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

SEPTEMBER/OCTOBER 2011

JAMES HOEKSTRA, MD Chair, SAEM Development Committee

ETHICS IN ACTION: Ethical and Legal Dilemmas

ALEXANDRIA PLAN Fifty Years of Emergency Medicine Practice

VOLUME XXVI NUMBER 5


SAEM STAFF

SAEM M em bership

Executive Director James R. Tarrant, CAE Ext. 212, jtarrant@saem.org Executive Director – CORD Barbara A. Mulder bmulder@saem.org

Membership Count as of August 16, 2011 2,245 Active 48 Associate 2,089 Resident/Fellow

Executive Assistant Sandy Rummel Ext. 213, srummel@saem.org Accountant Mai Luu Ext. 208, mluu@saem.org Bookkeeper Janet Bentley Ext. 202, jbentley@saem.org Customer Service Coordinator Michelle Iniguez Ext. 201, miniguez@saem.org Education Manager Kirsten Nadler Ext. 207, knadler@saem.org Grants Coordinator Melissa McMillian Ext. 207, mmcmillian@saem.org Help Desk Specialist Neal Hardin Ext. 204, nhardin@saem.org Marketing & Membership Manager Holly Gouin, MBA Ext. 210, hgouin@saem.org Meeting Coordinator Maryanne Greketis, CMP Ext. 209, mgreketis@saem.org Membership Assistant George Greaves Ext. 211, ggreaves@saem.org Receptionist Karen Freund Ext. 201, kfreund@saem.org Web and Information Systems Jason Smith Ext. 205, jsmith@saem.org Operations Manager Christopher Johnson, MBA Ext. 225, cjohnson@saem.org

89 10 12 4,493

Medical Students International Affiliates Emeritus Total

2010-11 SAEM DUES $545 $510 $480 $450 $325 $160

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

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

Fellow Resident Group Medical Student Emeritus Academies Interest Group

International – email membership@saem.org for pricing details. All membership categories include one free interest group membership.

Advertisement Rates The SAEM Newsletter is limited to postings for fellowship and academic positions available and offers classified ads, quarter-page, half-page and full-page options. The SAEM Newsletter publisher requires that all ads be submitted in camera-ready format meeting the dimensions of the requested ad size. See specific dimensions listed below. • A full-page ad costs $1250 (7.5” wide x 9.75” high) • A half-page ad costs $675 (7.5” wide x 4.75” high) • A quarter-page ad costs $350 (3.5” wide x 4.75” high) • A classified ad (100 words or less) costs $120 If there are any pictures or special fonts in the advertisement, please send the file of those along with the completed ad. We appreciate your proactive commitment to education, as well as to personal and professional advancement, and strive to work with you in any way we can to enhance your goals. Contact us today to reserve your ad in an upcoming SAEM Newsletter. The due dates for 2011 are: October 1, 2011 for the November/December issue


highlights

Hey NewSletter readers Are you looking for more from SAEM? More news, reminders, updates, and insight? Then become a fan of SAEM’s Facebook page, or follow us on Twitter! Just follow the links on the SAEM homepage to join. On our Facebook page, you’ll learn about upcoming events, reconnect with colleagues, browse photos and more! By following SAEM on Twitter, you can join in the conversation on current EM topics, follow links to important resources, and get updated on the latest SAEM news. SAEM has always been a social group – now you can participate through social media!

Join today.

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

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President’s Message

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Executive Director’s Message

6

Ethics in Action

7

Sleep and Residency

10

The Alexandria Plan

11

Judd E. Hollander Speech

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2011 AEM Consensus Conference

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Academic Announcements

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Calls And Meeting Announcements


President’s M essage SOCIETY FOR ACADEMIC EMERGENCY MEDICINE Debra Houry, MD, MPH

Debra Houry, MD, MPH

“Well-behaved women rarely make history.” Although Laurel Thatcher Ulrich was actually writing about Puritan funeral services, most use this phrase in the sense that women should break out of traditional roles and challenge authority. This is one of my favorite quotes and one that I remind myself of regularly when my headstrong toddler acts out (no idea where she gets it from!).

I think this quote should apply to everyone in our specialty. With proposed cuts in GME support, declining Federal funding for research, and our ever-growing patient volume, we cannot afford to be quiet and accept the status quo. We can no longer be just academicians or emergency physicians; we need to be vocal advocates for our specialty, our trainees, and our patients. In the 2010-2015 strategic plan spearheaded by Jill Baren, advocacy was added to SAEM’s mission statement. The intent was not mission drift, but rather to “collaborate with key organizations to enhance the voice of academic emergency medicine and to promote unity within the specialty”, “to educate and mobilize the SAEM membership in advocacy efforts as they relate to our mission,” and “to develop scholars in advocacy and policy”. The American Association of Medical Colleges (AAMC) released a report stating that even a 1% decrease in Medicare indirect medical education support would result in a reduction of $1.2 billion in annual teaching hospital support. The Fiscal Commission recommendation of a two-thirds reduction is much more severe, and would have a ruinous impact on teaching hospitals (https://www.aamc.org/initiatives/gmefunding/). This, coupled with the projected workforce shortage in emergency medicine, is distressing for the future of emergency medicine, our ability to train new physicians, and our capacity to deliver care to patients in our overcrowded, underfunded emergency departments. The Institute of Medicine recommended enhancing emergency care research through additional Federal funding and suggested looking into a center or institute for emergency care research. However, Federal funding for research has been cut for FY11 and in general has not been increasing at the same rate as inflation or the number of applications. With the proposed FY12 NIH funding, purchasing power would be at the same level as it was almost a decade ago. What can SAEM do? We have partnered with the American College of Emergency Physicians (ACEP), the American Academy of Emergency Medicine (AAEM), the Association of Academic Chairs of Emergency Medicine (AACEM), the Emergency Medicine Residents Association (EMRA), and several other private and state EM groups as part of the newly-formed Emergency Medicine Action Fund (EMAF). Bob Hockberger represented our organization at the first meeting of the EMAF in July. We will have more information posted on our website about the EMAF, as well as a mechanism for you to give feedback on issues SAEM



should advocate for through this group. Although this group is just forming, the collective impact we can have on issues such as GME funding and workforce shortages will be much greater than if we did this as smaller, splintered groups. The ACEP/SAEM Federal Funding Task Force has responded to multiple requests for information, participated in NIH site visits, assisted with roundtable discussions, and helped the recent NHLBI K12 funding come to fruition. These recent K12 awards have resulted in more funding for emergency medicine research than the total amount of grants awarded by the Emergency Medicine Foundation and the SAEM Foundation. SAEM is also co-sponsoring a fellowship with the Emergency Care Coordination Center (ECCC) of the United States Department of Health and Human Services to support emergency medical care collaboration and policy development at the Federal level. This one-year sabbatical grant will allow the Fellow to work in DC with the ECCC to conduct research and develop policy initiatives in emergency medical care. At the AAMC meeting, AACEM and SAEM are holding a joint academic session on “Defining the Value of Emergency Medicine to the Academic Health Center in the Era of Health Reform” on November 5th. This important session will engage a panel of experts from public health, emergency medicine and health services research to discuss possible future models for the emergency care system in response to health reform. We want the voices of our SAEM members to be heard. Please contact us with any concerns or issues that may affect SAEM and our constituents. The Board of Directors is committed to ensuring that academic emergency medicine continues to thrive in the current climate, and we will continue to advocate on issues relevant to our mission and to collaborate with other groups to further our causes. ◗


Executive director’s M essage In correlation with the annual meeting, SAEM launched its newly designed website. Members of the Web Committee and IT staff spent several months determining the requirements needed to provide a new face of SAEM. Increased functionality, more robust content and improved search capabilities are just a few of the additions to the new website. The Web Committee, chaired by Dr. D. Matthew Sullivan, did not want the website to be a static brochure site but to be a fluid ever evolving snap shot of SAEM. Along with Dr. Sullivan, the Web Committee determined three functional goals of a redesigned website. First, for groups to be able to easily access materials related to their interests; second, to have the ability to post materials of interest to the general membership; third, to provide information to the general public.

James Tarrant, CAE

When visiting the new website, the first change that can be seen is the addition of rotating slide show images. Each image corresponds with current news, upcoming events or other important information. The slide show images will allow for quick access to the topic by serving as a link to a more detailed page. As an example, a deadlines slide show image can be clicked on and a user will be directed to a page with information on deadlines for abstract submissions, meeting registrations, or nominations for elected offices. Additions of icons for Clerkship and Residency Directories will also allow for faster and easier access to information. Program coordinators were given access to the directories for the maintenance of their respective information. Another new and exciting area of the website is the “Affiliates” section which includes AACEM and seven Academies. These sections include sites that are only available to members of that specific group. This will allow designated members to post, edit, and upload information directly to the site. Still under development is a new “Groups” section that will serve as SAEM’s “member’s only” platform. Once functional, this section will allow members of a group to post questions, comments and archive comments for future reference. Information discussed in the group section remains private and is available only to members of that group. Once fully functional, the group can choose to publish selected information/reports for all SAEM members to view. As is a part of any new website, migration of legacy data is important. Early in 2011, the Web Committee contacted leaders of committees, task forces, academies and interest groups requesting the content on the old website to be reviewed. The leaders were asked to recommend which materials were to be transferred to the new site, updated or archived. If you are having trouble finding a document on the new SAEM

SAEM launched its newly designed website at this year’s annual meeting.

website, please let SAEM staff know by emailing your request to saem@saem.org. Until the document is uploaded to the new site, SAEM staff can email the file directly to you. Although it may take a little time to learn to navigate and locate items on the new SAEM website, we hope you appreciate the added features and functionality. I personally know the feeling when I have been to a site many times and the new and improved website is unveiled and I need to reorient myself to the location of information. We appreciate your help in identifying the materials to be moved to the new site and patience when something was not initially recommended for migration. If any document is currently used by the membership we want to make sure it has been reviewed, updated and made available for use. This website is beneficial to the SAEM membership so please visit the new website at www.saem.org and give us your feedback. ◗




Ethics in Action Christian Fromm, MD

Maimonides Medical Center Brooklyn, NY A 93-year-old woman was brought in to the emergency department from the hospice ward of a nearby nursing home for respiratory distress. She had a history of Alzheimer’s dementia, COPD and end-stage metastatic ovarian cancer. The paperwork accompanying the patient did not include a DNR order. The patient was in extremis and a decision regarding intubation was urgently needed. Moments later, the patient’s son arrived at the bedside. He confirmed that he had recently placed his mother, with the guidance of her primary care and oncology physicians, in hospice. His mother had lacked capacity for some time due to dementia and had been bed-bound, nonverbal and unable to recognize him at the time of her recent diagnosis of metastatic ovarian cancer. He had accepted her physicians’ recommendations not to pursue further treatment of the malignancy. He acknowledged that his mother, prior to her decline, had once told him “I don’t ever want to end up with machines keeping me alive,” but that she had never put her wishes in writing. He confirmed that the nursing home had insisted that he to agree to, but had not required a written declaration of DNR status for his mother upon hospice program intake. However, he had changed his mind when the hospice nurse called him in that night to be with his mother, who appeared to be dying. He said he could not bear to see her die and he now wanted “everything done,” including intubation, as it might give her even a few more days to live. When I told him that intubating



her would not only seem to contradict her previously stated wishes, but also, given her underlying conditions, might cause her unnecessary suffering, he replied that “even if it causes her more pain, I couldn’t live with myself if I didn’t do everything possible to prolong her life for even a few hours more.” In March 2010, the New York Family Health Care Decisions Act greatly expanded the ability of surrogates to make life-sustaining treatment decisions for patients who have not prepared advanced directives and who lack capacity. For a physician to countermand a surrogate’s decision requires the formal intervention of a (now required) hospital Bioethics Committee, a process which is obviously not a feasible option in the emergency department. I decided to call a bioethics consultation, a 24/7 service shared by the RN/JD and MD/JD co-chairs of our hospital’s Bioethics Committee. I was informed that the hospital would support a decision by me, on ethical grounds, not to intubate this patient, but that, in the absence of a formal Bioethics Committee determination that the surrogate was not acting in the patient’s interests, the hospital would be compelled to find another physician who would agree to proceed with the intubation. When surrogates and physicians collide in their interpretations of an incapacitated patient’s best interests, complex ethical and legal dilemmas can challenge emergency physicians and hospitals. ◗


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

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

Sleep and Residency Authored By: Theresa Pagana, MD, PGY 2 Resident Physician, Temple University Hospital & Manish Garg, MD, FAAEM, Associate Residency Program Director, Associate Professor of Clinical Emergency Medicine, Temple University Hospital Introduction: Sleep is vital and is often taken for granted until it is limited. Inadequate sleep affects about one third of normal adults, and resident physicians are particularly vulnerable to sleep deprivation. Residents commonly work long days or overnights, and 10% of residents perceive sleepiness as an almost daily occurrence1. What exactly sleep does for the body is unclear, but it does appear to be a very active process involving the brain. Most people require about eight hours of sleep nightly, but there is a great degree of variation around the mean2. Sadly, residents typically average less overall sleep than the general population and are often forced to reprioritize sleep as less important. This article: 1. Reviews the stages of sleep; 2. Discusses the importance of sleep for body function; 3. Highlights consequences associated with lack of sleep; 4. Discusses the revised American College of Graduate Medical Education (ACGME) regulations on duty hours; and 5. Provides strategies on how to counteract lack of sleep and improve sleep wellness.

The Sleep Stages: During sleep, the brain is involved in a variety of complex activities which can be categorized as rapid eye movement (REM) sleep or non-rapid eye movement (NREM) sleep3. Polysomnography is the “gold standard” technique used to define the main stages of sleep and wakefulness. It measures muscle tone, eye movements, and brain activity2. REM sleep recurs every 90 to 120 minutes and mimics the awake brain on an electroencephalogram (EEG), which is why it is often called paradoxical sleep. NREM sleep can further be classified into 3 stages, N1, N2, and N33. Stage N1 sleep is the first and lightest stage of sleep. It occurs during the transition from wakefulness to sleep and accounts for 2-5% of total sleep time2. It is sometimes not considered true sleep since it tends to be imperceptible to people if they are awakened during it. Stage Sleep and Residency Continued on Page 8




Sleep and Residency Continued from Page 7 N2 sleep is the longest stage of sleep and accounts for 40-50% of total sleep time. Stage N3 sleep is called deep sleep or slow wave sleep and accounts for 20% of total sleep time2. REM and NREM stages of sleep cycle throughout the night and depend on many factors4,5. Sleep typically starts with stage N1 (light sleep) and then proceeds with deeper sleep stages N2 and N3. The first episode of REM sleep occurs about 90 minutes into sleep onset and completes the first sleep cycle. After the first sleep cycle, NREM and REM sleep continue to alternate within each following sleep cycle until awakening2. Why does the body need sleep? Many studies attempt to prove that sleep is a fundamental biological process by observing effects on sleep-deprived animals or humans. For example, one study showed that just one night of sleep deprivation reduced energy expenditure in healthy men the next day6. This supports the “Energy Conservation Theory” which supposes that sleep provides a period of inactivity that acts to conserve energy for a day of wakefulness and activity2. Other studies have examined the body’s requirement for individual stages of sleep. In a study in which rats were deprived of only REM sleep, all rats in the study had significant morbidity and ultimately died within 1-2 months7. Furthermore, the human body compensates for lost REM sleep by increasing the amount of time spent in REM sleep during subsequent sleep cycles8. Thus, REM sleep itself appears protective to body function and survival. NREM sleep is also thought to have a unique function for the body. For example, time spent in NREM stage N3 sleep is increased after significant physical effort9. This supports the “Restorative Theory of Sleep” which supposes that sleep is necessary to restore the body and to prepare the brain for a day of wakefulness2,10. Lack of Sleep: Sleep deprivation is defined as a volitional reduction of total sleep time or a reduction of sleep quality (increased arousals). It results in inadequate alertness, performance, and health. A decrease in cognitive function occurs in sleep deprived people with decreased ability to perform tasks that require sustained attention11. A meta-analysis of sleep loss studies estimated that cognitive performances of healthy young adults who are sleep deprived are 1.3 or more standard deviations below the mean1. Sleep deprived people also report psychiatric symptoms such as depression, anxiety, poor mood, irritability, low energy, and poor judgment. These feelings contribute to a sense of decreased quality of life. Sleep restriction has also been shown to increase appetite by decreasing serum leptin and increasing serum ghrelin which could play an adjunct role in the national trend of obesity12. Resident physicians are subject to sleep deprivation due to work expectations and, although part of the definition, it would be difficult to find a resident who would say their deprivation is “volitional.” There have been several studies that demonstrate the negative effects of sleep-deprived residents in the hospital setting. For example, an article in the Journal of the American Medical Association found that extended work duration or night work was associated with an increased risk of percutaneous injuries (needlesticks) in first year residents (interns). The top contributing factors for these injuries were fatigue and lack of concentration from lack of sleep13. Certainly, worrying about



contracting HIV or hepatitis can make sleep even more challenging to achieve. Another prospective study on OB/GYN residents showed a significant decrease in cognitive function after a typical, sleep-deprived, on-call night. In this study, the mean length of call was 31.43 hours, the mean length of sleep was 3.83 hours (compared to 6.93 hours of sleep when not on duty), and the mean interruptions of sleep were 3.27 times. The study showed that peg board cognitive tests and verbal tests were statistically significantly better pre-call than post-call14. For residents, the greatest danger of sleep deprivation is its proven direct relationship with motor vehicle crashes, especially during the post-call period and after an overnight shift15. Overall, excessive sleepiness is the 2nd leading cause of car crashes in the United States16. In multiple studies, sleep deprivation of greater than 21 hours was thought to have the same impairment in driving tasks as a blood alcohol content (BAC) of 0.08%17,18. For this reason, states such as New Jersey have changed their vehicular-homicide statutes so that sleep deprivation of greater than 24 hours is now included under the definition of reckless or impaired driving18. This means sleep-deprived drivers could be subject to potential felony convictions for vehicular homicide if they kill someone in a motor vehicle collision (MVC). The New England Journal of Medicine study further reported an intern MVC rate of nearly 12%. To put that in perspective, it means one MVC for every nine interns in a class. Furthermore, these crashes were not inconsequential. Of the crashes reported, nearly one half required ED treatments or a minimum of one thousand dollars’ worth of repairs18. For time and financially strapped residents this can be devastating. Insomnia is defined as sleep deprivation despite ample opportunity for sleep. This includes difficulty initiating or maintaining sleep and impaired daytime function19. The prevalence of insomnia increases with age and is often persistent. Although there is little information about its incidence and risk factors, stress may be one major factor that interferes with sleep quality in insomnia20. The impaired daytime function reported by patients with insomnia is similar to that of general sleep deprivation. This includes Sleep and Residency Continued on Page 9


Sleep and Residency Continued from Page 8 fatigue, daytime sleepiness, poor concentration, increased errors, decreased energy, social dysfunction, depression, tension, headaches, or gastrointestinal symptoms19. There is often an associated worry over lack of sleep which in turn worsens the insomnia. People with insomnia are also more likely to be absent from work, more likely to have work accidents, and more likely to have health-related problems21,22. Circadian rhythm sleep disorders are chronic or recurring disturbances in sleep caused by misalignment between the environment and a person’s sleep-wake cycle (i.e. jet lag, shift work, or irregular sleep-wake patterns). One component of circadian rhythm is core body temperature. Sleep normally occurs when core body temperature decreases and wakefulness normally occurs when the temperature rises. Dissociation of temperature and sleep causes reduction of total sleep time until the cycles are realigned2. Until this happens, most people experience the negative effects of sleep deprivation. The American College of Graduate Medical Education & Duty Hours In response to resident sleep deprivation and to promote patient safety, the ACGME has approved the following duty hour regulations for 2011 (see complete list at the ACGME website)23: • Duty hours must be limited to 80 hours per week, averaged over a four week period, inclusive of all in-house call activities and all moonlighting. • Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days. • Duty periods of PGY-1 residents must not exceed 16 hours in duration. Duty periods of PGY-2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital. Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities. Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested. • Residents must not be assigned additional clinical responsibilities after 24 hours of continuous in-house duty. • It is essential for patient safety and resident education that effective transitions in care occur. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family. • Residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods. Future studies will be required to evaluate the impact of these regulations on residency education and safety. Correcting Sleep Deprivation: Seemingly intuitive, sleep is the most effective countermeasure for sleep loss1. It is important to identify what is causing the lack of sleep. For most residents, it is simply a lack of total sleep hours due to a busy and shifting work schedule. Well-timed napping and low-dose caffeine may help to reduce sleepiness during prolonged wake times. For example, planning a 2-8-hour nap

before a prolonged wake time or 15-minute naps every 2-3 hours during a prolonged wake time can help reduce the symptoms of sleep deprivation1. Also, following a progressive schedule can counteract circadian rhythm disturbances. The most important point to remember when it comes to sleep deprivation is to limit or eliminate the potential for motor vehicle collisions. Although not always an easy solution, this is the only way to significantly decrease the morbidity and mortality associated with driving while sleep-deprived. Encourage your colleagues and program leaders to adhere to the duty hour regulations and look out for one another to promote good sleep wellness. The ACGME requires each residency program, hospital, institution or faculty to provide sufficient education in physician sleep deprivation and mandates it as a question on the end-ofthe-year residency survey24. The authors hope that this article will satisfy this requirement and will help the reader better understand and promote sleep wellness. ◗ References 1. Veasey S, Rosen R, Barzansky B, Rosen I, Owens J. Sleep loss and fatigue in residency training: a reappraisal. JAMA. 2002; 288:1116-24. 2. Markov D, Goldman M. Normal sleep and circadian rhythms: neurobiologic mechanisms underlying sleep and wakefulness. Psychiatr Clin North Am. 2006 Dec;29(4):841-53. 3. Iber, C, Ancoli-Israel, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specification, 1st, American Academy of Sleep Medicine, Westchester, IL 2007 4. Guilleminault C, Pool P, Motta J, Gillis AM. Sinus arrest during REM sleep in young adults. N Engl J Med 1984; 311:1006. 5. Aserinsky E, Kleitman N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science 1953; 118:273. 6. Benedict C, Hallschmid M, Lassen A, et al. Acute sleep deprivation reduces energy expenditure in healthy men. Am J Clin Nutr. 2011. 7. Rechtschaffen A, Bergmann BM, Everson CA, et al. Sleep deprivation in the rat: X. Integration and discussion of the findings. Sleep 1989; 12:68. 8. Endo T, Roth C, Landolt HP, et al. Selective REM sleep deprivation in humans: effects o sleep and sleep EEG. Am J Physiol 1998; 274:R1186. 9. Shapiro CM, Bortz R, Mitchell D, et al. Slow-wave sleep: a recovery period after exercise. Science 1981; 214:1253. 10. Adam K, Oswald, I. Sleep is for tissue restoration. J R Coll Physicians Lond 1977; 11:376. 11. Lim J, Dinges DF. A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychol Bull 2010; 136:375. 12. Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141:846. 13. Ayas NT, Barger LK, Cade BE, et al. Extended work duration and the risk of self-reported percutaneous injuries in interns. JAMA 2006; 296:1055. 14. Halbach M, Spann C, Egan G. Effect of sleep deprivation on medical resident and student cognitive function: a prospective study. Am J Obstet Gynecol. 2003: 188: 1198-1201. 15. Steele MT, Ma OJ, Watson WA, Thomas HA Jr, Muelleman RL. The occupational risk of motor vehicle collisions for emergency medicine residents. Acad Emerg Med 1999; 6:1050-3. 16. Mitler MM, Dinges DF, Dement WC. Medicine, public policy, and public Health. In: Principles and Practice of Sleep Medicine, 2nd, Kryger, MH, Roth, T, Dement, WC (Eds), WB Saunders, Philadelphia 1994. p.453. 17. Fairclough SH, Graham R. Impairment of driving performance caused by sleep deprivation or alcohol: a comparative study. Hum Factors 1999;41:118-128. 18. Barger, L et al. Extended work shifts and the risk of motor vehicle crashes among interns. NJEM 2005. 353: 125-134. 19. International classification of sleep disorders: Diagnostic and coding manual. 2nd ed, American Academy of Sleep Medicine, Westchester, IL 2005 20. Leblanc M, Merette C, Savard J, et al. Incidence and risk factors of insomnia in a population-based sample. Sleep 2009; 32:1027. 21. Bonnet MH, Arand DL. Consequences of insomnia. Sleep Med Clin 2006; 1:351. 22. Leger D, Massuel MA, Metlaine A, SISYPHE Study Group. Professional correlates of insomnia. Sleep 2006; 29:171. 23. http://www.acgme.org/acwebsite/home/Common_Program_Requirements_07012011.pdf 24. http://www.acgme.org/acWebsite/navPages/nav_residents.asp#ACGMEResidentSurvey




Making the Most of Transitions as a Medical Student and Resident Prepared by the SAEM Resident and Student Advisory Committee As the fall of any year approaches, it becomes clear that a transition is on the horizon for trainees at all levels. The third year medical students are applying for away rotations, medical students are considering residency options, and senior residents are thinking about their post-residency plans which may include fellowship training. It is an exciting time which may also be accompanied by some angst about what lies ahead. Gathering the information necessary to make the best choice for the individual is an important first step towards a successful training experience. Training programs at all levels vary in size, duration, focus, clinical setting, location, and opportunities for extracurricular activities. Personal reflection is required to determine which of these variables is most important for the applicant. Once priorities and the “non-negotiables” have been established, it will be easier to identify programs that will be a good match for the individual, thereby narrowing the list of potential application options.

For fourth year medical students who are applying for emergency medicine residency training, choosing among the many excellent programs can seem overwhelming. Obtaining detailed information about each residency will help to make an educated choice about the options available. The SAEM Residency Directory contains important information on each program including clinical training opportunities and sites, educational curriculum, number of trainees, salary/benefits, research focus, and scholarly and extracurricular options. Please click on the Residency Directory map in this article to link directly to the SAEM Residency Directory.

For third year medical students who would like to pursue away rotations in emergency medicine, please link to the SAEM Clerkship Directory by clicking on the map icon in this article. The SAEM Clerkship Directory contains the information necessary to choose an away rotation which matches one’s interests. The information provided includes clinical setting, number of shifts, educational opportunities, prerequisites, dates of the rotation, and important contact information. Using this information carefully to choose the program most aligned with one’s interests could ultimately lead to a future match at the residency program. For fourth year residents considering post-graduate training options, there are a wide variety of fellowship training programs available. Detailed information about the types of fellowship available to emergency medicine resident graduates can be found on the SAEM website. The SAEM Fellowship Directory details fellowship training sites and format at http://www.saem.org/fellowship-directory Throughout one’s medical training, from medical student to fellow, multiple important training transitions occur. Having the information necessary to make the best choices for one’s training will optimize the chances for a successful training experience and ultimately a fulfilling career as an emergency medicine physician. ◗

Academic Emergency Medicine News on FACEBOOK page 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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Commemorating Fifty Years of Emergency Medicine Practice – The Alexandria Plan Brian J. Zink, MD

Professor and Chair — Department of Emergency Medicine, The Alpert Medical School of Brown University Past President, SAEM SAEM sponsored and participated in a special event to commemorate the 50-year anniversary of the Alexandria Plan on June 24, 2011 at the “new” Inova Alexandria Hospital. A diverse group from Alexandria Hospital, ACEP, the Society for Academic Emergency Medicine, the Association of Academic Chairs of Emergency Medicine, the Council of Residency Directors in Emergency Medicine, the American Board of Emergency Medicine, the Emergency Medicine Resident Association, and the Emergency Nurses Association organized and funded the event. Jim Tarrant, Executive Director of SAEM, and Brian Zink, MD, SAEM Past President attended the event. The program featured a historical review of the Alexandria Plan, speeches and commentary from elected officials and emergency physician and nurse leaders, and the presentation of certificates from the state of Virginia and the city of Alexandria. Perhaps the most special moment was the introduction of C.A. (Babe) Loughridge, MD, one of the Alexandria Plan’s four founding physicians, who was in attendance. Although he came in a wheelchair due to recent illness, Dr. Loughridge stood and acknowledged the clapping audience with a broad smile. The following is an excerpt of the “history lesson” presentation given by Dr. Zink as part of the program. To view a video of the event, go to: www.acep.org/content.aspx?id=80512 In 1961, the Alexandria Hospital emergency room (ER) in Alexandria, Virginia was reeling from a nearly 300% increase in patient visits in the previous decade – up to 18,000 per year. Complaints and wait times were rising. Staffing the ER was a big problem, as consigned medical staff objected to working in the ER, and the numbers of housestaff (primarily foreign medical graduates) had declined by 50%. A plan to use Georgetown University medical students to cover the night shifts had also failed. (1) Into this mix came James Mills, Jr., who had just been made President-Elect of the Alexandria Hospital medical staff. Mills, who was a well-regarded local general practitioner, had worked shifts in the ER, and he liked the pace and variety of cases and was committed to helping the poor and underserved in his community. Mills was also finding his general practice less than satisfying. His idea for solving the problem in the Alexandria Hospital ER came to him early one morning. He noted: “One night I came home after 1 a.m. from working a day that had started that morning at 7. ….It came to me that in emergency service, with regular hours, I would be able to practice much

better medicine. If I could get three other good men to join me, we’d have a team that could provide top-notch treatment…” (2) Mills did find three good men to help him: John McDade, MD, C.A. Loughridge, MD, and William Weaver, MD. These four general practitioners all gave up their private practices and established a contract with Alexandria Hospital for a revolutionary type of practice that was unheard of in the 1960s. They worked five straight days, 12-hour shifts that went from noon to midnight or the reverse. They then had five straight days without shifts, which was unheard of for a 1960s physician. By charging five dollars per visit, and collecting a hospital subsidy for indigent care, they were able to be as financially successful as they had been in their private practices. The Alexandria Plan met with some opposition from physicians who were concerned about the emergency physicians stealing from them patients who presented to the ER, from patients who felt abandoned by their GPs, and from some who felt this was too radical a move to solve the ER problem. But it was immediately a huge success, with patients and community physicians soon rallying around this new type of practice. ED visits at Alexandria Hospital doubled in the next five years. The Alexandria Plan garnered a great deal of attention from the world of medicine, the public, the media, and many physicians who wished to replicate what the Alexandria four had done in their own hospitals. Within five years, Alexandria-type plans had sprung up across the country. By 1968, emergency physicians had organized to create the American College of Emergency Physicians, with the Alexandria physicians playing a key role. James Mills, Jr. became the second ACEP President, and a founding member of the American Board of Emergency Medicine. John McDade was an early ACEP leader and a strong advocate and organizer for the development of emergency medical services (EMS). Fifty years later, as we reflect on what the Alexandria Plan accomplished, we confront similar issues, but in a very different environment of care. Our charge now, in a challenging new era of health care reform, is to be as innovative, persevering, and visionary as the four physicians, and their ED and EMS colleagues, who created the Alexandria Plan. ◗

Brian Zink, MD, and Jim Tarrant, Executive Director of SAEM

Dr. Zink congratulates one of the four Alexandria Plan founding physicians, C.A. Loughridge, MD

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References:

1.) Zink, BJ. Anyone, anything, anytime – a history of emergency medicine. 2006, Mosby Elsevier; Philadelphia, PA. pp 30-32. 2.) Maisel, AQ. Emergency service: medicine’s newest specialty, Reader’s Digest 86(518):96-100, 1965.


On Receiving the 2011 SAEM Leadership Award Judd E. Hollander, MD Thank you for this honor. I am deeply humbled and find it hard to believe that I can even be listed alongside many of the prior award winners. Unfortunately, in the time allotted, I could not possibly acknowledge all of the people in emergency medicine who have been a major influence on my life, but most of them are in this room.

Greg, and coached almost that many for my younger son, Dave. Until an hour ago, the last time my wife came to SAEM was 1994. She recognized that I could not accommodate both my family and my career at the meeting. Family time shouldn’t be while you are at work. Likewise, it’s not a bad idea to avoid doing work during family time.

I do, however, want to thank a couple people. My parents believed that I should always drive to accomplish more. When I got a 99 on a test, they wanted to know what happened to the other point. My father, in particular, talked about “having to be good at something,” to develop confidence and a drive to succeed. Although you might find it hard to believe, I was small as a child. My father was an athlete, so he bought me a football tee and football and sent me to the backyard to become a field goal kicker. Bad idea. Eventually, I learned the lessons that they wanted me to acquire through competitive tennis.

Second - ignore those mentors who teach you to say no. Just say yes. You need to be in the game to win the game, but you won’t always see the pot at the end of the rainbow when you are offered the first position. I began by applying for some grants, got rejected, but they noticed I kept giving them work, so they asked me to join the committee. I said yes. Then they asked me to chair the committee. I said yes. On the heels of the IOM report, I was fortunate enough to be asked to serve on the SAEM-ACEP NIH TF that met with Dr. Zerhouni, finally engaging the NIH. I was invited to attend the NIH roundtables, where I met a person who has been a remarkable influence for our specialty – Jane Scott. She introduced herself as an ex-ER nurse and head of training grants for NHLBI. Around the same time, Jeff Kline asked me to help develop a structured credentialing process for research training fellowships. I said yes. We asked the NIH to give us a representative. They said yes and appointed Jane Scott. While serving on our TF and learning about our unmet need for research training grants, Jane worked with NHLBI to create the K12 program. This week we credentialed the first 14 research training programs and NHLBI awarded more than 20 million dollars to six K12 sites. Could I have guessed that when I said yes to anything in that sequence? Not a chance. You need to just say yes. Good things happen.

But I learned the most from my wife, Jeanne. She spoke about her days as high school class president and often said when people come to you with an idea, encourage them to develop it. If it’s a bad idea, they will figure it out. You won’t have to tell them how bad it is. On the other hand, good ideas will naturally grow support. In fact, it was this philosophy and management style that ultimately led to the development of the SAEM Academy structure. Rather than talk about any specific accomplishments, I am hoping to impart just two kernels of advice to our young members searching for ways to become a leader in our society. They are two pieces of advice people don’t usually give. First – come to the meetings without your family. Realize the person sitting next to you is someone who has helped or will help shape our specialty and ultimately improve the care of our patients. Our annual meeting is your chance for you to network with colleagues. Take advantage of it. Don’t get me wrong. This does not mean you should not prioritize your family. I added it up yesterday - I have attended 340 baseball games for my older son,

In closing, I want to thank past leadership for giving me the opportunity to say yes – the opportunity to help make a difference in emergency care research and education. I also want to point out something to my parents. Mom, Dad – I think we just got back all those missing points. Thank you all. ◗

Peer-reviewed Lectures (PeRLs) Are Coming! Academic Emergency Medicine will be publishing a series of videos of lectures on topics in emergency medicine. These are intended to represent the state of the art in emergency medicine education. Residents, practicing physicians, and medical students may use them for didactic education. The videos should contain both the presented audiovisual materials for the lectures (such as PowerPoint slides) and live video of the presenter. Each video lecture should contain the following information: • A written abstract describing the content of the lecture • Conflict of interest statement • The body of the lecture (< 30 minutes) • Contact information for questions

• Lecture title, author, and institutional affiliation on a title slide • A brief overview of the lecture content (~ 1 minute) • References and further reading (~ 30 seconds)

Prospective authors should consider contacting the PeRLs editorial board (through John Burton, MD, Senior Associate Editor: jhburton@carilionclinic.org) for a discussion before starting on video production of a lecture for a determination of topic suitability. Videos can be complex to produce, and given the effort involved, having a discussion with an editor either by e-mail or by phone before producing it is recommended.

STAY TUNED FOR MORE INFORMATION!

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REPORT ON THE 2011 AEM CONSENSUS CONFERENCE

SAEM Trauma Interest Group Update

On June 1st 2011, 131 attendees gathered in Boston for the 2011 AEM Consensus Conference, “Interventions to Assure Quality in the Crowded Emergency Department”. The conference was co-chaired by Melissa McCarthy, ScD and Jesse Pines, MD, MBA, MSCE and led by the SAEM ED Crowding Interest Group. It was designed to “develop a research agenda that identifies promising interventions to safeguard the quality of emergency care during crowded periods and reduce ED crowding altogether through system-wide solutions.” There were three objectives for the conference:

Our membership is growing and becoming more active, but we know there are more SAEM members interested in trauma out there. Please consider joining the group.

1. To review interventions that have been implemented to reduce crowding and summarize the evidence of their effectiveness on the delivery of emergency care 2) To identify strategies within or outside of the healthcare setting (i.e. policy, engineering, operations management, system design, etc.) that may help reduce crowding or improve the quality of emergency care provided during episodes of ED crowding 3) To identify the most appropriate design and analytic techniques for rigorously evaluating ED interventions designed to reduce crowding or improve the quality of emergency care provided during episodes of ED crowding Suzanne Mason, MD of the University of Sheffield, UK delivered opening remarks about the experience and lessons of Britain’s 4-hour rule, which has successfully reduced length of stay in the UK’s EDs but, due to unintended consequences, has been recently rescinded. Several workshops were presented during the morning session, with one examining policy measures to reduce crowding in Europe and Canada, two others focusing on systems and engineering approaches to studying patient flow interventions, and a fourth discussing how to rigorously evaluate the implementation of possible strategies to address crowding and to preserve the quality of patient care under crowded conditions. This was followed by a lively lunchtime panel discussion on crowding interventions, during which panelists cited the need for strategies to be tailored to individual institutions, and for strong hospital leadership endorsement for any strategies to be effective. In the afternoon, several breakout sessions examined ways to preserve six specific domains of quality related to improving crowding: safety, patient-centered care, timeliness, efficiency, systems effectiveness, and equity. Participants helped group leaders hone research agendas that had been developed over the previous months. The groups voted on the most promising research questions for each quality domain. Overall, the conference received very positive reviews for the timeliness and importance of the topic and the quality of the speakers and workshops. The findings and ideas resulting from the conference will be published in the December issue of Academic Emergency Medicine. ◗

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We had a lively discussion at the SAEM Annual Meeting and we developed the following action plans: 1. Submit multiple didactics for the SAEM 2012 Annual Meeting 2. Develop a simple multicenter survey study 3. Submit “Trauma Reports” to the Academic Emergency Medicine Journal 4. Increase membership of emergency medicine physicians in EAST (Eastern Association for the Surgery of Trauma) to strengthen the voice of EM Our next meeting will be at National ACEP in Chicago. All are welcome. Kaushal Shah, MD, FACEP Chair, SAEM Trauma Interest Group Associate Professor, Mt. Sinai School of Medicine

PUBLIC HEALTH INTEREST GROUP UPDATE The Public Health Interest Group was proud to put on a very successful didactic at the 2011 Annual Meeting entitled “Navigating Large Datasets for EM Research Questions: A How-To Primer”. We are actively exploring a number of didactic proposal ideas for the 2012 meeting and welcome any who are interested in public health to join us. Please contact Brendan Carr at carrb@upenn.edu if interested.


SAEM Research Foundation Support: A Message and Plea from a Long Time SAEM Member Research; teaching; EM practice in a cutting edge environment; interaction and networking with academic colleagues - why do you practice in academia? Those of our SAEM members directly involved in research clearly understand the importance of establishing evidence-based EM practice. For those of our members performing other, but no less important functions in academia, we must all realize the future benefit research and education provide. We all benefit from EM research and education, including, and especially, our patients. For those of us “mature” enough to remember the early days of EM practice, before we became an established specialty, research helped develop our evidence-based knowledge, gradually helped define our specialty, and has now firmly established EM within the “House of Medicine.” Education continues the dissemination of this research and further defines our specialty. We have not completed the task, however. Today and into the future we must continue EM research and education to solidify and expand our evidence-based knowledge, continue to refine the definition of our specialty, and continue to improve our EM status amongst our medical peers. As members of the organization specifically representing academic EM, we have an opportunity to support our very own SAEM Foundation, and confirm our obvious understanding that both we and our patients mutually benefit from EM research and education. What other charities do we support where we directly benefit from our personal contribution? 100% of your donation is tax-deductible. The government subsidizes your beneficial societal donation, and your contribution actually “costs” you only approximately 60% of the total, after tax deductions (depending on your federal and state tax brackets, but full-time EM Physicians, even academicians, tend to be in the highest tax brackets). SAEM is requesting all members to contribute at least $100 annually to our Research Fund to support our research in Emergency Medicine. Although my SAEM membership number is 290, we now have over 6000 members. With several thousand attending-level “Active” members, I can’t understand why we don’t have 100% participation at or above this modest level. $100 won’t even buy dinner out for a couple at a nice restaurant. Even part-time Active members or Resident “Candidate” members can afford this level of support. It is important to begin annual support early in your career, and increase your support as you reap your rewards from EM practice. Regular and consistent annual articipation is the key to success. SAEM is also encouraging members to consider larger contributions, including the “Major Donor” level of $1000 or above (actual cost approximately $600 after federal/state tax deductions). Despite our persistent and not unreasonable complaint about our high level of charity care and inadequate insurance reimbursement, the average full-time EM academician is a top 1% earner, and can afford to give back to their specialty at this level. This is considered the “Give a Shift” level, and amounts to only approximately a 0.5% income given back to the specialty we chose.

We just need to realize that we can do this, we should do this, and both we and our patients directly benefit from our financial giveback support. During our training, we directly benefitted from tax dollar GME financial support to our hospitals and residencies, and it is only fitting that we should “pay it forward” to support those who come after us and represent the future of Emergency Medicine. As a new EM residency graduate university academician almost three decades ago, I started contributing to ACEP’s fledgling Emergency Medicine Foundation (EMF). Despite eventually leaving research, I continued to increase my annual tax-deductible contributions to EMF to support my specialty and my patients. In 1997, I established the ACEP Council EMF Challenge, matching the first $5 of each Councilor’s contribution to EMF. Over the subsequent years, the number of Councilors has grown from 250 to 338 with the growth in ACEP membership. At last September’s two-day Council meeting, we raised over $128,000, averaging almost $400 per Councilor, with almost 15% of the Councilors contributing at or above the $1000 “Give a Shift” Major Donor level. This two-day accomplishment was possible despite a large portion of the Councilors having already contributed to EMF through their ACEP dues statement check-off donation throughout the year. Since the early years of the ACEP Council EMF Challenge, the Councilors now “get it.” As leaders of the College, they must lead by example, and pave the path for their ACEP colleagues to follow. They understand the importance of EM research for our specialty and our patients, they understand that they can afford this modest, tax-deductible give-back to our specialty, and they have repeatedly demonstrated their 100% participation support year after year at the ACEP Council meeting. Although I am no longer an academician, I have maintained my SAEM membership. When the newly-formed SAEM Research Foundation originally called for support in 2008, I immediately responded with my first annual “Give a Shift” Major Donor contribution, despite also having contributed similarly every year to the ACEP EMF. The SAEM Research Foundation plays a role specific to SAEM. It deserves your give-back support. If you work part time, or are a resident, please feel free to adjust your donation amount to a comfortable proportionate contribution, but please participate. 100% membership participation is the key to success for our SAEM Research Foundation. Every SAEM member should give back to our specialty and our patients. My Challenge to my SAEM colleagues is this: We must recognize and accept our personal “give-back” responsibility, and significantly increase our annual SAEM membership participation in our own SAEM Research Foundation, for the benefit of our specialty and our patients. Please enthusiastically demonstrate your understanding, acceptance and financial support for our SAEM Research Foundation. ◗ Thank you for your kind attention and generous consideration. David E. Wilcox, MD, FACEP

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Academ ic Announcements Douglas Ander MD has been promoted to Professor,

Emory University Department of Emergency Medicine. Dr. Ander is the Director of Undergraduate Education for the Department, and serves as Assistant Dean, Emory School of Medicine, with a focus on medical student curricular design, delivery and evaluation, utilizing the Emory Center for Experiential Learning and Simulation.

Dr. Francis Mencl, MD, MS has been promoted

to Professor of Emergency Medicine at Northeast Ohio Medical University (NEOMED), formerly the Northeastern Ohio University Colleges of Medicine (NEOUCOM). He is the EMS Director at Summa Health System in Akron, Ohio, as well as the International EMS Fellowship Director.

Daniel C. Morris, MD, was recently awarded by Gary M. Gaddis, MD, PhD has been promoted

to Professor of Emergency Medicine at the University of MissouriKansas City (UMKC) School of Medicine. Dr. Gaddis serves as the St. Luke’s/Missouri Endowed Chair for Emergency Medicine at the St. Luke’s Hospital of Kansas City, an affiliate hospital of the UMKC School of Medicine. He is also a Senior Associate Editor for the journal Academic Emergency Medicine.

the NIH/National Institutes of Aging a R01 “Treatment of stroke in young and aged rats using Thymosin beta 4.” Dr. Morris is a senior staff physician at Henry Ford Hospital, Department of Emergency Medicine. The grant will focus on optimizing dose and time of administration of Thymosin beta 4 in a rat model of embolic stroke. The results of this preclinical trial will provide data for clinical trials in humans.

Elisabeth Edelstein, MD, Director of Wilderness

Henry E. Wang, MD, MS, Associate Professor

Medicine and Associate Director of Undergraduate Medical Education in the Department of Emergency Medicine at Jefferson Medical College, has been awarded the Wilderness Medicine Society Education Award. This award is given in recognition of outstanding contributions in education to students, members, or the public in the field of Wilderness Medicine.

MEDICAL DIRECTOR POSITION The University of Washington (UW) School of Medicine, Division of Emergency Medicine is seeking a Medical Director for the University of Washington Medical Center (UWMC) Emergency Department. The UWMC is a tertiary/quaternary care hospital serving the locale as well as a large regional area, and is the home of the UW Medicine Regional Heart Center. There is a very active QA/QI program that is well integrated and supported by the medical center. The Division of Emergency Medicine encompasses both the UWMC and the Harborview Medical Center EDs. This position will join a broader team of Operations Improvement that spans the EDs of both medical centers. The position holds tremendous opportunity for growth and great program development potential. The UW Emergency Medicine Residency Program recently received ACGME accreditation and will be welcoming our first class of residents in July 2011. The UWMC ED will be core to this program. This is a full-time position that would be at the Assistant Professor, Associate Professor or Full Professor rank, commensurate with experience, and without tenure due to funding. Candidates must hold an M.D. degree and must be Board Certified/Eligible in emergency medicine. University of Washington faculty engage in teaching, research and service. Please send your CV and cover letter to: Dr. Susan Stern, Professor and Head, Division of Emergency Medicine at sstern@uw.edu (206-744-2122). The UW School of Medicine is a regional resource for Washington, Wyoming, Alaska, Montana and Idaho - the WWAMI states. The UW School of Medicine is recognized for its excellence in clinical training, for its world-class research initiatives, and for its commitment to community service. Graduates of foreign (non-U.S.) medical schools must show successful completion of all three steps of the U.S. Medical Licensing Exam (USMLE), or equivalent as determined by the Secretary of Health and Human Services. The UW is an affirmative action, equal opportunity employer.

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and Vice Chair for Research, Department of Emergency Medicine, University of Alabama at Birmingham, received grant award R01NR012726 from the National Institute of Nursing Research for his proposal “Risk Factors for Sepsis in the Community.” Dr. Wang’s $2.7-million, five-year study will use the infrastructure of the 30,000subject REGARDS cohort to identify the individual- and communitylevel risk factors associated with the development of sepsis.

Acad e m i c Em e r g e n cy M e d i c i n e N o w O f f e rs C M E Cr e d it ACADEMIC EMERGENCY MEDICINE is now offering continuing medical education (CME) credits for reading select articles in the journal and successfully completing a test on the content. Physicians interested in completing the exam should log on to www.wileyblackwellcme.com. Upon

successfully

finishing

the

activity,

physicians will receive an electronic certificate of completion, which can be printed and saved online under the user’s profile. The program is free to subscribers of the journal. Stay tuned for updates!


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

Call For Papers

2012 Academic Emergency Medicine Consensus Conference “Education Research in Emergency Medicine: Opportunities, Challenges and Strategies for Success” The 2012 Academic Emergency Medicine Consensus Conference, “Education Research in Emergency Medicine: Opportunities, Challenges and Strategies for Success,” will be held on May 9, 2012, immediately preceding the SAEM Annual Meeting in Chicago, Illinois. Original papers on the conference topic, if accepted, will be published together with the conference proceedings in the December 2012 issue of Academic Emergency Medicine. A divide has traditionally existed in academic medicine between the educator and the researcher. The goal of this conference is to bridge this gap, by exploring the principles that guide these two allied disciplines in order to create a unified focus on education research science that will benefit our teachers, our learners, and, ultimately, our patients. Emergency medicine (EM) educators have long perceived the need for better research to guide the frequent challenges encountered in the academic environment. These include identifying best practice teaching methods, validating assessment tools, evaluating competency, and preventing cognitive errors. Efforts to address these challenges have begun; however, the historical use of suboptimal study designs, subjective outcomes, small samples sizes, and lack of expertise in methods useful in other domains can limit the success of education research studies. A coordinated agenda for EM education research is needed to address these topics and streamline our research efforts. The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project now mandates that training programs demonstrate the effectiveness of educational interventions and show evidence of trainee aptitude and achievement in the core competencies. The American Board of Emergency Medicine (ABEM) now requires its diplomates to provide evidence of Assessment of Practice Performance in order to receive continuous certification. These and other requirements highlight the current paucity of available evidence to inform our instruction and evaluation of emergency physicians, and call for our field to develop high-quality education research. A systematic approach to education research in EM is essential for the continued improvement of clinical emergency care, even for providers beyond residency training. In the decade since the Institute of Medicine’s 2001 “Crossing the Quality Chasm” report identified the failure of health care environments to consistently deliver evidence-based care, the increased emphasis on translational research and patient safety has identified even broader needs for education-based research. Without welldesigned studies to investigate the most effective methods to teach and evaluate emergency physicians, scientific discoveries cannot be effectively disseminated to physicians in training or in practice, nor can the benefits be fully realized by our patients. This Consensus Conference on “Education Research in Emergency Medicine” proposes to build a solid foundation upon

which EM education researchers can build interdisciplinary scholarship, networks of expertise, discussion forums, multicenter collaborations, evidence-based publications and improved learner education. Such efforts will enable us to make significant contributions to the state of knowledge in medical education and, ultimately, to optimize patient care. Consensus Conference Goals: • Provide an overview of the current state of education research in EM • Identify and examine the barriers that educators face in conducting well-powered, rigorous education research, and develop recommendations for overcoming these barriers • Define most appropriate and effective methods for conducting education research studies • Identify priority agenda areas within specific education research domains, such as: o Establishing the effectiveness of clinical and didactic curricula in educating EM trainees in each of the six ACGME core competencies o Evaluating performance of learners across the continuum of medical education, from medical student to practicing emergency physician o Validating educational assessment tools o Teaching and evaluating non-cognitive ACGME core competencies, such as “Professionalism” and “Interpersonal and Communication Skills” o Measuring the impact of educational interventions to improve patient safety o Research designs conducive to studying education outcomes • Develop a framework to increase collaboration, access to research support and potential funding sources and promote faculty development in education research Original contributions describing relevant research or concepts on this topic will be considered for publication in the December 2012 issue of Academic Emergency Medicine if received by Monday, March 12, 2012. All submissions will undergo peer review and publication cannot be guaranteed. For queries, please contact Nicole DeIorio, MD (deiorion@ohsu.edu), Joseph LaMantia, MD (JLaManti@nshs.edu), or Lalena Yarris, MD (yarrisl@ohsu.edu), Consensus Conference Co-chairs. Information and updates will be regularly posted in Academic Emergency Medicine, the SAEM Newsletter, and the journal and SAEM websites.

DEADLINES Abstracts – Open October 31, 2011 — Close December 9, 2011 IEMEs – Open November 14, 2011 — Close January 13, 2012 Photo Competition – Open December 5, 2011— Close February 2012

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CALLS AND M EETING ANNOUNCEM ENTS continued...

Call For Papers

Evidence-based Medicine Academic Emergency Medicine is soliciting authors for writing structured Evidence-based Medicine (EBM) review articles on topics relevant to the practice of emergency medicine. These reviews are designed to provide answers to the clinical questions raised by emergency physicians in their day-to-day practice. These reviews are expected to identify and appraise high-quality studies with designs most appropriate for the research question at hand. The structured format and methodical approach of these manuscripts ensure a unified stepwise evidence-based approach to translate the research findings into clinical practice. In the absence of high-quality systematic reviews and metaanalyses, these reviews can cast light on numerous dilemmas that emergency physicians encounter in their practice. The instructions for preparing structured EBM reviews can be found under the “Progressive Clinical Practice” section (http://www.wiley.com/ bw/submit.asp?ref=1069-6563&site=1). The authors will be guided through the manuscript preparation by one of the editors with experience in writing EBM and/or systematic reviews. The editors also welcome topic suggestions for such reviews. These suggestions will help generate a topic list that would be made available to interested authors. The format of EBM reviews can be viewed in some of the published manuscripts from these series: Hom J. The risk of intra-abdominal injuries in pediatric patients with stable blunt abdominal trauma and negative abdominal computed tomography. Acad Emerg Med. 2010;17:469-75. Palamidessi N, Sinert R, Falzon L, Zehtabchi S. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Acad Emerg Med. 2010;17:126-32. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17:11-7. Zehtabchi S, Nishijima DK. Impact of transfusion of fresh-frozen plasma and packed red blood cells in a 1:1 ratio on survival of emergency department patients with severe trauma. Acad Emerg Med. 2009;16:371-8 To get started on your EBM review, or with questions or suggestions, please contact Shahriar Zehtabchi, MD (Shahriar.zehtabchi@downstate.edu).

Call For Papers

SAEM Seeks Award Nominations for 2012 The Awards Committee wishes to consider as many exceptional candidates as possible. For submission information, see our web site at http://www.saem.org Click on Education & Careers and then Awards

Young Investigator Awards Deadline: December 14, 2011 SAEM identifies up to three (3) awardees for the Young Investigator Awards each year. This award recognizes 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 and this award recognizes those who have achieved early success in this sphere. Hal Jayne Educational Excellence Award Deadline: January 2, 2012 SAEM seeks nominations for the Hal Jayne Educational Excellence Award. Complimentary to the Research Award and as the second pillar of SAEM, this 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 2, 2012 SAEM seeks nominations for the Excellence in Research Award. Complimentary to the Hal Jayne Education Award and as the third pillar of SAEM, 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

Consensus Conference Follow-Up Manuscripts

Deadline: January 9, 2012

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

SAEM is soliciting nominees for the Advancement of Women in Academic Emergency Medicine Award. This award recognizes an SAEM member who has made significant contributions to the advancement of women in academic emergency medicine.

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Leadership Award Deadline: January 2, 2012 SAEM seeks nominations for the Leadership Award. This award honors a SAEM member who has made exceptional contributions to emergency medicine through leadership - locally, regionally, nationally or internationally.


CALLS AND M EETING ANNOUNCEM ENTS

Call for Abstract Reviewers

continued...

Call for Abstracts 2012 Society for Academic Emergency Medicine Annual Meeting May 9-12, 2012 Chicago, Illinois The Program Committee is accepting abstracts for review for presentation at the 2012 SAEM Annual Meeting. Authors are invited to submit original emergency medicine research in the following categories: Abdominal/Gastrointestinal/ Genitourinary

Ethics

AEM Consensus Conference - Education Research in Emergency Medicine: Opportunities, Challenges and Strategies for Success

Health Care Research and Policy

Geriatrics

The Program Committee is currently accepting applications to serve as expert reviewers of scientific abstracts submitted for consideration of presentation at the 2012 Annual Meeting, which will be held May 9-12 in Chicago, IL. The minimum requirement for new abstract reviewers is at least two first author peer-reviewed original research manuscripts in the topic area for which you are applying. Residents are invited to apply but must meet the same criteria. If you have been an abstract reviewer in the past five years, you do not need to reapply. Interested individuals should submit to saem@saem.org the following by October 5, 2011: an abbreviated CV (full CVs will not be considered) with a detailed listing of peer-reviewed original research publications, review articles, textbook chapters, and prior scientific abstract presentations published on the specific area(s) of expertise selected from the list below:

Infectious Diseases International Emergency Medicine

Abdominal/Gastrointestinal/ Genitourinary

Ethics

Cardiovascular – Basic Sciences

Neurology

Cardiovascular – Clinical Research

Health Care Research and Policy

Orthopedics Pediatrics – Infectious Diseases

AEM Consensus Conference - Education Research in Emergency Medicine: Opportunities, Challenges and Strategies for Success

Pediatrics - General

Airway/Anesthesia/Analgesia

Professional Development

Cardiovascular – Basic Sciences

Neurology

Pulmonary

Cardiovascular – Clinical Research

Orthopedics

Research Design/Methodology/ Statistics

Clinical Decision Guidelines

Airway/Anesthesia/Analgesia

Clinical Decision Guidelines Clinical Operations – Personnel Clinical Operations – Processes Computer Technology Critical Care/Resuscitation Diagnostic Technologies/ Radiology Disaster Medicine Disease/Injury Prevention Education EMS/Out-of-Hospital – Cardiac Arrest

Obstetrics/Gynecology

Psychiatry/Social Issues

Simulation Toxicology/Environmental Trauma Other

EMS/Out-of-Hospital – Non-Cardiac Arrest

Proposals for Innovations in Emergency Medicine Education (IEME) will be solicited with a deadline in January 2012. Submission information will appear online on the SAEM Annual Meeting webpage www.saem.org in October 2011. The abstract submission form and instructions will be available on the SAEM website at www.saem.org in October 2011. For further information or questions, contact SAEM at saem@saem.org or 847-813-9823. Only reports of original research may be submitted. The data must not be published in a manuscript or e-publication prior to the first day of the annual meeting. Original abstracts presented at SAEM 2011-2012 regional meetings or the 2012 CORD Academic Assembly will be considered. Abstracts accepted for publication at the Annual Meeting will be published in the Academic Emergency Medicine online supplement. SAEM strongly encourages authors to submit their manuscripts to AEM. AEM will notify authors of a decision regarding publication within 60 days of receipt of a manuscript.

Clinical Operations – Personnel Clinical Operations – Processes Computer Technology Critical Care/Resuscitation Diagnostic Technologies/ Radiology Disaster Medicine Disease/Injury Prevention Education EMS/Out-of-Hospital – Cardiac Arrest

Geriatrics

Infectious Diseases International Emergency Medicine Obstetrics/Gynecology Pediatrics – Infectious Diseases Pediatrics - General Professional Development Psychiatry/Social Issues Pulmonary Research Design/Methodology/ Statistics Simulation Toxicology/Environmental Trauma Other

EMS/Out-of-Hospital – Non-Cardiac Arrest

Each year, the Program Committee selects approximately six reviewers for each of the topic areas, including expert reviewers and members of the Program Committee. Therefore, not every approved reviewer will be invited to review each year. Individuals selected to review submitted abstracts will be expected to review up to 100 abstracts, must adhere to the SAEM abstract scoring system, and must submit their abstract scores by the deadline. The deadline for authors to submit abstracts is December 9, 2011. Abstracts will be available for review by December 12 and abstract scores will be due by 5:00 pm CST on January 4, 2012. All scores will be submitted online.

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CALLS AND M EETING ANNOUNCEM ENTS continued...

Call for Nominations Nominations are sought for the election for the resident board of directors member of SAEM that will be held in 2012. The Nominating Committee will select a slate of nominees based on the following criteria: previous service to SAEM, leadership potential, interpersonal skills, and the ability to advance the broad interests of the membership and academic emergency medicine. This is a one year term. Interested members are encouraged to review the appropriate SAEM orientation guidelines (to consider the responsibilities and expectations of an SAEM elected position. The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more than one nominee for each position. Nominations may be submitted by the candidate or any SAEM member . Orientation guidelines are available at www.saem.org. Please submit your CV and letter of interest to saem@saem.org Deadline: Tuesday, December 7, 2011

Honoraria Assignment: A Painless Way to Contribute to the SAEM Foundation A $1000 contribution to anything sounds daunting, especially when gas is expensive and taxes are going up, but one method by which many SAEM members can contribute to the SAEM Foundation may make the donation less painful. Many SAEM members receive honoraria for speaking, consulting, etc. Often these checks are greater than the $1000 level. Wouldn’t it be easy to just sign one of those checks over to the SAEM Foundation? If it never hits the checkbook, you may not feel it as much. It’s similar to the pre-tax contributions to a 401K or pension fund, for instance, in that you never have to write the check. The problem with assignment of honoraria to the SAEM Foundation, however, is that it must to be done right in order to avoid tax penalties. Rather than take an honorarium as income, and be taxed on it, simply assign the honorarium to the SAEM Foundation. When filling out the appropriate paperwork for honoraria reimbursement, simply put that the check should be made out to the “SAEM Foundation,” and give the honorarium payer the SAEM Tax ID number: 20-4866532. On the memo line, ask that they designate Education or Research Fund. Have the check sent to you, but made out to the SAEM Foundation. You can then send the check to SAEM, with a cover letter that explains the nature of the contribution. That way you can get “credit” for the contribution from SAEM. This method is simple, painless, and, most importantly, an investment in the future of academic emergency medicine. Thank you for your contributions. If you have further questions regarding contributions to the SAEM Foundation, please contact Holly Gouin at hgouin@saem.org or 847-813-9823 ext. 210 at SAEM headquarters. Contributions can be mailed to: SAEM Foundation 2340 S. River Road, Suite 200 • Des Plaines, IL 60018

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2011/2012 SAEM Grant and Scholarship Information SAEM is pleased to offer a variety of grants available for competitive application. SAEM/Physio-Control EMS Fellowship – This grant awards $60,000 over a 12-month period to support a fellowship in Emergency Medical Services (EMS). The Emergency Medical Services Research Fellowship Grant strives to foster teaching, education, and research in emergency medicine. Through the generous support of Physio-Control, this fellowship in EMS provides an opportunity for a qualified emergency physician to acquire important skills and begin to develop expertise as part of an academic career with a focus in EMS. The mission of the grant is to develop the academic potential of the selected fellow by providing support for a one-year training fellowship that develops both EMS leadership and research. Potential for, and experience with, EMS leadership and research will be weighted equally when evaluating applications. Leadership will include, but will not be limited to, involvement with administration, education, and prehospital medical direction. Application Deadline Extended to November 1, 2011 Additional upcoming SAEM grants include: SAEM / ACMT Michael P. Spadafora Toxicology Scholarship ($1,500) - Scholarship fund to encourage Emergency Medicine residents to pursue Medical Toxicology fellowship training. One recipient will be chosen to attend a national toxicology conference. Application Deadline: August 1, 2012 SAEM Institutional Research Training Grant ($75,000/yr. for 2 years) - The Institutional Research Training Grant (IRTG) is intended to identify, develop, and fund promising institutions dedicated to providing high quality training to research fellows in emergency medicine. Application Deadline: August 1, 2012 SAEM Research Training Grant ($75,000/yr. for 2 years) - The Research Training Grant (RTG) is intended to provide funding to support the development of a scientist in emergency medicine. Application Deadline: August 1, 2012 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.


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

VIRTUAL ISSUES “Virtual Issues” will be a key feature of the journal’s new home page on our publisher’s recently implemented platform, Wiley Online Library (WOL). A virtual issue is basically just a collection of articles on a given topic - so the EMS virtual issue, for example, will be a running compilation of all EMS articles that we publish. The idea is that a reader will go there to look for a particular article, but then will see our other offerings on that topic as well - increasing our full-text download numbers and helping ensure the broadest dissemination of our authors’ work. The first Geriatrics Virtual Issue is online. Go to the journal’s home page on the WOL platform, see “Special Features” on the left-hand side and click on the feature. http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1553-2712 Stay tuned for updates!

Academic Emergency Medicine on the Wiley Online Library Platform Make sure you keep checking the journal’s home page on the recently implemented platform, Wiley Online Library (WOL) - http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1553-2712. Many new features appear in the form of “modules” and will be updated on a regular basis. The new platform is more robust and easier to navigate, with enhanced online functionality. Visit often and stay tuned for updates!

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University of Washington, School of Medicine

DISTRICT OF COLUMBIA-The Department of Emergency Medicine of the George Washington University is seeking physicians for our academic practice. Physicians are employed by Medical Faculty Associates, an independent, University-affiliated, not-for-profit multispecialty physician group. The Department provides staffing for the Emergency Units of George Washington University Hospital, Prince Georges Hospital Center, the Walter Reed National Military Medical Center and the DC Veterans' Administration Medical Center. The Department sponsors an Emergency Medicine Residency, 8 Emergency Medicine Fellowships and a variety of student programs. We are seeking physicians who will participate in our clinical and educational programs and contribute to the Department's research and consulting agenda. Basic Qualifications: Physicians should be residency trained in Emergency Medicine. University faculty rank will be commensurate with experience. Application Procedure: A CV is considered a completed application. Review of applications will begin on October 10, 2011 and continue until all positions are filled. Please submit CV by mail to Robert Shesser MD, Chair, Department of Emergency Medicine, George Washington University, 2150 Pennsylvania Avenue NW, Suite 2B-417, Washington DC 20037 or by email at: rshesser@mfa.gwu.edu. The George Washington University is an Equal Opportunity/Affirative Action employer. www.gwemed.edu

Academic Emergency Physician

The University of Washington (UW) School of Medicine, Division of Emergency Medicine is seeking highly motivated, board prepared/certified, academically oriented Emergency Medicine physicians. There are excellent and wide ranging opportunities for those who seek a career with an academic focus in research (basic science or clinical) or medical education. Opportunities to collaborate with wellestablished researchers in areas such as Resuscitation, Injury Prevention, Public Health, Health Services, Pre-Hospital Care, Simulation and many others are abundant. There are also opportunities to work with the UW Department of Medical Education and Biomedical Informatics, which offers course work focused on faculty development and general medical education, including their nationally recognized Teaching Scholars Program. Faculty will work at Harborview Medical Center Emergency Department, which is the only Level I Trauma Center for a 4-state region and sees 65,000 patients per year, and the University of Washington Medical Center Emergency Department, which sees 26,000 patients per year. The UW School of Medicine is a regional resource for Washington state, Wyoming, Alaska, Montana and Idaho - the WWAMI states. If you love to teach and are interested in helping to build a world-class EM Residency program at the highly acclaimed UW School of Medicine please send your CV to: Susan Stern, MD; Professor and Division Head, Emergency Medicine; Harborview Medical Center; 325 9th Avenue; Box 359702; Seattle, WA 98104-2499 (sstern@uw.edu). The UW is building a culturally diverse faculty and strongly encourages applications from women and minority candidates. UW is an Equal Opportunity/Affirmative Action employer.

Oregon Health and Science University Emergency Medicine Fellowships

Emergency Medicine Faculty Positions The University of Miami Miller School of Medicine is presently recruiting for faculty positions in the Division of Emergency Medicine. Applicants must be Board Certified or Board Eligible in Emergency Medicine (ABEM or AOBEM), with an active (or eligible) Florida medical license. Initial appointments will focus on clinical care in our high-acuity Emergency Department, with an active role in medical education for medical students, residents and staff. Our hospital serves as a major cardiovascular referral center with 24/7 specialty back-up in all disciplines. There are outstanding opportunities available for special interests, including disaster management, EMS, medical administration, geriatric emergency care, palliative care, toxicology, simulation education, sports medicine and global medicine. There are significant opportunities for collaborative research, clinical and educational projects with UM faculty from all other medical specialties, plus other UM schools such as Law, Business, and Marine Sciences. These faculty positions will be in the Clinical Educator track, with competitive salary and full UM benefits. Rank and compensation are dependent upon qualifications. UMMSM seeks qualified applicants with a strong commitment to support our academic and clinical missions. Please send a cover letter and your CV to: Marc Halman, Vice Chair Administration Department of Medicine mhalman@med.miami.edu An equal opportunity/affirmative action employer.

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Administration Global Health Toxicology Pediatric EM

Education Research Ultrasound

Get more out of your fellowship at OHSU. Experience the healing, teaching and discovery of a renowned academic health center. Be captivated by the outdoor adventures, art and culture of the Pacific Northwest. Enjoy the breadth of diversity Portland offers as the #1 most livable city named by Forbes magazine â&#x20AC;&#x201C; make OHSU and Portland your home. For more information please visit our website: http://www.ohsu.edu/emergency/education Or contact: Glenna Davis Human Resources Manager OHSU Emergency Medicine, CDW-EM 3181 SW Sam Jackson Park Road Portland, OR 97239-3098 Phone: (503) 494-7008 Email: davisgl@ohsu.edu


The University of California, Davis School of Medicine, Department of Emergency Medicine is conducting a faculty search for a mid-career Emergency Medicine physician with performance improvement (PI) interest and experience, and interest in programmatic development and administration. The Department currently has a robust PI committee, but is looking for a candidate to incorporate quality measures and benchmarks into our clinical practice and ED electronic health record. For the qualified individual, there are substantial opportunities for leadership and growth within the Department and the School of Medicine. Candidates must be residency trained in Emergency Medicine with board certification/preparation and be eligible for licensure in California. Fellowship training and at least two years of post-training clinical experience, including PI and quality work are desired. Candidates are expected to enter at the Assistant, Associate or Professor level, commensurate with experience and credentials. The University of California, Davis Medical Center is one of the nationâ&#x20AC;&#x2122;s â&#x20AC;&#x153;Top 50 Hospitals.â&#x20AC;? It is a 576-bed academic medical center with approximately 55,000 Emergency Department visits annually. The Clinical and Translational Science Center (CTSC) at the School of Medicine was one of the first in the nation. Our Department of Emergency Medicine provides comprehensive emergency services to a large local urban and referral population as a level 1 trauma center, paramedic base station and training center. The Department also serves as the primary teaching site for a fully accredited Emergency Medicine residency program, which began more than two decades ago and currently has 40 residents. In 2010 we moved to a new, state-of-the-art ED. In addition to our residency program, there are 5 fellowships, comprising research, ultrasound, toxicology, medical simulation, and advocacy/policy. The Department is also a recent recipient of an NHLBI K12 programmatic award to train the next generation of Emergency Medicine researchers. Salary and benefits are competitive and commensurate with training and experience. Sacramento is located near the northern end of California's Central Valley, with close proximity to Lake Tahoe, San Francisco, and the "wine country" of the Napa and Sonoma valleys. Sports enthusiasts will find Sacramento's climate and opportunities ideal. Interested candidates should submit a letter outlining interests and experience, and curriculum vitae to Deborah Diercks, MD, Search Committee Chair; UC Davis Department of Emergency Medicine; 2315 Stockton Blvd., PSSB 2100; Sacramento, CA 95817. Applications must be received by 1/31/12 to be fully considered. The University of California is an affirmative action/equal opportunity employer.

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PROGRAM DIRECTOR Department of Emergency Medicine Opportunity Charleston Area Medical Center (CAMC) in Charleston, West Virginia is seeking candidates for the position of Program Director within the Department of Emergency Medicine. Candidates must be residency trained in Emergency Medicine and AOBEM certified or eligible for AOBEM certification and have a minimum of three (3) years clinical experience. Providing an excellent experience for residents, CAMC is an 838-bed teaching hospital consisting of three hospital facilities, including a Level I trauma center and a Women and Children’s Hospital. The three Emergency Departments see more than 100,000 patients per year. The Emergency Medicine residency program is a fully accredited four-year program by the American Osteopathic Association (AOA) and approved for a complement of 16 residents. The program is well established and achieved a maximum accreditation status at its most recent review cycle.

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CAMC is the regional campus for more than 100 medical students completing their 3rd and 4th year of clinical training. CAMC has received numerous awards and recognitions for its patient care quality and many services to the community. As West Virginia’s largest city, picturesque Charleston offers both urban amenities and abundant outdoor activities. The Program Director position offers an opportunity to serve as a member of a dynamic team of professionals and faculty serving Southern West Virginia and the region. A highly appealing package is offered which includes excellent remuneration and benefits including equity ownership eligibility within an established democratic group. For additional information please contact: Rachel Klockow Premier Health Care Services (800) 406-8118 | rklockow@phcsday.com Fax: (954) 986-8820

University of Pittsburgh

EMERGENCY MEDICINE FACULTY INSTRUCTOR THROUGH PROFESSOR LEVEL

The University of Pittsburgh in collaboration with the University of Pittsburgh Medical Center (UPMC) have full-time opportunities for emergency medicine residency trained and board certified/prepared candidates. UPMC’s diverse faculty are widely recognized for excellence in research, teaching and clinical care. Our three clinical sites provide tertiary and Level I trauma care to approximately 170,000 ED patients collectively each year while training residents, fellows and students. The toxicology and hyperbaric medicine treatment programs are a part of our department, and we have multiple fellowships. Academic clinician, clinician-investigator or clinician-educator career opportunities exist. We have particular interest in candidates with ultrasound or investigative interests that compliment our current excellence. Salary is commensurate with experience and duties. For further information write to: Donald M. Yealy, MD, Chair, Department of Emergency Medicine, University of Pittsburgh Physicians, 3600 Meyran Avenue, Suite 10028, Pittsburgh, PA 15260.

EOE

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The University of California, Davis School of Medicine, Department of Emergency Medicine is conducting a faculty search for an emergency medicine physician in either a clinician/educator or clinician/researcher track. Candidates must be residency trained in Emergency Medicine with board certification/preparation and be eligible for licensure in California. At least one year of post-training clinical experience and fellowship training are preferred. Candidates are expected to enter at the Assistant/Associate level, commensurate with experience and credentials. The University of California, Davis Medical Center, one of the nationâ&#x20AC;&#x2122;s â&#x20AC;&#x153;Top 50 Hospitals,â&#x20AC;? is a 576-bed academic medical center with approximately 55,000 emergency department visits annually. Our program provides comprehensive emergency services to a large local urban and referral population as a level 1 trauma center, paramedic base station and training center. The Department has a separate area for the care of children, and is one of the leading centers in the Pediatric Emrgency Care Applied Research Network (PECARN). The department also serves as the primary teaching site for a fully-accredited Emergency Medicine residency program. Our residency training program in Emergency Medicine began more than a decade ago and currently has 42 residents. Last year we moved to a new, state-of-the-art facility with greatly expanded space and amenities. Salary and benefits are competitive and commensurate with training and experience. Sacramento is located near the northern end of California's Central Valley, with close proximity to Lake Tahoe, San Francisco, and the "wine country" of the Napa and Sonoma valleys. Sports enthusiasts will find Sacramento's climate and opportunities ideal. Interested candidates should submit a letter outlining interests and experience, and curriculum vitae to: Deborah Diercks, MD, Search Committee Chair UC Davis Department of Emergency Medicine 2315 Stockton Blvd., PSSB 2100 Sacramento, CA 95817. Applications must be received by 1/31/12 to be fully considered. The University of California is an affirmative action/equal opportunity employer.

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Yale University School of Medicine Department of Emergency Medicine Fellowship Programs The Department of Emergency Medicine, Yale University School of Medicine offers fellowships in multiple programs including Research, Ultrasound, Emergency Medical Services, and Global Health in New Haven, Connecticut. The Research fellowship is a new 2-3 year program focused on training clinician scholars as independent researchers in Emergency Medicine. Scholars will earn a Master of Health Sciences degree from Yale combining clinical experience with extensive training in research methods, statistics and research design. With the guidance of research content experts and professional coach mentors, the scholar will develop a research program, complete a publishable project and submit a grant application prior to completion of the program. The program is credentialed by the Society for Academic Emergency Medicine. For further information, contact Gail D’Onofrio MD, MS, gail.donofrio@yale.edu The fellowship in Emergency Ultrasound is a 1-year program that will prepare graduates to lead an academic and/or community emergency ultrasound program. This fellowship satisfies recommendations of all major societies for the interpretation of emergency ultrasound as well as RDMS/RDCS/RVT certification, and will include exposure to aspects of program development and quality assurance. The program consists of structured time in the emergency department performing bedside examinations, examination QA and review, research into new applications, and education in both the academic and the community arenas. We have a particular focus on emergency echo and utilize state-of-the-art equipment and DVD review. For further information, contact Chris Moore, MD, RDMS, RDCS, chris.moore@yale.edu The fellowship in EMS is a 1-2 year program that provides training in all aspects of EMS, including academics, administration, medical oversight, research, teaching, and clinical components. The program focuses on operational EMS, with the fellow actively participating in the system’s physician response team, and all fellows offered training to the Firefighter I or II level. A 1-year MPH program is available for fellows choosing the 2-year program. The fellowship graduate will be prepared for a career in academic EMS and/or medical direction of a local or regional EMS system. For further information, contact David Cone, MD, dave.cone@yale.edu. The program’s SAEM credentialing application is available for review at http://medicine.yale.edu/emergencymed/fellowships/ems/curriculum.aspx The Global Health and International Emergency Medicine fellowship is a 2-year program offered by Yale, partnering Yale with the London School of Hygiene and Tropical Medicine (LSHTM). Fellows will develop a strong foundation in Tropical Medicine and Infectious Disease, Public Health in Developing Countries and Evidence-Based International Medicine. With joint administration through Yale DEM and the LSHTM, the fellowship serves to train future leaders in Global Health and International Emergency Medicine. Fellows will earn a Master of Science degree from the London School of Hygiene and Tropical Medicine. The program provides six months of field experience, ICRC humanitarian assistance training, DTM&H certification, and structured EMS and disaster response training. For further information, contact the fellowship director, Dr. Simon Kotlyar at simon.kotlyar@yale.edu. All require the applicant to be board prepared/certified EM physicians and offer an appointment as a Clinical Instructor to the faculty of the Department of Emergency Medicine at Yale University School of Medicine. Applications are available at the Yale Emergency Medicine web page http://medicine.yale.edu/emergencymed/ and are due by November 15, 2011. Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women and members of minority groups are encouraged to apply.

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¸ Clinician Educator ¸ Clinical Researcher ¸ filled. ¸ Pediatric Emergency Medicine ¸ Ultrasound ¸

Washington DC - The Department of Emergency Medicine at the George Washington University is offering FELLOWSHIP positions begining July 2012: Disaster/EMS * International Emergency Medicine * ED Operations & Leadership * Travel & Transport * Ultrasound * Toxicology * Health Policy * Operations Research * Research * Telemedicine * Extreme Environmental Fellows receive an academic appointment at George Washington University School of Medicine and work clinically at a site staffed by the Department. The Department offers Fellows a common interdisciplinary curriculum, focusing on research methodologies and grant writing. Tuition support for an MPH or equivalent degree is also provided. Complete description of all programs, application instructions and Fellowship Director contacts can be found at http://www.gwemed.edu/fellowships/.

The Department of Emergency Medicine at the Brody School of Medicine at East Carolina University seeks BC/BP emergency and pediatric emergency physicians for tenure or clinical track positions at the rank of assistant professor or above, depending on qualifications. Our current faculty possesses diverse interests and expertise leading to extensive state and national-level involvement. Through this expansion we hope to increase our depth and further develop programs in clinical pediatric EM, clinical research, and our cadre of clinician-educators. The emergency medicine residency is well-established and includes 12 EM and 2 EM/IM residents per year. We treat more than 105,000 patients per year in a state-of-the-art ED at Pitt County Memorial Hospital. PCMH is a rapidly growing level I trauma, cardiac, and regional stroke center. Our tertiary care catchment area includes more than 1.5 million people in eastern North Carolina, many of whom arrive via our integrated mobile critical care and air medical service. Greenville, NC is a fast-growing university community located ninety minutes from the beautiful North Carolina beaches. Cultural and recreational opportunities are abundant. Compensation is competitive and commensurate with qualifications; excellent fringe benefits are provided. Successful applicants will possess outstanding clinical and teaching skills and qualify for appropriate privileges from ECU Physicians and PCMH. Screening will remain open until filled. Confidential inquiry may be made to Theodore Delbridge, MD, MPH, Chair, Department of Emergency Medicine (delbridget@ecu.edu). Must apply online by using ECU OneStop on the main ECU page: www.ecu.edu. ECU is an EEO/AA employer and accommodates individuals with disabilities. Applicants must comply with the Immigration Reform and Control Act. Proper documentation of identity and employability required at the time of employment. Current references must be provided upon request.

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University of Pittsburgh

FELLOWSHIPS The University of Pittsburgh in collaboration with the University of Pittsburgh Medical Center (UPMC) offer fellowships in Toxicology, Emergency Medical Services, Research, and Education. Each fellowship provides intensive training and interaction with the nationally-known experts in each domain from among the faculty in the Department of Emergency Medicine and from the University, with strong multidisciplinary collaboration ongoing. We provide experience in basic or clinical research and 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 one of our core academic Emergency Departments or an affiliated institution. Each applicant should have an MD/DO background or equivalent degree and be board certified/prepared in emergency medicine, Other doctoral prepared candidates also are considered for our research fellowship. 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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Department of Emergency Medicine Yale University School of Medicine Advancing the Science and Practice of Emergency Medicine Residency Program Director and Section Chief The Department of Emergency Medicine at the Yale University School of Medicine seeks to fill the position of Residency Program Director and Chief of the Section of Education. The Department has a fully-accredited four-year residency hosting 52 residents at two teaching hospitals, including the Level One Trauma Center at Yale-New Haven Hospital, which treats 90,000 patients annually. Our didactic curriculum makes extensive use of small-group discussions, audience response technologies, e-learning, and simulation. This year we launched an Area of Concentration Program, to allow residents to explore subspecialties of EM in greater depth. These include Global Health, Public Health, Critical Care, EMS, Toxicology, Ultrasound, and Education. Current fellowship programs in the Department include ultrasound, prehospital care, and global health. The Section of Education consists of seven faculty members, including the Director of Medical Student Education and the Director of Simulation. The successful candidate will be expected to lead the residency and provide visionary leadership for the Section during this time of rapid expansion of the Department. Eligible candidates must be residency-trained and board-certified in emergency medicine, and eligible for appointment at the Associate or full Professor rank. At least three-five years of experience in resident education, with progressive responsibility, is required. A national reputation is expected, as evidenced by publications, presentations at national meetings, and involvement in national organizations. Protected time and salary will be commensurate with education, training and experience. The Department provides an environment fostering faculty development with strong mentorship. We have an outstanding track record of Federal and foundation funding, as well as a mature research infrastructure supported by a faculty Research Director, a Director of Resident Research, a staff of research associates, administrative assistants, and pre-/postaward grant support. The Department currently has in excess of $18 million in Federal funding, including 5 R01 grants. Yale University is a world-class institution providing a wide array of benefits and research opportunities. To apply, please forward your CV and cover letter to Gail Dâ&#x20AC;&#x2122;Onofrio, MD, Chair, marked to the attention of Jamie Petrone via email: jamie.petrone@yale.edu, or mail: Yale University School of Medicine, Department of Emergency Medicine, 464 Congress Ave, P.O. Box 208062, New Haven, CT 06519-1315. Yale University is an affirmative action, equal opportunity employer. Women and members of minority groups are encouraged to apply.

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The University of California, Davis School of Medicine, Department of Emergency Medicine is conducting a faculty search for a pediatric emergency medicine physician in either a clinician/educator or clinician/researcher track. Candidates must be fellowship trained in Pediatric Emergency Medicine with board certification/preparation and be eligible for licensure in California. Candidates are expected to enter at the Assistant/Associate level, commensurate with experience and credentials. The University of California, Davis Medical Center, one of the nationâ&#x20AC;&#x2122;s â&#x20AC;&#x153;Top 50 Hospitals,â&#x20AC;? is a 576-bed academic medical center with approximately 55,000 emergency department visits annually. Our program provides comprehensive emergency services to a large local urban and referral population as a level 1 trauma center, paramedic base station and training center. The Department has a separate area for the care of children, and is one of the leading centers in the Pediatric Emrgency Care Applied Research Network (PECARN). The department also serves as the primary teaching site for a fully accredited Emergency Medicine residency program. Our residency training program in Emergency Medicine began more than a decade ago and currently has 42 residents. Last year we moved to a new, state-of-the-art facility with greatly expanded space and amenities. Salary and benefits are competitive and commensurate with training and experience. Sacramento is located near the northern end of California's Central Valley, with close proximity to Lake Tahoe, San Francisco, and the "wine country" of the Napa and Sonoma valleys. Sports enthusiasts will find Sacramento's climate and opportunities ideal. Interested candidates should submit a letter outlining interests and experience, and curriculum vitae to: Deborah Diercks, MD, Search Committee Chair UC Davis Department of Emergency Medicine 2315 Stockton Blvd., PSSB 2100 Sacramento, CA 95817. Applications must be received by 1/31/12 to be fully considered. The University of California is an affirmative action/equal opportunity employer.

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Emergency Physician Exceptional opportunity for highly motivated Emergency Physician (BE/BC) to join the Division of Emergency Medicine at the University of Wisconsin School of Medicine & Public Health in Madison, Wisconsin. We are seeking applicants who are interested in furthering a professional career in academic emergency medicine. Specific leadership and/or program development opportunities exist in medical direction, ultrasound and research. EM faculty provide clinical services in the Emergency Department (ED) of the University of Wisconsin Hospital & Clinics (UWHC). UWHC is a busy, university-based, referral hospital; one of only two academic medical centers in the state, and a Level I Trauma and Burn center for both adult and pediatric patients. EM faculty supervises EM and off-service residents, as well as medical students. The successful candidate will join a faculty of over 23 emergency physicians and pediatric emergency physicians. Madison is the capital of Wisconsin and a vibrant city boasting many recreational resources, cultural, and athletic events. Madison consistently ranks as a top community in which to live, work, play, and raise a family. Compensation and benefits are extremely competitive. To inquire, send your curriculum vitae and cover letter to: (E-mail preferred) agh@medicine.wisc.edu, Azita G. Hamedani, MD MPH, F2/217 Clinical Science Center, MC 3280, 600 Highland Ave., Madison, WI 53792. The UW Madison is an EEO/AA Employer, Minorities and women are encouraged to apply. Wisconsin caregiver and open records laws apply. A background check will be conducted prior to employment.

The Department of Emergency Medicine at the University of Alabama School of Medicine is seeking talented residency-trained Emergency Medicine physicians at all academic ranks to join our faculty. The University offers both tenure and non-tenure earning positions. The University of Alabama Hospital is a 903-bed teaching hospital, with a state of the art emergency department that occupies an area the size of a football field. The Department treats over 75,000 patients annually and houses Alabama’s only designated Level I trauma center. The Department’s dynamic, challenging emergency medicine residency training program is the only one of its kind in the State of Alabama. The University of Alabama at Birmingham (UAB) is a major research center with over #15405 $440 million in NIH and other extramural funding. The Department of Emergency is a site for the NIH-funded Resuscitation Outcomes Consortium (ROC) and 3.5”Medicine x 4.75” for the Protocolized Care of Early Sepsis Shock trial (ProCESS). The Department has been highly successful in developing extramural research support in this warmly collaborative institution.

Birmingham Alabama is a vibrant, diverse, beautiful city located in the foothills of the Appalachian Mountains. The metropolitan area is home to over one million people, who enjoy recreational activities year round because of its mild southern Climate. Birmingham combines big city amenities with Southern charm and hospitality. 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; OHB 251; Birmingham, AL 35249-7013

Department of Emergency Medicine  Yale University School of Medicine  Advancing the Science and Practice of Emergency Medicine The Department of Emergency Medicine at the Yale University School of Medicine is expanding! We are seeking  faculty at all levels with interests in patient care, education, and research to enhance our existing strengths. The successful candidate will be committed to excellence in patient care, education and promoting scholarship to enhance the mission of  the department. We offer an extensive faculty development program for junior and more senior faculty.  We have a wellestablished track record of collaborating with other renowned faculty, obtaining federal and private foundation funding,  and a mature research infrastructure supported by a faculty Research Director, a staff of research associates and  administrative assistants.   Eligible candidates must be residency-trained and board-certified in emergency medicine.  Rank, protected time, and  salary will be commensurate with education, training and experience.  Yale University is a world-class institution providing a wide array of benefits and research opportunities.   To apply, please forward your CV and cover letter to Gail D’Onofrio, MD, Chair, via email: jamie.petrone@yale.edu, or mail: Yale University School of Medicine, Department of Emergency Medicine, 464 Congress Ave, P.O. Box 208062, New Haven, CT 06519-1315. Yale University is an affirmative action, equal opportunity employer. Women and members of minority groups are encouraged to apply.

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Ƒ Active - $545.00 Individuals with advanced degree university

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Interest Groups: Society members are invited to join any of the dedicated Interest Groups listed below. Each membership category includes ONE Interest Group free of charge. Additional Interest Groups can be added for $25.00 Ƒ Academic Informatics Ƒ Airway Ƒ CPR/Ischemia/Reperfusion Ƒ Clinical Directors Ƒ Disaster Medicine Ƒ Diversity Ƒ ED Crowding

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

Rev. Date 10/13/2010


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

Board of Directors Debra E. Houry, MD, MPH President Cherri D. Hobgood, MD President-Elect Deborah B. Diercks, MD Secretary-Treasurer Jeffrey A. Kline, MD Past President Brigitte M. Baumann, MD, DTM&H, MSCE Andra L. Blomkalns, MD Robert S. Hockberger, MD Alan E. Jones, MD Brent R. King, MD Sarah A. Stahmer, MD Melinda J. Morton, MD, Resident Member Executive Director James R. Tarrant, CAE Send Articles to: newsletter@saem.org Send Ads to: mgreketis@saem.org The SAEM Newsletter is published bimonthly by the Society for Academic Emergency Medicine. The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. For Newsletter archives and e-Newsletters Click on Publications at www.saem.org

FUTURE SAEM ANNUAL M EETINGS 2012 May 9-12 Sheraton Hotel and Towers, Chicago, IL 2013 May 15-19 The Westin Peachtree Plaza, Atlanta, GA 2014 May 14-18 Sheraton Hotel, Dallas, TX 2015 May 13-17 Sheraton Hotel and Marina, San Diego, CA 2012 CORD ANNUAL ACADEMIC ASSEMBLY April 1-4, 2012 Atlanta Marriott Marquis, Atlanta, GA AEM Consensus Conference May 9, 2012 Topic: “ Education Research in Emergency Medicine: Opportunities, Challenges and Strategies for Success.” Co-chairs: N  icole DeIorio, MD; Joseph LaMantia, MD; Lalena Yarris, MD, MCR

Sept - Oct 2011 Newsletter_0  

JAMES HOEKSTRA, MD Chair, SAEM Development Committee Fifty Years of Emergency Medicine Practice Ethical and Legal Dilemmas SEPTEMBER/OCTOBER...

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