January-February 2003

S A E M

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

901 North Washington Ave. Lansing, MI 48906-5137 (517) 485-5484 saem@saem.org www.saem.org

January/February 2003 Volume XV, Number 1

PRESIDENT’S MESSAGE My Changing Perspective on the Medical Literature Much has been written on the evolution of the medical literature.

The primary, research-based clinical literature is rapidly growing both in volume and in sophistication. With rigorous methodology, clinical research studies are more likely to Roger J. Lewis, MD, PhD yield results that are unbiased, can be applied in clinical practice, and will improve the effectiveness of emergency medical care.

The effect of published research on the quality of clinical care depends on several factors, however. The first is the quality of the research itself. In this context, the term quality includes many or all of the considerations taught in the paradigm of evidence-based medicine, including the definition of the research question, the patient population, the definition of outcome, and methods to reduce sources of bias. The second factor, however, is the mind set and expertise of the physician reading the article. Much of the evidence-based medicine paradigm and the literature surrounding journal clubs focuses on education to ensure the physician-reader is able to appropriately assess the methodologic quality of a clinical research study and identify threats to validity. The underlying assumption is that the quality of the research is the principal determinant of clinical impact.

I believe however, that there is a natural evolution in perspective regarding the medical literature, which significantly influences one’s assessment of the value of an individual publication and one’s willingness to incorporate the results into clinical practice. My hope is that by describing my own evolution in this regard, some may gain a little perspective on the evolution of their own attitudes towards the medical literature.

The first stage in my evolution as a reader was the “confused-awe” stage. During my tenure as a medical student, I was a faithful subscriber to the New England Journal of Medicine, but only because it seemed like I should subscribe.

I would frequently skim through the articles, or at least the abstracts, in a state of confused awe. I was in awe of the authors who could study and write about the bewildering array of topics covered, and confused because none of it made any sense to me whatsoever. To this day, I am impressed whenever a clinical evaluation states that a medical student was able to assimilate the primary literature and apply it to patients (continued on page 13)

Call for AEM Reviewers Deadline: March 1, 2003

The editors of AEM, the official journal of the Society for Academic Emergency Medicine invite interested SAEM members to submit nominations to serve as peer reviewers for Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine. As an indicator of familiarity with the peerreview process, the medical literature, and the research process in general, peer-reviewers are expected to have published at least two peer-reviewed papers in the medical literature as first or second author. Some of these papers should be original research work.

Alternatively, other scholarly work or experience will be considered as evidence of expertise (i.e., informatics experience demonstrated by network/data-base/desktop development).

AEM peer-reviewers are invited to review specific manuscripts based on their area(s) of expertise. Once a reviewer has accepted an invitation to review a manuscript, the reviewer is expected to complete the review within 14 days of receipt of the manuscript.

In order to provide feedback to reviewers, reviewers receive the consensus review from each manuscript that they review. In addition, each review is evaluated by the decision editor in the areas of timeliness, assessment of manuscript strengths and weaknesses, constructive suggestions, summarizing major issues and concerns, and overall quality of the review. Scores are compiled in the AEM database. Each year the Editor-inChief designates Outstanding Reviewers for public acknowledgment of excellent contributions to the peerreview process. Most appointments as peer reviewer are for three years. Reviewers whose consistently fail to respond to request to review, who are unavailable to perform reviews, or who submit later or incomplete reviews may be dropped from the peer reviewer database at any time, at the discretion of the Editor-in-Chief.

Individuals interested in being considered for appointment as an AEM peer reviewer must send a letter of interest including areas of expertise as defined on the reviewer topic survey and a current CV. The reviewer topic survey can be found at www.saem.org/ inform/resurvey.htm. All applications should be submitted electronically to aem@saem.org by March 1, 2003.

2003-2004 Committee and Task Force Appointments: The Selection Process and How to Apply Donald Yealy, MD University of Pittsburgh SAEM President-elect All SAEM members interested in serving on an SAEM committee or task force in 2003-2004 (appointments will be May 2003 through May 2004) must complete a Committee/Task Force Interest Form by February 1, 2003. This year the Committee/Task Force Interest Form has been developed as an online submission form on the SAEM web site at www.saem.org SAEM committees and task forces are the “engine” that drives the organization. It is through the work of these committees and task forces that the SAEM mission is advanced, the quality of the Annual Meeting maintained and improved, and many of the new ideas which strengthen our organization are developed and nurtured.

Being appointed to a SAEM committee or task force is both an opportunity and a commitment. It is an opportunity to improve the world of academic emergency medicine and to influence the direction of the Society as a whole.

Because there are frequently more members who wish to serve on committees/task force than available positions, it is expected that each member applying for a position is prepared to make a significant commitment towards completing the work of the committee.

Members should only apply to become a member of a SAEM committee/task force if they are willing and able to commit substantial time and energy.

It is important that members be aware that the goals and objectives of each committee/task force are not set by the committees themselves, but are guided by the five-year goals and objectives of the Society and defined by the Board of Directors. The SAEM Board sets the goals and objectives to ensure a coordinated set of activities and to reduce duplicate efforts. Thus, committee/task force members must be prepared to put their efforts towards the completion of predefined goals and objectives. As outlined below, however, there is significant opportunity to influence the goals and objectives to the committees through feedback to each committee chair or to the Board directly.

Members should be aware that onehalf or more of the goals and objectives

for each committee/task force are repeated each year. For example, one can anticipate that an objective for the Program Committee will always be to coordinate the Annual Meeting and to select abstracts and didactic proposal for presentation. However, each year current committee/task force chairs and members are urged to submit new objectives for consideration by the Board and President-elect as they develop the objectives for the next year.

How are new committee/task force members selected? First, each committee chair is asked to evaluate the performance of each current committee/task force member.

Members are evaluated in terms of their productivity, work effort, responsiveness to requests, and overall contribution to the function of the committee/task force.

Approximately one-third of each committee/task force membership is rotated off each year, based on both the chair’s evaluation and on the number of years each member has served on the committee/task force. This rotation is extremely important to ensure that as many SAEM members as possible have an opportunity to participate in the Society’s efforts. For this reason, in general, SAEM members will be appointed to serve on a single committee/task force at one time.

All prospective committee/task force members, whether currently on a SAEM committee/task force or with no prior experience, are required to complete a Committee/Task Force Interest Form in order to be considered for reappointment or new appointment. The Form must be accompanied by a current CV. The Interest Form should include the applicant’s motivation for joining the committee/task force, ideas regarding areas in which they may contribute to the committee/task force, and any other information the applicant deems relevant. In evaluating these applications, the President-elect looks for evidence of enthusiasm, focus, realism, new ideas, and commitment. Applications are generally much stronger if they demonstrate an understanding of SAEM’s mission, the five-year plan for the organization, and the current year’s goals and objec-

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tives for the individual committee/task force. All of this information is available on the SAEM web site at www.saem.org.

Among some SAEM members there is an unfortunate perception that being appointed to a SAEM committee/task force requires being a member of some inner circle. On the contrary, each year the President-elect makes a concerted effort to appoint members who have not previously had an opportunity to serve, as part of an ongoing effort to develop new leadership talent in the Society.

Because the President-elect cannot know all members equally well, the information provided in the Committee/Task Force Interest Form and the CV is weighted heavily in the selection process. This helps ensure fairness, opportunity, and a well-balanced committee/task force membership.

It cannot be emphasized enough that first-time appointment to a committee/task force in SAEM is most likely when a complete and thoughtful Interest Form is submitted.

Reappointment to a committee/task force is most likely when the member has been an active and productive member of a current committee/task force.

Members of SAEM who wish to be considered for appointment or reappointment to a SAEM committee or task force in 2003-04 must submit an online Committee/Task Force Interest Form by February 1, 2003. The Form is now available on the SAEM web site at www.saem.org.

SAEM Research Fund – The Greater Context of Giving Brian J. Zink, MD University of Michigan Medical Center Chair, SAEM Financial Development Committee The initial response to the SAEM member appeal for the SAEM Research Fund has been very positive.

Contributions from members have been unprecedented, with several members contributing at the Professor, or highest level of giving. Still, those who have donated to the SAEM Research thus far represent only a tiny minority of active members. Two essential components to giving are having the resources to donate, and believing in the cause that is represented. As physician wage earners, nearly all of us have the means to contribute at least some small portion of our income to the SAEM Research Fund. The issue at hand therefore, is believing in the cause.

As each member decides whether it is worth contributing to the SAEM Research Fund, it may be useful to look at this cause in a larger context.

Emergency Medicine as a specialty has finally come of age, both in the community and academic environment. We can look across the country and find high quality, residency-trained emergency physicians staffing many Emergency Departments, strong residency programs that are attracting the best and brightest medical students, strong and vigorous professional organizations, and a strong and innovative specialty board. Our journals are widely read and cited, our scientific meetings are well attended, and we have a strong voice and presence in national health care policy. The only realm where Emergency Medicine has lagged behind is in research. This is not for lack of awareness of the importance of research to academic success. Thirty years ago our academic founders articulated that a credible research base would be an integral component of the academic development of Emergency Medicine. But, we have struggled to match our academic peers in terms of research training, productivity and building a strong group of independent Emergency Medicine senior investigators. We have certainly made some strides in recent years.

Some Emergency Medicine investigators have been successful in securing long term NIH funding and wide spread recognition for the quality of their research.

However, as a field, our success is spot-

ty, and funded research opportunities for young emergency physicians, and support for junior level investigators is not plentiful. The Emergency Medicine Foundation has helped by funding research for many years. The SAEM Research Fund was developed to provide more training grants for emergency physicians.

With our two-year, $150,000 research training grants, we hope to provide the boost that young academic emergency physicians need to become successful researchers.

Currently only two people are able to get this support each year – we would like to see that number increase as the Research Fund grows.

An even bigger context to consider is the benefit that emergency medicine research can have for our patients.

Beyond training emergency physicians and providing grant funding, the Research Fund is about helping the legions of people we treat every day in our Emergency Departments. The promises of new drugs, new devices, practice standards, social and epidemiological interventions, and discoveries of the basic mechanisms of disease, will all be empty unless they are carefully researched by emergency physicians.

The SAEM Research Fund will provide the training so that emergency physicians are leading the way in research that will benefit emergency patients.

Another larger context is a historical one, gleaned from interviews that I have been doing with the founders of emergency medicine. When we look at the complexity of our days, and the magnitude of our academic work, it seems that we are giving to the field in an unprecedented manner. But, our forefathers in emergency medicine practice and academics set the standard for giving to the field. Although they are too modest for me to include their names, consider what they gave. In the early days of forming the specialty, one early leader worked 56 clinical hours per week. In his “spare time” he organized and led the early organizational meetings, contacted people from the AMA and other national organizations, and traveled extensively to promote the formation of Emergency Medicine. These travel expenses came out of his own pocket, and in today’s dollars would

amount to about 4 months of an average academic emergency physician’s annual salary. In order to allow for this amount of travel, the emergency physician colleagues of the early EM leaders also had to give. They were often asked to fill in shifts, work double shifts, and otherwise hold down the fort while the leaders were away.

In the academic realm the early leaders were also sacrificing a great deal.

Many of them were fighting two vigorous battles at once. One was to justify and maintain their existence in hostile academic medical center environments.

The other was to build an academic specialty amidst similar hostile forces on a national level. Many of these early leaders had interests in research, teaching, and other areas of academic medicine. However, they gave up their individual interests and aspirations in order to create an environment where their successors could flourish. In doing so, many of them ignored their own career development, and especially in the area of research were unable to live out their dreams. Even those who were never involved in research now reflect on it.

One early leader, who was instrumental in the establishment of quality emergency medicine residencies and teaching, but not research, in response to a question about how emergency medicine has changed over the years said: ... “I think that things ...that have pleased me most about emergency medicine is the kind of people who have gone into it, and what has been accomplished as far as investigators work ...we have taken our practice and examined it. We have examined at the bench and we’ve examined it in the clinical work place. We’ve done it in a way that many other specialties much larger, more powerful have not ... I think that that probably more than anything makes me very proud that we have sought out our best practices and tried scientifically and objectively to determine what best practice is. It has benefited patient care immeasurably.”

The purpose of pointing out the tremendous passion and sacrifices of our founders is not to heap shame or guilt on current academic emergency physicians – we have different challenges. It is to emphasize that today it (continued on page 4)

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SAEM Research Fund (Continued) is much easier for us to have an impact on the development of our specialty in this last great area of research. We now have the structure, resources, and trainees who are eager to do research.

All we need is the funding to make it

happen on a scale that will eclipse anything we have ever seen before in emergency medicine. As you consider whether to give to the SAEM Research Fund, look at your emergency patients, and reflect for a moment on the people

who made your career possible – it should then be an easy decision. To make a contribution to the Research Fund, go to www.saem.org and click on “to contribute to the Research Fund” or call 517-485-5484.

SAEM/ACMT Michael P. Spadafora Medical Toxicology Scholarship Dr. Michael P. Spadafora was an academic emergency physician and medical toxicologist who was a member of SAEM and the American College of Medical Toxicology (ACMT) and was dedicated to resident education. After his death in October 1999, donations were directed to SAEM for the establishment of a scholarship fund to encourage Emergency Medicine residents to pursue Medical Toxicology fellowship training. ACMT has graciously agreed to donate matching funds.

Two recipients will be chosen to attend the North American Congress of

Clinical Toxicology (NACCT), which will be held September 4-9, 2003 in Chicago. Each award of $1250 will provide funds for travel, meeting registration, meals, and lodging. Any PGY-1 or 2 (or PGY-3 in a 4 year program) in an RRC-EM or AOA approved residency program is eligible for the award. The deadline for application is May 1, 2003.

Scholarship recipients will be announced at the annual SAEM and NACCT meetings. Each recipient will also be required to submit a summary of the ACMT scientific symposium and the ACMT practice symposium for publica-

tion in the SAEM Newsletter and the Internet Journal of Medical Toxicology.

Applications must be submitted electronically to saem@saem.org and include: 1. Curriculum Vitae of applicant 2. Verification of employment and letter of support from the applicant’s program director 3. Letter of nomination from an active member of SAEM and/or ACMT 4. 1-2 page essay describing the applicant’s interest and background in Medical Toxicology

Call for Nominations AEM Editorial Board Deadline: March 1, 2003 Michelle Biros, MD, MS, Editor-in-Chief, invites nominations for potential members of the Editorial Board of Academic Emergency Medicine. A limited number of individuals will be appointed to the Editorial Board to begin three-year terms, beginning during the SAEM Annual Meeting in Boston in May. Preference will be given to those who have demonstrated previous service to the Journal, especially those with a track record of peer review and active participation in the Journal.

Editorial Board member responsibilities include: 1. Perform peer review of at least three manuscripts per year.

2. Assist in peer review of additional manuscripts on an ad hoc basis.

3. Contribute commentaries as requested by the Editor or Senior Associate Editors. These may be on specific articles or concepts. It is expected that each Editorial Board member will contribute at least one commentary during their tenure on the Board.

4. Attend the Editorial Board meeting held during the SAEM Annual Meeting.

5. Respond to e-mail communications regarding the workings of the journal, through the Editorial Board list-serv.

6. Participate in, and complete, tasks assigned by task forces and committees created to investigate or develop specific policies or procedures and topics of the Journal and its operations. Provide on-going reports of the progress of these tasks as requested.

7. Represent AEM among peers, their institutions, at meetings, conferences, exhibits, etc. Suggestions include distributing copies of the Journal, soliciting and submitting articles, providing contacts for potential peer reviewers, staffing the AEM Booth, and nominating additional members to the Editorial Board.

Other involvement that is requested but not mandatory: 8. Service as a guest decision editor.

9. Assist decision editors in manuscript processing.

10. Attend a second Editorial Board meeting, usually held during the ACEP Scientific Assembly.

Nominations must be submitted electronically to aem@saem.org by March 1, 2003. Nominations must include the following materials: 1. A letter of interest.

2. Names and contact information of two academic references.

3. An updated curriculum vita.

Energetic and qualified individuals are strongly urged to consider submitting a nomination to serve on the Academic Emergency Medicine Editorial Board. AEM owes much of its success and development to the active participation of the SAEM membership as peer reviewers, Editorial Board members, and decision editors.

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Report from the AAMC: Improving the Nation’s Health James Hoekstra, MD Ohio State University David P. Sklar, MD University of New Mexico SAEM representatives to the AAMC On November 10-13, 2002, in San Francisco, the Association of American Medical Colleges (AAMC) held its annual meeting. The theme of the meeting was “Improving the Nation’s Health.” In his Chair’s Address, Dr. Ralph Snyderman spoke eloquently about what he termed the “next health care transformation,” from acute and episodic care to “prospective care.” He envisioned a health care system of the future which would take our present knowledge of genomics, proteomics, and metabolomics, and apply it to individuals to predict risk of many chronic cardiovascular, neoplastic, and neurodegenerative diseases. This database of risk predictors could be used to “prospectively” plan a life-long medical and psychosocial treatment program to prevent disease.

He described the present national health care system as reactive, sporadic, physician directed, poorly integrated, and expensive. With the nation’s baby boomers reaching retirement age, the present health care system does not have the financial or facility capacity to deal with the load of acute illness that will be present in the next decade. As such, only with the full application of our scientific knowledge of chronic disease states in the area of prevention, can we stem the tide of an aging population.

Dr. Jordan Cohen, in his President’s Address, echoed the thoughts of Dr. Snyderman, calling on the nation’s medical schools to renew the public’s trust in physicians. He pointed out that patients still trust their doctors, even though they don’t trust insurers, health systems, or the institutions of medicine. He called on physicians to make health care safer, to change the culture of GME to provide safe working conditions for residents, to manage conflicts in clinical research, to restructure the nature of health care delivery to provide “prospective” care, and to prepare tomorrow’s doctors to practice in an environment of prospective and preventive care.

He announced the creation of an Institute for the Improvement of Medical Education to help accomplish this task.

There was a palpable shift in the health care emphasis at this year’s AAMC meeting. There is no doubt that

the AAMC sees the future of medicine in disease prevention and the prospective care of chronic diseases. There were numerous sessions surrounding the topics of incorporating public health and disease prevention into the medical school curriculum, as well as into our health care systems. The implications of this shift in the AAMC’s direction on emergency medicine are unclear. If the AAMC is right, however, there may be a shift in emphasis at the research funding level in the near future. Alliances with funding agencies and academic departments that promote or study public health, injury prevention, and risk factor detection or modification may become more important for emergency medicine research as we move into the next decade. We can’t afford to sit by and miss the boat.

There were a few other prominent themes at AAMC which deserve mention.

Professionalism remained a prominent topic, as medical schools and GME programs struggle to define it and devise systems to evaluate it. GME core competencies and the evaluation methods used to provide 360-degree assessment of resident performance also remained a concern for attendees.

The effects of resident work hours limitations remained foremost in many attendees' agendas, with a number of sessions devoted to this issue.

Although the limitations do not directly affect EM residents in the ED, the effects on off-service rotations or ED specialty coverage remain to be seen.

There were also several sessions on the use of simulators (mannequins and virtual reality) technology on resident education. This appears to be a promising method of assuring procedural competency without jeopardizing patient care.

Finally, there was discussion regarding a recent lawsuit brought against the NRMP, the AAMC, and various specialty societies alleging noncompetitive practices concerning the resident match. This anti-trust lawsuit, whether meritorious or not, will undoubtedly cost the AAMC and its constituencies thousands of dollars to defend. Its ramifications on the future of the match and resident recruitment, as we have come to know it, is unclear. The AAMC is hoping 5

for financial help from all its academic partners as it gets ready to defend the case.

A number of sessions centered on the concept of “consumerism,” which is defined broadly as the empowerment of patients to make decisions regarding their own care. Patients are presented with quality and price indicators on everything from medications to procedures to hospitals. They can then make their own choices regarding their care.

Since insurers are moving more and more to tiered systems of health care reimbursements with adjustable copays, it is inevitable that patients must be provided the data to make these decisions. The implications of this payment system for acute or emergent care are unclear, since the lack of patient choice in emergent situations often makes informed decisions impossible.

SAEM and the AACEM jointly sponsored a well-attended 3-hour session on November 10. Bob Derlet, MD, Brent Asplin, MD, and Mark Henry, MD, led a discussion on “ED Overcrowding: Effects on Medical Education.”

Dr. Derlet introduced the concept of ED overcrowding, shared some of the reasons for overcrowding, and speculated on the effects of overcrowding on resident and medical student education. Dr. Asplin discussed legislative, regulatory, and process-centered interventions that have been introduced to alleviate hospital under-capacity, and their effectiveness at decreasing ED boarding of admitted patients.

Finally, William Petasnick, the President-elect of the Council of Teaching Hospitals, provided his views regarding hospital capacity, ED boarding, and the interventions that he felt would provide the best chance for alleviation of this issue. Dr. Henry led a discussion in which there was a remarkable synergy notable between the emergency physicians in attendance and Mr. Petasnick regarding this issue. What resulted was an excellent session, and a chance for emergency medicine to form an allegiance with a powerful group of administrators who apparently share our views on this issue.

In the second session, John Moorhead, MD, presented the results of the ED Workforce Study, which was (continued on page 6)

CDC Advisory Committee for Injury Prevention and Control Ronald F. Maio, DO, MS University of Michigan SAEM representative to CDC National Center for Injury Prevention and Control Meeting On November 7, 2002, I was invited to attend the Advisory Committee for Injury Prevention and Control for the CDC's National Center for Injury Prevention and Control (NCIPC) in Atlanta, Georgia. Other invited guests from Emergency Medicine included: Bob O'Connor from Christiana Hospital in Delaware and Bob Schafermeyer from Carolinas Medical Center in North Carolina. Representatives from Trauma Surgery included: Wayne Meredith from Wake Forest University, Ron Maier from Harborview Medical Center, and Dave Hoyt from University of California San Diego.

We had been asked to attend this meeting to help the Advisory Committee and Sue Binder, the Director of the CDC's National Center for Injury Control and Prevention, to develop research priorities for acute care within the center.

Acute care resides within the Division of Injury and Disability Outcomes and Programs (DIDOP). The newly appointed division head is Dr. Joe Sniezek.

In discussing the budget for the Injury Prevention and Control Center of the CDC, Dr. Binder noted that the budget for 2003 was going to decrease by about 3%. She went on to say that there will be cuts for funding all the different activities that the Center supports, including acute care. She said that one of her main goals to accomplish at this meeting was to identify important areas and potential "low-hanging fruit" for future research funding.

She thought that a major way for increasing funding for the Center's activities will be to demonstrate the importance and impact of the research that it is funding.

Another area that she was very concerned in addressing was the area of bioterrorism and emergency operations.

The CDC is increasing the funds for bioterrorism and emergency operations in 2003 by 800%. Funding has gone from approximately $182 million in fiscal year 2002 to over $1.5 billion in fiscal year 2003. Although the CDC has emphasized biological agents in its research activities, Dr. Binder wants to determine how her center might play a role in addressing threats from radiologic or chemical related acts of terrorism, and also the effect of multiple casualties from conventional weapons. Dr. Binder also went on to say that even if funding

within the Injury Control Center is limited, that she and her colleagues could work to help facilitate injury related research that would be funded by other governmental agencies, in particular the NIH. For example, Dr. Binder acknowledged the importance of laboratorybased large animal research and clinical studies on acute trauma physiology, yet stated that these were areas that it would be unlikely for the CDC to adequately fund.

Drs. Hoyt, Maier and Meredith represented trauma surgery, and more specifically, the American College of Surgeon's Committee on Trauma. Dr. O'Connor represented NAEMSP, Dr. Schafermeyer represented ACEP, and I represented SAEM. Prior to beginning discussions, three presentations were made regarding acute care for injury.

Dr. O'Connor addressed issues relevant to prehospital care, Dr. Schafermeyer discussed issues relevant to emergency department care, and Dr. Maier discussed issues relevant to trauma surgery. These presentations were very brief and addressed previous and current work in these areas, as well as areas that need to be addressed in future research. Dr. Maier emphasized the importance of continuing to do evaluation and research on determining the best way to deliver trauma care, in particular improving the distribution and effectiveness of trauma systems. Dr. Schafermeyer underscored the importance of how overloading of the emergency department and inadequacy of resources limits the effectiveness of our current emergency systems to obtain and sustain any surge capacity to address terroristic events occurring from bioterrorism activities or from the effects of weapons of mass destruction. Dr. Schafermeyer also went on to underscore the role that emergency medicine is playing in its implementation of primary injury prevention interventions in the emergency department.

Dr. O'Connor emphasized the role that EMS prehospital care plays in responding to any terroristic activities. He also discussed the role that prehospital care providers can play in injury prevention activities that dovetail with their normal clinical work. All three speakers suggested that rather than develop a completely new system to address terroristic 6

events that the country should build and strengthen its current EMS and trauma system infrastructure.

It became clear as the discussions proceeded that identifying research priorities for acute care within the NCIPC was not going to easily be determined in one session. We were therefore invited to participate in another meeting regarding acute care research priorities that will be held in April 2003. Furthermore, Dr. Binder said she is looking for a team leader in acute care to be assigned to the DIDOP to assist Dr. Sniezek in developing research and a research agenda. She said that this individual could come on at a part-time employment and would not have to give up their current position. The CDC would pay a part or all of this individual's salary, at their current rate, in order to get assistance in developing an acute care research agenda.

I would encourage members of SAEM and particularly members of the Injury Prevention or Trauma interest groups to contact Dr. Sniezek: Joseph Sniezek, MD, Centers for Disease Control & Prevention, 4770 Buford Hwy., Mail Stop F41, Atlanta, GA 30341. Or call (770) 488-4031, or fax (770) 488-4338 or email at jsniezek@cdc.gov.

If anyone has any concerns or comments, please do not hesitate to contact me at ronmaio@umich.edu.

Improving the Nation’s Health (Continued) published in Annals of Emergency Medicine. He eloquently presented the complexity of this issue, and the large number of factors that can effect workforce predictions. He was cautiously optimistic regarding emergency medicine opportunities in the future, and recommended modest increases in our capacity of emergency medicine training slots. Interestingly, the AAMC recently conducted a similar workforce study analyzing the physician workforce across all specialties. Their results were very similar, concluding that they weren’t real sure about their findings, but they think there may be an undersupply of physicians in the near future.

Board of Directors Update and 2003 Budget The SAEM Board of Directors meets monthly. Three times a year, this is done ‘in person’, at the SAEM Annual Meeting, the ACEP Scientific Assembly, and the CORD Navigating the Academic Waters Conference. The remaining meetings are done via conference call. This article will cover the Board’s activities during its meeting during the ACEP Scientific Assembly on October 7 in Seattle and the November Board conference call.

The agenda during the meeting in Seattle focused on financial issues. The Board reviewed a number of proposals submitted by the Financial Development Committee. The Board agreed to formally split the Society’s financial resources into three separate entities: operating budget, reserve account, and Research Fund. The Board agreed that the reserve account will be established in an amount representing six months of the annual operating budget. The Board also agreed that at the end of each year the Board will transfer funds in excess of the six month reserve account to the Research Fund.

The Board endorsed a proposal to investigate using a professional money manager for the Research Fund. The Financial Development Committee will develop proposals that will be presented to the Board during the February Board meeting. The Board also agreed with the Financial Development Committee’s proposal to identify a financial development individual to assist with the development of the Research Fund. It is expected that the Board will interview potential financial development officers during the February Board meeting.

The Board reviewed and approved a draft 2003 operating budget as follows:

Interest Group grants.

The Board agreed that the financial decisions of the Board will be reported to the membership, including a year-end financial report. A year-end 2002 financial report will be included in the February/March issue of the Newsletter.

The Board also reviewed and approved a five-year contract between SAEM and Hanley & Belfus, Inc., the publisher of AEM. It was noted that SAEM will be provided with a copy of the program, Editorial Manager, which will allow authors to submit manuscripts to AEM online, and will allow AEM to track manuscripts online. The new version of Editorial Manager will probably not be available until mid-2003.

The Board selected a slate of nominees to be forwarded to the American Board of Emergency Medicine. The Board selected Jim Adams, MD, and Brian O’Neil, MD, to represent SAEM at the Stroke Symposium sponsored by the National Institute of Neurological Disorders and Stroke. The Board approved the appointment of Judd Hollander, MD, and Sue Stern, MD, to serve as the SAEM representatives to the Emergency Medicine Foundation beginning January 1, 2003.

The Board elected Kate Heilpern, MD, to serve as the Board member representative to the 2002-03 Nominating Committee. The Board approved the appointment of Steve Meldon, MD, as the SAEM alternate representative to the Section on Surgical and Related Specialties of the American Geriatric Society.

The Board approved the development of a brief survey regarding members’ federal funding history to be sent via email to the membership, along with the announcement of the November/December issue of the Newsletter.

The Board reviewed the proposal of the Ethics Committee, chaired by Catherine Marco, MD, which included a list of topics for development of a position paper or statement. The Board selected the issue of informed consent.

The Board approved the proposal by the Question and Answer Task Force, chaired by Stephen Thomas, MD, to post the question and answer bank on the SAEM web site, once it was completed.

The Board approved Dr. Chisholm’s proposal for the continued development of the Resident Mentoring Program. A formal program will be presented on May 28, the day before the Annual Meeting, beginning at 5:00 pm. The program will include a dinner for the members of the Board, the committee/task force chairs, and the residents appointed to the 200203 committees and task forces.

The Board agreed to develop a membership drive aimed at the chairs of departments and divisions of emergency medicine. The Board approved Washington, DC as the site of the 2008 Annual Meeting.

The next Board of Directors meeting will be held on Saturday, February 22 in Arlington, Virginia during the CORD Navigating the Academic Waters Conference. All members are invited to attend this and any Board meeting.

REVENUE Dues: $1,086,725 Annual Meeting: $420,000 Journal/Newsletter: $215,000 Sales/Service: $26,500 TOTAL: $1,748,225 EXPENSE Salaries/Wages: $315,000 Administration*: $199,000 Meetings**: $273,000 Journal/Newsletter: $510,000 Representation/Support: $45,000 TOTAL: $1,342,000 *Includes health insurance, payroll taxes, employee pension plan, postage and printing, telephone/fax/conference calls, accounting, photocopying, computer consultants, bank charges, and office maintenance. **Includes SAEM Annual Meeting and regional meetings, as well as expenses associated with the AAMC Annual Meeting and the ACEP Scientific Assembly.

The Board reviewed and approved a draft 2003 Research Fund budget with revenue of $75,000 and expenses of $346,500. This budget assumes funding of one grant recipient in the following grant programs: Research Training, Institutional Training, Scholarly Sabbatical, Neuroscience Fellowship, EMS Fellowship, and Geriatric Grant. The budget also includes 7 recipients of the SAEM/EMF Medical Student Research Grants and 6 Emergency Medicine Medical Student

Check the SAEM web site for information on the 2003 Annual Meeting. Watch for the updates beginning Janaury, 2003.

7

Fellowship, Clerkship, and Residency Catalog Updates Requested The Emergency Medicine Fellowship and Undergraduate Rotation Lists on the SAEM web site are very popular.

These lists are updated continuously, but it is difficult to ascertain if any institutions are being missed. If your institution has an emergency medicine fellowship or offers a clerkship, please take a

few moments to review these sites and contact SAEM at saem@saem.org with corrections or additions.

The Fellowship List can be found at www.saem.org/services/fellowsh.htm and the Undergraduate Rotation List can be found at www.saem.org/rotation/ contents.htm

The Residency Catalog is also undergoing its annual update.

Residency directors are encouraged to update their institution’s listing prior to the upcoming interview season. The Residency Catalog can be found at www.saem.org/rescat/contents.htm

SAEM Responds to CMS Medicare Part B Teaching Position Policy On December 3 SAEM sent the following letter to Thomas Scully, the Administrator of the Center for Medicare and Medicaid Services. The letter was developed by the National Affairs Committee, chaired by Robert Schafermeyer, MD. I am writing on behalf of the Society for Academic Emergency Medicine (SAEM), its more than 5,000 members and the patients they serve at over 130 teaching hospitals. SAEM is also a member organization of the Association of the American Medical Colleges (AAMC) Council of Academic Societies.

For over 30 years, teaching physicians have been obligated to comply

with Medicare documentation requirements when they bill for a Medicare service involving a resident. At issue, over the years, has been the involvement of the teaching physician during such service and the documentation that must be provided to support the level of service billed to Medicare.

SAEM strongly supports appropriate physician service documentation for all

of the patients to whom we provide emergency medical care. In the past we have stated to CMS (then HCFA) that Medicare patients should have access to high quality care and that such care be appropriately documented in their medical record. However, when the issue of teaching physician documentation was discussed with HCFA, we stated that the regulations were overly bur(continued on page 10)

Federally-Funded Principal Investigators in Emergency Medicine Clifton Callaway, MD, PhD University of Pittsburgh SAEM Research Committee Obtaining federal support for an investigation is often considered an index of successful research development. Department chairs, deans, and policy makers often focus on federal funding when gauging the maturity and depth of research efforts in our specialty. Who and what has been successfully funded also provides examples for other investigators about centers of expertise and successful funding strategies. For those reasons, the SAEM Research Committee has attempted to compile a consolidated list of federally funded emergency medicine research.

This list was first published in the January/February 2002 Newsletter, and included 37 NIH-funded projects. This list now includes 48 NIH-funded projects (14 career development awards and 34 project grants). This updated list includes some projects we missed, as well as several new projects that were funded in 2002. For completeness, we also list projects that are terminating in 2002 (one career development grant and one project grant). Detailed information about NIH-funded projects can be viewed in the CRISP database available at www.nih.gov.

In response to publication of the original list, we received numerous queries about other funded research. In many cases, SAEM members serve as coinvestigators or site investigators.

Because it is difficult to group all coinvestigators together (as their degrees of effort on projects vary widely), we choose to report only principal investigators (who bear overall responsibility for projects). Quantifying the level of federal support for emergency medicine co-investigators is an ongoing project.

The list of non-NIH federal grants is smaller. These grants are less easily tracked than NIH grants, as there is no central database to search. At this point, we still rely on word-of-mouth and self-report. However, the CDC and DOD are important sources of large research funding, and we will begin to include our growing list of principal investigators as a separate category.

Centers for injury control research are funded in large part through the CDC. We note that several emergency physicians not only draw project support through these organizations, but also are core leaders or directors for these centers. Data about these research 8

projects are available through National Association of Injury Control Research Centers (www.naicrc.org). The Project Bank at that site provides listings of previous and ongoing projects. Additional information about CDC-funded projects is listed at www.cdc.gov/ncipc/ res-opps/extra.htm.

In November, all SAEM members received an email asking whether or not they have received research funding from federal, state, or other sources.

They were also asked whether they have served on a grant review committee. During the coming months, the Research Committee will contact those members who responded in order to get more detailed information. This activity will allow us to develop a more complete picture of where we derive the funding to support research in our specialty, and properly emphasize the importance and prestige of the many non-government sponsors.

If you wish to provide information about your own funding successes and/or experience in grant review committees, please email your contact information to the Research Committee via saem@saem.org. (continued on page 9)

Principal Investigator

Institution

Award Number

Children’s Hospital of Philadelphia Health Partners Research Foundation University of Rochester University of Illinois, Chicago University of Pittsburgh Brown University Ohio State University Children’s Hospital of Boston UCSF Johns Hopkins University University of Chicago Brown University UCLA - Harbor University of Michigan

1K23HD001320 1K08HS013007 1K23NS041952 5K01DA000285 5K02NS002112 5K08AG001008 5F32HL010216 1K08HS011660 5K23AR002137 1K23RR016070 5K08HL003779 5K23ES000381 1K23RR016180 5K08HL003817

Team tageting the environment and asthma management Peroxynitrite in Cardiac Ischemia/Reperfusion Injury Apoptosis and oxidants after murine cardiac arrest Optimizing heart and brain cooling during cardiac arrest Randomized trial of the brief negotiated interview Relationship between the internet and illicit drug use Hypothermia and gene expression after cardiac arrest Diet and chronic obstructive pulmonary disease Emergency physicians’ brief intervention for alcohol Heart attack survival kit project PEAT: pediatric emergency assessment tool Coronary thrombosis and risk in the emergency department Effects of dihydroepiandrosterone on brain injury Progesterone treatment of blunt traumatic brain injury Suppression of protein synthesis in reperfused brain Alcohol and general aviation Pilot aging and aviation safety GLU6PASE and 6P2K/FBASE gene regulation in sepsis Calpain-mediated injury in post-ischemic neurons Mechanisms of gene dysregulation in HD Mechanisms of cellular taurine transport in brain edema Combination approach to lysis in acute ischemic stroke study Effect of inducible antioxidants on hemoglobin toxicity Evaluation of febrile IV drug users guidelines for emergency management Progestrone after traumatic brain injury The effects of progesterone and its metabolites on TBI Cell survival in brain reperfusion Specialized center of research in hyperbaric oxygen therapy CO poisoning in the context of a reperfusion injury Preconditioning against a source of reperfusion oxidants Center for safety in emergency care An empiric risk stratification rule for heart failure VP 63843 in treatment of enteroviral meningitis in adolescents & adults Short-term training in health professional schools

Yeshiva University Thomas Jefferson University University of Chicago University of Chicago Boston University University of Massachussetts University of Pittsburgh Brigham and Women’s Hospital Yale University King County EMS Children’s Hospital of Wisconsin The Johns Hopkins University Emory University Emory University Wayne State University Johns Hopkins University Johns Hopkins University SUNY, Stony Brook University of Pennsylvania Wright State University Wright State University University of Cincinnati Thomas Jefferson University

5U01AI039900 1R01HL063828 1R01HL071734 1R01HL067630 5R01DA010792 5R21DA014929 1R01NS046073 5R01HL063841 1R01AA012417 5R01HL063136 5R03HS011395 1R01HL069746 1R03HD040295 1R01NS039097 5R01NS033196 5R01AA009963 5R01AG013642 5R01GM058047 5R01NS039481 1R01NS042157 5R01NS037485 1P50NS044283 1R01NS042273

Johns Hopkins Emory University Emory University Wayne State University University of Pennsylvania University of Pennsylvania University of Chicago University of Florida, Gainesville University of Pittsburgh

2M01RR000052 1R01NS038664 1R01NS040825 1R01NS041919 5P50AT000428 5R01ES005211 1R01HL068951 5P20HS011592 1R01HS010888

UCLA-Harbor University of Michigan

5M01RR000425 5T35HL007690

New metabolic engineering strategy for shock.

Asthma surveillance and intervention in hospital emergency departments Eye oximeter for trauma care Comprehensive youth violence center Analysis of violence related fatalities and injuries in Wisconsisn Computer based intervention to prevent alcohol use/misuse in adolescents measuring children’s health post-traumatic brain injury Optimizing resuscitation for the casualty with combined hemorrhagic shock and traumatic brain injury WV Fatality Assessment Control and Evaluation (FACE) Program Injury Control Training and Demonstration Center (ICTDC)

Virginia Commonwealth University

DARPA

Michigan State University of Alabama Birmingham University of Alabama Birmingham Medical College of Wisconsin

CDC Office of Naval Research CDC CDC

University of Michigan Johns Hopkins University

CDC CDC

University of Michigan West Virginia University West Virginia University

Office of Naval Research CDC/NIOSH CDC/NIOSH

Award Title

Career Development Awards (14) Alessandrini, Evaline Predicting vaccine status and ED used in medicaid newborns Asplin, Brent Emergency department crowding: causes and consequences Bazarian, Jeffrey Epidemiology of traumatic brain injury Bunney, E.B. Electrophysiology of cocaine, ethanol and cocaethylene Callaway, Clifton Brain ischemia and MAP kinase activation Jay, Gregory Immunoprobes for lubricin from human synovial fluid Klawitter, Paul Redox regulation of metabolism in hypoxic diaphragm Porter, Stephen Informative’ technology: linking parents and providers Quinn, James A network of research sites to study clinical wound care Rothman, Richard ED guidelines for evaluation of febrile intravenous drug users Vanden Hoek, Terry Oxidants in myocardial preconditioning Wright, Robert Neurochemical and genetic markers of lead toxicity Young, Kelly Mentored patient-oriented career development award Younger, John Lung injury, perfluorocarbons and hemorrhagic shock Project Grants (34) Crain, Ellen Ma, Xin-Liang Becker, Lance Becker, Lance Bernstein, Edward Boyer, Edward Callaway, Clifton Camargo, Carlos D’Onofrio, Gail Eisenberg, Mickey Gorelick, Marc Green, Gary Hoffman, Stuart Kellermann, Arthur Krause, Gary Li, Guohua Li, Guohua Maitra, Subir Neumar, Robert Olson, James Olson, James Pancioli, Arthur Regan, Raymond Rothman, Richard Stein, Donald Stein, Donald Sullivan, Jonathon Thom, Stephen Thom, Stephen Vanden Hoek, Terry Wears, Robert Yealy, Donald Young, Kelly Zink, Brian Non-NIH Federal Grants (10) Barbee, R. Wayne Brown, Michael Denninghoff,Kurt Denninghoff,Kurt Hargarten, Stephen Maio, Ronald McCarthy, Melissa Stern, Susan Williams, Janet Williams, Janet

9

CMS Medicare (Continued) densome and did not promote access to high-quality care. Instead, the regulations focused on the medical record as the most important component of the patient visit, rather than quality of the medical care and supported by reasonable documentation.

The rule issued by HCFA in 1995 and effective in July 1996 provided some clarification but also increased the duplication of entries in the medical record. We do not believe that this rule enhanced care to the patient or allowed our teaching physicians to make efficient use of their time with either the patient or the resident. This rule requires that after the resident evaluated the patient in the presence of or jointly with the teaching physician, the resident and the teaching physician both had to document each component of the evaluation. This contributed nothing to quality patient care and was responsible for significant redundancy in the patient’s medical record.

Our

Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) also has a requirement that an attending emergency physician must be present in the emergency department (ED) 24 hours a day, which makes this redundancy of documentation even more superfluous.

Overall the direction in which CMS is moving, as it considers revisions to Section 15016 of the Carrier Manual of Instructions, is a positive step in reducing the regulatory burden of the Medicare program requirements and will provide a clearer direction for teaching physicians. I have had the opportunity, along with my colleagues, to review the revised scenarios reflecting current clinical situations involving residents and teaching physicians and the examples of documentation to accurately reflect the practices of teaching physicians. Generally, the use of the scenarios and examples of documentation are helpful in telling us what documentation

is needed. The proposed changes reduce the need for duplicative entries which teaching physicians are now required to perform while assuring adequate documentation of the presence and participation of the teaching physician.

It will be important for CMS to develop other examples that address areas of continued confusion particularly the use of medical students as scribes and the ability of teaching physicians to refer to medical student documentation for more than the review of systems and past medical and social history. We would welcome the opportunity to work with CMS to clarify these scenarios in order to make them more applicable and adaptable.

Again, on behalf of SAEM I appreciate the effort of CMS in the revisions of the Medicare Carrier’s Manual, Section 15016 and look forward to discussing our other concerns with you in the near term.

SAEM Comments on Definition of Under-represented Minorities On December 12 SAEM sent the following letter to the Advisory and Staff Committees on the Definition of Under-Represented Minorities (URM) of the AAMC. The letter was developed by Glenn Hamilton, MD, on behalf of the Board of Directors.

The Society for Academic Emergency Medicine is appreciative of the opportunity to comment on the recently published discussion document and alternative policy option developed as part of the review of the definition of "under-represented minorities" by the AAMC. SAEM as an organization represents almost 5000 physicians, residents and medical students involved in the teaching and research of emergency medicine. These individuals are a significant portion of the 63 academic departments and 125 residency programs integrated closely with the 125 medical schools in the United States. These sites care for a significant number of the more than 100 million people seen in this country's emergency departments, many of them under-represented minorities. The specialty of emergency medicine all too well represents the disparities and concerns raised as part of this definition review.

Less than 15 percent of its residents-intraining would be categorized as underrepresented minorities. We are a significant stakeholder in the training and clinical care of under-represented minorities and share the AAMC's longstanding commitment to diversity.

Our Board of Directors strongly supports the adoption of the Alternative 5th Policy Option, to replace the URM definition with a new designation, those "under-represented in medicine." This new definition recognizes the fundamental regional orientation of medical training, and would encourage medical schools to track racial and ethnic populations in proportion to the general population. This definition would also encourage a similar monitoring of these groups at the graduate medical education level. Both levels of academic training would be challenged to establish longitudinal tracking that would allow for disparities to be addressed based on both speciality and regional community needs.

We are most supportive of the proposed diversity plan outlined for AAMC institutions and the AAMC. We have particular interest in the efforts toward improving the development, recruitment and retention of both under-represented minority faculty and students. We are currently hosting a number of focus groups nationwide to specifically determine the rationale for African American and Hispanic medical students who are considering emergency medicine as a 10

future career choice.

In addition, we are developing a case-based cultural competency curriculum to assist patient care understanding in our graduate medical education programs as well as potentially integrating these cases and principles into undergraduate medical education.

Our journal, Academic Emergency Medicine, is sponsoring a consensus conference on "Disparities in Healthcare" to be held in May 2003.

This revised and broadened definition will assist us in developing our own research agenda and implementation for change strategy.

We applaud the current efforts of the AAMC, and the careful deliberation of the staff and advisory committees over the last two years. This thoughtful approach has allowed considerable input and, importantly, generated a new "5th option," one which we heartily endorse.

We look forward to the final report of these committees, and more importantly, toward a sustained effort on the part of the AAMC and our own Society to expand the awareness of diversity in our society and assist in correcting the current disparities that exist in health-

Funding of Postdoctoral Training in Clinical Epidemiology and Health Services Research: Merging Good Ideas with Solid Methods Lawrence A. Melniker, MD New York Methodist Hospital SAEM Research Committee Following the 2002 SAEM Annual Meeting, and especially after participating in the Research Committee’s panel discussion on unfunded grant applications, it became clear that my research had become far more complex than my understanding of research methodology, grantsmanship, and management.

With much encouragement from many quarters, I applied for the two-year Master of Science Program in Clinical Epidemiology and Health Services Research at the Weill Graduate School of Medical Sciences of Cornell University. Soon after my acceptance into the program, I was offered an AHRQ-funded two-year fellowship position and, with the blessing of my chair (and my wife), became a research fellow on July 1. Mary Charlson, MD, and Carol Mancuso, MD, are the co-directors of the fellowship program.

The Cornell program started with an aptly named “Intensive Summer Session.” We were given nine courses in seven weeks of daily afternoon classes. It was tough, but truly fascinating and a great foundation upon which to build. A total of at least 30 credits of course work will be completed by the end of the first year. The emphasis is always on the fellow’s or graduate student’s area of research interest. The program concludes with the writing and defense of a Masters thesis by March of the second year, and the preparation of one or more grant applications in the final spring semester.

Coincidently, Edward A. Panacek, MD, MPH, was honored at the ACEP Research Section luncheon on October 7 in Seattle, and after the award presentation, Dr. Panacek made some very insightful and provocative remarks. He expressed his strong belief that while bench research was vital, the main thrust of emergency medicine research should be in the area of clinical outcomes assessment. He urged emergency physicians to collaborate more frequently with general internists, and was emphatic about the need for emergency physicians to undergo advanced training in clinical epidemiology and health services research. It was an extraordinary experience, hearing Ed preach what I just now am trying to

practice.

Why am I devoting my time and effort to realize what Dr. Panacek has recommended? There are a number of important reasons including: 1. There is a substantial deficiency of clinical outcomes research in emergency medicine. Recently, using the medical subject headings “exp outcomes assessment” and “exp emergency medicine,” a search of the Cochrane, Embase, and Medline databases yielded only 55 publications of studies assessing clinical outcomes of emergency department patients since 1966 (5 case reports, 12 retrospective reviews, 1 retrospective study, 25 literature reviews, 6 prospective, observational trials and 2 RCTs). The percentage of our “standard” clinical practice that is rooted in scientific evidence is small.

In the setting of increasingly limited resources, the delivery of evidencebased care has never been more important.

2. There is a substantial dissociation between good ideas and solid research methodology. At the SAEM research session, members with experience on NIH study sections raised concerns regarding a frequently observed dichotomy: clinician-generated projects which propose interesting research hypotheses but are methodologically flawed, versus non-clinician-generated studies with impeccable methods but less appealing hypotheses. Currently, graduate medical education, as it is delivered in the United States, does not adequately train physicians in the rigors of scientific research methodology, nor does it provide the expertise to secure funding for such research.

3. Advanced training in clinical epidemiology and health services research can provide the skill set needed to develop, organize, obtain funding for, and execute highly sophisticated research projects that result in clinically useful findings and improved patient care. Conducting the training in a general internal medicine milieu is an added advantage for the emergency physician. Not only is the fac11

ulty a collection of experts in the many facets of the area of study, but developing research protocols and writing grant applications in this setting necessitates a level of clarity in describing specialty- and projectspecific concepts and nomenclature that otherwise might not be appreciated. Without such clarification positive study section evaluations are less likely.

AHRQ has increased its funding for advanced research training by 50% since 1994 to $600 million in 2001, and currently funds postdoctoral research fellowships at 20 centers around the nation. A listing of the institutions and descriptions of the programs offered can be found at www.ahrq.gov/fund/ training/t32.htm. If you are recommending advanced research training to others or are considering it for yourself, go to the URL listed, and feel free to email me at: lam9004@med.cornell.edu.

Newsletter Submissions Welcomed David C. Cone, MD Yale University Editor, SAEM Newsletter SAEM invites submissions to the Newsletter pertaining to academic emergency medicine in the following areas: 1) clinical practice; 2) education of EM residents, off-service residents, medical students, and fellows; 3) faculty development; 4) politics and economics as they pertain to the academic environment; 5) general announcements and notices; and 6) other pertinent topics. Materials should be submitted electronically, preferably by e-mail to saem@saem.org. Be sure to include the names and affiliations of authors and a means of contact. All submissions are subject to review and editing. Queries can be sent to the SAEM office or directly to the Editor at david.cone@yale.edu.

SAEM Sponsors Federally Funded Alcohol Screening Program; Members Receive Free Materials To Screen Patients SAEM is once again pleased to announce that it will sponsor the fifth annual National Alcohol Screening Day (NASD) held on April 10, 2003. As part of the program, SAEM members will receive, at no charge, materials to screen patients for alcohol problems, as well as educate patients about alcohol’s effect on medical conditions and drug interactions.

Addressing a range of alcohol problems from at-risk drinking to alcohol dependence, the materials are geared at helping Emergency Department staff identify and manage patients with existing or developing alcohol problems.

NASD is a program of Screening for Mental Health, a nonprofit organization, in partnership with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration.

Because of the federal support, the program is free to all health care providers.

Registered providers receive a kit of ready-to-use education and screening materials, including brochures, educational flyers, videotape and screening

forms. Sites also receive step-by-step instructions for planning and conducting a screening event and a publicity guide.

The materials are designed to be used either of two ways. Clinicians are invited to conduct a special outreach event on National Alcohol Screening Day, (April 10) or incorporate the screenings into their day-to-day Emergency Department procedures and screen regularly scheduled patients.

There are approximately 100 million emergency department visits each year.

As many as 30% of these ED patients present with alcohol related problems, and patients from racial and ethnic minorities and those who lack access to other health services are over-represented in this group. Hospital EDs offer a concentrated opportunity not available elsewhere for alcohol abuse screening, brief counseling and referral, or, in other words, a teachable moment for contemplating change in behavior. The ED is an ideal setting to meet people with harmful or hazardous drinking with a targeted intervention. By participating in National Alcohol Screening Day, clini-

cians can help improve overall patient care in ED settings.

Since its inception in 1999, NASD has provided thousands of health care facilities, treatment centers, mental health clinics, colleges, and primary and specialty care providers with a readymade, easy-to-use program for conducting free, voluntary alcohol screenings with referrals for individual evaluation and treatment. Over the last four years, NASD has attracted over 150,000 people to the event, screening some 100,000 individuals and educating friends and family about signs, symptoms, available treatments, and where to seek counseling and help.

To participate, sites can register online by going to www.nationalalcoholscreeningday.org or by calling the NASD office at (800) 253-7658. To receive a registration form or for more information about National Alcohol Screening Day, contact One Washington Street, Suite 304, Wellesley Hills, MA 02481, or call (800) 253-7658, or fax (781) 431-7447.

Patient Safety Curriculum Now Available Karen Cosby, MD Cook County Hospital SAEM Patient Safety Task Force The SAEM Patient Safety Task Force is pleased to announce the development of web-based teaching materials on Medical Error and Patient Safety.

The Task Force has worked to define appropriate curriculum content and suggested teaching guidelines. The materials are posted on the SAEM web site at www.saem.org.

The content is divided into sections

addressing the scope and reality of medical error, models of error, cognitive error and medical decision-making, and system causes of harm. The materials include case studies, interactive teaching exercises, and guidelines for incorporating the content into existing emergency medicine curricula. The material is targeted primarily for emergency medicine resident education but can be

adapted to medical students, faculty, as well as students in other disciplines. A comprehensive list of references and recommended reading materials is included. An abbreviated version of the content will be published in an upcoming edition of Academic Emergency Medicine. We encourage educators to take advantage of these materials.

Ethics Curriculum Available Online Catherine Marco, MD St. Vincent Mercy Medical Center Chair, Ethics Committee Now available on the SAEM web site at www.saem.org is a downloadable slide set of Ethics Cases, designed for Emergency Medicine programs to use for ethics discussions. The cases address a wide variety of professional and ethical issues, including physician impairment, autonomy, interactions with pharmaceutical companies, managed

care issues, confidentiality, honesty, and many others. The cases were developed by members of the SAEM Ethics Committee, and are downloadable in Microsoft PowerPoint format, and are available for free use by Emergency Medicine teaching programs. Also available on the SAEM web site is the Ethics Curriculum, a manual of study 12

topics, cases, and discussion questions.

Continued additions to the online curriculum materials are being developed by the Ethics Committee, and will be available in the future. Questions or comments may be directed to: saem@saem.org or cmarco2@aol.com.

Resident Group Discount Membership Participation Carey Chisholm, MD Indiana University SAEM Secretary/Treasurer On behalf of the Board of Directors, I would like to thank the residency programs that have elected to participate in the resident group discount membership. These 74 programs bring 2,267 resident members to the Society. This program provides residents with invaluable exposure to all facets of academic emergency medicine. Each resident member receives subscriptions to Academic Emergency Medicine and the SAEM Newsletter, plus a discounted registration fee to attend the Annual Meeting. The participating programs are: Akron General Medical Center Albert Einstein Medical Center Allegheny General Hospital Baystate Medical Center Boston Medical Center Brigham and Women's / Massachusetts General Hospital Carolinas Medical Center Case Western Reserve University/MetroHealth Christ Hospital Christiana Care Health System Cooper Hospital East Carolina University Eastern Virginia Medical Center Emory University George Washington University Hennepin County Medical Center Henry Ford Hospital Howard University Indiana University Johns Hopkins University Long Island Jewish Hospital Louisiana State University - Baton Rouge Maimonides Medical Center Maricopa Medical Center Mayo Clinic

Medical College of Virginia Medical College of Wisconsin Michigan State University-Kalamazoo New York Methodist Hospital Newark Beth Israel Medical Center North Shore University Hospital Northwestern University Ohio State University Oregon Health and Science University Palmetto Richland Memorial Hospital Regions Hospital Resurrection Medical Center Saginaw Cooperative Hospitals Inc. Spectrum Health-Grand Rapids/MERC St. John Hospital St. Luke's - Roosevelt Hospital Center St. Vincent Mercy Medical Center Stanford University/Kaiser Permanente State University of New York at Buffalo State University of New York at Stony Brook State University of New York Health Science Center at Syracuse State University of New York Downstate/Kings County Hospital Texas Tech University Thomas Jefferson University University of Alabama at Birmingham

University of Arizona University of Arkansas University of California, San Diego University of Chicago University of Cincinnati University of Connecticut University of Louisville University of Michigan University of New Mexico University of North Carolina University of Pennsylvania University of Pittsburgh University of Rochester University of Texas at Houston University of Virginia University of Washington Wake Forest University Wayne State University/Detroit Medical Center Wayne State University/Sinai-Grace West Virginia University William Beaumont Hospital Wright State University Yale-New Haven Medical Center York Hospital / Pennsylvania State University

President’s Message (Continued) on their service. I am also occasionally skeptical that this is, in fact, the case.

My next phase might be termed the naïve phase. During early residency, when some of the primary literature actually started to make sense and seem relevant to me, I saved each piece of literature potentially relevant to emergency medicine and placed them in large stacks, because the lesson from each article might be important to me some day. My belief in the fundamental importance of each article was occasionally shaken when I noticed that some of the articles tended to contradict each other. The stacks never got filed.

As I entered the world of academic medicine, however, I found that a naïve approach to the medical literature didn’t work. My superficially confident statements regarding the effectiveness of

one treatment over another, or the superiority of one test over another, usually based on a single article that I had just read, were often met with comments such as “that was a small retrospective study” or “that study used a historical control group” or some other methodologic criticism.

As many before me have learned, I soon realized that the best defense against making such embarrassing statements was to evolve from a naïve state to a hypercritical one. It is the existence of this hypercritical state, which I believe is not uncommon among academicians, that motivated me to write this column. As a hypercritical reader, I was soon armed with many stock methodologic criticisms such as “the sample size was too small,” “they didn’t correct for multiple comparisons”

or, my favorite, “they overfit the data.” I found that in the academic world, in which one never wants to appear naïve, it was much safer to criticize every possible methodologic weakness of a study, rather than admit that the results seemed plausible, useful, and that I planned (God forbid) to change my clinical practice based on the article.

Some academic physicians never get past this hypercritical state. The hypercritical state is comfortable because no one dares argue in support of an article that, we all know, might be contradicted by a more sophisticated and larger study in the future.

Furthermore, methodologic weaknesses in clinical research are important.

Studies that are poorly randomized, inadequately masked, or whose analyses are poorly planned are likely to lead (continued on page 22)

13

ACADEMIC RESIDENT News and Information for Residents Interested in Academic Emergency Medicine Edited by the SAEM GME Committee

Systems-Based Practice Core Competency – The Problematic One? Michael S. Beeson, MD, MBA Summa Health System, Chair, SAEM Graduate Education Committee As most GME educators and many residents are aware, the ACGME instituted a requirement effective July 1, 2002, stating that residents obtain competency in six areas: • Patient Care • Medical Knowledge • Practice-Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-Based Practice

controlling health care costs and allocating resources • Practice cost-effective health care and resource allocation that does not compromise quality of care • Advocate for quality patient care and assist patients in dealing with system complexities • Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance

The ACGME states that “…programs must define the specific knowledge, skills, and attitudes required and provide educational experiences as needed…” (ACGME Outcome Project) The ACGME has effectively ended all residency training modeled after a traditional apprenticeship. All residency programs must now provide education and evaluation of all six core competencies. Only two of the six are specialty-specific: Patient Care and Medical Knowledge. The other four are general competencies not necessarily related to any specific specialty. The importance of this is that multi-specialty or institution-wide approaches to education and evaluation of the remaining four competencies may provide an efficient method of satisfying this requirement.

These five aspects of Systems-Based Practice can be summarized as interdependency of medical practice, differences in medical care delivery systems, cost-effective care, patient advocacy, and collaboration. Each of these five aspects requires the health care provider to realize that their medical practice is not in a vacuum. The next question is: how to teach these skills to our residents?

Review of the six core competencies reveals that out of the six, only one may be a somewhat new area that must be focused on. Even if not directly taught, most residency programs have traditionally placed emphasis on evaluation of Patient Care skills, Medical Knowledge, Practice-Based Learning and Improvement (the ability to adapt to self-evaluation and new knowledge), Interpersonal and Communication Skills, and Professionalism. Of the six core competencies, Systems-Based Practice is the one that requires new resources for teaching and education. This article will review this core competency, and look at potential ways to address the education and evaluation of it.

The ACGME defines Systems-Based Practice as “…actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value” (ACGME Outcome Project). The Outcome Project goes on to state that residents must be taught and evaluated on the following topics: • Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice • Know how types of medical practice and delivery systems differ from one another, including methods of 14

Interdependency of Medical Practice Emergency Medicine, perhaps more than other specialties, is directly affected by virtually all aspects of the overall health care system. Likewise, the extent that an individual emergency department is integrated within the overall local health care system and community will have a direct impact on the quality of care a patient receives. The most obvious example is the ease and length of time it takes for a follow-up appointment to be obtained following an ED visit.

Differences in Medical Care Delivery Systems Emergency Medicine is affected by the health care system as a whole, as well as the local medical delivery systems in place. Depending on the patient’s insurance status, there may be restrictions on the type of medications that are covered. Managed care entities may have strict controls on tests and medications, in an overall attempt to control costs. It is important that residents be taught these differences, as well as the underlying reasons behind what may appear to be arbitrary dictations of professional practice. To be truly effective, emergency physicians should be activists in patient advocacy within these organizations. Residency education should include methods to demonstrate effective patient advocacy.

Cost-Effective Care Emergency Medicine has been engaged in the study of costeffective care since nearly its inception. The major EM organizations have been extremely proactive in this pursuit.

Part of this is related to the overall perception that EM is an expensive alternative to traditional primary care. We should be teaching our residents methods to determine costs of care and continuing quality improvement methods to decrease

these costs while maintaining quality of care. This should be ideally integrated into the study of costs within the health care system as a whole, with system-wide approaches to decreasing costs.

lations, and resource management in EM. These topics provide an excellent venue for hospital and community leaders to give their perspectives, perhaps leading to better understanding of the current and potential roles of the ED.

Patient Advocacy Emergency Medicine can be and is proud of its tradition of being the safety net of the health care system. In order to be effective patient advocates within a local health care system, system-wide and community resources must be defined for vulnerable populations such as the elderly, the homeless, and the indigent. The health care system is complex, and the resources seem to continually shrink even as the demand for these resources increase.

Emergency physicians can play a significant role in helping to define the resources that are needed.

Conclusion The core competency of Systems-Based Practice presents a relatively new and structured aspect of residency education that must be addressed. Interdependency of medical practice, differences in medical care delivery systems, costeffective care, patient advocacy, and collaboration must be addressed. This core competency can benefit EM to a significant extent in that it can instill into residents a sense of activism towards patient advocacy. Residency programs will need to develop ways to address this core competency, and can potentially improve their local health care delivery system as a whole in the process. Ultimately, the long-term effect will be to graduate emergency physicians who will be activists within their own practice situations, leading to improved health care delivery within their health care system.

Collaboration In order for all of the above Systems-Based Practice aspects to be implemented, collaboration must occur in order to cross the boundaries of traditionally well-defined specialties. The paradigm shift from specialty-specific care to system-wide care requires collaboration among all stakeholders. Residents must be exposed to this, and see examples that they can take with them when they begin practice in their own health care setting.

Methods to Teach Systems-Based Practice How then do you teach these different aspects of SystemsBased Practice? The first answer lies with attitudes towards health care as a whole. Residents must be exposed to a caring faculty that practice beyond the boundaries of the emergency department. The frustrations that can occur as a clinic begins shifting patients to the ED as it approaches closing hour must be turned into a constructive collaboration to improve patient care, without the delay of a patient going to that clinic near the closing hour. This difference in attitude will impress upon the resident the need to look for constructive solutions, rather than dwell on nonproductive complaints.

The second answer lies with developing ongoing projects that residents can get involved with that address various aspects of Systems-Based Practice. These projects may be PGY level specific, or may occur on specific rotations, such as an administrative month. There are always problems referred to the department chairman or ED director that require study of an issue and usually a collaborative approach to improve or resolve. Projects can be identified that result from this process that residents can work on.

These projects can address various aspects of SystemsBased Practice, including interdependency of medical practice, differences in medical care delivery systems, costeffective care, patient advocacy, and collaboration.

The weekly conference series provides an excellent forum for Systems-Based Practice topics. Potential topics include health care economics, health care delivery systems, team building techniques, the role of EM in health care, system and community health care resources for vulnerable popu-

CPC Competition Submissions Sought Submissions are now being accepted from emergency medicine residency programs for the 2003 Semi-Final CPC Competition to be held May 28, the day before the SAEM Annual Meeting in Boston. The deadline for submission of cases is February 3, 2003 with an entry fee of $250. Case submission and presentation guidelines will be posted on the CORD website at www.cordem.org and it is anticipated that online submission will be required.

Residents participate as case presenters, and programs are encouraged to select junior residents who will still be in the program at the time of the Finals Competition. Each participating program selects a faculty member who will serve as discussant for another program’s case. The discussant will receive the case approximately 4-5 weeks in advance of the competition. All cases are blinded as to final diagnosis and outcome. Resident presenters provide this information after completion of the discussants presentation.

The CPC Competition will be limited to 50 cases selected from the submissions. A Best Presenter and Best Discussant will be selected from each of the five tracks.

The Best Presenter and Best Discussant recipients will receive a plaque and $250.

Winners of the semi-final competition will be invited to participate in the CPC Finals to be held during the ACEP Scientific Assembly in October in Boston. A Best Presenter and Best Discussant will be selected. Both will receive a plaque and $500.

The CPC Competition is sponsored by ACEP, CORD, EMRA, and SAEM. If you have any questions, please contact CORD at cord@cordem.org, 517-485-5484, or via fax at 517-485-0801.

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Call for Papers AEM Consensus Conference: Disparities in ED Health Care

S A E M

Deadline: March 1, 2003

The Editors of Academic Emergency Medicine announce the 2003 AEM Consensus Conference on "Disparities in Health Care" to be held on May 28, 2003 in Boston, the day before the SAEM Annual Meeting. Disparities in health care are likely to present both within the ED decision making process and in the larger health care system. The US emergency departments might be important sources of information about both facets. However, disparities need to be recognized in order to be addressed.

Do inequalities exist in our treatment of emergency patients? If so, under what circumstances, at what level and for what reason? In the larger health care system there is evidence that people of color and women do not always receive the same level of care. Are such disparities real? When, why, how, do disparities occur? Who is at risk of receiving less than optimal care? What is the degree of disparity? How can disparity be eliminated? In a larger sense, what are the best ways to promote a highly reliable system of low variability? Do we teach our residents to deliver disparate care? How does the greater healthcare system contribute to real or perceived disparities in ED management? Are disparities sometimes due to systems incompetence? Is there a relationship between the degrees of inequality and degrees of system incompetence?

How can we study these questions? What measures can be used? Most emergency physicians assume that there should be no disparities in health care. If the general public holds this belief as well, why has our society not insisted upon the development of an equitable system of health care?

The goals of the conference will be to examine the presence, causes, and outcomes related to disparities of health care as they occur in emergency departments, and determine the degree to which forces from outside have an impact on our patients. The conference will aim to describe means of defining, assessing, measuring, and researching disparities that may occur in emergency care. The hope is to establish a research agenda for further assessment of these, and other related questions. The conference is a logical progression in the AEM consensus series, which has included "Errors in Emergency Medicine," "The Unraveling Safety Net, " and " Assuring Quality."

We therefore issue this Call for Papers related to the topic of Disparities in ED Health Care. Submitted manuscripts must be received at the AEM editorial office by March 1, 2003. Electronic submission to aem@saem.org of the original and a blinded copy is required. Also include a cover letter indicating that the submission is in response to this Call.

Accepted papers will be published in the late fall of 2003, along with Proceedings from the Consensus Conference.

Questions can be directed to Michelle Biros biros001@umn.edu or Jim Adams jadams@nmh.org.

Nominations Sought for Resident Member of the SAEM Board The resident Board member is elected to a one-year term and is a full voting member of the SAEM Board of Directors. The deadline for nominations is February 3, 2003.

Candidates must be a resident during the entire one-year term on the Board (May 2003-May 2004) and must be a member of SAEM. Candidates should demonstrate evidence of strong interest and commitment to academic emer-

gency medicine. Nominations should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter.

Nominations must be sent electronically to saem@saem.org. Candidates are encouraged to review the Board of Directors orientation guidelines on the SAEM web site at www.saem.org or from the SAEM office.

The election will be held via mail bal-

lot in the Spring of 2003 and the results will be announced during the Annual Business Meeting in Boston, May, 2003.

The resident member of the Board will attend four SAEM Board meetings: at the ACEP Scientific Assembly, at the CORD Navigating the Academic Waters conference, and at the 2003 and 2004 SAEM Annual Meetings. The resident member will also participate in monthly Board conference calls.

Medical Student Excellence in Emergency Medicine Award Established in 1990, the SAEM Medical Student Excellence in Emergency Medicine Award is offered annually to each medical school in the United States and Canada. It is awarded to the senior medical student at each school (one recipient per medical school) who best exemplifies the qualities of an excellent emergency physician, as manifested by excellent clinical, interpersonal, and manual skills, and a dedication to continued professional

development leading to outstanding performance on emergency rotations. The award, presented at graduation, conveys a one-year membership in SAEM, which includes subscriptions to the SAEM monthly Journal, Academic Emergency Medicine, the SAEM Newsletter and an award certificate.

Announcements describing the program and applications have been sent to the Dean's Office at each medical school. Coordinators of emergency 16

medicine student rotations then select an appropriate student based on the student's intramural and extramural performance in emergency medicine. The list of recipients will be published in the SAEM Newsletter.

Over 100 medical schools currently participate. Please contact the SAEM office if your school is not presently participating.

Call for Submissions Innovations in Emergency Medicine Education Exhibits 2003 Annual Meeting Deadline: February 17, 2003 The Program Committee is accepting Innovations in Emergency Medicine Education (IEME) Exhibits for consideration of presentation at the 2003 SAEM Annual Meeting, May 29-June 1 in Boston. Submitters are invited to complete an application describing an innovative new educational methodology that they have designed, or an innovative educational application of an existing product. The exhibit should not be used to display a commercial product that is already available and being used in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teaching setting.

Commercial support of innovations is permitted but must be disclosed. IEME exhibits will not be published in Academic Emergency Medicine with other abstracts, but will be published in the on-site program. However, if submitters have conducted a research project on or using the innovation, the project may be written up as a scientific abstract and submitted for scientific review in the appropriate subject category by the January 7 deadline.

The deadline for submission of IEME Exhibit applications is Monday, February 17, 2003 at 5:00 pm Eastern Time. Only online submissions using the form on the SAEM web site at www.saem.org will be accepted. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Call for Advisors The inaugural year for the SAEM Virtual Advisor Program was a tremendous success. Almost 300 medical students were served. Most of them attended schools without an affiliated EM residency program. Their “virtual” advisors served as their only link to the specialty of Emergency Medicine.

Some students hoped to learn more about a specific geographic region,

while others were anxious to contact an advisor whose special interest matched their own.

As the program increases in popularity, more advisors are needed. New students are applying daily, and over 100 remain unmatched! Please consider mentoring a future colleague by becoming a virtual advisor today. It is a brief time commitment – most communica-

tion takes place via e-mail at your convenience. Informative resources and articles that address topics of interest to your virtual advisees are available on the SAEM medical student web site.

You can complete the short application on-line at http://www.saem.org/advisor/ index.htm. Please encourage your colleagues to join you today as a virtual advisor.

Emergency Medicine Foundation Update Donald M. Yealy, MD University of Pittsburgh Robert Neumar, MD, PhD University of Pennsylvania SAEM representatives to EMF During the ACEP Annual Scientific Assembly, the EMF Board of Trustees met. The agenda covered fund-raising, recent research funding decisions, and inter-organization relationship issues.

The current assets and funding liabilities were reviewed by the Board, and followed by a broad discussion of mechanisms to increase individual and corporate donations, along with asset management issues to enhance the current and future reserves. Like all funding organizations, EMF is dedicated to maintaining their mission in a challenging financial environment. Future efforts are being planned to target corporate donors using directed/topic appeals,

and individuals using both dollar and other gifts (including dedicating portions of one’s will, life insurance or other assets to EMF). Working groups are currently exploring these possibilities and will report to the Board in the future.

The relationships with the Emergency Nurses Association and SAEM were reviewed, followed by a motion to approve the recent grants recommended for funding by the EMF Scientific Review Committee. The latter passed unanimously, with the recipients data available through the EMF web site.

The Board approved a $75,000 grant to fund a mentored clinical scientist 17

each year, providing a true ‘bridge grant’ for those in the early phases of an investigative career preparing for a K or R series federal grant. The Board took no action on one external unsolicited funding request pending further data gathering, and declined a second unsolicited request for funding. The Board also approved a grant of $35,000 to help EMF participate in an American Hospital Association coordinated study on the effects of EMTALA on emergency medical care.

The meeting was adjourned, with more agenda items available for discussion at the next conference call in December 2002.

SAEM Ethics Consultation Service Emergency physicians are faced with countless ethical dilemmas. We make choices based not only on our knowledge but also on our personal beliefs and value systems.

Occasionally, an ethical issue arises that is outside our world view or consideration, or a situation confronts us that makes us uncomfortable. We may lack the knowledge to make a reasonable choice, we may be faced with something totally out of our experience, or we feel at a loss because we cannot determine the possible options. We may witness an ethically questionable act, may observe unprofessional and possibly harmful actions, may disagree about the correctness of another’s decision, or may feel we ourselves are being subjected to exploitation, abuse, or other unethical behavior. Such situations are frightening; it is difficult to distinguish reality from perception, to know who can

be approached for advice, or where resources can be found to assist in developing an appropriate response.

Some institutions have committees or other authoritative bodies designed to examine grievances, allegations of scientific misconduct or specific ethical dilemmas in clinical practice. The advice of these groups, however, may have limited applicability to emergency medicine; they may not include emergency physicians, or have the expertise to relate to the unique aspects of the ethics of emergency medicine. In addition, these groups are charged with developing a response to a particular crisis that has arisen locally. They are goal directed and not necessarily able to provide a thoughtful method to educate beyond the concrete response to the problem at hand.

For these reasons, SAEM has developed an Ethics Consultation Service to

assist SAEM members with questions concerning ethical issues or decisions they must make during the course of their clinical, academic or administrative responsibilities.

Opinions from the Ethics Consultation Service will be offered to SAEM members in a timely manner; requests from nonmembers will be considered on a case by case basis. The opinions rendered are not meant to be part of an ‘appeal process.’ All communications will be anonymous and confidential. However, because many ethical issues confronting emergency physicians are universal in their scope, and others may learn from the issue presented, we hope to develop a series of articles for publication, assuming that confidentiality can be maintained. All requests, inquiries, or correspondence should be directed to saem@saem.org.

Call for Photographs Deadline: February 17, 2003 Original photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data are invited for presentation at the 2003 SAEM Annual Meeting in Boston. Submissions should depict findings that are pathognomonic for a particular diagnosis relevant to the practice of emergency medicine or findings of unusual interest that have educational value. Accepted submissions will be mounted by SAEM and presented in the “Clinical Pearls” session and/or the “Visual Diagnosis” medical student/resident contest.

No more than three different photos should be submitted for any one case. Submit one glossy photo (5 x 7, 8 x 10, 11 x 14, or 16 x 20) and a digital copy in JPEG or TIFF format on a disk or by email attachment (resolution of at least 640 x 48).

Radiographs should be submitted as glossy photos, not as x-rays. For EKGs send an original and a digital image. The back of each photo should contain the contributor’s name, address, hospital or program, and an arrow indicating the top.

Submissions should be shipped in an envelope with cardboard, but should not be mounted.

Photo submissions must be accompanied by a brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding, 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.”

The case history must be submitted on the template posted on the SAEM web site at www.saem.org and must be submitted electronically. The case history is limited to no more than 250 words. If accepted for display SAEM reserves the right to edit the submitted case history. Submissions will be selected based on their educational merit, relevance to emergency medicine, quality of the photograph, the case history and appropriateness for public display. Contributors will be acknowledged and photos will be returned after the Annual Meeting. Academic Emergency Medicine (AEM), the official SAEM journal, may invite a limited number of displayed photos to be submitted to AEM for consideration of publication. SAEM will retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

Photographs must not appear in a refereed journal prior to the Annual Meeting. Patients should be appropriately masked.

Submitters must attest that written consent and release of responsibility have been obtained for all photos EXCEPT for isolated diagnostic studies such as EKGs, radiographs, gram stains, etc.

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EMF Grants Available The Emergency Medicine Foundation (EMF) grant applications are available on the ACEP web site at www.acep.org. The funding period is July 1, 2003 through June 30, 2004.

Career Development Grant A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who needs seed money or release time to begin a promising research project. Deadline: January 15, 2003. Notification: March 2003.

Research Fellowship Grant A maximum of $75,000 to emergency medicine residency graduates who will spend another year acquiring specific basic or clinical research skills and further didactic training research methodology. Deadline: January 15, 2003. Notification: March 2003.

Neurological Emergencies Grant This grant is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE). The goal of this directed grant program is to fund research on acute disorders of the neurological system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 will be awarded annually. Deadline: January 15, 2003. Notification: March 2003.

Medical Student Research Grant This grant is sponsored by EMF and the Society for Academic Emergency Medicine (SAEM). A maximum of $2,400 over 3 months is available for medical students to encourage research in emergency medicine. Deadline: February 3, 2003. Notification: March 2003.

Call for Abstracts Southeastern Regional SAEM Meeting April 11-13, 2003 Jacksonville, FL The program committee is accepting abstracts for oral and poster presentations. Abstracts may be submitted electronically via the SAEM web site at www.saem.org or by email to se.saem@jax.ufl.edu until January 10, 2003.

There will be oral and poster research presentations, round table discussions with leaders in academic emergency medicine, keynote presentations by nationally recognized emergency physicians, and hands on educational sessions, all in a relaxed atmosphere in sight of the Atlantic Ocean!

Registration: medical students and residents are particularly encouraged to attend, and receive a discounted registration fee of $50 (medical students) and $75 (residents). Registration for attending physicians is $110. To register, contact: Ms. Everlena Owens • phone: (904) 244-4106 • fax: (904) 244-4508 • email everlena. owens@jax.ufl.edu Rooms have been reserved at the host hotel, the Sea Turtle Inn http://www.seaturtle.com/ • phone (800) 8746000 or (904) 249-7402, for $140 – $180 per night.

Mention the SE SAEM conference to receive the discounted rates. Spouses and children are welcome. The beach is the main attraction.

Call for Abstracts 6th Annual SAEM Western Regional Meeting

SAEM 2003 Research Grants EMF/SAEM Medical Student Research Grants This grant is co-sponsored by the Emergency Medicine Foundation and SAEM. It provides up to $2,400 over 3 months to encourage research in emergency medicine.

More than one grant is awarded each year. The medical student must have a qualified research mentor and a specific research project proposal. Deadline: February 3, 2003.

Geriatric Emergency Medicine Resident/Fellow Grant This grant is made possible by the John A. Hartford Foundation and the American Geriatric Society. It provides up to $5,000 to support resident/fellow research related to the emergency care of the older person. Investigations may focus on basic science research, clinical research, preventive medicine, epidemiology, or educational topics.

Deadline: March 3, 2003.

Further information and application materials can be obtained via the SAEM web site at www.saem.org.

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April 5 & 6, 2003 Mayo Clinic Scottsdale Scottsdale, AZ The 2003 meeting will include lectures by renowned speakers, oral and poster presentations and a special clinical and basic research breakout track sessions.

Deadline for abstract submission: January 31, 2003 via the SAEM online abstract submission form at www.saem.org.

Hotel reservations can be made at the Courtyard Marriott-Mayo Clinic in Scottsdale ($99/night, phone 1-480-860-4000) and transportation from the airport may be arranged. Contact: Marie Kirkendolph or Christopher Lipinski, MD, Department of Emergency Medicine, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, AZ, 85008; phone (602344-5418) or email: Marie.Kirkendolph@hcs.maricopa.gov. The deadline for conference registration is March 14, 2003.

S A E M

Call for Nominations SAEM Elected Positions Deadline: February 5, 2003 Nominations are sought for the SAEM elections which will be held in the spring of 2003. The Nominating Committee will select a slate of nominees based on the following criteria: previous service to SAEM, leadership potential, interpersonal skills, and the ability to advance the broad interests of the membership and academic emergency medicine. Interested members are encouraged to review the appropriate SAEM orientation guidelines (Board, Committee/Task Force or President-elect) to consider the responsibilities and expectations of an SAEM elected position. Orientation guidelines are available at www.saem.org or from the SAEM office.

Call for Abstracts 2003 Annual Meeting May 29-June 1 Boston, Massachusetts Deadline: January 7, 2003 The Program Committee is accepting abstracts for review for oral and poster presentation at the 2003 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/ health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obstetrics/ gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more than one nominee for each position. Nominations may be submitted by the candidate or any SAEM member and should include the candidate’s CV and a cover letter describing the candidate’s qualifications and previous SAEM activities. Nominations must be submitted electronically to saem@saem.org and are sought for the following positions: President-elect: The President-elect serves one year as President-elect, one year as President, and one year as Past President. Candidates are usually members of the Board of Directors.

Board of Directors: Two members will be elected to three-year terms on the Board. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces.

The deadline for submission of abstracts is Tuesday, January 7, 2003 at 3:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instructions are available on the SAEM web site at www.saem.org, For further information or questions, contact SAEM at saem@saem.org or 517-4855484 or via fax at 517-485-0801.

Resident Board Member: The resident member is elected to a one-year term. Candidates must be a resident during the entire term on the Board (May 2003-May 2004) and should demonstrate evidence of strong interest and commitment to academic emergency medicine.

Nominations should include a letter of support from the candidate’s residency director.

Nominating Committee: Two members will be elected to two-year terms. The Nominating Committee selects the recipients of the SAEM awards (Young Investigator, Academic Excellence, and Leadership) and develops the slate of nominees for the elected positions. Candidates should have considerable experience and leadership on SAEM committees and task forces.

Only reports of original research may be submitted.

The data must not have been published in manuscript or abstract form or presented at a national medical scientific meeting prior to the 2003 SAEM Annual Meeting. Original abstracts presented at national meetings in April or May 2003 will be considered.

Constitution and Bylaws Committee: One member will be elected to a three-year term, the final year as the chair of the Committee. The Committee reviews the Constitution and Bylaws and makes recommendations to the Board for amendments to be considered by the membership. Candidates should have considerable experience and leadership on SAEM committees and task forces.

Abstracts accepted for presentation will be published in the May issue of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine. SAEM strongly encourages authors to submit their manuscripts to AEM. AEM will notify authors of a decision regarding publication within 60 days of receipt of a manuscript.

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Executive Leadership in Academic Medicine Program for Women The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is now seeking applicants for its 20032004 class of approximately 45 Fellows.

ELAM offers extensive educational, networking and mentoring opportunities in support of women leaders who aspire to the highest administrative ranks at academic health centers.

The year-long curriculum mixes traditional executive seminars and workshops on topics pertinent to AHC management with group projects and individual assignments aimed at developing personal leadership. The program encompasses in-depth, case analyses, self-assessments, experimental learn-

ing, small group activities, and interactions with leaders in academic medicine and dentistry. The program culminates in a 1.5 day Forum on Emerging Issues, where program Fellows, their Deans and other invited guests gather with top experts to explore a timely, substantive issue facing AHC leaders. During the year, Fellows attend three educational sessions of 5-7 days each, two at a suburban setting outside of Philadelphia, held in the fall and spring, and one coinciding with the November annual meeting of the Association of American Medical Colleges. In addition, Fellows work on independent and group assignments between sessions.

Candidates must be at associate

Call for Abstracts 6th Annual SAEM Mid-Atlantic Regional Meeting

professor rank or higher, and must demonstrate significant administrative responsibilities and potential for advancement to top levels of academic administration. In addition to nomination from the Dean, candidates submit an application form and letters of recommendation from their supervisor and one other senior colleague. Submission deadline is February 1, 2003. Brochure and application details are available on the ELAM web site at www.drexel.edu/elam. For an application or additional information contact Deidra Lyngard, Assistant Director at (215) 842-6041.

Call for Abstracts 3rd Annual New York State Regional SAEM Meeting

March 15, 2003 George Washington University Hospital Washington DC

April 9, 2003 Metropolitan Hospital Center

Abstracts are invited for this one day conference in the heart of Washington DC. All accepted papers will be presented orally, giving researchers at all levels a special opportunity to share their work and findings. In addition, there will be round table discussions with leaders in academic emergency medicine, medical student sessions, and a unique forum to meet with representatives of the National Highway Traffic Safety Administration and discuss research opportunities.

The deadline for abstract submission is February 1, 2003 via the SAEM online abstract submission form at www.saem.org Hotel reservations can be made at One Washington Circle, across the road from the conference site (202466-1868). Please mention the meeting to obtain the discounted rate.

For information contact: Jeremy Brown MD or Dave Milzman MD, Dept of Emergency Medicine, George Washington University, 2150 Pennsylvania Ave NW, Suite 2B-417 Washington, DC 20037. 202-741-2911 or jbrown@mfa.gwu.edu.

Registration Fees: Faculty-$75; Residents/Nurses-$35; Medical Students/Physician Assistants-$25; EMTs/paramedics-$10 Deadline for conference registration is February 28, 2003.

The program committee is now accepting abstracts for oral and poster presentations. All abstracts must be submitted electronically via the SAEM website at www.saem.org The deadline for abstract submission is 5:00 pm Eastern Standard Time, Tuesday, January 21, 2003.

Location: Metropolitan Hospital Center, 1901 First Avenue, New York, NY 7:30 am – 4:30 pm.

Registration fees: Faculty - $55; Residents/Nurses $35, Medical Students - free. Registration deadline is March 26, 2003. Make checks payable to: New York Medical College. Mail to: Metropolitan Hospital Center, 1901 First Avenue, Rm. 2A20, New York, NY 10029.

Keynote Speaker: Carlos A. Camarago, Jr, MD, DrPH, Director, EMNet Coordinating Center, Massachusetts General Hospital, will speak on the topic of Asthma Research in Emergency Medicine.

Contact: Hazel Hunt, administrative coordinator, New York Medical College (Metropolitan) Emergency Medicine, 212-423-6684, fax: 212-4236383, hazel_hunt@nymc.edu

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SAEM Makes Important Changes in Membership Criteria Carey Chisholm, MD Indiana University SAEM Secretary-treasurer For many years active membership in SAEM required a university faculty appointment or a special request for applicants who did not have a faculty appointment. This was widely interpreted by potential members to mean that SAEM membership was limited to individuals with a faculty appointment.

However, this past May the SAEM membership, as recommended by the Board of Directors, approved a change in the Constitution and Bylaws as follows: “Candidates for active membership shall be individuals with an advanced degree (MD, DO, PhD,

PharmD, DSc., or equivalent other doctoral degree) who hold a university appointment or are actively involved in emergency medicine teaching or research.”

The Board agreed, as did the hundreds of SAEM members who voted to approve this amendment, that this change better reflects the reality of SAEM membership….those individuals dedicated to academic emergency medicine. Many ideal future members teach or perform research at settings outside of a university or medical school, such as community based physicians or

those working at federal governmental agencies.

The SAEM Board would like to encourage current members to “get the word out” that full membership in SAEM is not limited to those with a formal faculty appointment. Please let your colleagues know that their participation and membership in SAEM is desired and welcomed. Membership applications are available on the SAEM web site at www.saem.org and published in this issue of the SAEM Newsletter.

CORD/AACEM Faculty Development Conference: Navigating the Academic Waters February 22-24, 2003 - Washington, DC Academic Waters: Tools for Educators of Emergency Medicine. This conference was first held in November 1996 and received high praise from attendees. The conference is designed specifically for the unique needs of junior Emergency Medicine faculty and will address essential elements necessary for success in an academic environment including research development, bedside teaching, negotiating skills, resident evaluation, mentoring and clinical

teaching, as well as time and personal management. This course nicely augments the ongoing efforts made by SAEM in the area of faculty development. Young faculty or senior residents interested in an academic career should contact the CORD/AACEM office at 517-485-5484 or the CORD web site at www.cordem.org. Registration is limited to 125 people.

One must be open-minded to the fact that a newly-published study might truly warrant a change in one’s own clinical practice, regardless of how long one has been practicing. One should also be open-minded to the fact that many long-held beliefs may, upon careful investigation, be found to be untrue.

However, one must also be wary of the fact that poorly designed studies can, at times, yield results that are misleading or just plain wrong. The challenge is recognizing both the former and latter events, which requires distinguishing among those methodologic flaws which are minor or might limit broad generalizability, from those that are truly fatal or invalidating.

As I read the medical literature now, I am increasingly optimistic about the quality and effectiveness of emergency medical care. I am also impressed with

the tremendous effort required to answer even simple clinical questions in a convincing manner. Within both emergency medicine-specific journals and general medical journals, there is an increasing quantity and quality of clinical research directly applicable to the care of patients in the emergency department. By having an open-mind and, simultaneously, being cognizant of methodologic quality issues which affect the reliability and validity of studies, one is in the best possible position to apply newly-published knowledge to improve the care of patients in the emergency department.

(Editor’s Note: Dr. Lewis is the Senior Statistical Editor for Academic Emergency Medicine and a consulting reviewer for a number of other medical and statistical peer-reviewed journals.)

Faculty development continues to be one of the most carefully scrutinized areas by the RRC-EM. Due to the relative growth of our specialty, coupled with rapid growth of residency programs over the past 10 years, many younger faculty struggle to develop needed personal, management, teaching, and research skills required for successful career advancement.

CORD and AACEM have conjointly developed a seminar entitled: "Navigating the

President’s Message (Continued) to results which are falsely positive.

Conversely, studies that are too small or have poorly-chosen endpoints are more likely to yield results that are falsely negative. In my mind, however, the most difficult task is to appropriately weigh the effect of inevitable methodologic weaknesses when evaluating the value of a newly-published clinical study. Not all methodologic weaknesses are equal in their importance, nor are all flaws fatal. In fact, because many clinical problems in the emergency department are inherently complex, and therefore difficult to study, much of the most useful clinical literature is fundamentally imperfect from a methodologic point of view.

What then, is the next stage in evolution for a reader of the medical literature? I believe the next stage is characterized by a wary open-mindedness.

22

Medical Student/Resident Subcommittee Progress Report Brian Euerle, MD University of Maryland SAEM Program Committee I am pleased to provide a progress report on the work of the Medical Student/Resident Subcommittee of the Annual Meeting Program Committee.

This year’s Medical Student Forum will be held on Saturday, May 31, 2002.

Students are encouraged to attend as much of the rest of the SAEM Annual Meeting as possible, in order to maximize their exposure to emergency medicine.

The Medical Student Forum has proven to be a very popular event at the Annual Meeting, with increasing numbers of students attending each year.

The schedule for the 2003 Forum has been finalized, and features experienced educators, residency directors, and department chairs from across the country as speakers. A session of breakout groups is featured which will allow the students to select a topic which is of special interest, and discuss this in a small group session.

In addition to hearing informative lectures on topics such as the residency application and selection process, students will have significant exposure to residency directors. This occurs during the lunch with program directors in attendance, as well as the residency fair/reception at the conclusion of the day.

The Chief Resident’s Forum continues to be scheduled as a pre-day event, and will be held on Wednesday, May 28, 2003. In this session, upcoming chief residents from across the country gather together with their peers for a daylong event designed to prepare them for the demands of chief residency. A variety of lectures are provided, as well as two small group sessions which cover administrative and ethical problems.

Besides the formal educational process, many attendees benefit from meeting each other and discussing common problems and solutions. Many residen-

Call for Abstracts 7th Annual New England Regional SAEM Meeting

cy programs have found it beneficial to support their upcoming chief residents’ attendance at the Chief Resident’s Forum, as well as the SAEM Annual Meeting. It is greatly appreciated by the residents and can serve as a “reward” for their upcoming year of service.

The subcommittee has also developed two didactic sessions. The first is the annual Spivey Lecture, which is given in the memory of Dr. Bill Spivey.

This year we are privileged to have Dr. Peter Rosen speaking on “ Research in Emergency Medicine: It’s Physiognomy”. The lecture will be of interest to all members of the Society.

The other didactic is entitled “Evaluating an Academic Position” and will feature Dr. Marcus Martin as the moderator.

There will be a panel of experienced chairs who will be able to discuss the approach a graduating resident should take when looking for a position in academic emergency medicine.

Call for Abstracts 13th Annual Midwest Regional SAEM Meeting

April 9, 2003 Shrewsbury, Massachusetts

September 19, 2003 Saginaw Cooperative Hospitals, Inc. Saginaw, MI

Keynote Speaker: Peter Rosen, MD, FACS, FACEP The Program Committee is now accepting abstracts for review for oral and poster presentations. The meeting will take place April 9, 2003, 8:00 am-4:00 pm, at the Hoagland-Pincus Conference Center in Shrewsbury, MA; www.umassmed.edu/conferencecenter/ The deadline for abstract submission is Tuesday, January 7, 2003 at 3:00 pm Eastern Standard Time.

Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notifications will be sent in late February 2003.

Send registration forms to: Tania Strout, RN, BSN, Department of Emergency Medicine, Maine Medical Center, 47 Bramhall Street, Portland, ME 04102. E-mail contact is strout@mmc.org Registration Fees: Faculty-$100; Residents/Nurses-$50; EMTs/Students-$25. Late fee after March 21, 2003: add $25. Make checks payable to Maine Medical Center Department of Emergency Medicine.

The Program Committee is now accepting abstracts for review for oral and interactive poster presentations. The meeting will take place September 19, 2003, 8:00 am – 5:00 pm, at Curtis Hall on the campus of Saginaw Valley State University, Saginaw, Michigan.

The deadline for abstract submission is Monday, July 14, 2003, by 3:00 p.m. EDT. Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notifications will be sent in late July.

Registration forms are available from Melinda Wardin, Department of Emergency Medicine, Saginaw Cooperative Hospitals, Inc., 1000 Houghton Avenue, Saginaw, MI 48602. E-mail contact is mwardin@schi.org Registration Fees: Faculty--$75; Residents/Nurses--$30; EMTs/Students—No Charge. Late fee after September 12, 2003: add $25.

Visit our website for updated information: www.schi.org

23

FACULTY POSITIONS COOK COUNTY HOSPITAL, CHICAGO, IL: The Department of Emergency Medicine is seeking energetic and motivated candidates for a faculty position. Applicants must be residency trained and BC/BE in EM. The Department has 54 residents in a PGY II-IV format and 26 faculty. The EDs care for 115,000 adult, 30,000 pediatric and 5000 Level I trauma patients each year. A new 463 bed Cook County Hospital will be completed in the fall of 2002. The department offers a very competitive benefit package and protected time to pursue educational, administrative and research projects.

Contact: Jeff Schaider, MD, FACEP, Department of Emergency Medicine, 1900 West Polk Street 10th floor, Chicago, IL 60612; Telephone (312) 6335451; email jschaider@ccbh.org

Molecular Brain Resuscitation Fellowship The Molecular Brain Resuscitation Laboratory at the University of Pennsylvania is offering a two-year research fellowship to Emergency Medicine Residency graduates interested in studying the molecular mechanism of acute neuronal injury caused by stroke, cardiac arrest and head trauma. This training program is part of a multidisciplinary collaboration between NIH-funded laboratories in the Departments of Emergency Medicine, Neurosurgery, Neurology and Pharmacology.

The fellowship is supported by an Institutional Training Grant from the Society for Academic Emergency Medicine. Fellows will be enrolled in the Neuroscience Graduate Program enabling them to pursue a PhD in Neuroscience. Clinical duties are limited to 4 ED shifts/month. Salary ~95K. Start date July of 2003.

INDIANA UNIVERSITY SCHOOL OF MEDICINE, Department of Emergency Medicine is recruiting a clinician teacher to provide care at the public hospital ED located on the medical center campus. Wishard Hospital is a Level One-Trauma Center, base for one of the country’s busiest pre-hospital emergency transport services, and regional burn center. The ED recorded 105,000 visits in 2001. Wishard complements Methodist in providing clinical experiences for IUSM EM residents. Enthusiasm for medical education, facilitation of clinical research and excitement for patient care in a busy public hospital ED are expectations. Residency training and certification/preparation in EM are required. Rank and tenure are dependent upon qualifications. Apply to Jamie Jones, MD (jhjones@iupui.edu) or Rolly McGrath, MD (rmcgrath@iupui.edu), Fax (317) 656-4216. IU is an EEO/AA Employer, M/F/D.

Send letter of interest and curriculum vitae to:

MINNESOTA: Academic Emergency Medicine Faculty - Excellent opportunity for EM residency-trained, BC/BE Emergency Medicine faculty to join our progressive academic EM group at Regions Hospital, a Level I Trauma and Burn Center in St. Paul. Numerous opportunities in clinical research, health services research, EMS, Informatics, Toxicology, and education. Established 3-year emergency medicine residency. ED volume: 65,000. Must have or be eligible to attain Minnesota and Wisconsin medical licensure. Forward CV to: HealthPartners Medical Group, Attn: Sandy Lachman, Physician Recruitment Coordinator, Mail Code 21110Q, P.O. Box 1309, Minneapolis, MN 55440-1309. Fax (952) 883-5395. For more information, email sandy.j.lachman@healthpartners.com or call 800-472-4695. EO Employer.

Robert W. Neumar, MD, PhD Hospital of the University of Pennsylvania Department of Emergency Medicine 3400 Spruce Street Philadelphia, PA 19087 Voice: (215) 898-4960 Fax: (215) 573-5140 Email: rneumar@mail.med.upenn.edu Website: http://www.uphs.upenn.edu/em/brain/

OREGON: The Oregon Health & Science University, Department of Emergency Medicine is conducting an ongoing recruitment campaign for talented faculty members. Entry-level clinical faculty members at the instructor and assistant professor level. Preference given to those with fellowship training (especially in pediatric emergency medicine) or equivalent experience. Knowledge of emergency medicine as a faculty discipline is expected. Please submit a letter of interest, CV, and the names and phone numbers of three references to: Jerris Hedges, MD, MS, Professor & Chair, OHSU Department of Emergency Medicine, 3181 SW Sam Jackson Park Road, CDW -EM, Portland, OR 97239-3098.

SAINT LOUIS UNIVERSITY, a catholic, Jesuit institution dedicated to education, research and healthcare, is seeking qualified applicants for full-time faculty positions in the Division of Emergency Medicine. The Emergency Department sees approximately 30,000 patients yearly and is a Level I Trauma Center staffed by dedicated academic Emergency Medicine faculty in the School of Medicine. Applicants must be EM board certified or eligible. Applications containing a letter of interest and curriculum vitae should be sent to Chris Brooks, M.D., Director, 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 from women and minorities.

We could have worked with anyone… we chose EMP.

UNIVERSITY OF KENTUCKY: The Department of Emergency Medicine at the University of Kentucky is recruiting full-time faculty members at the assistant or associate professor level. The desired individual must be BP/BC in emergency medicine. Academic tenure track and clinical non-tenure track positions available. The EM residency has full accreditation. The Emergency Department at the UK Hospital is a level I trauma center with 40,000 annual visits. The department has nine full-time faculty. Contact: J. Stephan Stapczynski, MD, Department of Emergency Medicine, UKMC, 800 Rose Street, Room M-53, Lexington, KY 40536-0298, Phone: (859) 323-5908, Fax: (859) 323-8056, or Email: jsstap01@uky.edu. We are an EOAAE.

Emergency Medicine Physicians offers you more than a job. EMP offers you a career and a future.

We are owned and operated by emergency medicine physicians. As an EMP physician, you are also an equity owner. You control your future.

EMP provides equity ownership, the most attractive compensation package in the industry, career growth, geographic flexibility and extraordinary job security.

EMP Emergency Medicine Physicians The Best in Emergency Medicine ™

WASHINGTON HOSPITAL CENTER AND GEORGETOWN UNIVERSITY HOSPITAL in Washington, D.C., and Franklin Square Hospital in Baltimore, MD are seeking physicians board certified or residency trained in emergency medicine to join their faculty. Our department is both traditional and cutting edge: traditional in that we believe that the provision of medical care is a

800-828-0898 www.emp.com

24

If you are residency trained in emergency medicine, contact Dominic J. Bagnoli, Jr, MD, FACEP at 800-828-0898 or email us at careers@emp.com to be part of… The Best in Emergency Medicine.

Clinical faculty position available at Ohio Valley Medical Center in Wheeling WV.

sacred trust; cutting edge in that we are committed to using the most advanced information technology to improve clinical care. Contact Mark Smith, MD, FACEP, Chairman, at (202) 877-0808, fax (202) 877-2468 or write to him at Washington Hospital Center, Department of Emergency Medicine, 110 Irving Street, NW, Washington, D.C. 20010-2975.

Residency Vacancy Service The SAEM Residency Vacancy Service was established more than ten years ago to assist residency programs and prospective emergency medicine residents. The Residency Vacancy Service is posted on the SAEM web site at www.saem.org.

Residency programs are invited to list their unexpected vacancies or additional openings by contacting SAEM. SAEM monitors and updates the listings. Prospective emergency medicine residents are invited to review these listings and contact the residency programs to obtain further information.

Listings are deleted only when the residency program informs SAEM that the position(s) are filled.

Keep Your Membership Mailings Coming!

Be sure to keep the SAEM office informed of changes in your address, phone or fax numbers, and especially your e-mail address. SAEM sends infrequent e-mails to members, but only regarding SAEM issues or activities. SAEM does not sell or release its mailing list or email addresses to outside organizations. Send updated information to saem@saem.org

Open Rank: The University of Cincinnati Department of Emergency Medicine has a full-time academic position available with research, teaching, and patient care responsibilities. Candidate must be residency trained in Emergency Medicine with board certification/ preparation. Salary, rank, and track commensurate with accomplishments and experience.

The University of Cincinnati Department of Emergency Medicine established the first Emergency Medicine residency training program in 1970. The Center for Emergency Care evaluates and treats 86,000 patients per year and has 44 residents involved in a four year curriculum. Our department has a long history of academic productivity, with outstanding institutional support.

The SAEM Newsletter is mailed every other month to the 5,500 members of SAEM. Advertising is limited to fellowship and academic faculty positions.

Deadline for receipt: February 1 (March/April), April 1 (May/June), June 1 (July/August), August 1 (September/October), October 1 (November/ December), and December 1 (January/February). Ads received after the deadline can often be inserted on a space available basis.

Advertising Rates: Classified Ad (100 words or less) Contact in ad is SAEM member ..............................................................$100 Contact in ad non-SAEM member ..........................................................$125 1/4 - Page Ad (camera ready) 3.5" wide x 4.75" high ............................................................................$300 To place an advertisement, e-mail or fax the ad, along with contact person for future correspondence, telephone and fax numbers, billing address, ad size, and Newsletter issues in which the ad is to appear to: Carrie Barber at carrie@saem.org, via fax at (517) 485-0801. For more information or questions, call (517) 485-5484.

All ads posted on the SAEM web site at no additional charge.

Please send Curriculum Vitae to: W. Brian Gibler, MD Chairman, Department of Emergency Medicine University of Cincinnati Medical Center 231 Albert Sabin Way Cincinnati, OH 45267-0769 Phone: (513) 558-8086 Fax: (513) 558-4599 E-mail: Diane.Shoemaker@uc.edu

25

Indiana University School of Medicine Research Director Department of Emergency Medicine The Department of Emergency Medicine at the University of Michigan is seeking one – two faculty members in the Instructional or Tenure Track. We are looking for individuals committed to developing an academic and research career in emergency medicine. Prior research experience desired but not required. We are particularly interested in attracting candidates who are women or members of underrepresented minorities, although we are certainly interested in attracting the most qualified candidates.

The recruited faculty member will be provided with appropriate senior mentorship as well as research start-up funds and will have adequate protected time to develop a research program. Interested candidates should contact Dr. William Barsan, Chair, Department of Emergency Medicine at wbarsan@umich.edu or by phone (734) 936-6020. The University of Michigan is an equal opportunity employer.

We are seeking qualified candidates for the position of Director of Research. The Director will assume the leadership of an established, successful program. The Director will oversee current projects, mentor resident and junior faculty projects, and perform new laboratory or clinical projects. In addition, the Director will provide support for the Research Division's Assistant Directors for Clinical Trials and for Resident Scholarly Activities. Experience in securing extramural grants is mandatory. Substantial protected time is provided to accomplish these goals.

The Indiana University Emergency Medicine Residency Program is based at two large urban hospitals with an annual census of over 200,000 patients. Support within the program includes two research associates, and statistical and clerical support. The Department sponsors fellowships in Medical Toxicology and Out of Hospital Care (EMS), and works closely with the IU Informatics Fellowship. Two of our current faculty are enrolled in a Masters of Clinical Research program. The research program is also supported by the university's research department and a large private research institute, and enjoys a strong track record of collaborative efforts. This position includes a highly competitive salary and benefit program. Faculty appointment is available at rank commensurate with experience and productivity.

A letter of interest and Curriculum Vitae should be submitted to: Charles M. Shufflebarger, MD Emergency Medicine and Trauma Center 1701 North Senate Boulevard Indianapolis, Indiana 46202 Email: cshuffle@clarian.org

Department of Emergency Medicine

Fellowship in Cardiovascular Emergencies

University of Florida/Jacksonville

University of Virginia Department of Emergency Medicine in conjunction with the Division of Cardiology is pleased to announce the creation of a new Fellowship in Cardiovascular Emergencies. This innovative clinical fellowship is intended to provide additional training for BC/BE emergency physicians in clinical management and research in the specialized area of cardiovascular emergency. The Fellow will also receive direct experience in the operations and administration of an ED-based chest pain observation and diagnostic unit.

• 4,000 patients evaluated in CPC annually • Outcomes research related to use of advanced imaging, serum cardiac markers and observation protocols in the CPC • One-year curriculum emphasizes CPC patient evaluation, research methodology training, exposure to basic echocardiography & nuclear imaging techniques, and CPC administration • Opportunity for certification in exercise stress testing • Faculty appointment as Clinical Instructor • Must have completed residency in EM and be boardcertified/prepared prior to July 2003 Please submit a letter of interest and CV to: Chris Ghaemmaghami, MD Director, Chest Pain Center, UVa Health System PO Box 800699, Charlottesville, VA 22908-0699 Phone: (434) 982-1999 Email: cg3n@virginia.edu

We are actively recruiting 9 Board Certified or Board Eligible Emergency Medicine Physicians in an exciting opportunity to expand our Department at a community-based hospital in the greater OrlandoTampa area. Newly renovated 24,000 square foot emergency department, 33 patient care bays including a 7 bed minor care area, 3 x-ray suites, a radiology viewing area, ample work space, and a large waiting area, that serves a growing volume of 45,000 patient visits per year. In addition to a salary line of approx. $120 per hour, we offer the full range of University of Florida state benefits that include health, life, disability insurance, vacation & sick leave, 403B retirement plan with immediate vesting, and sovereign immunity occurrence medical liability insurance. Individuals will be appointed at the rank of Clinical Assistant Professor or Clinical Associate Professor. Interested? Mail your letter of interest and CV to Dr. Kelly Gray-Eurom, Dept. of Emergency Medicine, University of Florida Health Sciences Center, 655 W. 8th Street, Jacksonville, Florida 32209. Application deadline is 6/1/03 with anticipated start date of 7/1/03. EOE/AA Employer.

26

PROGRAM DIRECTOR

Brigham and Women’s Hospital/Harvard Medical School

The Department of Emergency Medicine at the University of Texas Houston Medical School is soliciting applications for the position of program director. Applicants must be residency trained and board certified in emergency medicine and should have a portfolio of scholarly accomplishments and a strong interest in education.

Full-time academic faculty position Includes excellent academic support, appointment at Harvard Medical School, unparalleled research opportunities, competitive salary, and an outstanding comprehensive benefit package.

Brigham and Women’s Hospital is a major Harvard affiliated teaching hospital, level I trauma center, and the base hospital for the four-year ACGME accredited Brigham and Women’s Hospital/Massachusetts General Hospital Harvard Affiliated Emergency Medicine Residency Program. The Department of Emergency Medicine cares for over 55,000 ED patients per year and includes a stateof-the-art 9 bed ED Observation Unit. The department has a robust International Emergency Medicine Program and offers international EM fellowships.

The successful candidate must have successfully completed a four year residency training program in emergency medicine or a three year program followed by a fellowship, and be board prepared or board certified in emergency medicine. Interest and proven ability in Emergency Medicine research and teaching are essential.

Please send inquiries and CV to Ron M. Walls, MD, FACEP, Chairman Department of Emergency Medicine Brigham and Women’s Hospital 75 Francis Street, Room PBB-100 Boston, Massachusetts 02115.

Email rwalls@partners.org

The emergency medicine residency training program at The University of Texas Houston Medical School is a three-year program with 10 residents per class. The program has just received full accreditation for the next three years. Our primary teaching hospital is Memorial Hermann Hospital.

The emergency department has an annual volume of approximately 55,000 patients and is one of the nation’s busiest level I trauma centers. Duties of the program director include oversight of the residency program and of other departmental educational activities.

Interested applicants should send a curriculum vitae and a list of professional references to Dr. Brent King Chairman, Department of Emergency Medicine, The University of Texas Houston Medical School, 6431 Fannin St. MSB. 6.264, Houston, TX 77030.

The University of Texas is an Equal Opportunity, Affirmative Action Employer. Minorities and women are strongly encouraged to apply. This is a security-sensitive position and thereby subject to Texas Education code §51.215.

CHILDREN'S HOSPITAL OF NJ at NEWARK BETH ISRAEL MEDICAL CENTER

ATLANTA, GA

The Division of Pediatric Emergency is searching for full time faculty position to join our team. We care for 28,000 pediatric patients annually in an urban setting and are dedicated to clinical excellence, education and patient satisfaction. Children's Hospital of New Jersey has dually accredited residencies in both emergency medicine and pediatrics and provides excellent opportunities clinically, academically and administratively.

DEPARTMENT OF EMERGENCY MEDICINE Due to continued growth, we anticipate openings for fulltime academic emergency physicians in both research and clinician-educator tracks. Emory offers a dynamic and professional environment with special strengths in patient care, teaching, community service, EMS, toxicology, clinical and laboratory research, and public health. Excellent salary and benefits. Applicants must be residency trained and/or board certified in EM. Emory is an equal opportunity/affirmative action employer. Women and minorities are encouraged to apply. For further information visit our web site at http://www.emory.edu/em or contact:

Motivated candidates will receive excellent salary and benefits package and will be a part of a growing and dynamic group. Interested candidates should be BC/BE in Pediatric Emergency Medicine. Consider Newark Beth Israel! For more information, contact Neil Schamban, MD, FACEP, Director, Pediatric Emergency Medicine by phone (973) 926-3463, email: NSchamban@SBHCS.com, or fax (973) 282-0562.

Arthur Kellermann, MD, MPH, Professor and Chair Department of Emergency Medicine 1365 Clifton Rd., Suite B-6200 Atlanta, GA 30322 Phone: (404) 778-2600 Fax: (404)778-2630 Email: Paula Bokros - pbokros@emory.edu Emory is an equal opportunity/affirmative action employer

27

S A E M

Society for Academic Emergency Medicine 901 N. Washington Avenue Lansing, MI 48906-5137

NEWSLETTER

Presorted Standard U.S. Postage PAID Lansing, MI Permit No. 485

Newsletter of the Society for Academic Emergency Medicine Board of Directors Roger Lewis, MD, PhD President Donald Yealy, MD President-Elect Carey Chisholm, MD Secretary-Treasurer Marcus Martin, MD Past President James Adams, MD Glenn Hamilton, MD Katherine Heilpern, MD James Hoekstra, MD Judd Hollander, MD Donald J. Kosiak, Jr., MD Susan Stern, MD

Editor David Cone, MD David.Cone@yale.edu Executive Director/Managing Editor Mary Ann Schropp mschropp@saem.org Advertising Coordinator Carrie Barber Carrie@saem.org

“to improve patient care by advancing research and education in emergency medicine”

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.

2003 Annual Meeting May 29 - June 1 Boston Marriott Copley Place Boston, MA

2004 Annual Meeting May 16 - 19 Wyndham Palace Resort Orlando, FL

2005 Annual Meeting May 22 - 25 Hilton New York New York, NY

2006 Annual Meeting May 18 - 21 San Francisco Marriott San Francisco, CA

Call for Nominations Deadline: February 3, 2003 Nominations are sought for the Hal Jayne Academic Excellence Award and the Leadership Award. These awards will be presented during the SAEM Annual Business Meeting in Boston. Nominations for honorary membership for those who have made exceptional contributions to emergency medicine are also sought. The Nominating Committee wishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or any SAEM member.

Nominations should include a copy of the candidate’s CV and a cover letter describing his/her qualifications. Nominations must be sent electronically to saem@saem.org. The awards and criteria are described below:

Academic Excellence Award The Hal Jayne Academic Excellence Award is presented to an individual who has made outstanding contributions to emergency medicine through research, education, and scholarly accomplishments. Candidates will be evaluated on their accomplishments in emergency medicine, including: 1. Teaching A. Didactic/Bedside B. Development of new techniques of instruction or instructional materials C. Scholarly works D. Presentations E. Recognition or awards by students, residents, or peers 2. Research and Scholarly Accomplishments A. Original research in peer-reviewed journals

B. Other research publications (e.g., review articles, book chapters, editorials) C. Research support generated through grants and contracts D. Peer-reviewed research presentations E. Honors and awards

Leadership Award The Leadership Award is presented to an individual who has demonstrated exceptional leadership in academic emergency medicine. Candidates will be evaluated on their leadership contributions including: 1. Emergency medicine organizations and publications.

2. Emergency medicine academic productivity.

3. Growth of academic emergency medicine.