The health of a population depends upon several factors, including disease, public health initiatives, and the social determinants of health (SDH). These factors often converge in the emergency department (ED) where the impact of social conditions such as homelessness, low-literacy, and poverty lead to recidivism and may contribute to provider burnout. Inclusion of SDH topics in EM residency curricula can provide needed background information and effective strategies for coping with these patients in the clinical setting. Exercises that simulate poverty, the development of and familiarity with meaningful community partnerships, and inclusion of SDH topics in standard ED conferences (e.g., mortality and morbidity conference) can promote understanding and outline a detailed plan for treating patients facing these challenges. By incorporating educational interventions aimed at identifying and intervening on issues of SDH in the ED we may be able to better serve those patients who need us the most.

Individualized interactive instruction provides an opportunity for significant innovation and advances in curriculum design. We describe the development and implementation of virtual small group exercises into the curriculum of an emergency medicine residency training program using a free social media and communication platform (Slack). Two virtual small group exercises, one case-based and one open-ended, were trialed during the 2016 to 2017 academic year. We found that the exercises were feasible to implement in a learner group where 66% (41/ 62) had little or no prior experience with Slack. There was a trend toward a more favorable rating of the quality of the dialogue and of the task-technology fit for the case-based format as opposed to the open-ended educational activity.

In 2008, 1.6 million new cases of lung cancer were diagnosed worldwide, representing 13% of all cancer cases for the year, and in 2010, 19% of cancer deaths were attributed to lung cancer. Though lung cancer frequently metastasizes to the adrenal glands, bone, brain, liver, and other lung, it infrequently metastasizes to the heart. Here, we report a case of lung cancer metastatic to the mitral valve.