November-December 2010

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

November/December 2010 VOLUME XXV number 6

James A. Gordon, MD, MPA

SAEM

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FACEBOOK euthanasia masquerading as pain control?

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SAEM membership

2010-11 SAEM Dues

Membership Count as of October 15, 2010

$545 Active

$160 Fellow

$510 Associate

$135 Resident Group

$480 Faculty Group

$135 Medical Student

$450 2nd yr. Graduate

$115 Emeritus

$325 1st yr. Graduate

$100 Academies

$160 Resident

$ 25 Interest Group

2322 65 2538 122 9 13 9 5123

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Highlights 4

President’s Message

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8 Ethics In Action

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We have heard the request for SAEM to go “green” and we are listening. Beginning January 2011, SAEM will be taking a step forward in the green movement by delivering the SAEM Newsletter electronically to your email. The electronic newsletter can be downloaded from our website to your laptop, net book, or IPad to be read wherever you are. Whether on an airplane or sitting at your kitchen counter, members will still have easy access to the newsletter.

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Academic Announcements

13

Teaching Emergency Medicine Procedures

16 Health Services and Comparative Effectiveness Research

CDEM Highlights

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21

Calls and Meeting Announcements

President’s Message Society for Academic Emergency Medicine Jeffrey A. Kline, MD

Expertise, Part II As a teenager, Gallileo Galilei sat in the Cathedral of Pisa and did what millions of young men have done since the dawn of organized religious services and that is look around and see if he might spot a nice bosom or two.

However, either because all the young ladies were completely covered with 18 layers of 16th century clothing, or because he really was not interested in Jeffrey A. Kline, MD women, GG decided to fixate on the sanctuary’s illuminated ornaments. On one insufferable service in about 1580, GG fixated upon a lantern, watching it swing back and forth like a pendulum, observing that the lantern slowed in velocity at the ends of its arc, and increased its speed in the middle.

Through inductive thought, he developed the theorem of angular momentum. Gallileo went on to go to medical school, only to flunk out, then to go into mathematics, “Because the money is a heck of a lot better and you don’t have to mess with corpses, which is just weird” he famously said in a Rolling Stone magazine interview. He then invented the telescope, discovered a few of Jupiter’s moons, founded the field of astronomy, fought crime, and invented the internet, all as fruits of empiric observation and inductive reasoning. But none of us will be a Gallileo. Gone are the days of becoming an expert in natural science based upon simple observations of phenomena that no one else bothered to think much about.

And the same goes for academic emergency medicine.

Expertise does not just happen after you say it out loud. To become interconnected with medical science requires selfmotivation, training and mentorship.

Expertise requires self-motivation. Poet T.S. Elliott was “credited” with saying “Good poets borrow, and great poets steal” (actually, this was paraphrased from an essay he wrote about English playwright Philip Massinger). In my last President’s Newsletter, I continue my ongoing attempt to earn poetic license, thus borrowing from E. Scott Gellar’s book When No One’s Watching, Living & Leading Self-Motivation, to assert that expertise requires choice, competence and connectivity. Dr. Gellar, Professor of Psychology at Virginia Tech, forwards these three Cs as keystones to self-motivation.

I submit that expertise and self-motivation occupy two sides of the same coin.

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In modern medical academic medical centers, political power comes from valuable knowledge and from money. Knowledge that has value almost always comes from funded research, and funds for research almost always come from awarded grant applications. Reviewers reward grant applications that contain an important and focused question, and include the pledged efforts of the right people, access to the places and stuff needed to do the work, and perhaps most importantly convincing preliminary data. My own experience has taught me that “preliminary” often means saying “I pretty much have done all the work, I know the answer, and I am asking to get the money now”. These elements require education, training, and connectivity with other people. In addition to learning how to put them on paper, the protégé scholar must also assemble these elements into a working mental machine— an instrument that has basic core competencies. These competencies include the ability to formulate the question rightly, to write and speak persuasively, to motivate and recruit others to help, to use and understand statistical software, and most of all, the ability to photocopy front to back. (Wait, that was during my fellowship, about the time Gallileo retired).

And herein lies the rub: building a competent mental machine requires assiduous attention to detail, unremitting desire and years of fiddling. For most of us, this machine will frequently refuse to start, and if it does start it will run noisily, leak oil, sputter, and stop working at the worst possible time. Usually when everyone is watching. Much of competence-building comes from mind-numbing tinkering; taking apart and putting back together again and again, sometimes as critics direct incredulous glances your way, and maybe a smirk or two.

But consumers of competence must beware of wasted money and time. Residencies in emergency medicine must pass a rigorous standard set by the ACGME that is well known. The industry of masters programs that purport to teach all things is less well regulated. Many masters programs will charge you $50K and will burn two or more years of your life that might be better spent. Years that can never be refunded. The SAEM leadership does not want you to waste years of your life and we—the community that comprises SAEM--hold a pivotal role in defining academic competence in emergency care.

(Clearly, this overlaps the area of interconnectivity, which will be the focus of the third and final installment in this series).

One example is the Research Fellowship Credentialing Committee. The charge of this committee is to ensure any outfit calling itself a research fellowship in emergency care really does provide the building blocks and planning that will enable the three Cs required for expertise.

Continued on Page 10

Executive Director’s Message

SAEM Office Update The Chicago area relocation of the SAEM Headquarters is progressing toward the objectives of the move. The location near O’Hare airport anticipated greater opportunities for members to visit the headquarters and would offer a convenient location for meetings and educational programs.

In the first eight months, more members have visited the headquarters than in my two and a half years in the Lansing headquarters. ACEP/EMF has discussed hosting the ACEP/SAEM Grantee Workshop normally held at the ACEP Headquarters at SAEM in 2012. Other positive changes will be the launch of a new SAEM website in early 2011.

The relocation also meant new headquarters staff. As staff joins SAEM there will be new skill sets and the potential for reassignment of responsibilities. As these transitions occur, every effort will be made to have staff overlap to create redundancy and position backup. Currently, new SAEM staff include: Grants Coordinator, Melissa McMillian, who in her first week, submitted three grant applications. For the consensus conference she worked with the planning committee to submit grants to AHRQ and Robert Wood Johnson Foundation. The third grant application was to Emergency Care Coordinating Council to create an SAEM Health Policy Fellowship. Melissa graduated from North Park University in Chicago with a degree in Non-Profit Management with a concentration in fundraising and development. She is originally from Olympia, Washington, where her mother is an ED nurse. Melissa will be working with the Grants, Development, and Research Committees.

Education Manager, Kirsten Nadler, will work with the Annual Meeting Program Committee and begin developing new educational offerings in collaboration with the academies, committees and interest groups. Kirsten was a consultant with the American Medical Association where she managed the AMA/CDC 2nd National Congress on Health System Readiness in the Center for Public Health Preparedness and Disaster Response. She has a degree in English and a Master of Science in Biotechnology Studies from the University of Maryland, where she was a teaching assistant serving as an instructor in Bioterrorism and Biosecurity.

Membership Assistant, Christine Baroud, has day-to-day responsibility for maintaining the accuracy of the SAEM membership database, dues invoicing for all categories of membership, liaison to institution staff for faculty and resident groups and data entry of all Annual Meeting registrations.

She responds to membership inquiries and ensures correct member information and payments are in the database.

Christine’s undergraduate degree is from Marquette University in psychology.

James Tarrant, CAE SAEM Executive Director

Positions which have not been filled are: Receptionist who serves as the first contact and voice of SAEM. This person will greet members and direct inquiries to the appropriate staff member. Responsible for creating a paperless office by scanning all documents received in the mail for electronic distribution and storage, electronic deposit of funds received and assistance with other inquiries. Operations Manager will assist the office operations, human resources, monitor the budget and maintain smooth operations within the headquarters.

These changes represent the SAEM Board’s long term vision adopted in 2006-07 to improve the infrastructure of the organization and enable responsiveness to the membership as the Society matures as an organization.

A full list of current SAEM staff with contact information is available at www.saem.org. The SAEM staff looks forward to your visit to the headquarters.

IT Systems, Donald Geschke, joins our IT staff with responsibilities for the hardware operations at SAEM. Don has previously maintained corporate systems consisting of 150 desktop and laptop computers. Don will work closely with David Kretz as backup for the website and will maintain vendor relationships for outsourced functions and equipment, such as Internet and telephone systems as well as list serve hosting. He has a BS in network computing from Roosevelt University.

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James A. Gordon, MD, MPA SAEM Member Highlight Just over 13 years ago, while serving as a fellow in the Robert Wood Johnson (RWJ) Clinical Scholars Program after completing residency at the University of Michigan, I wrote my first contribution to the SAEM Newsletter. As one of the few EMtrained physicians with experience in the RWJ fellowship to that point, the article was meant to “spread the word” about its remarkable faculty development opportunities. At the time my academic work focused on “The Hospital Emergency Department as a Social Welfare Institution,” and explored how the unique social role of the ED could be leveraged to advance total community health. As a testament to our specialty’s academic maturation over the last two decades, EM residency graduates are now routine recipients of national fellowship and funding awards. This year I was honored to serve on the Scientific Advisory Panel of the new Levitt Center for Social Emergency Medicine (http://levittcenter.org/); the first of its kind in the country, the center sponsors dedicated fellowship training in precisely the kind of work that launched my career in academic EM. During the transition from Michigan to Boston/Mass General with my wife after fellowship, I began to focus on another field of study for which EM faculty are well-prepared—medical simulation. Over the last decade, our specialty has played a leading role in the study and practice of simulation-based training worldwide. It was a sincere pleasure to serve as Chair of the SAEM Simulation Task Force and Technology in Medical Education Committee from 2005-2009, during a time of rapid growth in the use medical simulation. In EM, dynamic mannequin-simulator use expanded from 29% to 85% across residency programs between 2003-2008 (Okuda, et al, Academic Emergency Medicine 2008). At the same time, EM faculty played an important role in founding the international Society for Simulation in Healthcare and its journal; many currently serve as key leaders of institutional simulation programs nationwide.

Working together with Academic Emergency Medicine, SAEM-based simulation faculty led the first federally-funded

research consensus conference on the Science of Simulation in Healthcare in 2008 (AHRQ publication OM-09-0021; journal proceedings disseminated to all medical school deans in North America). SAEM expertise in the field is now consolidated within the Simulation Academy, offering a powerful new resource for EM educators and investigators who continue to lead in the field. (To come full circle with some good news to share…A few days before writing this article, the editorial office of Academic Medicine [journal of the Association of American Medical Colleges] emailed me about an early simulation article we wrote jointly with Michigan and Harvard colleagues when I first came to Boston—apparently the article has just been selected as a journal “classic”!).

My career in Emergency Medicine has been supported over nearly 20 years—all the way back to my med school advisors at Virginia—by mentors, colleagues, and friends who, like me, called SAEM their home. Many thanks to you all.

James A. Gordon, MD, MPA, is Chief of the Division of Medical Simulation in the Department of Emergency Medicine at Massachusetts General Hospital, where he leads the hospital-wide Learning Laboratory initiative.

He is also Director of the Gilbert Program in Medical Simulation at Harvard Medical School, where he is an Associate Professor of Medicine (Emergency Medicine) and Academy Scholar. Dr. Gordon Olympic Torch Relay (2002) co-founded the Institute for Medical Simulation at the Center for Medical Simulation in Cambridge, Massachusetts.

After earning a bachelor’s degree in intellectual history at Princeton, Dr. Gordon attended medical school at the University of Virginia and completed his training in emergency medicine at the University of Michigan. Following residency he completed a fellowship in the Robert Wood Johnson Clinical Scholars Program, also receiving a master’s degree in public administration.

Dr. Gordon served as principal investigator and national co-chair of the first federally-funded research consensus conference on simulation in healthcare, and was a founding board member of the international Society for Simulation in Healthcare. He has received both Young Investigator and Special Contribution Awards from the Society for Academic Emergency Medicine, and served as a Morgan-Zinsser Teaching Fellow at Harvard Medical School. His work has been featured in the New Yorker magazine, and highlighted as medical news in the Journal of the American Medical Association (JAMA).

Jim lives outside of Boston with his wife (Ellen, his medical school sweetheart) and their two wonderful boys (Michael, 6, and Stephen, 3).

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SAEM Newsletter for the Interest Group on Crowding The SAEM Interest Group (IG) on Crowding consists of approximately 45 members who work collaboratively to fight crowding in our emergency departments. It was started four years ago as a task force and lead by Dr. Brent Asplin the first year, Dr. Steven Bernstein the second year and Dr. Jesse Pines the third year. This year it is being co-chaired by Dr. Melissa McCarthy and Dr. Drew Richardson. We have a number of exciting initiatives underway for 2010-2011 which this article briefly describes.

First and foremost, the IG on Crowding is leading the planning of the 2011 SAEM consensus conference. The purpose of this year’s consensus conference is to develop a research agenda that will identify promising solutions to safeguard all dimensions of the quality of emergency care, particularly during crowded periods. The SAEM consensus conference is meant to stimulate ED clinician scientists, researchers and administrators to develop and rigorously evaluate innovative solutions that will prevent crowding from having a negative impact on the timeliness, effectiveness, efficiency, safety, patient-centeredness, and equity of emergency care. The conference is being funded by the Agency for Healthcare Research and Quality and the Robert Wood Johnson Foundation. It will be held on Wednesday, June 1, 2011, the day before the onset of the SAEM annual meeting in Boston, Massachusetts. Everyone is encouraged to participate.

Second, the SAEM IG on Crowding has developed a crowding network that includes 30 researchers from different institutions and facilities interested in collaborating on crowding research. This collaborative network plans to pool data across institutions to increase its power to study the impact of crowding on rare conditions or events and to study how crowding varies based on ED and institutional differences in patient populations, resources, staffing and policies. In the future, we plan to secure funding so that we can create an infrastructure for the crowding network to develop and test interventions to reduce crowding and/or improve the quality of emergency care at different facilities.

To join the crowding network, please complete the form at: http://www.surveymonkey.com/s.aspx?sm=hUl_2bpLm Goq5xapk36Gfkcg_3d_3d.

Finally, the Crowding IG is also working on educating healthcare professionals, policymakers and the public about the causes of crowding and its negative impact on patient care, medical education and staff well-being. Members of the IG are currently collaborating on several papers including a paper on health care reform, one day hospital admissions and boarding. A list of the Crowding IG’s publications to date are: (1) Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, John McConnell K, Pines JM, Rathlev N, Schafermeyer R, Zwemer F, Schull M, Asplin BR. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med, 16(1):1-10, 2009.

(2) Shayne P, Lin M, Ufberg JW, Ankel F, Barringer K, Morgan-Edwards S, DeIorio N, Asplin B. The effect of emergency department crowding on education: blessing or curse? Acad Emerg Med ,;16(1):76-82, 2009.

(3) Handel DA, Hilton JA, Ward MJ, Rabin E, Zwemer FL Jr, Pines JM. Emergency department throughput, crowding, and financial outcomes for hospitals. Acad Emerg Med, 17(8):840-7, 2010.

The IG on Crowding holds monthly conference calls on the first Wednesday of each month at 1pm EST to discuss progress on our activities. Our next monthly conference call is November 3, 2010. If you have an interest in crowding, please get involved. To become a member of the IG on Crowding, go to the SAEM website below and learn more about our interest group and how to join. http://www.saem.org/saemdnn/Home/Communities/ InterestGroups/EDCrowdingIG/tabid/1291/Default.aspx

Academic Emergency Medicine News on FACEBOOK on SAEM’s website

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

Comments on articles are featured there, as well as journal announcements. Another way to keep up to

date with the latest information relevant to Academic Emergency Medicine, as well as other emergency medicine topics, happenings, etc!

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ETHICS IN ACTION

Ryan Paterson, MD Denver Health Medical Center On your shift, a 92 year-old female is brought in from a nursing home by ambulance following a reported “near fall.” The paramedics state that the nursing home staff “caught” the patient prior to any true fall, but called EMS to transport the patient to your ER for evaluation and medical clearance.

During your exam, you initially note bilateral femur deformities in a hypotensive patient. The deformities are confirmed on Xray to be comminuted, spiral fractures of both femurs. No other trauma is noted, but your screening FAST exam is positive for intra-abdominal free fluid.

Following discussions with surgery, orthopedics and the patient’s family, it is agreed that your patient should be continued on comfort care with no further procedures or resuscitation efforts attempted. Over the next two hours, knowing she would die shortly, you give your patient morphine totaling 100mg with the expressed intention of “treating her pain.” With each subsequent dose of morphine and vital sign check, the patient’s respiratory rate gradually slows and her blood pressure drops until her death a few hours later.

Was this dosing of morphine truly for pain control or was it euthanasia masquerading as pain control? How can we even tell the difference?

Cases such as these are addressed by the Principle of Double Effect. This has been debated since it was first introduced by the philosopher and theologian Thomas Aquinas. This principle states that doing an action that has a bad effect as well as a good effect is permissible if: (a) The action is not bad in itself (b) The intention is solely to produce the good effect (c) The good effect is not achieved through the bad effect (d) There is sufficient reason to permit the bad effect1

In this case this would mean that although the narcotic administration resulted in both analgesia and death, if we only intended to provide analgesia (which is not itself a result of death) the narcotic administration may be permissible.

Despite its relevance to cases such as this one, most ethicists are uncomfortable applying the principle of double effect. Motives are generally mixed, and it is difficult to separate purpose and outcome. This is especially true in a case like this one, where the bad outcome is entirely foreseen, and to some extent desired, or at least expected.

This makes it difficult to say that there was absolutely no intention to hasten death. Thus, double effect alone is too limited to justify the actions in this case.

Cellarius and Henry provide a different approach to our case. They write that the degree of palliative sedation should be chosen under the notion of “proportionality, in which all types of palliative sedation are given only to the extent demanded by symptoms. Low demands imply minimal sedation, and higher demands imply greater sedation. In this way, prognosis does not change the rationale or the practice of sedation, but it places limits on the degree of acceptable sedation.”2 This provides clarity and lessens the ambiguity of such treatments.

In this case, the large dose of narcotics would be justified if it was given proportionately to treat severe pain. In this case, the patient continued to complain of desperate pain despite large doses of narcotics, and, given that the goal of treatment was comfort care, her treatment was appropriate under Cellarius and Henry’s guidelines. The principle of double effect is vague and arguably problematic in scenarios as discussed to this point, but when the principle of proportionality in palliative sedation is invoked, ethical lines are straighter and morality less ambiguous.

Linacre Centre. Prolongation of life. I. The principle of respect for human life London: Linacre Centre, 1978:10.

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Cellarius V, Henry B. Letter to the Editor. Annals of Internal Medicine. 152(5):332.

2

Program Committee deadlines All Program Committee set deadlines are at 5PM EST • Call for Abstracts

• Call for Medical Student Ambassadors

• Call for IEME

• Call for Manuscripts

Deadline Tuesday, December 7, 2010 Deadline Tuesday, January 25, 2011

• Call for Photos

Tuesday, February 8, 2011

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Deadline Tuesday, February 15, 2011 AEM Consensus Conference Deadline Saturday, March 28, 2011

Academic Announcements Craig D. Newgard, MD, MPH, Associate Professor of Emergency Medicine at the Oregon Health & Science University, was awarded a R01 grant by the Centers for Disease Control and Prevention. The project, “Prospective Validation and Cost Analysis of the National Guidelines for Field Triage,” will be funded for $600,000 over two years and will include 3 regions (including a rural location in Oregon).

Gus M. Garmel, MD, FACEP, FAAEM, Co-Program Director, Stanford/Kaiser EM Residency, was awarded EMRA’s Mentorship Award in Las Vegas at the ACEP Scientific Assembly.

Kristi L. Koenig, MD and Carl H. Schultz, MD announce the creation of the Center for Disaster Medical Sciences at the University of California at Irvine, School of Medicine. The Dean appointed Dr. Koenig as the Center Director and Dr. Schultz as Director of Research.

The Center’s three main areas of expertise are disaster research, education and training, and public policy. In addition, the Center will facilitate connecting volunteers to disaster response teams.

Lisa Moreno-Walton, MD, MS has been promoted to Associate Professor of Clinical Emergency Medicine at the Louisiana State University School of Medicine in New Orleans effective June 2010. She also holds the ranks of Assistant Professor of Medicine Research and Assistant Professor of Research Genetics. Dr. Moreno is the Associate Program Director and the Director of Resident Research at LSU Health Sciences Center in New Orleans.

Manish Shah, MD, FACEP, Associate Professor of Emergency Medicine at the University of Rochester Medical Center was appointed as a member of the Health Care Research Training (HCRT) Study Section. The HCRT is a division of the Agency for Healthcare Research and Quality (AHRQ) that is responsible for the scientific review and ranking of grants, such as R01and K awards. The AHRQ is a U.S. government program under the U.S. Department of Health & Human Services and focuses on clinical practice, outcomes, and healthcare quality.

Rahul Khare, MD, MS, Assistant Professor of Emergency Medicine at Northwestern University was recently awarded a 5-year K08 Grant, Mentored Clinical Scientist Research Career Development Award, from the Agency of Healthcare Research and Quality entitled “Improving ED Quality and Safety by Enhancing Operations and Quality Management”.

He will evaluate ED operations (e.g., admitted patient’s length of stay, left without being seen rates) and quality management approaches (e.g., self-directed quality improvement processes) and their effects in mortality in patients with ST-elevation myocardial infarctions.

Rollin J. (Terry) Fairbanks, MD, MS has joined the MedStar Institute for Innovation in Washington, D.C. as the Founding Director of the National Center for Human Factors Engineering in Healthcare, and as a faculty member in the Georgetown University and Washington Hospital Center Departments of Emergency Medicine, and in the MedStar Health Research Institute.

2010 / 2011 SAEM Grant and Scholarship Information SAEM is pleased to offer a variety of grants available for competitive application. The grant below has an upcoming deadline:

These grants provide funding to help support the educational or research activities of emergency medicine medical student organizations at U.S. medical schools.

SAEM / EMPSF Patient Safety Research Grant ($75,000/yr for 1 year) – Application deadline: January 31, 2011

SAEM / EMF Medical Student Research Grant ($2,400 for 3 months) — Application deadline: January 5, 2011

This grant is intended to enhance the development of an emergency medicine patient safety researcher. Additionally, funds are provided for the recipient to participate in the AHA Quality Forum.

This grant program is sponsored by the Emergency Medicine Foundation (EMF) and the Society for Academic Emergency Medicine (SAEM). A maximum of $2,400 over three months is available for a medical student to encourage research in emergency medicine.

Additional upcoming SAEM grants include: SAEM Emergency Medicine Interest Group Grants ($500/yr for 1 year)—Application deadline January 1, 2011

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

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SAEM Seeks Award Nominations

Young Investigator Awards Deadline: December 15, 2010 These recognize those SAEM members who have demonstrated commitment and achievement in research during the early stage of their academic career. The society’s core mission includes the creation of knowledge (in addition to the spread of knowledge), and this award recognizes those who have achieved early success in this sphere.

Hal Jayne Educational Excellence Award Deadline: January 3, 2011 This prestigious award is presented to a member of SAEM who has made outstanding contributions to emergency medicine through the teaching of others and improving knowledge about the teaching of learners.

Excellence in Research Award Deadline: January 3, 2011 This prestigious award is presented to a member of SAEM who has made outstanding contributions to emergency medicine through the creation and sharing of new knowledge.

Advancement of Women in Academic Emergency Medicine Award Deadline: January 10, 2011 This award recognizes an SAEM member who has made significant contributions to the advancement of women in academic emergency medicine.

Leadership Award Deadline: January 3, 2011 This award honors a SAEM member who has made exceptional contribution to emergency medicine through leadership – locally, regionally, nationally, or internationally.

For submission information, see our web site at www.saem.org – Click on Grant & Awards and then Awards

Expertise, Part II – Continued from Page 4

The efforts of SAEM’s leadership over the past 15 years has generalized the message of a need for a National competency in emergency care research. In July of this year, the National Heart Lung and Blood Institute of the National Institutes of Health helped realize a national competency in emergency care research methodology by issuing the Request For Application (RFA) known as HL 11-011, NHLBI Research Career Development Programs in Emergency Medicine Research (K12). In full form, this project could 10

provide nearly $5MM in funding to each of five emergency care research training programs. Reliable sources indicate that an astounding 25 programs applied for this RFA. This unprecedented, giant leap forward, could double the number of independent, expert, clinician-researchers in our field over the next decade who will be prepared to say “I am expert,” among other quotes in their own Rolling Stone interview.

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CLASSIFIEDS OHIO, The Ohio State University: Department of Emergency Medicine seeks physician to work clinically in our 20 bed comprehensive ED observation unit. The physician will work with a team of experienced mid-level providers and deliver care to over 500 patients/month on more than 30 observation protocols. EM and IM experience preferred. For qualified applicants, flexibility available to split shifts in the ED and observation medicine. Compensation commensurate with qualifications, experience and academic appointment. Send CV to: Douglas A. Rund, MD, Professor and Chairman, OSU Emergency Medicine, 456 W. 10th Avenue, 4510 Cramblett Hall, Columbus, OH 43210; mary-jayne.fortney@osumc. edu; (614)293-8176. AAEOE.

Social Media Committee SAEM’s Social Media committee met at ACEP in Las Vegas. The group is hard at work developing guidelines for the Board regarding official (and personal) use of social media. We’re also developing plans to bring our fans and followers unprecedented access and background materials for the upcoming Annual Meeting in Boston.

And, as always, we’re updating the Facebook account and Twitter feed with timely and important academic emergency medicine news, reminders, and interesting links. Be sure to follow us at http://Facebook.com/SAEMonline and http://Twitter.com/SAEMonline Committee Members: Nick Genes, Michelle Lin, Graham Walker, Jim Miner, Mark Hauswald, Matt Sullivan, Rob Rodgers

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SAEM Annual Meeting Residency Fair Saturday, June 4, 2011 4:30 pm – 6:30 pm

All Emergency Medicine Residency Programs, All opathic and Osteopathic are invited to participate.

Each participating program will receive one table, 6 ft long x 18 in. wide.

The registration fee for the Residency Fair is only $100 per program until February 28, 2011. After February 28th the fee is $150. The registration fee after March 28, 2011, including on-site registrations on June 4 is $175. Book your space now!

For more information contact Michelle Iniguez at 847-813-9823 or e-mail miniguez@saem.org.

Academic Resident Section On behalf of the SAEM GME Committee, we are pleased to re-introduce the “Academic Resident” section of the SAEM newsletter. Quarterly articles will focus on topics of interest and importance to emergency medicine residents, with topics recurring on a roughly 3-year cycle. It is our hope that you will find these articles to be useful tools in your academic/professional development. We encourage your feedback and suggestions regarding additional content areas that would be of value to residents and recent residency graduates. Feel free to email comments and suggestions to newsletter@saem.org Jonathan Davis, MD, Georgetown University | Douglas McGee, DO, Albert Einstein | Jacob Ufberg, MD, Temple University

Teaching Emergency Medicine Procedures Nicholas Connors, M.D., Emergency Medicine Resident, New York Presbyterian Hospital, SAEM GME Committee Louis Binder, M.D., Professor of Emergency Medicine and Vice Chair for Academic Affairs, University of Nevada School of Medicine, SAEM GME Committee On Fourth of July weekend, a patient is brought into a Level I Trauma Center from an MVC where he was a restrained driver. On the stretcher he is screaming, complaining of chest pain. The EM PGY-2 ascertains that his airway is intact, but hears decreased breath sounds on the right. The EM PGY-3 works with the PGY-1 through the thoracostomy tube placement and notes appropriate use of landmarks, an appropriate incision, effective blunt dissection and apparently proper placement of the chest tube. The patient is stabilized and admitted to the Trauma service. On confirmatory CXR, the tube appears in the correct position though there is a right pneumothorax and the patient complains of persistent right back and chest pain. On CT chest, the thoracostomy tube is found to be in the subcutaneous tissue of the right flank and back, apparently having dissected along a facial plane. That same weekend, a brand new attending works her first shift in her hospital’s single coverage ER. Her fifth patient of the night, a classical pianist, has a subungual hematoma of the second digit of his right hand. She knows the procedure, but has never trephinated a nail and scrambles to read through that section of Roberts and Hedges, wishing she had done this before under supervision.

In training residents in Emergency Medicine, development of technical proficiency in a wide array of procedures is required. From simple tasks like wound closure or abscess drainage to intense activities such as securing a difficult airway or ED thoracotomy, appropriate treatment of a variety of ED patients requires the ability to perform these techniques expertly, effectively and safely.

Residency programs are charged with the responsibility for the proficiency of the physicians they graduate.

As late as the 1990’s there were no requirements for procedures performed set by the RRC. Programs were asked to report the average numbers performed by each graduating resident.i Twenty years later RRC dictates procedural requirements and a significant portion of resident education is dedicated to the procedure training, often addressed in the program’s didactic sessions. These procedures include common and critical ED techniques and now include bedside ultrasound.

Assuring the technical competence of emergency physicians and therefore preventing procedural mishaps is the reasons why the teaching of clinical procedures is one of the primary objectives in EM training. Many methods of procedural teaching exist. All strive to provide the learner with the ability to recognize the indications for the procedure, knowledge of the important risks and the technical ability to carry out the procedure. Various studies show a physician’s competence in successfully performing a procedure relies on their ability to describe the process as a series of very specific tasks that need to be completed in a stepwise manner. Having seen the procedure performed and explained in that same stepwise fashion is also very influential on trainees’ ability to execute the procedure successfully. It is the duty of the instructor to review the indications of the procedure, discuss the general concepts of the technique, break the task into discrete steps and demonstrate the procedure or refer the student to one of many instructional videos.ii Guiding the student through the steps, noting the pearls and pitfalls along the way provides great educational benefit and minimizes the risk to the patient. Finally, senior residents need to be instructed in the art of teaching and the methods that are most effective in educating a junior resident. This will both enrich their own abilities as physician educators and ensure the proper instruction of the juniors in the performance of these potentially harmful techniques.

Learning procedures based on the patients who come into the ED and their individual needs is a strategy that has worked in the past, with noted improvement in procedural competency with increasing seniority. For example, technical proficiency of senior residents compared to junior resident in intubating critically ill patients shows an expected increase in training level.iii Compared to other methods of procedural instruction, there is nothing that would better prepare physicians to perform procedures on ED patients than practicing those procedures on patients.

Complicating training, though, is the call to reduce the risk of inexperienced hands performing potentially hazardous interventions on patients. While it is clearly an unwritten rule that patients presenting to academic medical centers Continued on Page 14

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Teaching Emergency Medicine Procedures – Continued from Page 13

will take part in the training of junior clinicians, patients prefer excellence in tertiary and quaternary care found at these centers rather than their participation in medical education. In fact, evidence shows that a majority of patients are not only unaware that a physician in training may perform their procedure, but that it could be the first time for that clinician. As part of their informed consent, patients want to be aware that a physician has never before performed a procedure and given the right to refuse.iv At some point, a physician will have to execute a procedure for the first time and educators have gone to great lengths to prepare residents, and to teach them proper and safe techniques. The use of human cadavers in training residents minimizes the risk of harm to those on whom the procedure is being performed, and simultaneously maximizes the accuracy in representing an ED patient. The nature of Emergency Medicine provides physicians with access to patients who expire within the ED. In the past, procedures have been performed on these patients with the sole intent of training residents in rare techniques. In deference to the value of patient autonomy, it is now commonly accepted that these procedures only be performed with the informed consent of a patient’s next of kin. Unfortunately, only 40% of families of a deceased patient are willing to consent to the performance of a cricothryrotomy with the sole objective being resident education. In contrast, when ED patients were surveyed about their feelings about post mortem procedural instruction, a majority noted that they would be willing to give permission, but not without their prior consent as indicated in a living will or a wallet card similar to organ donor status.vi While ethical questions abound, this is a viable and understudied possibility for instructing residents. The cadaver lab on the other hand, where virtually all physicians received their initial anatomy training, provides a more reliable and ethically acceptable opportunity for residents to learn and practice procedures such as chest tubes, cricothryrotomies, thoracotomy and difficult intubation in a calm, controlled setting. Training on cadavers is efficacious in educating residents and results in good technical skill in the clinical setting when these abilities are followed after the training sessions.vii While the lack of active bleeding and the stiffness of the joints and soft tissues provide an imperfect simulation of a live patient, the ability to practice a procedure on a cadaver that provides all relevant landmarks is a significant benefit to the resident in training. No evidence in the literature compares the effectiveness of cadaver-based instruction to the other methods of teaching procedures but the benefits of training on the human form seem self-evident.

Though they do not fully replicate the complexity of the human form, medical models have become more prevalent of late in teaching of procedures in a fashion that can be reused and in some cases minimizes expense. The sophistication of the models varies greatly; some are very basic and inexpensive constructs while others are complicated pieces of robotic engineering and computer programming. Models used to teach one skill can be very simple such as the “Thanksgiving Turkey Tap” used to instruct residents in the use of ultrasound to perform thoracentesis. This model employs air-filled balloons within a water-filled thoracic cavity of a storebought turkey. Residents perform the technique between the turkeys’ ribs aiming to withdraw fluid without rupturing the balloon.viii Another example is the use of a Word 14

catheter tunneled under the skin of a cadaver and filled with tapioca to simulate an abscess.ix This model was found to be accurate and instructional then was used in the production of the New England Journal’s video series for abscess incision and drainage.x The use of models is an effective strategy to teach procedures with demonstrated increases in proficiency. While the degree to which the model simulates an actual patient interaction varies, they succeed in forcing the trainee to mentally plan the procedure, collect the appropriate equipment, organize the steps and practice the physical act, all of which are crucial aspects of learning to properly perform the technique.

High fidelity simulation has been studied more as an assessment module rather than in its effectiveness in training residents. It has proven to be quite useful in gauging resident proficiency.xi By its nature, with the use of expensive and technical models, the performance of procedures is limited but they are excellent in the training and evaluation of residents managing complicated clinical situations. These situations frequently involve intubation, use of ultrasound or other strictly procedural aspects that can be performed, and then reviewed during the simulation debrief, which can be extremely instructive in the technical training of residents. The simulated scenario also has the benefit of recreating the potential stress of a critical situation, requiring the resident to perform the procedure under similar pressure, an aspect missing from model or cadaver training. The use of an intensive simulator training session has resulted in significant increases in resident confidence and procedural competency with senior residents being able to maintain and increase these gains in a three-month follow up.xii In a departure from the human anatomy of cadaver and human simulator based instruction, animal models provide training opportunities that are far less costly, and possibly more accessible while still teaching the principals of the particular technique. Many different variations of this exist.

Pigs are frequent models, possibly due to the relative ease in obtaining porcine models from butcher shops.They have been effectively used in the instruction of suture techniques and laceration repair,xiii thoracotomyxiv and lateral canthotomy.xv Citing shrinking budgets, one program studied whitetail deer heads in the instruction of rescue airway techniques finding this to be more effective than training with an airway mannequin in terms of resident opinion and time and accuracy of use of rescue airway devices post training.xvi The biggest disadvantage of an animal model is that they do not exactly replicate the human form, but the accessibility and effectiveness of animal models make training with them a cost-conscious and effective modality.

Educating residents in the performance of clinical procedures is apparently more complicated than “See one, do one, teach one.” Patients have the right to receive quality care from their providers which in the case of diagnostic or therapeutic procedures in the ED includes a physician walked through the procedure by their senior or a physician who has previously proven competency in that technique. Residency programs help residents and attain this competency using methods that pose no risk to patients. Though there is little data supporting one method over the others and conclusive data concerning the best investment of a program’s training dollars is still lacking,

the use of human cadavers, medical models, high fidelity simulation and animal models each provide residents with added experience and the opportunity to learn to strategize and break down each procedure into its component parts.

The mastery of this ability to achieve several consecutive tasks allows the trainee to become proficient and starts them on the road to expertise. Training with these methods helps residents become better prepared for the shift when they are called on to perform the procedure on their patient and to do so expertly, effectively and safely.

Langdorf MI, Montague BJ, Bearie B, Sobel CS. Quantification of procedures and resuscitations in an emergency medicine residency. J Emerg Med. 1998 Jan-Feb;16(1):121-7.

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Richardson D, Straff D. The Thanksgiving Turkey Tap: A new and simple model for teaching ultrasound-guided thoracentesis. 2009 SAEM Annual Meeting Abstracts.

Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. A skin abscess model for teaching incision and drainage procedures.

BMC Med Educ. 2008 Jul 3;8:38.

Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Videos in clinical medicine. Abscess incision and drainage. N Engl J Med. 2007 Nov 8;357(19):e20.

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Sagarin MJ, Barton ED, Chng YM, Walls RM; National Emergency Airway Registry Investigators. Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med. 2005 Oct;46(4):328-36.

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Santen SA, Hemphill RR, McDonald MF, Jo CO. Patients; willingness to allow residents to learn to practice medical procedures. Acad Med. 2004 Feb;79(2):144-7

Frezza EE, Solis RL, Silich RJ, Spence RK, Martin M. Competency-based instruction to improve the surgical resident technique and accuracy of the trauma ultrasound. Am Surg. 1999 Sep;65(9):884-8.

Overly FL, Sudikoff SN, Shapiro MJ. High-fidelity medical simulation as an assessment tool for pediatric residents’ airway management skills. Pediatr Emerg Care. 2007 Jan;23(1):11-5.

Langhan TS, Rigby IJ, Walker IW, Howes D, Donnon T, Lord JA. Simulation-based training in critical resuscitation procedures improves residents’ competence. CJEM. 2009 Nov;11(6):535-9.

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Olsen J, Spilger S, Windisch T. Feasibility of obtaining family consent for teaching cricothyrotomy on the newly dead in the emergency department. Ann Emerg Med. 1995 May;25(5):660-5.

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Manifold CA, Storrow A, Rodgers K. Patient and family attitudes regarding the practice of procedures on the newly deceased. Acad Emerg Med. 1999 Feb;6(2):110-5.

Snell GF. A method for teaching techniques of office surgery. J Fam Pract. 1978 Nov;7(5):987-90.

Chapman DM, Rhee KJ, Marx JA, Honigman B, Panacek EA, Martinez D, Brofeldt BT, Cavanaugh SH. Open thoracotomy procedural competency: validity study of teaching and assessment modalities. Ann Emerg Med. 1996 Dec;28(6):641-7.

Suner S, Simmons W, Savitt DL. A porcine model for instruction of lateral canthotomy. Acad Emerg Med. 2000 Jul;7(7):837-8.

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Cummings AJ, Getz MA. Evaluation of a novel animal model for teaching intubation. Teach Learn Med. 2006 Fall;18(4):316-9.

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Health Services and Comparative Effectiveness Research Part I of a series on unmet needs and future funding opportunities for emergency care researchers Increased attention from the NIH on emergency care research, along with strong support for meaningful outcomes research as described in the Patient Protection and Affordable Care Act of 2010, have combined to make the future of emergency medicine research very promising, with a potential for unprecedented level of funding. In this multi-part report from the SAEM Research Committee, we discuss some current unmet needs and interview current leaders in emergency medicine research to attempt to predict areas where research will be highly funded over the next five years.

The first part of this report focuses on health services and public health research, and features some thoughts from Jesse Pines, MD, MSCE, MBA, who is the Director of the Center for Health Care Quality and an Associate Professor in the Departments of Emergency Medicine and Health Policy at the George Washington University. His research has focused on ED crowding, hospital quality, and diagnostic testing.

Currently, Dr. Pines feels that an unmet need is research that focuses on improving the value of emergency care and studies that lead to a better understanding of how optimal emergency care can help “bend the cost curve,” or reduce the rate of cost increases over time. This need is particularly acute as health care spending in the United States experiences yearly double-digit increases, and as a growing emphasis is placed by multiple entities on the value of the healthcare dollar. When it comes to emergency care, research is needed to help understand our daily high-cost decisions, particularly with regard to advanced imaging and hospital admissions.

Dr. Pines predicts that one area likely to be highly funded over the next five years is comparative effectiveness of health system delivery. In 2009-2010 as part of the American Recovery and Reinvestment Act of 2009, 400 million dollars were designated for comparative effectiveness research (CER). The NIH defines CER as research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures, that are used to prevent, diagnose, or treat disease, disorders, or other health conditions. With increasing recognition of the tremendous variability between different EDs and individual providers, funding of research to better understand optimal systems for the delivery of safe, efficient, patient-centered emergency care will be necessary in a manner that appropriately minimizes high-cost resource utilization, including advanced radiography and admissions.

Investigators interested in further exploring this avenue of potential funding and sources that are active in this area can obtain further information at: www.commonwealthfund. org and www.ahrq.gov/fund. Additionally, a good overview of CER is available at effectivehealthcare.ahrq.gov, click on the “What Is Comparative Effectiveness Research” link on the left.

On behalf of efforts from the SAEM Research Committee Erik Kulstad, Hillary Cohen, Jon Valente, and Larissa May

SAVE THE DATE May 31 and June 1, 2011 Boston, MA SAEM 2011 Leadership Forum The Business of Academic Medicine Bootcamp This exciting two-day course is designed for junior faculty leaders in academic Emergency Medicine seeking a fundamental understanding of the business

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issues related to leading an academic Dept. of Emergency Medicine. The presentations are designed to be interactive and will be presented by experts in Academic Emergency Medicine. The course will cover topics such as; strategic planning, revenue generation, finances of graduate medical education and research, developing a business plan, human resource management (and many more).

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University of alabama at birmingham Department of emergency medicine The Department of Emergency Medicine at the University of Alabama School of Medicine is seeking talented Emergency Medicine clinicianscientists at the rank of Professor, Associate Professor or Assistant Professor to join its NIH-funded research program.

University of Alabama at Birmingham (UAB) is a major academic research medical center with over $440 million in NIH and other extramural funding. The Department of Emergency Medicine is a site for the NIH-funded Resuscitation Outcomes Consortium (ROC) and the Protocolized Care of Early Sepsis Shock trial (ProCESS). The Department also coordinates activities of the multidisciplinary Center for Emerging Infections and Emergency Preparedness. The Department has been highly successful in developing extramural research support in this warmly collaborative institution.

The UAB Hospital is a 930-bed teaching hospital. The ED treats over 60,000 patients annually and is the only Level I Trauma Center in Alabama. The Department is the site of a PGY 1-3 Residency Program. significant protected time, start-up funds and tenure-stream pathways will be available to qualified applicants. A highly competitive salary is offered. Applicants must be EM board eligible or certified. UAB is an Affirmative Action/Equal Opportunity Employer.

Women and minorities are encouraged to apply.

Please send your curriculum vitae to: Janyce Sanford, M.D., Associate Professor & Chair of Emergency Medicine, University of Alabama at Birmingham; Department of Emergency Medicine; 619 South 19th Street; JTN 266; Birmingham, AL 35249-7013

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CDEM Highlights CDEM continues to grow its membership and provide an increasing number of services to its members. The Self-Study Modules are available on-line at www.cdemcurriculum.org.

This is a tremendous resource for students and educators.

The Medical Student Educators Handbook will be available on the CDEM website and hard copies can be purchased.

With the support of the SAEM Board of Directors, CDEM will be co-sponsoring the Academic Emergency Medicine Educational Advances Supplement. The plans are to publish the supplement on a bi-annual basis. We will be looking for innovative educational scholarship with good research methodology, so start working on your projects. Several committees are hard at work to increase our membership and increase our educational product line. This includes membership, third year curriculum, pediatric EM curriculum, simulation, and final examination are underway. CDEM is an exciting and evolving academy. If anyone is interested in becoming more involved please contact me, Douglas Ander at dander@emory.edu.

Kudos to Rob Rogers who has recently been promoted to Associate Professor and was just awarded the EMRA Excellence in Teaching Award.

Remember, CORD Academic Assembly 2011 in San Diego, CA, March 3-5, 2011 Visit www.cordem.org.

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

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

Previous topics have included and will include (2011): • • • • • • • • • • • •

2000: Errors in emergency medicine 2001: The unraveling safety net 2002: Quality and best practices in emergency care 2003: Disparities in emergency care 2004: Information technology in emergency medicine 2005: Emergency research without informed consent 2006: The science of surge 2007: Knowledge translation 2008: Simulation in emergency medicine 2009: Public health in the emergency department: surveillance, screening, and intervention 2010: Beyond regionalization: integrated networks of emergency care 2011: Interventions to assure quality in the crowded emergency department

Well-developed proposals will be reviewed on a competitive basis by a sub-committee of the AEM editorial board. The 2012 AEM Consensus Conference topic was announced at the SAEM Annual Business Meeting during the 2010 annual meeting in Phoenix: Education Research in Emergency Medicine: Opportunities, Challenges and Strategies for Success, Nicole M. DeIorio, MD, Joseph LaMantia, MD, and Lalena Yarris, MD. Proceedings of the meeting and original contributions related to the topic will be published exclusively by AEM in its special topic issue in December, 2012.

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

Proposals must include the following: 1. Introduction of the topic • brief statement of relevance • justification for this topic choice 2. Proposed conference chairs, and sponsoring SAEM interest groups or committees (if any) 3. Proposed conference agenda and proposed presenters • plenary lectures • panels • breakout topics and questions for discussion and consensus-building 4. Anticipated audience • stakeholder groups/organizations • federal regulators • national researchers and educators • others 5. Anticipated budget, to include such items as: • travel costs • audiovisual equipment and other materials • publishing costs (brochures, syllabus, journal) • meals 6. Potential funding sources and strategies for securing conference funding How to submit your proposal: Proposals must be submitted electronically to aem@saem.org no later than 5PM Eastern Daylight Time on April 15, 2011.

Late submissions will not be considered. The review sub-committee may query submitters for additional information prior to making the final selection. Questions may be directed to aem@saem.org or to the editor-in-chief at editor@saem.org.

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Call for Judges

2011 National Emergency Medicine CPC Competition Deadline: January 14, 2011 The Clinical Pathological Case (CPC) Task Force of the Council of Emergency Medicine Residency Directors (CORD) is charged with the organization and judging of the 2011 National Emergency Medicine CPC Competition.

They are now soliciting letters of interest from as many as 30 individuals who will be appointed to the CPC Task Force to serve during the entire one-year competition cycle. Judges will be responsible for the evaluation of cases submitted by Emergency Medicine Residencies for the Preliminary Competition.

Cases will be forwarded to the CPC Task Force in March 2011 and must be judged and returned within 10 days.

Each member of the CPC Task Force must attend the Semi-Final Competition held during the 2011 SAEM Meeting.

Judges must be present during the entire competition that begins at 8:00 am and usually concludes by 5:00 pm.

Team Leaders must also attend and judge the Final Competition held during the 2011 ACEP Scientific Assembly.

If you or a member of your faculty would like to serve as a CPC Task Force Member and judge the 2011 National Emergency Medicine CPC Competition, please contact the CORD office by e-mail at miniguez@saem.org by January 14, 2011. Please indicate if you have served as a CPC judge before.

If you have any questions or concerns, please contact Saadia Akhtar, MD, Chair, CPC Task Force at SAkhtar@chpnet.org

Great Medical Student Opportunity!

Jump Start a Career in Academic Emergency Medicine!

SAEM is looking for 15 energetic, self-starting, responsible, and enthusiastic medical students to work with the SAEM Program Committee at the Annual Meeting in Boston in June 1-5, 2011. The Program Committee is responsible for the planning, coordination, and execution of SAEM’s Annual Meeting.

It is comprised of nearly 40 faculty members selected by the President of SAEM from Emergency Medicine programs all over the country.

Benefits for medical student committee members: • Waiver of your registration fee to the SAEM Annual Meeting* • A member of the Program Committee will be assigned to you to serve in an advisory capacity for future EM pursuits • Learn much more about the current research and educational activities taking place in the field of Emergency Medicine • Have the opportunity to form relationships with faculty members from EM programs around the country.

• A personal letter from the Committee Chair will be sent to your Dean of Student Affairs, acknowledging your contributions to the Program Committee.

Requirements and expectations of medical student committee members: • Approximately 6 hours of responsibilities per day • Soliciting reviews • Assisting in AV needs • Facilitating workshops • Being responsive and flexible to the needs of the Program Committee Interested medical students should submit their name and contact information to the SAEM office by emailing Michelle Iniguez at miniguez@saem.org. Please write “Medical Student Program Committee Member Annual Meeting” in the subject line and attach a very short statement of interest (<150 words) as well as an updated electronic copy of your CV. Deadline is February 1st, 2011. Recipients will be notified by February 21st, 2011. * Travel and hotel will be the responsibility of the individual student; however.

SAEM will provide the emails of other selected students to facilitate consolidating lodging expenses.

www.SAEM.org

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Call for Photographs Deadline: February 8, 2011

Original high quality clinical images relevant to the practice of Emergency Medicine are invited for presentation at the 2011 SAEM Annual Meeting. EKGs, radiographic studies and other visual data are also considered but photographs are preferred.

Submissions should depict classic diagnostic examination findings or catalog unusual exam features with high educational value. Accepted submissions will be displayed at the Clinical Images Exhibit and may be featured in the “Clinical Pearls” session or the “Visual Diagnosis” medical student/resident contest.

No more than three different images should be submitted for any one case. Submit digital copies only in JPEG or TIF format by email attachment to miniguez@saem.org (resolution of at least 2000 x 1600 pixels required, higher resolution images preferred).

Submissions will be selected based on their educational merit, relevance to emergency medicine, image quality, the case history and appropriateness for public display. Contributors will be acknowledged in the Annual Meeting onsite program, the exhibit itself, and the 2011 July/August SAEM newsletter. Academic Emergency Medicine (AEM), the official SAEM journal, may invite a limited number of displayed photos to be submitted to AEM for consideration of publication. SAEM will retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

Photo submissions must be accompanied by a brief case history (250 word limit) written as an “unknown” in the following format: Two-page word document, 14pt font: Page One- 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding(s); Page Two- 1) answer(s) and brief discussion of the case, including an explanation of the finding(s) in the photo and 2) one to three bulleted take home points or “pearls.” If accepted for display, SAEM reserves the right to edit the submitted case history.

Photographs must not appear in a refereed journal prior to the Annual Meeting.

If a patient can be identified in the image, written consent from the patient must be obtained for the image to be displayed or the patient must be appropriately masked to insure anonymity. An attestation statement to confirm that written consent has been obtained is included in the submission template.

If you have any questions or concerns, please contact SAEM at miniguez@saem.org or 847-813-9823.

2010 Final CPC Competition Winners The 2010 Final CPC competition was held at the ACEP Scientific Assembly in Las Vegas. The Best Resident Presenter is Leana Wen, MD, MSc, Brigham & Women’s/Massachusetts General Hospital and the Best Faculty Discussant Presenter is Todd Parker, MD, Naval Medical Center Portsmouth. The Runnersup are Resident Presenter, Trushar Naik, MD, SUNY Downstate/Kings County Hospital Center and Faculty Discussant Presenter, Dimitrios Papanagnou, MD, SUNY Downstate/Kings County Hospital Center.

We would like to thank all of the participants and judges of the 2010 CPC Competition.

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2011 SAVE THE DATE Annual Academic Assembly “Residency 2.0: Integrating Technology Into Training” March 2-5, 2011 Marriott Mission Valley San Diego, CA

Call for Abstracts CORD is now accepting abstracts for review for poster presentation at the 2011 CORD Academic Assembly. Authors are encouraged to submit work involving all aspects of education; such as educational modalities, assessment techniques, program and faculty development, and competency-based research. Submissions can be in either of two formats: Descriptive reports of educational innovations: • Educational purpose of rationale • Design • Methods used for implementation • Results if applicable • Conclusion Research Abstracts: • Purpose of hypothesis with the introductory material as needed • Methods to include design, setting, participants, interventions and observations to demonstrate how the study was conducted • Results present in sufficient detail to support the conclusions reached, with important limitations if applicable Abstracts must be submitted electronically to http://abstracts.cordem.org and must be received by December 9, 2010. We will work with the authors to maximize the chance of acceptance at the Academic Assembly. Alternative presentation modalities such as video, computer simulation, etc will be considered. For further information or questions, contact CORD at cord@cordem.org or 517-647-6400.

AEM Author Announcements “Virtual issues” will be a key feature of the journal’s new home page on our publisher’s recently implemented platform, Wiley Online Library. A virtual issue is basically just a collection of articles on a given topic - so the EMS virtual issue, for example, will be a running compilation of all EMS articles that we publish. The idea is that a reader will go there to look for a particular article, but then will see our other offerings on that topic as well - increasing our fulltext download numbers and helping ensure the broadest dissemination of our authors’ work. See the “Clinical Reviews in Asthma” virtual issue on the web site of Clinical & Experimental Allergy here, for an example of how this works and what it looks like: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-222. Stay tuned for updates!

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

Physicians interested in completing the exam should log on to www.wileyblackwellcme.com. Upon successfully finishing the activity, physicians will receive an electronic certificate of completion, which can be printed and saved online under the user’s profile.

Make sure you keep checking the journal’s home page on the recently implemented platform, Wiley Online Library (WOL) - http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)15532712. Many new features appear in the form of “modules” and will be updated on a regular basis. The new platform is more robust and easier to navigate, with enhanced online functionality. Visit often and stay tuned for updates!

The program is free to subscribers of the journal. The first feature will appear in the January 2011 issue. Stay tuned for updates!

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

Call for Abstracts – SAEM Annual Meeting The Program Committee is accepting abstracts for review for oral and poster presentation at the 2011 Society for Academic Emergency Medicine (SAEM) Annual Meeting scheduled to be held June 1-5, 2011 in Boston, MA. Visit www.saem.org for link to online submission system.

Deadline for Abstracts: December 7, 2010 at 5 pm EST Call for Papers – AEM 2011 Academic Emergency Medicine Consensus Conference “Interventions to Assure Quality in the Crowded Emergency Department” will be held on June 1, 2011, immediately preceding the SAEM Annual Meeting in Boston, Massachusetts. Original papers on the conference topic, if accepted, will be published together with the conference proceedings in the December, 2011 issue of Academic Emergency Medicine.

Innovations in Emergency Medicine Education Exhibits (IEME) Submitters are invited to complete an application describing an innovative new educational methodology that they have designed, or an innovative educational application of an existing product.

Visit www.saem.org to learn more.

Deadline: Tuesday, January 25, 2011 at 5 pm EST Call for Photographs Original photographs of patients, pathology specimens, gram stains, EKGs and radiographic studies of other visual data are invited for presentation at the 2010 SAEM Annual Meeting. Visit www.saem.org Deadline: Tuesday, February 8, 2011 at 5 pm EST Submit to miniguez@saem.org

Deadline for Abstracts: March 28, 2011 CORD AWARD NOMINATIONS *Voting will be by online electronic ballot from Feb. 7th to Feb. 18th, 2011. (1 vote per paid program) Visit www.cordem.org for online submission form and other information

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University of Pittsburgh

University of Pittsburgh Department of Emergency Medicine The University of Pittsburgh in partnership with the University of Pittsburgh Medical Center (UPMC), is offering fellowships in the following areas: • Toxicology • Emergency Medical Services • Research • Education These fellowships provide intensive training and interaction with the nationally-known experts in each domain among the faculty in the Department of Emergency Medicine. Multidisciplinary collaboration with other departments on campus is encouraged. We provide experience in basic or clinical research. Teaching opportunities exist with medical students, residents, and other health care providers. Fellows enroll in one of several available Master’s level degree programs as a part of formal training. Fellowships include clinical responsibilities with limited hours as attending physicians in the Emergency Department at UPMC and affiliated institutions.

The University of Pittsburgh and UPMC are Equal Opportunity Employers, and we welcome candidates from diverse backgrounds. Each applicant should have an MD/DO background or equivalent degree and be board certified/prepared in emergency medicine. Applicants with similar experience will be considered. To discuss your future, contact Clifton W. Callaway, MD, PhD, University of Pittsburgh, Department of Emergency Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15261 or e-mail callawaycw@upmc.edu.

EOE

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Society for Academic Emergency Medicine 2340 S. River Road, Suite 200 Des Plaines, IL 60018

Newsletter

Board of Directors Jeffrey A. Kline, MD President

Executive Director James R. Tarrant, CAE

Debra E. Houry, MD, MPH President-Elect

Send Articles to: newsletter@saem.org

Adam J. Singer, MD Secretary-Treasurer

Send Ads to: mgreketis@saem.org

Jill M. Baren, MD, MBE Past President

The SAEM newsletter is published bimonthly by the Society for Academic Brigitte M. Baumann, MD, MSCE Emergency Medicine. The opinions expressed in this Deborah B. Diercks, MD, MSc publication are those of the Cherri D. Hobgood, MD authors and do not necessarily reflect those of SAEM. Robert S. Hockberger, MD

Alan E. Jones, MD

For newsletter archives and e-Newsletters Click on Publications at www.saem.org

O. John Ma, MD Jody A. Vogel, MD

Future SAEM Annual Meetings Midwest Regional Meeting

2011 June 1 - 5 Marriott Copley Place, Boston, MA

2012 May 9 – 13 Sheraton Hotel and Towers, Chicago, IL

2013 May 15 – 19 The Westin Peachtree Plaza, Atlanta, GA

2014

20th Annual Midwest Regional SAEM Meeting November 8, 2010 • Wright State University Boonshoft School of Medicine Dayton, Ohio For additional information contact Nancy Andrews at nancy.andrews@wright.edu

2011 CORD Annual Academic Assembly March 2-5, 2010 Marriott Mission Valley • San Diego, California

May 14 – 18 Sheraton Hotel, Dallas, TX

2015 May 13 – 17 Sheraton Hotel and Marina, San Diego, CA

AEM Consensus Conference June 1, 2011 Topic: “Interventions to Assure Quality in the Crowded Emergency Department”.