September-October 2010

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

SEPTEMBER/OCTOBER 2010 VOLUME XXV NUMBER 5

Caring for

potential organ donors

GIVING BACK in medical education

Improving

PATIENT CARE through collaborative research

David Seaberg, MD Advancing Emergency Medicine for More Than 25 Years.

6$(0 67$)) ([HFXWLYH 'LUHFWRU James R. Tarrant, CAE ext. 212, jtarrant@saem.org

0DUNHWLQJ 0HPEHUVKLS 0DQDJHU Holly Gouin, MBA ext. 210, hgouin@saem.org

+HOS 'HVN 6SHFLDOLVW Neal Hardin ext. 204, nhardin@saem.org

([HFXWLYH 'LUHFWRU &25' Barbara A. Mulder bmulder@saem.org

(GXFDWLRQ &RRUGLQDWRU Kirsten Nadler ext. 207, knadler@saem.org

%RRNNHHSHU Janet Bentley ext. 202, jbentley@saem.org

([HFXWLYH $VVLVWDQW Sandy Rummel ext. 213, srummel@saem.org

0HHWLQJ &RRUGLQDWRU Maryanne Greketis, CMP ext. 209, mgreketis@saem.org

*UDQWV &RRUGLQDWRU Melissa McMillian ext. 207, mmcmillian@saem.org

&XVWRPHU 6HUYLFH &RRUGLQDWRU Michelle Iniguez ext. 201, miniguez@saem.org

,7 &RPPXQLFDWLRQV David Kretz ext. 205, dkretz@saem.org

0HPEHUVKLS $VVLVWDQW Christine Baroud ext. 211, cbaroud@saem.org

,7 +HOS 'HVN Don Geschke ext. 204, dgeschke@saem.org

6$(0 0(0%(56+,3 0HPEHUVKLS &RXQW DV RI $XJXVW

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Active Associate Resident/Fellow Medical Students ,QWHUQDWLRQDO $IÂżOLDWHV Emeritus Honorary 7RWDO

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$155 $130 $130 $110 $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.

6$(0 1(:6/(77(5 $'9(57,6(0(17 5$7(6 The SAEM Newsletter is limited to postings for fellowship and academic positions available and RIIHUV FODVVL¿HG DGV TXDUWHU SDJH KDOI SDJH DQG IXOO SDJH RSWLRQV 7KH 6$(0 1HZVOHWWHU SXEOLVKHU UHTXLUHV WKDW DOO DGV EH VXEPLWWHG LQ FDPHUD UHDG\ IRUPDW PHHWLQJ WKH GLPHQVLRQV RI WKH UHTXHVWHG DG VL]H 6HH VSHFL¿F GLPHQVLRQV OLVWHG EHORZ ‡ $ IXOO SDJH $' FRVWV ´ ZLGH [ ´ KLJK

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We appreciate your proactive commitment to education, as well as 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 2010 are: October 1, 2010 for the November/December issue December 1, 2010 for the January/February 2011 issue February 1, 2011 for the March/April 2011 issue

April 1, 2011 for the May/June 2011 issue June 1, 2011 for the July/August 2011 issue August 1, 2011 for the September/October 2011 issue

Nominations Sought ABEM Board of Directors Deadline: November 1, 2010 The American Board of Emergency Medicine will elect two new directors at its February 2011 Board of Directors meeting. ABEM is soliciting nominations for these two positions from Emergency Medicine organizations. ABEM has invited and encouraged SAEM to submit nominations.

Highlights Hig g 4

President’s Message

The ABEM Nominating Committee will review all nominations and prepare a slate of candidates for consideration by the ABEM Board of Directors, who will vote on this slate at its February, 2011 meeting. The newly elected directors will begin an initial four year term in July, 2011 and upon successful completion of that term, will be eligible for election to a second and ÂżQDO four year term. New directors ZLOO attend the summer 2011 ABEM Board meeting as observers.

7 SAEM Member Highlight

Nominated physicians must meet the following criteria:

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Q Be a graduate of an ACGME-accredited Emergency Medicine residency program.

Ethics In Action

Q Be an ABEM diplomat for a minimum of ten years.

Q Have demonstrated extensive active involvement in organized Emergency Medicine. ,GHDOO\ this LQFOXGHV ORQJ WHUP experience as an ABEM item writer, oral examiner, or ABEM appointed representative.

10

Academic Resident Section

Q Be actively involved in the clinical practice of Emergency Medicine.

Interested SAEM members should send a letter of interest, a current CV, and a letter of willingness to serve by November 1, 2010 to James Tarrant, SAEM Executive Director, jtarrant@saem.org. The SAEM Board of Directors will select a slate of nominees to forward to ABEM.

The 2010 NRMP Match

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20 CDEM Highlights

Midwest Regional Meeting November 8, 2010 Dayton, OH Submit abstracts online at saem.org

Wilderness Medicine Interest Group

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21

RFA for Emergency Medicine Research Training Programs

President’s Message SOCIETY FOR ACADEMIC EMERGENCY MEDICINE Jeffrey A. Kline, MD

Expertise, Part I The good news about this newsletter is that I am not going to mention the words Arizona or Law. Except for that time.

Instead, I am going to address a topic that most of you have been clamoring to read about in exquisite GHWDLO for a ORQJ time.

And that topic is my heirloom tomatoes.

Occasionally, I am fortunate enough, I suppose, to overhear someone refer to me an expert in the disease topic of pulmonary embolism. These words are usually said by a person who happens to be one of my research coordinators, ostensibly to a patient consenting for a clinical study that helps pay the research coordinator’s salary. On other occasions, a resident or medical student, whose grade depends upon my opinion, will ask me how I became a PE expert. In either FDVH I must ÂżJKW to ignore my YHVWLJLDO inner 14 \HDU ROGÂśV sarcastic yammering “you got ‘em fooled ‌the only thing that you are expert in is growing tomatoes!â€? %XW I do not want to OHW a patient or student or resident down. I maintain an expert facial expression and make some expert statements.

JJeffrey ff A. A Kline, Kli MD

But let’s get back to what you really want to know more about. I grow heirlooms from seeds that I either save from last year’s crop using a fermentation process, or I buy them online from my pal, Bob, at www.tomatobob.com. Growing these KHLUORRPV requires a great GHDO of background UHDGLQJ hypothesis generation, experimentation, documentation, household mess, and family cooperation. And by ÂłFRRSHUDWLRQ´ what I mean is putting up with DOO my tomato growing crap in and around the house from about February to August. (And my FXUVLQJ but I am working on that). I sew the seeds in VSHFLDO pH-adjusted starting VRLO in mid February. I XVXDOO\ SODQW 10-12 different varieties with names OLNH “Hanks Big Giant Redâ€? or “Boxcar :LOOLHÂśV Pink Petuniasâ€? or Âł5HDOO\ Good Beefsteak from Last Year.â€? The SURWRFRO requires ORWV of VPDOO FXSV ODEHOV VRLO VHHGV forceps \HV and some huge Tupperware containers. The seeds sprout in 10-14 days.

Then in comes the OLJKWV )LUVW 40-watt ÀXRUHVFHQW EXOEV for three ZHHNV then the HOHFWULF ELOO HOHYDWLQJ 400-watt halogen lights, followed by a visit from the DEA. Eventually, this indoor phase FXOPLQDWHV with WUDQVSODQWLQJ the four-inch tall plants outdoors around tax day. The outdoor phase is even more ULGLFXORXV requiring PXOWLSOH steps to FRPSRVW WLOO aerate, calcinate, phosphorylate, nitrogenate and mulch the 4

soil and my own super special watering system that involves lots of PVC piping. My wife refers to this as my white trash irrigation system, a term that does not offend me in the least.

Also, the invisible fence must be coursing with radio signal to keep Gracie out (for more on *UDFLH see the ÂżUVW SAEM QHZVOHWWHU of this year). This \HDU one of my key VSHFLÂżF aims was to test if plastic ground liner would prevent weed growth, trap moisture and improve yield.

All of this work is worth it because heirlooms taste so much better than those genetic monstrosities FDOOHG hybrids at :DO Mart. +HLUORRPV are ÂżQLFN\ with weak innate LPPXQLW\ and minimal tolerance of heat or pest stress. Best grown by an expert. Expecting a high mortality rate, I start far too many seedlings for my own use, such that I always have many plants to spare. I like to give these to whomever will agree to grow them. This year, I foisted a dozen or so on my colleague, Alan Jones. Alan was my research fellow at one point, and then protĂŠgĂŠ and is now an independent FOLQLFLDQ VFLHQWLVW an expert in sepsis in his own right, funded by NIH, publishing like crazy, and often now my mentor. But he cannot grow tomatoes as well as I can.

I EHOLHYH that WRSLFDO expertise requires three Cs: FKRLFH competence and connectivity. If you are an aspiring LQYHVWLJDWRU then to become an H[SHUW you must ÂżUVW choose to become an expert. You may detest this exercise, but this requires you to say it out ORXG Somebody has to hear these words outside of your mind: “I want to become an expert in‌ VLPXODWLRQ EDVHG approach to invasive SURFHGXUHV VWURNH burns, pain management, informed consent or growing pumpkins.â€? Then it becomes something of a promise to yourself as well as your witness. Much like the aphorism that a great journey begins but with the ÂżUVW VWHS the path to expertise starts the day that you can say that you want to be an expert. So say it. The second C is competence, which is DOO about training and experience (to be the subject of my next PHVVDJH and the third C is connectivity with your peers (the subject of my message after that). To achieve true H[SHUWLVH this third & FRQQHFWLYLW\ requires that you manifest the FRQÂżGHQFH and ZLOOLQJQHVV required to share \RXUVHOI as a mentor. 7KHQ and RQO\ then can you for certain VWLĂ€H your yammering inner 14 year old. I chose to be an expert in thromboembolism and tomatoes, but I have mentored on other topics.

This year, I got my tomatoes in my carefully tended garden a little late. Alan planted his in some untilled red clay in his back yard. I thought sure his would all die from malnutrition, QHJOHFW or perhaps a WHUULEOH EHDJOH UHODWHG GHDWK and if Continued on Page 6

Executive Director’s Message

Intellectual Curiosity: Art and Science of Medicine This time of year medical students are dreaming of the next phase of their journey to become physicians, and residents are viewing the OLJKW at the end of the WXQQHO -- when they can begin to earn a living and practice medicine.

It may also be a time to ponder the intellectual curiosity that brought you to this point in life. Whether choosing an academic career or focusing on patients in the community setting, I hope none of you lose the intellectual curiosity inherent in your profession. SAEM members discuss scholarly activity as a part of a physicians training. A Baylor Medical School article describes the importance of physicians embracing OLIH ORQJ OHDUQLQJ and quest for knowledge by inserting a little scientist in every physician.

Thinking like a scientist is increasingly important for doctors to be effective in treating patients. Medical discoveries are happening so rapidly, much of what medical students learn today will be obsolete in the coming years. Keeping current throughout their career ZLOO require doctors to read and DQDO\]H information about their ¿HOG As medicine has become more complex, the need for this new breed of physician—ones that can translate laboratory discoveries to patient care—has never been greater; however, the supply has not kept pace with the demand.

During my medical administrative career, I have known several physicians who talk about how the path they chose was diverted along the way. Early in my career as Director of Medical Education, a community based internist told me how he was planning a career as a nuclear physicist who was advised that being a physician was the same as “being a scientist�. More UHFHQWO\ a biochemistry major working toward a PhD, was encouraged to consider becoming a physician to combine medicine with his interest in biochemistry. He is an academic anesthesiologist conducting research in Sickle Cell Anemia.

Life takes many turns. The majority of emergency medicine residents ZLOO be providing OLIH VDYLQJ care for patients in the community hospital setting. A smaller number will select an academic career, training the next generation of emergency physicians while advancing the level of training through education and research. A third group will be hybrids, spanning the bridge between academia and community. These EM physicians are at hospitals that serve as DIÂżOLDWH FOLQLFDO training sites for academic programs.

These physicians are challenged daily by the intellectual curiosity of medical students and residents, while providing experience in the art and science of patient care. Residents and faculty can encourage these clinical instructors to reengage with SAEM.

How can we reach more of the residents entering practice, community and clinical faculty to rekindle or retain their VFLHQWLÂżF curiosity?

At the 2010 SAEM Annual Meeting, a California physician approached registration.

I asked him where he worked and he named a hospital which was unfamiliar to me. He stated it was a community hospital with no academic DIÂżOLDWLRQ If James Tarrant Tarrant, CAE this were true, then why was he SAEM Executive Director attending the SAEM meeting?

He described the emphasis that was imparted at his residency training program to retain intellectual curiosity and OHDUQ from the forefront of changes in the ÂżHOG which SAEM provided for him.

As residents consider career choices they need to maintain the commitment to OLIH ORQJ OHDUQLQJ and VWLPXODWLRQ to maintain a high level of knowledge and the opportunity to give back to the profession and patients. .QRZOHGJH and techniques in the KHDOWK ÂżHOG are rapidly expanding. According to Carl Lindsay, James Morrison, and E. James Kelley, it is estimated that the KDOI OLIH of NQRZOHGJH acquired in PHGLFDO VFKRRO is DSSUR[LPDWHO\ ÂżYH years. 7KHUHIRUH in just ÂżYH \HDUV half of what a doctor learns in medical school will be obsolete. With such a vast increase in the knowledge base, it is essential that health professionals, particularly doctors, dentists and nurses, constantly update their VNLOOV In IDFW their SDWLHQWVÂś OLYHV and ZHOO EHLQJ often depend on health professionals keeping current on the latest advances.

Patricia A. McPartland Ed. D. Southeastern Massachusetts Area Health Education Center.

A physician at Cottage Hospital in Grosse Pointe Michigan was respected for his diagnostic skill. He shared his secret.

He said it wasn’t that he was smarter than others, but that he attended courses that challenged him and maintained his knowledge with cutting edge information. With the majority of PHGLFDO VFKRRO NQRZOHGJH out dated in ¿YH \HDUV how ZLOO the next generation retain current NQRZOHGJH" How do you perceive SAEM can help residents prepare for their future careers and be a resource throughout your career no matter what career path you VHOHFW" 3OHDVH forward your thoughts to membership@saem.org.

5

Academic Announcements DR. ROSS DONALDSON, received the 2010 Humanitarian Award from the California chapter of ACEP in recognition of the role he has played with the International Medical Corps in developing a civilian emergency medical care system in ,UDT training over 350 Iraqi physicians to provide emergency care in local communities, establishing three EM residency programs in the FRXQWU\ and authoring ,UDTÂśV 5-Year Strategy for Emergency Medical Care. Dr. Donaldson is the director of the *OREDO +HDOWK )HOORZVKLS at Harbor-UCLA 0HGLFDO Center and an Assistant Clinical Professor of Medicine at the David Geffen 6FKRRO of Medicine at UCLA. NICOLE M. DEIORIO, MD, Associate Professor of Emergency Medicine at Oregon Health and Science 8QLYHUVLW\ has received the )DFXOW\ Mentor Award from the 2010 graduating class of medical students. This award recognizes the faculty member who has best demonstrated outstanding mentoring and advising skills.

DAVID BAHNER MD, RDMS, has been chosen as Professor of the Year at Ohio State’s College of Medicine.

This annual honor is given by the graduating class to one faculty member who they consider a role model and mentor.

Started in 1931, many distinguished Ohio State medical IDFXOW\ have been awarded this distinction. This is the ÂżUVW time in the history of this award that an Emergency Medicine physician has received this honor. Over his 12 years on the

Department of Emergency Medicine faculty, Bahner has been instrumental in introducing and advancing ultrasound in PHGLFDO education. 8OWUDVRXQG is now embedded into all four years of the medical student curriculum, and each student receives a core exposure to XOWUDVRXQG techniques.

The Emergency Department at Ohio State is chaired by Douglas Rund, MD. SHANA KUSIN, MD, McGaw Medical Center of Northwestern University has been named the recipient of the 2010 SAEM Michael P. Spadafora Toxicology Scholarship Award. One recipient is chosen each year to attend the North American Congress of &OLQLFDO 7R[LFRORJ\ (NACCT) conference. This years conference will be held in Denver, &2 October 2010.

PETER D. PANAGOS, MD, has been promoted to Associate Professor of Emergency Medicine and Neurology at Washington University in St. Louis. Dr. Panagos is DOVR the Co-Director of the Barnes-Jewish/Washington University Stroke Network and Barnes-Jewish +RVSLWDO Stroke Center.

He has recently been appointed a Fellow of the American Heart Association/American Stroke Association.

Expertise, Part I – Continued from Page 4

not that, they would just die because they like to die. I expected great things from my tomatoes. What with my expertise and all. $ODV this \HDU SRVVLEO\ as a consequence of the VSHFWDFXODU IDLOXUH of the SODVWLF OLQHU VSHFLÂżF DLP my tomatoes contracted some version of tomato LPPXQRGHÂżFLHQF\ syndrome.

Their roots cooked under the plastic this hot summer, and my babies succumbed to leaf rust, Tomato Mosiac virus, nematodes, blossom rot, end rot, and general rot. They got it DOO Figure 1 demonstrates my SOLJKW 2K the pain of a VSHFLÂżF aim gone bad.

Figure 1. Typical example of my disastrous crop of 2010

On the other KDQG when $ODQ invited my IDPLO\ over for dinner in PLG VXPPHU I witnessed his tomatoes Ă€RXULVKLQJ UHVSOHQGHQW and fat in their beds of red FOD\ No fancy watering system. No death by dog. Of course, they were delicious as heirlooms always are. See Figure 2. “His tomatoes are better than mineâ€? I sighed to my wife as we drove home. “But at OHDVW I grew the VHHGOLQJV for himâ€? I said with a OLJKWHU LQĂ€HFWLRQ trying to VHOI DGPLQLVWHU my tomato mentoring role to sooth my pain. “Those were not your tomatoes‌â€? she said. “Reagan $ODQÂśV wife) said he got those at :DO 0DUW ´ I don’t think Alan wanted me to know that.

Figure 2. Typical example of Alan’s tomato crop in 2010

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David Seaberg, MD – SAEM Member Highlight Dr. David Seaberg has had a career of service in advancing Emergency Medicine over the last 25 years. A strong believer in Servant Leadership, Dr. Seaberg believes that in order to OHDG one must ¿UVW serve.

This tenant is demonstrated throughout his rise from research director, to residency director, to chairman and to his current position as Dean at the University of Tennessee College of Medicine Chattanooga.

After graduating from Washington University with a degree in Chemistry, Dr. Seaberg received his medical degree from the University of Minnesota 6FKRRO of Medicine.

Between his second and third years of medical school, he did a research fellowship in Pediatric Cardiology, which laid the foundation to a career in academic medicine.

It also started a series of mentorships that would help guide him throughout his career. “I was EOHVVHG to have excellent mentors throughout my career to help guide my development. As I advanced in my career, I wanted to give back by serving as a mentor to those training behind me. �Dr. Martin returned home to train in both Emergency Medicine and ,QWHUQDO Medicine at the University of Maryland Medical Center—where he also served as Chief Resident.

He completed his Emergency Medicine training at the University of Pittsburgh $IÂżOLDWHG Residency in Emergency Medicine and was Chief Resident in 198990. After spending one year as Research Director and helping establish an Emergency Medicine residency program at MetroHealth Medical Center in Cleveland, 2KLR he returned to IDFXOW\ at the University of Pittsburgh and served as Vice Chairman of Research at the Mercy Hospital of Pittsburgh.

preparedness for domestic security events. He founded and chaired the University $OOLDQFH for Weapons of Mass Destruction Education and Chaired the Medical/Hospital/ EMS Committee of the State Workgroup on Domestic Security. He also helped form the Emergency Medicine Learning and Resource Center which is a leading source of emergency physician, nursing and EMS education in the Southeast.

In Dr. Seaberg OHIW )ORULGD to become the ÂżUVW Dean of the University of Tennessee &ROOHJH of Medicine Chattanooga where he oversees 576 faculty, 168 residents in 9 residency and 5 fellowship programs, and has over 170 medical students rotating through the campus. He helped establish another Emergency Medicine Residency Program at the University of Tennessee and ZLOO create an academic Department of Emergency Medicine this year. He has worked over the last 2 years to establish the PXOWL VSHFLDOW\ 87 (UODQJHU Physician Practice 3ODQ which has over 130 physicians.

Dr. Seaberg continues to be actively involved in Emergency Medicine. He has served on the ACEP Board of Directors for the ODVW ¿YH years and FXUUHQWO\ serves on the Episodes of Care Taskforce. He was President of the )ORULGD Chapter of ACEP and now serves as an H[ RI¿FLR Board of Directors member of the Tennessee Chapter. He has served on the SAEM Program Committee and has had 40 presentations at the SAEM Annual Meeting over the years, including two at this year’s meeting in Phoenix.

He was recently named to the Board of Directors of the &KDWWDQRRJD +DPLOWRQ County 0HGLFDO Society and serves on the State of Tennessee Health Planning Committee.

Dr. Seaberg and his wife Carol have been married nearly 19 years and have two sons, Ryan, age 16 and Tyler, age 13.

In Dr. Seaberg OHIW the University of Pittsburgh to become the Emergency Medicine Residency Director at the University of )ORULGD -DFNVRQYLOOH program. He was the recipient of the ACEP National Faculty Teaching Award in 1999. After helping create an academic Department of Emergency Medicine, Dr. Seaberg became Chairman of the Gainesville campus in 2000. During his tenure, the Department developed a new Emergency Medicine Residency Program on the Gainesville campus and started the construction of a new Emergency Department.

While in Florida, Dr. Seaberg helped the state’s 7

ETHICS IN ACTION

Caring for Potential Organ Donors in the Emergency Department Glen E. Michael, M.D.a and John E. Jesus, M.D.b a. University of Virginia Dept. of Emergency Medicine, Charlottesville, VA b. Beth-Israel Deaconess Medical Center, Dept. of Emergency Medicine, Boston, MA

Case: A 29 year-old woman is brought to the emergency department (ED) by ambulance after being struck on her bicycle by a FDU WUDYHOOLQJ DW KLJK VSHHG 6KH ZDV LQWXEDWHG LQ WKH ¿HOG ZLWKRXW WKH QHHG IRU DQ\ VHGDWLYH RU SDUDO\WLF PHGLFDWLRQV DIWHU being found unresponsive and apneic by paramedics. On arrival to the ED she has a Glasgow Coma Score (GCS) of 3 ZLWK ¿[HG DQG GLODWHG SXSLOV 6KH LV QRW EUHDWKLQJ VSRQWDQHRXVO\ EXW RQ WKH YHQWLODWRU KHU YLWDO VLJQV DUH VWDEOH +HU LQLWLDO trauma workup reveals atlanto-occipital dissociation and diffuse axonal injury, but CT scans of her chest, abdomen, and pelvis are unremarkable. As you begin to wonder if the patient’s head trauma and apneic period have left her brain dead, a nurse safeguarding her belongings announces that the patient’s driver’s license indicates that she has joined the organ donor registry.

Broaching the Question Approaching the family of a young healthy patient who has died suddenly of traumatic injuries is one of the more GLI¿FXOW tasks we face as physicians. 6LPXOWDQHRXVO\ approaching IDPLO\ members with a request to harvest their daughter’s organs, during a time of maximum shock and grief, can feel like an impossibly cruel gesture. In fact, the rates of obtaining family consent are abysmal when discussions of potential brain death and organ donation are included in the same conversation. Separating the QRWL¿FDWLRQ of SRWHQWLDO brain death from the request for organ donation W\SLFDOO\ made by a trained representative from a ORFDO organ procurement RUJDQL]DWLRQ [OPO]) has been found to be 3-8 times as OLNHO\ to UHVXOW in IDPLO\ consent for donation as FRXSOHG requests. The dramatic difference in rates of consent may be the result of protecting physicians from the perception of a FRQÀLFW of interest when advocating for a patient’s best interests and the interests of the potential organ recipients. Finally, brain death determination requires testing that is DOPRVW never performed in the emergency department. Given these considerations, the most prudent course of action in the ED is to make an early referral to an OPO while refraining from broaching the topic of organ donation with the patient’s family.

Issues of Consent and Autonomy &RQÀLFW can arise when an LQGLYLGXDOœV organ donor registry status and the wishes expressed by the individual’s family differ. It is helpful to consider the legal, ethical, and SUDFWLFDO perspectives in such FRQÀLFWV 1HDUO\ DOO states have adopted the Uniform $QDWRPLFDO Gift $FW which

8

mandates that the donor registry status printed on most state driver’s licenses is considered a legal document, and provides a legal basis that supports using registry status over IDPLO\ wishes when in FRQÀLFW 6LPLODUO\ the ethical principle of respect for autonomy suggests that we should honor the individual’s own previously expressed wish regarding organ donation rather than valuing their family members’ opinion over their own. However, practical considerations often result in deferring to the family’s desires regarding donation. Taking an individual’s organs for donation over the wishes of their family, even when the individual would have wanted to become an organ donor, can result in extreme misgivings among the family and has the potential to negatively impact the societal impression of the organ donation process.

Care of the Patient vs. Care of the Potential Organ Donor Once a family has decided to consent to donate the organs of their brain dead relative, several interventions may be used to preserve those organs including a ventilator to ensure oxygenation, vasopressors to maintain hemodynamic stability, bronchoscopy to maximize pulmonary function, and heparin to prevent vascular thrombosis and ischemia. If brain death is diagnosed and organ procurement is in line with the patient’s wishes and the family’s wishes, then it is acceptable to administer the preceding organ-sustaining treatments. Because brain death is almost never determined in the emergency department, however, emergency physicians cannot ethically administer interventions with the sole purpose of preserving the patient’s organs for donation. This is especially true if those interventions would hasten the

patient’s death or cause the patient harm. As a result, the interventions administered in the ED ought to be those LQWHQGHG WR EHQH¿W WKH SDWLHQW

,PSRUWDQFH DQG &DVH 'LVFXVVLRQ A recent study demonstrated that patients referred from WKH (' IRU SRWHQWLDO RUJDQ GRQDWLRQ ZHUH VLJQLÂżFDQWO\ more likely to become successful donors than patients referred from inpatient settings. 1 Another ongoing study is currently examining the feasibility of harvesting organs from patients after the declaration of cardiac death, and within minutes of their arrival to the E.D.2. These studies highlight the need for emergency physicians to have a basic understanding of the care of the potential organ donor as well as of the ethical issues surrounding the organ procurement process.

In the case presented above, the patient has sustained injuries that have spared her healthy organs and may have resulted in brain death. Though she represents the ideal organ donor, it is important to uncouple the IDPLO\ÂśV QRWLÂżFDWLRQ RI KHU FRQGLWLRQ IURP DQ\ GLVFXVVLRQ

of organ donation. Whenever possible patient autonomy should be respected by following patients’ organ registry status, but in practice family wishes often prevail. An OPO representative should be contacted as soon as possible in order to begin the process of evaluating the patient for organ donation and to facilitate the donation UHTXHVW 8QWLO EUDLQ GHDWK LV GLDJQRVHG DQG FRQVHQW LV obtained, the patient should be treated without regard to the interests of potential organ recipients and transferred WR WKH ,&8 1 Michael GE, O’Connor RE. The importance of emergency medicine in organ donation: successful donation is more likely when potential donors are referred from the emergency department. Acad Emerg Medicine

2 Stein R. Project to get transplant organs from ER SDWLHQWV UDLVHV HWKLFV TXHVWLRQV :DVKLQJWRQ 3RVW Mar 2010; A1

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ACADEMIC RESIDENT SECTION On EHKDOI of the SAEM GME &RPPLWWHH we are SOHDVHG to re-introduce the “Academic Residentâ€? section of the SAEM newsletter. Quarterly articles will focus on topics of interest and importance to emergency medicine residents, with topics recurring on a URXJKO\ 3-year F\FOH It is our hope that you ZLOO ÂżQG these DUWLFOHV to be XVHIXO WRROV in your DFDGHPLF SURIHVVLRQDO 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 0' Georgetown University | Douglas McGee '2 $OEHUW Einstein | Jacob Ufberg 0' 7HPSOH University

Giving Feedback in Medical Education John Houghland MD Chief Resident Denver Health Residency Program in Emergency Medicine Department of Emergency Medicine University of &RORUDGR 6FKRRO of Medicine

Introduction As a compendium of cognitive, psychomotor, and affectual behaviors, clinical skill is easier demonstrated than described. And, like ballet, it is best learned in front of a mirror. Feedback occurs ZKHQ D VWXGHQW RU KRXVH RIÂżFHU LV RIIHUHG LQVLJKW LQWR ZKDW KH RU VKH actually did well as the consequences of his or her actions.

Since Ende’s seminal article, giving learners feedback has been recognized as a crucial component to clinical medical education.1-4 Moreover, medical education has been, and continues to EH a KLJKO\ apprentice-based system. 7KXV it is imperative that all physicians who supervise learners are capable of giving feedback effectively.5 However, feedback has been YDULDEO\ GH¿QHG in the OLWHUDWXUH 6 and disagreement between teachers and learners exists regarding the type and frequency of feedback that DFWXDOO\ occurs.3,7,8 Furthermore, physicians have reported feeling uncomfortable giving feedback9 and may be JHQHUDOO\ LOO HTXLSSHG to do so.10 This DUWLFOH 1. Provides an RSHUDWLRQDO GH¿QLWLRQ of feedback based on recent literature; 2. Discusses the importance of feedback to medical education; 3. Highlights key components of the content and process of effective feedback; 4. Focuses on important behaviors of teachers as well as learners in the feedback process, and 5. Addresses potential problem areas of the feedback process.

What is Feedback? +LVWRULFDOO\ there has been no ZHOO DFFHSWHG GHÂżQLWLRQ of feedback. Believing this to be likely harmful to medical HGXFDWLRQ van de Ridder et DO UHFHQWO\ performed a metaanalysis to investigate the concept of feedback. Within the body of medical education and social sciences literature, three concepts of feedback dominated: 1. Feedback as information, 2. Feedback as a reaction, and 3. Feedback as a cycle. Therefore, the authors proposed the following FRQFHSWXDO and RSHUDWLRQDO GHÂżQLWLRQ of feedback that incorporates each of these elements for further research: ÂłVSHFLÂżF information about the comparison between a WUDLQHHÂśV observed performance and a standard, given with the intent 10

Jeff Druck MD Associate Residency Director Denver Health Residency Program in Emergency Medicine Department of Emergency Medicine University of &RORUDGR 6FKRRO of Medicine

to improve the WUDLQHHœV performance.� 6 This GH¿QLWLRQ directs the supervisor to describe objective performance measures to the WUDLQHH to give constructive critique comparing his or her performance to this standard, and to provide information to help close this performance gap.

Why Feedback?

Having HVWDEOLVKHG a working GHÂżQLWLRQ of IHHGEDFN the question remains: Why give feedback? The VLPSOH answer LV physicians and trainees are QRWRULRXVO\ inaccurate at VHOI assessment.11 To counter this, regulatory guidelines mandate, and experts in graduate medical education recommend, frequent and objective feedback. The Accreditation &RXQFLO for Graduate 0HGLFDO Education requires residency training programs to “provide objective assessments of resident physician competence, use multiple evaluators, document progressive performance, and provide evaluation of performance with feedback.â€? 3 A recent consensus statement from the Council of Emergency Medicine Residency Directors (CORD) Academic $VVHPEO\ states that frequent feedback is important, particularly in the education of the current generation of medical students and residents.12 :KLOH the ODFN of a ZHOO DFFHSWHG GHÂżQLWLRQ of feedback has limited rigorous study of feedback, the available evidence suggests that feedback in its various forms improves both cognitive and procedural competency. Early on, Wigton et al. demonstrated that computer program feedback improved clinical diagnostic skills among medical students,13 and Porte et al. showed that verbal feedback created immediate and lasting improvement in the technical skills performance of medical students learning to suture.14 Finally, there is increasing evidence that UHDO WLPH feedback in the form of simulation medicine is an effective tool that improves learners’ knowledge, clinical decision making, and procedural competency.15-26 Simulation medicine additionally has the advantage of being able to instruct, test, and provide feedback to the learner in both cognitive and procedural realms simultaneously.

*RRG (YDOXDWRUV :KR $UH 7KH\"

connection to feedback likely decreases the signal strength and effectiveness of feedback.

+RZ GR \RX EHFRPH SUR¿FLHQW DW JLYLQJ IHHGEDFN" 7R DQVZHU WKLV TXHVWLRQ ¿UVW LGHQWLI\ \RXU UROH PRGHOV 7KH OLWHUDWXUH suggests that certain behaviors and characteristics are IUHTXHQWO\ DWWULEXWHG WR ³JRRG´ HYDOXDWRUV ([FHOOHQW HYDOXDWRUV DUH IUHTXHQWO\ DEOH WR GHWHFW DQG GLVFXVV HPRWLRQDO UHVSRQVH DPRQJ OHDUQHUV DQG KDYH SUR¿FLHQF\ LQ KDQGOLQJ FRQÀLFW Furthermore, these individuals begin teaching interactions by asking learners for educational goals, and make professional goals clear to the learner by writing down or discussing them.

2I QRWH WKH ODWWHU WZR EHKDYLRUV DUH DOVR DVVRFLDWHG ZLWK FUHDWLQJ D SRVLWLYH OHDUQLQJ HQYLURQPHQW LQ JHQHUDO )LQDOO\ JRRG HYDOXDWRUV KDYH EHHQ UHSRUWHG WR ZRUN IUHTXHQWO\ with learners to establish mutually agreed upon goals and REMHFWLYHV DQG HQFRXUDJLQJ OHDUQHUV WR SUREOHP VROYH ZD\V WR achieve these goals, as well as other issues, themselves.27

3. %H VSHFLÂżF Overly general statements do not provide learners a guide on which elements need correction or how to improve.4 5DWKHU WKDQ DGYLVLQJ WKH OHDUQHU Âł<RX QHHG WR ZRUN RQ \RXU ZRUN XS RI FKHVW SDLQ´ IRFXV RQ FRUUHFWLQJ D VSHFLÂżF EHKDYLRU VXFK DV Âł<RX VHHP WR have misread this patientâ&#x20AC;&#x2122;s EKG and missed their ST HOHYDWLRQ 0, ´

*LYLQJ )HHGEDFN %HVW 3UDFWLFHV

5. 2ZQ WKH IHHGEDFN 6WDWH VSHFLÂżFDOO\ WKDW WKH IHHGEDFN is your opinion. Doing so adds credibility and weight to the information. At the same time, it gives the learner the opportunity to critically evaluate the feedback, and if he or she, to engage the teacher in further discussion.

Setting the Stage. When you are ready to give feedback, perhaps the most important step to doing so effectively is setting the stage: ensuring a ready and willing recipient and an appropriate setting. A key element is recognizing there is a large emotional component to receiving feedback.28 The majority of clinical performance evaluations are comprised of subjective feedback, and the literature suggests that learners may at times disregard feedback that is negative RU LQ RSSRVLWLRQ WR WKHLU VHOI SHUFHSWLRQ RI SHUIRUPDQFH Effective feedback may be further hampered when learners are GLVVDWLVÂżHG ZLWK RU SHUFHLYH WKH HYDOXDWLRQ V\VWHP DV XQIDLU 28 Therefore, avoid giving feedback that could be misconstrued as a personal attack, and instead guide the learner through a FRQVWUXFWLYH VHOI UHĂ&#x20AC;HFWLRQ SURFHVV RQ REMHFWLYH SHUIRUPDQFH measures.1 Consider developing the habit of asking the learner for permission to give feedback. This not only may LQFUHDVH OHDUQHU DFFHSWDQFH RI WKH SURFHVV EXW LGHQWLÂżHV WKH IHHGEDFN DV VXFK DQG UHGXFHV WKH FKDQFH WKDW \RXU FULWLTXH is viewed as negative or as personal.3,7 Finally, choose an appropriate setting to give feedback. Positive feedback may EH ZHOO UHFHLYHG LQ IURQW RI SDWLHQWV RU FROOHDJXHV EXW GHOLYHU constructive criticism in a more private setting.4 (66(17,$/ &20321(176 2) )(('%$&. During the feedback process, be sure to incorporate these elements into the feedback to maximize learner reception.

1. 8WLOL]H WKH PHWKRG RI ÂłSRVLWLYH FULWLTXH ´ This WHFKQLTXH LQFRUSRUDWHV WKH F\FOH FRQFHSW PHQWLRQHG above, involving a series of exchanges regarding the learnerâ&#x20AC;&#x2122;s performance. First, ask the learner what elements of his or her performance went well; then list elements you thought went well. Second, ask the learner what he or she thinks could be improved; add your thoughts for what could be improved. Soliciting the learnerâ&#x20AC;&#x2122;s view in both cases not only increases his or her participation in the feedback, but also gives the teacher LQVLJKW LQWR KLV KHU VHOI SHUFHSWLRQ RI SHUIRUPDQFH allowing correction of behaviors and misconceptions.4 2. %H WLPHO\ Timely feedback allows the learner to more rapidly correct errors, preventing cementing of misconceptions and incorrect behaviors.

Timely feedback also provides immediate positive reinforcement for appropriate behavior and thought processes.4 Finally, as medical education is a highly situated learning environment, a lack of a temporal

4. %H UHDOLVWLF &HUWDLQ HOHPHQWV RI SDWLHQW OHDUQHU interaction cannot be changed. A learnerâ&#x20AC;&#x2122;s gender and speech pattern are impossible to change. Still other aspects, such as body habitus, hairstyle, and dress are inappropriate to comment on unless there is a clear violation of a written guideline regarding the latter WZR ,QVWHDG IRFXV IHHGEDFN RQ PRGLÂżDEOH DUHDV RI knowledge and behavior.4

6. 6WDUW ZLWK D SRVLWLYH As mentioned previously, learners may be less receptive to feedback that is negative RU LV GLVVRQDQW ZLWK WKHLU VHOI SHUFHSWLRQ 7KHUHIRUH augment learner acceptance by preceding any FULWLTXH ZLWK D SRVLWLYH VRPHWKLQJ WKH OHDUQHU GLG ZHOO Anecdotally, many teachers in the authorsâ&#x20AC;&#x2122; collective PHGLFDO HGXFDWLRQ KDYH XVHG WKH ÂłFUDS VDQGZLFK´ where negative elements are sandwiched between positive elements, additionally allowing the feedback to conclude on a positive note.34

3UREOHP $UHDV 352%/(06 :,7+ )(('%$&. Several problems are inherent to the process of giving feedback. The personal interaction that occurs with both giving and receiving feedback introduces potential problem areas related to body language, which communicates attitudes and feelings, voice tone, silences and other nuances of interpersonal communication which may result in poor reception of feedback. Second, educators may have received no formal training on giving feedback; thus many key elements of feedback may be lost.

Finally, while educators may generally know the elements of appropriate feedback, without priming, they may not focus on enough on objective measures of performance.

352%/(0 5(&,3,(176 Learner resistance to feedback happens. Before attempting to tackle what you assume WR EH D SXUHO\ EHKDYLRUDO LVVXH ÂżUVW UHĂ&#x20AC;HFW FULWLFDOO\ RQ WKH situationâ&#x20AC;&#x201D;look for problematic aspects of the feedback or learner barriers to progress, such as underlying personal issues. Consider whether the feedback was provided in a clear manner and understood by the learner, or if your expectations for improvement were unrealistic. Alternatively, consider whether personal issues or drug or alcohol abuse may be interfering with learner improvement. If these issues can safely be excluded, consider the following solutions to several common behavioral issues.

1. ([WHUQDO ORFXV RI FRQWURO Overwhelmed at times with the pressure to perform or increasing responsibility,

11

this learner will not accept responsibility for errors, LQVWHDG SODFLQJ EODPH H[WHUQDOO\ D OD Âł7KH GRJ DWH P\ KRPHZRUN´ +H RU VKH PD\ EODPH WKH QXUVH IRU providing misinformation, or emphasize that certain data points are unknowable due to the patient not disclosing them. If these behaviors occur consistently, they likely poor coping mechanism that has become a habit. To remediate these learners, constant reproducible and measurable documentation is critical. Only by showing the repeated nature of the error will the learner recognize WKDW WKH LVVXH LQ TXHVWLRQ LV KLV RU KHU UHVSRQVLELOLW\ DQG DQ LVVXH RI GHÂżFLHQW SHUIRUPDQFH 9 2. %ODPLQJ WKH HYDOXDWRU Some learners will turn on the evaluator when receiving negative feedback, blaming D SHUVRQDO FRQĂ&#x20AC;LFW DV WKH FDXVH &RQVLVWHQW IHHGEDFN from multiple sources will help remedy this issue. Even better, we recommend archived, written evaluations on a regular basis to prevent confusion and misinterpretation, as learners who blame the evaluator have even brought their disagreements with feedback into the legal arena.

3. 1R GHVLUH WR LPSURYH Finally, some learners will appear to have no interest in improving in a certain area, rationalizing that performance in this area is irrelevant to their ultimate career goals. Often this is a false DVVHUWLRQ VR DWWHPSW ÂżUVW WR UHFRQQHFW WKH LPSRUWDQFH of the tasks at hand to their future goals. For example, for the medical student going into General Surgery, emphasize the similarity of the elements used in the history and physical for medical and surgical patients.

For the student going into Internal Medicine, emphasize the importance of learning a good physical exam during their General Surgery rotation for when they will later refer their patients for elective hernia repairs.9

)XWXUH 'LUHFWLRQV /HDUQHU 5HVSRQVLELOLW\ Current teaching methods and evaluative processes emphasize the best practices of the teacher. However, future emphasis may shift away from modifying evaluator behaviors WR IRFXV RQ EHVW OHDUQHU EHKDYLRUV ([LVWLQJ OHDUQHU VSHFLÂżF barriers to effective feedback include the low capacity of OHDUQHUV IRU VHOI DVVHVVPHQW DQG PHWDFRJQLWLRQ DV ZHOO DV WKH aforementioned overpowering affective reactions of learners WR IHHGEDFN L H FRQĂ&#x20AC;LFW ZLWK VHOI DVVHVVPHQW OHDGLQJ WR HPRWLRQDO UHVSRQVH 1 Interventions focusing on the teacher KDYH VKRZQ WKDW IHHGEDFN EHKDYLRUV DUH PRGLÂżDEOH DQG FDQ improve feedback. In the future, educational focus needs to be additionally directed at the learner.11,35,36 Reference %LQJ <RX 5* 7URZEULGJH 5/ :K\ PHGLFDO HGXFDWRUV PD\ EH IDLOLQJ DW IHHGEDFN -$0$

2. Ende J. Feedback in clinical medical education. JAMA.

3. Yarris LM, Linden JA, Gene Hern H, et al. Attending and resident satisfaction with feedback in the emergency department. Acad (PHUJ 0HG 6XSSO 6 4. Vickery AW, Lake FR. Teaching on the run tips 10: giving IHHGEDFN 0HG - $XVW

12

7. Sender Liberman A, Liberman M, Steinert Y, McLeod P, Meterissian S. Surgery residents and attending surgeons have GLIIHUHQW SHUFHSWLRQV RI IHHGEDFN 0HG 7HDFK

472.

8. Hutul OA, Carpenter RO, Tarpley JL, Lomis KD. Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency. &XUU 6XUJ

9. Lake FR, Ryan G. Teaching on the run tips 11: the junior doctor LQ GLIÂżFXOW\ 0HG - $XVW

%DKDU 2]YDULV 6 $VODQ ' 6DKLQ +RGRJOXJLO 1 6D\HN , A faculty development program evaluation: from needs DVVHVVPHQW WR ORQJ WHUP HIIHFWV RI WKH WHDFKLQJ VNLOOV LPSURYHPHQW SURJUDP 7HDFK /HDUQ 0HG

.UXLGHULQJ +DOO 0 2Âś6XOOLYDQ 36 &KRX &/ 7HDFKLQJ IHHGEDFN WR ÂżUVW \HDU PHGLFDO VWXGHQWV ORQJ WHUP VNLOO UHWHQWLRQ DQG DFFXUDF\ RI VWXGHQW VHOI DVVHVVPHQW - *HQ ,QWHUQ 0HG

0RUHQR :DOWRQ / %UXQHWW 3 $NKWDU 6 'H%OLHX[ 30& Teaching across the generation gap: a consensus from the Council of Emergency Medicine Residency Directors 2009 DFDGHPLF DVVHPEO\ $FDG (PHUJ 0HG 6XSSO 6 24.

13. Wigton RS, Patil KD, Hoellerich VL. The effect of feedback in OHDUQLQJ FOLQLFDO GLDJQRVLV - 0HG (GXF

14. Porte MC, Xeroulis G, Reznick RK, Dubrowski A. Verbal IHHGEDFN IURP DQ H[SHUW LV PRUH HIIHFWLYH WKDQ VHOI DFFHVVHG IHHGEDFN DERXW PRWLRQ HIÂżFLHQF\ LQ OHDUQLQJ QHZ VXUJLFDO VNLOOV $P - 6XUJ

15. Issenberg SB, McGaghie WC, Gordon DL, et al. Effectiveness of a cardiology review course for internal medicine residents using simulation technology and deliberate practice. Teach /HDUQ 0HG

16. Ten Eyck RP, Tews M, Ballester JM. Improved medical student VDWLVIDFWLRQ DQG WHVW SHUIRUPDQFH ZLWK D VLPXODWLRQ EDVHG emergency medicine curriculum: a randomized controlled trial. $QQ (PHUJ 0HG

17. Kneebone R. Simulation in surgical training: educational issues DQG SUDFWLFDO LPSOLFDWLRQV 0HG (GXF

18. Okuda Y, Bryson EO, DeMaria S, et al. The utility of simulation LQ PHGLFDO HGXFDWLRQ ZKDW LV WKH HYLGHQFH" 0W 6LQDL - 0HG

/\QDJK 0 %XUWRQ 5 6DQVRQ )LVKHU 5 $ V\VWHPDWLF UHYLHZ RI PHGLFDO VNLOOV ODERUDWRU\ WUDLQLQJ ZKHUH WR IURP KHUH" 0HG (GXF

20. Fried GM, Feldman LS, Vassiliou MC, et al. Proving the value of simulation in laparoscopic surgery. Ann. Surg.

GLVFXVVLRQ 21. Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon ' 6FDOHVH 5- )HDWXUHV DQG XVHV RI KLJK ÂżGHOLW\ PHGLFDO simulations that lead to effective learning: a BEME systematic UHYLHZ 0HG 7HDFK

22. Boulet JR. Summative assessment in medicine: the promise RI VLPXODWLRQ IRU KLJK VWDNHV HYDOXDWLRQ $FDG (PHUJ 0HG

23. Maker VK, Bonne S. Novel hybrid objective structured assessment of technical skills/objective structured clinical examinations in comprehensive perioperative breast care: a WKUHH \HDU DQDO\VLV RI RXWFRPHV - 6XUJ (GXF

351.

24. Xeroulis G, Dubrowski A, Leslie K. Simulation in laparoscopic surgery: a concurrent validity study for FLS. Surg Endosc.

+HQGHUVRQ 3 )HUJXVRQ 6PLWK $& -RKQVRQ 0+ 'HYHORSLQJ essential professional skills: a framework for teaching and OHDUQLQJ DERXW IHHGEDFN %0& 0HG (GXF

25. Binstadt E, Donner S, Nelson J, Flottemesch T, Hegarty C. 6LPXODWRU WUDLQLQJ LPSURYHV ÂżEHU RSWLF LQWXEDWLRQ SURÂżFLHQF\ among emergency medicine residents. Acad Emerg Med.

6. van de Ridder JMM, Stokking KM, McGaghie WC, ten Cate 27- :KDW LV IHHGEDFN LQ FOLQLFDO HGXFDWLRQ" 0HG (GXF

26. Lammers RL. Learning and retention rates after training in posterior epistaxis management. Acad Emerg Med.

Continued on Page 15

The CTSA and Emergency Medicine: Improving Patient Care through Collaborative Research Sean &ROOLQV 0' MSc â&#x20AC;˘ Christopher /LQGVHOO PhD â&#x20AC;˘ Jeff .OLQH MD In 2006, the National Institutes of Health launched The &OLQLFDO and 7UDQVODWLRQDO Science Awards (CTSA) Program.

The goals of the program are to reduce the time it takes for laboratory discoveries to become treatments for patients, to engage communities in clinical research efforts, and to train the next generation of clinical and translational researchers.

There are now 55 institutions that have received CTSA funding from the National Center for Research Resources 1&55 and emergency medicine researchers at these 55 institutions are asking how this impacts them.

In our experience, the greatest impact occurs when emergency medicine researchers offer to support their CTSA, rather than simply asking how the CTSA can help the researcher. Emergency Medicine is a highly interdisciplinary specialty, and the emergency department is a wonderful laboratory for clinical and translational research. Few illnesses or injuries are not seen by emergency physicians and the emergency department is visited by the rich and poor, blacks and whites, and both the acutely ill and not so sick. Clinical research in the emergency department has improved the care of patients with acute coronary syndromes, sepsis, and acute ischemic stroke, and health services research rightly positions the emergency department as a cornerstone and safety net for the entire system of care. By making the clinical research community aware of our access to patients, diseases, and systems, and collaborating with CTSAs in areas such as community engagement and patient UHFUXLWPHQW we can ÂżUPO\ entrench emergency medicine within the framework of CTSAs, and ensure that our LQYROYHPHQW is sought after (and XOWLPDWHO\ paid for). The opportunities for FROODERUDWLRQ are HQGOHVV One just needs to browse the CTSA website to ÂżQG the numerous opportunities. http://www.ctsaweb.org/index. cfm?fuseaction=home.showHome Several groups of emergency medicine researchers have already begun to capitalize on this change in paradigm.

Craig Newgard, MD, MPH, an emergency medicine physician from Oregon +HDOWK & Science University 2+68

is leading a major project that incorporates expertise from emergency medicine, pediatrics, trauma surgery and emergency medical services. Initially independent of the CTSA, the multicenter study is now being hailed by the ORFDO CTSA as an DUFKHW\SDO FROODERUDWLRQ of communitybased translational research. As such, the investigators have garnered funding to support their collaboration, which is GHYHORSLQJ cost-effective trauma triage JXLGHOLQHV to more HIÂżFLHQWO\ match SDWLHQWÂśV FOLQLFDO and resource needs with hospital resource availability. This effort was catalyzed

through an inter-CTSA FROODERUDWLRQ (WESTRN) LQYROYLQJ 7 sites: 2+68 University of :DVKLQJWRQ UC 'DYLV UCSF/ San Franscisco General Hospital, Stanford, Denver Health, and University of Utah. :KLOH such FROODERUDWLRQV may be somewhat typical for emergency medicine, they are not typical in clinical research, and we should make our CTSA leaders aware of how we routinely bring researchers together to solve complex problems.

As well as bringing teams together to help solve systems issues, emergency medicine is also bringing together more diverse teams. A group of emergency medicine heart failure UHVHDUFKHUV (0(5* +) is partnering with the Texas CTSA ELRVWDWLVWLFDO HSLGHPLRORJ\ and research design (BERD) network to DSSO\ adaptive designs to PXOWL FHQWHU heart failure clinical trials. The aim of this â&#x20AC;&#x2DC;network of networksâ&#x20AC;&#x2122; is to design and LPSOHPHQW ODUJH VFDOH FOLQLFDO WULDOV that can ÂżQH tune HQUROOPHQW using biomarkers and patient characteristics to identify patients most likely to respond to therapies. This collaboration between investigators and methodologists serves both partners: it provides the methodologists with complex and exciting problems that require HOHJDQW VWDWLVWLFDO VROXWLRQV ZKLOH offering the investigators ready access to some of the best clinical trial design minds in the world.

As the CTSA consortium nurtures collaboration, emergency medicine researchers should be thinking broadly about synergistic partnerships. How can we EHQHÂżW from a strategic DOLJQPHQW with the CTSA key functions? Perhaps a partnership between clinical trialists conducting research with exception from informed consent might EHQHÂżW from building a relationship with a CTSA community engagement core. Collaboration between emergency physicians and novel technologies might bring new problems to the fore that can be tackled by engineers and scientists. In the future we could see EM investigators partnering with biomedical informatics, providing a framework for research using biobanks and data warehouses, which commonly house thousands to millions of patient records. By creating PXWXDOO\ EHQHÂżFLDO partnerships and forming new networks of interdisciplinary teams focused on emergency medicine problems, the CTSA consortium has tremendous potential to SRVLWLYHO\ impact research efforts and drive evidenceinformed patient care. All we need to do is seek to support, not to be supported.

13

'(3$570(17 2) (0(5*(1&< 0(',&,1( 0$66$&+86(776 *(1(5$/ +263,7$/ $ 0DMRU 7HDFKLQJ $IÂżOLDWH 2I +DUYDUG 0HGLFDO 6FKRRO The Department of Emergency Medicine at Massachusetts General Hospital is seeking candidates for faculty positions at all academic levels.

Special consideration will be given to those with an established track record in clinical or laboratory research and a commitment to excellence in clinical care and teaching. Academic appointment is at Harvard Medical School and is commensurate with scholarly achievements.

0*+ LV DQ HTXDO SDUWQHU LQ WKH \HDU %:+ 0*+ +DUYDUG $IÂżOLDWHG Emergency Medicine Residency Program. The ED at MGH is a high volume, high acuity level 1 trauma and burn center for both adult and SHGLDWULF SDWLHQWV DQG LQFOXGHV D EHG 2EVHUYDWLRQ 8QLW 7KH DQQXDO ED visit volume is ~91,000.

The successful candidate will join a faculty of 37 academic emergency physicians in a department with active research and teaching programs, as well as fellowship programs in research, global health, medical simulation, ultrasonography, and wilderness medicine. Candidates must have completed an accredited residency program in EM and have at least 4 years of training/experience. ,QTXLULHV VKRXOG EH DFFRPSDQLHG E\ D FXUULFXOXP YLWDH DQG PD\ EH addressed to: 'DYLG ) 0 %URZQ 0' )$&(3 9LFH &KDLUPDQ 'HSDUWPHQW RI (PHUJHQF\ 0HGLFLQH 0DVVDFKXVHWWV *HQHUDO +RVSLWDO )RXQGHUV )UXLW 6WUHHW %RVWRQ 0DVVDFKXVHWWV H PDLO dbrown2@partners.org 0DVVDFKXVHWWV *HQHUDO +RVSLWDO LV DQ HTXDO RSSRUWXQLW\ DIÂżUPDWLYH DFWLRQ HPSOR\HU

14

David Levine, MD, FACEP, Former ED Director at Stroger Hospital, Joins University HealthSystem Consortium as Associate Vice President, Medical Director OAK %522. ,OO -- The University +HDOWK6\VWHP Consortium (UHC) today announced that David Levine, MD, FACEP, has joined the organization as associate vice president of informatics and medical director of 8+&ÂśV Comparative Data & Informatics department.

Dr. Levine ZLOO oversee 8+&ÂśV risk-adjustment PHWKRGRORJLHV and OHDG physician engagement activities in 8+&ÂśV ZRUOG FODVV comparative data products and services for the 107-member academic PHGLFDO center consortium.

Dr. Levine has spent his 15-year FOLQLFDO career as an emergency department physician at the 464-bed John H. Stroger Jr. +RVSLWDO of Cook County, Ill.â&#x20AC;&#x201D;the last 7 years as medical director of the emergency department. He has also served as a physician leader for information technology upgrades including expansion of computer physician order entry and documentation improvements. In addition, he has been a consultant for emergency departments and physician groups to RSWLPL]H LQIRUPDWLFV TXDOLW\ and FRPSOLDQFH He is DOVR an assistant professor of emergency medicine at Rush Medical School in Chicago. â&#x20AC;&#x153;We FRXOG not be happier to ZHOFRPH David to the RUJDQL]DWLRQ ´ said Steve 0HXUHU 3K' UHC senior vice SUHVLGHQW Comparative Data & Informatics. â&#x20AC;&#x153;The FOLQLFDO OHDGHUVKLS he brought to Cook County for so many years and his experience in RSWLPL]LQJ LQIRUPDWLFV TXDOLW\ and compliance in a large, complex academic medical center will be a tremendous EHQHÂżW to our members.â&#x20AC;?

Dr. Levine received his medical degree from Northwestern 8QLYHUVLW\ÂśV Feinberg 6FKRRO of Medicine and his SV\FKRORJ\ degree from the University of Michigan. He FRPSOHWHG his emergency medicine residency at Boston City +RVSLWDO (now known as Boston 0HGLFDO Center). He is a IHOORZ in the American &ROOHJH of Emergency Physicians.

About UHC The University +HDOWK6\VWHP &RQVRUWLXP formed in is an DOOLDQFH of 107 academic PHGLFDO centers and 238 of their DIÂżOLDWHG KRVSLWDOV representing DSSUR[LPDWHO\ 90% of the QDWLRQÂśV QRQSURÂżW academic PHGLFDO centers. UHC offers its members VSHFLÂżF programs and services to improve FOLQLFDO RSHUDWLRQDO ÂżQDQFLDO and patient safety performance. The mission of UHC is to advance NQRZOHGJH foster collaboration, and promote change to help members succeed in their respective markets. For more information, visit www.uhc.edu.

AW$(0 KDV KDG DQ DPD]LQJ ÂżUVW \HDU We have remained focused on our goal to promote the recruitment, retention, advancement and leadership of women in academic emergency medicine throughout their careers. We are in the ÂżQDO stages of HVWDEOLVKLQJ the framework to give you â&#x20AC;&#x201C; our AWAEM members- a network for women physicians to facilitate mentoring and research collaboration. We have a new team of involved members working on some intriguing projects.

AWAEM Research and Mentoring Committee â&#x20AC;&#x201C; Marna Greenberg is the lead. They will be compiling list of researchers and their areas of interest in research related to careers of women in medicine or womenâ&#x20AC;&#x2122;s health issues Extracting and monitoring data from AAMC and SAEM regarding number and percentage of women by academic rank- Fiona *DOODKXH is the OHDG Regional Mentoring Oversight Group- Linda 'UXHOLQJHU is the OHDG They are identifying leaders and working group members for each of the 6 SAEM regions 0LGZHVW :HVWHUQ New (QJODQG 0LG$WODQWLF 6RXWKHDVWHUQ New York). The JRDO is to RUJDQL]H AWAEM meeting at DQQXDO SAEM 5HJLRQDO meeting and coordinate networking opportunities within region.

Development of Process by which we maintain a list of women who are interested in leadership positions - Tracy Sanson is the OHDG They are creating a list of women who are interested in leadership positions in medical schools which can be supplied to national searches to match suitable candidates with vacant positions.

Medical school liaison- Preeti -RVH %LORZLFK is the OHDG They are creating presentations to female students about EM and academic emergency medicine and/or becoming involved with EM interest groups to encourage women to consider an academic career.

Develop a list of med schools which have programs to support women faculty- Keme Carter is the OHDG They are identifying the best practices/ SROLFLHV for maternity OHDYH part-time SRVLWLRQV OHDGHUVKLS SURJUDPV womenin-medicine programs.

Book Club Kathryn Dong is the lead. This group has compiled and maintains resources for women including online resources, articles, monographs, and books which have information of interest to women in academic EM. Bio form â&#x20AC;&#x201C; Alice Mitchell is the lead. This is one of our most exciting initiatives and ZLOO EHQHÂżW DOO AWAEM members. This bio-form ZLOO be used for PXOWLSOH functions. It will help with research mentoring, serves as a database for tracking demographics for practice representation, academic rank, interests, and leadership interests.

Any SAEM member in good standing at any level of training may join. Dues are payable when you join and are currently $100 per year. Residents and Fellows may join free of charge with a current SAEM membership.

(Remember to sign up when you renew your SAEM membership.)

Log on to your SAEM Web Account and click on the link to Join an Academy (http://member.saem.org).

PROGRAM COMMITTEE DEADLINES All Program Committee set deadlines are at 5PM EST â&#x20AC;˘ Call for Didactics

â&#x20AC;˘ Call for Photos

â&#x20AC;˘ Call for Expert Abstract Reviewers

â&#x20AC;˘ Call for Medical Student Ambassadors

â&#x20AC;˘ Call for Abstracts

â&#x20AC;˘ Call for Manuscripts

Deadline Tuesday, September 7, 2010 Deadline Tuesday, October 05, 2010

Deadline Tuesday, December 7, 2010

â&#x20AC;˘ Call for IEME

Deadline Tuesday, February 8, 2011 Deadline Tuesday, February 15, 2011 AEM Consensus Conference Deadline Saturday, March 26, 2011

Deadline Tuesday, January 25, 2011

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&/$66,),('6 6FKRRO RI 0HGLFLQH 'HSDUWPHQW RI (PHUJHQF\ 0HGLFLQH

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7KH 8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH LV UHFUXLWLQJ RQH QHZ IXOO WLPH faculty member in the Health Sciences Clinical Series at the Assistant or Associate Professor level. The HS Clinical Series includes substantial patient care, medical student and resident teaching, and RSWLRQDO FOLQLFDO UHVHDUFK %RDUG SUHSDUDWLRQ RU FHUWL¿FDWLRQ LQ (0 UHTXLUHG )HOORZVKLS RU DGYDQFHG GHJUHH RU ERWK VWURQJO\ GHVLUHG $SSURSULDWH 5DQN DQG 6HULHV FRPPHQVXUDWH ZLWK TXDOL¿FDWLRQV 7KH 8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH 0HGLFDO &HQWHU LV D EHG tertiary care hospital with all residencies. The ED is a progressive EHG /HYHO , 7UDXPD &HQWHU ZLWK SDWLHQWV LQ XUEDQ 2UDQJH County. Collegial relationships with all services. Excellent salary DQG EHQH¿WV ZLWK LQFHQWLYH SODQ 6HQG LQTXLULHV WR 0DUN /DQJGRUI 0' 0+3( )$&(3 8&, 0HGLFDO &HQWHU 5RXWH &LW\ 'ULYH Orange, CA 92868, or at mark.langdorf@uci.edu, Apply online at https://recruit.ap.uci.edu.

Position: Health Sciences Clinical Professor Series, Open Ranks 7KH 8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH 6FKRRO RI 0HGLFLQH 'HSDUW ment of Emergency Medicine anticipates openings in the HS &OLQLFDO 3URIHVVRU 6HULHV 5HTXLUHPHQWV 7KH +6 &OLQLFDO 6HULHV includes substantial patient care, medical student and resident teaching, and optional clinical research. Board preparation or FHUWL¿FDWLRQ LQ (0 UHTXLUHG )HOORZVKLS RU DGYDQFHG GHJUHH RU ERWK VWURQJO\ GHVLUHG 7KH 8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH 0HGLFDO &HQWHU LV D EHG WHUWLDU\ FDUH KRVSLWDO ZLWK DOO UHVLGHQFLHV 7KH (' LV D SURJUHVVLYH EHG /HYHO , 7UDXPD &HQWHU ZLWK patients, in urban Orange County. Collegial relationships with all VHUYLFHV ([FHOOHQW VDODU\ DQG EHQH¿WV ZLWK LQFHQWLYH SODQ 6DODU\ DQG UDQN ZLOO EH FRPPHQVXUDWH ZLWK TXDOL¿FDWLRQV DQG H[SHULHQFH Application Procedure: Interested candidates should apply through 8& ,UYLQH¶V 5(&58,7 V\VWHP ORFDWHG DW https://recruit.ap.uci.edu/ apply/ $SSOLFDQWV VKRXOG FRPSOHWH DQ RQOLQH DSSOLFDWLRQ SUR¿OH and upload the following application materials electronically to be considered for the position: Curriculum vitae and Names and ad dresses of four references.

8&, LV DQ HTXDO RSSRUWXQLW\ HPSOR\HU FRPPLWWHG WR H[FHOOHQFH through diversity.

7KH 8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH LV DQ HTXDO RSSRUWXQLW\ HP ployer committed to excellence through diversity.

17

The 2010 NRMP Match in Emergency Medicine Louis Binder, MD, Professor of Emergency Medicine and Vice Chair for Academic $IIDLUV University of Nevada 6FKRRO of Medicine The UHVXOWV of the 2010 NRMP Match became ÂżQDO on March 2010. Emergency Medicine residency programs offered a WRWDO of 1575 entry OHYHO positions (7% of WRWDO positions in DOO VSHFLDOWLHV The IROORZLQJ numbers (taken from the 2010 NRMP Data Book) LQFOXGH information from DOO programs that entered the 2010 Match:

Total # of NRMP positions 2YHUDOO % of positions XQÂżOOHG Number of EM programs listed Total PG1/PG2 entry positions EM positions/total NRMP positions

2008 2009 25,066 25,185 5.6% 4.6% 141 147 (133 3* 8 PG2) (141 3* 6 PG2) 1475 1515 (1399 3* 76 PG2) (1472 3* 43 PG2) 6.0% 6.0%

2010 25,520 4.5% 150 (147 3* 3 PG2) 1575 (1556 3* PG2) 6.8%

# EM programs with PG1 vacancies # unmatched EM PG1 positions

11/133 (7.5%) 29/1399 (2.1%)

5/141 (3.6%) 13/1472 (1%)

5/147 (3.4%) 16/1556 (1.0%)

# EM programs with PG2 vacancies # unmatched EM PG2 positions

1/8 (12%) 1/76 (1%)

0/6 (0%) 0/43 (0%)

0/3 (0%) 0/19 (0%)

7RWDO # EM programs with vacancies 7RWDO # unmatched EM positions

12/141 (9%) 30/1475 (2%)

5/147 (3%) 13/1515 (1%)

5/150 (3%) 16/1575 (1%)

2008 1125 317 1442

2009 1167 457 1624

2010 1175 439 1614

1239 606 1845

1324 684 2008

1343 791 2074

36/1071 (3.4%)

64/1167 (5.9%)

68/1175 (5.7%)

Independent DSSOLFDQWV DSSO\LQJ only to EM programs who went unmatched

117/371 (32%)

181/457 (40%)

151/439 (34%)

Percent of matched US seniors who matched in EM residencies

(8%)

Applicant Pool Data Applicants who ranked only EM programs: US graduates Independent applicants Total applicants Applicants who ranked at least one EM program: US graduates Independent applicants Total applicants US seniors DSSO\LQJ RQO\ to EM Programs who went unmatched

18

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PG1 EM positions )LOOHG E\ 86 JUDGXDWHV )LOOHG E\ LQGHSHQGHQW DSSOLFDQWV 7RWDO ÂżOOHG

1399

1472

1556

PG2 EM positions )LOOHG E\ 86 JUDGXDWHV )LOOHG E\ LQGHSHQGHQW DSSOLFDQWV 7RWDO ÂżOOHG

76

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Total EM positions )LOOHG E\ 86 JUDGXDWHV )LOOHG E\ LQGHSHQGHQW DSSOLFDQWV 7RWDO ÂżOOHG

1475

1515

1575

)RU 3* ÂżOOHG HQWU\ SRVLWLRQV

ZHUH ÂżOOHG E\ 86 VHQLRUV ZHUH ÂżOOHG E\ 86 SK\VLFLDQV E\ RVWHRSDWKLF physicians, 109 by US international medical graduates, 22 by international medical graduates, 2 by Canadian physicians, and 0 by Fifth Pathway graduates.

From these data, several conclusions can be drawn: (PHUJHQF\ 0HGLFLQH H[SHULHQFHG D VL]DEOH LQFUHDVH RI HQWU\ OHYHO SRVLWLRQV LQ WKH 0DWFK RYHU 0DWFK QXPEHUV D LQFUHDVH FRPSDUHG ZLWK ODVW \HDU RFFXUULQJ IURP TXRWD LQFUHDVHV LQ (0 SURJUDPV DQG IURP WKUHH QHZ SURJUDP LQ WKH (0 PDWFK (PHUJHQF\ 0HGLFLQH QRZ FRPSULVHV SHUFHQW RI WKH WRWDO 1503 SRVLWLRQV DQG RI PDWFKHG 86 VHQLRUV 8VLQJ WKH KLJKHU GHPDQG ÂżJXUHV DSSOLFDQWV UDQNLQJ DW OHDVW (0 SURJUDP WKH RYHUDOO GHPDQG IRU (0 HQWU\ OHYHO SRVLWLRQV LQFUHDVHG DPRQJ 8 6 6HQLRUV DSSO\LQJ WR (0 SURJUDPV DQG GHPDQG IURP RWKHU FDWHJRULHV RI DSSOLFDQWV LQFUHDVHG VLPLODUO\ DSSOLFDQWV RU 7KH H[FHVV DSSOLFDQW GHPDQG RYHU DQG DERYH WKH VL]H RI WKH WUDLQLQJ EDVH LV WR DSSOLFDQWV WR VXUSOXV GHSHQGLQJ RQ KRZ WKH SDUDPHWHUV RI WKH applicant pool are determined.

7KH SURSRUWLRQV RI (0 SRVLWLRQV ÂżOOHG E\ 86 VHQLRUV YHUVXV ,QGHSHQGHQW $SSOLFDQWV 86 JUDGXDWHV 2VWHRSDWKV DQG ,QWHUQDWLRQDO 0HGLFDO *UDGXDWHV

UHPDLQHG VLPLODU LQ FRPSDUHG ZLWK DQG ,Q RI (0 HQWU\ SRVLWLRQV ZHUH ¿OOHG ZLWK 86 JUDGXDWHV ZKLFK LV D FRPSDUDEOH percentage with recent years. $Q LQFUHDVH RI LQ WKH VXSSO\ RI (0 HQWU\ OHYHO SRVLWLRQV LQ FRXSOHG ZLWK D VLPLODU LQFUHDVH LQ GHPDQG DPRQJ 8 6 6HQLRUV DQG RWKHU FDWHJRULHV RI DSSOLFDQWV UHVXOWHG LQ DQ HTXLYDOHQW ¿OO UDWH IRU (0 SURJUDPV LQ YHUVXV 7KH FXPXODWLYH HIIHFW RI WKHVH WKUHH WUHQGV ZDV DOVR PDQLIHVWHG E\ D QHDUO\ HTXDO QXPEHU RI XQ¿OOHG (0 SRVLWLRQV LQ WKH 0DWFK LQ YHUVXV LQ %\ KLVWRULFDO WUHQGV DQG VXSSO\ GHPDQG FRQVLGHUDWLRQV ZDV D ³VHOOHUœV \HDU´ D VPDOO LQFUHDVH LQ WKH VXSSO\ RI (0 SRVLWLRQV SDLUHG ZLWK D VLPLODU LQFUHDVH LQ WKH DSSOLFDQW SRRO OHG WR D KLJK ¿OO UDWH IRU (0 SURJUDPV DQG D VLPLODU XQPDWFKHG UDWH IRU DSSOLFDQWV 7KH XQPDWFKHG UDWH RI IRU 86 VHQLRUV DQG IRU ,QGHSHQGHQW $SSOLFDQWV JRLQJ LQWR (0 FRQWLQXH WR VXSSRUW WKH QRWLRQ WKDW PRVW 86 VHQLRUV and Independent Applicants who apply will match into an EM residency.

(â&#x20AC;&#x153;Giving Feedback in Medical Educationâ&#x20AC;?, Continued) 0HQDFKHU\ (3 :ULJKW 60 +RZHOO (( .QLJKW $0 3K\VLFLDQ WHDFKHU FKDUDFWHULVWLFV DVVRFLDWHG ZLWK OHDUQHU FHQWHUHG WHDFKLQJ VNLOOV 0HG 7HDFK H 28. Watling CJ, Lingard L. Toward meaningful evaluation of PHGLFDO WUDLQHHV WKH LQĂ&#x20AC;XHQFH RI SDUWLFLSDQWVÂś SHUFHSWLRQV RI the process. Adv Health Sci Educ Theory Pract. 2010. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20143260 [Accessed February 10, 2010].

29. Sargeant J, Mann K, Ferrier S. Exploring family physiciansâ&#x20AC;&#x2122; reactions to multisource feedback: perceptions of credibility and XVHIXOQHVV 0HG (GXF

30. Sargeant J, Mann K, Sinclair D, Van der Vleuten C, 0HWVHPDNHUV - 8QGHUVWDQGLQJ WKH LQĂ&#x20AC;XHQFH RI HPRWLRQV DQG UHĂ&#x20AC;HFWLRQ XSRQ PXOWL VRXUFH IHHGEDFN DFFHSWDQFH DQG XVH $GY +HDOWK 6FL (GXF 7KHRU\ 3UDFW

31. Lave J, Wenger E. Situated Learning: Legitimate Peripheral 3DUWLFLSDWLRQ &DPEULGJH 8. &DPEULGJH 8QLYHUVLW\ 3UHVV 1991.

32. Orey MA, Nelson WA. Situated Learning and the Limits of Applying the Results of These Data to the Theories of Cognitive Apprenticeships. In: ; 1994. Available at: http:// www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ (5,&6HUYOHW"DFFQR (' >$FFHVVHG $SULO @ 33. Brown J, Collins A, Duguid P. Situated cognition and the culture RI OHDUQLQJ (GXF 5HV

34. Kilminster S, Cottrell D, Grant J, Jolly B. AMEE Guide No. 27: Effective educational and clinical supervision. Med Teach.

35. Notzer N, Abramovitz R. Can brief workshops improve clinical LQVWUXFWLRQ" 0HG (GXF

36. Salerno SM, Jackson JL, Oâ&#x20AC;&#x2122;Malley PG. Interactive faculty GHYHORSPHQW VHPLQDUV LPSURYH WKH TXDOLW\ RI ZULWWHQ IHHGEDFN LQ DPEXODWRU\ WHDFKLQJ - *HQ ,QWHUQ 0HG

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CDEM Highlights CDEM members have been busy since the SAEM DQQXDO meeting putting the ÂżQDO touches on VHYHUDO important resources. The VHOI VWXG\ modules are available at www.cdemcurriculum. org. They are a set of learning modules based on the national emergency medicine curriculum and provide substantial information on all the core topics in emergency medicine including the â&#x20AC;&#x153;approach toâ&#x20AC;? and VSHFLÂżF disease processes. The Medical Student Educators Handbook is nearing completion and a hard copy will be available for purchase. Updates to our ZHEVLWH addition of more educator resources, and work on a third year curriculum, pediatric EM curriculum and ÂżQDO examination are underway. The Academic Emergency Medicine Education Supplement will be coming out soon with articles from CDEM members.

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Wilderness Medicine Interest Group Holds Inaugural Meeting

By N. Stuart Harris MD, MFA, FAAEM The SAEM Wilderness Medicine Interest Group held its inaugural meeting in Phoenix in June. Over 25 new members from across the country â&#x20AC;&#x201D; ranging from medical students to wilderness medicine fellowship directors â&#x20AC;&#x201D; engaged in an energetic discussion over SODQV for this UDSLGO\ JURZLQJ subspecialty of Emergency Medicine. :LOGHUQHVV medicine is GHÂżQHG by the practice of medicine in resource-limited, austere environments not exclusively by distance from human population centers.

The VNLOOV taught through this training have broad and unique DSSOLFDWLRQ in ZLOGHUQHVV DUHDV SUH KRVSLWDO FDUH disaster PHGLFLQH LQWHUQDWLRQDO and GHYHORSLQJ ZRUOG SURMHFWV and environmental/medical policy development.

The goals of the SAEM Wilderness Interest Group are: 1. To establish a community of providers interested in Wilderness Medicine.

2. To act as a resource base for our members (from very curious PHGLFDO students to very experienced staff) to help advance their careers and the continued growth of wilderness medicine as a vibrant emergency medical discipline.

3. To provide a forum to advance our membersâ&#x20AC;&#x2122; expertise and opportunities in wilderness medical research, teaching, and administration.

4. To enable our members to develop their expertise and LQĂ&#x20AC;XHQFH in SXEOLF SROLF\ issues â&#x20AC;&#x201C; most QRWDEO\ on the myriad intersections between human health and local and global â&#x20AC;&#x2DC;environmentalâ&#x20AC;&#x2122; issues.

Currently, there are four Wilderness Medicine Fellowship programs: at Stanford 8QLYHUVLW\ Massachusetts *HQHUDO +RVSLWDO Harvard 0HGLFDO 6FKRRO University of 8WDK and UCSF-Fresno. Other OHDGLQJ residencies are FXUUHQWO\ working to establish additional fellowships. Numerous Emergency Medicine residencies are developing expertise in this discipline and have published research on wilderness medicine topics, from high altitude physiology, to wilderness policy planning. Over twenty wilderness medicine interest groups exist at LQGLYLGXDO PHGLFDO VFKRROV across the U.S..

We seek to encourage them all.

Great opportunities exist for SAEM members to explore wilderness medical teaching, research, and clinical care.

Research expeditions have pursued their work in wilderness areas from the FRQWLQHQWDO 86 to $ODVND the $QGHV the Himalaya, Mt. Kilimanjaro and other austere environments. &OLQLFDO care opportunities are HTXDOO\ ZLGHO\ distributed.

We welcome new members of any level of experience to join our group and help develop this exciting discipline of emergency medicine. 3OHDVH be in touch with any questions.

Iâ&#x20AC;&#x2122;ll look forward to meeting you in Boston in June, 2011.

N. Stuart Harris MD MFA FAAEM Director, MGH Wilderness Medicine Fellowship.

Chief, MGH Division of Wilderness Medicine.

MGH Department of Emergency Medicine.

Assistant Professor of Surgery Harvard Medical School

2010 / 2011 SAEM Grant Information SAEM is pleased to offer a variety of grants available for competitive application. The grant below has an upcoming deadline: SAEM / 3K\VLR &RQWURO Emergency 0HGLFDO Services Research )HOORZVKLS \U for 1 year) â&#x20AC;&#x201C; $SSOLFDWLRQ deadline: November 1, 2010 Through the generous support of 3K\VLR &RQWURO this IHOORZVKLS in emergency PHGLFDO services (EMS) provides an opportunity for a TXDOLÂżHG emergency physician to acquire important skills and begin to develop expertise as part of an academic career with a focus in EMS. SAEM/EMPSF Patient Safety Research Grant for 1 year) â&#x20AC;&#x201C; $SSOLFDWLRQ GHDGOLQH (has been extended): January 1, 2011

Additional SAEM grants include: SAEM Research Training Grant \U for 2 years) â&#x20AC;&#x201C; Application deadline: August 1, 2011 This grant provides support to emergency physicians for two years of concentrated training in research methods and concepts.

SAEM ,QVWLWXWLRQDO Research Training Grant \U for 2 years) â&#x20AC;&#x201C; $SSOLFDWLRQ GHDGOLQH August 2011 The Institutional Research Training Grant is intended to identify and fund centers of excellence to train Emergency Medicine research fellows.

For more details as well as detailed application instructions, SOHDVH go to the SAEM website (www.saem.org) and FOLFN on â&#x20AC;&#x153;Grantsâ&#x20AC;? under the â&#x20AC;&#x153;Grants & Awardsâ&#x20AC;? tab.

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5)$ IRU (PHUJHQF\ 0HGLFLQH 5HVHDUFK 7UDLQLQJ 3URJUDPV 7KH 1DWLRQDO +HDUW /XQJ DQG %ORRG ,QVWLWXWH 1+/%, RI WKH 1DWLRQDO ,QVWLWXWHV RI +HDOWK 1,+ DQQRXQFHG RQ -XO\ WK WKHLU LQWHQW WR IXQG LQVWLWXWLRQDO UHVHDUFK FDUHHU GHYHORSPHQW .

SURJUDPV ³IURP DSSOLFDQW RUJDQL]DWLRQV WKDW SURSRVH WR GHYHORS PXOWLGLVFLSOLQDU\ FOLQLFDO UHVHDUFK WUDLQLQJ SURJUDPV LQ HPHUJHQF\ PHGLFLQH (0 WKDW SUHSDUH FOLQLFLDQ VFLHQWLVWV IRU DFDGHPLF OHDGHUVKLS UROHV DQG LQGHSHQGHQW UHVHDUFK FDUHHUV LQ HPHUJHQF\ PHGLFLQH´ VHH KWWS JUDQWV QLK JRY JUDQWV JXLGH UID ¿OHV 5)$ +/ KWPO 7KH GHDGOLQH IRU WKH UHFHLSW RI DSSOLFDWLRQV LV 2FWREHU 7R VXSSRUW WKHVH UHVHDUFK WUDLQLQJ SURJUDPV 1+/%, LQWHQGV WR FRPPLW RYHU PLOOLRQ GROODUV RYHU D \HDU SHULRG 7KH VSHFL¿F IRFXV RI WKLV SURJUDP RQ HPHUJHQF\ PHGLFLQH UHVHDUFK LV KLJKO\ VLJQL¿FDQW 7R RXU NQRZOHGJH WKLV SURJUDP UHSUHVHQWV the single largest, directed investment in emergency medicine research training to date. In developing the vision for and securing the resources to support this program, NHLBI has demonstrated a thorough understanding of, and is addressing, our national VKRUWDJH LQ WKH QXPEHU RI ZHOO WUDLQHG FOLQLFLDQ LQYHVWLJDWRUV ZRUNLQJ RQ WUDQVODWLRQDO DQG FOLQLFDO HPHUJHQF\ PHGLFLQH UHVHDUFK 2QH LPPHGLDWH PHDVXUH RI WKH QHHG IRU WKLV SURJUDP DQG LWV LQLWLDO VXFFHVV ZLOO EH WKH QXPEHU RI KLJK TXDOLW\ DSSOLFDWLRQV UHFHLYHG LQ 2FWREHU ,W LV QRZ XS WR WKH HPHUJHQF\ FDUH UHVHDUFK FRPPXQLW\ WR GHYHORS KLJK TXDOLW\ LQWHUGLVFLSOLQDU\ DQG rigorous research training programs worthy of this federal support. Please note that institutions submitting K12 applications to 1+/%, LQ UHVSRQVH WR WKLV 5)$ ZLOO VLPXOWDQHRXVO\ EH IXO¿OOLQJ WKH UHTXLUHPHQWV IRU 6$(0 FHUWL¿FDWLRQ RI WKHLU UHVHDUFK IHOORZVKLS training program. Please see KWWS ZZZ VDHP RUJ 6$(0'11 3RUWDOV )HOORZVKLS 6$(0 5HVHDUFK )HOORZVKLS 3URJUDP $SSOLFDWLRQB -XO\ SGI for details.

Roger J. Lewis, MD, PhD Charles B. Cairns, MD &R FKDLUV 6$(0 $&(3 -RLQW 7DVN )RUFH RQ )HGHUDO )XQGLQJ RI (PHUJHQF\ &DUH 5HVHDUFK

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$77(17,21 $// $(0 5($'(56 $1' $87+256 7KH FXUUHQW :LOH\ %ODFNZHOO RQOLQH SODWIRUP Wiley InterScience, will be shut down at the end of July and replaced with the Wiley Online Library. Please take a look at this material very carefully, as this will be your entry into accessing the new Academic Emergency Medicine home SDJH $OVR SOHDVH FRQVXOW WKH IROORZLQJ 85/V IRU IXUWKHU LQIRUPDWLRQ )UHTXHQWO\ $VNHG Questions, etc. Should you experience any GLIÂżFXOW\ LQ DFFHVVLQJ WKH QHZ SODWIRUP SOHDVH contact Sandra Arjona, sandrak.arjona@gmail. com. We are looking forward to a much more robust platform, with many innovative features.

ZLOH\RQOLQHOLEUDU\ FRP

26

8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH 'HSDUWPHQW RI (PHUJHQF\ 0HGLFLQH

8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH 'HSDUWPHQW RI (PHUJHQF\ 0HGLFLQH

is seeking applicants for a faculty position in the HS Clinical Series at the associate or full professor level. The applicant must have a PhD in FOLQLFDO FKLOG SV\FKRORJ\ DQG FRPSOHWHG D FKLOG DGROHVFHQW LQWHUQVKLS with postdoctoral training. The individual must also have extensive experience in the initial psychological assessment of disaster victims and also have at least 10 years of experience in the clinical assessment of childrenâ&#x20AC;&#x2122;s psychological needs. Demonstration of successful sustained grant funding in the area of disaster psychological assessment is UHTXLUHG ([WHQVLYH NQRZOHGJH DQG H[SHULHQFH LQWHUDFWLQJ ZLWK FRXQW\ state, and federal government agencies, including the Department of Defense, the Centers for Disease Control and Prevention, and the American Red Cross is also necessary. Possession of a national VHFXULW\ FOHDUDQFH LV SUHIHUUHG 8&, 0HGLFDO &HQWHU LV D /HYHO , 7UDXPD center with 2200 runs/year and a 40,000 ED census. The applicant will participate in the disaster education of emergency medicine residents and will support research in the proposed Disaster Medical Sciences Institute. Salary is commensurate with level of academic productivity.

is seeking applicants for the fellowship in EMS and Disaster Medical 6FLHQFHV IRU -XO\ 8&, 0HGLFDO &HQWHU LV D /HYHO , 7UDXPD center with 2200 runs/year and a 40,000 ED census. Fellows serve as HS Clinical Instructors. The program combines the disciplines of emergency management/disaster medicine and public health with traditional emphasis on services systems research including mass casualty management and triage. Completion of American Council RI *UDGXDWH 0HGLFDO (GXFDWLRQ $&*0( DFFUHGLWHG (PHUJHQF\ 0HGLFLQH 5HVLGHQF\ UHTXLUHG SULRU WR VWDUW 7KH WZR \HDU FRPELQHG program, with an integrated Masters of Public Health, will be jointly administered by Director, Emergency Medical Services and Disaster Medicine. Salary commensurate with level of clinical work.

,QWHUHVWHG FDQGLGDWHV VKRXOG DSSO\ WKURXJK 8& ,UYLQHÂśV 5(&58,7 system located at: https://recruit.ap.uci.edu/apply/. Applicants should FRPSOHWH DQ RQOLQH DSSOLFDWLRQ SURÂżOH DQG XSORDG WKH IROORZLQJ application materials electronically to be considered for the position: Curriculum vitae; Names and addresses of three references. For additional information regarding this position, you may contact: Mark Langdorf, MD, MHPE Chair, Department of Emergency Medicine 5RXWH 8& ,UYLQH 0HGLFDO &HQWHU 101 City Drive, Orange, CA 92868.

7KH 8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH LV DQ HTXDO RSSRUWXQLW\ HPSOR\HU committed to excellence through diversity.

Send CV, statement of interest and three letters of recommendation to: Carl Schultz, MD. Department of Emergency Medicine, Rte. 128 8& ,UYLQH 0HGLFDO &HQWHU 101 The City Drive South, Orange, CA 92868.

7KH 8QLYHUVLW\ RI &DOLIRUQLD ,UYLQH LV DQ HTXDO RSSRUWXQLW\ HPSOR\HU committed to excellence through diversity.

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

Newsletter

NONPROFIT ORG. US POSTAGE PAID MILWAUKEE, WI PERMIT NO. 3563

Board of Directors Jeffrey A. Kline, MD President

Executive Director James R. Tarrant, CAE

Debra E. Houry, MD, MPH President-Elect

Send Articles to: newsletter@saem.org

Adam J. Singer, MD Secretary-Treasurer

Send Ads to: mgreketis@saem.org

Jill M. Baren, MD, MBE Past President

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

Alan E. Jones, MD

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

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

Future SAEM Annual Meetings 2011 June 1 - 5 Marriott Copley Place, Boston, MA

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

2013

Midwest Regional Meeting 20th Annual Midwest Regional SAEM Meeting November 8, 2010 • Wright State University Boonshoft School of Medicine Dayton, Ohio Abstracts may be submitted from May 1 to October 1 For additional information contact Nancy Andrews at nancy.andrews@wright.edu

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 At www.saem.org, you will find more information on each regional meeting in the Meetings > SAEM Regional Meetings section of the site.

Great Plains Regional Meeting Friday, September 17, 2010 (Reception: September 16, 2010) Michael F. Sorrell Center for Health Science Education University of Nebraska Medical Center • Omaha, Nebraska

For More Information: Robert Williams rlwilliams@unmc.edu (402) 559-6705

Brenda Ram, CMP bram@unmc.edu (402) 559-9250