January-February 2001

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE Advocating for Emergency Physician Advocacy Over the past year I have had the opportunity to visit every region of our country, witnessing emergency care in our academic medical centers, and speaking with emergency physicians, residents, medical students, and patients from California to Rhode Island. So, you might forBrian Zink, MD give me for humming a few bars of “This Land is Your Land” while I stroll down the all too similar hallways of nameless airports. I was surprised to learn that this song, written by the legendary folk singer, Woody Guthrie, is not as celebratory as one would gather upon first hearing it. It was a protest song, written as a parody to Irving Berlin’s “God Bless America”. Joe Klein, in his authoritative biography, notes that Woody Guthrie’s original verses of “This Land is Your Land” talk about private property restrictions, and implore open access to the land for all Americans. These more socialist verses were omitted by other singers over the years, and the song is now regarded as a patriotic anthem.1 One thing that Woody Guthrie had going for him was credibility. He knew of what he sang. He grew up in an Oklahoma frontier town with tremendous personal tragedy. He adored his older sister, and watched her die from severe burns after she impulsively lit her clothes on fire after an argument with their mother. Woody’s mother suffered from a wild mood swings, depression and neurological symptoms that were eventually diagnosed as Huntington’s disease. Her final act before being sent to deteriorate and die in a state mental hospital was to douse her sleeping husband with lamp oil and light him on fire. Following the collapse of his family, Woody learned of hunger, poverty, and hardship. He traveled with the hobo culture, telling tales and singing folk songs with other destitute men and women in the post-depression era.

The songs he composed were unfailing true to the lives of the people he met. His songs railed against the hardheartedness of big business and the inadequacies of government in helping the poor. They were painfully accurate depictions of the problems experienced by the common man.

When Woody Guthrie advocated for a cause through his music, people listened. His songs helped guide the direction of advocacy for the poor in those times.1 Emergency physicians have that same type of credibility when it comes to health care advocacy that Woody Guthrie had with social causes in the middle of the 20th century.

Fortunately, most of us have not had to endure the tragedies and hardships that Woody did. But our work immerses us in (continued on page 9)

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

January-February 2001 Volume XIII, Number 1

Call for “Virtual Advisors” Felix Ankel, MD Chair, Undergraduate Committee Wendy Coates, MD Undergraduate Committee SAEM will soon be looking for virtual advisors to provide career advice to medical students attending schools without emergency medicine residencies. The SAEM Undergraduate Committee is developing the Virtual Advisor Web Site where students can browse commonly asked questions/answers and then be assigned to a “virtual” EM advisor from somewhere in the U.S. This service should be especially useful for students who do not have an EM advisor. We will soon be looking for EM faculty with experience in advising students.

For further information contact SAEM at saem@saem.org.

The Unraveling Safety Net: Current Crises of U.S. Emergency Departments Call for Papers Academic Emergency Medicine is sponsoring a Consensus Conference to discuss this topic on May 9, 2001 at the SAEM Annual Meeting in Atlanta. Topics to be discussed include the importance of emergency departments as a medical and social safety net, challenges currently faced by U.S. emergency departments, and trends that threaten emergency care delivery. Manuscripts relevant to this theme are being solicited. The deadline is March 1, 2001, and authors should use the AEM Instructions for Authors posted on the AEM and SAEM web sites. Please send manuscripts electronically to aem@saem.org or by mail to: Academic Emergency Medicine, Special Issue, 901 North Washington Ave., Lansing, MI 48906.

Neuroscience Research Fellowship SAEM is pleased to announce the availability of the FAEM Neuroscience Research Fellowship, made possible by an unrestricted educational grant from AstraZeneca LP. The Grant provides for one year of funding at $50,000 for a mentored research training experience in cerebrovascular emergencies. The research training may be in basic science research, clinical research, or a combination of both. Completion of a research project is required, but the emphasis of the fellowship is on the acquisition of research skills.

The Grant application and criteria are posted on the SAEM web site at www.saem.org by. The deadline for the submission of completed applications will be February 15, 2001, with announcement of the recipient by March 15. The funding will be for the period from July 1, 2001 to June 30, 2002. Contact SAEM at saem@saem.org for questions or further information.

We’re Making Changes to the Annual Meeting Ellen Weber, MD Chair, 2001 Annual Meeting Program Committee University of California, San Francisco Next time you think about tossing that annual meeting evaluation form in the trash, think twice! We do want to know what you think, and we are making many of the changes our members have asked for.

Each year the Program Committee reviews the evaluations of the Annual Meeting that attendees submit. I read (and have for the last three years) every written comment, exclamation points, capital letters and all. Two years ago, under the very capable leadership of Sue Stern, the Program Committee organized a Needs Assessment Task Force (headed by Bob Neumar) to find out how the Program Committee had been doing in meeting the needs of its members. The overwhelming majority of respondents said the Annual Meeting met their needs and expectations. But there were some areas for improvement. Specifically, members requested more “state-of-the-art” sessions and more opportunities for networking with senior members of the organization.

This past summer, we received over 600 responses to our survey about the Annual Meeting banquet and we want to thank you all for your responses and the extra time you took to write comments. Overwhelmingly, members wanted us to hold the banquet earlier. Many also felt we should “reconsider” the entertainment. Most members said they were willing to pay more for the banquet to help offset the costs of a larger banquet, but also felt that we should charge less to the residents. And, in addition to these formal requests for information, we also pay attention to the more spontaneous expressions of frustration, such as, the digs made at last year’s banquet about how hard it is to get a didactic accepted!

Well, we wanted you to know that we heard you. Here are some of the innovations we are working on for the 2001 meeting. Your comments and additional suggestions are welcome.

• We’re looking at ways to increase informal opportunities for meeting people and networking. One thought is a happy hour at the end of the day, where people can talk to the days’ presenters, and meet up with friends before going out on the town. We’d also like to hold the Keynote Lecture towards the end of one of our days

and follow it with a reception, so we can all meet and talk to the speaker (and each other). We’re looking at holding a large buffet lunch one day where you can catch up with friends, introduce colleagues to each other, have informal discussions about your research and programs, and meet the Board members. If possible, we’ll try to put in a few more scheduled breaks between sessions to give people some time to hobnob and move from room to room. We’re considering what we used to call at summer camp, an “evening activity” a late night fun, yet educational activity that you can come back to after dinner, eat popcorn and drink beer and still get to bed at a reasonable hour. Right now we’re thinking about a session that would help you get the most of your palmtop for ED clinical work and education.

• The banquet will not be held on the last night of the meeting. We’re hoping to hold it on the first night, as an opening banquet. Gone of course will be the imago obscura award, because you can’t steal slides you haven’t seen yet. I know some of you will miss it, but judging from the banquet responses, only some of you will miss it. Maybe we can find another venue for it. We’ll take suggestions.

• Many of you said the meeting was too long and you wanted to get home right after the last day of the meeting. So we’re looking at compacting the formal programming on the last day. It will still be a very full day with lots of research and didactic sessions. And there will be several excellent but optional workshops that afternoon that will still end in time to get you home that night. Sue Fish has agreed to teach an IRB certification course that many of us need to conduct clinical trials for the NIH. A workshop on negotiation and resolving conflict in the workplace offered by faculty from the Harvard School of Public Health is also under consideration. We understand AEM is planning a Consensus Conference and we hope to be able to tie this in with some of our research presentations on that day.

• We re-wrote the guidelines for the didactic submissions, which we hope clarified what the Society was looking for in these proposals. We received over 90 excellent proposals. Of course, we can’t accept all of them, unless we make the meeting two weeks long! For those of you whose

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submissions were not accepted this year, we want to assure we spent a great deal of time reviewing and discussing all of the proposals.

Please continue to offer proposals!

• We are looking into ways to improve the lunches. Believe me, the entire Program Committee has tasted the rubber chicken and we feel your pain. Some of this is a hotel issue and may be out of our control. But we’re working on it. We may have fewer “luncheon” didactics, and instead hold meetings over the lunch hour. In particular, we are looking at having more interest group, task force and committee meetings in the early mornings, lunch hour and late afternoons to avoid the conflicts with didactic and research sessions.

• We know that many of you have accomplished important tasks in your interest groups and want to present what you’ve done to the larger membership. We’d like to help get the word out to others that might like to attend. If interest groups get their agendas in to their Board Liaison in a timely fashion, and they are approved by the Board, we will highlight the content of these meetings in the on-site brochure.

Finally, a confession. It was my pleasure and honor to accept the position of Chairperson of the Program Committee this year, following in the (figuratively) large footsteps of Sue Stern. Three years ago, when I joined the Program Committee, I barely knew a soul in SAEM . . . and I doubt many people knew me. I had been a member of SAEM since 1990, but as an attending in a relatively small program, without its own residency, it was hard to meet people at this large, very busy Annual Meeting.

Three years ago, I filled out the application to join my first SAEM committee with a specific request to work on the Annual Meeting. I have to thank Scott Syverud, that year’s president, for offering me a spot on the Program Committee. I urge you all to do something similar. It is easy to feel like an outsider in a large organization with a structured leadership; but its also very easy to get involved and feel part of things. And even if you don’t join a committee, just remember this when you are about to crumple up that Annual Meeting evaluation form and toss it in the circular file — we do hear you!

Comments and additional suggestions are welcome. Send emails to saem @saem.org or weber@itsa.ucsf.edu

SAEM Joins CORD and AAEM in FSMB Proposal Carey Chisholm, MD Indiana University Jerris Hedges, MD Oregon Health Sciences University In May 2000 representatives of the Council of Emergency Medicine Residency Directors (CORD, Sam Keim), the American Academy of Emergency Medicine (AAEM Antoine Kazzi, Joseph Woods and Robert McNamara), the Federation of State Medical Boards (FSMB Ron Joseph) and SAEM (Marcus Martin and Carey Chisholm) met to discuss the recent FSMB proposals about medical licensure and reporting during the post graduate training period.

Over the summer this group, joined by Jerris Hedges, developed a proposal that has been endorsed by all three EM organization boards and forwarded to the FSMB for action at their February Board of Directors meeting.

The proposal can be found below.

The major changes include a strong recommendation for a “dependent practice” license that residents may obtain prior to completion of their postgraduate training. This form of a limited license would permit residents to work in their own specialty in specific supervised work conditions independent of their postgraduate training program. Supervision would have to be provided by American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) certified physicians in that resident’s specialty. These physicians would have to be on-site and would share medicolegal responsibility for patient care rendered by the resident.

The second major proposal is to oppose the FSMB-recommended mandated reporting of adverse actions against residents (e.g. probation or remediation) by program directors to the state licensing board. All participating organizations feared the potential adverse impact this would have on the learning environment. Instead, all reports would come through the teaching institution’s GME office, and only serious actions (e.g. termination) would be reported.

Why did SAEM make these recommended changes to the FSMB proposal? First and most important, for the safety and welfare of our patient populations. Patients presenting for care at an emergency facility desire and deserve consistently high quality care. The SAEM Board of Directors believes that high quality emergency care is best rendered by an emergency medicine (EM) residency-trained and board certified specialist. An EM resident lacks the requisite skill set to consistently deliver such high quality care in an independent practice setting. Furthermore, residents are often inexperienced in the art of

dealing with private medical staffs, and therefore are less well positioned to serve as patient advocates in the face of inappropriate treatment or disposition recommendations by a consulting physician. By functioning under the direct supervision of a ABEM/ABOEM certified physician, the resident is less likely to inadvertently administer substandard care.

Second, we make these recommendations for the welfare of our residents.

Unsupervised moonlighting activities prior to completion of the requisite training and acquisition of the full skill set necessary to practice the specialty of emergency medicine places not only the patient at risk, but our residents at risk as well. In addition to the psychological stress of working alone before acquiring the skill set necessary for success, the resident is at risk for malpractice claims.

Mandated reporting of such claims to the National Practitioners Data Base will magnify the impact of a malpractice claim against an independently practicing resident, potentially adversely affecting their future malpractice fees and medical staff privileges.

Lastly, this is the correct thing to do for the specialty of Emergency Medi-

cine. If we truly believe that there is a specific knowledge base and skill set necessary for the successful practice of EM, then it is hypocritical to allow those who are incompletely trained to work unsupervised in an ED. Some will say that it is better to have a partially trained emergency physician than a non-emergency physician delivering emergency care. This argument harms both our specialty and our patients.

This claim appears to be self-serving by those who stand to gain immediate fiscal reward from the current status quo. Until we as a specialty insist that fully trained practitioners practice EM, the impetus to train adequate numbers of specialists in emergency medicine will remain stifled. Our specialty, our training programs, and ultimately, the public suffer as a consequence.

No other specialty advocates that trainees should be considered at the same level as their residency-trained, board certified colleagues. It is time for emergency medicine to step forward and advocate for professionalism in our specialty. Revising the standards for medical licensure is an important step in this direction.

Consensus Recommendations to the Federation of State Medical Boards (FSMB) I. FSMB recommends “3. All applicants for licensure should have satisfactorily completed a minimum of three years of postgraduate training in an ACGME- or AOA-approved postgraduate training program, including completion of PGY3 level training prior to full and unrestricted licensure.”

With regard to the FSMB recommendation to restrict full licensure to physicians that have completed 3 years of post-graduate training, we agree with this recommendation, which will raise the medical standards for new licensees. The current practice of moonlighting by physicians-in-training subjects patients to care by physicians with less than optimal training.

We also acknowledge that a shortage of board-certified emergency physicians persists at this point, particularly in rural and underserved areas.

We therefore propose the following addition to the FSMB recommendation: “the FSMB should support the establishment of a dependent practice of medicine license by state boards that a physician in-training can secure after successfully completing one year of residency training in a US -accredited allopathic or osteopathic program (ACGME or AOA).” ❐ The dependent practice license is to be time-limited. A “physician in-training” is defined as a resident physician who maintains current, satisfactory enrollment in an ACGME or AOA approved residency-training program. ❐ Such a dependent practice is to be restricted in scope to clinical activities consistent with those that the resident is performing in the course of their residencytraining program and the scope of practice for that clinical specialty. ❐ On-site supervision of the resident physician that is working under the dependent practice of medicine license is required. ❐ Such supervision should be 1) continuous, 2) onsite, and 3) provided by fully licensed physicians who are board-certified/prepared in the resident’s own field of training. ❐ A certifying body recognized by the American Board of Medical Specialties or the American Osteopathic Board of Specialties must provide board certification or preparation of the supervising physician. (continued on page 5) 3

Password Required to Receive AEM Online

Medical Student Excellence in Emergency Medicine Award

Academic Emergency Medicine (AEM), SAEM members must now use a password to access their online subscription. All SAEM members are entitled to a receive a free subscription of both the print copy and online version of AEM. To activate your subscription go to the website: <www.aemj.org>. Click on the subscriptions button. Click on the link “activate your member subscription.” Enter your membership number (which is printed above your name on the mailing label of this Newsletter) and click the submit button. You will then be asked to select a user name and password. If you need assistance or do not have a member number, send an email to saem@saem.org or call 517485-5484.

The SAEM Medical Student Excellence in Emergency Medicine Award is offered annually to each medical school in the United States and Canada. It is awarded to the senior medical student at each school who best exemplifies the qualities of an excellent emergency physician, as manifested by excellent clinical, interpersonal, and manual skills, and a dedication to continued professional development leading to outstanding performance on emergency medicine rotations. The award, presented at graduation, conveys a one-year membership in SAEM, which includes subscriptions to the SAEM monthly journal, Academic Emergency Medicine, the SAEM Newsletter and an award certificate.

Announcements describing the program and applications have been sent to the Dean’s Office at each medical school. Coordinators of emergency medicine student rotations then select an appropriate student based on the student’s intramural and extramural performance in emergency medicine. The list of recipients will be published in a summer issue of the SAEM Newsletter.

Over 110 medical schools currently participate in this award. The goal is to have all medical schools participate. Please contact the SAEM office if your school is not presently participating.

Newsletter Advertising

CORD/AACEM Faculty Development Conference: Navigating the Academic Waters

The SAEM Newsletter is mailed every other month to the 5,000 members of SAEM. Advertising is limited to fellowship and academic faculty positions. All ads will be posted on the SAEM web site at no additional charge.

Deadline for receipt: December 1 (Jan/ Feb issue), February 1 (March/April issue), May 1 (May/June issue), June 1 (July/August issue), August 1 (Sept/Oct issue), and October 1 (Nov/Dec issue).

Ads received after the deadline can often be inserted on a space available basis.

March 3-5, 2001 — Washington, DC Faculty development continues to be one of the most carefully scrutinized areas by the RRC-EM. Due to the relative growth of our specialty, coupled with rapid growth of residency programs over the past 10 years, many younger faculty struggle to develop needed personal, management, teaching, and research skills required for successful career advancement. CORD and AACEM have conjointly developed a seminar entitled: “Navigating the Academic Waters: Tools for Emergency Medicine.” This conference was first held in November 1996 and received high praise from attendees. The conference is designed specifically for the unique needs of junior Emergency Medicine faculty and will address essential elements necessary for success in an academic environment including research development, grants, presentation skills, resident evaluation, mentoring, and clinical teaching, as well as time and personal management. This course nicely augments the ongoing efforts made

by SAEM in the area of faculty development. Young faculty or senior residents interested in an academic career should contact the CORD/AACEM office at 517-485-5484 or the CORD web site at www.cordem.org. Registration is limited to 125 people, so call today!

Advertising Rates: Classified Ad (100 words or less) Contact in ad SAEM member .........$100 Contact in ad non-SAEM member ..$125 1/4-Page Ad (camera ready) 3-1/2” wide x 4-3/4” high...............$300 To place an advertisement, e-mail, fax or mail the ad, along with contact person for future correspondence, telephone and fax numbers, billing address, ad size and Newsletter issues in which the ad is to appear to: Jennifer Mastrovito at <jmastrovito@saem.org>, via fax at 517-485-0801 or mail to 901 N. Washington Avenue, Lansing, MI 48906. For more information or questions, call 517-485-5484 or <jmastro vito@saem.org>.

No rate increases in 2001!

All ads posted on SAEM web site at no additional charge!

Geriatric Emergency Medicine Resident/Fellow Grants Available SAEM with funding from the John A. Hartford Foundation and the American Geriatric Society (AGS), is pleased to announce the availability of grants to support resident/fellow research related to the emergency care of the older person.

Investigations may focus on basic science research, clinical research, preventive medicine, epidemiology, or educational topics. Awards may be up to $5,000 for each project.

Applications for the Geriatric Emergency Medicine Resident/Fellow Grant will be sent to each residency program or may be obtained from the SAEM office or the website at <www.saem.org>. The deadline for receipt of a complete application at the SAEM office is March 5, 2001 with notification of selections by May 7 and funding awarded by July 1.

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Semi-Final CPC Competition Submissions Sought Submissions are now being accepted from Emergency Medicine residency programs for the 2001 Semi-Final CPC Competition to be held May 5, the day before the SAEM Annual Meeting in Atlanta. This event has increased in popularity every year and is an excellent opportunity to showcase a residency program. The deadline for submission of cases is February 2, 2001 and there is an entry fee of $200.

Case submission and presentation guidelines can be obtained from the CORD home page at <www.cordem.org> or the CORD office 517-485-5484.

Residents participate as case presenters, and programs are encouraged to select junior residents who will still be in the program at the time of the finals competition in October. Each participating program selects a faculty member who will serve as discussant for another program’s case. The discussant will receive the case approximately 4-5 weeks in advance of the competition. All cases are blinded as to final diagnosis and outcome. Resident presenters provide this information after completion of the discussant’s presentation.

The CPC Competition will be limited to 50 cases selected from the submissions. A Best Presenter and Best Discussant will be selected from each region. The Best Presenter recipients will receive a placque and $250; the Best Discussants will receive a placque.

Winners of the semi-final competition will be invited to participate in the CPC Finals to be held during the ACEP Scientific Assembly in October in Chicago. At the finals competition a Best Presenter and Best Discussant will be selected.

Both will receive a statue and $500.

The CPC Competition is sponsored by ACEP, CORD, EMRA, and SAEM. If you have any questions, please contact the CORD office at <cord@cordem.org> 517-485-5484, or via fax at 517-485-0801.

Consensus Recommendations (Continued) ❐ Such a dependent practice of medicine is equivalent to extending eligibility for a “Physician Extender” status to residents who are in good standing in their training program. ❐ Such dependent practice licensure will require annual renewal. ❐ Physician groups and institutions that contract or employ physicians who are practicing under a dependent practice license must share the legal liability for the quality of care provided by the residents working for them. They must assume the responsibility of clearly documenting the supervision mechanism for the dependent practitioner. This mechanism must not vary substantially from that provided in the resident’s training program.

II. FSMB recommends “2. All physicians enrolled in postgraduate training programs shall be subject to medical board regulation and oversight through a mechanism that requires the physician to obtain a training permit or limited license expressly designed for such purpose. This mechanism shall also require that program directors report annually to the medical board on all individuals enrolled in their respective programs.”

We believe this recommendation requiring program directors to annually report details of each resident’s education process is counterproductive. All represented Emergency Medicine organizations are strongly opposed to this requirement. We propose modifying this 1998 FSMB position by shifting the responsibility and timing of the reporting of residents and the permit renewals from the program director to the Graduate Medical Education Office (GME) of their medical institution.

The proposed revision is: “All physicians enrolled in postgraduate training programs shall be subject to medical board regulation and oversight through a mechanism that requires the physician to obtain a training permit or limited license expressly designed for such purpose. This mechanism shall also require that the graduate medical offices of training institutions report annually to the medical board any serious disciplinary action taken against a resident such as termination.

However, remediation programs and probationary actions are best handled internally within the training institution. Such a process permits deficiencies in performance to be openly addressed by the program director with the trainee rather than overlooked or inadequately addressed for fear of harming the resident’s future career. Mandated reporting of such activities by the program director would create an environment in which residents attempt to hide or cover up educational mistakes or deficiencies, rather than proactively seeking assistance through the residency.

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Academic Announcements Frank Day, MD, a fellow at UCLA has been awarded a Postdoctoral Fellowship Award from the Agency for Healthcare Research and Quality (AHRQ). Dr. Day’s study concerns the development and evaluation of the Emergency Department Patient Classification system, being designed to identify similar types of patients as they present to an ED. David Schriger, MD, will be Dr. Day’s mentor for the fellowship.

Wyatt Decker, MD, was appointed Chair of the newly created Department of Emergency Medicine at Mayo Medical School in October 2000. Dr. Decker oversees the newly accredited emergency medicine residency training program and supervises the development and implementation of the department’s operational plans.

The Division of Emergency Medicine was redefined into a new academic and administrative department on January 1, 1999.

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Robert A. Schwab, MD, has been named the Chief of Emergency Medicine at Truman Medical Center Hospital Hill and the Chair of the Department of Emergency Medicine at the University of Missouri-Kansas City. Dr. Schwab has been with Truman Medical Center for six years, most recently serving as Vice-Chair and Interim Chief of Emergency Medicine.

Terry VandenHoek, MD, Lance Becker, MD, and colleagues at the University of Chicago’s Emergency Resuscitation Research Center, have received a four-year $1,000,000 grant entitled, “Cardiac Oxidants and Apoptosis: Lessons of Preconditioning” that will investigate the role of cell suicide (apoptosis) in myocardial ischemic injury, and how intrinsic adaptive responses of the heart can stop this process. The ultimate goal is to discover new potential therapies that improve survival from cardiac arrest and myocardial infarction.

Robert O. Wright, MD, MPH, Assistant Professor of Pediatrics at the Division of Pediatric Emergency Medicine, Section of Emergency Medicine, Brown Medical School, has received a K23 Mentored Clinical Scientist Research Award from the National Institute of Environmental Health Science. Dr. Wright will be the principal investigator of the project entitled, “Neurochemical and Genetic Markers of Lead Toxicity.”

Donald M. Yealy, MD, Professor of Emergency Medicine, University of Pittsburgh, is the principal investigator and Thomas E. Auble, PhD, Research Assistant Professor of Medicine, is the co-principal investigator, of a two year, $368,000 grant from the Agency for Healthcare Research and Quality (AHRQ). The project, “A Risk Stratification Rule for Health Failure” aims to derive a clinical guideline to help identify patients at low risk for short term mortality and morbidity.

Kelly D.Young, MD, Harbor-UCLA Medical Center, has received a 5-year Mentored Patient-Oriented Research Career Development Award (K23) from the National Institutes of Health, National Center for Research Resources. Dr. Young’s project is entitled “PostTraumatic Stress and Pain in Children Undergoing Painful Medical Procedures.” Dr. Young will study ethnic differences in the stress response and posttraumatic stress syndrome in children who have undergone painful medical procedures. Dr. Young’s mentor will be Roger J. Lewis, MD, PhD.

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Ethics Corner: Questions and Answers Column

“Can Families Give Informed Consent for Ethnic Patients?”

H. Gene Hern, Jr., MD, MS Highland General Hospital This is the second in a series of columns, regarding ethical issues, written by members of the SAEM Ethics Committee. Readers are invited to submit ethical questions or cases to: saem@saem.org Question A 77 year-old Chinese female is seen in the Emergency Dept for abdominal pain and weight loss. During the course of her evaluation, a CT scan is obtained which showed multiple liver masses with metastases. On your way back to her room to deliver the news, her daughter stops you in the hall and asks to speak with you. She has already guessed the diagnosis and she asks that you not tell her mother. The daughter pleads that, in her culture, it would do her more harm. She states the family is willing to make any decisions that were required. She begs you to not tell her mother. What do you do?

Introduction The question of how to allow cultural variation into the medical interaction without creating a checklist of cultural characteristics forces us to be very careful in this situation. We must first look at what is required in informed consent and then allow some variation on our clinical practice. Can the family make decisions for a patient from another culture? The short answer is yes, but with some reservations. We will briefly look at the requirements for informed consent from the last “Ethics Corner” column, and then look at the complicating factors of different cultural values.

Elements of Informed Consent In the previous Ethics Corner, Catherine Marco discussed informed consent as consisting of the following three elements: patient capacity , delivery of information, and voluntary participation. While the patient in our case may have the mental capacity to make decisions, she may not want to do so, based on her cultural background. This makes our job all the more difficult as we must ensure the patient has the ability to make the decisions if she so desires, but is not forced to if she doesn’t.

Case Discussion Considering the complications involved in openly discussing the diagnosis and treatment options with patients from different cultures, any approach will

have to address the value of patient involvement in the decision process, yet allow patients to retain their cultural norms and values if they desire. Many Asian cultures, including Chinese cultures, maintain that the family should make decisions for patients, especially if they are terminally ill. To speak the term “cancer” often carries with it the significance of “giving up hope” or “abandoning” the ill family member. The peril lies in the conflict between our “western” culture, which cherishes individual autonomy, and other cultural values, which may not.

Our practice is further complicated by the difficulties in discussing informed consent in the ED. One approach which retains both patient choice and respect for cultural values requires that patients be offered multiple opportunities for discussing their situation, yet does not mandate telling the diagnosis or requiring active participation if the patient does not wish it. The limited time available in the ED may make such an approach difficult but may allow the patient to retain their cultural values within our western system. In addition, the admitting team and the ethics committee should have a role in this process.

This process has the following elements: 1. Listening to the patient and family to try to understand their values.

2. Explaining the western notion of individual choice and autonomy.

3. Offering to the patient the option of autonomy.

It is this last point which requires that even the most experienced clinician to be careful. The interaction acquires different characteristics depending on individual circumstances.

Patients and physicians communicate through a number of different means; verbal information, non-verbal cues, and body language all can affect the interaction. Offering autonomy differs from the standard western notion of autonomy. Rather than determining a patient’s lucidity and then proceeding to explain the diagnosis, prognosis, and all possible treatment options, the process of offering autonomy requires that repeated attempts be made to ascertain from the patient how much he or she wants to know, and how involved he or she wants to be in the process. This approach outlines a compromise between the possible harm associated with patient ignorance and the possible harm caused by callously presented unwanted information.

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Choosing not to become engaged and to leave decisions up to the family is then a decision, not a default setting.

Regardless of the patient’s choice, this model retains the patient’s autonomy, including the autonomous option of not wanting to know. Choosing to not participate is still an exercise of autonomy. Legal precedent confirms this assertion. In the case of Cobbs vs. Grant (Cal 1972), the court ruled that “a medical doctor need not make disclosure of risks when the patient requests that he be not so informed.”

Conclusion Patients from different backgrounds pose challenges to our standard approach to ethical problems. When patients don’t share similar values, the approach we use to deal with ethical issues may not reflect the way our patients are used to thinking or acting.

While this is far from stating that all cultural differences should be respected, clinicians should at least try to understand why a patient or family acts the way they do. Autonomy is the classic example of this conflict. Some patients are used to having lots of choices in their medical care, others are not. We have to approach clinical practice from the vantage point of western medicine and western values, yet we need to be flexible to sometimes allow non-western practices to be respected. While this is not a call for universal cultural relativism (the notion that all values is other cultures are right within that culture) this discussion might at least provide a framework for understanding and exploring non-western values and helping patients from other cultures receive care within ours.

References Brotzman GL, Butler DJ. Crosscultural issues in the disclosure of terminal diagnosis. J Fam Prac 1991; 32: 426-427.

Freedman B. Offering truth. Arch Int Med 1993: 153: 572-576.

Hern HE, Koenig BA, Moore LJ, Marshall PA. The difference that culture can make in end-of-life decision making. Cambridge Quarterly Healthcare Ethics 1998; 7: 27-40 Jecker et al. Caring for patients in cross cultural settings. Hastings Center Report 1995; 25: 6-14.

Moskop JC: Informed consent in the emergency department. Emerg Med Clin NA 17: 327-40; 1999.

Resident Group Discount Membership Participation Marcus Martin, MD University of Virginia SAEM Secretary/Treasurer On behalf of the Board of Directors, I would like to thank the residency programs which have elected to participate in the resident group discount membership. These 64 programs bring 1,879 resident members to the Society. This program provides residents with invaluable exposure to all facets of academic emergency medicine. Each resident member receives subscriptions to Academic Emergency Medicine and the SAEM Newsletter, plus a greatly discounted registration fee to attend the Annual Meeting. The participating programs are: Albany Medical Center Albert Einstein Medical Ctr., Philadelphia Baystate Medical Center Boston Medical Center Brigham & Women’s Hospital Carolinas Medical Center Charity Hospital Christ Hospital and Medical Center Christiana Care Health System Cooper Hospital/Univ. Medical Center Earl K. Long Medical Center East Carolina University Emory University Grand Rapids Merc/MSU Hennepin County Medical Center Henry Ford Hospital Howard University Indiana University/Methodist Johns Hopkins University Loma Linda University Long Island Jewish Medical Center MetroHealth Medical Center Michigan State University, Kalamazoo

North Shore University Hospital Northwestern University Ohio State University Oregon Health Sciences University Palmetto Richland Memorial Hospital Regions Hospital Resurrection Medical Center Saginaw Cooperative Hospitals, Inc. St. Luke’s-Roosevelt Hospital Center St. Vincent Mercy Medical Center Stanford/Kaiser State University of New York, Buffalo State University of New York, Stony Brook State University of New York, Syracuse Temple University Texas Tech University Thomas Jefferson University University of Arizona University of Arkansas University of Chicago University of Cincinnati University of Connecticut

University of Illinois, Chicago University of Kentucky University of Louisville University of Michigan University of New Mexico University of North Carolina Chapel Hill University of Pennsylvania University of Pittsburgh University of Rochester University of Texas, Houston University of Virginia Wake Forest University Baptist Medical Center Wayne State University/Detroit Receiving Hospital Wayne State University/Grace Hospital William Beaumont Hospital West Virginia University Wright State University Yale-New Haven York Hospital

Call for Photographs Deadline: February 15, 2001 4. Pertinent laboratory data 5. One or two questions asking the viewer to identify the diagnosis or pertinent finding 6. Answer(s) and brief discussion of the case, including an explanation of the findings in the photo 7. One to three bulleted take home points or “pearls” The case history must be 250 words or less and fit on a single page in 14 point font with at least one blank line between sections. The case history should be submitted as a hard copy and as a file on a disk or as an email attachment.

Submissions will be judged by the Program Committee and accepted based on their educational merit, relevance to emergency medicine, quality of the photograph and the case description. Submissions will also be reviewed to assure appropriateness for public display at a national meeting. SAEM will mount accepted photos and display them at the 2001 Annual Meeting in Atlanta. Contributors will be acknowledged and photos will be returned after the meeting.

Photographs must not appear in a refereed journal prior to the Annual Meeting. Appropriate masking of recognizable patients or written consent is the responsibility of the contributor. Documentation of written consent must accompany submissions and include a release of responsibility. All submissions will be considered for publication in Academic Emergency Medicine. SAEM will retain the rights to use submitted photographs for use in future educational projects, with full credit given for the contribution.

Send submissions to SAEM at 901 North Washington Avenue, Lansing, MI 48906 or saem@saem.org

Original photographs of the practice of emergency medicine are invited for presentation at the 2001 SAEM Annual Meeting. The theme for the photographs is “Clinical Pearls and Visual Diagnosis.” Original photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data may be submitted. The deadline for receipt is February 15, 2001.

Submissions should depict findings that are pathognomonic for a particular diagnosis relevant to the practice of emergency medicine or findings of unusual interest that have educational value. Accepted submissions will be used for the “Clinical Pearls” photography session, and may also be used in the Medical Student-Resident Visual Diagnosis contest.

No more than three different photos should be submitted for any one case. Submit one glossy photo (5”x 7,” 8”x 10”, 11”x 14” or 16”x 20”) and a digital copy in either JPEG or TIFF format on a disk or by email attachment (resolution at least 640 x 480). Radiographs should be submitted as glossy photos, not as x-rays. For EKG’s, the original and one photocopy (or digital image) is preferred. The back of each photo should contain the contributor’s name, address, hospital or program, and an arrow indicating the top. Submissions should be shipped in an envelope with cardboard but should not be mounted.

All photo submissions must be accompanied by a case history written as an “unknown” in the following format: 1. Chief complaint 2. History of present illness 3. Pertinent physical exam 8

President’s Message (Continued) the lives of common people. Because we provide care to the disenfranchised, the uninsured, and the patients who others shun, and because we are there in our emergency departments, capable and prepared every day of the year, 24 hours a day, we have the credibility and experiences to be able to speak on behalf of those patients whose voices are suppressed or never heard. When emergency physicians advocate for changes in our health care system that will improve emergency care, increase access to care, and make our patients’ environments safer, people listen.

In some ways academic emergency departments are the last vestiges of the huge philanthropic effort of medical school teaching hospitals in providing care to the underserved. Historically, the missions of teaching hospitals included providing a great deal of “charity” care. In fact, in the early to mid 1900’s, it was considered inappropriate for a teaching hospital to have a majority of patients who were not indigent.2 While our history is in caring for and advocating for the poor, we in academic medical centers are now focused almost totally on the business side of medicine — efficiency, throughput, funding, grants, and margin. The large public appropriations that funded teaching physician salaries and hospitals are also history. But, our emergency departments continue to take all comers, and are the last and only resort for many indigent patients who need health care.

Emergency medicine is a taxing job.

An emergency physician might reasonably ask — is it not enough that I provide care for the destitute in our society? Am I also expected to be an advocate for the uninsured, the victims of violence and abuse, the homeless, and those who are otherwise harmed by our society and medical care system? How can I find the time to be an advocate when the expectations are that I will also be an excellent clinician, teacher, and perhaps researcher?

These are all good questions, and to answer them we can turn to the giants of advocacy in emergency medicine — people like Ed Bernstein, Art Kellermann, and Steve Hargarten. The first lesson to be gained from these academic emergency physicians is that advocacy is most effective when it is focused. Although we may feel an altruistic sense that we must advocate for all of those who are wronged, it is not expected, or desired, that academic emergency physicians will be all-purpose advocates. In the areas of research and teaching, we have found that the best results are achieved with a focused approach. The same is true with advocacy. A physician advocate who is expert in an area can use his or her academic credibility to full advantage. This

is why, for example, that Ed Bernstein in the area of access to care and substance abuse, and Art Kellermann in the area of violence and hand guns, have had so many advocacy triumphs.

How does an academic emergency physician incorporate advocacy into his or her personal mission and practice?

One way is to view advocacy as a natural component of academic endeavors. Steve Hargarten, the Professor and Chair of Emergency Medicine at the University of Wisconsin, is a long time public health advocate who has been remarkably effective in the field of injury prevention. Dr. Hargarten describes 4 potential sites of advocacy for the physician scientist: bedside, curbside, tableside, and courtside. 3 An emergency physician advocate who has a special interest in, for example, asthma, can function at the bedside in caring for patients with acute exacerbations of asthma, and also by educating patients, families, resident physicians, medical students, and nurses about emergency asthma care. Bedside advocacy would also include research that is conducted on treatment of acute asthma. Curbside advocacy for this physician would include exploring the environmental and socioeconomic factors that have lead to an increase in asthma in children in that community.

Media advocacy may become a part of this — the emergency physician may report to the media his or her findings that a neighborhood next to a factory smokestack has a high prevalence of asthma in children. An example of tableside advocacy in this case would be the emergency physician meeting with representatives of the company that runs the factory, and promoting efforts to eliminate or reduce smoke emissions from the factory. Courtside advocacy might be necessary in this case, as governmental organizations may regulate factory emissions. The emergency physician could play a role in testifying before a state or federal government about the plight of asthmatic children whose symptoms are worsened by factory emissions.

If advocacy is omitted from our academic lives, the circle remains open — we settle for a triple when we could have had a home run. In order to be effective advocates, academic emergency physicians must learn to deal effectively with two institutions from which we inherently shy away — government and the media. Like it or not, many of the large scale changes that we seek through advocacy, will only be possible through new policies, laws, or regulations. An advocate must become familiar with the local, state, and federal government laws and regulations that apply to the advocacy focus area. In conjunc9

tion with this, one must learn the faces and gain access to the ears of those who make the laws and rules. A full lesson on governmental advocacy is beyond the scope of this article, but a couple good places to start are as follows: 1. “The School of Political Advocacy”, held as part of the ACEP Leadership and Legislative Issues Conference, April 29th — May 2nd, 2001, Washington, D.C. 2. The Advocacy Gurus, at www.advocacyguru.com, — an informative site with nice coverage of frequently asked questions about how to get started with political advocacy, and a number of helpful links, including how to email your Congressional representatives.

The second component of effective advocacy is learning how to use the media to advance a purpose. Despite our sometimes negative and cynical view of how the media functions in our society, it is a fact that media coverage of an advocacy issue validates it as an issue. As the veteran news reporter and journalist, Daniel Schorr, has said: “If you don’t exist in the media, for all practical purposes, you don’t exist.” 4 As most of us now ponder how we don’t exist, some strategies are necessary to improve media advocacy in emergency medicine. It is clear from the great public interest in emergency care topics, that if advocacy issues are properly presented, they will receive coverage.

The techniques that can be used to properly frame and disseminate an issue to the media are expertly covered in the book: “ Media Advocacy and Public Health — Power for Prevention”,

by Wallack, et al.5. This book speaks of the power of an “authentic voice” — the type of voice that academic emergency physicians develop through years of practice, teaching and research in academic emergency departments.

It was noted that Woody Guthrie favored his mother’s side of the family, and this genetic link proved to be tragic as he developed the symptoms of Huntington’s disease when he was at the prime of his career. During the years of his slow neurological deterioration, leading to his death in 1967, he lost the ability to write and sing, but his work and his history as an advocate for the common man were highly influential in the careers of new folk singers, such as young Robert Zimmerman who played guitar and sang in the bohemian section of Minneapolis in the late 1950’s and early 1960’s. Zimmerman became enthralled with the music and spirit of Woody Guthrie, and switched from a rock to folk music focus, and later changed his name to Bob Dylan. (continued on next page)

SAEM Ethics Consultation Service Now Available Everyday, emergency physicians are faced with countless ethical dilemmas.

In our practice, our teaching, our research and our administrative duties, we make choices based not only on our knowledge but also on our personal beliefs and value systems. For the most part, these decisions are made in typical emergency medicine style — we think, we decide, we act, and we move on. We feel confident that we have acted appropriately, based on a reasoned assessment of the circumstances and the strengths of our convictions. We act in good faith, and hope that we have acted wisely and justly.

Occasionally, an ethical issue arises that is outside our world view or consideration, or a situation confronts us that makes us uncomfortable. We may lack the knowledge that we need to make a reasonable choice, we may be faced with something totally out of our experience, or we feel at a loss because we cannot determine the possible options. We may witness an ethically questionable act, may observe unprofessional and possibly harmful actions, may disagree about the correctness of another’s decision, or may feel we ourselves are

being subjected to exploitation, abuse, or other unethical behavior. Such situations are frightening; it is difficult to distinguish reality from perception, to know who can be approached for advice, or where resources can be found to assist in developing an appropriate response.

Some institutions have committees or other authoritative bodies designed to examine grievances, allegations of scientific misconduct or specific ethical dilemmas in clinical practice.

The advice of these groups, however, may have limited applicability to emergency medicine; they may not include emergency physicians, or have the expertise to relate to the unique aspects of the ethics of emergency medicine. In addition, these groups are charged with developing a response to a particular crisis that has arisen locally.

They are goal directed and not necessarily able to provide a thoughtful method to educate beyond the concrete response to the problem at hand.

For these reasons, the SAEM Board of Directors charged the Ethics Committee to develop an Ethics Consultation Service. As the title implies, the Ethics Consultation Service is now

EMF Call for Grant Proposals EMF is accepting applications for its annual grants. Funding is for research done within the academic year of July 1, 2001 through June 30, 2002 unless otherwise specified. To request an application, contact EMF, P.O. Box 619911, Dallas, Texas 75261-9977 or call (972) 550-0911 ext. 3340. The following is a description of the awards and application deadlines: EMF/FERNE Neurological Emergencies Grant A maximum of $50,000. This grant is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE). The goal is to fund research based towards acute disorders of the neurological system, such as the identification and treament of diseases and injury to the brain, spinal cord and nerves.

Deadline: January 15, 2001 EMF/SAEM Medical Student Research Grant A maximum of $2,400 over 3 months for a medical student or resident to encourage research in emergency medicine.

Deadline: January 29, 2001 EMF/SAEM Innovations in Medical Education Grant A maximum of $5,000 to support projects related to educational techniques pertinent to emergency medicine training.

Deadline: February 12, 2001 EMF/ENAF Team Grant A maximum of $10,000 to be used for physician and nurse researchers to combine their expertise in order to develop, plan and implement clinical research in the specialty of emergency care.

Deadline: March 5, 2001 EMF Established Investigator Award A maximum of $50,000 to established researchers. An established investigator is one who has obtained significant extramural funding and made significant contributions to emergency medicine research. Priority will be given to those who have been principal investigators on federal and/or foundation grants.

Deadline: March 19, 2001 10

available to assist SAEM members with their questions concerning ethical issues or decisions they must make during the course of their clinical, academic or administrative responsibilities.

Opinions from the Ethics Consultation Service will be offered to SAEM members in a timely manner; requests from nonmembers will be considered on a case by case basis. The opinions rendered are not meant to be part of an ‘appeal process.’ This service is offered to SAEM members who may need advice or assistance when faced with a difficult ethical decision.

All communications with the Ethics Consultation Service will be anonymous and confidential. However, because many ethical issues confronting practicing emergency physicians are universal in their scope, and others may learn from the issue presented, we hope to develop a series of articles for publication for the Society, assuming that confidentiality can be maintained.

All requests, inquires, or correspondence should be directed to the Ethics Consultation Service at SAEM, 901 North Washington Avenue, Lansing, MI 48906 or saem@saem.org

President’s Message (Continued) Woody Guthrie had a hard life, but was frequently noted to have an optimistic outlook. His songs gave poor and disenfranchised people a voice, and this advocacy fueled him, and kept him moving forward, even as he battled alcoholism and Huntington’s disease. 1 Maybe we can take a similar approach.

Maybe by being emergency physician advocates, we can do the same for our patients. And instead of being another task that weighs us down, advocacy may be the catalyst that keeps our careers moving forward.

References: 1. Klein J: Woody Guthrie: A Life .

Delta Book, Dell Publishing, Random House, Inc., NY, 1980.

2. Ludmerer KM: Time to Heal — American Medical Education from the Turn of the Century to the Era of Managed Care. Oxford University Press, NY, 1999. Pages 118-122.

3. Hargarten S: Physician Scientist Advocacy. Grand Rounds Presentation, University of Michigan Department of Emergency Medicine, 2000.

4. Schorr D. Quote from the Communications Consortium Media Center, 1991, p. 7.

5. Wallack L, Dorfman L, Jernigan D, Themba M : Media Advocacy and Public Health — Power for Prevention . Sage Publications, Newbury Park, CA, 1993.

FACULTY POSITIONS

University of Pittsburgh

GEORGIA: The Department of Emergency Medicine at the Medical College of Georgia has an opening for a full-time emergency attending.

Candidates must be board certified or prepared in emergency medicine.

Established emergency medicine residency program with eight residents per year. Spacious ED facilities. Children’s hospital and beautiful pediatric ED. Over 50,000 visits per year. Level I trauma center for pediatric and adult patients. Energetic young faculty with diverse academic backgrounds. Augusta is an excellent family environment and offers a variety of social, cultural, and recreational activities. Compensation and benefits are excellent and highly competitive. Please contact: Larry Mellick, MD, Chair and Professor, Department of Emergency Medicine, 1120 15th St. AF 2036, Augusta, GA 30912; 706-721-7144; e-mail: Lmellick@mail. mcg.edu EOE/AA

The Department of Emergency Medicine offers fellowships in the following areas: • Toxicology • Emergency Medical Services • Research • Education

IOWA: Emergency medicine faculty positions are available. We have a wonderful opportunity to build emergency medicine excellence in a superb academic setting. Iowa is a Level 1 Trauma Center with an active aeromedical program. Emergency medicine faculty are positioned in a clinical track within the Division of Emergency Medicine, Department of Surgery. Comprehensive back up is readily available. Low volume (24,000/year), with interesting patient mix. There is 30 to 36 hours of attending coverage daily plus PAs. Residents from IM, FP, OB/GYN and Pediatrics rotate in the ED. There are opportunities in curriculum development, EMS, telemedicine, ALS education, paramedic training, and research. Salaries and schedules are competitive, and fringe benefits are excellent. Iowa City offers a superb school system and a great life style. Applicants should send curriculum vitae to Alfred Hansen, MD, FACEP, Emergency Medical Services, UIHC, 200 Hawkins Drive, Iowa City, IA 52242. The University of Iowa is an equal opportunity and affirmative action employer. Women and minorities are strongly encouraged to apply.

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

NEW YORK CITY, Director of Clinical Operations: Exciting position for experienced board certified emergency physician to join the faculty, Department of Emergency Medicine, Mount Sinai School of Medicine; manage operations, informatics and fiscal issues during a time of significant departmental growth. Combined annual ED census over 80,000, EM residency program, 1100-bed tertiary center. Academic rank commensurate with qualifications. Please submit confidential letter and CV to Scot Hill, MD, Chair of Search Committee, Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029. Fax: 212-426-1946.

North Carolina: Opening for Director of Education/Assistant Residency Director at WakeMed, a private level II trauma center in Raleigh.

Join an independent democratic group of board certified emergency physicians staffing 2 hospitals including a large trauma center and a community hospital. WakeMed emergency department sees over 90,000 visits annually, includes a separate Children’s Emergency Department, and is a major teaching site for emergency medicine residents. Affiliated with the University of North Carolina at Chapel Hill emergency medicine residency. Academic appointment based on credentials. Excellent mix of clinical, research, educational, and administrative duties. Excellent compensation and benefit package with ample protected academic time. Interested applicants should send CV to Lance Brown, MD, MPH, Interim Director of Education, Department of Emergency Medicine, WakeMed, PO Box 14465, Raleigh, NC 27520-4465. (919) 350-8823, fax (919) 350-8874; e-mail: LBROWNMD@AOL.com.

TEMPLE UNIVERSITY SCHOOL OF MEDICINE: We currently have a Faculty Position open for an individual BC/BP in EM, with commitment to academic career. Rank and salary commensurate with experience.

Benefits highly competitive. Protected time for research/academic pursuits. Temple University Hospital is a 500-bed tertiary care teaching hospital with a Level 1 Trauma Center. 48,000 adult emergency department visits annually. New EM residency began 7/1/97. Send curriculum vitae to Robert McNamara, MD, FAAEM, Professor and Chief, Section of Emergency Medicine, Temple University School of Medicine, 3401 N. Broad St., 1002 Jones Hall, Philadelphia, PA 19140 or via e-mail at rmcnamar@unix.temple.edu. Temple University is an equal opportunity/affirmative action employer and strongly encourages applications from women and minorities.

The Division of Emergency Medicine at the UNIVERSITY OF COLORADO SCHOOL OF MEDICINE is seeking a residency-trained and board-certified (or prepared) emergency physician to join our faculty.

Fellowship training, research experience, or other post-graduate education is preferred. All faculty are expected to participate in education, research, and clinical activities. Salary is negotiable. Minorities and women are encouraged to apply. UCHSC is an equal opportunity employer. Mail CV and cover letter stating interest to: Benjamin Honigman, MD, UCHSC, Campus Box B215, 4200 E. 9th Avenue, Denver, CO 80262. You may e-mail inquiries to: Joline.Constance@UCHSC.edu UNIVERSITY OF CONNECTICUT: Community Faculty. Excellent new opportunity for clinically inclined EM physician looking for community practice with teaching affiliation. New hospital with modern 38,000 visit ED, 9-hour shifts, dictation, and Fast Track coverage by PAs. Central location allows easy access to beaches, cities, schools, countryside and all other benefits of New England lifestyle. Clinical and academic relationship with EM residency and tertiary care hospital. Inquiries to Robert D. Powers, MD, MPH, Professor & Chief, Hartford Hospital/UCONN Emergency Medicine. Please use email: Rpowers@Harthosp.org.

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UNIVERSITY OF CONNECTICUT/HARTFORD HOSPITAL: Research Director. Senior faculty position, Spring/Summer 2001. Established investigator to manage and build research endeavors at multihospital EM program. 23 faculty, 30 residents, two fellows, 100,000 + patient visits.

Strong infrastructure at Medical School and Hospitals, funded projects currently underway. Very competitive salary, substantial protected time.

Inquires to Robert D. Powers, MD, MPH, Professor & Chief, UCONN Emergency Medicine. Please use email: Rpowers@harthosp.org.

Open Rank: The University of Cincinnati Department of Emergency Medicine has a full-time academic position available with research, teaching, and patient care responsibilities. Candidate must be residency trained in Emergency Medicine with board certification/preparation. Salary, rank, and track commensurate with accomplishments and experience. The University of Cincinnati Department of Emergency Medicine established the first residency training program in Emergency Medicine in 1970.

The Center for Emergency Care evaluates and treats 76,000 patients per year and has 40 residents involved in a four-year curriculum. Our department has a long history of academic productivity, with outstanding institutional support.

Please send Curriculum Vitae to:

UNIVERSITY OF FLORIDA/JACKSONVILLE is expanding its Emergency Medicine operations. Full and part-time clinical opportunities available at Orange Park Medical Center and Shands Jacksonville (formerly Methodist Medical Center and University Medical Center). Positions are nontenure accruing; salary is negotiable. Full-time (1.0 FTE) positions offer faculty appointments to the University. Part-time positions pay competitive hourly rates. If interested, fax current CV to Dr. Robert Luten, Chairman, Search Committee, (904) 549-5666 or e-mail luten.robert@ufl.edu.

Application deadline: 4/30/01, anticipated start date 7/1/01. The University of Florida is a stable and reliable health care employer (EEO/AA) in Northeast Florida (Jacksonville).

UNIVERSITY OF MISSOURI-KANSAS CITY/TRUMAN MEDICAL CENTER, Department of Emergency Medicine seeks academic faculty for a full-time appointment at the assistant or associate professor level. Candidates must be board-certified or board-eligible in EM and have demonstrated research interests. TMC is the primary teaching hospital for the UMKC School of Medicine; fully accredited EM residency since 1973. Current research in infectious disease surveillance, trauma, ED ultrasonography, asthma, EMS, public health, and clinical process improvement. Contact Robert A. Schwab, MD, Truman Medical Center, 2301 Holmes S., Kansas City, MO 64108. (816) 556-3250. Schwabra@trumed1.trumanmed.org. An equal opportunity employer.

W. Brian Gibler, MD Chairman, Department of Emergency Medicine University of Cincinnati Medical Center 231 Bethesda Avenue Cincinnati, OH 45267-0769.

D ISTRICT OF C OLUMBIA

NORTH CAROLINA: Instructor/Assistant Professor in Emergency Medicine. The Department of Emergency Medicine of the Wake Forest University School of Medicine is seeking a Research Director. This is a wellestablished training program with full RRC approval. The hospital itself is a Level I Trauma Center seeing in excess of 57,000 patients per year and a full compliment of residency training programs in addition to Emergency Medicine. The residency training program itself is configured as a PGY-I through PGY-III program with ten residents per year. All academic positions are tenure tract with Wake Forest University School of Medicine.

Salary and benefits are extremely competitive.

Candidates must be residency trained and either Board Certified or eligible to sit for the boards in Emergency Medicine. Interested applicants should contact: Earl Schwartz, M.D., Chairman, Department of Emergency Medicine, Medical Center Boulevard, Winston-Salem, NC 271571089., Phone (336) 716-4626, FAX: (336) 7165438 or E-mail eschwart@wfubmc.edu. Equal Opportunity Affirmative Action Employer.

T

he Department of Emergency Medicine at The George Washington University Medical Center is seeking applications for full-time faculty physicians. Emergency Medicine is a full academic Department in the University. The Department provides physician staffing for the Emergency Unit (annual patient volume 45,000) and Hyperbaric Medicine Service at The George Washington University Hospital. The Department also sponsors an Emergency Medicine Residency and multiple student programs.

Under the auspices of its Ronald Reagan Institute of Emergency Medicine, the Department manages educational, research, and consulting programs in the areas of International Emergency Medicine, Injury Epidemiology/Violence Prevention, Health Policy and Disaster Medicine.

We are currently seeking physicians who will actively participate in our clinical and educational programs and contributed to an area of the Departmentâ&#x20AC;&#x2122;s research/consulting agenda. We are particularly seeking candidates with backgrounds in medical informatics or bedside diagnostic imaging.

Physicians should be residency trained or board certified in Emergency Medicine. Please submit your curriculum vitae to Robert Shesser, MD, MPH, Chair, Department of Emergency Medicine, The George Washington University Medical Center, 22140 Pennsylvania Ave., NW, Washington, DC 20037. E-mail: emdrfs@gwumc.edu.

12

UNIVERSITY OF NEW MEXICO: Department of Emergency Medicine invites applications for a medical toxicologist/emergency physician who will serve as Assistant Medical Director of the New Mexico Poison Center. Academic rank will be based on experience and prior research productivity. Clinical responsibilities include patient care in the emergency department and on the toxicology consult service; academic responsibilities include original research and medical student and house officer training in emergency medicine and toxicology. Qualified applicants will be residency trained and board certified in emergency medicine and in medical toxicology. Send letter of interest, CV, and two letters of recommendation to David Sklar, MD, Professor & Chair, Department of Emergency Medicine, UNM Health Sciences Center, ACC 4-West, Albuquerque, NM 87131. Position open until filled. EEO/AA

MICHIGAN:

EMS Medical Director sought by Saginaw Cooperative Hospitals Department of Emergency Medicine. The successful applicant will be BC/BP in emergency medicine, eligible for faculty appointment (Michigan State University College of Human Medicine [MSUCHM}), and have completed an EMS fellowship or have extensive EMS experience. Saginaw Cooperative Hospitals is a not-for-profit educational corporation sponsoring multiple residencies, including a PGY 1-3 emergency medicine residency with 24 residents and is a campus of MSUCHM. The EMS Medical Director will provide direction for a high-performance EMS provider (48,000 runs annually) providing service to urban, suburban, and rural populations in 7 counties. In addition, this individual shall be a full-time faculty member of the emergency medicine residency, responsible for the EMS portion of the curriculum, and provide clinical services in the 2 ED training sites. Mid-Michigan provides an excellent family oriented environment with 4 season recreation, affordable housing, and good schools. Contact: Robert W. Wolford, MD, Dept. of Emergency Medicine, Saginaw Cooperative Hospitals, 1000 Houghton Ave., Saginaw, MI 48602. Telephone: (517) 583-6817, fax: (517) 754-2741, email: rwolford@concentric.et, web: www.schi.org.

Department of Emergency Medicine — UNIVERSITY OF NEW MEXICO, ALBUQUERQUE: Faculty positions, Clinician Educator or Tenure track, are available for board certified/board eligible Emergency Physicians, with strong clinical skills and demonstrated interest and experience in teaching and in research. Qualified applicants are invited to send a letter of interest, CV, & two letters of recommendation to David Sklar, MD, Chair, Department of Emergency Medicine, UNM Health Sciences Center, ACC 4-West, Albuquerque, NM 87131. Positions open until filled. EEO/AA UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS: Unique academic opportunity in EM. EM faculty will have an opportunity to be involved in the establishment of a first-rate EM division committed to excellence in patient care, education and clinical research.

Full-time and part-time openings BC/BP faculty for the University of Texas Affiliated Emergency Medicine Training program, comprised of Parkland Hospital and Children’s Medical Center. An equal opportunity employer.

Respond in full confidence to Paul E. Pepe, MD, Chairman, Division of Emergency Medicine, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-8579, (214) 646-3916.

WEST VIRGINIA UNIVERSITY

NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM

Department of Emergency Medicine OPEN RANK: The Department of Emergency Medicine at West Virginia University has a full-time faculty position available. The qualified emergency physician will have patient care and teaching responsibilities. The WVU Hospital System includes a Level I Trauma Center with 38,000 annual patients, a well-established Emergency Medicine residency and an active aeromedical program. The Department has eighteen EM residents involved in a 1,2,3 program and sixteen Physician Assistants enrolled throughout the country in a graduate program in Emergency Medicine. Duties include direct patient care and the supervision of medical student’s, physician assistants, and residents. Significant research opportunities with an emphasis on injury control are available through the affiliated Center for Rural Emergency Medicine. The department has obtained nearly seven million dollars in grant and foundation monies since 1992. Morgantown has scenic beauty and low-cost living that is within commuting distance of Pittsburgh, PA. The local area offers nearby lakes, hiking trails, skiing, whitewater sports, and numerous other outdoor activities. Preferred candidates will be residency trained in emergency medicine and board certified/eligible. Salary and rank commensurate with accomplishments and experience. This position will remain active until filled. Applicants should forward a letter of interest, curriculum vitae, and names and addresses of three professional references to Ann S. Chinnis, MD, Interim Chair, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, PO Box 9149, West Virginia University, Morgantown WV 26506-9149. West Virginia University is an Affirmative Action/Equal Employment Opportunity Employer.

North Shore University Hospital at Manhasset, a 700 plus bed tertiary care teaching hospital seeks board certified, residency trained career emergency physicians to augment its staff. We have an active and fully accredited Emergency Medicine Residency Program affiliated with the NYU School of Medicine. We are seeking faculty with a demonstrated record of achievement in clinical and academic activity. We offer the opportunity to work with a dynamic group of residents and faculty in a high acuity, Level 1 trauma facility. We maintain a comprehensive educational program and a substantial research structure supporting both clinical and basic science research. We are particularly interested in faculty for the following positions: Director, Emergency Medicine Trauma and Critical Care Faculty, Ultrasound Medicine An excellent salary in association with an outstanding benefit package is available with the potential for growth.

Academic rank for faculty appointment at the NYU School of Medicine will be determined by credentials.

Please forward resumes and inquires to: Andrew Sama, MD, Chairman Department of Emergency Medicine North Shore University Hospital 300 Community Drive Manhasset, NY 11030 (516) 562-3090 Phone • (516) 562-3680 Fax E-Mail: asama@nshs.edu 13

Academic and Private Practice Emergency Medicine Positions Available

Jackson, MS The Department of Emergency Medicine at the University of Mississippi Medical Center is expanding and has positions available for academic emergency medicine careers, private practice emergency medicine and combination tracts. Academic positions are available at the assistant or associate professor level. Excellent support is provided to young faculty interested in starting a career. The department has a fully accredited residency program accepting eight residents per year.

Applicants should be highly motivated toward teaching and academic pursuits. Our program has full departmental status with a medical toxicology division and excellent institutional support. Our current faculty have active research programs in acute coronary care, toxicology, medical informatics and ED ultrasound. The department has its own well-equipped research laboratory. All faculty are trained in ED ultrasound. The department has two ultrasound machines as well as biomedicine monitors for non-invasive cardiac hemodynamics monitoring.

Mississippi has a funded state wide trauma system and we are the only Level 1 trauma center in the entire state. We also have an active air ambulance program.

Because of its excellent standing in the community, the Department of Emergency Medicine at the University of Mississippi Medical Center was asked to assume management and staffing of two of the three major private emergency departments in Jackson. Excellent opportunities are available for qualified individuals interested in a private career in emergency medicine. It is also possible to combine these positions with academic work at University Medical Center.

Jackson, Mississippi offers small city atmosphere with the cultural benefits of a state capital. It has a low cost of living and very affordable housing. Outdoor recreation is plentiful in Mississippi, with boating, fishing, and hunting topping the list. Good area schools, churches and regional youth sports programs make this an excellent place to raise a family.

If interested in either of these opportunities, please contact Robert Galli, MD, Chair and Professor, Department of Emergency Medicine, 2500 North State Street, Jackson, MS 39216-4505; 601-984-5572. EOE, M/F/D/V

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RESIDENCY DIRECTOR St. Luke’s-Roosevelt Hospital Center

DUKE UNIVERSITY

New York, New York

DUKE UNIVERSITY HEALTH SYSTEM

We are seeking a leader with a demonstrated record of achievement in academic, administrative and clinical activity. The residency is a fully RRC accredited program with 30 residents (EM 1,2,3) There are currently 36 Full-time faculty (including six Pediatric Emergency Physicians). Columbia University College of Physicians and Surgeons Faculty Appointment commensurate with academic status.

The SLRHC ED consists of two sites, three miles apart serving Midtown Manhattan, Upper West Side, Columbia University/Morningside Heights, and Central Harlem. Level I Trauma Center. 120,000 annual visits. Separate Pediatric, Adult, Psychiatric and Fast Track EDs at each site. Clinical Toxicology Service. Associate and Assistant Residency Director Positions, EMS Director, Director of Toxicology, as well as Research Director and Associate Research Director Positions in place. Medical student elective. Hospital-based EMS service. Visit our website – stlukes-roosevelt-ed.com.

Faculty Position The Division of Emergency Medicine at Duke University Medical Center is working to develop an Emergency Medicine Residency Program. We are currently seeking full-time academic faculty members. These positions offer a variety of opportunities for clinical practice, teaching, and research.

Residency training and BC in EM required. Duke University Medical Center Emergency Department is a Level I Trauma Center in Durham, North Carolina, with a annual volume of 65,000 patient visits. Competitive salary and benefits.

Faculty at all academic levels are invited to apply.

Please contact: Kathleen J. Clem, MD, FACEP Chief, Division of Emergency Medicine DUMC 3096, Durham, NC 27710 email: clem0002@mc.duke.edu

Send CV to: Dan Wiener, MD, Chair Department of Emergency Medicine, St. Luke’s-Roosevelt Hospital Center 1111 Amsterdam Avenue New York, New York 10025 Hospital Center is an affirmative action/equal opportunity employer

Advertising Positions Available at Annual Meeting

ACADEMIC EMERGENCY MEDICINE The Department of Emergency Medicine, Wright State University School of Medicine seeks a faculty member at the Instructor, Assistant or Associate Professor level. Faculty rank and salary are commensurate with the candidate’s professional qualifications and School of Medicine standards.

Faculty activities include medical education at all levels, curriculum coordination, administration and patient care. An interest and ability in clinical and classroom education are preferred. Requirements for appointees include: Instructor, Board prepared; Assistant, Board Certified; Associate, Board Certified and 5 years Emergency Medicine experience. All must be graduates of Emergency Medicine Residency and eligible for Ohio License.

Applicants should send curriculum vitae and names of three references to: Glenn C. Hamilton, MD, Professor and Chair Department of Emergency Medicine Wright State University School of Medicine 3525 Southern Blvd.

Kettering, Ohio 45429

SAEM is again offering an opportunity to advertise in the on-site program. The Annual Meeting will be held May 6-9 in Atlanta and will attract approximately 1,800 academic emergency physicians.

A limited amount of space is being set aside for the position available section and only academic positions available will be accepted. The deadline for receipt of ads at the SAEM office is April 1.

The following ad requirements and prices are available for the on-site program: Classified line ads (100 words maximum): $100 (contact SAEM member) or $125 (non-SAEM member) Quarter page ads: 3-1/2" wide x 4-3/4" deep

$300

Half page ads: 7-1/2" wide x 4-3/4" deep or 3-1/2" wide x 9-3/4" deep

$350

Full page ads: 7-1/2" wide x 9-3/4" deep

$450

A typesetting fee ($25-$50) will be charged if the quarter, half, or full page ads are not camera-ready.

Consideration of applications begins November 15, 2000, and will continue until position is filled. Wright state University is an Affirmative Action and Equal Opportunity Employer.

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NEWSLETTER

Newsletter of The Society For Academic Emergency Medicine Board of Directors Brian Zink, MD President Marcus Martin, MD President-Elect Roger Lewis, MD, PhD Secretary-Treasurer Sandra Schneider, MD Past President James Adams, MD Michelle Biros, MS, MD Carey Chisholm, MD Judd Hollander, MD Patricia Short, MD Susan Stern, MD Donald Yealy, MD

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

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

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