The acute phase of COVID-19 was a time of cultural magnification and transformation in emergency medicine. It was a time when we could see who we are, recognized what aligned with those values and identified what conflicted with them. #ACEMWS21 @Qemerg 
A group of clinicians @Qemerg @KingstonHSC engaged in a rapid cycle collaborative ethnography by gathering >50,000 words in field notes and >40 interviews with staff during 12 week period (March-May 2020). Weekly we reported the "pulse" of the ED to department + hospital leaders.
This work highlighted aspects of pandemic reality that aligned with our core values, beliefs, and practices. For example, managing uncertainty is core to emergency medicine. Many thrived in doing so in the early days.
On the other hand there were significant threats to identity - the biggest of which was the ability to provide patient and family centred care. A mismatch between practice and values/beliefs is extremely problematic in the longterm.
As we move forward we must strive to align realities of practice with core values. Choices at individual, departmental, and organizational levels must strive to maximize overlap. This is relevant to ongoing COVID response but also in normal times. Try asking simple questions.
The impending disastrous efflux of staff from emergency and critical care in Canada is certainly complicated but I am confident mismatches (predating but magnified by Covid) between core values and realities of practice are at the heart of why good people are leaving.
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