March/April 2011

2340 S. River Road, Suite 200 • Des Plaines, IL 60018 • 847-813-9823 • saem@saem.org • www.saem.org

MARCH/APRIL 2011

JODY A. VOGEL, MD

SAEM

Member Highlight SAEM News on

FACEBOOK RESEARCH

what does the future hold?

BEAT THE REGISTRATION RUSH! Annual Meeting, Boston, MA

VOLUME XXVI NUMBER 2

SAEM M em bership

SAEM STAFF Executive Director James R. Tarrant, CAE Ext. 212, jtarrant@saem.org Executive Director – CORD Barbara A. Mulder bmulder@saem.org Executive Assistant Sandy Rummel Ext. 213, srummel@saem.org Bookkeeper Janet Bentley Ext. 202, jbentley@saem.org Customer Service Coordinator Michelle Iniguez Ext. 201, miniguez@saem.org Education Coordinator Kirsten Nadler Ext. 207, knadler@saem.org Grants Coordinator Melissa McMillian Ext. 207, mmcmillian@saem.org Help Desk Specialist Neal Hardin Ext. 204, nhardin@saem.org IT/Communications David Kretz Ext. 205, dkretz@saem.org

Membership Count as of February 3, 2011 2,550 67 2679 137

Active Associate Resident/Fellow Medical Students

11 19

9 5,463

International Affiliates Emeritus Honorary Total

2011-12 SAEM DUES $545 $510 $480 $450 $325 $160

Active Associate Faculty Group 2nd yr. Graduate 1st yr. Graduate Resident

$160 $135 $135 $115 $100 $25

Fellow Resident Group Medical Student Emeritus Academies Interest Group

International – email membership@saem.org for pricing details.

All membership categories include one free interest group membership.

Advertisement Rates The SAEM Newsletter is limited to postings for fellowship and academic positions available and offers classified ads, quarter-page, half-page and full-page options.

The SAEM Newsletter publisher requires that all ads be submitted in camera-ready format meeting the dimensions of the requested ad size. See specific dimensions listed below.

IT Help Desk Don Geschke Ext. 204, dgeschke@saem.org

• A full-page ad costs $1250 (7.5” wide x 9.75” high) • A half-page ad costs $675 (7.5” wide x 4.75” high) • A quarter-page ad costs $350 (3.5” wide x 4.75” high) • A classified ad (100 words or less) costs $120

Marketing & Membership Manager Holly Gouin, MBA Ext. 210, hgouin@saem.org

If there are any pictures or special fonts in the advertisement, please send the file of those along with the completed ad.

Meeting Coordinator Maryanne Greketis, CMP Ext. 209, mgreketis@saem.org

We appreciate your proactive commitment to education, as well as to personal and professional advancement, and strive to work with you in any way we can to enhance your goals.

Contact us today to reserve your ad in an upcoming SAEM Newsletter. The due dates for 2011 are:

Membership Assistant Mike Allen Ext. 211, mallen@saem.org Receptionist Karen Freund Ext. 201, kfreund@saem.org

April 1, 2011 for the May/June issue June 1, 2011 for the July/August issue August 1, 2011 for the September/October issue October 1, 2011 for the November/December issue

highlights

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SAEM has always been a social group – now you can participate through social media!

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SAEM Is Going Green!

We have heard the request for SAEM to go “green” and we are listening. Beginning January 2011, SAEM has taken a step forward in the green movement by delivering the SAEM Newsletter electronically to your email. The electronic newsletter can be downloaded from our website to your laptop, net book, or iPad to be read wherever you are. Whether on an airplane or sitting at the kitchen counter, members will still have easy access to the newsletter. Also, if you have missed an issue, don’t forget all newsletters are archived on our website at www.saem.org under Publications.

The newsletter contains valuable information and we don’t want you to be left out! Make sure you review your profile to ensure SAEM has your email on file.

4

President’s Message

6

Saem Member Highlights

9

Program Committee Update

11

Academic Announcements

13

Academic Resident

15

Caring for the Caregivers

17

Ethics in Action

20

Call for Proposals

26

Calls and Meeting Announcements

President’s M essage SOCIETY FOR ACADEMIC EMERGENCY MEDICINE Jeffrey A. Kline, MD

The Discus Circle “As a good example, Kline is a total idiot…”

Coach Bugg observed with good accuracy as he addressed our attitudes. He paced back and forth, clenching his hands behind his back, chewing tobacco. He turned, raised an eyebrow, and squared off toward his languid teen audience, continuing the mini-lecture.

Jeffrey A. Kline, MD

“…most of the time. Outside the circle, he is just as much of a goofball and pain in my ass as all of the rest of you.”

All of us were the Harrisonburg High School boys discus team in March of 1980. Reclining there--scattered really--across a short grassy hill, we each held a pinch of Skoal in our lips, persevering in the associated nicotinic vertigo, trying hard to appear bored.

Coach Bugg did not like being called “Coach Buggs.” That made his eyes pop out. He liked to lecture and be cool at the same time.

“But when he gets in the discus circle, he is dead serious. He is not particularly talented, but he gets in there and blocks all the rest of you knuckleheads out and focuses on his throw. Regionals are next week. You guys better be more like Kline in the circle. I bet he places.”

“Oh, my God. They’ll crucify me,” I thought to myself, feeling justifiable fear of my skoal-dipping colleagues’ inevitable shockand-awe sarcasm campaign in retaliation for being instructed by Bugg to be Kline-like.

A honeybee buzzed over to a clover flower next to me.

“Please sting me,” I thought, in a futile attempt at apiarian telepathy.

“That would be cool because then I might have some kind of an allergic reaction and I can fake breathing trouble and they will have to call a rescue squad to take me to the hospital. Better than listening to this,” I mused to myself, watching Maria Morris in the distance, practicing hurdles. “Either that or Maria would have to hurdle on over for some mouth to mouth resuscitation,” I thought, again, ineffectively.

The bee flew away.

In February of 2011, I can write about my first completed interview season as the interim Chair of an academic Department of Emergency Medicine. This role afforded me the chance to speak to and learn from some 140 fourth-year medical students applying to our residency at Carolinas Medical Center. They are still interested in everything. Their common-theme rationale for choosing Emergency Medicine: they liked all their rotations, but could not see themselves doing only pediatrics, ortho, or cardiology. They wanted to put all of their broad learnings to use. They did not want to be the left eye doctor. When asked “Why did you choose emergency medicine?” I believe this quote summarizes the feelings and beliefs of many of us: A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort

the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, and die gallantly.

Specialization is for insects.

Robert Heinlein Emergency care appeals to those with open minds and open hearts. Engage in any discussion with our colleagues in Boston this June, and listen as the topic of conversation wanders rapidly and widely, but with reasonable acumen, from myths of epinephrine in lidocaine, to the use of logistic regression, derivation of decision rules, and then Beatles trivia. We did not want to be specialists.

In general, most emergency physicians have a keen interest in the entire human experience. A wonderful attribute.

And a curse. Especially in the setting of academic medicine.

I heard Jim Adams (the Chair at Northwestern) say, “No one ever changed the world by being well-rounded.” Prospective researchers and academicians need to remember that quote.

You drive a nail by hitting the same nail again and again. This requires focus, concentration, persistence, perseverance. Every accomplished educator, researcher, or (ahem) administrator I know has done something that more than 10 people care about because of focus. The trouble is, by the time academic role models in medicine reach high success, their prospective protégés see them as “doing everything” and get the idea that the path to success is to say yes all the time.

Among the many gifts in my life, one of the most important of all from a professional standpoint has been an ability to create and stay in my discus circle, which for me has been the study of pulmonary embolism (and tomatoes, but that is a different story, and I have to stay focused). As a discus thrower in 1980, I tried to convert all of my 170 pounds into distance thrown. Now, I use the same amount of force in a different way, trying to create knowledge about pulmonary embolism that helps us help our patients.

My wish, and my plea to young faculty, fellows, and residents who would aspire to a career in academic medicine, is this: please, define your discus circle. Create the zone that defines who you are, and makes your pulse increase: the thing you want to do better than anyone in the world. Start on the ground, get the training and technical competence required to belong there. Define a hypothesis (a question worth asking), learn and use methods that stand up over time and give quality to your answer. A mentor helps tremendously with these steps, and I look forward to the day when we have an adequate number of research mentors in emergency medicine. I believe that day is probably 15 years off. So, for now, most of us have to bootstrap and create the best out of what is around us. One starting point is to carefully consider saying yes to anything outside of your discus circle. I advise you to guard your time as the one thing in your life that you can never get back, while remembering the vital role of connectivity in your career. If you do not value your time and expertise, neither will others. To be the metaphorical “shining beacon of light” is nice for administrators and politicians, but ineffective for a scholarly career in academic medicine. We need more laser pointers.

At regionals, I placed 7th out of 8. I should also say, focus cannot substitute for talent.

Executive director’s M essage Voice for Emergency Medicine Members will recall my last column on the Congressional elections and the importance of being engaged in the political process. I want to share a member response regarding his experience and continued interaction with a member of Congress.

I enjoyed reading your message in the latest newsletter [January/February 2011] and agree wholeheartedly with your suggestion that our members take the James Tarrant, CAE initial step to get involved in our political process. I am not a “political animal” by any means, but I had the opportunity to meet our local congressional representative (Congresswoman Jane Harman) in 2000 when the Los Angeles County Board of Supervisors contemplated closing Harbor-UCLA Medical Center to help balance the County budget. We held a rally (and press conference) on the Harbor campus to gain local public support for keeping the hospital open. She attended the event because she is a staunch supporter of trauma centers and we are the only trauma center in our area. She asked me to give her a tour of our ED afterward, and as she left asked me to join her “Medicine Cabinet,” a group of physician leaders and hospital CEO’s that she meets with several times a year to get input regarding healthcare-related issues coming before Congress. There are about 20 people in the group and I am the only one from an academic institution.

Very few of the issues that have come up over the years have involved academic EM directly, but I am in a position to voice an opinion when the need arises. This involvement comes with two requirements. First, that I know something about the issues she wants input on, which means occasional homework. Second, I need to attend a free round-table luncheon 2-3 times a year.

It’s difficult to quantify what impact, if any, my opinions have on the legislative process, but it’s hard to believe that the issues affecting academic EM wouldn’t somehow be impacted in a positive way if we had members of SAEM sitting on Medicine Cabinets all around the country.

Robert S. Hockberger, M.D. David Geffen School of Medicine at UCLA Chair, Department of Emergency Medicine Harbor-UCLA Medical Center Dr. Hockberger commented that he is unsure of the impact his input has in the legislative process. Too often I have heard from elected officials that they don’t hear from physicians on the issues.

They hear from the hospitals, insurance companies and trial attorneys, but not from physicians. I believe that Dr. Hockberger is making a difference by being at the table, expressing his opinions and representing his peers and most importantly his patients.

I agree with his concluding statement that having SAEM members across the country advising members of Congress would have a strong impact. It isn’t necessary to know everything about all health issues when meeting with members of Congress or the Legislature. On subjects you are not familiar with, you can let members of Congress know that you will conduct research and provide them with information. All of the emergency medicine associations have access to information and/or position papers on proposed legislation, or they know where to obtain background information. Use these sources to obtain information on current issues and the impact legislation may have on patients, physicians and hospitals.

The media are talking about politicians posturing for the next election cycle. SAEM members should position themselves to be advisors to current and future representatives at the state or national level. What action can you take to become a voice for academic emergency medicine in your district?

• Take an hour and schedule a meeting with your representative at his/her home office.

• Invite members of Congress to visit your hospital

- Morning coffee with faculty and residents

- Extended visit to the department

• Write a letter expressing your opinion on an issue. It is generally the case that a handwritten letter gets more attention than a form letter.

• Volunteer to participate in the representative’s advisory group.

Think about the number of new members of Congress elected in 2010. Few are experts or even knowledgeable in healthcare, or the majority of topics contained in bills for which they will be voting. You have knowledge to share with them. It may seem an overwhelming task to try to influence the 535 members of the Federal Congress, let alone the numerous members of individual state legislatures. Bear in mind, though, that you yourself need focus your efforts only on your own Federal and state representatives – and if all of us do that, we will as a group have applied our expertise and experience towards improving the practice of academic emergency medicine, research and education in the field, and above all the care of our patients.

Most physicians are not excited about meeting with politicians, but it is important that physicians be heard and that concerns be voiced to improve the system and protect the profession. If you need advice on where to begin or what to say, take advantage of the resources of your emergency medicine organizations to help you take those important first steps in advocacy.

SAEM M em ber highlight Jody A. Vogel, MD Jody A. Vogel, MD is the current resident member of the Board of Directors. She is also a Chief Resident at the Denver Health Residency in Emergency Medicine.

After graduating from the University of Michigan with a Master’s Degree in Social Work, Dr. Vogel received her medical degree from the Wayne State University School of Medicine.

Dr. Vogel has a dedicated interest in research, and became involved with scientific investigations prior to medical school as a Clinical Research Associate at the University of Michigan. She continued her research work during medical school through investigation of cardiac risk reduction at Wayne State University, and completed a medical student summer research fellowship at the Cleveland Clinic Foundation. Her research activities have flourished in residency, and she has obtained two grants from the Emergency Medicine Foundation (EMF), the EMF / Emergency Medicine Residents’ Association Resident Research Grant and the Emergency Medicine Basic Research Skills Grant. Dr. Vogel has been recognized locally and nationally with the Denver Health Outstanding Resident Research Award and the Emergency Medicine Residents’ Association Academic Excellence Award. Dr. Vogel’s scholarly interests include cardiac arrest, post-resuscitative outcomes, and post-injury multiple organ failure. She will complete a research fellowship at the Denver Health Medical Center beginning in 2011 under the mentorship of Jason Haukoos, MD, MSc, and will obtain a Master of Science in Epidemiology from the Colorado School of Public Health.

Dr. Vogel became an active resident member of SAEM following attendance at the Annual Meeting. She states, “The novel research and informative educational sessions, along with the collegiality of the meeting environment, were inspiring. Motivated by these experiences, I eagerly sought involvement in the Society and became an active member of the GME and Program Committees.

Each of these opportunities increased my understanding of the role of the Society in improving our delivery of care to patients through research and education. I came to fully appreciate the benefits of the collaborative relationships developed through the Society, which foster education and research and the exchange of ideas that improve patient care.”

As Dr. Vogel reflects on her year of service on the Board of Directors, she says that “serving as the Resident Member has truly been an outstanding experience. My fellow board members and the Society as a whole have played an integral role in my development as a future academician. I would encourage residents and students to take an active role in the Society so they may also benefit from the Society’s rich resources. Just as in my case, residents and students will recognize SAEM as an organization dedicated to supporting their education, research and development as junior academicians.”

Dr. Vogel would like to encourage early mentorship through the Society “that will be instrumental in the development of our future academicians who will carry forth the Society’s mission. With this aim in mind, the Society has formed a new committee dedicated solely to the interests of residents and students, the Resident and Student Advisory Committee. The committee will advise SAEM of issues and opportunities for residents and students, including creating Annual Meeting didactics, composing articles relevant to student and resident interests, collaborating with other EM organizations, and in general advocating for the interests of medical students and residents at the Society level. It will be an honor to serve as the inaugural Chair of the Resident and Student Advisory Committee.

“As I contemplate my time as the Resident Board Member, I fully appreciate the unique privilege of learning from fellow board members who are leaders in emergency medicine. Through their excellent mentorship, I have an enhanced appreciation of the ‘small community’ of the specialty of emergency medicine. My belief that collaboration is the only path to success in medicine has been strongly reaffirmed through my work within this organization.

The outstanding mentorship that I have received through my involvement in the Society has enhanced both my growth as a physician and my development as a researcher and academician.

“Patient-centered care combined with the intellectual stimulation of teaching and medical research is irresistible and compelling. It is for this reason that I am firmly committed to a career in academic emergency medicine. I very much look forward to maintaining continued active leadership within the Society throughout my career. I fully appreciate the many outstanding opportunities that are afforded by the Society, and it has been an absolute honor and privilege to serve as the Resident Member of the SAEM Board of Directors.”

AEM Author Announcements CrossCheck Academic Emergency Medicine now employs a plagiarism detection system. By submitting your manuscript to this journal, you accept that your manuscript may be screened for plagiarism against previously published works.

CHAIR UNIVERSITY OF TENNESSEE COLLEGE OF MEDICINE CHATTANOOGA DEPARTMENT OF EMERGENCY MEDICINE The University of Tennessee College of Medicine Chattanooga is seeking applicants for the position of Chairman of the Department of Emergency Medicine with faculty rank commensurate with experience.

Academic Emergency Medicine News on FACEBOOK (on SAEM’s website)

Please be sure to regularly frequent and follow many activities of the journal on SAEM’s Facebook.

Comments on articles are featured there, as well as journal announcements. Another way to keep up to date with the latest information relevant to Academic Emergency Medicine, as well as other emergency medicine topics, happenings, etc!

Qualified individuals must hold the M.D. degree or its equivalent and board certification by the American Board of Emergency Medicine; must have documented and proven experience as a faculty member with experience in academics and currently hold the rank of Associate Professor or above; and must have evidence of scholarly activity.

Previous administrative experience is required. The Department of Emergency Medicine has an approved residency program. The goal of our residency is to educate and train excellent practitioners so that they are prepared to enter community practice or subspecialty training.

The UT College of Medicine is affiliated with Erlanger Health System, one of the busiest Level One Trauma Centers in the U.S. Approximately 165 residents are appointed currently in nine disciplines. Visit our website at www.utcomchatt.org.

The University of Tennessee is an Equal Opportunity/Affirmative Action/Title VI/TitleIX/Section504/ADA/ADEA Employer.

Please submit CV and references to:

Chair, Emergency Medicine Search Advisory Committee.

University of Tennessee College of Medicine, Chattanooga 960 East Third St. Suite 100 Chattanooga, TN 37403

The Academy for Women in Academic Emergency Medicine (AWAEM) Research Committee has a goal this year to compile a list of researchers and their areas of interest related to women’s health issues and careers of women in medicine. We would like to ask you a few questions in a brief survey (approximately 2 minutes) about your personal research experience. After compiling this list we plan to share it with other AWAEM members to promote networking and collaboration and plan to put this up on our web site.

We appreciate the support you provide us with your participation. The survey can be accessed at the link provided below.

http://www.surveymonkey.com/s/B3RRJW3

M eeting Announcem ents 2011/2012 SAEM Grant and Scholarship Information

Don’t miss this exceptional educational opportunity!

SAEM is pleased to offer a variety of grants available for competitive application. The grant below has an upcoming deadline:

The SAEM 2011 Leadership Forum will be a two-day Business of Academic Emergency Medicine Boot Camp, May 31 & June 1, 2011.

Two-day session cost: $175.00. Coffee/tea provided in the morning both days. May 31, 2011: lunch on your own, Networking Reception provided. June 1, 2011: lunch provided.

The knowledge and business skills that will be discussed at this Leadership Form are essential tools for anyone leading or hoping to lead a program or department. The participants will be taught by leaders in academic Emergency Medicine and will be introduced to topics such as cost accounting, reimbursement, revenue generation, finances of research, human resource issues and risk management. In addition, participants will learn business skills such as strategic planning, development of budgets and business plans, marketing, and utilization of balanced scorecards.

Leaders in academic Emergency Medicine must have an understanding of these topics and skills in order to be able to attract the appropriate resources and to effectively manage and lead their department or program.

The program will include the following subjects and speakers; Cost Accounting Jim Bihun, MBA Reimbursement Rob Shesser, MD Finances of GME Mary Jo Wagner, MD Strategic Planning, Budgeting Ann Chinnis, MD Revenue Generation Rich Wolfe, MD Finances of Research Bill Barsan, MD Business Plan Stephen Thomas, MD Marketing Neil Sikka, MD Balanced Scorecard Kate Heilpern, MD Malpractice, Risk Management Tracy Sanson, MD Human Resource Management Leslie Zun, MD Managing Multiple Priorities Brian Zink, MD On-line registration: http://www.saem.org/saemdnn/Meetings/ AnnualMeeting2011/tabid/1457/Default.aspx

Additional upcoming SAEM grants include: SAEM / ACMT Michael P. Spadafora Toxicology Scholarship Scholarship fund to encourage Emergency Medicine residents to pursue Medical Toxicology fellowship training. One recipient is chosen each year to receive funds to allow them to attend the North American Congress of Clinical Toxicology (NACCT) conference, which is held in different locations every fall.

Application Deadline: May 2, 2011 SAEM Institutional Research Training Grant ($75,000/yr. for 2 years) – The Research Training Grant is intended to identify and fund centers of excellence to train emergency medicine research fellows.

Application Deadline: August 1, 2011 SAEM Research Training Grant ($75,000/yr. for 2 years) – To provide support to emergency physicians for two years of concentrated training in research methods and concepts.

Application Deadline: August 1, 2011 For more details as well as detailed application instructions, please go to the SAEM website (www.saem.org) and click on “Grants” under the “Grants & Awards” tab.

NEW for 2011! Professional Poster Printing Made Easy –Coming Soon for the 2011 SAEM Annual Meeting Poster Presenters • Use a professional PowerPoint™ template to build your poster from or upload an existing poster file you have created (PowerPoint® file or PDF). Then simply submit the file online for our high-quality professional printing service.

• Request your poster be conveniently shipped direct to the meeting for on-site pick-up. Only through this poster service can you have your poster printed and shipped directly to the meeting in Boston!

Watch the SAEM website for more information on when this service goes live!

Great Plains Regional Meeting September 10, 2011 in St. Louis, Missouri For information contact Michael Mullins, MD at mullinsm@wusm.wustl.edu

Program Comm ittee Update Feel the Difference!

Every year the Program Committee (PC) strives to improve and innovate the Annual Meeting. We take your feedback very seriously and do something “different” each year. Thanks to some extraordinary PC members, SAEM staff, and the support of the Board of Directors, this year will exceed your expectations for something “different”. Here is what’s in store: Itinerary planner – Please make sure to

Andra L. Blomkalns, MD log in to the Annual Meeting website before

you leave for the meeting to generate a personalized meeting agenda JUST FOR YOU. Search for a keyword, presenter, institution, or topic and plan your meeting attendance in advance.

Disclosures of potential conflicts of interest – Over the last several years, and along with the Industry Relations Task Force, we have stage-implemented disclosures of potential conflicts of interest. This year ALL presenters (oral abstract, poster abstract, moderated abstract, lightning oral abstract, didactic session, and Innovation in Emergency Medicine Education (IEME) exhibit) shall disclose potential conflicts of interest.

Professional poster printing made easy – Use a professional PowerPoint™ template to build your poster from or upload an existing poster file you have created (PowerPoint® file or PDF).

Then simply submit the file online for our high-quality professional printing service. Request your poster be conveniently shipped direct to the meeting for on-site pick-up. Only through this poster service can you have your poster printed and shipped directly to the meeting in Boston! Check in on the annual meeting webpage [http://www.saem.org/saemdnn/Meetings/AnnualMeeting2011/ tabid/1457/Default.aspx] to get further information.

Online handouts – Please check our website closer to the meeting date and print copies of session handouts to bring with you. Paper handouts will not be available at the meeting. Handouts will remain on the website for one month after the meeting and are free for anyone to download.

Daily Sessions and Academy Tracks – The Annual Meeting each day is divided into five simultaneous activities. One of these tracks is devoted to academy-related didactic sessions and research topics. The PC does its best to have sessions for attendees with diverse interests at any given time, and also tries to In the last newsletter we discussed Robert McCloskey’s 1987 “Make Way for Ducklings” bronze sculpture in Boston’s Public Garden.

In this newsletter, we find out the scoop on “duck tours.” DUKW (the first such vehicle colloquially known as “duck”) tours are city-centered excursions on amphibious (often military) vehicles. Because I just know you are wondering, in General Motors language the “D” indicates a vehicle designed in 1942, the “U” means “utility (amphibious)”, the “K” indicates all-wheel drive, and the “W” indicates two powered rear axles. You gotta love acronyms…

These tours occur in many United States locations and even in several other countries (Boston, Washington, DC, Seattle, Chattanooga,

avoid scheduling conflicts with similar topics. With so many great sessions, there will unfortunately be conflicts. Split the sessions with your colleagues and glean the pearls from each other!

Expanded Meeting Schedule – With so many great groups and expanding presentations, the annual meeting has been extended one day. Please see the schedule below to help make your travel plans.

SAEM Annual Meeting Schedule as of February 01, 2011.

Check back on the website for updates. *Denotes that the event requires preregistration Tuesday, May 31, 2011 Pre-Day • Leadership Forum Boot Camp Day 1 of 2 Wednesday, June 1, 2011 Annual Meeting Day #1 • Leadership Forum Boot Camp Day 2 of 2 • AEM Consensus Conference* • Grant Writing Workshop* • Conference on Community Consultation in Emergency Research* • Selected abstracts • Baseball Networking Night at Champs Sports Bar in the Marriott • CPC Semi-Final Competitions Thursday, June 2, 2011 Annual Meeting Day #2 • Plenary Abstracts • Didactic Sessions • Innovations in Emergency Medicine Education (IEME) Exhibits • Photos • Board of Directors Open Forum Q&A Session • Opening Reception • Exhibits Friday, June 3, 2011 Annual Meeting Day #3 • Abstracts • Didactic sessions • Innovations in Emergency Medicine Education (IEME) Exhibits

• Photos • Foundation Donor Luncheon* • Networking Breakfast • Chief Resident Forum* • Fellowship Fair * • AWAEM Academy Meeting • Simulation Academy Meeting • Exhibits Saturday, June 4, 2011 Annual Meeting Day #4 • Abstracts • Didactic Sessions • Innovations in Emergency Medicine Education (IEME) Exhibits • Photos • Awards and Annual Business Meeting • 5K Run/Walk* • Medical Student Symposium* • Residency Fair* • AWAEM Luncheon* • CDEM Academy Meeting • AGEM Academy Meeting • Wine and Cheese poster session Sunday, June 5, 2011 Annual Meeting Day #5 (Meeting officially ends at noon) • Abstracts • Innovations in Emergency Medicine Education (IEME) Exhibits • Didactic sessions • Procedural Sedation Session (afternoon)

Pittsburgh, Albany, Malaysia, Osaka, Singapore, and Qingdao). The Boston Celtics celebrated their 2008 championship and the Boston Red Sox their 2004 and 2007 World Series victories in parades of DUKW vehicles. Apparently these vehicles own a precarious accident record.

In 1999, 13 people were killed in a duck boat accident, and in 2002, four people drowned in Canada when their duck boat suddenly sank. In downtown Boston, five people sustained minor injuries in a 2010 crash involving a duck boat and seven other vehicles. That same week, a duck boat and two other cars were involved in an accident near Government Center when three women on their way to a wedding tried unsuccessfully to maneuver their car around the duck boat. Note to self: “Do not play chicken with a duck boat.” To that end, the PC encourages you to book your Beantown adventures in vehicles that are Coast Guard approved.

No, I’m not kidding. See you there and save me a seat!

Andra L. Blomkalns, MD Program Committee Chair

June 3, 2011 in Boston, MA The 2011 SAEM Foundation Luncheon featured speaker is Michael S. Sparer, PhD, JD, Professor and Chair of the Department of Health Policy and Management at the Mailman School of Public Health at Columbia University. He will be speaking on the recent health care legislation, obstacles to its enactment, and its anticipated effects on academic emergency medicine.

Dr. Sparer is a well-published and nationally recognized expert in health policy, and an outstanding speaker. This should be an incredible opportunity for membership, and worth the price of admission.

Michael S. Sparer, PhD, JD

Luncheon Cost: $70.00 Register online ~ www.saem.org * Fax ~ 847-813-5450 Mail ~ SAEM, 2340 S. River Road, Suite 200, Des Plaines, IL 60018 Attention Department Chairs: Also a great opportunity to sponsor a resident to attend this one-ofa-kind educational event. Call SAEM for details 847-813-9823.

The SAEM Foundation Luncheon is open to Foundation donors only!

Boyer’s four areas of scholarship The scholarship of discovery

The scholarship of integration

The scholarship of application

The scholarship of teaching Emergency Medicine is about making a difference.

Sometimes through treating. Always through caring.

Eternally through teaching.

Make your donations today at www.saem.org or to SAEM Foundation, 2340 S. River Rd., #200, Des Plaines IL 60018 Contact hgouin@saem.org with any question regarding donations **** Please note that all donations are for Education

10

Academ ic Announcements Jill M. Baren, MD, MBE, FACEP, FAAP

has been promoted to Full Professor of Emergency Medicine and Pediatrics at the University of Pennsylvania School of Medicine.

Kerryann B. Broderick, MD and Robert L. Muelleman, MD were recently elected to serve on

the ABEM board of directors. Details regarding their professional affiliations and ABEM activities can be found at - http://www. abem.org/PUBLIC/portal/alias__Rainbow/lang__en-US/tabID__ 4152/DesktopDefault.aspx

AWAEM Early Career Faculty Award Description: To honor early career female faculty who have shown promise for significant career achievements in Emergency Medicine, whether through research, education, advocacy, or administration, and/or who have worked to promote the role of women in academic Emergency Medicine.

Eligibility: 1) Female EM physician

AWAEM Beacon Award for Leadership and Mentorship of Women in Academic Emergency Medicine Description: The Beacon Award recognizes a faculty member whose outstanding efforts and achievements have promoted the careers of women in academic Emergency Medicine.

Efforts to be recognized are: leadership and influential mentorship through administration, research, program development or advocacy that has advanced women faculty and trainees and improved the likelihood and/or climate for success. The accomplishments of the winner of this award should have had significant impact on advancing women faculty and/or trainees in academic emergency medicine, either on a national level or as an outstanding example of a local model of innovative leadership that has broadly influenced others.

Eligibility criteria: 1) Female Emergency Medicine physician 2) Faculty in a U.S. academic Emergency Medicine department 3) Current SAEM membership

2) Involvement on a national level (e.g., through SAEM committees, research consortiums, or advocacy groups)

Selection criteria: Nominees should have: 1) Demonstrated dedication to the recruitment, support, retention, and promotion of women in Emergency Medicine; 2) Served as a role model and mentor for women in academic Emergency Medicine through career achievements in one or more of the following areas: research, education, advocacy/ health policy, clinical practice, or administration.

3) Served in a leadership position that helped impact the growth of women in academic Emergency Medicine at regional or national level.

3) Activities demonstrating commitment to advancing the role of women in academic Emergency Medicine

Nomination process: 1) Nominee’s CV

Nomination process: 1) Nominee’s CV

2) Nomination letter* explaining why the candidate merits the award.

2) Faculty member in a U.S. academic EM department 3) Graduation from residency within 10 years (as of June 2001) 4) Current SAEM membership Selection criteria: 1) Evidence of achievements, innovation, and dedication in academic Emergency Medicine, whether through education, research, advocacy, or administration.

2) Nomination letter* 3) Letter of support from chair or mentor† Other supporting documentation, such as additional letters of support from mentors, is optional and will be reviewed by the awards committee on a time-available basis. Submit all materials electronically to esther_choo@brown.edu.

Deadline: Tuesday, March 15, 2011, 5 pm EST *Nomination letter may be submitted by former or current colleagues, mentors, mentees, or employers. Self-nominations are welcome and encouraged.

If nominator is the chair or dean, one letter addressing #2 & 3 may suffice. †

3) Letter of recommendation from department chair OR medical school dean† attesting to the nominee’s leadership and mentorship achievements and influence.

Other supporting documentation, such as additional letters of support from mentees, is optional and will be reviewed by the awards committee on a time-available basis. Submit all materials electronically to esther_choo@brown.edu.

Deadline: Tuesday, March 15, 2011, 5 pm EST *Nomination letter may be submitted by former or current colleagues, mentees, or employers.

Self-nominations are welcome and encouraged.

If nominator is the chair or dean, one letter addressing #2 & 3 may suffice. †

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Emergency Medicine Leader Inducted Into the Institute of Medicine Michelle H. Biros, MD, MS

By Alisa K Hayes MD Faculty Development Committee

Michelle H. Biros, MD, MS, a true leader in Emergency Medicine, has been inducted into the Institute of Medicine. The Institute of Medicine inducts 65 new members and 5 foreign associates each year. The IOM has over 1,700 members, all of whom donate hours and knowledge in their areas of expertise to improve the nation’s health. Members are nominated and inducted based on excellence and professional achievement in their field and for Dr. Biros- the field of Emergency Medicine is honored to have her as a leader.

Dr. Biros recognizes that her involvement with SAEM played a large role in her induction into this prestigious group. Specifically her hard work and numerous publications on the topic of exception from informed consent for emergency research were what she believed prompted her nomination. Her work on this topic was supported fully by the SAEM research committee. She believes the backing of SAEM and their trust allowed her to move forward, exercise her talents and change regulations securing a balanced approach to emergency

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research for the patients and researchers.

Her work as chair of the research committee of SAEM over a number of years culminated in the revisions to the U.S. FDA Code of Federal Regulations 21CFR50.24 which allows for an exception from the usual informed consent requirements in order to perform research in emergency settings in which consent would not be feasible.

While serving as the editor in chief of Academic Emergency Medicine for 10 years, she also was integral in developing the yearly consensus conferences. These conferences often related directly to the Institute of Medicine Reports with topics including Errors in Emergency Medicine and Public Health in the Emergency Department. Her participation on numerous subcommittees resulted in a large amount of progress in these areas.

Her involvement with SAEM also includes serving as a virtual advisor, sitting on the Nominating Committee and attending every annual meeting since her residency. Additionally she has been a frequent

presenter, moderator served on the SAEM Board of Directors and won numerous research awards.

Dr. Biros’ commitment to service is evident not only in her IOM membership but in numerous other ways within her institution and beyond. She is serving as the Vice Chair of Research, in the Department of Emergency Medicine, at the University of Minnesota Medical School.

Other research interests include procedural sedation, health care disparities specifically related to hunger and alcoholism as well as research ethics and neurological emergencies. Her words of advice for residents and students are to attend conferences early in your career giving yourself time to develop interests and become a part of supportive groups. She also has served as a mentor for many but advises everyone to seek out a good mentor and do not be afraid to take the first step and establish and maintain good contact.

Academ ic Resident Section On behalf of the SAEM GME Committee, we are pleased to re-introduce the “Academic Resident” section of the SAEM newsletter.

Quarterly articles will focus on topics of interest and importance to emergency medicine residents, with topics recurring on a roughly 3-year cycle. It is our hope that you will find these articles to be useful tools in your academic/professional development. We encourage your feedback and suggestions regarding additional content areas that would be of value to residents and recent residency graduates.

Feel free to email comments and suggestions to techsupport@saem.org

Jonathan Davis, MD, Georgetown University | Douglas McGee, DO, Albert Einstein | Jacob Ufberg, MD, Temple University

Ultrasound in Emergency Medicine Residency Training (& Beyond) Authored By: Danielle Silverman, MD, Emergency Medicine Resident, Georgetown University/Washington Hospital Center EM Residency Program, Washington, D.C. & Michael Antonis, DO, RDMS, FACEP, FAAEM, Assistant Professor of Clinical Emergency Medicine Director of Ultrasound Program and Fellowship, Washington Hospital Center & Georgetown University Hospital, Washington, D.C. We have all heard the story growing up about how our parents walked uphill both ways to school in 18 inches of snow. Less than 10 years ago, ultrasound training in emergency medicine (EM) was not much different. The machines were heavy (over 100 pounds), barely fit into a large exam room, took five minutes to reach the start-up screen, produced poor-quality thermal prints or, if you were fortunate enough, the ultrasound machine had VCR recording capabilities. This is certainly not the case with present-day ultrasound machines that typically weigh less than 25 pounds, can easily fit inside a cramped exam room, and contain an internal hard drive and digital imaging communications in medicine (DICOM) capabilities. The rapid leap of ultrasound technology has coincided with the advancement and implementation of emergency department (ED) point-of-care ultrasound as an essential component in the EM residency curriculum.

As emergency ultrasound has become more widespread, the American College of Emergency Physicians (ACEP) published revised guidelines in 2008, supported by the Society for Academic Emergency Medicine (SAEM).1 The eleven core applications of emergency ultrasound are trauma, intrauterine pregnancy, abdominal aorta, cardiac, biliary, urinary tract, deep vein thrombosis, softtissue/musculoskeletal, thoracic, ocular, and procedural guidance, with new applications including testicular, bowel pathology, and contrast studies. Each ED is encouraged to designate in which of the eleven applications they will require their physicians to maintain competency.

The Council of Emergency Medicine Residency Directors (CORD) in 2008 commissioned an Emergency Ultrasound Consensus Committee (EUCC) to establish a standardized minimum ultrasound education curriculum for EM residency programs.2 CORD, in conjunction with the Accreditation Council for Graduate Medical Education (ACGME), further stated that graduating EM residents must demonstrate competency in limited bedside ultrasound. The EM specialist should use limited bedside ultrasound in conjunction with clinical examination, resuscitation, and procedures in the ED. The ED limited ultrasound has been described as the palpating hand or “visual stethoscope” during the examination, providing both anatomic and functional information at the patient’s bedside. The EM sonologist attempts to answer a single, focused clinical question, rather than provide a comprehensive ultrasound examination.

The EUCC’s recommendations further specify that residency programs should include training in at least the following core applications: abdominal aorta, cardiac, focused assessment with sonography in trauma (FAST), intrauterine pregnancy (via both

transabdominal and endocavity scans), and procedural guidance.

These five applications were selected due to their crucial role in lifethreatening situations. Training in the remaining six core applications is also highly recommended.

In accordance with 2008 ACEP guidelines, the recommended training to gain competency in emergency ultrasound may be accomplished in one of two ways. As the Residency Review Committee in Emergency Medicine (RRC-EM) now requires ultrasound training during residency, current and future residents should be proficient in emergency ultrasound prior to graduating. For emergency physicians who did not receive residency-based ultrasound training, practicebased training should be utilized. In both cases, training should involve a combination of didactics and hands-on practice. All scans performed during the training period should undergo quality assurance (QA) review. The learner should perform at least 150 reviewed scans, with at least 25 scans in each core application. Among the minimum 150 required scans, an emergency physician must have a satisfactory number of abnormal scan findings. Although numerical thresholds are not ideal, the basic educational premise is that proficiency and competency increase with repetition.

For residency training in emergency ultrasound, the consensus recommendations from CORD encourage programs to have designated ultrasound core faculty, which should number at least 50% of the total program core faculty, although not all ultrasound core faculty need to be program core faculty. Ultrasound training should begin within the first year and should include at least 20 hours of ultrasound education during the course of the residency program. This education may involve simulation training or lectures during program didactics. Regardless of format, however, ultrasound education should be provided throughout the entire residency program, not just in a single, dedicated experience or rotation.

As part of the training, residents should be encouraged to incorporate bedside ultrasound into their clinical evaluations on a routine basis during ED shifts, but for specific hands-on training, dedicated ultrasound shifts are recommended. On these “sounding” shifts, residents should have no other clinical responsibilities and should be instructed by a core ultrasound faculty member. We frequently utilize dedicated “sounding” shifts in our curriculum, and schedule them in conjunction with our weekly ultrasound QA sessions. Trainees should keep a log of scans performed, as well as document follow-up findings, such as confirmatory imaging results, in order to encourage a habit of “self QA.”

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Ultrasound in Emergency Medicine Residency Training (& Beyond) (Continued) To help residents and ultrasound faculty gauge progress, residents should be given timely feedback. At our institution, we have established three levels of ultrasound proficiency, with each level requiring an increased number of scans, ultrasound knowledge and ability to instruct in ultrasound. At the third level, residents will have exceeded the required 150 reviewed scans, with at least 25 in each of our seven core applications. In addition, senior residents should feel comfortable instructing junior residents and will have at least basic knowledge of advanced ultrasound applications. Residents receive a yearly summary listing their current level, the number of scans they have performed in each core application, the number of departmental QA sessions they have attended, and the requirements needed to move on to the next proficiency level. All of our trainees receive a comprehensive summary of their ultrasound training, detailing the number of scans performed in each category, to assist in the credentialing process at their desired practice environment following graduation.

In keeping with ACEP recommendations, all scans from precredentialed physicians are subject to QA review, and learners should be provided timely feedback. During QA reviews, images are assessed for both technique and appropriate interpretation. The findings may be compared to other data obtained during the patient’s visit, including formal imaging or surgical findings. Physicians unable to attend QA sessions should ideally receive timely feedback regarding each scan performed.

Credentialed attending physicians in emergency bedside ultrasound must have completed at least 16 hours of emergency ultrasound continuing medical education and at least 25 reviewed scans in each of the chosen core applications. The CME hours may include didactics, but at least 8 hours must be from hands-on training. Until physicians are credentialed in ultrasound, they are required to order a confirmatory study for any scans performed. All resident scans must be reviewed by their attending regardless of the resident’s level of ultrasound training, and if their attending is not credentialed, a confirmatory study is still required. Due to the large number of pregnancy-related visits in many departments, physicians often achieve the required number of intrauterine pregnancy scans before they have completed full credentialing criteria. At our institution, physicians still ineligible for full ultrasound credentialing are granted pregnancy application-specific credentialing if they have performed at least 25 reviewed scans in this application.

Credentialed physicians are expected to document every scan performed, which includes documenting the indications for the scan, the scan findings, and the interpretation of the scan. When documenting, physicians also should note the limited nature of the emergency ultrasound scan and should avoid commenting on findings outside of the limited scope of emergency ultrasound training. The focused approach of an emergency ultrasound scan should also be explained to patients, to avoid confusion over the examination and the significance of the results.

Once fully credentialed, the EM specialist must continue to maintain proficiency by completing five hours of ultrasound-specific continuing medical education within the credentialing cycle.1 The credentialing cycle varies among EDs and specific hospital bylaws, but typically is two years in length. The Joint Commission has adopted the expectation of a continuous performance competency that is also mandated by the ACGME. Though there is concern about potential litigation should an emergency ultrasound be misinterpreted or a finding missed, it is widely recognized that these scans are performed for a specific goal in

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a limited setting, so therefore are not comparable to the formal scans performed by ultrasound technicians and radiologists. As emergency ultrasound quickly approaches the standard of care, however, the bigger risk may be liability resulting from the failure to perform a bedside ultrasound, leading to a delayed or missed diagnosis. While as of 2007 no known suits had been filed against an emergency physician for a misread emergency ultrasound, there have been a handful of suits filed for failing to perform an emergency ultrasound.3, 4 An additional concern with the increased use of bedside emergency ultrasound is how to handle incidental findings. Emergency departments should allow only clinically-indicated scanning, even when scanning for education. When incidental findings do arise, they must be acknowledged and discussed with the patient. If indicated based on the finding, additional testing should be ordered from the ED and patients should be instructed regarding necessary follow-up.

The number of emergency ultrasound fellowships has exploded in the past few years. Currently, there are more than 60 fellowship programs in 23 states and the District of Columbia. It was estimated that 200 physicians would have graduated from ultrasound fellowship programs by summer 2010.5 This surge in ultrasound fellowships is a direct result of the successful application of bedside, focused ultrasound in the efficient and safe management of ED patients.

The emergency ultrasound fellowship program is a certificate program, and has proposed guidelines delineated by a consensus statement from the ACEP ultrasound section in 2005.6 The ultimate goal of an emergency ultrasound fellowship program is to train the next generation of ultrasound directors and leaders. The training, departmental support, and equipment available in an emergency ultrasound fellowship is highly variable. It requires research and inperson interviews to determine if a prospective fellow will acquire the necessary ultrasound and administrative skills at a particular program to make it worth the dedication of a year of training. Information regarding ultrasound fellowship programs is provided on the SAEM website, as well as at www.eusfellowships.com.

Emergency ultrasound has come a long way from the days of the proverbial uphill walk in the snow. New emergency ultrasound applications have increased the number of diagnoses that now can be made confidently at the bedside. The mandated focus on EM resident education in ultrasound, along with the prevalence of ultrasound fellowships, has led to an increasing number of physicians able to perform high-quality, clinically-useful scans. With these increased opportunities, however, comes a responsibility for quality resident training, formal credentialing processes, appropriate documentation, and rigorous QA reviews, all to ensure the ultimate goal of fostering safe and efficient patient care.

REFERENCES: 1. U se of ultrasound imaging by emergency physicians. American College of Emergency Physicians (ACEP) Policy Statement. Approved October 2008.

2. A khtar S, Theodoro D, Gaspari R, et al. Resident training in emergency ultrasound: consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors Conference.

Acad Emerg Med 2009;16 Suppl 2:S32-6.

3. B laivas M, Pawl R. Analysis of lawsuits filed against emergency physicians over bedside emergency ultrasound examination performance or interpretation over a 20-year period. Ann Emerg Med 2007;50:S85.

4. L awsuit for a Misread of ED Ultrasound? Not Likely. ED Legal Letter 2010; 21:9:101-4.

5. M oak JH, Gaspari RJ, Raio CC, et al. Motivations, job procurement, and job satisfaction among current and former ultrasound fellows. Acad Emerg Med 2010;17:6:644-8.

6. A CEP Section of Emergency Ultrasound. Emergency Ultrasound Fellowship Guidelines (informational paper). Reviewed by the ACEP Board of Directors, January 2005.

Caring for the caregivers:

The Key to Emergency Department Patient Satisfaction Ajeet Jai Singh, MD Introduction: From 1993 to 2003, emergency department visits increased from 90.3 million to 114 million annually (27%) while, concurrently, the number of hospital-based emergency departments decreased by 14%.1 This increase outpaced the general population growth by a factor of two, representing a real and significant jump in emergency department usage. The average waiting time to see a physician is nearly 47 minutes1 and the median time has risen from 22 minutes in 1997 to 30 minutes in 2006, representing a 36 percent increase.2 Emergency departments are overcrowded, dissatisfying patients and providers.

In an era in which most hospitals function in a quasi-commercial mode, patient dissatisfaction can only be ignored at the financial peril of the institution.

The apparent linkage between extended time spent in the emergency department and overall ED patient satisfaction 3 has compelled hospital administrators to take note. Hospital profitability is intimately linked to establishing a satisfied patient clientele.

It’s Not About the Wait…

Regrettably, it has become standard practice to place emergency department patient dissatisfaction at the doorstep of prolonged wait times to the relative exclusion of the expressive qualities of care. This bias has little support in the academic literature and may very well be at the expense of less tangible yet critical variables, such as staff attitudes, communication skills, and the provision of information. In fact, none of the top five issues in the National Emergency Department Priority Index,3 representing the experiences of over 1.5 million patients, specifically cited emergency department wait time as a significant priority item: communication, caring, and pain control were the highlights of patient concerns. Despite this, it would be wrong to say that patient wait time had absolutely no bearing on overall patient satisfaction. However, it appears that it is the perception of this time rather than actual time that is important. Thompson, et al., noted that when perceived physician wait time was “shorter than expected,” patients were more satisfied with their ED visit. Actual physician wait time, or, for that matter, total wait time (door to discharge), were not statistical predictors of patient satisfaction or “likelihood to recommend.” 4, 5 Longer total wait times, when explained and congruent with services rendered, do not appear to have a negative impact on overall satisfaction.3, 4, 6 Despite this, wait time reduction continues to get disproportionate priority from most process-improvement groups, perhaps because it is intellectually accessible, measurable, and can be used as a crude gauge of physician and department performance; it is the lowhanging fruit. This narrow focus is unlikely to achieve the desired result of enhanced overall ED satisfaction.7 This goal necessitates consideration of a new hypothesis: that patient dissatisfaction is a result not of long wait times, but of the ancillary consequences of a stressed system: the collapse of the expressive qualities of care.

A Higher Order of Care…

Levitt and Dubner, in their engaging book, Freakonomics, explore the association between events and causes and come to the conclusion that “conventional wisdom is often wrong.”8 Conventional wisdom leads us to believe that longer wait times result in patient dissatisfaction. While this may be true for some

patients, the data suggests that patients are remarkably tolerant about waits so long as communication and staff attitudes remain optimal. In fact, it may be more productive to focus on patient-staff interpersonal relationships, communication, and attention to patient needs than on marginal improvements in wait times to promote ED satisfaction.7 Fred Lee, author of If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently, outlines an increasing hierarchy of care: competence, caring, and compassion.9 These elements elevate emergency care from a commodity to something that helps differentiate the best emergency departments from average ones. Disney doesn’t promise immediate access to their most popular rides; rather, it creates a positive customer experience through expressive qualities of customer satisfaction. Similarly, in emergency departments, the road to patient satisfaction may not be through reduction in wait times, but by providing a humanistic patient experience, the core of which is excellent expressive care.

Caring for the Caregivers…

Salvaging the expressive qualities of care begins first and foremost by recognizing that stressed systems are dysfunctional and need change. Anyone who has ever worked in an emergency department can attest to the fact that a stressed system is practically palpable: staff-staff and patient-staff interactions become short, curt, and sometimes angry. Meals are forgotten, bedpans are slow to come, repeat evaluations are overlooked, and clinical treatments are frequently delayed. Furthermore, patient “compliance is related to the quality, duration and frequency of interaction between the patient and doctor,”10 something that gets sacrificed in a stressed system. Recasting and retooling the emergency department in the new paradigm of the primacy of expressive care begins by recognizing the paramount importance of each and every member of the emergency department team. Without exception, caregivers must feel cared for, thus rationalizing the expectation that patients will receive similar consideration. It cannot be overemphasized that “organizations seeking to enhance the professional fulfillment of their employees cannot afford to ignore the influence of personal factors on overall fulfillment.” 11 Meier, et al. note that “the patientphysician relationship is fundamentally asymmetrical” where “physicians’ feelings are extraneous.”12 But without acknowledging these emotions, unintended consequences such as “physician distress, disengagement, burnout, and poor judgment” may result. 12 Emergency department personnel work in an inherently stressful environment where both good and bad outcomes occur.

Doctors report that the delivery of bad news is one of the most difficult tasks they engage in, characterized by anticipatory stress, fear, and anxiety.13 It is not unreasonable to assume that multiple micro-psychological traumas cumulate to cause low-level posttraumatic stress disorder (PTSD) in many emergency department practitioners. In one study of emergency department nurses, 33% fit the criteria for secondary traumatic stress, defined as the presence of PTSD symptoms in caregivers that may occur in association with an empathetic response in frequent exposure to trauma.14 Coupled with frequently erratic, non-circadian schedules, leading to chronic sleep deprivation, these factors may contribute to emergency department physicians functioning at a less-thanoptimal level. Intuitively, dissatisfied physicians are less likely to be effective clinicians or good communicators. Most importantly, respect and appreciation for the personal and collective needs

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Caring for the caregivers of emergency department staff members by administration are critical to the culture of positive expressive care. SAS Institute, a large, multinational software corporation, recently ranked first in Forbes magazine’s “Best Companies to Work For,” gained this distinction in part “through a culture of trust and respect, generous benefits, and recognition of the importance of people’s personal lives.”15 In an SAS blog, executive vice-president Mikael Hagstrom articulates his company’s philosophy: “Treat employees well and, in return, they will reward their employer with increased loyalty, productivity and innovation. And this extends to customer satisfaction; while most companies buy from other companies, in reality, the transaction occurs between people.”16 There can be no more intimate transaction between people than that between caregiver and patient. In short, we must create an environment that allows our personnel to be kind. According to Debbie Cardello of the Studer Group, “when the postscript on hospital care in the early 21st century is written, improving the satisfaction of employees will be recognized as the necessary first step toward enjoying clinical success and patient satisfaction.” 17 Changing…

In order to implement a culture of care, the emergency department must achieve maximum efficiency in order to reduce stress. Achieving this is not easy, nor can it be prescribed, as it defies a simple template: each emergency department has its own strengths, weaknesses, and limiting parameters, and exists within the larger context and efficiencies of the hospital institution. However, certain general principles apply: elimination of redundant and unnecessary activities, freeing of clinical staff from distracting bureaucratic work, application of evidencebased clinical algorithms, parallel “processing” of patients, and consistent matching of staff-to-patient volume. Organizationally, the emergency department team must be broken down into manageable units of individuals who work together frequently and develop familiarity and trust in each other. Anthropologist Robin Dunbar argues that when working groups consist of fewer than 150 people, “orders can be implemented and unruly behavior controlled on the basis of personal loyalties and direct man-toman contacts. With larger groups, this becomes impossible.”18 Given the complexity and pace of the emergency department, effective groupings are most likely even smaller. Additionally, empowering emergency department staff to identify problems and independently institute change is essential, as this builds partnerships and promotes ownership in the process to advance agreed-upon goals. Lastly, as Richard (Rick) Bukata, MD, noted educator of emergency medicine is fond of saying, “anything that removes the doctor from the bedside…is bad!” 19 This includes poorly-conceived and executed electronic medical records processing and physician order entry that may cause physicians to spend more time at a computer terminal than with patients.

Conclusion…

In a severely competitive health care environment, emergency departments are promoting shorter and shorter wait times, some advertising no waits, and offering incentives to patients for emergency department failure to meet these assurances. Hospitals are investing heavily in enlarging emergency departments and altering processes so patients can be brought directly into rooms from time of arrival. Although laudable, our desire to see everyone first may be chasing a ghost we cannot catch or making a promise

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(Continued)

we cannot keep. We must guard against gimmickry over substance, as these maneuvers tend to deliver short-term benefits but in the long run reduce patient confidence. Scripting is one example of this shortsightedness. Scripting is fine if the alternative is rudeness, but it is no substitute for the normal architecture of human interaction. Ultimately, no emergency department has unlimited staffing, space, or finances, and each emergency department has a threshold beyond which patients will have to wait. Applying arbitrary and unreasonable patient throughput time expectations is self-defeating, undermines staff morale, and adds system stress. Even when efficiencies are maximized, there are minimal irreducible times necessary to appropriately evaluate and treat patients, and the temptation to meet unrealistic and unsustainable turnover goals will degrade the clinical and expressive qualities of care. Only through the recognition and return of humanism to the practice and management of emergency medicine will practitioners and their patients be finally satisfied. This does not mean we should continue to do business in the inefficient and unaccountable ways of the past. Rather, the challenge is to apply best clinical practices in an environment permeated by the soft power of kindness for patients, and their caretakers.

References:

1. C DC. CDC-Press Release: Visits to U.S. Emergency Departments at All-Time High; Number of Departments Shrinking. 2005. Available at: http://www.cdc.gov/media/pressrel/r050526.htm.

Accessed 2. W ilper AP, Woolhandler S, Lasser KE, et al. Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997–2004. Health Affairs. Vol 27. Project Hope; 2008:w84-w95.

3. T he Emergency Department Pulse Report: Patient Perspectives on American Health Care. PressGaney Associates; 2009. Available at: . Accessed May 13, 2010 4. T hompson DA, Yarnold PR, Williams DR, et al. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department.

Ann Emerg Med. Dec 1996;28(6):657-665.

5. T rout A, Magnusson AR, Hedges JR. Patient satisfaction investigations and the emergency department: what does the literature say? Acad Emerg Med. Jun 2000;7(6):695-709.

6. K rishel S, Baraff LJ. Effect of emergency department information on patient satisfaction. Ann Emerg Med. Mar 1993;22(3):568-572.

7. H edges JR, Trout A, Magnusson AR. Satisfied Patients Exiting the Emergency Department (SPEED) Study. Acad Emerg Med. Jan 2002;9(1):15-21.

8. Levitt

SD, Dubner SJ. Freakonomics. New York, NY: Harper Collins; 2006.

9. A ssociation HFM. Compassion is Secret to Achieving High Patient Satisfaction. Vol V. Healthcare Financial Management Association; 2006. Available at: . Accessed Nov 23, 2007.

10. G riffith S. A review of the factors associated with patient compliance and the taking of prescribed medicines. Br J Gen Pract. Mar 1990;40(332):114-116.

11. B rown S, Gunderman RB. Viewpoint: enhancing the professional fulfillment of physicians. Acad Med. Jun 2006;81(6):577-582.

12. M eier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. Dec 19 2001;286(23):3007-3014.

13. B rown R, Dunn S, Byrnes K, et al. Doctors’ stress responses and poor communication performance in simulated bad-news consultations. Acad Med. Nov 2009;84(11):1595-1602.

14. D ominguez-Gomez E, Rutledge DN. Prevalence of secondary traumatic stress among emergency nurses. J Emerg Nurs. Jun 2009;35(3):199-204; quiz 273-194.

15. C ohen DJ, Prusak L. In Good Company: How Social Capital Makes Organization Work. Boston, MA: Harvard Business School Press; 2001.

16. H agstrom M. Why Employee Satisfaction Matters. Vol 2010. 2010: Blog. Available at: http://blogs. sas.com/mikaelhagstroem/index.php?/archives/14-Why-Employee-Satisfaction-Matters.html.

Accessed March 9, 2010.

17. C ardello D. Employee Satisfaction: Key to Driving Performance Excellence. Urgent Matters Vol 4.

2007. Available at: http://urgentmatters.org/346834/318733. Accessed May 14 2010.

18. G ladwell M. The Tipping Point. New York, NY: Little, Brown and Company; 2002.

19. Bukata WR. Going from Good to Great. Dallas; 2008: Course lecture presented as: American College of Emergency Physicians/Emergency Department Directors Academy.

Ethics in Action Whitney Barrett, MD, EM Resident, Denver Health Emergency Medicine Residency Jean Abbott, MD, MH, Faculty, Denver Health Emergency Medicine Residency Case: A 37-year-old male presents to the ED for the second time in a month. He is well known to the department because of C4/5 quadriplegia. He has frequent UTIs from his suprapubic catheter, and has recurrent IV access problems. Today he presents with his family because of subjective fevers and generally feeling worse over the past few days.

On exam, the patient is afebrile with a normal blood pressure, but is tachycardic and tachypneic . He has crackles in the left lung base, a neurological exam that is at his baseline, and dark urine with significant sediment draining from his suprapubic catheter. The patient is withdrawn and only mildly cooperative with questions. A chest x-ray is concerning for developing left lower lobe pneumonia, and urine is consistent with infection.

The patient refuses a peripheral IV line, but the treating team manages to get the patient scheduled for PICC line placement from the ED, anticipating prolonged need for parenteral antibiotics.

When the patient goes to get his PICC line placed, he refuses, and subsequently refuses hospitalization. In conversation with the ED team, he states he is tired of living with so much pain, with no control of his life, and he doesn’t want anything else done. He cannot be persuaded to change his mind.

On many levels, you can understand where he is coming from.

You might even think you would feel the same in a similar situation.

However, several ethical questions come to mind: - Does a patient who is clearly depressed have capacity to make this decision?

- At what point should he be allowed to refuse treatment?

- What is the best way to show respect for this patient?

- How does your own judgment of his quality of life affect your care?

The literature states that, in general, a patient has capacity if he or she is able to: a) express a choice b) demonstrate understanding of medical information c) appreciate how the medical information impacts him or her d) demonstrate logical reasoning (1) This patient clearly met the first three of these conditions. He was very familiar with the medical system, was able to clearly understand what procedure and treatments were needed, as well as their purpose. In addition, he could give reasons for refusing care. But was his reasoning clouded by underlying depression?

While depression does not, per se, indicate a lack of decisionmaking capacity, it may if it is a significant driver of the decision.

(1,2) As physicians, we are often reluctant to examine a patient’s mental state when it has no direct bearing on the chief complaint.

In this case, this disinclination may have been strengthened by the providers’ feelings that being a C4 quadriplegic implied a poor quality of life. This, together with the patient’s depressed

assessment of his life, may preclude further exploration of the “why” of his choices because his reasoning seemed logical.

However, Gerhart, al., studied self-rated quality of life in spinal cord injury patients and compared it to provider-perceived quality of life. Providers consistently underestimated the actual quality of life described by spinal cord injury patients. In their study, eightysix percent of spinal cord injury patients rated their quality of life as average or better, compared to 17% of providers imagining themselves in the same situation. (3) Although in low-stakes cases this failure to appreciate and explore depression as a cause for refusal of treatment may not matter, in potentially life-changing decisions we must be more careful. Appelbaum and Simon both discuss the sliding scale of capacity determination, emphasizing the difference between, for example, choosing to not have a laceration repaired and refusing a life-saving procedure. (1,2) Clinicians should require much better understanding and a rigorous assessment of capacity in lifechanging situations before allowing patients to refuse care. While both articles agree that autonomy of the patient is of the utmost importance, the issue of underlying depression and the relatively high risk of his refusal is enough to spur further evaluation.

What, then, is the best way to show respect for this patient, balancing our obligation to respect autonomy with our obligation to protect patients from harming themselves? The provider must acknowledge the patient’s pain and suffering. Simon suggests that attention, patience and empathy may help show this patient you care. (2) Family may be useful in understanding how stable this wish to stop treatments has been over time.

In the ED, without the benefit of longitudinal conversation, a compromise such as a less than ideal oral antibiotic, time-limited trial of an IV for fluid and antibiotic administration, and admission for continuing conversation and treatment of reversible acute medical problems and depression may be the best negotiated solution. As Simon points out, compromise is almost always possible – more often than we think! If the patient is not willing to compromise, assessment of capacity with an ethics consult or a psychiatric evaluation should be sought before the provider honors the patient’s initial expression of hopelessness. Outcome: The psychiatry-social liaison in the ED was able to have a long conversation with the patient; he agreed that the patient had capacity, but together they negotiated admission for observation and oral antibiotics, even though the team honored the patient’s refusal of an IV for the time being.

1. Appelbaum P. “Assessment of patients’ competence to consent to treatment”. N Engl J Med 2007;357: 1834-40.

2. Simon J. “Refusal of care: The physician-patient relationship and decision-making capacity”. Ann Emerg Med. 2007;50: 456-461.

3. Gerhart KA, Koziol-McLain J, Lowenstein SR, Whiteneck GG. “Quality of life following spinal cord injury: Knowledge and attitudes of emergency care providers”. Ann Emerg Med. 1994; 23:807-812.

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FUTURE DIRECTIONS IN EM ERGENCY M EDICINE RESEARCH: MOVING EM ERGENCY M EDICINE RESEARCH TO THE NEXT LEVEL For part three of the SAEM Research Committee’s series on unmet needs and opportunities in emergency medicine research, we interviewed Don Yealy, MD, Chair of the Department of Emergency Medicine at the University of Pittsburgh Medical Center. In this segment we continue to explore the topics of interdisciplinary collaboration, importance of expanded formal training opportunities, and patient-centered outcomes. Dr. Yealy is the Co-Principal Investigator of the NIH-funded multicenter clinical trial “Protocolized Care for Early Septic Shock” (ProCESS), which tests whether specific protocols of care improve mortality in these patients. In addition, the study aims to examine mechanisms of illness and recovery in sepsis by measuring concentrations over time of circulating markers of organ dysfunction, and to measure costs and resource utilization for protocolized resuscitation. This important clinical trial addresses outcomes in sepsis through a multi-disciplinary investigative approach by leading academic centers. The ProCESS team approach suggests ways that patient-centered outcomes research can be done on disease states where care begins in the ED but extends beyond the emergency department.

What are some unmet needs and opportunities in EM clinical research?

One of the greatest needs is for additional well-trained investigators who can “ask and answer the important questions in emergency medicine research.” Dr. Yealy believes that EM needs a steady stream of people with the skill-set and training to conduct research. The National Heart Lung and Blood Institute’s (NHLBI) recent RFA to create a specific career development (K12) grant mechanism for junior investigators seeking this type of training is a major step. This mechanism will provide training opportunities for new investigators in our field; however, one of the “downsides is that the topics funded will have to fit within NHLBI funding themes.” If this process is well received, it “may lead to the opportunity for renewal, expansion, or new institutional K initiatives for acute care research.”

What are some of the areas you predict will be highly funded in the next five years?

The major goal of future EM research will be to “demonstrate with appropriate science and outcomes what acute care actions truly improve the short- and long-term well-being of patients.”

The major opportunity in EM is that we see a large number of patients with a wide spectrum of illness. “The first few hours

may be squandered, and this can impact outcomes” - examples include sepsis and stroke. EM, however, needs to move forward from the type of research questions that we have been examining, such as “can we deploy a new intervention or test to confirm what we already know,” to looking at “patient-centered outcomes.”

High-impact research must include the pathobiology of acute illness and recovery in the acute setting, but also evaluate better endpoints of outcomes. “Another example of an area in which we have focused is the study of single biomarkers without important clinical correlation. We need to move beyond this again and look at patient-centered outcomes.” The biggest changes are to ask the important questions, involve interdisciplinary collaboration, and focus on patient outcomes. Picking the right questions and choosing a team that reaches outside EM is exemplified by the ProCESS model. In ProCESS, partnering with intensivists allows a coordinated and broader study to be designed and to improve implementation opportunities, as each partner brings their expertise to the effort. It also requires shared and joint leadership across EM and CCM, focusing on optimal acute care research rather than “The ED or the ICU”. Dr. Yealy notes that absent this type of collaboration, “We have a limited ability to ask and answer these important questions”.

What are some next steps after PROCESS? This study will uncover new questions: If one approach is clinically better, how can we implement it more widely? Once the biology is examined in Aim 2, how can we influence the next attempts to predict or alter the outcomes? For example, data from this effort could serve as a springboard for regionalization of sepsis care, such as in MI or stroke.

Resources: https://crisma.upmc.com/processtrial/info2.asp http://grants.nih.gov/grants/guide/rfa-files/RFA-HL-11-011.html See also - Annals of EM November 2010; 56(5):522-570 , which contains multiple articles highlighting future directions in emergency care research, including NIH roundtables On behalf of efforts from the SAEM Research Committee -- Larissa May, MD, Jonathan Valente, MD, Erik Kulstad, MD, Hillary Cohen, MD, and Mark Courtney, MD,

Academic Emergency Medicine Now Offers CME Credit ACADEMIC EMERGENCY MEDICINE is now offering continuing medical education (CME) credits for reading select articles in the journal and successfully completing a test on the content.

Physicians interested in completing the exam should log on to www.wileyblackwellcme.com. Upon successfully finishing the activity, physicians will receive an electronic certificate of completion, which can be printed and saved online under the user’s profile. The program is free to subscribers of the journal. Stay tuned for updates!

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CDEM Newsletter The Clerkship Directors of Emergency Medicine (CDEM) Academy has had a busy winter. As we dig out from snow storms, ice storms, and rain storms, we are looking forward to a fruitful, sunny spring.

CDEM members have been working hard on committee and task force matters.

This is a member-driven organization, and I would like to extend my thanks to all members, their families, and their significant others for the extra time they spend on CDEM projects. The CDEM track at CORD Academic Assembly was an overwhelming success. The excellent didactics were well attended by medical educators from across the country.

Take a look at our Self-Study Modules and Digital Instruction in Emergency Medicine at www. cdemcurriculum.org. This is a welldesigned and innovative on-line resource for your students. Other initiatives include development of an examination, a third-year curriculum, a simulation case bank, a pediatric EM curriculum, a direct observation tool with faculty development resources, additional DIEM cases, and many more initiatives. There will be a significant CDEM presence at SAEM, including our annual academy meeting, “Best of CDEM� presentations, and multiple educational programs. Look forward to meeting in person in Boston.

Douglas Ander, Z [ K MD, Chair, CDEM

Heal the sick, advance the science, share the knowledge.

Academic Emergency Medicine Physician Jacksonville, Florida The Department of Emergency Medicine, Mayo Clinic in Jacksonville, Florida is seeking a full-time academic Emergency Medicine physician. This job provides the opportunity to join a dynamic faculty with commitment to practice, education and research in a 24,000 visit/year high acuity department.

Mayo Clinic’s new state-of-the-art, regional referral hospital opened in April 2008, integrating our inpatient and outpatient practice on a single 400-acre campus. Mayo Clinic in Jacksonville is a 340-physician practice with a national and international referral base. Northeast Florida’s coastal location offers a pleasant climate and many outdoor recreational activities.

The successful candidate must be an individual with a demonstrated interest in academic emergency medicine as proven by performance in residency or fellowship training or faculty positions. EM residency trained, ABEM certification/preparedness and eligibility for Florida medical license required. A comprehensive and competitive salary and benefits package is being offered. To learn more about Mayo Clinic in Jacksonville, Florida, please visit www.mayoclinic.org/physician-jobs Interested individuals should submit a letter of interest and curriculum vitae to: Scott Silvers, M.D. Department of Emergency Medicine Mayo Clinic 4500 San Pablo Road • Jacksonville, FL 32224 E-mail: silvers.scott@mayo.edu Mayo Foundation is an affirmative action and equal opportunity employer and educator. Post-offer/pre-employment drug screening is required. Š 2011 NAS (Media: delete copyright notice)

SAEM Newsletter 3.5 x 4.75 &+$,5 2) 7+( '(3$570(17 2) (0(5*(1&< 0(',&,1( B&W

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19

Call for Proposals 2013 AEM Consensus Conference Submission deadline: April 15, 2011 The editors of Academic Emergency Medicine are now accepting proposals for the 14th annual AEM Consensus Conference, to be held on May 15, 2013, the day before the SAEM Annual Meeting in Atlanta.

Proposals must advance a topic relevant to emergency medicine that is conducive to the development of a research agenda, and be spearheaded by thought leaders from within the specialty. Consensus conference goals are to heighten awareness related to the topic, discuss the current state of knowledge about the topic, identify knowledge gaps, propose needed research, and issue a call to action to allow future progress. Importantly, the consensus conference is not a “state of the art” session, but is intended primarily to create the research agenda that is needed to advance our knowledge of the topic area.

Previous topics have included and will include (2011): • 2000: Errors in emergency medicine • 2001: The unraveling safety net • 2002: Quality and best practices in emergency care • 2003: Disparities in emergency care • 2004: Information technology in emergency medicine • 2005: Emergency research without informed consent • 2006: The science of surge • 2007: Knowledge translation • 2008: Simulation in emergency medicine • 2009: Public health in the emergency department: surveillance, screening, and intervention • 2010: Beyond regionalization: integrated networks of emergency care • 2011: Interventions to assure quality in the crowded emergency department Well-developed proposals will be reviewed on a competitive basis by a sub-committee of the AEM editorial board. The 2012 AEM Consensus Conference topic was announced at the SAEM Annual Business Meeting during the 2010 annual

meeting in Phoenix: Education Research in Emergency Medicine: Opportunities, Challenges and Strategies for Success, Nicole M. DeIorio, MD, Joseph LaMantia, MD, and Lalena Yarris, MD. Proceedings of the meeting and original contributions related to the topic will be published exclusively by AEM in its special topic issue in December 2012.

Submitters are strongly advised to review proceedings of previous consensus conferences, which can be found in the past November issues of AEM, to guide the development of their proposals. All prior consensus conference issues are available free of charge online. Submitters are also welcome to contact the journal’s editors or leaders of prior consensus conferences with any questions.

Proposals must include the following: 1. Introduction of the topic • brief statement of relevance • justification for this topic choice 2. Proposed conference chairs, and sponsoring SAEM interest groups or committees (if any) 3. Proposed conference agenda and proposed presenters • plenary lectures • panels • breakout topics and questions for discussion and consensus-building 4. Anticipated audience • stakeholder groups/organizations • federal regulators • national researchers and educators • others 5. Anticipated budget, to include such items as: • travel costs • audiovisual equipment and other materials • publishing costs (brochures, syllabus, journal) • meals 6. Potential funding sources and strategies for securing conference funding.

How to submit your proposal.

Proposals must be submitted electronically to aem@saem.org no later than 5PM Eastern Daylight Time on April 15, 2011. Late submissions will not be considered. The review sub-committee may query submitters for additional information prior to making the final selection. Questions may be directed to aem@saem.org or to the editor-in-chief at editor@saem.org.

Academic Emergency Medicine on the Wiley Online Library Platform Make sure you keep checking the journal’s home page on the recently implemented platform, Wiley Online Library (WOL) - http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1553-2712.

Many new features appear in the form of “modules” and will be updated on a regular basis. The new platform is more robust and easier to navigate, with enhanced online functionality. Visit often and stay tuned for updates!

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Wright State University Boonshoft School of Medicine Department of Emergency Medicine Faculty Position

Wright State University Boonshoft School of Medicine Department of Emergency Medicine seeks applications for a full time faculty member at the Instructor, Assistant or Associate Professor level. Faculty rank and salary are commensurate with the candidate’s professional qualifications and Boonshoft School of Medicine standards. Faculty activities include medical education at all levels, curriculum coordination, administration and patient care. An interest and ability in clinical and classroom education are preferred. Requirements for appointees include: MD or DO; Instructor, EM board prepared; Assistant, EM board certified; Associate, EM board certified and 5 years emergency medicine experience. All must be graduates of an emergency medicine residency and eligible for Ohio license. For additional requirements and to apply, go to https:// jobs.wright.edu/hr, by March 31, 2011. Work location is in Kettering. An AA/EO Employer.

                                                                                                                      

                           

                                          

                                                                                   

                                                                                                 

    

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Imagine being part of a team that makes a discovery.

Emergency Medicine Faculty UMDNJ-Robert Wood Johnson Medical School is searching for faculty physicians for its Department of Emergency Medicine on the New Brunswick campus.

Candidates should be residency trained board certified/prepared in Emergency Medicine (ABEM, ABOEM). Clinical responsibilities include direct patient care and attending supervision of residents and medical students in the Robert Wood Johnson University Hospital Emergency Department.

The department has a residency program in Emergency Medicine and has an established EMS fellowship, is developing a research program and increasing Emergency Medicine education within the medical school. Academic responsibility includes contribution to all aspects of the Department’s growth.

Robert Wood Johnson University Hospital serves as the medical school’s primary teaching affiliate. Robert Wood Johnson is a 580 bed Level One trauma center with an annual ED census of greater than 65,000 adult visits. A separate pediatric Emergency Department sees approximately 20,000 patients per year.

RWJUH has an active EMS system.

Qualified candidates should send a letter of intent and curriculum vitae to: Robert Eisenstein, MD Associate Professor & Vice Chairman, Department of Emergency Medicine, Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB 104, New Brunswick, New Jersey, 08903. Email: eisensrm@umdnj.edu Call: 732-235-8717, or Fax: 732-235-7379.

Academic appointment is commensurate with experience. UMDNJ is and Affirmative Action/Equal Opportunity Employer.

SAEM NEWSLETTER 03/01/2011, 05/01/2011 6150977-NYPC45767 UMDNJX 3.5” x 4.75” Colleen Gilrain v.4 PAGE 2

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EMERGENCY MEDICINE PHYSICIANS DIVISION OF EMERGENCY MEDICINE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO The Division of Emergency Medicine at University of Texas Health Science Center at San Antonio is recruiting full-time residency trained, BC/BE Emergency Medicine Physicians committed to developing an academic career. Academic rank and salary will be commensurate with experience. UTHSCSA is in the process of developing an emergency medicine residency program for year 2013. University Hospital will open a new Emergency Center in 2013. University Hospital is a 700 bed tertiary care facility. University Hospital Emergency Center is a 55 bed Level 1 trauma center which evaluates and treats nearly 70,000 patients annually. There is double physician coverage daily along with mid-level providers.

UTHSCSA offers a competitive salary, comprehensive insurance package, and generous retirement plan. Candidates are invited to send their curriculum vitae to: Justin Williams, M.D., FACEP, Interim Chief of Emergency Medicine, 7703 Floyd Curl Drive, MC 7840, San Antonio, TX 78229-3900.

Telephone: (210)358-2078, FAX: (210)358-1972. All faculty appointments are designated as security sensitive positions.

The University of Texas Health Science Center at San AntoQLR LV DQ (TXDO (PSOR\PHQW 2SSRUWXQLW\ $I¿UPDWLYH $FWLRQ Employer.

OHIO, The Ohio State University: Department of Emergency Medicine seeks physician to work clinically in our 20 bed comprehensive ED observation unit. The physician will work with a team of experienced mid-level providers and deliver care to over 500 patients/month on more than 30 observation protocols. EM and IM experience preferred.

For qualified applicants, flexibility available to split shifts in the ED and observation medicine. Compensation commensurate with qualifications, experience and academic appointment. Send CV to: Douglas A. Rund, MD, Professor and Chairman, OSU Emergency Medicine, 456 W. 10th Avenue, 4510 Cramblett Hall, Columbus, OH 43210; mary-jayne.fortney@osumc. edu; (614)293-8176. AAEOE.

Osler Drive Emergency Physician Associates (ODEPA), a well-recognized Emergency Medicine group in Towson, MD at St. Joseph Medical Center (SJMC) has opportunities for full-time and part-time BC/BP Emergency Medicine physicians. Physicians at ODEPA are rewarded with a productivity-based compensation model.

St. Josephâ&#x20AC;&#x2122;s is a 364-bed, acute care regional medical center, recognized as one of the nationâ&#x20AC;&#x2122;s top heart hospitals. This Level II facility has a 28-bed ED, a 10bed fast track, and an annual ED volume of 50,000.

Ample and equitable coverage is provided by both physicians and mid-levels.

Qualified candidates please contact Sharon Doggett, CPC, PRC at (800) 346-0747, Ext. 6008 or e-mail CVs to sdoggett@psrinc.net.

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Yale University School of Medicine, Department of Emergency Medicine

EMS MEDICAL DIRECTOR The Department of Emergency Medicine at the Yale University School of Medicine is currently seeking an EMS Medical Director to oversee the 12-town, 20-agency EMS system serving the greater New Haven area through the New Haven Sponsor Hospital Program (NHSHP). Approximately 200 paramedics and 500 EMTBasics receive medical oversight through NHSHP, which is a joint operation of Yale-New Haven Hospital and the Hospital of St. Raphael.

The EMS Medical Director will be appointed to the Department of Emergency Medicine academic faculty, and will work clinically in the Yale-New Haven Hospital ED (an urban, Level I trauma center with approximately 77,000 visits per year) and the Yale-New Haven Shoreline Medical Center ED (a suburban, freestanding ED with approximately 25,000 visits per year). The EMS Medical Director will join a well-established EMS leadership team with a commitment to continuous quality improvement, providing efficient care, and improving patient and provider satisfaction. The EMS Medical Director will serve on the New Haven SHARP Team (the only licensed physician response team in CT), and will have expectations of academic productivity in the Section of EMS, as well as teaching obligations in the Sectionâ&#x20AC;&#x2122;s EMS fellowship program, which will seek accreditation through ACGME as this process becomes available, and at NHSHP, which runs the largest paramedic training program in the state.

Candidates must be emergency medicine trained and board certified; and EMS fellowship training is preferred.

A field provider background is preferred due to the intense operational nature of the position. The successful candidate must demonstrate excellence in clinical, interpersonal, and administrative skills.

For more information, contact Dr. Gail Dâ&#x20AC;&#x2122;Onofrio at (203) 785-4404 or gail.donofrio@yale.edu. To apply, please forward your CV and cover letter via fax at (203) 785-4580, email: jamie.petrone@yale.edu, or mail at Yale University School of Medicine, Department of Emergency Medicine, 464 Congress Ave, P.O. Box 208062, New Haven, CT 06519-1315.

Yale University is an affirmative action, equal opportunity employer and women and members of minority groups are encouraged to apply.

24

Michigan State University Kalamazoo Center for Medical Studies

Associate Program Director The Department of Emergency Medicine at Michigan State University .DODPD]RR &HQWHU IRU 0HGLFDO 6WXGLHV VHHNV WR ÂżOO WKH QHZO\ FUHDWHG position of Associate Program Director.

2XU ZHOO HVWDEOLVKHG HPHUJHQF\ PHGLFLQH UHVLGHQF\ SURJUDP HQWHUV WZHQW\ UHVLGHQWV SHU \HDU LQ D IRUPDW :H WUHDW QHDUO\ SDWLHQWV DQQXDOO\ LQ RXU WZR /HYHO , WUDXPD FHQWHUV 2XU LQQRYDWLYH UHVLGHQF\ FXUULFXOXP IHDWXUHV SDUWLFXODU VWUHQJWKV LQ FULWLFDO FDUH (06 DQG DLU PHGLFLQH PDNHV H[WHQVLYH XVH RI PHGLFDO VLPXODWLRQ DQG SUR YLGHV H[FHOOHQFH LQ FOLQLFDO WUDLQLQJ :H VHHN D KLJK HQHUJ\ LQGLYLGXDO ZLWK D GHPRQVWUDWHG SDVVLRQ IRU medical education and residency leadership. The Associate Program 'LUHFWRU ZLOO UHSRUW WR WKH 3URJUDP 'LUHFWRU DQG EH UHVSRQVLEOH IRU assisting in and sharing the leadership of the Program and all its edu cational activities. &DQGLGDWHV VKRXOG EH $%(0 $2%(0 FHUWLÂżHG ,QGLYLGXDOV ZLWK IHO ORZVKLS WUDLQLQJ DUH HQFRXUDJHG WR DSSO\ 7KLV SRVLWLRQ SURYLGHV DQ DSSURSULDWH DFDGHPLF DSSRLQWPHQW KLJKO\ FRPSHWLWLYH FRPSHQVDWLRQ DQG EHQHÂżWV DPSOH SURWHFWHG WLPH DQG D GHOLJKWIXO IDPLO\ IULHQGO\ XQLYHUVLW\ FRPPXQLW\ LQ ZKLFK WR OLYH DQG ZRUN ,QWHUHVWHG FDQGLGDWHV VKRXOG IRUZDUG D FRYHU OHWWHU DQG &9 WR 'DYLG 2YHUWRQ 0' 0%$ )$&(3 )$&3 Professor of Emergency Medicine Michigan State University Kalamazoo Center for Medical Studies 2DNODQG 'ULYH .DODPD]RR 0LFKLJDQ

)$; RYHUWRQ#NFPV PVX HGX

Saint Louis University, a Catholic, Jesuit institution dedicated to student learning, research, healthcare and service is seeking qualified applicants for full-time faculty positions in the Division of Emergency Medicine.

Applicants must be Emergency Medicine board certified or eligible.

The Emergency Department at Saint Louis University Hospital, a Level I Trauma Center, evaluates over 34,000 patients a year.

Join the group of dedicated Emergency Medicine faculty in the School of Medicine. Teaching, administrative and research opportunities are available. Excellent benefits and unique opportunities are available. (http://www.slu.edu/services/HR/ benefits_overview.html) Interested candidates must submit a cover letter, application and current curriculum vitae to http://jobs.slu.edu. An initial letter of interest and curriculum vitae should be sent to: Laurie Byrne, M.D. Chief, Emergency Medicine Division Saint Louis University School of Medicine Saint Louis University Hospital 3635 Vista Avenue at Grand Boulevard St. Louis, MO 63110-0250 Saint Louis University is an affirmative action, equal opportunity employer and encourages applications of women and minorities.

MEDICAL DIRECTOR POSITION The University of Washington (UW) School of Medicine, Division of Emergency Medicine is seeking a Medical Director for the University of Washington Medical Center (UWMC) Emergency Department. The UWMC is a tertiary/quaternary care hospital serving the local as well as a large regional area, and is the home of the UW Medicine Regional Heart Center. There is a very active QA/QI program that is well integrated and supported by the medical center. The Division of Emergency Medicine encompasses both the UWMC and the Harborview Medical Center EDs. This position will join a broader team of Operations Improvement that spans the EDs of both medical centers. The position holds tremendous opportunity for growth and great program development potential. The UW Emergency Medicine Residency Program recently received ACGME accreditation and will be welcoming our first class of residents in July 2011. The UWMC ED will be core to this program.

This is a full-time position that would be at the Assistant Professor, Associate Professor or Full Professor rank, commensurate with experience, and without tenure due to funding. Candidates must hold an M.D. degree and must be board certified/eligible in emergency medicine. University of Washington faculty engage in teaching, research and service.

Please send your CV and cover letter to: Dr. Susan Stern, Professor and Head, Division of Emergency Medicine at sstern@uw.edu (206-744-2122).

The UW School of Medicine is a regional resource for Washington, Wyoming, Alaska, Montana and Idaho - the WWAMI states. The UW School of Medicine is recognized for its excellence in clinical training, for its world-class research initiatives, and for its commitment to community service. Graduates of foreign (non-U.S.) medical schools must show successful completion of all three steps of the U.S. Medical Licensing Exam (USMLE), or equivalent as determined by the Secretary of Health and Human Services. The UW is an affirmative action, equal opportunity employer.

25

CALLS AND M EETING ANNOUNCEM ENTS For details and submission information on the items below, see www.saem.org and look for the Newsletter links on the home page or links within the Meetings section of the web site.

Call for Papers – AEM

2011 Academic Emergency Medicine Consensus Conference “Interventions to Assure Quality in the Crowded Emergency Department” will be held on June 1, 2011, immediately preceding the SAEM Annual Meeting in Boston, Massachusetts. Original papers on the conference topic, if accepted, will be published together with the conference proceedings in the December 2011 issue of Academic Emergency Medicine.

Deadline for Abstracts: Monday, March 28, 2011.

Call For Papers

Consensus Conference Follow-Up Manuscripts Submissions in any category (Original Contributions, Brief Reports, etc.) that describe research that was initiated to address a research agenda topic generated at one of the prior Academic Emergency Medicine consensus conferences should be identified as such in the cover letter that accompanies the manuscript, when the manuscript is submitted for review. Authors should state to which consensus conference the manuscript relates, and should also state which issue(s) discussed or raised at that consensus conference is/are addressed by the manuscript. Attempts will be made to publish consensus conference follow-up manuscripts as a group, rather than individually, and if authors are aware of other papers underway from that same conference’s research agenda, they are encouraged to coordinate submission with the authors of those other papers. Contact: Gary Gaddis, MD, PhD (ggaddis@ saint-lukes.org).

Call for Manuscripts

2011 Academic Emergency Medicine CORD Educational Advances Supplement Deadline: 5:00 p.m. ET Friday, April 22, 2011 Academic Emergency Medicine is accepting manuscripts for consideration for selection in the 2011 Academic Emergency Medicine Council of Residency Directors in Emergency Medicine (CORD) Educational Advances Supplement.

Authors are invited to submit manuscripts in the areas of emergency medicine education research, education advances in emergency medicine, and CORD Academic Assembly education proceedings.

The deadline for submission of manuscripts for the CORD Educational Advances Supplement is Friday, April 22, 2011 at 5:00 pm Eastern Standard Time and will be strictly enforced.

Only electronic submissions will be accepted, via http:// mc.manuscriptcentral.com/aemj.

Manuscripts accepted for publication will be published in the October 2011 supplement issue of Academic Emergency Medicine (AEM), the official journal of SAEM. AEM and CORD will notify authors of a decision regarding publication within 45 days of the deadline for submission of materials. Please indicate in your cover letter that the submission is intended for the 2011 CORD Educational Advances Supplement.

Any questions should be directed to John Burton, MD, Guest Editor, at BurtonJ@mail.amc.edu, or David C. Cone, MD, Editor-in-Chief, at editor@saem.org.

VIRTUAL ISSUES “Virtual issues” will be a key feature of the journal’s new home page on our publisher’s recently-implemented platform, Wiley Online Library. A virtual issue is basically just a collection of articles on a given topic - so the EMS virtual issue, for example, will be a running compilation of all EMS articles that we publish. The idea is that a reader will go there to look for a particular article, but then will see our other offerings on that topic as well - increasing our full-text download numbers and helping ensure the broadest dissemination of our authors’ work.

See the “Clinical Reviews in Asthma” virtual issue on the web site of Clinical & Experimental Allergy here, for an example of how this works and what it looks like: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-222 (Note: you must be logged into your member profile on the SAEM website to access this link.)

Stay tuned for updates!

26

Membership Application Name:

Title:

Email:

Institution address: City:

State:

Zip:

Country:

State:

Zip:

Country:

Home address: City:

Preferred mailing address: Ƒ Office Ƒ Home Office phone: (

)

Home phone: (

Sex:

ƑM ƑF

)

Birth date: Fax: (

)

Check Membership Category

Ƒ Active - $545.00 Individuals with advanced degree university

Ƒ International - email membership for pricing

Ƒ Associate - $510.00 Open to those with interest in EM

Ƒ *Active/Associate/YP1 or YP2 Academy - $100.00 ea. Ƒ CDEM Ƒ AWAEM Ƒ Simulation Ƒ Geriatrics

appointment actively involved in EM teaching or research.

Ƒ Young Physician Year One - $325.00 First year following

Country:

residency graduation.

Ƒ *Medical Student/Resident/Fellow Academy - $50.0 ea. Ƒ CDEM Ƒ Simulation Ƒ Geriatrics Ƒ Young Physician Year Two - $450.00 Second year following residency graduation.

Ƒ *AWAEM Resident/Medical Student - FREE

Ƒ Resident/Fellow - $160.00 Open to residents/fellows interested in EM. Graduation date:

*must be a current SAEM member to join an academy

Ƒ Medical Student - $135.00 Open to medical students interested in EM. Graduation date:

Interest Groups: Society members are invited to join any of the dedicated Interest Groups listed below.

Each membership category includes ONE Interest Group free of charge. Additional Interest Groups can be added for $25.00 Ƒ Academic Informatics Ƒ Airway Ƒ CPR/Ischemia/Reperfusion Ƒ Clinical Directors Ƒ Disaster Medicine Ƒ Diversity Ƒ ED Crowding

Method of Payment

Ƒ Educational Research Ƒ EMS Ƒ Ethics Ƒ Evidence-Based Medicine Ƒ Health Services & Outcomes Ƒ International Ƒ Neurologic Emergencies

Ƒ Enclosed Check

Ƒ Palliative Medicine Ƒ Patient Safety Ƒ Pediatric EM Ƒ Public Health Ƒ Observational Medicine Ƒ Research Directors Ƒ Sports Medicine

Ƒ Toxicology Ƒ Trauma Ƒ Triage Ƒ Ultrasound Ƒ Uniformed Services Ƒ Wilderness Medicine

Ƒ Credit Card (Visa or MC) Total:

Name as it appears on credit card

Card Number:

Expiration Date:

Signature:

Billing Zip Code:

SAEM, 2340 S. River Rd, Suite 200 Des Plaines, IL 60018. email: membership@saem.org You may also join at member.saem.org

Rev. Date 10/13/2010

Society for Academic Emergency Medicine 2340 S. River Road, Suite 200 • Des Plaines, IL 60018 • 847-813-9823 • saem@saem.org • www.saem.org

Board of Directors Jeffrey A. Kline, MD President Debra E. Houry, MD, MPH President-Elect Adam J. Singer, MD Secretary-Treasurer Jill M. Baren, MD, MBE Past President Brigitte M. Baumann, MD, MSCE Deborah B. Diercks, MD, MSc Cherri D. Hobgood, MD Robert S. Hockberger, MD Alan E. Jones, MD O. John Ma, MD Jody A. Vogel, MD Executive Director James R. Tarrant, CAE Send Articles to: newsletter@saem.org Send Ads to: mgreketis@saem.org The SAEM Newsletter is published bimonthly by The Society for Academic Emergency Medicine.

The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. For Newsletter archives and e-Newsletters Click on Publications at www.saem.org

FUTURE SAEM ANNUAL M EETINGS 2011 June 1-5 Marriott Copley Place, Boston, MA 2012 May 9-13 Sheraton Hotel and Towers, Chicago, IL 2013 May 15-19 The Westin Peachtree Plaza, Atlanta, GA 2014 May 14-18 Sheraton Hotel, Dallas, TX 2015 May 13-17 Sheraton Hotel and Marina, San Diego, CA AEM Consensus Conference June 1, 2011 Topic: “Interventions to Assure Quality in the Crowded Emergency Department”.