Catherine A Marco

Wright State University, Dayton, Ohio, United States

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Publications (93)245.52 Total impact

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    ABSTRACT: The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to US emergency physicians, emergency nurses and other stakeholders in the healthcare system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to US emergency departments in how they approach preparation for and management of potential patients with EVD. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
    Academic Emergency Medicine 03/2015; 41(2):e5-e16. DOI:10.1016/j.jen.2015.01.012 · 2.20 Impact Factor
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    ABSTRACT: Ambulance diversion is a common and controversial method used by emergency departments (EDs) to reduce stress on individual departments and providers and relieve mismatches in the supply and demand for ED beds. Under this strategy, ambulances bound for one hospital are redirected to another, usually under policies established by regional emergency medical services systems. Other responses to this mismatch include maladaptive behaviors (such as "boarding" in "hallway beds") and the development of terminology intended to normalize these practices, all of which are reviewed in this article. We examine the history and causes of diversion as well as the ethical foundations and practical consequences of it. We contend that (1) from a moral viewpoint, the most important stakeholder is the individual patient because diversion decisions are usually relative rather than absolute; (2) decisions regarding ambulance diversion should be made with careful consideration of individual patient preferences, local and state emergency medical services laws, and institutional surge capacity; and (3) authorities should consider the potential positive effects of a regional or statewide ban on diversion. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Journal of Emergency Medicine 12/2014; DOI:10.1016/j.ajem.2014.12.002 · 1.15 Impact Factor
  • Catherine A Marco, Terry Kowalenko
    American Journal of Emergency Medicine 12/2014; DOI:10.1016/j.ajem.2014.11.037 · 1.15 Impact Factor
  • Jeffrey Kline, Catherine A. Marco
    Academic Emergency Medicine 11/2014; 21(12). DOI:10.1111/acem.12519 · 2.20 Impact Factor
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    ABSTRACT: Objectives The initial step in certification by the American Board of Emergency Medicine (ABEM) requires passing a multiple-choice-question qualifying examination. The qualifying examination is typically taken in the first year after residency training. This study was undertaken to determine if a delay in taking the qualifying examination is associated with poorer performance. The authors also examined the relationship between in-training examination scores and qualifying examination scores.Methods This was a pooled time-series cross-section study. Primary measurements were initial qualifying examination scores, the timing of the qualifying examination, and in-training examination scores. The three groups, based on qualifying examination timing, were immediate, 1-year delay, and ≥2-year delay. In-training examination scores were analyzed to determine the relationship between intrinsic ability, examination timing, and qualifying examination scores. For analysis, a generic pooled ordinary least-squares dummy variable model with robust standard errors was used. A pre hoc level of significance was determined to be α < 0.01.ResultsThere were 16,353 qualifying examination test administrations between 2000 and 2012. In-training examination scores were positively correlated with qualifying examination scores (p < 0.001). The group pass rates were 98.9% immediate, 95.6% 1-year delay, and 86.6% ≥2-year delay. After controlling for in-training examination scores, delay taking the qualifying examination of 1 year was associated with a decrease in score of –0.6 (p = 0.003). A delay in taking the qualifying examination ≥2 years was associated with a decrease in score of –2.5 points (p < 0.001).Conclusions After accounting for innate ability using in-training examination scores, delay taking the qualifying examination was associated with poorer performance. This effect was more pronounced if the delay was ≥2 years.ResumenObjetivosEl paso inicial en la certificación por la American Board of Emergency Medicine (ABEM) requiere aprobar un examen de cualificación (EC) de preguntas de elección múltiple. El EC se realiza habitualmente en el primer año tras la formación de la residencia. Este estudio se llevó a cabo para determinar si un retraso en la realización del EC está asociado con un peor rendimiento. También se examinó la relación entre las puntuaciones del examen durante la formación (EDF) y las puntuaciones del EC.MetodologíaEstudio transversal de series temporales sumatorias. Las mediciones principales fueron las puntuaciones iniciales del EC, el momento del EC y las puntuaciones del EDF. Los tres grupos, basados en el momento del EC fueron: inmediato, un año de retraso y 2 o más años de retraso. Se analizaron las puntuaciones del EDF para determinar la relación entre la capacidad intrínseca, el tiempo del examen y las puntuaciones del EC. Para el análisis, se utilizó un modelo variable de mínimos cuadrados ordinarios sumatorio genérico con errores estándar robustos. Se determinó un nivel de significación pre hoc de α < 0,01.ResultadosHubo 16.353 EC entre el 2000 y el 2012. Las puntuaciones del EDF se correlacionaron positivamente con las puntuaciones del EC (p < 0,001). La proporción de aprobados de cada grupo fue: 98,9% para el grupo inmediato, 95,6% para 1 año de retraso y 86,6% para 2 o más años de retraso. Tras ajustar por las puntuaciones de EDF, el retraso del EC un año se asoció con un descenso en la puntuación de -0,6 (p = 0,003). Un retraso de realización del EC de 2 o más años se asoció con descenso en la puntación de -2,5 puntos (p < 0,001).ConclusionesTras tener en cuenta las capacidades innatas mediante las puntuaciones del EDF, el retrasar la realización del EC se asoció con un peor rendimiento. Este efecto fue más pronunciado si el retraso fue ≥ a 2 años.
    Academic Emergency Medicine 06/2014; 21(6). DOI:10.1111/acem.12391 · 2.20 Impact Factor
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    ABSTRACT: Background: Night shift work is an integral component of the practice of emergency medicine (EM). Previous studies have demonstrated the challenges of night shift work to health and well being among health care providers. Objective: This study was undertaken to describe the self-reported experience of emergency physicians regarding night shift work with respect to quality of life and career satisfaction. Methods: The 2008 American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) was administered by mail to 1003 ABEM diplomates. Results: Among 819 participants in the 2008 LSEP Physician Survey, most participants responded that night shift work negatively influenced job satisfaction with a moderate or major negative influence (58%; n = 467/800). Forty-three percent of participants indicated that night shifts had caused them to think about leaving EM (n = 344/809). Most participants responded that working night shifts has had mild negative effects (51%; n = 407/800) or major negative effects (9%; n = 68) on their health. Respondents were asked to describe how working night shifts has affected their health. Common themes included fatigue (36%), poor quality of sleep (35%), mood decrement/irritability (29%), and health maintenance challenges (19%). Among participants in the 2008 LSEP Retired Physician Survey, night shifts were a factor in the decision to retire for 56% of participants. Conclusions: Emergency physicians report negative impacts of night shift work, including fatigue, poor quality of sleep, mood decrement, irritability, and health challenges. Night shifts have a negative influence on job satisfaction and can be a factor in the decision to retire. (C) 2014 Elsevier Inc.
    Journal of Emergency Medicine 05/2014; 47(3). DOI:10.1016/j.jemermed.2014.04.020 · 1.18 Impact Factor
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    ABSTRACT: In 2001, “The Model of the Clinical Practice of Emergency Medicine” was first published. This document, the first of its kind, was the result of an extensive practice analysis of emergency department (ED) visits and several expert panels, overseen by representatives from six collaborating professional organizations (the American Board of Emergency Medicine, the American College of Emergency Physicians, the Society for Academic Emergency Medicine, the Residency Review Committee for Emergency Medicine, the Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association). Every 2 years, the document is reviewed by these organizations to identify practice changes, incorporate new evidence, and identify perceived deficiencies. For this revision, a seventh organization was included, the American Academy of Emergency Medicine.ResumenEn 2001 se publicó por primera vez el “Modelo de Práctica Clínica de la Medicina de Urgencias y Emergencias.” Este documento, el primero de su tipo, fue el resultado de un extenso análisis práctico de las visitas al servicio de urgencias y varios grupos de expertos, supervisado por los representantes de seis organizaciones profesionales colaboradoras (la American Board of Emergency Medicine, el American College of Emergency Physicians, la Society for Academic Emergency Medicine, el Residency Review Committee for Emergency Medicine, el Council of Emergency Medicine Residency Directors y la Emergency Medicine Residents' Association). Cada dos años, se revisa el documento por estas organizaciones para identificar los cambios en la práctica clínica, incorporar nueva evidencia e identificar las deficiencias percibidas. En esta revisión, se incluye una séptima organización, la American Academy of Emergency Medicine.
    Academic Emergency Medicine 05/2014; 21(5). DOI:10.1111/acem.12373 · 2.20 Impact Factor
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    ABSTRACT: The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency programs and the residents in them. We present the 2014 annual report on the status of US emergency medicine training programs.
    Annals of Emergency Medicine 05/2014; 63(5):637-645. DOI:10.1016/j.annemergmed.2014.03.008 · 4.33 Impact Factor
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    ABSTRACT: Objectives The American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program is a four-step process that includes the Continuous Certification (ConCert) examination. The ConCert examination is a validated, summative examination that assesses medical knowledge and clinical reasoning. ABEM began administering the ConCert examination in 1989. The ConCert examination must be passed at least every 10 years to maintain certification. This study was undertaken to determine longitudinal physician performance on the ConCert examination.Methods In this longitudinal review, ConCert examination performance was compared among residency-trained emergency physicians (EPs) over multiple examination cycles. Longitudinal analysis was performed using a growth curve model for unbalanced data to determine the growth trajectories of EP performance over time to see if medical knowledge changed. Using initial certification qualifying examination scores, the longitudinal analysis corrected for intrinsic variances in physician ability.ResultsThere were 15,085 first-time testing episodes from 1989 to 2012 involving three examination cycles. The mean adjusted examination scores for all physicians taking the ConCert examination for a first cycle was 85.9 (95% confidence interval [CI] = 85.8 to 85.9), the second cycle mean score was 86.2 (95% CI = 86.0 to 86.3), and the third cycle was 85.4 (95% CI = 85.0 to 85.8). Using the first examination cycle as a reference score, the growth curve model analysis resulted in a coefficient of +0.3 for the second cycle (p < 0.001) and –0.5 for the third cycle (p = 0.02). Initial qualifying (written) examination scores were significant predictors for ConCert examination scores.Conclusions Over time, EP performance on the ConCert examination was maintained. These results suggest that EPs maintain medical knowledge over the course of their careers as measured by a validated, summative medical knowledge assessment.ResumenObjetivosEl programa de mantenimiento de certificación (MC) de la American Board of Emergency Medicine (ABEM) es un proceso de cuatro pasos que incluye el examen de certificación continuada (continuous certification, ConCert). El ConCert es un examen sumatorio y validado que valora el conocimiento y el razonamiento clínico médico. La ABEM comenzó a realizar el examen ConCert en 1989. El ConCert debe ser aprobado al menos cada diez años para mantener la certificación. Este estudio se llevó a cabo para determinar el rendimiento del médico en el examen ConCert a lo largo del tiempo.MetodologíaEn esta revisión longitudinal, el rendimiento del examen ConCert se comparó entre los médicos de urgencias y emergencias (MUE) formados en el programa de residencia a lo largo de múltiples periodos de examen. Se realizó un análisis longitudinal mediante un modelo de curva de crecimiento (MCC) para datos no balanceados para determinar las trayectorias de crecimiento del rendimiento del MUE a lo largo del tiempo para ver si el conocimiento médico había cambiado. Con las puntuaciones iniciales del examen ConCert, el análisis longitudinal se ajustó por las varianzas intrínsecas en la habilidad del médico.ResultadosHubo 15.085 episodios de exámenes por primera vez desde 1989 a 2012, que incluían tres ciclos de examen. La media ajustada de las puntuaciones del examen para todos los médicos que realizaron el examen ConCert para un primer ciclo fue 85,9 (IC 95% = 85,8 a 85,9); la media de puntuación del segundo ciclo fue de 86,2 (IC 95% = 86,0 a 86,3); y la del tercer ciclo fue de 85,4 (IC 95% = 85,0 a 85,8). Usando el primer ciclo de examen como referencia de puntuación, el análisis de los MCC resultó en un coeficiente de +0.3 para el segundo ciclo (p<0,001), y de -0,5 para el tercer ciclo (p = 0,02). Las puntuaciones del examen (escrito) de cualificación inicial fueron predictivas de forma significativa para las puntuaciones del examen ConCert.ConclusionesA lo largo del tiempo, el rendimiento de los MUE en el examen ConCert se mantuvo. Estos resultados indican que los MUE mantienen el conocimiento médico durante el curso de sus carreras profesionales cuando se mide mediante una evaluación del conocimiento médico acumulado.
    Academic Emergency Medicine 05/2014; 21(5). DOI:10.1111/acem.12378 · 2.20 Impact Factor
  • The American journal of emergency medicine 10/2013; 32(2). DOI:10.1016/j.ajem.2013.10.041 · 1.15 Impact Factor
  • Annals of Emergency Medicine 10/2013; 62(4):S138. DOI:10.1016/j.annemergmed.2013.07.211 · 4.33 Impact Factor
  • Annals of Emergency Medicine 10/2013; 62(4):S23. DOI:10.1016/j.annemergmed.2013.07.343 · 4.33 Impact Factor
  • Hemangini C Bhakta, Catherine A Marco
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    ABSTRACT: Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions.
    Journal of Emergency Medicine 07/2013; 46(4). DOI:10.1016/j.jemermed.2013.04.018 · 1.18 Impact Factor
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    ABSTRACT: BACKGROUND: The Model of the Clinical Practice of Emergency Medicine is the basis for the content specifications of all American Board of Emergency Medicine (ABEM) examinations. This study describes the frequency with which ABEM diplomates diagnose and manage the conditions and components listed in the Model of the Clinical Practice of Emergency Medicine. OBJECTIVES: The objectives of this study were to determine the frequency with which ABEM diplomates diagnose and manage the conditions and components described in the Model of the Clinical Practice of Emergency Medicine. METHODS: The listing of conditions and components of the Model of the Clinical Practice of Emergency Medicine were sent to 16,230 randomly selected ABEM diplomates. One of five surveys was sent to each diplomate. Each condition and component was assessed by participants for the frequency that emergency physicians diagnose (D) and manage (M) that condition, as seen in their practice of Emergency Medicine. RESULTS: Of the 16,230 surveys sent, 5006 were returned (30.8% response rate). The genders of the respondents were 75% male and 24% female. The ages of the respondents were primarily in the age 40-49 years, and 30-39 years age groups. All categories of the listing of conditions and components of the Model of the Clinical Practice of Emergency Medicine were encountered frequently in the practice of Emergency Medicine, as indicated by study participants. CONCLUSIONS: A survey of practicing ABEM diplomates was useful in defining the frequency with which specific conditions and components are diagnosed and managed in the practice of Emergency Medicine.
    Journal of Emergency Medicine 03/2013; 44(6):1153-1166. DOI:10.1016/j.jemermed.2012.11.089 · 1.18 Impact Factor
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    ABSTRACT: The 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM) addressed various issues, including that of ethics in medical education research for EM. Education research in EM is essential to patient care and safety, and with recent advances in simulation and the advent of the Milestones project, it will become even more vital. Education research in EM is guided by the same principles that guide the ethical conduct of all human subjects' research: respect for persons, beneficence, and justice. Regulatory provisions and widely accepted ethical standards provide a framework for research in EM education; however, special considerations exist for education research. To ensure patient and trainee safety and to maintain the integrity of new knowledge, ethical considerations should remain at the forefront of EM education research. For EM education researchers, recognition of the vulnerability of residents, medical students, and others as research subjects is paramount. This article fills an important gap by outlining the principles guiding education research in EM, exploring the ethical challenges and approaches to education research, and offering a framework and future directions for the ethical conduct of education research in EM.
    Academic Emergency Medicine 12/2012; DOI:10.1111/acem.12019 · 2.20 Impact Factor
  • Catherine A Marco, Terry Kowalenko
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    ABSTRACT: BACKGROUND: The American Board of Emergency Medicine conducts an annual survey of residents in Emergency Medicine, the Longitudinal Study of Residents in Emergency Medicine survey. Objective: This study was undertaken to describe self-reported competence and challenges facing Emergency Medicine (EM) residents. METHODS: In this descriptive, observational analysis of the Longitudinal Study of Residents in Emergency Medicine survey, survey data from 1996-2008 were compared for 70 survey items. Responses were analyzed with means and 95% confidence intervals by post-graduate year (PGY) and over time. RESULTS: A total of 496 residents were included in this study. Most participated for 3 years, for a total of 1320 total responses. The most serious day-to-day challenges reported by residents (overall median scores of 3 or more) included knowing enough, keeping up with the medical literature, having enough time for personal life, ancillary support, and having enough time for family. Current level of competence in areas deemed weakest by residents included grant writing, contract negotiation, academic writing, disaster planning, research, and financial management. Residents reported improved competence in most (15 out of 16) areas from PGY-1 to PGY-3 year of training. Resident reports of competence did not change significantly over time from 1998-2008 (15 out of 16 items). CONCLUSIONS: Emergency Medicine residents identified several important day-to-day problems, including knowing enough, keeping up with the medical literature, and having enough time for a personal life. PGY-3 residents reported improved competence in almost all aspects of EM work and clinical EM as compared to PGY-1 residents. Knowledge of perceived competence and problems among EM residents is crucial to the development of improved educational approaches to address these issues.
    Journal of Emergency Medicine 08/2012; 43(6). DOI:10.1016/j.jemermed.2012.05.033 · 1.18 Impact Factor
  • Catherine A Marco, William Kanitz, Matthew Jolly
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    ABSTRACT: BACKGROUND: Treatment for pain and pain-related conditions has been identified as the most common reason for Emergency Department (ED) visits. OBJECTIVE: This study was undertaken to characterize the distribution of self-reported pain scores for common ED diagnoses. METHODS: In this retrospective exploratory chart review, eligible participants included all adult ED patients age 18 years and over, with a self-reported triage pain score of 1 or higher during January-June 2011. Data were collected from ED electronic medical records. RESULTS: Among 1229 patients, the mean age was 44 years; 56% of patients were female, and 59% were white. The mean triage pain score for all patients was 7.1 (interquartile range 6-9). The most common reported diagnoses included: minor injuries (10%), abdominal pain (8%), and respiratory infections (8%). The diagnoses with the highest mean pain scores were: sickle cell crisis (mean pain score 8.7), back/neck/shoulder pain (8.5), and headache/migraine (8.3). Higher pain scores were significantly correlated with younger age (p<0.001) and number of ED visits (p<0.001). Demographic factors including female gender, African American race, and Medicaid insurance reported significantly higher pain scores (p<0.001). Patients with multiple ED visits in the recent 12 months reported significantly higher pain scores (p<0.001). CONCLUSION: ED patients report a wide variety of pain scores. Factors associated with higher pain scores included younger age, female gender, African American race, Medicaid insurance status, multiple ED visits in the past year, and ED diagnoses of sickle cell crisis, back/neck/shoulder pain, and headache.
    Journal of Emergency Medicine 07/2012; 44(1). DOI:10.1016/j.jemermed.2012.05.002 · 1.18 Impact Factor
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    ABSTRACT: The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents in those programs. We present the 2015 annual report on the status of US emergency medicine training programs. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
    Annals of emergency medicine 05/2012; 59(5):416-24. DOI:10.1016/j.annemergmed.2012.03.014 · 4.33 Impact Factor
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    ABSTRACT: The recent enactment of the Patient Protection and Affordable Care Act (ACA) of 2010, and the ongoing debate over reform of the U.S. health care system, raise numerous important ethical issues. This article reviews basic provisions of the ACA; examines underlying moral and policy issues in the U.S. health care reform debate; and addresses health care reform's likely effects on access to care, emergency department (ED) crowding, and end-of-life care. The article concludes with several suggested actions that emergency physicians (EPs) should take to contribute to the success of health care reform in America.
    Academic Emergency Medicine 04/2012; 19(4):461-8. DOI:10.1111/j.1553-2712.2012.01313.x · 2.20 Impact Factor
  • Annals of Emergency Medicine 10/2011; 58(4). DOI:10.1016/j.annemergmed.2011.06.170 · 4.33 Impact Factor

Publication Stats

866 Citations
245.52 Total Impact Points

Institutions

  • 2014–2015
    • Wright State University
      • Department of Emergency Medicine
      Dayton, Ohio, United States
    • American Osteopathic Board of Emergency Medicine
      East Lansing, Michigan, United States
    • American Board of Emergency Medicine
      Ист-Лансинг, Michigan, United States
  • 2008–2014
    • University of Toledo
      Toledo, Ohio, United States
  • 2000–2013
    • Medical University of Ohio at Toledo
      • Department of Surgery
      Toledo, Ohio, United States
  • 2010
    • Christian Medical College & Hospital
      Ludhiana, Punjab, India
    • University of California, Davis
      Davis, California, United States
  • 1995–2009
    • Johns Hopkins Medicine
      • Department of Emergency Medicine
      Baltimore, Maryland, United States
  • 2000–2008
    • Mercy St. Vincent Medical Center
      Toledo, Ohio, United States
  • 2005
    • East Carolina University
      • The Bioethics Center
      Greenville, NC, United States
  • 1994–1999
    • Johns Hopkins University
      • Department of Emergency Medicine
      Baltimore, Maryland, United States