May-June 2004

S A E M

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE Opportunity….

This is my final “President’s Message” for the SAEM Newsletter. In previous columns, I covered topics of importance (at least in my view) to you, the member. These included: the goals of the year for the Board of Directors and organization; discourse within our Society; fund raising to advance our mission vs. altering SAEM’s ‘tradiDonald M. Yealy, MD tion’ dialogue; the abstract submission, acceptance and rejection process; and critical care certification for emergency physicians. Now, I’d like to offer one man’s perspective on SAEM and emergency medicine. Like previous messages, I’ll try to be clear and brief – your time (including that used reading this) is valuable.

Opportunity is the word that keeps coming to me when I reflect on emergency medicine (as a career) and SAEM (as an organization). I’ll explain.

The features of emergency medicine and emergency physicians – by nature (our choosing this field) and nurture (our training and living in the emergency department) - put us in an ideal setting for accomplishment. We care for those in need whenever they perceive need; we teach the most difficult skills and information (‘who is sick and what needs to be done’) in the most challenging environment; and we spend much of our time convincing others ‘this is the right thing to do’ – including all our students, EM and non-EM colleagues, care regulators and administrative/finance counterparts. As academic emergency physicians, we do all this and seek better ways for the future. This unique position allows countless of us to alter lives and limit suffering near and far – through the practice and teaching opportunities in the ED, and through the leadership opportunities we get at our institution, in our government, and in organized medicine.

Healthcare colleagues recognize our special traits – ability to focus and juggle, combine pragmatism with principle, offer clarity with compassion. This recognition created opportunity; opportunity produced departmental chairs, deans, practice plan directors, chief officers, and elected leaders in medicine and government. I see even more opportunity and growth in the future, dwarfing this exceptional growth already seen.

Within SAEM, similar opportunities exist, and the same zeal, skill and accomplishment are rampant. The organizations continues to grow – in size, in resources, and in ‘doings

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

May/June 2004 Volume XVI, Number 3

SAEM Research Fund – Support Made Simple

Brian Zink, MD University of Michigan Chair, SAEM Financial Development Committee Academic emergency physicians’ practice is a whirling dervish of medical and social issues that grow more complex each year.

Even the most energetic adrenaline junkies may meet their match in today’s busy academic ED. It is a small pleasure to help a patient who has a non-complicated presentation. One of my favorite adages when supervising residents is: “Don’t make the easy ones hard.” A similar concept can be invoked as you consider how you might support the academic future of our specialty.

The SAEM Research Fund is support made simple. SAEM members are solicited to donate their hard earned money to many causes. For some of these causes, it may be difficult to figure out what your contribution will support and where your money goes. The SAEM Research Fund is only about one thing – providing training grants for emergency physicians. The mission for the Fund are as follows: • To improve the care of patients in the emergency department and pre-hospital settings, through medical research and scientific discovery.

• To enhance the research capability within the field of emergency medicine through financial support of investigators.

• To enable investigators to gain knowledge and skills related to: the responsible and ethical conduct of research; research design; funding mechanisms; practical aspects of data collection, management, and analysis; and the publication and dissemination of new information.

The vision for the fund is: Our vision is that well-trained, ethical, and productive investigators will conduct emergency medicine research. Because of their knowledge and contribution, emergency medicine specialists will be involved in the planning and conduct of virtually all research related to emergency medicine, whether the research is investigator-initiated and supported by federal, state, or local agencies, or initiated and supported by industry.

SAEM Research Fund grants help to develop the research and educational careers of young emergency medicine academicians. The recipients of this year's major grants are published in

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Residency and the SAEM Research Fund Steven J. Davidson, MD Maimonides Medical Center At the end of each calendar year, my wife and I determine which charitable efforts we will financially support.

Though I’ve contributed in past years to the SAEM Research Fund, this year I was motivated to do so in memory of deceased residents from the residency where I trained, Medical College of Pennsylvania in Philadelphia (now the “Drexel University College of Medicine”).

Six graduates of that program have perished since its founding over three decades ago and I learned from and taught all of them. That observation startled me and caused me to reflect back upon various experiences with each of them. It occurred to me that in my planned giving to the SAEM Research Fund, I wanted to honor their memory.

In this brief article, I’d like to encourage you to consider doing likewise out of respect to your experience of residency and graduates of it who are deceased. Why would you do so?

Though I count myself among the

first generation of EM residency graduates, this not particularly important characterization nonetheless describes a key aspect of my persona. Since I perceive myself as indelibly affected by my residency experience and all who passed through it during the two decades I was there, I feel indebted to all those people. Yet gratitude and a gift to my residency seemed too limiting— narrowing rather than expanding the world of emergency medicine.

It occurred to me that just as with my children, from whom I don’t seek gratitude, but rather wish for their success through their contributions to the wider world; so too, my residency and all associated with it weren’t looking for my gratitude but rather for our specialty’s success in the world of medicine.

So too, my contribution to the SAEM Research Fund in memory of my deceased colleagues is an effort to extend their contributions—beyond their lives—to the greater world of emergency medicine. I know these men loved their practices and their careers in

emergency medicine. Some were notable researchers—early in their careers; others practitioners just starting out or in mid-career, yet all contributed through their lives and their practices to establishing not only their own reputation, but the credibility and reputation of emergency physicians more widely.

Surely, you know an emergency physician, perhaps a graduate of your residency who has perished before his/her contributions were fully manifest.

Enable the contribution you know they would have confirmed through their own lives if given a chance. Make a contribution in that physician’s honor to the SAEM Research Fund and urge your residency mates to do likewise.

MCP resident graduate deaths as of February 16, 2004 Lawerence J. Carley - 1979 graduate John S. Foster – 1984 graduate William H. Spivey - 1984 graduate Michael McDonald – 1986 graduate Richard Wuerz - 1990 graduate Haif Alnajjar – 1995 graduate

2003 Year-end Financial Report James Adams, MD Northwestern University SAEM Secretary/treasurer It is a pleasure to present the financial statements from SAEM. The leadership is pleased with the efficient management and conservative use of funds organization-wide, most notably demonstrated at the headquarters. It is an expert, but lean operation that is tightly run. SAEM succeeds because of the volunteer contributions of the talented members and elected leaders. The Annual Meeting, accomplished without industry support, succeeds financially because it is effectively organized and generously delivered by excellent chairs, committee and task force members, and speakers. Excess revenue from any source is entirely invested into the core mission of advancing research and education in emergency medicine. The important next challenge for SAEM is to enhance the financial position by developing other productive revenue streams. This exploration is beginning. The highest priority remains dedication to the mission and preservation of the strong ethical values upon which SAEM is built.

2003 Expenses: Operating Budget Salaries/Wages, Insurance, Pension: $373,649 Journal and Newsletter: $308,498 Annual Meeting: $204,175 Office: postage, printing, phone, computer: $128,664 Representation, Travel, Meetings: $69,741 TOTAL: $1,084,745 2003 Research Fund Revenues Sponsorship: $81,250 Member Donations: $47,280 TOTAL: $128,530 2003 Research Fund Expenses Grants: $372,500 TOTAL: $372,500

2003 Revenues: Operating Budget Membership Dues: $1,105,359 Annual Meeting: $430,636 Journal and Newsletter: $230,680 Other: $20,914 TOTAL: $1,787,589

The total value of the Research Fund was $2,999,975 as of December 31, 2003. SAEM contributed $250,000 to the Research Fund in mid-2003.

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Research Fund Update Frank Counselman, MD Eastern Virginia Medical School The 2004 Member Campaign of the Society for Academic Emergency Medicine (SAEM) Research Fund is off to an impressive start. To date, contributions total over $19,000. 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 40906. You can also make your donation on-line by going to www.saem.org and click on “Click here to contribute to the Research Fund”.

Mentor ($1000-$2499) Michelle Biros, MS, MD Glenn Hamilton, MD Mary Ann Schropp Susan Stern, MD Sponsor ($500-$999) William Barsan, MD Louis Binder, MD Carey Chisholm, MD Steven Dronen, MD James Hoekstra, MD Roger Lewis, MD, PhD Lawrence Melniker, MD Robert Shesser, MD, MPH Donald Yealy, MD Investigator ($250-$499) Brent Asplin, MD Christopher Beach, MD John Beecher, DO Francis Counselman, MD Steven Davidson, MD, MBA Leon Haley, Jr., MD, MHSA Cherri Hobgood, MD Kevin Knoop, MD David Lee, MD Lawrence Lewis, MD Benson Munger, PhD Daniel Pallin, MD, MPH Edward Panacek, MD Mary Patterson, MD Jedd Roe, MD, MBA Leland Ropp, MD Brian Zink, MD Supporter ($100-$249) Roy Alson, MD, PhD James Amsterdam, DMD, MD David Bahner, MD

Jill Baren, MD Patricia Bayless, MD Steven Bernstein, MD Marc Borenstein, MD Christopher Bourdon, MD James Calabro, MD E. Martin Caravati, MD, MPH Michael Cassara, DO Shu Boung Chan, MD, MS Paul Cheney, MD Amy Church, MD Rita Cydulka, MD Gail D'Onofrio, MD Daniel Danzl, MD Genevieve DeBeaubien, MD Lynn Dezelon, MD Barry Diner, MD Kelly Anne Foley, MD Robert Galli, MD Gregory Garra, DO Romolo Gaspari, MD Lowell Gerson, PhD James Giglio, MD Mary Hegenbarth, MD Jon Hirshon, MD, MPH Debra Houry, MD, MPH Gregg Husk, MD Charlene Babcock Irvin, MD Kristi Koenig, MD Steven Krug, MD Steven Kushner, MD, MPH Christopher Lai, MD Christopher Linden, MD Gretchen Lipke, MD Thomas Lukens, MD, PhD James Menegazzi, PhD Donna Moro-Sutherland, MD Daniel Morris, MD Gene Pesola, MD, MPH Gary Pollock, MD

Joel D. Rosenbloom, DO Douglas Rund, MD Michael Runyon, MD Daniel Rusyniak, MD Augusta Saulys, MD Fred Anthony Severyn, MD Paul Silka, MD Marco Sivilotti, MD, MSc John Skiendzielewski, MD Rebecca Smith-Coggins, MD Linda Spillane, MD Susan Stroud, MD Robert Swor, DO Matthew Walsh, MD Marvin Wayne, MD Christopher Weaver, MD Scott Wilber, MD Mildred Willy, MD Lance Wilson, MD Other Lisa Cowan Valerie DeMaio, MD Bridget Dyer Kenneth Fine, MD Gregory Guldner, MD Christopher Kerwin Naghma Khan, MD PJ Konicki, MD Jo Ellen Linder, MD Frank Messina, MD Martha Neighbor, MD Alfred Sacchetti, MD John Sakles, MD Mark Scheatzle, MD, MPH Matthew Spencer, MD Joshua VanderLugt Kelly Young, MD

All Research Fund donors in 2003 and 2004 are invited to attend a special “thank you” reception on May 17 in Orlando.

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Academic Excellence Award

Tom P. Aufderheide, MD

Tom P. Aufderheide, MD, is a wellestablished, nationally and internationally recognized researcher in the field of emergency cardiac care. His scholarly achievements include numerous stateof-the-art research studies and publications that have had a significant effect on the practice of emergency medicine.

He has secured numerous extramural funding awards from industry, foundations, and the National Institutes of Health, serving as principal and co-principal investigator on many important national studies. His recently completed Trial of the Time-Insensitive Predictive Instrument (TIPI) demonstrated increased detection of acute cardiac ischemia with its use in the emergency department. His recently co-authored study “Missed Diagnosis of Acute Cardiac Ischemia in the Emergency Department” published in the New England Journal of Medicine definitively describes the scope and nature of this major health problem. Dr. Aufderheide just completed serving as the principal investigator in Milwaukee for the Public Access Defibrillation (PAD) Trial, which doubled survival rates for out-of-hospital cardiac arrest and will provide the objective data on which to base national healthcare policy for the next decade.

Dr. Aufderheide pioneered the use of prehospital 12-lead ECGs for rapid identification of the ischemic patient and reduction in time delays to definitive treatment. His curriculum vita indicates significant scholarly development from discovery (feasibility, safety, and effectiveness of prehospital 12-lead ECGs) to application (national and international consultations leading to implementation of prehospital 12-lead ECGs throughout the United States and the world). He is one of a handful of nationally recog-

nized researchers actively engaged and NIH-supported in the complex area of out-of-hospital cardiac resuscitation.

His very recent discoveries identifying an inversely proportional relationship between mean intrathoracic pressure and coronary perfusion pressure and survival from cardiac arrest are likely to significantly change national and international CPR education, training, and clinical practice.

Dr. Aufderheide’s scientific discoveries and national leadership have been recognized by the American Heart Association (AHA) through his numerous committee appointments and in his current role as Basic Life Support Science Editor. Through these positions, Dr. Aufderheide has been instrumental in developing new techniques of CPR instruction and instructional materials for AHA, including simplification of course content, evidence-based course development (piloting and documenting course effectiveness until the course consistently succeeds in meeting all educational objectives), video-mediated instruction (assuring consistent delivery of educational content), and practiceafter-watching techniques (maximizing student practice time for mastery of psychomotor skills). He has authored over 30 CPR courses for AHA (including provider materials, instructor materials, CDs, videos, posters, and ancillary training materials), which have been disseminated worldwide and translated into many foreign languages. These courses teach CPR and AED use to over 8 million people per year in the United States alone. He has published two definitive textbooks related to cardiac disease: Emergency Cardiac Care and Advances in Prehospital Care. As a result of these educational achievements, Dr. Aufderheide has emerged as a leading national and international lecturer. He is a superb presenter to students, residents, and faculty, consistently earning excellent ratings for his lectures.

In addition to these national educational achievements, Tom has served as a teacher and mentor to dozens of residents and students at the Medical College of Wisconsin. Many of his over 70 publications in the peer-reviewed literature have been co-authored by residents or students who have gone on to academic careers in emergency medicine. He provides significant advisory

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time with the Medical College’s junior and senior students and actively participates in the Emergency Medicine Club Clinical Experience Mentorship program. His leadership in research education has been demonstrated through his creation and implementation of the department’s Annual Emergency Medicine Research Forum, held yearly for the past 12 years at the Medical College of Wisconsin. Consistent with his demonstrated educational excellence, Dr. Aufderheide will host the SAEM Midwest Regional Meeting here in Milwaukee in September 2004.

Along with these significant accomplishments in research and education, Dr. Aufderheide has achieved many additional scholarly accomplishments.

He serves as a member of the National Heart, Lung, and Blood Institute’s National Heart Attack Alert Program Working Group on Methods/Technologies for Early Identification of Acute Cardiac Ischemia/Acute Myocardial Infarction in the Emergency Department. He is also a member of the National Institutes of Health Small Business Innovation Research (SBIR) Grant Review Committee. He has served on the International Liaison Committee on Resuscitation (ILCOR – a committee that develops international CPR guidelines) and the National Highway Traffic Safety Administration’s Steering Implementation Committee for the EMS Agenda for the Future. Wisconsin’s governor, Tommy Thompson (now the United States Secretary of the Department of Health and Human Welfare), recognized Dr. Aufderheide for his work in supporting Automated External Defibrillation (AED) legislation in the State. Dr. Aufderheide served as a formal consultant to the Assistant Surgeon General of the United States for implementation of public access defibrillation in federal buildings.

It is therefore, with great pleasure and enthusiasm that I present to you this exceptional academic emergency physician who has significantly impacted the practice of emergency medicine: this year’s recipient of the Hal Jayne Academic Excellence Award, Dr. Tom P. Aufderheide.

William Barsan, MD University of Michigan

SAEM Leadership Award

Joseph Waeckerle, MD

Joseph Waeckerle, MD, is one of the most influential academic physicians in the specialty of emergency medicine. His impact is felt whenever a medical student or emergency medicine resident joins EMRA, or subsequently decides to pursue subspecialty training in sports medicine; whenever federal, state or local government officials turn to emergency physicians for advice or assistance in disaster planning or response, and whenever any health care professional anywhere in the world picks up a copy of Annals of Emergency Medicine.

One of the first doctors in the country to sign up for residency training in the fledgling specialty of emergency medicine, Dr. Waeckerle founded the Emergency Medicine Resident’s Association (EMRA) in 1974 and served as its first representative on the Executive Committee of UAEM. He went on to make landmark contributions to the growth and maturation of EM through work with almost every major specialty organization. Most of us aspire to be considered a national expert in one small aspect of our clinical or academic practice. Dr. Waeckerle has achieved widespread acclaim in 4 distinct fields - disaster medicine/domestic preparedness, sports medicine, wound care, and medical publishing.

His remarkable career to date includes an array of service and/or national leadership roles, both inside and outside academic emergency medicine.

The following positions are representative of a larger whole:

Founder and Representative of the Emergency Medicine Residents’ Association to the University Association for Emergency Medicine (now SAEM), 1974-75

Program Chair, University Association for Emergency Medicine (now SAEM), 1978-80

President, University Association for Emergency Medicine (now SAEM), 1981-82

Member, Board of Directors, American College of Emergency Physicians, 1981-1984

Member, Board of Directors, Emergency Medicine Foundation, 1985-1990

Editor-in-Chief, Annals of Emergency Medicine, 1989-2002

Club Physician, Kansas City Chiefs Football Club, 1993-Present

Consultant to the National Football League, 1995-Present

Medical Officer, Kansas City Division, Federal Bureau of Investigation, 1995-Present

Chair, Task Force of Health Care and Emergency Services Professionals on Preparedness for Nuclear, Biological and Chemical Incidents – ACEP and the Office of Emergency Preparedness, US Dept. of Health and Human Services, 1998-2001

Defense Science Board, Dept. of Defense, Task Force on Biologic Weapons, 2000-2001

Advisor, Bioterrorism Preparedness and Response Program, CDC, 2000-2001

Senior Advisor to the U.S. Surgeon General on Domestic Pre-

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paredness, 2002 – present Over the course of his career, Dr. Waeckerle has received numerous honors and awards, including Kansas City’s proclamation of November 21, 1991 as “Dr. Joseph F. Waeckerle Day”; Missouri Senate Resolution No. 789, which recognized his dedicated service to his fellow citizens; EMRA’s creation of the “Joseph F. Waeckerle Founder’s Award” given annually to a worthy recipient since 1992, and ACEP’s decision to award Dr. Waeckerle its 2003 Mills Award for outstanding service to the specialty of EM. These titles and awards signify a career of service, but they do not adequately convey the impact that Joe has had (and continues to have) on his colleagues, his trainees and his friends through work in the classroom, in the E.D., on various task forces, boards and committees, through 27 years of service with Annals of Emergency Medicine, and through his vital and ongoing collaboration with local, state and federal officials to strengthen disaster preparedness and enhance homeland security.

These accomplishments are not simply the product of brilliance (although Joe is certainly brilliant) or originality (he is definitely one of a kind). Rather, Joe personifies the qualities that characterize successful academic emergency physicians everywhere – intellectual curiosity, versatility, far-seeing vision, perseverance, a burning desire to serve, and a strong commitment to personal and professional integrity.

None of us can hope to match him, but we would do well to try.

Arthur L. Kellermann, MD, MPH Emory University

2004 Young Investigator Award Recipients

Dr. Debra Houry first became interested in research while working as an undergraduate student volunteer in the emergency department of Emory University Hospital. After attending medical school at Tulane, where she earned dual MD and MPH degrees, she completed residency training in Emergency Medicine at Denver Health Medical Center. She joined Emory’s Department of Emergency Medicine in 2002 as Associate Director of the Emory Center for Injury Control.

Her scholarly output to date is extraordinary. She has authored more than 30 peer-reviewed publications and book chapters, and has five more in press. Even prior to her arrival at Emory, she secured an EMF/Riggs Family Foundation grant to study use of 911 computer-assisted dispatch data to identify households at high risk for domestic violence. On the strength of that work, she recently secured two major federal grants as principal investigator. The first is a 3 year, R49 grant from the CDC to study the safety and efficacy of computer screening for domestic violence in the ED. The second is a 5 year, NIH K23 grant to study mental health symptoms in association with domestic violence among ED visitors. Collectively, these two awards total more than $1.6 million in extramural support.

Despite her youth, Dr. Houry has already received an extraordinary number of local, regional and national awards. These include, most notably, the American Public Health Association’s 2002 Jay Drotman Award, which is given annually to the most outstanding public health researcher under age 30 in the country.

In addition to her numerous awards, Dr. Houry has compiled an exemplary record of service to her specialty. She served as a resident member of the Board of Directors of the Society for Academic Emergency Medicine, and as resident member on the editorial boards of

Craig D. Newgard, MD, MPH, attended Loyola University of Chicago School of Medicine where he evaluated the use of crash photography to predict injury patterns for persons involved in motor vehicle crashes. He also spent time at NHTSA in Washington, DC, doing further research. He completed his residency in EM at Harbor-UCLA Medical Center in 2000 and remained at Harbor-UCLA for a 2-year research fellowship, mentored by Dr. Roger Lewis, during which he obtained an MPH in Epidemiology. In July 2002, Dr. Newgard joined the faculty at Oregon Health & Science University in the Department of Emergency Medicine and the Center for Policy and Research in Emergency Medicine.

Dr. Newgard has studied emergency medical services, trauma, injury prevention, and the use of advanced analytic methods to address common analytic problems (e.g., missing data, clustering, estimating treatment effects in observational research, data linkage). As a fellow, he coordinated all aspects of a prospective EMS study encompassing 20 fire stations and 26 pediatric receiving hospitals in Los Angeles County. To carry out this research and his fellowship training, Dr. Newgard obtained 3 grants, including an AHRQ National Research Service Award, the SAEM Research Training Grant, and a grant from the Southern California Injury Prevention Research Center. His efforts have resulted in numerous publications and presentations, including during the SAEM Plenary Session.

Dr. Newgard is currently a co-investigator on a CDC grant for rural trauma research through the National Center for Injury Prevention and Control and was recently awarded the 2004-2005 EMF Career Development grant to use probabilistic linkage and multiple imputation methods to develop a statewide database of injured patients for derivation of a clinical decision rule for interhospital 6

We in the Canadian emergency medicine community are extremely proud of Michael Schull, MD, MSc, both for his humanitarian work, and his impressive accomplishments as a health services researcher. Dr. Schull completed medical school at Queen’s University, in Kingston, Ontario. He worked as a general practitioner in remote parts of Canada and in developing countries with the medical aid organization Doctors Without Borders for several years prior to obtaining his emergency medicine specialty training at the University of Toronto, and his epidemiology training at McGill University. He is currently a Clinician Scientist and Assistant Professor in the Department of Medicine, University of Toronto, and a Scientist at the Institute for Clinical Evaluative Sciences (ICES), Canada’s premier health services research center. He practices emergency medicine at the Sunnybrook and Women’s College Health Sciences Centre, and is coordinator of their EM Fellowship program. Since his arrival at University of Toronto in 1998, he rapidly established himself as one of the best young health services researchers in Emergency Medicine. Dr. Schull’s area of expertise is the use of large administrative databases to address the important issue of ED overcrowding. Emergency department overcrowding is a very pressing problem for both Canadian and American health care systems and one that potentially affects all citizens in both countries. To my knowledge, he is one of a very few health services investigator in North America focusing on the problem of ED overcrowding. A major testament to Dr. Schull’s research program was his receipt of the Peter Lougheed Award in 2001 from the Canadian Institutes of Health Research (CIHR), Canada’s equivalent to the NIH. This award recognized that Dr. Schull was the top ranked applicant in the pool of young investigators being considered for the

Annals of Emergency Medicine and JAMA. She is currently a member of the editorial board of Annals of Emergency Medicine and serves as didactic subcommittee chair on the SAEM Program Committee.

Dr. Houry’s research on domestic violence and other topics is having a major impact on our specialty and more important, for our patients. I am certain that she will be an outstanding advocate for the disciplines of emergency medicine, public health and violence prevention for decades to come.

Arthur Kellermann, MD, MPH Emory University

transfer practices in a rural trauma system. He has served 4 years on the Research Committee and currently serves on the Program Committee and Constitution and Bylaws Committee. Dr. Newgard is a reviewer for 3 medical journals, including his service as a statistical reviewer for AEM. He also served as an expert reviewer for a special report on safety belt technology produced by the Transportation Research Board of the National Academies of Science.

Dr. Newgard is highly regarded by his colleagues here at OHSU and we look forward to his continued success as an innovative investigator in emergency medicine.

CIHR New Investigator Salary Support Award that year. A testament to Dr. Schull’s great humanitarian interest is the fact that he was President of the Canadian section of Doctors Without Borders when the organization won the 1999 Nobel Peace Prize. Review of Dr. Schull’s CV indicates that he has succeeded, with distinction, in obtaining numerous important peer-reviewed grants including those from the CIHR. Dr. Schull now has 30 peer-reviewed publications, which is an outstanding track record for someone at this stage of his career. He has also begun to establish an international reputation, and has presented his research in Canada, the U.S., Australia and the U.K.

Jerris R. Hedges, MD, MS Oregon Health and Science University Robert A. Lowe, MD, MPH Oregon Health and Science University

Ian G. Stiell, MD University of Ottawa

2004 CPC Semi-Final Competition Participants Selected This year 84 EM residency programs submitted cases for consideration of presentation at the 2004 CPC Semi-Final Competition in Orlando on May 15. For the first time the CPC Committee has selected 60 cases, meaning there will be 6 simultaneous tracks of CPC cases. A Best Presenter and Best Discussant will be selected from each track and the winners will compete at the CPC Finals, which will be held on the afternoon of Monday, October 18 in conjunction with the ACEP Scientific Assembly in San Francisco.

Advocate Christ Medical Center Albany Medical Allegheny General Hospital Baystate Medical Center Beth Israel Deaconess, Boston Beth Israel Medical Center, New York Boston Medical Center Brown Medical School Brigham and Womens Hospital/Harvard Carolinas Medical Center Christiana Care Health Services Drexel University (formerly MCP - Hahnemann) Eastern Virginia Medical School George Washington University Indiana University Jacobi/Montefiore Lehigh Valley – Muhlenburg Lincoln Medical Center Long Island Jewish Medical Center Madigan/University of Washington Maimonides Medical Center Maine Medical Center Maricopa Medical Center Mayo Clinic McGaw Medical Center of Northwestern University McGill University Medical College of Georgia Medical College of Virginia MetroHealth/Case Western Reserve/Cleveland Clinic Foundation Metropolitan Hospital

Morristown Memorial Hospital Mount Sinai , New York Naval Medical Center, San Diego North Shore University Hospital New York University, Bellevue Ohio University/Doctors Hospital Robert Wood Johnson/Cooper Hospital San Antonio Uniformed Services Health Education Consortium St. Luke's – Roosevelt Stanford University / Kaiser State University of New York, Buffalo Synergy / Michigan State University Temple University Texas Tech University Thomas Jefferson University University of Alabama University of California, Irvine University of California, Los Angeles - Olive View University of California, San Diego University of California, San Francisco – Fresno University of Cincinnati University of Florida University of Pennsylvania University of Pittsburgh University of South Florida University of Texas at Houston University of Virginia Washington University, St. Louis Yale - New Haven Medical York Hospital 7

2004-06 Research Training Grant Recipient Clifton Callaway, MD University of Pittsburgh Chair, SAEM Grants Committee The 20042006 SAEM Research Training Grant will be awarded to Brian Blythe, MD, at the University of Rochester.

This award provides $75,000 support per Brian Blythe, MD year for two years to a promising investigator for the purpose of increasing their research and investigative skills. Research training is a critical part of the proposed program.

Dr. Blythe’s project, entitled “Mechanisms of EGR-1 Mediated Neuroprotection” will be the core of an integrated

training program in translational neuroscience research. EGR-1 is an immediate early gene that appears in cells within minutes after injury or stress. EGR-1 can act as a transcription factor that regulates expression of other genes, thereby contributing to both cell survival or cell death, depending on the setting.

Interestingly, neurons exposed to hypoxia rapidly increase levels of EGR1. Indirect evidence suggests that this expression is associated with neuronal survival.

Dr. Blythe’s proposed experiments will directly test the contribution of EGR1 expression to neuronal survival after hypoxia. In cell culture, neuronal survival after hypoxia will be assessed when EGR-1 is overexpressed, when EGR-1 is absent, and when particular molecules that interact with EGR-1 are

manipulated. These studies could provide new insight into the molecular response of neurons to hypoxic or ischemic injury, and suggest new targets for neuroprotective drugs.

The core research project will be combined with a didactic training program that includes both graduate level neurosciences courses and research design courses. Other faculty at the University of Rochester who conduct clinical research on brain injury will collaborate with Dr. Blythe’s training. In this way, the basic science investigations can be linked directly to clinical problems. SAEM hopes that this grant will foster a focused research program that soon will be competitive for NIH funding.

2004-06 Institutional Research Training Grant Awarded Jason S. Haukoos, MD, MS Denver Health Medical Center SAEM Grants Committee Johns Hopkins University Department of Emergency Medicine was awarded this year’s SAEM Institutional Research Training Grant.

The principal investigator is Richard E. Rothman, Richard E. RothMD, PhD man, MD, PhD, who is an Assistant Professor in the Department of Emergency Medicine. Dr. Rothman will act as the primary mentor for the fellow selected as part of this grant. Johns Hopkins University offers a comprehensive training program that incorporates six individualized research tracks (acute coronary syndromes, translational research in infectious dis-

eases, infectious disease epidemiology, health services and outcomes, operational research, and injury prevention).

Dr. Rothman’s primary research interests include translational research in infectious diseases, and he has previously competed successfully for extramural funding from AHRQ, NCCR, and NIAID. The Emergency Medicine Research Center currently holds eight grants from NIH, AHRQ and CDC. It is expected that the fellow will complete a core-training program in clinical research, and then choose to focus in one of the core areas. The course work can lead to a degree (MSc or DrPH). Each research track is led by established investigators, drawing from faculty both inside and outside emergency medicine. These investigators will act as associate mentors for the fellow during the training. The Departments of Infectious Disease, Medicine, 8

Health Policy and Management, and Pathology each contribute to this comprehensive fellowship program. Each area for the Fellow’s research focus has been developed to offer training in data collection, database analysis, medical writing, and grantsmanship. Each area also provides opportunities for the fellow to complete a start-to-finish simple study.

The SAEM Institutional Research Training Grant provides support in the form of $75,000 per year for two years in order to train a research fellow. This grant is awarded to the institution of an established investigator who has demonstrated excellence in academic emergency medicine and who is capable of successfully training future clinician-scientists.

EMS Research Fellowship Grant Recipient Jason S. Haukoos, MD, MS Denver Health Medical Center SAEM Grants Committee Jonnathan M. Busko, MD, MPH, EMT-P, has been selected as the recipient of the 2004-2005 EMS Research Fellowship Grant.

Dr. Busko is currently finishing Jonnathan M. Busko, the first year of a MD, MPH, EMT-P two-year EMS fellowship at Carolinas Medical Center in Charlotte, North Carolina. Prior to beginning his fellowship, Dr. Busko completed an emergency medicine residency at Albany Medical Center in Albany, New York. In addition, Dr. Busko began working as a paramedic while in college, and while in medical school obtained a Master of Public

Health degree in Community Health Sciences.

This grant will provide Dr. Busko with $60,000 over one year to complete his EMS fellowship. Dr. Busko has already demonstrated significant interest in EMS systems through administration, education, and research. As part of the second year of his fellowship, Dr. Busko anticipates completing several ongoing studies, including evaluating the use of carbon monoxide detectors as screening tools in the prehospital setting. He also anticipates completing a one-year graduate-level certificate program focusing on community preparedness and disaster management.

In addition to selecting Dr. Busko as the 2004-2005 EMS Research Fellow, the Grants Committee designated or redesignated five programs as approved sites to host an SAEM/Medtronic Physio-Control EMS Research Fellow-

ship. They include the Medical College of Wisconsin (Fellowship Director: Ronald G. Pirrallo, MD, MHSA), the University of Buffalo, State University of New York (Fellowship Director: Anthony J. Billittier, MD), the University of North Carolina School of Medicine (Fellowship Director: Jane H. Brice, MD, MPH), the University of Pittsburgh School of Medicine (Fellowship Director: Theodore R. Delbridge, MD, MPH), and the University of Rochester Medical Center (Fellowship Director: Eric Davis, MD).

In total, over 20 sites are approved for the EMS Fellowship (listed at http://www.saem.org/awards/physite.htm).

The EMS Research Fellowship is funded by Medtronic Physio-Control.

SAEM is extremely grateful to Medtronic as Dr. Busko will be the 15th consecutive fellow funded by Medtronic.

Neuroscience Research Fellowship Recipient Chair, Clifton Callaway, MD University of Pittsburgh SAEM Grants Committee D a n i e l Rusyniak, MD, of the Indiana University School of Medicine will be the recipient of the Neuros c i e n c e Research Fellowship for 2004-2005.

Daniel Rusyniak, MD Funding of this grant is provided by AstraZeneca. Dr. Rusyniak's project, entitled “Ecstasy: Hyperthermia and the Hypothalamus” will examine the contribution of the dorsomedial hypothalamus to the sympathomimetic effects of MDMA (3,4-methylene-dioxy-methamphetamine). MDMA is a popular club drug known colloquially as “ecstasy.” Recreational use of MDMA declined somewhat after a peak

in the late1980s, but there has been a recent resurgence in its popularity.

MDMA releases both dopamine and serotonin in the brain to produce a mild amphetamine-like stimulation accompanied by pleasant alterations of mood, making its behavioral effects distinct from both pure stimulants and mild hallucinogens.

Two principal dangers are associated with MDMA use. First, large doses of MDMA may be neurotoxic. Degeneration of particular subsets of neurons is observed in the brains of animals treated with MDMA, but the clinical significance of this toxicity is unclear. Second, “therapeutic” doses of MDMA occasionally result in a sympathetic discharge that includes severe hyperthermia. This hyperthermia can result in rhabdomyolysis, renal failure or death. This latter adverse effect of MDMA requires emergency treatment.

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Dr. Rusyniak’s project will help elucidate the mechanisms of MDMA-induced hyperthermia. He plans to use chronically instrumented, non-anesthetized rats to recreate the toxic effects of MDMA. In these same animals, he will use microinjection of drugs into the hypothalamus to test the contribution of that brain region to the toxic effects.

These studies could help identify more specific ways to treat acute, life-threatening reactions to MDMA or related drugs. The Neuroscience Fellowship provides $50,000 for one year to promote mentored research training in neuroscience by an emergency medicine resident, graduate or faculty member.

The research may be basic science, clinical or a combination of both. SAEM is grateful to AstraZeneca for its continued support of this important grant.

Scholarly Sabbatical Grant Recipient Marc S. Rosenthal, PhD, DO Wayne State University SAEM Grants Committee The SAEM Scholarly Sabbatical Grant provides up to $60,000 in funding to help an emergency medicine faculty member obtain release time for research or furRobert Wears, MD ther training to advance their academic careers. Faculty at the level of assistant professor and above are eligible for this award. This

year’s recipient is Robert Wears, MD. His project is entitled “Research Methods for Patient Safety in Emergency Care.” Dr. Wears is currently a Professor in the Department of Emergency Medicine in the College of Medicine at the University of Florida. He graduated from the Johns Hopkins University School of Medicine followed by an emergency medicine residency at the University Medical Center, University of Florida, and has also received a MS degree in Medical Informatics from the University of North Florida. Dr. Wears has focused his research interests in the area of medical informatics and more

recently in the area of patient safety.

His sabbatical grant will be applied to further develop skills in cognitive psychology and human factors engineering as applied to patient safety. He will spend his sabbatical year at the Clinical Safety Research Unit in the Department of Surgical Oncology and Technology, Division of Accident and Emergency Medicine at Imperial College, St. Mary’s Hospital, London, England. Dr. Wears will work with professors Charles Vincent and James Reason, leaders in the field of patient safety. His goal is to further develop the field of patient safety as applied to emergency medicine.

2004-2005 SAEM Committee/Task Force Objectives Listed below are the 2004-05 committee and task force objectives (SAEM’s year runs from May to May to coincide with the Annual Meeting). While SAEM’s mission “to improve patient care by advancing research and education in emergency medicine” gives direction to SAEM’s activities, and the Five-Year goals and objectives (http://www.saem.org/newsltr/hd5yrpla.htm) lay the foundation, it is the extensive and detailed work of each committee and task force towards the fulfillment of their specific goals and objectives, which really advance the academic specialty.

Although the committee and task force objectives are developed and approved by the Board of Directors, they are based on SAEM’s Five Year Goals and Objectives and on the suggestions of prior committee and task force chairs and members, and from individual SAEM members. The Board strives to ensure that the objectives assigned to each committee and task force are welldefined, achievable, and directly related to SAEM’s core mission. The Board appreciates feedback regarding these objectives from the membership, and most importantly, invites suggestions for future objectives.

Awards Committee: Chair, Louis Ling, MD 1. Review announcements for all awards to assure consistency and clarity of qualifications and criteria. Deadline: August 1, 2004.

2. Develop a standardized application format/CV for the Young Investigators, Hal Jayne Academic Excellence and Leadership Awards. Deadline: September 1, 2004.

3. Solicit and review nominations for the Academic Excellence and Leadership Awards and recommend recipients to the Board. Deadline: January 15, 2005 4. Solicit and review nominations for the Young Investigator Award and recommend recipients to the Board. Deadline: January 15, 2005

Critical Care Fellowship Task Force: Chair, Stephen Trzeciak, MD 1. Explore the feasibility for training opportunities (not certification options) for EM graduates interested in pursuing critical care fellowship training through the Anesthesiology/Surgery pathway and report to the Board. Deadline: February 1, 2005.

2. Develop a database of existing EM physicians either in the active practice of Critical Care Medicine or trained in Critical Care Medicine. Deadline: November 1, 2004.

Development Committee: Chair, Brian Zink, MD 1. Make recommendations to the Board for mechanisms to expand the Research Fund through collaborative undertakings with industry, philanthropic organizations, nonmembers and members. Deadline: October 1, 2004.

2. Develop oral presentations, web-based material and publications targeted at each of these groups (in objective 1). Deadline: November 15, 2004 (members and industry), February 15, 2005 (philanthropic organizations and non-members).

3. With the Board and the Program Committee, develop a mechanism to recognize contributors at the Annual Meeting. Deadline: November 15, 2004.

Constitution and Bylaws Committee: Chair, Catherine Marco, MD 1. Review the Constitution and Bylaws to ensure accuracy relative to the Society’s activities and internal functions.

Propose needed amendments to the Board for approval.

Deadline: January 1, 2005.

2. Develop “minimum criteria” for candidates to Board, Secretary-Treasurer, President-elect, Constitution and Bylaws Committee, Nominating Committee and committee and task force chair positions. Deadline: December 1, 2004.

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4. Investigate the development of a multi-year campaign for members targeting a total amount and/or percentage participation and report to the Board. Deadline: October 1, 2004.

Finance Committee: Chair, Steve Dronen, MD 1. Provide oversight for the investment and accounting of SAEM’s non-operational funds. Provide quarterly written performance reports to the Board and annually undertake a review by a professional funds manager.

2. Annually review the SAEM budget with the Secretary – Treasurer.

Provide recommendations for operational finances or non-salary capital expenses.

CORD/SAEM Diversity Training Task Force: SAEM CoChair, Sheryl Heron, MD 1. Develop learning modules and resources (using previously developed guides by SAEM Graduate Medical Education Committee) to incorporate diversity awareness and skills to residency training programs. This will be done jointly with the CORD. 2. Finalize Web site product based on objective #1 and submit to SAEM and CORD Boards for their consideration. Deadline: April 15, 2005.

Graduate Medical Education Committee: Chair, Douglas McGee, DO 1. Coordinate the Resident Section of the SAEM Newsletter, including the solicitation, selection, and editing of articles, with strict attention to focus, quality, and timely completion to meet publication. Ensure at least one submission per issue from the Committee or others devoted to resident issues/concerns. One topic should be written by one or more fellowship graduates discussing the value of their training on their academic career. Another topic should evaluate the pros and cons of doing a fellowship at the same institution that one does their EM residency. Deadlines: August 1, October 1 and December 1, 2004 and February 1, April 1 and June 1, 2005.

2. Maintain and complete the revision of the Resident Section of the Web site. This includes all posted articles in the current residency section. Deadline: November 1, 2004.

3. Distribute and integrate the ‘Fellowship Catalog’ being developed by Fellowship Task Force into current GME venues including the Web site. Deadline: October 1, 2004.

4. Develop resources (implementation guides and assessment tools) for the “Systems-Based Practice Core Competency” and post on the Web site. Deadline: November 1, 2004.

5. Working with the Undergraduate Educators Committee, revise the Residency Catalog data fields. Prepare a Newsletter announcement describing the changes.

Deadline: July 1, 2004.

6. With the Web Page Task Force, write a Newsletter article describing the new ability of program directors to directly access their Residency Catalog database, and the expectation that they will maintain their own program data. Deadline: August 1, 2004.

7. Working with the EMS Interest Group and the National Association of EMS Physicians, revise and update the EMS fellowship curriculum document and post on the web. Deadline: March 1, 2005.

8. Develop and administer a survey instrument to assess whether academic chairs value additional training in their hiring practices, and whether their hiring practices for new faculty have changed over the past 3-5 years. Prepare a document discussing the survey results for the Board. Deadline: May 1, 2005.

9. Develop a list of skill sets required by clinician teachers and possible mechanisms to develop those skills. Deadline: May 1, 2005.

Ethics Committee: Chair, Terri Schmidt, MD 1. Assist in the development of the 2005 AEM Consensus Conference on Research Integrity in EM. Serve as peer reviewer resources for manuscript submissions.

2. Revise and update the “Ethics Curriculum for EM Residencies” web based site. Rename “Ethics Teaching Resource for EM Residencies”. Deadline: March 1, 2005.

3. With the Research Committee, develop a document built on issues discussed in the “Clinical Research and the HIPAA Privacy Rule” session at the 2004 Annual Meeting. Deadline: November 1, 2004.

4. Prepare three documents on the following ethics-related subjects: “Publication ethics and issues” and “Teacherlearner relationships” and “Issues surrounding the response to a dishonest faculty member” (fabrication of CV/data/authorship). Deadlines: September 15, 2004, February 15, 2005 and May 1, 2005. Include these subjects in the web based teaching resource.

Faculty Development Committee: Chair, Frank Counselman, MD 1. Develop 2004 Annual Meeting sessions on “Becoming a leader in the medical school’s Dean’s office, ” “Advancement to the position of academic chair, ” and “Career development awards” into Newsletter submissions and web-based resources. Deadlines: September 15, 2004, February 15, 2005 and May 1, 2005.

2. Review and revise the Faculty Development web site.

Deadline: November 1, 2004.

3. Develop a series of didactic proposals about general leadership skills for the Program Committee’s consideration of presentation at the 2005 Annual Meeting. At least one of these sessions should target senior level leadership needs, and one should target mid-career level needs. Deadline: September 1, 2004.

4. Develop a resource about junior committee member leadership development, timeline management, and task delegation for use by committee and task force chairs.

This resource should also include recommendations about effective committee management and how to maximize the productivity of a working group that are targeted to the actual committee chair. Deadline: March 1, 2005.

5. Conduct the bi-annual Faculty Salary Survey and prepare a manuscript for submission to the Board and to AEM for consideration of publication. Deadline: February 15, 2005.

Grants Committee: Chair, Clifton Callaway, MD 1. Coordinate the grant application reviews (working with expert reviewers from committees, task forces and interest groups) and recommend recipients to the Board for the following grants: Research Training, Institutional Research Training , Scholarly Sabbatical, Medical Student Interest Group, EMS Research Fellowship, Neuro11

2.

3.

4.

5.

6.

science Research Fellowship, and EMF/SAEM Medical Student Research. Deadline: varies by grant program.

Develop a plan for offering a one-year medical student research training fellowship and prepare a report to the Board. Deadline: January 1, 2005.

Review all grant applications for clarity and consistency, offer a report summarizing any changes to Board and incorporate any proposed changes before next grant cycle. Specifically evaluate and offer advice on electronic-only (Web-based) applications and creation of common on-line form mirroring NIH format for all submissions. Deadline: September 1, 2004.

Working with the Research Committee, explore the feasibility of developing and maintaining a grant database for emergency physicians and report to the Board. Deadline: January 1, 2005.

Develop and implement a mechanism to assess outcomes of prior SAEM grants recipients and report to the Board. Deadline: March 1, 2005.

Working with the Research Committee, explore the feasibility of implementing a “virtual advisor” grants mentoring process. Establish a mechanism to track outcomes and report to the Board. Deadline: December 1, 2004.

National Affairs Committee: Chair, Robert Schafermeyer, MD 1. Develop a draft program for the fall AAMC Annual Meeting. Deadline: March 1, 2005.

2. Submit reports on interactions with the AAMC for publication in the January/February and May/June issues of the SAEM Newsletter. Deadlines: December 1, 2004 and April 1, 2005.

3. Implement an advocacy network plan. Prepare an accompanying Newsletter article discussing the network.

Deadline: July 1, 2004.

4. Monitor legislative and regulatory issues pertinent to academic emergency medicine.

5. Develop policy statement on Principles for Measuring Quality and Reporting of Medical Errors and submit to the Board. Deadline: January 1, 2005.

6. Submit a didactic proposal to the Program Committee for consideration of presentation at the 2005 Annual Meeting. Deadline: September 1, 2004.

NIH Roadmap Task Force: Chair, Roger Lewis, MD, PhD 1. Using the information outlined in NIH’s new policy shift (Roadmap), make specific recommendations to the Board about actions SAEM can take to increase EM’s interaction with the NIH. Deadline: February 1, 2005.

Healthy People 2010 Task Force: Chair, Charlene Irvin, MD 1. Implement activities with the Department of Health and Human Services (DHHS) in the following areas: 1) Access to Quality Health Services, 2) Injury and Violence Prevention, and 3) Substance Abuse. Each working group should submit a written report to Board detailing specific progress. Deadline: November 1, 2004.

2. Submit at least one Annual Meeting didactic proposal from each working group for consideration of presentation by the Program Committee for presentation at the 2005 Annual Meeting. Deadline: September 1, 2004.

3. Working with the National Affairs Advocacy program, inform SAEM members of Healthy People 2010 issues of interest to the membership. Deadline: December 1, 2004.

Nominating Committee: Chair, President-elect 1. Develop a slate of nominees for the elected positions on the Board of Directors, Nominating Committee, and Constitution and Bylaws Committee and submit to the Board for approval. Deadline: March 1, 2005 2. Prepare recommendations for the Board about a standardized mechanism for identification and selection of nominees to the Nominating Committee. Deadline: November 1, 2004.

3. Develop a standardized “mini-bio” for potential candidates to elected positions. This should emphasize elements of prior service and performance in leadership capacities within SAEM. Deadline: January 1, 2005.

4. Working with the web editor, develop an on-line tool for use by committee and task force chairs to evaluate their members. Establish a databank of the electronic committee and task force evaluation reports for use in candidate selection. Deadline: November 1, 2004.

5. Create a Web-based evaluation tool for members of committees and task forces to assess their chairs. Data should be accessible for the use by the Board on an annual basis. Develop a databank of these evaluations for use in candidate selection. Deadline: February 1, 2005.

6. Develop a tool for the Board to perform and maintain an annual committee and task force chair assessment.

Deadline: February 1, 2005.

7. Develop and maintain a database of potential candidates for elected offices, as well as those who have served in elected offices in the past. Deadline: February 1, 2005.

Membership Survey Task Force: Chair, Wendy Coates, MD 1. Develop and complete a comprehensive survey of the SAEM membership to ascertain services that are most valued and areas of greatest need. Areas to investigate may include the concept of creating limited access areas on the web page, the AEM journal and editorial review process, election process, whether or not minimum criteria for appointment as a chair or to stand for election is necessary, issues surrounding the Annual Meeting activities (no-industry policy, banquet or not, social events from dues or meeting registration, extracurricular events), regional meetings, need for a “professors section” and the development of position statements that cross into clinical practice or specialties (e.g. stroke, care of pediatric emergencies). Wherever possible, an explanation of the rationale for the way SAEM currently addresses an area should accompany specific questions. A written report should be presented to the Board.

Deadline: February 1, 2005.

Program Committee: Chair, Judd Hollander, MD 1. Plan 2005 Annual Meeting, and deliver quarterly reports to Board on progress, successes, limits and opportunities.

2. Create an operating manual describing timelines, protocols and prior problem areas. Update annually. Deadline: May 1, 2005.

CORD/SAEM Model Curriculum Task Force: SAEM CoChair, Sam Keim, MD 1. Continue the collaborative development of a model curriculum revision based upon the ABEM Model of the Clinical Practice of Emergency Medicine.

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3. Submit a preliminary budget for the 2005 Annual Meeting to the Board. Deadline: November 1, 2004.

4. Evaluate success and offer suggestions to enhance participation/attendance at SAEM meetings by non-members, particularly other academic physicians. Submit a report to Board. Deadline: December 1, 2004.

5. Conduct a review of the 2004 Annual Meeting feedback and submit a report to the Board. Deadline: July 1, 2004.

6. Develop a regional meeting orientation session targeting Regional Meeting coordinators to be delivered in October 2004 (in conjunction with the SAEM committee and task force sessions during the ACEP Scientific Assembly or via conference call). Deadline: October 1, 2004.

7. Make a recommendation to the Board about whether or not contributors to educational sessions at the annual meeting (non-commercial) should be acknowledged in the annual meeting brochure (e.g. “The following contributed proposals or ideas that have been incorporated into the 2005 Annual Meeting: Ethics committee, AACEM, NIH Task Force, etc.”). Deadline: November 1, 2004

Undergraduate Education Committee: Chair, Cherri Hobgood, MD 1. Working with the Web Editor, update and revise the Medical student Section of the home page. Deadline: June 1, 2004.

2. Working with the Graduate Medical Education Committee, revise the Residency Catalog. Deadline: July 1, 2004.

3. Working with the Research Committee, develop a resource available to education researchers outlining federal or foundation funding sources specifically for education research. Deadline: January 1, 2005.

4. Working with the Research and Graduate Medical Education Committees, continue the development of the three-year curriculum in educational research. Submit to the Program Committee for consideration of presentation at the 2005 Annual Meeting. Deadline: September 1, 2004.

5. Develop an article directed towards medical students about how to get the most out of the Annual Meeting and post on the web site. Deadline: March 1, 2005.

6. Develop an article for the September/October Newsletter outlining the importance of attending the AAMC meeting, and highlight sessions that would be of particular interest to medical student coordinators. Deadline: August 1, 2004.

7. Examine how LCME requirements are affecting EM rotations and make recommendations regarding potential methods to address these requirements. Deadline: March 1, 2005.

8. Develop an educational module for “the resident as a teacher” and post on the Web site. Deadline: May 1, 2005.

9. Develop a resource for use by a faculty member who is developing or managing a Medical Student Interest Group and post on the web site. Deadline: May 1, 2005.

10.Finalize the implementation of the medical student question bank, evaluate the product and establish a mechanism for upkeep. Deadline: July 1, 2004.

Research Committee: Chair, Jim Olson, PhD 1. Identify and highlight emergency medicine researchers who attain new federal grant funding or large scale industry funding, and any new or under-recognized funding sources and publish in the Newsletter. Deadline: October 1, 2004.

2. In conjunction with the Grants Committee, develop and implement a grants mentorship process for SAEM members. Develop an accompanying Newsletter article describing this service. Establish a mechanism to track outcomes. Deadline: August 1, 2004.

3. Working with the Grants Committee, explore the feasibility of developing and maintaining a grant database of emergency physicians and report to the Board. Deadline: January 1, 2005.

4. Assist the Ethics Committee and AEM in planning the 2005 AEM Consensus Conference on “Integrity in Research”. Deadline: September 1, 2004.

5. With the Ethics Committee, develop a manuscript for submission to AEM for consideration of publication on issues discussed in the “Clinical Research and the HIPAA Privacy Rule” session at the 2004 Annual Meeting. Deadline: November 1, 2004.

6. Develop a list of needed skills and possible methods to attain those skills for an EM educational researcher.

Prepare a Newsletter article and post of the web. Deadline: February 1, 2005.

7. Establish a research agenda for EM educational research and report to the Board. Deadline: January 1, 2005.

8. Examine the ACGME core competencies, including procedural competency and maintenance, for specific research needs and report to the Board. Deadline: February 1, 2005.

9. Working with the Undergraduate Education and Graduate Medical Education Committees, continue the development of the three-year curriculum in educational research. Submit to the Program Committee for consideration of presentation at the 2005 Annual Meeting.

Deadline: September 1, 2004.

Web Page Development Task Force: Chair, Felix Ankel, MD 1. Evaluate the need for an assistant Web developer and recommend candidates to the Board. Deadline: August 1, 2004.

2. Review current Web policy and make recommendations to the Board about areas that require clarification of the development of a new policy. Deadline: August 1, 2004.

3. Develop a plan for ultimate “housing” of the web page.

Deadline: May 1, 2005.

4. Develop an editorial board structure for the web page and present to the Board. Deadline: May 1, 2005.

5. Establish the plan with logistical priorities and timeline for the ultimate Web page and present to the Board.

Deadline: May 1, 2005.

2005 SAEM Annual Meeting May 22-25 New York Hilton, New York City

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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 June 1, 2004 to be included in the July/August issue.

Nicholas H. Benson, MD, MBA, has been appointed Senior Associate Dean for Operations for the Brody School of Medicine at East Carolina University.

Dr. Benson previously served as Professor and Chair of the Department of Emergency Medicine at East Carolina University.

Robert E. Collier, MD, has been elected to the American Board of Emergency Medicine from a slate of nominees submitted by the Emergency Medicine community-at-large. Dr. Collier is an Assistant Professor of Emergency Medicine at the University of MinnesotaHennepin County Medical Center.

In February, Valerie De Maio, MSc, MD, was appointed to the Editorial Board of Annals of Emergency Medicine. Dr. De Maio is currently the resident member of the SAEM Board of Directors and in July will be an Assistant Professor in the Department of Emergency Medicine at the University of North Carolinas at Chapel Hill.

Eric W. Dickson, MD, has been named Chairman of the Department of Emergency Medicine at the University of Iowa Hospitals and Clinics. The Iowa Board of Regents unanimously approved full departmental status on March 10.

Herbert G. Garrison, MD, MPH, has been named Interim Chair of the Department of Emergency Medicine at the Brody School of Medicine at East Carolina University, effective April 1, 2004. Dr. Garrison is a Professor of Emergency Medicine and Director of the Eastern Carolina Injury Prevention Program.

Sheryl Heron, MD, MPH, has been selected to serve on the Advisory Committee for Injury Prevention and Control, Centers for Disease Control and Prevention. The Committee advises and makes recommendations to the Secretary of Health and Human Services and the Director of the CDC regarding goals, policies, strategies and

priorities toward injury prevention and control, as well as recommendations for areas of research to be supported by grants and cooperative agreements.

Dr. Heron is an Associate Professor, Department of Emergency Medicine at Emory University.

Jo Ellen Linder, MD, has been elected to the American Board of Emergency Medicine from a slate of nominees submitted by the American Medical Association. Dr. Linder is an Associate Professor, Department of Surgery at the University of Vermont.

Harvey W. Meislin, MD, has become the 30th President of the American Board of Medical Specialties (ABMS), beginning his two-year term on March 18, 2004. Dr. Meislin has been active in the ABMS since 1990, as a representative of the American Board of Emergency Medicine. Dr. Meislin is the Professor and Chair of the Department of Emergency Medicine at the University of Arizona. ABMS is the umbrella organization representing the 24 approved medical specialty certifying boards in the U.S. The boards set the national standards for evaluating physicians in their specialty and subspecialty fields of practice.

J. Mark Meredith, MD, has been elected to the American Board of Emergency Medicine from a slate of nominees submitted by ACEP. Dr. Meredith is chair of the Department of Emergency Medicine at the Community Medical Center in Toms River, New Jersey.

John C. Moorhead, MD, has been elected to the American Board of Emergency Medicine from a slate of nominees submitted by the Emergency Medicine community-at-large.

Dr. Moorhead is a Professor in the Department of Emergency Medicine at the Oregon Health and Science University.

Richard N. Nelson, MD, has been elected to the American Board of Emergency Medicine from a slate of nominees submitted by ACEP. Dr. Nelson is

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Professor and Vice-Chair of the Department of Emergency Medicine at the Ohio State University College of Medicine and Public Health.

Ronald G. Pirrallo, MD, MHSA, Associate Professor of Emergency Medicine at the Medical College of Wisconsin and Director of Medical Services for the Milwaukee County Emergency Medical Services, has been re-elected to the Board of Directors of the National Association of EMS Physicians.

Jeremy Sperling, MD, has been appointed Assistant Director of the Emergency Medicine Residency Program at New York Presbyterian.

Kevin Terrell, DO, Assistant Professor in the Department of Emergency Medicine at Indiana University has received a 2004 Dennis W. Jahnigen Career Development Scholars Award, which is a two-year, $100,000 per year stipend for salary support and research funds. Dr. Terrell’s project is “ComputerAssisted Decision Support to Increase the Safety of Prescribing to Older Adults in the ED.” Henry Wang, MD, MPH, Assistant Professor, Department of Emergency Medicine at the University of Pittsburgh, has been awarded a five-year K08 career development award in the amount of $620,000 from the Agency for Healthcare Research and Quality. Dr. Wang’s proposed patient safety investigation involves the evaluation of out-ofhospital endotracheal intubation errors and their linkages to in-hospital outcomes and course of care.

Brian Zink, MD, has received a Publication Grant from the National Library of Medicine for his book project on the History of Emergency Medicine. The twoyear, $100,000 grant will support the research, oral histories and writing of the book.

2003 Academic Emergency Medicine Journal Report Michelle H. Biros, MD, MS Hennepin County Medical Center AEM Editor-in-Chief Jim Adams, MD Northwestern University AEM Senior Associate Editor Dave Cone, MD Yale University AEM Senior Associate Editor Academic Emergency Medicine continues to thrive in its 10th year of publication, and it is our pleasure to give you this brief report of some of the journal’s highlights for the 2003 production year.

The editors are dedicated to providing our readers and our authors with excellent service and high quality information. We all are authors, researchers and educators ourselves, and we appreciate and understand what is needed by each of our relevant constituencies. From an author’s standpoint, we value responsiveness, constructive criticism and rapid decisions.

The Editorial Board continues to develop and improve on each of these areas. We have a database of over 300 experts who serve as our peer reviewers. The selection of who reviews each submission and who serves as the decision editor is directed by the authors themselves, in the form of the manuscript checklist provided by them, which is compared to the listed expertise among our reviewers and associate editors.

We continue to provide consensus reviews to our authors, rather than the raw peer reviews. We believe the associate editor’s interpretations and weighing of the analysis received from each peer and statistical reviewer provides the authors with directions for revisions that are free from contradictions and focused at the most important areas that would benefit from improvement and if addressed, would strengthen the quality of the work.

Our recognition of the need for timeliness in decision making has resulted in periodic assessments of the performance of the peer reviewers and of the associate editors, and we continue to improve our timeliness. From January 1 to December 31, 2003, AEM received 827 submissions and publication decisions have been made on 825. Of these, 643 were externally reviewed and 182 were reviewed within the editorial board. The overall acceptance rate was 32%. The overall turnaround time of first reviews was 34 days, and for revisions, 11 days. This compares with 739 submissions in 2002, with a 2002 acceptance rate of 39%, first review turn around time of 40 days and revision turn around time of 19 days. Therefore, we are pleased to report that AEM received 12% more manuscripts in 2003 yet our turnaround time was decreased by 6 days (15%) for first time reviews and 8 days (42%) for revisions. With our anticipated summer 2004 launching of a totally electronic editorial management system we believe we will be able to improve our rapid submission review times.

We have had a number of other remarkable achievements this last year. We held another successful consensus conference in May 2003, on “Disparities in Emergency Health Care,” which was attended by over 100 individuals from across many clinical and research specialties, as well as from a number of federal and non federal regulatory and research agencies. The November 2003 special topics issue of AEM presents proceedings from the conference, as well as original related research and concepts papers. The November 2003 issue is

free of charge on our electronic journal platform; other issues are available on-line to current AEM subscribers. We also developed a relationship with the Institute of Medicine. AEM will serve as a forum for dissemination of selected reports relevant to our specialty from this prestigious group. The first is published in the April issue of AEM; others will be published periodically.

For the last three years, the electronic version of AEM has been distributed for free to 65 World Health Organization designated underdeveloped countries. It is encouraging that the annual statistics show an increasing international presence of our journal. In addition to dissemination of information, we are seeing another benefit of this program in the increasing numbers of original scientific submissions coming from these countries.

This year AEM has increased its use of another electronic feature, called “data supplements.” Using this electronic option, we are able to publish on-line material that could not be included in the paper version of the journal because of their excessive length, narrow focus, or complexity. Included in this category are data collection vehicles, expanded data, and on occasion, specific peer reviewed articles not published in the paper journal. We expect to expand our use of this option in the coming year.

So, as you can see, Academic Emergency Medicine continues in its development and growth as we enter our 11th year of publication, thanks to our outstanding Editorial Board, excellent editorial staff, our hardworking peer reviewers and our loyal and supportive authors and readers. We hope that we will be able to continue to serve your academic and research needs, and be assured that it is our continued pleasure to do so.

Table 1: Top 10 underdeveloped countries accessing AEM electronically India Indonesia Viet Nam Pakistan Ukraine Nigeria Nepal Bangladesh Nicaragua Kenya

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Aug 01, 2000 7: 873-877 5. Section: CLINICAL INVESTIGATIONS David F. Salo, Robert Lavery, Vikram Varma, Jennifer Goldberg, Tara Shapiro, Alan Kenwood A Randomized, Clinical Trial Comparing Oral Celecoxib 200 mg, Celecoxib 400 mg, and Ibuprofen 600 mg for Acute Pain Jan 01, 2003 10: 22-30 6. Section: CLINICAL INVESTIGATIONS Peter A. McCullough, Judd E. Hollander, Richard M. Nowak, Alan B. Storrow, Philippe Duc, Torbjorn Omland, James McCord, Howard C. Herrmann, Philippe G. Steg, Arne Westheim, Cathrine Wold Knudsen, William T. Abraham, Sumant Lamba, Alan H.B. Wu, Alberto Perez, Paul Clopton, Padma Krishnaswamy, Radmila Kazanegra, Alan S. Maisel Uncovering Heart Failure in Patients with a History of Pulmonary Disease: Rationale for the Early Use of B-type Natriuretic Peptide in the Emergency Department Mar 01, 2003 10: 198-204 7. Section: COMMENTARIES Gene R. Pesola The Use of B-type Natriuretic Peptide (BNP) to Distinguish Heart Failure from Lung Disease in Patients Presenting with Dyspnea to the Emergency Department Mar 01, 2003 10: 275-277 8. Section: BRIEF REPORTS Stewart Siu Wa Chan Emergency Bedside Ultrasound to Detect Pneumothorax Jan 01, 2003 10: 91-94 9. Section: CLINICAL PRACTICE Michael A. Kohn, Kristi Kerr, David Malkevich, Nelda O'Neil, M. James Kerr, Beth C. Kaplan Beta-Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding Feb 01, 2003 10: 119-126 10. Section: CLINICAL PRACTICE Alan J. Forster, Ian Stiell, George Wells, Alexander J. Lee, Carl van Walraven The Effect of Hospital Occupancy on Emergency Department Length of Stay and Patient Disposition Feb 01, 2003 10: 127-133

Table 2: Outstanding Reviewers, 2002-2003 Felix K. Ankel, MD Adrienne Birnbaum, MD Wallace Carter, MD David M. Cline, MD Robert Dart, MD Stephen J. Dresnick, MD Louis Graff, MD Gary B. Green, MD, MPH Robert J Hoffman., MD Margaret Hsieh, MD E. Brooke Lerner, PhD Laurie J. Morrison, MD James Thomas Niemann, MD Paul M. Paris, MD Lee W. Shockley, MD Kelly D. Young, MD Table 3: Top 10 cited AEM articles 2003 1. Section: SPECIAL CONTRIBUTIONS Michael A Gibbs, Carlos A Camargo, Brian H Rowe, Robert A Silverman State of the Art: Therapeutic Controversies in Severe Acute Asthma Jul 01, 2000 7: 800-815 2. Section: CLINICAL INVESTIGATIONS David Donaldson, David Poleski, Eric Knipple, Kurt Filips, Linda Reetz, Rebecca G. Pascual, Raymond E. Jackson Intramuscular versus Oral Dexamethasone for the Treatment of Moderate-to-severe Croup: A Randomized, Double-blind Trial Jan 01, 2003 10: 16-21 3. Section: CONCEPTS Stephen Schenkel Promoting Patient Safety and Preventing Medical Error in Emergency Departments Nov 01, 2000 7: 1204-1222 4. Section: CLINICAL INVESTIGATIONS Jim Edward Weber, Carl R. Chudnofsky, Michael Boczar, Edward W. Boyer, Mark D. Wilkerson, Judd E. Hollander Cocaine-associated Chest Pain: How Common Is Myocardial Infarction?

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, 2004 in Seattle. 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, 2004. 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

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Board of Directors Update The SAEM Board of Directors meets monthly, usually by conference call.

This report includes the Board highlights of the February 10 conference call and the Board meeting held on March 6 during the CORD Navigating the Academic Waters and Best Practices conferences: The Board approved a slate of candidates for the consideration of the membership. A ballot has been developed and mailed to the membership.

The slate of nominees is published in this issue of the Newsletter. All ballots returned to SAEM with a postmark no later than May 8, 2004 will be counted.

The Board reviewed approved amendments to the Constitution and Bylaws. The amendments are included in this issue of the Newsletter, and a ballot has been submitted to the membership for consideration. Results of the election and the Constitution and Bylaws amendments will be announced during the Annual Business Meeting on May 18 at 11:00-12:00 noon in Orlando.

All members are urged to attend.

The Board approved a 2004 operating budget, which included anticipated revenues of $1,824,000 and anticipated expenses of $1,377,725. In addition, the Board approved a draft 2004 budget for the Research Fund, which included revenues of $106,250 and expenses

of $410,000. A 2003 year-end financial report has been published in this issue of the Newsletter.

The Board approved the selection of Dr. Yealy and Dr. Chisholm to attend the meetings of the Institute of Medicine's proposed Conference on Emergency Medicine. Dr. Yealy and Dr. Chisholm will attend the meetings and report to the Board on the activities and important issues relevant to the conference.

The Board selected Dr. Larry Lewis as the SAEM representative to attend the Symposium on the Definition and Management of Anaphylaxis. Dr. Lewis will publish a report on the meeting in the next issue of the Newsletter.

The Board approved the proposed response to the Residency Review Committee for Emergency Medicine (RRC-EM) in regards to the new Resident Duty Hours. The Board approved a proposal by the National Affairs Committee to develop an educational session to be held during the AAMC Annual Meeting, which will be held in November in Boston.

The Board approved the submission of a grant application to the AAMC to request funding on the topic "Research Integrity in Emergency Medicine." If funded, it is anticipated that the topic will be the focus of the AEM Consensus

Conference held in conjunction with the 2005 SAEM Annual Meeting in New York City.

The Board approved a proposal to convene a focus group with industry representatives during the SAEM Annual Meeting. The Board also approved a mailing to the membership requesting donations to the Research Fund. An interim report on the success of that program is published in this issue of the Newsletter.

The Board approved a membership drive directed towards the chairs of Departments of Emergency Medicine encouraging them to provide to SAEM the names of their faculty who are not members. The Board approved the development of a Sepsis/Early Goal Directory Therapy Interest Group. The interest group was proposed by Dr. Nathan Shapiro, and the first meeting of the interest group will be held in Orlando. A list of interest group meetings that will be held in Orlando is published in this Newsletter.

The Board of Directors will meet twice during the SAEM Annual Meeting: May 15, 8:00-10:00 pm and May 18, 12:30-4:30 pm. All SAEM members are welcome to attend the Board meetings.

Meeting the Challenges of Educational Research Michelle Lin, MD San Francisco General Hospital Wendy C. Coates, MD Harbor-UCLA Medical Center Gloria Kuhn, DO, PhD Wayne State University SAEM Educational Research Task Force In the May-June 2003 SAEM Newsletter, the President’s Message focused on the current state of educational research in emergency medicine.

In this essay entitled “Educational research: Time to reach the bar, not lower it,” Dr. Roger Lewis insightfully addressed the major problems and hurdles in educational research and proposed potential solutions. Specifically, he defined the goal of improving the quality of medical educational research to match the rigorous standards set for clinical and bench research. He further proposed that although educational research has unique methodologic

obstacles, it should not have a lower standard for publication; that is, the bar should not be lowered. To reach this goal, he suggests that changes need to occur on the part of investigators. Particularly, educational researchers need to comprehend and apply appropriate biostatistical and methodologic designs.

In recognition of the importance of providing a means for the investigator to build a stronger knowledge base in educational research, we have proposed a three-year Educational Research Track at upcoming SAEM Annual Meetings.

This longitudinal curriculum is designed to provide a foundation for both aspiring

and established educational researchers in EM. Each year, there will be three modules. Although each module will cover a topic thoroughly, the modules will build upon each other to enable members with a serious interest in conducting educational research to develop a comprehensive, solid knowledge base in the subject. At the 2004 Annual Meeting, the first-year track will have the following three modules: “The Current State of Medical Education Research”: This session will offer an introduction to the current status of medical education research. Dr. Larry Gruppen, the chair of medical education

(continued on page 21) 17

Financing of Emergency Medicine GME Programs in an Era of Declining Medicare Reimbursement and Support Michael R. Baumann, MD Maine Medical Center Tyler F. Vadeboncoeur, MD University of California, San Diego Robert W Schafermeyer, MD Carolinas Medical Center SAEM National Affairs Committee tals exceeding their allowed number of residents make a conscious decision to fund the overage themselves without any support from Medicare.

Current payments to hospitals for DME can be viewed as dependent on three factors: the per resident payment amount (PRA), a weighted count of full-time equivalent residents in training, and the ratio of Medicare patient days to total patient days in the acute inpatient setting.2 The DME amount paid to the hospital uses a formula as follows: hospital specific per resident amount (PRA), updated for inflation, multiplied by the number of residents multiplied by the hospital’s ratio of Medicare inpatient days/total days. This formula is affected by the cap and the initial residency period (IRP).

The method by which the government arrived at DME payments per resident was established by COBRA legislation in 1986. For all teaching hospitals extant in 1986, the DME payment in use today is derived from calculations from a base year, either 1984 or 1985. The teaching institutions provided their cost associated with training residents in the base year and were specific to each hospital. Allowable costs included resident salaries and benefits, costs for program directors and faculty salary, as well as overhead for resident education.

There was no attempt to normalize the data, and the range of reported costs between institutions was quite broad. By 1995, this payment varied across teaching hospitals from $10,000 to $240,000 per resident with a median payment of $65,000.3,4 These differences were accepted “as is” by Medicare and have had one of the most dramatic effects on the variability of DME payments until the passage of Benefits Improvement and Protection Act of 2000 (BIPA). DME amounts had seen some minor modifications and had been adjusted for inflation, however there was little opportunity for teaching hospitals to change or update the information initially submitted to the government. BIPA not only made changes in the IME payments but froze PRA payments for hospitals above 140 per cent of the locally adjusted national average. For 2003-05 these hospitals’ PRAs will increase by the market basket minus 2 percent. Those at the other extreme, below the 85th per cent are to receive payment at that per centage.

Background Graduate medical education (GME) financing is a broad term that encompasses several funding streams to support medical education efforts. GME is a composite of direct medical education (DME) funding, a payment to hospitals and training programs for each resident, and indirect medical education (IME) funding (an additional payment designed to cover the inefficiencies of providing medical care in a teaching setting). These payments are currently made directly to hospitals and are often incorporated into the general operating funds of the hospital. As of the December 2000 Council on Graduate Medical Education (COGME) 15th report1, Medicare was paying $7.8 billion per year for GME, while Medicaid funded over $2 billion to GME. The Department of Defense, the Veterans Administration, and private payers were also providing for portions of resident physician education. Despite this support, teaching hospitals, physicians and legislators are still struggling to provide an appropriate physician workforce without bankrupting teaching hospitals or Medicare. Emergency physicians need to be aware of the issues and controversies surrounding graduate medical education, particularly with regards to financing. This paper will review the history and current state of GME financing, current legislative issues surrounding GME and proposals for improving GME to provide a stable source of funding.

History of Direct Medical Education (DME) Funding DME funding has been linked to Medicare since its establishment in 1965. Prior to Medicare, the cost of training physicians fell to hospitals who usually passed the costs on through patient charges. With the establishment of Medicare in 1965, the federal government recognized that there was a societal benefit to a self-replenishing physician supply. DME costs were explicitly approved for inclusion by a teaching hospital in their “reasonable costs.” These costs were included in hospital charges and extended to Medicare, as well as most private payers of the time. Medicare hospital payments began providing for resident salaries and benefits, administrative costs for medical education, and the cost of the physician educators.

At the outset and until the early 1980s, there were few limits on the number of residents reimbursed. Hospitals could indirectly increase their amount of Medicare support by increasing their resident complement or adding new residency programs.

Dollars paid for GME went directly to the hospitals and accounting for these monies was not required.

As Medicare funding became more constrained in the early 1980s, efforts were made to control hospital costs and attention focused on DME payments. The number of residents per institution was capped in 1996. This made it more difficult for residencies to expand in institutions at or above their residency cap. Hospitals wishing to add new residencies would need to be committed to bearing the entire cost of the position, unless they were below their cap on resident positions. Hospi-

Determining the Initial Residency Period (IRP) The weighting of resident FTEs training in a facility is based on the length of the resident’s initial training period. The initial training period varies by specialty and is defined as the minimum number of years of formal training necessary to satisfy the specialty’s requirements for board eligibility, up to five years.5 The initial training period does not change if the resident switches to a different residency. A resident selecting general surgery is allotted 5 years, while internal medicine, family practice, emergency medicine and pediatrics have 3 years. A resident switching to another residency after two years of surgery would still be weighted as 1.0 FTE for three years of additional residency training. A resident switching into 18

Financing (Continued) DSH payments and future increases tied to the consumer price index for urban areas. These funds are a small amount when compared to the overall GME funding stream, but add to the variability inherent in the current GME formula.

surgery after two years in pediatrics would be counted as 1.0 FTE for one year of surgery and 0.5 FTE for the remaining 4 years of surgery residency. There have been a few refinements to this basic rule since it’s enactment in an attempt to constrain growth in specialty training. To encourage primary care training, residents beyond their initial residency were only counted as 0.5 full-time equivalents; essentially cutting the payment to the sponsoring institution in half after the initial training was completed. Additionally, in 1994 and 1995 the inflation update was withheld for specialty positions, giving primary care positions a 6% higher per-resident payment. An exemption was made for geriatric fellowship training in 1986 and preventive medicine in 1993, allowing full payment for an additional two years in these two fellowships. Additional changes included in the Balanced Budget Act (BBA) of 1997 extended the initial residency training period for combined primary care residencies (family practice, pediatrics, internal medicine, geriatrics and preventive medicine) for 1 year, making these combined programs fully funded for four years of training. The Balanced Budget Refinement Act (BBRA) of 1999 extended the funding for child neurology two years covering the full 3 years for pediatrics and 2 years for fellowship in neurology.2

Current/impending Changes in GME While there is much discussion about needed reform in GME financing, current legislation regarding the issue is fairly meager. The newly passed Medicare Act of 2003 states that the indirect medical education (IME) adjustment factor will be increased (Table 1). There remains bipartisan support for addressing IME payment problems. During the recent Medicare reform discussions, the Senate circulated a letter with 38 senators in support of addressing the projected decrease in IME to teaching hospitals over the next decade. A similar letter was circulated in the House of Representatives.

The Medicare Act also provides protection for “safety net” hospitals by addressing DSH payments and gives small increases to the states, particularly in rural areas. The cap on Medicare disproportionate share (DSH) payments for rural and small urban hospitals is increased from 5.7 percent to 12 percent of total payments; payment adjustments of up to 25 percent are provided for low volume hospitals (less than 800 total discharges per year) that are 25 miles or more from another hospital.

Another provision of the Act is the redistribution of unused resident positions amongst teaching hospitals. The Act allows for a reduction of 75% of the number of unused resident positions at a given hospital that has not used their allotted positions for three years. The proposal is to redistribute these positions to hospitals that request an increase in their cap, with no single hospital receiving an increase of more than 25 residents.

Fellowship training in geriatrics is also addressed in the legislation. The bill stipulates that residents training in geriatrics are allowed to count the additional 2 years of training to become board-eligible as part of their initial residency period.

The Medicare Prescription Drug Act of 2003 has provisions for IME relief, continued freeze for DME amounts, geriatric residency provision and a section on unused residency slot reallocation of GME payments. The IME changes increase IME to 6.0% for April to September of 2004, reduced to 5.8% in 2005, 5.55 % in 2006, 5.35% in 2007 and back to 5.5% in 2008 and beyond. The DME freeze will continue for 10 years on the PRAs for hospitals over the 140% national average.

History of Indirect Medical Education (IME) Funding Research in the 1970s continued to show that teaching institutions had higher costs even after the direct resident costs (DME) were removed from the accounting process. Further research showed a correlation between teaching hospitals costs and the ratio of residents to hospital beds. This factor is called the intern and resident-to-bed (IRB) ratio and forms the basis for IME funding. The higher costs associated with teaching hospitals were attributed to the education and research mission of teaching hospitals, and the advanced equipment and personnel to support the highly specialized care delivered to the sickest patients. IME funding developed out of the Tax Equity and Fiscal Responsibility Act of 1982, and is an integral part of the Prospective Payment System (PPS) created in 19836. Since its inception in 1983, IME makes up the majority of GME support to hospitals, comprising over two thirds of the total dollars.

Reductions in IME have occurred periodically over the past decade, from 8.1% in 1986 to 7.7% in 1989 and then a stepwise reduction with the Balanced Budget Act of 1997, which was slightly amended by the Balanced Budget Refinement Act of 1999, resulting in its current rate at 5.5%2,7. Medicare currently pays IME as an add-on to a hospital’s PPS payment.

The amount of IME a hospital receives is dependent on the amount of graduate medical education it provides and, as such, is directly related to the number of Medicare inpatient days and the IRB ratio. The BBA of 1997 did allow hospitals to count non-hospital resident time for IME if they pay the costs and do not exceed the IME limits for that hospital (Table 1).

Issues for Discussion in GME Several major issues in current GME funding emerge as focus points in any discussion of reform. The themes that recur include: 1. all payer funding, 2. reduction of variability in payments, 3. overhaul of the current resident cap process and accountability for the use of DME funds by institutions, and 4. principles for GME funding.

1. COGME issued a report at the end of 2002 on financing GME recommending that the cost of GME be redistributed to all payers rather than relying solely on government sources.8 Third party insurers argue that they have been subsidizing care all along because they reimburse at a higher rate than Medicare coverage, however the introduction of managed care and contracting has changed this dynamic as the third party payers aggressively negotiate better rates from medical providers. The end result is that they are often paying less

Disproportionate Share Hospital (DSH) Funding DSH payments were developed in 1986 to support hospitals that had a disproportionate share of uninsured patients.

This funding tends to be concentrated in rural and inner city hospitals. DSH facilities include tertiary care centers that are required to serve all patients. Recent adjustments in DSH payments have usually been tied to IME reductions, although the 2003 Medicare Bill includes a 16% one-time increase in 19

Financing (Continued) than governmental sources. Several Senators and Congressional representatives see GME as a public good that should be financed by an all payer fund. It could create trust funds for medical schools and teaching hospitals. The funds would pay DGME and IME costs. The funds would come from a fee assessed on health insurance plan premiums and from the federal government. As one would expect, the insurance industry does not favor such a plan, yet many health educators believe it will be needed to ensure adequate funding for GME and it is a matter of fairness.

2. DME funds currently paid to individual hospitals continue to have their basis in the 1995 numbers provided by the hospitals themselves and as modified by BIPA. The disparity in the cost per resident is still quite broad, even in like training institutions.

For example, if hospital A informed Medicare in 1995 that it cost $100,000 per resident per year for training while hospital B told Medicare its costs were $50,000 per resident per year that is what they were reimbursed. While there have been some adjustments in these reimbursement rates since 1995, disparities still exist today between similar training settings.

3. The number of residents funded by GME per institution has remained capped at 1986 levels. Residency slots have become a commodity, especially evident as hospitals undergo mergers and acquisitions. Emergency Medicine as a relatively new training program is at a distinct disadvantage under this system, since hospitals that meet or exceed their assigned number of residents and do not have Emergency Medicine training programs have a relative financial disincentive to open new residency slots.

Looking forward it will be important for academic physicians interested in GME to be armed with their institution specific GME data. The GME payment per resident, the percentage of Medicare, the IRB ratio and housestaff cap are good starting points. Knowledge about whether your institution receives any disproportionate share payments should also factor into discussions. Lastly, institutions looking to add to their resident complement should closely follow the enactment of the 2003 Medicare Act and the provision to redistribute resident positions.

In addition, GME funding is complex and it is important for academic physicians in leadership, to have not only knowledge of the history of the payment system but also what it means in real dollars for their own institution and department (Tables 2,3,4). Once you understand the amounts, you are in a better position to be an advocate for GME funding at your institution and at the federal level.

Bibliography 1. COGME Fifteenth Report: Financing Graduate Medical Education in a Changing Health Care Environment. U.S. Department of Health and Human Services; December 2000.

2. Report to the Congress: Medicare Payment Policy, Treatment of the initial residency period in Medicare’s direct graduate medical education payments. Washington DC: Medicare Payment Advisory Commission; March 2001.

3. Oliver TR, Grover A, Lee PR. Variations in Medicare payments for Graduate Medical Education. Calif. Healthcare Foundation Report: June 2001.

4. Anderson GF. What Does Not Explain the Variation in the Direct Costs of Graduate Medical Education. Academic Medicine 1996;71:164-169.

5. Journal of the American Medical Association. Appendix II: graduate medical education, American Medical Association. Sept 6, 2000, Vol. 284, No. 9, 1159-1172.

6. Rich EC, Liebow M, Srinivasan M, Parish D, Wolliscroft JO, Fein O, Blaser R. Medicare financing of Graduate Medical Education: Intractable Problems, Elusive Solutions. J Gen Intern Med 2002;17:283-292.

7. COGME Resource Paper: The Effects of the Balanced Budget Act of 1997 on Graduate Medical Education.

8. COGME 2002 Summary Report. U.S. Department of Health and Human Services; June 2002.

Table 1. Changes in IME adjustment factor with the Medicare Prescription Drug, Improvement and Modernization Act , passed in 2003.

Current factor Starting April FY 04 FY 05 FY 06 FY 07 FY 08

Table 2. Payment for 2003 GME DGME estimated payment $2.54 billion IME estimated payment $5.07 billion

5.5% 6.0% 5.8% 5.5% 5.35% 5.5%

Table 3. DGME example PRA X Medicare share IRP (1.0) X ($75,000) X 30% Beyond IRP (0.5)X (75,000) X 30%

Table 4. IME Example Calculate IRB ratio Statistical formula IME payment DRG

200 residents/1000 beds (1.35 x ((1+0.2)n – 1 x 100 DRG306 * IME % = $5,031 * 10.35%

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IRB = 0.20 IME % = 10.35% IME pay = $521

Payment amount $22,500 $11,250

National Alcohol Screening Day and Academic Emergency Medicine Department Collaboration The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), have kicked off a major collaborative study that will investigate ways to screen, identify, and treat patients in hospital emergency departments for alcohol problems. Academic EDs at 14 institutions throughout the U.S. will participate in the study, the first to rely solely on ED personnel, rather than research staff, to conduct the screening and intervention.

A recent report in the Archives of Internal Medicine concluded that the number of alcohol-related ED visits is approximately three times higher than previously estimated, based on physician documentation or patient disclosure of alcohol involvement. Controlled clinical trials of screening, brief intervention, and referral have shown positive outcomes in decreasing or eliminating alcohol use, reducing injury rates, and reducing costs to society. The ED is an ideal setting in which to provide people who drink in harmful or hazardous patterns with a targeted intervention at the time of an adverse event – a situation sometimes referred to as a “teachable moment.” This project will attempt to demonstrate that it is possible to conduct ED screenings for alcohol problems and increase the likelihood of intervening via brief interventions and referrals to appropriate alcohol treatment.

Approximately 1000 patients from all 14 sites will be involved in the study. At three and six months following their ED visits, patients in both the treatment and control arms will

complete follow-up interviews by telephone. Primary outcomes assessed will include drinking behavior and alcoholrelated health consequences (e.g., drunk driving, fights, etc.)

Drs. Edward and Judith Bernstein (Boston University) and Gail D’Onofrio (Yale University) will coordinate the training of ED site personnel through the development of a curriculum and training program. Dr. Robert H. Aseltine, Jr. (University of Connecticut) is heading up the Data Coordinating Center for the project. The 14 centers and primary investigators that will take part in the study are affiliated with the following institutions: Boston University: William G. Fernandez, MD, MPH Brown University: Robert H. Woolard, MD Charles R. Drew University: Shahrzad Barzargan, PhD Denver Health Medical Center: Kerry Broderick, MD Emory University: Arthur Kellermann, MD, MPH Howard University: Robert Taylor, MD, PhD Tufts University: Denise Rollinson, MD, MS University of California, San Diego: Ted Chan, MD University of Medicine and Dentistry of New Jersey: Brigitte Baumann, MD University of Michigan: Ronald R. Maio, DO, MS University of New Mexico: David Doezema, MD University of Southern California: Deirdre Anglin, MD University of Virginia: Marcus Martin, MD Yale University: Gail D’Onofrio, MD

Meeting the Challenges (Continued) at the University of Michigan, will present a brief overview of the history of medical education research and focus on unique issues that are currently important. This introductory lecture will provide a context for how EM can fit into the realm of educational research in the present and in the future.

“Defining the Research Question”: This session will define the characteristics of well-designed research studies in medical education. Dr. Michelle Biros, editor-in-chief of Academic Emergency Medicine, will join Dr. Gruppen in discussing the choice of a research topic, the generation of an appropriatelybound research hypothesis, and the rigorous standards that must be met to prepare a publishable manuscript. The speakers will provide both traditional research and medical education research perspectives.

“Educational Research in EM: Examining the Literature”: This panel session

will focus on medical education in EM and lead the audience through an analysis of selected studies to highlight specific strengths and pitfalls in study design and implementation. Drs. LuAnn Wilkerson, Gloria Kuhn, and Wendy Coates will provide a critical appreciation of how to read the medical educational literature. Instruction on how to report on educational innovations (e.g., evaluating a new curriculum) will be presented. A strategy for searching education databases, such as ERIC, will be introduced by leading the audience through a prepared practical example.

The proposed second year in the Educational Research Track will build upon these sessions. The anticipated modules are entitled “Educational Research Methodology,” “Evaluating an Educational Research Design,” and “Interpreting and Presenting Results.”

The proposed third year will focus on more advanced topics such as “Creat21

ing Databases for Educational Research in EM,” “Forming Educational Research Consortia,” and “Implementation of a Research Design: Grant-writing and Funding.”

Thus in response to Dr. Lewis’ “reaching the bar” call for a high-quality standard in educational research, our three-year Educational Research Track is intended to provide members of SAEM with a solid foundation of knowledge in educational research that will assist them in performing valid and reliable studies. The information obtained as a result of quality research can then be used in the classroom and bedside settings and in future research efforts.

We hope that this is the beginning of an effort that must be continuous and ongoing for our membership, so that we not only “reach the bar” but surpass it.

Alcohol Screening and Brief Intervention Conference Leon L. Haley Jr., MD, MHSA Emory University SAEM Board of Directors On February 12, 2004, I represented SAEM at “The National Medical Leaders” meeting in Washington, D.C. for a discussion on the future policies and practices on alcohol screening and brief intervention. The meeting was co-sponsored by the National Highway Traffic Safety Administration (NHTSA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). These organizations united because of the growing belief on the federal level that the “body of evidence” on the efficacy of alcohol screening and brief intervention (SBI) is indisputable and that reducing the public health burden of alcohol misuse would have a dramatic effect on its numerous consequences (i.e., reducing drunk driving, alcohol-impaired injuries and fatalities, domestic violence, falls and cirrhosis).

Emergency Medicine was well represented at this meeting as leaders from SAEM, ACEP, NAEMSP, ENA, ACS and the American Trauma Society joined several other national organizations and federal agencies in a series of presentations and discussions. The meeting opened with remarks and introductions from emergency physician, Dr. Jeffrey Runge, the current administrator for NHTSA. Dr. Runge set the stage for the rest of meeting by stressing the importance of this issue at the federal level, especially as he carefully connected the Administration’s safety initiatives with their relationships to alcohol with startling statistics about accident rates, injuries and fatality data. NHTSA has established a goal of 0.53 Alcohol Related Fatalities per 100 million vehicle miles traveled, but currently the rate is at 0.63 without any significant movement over the past three years. NHTSA believes that reducing that rate requires 3 primary needs: 1) High visibility in Law Enforcement; 2) Specific courts and prosecutors for DWI/DUI; and 3) Alcohol Screening and Brief Intervention. Dr. Runge was followed by Surgeon General and Trauma Specialist Dr. Richard Carmona who delivered the Keynote Address, which focused primarily on

discussions about alcohol abuse and dependency, the role of “population vs. individual health” as it relates to alcohol, as well the speaker’s personal anecdotes about alcohol and trauma patients he had cared for in the past.

Following the opening presentations, the meeting focused on alcoholism screening definitions and tools, specific examples of intervention in the emergency department setting, the role of National Alcohol Screening Day, grants that have been awarded to 14 emergency departments across the country to study SBI (see related article in this issue of the Newsletter) and the additional roles of federal agencies. Speakers included Dr. Ting-Kai Li, the Director of NIAAA, who assigned definitions to moderate and risky drinking behavior, as well as defined several of the current screening and assessment tools available to practicing physicians. Dr. Gail D’Onofrio, Associate Professor of Surgery at Yale University, provided specific examples of screening and intervention projects involving both the direct health care practioner providing direct intervention, and the use of outside health care professionals who could provide screening and intervention without being directly involved in the patient’s care process.

Another highlight of the meeting was discussion about the 6th Annual National Alcohol Screening Day (NASD) on April 8, 2004 and the 14 emergency departments around the country that have been awarded grants from NIH and NIAAA to study brief intervention in the ED setting. NASD is a free event that provides information about alcohol and health, and free, anonymous screening for alcohol-use disorders.

Event sites are located in community, college, primary health care, military and employment settings. The program is designed to provide outreach, screening and education about alcohol’s effects on health for the general public.

This year’s theme is “Alcohol and Health, Where Do You Draw the Line?” and SAEM is proud to be a sponsor for this year’s program joining many other leading organizations across the coun-

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try. And as a correlate, LAC+USC, Cooper Health System, Boston Medical Center, Denver Health, Yale, University of Connecticut, Charles Drew, the University of New Mexico, the University of Michigan, Howard University, Emory University, the University of Virginia, the New England Medical Center and Brown Medical School will collaborate to study screening and brief intervention in the ED setting.

The meeting concluded with discussion about some of the key issues for screening and brief intervention (SBI).

The major themes were: • Training – What can organizations do to develop and encourage training?

• Dissemination – What mechanisms exist for disseminating information on SBI and SBI training?

• UPPL (Uniform Individual Accident and Sickness Policy Provision Law) – What are the next steps in organizing efforts to repeal UPPLs? This is the law that states that “insurers shall not be liable for any loss sustained or contracted on consequence of the insured’s being intoxicated or under the influence of any narcotic unless administered on the advice of a physician” and thus allows insurers to deny payment for treatment of alcohol-related injuries.

• Billing – How can we provide information to physicians to increase their understanding of using CPT codes to bill for SBI • Screening Day – What are we all doing now – or could we do – to actively support National Alcohol Screening Day? • Treatment – What can organizations do to advocate for more treatment and for insurance parity?

In summary, I found the meeting to be highly informative both about screening and brief intervention and the role it will increasingly play in emergency departments and the increasing role of the federal government to support this activity. I was also encouraged by the extensive roles played by many emergency physicians in setting the clinical, research, and educational agenda necessary to intervene on a significant public health matter.

Opportunities Available Through the SAEM Consult Service Glenn Hamilton, MD Wright State University Chair, SAEM Consulting Service The SAEM Consult Service has a long history beginning with the Society of the Teachers of Emergency Medicine (founded by Gus Roussi in the late 1970s). Its greatest activity was under the guidance of Steve Dronen, MD, who chaired the Consulting Service for many years and provided over 70 consultations during the 1990s. The SAEM Consult Service is well prepared to offer its considerable capabilities to interested parties in our specialty.

Although a variety of services are available, the primary foci have been the following: 1. Establishment of an EM residency – this consult is in advance of application to the ACGME and RRC-EM for consideration of a new EM residency. The consultation will assess the suitability and potential of the site for residency training and assist in the development of the program information forms required by the ACGME. This service has been successfully offered to more than 40 programs in the last two decades.

2. “Mock” survey prior to RRC-EM site survey – this service serves as a preparatory guide to residencies preparing for their official site survey by the RRC-EM. This is a useful process for making sure the issues of potential concern by the RRC-EM are addressed, and convincing institutional administration of the benefits of EM and its continued support.

There have been more than 40 of these consults in the last 20 years.

3. Research Consultation – this relatively new aspect of the service helps programs develop a research program suitable to their environment. Several sites have participated in this type of consultation with appropriate guidance and net gains in their research activity.

4. Faculty Development – EM remains one of the few specialties that requires faculty development as part of its program requirements.

Programs who are initiating or having difficulty in this area may request a faculty development consultation

to assist in planning effective programs for their faculty.

Consultations are done by experienced individuals who are Program Directors, Academic Chairs, and/or RRC-EM Site Surveyors. Usually 1-2 individuals participate in the consultation depending upon the needs of the institution. The individuals are selected with input from the institution and the consult service. Fees are $1,250 per individual per day plus expenses. An additional $500 is paid to SAEM to support the administrative aspects.

The 1980s and 90s were a time of tremendous growth for EM residencies.

The Consult service played a significant role in sustaining the quality of these residencies and assisting numerous Program Directors in developing and creating solutions to their problems.

The SAEM Consult Service looks forward to assisting in residency or academic development needs. Please contact me directly or through SAEM for further information and assistance.

Call for Abstracts 14th Annual Midwest Regional SAEM Meeting

Call for Abstracts 7th Annual Mid Atlantic Regional SAEM Meeting

September 9-10, 2004 The Wyndham Milwaukee Center Hotel Milwaukee, Wisconsin

October 1, 2004 Washington Hospital Center Georgetown University Medical Center/ Marriot Conference Center Washington, DC

The Program Committee is now accepting abstracts for review for oral and interactive poster presentations.

The meeting will take place Thursday, September 9, 2004, 6:30-8:30 pm, and Friday, September 10, 2004, 8:00 am-4:00 pm at the Wyndham Milwaukee Center Hotel, 139 East Kilbourn Avenue, Milwaukee, WI 53202.

The deadline for abstract submission is Friday, July 9, 2004, by 3:00 pm EDT. Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notifications will be sent in late July.

Registration forms are available from Dawn Kawa, Department of Emergency Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, FEH Room 1870, Milwaukee, WI 53226 or dkawa@mcw.edu.

Registration Fees: Faculty--$75; Other health care professionals--$40; Fellows/residents/students--No Charge. Late fee after Wednesday, September 1, 2004: add $10. For questions or additional information, call 414-805-6452.

The Program Committee is now accepting abstracts for review for oral and interactive poster presentations. The meeting will take place Friday October 1, 2004; 8 am to 4 pm The deadline for abstract submission is Monday August 2, 2004, by 3:00 pm EDT. Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notifications will be sent in late August. All registration and Hotel Information will be published in the next newletter and available on line at SAEM website by May 15, 2004. The same successful format of all presentation in oral format with plenary paper allowed 15 minute presentations and standard acceptances allowed 5 minutes for presention.

All presentations will be made in powerpoint. there will be teaching, research and a large medical student residency application session. All medical students from the MidAtlantic Region within a days drive are enouraged to attend.

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

Edited by the SAEM GME Committee

Resident Conference: Getting the Most Out of the Curriculum Esther Chen, MD University of Pennsylvania for the SAEM GME Committee The Residency Review Committee-Emergency Medicine (RRC-EM) mandates that each residency training program should provide at least 5 hours of “planned educational experiences,” each week. Emergency medicine (EM) residency programs must satisfy this requirement in ways that are both stimulating and educational for a relatively diverse group that includes new residents still formulating their basic knowledge base and experienced residents refining their skills for unsupervised practice. In order to see the different ways residency programs are satisfying this requirement, we conducted a nationwide informal e-mail survey of EM chief residents. We used the results of this survey to construct the following guide to help residency program directors and chief residents update or complement their educational curricula.

Core EM Lectures Most programs have a core emergency medicine lecture series. A comprehensive list of potential topics may be found in the Model of the Clinical Practice of Emergency Medicine Curriculum (http://www.cordem.org/download/practice.pdf).

Depending on the length of residency training, this core set of lectures may be cycled every 1.5 years or 2 years. A few residencies organize their core content lectures by organ system, which may help residents coordinate their textbook reading with the lectures.

Journal Club/Evidence-based Medicine Journal clubs may use articles from the EM literature or major journals (NEJM, J Cardiology, JAMA) in other relevant disciplines. Discussions may focus on methodology or impact on clinical practice. Methodology discussions may include definitions of key biostatistics and epidemiology concepts (e.g. case-control study, sensitivity, specificity). Some programs make journal club presentations available on the internet for easy access. A variety of formats may be used: a. Focus on an Article or Articles. The resident presents an article or articles, and a faculty member leads the discussion of each article, using either his/her own PICO format (Problem, Intervention, Comparison, Outcome) or the McMaster University’s critical appraisal of the literature guidelines. b. Focus on a Clinical Question. Each month, different residents formulate clinical questions (e.g. the utility of blood cultures in patients with pneumonia), search the literature for answers, and present a summary of the evidence, followed by a brief discussion with faculty participation. Presentations should include a list of references. c. Debates or Mock Trials. Friendly competitions can be fun and motivate excellent discussions. Residents can be assigned different sides of a clinical argument in a 24

debate or be forced to defend a point in a mock trial with evidence from the literature.

Interdepartmental Case Conferences Since EM intersects and interacts with many other specialties, interdepartmental case conferences are great opportunities to exchange viewpoints and knowledge with different departments and divisions. EM residents can present the emergency department (ED) course and residents from other departments can present the hospital course. While Cardiology, Critical Care, Pediatrics, Trauma, Internal Medicine, and Radiology most commonly participate in such conferences, other departments can be included as well. Interdepartmental conferences are a great way to help address the systemsbased practice ACGME-defined core competency.

Morbidity and Mortality (M&M) Conference Residents present actual ED cases (either several similar cases on a single topic or 1-2 cases with different learning points) in which either management errors or unexpected outcomes occurred. The ensuing discussion should avoid administrative or quality assurance issues and focus on the educational aspects of the case. Using multimedia aids and inviting people directly involved in the case (e.g., patients, family members, and physicians from various departments) can improve the discussion.

ECG/Radiology/Procedure Conference Some conferences can teach and review basic skills such as electrocardiogram (ECG) and radiographic interpretation, or common emergency department procedures (e.g., splinting, slit lamp exam, intubation). These should include didactic lectures reviewing important steps and concepts as well as hands-on laboratories in which residents can practice these skills in a controlled setting. Various teaching formats may be used. Residency programs may distribute written guides on certain topics (e.g., an ECG interpretation manual) or packets of unknown cases for practice. Residents can collect in small groups and rotate through different stations, with each station focusing on a specific topic (e.g., wide complex arrhythmias, ischemia, toxic/metabolic ECG abnormalities). It may be helpful to recruit relevant specialists (e.g., radiologists for film interpretation) to teach these sessions. Finally, whenever interesting films or ECG’s appear in the ED, faculty or chief residents may want to present them in conferences.

Textbook Conferences Chapter reading in either Tintinalli or Rosen textbooks are reviewed in a discussion format where important points from the chapter are highlighted. A fun way to encourage habitual textbook reading is to set up a jeopardy contest between the

junior and senior residents with questions based on the assignment.

port and medication approvals. If medical command audiotapes are not easily accessible, mock scenarios can be discussed.

Trauma Conference Several formats may be used for trauma conferences: a. Presenting Video Tapes: Reviewing evaluating videotapes of actual or simulated resuscitations can help teach residents about being effective trauma leaders, using proper techniques, and allocating resources appropriately. b. Trauma Stations: Residents can rotate through stations that simulate different trauma scenarios. A faculty member at each station can evaluate each resident’s competence as a trauma leader. c. Mass Casualty Scenarios: Mock drills and discussions of mass casualty scenarios can give residents practice in properly triaging and managing large groups of patients. Residents should be familiarized with their institutions’ disaster protocols and procedures.

Case Conferences Case conferences involve discussing either the initial evaluation and management or the follow-up inpatient/outpatient workup of actual ED patients. An appropriate variety of pediatric, cardiology, critical care, and trauma cases should be selected. Cases representing different scenarios (e.g. patients who bounce back to the ED 72 hours later) should be selected as well.

Intern Survival Series Several programs have a specific series of lectures/labs for incoming interns during the first 1-2 weeks of their residency. Didactics on the management of common chief complaints such as headache, dizziness, chest pain, and shortness of breath are reviewed, along with radiographic and ECG interpretation, and procedural skills. In addition, chief residents from off-service rotations should be invited to meet the interns and discuss the expectations and educational goals during those rotations.

Medical Resuscitations Since actual medical codes may not be frequent enough, mock adult and pediatric medical resuscitations should be performed to give residents adequate experience. Residents should be able to competently play various roles (e.g. code leader, airway manager) during these simulations.

Getting the Most Out of Attending Structured Conferences There are two ways to enhance your education from attending conferences. The first is to simply be aware of what the topics and speakers are for a given conference day. The second is to briefly prepare for conference. As an example, if the topic is going to be pancreatitis, your learning will be enhanced by reading a chapter on the topic prior to attending conference. Alternatively, you can review a particular aspect of this topic, such as whether amylase or lipase represents a better screening test. With preparation, you will be better able to ask good questions at conference, as well as enhance the discussion.

Board Reviews Oral or written board review sessions may be conducted in various formats: didactic lectures, visual diagnosis tests, quiz games asking Jeopardy-style questions, and mock written and oral board exams.

EMS Tape Review Reviewing Emergency Medicine Services (EMS) audiotapes can teach residents about prehospital transport and EMS protocols. Senior residents need to be familiar with common medical command issues such as refusal of trans-

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.

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

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

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

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The 2004 NRMP Match in Emergency Medicine Louis Binder, MD MetroHealth Medical Center The results of the 2004 NRMP Match became final on March 18, 2004. Emergency Medicine residency programs offered a total of 1295 entry level positions (5.5% of total positions in all specialties). The following numbers (taken from the 2004 NRMP Data Book) include information from all programs that entered the 2004 Match:

EM positions/total NRMP positions

2002 22,916 10% 125 (112 PG1, 13 PG2) 1211 (1073 PG1, 138 PG2) 5.3%

2003 23,365 9% 125 (112 PG1, 13 PG2) 1251 (1114 PG1, 137 PG2) 5.4%

2004 23,704 8% 129 (116 PG1, 13 PG2) 1295 (1151 PG1, 144 PG2) 5.5%

# EM programs with PG1 vacancies # unmatched EM PG1 positions

9/1148 (8%) 20/1073 (2%)

17/112 (15%) 41/1114 (3.7%)

7/116 (6%) 22/1151 (2%)

# EM programs with PG2 vacancies # unmatched EM PG2 positions

2/13 (15%) 5/138 (4%)

4/13 (31%) 7/137 (5%)

1/13 (8%) 2/144 (2%)

Total # EM programs with vacancies Total # unmatched EM positions

11/125 (9%) 25/1211 (2%)

21/125 (17%) 48/1251 (3.8%)

8/129 (6%) 24/1295 (2%)

Total # of NRMP positions Overall % of positions unfilled Number of EM programs listed Total PG1/PG2 entry positions

Applicant Pool Data Applicants who ranked only EM programs: US graduates Independent applicants Total applicants

2002 858 276 1134

2003 856 300 1136

2004 1014 360 1374

Applicants who ranked at least one EM program: US graduates Independent applicants Total applicants

1126 438 1564

1062 433 1495

1146 360 1506

56/858 (6.5%)

36/856 (4.2%)

71/1014 (7.0%)

Independent applicants applying only to EM programs who went unmatched

145/276 (53%)

114/300 (38%)

140/360 (39%)

Percent of matched US seniors who matched in EM residencies

858/11,915 (7.2%)

856/12,037 (7.1%)

1014/13,572 (7.5%)

Breakdown of filled EM positions by type of applicant: 2002 PG1 EM positions 1073 Filled by US graduates 866 (81%) Filled by independent applicants 186 (17%) Total filled 1052 (98%)

2003 1114 859 (77%) 214 (19%) 1073 (96%)

2004 1151 892 (77%) 237 (21%) 1129 (98%)

PG2 EM positions Filled by US graduates Filled by independent applicants Total filled

137 97 (71%) 33 (24%) 130 (95%)

144 119 (83%) 23 (16%) 142 (99%)

US seniors applying only to EM Programs who went unmatched

138 113 (82%) 21 (15%) 134 (97%) 26

(continued on page 27)

2004 NRMP Match (Continued) Total EM positions Filled by US graduates Filled by independent applicants Total filled

1211 979 (81%) 207 (17%) 1186 (98%)

1251 956 (76%) 247 (20%) 1203 (96%)

1295 1011 (78%) 260 (20%) 1271 (98%)

** For PG1 filled entry positions (1129), 892 were filled by US seniors, 72 were filled by US physicians, 100 by osteopathic physicians, 47 by US international medical graduates, 11 by international medical graduates, 4 by Canadian physicians, and 3 by Fifth Pathway graduates.

From these data, several conclusions can be drawn: 1. Emergency Medicine experienced an increase of 44 entry level positions in the 2004 Match over 2003 Match numbers (a 3.5% increase), occurring from a combination of quota increases occurring in EM 1-3 and 1-4 programs, and several new programs in the EM match. Emergency Medicine now comprises 5.5 percent of the total NRMP positions and 8.4% of matched US seniors (both all time highs).

2. The overall demand for EM entry level positions increased by 129 (applicants ranking at least 1 EM program position) to 238 (applicants ranking only EM programs) positions, after no growth of the applicant pool in 2000 and 2001, and only modest growth in 2002. The majority of this increase came from US seniors who ranked only EM programs on their rank order list (158 additional students in this category). The excess applicant demand over and above the size of the training base is 248 to 324 applicants (20% to 26% surplus), depending on how the parameters of the applicant pool are determined. Last year, the excess applicant demand data were 131 to 244 applicants (10% to 20% surplus).

3. A increase of 44 in the supply of EM entry level positions in 2004, coupled with an increase in demand by 129 to 238 applicants, resulted in an increased fill rate for EM programs in 2004 (98.1%), compared with 96% in 2003. The growth of demand over supply was also manifested by a decreased number of unfilled EM positions in the Match (24 in 2004, compared with 46 in 2004 and 25 in 2002).

4. The proportions of EM positions filled by US seniors versus Independent Applicants (US graduates, Osteopaths, and International Medical Graduates) remained the same in 2004 compared with 2003. In 2004, 85.4% of EM entry positions were filled with US graduates, compared with 86% in 2003.

5. Overall, the increase in applicant demand for EM training positions exceeded the increase in the supply of these positions, even with several new EM programs and quota increases in many existing programs in this year’s Match. This resulted in a decreased number of unmatched positions, a decrease in the number of programs with unmatched positions, and an increase in the number of unmatched applicants (7.0% in 2004, versus 4.2% in 2003), creating more of a “seller’s market” for EM positions than has been the case over the past few years. The unmatched rate of 7.0% for US seniors going into EM in 2004 (5.8% in 2003) and 39% for Independent Applicants going into EM support the notion that most US seniors and Independent Applicants who apply will match into an EM residency.

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

Some students hoped to learn more about a specific geographic region, while others were anxious to contact

an advisor whose special interest matched their own.

As the program increases in popularity, more advisors are needed. New students are applying daily, and over 100 remain unmatched! Please consider mentoring a future colleague by becoming a virtual advisor today. We have a special need for osteopathic emergency physicians to serve as advisors. It is a brief time commitment

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– most communication takes place via e-mail at your convenience.

Informative resources and articles that address topics of interest to your virtual advisees are available on the SAEM medical student web site. You can complete the short application on-line at http://www.saem.org/advisor/ index.htm. Please encourage your colleagues to join you today as a virtual advisor.

Interest Group Meetings in Orlando All SAEM interest groups are required to meet during the SAEM Annual Meeting. Many have elected to develop an agenda for dissemination to the membership. All SAEM members are invited to attend the interest group meetings. Membership in the interest groups is not required and there is no registration fee.

Airway Interest Group Meeting May 18, 2004 (9:00-11:00 am)

EMS Interest Group May 17, 2004 (2:00-3:00 pm)

The Airway Interest Group meeting will be divided into two parts. The first part will be both educational and an effort to present cutting edge research or ideas for the purpose of group collaboration on future studies. All individuals with an interest in airway research are invited to attend.

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Part 1: This year as part of our Program Subcommittee we will present "Asthma Education in the ED," the results of an international consensus conference (30 minutes). It will cover the content of asthma education, feasibility of doing this in an ED setting, and research and future directions. We will then have the presentation of four preliminary studies for possible group collaboration. Each of these will last 6-7 minutes with a brief question and answer session. These presentations will be submitted and selected by the Research Subcommittee.

Please submit these to bdiner@emory.edu. Due to time consideration, there will be only four presentations. The other projects would be handed out to the attendees at the meeting.

Ethics Interest Group May 18, 2004 (8:00-9:30 am) 1.

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Part 2: Reports from the subcommittees: a. Research: Barry Diner, MD, will present one "easy" project for collaboration not requiring much, if any, funding and the other more elaborate, long range requiring funding. b. Education: Michael Radeos, MD, MPH, will present areas to collaborate in asthma education, both research and promulgating best practices for emergency medicine. c. Program: Adrian Tyndall, MD, will present concepts to present next year at the SAEM Annual Meeting, both to the SAEM membership at large, as well as to the Airway Interest Group.

Clinical Directors Interest Group May 17, 2004 (3:00-4:00) pm 5.

CPR Reperfusion Interest Group Meeting May 17, 2004 (1:00-2:00 pm) 1.

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Introductions Old Business: Follow up on EM intra-professional dating survey New Business: Where do we go from here?

Discussions on major topic areas: a. Research: The Ethics Research Agenda for Emergency Medicine 1. Provider/researcher foci 2. Resident/student foci 3. Patient/consumer foci 4. Systemic/policy foci b. Education/Teaching 1. Ethics and Humanities: Teaching Ethics using literature, film, and developing a resource for EM teachers (Mike Burg, MD) 2. The Core Competencies: What are we doing to evaluate professionalism, cultural competency and ethics in EM learners?

3. Submitting proposals for the 2005 SAEM Annual Meeting 4. Election of new Interest Group Chair Adjourn

Evidence-Based Medicine Interest Group Meeting May 18, 2004 (12:00-1:00 pm)

Introduction Norman Paradis MD Activities and Projects – Old Business - Review of previous initiatives.

- PULSE Initiative and status of consortium Hot topics and State-of-the-Art discussion New Business - Proposals for upcoming sessions - Other new projects

Business 1. Announcement of chair for 2004-05, Michael Brown, MD 2. Membership report, Peter Wyer, MD 3. List-serv and SAEM website transition, Dr. Yeh Activities and Projects (Old Business) 4. Evidence-Based Medicine Journal Club Luncheon, Eddy Lang, MD 5. SAEM online course, Charlene Irvin, MD 6. Rational clinical examination project, Dr. Newman 7. Consultancy for EM programs (survey results), Michael Brown, MD Forward Plans, Meetings and Perspectives (New Business) 8. Undergraduate EBM Proposal (SAEM 2005), Dr. Ismach 9. Practice-based learning proposal (SAEM 2005), Dr. Brown for Dr. Gerhardt 10. Other new projects

Disaster Medicine Interest Group May 17, 2004 (10:00-11:30 am) 1.

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Introductions Define interest group goals Elect chair for coming year Discuss EMS fellowship curricula development Review NAEMSP Research Agenda Open forum

Welcome Review of prior minutes Educational sessions Integration of Disaster Medicine Training into EM Residency and Medical School Curricula-Sharing of ideas Use of list service Open forum Adjournment 28

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Geriatric Interest Group Meeting May 16, 2004 (12:00-1:00 pm)

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Introduction Interest Group chair's report Program: Adam Golden, MD, a geriatrician from Orlando Regional Healthcare, who has interests in EM geriatric education curriculum and geriatric medication issues is the invited speaker and will present a short program.

Objectives for the coming year a. Discussion of possible collaborative research projects among Interest Group members b. Submission of a didactic session proposal for the 2005 SAEM Annual Meeting c. Discussion of an update and possible autumn presentation of the Emergency Care of the Elder Person course d. Discussion regarding the use of the AGS/Hartford Foundation/EMF resident research funds.

Mentoring Women Interest Group Meeting May 16, 2004 (4:00-5:30 pm) 1.

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Health Services and Outcomes Research Interest Group Meeting May 17, 2004 (2:30-4:00 pm)

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Development of didactic proposals for the 2005 SAEM Annual Meeting a. The role of Emergency Medicine in health services research b. Common pitfalls in outcomes research in Emergency Medicine c. Resources for outcomes and health services research training and education for the emergency physician Development of a consultation service for outcome and health services research protocol and grant application reviews.

Election of Interest Group chair

International Interest Group Meeting April 17, 2004 (4:00-5:30 pm) 1.

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Reaffirm interest group objectives Mentorship form Elect chair for coming year Plans for the future Open forum

Neurologic Interest Group Meeting May 18, 2004 (2:30-4:30 pm)

Goal Directed Therapy Research Interest Group May 17, 2004 (2:00-3:30 pm)

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Educational component (1.5 hours): topic to be announced Business Meeting (1 hour) a. Review of last year's activities b. Election of new officers c. Growth of group d. Ideas for next year's educational program.

Active Items a. List-serv update optimizing use b. International faculty mentorship program New Items a. Upcoming international meetings b. New Fellowship programs c. Fellowship Directors list-serv d. Proposals for didactic sessions 2005 e. Scholarships for international faculty Additional items Elections

Business meeting - election FERNE update Stroke Centers Designation and the Impact on Emergency Medicine: What is the impact of developing stroke centers on the practice of emergency medicine? a. Introduction and overview, Andy Jagoda, MD b. American Stroke Association, Ellen Magnes, PhD • What they know?

• What they want and why? c. JCAHO (Joint Commission), TBA • What are the guidelines?

• How are they derived?

• Why were they derived? d. SAEM, Jim Adams, MD • What is the perspective of academic emergency physicians e. National Association of EMS Physicians, Robert O'Conner, MD • What would a protocol look like?

• Triage? f. ACEP, Brian Hancock, MD • What is the College's view/position?

• What activities has the College undertaken? g. Questions and Answers

Palliative Care Interest Group Meeting May 17, 2004 (2:00-3:30 pm) 1.

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Medical Student Educators Interest Group Meeting May 17, 2004 (3:00-5:30 pm)

Introduction to Palliative Care Creation of a Strategic Plan for the Palliative Care in Emergency Medicine Interest Group Project plan for 2004-2005 a. Research b. Education c. Administrative Election of Interest Group chair

Patient Safety Interest Group Meeting May 16, 2004 (12:00-1:00 pm)

In an effort to better support medical student educators in their endeavor to develop the best Emergency Medicine education, the interest group will offer a 2.5 hour session. This session will consist of an educational component (topic to be announced). It will be followed by an annual business meeting. Previous members and anyone interested in medical student education are invited.

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Identification of interest group members a. Dues b. Contact information, updating membership list Governance - election of chair Development of objectives for 2004-05

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Membership update / introduction of new members.

(10 minutes) 2. Progress report on the simulation scenario library. (Vozenilek, Bond, McLaughlin) (30 minutes) • Review of the template for scenarios • Review of the scenario scoring rubric • Review of the editorial process 3. Educational update: Clinical Competency Assessment.

(P. Phrampus) (15 minutes with 15 minutes for discussion) 4. Update on interactions with other simulation organizations (10 minutes) • Society for Medical Simulation (J. Gordon) • Simdot (W. Bond) 5. Future directions (roundtable)(30 minutes) • Use of the website / library to facilitate multi-center research • How to incorporate more VR into the group • Other simulation technology developments 6. Election of new officers. (15 minutes)

a. Prepare a Newsletter article on research opportunities related to patient safety? b. Collaborate with other professional societies and disciplines on patient safety as needed. c. Develop didactic session proposal for 2005 Annual Meeting d. Refine curriculum and teaching materials e. Other?

General discussion/current research efforts Assignments and adjournment

Pediatric Emergency Medicine Interest Group Meeting May 17, 2004 (1:30-3:00 pm) 1.

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Welcome and Introduction Business Meeting a. Review and development of annual objectives b. Governance, leadership c. Election of chair Didactic proposal discussion Brief presentation: The Ethical Conduct of Research Involving Children, Norm Christopher, MD Announcements

Toxicology Interest Group May 17, 2004 (4:00-5:00 pm)

Public Health Interest Group May 16, 2004 (12:00-2:00 pm) 1.

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Trauma May 18, 2004 (2:30-3:30 pm)

Welcome, introduction Review of first year a. Membership b. Votes (decisions, insurance) c. Public health database d. NHTSA/SAEM course e. Committees Healthy People 2010, Steps Development of annual objectives Governance, election of chair(s) Other business, announcements

Triage Interest Group Meeting May 17, 2004 (12:00-1:00 pm) 1.

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Ultrasound Interest Group May 18, 2004 (2:00-5:00 pm) 1.

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Research Directors Interest Group May 17, 2004 (3:00-4:00 pm) 1.

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Election of chair Triage Research Projects Didactic Session for 2005 Other business

Report of the research directors’ survey working group Development of an EM research resource website Other tools for enhancing communication and pooling resources Discussion of future goals and objectives

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Simulation Interest Group Meeting May 17, 2004 (2:00-4:00 pm)

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The Simulation Interest Group was created to promote the use of simulation of all types for education in Emergency Medicine.

The group also fosters collaboration in educational research and provides a forum for discussion of issues of clinical competency assessment. This year the meeting will include an educational update from Paul Phrampus, MD, of the University of Pittsburgh regarding the use of simulation for difficult airway instruction and competency assessment. The Interest Group will review its progress on the editorial process for the simulation scenario library. Elections will be held for the offices of chair. Nominations are open until May 10. To nominate someone please e-mail the name of the nominee to william.bond@lvh.com. The Interest Group meeting is open to all SAEM members.

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Introduction and Year in Review Educational Presentations on novel uses of Ultrasound in Emergency Medicine a. Christine Irish: Pneumothorax b. Paul Sierzenski: Hand and Tendon US c. Anthony Dean: CHF and wet lung d. Mike Blaivas: Ocular US Pitfalls with Ultrasound Manuscripts (Mike Blavis) Community Ultrasound Survey Results (Chris Moore) Development of didactic proposals for the 2005 SAEM Annual Meeting (Larry Melniker) Sonographic Outcome Asseesment Protocol Report (Larry Melniker) Election of Interest Group chair ACEP Ultrasound Section meeting (John Kendall)

Web Educators Interest Group May 17, 2004 (2:00-4:00 pm)

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2004 SAEM Proposed Constitution and Bylaws Amendments The Constitution and Bylaws Committee, chaired by Linda Spillane, MD, carefully reviewed the SAEM Constitution and Bylaws and proposed 17 amendments for the consideration of the membership this year. The amendments range from minor wording changes that clarify, but don't change the meaning of the text, to an amendment that allows for the development of a separate Awards Committee.

The proposed amendments were submitted to the Board of Directors for review and approval. After Board approval a ballot was developed. The ballot was mailed to the active members of the organization by April 8. Ballots are required to be completed and returned, with a postmark of no later than May 8, 2004 in order to be considered. Following the May 8 deadline the ballots will be counted and the results of the ballot will be announced during the Annual Business Meeting, which will be held on May 18 at 11:00-12:00 in Orlando. All SAEM members are invited to attend the Annual Business Meeting.

The proposed amendments are published below for the benefit of the entire membership. Proposed new wording is printed in boldface. Wording that is proposed to be deleted is indicated with strikeouts.

PROPOSED AMENDMENTS Establishment of an Awards Committee: The C&B Committee proposes that an Awards Committee be established.

Currently the C&B requires that the Nominating Committee develop the slate of candidates for the elected positions, as well as select the recipients of the SAEM awards (Academic Excellence, Leadership, and Young Investigator). To establish an Awards Committee the following amendment is proposed: 1. Bylaws: Article VI, Section 3: The Nominating Committee will also provide recommendations to the Board of Directors for Society awards.

Clarifying the Annual Business Meeting: The C&B Committee recommends wording changes that clarifies the Annual Business Meeting.

2. Bylaws: Article III, Section 1: Business items presented as informational or for vote by active members

shall include, but not be limited to: transaction of other business which may come before the membership, and a "State of the Society" address by the President and announcement of the results of the election of officers and committee members and any amendments. Where dictated by the Constitution and Bylaws. Where dictated by the Constitution and Bylaws, the Society shall be governed by a plurality of eligible members voting.

The President of the Society shall preside over the meeting and the Secretary-Treasurer will circulate agenda items to the membership 30 days or more before the annual business meeting. The chairs of the Constitution and Bylaws Committee and Nominating Committee will preside over the respective parts of the Annual Meeting.

Clarifying the Role of the Nominating Committee: Traditionally the Board has approved the slate of nominees proposed by the Nominating Committee, however the C&B does not require this action. The C&B Committee recommends that the following sentence be added to the Bylaws: 3. Bylaws: Article VI, Section 3: The slate of nominees selected by the Nominating Committee shall be approved by the Board of Directors prior to distribution to the membership for consideration.

Clarifying the Role of the SecretaryTreasurer: The C&B Committee recommends a number of amendments that would clarify the role of the SecretaryTreasurer, specifically those functions that are assigned to the Secretary-Treasurer, but are more appropriately handled by the SAEM Executive Director.

4. Bylaws: Article II, Section 11: The Secretary-Treasurer in conjunction with the President shall be responsible keep a true complete and correct record of for the agenda proceedings of the annual business meeting and meetings of the Board of Directors. The SecretaryTreasurer shall oversee the financial accounts and records of the Society. The Executive Director shall keep a true, complete and correct record of meetings of the Board of Directors and preserve

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documents belonging to the Society, and issue notice of the annual business meeting and meetings of the Board of Directors. The administrative staff of the Society shall keep an account of the Society with its members and maintain a current register of members with dates of their election to membership and preferred mailing address. The SecretaryTreasurer shall be responsible for reporting unfinished business requiring action from previous meetings of the membership or Board of Directors and in conjunction with the President shall be responsible for the agenda of the annual business meeting and meetings of the Board of Directors. The administrative staff of the Society shall collect the dues keep an account of the Society with its members and maintain a current register of members with dates of their election to membership and preferred mailing address. The administrative staff of the Society shall collect the dues of the Society. The Secretary-Treasurer shall make disbursements of expenses, and oversee the financial accounts and records of the Society.

5. Constitution: Article VII, Section 2: The Secretary-Treasurer Executive Director shall mail the proposed amendments to the membership at least 30 days prior to that meeting.

6. Bylaws: Article II, Section 8: A final notice of time and place of such meetings shall be sent to all members of the Board by the SecretaryTreasurer at least via the Executive Director at least 7 days before the meeting. Six members of the Board of Directors will constitute a quorum. Agenda items for Board meetings may originate from any member of the Society and are submitted for review to either the Secretary-Treasurer or the Executive Director no fewer than 30 days before the meeting date.

7. Bylaws: Article III, Section 3: A final notice of the time, place, and program of the annual assembly meeting shall be sent to all members of the Society by the Secretary-Treasurer Executive Director at least 30 days before the meeting.

8. Bylaws: Article III, Section 4: Such meetings shall be convened by the President, Board of Directors, and Program Committee Chair and publicized at least 30 days in advance by the Secretary-Treasurer Executive Director.

Amending Wording Regarding Resident/Fellow and Medical Student Membership: The C&B Committee recommends deleting some of the wording regarding the definition of resident/fellow and medical student membership.

The proposed changes have no effect on the criteria or status of these members.

9. Constitution: Article III, Section 2: (3) Candidates for resident/fellow membership must be residents or fellows in good standing. This category of membership shall apply only to residents or fellows currently enrolled in a training program. and an individual's membership in this category expires on the last day of the calendar year of his or her enrollment in the program. The individual may then be eligible for membership in another category. (4) Candidates for medical student membership must be medical students who have an interest in emergency medicine. Medical student membership expires on the last day of the calendar year in which the member is no longer enrolled as a medical student. The individual may then be eligible for membership in another category.

Deleting the Requirement that the President-Elect Serve on All Committees:

select candidates a slate of officers to fill the naturally occurring vacancies on the Board of Directors and elected positions on the standing committees of the Society not otherwise designated and provided for by these Bylaws.

The C&B Committee recommends that the C&B be amended to no longer require that the President-Elect serve as an ex-officio member of all committees.

10. Bylaws: Article II, Section 10: The President-Elect shall serve as chair of the Nominating Committee. and ex-officio member of all committees.

Minor Wording Changes: The C&B Committee has proposed a number of minor wording changes for consideration by the membership.

11. Constitution: Article II, Section 2: (4) serving in an academic capacity to develop and promote further the most appropriate improved measures for the of care of for the acutely ill or injured patient, 12. Constitution: Article III, Section 3: All members may have the privilege of the floor and of serving on the standing and ad hoc committees, task forces, and interest groups of the Society.

13. Bylaws: Article II, Section 9: The President may appoint task forces with specified goals. The President shall appoint a Board liaison to each committee, task force, and interest group. The President may appoint task forces with specified goals.

14. Bylaws: Article III, Section 3: The Society shall sponsor an annual scientific and educational meeting or assembly to meet its purpose and objectives.

16. Bylaws: Article II, Section 9: It shall be the duty of the President to see that the rules of order and decorum are properly enforced in all deliberations of the Society, to set the agenda for each Board meeting, and to sign the approved minutes of each meeting, and to execute all documents which may be required for the Society, unless the Board of Directors shall have expressly authorized some other person to perform such execution.

17. Bylaws: Article I, Section 1: Application Process. Aapplications for membership forms may be obtained from the Society Headquarters. The Applicant must return the completed application forms and supporting letters to the Executive Director. The qualifications of applicants for membership will be reviewed by the Executive Director and Secretary-Treasurer Approval of applicants by the Executive Director and Secretary-Treasurer shall constitute election to one of the membership categories, effective immediately.

15. Bylaws: Article VI, Section 3: It shall be the task of this committee to

Photography Display Contributors SAEM would like to thank the following individuals who contributed to this year's Clinical Pearls and Visual Diagnosis Contest entries. It is a significant commitment of time and intellect to develop the ever-popular Photo Display, which once again will be presented at the SAEM Annual Meeting in the Exhibit Hall, along with the poster and Innovations in Emergency Medicine Education Exhibits.

Opeolu Adeoye Alexander Baer,MD Kismet Baldwin Keith Bricking, MD David Bryant, DO Susie Chiang, DO Greg Christiansen, DO Richelle Cooper MD, MSHS Adam Corrado, MD Libby Crenshaw, MD Nahla Darkazally, MD

Nikhil Goyal Raj Guharoy, MD Barry Hahn, MD Kenneth Heng, MD Jennifer Hess, MD Carl Hsu, MD Andy Hsu, MD Yanick Isaac, MD Leslie Iverson, ARNP-MPH Kerin Jones, MD Kevin Joseph

Chien-Chang Lee, MD Tiffany McCalla Michael Menchine Edward Michelson, MD Rakesh Mistry, MD Risa Moriarity, MD Robert Moskowitz, MD Sergey Motov, MD Charles Muntan Ira Nemeth Floriano Putigna, DO 32

Martin Reznek, MD Christopher Russi, DO Mary Ryan, MD Michael Schmidt, MD Scott Sherman, MD Carl Skinner, MD Stephen Small, MD Amy Stromwall, MD Jonathan Valente, MD David Vega Muhammas Waseem, MD

2004 Slate of Nominees The Board of Directors has approved the slate of nominees developed and proposed by the Nominating Committee. A ballot has been mailed to all eligible SAEM members. Results of the election ballot will be compiled at the SAEM office and announced during the SAEM Annual Business Meeting on May 18 at 11:00 am-12:00 noon. All members are urged to participate in the election and attend the Annual Business Meeting. The slate of nominees is as follows: President-elect Candidates Specific Prior SAEM Activities: • Established predecessor SAEM Consultation Service (1981) • Chair, AAMC Liaison Committee (1989-1994) • Received Hal Jayne Academic Excellence Award (1986); Academic Leadership Award (1991) • Established first Regional Research Meeting (1990) • Chair, Education Committee (1998-1999) • Board of Directors (1989-1990, re-elected 2001) • Reactivated Consultation Service (2002-present) • Chair, Under-Represented Minority Task Force (2001-2003) • Industrial Relations Focus Group (2004) Brief CV: Emergency Medicine and I have grown up together. Departing the University of Michigan MedGlenn C Hamilton, ical School (1973), I trained in Internal Medicine, then was Chief Resident Denver General EM Program MD (1977-1979) and served the University of Cincinnati EM Program as Education Director 1979-1982.

Since 1982 Chair (present) and Program Director (1982-1990) at Wright State SOM, having trained over 230 EM residents. Academic activities include funded research for NASA and private foundations, three textbooks and over 75 articles/chapters, facilitating EM in Australia and China, and helping develop over 25 residency programs. I've been Director of the Office of Clinical Research and President of the Practice Plan for WSU SOM. Perspective on SAEM Important Issues: • Establish active and successful financial management/development programs • Expand proactive engagement activities with membership, EM organizations, and established medicine, ie, the NIH, AAMC, IOM • Expand our educational offerings and involvement at all training levels • Establish Academic Leadership Skills Workshops for future leaders in EM • Create Simulator Skills and Use Task Force to promote new technology • Promote Diversity Curriculum for EM • Sustain SAEM's strengths: Annual Meeting, AEM, Task Force/Committee Structure, Regional Meetings and Membership.

Specific Prior SAEM Activities: My first SAEM meeting was as a resident in 1990; I was hooked!

• Board of Directors (2000-present) • Fellowship Task Force (2003-2004) • Representative - EMF Board of Directors (2003-2004) • Co-Chair, Annual Meeting/Program Committee TF (2002-2003) • National Coordinator, SAEM Regional Meetings (2001-present) • Chair - Program Committee (1998-2000) • Member, Program Committee (1995-1998) • Member, Education Committee (1994-1995) • Young Investigator's Award (1998) Brief CV: I am an Associate Professor with tenure at the University of Michigan. After attending Case Susan A Stern, MD Western Medical School, I completed an EM Residency (1987-91) and Research Fellowship (1991-93) at the University of Cincinnati. My research focus is Trauma/Resuscitation, and is funded by the Department of Defense. I review for AEM, Annals of EM, Resuscitation, and AIBS. At University of Michigan, I served as Education Coordinator (1994-00) during the building phase of the EM Residency, and am on the medical school Admissions Executive Committee.

Perspective on SAEM Important Issues: While SAEM has effectively advanced academic EM, our mission is threatened by dwindling resources and a healthcare system in crisis. Ensuring ongoing academic advancement of EM and delivery of the highest quality care requires: 1) further promotion of academic EPs to local and national leadership positions; 2) enhanced research efforts and funding; and 3) support for development of educational methods/curricula to meet our changing practice environment.

We will reach these goals only by continually developing our most valuable resource, our members. As President, I will emphasize leadership and faculty development (aka "member development"), expand the SAEM Research Fund, and enhance national affairs activities. I would be honored to be your President.

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Secretary/Treasurer Candidates Specific Prior SAEM Activities: I am a current member of the Board of Directors (2002-2005). Past SAEM activities include election to the Constitution and Bylaws Committee (1999-2002), selection to the Program Committee (1999-00), Chair of the Medical Student Forum (1999-2000), member of Education Committee (1996-1998) and member of the Patient-Physician Communication Task Force (1994-1996).

Brief CV: I am Vice Chair for Academic Affairs, Department of Emergency Medicine, and Emory School of Medicine. I hold a dual appointment as Assistant Dean for Medical Education and Student Affairs. I graduated from the University of Virginia and received my medical degree from Emory School of Medicine. I trained at Temple School of Medicine and am board certified in emergency medicine and internal medicine. I have been an active educator with a focus on novel curriculum design, teaching methodologies and evaluation. I am the recipient of teaching awards at Emory and the ACEP National Katherine L Heilpern, Faculty Teaching Award. Through CDC funding, my primary research focus addresses ED recognition MD and management of emerging infectious diseases.

Perspective on SAEM Important Issues: Our research and educational accomplishments have made SAEM an academic force, and our growth and recognition reflects that course. Our vision must be forward thinking and strategic. This includes: stewardship of current funds; philanthropic development, including exploring opportunities to develop research and educational relationships with industry; development and recognition of our educators; growth of our research funds; enhanced, active partnership with other emergency medicine societies and national education and research organizations.

Specific Prior SAEM Activities: I have been a member of the SAEM Pharmaceutical and Biotechnology Liaison Committee, Undergraduate Education Committee, National Affairs Committee, and the Nominating Committee. In addition, I have been on the Board of Directors for two years. As a part of my Board duties, I have been the liaison to the National Affairs Committee, the Financial Development Committee, and numerous interest groups. In addition, I am a SAEM representative to the Council of Academic Societies.

Brief CV: I graduated from the University of Cincinnati Emergency Medicine Residency. I am presently Chairman of the Department of EM at Wake Forest University. My areas of expertise include cardiovascular emergencies and acute coronary syndromes, including clinical research on ACS and the treatment of chest pain in the ED. Perspective on SAEM Important Issues: Through my Board membership, I have learned a great deal James W Hoekstra, about the mission and direction of SAEM. I believe we are poised on the brink of expansion from a facMD ulty development and research-fostering organization to the visible and recognizable voice of academic emergency medicine. This transformation involves opening our doors to the NIH, CDC, AHRQ, foundations, and industry to increase our research endowment and partner in national research initiatives. It also includes increasing our activity in national affairs to foster the growth of academic emergency medicine programs. I am especially excited to spearhead the enhancement of our relationships with industry, with the goal of increasing our research funds, and increasing the number of fellows we support. I welcome the opportunity to participate in SAEM's growth as Secretary/Treasurer.

Board of Directors Candidates Specific Prior SAEM Activities: SAEM Pharmaceutical and Biotechnology Liaison Committee (19911993); SAEM Research Committee, (1996-2001), Subcommittee chair for research; didactic program (19992001); SAEM Program Committee (1999-2000); Chair SAEM Research Committee (2001-2004); Abstract reviewer for SAEM Meeting: (1996-2003); Program session moderator at SAEM Annual Meetings: (1996, 1998, 1999, and 2001); Abstract Presentations each year at SAEM Meeting: (1994, 19962003); Lecture presentations at SAEM Annual Meetings: (1998, 1999, 2001 and 2003); Associate Editor: Academic Emergency Medicine (1999-present.); SAEM Grants: SAEM Institutional Research Training Grant Award. Principal Investigator: "Studies in Reactive Oxygen Species and Heart Reperfusion."

Society of Academic Emergency Medicine, 7/1/03-6/30/05.

Brief CV: University of Utah Medical School, Salt Lake City, UT (1978-1982); Wright State University, Mark G Angelos, MD Dayton, OH. Residency in Emergency Medicine (1982-1985); University of Pittsburgh, Pittsburgh, PA. Fellowship in Critical Care Medicine (1985-1987); Present position: Professor and Vice Chair for Research, Department of Emergency Medicine, The Ohio State University. Research interests: Myocardial ischemia and reperfusion, cardiac arrest, research fellowship training Perspective on SAEM Important Issues: Advanced research training of fellows and junior faculty, including degree programs; Research Mentorship within the academic research setting; Interdisciplinary collaborative research partnerships within medical schools and between SAEM and other research societies; Broader educational initiatives to educate faculty and fellows regarding research training and research support opportunities, particularly from federal and national foundation sources; Membership education to facilitate promotion and tenure within the University system.

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Specific Prior SAEM Activities: I have reviewed abstracts for 10 consecutive years and reviewed SAEM grants intermittently for four years in total. I am now serving my second year as Scientific Subcommittee Chair of the Program Committee. I was a member of the Research Committee for 8 consecutive years, where I served as chair of two subcommittees. I was elected to the Nominating Committee 2001-2003. I directed the SAEM Mid-Atlantic regional meeting in Charlotte in 2001. Since 2001, I have been on the Editorial Board of Academic Emergency Medicine and Associate Editor for two years. In 1996, I served on a task force related to academic development.

Brief CV: I graduated from the Medical College of Virginia in 1990. I completed my residency in emergency medicine and a research fellowship at Carolinas Medical Center in 1994 where I have since remained on faculty. My research interest is diagnosis and consequences of pulmonary embolism. I am Jeffrey A Kline, MD principal investigator on two grants from NIH/NHLBI. Perspective on SAEM Important Issues: I would bring the perspective of someone who understands the struggle to succeed as a researcher in emergency medicine. My specific aims for SAEM are: 1) Promulgate a position that publication quality as opposed to quantity should drive promotion and tenure; 2) Provide a framework to establish a mentor network for young faculty; 3) Re-evaluate our methodology of the grant review process; 4) Implement the use of press releases to publicize our research at the Annual Meeting; 5) Develop guidelines for "release time buy-out" for EM researchers.

Specific Prior SAEM Activities: SAEM member for 15 years. Research Committee (1991-1993); Program Committee (1996-2001); Chair, Scientific Subcommittee of Program Committee (2000-2001); Constitution and Bylaws Committee (2000-2003); Chair, Constitution and Bylaws Committee (2002-2003); Task Force on Federal Funding of Emergency Medicine and Disaster Medicine Research (2002-2003); SAEM representative to the Emergency Medicine Foundation Board of Trustees (2001-2003); Chair, Fellowship Training Task Force (2003-2004).

Brief CV: BS, Juniata College (1985); MD, University of Pittsburgh (1990); PhD, Wayne State University (1996); Sarnoff Medical Student Research Fellow, Ohio State University (1988-1989); Emergency Medicine Residency, University of Pittsburgh (1990-1993); Emergency Medicine Research Fellow, Wayne State University (1993-1995); Assistant Professor of Emergency Medicine, Wayne State University (19951997); Assistant Professor of Emergency Medicine, University of Pennsylvania (1997-present); Faculty Robert W Neumar, Member, Neuroscience Graduate Group, University of Pennsylvania (2002-present); Chair, ACEP MD, PhD Research Section (1999-2000); Chair, ACEP Scientific Review Committee (2002-present); NIH-K08 Award (1995-2000); NIH R01 Grant (2000-present).

Perspective on SAEM Important Issues: As a Board member, I would work towards enhancing the quality and quantity of bench, clinical, health services, and educational research within the specialty of Emergency Medicine. Specifically, I would like to see SAEM facilitate the expansion of research-training opportunities for Emergency Medicine residents and residency graduates. I also believe it is critical that we recruit research-oriented medical students into our specialty. Finally, I think we need to do a better job of convincing our own leadership and members that research training is critical to achieving the overall goal of advancing Emergency Medicine as an academic specialty and improving emergency medical care.

Specific Prior SAEM Activities: A member of SAEM since 1989, I served on SAEM Program Committee, 1993-1995, and National Affairs Task Force from 1996-2000. I've served as the chair of the National Affairs Committee from 2002-2004. I am a supporter of the SAEM Research Fund.

Brief CV: Clinical Professor of EM and Pediatrics and Associate Chair, Department of Emergency Medicine at Carolinas Medical Center. I was EM Residency Program Director from 1982-1991 and a past EMS regional medical director. During 22 plus years of academic practice, I have been involved in resident education, clinical research, and patient care. Appointed by ABEM to help lead development of requirements and testing for pediatric emergency medicine and served as sub-board chair, 1994-1996; oral board examiner. Served on ACEP Board of Directors and served as president from 2000-2001 and helped promote health policy and practice issues, importance of EM residency training, and promoted the specialty internationally.

Robert W Perspective on SAEM Important Issues: SAEM serves us well with educational development and with Schafermeyer, MD, promotion of research excellence. I believe that current health policy issues, budget deficits and regulaPhD tory changes in education make it essential that SAEM serve as the voice of academic emergency medicine. We can't assume that some one else understands our issues, will protect our patients and residents, and fund essential life-saving research needed. We must be "at the table" with the key organizations such as AAMC, ACGME, AHRQ, NIH, IOM, etc.

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Specific Prior SAEM Activities: Member (1988-present); Chair, Ethics Committee (1990-1992 and 2003-2004); Helped guide development of SAEM Professionalism in Emergency Medicine document; Developed the Ethics Curriculum for Emergency Medicine residencies (available on the SAEM website); Lecturer, SAEM Annual Meeting (e.g., professionalism and end-of-life issues); Associate editor, Academic Emergency Medicine.

Brief CV: Professor and Academic Vice-Chair of Emergency Medicine at Oregon Health & Sciences University; Medical director for regional transporting EMS agency; Research focus: EMS research including the PAD Trial and development of the Neely conference on EMS Triage, end-of-life issues including development of AHA consensus statement on prehospital DNR orders for 2005 and federal guidelines on exception Terri Schmidt, MD from consent in resuscitation research.

Perspective on SAEM Important Issues: Foster the SAEM mission by promoting research and education in emergency medicine; Advance the science of resuscitation while protecting research subjects; Train the next generation of emergency physicians to be highly professional, technically competent, compassionate providers of emergency care; Foster academic advancement of women in emergency medicine. I am excited about the opportunity to run for a Board position at SAEM and hope to serve the Board, our membership and our patients who are some of the most vulnerable people in our county. The Society is ideally suited to promoted excellence in emergency care and to promote the interests of our patients and society.

Specific Prior SAEM Activities: Chair, Program Committee 2000-2003 Annual Meetings; Program Committee member 1996-99; Co-authored and won AAMC grant for Responsible Conduct of Research series, being presented at 2004 Annual Meeting; Airway Interest Group; Program Committee Task Force.

Brief CV: Clinical Professor of Medicine, Clinical Director, Emergency Department, UCSF; BC EM, IM. Consulting Editor, Annals of Emergency Medicine. Research: asthma, peer review, ED utilization. Member of MARC. Perspective on SAEM Important Issues: My primary goals for serving on the SAEM Board are to accelerate research development in our specialty and increase SAEM's role in health policy. Although SAEM has been instrumental in increasing the number of emergency physicians funded in research, only a limited number of members have achieved this goal, much EM research is still conducted at single institutions, and many funded researchers publish in other specialties. We should ask our members what more Ellen J Weber, MD SAEM can do to involve them in funded and significant research in EM. I believe SAEM should develop a research agenda and provide organizational support to allow more members to participate in multicenter collaborations, resulting in practice and policy advances. We should also establish a greater variety of ongoing educational opportunities, including visiting fellowships with a mentor, and SAEM-sponsored CME courses on statistics, research design, funding, educational theory. As an educational and research-based society, whose members daily witness the failures of our health care system, SAEM is pivotally positioned to offer credible testimony on problems and solutions. SAEM must accept this responsibility by organizing specific research projects on policy questions, and by pro-active discussions with legislators.

Resident Member of the Board Candidates Specific Prior SAEM Activities: Multiple presentations at national and regional meetings: 2001, 2003; Kwon, Raven, Chiang, et al., Emergency Physicians' Perspectives on Smallpox Vaccination AEM 2003 10: 599-605.

Brief CV: I am a 3rd year resident in the NYU/Bellevue EM residency. After graduating from UC Berkeley, I interned with the UCSF AIDS Health Project, and then completed my MD and MPH at OHSU. Currently, I actively advocate for residents as a member of the NYU House Staff Council executive committee and the Graduate Medical Education Committee. Given my interest in Public Health and policy, I am developing a health policy component to my department's didactic curriculum, and speaking city-wide on behalf of Physicians for a National Health Program (PNHP).

Perspective on SAEM Important Issues: SAEM can increase the numbers and improve preparedness of residents who desire academic careers. We must determine what resources are lacking, increase Maria Raven, MD access to funding opportunities, and most importantly, develop creative ideas to spur resident interest.

SAEM should be a valuable resource for residents' education about public health issues and the role these issues play both during residency and throughout their career. My objectives are to develop a SAEM resident member focus group to determine which issues in academic EM are most pertinent to resident members. Personally, I would concentrate on public policy, forming a resident section addressing issues such as insurance and access. Additionally, I would develop a Health Policy Database for residents, with links to relevant web-sites and a catalogue of presentations residents can access to offer relevant health policy lectures at their sites.

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Specific Prior SAEM Activities: Like most residents, my involvement in SAEM to date consists of attending the Annual Meeting and reading SAEM literature. My interest in SAEM has been stirred by several of my mentors who are closely involved with SAEM. Brief CV: As a second year EM Resident at the University of Pittsburgh, I presently serve as a Flight Physician for STAT MedEVAC and Medical Command Physician for the City of Pittsburgh Emergency Medical Services. My teaching interests began at the Center for EM, where I serve as a Clinical Instructor for CPR, EMT-B, EMT-P, CCEMTP, ACLS, AMLS, BTLS, and Pediatric BTLS. I also serve as Course Faculty for the University of Pittsburgh Department of Surgery ATLS courses. Presently, my areas of research interest include: errors in prehospital care and the efficacy of BLS resuscitation in the prehospital arena. I was President of the American Medical Student Association at the University of Pittsburgh Jon Rittenberger, MD School of Medicine (2000-2001). I also served as the Region III Trustee for AMSA (2000-2001), working on both the Board of Directors and Board of Trustees.

Perspective on SAEM Important Issues: SAEM strives to provide residents the opportunity to lead our field as academicians and educators. As residents, we are frequently called upon to teach and research topics that are unique to Emergency Medicine.

These skills must be learned and are areas of our residency education that require improvement. I will focus on this as your resident SAEM Board member. Moreover, I will help prepare our resident members to assume leadership roles in the future.

Specific Prior SAEM Activities: I have been an SAEM member for four years.

Brief CV: I graduated from the MCP Hahnemann School of Medicine in 2001 and completed a transitional internship at Naval Medical Center San Diego (NMCSD). After internship I deployed in support of Operation Iraqi Freedom, serving as a Battalion Surgeon for the United States Marine Corps. I then began my residency at NMCSD in 2003. I have numerous publications, the most notable of which is a textbook for medical students interested in Emergency Medicine entitled, “Emergency Medicine: AAEM's Rules of the Road for Medical Students. The Guide for a Career in Emergency Medicine.� I served as Chief Editor of this text, which is comprised of over 50 chapters and 400 pages and was recently reviewed in Academic Emergency Medicine (Acad Emerg Med 2004 11: 325). I am currently the Vice President of the AAEM Resident Section and have served both as its Student Representative and Secretary/Treasurer. I maintain membership in ACEP, EMRA, and the AMA. My honors include membership in Phi Beta Kappa and Joel M Schofer, MD Alpha Omega Alpha.

Perspective on SAEM Important Issues: If elected to the SAEM Board of Directors, I will serve with unparalleled dedication and drive. During my time on the AAEM Resident Section Board I have been extremely productive and wish to bring this same productivity to SAEM. My specific focus will be on improving the services we provide to our resident and student members.

Improvements in the student and resident websites would be my first priority.

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Nominating Committee Candidates

Wendy C Coates, MD

Francis L Counselman, MD

Specific Prior SAEM Activities: I began my SAEM service in 1990 as a resident member to the Education Committee. I served as a both member and sub-committee chair for several years. I am the current Chair of the Undergraduate Education Committee (2001-2004). I led the development of the SAEM Virtual Advisor Program and revision of the medical student website. As a member of the EducationResearch Task Force (2002-2004), I was involved in designing the Educational Research Track for the 2003 and 2004 Annual Meetings. I was appointed as an SAEM representative to the multi-organizational task force for a standardized EM curriculum.

Brief CV: I have been Director of Education at Harbor-UCLA since 1992 and have been recently appointed by the dean of the School of Medicine as Chair of the Acute Care College at UCLA, where I am an Associate Professor of Medicine. I am a graduate of Case-Western Reserve University School of Medicine and completed my EM training in 1991 at Allegheny General in Pittsburgh. I am a reviewer for Academic Emergency Medicine and an Item Writer for the ABEM Certification Examination.

Perspective on SAEM Important Issues: I would be honored to serve SAEM as a member of the Nominating Committee. I would like to foster the advancement of all forms of scholarship of our members and improve the potential for extramural funding for researchers in basic science, clinical, and educational fields. It is my hope that we can reach out to students and residents to introduce the brightest to consider a career in academic emergency medicine.

Specific Prior SAEM Activities: Graduate Medical Education Subcommittee (1991-1992); Education Committee (1992-1994); In-Service Exam Survey Committee (1995-1996); Program Committee (19992001); Moderator/Program Director, SAEM Medical Student Forum (2001); Financial Development Committee (2002-present); Chairman, Faculty Development Committee (2003-present).

Brief CV: Distinguished Professor and Chairman, Department of EM, Eastern Virginia Medical School (EVMS), Norfolk, VA (1992-present); Program Director, EM Residency, EVMS (1990-present); B.S. University of Notre Dame (1979); M.D., EVMS, Norfolk, VA (1983); Residency, Emergency Medicine, EVMS (1986). I have served as: Chairman, ACEP Academics Affairs Committee (1999-2001); Immediate Past-President, Association of Academic Chairs of Emergency Medicine (2002-2003); Editorial Board, Emergency Medicine (1999-present); ABEM Item Writer (2003-present); and Reviewer for Annals of Emergency Medicine and American Journal of Emergency Medicine.

Perspective on SAEM Important Issues: If elected, I will bring to the position my hard earned experience and sincere desire to further the mission of SAEM. Constitution and Bylaws Committee Candidates

Michael S Beeson, MD

Specific Prior SAEM Activities: SAEM GME Committee (2000-2001 as member, 2001-2004 as Chairman); Resident Support Task Force (1999-2000).

Brief CV: Program Director, Emergency Medicine Residency at Summa Health System, Akron, Ohio (1994- present); Professor of Clinical Emergency Medicine, Northeastern Ohio Universities College of Medicine; MD, The Ohio State University College of Medicine (1982); EM Residency- Akron City Hospital (now Summa Health System) (1982-1985); MBA, Case Western Reserve University (1994); ABEM Diplomate, 1986, 1996; Oral Examiner for ABEM; ACEP National Faculty Teaching Award (2000); CORD Impact Award (2003).

Perspective on SAEM Important Issues: SAEM is a dynamic, evolving organization. The Bylaws must reflect the Society's activities and internal functions. However, there must be attention to detail so that inadvertent effects do not occur with Bylaws changes. I have learned that time after time reference is made to "What do the Bylaws say about that?" It is vitally important that the Bylaws reflect our current activities. I am very proud of being nominated to the Constitution and Bylaws Committee. I have worked hard on other committees that I have been a member of, and will do so with the Constitution and Bylaws Committee. If elected I will work diligently at knowing the details of the Constitution and Bylaws, as well as the implications of suggested change. I appreciate the consideration of the membership for this position.

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Specific Prior SAEM Activities: My current academic commitments include serving on the Editorial Board for Academic Emergency Medicine, a subcommittee chair for the SAEM Research Committee, and also a member of the SAEM Trauma Interest Group. In January 2003, I was awarded the SAEM Research Training Grant and am currently finishing my first year of this grant.

Brief CV: My medical career began when I entered the University of Alabama School of Medicine and graduated with honors in 1994. I completed the UC Davis EM Residency Program in 1997, and served as Chief Resident during 1996 - 1997. I am board certified in Emergency Medicine and currently I am an Assistant Professor in the Division of Emergency Medicine at the UC Davis School of Medicine. I serve as a reviewer for Annals of Emergency Medicine. I am also the recipient of the John Mitchell Award in 2003 for Outstanding Paper in the Journal of Emergency Medicine. I have a research interest in the trauma with a special focus in pediatric trauma. In addition to my involvements in academia, I have also James F Holmes Jr, MD served as the Medical Coordinator for the US Olympic Track and Field Trials in 2000 and will do so again in July, 2004.

Perspective on SAEM Important Issues: I have personally benefited a great deal from SAEM and wish to give something back.

I would like to expand SAEM's role in developing further support in the area of trauma, specifically pediatric trauma. I do not have a large number of other commitments and feel I could give my service to the committee my full attention.

Charlene Irvin, MD

Specific Prior SAEM Activities: I have been a member of SAEM for 18 years. I joined the public Health Task Force in 1998, and served as chair from 1999-2001. I am also a member of the EBM interest group and am the course director for the first on-line EBM course held this spring.

Brief CV: My current position is Research Director and Assistant Vice Chief, Department of Emergency Medicine, St. John Hospital and Medical Center, and Assistant Clinical Professor, Wayne State University School of Medicine. I attended the University of Michigan School of Engineering and Medical School, followed by residency training at the University of Cincinnati. I also completed a research fellowship while at the University of Cincinnati. I currently serve on the Board of Trustees for St. John Hospital and Medical Center, as an associate editor for Academic Emergency Medicine, and as an ABEM oral board examiner.

Perspective on SAEM Important Issues: I am honored to be nominated for this position.

Report of the Council of Academic Societies Spring Meeting David P. Sklar, MD University of New Mexico SAEM Representative to the AAMC The Council of Academic Societies (CAS) met in Santa Monica, California from March 11-14, 2004. Representatives from SAEM, CORD and AACEM joined representatives from other academic societies to address improvement in the quality of our clinical, educational, and research programs. Speakers such as Nobel Prize winner David Baltimore, PhD; Thomas Garthwaite, MD, Director and Chief Medical Officer of the Los Angeles Department of Health Services; and Carolyn Clancy, MD, Director of AHR, provided provocative challenges for the participants to utilize the creativity that usually is applied to scientific questions to quality improvement. In education, the AAMC has convened a subcommittee of Deans to re-examine medical education and look at what changes should be instituted to bring medical education into line with priorities for health care improvement in the health care system. With the core competencies, the line between educators, health services researchers and managers has begun to blur as students and residents are being required to demonstrate competence in practice-based learning and improvement. In addition, the current emphasis on medical error and patient safety requires a change in emphasis in the educational programs for medical students, residents, and practicing physicians. For emergency medicine, this coincides with recent attention to barriers to access, patient satisfaction, and medical error. Our work in this area is already being utilized by other specialties that are beginning to address these issues. Emergency Medicine has also been out in front of other specialties in defining a core content, surveying practicing physicians, and developing a

Model of Practice that draws from the survey which is used by the RRC of Emergency Medicine in assessing residency programs and ABEM in testing graduates. Because most of us have lived under this system for our entire careers, we do no realize how unique it is and how valuable it is as an example for other specialties. As we go toward competency-based education and evaluation, we will find that having a model of practice allows us a way to assess competency that is not defined for other specialties.

Outside of the formal discussions and presentations there were many informal discussions that suggested that financial belt tightening was occurring in many states due to reductions in Medicaid and other state resources. NIH will also see a flattening of its budget and after years of substantial increases this will lead to increased competition for grants. There will probably also be increasing governmental scrutiny of NIH grants to assure that money is being used as it was intended.

As state Medicaid budgets tighten and medical school support is reduced, clinical practice will come under increased pressure and this may impact emergency care and support of academic emergency medicine. As a Society, we will need to be vigilant to any departments or divisions of emergency medicine that may fall victim to this worsening economic pressure and provide support.

The AAMC will hold its annual meeting in Boston, Massachusetts, from November 5-10, 2004 and the Council of Academic Societies will meet next year in Tucson, Arizona, March 10-13, 2005.

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Solicitation of Readings for ABEM Future Lifelong Learning and Self-Assessment Test A cornerstone of ABEM’s new EMCC program is the concept of Lifelong Learning and Self-Assessment (LLSA). The primary goal of LLSA is to promote continuous learning on the part of ABEM diplomates. ABEM will facilitate this learning within the context of LLSA by identifying an annual set of readings to guide diplomates in self-study of recent Emergency Medicine (EM) literature.

ABEM has sought to involve the EM community-at-large in the LLSA process by inviting EM organizations and ABEM diplomates to make suggestions for readings to the ABEM Board of Directors. For the 2005 LLSA to be developed next year the Board received over 125 suggestions collectively from ACEP, SAEM, CORD, AAEM, and a number of individual ABEM diplomates.

ABEM will select 50% of the readings for the 2005 LLSA test from these two designated areas, while the remaining 50% of 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. Complete an LLSA Form for each reference that you recommend to the Board. 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. The form can be computer-printed or typewritten.

Submission Criteria for LLSA Readings The Board has determined that readings used for the LLSA tests should meet the following criteria: 1. Focus on recent advances or current clinical knowledge in Emergency Medicine; 2. Be clinically oriented in content; 3. Be drawn from peer-reviewed EM journals, peer-reviewed journals from related primary specialty fields, textbook chapters, or updated practice guidelines; 4. Be published in printed or electronic form within the immediate five years preceding the LLSA test in which it will be used; 5. Relate to either the designated content areas for a given year (50%), or to the remaining content areas (50%) of the EM Model “Listing of Conditions.”

2. Provide one paper copy of the article, chapter or other text for which you have submitted a reference must be mailed or faxed to ABEM in order to be considered for inclusion.

Electronic copies of references cannot be accepted due to copyright restrictions.

References received by June 1, 2004, will be considered for inclusion in the 2005 LLSA module. Materials submitted after that date may be considered for future LLSA tests. Recommendations may be submitted via fax to (517) 332-3943 or mail to LLSA References, American Board of Emergency Medicine, 3000 Coolidge Road, East Lansing, MI 48823. If you have specific questions or comments contact Timothy J. Dalton, Examination and Evaluation Project Specialist, at (517) 332-4800.

Content of LLSA Test in 2006 Although readings for the first LLSA test in 2004 have already been selected, the Board welcomes reference suggestions for future LLSA tests from the larger EM community on an ongoing basis. Currently, ABEM is soliciting readings for the 2005 LLSA test, for which the designated content areas will be Traumatic Disorders and Cutaneous Disorders.

Important Notice to Current and Former ABEM Diplomates Emergency Medicine Continuous Certification (EMCC) will begin in 2004.

examination as it currently exists will be offered for the last time on November 2, 2003.

All diplomates who want to maintain their certification with ABEM beyond the current expiration date must participate fully in the EMCC program.

A special option will be available only from 2004-2006 for former diplomates to regain their diplomate status through participation in EMCC. Former diplomates must begin their participation in EMCC in 2004 to take advantage of this option.

Effective 2004, the licensure requirement for all diplomates will change. Diplomates will be required to continuously maintain a current, active, valid, unrestricted, and unqualified license in at least one jurisdiction in the United States, its territories, or Canada, and in each jurisdiction in which they practice.

Inactive medical licenses voluntarily held by physicians are in compliance with the Policy on Medical Licensure.

A full description of EMCC including details of diplomates’ participation requirements are available on the ABEM website http://www.abem.org. Questions should be directed to: American Board of Emergency Medicine, 3000 Coolidge Road, East Lansing, MI 48823, or call 517-332-4800 or emcc@abem.org.

Physicians eligible for ABEM recertification under current rules will maintain eligibility under EMCC. The written recertification 40

President’s Message (Continued) and importance’ – in a manner parallel to that noted in emergency medicine. Many of you volunteer time and expertise to gain experience, skills and become ‘part of something’. That something – whether it is as a committee, task force, or interest group member, or an appointed or elected leader in SAEM – is improving emergency medicine and care for you and others, most of whom you will never meet. The latter includes those cared for by physician far away from your site who heard your conversation or lecture, who worked with you in SAEM, or who read your abstract. It includes those who will be cared for by the current and future emergency physicians, armed with better knowledge and skills. It includes those whose life is better because you and SAEM participated in a larger process – a solo SAEM effort, a joint effort SAEM and other medical

organizations, a research initiative, a community or governmental program aided by SAEM and its members.

Thanks for working with me (and us) over the past year. I had the honor of seeing and overseeing all of SAEM, watching many of you contribute and take advantage of this special opportunity pool. When I step back, I realize that I have gotten more from SAEM – based on real opportunities to improve my abilities – than I gave. I am confident that I will stay engaged with SAEM, and that SAEM – like all of emergency medicine – will continue to offer you (and me) more opportunity.

That ends it – my message, my messages, and my year tenure as President.

SAEM Research Fund (Continued) this issue of the Newsletter, and a Call for Grants for next year's grants is also published in this issue of the Newsletter.

This approach of supporting research training and research fellowships to enhance research skills is based on the simple and well-substantiated concept that a concentrated research training period early in a physician’s career translates in to increased success and productivity as a researcher down the line. Because we want the researcher to choose his or her area of focus and passion, the Research Fund training grants are mostly non-directed. The EMS Research Fellowship (supported

by Medtronic) and Neuroscience Fellowship (supported by AstraZeneca) are offered in specific fields, but the trainee can choose a wide range of projects in each of these areas. Although the Research Fund is young, we are already seeing the fruits of our support, as the fellows who have been supported contribute to the new knowledge in emergency medicine, and go on to careers as successful physician scientists.

The mechanisms for building the Research Fund are also simple. The biggest donor to the Fund is the parent organization. SAEM has contributed hundreds of thousands of dollars to the Fund over the past five years, including $250,000 in 2003. It makes sense that once the other major initiatives of the

organization, the Annual Meeting and the journal are paid for, excess revenues are invested in a manner consistent with the basic mission of the Society – to improve patient care by advancing research and education in emergency medicine. The other major source of funds is contributions from dedicated SAEM members and friends who value the simple mission of the organization and purpose of the Research Fund. Last year we raised a record amount of money from SAEM members and friends. This year’s donors (so far) are published in this issue of the Newsletter. We are also building our relationships with industry, foundations and other possible funding sources, but always with the simple request for undirected funds that will be used to support research training fellowships. Donors know that SAEM has a simple 100% rule for contributions: 100% of donations to the Research Fund are used to support the training grants. SAEM takes care of all administrative costs. And although dealing with the IRS is never simple, it will hearten donors to know that your contribution is 100% tax deductible. Contributing is simple – a check made out to the SAEM Research Fund can be sent to SAEM at 901 N. Washington Avenue, Lansing, MI, 48906, or even simpler, you can make a credit card donation through our secure website at www.saem.org.

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A simple thank you is all that most of our generous donors expect for their contribution to the SAEM Research Fund. SAEM would like to extend that “thank you” in the form of a special Research Fund Donor/Past President’s Reception that will be held during the Annual Meeting in Orlando on the evening of May 17. Research Fund donors are invited to attend this reception, share a glass of wine and some conversation with SAEM Past Presidents, and the current Board of Directors, and listen to a brief presentation from John Marx, MD, SAEM President in 1997-1998. Dr. Marx promises he will make simple remarks.

Your ED work, academic career, and life outside medicine may seem crazy and complex. There is beauty in simplicity, and this is an opportunity to embrace and promote simplicity. The SAEM Research Fund has a simple, but noble mission, a simple mechanism – training grants – for developing research and education in our field, and a simple contribution process. Supporting the SAEM Research Fund is simply a great way to nurture the academic future of emergency medicine.

We look forward to your continuing support, and hope to see you at the Research Fund Donor/Past President’s Reception on May 17.

FACULTY POSITIONS MICHIGAN: Michigan State University – Kalamazoo Center for Medical Studies The Department of Emergency Medicine is seeking a Director of Pediatric Emergency Medicine to serve as academic faculty for our emergency medicine residency program. Candidates must be BC/BP in emergency medicine, as well as BC/BP in pediatrics or pediatric emergency medicine. This exciting opportunity involves outstanding compensation and benefits, protected academic time, and a delightful university community in which to live and work. Please contact: David Overton MD, MBA, Michigan State University - Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008 NEW JERSEY: UMDNJ (Newark) – Come in on the ground floor at a major medical school and university hospital. We're planning to start an EM Residency and have faculty opportunities for Emergency Physicians at ALL LEVELS, including Residency Director, EMS Director and Director of Clinical Operations. The ED has an annual volume of 72,000, including 2,700 level I trauma patients.

Competitive compensation and benefits package including on-site fitness andchild care centers. For information please contact Ronald Low, MD, MS, at 973972-7882. UMDNJ-University Hospital is an AA/EOE, M/F/D/V. Visit us on the web at www.TheUniversityHospital.com.

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.

OREGON: The Oregon Health & Science University, Department of Emergency Medicine is conducting an ongoing recruitment campaign for talented faculty members. Entry-level clinical faculty members at the instructor and assistant professor level. Preference given to those with fellowship training (especially in pediatric emergency medicine) or equivalent experience. Knowledge of emergency medicine as a faculty discipline is expected. Please submit a letter of interest, CV, and the names and phone numbers of three references to: Jerris Hedges, MD, MS, Professor & Chair, OHSU Department of Emergency Medicine, 3181 SW Sam Jackson Park Road, CDW -EM, Portland, OR 972393098.

PENNSYLVANIA: Penn State University College of Medicine & Hershey Medical Center – Department of Emergency Medicine is seeking to add experienced academic emergency physicians to our internationally known faculty. We are seeking faculty to supplement our research and educational missions and participate with our newly approved PENN STATE EMERGENCY MEDICINE RESIDENCY. Physicians must be board certified with some academic experience.

Faculty rank will be commensurate with experience. Confidential inquiry to Kym Salness, M.D. (Chair) or Christopher J. DeFlitch, M.D. (Vice-Chair), Department of Emergency Medicine, P.O. Box 850 (H043), Hershey, PA 17033, Phone (717) 531-8955 or email cdeflitch@psu.edu or www.pennstateemergencymedicine.com. AAEOE. Women and minorities are 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 July/August issue is June 1, 2004. 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 Contact in ad non-SAEM member Quarter page ad (camera ready) 3.5” wide x 4.75” high

$100 $125 $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: Carrie Barber at carrie@saem.org

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Newark Beth Israel Medical Center An Affiliate of the St. Barnabas Health Care System

Department of Emergency Medicine

Pediatric EM Faculty Position

Director of Academic Affairs

Penn State's Milton S. Hershey Medical Center, Department of Emergency Medicine and Penn State Children's Hospital in Hershey, PA is seeking a Pediatric Emergency Medicine academic faculty to join the Emergency Medicine faculty. The applicant should be trained in pediatric emergency medicine and would have the opportunity for dual appointments in the Department of Emergency Medicine, and Pediatrics. As the only Children's Hospital between Pittsburgh and Philadelphia, with a Level 1 Pediatric trauma center, we train high quality residents in the Penn State Emergency Medicine and Pediatric residencies, as well as students from the Penn State College of Medicine. With a growing census of 46,000 per year, 23% of which are complex and routine pediatric patients, we are expanding our faculty and space dedicated to Pediatric Emergency Medicine. The Department of Emergency Medicine also boasts of a strong ultrasound, ground EMS, areomedical helicopter and observational medicine programs. There is an outstanding and expanding 15-person, faculty group. This opportunity combines comprehensive university health care, a medical school, an attractive small community lifestyle, excellent schools, and fabulous recreational and cultural opportunities in south central Pennsylvania. There are ample opportunities for clinical research, if interested. Contact Kym A. Salness, M.D., FACEP, Chair or Christopher J. DeFlitch, M.D., Vice-Chair, Department of Emergency Medicine (H043), PO Box 850, Hershey, PA 17033 phone (717) 531-8955 or e-mail at cdeflitch@psu.edu. The Penn State University Milton S. Hershey Medical Center is an affirmative action/equal opportunity employer. Women and minorities are encouraged to apply.

We are searching for an emergency medicine physician experienced in research, academics, grant writing, and residency administration to assume a key leadership role in our department. We are looking for an enthusiastic, energetic individual who is 5-10+ years post-EM residency graduation and desires an opportunity to lead a team of talented, dedicated faculty and be part of an Emergency Department committed to scholarship, clinical excellence, community service, and humanistic values. An MS or MPH and/or expertise in medical toxicology or ultrasound would be a very desirable plus. Academic appointment at the Mount Sinai School of Medicine. Applicant must be able to qualify at the Associate Professor or Professor level. This position carries a very competitive compensation package and ample protected time commensurate with experience and seniority. Please contact or forward your CV/letter of interest to Marc Borenstein, MD, Chair, Department of EM, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, phone - (973) 926-7562, e-mail - mborenstein@sbhcs.com.

Take Pride. Take Ownership. Deliver Excellence.

Patients 1st.

Academic Emergency Physician Exciting position for an experienced, residency trained, board certified/ prepared emergency physician to join the faculty of the Department of Emergency Medicine, a full academic department of the Mount Sinai School of Medicine in New York City.

The Mount Sinai School of Medicine is a leader in medical education and research. The hospital is a 900 bed tertiary center with an annual ED census of over 70,000. The EM residency is fully accredited.

Academic rank commensurate with qualifications.

Please submit confidential letter and C.V. to: Carol Barsky MD, Director and Vice Chair, Department of Emergency Medicine, Mount Sinai School of Medicine, Box 1149, One Gustave L. Levy Place, New York, NY, 10029. Fax (212) 427-2180.

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EMERGENCY MEDICINE Academic Positions

The Johns Hopkins Disaster Medicine Fellowship is a joint program of the Johns Hopkins University Office of Critical Event Preparedness and Response (CEPAR) and the Johns Hopkins University School of Medicine, Department of Emergency Medicine.

Available in the

Department of Emergency Medicine of

Allegheny General Hospital, Pittsburgh, PA

The JHU Disaster Medicine Fellowship seeks to develop academic, clinical and administrative skills relevant to disaster preparedness and response. This is a one-year fellowship with an optional twoyear track that includes a Masters of Public Health (MPH) degree.

Practice Emergency Medicine in Western PennsylvaniaĂ­s Most Dynamic Emergency Department

Specific opportunities include institutional, regional, and international disaster preparedness activities; participation in multijurisdictional training exercises and actual critical event response; research, including publication and grant writing; and educational initiatives relevant to the advancement of disaster medicine.

Emergency Medicine Residency Emergency Medicine Residency Training Program Training Program Level I Trauma Center Center Level I Trauma Level I HAZMAT Receiving Facility Level I HAZMAT Receiving Facility 20% Pediatrics 20% Pediatrics Medical Toxicology Treatment Medical Toxicology Center Treatment Center Fellowships - EMS, -Sports Medicine, Administrative, Research Fellowships EMS, Sports Medicine, Administrative, Research

Salary Commensurate with Experience

Salary Commensurate with Experience

Contact: Fred Harchelroad, M.D. Contact: (412) 359-3961 aghemadmin@wpahs.org Fred Harchelroad, M.D.

Send a letter of interest, a brief personal statement, and a CV to: Gary B. Green, M.D., MPH, Fellowship Director Office of Critical Event Preparedness and Response Department of Emergency Medicine 201 N. Charles St., !!Suite 1400 Baltimore, MD 21202 ggreen@jhmi.edu

(412) 359-3961

!! West Penn Allegheny Health System, an Equal Opportunity Employer !! aghemadmin@wpahs.org

!!

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

DIRECTOR OF INFORMATION TECHNOLOGY Department of Emergency Medicine University of Florida/Jacksonville

The Department of Emergency Medicine at Johns Hopkins University is seeking a full time faculty to serve as the Director of Information Technology. The University and the Johns Hopkins Medicine Center for Information Services, a highly sophisticated informatics program, have joined with EM to make IT development a major Institutional priority. Responsibilities include oversight of IT programs at our 3 hospitals (180,000 total visits annually), our research programs, as well as the medical student and resident programs. The successful candidate is expected to develop and foster a fellowship in medical informatics.

We are actively recruiting a Board Certified or Board Eligible Emergency Medicine Physician in an exciting opportunity to expand our Department at a communitybased hospital in the greater Orlando-Tampa area.

Newly renovated 24,000 square foot emergency department, 33 patient care bays including a 7 bed minor care area, 3 x-ray suites, a radiology viewing area, ample work space, and a large waiting area, that serves a growing volume of 45,000 patient visits per year. In addition to a salary line of approx. $120 per hour, we offer the full range of University of Florida state benefits that include health, life, disability insurance, vacation & sick leave, 403B retirement plan with immediate vesting, and sovereign immunity occurrence medical liability insurance. Individuals will be appointed at the rank of Clinical Assistant Professor or Clinical Associate Professor. Interested? Mail your letter of interest and CV to Dr. Kelly Gray-Eurom, Dept. of Emer. Med. University of Florida Health Sciences Center, 655 W. 8th Street, Jacksonville, Florida 32209. Anticipated start date of 7/1/04 or sooner. EOE/AA Employer.

Faculty development in research and scholarship will be supported as appropriate. Interested physicians should be residency-trained and board prepared in emergency medicine. Johns Hopkins Hospital is a full service ED, Level I trauma center, and the State pediatric trauma center. EM is an autonomous academic department within the School of Medicine.

Interested candidates may respond in confidence to Michael VanRooyen, M.D., Associate Professor and Vice Chair, Department of Emergency Medicine, Johns Hopkins University, Suite 6-100, 1830 E. Monument St., Baltimore, MD 21287. mvanrooy@jhmi.edu.

Johns Hopkins University is an equal opportunity employer.

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The University of Washington Medical Center (UWMC)

The Mount Sinai Hospital Department of Emergency Medicine Associate Director

The University of Washington seeks a physician to join its faculty in the Division of Emergency Medicine in the Department of Medicine at the University of Washington Medical Center. This full-time position requires direct patient care, teaching and supervision of medical students and housestaff, participation in EM resident didactics, and the expectation for productivity in scholarly activities. The applicant must be BC/BE in emergency medicine. The successful candidate will be appointed as full-time faculty in the Division of EM. The appointment will be at the rank of assistant or associate professor depending on background and qualifications. Appointment will be in the physician/scientist (research emphasis) pathway, or physician/teacher (patient care/teaching emphasis) pathway.

We are seeking an experienced emergency physician to assume the role of Associate ED Director in our high-volume (~75,000), medical school based practice. The Mount Sinai Hospital is one of two main sites for our fully accredited, 36-resident, training program. Our mission embodies a firm commitment to excellence in patient care, education and research.

The clinical leadership team is physician-led and includes Nursing, Administrative Support, IT and Finance. The Emergency Department leadership is highly regarded in both the hospital and medical school and is represented on all major committees.

The position includes a competitive salary, an academic MSSM appointment, administrative space, and support.

Applicants should submit a curriculum vitae and statement of career goals to: Kathleen Jobe, MD, Medical Director, Emergency Department, Box 356123, Seattle, WA 981956123. The University of Washington is building a culturally diverse faculty and strongly encourages applications from female and minority candidates. The University is an Equal Opportunity/Affirmative Action employer. Deadline for inquiries is July 30, 2004.

If interested in becoming part of a dynamic team and prepared to bring innovative management to a progressive department, please send your letter of interest and curriculum vitae to: Carol Leah Barsky, MD, Director and Vice Chair, Department of Emergency Medicine, 1 Gustave Levy Place, Box 1149, NY, NY 10029, Tel: (212) 241-7403, Fax: (212) 427-2180, Email: carol.barsky@mssm.edu We are an equal opportunity employer.

The Department of Emergency Medicine of New York Medical College is recruiting a Residency Director for our established, fully accredited thee-year training program.

Metropolitan Hospital Center, located in Manhattan, New York, serves as the program’s primary site with a census of 75,000 visits.

Other affiliated hospitals include Westchester Medical Center, Our Lady of Mercy Medical Center and Harlem Hospital. Each provides a diverse clinical experience for our residents.

Applicants must have a minimum of three years post Emergency Medicine residency training experience in academics and administration. The applicant must be enthusiastic about the administration and education of Emergency Medicine backed by excellent organizational and communication skills, interpersonal relations and the ability to evolve to the program to the next level. Academic rank commensurate with qualifications. We are an equal opportunity employer fostering diversity in the workplace.

Qualified applicants should submit their CV and confidential letter of interest to: Gregory Almond, MD, MPH, MS Chairman New York Medical College Department of Emergency Medicine Metropolitan Hospital Center 1901 First Avenue Room 2A19 New York, NY 10029

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Fellowship Opportunities Critical Care/Resuscitation or Disaster Medicine

Newsletter Submissions Welcomed

Fellowship Co-Directors: Thomas Terndrup, M.D. E-mail tterndrup@uabmc.edu Jason Begue, M.D. E-mail jbegue@uabmc.edu Institution: University of Alabama at Birmingham Fellowship Length: 1 year. Number of Positions: 1 each. Salary: negotiable, competitive.

Deadline for Applications: Rolling, No Deadline Eligibility: Completion of residency training in Emergency Medicine EM Critical Care/Resuscitation. The Department of Emergency Medicine at UAB is seeking a physician residency trained in Emergency Medicine (EM) for its one year Critical Care/Resuscitation Fellowship. The training program was developed and is run by the DEM with the intent of training emergency physicians, but is highly multidisciplinary. The objectives of this program are three-fold; (1) learn advanced critical care and resuscitation techniques with a concentration on their application to critically ill patients in the emergency department, (2) receive training in clinical or fundamental research, and (3) 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 very flexible depending on the individual training needs. Currently it consists of 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). UAB also has tremendous resources for conducting both clinical and basic science research and training.

Disaster Medicine Research Fellowship. 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 receives broad support from ~50 faculty members, and funding from 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. Engagement in complimentary clinical and educational activities in Emergency Medicine are desirable. Most fellows have completed a single year, but the duration is flexible and compensation is competitive.

Interested parties are encouraged to send a current curriculum vitae to: Thomas E. Terndrup, M.D., Professor and Chairman, 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, Phone: 205.975.9358

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.

Keep Your Membership Mailings Coming!

Be sure to keep the SAEM office informed of changes in your address, phone or fax numbers, and especially your e-mail address. SAEM sends infrequent e-mails to members, but only regarding SAEM issues or activities.

SAEM does not sell or release its mailing list or e-mail addresses to outside organizations. Send updated information to carrie@saem.org

The 5 Most-Frequently-Read Articles of AEM – March, 2004 Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articles archived on AEMJ.org.

1 2 3 4 5

Stuart P. Swadron, Maria I. Rudis, Kian Azimian, Paul Beringer, Diana Fort, Michael Orlinsky A Comparison of Phenytoin-loading Techniques in the Emergency Department Acad Emerg Med Mar 01, 2004 11: 244-252. (In "CLINICAL INVESTIGATION") John J. Cienki, Lawrence A. DeLuca, Natalie Daniel The Validity of Emergency Department Triage Blood Pressure Measurements Acad Emerg Med Mar 01, 2004 11: 237-243. (In "CLINICAL INVESTIGATION") Siu Fai Li, Jessica Henderson, Eitan Dickman, Robert Darzynkiewicz Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Acad Emerg Med Mar 01, 2004 11: 276-280. (In "CLINICAL PRACTICE") Pat Croskerry, Marc Shapiro, Sam Campbell, Connie LeBlanc, Douglas Sinclair, Patty Wren, Michael Marcoux Profiles in Patient Safety: Medication Errors in the Emergency Department Acad Emerg Med Mar 01, 2004 11: 289-299. (In "SPECIAL CONTRIBUTIONS") Michael A Gibbs, Carlos A Camargo, Brian H Rowe, Robert A Silverman State of the Art: Therapeutic Controversies in Severe Acute Asthma Acad Emerg Med Jul 01, 2000 7: 800-815. (In "SPECIAL CONTRIBUTIONS") Log onto www.aemj.org and start taking advantage today!

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2004 AACEM Annual Meeting and Workshop Saturday, May 15, 2004 Annual AACEM Educational Session (attendance limited to AACEM members and an AACEM member guest) 7:00 am Continental Breakfast 7:30 am

Review of Schedule; Introductions

8:00 am

Keynote Speaker - Michael O'Connor, MD Michael O'Connor is the Chair of the first Department of Emergency Medicine in Canada and is the Chair of the Emergency Medicine Program Committee for the Royal College of Physicians and Surgeons of Canada (a body that fulfills RRC and ABEM roles for Emergency Medicine). He will provide an overview of the development of academic emergency medicine in Canada. He will address the challenges for the future and related strategies for the development of academic emergency medicine in Canada.

9:15 am

Moderated Topics (speakers) Faculty Incentives and Rewards - Frank Pettyjohn, MD Faculty Evaluation - Waste of Time or Motivational Tool? - Sandra Schneider, MD Difficult Faculty Member - Arthur Kellermann, MD, MPH Strategies for Aging Faculty Members - Norman Christopher, MD Care and Feeding of the Dean - Barry Brenner, MD Alternative/Innovative Programs for Support of the Academic Department - Robert Shesser, MD Preserving the Academic Mission in Difficult Fiscal Times - Brooks Bock, MD Establishing Endowments - Why and How - Francis Counselman, MD

11:30 am

Brief Late-Breaking Topic Presentation

Annual AACEM Business Meeting (AACEM members only) 12:00 pm Annual Business Meeting - Lunch

AACEM New and Future Chairs of Emergency Medicine Workshop AACEM is pleased to offer the New and Future Chairs Workshop on May 15, 2004 in Orlando. This program has recruited Emergency Medicine exemplar leaders who will discuss critical issues that can contribute to becoming a successful academic chair and leader in Emergency Medicine. An informal gathering will immediately follow the last session.

1:30-2:30 pm

Leadership Principles and Skills: how to be a successful chair and leader and avoid failure, John Marx, MD, Carolinas Medical Center and Glenn Hamilton, MD, Wright State University This leadership session is focused on models of chair successes and ways to avoid failures. The philosophy of departmental leadership (e.g., "lead by example", "lead by consensus") and the role of other departmental leaders such as residency program director, vice-chair, operations chief will be discussed. Group dynamics and personality types; institutional hierarchy; serving as a "change leader" and overcoming institutional inertia; and conflict resolution techniques are just some of the content areas to be explored.

2:30-3:30 pm

Advancing Emergency Medicine in Medical Schools/Hospitals/Practice Plans: Insights/Advice, Lewis Goldfrank, MD, Bellevue Hospital Center and Brooks Bock, MD, Wayne State University In this session, negotiating principles, development of allies, neutralizing enemies, use of institutional resources, and developing an academic base will be discussed. The session presenters are experienced Emergency Medicine leaders who will share their experiences and lessons.

3:30-4:30 pm

Business and Finance: how to assure a successful bottom line, Jerris Hedges, MD, MS, Oregon Health and Science University and Nicholas Benson, MD, MBA, East Carolina University In this session, mission based administration, faculty incentive/bonus plans, and budget negotiations will be discussed. This session will build on the experience of these physician leaders in their respective departments and medical schools

4:45-5:30 pm

Informal gathering of participants.

All SAEM members and others are invited to attend this Workshop. The registration fee is $100 (refundable to AACEM members after verification of attendance). To register, send an email to saem@saem.org stating you would like to attend the Workshop and indicate your method of payment. Checks should be made payable to AACEM and mailed to 901 N. Washington Ave., Lansing, MI 48906.

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SAEM 2005 Research Grants Emergency Medicine Medical Student Interest Group Grants These grants provide funding of $500 each to help support the educational or research activities of emergency medicine medical student organizations at U.S. medical schools. Established or developing interest groups, clubs, or other medical student organizations are eligible to apply. It is not necessary for the medical school to have an emergency medicine training program for the student group to apply. Deadline: September 9, 2004.

Research Training Grant This grant provides financial support of $75,000 per year for two years of formal, full-time research training for emergency medicine fellows, resident physicians, or junior faculty. The trainee must have a concentrated, mentored program in specific research methods and concepts, and complete a research project. Deadline: November 4, 2004.

Institutional Research Training Grant This grant provides financial support of $75,000 per year for two years for an academic emergency medicine program to train a research fellow. The sponsoring program must demonstrate an excellent research training environment with a qualified mentor and specific area of research emphasis. The training for the fellow may include a formal research education program or advanced degree. It is expected that the fellow who is selected by the applying program will dedicate full time effort to research, and will complete a research project. The goal of this grant is to help establish a departmental culture in emergency medicine programs that will continue to support advanced research training for emergency medicine residency graduates. Deadline: November 4, 2004.

Scholarly Sabbatical Grant This grant provides funding of $10,000 per month for a maximum of six months to help emergency medicine faculty at the level of assistant professor or higher obtain release time to develop skills that will advance their academic careers. The goal of the grant is to increase the number of independent career researchers who may further advance research and education in emergency medicine. The grant may be used to learn unique research or educational methods or procedures which require day-to-day, in-depth training under the direct supervision of a knowledgeable mentor, or to develop a knowledge base that can be shared with the faculty member’s department to further research and education. Deadline: November 4, 2004.

Emergency Medical Services Research Fellowship This grant is sponsored by Medtronic Physio-Control. It provides $60,000 for a one year EMS fellowship for emergency medicine residency graduates at an SAEM approved fellowship training site. The fellow must have an in-depth training experience in EMS with an emphasis on research concepts and methods. The grant process involves a review and approval of emergency medicine training sites as well as individual applications from potential fellows. Deadline: November 4, 2004.

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

SAEM Medical Student Symposium Susan B. Promes, MD Duke University SAEM Program Committee Each year at the Society of Academic Emergency Medicine (SAEM) Annual Meeting, SAEM hosts a Medical Student Symposium for individuals interested in pursuing a career in emergency medicine. The Symposium is a daylong event and is followed by an Emergency Medicine Residency Fair where the medical students have an opportunity to meet representatives from the various residency programs across the country.

The Medical Student Symposium and Residency Fair have really gained popularity over the years. In May, 2003 in Boston, there were more than 150 medical students in attendance from all over the country. The majority of students

were in their third year of medical school. The program began in the morning with an overview lecture on how to select the right residency program. Picking a residency is a personal choice and it is very important that the student is a good match for the program they choose. Nationally recognized speakers presented lectures to the students on topics such as Getting Good Advice, Navigating the Residency Application Process, Getting the Most out of Your EM Clerkship and many more.

The students were able to have lunch with Residency Directors from across the country and “pick their brains.�

Unfortunately, I am not sure the stu48

dents or the faculty got to eat much because they were so engrossed in conversation! The day closed with a Residency Fair where the students could peruse the tables and get information from representatives from 75 EM residency programs that participated.

The 2004 Medical Student Symposium will be held on May 15 in Orlando at the Wyndham Palace Resort and Spa. The program is appropriate for medical students at any level of training. If you have any questions about the program, please contact the SAEM office at saem@saem.org.

NEWSLETTER

S A E M

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

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

Newsletter of the Society for Academic Emergency Medicine Board of Directors Donald Yealy, MD President

Carey Chisholm, MD President-Elect James Adams, MD Secretary-Treasurer Roger Lewis, MD, PhD Past President Valerie DeMaio, MD Leon Haley, Jr, MD, MHSA Glenn Hamilton, MD Stephen Hargarten, MD, MPH Katherine Heilpern, MD James Hoekstra, MD Susan Stern, MD

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

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

The SAEM newsletter is published bimonthly by the Society for Academic Emergency Medicine. The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM.

Call for Didactic Proposals 2005 Annual Meeting May 22-25, 2005 New York, New York The Program Committee is inviting proposals for didactic sessions for the 2005 Annual Meeting. This year the Program Committee would like to emphasize proposals on educational research methodology and leadership development (including advancement within academic departments, medical schools and national organizations). Didactic proposals may be aimed at medical students, residents, junior faculty and/or senior faculty. The format may be a lecture, panel discussion, or workshop. The Program Committee will also consider proposals for pre- or post-day workshops or multiple sessions during the Annual Meeting aimed at in-depth instruction in a specific discipline.

Didactic proposals must support the mission of SAEM (to improve patient care by advancing research and education in emergency medicine) and should fall into one of the following categories: • • • • •

Education (educational research methodology, education methodology, improving the quality of education, enhancing teaching skills) Research (research methodology, improving the quality of research) Career Development State-of-the-Art (presentation of cutting-edge basic science or clinical research that has important implications for further investigation or the future practice of emergency medicine, not a review of the literature or a summary of clinical practice) Health Care Policy and National Affairs

The deadline for submission is Thursday, September 9, 2004 at 5:00 pm Eastern Daylight Time. Only online submissions will be accepted. To submit a proposal, complete the online Didactic Submission Form at www.saem.org.

For additional questions or information, contact SAEM at saem@saem.org or call 517-485-5484 or send a fax to 517-4850801.