Creating Consensus: Revisiting the Emergency Medicine Resident Scholarly Activity Requirement.

INTRODUCTION: In the context of the upcoming single accreditation system for graduate medical education resulting from an agreement between the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association and American Association of Colleges of Osteopathic Medicine, we saw the opportunity for charting a new course for emergency medicine (EM) scholarly activity (SA). Our goal was to engage relevant stakeholders to produce a consensus document. METHODS: Consensus building focused on the goals, definition, and endpoints of SA. Representatives from stakeholder organizations were asked to help develop a survey regarding the SA requirement. The survey was then distributed to those with vested interests. We used the preliminary data to find areas of concordance and discordance and presented them at a consensus-building session. Outcomes were then re-ranked. RESULTS: By consensus, the primary role(s) of SA should be the following: 1) instruct residents in the process of scientific inquiry; 2) expose them to the mechanics of research; 3) teach them lifelong skills, including search strategies and critical appraisal; and 4) teach them how to formulate a question, search for the answer, and evaluate its strength. To meet these goals, the activity should have the general elements of hypothesis generation, data collection and analytical thinking, and interpretation of results. We also determined consensus on the endpoints, and acceptable documentation of the outcome. CONCLUSION: This consensus document may serve as a best-practices guideline for EM residency programs by delineating the goals, definitions, and endpoints for EM residents' SA. However, each residency program must evaluate its available scholarly activity resources and individually implement requirements by balancing the ACGME Review Committee for Emergency Medicine requirements with their own circumstances.

Systemic lupus erythematosus following meningococcal vaccination.

Systemic erythematosus lupus (SLE) affects multiple organs and involves complex immune dysfunction. Because vaccinations are inherently designed to stimulate the immune response, they have been linked with increased risk for flare of SLE and other autoimmune disorders, and their association with new-onset autoimmune disease has been postulated in several case reports. To our knowledge, this is the first reported case of the meningococcal vaccine precipitating SLE in a previously undiagnosed patient. We present a case of a previously healthy, 17 year old Asian female who presented to the ED with 14 days of fever and fatigue after administration of the meningococcal vaccine, as well as 5 days of facial rash. Initial labs showed pancytopenia, bandemia, proteinuria, elevated erythrocyte sedimentation rate, and elevated d-dimer. Both the antinuclear antibodies (ANA) and anti-double stranded DNA were positive and cervical lymphadenopathy was present. This case highlights the importance of considering acute autoimmune reactions such as SLE in the differential diagnosis when assessing previously healthy patients presenting with systemic symptoms such as fever and rash in the setting of recent vaccination.