Hydration Is To Plan To Fail With Shift Hydration, James Espinosa, Alan Lucerna, Swet Patel, Robin Lahr, Sergey Medlenov, Adam Kandil, Frank Wheeler, Wayne Tamaska, James Lee, Neel Parikh, Henry Schuitema

Rowan-Virtua Research Day

Emergency Medicine (EM) clinicians work prolonged, cognitively demanding shifts in environments characterized by unpredictability, interruptions, and high decision density. While fatigue, burnout, and circadian disruption have been widely studied, hydration during active clinical shifts has received little focused attention. Evidence from cognitive, military, and sports physiology literature demonstrates that even mild dehydration can impair attention, working memory, mood, and reaction time. Despite these findings, hydration in Emergency Medicine is typically treated as an individual behavior rather than a systems-level design consideration. This review synthesizes relevant physiologic and performance literature, identifies cultural and structural barriers to hydration during EM shifts, and …

Learning From Our Dental Colleagues: A Brief Review Of Counter-Stimulation To Reduce Procedural Pain In Emergency Medicine Mechanisms, Existing Evidence, And A Pragmatic Research Agenda, James Espinosa, Neal Appelstein, Alan Lucerna

Rowan-Virtua Research Day

Counter-stimulation techniques such as tapping, pressure, vibration, and tissue shaking are commonly observed in dental practice during administration of local anesthetic nerve blocks. Although not systematically described in the Emergency Medicine literature, individual clinicians may employ tactile counter-stimulation techniques during needle-based procedures. The practice remains under-theorized and under-studied within the Emergency Medicine literature. This brief review synthesizes mechanistic neurobiology—including segmental gate control theory (Melzack & Wall, 1965), descending inhibitory modulation, and attentional salience models—with evidence from dental and needle-procedure research. We propose a practical taxonomy of counter-stimulation techniques applicable to Emergency Medicine and identify gaps in the current literature. Finally, …

The Complex World Of Emergency Department Medication Dosing: Weight Scalars, Dose And Area Under The Curve (Auc) In Medication Dosing--Areas For Future Research, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Weight-based dosing is foundational to emergency medicine practice. With modern ED beds capable of automatic patient weighing, inaccuracies in estimated weight have largely diminished. However, medication misalignment persists, particularly in patients at extremes of body weight and in high-stakes clinical contexts such as rapid sequence intubation (RSI), antimicrobial therapy, and anticoagulation. Emerging pharmacokinetic literature emphasizes total drug exposure—represented by the area under the concentration–time curve (AUC)—as a stronger correlate of efficacy and toxicity than single-point serum levels. This review explores where weight precision most likely matters in the ED, examines weight scalars, and reframes dosing decisions through an exposure-centered paradigm. …