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Newsletter of the Society for Academic Emergency Medicine March/April 2005 Volume XVII, Number 2

PRESIDENT’S MESSAGE Medical Education: Revolution, Evolution or Adrift? The past 5 years have witnessed many profound changes in the medical education system at all three levels: medical school, graduate and post-residency. The forces that sparked these changes are complex and multiple: the IOM Carey Chisholm, MD Medical Error report, a nebulous societal call for “accountability” (spending? outcomes? services rendered?), a perception that the product (the practicing physician) was broken, the burgeoning health care budget, and a “rediscovery” of professionalism. The facts fueling this movement are scarce in many areas, and data are often equivocal when present. There is no doubt that medical error does occur, and that those errors are usually not reported or analyzed due to the culture of medical (and legal) practice. The historic fixation remains on the culpability of the individual, rather than the individual’s role within a delivery mechanism that facilitates or compounds error producing situations, or lacks adequate failsafes to protect that practitioner and patient. Yet the forces of change are now systematic and dramatic for all levels of medical education. Medical students now must pass an OSCE, delivered at a remote testing site, as part of their USMLE Step 2 examination. The Dean’s letter has been replaced by the Medical Student Performance Evaluation, complete with quartile or quintile comparisons to their peers. Attestations of meeting levels of competency abound. For instance, Indiana University (IU) presents a one page description to the reader about the 9 competencies, each having 3 levels. Every IU graduate must attain “Level 2” in all 9, but “Level 3” is required in only 3 of the 9…each individual student can decide which of the 6 aren’t important in their future career. Each competency’s definition has a brief paragraph descriptor. An example is competency III “Using Science to Guide Diagnosis, Management, Therapeutics, and Prevention.” Here’s the definition: “The competent graduate knows and can explain the scientific underpinnings, at the molecular, cellular, organ, whole body, and environmental levels for states of health and disease based upon current understanding and cutting-edge advances in contemporary basic science. The graduate uses this information to diagnose, manage and present the common health problems of individuals, families, and communities in collaboration with them. The graduate develops a problem list and differential diagnosis, carries out additional investigations, chooses and implements interventions with consultation and referral as (continued on page 21)

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

Medical Student Excellence 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 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 Applications Geriatrics Education for Specialty Residents Program Deadline: April 8, 2005 The American Geriatrics Society, through a program funded by The John A. Hartford Foundation, entitled "Geriatrics Education for Specialty Residents" (GESR) addresses the urgent need to create a structure for developing leaders in geriatrics in related medical specialties. The GESR allows interested specialists to work in collaboration with the geriatrics program in their institution, thereby enhancing their knowledge and skills in teaching geriatrics principles to specialist residents. Applications to develop, initiate and evaluate programs designed to increase education for residents in the geriatric aspect of their disciplines are sought. The disciplines targeted by the grant include Emergency Medicine. Eight two-year grants of $16,000 per year will be awarded to institutions that demonstrate in their proposals the most promise for success. No funds will be provided in support of indirect costs. For additional information or to receive an application, contact: http://www.americangeriatrics.org/2005GESR.shtml or contact Ellen Baumritter at ebaumritter@americangeriatrics.org or 212-308-1414.

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


SAEM Scholarly Sabbatical Grant Awarded to Dr. Timothy Mader The SAEM Scholarly Sabbatical Grant for 2005-2006 will be awarded to Dr. Timothy Mader at Baystate Health Center. This grant awards up to $60,000 or $10,000 per month for 2-12 months to an individual emergency physician. The intent of the award is to allow a faculty member the opportunity to acquire new research skills that will enhance their productivity and career. It is envisioned that this award will allow travel to other institutions and work with other investigators not usually available to the applicant. It is also expected that the applicant is beyond the beginning stages of their career when more comprehensive research training would be appropriate. SAEM selects one award each year. Dr. Mader is an Associate Professor of Emergency Medicine and Associate Director of Research for the Department of Emergency Medicine at Baystate Health Center. For his sabbatical, Dr. Mader plans to work with Dr. James Menegazzi at the University of Pittsburgh to acquire the skills necessary for performing large animal resuscitation experiments. Dr. Mader already has experience with clinical resuscitation research, having participated in prior trials of drug therapy for cardiac

arrest. In order to extend his studies of resuscitation pharmacology, Dr. Mader will need to perform large animal resuscitation studies. Although Dr. Mader’s own institution can provide surgical facilities for this type of experiment, there are no local investigators who can facilitate the development of an animal model. Dr. Menegazzi will serve as the host mentor for Dr. Mader. Dr. Menegazzi has used swine models of cardiac arrest and resuscitation for 15 years. His prior work includes the development of novel pharmacological treatments for cardiac arrest, and the use of quantitative ECG analysis to guide resuscitation. The Department of Emergency Medicine at the University of Pittsburgh has a large commitment to resuscitation research at all levels. One challenge of the sabbatical is the development of a long-distance training relationship. Dr. Mader plans to execute a research study over the course of several visits to Pittsburgh. Each physical visit will consist of several days performing animal experiments. Specific goals for each visit are included in his training plan. Additional didactic training on grant writing skills for these types of studies is also planned. Dr. Menegazzi has successfully trained many research fellows during his tenure at the University of Pittsburgh. In addition to completing one study of drug therapy in the Pittsburgh animal model, it is expected that this experience will allow Dr. Mader to initiate a series of investigations at Baystate.

SAEM Selects Francis Guyette as Emergency Medical Services Research Fellow The Emergency Medical Services (EMS) Research Fellowship for 2005-2006 will be awarded to Dr. Frank Guyette. Dr. Guyette will begin his second year of EMS fellowship at the University of Pittsburgh. This grant awards $60,000 over one year to the training institution. Fellows are selected from their own application and are expected to complete fellowship training at one of the approved EMS fellowship sites. Institutions apply separately to be listed as approved sites and current sites are listed on the SAEM website (www.saem.org/awards/ 03ems.htm). The goal of this program has been to develop future leaders of EMS as well as to stimulate training programs in EMS. The award is funded by Medtronic Emergency Response Systems, Inc., which placed no restrictions on the selection of awardees. Dr. Guyette is a 2004 graduate of the University of Pittsburgh Residency in Emergency Medicine. During his fel-

lowship, he will serve as medical director of two local EMS systems, complete the second year of an MPH program, and initiate a new project in airway management. His proposal was evaluated by the SAEM Grants Committee based on demonstrated commitment to EMS, teaching and academic activities. A proposal for a research project is also a central part of the EMS fellowship application. Dr. Theodore Delbridge will serve as the fellowship director for this program. The research project proposed by Dr. Guyette will focus on the ability of basic life support-trained first responders to use the laryngeal mask airway (LMA). The potential significance of this work to the EMS community is high. First responders are limited to the difficult task of bag valve mask ventilation currently. While paramedics are able to perform endotracheal intubation, there are conflicting data about the safety of that procedure and the cost of interrupting other resuscitation interventions for laryngoscopy. It is possible to imagine future EMS systems in which an intermediate airway is secured during initial resuscitation or stabilization and pending definitive endotracheal intubation later. Dr. Guyette intends to begin this line of investigation by training and testing EMS providers using patient simulators. 2


Dr. Michelle Charfen Selected for SAEM Research Training Grant Dr. Michelle Charfen, Research Fellow at Harbor-UCLA Medical Center was selected for the 20052006 Research Training Grant. This grant awards $75,000 per year for two years to be used to enhance the research training of an emergency physician. Detailed use of the budget is determined by the institution, although it is expected that the award will reduce the required clinical duties to allow formal research training. The grant application process and criteria are modeled after the research training grants (“K” awards) offered by NIH. SAEM selects one recipient of this award each year. Dr. Charfen is a 2004 graduate of the Harbor-UCLA Medical Center Emergency Medicine Residency. She is currently in place as a research fellow. Her mentors for the award include Dr. Roger Lewis of Emergency Medicine and Dr. Eli Ipp of Medicine. The curriculum for research training includes an established series of courses offered by the UCLA School of Public Health. Successful completion of the program will lead to an MPH degree.

The proposed research project will identify high risk clinical and laboratory factors for undiagnosed diabetes in emergency department patients. Undiagnosed diabetes and risk factors for subsequent development of diabetes (prediabetes or metabolic syndrome) are now recognized as major contributors to long-term morbidity. Moreover, health interventions for patients at risk may reduce long-term cardiac and vascular complications of these disorders. Interventions may be relatively simple and low-cost such as dietary adjustments. It is unknown to what extent screening of patients in the emergency department, who have concurrent acute illness, might identify patients with diabetes or at risk for diabetes. Determining the validity of random blood samples or clinical information in this population requires subsequent confirmation of the diagnosis. Therefore, Dr. Charfen plans to prospectively identify subjects in the emergency department. Subjects will subsequently undergo formal glucose tolerance testing and evaluation in the General Clinical Research Center at Harbor-UCLA. The results should help guide rational selection of patients in the emergency department for referral or further counseling. Whether that type of screening affects longterm health will remain for future investigations.

SAEM Institutional Research Training Grant Awarded to Oregon Health Sciences University Dr. Robert Lowe, the Director of Research in the Department of Emergency Medicine at Oregon Health & Science University (OHSU) and the Director of the Center for Policy and Research in Emergency Medicine will be Principal Investigator for the 2005 SAEM Institutional Research Training Grant. This grant awards $75,000 per year for two years to an institution to foster training of emergency physician fellows. SAEM selects one award each year, and bases its selection on the ability of the institution to provide a meaningful research training experience. Selection of a particular fellow is left to the discretion of the institution, but SAEM does not release funds until a research fellow is in place. The primary research focus for OHSU’s department is health services, with a specific focus on access to emergency medical care. The Center for Policy and Research in Emergency Medicine was established in 2002. This center has four full-time faculty and a research fellow in training. Its goals are to foster and support research in emergency medi-

cine and to partner with and advise health policy makers. This program has already acquired other extramural funding that enhances the potential training of research fellows. Formal didactic training will take advantage of the Human Investigations Program which is offered in conjunction with the Department of Medical Informatics and Clinical Epidemiology. The course and activities of this program will move fellows towards an MPH degree. This program also provides another potential source of mentors for the fellow. The OHSU Department of Emergency Medicine has developed strong collaborative relationships within its institution, and potential mentors are identified for variety of topics. The topic areas for specific ongoing research activities include medical economics, informatics, ethics, women’s health and community health and preventive medicine. A unique aspect of this program is its close relationship with the Oregon Health Policy Institute, which will expose a research fellow to the flow of information from research to policy. OHSU has an outstanding academic faculty, and this department already has secured over $4 million in extramural funding. Given the epidemiological flavor of the research program, fellows are likely to undertake studies using existing datasets. The strong institutional infrastructure guarantees excellent formal research training.

Call for Medical Student Volunteers The Program Committee for SAEM is soliciting a request for medical students who are interested in working at the 2005 Annual Meeting in New York City on May 22-25. The Program Committee will waive the registration fee for a limited number of medical students willing to assist with some administrative duties. Each medical student will be responsible for coordinating evaluations at assigned didactic sessions during two half

days and one luncheon session. The Annual Meeting provides a unique opportunity for medical students to familiarize themselves with the research and educational interests of emergency medicine. In return the students will receive a complimentary registration fee. Interested medical students should contact SAEM at saem@saem.org and include “Medical Student Volunteer for Annual Meeting” in the subject line. 3


Program Committee Update: Scientific Abstracts Selected for Presentation Judd E. Hollander, MD University of Pennsylvania Chair, 2005 Program Committee The SAEM Annual Meeting is taking shape. This year 1006 abstracts were submitted. There will be 502 abstracts presented at the New York Meeting. The abstract review process is rigorous. Each abstract receives peer review by approximately 6 abstract reviewers: typically two program committee members and four ad-hoc reviewers who must meet standards to be considered an “expert” in that field. Each expert grades each abstract on 9 individual components that are totaled to give a final abstract score that ranges from 0 to 20. An average abstract score is calculated for each abstract. Before final decisions are made the system has several quality checks so that we may attempt to find abstracts scored spuriously low. Within each category, we review the mean scores for each reviewer to make sure that one category does not contain exceptionally hard or easy reviewers. We review the range of scores within each category and compare that to the study designs submitted within each category to reduce biases for or against a particular type of research. We review a report of all the scores for each individual abstract to try to make certain that an abstract with a single low score did not end up with an average below the cutpoint. Abstracts that receive one spuriously low score have the mean abstract score calculated without that reviewer. If it falls near the meeting cut-off, it is reviewed by a panel of 2-4 people who oversee the scoring system. A final decision is then made about whether that abstract should be accepted or not. Additionally, the PC reviews a report of all comments sent in by abstract reviewers to look for data splitting or duplicate submissions. These are just a sample of the reports that we review to make the abstract submission process as valid as possible. Once again, there were a large number of abstracts submitted in each abstract submission category reflecting the breadth of our specialty (table 1). Category Abdominal/GI/GU Administrative Airway Cardiovascular (non-CPR) Clinical Decision Guidelines Computer Technologies CPR Diagnostic Tech/Radiology Disease/Injury Prevention Education/Prof Development EMS/Out-of-Hospital Ethics Geriatrics Infectious Disease Ischemia/Reperfusion Neurology Obstetrics/Gynecology Pediatrics Psychiatry/Social Issues Research Design/Meth/Stats Respiratory/ENT Disorders Shock/Critical Care Toxicology Trauma Wound/Burns/Orthopedic

Number of abstracts submitted 21 126 49 83 16 7 20 48 60 88 86 11 22 34 18 35 10 61 31 18 32 22 36 56 15

Over the years, the quality of our science has also improved. The abstract submission process requires each submitter to self report a study design category for their work. The table below reports this year’s (2005) reported study designs, as well as a comparison of 2003 and 2004 study designs. The table includes only the abstracts accepted for presentation. Research Design Randomized controlled trial Nonrandomized comparison Prospective cohort study Cross sectional study Prospective observational study Before and after trial Retrospective case control Retrospective case series/cohort Survey Other Basic Science

2003

2004

2005

44 6 58 17 104 19 12 66 35 30 58

48 23 79 20 84 13 21 87 32 41 55

39 17 92 17 95 20 25 78 29 45 36

Thus more than half of the science to be presented at the Annual Meeting is conducted in a prospective manner. Cohort studies are becoming more common in our field, as we develop the research infrastructure to follow patients over time. Surveys are becoming more difficult to get accepted at the meeting, as most research questions can be better answered through more sophisticated study designs. The meeting will include a litany of great research that spans the full spectrum of academic emergency medicine, including clinical disease, laboratory investigation and educational initiatives. The outstanding didactic sessions, photography exhibits, and innovations in medical education exhibits should make this meeting another great one. I hope you all plan on joining us in New York City May 22-25.

SAEM Membership as of 1-31-05 Active - 2386 Associate - 252 Resident - 2337 Fellow - 90 Medical Student - 420 Emeritus - 21 Honorary - 6 TOTAL: 5,512

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Call for AEM Reviewers SAEM members are invited to submit nominations to serve as peer reviewers for Academic Emergency Medicine. As an indicator of familiarity with the peer-review 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. Other scholarly work or experience will be considered as evidence of expertise (i.e., informatics experience demonstrated by network/database/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. 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-in-Chief designates Outstanding Reviewers for public acknowledgment of excellent contributions to the peer-review process. Most appointments as peer reviewer are for three years. Reviewers who consistently fail to respond to requests 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 must be submitted electronically to aem@saem.org by March 22, 2005.

Board of Directors Update The SAEM Board of Directors meets monthly usually by conference call. This report includes the highlights from the December 14 and the January 18 Board conference calls. The Board will meet on March 5 during the CORD Meeting in New Orleans. The Board completed the development of a new five-year plan for the Society. This will assist the Board and the membership to focus on the Society's mission, goals, and objectives. More information on the five-year plan will be published in the May/June issue of the Newsletter. The Board approved the recommendations of the Grants Committee, chaired by Callaway, MD, to fund the 2005-06 SAEM grants program. Funding was approved for $150,000 for a two-year Institutional Research Training Grant, a $150,000 two-year grant for the Research Training Grant, a one-year $60,000 Scholarly Sabbatical Grant, and a $60,000 EMS Research Fellowship Grant, which is funded by Medtronic. The Board also approved the Grants Committee recommendations regarding approved sites for EMS Research Fellowship grants. SAEM funds its grants program through the Research Fund. Detailed information regarding the grant recipients is published in this issue of the Newsletter. The Board approved a proposal to sponsor a booth at the March meeting of the Student National Medical Association (SNMA) in St. Louis. The Board approved the proposed fourth year medical student curriculum, which was developed by a multi-organizational task force including representatives from AACEM, ACEP, CORD, EMRA,

and SAEM. The Board approved the position statement developed by the National Affairs Committee entitled, "Principles for Measuring Quality and Reporting Incidents and Adverse Events." The position statement is published in this issue of the Newsletter. In keeping with accounting best practices standards, the Board approved the funding for an audit of the Society. The Board approved a 2005 budget that includes revenues in the amount of $2,088,500 and expenses in the amount of $1,700,000. The Board approved a proposal from Michelle Biros, MD, the Editor-in-Chief of Academic Emergency Medicine to publish a May issue of AEM, and to develop the Annual Meeting abstracts as a supplement to the May issue. The Board also approved Dr. Biros proposal to fund an additional 100 editorial pages in AEM in 2005 and approved increased funding for staff support. The Board appointed Rita Cydulka, MD, to serve as the SAEM representative to the National Asthma Education and Prevention Program. The Board agreed to send representation to the AAMC Conference on Workforce Issues, which will be held in Washington, DC in April. The Board approved three evaluation tools developed by the Nominating Committee. The Board also approved the development of a "mini-bio" form, which will be completed by potential candidates requesting consideration as a nominee for elected position within the Society. The Board agreed to assist ABEM in the solicitation of "readings" for the 5

Lifelong Learning and Self-Assessment Test. Further information, asking SAEM members to consider submitting proposed "readings" is published in this issue of the Newsletter. The Board agreed to provide funding in the amount of $500 to help support the memorial service planned for Dr. Wiegenstein on February 21 in Lansing, Michigan. The service is being coordinated by the Michigan Chapter of ACEP. The Board agreed to participate in the multi-organizational task force to review, revise and update the Model of Clinical Practice document. The first meeting of the task force, coordinated by ABEM, will be held during the SAEM Annual Meeting. ACEP, CORD, EMRA, and SAEM will participate in this project. The Board approved a Web Policy and a policy regarding requests for letters of support. Both policies are published in this issue of the Newsletter. The Board also approved a revised Clerkship Directors Survey, which was developed by the Undergraduate Committee. The Board approved the regional meeting application of the 5th Annual New York State Regional Meeting, which will be held on April 3 in Brooklyn. Information on upcoming regional meetings is published in this issue of the Newsletter. The Board approved the development of a joint grant proposal with the American College of Emergency Physicians to receive up to $10,000 in funding from the American Geriatric Society. The funds, if approved, will be used to convene a geriatric consensus conference.


SAEM Research Fund The SAEM Research Fund – Growing Strong The year end status of the SAEM Research Fund was very encouraging. The Fund now sits at 3.7 million dollars. The response of SAEM members to our most recent member appeal has been the best ever. To date, we have raised over $33,000 dollars from SAEM members in the 2005 member appeal, and more contributions continue to come in. As we see the overall amount of money in the Research Fund rise, we come closer to our eventual goal of having a self-sustaining endowment to fund numerous research training grants each year. SAEM also believes strongly that a big part of supporting its mission is to contribute a large percentage of annual revenues to the Research Fund. This has resulted in over $650,000 in Fund growth from SAEM organizational contributions in the past three years. If you would like to make a contribution, you can make a donation on line at www.saem.org. What Are We Investing In? SAEM is using Research Fund contributions to support the Research Training Grant, Institutional Research Training Grant, and Scholarly Sabbatical Grant. The 2005-2006 grant recipients and their research projects

are publicized in this issue of the Newsletter. What if we could fund a list three times this long in 2010? What if by 2015 one hundred emergency physicians had realized the benefit of a two-year research fellowship, supported by the SAEM Research Fund? Our emergency patients would benefit from the scientific discovery, our residents would benefit from the increased knowledge of emergency care, and our faculty would benefit from having successful colleagues with fine research credentials. And these numbers, with a little work and dedication, are not a pipe dream. SAEM is committed to building the Research Fund to this level. Have We Said Thank-You Lately? SAEM wants to acknowledge and thank donors to the Research Fund. Last year we kicked off what will be come an annual special reception at the Annual Meeting. This year the reception will feature a speaker and report on the Fund. The reception will be on May 23 at 5:00-6:00 pm. Dr. Brian Zink will provide a brief session of the history of academic emergency medicine entitled, “The Strange and Strenuous History of Academic Emergency Medicine.” A formal invitation to donors is forthcoming. Also, SAEM Research Fund donors will

have a special designation at the Annual Meeting – details will be announced in the coming months. These small tokens of our appreciation are meant to say thanks, but we know that the reason you give is your belief that training in research is a cornerstone of progress in emergency medicine. A New, Quiet Approach to Raising Money – the Silent Auction This year the SAEM Development Committee will roll out what we hope will be a fun, exciting event at the Annual Meeting in New York City to benefit the Research Fund - a Silent Auction. SAEM members, businesses and other donors have already contributed items of value to the auction, and you get to decide how valuable these items are. The items or descriptions will be posted on the SAEM website beginning in March and will be on display at the SAEM meeting. Many items can be used or redeemed in New York City. We need your help in two ways – first by making a donation of an item to the Auction, and second, by participating in the Auction at the Annual Meeting. For ideas on what you might contribute, and for a sneak preview on what has already been donated, contact Mary Ann Schropp, the SAEM Executive Director at saem@saem.org.

Research Fund: 2005 Membership Campaign Report The 2005 Member Campaign of the Society for Academic Emergency Medicine (SAEM) Research Fund is off to an impressive start. To date, contributions total approximately $33,000. To those members who have contributed, we thank you. If you have not had the opportunity to contribute, please consider joining your fellow members in contributing to this worthy effort. The mission of the SAEM Research Fund is three-fold: to improve the care of patients in the Emergency Department and prehospital setting through medical research and scientific discovery; to enhance research capability within the field of Emergency Medicine; and to support investigators in pursuit of the skills necessary to conduct ethical and important research to create new knowledge for the benefit of all patients in the Emergency Department. The emphasis of the SAEM Research Fund is to support research training grants, open to all members who seek such training. One hundred percent of your contributions go directly to the Fund; the administrative costs of maintaining the fund are borne separately by the SAEM operating budget. Remember, your donation is 100% tax deductible. We would like to have 100% participation of the membership in supporting the SAEM Research Fund. Please consider making a donation equal to two to three hours of work. Make your check payable to "SAEM Research Fund" and mail it to: Society for Academic Emergency Medicine, 901 N. Washington Ave., Lansing, MI 48906. You can also make your donation on-line by going to www.saem.org and click on the "Click here to contribute to the Research Fund" link. Professor ($2500+) Gabor Kelen, MD Mentor ($1000-$2499) John Becher, DO Glenn Hamilton, MD Jerris Hedges, MD, MS

Jeffrey Kline, MD John Marx, MD Brian O'Neil, MD Peter Van Ligten, MD Sponsor ($500-$999) Brent Asplin, MD

William Barsan, MD Carey Chisholm, MD Theodore Christopher, MD Steven Dronen, MD James Hoekstra, MD Judd Hollander, MD Kenneth Iserson, MD, MBA

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(continued from page 6) Mark Langdorf, MD Scott Syverud, MD Ron Walls, MD Investigator ($250-$499) Todd Allen Michael Bohrn, MD Kris Brickman, MD E. Martin Caravati, MD, MPH Daniel Danzl, MD Eric Dickman, MD Susan Gin-Shaw, MD Lewis Goldfrank, MD James Holmes, Jr., MD Charlene Babcock Irvin, MD James Jones, MD Paul Paris, MD Gene Pesola, MD, MPH Stephen Pitts, MD Michael Runyon, MD Brian Zink, MD Supporter ($100-$249) Susan Ambrose, MD James Amsterdam, DMD, MD Amy Archer-Uyenishi, MD Lydia Baltarowich, MD Richard Barry, MD Carol Barsky, MD James Bouzoukis, MD Mark Brautigan, MD Michael Brown, MD Patrick Brunett, MD Carlos Camargo, Jr., MD, DrPH Christopher Carpenter, MD Douglas Char, MD Stanley Chartoff, MD Amy Church, MD Wendy Coates, MD Jeffrey Cukor, MD Christopher Dong, MD David English, MD Jay Falk, MD Kelly Anne Foley, MD Robert Frank, MD Steven Frei, MD Susan Fuchs, MD E. John Gallagher, MD Robert Galli, MD Gregory Garra, DO Lowell Gerson, PhD Michael Gibbs, MD Juan Gonzalez-Sanchez, MD Louis Graff, MD Michael Greenberg, MD

John Griswell, MD Jason Haukoos, MD, MS Mark Henry, MD Brian Hiestand, MD David Hnatow, MD Robert Hockberger, MD Dee Hodge, III, MD Anita Hodson, MD Debra Houry, MD, MPH Frank Illuzzi, MD Jennifer Isenhour, MD Edward Jauch, MD Sharhabeel Jwayyed, MD David Karras, MD Karen Kerner, MD Sorabh Khandelwal, MD Steven Krug, MD Joseph Kuchinski, DO Nathan Kuppermann, MD, MPH Thomas Kwiatkowski, MD Evan Leibner, MD E. Brooke Lerner, PhD, EMT-P Phillip Levy, MD Joseph Lex, Jr., MD Louis Ling, MD Jeffrey Love, MD Robert Lowe, MD, MPH Stephan Lynn, MD Anil Mahajan, MD Brian Daniel Mahoney, MD Catherine Marco, MD Marcus Martin, MD Eduardo Marvez-Valls, MD Jon Mason, MD Amal Mattu, MD Dale McNinch, DO James Menegazzi, PhD John Mertz, MD Glenn Mitchell, MD Daniel Morris, MD Gerald O'Malley, DO Norman Paradis, MD Michael Paul, MD Peter Peacock, Jr., MD Steven Polevoi, MD Susan Promes, MD Michael Radeos, MD Phillip Rice, Jr., MD Raul Rodriguez, MD Robert Rosenbloom, MD Robert Rosenthal, MD Winston Ryan, MD Joseph Salomone, III, MD Andrew Sapira, MD Augusta Saulys, MD

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Robert Schafermeyer, MD Daniel Schelble, MD Kathleen Schrank, MD Robert Schwab, MD Lawrence Schwartz, MD Hosseinali Shahidi, MD Neal Shipley, MD Paul Sierzenski, MD Paul Silka, MD Marco Sivilotti, MD, MSc David Sklar, MD Earl Smith, III, MD Linda Spillane, MD Karl Sporer, MD Lawrence Stock, MD Judith Tintinalli, MD, MS Thomas Tsou, MD Alan Tuttle, II, MD Phyllis Vallee, MD Keith Van Meter, MD Annette Visconti, MD David Vukich, MD Marvin Wayne, MD Robert Wears, MD, MS Christopher Weaver, MD Ellen Weber, MD Dan Wiener, MD Mildred Willy, MD Stephen Wolf Brian Zachariah, MD Other Steven Bird, MD Andrew Butterfass, MD Russell Clark, MD Robert Darling, MD Cory Duncan, MD Daniel Girzadas, Jr., MD Shantall Hall Fred Harchelroad, Jr., MD Linda Herman, MD Terry Kowalenko, MD Christopher Linden, MD Darrell Looney, MD James Mayo Ron Medzon, MD Francis Mencl, MD Samuel Nay Sean-Xavier Neath, MD, PhD Bruce Quinn, MD Marcelo Sandoval, MD Michael Sayre, MD Stephen Schenkel, MD Michael Slater, MD Anita Ziemak, MD


Ethical Conduct of Resuscitation Research

Academic Emergency Medicine Consensus Conference May 21, 2005 New York City 8:00-8:45

Opening Remarks: A Historical Perspective on the Final Rule for Conducting Research using Exception from Informed Consent, Michelle Biros, MD, MS This session will also include an electronic survey of the participants. 8:45-9:30 Panel: Update of Existing Research about the Rules, Lynne Richardson, MD, Terri Schmidt, MD, Roger Lewis, MD, PhD This session will provide an overview of research that has been published on the effectiveness of the current rules. 9:45-11:15 Breakout Sessions: Protecting Subjects 11:15-12:00 Reports of Breakout Sessions 12:00-1:30 Lunch and Keynote Address 1:30-3:00 Breakout Sessions: Impact on Research 3:15-4:00 Reports of Breakout Sessions 4:00-4:30 Electronic Survey of Participants 4:30- 5:00 Closing and Consensus Process

Determining how well the rules are currently protecting subjects ● What is empirically known about whether or not the current rules provide adequate protection of subjects in resuscitation research? ● What is known about the best methods of community consultation and notification? ● What are the future research directions that should be taken to further study the regulations?

Afternoon breakout sessions: Impact on Research Using the regulations in research ● What evidence exists that research is hindered by these regulations? ● What evidence exists that research has successfully used these regulations? ● What are the future research directions that should be taken to further study the regulations? Researchers understanding of the guidelines ● What is known about the direction that has been provided to researchers about how and when to use exception to consult? ● What more is needed to interpret the guidelines? ● What are the future research directions that should be taken to further study the regulations?

Morning breakout sessions: Protecting Subjects Communicating with communities ● What constitutes effective community consultation and public disclosure? ● How is this measured? ● What is known about the best methods of community consultation and notification? ● How should community consultation and public disclosure address language barriers, ethnic minorities and cultural diversity? ● What are the future research directions that should be taken to further study the regulations?

Research conditions that qualify for exception to consent ● What is the definition of life-threatening condition? ● How is equipoise determined? ● What level of evidence is required before an intervention can be tested? ● What is empirically known about whether or not the current rules create undue barriers to performing important resuscitation research? ● What are the future research directions that should be taken to further study the regulations?

Communicating with subjects ● What is known about whether or not emergency department patients can ever give informed consent? ● Who can/should consent for subjects? (Patient, surrogate?) ● Can research assistants adequately consent subjects? ● What is known about readability and subject understanding of consent documents? ● What are the future research directions that should be taken to further study the regulations?

Issues related to IRBs Review ● How do IRBs balance the risk to subjects in the proposed research with the potential benefit? ● What criteria should IRBs use in evaluating the community consultation and public disclosure plan for a study? ● What are the future research directions that should be taken to further study the regulations?

Research without consent with subjects with diminished capacity ● What if any, special safeguards should apply before enrolling children into studies using exception to informed consent? ● Can prisoners ever be enrolled? ● What special safeguards are needed for other special groups (elderly people, persons with mental illness)? ● What are the future research directions that should be taken to further study the regulations?

The AEM Consensus Conference is designed to attract a broad audience including resuscitation researchers, ethicists, IRB members and regulators. The goals of this conference are twofold. First, the conference is designed to provide an overview of the current status of the regulations in order to increase understanding of how the rules are currently working. Secondly, this is a consensus conference with the goal of developing consensus on the important issues for subjects and researchers surrounding these regulations. Several innovative methods will be used to develop consensus. Each

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of the small groups will be asked to discuss and develop consensus statements on broad questions. In addition, the day will begin and end with participant surveys using sophisticated electronic tools to gather and report participate opinions in real time. The final product of the conference will be a special issue of Academic Emergency Medicine published in November, 2005. This conference is partially

funded by a special grant from Association of American Medical Colleges (AAMC) and the Office of Research Integrity. Interested people can register for the conference at http://www.saem.org/meetings/05regisform.html. The registration fee is only $50 and includes lunch.

Academic Emergency Medicine Call for Papers "Conducting Ethical Resuscitation Research" Clinical research hinges on the ability of investigators to identify, recruit and enroll human subjects into clinical trials. The process of informed consent for research participation is designed to protect potential research subjects by educating them about the trial and their rights as participants, allowing them to ask questions regarding the study and their role, and assisting them in making an informed decision about research participation. There is evidence that even when done under the most controlled clinical circumstances, potential study subjects do not always fully comprehend or even recall the issues presented to them. In the ED, this possibility is even greater because of time pressures to enroll patients when study interventions have narrow therapeutic windows, when patients have language and reading skills discordant with the investigators, and where investigators are often clinicians with competing attention demands. An additional circumstance, faced by emergency and resuscitation researchers, involves patients who are eligible for enrollment into studies but who cannot provide consent because of their critical clinical condition. Current regulations for waiver of and exception from prospective informed consent are cumbersome and have not often been successfully applied. The methods for fulfilling the requirements of the regulations have not been well defined, and individual IRBs have different levels of comfort in allowing these studies to proceed.

It is also not certain if the patient safeguards built into these regulations, actually provide the protections they were intended to. The AEM Consensus Conference will be held on May 21, 2005 the day before the SAEM Annual Meeting. It will address issues of informed consent for research participation as it is provided and obtained in the ED, problems arising when informed consent is waived, and challenges when attempting studies with exception from informed consent. It is our hope that the conference will result in recommendations, a research agenda, and a call for action from the emergency research community on how to ensure patient safety as research subjects while providing reasonable and practical guidelines for refining current regulations on waiver of and exception from prospective informed consent. Original contributions describing relevant research or concepts in this topic area will be considered for publication in the Special Topics issue of AEM, November 2005, if received by March 1, 2005. Proceedings of the conference will also appear in the November Special Topics issue. All submissions will undergo peer review by guest editors with expertise in this area. If you have any questions, please contact Michelle Biros at biros001@umn.edu. Watch the SAEM Newsletter and the AEM and SAEM websites for more information about the Consensus Conference.

Medical Student Educators Handbook Douglas Ander, MD Emory University The SAEM Undergraduate Education Committee and the SAEM Medical Student Educators Interest Group have worked collaboratively to complete a Medical Student Educators Handbook, which can be found on the SAEM website at http://www.saem.org/TOC1.htm. The Handbook was edited by Douglas Ander, MD, Wendy Coates, MD and David Manthey, MD. Experts in the field of education have written chapters to address key topics that pertain to medical student education. Although the Handbook was designed as a resource for undergraduate medical educators, many of the topics can be applied in any

educational venue. The purpose behind the creation of this handbook was to assist the faculty placed in the position of teaching and directing medical students. Many of these faculty are not formally trained as educators, and may not have the background that enables them to organize a clinical rotation, design a curriculum and evaluation system, and chair an emergency medicine course. Guidance in undergraduate medical education is limited and resources developed for other medical specialties do not always reflect our learning environments. The chapters provide insight and 9

guidance to the medical student educator. Topic areas include: the development of curricula, different teaching venues, evaluation techniques, and various administrative topics such as budget issues and dealing with difficult students. The authors offer generic recommendations that can be adapted for individual institutional climates. We expect that this guidebook will be a valuable tool for all medical educators. Whether you are the junior faculty member assigned to running the medical student rotation or the more senior faculty looking for innovative techniques, this handbook should be on your shelf.


The 2005 SAEM Annual Meeting: A Guide for Students Kimberly Schertzer Penn State University Susan E. Farrell, MD Brigham and Women's Hospital Christopher S. Russi, DO University of Iowa Cherri Hobgood, MD University of North Carolina Chapel Hill For the SAEM Undergraduate Committee The 2005 Annual SAEM Annual Meeting will be held May 22-25, 2005 in New York City. The meeting provides an extraordinary environment for students interested in emergency medicine, by providing a glimpse into many of the topics and issues relevant to the specialty today, and an opportunity to network with residents and faculty from across the country. The registration fee is dramatically reduced for students ($25 member/$50 non-member for registration before April 15). Approximately 35% of allopathic medical schools do not have academic departments of Emergency Medicine. As a result, medical students exposure to EM is often limited and without guidance or mentorship. This article offers a “must see” at the SAEM Annual Meeting for medical students, in order to maximize their experience and gain knowledge about residencies and careers in this specialty. The SAEM Medical Student Symposium The Medical Student Symposium is perhaps the most useful conference event for students. It will be held on Saturday, May 21, 2005, and is a full day of activities and didactics designed solely for medical students. The registration fee is $75. This symposium is intended to help medical students understand potential career paths in EM, and to provide guidance in planning for residency application. It is a “mustdo” for students who are planning their 3rd and 4th year electives, preparing personal statements, and deciding how to apply to different residencies. It is also an excellent opportunity for first year students to gain exposure to faculty leaders who are invested in medical students interested in emergency medicine. There is a considerable amount of planning required in order to maximize medical school opportunities and prepare for the residency application process. This day’s session helps answer questions and offers advice on coordinating a successful 4th year.

Formal Lectures – The morning’s lectures are intended for all students regardless of their level of training. The lectures open with a discussion of how to select the right residency for you, including issues of geographic location, residency length, and patient demographics. This is followed by a talk about how to get good advice about your future residency and career options, and what to do if there is no EM advisor at your school. Navigating the residency application process discusses the nuts and bolts of residency application, explains the ERAS application, and gives tips on how to successfully interview. The dean’s letter discussion details the components of the Dean’s letter, which are reviewed by programs as part of the application process. Afternoon lectures provide valuable tips for optimizing your learning and being successful on a 4th year EM clerkship, including where and when to do an “audition” elective. The final group lecture of the afternoon will address potential career paths in emergency medicine, academics, dual residency training, and fellowship. Lunch – While generally delicious, an added benefit of lunch at the student symposium is that it provides the opportunity to meet with program directors in an informal, small group setting. It is a great time to ask questions, learn directly from program directors, and to meet students from other schools, as well. Breakout Groups – There will be four small group sessions, focusing on topics for specific audiences. One session discusses the intricacies of balancing career and personal life, and provides valuable advice on the importance of finding balance. A second session deals with finances, budgeting and managing student loan debt. A third session addresses how to optimize the 4th year schedule, and provides useful insight into electives, research, and USMLE timing. The fourth session is designed specifically for students at schools without emergency medicine residencies 10

and will employ a Q &A session to guide students through the complicated maze that leads to a residency and career in EM. Residency Fair – Each year SAEM sponsors a residency fair, this year held at the end of the medical student symposium day. All EM residency programs, both allopathic and osteopathic, are invited to participate. In 2004, there were 69 programs participating in this event and over 150 students attended. Most programs in attendance have at least one representative at their table, often a program director, faculty member and/or a resident, and they are more than willing to answer questions. Residency program tables are arranged in rows geographically. To participate, students must be registrants of the medical symposium. The residency fair provides an excellent opportunity to meet with representatives of programs from across the country on this one day, especially useful when considering residencies in different geographic areas. It is a great chance to meet people, ask about 4th year clerkships, and pick up literature about each residency program. The SAEM Annual Meeting There is much to do at the remainder of the conference. Lecture sessions may provide a glimpse into “hot topics” in Emergency Medicine, which frequently come up during residency interviews. Understanding these topics demonstrates an interest and maturity about Emergency Medicine that program directors seek. These sessions are led by nationally recognized faculty in EM. This year’s topics include education research, introductory statistics, space medicine, diagnostic testing, and grantsmanship. Lectures of potential interest to students include: ● Understanding Diagnostic Testing (May 22)

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2005 SAEM Meeting…(continued from page 16) ● ●

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The Top 10 Errors in Emergency Medicine Research (May 22) Knowledge Translation and Emergency Medicine: Bridging the Gap from Evidence to Clinical Practice (May 23) Public Health Research: Challenges and Solutions for the Future (May 23) Introduction to Statistics (May 24) Emergencies in Space (May 24) Spivey Lecture: Developing the Leader within You (May 25)

In addition, there are oral paper pre-

sentations, poster sessions and lunch sessions every day, and an opportunity to meet with Emergency Medicine physicians from across the country. The papers and posters being presented compile current research in EM. For those students interested in research, these sessions may stimulate research ideas, to take with you to residency and beyond. One of the most fascinating parts of the meeting is the visually stimulating photography display. This display is a unique opportunity to see interesting radiographs, ECGs, and photos from

around the country. The photo presentation is completely informal and allows for “testing” your knowledge. The photo displays will be set up in the Exhibit Hall and available for viewing throughout the Annual Meeting. The SAEM Annual Meeting provides a fantastic opportunity for medical students to explore Emergency Medicine, and for a $25 early registration fee, it should not be missed. For more information, refer to www.saem.org, and click on the 2005 Annual Meeting link.

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 9-14, 2005 in Orlando. 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, 2005. Scholarship recipients will be announced at the annual SAEM and NACCT meetings. Each recipient will also be required to submit a summary of the meeting for publication in the SAEM Newsletter and the ACMT Newsletter. The articles of the inaugural recipients of the Scholarship, Dr. Lindgren and Dr. Ferguson are published in this issue of the Newsletter. 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

New York Symposium on International Emergency Medicine Kumar Alagappan, MD Long Island Jewish Medical Center The Second Annual New York Symposium on International Emergency Medicine will be held on May 20, 2005. This program is a satellite conference of the 2005 SAEM Annual Meeting. This one-day conference is sponsored by North Shore-Long Island Jewish, New York University-Bellevue Emergency Services and the New York Chapter of ACEP, and will be awarded 7 category 1 CME credits.

This one-day symposium will bring together national and international experts on international EM. The morning session will lead off with a keynote address from Dr Michael Van Rooyen from Harvard University and this will be followed by several lectures from experts both nationally and internationally. In the afternoon there will be 5 separate tracks on International EM. The tracks will include a panel 11

discussion/workshop on international research, international funding, NGO’s and a showcase of EM from countries around the globe. There will also be a track with original research presented as either poster or oral presentations. For more information contact Mary Strong at 516-465-2500 or go to www.nyacep.org and click on the International Symposium link.


Position Statement: Principles for Measuring Quality and Reporting Incidents and Adverse Events The following position statement was developed by the SAEM National Affairs Committee, chaired by Dr. Michael Baumann. The authors are Jack Kelly, MD, Robert Wears, MD and Brad Weir, MD. The SAEM Board approved the position statement during the January 18, 2005 Board of Directors conference call. Healthcare quality is the application of "best practice" to achieve optimal outcome for every patient. Emergency physicians face several unique medical challenges, such as high patient acuity, lack of medical information or prior relationships with patients, frequent interruptions, Emergency Department overcrowding and diversion, and essential patient care interactions with physicians of other specialties. The principles described herein are integral to the Society for Academic Emergency Medicine (SAEM) mission to improve patient care by advancing research and education in Emergency Medicine.

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Measuring healthcare quality starts with defining opportunities for improvement and defining actionable steps. Measurement should be honest and transparent with a defined benchmark. Incidents, defined as situations of potential harm (near misses), and Adverse Events, in which actual harm occurred,

should include all events in which care in the ED played a role. Incidents and Adverse Events should be reported within a blame-free, voluntary, and anonymous system, which has been shown to promote reporting. Each Incident or Adverse Event should be described in a narrative form to include the context in which it occurred (e.g., overcrowding, high acuity, lack of prompt consultant back-up) to encourage improvements to the practice of Emergency Medicine. Reporting of quality measurements, Incidents and Adverse Events should focus on advancing education and improving patient care in Emergency Medicine. Investments in reporting should be accompanied by equal or greater investments in research and analysis for understanding and learning.

Newsletter Submissions Welcomed

Drs. JT Finnell and his wife Maria were recently invited to the White House Christmas Reception. Dr. Finnell worked with President Bush last May as part of his initiative to assure better delivery of healthcare through information technology. He will complete his fellowship in medical informatics this summer.

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 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.

Policy: Letters of Support During the October 17, 2004 meeting of the SAEM Board of Directors, the following policy was approved by the Board of Directors. Given the mission of SAEM to advance research and education in emergency medicine, many Society members may submit research grant proposals to various institutions. SAEM clearly supports research efforts by its members. However, SAEM does not provide letters of support or endorsement for such purposes. 12


Academic Announcements SAEM members are encouraged to submit Academic Announcements on promotions, research funding, and other items of interest to the SAEM membership. Submissions must be sent to saem@saem.org by April 1 to be included in the May/June issue. Steven B. Bird, MD, has received a $612,000 grant from the National Institute of Environmental Health Sciences. His study, funded under a KO-8 mechanism, applies the use of functional MRI to evaluate neurochemical changes produced by acute organophosphate poisoning. Dr. Bird is an Assistant Professor in the Department of Emergency Medicine, and a recent graduate of the Medical Toxicology fellowship, at the University of Massachusetts. Valerie De Maio, MS, MD, Assistant Professor of Emergency Medicine at the University of North Carolina at Chapel Hill, received a Junior Faculty Award for her project, "Development of an EMS Research Database." To better address the acute medical needs of the growing number of adults aged 75 and older, New YorkPresbyterian Hospital/Weill Cornell Medical Center has created a Geriatric Emergency Medicine Fellowship, a first-of-its-kind program for physicians who have completed their residency training emergency medicine. The fellowship will be led by Neal Flomenbaum, MD, Professor of Clinical Medicine at Weill Cornell Medical College and Dr. Mark Lachs (Professor of Medicine at Weill Cornell) and Dr. Ron Adelman (Associate Professor of Medicine at Weill Cornell). The Centers of Disease Control and Prevention (CDC) is developing an agency-wide public health research agenda that will provide guidance for research that supports CDC's health impact goals. Robert Galli, MD, Chair, Department of Emergency Medicine, University of Mississippi, has been named co-chair of the Research Agenda Steering Workgroup Advisory Committee to the Director of the CDC. The Committee will provide advice and guidance to

the Office of Public Health Research on efforts to build the CDC research agenda.

National Highway Traffic and Safety Administration for the National EMS Information System project.

Paul Hinchey, MBA, MD, chief resident in Emergency Medicine at the University of North Carolina at Chapel Hill, was named a consultant to the North Carolina Office of EMS. He will assist in the development of EMS performance indicators. He also received a scholarship to attend the NAEMSP Pediatric Research Forum, which was held in January.

Kevin Rodgers, MD, has been named the Residency Director of the Year by the American Academy of Emergency Medicine. Dr. Rodgers is Adjunct Professor of Clinical Emergency Medicine and co-director of the Emergency Medicine Residency Program, Indiana University.

An academic Department of Emergency Medicine has been established at the University of Alberta and Brian Holroyd, MD, has been named Acting Chair. The University of Alberta is the fourth Canadian university to create an academic Department of Emergency Medicine. James H. Jones, MD, has been elected to the Board of Directors of the American Board of Emergency Medicine, from a slate of nominees submitted by SAEM. Dr. Jones is Associate Professor of Clinical Emergency Medicine and ViceChairman, Department of Emergency Medicine, Indiana University. Greg Mears, MD, Associate Professor of Emergency Medicine at the University of North Carolina at Chapel Hill and Medical Director of the North Carolina Office of EMS, has received a 1.5 million dollar HRSA Hospital Bioterrorism Preparedness Grant for the North Carolina Prehospital Medical Information System; a Duke Endowment Award for 3 years ($300,000 per year) for the EMS Performance Improvement Toolkit Project; $240,000 from the American Heart Association Emergency Cardiac Care Educational Grant for the support and implementation of the National EMS Information System; and $320,000 from the

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Robert L. Rogers, MD, has been appointed the Director of Medical Student Education at the University of Maryland School of Medicine Emergency Medicine Residency. He has also been named the Program Director of the combined emergency medicine/internal medicine residency. Matt Scholer, MD, Assistant Professor of Emergency Medicine at the University of North Carolina at Chapel Hill, received a Junior Faculty Development Award for his project, "Development of an Emergency Department Research Database." Susan Stern, MD, has been appointed Associate Chair for Education in the Department of Emergency Medicine at the University of Michigan. She began this position November 1, 2004. Stephen Trzeciak, MD, Assistant Professor, Department of Emergency Medicine and the Section of Critical Care Medicine at UMDNJ-Robert Wood Johnson Medical School in Camden, Jersey, has received a three-year research grant from the American Heart Association for his project, "Investigation of Microcirculatory Blood Flow in Early Goal-Directed Therapy of SepsisInduced Hypoperfusion States in Humans."


ACADEMIC RESIDENT News and Information for Residents Interested in Academic Emergency Medicine

Edited by the SAEM GME Committee

Developing a Mentorship Relationship Jeffrey Hackman, MD Truman Medical Center For the SAEM Graduate Medical Education Committee Teacher, guide, counselor. Regardless of what they are called, many people consider a mentor essential to a professional’s success. This may be especially true for people contemplating or entering a career in academic medicine.

be the hardest part of the process because you may not know each person’s specific talents. Your program director, chair, or faculty development chair can be invaluable in identifying the person or people right for you.

The difference between a mentor and an advisor or supervisor may be blurred sometimes, but the difference should be clear in your mind. Residency programs generally assign faculty advisors to residents to keep them on track in the program and answer questions about the residency itself. A mentor, on the other hand, is someone you seek out yourself for guidance on the “big picture” issues: entering academics or private practice, becoming the type of physician you want to be, and “style of medicine” issues. A mentor is someone who has a great deal of interest in you professionally and personally. You will discover that a mentor is someone who’s opinion you will always seek, who’s advice you will often take and who’s relationship you value. Residents often find that someone is mentoring them even before they realize they have developed such a relationship. While virtually any faculty member can serve as a mentor, some may be more able or willing. Program Directors and senior faculty often fill this role. Perhaps your faculty advisor will evolve into a mentor, but that may not be the case. Rather than being something you fall into, developing a mentorship relationship should be a deliberate process.

Your next step should be to analyze your strengths to determine what you have to offer a prospective mentor. If you can offer your services as a budding researcher or just your enthusiasm as a new physician, it is important to recognize that the most effective relationship with a mentor will be a two way street. It is critical to recognize that mentors mentor because they get personal and professional satisfaction from the relationship.

A mentor relationship may take the form of a traditional apprentice/expert affiliation. On the other hand, you may find your situation is better suited for a more open mentorship. In this model you work with multiple people, each of whom excels in a particular area. This allows you to draw from the experiences and expertise of several people. Successful individuals often have personal and professional mentors although a single individual can work in some relationships. You should first decide what you want from a mentor. Are you looking for someone to assist you form your style as an emergency physician? Are you seeking an experienced researcher to help you get started with a career in research? On the other hand, do you want an experienced educator to guide you into a career in academic medicine? A clear target will help you determine who will be able to get you where you want to be. Your mentor may provide advice and direction for everything from your contact negotiations to financial advice. You then need to identify the people who have the skill sets you want, or the people who embody the type of physician you want to become. If you are just getting started this may

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Finally, you should connect with the person or people you have identified. Take with you the information you have gathered thus far to be prepared to discuss your objectives for your mentorship relationship. Do not be offended if he or she recommends you work with someone else. This may happen if the person you have chosen feels unable to help with your goals, either because of preexisting time commitments or a perceived lack of expertise. Most likely he or she will be eager to help a new physician. As you approach residency graduation review some of the excellent articles on mentorship available on the SAEM website and elsewhere, as your needs may change once you enter practice. Establishing a mentorship relationship will not only help you achieve your goals but will make your residency and future career more enjoyable.


Southeast Regional SAEM Meeting April 8-9, 2005 Chapel Hill, NC

New York State Regional SAEM Conference 2005 April 3, 2005 Brooklyn, NY

This year’s Southeastern Regional SAEM meeting will take place at the Friday Center in Chapel Hill, North Carolina on April 8 and 9. Dr. Hobgood and Dr. Promes, the Program Co-Chairs have put together an exciting program. We are delighted to have Dr. Ian Steill giving the opening address on Friday morning entitled “Applied Clinical Research.” Dr. Steill will also be participating in a panel discussion with Dr. Kline on Clinical Decision rules. Dr. Glenn Hamilton, President-elect of SAEM, will be speaking to the participants on the second day about “Future Directions of SAEM.” There will be over 100 research presentations in addition to didactic sessions and hands on practical sessions. There will be interactive sessions on “How to Read a Brain CT”, “Regional Anesthesia”, “Suturing Workshop” and “Vascular Ultrasound”. There will be multiple faculty development sessions, as well as a session for Emergency Medicine Residency Directors. The fee for attending physicians is $125 and includes the educational sessions, breakfast and lunch each day, as well as an Opening Reception on Friday, April 8. Medical students as well as Emergency Medicine residents are encouraged to attend. There is a special reduced conference fee for these individuals. The program committee has developed a special session on April 8 specifically for medical students. To register for the conference, please call 866-924-7929 or 503-635-4871. The host hotel is the Courtyard by Marriott. The room rate is $94/night. Room reservations must be made by March 17, 2005 to get this rate. We hope to see you at this exciting conference! You will definitely learn something and have fun while you are doing it. This is a great opportunity to spend some time mingling with friends and academic leaders in the Southeast.

The Research Directors of New York State invite you to join us for our regional SAEM conference on April 3, 2005, at SUNY-Downstate Medical Center in Brooklyn. The conference will focus on Evidence Based Medicine with a presentation from keynote speaker; Dr. Dan Mayer of Albany Medical College and a workshop with Dr. Peter Wyer of Columbia University on “Using Online Interactive Resources to Enhance, Teach and Evaluate EBM Skill Sets.” The conference will also feature a firsthand report from Iraq by internationally recognized expert in Disaster Management, Dr. Almeida from Portugal. The PresidentElect of SAEM, Dr. Glenn Hamilton, will address the gathering as well. Oral presentations of all accepted abstracts will be offered in multiple concurrent sessions. For more information call 718-245-2973 or email: nephron1@bell atlantic.net. Please join us for this productive and stimulating day.

SAEM Western Regional Meeting April 9-10, 2005 Marina Del Rey, CA The 8th Annual Western Regional SAEM Research Forum will be held April 9 and 10, 2005 at the beautiful Marina Del Rey Marriott, located in the residential community of Marina Del Rey across from the world's largest man-made harbor. The hotel is only five miles from LAX international airport and three blocks from Venice Beach. World famous outdoor shopping is available on the Third Street Promenade, located a short distance from the hotel. Local attractions include the Getty Museum, Universal Studios, and Disneyland. Accepted posters will be previewed on Saturday April 9, and moderated poster sessions will be on Sunday April 10. There will also be an oral plenary session for the region’s best 4 or 5 abstracts. The conference’s didactic segments will focus on exploring, understanding, and managing the role of uncertainty in multiple aspects of clinical and academic EM practice. The conference will conclude with a fun and interactive game show format with audience participation! Please contact the conference chair, Dr. Pam Dyne at pdyne@ucla.edu for more information. Registration and fees may be sent to Mr. Wayne Hasby, Residency Coordinator, UCLA/Olive View-UCLA EM Residency, 924 Westwood blvd, Suite 300, Los Angeles, CA 90024. His email is whasyb@mednet.ucla.edu. Registration fees are $125 faculty, $50 residents, nurses, and paramedics, and $10 for medical students. Make checks payable to UCLA Division of Emergency Medicine. Please contact the Marriott directly at 1800-228-0209 or 310-301-3000 to make your hotel reservations. Reservations must be made before March 15 to take advantage of the discounted rate of $149.

9th Annual SAEM New England Regional Meeting April 27, 2005 Shrewsbury, MA The meeting will take place April 27, 2005, 8:00 am – 3:30 pm at the Hoagland-Pincus Conference Center in Shrewsbury, MA. For information: www.umassmed.edu/conferencecenter/. Send registration forms to: Linda Quattrucci, Research Assistant, Department of Emergency Medicine; Rhode Island Hospital, Coro West, Suite 106, One Hoppin Street, Providence, RI 02903. Email contact is lquattrucci@lifespan.org. Registration Fees: Faculty = $100; Residents/Nurses = $50; EMTs/Students = $25. Late fee after April 8, 2005 = add $25. Make checks payable to Brown Medical School, Department of Emergency Medicine.

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What is Educational Research? Gloria Kuhn, DO, PhD Wayne State University Chair, SAEM Educational Research SubCommittee of the Research Committee On behalf of the Educational Research Subcommittee That question, asked by a medical colleague, is the impetus for this article. The simple answer is that it is investigation about educational outcomes. Educational research is not a mysterious thing - it is investigation of educational outcomes. So how is that different than clinical research? Well, it’s not different, really. Clinical outcomes, educational outcomes... it doesn't really matter, except that the measurement of many clinical outcomes is much more precise than many educational outcomes. Therefore, the educational researcher has to be aware of things like psychometrics. In clinical research the investigator examines diagnostic properties of clinical tests (false positives, false negatives, sensitivity, specificity....) while educational researchers look at the psychometric properties of educational tests (validity and reliability). In educational research, the effects of instruction on thinking and behavior are of interest. We, as both physicians and educators, are really interested in learning about and understanding that portion of educational research that specifically relates to medical education. In contrast to educational research, which is extremely broad and researches the instruction and education of all learners, medical education research is confined to the study of adult learners who are engaged in learning and practicing medicine and the educational methods used by their teachers. It may use many of the principles generated as a result of educational research, but it has both a specific target population of subjects and specific environments in which it is conducted. A more helpful way to answer my colleague’s question is to examine medical education research within the perspective of scientific and clinical research with which we, as physicians, are all familiar. Areas of discussion include: examination of the field of medical education research, examining the challenges of performing good educational research, determining how it differs from clinical research, and examining some of the future trends in this discipline.

Related questions whose answers will be of value include how to get started in performing medical education research, and deciding what is good educational research. This article will discuss all of these questions. It is divided into two parts, with part 1 (this issue) providing an overview of the field of medical education research, and part 2 (next issue) discussing how to get started in this area. Much of the information in this article comes from the October 2004 issue of Academic Medicine, which is devoted to the topic of medical education research. Reading this issue will allow an overview of the field to be quickly acquired. The Field of Medical Education Research Part 1 Definitions There are several definitions of research including 1: careful or diligent search 2: studious inquiry or examination; especially: investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws 3: the collecting of information about a particular subject. Psychometrics is defined as the psychological theory or technique of mental measurement.1 In essence, any type of research is the careful and systematic examination of phenomena to answer questions about an area of interest. Using the above definitions, research can be, and is, conducted in almost all fields, from architecture, to education, to medicine, to zoology. The content of study will differ and the methods will be chosen to best answer a specific question in a particular discipline, but research is the discovery of new information or the revision/interpretation of existing knowledge in light of new information. Research may be theoretical or applied but it should be as unbiased as possible and attempt to answer a question asked by those conducting the research as accurately as possible. It is an ongoing quest to discover the “truth”. It is how 16

knowledge is advanced and in many cases allows practitioners to become more effective in their actions. In clinical research, the effect of disease, diagnostic interventions, and therapies on humans is studied. There are multiple research designs and methodologies, some much more effective than others. The double-blind randomized clinical trial (RCT) is at the “top of the heap” but in reality, when all clinical research is considered, is rarely conducted because it is so difficult and expensive. The medical community continually and passionately debates 1) the merits of research methods and individual research studies, and 2) whether to accept the results of a study and change behavior as a result of the conclusions of a study. Educators and medical educators carry on similar debates regarding educational and medical education research. Medical Education Research Medical education as a specialty, and formalized research in the area, began over 30 years ago with the founding of the first office in medical education by George Miller in the early 1960s. This was followed by efforts in other universities, all of which started master’s level programs in medical education.2 Norman notes that the most important evidence of progress in the field is that “…we are now more likely than before to demand evidence to guide educational decision making.” Pg 15603 He sees this as a cultural change because before the 1970s persuasion and politics were the guiding forces behind educational changes rather than evidence. Very simply and broadly stated, medical education research examines any facet of the education of physicians, students, or residents and the change in behavior or cognitive processes of learners as a result of that education. Teaching methods, faculty development, how medical students, residents, and physicians learn, what their practice behaviors are, how technology impacts learning, assessment of learner performance, and a host of other topics are all studied and the results reported. Medical education research may draw upon methods and information

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ABEM Requests Suggestions for Lifelong Learning and Self-Assessment Readings A cornerstone of ABEM's new EMCC program is the concept of Lifelong Learning Self-Assessment (LLSA), which is developed to promote continuous learning on the part of ABEM diplomates. ABEM facilitates this learning by identifying an annual set of readings to guide diplomates in self-study of recent Emergency Medicine (EM) literature. You can have a voice in the identification of these readings. ABEM welcomes and requests that EM organizations and ABEM diplomates submit suggestions for readings. As a result of these efforts, over the past three years, ABEM has received a significant number of recommended quality readings. There is concern, however, that the number of suggested readings may naturally diminish over time as organizations and individuals are increasingly busy. Developing high-quality LLSA tests is dependent on high-quality readings. ABEM urges SAEM and its members to participate actively in the selection of LLSA readings. As the publisher of EM’s academic journal and a leading academic organization in EM, SAEM is in a uniquely positive position to identify important, high quality readings.

Symptoms, and Presentations and Psychobehavioral Disorders. ABEM will select approximately 50% of the readings for the 2007 LLSA from these two designated areas, while approximately 50% of the test content will be drawn from the remaining content areas of the EM Model Listing of Conditions. How to Submit Recommendations for LLSA Readings For each reference submitted, ABEM must receive the following two items: 1. Lifelong Learning and Self-Assessment Reference Form Complete an LLSA Reference Form for each reference that you recommend to ABEM. Be sure to provide all requested information for each reference, including the article title completely written out, the journal name, etc. Do not use abbreviations. Do not alter the form in any way, except to add the requested information in the space provided. The LLSA Reference Form is available from ABEM and may also be downloaded as an MS Word document from the ABEM website, www.abem.org. The form can be computer-printed or typewritten. 2. One Paper Copy of the Article, Chapter, or Other Text One paper copy of the article, chapter, or other text for which you have submitted a reference must be mailed or faxed to ABEM to be considered for inclusion. Electronic copies of readings cannot be accepted due to copyright restrictions. References received by June 1, 2005, will be considered for inclusion in the 2007 LLSA module. Materials submitted after that date will be considered in the future. Recommendations may be submitted via fax or mail: FAX: 517.332.3943; Mail: LLSA References, American Board of Emergency Medicine, 3000 Coolidge Road, East Lansing, MI 48823 If you have specific questions or comments regarding the process for recommending references for the LLSA component of the EMCC program, please contact Timothy J. Dalton, Examination and Evaluation Project Specialist, at the ABEM office, telephone 517.332.4800. If you have questions of a more general nature regarding LLSA or about the overall EMCC program, please contact Robert C. Korte, Ph.D., Senior Psychometrician.

Submission Criteria for LLSA Readings ABEM has established the following criteria for LLSA readings: 1. Focused on recent advances or current clinical knowledge in Emergency Medicine; 2. Clinically oriented in content; 3. Drawn from peer-reviewed EM journals, peer-reviewed journals from related primary specialty fields, textbook chapters, or updated practice guidelines; 4. Published in printed or electronic form within the immediate five years preceding the LLSA test in which it will be used; 5. Related to either the designated content areas for a given year (approximately 50%), or to the remaining content areas (approximately 50%) of the EM Model "Listing of Conditions." Content of the 2007 LLSA Test Although readings for the second LLSA test in 2006 have already been selected, ABEM welcomes reference suggestions for future LLSA tests from the larger EM community on an ongoing basis. Currently, ABEM is soliciting readings for the 2007 LLSA test, for which the designated content areas will be Signs,

Call for Advisors The SAEM Virtual Advisor Program has been a tremendous success. Hundreds of medical students have been 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. Please consider mentoring a future colleague by becoming a virtual advisor today. We have a special need for osteopathic emergency physicians to serve as advisors. It is a brief time commitment – most communication

17

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 website. 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.


from any or all of the disciplines of education, clinical medicine, or psychology. Both theoretical and practical educational literature may need to be consulted when researchers are designing methods of study. Both educational and medical education research are broad based endeavors which draw on methods and knowledge from many disciplines and their findings are of use in almost all fields. Current Status of Medical Education Research Publications There has been an increase in both the quantity and variety of publications in medical education research. In 1980 there were just over 1300 articles dealing with research in medical education, while in 2003 the number was 2,907. From 1994 to 2003 there were 24,028 articles in the English language on medical education research. The journal Academic Medicine is the leading publisher of articles in this area (11%), followed by Medical Education (approximately 6%). Family Medicine and the British Medical Journal each published about 3% of these articles. Academic Medicine, Medical Education, and Family Medicine have a combined circulation of only 14,000, which is small when you consider that JAMA, which published only 1.5% of the articles in medical education research, has a readership of 332,337.4 Medical specialty and subspecialty journals sporadically publish articles related to education. Although they usually deal with research relating to education within their particular discipline of medicine, they may publish material of interest depending upon the project being considered by a researcher. Funding of Medical Education Research Funding of research in medical education has been small and remains so while support for this activity has been sporadic. This is mirrored by what has happened in education in general. In 1998 the total education budget in the United States was $300 billion dollars, but only 0.01% of this funding was spent on research in education.5 Similarly, in 1994 spending on health care professions education research was 0.001% of the total amount of direct federal spending on graduate medical education, for a total of $1.1 million annually. In contrast, the government spent approximately $11 billion for biomedical research. In fiscal year 1995 the increase of National Institutes of Health (NIH) appropriations for research was

400 times the total allocation for education research.6 In essence, in the United States, we spend a lot of money on education, demand quality and results from educational endeavors, but are unwilling to spend money on research which could tell us how to get the most value for our money. Certainly there has been no systematic plan for conducting research in medical education, and there has been no central agency comparable to the NIH to help lead, support, and guide efforts. Without adequate funding, performing educational studies that are comparable in quality and scope to those performed in clinical medicine is impossible. This lack of funding and support may explain why some of the weaknesses in medical education research exist. A broad and overarching criticism of medical education research efforts was leveled by Wartman and O’Sullivan who stated that “programmatic research in health professions education had not been established as part of the academic mainstream, and that the process of health profession education was fraught with unexamined assumptions at virtually every level.” pg 9104 They called for a national center for health professions education research.7 That call was never answered, and no progress has been made in supporting, leading, or coordinating research efforts in the field. Carline5 reviewed a sample of research reports from Academic Medicine and Teaching and Learning in Medicine (two of the leading journals in publication of research in medical education in the United States) in order to determine funding sources. He chose the May issues of Academic Medicine from 2000 to 2004 and the spring issues of Teaching and Learning in Medicine from 1999 to 2003. Of the 70 articles published within this timeframe, 45 did not list any funding. Of the 25 articles which listed funding, five were supported by departmental or institutional awards, while 20 articles listed external funding. Eight of the 20 articles with external funding received US federal funding or funding from the Canadian Institutes of Health, seven got funding from national organizations such as the American Association of Medical Colleges (AAMC) or National Board of Medical Examiners, and four authors obtained funding from the Robert Wood Johnson Foundation or the W.K. Kellogg Foundation. The remaining 11 18

citations had funding from a number of private foundations, each mentioned once. Carline concluded that the research which did not report funding was performed as part of the author(s) employment duties and supporting funds were derived from operational budgets. The result of this lack of large scale funding is that studies tend to occur in one institution, are small in scale with small numbers of subjects, and are short term. This situation leads to many of the criticisms of educational research, namely that methodology is poor, numbers are small, findings are not generalizable, and conclusions are suspect as a result of these shortcomings. These studies cannot have the power and robustness of the multi-center, randomized double blind studies, or longitudinal studies which researchers in clinical medicine are fond of performing and quoting and which cost millions of dollars to fund. The rigorous process of review which the NIH conducts on any application for research funds tends to improve the study proposal through peer review by experts in the field. Researchers can use the advice from peer reviewers who are experts in the area to improve the design of their studies. Additionally, the NIH guides the type of research performed by allocating funds to some areas of research and not others. In many cases funding by the NIH is extremely generous. Examples of the amounts of money provided by the NIH for medical research they agree to fund include $12.5 M to Stanley Prusiner for prion research, $9.9 M to Alfred Gilman for cell signaling studies, and $4.9 M to Michael Gimbrone for studies on vascular endothelium.8 While some may criticize the philosophy and methods of the NIH it does have money to spend and support to give to research, medical not educational research. Progress in Medical Education Research Yet progress has been made in medical education research. Norman3 reviewed the advances in medical education research over the past 30 years and noted progress in the following areas: basic research in acquisition of medical expertise, problem based learning, methods of assessment, continuing medical education, recertification, and licensure. Several of these areas, which Norman has cited, will be discussed in more detail as they impact

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heavily on both the teaching of medicine and our clinical practice. Acquisition of Expertise Research in the acquisition of medical expertise has used many of the methods developed by cognitive psychologists and has demonstrated that medical expertise is dependant on the accumulation of a rich knowledge base which is both didactic and experiential in nature. This is in direct contrast to an earlier incorrect belief that medical experts possessed more efficient “clinical problem solving” skills. The value of much of the literature on expertise is its proof of the generalizability of methods of instruction which cross domains. “Deliberate practice” is engaged in by all who wish to become experts, and the time to gain expertise is 10 years whether the domain studied is medicine or chess (for a detailed discussion of deliberate practice and expertise see Ericcson, A. Attaining Excellence Through Deliberate Practice: “Insights from the Study of Expert Performance” in The Pursuit of Excellence Through Education ed. Ferrari, M ).9 What has been missing in medicine is an implementation of methods of instruction used for deliberate practice and systematic studies of the effects of these practices. We continue to use the “apprentice” model in resident education and do not customize education and training to the needs and learning styles of residents. Performance Assessment A great deal of research has been conducted in performance assessment and has shown that performance as well as cognitive knowledge can be reliably and validly assessed, but only if multiple sampling strategies are used on multiple occasions. One of the most important results of this research is the development of assessment strategies using standardized patients and the objective standardized clinical exam, and demonstration of both reliability and validity for assessment of performance using these and other methods. Continuing Medical Education The areas of continuing medical education (CME) and the need to find methods of instruction which are more effective than standardized lecturers are a direct result of research which looked at change in behavior of physicians after attending courses in CME.10,11 Recertification Both Canada and Britain have shown that licensed, practicing physicians may not be able to demonstrate competency

when tested. A change in culture is occurring as medical specialty boards adopt a requirement for periodic recertification of their members and licensing boards require proof of competency for relicensure of physicians. (For a more detailed discussion of these areas of medical education research see Norman, G Research in Medical Education: Three decades of Progress BMJ 2002) Regehr12 examined four key journals which publish medical education research, Academic Medicine, Advances in Health Sciences Education, Medical Education, and Teaching and Learning in Medicine, looking for the trends in medical education research. He found extensive research in the following four areas: curriculum and teaching issues, skills and attitudes relevant to the medical profession, characteristics of medical students, and evaluation of medical students and residents. Prystowsky13 looked at medical education from 1996 through 1998 using an outcomes research paradigm. Using this perspective he suggested a three dimensional framework for analyzing medical education research in which participants (trainees, faculty, patients, and providers), outcomes (performance, satisfaction, professionalism, and cost) and level of analysis (geographic, system, institution, and individual) could all be studied. He used four data sources, Academic Medicine, Medical Education, Teaching and Learning in Medicine, and all papers presented at the Research in Medical Education (RIME) conferences held annually at the AAMC. He required that articles be data driven and look at some aspect of the educational environment. There were 599 publications meeting these specifications. When looking at participants, trainees were most commonly studied (n=413, 68.9%), followed by faculty (n=116, 19.4%). Providers (n=49, 8.1%) and patients (n=21, 3.5%) were rarely studied. The most commonly studied outcome measure was performance (n=296, 49.4%). The performance (i.e. performance on a paper and pencil test or examination of a standardized patient) of the trainee, faculty, or provider accounted for the vast majority of studies (n=292, 48.7%) while clinical outcomes of patients, presumably the most important measure of effective medical education, was the least studied parameter (n=4, 0.7%). Satisfaction of the learner was the sec19

ond most common primary outcome measured (n=204, 34.1 %). Most analyses were performed at either the individual level (n=235, 39.2%) or the institutional level (n=220, 36.7%). Although it is of value to study trainee performance and satisfaction, there are few studies of the ability of trainees to care for patients and almost no studies of cost of education, provider behavior, or patient outcomes, all areas which could provide valuable information regarding the efficacy of medical education. One of the greatest values of the type of overview of medical education research provided by Norman, Regehr, and Prystowsky is that it dramatically demonstrates the gaps in medical education research and fruitful areas for further study. Criticisms of Medical Education Research Yet, despite progress, there are a number of critics and criticisms of the state of medical education research. The comments of Wartman and O’Sullivan have already been mentioned.7 Bordage14 performed a content analysis of reviewers’ comments, both positive and negative, of 151 manuscripts which were submitted to the 1997 and 1998 RIME conference proceedings. The main strengths of accepted manuscripts included: the importance or timeliness of the problem(s) studied, excellence of writing, and soundness of study design. The top ten reasons for rejection included inappropriate or incomplete statistics; over interpretation of results; inappropriate or suboptimal instrumentation; sample too small or biased; text difficult to follow; insufficient problem statement; inaccurate or inconsistent data reported; incomplete, inaccurate, or outdated review of the literature; insufficient data presented; and defective tables or figures. These criticisms are not minor but are major deficits of the research submitted. Interestingly, they sound similar to the criticisms that reviewers level at submitted manuscripts of medical research. Difficulties in Conducting Research Educational researchers often encounter difficulties that medical researchers have been able to overcome, in the areas of blinding, use of control groups, and controlling for confounding variables. The clinical gold standard of the double-blind randomized clinical trial can rarely be conducted in educational or medical education

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research. Bias and confounding variables are potentially the biggest problems in research of any kind. Medical researchers overcome potential bias by blinding both the investigator and the subject whenever possible. A simple example to illustrate this point would be a study on control of hypertension comparing a new drug with a placebo. While the “control group” patients might cheat and use medications other than the placebo they receive, there is little motivation to do this because they are blinded as to whether they are receiving the placebo or experimental drug. The investigator is also blinded so that results and adverse outcomes are honestly reported. To ensure compliance in the experimental group researchers have resorted to watching the subject take the medication, counting pills left in pill bottles, and other devices to control compliance. Most clinical trials show a measurable advantage of one intervention over another but this is rare in education where “no significant difference” is the rule rather than the exception due in part to the inventiveness of learners.15 Overcoming bias and confounding variables is difficult or impossible in educational research. In most cases subjects as well as educators know what the intervention is, and this fact leads to the possibility of bias. Medical educators have not yet developed a “placebo” for instruction because the

learner will often overcome perceived or real deficits in instruction. Motivated learners will find a way to learn the material they perceive as necessary for their success, overcoming any deficit in curriculum or instructional strategy. This often leads to finding “no difference” between the experimental and control groups. Both Norman and ten Cate have concluded that true blindness in randomization in education is impossible.3,16 This fact makes it difficult to use control groups in the same manner as they are used in medical research. As long as motivated students have access to printed or electronic information there is no way to constrain their learning unless the educational treatment and testing occur with little intervening time. Some researchers have utilized this methodology but it prevents long term studies or study of instructional strategies and learning outcomes in the work place setting. Learners have confounding variables other than motivation to learn. Previously acquired knowledge and variable efficiency in learning can affect outcomes. This may be explained by the fact that, as ten Cate has noted, an educational intervention will tell more about students’ inventiveness about constructing their own learning program than about the educational intervention.16 (For an in-depth discussion of students’ learning strategies and the differences between expert and non

expert learners see Thomas J and Rohwer W, Proficient Autonomous Learning: Problems and Prospects in Cognitive Science Foundations of Instruction, ed Rabinowitz M)17 One solution to some of these problems is to use a randomized control group pre-test/post-test design so that the learner, even if not blinded, acts as his own control. However, the pre-test itself may affect the post-test by allowing subjects to “guess” what they are supposed to learn, allowing them to acquire knowledge as a result of taking the pre-test, or being primed for learning as a result of taking the pre-test. The Solomon four-group design, in which not all groups are given a pre-test, is one solution to this problem. This is a very powerful experimental design controlling well for both internal and external potential sources of error or ambiguity. One disadvantage of using the Solomon’s four group design is that it requires a larger group of subjects, but it illustrates some of the ingenious methods educational researchers have developed to overcome difficulties encountered. (For an in-depth discussion of this and other research designs see Campbell, D.T., & Stanley, J.C. Experimental and Quasi-Experimental Designs for Research. Houghton)18 Part 2 of this article will be published in the May/June issue of the Newsletter.

AACEM to Meet at SAEM Annual Meeting The Association of Academic Chairs of Emergency Medicine (AACEM) will meet on the day before the SAEM Annual Meeting, on May 21, 2005 at the New York Hilton. All AACEM members are encouraged to attend. Here is the preliminary schedule of events: 8:00-9:00 am

AACEM/University of Cincinnati/Dr. Levy International Visiting Professor Lecture

9:00-11:00 am

Leadership Challenges in Complex Academic Environments

11:00-12:00 noon

Open Discussion of AACEM issues

12:00-1:30 pm

AACEM Annual Business Meeting and Lunch (AACEM members only are invited to attend)

1:30-4:00 pm

New and Future Chairs Workshop (all interested individuals are invited to attend. Contact AACEM through the SAEM office for registration information. Registration fee is $0 for AACEM members and $100 for non-members).

6:00 pm

AACEM Reception and Dinner at Explorer's Club (active members and spouses only) 20


President’s Message…(continued from page 1) needed, determines outcome goals, recognizes and utilizes opportunities for prevention, monitors progress, shares information and educates, and adjusts therapy and diagnosis according to results.” Sure…why not? After all, who could argue with that? Moving next to graduate (residency level) medical education, we see our program directors in all specialties wrestling with a system to implement teaching of, and assessment of, 6 “core competencies” under the ACGME mandate of 2002. The method utilized for this process was fascinating and clever…rather than define what these competencies were and how they could best be implemented into already bursting curricula, the ACGME “allowed” each specialty to chart its own course. The ACGME will later decide how to measure the implementation strategies. Hmmm….and at the same time, the radical discovery that tired humans are more likely to be irritable, lack empathy and more prone to error swept the GME community, resulting in the 80-hour workhours implementation across all specialties (let’s see, I believe it was 1985 for EM to take such a bold step….). Draconian threats of the loss of entire institutional accreditation for non-compliers has spawned new industries in resident workhour accounting, while other schools simply added additional reporting forms onto their busy residents. The certification process for new graduates has garnered less attention, but this is most likely only temporary. Pressure to “prove” procedural competency in addition to the other ACGME core competencies will have an impact on this process. Our current system mandates a signature from the graduate’s program director that the resident met all curricular elements, followed by successfully passing a multiple choice examination and then an oral examination that effectively assess cognitive components (at the expense of reinforcing behaviors known to promote clinical medical error). Not to be ignored, attention also fil-

tered to the practicing physician. Concerns were being raised that practitioners failed to adopt the most current “best practices” into their patient care, or were unduly influenced by bioindustry promotional efforts as opposed to the “best evidence”. Traditional CME processes (largely the traditional lecture format) were acknowledged for their universal lack of effectively changing physician behavior, yet the financial ramifications for overhauling this process provided little professional society incentive for change. The ABMS weighed in with a mandate to all 23 specialty organizations to develop a 4 component “Maintenance of Certification” process. The ABMS initiative (in theory) will protect society from poor or outdated practitioners by providing incentives to maintain a life long learning process and self assessment. ABEM faces many challenges in developing a meaningful yet practical system. So, are we in the midst of a revolution involving all phases of medical education that will ultimately address societal concerns (real or perceived)? The implication of a “revolution” is that the status quo is so dysfunctional that an overwhelming overhaul in entirety is time critical. Perhaps we are witnessing an acceleration of a logical evolution in the process of training tomorrow’s emergency practitioners? Or are we adrift in the ocean, without a compass and a clearly articulated (or realistic) destination for tomorrow’s practitioners? I would ask us to step back to our physician scientist roles (see Nov/Dec 2004 Newsletter) as educators. Could we do better preparing future physicians? Of course! Was the product universally broken? I remain unconvinced. Will the changes described above meaningfully assure the preparation of a more capable practicing physician? I am a skeptic. Shouldn’t profound systems changes in medical education undergo a similar process of hypothesis generation, testing through methodologically sound means, analysis, and refinement? Shouldn’t we insist that there are

at least “pilot studies” demonstrating measurable efficacy (or even effectiveness) before deconstructing the existing process? Isn’t it important to articulate a measurable endpoint before forging ahead? Isn’t it important to gather data about unanticipated side effects of our education system changes? For instance, workhours mandates universally appear to be a no-brainer. Yet they have created a new layer of resident “service-only” (the “night float”) experience that appears to be counter-intuitive to our goals of improving education. The Draconian enforcement has taken personal choice away from motivated adult learners. And while workhours are capped, the mandated curriculum for every specialty has grown every year, with little being removed. The latest is the mandated teaching in the 6 core competencies, but many more have preceded such as ultrasonography, wellness and cultural competence. Important? Absolutely. But what should we remove? Should we scale back on our pediatric airway management? We know that it takes 40,000 patient encounters in order to attain expertise…will we and should we consider extending the training time required to assimilate the skills necessary for successful practice of EM? Is it time for a 4 year edict? Will uniform limits of workhours in every specialty during residency result in a graduate poorly prepared for the rigors of post-graduate practice, or will these graduates adopt a differing practice pattern mirroring residency? And please do not misinterpret my thoughts above as constituting a universal dismissal of the changes in medical education. In fact, the universe of creativity mandated in these changes has been professionally rewarding. I simply am uncomfortable with a process that changes so many variables simultaneously without a clear destination or an eye towards unintended adverse side effects. Unless a revolution is truly required, we should apply our scientist training to the changes in medical education.

Residency Vacancy Service The SAEM Residency Vacancy Service was established to assist residency programs and prospective emergency medicine residents and is posted on the SAEM website at www.saem.org. Residency programs are invited to list their unexpected vacancies or additional openings by contacting SAEM. 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. 21


FACULTY POSITIONS

EMERGENCY MEDICINE

ALABAMA: The University of Alabama at Birmingham, Department of Emergency Medicine, in Birmingham, AL, seeks a full-time Medical Toxicologist to assist in providing clinical emergency and toxicological care to patients of northern and central Alabama. Immediate availability by July 2005 is required. Prevailing wage and benefits available. Must have residency training in emergency medicine, AL license, DEA, and U.S. BC/BE in Medical Toxicology. Send CV and letter of interest to: Thomas E. Terndrup, MD; Professor and Chair, Department of Emergency Medicine; JTN 266; 619 19th St. South, Birmingham, AL 35249-7013.

Academic Positions Available in the

Department of Emergency Medicine of

Allegheny General Hospital, Pittsburgh, PA

INDIANA: Indiana University School of Medicine, Department of Emergency Medicine is recruiting a clinician teacher to provide care at public hospital ED located on medical center campus. Wishard Hospital is Level One Trauma Center, base for busy pre-hospital emergency transport services, and regional burn center. The ED recorded 108,000 visits in 2003. Wishard complements Methodist in providing clinical experiences for IUSM EM residents. Enthusiasm for medical education, clinical research, and patient care in busy public hospital ED are expectations. Residency training, certification/preparation in EM are required. Rank and tenure 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.

Practice Emergency Medicine in Western Pennsylvania’s Most Dynamic Emergency Department ✩ ✩ ✩ ✩ ✩ ✩

Emergency Medicine Residency Training Program Level I Trauma Center Level I HAZMAT Receiving Facility 20% Pediatrics Medical Toxicology Treatment Center Fellowships - EMS, Sports Medicine, Administration, Research, Toxicology, Patient Safety ✩ Salary Commensurate with Experience

MICHIGAN: Director of Research position available for BC EM physician in academic setting at 92,000 annual visit Level II Trauma Center. The 39,000 square foot ED housing 76 beds, includes an ED, adult and pediatric ambulatory care centers, chest pain observation unit, & an on-site Medflight air ambulance. St. Joseph Mercy Hospital is an approved EM Residency program sponsored by this 600-plus bed hospital and the University of Michigan Medical Center. Clinical research experience (3 years) is required; dedicated protected time provided. Employed positions offer excellent remuneration plus faculty stipend, productivity bonus, paid malpractice, full benefits, & relocation allowance. Please contact Nancy Ely @ (800) 466-3764, ext.337 or nely@epmgpc.com. Visit us at www.epmgpc.com.

Contact: Fred Harchelroad, M.D. via Michelle Malsch, Executive Asst. (412) 359-3961 mmalsch@wpahs.org

NEW YORK: Columbia University – Attending Emergency Physician – Harlem Hospital Center Emergency Services affiliated with Columbia University, seeks residency-trained or ABEM-certified Emergency Physicians who have excellent clinical skills, a strong interest in teaching and a commitment to public medicine. We are a 290-bed, Level 1 trauma center, regional burn center, EMS-based station with over 75,000 annual visits. An appointment to the faculty of the Columbia University College of Physicians and Surgeons is anticipated at the Instructor or Assistant Clinical Professor level, commensurate with experience. Competitive salary and benefits package provided. Submit CV to: Reynold Trowers, M.D. Director of Emergency Medicine Services, Harlem Hospital Center, 506 Lenox Avenue, New York, N.Y. 10037. Call him at (212) 939-2253 or e-mail at RLT2@columbia.edu. Columbia University takes affirmative action to ensure equal opportunity.

✩✩ West Penn Allegheny Health System, an Equal Opportunity Employer ✩✩

University of Pittsburgh The Department of Emergency Medicine offers fellowships in the following areas:

OHIO: The Ohio State University - Assistant/Associate or Full Professor. Established residency training program. Level 1 Trauma center. Nationally recognized research program. Clinical opportunities at OSU Medical Center and affiliated hospitals. Send curriculum vitae to: Douglas A. Rund, MD, Professor and Chairman, Department of Emergency Medicine, The Ohio State University, 146 Means Hall, 1654 Upham Drive, Columbus, OH 43210, email Dailey.1@osu.edu, or call (614) 293-8176. Affirmative Action/Equal Opportunity Employer.

• Toxicology • Emergency Medical Services • Research • Education

PENNSYLVANIA: University of Pittsburgh: Full-time emergency medicine faculty positions are available at the Instructor through Associate Professor levels. Candidates must be residency trained and board certified/prepared in emergency medicine. We offer career opportunities as a clinician-investigator or clinician-teacher. Our faculty have local, national and international recognition in research, teaching and clinical care. The ED serves a primarily adult population with a volume of approximately 50,000 per year, and is a Level I trauma center with both toxicology and hyperbaric medicine treatment programs housed within our Department. Salary is commensurate with experience. For further information write to: Donald M. Yealy, MD, Vice Chair, Department of Emergency Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 500, Pittsburgh, PA 15213. The University of Pittsburgh is an Affirmative Action, Equal Opportunity Employer.

Enrollment in the Graduate School is a part of all fellowships with the aim of obtaining a Master’s Degree. In addition, intensive training and interaction with the nationally-known faculty of the Department of Emergency Medicine, with experts in each domain, is an integral part of the fellowship experience. Appointment as an Instructor is offered and fellows assume limited clinical responsibilities in the Emergency Department at the University of Pittsburgh Medical Center and affiliated institutions. Each fellowship offers the experience in basic and/or human research and teaching opportunities with medical students, residents and other health care providers. The University of Pittsburgh is an Equal Opportunity Employer, and will welcome candidates from diverse backgrounds. Each applicant should have an MD/DO background or equivalent degree and be board certified or prepared in emergency medicine (or have similar experience). Please contact Donald M. Yealy, MD, University of Pittsburgh, Department of Emergency Medicine, 230 McKee Place, Suite 500, Pittsburgh, PA 15213 to receive information.

WASHINGTON, DC: Washington Hospital Center (WHC), Georgetown University Hospital (GUH), Franklin Square Hospital (FSH), and Union Memorial Hospital (UMH) in the Washington, D.C. – Baltimore, MD corridor seek physicians board-certified or residency-trained in emergency medicine to join their faculty. WHC is the largest Washington, DC hospital, seeing more than 67,000 annual visits; GUH is a renowned academic institution; and FSH and UMH emergency departments in Baltimore are very busy. Contact Mark Smith, MD, FACEP, Chairman of Emergency Medicine, at 202-877-0808, fax 202-8772468 or write to him at the Washington Hospital Center, Department of Emergency Medicine, 110 Irving Street, NW, Washington, D.C. 20010.

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Boston Harvard Affiliated Teaching Hospital

University of Alabama at Birmingham

The Department of Emergency Medicine of the Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center has positions available for faculty committed to academic Emergency Medicine. Board certifi-cation or prepara-tion in Emergency Medicine with four years of training or experience are prerequisites. The base hospital is Beth Israel Deaconess Medical Center, a Level I trauma center, with an ED that sees nearly 50,000 patients a year, and the seat of a three year emergency medicine residency. Our community practice, Beth Israel Deaconess Needham, sees 12,000 patients a year. We provide needed direction for three 911 systems. Academic opportunities include access to lab space, international programs, and teaching at Harvard Medical School. Salaries are highly competitive for the community and are incentive based. We are currently seeking faculty with interests in academics, EMS, basic science, or postgraduate education.

Fellowship Opportunity Resuscitation/Critical Care Fellowship Co-Directors: Thomas Terndrup, MD tterndrup@uabmc.edu; Jason Begue, MD jbegue@uabmc.edu; Fellowship Length: 1 -2 years. Salary: negotiable, competitive; Deadline for Applications: Rolling, No Deadline; Eligibility: Completion of residency training in Emergency Medicine The Department of Emergency Medicine (DEM) at UAB is seeking physicians residency trained in Emergency Medicine (EM) for its one or two year Resuscitation Fellowships. The training program was developed and is run by the DEM with the intent of training emergency physicians, but is highly multidisciplinary, and now is supported by NIH for resuscitation science training. The objectives of this program are three-fold; (1) to learn advanced resuscitation and critical care techniques with a concentration on their application to critically ill patients in the emergency department, (2)to receive training in clinical or fundamental research, and (3) to conduct clinical or bench research in resuscitation or critical care. Join a multidisciplinary team of investigators from EM, Cardiology, Trauma, and the Joint Health Sciences who will provide mentorship and training. Funded research is supported by NHLBI and HRSA. Degree seeking candidates will require 24 months of training. The program is flexible depending on the individual training needs. Currently it consists of two tracks: (1) clinical directed rotations through various critical care units to include surgical, medical, trauma/burn, neonatal, neurological, and heart transplant, with faculty from other programs serving as facilitators. In additional, opportunity is available for training in various specialty areas (i.e. echocardiography, advanced airway techniques). (2) research directed research training through MPH/MSPH degree at UAB School of Public Health, resuscitation interest group mtgs., and participation in research activities under NHLBI Resuscitation Outcomes Consortium grant. UAB has additional resources for conducting both clinical and basic science research and training. Interested parties are encouraged to send a curriculum vitae and letter of intent to: Thomas E. Terndrup, MD, Professor and Chair, Department of Emergency Medicine, Director, UAB Center for Emergency Care and Disaster Preparedness, The University of Alabama at Birmingham, Department of Emergency Medicine, 619 19th Street South, Birmingham, Al 35249-7013, E-mail (preferred): tterndrup@uabmc.edu, Fax: 205.975.4662

Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers. Women and minorities are particularly encouraged to apply. Please send applications or nominations, together with a current curriculum vitae, to: Richard E. Wolfe, M.D., Chief of Emergency Medicine Beth Israel Deaconess Medical Center One Deaconess Road (W/CC2) Boston, MA 02215

Department of Surgery

University of Alabama at Birmingham

Division of Emergency Medicine/South Texas Poison Center

Fellowship Opportunity Disaster Medicine

The Division of Emergency Medicine/South Texas Poison Center at University of Texas Health Science Center at San Antonio is recruiting 1-2 residency trained, BC/BE Emergency Medicine Clinician-Investigators committed to developing an academic career. We have full-time positions available for the academic year commencing August 2005. Preference is given to individuals with fellowship training or research experience. Candidates who have toxicology training will also have the opportunity to work with the South Texas Poison Center. Adequate protected time is provided and start-up funding is available. The University Hospital Emergency Center is a level 1 trauma center which evaluates and treats 70,000 patients annually. The hospital serves as our major teaching facility. There is 80 hours of physician coverage daily. UTHSCSA offers a competitive salary, a comprehensive insurance package, and a generous retirement plan. South Texas is a great place to raise a family and accentuate a career. For more information visit our web site at www.uthscsa.edu. All faculty appointments are designated as security sensitive positions. UTHSCSA is an Equal Employment Opportunity Affirmative Action Employer.

Fellowship Co-Directors: Thomas Terndrup, MD tterndrup@uabmc.edu; Jason Begue, MD jbegue@uabmc.edu; Fellowship Length: 1 -2 years. Salary: negotiable, competitive; Deadline for Applications: Rolling, No Deadline; Eligibility: Completion of residency training in Emergency Medicine We are seeking applicants for our fifth research fellowship position in Disaster Medicine within the Center for Emergency Care and Disaster Preparedness (CECDP) in the Department of Emergency Medicine. The CECDP is a multidisciplinary research and service center established in 1999 and has received broad support from ~60 faculty members, and funding from the Department of Defense, AHRQ, FEMA, Department of Homeland Security, CDC, and others. Appropriate training in research methodology, operational experiences, publication and grant preparation are provided. Excellent collaborative research opportunities and advanced training is provided with other investigators at UAB. Candidates must be physicians and those who are eligible or board-certified in Emergency Medicine are preferred. Experience in coordinating multi-disciplinary conferences and research projects preferred. Other formal educational opportunities at UAB are available. Most fellows have completed a single year, but the duration is flexible and compensation is competitive.

Contact Information: Please contact or send your CV to David Hnatow, MD, Chief of Emergency Medicine/South Texas Poison Center, 4502 Medical Drive, TX 78229

Interested parties are encouraged to send a curriculum vitae and letter of intent to: Thomas E. Terndrup, MD, Professor and Chair, Department of EM, Director, UAB Center for Emergency Care and Disaster Preparedness, The University of Alabama at Birmingham, Department of EM, 619 19th Street South, Birmingham, Al 35249-7013, E-mail (preferred): tterndrup@uabmc.edu, Fax: 205.975.4662

E-Mail: hnatow@uthscsa.edu Phone: 210-358-2078 Fax: 210-358-1972

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Academic Emergency Medicine Research Faculty Position Due to an expansion of the faculty, the University of Florida, Department of Emergency Medicine is seeking a full-time Assistant/Associate Professor with an interest in research to join our faculty practicing at Shands Teaching Hospital Emergency Department. The Department emphasizes active involvement with emergency medicine residents and medical students. Qualified applicants will be board certified/eligible in emergency medicine and ability to develop a funded research program is prefered. Faculty will provide clinical guidance and supervision of treatment delivered in the ED. Shands at UF is the hub of a multi-hospital network. Emergency Medicine medically directs county EMS and hospital transport including the ShandsCair helicopter and NASA Medical Support. Excellent compensation, great benefits package, great city! Join a progressive, democratic, superb, 13 person faculty group of team players with emphasis on quality emergency care with dedicated customer service. Anticipated Start date is July 2005. Application deadline is April 30, 2005. Please send personal statement and CV to : David C. Seaberg, MD, FACEP, Professor & Associate Chair, Department of Emergency Medicine, University of Florida, PO Box 100186, Gainesville, FL 32610-0392. Women and minorities are encouraged to apply. University of Florida is an Equal Opportunity Employer.

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University of Iowa Faculty Positions The Department of Emergency Medicine at the University of Iowa is actively seeking clinical and tenure track faculty members to fill newly created core faculty positions. Competitive applicants will have completed an ACGME accredited emergency medicine residency-training or pediatric emergency medicine program and be actively participating in research or residency training. Successful applicants interested in either basic science or clinical research careers will be aligned with an appropriate NIH funded mentor(s) and receive considerable start up funds to jump-start their academic career. Qualified individuals will receive significant release time to develop their academic interests. Clinical duties will be performed at the University of Iowa Health Care’s Emergency Treatment Center; the regions only Level I Trauma Center. Individuals selected for these positions will be involved in Iowa’s only Emergency Medicine training program. Responsibilities will include teaching and supervising pediatric and emergency medicine residents. Salaries, schedules and fringe benefits are very competitive. Iowa City is a beautiful outdoor and family oriented community located along the banks of the Iowa River just 200 miles west of Chicago. The area offers a superb school system and a great lifestyle. Interested applicants should send a CV to Eric Dickson, M.D., Head, Department of Emergency Medicine – 1193 RCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242-1009. Applicable background checks will be conducted. The University of Iowa is an Equal Opportunity and Affirmative Action Employer. Women and minorities are strongly encouraged to apply.

The SAEM Newsletter is mailed every other month to approximately 6000 SAEM members. Advertising is limited to fellowship and academic faculty positions. The deadline for the May/June issue is April 1, 2005. All ads are posted on the SAEM website at no additional charge. Advertising Rates: Classified ad (100 words or less) Contact in ad is SAEM member $100 Contact in ad non-SAEM member $125 Quarter page ad (camera ready) 3.5" wide x 4.75" high $300 To place an advertisement, email 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: Elizabeth Webb at elizabeth@saem.org

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SAEM Medical Student Symposium May 21, 2005

The Medical Student Symposium is intended to help medical students understand the residency and career options that exist in emergency medicine, evaluate residency programs, explore research opportunities, and select the right residency. At the completion of the session, participants will: 1) know the characteristics of good emergency physicians and the "right" reasons to seek a career in this specialty, 2) have a better understanding of the application process with regard to letters of recommendation, personal statement, planning the 4th year, etc., 3) consider factors important in determining the appropriate residency, including geographic locations, patient demographics, length of training, etc., 4) understand the composition of an emergency medicine rotation and what to expect while they are rotating in the ED, 5) discuss the skills needed to get the most out of your educational experience in the ED rotation, 6) Identify the standard sources of information in the field of emergency medicine, 7) have an appreciation of various career paths available in Emergency Medicine, including academics, private practice, and fellowship training, and 8) discover current areas of research in Emergency Medicine. To register for the Symposium, use the online Annual Meeting registration form at www.saem.org. The cost is $75. 9:00-9:15 9:15-10:00

10:00-10:30

10:45-11:45

11:45-12:15

12:30-2:00 2:00-2:45

2:45-3:30

3:45-4:45

5:00-6:30

Welcome and Introduction, Kevin Rodgers, MD, Indiana University How to Select the Right Residency for You, Cherri Hobgood, MD, University of North Carolina An overview of EM residency programs will be discussed. Important factors to consider in the selection process including length of training, geographical location, patient demographics, and academic vs. clinical setting will be reviewed. The speaker will also discuss the difference between allopathic and osteopathic programs. Getting Good Advice, Wendy Coates, MD, Harbor – UCLA Medical Center One of the keys to any successful career is getting and following good advice. How do you choose the right advisor(s) and use their wisdom to help your succeed? What do you do when your medical school doesn't have an EM Residency Program? What resources are available to you about the various programs? Navigating the Residency Application Process, Peter DeBlieux, MD, Charity Hospital - Louisiana State University This presentation will provide students with tips on how to prepare their ERAS application, how and when to successfully interview and how to follow-up with top programs. The Dean's Letter, Brian Zink, MD, University of Michigan The speaker, an emergency physician and Dean, will review with the students the components of the Dean's letter. The importance of your input into the contents of the Dean's letter will be discussed. Lunch with Program Directors Getting the Most out of Your EM Clerkship, Gus Garmel, MD, Stanford University This session will provide the student with valuable tips for getting the most from your Emergency Department Clerkship. Specific topics to be discussed will include: 1) appropriate educational goals for an emergency medicine rotation; 2) how to best prepare for your rotation in order to make the most of your ED experience; 3) recommended textbooks and references; and 4) important considerations when deciding when and where to do your emergency medicine rotation. Career Paths and Prospects in Emergency Medicine, Carey Chisholm, MD, Indiana University This session will expose students to a variety of career paths including private practice, academics, and dual training (EM-IM / EM-PEDS) as well as fellowship training. Breakout Groups Balancing Act - Susan Promes, MD, Duke University and Elizabeth Datner, MD, University of Pennsylvania This session will discuss how to optimize your career and personal life. Financial Planning - David Overton, MD, Michigan State University This session will review practical tips on financial issues. The speaker will address such issues as how to put together a budget and what to so with medical student loan debt. Optimizing Your Fourth Year - Doug Ander, MD, Emory University This session will provide students with recommendations for making the most of their senior year including information about EM and other electives, research experience, and when to take their Board exams. Medical Schools without EM Residencies – Kevin Rodgers, MD, Indiana University This Q&A session will help guide medical students from medical schools without EM residencies through the complicated maze that leads to a residency and career in EM. It will specifically address how this process differs from those students with a EM residency at their medical school. Residency Fair and Reception All osteopathic EM residency programs are invited to exhibit and should contact elizabeth@saem.org to register. Last year residency 69 programs participated in the Residency Fair.

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Chief Resident Forum May 24, 2005 Chief residency is a demanding and highly responsible position, however little formal and structure preparation is available prior to becoming a chief resident. New chief residents typically have not had the benefit of training in essential administrative, academic, and leadership skills. This one-day course will include a variety of sessions covering administrative and academic topics relevant to new chief residents. Talks and small group discussions will be led by experienced program directors and past chief residents. All sessions will include ample time for questions. In addition, a lunch session and coffee breaks will provide opportunities for chiefs from different programs to meet and exchange ideas. The small group discussion sessions will also allow for interaction with workshop faculty and former chief residents. At the completion of this course, participants will be able to understand basic characteristics of good leadership, management techniques, administration and problem solving concepts; have learned successful scheduling and back-up techniques; become aware of common pitfalls faced by chief residents; learned effective communication techniques; had the opportunity to discuss potential ethical dilemmas that may arise during the chief resident year; and learned time management techniques. All chief residents registered to attend the Annual Meeting are invited to register for the special Chief Resident Forum. Enrollment is limited and the fee is $100, in addition to the basic Annual Meeting registration fee. Use the online Annual Meeting registration form to register for the Annual Meeting and the Chief Resident Forum. 7:30-8:00 am

Registration and Continental Breakfast

8:00-8:45 am

So You’re Chief Resident. What Does that Mean?, Stephen Playe, MD, Baystate Medical Center This session will explain the various roles and requirements of chief residents.

8:45-9:45 am

Leadership and the Management Role, Robert Hockberger, MD, Harbor-UCLA Medical Center This session will describe the scope of authority and responsibility in your role and explain leadership theories focusing particularly on action-centered leadership.

9:45-10:00 am

Break

10:00-11:00 am

Effective Communication, Marc Borenstein, MD, Newark Beth Israel Medical Center Communication is a key element to the success of any leader. At the end of this discussion, participants will understand how to build effective communication networks, identify the key communication skills required to manage staff, explain formal and informal communication networks, facilitative questioning, active listening, and describe the principles of giving and receiving feedback.

11:00-12:00 noon

Developing a Schedule, Kevin Rodgers, MD, University of Indiana (moderator) The emergency department schedule is a central element of any chief resident’s responsibility. This discussion will outline the RRC requirements for scheduling in EM, suggest tips for managing the complexities of an ED work schedule and explain mechanisms for dealing with sudden changes.

12:00-1:30 pm

Lunch - Question and answer session

1:30-2:15 pm

Professional Growth, Sandra Schneider, MD, University of Rochester This session will illustrate strategies for successful career development, describe various routes to advancement and describe the challenges and barriers to promotion.

2:15-3:00 pm

Ethics and Professionalism, James Adams, MD, Northwestern University As chief resident, you may confront a new series of ethical dilemmas. This session will highlight ethical and confidential issues that involve other residents and describe how to set professional examples for others.

3:00-3:45 pm

Time Management, Susan Promes, MD, Duke University At the end of this session, participants will understand what you can realistically achieve with your time, recognize the importance of prioritizing To-Do lists and describe time management principles that can help you in your role as chief resident.

3:45-5:00 pm

Lessons Learned - Panel discussion of former chief residents

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S A E M

Newsletter of the Society for Academic Emergency Medicine

Board of Directors Carey Chisholm, MD President

Glenn Hamilton, MD President-Elect Katherine Heilpern, MD Secretary-Treasurer Donald Yealy, MD Past President Leon Haley, Jr, MD, MHSA James Hoekstra, MD Jeffrey Kline, MD Maria Raven, MD Robert Schafermeyer, MD Susan Stern, MD Ellen Weber, MD

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

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

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March-April 2005