Introduction: Detroit, Michigan, is among the leading United States cities for per-capita homicide and violent crime. Hospital- and community-based intervention programs could decrease the rate of violent-crime related injury but require a detailed understanding of the locations of violence in the community to be most effective.

Methods: We performed a retrospective geospatial analysis of all violent crimes reported within the city of Detroit from 2009-2015 comparing locations of crimes to locations of major hospitals. We calculated distances between violent crimes and trauma centers, and applied summary spatial statistics.

Results: Approximately 1.1 million crimes occurred in Detroit during the study period, including approximately 200,000 violent crimes. The distance between the majority of violent crimes and hospitals was less than five kilometers (3.1 miles). Among violent crimes, the closest hospital was an outlying Level II trauma center 60% of the time.

Conclusion: Violent crimes in Detroit occur throughout the city, often closest to a Level II trauma center. Understanding geospatial components of violence relative to trauma center resources is important for effective implementation of hospital- and community-based interventions and targeted allocation of resources.

Learning Objectives: Understand the environmental factors which influence selection of Emergency Medicine as a specialty by women medical students.

Background: Women represent 28.3% of EM physicians. There is now gender parity in US medical schools, but women applicants to EM ranges 33-37%. Prior research does not explain these gender differences. There are known differences in resident experiences and assessments based on gender.

Objectives: We sought to explore how clinical experiences and perceptions of the specialty influence selection of EM by women.

Methods: Using purposive and convenience sampling to represent diverse learning environments, we conducted semi-structured interviews of men and women US senior medical students who considered EM as a specialty. Interviews were transcribed, de-identified, and coded using constant comparative analysis until saturation. We conducted thematic analysis using a constructivist approach and grounded theory. Reflexivity and credibility activities were performed.

Results: 25 students from 11 geographically diverse schools completed interviews. 68% (17/25) were women. The majority (21/25) expressed commitment to EM. Four main themes were identified: 1. EM culture was perceived as exclusionary; 2. Beliefs about attributes of EM physicians and the specialty were influenced by gender; 3. Distressing patient encounters and physician/staff behaviors negatively affected students; and 4. Access to mentors, representation and exposure to EM affected interest. Table 1.

Conclusions: The EM gender differential is affected by societal gender roles and an environment that rewards traditional masculine traits. Conflict with behavioral norms may hinder women forming their professional identity as an emergency physician. Potential interventions include recognizing the gendered perception of the field; establishing early, longitudinal mentoring and engagement with the specialty; and building a supportive culture to overcome mistreatment concerns. As for limitations, students hold multiple intersecting identities, and this study primarily focused on gender.